Integrating dosimetric and clinical insights: correlating acute bone marrow toxicity with irradiated marrow volume in rectal cancer patients undergoing concurrent chemoradiation

Background: Concurrent chemoradiation is one of the major treatments for locally advanced rectal cancer. As radiation therapy suppresses the bone marrow, it is essential to quantify the dose received by the pelvic bone marrow (PBM), which constitutes about 50% of the hematopoietic bone marrow. Methods: A prospective study conducted in 50 patients with locally advanced rectal cancer treated with long course concurrent chemoradiation. All the patients were followed up with weekly complete blood count for assessing hematological toxicities and were graded. PBM was contoured and subdivided into ilium bone marrow (IBM), lower pelvis bone marrow (LPBM) and lumbosacral bone marrow (LSBM). Volumes of bone marrow receiving different doses were quantified. Results: Among the 50 patients, 40 (80%) developed acute bone marrow toxicity, during the course of treatment. Highest grade of bone marrow toxicity developed in 20 (40%) patients which was grade 2. Compared to grade 1, grade 2 neutropenia patients exhibited significantly higher levels of V10 to V40 (p<0.05) in PBM and significantly higher levels of V20 in IBM and LSBM. In LPBM, compared to grade 1 leukopenia and neutropenia, grade 2 leukopenia and neutropenia exhibited significantly higher levels of V10 and V20 (p<0.05). Conclusions: Increased PBM V10 to V40, IBM V20, LSBM V20, LPBM V10 and V20 were significantly related to the higher grades of neutropenia in locally advanced rectal cancer patients undergoing long course concurrent chemoradiation. Increased LPBM V10 and V20 were also significantly related with higher grades of leukopenia.

Comparison of the incidence of post-ERCP pancreatitis between combined rectal indomethacin and sublingual nitroglycerin with that of rectal indomethacin alone

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is now widely accepted as a therapeutic modality for benign and malignant diseases of the pancreaticobiliary tree. Acute pancreatitis is the most common and feared complication of ERCP, associated with substantial morbidity and mortality. This study aimed to compare the incidence of post-ERCP pancreatitis in combined rectal indomethacin and sublingual nitroglycerin with that of rectal indomethacin alone. Methods: This was a randomized controlled trial conducted in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from July, 2019 to September, 2020. In this study, 100 hospitalized patients of >18 years age undergoing ERCP based on clinical indication and proper investigation were included. The study population was randomly divided into two groups - group A (patients who were given indomethacin suppository plus sublingual glyceryl trinitrate) and group B (patients who were given indomethacin alone). Results: In this study, we found that PEP developed in 11 out of 100 patients (11%). Post-ERCP pancreatitis developed in 2 (4%) in group A and 9 (18%) in group B (p=0.025), which was statistically significant. Mild PEP developed in none in group A and 4 (8%) in group B whereas moderate in 2 (4%) in group A and 3 (6%) in group B. Severe pancreatitis occurred in none in group A and 2 (4%) in group B (p=0.231) which was not statistically significant. Conclusions: This study showed that the combination of indomethacin suppository and sublingual GTN is superior to indomethacin suppository alone in preventing post-ERCP pancreatitis.

A study to evaluate the effectiveness of planned educational programme on knowledge and attitude regarding psychosocial problems of eating disorders among adolescent girls studying in selected P.U Colleges at Vijayapur

Background: Eating problems are prevalent, with girls more likely to develop issues in adolescence. Concerning indicators include weight fluctuations, altered eating patterns, and excessive physical activity. Outpatient treatment is effective for most, but some may require hospitalization or residential programs for stability and care. Methods: This research adopted an evaluative research approach and employed a pre-experimental (one group pre-test post- test design), and a sample of 60 adolescent girls studying in PU College is recruited through simple random sampling technique. The investigation was conducted at selected PU colleges, Vijayapur. Karnataka, among the adolescents. Results: This study assessed the knowledge and attitudes of adolescent girls in PU colleges in Vijayapur regarding eating disorders. Pretest results showed a majority with moderate knowledge and unfavorable attitudes. Following an educational program, significant improvements in knowledge and attitudes were observed. The findings highlight the effectiveness of targeted interventions in enhancing awareness and promoting positive attitudes. H1: Post-test knowledge scores significantly improved compared to pre-test scores (p<0.05). H2: Post-test attitude scores significantly enhanced compared to pre-test scores (p<0.05). H3: No significant associations were found between knowledge and attitude scores and socio-demographic variables among adolescent girls. Conclusions: In summary, targeted interventions can enhance knowledge and attitudes about eating disorders among adolescent girls in PU colleges. Outpatient treatments and education are crucial for addressing these issues, but more research and interventions are needed to promote awareness and positive attitudes.

A case study on the relationships between the dietary patterns and the nutritional status of school children in Galkadapathana village in Sri Lanka

Background: Nutritional status is an important indicator in measuring the quality of life of children. Galkadapthana is a rural agricultural village in the Nuwara Eliya district, Sri Lanka. Villagers confront difficulties regarding their nutritional status due to low income, inadequate education and poor infrastructure facilities. This study was undertaken to identify the relationships between the nutritional status of school children in Galakadapathana village and their dietary patterns. Methods: A community-based cross-sectional study was carried out using a deductive approach. A total of 85 households with 137 school children aged 6-18 years were randomly selected. Data was collected using structured surveys and conducting face-to-face interviews. The nutritional status of children was assessed through anthropometric measurements. Results: A severely stunted condition was observed in 5.8% of children, while 7.3% represent severely underweight conditions according to the WHO growth references, 2007. The maximum number of 6 was scored in the Individual Dietary Diversity Score (IDDS) by 24.8% of the population. The maximum number of 7 in the Household Dietary Diversity Score (HDDS) was scored by 21.2% of the population. There was no significant (P>0.05) relationship between the BMI-for-age status and the aggregate level of education of the breadwinner, birthweight of the child, IDDS, and HDDS. However, the amount of starchy food intake significantly (P<0.05) impacted the BMI-for-age status. Conclusions: The amount of starchy food intake showed a significant impact on the prevalence of wasting (P<0.05), but not the aggregate level of education of the breadwinner, birthweight of the child and dietary diversity.

Understanding the knowledge and experience of menarche among secondary school female students in Nnewi, Anambra State, Nigeria

Background: Menstruation, a key physiological change in females of reproductive age, necessitates providing young girls with crucial information on menarche to better prepare them. Methods: This study assessed the knowledge and experience of menarche among secondary school female students in Nnewi, Anambra State, Nigeria, utilizing a descriptive cross-sectional survey method. Conducted from August to September 2023, the study involved 420 participants and employed multistage sampling for selection. Results: The findings revealed a paradoxical decrease in the mean age of menarche to 12.02 +/- 1.15 years, with most girls experiencing menarche at age 13. Notably, 91.4% of participants had substantial knowledge of menarche, primarily acquired from mothers. Although 86.9% recognized menarche as a normal puberty change, experiences varied: 45.5% felt normal, 39.3% were afraid, and 12.9% felt ashamed during their menarche. Conclusions: The study concludes that despite high awareness levels, poor menarche experiences prevail due to inadequate preparation. It recommends enhanced awareness campaigns in schools, spearheaded by NGOs and health workers, to educate and prepare young girls for menarche effectively.

Incidence of hypertension and its risk factors: a systematic review

Hypertension is a persistent, metabolic condition indicated by elevated blood pressure levels. Since hypertension comes with no warning signs, mostly people are not aware of it. The aim of the study was to assess the change in the prevalence of hypertension among adults of Punjab and Haryana and to investigate its risk factors. Medline, Web of Science and Scopus databases from 2009 to 2023 were searched for ‘prevalence, burden, awareness, and control of blood pressure (BP) or hypertension (?140 SBP and or ?90 DBP) among Indian adults’ (?18 years). The incidence of hypertension varied from 32.4 to 88.2 percent in male subjects and 30 to 84.7 percent in female subjects. Hypertension was more prevalent among males of Punjab and Haryana. Whereas females were more hypertensive in different districts of Haryana. The considerable upward trend has been observed over the time, among males and females in both Punjab and Haryana, yet awareness and control rates are comparatively low. Various researchers have discovered that younger the age of beginning of hypertension, the higher the decline in life expectancy if raised blood pressure is not managed.

Oral health problems among school children in rural area: a cross-sectional study

Background: Students are the wealth of the nation as they constitute one of the important segments of the population. The foundation of good health and sound mind is laid during the school age period. During this period, they are vulnerable to various oral health problems. These conditions are the hurdles in their physical, mental, emotional, and social development. In view of this, a study was conducted to assess the oral health status of the school students in rural areas. Methods: Cross-sectional study was conducted in rural area among school children in the month of March 2023. Standard proforma was used to record the data related to oral morbidity among the subjects. Data entry and statistical analysis was done with the help of Microsoft Excel. ?2 and SE (p1-p2) tests were used to compare difference in categorical variables. The statistical level of significance was fixed at p<0.05. Results: 432 students were examined. 226 (52.31%) subjects were having oral morbidity. 151 (66.81%) subjects in the age group of 5-10 years while 75 (33.19%) in the age group of >10-16 years were having oral health problems (p<0.05). 155 (59.73%) students from primary section and 71 (40.27%) students from secondary section were suffering from oral morbidity (p<0.05). Dental caries was observed among 194 (44.91%) subjects followed by mouth ulcers (09.72%). 143 (53.36%) underweight subjects were suffering from dental caries (p<0.05). Conclusions: Common oral health problems found in school going children can be addressed with the implementation of school health program in effective way. These common infirmities can be prevented by actively involving parents and teachers in school health services.

Presacral tumor, experience of two cases in Mexico and review of the literature

Presacral or retrorectal tumors are rare, they can present different histologic strains and they can also be benign or malignant. These tumors represent a challenge for the surgeon due to their location in the presacral space and due to the low incidence and written information. Various surgical approaches have been described. We present the case of two patients who were diagnosed with presacral tumors (hamartoma and schwannoma) and who underwent a posterior approach for the removal of the tumors. There are several approaches for the treatment of presacral tumors, but in our experience, the posterior approach has shown adequate results without recurrence in the medium-term follow-up. The purpose of the manuscript is to document our experience in the management of two patients.

Caregiver burden of the elderly in a selected urban community, Chittoor district, Andhra Pradesh

Background: In India, families are the primary source of support in caring for the elderly, whereas the potential group of family caregivers is shrinking. Caregivers need greater recognition and support to help them care for the elderly and to maintain their own health and well-being. Assessment of the perceived burden of caregivers helps identify those in need of support. Methods: A cross-sectional questionnaire-based study was conducted to estimate the perceived level of caregiver burden in families of elderly and to identify the association between selected socio-demographic characteristics of the caregivers and the level of caregiver burden. The caregivers of 50 elderly people categorized as mild and moderate dependents as per the Katz index of Independence were included in the study. The Zarith caregiver burden scale was used to evaluate their perceived level of caregiver burden. Results: Thirty-two (64%) caregivers were found to experience a mild to moderate perceived level of caregiver burden. An ordinal regression analysis between other burdens/responsibilities (predictor) of the caregiver and the perceived level of caregiver burden showed a significant association (?2; p=0.009) between the two. An odds ratio of 6.7 (95% CI, 2.22 to 22.7; p=0.00115) showed that as the predictor increased, the event (caregiver burden) increased as well. Conclusions: The majority of the caregivers suffer from a mild to moderate perceived level of caregiver burden. They experience more burden when they hold additional responsibility of caring for the elderly.

Diabetes, hemoglobin A1c, and cognitive performance in older adults: is there any impact of frailty? Evidence from the ELSI-Brazil study

Abstract The aim of this study was to evaluate the association between diabetes and cognitive performance in a nationally representative study in Brazil. We also aimed to investigate the interaction between frailty and diabetes on cognitive performance. A cross-sectional analysis of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline data that included adults aged 50 years and older was conducted. Linear regression models were used to study the association between diabetes and cognitive performance. A total of 8,149 participants were included, and a subgroup analysis was performed in 1,768 with hemoglobin A1c data. Diabetes and hemoglobin A1c levels were not associated with cognitive performance. Interaction of hemoglobin A1c levels with frailty status was found on global cognitive z-score (P-value for interaction=0.038). These results suggested an association between higher hemoglobin A1c levels and lower cognitive performance only in non-frail participants. Additionally, undiagnosed diabetes with higher hemoglobin A1c levels was associated with both poor global cognitive (β=-0.36; 95%CI: -0.62; -0.10, P=0.008) and semantic verbal fluency performance (β=-0.47; 95%CI: -0.73; -0.21, P=0.001). In conclusion, higher hemoglobin A1c levels were associated with lower cognitive performance among non-frail participants. Higher hemoglobin A1c levels without a previous diagnosis of diabetes were also related to poor cognitive performance. Future longitudinal analyses of the ELSI-Brazil study will provide further information on the role of frailty in the association of diabetes and glycemic control with cognitive decline.

Identification of skin bacterial profiles of early deceased bodies and the relation to post-mortem interval

@#Post-mortem microbiology (PMM) is an important tool in identifying possible causes of sudden unexpected death, as an infectious cause is highly suspected. However, contamination is a major problem in microbiology, and this has increased the difficulty determining the true pathogen that contributes to death in post-mortem cases. Skin commensals are common contaminants in blood cultures. This study was conducted to investigate the skin flora on early deceased bodies and observe the bacteria detected at different post-mortem intervals (PMIs). As blood is usually drawn from the neck and femoral sites for PMM examination, the two body sites were chosen as the sampling sites. Skin swab samples from the neck and femoral (n=80) of each early deceased body were collected by sterile cotton swabs. DNA was extracted from the swabs and then subjected to high-throughput 16S rRNA sequencing by using the Illumina MiSeq platform. Staphylococcus was found to be the most dominant genus in both neck and femoral sites. LEfSe results showed that Cutibacterium is significantly different at the neck site while Corynebacterium is more abundant at femoral site. There are significant differences at genus level between PMI<5H and PMI>5H at both neck and femoral sites. The findings of the present study may act as a reference for microbiologists and forensic pathologists when mixed growth or contamination occurs in post-mortem blood cultures.

Detection of microbial pathogens colonizing foot ulcers of diabetic patients in Enugu, Nigeria

Background: Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus (DM) which is associated with high morbidity and mortality. There is high rate of bacteria colonization especially in those with tendencies for poor wound dressing. This is accompanied by high rate of inappropriate antibiotic usage. The aim of this study is to characterize microbial pathogens colonizing foot ulcers of diabetic patients in Enugu, Nigeria, and to determine the antibiotic susceptibility of these isolates. Methodology: This was a descriptive cross-sectional study of consecutively enrolled diabetic patients with foot ulcers in two tertiary healthcare facilities in Enugu, Nigeria, between May 2021 and February 2022. A structured questionnaire was used to obtain socio-demographic and clinical data of the patients. Pus samples and/or tissues were collected from the ulcer lesion of each patient for aerobic and anaerobic microbial cultures and biochemical identification using standard conventional techniques. Results: A total of 310 diabetic patients with foot ulcers were recruited into the study, with 62.3% (193/310) males and 37.7% (117/310) females, and mean age of 56.0±13.9 years. Bacteria and yeast were isolated from samples of 280 (90.3%) patients while samples of 30 (9.7%) patients had no microbial growth. Males had higher frequency of microbial isolates (90.7%, 175/193) than females (89.7%, 105/117), while the age group ≤ 40 years had higher frequency of microbial isolates (100%, 43/43) compared to other age groups, although the differences are not statistically significant (p>0.05). The distribution of the isolates showed that 15.7% (44/280) were monomicrobial while 84.3% (236/280) were polymicrobial. The highest single isolate was Bacteroides fragilis with 5.0% (14/280), followed by Staphylococcus aureus with 3.2% (9/280). Bacteroides fragilis and S. aureus occurred as the highest combined bacteria isolates with 5.7% (16/280). Most of the patients were colonized by combination of bacterial isolates. The susceptibility indicates that most of the anaerobic bacteria were sensitive to metronidazole while S. aureus isolates were resistant to ofloxacin at a rate of 65.0%. Conclusion: The findings in this study showed that there is high bacteria and fungi colonization of foot ulcers of diabetic patients in Enugu, Nigeria. Routine care of wounds especially frequent changes of dressing materials and the use of potent antiseptics, are recommended.

Public health surveillance and the data, information, knowledge, intelligence and wisdom paradigm / Vigilancia de salud pública y el paradigma de datos, información, conocimiento, inteligencia y sabiduría / Vigilância em saúde pública e o paradigma de dados, informações, conhecimento, inteligência e sabedoria

ABSTRACT This article points out deficiencies in present-day definitions of public health surveillance, which include data collection, analysis, interpretation and dissemination, but not public health action. Controlling a public health problem of concern requires a public health response that goes beyond information dissemination. It is undesirable to have public health divided into data generation processes (public health surveillance) and data use processes (public health response), managed by two separate groups (surveillance experts and policy-makers). It is time to rethink the need to modernize the definition of public health surveillance, inspired by the authors' enhanced Data, Information, Knowledge, Intelligence and Wisdom model. Our recommendations include expanding the scope of public health surveillance beyond information dissemination to comprise actionable knowledge (intelligence); mandating surveillance experts to assist policy-makers in making evidence-informed decisions; encouraging surveillance experts to become policy-makers; and incorporating public health literacy training - from data to knowledge to wisdom - into the curricula for all public health professionals. Work on modernizing the scope and definition of public health surveillance will be a good starting point.

RESUMEN En este artículo se señalan las deficiencias de las definiciones actuales de la vigilancia de salud pública, que incluyen la recopilación, el análisis, la interpretación y la difusión de los datos, pero no las medidas de salud pública. El control de un problema de salud pública de interés exige una respuesta de salud pública que vaya más allá de la difusión de información. No es deseable que la salud pública esté dividida por un lado en procesos de generación de datos (vigilancia de salud pública) y por otro en procesos de uso de datos (respuesta de salud pública), gestionados por dos grupos diferentes (expertos en vigilancia y responsables de la formulación de políticas). Ha llegado el momento de replantear la necesidad de modernizar la definición de la vigilancia de salud pública tomando como referencia el modelo mejorado de Datos, Información, Conocimiento, Inteligencia y Sabiduría de los autores. Entre las recomendaciones que se proponen se encuentran las de ampliar el alcance de la vigilancia de salud pública más allá de la difusión de información para que incluya también el conocimiento aplicable (inteligencia); instar a los expertos en vigilancia a que presten ayuda a los responsables de la formulación de políticas en la toma de decisiones basadas en la evidencia; alentar a los expertos en vigilancia a que se conviertan en responsables de la formulación de políticas; e incorporar la formación en conocimientos básicos de salud pública (desde los datos hasta los conocimientos y la sabiduría) en los planes de estudio de todos los profesionales de la salud pública. Un buen punto de partida será trabajar en la modernización del alcance y la definición de la vigilancia de salud pública.

RESUMO Este artigo aponta deficiências nas definições atuais de vigilância em saúde pública, que incluem coleta, análise, interpretação e disseminação de dados, mas não ações de saúde pública. O controle de um problema preocupante de saúde pública exige uma resposta de saúde pública que vá além da disseminação de informações. A saúde pública não deve ser dividida em processos de geração de dados (vigilância em saúde pública) e processos de uso de dados (resposta de saúde pública) gerenciados por dois grupos distintos (especialistas em vigilância e formuladores de políticas). É hora de repensar a necessidade de modernizar a definição de vigilância em saúde pública, inspirada no modelo aprimorado de Dados, Informações, Conhecimento, Inteligência e Sabedoria dos autores. Nossas recomendações incluem: expansão do escopo da vigilância em saúde pública para além da disseminação de informações, de modo a abranger conhecimentos acionáveis (inteligência); obrigatoriedade de que os especialistas em vigilância auxiliem os formuladores de políticas na tomada de decisões baseadas em evidências; incentivo para que os especialistas em vigilância se tornem formuladores de políticas; e incorporação de capacitação em letramento em saúde pública (partindo dos dados para o conhecimento e em seguida para a sabedoria) nos currículos de todos os profissionais de saúde pública. O trabalho de modernizar o escopo e a definição de vigilância em saúde pública será um bom ponto de partida.

Sowing Time and Spacing Influenced Yield, Quality and Economics of Bt Cotton (Gossypium hirsutum L.)

A field study was conducted in the 2019 kharif season at the Agronomy Instructional Farm, SDAU, SKNagar, Gujarat, India. To investigate that the sowing time and spacing influenced yield, quality and economics of Bt cotton (Gossypium hirsutum L.) in loamy sand soil. Twelve treatment combinations were examined, involving three sowing times (T1: 3rd week of May, T2: 1st week of June, T3: 3rd week of June) and four plant spacings (S1: 90 cm × 60 cm, S2: 90 cm × 45 cm, S3: 60 cm × 60 cm, S4: 60 cm × 45 cm). Four replications of a split plot design were used for the experiment. The third week of May was consistently the best time to sow cotton, according to the results, producing the maximum yields of seed cotton and stalk cotton. The quantity of monopodial branches/plant, harvest index and plant population as well as quality parameters such as oil content and ginning percentage were not significantly impacted by sowing time. The 3rd week of May sowing also yielded the highest benefit cost ratio and net realization. In terms of plant spacing, the spacing of 60 cm × 45 cm promoted highest plant population, taller plants and increased yield attributes like the bolls/plant, boll weight and seed cotton yield/plant. The highest seed cotton yield and stalk yield were achieved with this spacing. Harvest index and quality parameters were unaffected by plant spacing. The narrow spacing of 60 cm × 45 cm also resulted in the highest benefit cost ratio and net realization. The interaction effect between sowing time and plant spacing did not significantly influence growth, yield, yield attributes and quality parameters of Bt cotton.

Evaluating descriptive and clinical characteristics of type 2 diabetes mellitus patients with physical and environmental barriers to exercise

Background: Exercise is critical in the treatment of Type 2 diabetes mellitus. It is critical to identify exercise barriers in non-exercising T2DM patients. The present study aimed to evaluate the physical and environmental barriers among non-exercising T2DM patients attending a tertiary care hospital in Karachi, Pakistan. Methods: A cross-sectional study was conducted by recruiting patients from Family Medicine outpatient clinics at the Agha Khan University Hospital from October 2018 to April 2019. Patients between the ages of 18 and 65 who had T2DM for at least six months and exercised for fewer than 150 minutes per week or 30 minutes per day were enrolled. Barriers to exercise like physical (pain/discomfort, too overweight, co-existing illness) and environmental (too hot or cold weather, unavailability or no convenient place to exercise) were observed. The Chi-square test was used for inferential statistics. Results: Of 275 patients, mean age of the patients was 46.58 ±10.96 years. There were 146 (53.1%) males and 129 (46.9%) females. Pain and physical discomfort 110 (40%) was the most common physical barrier. Moreover, hot or cold weather was reported in 48 (17.5%) patients, no convenient or nearby place to exercise in 53 (19.3%), unavailability of parks/gym in 48 (17.5%), and environmental barriers like traffic in 35 (12.7%). Conclusions: A variety of physical and environmental barriers were discovered in this study; therefore, implementing suitable therapy to overcome these barriers will allow patients to engage in physical activities that will help them control their diabetes.

Application Methodology and Physiological Insights of Melatonin Hormone for Water Stress Alleviation in Black Pepper (Piper nigrum L.)

Black pepper is highly sensitive to water deficit stress especially during summer, resulting in significant losses in yield; therefore, strategies aimed at enhancing water stress tolerance are essential. Melatonin improves stress tolerance in plants; however, its method of application and optimum concentration in black pepper under water deficit stress remains unclear. Therefore, we conducted a two pot culture experiment during March and April, 2022 (var. Panniyur-1) to investigate the effects of foliar-sprayed and root-irrigated melatonin (50, 100 and 150 µM L-1) on the recovery per cent and physiological mechanism under water stress. The treatment details were, WW - Well-watered; WS - Water stressed; FM50 - Waterstress+50µM Melatonin (Foliar spray); FRM50 - Water stress + 50µM Melatonin (Foliar spray + Soil drenching @ 50ml/plant); FM100 - Water stress + 100µM Melatonin (Foliar spray); FRM100 - Water stress + 100µM Melatonin (Foliar spray + Soil drenching @ 50ml/plant); FM150 - Water stress + 150µM Melatonin (Foliar spray); FRM150 - Water stress + 150µM Melatonin (Foliar spray + Soil drenching @ 50ml/plant). The melatonin-induced enhanced stress tolerance could be attributed to improved recovery %, leaf relative water content, photosynthetic pigments, activity of antioxidant enzymes (SOD, POD, and CAT), and ultimately significantly relieved the inhibitory effects of water stress on leaves. After rehydration, melatonin-treated plants recovered more quickly than untreated plants. In addition, melatonin counteracted the water stress induced accumulation in proline content. Overall, the results of this study demonstrated that melatonin at 100 µM L-1 (Foliar spray and root irrigation) significantly alleviated the adverse effects of water deficit stress compared untreated plants. In addition, application of exogenous melatonin combined with root and foliar application is superior than foliar spraying alone.

Response of Plant Growth Regulators on Vegetative Growth, and Flower Quality of Chrysanthemum at Central India

A study on the effect of plant growth regulators on growth of chrysanthemum was carried out at K.N.K. College of Horticulture, Mandsaur. Experiment was laid out in completely randomized design(CRD) with three replications. Chrysanthemum cultivar- Hybrid-2 was used for the experiment. Six PGR treatments consisting of three concentrations each of GA and NAA i.e., GA3 (100, 150 & 200 ppm) and NAA (75 ppm, 125 ppm and 200 ppm) were applied to the experiment. GA3 (200 ppm) recorded the maximum values for plant height, plant spread, number of branches / plant, number of leaves/ plant, leaf length (cm), leaf stalk length (cm), number of suckers per plant, number of flowers per plant, flower stalk length (cm), flower diameter and flowering duration as well as the earliest first flower bud appearance and first flower opening. This treatment also recorded the longest vase life of cut flowers (days), the maximum total water uptake in vase and the maximum diameter of fully opened flower in vase life.

Renal biopsy - indication and its implications in management of children admitted at a tertiary care hospital, Mangalore

Background: Percutaneous renal biopsy is an established diagnostic tool for identification of renal pathology required for diagnosis, treatment, and prognostication. The present study was conducted to know the common indications and histopathological findings of renal biopsy, impact of biopsy report on treatment, and complications of procedure.Methods: This was a retrospective observational study conducted in the paediatric ward of a tertiary care level hospital. Indications of renal biopsy as suggested by medical records were noted down. Any treatment changes happened after final histopathological report were recorded. Statistical analysis was made using statistical package for the social sciences (SPSS) version 20.0 (IBM, NY).Results: The mean age of patients at which biopsy was done was 9.83±5.31 years. Most common indications of renal biopsy were nephritic onset nephrotic syndrome (34.8%), steroid-resistant nephrotic syndrome (21.7%), steroid-dependent nephrotic syndrome requiring calcineurin inhibitors (CNI) (17.4%), lupus nephritis (8.7%), nephrotic syndrome with later age of onset (8.7%), acute kidney injury (AKI) stage 3 (4.3%) and for evidence of calcineurin inhibitor toxicity (4.3%). Focal segmental glomerulosclerosis (26.1%), minimal change disease (21.7%) and membranoproliferative glomerulonephrosis (17.4%) were the most common histopathological findings.Conclusions: This study reiterates the fact that renal biopsy is one of the decisive and diagnostic procedures and has good prognostic value in further management of medical renal disease.

Angiotensin Receptor-Neprilysin Inhibitor Therapy and Cardiac Remodeling in Heart Failure: Consensus Statement from India

Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ?-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).

Role of Iron Therapy in Heart Failure: A Consensus Statement from India

Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.