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ABSTRACT This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient’s quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described.

BACKGROUND- The lack of preparedness among suddenly bereaved persons is shown to be associated with higher mortality among the bereaved than when the deceased had a known pre-existing morbidity(1). Most deaths due to COVID-19 came as a sudden surprise for unprepared family members. However,there are no studies or research that are being conducted regarding the psychopathology of family members of patients who died of COVID-19. AIMS/OBJECTIVES- To study proportion of psychiatric illness in family members of patients who died of COVID-19. To find the association between the death of an earning member & psychiatric illnesses in the family. METHODS- We began a door-to-door survey in an urban locality begetting permission from the Institutional Ethics Committee. After obtaining informed consent, 40 families of COVID-19 patients were identified,whose members were interviewed using a semi-structured proforma. The deaths due to COVID19 occurred between the months of March'21 and June'21 and the interviews were carried during August'21. Data collected was tabulated and analysed statistically and results were obtained. RESULTS - Of the 79 participants 11 had psychiatric illness. The proportion of psychiatric illness was observed to be 13.924% and the most common illnesses observed were depression (54.5%) followed by adjustment disorder (36.7%) and anxiety (18.2%). Of these 79 participants 15 (18.9%) had lost an earning member,of which 4 (26.7%) participants developed a psychiatric illness. The proportion of participants with psychiatric illness who lost an earning member of the family was 26.7% which was more than that in non-earning group (10.9%). But this difference is not statistically significant. CONCLUSION- We observed that family members of patients who died of COVID-19 are more prone for psychopathology. Various psychopathologies were seen in this study of which the most common psychopathology was depression. Further studies are required for the family members of patients who died due to COVID-19. Reference: * Shah SM, Carey IM, Harris T, DeWilde S, Victor CR, Cook DG. The effect of unexpected bereavement on mortality in older couples. American Journal of Public Health. 2013 Jun;103(6):1140-5.

Background COVID pandemic has added to the stress during medical residency Stress during residency has been found associated with burnout Personality is associated to coping with stress and resulting outcome Personality factors are likely to modify the effect of stress on Burnout & Professional Fulfilment Table 1 Personality profile of Resident Doctors Table 2 Personality Correlation with Stress Table 3 Conditional effect of Stress at Conscientiousness levels Aim To study the role of personality on the association of stress with burnout and professional satisfaction among resident doctors during COVID second wave in India Methods A cross-sectional observational study among resident doctors in India using Google forms, approved by Institutional Ethics Committee Stanford Professional Fulfilment Index for Professional Fulfilment and Burnout 10 item Big five inventory (BFI) assed personality and Depression, Anxiety & Stress Scale - 21 to sassed Stress Pearson correlation to assess correlation and Hayes Process for moderation using SPSS V24 © IBM Results 152 participants 49.3% Males and 50.7% Females Mean age - 29.6 years (SD 4.5) 35.5% reported significant stress Average Stress score on DASS - 12.9 (SD 11.1) Mean Professional fulfilment (PF) score - 2.0 (SD 1.0) Mean Burnout score - 1.3 (SD 0.9) 20.4% residents felt professionally fulfilled 41.4% residents had burnout Stress negatively correlated with Agreeableness Stress positively correlated with Neuroticism Stress positively correlated with Burnout (ρ 0.67; p 0.00) Stress negatively correlated with Professional fulfillment (ρ -0.41; p 0.00) Only Conscientiousness moderated the effect of stress on Burnout and Professional fulfillment Conclusion COVID pandemic generated significant stress among resident doctors Stress is associated with Burnout and Professional fulfilment Higher Conscientiousness reduced burnout due to stress Residents with higher Conscientiousness would experience more negative effect of stress on their professional fulfillment

Aim: To study unusual presentation of opioid withdrawal in opioid userss Methodology: Patients coming to avail services from Emergency and OPD with opioid withdrawal were taken using convenience sampling. Out of 30 opioid withdrawal patients screened, 3 presented with seizure as a primary symptom. Case Description: Three male patients aged 20,29,24 years with Opioid withdrawal symptoms presented with generalized tonic clonic seziures within 2-5 days of their last opioid use. All three were consuming opioid in form of Smack (street form of heroin) in dependence pattern in large amounts with an average of 1-1.5 gram per day. Any other drug use and other possible causes for such presentation were ruled out with help of detailed examination and exhaustive investigations including urine drug screening and neuroimaging leaving only possibility of opioid withdrawal. Discussion: Standard textbooks are silent on such complication due to opioid withdrawal despite evidence of opioid withdrawal seizures in infants of opioid dependent mothers. The already published data reveals that similar complicated opioid withdrawal is seen in subjects abusing impure form of opioids with impurities being the offending agent. While this cannot be completely refuted, various other probable mechanisms for association have been described involving opioid receptors and activity of neurons in the brain circuitry. Conclusion: Unusual rare presentation of seizure could be a primary manifestation of opioid withdrawals and needs stringent evaluation and management.

Clean and efficient energy has become the foremost objective of human sustainable development. Hydrogen energy, recognized as a green and efficient energy source, has emerged as a focal point worldwide. So far, commonly used hydrogen storage methods pose safety concerns, such as compressing hydrogen into gas cylinders with high-pressure and extremely low-temperature liquefaction. Therefore, the solid hydrogen storage method has received significant attention. 2D materials seek more attention than other solid-state materials due to their astonishing properties, such as wide surface area, layered morphology, magnificent electrical properties, high thermal stability, and tunable interlayer spacing. These outstanding properties make 2D materials a wonderland for hydrogen storage. Many emerging 2D materials have not been explored experimentally but theoretically reveal impactful results for hydrogen storage. To the best of our knowledge, there is no comprehensive review article on 2D materials for hydrogen storage applications. This article presents a comprehensive review of the various 2D materials used for hydrogen storage, such as graphene, MXene, h-BN, borophene, phosphorene, TMDs, aluminene, silicene, etc. The various parameters which influence the hydrogen storage profile of the 2D materials are also discussed. Ultimately, the current significant challenges and future research directions are addressed insightfully to make 2D materials viable for hydrogen storage-based technologies.

Biomembrane order, dynamics, and other essential physicochemical parameters are controlled by cholesterol, a major component of mammalian cell membranes. Although cholesterol is well known to exhibit a condensing effect on fluid lipid membranes, the extent of stiffening that occurs with different degrees of lipid acyl chain unsaturation remains an enigma. In this review, we show that cholesterol locally increases the bending rigidity of both unsaturated and saturated lipid membranes, suggesting there may be a length-scale dependence of the bending modulus. We review our published data that address the origin of the mechanical effects of cholesterol on unsaturated and polyunsaturated lipid membranes and their role in biomembrane functions. Through a combination of solid-state deuterium NMR spectroscopy and neutron spin-echo spectroscopy, we show that changes in molecular packing cause the universal effects of cholesterol on the membrane bending rigidity. Our findings have broad implications for the role of cholesterol in lipid–protein interactions as well as raft-like mixtures, drug delivery applications, and the effects of antimicrobial peptides on lipid membranes.

We consider a free-fermion chain undergoing dephasing, described by two different random-measurement protocols (unravelings): a quantum-state-diffusion and a quantum-jump one. Both protocols keep the state in a Slater-determinant form, allowing to address quite large system sizes. We find a bifurcation in the distribution of the measurement operators along the quantum trajectories, that’s to say, there is a point where the shape of this distribution changes from unimodal to bimodal. The value of the measurement strength where this phenomenon occurs is similar for the two unravelings, but the distributions and the transition have different properties reflecting the symmetries of the two measurement protocols. We also consider the scaling with the system size of the inverse participation ratio of the Slater-determinant components and find a power-law scaling that marks a multifractal behaviour, in both unravelings and for any nonvanishing measurement strength. Graphical abstract Position of the maxima of P n vs γ for the QSD protocol. The two maxima stem continuously and symmetrically at the bifurcation point γ QSD ∼ 0.2 , with a discontinuity of the derivative.

ObjectiveThis study aimed to develop and validate a patient-reported outcome measure (PROM) in acute pancreatitis (AP) as an endpoint centred on the patient.DesignA PROM instrument (PAtieNt-rePoRted OutcoMe scale in acute pancreatItis, an international proSpEctive cohort study, PAN-PROMISE scale) was designed based on the opinion of patients, professionals and an expert panel. The scale was validated in an international multicentre prospective cohort study, describing the severity of AP and quality of life at 15 days after discharge as the main variables for validation. The COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) methodology was applied. Both the design and validation stages considered the content and face validity of this new instrument; the metric properties of the different items, reliability (reproducibility and internal consistence), the construct, structural and criterion validity, responsiveness and interpretability of this scale.ResultsPAN-PROMISE consists of a seven-item scale based on the symptoms that cause the most discomfort and concern to patients with AP. The validation cohort involved 15 countries, 524 patients. The intensity of symptoms changed from higher values during the first 24 hours to lower values at discharge and 15 days thereafter. Items converged into a unidimensional ordinal scale with good fit indices. Internal consistency and split-half reliability at discharge were adequate. Reproducibility was confirmed using test–retest reliability and comparing the PAN-PROMISE score at discharge and 15 days after discharge. Evidence is also provided for the convergent-discriminant and empirical validity of the scale.ConclusionThe PAN-PROMISE scale is a useful tool to be used as an endpoint in clinical trials, and to quantify patient well-being during the hospital admission and follow-up.Trial registration number NCT03650062

Eutectic high-entropy alloys (EHEAs) offer a good balance between strength and ductility alongside excellent castability and chemical homogeneity. However, identifying optimal eutectic compositions in HEAs has been a persistent challenge primarily due to the lacuna of higher-order phase diagrams. Since their discovery in 2014, following sporadic reports, the compositional design of EHEAs has relied on a trial-and-error empirical approach through experimental adjustments, which is time-consuming, costly, and often ineffective. Recently, the CALPHAD (CALculation of PHAse Diagrams) methodology has emerged as an effective alternative to empirical approaches despite its notable limitations. Combinatorial approaches have also been explored to design EHEA compositions, albeit with significant reliance on existing databases. However, despite a decade of efforts, there remains no universal design strategy for EHEA compositions to date, highlighting the need to address this research gap. To this end, the present article provides a critical review of the hitherto reported efforts in the composition design and development of EHEAs, categorizing them broadly into empirical, CALPHAD, and combinatorial approaches for the first time. This analysis aims to underscore the persistent challenges in designing EHEA compositions and provide insights to guide future research toward more effective strategies.