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Abstract: Variances in global access to drugs and treatment practices make it challenging to understand the benefit of contemporary therapies in patients with relapsed and refractory (R/R) mature T-cell and natural killer–cell lymphomas (MTCL and MNKCL). We conducted an international retrospective cohort study of 925 patients with R/R MTCL and MNKCL. In peripheral T-cell lymphoma–not otherwise specified and anaplastic lymphoma kinase–negative anaplastic large cell lymphoma (ALK– ALCL), patients with relapsed lymphoma demonstrated a superior median overall survival (OS) relative to refractory from the time of second-line treatment. We identified several independent predictors of OS for R/R lymphoma including age >60 years, primary refractory disease, histological subtype other than angioimmunoblastic T-cell lymphoma (AITL), extranodal sites >1, Ki67 ≥40%, and absolute lymphocyte count less than the lower limit of normal. A multivariable model incorporating these formed the basis for a prognostic index for R/R TCL, in which patients are stratified into low-risk (0-1 risk factor), intermediate-risk (2-3 risk factors), or high-risk (≥4 risk factors) groups, which were associated with 3-year OS of 57.14%, 23.3%, and 7%, respectively. Patients received either a ''novel'' single agent (SA; 35%) or cytotoxic chemotherapy (CC; 60%) for their second-line treatment. Higher progression-free survival was observed with SA over CC for the entire cohort with a higher 3-year OS in AITL and ALK– ALCL. Among the SA, small-molecule inhibitors demonstrated OS advantage relative to CC in AITL. Our results highlight continued efficacy of novel drugs globally and the potential of a new prediction model in informing heterogeneous prognosis within the R/R population of MTCL and MNKCL.

Purpose: This study examines the influence of social media use among orthopedic and plastic-trained hand surgeons on patient-reported ratings online and academic productivity. Methods: The American Society of Surgery of the Hand directory was queried for actively practicing orthopedic and plastic surgeons with a hand surgery fellowship. Each name was searched on various social media platforms. Average ratings, number of reviews, and number of comments were collected from Healthgrades, Google reviews, and Vitals. H-index was searched on Scopus. A summated social media presence score was calculated to identify the top 20% of social media users in each cohort. Results: A total of 97 orthopedic and 102 plastic surgeons were included. Overall, plastic surgeons were more active on social media compared to orthopedic surgeons. There was a positive association between having active profiles and Healthgrades ratings. When looking within the subgroups, the top 20% of social media orthopedic users were found to have a significantly higher mean Healthgrades rating and a mean number of comments than the rest of the cohort. On Vitals, the top 20% of social media users had higher mean ratings compared to the remaining 80%. The top 20% of plastics social media users had a significantly higher average Healthgrades rating compared to the rest of the plastics group. On Google reviews, the top 20% also had higher mean ratings, as well as mean number of ratings, compared to the rest of the cohort. Plastic surgeons with a Twitter/X account had a significantly higher h-index than plastic surgeons without a Twitter/X account (14.5 vs 9.2, P < .05). Conclusions: Social media involvement is positively associated with surgeon ratings and the number of reviews and comments on physician rating websites. Using web-based marketing tools is still rare in hand surgery, especially among orthopedic surgeons. Type of study/level of evidence: Economic/decision analysis IV.

ABSTRACT: This study aimed to determine the prevalence of antimicrobial resistance (AMR) in commensal Escherichia coli from healthy lactating cows and calves in the Mediterranean pasture-based feeding dairy system of Western Australia (WA). Fecal samples were collected from healthy adult lactating cows and healthy calves from dairy farms in WA. Presumptive commensal E. coli was isolated from these samples and confirmed using matrix-assisted laser-desorption/ionization time-of-flight mass spectrometry. Broth microdilution was used to assess the prevalence and the phenotypic AMR profiles of the E. coli isolates to 8 antimicrobial agents of dairy industry and human importance. The minimum inhibitory concentration for each isolate was interpreted using the epidemiologic cutoff (ECOFF) and Clinical and Laboratory Standards Institute breakpoints. Genomic characterization provided multilocus sequence types and AMR genes for a selection of isolates categorized as nonwild type (NWT) by ECOFF values for the combination of ampicillin, trimethoprim-sulfamethoxazole, and tetracycline. From a total of 1,117 fecal samples (633 adult, 484 calf) collected across 26 randomly selected farms, 891 commensal E. coli isolates were recovered (541 adult, 350 calf). Commensal E. coli classified as NWT was highest for ampicillin for both adult (68.8%; 95% CI [64.7, 72.7]) and calf feces (67.1%; 95% CI [62.0, 72.0]). A large proportion of tetracycline NWT and trimethoprim-sulfamethoxazole NWT organisms were also identified from calf feces, being 44.0% (95% CI [38.7, 49.4]) and 24.6% (95% CI [20.2, 29.4]), respectively. Clinical resistance prevalence was low, being higher for calves than for adult feces for ampicillin (adult: 7.8%, 95% CI [5.7, 10.3]; calf: 30.0%, 95% CI [25.2, 35.1]), tetracycline (adult: 6.3%, 95% CI [4.4, 8.7]; calf: 40.3%, 95% CI [35.1, 45.6]), and trimethoprim-sulfamethoxazole (adult: 2.6%, 95% CI [1.4, 4.3]; calf: 22.0%, 95% CI [17.7, 26.7]). Commensal E. coli originating from calf feces was significantly higher in NWT prevalence compared with adult feces for ciprofloxacin, gentamicin, tetracycline, and trimethoprim-sulfamethoxazole. The overall number of antimicrobials an isolate was classified as NWT toward varied among farms and was significantly higher for isolates originating from calf rather than adult feces. The strain type and sampling source of the commensal E. coli investigated were both associated with the commonality of the resultant resistance genome. Clinical resistance and NWT classification were highest for ampicillin, tetracycline, and trimethoprim-sulfamethoxazole, all antimicrobials commonly used in the treatment of dairy cattle in Australia. Although highly variable across farms, commensal E. coli isolated from healthy dairy calf feces had significantly higher NWT and multidrug resistance (MDR) prevalence compared with feces from healthy adult lactating dairy cows. The resistant genome identified in MDR isolates, although not always consistent with the phenotype, included QnrS1 and genes encoding AmpC β-lactamase and aminoglycoside phosphotransferase.

BACKGROUND: Cysticercosis is a parasitic disease caused by the larval form of Taenia solium (pig tapeworm). It most commonly affects the human nervous system. Isolated involvement of the muscle is rare and only sporadic case reports are available. THE CASE: A 49-year-old male presented with pain and swelling in the right lateral infraclavicular area for 2 weeks. The swelling was well defined, 2×1.5 cm in size, firm on palpation and immobile. It was non fluctuant and non-reducible with no tenderness or overlying skin changes. There was no other swelling on the body. The patient complained of mild pain on movement of the right arm especially on overhead abduction but without any neurological involvement. There was no history of fever, cough or any recent sick contacts. There was a history of neurocysticercosis in the past. Rest of the physical examination and laboratory results were within normal limits. Ultrasonography showed a cyst with an echogenic scolex and an inflammatory mass surrounding it. Magnetic resonance imaging showed a 15×10×9mm cystic mass in the right pectoralis major muscle, accompanied by scolex, muscular oedema, and subcutaneous oedema. The patient refused surgical intervention. He was started on albendazole for two weeks to expedite cyst involution and corticosteroids to minimize inflammation around the lesion. Steroids were stopped after two weeks and Albendazole was continued for three months. The patient showed complete resolution of the swelling after 3 months. This case highlights the need of investigating intramuscular cysticercosis as a possible diagnosis for individuals with a single intramuscular or subcutaneous mass. Early suspicion of cysticercosis especially in endemic areas is important, to distinguish it from various similar conditions. CONCLUSION: The diagnosis of intramuscular cysticercosis is frequently delayed or overlooked due to vague clinical symptoms. Clinically, the diagnosis of intramuscular cysticercosis might be problematic because there are various clinical differentials, including epidermoid cysts, lipoma, sarcoma, neuroma, neurofibromas, cold abscess, and pyomyositis. Therefore, radiological evaluation is at times the only diagnostic modality especially when patient refuses surgical intervention.

The current review intends to summarize the bioactive components, nutritional profile, phytopharmaceutical properties, mechanism of action, and functional food aspects of Hygrophila auriculata. It was traditionally used to prepare ancient Indian ayurvedic medicines for treating chronic disorders. Indeed, the plant is a copious source of bioactive compounds like quercetin, ellagic acid, gallic acid, betulin, lupeol, and stigmasterol. The plant is also abundant in sodium, potassium, iron, fiber, vitamin C, and β-carotene. The bioactive compounds are linked to phytopharmaceutical properties like antioxidant, cardioprotective, anti-diabetic, diuretic, hepatoprotective, androgenic, haematinic, anti-cancer, anti-inflammatory, etc. However, more research is still needed to connect existing literature with contemporary pharmacology. The plant holds a promising future in functional food development and bio-packaging. Future research should also focus on isolating bioactive compounds from numerous parts of the plant and analyzing the mechanisms of action of such compounds.

Asthma is a heterogeneous disease characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and intensity, together with variable expiratory airflow limitation. A personal history or a family history of allergy is the factor most strongly associated with the development of asthma. Our primary aim was to investigate interleukin-4 receptor α (IL-4Rα) polymorphism to determine whether the presence of the R576 IL-4Rα allele was associated with asthma and whether the presence of the R576 allele influenced the severity of asthma in affected individuals. The data obtained indicated asthmatic patients were characterized by a higher prevalence of positive family history of asthma (p

Osmotic dehydration (OD) is a sustainable alternative, offering reduced energy consumption compared to traditional drying approaches. This study investigates the role of OD in stabilizing bioactive compounds in lemon peel, fostering sustainable citrus by-product applications. Employing Response Surface Methodology (RSM) framework, pivotal variables—temperature (30–60 °C), exposure time (60–180 min), and sucrose concentration (50–70°Brix)—were optimized to enhance water loss (WL) and solid gain (SG) while safeguarding bioactive retention. The optimal conditions (58.92 °C, 70°Brix, 159 min) yielded a WL of 3.4 g/g, SG of 1.5 g/g, and high sensory acceptability. The OD treated lemon peel powder exhibited substantial retention of bioactive compounds, including ascorbic acid (4.1 mg/g) and total phenols (2.3 mg gallic acid/g), surpassing untreated controls. This enhanced bioactive profile underscores its potential as a sustainable and functional ingredient in nutraceutical applications.

PURPOSEHead and neck cancers (HNCs) are in general treated with conventional fractionation regimen of 1.8-2 Gy per fraction. Altered fractionation (ALFT) strategies such as hypofractionation radiotherapy (HYPO-RT), accelerated fractionation radiotherapy (AFRT), and hyperfractionation radiotherapy (HFRT) have not been practiced uniformly across centers in different parts of the world. Countries in Asia share common cancer demographics, and we designed this survey for Federation of Asian Radiation Oncology (FARO) member countries to understand the usage and challenges in the delivery of ALFT in HNCs.MATERIALS AND METHODSA 21-point electronic survey (Federation of Asian Radiation Oncology Research Network [FERN]-S-005) was designed by the FERN and was circulated through the FARO research secretariat to the FARO council member countries and the responses were collected between August and November 2023.RESULTSTwelve of 14 member countries (85.7%) responded to the survey. Twenty-seven responses were received and 78% of the respondents belonged to government/teaching academic institute. 4/27 (14.8%) reported never using HYPO-RT for any of the clinical subsite of HNCs, while the majority (85.2%) used it for glottic cancers and 22% also used it for postoperative setting. Majority (77.7%) used a fractionation schedule with dose per fraction ranging between 2.2 and 2.5 Gy. 6/27 (22.2%) used AFRT for definitive setting and five of these also used concurrent chemoradiotherapy. 4/27 (14.8%) centers reported using HFRT. The most common reason (62.9%) for the limited usage of AFRT/HFRT was reported to be logistical, such as unavailability of machine slots, patient load, and so on.CONCLUSIONThe result of the survey suggests that among the ALFT strategies for HNCs, HYPO-RT schedules have common interest and feasibility among the FARO member countries and also highlights the challenges in the delivery of AFRT/HFRT in the Asian region.

Skin aging, often called as premature skin aging, is the hastened deterioration of the skin resulting from multiple factors, including UV radiation, environmental contaminants, inadequate nutrition, stress, etc. Dietary phytochemicals, present in fruits, vegetables, and other plant-derived meals, have gained interest due to their efficiency to eradicate free radicals and lowering the release of inflammatory mediators which accounts for premature skin aging. Several dietary phytochemicals, i.e., carotenoids, polyphenols, flavonoids, terpenes, alkaloids, phytosterols, etc., exhibited potential anti-oxidant, anti-inflammatory, suppression of UV damage, and promote collagen synthesis. In addition, dietary phytochemicals include sulfur, present in various foods safeguard the skin against oxidative stress and inflammation. Thus, this article delves into the comprehension of various dietary phytochemicals investigated to alleviate the premature skin aging. The article further highlights specific phytochemicals and their sources, bioavailability, mechanisms, etc., in the context of safeguarding the skin against oxidative stress and inflammation. The present manuscript is a systematic comprehension of the available literature on dietary phytochemicals and skin aging in various database, i.e., PubMed, ScienceDirect, Google Scholar using the keywords, i.e., “dietary phytochemicals”, “nutraceuticals”, “skin aging” etc., via Boolean operator, i.e., “AND”. The dietary guidelines presented in the manuscript is a unique summarization for a broad reader to understand the inclusion of various functional foods, nutrients, supplements, etc., to prevent premature skin aging. Thus, the utilization of dietary phytochemicals has shown a promising avenue in preventing skin aging, however, the future perspectives and challenges of such phytochemicals should be comprehended via clinical investigations.

IntroductionIntravenous non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in healthcare settings, but their comparative safety and resource utilization impacts remain understudied. This study aimed to compare adverse drug reactions (ADRs) and healthcare resource utilization (HCRU) between patients receiving IV-ibuprofen versus IV/IM ketorolac.MethodsA retrospective, longitudinal analysis was conducted using an all-payer database, examining records from January 1, 2014, to June 3, 2023. The study included both adult (≥18 years) and pediatric (