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Key Clinical Message The immunomodulatory effect of CMV makes coinfection with other microbes, like VZV possible and potentially deadlier in the post kidney transplant period. Treatment should be started promptly. Both infections can be treated with Valganciclovir. Abstract Infections are common complications in kidney transplant recipients owing to the lifelong immunosuppression. Cytomegalovirus (CMV) and Varicella Zoster Virus (VZV) infections are quite common in the posttransplant period. Coinfection with both however has been reported only once. The immunomodulatory effect of CMV makes their interaction with other organisms like VZV potentially sinister. This is a case of a young woman who developed coinfection with HZV and CMV in the first month following a live related kidney transplantation from her mother. Transplant surgery went well with good urine output, but serum creatinine did not fall below 1.7 mg/dL. Immunosuppression consisted of intravenous (IV), followed by oral prednisolone, Mycophenolate Sodium (MPS) and Tacrolimus. 25 days after an uneventful surgery, she developed fever, followed by pain and vesicular eruption on the forehead, typical of VZV infection, along with rising creatinine. CMV PCR yielded 300 copies/mL of DNA, which was undetectable in both donor and recipient pre‐transplant. Total white blood cell count fell to 2 × 109/L. MPS was temporarily stopped. Treatment with Valgancyclovir led to resolution of fever, skin lesions and brought serum creatinine down to baseline over 2 weeks.

Background Idiopathic intracranial hypertension (IIH) is prevalent among the US population, with exacerbation of symptoms during pregnancy. Transverse sinus stenting is a new effective treatment for IIH. Stenting is avoided in pregnancy largely due to the requirement of dual antiplatelet therapy. Methods We present a case of a pregnant patient in her first trimester with signs and symptoms of fulminant IIH, including progressive visual loss, who underwent placement of a transverse sinus stent and administration of dual antiplatelet therapy with ticagrelor. Results Ticagrelor was administered pre–operatively. The patient underwent venous sinus stenting for fulminant IIH. There were no complications. She had resolution of symptoms and underwent cesarean delivery without issues. Her child displayed no signs and symptoms of abnormalities. Conclusion Venous sinus stenting for IIH can be considered in pregnant patients presenting with new or worsening IIH with associated papilledema. The use of ticagrelor did not lead to any adverse outcomes for the patient or the fetus in our case.

Abstract Introduction As patient and public involvement (PPI) in research has become increasingly common, research‐based recommendations on its principles and impacts have been established. The specifics of conducting PPI are likely to differ when involving different groups. Family/informal carers for those with health conditions or disabilities have a lot to contribute to research, but instances of their involvement have yet to be reviewed. Objective To systematically review and synthesize studies where family/informal carers have been involved in the research process, to develop an understanding of the benefits, barriers and facilitating factors. Methods A search of five electronic databases was conducted using a combination of terms relating to carers, involvement and research. A grey literature search, expert consultation and hand‐searching were also used. Following screening, data extraction and quality assessment, a narrative synthesis incorporating thematic analysis was conducted. Findings A total of 55 studies met the inclusion criteria, with diverse design and participatory approaches. Four themes were identified, relating to the outcomes, challenges, and practicalities of involving carers: (re) building relationships with carers; carers as equals not afterthoughts; carers have unique experiences; carers create change. Full involvement throughout the research was not always possible, due to barriers from the research world and responsibilities of the caring role. The literature demonstrated ways for carers to contribute in ways that suited them, maximizing their impact, while attending to relationships and power imbalances. Conclusion By summarizing the reported instances of carer involvement in research, this review brings together different examples of how successful research partnerships can be built with carers, despite various challenges. Carers are a heterogeneous group, and participatory approaches should be tailored to specific situations. Wider understanding of the challenges of conducting empowering research with carers, and the resources required to address these, are needed. Patient and Public Involvement The initial findings and themes were presented to a group of carers who had been involved in research and whose reflections informed the final synthesis.

Abstract Mitochondrial dysfunction alters cellular metabolism, increases tissue oxidative stress, and may be principal to the dysregulated signaling and function of CD4+ T lymphocytes in the elderly. In this proof of principle study, it is investigated whether the transfer of functional mitochondria into CD4+ T cells that are isolated from old mice (aged CD4+ T cells), can abrogate aging‐associated mitochondrial dysfunction, and improve the aged CD4+ T cell functionality. The results show that the delivery of exogenous mitochondria to aged non‐activated CD4+ T cells led to significant mitochondrial proteome alterations highlighted by improved aerobic metabolism and decreased cellular mitoROS. Additionally, mito‐transferred aged CD4+ T cells showed improvements in activation‐induced TCR‐signaling kinetics displaying markers of activation (CD25), increased IL‐2 production, enhanced proliferation ex vivo. Importantly, immune deficient mouse models (RAG‐KO) showed that adoptive transfer of mito‐transferred naive aged CD4+ T cells, protected recipient mice from influenza A and Mycobacterium tuberculosis infections. These findings support mitochondria as targets of therapeutic intervention in aging.

ABSTRACT Cardiotoxicity is a growing concern in the oncology population. Transthoracic echocardiography and multigated acquisition scans have been used for surveillance but are relatively insensitive and resource intensive. Innovative imaging techniques are constrained by cost and availability. More sensitive, cost‐effective cardiotoxicity surveillance strategies are needed. Circulating cardiovascular biomarkers could provide a sensitive, low‐cost solution. Biomarkers such as troponins, natriuretic peptides (NPs), novel upstream signals of oxidative stress, inflammation, and fibrosis as well as panomic technologies have shown substantial promise, and guidelines recommend baseline measurement of troponins and NPs in all patients receiving potential cardiotoxins. Nonetheless, supporting evidence has been hampered by several limitations. Previous reviews have provided valuable perspectives on biomarkers in cancer populations, but important analytic aspects remain to be examined in depth. This review provides comprehensive assessment of critical challenges and solutions in this field, with focus on analytical issues relating to biomarker measurement and interpretation. Examination of evidence pertaining to common and serious forms of cardiotoxicity reveals that improved study designs incorporating larger, more diverse populations, registry‐based approaches, and refinement of current definitions are key. Further efforts to harmonize biomarker methodologies including centralized biobanking and analyses, novel decision limits, and head‐to‐head comparisons are needed. Multimarker algorithms incorporating machine learning may allow rapid, personalized risk assessment. These improvements will not only augment the predictive value of circulating biomarkers in cardiotoxicity but may elucidate both direct and indirect relationships between cardiovascular disease and cancer, allowing biomarkers a greater role in the development and success of novel anticancer therapies.

Abstract INTRODUCTION The precise apolipoprotein E (APOE) ε4‐specific molecular pathway(s) for Alzheimer's disease (AD) risk are unclear. METHODS Plasma protein modules/cascades were analyzed using weighted gene co‐expression network analysis (WGCNA) in the Alzheimer's Disease Neuroimaging Initiative study. Multivariable regression analyses were used to examine the associations among protein modules, AD diagnoses, cerebrospinal fluid (CSF) phosphorylated tau (p‐tau), and brain glucose metabolism, stratified by APOE genotype. RESULTS The Green Module was associated with AD diagnosis in APOE ε4 homozygotes. Three proteins from this module, C‐reactive protein (CRP), complement C3, and complement factor H (CFH), had dose‐dependent associations with CSF p‐tau and cognitive impairment only in APOE ε4 homozygotes. The link among these three proteins and glucose hypometabolism was observed in brain regions of the default mode network (DMN) in APOE ε4 homozygotes. A Framingham Heart Study validation study supported the findings for AD. DISCUSSION The study identifies the APOE ε4–specific CRP–C3–CFH inflammation pathway for AD, suggesting potential drug targets for the disease. Highlights Identification of an APOE ε4 specific molecular pathway involving blood CRP, C3, and CFH for the risk of AD. CRP, C3, and CFH had dose‐dependent associations with CSF p‐Tau and brain glucose hypometabolism as well as with cognitive impairment only in APOE ε4 homozygotes. Targeting CRP, C3, and CFH may be protective and therapeutic for AD onset in APOE ε4 carriers.

Abstract Global climate change has threatened world crop production and food security. Decoding the adaptive genetic basis of wild relatives provides an invaluable genomic resource for climate‐smart crop breedinG. Here, we performed whole‐genome sequencing of 185 diverse wild soybean (Glycine soja) accessions collected from three major agro‐ecological zones in China to parse the genomic basis of local adaptation in wild soybean. The population genomic diversity pattern exhibited clear agro‐ecological zone‐based population structure, and multiple environmental factors were observed to contribute to the genetic divergence. Demographic analysis shows that wild soybeans from the three ecological zones diverged about 1 × 105 years ago, and then the effective population sizes have undergone different degrees of expansions. Genome‐environment association identified multiple genes involved in the local adaptation, such as flowering time and temperature‐related genes. A locus containing two adjacent MADS‐box transcription factors on chromosome 19 was identified for multiple environmental factors, and it experienced positive selection that enables the adaptation to high‐latitude environment. This study provides insights into the genetic mechanism of ecological adaptation in wild soybean that may facilitate climate‐resilient soybean breeding.

Abstract Antimicrobial peptides (AMPs) are potentially powerful alternatives to conventional antibiotics in combating multidrug resistance, given their broad spectrum of activity. They mainly interact with cell membranes through surface electrostatic potentials and the formation of secondary structures, resulting in permeability and destruction of target microorganism membranes. Our earlier work showed that two leading AMPs, MSI‐78 (4–20) and pardaxin (1–22), had potent antimicrobial activity against a range of bacteria. It is known that the attachment of moderate‐length lipid carbon chains to cationic peptides can further improve the functionality of these peptides through enhanced interactions with the membrane lipid bilayer, inducing membrane curvature, destabilization, and potential leakage. Thus, in this work, we aimed to investigate the antimicrobial activity, oligomerization propensity, and lipid‐membrane binding interactions of a range of N‐terminal lipidated analogs of MSI‐78 (4–20) and pardaxin (1–22). Molecular modeling results suggest that aggregation of the N‐lipidated AMPs may impart greater structural stability to the peptides in solution and a greater depth of lipid bilayer insertion for the N‐lipidated AMPs over the parental peptide. Our experimental and computational findings provide insights into how N‐terminal lipidation of AMPs may alter their conformations, with subsequent effects on their functional properties in regard to their self‐aggregation behavior, membrane interactions, and antimicrobial activity.

Abstract Aims/Introduction We aimed to assess the health‐related quality of life (HRQoL) and identify its predictors among type 2 diabetes patients of Bangladesh. Materials and Methods This nationwide cross‐sectional study assessed HRQoL among 1,806 type 2 diabetes patients using the EuroQol‐5 Dimensions Questionnaire (EQ‐5D‐5L), and the responses were further translated into a single summary crosswalk index score using the UK time trade‐off value set. The predictors were determined using multinomial logistic regression analysis. Results The mean EQ‐5D‐5L index score was 0.62 (standard deviation 0.25), and men scored better than women. More than half of the study participants (53.4%) were ranked as “average” HRQoL. Overall, 64% of respondents had a “problem” at least in one of the dimensions of the EQ‐5D‐5L, and the burden of reported “problems” was higher among women (70%). Among the five dimensions, the highest reported “problem” was 79.8% for anxiety/depression, 77.7% for pain/discomfort and 60.1% for mobility. However, younger participants (aged 1) were being men, living in a rural area, married, literate, a monthly income >19,488 BDT, absence of comorbidity and had a duration of diabetes ≤5 years. Conclusions The majority of Bangladesh’s type 2 diabetes patients had an “average” HRQoL based on the EQ‐5D‐5L index score. In broad terms, the identified predictors were sex, place of residence, marital status, literacy, monthly income, comorbidity and duration of diabetes.

Abstract Background and Aim As the interrelationship between Helicobacter pylori, metabolic syndrome (MetS), and non‐alcoholic fatty liver disease (NAFLD) is controversial, we undertook a community‐based study with the aim to find the seroprevalence of H. pylori and its relationship with MetS and NAFLD. Methods This door‐to‐door survey was conducted among the adult subjects (≥18 years) of two villages (Charcharia of Dhaka district and Kharrah of Munshiganj district) of Bangladesh. Interviews using a structured questionnaire, clinical examination, anthropometric measurements, ultrasonogram of the liver, and biochemical tests were performed. Results Of 1021 subjects, 781 responded (76.49%), and 767 were included in the final analysis (mean age 40.35 ± 15.56 years; female 63.5%). Anti‐H. pylori antibodies were found in 418 of 767 (54.5%). There were no H. pylori serostatus association with MetS and diabetes mellitus (DM) in univariate or multivariate analysis (all P > 0.05). However, H. pylori seropositive subjects had lower systolic blood pressure (odds ratio [OR] = −2.95 [−5.58, −0.32]) and low density lipoprotein ‐cholesterol (OR −7.79 [−15, −0.57]) compared to seronegative subjects in the linear regression model. Seronegativity of H. pylori was associated with NALFD in univariate (P = 0.007) but not multivariate analysis (P = 0.086). There were no differences in the frequency of H. pylori seropositivity among the participants with nonobese compared to obese NAFLD (19/42 [45%] vs 43/99 [43.4%], P = 0.844). Conclusion In a rural community of Bangladesh, about 55% of the population were H. pylori seropositive, which was more common among the underweight than normal or obese subjects. However, there was no relationship observed between H. pylori seroprevalence and MetS, DM, or NAFLD.

Abstract Background We aimed to determine the prevalence of type 2 diabetes (T2D) and pre‐diabetes (pre‐DM) among patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) in Bangladesh. We also examined the association between type of TB and hyperglycaemia as an adjunct to the primary objective. Materials and Methods This cross‐sectional analytical study recruited 350 TB patients (175 PTB and 175 EPTB) from two tertiary care hospitals specialized for TB treatment. Oral glucose tolerance tests and fasting plasma glucose measurements were carried out for unknown glycaemic status and those with previously known diabetes, respectively. Results Overall, the prevalence of T2D and pre‐DM was 19.1% (new 85.1%, old 14.9%) and 34.3%, respectively. Although the risk factors were highly prevalent among the patients with EPTB, a higher proportion of T2D (26.3%) and pre‐DM (34.3%) was detected among the patients with PTB. The proportion of impaired fasting glucose was low in both groups, but a high trend of impaired glucose tolerance was observed across the groups, with a higher proportion (35.4%) in the PTB group. Both pre‐DM and T2D showed significantly higher odds (pre‐DM, AOR: 4.488; CI: 2.531–7.958; p

Background Radial artery spasm is a common hinderance during transradial approaches for neuroangiography. Ways of alleviation have been described, including patient sedation, local lidocaine, or even prophylactic administration of intra‐arterial vasodilators. Methods We present a case of a wedged catheter attributable to radial artery spasm, which failed all conventional methods to relieve spasm. Results The catheter was ultimately removed after administration of sublingual nitroglycerin. Conclusion To our knowledge, this is the first time sublingual nitrogen has been reported as an effective means to alleviate radial artery spasm during a transradial approach for neuroangiography.

This study was conducted to isolate and identify the endophytic fungi from the bark and leaves of the Syzygum cumini plant and investigate the pharmacological activities of endophytic fungi along with plant parts. After isolation, endophytic fungi were identified based on morphological characteristics and molecular identification. Antimicrobial, antioxidant, and cytotoxic activities were studied by a disc diffusion method, free radical scavenging DPPH assay, and brine shrimp lethality bioassay, respectively. A total of eight endophytic fungi were isolated and identified up to the genus level based on morphological characteristics and confirmed by molecular identification techniques. Among the eight isolates, three isolates were identified as Colletotrichum sp. (SCBE-2, SCBE-7, and SCLE-9), while the rest of the isolates belonged to Diaporthe sp. (SCBE-1), Pestalotiopsis sp. (SCBE-3), Penicillium sp. (SCBE-4), Phyllosistica sp. (SCLE-7), and Fusarium sp. (SCLE-8). The presence of flavonoids, anthraquinones, coumarins, and isocoumarins was assumed by the preliminary screening of the fungal and plant extracts by a thin-layer chromatographic technique under UV light. Fungal extracts of Pestalotiopsis sp. Penicillium sp. were found sensitive to all test bacteria, but only extracts from the leaf and bark showed significant antifungal activity along with their antimicrobial activity. Penicillium sp. The fungal extract showed the highest free radical scavenging activity (2.43 μg/mL) near that of ascorbic acid (2.42 μg/mL). Some fungal extracts showed cytotoxic activity that, in general, suggests their probable abundance of biological metabolites. This is the first approach to investigate the endophytic fungi of Syzygium cumini Linn. in Bangladesh, to find the pharmacological potential of endophytes, and to explore novel compounds from those endophytes.

Abstract Soybean is an important food crop that provides edible protein and oil for human and animal nutrition. Conventional phenotypic‐based breeding approaches have made significant contribution in the last century by developing many improved soybean varieties. However, due to the longer time taken to develop a variety, low genetic gain per unit time, and adverse environmental influence of phenotypic‐based selection, conventional approaches are not sufficient to maintain pace with growing population and climate change. In this context, the recent method of genotypic selection, that is, genomics‐assisted breeding (GAB) is considered a promising approach to address the challenges in soybean breeding. However, to harness the true potential of GAB in soybean improvement, the great coverage and precision in the genotyping and phenotyping are required. Previously, a huge gap was observed between the discovery and practical use of quantitative trait loci (QTLs) in soybean improvement. It has been suggested that low marker density and manually collected phenotypes are the major reasons for this failure. Hence, high‐throughput genotyping (HTG) providing higher genome‐wide marker density, as well as accurate and precise phenotyping using high‐throughput digital phenotyping (HTP) platforms, can significantly increase the success of QTL and candidate gene identification in soybean. These approaches can greatly increase the practical utility of GAB in soybean and also offer a faster characterization of germplasm and breeding materials. This review provides the detailed information on how the recent innovations in genomics and phenomics can assists in improving the efficiency and potential of GAB in soybean improvement.

Abstract Background Disability assessment in leprosy patients is a very important factor in the evaluation of the effectiveness of a leprosy elimination program. Little information exists on deformities in leprosy patients in Bangladesh. Objectives To describe the pattern and prevalence of deformities in leprosy patients after leprosy has been declared eliminated from Bangladesh in 1998. Methods A descriptive retrospective cross‐sectional study was carried out in Chittagong Medical College Hospital using the registered records of patients for the period 2004–2013. Results Out of 670 leprosy patients, 213 (31.79%) had deformities. The prevalence of deformity was for grade 1: 92 (43.20%), for grade 2: 121 (56.80%). Among the patients with deformity, males 144 (67.60%) outnumbered females 69 (32.40%). Four age groups were considered. The calculated age‐specific cumulative detection rates showed the highest case detection in >40 years group at 81 (38.02%). The rate of children (

Background Human relaxin‐2 is a peptide hormone capable of pleiotropic effects in several organ systems. Its recombinant formulation (serelaxin) has been demonstrated to reduce infarct size and prevent excessive scar formation in animal models of cardiac ischemia‐reperfusion injury. B7‐33, a synthetically designed peptide analogous to B‐chain of relaxin‐2, invokes signaling at relaxin family peptide receptor 1 (cognate receptor for relaxin‐2) by preferentially phosphorylating the mitogen‐activated protein kinase extracellular signal‐regulated kinase 1/2. We sought to investigate the effects of B7‐33 treatment post ischemia‐reperfusion injury in mice. Methods and Results Adult male CD1 mice were subjected to ischemia‐reperfusion via ligation of left anterior descending artery for 30 minutes, followed by 24 hours or 7 days of reperfusion. Echocardiography was performed to assess cardiac function, and cardiac tissue was stained to determine infarct size at 24 hours. B7‐33 significantly reduced infarct size (21.99% versus 45.32%; P=0.02) and preserved fractional shortening (29% versus 23%; P=0.02) compared with vehicle. The difference in fractional shortening further increased at 7 days post myocardial infarction (29% versus 20% for B7‐33 and vehicle groups, respectively). In vitro, primary cardiomyocytes were isolated from adult hearts and subjected to simulated ischemia‐reperfusion injury (simulated ischemia reoxygenation). B7‐33 (50 and 100 nmol/L) improved cell survival and reduced the expression of GRP78 (glucose regulated protein), an endoplasmic reticulum stress marker. Subsequently, B7‐33 (100 nmol/L) reduced tunicamycin (2.5 μg/mL) induced upregulation of GRP78 in an extracellular signal‐regulated kinase 1/2–dependent manner. Conclusions B7‐33 confers acute cardioprotection and limits myocardial infarction–related adverse remodeling in mice by attenuating cardiomyocyte death and endoplasmic reticulum stress as well as preserving cardiac function.

Abstract Background Beck Depression Inventory (BDI‐II) is a widely used valid instrument to assess the severity of depression in clinical and normal settings. To meet the necessity of a standard scale for measuring depression among above 265 million Bangla speaking population around the world, this scale was translated and validated. Methods Two translations of BDI‐II into Bangla were prepared, and then, two back translations were done by medical and language experts in parallel. Thereafter, sentence revision followed by pretest on 20 respondents was done to finalize the Bangla version of BDI‐II (BDI‐II BV). Afterward, a cross‐sectional, comparative, and descriptive study was conducted to validate the scale by purposive sampling technique consisting of 111 persons (both clinical and normal) in three tertiary‐level hospitals in Bangladesh. Everyone was given to fill up BDI‐II BV at first. Then, they were given to fill up BDI‐II BV (n = 49), Bangla version of Depression Anxiety Stress Scales 21‐item (DASS21‐BV, n = 47) and BDI‐II (n = 25) 3–7 days later. The diagnosis of depressive disorder was made according to DSM‐5. Correlation study and factor analysis were completed. Results The mean age was 28.83(±8.70) years. The male–female ratio was 1:0.82. Correlation of scores for BDI‐II BV with the DASS21‐BV depression subscale was .920; BDI‐II BV with BDI‐II was .985 (Cronbach's α .993; t test not significant) and BDI‐II BV applied first and the second time was .960 (Cronbach's α .979; z test not significant). The interitem correlation for all the items was found highly significant (p

The eccentric connectivity polynomial (ECP) of a connected graph G=VG,EG is described as ξcG,y=∑a∈VGdegGayecGa, where ecGa and degGa represent the eccentricity and the degree of the vertex a, respectively. The eccentric connectivity index (ECI) can also be acquired from ξcG,y by taking its first derivatives at y=1. The ECI has been widely used for analyzing both the boiling point and melting point for chemical compounds and medicinal drugs in QSPR/QSAR studies. As the extension of ECI, the ECP also performs a pivotal role in pharmaceutical science and chemical engineering. Graph products conveniently play an important role in many combinatorial applications, graph decompositions, pure mathematics, and applied mathematics. In this article, we work out the ECP of ℱ-sum of graphs. Moreover, we derive the explicit expressions of ECP for well-known graph products such as generalized hierarchical, cluster, and corona products of graphs. We also apply these outcomes to deduce the ECP of some classes of chemical graphs.

Melanoma presenting with black pleural effusion is rare, with only five cases reported till date. In distinction to others, this is the only case where patient did not have a prior diagnosis of melanoma and was diagnosed by thoracoscopy. Reported is the case of a 49‐year‐old male who presented with dyspnoea and weight loss. Patient had a large left‐sided pleural effusion. Ultrasound showed thickened irregular pleura and multiloculated pleural effusion. Diagnostic pleural aspiration was performed, and fluid was black in colour and was exudative lymphocytic. Atypical cells were noted on pleural fluid cytology. Medical thoracoscopy was carried out and histopathology suggested metastatic melanoma. Patient had multiple nevi all over the body, but clinically none was indicative of melanoma. He refused skin biopsy. The case was referred to medical oncology where palliative management was planned. Patient died within two weeks of diagnosis.