Tamil Nadu Dr. M.G.R. Medical University

Background & Objective: Endometriosis is characterized by the growth of endometrial-like tissue outside the uterus, leading to inflammation, pain, and infertility. Its pathogenesis involves genetic, immunological, and hormonal factors. This study examines the synergistic roles of IL‑16 and KRAS gene expression in endometriosis and their interaction with oxidative stress markers to identify potential biomarkers for targeted therapy.Materials & Methods: A case-control study was conducted with 300 subjects, including 150 cases diagnosed with endometriosis and 150 healthy controls. Gene expression levels of IL‑16 and KRAS were analyzed using real-time PCR. Oxidative stress markers, including Superoxide Dismutase (SOD), glutathione peroxidase, and vitamin C, along with the inflammatory cytokine IL‑6, were measured.Results: IL‑16 and KRAS gene expression levels were significantly elevated in cases compared with controls, with KRAS identified as an independent predictor (P=0.002). Oxidative stress markers demonstrated a marked reduction in SOD and glutathione peroxidase levels, accompanied by decreased vitamin C levels. Elevated IL‑6 levels (>5.57 pg/mL, OR=7.91, P=0.032) were associated with increased inflammation and oxidative stress related cellular damage.Conclusion: The findings indicate that IL‑16 and KRAS contribute to the progression of endometriosis through oxidative stress-mediated genetic alterations and inflammatory pathways. The study underscores the combined impact of oxidative imbalance, IL‑6 driven inflammation, and KRAS dysregulation in disease pathogenesis. Unlike previous research focusing on genetic polymorphisms, this study provides novel insights into gene expression patterns and their clinical implications. Further investigation into the mechanistic interactions among IL‑16, KRAS, and oxidative stress may aid in the development of targeted therapeutic strategies.

Breastfeeding competency is a core professional requirement in midwifery practice and significantly influences maternal and neonatal health outcomes. Despite global recommendations advocating exclusive breastfeeding, gaps persist in practical skill preparation and clinical confidence among midwifery students. Simulation-based training has emerged as an innovative educational strategy; however, its conceptual meaning within breastfeeding competency development remains inadequately defined. This study aimed to clarify the concept of simulation-based training for breastfeeding competency development in midwifery practice using Walker and Avant’s eight-step concept analysis methodology. A systematic literature search was conducted across PubMed, Scopus, CINAHL, and Web of Science databases for studies published between 2000 and 2025. Sixty-four relevant articles were included in the final synthesis. Five defining attributes were identified: structured experiential learning, simulated clinical environment, competency-based evaluation, facilitated reflective debriefing, and clinical transferability. Antecedents included curricular gaps, technological advancement, maternal–infant health priorities, and ethical considerations in clinical training. Consequences encompassed improved psychomotor skills, enhanced clinical confidence, strengthened breastfeeding support practices, and potential improvement in maternal satisfaction and breastfeeding outcomes. An operational definition was developed to guide curriculum design, research standardization, and policy development. Concept clarification supports the integration of simulation-based strategies into competency-based midwifery education to enhance breastfeeding support quality and maternal–newborn health outcomes.

The growing penetration of different types of DERs, such as PV systems, WTs, BEVs, and BESS, is gradually changing the passive conventional distribution network into an active energy community. As the consumers become prosumers with the capability to produce, store, and trade electricity, optimal coordination of DERs is crucial for the facilitation of P2P energy trading in order to improve the local energy balance and enhance the overall performances of the distribution system. This paper presents an optimization framework to maximize the P2P trading benefits in an IEEE 12-bus radial distribution network through strategic integration and operation of DERs. The recently introduced COA is used for the optimal siting, sizing, and dispatch of PV, WT, BEVs, and BESS units with a view to maximizing the trading potential along with minimum network losses and improved voltage stability. Unlike the traditional DER scheduling models, the proposed model allows dynamic interaction between the consumers and prosumers by facilitating efficient trading of surplus renewable generation within the local network. The optimization further coordinates the charging/discharging cycles of both the BEVs and BESS units in order to improve the local energy availability and market participation of consumers in the distribution network. Comparative findings show that, in comparison to other traditional COA considerably increases the energy trading volume, lowers the active power losses, and improves the voltage profiles. The findings also demonstrate that a cost- effective and sustainable P2P energy trading environment can be established in future distribution networks through coordinated DER operation enabled by an effective metaheuristic optimizer.

Objective: The present study aimed to develop and validate a novel, simple, rapid, and precise RP-HPLC (Reverse-Phase High-Performance Liquid Chromatography) method for the simultaneous estimation of Chlorpheniramine Maleate (CPM) and Dextromethorphan Hydrobromide (DXM) in combined pharmaceutical dosage forms. Methods: Using an isocratic mobile phase composed of Phosphate Buffer (pH 6.2): Acetonitrile: Methanol in the ratio of 35:34:31 (v/v), a Spherisorb 5µ CN column (250 mm x 4.6 mm) was used to optimize chromatographic separation. The flow rate was 1.5 mL/min. The column temperature throughout runs was held at 40°C and detection used 228 nm with an injection volume of 20 µL. The method was validated comprehensively according to general ICH Q2(R1) guidelines for the outtake of specificity, linearity, accuracy and precision. Results: The method was capable of providing sharp, well-resolved peaks for CPM and DXM at retention times of 6.53 min and 8.18 min, respectively. The method showed excellent linearity in the range of 80-120% of the test concentration for both drugs. Correlation coefficients (r²) were 0.9995 for CPM and 0.9998 for DXM. The accuracy, determined by recovery studies, was mean recoveries of 98.96-101.16% for CPM and 95.87-98.06% for DXM. The method was precise with %RSD for repeatability and intermediate precision both being less than 1% of that measured (1.9-0.39% respectively) for both analytes. Robustness studies confirmed that the method remained unaffected by minor, intentional variations in chromatographic parameters. Conclusion: The present RP-HPLC method is simple, accurate, precise, robust, and specific. It provides a means for simple simultaneous determination of CPM and DXM in combined pharmaceutical formulations. It is an ideal method for routine quality control and KNP analysis of all pharmaceutical formulas containing Chlorpheniramine Maleate and Dextromethorphan Hydrobromide.

Background: Asthma is a chronic obstructive pulmonary disease characterized by episodic airway obstruction, hyperresponsiveness, and inflammation, leading to symptoms such as shortness of breath, wheezing, chest tightness, and cough. Complementary and alternative medicine, including acupuncture and moxibustion, is increasingly used to manage asthma symptoms. There is a lack of studies pertinent to lung-specific points such as BL 13 (a back shu point of the lung) and LU 9 (source point of the lung meridian). This study evaluates the impact of acupuncture and moxibustion at BL 13 and LU 9 on pulmonary function in patients with bronchial asthma. Methods: In this single-blinded randomized controlled trial, a total of 60 participants with bronchial asthma will be recruited and randomly assigned into two groups. The study group will receive acupuncture and moxibustion at BL 13 and LU 9 for 20 min a day, 5 days a week for 2 weeks, while the control group will receive placebo acupuncture for the same period. Pulmonary function tests (PFT) and quality of life (QoL) will be assessed at baseline and after 14 days. Results: Acupuncture and moxibustion at BL 13 and LU 9 acupuncture points might significantly improve PFT and QoL than the placebo acupuncture points in patients with bronchial asthma. Conclusion: Two weeks of acupuncture and moxibustion at BL 13 and LU 9 may improve pulmonary function and quality of life in patients with bronchial asthma. These findings may help to support the integration of these techniques into standard asthma care.

Abstract Background Inappropriate prescribing of antibiotics in people with nonspecific urinary symptoms is a challenge in low-resource rural areas, where diagnostic limitations worsen antimicrobial resistance. The Bladder Health Score (BHS), a validated clinical tool differentiates true urinary tract infections (UTIs) from asymptomatic bacteriuria, providing a stewardship opportunity. This study evaluated a clinical pharmacist-led intervention to reduce inappropriate antibiotic use in elderly patients of Rural South Indian villages. Methods A prospective study was conducted from July 2024 to March 2025 in two demographically similar villages. One served as the intervention village, where clinical pharmacists implemented the BHS to guide antibiotic decision-making; the other served as the control village, where patients received standard care. Participants included were elderly residents (≥60 years) presenting with urinary symptoms, delirium or altered mental status. In the intervention village, pharmacists implemented BHS assessments (score ≥3 indicating UTI likelihood) and provided real-time antibiotic recommendations to providers. Primary outcome was inappropriateness of antibiotic prescriptions. Secondary outcomes were days of therapy with antibiotics (DOT), empirical-culture concordance and readmissions at 30 days Results Of 462 enrolled patients (intervention: 234; control: 228), the intervention village demonstrated:58% reduction in inappropriate antibiotic prescriptions (OR 0.42, 95% CI 0.29–0.61; *p*< 0.001).Lower mean antibiotic DOT (4.2 vs. 7.1 days; *p*=0.003) with comparable clinical cure rates (93.0% vs. 91.7%).89% positive predictive value of BHS ≥3 for culture-confirmed UTI.87.3% provider acceptance rate of pharmacist recommendations.No significant difference in 30-day readmissions (4.7% vs. 5.2%; *p*=0.78). Conclusion This pharmacist-delivered BHS intervention strongly decreased rural elderly populations' inappropriate antibiotic use, proving to be feasible and clinically safe. The high predictive value of BHS and strong provider acceptance underscore its utility in low-resource settings. By aligning with WHO AMR priorities, this model offers a cost-effective stewardship strategy for regions with diagnostic limitations. Disclosures All Authors: No reported disclosures

Abstract Background Antimicrobial resistance (AMR) is a major public health concern, particularly in low-resource rural settings with limited antimicrobial stewardship. Rural Tamil Nadu represents a critical region to monitor resistance patterns due to major OTC antibiotic misuse This study assessed antibiotic resistance profiles of bacterial isolates from clinical specimens in rural Tamil Nadu, India. Methods A prospective observational study was conducted from October 2024 to February 2025 across three rural primary health centers in Tamil Nadu, India. Clinical specimens (urine, sputum, blood) were processed using standard microbiological methods. Bacterial identification and antibiotic susceptibility testing (Kirby-Bauer disk diffusion) were performed. Resistance trends were stratified by specimen type and organism. Results A total of 952 clinical isolates were recovered from 1,229 specimens. The most common organisms: Escherichia coli (32.7%), Klebsiella pneumoniae (18.4%), Staphylococcus aureus (15.3%), Pseudomonas aeruginosa (11.7%), and Enterococcus spp. (7.2%). • E. coli showed high resistance to ciprofloxacin (78%), co-trimoxazole (64%), and third-generation cephalosporins (ceftriaxone 71%; cefotaxime 68%) with lower resistance to nitrofurantoin (22%) and meropenem (9%). • K. pneumoniae showed resistance to cefotaxime (76%), gentamicin (52%), and amoxicillin-clavulanate (65%); 18% were carbapenem-resistant. • MRSA prevalence was 39% with 100% susceptibility to vancomycin and linezolid. • P. aeruginosa demonstrated multi-drug resistance (resistance to ≥3 classes) in 27% of isolates, retaining susceptibility to amikacin (81%) and piperacillin-tazobactam (74%). • Enterococcus spp. showed 100% linezolid susceptibility with ampicillin (41%) and vancomycin (5%) resistance. Conclusion Alarming resistance rates were observed against first-line antibiotics, including emerging carbapenem resistance in Klebsiella spp. and E. coli (indicative of ESBL/carbapenemase production). MRSA and vancomycin-resistant Enterococcus highlight urgent needs for local stewardship programs. These findings can guide empirical therapy and inform regional antibiotic guidelines to preserve antimicrobial efficacy in resource-limited rural settings. Disclosures All Authors: No reported disclosures

Bilateral acute angle closure glaucoma (AACG) is an uncommon ophthalmic emergency which can occur due to pupillary block or ciliochoroidal effusion. This can occur due to underlying risk factors which can be exacerbated with drugs in widespread use such as antidepressants – evidence with drugs such as Citalopram, Paroxetine being higher and substantially rarer in Sertraline. We report a case of a 74-year-old female who developed bilateral AACG 4 days after Sertraline initiation, who also had hyponatremia. Though antiglaucoma medications reduced the intraocular pressure, it was brought under control further only on cessation of the drug and hyponatremia correction. Unusual causes such as the above should not be overlooked, and multidisciplinary management is essential in preventing irreversible complications.