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Background: The mucogingival conditions associated with the recession defects at the mandibular anterior region, not only make plaque control difficult to be performed by the patient but also pose a problem in passively advancing the tissues at the recipient site. This surgical technique is used to treat multiple recession defects in the mandibular anterior region. Materials and Methods: Twenty-five sites in 17 subjects (11 women and 6 men) underwent modified bridge flap and de-epithelized gingival unit graft (d-GUG) as a single-step treatment modality to cover the denuded root surface, as well as increase the width of keratinized gingiva in recession type 1 gingival recession defects in the mandibular anterior region. Results: Nearly 60% of sites in our study showed complete root coverage, with a mean root coverage percentage of 88.08%. Furthermore, keratinized tissue width, keratinized tissue thickness as well as vestibular depth showed statistically significant increases as compared to baseline levels. Conclusion: Thus, the modified bridge flap technique using d-GUG within the limitations of our study design, showed promising results in terms of recession coverage as well as management of the difficult mucogingival conditions at the mandibular anterior region.

Abstract Introduction Disparities in HIV and other sexually transmitted infections (STIs) persist among cisgender sexually minoritized men in the United States, driven in part by sexual behavior stigma, which is a barrier to clinic-based HIV/STI testing. HIV/STI biospecimen self-collection (HSBS) is a novel testing approach that mitigates stigma by allowing for some testing-related procedures to be conducted by oneself in one’s home or any private location rather than a facility that requires interpersonal interactions and exposure to other members of the public. HSBS has demonstrated acceptability, feasibility, and effectiveness in testing uptake, but the extent to which stigma persists in HSBS and the quantification of stigma’s role in HSBS is limited. Methods From 2019–2020, a nationwide sample of sexually minoritized men completed an online biobehavioral survey. Those who agreed to be recontacted (N = 4147) were invited to participate in HSBS; consented participants received self-collection kits that were laboratory-tested if completed. Sexual behavior stigma and HSBS associations were assessed with logistic regression. Results Mean age of participants was 35 years, 58% (2421/4147) were non-Hispanic white, 82% (3391/4147) were gay-identifying, 47% (1967/4147) had at least a college degree, and 56% (2342/4147) earned ≥ $40,000 annually; 27% (1112/4147) expressed HSBS interest, and 67% (689/1034) completed HSBS. HSBS interest and completion were less common among non-Hispanic Black sexually minoritized men and sexually minoritized men of lower socioeconomic status. Stigma from family and friends was significantly, negatively associated with HSBS interest (aOR = 0.72, 95% CI = 0.56, 0.93). Among those who had not tested for HIV/STIs in the past year, anticipated healthcare stigma was marginally, negatively associated with HSBS completion (aOR = 0.40, 95% CI = 0.15, 1.07). Among those who had never previously tested for HIV/STIs, anticipated healthcare stigma was significantly, negatively associated with HSBS interest (aOR = 0.32, 95% CI = 0.14, 0.72). Conclusions Sexual behavior stigma persists as an HIV/STI testing barrier, even in the case of HSBS, limiting its utilization. Increasing HSBS among sexually minoritized men in the US necessitates stigma mitigation efforts that directly address equity in implementation.

Abstract Surfaces – by breaking bulk symmetries, introducing roughness, or hosting defects – can significantly influence magnetic order in magnetic materials. Determining their effect on the complex nanometer-scale phases present in certain non-centrosymmetric magnets is an outstanding problem requiring high-resolution magnetic microscopy. Here, we use scanning SQUID microscopy to image the surface of bulk Cu2OSeO3 at low temperature and in a magnetic field applied along $$\left\langle 100\right\rangle$$ 100 . Real-space maps measured as a function of applied field reveal the microscopic structure of the magnetic phases and their transitions. In low applied field, we observe a magnetic texture consistent with an in-plane stripe phase, pointing to the existence of a distinct surface state. In the low-temperature skyrmion phase, the surface is populated by clusters of disordered skyrmions, which emerge from rupturing domains of the tilted spiral phase. Furthermore, we displace individual skyrmions from their pinning sites by applying an electric potential to the scanning probe, thereby demonstrating local skyrmion control at the surface of a magnetoelectric insulator.

Abstract Background Key populations (KP), including men who have sex with men (MSM), female sex workers (FSW), and transgender women (TGW), experience a disproportionate burden of HIV, even in generalized epidemics like South Africa. Given this disproportionate burden and unique barriers to accessing health services, sustained provision of care is particularly relevant. It is unclear how the COVID-19 pandemic and its associated restrictions may have impacted this delivery. In this study, we aimed to describe patterns of engagement in HIV prevention and treatment services among KP in South Africa and assess the impact of different COVID-19 restriction levels on service delivery. Methods We leveraged programmatic data collected by the US President’s Emergency Plan for AIDS Relief (PEPFAR)-supported KP partners in South Africa. We divided data into three discrete time periods based on national COVID-19 restriction periods: (i) Pre-restriction period, (ii) High-level restriction period, and (iii) After-high level restriction period. Primary outcomes included monthly total HIV tests, new HIV cases identified, new initiations of pre-exposure prophylaxis (PrEP), and new enrollments in antiretroviral therapy (ART). We conducted interrupted time series segmented regression analyses to estimate the impact of COVID-19 restrictions on HIV prevention and treatment service utilization. Results Between January 2018 and June 2022, there were a total of 231,086 HIV tests, 27,051 HIV positive cases, 27,656 pre-exposure prophylaxis (PrEP) initiations, and 15,949 antiretroviral therapy initiations among MSM, FSW and TGW in PEPFAR-supported KP programs in South Africa. We recorded 90,457 total HIV tests during the ‘pre-restriction’ period, with 13,593 confirmed new HIV diagnoses; 26,134 total HIV tests with 2,771 new diagnoses during the ‘high-level restriction’ period; and 114,495 HIV tests with 10,687 new diagnoses during the after high-level restriction period. Our Poisson regression model estimates indicate an immediate and significant decrease in service engagement at the onset of COVID-19 restrictions, including declines in HIV testing, treatment, and PrEP use, which persisted. As programs adjusted to the new restrictions, there was a gradual rebound in service engagement, particularly among MSM and FSW. Towards the end of the high-level restriction period, with some aspects of daily life returning to normal but others still restricted, there was more variability. Some indicators continued to improve, while others stagnated or decreased. Conclusion Service provision rebounded from the initial shock created by pandemic-related restrictions, and HIV services were largely maintained for KP in South Africa. These results suggest that HIV service delivery among programs designed for KP was able to be flexible and resilient to the evolving restrictions. The results of this study can inform plans for future pandemics and large-scale disruptions to the delivery of HIV services.

Abstract Background Respiratory syncytial virus (RSV) is one of the main causes of hospitalization for lower respiratory tract infection in children under five years of age globally. Maternal vaccines and monoclonal antibodies for RSV prevention among infants are approved for use in high income countries. However, data are limited on the economic burden of RSV disease from low- and middle-income countries (LMIC) to inform decision making on prioritization and introduction of such interventions. This study aimed to estimate household and health system costs associated with childhood RSV in Kenya. Methods A structured questionnaire was administered to caregivers of children aged

The endoplasmic reticulum (ER) is a vital cell organelle that is primarily involved in the processes of protein folding, maintenance of intracellular calcium storage and lipid synthesis in order to maintain cellular homeostasis. To achieve this meticulous order, several ER-dependent processes have to be in unison and perfect harmony. However, a persistent supply of newly synthesized proteins strains the ER mainly due to the accumulation of unfolded proteins, thus ultimately leading to an imbalance termed ER stress. Although the accumulation of misfolded proteins is a frequent reason for the initiation of ER stress, it is also induced by the hyper-production of reactive oxygen species, aberrant calcium leakage from the ER and due to the effect of cytokines. ER stress signals are conveyed via three arms of ER, namely PERK, IRE1 and ATF6. Signal transduction form these signaling molecules often converges on the transcriptional upregulation of CHOP and its related signaling mechanisms. If the ER stress is unresolved, then it can lead to cell death through different cell death mechanisms, including apoptosis, proptosis, etc. In the liver, it has been observed that ER stress plays a critical role in hepatic damage under different experimental conditions. This review highlights the role of ER stress in liver pathologies.

Abstract Correctly identifying perturbed biological pathways is a critical step in uncovering basic disease mechanisms and developing much-needed therapeutic strategies. However, whether current tools are optimal for unbiased discovery of relevant pathways remains unclear. Here, we create “Benchmark” to critically evaluate existing tools and find that most function sub-optimally. We thus develop the “Pathway Ensemble Tool” (PET), which outperforms existing methods. Deploying PET, we identify prognostic pathways across 12 cancer types. PET-identified prognostic pathways offer additional insights, with genes within these pathways serving as reliable biomarkers for clinical outcomes. Additionally, normalizing these pathways using drug repurposing strategies represents therapeutic opportunities. For example, the top predicted repurposed drug for bladder cancer, a CDK2/9 inhibitor, represses cell growth in vitro and in vivo. We anticipate that using Benchmark and PET for unbiased pathway discovery will offer additional insights into disease mechanisms across a spectrum of diseases, enabling biomarker discovery and therapeutic strategies.

Visceral leishmaniasis (VL) is widespread in tropical and temperate region. It is caused by the protozoan parasite leishmania species and is transmitted through the bite of infected female sandflies. It manifests as pancytopenia, hepatosplenomegaly and fever. Here, we present a case of 20-year-old male presented with difficulty in swallowing for 2 months, abdominal distention for 30 days and shortness of breath for 20 days along with progressive renal impairment. Clinical examination revealed hepatosplenomegaly and laboratory investigations confirmed pancytopenia, nephrotic range proteinuria, hematuria and hypocomplementemia. Bone marrow aspiration and biopsy was performed which showed leishmania donovani (LD) bodies. It’suncommon presentation makes it challenging for physicians as well as pathologist to make a timely diagnosis.

Background: Examination of blood smears and various hematologic parameters is the first step in assessment of hematologic function and diagnosis of possible underlying diseases. The aim of this study was to identify artefacts in stored red blood cells and classify the occurrence of such alterations according to the age of the stored sample. This studyalso aimed to note the changes in platelet count dispatched by automated hematology coulter in such stored blood samples. Material and Methods: A prospective cross sectional study was conducted from the EDTA anticoagulated blood samples of 100 patients received in the department of Pathology after receiving ethical approval from the institutional review committee. All the samples were analyzed in 4 occasions i.e. within 2 hours, at 24 hours, at 48 hours and at 96 hours. Analysis was carried out by Sysmex 5 part analyzer for platelet counts and the Leishman stained blood films were examined to note changes in the erythroctyte morphology. Results: There was alterationsin platelet counts in 22% cases between 2-hour samples and other samples. The red blood cell morphology was not different among 2 hours samples and 24 hours sample. However, the red blood cell morphology was altered in 48 hours samples and 96 hours samples. Conclusion: Storage of EDTA anticoagulated blood even upon refrigeration can cause changes in platelet counts as well as morphology of red blood cells. Changes in red blood cells are not significant till 24 hours while the platelet counts may alter within 24 hours.

Factors associated with the habitat suitability of northern red muntjac (Muntiacus vaginalis) especially outside protected areas in the human-dominated landscape are still lacking. Fine-scale environmental variables can influence the habitat suitability of the animals. This study aimed to explore the different eco-geographic fine-scale variables for the distribution of the northern red muntjac; and predict suitable habitats using the maximum entropy (Maxent) model in the Chitwan Annapurna landscape (CHAL). The presence points of the northern red muntjac (n = 265) were collected between 2018 to 2021 using 150 transects of various lengths in four blocks. Density-based occurrence points rarify and performance-based variable selection were applied to improve the output of the model. The model was evaluated based on the area under the curve (AUC) value of operator characteristic (ROC) and analyzed on the basis of the response curve, the relative importance of variables, Jackknife test and suitability map. Results indicated the model was statistically satisfactory (mean AUC > 0.75). The distance to the nearest cropland was the most contributed variable followed by Normalized Difference Built-up Index (NDBI), distance to developed/settlement area and distance to grassland that explained suitability of Northern red muntjac. The species distribution model predicted 6.52% highly suitable and 23.77% suitable area for northern red muntjac. Therefore, this area is important for the muntjac and provides a possible alternative habitat for other wild animals outside the protected areas. Our research suggests that human dominated landscape should be prioritized in management plans for the conservation of muntjac.

Abstract In the years 2021–2022 and 2022–2023, an experiment was carried out at the IFS Unit, College of Agriculture, PJTSAU, Rajendranagar in order to determine the best one-acre integrated farming system model for Telangana's small and marginal farmers. Seven farm models among which six models were developed by combining the various components i.e., cropping systems, fruit cropfodder crops and livestock components, in different proportions, and compared with rice-groundnut system which is a major farming approach in Telangana using randomized block design. The seven models were as follows: M1: Rice–Groundnut; M2: Rice–Groundnut, Pigeonpea + Sweetcorn (1:3)—Bajra, Bt cotton + Greengram (1:2)—Maize; M3: Rice–Groundnut, Pigeonpea + Sweetcorn (1:3)—Bajra, Pigeonpea + Maize (1:3)—Sunhemp; Napier grass, Sheep (5 + 1); M4: Rice–Groundnut, Pigeonpea + Sweetcorn (1:3)—Bajra, Bt cotton + Greengram (1:2)—Maize, Pigeonpea + Maize (1:3)—Sunhemp, Poultry unit; M5: Guava, Hedge Lucerne, Napier grass, Bt cotton + Greengram (1:2)—Maize, Sheep (5 + 1); M6: Guava, Bt cotton + Greengram (1:2)—Maize, Rice–Groundnut, Poultry; M7: Rice–Groundnut, Pigeonpea + Sweetcorn (1:3)—Bajra, Pigeonpea + Maize (1:3)—Sunhemp; Napier grass, Hedge lucerne, Poultry (100), Sheep (5 + 1). Based on a 2-year average, the Model M7 system produced 9980 Rice Grain Equivalent Yield(RGEY)kg of output per acre, with gross and net returns of ₹210,439 and ₹124,953 respectively, and recovered a B:C ratio of 2.46. It has recorded highest sustainable yield index (SYI) of 0.673 and value index of 0.772 with the lowest water footprint of 259.0 L/kg. This study reveals that adopting an integrated farming system is the optimal approach for effectively combining productive, financially rewarding, and diversified enterprises within a single acre of land.d. This system should be recommended for maximum benefits to smallto small and marginal farmers in Telangana's southern hills and plateau.

Yantao Yu,1– 3,* Chenkai Zhang,2,3,* Qiannan Sun,2– 4 Shantanu Baral,2,3 Jianyue Ding,2,3 Fanyu Zhao,2,3 Qing Yao,2,3 Shuyang Gao,2,3 Bin Liu,2– 4 Daorong Wang1– 4 1The Yangzhou School of Clinical Medicine of Dalian Medical University, Yangzhou, 225001, People’s Republic of China; 2General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, People’s Republic of China; 3Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, People’s Republic of China; 4Northern Jiangsu People’s Hospital, Yangzhou, 225001, People’s Republic of China*These authors contributed equally to this workCorrespondence: Daorong Wang; Bin Liu, Email 18051062590@yzu.edu.cn; liubin2006cool@126.comBackground: Gastric cancer (GC) is a highly phenotypically heterogeneous disease and is caused by a combination of factors. Retinol binding protein 4 (RBP4) is a member of a family of lipid transport proteins that are involved in the transport of substances between cells and play a crucial role in a variety of cancers. However, the expression and role of RBP4 in GC remain unknown.Methods: In this study, we explored the expression, prognostic significance, immune microenvironment, drug responsiveness and function of associated signaling pathways of RBP4 in GC using web-based bioinformatics tools. Immunohistochemistry and real-time quantitative PCR were utilized to analyze the tissue and cell expression levels of RBP4. CCK-8, colony formation, EDU incorporation, wound healing and transwell assays were applied to demonstrate the effect of RBP4 on GC cell function. Flow cytometric detection of apoptosis after RBP4 knockdown. Nude mice xenograft model elucidates the role of RBP4 for GC in vivo. Related proteins of the RAS signaling pathway were analyzed by employing Western blot assays.Results: RBP4 is highly expressed in GC. RBP4 is closely associated with patient survival and sensitivity to a wide range of antitumor agents. Knockdown of RBP4 promoted apoptosis and inhibited cell proliferation, invasion and migration. RBP4 promotes GC tumorigenesis in vivo. Finally, RBP4 modulates the RAS/RAF/ERK axis.Conclusion: RBP4 may promote gastric carcinogenesis and development through the RAS/RAF/ERK axis and is expected to be a novel target for GC treatment.Keywords: RBP4, gastric cancer, invasion, migration, RAS/RAF/ERK axis

Abstract Interleukin-9 (IL-9) is a multifunctional cytokine with roles in a broad cross-section of human diseases. Like many cytokines, IL-9 is transcriptionally regulated by a group of noncoding regulatory elements (REs) surrounding the IL9 gene. These REs modulate IL-9 transcription by forming 3D loops that recruit transcriptional machinery. IL-9-promoting transcription factors (TFs) can bind REs to increase locus accessibility and permit chromatin looping, or they can be recruited to already accessible chromatin to promote transcription. Ample mechanistic and genome-wide association studies implicate this interplay between IL-9-modulating TFs and IL9 cis-REs in human physiology, homeostasis, and disease.

The aim of this case report is to present a unique and rare finding in a 29-year-old male with the chief complaint of swelling in the gums related to the back teeth of the lower left jaw, since 20 days. In the absence of any alarming findings on the intraoral periapical radiograph and blood profile, an excisional biopsy of the provisionally diagnosed pyogenic granuloma was planned with a high-power diode LASER (Light Amplification by Stimulated Emission of Radiation). Following the excision, an unusual amount of bleeding was encountered from a single point on the buccal cortical plate between the teeth #35 and #36. On reevaluating the left face with advanced radiodiagnostic methods, an accessory buccal foramen was reported distal to #35 which housed a thin, tortuous, and aberrant branch of the inferior alveolar artery. The swelling was histopathologically diagnosed as lobular capillary hemangioma, and the aberrant artery was labeled as its feeder vessel. The patient had no episode of recurrence until 2 years of follow-up.

Abstract Chronic lower respiratory disease (CLRD) related mortality has decreased in the United States due to increasing awareness in the general population and advancing preventative efforts, diagnostic measures, and treatment. However, demographic and regional differences still persist throughout the United States. In this study, we analyzed the temporal trends of demographic and geographical differences in CLRD-related mortality. Data was extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Using this data, age-adjusted mortality rates per 100,000 people (AAMR), annual percentage change (APC), and average annual percentage changes with 95% confidence intervals (CIs) were assessed. The Joinpoint Regression Program was used to determine mortality trends between 1999 and 2020 based on demographic and regional groups. During this study period, there were 3,064,049 CLRD-related deaths, with most demographics and regional areas showing an overall decreasing trend. However, higher mortality rates were seen in the non-Hispanic White population and rural areas. Interestingly, mortality rates witnessed a decreasing trend for males throughout the study duration compared to females, who only began to show decreases in mortality during the latter half of the 2010s. Using these results, one can target efforts and build policies to improve CLRD-related mortality and reduce disparities in the coming decades.

Abstract Objective This review specifically investigates ketamine’s role in SRSE management. Methods PubMed, EMBASE, and Google Scholar databases were searched from inception to May 1st, 2023, for English-language literature. Inclusion criteria encompassed studies on SRSE in humans of all ages and genders treated with ketamine. Results In this systematic review encompassing 19 studies with 336 participants, age ranged from 9 months to 86 years. Infections, anoxia, and metabolic issues emerged as the common causes of SRSE, while some cases had unknown origins, termed as NORSE (New Onset RSE) or FIRESs (Febrile Infection-Related Epilepsy Syndrome). Most studies categorized SRSE cases into convulsive (N = 105) and non-convulsive (N = 197). Ketamine was used after failed antiepileptics and anesthetics in 17 studies, while in others, it was a first or second line of treatment. Dosages varied from 0.5 mg/kg (bolus) and 0.2-15 mg/kg/hour (maintenance) in adults and 1-3 mg/kg (bolus) and 0.5-3 mg/kg/hour (maintenance) in pediatrics, lasting one to 30 days. Ketamine was concurrently used with other drugs in 40–100% of cases, most frequently propofol and midazolam. Seizure resolution rate varied from 53.3 to 91% and 40–100% in larger (N = 42–68) and smaller case series (N = 5–20) respectively. Seizure resolution occurred in every case of case report except in one in which the patient died. Burst suppression in EEG was reported in 12 patients from two case series and two case reports. Recurrence was reported in 11 patients from five studies. The reported all-cause mortality varied from 38.8 to 59.5% and 0-36.4% in larger and smaller case series., unrelated directly to ketamine dosage or duration. Significance Ketamine demonstrates safety and effectiveness in SRSE, offering advantages over GABAergic drugs by acting on NMDA receptors, providing neuroprotection, and reducing vasopressor requirement.

This case report presents a 21-year-old male with recurrent seizures attributed to isolated temporal lobe closed-lip schizencephaly coexisting with septo-optic dysplasia. Despite adult-onset seizures, the patient lacked motor deficits, maintaining normal developmental milestones. Comprehensive diagnostic modalities, including MRI revealing temporal lobe atrophy and associated abnormalities, contributed to the unique identification of schizencephaly. The classic triad of septo-optic dysplasia further complicated the clinical spectrum. Financial limitations influenced the predominantly conservative management, highlighting healthcare challenges. This case enhances our understanding of the rare congenital disorder, emphasizing the importance of tailored diagnostics and management strategies for diverse presentations of schizencephaly, particularly in the context of associated congenital anomalies.

Producing scalable, economically viable, low-carbon biofuels or biochemicals hinges on more efficient bioconversion processes. While microbial conversion can offer robust solutions, the native microbial growth process often redirects a large fraction of carbon to CO2 and cell mass. By integrating genome-scale metabolic models with techno-economic and life cycle assessment models, this study analyzes the effects of converting cell mass lipids to hydrocarbon fuels, and CO2 to methanol on the facility’s costs and life-cycle carbon footprint. Results show that upgrading microbial lipids or both microbial lipids and CO2 using renewable hydrogen produces carbon-negative bisabolene. Additionally, on-site electrolytic hydrogen production offers a supply of pure oxygen to use in place of air for bioconversion and fuel combustion in the boiler. To reach cost parity with conventional jet fuel, renewable hydrogen needs to be produced at less than $2.2 to $3.1/kg, with a bisabolene yield of 80% of the theoretical yield, along with cell mass and CO2 yields of 22 wt% and 54 wt%, respectively. The economic combination of cell mass, CO2, and bisabolene yields demonstrated in this study provides practical insights for prioritizing research, selecting suitable hosts, and determining necessary engineered production levels.

Producing scalable, economically viable, low-carbon biofuels or biochemicals hinges on more efficient bioconversion processes. While microbial conversion can offer robust solutions, the native microbial growth process often redirects a large fraction of carbon to CO2 and cell mass. By integrating genome-scale metabolic models with techno-economic and life cycle assessment models, this study analyzes the effects of converting cell mass lipids to hydrocarbon fuels, and CO2 to methanol on the facility’s costs and life-cycle carbon footprint. Results show that upgrading microbial lipids or both microbial lipids and CO2 using renewable hydrogen produces carbon-negative bisabolene. Additionally, on-site electrolytic hydrogen production offers a supply of pure oxygen to use in place of air for bioconversion and fuel combustion in the boiler. To reach cost parity with conventional jet fuel, renewable hydrogen needs to be produced at less than $2.2 to $3.1/kg, with a bisabolene yield of 80% of the theoretical yield, along with cell mass and CO2 yields of 22 wt% and 54 wt%, respectively. The economic combination of cell mass, CO2, and bisabolene yields demonstrated in this study provides practical insights for prioritizing research, selecting suitable hosts, and determining necessary engineered production levels.

Tuberculous Meningitis (TBM) is a rare manifestation of Mycobacterium tuberculosis infection affecting the meninges. We present a case of a 40-year-old male initially presenting with neurological deficits mimicking ischemic stroke. Despite classic signs, including fever, headache, and neck stiffness, TBM was initially overlooked, leading to delayed treatment. Comprehensive assessment, imaging findings, and characteristic cerebrospinal fluid findings, confirming TBM with tubercular stroke. The patient responded positively to antitubercular therapy and steroids. This case underscores the diagnostic challenges of TBM, emphasizing the need for a broad differential diagnosis, particularly in regions with a high tuberculosis prevalence. Recognition of atypical presentations is crucial for timely intervention and improved outcomes.

The Endangered dhole Cuon alpinus is a medium-sized canid that was historically distributed widely across East, Central, South and Southeast Asia. In Nepal, following heavy persecution during the 1970s and 1980s, the species was locally extirpated across large parts of the country. After decades of near absence, the dhole is reportedly showing signs of recovery in various areas of Nepal. We carried out three surveys using camera traps (resulting in a total of 6,550 camera-trap days), reviewed literature and interviewed herders and conservation practitioners (40 interviews) to determine the historical and current distribution of dholes in the country, and the species’ current status. Our camera traps recorded five images of dholes, and the literature review and interview survey provided further insights into the historical and current presence of dholes in Nepal. The combined findings suggest dholes have recolonized many areas where they had been locally extirpated, such as the Annapurna Conservation Area in central Nepal and the Tinjure–Milke–Jaljale forests in the eastern part of the country. Although these returns are encouraging, challenges remain for dhole recolonization, including conflict with livestock herders, human hunting of wild ungulates affecting the species’ prey base, increasing infrastructure development in forested areas, and diseases.

Background: There are sporadic facility-based reports but an information gap in the cancer burden in the community is apparent. To address this, the Nepal Health Research Council (NHRC) started a Population-based Cancer Registry (PBCR) in 2018 in the country. Thus, this study aims to identify the cancer burden in the female population, especially in the reproductive organs. Methods: A quantitative database analysis of the Population-based Cancer Registry for year 2018 and 2019 was performed. Data entered in the TSV (Tab-separated values) files were imported to MS Excel and SPSS data Window and variables regrouped before analysis. The national census, WHO standardized population, and registry data were used for the descriptive analysis of the registry variables. Ethical approval was taken from the Ethical Review Board of NHRC. Result: Out of 6854 cancer registries, the female population was 3590 with a male-to-female ratio of 10:11. This registry covers 10.75% of the country’s population. The crude and age-standardized cancer incidence rates were 1.24% and 66.2 per 100,000 for the female population respectively. Reproductive organs (21%) and breast (19.7%) cancers are the most common in females, and out of reproductive organs cervical (58%) and ovarian (25%) cancers are the commonest. Surgery was the main treatment modality (32.7%) with or without chemotherapy and radiotherapy. Conclusions: The burden of cancer is higher in females because of breast cancer. Reproductive organ cancers and breast cancers share an equal burden of around 20% each. The most common female genital cancer is of uterine cervix followed by the ovary. Keywords: Breast; burden of cancer; cancer registry; cervix; ovary.

Background: Caudal block is a commonly used method of postoperative pain management in children. However, single shot caudal block has shorter duration of analgesia that can be extended by addition of adjuncts like opioids, clonididine, and dexmedetomidine along with local anesthetics. Recently, dexmedetomidine has been used as an adjunct for prolonging the duration of analgesia. This study aimed to find out prevalence of the caudal block and the duration of analgesia with dexmedetomidine adjunct among children undergoing lower abdominal surgeries. Methods: A cross-sectional, observational study was conducted among the children admitted to the tertiary care children hospital of Nepal during the period of six months. Children of age 2 to 7 years, who had undergone lower abdominal surgeries under general anesthesia were enrolled in the study. We observed the prevalence of the caudal block and duration of analgesia of caudal dexmedetomidine with ropivacaine Results: Throughout the study period, 449 children were posted for lower abdominal surgeries. Out of which 226 children (50.03%) received caudal block. Among the caudal block, 51 children (22.56%)) were administered ropivacaine with dexmedetomidine, 45 children (19.91%) received ropivacaine alone, 43 children (19.02%) were given bupivacaine alone, 46 children (20.35%) received a combination of bupivacaine and fentanyl, and 41 children (18.14%) received bupivacaine and dexmedetomidine. Dexmedetomidine with ropivacaine provides 840.35±14.97 minutes of postoperative pain relief. Conclusions: The prevalence of the caudal block was 50.03%, and the combination of Dexmedetomidine with ropivacaine provides longer duration of postoperative analgesia. Keywords: Analgesia; caudal block; children; prevalence.

This study investigated the pH of four popular Nepalese tea brands such as Tokla, Ridhisidhi, Suman, and Muna, under different conditions to assess their acidity and potential health implications. The teas were prepared using standardized brewing methods, and pH measurements were taken at room temperature and after chilling to observe any temperature-related variations. Freshly brewed teas tended to be more alkaline, while those with added sugar and lemon were more acidic. Temperature changes had minimal impact on pH, indicating that acidity remains stable whether the tea is consumed hot or cold. While the pH range of these teas is generally safe for consumption, it may cause discomfort for those with acid sensitivity. These findings provide insights into the acidity of Nepalese teas and its potential effects on sensory and health attributes.

Crusher run dust is a waste product produced in significant quantities during the removal and processing of rocks at crusher plants. This experiment examines how high-performance concrete characteristics are affected when sand is partially replaced with crusher-run dust in various ratios. The replacement of fine aggregate with crusher run dust has been considered for M50 grade design mix concrete with 0%, 15%, 30%, 45%, and 60%, and the change in characteristics has been considered. To keep the workability between 76mm and 85mm, a superplasticizer was utilized. In this experimental investigation, the mechanical properties of concrete such as compressive strength, flexural strength, split tensile strength, and porosity have been examined. Concrete's characteristics showed improvement. Crusher-run dust with a 30% concentration in concrete has produced the best results.

Summary: Background: The HVTN 705 Imbokodo trial of 2636 people without HIV and assigned female sex at birth, conducted in southern Africa, evaluated a heterologous HIV-1 vaccine regimen: mosaic adenovirus 26-based vaccine (Ad26.Mos4.HIV) at Months 0, 3, 6, 12 and alum-adjuvanted clade C gp140 at Months 6, 12. Per-protocol vaccine efficacy (VE) against HIV-1 diagnosis from seven to 24 months was 14.1% (95% CI: −22.0% to 39.5%). Immune correlates analysis was performed for markers selected based on prior evidence in efficacy trials and/or nonhuman primate models. Methods: Humoral and cellular immune response markers at Month 7 were evaluated as immune correlates of risk and of protection in a breakthrough case–control cohort (n = 52 cases, 246 non-cases). Primary markers were IgG binding to vaccine-strain gp140, IgG3 binding to diverse Env antigens (IgG3 Env breadth), IgG3 binding to diverse V1V2 antigens (IgG3 V1V2 breadth), antibody-dependent phagocytosis against the vaccine-strain gp140, Env-specific CD4+ and CD8+ T-cell responses, and multi-epitope functions. Findings: No immune markers were statistically significant correlates of risk. IgG3 V1V2 breadth trended toward an inverse association: hazard ratio 0.70 (95% CI: 0.36 to 1.35; p = 0.29) per 10-fold increase and 0.51 (95% CI: 0.21 to 1.24; p = 0.14) in a Cox model with all primary markers. The VE estimate was 11.8% (95% CI: −17.9% to 34.0%) at all IgG3 V1V2 breadth values below 667 weighted geometric mean net MFI; just above this value, the VE estimate sharply increased to 62.6% (95% CI: −17.9% to 89.6%), and further increased to 80.9% (95% CI: −17.9% to 99.5%) at 1471 MFI, the 95th percentile of the marker distribution. Mediation analysis yielded a VE of 35.7% (95% CI: 15.0% to 51.3%) attributable to the vaccine's impact on this marker. Interpretation: The trend in association of greater IgG3 V1V2 antibody breadth with lower likelihood of HIV acquisition is consistent with the identification of antibodies against V1V2 as immune correlates in three other HIV vaccine efficacy trials and suggests that a greater emphasis should be placed on studying this region in the HIV-1 envelope as a vaccine immunogen. Funding: National Institute of Allergy and Infectious Diseases and Janssen Vaccines & Prevention BV.

Background Scientific publications have been growing exponentially, contributing to an oversaturated information environment. Quantifying a research output’s impact and reach cannot be solely measured by traditional metrics like citation counts as these have a lag time and are largely focused on an academic audience. There is increasing recognition to consider ‘alternative metrics’ or altmetrics to measure more immediate and broader impacts of research. Better understanding of altmetrics can help researchers better navigate evolving information environments and changing appetites for different types of research. Objectives Our study aims to: 1) analyse the amount and medium of Altmetric coverage of health research produced by Irish organisations (2017 – 2023), identifying changes over time and 2) investigate differences in the amount of coverage between clinical areas (e.g., nutrition vs. neurology). Methods Using Altmetric institutional access, we will gather data on research outputs published 1 January 2017 through 31 December 2023 from active Irish organisations with Research Organisation Registry (ROR) IDs. Outputs will be deduplicated and stratified by their Australian and New Zealand Standard Research Classification relating to ≥1 field of health research: Biological Sciences, Biomedical and Clinical Sciences, Chemical Sciences, Health Sciences, and Psychology. We will clean data using R and perform descriptive analyses, establishing counts and frequencies of coverage by clinical area and medium (e.g., traditional news, X, etc.); data will be plotted on a yearly and quarterly basis where appropriate. Results and Conclusions Improved understanding of one’s information environment can help researchers better navigate their local landscapes and identify pathways for more effective communication to the public. All R code will be made available open-source, allowing researchers to adapt it to evaluate their local landscapes.

Coinfection of pathogenic bacteria and viruses is associated with multiple diseases. During the COVID-19 pandemic, the co-infection of other pathogens with SARS-CoV-2 was one of the important determinants of the severity. Although primarily a respiratory virus gastric manifestation of the SARS-CoV-2 infection was widely reported. This study highlights the possible consequences of SARS-CoV-2 -Helicobacter pylori coinfection in the gastrointestinal cells. We utilized the transfection and infection model for SARS-CoV-2 spike Delta (δ) and H. pylori respectively in colon carcinoma cell line HT-29 to develop the coinfection model to study inflammation, mitochondrial function, and cell death. The results demonstrate increased transcript levels of inflammatory markers like TLR2 (p

Objective To identify directionality of SARS-CoV-2 cases within households and schools, and characterize school, household, and neighbourhood factors associated with school and non-school linked cases. Approach Using linked administrative data housed at the Manitoba Centre for Health Policy, a cohort of 449,425 individuals from 126,670 households with school-aged children enrolled in Manitoba public schools between September 1, 2020-June 30, 2021 was created. Using population-based SARS-CoV-2 laboratory test results, education enrolment and household composition data, index and transmission cases were counted and categorized at an individual and household level as school or non-school linked. Logistic regression models examined school, household and neighbourhood factors associated with school- and non-school linked households. Results 143280 individuals were tested for SARS-CoV-2 during the study period; 14712 individuals (10.3%) tested positive. Amongst positive cases, 1695 (11.5%) were school-linked; the remaining 13017 (88.5%) were non-school linked. 13.7% of SARS-CoV-2 positive households had ≥1 case linked to school; 86.3% did not. Preliminary results found higher incomes quintiles had lower odds of being a school-linked household, as did living outside the Winnipeg region. Having more children in a grade and more household members resulted in higher odds of being a school-linked transmission household. No associations were observed for having a child under age five in the household. Conclusions Taken together, these data suggest schools were not a large source of SARS-CoV-2 cases in Manitoba and factors associated with school-linked households largely mirrored broader community transmission patterns. Implications These findings may influence public health approaches to future pandemic control.

The occurrence of arsenic in the surroundings raises apprehension because its detrimental impacts on both human health and the ecology. Since adsorption is an effective, affordable method that can be adjusted to specific environmental circumstances, it is a sustainable solution for the removal of arsenic from the aquatic environment. Utilizing biomass that has been chemically activated may be a viable way to increase the adsorption capacity of the material, reduce arsenic pollution, and protect the environment and human health. In the proposed research, Fe(III) loaded saponified Punica granatum peel (Fe(III)-SPGP) has been synthesized to remove arsenic from aqueous solutions. FTIR and SEM analysis were utilized to carry out the characterization of the biosorbents. Batch experiments were carried out by altering several factors including pH and contact time, in addition to initial concentration and desorption. The most effective pH for As(III) adsorption using Fe(III)-SPGP was discovered to be 9.0. After determining that a pseudo-second-order kinetic model was the one that provided the greatest fit for the results of the experiment, the model developed by Langmuir was applied. It was discovered that the maximum adsorption of As(III) that could be adsorbed by Fe(III)-SPGP was 63.29 mg/g. The spent biosorbent may easily be reused again in subsequent applications. Based on these findings, Fe(III)-SPGP shows promise as a cheap effective sorbent for excising contaminants of As(III).

The present study illustrates the mechanical and wear behaviour of Al-MWCNT composites by varying MWCNTs concentration (0 %,0.25 %, 0.50 % & 1 %) by weight in composites. These composites were synthesized through sintering in the muffle furnace after mechanical alloying which involved flattening and welding particles to form flake-shaped lamellar particles. The presence of MWCNT lamellas restricted grain growth, creating a 2D aluminium layer between the MWCNTs during sintering. Increasing the MWCNT content in aluminum refined the interlayer thickness of the composites. The compressive strength of Al is increased exponentially with the addition of CNTs. By adding CNTs to aluminium, the maximum strength was reached at 460 MPa in 1% samples, and the compression strength of the aluminium increased by 84 % as well. The sintered composites exhibited higher hardness and its value increased significantly when CNTs were added to the Al composite. The wear resistance of aluminium is substantially increased when CNTs are added, and the maximum wear resistance is achieved when CNTs are added at 0.5 wt%. The addition of CNTs reduced wear resistance, which could be attributed to the decrease in interface adhesion and agglomeration effects of CNTs.

Alveolar macrophages (AMs) are a fully differentiated lung-resident immune cell population and are a critical component of lung immunity. AMs can be easily isolated from mice via bronchoalveolar lavage fluid (BALF) collection. The quality and quantity of AMs in BALF isolation are critical for generating reliable and high-quality data for ex vivo studies. Traditional techniques use ice-cold (4°C) buffer to collect AMs in BALF and result in low yield. Hence, a new method that consistently gives a higher yield of AMs is needed. We demonstrate here an optimized method that significantly increases the quantity of AM recovery in BALF (>2.8 times than the traditional method). Our method uses a warm-buffer (37°C) containing EDTA. We compared the viability and functional parameters (cytokine/chemokine expression, phagocytosis) of AMs isolated by our new and traditional methods. Our study revealed that AMs collected using our method have similar viability and functional characteristics to those collected using traditional method. Hence, our new method can be used for the collection of a higher number of AMs without altering their function. This protocol might also be useful for isolating tissue-resident immune cells from other anatomical sites for ex vivo and other downstream applications.

Various thermochemical and biochemical processes are resorted to transform agri-wastes into diverse green fuels. Current investigation encompassed three different types of biomass viz., gingelly, kodo millet and horse grams, whose desirability as biofuel feedstock have been largely unexplored till date. The existence of significant amount of cellulose (38.07 %), volatiles (75.19 %), calorific value (avg. 16.98 MJ/kg) in the gingelly biomass, demonstrates the effectiveness of the concerned biomass for utilization as feedstock in diverse industrial applications. The mean estimates of Eα were lower for kodo millet (approx. 150 kJ/mole), followed by gingelly (approx. 178 kJ/mole) and horse gram (approx. 180 kJ/mole). The mean estimates of ΔHα were 174.81 (FWO), 170.22 (KAS), 169.17 (S) and 170.40 (T) kJ/mol for the gingelly biomass. The mean estimates of ΔHα were 147.83 (FWO), 148.81 (KAS), 147.93 (S) and 149.04 (T) kJ/mol for kodo millet biomass, while for horse gram biomass, mean estimates of ΔHα were 178.91 (FWO), 169.61 (KAS), 168.56 (S) and 168.81 (T) kJ/mol. The minor difference of 3–4 kJ/mole between Aα and Hα, signifies the viability of the thermal disintegration process. From master plot, it's evident that the experimental curve intersects multiple theoretical curves, highlighting the intricate characteristics of the thermal disintegration process. The overall ethanol recovery was highest in gingelly as compared to both the biomasses. Gingelly biomass yielded an ethanol titer of 24.8 g/L after 24 h, resulting in a volumetric ethanol productivity of 1.03 g/L/h and an ethanol yield of 0.36 g/g.

Flexible piezoelectric nanogenerator (PENG) and triboelectric nanogenerators (TENG) have gained prodigious attention due to the increasing demand of nano and micro energy for driving of miniaturized electronic devices, sensors, and various internet of things. The key challenges that are currently in focus are material selection and simple fabrication techniques for improved electrical performance along with good mechanical properties and flexibility. Herein, a ferroelectric polymer, poly(vinylidenefluoride-co-trifluoroethyne) (PVDF-TrFE), is chosen as a flexible material due to its promising prospect for energy harvesting. To improve the performance, a ceramic material, 0.65Pb(Mg1/3Nb2/3)O3–0.35PbTiO3 (PMN-PT), with very high piezoelectric properties has been selected as the reinforcement. Further, reduced graphene oxide has been added as a conducting filler to promote charge conduction. A remarkable enhancement in output voltage of nearly 3 fold is achieved in PVDF-TrFE/PMN-PT (PP) polymer composite as compared to the base polymer PVDF-TrFE (P) TENG device. Furthermore, the PVDF-TrFE/rGO/PMN-PT (PPR) as a PENG illustrates a great improvement in output current of the order of 2 as compared to the pristine polymer. The maximum output voltage as shown by the TENG is 200 V and the maximum current that is shown by the PENG is 30 µA. Therefore, the fabricated PMN-PT based PVDF-TrFE nanogenerators have an immense prospect for applications in self-powered systems.

Abstract The populations of many species of large mammals occur in small isolated and fragmented habitat patches in the human‐dominated landscape. Maintenance of habitat connectivity in the fragmented landscapes is important for maintaining a healthy population of large mammal. This study evaluated the landscape patches and their linkages on two carnivores (leopard and Himalayan black bear) and seven prey species (northern red muntjac, chital, sambar, wild pig, Himalayan goral, rhesus macaque, and langur) between Chitwan National Park (CNP) and Annapurna Conservation Area (ACA) by using the least‐cost path (LCP) approach and the Linkage Mapper tool in ArcGIS. A total of 15 habitat patches (average area 26.67 ± 12.70 km2) were identified that had more than 50% of the total studied mammals. A weak relation among the habitat patches was found for chital and sambar (Cost‐weighted distance [CWD]: Euclidean distance EucD >100), showed poor connectivity between the habitat patches, while ratio of CWD and EucD was low (i.e., low LCP) between majority of the patches for muntjac, wild pig and leopard hence had potential functional connectivity along the landscape. Similarly, low LCP between the habitat patches located in the mid‐hills was observed for Himalayan goral and Himalayan black bear. Furthermore, the multi‐species connectivity analysis identified the potential structural connectivity between the isolated populations and habitat patches. Therefore, these sites need to be considered connectivity hotspots and be prioritized for the conservation of large mammals in the landscape.

IntroductionThis study estimates community forest tree species’ energy using allometric models. Accurate tree-level energy stock estimation is needed to evaluate community forest tree species for renewable energy development. Three commercial species in community forests utilized as temporary energy sources, Falcataria moluccana, Swietenia macrophylla, and Tectona grandis were sampled by cutting 45 trees. Those tree types were investigated as co-firing materials supplied by the community while the region develops a strategy including finding the best species for continuous wood energy stock to power Java and Bali.MethodsThis study recorded data to compare with the potential determined fast-growing species established specifically for the next annual energy stock. Multiplying the biomass calorific value gave each tree component’s energy stock and adding all energy stock tree components result in an estimate for each tree. Regression analysis was used to make allometric models that use diameter at breast height (DBH) and tree height as predictors.ResultsThe calorific value of components varied among species, with foliage having the highest (5,021.24 ± 39.37 kcal kg−1), followed by stem (4,352.8 ± 32.07 kcal kg−1) and branches (4,200.11 ± 33.54 kcal kg−1). Thus, leaves could be used for energy as trees are harvested for timber. All species stored most energy in stems (60.59 0.97%), branches (27.04 1.13%), and leaves (12.38 0.84%).DiscussionAs DBH classes grew, the energy stock of stems and branches improved but foliage fell. With adjusted R2adj of 0.84–0.99 and root mean square error (RMSE) of 0.03–0.64, allometric models accurately assessed species energy stocks in each component and the overall tree. Tree height does not necessarily improve model accuracy; therefore, each species had a different best-fit model. Generalized allometric models for all species might estimate component and tree energy storage and our study demonstrated that allometric models could measure community forest tree species energy stocks. These should also be estimated for the next species for co-firing wood biomass when coppice harvest is applied. The above alternative species and the proposed much faster-growing species for co-firing are compared.

Objective To determine the prevalence and factors associated with anxiety and depression and the care-seeking behaviour among Nepalese population.Design and settings Secondary analysis of the data from nationally representative Nepal Demographic and Health Survey 2022.Participants Analysed data of 12 355 participants (7442 females and 4913 males) aged 15–49 years.Outcome measures Depression and anxiety were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Assessment (GAD-7) tools, respectively.Statistical analysis We performed weighted analysis to account for the complex survey design. We presented categorical variables as frequency, per cent and 95% confidence interval (CI), whereas numerical variables were presented as median, inter-quartile range (IQR) and 95% CI. We performed univariate and multivariable logistic regression to determine factors associated with anxiety and depression, and results were presented as crude OR (COR), adjusted OR (AOR) and their 95% CI.Results The prevalence of depression and anxiety were 4.0% (95% CI 3.5 to 4.5) and 17.7% (95% CI 16.5 to 18.9), respectively. Divorced or separated participants were found to have higher odds of developing anxiety (AOR 2.40, 95% CI 1.74 to 3.31) and depression (AOR 3.16, 95% CI 1.84 to 5.42). Among ethnic groups, Janajati had lower odds of developing anxiety (AOR 0.77, 95% CI 0.65 to 0.92) and depression (AOR 0.67, 95% CI 0.49 to 0.93) compared with Brahmin/Chhetri. Regarding disability, participants with some difficulty had higher odds of developing anxiety (AOR 1.81, 95% CI 1.56 to 2.10) and depression (AOR 1.94, 95% CI 1.51 to 2.49), and those with a lot of difficulty had higher odds of anxiety (AOR 2.09, 95% CI 1.48 to 2.96) and depression (AOR 2.04, 95% CI 1.06 to 3.90) compared with those without any disability. Among those who had symptoms of anxiety or depression, only 32.9% (95% CI 30.4 to 34.4) sought help for the conditions.Conclusions Marital status and disability status were positively associated with anxiety and depression, whereas Janajati ethnicity had relatively lower odds of experiencing anxiety and depression. It is essential to develop interventions and policies targeting females and divorced individuals to help reduce the burden of anxiety and depression in Nepal.

This literature review offers an extensive exploration of Chaga mushrooms (Inonotus obliquus), focusing on their phytochemical composition, health-promoting attributes, and mechanisms of action. The aim was to provide an up-to-date overview of Chaga's significance in the medicinal sector, emphasizing its potential role in diverse health benefits. The review highlights Chaga's remarkable anticancer, antioxidant, anti-diabetic, anti-inflammatory, antimicrobial, and immunomodulating properties. By synthesizing recent findings, this work underscores Chaga's importance in the medicinal industries and provides valuable insights into its pharmacological potential.

Plant-mediated synthesis of silver nanoparticles (AgNPs) is an eco-friendly and convenient alternative to conventional methods. Brassaiopsis hainla (B. hainla) leaf extract (BHE) was used in this study to reduce metal salts and cap and stabilize nanoparticles (NPs), which were characterized and tested for antibacterial and anti-corrosion properties. Stirring the B. hainla extract with AgNO3 led to a color change, indicating nanoparticle formation. The absorption peak at 428 nm in the UV–visible spectrum further validated its formation. The AgNPs were characterized using various techniques such as FTIR, UV–visible, PXRD, HRTEM, SEM, and EDX. Powder X-ray diffraction analysis confirmed its nanocrystalline nature, with an average crystallite size of 17.92 nm. The FTIR spectrum showed hydroxyl, amine, amide, and carbonyl groups as capping and reducing agents for the AgNPs. SEM analysis revealed poly-dispersed NPs of various sizes, while EDX showed an intense peak for Ag, and TEM images revealed mostly hexagonal and triangular NPs. Antibacterial activity was tested against three human pathogens: Staphylococcus aureus (S. aureus), Pseudomonas, and Klebsiella oxytoca (K. oxytoca). Significant antibacterial activity was observed specifically against K. oxytoca, with an 11 mm inhibition zone. Both plant extracts and AgNPs inhibited acid-induced corrosion, with the highest inhibition efficiencies of 81.69 % and 69.54 % at 1000 ppm, respectively. With rising concerns over bacterial resistance and metal corrosion, this study addresses global challenges related to new antimicrobial agents, which are crucial for combating antibiotic resistance and protecting metals in various industries.

High mortality has been reported in severe cases of COVID-19. Emerging reports suggested that the severity is not only due to SARS-CoV-2 infection, but also due to coinfections by other pathogens exhibiting symptoms like COVID-19. During the COVID-19 pandemic, simultaneous respiratory coinfections with various viral (Retroviridae, Flaviviridae, Orthomyxoviridae, and Picoviridae) and bacterial (Mycobacteriaceae, Mycoplasmataceae, Enterobacteriaceae and Helicobacteraceae) families have been observed. These pathogens intensify disease severity by potentially augmenting SARSCoV-2 replication, inflammation, and modulation of signaling pathways. Coinfection emerges as a critical determinant of COVID-19 severity, principally instigated by heightened pro-inflammatory cytokine levels, as cytokine storm. Thereby, in co-infection scenario, the severity is also driven by the modulation of inflammatory signaling pathways by both pathogens possibly associated with interleukin, interferon, and cell death exacerbating the severity. In the current review, we attempt to understand the role of co- infections by other pathogens and their involvement in the severity of COVID-19.

Due to rapid urbanization and uncontrolled population growth, solid waste management has become a rising issue in developing nations like Bangladesh. Khulna ranks third among Bangladesh's metropolitan cities. The existing system of Khulna City for transporting municipal solid waste lacks route planning and depends exclusively on the driver's expertise. Hence, this study aims to minimize the length of the present travel paths and assess the advantages of using optimized routes. Secondary datasets like a list of vehicles, financial information, and a list of secondary transfer stations have been collected from the municipality. A field survey was conducted to capture the coordinates of secondary transfer stations. Multiple GPS devices have been installed for monitoring the current paths, stops, and travel time of 31 waste collector vehicles for 10 months. A network database has been prepared and modified by integrating driver's perceptions and field inspection. Network analysis of ArcGIS Pro has been used for finding the optimized routes. The optimized route minimizes the travel distance by 9.40%. By following the optimized routes, about 11.6% of fuel costs can be reduced. This research has the potential to make a significant contribution to the waste management of Khulna City and beyond.

Introduction: Spinal cord injury is one of the common injury which causes damage to the spinal cord due to trauma, diseases or degenerations leading to disability and decreasing life expectancy. The study aims to find the characteristics of spinal cord injury presenting at a tertiary care centre. Methods: A Descriptive hospital based cross-sectional study was conducted at Pokhara, Gandaki Province, from 28th March to 25th September, 2023. 139 participants were interviewed for the study. Structured interview schedule and validated questionnaires were used for data collection. Ethical approval was taken for the study (Reference number: 151/079). Results: A total of 139 cases were observed; most common affected age group was between 25-55 years with a mean age of 48.68 years. Most (66.9%) of the spinal cord injury patients were not enrolled in health insurance program. Most 107 (77.0%) common cause for spinal cord injury was falls from height. Age, gender, occupation and duration of stay in the hospital were statistically significant with mode of treatment. Conclusions: Spinal cord injury mostly traumatic commonly due to fall from height affecting mainly male population residing in rural areas at their fourth decade of life who are mainly involve in manual work and agriculture. Spinal cord injury is a major health problem at global and local level causing major morbidity.

The present study explores the function of FANCA gene, a pivotal member of the Fanconi anaemia (FA) pathway crucial for preserving genomic stability and preventing cancer, particularly in the context of gastric cancer (GC). Using immunohistochemistry, quantitative real-time PCR, and western blot analysis, we evaluate FANCA mRNA and protein expressions in GC cell lines. The relationship between FANCA expression and clinicopathological characteristics is also explored. Various assays, including CCK8, colony formation, wound healing, and Transwell assays, are used to assess functional changes in cells associated with FANCA. Flow cytometry is utilized to evaluate alterations in the cell cycle resulted from FANCA knockdown and overexpression. Our findings show elevated FANCA expression in GC cell lines, with levels correlated with pathologic stage and lymphatic metastasis. FANCA knockdown impedes cell proliferation, migration, and invasion and induces G1/S phase cell cycle arrest. Conversely, FANCA overexpression stimulates cell proliferation, migration, and invasion. In vivo xenograft experiments confirm the promotional role of FANCA in GC tumor progression. Moreover, FANCA overexpression is associated with the activation of cell cycle. Collectively, our results suggest that FANCA drives malignant cell behaviors in GC through the cell cycle pathway, highlighting its potential as a therapeutic target for the treatment of GC.

The liver is a multi-potent organ with important metabolic, immunological and endocrine functions. Hepatic physiology is maintained at a balanced state via the delicate actions of different liver-resident cells. Among several factors that modulate hepatic physiology, the harmony between the activity of pro- and anti-inflammatory cytokines is a crucial determinant. However, initiation of inflammatory activity can be detrimental if it goes unresolved, leading to severe consequences such as hepatitis, hepatic fibrosis, cirrhosis or even hepatocellular carcinoma (HCC). Different physiological processes can modulate the hepatic microenvironment; one such factor is a cytosolic protein complex called the inflammasome. Inflammasome activation is a consequence of the cellular encounter with pathogens or products of cellular damage. Once activated, inflammasomes promote the maturation of interleukin-1 family cytokines such as IL-1β and IL-18 via activation of caspase-1. These cytokines have a very potent role in modulating hepatic physiology. Various lines of reports suggest that inflammasome activation and IL-1 cytokines play critical roles in liver diseases, including hepatitis, hepatic fibrosis and HCC. Conversely, inhibition of inflammasome activation and/or IL-1 signaling prevents such effects. This review summarizes the mechanisms leading to inflammasome activation and the role it plays in hepatic physiology.

Abstract Background Klebsiella pneumoniae infections have become a major cause of hospital acquired infection worldwide with the increased rate of acquisition of resistance to antibiotics. Carbapenem resistance mainly among Gram negative is an ongoing problem which causes serious outbreaks dramatically limiting treatment options. This prospective cross-sectional study was designed to detect bla KPC gene from carbapenem resistant K. pneumoniae. Materials and Methods A totally of 1118 different clinical specimens were screened and confirmed for KPC producing K. pneumoniae phenotypically using Meropenem (10 μg) disc. The bla KPC gene was amplified from the isolates of K. pneumoniae to detect the presence of this gene. Result Of the total samples processed, 18.6% (n = 36) were K. pneumoniae and among 36 K. pneumoniae, 61.1% (n = 22/36) were meropenem resistant. This study demonstrated the higher level of MDR 91.7% (n = 33) and KPC production 47.2% (n = 17) among K. pneumoniae isolates. The bla KPC gene was detected in 8.3% (n = 3) of meropenem resistant isolates. Conclusion Since the study demonstrates the higher level of MDR and KPC producing K. pneumoniae isolates that has challenged the use of antimicrobial agents, continuous microbiology, and molecular surveillance to assist early detection and minimize the further dissemination of bla KPC should be initiated. We anticipate that the findings of this study will be useful in understanding the prevalence of KPC-producing K. pneumoniae in Nepal.

Abstract Background A water-soluble ingredient of mature leaves of the tropical mahogany ‘Neem’ (Azadirachta indica), was identified as glycoprotein, thus being named as ‘Neem Leaf Glycoprotein’ (NLGP). This non-toxic leaf-component regressed cancerous murine tumors (melanoma, carcinoma, sarcoma) recurrently in different experimental circumstances by boosting prime antitumor immune attributes. Such antitumor immunomodulation, aid cytotoxic T cell (Tc)-based annihilation of tumor cells. This study focused on identifying and characterizing the signaling gateway that initiate this systemic immunomodulation. In search of this gateway, antigen-presenting cells (APCs) were explored, which activate and induce the cytotoxic thrust in Tc cells. Methods Six glycoprotein-binding C-type lectins found on APCs, namely, MBR, Dectin-1, Dectin-2, DC-SIGN, DEC205 and DNGR-1 were screened on bone marrow-derived dendritic cells from C57BL/6 J mice. Fluorescence microscopy, RT-PCR, flow cytometry and ELISA revealed Dectin-1 as the NLGP-binding receptor, followed by verifications through RNAi. Following detection of β-Glucans in NLGP, their interactions with Dectin-1 were explored in silico. Roles of second messengers and transcription factors in the downstream signal were studied by co-immunoprecipitation, western blotting, and chromatin-immunoprecipitation. Intracellularization of FITC-coupled NLGP was observed by processing confocal micrographs of DCs. Results Considering extents of hindrance in NLGP-driven transcription rates of the cytokines IL-10 and IL-12p35 by receptor-neutralization, Dectin-1 receptors on dendritic cells were found to bind NLGP through the ligand’s peripheral β-Glucan chains. The resulting signal phosphorylates PKCδ, forming a trimolecular complex of CARD9, Bcl10 and MALT1, which in turn activates the canonical NFκB-pathway of transcription-regulation. Consequently, the NFκB-heterodimer p65:p50 enhances Il12a transcription and the p50:p50 homodimer represses Il10 transcription, bringing about a cytokine-based systemic-bias towards type-1 immune environment. Further, NLGP gets engulfed within dendritic cells, possibly through endocytic activities of Dectin-1. Conclusion NLGP’s binding to Dectin-1 receptors on murine dendritic cells, followed by the intracellular signal, lead to NFκB-mediated contrasting regulation of cytokine-transcriptions, initiating a pro-inflammatory immunopolarization, which amplifies further by the responding immune cells including Tc cells, alongside their enhanced cytotoxicity. These insights into the initiation of mammalian systemic immunomodulation by NLGP at cellular and molecular levels, may help uncovering its mode of action as a novel immunomodulator against human cancers, following clinical trials.

Abstract Background Tuberculosis (TB) remains a major public health problem in Nepal, high in settings marked by prevalent gender and social inequities. Various social stratifiers intersect, either privileging or oppressing individuals based on their characteristics and contexts, thereby increasing risks, vulnerabilities and marganilisation associated with TB. This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System (HMIS) of National Tuberculosis Programme (NTP) by conducting an intersectional analysis of TB cases recorded via HMIS. Methods A desk review of key policies and the NTP’s HMIS was conducted. Retrospective intersectional analysis utilized two secondary data sources: annual NTP report (2017–2021) and records of 628 TB cases via HMIS 6.5 from two TB centres (2017/18–2018/19). Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB, registration category and treatment outcome. Results Gender, social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation. NTP has initiated the collection of age, sex, ethnicity and location data since 2014/15 through the HMIS. However, only age and sex disaggregated data are routinely reported, leaving recorded social stratifiers of TB patients static without analysis and dissemination. Furthermore, findings from the intersectional analysis using TB secondary data, showed that male more than 25 years exhibited higher odds [adjusted odds ratio (aOR) = 4.95, 95% confidence interval (CI): 1.60–19.06, P = 0.01)] of successful outcome compared to male TB patients less than 25 years. Similarly, sex was significantly associated with types of TB (P

Abstract Introduction The COVID-19 pandemic has tested the resilience capacities of health systems worldwide and highlighted the need to understand the concept, pathways, and elements of resilience in different country contexts. In this study, we assessed the health system response to COVID-19 in Nepal and examined the processes of policy formulation, communication, and implementation at the three tiers of government, including the dynamic interactions between tiers. Nepal was experiencing the early stages of federalization reform when COVID-19 pandemic hit the country, and clarity in roles and capacity to implement functions were the prevailing challenges, especially among the subnational governments. Methods We adopted a cross-sectional exploratory design, using mixed methods. We conducted a desk-based review of all policy documents introduced in response to COVID-19 from January to December 2020, and collected qualitative data through 22 key informant interviews at three tiers of government, during January-March 2021. Two municipalities were purposively selected for data collection in Lumbini province. Our analysis is based on a resilience framework that has been developed by our research project, ReBUILD for Resilience, which helps to understand pathways to health system resilience through absorption, adaptation and transformation. Results In the newly established federal structure, the existing emergency response structure and plans were utilized, which were yet to be tested in the decentralized system. The federal government effectively led the policy formulation process, but with minimal engagement of sub-national governments. Local governments could not demonstrate resilience capacities due to the novelty of the federal system and their consequent lack of experience, confusion on roles, insufficient management capacity and governance structures at local level, which was further aggravated by the limited availability of human, technical and financial resources. Conclusions The study findings emphasize the importance of strong and flexible governance structures and strengthened capacity of subnational governments to effectively manage pandemics. The study elaborates on the key areas and pathways that contribute to the resilience capacities of health systems from the experience of Nepal. We draw out lessons that can be applied to other fragile and shock-prone settings.

Abstract Multi-walled Carbon Nanotubes (MWCNTs) are inert structures with high aspect ratios that are widely used as vehicles for targeted drug delivery in cancer and many other diseases. They are largely non-toxic in nature however, when cells are exposed to these nanotubes for prolonged durations or at high concentrations, they show certain adverse effects. These include cytotoxicity, inflammation, generation of oxidative stress, and genotoxicity among others. To combat such adverse effects, various moieties can be attached to the surface of these nanotubes. Curcumin is a known anti-inflammatory, antioxidant and cytoprotective compound derived from a medicinal plant called Curcuma longa. In this study, we have synthesized and characterized Curcumin coated-lysine functionalized MWCNTs and further evaluated the cytoprotective, anti-inflammatory, antioxidant and antiapoptotic effect of Curcumin coating on the surface of MWCNTs. The results show a significant decrease in the level of inflammatory molecules like IL-6, IL-8, IL-1β, TNFα and NFκB in cells exposed to Curcumin-coated MWCNTs as compared to the uncoated ones at both transcript and protein levels. Further, compared to the uncoated samples, there is a reduction in ROS production and upregulation of antioxidant enzyme-Catalase in the cells treated with Curcumin-coated MWCNTs. Curcumin coating also helped in recovery of mitochondrial membrane potential in the cells exposed to MWCNTs. Lastly, cells exposed to Curcumin-coated MWCNTs showed reduced cell death as compared to the ones exposed to uncoated MWCNTs. Our findings suggest that coating of Curcumin on the surface of MWCNTs reduces its ability to cause inflammation, oxidative stress, and cell death. Graphical Abstract (a) Synthesis of Curcumin-coated-Lysine-functionalized MWCNTs. (b) Flow of research depicting experimental groups and studies performed along with the underlying techniques used.

The shortest path problem is a classic optimization problem in graph theory and computer technology. It involves identifying the shortest path between two nodes in a graph, where each edge has a numerical weight. In this paper, we put our effort into examining the use of the dynamic programming method to evaluate the shortest path (SP) between the two specified nodes in a multistage network where the parameter is a multi-value neutrosophic number (MVNN). Firstly, we propose an algorithm based on the forward and backward approach in an uncertain environment and also implement our approach in the Python-3 programming language. Furthermore, a numerical illustration has been provided to showcase the effectiveness and robustness of the novel model.