ABSTRACT Tropical cyclones (TCs) pose a serious threat to India’s 5400 km long continental coastline strip. The historical data (1891–2019) claims that four eastern coastline states experience cyclonic storms more frequently than other coastal states. The analysis of historical data shows that the Bay of Bengal (BoB) has faced more TCs than the Arabian Sea (AS), with a frequency ratio of approximately 3:1. Most TCs in the BoB occur during the pre-monsoon and post-monsoon seasons with powerful winds, huge storm surges, and significant rains. This study also reveals an increasing intensification rate of severe TCs over both the BoB and AS, supported by regression and moving average trend lines. Fani, an extremely severe cyclonic storm (ESCS), was unique storm because of being a rare summer cyclone. It was one of the three most destructive storms in the last 150 years. The Sentinel-1 Synthetic Aperture Radar (SAR) dataset has been used in the Google Earth Engine (GEE) environment to determine the amount of inundation in West Bengal (203.30 km2) and Odisha (129.81 km2). So, this recent article successfully presents an overview of historical TCs in the North Indian Ocean (NIO) and provides a detailed account of the ESCS Fani.

Introduction: Multidrug-resistant (MDR) Pseudomonas aeruginosa poses a major therapeutic challenge in tertiary-care settings, necessitating local, Clinical and Laboratory Standards Institute (CLSI) -anchored susceptibility data for empiric therapy and stewardship. This study characterises Ceftazidime– Avibactam (CZA) activity and Minimum Inhibitory Concentration (MIC) distribution to support stewardship and local guideline updates Aim: To evaluate the in-vitro activity of CZA against MDR Pseudomonas aeruginosa clinical isolates from a tertiary care hospital in North India. Materials and Methods: This was a hospital-based, crosssectional study conducted in the Bacteriology Division, Postgraduate Department of Microbiology, Government Medical College, Srinagar, Jammu and Kashmir, India, from January 2022 to December 2022 and included 108 non duplicate MDR Pseudomonas aeruginosa clinical isolates. Standardised workflows encompassed specimen culture and identification, Kirby-Bauer disc diffusion, and ceftazidime-avibactam MIC determination by E-test interpreted per CLSI M100 (2022), while demographic parameters recorded for context included age group and gender. Susceptibility was reported as proportions, and predictors of CZA non susceptibility were estimated using multivariable logistic regression. A p-value of <0.05 was considered statistically significant. Results: Ceftazidime-Avibactam susceptibility was 63/108 (58.38%) and exceeded most β-lactam comparators, while aztreonam showed the highest susceptibility at 98/108 (90.74%). The MIC distribution clustered at 2-8 µg/mL with a peak at 8 µg/ mL. In multivariable modelling, burn diagnosis {adjusted Odds Ratio (aOR)=2.15; 95% Confidence Interval (CI) 1.05-4.41}, carbapenem non susceptibility (aOR=2.72; 95% CI 1.34-5.51), and ceftazidime non susceptibility (aOR=2.08; 95% CI 1.01- 4.29) independently predicted CZA non susceptibility. Conclusion: Ceftazidime-avibactam was the most active among core antipseudomonal β-lactams, while aztreonam showed the highest overall susceptibility. The MIC histogram peaked at 8 µg/mL, with most isolates clustering between 2-8 µg/mL. Burn diagnosis, carbapenem non susceptibility, and ceftazidime non susceptibility independently predicted CZA non susceptibility

Candida tropicalis is a leading cause of invasive candidiasis in the Asia-Pacific region with reported crude mortality rates exceeding 50%. The rising prevalence of azole-resistant strains presents a significant clinical challenge. We analyzed 1,016 C. tropicalis clinical isolates collected over nine years from 27 hospitals across North India. Fluconazole resistance was detected in 5.1% (n = 52) of isolates, with cross-resistance observed to voriconazole in 55.7% and itraconazole in 44.2% of isolates. Multilocus sequence typing (MLST) analysis of global 1,630 isolates including 208 Indian and whole-genome sequencing of 716 global isolates (139 Indian) confirmed the clonal emergence and persistence of azole-resistant MLST clade 4 strains in Indian hospitals. Phylogenomic analyses identified that Indian azole-resistant lineage was closely related to azole-resistant isolates from mainland China and Taiwan. The underlying mechanism of resistance involved hotspot mutations (Y132F) in the ERG11 gene along with its duplication, overexpression, and twofold high ergosterol content. Comparative transcriptomics of two clinical isolates exhibiting >512 fold difference in fluconazole susceptibility identified upregulation of virulence-associated genes, ALS7 gene (eightfold), SAP7 and SAP9 (1.6- and 2-fold, respectively) in azole-resistant isolate. Furthermore, azole-resistant isolates showed robust biofilm-associated metabolic activity (twofold), reduced β-glucan exposure, and greater survival in both neutrophil and macrophage killing assays. Notably, azole-resistant lineage exhibits several traits associated with adhesion and immune evasion that could possibly enable its spread in healthcare settings and signals the beginning of a greater spread of this clone. The urgent need for continuous genomic surveillance and antifungal stewardship is warranted to mitigate the spread of multidrug-resistant C. tropicalis.IMPORTANCEInvasive fungal infections affect 6.5 million people annually and are associated with high mortality rates. Despite being the leading cause of invasive yeast infections in the Asia-Pacific, this is the first comprehensive study of Candida tropicalis from India documenting the emergence of azole-resistant clonal lineage (clade 4) in several hospitals in India. Azole resistance is driven by mutations, gene duplication, and overexpression of its target gene ERG11. The Indian azole-resistant isolates showed high genetic relatedness with those from China. Also, resistant isolate showed overexpression of virulence-related genes and robust biofilm formation. Notably, reduced β-glucan exposure in fluconazole-resistant isolates may contribute to their decreased susceptibility to the innate immune system. Importantly, this study provides evidence for the emergence of azole-resistant C. tropicalis lineage in India, which exhibits several traits associated with adhesion and immune evasion that could possibly enable its spread in healthcare settings leading to a public health concern.

Missed Opportunities in Tuberculosis (TB) Prevention in Pediatric Population: A Retrospective Observational Study From North India

Kufri Jamunia, is a table purpose purple fleshed main season potato varietyrecommended for cultivation in North Indian plains (Northern, Central and Eastern Plains). It is aclonal selection developed from the cross between MS/8-1148 √ CP4242. Its plants are medium tallwith medium maturity and produce dark purple oblong tubers with shallow eyes, purple flesh andmealy texture. The variety is capable of producing a total tuber yield of 32-35 t/ha. Kufri Jamuniapossesses medium dormancy of 6-8 weeks with very good keeping quality and moderate tuber drymatter of 17-19%. It is moderately resistant to late blight under laboratory conditions; however,it was found susceptible in field conditions. Owing to its purple colour and good organoleptictaste, the variety will attract growers, traders and consumers, adding novelty in the preparation ofvarious dishes.

Celiac disease (CD) risk conferred by HLA-DQ2 and DQ8 varies significantly across populations. In north India, where CD is as prevalent as in European populations, reports on the association of HLA-DQ2 and DQ8 with CD are limited. In a north Indian CD case-control cohort (459 CD and 450 controls), known CD-associated risk HLA-DQ alleles, HLA-DQA1*05:01/02:01/03:01 and HLA-DQB1*02/*03:02, were genotyped using SSP-PCR to uncover their frequency and association with CD. Published dense Illumina_Immunochip genotyping data of the study cohort were used to identify proxy-SNPs for HLA-DQ genotypes and their alleles. We also investigated the correlation between common CD phenotypes and DQ2/8 genotypes. Ninety-nine percentof the CD patients were found to carry HLA-DQ2.5, DQ2.2 or 8. HLA-DQA1*05:01 (OR = 5.86 [4.39-7.81], p < 0.0001) and HLA-DQB1*02 (OR = 16.61 [11.37-24.25], p < 0.0001) were identified as the strongest susceptibility alleles. HLA-DQ2.5 was present in 92% of patients and conferred the highest CD risk (OR = 29.01 [19.56-43.00], p < 0.00001), while DQ8 appeared protective (OR = 0.42 [0.25-0.70], p < 0.0001). HLA-DQ2.5/8 and HLA-DQ2.5/2.2 were found significantly associated with serum anti-tTG-IgA and skin conditions, respectively, among CD patients. rs1129740, rs9273012 and rs7744001 were identified as proxy-SNPs to efficiently predict the presence/absence of DQ2.5, DQ2.2, DQ8 and its alleles. This was the first well-powered study to evaluate the susceptibility of HLA-DQ in CD among the north Indian population. HLA-DQ2.5 showed a strong association with CD, conferring a higher disease risk, while DQ8 appeared protective, and the contribution of DQ2.2 was inconclusive. Three proxy-SNPs, rs1129740, rs9273012 and rs7744001, could be utilized to predict HLA-DQ genotypes as a cost-effective alternative for CD risk assessment.

Abstract Background: Gamified learning in medical education involves using game elements to improve learning behaviors and outcomes. Digital gamification is underexplored in community medicine. We aimed to assess students’ perceptions about gamified learning and their preference for individual or team-based participation, and compare the user experience between different digital platforms. Materials and Methods: We conducted this one-group posttest-only quasiexperimental study at a medical college in North India. We included students of Phase II and Phase III part 1 MBBS who had attended at least one gamified learning session of community medicine during the study period. We utilized six platforms per batch to deliver electronic quizzes for team-based (Classmarker and Nearpod) or individual participation (Formative, Google Forms, Quizizz, and Slido). We sought feedback using semistructured questionnaires. We used Jamovi version 2.3 for descriptive and inferential statistics. We performed manual inductive thematic analysis involving semantic-level coding of complete response units for qualitative data. Results: All 292 respondents (Phase II: 143; Phase III part 1: 149) attended at least three gamified learning sessions. Over 75% of the participants perceived gamification favorably across all parameters. Phase II students showed significantly higher favorability for perceived increase in interest (92.3% vs. 81.9%, P = 0.001) and engagement (87.4% vs. 83.2%, P = 0.003). Only 26.4% of students preferred team-based participation, with a higher preference in the junior batch (35.7% vs. 17.6%, P &lt; 0.001). Formative and Slido received the highest median scores (9/10). Conclusion: Gamified learning is a well-received adjunct to traditional medical pedagogy.

Gliomas represent the tumors of the central nervous system that originate from glial cells. Overall survival predictions and treatment regimen selection are based on accurate tumor diagnosis and grading. However, the diagnosis of glioma remains critically dependent on either invasive biopsies or advanced imaging. This exploratory study aims to assess the diagnostic potential of urine specimens for discriminating gliomas from controls and identify the dysregulated pathways in a North Indian cohort. Urine is an ideal non-invasive candidate, requires no prior preparation, and considerably increases patient compliance. Urine samples from 50 glioma patients were analysed with 1H NMR (Nuclear Magnetic Resonance) spectroscopy and compared with those of healthy controls. Statistical analysis was performed in MetaboAnalyst 6.0 to identify significantly perturbed metabolites. Diagnostic performance was assessed using the Receiver Operating Characteristic (ROC) curve, and the Random Forest model was used to evaluate classification accuracy. Pathway enrichment and topology analysis based on the KEGG (Kyoto Encyclopedia of Genes and Genomes) database were performed to identify dysregulated pathways. 1H NMR metabolic analysis of urine samples revealed seven statistically significant (p < 0.05) metabolites namely acetate, pyruvate, creatinine, dimethylamine, glutamine, alanine and carnitine. This panel of metabolites displayed excellent diagnostic capability with an Area Under the Curve of 0.90 as measured by a multivariate ROC curve. The random forest model efficiently differentiated glioma from control samples using significant metabolites. Disruption in the primary energy pathways of the body and in the metabolism of major amino acids was observed in the pathway analysis. Integration of these urinary signatures into current clinical practice can serve as an additional diagnostic tool and a non-invasive screening method for populations at risk. They can also be monitored in real time, thus aiding in adaptive treatment strategies and therapy assessment.

A cross-sectional evaluation of mentorship program of undergraduate students from a medical college in North India

Tracheal morphometry using computed tomography in North Indian adults without any respiratory illness and its correlation with spirometry indices.

Abstract Mughal historiography has primarily focused on the lives of royal women vis-à-vis the harem and the imperial court. Looking at the entanglements of power, gender, and social capital, this article attempts to study another group of women—courtesans—as cultural and economic agents in early modern North India. The aim here is to move away from an empire-centric study of women and look closely at non-royal women who normally figure peripherally in official sources. The article locates them within the monetary and non-monetary transactions of the slave trade and explores how it acted as a form of generating social capital for such women. Since possession of slaves was a mark of distinction and affluence, the article argues that a section of courtesans, by being slave owners, belonged to the upper strata of the economic class. Moreover, relaxations in taxes as well as gifts and rewards further show that these courtesans managed to gain a foothold in the socio-political sphere. In this manner, they can be considered liminal actors who belonged to mobile communities, both geographically and socially. Departing from a homogenised narrative, the article shows that courtesans functioned within a patriarchal system that simultaneously empowered and marginalised them.

In regions such as North India, where anemia is prevalent, interpretation of the erythrocyte sedimentation rate (ESR) in rheumatoid arthritis (RA) may be challenging. We evaluated the independent associations of inflammation, autoantibody status, and anemia with ESR elevation and examined morphologic anemia patterns in this cohort. We conducted a retrospective cross-sectional analysis of 152 RA patients attending a tertiary care center. Multivariate logistic regression identified independent predictors of elevated ESR and of anemia after adjustment for covariates. Seropositivity was defined by rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) positivity. Among anemic patients, anemia was classified morphologically as microcytic or normocytic based on mean corpuscular volume (MCV), and inflammatory markers were compared across groups. Missing laboratory data were addressed using multiple imputation by chained equations (MICE). The cohort was predominantly female (133/152, 87.5%), and seropositive RA accounted for 75.7% (115/152) of cases. In the ESR model, C-reactive protein (CRP) positivity was the strongest independent predictor (adjusted odds ratio [aOR] 7.81, p<0.001), whereas anemia was not independently associated after adjustment (aOR 1.45, p=0.305). In a separate model predicting anemia, seropositive RA remained independently associated (aOR 2.12, p=0.024). Among anemic patients (n=89), 87 had available morphologic data; of these,47 (54%) were normocytic and 40 (46%) microcytic. The normocytic group demonstrated significantly higher ESR and CRP values than other groups (p<0.001). ESR elevation was independently associated with CRP-defined inflammatory activity after multivariate adjustment, whereas anemia did not demonstrate an independent association. These findings suggest that ESR retains clinical relevance in reflecting inflammatory burden when interpreted in conjunction with complementary laboratory parameters.

10eP Prognostic factors and outcomes of primary CNS lymphoma treated with high-dose methotrexate-based chemotherapy: A 12-year experience from North India

Background: Informal caregivers of cancer patients often experience reduced self-efficacy, impaired quality of life (QOL), and high caregiving burden. The aim of this study was to evaluate the impact of Comprehensive Caregiver Support on these outcomes. Methods: A quasi-experimental non-equivalent control group design was conducted among 65 caregivers in a tertiary care hospital in North India. Participants were allocated to experimental (n=33) and comparison (n=32) groups. The intervention included deep breathing exercises, symptom management training, financial aid awareness, and device demonstration over five days. Outcomes were measured at baseline, day 7, and day 14 using CSE-8, AC-QOL, and Modified Caregiver Burden Scale. Independent t-test and repeated measures ANOVA were applied. Results: Baseline scores were comparable between groups (p&gt;0.05). At day 14, the experimental group showed significantly higher self-efficacy (68.52±3.24 vs 33.47±8.21), improved QOL (98.7±4.72 vs 55.7±6.87), and lower burden (19.36±5.85 vs 51.44±4.37) compared with controls (p=0.01). Large effect sizes were observed (Cohen’s d 5.61–7.27). Self-efficacy positively predicted QOL (β=0.627, p=0.001) and negatively predicted burden (β=-0.424, p=0.01). Conclusion: Comprehensive Caregiver Support significantly enhances self-efficacy and quality of life while reducing caregiving burden among cancer caregivers. Integrating structured caregiver training into oncology services may improve caregiver well-being.

A BSTRACT Background: Pain assessment in children is often inconsistent despite its recognition as the “fifth vital sign.” Untreated perioperative pain has adverse physiological and psychological effects. Although validated tools exist, their use in clinical practice remains limited. This survey evaluated the knowledge of anesthesiology residents towards pediatric pain assessment. Materials and Methods: A prospective, cross-sectional survey was conducted using a validated 15-item questionnaire (Cronbach’s α = 0.82). The study was approved by the Institutional Review Board and registered with the Clinical Trial Registry of India (CTRI/2023/06/053717). The questionnaire was distributed electronically to anesthesiology residents (6 months–6 years of anesthesia experience, including ≥3 months in pediatric anesthesia) across teaching hospitals in North India. Results: Of 480 surveys circulated, 210 (43.7%) were returned. While 183 (87.1%) respondents reported awareness of pediatric pain assessment tools, knowledge was incomplete. Only 47% identified that the Face, Legs, Activity, Cry, Consolability scale is not a self-report tool. Most (85.7%) recognized that tool selection depends on age, cognition, and institutional protocols, but only 27.1% correctly noted that observational measures are inappropriate in older children capable of self-reporting. Just 24.3% knew that facial expressions are the most studied behavioral indicator of neonatal pain. Although 90% acknowledged the importance of documentation, responses indicated a gap between theoretical awareness and practical application. Conclusion: Anesthesiology residents possess partial but insufficient knowledge of pediatric pain assessment. Standardized training and institutional adoption of validated tools are needed to bridge the knowledge–practice gap and improve perioperative pain management in children.

Prostate cancer (PCa) is one of the most common malignancies in men worldwide. Androgens influence both prostate growth and hair patterns. Androgenic alopecia (male-pattern baldness) and excessive male-pattern body hair (hypertrichosis) have been hypothesized as clinical markers of long-term androgen exposure. Previous Western studies have reported mixed results on whether early-onset or severe androgenic alopecia correlates with increased prostate cancer risk. Data in South Indian (Dravidian) populations is lacking. To examine the association between androgenic hypertrichosis, androgenic alopecia, and prostate cancer in Dravidian men from the Cauvery Delta region of Tamil Nadu, India. We conducted an age-stratified, population-based case-control study among men in the Cauvery Delta. The cases consisted of 117 men with pathologically confirmed adenocarcinoma of the prostate (diagnosed 2010-2015). Controls were 123 men with benign prostatic hyperplasia (BPH) from the same hospital registries, frequency-matched by age. Individuals with incomplete data or non-Dravidian (North Indian) ancestry were excluded. Trained investigators performed face-to-face interviews, directly observing and recording postpubertal body hair growth (indicative of androgenic hypertrichosis) and scalp hair loss (androgenic alopecia classified by the Norwood scale). Statistical analysis included multivariate discriminant analysis (Wilks' Lambda), one-way ANOVA for continuous variables, chi-square cross-tabulation, and computation of Cramer's V statistic to assess association strength. A two-tailed p-value of <0.05 was considered statistically significant. The age distributions of cases and controls were comparable. The prevalence of androgenic hypertrichosis and alopecia did not differ significantly between prostate cancer cases and BPH controls. Cramer's V analysis showed that prostate cancer status accounted for only 1.1% of the variance in hypertrichosis (Cramer's V ≈ 0.011) and 1.5% of the variance in alopecia (Cramer's V ≈ 0.015). In this case-control study of Dravidian men from Tamil Nadu, we observed no significant association between androgenic alopecia or hypertrichosis and prostate cancer. These findings contrast with data from Western cohorts, suggesting that interethnic variation in androgen receptor polymorphisms, follicular sensitivity, and environmental exposures may modulate prostate cancer risk differently. Further research is needed to elucidate how androgenic traits influence prostate carcinogenesis across different ethnic groups.

Prevalence and outcome of children with acute viral hepatitis using complementary and alternative medications (CAM) presenting to a tertiary care center of North India: A prospective observational study

Long-term stability of bioactive compounds in Moringa oleifera leaf of north India: A shelf-life evaluation

A retrospective analysis of flow cytometry markers, cytogenetics and clinico-pathological characteristics in plasma cell neoplasms: Insights from a North Indian Centre

Introduction: Mismatch Repair (MMR) proteins are essential in correcting DeoxyRibo Nucleic Acid (DNA) replication errors, including point mutations, to maintain genetic stability. Among atleast seven MMR proteins in humans, four- MLH1 (MutL homolog 1), MSH2 (MutS homolog 2), MSH6 (MutS homolog 6), and PMS2 (Postmeiotic segregation increased 2) are most significant in cancer biology, particularly in Colorectal Carcinoma (CRC), gastric, endometrial, and ovarian cancers. Deficiencies in these genes can lead to Microsatellite Instability (MSI), which promotes tumourigenesis. Aim: The present study done to assess the expression of MMR proteins and their association with clinicopathological features in solid tumours like colon, liver, stomach, gall bladder and others. Materials and Methods: The present retrospective and comparative study was conducted at a North Indian Cancer Centre at Jaipur, Rajasthan, India for three years, 55 cases of various solid tumours were examined for the expression of MMR proteins using immunohistochemistry. The cases were categorised into two groups: proficient (normal expression of MMR proteins, low MSI probability) and deficient (loss of MMR proteins, high MSI probability). The immunophenotypic expression was analysed in relation to clinical and pathological parameters by tabulating the data in Microsoft Excel sheet and statistical analysis was done by using the Statistical Package for Social Sciences (SPSS) statistics software windows version 22.0 released 2013. Results: Results showed that 8 (14.5%) out of 55 patients had a loss of MMR protein expression. Of these cases, 5 (62.5%) displayed a combined loss of MLH1 and PMS2, while 3 (37.5%) showed a combined loss of MSH2 and MSH6. All cases with MMR deficiency were located proximal to the splenic flexure and exhibited mucinous differentiation along with high levels of Tumour-infiltrating Lymphocytes (TILs). The mean age in the proficient group (59.4 years) was higher compared to the deficient group (54.5 years), with males {5 (62.5%) in MMRd and 25 (53.2%) MMRp} being more commonly affected than females {3 (37.5%) in MMRd and 22 (46.5%) in MMRp} in both groups. Adenocarcinoma was the predominant histological type in both groups {5 (62.5%) in MMRd and 30 (63.8%) in MMRp}. Conclusion: The study highlights the importance of MMR protein testing, particularly for CRC patients aged around 50 years with low-grade tumours. However, given the limited sample size, larger studies are needed to further explore the relationship between MMR protein deficiencies and clinicopathological features in various cancers.