Borderline tumours of ovary and fertility preservation-Outcomes from a tertiary care center in India.

OBJECTIVE: Borderline ovarian tumors (BOT) are characterized by atypical epithelial proliferation without stromal invasion and majority are diagnosed in women of reproductive age group desirous of fertility preservation. METHODS: A retrospective review of medical records of patients diagnosed with BOT and on regular follow up at the All India Institute of Medical Sciences New Delhi, during a nine-year study period from March 2014 to March 2023 was performed. Surgical treatment was classified as radical or fertility sparing surgery (FSS). Surgical staging was defined as complete, partial or un-staged. RESULTS: Median age of 91 women was 34 years. Follow up period ranged from 4 to 222 months (median 77 months). Among 68 premenopausal women, 31 (46 %) underwent radical surgery and FSS in 37 (54 %) cases. Median time to conception in 29 women with future fertility wishes was 13 months (range, 4 to38 m). Seven of 29 cases (29 %) required ovulation induction. The pregnancy rate was 82.7 % and live birth rate was 80 %. Eight cases (8.7 %) had a recurrence (7- un-staged, 1- partially staged) and median time to recur was 36 months. There was no significant difference in recurrence between cystectomy/oophorectomy. Ovary was the site of recurrence in all surgically salvaged cases except peritoneal cavity in 1 case with mortality. Relapse free survival at 5 and 10 years in FSS and radical surgery group were similar. CONCLUSION: FSS is a safe procedure and should be considered in young patients desirous of future fertility along with a comprehensive peritoneal staging. Reproductive outcomes are excellent.

Quest for a Desolvated Structure Unveils Breathing Phenomena in a MOF Leading to Greener Catalysis in a Solventless Setup: Insights from Combined Experimental and Computational Studies.

The crystal structure of the metal-organic framework (MOF), {Mn2(1,4-bdc)2(DMF)2}n (1) (1,4-bdcH2, 1,4-benzenedicarboxylic acid; DMF, N,N-dimethylformamide), is known for a long time; however, its desolvated structure, {Mn2(1,4-bdc)2}n (1'), is not yet known. The first-principles-based computational simulation was used to unveil the structure of 1' that shows the expansion in the framework, leading to pore opening after the removal of coordinated DMF molecules. We have used 1' that contains open metal sites (OMSs) in the structure in cyanosilylation and CO2 cycloaddition reactions and recorded complete conversions in a solventless setup. The pore opening in 1' allows the facile diffusion of small aldehyde molecules into the channels, leading to complete conversion. The reactions with larger aldehydes, 2-naphthaldehyde and 9-anthracenecarboxaldehyde, also show 99.9% conversions, which are the highest reported until date in solventless conditions. The in silico simulations illustrate that larger aldehydes interact with Mn(II) OMSs on the surfaces, enabling a closer interaction and facilitating complete conversions. The catalyst shows high recyclability, exhibiting 99.9% conversions in the successive reaction cycles with negligible change in the structure. Our investigations illustrate that the catalyst 1' is economical, efficient, and robust and allows reactions in a solventless greener setup, and therefore the catalysis with 1' can be regarded as "green catalysis".

Assessment of functional efficacy of sheep plasma protein hydrolysates and their utilization in mutton sausage.

The present study examines the bioactive potential of sheep plasma protein hydrolysates (SPPH) produced by in-vitro gastrointestinal digestion as antioxidants, antimicrobials, anti-obesity agents, and inhibitors of lipid oxidation in sausage to address the oxidative stability and shelf-life issues of mutton. The antioxidant and antimicrobial activities, indicate a positive relationship between the degree of hydrolysis and digestion duration. The study finds that SPPH has a potent inhibitory effect on pancreatic lipase and cholesterol esterase. It has higher oil holding capacity than sheep plasma protein, observed at one hour of hydrolysis time. SPPH exhibit an improved behavior in foaming properties along alkaline pH and digestion time while display lower emulsifying activity and stability with hydrolysis advancement. The SPPH act as a natural preservative in developing functional mutton sausage by inhibiting lipid-oxidation. This study showed that the recovery of SPPH can be a cost-effective and sustainable strategy for generating available ingredients for enhanced shelf-life of meat products.

Hyponatremia-induced worsening of trigeminal neuralgia- When the sodium plays the game.

A 78-year-old elderly male who was on treatment for trigeminal neuralgia and hypertension was brought to the emergency with altered sensorium. His vital parameters were within normal limits; however, the arterial blood gas analysis showed severe hyponatremia. He was admitted to the ward, where further workup was carried out and hyponatremia correction started. He had a sudden worsening in his facial pain before he landed in encephalopathy. His medications (oxcarbazepine and chlorthalidone) that could cause hyponatremia were stopped, and judicious correction of hyponatremia was done. His baseline investigations, including a chest roentgenogram and electrocardiogram, were normal. After he regained consciousness, it was noted that the facial pain had regressed significantly despite stopping his first-line drugs. This case of worsening trigeminal neuralgic pain due to hyponatremia responded well to judicious sodium correction.

Decoding the genetic symphony: Profiling protein-coding and long noncoding RNA expression in T-acute lymphoblastic leukemia for clinical insights.

T-acute lymphoblastic leukemia (T-ALL) is a heterogeneous malignancy characterized by the abnormal proliferation of immature T-cell precursors. Despite advances in immunophenotypic classification, understanding the molecular landscape and its impact on patient prognosis remains challenging. In this study, we conducted comprehensive RNA sequencing in a cohort of 35 patients with T-ALL to unravel the intricate transcriptomic profile. Subsequently, we validated the prognostic relevance of 23 targets, encompassing (i) protein-coding genes-BAALC, HHEX, MEF2C, FAT1, LYL1, LMO2, LYN, and TAL1; (ii) epigenetic modifiers-DOT1L, EP300, EML4, RAG1, EZH2, and KDM6A; and (iii) long noncoding RNAs (lncRNAs)-XIST, PCAT18, PCAT14, LINC00202, LINC00461, LINC00648, ST20, MEF2C-AS1, and MALAT1 in an independent cohort of 99 patients with T-ALL. Principal component analysis revealed distinct clusters aligning with immunophenotypic subtypes, providing insights into the molecular heterogeneity of T-ALL. The identified signature genes exhibited associations with clinicopathologic features. Survival analysis uncovered several independent predictors of patient outcomes. Higher expression of MEF2C, BAALC, HHEX, and LYL1 genes emerged as robust indicators of poor overall survival (OS), event-free survival (EFS), and relapse-free survival (RFS). Higher LMO2 expression was correlated with adverse EFS and RFS outcomes. Intriguingly, increased expression of lncRNA ST20 coupled with RAG1 demonstrated a favorable prognostic impact on OS, EFS, and RFS. Conclusively, several hitherto unreported associations of gene expression patterns with clinicopathologic features and prognosis were identified, which may help understand T-ALL's molecular pathogenesis and provide prognostic markers.

A Rare Case of Ectocervical Pregnancy and Its Successful Management: A Case Report and Review of the Literature.

Cervical pregnancy is a very rare form of ectopic pregnancy, which can be life-threatening due to the potential risk of massive haemorrhage. The most likely site of cervical implantation is within the endocervical canal. We report here an unusual and another possible site of cervical pregnancy on the surface of the ectocervix (portio). The patient presented with vaginal bleeding after a period of six weeks of amenorrhea and a positive urinary pregnancy test. Clinical examination was suggestive of a cervical mass on the surface of the portio, which was successfully managed by local excision and the application of haemostatic sutures. Histopathology of the mass was suggestive of trophoblasts amidst cervical epithelium and stroma, which was cytokeratin positive in immunohistochemical staining, confirming the diagnosis of cervical ectopic pregnancy on the portio. Postoperatively, the patient recovered well and beta-human chorionic gonadotropin (ßhCG) normalised within two weeks. Thus, the surface of the ectocervix is another possible site of cervical pregnancy, which can be successfully managed by total excision of the ectopic mass and local haemostatic measures.

Fusarium wilt pandemic: current understanding and molecular perspectives.

Plant diseases pose a severe threat to the food security of the global human population. One such disease is Fusarium wilt, which affects many plant species and causes up to 100% yield losses. Fusarium pathogen has high variability in its genetic constitution; therefore, it has evolved into different physiological races to infect different plant species spread across the different geographical regions of the world. The pathogen mainly affects plant roots, leading to colonizing and blocking vascular bundle cells, specifically xylem vessels. This blocking results in chlorosis, vascular discoloration, leaf wilting, shortening of plant, and, in severe cases, premature plant death. Due to the soil-borne nature of the wilt pathogen, neither agronomic nor plant protection measures effectively reduce the incidence of the disease. Therefore, the most cost-effective management strategy for Fusarium wilt is developing varieties resistant to a particular race of the fungus wilt prevalent in a given region. This strategy requires understanding the pathogen, its disease cycle, and epidemiology with climate-changing scenarios. Hence, in the review, we will discuss the pathogenic aspect and genetics of the Fusarium wilt, including molecular interventions for developing climate-smart wilt tolerant/resistant varieties of crops. Overall, this review will add to our knowledge for advancing the breeding of resistance against the wilt pandemic.

Cervical Cancer Screening Coverage at Tertiary Care Institutes Across India.

OBJECTIVES: The 70% screening coverage target proposed in the global cervical cancer elimination strategy is not achieved even at tertiary centres in India. A situational analysis was done to assess the currently existing facilities and barriers in tertiary care institutes. METHODS: This cross sectional multicentric study was conducted from August to September 2021 in six tertiary care institutes across India. Women aged 30-49 years attending outpatient services (OPD) were invited for cervical screening. Women and health care professionals (HCPs) were administered structured questionnaires to assess knowledge, attitude and practices regarding cervical cancer screening services. RESULTS: Out of 6709 eligible women who attended OPD, 1666 (24.8%; range:19-57%) received screening. Availability of screening kits was limited to 10-25 Pap/HPV tests per day. Visual inspection with acetic acid (VIA) and HPV testing were offered only at certain centres. Colposcopy and treatment facilities were optimal at all centres. Knowledge, attitude and practices were analysed for 1800 women: 45.7% had heard of cervical cancer, 78.0% did not know that it is preventable, 75.8% never heard about screening. Common symptoms correctly identified included postmenopausal bleeding (4.8%), postcoital bleeding (5.7%), intermenstrual bleeding (5.8%) and vaginal discharge (12.4%). Risk factors were identified by minority: poor menstrual hygiene (6.6%), oral contraceptive pill use (6.4%), multiparity (4.4%), and HPV infection (3.0%). Out of 21, mean total knowledge score (MTKS) was 2.07± 2.67. Out of 317 HCPs, 96.5% knew that cervical cancer is caused by HPV infection, is preceded by premalignant stage, and that it is preventable by screening and treatment (80.1%). Knowledge about screening modalities was present in 87.4% for cytology, 75.1% for VIA, 68.8% for HPV test. MTKS of HCPs was 20.88±6.61 out of 32. CONCLUSION: Even at tertiary centres, limited availability of HPV tests, reluctance to implement VIA and lack of awareness among women remain the major barriers.

Screening for Cervical Cancer in Pregnancy.

Cervical cancer remains a leading cause of cancer related morbidity and mortality in low/low-middle income countries. Lack of screening is the leading cause of cases being diagnosed in advanced stages and screening is still opportunistic in a majority of these countries. Hospital visits during pregnancy provides a window of opportunity to screen these susceptible women and reduce the burden of disease. Screening women during pregnancy is not practiced widely due to concerns of pregnancy loss, bleeding and a lack of clear information among patients as well as healthcare professionals.

Modeling and simulation of multifaceted properties of X2NaIO6 (X = Ca and Sr) double perovskite oxides for advanced technological applications.

CONTEXT: In this study, the authors have investigated the structural, optoelectronic, thermoelectric, and thermodynamic properties of Ca2NaIO6 and Sr2NaIO6 double perovskite oxides. Both materials exhibit semiconductor behavior with direct band gaps (Eg) of 0.353 eV and 0.263 eV, respectively. Optical parameters like absorption coefficient α(ω), reflectivity R(ω), dielectric constants, and refractive index have been calculated. The most notable absorption peaks are identified at 5.52 eV (equal to 108.33 × 104 cm-1) in the case of Ca2NaIO6 and at 11.16 eV (equivalent to 118.17 × 104 cm-1) for Sr2NaIO6. These findings suggest a promising outlook for applications in optoelectronics. Moreover, their commendably low thermal conductivity and a high figure of merit, particularly at low temperatures (100 K), indicate their effectiveness as thermoelectric materials. This analysis underscores that these materials hold potential as suitable candidates for n-type doping, making them well-suited for use in thermoelectric devices. Studying thermal properties, including thermal expansion, bulk modulus, acoustic Debye temperature, entropy, and heat capacity, contributes to understanding the materials' thermodynamic stability. The titled materials are dynamically stable. The analysis of these double perovskite materials highlights their potential across various technological applications due to their advantageous structural, electronic, optical, and transport properties, offering new possibilities in material science and technology development. METHODS: The study utilized the full potential linearized augmented plane wave (FP-LAPW) method in conjunction with density functional theory within the WIEN2k simulation code. This approach is widely recognized as one of the most dependable methods for evaluating the photovoltaic characteristics of semiconducting perovskites. The thermoelectric properties were ascertained using the rigid band approach and the constant scattering time approximation, both implemented in the BoltzTraP computational code.

Spatio-temporal evaluation of surface water quality of Tawi watershed in the Himalayan region of Jammu (J&K, UT) using algal pollution indices: a geospatial approach.

In the present work, an investigation was performed based on the genera and species stated in Palmer pollution index to show the extent of organic pollution in the surface water of the Tawi watershed in the Jammu province of the Union Territory of Jammu and Kashmir using algal pollution indices. Sampling was carried out for two seasons, pre-monsoon (PRM) and post-monsoon (POM), at 16 locations distributed over the entire Tawi watershed. The physico-chemical variables like water temperature, pH, electrical conductivity, TDS, total alkalinity, total hardness, DO, BOD, COD, nitrate, and phosphate were analyzed. The seasonal distribution of the pollution-tolerant algal genera and species was recorded and the algal pollution index for both genus (AGP index) and species (ASP index) was also calculated. The concentration of BOD, COD, and nitrate in the sampled river water was found to be higher during the PRM season as compared to the POM season. The lower stretch of the watershed (Jammu Sub-Watershed) falls in class IV-V as per the polluted river stretch priority ranking based on BOD levels as BOD levels are >3 mg/L in the downstream locations during both seasons. A total of 23 algal taxa belonging to 8 families, Chlorophyceae (4 algal genera), Cyanophyceae (2 algal genera), Bacillariophyceae (7 algal genera), Zygnematophyceae (3 algal genera), Trebouxiophyceae (2 algal genera), Ulvophyceae (1 algal genus), Mediophyceae (1 algal genus), and Euglenophyceae (3 algal genera), have been reported in the Tawi watershed. The results of the Palmer indices showed a lack of organic pollution in the upstream, varying pollution levels in the midstream, and partially high to very high organic pollution levels in the downstream of the watershed. Comparative temporal analysis of the distribution of pollution-tolerant algal genera and species showed more organic pollution during PRM. Navicula and Cymbella were found to be the most abundant genera in almost all the stations, whereas Ulothrix, Cocconeis, Anacystis, and Crucigenia were the least recorded genera in the entire watershed. The results will enhance the understanding of the health status of the watershed, and provide database for watershed vulnerability assessment for sustainability and watershed management with spatio-temporal improvement.

CBCT Evaluation of Lingual Foramen and its Anatomic Variations in Northeast Indian Population.

Background: The identification of nearby neurovascular structures is a vital part of dental implant treatment planning. Commonly two implants are placed in the mandibular inter foraminal region to support the overdenture. Placing dental implants in this region is considered relatively safe. The purpose of this study was to employ cone beam computed tomography (CBCT) on a representative sample of Northeast Indians to find out the location and distribution of lingual foramen in the anterior mandible. Study Design: A total of 104 CBCT scans were performed using the Cranex 3D CBCT system. Three Oral and Maxillofacial Radiologists agreed on a visibility grade for assessing the lingual foramen using a 3-point scale. The number and presence of foramina were noted. On cross-sectional pictures, the distance in millimeters between the crest of the alveolar ridge and the superior cortical margin of the foramen was determined. Furthermore, the analysis of the distribution of lingual foramina in terms of frequency and percentages was performed. Results: Scan results showed that the lingual foramen was clearly visible in 65.4% of cases, somewhat visible in 12.5% of scans, and not visible at all in 22.1% of cases. Half of the people in the study had two foramina, whereas 27.9 percent had one and 22.1 percent had none. The mean distance from the crest of the alveolar ridge was 10.84 mm in males whereas 9.91 mm in females. Conclusion: The Northeast Indian population exhibits an unusually high prevalence of lingual foramen in the anterior portion of the mandible. This research will aid in the precise pre-operative identification of the position and number of lingual foramina prior to surgical treatments involving the midline of the mandible.

Biocompatible Drug Delivery System Based on a MOF Platform for a Sustained and Controlled Release of the Poorly Soluble Drug Norfloxacin.

Norfloxacin (NFX), an important antibacterial fluoroquinolone, is a class IV drug according to the biopharmaceutics classification system (BCS) and has low solubility and permeability issues. Such poor physicochemical properties of drug molecules lead to poor delivery and are of serious concern to the pharmaceutical industry for clinical development. We present here a conceptually new approach to deliver NFX, by loading the drug molecule on the porous platform of a biocompatible metal-organic framework (MOF), MIL-100(Fe). The loading of the drug on the MOF leading to NFX@MIL-100(Fe) was characterized by Fourier transform infrared (FTIR), UV-visible spectroscopy, thermogravimetric analyses (TGA), and nitrogen adsorption studies. Controlled experiments resulted in the high loading of the drug molecule (∼20 wt %) along with the desired sustained release. We could further control the release of norfloxacin by coating drug-loaded MIL-100(Fe) with PEG, PEG{NFX@MIL-100(Fe)}. Both drug delivery systems (DDSs), NFX@MIL-100(Fe) and PEG{NFX@MIL-100(Fe)}, were tested for their biocompatibility through toxicity studies. The DDSs are biocompatible and show insignificant cytotoxicity, as revealed by cell viability studies through the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay.

Involvement of DPP3 in modulating oncological features and oxidative stress response in esophageal squamous cell carcinoma.

Resistance to therapy in esophageal squamous cell carcinoma (ESCC) is a critical clinical problem and identification of novel therapeutic targets is highly warranted. Dipeptidyl peptidase III (DPP3) is a zinc-dependent aminopeptidase and functions in the terminal stages of the protein turnover. Several studies have reported overexpression and oncogenic functions of DPP3 in numerous malignancies. The present study aimed to determine the expression pattern and functional role of DPP3 in ESCC. DPP3 expression was assessed in normal and tumor tissues using quantitative real-time (qRT)-PCR and corroborated with ESCC gene expression datasets from Gene Expression Omnibus (GEO) and The cancer genome atlas (TCGA). DPP3 stable knockdown was performed in ESCC cells by shRNA and its effect on cell proliferation, migration, cell cycle, apoptosis, and activation of nuclear factor erythroid 2-related factor 2 (NRF2) pathway was assessed. The results suggested that DPP3 is overexpressed in ESCC and its knockdown leads to reduced proliferation, increased apoptosis, and inhibited migration of ESCC cells. Additionally, DPP3 knockdown leads to down-regulation of the NRF2 pathway proteins, such as NRF2, G6PD, and NQO1 along with increased sensitivity toward oxidative stress-induced cell death and chemotherapy. Conclusively, these results demonstrate critical role of DPP3 in ESCC and DPP3/NRF2 axis may serve as an attractive therapeutic target against chemoresistance in this malignancy.

Prognostic relevance of surface expression of cytokine receptor-like factor 2 in pediatric B-lineage acute lymphoblastic leukemia.

Overexpression of cytokine receptor-like factor 2 (CRLF2) resulting from its genomic rearrangement is the most frequent genetic alteration found in Philadelphia chromosome-like (Ph-like) B-cell acute lymphoblastic leukemia (B-ALL), a high-risk leukemia. Detection of CRLF2 expression by multiparameter flow cytometry has been proposed as a screening tool for the identification of Ph-like B-ALL. However, the prognostic relevance of flow cytometric expression of CRLF2 in pediatric B-ALL is not very clear. Additionally, its association with common copy number alterations (CNA) has not been studied in detail. Hence, in this study, we prospectively evaluated the flow cytometric expression of CRLF2 in 256 pediatric B-ALL patients and determined its association with molecular features such as common CNAs detected using Multiplex ligation-dependent probe amplification and mutations in CRLF2, JAK2 and IL7RA genes. Further, its association with clinicopathological features including patient outcome was assessed. We found that 8.59% (22/256) pediatric B-ALL patients were CRLF2-positive at diagnosis. Among CNAs, CRLF2 positivity was associated with presence of PAX5 alteration (P=0.041). JAK2 and IL-7R mutations were found in 9% and 13.6% CRLF2-positive patients, respectively. IGH::CRLF2 or P2RY8::CRLF2 fusions were each found in 1/22 individuals. CRLF2-positive patients were found to have inferior overall (hazard ratio (HR) =4.39, P=0.006) and event free survival (HR=2.62, P=0.045), independent to other clinical features. Furthermore, concomitant CNA of IKZF1 in CRLF2 positive patients was associated with a greater hazard for poor overall and event free survival, compared to patients without these alterations or presence of any one of them. Our findings demonstrate that the surface CRLF2 expression in association with IKZF1 copy number alteration can be used to risk stratify pediatric B-ALL patients.

Progress in theoretical study of lead-free halide double perovskite Na2AgSbX6 (X = F, Cl, Br, and I) thermoelectric materials.

CONTEXT: Herein, we have studied progressively novel metal lead-free halide double perovskite renewable energy materials. Due to their potential use in electronic devices, researchers have investigated these materials with a lot of interest. From the electronic structure, we have found that these are the indirect band gap semiconductors within the range between 1.273 and 3.986 eV. Optical parameters such as dielectric constant, electrical conductivity, and absorption coefficient have also been investigated, which have shown that these materials have potential use in photovoltaics. We have checked stability issues by thermodynamic parameters and phonon spectra. We have found them thermally stable; however, the phonon spectra show their dynamical instability and except for Na2AgSbF6 and Na2AgSbI6, the remaining compounds are weak in mechanical stability. For another futuristic purpose, thermoelectric parameters such as Seebeck coefficient, power factor, and figure of merit have also been calculated, which again verifies that these materials may be very useful in thermoelectric devices. Most of the parameters have been computed for the first time. METHODS: We have performed this computational work using WIEN2k simulation code, which is based on the full-potential linearized augmented plane wave (FP-LAPW) technique. It is one of the most reliable techniques to calculate the photovoltaic properties of semiconducting perovskites. The interaction between ion-core and valence electrons was dealt with within the PAW technique as implemented in Vienna Ab initio Simulation Package (VASP).

The development of carbohydrate polymer- and protein-based biomaterials and their role in environmental health and hygiene: A review.

Biological macromolecules have been significantly used in the medicine due to their certain therapeutic values. Macromolecules have been employed in medical filed in order to enhance, support, and substitute damaged tissues or any other biological function. In the past decade, the biomaterial field has developed considerably because of vast innovations in regenerative medicine, tissue engineering, etc. Different types of biological macromolecules such as natural protein and polysaccharide etc. and synthetic molecules such as metal based, polymer based, and ceramic based etc. have been discussed. These materials can be modified by coatings, fibres, machine parts, films, foams, and fabrics for utilization in biomedical products and other environmental applications. At present, the biological macromolecules can used in different areas like medicine, biology, physics, chemistry, tissue engineering, and materials science. These materials have been used to promote the healing of human tissues, medical implants, bio-sensors and drug delivery, etc. These materials also considered as environmentally sustainable as they are prepared in association with renewable natural resources and living organisms in contrast to non-renewable resources (petrochemicals). In addition, enhanced compatibility, durability and circular economy of biological materials make them highly attractive and innovative for current research.The present review paper summarizes a brief about biological macromolecules, their classification, methods of synthesis, and their role in biomedicine, dyes and herbal products.

Understanding of Stigmatization and Death Amid COVID-19 in India: A Sociological Exploration.

The unanticipated outbreak of Coronavirus had proven detrimental to human existence. It had created waves of panic, anxiety, and fear among people hence facilitating stigmatization toward an infected person. This stigmatization further influences patients health-seeking behaviour due to the trust deficit in the public health system. The virus had placed the world in an impotent situation as people helplessly watched their loved ones pass away in the absence of effective treatment. Dead bodies are denied a dignified death due to mandatory guidelines prescribed by countries to control the pandemic. This article attempts to understand the process of stigmatization of Coronavirus and its mechanism of influencing the health-seeking behaviour of people. Moreover, the way this stigmatization, accompanied by fear and anxiety, led to the denial of having a dignified death in India.