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Status, barriers and facilitators of comprehensive abortion care services in rural India: A multicenter mixed-methods study protocol

by Subhanwita Manna, Bijaya Kumar Mishra, Krishna Kant Yadav, Pratibha Dhiman, Smiteerekha Sahoo, Chiranjeet Mishra, Tanveer Rehman, Ranjan Kumar Prusty, Ragini Kulkarni, Mahadev Bhise, Ashok Kumar Pandey, Ravikumar B. S., Ipsita Pal Bhowmick, Subrata Kumar Palo, Narayana Swamy D. M., Neha Srivastava, Umaer Alam, Reeta Singh, Manish Barvaliya, Vani Kandpal, Barsha Gadapani Pathak, Reema Mukherjee, Sanghamitra Pati

Background

Unsafe abortion continues to be a significant cause of avoidable maternal morbidity and mortality especially in low- and middle-income countries. Despite India’s permissive Medical Termination of Pregnancy (MTP) Act, operational gaps continue to prevent women from accessing safe abortion services. There is still a dearth of multi-centric mixed-methods research from rural areas on women’s experiences, provider perspectives, and facility readiness. This study aims to assess the status of comprehensive abortion care (CAC) in rural India by evaluating public-sector facility preparedness, provider experiences, care-seeking pathways, and identifying key barriers and facilitators as per CAC guidelines (2023). The findings will guide the development of a preliminary implementation approach (Model 0+) as well as future phases focused on testing, adaptation, and scale up to strengthen CAC availability, quality, and uptake.

Methods

This study employs a convergent mixed-methods design across six geographically varied rural blocks in India (North, South, East, West, Central, and Northeast). There will be two participant groups: married women aged 18–49 years who are current, previous, or potential abortion service users, and public health system stakeholders involved in Comprehensive Abortion Care (CAC). A multistage cluster survey will enroll approximately 854 married women per site across 20 clusters. The qualitative component will comprise interviews with women who have had abortions in the last two years and healthcare practitioners, for a total of around 240 interviews. Additionally, 18 focus group discussions with Accredited Social Health Activists and Anganwadi Workers (three per site), will capture frontline worker’s perspectives. Quantitative data will be collected using KoboCollect and analysed using STATA (or an equivalent statistical software). Qualitative data will undergo combined phenomenological and thematic analysis using NVivo or equivalent software.

Discussion

This study constitutes the first phase of a multi-stage implementation research programme. The study builds upon national CAC guidelines as a foundation of implementation of “Model 0” for abortion care and assesses their functioning in routine public-sector settings. Insights from women, frontline workers, and providers will inform development of a refined implementation strategy (“Model 0+”) grounded in real-world contexts. This evidence-driven approach is expected to yield a practical, acceptable, and scalable model for subsequent piloting, adaptation, and wider health system uptake.

Computational identification and evaluation of <i>Adenium obesum</i> phytochemicals as potential EGFR inhibitors for targeted therapy against non-small-cell lung cancer

by Md. Naziur Rahman, Abu Yousuf Hossin, Shahriar Mannan Imon Talukder, Mt. Sumaiya Siddika, Md. Harun-Ur-Rashid, Shahanaz Parveen, Md. Ridwanul Islam, Md. Yeamin Hossain, Mahfuj Ahmed, Brototi Chakraborty Dyuti, Zarin Tabassum, Ajoy Kumer

Non-small-cell lung cancer (NSCLC) remains the leading cause of lung cancer–related mortality, largely driven by aberrant activation of the epidermal growth factor receptor (EGFR). Despite the clinical success of EGFR tyrosine kinase inhibitors (TKIs), intrinsic and acquired resistance, coupled with safety concerns, highlight the need for novel, safer inhibitors. Natural products represent an underexplored source of structurally diverse bioactive compounds with favorable biocompatibility. In this study, a comprehensive in silico approach is used to evaluate phytochemicals from Adenium obesum as potential candidate EGFR-targeting compound. Initially, sixteen phytochemicals were first assessed for predicted antineoplastic activity using PASS. High-scoring molecules were docked against the EGFR kinase domain (PDB ID: 1M17), besides performed detailed protein–ligand interaction analysis, drug-likeness and ADMET profiling, toxicity prediction and 100-ns molecular dynamics (MD) simulations. PASS-based bioactivity prediction revealed strong anticancer potential among the sixteen screened compounds, with consistently high antineoplastic and antiproliferative activity probabilities (Pa > 0.79) and low inactivity scores, supporting their selection for subsequent docking, ADMET, and molecular dynamics analyses. Next, several phytochemicals exhibited strong docking affinities, with Cardenolide achieving the highest binding score (–9.9 kcal/mol) and forming stable interactions with key catalytic residues. A 100-ns MD simulation confirmed the structural stability, persistent binding, and dynamic integrity of the EGFR–Cardenolide complex under physiological conditions. Importantly, interaction mapping revealed that Cardenolide engages conserved and functionally critical regions of the EGFR kinase domain associated with catalytic activity and structural stability, supporting its mechanistic relevance as an ATP-competitive scaffold. Additionally, predicted pharmacokinetic and toxicity profiles further supported Cardenolide’s suitability as a drug-like candidate. Collectively, these results identify Cardenolide as a computationally prioritized candidate with favorable predicted EGFR-binding characteristics, structural stability, and physicochemical and toxicity profiles. However, as the present study is based entirely on computational analyses, these findings should be considered hypothesis-generating and do not establish EGFR inhibitory activity or therapeutic efficacy. Experimental validation, including biochemical kinase inhibition and cellular assays, is therefore required to determine the actual EGFR inhibitory potential and anticancer activity of Cardenolide. Nevertheless, the findings provide a rational basis for prioritizing Cardenolide for further experimental investigation and illustrate the potential of Adenium obesum phytochemicals as a source of candidate EGFR-targeting compounds for future NSCLC drug discovery.

A data-driven approach to hepatitis C forecasting using machine learning and epidemiological models

by Abdul Mannan, Jamshaid Ul Rahman, Ebraheem Alzahrani, Osman Abubakar Fiidow

The hepatitis C virus is a significant global health concern and a major cause of chronic liver disease. Therefore, developing a mathematical model is essential for understanding, controlling and managing its transmission dynamics. In this paper, we developed a mathematical model and simulated the dynamics of transmission of the hepatitis C virus, considering alcohol use, a key factor contributing to increased damage to the liver of infected individuals. Computational investigation of nonlinear biological models by traditional numerical solvers is challenging due to their nonlinearity and inherent complexity. Furthermore, we proposed a deep learning-based technique to solve the nonlinear differential equations governing the model for transmission of the hepatitis C virus in six compartments. The proposed deep learning-based model is compared with other established methods like the Runge-Kutta method and Livermore solver for ordinary differential equations algorithm to validate its efficacy and accuracy in predicting hepatitis C dynamics. The basic reproduction number, R0, is calculated and stability is analyzed at both the disease-free and endemic equilibrium points. Sensitivity analysis is performed to determine key parameters that contribute to hepatitis C transmission. The results indicate that the proposed approach is an efficient and robust solution with better convergence and stability than existing methods. This study highlights the potential of deep learning methods in epidemiology as a promising tool for predicting and controlling infectious diseases such as hepatitis C, particularly in the presence of behavioral risk factors such as alcohol consumption.

<i>Vicia faba</i>-PGPB association improves soil health as a sustainable strategy to remediate moderately Pb and Cd contaminated soils

by Omar Saadani, Souhir Abdelkrim, Wael Taamalli, Imen Challougui Fatnassi, Khedhiri Mannai, Moez Jebara, Salwa Harzalli Jebara

Phytoremediation is an eco-friendly strategy for heavy metal bioremediation. This study focuses on assessing the potential of faba bean- plant growth promoting bacteria symbiosis in phytoremediation and soil fertility improvement of HMs contaminated soils. Vicia faba L. var. minor Saber 02 was inoculated with a consortium of three efficient and HMs resistant PGPB (Rhizobium sp. CCNWSX0481, R. leguminosarum bv. viciae and Pseudomonas sp.) and cultivated in soil treated with Cd and Pb to establish three contamination levels: uncontaminated (S1), moderately contaminated (S2; 2 mg kg-1 Cd and 100 mg kg-1 Pb), and highly contaminated (S3; 4 mg kg-1 Cd and 200 mg kg-1 Pb). Bacterial inoculation enhanced plant growth and metal uptake, most significantly in the moderately contaminated soil (S2). An increase in shoot dry weight and nodule dry weight was observed after bacterial inoculation mostly in the moderately contaminated soil S2. Furthermore, the effect of bacterial inoculation was particularly pronounced in S2 soil, resulting in significant increases in Pb and Cd accumulation in the shoots by 66% and 441%, respectively, compared to the uninoculated plants. Similarly, inoculated plants grown in S2 soil exhibited substantially higher total heavy metal contents than the uninoculated plants, reaching 179% for Pb and 319% for Cd, respectively. This increase was associated with an enhancement in the concentration of non-protein thiols, particularly in S2 soil, where inoculation increased root NPT levels by 49% compared to the uninoculated plants. Nevertheless, HMs induced a significant increase in roots enzyme such as superoxide dismutase, catalase and glutathione reductase. The inoculation further enhancing their activities essentially in S2. Moreover, PGPB considerably reduced total Pb as well as both the total and available fractions of Cd, mainly in S2 soil and increased total nitrogen and available phosphorus content, urease and β-glucosidase activities. The obtained results highlight the effectiveness of V. faba L var. minor Saber 02- PGPB symbiosis in the reclamation of moderately Pb and Cd contaminated soils. The bacterial consortium could be used as biofertilizer to improve soil quality of Cd/Pb contaminated sites.

Genetic association and computational analysis of <i>CYP2R1</i> gene polymorphisms rs2060793 and rs12794714 with vitamin D deficiency and acute myocardial infarction in the Bangladeshi population: A case control study

by Sadia Akter, Md. Nazid Bin Ibrahim, Zimam Mahmud, Sonia Tamanna, Md. Shakhawat Hossain Shawon, Farzana Ansari, Md. Zakir Hossain Howlader

Acute myocardial infarction (AMI) remains a leading cause of cardiovascular morbidity and mortality worldwide. Emerging evidence highlights vitamin D as a critical determinant of cardiovascular health. The CYP2R1 gene encodes the key 25-hydroxylase enzyme responsible for converting vitamin D to its principal circulating metabolite, 25-hydroxyvitamin D. However, the influence of CYP2R1 polymorphisms on AMI susceptibility, particularly within South Asian populations, has not been well characterized. This study investigates the association of two CYP2R1 variants, rs2060793 and rs12794714, with AMI risk and their relationship with serum vitamin D levels in a Bangladeshi cohort. A total of 502 participants comprising 251 AMI patients and 251 age- and sex-matched controls were analyzed. Genomic DNA was extracted and genotyped using PCR-RFLP, while serum 25-hydroxyvitamin D3 levels were quantified by HPLC. AMI patients exhibited markedly lower vitamin D concentrations (23.92 ± 0.94 ng/mL) than controls (30.3 ± 0.86 ng/mL; p p = 0.0064). The dominant model (TC + CC vs. TT) further confirmed this relationship (OR = 2.53, 95% CI: 1.39–4.61, p = 0.0016). In contrast, rs12794714 showed no significant association with AMI in this population. Stratified analysis indicated that rs2060793 was significantly linked to AMI in males but not females, while both variants were associated with increased risk in individuals aged ≤60 years, but not in those >60 years. Bioinformatic and molecular docking analyses (RegulomeDB, JASPAR, HADDOCK 2.4, DNAproDB) further demonstrated potential regulatory effects of these variants on CYP2R1 function. Collectively, our findings reveal a novel association between CYP2R1 rs2060793 and vitamin D deficiency with AMI risk in the Bangladeshi population, underscoring the interplay of genetic and metabolic determinants in the molecular pathogenesis of AMI.

Mapping the evidence on stillbirth prevention across the reproductive continuum: an umbrella review

Por: Gadapani Pathak · B. · Vats · P. · Manna · S. · Yadav · S. · Bhatt · A. · Mukherjee · R. · Patil · R. · Dayma · G. · Mazumder · S.
Objectives

To collate and appraise evidence from existing systematic reviews and meta-analyses on interventions to prevent stillbirth and reduce perinatal mortality across the reproductive continuum, including preconception, antenatal, intrapartum and immediate newborn periods.

Design

Umbrella review synthesising evidence from systematic reviews, including meta-analyses where available.

Data sources

A comprehensive search was conducted in CENTRAL (via Cochrane Register of Studies Online), PubMed, Embase and Web of Science, along with trial registries (WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ISRCTN Registry), from inception to 12 January 2026.

Eligibility criteria

Systematic reviews and meta-analyses synthesising randomised controlled trials or quasi-experimental studies that reported stillbirth, perinatal mortality, fetal loss or fetal death were included. Reviews focused exclusively on predefined high-risk populations were excluded.

Data extraction and synthesis

Two reviewers independently extracted data and assessed methodological quality using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty ratings were extracted as reported by the original review authors. Evidence synthesis followed a structured framework adapted from Ota et al, integrating direction of effect and certainty of evidence based on pooled estimates and GRADE assessments. Publication overlap was assessed using the Corrected Covered Area index where relevant.

Results

A total of 116 systematic reviews were included, synthesising evidence from randomised controlled and quasi-experimental studies across preconception, antenatal, intrapartum and immediate newborn periods. Evidence from individual reviews showed clear benefit for several interventions, including balanced energy-protein supplementation, home visits by community health workers, birth preparedness interventions, labour induction at or beyond 37 weeks of gestation and skilled or community-based intrapartum care, primarily for reducing perinatal mortality. Reduced antenatal visit schedules compared with standard care were associated with a possible increase in stillbirth or perinatal mortality, indicating potential harm. Many interventions—such as group antenatal care (ANC), nutritional education, case-note provision, routine ultrasound or Doppler monitoring, antibiotic treatment for bacterial vaginosis, antiretroviral therapy in pregnancy and several pharmacological or hormonal interventions—demonstrated unknown or inconclusive effects on stillbirth or perinatal mortality, largely due to imprecision and heterogeneity.

Conclusions

This umbrella review identifies a range of interventions with evidence of effectiveness across the reproductive continuum, particularly those addressing maternal nutrition, continuity of ANC and quality intrapartum and newborn care. However, substantial evidence gaps remain, especially for interventions widely implemented without strong supporting evidence. These findings highlight the need for context-specific implementation research and prioritisation of proven strategies in low- and middle-income countries, where the burden of stillbirth remains highest.

PROSPERO registration number

CRD42024531100.

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