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Abstract Lecithin-cholesterol acyltransferase (LCAT) serves as a pivotal enzyme in preserving cholesterol homeostasis via reverse cholesterol transport, a process closely associated with the onset of atherosclerosis. Impaired LCAT function can lead to severe LCAT deficiency disorders for which no pharmacological treatment exists. LCAT-based therapies, such as small molecule positive allosteric modulators (PAMs), against LCAT deficiencies and atherosclerosis hold promise, although their efficacy against atherosclerosis remains challenging. Herein we utilized a quantitative in silico metric to predict the activity of novel PAMs and tested their potencies with in vitro enzymatic assays. As predicted, sodium-glucose cotransporter 2 (SGLT2) inhibitors (gliflozins), sucrose and flavonoids activate LCAT. This has intriguing implications for the mechanism of action of gliflozins, which are commonly used in the treatment of type 2 diabetes, and for the endogenous activation of LCAT. Our results underscore the potential of molecular dynamics simulations in rational drug design.

Chondromalacia of patella (CMP) is a condition in which cartilages under patella and underlying surface soften and tear resulting in anterior knee pain that worsens especially while flexing and climbing stairs. Conservative treatments can delay or prevent the need of surgical interventions. The prime objective of this paper is to demonstrate the efficacy of certain conservative treatments for symptomatic relief from anterior knee pain due to CMP on a single case. A 45-year-old male diagnosed to have symptomatic CMP of grade-IV with anterior knee pain in both the legs sequentially and difficulty in flexion and climbing stairs has been treated conservatively with nutraceutical supplement, physical rehabilitation, and combined platelet rich plasma (PRP) and hyaluronic acid (HA) intra-articular (IA) injections. Knee flexion angle (KFA) and kneeling ability score (KAS) are considered as clinical evaluation parameters for demonstrating the efficacy of the conservative treatments. The conservative treatments with collagen peptide nutraceutical supplement and rehabilitation exercises for the right knee and the same along with combined PRP and HA IA injections for the left knee sequentially are found to be effective in symptomatic relief from the knee pain to a great extent with significant improvement in the knee joint flexibility as demonstrated on a single case. Thus, the treatments are remarkable for significant alleviation of the knee pain and improvement in the knee joint flexibility.

Background: Microdontia is a condition where the teeth are smaller than the normal size, which may involve all teeth or be limited to a single tooth or a group of teeth. The objective of this study was to find out the prevalence of microdontia among orthodontic patients of Kathmandu, Nepal. Methods: In this cross-sectional study, 190 orthodontic casts of patients (166 males and 224 females) who came for orthodontic treatment between the age of 14 to 28 years (mean age of 17.43±4.28 years) were randomly selected. The mesiodistal dimension of each tooth was recorded with the help of digital vernier caliper. A tooth was diagnosed as microdontia when it is smaller than the normal size. Data analysis was performed using SPSS version 21.0 with a confidence level set at 95% (P0.05). Conclusion: The most common tooth affected by microdontia was maxillary lateral incisor. There was no statistically significant difference in prevalence of microdontia among genders. Keywords: Microdontia, Nepal, Orthodontic patients, Prevalence

Objective This paper provides an in-depth examination of public attitudes towards salt reduction across seven culturally diverse countries: the USA, the UK, France, Japan, Indonesia, Thailand, and Brazil.Design Cross-sectional regression analysis with questionnaire data.Setting An analysis of questionnaire study in seven countries.Participants The study’s questionnaire collected responses from 7090 participants across seven countries with the mean age of respondents being 46.06 years (SD 16.96). The gender distribution encompassed 3473 men (49.12%), 3582 women (50.66%), 24 non-binary individuals (0.34%) and 11 who identified as ‘other’ (0.16%).Primary and secondary outcome measures Attitudes toward sodium reduction were measured on a seven-point Likert scale.Results Regression analysis revealed significant associations between attitudes towards sodium reduction and various factors across countries. Gender was a significant factor in France, with women showing less awareness than men (coefficient −0.123, 95% CI −0.237 to −0.008). Age was a significant factor in Japan and Thailand, with older generations exhibiting stronger awareness. Occupation was a significant factor in France (grocery, 0.678, 0.229 to 1.127) and Japan (food service, 0.792, 0.300 to 1.283). In France (0.090, 0.033 to 0.146) and Brazil (0.092, 0.040 to 0.144), attitudes towards reducing sugar intake were positively associated with sodium reduction attitudes. Government interventions showed varying impacts, with positive associations in Thailand (0.004, 0.001 to 0.008) and negative associations in France (−0.003 –0.005 to −0.000).Conclusion Our study reveals a complex array of factors shaping attitudes towards sodium reduction across seven countries. These findings support the need for nuanced, country-specific approaches in formulating sodium reduction strategies. Future research should validate these findings, explore further determinants and understand how attitudes translate into dietary behaviours.

Key Clinical Message This case illustrates sarcoidosis as a potential complication of COVID‐19, highlighting the need for a comprehensive diagnostic approach, including histopathology and prolonged monitoring, to distinguish it from post‐COVID fibrosis. Further research is crucial to elucidate these associations and understand their underlying mechanisms. Abstract Severe Acute Respiratory Syndrome Coronavirus‐ 2 (SARS‐CoV‐2), a positive‐sense single‐stranded RNA virus, causes COVID‐19 and has been linked to autoimmune disorders. Sarcoidosis is a multi‐system disease that is frequently triggered by infections. It is characterized by non‐necrotizing granulomas in multiple organs. We present a case of sarcoidosis as rare sequelae of COVID‐19. A 26‐year‐old man presented with mild COVID‐19 symptoms, followed by prolonged fever and cough despite initial therapy, prompting a provisional diagnosis of post‐COVID fibrosis. A subsequent assessment at a tertiary hospital revealed dyspnea, weight loss, and abnormal chest imaging, all of which were consistent with pulmonary sarcoidosis with pulmonary tuberculosis as a differential diagnosis. A biopsy taken during bronchoscopy confirmed pulmonary sarcoidosis and treatment with inhalation steroids resulted in symptom relief, which was followed by remission with oral steroid therapy. Sarcoidosis is a systemic disease of unknown etiology, characterized by non‐necrotizing granulomas in multiple organs. It may be triggered by infections and involves an abnormal immune response. COVID‐19 can potentially initiate sarcoidosis, with both sharing common immune mechanisms. Diagnosis involves imaging and biopsy, and treatment typically includes glucocorticoids and regular monitoring. This case report emphasizes the potential link between COVID‐19 and autoimmune conditions like sarcoidosis, highlighting the need for a comprehensive diagnostic approach and long‐term observation to distinguish between sarcoidosis and post‐COVID fibrosis.

Multidetector computed tomography is considered a reliable, non-invasive modality for diagnosing myocardial bridging. The prevalence of myocardial bridges varies greatly based on the technique used to identify the anomaly. We aimed to evaluate the frequency and morphological features of myocardial bridging in patients who underwent ECG-gated 640 slice Multidetector computed tomography coronary angiography at Shahid Gangalal National Heart Centre.

Introduction: Dental extraction is a common curative treatment against pain provided to the patients. A limited number of scientific literature are available that characterizes the reasons for teeth extractions in Nepalese population. The aim of this study is to find out the causes for dental extraction in patients and explore the relationships between demographic variables and loss of teeth in the Nepalese population. Methods: This is a descriptive cross-sectional study performed to assess the predictors and reasons for permanent tooth extraction among the Nepalese patients who visited dental department in a tertiary health care center from 18th June 2022 to 17th June 2023. Ethical approval was obtained from the Institutional Review Committee (Approval No: 52/22). Demographic details were recorded, diagnosis established and the teeth in question were extracted. Descriptive statistical analysis was performed. Results: A total of 465 (42.66%) permanent teeth were extracted from the 1090 patients, out of which 198 (18.16%) were male and 267 (24.49%) were female patients between the age of 10 years to 70 years. Among all the participants, 726 (66.60%) patients were educated while 364 (33.40%) were uneducated, 165 (15.13%) extraction were done due to peridontal disease and 213 (19.54%) of extraction was done due to endodontic disease. Conclusions: Endodontic and periodontal diseases were the most common causes of dental extraction. Permanent molars and incisors were extracted the most.

Key Clinical Message This case emphasizes the need for early recognition and accurate diagnosis of achalasia in young adults to avoid exacerbation of the condition and misdiagnosis as GERD. Patient outcomes and quality of life are greatly enhanced by suitable diagnostic techniques, appropriate therapy, interdisciplinary care, and comprehensive patient education along with frequent follow‐ups. Abstract Achalasia results from the degeneration of inhibitory ganglion cells within the esophageal myenteric plexus and the lower esophageal sphincter (LES), leading to a loss of inhibitory neurons and resulting in the absence of peristalsis with failure of LES relaxation. Its origins are multifactorial, potentially involving infections, autoimmune responses, and genetics, with equal incidence in males and females. The hallmark symptoms include progressive dysphagia for solids and liquids, along with regurgitation, heartburn, and non‐cardiac chest pain. A 22‐year‐old female patient initially diagnosed with gastroesophageal reflux disease (GERD) received proton pump inhibitors and antacid gel for persistent dysphagia and regurgitation. Subsequent tests including barium esophagogram and manometry indicated Type II Achalasia Cardia. The patient showed clinical improvement with relief of dysphagia, regurgitation, and heartburn symptoms after pneumatic balloon dilatation (PBD). She was advised to follow up after 6 months with upper gastrointestinal (UGI) endoscopy and manometry in the outpatient clinic for regular endoscopic surveillance as there is a risk of transformation to esophageal carcinoma. Diagnosing achalasia in young adults poses challenges due to its diverse presentation and resemblance to other esophageal disorders like GERD. Diagnosis relies on clinical symptoms and imaging studies such as barium esophagogram revealing a bird's beak appearance and esophageal manometry showing absent peristalsis. UGI endoscopy is needed to rule out malignancy. Treatment options include non‐surgical approaches like medication and Botox injections, as well as surgical methods such as pneumatic balloon dilation, laparoscopic Heller myotomy, and per‐oral endoscopic myotomy (POEM). The treatment options depend upon the patient's condition at presentation and their individual choices. This case report emphasizes that it is crucial to consider achalasia as a potential differential diagnosis in young adults with dysphagia, especially if conventional treatments for acid peptic disorder do not alleviate symptoms. Prompt diagnosis and appropriate management can lead to significant clinical improvement and better patient outcomes.

Objectives: This study aims to investigate the factors influencing parental willingness in COVID-19 vaccination for children in Japan in light of the introduction of pediatric vaccines. Methods: An online survey was conducted in February 2022, coinciding with the imminent start of pediatric COVID-19 vaccinations in Japan. It assessed attitudes toward vaccine uptake and included questions about health-related attributes, psychological considerations, and sources of COVID-19 information. Data from 2,419 respondents who had children under the age of 12 were analyzed using multinomial logistic regression to identify factors associated with parental willingness towards COVID-19 vaccination for children. The outcomes were “agree” (in favor of vaccination), “not sure” (undecided), with “disagree” (against vaccination) as the reference category. Results: Among participants supportive of vaccination (“agree” compared to the “disagree” reference), salient determinants included: gender (Men in reference to women: odds ratio [OR] 1.54; 95 % confidence interval [CI] 1.11–2.15), highest educational level (Junior College/Vocational in reference to under high school: OR 0.61; 95 % CI 0.40–0.93, Bachelor’s /Master’s/Doctoral degree in reference to under high school: OR 0.59; 95 % CI 0.42–0.84), perception of benefits of COVID-19 vaccination (Significant in reference to Insignificant: OR 2.04; 95 % CI 1.26–3.28), perception of risks of COVID-19 vaccination (Significant in reference to Insignificant: OR 0.28; 95 % CI 0.19–0.42, Neutral in reference to Insignificant: OR 0.48; 95 % CI 0.33–0.71), the number of referenced information sources utilized for COVID-19 was associated with attitudes towards children’s vaccination (OR 1.02; 95 % CI 1.00–1.04). Conclusion: The study highlights the multifaceted factors influencing parents’ COVID-19 vaccination attitudes for their children, encompassing socioeconomic, health, psychological, and informational aspects. Factors like cautious information gathering, vaccine concerns and diverse referenced information sources impact willingness. To facilitate informed decision-making, essential measures include government risk communication, widespread vaccine information dissemination, and enhancing parents’ health information accessibility and evaluation skills are important.

ABSTRACT A comprehensive pangenomic approach was employed to analyze the genomes of 75 type II methylotrophs spanning various genera. Our investigation revealed 256 exact core gene families shared by all 75 organisms, emphasizing their crucial role in the survival and adaptability of these organisms. Additionally, we predicted the functionality of 12 hypothetical proteins. The analysis unveiled a diverse array of genes associated with key metabolic pathways, including methane, serine, glyoxylate, and ethylmalonyl-CoA (EMC) metabolic pathways. While all selected organisms possessed essential genes for the serine pathway, Methylooceanibacter marginalis lacked serine hydroxymethyltransferase (SHMT), and Methylobacterium variabile exhibited both isozymes of SHMT, suggesting its potential to utilize a broader range of carbon sources. Notably, Methylobrevis sp. displayed a unique serine-glyoxylate transaminase isozyme not found in other organisms. Only nine organisms featured anaplerotic enzymes (isocitrate lyase and malate synthase) for the glyoxylate pathway, with the rest following the EMC pathway. Methylovirgula sp. 4MZ18 stood out by acquiring genes from both glyoxylate and EMC pathways, and Methylocapsa sp. S129 featured an A-form malate synthase, unlike the G-form found in the remaining organisms. Our findings also revealed distinct phylogenetic relationships and clustering patterns among type II methylotrophs, leading to the proposal of a separate genus for Methylovirgula sp. 4M-Z18 and Methylocapsa sp. S129. This pangenomic study unveils remarkable metabolic diversity, unique gene characteristics, and distinct clustering patterns of type II methylotrophs, providing valuable insights for future carbon sequestration and biotechnological applications.IMPORTANCEMethylotrophs have played a significant role in methane-based product production for many years. However, a comprehensive investigation into the diverse genetic architectures across different genera of methylotrophs has been lacking. This study fills this knowledge gap by enhancing our understanding of core hypothetical proteins and unique enzymes involved in methane oxidation, serine, glyoxylate, and ethylmalonyl-CoA pathways. These findings provide a valuable reference for researchers working with other methylotrophic species. Furthermore, this study not only unveils distinctive gene characteristics and phylogenetic relationships but also suggests a reclassification for Methylovirgula sp. 4M-Z18 and Methylocapsa sp. S129 into separate genera due to their unique attributes within their respective genus. Leveraging the synergies among various methylotrophic organisms, the scientific community can potentially optimize metabolite production, increasing the yield of desired end products and overall productivity.

Accurate forecasting of sea surface temperature (SST) is pivotal for a wide range of applications ranging from climate modelling to marine ecosystem management. This study introduces an ingenious multi-dilated model that employs dilated Convolutional Long Short-Term Memory (ConvLSTM) networks alongside a U-Net architecture which aims to enhance the precision of monthly SST predictions at lead periods of 3, 6 and 12 months. Our approach innovatively combines dilated convolutions within ConvLSTM with the segmentation capabilities of U-Net to adeptly capture the complex Spatio-temporal dynamics as well as relevant attributes of SST. The study utilizes a high-resolution MPI-ESM1-2-HR SST dataset for a series of rigorous tests, achieving a Mean Square Error of 0.01, indicating a high accuracy level in SST predictions. The model at a lead time of 12 months also showed a Sea Surface Microwave Index of 0.036, illustrating its effectiveness in reflecting SST’s microwave emissivity characteristics, and an Earth Mover’s Distance score of 0.97, highlighting its ability to closely match the predicted SST distribution with the actual one. Furthermore, a cosine similarity score of 0.99 suggests a significant alignment between the predicted and actual SST patterns. By merging multi-dilated convolutions with segmentation, our model tackles the intricate challenge of simultaneously capturing the spatial and temporal dependencies of SST, setting a new standard for forecasting accuracy in the field.

Diesel generators (gensets) are often the lowest-cost electric generation for reliable supply in remote microgrids. The development of converter-dominated diesel-backed microgrids requires accurate dynamic modeling to ensure power quality and system stability. Dynamic response derived using original genset system models often does not match those observed in field experiments. This paper presents the experimental system identification of a frequency dynamics model for a 400 kVA diesel genset. The genset is perturbed via active power load changes and a linearized dynamics model is fit based on power and frequency measurements using moving horizon estimation (MHE). The method is first simulated using a detailed genset model developed in MATLAB/Simulink. The simulation model is then validated against the frequency response obtained from a real 400 kVA genset system at the Power System Integration (PSI) Lab at the University of Alaska Fairbanks (UAF). The simulation and experimental results had model errors of 3.17% and 11.65%, respectively. The resulting genset model can then be used in microgrid frequency dynamic studies, such as for the integration of renewable energy sources.

Fifth-generation (5G) mobile communication systems are currently implemented worldwide. Moreover, the diversity between different deployments is growing, from operator-deployed macro networks to local private networks. The 5G system is very flexible with a large number of parameters and configurations impacting platform performance. With the availability of private spectrum and open-source software, there is an increasing possibility to get insight into what performance can be achieved in different dimensions, and how it depends on the configuration of various parameters, through experiments and testing. This paper presents a detailed account of a 5G Standalone (SA) platform based on the open5GS and srsRAN software suites installed on a general-purpose workstation. The performance of the platform is measured and compared to theoretical results and information from the 3GPP standardisation documentation. While some aspects of the performance are close to the theoretical expectations, others are further away. The software-defined radio (SDR) platform and the lack of hardware acceleration are probably the main limiting factors on coverage, uplink throughput and latency. The paper goes through several radio parameters and their impact on performance and discusses the performance implications and limitations of the experimental platform to share the lessons learned.

Abstract The cool-season (May to October) rainfall decline in southwestern Australia deepened during 2001–2020 to become 20.5% less than the 1901–1960 reference period average, with a complete absence of very wet years (i.e., rainfall > 90th percentile). CMIP5 and CMIP6 climate model simulations suggest that approximately 43% of the observed multi-decadal decline was externally-forced. However, the observed 20-year rainfall anomaly in 2001–2020 is outside the range of both preindustrial control and historical simulations of almost all climate models used in this study. This, and the fact that the models generally appear to simulate realistic levels of decadal variability, suggests that 43% might be an underestimate. A large ensemble from one model exhibits drying similar to the observations in 10% of simulations and suggests that the external forcing contribution is indeed larger (66%). The majority of models project further drying over the twenty-first century, even under strong cuts to greenhouse gas emissions. Under the two warmest scenarios, over 70% of the late twenty-first century years are projected to be drier than the driest year simulated during the 1901–1960 period. Our results suggest that few, if any, very wet years will occur during 2023–2100, even if strong cuts to global emissions are made.

Across the world and within Europe, a growing number of consumers are choosing to buy gluten-free products. Motivations for a gluten-free diet and the consequences of consuming gluten are varied, from a medical necessity for those diagnosed with celiac disease to a range of health complications and discomfort for those who are gluten-intolerant. In this research, 7296 gluten-free consumers across 13 European countries responded to an online survey on the 33 types of gluten-free products purchased, how frequently they purchased them, their satisfaction with gluten-free quality and availability, the problems they have experienced, and the strategies they have employed to cope with these problems. The investigation examines whether and how these consumer attitudes and behaviors differ between those diagnosed with celiac disease, those who are gluten-intolerant, and those who are caregivers for others with a gluten-free diet. The results show that significant differences existed for all these habits and issues across the three gluten-free consumer groups. Specifically, caregivers purchased most of the gluten-free product types more frequently than the other two groups, experienced more availability problems, and were more likely to shop at multiple stores or make their own gluten-free products. Celiac-diagnosed consumers tended to buy gluten-free products more frequently than those who are gluten-intolerant, and they tended to be the most satisfied with the quality and range of gluten-free offerings. Despite purchasing frequency differences between the groups, the results suggest a similar hierarchy of gluten-free products that could provide the foundation for a European gluten-free food basket.

A 41-year-old female who underwent right-sided styloidectomy via tonsillectomy approach experienced refractory short-lasting severe secondary haemorrhage on the third, seventh and thirteen postoperative days. On examination under general anaesthesia, no major vessel injury was noticed. Contrast-enhanced computerized tomography scan of the neck was done because no obvious bleeder was seen and refractory nature of bleeding. Contrast-enhanced computerized tomography scan neck showed pseudoaneurysm of facial artery which was managed with endovascular embolization successfully.

Key Clinical Message Pseudotumor cerebri (PTC) encompasses a constellation of symptoms caused by elevated intracranial pressure of unclear etiology. Various associations have been described, rarely hypovitaminosis D. Vitamin D deficiency should be considered as a potential etiology of neurological manifestations like PTC and seizures in children. Early diagnosis and correction of vitamin D deficiency is key to preventing morbidity and achieving good outcomes.

Key Clinical Message Early intervention is imperative for potentially fatal dermatologic diseases such as pemphigus vulgaris. In rural Nepal, limited public awareness, home remedies, and delays in healthcare access lead to poor outcomes. Although biopsy confirms the diagnosis, experienced dermatologists can make an accurate clinical diagnosis when characteristic skin lesions are present.

In the global push for carbon neutrality and the emergence of net-zero carbon buildings (NZCBs), the lack of substantial progress in achieving NZCB goals due to unaddressed barriers is a pressing issue. While there are ongoing initiatives for NZCB, a crucial research gap exists in the thorough examination of specific barriers and their interconnected complexities, impeding progress in the NZCB agenda. This study aims to fill this gap by identifying and investigating the barriers negating the implementation of Prefabricated NZCBs through a systematic literature review and analyzing their relationships using Interpretative structural modeling (ISM) analysis. Additionally, the study aims to provide a strategic roadmap to overcome the barriers that impede the successful implementation of prefabricated NZCBs. The findings reveal that the regulatory barriers, including regulations, policies, and implementation efforts, emerge as the most significant, followed closely by uncertainties related to long-term financial returns and payback periods. The study concludes that the acceleration of NZCB goals depends on addressing these identified barriers and underscores the imperative for collaboration among government bodies, supply and demand sectors, and end users. Policymakers are urged to integrate these findings into their guidelines for promoting NZCB. The implications of this research are substantial, offering a path forward that prioritizes regulatory obstacles and addresses the most crucial barriers, ultimately propelling the NZCB agenda and contributing to a more sustainable and environmentally friendly future.

Abstract Nepal is an endemic country for dengue infection with rolling of every 3 year’s clear cyclic outbreaks with exponential growth since 2019 outbreak and the virus gearing towards the non-foci temperate hill regions. However, the information regarding circulating serotype and genotype is not frequent. This research discusses on the clinical features, diagnosis, epidemiology, circulating serotype and genotype among 61 dengue suspected cases from different hospitals of Nepal during the window period 2017–2018 between the two outbreaks of 2016 and 2019. E-gene sequences from PCR positive samples were subjected to phylogenetic analysis under time to most recent common ancestor tree using Markov Chain Monte Carlo (MCMC) and BEAST v2.5.1. Both evolution and genotypes were determined based on the phylogenetic tree. Serotyping by Real-time PCR and Nested PCR showed the co-circulation of all the 3 serotypes of dengue in the year 2017 and only DENV-2 in 2018. Genotype V for DENV-1 and Cosmopolitan Genotype IVa for DENV-2 were detected. The detected Genotype V of DENV-1 in Terai was found close to Indian genotype while Cosmopolitan IVa of DENV-2 found spreading to geographically safe hilly region (now gripped to 9 districts) was close to South-East Asia. The genetic drift of DENV-2 is probably due to climate change and rapid viral evolution which could be a representative model for high altitude shift of the infection. Further, the increased primary infection indicates dengue venturing to new populations. Platelets count together with Aspartate transaminase and Aalanine transaminase could serve as important clinical markers to support clinical diagnosis. The study will support future dengue virology and epidemiology in Nepal.

Abstract Objective: The aim of this study is to conduct a comparative analysis across nations to: (1) identify the determinants influencing knowledge and attitudes related to sodium (Na) intake and (2) to analyse the association between knowledge and attitudes related to Na intake. Design: We utilised a secondary data from a cross-sectional study that was conducted across seven nations. Structural equation modelling (SEM) was utilised to assess the impact of socio-economic and health-related predictors on knowledge and attitudes pertaining to Na intake and further to investigate the relationship between knowledge and attitude. Setting: Indonesia, Brazil, Thailand, Japan, France, the UK and the USA. Participants: 7090 participants aged 15 years and above were included in the study. Results: SEM analysis showed a strong association between knowledge about Na intake and related attitude across all countries, particularly in the UK (2·65, 95 % CI 1·48–3·82), France (2·62, 1·45–3·79) and the USA (1·97, 1·21–2·73). In Brazil, Japan and France, individuals or family members having certain health conditions such as raised blood pressure, heart diseases, strokes or other diseases exhibited a positive attitude towards reducing Na intake. Conversely, socio-economic factors like education and income demonstrated the complexity of influences on knowledge and attitudes about Na intake. Conclusion: The study underscores the need for tailored public health interventions to reduce excessive Na consumption, considering the diverse cultural, social and economic factors. It highlights the complex determinants of knowledge and attitudes towards Na intake, calling for further research in varied populations.

Abstract Background COVID‐19 disease‐related coagulopathy and thromboembolic complication, an important aspect of the disease pathophysiology, are frequent and associated with poor outcomes, particularly significant in hospitalized patients. Undoubtedly, anticoagulation forms a cornerstone for the management of hospitalized COVID‐19 patients, but the appropriate dosing has been inconclusive and a subject of research. We aim to review existing literature and compare safety and efficacy outcomes of prophylactic and therapeutic dose anticoagulation in such patients. Methods We did a systematic review and meta‐analysis to compare the efficacy and safety of prophylactic dose anticoagulation when compared with therapeutic dosing in hospitalized COVID‐19 patients. We searched PubMed, Google Scholar, EMBASE and COCHRANE databases from 2019 to 2021, without any restriction by language. We screened records, extracted data and assessed the risk of bias in the studies. RCTs that directly compare therapeutic and prophylactic anticoagulants dosing and are not placebo‐controlled trials were included. Analyses of data were conducted using the Mantel–Haenszel random‐effects model (DerSimonian–Laird analysis). The study is registered with PROSPERO (CRD42021265948). Results We included three studies in the final quantitative analysis. The incidence of thromboembolic events in therapeutic anticoagulation was lower in comparison with prophylactic anticoagulation in hospitalized COVID‐19 patients and reached statistical significance [RR 1·45, 95% CI (1.07, 1.97) I2 –0%], whereas major bleeding as an adverse event was found lower in prophylactic anticoagulation in comparison with therapeutic anticoagulation that was statistically significant [RR 0·42, 95% CI(0.19, 0.93) I2 –0%]. Conclusion Our study shows that therapeutic dose anticoagulation is more effective in preventing thromboembolic events than prophylactic dose but significantly increases the risk of major bleeding as an adverse event. So, the risk–benefit ratio must be considered while using either of them.

A 30-year-old female patient with no previous chronic illness underwent hemithyroidectomy unusually complaint of ptosis on first postoperative day. On examination, she also had miosis. Thus, diagnosis of Horner’s syndrome was made on ground of ruling out other complication. As it is caused by nerve insult, with a prolonged observation under close follow-up, the patient is fully recovered. Horner’s syndrome after thyroidectomy is a rare entity. In textbook also, it is not mentioned as complication after thyroidectomy.

Background: Globally, the burden of malnutrition, especially undernutrition, as well as the consequences of malnutrition is of the rise which is especially of significant concern for underdeveloped countries. Countries like Nepal are also facing a similar problem of malnutrition. In Madhesh province, among the under 5 children the incidence of chronic malnutrition is 29.3%. Our aim is to assess the malnourishment in the children of Madhesh province in Nepal. Methods: This cross-sectional quantitative study was carried out among 409 malnourished children who were admitted from July 17, 2018 to July 16, 2022 at NRH in Gajendra Narayan Singh Hospital. Collected data were fed into Microsoft-excel and analyzed using SPSS software, version-2016. As data were normally distributed, frequency, percentage, mean and standard deviation were calculated for descriptive analysis. To find out the association of categorical variables, the Chi-square test or Fisher’s Exact test was used where appropriate. P-value

Background Official Development Assistance (ODA) significantly aids sustainable development in low- and middle-income countries (LMICs). However, the COVID-19 pandemic has impacted aid allocation, posing challenges for attaining the Sustainable Development Goals (SDGs). Objective This study explores and underscores the profound implications of shifts in ODA allocation by Development Assistance Committee (DAC) member countries, resulting from the COVID-19 pandemic, offering a unique perspective on the evolving landscape of international aid. Methods Drawing from the gross ODA disbursement data for LMICs by DAC member countries from 2011 to 2021, a linear regression analysis assessed the changes in ODA amount, ODA-to-gross national income (GNI) ratio, sectoral aid allocation, and the balance between bilateral and multilateral aid, primarily focusing on the differences pre- and post-COVID-19. For non-specialised multilateral agencies’ core funding, the OECD’s methodology for calculating imputed multilateral ODA was employed to estimate ODA flows. Results The study found an increasing trend in the total ODA provided by DAC member countries from 2011 to 2021. However, the average ODA/GNI ratio showed a slight but significant decrease before the pandemic, followed by an increase after the COVID-19 pandemic. The health sector received the highest percentage of aid after the pandemic, with a marked increase in both bilateral and multilateral aid. However, other sectors such as humanitarian aid, water and sanitation, and energy experienced a significant decrease in sectoral aid share. Conclusions Emerging from this analysis is a strong recommendation for DAC members to re-evaluate aid objectives and escalate their financial commitments to reinforce SDGs and sustainable development efforts. While the rise in health aid is essential, other sectors also require equal focus to offset the ramifications of the COVID-19 pandemic. Understanding the intricacies of aid allocation can improve aid efficacy, culminating in greater, transformative results for recipient countries.

The increasing burden of lifestyle-related diseases highlights the need to address unhealthy dietary habits. This study aims to explore the latest dietary patterns in Japan following the COVID-19 pandemic, focusing on trends in health-promoting food choices. A web-based survey was conducted among 27,154 Japanese adults, selected via quota sampling to mirror national demographics. The study evaluated dietary diversity, measured through the Dietary Variety Score (Outcome 1), and the prioritization of nutritional and health considerations in food selection, assessed via a Likert scale (Outcome 2). Uniform Manifold Approximation and Projection (UMAP) and Ordering Points To Identify the Clustering Structure (OPTICS) algorithms were used to delineate patterns in health-centric food selections. OPTICS clustering revealed four distinct clusters for each outcome. Cluster 3, with a diverse diet, comprised older, predominantly female individuals with higher well-being and lower social isolation compared to Cluster 4, which lacked distinct dietary patterns. Cluster 3 also engaged more in snacking, treat foods, home cooking, and frozen meals. Similarly, a divide emerged between those prioritizing dietary considerations (Cluster C) and those indifferent to such aspects (Cluster D). The findings underscore the need for holistic post-COVID-19 public health initiatives addressing socioeconomic and cultural barriers to healthier dietary practices.

Key Clinical Message We report the case of chyluria secondary to disseminated tuberculosis in a 13‐year‐old female child who presented with passage of white colored urine since 5 months, progressive weight loss for 3 months, abdominal distension for 2 months, generalized swelling of body for 15 days, and pain in abdomen for 10 days. Child had good recovery following treatment with antitubercular drugs. Though chyluria is uncommon in children, tuberculosis could be considered as a differential, after ruling out filariasis.

Abstract People with silicosis may develop Erasmus syndrome, a condition characterized by the emergence of systemic sclerosis (SSc) after silica exposure. This case study emphasizes the significance of understanding the connection between occupational silica exposure, silicosis, and SSc. A 24‐year‐old male stonecutter got silicosis and a form of SSc following 8 years on his job as a stonecutter. The signs and symptoms the patient experienced were Raynaud's phenomenon, cutaneous fibrosis, arthralgia, digital pitting, and respiratory distress. High‐resolution computed tomography (HRCT) revealed interstitial lung disease and calcified mediastinal lymph nodes. This case study demonstrates the clinical importance of the relationship between occupational silica exposure, silicosis, SSc, and Erasmus syndrome. Healthcare providers need to be aware of the possible difficulties and issues that may result from silica exposure. They should prioritize quick detection and efficient treatment plans for those who have been exposed to silica while on the job.

In today’s social media-dominated landscape, digital platforms wield substantial influence over public opinion, particularly during crucial political events such as electoral processes. These platforms become hubs for diverse discussions, encompassing topics, reforms, and desired changes. Notably, in times of government dissatisfaction, they serve as arenas for anti-establishment discourse, highlighting the need to analyze public sentiment in these conversations. However, the analysis of such discourse is notably scarce, even in high-resource languages, and entirely non-existent in the context of the Nepali language. To address this critical gap, we present Nepal Anti Establishment discourse Tweets (NAET), a novel dataset comprising 4,445 multi-aspect annotated Nepali tweets, facilitating a comprehensive understanding of political conversations. Our contributions encompass evaluating tweet relevance, sentiment, and satire, while also exploring the presence of hate speech, identifying its targets, and distinguishing directed and non-directed expressions. Additionally, we investigate hope speech, an underexplored aspect crucial in the context of anti-establishment discourse, as it reflects the aspirations and expectations from new political figures and parties. Furthermore, we set NLP-based baselines for all these tasks. To ensure a holistic analysis, we also employ topic modeling, a powerful technique that helps us identify and understand the prevalent themes and patterns emerging from the discourse. Our research thus presents a comprehensive and multi-faceted perspective on anti-establishment election discourse in a low-resource language setting. The dataset is publicly available, facilitating in-depth analysis of political tweets in Nepali discourse and further advancing NLP research for the Nepali language through labeled data and baselines for various NLP tasks. The dataset for this work is made available at https://github.com/rkritesh210/NAET.

Scanning electron microscopy (SEM) techniques have been extensively performed to image and study bacterial cells with high-resolution images. Bacterial image segmentation in SEM images is an essential task to distinguish an object of interest and its specific region. These segmentation results can then be used to retrieve quantitative measures (e.g., cell length, area, cell density) for the accurate decision-making process of obtaining cellular objects. However, the complexity of the bacterial segmentation task is a barrier, as the intensity and texture of foreground and background are similar, and also, most clustered bacterial cells in images are partially overlapping with each other. The traditional approaches for identifying cell regions in microscopy images are labor intensive and heavily dependent on the professional knowledge of researchers. To mitigate the aforementioned challenges, in this study, we tested a U-Net-based semantic segmentation architecture followed by a post-processing step of morphological over-segmentation resolution to achieve accurate cell segmentation of SEM-acquired images of bacterial cells grown in a rotary culture system. The approach showed an 89.52% Dice similarity score on bacterial cell segmentation with lower segmentation error rates, validated over several cell overlapping object segmentation approaches with significant performance improvement.

Abstract Background The acceptability of teachers delivering task-shifted mental health care to their school-aged students is understudied. Here, we evaluate teachers’, students’, and caregivers’ acceptability of Tealeaf (Teachers Leading the Frontlines), an alternative system of care in which teachers are trained and supervised to deliver transdiagnostic, non-manualized task-shifted care to their students. Methods In a 2019 single-arm, mixed methods, pragmatic acceptability pilot study in Darjeeling, India, 13 teachers delivered task-shifted child mental health care to 26 students in need. Teachers delivered care through using a transdiagnostic, non-manualized therapy modality, “education as mental health therapy” (Ed-MH). Measured with validated scales, teachers’ and students’ acceptability were compared after teacher training (PRE) and at the end of intervention (POST) using paired t tests. Teachers (n = 7), students (n = 7), and caregivers (n = 7) completed semi-structured interviews POST. Results Teachers’ quantitative measures indicated moderate acceptability PRE and POST and did not change PRE to POST. Children’s measures showed acceptability PRE and POST but decreased PRE to POST. Teachers and caregivers universally expressed acceptability in interviews. Facilitators of acceptability included impact, trust of teachers, and teachers’ ability to make adaptations. Conditions required for acceptability included supervision and teachers emphasizing academics benefits over mental health benefits to caregivers. Barriers to acceptability included a lack of teacher time and stigma. Interviewed students universally were unaware of receiving care; teachers intentionally avoided singling them out. Conclusion Teachers, caregivers, and children found teacher delivering task-shifted care acceptable, a key factor in care adoption and sustainability, though interviewed children were unaware of receiving care. Trial registration The trial was registered on January 01, 2018 with Clinical Trials Registry—India (CTRI), Reg. No. CTRI/2018/01/011471, Ref. No. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27

Abstract Vascular endothelial growth factor-C (VEGF-C) stimulates lymphatic vessel growth in transgenic models, via viral gene delivery, and as a recombinant protein. Expressing eukaryotic proteins like VEGF-C in bacterial cells has limitations, as these cells lack specific posttranslational modifications and provisions for disulfide bond formation. However, given the cost and time savings associated with bacterial expression systems, there is considerable value in expressing VEGF-C using bacterial cells. We identified two approaches that result in biologically active Escherichia coli-derived VEGF-C. Expectedly, VEGF-C expressed from a truncated cDNA became bioactive after in vitro folding from inclusion bodies. Given that VEGF-C is one of the cysteine-richest growth factors in humans, it was unclear whether known methods to facilitate correct cysteine bond formation allow for the direct expression of bioactive VEGF-C in the cytoplasm. By fusing VEGF-C to maltose-binding protein and expressing these fusions in the redox-modified cytoplasm of the Origami (DE3) strain, we could recover biological activity for deletion mutants lacking the propeptides of VEGF-C. This is the first report of a bioactive VEGF growth factor obtained from E. coli cells circumventing in-vitro folding.

Key Clinical Message Fetal bradycardia and congenital complete heart block could be the presentation of neonatal lupus. A high index of suspicion of this condition helps to identify an asymptomatic mother. Abstract Neonatal lupus erythematosus (NLE) is a rare acquired autoimmune disease of newborns due to placental transfer of Ro/SSA or La/SSB autoantibodies. Though cardiac, cutaneous, hematological, and hepatobiliary abnormalities are detected, cardiac defects cause significant morbidity and mortality. We report a case of complete congenital heart block due to NLE.

Abstract Background and Aims Unlike classically described polycythemia, anemia is found to be more prevalent in patients with chronic obstructive pulmonary disease (COPD). Anemia increases the cost of hospital stay and causes an increased risk of adverse outcomes including death in COPD patients. This study was done to find the prevalence of anemia in COPD patients, the factors associated, and the outcomes of anemic COPD. Methods It was a quantitative, descriptive‐analytical, and cross‐sectional study conducted in Tribhuvan University Teaching Hospital's medical wards and the Emergency Room from September 2019 to September 2020. A simple random sampling method was used. Clinical information was obtained, and patients were followed up 3 months after discharge to document the number of exacerbations and deaths if present. Results The patients in our study had a mean age of 70.80 ± 11.16 years. Most were female. Most (85.5%) had a history of exposure to firewood smoke. Twenty‐three percent of the patients had anemia and these patients had significantly greater mortality 3 months postdischarge. Middle‐old and old were more likely to have anemia with odds ratio (OR) of 2.55 (confidence interval [CI]: 0.48–13.5) and 13.6 (CI: 1.12–24.2), respectively. Current smokers had less likelihood of having anemia (OR: 0.05, CI: 0.006–0.49). Multivariate analysis showed that age, sex, and smoking status were significant determinants of anemia in COPD. There was no association between anemia and duration of hospital stay. However, mortality was higher at 3 months in COPD patients with anemia (p