Degradation and decolourization potential of ligninolytic enzyme producing Bacillus paramycoides BL2 and Micrococcus luteus BL3 for pulp paper industrial effluent and its toxicity evaluation.

Aim of this study was to optimize the production of Ligninolytic enzyme for the degradation of complex pollutants present in pulp paper industrial effluent (PPIE). Two ligninolytic enzyme-producing bacterial strains were isolated from PPIE and identified as Bacillus paramycoides strain BL2 (MZ676667) and Micrococcus luteus strains BL3 (MZ676668). The identified bacterial strain Bacillus paramycoides strain BL2 showed optimum production of LiP (4.30 U/ml), MnP (3.38 U/ml) at 72 h of incubation, while laccase (4.43 U/ml) at 96 h of incubation. While, Micrococcus luteus strains BL3 produced maximum LiP (3.98) and MnP (3.85 U/ml) at 96 h of incubation and maximum laccase (3.85 U/ml) at 72 h of incubation, pH 7-8, and temperatures of 30-35 °C. Furthermore, in the presence of glucose (1.0%) and peptone (0.5%) as nutrient sources, the enzyme activity of consortium leads to reduction of lignin (70%), colour (63%) along with COD (71%) and BOD (58%). The pollutants detected in control i.e. 3.6-Dioxa-2,7-disilaoctane, 2-Heptnoic acid,trimethylsilyl ester, 7-Methyldinaphtho [2,1-b,1',2'-d] silole, Hexadeconoic acid, trimethylysilyl ester, Methyl1(Z)-3,3-dipheny.1-4-hexenoale, 2,6,10,14,18,22-Tetracosahexane,2,2-dimethylpropyl(2Z,6E)-10,11epoxy5,6 Dihyrostigmasterol, acetate were completely diminished. The toxicity of PPIE was reduced up to 75%. Hence, knowledge of this study will be very useful for industrial sector for treatment of complex wastewater.

Navigating the Landscape of Cancer From Ancient Times to Modern Challenges: A Narrative Review.

Cancer, a pervasive and multifaceted disease, has afflicted humanity since ancient times, as evidenced by early references in the Edwin Smith Papyrus and the Ebers Papyrus. Over centuries, our understanding and treatment of cancer have evolved significantly, transitioning from rudimentary remedies to advanced modalities like chemotherapy, radiation therapy, and precision medicine. Despite these advancements, cancer remains a major global health challenge. As of 2022, nearly 20 million new cancer cases and 10 million cancer-related deaths were reported worldwide. In India, the situation is particularly dire, with over 1.41 million new cases and more than 916,827 deaths in 2022, exacerbated by socioeconomic disparities, cultural stigmas, and healthcare barriers. This review traces the historical evolution of cancer treatment from ancient civilizations to modern times, highlighting key medical milestones and breakthroughs. It examines the global and Indian cancer burden, emphasizing the critical barriers to early diagnosis and effective treatment. These barriers include health system deficiencies, socioeconomic challenges, delayed diagnosis, low health literacy, and inadequate screening programs. The review was conducted through a comprehensive literature search using databases such as PubMed, Google Scholar, Journal Storage (JSTOR), and various other sources focusing on historical texts, epidemiological studies, and current medical research. The search aimed to gather a broad spectrum of perspectives and evidence to provide a well-rounded understanding of cancer's historical journey and current landscape.

A Cross-Sectional Study on Sedentary Lifestyle Among Budding Doctors: Silent Killer?

Background Internship is the time period when young doctors learn to balance between professional and personal lives. If they have good awareness and practice of any kind of physical activity during this period, it will help them to continue it forward. This enables them to educate and inspire people and patients around them. The main objectives of this study were to assess patterns of physical activity among medical interns and to understand the factors preventing physical activity among them. Methodology This cross-sectional survey was carried out among interns of a tertiary care hospital in western Maharashtra from July 2022 to September 2022. Ethical clearance was obtained before starting data collection. The survey was administered to those who fulfilled the inclusion criteria. The questionnaire was adopted from the Global Physical Activity Questionnaire. The data collected were entered into Microsoft Excel (Microsoft Corporation, Redmond, WA) and analysis was done using MedCalc v.18.2.1 (MedCalc Software Ltd, Ostend, Belgium). Results A total of 220 interns were enrolled in the survey, of which 13 were removed due to incomplete data and 28 interns did not participate in the study. Finally, 179 interns were included for analysis in the study. The response rate was 87.27%. The mean age of participants was 23.12 years. The study population consisted of 72 (40.22%) males and 107 (59.78%) females. Among participants, 33 interns (18.44%) were involved in vigorous activity during work, and 108 interns (60.34%) were involved in moderate physical activity during work. The median time of a sedentary lifestyle was 300 minutes per day and was more common among males. Cumulatively busy working schedules and exam preparation were the important reasons for reduced physical activity. Conclusion There is a gap in the practice of physical activity among interns. A sedentary lifestyle was more prevalent among male interns than in female interns. The main constraints were demanding working hours and the pressure of competitive exams. Medical students will become doctors in the future who can advise their patients on healthy lifestyle habits. We recommend that it is necessary to promote physical activity in medical schools and to reinforce the importance of physical exercise in the medical curriculum.

Implementation of modified enhanced recovery after surgery (ERAS) following surgery for abdominal trauma; Assessment of feasibility and outcomes: A randomized controlled trial (RCT).

BACKGROUND: Enhanced recovery after surgery(ERAS) is a set of multiple perioperative care component not a rigid protocol with improved outcomes for elective surgeries. This study aimed to assess the feasibility and outcomes in trauma patients undergoing laparotomy. STUDY DESIGN: Prospective single-centre randomized controlled trial(RCT). Patients undergoing emergency laparotomy following trauma were randomized into ERAS(early removal of catheters, early mobilization and initiation of diet, use of opioid-sparing multimodal analgesia) and conventional care groups 24 â€‹h post-surgery. Outcome measures included length of hospitalization(LOH), recovery of bowel function, duration of removal of catheters and 30-day complications(Clavien-Dindo). RESULTS: Fifty patients were randomized into ERAS(n â€‹= â€‹25) and conventional care(n â€‹= â€‹25) groups. Ninety-two percent of patients were young males, 58 â€‹% had blunt trauma to the abdomen and the most common indication of surgery was hollow viscus injury(88 â€‹%). ERAS group had a reduced median LOH(days) (6 versus 8, p â€‹= â€‹0.007), early recovery of bowel function(p â€‹= â€‹0.010) and shorter times for nasogastric tube(p â€‹= â€‹0.001), urinary catheter(p â€‹= â€‹0.007) and drain(p â€‹= â€‹0.006) removal. The complications were comparable in both groups except for deep surgical site infection[significantly lower in ERAS group(p â€‹= â€‹0.009)]. CONCLUSION: ERAS is safe and significantly reduces LOH in select trauma patients undergoing laparotomy.

The Role of Neck Circumference as a Screening Tool for Obesity in Female Adults: A Cross-Sectional Study in Western Maharashtra.

INTRODUCTION: The rising prevalence of obesity has become a global public health crisis. Traditional screening tools like body mass index (BMI) and waist circumference (WC) have limitations, prompting the need for simpler, more effective alternatives. Neck circumference (NC) has emerged as a promising tool due to its simplicity, affordability, and reliability. The study aimed to evaluate neck circumference as a screening tool for obesity among female adults, alongside measuring BMI, waist-to-hip ratio (WHR), WC, and NC, and establishing NC cut-off values using body fat percentage as the gold standard. Additionally, it sought to compare the predictive accuracy of these measures for assessing obesity. METHODS: This cross-sectional study, conducted from March 2023 to October 2023, involved 362 female students from a health sciences university in Western Maharashtra, India. The participants provided informed consent and underwent anthropometric measurements, including height, weight, waist circumference, hip circumference, body fat percentage, and neck circumference. Body fat percentage, measured using a bioimpedance analyzer, served as the reference standard. RESULTS: The study identified a neck circumference (NC) cut-off of 31.3 cm using receiver operating characteristic (ROC) analysis, showing robust sensitivity (71.23%) and specificity (79.02%) for detecting obesity defined by body fat percentage. Waist circumference (WC) showed the highest sensitivity (73.97%) for diagnosing obesity in females, followed by NC (71.23%). CONCLUSION: Neck circumference is a practical, cost-effective, and reliable screening tool for obesity, offering advantages over traditional methods. Its noninvasive nature and ease of measurement make it suitable for large-scale screening, contributing to the early detection and management of obesity-related health risks. This study supports the inclusion of NC in routine clinical assessments and public health initiatives.

Exploring the Determinants of Tobacco Usage Among Adolescents: A Cross-Sectional Study in Western Maharashtra.

Introduction The widespread use of tobacco is a major global health threat, causing significant morbidity and mortality. The World Health Organization (WHO) estimates that annually, millions of people die prematurely due to tobacco use, with this number projected to increase significantly in the future. Developing countries, including India, bear a substantial burden of tobacco-related deaths, often beginning during adolescence. This study estimated the prevalence of tobacco use among adolescents in the 13-19 years age group, identified the types of tobacco products used, explored the reasons for initiation, and examined the influence of family, peers, and socio-demographic factors on tobacco use. Methods A community-based cross-sectional study was conducted from August 2022 to June 2024 in a medical college's urban and rural field practice areas in Pune district, Maharashtra. A total of 310 adolescents were surveyed using convenience sampling. Data were collected using a pre-designed, pre-tested questionnaire, and statistical analysis was performed using Jamovi software version 2.3.28. Chi-square and Fisher's exact tests were applied to assess associations between variables. Results Out of 310 participants, 94 (30.32%, 95% CI: 25.25%-35.77%) reported using tobacco. Among these 94 participants, 82 (87.23%) used smokeless tobacco, 19 (20.21%) used the smoked form of tobacco, and seven (7.45%) used both forms. The mean age of initiation was 15.94 years for smoking and 15.59 years for smokeless tobacco. The data indicate a higher percentage of tobacco use among females (50%) compared to males (24.8%). However, in terms of absolute numbers, more males (60) than females (34) reported using tobacco due to the larger number of males in the study sample. The most common reasons for initiation included curiosity (43.74%) and peer pressure (53.99%). Specifically, 49 individuals (42.6%) aged 13-15 were using tobacco, compared to 23 individuals (30.3%) aged 16-17, and only 22 individuals (18.5%) aged 18-19. Participants from urban areas reported higher tobacco use (48%) compared to those from rural areas (46.7%). Among those from joint families, about 24 (31.6%) reported tobacco use, while in nuclear families, it was slightly lower at about 70 (29.9%). Conclusion Factors such as peer pressure and curiosity played significant roles in the initiation of tobacco use, with more than half of the participants citing peer influence as the primary reason for starting. This study revealed differences in tobacco usage patterns across age groups, with younger participants showing higher usage rates. The findings highlight the need for targeted interventions, such as health education and anti-tobacco media campaigns, to reduce tobacco use among adolescents.

Influence of Packed Food Labeling on Shopping Practices: A Cross-Sectional Study.

Background: The basic product information, health, safety, and nutritional details, as well as food marketing, advertising, and promotion, are all provided on a packed food label. This study was carried out to assess the knowledge, attitude, and practices of the shoppers regarding food labels as there are few studies done in India and none in Pune. Methodology: A cross-sectional study was carried out among 226 participants using a validated semi-structured questionnaire, which consisted of sociodemographic details and questions on their knowledge, attitude, and practice regarding food labels while purchasing a packed food item. Quantitative data are presented in the form of mean, standard deviation, 95% confidence interval (CI) of mean, median, and interquartile range (IQR). Qualitative data are in terms of number (N), percentages (%), and 95% CI of percentage. Results: Of the 226 participants, 163 (72.12) were aware of the label on packaged foods. One hundred seventy-seven (78.32%) participants in all read the label on the packaged food. The maximum retail price (MRP) and expiration date were the most frequent labels sought. Although 17.7% of consumers did not consider nutrient composition when making a purchase, energy and protein were the most often considered nutrients. The majority (70.35%) falsely believed that juice was healthy. The packed food label's tiny font made it difficult to read for 30.38% of the customers. Conclusion: Despite the increased awareness about packed food labeling, a fraction of shoppers were not concerned about nutritional information. In contrast to the prevailing knowledge, the majority believes packed food has a positive effect on health.

Coverage, delays and implementation challenges of 'Direct Benefit Transfer' in the National Tuberculosis Elimination Programme - A mixed methods study.

INTRODUCTION: Food insecurity and undernutrition both contribute to the large tuberculosis burden in India. Indian government rolled out the direct benefit transfer (DBT) programme "Nikshay Poshan Yojana" on a national scale on April 1, 2018 largely to provide nutritional support. Hence, it was proposed to take up this study in Western Maharashtra (Pune district) to study the coverage, delays and implementation challenges of 'Direct Benefit Transfer' in the National Tuberculosis Elimination Programme as there have only been a limited number of studies conducted regarding the same. METHODOLOGY: This mixed methods study was conducted at Tuberculosis Units (TUs) under District Tuberculosis Officer (DTO) in Western Maharashtra (Pune district) for the duration August 2020 to September 2022. A total of 3373 participants were included for the quantitative component. For qualitative component In-depth interviews of key informants (healthcare providers involved in the implementation of Direct Benefit Transfer) and Focus Group Discussion (FGD) for patients and care givers was done and explored using thematic analysis. RESULTS: The total coverage was found to be 76.81%. The health providers reported staff related challenges (overburden and non-cooperative staff), bank related issues (local and cooperate banks not involved in the Public Financial Management System (PFMS) loop and lack of bank account), patient related issues (fear of being scammed), the DBT process (lengthy and complex) and software related issues as major hurdles involved in the scheme's implementation. The challenges to the implementation of DBT reported by the beneficiaries (TB patients) were lack of awareness and disbelief about the scheme, bank related issues (lack of bank account and necessary documents to open account), financial challenges (job insecurity, loans), physical challenges (weakness) and delays in delivering the benefit due to software errors. CONCLUSION: In the present study the DBT coverage was very encouraging. The common challenges identified by the staff members and patients in the implementation of the scheme were lack of awareness about the scheme, bank related issues and software issues. To increase the coverage of DBT, it is vital that these issues be resolved.

Stress in Caregivers of Stroke Patients During Rehabilitation: An Observational Study.

INTRODUCTION: Stroke causes a high burden of death and disability all over the world. The majority of stroke survivors continue to have difficulties, and their families must shoulder a considerable portion of the expenditures of ongoing rehabilitation and long-term care. In India, stroke rehabilitation is still underachieved due to various reasons leading to delay or incomplete recovery of the patients thus adding up more burden on the caregivers. Thus, studying the caregiver burden of stroke rehabilitation will help policymakers tackle this issue faced by our lower economically challenged citizens. OBJECTIVES: The objective is to measure the perceived burden on caregivers during stroke rehabilitation. METHODS AND MATERIALS: The observational study was conducted by interviewing the stroke survivors' caregivers and visiting the physiotherapy OPD using the caregiver burden scale/questionnaire. RESULTS: The study had 76 caregivers, 51.32% were women and 48.68% were men. The average age for caregivers was 42 years and 55 years for patients. The average duration of giving care was six months. The perceived caregiver burden score was low (mean-19.61) suggesting that not all assistance is associated with stress. The correlation of each burden measure with Modified Rankin Scale for disability is significantly correlated (r=0.7, P<0.0001). Further investigation revealed that caregivers had considerably higher levels of stress when the patient needed to exercise, walk or use the restroom. A low yearly income, a higher secondary education, and a small number of family members were shown to be connected with individuals who scored the highest on stress. CONCLUSION: Based on this study, we conclude that people with low income residing in nuclear families require more support for caregiving during rehabilitation. We recommend that health and welfare policy measures be developed to lessen caregiver burden in order to improve caregivers' post-stroke experiences.

People's Perspective on Out-of-Pocket Expenditure for Healthcare: A Qualitative Study From Pune, India.

Background Out-Of-Pocket Expenditure (OOPE) directly reflects the burden of health expenses that households bear. Despite the availability of social security schemes providing healthcare benefits, a high proportion of Indian households are still incurring OOPE. In order to recognize the reasons behind OOPE, a comprehensive understanding of people's attitudes and behavior is needed. Methodology By purposive sampling, 16 in-depth interviews were conducted using an interview guide in the catchment area of urban and rural health centers of a tertiary healthcare hospital. Interviews were conducted in Marathi and Hindi and were audio tape-recorded after taking informed consent. The interviews were transcribed and translated into English, followed by a thematic analysis. Results Although most participants knew that government hospitals provide facilities and experienced doctors, inconvenience and unsatisfactory quality deter them from utilizing government facilities. A few had experiences with government schemes; almost all concur that the formality and procedure of claiming insurance are cumbersome and all have had bad experiences. Cost of medications and consultation accounted for the majority of the healthcare expenditures. While some participants had benefitted from insurance, few regretted not enrolling in one. Conclusion The awareness regarding government schemes was derisory. Government-financed health insurance schemes and their utilization are crucial to reducing OOPE. Efforts should be made to increase accessibility to public healthcare services. Nevertheless, there is potential to redress the barriers to improve scheme utilization.

Radiocontrast-Diatrozate and Iopromide-Induced Severe Hypocalcemia Leading to Painful Tetanic and Severe Laryngeal Spasm: A Near Fatal Encounter.

Routinely advised radiological investigations like contrast-enhanced scans can have adverse effects on electrolyte imbalance due to the administration of Radiocontrast. Urograffin (Diatrizoate) and Ultravist (Iopromide) are some of the common examples of contrasts given to patients that possibly led to chelation of the calcium in serum causing severe carpopedal spasms and painful muscular tetany in our patient. Here we report a case of a 32-year-old female patient with acute gastroenteritis who presented with complaints of pain in the abdomen, multiple episodes of vomiting, and loose stools underwent contrast-enhanced computed tomography (CECT) scan of the abdomen, and developed severe painful muscular tetanic spasms after intravenous and oral contrast was administered.

The Act of Prevention: Knowledge, Attitudes, and Perception Among Caretakers of Kidney Disease Patients in Rural Wardha District of Central India.

Background There is a continual rise in the prevalence of non-cancerous conditions such as chronic kidney disease (CKD) owing to an enormous load of diabetes, hypertension, and vascular diseases. A positive attitude and healthy lifestyle for CKD prevention can only be followed when the masses are well aware and educated about the disease. This study aimed to compare, correlate, and evaluate the distribution of knowledge, attitudes, and perceptions among relatives or caretakers of patients with kidney disease or at risk of the disease. Methodology This cross-sectional study aimed at obtaining data on the knowledge, attitudes, and perceptions using the Chronic Kidney Diseases Screening Index questionnaire from the relatives of CKD patients. All data were computed and analyzed using SPSS version 28.0 (IBM Corp., Armonk, NY, USA). Results The majority of the relatives of CKD patients had poor knowledge (63.6%) and poor attitude (51.6%) levels. On the contrary, most respondents had good practices (52.8%) level toward the risk for CKD. A significant correlation was noted between education and knowledge (p < 0.050). A significant association was also observed between education and occupation with attitude (p < 0.001 and p < 0.050, respectively). Additionally, a significant association was noted between age and perception (p < 0.001). Conclusions Informed and well-educated populations are less prone to acquire or progress to CKD. From this study, we can understand the need for improvement in public knowledge, which has the potential to help in saving the lives of many patients progressing toward end-stage renal diseases.

Perspectives of nanoemulsion assisted oral delivery of docetaxel for improved chemotherapy of cancer.

CONTEXT: Nanoemulsions (NE) are one of the robust delivery tools for drugs due to their higher stability and efficacy. OBJECTIVES: The purpose of present investigation is to develop stable, effective and safe NE of docetaxel (DTX). METHODS: Soybean oil, lecithin, Pluronic F68, PEG 4000 and ethanol were employed as excipients and NEs were prepared by hot homogenization followed by ultra-sonication. NEs were optimized and investigated for different in vitro and in vivo parameters viz. droplet size, poly dispersity index, charge; zeta potential, drug content and in vitro drug release, in vitro cytotoxicity, in vitro cell uptake and acute toxicity. Transmission electron microscopy was performed to study morphology and structure of NEs. Stability studies of the optimized formulation were performed. RESULTS: Droplet size, poly dispersity index, zeta potential, drug content and in vitro drug release were found to be 233.23 ± 4.3 nm, 0.24 ± 0.010, -43.66 ± 1.9 mV, 96.76 ± 1.5%, 96.25 ± 2.1%, respectively. NE F11 exhibited higher cell uptake (2.83 times than control) and strong cytotoxic activity against MCF-7 cancer cells (IC50; 13.55 ± 0.21 µg/mL at 72 h) whereas no toxicity or necrosis was observed with liver and kidney tissues of mice at a dose of 20 mg/kg. Transmission electron microscopy ensured formation of poly-dispersed and spherical droplets in nanometer range. NE F11 (values indicated above) was selected as the optimized formulation based on the aforesaid parameters. CONCLUSION: Conclusively, stable, effective and safe NE was developed which might be used as an alternative DTX therapy.