Background:This study aimed to estimate the prevalence of candidemia, describe its clinical and risk factor profile, evaluate the diagnostic performance of serum (1→3)-β-D-glucan (BDG) compared with blood culture, and assess outcomes among probable sepsis patients with candidemia. Methods:A cross-sectional diagnostic study was conducted at a tertiary care referral hospital in North India between October 2022 and January 2024. Consecutive probable sepsis patients in whom empirical antifungal therapy was considered were enrolled. Data were collected using a structured questionnaire, serum BDG estimation (Fungitell® assay), and blood cultures using the BacT/Alert® system. Statistical analysis was performed using R version 4.2.3 and IBM SPSS Statistics v20.0. Results:Sixty-three patients were included, with a mean age of 56 ± 20 years; 73.0% were male. Culture-positive candidemia was detected in 31 patients (49%). Mean BDG levels were significantly higher in culture-positive cases compared with culture-negative cases (150.10 ± 32 vs. 68.62 ± 6.5 pg/mL), with an odds ratio (OR) of 4.59 (95% confidence interval [CI]: 1.40-14.96). The BDG assay demonstrated a sensitivity of 84% and specificity of 47%, with positive and negative likelihood ratios of 1.58 and 0.34, respectively. Diagnostic accuracy was 65%, and the number needed to diagnose was 3.25. Fever was a significant clinical risk factor, with an adjusted prevalence OR of 15.7 (P = 0.023). Conclusion:The BDG assay demonstrates high sensitivity for candidemia but limited specificity, requiring cautious interpretation. It is best used as an adjunctive screening and decision-support tool to guide early empirical antifungal therapy in high-risk intensive care patients.

Introduction:Nowadays, hypertension is seen in the young in whom it has a potential to cause target organ damage. The importance is to diagnose the secondary causes of hypertension in young and treat them to reduce morbidity and mortality. This study was planned for looking into the clinical profile of hypertension in young patients with the objective to evaluate the etiological profile in them.Materials and Methods:This was a cross-sectional observational study carried out at tertiary care center from July 2021 to June 2022. All patients with hypertension below 35 years of age were systemically reviewed using a predesigned preapproved standardized pro forma. The patients were evaluated for all causes of secondary hypertension; else it was labeled as primary hypertension.Results:About 33.3% of patients were diagnosed to have primary hypertension and 66.6% of patients were diagnosed to have secondary hypertension. The 2:1 male-to-female ratio was seen in this study with mean age of 30.6 +/- 3.8 years. The mean body mass index was 24.2 +/- 2.3 kg/m2. About 13.3% of patients had a family history of hypertension, 40% were smokers, 33.3% had cardiac involvement, 26.7% had renal involvement, and 23.3% had eye involvement. Twenty percent of patients had raised low-density lipoprotein, whereas 16.7% of patients each had reduced high-density lipoprotein and hypertriglyceridemia. Ten percent of patients had associated type 2 diabetes mellitus and 3.3% had impaired fasting glucose.Conclusion:This study found that the majority of young patients had the secondary cause of hypertension which may be amenable to cure in certain cases. Hence, it is important to do extensive screening. This is further highlighted in young male hypertensive cases.

Background:Younger people are being afflicted with the pandemic of diabetes mellitus (DM). Although DM is conventionally classified based on insulin requirement at a primary level, there is a large spectrum of DM in young. All subtypes of DM have their exclusive management strategy and 'one size fits all' strategy can lead to adverse clinical outcomes. Hence, all efforts should be put to differentiate individual entities of DM subtypes by applying appropriate clinical and laboratory tools. Materials and Methods:This observational cross-sectional study was conducted between December 2020 to March 2022 in 30 patients of age <35 years with established diagnosis of DM as per American Diabetes Association (ADA) criteria. Their clinical profile, Anti-GAD-65 Ab, abdominal imaging and genetics tests were used for the classification of DM and studying their clinical peculiarities. Results:The mean age of patients was 30.53 +/- 5.6 years and the group was male predominant, consisting of 22 (73.33%) males and 8 (26.67%) females with a ratio of 2.75:1. The main subtypes of DM detected in this study after application of the study protocol was as follows type 1 DM (T1DM) in 12 (40%), type 2 DM (T2DM) 11 (36%), pancreatogenic DM 3 (10%), maturity-onset diabetes of the young (MODY) 1 (3.3%), Cushing's syndrome 1 (3.3%) out of 30 patients, and 1 (3.3%) patient could not be classified. The most common comorbidity noted was primary hypertension in 3 (10.0%), followed by primary autoimmune hypothyroidism in 1 (3.3%). All patients having primary hypertension had T2DM, whereas primary autoimmune hypothyroidism was seen in a T1DM patient. T1DM had higher glycosylated hemoglobin (HbA1c) levels (average HbA1c >8.9%) and ketosis 10 (83%) and 6 (50%) out of 12 patients, respectively, as compared to T2DM patients in which lower HbA1c levels (average HbA1c <9%) and lower incidence of ketosis seen in 3 (27.2%) and 2 (18.1%) out of 11 patients, respectively. Conclusion:Various clues in history, clinical examination, and laboratory evaluation help in classification and establishing diagnosis among young DM patients. Apart from T1DM and T2DM, other subtypes of DM also need to be considered in young DM patients.

Introduction: Subclinical Autonomic Neuropathy is found in association with distal symmetric polyneuropathy in diabetic patients. The Aim of this study was to compare the Cardiac Autonomic Function Test parameters in Type 2 Diabetes Mellitus patients with and without Distal Peripheral Neuropathy. The Primary Objective was to compare the mean of Valsalva ratio in Type 2 Diabetes Mellitus patients with and without Distal Peripheral Neuropathy. The secondary Objective of this study was to find the correlation between Michigan Neuropathic Screening Instrument Score and Autonomic Function test parameters in type 2 Diabetes Mellitus patients. Methods: This was a single centre, cross sectional study conducted from July 2022 to Feb 2023. The study was commenced after obtaining Institute Ethics Committee clearance. Subjects who satisfied the inclusion and exclusion criteria, and gave informed consent for participation in this study were eligible for enrolment. The inclusion Criteria were patients aged between 18 and 65 years with diagnosis of Diabetes mellitus. The number required to study Diabetic patients with peripheral neuropathy was 34 and for Diabetic patients without peripheral neuropathy was 34. Total sample size of 68 patients was taken. Once the patient was enrolled a detailed history, clinical examination, ANS testing and MSNI scoring was done as per attached pre verified proforma duly vetted by institutional scientific committee.Patients were asked to refrain from vigorous exercise for the 24 hours before to the cardiovascular testing as well as from eating, drinking, or smoking for at least 2 hours before the autonomic testing. At the conclusion of the checkup, all antidiabetic and other prescriptions were given. After data collection, test for normality of data was done. Appropriate statistical tests were applied according to data distribution and analysed by using SPSS criteria 2011. Results: A total of 68 patients, 34 with symptoms of Diabetic Peripheral Neuropathy and 34 without Diabetic Peripheral Neuropathy were studied from July 2022 to December 2023. The age, BMI, duration of disease, HbA1c, resting systolic blood pressure and heart rate didn’t show any significant difference between the two groups and thus the groups were comparable. The median (interquartile range) of MNSI score of diabetic patients without neuropathy was 1(1,1) and diabetic patients with neuropathy was 8 (7,9) with p value < 0.005. There was a significant difference in E: I ratio ( P <0.0001) between diabetic patients with and without neuropathy. The mean ± SD of Valsalva ratio, in diabetic patients without neuropathy was 1.632 ± 0.115 and with neuropathy was 1.366 ± 0.045. There was a significant difference in Valsalva ratio ( P <0.0001). There was a good negative correlation between MNSI score and Valsalva ratio with r= -0.769 and p value < 0.0001 in Type 2 Diabetes mellitus patients. Conclusion: This study found that the Cardiac Autonomic Function Test parameters in Type 2 Diabetes Mellitus patients with and without Distal Peripheral Neuropathy, were significantly deranged in patients with symptomatic DPN. The mean of Valsalva ratio was significantly different in two study groups. The correlation between Michigan Neuropathy Screening Instrument Score and Autonomic Function test parameters in Type 2 Diabetes Mellitus patients showed strong negative correlation. The patients with symptomatic DSN were found to have higher MSNI scores, who in turn were having severe cardiac autonomic dysfunction. Recommendation of Study: Mean Valsalva ratio and MNSI testing are recommended to be used as a screening tool to assess cardiac autonomic functions as a low cost tool in patients of T2DM having symptoms suggestive of DSN.

We highlight two adult cases of secondary HLH triggered by mycobacterium tuberculosis. The first case, a 68-year-old succumbed to his illness due to lack of a definitive ante mortem diagnosis and rapid disease progression. In contrast, the second patient received a rapid evaluation and prompt diagnosis, with timely initiation of ATT and complete recovery. Both patients had evidence of disseminated tuberculosis with involvement of multiple organs, including the lungs, pleura, spleen, liver, and bone marrow. Prompt recognition and treatment of tuberculosis in patients with HLH are vital to prevent rapid disease progression and reduce mortality that to in developing countries like India where tuberculosis is more prevalent.

INTRODUCTION The rice eater is weightless like a bird; the one who eats Jowar is strong like a wolf: one who eats Raagi remains "nirogi" (illness-free) throughout his life – an old South Indian saying.[1] Millets are small-seeded annual grasses that are grown as grain crops, in dry areas of temperate, subtropical, and tropical regions with uniqueness in their short growing season.[2] In July 2018, India proposed a resolution to the Food and Agriculture Organization (FAO) for the observance of the International Year of Millets (IYM) 2023 which was adopted by the United Nations General Assembly in March 2021.[3] This resolution not only considers the nutritive benefits but also the climate-resilient generation, genetic diversity, sustainable production, and consumption of millets. The slogan for IYM 2023 is "Rich in heritage, full of potential" with a main theme around the 4 Bs, i.e., Better production, Better nutrition, Better environment, and Better life.[4] HISTORICAL BACKGROUND Although it is said that millets have possible origin in Wild African grasses in the Nile valley and the Sahel zone and are subsequently taken to Asia, the Americas, and Europe, Ayurveda, the ancient system of medicine in India which is more than 5000 years old, mentioned millets as belonging to the group of Trina dhanya varga (grains produced by grass-like plants) with various synonyms such as Trinadhanya, Shudra dhanya, and Kudhanya. It has been stated in Ayurveda classics that "" i.e., being thin is preferable to being obese, and the Laghu, Lekhaniya property of millets, with low glycemic content and the added benefit of long-term satiety, making it an excellent choice as food for a healthy life.[5,6] Ayurveda also mentions the qualities of millets in terms of humors (Tridosha), as depicted in Table 1.[7]Table 1: Qualities of millets as per principles of AyurvedaBefore the irrigation system was developed, millet used to be a staple in Asian and African cultures due to drought-resistant adaptations.[8] In the 19th century, especially postindependence, millets have been gradually superseded by wheat, rice, maize, and potatoes.[9] Green Revolution in India in the 1960s majorly focused on and promoted the cultivation of high-output and resistant strains of wheat. Besides, several factors such as the distribution of wheat and rice in the Public Distribution System (PDS), advanced research, and perfection in the cultivation of wheat and rice, pushed the millet's cultivation, production, and demand to the marginal side. The myths and misconceptions surrounding millet such as "Poor digestibility", "Animal food", "Low in nutrients", "Coarse cereal", etc., have led to decreased demand of millets. This all retarded the millet's growth to become a mainstream staple over the nation. NUTRI-CEREALS AS NATURE'S NUTRACEUTICALS The Ministry of Agriculture and Farmers Welfare (Government of India) recognized the importance of millets and declared millets as "Nutri-cereals" and observed 2018 as the "National Year of Millets" to prioritize and recognize the millets from production, consumption, and trade point perspective.[10,11] Various millets are enumerated in Table 2.Table 2: Classification and enumeration of milletsIt contains bioactive photochemical, namely feraxans, lignans, β-glucan, inulin, resistant starch, sterols, and phenolic compounds such as ferulic acid. Studies had proven its antioxidant, anticarcinogenic, anti-inflammatory, antiviral, and neuroprotective activities which in all have shown to be beneficial against diseases such as cancer and cardiovascular disease, diabetes, high blood pressure, high cholesterol, inflammatory diseases, metabolic syndrome, and Parkinson's disease.[12] APPLIED NUTRITIONAL ASPECTS Millets, often regarded as smart foods, have high nutrient content which includes protein, essential fatty acids, dietary fiber, B vitamins, and minerals such as calcium, iron, zinc, potassium, and magnesium. Millets are estimated to have a mean glycemic index of 42.4–63.[13] Most of the millets exhibit similar properties, but in particular, sorghum contains slowly digestible starch which has the functional property of prolonging digestion and absorption of carbohydrates in the intestine which is favorable for the dietary management of metabolic disorders such as diabetes and hyperlipidemia and pearl millets are known to increase insulin sensitivity and lower the level of triglycerides, thus helping in overcoming insulin resistance both in prediabetes and in Type 2 diabetes mellitus. Owing to the high fiber content in millet, they release glucose into the blood at a slower rate as compared to other foods. This effectively helps in maintaining the blood sugar level constant in diabetes patients for a long period.[14]Table 3 depicts the nutritive value of different types of millets in comparison with wheat and rice.[15]Table 3: Nutritional content of millets in comparison to wheat and rice (as per 100 g of edible portion)INTERNATIONAL YEAR OF MILLETS 2023 Millets are among the first domesticated crops being grown in 131 countries with more than 30 countries depending on it as staple food. Observing IYM not only raises awareness about increased millet production and consumption but also through millet health needs and food security can be targeted. Millets are a rich source of iron, zinc, folate, and calcium.[4] They have a low-glycemic index, are gluten-free, and are high in protein, fiber, and antioxidants. Hence, millet can easily fit into global food trends and fads. Aims To strengthen science-policy action To empower stakeholders to act To build new partnerships while strengthening the existing ones. Objectives To elevate the awareness of the contribution of millet to food security and nutrition To inspire all stakeholders, including national governments to work toward improving production, productivity, and quality of millet Governments to work toward improving production, productivity, and quality of millet. NUTRITIONAL AND FOOD SECURITY As per FAO, sustainable nutrition can lead to the sustainable transformation of the agrifood system.[16] Nutritional insecurity is a major threat to the world's population which is highly dependent on cereal-based diet which is deficient in micronutrients. The dietary transition from traditional to modern foods is considered to be one of the main reasons for diet-related noncommunicable illnesses as well as malnutrition in India. Millets are nutritionally superior as their grains contain high amounts of proteins, essential amino acids, minerals, fibers, and vitamins. Millets are smart food, good for human health, good for the farmer as resilient and climate-smart, and good for the environment requiring less water and ensuring a low-carbon footprint. Millets can grow on arid lands with minimal inputs, are resilient to changes in climate, and are recognized to have the potential to solve global nutritional security challenges and as a sustainable alternative to major cereals. They are, therefore, an ideal solution for countries to increase self-sufficiency and reduce reliance on imported cereal grains. Millets have the potential to assume significance not only for food security but also for nutritional security in India because of their hard nature and ability to grow in rain-fed lands with very little agricultural inputs and richness of many nutrients as compared to most of the cereals.[17] OPPORTUNITIES UNFOLDED BY MILLETS AS A ROAD TOWARD SUSTAINABLE DEVELOPMENT GOALS Sustainable development goal 2 (end hunger) Millets can strengthen the fight against hunger and contribute toward food security. Millets are often the crops cultivated and help to overcome food scarcity in the dry season, in poorly fertile soils alongside providing land cover which reduces soil degradation and promotes biodiversity. Sustainable development goal 3 (good health and well-being) Millets are rich sources of minerals, dietary fiber, antioxidants, and protein. Their inherent low-glycemic index, make them safe for diabetics and obese. As millets are gluten-free, they provide another good alternative to gluten-sensitive enteropathy. Sustainable development goal 8 (decent work and economic growth) With the rise in demand for cereals such as wheat, maize, or rice, production and demand for millet have declined. By raising awareness about millets and regaining market opportunities, millets hold the potential of revenue for smallholders in the food sector. Millets hold a strategic position to guarantee food security, especially in areas where they are culturally relevant. Sustainable development goal 12 (sustainable consumption and production) Millets despite their high potential account for <3% of the global grains trade. Greater trade in millets can significantly increase the diversity of the global food system and cushion the effects of risks related to production shocks. Digitalization, transparency, and promotion for a stable market for both volumes as well as prices of millets can ensure stability and sustainability at par with other cereal traders. Sustainable development goal 13 (climate action) and sustainable development goal 15 (life on land) Millets can grow on arid lands with minimal inputs and maintenance due to their inherent climate-resilient nature. They are tolerant/resistant to diseases and pests leading to a better sustainable agrifood system on land minimizing the use of pesticides. DEDICATED INSTITUTIONS Indian Council of Agricultural Research-Indian Institute of Millets Research (IIMR) and Millet Network of India (MINI) are the dedicated bodies that support the farmers as well as consumers with specific advanced research in production, genomic studies, targeted benefits for noncommunicable diseases as well as campaigning the legislative motion to include millets as subsidized foods. IIMR has launched its brand name "Eatrite" to promote millet-based products. The recipes on the consumption of various millets which include the supplementary action of various proteins have been released in the form of the booklet as Millet Recipes – A Healthy Choice and the same initiative also undertaken by MINI. Recipes, nutritive value, composition, and comprehensive guidance on millets can be accessed from the link provided in the reference.[18,19] THREATS RELATED TO MILLETS/CRITICISM OF INTERNATIONAL YEAR OF MILLETS Millets are rich in tannins and phytates which interfere with the absorption of minerals.[20] Hepatotoxicity – aflatoxins are a group of mycotoxins produced from Aspergillus flavus and Aspergillus parasiticus commonly known as storage fungus, which infests food grains including millets such as sorghum. Aflatoxins are hepatotoxic and are incriminated in liver cirrhosis as well as carcinoma. Four hundred cases and 100 deaths have been reported in Rajasthan and Gujarat in 1975. Ergotism – unlike Aspergillus, ergot is a field fungus (Claviceps purpurea) that gets harvested along with grains (bajra, rye, and sorghum) leading to ergotism which is characterized by acute symptoms of nausea, repeated vomiting, giddiness and in chronic cases can lead to painful cramps and peripheral gangrene due to vasoconstriction. Endemic ascites – Crotalaria seeds contain pyrrolizidine toxin which leads to endemic ascites and has a tendency to contaminate millet Panicum miliare (Gondhli) as weed seeds, which is particularly consumed by the local population in Madhya Pradesh (MP). These weed seeds have been incriminated in the outbreak of ascites and jaundice in 1973 and 1976 in the Nagesia tribes of MP.[21] History is replete with evidence of millets being a staple in the precultivation as well as cultivation eras. Indian emperors have been known to consume millet-based diets till as late as the 18th century.[8] In Uganda, where millet is a staple diet, people identify their ethnicity with the type of millet taste, delicacies, food choices, and way of consumption which strengthens the motto of IYM "Rich in Heritage and Full of Potential".[22] Furthermore, moderate evidence to prove efficacy on the growth of children has been generated in a systematic review and meta-analysis.[23] In the present era of sustainable development, millets carry a huge potential to regain their position as a mainstream staple food and be at par with wheat and rice, provided that advance research is dedicated to millets, timely policy action is taken like distribution of millets in PDS, stakeholders are empowered, farmers are encouraged through legislation and free insurance, and people are made aware of their benefits to increase their demand and reduce the demand–supply mismatch. CONCLUSION Millets are in a true sense the nutri-cereals and nature's handpicked nutraceutical. Unfolding their potential and bringing them in streamline at par with cereals can not only solve the crisis of nutritional and food security but also lead to climate-resilient production, responsible consumption, and road to health as well as SDGs. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Background Clostridium difficile (C difficile) is one of the leading causes of nosocomial diarrhea in developing countries. It is a commonly encountered infection in the ICU setting where critically ill patients are at significant risk. The aim of this study was to study the clinical and microbiological profile of Clostridium Difficile Infection (CDI) in intensive care unit (ICU) settings of a Tertiary Care Hospital with the primary objective to find out the prevalence of C difficile diarrhea among the patients and the secondary objective to find out the utility of Glutamate Dehydrogenase (GDH) in screening for such patients. Methods This was a single center, prospective, diagnostic study conducted from July to Dec 2023. The study was carried out after obtaining clearance from the Institute Ethics Committee. As per a 2017 study done by Segar et al, keeping the tolerable error as 1.5 at 95% confidence interval, minimum sample size was found to be 200. Results The prevalence of CDI among ICU patients was 6% and among diarrheic patients the prevalence was 20%. GDH showed a sensitivity and specificity of 100% with all cuture positive cases of CDI also showing GDH positivity. The length of ICU and hospital stay among CDI patients (28±17 days/56±17 days) was significantly longer compared to non CDI patients (11 ± 06 days/26 ± 18 days) (p-0.003). The overall hospital mortality among ICU patients with CDI patients was 33% as compared with 25% among those without CDI thus showing a statistically significant difference in mortality risk (p-0.030). Conclusion It is concluded that there is a need for additional prevention and treatment studies in this setting. No correlation could be established between the choice or duration of antibiotic therapy and the development of CDI. Similarly no correlation could be established between the primary diagnosis for admission of the patient and development of CDI.

Introduction Coronary Artery Disease (CAD) in less than 45 years of age is termed as young onset CAD. There is an alarming increase in young-onset CAD in Low- and Middle-Income countries, especially in the Asian Subcontinent. Aim and Objectives The study aimed to estimate the clinical profile, risk factors, and post-angiography outcome at six months among young-onset CAD patients. Method A prospective study was conducted at a national, tertiary care, government referral hospital in North India, from October 2022 to November 2023. All patients undergoing coronary angiography following CAD and less than 45 years of age were enrolled after obtaining informed consent. Data was collected using a structured pilot-tested interviewer-administered questionnaire and review of medical records and analysed using R version 4.2.3. Results The study included 55 patients with a mean age of 39.2 years and majority being males. The common risk factors observed were smoking (36.3%) and dyslipidemia (9%). Most of the participants presented with dyspnea and chest pain together (30.9%). The NYHA class at presentation was class III (73%). 5.5% had thrombocytopenia, transaminitis was in 14.5% and 36.7% had dyslipidemia. CRP was increased in 52.7% and abnormal cardiac markers in (63.6%). The ECG showed ST depression, T Inversion (51%), ST elevation (29%), left ventricle hypertrophy in 3.7%. Chest x-ray showed cardiomegaly in 16.4%. Coronary angiography showed that among total patients 60% had single vessel disease, 21.8% had double vessel disease and 18.2% had triple vessel disease. Further 32.7% were diagnosed NSTEMI, 29.1% with STEMI and 16.4% each had stable and unstable angina respectively. 20% had EF 45%- 55%, 11% had EF <45%+ hypokinesia, 5.5% had EF <45%, 3.6% each had EF 45%- 55%+ hypokinesia and EF <45%+ Hypokinesia+ Valvular insufficiency respectively and 1.8% had EF <45%+ valvular insufficiency. Angioplasty was done in 81.8% and CABG in 14.5%. At the 6th month of follow up NYHA grading was class I in 56.6% and class II in 37.8% and class III in 5.6%. The mortality rate was 3.6% (2 deaths) because of cardiac failure. Conclusion The study concludes that six month survival for the diagnosis was 96.4%. Modifiable risk factors (such as smoking, dyslipidemia, obesity) and non modifiable risk factors (sex and family history) both are directly associated with early Coronary artery disease. Majority of the patients presented with chest pain and dyspnea. The common biochemical derangements found were elevated CRP and cardiac biomarkers. In non invasive tests ECG and 2D Echocardiography were found to be good tools for evaluation of CAD as ECG changes such as ST elevation, T wave inversion, ST depression etc and 2D Echo findings like Reduced ejection fraction and regional wall motion abnormalities have been recorded in most of the patients. Angioplasty was done and after performing angioplasty patients showed improvement. At 6 months follow up NYHA score significantly improved i. e. Class 1 and class 2, and the patients were asymptomatic. During study among 55 patients 2 deaths were reported mainly because of cardiac failure.

In the history of medicine, the discovery of insulin marked a turning point. At first, the only form of insulin that could be administered to humans was this secretion from animal pancreas. Since its conception, technologies for purifying and altering insulin have been developed, although they are still a long way from simulating pancreatic-cells' natural production. The precise structure of the insulin molecule had been uncovered by the late 1950s, and with the development of molecular biology and recombinant DNA techniques, it is now feasible to manipulate genes to produce recombinant human insulins. This opened the door for the creation of short-acting analogs to mimic postprandial insulin secretion and long-acting analogs to mimic basal or background insulin secretion. The patients can more closely mimic pancreatic insulin secretion thanks to the characteristics of the new basal and bolus analogs than they could with the earlier insulins. However, there are still issues with the absence of portal delivery, night-time dip, morning surge, and responsiveness to ambient blood glucose. There are a number of noninvasive methods being researched for the delivery of insulin, including transdermal, buccal, oral, and pulmonary routes. The hunt for insulin that precisely mirrors the physiological profile and has improved stability, less variability, and perhaps selective action, is still ongoing.

Background: Acute respiratory distress syndrome caused by severe acute respiratory syndrome coronavirus 2, is a challenge to health-care system in the recent times. The nonavailability of specific treatment and rapid spread through aerosols has impacted the countries worldwide. Research on the subject is continuous, to understand the pathology and pathophysiology of the condition. In this regard, diagnosis of the disease, severity stratification and clinical prognostication helps the clinician to plan the management. Literature is silent on clinical biomarkers for this novel disease. Hence, a study was carried out to find out a suitable clinical biomarker for the disease. Methodology: The author carried out a retrospective analysis of the fatal case records of a tertiary center COVID intensive care unit to evaluate whether Carbon dioxide gradient can be used as an end-stage marker of COVID pneumonia. A record-based observational study was conducted and data were collected from the fatal case documents after an institutional ethical committee clearance. Results: A total of 42 fatal cases were analyzed. Carbon dioxide retention was found in more than 90% of cases and raised carbon dioxide gradient (>5 mmHg) was found in more than 50% of cases. The average days of mechanical ventilation was 9 days and on average, after 5 days of ventilation patients developed raised carbon dioxide gradient. Conclusion: We conclude that raised carbon dioxide gradient may be chosen as an end-stage marker for COVID pneumonia though large group studies are recommended.

Photonic crystals (PhCs) are spatially organized structures with lattice parameters equivalent to the operational wavelength of light. PhCs have been subject to extensive research efforts in the last two decades and are known for controlling light propagation with applications in sensing and time-delayed communication due to the slow-light phenomenon. Despite their exceptional properties, PhCs are difficult to fabricate using planar micromachining techniques due to their periodic structures. Techniques like two-photon stereolithography have been discussed for PhC fabrication in the literature, but the inherent disadvantage of poor refractive index (RI) contrast results in limited application. In this work, we present sequential infiltration synthesis performed on two-photon stereolithographically printed 3D PhCs for infiltration with zinc oxide to increase the RI of 3D PhCs. Finite element analysis was performed over a range of RI contrast values to study the change in photonic bandgap (PBG) with RI contrast. The transmission spectra were recorded on 3D PhCs before and after infiltration to demonstrate the change experimentally. An increase in the PBG width and absorbance is seen postinfiltration due to enhanced RI. This work presents the first, to our knowledge, sequentially infiltrated enhanced 3D PhC fabricated with two-photon stereolithography.

INTRODUCTION In recent years, the emergence of unparalleled global health concerns has prompted significant changes in multiple sectors, particularly in health-care and medical education. The emergence of novel infectious organisms has given rise to a series of issues that extend beyond local bounds, resulting in a global proliferation of medical emergencies.[1] The swift and substantial impact of these health concerns on global populations has firmly established their significance in the annals of contemporary medical history. Health-care systems globally have faced significant challenges, encompassing not only evident issues such as overwhelmed hospital capabilities and increasing patient volumes but also more nuanced and profound consequences. The field of medical education, specifically focusing on the training of surgical residents, has experienced significant transformative developments.[2] HISTORICAL CONTEXT Throughout history, the field of medical education has experienced numerous transformations. The field of study has consistently adjusted to the evolving needs of the era and the dynamic landscape of health care, similar to the broader field of medicine.[3] Throughout history, the medical profession has evolved from informal, individualized apprenticeships, in which experienced physicians imparted their knowledge to inexperienced individuals in close, practical settings, to more organized and structured educational models that revolve on predetermined curricula. The second half of the 20th century, as an example, observed numerous breakthroughs in technology and pedagogy. These included the introduction of simulation laboratories, standardized patient programs, and a heightened focus on evidence-based teaching.[4] Nevertheless, the medical community has faced unprecedented challenges due to recent global health crises, which have exposed the limitations and impracticality of old techniques.[5] The fundamental nature of a surgical residency program is centered around the application of practical skills and the acquisition of knowledge through direct experience, which in turn requires regular engagement and prompt evaluation.[6] The program relies on mentor–mentee interactions, direct observations, and a range of surgical techniques to cultivate in residents the essential confidence and skills required for the profession. The educational model has been significantly impacted by current health crises, leading educators and medical institutions worldwide to reconsider, assess, and redefine their approaches.[7] This paper thoroughly examines the numerous problems and the unique ways that arose in response. This study aims to provide significant insights into the immediate adjustments prompted by the crises, as well as prospective future trajectories for surgical resident training within a continuously changing global health context. ESSENCE OF SURGICAL RESIDENCY The fundamental aspect of surgical residency lies in its experiential nature, which places significant emphasis on practical application and hands-on training.[4] The enrichment of this experience is facilitated through the provision of quick feedback, interactions between mentors and mentees, and exposure to a diverse range of surgical procedures. Nevertheless, the present crisis has subjected these foundational principles to critical examination, hence necessitating a strategic reassessment. IMPACT ON TRADITIONAL TRAINING The traditional basis of surgical education has primarily revolved around practical learning opportunities within real-life clinical environments. However, the emergence of global health concerns has resulted in a fundamental change in the existing educational framework.[8] Certain areas that were previously filled with a vibrant instructional atmosphere, such as operating theaters, have now transformed into zones that require increased levels of prudence.[9] Cancellation of elective surgeries The occurrence of health crises necessitated a prioritization of medical operations, resulting in critical surgeries being given priority over elective ones.[10] The use of measures designed to conserve resources and reduce patient risk has led to a noticeable delay in the training advancement of surgical residents. There has been growing apprehension regarding the reduced level of resident engagement in specialized surgical procedures, such as otological and rhinological surgeries.[5] This has prompted inquiries regarding the potential impact on the quality of future surgical practices. Clinical clerkship disruptions In addition to the technical aspects of surgical operations, residency training encompasses the acquisition of soft skills through mentorship and patient consultations.[11] The implementation of physical separation measures during the health crisis has impeded the crucial educational interchange, resulting in the deprivation of residents from critical clinical experiences. Educational challenges Both practical training and theoretical education were affected.[3] The postponing or cancellation of vital workshops, surgical demonstrations, and specialist courses was encountered. The frequency of regular academic events, such as inter-departmental debates, decreased significantly, resulting in a pressing demand among residents for a cohesive learning framework.[12] Safety protocols The utilization of personal protective equipment has emerged as a critical aspect of ensuring safety. However, its implementation has also presented obstacles in the context of surgical education.[13] The implementation of these procedures occasionally resulted in a decrease in the quality of training as a consequence of limited access to the operation room and reduced opportunities for patient encounters. INNOVATIVE VIRTUAL SOLUTIONS In light of the challenges presented by the health crises, the medical community promptly adapted by using technology and fostering innovation. The current period observed a phenomenon commonly referred to as a “digital renaissance” in the field of medical education.[7] Digital platforms and global interaction The adoption of online platforms, such as Zoom® and Webex®, represented a notable divergence from traditional methods of education.[6] The utilization of live-streamed surgical procedures, accompanied by insightful expert analysis, has brought about a significant transformation in the field of surgical education, effectively eliminating the limitations imposed by geographical boundaries. Enhanced simulation-based training The significance of simulation in medical training has been more prominent during these challenging circumstances.[5] Simulation tools have become crucial in situations where direct surgical exposure is not available. Sophisticated virtual reality simulations and haptic feedback technologies offer immersive experiences that accurately replicate intricate surgical procedures. Cutting-edge software has been developed to simulate complex surgical procedures, incorporating tactile feedback tools to aid with the retention of surgical tactile memory among medical residents.[14] Universal resident engagement The transition of events such as ENT conferences to an online format has presented unanticipated benefits.[15] The removal of physical limitations enabled a wider range of individuals to engage, promoting an inclusive and diverse interchange of intellectual viewpoints. Empowering self-directed learning The limitations imposed by the crises prompted the inhabitants to engage in self-directed learning.[3] The popularity of online platforms providing tailored surgical content has experienced a significant increase, allowing residents to have greater control over customizing their educational paths. The innovative methods have effectively addressed the obstacles posed by global health concerns in the realm of surgical education. The medical community has demonstrated resilience, adaptation, and a forward-thinking mindset, suggesting a potential evolution toward a more comprehensive and adaptable surgical education system. ANALYSIS OF VIRTUAL TRAINING’S STRENGTHS AND WEAKNESSES: WEIGHING THE DIGITAL SCALE The transition from conventional medical practices to the digital realm represents not only a significant technological advancement but also a compelling imperative driven by the demands of the era. Although the virtual environment presented numerous benefits, it was not devoid of its own unique set of obstacles: Strengths: The digital dividends Accessibility and flexibility: A universal platform The advent of the digital revolution has led to a reduction in the constraints imposed by geographical and institutional barriers. The formerly inaccessible regions of the world now possess a means of accessing the knowledge and expertise of esteemed physicians and researchers. These platforms have facilitated the democratization of medical education, hence providing equal possibilities to all individuals.[3] Structured curriculum: Customized learning pathways Digital modules offer learners the opportunity to engage with structured content in a manner that suits their preferences, enabling them to pause, replay, or skip specific segments as desired.[16] The self-directed nature of this learning approach has demonstrated its efficacy in facilitating the understanding of complex topics. The user’s text does not contain any information to rewrite. Economical solutions: Redefining the cost of learning Virtual platforms have significantly decreased various costs, including those associated with travel, accommodation, and registration fees for intensive workshops. The expansion of economic efficiency has resulted in the broadening of medical education, hence enhancing its inclusivity.[17] Weaknesses: The digital quandaries Erosion of personal connection: The diminishing human essence Historically, the field of medicine has greatly benefited from the establishment and maintenance of interpersonal relationships. Virtual learning, on the other hand, limited the interpersonal connection. The mentor–mentee interactions, camaraderie among peers, and spontaneous discussions were negatively impacted during the process.[18] Theoretical over experiential learning: A delicate balance The devaluation of practical experience has been brought about by the increased focus on theoretical components, which can be attributed to factors such as restricted access to operating rooms and the utilization of virtual platforms. Simulations have proven to be beneficial; yet, they are unable to replicate the intricate details and complexities of actual surgical encounters.[5] Technical hurdles: A gap in the digital landscape The digital domain presents several obstacles. Unequal learning experiences might arise due to several challenges, such as inconsistent internet connections and poor technical resources, which hinder some individuals’ ability to navigate this area proficiently.[19] EMOTIONAL CONSIDERATIONS: THE SILENT CHALLENGES FACED BY SURGICAL RESIDENTS The advent of changes in medical education has brought about a sometimes underestimated emotional influence. In addition to its implications for public health, the epidemic has presented considerable emotional obstacles for surgical residents. Dual responsibilities, singular beings The residents’ stress was exacerbated by the simultaneous challenges of adjusting to new educational requirements and contending with a health crisis.[20] Escalating mental health issues The medical faculties, which were once bustling with activity, underwent a notable transition into a state of unsettling silence. This shift has been associated with a rise in experiences of isolation, burnout, anxiety, and depression.[21] A compassionate approach In recognition of these difficulties, medical communities have established counseling services, and peer support groups, and placed increased emphasis on mental well-being.[22] The discernible effect of the epidemic on medical education was immediately observable, yet it also functioned as a nuanced assessment of the community’s psychological resilience. The future of medical education is based on the core principles of adaptability, creativity, and empathy. THE PATH FORWARD FOR SURGICAL RESIDENCY EDUCATION Embracing change The changes brought about by the pandemic will serve as the fundamental framework for the future, although they will be adjusted based on acquired knowledge and understanding.[23] Merging tradition with innovation Although historical surgical approaches possess their own merits, it is imperative not to overlook the possibilities of virtual platforms. The incorporation of both methodologies represents a progressive approach.[18] Preserving the surgical craft While virtual platforms provide valuable information, they are unable to fully duplicate the practical experience of hands-on surgery. The importance of striking a balance between theoretical knowledge and actual experiences cannot be overstated.[3] Mental health: A forefront concern The current situation underscores the increasing need to prioritize mental health to provide a whole educational experience.[24] Enduring resilience The reaction of the medical community to the pandemic serves as evidence of its capacity to adjust and persevere. The aforementioned attribute, which emerges as a result of challenging circumstances, is poised to significantly influence the trajectory of medical education in the next years.[22] CONCLUSION The field of surgical education has seen periods characterized by instability, enlightenment, and significant change. As the global environment undergoes a shift toward what is popularly known as the “new normal,” a distinctive opportunity arises. At this point, the medical community is prompted to contemplate, restructure, and improve surgical training, by combining traditional methods with innovative techniques. At the current juncture, the field of surgical resident education presents itself as a captivating area, characterized by a multitude of obstacles and opportunities, accompanied by a revitalized feeling of hope.

Disseminated melioidosis is rarely seen in Northern India. Presentation of melioidosis in the form of oligoarthritis and other musculoskeletal symptoms is further rarer. In this report, such a rare case of melioidosis and built-up to diagnosis was discussed. The aim of reporting this case was to know the diagnostic difficulties in identifying this entity and to create awareness of extremely important neglected tropical infection.

Photonic crystals (PhCs) have periodically structured alternating dielectric layers, creating an energy band structure that prevents certain wavelengths of light from transmitting through the PhC. This range of wavelengths is called the photonic band gap (PBG). An engineered defect in the dielectric layers creates a defect mode in PBG that allows a few wavelengths of light to transmit at a slower group velocity, known as slow light. The ability to slow down the group velocity of light can be used for enhanced sensing of gases due to enhanced light–matter interaction. In this letter, we present direct-laser-written 3-D PhC fabricated using two-photon polymerization for enhanced mid-infrared spectroscopy sensing of carbon dioxide (CO $_{2}$ ), a potent greenhouse gas. Finite element analysis was performed to study defect mode in a perfect 2-D PhC, later extended to 3-D PhCs. A group velocity study of the defect mode is also shown. Two-photon polymerization was used to fabricate 3-D PhCs to realize the defect mode experimentally. The PhC sensors targeting CO $_{2}$ detection were fabricated and tested for 1% CO $_{2}$ at a room temperature of 295 K. An enhancement factor of 12 with 95% 2 $\sigma$ confidence is achieved by the addition of PhCs resulting in enhanced sensing of CO $_{2}$ .

"Care more particularly for the individual patient than for the special features of the disease." –Osler[1] Treating the disease is an important aspect of a bigger goal of healing the patient, which we all should be capable of doing. William Osler, considered by many to be the greatest of clinicians ever born, once famously said "The practice of medicine is an art based on science."[2] By this, what he meant was that understanding deranged physiology no doubt fundamental to medicine, but paying attention to the patient's needs, hopes, and desire to understand the meanings behind their illnesses was equally important and needed to be addressed. Sadly, the teachings of Osler, that it is the well-being of patient, which is paramount, and not accurate diagnosis and effective treatment alone seem to have been forgotten by now over the past many decades.[3] To bring back the focus on the forgotten art of patient care, we offer these simple 10 solutions appropriate to our context, which have been largely inspired by Osler's aphorisms. STUDY THE PATIENT AS AN INDIVIDUAL let your patients know that they are more than work for you, treat them as equal, and if possible, be friends. be on time, spend time with your patient, and use the unique clinician–patient relationship to motivate your patient. the patient must have the freedom, autonomy, and self-determination in decision-making or at least expressing opinions about the different treatment options, including sharing of information, and about accepting instructions of the doctor. it empowers patients and also improves services and the health outcomes.[4] Let your patients know that they are more than work for you, treat them as equal, and if possible, be friends. Be on time, spend time with your patient, and use the unique clinician–patient relationship to motivate your patient. The patient must have the freedom, autonomy, and self-determination in decision-making or at least expressing opinions about the different treatment options, including sharing of information, and about accepting instructions of the doctor. It empowers patients and also improves services and the health outcomes.[4] "Learn to study patients, not cases or individuals, not diseases."[5] LISTEN TO THE PATIENT "Listen to your patient; he is telling you the diagnosis." –William Osler[6] Listen to patient's woes; don't just record or hear, but actually listen; the patient might guide you to the best management plan too. There are published literature, where just listening to the patients by honoring their understanding and wishes have led to not only better diagnosis but also better patient outcomes.[7] CLEAR THE DOUBTS OF THE PATIENTS Share knowledge with the patient and reassure frequently. Many patients have doubts which they often are afraid to ask the doctors. Address those in the language they understand without using much of medical jargons. One of the easiest ways to allay anxiety is to address their queries and doubts. EMPATHIZE Laugh and cry with your patient; once they know you care, they become well too. Peabody in his landmark article, written a century ago, highlighted the value of establishing personal relationship between the physician and the patient; the failure of which might account for much of the ineffectiveness in the care of the patients.[8] He famously wrote, "Young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine--or, to put it more bluntly, they are too "scientific" and do not know how to take care of patients."[8] HONE YOUR SKILLS Work on the knowledge and skills you have acquired; actively and passionately work on them to do better every passing day. The science part of patient care is the core foundation of patient care, without which patient care is meaningless. Remember, caring, communication (listening and explaining), and competence are the 3 C's of clinical confidence. Today, e-learning through multiple ways and many physical workshops being conducted in various specialties are a good avenue for honing one's knowledge and skills.[9] PAY ATTENTION TO DETAILS AND TAKE ENTIRE RESPONSIBILITY OF YOUR PATIENTS Although there are many stakeholders in patient care, as the primary doctor, you are the one that the patient is looking up to and rely on. Make an effort to understand the uniqueness of your patient and know everything about your patient as much as practical.[8] Every disease manifests differently in different individuals. Thus, studying the patient as a whole also gives us an opportunity to gain experience and learn beyond literature, and develop more insight about the disease. Clinical care means the care that is essential to maintain the health and safety needs of a patient, but is not limited to, assistance with medication administration, medical needs, nutrition, and supervision for safety as well as activities of daily living. This also provides an opportunity for us to win over our patients, by clarifying on any guilt the patient feels for the disease. BE KIND AND CHOOSE YOUR WORDS WISELY Think before you speak. Patients tend to remember everything from their meetings with doctors. Never lose your cool with patients, however busy you are in your daily practice. The hurtful comments or the comments made with indifference will be remembered lifelong, in spite of all your time and efforts. Always be kind, and your kindness will attract more and more patients to you. "People will forget what you did, but they will never forget how you made them feel." –Maya Angelou.[10] BE AVAILABLE Be approachable enough, so that they can ask anything and anytime from you as far as practically possible. One should take pride that our patient has faith in us and trusts us, for the patient seeks you in trouble, in whatever hour. As such, there is no use of the massive knowledge and skills, unless you are there, when you are most needed. IMPROVE YOUR COMMUNICATION SKILLS Improve your attitude toward patients by treating them with respect like cheerfully greeting them, a simple smile, using patient's name while interacting, making eye contact, saying "please" and "thank you" more often, and not showing any restlessness on your face while interacting with your patient. Remember, you may not get a second chance to make a first impression. FOLLOW-UP ON YOUR PATIENTS Follow up with your patients since admission till discharge and also after discharge. This not only helps in managing patients better but it is also a great gesture to express your genuine concern. It helps in checking progress of a patient, addressing any confusion between the doctor and the patient, and in adjusting management plan. Patients need to be approached person to person, away from all the constraints of medical jargon, technology, laboratory tests, and statistics. Develop a long-term relation with every patient for better patient outcome as well as meaningful patient satisfaction. To conclude, in one of the most cited and revered articles of all times, Peabody wrote: "Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient."[8] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Background: There is a need to study the performance, validity, and accuracy of cartridge-based nucleic acid amplification test (CB-NAAT) for accessing drug resistance among pulmonary tuberculosis (TB) compared with the solid culture drug susceptibility test (DST). Methods: Patients with symptoms of cough for more than 2 weeks with anyone symptoms such as night sweats, fever, and unintentional weight loss were studied. Cases with previously diagnosed drug-resistant pulmonary TB by sputum CB-NAAT having constitutional symptoms but not on any ATT for a minimum of 2 months were also included in the study. The patient's information, including age, immune surveillance status, clinical features, and chest X-rays, were recorded. Each sputum sample was divided into three aliquots and tested for smear microscopy, liquid culture (LC), and genotypic DST. Results of all three diagnostic modalities were compared with CB-NAAT reports. Results: Of 236 patients with sputum-positive CB-NAAT (n = 236), 49.4% (n = 117) were rifampicin resistant, while 50. 4% (n = 119) were rifampicin sensitive. The genotypic DST assays carried out of all enrolled patients showed that 76.3% (n = 181) patients were resistant to one or more first-line antitubercular drugs (FL ATTs) or second-line (SL) ATTs, while 23.7% (n = 55) patients were sensitive to all ATTs. Among all the study participants, 56.4% (n = 133) of patients had sputum smear-positive by ZN stain, while 88.6% (n = 209) showed growth on LC (BACTEC) media. On concordant analysis of CB-NAAT with DST assays, we found that among 119 CB-NAAT rifampicin-sensitive patients, 66 patients were drug-resistant (DR) TB to any of the FL or SL ATTs. The sensitivity, specificity, positive predictive value, and negative predictive value of CB-NAAT for detecting rifampicin resistance on sputum for pulmonary TB when compared with the gold-standard DST assays were 97.67%, 76.67%, 70.59%, and 98.29%, respectively. Conclusions: This study found that the use of rapid molecular technique (CB-NAAT) in screening DRTB at the community level is suboptimal compared to the gold-standard solid culture method. Although CB-NAAT's sensitivity in detecting DR pulmonary TB is significantly higher, the specificity is lower in that population who have received ATT earlier.