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Osteosarcopenic obesity (OSO) describes the concurrent presence of obesity, low bone mass, and low muscle mass in an individual. Currently, no established criteria exist to diagnose OSO. We hypothesized that obese individuals require different cut-points from standard cut-points to define low bone mass and low muscle mass due to their higher weight load. In this study, we determined cutoff values for the screening of osteosarcopenia (OS) in obese postmenopausal Malaysian women based on the measurements of quantitative ultrasound (QUS), bioelectrical impedance analysis (BIA), and functional performance test. Then, we compared the cutoff values derived by 3 different statistical modeling methods, (1) receiver operating characteristic (ROC) curve, (2) lowest quintile of the study population, and (3) 2 standard deviations (SD) below the mean value of a young reference group, and discussed the most suitable method to screen for the presence of OS in obese population. One hundred and forty-one (n = 141) postmenopausal Malaysian women participated in the study. Bone density was assessed using calcaneal quantitative ultrasound. Body composition was assessed using bioelectrical impedance analyzer. Handgrip strength was assessed using a handgrip dynamometer, and physical performance was assessed using a modified Short Physical Performance Battery test. ROC curve was determined to be the most suitable statistical modeling method to derive the cutoffs for the presence of OS in obese population. From the ROC curve method, the final model to estimate the probability of OS in obese postmenopausal women is comprised of five variables: handgrip strength (HGS, with area under the curve (AUC) = 0.698 and threshold ≤ 16.5 kg), skeletal muscle mass index (SMMI, AUC = 0.966 and threshold ≤ 8.2 kg/m2), fat-free mass index (FFMI, AUC = 0.946 and threshold ≤ 15.2 kg/m2), broadband ultrasonic attenuation (BUA, AUC = 0.987 and threshold ≤ 52.85 dB/MHz), and speed of sound (SOS, AUC = 0.991 and threshold ≤ 1492.15 m/s). Portable equipment may be used to screen for OS in obese women. Early identification of OS can help lower the risk of advanced functional impairment that can lead to physical disability in obese postmenopausal women.

The concurrent presence of low bone density (osteopenia/osteoporosis) and low muscle mass (sarcopenia) in older adults has led to the recognition of “osteosarcopenia” (OS) as a singular entity. Vitamin D may play important role in the manifestation of OS, in terms of intake, absorption, and bioavailability. Evidence suggests that bioavailable 25(OH)D may be a better indicator of Vitamin D compared to total 25(OH)D due to its weak bind to albumin, increasing its ‘availability’. The aim of this study was to assess total and bioavailable 25(OH)D levels in postmenopausal women and to determine their associations to bone density and muscle mass. We assessed body composition, bone density, and 25(OH)D indices of multiethnic, postmenopausal Malaysian women. A significant and negative correlation was found between body fat % and each index of 25(OH)D. Both bioavailable and total 25(OH)D were positively correlated with serum calcium and negatively correlated with iPTH(intact parathyroid hormone). VDBP(Vitamin D binding protein) level was significantly correlated with bioavailable 25(OH)D level, but not with the total 25(OH)D level. Stepwise regression analysis revealed that bioavailable, but not total, 25(OH)D was significantly correlated to bone density and muscle mass, (where stronger correlation was found with bone density), suggesting its superiority. Nevertheless, the low effect size warrants further studies.

Consumption of dietary carotenoids or carotenoid supplements can alter the color (yellowness) of human skin through increased carotenoid deposition in the skin. As fruit and vegetables are the main dietary sources of carotenoids, skin yellowness may be a function of regular fruit and vegetable consumption. However, most previous studies have used tablets or capsules to supplement carotenoid intake, and less is known of the impact of increased fruit and vegetable consumption on skin color. Here, we examined skin color changes in an Asian population (Malaysian Chinese ethnicity) over a six week dietary intervention with a carotenoid-rich fruit smoothie. Eighty one university students (34 males, 47 females; mean age 20.48) were assigned randomly to consuming either a fruit smoothie (intervention group) or mineral water (control group) daily for six weeks. Participants' skin yellowness (CIELab b*), redness (a*) and luminance (L*) were measured at baseline, twice during the intervention period and at a two-week follow-up, using a handheld reflectance spectrophotometer. Results showed a large increment in skin yellowness (p

Introduction: A battered child is one who sustains repetitive physical injuries due to non-accidental violence inflicted by a parent or guardian. Child abuse encompasses behaviors exposing the child to various forms of physical or sexual abuse, neglect, or emotional misconduct. Typically, battered child syndrome is diagnosed through a disparity between the history provided by the child's caregivers and the findings of clinical examination. Case details: An 18-month-old girl child was admitted to a tertiary care hospital, presenting with a four-day history of fever, vomiting for two days and a seizure episode. The child had a history of head injury one week ago, resulting in transient unconsciousness. Upon examination, multiple healed and fresh injuries were observed on the face, hands, and right thigh. CT brain revealed hypodensity areas with a mildly displaced fracture of the left frontal bone. Fundus examination identified bilateral multiple intraretinal hemorrhages and papilledema. X-ray showed a fracture of the right proximal tibia. The child required ventilator support during the hospital stay, and subsequently, developed retinal blindness. The child was managed accordingly. Discussion: The classical feature of Battered Baby Syndrome is the discrepancy between the nature of injuries and the history provided, and the delay between the injury and medical attention. The parental risk factors for child abuse are poverty, social isolation, drug addiction, violent environment, family history of abuse, communication skills deficit and the child related risk factors are children with special needs, children with behavior problems, bonding deficit. etc. Conclusion: The current case sheds light on the unfortunate prevalence of this condition within the Indian context, urging point-of-care health providers to stay vigilant and informed about child abuse patterns in the community. It serves as a crucial reminder of the responsibility we all share in safeguarding the well-being of children.

Candida albicans is the predominant cause of systemic candidiasis, although other non albicans Candida species are progressively becoming more widespread nowadays. Candida auris has emerged as a deadly multidrug-resistant fungal pathogen, posing a significant threat to global public health. In the absence of effective antifungal therapies, the development of a vaccine against C. auris infections is imperative. Enolase, a key glycolytic enzyme, has emerged as a promising vaccine candidate due to its immunogenic properties and essential role in fungal virulence. Herein, full-length Enolase gene sequences from C. albicans and C. auris were cloned into suitable expression vector and transformed into Escherichia coli expression hosts. Recombinant Enolase proteins were successfully expressed and purified using affinity chromatography under native conditions, followed by SDS-PAGE characterization and Western blot analysis. CD spectroscopy verified the existence of expressed proteins in soluble native conformation. Preliminary in silico studies verified the immunogenicity of recombinant Enolase proteins isolated from both C. albicans and C. auris. Furthermore, bioinformatics analysis revealed conserved B-cell and T-cell epitopes across C. albicans and C. auris Enolase proteins, suggesting potential cross-reactivity and broad-spectrum vaccine efficacy. Our findings are anticipated to play a role in advancing therapeutic as well as diagnostic strategies against systemic candidiasis.

The development of peptide-based pharmaceutics is a hot topic in the pharmaceutical industry and in basic research. However, from the research and development perspective there is an unmet need for new, alternative, solid-phase peptide synthesizers that are highly efficient, automated, robust, able to synthetize peptides in parallel, inexpensive (to obtain and operate), have potential to be scaled up, and even comply with the principles of green chemistry. Moreover, a peptide synthesizer of this type could also fill the gap in university research, and therefore speed the advancement of peptide-based pharmaceutical options. This paper presents a Tecan add-on peptide synthesizer (TaPSy), which has operational flexibility (coupling time: 15–30 min), can handle all manual synthesis methods, and is economical (solvent use: 34.5 mL/cycle, while handling 0.49 mmol scale/reactor, even with ≤3 equivalents of activated amino acid derivatives). Moreover, it can carry out parallel synthesis of up to 12 different peptides (0.49 mmol scale in each). TaPSy uses no heating or high pressure, while it is still resistant to external influences (operating conditions: atmospheric pressure, room temperature 20–40 ˚C, including high [>70%] relative humidity). The system's solvent can also be switched from DMF to a green and biorenewable solvent, γ-valerolactone (GVL), without further adjustment. The designed TaPSy system can produce peptides with high purity (>70%), even with the green GVL solvent alternative. In this paper we demonstrate the optimization path of a newly developed peptide synthesizer in the context of coupling reagents, reaction time and reagent equivalents applying for a synthesis of a model peptide. We compare the results by analytical characteristics (purity of raw material, crude yield, yield) and calculated overall cost of the syntheses of one mg of crude peptide using a specified set of reaction conditions.

Introduction: Numerous studies have shown that innovation and entrepreneurship play a key role in different aspects including economic development, quality of life, and competitiveness on a global scale. Despite of similar parts that the regions have, their potentials, territorial assets, cultures and ways of thinking are diverse that guides them in choosing their unique development path. In this regard, studies of innovation systems reject the use of the same policies to design and guide the path of innovation-based development and consider it necessary to pay special attention to the different characteristics affecting innovation in each region.Previous studies of regional development have not dealt with the impact of social factors on regional innovation behavior due to its geographical breadth and historical depth, the existence of different ethnic groups with different cultures and at the same time centralized policy-making. Therefore, the study of entrepreneurship from a local perspective that shows the cultures, values, traditions, views and potentials of each region in Iran can provide a useful approach to formulate political and legal requirements to pave the correct way for effective use of the entrepreneurship concept based on culture and especial social structure based on every region. Entrepreneurship in the cultural sector needs more attention and support. Methodology: The most important reasons are due to the requirements of production and consumption of cultural goods, prevention of foreign culture spread in country, and the high potential of cultural industries to develop and create employment. Considering the cultural diversity in our country, it is very important to identify opportunities and potential talents in the field of local businesses in each specific region of the country and in such a context, the capacities and capabilities of the local subcultures of Iranian society and the role they can play in the process of local and national development should be discussed. Since Iran has different regions and climates with various cultural, social, geographical, etc. so it is necessary to identify the potentials and conditions of each region for economic and social policy-making. Regarding the urgent need to address the aforementioned challenges, this study conducted. The purpose of this study is to explain the variables of local entrepreneurship according to the potentials of different regions of Iran using a Meta-Synthesis Review. To conduct this research, all researches related to local entrepreneurship between 2006 and 2020 were reviewed. Finally, 91 articles were selected and reviewed. Results ana Discussion: We did the analyze of dates according to the steps presented by Barroso and Sandlowski in seven steps, 1. Defining the objectives of the research; 2. Systematic study of background; 3. Searching and selecting appropriate researches; 4. Information extraction; 5. Analysis and composition of findings from qualitative studies; 6. Quality control and 7. Findings, . In order to use newer sources, research related to the research topic was considered in the period 2006 to 2020. After reviewing the titles and abstracts of the researches, 263 related researches were selected. After reviewing the research abstract, 152 articles that had the most similarity and relevance to the research topic were selected.In this study, to validate the proposed model from the point of view of the focus group (experts), including two faculty members of Mazandaran University with entrepreneurial expertise and two PhD graduates in policy-making, was used in a systematic design and using the opinion. Experts in this field and making repeated corrections the validity of the research was reviewed and approved. In other words, to ensure the validity of the results with specific criteria of qualitative research, the necessary studies including acceptability and verification were performed. To increase the acceptance, the review method was used by experts and some experts in this field. For verification, in the final stage of the obtained classes, several experts were sent to review and confirm the submission and suggested points.Then, to evaluate the quality, with the help of selected experts, the 50-point scale of the Critical Assessment Skills Program was used and the researches were reviewed. The range of scores was considered as follows: Studies with a total score between 40 and 50 were considered excellent, 31 to 40 were very good, 21 to 30 were moderate, 11 to 20 were poor, and 0 to 10 were very poor. At this stage, 61 articles were deleted for scoring less than 30, and finally 91 articles were reviewed. In the present study, all the factors extracted through library studies were considered as a component (code). The information of each article (journal name, year of publication, authors' names, key variables, research result, proposed solutions and the province of the research) was entered in a table and a code (letter A and one number) was assigned to each research. Because some of the research was conducted in a specific city and village and the task of surveying spatial information was difficult, the province of that particular village or city was used to match the regions. Then, table (2) was prepared for presentation in this research. In the first column, the general classification of key indicators of local entrepreneurship extracted from research, in the second column, the concepts extracted from each research and in the third column, the codes related to related research are examined. Has been obtained and in front of each code, the province related to the research is listed. Conclusion: The results showed the 12 components of local entrepreneurship, including: artistic entrepreneurship, tourism entrepreneurship, rural entrepreneurship, women entrepreneurship, cultural entrepreneurship, regional entrepreneurship, sustainable entrepreneurship, traditional entrepreneurship, Wisely entrepreneurship, religious entrepreneurship, green entrepreneurship, medical entrepreneurship, and agricultural entrepreneurship were identified as explanatory components. Three components of rural entrepreneurship (26%); Tourism entrepreneurship (18%) and cultural entrepreneurship (12%) had the highest repetition rates among the research topics. According to the classification of regions, it was found that the highest number of articles on local entrepreneurship was related to the provinces of Tehran, Isfahan, Zanjan, Bushehr, and Mazandaran, which are among the most successful regions in the country's innovation systems. It is suggested that legal and systemic requirements and policies should be formulated to take advantage of these opportunities by both the local of the regions, and the whole country according to the local entrepreneurial potentials, and the gaps and shortcomings ahead of these potentials in each region. It is suggested that the status of each component of local entrepreneurship in the macro and sectoral policies of relevant institutions should be examined. One of the most important tools is the smart specialization strategy. Intelligent specialization is one of the newest regional development strategies which states that each region should set specific priorities according to the potential of the region, which is most appropriate in order to stimulate entrepreneurial culture and promote innovation in that region. It is suggested that future research using similar tools or instruments identify the local entrepreneurial priorities of each region.

To promote understanding of and interest in working with data among diverse student populations, we developed and studied a high school mathematics curriculum module that examines income inequality in the U.S. Designed as a multi-week set of applied data investigations, the module supports student analyses of income inequality using U.S. Census Bureau microdata and the online data analysis tool CODAP. Pre- and post-module data show that use of this module was associated with statistically significant growth in students’ understanding of fundamental data concepts and individual interests in statistics and data analysis, with small to moderate effect sizes. Student survey responses and interview data from students and teachers suggest that the topic of income inequality, features within CODAP, the use of person-level data, and opportunities to engage in multivariable thinking helped to support critical data literacy and its foundations among participating students. We describe our definitions of data literacy and critical data literacy and discuss curriculum strategies to develop them.

This study explores Indonesian schoolchildren’s dietary choices and evaluates parents’ awareness of the Indonesian well-balanced diet promoted by the Ministry of Health of the Republic of Indonesia. It also aims at parents’ perspectives on the Makan Bergizi Gratis (Nutritious Free Meal) program, which will soon be launched by the newly elected President Prabowo Subianto. Art based research and a Google Forms survey was used to gather information from schoolchildren and parents in Indonesia. The findings show common food choices, nutritional awareness gaps, and how parents feel about the new school meal program.

A 36-year-old male patient presented with a firm swelling in the left lacrimal sac region with a history of recurrent episodes of acute dacryocystitis, which partly resolved with systemic antibiotics. Computed tomography showed diffuse soft tissue mass without bony erosion in the same area. Incisional biopsy confirmed diffuse large cell lymphoma of non-Hodgkin's type by histopathology and immunohistochemistry. Oncologists did not detect systemic involvement, and the patient received six cycles of cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone (CHOP). Epiphora was resolved, and no recurrence of the lesion was seen with subsequent dacryocystorhinostomy with intubation and was in good health for up to 3 years of follow-up. Although primary lacrimal sac lymphoma is a rare entity, high suspicion, and prompt action in atypical cases can save lives from aggressive diffuse large cell lymphoma.

Abstract Clonal evolution in acute leukemias is one of the most important factors that leads to therapeutic failure and disease relapse. Delay in therapeutic intervention is one of the reasons that leads toward clonal evolution. In this report, we present a case of acute lymphoblastic leukemia in which therapeutic delay resulted in clonal evolution that was detected by conventional karyotyping and was responsible for non‐responsiveness of the disease to conventional chemotherapy. A 17‐year‐old boy presented with generalized body aches, rapidly progressive pallor and lethargy. Bone marrow analysis was consistent with the diagnosis of B‐cell ALL. Karyotypic analysis revealed 46, XY male karyotype. The patient left the hospital due to financial reasons and after 40 days came back to the hospital. Repeated bone marrow analysis including cytogenetic studies revealed presence of three different clones of blast cells: one clone showed 46, XY with del(9p) and t (11;14), second clone showed 46, XY with del(7q) and del(9p), and the third clone showed 46, XY normal karyotype. The patient did not respond to chemotherapy and died within 1 week of induction chemotherapy (HyperCVAD‐A). Timely diagnosis and institution of chemotherapy in acute leukemias patients is the key to prevent clonal evolution and thus resistance of the disease to therapeutic interventions.

The first complete mitochondrial genome sequencing of Asiatic Water snake or Checkered Keelback or Fowlea piscator (=Xenochrophis piscator) was carried out using Next-Generation Sequencing technology. The complete mitochondrial genome of Asiatic Water snake is 16,999bp long with a base composition of 33% A, 28% T, 12% G and 27% C, with a GC content of 39%. Like the typical snake mitochondrial genome, F. piscator also shows relatively similar mitogenome arrangement comprising 37 genes including 13 protein-coding genes, 22 tRNA genes, two rRNA genes and two non-coding regions or a duplicated control region (D-Loop) along with an origin of replication. Nine genes including eight tRNAs and NAD6 were encoded on the Light or L-strand. Phylogenetic analyses using the complete mitochondrial genome of F. piscator demonstrate a close relationship with the family Colubridae and sub family Natricinae.

Among different endangered animal species, snakes are the most neglected creature looked at with apathy and therefore, are ruthlessly killed, illegally trafficked, and poached for their venom, lucrative skin, meat, and bones for manufacturing of medicines, accessories, and food items. Establishing the identity of the endangered snake species is important for punishing the offenders under Wildlife Protection Act (WPA) (1972) but morphological characters fail to establish identity as they are often altered. The technique of identification of snake species at molecular level holds very effective conclusion in punishing offender. Here, we have constructed and demonstrated a novel multiplexing polymerase chain reaction technique, using 16S rRNA and C-mos gene for identification of four Indian snake species, namely Ptyas mucosa, Daboia russellii, Naja naja, and Xenochrophis piscator. They are listed in Appendix-II and III of convention on international trade in endangered species of wild fauna and flora and Schedule II; Part II of Indian WPA, 1972. Therefore, it may be considered a functional tool for establishing species-specific identity of four Indian snake species and promising to be useful for their conservation.

Ocular surface squamous neoplasia (OSSN) is the most common nonpigmented ocular surface neoplasm. Interferon-alpha (IFNα)-2b has been proved to be an effective immunotherapeutic agent to treat OSSN. We have used intralesional and topical (36 μg/ml) pegylated (peg) IFNα-2a to treat a recurrent surgically failed case of OSSN instead of IFNα-2b. In this case report, we have shared our initial experience with the novel use of peg-IFNα-2a to treat OSSN. According to our brief clinical experience, peg-IFNα-2a is nontoxic to ocular surface and has a promising role to treat OSSN.

Crocodiles, gharials and alligators (order Crocodilia), are aquatic reptiles that live in the tropics of Asia, America, Africa, and Australia. Asian countries such as India, Indonesia, Malaysia, and tropics of Australia are the stronghold of the family Crocodylidae. Among all 23 crocodile species, nine species occur in Asia and its surroundings, including the only member of Gavialidae and Alligatoridae family. They are “mugger” or “Crocodylus palustris,” “saltwater crocodile” or “Crocodylus porosus,” “Philippine crocodile” or “Crocodylus mindorensis,” “New Guinea crocodile” or “Crocodylus novaeguineae,” “Siamese crocodile” or “Crocodylus siamensis,” “gharials” or “Gavialis gangeticus,” “false gharial” or “Tomistoma schlegelii,” and “Chinese alligator” or “Alligator sinensis.” All of these species have been encompassed in “Appendix I” and “Appendix II” of the “Convention on International Trade in Endangered Species of Wild Fauna and Flora,” which prevents any kind of trade involving crocodilian species. However, it has been observed that these crocodiles are illegally poached and trafficked for their lucrative skin, meats, eggs, snouts, and bones in medicinal and cosmetic industries. Although many molecular biologists have come forward for the conservation of these species, lack of knowledge about the available, fast, and dependable techniques makes it difficult for forensic identification of seized or confiscated. It has been a major problem for the implementation of the “Wildlife Protection Law” on illegal trade. This article focuses on molecular techniques developed till date for the rapid and reliable species identification and conservation study of them.

Malaria is a global infectious disease that remains a leading cause of morbidity and mortality in the developing world. Multiple environmental and host and parasite factors govern the clinical outcomes of malaria. The host immune response against the Plasmodium parasite is heterogenous and stage-specific both in the human host and mosquito vector. The Plasmodium parasite virulence is predominantly associated with its ability to evade the host’s immune response. Despite the availability of drug-based therapies, Plasmodium parasites can acquire drug resistance due to high antigenic variations and allelic polymorphisms. The lack of licensed vaccines against Plasmodium infection necessitates the development of effective, safe and successful therapeutics. To design an effective vaccine, it is important to study the immune evasion strategies and stage-specific Plasmodium proteins, which are targets of the host immune response. This review provides an overview of the host immune defense mechanisms and parasite immune evasion strategies during Plasmodium infection. Furthermore, we also summarize and discuss the current progress in various anti-malarial vaccine approaches, along with antibody-based therapy involving monoclonal antibodies, and research advancements in host-directed therapy, which can together open new avenues for developing novel immunotherapies against malaria infection and transmission.

Recovery procedures are targeted at correcting issues encountered by robots. What are people’s opinions of a robot during these recovery procedures? During an experiment that examined how a mobile robot moved, the robot would unexpectedly pause or rotate itself to recover from a navigation problem. The serendipity of the recovery procedure and people’s understanding of it became a case study to examine how future study designs could consider breakdowns better and look at suggestions for better robot behaviors in such situations. We present the original experiment with the recovery procedure. We then examine the responses from the participants in this experiment qualitatively to see how they interpreted the breakdown situation when it occurred. Responses could be grouped into themes of sentience, competence, and the robot’s forms. The themes indicate that the robot’s movement communicated different information to different participants. This leads us to introduce the concept of movement acts to help examine the explicit and implicit parts of communication in movement. Given that we developed the concept looking at an unexpected breakdown, we suggest that researchers should plan for the possibility of breakdowns in experiments and examine and report people’s experience around a robot breakdown to further explore unintended robot communication.

Abstract Introduction The novel coronavirus, since its first identification in China, in December 2019, has shown remarkable heterogeneity in its clinical behavior. It has affected humans on every continent. Clinically, it has affected every organ system. The outcome has also been variable, with most of the older patients showing grave outcomes as compared with the younger individuals. Here we present a rare and severe variant of Guillain–Barre syndrome that complicated the disease in recovery phase. Case presentation A 60-year-old Afghan man, who had been recovering from symptoms related to novel coronavirus associated disease, presented with sudden onset of progressive muscle weakness and oxygen desaturation. Electrophysiological workup confirmed the diagnosis of Guillain–Barre syndrome, and early institution of intravenous immunoglobulin resulted in complete resolution. Conclusion Guillain–Barre syndrome has recently been reported in many patients diagnosed with novel coronavirus associated disease. While clinical suspicion is mandatory to guide towards an effective diagnostic workup, early diagnosis of this complication and timely institution of therapeutic interventions are indispensable and lifesaving.

Abstract Background Although, molecular genetic analyses became more and more important to guide therapy decisions in leukemia, banding cytogenetic analysis has retained its vital role in diagnosis and monitoring of chronic myeloid leukemia (CML), by quick and easy enabling identification of pathognomonic Philadelphia chromosome (Ph). Case presentation A 45 year old female presented with characteristic hematological features of CML in chronic phase; cytogenetic studies revealed the presence of the typical Ph and a deletion of almost entire long arm of a chromosome 5. Conclusion 5q deletions have rarely been reported in CML. Those seen yet were either associated with tyrosine kinase inhibitor therapy or detected post allogeneic stem cell transplantation. To our knowledge, this is the first case of Ph positive CML accompanied by a 5q deletion.

Abstract Introduction BCR-ABL1, resulting from t(9;22), is the oncogenic driver of chronic myeloid leukemia and the therapeutic target of the disease. Molecular studies have been the gold standard modality for patient assessment since the advent of tyrosine kinase inhibitor therapy. In spite of that, there are cytogenetic abnormalities that can render the disease unresponsive to conventional therapy, thus making cytogenetics an important component of patient management guidelines. Case presentation We present a case of a Tajik, Afghan patient with chronic myeloid leukemia with del(6)(q23.3q27), t(9;22)(q34;q11.2), monosomy 11, monosomy 12, and marker chromosome who, despite having typical clinical and hematological disease with initial response to therapy, progressed to blast crisis very early and thus required special interventions. Conclusion Cytogenetic monitoring is an important pillar in the management of patients with chronic myeloid leukemia that cannot be ignored. It should therefore be a part of patient management not only during diagnosis but also during management. We present an unusual cytogenetic abnormality in a patient with chronic myeloid leukemia that resulted in early disease progression.

Abstract Background The main purpose of this paper is to understand the multidimensional phenomenon of the nutrition transition in Malaysia, from 1980 to 2014, to inform future policies for a healthier nation. Methods Food and health data were obtained through Food Balance Sheets, Malaysian Adult Nutrition Survey (MANS) and National Health and Morbidity Surveys (NHMS) for year-to-year review. Interaction between changes in food supplies and dietary trends and the progression of diet-related diseases and risk factors in tandem with demographic and socioeconomic transitions were observed using quasi-historical approach. Results The period-under-review has seen Malaysia becoming more affluent, urbanised and modernised. Energy supply for Malaysian population remained consistently in excess of average calorie needs by a minimum of 30%. There were significant signs of shifting food trends, particularly in the supply of wheat (+ 56.5%), rice (− 23.7%), sugar and sweeteners (+ 23.9%), meat (+ 49.3%), fish and seafood (+ 38.7%), and eggs (+ 55.7%). The plant/animal protein ratio has decreased over time. Prevalence of NCD and associated risk factors has increased rapidly, some as high as 170%, despite various policy efforts to reduce them. Conclusion The study highlights the importance of policymakers taking a relook into its policies and strategies, and formulate sustainable, comprehensive and multifaceted actions together with all relevant stakeholders to ensure a conducive, healthy and nutritious food systems and environment for its population.

Abstract Background Mature brain heterotopic tissue in sacrococcygeal region is a very rare benign congenital abnormality of newborn. To date, only two cases of mature heterotopic brain tissue in the sacrococcygeal region is reported by literature. Heterotopic brain tissue in other areas such as lung, nose, face and retroperitoneal region are also rarely reported. Meanwhile, rather than brain heterotopic tissue in sacrococcygeal region, a case of adrenal gland heterotopic tissue in sacrococcygeal region also has been reported. Case presentation A 3.5 month-old male baby presented with history of sacrococcygeal mass since birth. Clinical examination of the child was good with no other problem. Sacrococcygeal region revealed an elevated round mass with no discharge. Computed tomography reported a large sacrococcygeal teratoma type-III arising from the sacrococcygeal region extending intra-abdominally to the level of L2 vertebral body. The mass was excised by the impression of sacrococcygeal teratoma (SCT). On gross examination, a gray-white irregular tissue fragment with 5 cm in greatest dimension was examined. Cut sections showed homogenous yellowish white appearance. Histological examination revealed solid fragments composed of mature neural tissue comprising glial cells and astrocytes with no other germ cell layer component. Conclusion Mature brain heterotopic tissue in sacrococcygeal area is a rare benign disease. Two ectopic brain tissue in sacrococcygeal region were previously also reported. Sacrococcygeal teratoma is the most common congenital tumor, but this current rare case of heterotopic brain tissue in sacrococcygeal region should also be in the differential diagnosis.

Mucormycosis is an invasive fungal infection caused by fungi belonging to order Mucorales. Recently, with the increase in COVID-19 infections, mucormycosis infections have become a matter of concern globally, because of the high morbidity and mortality rates associated with them. Due to the association of mucormycosis with COVID-19 disease, it has been termed COVID-19-associated mucormycosis (CAM). In the present review, we focus on mucormycosis incidence, pathophysiology, risk factors, immune dysfunction, interactions of Mucorales with endothelial cells, and the possible role of iron in Mucorales growth. We review the limitations associated with current diagnostic procedures and the requirement for more specific, cost-effective, convenient, and sensitive assays, such as PCR-based assays and monoclonal antibody-based assays for the effective diagnosis of mucormycosis. We discuss the current treatment options involving antifungal drug therapies, adjunctive therapy, surgical treatment, and their limitations. We also review the importance of nutraceuticals-based therapy for the prevention as well as treatment of mucormycosis. Our review also highlights the need to explore the potential of novel immunotherapeutics, which include antibody-based therapy, cytokine-based therapy, and combination/synergistic antifungal therapy, as treatment options for mucormycosis. In summary, this review provides a complete overview of COVID-19-associated mucormycosis, addressing the current research gaps and future developments required in the field.

IgM and B-1 cell deficient mice exhibit early C. neoformans dissemination from lungs to brain, but a definitive role for B cells in conferring resistance to C. neoformans dissemination has not been established. To address this question, we developed an intranasal (i.n.) C. neoformans infection model in B and T cell deficient Rag1−/− mice and found they also exhibit earlier fungal dissemination and higher brain CFU than wild-type C57Bl/6 (wild-type) mice. To probe the effect of B cells on fungal dissemination, Rag1−/− mice were given splenic (intravenously) or peritoneal (intraperitoneally) B cells from wild-type mice and infected i.n. with C. neoformans 7 d later. Mice that received B cells had lung histopathology resembling wild type mice 14 d post-infection, and B-1, not B-2 or T cells in their lungs, and serum and lung IgM and IgG 21 d post-infection. Lung CFU were comparable in wild-type, Rag1−/−, and Rag1−/− mice that received B cells 21 d post-infection, but brain CFU were significantly lower in mice that received B cells than Rag1−/− mice that did not. To determine if natural antibody can promote immunity in our model, we measured alveolar macrophage phagocytosis of C. neoformans in Rag1−/− mice treated with naive wild-type IgM-sufficient or sIgM−/− IgM-deficient sera before infection. Compared to IgM-deficient sera, IgM-sufficient sera significantly increased phagocytosis. Our data establish B cells are able to reduce early C. neoformans dissemination in mice and suggest natural IgM may be a key mediator of early antifungal immunity in the lungs.

Objectives In Afghanistan, breast diseases are a common reason for women to visit hospitals. This is the first study in Afghanistan aimed to describe the age distribution and types of breast diseases among patients diagnosed by fine needle aspiration cytology.Design Descriptive cross-sectional study.Setting French Medical Institute for Mothers and Children, Kabul, Afghanistan.Participants The study included 650 patients with breast lesions between 1 April 2015 and 1 April 2019.Results The mean age of diagnosis was 35.38 (SD ±13.11) years, ranging from 15 to 75 years. The most common diagnosis was cancer (24% of all cases). The second most common diagnosed lesion was fibroadenoma, constituting 22.4%, and the third most common lesion was fibrocystic changes, with 15.4% of cases. Inflammatory conditions were diagnosed in 9.7% of cases, granulomatous inflammation in 9.1%, lesions only suspicious for malignancy in 5.5%, lipoma in 2.8% and miscellaneous benign lesions in 11.1%. Cancer was diagnosed at the youngest age of 20 years. Cancer was more common on the left side (62%), and only one case (0.9%) was bilateral.Conclusion Our study showed that cancer was the most commonly diagnosed lesion and was reported at younger ages too. This suggests that physicians should not ignore any breast lump in younger patients and that the possibility of cancer must be considered. Further country-wide studies are suggested to assess breast cancer and associated risk factors.

Background: The association of the variant rs6265 (G>A) in the brain-derived neurotrophic factor (BDNF) gene with obesity and other obesity-related parameters is not known for the Pakistani population. Moreover, the effects of interaction between BDNF rs6265 and overweight/obesity on obesity-related traits have never been investigated before. Aim: To find the association of the BDNF rs6265 with obesity and related traits and to explore the effect of rs6265 × obesity interaction on obesity-related traits in Pakistanis. Subjects and methods: The study involved a total of 606 subjects, including 306 overweight and obese (OW/OB) cases and 300 normal weight (NW) controls. The genotyping of the BDNF rs6265 was done and obesity-related anthropometric, physical, behavioural and metabolic parameters were determined. Statistical analyses using SPSS software were performed to find the associations. Results: The study revealed a lack of association of the BDNF rs6265 with obesity and obesity-related traits. On the other hand, the interaction between the BDNF rs6265 and overweight/obesity was found to be significantly associated with some of the obesity-related anomalous traits. However, no association between rs6265 and these anomalous traits was seen in either group when the association test was performed in NW and OW/OB groups separately. Conclusion: The BDNF rs6265, in the presence of obesity, may be associated with elevated risk of anomalous metabolic, behavioural and physical traits and obesity-related co-morbidities, but it needs to be validated in a significantly larger Pakistani sample population.

Purpose: Assessment of drug substance and excipients compatibility is an important issue during pre-formulation studies as well as the quality control of pharmaceutical dosage forms. In this study, potential incompatibility between methyldopa and reducing excipients was evaluated using physicochemical methods. Methods: Dextrose and lactose (anhydrous & monohydrate) were selected as reducing carbohydrates. The initial incompatibility was studied with DSC and FTIR on binary mixtures with 1:1 mass ratio. Results were confirmed using HPLC studies coupled with mass spectrometry. Results: The DSC curves indicated the elimination of the melting endotherm of methyldopa in the binary mixtures. A new peak at 1719 cm-1 was observed in the FTIR spectra that can be attributed to the loss of type one amine functionality. The m/z of the proposed compound was observed in the mass spectra. Conclusion: The potential incompatibility of Methyldopa with reducing carbohydrates was established using physicochemical methods.

The recent simulation-based inference (SBI) movement in algebra-based introductory statistics courses (Stat 101) has provided preliminary evidence of improved student conceptual understanding and retention. However, little is known about whether these positive effects are preferentially distributed across types of students entering the course. We consider how two metrics of Stat 101 student preparation (precourse performance on concept inventory and math ACT score) may or may not be associated with end of course student performance on conceptual inventories. Students across all preparation levels tended to show improvement in Stat 101, but more improvement was observed across all student preparation levels in early versions of a SBI course. Furthermore, students' gains tended to be similar regardless of whether students entered the course with more preparation or less. Recent data on a sample of students using a current version of an SBI course showed similar results, though direct comparison with non-SBI students was not possible. Overall, our analysis provides additional evidence that SBI curricula are effective at improving students' conceptual understanding of statistical ideas postcourse regardless student preparation. Further work is needed to better understand nuances of student improvement based on other student demographics, prior coursework as well as instructor and institutional variables.