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Spontaneous and isolated necrosis of the falciform ligament is a rare condition. A 55-year-old lady presented with sudden onset of epigastric pain, fever and vomiting. Laboratory studies revealed less than three-fold increase in serum amylase and lipase levels. Ultrasound examination and contrast enhanced computed tomography (CECT) revealed features suggestive of inflammation and necrosis of the falciform ligament involving ligamentum teres hepatis and extending to the lesser omentum with an adjacent minimal ill-defined collection. Then, conservative management was started. However, the symptoms did not resolve completely. Therefore, CECT scan was repeated 12 days later which showed findings similar to previous scan with expansion and organization of the collection anterior to lesser omentum with peripheral enhancement, suggestive of an abscess. A minimally invasive approach to treatment was adopted. Aspiration of the collection was performed under ultrasound guidance. This was followed by continuation of supportive management. The patient improved clinically and was discharged. This case study highlights the importance of imaging in the diagnosis of falciform ligament necrosis. An innovative minimally invasive approach to treatment in the form of ultrasound guided aspiration may be considered when a collection is present adjacent to the necrosed falciform ligament.

Glutaric aciduria type 1 is a rare autosomal recessive disorder caused by a deficiency of glutaryl-CoA dehydrogenase, which is the key mitochondrial enzyme involved in the final degradation of lysine, L-hydroxylysine, and L-tryptophan. It is an inherited organic acidemia characterized by macrocephaly and dystonia, which results in high morbidity and mortality. In resource-limited countries like Nepal, where enzyme assays are not available, MRI has a great role to play in supporting diagnosis in such situations. Here, we present 2 cases of glutaric aciduria type 1 in brothers from the same parent that were diagnosed by MRI, and subsequent diet modification and L-carnitine therapy led to improvement of clinical symptoms.

Schwannomatosis is a rare neurocutaneous syndrome characterized by the presence of multiple schwannomas along the peripheral nerves, distinctly excluding the vestibular nerves. It is recognized as the third principal form of neurofibromatosis, alongside neurofibromatosis types 1 and 2. In this report, we discuss the case of a 45-year-old woman who initially sought medical attention for low back pain and swelling in her left axilla. Her magnetic resonance imaging revealed multiple enhancing intradural extramedullary lesions, along with a mass in the right upper thoracic region and another in the left axilla, raising suspicions of metastasis. However, a comprehensive analysis that aligned imaging results with histopathological findings confirmed the diagnosis of schwannomatosis. This case highlights the importance of differentiating between various conditions that can cause multiple intradural extramedullary masses, such as nerve sheath tumors, meningiomas, and metastasis. The presence of multiple schwannomas suggests a diagnosis of either neurofibromatosis type 2 or schwannomatosis, making the distinction between these two conditions critical for appropriate management.

Choriocarcinoma is a type of gestational trophoblastic disease that occurs as a complication of pregnancy-related events. The gestational trophoblastic disease includes both benign and malignant conditions including complete and partial mole, invasive mole, choriocarcinoma, and placental site trophoblastic disease. Choriocarcinoma generally presents with pervaginal bleeding, symptoms of anemia, and symptoms of its metastatic lesion. The common sites of metastasis are the lung, vagina, brain, and liver. The gastrointestinal (GI) tract is an uncommon site of metastasis occurring in

Ectopic teeth, growing in abnormal locations like the maxillary sinus, are rare occurrences, with uncertain causes including trauma, infection, and developmental abnormalities. They often appear in the second or third decade of life, sometimes without symptoms. They are often missed as symptoms can mimic chronic sinusitis but may include sinonasal issues like obstruction and facial pain. Complications ranging from recurrence to potential blindness or carcinoma have been reported. Diagnosis involves radiographic imaging, with CT scans providing precise localization. Following accurate diagnosis, treatment typically involves surgical removal, with endoscopic procedures gaining popularity due to reduced risks. Follow-up for asymptomatic cases can be conducted through periodic radiographs. We report a case of maxillary ectopic tooth as an incidental finding in an asymptomatic patient presenting to the emergency department with head trauma.

The goal of this study is to investigate the efficacy of tea-derived absorbents for the removal of heavy metals from contaminated water. For this, absorbents were prepared from milk tea (MT) waste, Ilam tea (IT) waste, and various types of tea leaves, including Immature (IML), mature (ML), and old leaves (OL). The characterization of the absorbents revealed distinct physical and chemical properties from X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR), with varying degrees of effectiveness observed across different absorbent types. Heavy metal removal efficiency was assessed using a chemical-free UV-spectrophotometer. The results show that the maximum removal efficiency for Cd using the IT absorbent reaches up to 82.14 % with 100 ppm cetyltrim ethylammonium bromide (CTAB), while the minimum removal efficiency is 32.14 % using the OL absorbent with 20 ppm CTAB. For Zn, the OL absorbent demonstrates a maximum removal efficiency of 52.59 % with 100 ppm CTAB, whereas the minimum efficiency is 3.70 % using the ML absorbent with 20 ppm CTAB. For Ni, the highest removal efficiency is achieved with the ML absorbent, reaching up to 97.73 % with 100 ppm CTAB, and the lowest is 31.82 % with the MT absorbent with 20 ppm CTAB. The addition of a catalyst further enhanced removal efficiencies in both absorbents and metals. Also, the removal of heavy metal ions using 0.05 g of tea absorbent combined with CTAB at varying concentrations. Results show that the addition of 20 ppm and 100 ppm CTAB significantly reduces metal ion concentrations from an initial 100 mg/L. The metal ion concentration decreases as CTAB concentration increases, demonstrating the effectiveness of CTAB in enhancing the absorption capacity of tea absorbent for heavy metal removal. The investigation of selective adsorption of Ni, Zn, and Cd by an adsorbent, revealing competitive adsorption behavior with Ni and Zn being adsorbed more rapidly than Cd, suggesting the impact of metal ion interference on adsorption efficiency. However, limitations were observed with certain absorbent types; for instance, immature leaves did not effectively remove Ni. Overall, this study underscores the potential of tea-derived absorbents as sustainable solutions for mitigating heavy metal pollution in industrial wastewater. Further research is needed to optimize absorbent formulations and explore their applicability in real-world environmental remediation scenarios.

Study objective: Assessing if Transcatheter Edge to Edge Repair (TEER) with Mitraclip™ in patients with moderate to severe mitral regurgitation (MR) and cardiogenic shock (CS) improves outcomes compared to medical management alone. Design: A single-center, retrospective study was performed in an urban tertiary referral center. Setting: Rush University Medical Center, United States. Participants: Adult patients presenting with CS and moderate to severe MR between 2012 and 2021 were included. Interventions: Undergoing Mitral TEER with Mitraclip versus medical management alone. Main outcome measures: Major adverse cardiovascular events (MACE) defined as cardiovascular death, heart failure admission, stroke, and myocardial infarction assessed at 30 days, 6 months, and 1 year. The secondary outcome was a change in New York Heart Association (NYHA) classification at 30 days and 6 months. Results: There were 28 patients included in the medical management and 33 in the mitral valve TEER groups. There was a decreased MACE in the intervention group at 30 days (24.2 % vs. 46.4 %, p ≤0.001) and 6 months (27 % vs. 75 %, p = 0.002), though not at 1 year (29.4 % vs. 41.7 %, p = 0.42). At 30 days, more patients in the mitral valve TEER group improved to NYHA classes I/II compared to medical management alone (10 [35.7 %] vs. 16 [50 %], p = 0.043). There were no differences in NYHA classes I/II at 6 months (7 [43.7 %] vs. 13 [54.2 %], p = 0.63). Conclusion: Mitral valve TEER using the Mitraclip™ system improves mid-term cardiovascular compared to medical management alone in patients with CS but does not improve mortality.

Intussusception is one of the common conditions in children presenting with abdominal pain. The exact etiology of intussusception is unknown. Lead point is not identified in the majority of cases in children. Commonly, radiographic evidence suggests the presence of a target sign is diagnosis of intussusception. However, the presence of a double target sign in the case of intussusception is rare and depicts the presence of double intussusception. We present a case report of a 1-year-old child who presented to the emergency department with excessive crying for more than 10 hours. After the initial clinical assessment and acute management, an abdominal ultrasound revealed a double target sign on the sub-hepatic and left para-umbilical region which suggested double intussusception. No lead point was identified in our case. Early diagnosis and prompt treatment are the mainstay of management in such cases.

Urban multi-energy systems (UMES) incorporating distributed energy resources are vital to future low-carbon energy systems. These systems demand complex solutions, including increased integration of renewables, improved efficiency through electrification, and exploitation of synergies via sector coupling across multiple sectors and infrastructures. Digitalization and the Internet of Things bring new opportunities for the design-build-operate workflow of the cyber-physical urban multi-energy systems. In this context, digital twins are expected to play a crucial role in managing the intricate integration of assets, systems, and actors within urban multi-energy systems. This review explores digital twin opportunities for urban multi-energy systems by first considering the challenges of urban multi energy systems. It then reviews recent advancements in digital twin architectures, energy system data categories, semantic ontologies, and data management solutions, addressing the growing data demands and modelling complexities. Digital twins provide an objective and comprehensive information base covering the entire design, operation, decommissioning, and reuse lifecycle phases, enhancing collaborative decision-making among stakeholders. This review also highlights that future research should focus on scaling digital twins to manage the complexities of urban environments. A key challenge remains in identifying standardized ontologies for seamless data exchange and interoperability between energy systems and sectors. As the technology matures, future research is required to explore the socio-economic and regulatory implications of digital twins, ensuring that the transition to smart energy systems is both technologically sound and socially equitable. The paper concludes by making a series of recommendations on how digital twins could be implemented for urban multi energy systems.

Carob pulp powder and chickpea flour were used as ingredients in the formulation of a plant-based fermented beverage (gurt). Three different exopolysaccharide-producing strains (Levilactobacillus brevis AM7, Weissella confusa CK15, and Pediococcus claussenii DSM 14800) were used as starters to obtain a gurt rich in fiber and protein. L. brevis AM7 showed the fastest and more intense acidification, whereas W. confusa CK15 induced the highest viscosity increase (reaching up to 3000 mPa × s) due to the in-situ synthesis of dextran. Gurts were characterized by a high antioxidant activity (86.37 %) mainly due to the ingredients used, since it was not affected by fermentation. Depending on the strain, fermentation determined a significant decrease of gurts starch hydrolysis index. Overall, the microbiological, biochemical, and rheological features were retained during the two-weeks refrigerated storage. All exopolysaccharide-producing strains resulted suitable starters for gurt production, but their metabolic traits reflected different fermentation performances and product features. Overall, W. confusa CK15 resulted an efficient dextran producer whereas, based on the growth and acidification kinetics, L. brevis AM7 showed optimal adaptation to carob/chickpea substrate and pro-technological performance.

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83–0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

Agriculture plays a critical role in ensuring food and nutrition security, livelihood, and rural employment in Nepal. Despite substantial investments and institutional reforms, irrigation projects have faced consistently low performance. While existing studies have shed light on technical aspects of irrigation performance, they often focus on specific themes rather than holistic evaluations of sustainability. This research systematically assesses barriers and challenges to effective irrigation water management in Nepal by assessing and ranking the challenges faced by three irrigation systems in western Nepal: Mahakali, Rani Jamara Kulariya, and Babai. To investigate these challenges, we collected data from 449 households, which provided insights into 33 indicators representing key barriers to effective irrigation and agricultural management. The identified challenges were categorized into four broad thematic areas: physical and structural, agricultural and water, socioeconomic and market, and gender and governance. A comprehensive evaluation was conducted to compare these challenges among the three irrigation schemes, different thematic areas, and various locations within each scheme (namely, the head, mid, and tail sections of the system). The findings revealed that timely access and availability of fertilizers, spring water availability and fair market prices of agricultural products are the most significant challenges. The Babai irrigation system faced the most substantial challenges among the three systems, particularly in the mid section. These findings emphasize the interconnectedness of these challenges, highlighting the need for a holistic approach to planning, implementation, and management. Integrated strategies are essential to address socioeconomic, market, and endogenous farming issues, ensuring reliable irrigation water availability for sustainable agricultural production.

Acute strokes can affect heart rate variability (HRV), the mechanisms how are not well understood. We included 42 acute stroke patients (2–7 days after ischemic stroke, mean age 66 years, 16 women). For analysis of HRV, 20 matched controls (mean age 60.7, 10 women) were recruited. HRV was assessed at rest, in a supine position and individual breathing rhythmus for 5 min. The coefficient of variation (VC), the root mean square of successive differences (RMSSD), the powers of low (LF, 0.04–0.14 Hz) and high (HF, 0.15–0.50 Hz) frequency bands were extracted. HRV parameters were z-transformed related to age- and sex-matched normal subjects. Z-values -1). No different connectivity could be found for the respective VC groups. Our results suggest that HRV alteration after acute stroke might be due to affecting resting-state brain networks.

This comprehensive study examines the concentration of natural radionuclides in bricks from the Terai region of the Koshi province, aiming to assess the radioactivity levels and associated radiological hazards, ultimately quantifying the dose limit. The average concentrations of 226Ra, 232Th, and 40K were 27.1 ± 5.7, 42.6 ± 9.8, and 601.5 ± 93.8 Bq/kg, with their respective contributions to total activity being 20.18 %, 45.35 %, 34.48 %,. Despite this, their concentration distribution followed the pattern 40K > 232Th > 226Ra. The elevated presence of 40K in the bricks is attributed to the use of phosphate fertilizers in the soil to enhance crop productivity. Notably, the calculated values of radiological hazard parameters, including radium equivalent activity, absorbed gamma dose, and effective dose, are well below the recommended safety thresholds. Consequently, this study suggests that bricks, when used in substantial quantities, pose no significant radiological risks and are considered safe for use as a building material. The extension of such investigations nationwide is recommended to assess the overall radioactivity levels and establish dose limits.

This study assessed perception and experience of trained primary health care workers in using a mobile app-based version of the WHO mental health gap action programme (mhGAP) Intervention Guide in the assessment and management of people with mental health conditions in primary care in Nepal. A qualitative study was conducted with primary healthcare workers who were trained in using the WHO mhGAP mobile application in Jhapa, a district in eastern Nepal. Semi-structured interviews were carried out with 15 healthcare workers (3 females and 12 males) nine months after the training. Interviews were audio recorded, transcribed and translated into English for the thematic qualitative data analysis. Health care workers (HCWs) found the mobile app helpful to verify and confirm their assessment and diagnosis. The other benefits reported by the participants were: bringing uniformity in diagnosis and management of mental health conditions across primary healthcare facilities; reminding the HCWs specific assessment questions; creating awareness on the importance of psychosocial intervention; improving the interaction between patients and service providers; and the importance of follow-up care. Despite these advantages, lack of clarity about report submission modality; lack of electricity or internet connectivity; and low technology literacy among older HCWs were some of the barriers in using the app. The major recommendation made by the HCWs for the guide included revision of the assessment process and system; inclusion of a chat function with supervisors; minimizing the amount of patients’ data to be collected in the app; and addition of conversion and anxiety disorders to the app. This study concludes that the mobile decision support application could be acceptable and feasible in primary care settings if the suggested modifications are incorporated, in addition to addressing other systemic issues facing the primary care-based delivery of mental health services.

Sensory deprivation can offset the balance of audio versus visual information in multimodal processing. Such a phenomenon could persist for children born deaf, even after they receive cochlear implants (CIs), and could potentially explain why one modality is given priority over the other. Here, we recorded cortical responses to a single speaker uttering two syllables, presented in audio-only (A), visual-only (V), and audio-visual (AV) modes. Electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) were successively recorded in seventy-five school-aged children. Twenty-five were children with normal hearing (NH) and fifty wore CIs, among whom 26 had relatively high language abilities (HL) comparable to those of NH children, while 24 others had low language abilities (LL). In EEG data, visual-evoked potentials were captured in occipital regions, in response to V and AV stimuli, and they were accentuated in the HL group compared to the LL group (the NH group being intermediate). Close to the vertex, auditory-evoked potentials were captured in response to A and AV stimuli and reflected a differential treatment of the two syllables but only in the NH group. None of the EEG metrics revealed any interaction between group and modality. In fNIRS data, each modality induced a corresponding activity in visual or auditory regions, but no group difference was observed in A, V, or AV stimulation. The present study did not reveal any sign of abnormal AV integration in children with CI. An efficient multimodal integrative network (at least for rudimentary speech materials) is clearly not a sufficient condition to exhibit good language and literacy.

Busy schedules, changes in lifestyle, and the rise in consumption of ultra-processed foods have resulted in inadequate bioactive compounds on the consumer's plate. This deficiency causes a weakening of the immune system, which further escalates exposure to viral infections. Dietary interventions through the consumption of foods rich in bioactive compounds can enhance immunity against pathogens. The term ‘designer foods’ encompasses all functional foods incorporating bioactive molecules, such as proteins, essential amino acids, vitamins, minerals, essential fatty acids, dietary fibers, probiotics, antioxidants, etc. Previous studies have elucidated the potential of these foods to improve the capability of the immune system. This review extensively explores the potential of these foods to enhance immunity especially against viral infections. The role of each class of designer food has been discussed in strengthening the immune system and the chemical interactions between food compounds and the immune system has been highlighted in case of viral infections, which will help to understand their role in a better way. Designer foods are excellent sources of functional components to discover new antiviral elements for the development of preventive or therapeutic approaches against viral infections.

This paper explores the potential of water jet eductor to replace large condensers and vacuum pump in the thermal desalination systems, with heat source temperatures below 95 °C. The operational limit of eductor has been investigated for active vapor transport and condensation to produce permeate. Combined system and its operational principle have been proposed with critical examination based on suction performance of Eductor. Experimental and computational study are the primary methodology of this work. The computational analysis of single-phase flow in Eductor, is in proper agreement with the experimental data. The result showed primary pressure & area ratio has positive impact and swirl ratio has negative impact on suction. The extended thermal analysis summarizes strength of Eductor while working with lower temperature sources and optimum cooling capacity of proposed system. Considering the simplicity and reduction in footprint, proposed application has been highlighted. The research disseminates knowledge on maximum vacuum generation capacity of Eductor and operational limit of thermal desalination system.

RNA molecules play essential roles in many biological functions, from gene expression regulation, cellular growth, and metabolism to catalysis. They frequently fold into three-dimensional structures to perform their functions. Therefore, determining RNA structure represents a key step for understanding the structure-function relationships and developing RNA-targeted therapeutics. X-ray crystallography remains a method of choice for determining high-resolution RNA structures, but it has been challenging due to difficulties associated with RNA crystallization and phasing. Several natural and synthetic RNA binding proteins have been used to facilitate RNA crystallography. Having unique properties to help crystal packing and phasing, synthetic antibody fragments, specifically the Fabs, have emerged as promising RNA crystallization chaperones, and so far, over a dozen of RNA structures have been solved using this strategy. Nevertheless, multiple steps in this approach need to be improved, including the recombinant expression of these anti-RNA Fabs, to warrant the full potential of these synthetic Fabs as RNA crystallization chaperones. This review highlights the nuts and bolts and recent advances in the chaperone-assisted RNA crystallography approach, specifically emphasizing the Fab antibody fragments as RNA crystallization chaperones.

Antibiotics have been used to cure bacterial infections for more than 70 years, and these low-molecular-weight bioactive agents have also been used for a variety of other medicinal applications. In the battle against microbes, antibiotics have certainly been a blessing to human civilization by saving millions of lives. Globally, infections caused by multidrug-resistant (MDR) bacteria are on the rise. Antibiotics are being used to combat diversified bacterial infections. Synthetic biology techniques, in combination with molecular, functional genomic, and metagenomic studies of bacteria, plants, and even marine invertebrates are aimed at unlocking the world's natural products faster than previous methods of antibiotic discovery. There are currently only few viable remedies, potential preventive techniques, and a limited number of antibiotics, thereby necessitating the discovery of innovative medicinal approaches and antimicrobial therapies. MDR is also facilitated by biofilms, which makes infection control more complex. In this review, we have spotlighted comprehensively various aspects of antibiotics viz. overview of antibiotics era, mode of actions of antibiotics, development and mechanisms of antibiotic resistance in bacteria, and future strategies to fight the emerging antimicrobial resistant threat.

This work presents the study of the thermodynamic properties of thermal electrons participating in scattering events. This is necessary because scattering with a thermal electron in presence of a laser field was not studied yet and it reduces the complexity of event measurement (differential cross-section). To study thermodynamic properties, the authors model the thermal Hamiltonian in presence of a laser field and used it to study the thermodynamic properties using the partition function. The study shows thermodynamic energy, around the target with distance at field amplitude 0.1 a.u. to 0.9 a.u. has destructive interference, above field amplitude 1 a.u. to 2.5 a.u. has superposition and at field amplitude 2.5 a.u. and 3 a.u. have coulomb potential like nature. Also, thermodynamic energy with temperature was found constant except at field amplitude 2.5 a.u. and at field amplitude 2.5 a.u. destructive interference at 10 °C and 21 °C. The thermodynamical potential at field amplitude 0.1 to 3.5 a.u. found constant and above field amplitude 3.5 a.u. increased linearly when studied with respect to temperature at 10 Å. The thermal Hamiltonian increase sharply when thermal electrons enter in 1–5 Å, slowly in 5–10 Å and beyond 10 Å constant, and the thermal Hamiltonian nature is like coulomb potential.

This study investigates the design and use of a printable, sustainable, aqueous paste for room-temperature low-energy material extrusion (ME) additive manufacturing (AM) of complex structures. To this end, pastes with controlled rheology and a total solid content of ∼42% are formulated. Constituents of the pastes are commercial graphite and cellulose nanocrystal (CNC) powder, as a dispersing additive, with 91:09 and 88:12 graphite:cellulose wt.% compositions. The AM structures are dried in air at three rates (slow, medium, and fast). The structure of printed parts is characterized using electron microscopy, X-ray diffraction, Infrared/X-ray photoelectron spectroscopy, X-ray micro-computed tomography, and thermogravimetric analysis. The compressive strength of AM graphite structures reached 5.8±0.6 MPa with almost no effect from drying rates. However, samples containing more cellulose were ∼30% stronger in compression. Carbonization of the AM parts increased their electrical conductivity by more than an order of magnitude to ∼2400 S.m−1. In addition, it enabled the fabrication of nearly pure graphite structures. The mechanical and electrical properties of samples fabricated in this study exceed the performance of previously reported AM graphite structures. Moreover, the recyclability of the printed parts was demonstrated by regenerating pastes via mixing printed parts in water and re-printing new parts with the paste. The AM graphite structures can be used in numerous applications, including but not limited to electrical discharge machining (EDM), electrochemical machining (ECM), high-temperature customized sealing, high-temperature composite tooling, and energy conversion and storage.

Background: Resilience is a multidimensional construct. Despite its importance as protective against psychiatric disorders, it remains largely unexplored in context of Nepal. We investigated the role of resilience in the development of various psychiatric symptoms as post-traumatic stress disorder, anxiety and depression following trauma in clinical population in a psychiatry outpatient. Methods: We interviewed one hundred patients who sought treatment in psychiatry outpatient of Tribhuvan University Teaching Hospital in Kathmandu, Nepal. The sampling strategy was purposive and inclusion criteria were 18–60 years and trauma history. We used the World Health Organization Composite International Diagnostic Interview version 2.1 for trauma categorization, the Post-Traumatic Stress Disorder Checklist-Civilian version to measure the post-traumatic stress disorder symptoms, and the 25-item Hopkins Symptom Checklist-25 to assess the level of anxiety and depression symptoms. We used Nepali adapted resilience scale derived from the original Wagnild and Young Resilience scale to measure resilience. We investigated the associations between resilience scores and the scores on depression, anxiety and post-traumatic stress disorder using bivariate and multivariate analysis. We adjusted for trauma type, socioeconomic status, employment, marital status and gender in the final models. Results: Resilience was found to have negative relation with post-traumatic stress disorder, anxiety, and depression symptoms even after adjusting for other important factors in patients with trauma in the final multivariate analysis. Conclusion: Resilience was independently and negatively related with symptoms of post-traumatic stress disorder, anxiety, and depression in patients with history of trauma presenting to the hospital. Interventions aiming to promote resilience in trauma patients might be effective in reducing psychiatric symptoms such as stress disorder, anxiety and depression. Prospective studies using more robust measures of resilience combining personal attributes to social support systems, across different settings in trauma population should be the focus of future research.

This study aimed to investigate the effects of different physicochemical modifications of Riceberry rice (Oryza Sativa L.) starch on its morphology, pasting behavior, and functional properties. The methods include HCl lintnerization (1 N, 1.5 N, 2 N), autoclaving (135 °C for 14 min), HCl lintnerization combined with autoclaving, and freeze-thawing (-20 °C for 30 min). The result demonstrates that all modifications applied to the native starch increased the resistant starch (RS) content. The autoclaved Riceberry rice starch showed the highest RS content (49.66 ± 0.14%) and lowest estimated glycemic index (eGI) (50.03 ± 0.01%), indicating a healthy, low glycemic food. All treatments improved the solubility and water holding capacity (WHC) of native starch without destroying granule structure, whereas swelling power decreased with increased acid temperature-dependent concentration. Autoclave treatment increased WHC significantly of the modified starches with the damaged starch granules. The color values of lintnerized starch were reduced due to the removal of color pigment anthocyanin. Therefore, the result of this study provides a better understanding of the various modification methods for the functional properties of Riceberry rice starches for potential applications in a wide range of food applications.

Summary: Background: Tremors are frequent and disabling in people with multiple sclerosis (MS). Characteristic tremor frequencies in MS have a broad distribution range (1–10 Hz), which confounds the diagnostic from other forms of tremors. In this study, we propose a classification method for distinguishing MS tremors from other forms of cerebellar tremors. Methods: Electromyogram (EMG), accelerometer and clinical data were obtained from a total of 120 [40 MS, 41 essential tremor (ET) and 39 Parkinson's disease (PD)] subjects. The proposed method - Soft Decision Wavelet Decomposition (SDWD) - was used to compute power spectral densities and receiver operating characteristic (ROC) analysis was performed for the automatic classification of the tremors. Association between the spectral features and clinical features (FTM - Fahn-Tolosa-Marin scale, UPDRS - Unified Parkinson's Disease Rating Scale), was assessed using a support vector regression (SVR) model. Findings: Our developed analytical framework achieved an accuracy of up to 91.67% using accelerometer data and up to 91.60% using EMG signals for the differentiation of MS tremors and the tremors from ET and PD. In addition, SVR further revealed strong significant correlations between the selected discriminators and the clinical scores. Interpretation: The proposed method, with high classification accuracy and strong correlations of these features to clinical outcomes, has clearly demonstrated the potential to complement the existing tremor-diagnostic approach in MS patients. Funding: This work was supported by the German Research Foundation (DFG): SFB-TR-128 (to SG, MM), MU 4354/1-1(to MM) and the Boehringer Ingelheim Fonds BIF-03 (to SG, MM).

Purpose: To study tolerability and outcome of oral favipiravir treatment among COVID-19 patients in Nepal. Methods & Materials: In this multi-centered randomized, open-labelled phase III clinical trial, we enrolled 18-80 years old, RT-PCR confirmed patients with mild to moderate COVID-19 infection from 9 participating hospitals of Nepal, within 6 days of onset of symptoms. The investigational product (Favipiravir) was compared against placebo in patients with mild infection and against Remdesivir in moderate infection. Patients who met the eligibility criteria were randomly enrolled in the study after taking informed consent. This is a preliminary report of the data analysis. Results: At the time of this preliminary data analysis, 90 cases were enrolled in the study including 70 mild and 20 moderate cases (see table). Among the participants with mild COVID19 infection, clinical improvement was noted in 30 (78.9%) and 27 (84.4%) patients who received Favipiravir and placebo, respectively (p=0.78). While among the participants with moderate infection, 9 (81%) and 8 (88.9%) patients who received Favipiravir and Remdesivir, respectively, had clinical improvement (p=1). Patients tolerated Favipiravir well with only 3 (6.12 %) patients showing adverse events, which were mainly elevated liver function test & uric acid level, both considered minor. None of the patients receiving placebo or remdesivir reported any adverse events. Conclusion: The investigational product has been tolerated well by this group of patients with only mild and reversible side effects in 6.12 % cases. The outcomes between the study groups were comparable.

Geographically, Jumla is a Himalayan mountainous region located in the Karnali Province of Nepal. It has a beautiful landscape with abundant plant and animal species and is rich in biodiversity. Jumli Marshi has been cultivated since prehistoric times. Marshi has nutritional, religious, and cultural significance. The Chumchaur of Jumla, a place where rice cultivation is carried out at the highest elevation (3050 m) of the world. In the past, the field at the bank of the Tila river was filled with Jumli Marshi rice; however, its cultivation is currently decreasing day by day due to low productivity and blast susceptibility. Farmers prefer to grow improved varieties such as Chandannath-1 and Chandannath-3 rather than Marshi. Jumla's peasant worked very hard to produce this local variety and the role of women in producing this variety is crucial. The cultivation practice for Marshi production is unique compared with other rice production practices in Nepal. Due to it’s richness in fiber (2.01 %), proteins (9.86 %), minerals such as 0.57 mg/100 ​g iron, 66.70 ​mg/100 ​g calcium, and 57.54 ​mg/100 ​g phosphorous, and low carbohydrates (72.74 %), it is regarded as suitable food for diabetes patients. Furthermore, it contains more nutrients than other rice varieties commonly grown in Nepal. Therefore, conservation and cultivation of Jumli Marshi should be promoted to preserve local diversity and contribute to sustainable local food production systems, agro-ecotourism, and crop improvement programs.

Pakistan has large variety of medicinal plants distributed throughout the country. Due to the unavailability and high cost of allopathic medicines, herbal therapists, especially in rural areas, prescribe phytomedicine for Epilepsy. The native people consider such treatments most effective for seizures. The data of the effective antiepileptic medicinal plants of Pakistan were collected from the published research articles by exploring article search engines like PubMed, Medline, Web of Science, Google Scholar, and ScienceDirect. Additional information such as mode of preparation and application of medicinal herbs were acquired from folk medicine users, traditional healers, and local people enriched in knowledge of herbal medicines. Total 97 families were uncovered to be used in epileptic and seizure disorders, of which, the foremost use belonged to Lamiacea 19 (18.56%), Asteraceae and Fabaceae 16 (16.5%) each, Fabaceae 11 (11.34%), Rubiaceae, Rutaceae, and Apocynaceae 6 (2.4%) each, Caesalpiniaceae, Solanaceae, Byrtaceae and Anacardiaceae 5 (2%) each, and Liliaceae, Mimosaceae, Ranunculaceae and Combretaceae 4 (1.6%) each. According to the plants habit, of 241 plants, herbs were 102 (42.15%), trees were 72 (29.75%), shrubs were 54 (22.31%), climbers were 12 (4.96%), and bulbs were 2 (0.83%). According to the part used, 105 (43.39%) plants were found to have antiepileptic potentials in leaves, 51 (31.07%) plants in roots, 20 (8.36%) plants in stem, 8 (3.31%) plants in rhizome, 4 (1.65%) plants in bulb, 32 (13.22%) plants in bark, 6 (2.48%) plants in gum, 19 (7.85%) plants in flowers, 18 (7.44%) plants in fruits, 24 (9.92%) plants in seeds, and 29 (11.98%) plants as a whole. This review provides foundation for researchers to understand the pivotal role of certain medicinal plants towards the treatment of epilepsy and seizures.

Background: Studies exploring neuroanatomic correlates of reading have associated white matter tissue properties with reading disability and related componential skills (e.g., phonological and single-word reading skills). Mean diffusivity (MD) and fractional anisotropy (FA) are widely used surrogate measures of tissue microstructure with high sensitivity; however, they lack specificity for individual microstructural features. Here we investigated neurite features with higher specificity in order to explore the underlying microstructural architecture. Methods: Diffusion weighted images (DWI) and a battery of behavioral and neuropsychological assessments were obtained from 412 children (6 – 16 years of age). Neurite indices influenced by orientation and density were attained from 23 major white matter tracts. Partial correlations were calculated between neurite indices and indicators of phonological processing and single-word reading skills using age, sex, and image quality metrics as covariates. In addition, mediation analysis was performed using structural equation modeling (SEM) to evaluate the indirect effect of phonological processing on reading skills. Results: We observed that orientation dispersion index (ODI) and neurite density index (NDI) were negatively correlated with single-word reading and phonological processing skills in several tracts previously shown to have structural correlates with reading efficiency. We also observed a significant and substantial effect in which phonological processing mediated the relationship between neurite indices and reading skills in most tracts. Conclusions: In sum, we established that better reading and phonological processing skills are associated with greater tract coherence (lower ODI) and lower neurite density (lower NDI). We interpret these findings as evidence that reading is associated with neural architecture and its efficiency.

Foresters rely on taper models to estimate total and merchantable volume for commercial species. While there is an abundance of literature in taper modeling for many softwood and hardwood species, little is known of teak tree stem form. Taper modeling is in early stage for the forestry sector in Nepal. Currently, no publicly available taper equations exist for teak trees in Nepal. Therefore, the main goal of this study was to develop a taper equation for valuable teak trees of lowland Nepal. Destructive sampling was carried out in teak plantations in the Sagarnath Forestry Development Project. Five common taper equations (simple, segmented, and variable exponent types) from the literature as well as one dynamic taper equation were considered as candidate models. Our results showed that the nonlinear dynamic taper equation performed best in terms of fit and cross-validation statistics with least error and bias. This new taper model can be considered as a step forward for hardwood forest management in Nepal. It is expected that this equation will assist forest managers to predict stem volume and diameters to any merchantable limit for teak growing in similar site conditions.

Juvenile polyp located in the recto sigmoid junction is a common pediatric condition. Albeit, being a common occurrence, in resource limited setting the diagnoses of polyp and subsequent polypectomy still possesses major challenges. The case presented here is of a 3-year-old boy who presented with rectal bleeding for 8 months and in whom the diagnoses of rectal polyp had been established. After failed attempts to remove the polyp colonscopically, an open approach was adopted for the removal of the polyp. The two main factors that hindered the more preferred colonoscopic method was the size of the polyp (3cm*3cm), and the setting we are in. Therefore, in conclusion we think an open approach should be on top of the list for removal of rectal polyp in children with large polpys in settings like ours.

The increasing research on science and innovation has shifted consumer awareness from conventional to functional foods that are more nutritious and healthier. The ideation of functional food is based on the addition of probiotics that promote cognitive response, improved immune system, and general wellbeing. At a time when there is noproven therapy for global pandemic SARS-CoV-2 causing infectious viral disease COVID-19, alternative food and nutritional interventions through diet are studied like never before to limit the infection. Probiotics are live microorganisms that have the potential to modulate the human immune system and prevent such infection, which is why several safety issues during its administration must be addressed. While at the same time, it is necessary to update, reform, and tighten the policies and regulations for the food manufacturers dealing with such functional foods to protect consumers from false and misleading claims. This review paper attempts to extensively provide insights into safety and regulatory considerations for probiotic-based foods and beverages.

In this work we present significant improvements to the open-source all-iron battery. We show higher power density and simpler fabrication. We also show a more reproducible procedure for preparing the electrolytes. The results are a highly rechargeable electrochemical cell based on iron, chloride, sulfate, and potassium ions in water at near-neutral pH. The cell is stable for thousands of cycles. It displays modest energy density consistent with the previous all-iron battery. The current is improved by a factor of 10 to a practical level of 500 mA/L and is able to deliver a maximal power of 250 mW/L. While this is modest performance compared to commercial rechargeable batteries, its low cost, simple synthesis, and safe manufacturing may make it suitable for storing renewable energy.

This project was aimed to formulate and characterize mucoadhesive buccal tablets of aceclofenac, utilizing different proportions of three polymers carbopol 934, hydroxypropyl methylcellulose, and sodium carboxymethylcellulose. Twelve batches of buccoadhesive aceclofenac were prepared by the direct compression method. The compressed tablets were then evaluated for physicochemical parameters such as hardness, thickness, weight variation, drug content, friability, swelling index, surface pH, and ex vivo mucoadhesion. In vitro dissolution test was conducted for 12 h according to Indian Pharmacopeia 2018, using the rotating paddle method in phosphate buffer of pH 7.4. Physiochemical parameters like weight variation (231.25–268.75 mg), hardness (8.32–11.56 kg), friability (0.04–0.2%), diameter (9.00 mm), thickness (3.8–4.05 mm), and drug content ((97.67–102.25%) were within the acceptable limit as per Indian Pharmacopeia 2018. The swelling index was reported to be in the range of 112.93–450.19%, at 8 h. The surface pHs of all the batches were in between 6.72 to 6.96. The mucoadhesive strengths (40.5–50 g) varied with the change in polymer concentrations especially of carbopol 934. The dissolution profile of all the batches varied greatly, with a maximum release of 109.41% (in batch 12 at 6 h) to a minimum release of 44.82% (in batch 3 at 12 h). Among them, only batch 1 ensured sustained and effective drug release (88.34% at 12 h) with appropriate swelling index (112.93%) and mucoadhesive strength (40 g). Fourier Transform Infrared Spectroscopy analysis showed no evidence of drug excipients interaction. Hence, the results concluded that buccal mucoadhesive aceclofenac tablets can be formulated. Furthermore, the property of the tablet not only depends on the concentration but also the behavior of the polymers used.

Temperature-dependent interaction parameters of Redlich-Kister (R–K) polynomials for Li–Mg alloy in liquid phase have been optimized using experimental data in the framework of linear and exponential models. These parameters have then been used to compute the thermodynamic properties (excess Gibbs free energy of mixing, enthalpy of mixing and activity) and structural property (concentration fluctuations in the long-wavelength limit) of the alloy at temperatures 1000 K, 1300 K, 1600 K, 1900 K, and 2200 K. The negative values of excess Gibbs free energy of mixing computed using linear T-dependent parameters increases with the rise in the temperature of the system beyond 1000 K while the same physical quantity computed using the exponential T-dependent interaction parameters decreases with the rise in temperatures and does not show any unusual trends up to 2200 K. Similar behavior has been found in the case of other thermodynamic and structural functions. The unusual behavior that appears in the thermodynamic and structural functions computed using linear T-dependent parameters can be eliminated if these functions are computed using exponential T-dependent parameters.

The surface tension and viscosity of Cu–Fe–Si ternary alloys were computed at different temperatures using thermodynamic approaches. The thermodynamic data of the alloy were optimized in the framework of the Redlich-Kister (R–K) polynomials and exponential temperature dependent coefficients of the R–K polynomial were obtained. These coefficients were used to compute the excess Gibbs free energy of mixing of the alloy and the partial excess free energy of the components. The partial excess free energy so obtained was used to compute the surface tension of the ternary Cu–Fe–Si alloy system and its binary sub-systems. The enthalpy of mixing was also optimized and it was used to compute the viscosity of the sub-binary and ternary alloys.

Objective: Bradykinesia has been associated with beta and gamma band interactions in the basal ganglia-thalamo-cortical circuit in Parkinson’s disease. In this present cross-sectional study, we aimed to search for neural networks with electroencephalography whose frequency-specific actions may predict bradykinesia. Methods: Twenty Parkinsonian patients treated with bilateral subthalamic stimulation were first prescreened while we selected four levels of contralateral stimulation (0: OFF, 1–3: decreasing symptoms to ON state) individually, based on kinematics. In the screening period, we performed 64-channel electroencephalography measurements simultaneously with electromyography and motion detection during a resting state, finger tapping, hand grasping tasks, and pronation-supination of the arm, with the four levels of contralateral stimulation. We analyzed spectral power at the low (13–20 Hz) and high (21–30 Hz) beta frequency bands and low (31–60 Hz) and high (61–100 Hz) gamma frequency bands using the dynamic imaging of coherent sources. Structural equation modelling estimated causal relationships between the slope of changes in network beta and gamma activities and the slope of changes in bradykinesia measures. Results: Activity in different subnetworks, including predominantly the primary motor and premotor cortex, the subthalamic nucleus predicted the slopes in amplitude and speed while switching between stimulation levels. These subnetwork dynamics on their preferred frequencies predicted distinct types and parameters of the movement only on the contralateral side. Discussion: Concurrent subnetworks affected in bradykinesia and their activity changes in the different frequency bands are specific to the type and parameters of the movement; and the primary motor and premotor cortex are common nodes.

Environmental pollution due to di-ethyl phthalate (DEP) is one of the major concerns all over the world. This is probably the first study regarding the biodegradation of DEP by newly isolated Pseudomonas juntendi strain CCNU-SK1, P. putida strain CCNU-SK2 and P. nitritireducens strain CCNU-SK3. Bacterial strains were isolated by morphological, biochemical, physiological and 16S rDNA gene sequencing techniques. The biodegradation of DEP was quantified, and degradation kinetics were studied by using high-performance liquid chromatography. The optimum growth of bacteria for strain CCNU-SK1 was obtained at 28 °C, pH 8, DEP (500 mg/L), NaCl (1.5%), half-life (10.19 h); in case of strain CCNU-SK2: 33 °C, pH 7, DEP (400 mg/L), NaCl (1.5%), half-life (13.86 h) and for strain CCNU-SK3: 33 °C, pH 7, DEP (500 mg/L), NaCl (1.75%), half-life (12.6 h). Strain CCNU-SK1 with lowest half-life period was the most efficient bacteria for biodegradation of DEP compared to other isolated strains. More than 99% of all DEP were biodegraded within the 4 days and the complete utilization of (50 mg/L) DEP occurred within 24 h by all strains. All of them were capable of metabolizing not only DEP but also other phthalate esters (PAEs) such as DMP (Di-methyl phthalate), DBP (Di-butyl phthalate), DOP (Di-octyl phthalate), BBP (Benzyl butyl phthalate), DEHP (Di-2-ethylhexyl phthalate) and PA (Phthalic acid), making them the promising agents for the bioremediation in the PAEs contaminated sites.

The continuous flow of new research articles on MDR-TB diagnosis, treatment, prevention and rehabilitation requires frequent update of existing guidelines. This review is aimed at providing clinicians and public health staff with an updated and easy-to-consult document arising from consensus of Global Tuberculosis Network (GTN) experts.The core published documents and guidelines have been reviewed, including the recently published MDR-TB WHO rapid advice and ATS/CDC/ERS/IDSA guidelines.After a rapid review of epidemiology and risk factors, the clinical priorities on MDR-TB diagnosis (including whole genome sequencing and drug-susceptibility testing interpretations) and treatment (treatment design and management, TB in children) are discussed. Furthermore, the review comprehensively describes the latest information on contact tracing and LTBI management in MDR-TB contacts, while providing guidance on post-treatment functional evaluation and rehabilitation of TB sequelae, infection control and other public health priorities. Keywords: MDR-TB, XDR-TB, Diagnosis, Treatment, Prevention, Rehabilitation of sequelae

Background: Self-care helps maintain health, prevents complications and improves the quality of life of patients living with heart failure (HF). Self-care is critical to HF management but has received limited attention in Nepal. Identification of the sociodemographic and clinical characteristics associated with self-care is crucial to tailoring appropriate self-care programs to improve health outcomes including patients’ quality of life. Aims: The aims of this study were to describe self-care including the factors influencing self-care and the relationship between self-care and health-related quality of life in patients living with HF in Kathmandu, Nepal. Methods: We used a cross-sectional observational study design to measure self-care maintenance, self-care management, and self-care confidence using the Nepali Self-Care of Heart Failure Index. To analyze data, we used descriptive statistics, bivariate associations and regression modeling. Results: We recruited 221 patients with HF: mean age 57.5 ± 15.76 years, 62% male. The results in this sample indicated poor self-care maintenance (38.5 ± 11.56), management (45.7 ± 15.14), and confidence (40.9 ± 16.31). Patients with higher education were associated with higher self-care maintenance and management. Living alone and a better New York Heart Association functional classification for HF were related to higher self-care confidence. Higher social support was associated with better self-care. Self-care confidence was an independent predictor of self-care maintenance, management and health-related quality of life on adjusted analyses. Conclusion: Self-care was limited among patients living with HF in Nepal yet was associated with better quality of life. The study identified various sociodemographic and clinical factors related to self-care, which could be crucial while developing self-care interventions.

We have performed a proteomics analysis of a human retinal pigment epithelial cell line (ARPE-19), which represents a widely used model for in vitro studies of cellular and molecular mechanisms related to human RPE cells (Dunn et al., 1996; Weigel et al., 2002) [1,2]. Whole cell protein extracts were separated in four gel fractions via short (10 min) SDS-PAGE runs. Following fractionation and trypsin digestion, the resulting peptides were separated on a nano UPLC LC system and analyzed on-line with a QTof-IMS instrument: a tandem mass spectrometer with ion mobility separation (Synapt G2-Si). Data were acquired in data-independent mode (UDMSE), which allows for absolute and/or relative post-acquisition protein quantification (Silva et al., 2006) [3]. The proteome profile data obtained from this study can be used as a protein reference database with qualitative and quantitative protein information related to ARPE-19 cells under normal growth conditions.

We present precision measurements of the target and beam-target spin asymmetries from neutral pion electroproduction in deep-inelastic scattering (DIS) using the CEBAF Large Acceptance Spectrometer (CLAS) at Jefferson Lab. We scattered 6-GeV, longitudinally polarized electrons off longitudinally polarized protons in a cryogenic 14NH3 target, and extracted double and single target spin asymmetries for ep→e′π0X in multidimensional bins in four-momentum transfer (1.0

Objectives: The South Asian neighboring countries of India include Bangladesh, Bhutan, Nepal, The Maldives, Pakistan and Sri Lanka. Interestingly all these countries possess either a land or a sea border with India and no border among themselves. These countries have historic, cultural, ethnic and genetic links with India. The paper describes the developmental history and current status of cardiac surgery in these countries. Methods: Thorough search of the printed and electronic materials has been made. The authors visited all these countries and contacted the eminent surgeons personally or through mails. All the information is cross-checked and compiled. Record keeping is not well organized in most of these countries. Best information often came from unusual sources like Anesthetists’ society or the corporate houses. Results: Four of these countries Bangladesh, Nepal, Pakistan and Sri Lanka have their cardiac surgical programs. Collectively they perform around 38000 cardiac operations a year which is a quarter of the cases performed in India. These countries are important sources of medical tourism in India which is worth 3 billion US$ of business annually. Conclusion: When the number of operations per million populations is considered, Bangladesh and Nepal are lagging behind India where as Pakistan has a comparable figure. Sri Lanka with 265 cardiac operations/million populations has the best figures in the region. However when compared with the Western countries even the Lankan figures also look quite inadequate.

Background: Heart failure is a highly burdensome syndrome and is rapidly increasing in prevalence in low and middle-income countries and outcomes are influenced at the level of the patient, provider and health system. Understanding heart failure beyond a biomedical perspective and the relationship between health outcomes and social determinants of health is critical for informing policy development and improving health outcomes. Aim: To identify the social determinants of health for improving health outcomes for individuals with heart failure in Thailand. Method: This integrative review included studies published between January 1, 2008, and March 31, 2016 in both the Thai and English language identified through searching Scopus, PubMed, and CINAHL. Results: Six experimental, eight descriptive and two qualitative studies were identified met the inclusion and exclusion criteria. The majority of study participants were elderly, female, had low-education and income levels, were participating in a universal coverage scheme and living in a rural setting. All interventions were delivered at the level of the individual, focusing on education to improve knowledge, self-care, and functional status. Findings showed an improvement in health outcomes which were moderated by social determinants of health such as gender and income. Conclusion: As the burden of heart failure increases in Thailand and other emerging economies, developing culturally appropriate, affordable and acceptable models of intervention considering social determinants of health is necessary.

Objective: The main objective of this study was to identify the problems of Nepalese breast cancer survivors living in an urban area who had completed their treatment for at least 6 months. Methods: A cross-sectional descriptive study was conducted to assess the problems of breast cancer survivors who were registered at the Nepal Cancer Support Group. Fifty-one women who were diagnosed with breast cancer (Stage 0 to III) and were currently disease-free were enrolled in the study. They were interviewed using structured interview schedule using the Breast Cancer Prevention Trial Symptom Scale. Statistical analysis was carried out with SPSS (version 16). Results: The mean age of the women at the time of enrollment was 47.3 years. The most common modality of treatment they received was the combination of surgery, chemotherapy, and radiotherapy (84%). Top five symptoms experienced by the survivors on the basis of frequency and severity were tiredness (61%), lack of energy (57%), forgetfulness (57%), lack of interest in sex (52%), general body aches (49%), and feeling of worrisome and anxiousness about future (49%). Women with age

Background: Chronic kidney disease is an important cause of global mortality and morbidity. Data for epidemiological features of chronic kidney disease and its risk factors are limited for low-income and middle-income countries. The International Society of Nephrology's Kidney Disease Data Center (ISN-KDDC) aimed to assess the prevalence and awareness of chronic kidney disease and its risk factors, and to investigate the risk of cardiovascular disease, in countries of low and middle income. Methods: We did a cross-sectional study in 12 countries from six world regions: Bangladesh, Bolivia, Bosnia and Herzegovina, China, Egypt, Georgia, India, Iran, Moldova, Mongolia, Nepal, and Nigeria. We analysed data from screening programmes in these countries, matching eight general and four high-risk population cohorts collected in the ISN-KDDC database. High-risk cohorts were individuals at risk of or with a diagnosis of either chronic kidney disease, hypertension, diabetes, or cardiovascular disease. Participants completed a self-report questionnaire, had their blood pressure measured, and blood and urine samples taken. We defined chronic kidney disease according to modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria; risk of cardiovascular disease development was estimated with the Framingham risk score. Findings: 75 058 individuals were included in the study. The prevalence of chronic kidney disease was 14·3% (95% CI 14·0–14·5) in general populations and 36·1% (34·7–37·6) in high-risk populations. Overall awareness of chronic kidney disease was low, with 409 (6%) of 6631 individuals in general populations and 150 (10%) of 1524 participants from high-risk populations aware they had chronic kidney disease. Moreover, in the general population, 5600 (44%) of 12 751 individuals with hypertension did not know they had the disorder, and 973 (31%) of 3130 people with diabetes were unaware they had that disease. The number of participants at high risk of cardiovascular disease, according to the Framingham risk score, was underestimated compared with KDIGO guidelines. For example, all individuals with chronic kidney disease should be considered at high risk of cardiovascular disease, but the Framingham risk score detects only 23% in the general population, and only 38% in high-risk cohorts. Interpretation: Prevalence of chronic kidney disease was high in general and high-risk populations from countries of low and middle income. Moreover, awareness of chronic kidney disease and other non-communicable diseases was low, and a substantial number of individuals who knew they were ill did not receive treatment. Prospective programmes with repeat testing are needed to confirm the diagnosis of chronic kidney disease and its risk factors. Furthermore, in general, health-care workforces in countries of low and middle income need strengthening. Funding: International Society of Nephrology.

Background: Our goal was to identify what impact chronic kidney disease (CKD) and its associated risk factors, such as body mass index (BMI), diabetes and hypertension, have on preeclampsia and other adverse pregnancy outcomes in the CKD population., Methods: This was a population-based cohort study of women with CKD who had a pregnancy from 2010 to 2022 (n = 95). At the time of the woman's pregnancy, data was collected on demographics, clinical measures, BMI, CKD etiology and other renal parameters. Outcomes included preeclampsia, pre-term delivery, and low birth weight., Results: Pre-pregnancy BMI increased over time in patients with CKD, with a median (interquartile range) BMI of 25 (22-29) prior to 2016 and 29 (25-34) after 2016 (p = 0.01). There were significant trends of increasing age at delivery and decreasing pre-pregnancy estimated glomerular filtration rate (eGFR) by delivery year. Preeclampsia affected nearly half of pregnancies in this cohort. In multivariate analyses, BMI and chronic hypertension did not impact the odds of preeclampsia, preterm delivery or low birth weight, though a CKD etiology of diabetes (19/20 with type I diabetes), was associated with a significant increase in preeclampsia risk (odds ratio (OR) 7.41 (95 % CI 2.1-26.1)). Higher pre-pregnancy eGFR was associated with a lower odds of preterm delivery (OR 0.81 (95 % CI 0.67-0.98)) per 10 ml/min/1.73 m 2 )., Conclusion: Pre-pregnancy BMI significantly increased over time, similar to the general population. While preeclampsia was common in CKD patients, outcomes were associated with eGFR and CKD etiology as opposed to BMI and chronic hypertension., (Copyright © 2024 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.)

Shell waste from shellfish processing contains valuable natural polysaccharides, including sulfated polysaccharides, acidic polysaccharides, glycosaminoglycans, chitin and their derivatives. These shellfish waste-derived polysaccharides have numerous functional and biological properties that can be applied in various industries, including the cosmeceutical industry. In keeping with global sustainability and green industry trends, the cosmeceuticals industry is transitioning from petrochemical-based ingredients to natural substitutes. In this context, shell waste-derived polysaccharides and their derivatives can play a major role as natural substitutes for petroleum-based components in various cosmeceutical skincare, hair care, oral care and body care products. This review focuses on the presence of polysaccharides and their derivatives in shell waste and discusses their various cosmeceutical applications in skin care, hair care, sun care, oral care and body care products. This indicates that shell waste utilization will help create a circular economy in which extracted polysaccharides are used to produce green cosmeceutical products., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)