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Abstract Individuals who consume alcohol have a higher chance of contracting tuberculosis (TB) due to their social mixing patterns. We aimed to study the social mixing patterns of TB patients who consume alcohol on a regular basis using a quantitative social network approach. In a high-TB prevalence context in India, a social network survey of 300 newly diagnosed pulmonary drug-sensitive TB patients was done. The survey found 52 (17%) male TB patients who shared alcohol on a regular basis with 106 (4%) of their first-degree social contacts. Alcohol sharing happened in 16 neighborhood venues. When compared to contacts who did not use alcohol, a higher proportion of contacts with regular alcohol use were diagnosed with TB (12.3%; 95% CI: 6.6–20.00 vs. 3.5%; 95% CI: 2.8–4.3). Social network analysis showed that the network consisting of patients and contacts was less dense and less connected (with density ratio of 0.009, and degree centrality of 1.3, and betweenness centrality of 0.5), indicating weaker transmission potential of the network. Comparatively the network consisting of patients, contacts and their alcohol sharing venues was more dense and more connected (with density ratio of 0.018, higher degree centrality of 3.1 and betweenness centrality of 154.2) indicating stronger transmission potential of the network. Regular alcohol sharing in four venues created a giant network component, that linked a higher proportion of contacts without TB (72.3%) to a higher proportion of TB patients (67.3%) and their contacts with TB (38.4%). When examined from a network perspective, the pooled TB transmission exposure of contacts with regular alcohol use grew by a factor of 10, which helped explain the unfavorable social mixing of patients and contacts with regular alcohol use.

Background: Surgeries involving the proximal third of the fibula are associated with the risk of common peroneal nerve (CPN) injury. Hence, a safe corridor using palpable anatomical landmarks is necessary to avoid injury to the CPN. Methodology: Sixty lower limbs (30 fresh cadavers) were in our study group. The distance between the Gerdy's tubercle (GT) and the CPN behind the fibular head (FH), distance from GT to the superficial branch of the CPN (superficial peroneal nerve [SPN]), and distance from GT to the anterior recurrent branch of the CPN (anterior tibial recurrent nerve [ATRN]) were measured, and a safe zone to avoid CPN injury was identified. Results: The distance between the GT and the CPN behind the FH was 45.52 ± 2.4 mm, distance from GT to the origin of the SPN was 46.44 ± 2.4 mm, and distance from GT to the ATRN was 45.59 ± 2.9 mm. Conclusion: The safe corridor to avoid CPN injury is identified by an arc trajectory with a radius of 45.85 mm with the GT as the center, which will be useful during surgical procedures to avoid injury to the CPN.

Background Disclosure of tuberculosis (TB) status by patients is a critical step in their treatment cascade of care. There is a lack of systematic assessment of TB disclosure patterns and its positive outcomes which happens dynamically over the disease period of individual patients with their family and wider social network relations. Methods This prospective observational study was conducted in Chennai Corporation treatment units during 2019–2021. TB patients were recruited and followed-up from treatment initiation to completion. Information on disease disclosures made to different social members at different time points, and outcomes were collected and compared. Bivariate and multi variate analysis were used to identify the patients and contact characteristics predictive of TB disclosure status. Results A total of 466 TB patients were followed-up, who listed a total of 4039 family, extra familial and social network contacts of them. Maximum disclosures were made with family members (93%) and half of the relatives, occupational contacts and friendship contacts (44–58%) were disclosed within 15 days of treatment initiation. Incremental disclosures made during the 150–180 days of treatment were highest among neighbourhood contacts (12%), and was significantly different between treatment initiation and completion period. Middle aged TB patients (31 years and 46–55 years) were found less likely to disclose (AOR 0.56 and 0.46 respectively; p71%). Conclusion Findings explain that family level disclosures were predominant and disclosures made to extra familial network contacts significantly increased during the latter part of treatment. Emotional support was predominantly received by TB patients from all their contacts post disclosure. Findings could inform in developing interventions to facilitate disclosure of disease status in a beneficial way for TB patients.

Abstract Background Contact tracing data of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is used to estimate basic epidemiological parameters. Contact tracing data could also be potentially used for assessing the heterogeneity of transmission at the individual patient level. Characterization of individuals based on different levels of infectiousness could better inform the contact tracing interventions at field levels. Methods Standard social network analysis methods used for exploring infectious disease transmission dynamics was employed to analyze contact tracing data of 1959 diagnosed SARS-CoV-2 patients from a large state of India. Relational network data set with diagnosed patients as “nodes” and their epidemiological contact as “edges” was created. Directed network perspective was utilized in which directionality of infection emanated from a “source patient” towards a “target patient”. Network measures of “ degree centrality” and “betweenness centrality” were calculated to identify influential patients in the transmission of infection. Components analysis was conducted to identify patients connected as sub- groups. Descriptive statistics was used to summarise network measures and percentile ranks were used to categorize influencers. Results Out-degree centrality measures identified that of the total 1959 patients, 11.27% (221) patients have acted as a source of infection to 40.19% (787) other patients. Among these source patients, 0.65% (12) patients had a higher out-degree centrality (> = 10) and have collectively infected 37.61% (296 of 787), secondary patients. Betweenness centrality measures highlighted that 7.50% (93) patients had a non-zero betweenness (range 0.5 to 135) and thus have bridged the transmission between other patients. Network component analysis identified nineteen connected components comprising of influential patient’s which have overall accounted for 26.95% of total patients (1959) and 68.74% of epidemiological contacts in the network. Conclusions Social network analysis method for SARS-CoV-2 contact tracing data would be of use in measuring individual patient level variations in disease transmission. The network metrics identified individual patients and patient components who have disproportionately contributed to transmission. The network measures and graphical tools could complement the existing contact tracing indicators and could help improve the contact tracing activities.

Key Clinical Message Neuroendocrine tumors, rare and slow‐growing, primarily affect the gastrointestinal tract, causing symptoms due to hormone secretion or mass effect. This case image described postprandial abdominal pain as an atypical initial presentation of abdominal neuroendocrine tumor recurrence in a middle‐aged male. Abstract Neuroendocrine tumors are a group of rare, slow‐growing neoplasms, most commonly affecting the gastrointestinal tract. Clinical presentations include symptoms related to the mass or hypersecretion of hormones, such as flushing, diarrhea, or bronchoconstriction. Postprandial abdominal pain is most commonly related to chronic mesenteric ischemia from atherosclerotic changes but is rarely linked to external mass compression, including gastrointestinal tumors. Hereby, the authors highlight an uncommon presentation of NET, which is very challenging to diagnose and demands a high index of suspicion.

Abstract Population declines of vultures of the genus Gyps in the Indian Subcontinent in the 1990s and 2000s were among the most rapid global population declines recorded for any bird species. Multiple lines of evidence identified veterinary treatment of cattle with the non‐steroidal anti‐inflammatory drug (NSAID) diclofenac as the principal cause of the vulture population crash. Diclofenac causes kidney failure and death within a few days of a vulture scavenging the carcass of a recently treated cow. Despite coordinated regulatory action by governments to ban veterinary diclofenac in South Asia, enforcement has been incomplete in many areas. Progress in preventing the veterinary use of other NSAIDs now also known to be vulture‐toxic has been slow. A mosaic of inconsistent licensing processes currently exists across South Asian vulture range states, leading to issues with successful policy implementation, legitimacy and effectiveness. At present, mandatory safety testing to ensure NSAIDs already in use or proposed for use are vulture‐safe is not part of drug licensing procedures in any vulture range state. In 2021, Bangladesh became the first country to ban a vulture‐toxic NSAID, in addition to diclofenac, by banning veterinary use of ketoprofen. In 2023, India became the second country to take this step when the government announced a ban on veterinary aceclofenac and ketoprofen. This government action in India may have been triggered by a recent legal challenge. Despite its veterinary use now being banned in South Asian and the Middle Eastern countries, diclofenac has been authorised for sale since 2013 as a veterinary drug in Spain, even though Spain holds 90% of the vulture population of Europe. The European Commission's decision to leave the authorisation of this drug to Member States is at odds with a central pillar of environmental law in the European Union (EU): the precautionary principle. Furthermore, this approach is not consistent with the stringent standards and burden of proof applied to the licensing of EU plant protection products. Solution. A solution to this lack of protection of Gyps vulture populations is for regulatory regimes for veterinary NSAIDs to be augmented.

Key Clinical Message Lymphadenopathy following recent immunization is usually regional. Generalized lymphadenopathy should arouse suspicion for alternative underlying pathology. Prostate adenocarcinoma should be considered in the differential diagnosis for malignancy in an elderly male patient. Metastatic prostate adenocarcinoma can have good prognostic outcomes if treatment is started promptly, even in the setting of widespread disease. Abstract Generalized lymphadenopathy is commonly attributed to infectious causes or malignancy, often lymphoproliferative disorders. We present a rare case of metastatic prostate cancer diagnosed after initially presenting as generalized lymphadenopathy following a coronavirus disease 2019 (COVID) booster vaccination. A 70‐year‐old Hispanic male presented with left lower quadrant abdominal pain, nausea, headache, myalgia, severe constipation, and a right‐sided neck swelling that had been increasing in size since the day of his vaccination. Computed tomography (CT) scans of soft tissue neck, chest, abdomen, and pelvis with contrast showed extensive lymphadenopathy. Ultrasound‐guided biopsy results of the enlarged right supraclavicular node and prostate revealed histopathology consistent with that of prostate acinar adenocarcinoma. He started on bicalutamide for 4 weeks, transitioned to gonadotropin releasing hormone analogue (leuprolide) injections every 3 months and oral androgen receptor signaling inhibitor (abiraterone with prednisone daily). PSA level declined from 121 ng/mL at diagnosis to 1.3 ng/mL after 3 months of therapy, and repeat imaging showed marked improvement in the size of his mediastinal, retroperitoneal, and pelvic lymphadenopathy. To the best of our knowledge, this is the first case reported of a COVID vaccine booster uncovering lymphadenopathy leading to the diagnosis of metastatic prostate cancer.

The use of energy sources for electric vehicle (EV) applications relies heavily on the power electronic interlinking and its successful control mechanism. A hybrid adaptive neuro-fuzzy inference system (ANFIS) proportional-integral (PI) based control strategy for a multi-input DC-DC converter is investigated in-depth for this purpose. At steady state, the proposed hybrid ANFIS PI controller uses the standard PI controller, and during the transient state, the ANFIS PI control strategy is used. Furthermore, the proposed control scheme aids in the tracing of a predetermined speed pattern in order to achieve total EV. A detailed simulation analysis of the proposed control strategy is carried out and its performace was compared with traditional controllers. The result indicated that the designed control strategy is reliable since it offers bidirectional power management, high gain with quick reaction, and low steady-state error. It enables rapid tracking and achieves improved dynamic response through increased flexibility and energy efficiency. The proposed scheme reduces component stress, as demonstrated by a reliability assessment using the MIL-HDBK-217F military handbook. At nominal power, the converter achieves 96.954% efficiency. An 80 W converter prototype was created and tested in the laboratory to monitor the real-time system’s response time.

Cancer is a condition marked by abnormal cell proliferation that has the potential to invade or indicate other health issues. Human beings are affected by more than 100 different types of cancer. Some cancer promotes rapid cell proliferation, whereas others cause cells to divide and develop more slowly. Some cancers, such as leukemia, produce visible tumors, while others, such as breast cancer, do not. In this work, in silico investigations were carried out to investigate the binding mechanisms of four major analogs, which are marine sesquiterpene, sesquiterpene lactone, heteroaromatic chalcones, and benzothiophene against the target estrogen receptor-α for targeting breast cancer using Schrödinger suite 2021-4. The Glide module handled the molecular docking experiments, the QikProp module handled the ADMET screening, and the Prime MM-GB/SA module determined the binding energy of the ligands. The benzothiophene analog BT_ER_15f (G-score −15.922 Kcal/mol) showed the best binding activity against the target protein estrogen receptor-α when compared with the standard drug tamoxifen which has a docking score of −13.560 Kcal/mol. TRP383 (tryptophan) has the highest interaction time with the ligand, and hence it could act for a long time. Based on in silico investigations, the benzothiophene analog BT_ER_15f significantly binds with the active site of the target protein estrogen receptor-α. Similar to the outcomes of molecular docking, the target and ligand complex interaction motif established a high affinity of lead candidates in a dynamic system. This study shows that estrogen receptor-α targets inhibitors with better potential and low toxicity when compared to the existing market drugs, which can be made from a benzothiophene derivative. It may result in considerable activity and be applied to more research on breast cancer.

The effects of varying modulation indices on the current and voltage harmonics of an induction motor (IM) powered by a three-phase space vector pulse-width modulation (SVM) inverter are presented in this research. The effects were examined using simulation and an experimental setup. IMs can be governed by an SVM inverter drive or a phase-angle control drive for applications that require varying speeds. The analysis of THD content in this study used the modulation index (MI), whose modification affects the harmonic content, and voltage-oriented control (VOC) with SVM in three-phase pulse-width modulation (PWM) inverters with fixed switching frequencies. The control technique relies on two cascaded feedback loops, one controlling the grid current and the other regulating the dc-link voltage to maintain the required level of dc-bus voltage. The control strategy was developed to transform between stationary (α–β) and synchronously rotating (d–q) coordinate systems. To test the viability of the suggested control technique, a 1-hp/3-phase/415-V experimental prototype system built on the DSPACE DS1104 platform was created, and the outcomes were evaluated with sinusoidal pulse-width modulation (SPWM).