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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.

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.

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.

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.

Rising atmospheric CO2 levels, a significant consequence of anthropogenic activities, profoundly impact global agriculture and food security by altering plant physiological processes. Despite extensive research, a comprehensive understanding of the specific effects of elevated CO2 on maize (Zea mays L.)’s primary and secondary metabolism remains elusive. This study investigated the responses of maize seedlings cultivated in open-top chambers (OTCs) under three CO2 concentrations: ambient (380 ppm), elevated (600 ppm), and high (1800 ppm). Key growth parameters, including plant height, leaf area, and aboveground biomass (leaf and stem), were assessed alongside metabolic profiles encompassing nonstructural and structural carbohydrates, syringyl (S) and guaiacyl lignin, the syringyl-to-guaiacyl (S/G)-lignin ratio, photosynthetic pigments, total soluble protein, and malondialdehyde (MDA) levels. The results demonstrated that exposure to 600 ppm CO2 significantly enhanced plant height, leaf area, and aboveground biomass compared to ambient conditions. Concurrently, there were notable increases in the concentrations of primary metabolites. In contrast, exposure to 1800 ppm CO2 severely inhibited these growth parameters and induced reductions in secondary metabolites, such as chlorophyll and soluble proteins, throughout the growth stages. The findings underscore the intricate responses of maize metabolism to varying CO2 levels, highlighting adaptive strategies in primary and secondary metabolism under changing atmospheric conditions. This research contributes to a nuanced understanding of maize’s physiological adaptations to future climate scenarios characterized by elevated CO2, with implications for sustainable agriculture and food security.

We present a previously healthy 63-year-old female with incidental polyps in the colon that were detected during a surveillance endoscopy. Clinical examination and imaging studies did not detect any lymphadenopathy or organomegaly. Histopathologic evaluation of polyps showed a low-grade primary follicular lymphoma. We suggest that follicular lymphoma should be considered as a differential diagnosis of polypoid lesions of the colon.

Autoimmunity refers to an organism’s immune response against its own healthy cells, tissues, or components, potentially leading to irreversible damage to vital organs. Central and peripheral tolerance mechanisms play crucial roles in preventing autoimmunity by eliminating self-reactive T and B cells. The disruption of immunological tolerance, characterized by the failure of these mechanisms, results in the aberrant activation of autoreactive lymphocytes that target self-tissues, culminating in the pathogenesis of autoimmune disorders. Genetic predispositions, environmental exposures, and immunoregulatory disturbances synergistically contribute to the susceptibility and initiation of autoimmune pathologies. Within the realm of immune therapies for autoimmune diseases, cytokine therapies have emerged as a specialized strategy, targeting cytokine-mediated regulatory pathways to rectify immunological imbalances. Proinflammatory cytokines are key players in inducing and propagating autoimmune inflammation, highlighting the potential of cytokine therapies in managing autoimmune conditions. This review discusses the etiology of autoimmune diseases, current therapeutic approaches, and prospects for future drug design.