Surya Hospitals

Artificial Intelligence (AI) is transforming societies by reshaping economies, democracies, and public services. This paper explores AI's dual role as both an enabler of progress and a source of new challenges. It examines its impact on labor markets, governance, healthcare, education, and urban development, highlighting both opportunities and risks such as bias, inequality, and misinformation. Through international cooperation, ethical frameworks, and inclusive policies, AI can be guided toward enhancing human well-being. Real-world case studies from Estonia and India demonstrate how AI can strengthen democracy and public services when developed responsibly.

Abstract: This paper proposes an advanced convolutional neural network (ECNN) for the automatic detection and classification of leaf diseases towards precision agriculture. The proposed approach was tested on a standard plant leaf dataset with 54,306 images belonging to 38 classes of leaf diseases, with an 80:20 train/test split. Multi-scale convolutional layers and an attention refinement layer were incorporated to enhance the robustness of the approach in complex field environments. The experimental results show that the proposed ECNN approach resulted in an overall classification accuracy of 98.7%, with precision, recall, and F1-measure values of 98.4%, 98.6%, and 98.5%, respectively. Compared with the latest state-of-the-art models such as EnConv, EfficientNet-B0, and hybrid CNN models, the proposed approach improved the accuracy by 2.1% and reduced the computational complexity by 18.3%. The proposed approach was also found to be reliable in early-stage disease detection and under varying illumination conditions, making it suitable for real-time implementation in smart farming systems. Keywords: Leaf Disease Detection, Enhanced CNN, Precision Agriculture, Attention Mechanism and Deep Learning

Abstract Background: Medical devices are crucial in health care; however, adverse events (AEs) require safety evaluation. Causality assessment determines the contribution of the device to AEs and guides decisions. India lacks a standardized scoring tool, leading to inconsistent interpretation. Aim: This study aimed to develop and validate a reliable causality assessment tool for AEs associated with medical devices. Materials and Methods: A nine-question structured scale was developed from a literature review to classify causality as certain, probable, possible, or unlikely. Validity was established through expert comparisons using the European Union Causality Assessment Scale. Sensitivity, specificity, and area under the curve (AUC) were calculated. Reliability testing occurred in two phases using 50 random Manufacturer and User Facility Device Experience database cases (2014–2024) assessed by six raters (physicians, biomedical engineers, and pharmacists). After 6 weeks, the same cases were reassessed. Reliability was determined using Cronbach’s alpha and intraclass correlation coefficient (ICC). Results: The ICC values for phases 1 and 2 were 0.324 and 0.399, respectively ( P < 0.001), indicating moderate agreement. Validity testing showed a sensitivity of 90.95%, specificity of 83.25%, and AUC of 0.8605, demonstrating strong accuracy in determining causality. The scale demonstrated high reliability (Cronbach’s alpha = 0.893). Conclusion: The validated causality assessment tool enhances consistency and reduces subjectivity among evaluators. It provides a reliable scoring system to support regulatory decisions, improve safety, and enable postmarket surveillance. This tool enables systematic assessment of device-related AEs across healthcare settings.

Moral capital represents the accumulated ethical goodwill and legitimacy that organizations cultivate through consistent value-aligned behavior, forming a critical foundation for sustainable value creation. This chapter examines the intricate relationships between moral capital, trust reserves, and social license to operate (SLO), exploring how these interconnected constructs shape organizational resilience and stakeholder relationships in contemporary business environments. Through comprehensive theoretical analysis and empirical insights, we demonstrate that moral capital functions as a strategic asset that enables organizations to navigate complex stakeholder expectations, regulatory landscapes, and social accountability pressures. The chapter develops an integrative framework linking moral capital accumulation to trust-building mechanisms and SLO maintenance, while examining the dynamic processes through which organizations can build, preserve, or deplete these critical resources.

Introduction: Artificial Intelligence (AI) is rapidly transforming the pharmaceutical marketing landscape by enabling more data-driven, personalized, and efficient strategies. Traditionally cautious in adopting new marketing technologies, the pharmaceutical industry is now embracing AI to enhance decision-making and customer engagement. Background: Pharmaceutical marketing has historically relied on conventional methods, but the advent of AI technologies such as natural language processing, machine learning, and predictive analytics is reshaping how companies approach customer relationship management, brand positioning, and market forecasting. These tools allow for deeper insights into customer behavior, sentiment analysis, and omnichannel engagement, which are critical in a highly regulated and competitive environment. Methodology: This review synthesizes current literature and case studies from leading pharmaceutical companies to evaluate the applications and impact of AI in marketing. It examines AI-driven tools used to optimize sales operations, improve medical representative efficiency, and ensure regulatory compliance. Challenges such as data privacy, ethical concerns, and regulatory constraints are also critically analyzed. Results: Findings indicate that AI adoption leads to measurable benefits including increased return on investment (ROI), enhanced market segmentation, and improved drug adoption rates. AI facilitates more personalized communication strategies and streamlines marketing workflows, contributing to cost efficiency and patient-centric approaches. Conclusion: AI integration marks a pivotal shift toward smarter, ethical, and more effective pharmaceutical marketing. Future trends such as generative AI, conversational analytics, and digital twins promise to further revolutionize the sector, driving sustainable digital growth.

The purpose of this systematic review was to evaluate the association between the timing of solid food introduction during infancy and the risk of childhood obesity. The review specifically examined whether early introduction (before four months of age) is linked with increased risk of overweight or obesity in childhood. We conducted a systematic search of five major databases (PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and Google Scholar) from inception to January 15, 2025. Eligible studies included observational cohort, cross-sectional, quasi-experimental, and case-control studies that assessed the relationship between the timing of solid food introduction and childhood obesity outcomes. Two independent reviewers screened articles, extracted data, and assessed study quality using appropriate tools (ROBINS-I tool (Risk Of Bias In Non-randomized Studies of Interventions), AXIS, or the Newcastle-Ottawa Scale (NOS). Due to heterogeneity in study design, population, and outcome definitions, a narrative synthesis was conducted instead of meta-analysis. Seventeen studies met the inclusion criteria out of 1,402 screened records. Most studies found that the introduction of solid foods before four months of age was associated with increased risk of childhood obesity or higher BMI z-scores. This association was more prominent in formula-fed infants. However, variation in study design, exposure classification, and measurement outcomes limited comparability. Risk of bias across studies ranged from moderate to serious, primarily due to confounding and reliance on parental recall. Early introduction of solid foods (before four months) appears to be associated with increased childhood obesity risk, particularly in the absence of breastfeeding. Nevertheless, due to variability and methodological limitations across studies, findings should be interpreted with caution. Further high-quality prospective studies using standardized outcome measures are warranted. The review protocol is registered in PROSPERO (CRD42025640375).

To evaluate diagnostic accuracy of urinary immune biomarkers (IBM) for late-onset sepsis (LOS) in very preterm infants. This multicenter, prospective diagnostic accuracy study, included preterm infants<32weeks of gestation and birth weight<1,500 g, needing evaluation for suspected LOS. Urine samples obtained concurrent to blood culture and sepsis screen were evaluated for interleukin-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) levels using enzyme immunoassay. Positive blood and/or CSF culture served as reference standards. Receiver operating characteristic curves were used to evaluate performance of urinary IBM for detection of LOS. During September 2021-September 2023, we evaluated 136 preterm, very low birth weight infants (mean gestational age: 28.2weeks, mean birth weight: 933 g) for sepsis after 72 h of postnatal age and prior to 37weeks postmenstrual age. Twenty four infants had culture-positive sepsis. Median IL-8 and MCP-1 levels in neonates with LOS were 86.5 pg/mL and 230.2 pg/mL and those in non-infected neonates were 66.5 pg/mL and 212.1 pg/mL. Urinary IL-8 had sensitivity and specificity of 42 and 51 % [AUC: 0.46 (0.35-0.57)] and urinary MCP-1 had sensitivity and specificity of 46 and 53 % [AUC: 0.49 (0.38-0.60)] for detection of LOS. Urinary IL-8 and MCP-1 had low sensitivity and specificity for diagnosis of LOS in very preterm infants. These findings underscore the need to establish reference ranges for urinary IBM in preterm neonates.

ABSTRACTBackgroundTenofovir alafenamide (TAF) has shown non‐inferior efficacy to tenofovir disoproxil fumarate (TDF), with superior bone and renal safety.AimTo characterise 5‐year TAF efficacy and safety in patients of East Asian ethnicity from pivotal Phase 3 studies.MethodsPatients were randomised (2:1) to receive TAF or TDF for up to 3 years of double‐blind treatment, followed by open‐label TAF. Patients either continued TAF or switched from TDF to TAF at Week 96 (TDF → TAF 3 years) or Week 144 (TDF → TAF 2 years) of treatment. Efficacy endpoints (virologic, biochemical and serologic) and safety were assessed.ResultsAmong 591 patients of East Asian ethnicity (TAF, n = 401; TDF → TAF 3 years, n = 84; TDF → TAF 2 years, n = 106), high rates of virologic control were achieved (89%, 94% and 92%, respectively) at Year 5 (missing = failure analysis). At Year 5, rates of alanine aminotransferase normalisation (85%, 90% and 78%) and hepatitis B e antigen loss (36%, 43% and 44%) were similar. Following the switch from TDF to TAF, changes in fasting lipid parameters were consistent with removal of the known lipid‐lowering effect of TDF. However, changes in the total cholesterol to high‐density lipoprotein ratio (marker of cardiovascular risk) were minimal and comparable in all groups by Year 5. Renal and bone parameters improved after switching.ConclusionsThrough 5 years, rates of virologic suppression were high in East Asian patients treated with TAF or switched from TDF to TAF. TAF and TDF were well tolerated, with improved renal and bone safety observed in patients switching from TDF to TAF.

The Ponseti method is a globally accepted treatment modality for Clubfoot or Congenital Talipes Equinovarus (CTEV). This study compares the kinematic and kinetic gait patterns in children with unilateral and bilateral idiopathic clubfeet with the age-matched control group. 40 children with a mean age of 9.61 ± 3.04 (6-15years) of which 23 (23 feet) were unilateral and 17 children (34 feet) were bilateral, who had completed 2years post weaning of splints. Clinical examination included a range of motion of the ankle, static and dynamic deformities, and rotational profile of the hip. 3D Gait analysis was performed with a multi-camera motion capture system. In unilateral CTEV, there was a significant difference in calf girth and foot size. Ankle dorsiflexion showed a statistically significant difference in mid-swing (p = < .001) although Initial contact and Loading Response and Terminal Stance were reduced and were not statistically significant for unilateral CTEV. A significant difference in ankle inversion p = < .001 was noted in mid-swing in Unilateral and Bilateral feet. On comparison to the control participant's normal, kinetic data showed Internal Ankle plantar flexor moments (p = < .001) to be reduced in the unilateral and bilateral groups. Internal ankle extensor movement was statistically significant in the bilateral group, while in the unilateral group, it was not. Ankle power was statistically reduced in both groups. Gait analysis shows subtle kinetic and kinematic changes in children with clubfeet, mainly deviations in ankle rockers and reduced ankle power generation which may impact clinical function.

Birthing in a hospital with on-site surgical facilities (co-located care) is considered preferable for neonates with surgical conditions. However, it may not always be feasible. Whether transfer of surgical neonates from birth hospital to a surgical facility affects the outcomes of this cohort is unclear. We conducted a systematic review to investigate the association of birth location/transfer with all-cause mortality and disability among neonates with congenital/acquired surgical conditions. Data Sources from PubMed, Embase, CINAHL, and Web of Science were searched till December 2024. Studies from high-income countries (HICs) comparing infants transferred to a surgical center for surgery versus infants born and operated in a co-located care facility were included. Random effects model was used for meta-analysis. The quality of studies and certainty of evidence were assessed using Newcastle-Ottawa Scale and the GRADE framework respectively. The primary outcomes of interest were all-cause mortality and neurodevelopmental impairment at latest follow up. A total of 61 studies from 20 HICs were included. Compared to co-located care, transfer for surgery did not increase the odds of risk-adjusted and crude mortality in neonates with congenital diaphragmatic hernia [adjusted odds ratio (aOR):0.86 (0.49 to 1.49), 5 studies, 8366 infants; crude OR:0.68 (0.51 to 0.91, i.e., decreased mortality), 22 studies, 12970 infants], critical congenital heart disease [aOR:0.79 (0.42 to 1.48), 3 studies, 13485 infants; OR:1.04 (0.66 to 1.64), 10 studies, 14447 infants], surgical necrotizing enterocolitis [aOR:0.99 (0.61 to 1.61), 4 studies, 5891 infants; OR:1.03 (0.64 to 1.65), 5 studies, 5915 infants], gastroschisis [aOR:1.07 (0.68 to 1.68), 2 studies, 5294 infants; OR:0.80 (0.48 to 1.35), 11 studies, 8708 infants], tracheo-oesophageal fistula [aOR:0.97 (0.39 to 2.39), 1 study, 937 infants; OR:0.62 (0.37 to 1.04), 4 studies, 4050 infants], congenital or perinatal intestinal conditions [OR:2.69 (0.26 to 28.34), 4 studies, 1799 infants]. Neurodevelopmental outcomes between the groups were comparable in the three studies that reported this outcome. Whilst many included studies were of good quality, certainty of evidence was very low due to their observational design and heterogeneity. In conclusion, transfer of neonates from the birth hospital to another facility for surgical intervention was not associated with increased risk of mortality or disability. The evidence from this comprehensive meta-analysis would be useful for clinicians, parents and health policy makers. Systematic review registration: PROSPERO CRD 42024565651.