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Alpha-gal syndrome (AGS) is an IgE-mediated allergic reaction to galactose-α-1,3-galactose, primarily linked with Lone Star tick bites in the United States. It presents with symptoms ranging from urticaria and gastrointestinal (GI) manifestations to delayed anaphylaxis following red meat consumption. We aimed to study AGS patients' clinical manifestations, diagnosis, and outcomes. A retrospective chart review of patients who underwent serological testing for suspected AGS between 2014 and 2023 at Mayo Clinic was performed. Patients with positive serology were age and sex matched with those who tested negative. Clinical characteristics of seropositive cohort with and without GI symptoms were compared, and outcomes assessed. Of 1260 patients who underwent testing, 124 tested positive for AGS. They were matched with 380 seronegative control subjects. AGS patients reported a higher frequency of tick bites (odds ratio [OR], 26.0; 95% confidence interval [CI], 9.8–68.3), reported a higher prevalence of urticaria (56% vs 37%; P =.0008), and were less likely to have asthma (OR, 0.4; 95% CI, 0.3–0.7). They had a lower prevalence of heartburn (6% vs 12%; P =.03) and bloating (6% vs 13%; P =.03). A total of 47% had GI symptoms, and a higher proportion were female than those without GI symptoms (69% vs 35%; P =.002). During a mean follow-up of 27 months, 22 of 40 patients reported symptom resolution after avoiding red meat, and 7 were able to transition to regular diet. A diagnosis of AGS should be strongly considered in patients with a history of tick bites and clinical presentation of allergic or GI manifestations. Dietary intervention is effective in most but not all patients. [Display omitted] [ABSTRACT FROM AUTHOR]

• In the early hours (12 h) can lead to significant changes in the transcranial ultrasonographic measurements. • Following ventriculoperitoneal shunt, the reductions in the optic nerve sheath diameter and the third ventricular diameter are substantial. • The improvements in intracranial hemodynamics are statistically significant following ventriculoperitoneal shunt. • The reductions in optic nerve sheath diameter is associated with the clinical improvement in headache following ventriculoperitoneal shunt as compared to other modalities. Transcranial sonographic (TCS) evaluation of optic nerve sheath diameter (ONSD), third ventricular diameter (TVD) and mean flow velocities (Vm) and pulsatility index (PI) of middle cerebral artery (MCA) can provide important insights to the change in intracranial dynamics following ventriculo-peritoneal (VP) shunt surgery. The primary objective of this study was to observe changes in ONSD values following VP shunt at 12 h, compared to pre-VP shunt values. After obtaining ethical approval, patients admitted with a diagnosis of hydrocephalus posted for a VP shunt surgery were prospectively enrolled. TCS evaluation was done before induction of anesthesia and 12-hour post-VP shunt surgery. We recorded the values of ONSD, TVD and Vm and PI MCA at both time points. Thirty-four patients (19 male) were evaluated for ONSD and for the improvement of symptoms. Transtemporal window could not be obtained in six patients. At 12 h following VP shunt, bilateral median ONSD values reduced significantly from their pre-VP shunt values [right ONSD- 0.62 (0.59–0.64) to 0.53 (0.5–0.54) mm (p < 0.001); left ONSD- 0.62 (0.59–0.63) to 0.53 (0.5–0.54) mm (p < 0.001)]. Similarly, the median TVD at 12 h post-VP shunt reduced significantly from its pre-VP shunt measurements [0.97 (0.85–1.09) to 0.74 (0.7–0.84) cm]. PI MCA values reduced significantly, while Vm MCA values increased significantly from the pre-VP shunt values. VP shunt reduced the ONSD, TVD, PI MCA and increased the Vm MCA after shunt surgery as early as 12hrs. [ABSTRACT FROM AUTHOR]

Gitelman syndrome (GS) is a rare genetic renal disease characterized by hypomagnesemia, hypokalemia, hypocalciuria, and metabolic alkalosis. It usually presents in late childhood or early adulthood. A 30-year-old female diagnosed case of multidrug-resistant (MDR-TB) pulmonary tuberculosis 2 months ago presented to our outpatient department with intermittent painful spasms in all four limb muscles. Her treatment regimen consisted of kanamycin, levofloxacin, cycloserine, and ethionamide. On further evaluation, her investigations revealed hypokalemia, hypocalcemia, hypomagnesemia, metabolic alkalosis with normal serum creatinine level. She was initially treated with intravenous calcium and potassium. However, the electrolyte abnormalities and metabolic alkalosis persisted. All her lab parameters became normal after discontinuing kanamycin and electrolyte replacement for 4 weeks. She was discharged and advised to continue her antituberculosis treatment. There was no recurrence of symptoms on further follow up. [ABSTRACT FROM AUTHOR]

Paclitaxel is commonly used as first-line chemotherapy for HER2-negative metastatic breast cancer (MBC) patients. However, with response rates of 21.5–53.7% and significant risk of peripheral neuropathy, there is need for better chemotherapy. This open-label phase II/III trial randomised HER2-negative MBC patients 1:1 to either 6 cycles of three-weekly cabazitaxel (25 mg/m2), or, weekly paclitaxel (80 mg/m2) over 18 weeks. The primary endpoint was progression free survival (PFS). Secondary endpoints included objective response rate (ORR), time to response (TTR), overall survival (OS), safety and tolerability and quality of life (QoL). 158 patients were recruited. Comparing cabazitaxel to paclitaxel, median PFS was 6.7 vs 5.8 months (HR 0.87; 80%CI 0.70–1.08, P = 0.4). There was no difference in median OS (20.6 vs 18.2 months, HR 1.00; 95%CI 0.69–1.45, P = 0.99), ORR (41.8% vs 36.7%) or TTR (HR 1.09; 95%CI 0.68–1.75, P = 0.7). Grade ≥3 adverse events occurred in 41.8% on cabazitaxel and 46.8% on paclitaxel; the most common being neutropenia (16.5%) and febrile neutropenia (12.7%) cabazitaxel and neutropenia (8.9%) and lung infection (7.6%) paclitaxel. Peripheral neuropathy of any grade occurred in 54.5% paclitaxel vs 16.5% cabazitaxel. Mean EQ-5D-5L single index utility score (+0.05; 95%CI 0.004–0.09, P = 0.03) and visual analogue scale score (+7.7; 95%CI 3.1–12.3, P = 0.001) were higher in cabazitaxel vs paclitaxel. Three-weekly cabazitaxel in HER2-negative MBC does not significantly improve PFS compared to weekly paclitaxel, although it has a lower risk of peripheral neuropathy with better patient reported QoL outcomes. It is well tolerated and requires fewer hospital visits. [Display omitted] • 3 weekly Cabazitaxel does not significantly improve PFS versus weekly paclitaxel. • PFS and OS were similar between 3 weekly Cabazitaxel and weekly Paclitaxel. • Cabazitaxel had better overall patient reported health outcomes. • Cabazitaxel had a lower risk of peripheral neuropathy. • Three weekly Cabazitaxel requires fewer hospital visits than weekly Paclitaxel. [ABSTRACT FROM AUTHOR]

• This study presents the RBP-CNN model for the precise classification of brain tumors in medical imaging. • This research is to bridge a critical gap by providing a more accurate and efficient model for classifying brain tumors. • A classification accuracy of 96% with a reduced false classification ratio of 7% across a dataset of 3000 samples. • RBP-CNN emerges as an innovative and effective solution, advancing the field of medical image categorization. • The findings of this study contribute a RBP-CNN as a potential state-of-the-art tool for medical image analysis. This study presents the RBP-CNN model, a convolutional neural network specifically designed for the precise classification of brain tumors in medical imaging. Conventional methods often encounter difficulties in extracting image noise and texture features, which has led to the incorporation of regional binary patterns (RBP) and Gray Standard Normalization (GSN) preprocessing techniques in CNN. The research addresses fundamental inquiries regarding the impact of the model on accuracy, false classifications, and efficiency. The novelty of RBP-CNN lies in its distinctive approach to extracting texture features, which involves optimizing pixel values through GSN preprocessing and generating regional binary patterns based on integral images. The objective of this research is to bridge a critical gap by providing a more accurate and efficient model for classifying brain tumors. The key findings reveal the exceptional performance of RBP-CNN, achieving a classification accuracy of 96% with a reduced false classification ratio of 7% across a dataset of 3000 samples. Comparative analyses position RBP-CNN as superior to alternative models in terms of accuracy, false classification rates, and efficiency. The structural insights and hyperparameter values of the model, as well as its application to the FigShare dataset, demonstrate its robustness and scalability. RBP-CNN emerges as an innovative and effective solution, advancing the field of medical image categorization. The findings of this study contribute a novel methodology, paving the way for future exploration in hyperspectral image applications and positioning RBP-CNN as a potential state-of-the-art tool for medical image analysis. [ABSTRACT FROM AUTHOR]

The use of domperidone (DOM) for gastroparesis (GP) remains controversial and limited. We aimed to present outcomes of DOM therapy for treatment of patients participating in the multicenter National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium (GpCRC) Registries (GpR). The GpCRC cohort consisted of patients with GP (75%) and with GP-like symptoms but with normal gastric emptying (25%). The DOM group initiated therapy during the 96 weeks of enrollment in GpR1 and GpR2. Patients who had previously taken or who were on DOM therapy at enrollment were excluded from this analysis. The control group did not use domperidone (non-DOM group) before or after enrollment. The following outcome measures were identified: change from baseline in Gastroparesis Cardinal Symptom Index total score, with 3 subscales, plus Gastroesophageal Reflux Disease and Patient Assessment of Upper Gastrointestinal Disorders–Quality of Life scores. Overall, of 748 patients, 181 (24%) were in the DOM group, whereas 567 were in the non-DOM group. Sixty-three percent of participants had idiopathic GP. At baseline, DOM patients compared with non-DOM patients were significantly younger, had lower body mass index, non-Hispanic ethnicity, a higher annual household income, lower narcotic utilization, lower supplemental and complimentary medication use, and were more likely to have delayed gastric emptying time, as well as worse nausea and fullness scores. Compared with non-DOM patients, DOM patients experienced moderate but significantly more improvement in GP outcome measures: Gastroparesis Cardinal Symptom Index total score (P =.003), nausea (P =.003), and fullness subscales (P =.005), upper abdominal pain score (P =.04), Gastroesophageal Reflux Disease score (P =.05), and Patient Assessment of Upper Gastrointestinal Disorders–Quality of Life score (P =.05). Utilizing the method of pragmatic modeling to evaluate long-term treatment of GP in a large GpCRC database, DOM treatment resulted in moderately but significantly improved GP. This project was based on data generated by 2 GpCRC Registry studies recognized under the Clinicaltrial.gov numbers: NCT00398801 and NCT01696747 symptoms compared with a group receiving standard-of-care but not DOM. [ABSTRACT FROM AUTHOR]

Coronavirus disease-2019 (COVID-19), associated with the outbreak of deadly virus originating in Wuhan, China, is now a global health emergency and a matter of serious concern. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is rapidly spreading worldwide, and WHO declared the outbreak of this disease a pandemic on March 11, 2020. Though some of the countries have succeeded in slowing down the rate of the spread of this pandemic, most the countries across the globe are still continuing to experience an increasing trend in the growth and spread of this deadly disease. Hence, in the current scenario, is has now become essential to control and finally irradicate this deadly disease using an effective vaccine. One can expect the prominent role of already available antivirals, antibodies and anti-inflammatory drugs in the market, in this pandemic. Immunomodulatory and biological therapeutics are also in the high expectations to combat COVID-19. RNA based vaccines might be more advantageous over traditional vaccines, to deal with the pandemic threat. Aiming towards this direction, clinical trials for SARS-CoV-2 vaccine are currently underway all across the globe. Currently, about 150 health related organizations and research labs are in the progress for the evolution of COVID-19 vaccines, globally. The initial aim of these clinical trials is to assess vaccine's safety, which is tested in Phase I/II/III studies where the primary outcomes typically examine the frequency of adverse effects. The vaccine is about to undergo phase III testing in several countries such as India, USA, South Africa, Brazil and England. US Government, under Operation Wrap Speed is even ready to sponsor three candidates, namely-The University of Oxford and AstraZeneca's AZD1222; Moderna's mRNA-1273; and Pfizer and BioNTech's BNT162 for Phase III trials. [ABSTRACT FROM AUTHOR]

The issue of vertical transmission of SARS-CoV-2 infection to the foetus has not yet been resolved. Its main reason is lack of a bigger study to analyse this question. The evidence of the affection of the foetus during antenatal or intrapartum period is limited to some anecdotal reports. To look for the possibility of vertical transmission of Severe Acute Respiratory Syndrome – Corona Virus-2 (SARS-CoV-2) infection to the foetus, this prospective pilot study was conducted at a tertiary health care COVID-19 designated centre of Armed Forces. This study was conducted during 01 June 2020 and 15 October 2020 and included 54 covid-positive pregnant mothers. During delivery, amniotic fluid and cord blood samples were collected in a sterile manner. Amniotic fluid samples were not collected during vaginal deliveries as chances of contamination was very high. These samples were tested for the presence of SARS-CoV-2 gene by Reverse Transcriptasee Polymerase Chain Reaction (RT-PCR) test, and the results were analysed. Newborns were allowed to room in with mother, and they underwent throat and nasal swab RT-PCR testing of covid within 24–48 h of delivery. A total of 1520 pregnant mothers underwent RT-PCR test during the study period. Total positivity rate among our pregnant women was 2.8%. Out of 54 covid-positive women during the study period, amniotic fluid RT-PCR tests were carried out for 43 women, and cord blood was tested for 45 women. RT-PCR test of amniotic fluid, cord blood and nasal and throat swab of all newborns delivered by SARS-CoV-2-positive pregnant women were negative. Based on our study, the possibility of intrauterine vertical transmission of SARS-CoV-2 infection appears to be unlikely. [ABSTRACT FROM AUTHOR]

• Influence of ring size on corrosion inhibition potential of Cycloalkyltriphenylphosphonium based ionic liquids has been evaluated. • Cyclohexyl ring containing IL (CHTPB) acts as better corrosion inhibitor than cyclopentyl ring containing IL (CPTPB). • Adsorption of CPTPB and CHTPB follows Langmuir adsorption isotherm model. • CPTPB and CHTPB behaved as mixed-type corrosion inhibitors. • Computational modelings were used to corroborate experimental results. Background: Corrosion mitigation potential of environmental sustainable cycloalkyltriphenylphosphonium based ionic liquids, namely, cyclopentyltriphenylphosphonium bromide (CPTPB), cyclohexyl triphenylphosphonium Bromide (CHTPB), differing in the size of cycloalkyl rings was demonstrated for mild steel corrosion in 0.5 M H2SO4. Methods: Electrochemical (EIS and PDP), surface (SEM and AFM) and computational modelings (DFT and MDS). Findings: Results suggest that CHTPB containing cyclohexyl ring exhibits superior inhibition potential as compared to the CPTPB containing cyclopentyl ring. CPTPB and CHTPB exhibit highest protection potential of 99.36% and 99.52%, respectively at 10−2 M. Both the inhibitors are mixed type of inhibitors. Potentiostatic polarization (PP) study showed that passivation was observed only at lower concentrations due to a synergistic effect. Adsorption mechanism of CPTPB and CHTPB was best explained using the Langmuir adsorption isotherm. Surface morphologies of protected metallic specimens were greatly enhanced due to the formation of protective film by CPTPB and CHTPB. MDS and DFT based computational analyses were support the experimental outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

The aim of this study was to clarify the pathophysiology of functional dyspepsia (FD), a highly prevalent gastrointestinal syndrome, and its relationship with the better-understood syndrome of gastroparesis. Adult patients with chronic upper gastrointestinal symptoms were followed up prospectively for 48 weeks in multi-center registry studies. Patients were classified as having gastroparesis if gastric emptying was delayed; if not, they were labeled as having FD if they met Rome III criteria. Study analysis was conducted using analysis of covariance and regression models. Of 944 patients enrolled during a 12-year period, 720 (76%) were in the gastroparesis group and 224 (24%) in the FD group. Baseline clinical characteristics and severity of upper gastrointestinal symptoms were highly similar. The 48-week clinical outcome was also similar but at this time 42% of patients with an initial diagnosis of gastroparesis were reclassified as FD based on gastric-emptying results at this time point; conversely, 37% of patients with FD were reclassified as having gastroparesis. Change in either direction was not associated with any difference in symptom severity changes. Full-thickness biopsies of the stomach showed loss of interstitial cells of Cajal and CD206+ macrophages in both groups compared with obese controls. A year after initial classification, patients with FD and gastroparesis, as seen in tertiary referral centers at least, are not distinguishable based on clinical and pathologic features or based on assessment of gastric emptying. Gastric-emptying results are labile and do not reliably capture the pathophysiology of clinical symptoms in either condition. FD and gastroparesis are unified by characteristic pathologic features and should be considered as part of the same spectrum of truly "organic" gastric neuromuscular disorders. NCT00398801 , NCT01696747 [ABSTRACT FROM AUTHOR]

Background: There is limited data regarding the electrophysiological abnormalities and arrhythmias in children with COVID-19, including those associated with treatment using potentially proarrhythmic hydroxychloroquine (HCQ) and azithromycin (AZN).Objectives: To describe the electrophysiologic findings and arrhythmias associated with pediatric COVID-19 and its treatment.Methods: A single-center retrospective chart review was undertaken and included all patients with (1) symptoms of COVID-19 and (2) PCR-positive nasopharyngeal swabs for SARS-CoV-2 who were placed on continuous telemetry for the duration of their hospitalization during March through May, 2020.Results: Thirty-six patients were included in the study. Significant arrhythmias were found in 6 (nonsustained ventricular tachycardia in 5 and sustained atrial tachycardia in 1). All were self-resolving and half prompted prophylactic antiarrhythmic therapy. Patients with significant arrhythmias were likely to have noncardiac comorbidities (4/6), but these were not more common than in patients without arrhythmias (20/30, P = 1). The use of HCQ was associated with statistically significant QTc prolongation (413 ± 19 ms vs 425 ± 16 ms, P =.005). QTc was not statistically different in patients with and without arrhythmias (425 ± 15 ms vs 425 ± 15 ms, P = 1).Conclusions: In pediatric patients with PCR-positive active COVID-19 infection, significant arrhythmias are infrequent, but are more common than expected in a general pediatric population. Comorbidities are not more common in patients with arrhythmias than in patients without arrhythmias. COVID-19 treatment using HCQ is associated with QTc prolongation but was not associated with arrhythmias in pediatric patients. [ABSTRACT FROM AUTHOR]

Campylobacter is an enteric pathogen and a leading bacterial cause of diarrhea worldwide. It is widely distributed in food animal species and is transmitted to humans primarily through the foodborne route. While generally causing self-limited diarrhea in humans, Campylobacter may induce severe or systemic infections in immunocompromised or young/elderly patients, which often requires antibiotic therapy with the first-line antibiotics including fluoroquinolones and macrolides. Over the past decades, Campylobacter has acquired resistance to these clinically significant antibiotics, compromising the effectiveness of antibiotic treatments. To address this concern, many studies have been conducted to advance novel and alternative measures to control antibiotic-resistant Campylobacter in animal reservoirs and in the human host. Although some of these undertakings have yielded promising results, efficacious and reliable alternative approaches are yet to be developed. In this review article, we will describe Campylobacter-associated disease spectrums and current treatment options, discuss the state of antibiotic resistance and alternative therapies, and provide an evaluation of various approaches that are being developed to control Campylobacter infections in animal reservoirs and the human host. [ABSTRACT FROM AUTHOR]

This article unveils a new hybrid configuration of ring type VCO (voltage controlled oscillator) consisting of CMOS and current starved inverter to generate full voltage swing. A certain number of such inverters are cascaded alternatively to obtain the output frequency (f osc). The novelty lies in the fact that this design offers a good trade-off of power, frequency and gate count against CMOS based or current starved based design counterpart. In a 90 nm process, the highest f osc achieved for a 7th stage VCO device footprint is 1.78 GHz with a power dissipation of 44.59 µW at a supply and control voltage of 1.2 V and 1 V respectively. The simulated phase noise and output noise of the layout read to be −95.15dBc/Hz and −144.55 dB respectively measured at 1 MHz offset frequency along with the corresponding figure of merit (FOM) of −173.67dBc/Hz. In order to understand the robustness and scalability of the proposed design, the performances are observed using Monte Carlo study and as small as UMC 28 nm CMOS process. [ABSTRACT FROM AUTHOR]

The pathogenesis of functional dyspepsia (FD) is complex and still remains to be established. Recent studies support duodenal inflammation with increased infiltration of eosinophils and a higher level of systemic cytokines among patients with FD. These findings may help to understand the underlying pathophysiology of FD. The aim of this study was to evaluate the association between duodenal eosinophilia and FD. A total of 84 patients (42 cases of FD and 42 subjects without dyspepsia as control, mean age 31 years, 56% female) were recruited for this prospective observational study. FD was diagnosed by validated Bangla version of the ROME III criteria. Patients with no symptoms of FD who were referred for upper gastrointestinal endoscopy for other reasons were included as control. Biopsy specimens were taken from the second part (D2) of the duodenum of all participants. The eosinophil count was quantitatively evaluated by hematoxylin and eosin staining and expressed in numbers per 5 HPF. The association between duodenal eosinophilia (defined as ≥22/5HPF a priori) and FD was assessed. Significantly increased duodenal eosinophil count was found in patients with FD than patients without dyspepsia (p = 0.001). 57.1% of patients with FD had duodenal eosinophilia. A significant positive association was found between duodenal eosinophilia and FD (OR = 5.67, 95% CI 1.92–17.2, p = 0.001). A positive association was also observed between duodenal eosinophilia and postprandial distress syndrome (OR = 5.54, 95% CI 0.86–45.24, p = 0.036). A higher odds ratio was noticed among those who complain of early satiety. A significant positive association was found between duodenal eosinophilia and FD especially among those with postprandial distress syndrome. It requires further large scale multicenter studies to establish duodenal eosinophilia as a biomarker of FD. [ABSTRACT FROM AUTHOR]

The anterior cruciate ligament (ACL) is a commonly affected knee ligament prone to frequent injuries. Henceforth, we aimed to determine the diagnostic accuracy of lever sign test in Acute and chronic ACL injuries. At the institution's initial outpatient visit, 150 consecutive patients (92 males and 58 females) were evaluated. Total 108 patients had injury in their right leg, whereas 42 had injury in their left leg. Based on time since injury, the patients were divided into Acute and chronic groups. Clinical examinations (lachman's test and lelli's test) of all patients were confirmed with arthroscopic findings and compared between the two groups. In the acute ACL injury, the lever test had a kappa value 0.704. The accuracy and sensitivity of the Lachman, anterior drawer, pivot shift, and lever tests were calculated. We found that the lever test had the highest accuracy and sensitivity (85.48 %, 91.18 %) than the rest. In the chronic ACL injury, the kappa value for the results of the Lachman test evaluation was 0.723. The chronic ACL injuries accuracy and sensitivity values for the Lachman (86.36 %, 91.67 %), anterior drawer (76.14 %, 81.25 %), pivot shift (55.68 %, 58.49 %), and lever tests were determined. The lever sign test is more accurate and reliable in the acute ACL injuries, while the Lachman test is more accurate and reliable in the chronic ACL injuries. [ABSTRACT FROM AUTHOR]

There has been increased reporting of chronic kidney disease of unknown etiology (CKDu) in certain agricultural communities in the world. In India, an increased prevalence of CKDu has been observed in the states of Andhra Pradesh, Odisha, Goa, and Maharashtra. Although no single causative factor has been proved, several have been proposed: water-borne agrochemicals, silica, chemical flavors in betel nuts, and pesticides. The renal biopsy findings have been similar to those seen in Sri Lanka and Mesoamerican nephropathy in that the predominant findings have been tubular atrophy and interstitial fibrosis with little or no involvement of the glomerular and vascular compartments. Because most of the affected communities belong to the lower socioeconomic group including farmers, a multipronged approach is required for addressing this CKDu epidemic with an emphasis on awareness, prevention, screening, surveillance, provision of renal replacement therapy, increased government spending on health care, and systematic research. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is a pain disorder classified by bowel habits, disregarding other factors that may influence the clinical course. The aim of this study was to determine if IBS patients can be clustered based on clinical, dietary, lifestyle, and psychosocial factors. Between 2013 and 2020, the Mayo Clinic Biobank surveyed and received 40,291 responses to a questionnaire incorporating Rome III criteria. Factors associated with IBS were determined and latent class analysis, a model-based clustering, was performed on IBS cases. We identified 4021 IBS patients (mean 64 years; 75% women) and 12,063 controls. Using 26 variables separating cases from controls, the optimal clustering revealed 7 latent clusters. These were characterized by perceived health impairment (moderate or severe), psychoneurological factors, and bowel dysfunction (diarrhea or constipation predominance). Health impairment clusters demonstrated more pain, with the severe cluster also having more psychiatric comorbidities. The next 3 clusters had unique enrichment of psychiatric, neurological, or both comorbidities. The bowel dysfunction clusters demonstrated less abdominal pain, with diarrhea cluster most likely to report pain improvement with defecation. The constipation cluster had the highest exercise score and consumption of fruits, vegetables, and alcohol. The distribution of clusters remained similar when Rome IV criteria were applied. Physiologic tests were available on a limited subset (6%), and there were no significant differences between clusters. In this cohort of older IBS patients, 7 distinct clusters were identified demonstrating varying degrees of gastrointestinal symptoms, comorbidities, dietary, and lifestyle factors. Further research is required to assess whether these unique clusters could be used to direct clinical trials and individualize patient management. [Display omitted] [ABSTRACT FROM AUTHOR]

Changes in skeletal muscle mass and quality are associated with type 2 Diabetes (T2D) and its complications. We evaluated the prevalence of sarcopenia in patients with T2D and its association with various anthropometric and metabolic parameters. A total of 229 patients with T2D, ≥20–60 years, were screened for sarcopenia using handgrip strength (HGS) by dynamometer, physical performance test (by Short Physical and chair stand test), and height-adjusted appendicular skeletal muscle index (ASMI) by Dual Energy X-ray Absorptiometry (DXA) applying Asian Working Group on Sarcopenia (AWGS). Multiple logistic regressions were performed to identify the factors associated with sarcopenia. The mean age was 46.2 ± 7.4 years with 55% being women. The prevalence of low HGS, poor physical performance, low ASMI, possible sarcopenia, sarcopenia, and severe sarcopenia was 16.2%, 39.3%, 33%, 43%, 18.8%, and 6.1%, respectively. Age >45 years and use of >2 oral hypoglycaemic agents (OHA's) were risk factors for low HGS (OR:3.51, 95%CI = 1.5–8.3) and low ASMI (OR:2.40, 95%CI = 1.05, 5.49, p-0.04), respectively. Female sex (OR:3.3 1.8–6.1 p < 0.01), age >45 years (OR:2.12, 95% CI = 1.2–3.8 p-0.012) and liver fibrosis (OR: 2.12, 95% CI = 1.01–4.46 p-0.048) were independently associated with poor performance. No association was found with HbA1c, dyslipidaemia, albuminuria, hypertension, or duration of diabetes and sarcopenia. Sarcopenia is becoming increasingly recognized as a significant complication in younger individuals with T2D, and poor physical performance plays a vital role in its development. The prevalence of sarcopenia rises with advancing age, underscoring the importance of early intervention to address this condition. • Sarcopenia affects a significant proportion of younger individuals with type 2 diabetes. • Men with diabetes had higher prevalence of low appendicular lean mass index (ALMI) than women. • Prevalence of poor physical performance was more in women than men with diabetes. [ABSTRACT FROM AUTHOR]

Tetralogy of Fallot with unilateral absence of the pulmonary artery is a rare congenital cardiac disorder that makes the ipsilateral lung susceptible to opportunistic infections. This disorder adds to the complexity of the case and tests the surgical and decision-making skills of the surgeon. We present an adult male patient with tetralogy of Fallot and absent left pulmonary artery who underwent physiologic exclusion of the left lung for aspergilloma along with intracardiac repair as a single stage procedure. [ABSTRACT FROM AUTHOR]

Spinal cord injury patients are at risk for urethral trauma during catheterisation. We report a patient in whom urethral perforation due to catheterisation was not recognised for ∼ four days. Following a routine catheter change by community nurses in a male person with tetraplegia, the catheter drained only a small amount of urine. Therefore, the patient attended the hospital where the staff removed the catheter but could not place a new catheter. The doctor tried different catheters and on fifth attempt, inserted a catheter. The patient continued to bypass urine and was prescribed Solifenacin. On self-referral to spinal unit, urethral trauma was suspected. CT of pelvis revealed the balloon of the Foley catheter in the penile urethra at penis base with the tip projecting beyond the penile shaft. Suprapubic cystostomy was done. The patient continued to leak urine from the penis; required penile sheath drainage and an additional leg bag. This case illustrates the value of CT of pelvis including the penis in detecting urethral trauma and misplacement of the catheter. Physicians should look for symptoms and signs of urethral trauma and incorrect positioning of the catheter. Imaging studies should be done without delay to assess urethral trauma and misplacement of urinary catheter. We use Urethrotech urethral catheterisation in patients in whom the first attempt to insert a catheter per urethra is unsuccessful, or in patients with a history of difficult catheterisation. This helped to minimise urethral trauma and achieve successful catheterisation. • Spinal injury patients are prone to trauma during catheterisation because of lack of sensation, and spasm of the sphincter. • In this patient, urethral perforation and misplacement of Foley catheter remained undetected for ~ four days. • When the patient was leaking urine because of misplacement of the catheter, it was misdiagnosed as due to bladder spasms. • CT of pelvis including penis should be done without delay to assess urethral trauma and check position of the catheter. • Urethrotech device is useful to achieve successful catheterisation with minimal trauma in selected spinal injury patients. [ABSTRACT FROM AUTHOR]

The widely employed short tandem repeat (STR)-based panels for forensic human identification (HID) have limitations while dealing with challenging forensic samples involving DNA degradation, resulting in dropping-out of higher molecular weight alleles/loci. To address this issue, bialleic markers like single nucleotide polymorphisms (SNPs) and insertion-deletions (indels), which can be scored even when the template DNA is heavily degraded (<100 bp), have been suggested as alternative markers for HID testing. Recent studies have highlighted their utility in forensic HID and several panels based on biallelic markers have been described for worldwide populations. However, there has been very little information about the behavior of such DNA markers in Indian populations, which is known to possess great genetic diversity. This study describes a two-step approach for designing a SNP-based panel consisting of 70 SNPs for HID testing in Indian populations. In the first step, candidate SNPs were shortlisted from public databases by screening them for several criteria including allelic distribution, genomic location, potential phenotypic expression or functionality and species specificity. The second step involved genotyping the shortlisted SNPs in various Indian populations followed by shortlisting of the best performers for identity-testing. Starting with 592,652 SNPs listed in Human660W-Quad Beadchip (Illumina Inc.), we shortlisted 275 candidate SNPs for identity-testing and genotyped them in 462 unrelated individuals from different population groups in India. Post genotyping and statistical analyses based on biogeographic regions, 206 SNPs demonstrated desired allelic distribution (Heterozygosity ≥ 0.4 and F ST ≤ 0.02), from which 2–4 widely separated (>20 Mb apart) SNPs from each chromosome were finally selected to construct a panel of 70 SNPs. This panel on average possessed match probability 10e-29 and probability of paternity of 0.99999997, which was orders of magnitude higher than most of the currently employed STR-based chemistries and SNP-based panels that were proposed previously for HID testing. For comparison purpose, genotyping previously reported SNPs for HID in our samples led us to conclude that the panel developed in this study is much more efficient and robust and better suited for the Indian populations. [ABSTRACT FROM AUTHOR]

Marine green macroalgae are a valuable natural resource for bioactive phytochemicals that have potential applications in therapeutics, even though they remain largely under-exploited. Green macroalgae Ulva or sea lettuce species are found at all levels of the intertidal zone that grows along rocky or sandy coasts of oceans and seas. Green algae are found in unicellular, colonial, and multicellular forms. Apart from carotenoids, Ulva is a good source of vitamin B, proteins, minerals (calcium, potassium, magnesium, sodium, copper, iron, and iodine), and dietary fibers. Ulva lactuca is a macroalgae grown widely along the Mediterranean coast, belongs to the phylum Chlorophyta, and is commonly known as "Sea lettuce". U. lactuca contains about 13.6 % protein on a dry weight basis. Nutrient-dense U. lactuca is used as salad and also in kimchi preparations. This review highlights the chemistry, structure, and food and pharmaceutical applications of bioactives in green seaweeds and Ulva spp. precisely to exploit as a future superfood material owing to its nutraceutical properties and pharmaceutical applications just like brown algae Wakame. Hence, research in this area is opening entries for connecting the potential of marine natural products. While there are several reviews highlighting the biological and pharmaceutical activities of marine algae and their-derived bioactives especially sulfated polysaccharides and lipids, reports on future food applications are sparse. Therefore, the present review provides details on recent progress in green algae and food applications due to their nutritional potential. • Seaweeds are a rich source of bioactive with various functional properties. • Dietary fibers and micronutrients in seaweeds contribute to nutritional security. • Foods with seaweeds help in reducing the use of synthetic preservatives. • Ulva lactuca as a food ingredient can serve as a superfood. [ABSTRACT FROM AUTHOR]

Summary Background & aims Patients with pancreatic cancer have a poor prognosis, are often cachectic, and frequently demonstrate features of systemic inflammation, which may contribute to the phenomenon of myosteatosis. Analysis of body composition from CT scans has been used to study sarcopenia and its association with prognosis in a number of types of cancer, particular in combination with obesity. It has also been suggested that myosteatosis, defined as attenuated mean skeletal muscle Hounsfield units (HU), is associated with reduced survival in cancer. This study aimed to assess the association between body composition (sarcopenia and myosteatosis) and outcome in patients with unresectable pancreatic cancer. Methods All patients diagnosed with unresectable pancreatic cancer at Nottingham University Hospitals NHS Trust between 2006 and 2013 were considered for the study. A total of 228 patients were included retrospectively. Body composition was assessed using cross-sectional CT analysis to calculate a skeletal muscle index (SMI) for sarcopenia and use mean skeletal muscle HU for myosteatosis. Results The prevalence of sarcopenia in the whole patient group at baseline was 60.5% (138/228). Overall, patients who were sarcopenic had no significant difference in overall survival versus those who were not ( p = 0.779). However, patients who were overweight/obese and sarcopenic had a significantly lower survival ( p = 0.013). Of the 58 patients who were overweight or obese and sarcopenic, 32 were also myosteatotic. The prevalence of myosteatosis overall at baseline was 55.3% (126/228) and this was associated with significant reduction in overall survival ( p = 0.049). Univariate Cox regression revealed myosteatosis but not sarcopenia to be predictive of reduced survival, however this relationship was lost on multivariate testing. Myosteatosis was associated with significantly greater levels of systemic inflammation (white cell count, neutrophil-lymphocyte ratio and C-reactive protein), anaemia and worsening of baseline blood urea. This relationship was not seen with sarcopenia. Conclusions This is the largest study on the association between body composition and survival in patients with unresectable pancreatic cancer and has shown that although sarcopenia alone did not have a bearing on survival, the presence of myosteatosis was associated significantly with the presence of systemic inflammation and reduced survival. [ABSTRACT FROM AUTHOR]

The Gastroparesis Clinical Research Consortium is a multicenter coalition created and funded by the National Institutes of Diabetes and Digestive and Kidney Disorders, with a mission to advance understanding of the pathophysiology of gastroparesis and develop an effective treatment for patients with symptomatic gastroparesis. In this review, we summarize the results of the published Gastroparesis Clinical Research Consortium studies as a ready and convenient resource for gastroenterologists and others to provide a clear understanding of the consortium's experience and perspective on gastroparesis and related disorders. [ABSTRACT FROM AUTHOR]

Scurvy is caused by prolonged severe dietary deficiency of vitamin C. Being rare as compared to other nutritional deficiencies, it is seldom suspected and this frequently leads to delayed recognition of this disorder. Children with abnormal dietary habits, mental illness or physical disabilities are prone to develop this disease. The disease spectrum of scurvy is quite varied and includes dermatological, dental, bone and systemic manifestations. Subperiosteal hematoma, ring epiphysis, metaphyseal white line and rarefaction zone along with epiphyseal slips are common radiological findings. High index of suspicion, detailed history and bilateral limb radiographs aids physician in diagnosing this eternal masquerader. We searched Pubmed for recent literature (2009–2014) with search terms “scurvy” “vitamin C deficiency” “ascorbic acid deficiency” “scurvy and children” “scurvy and pediatric age group”. There were a total of 36 articles relevant to pediatric scurvy in children (7 reviews and 29 case reports) which were retrieved. The review briefly recapitulates the role of vitamin C, the various disease manifestations and the treatment of scurvy to create awareness of the disease which still is reported from our country, although sporadically. The recent advances related to scurvy and its management in pediatric age group are also incorporated. [ABSTRACT FROM AUTHOR]

Oxygen mass transfer is an important phenomenon in any biological treatment systems, fermentation reactors and other biochemical reactors. In biological treatment processes, aeration and agitation is carried out to enhance the oxygen mass transfer in the system, which in turn enhances the fermentation or treatment efficiency. In case of wastewater treatment plant, this process takes around 45-50% of the total energy requirement of the treatment plant. This paper proposes a new method for enhancing an oxygen mass transfer phenomenon in biological treatment processes by introducing non-aqueous phase liquids in the treatment system. [ABSTRACT FROM AUTHOR]

Abstract: Tourette syndrome (TS) is a neurodevelopmental disorder associated with motor and phonic tics. While the aetiology has been debated, no single causative agent has been implicated in the development of TS. This systematic review aims to evaluate original studies investigating the role of immunological abnormalities in both tic expression and susceptibility to infection in patients with TS. A comprehensive literature search using the databases ‘EMBase’, ‘PsycInfo’, ‘Pubmed’, ‘Thomson World of Science’ and ‘Medline’ generated 21 original studies that met inclusion criteria. Results found that abnormalities related to lymphocytes, cytokines, antineuronal antibodies and immunoglobulins were relatively common in TS populations. In addition, abnormalities in immunoglobulin concentrations could be linked to a propensity to the development of infections in selected individuals with TS. While these results support the initial research question, further studies with fewer confounding factors are required to establish a definite association between immune dysfunction, TS and infection. [Copyright &y& Elsevier]

Abstract: Music is popularly believed to usher in bliss and serenity, and healing is considered its natural quality. It has an emotionally charging charisma of its own, that we all as listeners might have experienced at times. Music has been there with mankind since the beginning of history, but where does it stand as a therapy? Is there any evidence base? How this therapy came into being and how it has evolved, and what the old and current research says about its role in psychiatric disorders. This review tries to explore these questions and arrives at a conclusion that music certainly promises more than just entertainment, and evidence so far suggests music therapy can be beneficial in the treatment of psychiatric disorders, as a cost effective noninvasive adjunct to standard therapy in a variety of settings and patient groups, yet more validated scientific research is still required to establish it as a sole quantified therapy. [Copyright &y& Elsevier]

Abstract: Background: Cervical priming agents mainly prostaglandins in different doses and routes are used during first trimester vaccum aspiration to prevent cervical injury and shorten the abortion procedure. This study was carried out to assess women''s acceptability, the efficacy and side effects of oral versus vaginal administration of misoprostol in facilitating cervical dilatation prior to first trimester vaccum aspiration. Methods: A randomised control study where 120 women were divided in oral (51) and vaginal (69) group. Each group received 400 mcg of misoprostol either orally or vaginally 04 h prior to first trimester pregnancy termination. Baseline cervical dilatation, women''s acceptability and side effects and complications were noted in both the groups. Results: There was no difference between the oral and vaginal misoprostol groups with respect to mean cervical dilatation (5.53 mm vs 5.43 mm; p > 0.05). A total of 88% of women in the oral group expressed satisfaction with the route of misoprostol administration as compared to 74% in the vaginal route. The women in the vaginal group were experienced more preoperative vaginal bleeding (43% vs 25%). Conclusion: Oral administration of misoprostol is an effective alternative to vaginal administration in preinduction cervical ripening prior to first trimester pregnancy termination. [Copyright &y& Elsevier]