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Background: Phlebectasia is a term used for the dilatation of a vein without tortuosity. Rarely, the condition may affect the internal jugular vein (IJV), causing prominence in the neck, which may be confused with other neck swellings. Clinical Description: A 6-year-old boy presented with bilateral episodic swelling in the neck noticed since 2 years of age and a hoarse voice since 3 years of age. On examination, the neck swelling was soft, cystic, compressible, nontender, and nonpulsatile, increasing in size by all maneuvers increasing intrathoracic pressure. Systemic examination revealed the apex beat was on the right side, and the liver was palpable below the left subcostal margin. Management and Outcome: The workup for tuberculosis was negative, and direct laryngoscopy was normal. X-ray of the chest with abdomen showed dextrocardia and stomach shadow on the right side. Color Doppler revealed nontortuous dilatation of both IJVs. Dynamic computed tomography venography confirmed the diagnosis of bilateral IJV phlebectasia (IJVP). The child was started on speech therapy. The mother was counseled regarding the benign nature of the disease and advised regular follow-up. The child had no complications, and his voice improved with speech therapy at 1-year follow-up. Conclusion: Pediatricians should be aware that IJVP may rarely be the cause of neck swelling associated with hoarseness of voice. Increase in the size of the swelling with Valsalva maneuvers and color Doppler ultrasound helps to confirm the diagnosis.

Aim: The aim of this study is to determine the age and symptoms in menopausal women and providing hormonal treatment. Materials and Methods: This study was a community based cross sectional, descriptive, observational study conducted among 400 rural women living in and around Vijayapur. Women aged 40 to 55 years who attained natural menopause and cessation of menses for one year were included in the study. The study was carried out from November 2022 to October 2023. Ethical clearance has been taken for this study. The participants were interviewed on one-to-one basis using a self-constructed semi structured questionnaire. Results: A total of 400 women belonging to the age group of 40 to 55 years participated in the study. The mean age of the participants was 52.01 ± 2.89 years. The mean age of attaining menopause was 45.67 ± 3.9 years. The least age of attaining menopause was 37years and the maximum age noted was 54 years. Most women (55%) attained menopause in the age group of 45 to 49 years. The incidence of premature menopause was 4.6%. In women with hysterectomy Estrogen alone therapy is beneficial and in women with intact uterus, estrogen progesterone therapy is recommended. Conclusion: Almost majority of women are affected by menopausal symptoms and due to sociocultural factors, economic factors adversely affecting the women health. Better to initiate women with hormonal therapy in women with severe symptoms.

Background: Content and Language Integrated Learning (CLIL) is a European innovative interdisciplinary educational convergence that intends to promote multilingual competence among students through the learning of the subjects in a second/foreign language. This approach is considered one of the significant developments in the field of education. Purpose: A research study was designed with the objective of exploring and understanding the nature and method of CLIL practices prevalent in bilingual primary and secondary school classrooms in Castilla La Mancha, Spain. Spain was chosen because it is one of the pioneering countries that steered an exhaustive variety of research and experiments in CLIL practices in its diverse educational contexts. Methods: Adopting qualitative research method Participant Classroom Observations, twenty classes of two bilingual schools--fifteen classes of Natural Science and Social Science in primary school and five classes of Music at Secondary School that used CLIL approach were observed and findings recorded using observation template. Results: The findings provided a myriad view of the bilingual experiences in the classrooms, diversity and range of pedagogical practices used, student teacher interaction dynamics present, positive learning environment provided for the students in the classes to mention a few. Conclusion: The study concludes with the understanding of the 'added value' and the numerous benefits the approach provides for the students. As a fresh and innovative approach, CLIL promotes holistic and meaningful learning catering to the needs of twenty first century education systems.

To operate safely in a dynamic environment, autonomous vehicles must possess the same level of predictive driving abilities as human drivers and must be capable of anticipating the future actions of other dynamic objects in the environment, especially those of neighboring vehicles. The development of safe autonomous vehicles (AVs) poses a challenging task as it requires algorithms that can make real-time decisions in unpredictable circumstances. Reinforcement learning (RL) presents a promising approach for AV control, as it utilizes trial and error to enable optimal decision-making. However, traditional RL algorithms are unsuitable for safety-critical applications, as they may explore unsafe actions, potentially resulting in accidents. Safe reinforcement learning (SRL) algorithms have been developed to address this issue, prioritizing safe and reliable decisions. These algorithms incorporate constraints to prevent unsafe actions or utilize techniques to estimate action risk and avoid actions deemed excessively risky. Despite computational challenges, SRL holds significant promise for AV control, and is likely to play a crucial role in developing safe and reliable systems. SRL methods are critical for the general adoption of autonomous vehicles by guaranteeing their safety and reliability. These algorithms utilize methods like uncertainty and risk estimation along with penalty functions, to avoid excessively risky actions and have the potential to significantly reduce accidents and build public trust in autonomous driving. However, there are challenges that need to be addressed, such as the dynamic nature of real-world traffic, high computational costs, and the diversity of road design; and these varying conditions make the designing, testing, and validating of SRL algorithms difficult. Despite these challenges, SRL presents a promising solution, through integrating new sensing technologies and machine learning techniques, to develop safe, efficient, and environmentally friendly transportation systems.

Takayasu Arteritis (TA) is a chronic inflammatory disease affecting large blood vessels, particularly the aorta and its branches, making it a type of vasculitis. It is reported to be highly prevalent in Southeast Asian countries. Clinical presentations may vary, including headache, weight loss, malaise, fever, hypertension, visual disturbances, and musculoskeletal symptoms. Gangrene is a rare manifestation of TA, with relatively few cases reported globally. If gangrene is present, it is commonly noted in the lower limbs. Inflammation of the blood vessels caused by TA might lead to stenosis of the affected vessels. The underlying pathophysiology of gangrene development in TA is poorly understood but is mainly attributed to the occlusion of blood vessels. It is associated with inflammatory markers produced by lymphocytes and macrophages. Immunosuppressive drugs are recommended for symptomatic relief. Early diagnosis and intervention can be useful in managing TA, preventing adverse outcomes, and reducing its financial, social, and psychological consequences. This is a case report of a 32-year-old female, presented with gangrene and a history of rheumatoid arthritis. Further examination revealed a presentation of TA. The patient was managed by below-knee amputation for gangrene of the left leg and medical management for TA. Therefore, authors aim to draw attention to the diagnosis of TA and the rare associated morbidity, ‘gangrene,’ and the importance of timely intervention.

Neurological disorders including neurodegenerative disorders continue to pose significant therapeutic challenges. Triterpenoids, a diverse group of natural compounds found abundantly in plants, possess promising neuroprotective properties. This review aims to explore the potential of triterpenoids in mitigating neurodegeneration through various mechanisms, including antioxidant, anti-inflammatory, and anti-apoptotic activities. The neuroprotective potential of some notable triterpenoids, such as asiatic acid, asiaticoside, madecassoside, bacoside A, bacopaside I, ganoderic acids, and lucidenic acids are discussed in terms of their ability to modulate key pathways implicated in neurological disorders. Additionally, the potential therapeutic applications of triterpenoids in Alzheimer’s disease, Parkinson’s disease, cerebral ischemia, spinal cord injury, and epilepsy are examined. Furthermore, the review also underlines the challenges for the development of triterpenoids as neuroprotective agents, including the need for further preclinical and clinical studies to elucidate their efficacy and safety for translation into clinical practice.

Background: Genital ulcer disease (GUD) is regarded as the most difficult conundrum for clinicians, as valid and rapid methods to diagnose them are limited, especially in India. The sexual behavior of an individual plays a role in the causation of GUD, and it depends on psychological, behavioral, and social well-being, which was significantly affected during the COVID-19 pandemic. Hence, the present study was undertaken to determine the etiology of genital ulcers by using simple, rapid microbiological methods and to study various factors associated with them. Materials and Methods: Various rapid tests like staining (Giemsa, Gram, and Diff Quick) and serology for antibody detection were used to diagnose agents causing genital ulcers among 71 suspected patients during the study period of 1 year. After due informed consent, sociodemographic and behavioral factors were recorded in proforma and analyzed. Results: Rapid tests could aid in diagnosing 47.9% of cases of GUD. Turnaround time was less than 60 minutes for all tests carried out. Genital herpes was the most common GUD followed by syphilis. Male gender (74.6%), age group of more than 34 years old (62%), literate (71.8%), and earning (70.4%) constituted most of the population presenting with GUD. Behavioral factors like promiscuity with a known person (83.1%) had a significant association (P 0.04) with GUD. Conclusion: Rapid diagnostic tests could assist in the early treatment of GUD cases. Factors like literacy, financial independence, and promiscuity with known individuals were associated with GUD in our study during the COVID-19 pandemic.

Background: Electronic foetal heart rate monitoring (EFM) using cardiotocography (CTG) is crucial for assessing foetal well-being during labour and aiding in the early detection of intrapartum hypoxia. Admission CTG, short-term monitoring upon labour ward entry, identifies high-risk factors and guides subsequent interventions to prevent perinatal morbidity and mortality. Methods: A cross-sectional study conducted at Al Ameen Medical College and Hospital from August 2022 to July 2023 included booked and unbooked antenatal patients in latent labour. The study included 950 women in the first stage of labour in the low-(n=550) and high-risk (n=400) groups based on identified risk factors. Perinatal outcomes were assessed, including mode of delivery, liquor colour, APGAR scores, and NICU admissions. Results: High-risk factors such as hypertensive disorders (20%), anaemia (23.75%), gestational diabetes (6.25%), previous LSCS (37.50%), and post-date pregnancies (32.25%) were prevalent in the high-risk group. The majority of the participants were aged 20–30 years (52.7%), booked (39.2%), and presented at gestational ages ≥37 to

Cells switch genes ON or OFF by altering the state of chromatin via histone modifications at specific regulatory locations along the chromatin polymer. These gene regulation processes are carried out by a network of reactions in which the histone marks spread to neighboring regions with the help of enzymes. In the literature, this spreading has been studied as a purely kinetic, non-diffusive process considering the interactions between neighboring nucleosomes. In this work, we go beyond this framework and study the spreading of modifications using a reaction-diffusion (RD) model accounting for the diffusion of the constituents. We quantitatively segregate the modification profiles generated from kinetic and RD models. The diffusion and degradation of enzymes set a natural length scale for limiting the domain size of modification spreading, and the resulting enzyme limitation is inherent in our model. We also demonstrate the emergence of confined modification domains without the explicit requirement of a nucleation site. We explore polymer compaction effects on spreading and show that single-cell domains may differ from averaged profiles. We find that the modification profiles from our model are comparable with existing H3K9me3 data of S. pombe.

Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7-16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. This study quantifies the impact of a broader STARTPlay intervention combined with Botulinum toxin-A (BoNT-A) and phenol on the developmental trajectory of a 24 month-old child with bilateral spastic CP. In this AB +1 study, A consisted of multiple baseline assessments with the Gross Motor Function Measure-66 and the Assessment of Problem Solving in Play. The research participant demonstrated a stable baseline during A and changes in response to the combination of BoNT-A/phenol and 12 START-Play sessions during B, surpassing the minimal clinically important difference on the Gross Motor Function Measure-66. The follow-up data point (+1) was completed after a second round of BoNT-A/phenol injections. While the findings suggest the participant improved his gross motor skills with BoNT-A/phenol and START-Play, further research is needed to generalize these findings.

Three-dimensional (3D) object classification is crucial in various applications, including autonomous driving, robotics, and augmented reality, where precise detection of objects in 3D space is required. Traditional techniques for 3D object classification encompass voxel-based representations, multi-view projections, and point cloud analysis. However, these approaches can be computationally intensive, and might not capture complete structure of the underlying object. This research introduces a novel lightweight model for 3D object classification based on point clouds that achieves higher accuracy while requiring minimal computing overhead. The proposed system incorporates adaptive sampling, an Attentive-Convolution Feature block, a Dualpath feature processing block, and a non-local attention mechanism to enhance feature representation and classification performance. To our knowledge, this is the first study to propose a lightweight TnetLight module as a transformation network that aligns and converts input point clouds, capturing subtle geometric variations and highlighting differences between objects to enhance shape recognition and differentiation accuracy. Additionally, the model integrates an Attentive-Convolution Feature extraction block that combines local geometric features with global contextual information, enhancing the network’s ability to capture both detailed and broader characteristics for better differentiation between objects with slight variations. The network was evaluated on the ModelNet10 dataset, achieving an accuracy of 94.4%.

Phonocardiogram (PCG) signals generated by the heart contain information about heart conditions. This review examines how PCG analysis identifies and diagnoses heart issues. We studied traditional signal processing and artificial intelligence techniques and provided a complete picture of the current state of this field. Adhering to the systematic review guidelines, our comprehensive review covers 103 studies from reputed journals. It includes Machine Learning (ML) and Deep Learning (DL) techniques used to develop the computer-aided diagnostic tools using PCG signals. This review evaluates the strengths and weaknesses of various ML and DL methods, emphasizing their effectiveness in diagnosing several abnormalities. Additionally, we examine the obstacles and challenges limiting the widespread adoption of PCG-based diagnostic systems in clinical settings. We outline a plan for future research to develop improved versions of PCG analysis models. These models will be more robust, precise, and user-friendly. They will improve cardiovascular care by enabling machines to screen for problems automatically and intelligently.

Abstract Malaria is a major public health problem in developing countries. The burden of malaria in fragile and conflict-affected states (FCAS) is increasing year by year. Moreover, the population living in FCAS is often the most vulnerable and at high risk of malaria due to factors, such as deteriorating healthcare system, mass relocations, and reduced resilience to shocks. Therefore, this scoping review aims to map the interventions that are conducted at the FCAS on malaria prevention among the general population. In addition, this review can help policy-makers and international health bodies, providing a comprehensive overview that can lead to more targeted, effective, and context-specific interventions. Databases, such as PubMed, EBSCO-CINAHL, Web of Science, ProQuest, and Cochrane Central Register of Controlled Trials, were searched using specified search terms. A total of 3601 studies were retrieved from the search. After screening, 62 studies were included in the synthesis that met the eligibility criteria. Narrative analysis of the findings was done. The results revealed that in fragile countries, interventions for children below 5 years of age included IPTi, TDA, and ACT. In conflicted countries, interventions for children below 5 years of age included TDA, LLINs, SMC, drug trials, and vaccination. Similar interventions were reported for other age groups and populations. Despite ongoing conflicts, malaria interventions have been maintained in these countries, but a persistent high burden of malaria remains. To achieve the goals of malaria elimination, the results of the review highlight the need for continued research and evaluation of malaria control interventions to assess their effectiveness and impact. Strengthening health systems, building partnerships, utilizing digital health technologies, and conducting context-specific research are recommended to improve healthcare access and reduce the burden of malaria in FCAS.

The current work proposes an efficient assessment of hypertension (HTN) using a Directional-Guided Motion Sensitive (DGMS) descriptor and Machine Learning (ML) algorithm. The main objective of the proposed work is to automate the detection of HTN using ultrasound (US) images. The four-chamber US images from 70 healthy subjects and 70 HTN patients are collected. A novel pipelined architecture has been developed in two stages with four phases: preprocessing, feature extraction using DGMS descriptor, feature ranking and selection, and classification using shallow K-Nearest Neighbor classifier. The proposed model has achieved a classification accuracy of 98% using a set of prominent features, predominating the performance attained by other approaches. This study suggests US contains predictive signals even when standard measures are normal and lays the groundwork for artificial intelligence-assisted cardiac assessment to aid quicker, more objective diagnosis and earlier treatment. If further validated on additional diverse patient data, the technology could be integrated into clinics to enhance HTN detection through automated, early discernment of subtle manifestations missed by human eyes and traditional metrics.

The deprived electrochemical kinetics of the oxygen evolution reaction (OER) catalyst is the prime bottleneck and remains the major obstacle in the water electrolysis processes. Herein, a facile hydrothermal technique was implemented to form a freestanding polyhedron-like Co3O4 on the microporous architecture of Ni foam, its reaction kinetics enhanced through sulfide counterpart transformation in the presence of Na2S, and their catalytic OER performances comparatively investigated in 1 M KOH medium. The formed Co3S4 catalyst shows outstanding catalytic OER activity at a current density of 100 mA cm−2 by achieving a relatively low overpotential of 292 mV compared to the pure Co3O4 catalyst and the commercial IrO2 catalyst. This enhancement results from the improved active centers and conductivity, which boost the intrinsic reaction kinetics. Further, the optimized Co3S4 catalyst exhibits admirable prolonged durability up to 72 h at varied current rates with insignificant selectivity decay. The energy dispersive X-ray spectroscopy (EDX) and Raman spectra measured after the prolonged OER stability test reveal a partial transformation of the active catalyst into an oxyhydroxide phase (i.e., CoOOH@Co3S4), which acts as an active catalyst phase during the electrolysis process.

There has always been a power struggle regarding control over the administration of the university. In the Enlightenment era, the contenders were the State and the Church. However, as the role of the Church in modern educational institutes declined, the state clamoured for greater control (Delanty, 2001b; Rüegg, 1992). In the 1990s, academic autonomy was under the purview of the university. This in turn gave impetus to greater mobility of students across borders and to the larger process of Internationalization of Higher Education (IHE). However, in the post-democratic era, the autonomy of universities was severely restricted and research and curriculum were tainted with a protectionist attitude (Altbach and De Wit, 2018; Jenkins et al., 2018). Emerging conflicts between the state and the university highlight the urgent need to understand and assess state-university relations in the new political climate. Under these circumstances, the process of IHE has borne the brunt and in the last decade, we have seen a decrease in international outbound student mobility, an increase in the cancellation of offshore campuses and other cross-border education activities. While the process of IHE is still maintained, the original aim of this process, to tackle global issues with a local perspective while providing an inter-cultural university education is at risk. This paper examines the changing dynamics of state-university relations and their implications on the process of IHE.

Summary: The epithelial adaptations to mechanical stress are facilitated by molecular and tissue-scale changes that include the strengthening of junctions, cytoskeletal reorganization, and cell-proliferation-mediated changes in tissue rheology. However, the role of cell size in controlling these properties remains underexplored. Our experiments in the zebrafish embryonic epidermis, guided by theoretical estimations, reveal a link between epithelial mechanics and cell size, demonstrating that an increase in cell size compromises the tissue fracture strength and compliance. We show that an increase in E-cadherin levels in the proliferation-deficient epidermis restores epidermal compliance but not the fracture strength, which is largely regulated by Ezrin—an apical membrane-cytoskeleton crosslinker. We show that Ezrin fortifies the epithelium in a cell-size-dependent manner by countering non-muscle myosin-II-mediated contractility. This work uncovers the importance of cell size maintenance in regulating the mechanical properties of the epithelium and fostering protection against future mechanical stresses.

Catamenial epilepsy is a condition marked by an increased occurrence of seizures that coincide with the menstrual cycle in women. Our study explored the role of neurotransmitter/neuromodulator agmatine in progesterone withdrawal induced increased seizure susceptibility that is one of the causes of catamenial epilepsy. Additionally, it investigates potential interactions between agmatine and the central neurosteroid system. The experiments involved the use of female Sprague-Dawley rats. To mime the seizure susceptibility as seen in catamenial epilepsy, rats were treated with PMSG and b-HCG which cause a higher release of progesterone and later injected with Finasteride on the 11th day of post-human chorionic gonadotropin administration to cause a sudden drop of progesterone. On the 12th day, seizure susceptibility was assessed through a low-dose (35 mg/kg) pentylenetetrazol (PTZ) injection. The results revealed that agmatine treatment showed a protective effect against seizures. Furthermore, this study explored the impact of neurosteroids such as allopregnanolone or progesterone (a precursor of allopregnanolone) and neurosteroidogenic drugs like FGIN 1–27 or metyrapone (an 11β-hydroxylase inhibitor) on the anticonvulsant effect of agmatine. The findings indicated that prior administration of these substances significantly enhanced the anticonvulsant effect of agmatine. In contrast, inhibiting neurosteroid production with drugs like trilostane (a 3β-hydroxysteroid dehydrogenase inhibitor) or indomethacin (a 3α-hydroxysteroid dehydrogenase inhibitor) completely nullified agmatine's effect. Seizures were associated with elevated progesterone levels and reduced allopregnanolone levels, which were normalized by agmatine treatment. Notably, agmatine exhibited seizure protection even in ovariectomized rats, affirming the involvement of neurosteroids in its anti-seizure effects in progesterone withdrawal increased seizure susceptibility. In conclusion, these findings emphasize central neurosteroid involvement in agmatine's pharmacological effects against seizure susceptibility in progesterone withdrawal in female rats.