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Background: Skin conditions form a major bulk of diseases in the community. With a disproportionately low number of dermatologists in the country, and a greatly unequal distribution between urban versus rural areas, ineffective treatment and mismanagement of skin conditions are, however, commonplace. Objective: To develop standard treatment workflows (STWs) for certain skin diseases for use by clinicians at primary, secondary, and tertiary care centers. Methodology: Seven members, from various academic institutes across the country, were selected for formulation of the STWs. They were provided logistic and technical support by the ICMR, Department of Health Research (DHR), and WHO India office. Multiple rounds of online and physical discussions were performed to identify topics that would be most useful in the management of skin diseases for the health care personnel (HCP) and subsequently to frame the STW content. Results: The selected diseases included acne and rosacea, alopecia, bacterial skin infections, cutaneous adverse drug reactions, dermatophytosis, eczema/dermatitis, immunobullous dermatoses, psoriasis, scabies, varicella and herpes, vitiligo, and urticaria. There was one separate module on rational use of topical corticosteroids. The STWs for these conditions have been finalised and are available as physical posters in health centers and can also be accessed online and through mobile applications. Conclusion: Thirteen STW modules have been prepared with a view to optimize management of skin diseases at various levels of health care system of the country.

Background: Standard treatment workflows (STWs) indeed play a crucial role in enhancing healthcare delivery by providing structured guidelines for managing prevalent diseases. These guidelines are particularly beneficial in primary and secondary healthcare settings, where they help standardize treatment protocols, streamline referrals, and ultimately improve healthcare efficiency. Methods: Indian Council of Medical Research, in collaboration with the National Health Authority and the World Health Organisation India country office developed the STWs. The broad medical specialities were identified and speciality expert groups each of 5–12 experienced members led by an eminent chairperson were constituted. Priority disease conditions were identified and the speciality experts deliberated on the evidence available for various recommendations and developed the content for the STW. These were then converted to a one-pager infographic. The draft STWs were reviewed by relevant experts for internal and external validation of content. Results: 125 STWs in 23 specialties have been developed. Conclusion: STWs are one-page summaries of clinical guidelines designed to improve healthcare delivery in India. Training healthcare profesionals and collaboration with medical bodies are crucial for successful implementation. This can ensure standardized, evidence-based care throughout India's healthcare system.

Background: Tinea incognito presents with atypical, widespread, and recurrent lesions. Dermoscopy can aid its rapid diagnosis. Aim and Objectives: This study aimed at assessing dermoscopic features and response to treatment in patients with tinea incognito. Materials and Methods: An evaluation of 62 patients with tinea of glabrous skin (Group A (cases)—31 steroid modified and Group B (controls)—31 treatment naïve) was done. Clinical, dermoscopic, and mycological evaluations were done for both groups at baseline, 2, and 4 weeks of terbinafine therapy. Clinical severity (Clinical Assessment Severity Score (CASS) and Visual Analogue Scale (VAS)) and frequency of various dermoscopic changes were compared at 0 and 4 weeks between cases and controls, using unpaired Student's t-test, Mann–Whitney U-test, and Wilcoxon signed-rank test. Results: Baseline dermoscopic features for both groups were significantly different with respect to frequency of broken hair, bent hair, micropustules and Morse code hair. Earliest feature to resolve with treatment was micropustules at 2 weeks. Significant reduction in frequency of morphologically altered hair was evident at 4 weeks. Telangiectasia, dotted vessels, I-hair, and broken hair persisted for a longer period of time. Terbinafine for 4 weeks was an effective treatment, producing complete cure in 73% of cases and 93% of controls. Persistent dermoscopic changes at 2 weeks were found to be associated with treatment failure at 4 weeks, highlighting the role of dermoscopy in identifying patients requiring prolonged treatment. Conclusions: Dermoscopy can be used as a diagnostic and monitoring tool for tinea of glabrous skin.

Background The rate of underlying ruptured aneurysms, complications, and their relevance to outcomes in “benign” perimesencephalic subarachnoid hemorrhage are not well known and underreported. Methods Retrospective analysis of patients with perimesencephalic subarachnoid hemorrhage from a large tertiary care center (2007–2022). Results Eighty‐one patients were included with mean age of 55.5 ± 10.3 years. An underlying ruptured aneurysm was diagnosed in 5 patients (6.2%); 3 (60%) had negative computed tomography angiography and they were detected only in digital subtraction angiography (2 on initial digital subtraction angiography and 1 on follow‐up digital subtraction angiography). The most common complication was vasospasm in 25/81 patients (31%), and the majority 21/25 (84%) were asymptomatic. Symptomatic vasospasm occurred at a significantly higher rate among patients with underlying aneurysm (40% versus 2.6%; P = 0.01). Hydrocephalus occurred in 10% of patients, all within 1 day, but at a higher rate in the aneurysmal group (40% versus 8%; P = 0.07). A total of 88% of patients had modified Rankin scale score 0–2 at discharge, but at a significantly higher rate in nonaneurysmal patients (91% versus 40%; P = 0.01). An underlying aneurysm, hydrocephalus, and symptomatic vasospasm were associated with poor functional status (odds ratio [OR] = 14.7 [2.1–104]; P = 0.007, OR = 22.6 [4.2–123.5]; P

Cecilia Coale Van Hollen. Cancer and the Kali Yuga: Gender, Inequality and Health in South India, University of California Press, 2022, 306 pp. Cancer and the Kali Yuga begins with [...]

Abstract Background and Objectives There is a lack of well-controlled US studies of intramuscular (IM) interferon beta (IFNβ)-1a use in pregnant women with multiple sclerosis; however, in the European Medicines Agency region, IFNβ formulations may be considered during pregnancy if clinically needed based on data from European Union cohort registries. The AVONEX Pregnancy Exposure Registry was established to prospectively study the effects of IM IFNβ-1a on the risk of birth defects and spontaneous pregnancy loss in a US population. Methods Pregnant women with multiple sclerosis exposed to IM IFNβ-1a within ~ 1 week of conception or during the first trimester were included. Participants were followed until there was a pregnancy outcome, live-born infants were followed until age 8–12 weeks. Data were collected on IM IFNβ-1a exposure, demographics, patient characteristics, medical history, and pregnancy outcomes, including live births (with or without birth defect), spontaneous abortions/miscarriages and fetal death/stillbirth, elective abortions (with and without birth defect), and ectopic pregnancies. A population-based birth defect surveillance program, the Metropolitan Atlanta Congenital Defects Program (MACDP), served as the primary external control group for evaluating the risk of birth defects. Results Three-hundred and two patients with a median (range) age of 31.0 (16–48) years and a median (range) gestational age at the time of enrollment of 10.1 (4–39) weeks were evaluable. Most patients (n = 278/302; 92%) reported IM IFNβ-1a exposure in the week before conception and most (n = 293/302; 97%) discontinued treatment before the end of the first trimester. Of 306 pregnancy outcomes, there were 272 live births, 28 spontaneous abortions of 266 pregnancies enrolled before 22 weeks’ gestation (rate 10.5%; 95% confidence interval 7.2–15.0), five elective abortions, and one stillbirth. There were 17 adjudicator-confirmed major birth defects of 272 live births (rate 6.3%; 95% confidence interval 3.8–10.0); the pattern of birth defects observed was not suggestive of a relationship to prenatal IM IFNβ-1a exposure. Conclusions This large US registry study suggests IM IFNβ-1a exposure during early pregnancy was not clinically associated with adverse pregnancy outcomes in women with multiple sclerosis. These findings help inform clinicians and patients in weighing the risks and benefits of IM IFNβ-1a use during pregnancy. Clinical Trial Registration ClinicalTrials.gov: NCT00168714, 15 September, 2005.

There is increasing recognition of the crucial need for robust community engagement in health research and clinical trials. Despite this awareness, challenges persist in bridging the gap between researchers and communities. Much of the current discourse focuses on addressing issues such as cultural humility and equitable partnerships. To expand this conversation, we conducted community engagement studios, following the model by Joosten et al. We wanted to gather perspectives on research involvement across New Mexico. This process and resultant findings offer valuable insights into effective community engagement practices and advance clinical and translational science by amplifying community voices and needs.

We present the host galaxies of four apparently nonrepeating fast radio bursts (FRBs), FRB 20181223C, FRB 20190418A, FRB 20191220A, and FRB 20190425A, reported in the first Canadian Hydrogen Intensity Mapping Experiment (CHIME/FRB) catalog. Our selection of these FRBs is based on a planned hypothesis testing framework where we search all CHIME/FRB Catalog-1 events that have low extragalactic dispersion measure ( 10°) and saved baseband data. We associate the selected FRBs with galaxies with moderate to high star formation rates located at redshifts between 0.027 and 0.071. We also search for possible multimessenger counterparts, including persistent compact radio and gravitational-wave sources, and find none. Utilizing the four FRB hosts from this study, along with the hosts of 14 published local Universe FRBs ( z < 0.1) with robust host association, we conduct an FRB host demographics analysis. We find all 18 local Universe FRB hosts in our sample to be spirals (or late-type galaxies), including the host of FRB 20220509G, which was previously reported to be elliptical. Using this observation, we scrutinize proposed FRB source formation channels and argue that core-collapse supernovae are likely the dominant channel to form FRB sources. Moreover, we infer no significant difference in the host properties of repeating and apparently nonrepeating FRBs in our local Universe FRB host sample. Finally, we find the burst rates of these four apparently nonrepeating FRBs to be consistent with those of the sample of localized repeating FRBs observed by CHIME/FRB. Therefore, we encourage further monitoring of these FRBs with more sensitive radio telescopes.

Background: Impact of COVID-19 pandemic has been immense. An innocent casualty of this disaster is medical education and training. Dermatology, which primarily deals with out-patient services, medical and surgical interventions, and in-patient services, was one of the worst hit. The National Medical Commission of India has implemented competency-based medical education (CBME) in Dermatology, Venereology, and Leprosy since 2019. The new curriculum relies on acquiring practical and procedural skills, training skills in research methodology, professionalism, attitude, and communication. Objectives: The study was undertaken to understand the implications of the COVID-19 pandemic on postgraduate dermatology CBME training in India. Materials and Methods: A questionnaire-based survey was carried out on postgraduate dermatology teachers and residents in India after obtaining ethics committee approval. An online semi-structured English questionnaire was administered by Google Forms. The calculated sample size was 366 dermatology faculty and 341 postgraduate students. Validity (Content validity ratio (CVR) ≥0.56) and reliability (Cronbach's alpha coefficient 0.7249) of the questionnaire were determined. Results: Among the 764 responses received, 51.4% reported that their institutes were converted to exclusive COVID hospitals. Domains of dermatology education affected were procedural training (n = 655), bedside clinical teaching (n = 613), outpatient department-based clinical teaching (n = 487), bedside laboratory procedures (n = 463), research activities (n = 453), histopathology (n = 412), and theory classes (n = 302). To keep up with the teaching-learning process, online platforms were mostly utilized: Zoom Meeting (n = 379), Google Meet (n = 287), and WhatsApp Interaction (n = 224). Teaching during ward rounds was significantly more affected in exclusively COVID institutes than non-exclusive COVID institutes (P < 0.001). Psychomotor skill development suffered a major jolt with 26.7% of respondents reporting a standstill (P < 0.001). Communication skills among students suffered due to social distancing, mask, and poor attendance of patients. According to 23.84% of respondents, formative assessment was discontinued. Conclusion: Online seminars, journal clubs, and assessments have been incorporated during the pandemic. Online modalities should be used as a supplementary method as psychomotor skills, communication skills, research work, and bedside clinics may not be replaced by the e-learning.

Vaibhav Saria. Hijras, Lovers, Brothers: Surviving Sex and Poverty in Rural India. New York: Fordham University Press, 2021.268 pp. In an early, instructive ethnographic vignette, anthropologist Vaibhav Saria, who is [...]

Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80–90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC.

We present the discovery of 12 apparently nonrepeating fast radio burst (FRB) sources, detected by the Canadian Hydrogen Intensity Mapping Experiment (CHIME) telescope. These sources, only one of which has been presented previously in the first CHIME/FRB catalog, were selected from a database comprising ${ \mathcal O }({10}^{3})$ CHIME/FRB full-array raw voltage data recordings, based on their large signal-to-noise ratios and complex morphologies. Our study examines the time-frequency characteristics of these bursts, including drifting, microstructure, and periodicities. The events in this sample display a variety of unique drifting phenomenologies that deviate from the linear negative drifting phenomenon seen in many repeating FRBs, and motivate a possible new framework for classifying drifting archetypes. Additionally, we detect microstructure features of duration ≲50 μ s in seven events, with some as narrow as ≃7 μ s. We find no evidence of significant periodicities between subburst components. Furthermore, we report the polarization characteristics of seven events, including their polarization fractions and Faraday rotation measures (RMs). The observed ∣RM∣ values span a wide range of 17.24(2)–328.06(2) rad m ^−2 , with apparent linear polarization fractions between 0.340(1) and 0.946(3). The morphological properties of the bursts in our sample appear broadly consistent with predictions from both relativistic shock and magnetospheric models of FRB emission, as well as propagation through discrete ionized plasma structures. We address these models and discuss how they can be tested using our improved understanding of morphological archetypes.

We present an extensive contemporaneous X-ray and radio campaign performed on the repeating fast radio burst (FRB) source FRB 20220912A for 8 weeks immediately following the source’s detection by CHIME/FRB. This includes X-ray data from XMM-Newton, NICER, and Swift, and radio detections of FRB 20220912A from CHIME/Pulsar and Effelsberg. We detect no significant X-ray emission at the time of 30 radio bursts with upper limits on a 0.5–10.0 keV X-ray fluence of (1.5–14.5) × 10 ^−10 erg cm ^−2 (99.7% credible interval, unabsorbed) on a timescale of 100 ms. Translated into a fluence ratio η _x/r = F _X-ray / F _radio , this corresponds to η _x/r < 7 × 10 ^6 . For persistent emission from the location of FRB 20220912A, we derive a 99.7% 0.5–10.0 keV isotropic flux limit of 8.8 × 10 ^−15 erg cm ^−2 s ^−1 (unabsorbed) or an isotropic luminosity limit of 1.4 × 10 ^41 erg s ^−1 at a distance of 362.4 Mpc. We derive a hierarchical extension to the standard Bayesian treatment of low-count and background-contaminated X-ray data, which allows the robust combination of multiple observations. This methodology allows us to place the best (lowest) 99.7% credible interval upper limit on an FRB η _x/r to date, η _x/r < 2 × 10 ^6 , assuming that all 30 detected radio bursts are associated with X-ray bursts with the same fluence ratio. If we instead adopt an X-ray spectrum similar to the X-ray burst observed contemporaneously with FRB-like emission from the Galactic magnetar SGR 1935+2154 detected on 2020 April 28, we derive a 99.7% credible interval upper limit on η _x/r of 8 × 10 ^5 , which is only 3 times the observed value of η _x/r for SGR 1935+2154.

We use the Canadian Hydrogen Intensity Mapping Experiment (CHIME) Fast Radio Burst (FRB) Project to search for FRBs that are temporally and spatially coincident with gamma-ray bursts (GRBs) occurring between 2018 July 7 and 2023 August 3. We do not find any temporal (within 1 week) and spatial (within overlapping 3 σ localization regions) coincidences between any CHIME/FRB candidates and all GRBs with 1 σ localization uncertainties

In 2021, a catalog of 536 fast radio bursts (FRBs) detected with the Canadian Hydrogen Intensity Mapping Experiment (CHIME) radio telescope was released by the CHIME/FRB Collaboration. This large collection of bursts, observed with a single instrument and uniform selection effects, has advanced our understanding of the FRB population. Here we update the results for 140 of these FRBs for which channelized raw voltage (“baseband”) data are available. With the voltages measured by the telescope’s antennas, it is possible to maximize the telescope sensitivity in any direction within the primary beam, an operation called “beamforming.” This allows us to increase the signal-to-noise ratios of the bursts and to localize them to subarcminute precision. The improved localizations are also used to correct the beam response of the instrument and to measure fluxes and fluences with an ∼10% uncertainty. Additionally, the time resolution is increased by 3 orders of magnitude relative to that in the first CHIME/FRB catalog, and, applying coherent dedispersion, burst morphologies can be studied in detail. Polarization information is also available for the full sample of 140 FRBs, providing an unprecedented data set to study the polarization properties of the population. We release the baseband data beamformed to the most probable position of each FRB. These data are analyzed in detail in a series of accompanying papers.

We present a 400–800 MHz polarimetric analysis of 128 nonrepeating fast radio bursts (FRBs) from the first CHIME/FRB baseband catalog, increasing the total number of FRB sources with polarization properties by a factor of ∼3. A total of 89 FRBs have >6 σ linearly polarized detections, 29 FRBs fall below this significance threshold and are deemed linearly unpolarized, and for 10 FRBs, the polarization data are contaminated by instrumental polarization. For the 89 polarized FRBs, we find Faraday rotation measure (RM) amplitudes, after subtracting approximate Milky Way contributions, in the range 0.5–1160 rad m ^−2 with a median of 53.8 rad m ^−2 . Most nonrepeating FRBs in our sample have RMs consistent with Milky Way–like host galaxies, and their linear polarization fractions range from ≤10% to 100% with a median of 63%. We see marginal evidence that nonrepeating FRBs have more constraining lower limits than repeating FRBs for the host electron-density-weighted line of sight magnetic field strength. We classify the nonrepeating FRB polarization position angle (PA) profiles into four archetypes: (i) single component with constant PA (57% of the sample), (ii) single component with variable PA (10%), (iii) multiple components with a single-constant PA (22%), and (iv) multiple components with different or variable PAs (11%). We see no evidence for population-wide frequency-dependent depolarization, and, therefore, the spread in the distribution of fractional linear polarization is likely intrinsic to the FRB emission mechanism. Finally, we present a novel method to derive redshift lower limits for polarized FRBs without host galaxy identification and test this method on 20 FRBs with independently measured redshifts.

We present results from angular cross correlations between select samples of CHIME/FRB repeaters and galaxies in three photometric galaxy surveys, which have shown correlations with the first CHIME/FRB catalog containing repeating and nonrepeating sources: Wide-field Infrared Survey Explorer (WISE) × SCOS, DESI-BGS, and DESI-LRG. We find a statistically significant correlation ( p -value 395 pc cm ^−3 and WISE × SCOS galaxies with redshift z > 0.275. We demonstrate that the correlation arises surprisingly because of a statistical association between FRB 20200320A (extragalactic DM ≈ 550 pc cm ^−3 ) and a galaxy group in the same dark matter halo at redshift z ≈ 0.32. We estimate that the host halo, along with an intervening halo at redshift z ≈ 0.12, accounts for at least ∼30% of the extragalactic DM. Our results strongly motivate incorporating galaxy group and cluster catalogs into direct host association pipelines for FRBs with $\lesssim 1^{\prime} $ localization precision, effectively utilizing the two-point information to constrain FRB properties such as their redshift and DM distributions. In addition, we find marginal evidence for a negative correlation at 99.4% confidence limit between a sample of repeating FRBs with baseband data (median extragalactic DM = 354 pc cm ^−3 ) and DESI-LRG galaxies with redshift 0.3 ≤ z < 0.45, suggesting that the repeaters might be more prone than apparent nonrepeaters to propagation effects in FRB–galaxy correlations due to intervening free electrons over angular scales ∼0.°5.

Plain English Summary Involving patients in care improvement efforts is valuable for improving the quality and safety of health care services because patients offer unique insights and are directly impacted by the system. Involving patients in these efforts can also inform better patient and family experiences. Studies have shown that using video interviews highlighting good and bad patient experiences in healthcare is one of the promising way to include a wider range of patient narratives and feedback in care improvement. Videos used in these situations are now called catalyst films, formerly known as trigger films. This paper describes how catalyst films are similar to and distinct from other film products used in research and improvement projects. It examines a process for equitably engaging a team of many different stakeholders—patients, providers, and researchers—to select video excerpts from existing research-based patient experience interviews to create catalyst films. It describes methods used to ensure robust input from all team members, so that all perspectives influence the catalyst films. The study concluded that patient and public involvement had significant impact on both the research process and the final products created. Our findings can equip those making or selecting films for use in improving health and social care to ensure films are patient informed. The paper concludes by offering limitations and recommendations for future research to advance the fields of patient and public involvement and quality improvement.

Mycotoxins are fungi-produced secondary metabolites that can contaminate many foods eaten by humans and animals. Deoxynivalenol (DON), which is formed by Fusarium, is one of the most common occurring predominantly in cereal grains and thus poses a significant health risk. When DON is ingested, it can cause both acute and chronic toxicity. Acute signs include abdominal pain, anorexia, diarrhea, increased salivation, vomiting, and malaise. The most common effects of chronic DON exposure include changes in dietary efficacy, weight loss, and anorexia. This review provides a succinct overview of various sources, biosynthetic mechanisms, and genes governing DON production, along with its consequences on human and animal health. It also covers the effect of environmental factors on its production with potential detection, management, and control strategies.

Introduction Large vessel occlusion (LVO) is estimated to account for up to 39% of all ischemic strokes with 62% of them resulting in post‐ischemic stroke dependency and 96% of all post‐ischemic stroke mortality. Advanced imaging modalities and efficient stroke systems of care have resulted in faster reperfusion times. There is however limited data on the outcomes of thrombectomy as a function of age. We present a retrospective analysis on thrombectomy in younger (age 18–49 years) versus older (age >50 years) patients. Methods Retrospective single center study with population being identified using our procedural database and “SlicerDicer” tool on EPIC from 2017–2021. Patients who underwent mechanical thrombectomy were divided into 2 groups based on age. Younger group consists of patients between the ages 18–49 while older group is 50 and over. Primary outcome of the study was to identify good clinical outcome as defined by mRS of 0–2 in both groups. Secondary outcomes included rate of favorable reperfusion defined by TICI 2b‐3, symptomatic ICH and mortality rate. Results > We have identified 48 patients between the age of 18–49 and 436 over the age of 50. > We found that median groin puncture to repercussion time was lower in younger population (32 v/s 69 mins; p = 0.0044) > The median groin puncture to first pass time was lower in younger population (22 v/s 43; p = 0.056), but it failed to show statistical significance. > Younger compared to older patients had better clinical outcomes (mRS 0–2) at 77.1% v/s 32.3% (p< 0.0001) and higher rates of favorable repercussion (TICI 2b‐3) at 93.7% v/s 72.9% (p = 0.0016) > The older group required more passes to achieve recanalization (4 or more passes: 4.3% v/s 16.2%; p = 0.035) > Mortality rate was significantly less in the younger population (8.3% v/s 22.1%; p = 0.026) Conclusions Younger patients had better clinical outcomes than their older counterparts after mechanical thrombectomy in our analysis. Other than younger age, higher rates of favorable repercussion, earlier recanalization, and less passes to recanalization were seen in association with better observed outcomes.

Introduction Perimesencephalic subarachnoid hemorrhage (PMSAH) is characterized by bleeding centered in the basal cisterns anterior to the midbrain and pons without intraparenchymal or overt intraventricular extension. The term “benign” is often attached, because typically no source of bleeding is identified on high‐resolution vascular imaging, and recovery if often uncomplicated. Rarely, however, PMSAH can be secondary to ruptured vertebrobasilar aneurysms, and outcomes of these patients is underreported. Methods Retrospective analysis of patients with PMSAH to determine the rate of underlying ruptured aneurysm or vascular abnormality, associated complications, and outcomes. Age, sex, vascular risk factors, presenting symptoms, Hunt and Hess grade, modified Fisher grade, rate of underlying ruptured aneurysm, vasospasm, re‐bleed, hydrocephalus, and modified Rankin scale (mRS) were collected. Primary outcome was good functional status at discharge (mRS 0–2), reported as odds ratio (OR) with 95% confidence interval (CI). Results A total of 74 patients with PMSAH between 2007 and 2022 were identified. Mean age was 55.5± 10 years, and 60% were male. Hypertension and smoking were reported in 57% and 35% of patients, respectively. The most common presenting symptom was thunderclap headache in 89% of patients. Median (IQR) ofHunt and Hess grade was 2 (1‐2), and modified Fisher grade was 3 (1‐3). An underlying ruptured aneurysm was found in 3 patients (4%); two of which were in the vertebrobasilar system and one in the posterior communicating artery. Most common complications in this cohort was vasospasm in 28%, followed by hydrocephalus in 11%. Among patients with aneurysmal bleed, vasospasm and hydrocephalus occurred in 66% of patients each, compared to 8.5% and 27%, respectively in patients with non‐aneurysmal PMSAH. Re‐bleeding occurred only in one patient (1.3%); which occurred in a patient with non‐aneurysmal source of hemorrhage. A total of 88% of patients in our cohort had a favorable functional outcome (mRS 0–2) at discharge. An underlying ruptured aneurysm and acute hydrocephalus were associated with poor functional status(OR = 18.3, [1.5–228], P < 0.024), and OR = 25.8, [4.5–149], P < 0.001), respectively. However, vasospasm was noted to be asymptomatic in most cases (90%) and was not associated with unfavorable outcomes (OR = 0.75, [0.14–3.9], P < 0.73). Conclusions “Benign” PMSAH pattern was associated with a ruptured aneurysm in 4% of patients in our cohort.An underlying aneurysm and acute hydrocephalus were associated with poor outcomes. However, vasospasm was incidental and was not associated with unfavorable outcomes in patients with PMSAH.

Camptothecin (CPT), an alkaloid isolated from the Camptotheca tree, has demonstrated significant anticancer properties in a range of malignancies. However, its therapeutic efficacy is limited by its hydrophobicity, poor bioavailability, and systemic toxicity. Derivatives, analogues, and nanoformulations of CPT have been synthesized to overcome these limitations. The aim of this review is to comprehensively analyze existing studies to evaluate the therapeutic efficacy, mechanistic aspects, and clinical potential of CPT and its modified forms, including derivatives, analogues, and nanoformulations, in cancer treatment. A comprehensive literature review was performed using PubMed/Medline, Scopus, and Web of Science databases; articles were selected based on specific inclusion criteria, and data were extracted on the pharmacological profile, clinical studies, and therapeutic efficacy of CPT and its different forms. Current evidence suggests that derivatives and analogues of CPT have improved water solubility, bioavailability, and reduced systemic toxicity compared to CPT. Nanoformulations further enhance targeted delivery and reduce off-target effects. Clinical trials indicate promising outcomes with enhanced survival rates and lower side effects. CPT and its modified forms hold significant promise as potent anticancer agents. Ongoing research and clinical trials are essential for establishing their long-term efficacy and safety; the evidence overwhelmingly supports further development and clinical testing of these compounds. [ABSTRACT FROM AUTHOR]

Rationale Aims and objectives Method Results Conclusion A barrier to dedicating resources towards patient engagement in primary care quality improvement is the lack of clearly identified outcomes that might result from these initiatives.We sought to identify these potential outcomes at three healthcare levels as defined by the Institute of Medicine: 1) Micro/Direct Care; 2) Meso/Microsystem; and 3) Macro/Clinic/System using a Modified Delphi technique.Two focus groups of patients and primary care clinician leaders generated a first set of outcomes. These outcomes were then vetted and expanded through three web‐based surveys sent to twelve national experts. Experts indicated the level of agreement with prior elicited outcomes and generated potential new outcomes.Included outcomes achieved at least 80% agreement. The final list of 46 consensus‐derived outcomes was categorized across levels. 22 were at the Micro‐level, 9 were at the Meso‐level, and 15 were at the Macro‐level.Our findings suggest outcomes across all health system levels have the potential for progress when patients are engaged in primary care quality improvement initiatives. Future programs should consider validating and measuring these outcomes as part of their interventions. [ABSTRACT FROM AUTHOR]

Introduction: Although living kidney donation is generally considered a safe procedure, it is ethically critical that prospective donors are fully informed before consent. However, prospective donors lack a deep understanding of the donation experience, making the postdonation aftermath feel unanticipated. We sought to gain in‐depth qualitative descriptions of the short‐ and long‐term risks and benefits associated with kidney donation among an ethnically diverse group of donors to offer a balanced view of the positive and negative experiences that may occur postdonation. Methods: We conducted individual narrative in‐depth interviews (September 2020–March 2021) using the DIPEx (database of individual patient experiences) method with former living kidney donors primarily via Zoom. Results: Fourteen donors (10 women; 8 White, 5 Hispanic, and 1 Native American) completed interviews. Interactions with healthcare providers leading up to donation were largely positive; however, lack of clarity regarding postdonation laboratory values among primary care providers led three participants to be erroneously told they developed kidney disease. Most experienced unanticipated outcomes, including postsurgical complications (e.g., hernia), long‐term fatigue (i.e., ≥12 weeks), emotional distress (e.g., depression), hypertension, and gout. Difficulty obtaining life insurance following donation was an unexpected challenge. Despite these issues, participants were unanimously enthusiastic about living kidney donation and reported no regrets. Conclusions: Enthusiasm for living kidney donation remained high among all participants despite most experiencing negative outcomes. These findings suggest that greater transparency regarding postdonation experiences may not preclude the decision to move forward with living kidney donation. These narratives will be utilized for an online module of lived experiences of donation. [ABSTRACT FROM AUTHOR]

Background: The etiological pattern of hemoptysis has evolved, with pulmonary tuberculosis (PTB) becoming less prevalent as a cause. There is a paucity of literature regarding the spectrum of diseases that present as hemoptysis and the data related to detailed clinical profile are lacking. Hence, this study is taken up to determine the clinical profile of hemoptysis and its correlation with radiological and microbiological findings. Methods: This was a 3-year observational prospective study of a total of 50 patients who presented with active hemoptysis. Data were recorded from these patients for assessing the clinical characteristics, radiological, and microbiological correlation. Results: The most common etiologies of hemoptysis identified in this study were PTB in 60% of the patients, aspergilloma in 14%, followed by bronchiectasis in 8%, pneumonia in 8%, carcinoma lung in 4%, and lung abscess in 1 (2%). Mild hemoptysis was present in 8% of patients, whereas 42% had moderate hemoptysis, 18% of patients had severe, and 32% had massive hemoptysis. Sixty percent of patients had recurrent hemoptysis, and the majority of the patients, i.e., 68% tested negative on sputum smear examination for acid-fast bacillus. In 60% of patients, no growth was obtained in the sputum cultures. The most common organisms isolated from sputum cultures of the rest of the patients were Pseudomonas in 14%, Klebsiella in 10%, Escherichia coli in 4%, Staphylococci in 4%, and Streptococcus pneumoniae in 4% of the cases. The majority of the patients were having consolidation and cavitary disease. A highly significant correlation was noted between the radiological findings of consolidation, mycetoma, cystic shadows, lung mass, and lung abscess and the etiology of hemoptysis (P = 0.000). Conclusion: Hemoptysis of any volume implies a life-threatening process, which mandates immediate evaluation and treatment. It is evident that the etiological spectrum of hemoptysis is continuously changing, and more sophisticated investigations, better imaging techniques, bronchoscopic tools, availability of newer techniques in the developing world, and changing patterns of diseases, all contribute to these changes. Identification of the etiology, and localization of the bleeding site, is essential for the efficient management of hemoptysis.

This article aims to present the spectrum of pulmonary fungal infections observed in postcoronavirus disease 2019 (COVID-19) diabetic patients. In this case series, three post-COVID-19 diabetic patients with poor glycemic control were diagnosed with pulmonary mucormycosis, invasive candidiasis, and pulmonary aspergillosis, respectively. The patients were subjected to clinical, radiological evaluation, including bronchoscopy. The etiologic agents were isolated in these cases and identified by biopsy and subsequent histopathological confirmation. A high index of suspicion, early use of appropriate diagnostic methods aided with suitable antifungal agents, and control of risk factors such as diabetes mellitus are the main factors governing the successful management of fungal infections in post-COVID-19 immune-suppressed patients, presenting with worsening respiratory symptoms.

Background: Akin to cervical squamous intra-epithelial neoplasia (CIN), anal squamous intra-epithelial lesion (a-SIL) is attributed to persistent infection with high-risk human papilloma virus infection. Amplification of human telomerase reverse transcriptase (hTERT) gene and aneuploidy are known to correlate with CIN evolution. It is plausible that the underlying genetic events in a-SIL are similar. We conducted this cross-sectional analytical study with the objective of determining expression of hTERT gene expression and chromosome 7, as marker of cell ploidy in a-SIL. Methods: Conventional anal cytology was performed in 86 adult consenting subjects with history of receptive anal intercourse (RAI) and 4 controls without history of RAI. Cases with a-SIL and controls were subjected to fluorescent in-situ hybridization (FISH) to evaluate hTERT gene and chromosome 7 expression, as marker of cell ploidy. Results were expressed as number of abnormal nuclei (≥3 respective signals), maximum degree of amplification, mean signals/nucleus and proportion of cases showing abnormal nuclei. Results: Twenty cases showed a-SIL; with 15 atypical squamous cells of undetermined significance (ASCUS), 3 low grade squamous intra-epithelial lesion (LSIL) and 2 cases of high-risk cytology. Expression of both hTERT gene and chromosome 7 increased from controls to ASCUS to LSIL with concomitant increase in proportion of cases having abnormal hTERT gene and chromosome 7 expression. Conclusions: Positive association of hTERT gene with a-SIL suggests its possible role in evolution of anal squamous abnormalities. Increase in chromosome 7 also correlated positively with a-SIL. These findings corroborate the similarities between squamous carcinogenesis in CIN and a-SIL.

Abstract Background Recent concerns linked with the application of chemical pesticides and the increasing necessity of low inputs sustainable agriculture have put the use of microbial biocontrol agents and bio-pesticides to the forefront for their application against plant pathogens and insect–pest management. Results This review tended to scrutinize the prospects of microbial biocontrol agents and microbes-based nano-formulations against plant diseases and for pest management with emphasis on bacteria-based nanoparticles, especially derived from Bacillus species. It also tended to discuss the probable mechanism of action and effect on plant growth along with its prospects in a brief manner. Conclusion The use of microbial biocontrol agents offers effective, eco-friendly, and long-lasting management of plant diseases. The employment of nanotechnology in the field of biopesticides has emerged as a promising solution. Nano-biopesticides in the form of biologically derived active pesticides or compounds integrated as nanoparticles and integrated into a suitable polymer have application in insect–pest management.

Abstract Background Muscle wasting and unintentional weight loss (cachexia) have been associated with worse outcomes in heart failure (HF), but timely identification of these adverse phenomena is difficult. Spot urinary creatinine may be an easily accessible marker to assess muscle loss and cachexia. This study investigated the association of urinary creatinine with body composition changes and outcomes in patients with new‐onset or worsening HF (WHF). Methods In BIOSTAT‐CHF, baseline spot urinary creatinine measurements were available in 2315 patients with new‐onset or WHF in an international cohort (index cohort) and a validation cohort of 1431 similar patients from Scotland. Results Median spot urinary creatinine concentrations were 5.2 [2.7–9.6] mmol/L in the index cohort. Median age was 69 ± 12 years and 73% were men. Lower spot urinary creatinine was associated with older age, lower height and weight, worse renal function, more severe HF, and a higher risk of >5% weight loss from baseline to 9 months (odds ratio = 1.23, 95% CI = 1.09–1.39 per log decrease; P = 0.001). Spot urinary creatinine was associated with Evans criteria of cachexia (OR = 1.26 per log decrease, 95% CI = 1.04–1.49; P = 0.016) and clustered with markers of heart failure severity in hierarchical cluster analyses. Lower urinary creatinine was associated with poorer exercise capacity and quality of life (both P

Urinothorax is a rare condition which is defined as collection of urine in the pleural space due to retroperitoneal leakage of urine into the pleural space. It is a rare cause of transudative pleural effusion. It is usually obstructive or traumatic in etiology. It is a rare complication associated with percutaneous nephrolithotomy (PCNL). We report the case of a 29-year-old female who presented with massive pleural effusion that developed in the patient who had undergone PCNL for renal stones. Thoracocentesis was done, and creatinine levels in pleural fluids were measured for diagnosis of urinothorax. For diagnosis, awareness of condition and high degree of clinical suspicion is required. Imaging modality such as computed tomography of the abdomen is useful for allocation of anatomical defect causing retroperitoneal leakage of urine or urinoma. We highlight the importance of early diagnosis of urinothorax for prompt treatment of the underlying condition.