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Abstract Zygomycetous fungal infections pose an emerging medical threat among individuals with compromised immunity and metabolic abnormalities. Our pathophysiological understanding of these infections, particularly the role of fungal cell walls in growth and immune response, remains limited. Here we conducted multidimensional solid-state NMR analysis to examine cell walls in five Mucorales species, including key mucormycosis causative agents like Rhizopus and Mucor species. We show that the rigid core of the cell wall primarily comprises highly polymorphic chitin and chitosan, with minimal quantities of β-glucans linked to a specific chitin subtype. Chitosan emerges as a pivotal molecule preserving hydration and dynamics. Some proteins are entrapped within this semi-crystalline chitin/chitosan layer, stabilized by the sidechains of hydrophobic amino acid residues, and situated distantly from β-glucans. The mobile domain contains galactan- and mannan-based polysaccharides, along with polymeric α-fucoses. Treatment with the chitin synthase inhibitor nikkomycin removes the β-glucan-chitin/chitosan complex, leaving the other chitin and chitosan allomorphs untouched while simultaneously thickening and rigidifying the cell wall. These findings shed light on the organization of Mucorales cell walls and emphasize the necessity for a deeper understanding of the diverse families of chitin synthases and deacetylases as potential targets for novel antifungal therapies.

The ideal method of operative fixation for unstable distal clavicle fractures remains controversial, with particular emphasis on the need to restore the normal coracoclavicular distance. Our preferred method of fixation includes open reduction and internal fixation with a distal clavicle locking plate in combination with a polydioxanone suture wrapped around the plate and coracoid to restore the coracoclavicular distance and offload the bony repair. The purpose of this study is to report clinical, radiographic, and functional outcomes in patients with unstable distal clavicle fractures treated with this method of fixation.

Abstract Numerous studies proposed methods to detect Parkinson’s disease (PD) via speech analysis. However, existing corpora often lack prodromal recordings, have small sample sizes, and lack longitudinal data. Speech samples from celebrities who publicly disclosed their PD diagnosis provide longitudinal data, allowing the creation of a new corpus, ParkCeleb. We collected videos from 40 subjects with PD and 40 controls and analyzed evolving speech features from 10 years before to 20 years after diagnosis. Our longitudinal analysis, focused on 15 subjects with PD and 15 controls, revealed features like pitch variability, pause duration, speech rate, and syllable duration, indicating PD progression. Early dysarthria patterns were detectable in the prodromal phase, with the best classifiers achieving AUCs of 0.72 and 0.75 for data collected ten and five years before diagnosis, respectively, and 0.93 post-diagnosis. This study highlights the potential for early detection methods, aiding treatment response identification and screening in clinical trials.

Abstract Humans receive around 50% of natural radiation dose due to 222Rn (radon), 220Rn (thoron) and their decay products. Several field campaigns measuring these gases and the decay products in different regions of India have been conducted in the recent past. Some of these studies measured indoor activity concentration and/or dose due to these gases and the associated decay products. This work compares the fraction of 222Rn and decay products and 220Rn and decay products in inhalation dose for 10 studies conducted in Uttarakhand state. It is seen that AEDT (annual effective dose due to 220Rn and decay products) for these regions varies between 21 and 48% and it is significantly higher than the averaged worldwide reference value of 6%. Based on elaborative measurements performed in the Bageshwar district (present work), Almora and Nainital districts (our previous campaigns); the reasons for this high value have been explored. It was observed that a higher source term for mud houses could be the main reason for the high AEDT range. Interestingly, preliminary analysis revealed that the fraction is higher for the dwellings situated at higher altitudes thus indicating the role of the unavailability of modern building construction materials at remote locations. The study highlights the significant contribution of thoron in the Indian Himalayas.

Abstract Background Repository corticotropin injection (RCI) has been suggested to exert immunomodulatory and anti-inflammatory effects in ocular inflammation. The index retrospective study aimed to evaluate the efficacy and tolerability of subcutaneous RCI in patients with active scleritis or uveitis. Main body Medical records of patients who were diagnosed with different types of active scleritis or uveitis and received RCI for more than six months at a tertiary eye center were reviewed. Patient characteristics including age, sex, comorbidities, clinical findings, treatment details, and adverse events were recorded. A total of 17 eyes of 17 patients were included. Median age was 43 years old and 53% of patients were male. Mean treatment duration was 25.4 ± 15.5 months. Indications for RCI therapy were scleritis (7 anterior and 1 posterior) (47.8%), panuveitis (17.4%), retinal vasculitis (17.4%), chronic/recurrent anterior uveitis (13%), and posterior uveitis (4.35%). RCI was initiated at a dose of 40 to 80 units 3 times weekly. Given the adequate control of inflammation, RCI was successfully discontinued in four patients (23.5%). Prior to RCI therapy, 14 (82.3%) patients were on oral prednisone at an average of 10 mg daily (range 2.5–40 mg), and two (11.7%) patients discontinued prednisone immediately before initiating RCI due to side effects. After six months of therapy, the prednisone dose was reduced in four (23.5%) patients to an average of 3 mg daily (range 1–5 mg) and was stopped in eight (53%) patients. Concomitant immunomodulatory therapies (IMTs) included mycophenolate mofetil (23.5%) and methotrexate (23.5%), and adalimumab (23.5%). Ten patients were on IMTs prior to using RCI, and during the course of treatment, IMT was stopped in two patients and reduced in one. Side effects included insomnia (23%), hypertension (11.7%), lower extremity edema (11.7%), hyperglycemia (11.7%), weight gain (11.7%), and infection (5.8%). Conclusion RCI may be considered as a potential therapy with acceptable tolerability for patients with non-infectious scleritis or uveitis.

Abstract Tacticity is long known as a significant contributor in changing the chemical and mechanical properties of the polymers drastically. This study explores mechanism of bandgap formation in elastic mechanical metastructures designed with a focus on tacticity. We introduce metabeams, comprising a primary slender beam embedded with short secondary beams featuring end masses at their tips. The investigation delves into the numerically simulated vibration characteristics of metabeams using finite element analysis, with a subsequent comparison to experimental results for fabricated metabeams. Employing a unit-cell design approach that manipulates spatial and physical parameters, we explore a wide range of uniform and non-uniform metabeam configurations based on the distance between secondary beams and distribution of local resonators as per tacticity. Hence, drawing inspiration from tacticity, we extend our investigation to isotactic and syndiotactic metabeams, altering physical parameters (mass) within the unit cell for both configurations. The strategic distribution of end masses on attached secondary beams introduces unique characteristics to isotactic and syndiotactic metabeams, allowing for the modulation of bandgaps without altering the natural frequencies of the resonators in symmetric and anti-symmetric metabeam designs. Our research demonstrates, incorporating tacticity in metabeam design offers a novel and unconventional approach to modulate the bandgap formation mechanism.

Abstract Particle tracking (PT) is a popular technique in microscopy, microfluidics and colloidal transport studies, where image analysis is used to reconstruct trajectories from bright spots in a video. The performance of many PT algorithms has been rigorously tested for directed and Brownian motion in open media. However, PT is frequently used to track particles in porous media where complex geometries and viscous flows generate particles with high velocity variability over time. Here, we present an evaluation of four PT algorithms for a simulated dispersion of particles in porous media across a range of particle speeds and densities. Of special note, we introduce a new velocity-based PT linking algorithm (V-TrackMat) that achieves high accuracy relative to the other PT algorithms. Our findings underscore that traditional statistics, which revolve around detection and linking proficiency, fall short in providing a holistic comparison of PT codes because they tend to underpenalize aggressive linking techniques. We further elucidate that all codes analyzed show a decrease in performance due to high speeds, particle densities, and trajectory noise. However, linking algorithms designed to harness velocity data show superior performance, especially in the case of high-speed advective motion. Lastly, we emphasize how PT error can influence transport analysis.

Abstract Background Despite decades of a call to action to engage men in reproductive health, men are often left out of programs and interventions. In India, where half of pregnancies are reported as unintended, patriarchal gender norms and still dominant patterns of arranged marriages make engaging men in family planning and strengthening couples communication critical in increasing reproductive autonomy and helping young couples meet their reproductive goals. This study explores the feasibility and acceptability from the men’s perspective of the pilot of a gender transformative intervention for newly married couples in India. Methods A pilot study was conducted of TARANG, a 4 month intervention for newly married women, with light touch engagement of husbands (4 sessions). A total of 41 husbands participated in the pilot, and we collected baseline knowledge and endline feasibility and acceptability data from them, along with in depth qualitative interviews with 13 men. The study was conducted in June 2023-January 2024. Results Men had low levels of knowledge about biology, family planning, with the majority of men reporting that no one had provided them information about these topics. Most men wanted to delay the first birth by at least 2 years, yet less than a quarter had discussed childbearing plans with their partner or engaged in family planning methods. While all men reported high acceptability (satisfaction and usefulness), feasibility (participation) was low, with only 43% attending 2 or more sessions. Main barriers to participation included commitments due to work and migration. Men reported that the intervention led to improvements in their relationships with their wives, gave them a sense of empowerment, and led them to become resources for other men in their community. Conclusions Men in these rural communities are not receiving the information that they need to meet their reproductive goals, however, they greatly desire this information and ways to improve relationships with their new wives. Such an intervention appears to have the potential to help change norms and spread information in the community and provide men with positive, life affirming feelings. Providing information through technology could address barriers to in-person engagement. Trial registration clinicaltrials.gov 03/13/24.NCT06320964

Introduction: Herpes simplex virus type 1 (HSV-1) is the leading cause of sporadic fatal encephalitis, typically presenting with temporal lobe abnormalities. It usually manifests as fever, headache, seizure, altered sensorium, and focal neurological deficit. Hyperphagia as a sole complication of HSV-1 encephalitis is a rare presentation. Case Presentation: We report a 25-year-old woman with a 10-day history of fever, headache, and vomiting, progressing to confusion, visual hallucinations, and drowsiness. She had a history of meningoencephalitis at age 8 and well-controlled focal seizures. Upon admission, magnetic resonance imaging showed T2/fluid-attenuated inversion recovery hyperintensities in both temporal lobes with diffusion restriction. Electroencephalography indicated generalized slowing and cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis with elevated protein levels. Viral encephalitis was suspected, and intravenous acyclovir was initiated. CSF polymerase chain reaction (PCR) confirmed HSV-1. With treatment, she gradually improved but developed hyperphagia during hospital stay. Hyperphagia, a rare complication of herpes simplex virus (HSV) encephalitis, is a part of Kluver-Bucy syndrome typically associated with other cognitive dysfunctions. Despite early treatment, voracious appetite remained partially, emphasizing the need for rapid diagnosis and treatment to prevent severe outcomes. Conclusion: The case highlights that acute onset hyperphagia can be an isolated complication of HSV encephalitis, requiring tailored therapeutic strategies. Follow-up showed significant weight gain with partial improvement in hyperphagia, underscoring the challenges in managing this condition.

Abstract In the quest for early cancer diagnosis, early identification and treatment are paramount. Recently, ctDNA detection has emerged as a viable avenue for early screening of cancer. The examination of ctDNA in fluid biopsies has gained substantial attention in tumor diagnosis and therapy. Both the scientific community and industry are actively exploring this field. However, developing cost-effective, portable, and real-time ctDNA measurement methods using conventional gene detection equipment poses a significant challenge. This challenge has led to the exploration of alternative approaches. Electrochemical biosensors, distinguished by their heightened sensitivity, remarkable specificity, affordability, and excellent portability, have emerged as a promising avenue for ctDNA detection. This review is dedicated to the specific focus on ctDNA detection, highlighting recent advancements in this evolving detection technology. We aimed to reference previous studies related to ctDNA-targeted cancer detection using electrochemical biosensors to advocate the utilization of electrochemical biosensors in healthcare diagnostics. Further research is imperative for the effective integration of ctDNA analysis into point-of-care cancer testing. Innovative approaches utilizing multiple markers need to be explored to advance this technology and make substantial contributions to societal well-being.

Background. Acceleration ability and anaerobic power are critical determinants of sprinting performance, particularly for novice sprinters. Objectives. The purpose of the study was to examine the effects of a four-week interval training program on acceleration ability and anaerobic power among novice sprinters. Materials and methods. A within-subjects quasi-experimental design was used to fulfil the study’s objectives. A total of fifteen participants (age: 20.5 ± 1.4 years) underwent baseline assessments of acceleration ability (50 m dash) and anaerobic power (Running-Based Anaerobic Sprint Test). The adopted progressive interval training protocol consisted of four weekly sessions conducted over a four-week period, focusing on striding, high knees, single-leg hops, curve sprints and double-leg jumps to enhance acceleration ability and anaerobic power. Results. Following the intervention, significant improvements were observed in acceleration ability over a distance of 10 m (pre: 2.14 ± 0.16 s, post: 2.02 ± 0.14 s, p < 0.05, Cohen’s d = 1.02) and 20 m segments (pre: 3.47 ± 0.23 s, post: 3.32 ± 0.20 s, p 0.05). Conclusions. The study highlights the effectiveness of the interval training protocol in enhancing initial acceleration among novice sprinters, although it suggests a limited impact on anaerobic power within the study period. Further research should investigate the longer-term effects and tailored training approaches to optimize comprehensive sprint performance strategies.

In this paper, a concise review of the literature on the effects of beryllium (Be) on aquatic animals, as well as the effect of uptake of Be on the growth of some of the aquatic organisms and plants is compiled when studies are performed in water-based nutrient solutions containing Be. After referring to various important international reports published by different agencies such as the Agency for Toxic Substances and Disease Registry, Environmental Protection Agency, and World Health Organization (WHO), as well as other literature papers available on the topic over last (70–80) years, a compilation of different studies on the effect of toxicity of Be on aquatic animals, organisms, and some plants is reported. Furthermore, information on different limits/levels for the protection of marine and aquatic organisms, as recommended by various international agencies, is included. Based on the studies available in the literature, the reasons behind the establishment of discharge criteria for Be-based effluents are included in the paper. Information on the limits of Be in drinking water, as recommended by various international agencies, are also reported. It is hoped that the compiled information will provide comprehensive details about the effects of Be toxicity on plants, aquatic organisms, etc., and will be useful to researchers worldwide in understanding the toxicology of Be as well as in understanding the reasons behind the selection of 0.10 ppm as the discharge criteria for Be-based effluents adopted previously by countries such as USA, UK, and India. Based on the literature information, it has been argued that the discharge criteria of 0.10 ppm for Be-based waste effluents adopted almost 60 years earlier is still adequate and relevant as adverse effects of Be on aquatic animals, plants, etc., are reported to be at Be concentrations >0.10 ppm or so even for highly sensitive organisms. Be enters the environment mainly through industrial pollution; waste management of Be contaminants is a challenge. The present review also includes the recently reported information on the effective management of Be prevalent in liquid/aqueous media and various studies on behavior of Be in soils, techniques for sorption, and related chemical and physical processes associated.

While the radio-cephalic arterio-venous fistula (RCAVF) remains the procedure of choice for hemodialysis, the value of the ulnar-basilic arterio-venous fistula (UBAVF) is perhaps underappreciated. The challenge of placing the forearm in a suitable and comfortable position for both the surgeon and the patient during the creation of the UBAVF may be an important factor inhibiting its use. We present a new method of hand positioning in the creation of the UBAVF that we have termed the “Royal Wave” position, which facilitates both patient comfort and surgical access intraoperatively. Patients suffering from chronic kidney disease stage -V were operated upon for the creation of UBAVF following the standardized protocol in the Royal Wave position. Patency (by Color Doppler) was recorded before discharge. Patients were clinically followed up for a period of 3 months. A total of five patients (four males) with the age range of 43–66 years were studied. The position was found to be comfortable for patients and suitable for surgeons. All five patients had successful creation of fistulas that remained patent, which was documented by Doppler report prior to discharge. The patients were followed up till 3 months post fistula creation. Thrombosis was not seen in any patient, and the basilic veins arterialized and were used for dialysis in all five patients. This innovation in positioning, the “Royal Wave” position improves the comfort of both the operator and the patient during surgery, and merits consideration when creating a UBAVF.

Abstract We present the formation of a composite film made out of formamidinium lead iodide (FAPI) and molybdenum disulphide quantum dots (MoS2 QDs) and propose a corresponding photovoltaic device architecture based on a ‘type-I’ alignment of the two materials’ electronic energy levels. The introduction of the MoS2 QDs has not compromised the overall crystallinity of the FAPI film and the composite absorber has shown improved stability. We report on the benefits of this composite film and energy band arrangement as the photogenerated carriers in MoS2 QDs, both positive and negative, are injected into the FAPI host matrix, resulting in an increased current density of 24.19 mA cm−2 compared to a current density of 19.83 mA cm−2 for the control device with FAPI only. The corresponding photoconversion efficiency increases from 12.6 to 15.0%. We also show that inclusion of MoS2 QDs in FAPI films resulted in a notable improvement in the fill factor and open-circuit voltage of the solar cells. Most importantly, MoS2 QDs enhanced the film stability by reducing defect formation and acting as passivating agents that minimize recombination losses and improve charge carrier transport. Our results suggest that a composite film in a type-I device architecture can introduce benefits for both future developments in perovskite solar cells and effectively tackling the longstanding challenges of carrier transport in QDs solar cells.

Abstract The activation of the NLRP3 inflammasome has been linked to several inflammatory and autoinflammatory diseases. Despite cases of potential hearing improvement in immune-mediated diseases, direct evidence of the efficacy of targeting this mechanism in the inner ear is still lacking. Previously, we discovered that macrophages are associated with Sensorineural Hearing loss (SNHL) in Chronic Suppurative Otitis Media (CSOM), the leading cause of this permanent hearing loss in the developing world and incurring costs of $4 to $11 billion dollars in the United States. However, the underlying mechanism remained unknown. Here, we investigate how macrophages drive permanent hearing loss in CSOM. We first confirmed the occurrence of NLRP3 inflammasome activation in cochlear macrophages in CSOM. We then revealed that Outer Hair Cells (OHCs) were protected in CSOM by macrophage depletion and subsequently confirmed the same protection in the NLRP3 knockout condition. Furthermore, we showed that therapeutic inhibition of NLRP3 inflammasome activation and downstream inhibition of IL-1β protects OHCs in CSOM. Collectively, our data demonstrates that the main driver for hearing loss in CSOM is NLRP3 inflammasome activation in cochlear macrophages and this is therapeutically targetable, leading the way for the development of interventions to prevent the leading cause of permanent hearing loss and a costly disease in the developed world.

Abstract Here in this study, a novel ternary CuS/HKUST‒1/Ni(acac)2 nano photocatalyst (CSHK‒Ni) was developed through a facile modification of HKUST‒1 MOF with Ni(acac)2 metal complex and by immobilizing CuS into the metal-organic framework (MOF). The incorporation of CuS, a narrow bandgap semiconductor, is anticipated to allow easy excitation by visible-light and improve the photocatalytic potential of the formulated catalyst which is validated by the decrease in the bandgap energy from 3.10 eV of pristine MOF to 2.19 eV. Moreover, the anchoring of the metal complex improves the light harvesting behavior by increased conjugation. Photoluminescence studies provided evidence of the effective separation of the photoinduced charge-carriers, reducing the rate of recombination and enhancing the photocatalytic potential of the CSHK‒Ni nanocomposite. The engineered catalyst displayed remarkable efficiency in the degradation of nitroimidazole containing antibiotics, Tinidazole (TNZ) and Metronidazole (MTZ), via H2O2 assisted AOP achieving a maximum photocatalytic efficiency of 95.87 ± 1.64% and 97.95 ± 1.33% in just 30 min under irradiation of visible light at optimum reaction conditions. The possible degradation pathway was elucidated based on the identification of ROS and degradation intermediates via HR‒LCMS and quenching experiments. Meanwhile, the chemical oxygen demand (COD) and total organic carbon (TOC) removal were also examined, encompassing the discussing of various aspects including reaction conditions, influence of various oxidizing agents, competing species and dissolved organic substrates present in the wastewater, marking the novelty of the study. This research elucidated the role of the CSHK‒Ni nanocomposite as an interesting photocatalyst in the elimination of emerging nitroimidazole containing pharmaceutical pollutant under visible-light exposure, presenting an exciting novel avenue for a cleaner and greener environment in the days to come.

Abstract Background Due to the complex pathophysiological mechanisms involved in cancer progression and metastasis, current therapeutic approaches lack efficacy and have significant adverse effects. Therefore, it is essential to establish novel strategies for combating cancer. Phytochemicals, which possess multiple biological activities, such as antioxidant, anti-inflammatory, antimutagenic, immunomodulatory, antiproliferative, anti-angiogenesis, and antimetastatic properties, can regulate cancer progression and interfere in various stages of cancer development by suppressing various signaling pathways. Methods The current systematic and comprehensive review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, using electronic databases, including PubMed, Scopus, and Science Direct, until the end of December 2023. After excluding unrelated articles, 111 related articles were included in this systematic review. Results In this current review, the major signaling pathways of cancer metabolism are highlighted with the promising anticancer role of phytochemicals. This was through their ability to regulate the AMP-activated protein kinase (AMPK)/peroxisome proliferator-activated receptor-gamma coactivator-1α (PGC-1α) signaling pathway. The AMPK/PGC-1α signaling pathway plays a crucial role in cancer cell metabolism via targeting energy homeostasis and mitochondria biogenesis, glucose oxidation, and fatty acid oxidation, thereby generating ATP for cell growth. As a result, targeting this signaling pathway may represent a novel approach to cancer treatment. Accordingly, alkaloids, phenolic compounds, terpene/terpenoids, and miscellaneous phytochemicals have been introduced as promising anticancer agents by regulating the AMPK/PGC-1α signaling pathway. Novel delivery systems of phytochemicals targeting the AMPK/PGC-1α pathway in combating cancer are also highlighted in this review.

Abstract Background Emergence of coronary giant pseudoaneurysm (PSA) after stent implantation is potentially catastrophic and may end up with life threatening complications if not managed promptly. There is scarcity of data in existing literature with respect to guidelines on the management of coronary PSA following stent implantation. We report the recurrence of coronary PSA following initial percutaneous management of a giant coronary PSA using multiple stent grafts. Case presentation A 38-year-old male who underwent primary angioplasty of the right coronary artery (RCA) about a month back, presented with dull aching precordial chest pain for the last 15 days. A repeat coronary angiography revealed giant coronary PSA in proximal to mid RCA. Considering the significantly large size of the coronary PSA with symptoms of impending rupture, the giant coronary PSA was successfully excluded by implanting three sequentially coronary stent grafts. However, after one and a half months, the patient again presented with a similar kind of dull aching chest pain. We found a recurrence of coronary PSA in a segment of the coronary artery distal to the portion excluded by stent grafts. This recurrent coronary PSA was once again successfully excluded by redeploying two more stent grafts with the help of a guide extension catheter. Conclusions In this case, vessel wall injury as a result of aggressive post dilatation using an oversized balloon during the index procedure was the contributor to the giant coronary PSA formation. It usually appears early after the index procedure (within 4 weeks). Though the usual strategy used to exclude coronary aneurysm is by using the minimal number of stent grafts (due to the inherent increased risk of restenosis/thrombosis in stent grafts) in post angioplasty traumatic aneurysm it is prudent to exclude the entire damaged artery by placing stent grafts to prevent recurrence in segments with even minimal dilatation on initial evaluation.

Retrosplenic colonic interposition is a rare anatomical variant which involves an aberrant positioning of the colon between the spleen and the left hemidiaphragm. Cross-sectional imaging, particularly preoperative computed tomography, plays a critical role in identifying this variant. Recognition of a retrosplenic colonic interposition is essential in certain surgical procedures for ensuring appropriate management tailored to individual patient anatomy and minimizing complications. To our knowledge, this is the first case report describing retrosplenic colonic interposition during colonic resection.

Internal carotid artery hypoplasia is a rare vascular anomaly that can lead to various neurological symptoms due to altered cerebral blood flow. We present a case of a 36 years old female who presented to us with forgetfulness and right sided weakness. She was ultimately diagnosed with bilateral internal carotid artery hypoplasia through imaging studies. This case highlights the importance of considering vascular anomalies in patients presenting with neurological symptoms and the significance of comprehensive diagnostic evaluation for appropriate management.

The use of Prostate Imaging Reporting and Data System (PI-RADS) with multiparametric magnetic resonance imaging (MRI) has significantly improved the detection of clinically significant prostate cancer (csPCa), but there are certain challenges that the reader may face. This review provides an overview of the pitfalls associated with the PI-RADS system for multiparametric prostate MRI (mpMRI), with suggestions/pearls to help overcome these pitfalls.

Prostate cancer remains a significant global health concern, necessitating continuous research and innovation in treatment modalities. This review explores the currently employed techniques in radiation dose planning and tumor irradiation in the context of prostate cancer management. In addition, we delve into the nuances of expected posttreatment magnetic resonance imaging (MRI) appearances within the gland or in the prostate bed, postradiation tumor recurrence, and its mimics.

Congenital diaphragmatic malformations include congenital diaphragmatic hernia (CDH) and eventration of the diaphragm. The clinical presentation is variable, and the prognosis depends on multiple factors. The coexistence of CDH and diaphragmatic eventration in the same patient is extremely unusual and has not been reported previously in the literature. We report this rare association in a 3-month-old male infant who was managed successfully by minimally invasive approach.

Background and Aims: None of the clinical difficult airway predictors are 100% sensitive and specific. Ultrasound is being used for airway assessment, but there is still no established parameters or model to predict difficult laryngoscopy. This observational study was planned to determine the predictive ability of clinical and sonography-based airway assessment parameters for difficult laryngoscopy and intubation. Material and Methods: A total of 130 patients of 18–60 years of age undergoing elective intubation were included. The distribution of Cormack–Lehane (CL) grade and intubation difficulty scale (IDS) was correlated with the clinical and sonographic screening parameters for difficult airways. Results: The prevalence of difficult laryngoscopy and difficult intubation in our study was 17.6% and 11.5%, respectively. Mallampati grade (MMG), upper lip bite test (ULBT), neck circumference, hyomental distance ratio (HMDR), tongue thickness (TT), skin to epiglottis/epiglottis to vocal cord distance (SED/E-VC), and mandibular condylar mobility (MCM) had significant association with the difficult laryngoscopy and MMG, neck circumference, SED, SED/E-VC; MCM had significant association with the difficult intubation. The combination of these predictors showed better diagnostic ability for difficult airways. Model 1 based on ultrasound parameters showed an area under the curve (AUC) of 0.848 (CI- 0.748-0.947, P value < 0.0001) and model 2 based on combined clinical and ultrasound parameters showed an AUC of 0.755 (95% CI- 0.631-0.879, P value < 0.0001). Conclusions: Ultrasound-based airway predictors can help in predicting difficult laryngoscopy and intubation along with the clinical parameters. Individual sonographic predictors have moderately satisfactory diagnostic profiles. The models based on combined tests have better diagnostic value.

Background and Aims: Preoperative parental anxiety can have a profound impact on their children undergoing surgery. The present study was done to analyse the correlation between preoperative parental anxiety and their child’s anxiety in paediatric patients undergoing elective surgery. Methods: Paediatric patients aged 2–12 years, scheduled for elective surgeries under general anaesthesia, were included in the study. The child’s behaviour and anxiety were assessed in the preoperative area using the modified Yale Preoperative Anxiety Scale (m-YPAS). The parent filled out the demographic questionnaire and the Spielberger State–Trait Anxiety Inventory (STAI) form in the preoperative area on the day of surgery. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) statistics software version 23.0 (IBM Corp, Armonk, NY, USA). Results: A total of 150 children undergoing elective surgery were analysed. Our results showed a strong positive correlation between a child’s m-YPAS and his/her parents’ anxiety on the day of the surgery (STAI-state) (r = 0.545, P < 0.001). However, the correlation between a child’s m-YPAS and his/her parents’ anxiety levels (STAI-trait) was not found to be significant (r = 0.109, P = 0.188). A positive correlation was observed between a parent’s STAI-state and STAI-trait (r = 0.366, P < 0.001). Factors like area of residence, type of surgery and previous hospitalisation had an influence on the anxiety levels of the child. The birth order of the child, previous hospitalisation and gender of the parent also influenced parental anxiety. Conclusion: Parental anxiety has a significant impact on the child’s anxiety during the preoperative period.

Abstract Ontologies and terminologies serve as the backbone of knowledge representation in biomedical domains, facilitating data integration, interoperability, and semantic understanding across diverse applications. However, the quality assurance and enrichment of these resources remain an ongoing challenge due to the dynamic nature of biomedical knowledge. In this editorial, we provide an introductory summary of seven articles included in this special supplement issue for quality assurance and enrichment of biological and biomedical ontologies and terminologies. These articles span a spectrum of topics, such as development of automated quality assessment frameworks for Resource Description Framework (RDF) resources, identification of missing concepts in SNOMED CT through logical definitions, and developing a COVID interface terminology to enable automatic annotations of COVID-19 related Electronic Health Records (EHRs). Collectively, these contributions underscore the ongoing efforts to improve the accuracy, consistency, and interoperability of biomedical ontologies and terminologies, thus advancing their pivotal role in healthcare and biomedical research.

Abstract With an aging population and an increase in chronic sickness, healthcare systems are under increasing pressure. Internet of Things (IoT) technology has recently garnered a lot of interest for its ability to alleviate this burden. The IoT is a network of interconnected wireless digital devices that can gather, transmit, and store data automatically, without the need for human or computer intervention. In order to better anticipate health problems, diagnose, treat, and monitor patients in and out of the hospital, the IoT offers numerous advantages that could streamline and improve health care delivery. As a matter of urgency, decision-makers and heads of state around the world are enacting policies to provide healthcare services through the use of technology. Thanks to recent advancements in the IoT, healthcare has been able to evolve at a rapid pace. Research on Internet IoT uses in healthcare and newly developed emergency equipment are summarized in this article.

Background The normative data for finger range of motion (ROM) are not available for the Indian population. The aim of our study was to measure the active ROM of finger joints in normal healthy volunteers in a sample of Indian population.

Objective Medulloblastoma is the most common central nervous system embryonal tumor and the most common malignant brain tumor of childhood. This study aims to find out the incidence of the ABO-Rh blood group in medulloblastoma patients of northern India to assess the utility of the blood group as a preclinical non-modifiable risk factor.

Accurate identification of prostate cancer Gleason grade group remains an important component of the initial management of clinically localized disease. However, Gleason score upgrading (GSU) from biopsy to radical prostatectomy can occur in up to a third of patients treated with surgery. Concern for disease undergrading remains a source of diagnostic uncertainty, contributing to both over-treatment of low-risk disease as well as under-treatment of higher-risk prostate cancer. This review examines the published literature concerning risk factors for GSU from time of biopsy to prostatectomy final pathology. Risk factors identified for Gleason upgrading include patient demographic and clinical factors including age, body mass index, race, prostate volume, and biomarker based assays, including prostate-specific antigen (PSA) density, and testosterone values. In addition, prostate magnetic resonance imaging (MRI) findings have also been associated with GSU. Biopsy-specific characteristics associated with GSU include lower number of biopsy cores and lack of targeted methodology, and possibly increasing percent biopsy core positivity. Recognition of risk factors for disease undergrading may prompt confirmatory testing including repeat sampling or imaging. Continued refinements in imaging guided biopsy techniques may also reduce sampling error contributing to undergrading.

Objective: To assess efficacy of albendazole against Ascaris (A.) lumbrìcoides among school-children at three sites of Rajahmundry, Sundergarh and Wayanad. Methods: Sites were selected based on soil-transmitted helminths prevalence, different sociocultural-geographical characteristics and operational feasibility. 9-12 Years old children from 14 schools were included. The study was conducted in two rounds: baseline & follow up survey. All eligible children found positive for A. lumbricoides at baseline were administered supervised single tablet albendazole 400 mg under the National Deworming Day Initiative. During post-treatment follow-up survey, eligible children who provided second stool sample were included in the final analysis. Stool samples were examined using WHO recommended Kato-Katz technique. Efficacy was estimated based on cure rate (CR) and Fecal Egg Count Reduction Rate (FECRR) among children found positive in baseline and follow-up surveys. Results: 328 Out of 625 (52.5%) were found positive for A. lumbricoides in the baseline survey and 85 out of 178 samples (47.8%) during post-treatment follow-up survey. Overall, the estimated CR was 52.2%. FECRR (95% CI) for albendazole was 72.6% (79.2%-66.0%). The FECRR was highest in East Godaveri [89.7% (96.8%-82.6%)], followed by Sundergarh [86.4% (95.3%-77.5%)] and Wayanad [69% (81.7%-56.4%)]. Conclusions: Our study confirmed overall reduction in FEC although with varying albendazole efficacy for A. lumbricoides infection at three different locations in India. However, these finding may be assessed in context of ongoing MDA under Filaria control program and further studies by in vivo as well as in vitro methods are required to reach to a conclusion on possible resistance if any.

Abstract We investigate the effect on neutrino oscillations generated by beyond-the-standard-model interactions between neutrinos and matter. Specifically, we focus on scalar-mediated non-standard interactions (NSI) whose impact fundamentally differs from that of vector-mediated NSI. Scalar NSI contribute as corrections to the neutrino mass matrix rather than the matter potential and thereby predict distinct phenomenology from the vector-mediated ones. Similar to vector-type NSI, the presence of scalar-mediated neutrino NSI can influence measurements of oscillation parameters in long-baseline neutrino oscillation experiments, with a notable impact on CP measurement in the case of DUNE. Our study focuses on the effect of scalar NSI on neutrino oscillations, using DUNE as an example. We introduce a model-independent parameterization procedure that enables the examination of the impact of all non-zero scalar NSI parameters simultaneously. Subsequently, we convert DUNE’s sensitivity to the NSI parameters into projected sensitivity concerning the parameters of a light scalar model. We compare these results with existing non-oscillation probes. Our findings reveal that the region of the light scalar parameter space sensitive to DUNE is predominantly excluded by non-oscillation probes, especially when considering all nonzero parameters simultaneously for DUNE.

Abstract Workplace mental health challenges have emerged as a significant concern post-pandemic. Despite this, the pervasive stigma surrounding mental illness leads to the concealment of symptoms and reluctance to seek professional help among employees. This study aims to explore the perception of different stakeholders towards the ‘Detection and disclosure’ of workplace mental health challenges in the Indian context. Fifteen semi-structured interviews were conducted with human resource professionals, counselors, and employees who had previously experienced mental health challenge(s). Thematic analysis was done to identify recurring themes and sub-themes. Three critical pathways were identified: minimizing the inhibitory factors, including lack of awareness, denial, low self-efficacy, stigma, and underestimating organizational capability; maximizing the encouraging factors, including psychological safety, perceived social support, and communicating success stories; and implementing supportive organizational practices, including generating awareness and literacy, build the organizational capability, strengthen the role of managers, leadership advocacy, policies, and processes. By fostering a culture of support and prioritizing employee well-being, organizations in India can create healthier and more resilient work environments, benefiting both individuals and the larger society.

Abstract Objectives We aim to compare efficacy and safety of water vapour therapy (Rezūm), transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT) for treating men with moderate to severe benign prostatic hyperplasia (BPH) symptoms. Materials PubMed/MEDLINE, EMBASE and Cochrane Library were searched from inception to 30 July 2023, followed by reference searching and dual‐independent study selection. We analysed only randomized clinical trials. RoB‐2, NIH‐quality assessment tool and GRADE guidelines were used for quality‐of‐evidence (QoE) assessment. Relevant prospective studies without a critical risk‐of‐bias were included. Results At 12 months, Rezūm showed similar efficacy to TUNA and TUMT for improvement in International Prostate Symptoms Score – Rezūm versus TUMT: 1.33 points (95% CI: −1.66 to 4.35) favouring TUMT (QoE: Moderate) and Rezūm versus TUNA: 0.07 points (95% CI: −3.64 to 3.88) favouring TUNA (QoE: Low). Rezum had similar outcomes to TUNA and TUMT for Maximum Peak‐Flow Rate (Qmax): Rezūm versus TUMT: 1.05 mL/s (95% CI: −4.88 to 2.82) favouring Rezūm (QoE: Low) and Rezūm versus TUNA: 0.37 mL/s (95% CI: −4.61 to 4.21) favouring TUNA (QoE: Low). Furthermore, post‐void residual volume (PVR) comparisons demonstrated that Rezūm was similar, or inferior to other techniques at 12 months – Rezūm versus TUMT: 11.20 mL (95% CI: −32.40 to 10.30) favouring TUMT (QoE: Low) and Rezūm versus TUNA: 24.10 mL (95% CI: 2.81 to 45.10) favouring TUNA (QoE: Low). Rezūm also had a similar surgical retreatment rate with TUMT and TUNA up to 3‐years – TUMT versus Rezūm RR: 1.21 (95% CI: 0.20 to 15.90) (QoE: Low) and TUNA versus Rezūm showed RR: 1.81 (95% CI: 0.2 to 24.60) (QoE: Low). In the first 12 months after treatment, Rezūm had a higher rate of serious adverse events (Clavien‐Dindo ≥ Grade 3) than TUMT and TUNA. TUMT versus Rezūm with RR = 0.53 (95% CI: 0.13 to 3.14) (QoE: Low) and TUNA versus Rezūm with RR = 0.38 (95% CI: 0.04 to 3.49) (QoE: Low). Conclusions Moderate to weak evidence suggests that Rezūm is not superior to TUNA and TUMT in all domains studied.

Abstract Background Normal saline (NS) infusion in large volumes may result in hyperchloremic metabolic acidosis and renal compromise. Balanced crystalloid (BC) with physiochemical composition akin to that of plasma may avoid these problems associated with NS. The present study aimed to evaluate effects of NS versus BC on acid–base balance and renal functions in patients undergoing intracranial tumor resection surgeries. Methods Fifty adult patients scheduled to undergo elective neurosurgery for intracranial tumor resection were randomized to receive either NS or BC as intraoperative or maintenance fluid. Metabolic and renal parameters were estimated prior to induction (baseline), at 1 h and 2 h after induction, at the end of surgery and 4 h after extubation. Serum neutrophil gelatinase-associated lipocalin (NGAL) was measured postoperatively. Brain relaxation score was assessed by the operating surgeon. Results Baseline values of variables were similar between the groups. At rest of the observed time-points, pH was significantly lower, while blood urea, serum creatinine, sodium, chloride, NGAL and plasma osmolality were significantly higher in the NS group as compared to the BC group. Brain relaxation score, serum bicarbonate and base excess were comparable between the two groups. Conclusion Use of balanced crystalloid (plasmalyte) resulted in better metabolic and renal profile as compared to normal saline in neurosurgical patients.

Abstract This study investigates the use of carbonized Himalayan Chir Pine Biomass, known as Chir Pine Activated Carbon (CPAC), as an eco-friendly and cost-effective adsorbent for efficient industrial dye removal, with a focus on environmental sustainability. By applying different additive treatments, four adsorbents (C1, C2, C3, and C4) were formulated. CPAC was synthesized through pyrolysis and characterized using various analytical techniques including FE-SEM, X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and differential scanning calorimetry (DSC). The adsorption capacity of CPAC was evaluated using Malachite Green (MG) dye as a model contaminant. FE-SEM images revealed high porosity (~ 10 µm) and a high surface area (119.886 m2/g) as confirmed by BET testing. CPAC effectively removed MG dye within 30 min at a solution pH of 7. Langmuir and Freundlich isotherm models indicated both monolayer and multilayer adsorption, while kinetic models suggested chemisorption. The regeneration efficiency was assessed using 0.1 N HCl over five consecutive cycles, with C4 demonstrating a high regeneration tendency of 85% and only a 9% reduction in adsorption ability after the fifth cycle. The developed CPAC shows excellent potential for use in the textile, paper, and leather industries for industrial dye adsorption, contributing to the protection of aquatic ecosystems. Additionally, CPAC can be utilized in other water and air purification applications.

When repairing facial wounds, it is crucial to possess a thorough understanding of suitable suture materials and their evidence base. The absence of high-quality and comprehensive systematic reviews poses challenges in making informed decisions. In this study, we conducted a review of the existing literature and assessed the quality of the current evidence pertaining to the clinical, aesthetic, and patient-reported outcomes associated with absorbable and nonabsorbable sutures for facial skin closure.

Background: Subclinical involvement of nerves may sometimes be present much before the overt clinical manifestations become apparent. Protein gene product (PGP) 9.5, a ubiquitin-C-terminal hydrolase, has been widely used as a marker to study the involvement of peripheral nerve fibers in many diseases. Aim and Objectives: To evaluate the change in cutaneous nerve fiber staining and distribution from pre-treatment and post completion of multidrug therapy through the expression of PGP9.5 and to assess PGP9.5 as a marker of treatment response. Materials and Methods: In this prospective single-center observational study, skin biopsy was taken in patients with leprosy, having areas of nerve function impairment (NFI), based on findings of nerve conduction studies (NCSs), but not having lesions or impaired tactile or thermal impairment clinically. The thin nerve fiber density in the clinically normal skin in areas supplied by nerve showing changes of sensory neuropathy was evaluated to study the density of the fibers. A second biopsy was taken at the end of treatment from a site near the previous site to assess the changes in intra-epidermal nerve fiber staining and distribution. Results: Thirty-three patients were recruited in the present study (24 males and 9 females). Pre-treatment, 27 patients had abnormal NCSs, while six patients did not have any evidence of neuropathy on NCSs. Staining for nerve fibers using PGP9.5; in the epidermis was positive in five patients pre-treatment and 11 patients post treatment (P = 0.181). Staining in the dermis revealed positivity in 14 pre-treatment, which increased to 18 post treatment (P = 0.342). Adnexae showed positivity in five patients pre-treatment and increased to 17 post treatment (P = 0.005). Conclusion: A reduced PGP9.5 staining in the epidermal, dermal, and adnexal regions was seen in leprosy patients, which improved post treatment. Thus, PGP9.5 may serve as a marker of NFI and treatment response.

Objective We hypothesized that the administration of amantadine would increase awakening of comatose patients resuscitated from cardiac arrest. Methods We performed a prospective, randomized, controlled pilot trial, randomizing subjects to amantadine 100 mg twice daily or placebo for up to 7 days. The study drug was administered between 72 and 120 hours after resuscitation and patients with absent N20 cortical responses, early cerebral edema, or ongoing malignant electroencephalography patterns were excluded. Our primary outcome was awakening, defined as following two-step commands, within 28 days of cardiac arrest. Secondary outcomes included length of stay, awakening, time to awakening, and neurologic outcome measured by Cerebral Performance Category at hospital discharge. We compared the proportion of subjects awakening and hospital survival using Fisher exact tests and time to awakening and hospital length of stay using Wilcoxon rank sum tests. Results After 2 years, we stopped the study due to slow enrollment and lapse of funding. We enrolled 14 subjects (12% of goal enrollment), seven in the amantadine group and seven in the placebo group. The proportion of patients who awakened within 28 days after cardiac arrest did not differ between amantadine (n=2, 28.6%) and placebo groups (n=3, 42.9%; P>0.99). There were no differences in secondary outcomes. Study medication was stopped in three subjects (21.4%). Adverse events included a recurrence of seizures (n=2; 14.3%), both of which occurred in the placebo group. Conclusion We could not determine the effect of amantadine on awakening in comatose survivors of cardiac arrest due to small sample size.

Artificial intelligence is an ever-growing modality revolutionizing the field of medical science. It utilizes various computational models and algorithms and helps out in different sectors of healthcare. Here, in this scoping review, we are trying to evaluate the use of Artificial intelligence (AI) in the field of pediatric anesthesia, specifically in the more challenging domain, the pediatric airway. Different components within the domain of AI include machine learning, neural networks, deep learning, robotics, and computer vision. Electronic databases like Google Scholar, Cochrane databases, and Pubmed were searched. Different studies had heterogeneity of age groups, so all studies with children under 18 years of age were included and assessed. The use of AI was reviewed in the preoperative, intraoperative, and postoperative domains of pediatric anesthesia. The applicability of AI needs to be supplemented by clinical judgment for the final anticipation in various fields of medicine.

Abstract Natural killer (NK) cells play a key role in defense against Salmonella infections during the early phase of infection. Our previous work showed that the excretory/secretory products of Ascaris suum repressed NK activity in vitro. Here, we asked if NK cell functionality was influenced in domestic pigs during coinfection with Ascaris and Salmonella enterica serotype Typhimurium. Ascaris coinfection completely abolished the IL-12 and IL-18 driven elevation of IFN-γ production seen in CD16 + CD8α + perforin + NK cells of Salmonella single-infected pigs. Furthermore, Ascaris coinfection prohibited the Salmonella-driven rise in NK perforin levels and CD107a surface expression. In line with impaired effector functions, NK cells from Ascaris-single and coinfected pigs displayed elevated expression of the inhibitory KLRA1 and NKG2A receptors genes, contrasting with the higher expression of the activating NKp46 and NKp30 receptors in NK cells during Salmonella single infection. These differences were accompanied by the highly significant upregulation of T-bet protein expression in NK cells from Ascaris-single and Ascaris/Salmonella coinfected pigs. Together, our data strongly indicate a profound repression of NK functionality by an Ascaris infection which may hinder infected individuals from adequately responding to a concurrent bacterial infection.

Abstract The selection of drought-tolerant genotypes from the existing gene pool is a preliminary step for breeding for drought tolerance. Research efforts aimed at exploring the ability of crops to withstand drought stress have not yet touched the realm of reproductive drought performance of local genotypes. To examine how local crop accessions demonstrate varying reproductive performance under drought conditions, twenty accessions of maize (Zea mays L.) were evaluated for six quantitative traits in a two-factor factorial completely randomized design with two replications between February to June of 2023. All the traits under study showed significant differences among the genotypes (p

Abstract The quanta of scalar fields like the dilaton ( $$\phi $$ ϕ ) of scale symmetry origin and those of pseudoscalar fields like the axion ( $$\phi '$$ ϕ ′ ) of Peccei–Quinn symmetry origin couple to di-photons through dimension-5 operators. In a magnetized medium (MM), they in principle can interact with the two transverse ( $$A_{\parallel ,\perp }$$ A ‖ , ⊥ ) and one longitudinal ( $$A_{L}$$ A L ) degree of freedom of photons ( $$\gamma $$ γ ) as long as the total spin is conserved. However, of $$\phi $$ ϕ and $$\phi '$$ ϕ ′ , only one interacts with $$A_{L}$$ A L . We found that the ambient external magnetic field B and media break the intrinsic Lorentz symmetry of the system affecting the dispersion relation of the propagating modes. The boost and the rotational symmetry along and around B are however the ones that are preserved. Invoking C, P, and T symmetries, we analyze the mixing dynamics of $$\phi \gamma $$ ϕ γ and $$\phi '\gamma $$ ϕ ′ γ systems and the structural difference in their mixing pattern. It is noted that while the $$\phi \gamma $$ ϕ γ mixing matrix is $$3\times 3$$ 3 × 3 , the $$\phi ^{\prime }\gamma $$ ϕ ′ γ is governed by a $$4\times 4$$ 4 × 4 mixing matrix. Using the exact solutions of both systems in MM, we estimate the strength of the electromagnetic (EM) signals available due to these interactions, which are found to be different in strength. We conclude by commenting on (a) the possibility of detecting this difference in polarimetric observables of the EM signal, (b) the implications of these different mixing patterns with respect to the minimum detectable signal for astrophysical observations, and (c) the variation in the energy of the dispersed photons of different polarization with the variation in B.

3D printing has emerged as a highly efficient process for fabricating electrodes in hydrogen evolution through water splitting, whereas metals are the most popular choice of materials in hydrogen evolution reactions (HER) due to their catalytic activity. However Current 3D printing solutions face challenges, including high cost, low surface area, and sub-optimal performance. In this work, we introduce metal-deposited 3D printed pyrolytic carbon (PyC) as a facile and cost-effective HER electrode. We adopt an integrated approach of resin 3D printing, pyrolysis, and electrochemical metal deposition. 3D printing of a resin and its subsequent pyrolysis led to 3D complex architectures of the conductive substrate, facilitating the electrochemical metal deposition and leading to layered 3D metal architecture. Both monolayers of metals (such as copper and nickel), and bi-metallic 3D PyC structures are demonstrated. Each metal layer thickness ranges from 6 to10 µm. The metal coatings, particularly the bi-metallic configurations, result in achieving significantly higher mechanical properties under compressive loading and improved electrical properties due to the synergistic contributions from each metal counterpart. The metalized PyC structures are further demonstrated for HER catalysts, contributing to developing highly efficient and durable catalyst systems for hydrogen production. Among the materials studied here, Ni@Cu bimetallic 3D PyC electrodes are particularly well-suited, demonstrating low HER overpotential value 264 mV (100 mA/cm2, KOH (1 M)) with corresponding Tafel slopes of 107 mV/dec, with exceptional stability during a 10 h operation at a high applied current of -50 mA/cm2.

Key Clinical Message Early recognition and management of familial hypercholesterolemia (FH) are crucial, especially in patients with extensive xanthomas and premature coronary artery disease. Prompt diagnosis and aggressive lipid‐lowering therapy can significantly reduce morbidity and mortality rates. Careful clinical assessment in resource‐limited settings is essential for optimal outcomes. Abstract Familial hypercholesterolemia (FH) is an autosomal dominant inherited disorder that causes chronically elevated levels of low‐density lipoprotein (LDL) cholesterol. Based on LDL levels, FH can be heterozygous or homozygous, further established through clinical features, laboratory findings, and genetic analysis. Elevated cholesterol levels cause atherosclerosis, coronary artery disease, myocardial infarction, and sudden death. Xanthomas are a clinical manifestation of FH that reveal the underlying systemic genetic disease. We present the case of a 47‐year‐old male with triple vessel coronary artery disease and widespread xanthomas, diagnosed with homozygous FH based on “The Dutch Lipid Clinic Network Diagnostic Criteria for Familial Hypercholesterolemia.” Lifelong therapy with lipid‐lowering medications and lifestyle changes is necessary in such cases.

Objectives This study aims to determine the usage pattern, effectiveness and safety of oral tramadol 75 mg and dexketoprofen trometamol 25 mg fixed-dose combination (TRAM/DKP FDC) in the short-term treatment of moderate-to-severe acute pain in real-world clinical practice in Asia.Design Real-world, prospective, multicentre, observational, phase IV study.Setting 13 tertiary-care hospital sites across the Philippines, Thailand, Malaysia and Singapore.Participants Adult patients aged 18–80 years prescribed TRAM/DKP FDC for the short-term (up to 5 days) treatment of moderate-to-severe acute pain.Main outcome measures Primary endpoints were the proportion of patients prescribed TRAM/DKP FDC with different types of postsurgical and non-surgical treatments, and the average dosing frequency and duration of TRAM/DKP FDC treatment. Secondary endpoints were the proportion of patients achieving ≥30% pain reduction at 8 hours post the first dose (pain severity was assessed using the 11-point Numeric Pain Rating Scale); patient satisfaction at the end of treatment (based on a 5-point Patient Global Evaluation Scale (PGE)) and safety including the incidence of adverse drug reactions (ADRs).Results Among 599 patients (median age 44 years, 61.3% female) enrolled in this study, 68.61% (n=411) were postsurgical and 31.39% (n=188) were non-surgical patients. TRAM/DKP FDC was prescribed in a diverse group of postsurgical patients (eg, orthopaedic, general and cancer surgery) as well as in non-surgical conditions (eg, lower back pain and musculoskeletal pain). In the majority of patients, TRAM/DKP FDC was prescribed every 8 hours (65.94%) and for 5 days (78.80%). There was a significant reduction in pain intensity throughout the study and 65% of patients achieved ≥30% pain reduction from baseline at 8 hours post the first dose of TRAM/DKP FDC on day 1. 95.69% of patients were satisfied with the treatment (rated good, very good and excellent on the PGE scale). Overall, 13.9% of patients reported ADRs; most were mild to moderate in severity. The most common ADRs were nausea, vomiting and dizziness.Conclusion This study showed that TRAM/DKP FDC was used in diverse types of postsurgical and non-surgical patients in the real-world setting in Asia. It effectively reduced pain and was well tolerated with a high level of patient satisfaction.