Modified NUTRIC Score as a Predictor of All-cause Mortality in Critically Ill Patients: A Systematic Review and Meta-analysis.

Purpose: The purpose of our meta-analysis was to look at the impact of modified nutrition risk in the critically ill (mNUTRIC) on mortality in patients with critical illness. Materials and methods: Literature relevant to this meta-analysis was searched in PubMed, Web of Science, and Cochrane Library till 26 August 2023. Prospective or retrospective studies, patients >18 years of age, studies that reported on mortality and mNUTRIC (mNUTRIC cut-off score) were included. The QUIPS tool was used to evaluate the risk for bias in prognostic factors. Results: A total of 31 studies on mNUTRIC score, involving 13,271 patients were included. The summary area under the curve (sAUC) of 0.80 (95% CI: 0.76-0.83) illustrates the mNUTRIC score's strong discrimination. The pooled sensitivity was 0.79 (95% CI: 0.74-0.84) and pooled specificity was 0.68 (95% CI: 0.63-0.73). We found no discernible variation in the mNUTRIC's prediction accuracy among cut-off values of <5 and >5 in our subgroup analysis and sAUC values were 0.82 (95% CI: 0.78-0.85) and 0.78 (95% CI: 0.74-0.81), respectively. Conclusion: We observed that mNUTRIC can discriminate between critically ill individuals and predict their mortality. Prospero: CRD42023460292. How to cite this article: Prakash J, Verma S, Shrivastava P, Saran K, Kumari A, Raj K, et al. Modified NUTRIC Score as a Predictor of All-cause Mortality in Critically Ill Patients: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2024;28(5):495-503.

From soil to health hazards: Heavy metals contamination in northern India and health risk assessment.

Heavy metals contamination in soil is a global concern affecting the environment with far-reaching consequences for ecosystems and the health of human beings. Heavy metals contamination of soil entails a significant threat to the environment and human health. This research paper focuses on the quantification of heavy metals contamination in soil in Kanpur district, a highly industrialized and densely populated region in India. The study was aimed to identify the sources of heavy metals, map their spatial distribution, and evaluate the potential implications on the environment and human well-being. The prime intent of the current study was quantification of heavy metals in the soil as well as the comparison of risk on the health of human being using two different methods i.e., US EPA methodology for risk assessment and epidemiological study-based risk assessment. Heavy metals like Fe, Ni, Co, Cu, Mn, Cr, and Cd were analyzed in agricultural samples of soil with the help of inductively coupled plasma optical emission spectroscopy. On the basis of epidemiological data, the attributable and relative risk came out to be 0.001 and 1.060, respectively. On the basis of the calculation of Cr alone, the values of carcinogenic risk for adults came out to be 3.87 × 10-7 and for children it was 3.01 × 10- 6. In conclusion, this research paper highlights the alarming levels of heavy metals contamination in the soil of Kanpur district, emphasizing the urgent need for remediation and mitigation efforts, thereby guiding policy makers and stakeholders in developing targeted strategies for soil protection and safeguarding human health.

Novel Mutation in CYP2R1 Causing Vitamin D-Dependent Rickets Type 1b.

Monogenic forms of rickets are being increasingly recognized. However, vitamin D-dependent rickets 1b (VDDR1b) due to CYP2R1 gene mutation is exceedingly rare. We report a 4.5-year-old girl and her younger sibling who presented with clinical, radiological, and biochemical features suggestive of nutritional rickets that did not resolve despite repeated therapeutic doses of vitamin D3. This led to evaluation for resistant rickets, which revealed a novel homozygous CYP2R1 c.50_51insTCGGCGGCGC; p.Leu18ArgfsTer79 variant in the affected siblings. The children were treated with oral calcium and cholecalciferol, dose titrated to maintain serum alkaline phosphatase, 25 hydroxy vitamin D, and parathyroid hormone levels in the normal range, with good clinical and radiological response. This case highlights the importance of genetic evaluation in patients with suspected nutritional rickets who have a family history of similar illness and require higher than usual doses of vitamin D for healing or relapse on stopping treatment. To the best of our knowledge this is the first case of VDDR1b reported from Asia.

A comprehensive evaluation of predictors of obesity in women during the perimenopausal period: A systematic review and narrative synthesis.

INTRODUCTION: Obesity during perimenopausal transition can be attributed to various factors. Identifying these factors is crucial in preventing obesity and developing effective strategies to manage weight during this phase. This review aimed to systematically understand predictors of obesity during menopausal transition. METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched databases like PubMed, Wiley Online Library, and Cochrane Reviews. Cohort and cross-sectional studies in English language assessing obesity among menopausal women were included. The methodological quality was assessed using Joanna Briggs Checklist for critical appraisal. Risk of Bias (RoB) was generated using Review Manager 5.4.1 (RevMan). Identified predictors were assessed for overall quality of evidence using adopted Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: This review encompassed 42 studies, (21 cross-sectional and 21 cohort) with sample ranging from 164 to 107,243 across studies. Higher parity( ≥ 3 children) emerged as a strong predictor of obesity across seven studies, with good-quality evidence. Lower physical activity was another predictor, supported by eight studies with good-quality evidence. Sociodemographic factors like lower education(<8 years or < than college degree), socioeconomic background, menopausal transition, and older age at menarche showed associations with weight gain, with moderate-quality evidence. Lifestyle factors (high-fat consumption, sedentariness, active smoking status, and psychological difficulties) also showed moderate-quality evidence. CONCLUSION: This review underscores the multifaceted factors associated with obesity during the perimenopausal transition. Identifying these factors will be helpful in prevention and management of obesity among these women.

2D-MoS2-supported copper peroxide nanodots with enhanced nanozyme activity: application in antibacterial activity.

Peroxidase (POD)-like nanozymes are an upcoming class of new-generation antibiotics that are efficient for broad-spectrum antibacterial action. The POD-like activity employs the generation of reactive oxygen species (ROS), which have been utilized for bactericidal action. However, their intrinsic low catalytic activity and stability limit their bactericidal properties. In this study, we prepared a MoS2-based nanocomposite with copper peroxide nanodots (MoS2@CP) to achieve pH-dependent light-induced nanozyme-based antibacterial action. It has shown superior peroxidase and antibacterial activity at low pH. The mechanism behind the enhanced POD-like activity and high antibacterial activity was established. The mechanistic pathway involves estimating ROS generation, membrane depolarization, inner membrane permeabilization, metal ion release, and the effect of NIR on photothermal and photodynamic activities. Overall, our work highlighted the combinatorial approach for eradicating bacterial infections using enzyme-based antibacterial agents.

A Cross-Sectional Survey of 505 Postpartum Women to Assess Lifestyle-Related Behaviour, Barriers, and Myths Affecting Postpartum Weight Retention and Its Management.

Background/Purpose: This study aims to assess lifestyle-related factors such as diet, physical activity and sleep along with common myths, beliefs, and barriers to a healthy lifestyle and resultant postpartum weight retention. It has also explored the association of the aforementioned factors with socio-demographic variables. Methods: A cross-sectional survey was conducted using a comprehensive pre-validated questionnaire on a convenience sample of postpartum women using a telephonic interview schedule. Results: A total of 505 postpartum women were recruited with median postpartum weight retention of 5 kg. More than half of the participants had incorrect dietary practices with less than one-tenth of women indulging in low/moderate-intensity physical activity. Postpartum women had poorer diet (p < 0.05) and sleep (p < 0.01) in the initial phase postpartum as compared to late postpartum. These women were also less physically active in the initial months and as the postpartum period progressed their physical activity also improved significantly (p < 0.001). Socio-demographic variables such as socio-economic status, education, and employment status were significantly associated with unhealthy lifestyle practices. Common barriers were lack of knowledge, time constraints, lack of childcare support and cultural myths and beliefs. Conclusion: The findings of the study will help in developing a comprehensive women-centric weight management module focusing on practical guidelines for lifestyle, breastfeeding and other confounding factors associated with postpartum weight management.

Crater formation and deuterium production in laser irradiation of polymers with implanted nano-antennas.

Recent validation experiments on laser irradiation of polymer foils with and without implanted golden nanoparticles are discussed. First we analyze characteristics of craters, formed in the target after its interaction with the laser beam. Preliminary experimental results show significant production of deuterons when both the energy of laser pulse and concentration of nanoparticles are high enough. We consider the deuteron production via the nuclear transmutation reactions p+C→d+X where protons are accelerated by the Coulomb field generated in the target plasma. We argue that maximal proton energy can be above threshold values for these reactions and the deuteron yield may noticeably increase due to presence of nanoparticles.

Robert's Uterus versus Juvenile Cystic Adenomyoma - Diagnostic and Therapeutic Challenges - Case Report and Review of Literature.

This case report highlights the diagnostic dilemma and therapeutic challenges encountered while managing adolescent girls with progressive dysmenorrhoea and management of Robert's uterus. Two girls aged 20 years and 13 years presented with severe progressive dysmenorrhoea. In the first case, laparoscopy revealed juvenile cystic adenomyoma (JCA) of 3 cm × 3 cm on the left side anteroinferior to the round ligament. Laparoscopic resection of the lesion was done, and histopathology revealed features of adenomyosis. In the second case, there was a globular enlargement of the right half of the uterine body with round ligament and adnexa attached to the lesion (Robert's uterus). In view of severe symptoms, complete resection of the lesion and partial resection of hemi-uterus was done, followed by myometrial defect closure. Both cases were initially diagnosed as JCA, and the final diagnosis was made on laparoscopy. Both girls had complete symptomatic relief from the next menstrual cycle and have been under follow-up for 24 months and 18 months, respectively. Due to the rarity of conditions, Robert's uterus and JCA are usually misdiagnosed with each other or with other Mullerian anomalies such as a non-communicating unicornuate uterus. Radiologists and clinicians should be aware of these different pathologies causing similar symptoms. Understanding the pathology, early diagnosis, timely referral and correct surgical procedure are emphasised to improve reproductive outcomes.

A Comparative Evaluation of Soft and Hard Tissue Changes Around Dental Implants Placed With and Without Platelet-Rich Fibrin.

BACKGROUND: A patient's ability to maintain a healthy bone-implant interface seems to be a major predictor of implant longevity over the long term. The implant surface is protected from the oral environment, the bone, and the implant itself by the peri-implant tissues. Platelet-rich fibrin (PRF) has been shown to help in the regeneration of bone and other connective tissues. Since there has been inadequate information on the role of PRF in maintaining soft tissue integrity and crestal bone changes, the present study aimed to evaluate these challenges clinically and radiographically in human patients who had dental implants placed with PRF. MATERIALS AND METHODS: There were a total of 15 patients who were recalled for the analysis, and they were split into two groups. PRF was used to complete the implant procedure in the experimental group, but PRF was not used in the control group. Cone beam computed tomography (CBCT) was used to evaluate the amount of alveolar bone prior to dental implant placement and intra-oral periapical radiograph (IOPAR) for postoperative assessment. Gingival index, plaque index, probing depths, papilla bleeding index, and crestal bone changes were used to document clinical limits. IOPAR using a similar approach was used to evaluate the crestal bone level alterations. Patients were evaluated clinically and radiographically for changes in the peri-implant soft tissue and crestal bone during implant placement, six and nine months postoperatively. RESULTS: From baseline (p=0.02) to six months (p=0.04) and nine months (p=0.04), both groups showed changes in crestal bone loss and soft tissue although the changes in the test group were smaller. Soft tissue changes showed significant differences for probing depth and papilla index score at baseline and at the end of the six and nine months (p<0.05), whereas no significant difference was noted with bleeding index and plaque index score during the follow-up (p>0.05). CONCLUSION:  To conclude, the provided data demonstrated that the local injection of PRF during implant placement has the potential to favorably stimulate bone formation, and may be used as a therapeutic adjuvant in the clinical setting of implant placement.

Effect on neonatal sepsis following immediate kangaroo mother care in a newborn intensive care unit: a post-hoc analysis of a multicentre, open-label, randomised controlled trial.

Background: To implement the immediate Kangaroo mother care (iKMC) intervention in the previous multicentre, open-label, randomised controlled trial, the mother or a surrogate caregiver and neonate needed to be together continuously, which led to the concept of the Mother-Newborn Care Unit (MNCU). Health-care providers and administrators were concerned of the potential increase in infections caused by the continuous presence of mothers or surrogates in the MNCU. We aimed to assess the incidence of neonatal sepsis in sub-groups and the bacterial profile among intervention and control neonates in the study population. Methods: This is a post-hoc analysis of the previous iKMC trial, which was conducted in five level 2 Newborn Intensive Care Units (NICUs) one each in Ghana, India, Malawi, Nigeria, and Tanzania, in neonates with birth weight 1 to <1.8 kg. The intervention was KMC initiated immediately after birth and continued until discharge and compared to conventional care with KMC initiated after meeting stability criteria. The primary outcomes of this report were the incidence of neonatal sepsis in sub-groups, sepsis-related mortality and bacterial profile of isolates during hospital stay. The original trial is registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12618001880235) and the Clinical Trials Registry-India (CTRI/2018/08/01536). Findings: Between November 30, 2017, and January 20, 2020, 1609 newborns in the intervention group and in the control group 1602 newborns were enrolled in iKMC study. 1575 newborns in the intervention group and 1561 in the control group were clinically evaluated for sepsis. Suspected sepsis was 14% lower in intervention group in sub-group of neonates with birth weight 1.0-<1.5 kg; RR 0.86 (CI 0.75, 0.99). Among neonates with birth weight 1.5-<1.8 kg, suspected sepsis was reduced by 24%; RR 0.76 (CI 0.62, 0.93). Suspected sepsis rates were lower in intervention group than in the control group across all sites. Sepsis related mortality was 37% less in intervention group than the control group; RR 0.63 (CI 0.47-0.85) which was statistically significant. The intervention group had fewer cases of Gram-negative isolates (n = 9) than Gram positive isolates (n = 16). The control group had more cases of Gram-negative isolates (n = 18) than Gram positive (n = 12). Interpretation: Immediate Kangaroo Mother care is an effective intervention to prevent neonatal sepsis and sepsis related mortality. Funding: The original trial was funded by the Bill and Melinda Gates Foundation through a grant to the World Health Organization (grant No. OPP1151718).

A critical insight into occurrence and fate of polycyclic aromatic hydrocarbons and their green remediation approaches.

Over the last century, the tremendous growth in industrial activities particularly in the sectors of pharmaceuticals, petrochemicals and the reckless application of fertilizers and insecticides has raised the contamination of polyaromatic hydrocarbons (PAHs) tremendously. For more than a decade, the main focus of environmental experts is to come up with management approaches for the clean-up of sites polluted with PAHs. These are ubiquitous in nature i.e., widely distributed in ecosystem ranging from soil, air and marine water. Most of the PAHs possess immunotoxicity, carcinogenicity and genotoxicity. Being highly soluble in lipids, they are readily absorbed into the mammalian gastro intestinal tract. They are widely distributed with marked tendency of getting localized into body fat in varied tissues. Several remediation technologies have been tested for the removal of these environmental contaminants, particularly bioremediation has turned out to be a hope as the safest and cost-effective option. Therefore, this review first discusses various sources of PAHs, their effect on human health and interactions of PAHs with soils and sediments. In this review, a holistic insight of current scenario of existing remediation technologies and how they can be improvised along with the hindrances in the path of these technologies are properly addressed.

SCOPE: Surveillance of COVID-19 in pregnancy- results of a multicentric ambispective case-control study on clinical presentation and maternal outcomes in India between April to November 2020.

OBJECTIVE: To determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group. DESIGN: Multicentric case-control study. DATA SOURCES: Ambispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020. STUDY POPULATION: All pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls. DATA QUALITY: Dedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy. STATISTICAL ANALYSIS: Data converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression. RESULTS: A total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%). CONCLUSION: Covid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls.

Anterior and Posterior Tongue Regions and Taste Papillae: Distinct Roles and Regulatory Mechanisms with an Emphasis on Hedgehog Signaling and Antagonism.

Sensory receptors across the entire tongue are engaged during eating. However, the tongue has distinctive regions with taste (fungiform and circumvallate) and non-taste (filiform) organs that are composed of specialized epithelia, connective tissues, and innervation. The tissue regions and papillae are adapted in form and function for taste and somatosensation associated with eating. It follows that homeostasis and regeneration of distinctive papillae and taste buds with particular functional roles require tailored molecular pathways. Nonetheless, in the chemosensory field, generalizations are often made between mechanisms that regulate anterior tongue fungiform and posterior circumvallate taste papillae, without a clear distinction that highlights the singular taste cell types and receptors in the papillae. We compare and contrast signaling regulation in the tongue and emphasize the Hedgehog pathway and antagonists as prime examples of signaling differences in anterior and posterior taste and non-taste papillae. Only with more attention to the roles and regulatory signals for different taste cells in distinct tongue regions can optimal treatments for taste dysfunctions be designed. In summary, if tissues are studied from one tongue region only, with associated specialized gustatory and non-gustatory organs, an incomplete and potentially misleading picture will emerge of how lingual sensory systems are involved in eating and altered in disease.

Synthesis, Drug-Likeness Evaluation of Some Heterocyclic Moieties Fused Indole Derivatives as Potential Antioxidants.

BACKGROUND: Indole and its derivatives have a wide range of pharmacological effects, including analgesic, antimicrobial, antidepressant, anti-diabetic, anti-convulsant, anti-helminthic, and anti-inflammatory properties. They are crucial structural components of many of today's powerful antioxidant medications. OBJECTIVE: Using the Schotten-Baumann reaction, the indole ring was linked to other key heterocyclic moieties such as morpholine, imidazole, piperidine, and piperazine at the active 3rd position and then tested for antioxidant activity. METHODS: Synthesis of derivatives was accomplished under appropriate conditions and characterized by IR, NMR (1H and 13C), and mass spectrum. Using the Swiss ADME online application, ADME properties were also determined. The in vitro antioxidant activity was measured using DPPH and Reducing power method. RESULTS: In the DPPH assay, compounds 5a (IC50=1.01±0.22 µg/mL), 5k (IC50=1.21 ± 0.07 µg/mL), whereas compounds 5a (EC50=23 ± 1.00 µg/mL), 5h (EC50=26±2.42 µg/mL) in the reducing power assay were most potent as compared with standard Ascorbic acid. Compounds 5a, 5h, and 5k demonstrated maximal potency equivalent to standard. Lipinski's rule was followed in ADME outcomes. CONCLUSION: The synthesis and evaluation of indole derivatives to investigate their antioxidant action has received a lot of attention. These discoveries could lead to more effective antioxidant candidates being designed and developed.

Postpartum weight retention and its association with socio-demographic and obstetrics correlates: A cross-sectional hospital-based preliminary survey in India.

BACKGROUND AND AIMS: Postpartum weight retention can predispose women to an elevated risk of obesity and associated complications. The study aims to assess the magnitude of postpartum weight retention and its association with socio-demographic and obstetrics correlates. METHODS: A cross-sectional survey was carried out in February and March 2022 via telephonic interviews. Convenience sampling technique was used for recruiting postpartum women in first three months, four to six months and beyond six months post-delivery (date of delivery January 2021 to January 2022). Chi2 test and regression analysis were employed to study the association of socio-demographic and obstetrics correlates with postpartum weight retention. RESULTS: The final sample comprised 505 postpartum women with a mean age of 29 ± 4 years. The mean postpartum weight retention was 4.96 ± 3.64 kg, 5.38 ± 3.93 kg and 5.80 ± 3.95 kg in the first three months, four to six months and beyond six months post-delivery respectively. In the first three months, socio-economic status and gestational weight gain were associated with weight retention (p < 0.05). In four-six months, type of family, education qualification, and gestational weight gain were associated with weight retention (p < 0.05). Beyond six months post-delivery, gestational weight gain was associated with postpartum weight retention (p < 0.05). CONCLUSION: The findings provide preliminary data on the magnitude of weight retention in Indian postpartum women. Postpartum women are at an increased risk of weight retention with the overall shift to a higher body mass index category as compared to the pre-pregnancy period. It is crucial to timely screen women at risk and implement weight management strategies.

Dual localization of the carboxy-terminal tail of GLR3.3 in sieve element-companion cell complex.

Glutamate receptor-like (GLR) 3.3 and 3.6 proteins are required for mediating wound-induced leaf-to-leaf electrical signaling. In the previous study, we found that the carboxy-terminal tail of GLR3.3 contains key residues that are indispensable for its action in electrical signaling. In the present work, we generated plants that expressed the truncated C-tail fraction of GLR3.3. To our expectation, the truncated C-tail itself was not functional in propagating leaf-to-leaf signals. However, we identified that the C-tail-mVENUS fusion proteins had dual localization patterns in sieve elements and companion cells. In companion cells, the fusion proteins overlapped largely with the nucleus. We speculated that a possible nuclear localization signal is present in the C-tail of GLR3.3, paralleling the C-tails of the ionotropic glutamate receptors in animal cells. Our further findings on the C-tail of GLR3.3 open up new possibilities for the regulatory roles of the C-tails to GLR proteins.

Negative Emotions, Triggers, and Coping Strategies Among Postpartum Indian Women During Second Wave of COVID-19 Pandemic: Lessons for the Subsequent Waves and Beyond.

Introduction: The study aimed to evaluate COVID-19 associated psychological distress among pregnant and postpartum women during the second wave of COVID-19 in India. Methods: A cross-sectional survey was done using a pre-validated tool involving 491 participants attending a tertiary-care hospital during the second wave of COVID-19 in India. Results: Three-fourths of participants experienced negative emotions such as fear and various features of depression. Participants (75%) reported COVID-related news on TV/Radio/Newspapers including social media as the major trigger for these negative emotions. Loss of social support mainly affected postpartum women (p < 0.001) and working women (p < 0.001). Inability to access healthcare services had negative associations with age (p < 0.001), education (p < 0.001), and socioeconomic class (p < 0.001). Various coping strategies being followed by participants included watching TV/Videos or reading books (93%), resorting to social media (77%), spending more time praying and meditating (86%), and engaging in hobbies (56%). Conclusion: During the second wave, the COVID-19 pandemic had a significantly high negative impact on the psychological and social well-being of pregnant and postpartum women. Hence, it is important to initiate appropriate preventive and corrective steps by the policymakers for any future waves of the pandemic.

Synthesis, Molecular Docking and ADME Prediction of 1H-indole/5- substituted Indole Derivatives as Potential Antioxidant and Anti- Inflammatory Agents.

BACKGROUND: Inflammation is a protective biological process, but under extreme conditions, it can become highly dreadful to the body. Antioxidant and anti-inflammatory agents treat similar disease conditions as inflammation and oxidative stress commonly follow similar causative pathways. OBJECTIVE: The goal of this study was to synthesize N-substituted indole derivatives with different heterocyclic moieties through propyl linker with the aim of getting highly potent anti-inflammatory and antioxidant agents. METHODS: Synthesized compounds were analyzed by analytical techniques such as IR, 1H NMR, 13C NMR spectra, and mass spectrometry. Molecular docking and ADME calculation were employed on synthesized compounds to estimate their COX-2 enzyme inhibition and drug like properties, respectively. Antioxidant activity was evaluated by the DPPH assay and the reducing power assay. Selected derivatives were evaluated for anti-inflammatory activity at an acute (carrageenan-induced paw edema method) and chronic level (formalin-induced inflammation method) using indomethacin as a standard drug. RESULTS: Herein, twelve indole derivatives (11a-c, 12a-c, 13a-c, and 14a-c) were synthesized. Among all, compound 12c was found to be the best inhibitor of the COX-2 enzyme as it displayed good interaction energy. Zero violations of Lipinski's rule were found in the ADME investigation, confirming the drug-like qualities of synthesized compounds. The compounds 11a and 12c were found to be the most potent as compared with standard ascorbic acid in antioxidant evaluation. From the collected results, compounds 12c and 13b were the most potent against acute and chronic inflammation. CONCLUSION: The novel synthetic indole derivatives could act as potent leads for the development of novel antioxidant and anti-inflammatory agents.

Acceptance Rate of COVID-19 Vaccine and Its Determinants Among Indian Pregnant Women: A Hospital-Based Cross-Sectional Analysis.

Background Vaccination is more widespread when the determinants and hesitancy of vaccination are identified, especially in vulnerable groups, such as pregnant women. Pregnant women if infected with COVID-19 are more likely to get severe COVID-19 illness and adverse neonatal outcomes as compared to non-pregnant women. The present study was designed with the aim to estimate the rate of COVID-19 vaccine acceptance and to identify the associated factors which influence the vaccine acceptance. Methods This study was a hospital-based cross-sectional study conducted in the Obstetrics Department of Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, from February 2022 to April 2022. Our study included 298 pregnant women above 18 years who were willing to participate in the study. Information was collected by face-to-face interview using a structured and pretested questionnaire. Binomial logistic regression (univariate and multivariate) was used to identify the associated factors on vaccination acceptance. Results Among 298 pregnant women, 234 expressed willingness to receive vaccine, giving an acceptance rate of 78.52%. The educational status, ethnicity, occupation of the woman and husband, and type of family showed no significant relationship with the vaccine acceptance. On multivariate logistic regression analysis, the determinants found to be significantly associated with COVID-19 vaccine acceptance among pregnant women were as follows: Muslim religion (aOR=0.27, CI: 0.12-0.61), gravida >2 (aOR=1.84, CI: 1.30-2.61), and awareness that COVID-19 vaccine has been approved by the government (aOR=3.03, CI: 1.45-6.36). Awareness that COVID-19 infection causes more severe complications in pregnant women than non-pregnant women (aOR=1.89, CI: 0.93-3.87) and hypertension (aOR=0.36, CI: 0.11-1.20) were non-significantly associated. Conclusion The acceptance of COVID-19 vaccination was high in this study and was well received especially by mothers who had knowledge about the importance of vaccination during pregnancy. Concerns about the side effects of vaccination and the possibility of harming the baby were the main reasons for refusal. During prenatal care, health care providers should reinforce the benefits of COVID-19 vaccination during pregnancy.