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Abstract Background Anaplastic large-cell lymphoma primarily involving the omentum is an extremely rare entity with variable clinical presentation. Owing to its rarity and nonspecific clinical manifestation, omental T-cell lymphoma is often diagnosed at a later stage, riddled with complications. While imaging modalities such as computed tomography scan can help a physician reach a diagnosis, cases that present with complications may require a multidisciplinary approach that combines surgical exploration along with consultation from Oncology. Case presentation We hereby report a rare case of a 66-year-old African American male patient who presented to the emergency department with complaints of acute gastrointestinal obstruction. A computed tomography scan of the abdomen and pelvis revealed evidence of an internal hernia and surgical exploration revealed a hemorrhagic and infarcted omentum. Biopsies along with immunophenotypic studies confirmed the diagnosis of anaplastic T-cell lymphoma of the omentum complicated by Massilia timonae infection. Conclusion The case highlights the significance of considering lymphoma, although rare, as a differential in a patient who presents with small bowel obstruction and the importance of investigating for malignancy for early diagnosis and treatment of primary omental lymphomas, before complications develop.

Compact, rechargeable batteries in the capacity range of 1-100 mAh are targeted for form-factor-constrained wearables and other high-performance electronic devices, which have core requirements including high volumetric energy density (VED), fast charging, safety, surface-mount technology (SMT) compatibility, and long cycle life. To maximize the VED, anodeless solid-state lithium thin-film batteries (TFBs) fabricated by using a roll-to-roll process on an ultrathin stainless-steel substrate (10-75 μm in thickness) have been developed. A high-device-density dry-process patterning flow defines customizable battery device dimensions while generating negligible waste. The entire fabrication operation is performed in a conventional, humidity-controlled cleanroom, eliminating the need for a costly dry-room environment and allowing for simplified, lower-cost manufacturing. Such scale-up using an anodeless architecture also enables a thermal-budget-compatible packaging and metallization scheme targeted at industry-compatible SMT processes. Further manufacturability improvements, such as the use of high-speed tests, add to the overall range of elements necessary for mass production.

BACKGROUND: Metabolic syndrome varies by socio-demographic characteristics, with younger (18-29 years) and older (50-69 years) Hispanic/Latino having higher prevalence compared to other groups. While there is substantial research on neighborhood influences on cardiometabolic health, there are mixed findings regarding the effects of gentrification and few studies have included Hispanic/Latinos. The role of neighborhood income inequality on metabolic health remains poorly understood. OBJECTIVES: Examined associations of neighborhood gentrification and income inequality with metabolic syndrome (MetSyn) using data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). DESIGN, SETTING AND PARTICIPANTS: The HCHS/SOL is a community-based cohort of adults of Hispanic/Latinos (aged 18-74). Analyses included 6710 adults who did not meet criteria for MetsS at baseline (2008-2011) and completed the visit 2 examination (2014-2017). Poisson regressions estimated odds ratios (IRR) and 95% confidence intervals (CI) for neighborhood gentrification and change in income inequality with MetSyn incidence. MAIN OUTCOME AND EXPOSURE MEASURES: Gentrification was measured with an index that included changes (2000 to 2006-2010) in education, poverty, and income. Change in neighborhood income inequality (2005-2009 to 2012-2016) was measured using the Gini coefficient of income distribution. MetSyn was defined using National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: Among 6647 Hispanic/Latino adults, 23% (N = 1530) had incident MetSyn. In models adjusted for socio-demographic, health insurance status, and neighborhood characteristics, gentrification (IRR, 1.00, 95%CI, 0.96-1.03) and income inequality change (IRR, 1.00, 95%CI, 0.99-1.00) were not associated with MetSyn at visit 2. There was no association between cross-sectional income inequality (2005-2009) and MetSyn at visit 2 (IRR, 0.97, 95%CI, 0.82-1.15). CONCLUSION: Neighborhood gentrification and income inequality change were not associated with incidence of MetSyn over 6 years among Hispanic/Latino adults. This study demonstrated that income-based residential changes alone may not be sufficient to explain neighborhood influences on health outcomes among this population.

Let G be a graph of size m and [Formula: see text] be the spectral radius of its adjacency matrix. A graph is said to be H-free if it does not contain a subgraph isomorphic to H. Let [Formula: see text] be the graph obtained by adding a pendent vertex to a cycle of length l. In this paper, we determine the graphs with the maximum spectral radius over [Formula: see text]-free graphs, and [Formula: see text]-free graphs with [Formula: see text].

Developments in low-cost techniques for growing high-quality nickel oxide thin films (NiOTFs) are critical enablers for the fabrication of NiO-based devices, particularly solar cells, light-emitting diodes, lasers, and many other applications. In this study, it has been demonstrated that the optical, electrical, and structural characteristics of NiOTFs coated on glass substrate employing a low-cost solution method are strongly influenced by post-thermal annealing treatments in ambient air. A comprehensive study was carried out on the characteristics of the deposited NiOTFs. X-ray diffraction (XRD) measurements indicate the enhancement of the crystal quality of films after annealing. There is a noticeable change and improvement in coated NiOTFs with heat treatment at 300 and 600 ℃ due to clear shifts in density. During the heating temperature increment, the energy of the band gap was shifted from 3.63 to 3.44 eV, and the electrical resistance of the NiOTFs varied from 1020 to 700 Ω-cm. Furthermore, the results indicate that the low-cost sol-gel (SG) deposition technique has a greater potential for producing high-quality p-type NiOTFs with minimal defects for electronic device applications.

A less hazardous, environmentally friendly, and energy-efficient Knoevenagel reaction performed using proline as a catalyst has been designed and implemented within a sophomore-level organic chemistry laboratory as a guided inquiry activity. The main learning objective is to enable students to identify and understand various green chemistry principles such as atom economy, use of safer chemicals, design for energy efficiency, and inherently safer chemistry for accident prevention. Students were successful in synthesizing α,β-unsaturated diesters using unknown substituted benzaldehydes (later identified by the students spectroscopically) and Meldrum’s acid at room temperature in the presence of proline as a catalyst without the need for an additional base. By analyzing 1H NMR spectroscopic data, infrared spectroscopy, and mass spectrometry to identify the synthesized product, the unknown benzaldehyde starting material, and the major reaction pathway, students have enhanced their spectroscopy skills and developed a deeper understanding of the mechanism of the reaction that may not be covered in the lecture course.

PURPOSE: Examine the association between neighborhood segregation and 6-year incident metabolic syndrome (MetSyn) in the Hispanic Community Health Study/Study of Latinos. METHODS: Prospective cohort of adults residing in Miami, Chicago, the Bronx, and San Diego. The analytic sample included 6,710 participants who did not have MetSyn at baseline. The evenness and exposure dimensions of neighborhood segregation, based on the Gini and Isolation indices, respectively, were categorized into quintiles (Q). Racialized economic concentration was measured with the Index of Concentration at the Extremes (continuously and Q). RESULTS: Exposure, but not evenness, was associated with higher disease odds (Q1 (lower segregation) vs. Q4, OR = 1.53, 95% CI = 1.082.17; Q5, OR = 2.29, 95% CI = 1.493.52). Economic concentrationprivilege (continuous OR = 0.87, 95% CI = 0.770.98), racial concentrationracialized privilege (Q1 (greater concentration) vs. Q2 OR = 0.75, 95% CI = 0.541.04; Q3 OR = 0.68, 95% CI = 0.441.05; Q4 OR = 0.68, 95% CI = 0.451.01; Q5 OR = 0.64, 95% CI = 0.420.98)(continuous OR = 0.93, 95% CI = 0.821.04), and racialized economic concentrationprivilege (i.e., higher SES non-Hispanic White, continuous OR = 0.86, 95% CI = 0.760.98) were associated with lower disease odds. CONCLUSION: Hispanics/Latino adults residing in neighborhoods with high segregation had higher risk of incident MetSyn compared to those residing in neighborhoods with low segregation. Research is needed to identify the mechanisms that link segregation to poor metabolic health.

Background Medical complications in peripartum patients are uncommon are uncommon. Often, these patients are transferred to tertiary care centers, but their conditions and outcomes are not well understood. Our study examined peripartum patients transferred to an intensive care unit (ICU) at an academic quaternary center. Methods We reviewed charts of adult, non-trauma, interhospital transfer (IHT) peripartum patients sent to an academic quaternary ICU between January 2017 and December 2021. We conducted a descriptive analysis and used multivariable ordinal regression to examine associations of demographic and clinical factors with ICU length of stay (LOS) and hospital length of stay (HLOS). Results Of 1,794 IHT peripartum patients, 60 (3.2%) were directly transferred to an ICU. The average age was 32 years, with a median Sequential Organ Failure Assessment (SOFA) score of 3 (1–4.25) and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 8 (7–12). Respiratory failure was most common (32%), followed by postpartum hemorrhage (15%) and sepsis (14%). Intubation was required for 24 (41%), and 4 (7%) needed extracorporeal membrane oxygenation. Only 1 (1.7%) died, while 45 (76.3%) were discharged. Median ICU LOS and HLOS were 5 days (2–12) and 8 days (5–17). High SOFA score was linked to longer HLOS, as was APACHE II. Conclusions Transfers of critically ill peripartum patients between hospitals were rare but involved severe medical conditions. Despite this, their outcomes were generally positive. Larger studies are needed to confirm our findings.

Background: During COVID-19 pandemic, service providers and beneficiaries of Rashtriya Bal Swasthya Karyakram (RBSK) faced certain challenges. Objectives: The objective was to assess the perception and challenges faced by service providers and beneficiaries in general and amid the pandemic for availing the services at an urban health center in Ahmedabad. Methodology: Data of registered cases under RBSK at Urban Health Center (UHC) Ognaj in 2018–2019 and 2019–2020 were compared. In depth interviews (IDIs) of Medical Officer RBSK were done. Home visits were done to document the perception and challenges of beneficiaries through semi/unstructured questionnaire. Results: Considering the cases of 2018–2019 as base, registered cases decreased by 22.8% in 2019–2020 and 92.4% in 2020–2021. The pandemic affected 15.6% of beneficiaries in availing the services. Program was affected due to: (1) less workforce (vacant pharmacist post), (2) target-based approach, and (3) birth defects, deficiency disorders, chronic diseases, and development delays, especially deficiency not perceived a serious health issue by beneficiaries. Corona-specific reasons included: (1) staff deployment in COVID-19 activities, (2) reluctance/fear in visiting District Early Intervention Center (DEIC)/health facility, (3) reduced screening due to the closure of schools/Anganwadi Kendras, and (4) enforced lockdown. Conclusions: RBSK mobile health teams found it difficult to reach all 4Ds, more so for follow-up. RBSK was badly affected due to the engagement of providers in COVID-19 work, the closure of facilities, perception of beneficiaries that 4Ds are not of urgent medical concern, prevailing myths. A clear strategy is required to address such problems when the same or a similar type of pandemic strikes us in future.

The field of study pertaining to environmental, social, and governance (ESG) concerns has gained significant interest in recent years, primarily driven by increasing worldwide concern about climate change and environmental challenges. Prior research has examined corporate social responsibility (CSR) and environmental, social, and governance (ESG) initiatives as actions that may be susceptible to opportunistic conduct by managers, which may be observed via earnings management. This research aims to investigate different perspectives of earnings quality (EQ) by examining the determinants of EQ described as inherent operating environment and risk of the industry business process (innate factors of EQ) and management reporting decision (manager’s discretion of EQ). Separating the components of EQ determinants individually is considered an advantage by the previous researcher. Using fixed effect panel data, this study demonstrates that ESG performance is positively associated with discretionary accruals and negatively related to innate earnings quality. This phenomenon might perhaps be attributed to the challenges posed by the sector, characterized by rapid digital transformation and unexpected digital development in the markets. This observation suggests that over time, the utilization of symbolic ESG business practices, which are susceptible to greenwashing, would have a detrimental effect on the fundamental earnings quality influenced by the operational context and the risk of uncertainty associated with the organization.

Let $G$ be a simple connected graph of order $n$ and size $m$. The matrix $L(G)=D(G)-A(G)$ is the Laplacian matrix of $G$, where $D(G)$ and $A(G)$ are the degree diagonal matrix and the adjacency matrix, respectively. For the graph $G$, let $d_{1}\geq d_{2}\geq \cdots d_{n}$ be the vertex degree sequence and $\mu_{1}\geq \mu_{2}\geq \cdots \geq \mu_{n-1}>\mu_{n}=0$ be the Laplacian eigenvalues. The Laplacian resolvent energy $RL(G)$ of a graph $G$ is defined as $RL(G)=\sum\limits_{i=1}^{n}\frac{1}{n+1-\mu_{i}}$. In this paper, we obtain an upper bound for the Laplacian resolvent energy $RL(G)$ in terms of the order, size and the algebraic connectivity of the graph. Further, we establish relations between the Laplacian resolvent energy $RL(G)$ with each of the Laplacian-energy-Like invariant $LEL$, the Kirchhoff index $Kf$ and the Laplacian energy $LE$ of the graph.

In this article, we explore the concept of spectral redundancy within the class of pineapple graphs, denoted as P(α,β). These graphs are constructed by attaching β pendent edges to a single vertex of a complete graph Kα. A connected graph G earns the title of being spectrally non-redundant if the spectral radii of its connected induced subgraphs are all distinct. Spectral redundancy, on the other hand, arises when there is a repetition of spectral radii among the connected induced subgraphs within G. Our study analyzes the adjacency spectrum of P(α,β), identifying distinct eigenvalues such as 0, −1, along with other positive and negative eigenvalues. Our investigation focuses on determining the spectral redundancy within this class of graphs, shedding light on their unique structural properties and implications for graph theory. Understanding spectral redundancy in these graphs is crucial for applications in network design, where distinct spectral radii can indicate different connectivity patterns and resilience features.

In the face of escalating environmental challenges driven by human activities, the quest for innovative solutions to counter pollution, contamination, and ecological degradation has gained paramount importance. Traditional approaches to environmental remediation often fall short in addressing the complexity and scale of modern-day environmental problems. As industries transition towards sustainable paradigms, the exploration of novel materials and technologies becomes crucial. Lignin nanoparticles have emerged as a promising avenue of exploration in this context. Once considered a mere byproduct, lignin’s unique properties and versatile functional groups have propelled it to the forefront of environmental remediation research. This review paper delves into the resurgence of lignin from an environmental perspective, examining its pivotal role in carbon cycling and its potential to address various environmental challenges. The paper extensively discusses the synthesis, properties, and applications of lignin nanoparticles in diverse fields such as water purification and soil remediation. Moreover, it highlights the challenges associated with nanoparticle deployment, ranging from Eco toxicological assessments to scalability issues. Multidisciplinary collaboration and integration of research findings with real-world applications are emphasized as critical factors for unlocking the transformative potential of lignin nanoparticles. Ultimately, this review underscores lignin nanoparticles as beacons of hope in the pursuit of cleaner, healthier, and more harmonious coexistence between humanity and nature through innovative environmental remediation strategies.

Cancer of the oral cavity in Pakistan is among the highest in the world which is attributed to the local custom of chewing tobacco products such as paan, gutka and naswar. These things are widely used in Pakistan mainly by the lower socioeconomic group. They pose a high risk for oral cancer. The continuous exposure to corrosive condiments causes abrasions of oral mucosal surface making it more susceptible for virulent strains to gain entry into the basal cells…

Summary: Background: Repurposed drugs with host-directed antiviral and immunomodulatory properties have shown promise in the treatment of COVID-19, but few trials have studied combinations of these agents. The aim of this trial was to assess the effectiveness of affordable, widely available, repurposed drugs used in combination for treatment of COVID-19, which may be particularly relevant to low-resource countries. Methods: We conducted an open-label, randomized, outpatient, controlled trial in Thailand from October 1, 2021, to June 21, 2022, to assess whether early treatment within 48-h of symptoms onset with combinations of fluvoxamine, bromhexine, cyproheptadine, and niclosamide, given to adults with confirmed mild SARS-CoV-2 infection, can prevent 28-day clinical deterioration compared to standard care. Participants were randomly assigned to receive treatment with fluvoxamine alone, fluvoxamine + bromhexine, fluvoxamine + cyproheptadine, niclosamide + bromhexine, or standard care. The primary outcome measured was clinical deterioration within 9, 14, or 28 days using a 6-point ordinal scale. This trial is registered with ClinicalTrials.gov (NCT05087381). Findings: Among 1900 recruited, a total of 995 participants completed the trial. No participants had clinical deterioration by day 9, 14, or 28 days among those treated with fluvoxamine plus bromhexine (0%), fluvoxamine plus cyproheptadine (0%), or niclosamide plus bromhexine (0%). Nine participants (5.6%) in the fluvoxamine arm had clinical deterioration by day 28, requiring low-flow oxygen. In contrast, most standard care arm participants had clinical deterioration by 9, 14, and 28 days. By day 9, 32.7% (110) of patients in the standard care arm had been hospitalized without requiring supplemental oxygen but needing ongoing medical care. By day 28, this percentage increased to 37.5% (21). Additionally, 20.8% (70) of patients in the standard care arm required low-flow oxygen by day 9, and 12.5% (16) needed non-invasive or mechanical ventilation by day 28. All treated groups significantly differed from the standard care group by days 9, 14, and 28 (p

Summary: Psychiatric disorders are highly prevalent in Pakistan and burdens the scarce number of psychiatrists present in the country. The establishment of evidence-based clinical practice guidelines (EBCPGs) and primary-care referral pathways within the local context is imperative to make the process efficient. In this Health Policy, we aimed to develop EBCPGs and primary-care referral pathways that are specific to Pakistan's primary-care setting, with the aim of facilitating the management of psychiatric conditions. Ten EBCPGs were created through the GRADE-ADOLOPMENT process; two recommendations were adopted with minor changes, 43 were excluded, and all others were adopted without any changes. Ten primary-care referral pathways for managing ten psychiatric disorders were created and 23 recommendations were added which will help to bridge the gap in care provision. These psychiatric referral pathways and EBCPGs will bring Pakistan's healthcare system a step closer to achieving optimal health outcomes for patients.

Objective To develop and content validate a questionnaire to assess the financial and functional impact of major lower limb amputation in patients with diabetes-related foot disease.Design Prospective observational study.Setting This study was conducted at a tertiary care centre in Pakistan.Participants We conducted a thorough literature review and a group interview with 10 participants, resulting in domain identification and item generation. The group included seven patients with diabetes-related foot disease who underwent major lower limb amputation and three caregivers. Subsequently, a focused group discussion was held to assess overlap and duplication among the items, and two rounds of content validation were carried out by five content and five lay experts in both English and Urdu. Question items with a Content Validity Index (CVI) score of >0.79 were retained, items with a CVI score between 0.70 and 0.79 were revised and items with a CVI score of

The process of developing of new drugs is greatly hampered by their inadequate physicochemical, pharmacokinetic, and intrinsic characteristics. In this regard, the selected chloro indolinone, (Z)-6-chloro-3-(2-chlorobenzylidene)indolin-2-one (C1), and nitro indolinone, (Z)-6-chloro-3-(2-nitrobenzylidene)indolin-2-one (C2), were subjected to SwissADME and density function theory (DFT) analysis. For compounds C1 and C2, the BOILED-Egg pharmacokinetic model predicted intestinal absorption, blood–brain barrier (BBB) penetration, and p-glycoprotein interaction. According to the physicochemical analysis, C1 has exceptional drug-like characteristics suitable for oral absorption. Despite only being substrates for some of the major CYP 450 isoforms, compounds C1 and C2 were anticipated to have strong plasma protein binding and efficient distribution and block these isoforms. The DFT study using the B3LYP/6-311G(d,p) approach with implicit water effects was performed to assess the structural features, electronic properties, and global reactivity parameters (GRP) of C1 and C2. The DFT results provided further support for other studies, implying that C2 is more water-soluble than C1 and that both compounds can form hydrogen bonds and (weak) dispersion interactions with other molecules, such as solvents and biomolecules. Furthermore, the GRP study suggested that C1 should be more stable and less reactive than C2. A concentration-dependent 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid (ABTS) radical scavenging activity was shown by both C1 and C2. In brief, this finding has provided a strong foundation to explore further the therapeutic potential of these molecules against a variety of human disorders.

For a $ \nu $-vertex connected graph $ \Gamma $, we consider the reciprocal distance Laplacian matrix defined as $ RD^L(\Gamma) = RT(\Gamma)-RD(\Gamma) $, i.e., $ RD^L(\Gamma) $ is the difference between the diagonal matrix of the reciprocal distance degrees $ RT(\Gamma) $ and the Harary matrix $ RD(\Gamma) $. In this article, we determine the graphs with exactly two distinct reciprocal distance Laplacian eigenvalues.We completely characterize the graph classes with a $ RD^L $ eigenvalue of multiplicity $ \nu-2 $. Moreover, we characterize families of graphs with reciprocal distance Laplacian eigenvalue whose multiplicity is $ \nu-3 $.

Temporary transvenous pacing is generally considered a safe procedure and is commonly performed for various emergent indications. However, complications are quite common with minor complications being more frequent than major life-threatening events. Cardiac perforation is a serious complication associated with the procedure with possible life- threatening consequences. Our report describes the imaging findings in a rare case of cardiac perforation with accompanying diaphragmatic perforation during temporary transvenous pacemaker placement.

Background and Purpose Social determinants of health (SDOH) are non-medical factors that may contribute to the development of diseases, with a higher representation in underserved populations. Our objective is to determine the association of unfavorable SDOH with self-reported stroke/transient ischemic attack (TIA) and vascular risk factors (VRFs) among Hispanic/Latino adults living in the US. Methods We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos. SDOH and VRFs were assessed using questionnaires and validated scales and measurements. We investigated the association between the SDOH (individually and as count: ≤1, 2, 3, 4, or ≥5 SDOH), VRFs and stroke/TIA using regression analyses. Results For individuals with stroke/TIA (n=388), the mean age (58.9 years) differed from those without stroke/TIA (n=11,210; 46.8 years; P

Achieving synchronization between the central and peripheral body clocks is essential for ensuring optimal metabolic function. Meal timing is an emerging field of research that investigates the influence of eating patterns on our circadian rhythm, metabolism, and overall health. This narrative review examines the relationship between meal timing, circadian rhythm, clock genes, circadian hormones, and metabolic function. It analyzes the existing literature and experimental data to explore the connection between mealtime, circadian rhythms, and metabolic processes. The available evidence highlights the importance of aligning mealtime with the body’s natural rhythms to promote metabolic health and prevent metabolic disorders. Specifically, studies show that consuming meals later in the day is associated with an elevated prevalence of metabolic disorders, while early time-restricted eating, such as having an early breakfast and an earlier dinner, improves levels of glucose in the blood and substrate oxidation. Circadian hormones, including cortisol and melatonin, interact with mealtimes and play vital roles in regulating metabolic processes. Cortisol, aligned with dawn in diurnal mammals, activates energy reserves, stimulates appetite, influences clock gene expression, and synchronizes peripheral clocks. Consuming meals during periods of elevated melatonin levels, specifically during the circadian night, has been correlated with potential implications for glucose tolerance. Understanding the mechanisms of central and peripheral clock synchronization, including genetics, interactions with chronotype, sleep duration, and hormonal changes, provides valuable insights for optimizing dietary strategies and timing. This knowledge contributes to improved overall health and well-being by aligning mealtime with the body’s natural circadian rhythm.

AbstractLet G be a connected simple graph with n vertices. The distance Laplacian matrix [Formula: see text] is defined as [Formula: see text], where [Formula: see text] is the diagonal matrix of vertex transmissions and [Formula: see text] is the distance matrix of G. The eigenvalues of [Formula: see text] are the distance Laplacian eigenvalues of G and are denoted by [Formula: see text]. The largest eigenvalue [Formula: see text] is called the distance Laplacian spectral radius. Lu et al. (2017), Fernandes et al. (2018), and Ma et al. (2018) completely characterized the graphs having some distance Laplacian eigenvalue of multiplicity [Formula: see text]. In this paper, we characterize the graphs having distance Laplacian spectral radius of multiplicity [Formula: see text] together with one of the distance Laplacian eigenvalues as n of multiplicity either 3 or 2. Further, we completely determine the graphs for which the distance Laplacian eigenvalue n is of multiplicity [Formula: see text].