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1.
Front Microbiol ; 15: 1469280, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39364170

RESUMEN

The efficacy of the tuberculosis treatment is restricted by innate drug resistance of Mycobacterial tuberculosis and its ability to acquire resistance to all anti-tuberculosis drugs in clinical use. A profound understanding of bacterial ploys that decrease the effectiveness of drugs would identify new mechanisms for drug resistance, which would subsequently lead to the development of more potent TB therapies. In the current study, we identified a virulence-associated small RNA (sRNA) MTS1338-driven drug efflux mechanism in M. tuberculosis. The treatment of a frontline antitubercular drug rifampicin upregulated MTS1338 by >4-fold. Higher intrabacterial abundance of MTS1338 increased the growth rate of cells in rifampicin-treated conditions. This fact was attributed by the upregulation of an efflux protein CydC by MTS1338. Gel-shift assay identified a stable interaction of MTS1338 with the coding region of cydC mRNA thereby potentially stabilizing it at the posttranscriptional level. The drug efflux measurement assays revealed that cells with higher MTS1338 abundance accumulate less drug in the cells. This study identified a new regulatory mechanism of drug efflux controlled by an infection-induced sRNA in M. tuberculosis.

2.
Food Chem (Oxf) ; 9: 100213, 2024 Dec 30.
Artículo en Inglés | MEDLINE | ID: mdl-39157717

RESUMEN

The present study assessed the efficacy of kinnow peel pectin-acetic acid extraction using microwave heating at 110 °C, pH 2.2 for 10 min with a 1:2 ratio supernatant to ethanol for higher yield. The kinnow peel was freeze dried and grinded to fine powder for pectin extraction. The microwave extracted (ME) kinnow pectin showed 833 mg equivalent weight, 7.44 % methoxyl content, 66.67 % degree of esterification, 63.15 % galacturonic acid content and evinced higher purity than commercial citrus pectin. ME kinnow pectin exhibited shear thinning behaviour while higher apparent viscosity (Pa. s) at 20 % concentration. The ME kinnow pectin showed characteristic functional groups and a less crystalline structure as deduced from FT-IR, SEM and XRD respectively, and a higher thermal decomposition analysed from TGA. Further, life cycle assessment (LCA) predicted that the ethanol and acetic acid were major contributors toward climate change in this study. ME kinnow pectin has the potential to be used as a commercial pectin in various food applications.

4.
Cureus ; 16(4): e58788, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38784312

RESUMEN

Muscular tuberculosis as a primary focal lesion in an immunocompetent individual without any underlying bone involvement is a rare finding. The authors present a case of a young female in her 30s who presented with complaints of recurrent discharging sinus in the posteromedial aspect of the proximal right thigh for eight months. The patient was treated by surgical debridement followed by antitubercular therapy (ATT) and has shown full recovery during the post-eight-month treatment period. Such a presentation of primary tubercular pyomyositis imposes a diagnostic as well as a therapeutic challenge.

5.
Biotechnol Biofuels Bioprod ; 17(1): 31, 2024 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-38402217

RESUMEN

The present work models the fermentation process parameters of the newly isolated, Meyerozyma caribbica CP02 for enhanced xylitol production and its fermentability study on rice straw hydrolysate. The study examined the impact of each of the process variables by one variable at a time optimization followed by statistical validation. Temperature of 32 °C, pH of 3.5, agitation of 200 rpm, 1.5% (v/v) inoculum, 80 gL-1 initial xylose was optimized. Subsequently, a sequential two-stage agitation approach was adopted for fermentation. At these optimized conditions, xylitol yield of 0.77 gg-1 and 0.64 gg-1 was achieved using media containing commercial and rice straw derived xylose, respectively. For scale up, in 3L batch bioreactor, the highest xylitol yield (0.63 gg-1) was attained at 72 h with rice straw hydrolysate media containing initial xylose (59.48 ± 0.82 gL-1) along with inhibitors (1.55 ± 0.10 gL-1 aliphatic acids, 0.0.048 ± 0.11 gL-1 furans, 0.64 ± 0.23 gL-1 total phenols). The results imply that even under circumstances characterized by an acidic pH and elevated initial xylose level, M. caribbica CP02, as an isolate, displays robustness and shows favorable fermentability of rice straw hydrolysate. Therefore, isolate CP02 has potential to be used in bio-refineries for high yield xylitol production with minimal hydrolysate processing requirements.

6.
Pediatr Res ; 95(7): 1843-1850, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38238566

RESUMEN

BACKGROUND: Congenital Central Hypoventilation Syndrome (CCHS) has devastating consequences if not diagnosed promptly. Despite identification of the disease-defining gene PHOX2B and a facial phenotype, CCHS remains underdiagnosed. This study aimed to incorporate automated techniques on facial photos to screen for CCHS in a diverse pediatric cohort to improve early case identification and assess a facial phenotype-PHOX2B genotype relationship. METHODS: Facial photos of children and young adults with CCHS were control-matched by age, sex, race/ethnicity. After validating landmarks, principal component analysis (PCA) was applied with logistic regression (LR) for feature attribution and machine learning models for subject classification and assessment by PHOX2B pathovariant. RESULTS: Gradient-based feature attribution confirmed a subtle facial phenotype and models were successful in classifying CCHS: neural network performed best (median sensitivity 90% (IQR 84%, 95%)) on 179 clinical photos (versus LR and XGBoost, both 85% (IQR 75-76%, 90%)). Outcomes were comparable stratified by PHOX2B genotype and with the addition of publicly available CCHS photos (n = 104) using PCA and LR (sensitivity 83-89% (IQR 67-76%, 92-100%). CONCLUSIONS: Utilizing facial features, findings suggest an automated, accessible classifier may be used to screen for CCHS in children with the phenotype and support providers to seek PHOX2B testing to improve the diagnostics. IMPACT: Facial landmarking and principal component analysis on a diverse pediatric and young adult cohort with PHOX2B pathovariants delineated a distinct, subtle CCHS facial phenotype. Automated, low-cost machine learning models can detect a CCHS facial phenotype with a high sensitivity in screening to ultimately refer for disease-defining PHOX2B testing, potentially addressing gaps in disease underdiagnosis and allow for critical, timely intervention.


Asunto(s)
Cara , Proteínas de Homeodominio , Hipoventilación , Fenotipo , Apnea Central del Sueño , Factores de Transcripción , Humanos , Proteínas de Homeodominio/genética , Femenino , Masculino , Factores de Transcripción/genética , Hipoventilación/congénito , Hipoventilación/diagnóstico , Hipoventilación/genética , Niño , Cara/anomalías , Apnea Central del Sueño/diagnóstico , Apnea Central del Sueño/genética , Preescolar , Diagnóstico por Computador/métodos , Análisis de Componente Principal , Adolescente , Aprendizaje Automático , Adulto Joven , Lactante , Genotipo , Fotograbar , Estudios de Casos y Controles , Modelos Logísticos
7.
iScience ; 26(11): 108263, 2023 Nov 17.
Artículo en Inglés | MEDLINE | ID: mdl-38026195

RESUMEN

Future changes in heat wave characteristics over India have been analyzed using Coordinated Regional Climate Downscaling Experiments (CORDEX) for South Asia (SA) regional climate model simulations for mid-term (2041-2060) and long-term (2081-2099) future under the representative concentration pathway (RCP) 4.5 and RCP 8.5 emission scenarios, respectively. SMHI_CSIRO-MK3.6 was found to be the best model in simulating heat wave trend over India for historical period. Future projections show a four-to-seven-fold increase in heat wave frequency for mid-term and long-term future under RCP 4.5 scenario, and five-to-ten-fold increase under RCP 8.5 scenario with increase in frequency dominating intensity in both the scenarios. Northwestern, Central, and South-central India emerged as future heat wave hotspots with largest increase in the south-central region. This high-resolution regional future projection of heat wave occurrence will serve as a baseline for developing transformational heat-resilient policies and adaptation measures to reduce potential impact on human health, agriculture, and infrastructure.

8.
Natl J Maxillofac Surg ; 14(2): 317-320, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37661975

RESUMEN

A systemic parasitic infestation caused by the larval stages of the pork tapeworm, Taenia solium is known as Cysticercosis. While encysted form of the larval stage is attributed to rare variant of Cysticercosis of soft tissues. Muscle infestation by this parasite can lead to vague clinical presentation. We are presenting a series of 4 rare cases of extracranial, cervicofacial cysticercosis their clinical attributes and imaging characteristics leading to diagnosis of cysticercosis and approach to successful outcome with pharmacotherapy alone that spared the need of surgical management.

9.
Environ Sci Pollut Res Int ; 30(43): 97645-97659, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37594711

RESUMEN

The darker side of food behavior is that millions of tons of food have been shown the doors of garbage. Therefore, food waste behavior needs an eye to look upon. The purpose of this research is to inculcate the concept of systematic literature review along with meta-analysis in order to examine the Theory of Planned Behavior (TPB) with respect to food waste behavior. The methodology includes Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) that is conducted for the identification, screening, and inclusion of studies. In all, twenty-six independent studies with (N = 13373) met the inclusion criteria. For validating the related literature, random-effects meta-analysis has been applied for ascertaining the average correlation among the variables. More specifically, the present study also examines the sub-group analysis effect among TPB variables. The findings reveal that the strongest association was observed between Attitude and Intention followed by Subjective Norm (SN) and Intention (INT), Perceived Behavioral Control (PBC) and Intention, and Intention and Behavior. Furthermore, the subgroup analysis using multi-cultural groups explores the highest composite correlation in the case of other cultural groups that included countries like Canada. The outcomes of the present study seek to serve in the best interest of households, event management stakeholders, and food policy makers.


Asunto(s)
Residuos de Alimentos , Eliminación de Residuos , Alimentos , Teoría del Comportamiento Planificado , Canadá
10.
Anal Chem ; 95(30): 11342-11351, 2023 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-37463121

RESUMEN

There has been a steep rise in the emergence of antibiotic-resistant bacteria in the past few years. A timely diagnosis can help in initiating appropriate antibiotic therapy. However, conventional techniques for diagnosing antibiotic resistance are time-consuming and labor-intensive. Therefore, we investigated the potential of Raman spectroscopy as a rapid surveillance technology for tracking the emergence of antibiotic resistance. In this study, we used Raman spectroscopy to differentiate clinical isolates of antibiotic-resistant and -sensitive bacteria of Escherichia coli, Acinetobacter baumannii, and Enterobacter species. The spectra were collected with or without exposure to various antibiotics (ciprofloxacin, gentamicin, meropenem, and nitrofurantoin), each having a distinct mechanism of action. Ciprofloxacin- and meropenem-treated sensitive strains showed a decrease in the intensity of Raman bands associated with DNA (667, 724, 785, 1378, 1480, and 1575 cm-1) and proteins (640 and 1662 cm-1), coupled with an increase in the intensity of lipid bands (891, 960, and 1445 cm-1). Gentamicin- and nitrofurantoin-treated sensitive strains showed an increase in the intensity of nucleic acid bands (668, 724, 780, 810, 1378, 1480, and 1575 cm-1) while a decrease in the intensity of protein bands (640, 1003, 1606, and 1662 cm-1) and the lipid band (1445 cm-1). The Raman spectral changes observed in the antibiotic-resistant strains were opposite to that of antibiotic-sensitive strains. The Raman spectral data correlated well with the antimicrobial susceptibility test results. The Raman spectral dataset was used for partial least-squares (PLS) analysis to validate the biomarkers obtained from the univariate analysis. Overall, this study showcases the potential of Raman spectroscopy for detecting antibiotic-resistant and -sensitive bacteria.


Asunto(s)
Acinetobacter baumannii , Antibacterianos , Antibacterianos/farmacología , Meropenem , Nitrofurantoína , Espectrometría Raman/métodos , Farmacorresistencia Bacteriana , Bacterias , Ciprofloxacina/farmacología , Gentamicinas/farmacología , Lípidos , Pruebas de Sensibilidad Microbiana
11.
Cureus ; 15(5): e38907, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37303338

RESUMEN

Neurogenic orthostatic hypotension (nOH) is a disabling problem of autonomic dysfunction in patients with Parkinson's disease, which is associated with poor quality of life and higher mortality rates. The purpose of this literature review was to explore and compare the efficacy and safety of droxidopa (an existing treatment) and ampreloxetine (a newer medication) in the treatment of nOH. We used a mixed-method literature review that addresses the epidemiology, pathophysiology, and pharmacological and non-pharmacological management of nOH in Parkinson's disease in a general way, with a more exploratory approach to droxidopa- and ampreloxetine-controlled trial studies. We included a total of 10 studies of randomized controlled trials with eight studies focused on droxidopa and two studies focused on ampreloxetine. These two drugs were analyzed and compared based on the collected individual study results. Treatment of nOH in Parkinson's disease patients with droxidopa or ampreloxetine showed clinically meaningful and statistically significant improvements relative to placebo on the components of the OHSA (Orthostatic Hypotension Symptom Assessment) composite score and OHDAS (Orthostatic Hypotension Daily Activity Scale composite scores) composite score. Droxidopa had an improved effect on daily activities, with an associated increase in standing systolic blood pressure (BP), but the long-term efficacy of droxidopa has not been documented. Standing systolic BP was maintained by ampreloxetine and worsened after the withdrawal phase. This highlights the importance of conducting further research which will help us to improve the therapeutic approach for patients with nOH and Parkinson's disease.

12.
Sci Rep ; 13(1): 5863, 2023 04 11.
Artículo en Inglés | MEDLINE | ID: mdl-37041167

RESUMEN

Beer is the world's third most popular fermented beverage. It is typically made from malted barley. Tropical countries must import barley from temperate countries for brewing, which is an expensive process. Therefore, it is critical to investigate alternative possible substrates for beer production in order to meet the growing demand for high-nutritional-quality beer. The current study involves the creation of a fermented beverage from anthocyanin-rich black wheat with the help of yeast, Saccharomyces cerevisiae CMS12, isolated from fruit waste. Characterization (UV, HPLC, NMR, FTIR, and ICPMS) was then performed, as well as a comparative study with white (amber) wheat beer. Further, process parameters optimization included initial sugar concentration, inoculum size, and pH. Black wheat wort contained 568 mg GAE/L total phenolic content, 4.67 mg/L anthocyanin concentration, 6.8% (v/v) alcohol content, and a pH of 4.04. The sensory analysis revealed that black wheat beer was more acceptable than white wheat beer. The developed fermented beverage has enormous commercialization potential.


Asunto(s)
Antocianinas , Cerveza , Saccharomyces cerevisiae , Triticum , Antocianinas/análisis , Cerveza/análisis , Cerveza/microbiología , Fermentación , Saccharomyces cerevisiae/aislamiento & purificación , Triticum/química , Triticum/metabolismo , Triticum/microbiología
13.
Artículo en Inglés | MEDLINE | ID: mdl-36749895

RESUMEN

The tight regulation of the glucose concentration in the body is crucial for balanced physiological function. We developed an electrochemical transistor comprising an n-type conjugated polymer film in contact with a catalytic enzyme for sensitive and selective glucose detection in bodily fluids. Despite the promise of these sensors, the property of the polymer that led to such high performance has remained unknown, with charge transport being the only characteristic under focus. Here, we studied the impact of the polymer chemical structure on film surface properties and enzyme adsorption behavior using a combination of physiochemical characterization methods and correlated our findings with the resulting sensor performance. We developed five n-type polymers bearing the same backbone with side chains differing in polarity and charge. We found that the nature of the side chains modulated the film surface properties, dictating the extent of interactions between the enzyme and the polymer film. Quartz crystal microbalance with dissipation monitoring studies showed that hydrophobic surfaces retained more enzymes in a densely packed arrangement, while hydrophilic surfaces captured fewer enzymes in a flattened conformation. X-ray photoelectron spectroscopy analysis of the surfaces revealed strong interactions of the enzyme with the glycolated side chains of the polymers, which improved for linear side chains compared to those for branched ones. We probed the alterations in the enzyme structure upon adsorption using circular dichroism, which suggested protein denaturation on hydrophobic surfaces. Our study concludes that a negatively charged, smooth, and hydrophilic film surface provides the best environment for enzyme adsorption with desired mass and conformation, maximizing the sensor performance. This knowledge will guide synthetic work aiming to establish close interactions between proteins and electronic materials, which is crucial for developing high-performance enzymatic metabolite biosensors and biocatalytic charge-conversion devices.

14.
Drug Discov Today ; 28(2): 103467, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36528281

RESUMEN

Perinatal depression is the most common psychiatric complication of pregnancy, with its detrimental effects on maternal and infant health widely underrated. There is a pressing need for specific molecular biomarkers, with pregnancy-related decline in brain-derived neurotrophic factor (BDNF) in the blood and downregulation of TrkB receptor in the brain reported in clinical and preclinical studies. In this review, we explore the emerging role of BDNF in reproductive biology and discuss evidence suggesting its deficiency as a risk factor for perinatal depression. With the increasing evidence for restoration of serum BDNF levels by antidepressant therapy, the strengthening association of perinatal depression with deficiency of BDNF supports its potential as a surrogate endpoint for preclinical and clinical studies.


Asunto(s)
Depresión , Trastorno Depresivo , Embarazo , Femenino , Humanos , Depresión/tratamiento farmacológico , Factor Neurotrófico Derivado del Encéfalo/metabolismo , Antidepresivos/farmacología , Antidepresivos/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Encéfalo/metabolismo , Biomarcadores
15.
Curr Psychol ; : 1-12, 2022 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-36406849

RESUMEN

The working systems of organizations/institutions have undergone continuous transformations over the years for various reasons. Researchers have continually strived to find effective solutions/appropriate work systems to sustain an individual's performance in spite of the challenging working/business environment. The global pandemic Covid-19 prompted a rethinking of organizational work practices across sectors. Work from home (WFH) became a key component of continuing the organization's working system. This paper specifies the following six factors that may moderate the effectiveness of a work-from-home setting on individual performance such as dedication, disposition, determination, configuration, collaboration, and coordination. The paper uses self-determination theory (SDT) to develop a conceptual framework for WFH-individual performance, which specifies dedication, disposition, and determination as intrinsic motivators, while configuration, collaboration, and coordination as extrinsic motivators. Moreover, it provides implications and future research directions for theory development and practice.

16.
Anal Chem ; 94(42): 14745-14754, 2022 10 25.
Artículo en Inglés | MEDLINE | ID: mdl-36214808

RESUMEN

The rapid identification of bacterial pathogens in clinical samples like blood, urine, pus, and sputum is the need of the hour. Conventional bacterial identification methods like culturing and nucleic acid-based amplification have limitations like poor sensitivity, high cost, slow turnaround time, etc. Raman spectroscopy, a label-free and noninvasive technique, has overcome these drawbacks by providing rapid biochemical signatures from a single bacterium. Raman spectroscopy combined with chemometric methods has been used effectively to identify pathogens. However, a robust approach is needed to utilize Raman features for accurate classification while dealing with complex data sets such as spectra obtained from clinical isolates, showing high sample-to-sample heterogeneity. In this study, we have used Raman spectroscopy-based identification of pathogens from clinical isolates using a deep transfer learning approach at the single-cell level resolution. We have used the data-augmentation method to increase the volume of spectra needed for deep-learning analysis. Our ResNet model could specifically extract the spectral features of eight different pathogenic bacterial species with a 99.99% classification accuracy. The robustness of our model was validated on a set of blinded data sets, a mix of cultured and noncultured bacterial isolates of various origins and types. Our proposed ResNet model efficiently identified the pathogens from the blinded data set with high accuracy, providing a robust and rapid bacterial identification platform for clinical microbiology.


Asunto(s)
Ácidos Nucleicos , Espectrometría Raman , Espectrometría Raman/métodos , Bacterias , Aprendizaje Automático , Extractos Vegetales
18.
J Phys Chem B ; 126(41): 8140-8154, 2022 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-36205931

RESUMEN

Antibiotic resistance is a major global health concern. The increased use of herbicides may lead to multiple antibiotic resistance in bacteria. Conventional techniques for diagnosing antibiotic resistance are laborious, time-intensive, expensive, and lack information about antibiotic susceptibility. On the other hand, Raman spectroscopy is a rapid, label-free, noninvasive alternative to traditional techniques to detect antibiotic resistance. In this study, two popular herbicides 2,4-dichlorophenoxy acetic acid (2,4-D) and N-(phosphonomethyl)glycine (glyphosate) were used to study their effects on the emergence of antibiotic resistance. The Escherichia coli wild-type (WT) MG1655 strain and two isogenic mutants, Δlon and ΔacrB, were used together with Raman spectroscopy. The WT E. coli is sensitive to antibiotics, but exposure to both herbicides induces antibiotic resistance. Using an excitation wavelength of 785 nm, the intensity ratios (e.g., I740/I785, I740/I1003, I1480/I1445, I2934/I2868, and I2934/I2845) were identified as biomarkers to study the induction of antibiotic resistance in bacteria but not NaCl-mediated stress. Using an excitation wavelength of 633 nm, the peak intensity at 740 cm-1 assigned to cytochrome bd decreases under antibiotic stress but increases upon exposure to both herbicides and antibiotics, indicating the development of resistance. Thus, this study can be applied to monitor antibiotic resistance using Raman spectroscopy.


Asunto(s)
Escherichia coli , Herbicidas , Herbicidas/farmacología , Espectrometría Raman , Ácido Acético , Antibacterianos/farmacología , Farmacorresistencia Microbiana , Ácido 2,4-Diclorofenoxiacético/farmacología , Citocromos , Glifosato
19.
Microbiol Res ; 262: 127075, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-35688099

RESUMEN

In the present study Piriformospora indica (Pi) a phyto-promotional fungus and Azotobacter chroococcumWR5 (AzWR5) a rhizobacterium, were symbiotically evaluated for their role in improving the nutritional quality of wheat (Triticum aestivum L.). Co-inoculation of Pi+AzWR5 modified root system architecture of host and along with increasing the proportion of finer roots by 88% and 92% in C306 and Hd2967 respectively. Furthermore, the synergistic impact of Pi+AzWR5 interplayed for enhanced accumulation of Zn and Fe in different plant parts including grains (3.12 and 1.33 fold respectively). Pi+AzWR5 increased the transfer factor of Zn (62%, 94%, 91% and 213%) and Fe (31%, 54%, 68% and 32%) in root, stem, leaves and grains, respectively, and translocation factor of Zn (20%, 18% and 63%) and Fe (18%, 29% and 29%) for root-stem, root-leaves and root-grains, respectively. In addition to these co-inoculation of endophytes led to several fold increase in expression of four ZIP transporter genes in roots and shoot. In addition to these symbiotic association of endophytes with host led to 3 fold increase in grain yield. We thereby conclude that co-inoculation of Pi+AzWR5 substantially improves mobilization of Zn and Fe from soil and increase its concentration in grains as well as improves crop yield.


Asunto(s)
Azotobacter , Biofortificación , Azotobacter/genética , Azotobacter/metabolismo , Basidiomycota , Endófitos/genética , Endófitos/metabolismo , Hierro/metabolismo , Raíces de Plantas/metabolismo , Triticum/microbiología , Zinc/metabolismo
20.
Int J Transgend Health ; 23(1-2): 149-163, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35403111

RESUMEN

Background: There is immense diversity among transgender people in India with respect to ethnicity, sub-culture, and gender expression. Aim: This study examines psychological distress, gender dysphoria, transgender congruence, and social strain among transgender women, and explores their reflections on self and community using a mixed-method approach. Method: Gender dysphoria, psychological distress, and transgender congruence were assessed with standardized scales while the participants' reflections were captured using semi-structured interviews. A total of 20 transgender women and Hijras were included in the study using convenience sampling. Data was analyzed using quantitative and qualitative techniques. Results: A positive correlation was found between psychological distress and social strain, but no correlation was found between psychological distress and gender dysphoria. Half of the participants fell into the range of gender dysphoria, five of them underwent gender affirming surgery, while two could not undergo the surgery and the rest did not express any discomfort with their gender. While all participants experienced psychological distress due to psycho-socio-cultural stressors, Hijra reported additional stressors related to the Hijra tradition. Discussion: Findings reveal that the psychological distress experienced by transgender women and Hijra had a significant, positive relationship with social strain rather than gender dysphoria. Participants reported various psycho-socio-cultural factors causing psychological distress, which impacted their lives more negatively than gender identity conflicts. These findings support the recent advances by the World Health Organization in ICD-11 to extract transgender conditions from the Mental and Behavioral Disorders category. Limitations of the study are elucidated by authors and the need for a culturally relevant and nonbinary gender dysphoria scale, and implications are discussed.

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