Oral versus topical tamoxifen in cyclical mastalgia-A randomized controlled trial.

Mastalgia affects premenopausal in which cyclical mastalgia affects up to 40% of women. In approximately 8% of these women, pain will be severe and interfere with their normal activities. oral tamoxifen widely used in the treatment of mastalgia is associated with a wide range of side effects. Topical tamoxifen has the potential to be a more efficacious and safer alternative with lower blood drug levels hence having lower systemic side effects. To compare reduction in the pain, nodularity and blood drug levels of tamoxifen using topical verus oral tamoxifen in cyclical mastalgia. Patients who presented to the surgery outpatient department with complaints of breast pain were provided with a breast pain evaluation questionnaire. Patients were randomized using a computer generated sequence into two groups with 75 participants in each group. In Group 1, the participants received topical tamoxifen gel and a placebo tablet for 3 months, and in Group 2, the participants received Oral Tab Tamoxifen 10 mg OD and a placebo gel for 3 months. They were provided with a Cardiff Breast Pain assessment chart and asked to mark the severity of their pain and response to treatment in the following month and asked to report to the investigator. Patients were called for review every month, and the pain chart was monitored and documented. The response to therapy (relief of pain) was assessed after 3 months of treatment and once more at the end of 6 months for recurrence. After completion of 1 month of treatment, blood sample was drawn to check for the blood drug levels. There is a significant difference of mean pain score between oral and topical tamoxifen groups (P < .001) at the end of 1 month, 3 months (P < .001), and 6 months (P < .001). There is a significant difference in the Nodularity found between oral and topical groups at presentation (P = .004), at 1 month (P = .003) and at 6 months (P < .001). There is a significant difference of mean blood tamoxifen level (ng/mL) in oral and topical tamoxifen groups (P < .001). From this study, we conclude that topical tamoxifen is more effective than oral tamoxifen treatment in reducing cyclical breast pain and decreasing breast nodularity with lesser side effects and lower recurrence rates.

Decreasing medication errors in four intensive care units of a tertiary care teaching hospital in India using a sensitization programme.

Background: Medication errors have an adverse impact on the healthcare system by increasing patient morbidity and mortality. They are preventable, and educational or technology-based interventions are needed to reduce their prevalence and improve medication safety. We aimed to study the impact of a sensitization programme and a blame-free reporting tool for doctors and nurses on the prevalence and reporting of medication errors in the intensive care units (ICUs) of a tertiary care teaching hospital. Methods: This prospective interventional study was conducted in the ICUs of cardiology, medicine, paediatrics and neonatology. Baseline medication errors were detected by prescription order review and direct observation of administration of medication for 30 days. A sensitization programme was conducted for doctors and nurses in these ICUs, the results were discussed, and a blame-free medication error reporting tool was introduced. Medication charts were modified to remove the transcription process in the cardiology and paediatrics ICUs. The follow-up study was conducted for 30 days in each ICU to monitor the impact of the sensitization programme. Results: The prevalence of medication errors was found to be 334.1/1000 patient observation days. Prescription errors were the most common types of errors at 129.1/1000 patient observation days. The interventions significantly reduced the error rate in all four ICUs. The overall number of prescriptions with errors was reduced from 9.1% (177/1944) to 3.5% (48/1373) and no medication error was reported using the tool. Conclusion: The sensitization programme on medication errors for doctors and nurses may be effective in improving medication safety. The impact was more pronounced in prescription errors. Reporting of medication errors did not improve in this study despite the introduction of a blame-free reporting tool.

The cytotoxicity and cellular stress by temperature-fabricated polyshaped gold nanoparticles using marine macroalgae, Padina gymnospora.

Bioreduction of metal ions for the synthesis of stable nanoparticles (NPs) in physiological environment has been a great challenge in the field of nanotechnology and its application. In the present study, well-defined biofunctionalized gold nanoparticles (AuNPs) were developed following a biomimetic approach for an enhanced anticancer activity. The fucoxanthins-capped crystalline AuNPs showed a particle size of 14 nm. The temperature-mediated biosynthesized NPs were characterized by UV-vis, dynamic light scattering, high-resolution transmission electron microscopy, and energy-dispersive X-ray spectroscopy. The cytotoxicity of the NPs was analyzed on liver (HepG2) and lung (A549) cancerous cells. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay infers that the biofunctionalized polyshaped AuNPs synthesized with an aqueous macroalgae extract showed a satisfactory anticancer effect on the cell lines, as evaluated by changes in cell morphology, cell viability, and metabolic activity. An altered cellular function and the morphology of cancer cell lines suggest a potential for in vivo application of AuNPs and the need to understand the interactions between nanomaterials, biomolecules, and cellular components. With continued improvements, these NPs may prove to be potential drug delivery vehicles for cancer therapy.

Preparation and Thermo-Physical Properties of Fe2O3-Propylene Glycol Nanofluids.

Iron oxide (Fe2O3) nanoparticles were prepared from ferric chloride and ferrous sulphate by precipitation reaction. Fe2O3-propylene glycol nanofluid was prepared by dispersing Fe2O3 nanoparticles in propylene glycol through stirred bead milling, shear homogenization and probe ultrasonication. The nanofluid was characterized through measurement of viscosity, particle size distribution and thermal conductivity. The interactions between Fe2O3 nanoparticles and propylene glycol on the nanoparticle surfaces lead to reduction in viscosity, the magnitude of which increases with nanoparticle concentration (0-2 vol%) at room temperature. The thermal conductivity enhancement for 2 vol% nanofluid was about 21% at room temperature, with liquid layering being the major contributor for thermal conductivity enhancement.

Modeling and optimization of supercritical fluid extraction of anthocyanin and phenolic compounds from Syzygium cumini fruit pulp.

Supercritical carbon dioxide extraction (SC-CO2) of total anthocyanin and phenolic compounds from jamun fruits was investigated using three factors at three levels Box-Behnken response surface design. Experiments were conducted to evaluate the effects of three independent variables (pressure, temperature and co-solvent flow rate) on the maximum extraction yield of anthocyanin and phenolic compounds from jamun fruits. From the experimental data, second order polynomial mathematical models were developed with high coefficient of determination values (R (2) > 0.98). From response surface plots, pressure, temperature and co-solvent flow rate exhibited independent and interactive effects on the extraction yields. Pressure of 162 bar, extraction temperature at 50 °C and co-solvent flow rate of 2.0 g/min was identified as optimal conditions. Under these optimal conditions, the experimental value agreed well with the predicted values and indicates the suitability of developed models.

Metallic silver nanoparticle: a therapeutic agent in combination with antifungal drug against human fungal pathogen.

Silver nanoparticles (Ag-NPs) are known to have inhibitory and fungicidal effects. Resistance against fungal infection has emerged as a major health problem in recent years, which needs great and immediate concern. Here, we report the extracellular biological synthesis of silver nanoparticles through a simple green route approach using a marine mangrove (Rhizophora mucronata) and silver nitrate. Aqueous extract of marine mangrove helped in reduction and was used as capping agent in biological synthesis. Nanoparticles were characterized using microscopy and spectroscopy techniques such as HRTEM, UV-Vis absorption spectroscopy and FTIR spectroscopy. X-ray diffraction analysis showed that the nanoparticles had face centered cubic structure with crystalline nature. FTIR spectroscopy showed the presence of different functional groups, such as hydroxyl and carbonyl, involved in the synthesis of nanoparticles. The antifungal activity of fluconazole and itraconazole was enhanced against the tested pathogenic fungi in the presence of Ag-NP and confirmed from increase in fold area of inhibition. This environmentally friendly method of biological synthesis can be easily integrated for various medical applications.

The National List of Essential Medicines of India 2022 (NLEM 2022): Tommy, Toe the Line.

India recently released its fifth National List of Essential Medicines 2022 (NLEM 2022). A critical analysis of the list was performed and was compared with the WHO 22nd Model List of Essential Medicines published in 2021. The Standing National Committee, since its inception, have taken four years to finalise a list. The analysis identified that all the available formulations and strengths of the selected drugs are included in the list, which must be avoided. Furthermore, the antibacterial agents are not categorised as access, watch and reserve (AWaRe) and this list is not aligned with the national programs, standard treatment guidelines and nomenclature. There are a few factual errors and some typographic errors. These problems in the list need to be rectified immediately so that the document would be able to serve the community more effectively as a true model list.

Resource potential mapping of bifacial photovoltaic systems in India.

Bifacial photovoltaic is one of the technologies that can spearhead Indian ambitions to achieve the 7th United Nations Sustainable Development Goals and Nationally Determined Contributions of COP 26. But, like all emerging technology, the lack of awareness and unavailability of extensive data, like technology potential maps that could aid people in identifying the advantages of newer technologies, has led to sluggish growth in the Indian market. To expedite the growth of bifacial PV in the Indian market, optimized resource potential maps of bifacial PV were developed from an experimentally validated view factor-based bifacial PV model. The annual average bifacial gain was found to vary between 2.5% and 22% at various locations in India. The effect of ground albedo and height of installation was also studied. Furthermore, the annual and seasonal power out of bifacial PV was higher than monofacial PV at any location in India.

Comparison of Occlusal Digital Analysis Using T-Scan in Orthognathic Surgery with Only Conventional Orthodontic Patients.

Aim and Objectives: The aims of this study were to compare the changes in occlusal parameters, TMJ status clinically in patients after the completion of orthognathic surgery, and patients undergoing only orthodontic treatment and with patients having normal occlusion, using T-Scan. Methodology: This prospective controlled clinical trial, consisting of three groups with a sample size of twelve. Group 1 consisted of patients who underwent orthognathic surgery and orthodontic treatment. Group 2 consists of patients who underwent only orthodontic treatment (camouflage). Clinical examination of the patient (TMJ and Occlusal status) and T-Scan was performed at the time of debonding of the orthodontic brackets, 6 months and 1-year after first evaluation for group 1 and 2 patients. Results: The collected data between groups are compared and interpreted. The statistical analysis was performed using STATA/IC version 16.1 statistical software. Intragroup comparison for the study variables occlusion time, disocclusion time and maximum bite force between different time periods (T1, T2, T3) for all the three intervention groups using repeated measures. Hypothesis testing for maximum bite force, occlusion time and disocclusion time in orthognathic group (Group 1) as compared to orthodontic group (Group 2) for three different time periods using repeated measures ANOVA and Bonferroni test showed P value < 0.05 which is statistically significant. Conclusion: In conclusion, evaluation of occlusion using T-Scan give us an insight of the discrepancies in occlusion which is useful during pre-operative planning and especially in the post-operative follow-up period during the retention phase. Examination of TMJ in these patients at various intervals is necessary as any minor occlusal disturbances may lead to TMJ disorders.

Origin, transport and ecological risk assessment of illicit drugs in the environment - A review.

Illicit drugs are a novel group of emerging pollutants. A growing global environmental load and ecological risk is created by the ongoing release of these toxins into the environment. Conventional water processing plants fail to completely remove drugs of abuse from both surface water and wastewater. The origin, environmental fate and ecological repercussions of illicit drugs, despite their detection in surface waterways around the world, are not well understood. In this review, illicit drug detections in potable water, surface water and wastewater globally have been studied during the past 15 years in order to establish a baseline for future years. The most common drugs with abuse potential detected in different sources of potable and surface water were methadone (0.12-22.7 ng/L), cocaine (0.05-506.6 ng/L), benzoylecgonine (0.07-1019 ng/L), amphetamine (1.4-342.6 ng/L), and codeine (0.002-42 ng/L). The bulk of research only looked at a small number of drugs of abuse, indicating that despite widespread use, a large spectrum of these intoxicants has yet to be detected. This review focuses on the origin of illicit drug contaminants in water bodies, air, and soil, their persistence in the environment, and the typical concentrations at which they occur in the environment. The impact of these drugs on aquatic organisms like Elliptio complanata mussels, crayfish and zebrafish has also been reviewed.

Advanced technologies for the determination of quantitative structure-activity relationships and degradation efficiency of micropollutants and their removal in water - A review.

The growing concentrations of micropollutants in aquatic ecosystems are a global water quality issue. Understanding micropollutants varied chemical composition and potency is essential to solving this complex issue. Micropollutants management requires identifying contaminants to reduce, optimal reduction targets, and the best wastewater recycling locations. Management requires appropriate technological measures. Pharmaceuticals, antibiotics, hormones, and other micropollutants can enter the aquatic environment from point and diffuse sources, with wastewater treatment plants (WWTPs) distributing them in urban areas. Micropollutants like pharmaceuticals and hormones may not be removed by conventional WWTPs. Micropollutants affect the EU, especially in densely populated areas where surface water is consumed. This review examines several technological options that can be integrated into existing treatment methods to address this issue. In this work, oxidation, activated carbon, and their combinations as potential solutions, considering their efficacy and cost were evaluated. This study illuminates micropollutants origin and physico-chemical properties, which affect distribution, persistence, and environmental impacts. Understanding these factors helps us develop targeted micropollutant mitigation strategies to protect water quality. This review can inform policy and decision-making to reduce micropollutant impacts on aquatic ecosystems and human health.

Carbon-based nanomaterial intervention and efficient removal of various contaminants from effluents - A review.

Water treatment is a worldwide issue. This review aims to present current problems and future challenges in water treatments with the existing methodologies. Carbon nanotube production, characterization, and prospective uses have been the subject of considerable and rigorous research around the world. They have a large number of technical uses because of their distinct physical characteristics. Various catalyst materials are used to make carbon nanotubes. This review's primary focus is on integrated and single-treatment technologies for all kinds of drinking water resources, including ground and surface water. Inorganic non-metallic matter, heavy metals, natural organic matter, endocrine-disrupting chemicals, disinfection by-products and microbiological pollutants are among the contaminants that these treatment systems can remediate in polluted drinking water resources. Significant advances in the antibacterial and adsorption capabilities of carbon-based nanomaterials have opened up new options for excluding organic/inorganic and biological contaminants from drinking water in recent years. The advancements in multifunctional nanocomposites synthesis pave the possibility for their use in enhanced wastewater purification system design. The adsorptive and antibacterial characteristics of six main kinds of carbon nanomaterials are single-walled carbon nanotubes, multi-walled carbon nanotubes, graphene, graphene oxide, fullerene and single-walled carbon nanohorns. This review potentially addressed the essential metallic and polymeric nanocomposites, are described and compared. Barriers to use these nanoparticles in long-term water treatment are also discussed.

Advanced biofuel production, policy and technological implementation of nano-additives for sustainable environmental management - A critical review.

This review article critically evaluates the significance of adopting advanced biofuel production techniques that employ lignocellulosic materials, waste biomass, and cutting-edge technology, to achieve sustainable environmental stewardship. Through the analysis of conducted research and development initiatives, the study highlights the potential of these techniques in addressing the challenges of feedstock supply and environmental impact and implementation policies that have historically plagued the conventional biofuel industry. The integration of state-of-the-art technologies, such as nanotechnology, pre-treatments and enzymatic processes, has shown considerable promise in enhancing the productivity, quality, and environmental performance of biofuel production. These developments have improved conversion methods, feedstock efficiency, and reduced environmental impacts. They aid in creating a greener and sustainable future by encouraging the adoption of sustainable feedstocks, mitigating greenhouse gas emissions, and accelerating the shift to cleaner energy sources. To realize the full potential of these techniques, continued collaboration between academia, industry representatives, and policymakers remains essential.

National list of essential medicines of India: the way forward.

Essential medicines lists have been shown to improve the quality and cost-effectiveness of health care delivery when combined with proper procurement policies and good prescribing practices. The Ministry of Health, Government of India revised the National List of Essential Medicines of India (NLEMI 2011) in June 2011, eight years after the last revision. The NLEMI 2011 contains 348 medicines and was prepared over one and a half years by 87 experts. Though there are some positive aspects to the list such as the documentation of a detailed description of the revision process, inclusion of many experts from various fields in the review committee, well written description of the essential medicines concept and others, a critical review of the list reveals areas of major and minor concerns. Improper medicine selection like the inclusion of a nearly obsolete medicine such as ether, an anesthetic agent; non-inclusion of pediatric formulations; spelling errors; and errors in the strengths of formulations diminishes the significance of the NLEMI 2011. In its present form, the NLEMI 2011 did not align with the Indian Pharmacopoeia, and the National Health Programs as well as the National Formulary of India 2010. Formatting errors, non-inclusion of an index page, syntax and spelling errors may also undermine the usefulness of the NLEMI 2011 as a reference material. An urgent revision of the NLEMI 2011 is suggested so as to avert misinforming the wider international and local readers.

Endoscopic transsphenoidal excision of a GH-PRL-secreting pituitary macroadenoma in a patient with McCune-Albright syndrome.

We describe an endoscopic transsphenoidal excision of a GH-PRL-secreting pituitary adenoma and remodeling of frontotemporal fibrous dysplasia in a patient with McCune-Albright syndrome. Sphenoid dysplasia rendered transsphenoidal surgery challenging, but a study of the radiological anatomy and good surgical planning made this feasible. Medical therapy and radiation was required for persistent acromegaly after surgery.

Transesophageal echocardiography and intraoperative phlebotomy during surgical repair of coarctation of aorta in a patient with atrial septal defect, moderately severe mitral regurgitation and severe pulmonary hypertension.

Acute left ventricular (LV) or right ventricular (RV) dysfunction during repair of coarctation of aorta (CoA) is rare. Well-developed collateral circulation between branches of both the subclavian arteries (SCAs) and upper descending thoracic aorta decompress LV and prevents acute rise in afterload. An adult patient presented for CoA repair. On chest X-ray, rib notching was not seen. Magnetic Resonance Imaging showed about 7 mm long CoA distal to the origin of left common carotid artery. Reconstruction images of distal arch and descending thoracic aorta showed origin of both the SCAs from CoA segment. Transthoracic echocardiography showed 1.3 cm atrial septal defect (ASD), left to right shunt, moderately severe mitral regurgitation (MR), dilated RV, and severe pulmonary artery hypertension (PH). During cardiac catheterization, the peak gradient across CoA was 60 mmHg. On aortic-root angiography, both the common carotids and the distal arch opacified simultaneously, the CoA segment and the distal aorta opacified a little later. Both the SCAs were filling retrograde. A unique anatomy in which aortic-clamping proximal to CoA and both the SCAs would increase flow to spinal-cord as clamping of the SCAs will stop stealing of blood into the CoA but potentially increase LV afterload, MR, left to right shunt across ASD and RV volume and pressure load depending on the magnitude of flow across the CoA. The increases in LV afterload, MR, and RV afterload and volume overload were managed by controlled phlebotomy and fine-tuned by manipulating inhaled isoflurane concentration whereas the Transesophageal echocardiography (TEE) monitored and guided the management.

Enhanced biogas production from food waste and activated sludge using advanced techniques - A review.

Biogas generation using food waste anaerobic co-digestion with activated sludge provides a cleaner addressable system, an excellent solution to global challenges, the increasing energy demands, fuel charges, pollution and wastewater treatment. Regardless of the anaerobic digestate end product values, the technology lacks efficiency and process instability due to substrate irregularities. Process parameters and substrate composition, play a vital role in the efficiency and outcome of the system. Intrinsic biochar properties such as pore size, specific surface properties and cation exchange capacity make it an ideal additive that enriches microbial functions and enhances anaerobic digestion. The pretreatment and co-digestion of food waste and activated sludge are found to be significant for efficient biogas generation. The advantages, drawbacks, limitations, and technical improvements are covered extensively in the present review besides the recent advancement in the anaerobic digestion system.

Graphene oxide-based nanomaterials for the treatment of pollutants in the aquatic environment: Recent trends and perspectives - A review.

Graphene oxide can be used to store energy, as electrodes and purify industrial and domestic wastewater as photocatalysts and adsorbents because of its remarkable thermal, electrical, and chemical capabilities. Toward understanding graphene oxide (GO) based nanomaterials considering the background factors, the present review study investigated their characteristics, preparation methods, and characterization processes. The removal of contaminants from wastewater has recently been a focus of attention for materials based on GO. Progress in GO synthesis and surface modification has shown that they can be used to immobilize enzymes. It is possible to immobilize enzymes with varying characteristics on graphene-oxide-based substrates without sacrificing their functioning, thus developing a new environmental remediation platform utilizing nano biocatalysts. GO doping and co-doping with a variety of heterogeneous semiconductor-based metal oxides were included in a brief strategy for boosting GO efficiency. A high band-gap material was also explored as a possibility for immobilization, which shifts the absorption threshold to the visible range and increases photoactivity. For water treatment applications, graphene-based nanomaterials were used in Fenton reactions, photocatalysis, ozonation, photo electrocatalysis, photo-Fenton, and a combination of photon-Fenton and photocatalysis. Nanoparticles made from GO improved the efficiency of composite materials when used for their intended applications. As a result of the analysis, prospects and improvements are clear, especially when it comes to scaling up GO-based wastewater treatment technologies.

Advances in bioremediation of emerging contaminants from industrial wastewater by oxidoreductase enzymes.

The bioremediation of emerging recalcitrant pollutants in wastewater via enzyme biotechnology has been evolving as cost-effective with an input of low-energy technological approach. However, the enzyme based bioremediation technology is still not fully developed at a commercial level. The oxidoreductases being the domineering biocatalysts are promising candidates for wastewater treatments. Henceforth, comprehending their global market and biotransformation efficacy is mandatory for establishing these techno-economic bio-enzymes in commercial scale. The biocatalytic strategy can be established as a combinatorial approach with existing treatment technology to achieve towering bioremediation and effective removal of emerging pollutants from wastewater. This review provides a novel insight on the toxicological xenobiotics released from industries such as paper and pulps, soap and detergents, pharmaceuticals, textiles, pesticides, explosives and aptitude of peroxidases, nitroreductase and cellobiose dehydrogenase in their bio-based treatment. Moreover, the review comprehensively covers environmental relevance of wastewater pollution and the critical challenges based on remediation achieved through biocatalysts for future prospectives.

Recent advances in biogas production using Agro-Industrial Waste: A comprehensive review outlook of Techno-Economic analysis.

Agrowaste sources can be utilized to produce biogas by anaerobic digestion reaction. Fossil fuels have damaged the environment, while the biogas rectifies the issues related to the environment and climate change problems. Techno-economic analysis of biogas production is followed by nutrient recycling, reducing the greenhouse gas level, biorefinery purpose, and global warming effect. In addition, biogas production is mediated by different metabolic reactions, the usage of different microorganisms, purification process, upgrading process and removal of CO2 from the gas mixture techniques. This review focuses on pre-treatment, usage of waste, production methods and application besides summarizing recent advancements in biogas production. Economical, technical, environmental properties and factors affecting biogas production as well as the future perspective of bioenergy are highlighted in the review. Among all agro-industrial wastes, sugarcane straw produced 94% of the biogas. In the future, to overcome all the problems related to biogas production and modify the production process.