Nanogap-Rich Surface-Enhanced Raman Spectroscopy-Active Substrate Based on Double-Step Deposition and Annealing of the Au Film over the Back Side of Polished Si.

Surface-enhanced Raman spectroscopy (SERS) is a highly sensitive and rapid detection technique that is used for detection of various analytes in trace quantities. We present a sensitive, large-area, and nanogap-rich SERS-active substrate by altering a thin gold (Au) film on the unpolished side of a single-side polished silicon wafer by repeated thermal deposition and annealing in an argon environment. The repeated thermal deposition and annealing process was compared on both sides of a one-side-polished silicon wafer; however, the rear side (etched/unpolished side) demonstrated a more enhanced Raman signal owing to the larger effective area. The proposed substrate can be fabricated easily, having a high density of hotspots distributed uniformly all over the substrate. This ensures easy, rapid, and sensitive detection of analytes with a high degree of reproducibility, repeatability, and acceptable uniformity. The optimized substrate shows a high degree of stability with time when exposed to the ambient environment for a longer duration of 148 days. The reported substrate can detect up to 10-11 M concentrations of 2,4,6-trinitrotoluene (TNT) and 2,4-dinitrotoluene (DNT), with limits of detection (LODs) of 1.22 and 1.26 ng/L, respectively. This work not only presents the efficient and sensitive SERS-active substrate but also shows the advantages of using the rear side of a one-side-polished silicon substrate as a SERS-active chip.

Dental professionals' attitude and willingness to respond during disaster events: a cross-sectional study.

INTRODUCTION: In the present times, natural and man-made threats have questioned our existence on this planet. Health care professionals need to be aware of all the procedures to follow during such an event that threatens to paralyze the entire community and should be able to respond effectively. OBJECTIVE: The present study was conducted to assess the willingness and attitude of dental professionals to render help during any disaster or catastrophic event. MATERIAL AND METHODS: The present cross-sectional study among 480 subjects who were residing in Tricity (Chandigarh, Mohali and Panchkula). Informed consent was taken from all the subjects. Systematic random sampling methodology was employed for selection for study sample. The study utilized a self-designed close-ended questionnaire written in English and verified by experts. The questionnaire was divided into two parts to collect the required information. The data was analyzed using SPSS software version 21; chi-square test and multiple regression analysis were used to arrive at the results. RESULTS: More than 85% of subjects had awareness regarding natural and manmade disasters. A positive response was given by 79.2% of subjects regarding willingness to help during disaster. Educational qualification of subjects was significantly associated with attitude towards some aspects of disaster response (p<0.05). Postgraduate subjects and subjects who were academicians were more willing to render help (OR: 2.18 & 3.65 respectively). CONCLUSIONS: The study emphasizes the need for educational and training programs for dentists' regarding disaster management. A short course on emergency and disaster management can be included in undergraduate and postgraduate dental curriculum.

Identifying monkeypox: do dental professionals have adequate knowledge and awareness?

Background: The emergence of monkeypox has presented a new challenge for health agencies around the globe. There is significant increase in the number of cases that too in non-endemic countries with more than 18000 cases reported worldwide. Objective: The present study was conducted to assess knowledge and awareness regarding monkeypox among dental professionals. Materials and Method: The present cross-sectional study among 410 subjects who were residing in a northern state of the country. Informed consent was obtained from all the subjects. Study sample was selected on the basis of Systematic random sampling methodology. A self-designed close-ended questionnaire written in English and verified by experts was utilized for the study. The questionnaire was delivered personally to study subjects to collect the required information. Chi-square test and ANOVA were used for statistical analysis. Results: One-fourth (24.8%) of the subjects never heard about monkeypox disease. Negative response was given by 44.8% of subjects regarding resemblance of monkeypox with small pox. Only 31.2% of subjects had knowledge regarding oral manifestations of the disease. High knowledge scores were reported by only 28% of subjects. Higher knowledge levels were significantly related to education level and working profile of study subjects. Online media (Internet) was preferred as the main source to obtain more information by 42.2 of subjects. Conclusion: There was low level of knowledge regarding monkeypox among study subjects. There is an urgent need for dental professionals to keep themselves updated with recent knowledge on new emerging infectious diseases.

Pheochromocytoma with an unusual presentation.

Pheochromocytoma, is a rare neuroendocrine tumor, which usually presents as hypertension. We report a young male patient, who presented with intracerebral hemorrhage and intractable hypertension. On further evaluation, for uncontrolled secondary hypertension, he was diagnosed to have right adrenal pheochromocytoma. After hemodynamic stabilization, laparoscopic adrenelectomy was performed. Pheochromocytoma crisis presenting as intracerebral hemorrhage and cardiomyopathy is an uncommon phenomena. Even though it is a crisis, it is not a surgical emergency. Proper preoperative hemodynamic stabilization is essential before surgery is performed. An experienced anesthetist, to manage intraoperative fallacies, is warranted. Postoperatively, they must be on lifelong follow-up to watch for recurrence.

Structural Modifications and Strategies for Native Starch for Applications in Advanced Drug Delivery.

Pharmaceutical excipients are compounds or substances other than API which are added to a dosage form, these excipients basically act as carriers, binders, bulk forming agents, colorants, and flavouring agents, and few excipients are even used to enhance the activity of active pharmaceutical ingredient (API) and various more properties. However, despite of these properties, there are problems with the synthetic excipients such as the possibility of causing toxicity, inflammation, autoimmune responses, lack of intrinsic bioactivity and biocompatibility, expensive procedures for synthesis, and water solubility. However, starch as an excipient can overcome all these problems in one go. It is inexpensive, there is no toxicity or immune response, and it is biocompatible in nature. It is very less used as an excipient because of its high digestibility and swelling index, high glycemic index, paste clarity, film-forming property, crystalline properties, etc. All these properties of starch can be altered by a few modification processes such as physical modification, genetic modification, and chemical modification, which can be used to reduce its digestibility and glycemic index of starch, improve its film-forming properties, and increase its paste clarity. Changes in some of the molecular bonds which improve its properties such as binding, crystalline structure, and retrogradation make starch perfect to be used as a pharmaceutical excipient. This research work provides the structural modifications of native starch which can be applicable in advanced drug delivery. The major contributions of the paper are advances in the modification of native starch molecules such as physically, chemically, enzymatically, and genetically traditional crop modification to yield a novel molecule with significant potential for use in the pharmaceutical industry for targeted drug delivery systems.

Omicron sub-variants: is the world going to witness another wave?

Omicron, the new 'Variant of Concern' of SARS-CoV-2, is rapidly evolving into new sub-variants or sub-lineages (BA.1, BA.2 etc.). These sub-variants have higher transmissibility, decreased vaccine effectiveness and increased risk of reinfection. As a result, many nations across the globe are reporting surge in infections which is a matter of concern. Understanding Omicron and its sub-variants is vital for development of public health policy and preventing disease transmission. The present paper throws a spotlight on the newly detected sub-variants of Omicron as reported in ongoing researches which are available only in pre-print form and also the importance of a booster dose of the vaccine. Information regarding recent research on a new nasal vaccine formulation, which may be effective against the new variants, is also highlighted in the paper.

Identification of Potent Bioassay Guided Terpenoid and Glycoside Root Fractions of Astragalus candolleanus against Clinically Significant Bacterial Strains.

Antibiotic resistance represents one of the biggest challenges, and there is an urgent need for plant-based antimicrobial agents that enable managing this crisis effectively. In this work, we aimed to investigate the antibacterial activity of Astragalus candolleanus (A. candolleanus) hydromethanolic root extract against Gram-positive (Bacillus subtilis and Staphylococcus aureus) and Gram-negative (Escherichia coli, Salmonella typhimurium, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Kocuria rhizophila) strains by the cup-plate method. The root was powdered and extracted with 70% methanol by cold maceration for 5 days. Preliminary phytochemical screening was performed with different solvents in the order of increasing polarity. Pure compounds were isolated by column chromatography and were characterized through liquid chromatography-mass spectrometry. Targeted predictions of the isolated compounds were also studied using Swiss Target prediction software and prediction of activity spectra for substances. The extract showed a broad zone of inhibition against pathogenic bacteria. Four pure compounds were isolated, of which a novel terpenoid compound has been identified as stemmadenine along with scillirosidin, cephalotaxine, and myxoxanthophyll. The structures of the isolated phytoconstituents were elucidated by spectral analysis. The four pure components isolated from the roots of A. candolleanus are suggested to be effective against tested pathogens. Overall results of drug design suggest that myxoxanthophyll is a promising bioactive compound endowed with antibacterial activity.

Covid-19 update: Omicron variant - a new emerging threat.

A new health threat in the form of a new variant of Covid-19 called Omicron has emerged globally in this holiday season. This new variant has been declared a variant of concern (VOC) by the World Health Organization and experts are expecting another wave of the pandemic. A lot still unknown about this variant and researchers worldwide are conducting studies to find the nature and characteristics of this mutated strain. Cases have begun to rise dramatically around the world and many countries have already imposed travel restrictions again to prevent disease transmission. It is being speculated that this particular variant has got tendency of immune escape and therefore can even infect fully vaccinated individuals. Vaccination and adhering to Covid-19 guidelines and protocols can curtail the spread of the virus. The present paper focuses on what is currently known about this variant, antigen diagnostic tests, importance of getting fully vaccinated and having booster dose etc. If we want to emerge from this pandemic, countries should practice vaccine equality and solidarity for the good of mankind.

Presence of birth companion-a deterrent to disrespectful behaviours towards women during delivery: an exploratory mixed-method study in 18 public hospitals of India.

Birthing women require support, particularly emotional support, during the process of labour and delivery. Traditionally, across cultures, this support was made available by the continuous presence of a companion during labour, childbirth and the immediate post-partum period. However, this practice is not universal, especially in health facilities in low- and middle-income countries. This cross-sectional study was conducted in 18 tertiary health care facilities of India using a mixed-method approach. The quantitative data were collected to document the number of birthing women, birth companions and healthcare providers in the labour rooms, and the typology of disrespect and abuse (D&A) faced by women. This was followed by in-depth interviews with 55 providers to understand their perspective on the various dimensions of D&A and the challenges they face to provide respectful care. This article explores the status of birth companionship in India and its plausible associations with D&A faced by birthing women in public facilities. Our study reveals that birth companionship is still not a common practice in Indian public hospitals. Birth companions were present during less than half of the observational period, also less than half of the birthing women were accompanied by a birth companion. Lack of hospital policy, space constraints, overcrowding and privacy concerns for other patients were cited as reasons for not allowing birth companions in the labour rooms, whose supportive roles, both for women and providers, were otherwise widely acknowledged during the qualitative interviews. Also, the presence of birth companions was found to be critically negatively associated with occurrences of D&A of birthing women. We contend that owing to the high pressure on the public hospitals in India, birth companions can be a low-cost intervention model for promoting respectful maternity care. However, adequate infrastructure is a critical aspect to be taken care of.

Timing of steroid initiation and response rates to immune checkpoint inhibitors in metastatic cancer.

BACKGROUND: Corticosteroids (CS) are the mainstay of immune-related adverse effect (irAE) management, as well as for other indications in cancer treatment. Previous studies evaluating whether CS affect immune checkpoint inhibitor (CPI) efficacy compared patients receiving CS versus no CS. However, there is a paucity of clinical data evaluating the timing of concomitant CS and CPI efficacy. METHODS: We retrospectively collected data from patients who received CS during CPI treatment at a single institution. Patients were in two cohorts based on timing of initiation of CS (≥2 months vs <2 months after initiating CPI). Patient characteristics, irAEs, cancer type, treatment type, treatment response/progression per RECIST V.1.1, and survival data were collected. Kaplan-Meier and Cox proportional hazard regression methods estimated HRs for the primary endpoint of progression-free survival (PFS) along with overall survival (OS). RESULTS: We identified 247 patients with metastatic cancer who received CS concurrently with CPIs. The median time on CS was 1.8 months. After adjusting for treatment type, tumor type, brain metastases, and irAEs, those treated with CS ≥2 months after starting CPI had a statistically significant longer PFS (HR=0.30, p<0.001), and OS (HR 0.34, p<0.0001) than those who received CS <2 months after starting CPI. Objective response rate (ORR) for patients on CS ≥2 months was 39.8%, versus ORR for patients <2 months was 14.7% (p value =<0.001) CONCLUSION: Our results suggest that early use of CS during CPI treatment significantly hinders CPI efficacy. This data needs to be validated prospectively. Future studies should focus on the immune mechanisms by which CSs affect T-cell function early in the CPI treatment course.

Barriers to optimal and appropriate use of uterotonics during active labour and for prevention of postpartum haemorrhage in public health care facilities: An exploratory study in five states of India.

OBJECTIVE: The main objective is to understand the practices regarding use of uterotonics during active labour and for prevention of postpartum haemorrhage and the barriers for its optimal and appropriate use at different levels of health facilities in five states of India. STUDY DESIGN: Mixed methods approach comprising of cross-sectional observational study of existing practices of uterotonics use during labour and early postpartum period for 1479 vaginal deliveries at 56 facilities. Quantitative data was collected using pre-tested proformas filled by on-site observers and qualitative data was collected by in-depth interviews of 125 maternity care providers of the observed facilities. MAIN OUTCOME MEASURE: Providers' knowledge, attitude and patterns of use of uterotonics during active labour and for prevention of postpartum haemorrhage during childbirth. RESULTS: On-site observation and interviews indicated inappropriate choice of uterotonics administered in varied doses for labour management across facilities. Unnecessary augmentation of labour was observed in 44.7% low-risk pregnancies and only 31% women were administered uterotonics in optimal doses for preventing postpartum haemorrhage. Only 46.4% providers in the observed facilities reported to have received maternal and child healthcare training according to the updated guidelines. Lack of supportive supervision for mandated practices among peers emerged as an important barrier for appropriate uterotonics usage in labour. CONCLUSION: There is an urgent scope of standardizing the institutional health policies regarding administration of uterotonics during labour and for prevention of postpartum haemorrhage. Capacity building of maternity care providers regarding appropriate uterotonics usage is recommended for all levels of health facilities.

Dual-channel ratiometric recognition of Al3+ and F- ions through an ESIPT-ESICT signalling mechanism.

An optical probe 1 has been synthesized comprising naphthalimide unit conjugated with Schiff base, exhibiting excited state intramolecular proton transfer and intramolecular charge transfer as a potential sensor for Al3+ and F- ions using standard spectroscopic techniques. The probe 1 exhibited local and charge-transfer excitation at 340 nm and 460 nm, respectively. On excitation at 460 nm, probe 1 displayed two emission bands at 510 nm and 610 nm, accompanied by Stokes' shift of 50 nm and 150 nm, respectively. The solvatochromic effect and theoretical calculation depicted that the representative emissions resulted from the ESICT/ESIPT phenomenon. Upon addition of Al3+ ions, the charge transfer excitation at 460 nm was enhanced ratiometrically to local excitation at 340 nm and showed a color change from orange to yellow. Similarily, probe 1.Al3+ displayed emission enhancement at 540 nm in H2O/CH3CN (1:9; v/v) and showed a color change from yellow to blue-green emission. Following the detection of Al3+ ions, hydrolysis of probe 1 to its reacting precursors was observed. The detection of Al3+ ions was also demonstrated in surfactant-containing water. The limit of detection (LOD) of probe 1 (H2O/CH3CN (1:9; v/v)) towards Al3+ ions was measured to be 3.2 × 10-8 M. The probe 1 displayed a ratiometric absorption response towards F- ions with a new peak at 570 nm and showed a color change from orange to purple. The probe 1.F- displayed a decrease in emission at 635 nm. The LOD of probe 1 (CH3CN) towards F- ions was measured to be 7.5 × 10-7 M.

Patient safety in primary and outpatient health care.

Primary care services provide an entry point into the health system which directly impact's people well-being and their use of other health care resources. Patient safety has been recognised as an issue of global importance for the past 10 years. Unsafe primary and ambulatory care results in greater morbidity, higher healthcare usage and economic costs. According to data from World Health Organization (WHO), the risk of a patient dying from preventable medical accident while receiving health care is 1 in 300, which is much higher than risk of dying while travelling in an airplane. Unsafe medication practices and inaccurate and delayed diagnosis are the most common causes of patient harm which affects millions of patients globally. However, majority of the work has been focussed on hospital care and there is very less understanding of what can be done to improve patient safety in primary care. Provision of safe primary care is priority as every day millions of people use primary care services across the world. The present paper focuses on various aspects of patient safety, especially in the primary care settings and also provides some potential solutions in order to reduce patient harm as much as possible. Some important challenges regarding patient safety in India are also highlighted.

Socioeconomic inequality in functional deficiencies and chronic diseases among older Indian adults: a sex-stratified cross-sectional decomposition analysis.

OBJECTIVES: Older adults with adverse socioeconomic conditions suffer disproportionately from a poor quality of life. Stratified by sex, income-related inequalities have been decomposed for functional deficiencies and chronic diseases among older adults, and the degree to which social and demographic factors contribute to these inequalities was identified in this study. DESIGN: Cross-sectional study. PARTICIPANTS: Data used for this study were retrieved from the WHO Study on Global AGEing and Adult Health Wave 1. A total of 3753 individuals (men: 1979, and women: 1774) aged ≥60 years were found eligible for the analysis. MEASURES: Instrumental Activity of Daily Living (IADL) deficiency and presence of chronic diseases. METHOD: The decomposition method proposed by Adam Wagstaff and his colleagues was used. The method allows estimating how determinants of health contribute proportionally to inequality in a health variable. RESULTS: Compared with men, women were disproportionately affected by both functional deficiencies and chronic diseases. The relative contribution of sociodemographic factors to IADL deficiency was highest among those with poor economic status (38.5%), followed by those who were illiterate (22.5%), which collated to 61% of the total explained inequalities. Similarly, for chronic diseases, about 93% of the relative contribution was shared by those with poor economic status (42.3%), rural residence (30.5%) and illiteracy (20.3%). Significant difference in predictors was evident between men and women in IADL deficiency and chronic illness. CONCLUSION: Pro-poor intervention strategies could be designed to address functional deficiencies and chronic diseases, with special attention to women.

Labour & delivery monitoring patterns in facility births across five districts of India: A cross-sectional observational study.

BACKGROUND & OBJECTIVES: India has recorded a marked increase in facility births due to government's conditional cash benefit scheme initiated in 2005. However, concerns have been raised regarding the need for improvement in the quality of care at facilities. Here we report the monitoring patterns during labour and delivery documented by direct observation in reference to the government's evidence-based guidelines on skilled birth attendance in five districts of India. METHODS: A cross-sectional study design with multistage sampling was used for observation of labour and delivery processes of low-risk women with singleton pregnancy in five districts of the country. Trained research staff recorded the findings on pre-tested case record sheets. RESULTS: A total of 1479 women were observed during active first stage of labour and delivery in 55 facilities. The overall frequency of monitoring of temperature, pulse and blood pressure was low at all facilities. The frequency of monitoring uterine contractions and foetal heart sounds was less than the expected norm, while the frequency of vaginal examinations was high at all levels of facilities. Partograph plotting was done in only 15.8 per cent deliveries, and labour was augmented in about half of the cases. INTERPRETATION & CONCLUSIONS: The findings of our study point towards a need for improvement in monitoring of maternal and foetal parameters during labour and delivery in facility births and to improve adherence to government guidelines for skilled birth attendance.

Primarycare teams and recent experiments towards population coverage in India.

Many people in India, especially the poor, face the hurdle of seeking effective health care at an affordable cost, at a distance they can travel, and with the dignity they deserve. According to reports from across the world, it is evident that countries having a strong primary health care system, have better health outcomes, lower inequalities, and lower costs of care. Primary care requires a team of health professionals, workers, and volunteers having a judicious skill mix. Some initiatives have been taken by the government in states like Kerala, Assam, Chhattisgarh, etc., to strengthen the primary health care infrastructure and provide primary care as close to their homes as possible. Staff deficiencies were addressed and training was also provided to the untrained staff. The current review focuses on several other primary care organizations that are working in different parts of the country (rural and urban), for e.g. Healthspring, MeraDoctor, Swasth India, Rashtriya Swasthya Bima Yojna (RSBY) Outpatient Pilot Program, etc. The current review also throws spot light on the type of primary health care system existing in countries like China, South Africa and Brazil. Some lacunae in service delivery are also identified and addressed so that changes can be incorporated at the policy and program level.

Investigation of rotameric conformations of substituted imidazo-[1,2-a]pyrazine: experimental and theoretical approaches.

The different rotameric conformations of imidazo-[1,2-a]pyrazine have been synthesized and characterized by means of different experimental techniques, such as NMR, FTIR, and absorption spectroscopy and quantum chemical calculations. The different conformations were stabilized by hydrogen bonds, such as OH⋯N, ArH⋯N and ArH⋯ArH. The ground state optimizations and potential energy surface (PES) scanning profiles produced using density functional theory (DFT) show two stable rotameric forms for each molecule. The relative population of the conformations is affected by the strength of the hydrogen bonds. The calculated absorption spectra and isotopic shielding constants were acquired by time-dependent density functional theory (TD-DFT) and gauge invariant atomic orbitals (GIAO)-DFT, respectively. The strength of the hydrogen bonding interactions that resulted in the different conformations was studied by quantum theory of atoms in molecules (QTAIM).

An Increase Incidence in Uric Acid Nephrolithiasis: Changing Patterns.

INTRODUCTION: Nephrolithiasis is a complex disease affecting all age groups globally. As the causative factors for nephrolithiasis rises significantly, its incidence, prevalence and recurrence continues to baffle clinicians and patients. AIM: To study the prevalence of different types of renal stones extracted by Percutaneous Nephrolithotomy (PCNL) and open surgical procedures. MATERIALS AND METHODS: Renal stones from 50 patients were retrieved by Percutaneous Nephrolithotomy (PCNL), Ureterorenoscopy (URS) and open surgical techniques for qualitative tests for detection of calcium, oxalate, uric acid, phosphate, ammonium ion, carbonate, cystine and xanthine. RESULTS: Three patients had stone removed by open surgery and rest had undergone PCNL. Nine of the stones were pure of calcium oxalate, 9 were of pure uric acid and 32 were mixed stones. Forty one stones had calcium. Among the mixed stones, oxalate was present in 25 samples (39 of total), uric acid was seen in 17 (25 of total stones), phosphate was present in 23 (23 of total) and carbonate was present in 4 stones (4 of total). Only 1 patient had triple phosphate stone. 12 were of staghorn appearance of which 6 were of struvite type, 6 were pure uric acid and remaining were mixed oxalate-phosphate stones. CONCLUSION: Our study, though in a small number of hospital based patients, found much higher prevalence of uric acid stones and mixed stones than reported by previous hospital based studies in north India (oxalate stones~90%, uric acid~1% and mixed stones~3%). Biochemical analysis of renal stones is warranted in all cases.

Clinical and radiographic comparison of various medicaments used for pulpotomy in primary molars: A randomized clinical trial.

OBJECTIVE: To evaluate and compare the efficacy of ferric sulfate, glutaraldehyde, and mineral trioxide aggregate (MTA) as pulpotomy medicaments in primary molars. MATERIALS AND METHODS: This was a perspective randomized clinical trial. A total of 90 molars from 42 children aged 4-8 years were selected for pulpotomy procedure. Teeth were randomly divided into three equal groups of 30 teeth each. Teeth in Group I were intended to be treated with ferric sulfate, Group II were intended to be treated with buffered glutaraldehyde and Group III with MTA. All the molars were evaluated clinically at 24 h and both clinically and radio graphically at 1, 3, and 6 months. The observations were statistically analyzed using Chi-square test and Fisher's exact test. RESULTS: After 1 month, there was no clinical finding observed in all the three groups. At 3 months postoperative evaluation, 13.3% of teeth in Group I and 12.5% of teeth in Group II had mobility. At 6 months interval, pain and sinus formation each was noted in 9.1% of primary teeth in Group I while periodontal ligament widening was reported in 66.7% of teeth in Group I and 85.7% of teeth in Group II. CONCLUSION: MTA exhibited overall best results as pulpotomy agent for primary molars followed by 15.5% ferric sulfate, whereas 2% buffered glutaraldehyde was found to be least effective as a pulpotomy agent.

Imidazo[1,2-a]pyridines: Promising Drug Candidate for Antitumor Therapy.

Imidazo[1,2-a]pyridine has been shown to be an important biologically active moiety. This review is a compilation of the scattered output of results of the anticancer activities of the imidazo[1,2-a]pyridine system since 2001, which have been classified as inhibition of CDK, VEGFR, PI3K, EGFR, RGGT etc. along with inhibition against different tumor cell lines. Various imidazo[1,2-a]pyridine based analogues have been used as lead molecules and are now under human clinical trials. This review will help the wider scientific community in the area of drug discovery of imidazo[1,2-a]pyridines as novel anticancer agents.