Dr. NTR University of Health Sciences

Influenza is an acute viral respiratory infection that affects all age groups and is associated with high mortality during pandemics, epidemics, and sporadic outbreaks. Nearly 10% of the world's population is affected by influenza annually, with about half a million deaths each year. Influenza vaccination is the most effective method for preventing influenza infection and its complications. The influenza vaccine's efficacy varies each season based on the circulating influenza strains and vaccine uptake rates. Currently, three antiviral drugs targeting the influenza virus surface glycoprotein neuraminidase are available for treatment and prophylaxis of disease. Given the significant burden of influenza infection globally, this review is focused on the latest findings in the etiology, epidemiology, transmission, clinical manifestation, diagnosis, prevention, and treatment of influenza.

AIM: To perform a systematic review and meta-analysis on clinical outcomes of photodynamic therapy (PDT) in non-resectable cholangiocarcinoma. METHODS: statistic. RESULTS: BS group was 0.57 (95%CI: 0.35-0.94). In PDT group, 10.51% (95%CI: 6.94-14.72) had photosensitivity reactions that were self-limiting. Subgroup analysis of prospective studies showed similar results, except the incidence of cholangitis was comparable in both groups. CONCLUSION: In palliation of unresectable cholangiocarcinoma, PDT seems to be significantly superior to BS alone. PDT should be used as an adjunct to biliary stenting in these patients.

Background. Palliation in advanced unresectable hilar malignancies can be achieved by endoscopic (EBD) or percutaneous transhepatic biliary drainage (PTBD). It is unclear if one approach is superior to the other in this group of patients. Aims. Compare clinical outcomes of EBD versus PTBD. Methods. (i) Study Selection Criterion. Studies using PTBD and EBD for palliation of advanced unresectable hilar malignancies. (ii) Data Collection and Extraction. Articles were searched in Medline, PubMed, and Ovid journals. (iii) Statistical Method. Fixed and random effects models were used to calculate the pooled proportions. Results. Initial search identified 786 reference articles, in which 62 articles were selected and reviewed. Data was extracted from nine studies (N = 546) that met the inclusion criterion. The pooled odds ratio for successful biliary drainage in PTBD versus EBD was 2.53 (95% CI = 1.57 to 4.08). Odds ratio for overall adverse effects in PTBD versus EBD groups was 0.81 (95% CI = 0.52 to 1.26). Odds ratio for 30-day mortality rate in PTBD group versus EBD group was 0.84 (95% CI = 0.37 to 1.91). Conclusions. In patients with advanced unresectable hilar malignancies, palliation with PTBD seems to be superior to EBD. PTBD is comparable to EBD in regard to overall adverse effects and 30-day mortality.

BACKGROUND: India faces an acute shortage of nurses. Strategies to tackle the human resource crisis depend upon scaling up nursing education provision in a context where the social status and working conditions of nurses are highly variable. Several national and regional situation assessments have revealed significant concerns about educational governance, institutional and educator capacity, quality and standards. Improving educational capacity through nursing faculty development has been proposed as one of several strategies to address a complex health human resource situation. This paper describes and critically reflects upon the experience of one such faculty development programme in the state of Andhra Pradesh. DISCUSSION: The faculty development programme involved a 2 year partnership between a UK university and 7 universities in Andhra Pradesh. It adopted a participatory approach and covered training and support in 4 areas: teaching, research/scholarship, leadership/management and clinical education. Senior hospital nurses were also invited to participate. SUMMARY: The programme was evaluated positively and some changes to educational practice were reported. However, several obstacles to wider change were identified. At the programme level, there was a need for more intensive individual and institutional mentorship as well as involvement of Indian Centres of Excellence in Nursing to provide local (as well as international) expertise. At the organisational level, the participating Colleges reported heavy workloads, lack of control over working conditions, lack of control over the curriculum and poor infra-structure/resources as ongoing challenges. In the absence of wider educational reform in nursing and government commitment to the profession, faculty development programmes alone will have limited impact.

Information hiding is particularly used for security applications to protect the secret message from an unauthorised person. Due to the tremendous development of the Internet and its usage, the issue of protection over the internet is increasing. Under such a condition, transforming the information from the transmitter to the receiver requires more security. Accordingly, in my previous research, an efficient medical image watermarking technique in E‐healthcare application using a combination of compression and cryptography algorithm was proposed. The system only gives confidentiality and reliability. To overcome the problem, the authors propose a biometric‐based on an efficient medical image watermarking in E‐healthcare application, which produces a system for authentication, confidentiality, and reliability of the system. The proposed system utilises the fingerprint biometric for authentication, cryptography process for confidentiality, and reversible watermarking for the integrity. Basically, the proposed system consists of two stages such as (i) watermark embedding process and (ii) watermark extraction process. The experiments were carried out on the different medical images with electronic health record and the effectiveness of the proposed algorithm is analysed with the help of peak signal‐to‐noise ratio and normalised correlation.

The Russia-Ukraine crisis has been at the center of international talks since early 2022. This conflict, bursting after the sanitary crisis of the covid 19 pandemic, creates an atmosphere of uncertainty and instability, which negatively impacts many aspects, including mental health. Young Ukrainians have been suffering from socio-political instability for decades, and the current war, together with the Covid 19 pandemic, shatters hopes of brighter days. This commentary covers the challenges facing the younger generation in Ukraine and the impact of this situation on their mental health.

Clinical management of metastatic melanoma suffered historically from a lack of effective targeted and immunotherapies due to short-lived clinical responses. Recent advances in our understanding of tumor-immune signaling pathways, discovery of immunosuppressive checkpoints, and subsequent development of antibodies that target these checkpoints reverses the situation to some extent. Two antibodies ipilimumab and nivolumab gained Food and Drug administration approval for the treatment of metastatic melanoma and target two major immunosuppressive checkpoints cytotoxic T lymphocyte antigen and programmed cell death protein 1 (PD-1), respectively. Nivolumab binds to PD-1, prevents PD-1 interaction with ligand Programmed death ligand 1 (PD-L1), and thus releases the T-cell exhaustion events (such as T cell apoptosis, decrease in T cell proliferation, etc.) leading to buildup of potent tumor-specific immune response. Successful Phase I-III results with remarkable antitumor activity and safety led to approval of nivolumab against ipilimumab refractory metastatic melanoma. Nivolumab therapy is exciting in that it not only provides substantial benefit but also provides durable responses. This review focuses on the evolution of immunotherapy leading to nivolumab approval and its potential in treating melanoma either alone or in combination with other therapies.

BACKGROUND: Enterococci tend to be one of the leading causes of nosocomial infections, with E. faecalis and E. faecium accounting up to 90% of the clinical isolates. Nevertheless, the incidence of other species of enterococci from clinical sources shows an alarming increase with the properties of intrinsic resistance to several antibiotics including beta-lactams and glycopeptides. Thus proper identification of enterococci to species level is quintessential for management and prevention of these bacteria in any healthcare facility. Hence this work was undertaken to study the prevalence of unusual species of enterococci causing human infections, in a tertiary care hospital in South India. METHODS: The study was conducted in a tertiary care hospital in South India from July 2001 to June 2003. Isolates of enterococci were collected from various clinical specimens and speciated using extensive phenotypic and physiological tests. Antimicrobial susceptibility testing were performed and interpreted as per NCCLS guidelines. Whole cell protein (WCP) fingerprinting of enterococci were done for species validation by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and analyzed computationally. RESULTS: Our study showed the prevalence of unusual (non-faecalis and non-faecium enterococci) and atypical (biochemical variant) species of enterococci as 19% (46 isolates) and 5% (12 isolates) respectively. The 7 unusual species (46 isolates) isolated and confirmed by phenotypic characterization includes: 15 E. gallinarum (6.2%), 10 E. avium (4.1%), 6 E. raffinosus (2.5%), 6 E. hirae (2.5%), 4 E. mundtii (1.7%), 3 E. casseliflavus-including the two atypical isolates (1.2%) and 2 E. durans (0.8%). The 12 atypical enterococcal species (5%) that showed aberrant sugar reactions in conventional phenotyping were confirmed as E. faecalis, E. faecium and E. casseliflavus respectively by WCP fingerprinting. The antimicrobial susceptibility testing depicted the emergence of high-level aminoglycoside and beta-lactam resistance among different species apart from intrinsic vancomycin resistance by some species, while all the species tested were susceptible for linezolid and teicoplanin. CONCLUSION: Our study reveals the emergence of multi-drug resistance among unusual species of enterococci posing a serious therapeutic challenge. Precise identification of enterococci to species level enables us to access the species-specific antimicrobial resistance characteristics, apart from knowing the epidemiological pattern and their clinical significance in human infections.

Abstract MXenes are novel transition‐metal‐carbide‐ and/or nitride‐based 2D materials that attract considerable attention in the field of energy storage and conversion because of their unique layered structures, electronic properties, and surface chemistries, which facilitate various electrochemical reactions. MXenes have been rarely investigated as probable catalysts or catalyst supports for the oxygen reduction reaction (ORR). In this review, recent developments in experimental and theoretical research on MXene‐based electrocatalysts for the ORR are examined. MXenes are known to have tremendous potential as stable supports for various Pt and non‐Pt metals for electrocatalytic ORR processes. Theoretical analyses have determined several potential MXene candidates for applications as supports for Pt and non‐Pt metal nanoparticles; experimental studies have shown that Pt‐ and non‐Pt‐deposited MXenes exhibit appreciable ORR activity and stability in alkaline media, followed by acidic media. However, experimental studies also indicate several limitations and challenges that must be addressed for efficient application of MXenes as supports for the ORR. Therefore, current research on MXenes with respect to the ORR is discussed, with a focus on synthesis strategies, ORR activities, and factors responsible for enhancing the electrocatalytic performance. Several strategies for the further development of efficient and durable ORR‐based MXene catalysts are also proposed.

This paper mainly deals with three different topologies of cascaded H-Bridge multilevel inverter. The Existing Topology is a general type of multilevel inverter and has two DC sources for each phase. In Proposed Topology-I the number of DC sources has been reduced to one for all the three phases and the usage of transformers comes into picture. Proposed Topology-II has also only one DC source for all the three phases and the number of switches has been reduced than compare to all other proposed topologies of Cascaded H-bridge multilevel inverter. MATLAB simulations has been carried out for all three Topologies and compared with each other.

The third generation wide bandgap (WBG) semiconductor materials exhibit a prominent role in various applications such as adapters, uninterrupted power supplies, smart grids, and electric vehicles (EVs). They have the phenomenal properties such as high critical breakdown field, WBG, and high-saturated drift velocity as compared to the silicon (Si). This article throws a light on the classification and recent advancements of the GaN-based power devices along with their structural features. Moreover, it explores the critical issues that degrade the device performance and also various methods to improve their performance. The recently developed commercial GaN devices are enumerated with their figure of merits (FOMs) comparison with the Si and SiC devices. The outrageous features of GaN devices are well utilized for realizing the high power density and high efficiency power converters in case of EV applications. The updated survey of various GaN devices-based ac-dc, dc-dc, and dc-ac converters is presented along with their salient features. This article also emphasizes the approaches for resolving the power module issues such as parasitics, layout, and thermal design other than the power converters. This review is ultimately helpful for the design engineers to abridge the technical gaps arising due to the power electronics barriers.

BACKGROUND: National oral health policy was conscripted by the Indian Dental Association (IDA) in 1986 and was accepted as an integral part of National Health Policy (NHP) by the Central Council of Health and Family Welfare in one of its conferences in the year 1995. Objectives of this paper were to find out the efforts made or going on towards its execution, its current status and recent oral health-related affairs or programs, if any. METHODS: Literature search was done using the institutional library, web-based search engines like 'Google' and 'PubMed' and also by cross referencing. It yielded 108 articles, of which 50 were excluded as they were not pertinent to the topic. Twenty-four were of global perspective rather than Indian and hence were not taken into account and finally 34 articles were considered for analyses. Documents related to central and state governments of India were also considered. RESULTS: All the articles considered for analysis were published within the past 10 years with gradual increase in number which depicts the researchers' increasing focus towards oral health policy. Criticisms, suggestions and recommendations regarding national oral health programs, dental manpower issues, geriatric dentistry, public health dentistry, dental insurance, oral health inequality, and public-private partnerships have taken major occupancies in the articles. Proposals like "model for infant and child oral health promotion" and "oral health policy phase 1 for Karnataka" were among the initiatives towards national oral health policy. CONCLUSION: The need for implementation of the drafted oral health policy with modification that suits the rapidly changing oral health system of this country is inevitable.

The ongoing COVID-19 pandemic caused by SARS-CoV-2 is associated with high morbidity and mortality. This zoonotic virus has emerged in Wuhan of China in December 2019 from bats and pangolins probably and continuing the human-to-human transmission globally since last two years. As there is no efficient approved treatment, a number of vaccines were developed at an unprecedented speed to counter the pandemic. Moreover, vaccine hesitancy is observed that may be another possible reason for this never ending pandemic. In the meantime, several variants and mutations were identified and causing multiple waves globally. Now the safety and efficacy of these vaccines are debatable and recommended to determine whether vaccines are able to interrupt transmission of SARS-CoV-2 variant of concern (VOC). Moreover, the VOCs continue to emerge that appear more transmissible and less sensitive to virus-specific immune responses. In this overview, we have highlighted various drugs and vaccines used to counter this pandemic along with their reported side effects. Moreover, the preliminary data for the novel VOC "Omicron" are discussed with the existing animal models.

BACKGROUND: Dentists encounter numerous professional stressful situations, beginning from education to day-to-day practice. The resulting stress tends to have a negative impact on their personal as well as professional lives. OBJECTIVES: To measure daily burnout, and to investigate the extent of expectations from dental career and the feeling of being unqualified new dental practitioner. MATERIALS AND METHODS: A close-ended questionnaire, i.e., "the Copenhagen Burnout Inventory," was utilized for evaluation. A total of 121 dentists with an experience ranging between 6 months and 5 years were included. The period was considered initiating from graduation to dental practicing in urban or rural areas. Ninety-seven dentists replied with filled questionnaires (80.16%). The multivariant analysis was done using SPSS 11.0 ver. (Chicago, USA). RESULTS: = 97) were calculated. The factors most commonly considered responsible for professional burnout were emotional exhaustion (39.27%), frustrations (47.83%), feeling worn out at the end of the day (35.05%), feeling worn out at the end of the working day (46.80%), exhaustion in the morning at the thought of another day at work (35.05%), feeling that every working hour is tiring (46.80%), less energy and less time for family and friends (47.83%). The most common cause for stress was professional burnout that was recorded commonly in females in the age range of 26-28 years. CONCLUSIONS: Dentists are more prone for professional burnout, anxiety, and depression. The main reason for this is the nature of their practice and their personality traits, especially while pursuing dentistry as a carrier. Stress may lead to negative impact on dentists' personal as well as professional lives.

Abstract Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it was first identified in 2019 in Wuhan, China and has resulted in the 2019–20 coronavirus pandemic. As of March 1, 2020, 79,968 patients in China and 7169 outside of China had tested positive for COVID-19 and a mortality rate of 3.6% has been observed amongst Chinese patients. Its primary mode of transmission is via respiratory droplets from coughs and sneezes. The virus can remain viable for up to three days on plastic and stainless steel or in aerosols for upto 3 hours and is relatively more stable than the known human coronaviruses. It is stable in faeces at room temperature for at least 1-2 days and can be stable in infected patients for up to 4 days. Heat at 56°C kills the SARS coronavirus at around 10000 units per 15 minutes. Thus, temperature is an important factor in survival of COVID-19 virus and this article focuses on understanding the relationship between temperature and COVID-19 transmission from the data available between January-March 2020.

The novel coronavirus disease 2019 (COVID-19) predisposes patients to venous thromboembolism (VTE) due to risk factors, severe infection, and severe inflammatory responses. The objective is to determine the risk of developing VTE after corticosteroid administration during COVID-19 treatment. Using PRISMA reporting guidelines, a review was conducted from inception until 20 September 2020 with MESH terms including “venous thromboembolism” and “covid-19,” using MEDLINE, Scopus, CINAHL Plus, and WHO Global Database. The inclusion criteria included studies with COVID-19 patients aged 18 years and older with VTE diagnosed by duplex ultrasonography or computed tomography pulmonary angiography (CTPA). Exclusion criteria were studies with non COVID-19 patients and non-VTE patients aged less than 18 years. Quality appraisal was conducted of included studies using the Newcastle-Ottawa Scale (NOS). A random-effect model using 95% confidence intervals, and significance of findings was assessed using Review Manager V5.4.We included 12 observational studies with 2801 patients (VTE n = 434; non-VTE; n = 2367). Patients had a higher risk of presenting with VTE when being administered corticosteroids during treatment of COVID-19 (RR = 1.39, 95% CI = 1.10 to 1.77, I 2 = 0%). A positive effect size was found (SMD = 1.00, 95% CI = 0.67 to 1.32, I 2 = 85%) for D-dimer laboratory values (µg/mL) in the VTE group. While critically ill COVID-19 patients are more likely to require corticosteroid treatment, it may be associated with increased risk of VTE, and poor clinical prognosis. Risk assessment is warranted to further evaluate patients as case-by-case in reducing VTE and worsening clinical outcomes.

Abstract This study focuses on the improvement of the power quality in interconnected power distribution systems using connected microgrids. The power quality issues at the secondary distribution level are addressed using a unified power quality conditioner, which aids in controlling voltage imbalances and current harmonics. Further, a power control method, adaptive network‐based fuzzy inference system, is proposed as a global solution by installing independent compensating devices at the point of common coupling. The proposed strategy can improve the power quality in traditional installations because the proposed unified power quality conditioner method maximizes power utilization and improves the efficiency of the system. The microgrids integrate renewable energy sources, which generate green energy with low loss. Case studies, a prototype, and simulations via MATLAB/Simulink are used to validate the proposed method, and the results prove the enhancement in power quality control. The proposed control strategy had a response time of 0.3 s, reduced peak voltage distortions, and restored the voltage at the interconnecting point to a normal level. The total harmonic distortion of currents decreased from 21.13% to 14.74% when a PI technique was used to control the UPQC‐P, and the proposed adaptive network‐based fuzzy inference system‐based UPQC‐P reduced the harmonic content to 2.43% from 21.13%.

To evaluate combinations of quercetin with gallic acid, p-anisic acid and cinnamic acid in vitro for synergistic activity against common Gram-negative bacterial pathogens of fish viz., Aeromonas hydrophila, Aeromonas salmonicida and Edwardsiella tarda. Antibacterial activity of quercetin, gallic acid, p-anisic acid and cinnamic acid was determined against selected bacterial pathogens individually, followed by combination of quercetin with polyphenolic acids using serial microplate dilution method measuring minimum inhibitory concentrations. Fractional inhibitory concentration indices were calculated. Quercetin and other polyphenolic compounds exhibited antibacterial action against the selected fish pathogens with mean minimum inhibitory concentrations ranging from 0.83 to 2.5 mg/mL. It was observed that fractional inhibitory concentration indices for combination of quercetin with gallic acid, p-anisic acid or cinnamic acid against Aeromonas salmonicida were less than 0.5, indicating synergistic interaction. However, the above combinations produced additive antimicrobial activity against Aeromonas hydrophila and Edwardsiella tarda. Positive antibacterial interaction was evident between quercetin and selected polyphenolic acids in vitro.

The prevalence, incidence, and characteristics of bacterial infections in patients infected with severe acute respiratory syndrome coronavirus 2 are not well understood and have been raised as an important knowledge gap. Therefore, our study focused on the most common opportunistic infections/secondary infections/superinfections in coronavirus disease 2019 (COVID-19) patients.

Throughout the world, there have been drastic decline in mortality rate in pediatric leukemic population due to early diagnosis and improvements in oncology treatment. The pediatric dentist plays an important role in the prevention, stabilization, and treatment of oral and dental problems that can compromise the child's health and quality of life during, and follow up of the cancer treatment. This manuscript discusses recommendations and promotes dental care of the pediatric leukemic patients.