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Multidrug‐resistant (MDR) bacteria cause infections with higher risks of morbidity, mortality, and financial burden. Understanding the antimicrobial resistance patterns of these pathogens is crucial for effective treatment and managing resistance. Therefore, this retrospective study examined the prevalence, causes, and trends in antimicrobial resistance in bacterial infections at a neurosurgical hospital in Nepal. We analyzed the demographics, bacteriological profiles, and antimicrobial susceptibility results in patients who visited Dirghayu Guru Hospital and Research Center, Kathmandu, Nepal, between January 2014 and January 2024, using SPSS, version 17.00. Among 4758 patients, 465 (9.77%) had infections caused by 571 bacteria. Of them, 435 (93.55%) patients had urinary tract infections, 89 (19.14%) had bloodstream infections, and 31 (6.67%) had respiratory tract infections. Klebsiella pneumoniae (n = 172, 30.12%) was the predominant bacteria. Proportions of drug‐resistant Enterobacterales and gram‐positive cocci among drug‐resistant bacteria against tetracyclines were 83.33% and 45.83%, cephalosporins were 78.02% and 40.45%, quinolones were 72.25% and 50.00%, aminoglycosides were 65.14% and 43.53%, carbapenems were 62.96% and 30.00%, penicillins were 54.55% and 57.89%, and penicillin with beta‐lactamase inhibitors (PwBLIs) were 40.54% and 42.31%, respectively. Proportions of drug‐resistant nonfermenters among drug‐resistant bacteria showed 100.00% resistance to these antimicrobials. MDR isolates (n = 118, 20.67%) were 100.00% susceptible to piperacillin–tazobactam and 83.33% to polymyxin B. Over the years, resistance increased for cephalosporins (48.15%–60.53%) but decreased for carbapenems (50.00%–33.33%), penicillins (64.29%–42.31%), PwBLIs (50.00%–12.50%), aminoglycosides (60.00%–49.12%), tetracyclines (100.00%–16.67%), and polymyxins (76.22%–16.67%). One‐tenth of hospital‐visiting patients had bacterial infections, with three‐fourths involving Enterobacterales and one‐fifth involving MDR bacteria. In recent years, resistance to cephalosporins has increased, whereas resistance to other beta‐lactams, aminoglycosides, and polymyxins has decreased. [ABSTRACT FROM AUTHOR]

Serum sickness is rare; however, there is a significant hypersensitivity reaction to streptokinase used in different cardiac problems. Treatment often involves discontinuing the offending agent and administering corticosteroids. This case underscores the complexities of managing prosthetic valve thrombosis and highlights the importance of monitoring and addressing complications of thrombolytic therapy. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Brucellosis, especially with osteoarticular involvement, is uncommon and difficult to diagnose, but it should be considered in a case presenting with prolonged fever, joint pain, and back pain. The diagnosis requires a combination of history, serological examinations, and radiographic studies. When the condition is detected and treated early, the prognosis is good. Brucella exploits host immune defenses to establish the chronic infection brucellosis, an endemic zoonotic disease. While human brucellosis affects multiple organs, osteo articular involvement is rare. We report the case of a 41‐year‐old woman with a history of goat farming who presented with fewer associated with low back pain and multiple joint pain for 4 months. Brucellosis was documented by positive serological tests (ELISA). Radiological findings suggested of right sacroiliitis and fracture line on the right sacral ala though had no history of trauma. Treatment consisted of NSAIDs and multiple antibiotic therapy. At follow‐up, her low back pain, joint pain, and fever had subsided. After 4 weeks of follow‐up, her symptoms were completely relieved with no recurrence. Brucellosis with atypical localization should be considered with a high index of suspicion based on detailed history and physical examination to ensure timely diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Invasive fungal mucormycosis and its outcome as SIADH and orbital apex syndrome is uncommon. Mucormycosis in paranasal sinuses can even lead to intracranial invasion and its treatment with the use of amphotericin B can cure improve the prognosis of the disease. Early diagnosis and prompt treatment with antifungal, endoscopic surgery, and controlling of diabetes can be beneficial. Mucormycosis is an opportunistic invasive fungal infection which is rare and fatal and can even cause intracranial invasion leading to SIADH. The infrequency with which mucormycosis with SIADH is encountered makes it a formidable diagnostic challenge. 70‐year‐old women uncontrolled diabetes mellitus presented with bilious vomiting and persistent headache with ptosis, proptosis, absence of extraocular movement, pupillary light reflex, and light perception of left eye. Radiographic investigation, KOH mount, and Biopsy showed mucormycosis in sinus with intracranial extension leading to SIADH. Further investigation revealed hyponatremia, decreased plasma osmolality. Then, when diabetes was controlled and hydrocortisone and amphotericin was given along with Endoscopic sinus debridement, SIADH was well controlled. This case illustrates the potential of mucormycosis in paranasal sinuses can even lead to intracranial invasion and its treatment with the use of amphotericin B can cure improve the prognosis of the disease. Prompt diagnosis through clinical history, radiological investigation, and laboratory parameters are important and its treatment is crucial for the better prognosis. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Pneumomediastinum (PM) and subcutaneous emphysema (SCE) following foreign body aspiration are very rare. Pneumomediastinum (PM) occurs due to alveolar rupture, whereas subcutaneous emphysema occurs if air leak persists. It is benign in nature, but in some cases, it might be fatal. Therefore, proper assessment and management are required to limit the life‐threatening complications and FB should always be suspected whenever spontaneous PM and SCE is seen. PM and SCE are very rare presentations of foreign body aspiration in children of age less than 3 years and in such circumstances, the possibility of foreign body should be considered. There is also a rare possibility of spontaneous expectoration of a foreign body dislodged in the trachea. [ABSTRACT FROM AUTHOR]

Autoimmune pulmonary alveolar proteinosis (PAP) is characterized by antibodies to granulocyte–macrophage colony‐stimulating factor (GM‐CSF), alveolar macrophage dysfunction, and surfactant accumulation. Whole lung lavage (WLL) is the treatment of choice in patients with PAP and severe hypoxemia. In resource‐limited settings, WLL can be performed in the intubated, anesthetized patient who is being one lung ventilated using a Y‐type bladder irrigation catheter for saline instillation and drainage. [ABSTRACT FROM AUTHOR]

The need to address antimicrobial resistance (AMR) through a One Health (OH) approach is now well recognized. There is, however, limited guidance on how AMR surveillance should be implemented across sectors to generate meaningful AMR and AMU data for decision‐making. Using a sympatric approach to cross‐sector sample collection, Nepal adopted the WHO extended‐spectrum beta‐lactamase (ESBL)–producing Escherichia coli (E. coli) Tricycle Project as a step toward OH surveillance for assessing the prevalence of ESBL‐producing E. coli across human, veterinary, and environment sectors. This involved a three‐stage approach: identification of human hotspots (Stage 1) and sample collection sites for poultry (Stage 2) and wastewater (Stage 3). A total of 53 blood cultures from patients with bloodstream infections (BSIs), 100 stool samples from healthy pregnant women, 220 poultry ceca from slaughterhouses and live markets, and 48 wastewater samples were processed for bacterial culture and analyzed for the presence of ESBL‐producing E. coli. The prevalence of ESBL‐producing E. coli among isolated E. coli was the highest in wastewater samples (91%) followed by human BSIs (49%), poultry (38.6%), and fecal carriage isolates from healthy pregnant females (15%). A statistically significant association was seen in the prevalence of multidrug resistance among ESBL producers (52%) and nonproducers (26%). ESBL‐producing E. coli was detected in all wastewater samples tested except for the upstream river. The findings of the study showed a high prevalence of ESBL‐producing E. coli in samples from all three sectors and provided baseline data based upon which strategies for the safe disposal of communal and hospital waste, integrated AMR surveillance, and control strategies could be planned and implemented. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In 2018, the World Health Organization recognized traditional healers as community stakeholders in dementia care. This scoping review aimed to summarize the existing dementia care literature regarding strategies for the integration of traditional healing in dementia care and the roles of traditional healers. METHODS: A group of Indigenous Elders from Northern Ontario, Canada, guided, reviewed, and validated the research process and findings. The Joanna Briggs Institute approach was applied to a structured search strategy across the CINAHL, Embase, MEDLINE, and PsycINFO databases. A title and abstract screening were completed, followed by a full‐text assessment of the identified manuscripts. RESULTS: A total of 143 full manuscripts were reviewed, of which two studies fully met the community‐determined inclusion/exclusion criteria. DISCUSSION: The integration of traditional healing practices into dementia care offers a pathway to culturally‐safe care for people with dementia. The findings identified policy advocacy as key to engage, educate, and empower traditional healers. Highlights: The WHO recognized traditional healers as community stakeholders in dementia care and prevention worldwide in 2018; however, traditional healers are underrepresented and marginalized in healthcare systems due to the lack of culturally‐safe dementia care (CSDC) policies at community and national levels globally.Community‐based CSDC models were critically reviewed and validated by local Indigenous community stakeholder consultations.The result is a call to action to assist the WHO and Alzheimer's Disease International in developing guidelines for CSDC policy improvements with the global Indigenous community for the engagement and empowerment of traditional healers to navigate dementia care and to implement the WHO Global Action Plan on the Public Health Response to Dementia (2017–2025).Integration of Western biomedical and Indigenous traditional healing and medicine in dementia care in the healthcare system can reduce health disparities and empower traditional healers on a global scale. Indigenous‐led models that include traditional healers in dementia care are critical for improving equity gaps in dementia care for Indigenous Peoples. [ABSTRACT FROM AUTHOR]

Biogas plays a significant part in replacing solid biomass and fossil fuels for cooking. However, the implementation of appropriate policies to promote the development of biogas plants is hindered by a lack of adequate assessment of the biogas potential in Nepal. Thus, we estimate the potential of biogas production at the district level of Nepal from available waste biomass, including livestock manure, agricultural residues, and organic fraction of municipal solid waste (OFMSW). Our estimates show the theoretical potential of biogas production from livestock manure of 1890 million m3 year−1, agricultural residues of 2290 million m3 year−1, and OFMSW of 234 million m3 year−1. The total biogas production is 4412 million m3 year−1, equivalent to 153 million liquefied petroleum gas (LPG) cylinders yearly. Using this biogas potential to replace LPG and solid biomass for cooking could result in avoided CO2, CO, and PM2.5 emissions of 6.3 million tons year−1, 0.4 million tons year−1, and 0.04 million tons year−1, respectively. Our findings suggest that the Terai districts of Morang, Sunsari, Saptari, and Banke, as well as the Hilly districts of Kavrepalanchok, Dhading, and Nuwakot, have a significant amount of biogas‐producing potential. Utilising this potential could also contribute to achieving several Sustainable Development Goals and a clean cooking energy transition in Nepal. For this, governments need careful planning, designing, policy support, and facilitation on bio‐resource management and utilisation at the local level. [ABSTRACT FROM AUTHOR]

Environmental parameters along elevational gradients affect the number of butterflies and the variety of species. However, which variables play significant roles and how they operate can be difficult to untangle. Here, we examine the relationships between observed butterfly richness (overall and subgroups) at different elevation gradients and remotely sensed environmental variables (vegetation productivity, surface temperature, landscape heterogeneity, and moisture stress) using generalized linear models. We surveyed butterflies with a fixed‐point count method in 19 elevation bands within 1600–5200 m above sea level in Manang district, trans‐Himalayan region, north‐central Nepal. The number of butterflies in each elevation band was studied and estimated, then interpolated across the lowest and highest elevation to estimate butterfly species richness. Then, the selection of models was performed on butterfly richness and elevations to test the best model support based on the lowest value of the Akaike information criterion and a multimodel averaging for other environmental variables. Altogether, 94 butterfly species, representing 20 subfamilies and six families, were recorded throughout the study periods. We obtained cubic model support for overall species richness, Papilionidae, and Hesperiidae, quadratic to Nymphalidae and Pieridae, and the linear model to Lycaenidae. In our study, vegetation productivity was found to have a significant positive impact on butterfly communities. Our study further suggests species richness of Papilionidae and Hesperiidae has a strong positive correlation with surface temperature and landscape heterogeneity and negative associations with moisture stress but other subgroups of butterfly communities including overall species richness showed insignificant relationships with these variables. This study provides significant information related to the responses of montane butterflies to environmental variables along elevational gradients from the Himalayas Nepal. However, further detailed studies on the functional behaviors of butterflies potentially offer more insights into their distribution patterns and ecological relationship in the montane environment. [ABSTRACT FROM AUTHOR]

Measuring the intracellular pH (pHi) is of interest for brain tumor diagnostics. Common metrics of CEST imaging like the amide proton transfer‐weighted (APTw) MTRasym are pHi sensitive and allow differentiating malignant tumor from healthy tissue. Yet, the image contrast also depends on additional magnetization transfer effects and T1. In contrast, the apparent exchange‐dependent relaxation (AREX) provides a T1 corrected exchange rate of the amide protons. As AREX still depends on amide proton density, its pHi sensitivity remains ambiguous. Hence, we conducted this study to assess the influence of pathologic tissue changes on the pHi sensitivity of AREX in vivo. Patients with newly diagnosed intra‐axial brain tumors were prospectively recruited and underwent conventional MRI, quantitative T1 relaxometry, APT‐CEST and 31P‐MRS on a 3T MRI scanner. Tumors were segmented into contrast‐enhancing tumor (CE), surrounding T2 hyperintensity (T2‐H) and contralateral normal appearing white matter (CNAWM). T1 mapping and APT‐CEST metrics were correlated with 31P‐MRS‐derived pHi maps (Pearson's correlation). Without differentiating tissue subtypes, pHi did not only correlate significantly with MTRasym (r = 0.46) but also with T1 (r = 0.49). Conversely, AREX only correlated poorly with pHi (r = 0.17). Analyzing different tissue subtypes separately revealed a tissue dependency of the pHi sensitivity of AREX with a significant correlation (r = 0.6) in CNAWM and no correlation in T2‐H or CE (r = −0.11/−0.24). CE showed significantly increased MTRasym, pHi, and T1 compared with CNAWM (p < 0.001). In our study, the pHi sensitivity of AREX was limited to CNAWM. The lack of sensitivity in CE and T2‐H is probably attributable to altered amide and water proton concentrations in these tissues. Conversely, the correlation of pHi with MTRasym may be explained by the coincidental contrast increase through increased T1 and amide proton density. Therefore, limited structural deviations from CNAWM might be a perquisite for the use of CEST contrasts as pHi‐marker. [ABSTRACT FROM AUTHOR]

Background: The prevalence of suboptimal self‐rated health (SRH) and its association with subsequent all‐cause and cause‐specific mortality after blood or marrow transplantation (BMT) were examined. Methods: Study participants were drawn from the multicenter Blood or Marrow Transplant Survivor Study, and included patients who were transplanted between 1974 and 2014 and had survived ≥2 years after BMT. Participants (aged ≥18 years) completed a survey at a median of 9 years from BMT, and were followed for a median of 5.6 years after survey completion. Survivors provided information on sociodemographic factors, chronic health conditions, health behaviors, and SRH (a single‐item measure rated as excellent, very good, good, fair, or poor; excellent, very good, and good SRH were classified as good SRH, and fair and poor were classified as suboptimal SRH). The National Death Index Plus and Accurint databases and medical records provided vital status through December 2021. Results: Of 3739 participants, 784 died after survey completion (21%). Overall, 879 BMT survivors (23.5%) reported suboptimal SRH. Pain, low socioeconomic status, psychological distress, lack of exercise, severe/life‐threatening chronic health conditions, post‐BMT relapse, obesity, smoking, and male sex were associated with suboptimal SRH. BMT survivors who reported suboptimal SRH had a 1.9‐fold increased risk of all‐cause mortality (95% confidence interval [CI], 1.6–2.3), 1.8‐fold increased risk of recurrence‐related mortality (95% CI, 1.4–2.5), and 1.9‐fold increased risk of non–recurrence‐related mortality (95% CI, 1.4–2.4) compared to those who reported good SRH. Conclusions: This single‐item measure could help identify vulnerable subpopulations who could benefit from interventions to mitigate the risk for subsequent mortality. A single‐item question on self‐rated health can serve as a predictor of subsequent mortality independent of all other demographic and clinical prognosticators of late mortality. This finding suggests that self‐rated health can possibly be incorporated into the workflow of clinical follow‐up of blood or marrow transplantation survivors to provide risk‐stratified care. [ABSTRACT FROM AUTHOR]

Introduction. Traumatic pneumothorax is a life‐threatening condition requiring vigilant clinical assessment and urgent management. Lung ultrasound (LUS) is considered to be a safer, rapid, and accurate modality for the early diagnosis of traumatic pneumothorax. The principle objective of this study was to evaluate the diagnostic accuracy of bedside LUS performed by trained novice physicians in the diagnosis of traumatic pneumothorax as compared to supine chest X‐rays (CXRs) and/or computed tomography (CT) scans and/or air leak during needle/tube thoracostomy as composite standard. Methods. It is a prospective, cross‐sectional, single‐blinded study using a nonprobability quota sampling technique. A total of 96 patients presenting to the emergency department (ED) with polytrauma and chest injuries within a period of twelve months were included. The diagnostic accuracy of bedside LUS performed by trained novice physicians was calculated in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and compared with the composite standard. Results. The sensitivity of LUS in diagnosing traumatic pneumothorax as compared to the composite standard was 100% (95% confidence interval (CI): 59.05%–100.00%), whereas its specificity was 97.75% (95% CI: 92.12%–99.73%). Similarly, the PPV and NPV of LUS were 77.7% (95% CI: 39.99%–97.19%) and 100% (95% CI: 95.85%–100.00%), respectively. Conclusion. The results of the study showed that the application of LUS in detecting traumatic pneumothorax had similar diagnostic accuracy as supine CXR. Bedside LUS is widely available, portable, and inexpensive. It also has the capability of real‐time imaging and can be repeated as necessary with less risk of radiation exposure. Therefore, physicians working in tertiary and rural health institutions must be trained adequately in order to uplift the clinical utility of LUS for the timely and cost‐effective detection of traumatic pneumothorax. [ABSTRACT FROM AUTHOR]

Background. Acute disseminated encephalomyelitis (ADEM) is a rare immune‐mediated pathology involving inflammatory demyelination of the central nervous system. Case Presentation. In this case report, we present the case of a nine‐year‐old female who exhibited altered mental status and focal neurological deficit, subsequently diagnosed as ADEM based on clinical presentation and magnetic resonance imaging (MRI) findings. The patient was managed symptomatically along with glucocorticoids. Conclusion. ADEM must be suspected when a patient, especially a child, presents with prodromal symptoms followed by multifocal neurological symptoms. Diagnosis can be established with an MRI brain scan. Most patients respond to high‐dose intravenous glucocorticoids. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Appropriate anesthetic technique for fracture fixation in multiple myeloma is crucial in minimizing perioperative complications. The use of pericapsular nerve group block followed by spinal anesthesia for the operative management of pathological fracture in multiple myeloma patient along with proper pre‐ and postanesthetic care ensures better outcome for the patient. Multiple myeloma is a malignant plasma cell disease that often presents with anemia, renal failure, hyperkalemia and osteolytic bone lesions. The advancements in drug therapy of multiple myeloma have prolonged the lifespan of the affected people, resulting in a rise in cases of surgical management of fractures in such patients. Anesthetic management, despite being of utmost importance in minimizing perioperative complications in such patients, has not been widely studied, especially in this part of the world. Hence, we report a case of 64 years diabetic, HbSAg positive male with hypothyroidism and a known case of multiple myeloma since the last 6 years, under medication for his comorbidities who suffered acetabular fracture. In this case report, the use of pericapsular nerve group block followed by spinal anesthesia for the operative management of the fracture has been discussed along with several pre‐ and postanesthetic considerations. With appropriate anesthetic techniques and proper pre‐ and postanesthetic care, better outcomes can be guaranteed. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Lateral medullary syndrome, resulting from cerebellar/brainstem infarction, can occur due to cardioembolic stroke from atrial fibrillation caused by rheumatic heart disease. This rare association highlights the importance of strict arrhythmia management, prophylactic anticoagulation, and timely diagnosis to prevent debilitating neurological outcomes. [ABSTRACT FROM AUTHOR]

Multidrug‐resistant (MDR) Acinetobacter baumannii poses a significant therapeutic challenge due to its resistance to multiple antibiotics and its ability to form biofilm. This study aimed to characterize MDR A. baumannii isolates for their biofilm‐forming capabilities and the presence of common biofilm‐related genes at a tertiary care university hospital in Nepal. In addition, it assessed the efficacy of various compounds, particularly essential oils, in inhibiting biofilm formation. Identification and antibiotic sensitivity testing of A. baumannii isolates from clinical specimens were conducted according to the guidelines of the American Society for Microbiology. Isolates were screened for motility profiles, biofilm production in a microtiter plate assay, and the presence of biofilm‐related gene(s) by conventional polymerase chain reaction. The ability of cinnamaldehyde, ethylenediaminetetraacetic acid (EDTA), Tween 80, amino acids (glycine and glutamic acid), and natural plant extracts to inhibit biofilm formation was also tested using the microtiter plate system. Out of the total 200 A. baumannii isolates, 195 were MDR, with 192 able to produce biofilms. Among them, 83.1% were strong biofilm producers. In this study, 42.0% and 66.2% of the isolates exhibited twitching motility and surface‐associated motility, respectively. Thirty MDR A. baumannii isolates from medical devices contained biofilm‐related genes csuE, ompA, bap, and blaPER−1, in 90.0%, 53.3%, 46.6%, and 26.6% of strains, respectively. Cinnamaldehyde (0.875 mg/mL) was the most effective compound, inhibiting biofilm formation by 77.3%, followed by ethanolic extract of onion (77.2%), 0.5% Tween 80 (76.8%), and essential oil of ginger (70.8%). The majority of A. baumannii clinical isolates were strong biofilm producers and often possessed the biofilm‐related genes csuE and ompA. Essential oils at 200 mg/L, along with Tween 80, were the most effective (≥ 67%) at inhibiting the formation of biofilms. These findings help to understand biofilm production and provide valuable insights into MDR A. baumannii isolates in this clinical setting. [ABSTRACT FROM AUTHOR]

Rationale: Nd and Sm isotope ratios play an important role in geological dating and as nuclear forensic signatures; however, the overlap of the respective 144, 148, 150 Nd/Sm isobars requires prior separations to be performed before analysis on typical MS platforms. The work presented here overcomes these isobaric interferences using ultrahigh‐mass resolution to alleviate interference without prior chemical separations. Methods: A liquid sampling‐atmospheric pressure glow discharge ion source was coupled to a standard, QExactive Focus Orbitrap mass spectrometer, providing a mass resolution of ~80 k. A Spectroswiss FTMS booster X2 data acquisition package was used to collect extended transients, providing much higher mass resolution; ~230 k and ~600 k are employed here for Nd and Sm isotopes. Results: While the standard Orbitrap resolution is far greater than typical "atomic" MS platforms, it was insufficient to alleviate all isobars. The use of a resolution of ~230 k resulted in baseline separation across the entire isotopic envelope for both Nd and Sm. Isotope ratios obtained from Nd:Sm mixtures using high‐resolution were equivalent to those found for individual‐element solutions, while isotope ratios obtained at a resolution of ~80 k (standard for the OEM data system) showed large deviations. Conclusions: Use of ultrahigh‐resolution is an attractive alternative to extensive chemical separations to alleviate severe isobaric interferences. Sufficient mass resolution greatly reduces/eliminates the need for sample manipulations (separations) before analysis while reducing costs and total analysis times. [ABSTRACT FROM AUTHOR]

The article discusses a case of effort-induced upper extremity deep vein thrombosis in a healthy painter, highlighting the importance of recognizing this uncommon condition. The patient presented with pain and swelling in the right upper limb, which was diagnosed through venous ultrasound. Treatment involved early anticoagulation, with catheter-directed thrombolysis and first rib resection being common therapeutic approaches. The case underscores the need for suspicion of primary UEDVT in young individuals engaged in repetitive upper extremity movements, emphasizing the importance of prompt diagnosis and appropriate management to prevent complications. [Extracted from the article]

The case report examines a rare presentation of tricuspid valve infective endocarditis (TVIE) following a septic abortion. A 31‐year‐old female presented with persistent high‐grade fever, chills, and mild vaginal bleeding post medical termination of pregnancy. Despite initial management for septic abortion, including manual evacuation and antibiotics, her symptoms recurred, necessitating further evaluation. Diagnostic workup revealed methicillin‐resistant Staphylococcus aureus (MRSA) bacteremia and echocardiographic evidence of vegetations on the tricuspid valve. Treatment included targeted intravenous antibiotics and supportive care, but due to family preference, the patient was referred for advanced management. The report underscores the importance of considering endocarditis in patients with unresolved infections post‐gynecological procedures. It highlights the role of blood cultures and echocardiography in diagnosis and emphasizes prophylactic measures and sterile techniques to prevent such complications. This case exemplifies a critical need for prompt multidisciplinary interventions to mitigate morbidity associated with rare but severe sequelae of septic abortion. [ABSTRACT FROM AUTHOR]

Excited‐state intramolecular proton transfer (ESIPT)‐associated dual‐state emissive aliphatic dual‐light emitting conducting polymers (DLECPs) having oxidation‐reduction capacities are prepared polymerizing 2‐acrylamido‐2‐methylpropane‐1‐sulfonic acid, methacrylic acid, and 2‐methyl‐3‐(N‐(2‐methyl‐1‐sulfopropan‐2‐yl)acrylamido)propanoic acid monomers. Of as‐synthesized DLECPs, nuclear magnetic resonance (NMR) and Fourier transform infrared (FTIR) spectroscopies, fluorescent enhancements (I/I0), and computational investigation indicate intriguing photophysical features in DLECP3 (optimum composition). In DLECP3, ─CONH─, ─CON<, and ─COOH subluminophores are recognized by density‐functional theory (DFT)/time‐dependent‐DFT calculations and experimental investigations. ESIPT‐associated dual‐state emission/conductivity, aggregation‐enhanced emissions, selective opto‐electronic responses toward Hg(II)/Cr(III) at 437/574 nm, and redox properties of DLECP3 are supported by solid‐state/solution spectroscopies, time‐correlated single photon counting (TCSPC) measurements, dual‐state excitation dependent emissions, microscopic images, electrochemical measurements, and DFT calculations. Here, preferential interaction of Hg(II)/Cr(III) with DLECP3 (amide)/DLECP3 (imidol) and reduction/oxidation of Hg(II)/Cr(III) to Hg(I)/Cr(VI) are substantiated by UV–vis, FTIR, and X‐ray photoelectron spectroscopies; TCSPC measurements; NMR‐titration; electrochemical studies; alongside computational calculations. The proton‐electrical conductivities of DLECP3, Hg(II/I)‐DLECP3, and Cr(III/VI)‐DLECP3 in solids/solutions are 15.27 × 10−5/6.16 × 10−5, 19.60 × 10−5/25.52 × 10−5, and 26.69 × 10−5/27.60 × 10−5 S cm−1, respectively. [ABSTRACT FROM AUTHOR]

Lung cancer (LC) continues to pose the highest mortality and exhibits a common prevalence among all types of cancer. The genetic interaction between human eukaryotes and microbial cells plays a vital role in orchestrating every physiological activity of the host. The dynamic crosstalk between gut and lung microbiomes and the gut–lung axis communication network has been widely accepted as promising factors influencing LC progression. The advent of the 16s rDNA sequencing technique has opened new horizons for elucidating the lung microbiome and its potential pathophysiological role in LC and other infectious lung diseases using a molecular approach. Numerous studies have reported the direct involvement of the host microbiome in lung tumorigenesis processes and their impact on current treatment strategies such as radiotherapy, chemotherapy, or immunotherapy. The genetic and metabolomic cross‐interaction, microbiome‐dependent host immune modulation, and the close association between microbiota composition and treatment outcomes strongly suggest that designing microbiome‐based treatment strategies and investigating new molecules targeting the common holobiome could offer potential alternatives to develop effective therapeutic principles for LC treatment. This review aims to highlight the interaction between the host and microbiome in LC progression and the possibility of manipulating altered microbiome ecology as therapeutic targets. [ABSTRACT FROM AUTHOR]

BRASH syndrome characterized by bradycardia, renal dysfunction, atrioventricular nodal blockade (AVNB), shock, and hyperkalemia presents diagnostic and management challenges due to its complex pathophysiology and varied clinical presentations. We describe a 90‐year‐old woman with a history of multiple comorbidities who was on beta blockers bisoprolol for heart failure, presented with shock, refractory hyperkalemia along with bradycardia that required intermittent hemodialysis. Initial management involved aggressive hyperkalemia medical therapy and fluid resuscitation, with subsequent consideration of renal replacement therapy hemodialysis following collaboration with a multidisciplinary team, including cardiology and nephrology specialists. Despite aggressive medical management for hyperkalemia, some cases of BRASH syndrome may remain challenging to treat, requiring intermittent hemodialysis highlighting the need for further research and understanding of this complex clinical entity to improve treatment outcomes. [ABSTRACT FROM AUTHOR]

Primary vulvar diffuse large B‐cell lymphoma is a diagnostically challenging malignant tumor due to its low incidence and diverse clinical presentations. It has a good prognosis and is usually radio‐chemotherapy‐responsive. This case report emphasizes considering lymphoma as a differential in vulvar inflammatory conditions. [ABSTRACT FROM AUTHOR]

Acute myocardial infarction (AMI) is an important subset of cardiovascular disease, and a medical emergency, where timely reperfusion is needed to reduce short‐term and long‐term complications from it. AMI following blunt chest trauma is a rare but serious complication of motor vehicle accidents and should be treated promptly. We are presenting a case of 26 years‐old male, who presented to ED after a motor vehicle accident, went into cardiac arrest, and was found ST elevated MI (STEMI) on electrocardiography. Subsequently, cardiac catheterization revealed ruptured plaque in the proximal left anterior descending artery, with thrombus extending to mid‐LAD, requiring a stent placement. [ABSTRACT FROM AUTHOR]

Timely diagnosis and surgical intervention are crucial in managing hydrocele of the canal of Nuck. A systematic approach, including thorough examination and appropriate imaging, followed by meticulous surgical technique, ensures successful treatment and favorable long‐term outcomes for patients. [ABSTRACT FROM AUTHOR]

Energy storage in electrochemical hybrid capacitors involves fast faradaic reactions such as an intercalation, or redox process occurring at a solid electrode surface at an appropriate potential. Hybrid sodium‐ion electrochemical capacitors bring the advantages of both the high specific power of capacitors and the high specific energy of batteries, where activated carbon serves as a critical electrode material. The charge storage in activated carbon arises from an adsorption process rather than a redox reaction and is an electrical double‐layer capacitor. Advanced carbon materials with interconnecting porous structures possessing high surface area and high conductivity are the prerequisites 1128to qualify for efficient energy storage. Herein, we have demonstrated that a porous honeycomb structure activated carbon derived from Australian hemp hurd (Cannabis sativa L.) in aqueous Na2SO4 electrolyte showed a specific capacitance of 240 F/g at 1 A/g. The mass ratio of biochar to KOH during the chemical activation associated with the synthesis temperature influences the change in morphologies, and distribution of pore sizes on the adsorption of ions. At higher synthesis temperatures, the tubular form of the honeycomb starts to disintegrate. The hybrid sodium‐ion device employing hemp‐derived activated carbon (HAC) coupled with electrolytic manganese dioxide (EMD) in an aqueous Na2SO4 electrolyte showed a specific capacitance of 95 F/g at 1 A/g having a capacitance retention of 90 %. The hybrid device (HAC||EMD) can possess excellent electrochemical performance metrics, having a high energy density of 38 Wh/kg at a power density of 761 W/kg. Overall, this study provides insights into the influence of the activation temperature and the KOH impregnation ratio on morphology, porosity distribution, and the activated carbon's electrochemical properties with faster kinetics. The high cell voltage for the device is devoted to the EMD electrode. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernias are encountered commonly, but there is a lack of uniformity and standardization in repair techniques. There are a variety of repair methods, from open methods to laparoscopic approaches. The available laparoscopic techniques that exist for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. This study aims to compare the outcomes of these two laparoscopic procedures. Methods: The study was initiated after receiving ethical clearance. This single‐centric retrospective study included the patients that underwent laparoscopic inguinal hernia repair from January 1, 2020, to December 31, 2023. Patient records were reviewed and assessed against the inclusion criteria of the study. Systematic random sampling was applied to select patients from the records. A structured questionnaire was prepared for the purpose of data collection. The data were refined and analyzed using the SPSS software. Results: A total of 200 patients (100 in each group) who underwent laparoscopic repair of an inguinal hernia were part of this study. The median (IQR) age of patients in the TAPP group was 50 (41.25–64.75) years, and that in the TEP group was 48.5 (39.25–64.75) years. The TAPP procedure took a median (IQR) time of 81 (77–88) min, while the TEP procedure took 69 (66–73) min to finish. The patients in the TAPP group returned to their normal activities after 15 (14–16) days of surgery, and the patients in the TEP group returned after 13 (11–14) days. The pain score at 1 week was found to be better in the TEP group. No difference was observed in complications or recurrence. Conclusion: TEP repair was found to be superior to TAPP repair in terms of procedural time, return to normal activities, and pain score at 1 week. [ABSTRACT FROM AUTHOR]

Organic light‐emitting diodes (OLEDs) have revolutionized display and lighting technologies, offering unparalleled design, device flexibility, vibrant colors, and energy efficiency. In this comprehensive review we elucidate the evolution of OLED technology, summarizing its progression from the fundamental principles of fluorescence (1st generation) and phosphorescence (2nd generation) to the emergence of thermally activated delayed fluorescence (TADF) (3rd generation), hyper fluorescence (4th generation), and exceptional future generation OLEDs. This review highlights the development and challenges of early‐generation OLEDs, scrutinizing their mechanisms, emitters, and limitations. As TADF OLEDs mark a significant paradigm shift, we explore their enhanced efficiency and potential for cost‐effective production without the involvement of toxic heavy metals. Building upon this foundation this review explores the burgeoning concepts of hyper‐fluorescence and future‐generation OLEDs, poised to push the boundaries of color purity, efficiency, and operational stability. This consolidated comprehensive exploration described herein may provide enormous information for designing future‐generation OLED materials for sustainable development. [ABSTRACT FROM AUTHOR]

On 8 April 2024, a rare total solar eclipse (TSE) passed over western New York State (NYS), the first since 1925 and the last one until 2079. The NYS Mesonet (NYSM) consisting of 126 weather stations with 55 on the totality path provides unprecedented surface, profile, and flux data and camera images during the TSE. Here we use NYSM observations to characterize the TSE's impacts at the surface, in the planetary boundary layer (PBL), and on surface fluxes and CO2 concentrations. The TSE‐induced peak surface cooling occurs 17 min after the totality and is 2.8°C on average with a maximum of 6.8°C. It results in night‐like surface inversion, calm winds, and reduced vertical motion and mixing, leading to the shallowing of the PBL and its moistening. Surface sensible, latent and ground heat fluxes all decrease whereas near‐surface CO2 concentration rises as photosynthesis slows down. Plain Language Summary: On 8 April 2024, a rare total solar eclipse (TSE) passed over western New York State (NYS), the first one since 1925 and the last one until 2079. The entire NYS witnessed at least 88% obscuration at the peak of the eclipse. It provides an excellent opportunity to study the impacts of the TSE. The NYS Mesonet (NYSM), an advanced statewide weather network, has 55 stations on the totality path and provides unprecedented measurements of surface meteorological variables, atmospheric vertical profiles, the heat exchange between the atmosphere and the surface and carbon dioxide (CO2) concentration. It enables one to study the TSE in greater details on a regional scale for the first time. This study found that the moon shadow cools the surface by as much as 6.8°C and creates a surface inversion layer. The cooling calms down winds and vertical mixing, leading to less escape of the water vapor and moistening of the air. It also reduces the heat exchange between the surface and the air. Without sunlight, the photosynthesis shuts down, causing a robust rise in near‐surface CO2 concentration. One‐minute camera images provide a fantastic view of the darkening of the sky during the TSE. Key Points: The New York State Mesonet provided unprecedented surface, profile, flux and image data during the 8 April 2024 total solar eclipse across New York StateThe eclipse resulted in significant cooling and moistening near the surface and in the boundary layer, leading to a surface inversion layerIt also weakened surface winds, turbulent mixing, heat fluxes, but caused a robust rise in near‐surface CO2 concentrations [ABSTRACT FROM AUTHOR]

Animal consumers excrete dissolved inorganic nitrogen, an essential nutrient for regulating primary production and macroalgal growth in the ocean. Often overlooked in attempts to explain kelp forest productivity, relatively little is known about the role of consumers in nutrient cycling in temperate systems, such as the magnitude of nutrients excreted and the factors that influence spatial and temporal variability in consumer‐derived nutrients. To investigate the supply of ammonium (NH4+) excreted by the dominant members of the nearshore rocky reef fish community, we combined empirically‐measured relationships between excretion rate and body mass with data on fish density and size structure from visual SCUBA surveys conducted from 2005 to 2018 in the northern Channel Islands, California, USA. The fish community excreted a substantial amount of ammonium to the kelp forest (mean: 95.5–131.3 μmol·m−2·h−1), however excretion varied substantially among sites and over time (range: 23.1–247.9 μmol·m−2·h−1). The ammonium supply was influenced by the establishment of marine protected areas (MPAs) that restricted fishing activities and environmental characteristics that influenced geographic and temporal shifts in the overarching fish community structure. Fish‐derived ammonium excretion rates were 50%–80% greater inside MPAs compared to areas open to fishing, while environmental and habitat characteristics (e.g. habitat vertical relief, kelp biomass, wave exposure, chlorophyll a) explained 85% of the spatial variation in community excretion rates. In contrast, large‐scale oceanographic phenomena (e.g. North Pacific Gyre Oscillation index) and past patterns of fish recruitment explained 57% of the temporal variation in nutrient excretion over the 14‐year time series. Results suggest that fish‐derived ammonium may provide an important and underappreciated nutrient source to kelp beds, particularly during low‐nutrient periods (e.g. seasonal reductions in upwelling or El Niño‐Southern Oscillation events), and that fishing disrupts these nutrient cycling pathways. Fishes likely play a critical role in supporting the resiliency of kelp forest ecosystems by supplying a relatively constant source of reduced nitrogen that can be utilized by giant kelp and other macroalgae to fuel primary production of biogenic habitat. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

ABSTRACT Spotted‐wing drosophila (SWD), Drosophila suzukii, is a major pest of various soft‐skinned fruit crops worldwide. We investigated an alternative approach to traditional insecticides to manage SWD. Previously, we have shown that 2‐pentylfuran (2pf) reduced oviposition in raspberries in laboratory and small‐scale field studies. Here, we further investigated the potential of 2pf as a management tool for SWD under more realistic field conditions. We tested the efficacy of 2pf under open field conditions in 2019 and 2020 using isolated plots of raspberries. For the two 2019 field trials, we used single raspberry fruiting inflorescences and deployed 2pf using a sachet for 48 h and 6 days, respectively, and assessed SWD infestation. We did not find any significant differences in SWD infestation in the 48 h trial but found noticeable reductions when 2pf was deployed for 6 days. In 2020, we randomly assigned treatments to an entire small, research planting of raspberries with different doses of 2pf (low, medium, and high) for both the summer and fall crops and recorded infestations. The low and medium doses of 2pf resulted in significant reductions in SWD infestation in field plantings when SWD densities were low (summer crop), but only the high dose reduced infestations when SWD pressure was high in the fall crop. Our study shows that 2pf has potential as a management tool for SWD under field conditions using a highly susceptible crop, but its effectiveness may vary depending on 2pf release rates and SWD abundance. Future studies are needed to test 2pf in combination with other repellents or with targeted insecticides. [ABSTRACT FROM AUTHOR]

Summary: Lignin, a complex heterogenous polymer present in virtually all plant cell walls, plays a critical role in protecting plants from various stresses. However, little is known about how lignin modifications in sorghum will impact plant defense against sugarcane aphids (SCA), a key pest of sorghum.We utilized the sorghum brown midrib (bmr) mutants, which are impaired in monolignol synthesis, to understand sorghum defense mechanisms against SCA. We found that loss of Bmr12 function and overexpression (OE) of Bmr12 provided enhanced resistance and susceptibility to SCA, respectively, as compared with wild‐type (WT; RTx430) plants.Monitoring of the aphid feeding behavior indicated that SCA spent more time in reaching the first sieve element phase on bmr12 plants compared with RTx430 and Bmr12‐OE plants. A combination of transcriptomic and metabolomic analyses revealed that bmr12 plants displayed altered auxin metabolism upon SCA infestation and specifically, elevated levels of auxin conjugate indole‐3‐acetic acid–aspartic acid (IAA–Asp) were observed in bmr12 plants compared with RTx430 and Bmr12‐OE plants. Furthermore, exogenous application of IAA–Asp restored resistance in Bmr12‐OE plants, and artificial diet aphid feeding trial bioassays revealed that IAA–Asp is associated with enhanced resistance to SCA.Our findings highlight the molecular underpinnings that contribute to sorghum bmr12‐mediated resistance to SCA. [ABSTRACT FROM AUTHOR]

In this study, a breathable and strain‐insensitive multi‐layered electronic skin (e‐skin) capable of real‐time detection and distinction of electrocardiogram (ECG) signals, temperature, and skin hydration is developed. Leveraging a scalable benchtop method, sensing elements are transferred onto porous and hydrophobic substrates, followed by multi‐layer stacking to enable multimodal sensing. The sensing elements, a combination of carbon nanotube and nanoporous carbon (CNT@NPC) ink, are applied using strain‐insensitive patterned masks, then spray‐coated with styrene–ethylene–butylene–styrene (SEBS) to create a hierarchical porous network through phase separation. The CNT@NPC networks exhibit an improvement in strain insensitivity with active sensing capabilities due to their adaptable molecular tuning capacity and exceptional electrical conductivity. The porous SEBS substrate offers strong bonding with CNT@NPC attributed to the π–π interactions and high kinetic energy dispersion from spray coating allowing effective transfer. This unique design facilitates breathability, and miniaturization that minimizes the interference between different sensing modalities, ensuring accurate and reliable data acquisition. The breathability (3.49 mg cm−2 h−1) and the non‐smearing nature of the multi‐layered e‐skin enables simultaneous monitoring of temperature (0.198% °C−1), skin hydration (relative humidity = 0.77% %−1), and ECG (26 ± 1 dB) with continuous data transmission to a remote smartphone interface. [ABSTRACT FROM AUTHOR]

Objectives: Resident pain has been a common quality challenge in congregate care for older adults, and organizational context may explain variations in resident pain beyond resident‐level factors. Most studies have focused on nursing homes (NHs), largely neglecting assisted living (AL). AL residents are at similar risk for pain as NH resident, but with AL providing fewer services and staffing resources. Our objective was to examine whether organizational context in AL was associated with resident pain during the first two waves of the COVID‐19 pandemic. Methods: This repeated cross‐sectional study linked AL home surveys, collected in COVID‐19 waves 1 (March–June 2020) and 2 (October 2020–February 2021) from a key contact, to administrative Resident Assessment Instrument‐Home Care (RAI‐HC) records in these homes. Surveys assessed preparedness for COVID‐19 outbreaks, availability of a registered nurse or nurse practitioner, direct care staff shortages, decreased staff morale, COVID‐19 outbreaks, confinement of residents to their rooms, supporting video calls with physicians, facilitating caregiver involvement. The dependent variable (moderate daily pain or pain of a severe intensity) and resident covariates came from the RAI‐HC. Using general estimating equations, adjusted for repeated resident assessments and covariates, we assessed whether AL organizational context was associated with resident pain during the pandemic. Results: We included 985 residents in 41 facilities (wave 1), and 1134 residents in 42 facilities (wave 2). Pain prevalence [95% confidence interval] decreased non‐significantly from 20.6% [18.6%–23.2%] (March–June 2019) to 19.1% [16.9%–21.6%] (October 2020–February 2021). Better preparedness (odds ratio = 1.383 [1.025–1.866]), confinement of residents to their rooms (OR = 1.616 [1.212–2.155]), availability of a nurse practitioner (OR = 0.761 [0.591–0.981]), and staff shortages (OR = 0.684 [0.527–0.888]) were associated with resident pain. Conclusions: AL organizational context factors were associated with resident pain. Policy and management interventions can and must address such factors, providing potentially powerful levers for improving AL resident quality of care. [ABSTRACT FROM AUTHOR]

Objective: To explore the efficacy and safety of 5% lidocaine‐medicated plaster (LMP) in patients with trigeminal neuralgia (TN). Background: TN is an excruciatingly painful type of neuropathic facial pain. Anti‐epileptics are the first‐line treatment for TN; however, these oral drugs alone sometimes fail to achieve satisfactory analgesic effects. Two retrospective studies have shown that LMP can be an effective and safe treatment option for some patients with TN. No other high‐quality clinical studies have explored the effect and safety of LMP in patients with TN. Methods: The PATCH trial is an enriched enrollment with randomized withdrawal, double‐blind, vehicle‐controlled, parallel‐group trial performed at five study centers. Eligible patients with TN received LMP during a 3‐week initial open‐label phase. Patients who met the response criteria entered the double‐blind treatment phase and were randomly assigned for treatment with either LMP (LMP group) or vehicle patches (control group) at a 1:1 ratio. Patients who met the criteria for treatment failure were withdrawn from the double‐blind treatment phase, and treatment was continued in the remaining patients for up to 28 days. The primary outcome was the number of treatment failures. The secondary endpoints were the time to loss of therapeutic response (LTR) in the double‐blind phase and the weekly mean pain severity in both the open‐label phase and the double‐blind phase of the study. Results: The first patient was enrolled in this study on May 1, 2021, and the enrollment of the last patient was completed on August 26, 2022. A total of 307 patients were initially screened, 226 (74.0%) of whom entered the open‐label phase. Of the 226 respondents, 124 (55.0%) were randomized to the double‐blind phase. In the double‐blind phase, 62 patients were assigned to the LMP group, and 62 were assigned to the control group. For the primary endpoint, 16 (26.0%) patients with LMP and 36 (58.0%) patients with vehicle patches met the treatment failure criteria during the double‐blind phase (relative risk, 0.48; 95% confidence interval [CI], 0.31 to 0.75; p < 0.001). The survival curve of the LTR showed that the LTR of LMP was significantly longer than that of the vehicle patches (hazard ratio, 0.275; 95% CI, 0.15 to 0.50; log‐rank p < 0.001). LMP also significantly reduced the weekly mean pain severity in the double‐blind phase of the study (p = 0.007). Conclusions: LMP produced partial relief of pain symptoms in some patients with TN. For responders, LMP may be used as an add‐on therapy in a multidrug treatment protocol. Plain Language Summary: The PATCH trial is an enriched enrollment, randomized withdrawal, double‐blind, vehicle‐controlled, parallel‐group study. The results of the PATCH trial supported that 5% lidocaine‐medicated plaster (LMP) produces partial relief of pain symptoms in some patients with trigeminal neuralgia. For responders, 5% LMP may be used as an add‐on therapy in a multidrug treatment protocol. [ABSTRACT FROM AUTHOR]

The article discusses a case of delayed detection of coarctation of the aorta causing resistant hypertension in an elderly male. Despite the absence of typical signs, renal Doppler showing bilateral parvus et tardus flow pattern led to the diagnosis. The patient underwent surgical repair, resulting in improved blood pressure control and a successful outcome. The case highlights the importance of considering coarctation of the aorta as a differential diagnosis in cases of resistant hypertension, even in the absence of typical clinical signs. [Extracted from the article]

This case report documents the first confirmed outbreak of African swine fever (ASF) in a wild boar (Sus scrofa) in Nepal. The case was identified in a wild boar carcass found in Shuklaphanta National Park in February 2023. Post‐mortem findings, including splenomegaly, haemorrhagic lymph nodes and congested organs, were suggestive of ASF, which was confirmed by real‐time PCR. Epidemiological evidence indicates potential transmission from nearby ASF‐infected domestic pigs. This case underscores the critical need for rigorous biosecurity protocols, comprehensive surveillance and targeted wildlife management strategies to prevent further transmission between domestic pig and wild boar populations. [ABSTRACT FROM AUTHOR]

This article from Clinical Case Reports discusses a case of a diabetic patient with focal segmental glomerulosclerosis (FSGS) and infection-related glomerulonephritis (IRGN) leading to rapid renal decline. The patient's complex condition required careful management to balance immunosuppressive treatments for FSGS with infection control strategies for IRGN. The case highlights the importance of multidisciplinary collaboration, timely histopathological assessment, and personalized treatment approaches to prevent irreversible kidney damage in high-risk patients with overlapping pathologies. [Extracted from the article]

Summary: The Glasgow prognostic score (GPS) and CAR‐HEMATOTOX (CAR‐HT) score identify multiple myeloma (MM) patients at high risk for immune‐mediated toxicity and early mortality with cellular immunotherapy. However, their association with outcomes in patients receiving T‐cell redirecting bispecific antibodies (bsAb) is unclear. This multi‐centre retrospective study examines the association of baseline GPS and CAR‐HT scores with outcomes in 126 MM patients treated with bsAb. Overall, 19% were identified as GPS high risk but did not experience increased toxicity or mortality. Conversely, high‐risk CAR‐HT patients had a higher incidence of infections and inferior survival, suggesting a need for aggressive infection mitigation strategies. [ABSTRACT FROM AUTHOR]

Cucurbita crops, which include market types of pumpkin and squash, have unparalleled fruit variation and equally important economic value worldwide. Pumpkin and squash have versatile uses but are most popular in culinary, ornamental, snacking, and seed oil industries. The production of Cucurbita crops is hindered by diseases caused by fungal, oomycetes, and viral pathogens. Host resistance is an important component of integrated disease management for Cucurbita crops and is a major goal for plant breeders. This review addresses the major diseases of Cucurbita, including powdery mildew, downy mildew, Phytophthora rot, and aphid and whitefly transmitted viruses, with an emphasis on germplasm exploitation for the development of resistant cultivars. Resistance to powdery mildew derived from Cucurbita okeechobeensis subsp. martinezii (designated PM‐0) has been extensively deployed in commercial cultivars and was recently mapped on chromosomes 3 and 10 of Cucurbita moschata and Cucurbita pepo, respectively. Resistance to Phytophthora crown rot is present across several Cucurbita species, including Cucurbita lundelliana, C. okeechobeenesis subsp. okeechobeenesis, C. moschata, and C. pepo. Mapping studies have identified significant loci associated with Phytophthora crown rot resistance on chromosomes 4, 11, and 20 of C. moschata and chromosomes 4, 5, 8, 12, 13, 16, and 19 of C. pepo. Sources of resistance to aphid‐transmitted viruses exist in C. moschata, Cucurbita ficifolia, Cucurbita ecuadorensis, Cucurbita martinezii, C. ecuadorensis, Cucurbita maxima, and Cucurbita foetidissima. The availability of DNA markers linked to resistance against zucchini yellow mosaic virus and papaya ringspot virus in C. moschata and C. pepo has facilitated marker‐assisted selection (MAS) in breeding programs. On the other hand, sources of resistance to tomato leaf curl New Delhi virus (ToLCNDV), a major whitefly‐transmitted virus in Cucurbita, have been identified in C. moschata, C. lundelliana, and C. okeechobeensis. A major locus conferring resistance to ToLCNDV in C. moschata was recently mapped on chromosome 8 enabling the application of MAS with a prediction accuracy of 94.3%. Overall, the continued discovery and application of genomic tools for resistance breeding in Cucurbita will accelerate the rate of genetic gain while reducing costs associated with phenotyping. Core Ideas: Resistance to powdery mildew, designated PM‐0, has been extensively deployed in commercial cultivars.Resistance to Phytophthora crown rot is available in Cucurbita lundelliana, Cucurbita okeechobeenesis, Cucurbita moschata, and Cucurbita pepo.Sources of resistance to aphid‐transmitted viruses exist in at least seven Cucurbita species.Resistance to tomato leaf curl New Delhi virus is present in C. moschata, C. lundelliana, and C. okeechobeensis.Availability of genomic tools in Cucurbita will accelerate the rate of genetic gain for resistance breeding. Plain Language Summary: Pumpkin and squash are important crops worldwide. Some of the main plant diseases affecting cultivation of pumpkin and squash include mildews, viruses, and fruit and stem rots. Development of cultivars resistant to these diseases is important for growers as it helps cut the costs associated with production. Many sources of resistance to these diseases have been identified. DNA markers linked to genetic resistance will aide plant breeders in the process of selecting plants carrying suitable resistance genes. [ABSTRACT FROM AUTHOR]

Increasing integrity concerns in medical research have prompted the development of tools to detect untrustworthy studies. Existing tools primarily assess published aggregate data (AD), though scrutiny of individual participant data (IPD) is often required to detect trustworthiness issues. Thus, we developed the IPD Integrity Tool for detecting integrity issues in randomised trials with IPD available. This manuscript describes the development of this tool. We conducted a literature review to collate and map existing integrity items. These were discussed with an expert advisory group; agreed items were included in a standardised tool and automated where possible. We piloted this tool in two IPD meta‐analyses (including 116 trials) and conducted preliminary validation checks on 13 datasets with and without known integrity issues. We identified 120 integrity items: 54 could be conducted using AD, 48 required IPD, and 18 were possible with AD, but more comprehensive with IPD. An initial reduced tool was developed through consensus involving 13 advisors, featuring 11 AD items across four domains, and 12 IPD items across eight domains. The tool was iteratively refined throughout piloting and validation. All studies with known integrity issues were accurately identified during validation. The final tool includes seven AD domains with 13 items and eight IPD domains with 18 items. The quality of evidence informing healthcare relies on trustworthy data. We describe the development of a tool to enable researchers, editors, and others to detect integrity issues using IPD. Detailed instructions for its application are published as a complementary manuscript in this issue. [ABSTRACT FROM AUTHOR]

Increasing concerns about the trustworthiness of research have prompted calls to scrutinise studies' Individual Participant Data (IPD), but guidance on how to do this was lacking. To address this, we developed the IPD Integrity Tool to screen randomised controlled trials (RCTs) for integrity issues. Development of the tool involved a literature review, consultation with an expert advisory group, piloting on two IPD meta‐analyses (including 73 trials with IPD), preliminary validation on 13 datasets with and without known integrity issues, and evaluation to inform iterative refinements. The IPD Integrity Tool comprises 31 items (13 study‐level, 18 IPD‐specific). IPD‐specific items are automated where possible, and are grouped into eight domains, including unusual data patterns, baseline characteristics, correlations, date violations, patterns of allocation, internal and external inconsistencies, and plausibility of data. Users rate each item as having either no issues, some/minor issue(s), or many/major issue(s) according to decision rules, and justification for each rating is recorded. Overall, the tool guides decision‐making by determining whether a trial has no concerns, some concerns requiring further information, or major concerns warranting exclusion from evidence synthesis or publication. In our preliminary validation checks, the tool accurately identified all five studies with known integrity issues. The IPD Integrity Tool enables users to assess the integrity of RCTs via examination of IPD. The tool may be applied by evidence synthesists, editors and others to determine whether an RCT should be considered sufficiently trustworthy to contribute to the evidence base that informs policy and practice. [ABSTRACT FROM AUTHOR]

The study aims to identify the motives of foreign direct investment in Nepal and analyse the perceived strengths and weaknesses of investment climate. Additionally, it examines the experience of foreign investors in Nepal in terms of further investment plans and net promoter scores attributed to the host country. The study relies on primary data collected from the survey of 65 sampled industries with foreign direct investment, using structured questionnaires. Descriptive analysis has been used to assess the key factors motivating foreign investors. The findings reveal that labour cost, repatriation facility, industrial security, low operating costs, access to neighbouring market/trade openness, and investment and communal hospitality stand out as major motivating factors, while political instability, macroeconomic instability, availability of machinery and equipment, road access, and bureaucracy are the major precluding factors. The policy reforms in Nepal have notably shaped investors' perceptions. Acts like the Foreign Investment and Technology Transfer Act, 1992, and subsequent amendments such as the Foreign Investment and Loan Management, 2021, have significantly motivated investors by improving repatriation facilities and ease of VISA and work permit accessibility. Despite the efforts, land facilitation for foreign investors has been perceived as a weakness. The net promoter score for Nepal is 12 on a scale from −100 to +100, which is positive, albeit low, indicating a substantial gap to attain full promoters and needs to be improved by further enhancing the investment climate. [ABSTRACT FROM AUTHOR]

Splays—fan‐shaped depositional landforms produced by overbank deposition by unconfined flows—can damage structures, degrade arable land and incur substantial mitigation costs. Splay‐related hazards along many rivers are likely to worsen with the increasing magnitude and frequency of major floods. The highly incomplete understanding of splays on braided streams is a conspicuous knowledge gap in a changing world with more frequent and intense floods. The largest recorded flood on the braided, sand‐dominated lower Platte River (eastern Nebraska, USA) in March 2019 resulted from the rapid melting of a deep, moist snowpack during an extreme rain‐on‐snow, bomb‐cyclone event. This flood produced 32 large (as much as 234 ha) splays that buried structures and cropland under sand. A total of 1,438 ha of row crop was buried, equating to 1.2 million dollars in lost revenue. These splays diverged from the channel by 14° to 104° along a 122 km reach. The topography of preexisting abandoned channels strongly controlled the shape and orientation of most splays, although forested areas tended to trap or divert sediment. The flood eroded 2.2 to 202 m2 m−1 of the streambank at 11 of the splays. The five largest splays (>100 ha) deposited as much as 2.4 m of sand. Ground‐penetrating radar profiles of the largest splay indicate that it consisted almost entirely of overbank deposits exhibiting simple downstream accretion that buried the pre‐flood soil under ≤ 1 m or less of sand. Locally, however, this soil was eroded during the flood. Climate models predict increasing winter precipitation in the Platte River basin; therefore, the frequency of major floods should increase, making splays recurrent hazards. Our geomorphic assessment of the splays on the lower Platte River illustrates the need for future hazard and mitigation planning. [ABSTRACT FROM AUTHOR]

Background: "Kaposi varicelliform eruption" (KVE), also known as "eczema herpeticum," refers to a rare widespread skin infection. The primary causal agent is thought to be the herpes simplex virus (HSV). Though common in patients with underlying skin dermatosis, systemic immunosuppression can at times lead to KVE. Case Presentation: A 27‐years male, a renal transplant recipient, under systemic immunosuppressants, presented with lesions over the whole body for 2 weeks and fever for 10 days. Skin examination revealed multiple flaccid vesicles with hemorrhagic fluid over the face, trunk, and bilateral extremities. Multiple erythematous erosions over the chest and abdomen, multiple petechiae and purpura over bilateral legs, palms, soles, and abdomen, erosions over the hard palate along with thick crusts over the scalp. A tzanck smear showed plenty of acantholytic cells. With a diagnosis of KVE, he was managed with an injection of acyclovir that led to resolution of his symptoms. Conclusion: KVE is a serious condition that may have fatal outcomes. Early diagnosis and appropriate treatment of patients at risk for viral complications are very important medical considerations. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is a common morbid arrhythmia that can cause thromboembolic events such as stroke. Despite advancements in diagnostic technologies, a significant number of AF patients may remain undetected and undiagnosed, and these asymptomatic patients possess sufficient risk of cardioembolic stroke. Identifying such patients through appropriate screening techniques and timely initiation of systemic anticoagulation therapy is essential to prevent such life‐threatening complications. Objectives: The objectives of this study encompass screening of AF among residents of the Dhulikhel Municipality and identifying its prevalence, along with evaluation of stroke risk and use of antithrombotic therapy in patients confirmed with AF. Methods: All residents of four wards of Dhulikhel Municipality, aged 50 years and above (n = 2048), underwent one‐time electrocardiogram (ECG) screening using a portable 12‐lead ECG machine. The cardiologist checked the cardiogram, and suspected AF cases were referred to the hospital for further evaluation and appropriate management. They were followed up to find out information on disease confirmation and management. Results: Out of 2048 participants, AF was detected in 16 participants, resulting in an overall prevalence of 0.78% (CI 0.4%–1.3%). The prevalence of AF was highest (2.98%) in population aged 80 years and above. Among individuals with AF, the median age was 71.5 (66.3–79.5) years, 50.0% were male and 75.0% had high stroke risk as indicated by a CHA2DS2‐VASc score ≥ 2. Among these patients, only 41.66% were treated with oral anticoagulants (OACs), while 58.34% were treated either with single or dual antiplatelet therapy (DAPT). Conclusion: This study provided important insight into the prevalence of AF at the community level. Many AF patients were at high risk of stroke, but the OAC use was less than 50%. Screening of AF needs to be carried out on a larger scale in Nepal for early detection and timely management of the disease. [ABSTRACT FROM AUTHOR]