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Introduction One of the most significant changes to society came with the advent of social media, and with it a cultural shift in whom people consider their actual friends. The cultural influence of entertainment figures is not a new phenomenon; however, there has a revolution in the way celebrities interact with their fans, specifically in the Korean Pop (Kpop) industry. In contrast with musicians who release an album and then disappear into mysterious obscurity, Kpop stars constantly interact with fans through meet and greets, live streams, variety tv shows, and most importantly, through social media. With a concomitant rise in parasocial interactions and relationships, Kpop blurs the line between what constitutes pathological delusions and healthy fan activity. Objectives • To learn the assessment and management of patients with anorexia nervosa • To understand changes in management to address suicidality in patients with anorexia nervosa • To understand influences by media in perpetrating certain body types in impressionable adolescents Methods Patient is a 19 year-old Hispanic female with a Past Psychiatric History of Bipolar Disorder, who was brought in by EMS due for agitation and disorganized behavior. Patient presented manic, labile, and her delusions extended to beliefs that the Kpop group EXO has been communicating with her through morse code in their videos, and that certain members would wink at her through the computer screen in real time. The patient’s BMI at the time of admission was 15.4, and she continued to compare her own body to Kpop idols. Results Patient shared a lifetime mix of both shame and trauma concerning her eating habits, with multiple incidents that may have contributed to her fear of eating, and simultaneously into her becoming obsessed with the Kpop group (“2018 and COVID were a miracle for me. I got closer to EXO”). Patient denies looking ugly or fat and seems mostly satisfied with her current appearance. Conclusions With social isolation growing due to the pandemic, online parasocial relationships are becoming an increasingly normal part of people’s lives. We discuss a case where an unhealthy obsession with Kpop contributed to body dissatisfaction, and the precipitating factors that lead to these circumstances, as well as the challenges that are present in helping these adolescents and young adults in coping with social media use. As such, it is important to discuss the challenges faced by psychiatrists who must be sufficiently aware of the ever-changing face of contemporary cultural landscape when forming an accurate diagnosis. Disclosure of Interest None Declared

Introduction Trans-cranial magnetic stimulation (TMS) as a non-invasive method of altering brain activity (1) has widened the array of therapeutic options available for various psychiatric disorders. Objectives Trans-cranial Magnetic stimulation (TMS) as a non-invasive method of altering brain activity has widened the array of therapeutic options available for various psychiatric disorders. •A large number of studies have shown therapeutic benefits in a wide range of patient population with majority of studies in adults. •TMS is used increasingly for the treatment of child and adolescent depression. •Yet, the scarcity of studies and lack of published guidelines for this population is notable. •As TMS use is expanding in this population, an overview of the use of TMS in children and adolescents with depression may provide much needed and timely perspective on this neuropsychiatric intervention. Methods We searched all published studies using PubMed database, on TMS use in depressive disorders in children and adolescents. A total of 13 studies were found to have reported use of TMS in depression in children and adolescents. Results We found various case series, open label studies as well as sham controlled blind studies indicating that TMS has been effective in treating depression in children and adolescents. No significant side effects were found in our review. Conclusions Studies have shown that TMS is an effective treatment option for depressive disorders in children and adolescents. Initial studies look promising but implications in large pediatric population may be different and there is a need for more double blind, controlled trials with larger sample size. Disclosure No significant relationships.

Introduction Ziprasidone is an atypical antipsychotic that has demonstrated efficacy for the treatment of bipolar disorder and schizophrenia. There is some preliminary evidence for Ziprasidone use in children and adolescents with several open label studies and some randomized control trials, therefore it is advantageous to understand where Ziprasidone lies in the treatment algorithm of children and adolescents. Objectives The aim of our study is to examine the efficacy and tolerability of Ziprasidone in children and adolescents. Methods We conducted a literature search consisting of open label or randomized control trials (RCT) that report on Ziprasidone use in children on the PubMed database. We found 13 studies (11 open label and 2 RCT) that met our inclusion criteria. Our outcome measures included efficacy measures such as BPRS, YMRS, CGI-S and adverse effects such as weight gain, increase in BMI, QTc prolongation, sedation, dizziness and EPS. Results Data from thirteen studies was meta-analyzed (Total n= 560, mean age=13.16 years, male= 70.35% that reported the use of Ziprasidone in children and adolescents. We found that Ziprasidone was efficacious in children and adolescents in measures of BPRS (-13.493, p0.05) or change in BMI (-0.159, p>0.05). QTc prolongation was found to be significant (13.122, p

Introduction Studies have demonstrated that Ziprasidone use may be beneficial in children. Determining its potential risks and benefits when used in children is therefore important. Objectives To examine the tolerability of Ziprasidone, an atypical antipsychotic, in children and adolescents. Methods We conducted a literature search of open label or randomized control trials that report on Ziprasidone use in children on three databases: Embase, PsychInfo and PubMed using the PRISMA guidelines of Systematic review and Meta-analysis. Out of 1690 articles, 11 studies met inclusion criteria. Outcome measures included adverse effects such as weight gain, increase in BMI, QTc prolongation, changes in metabolic parameters, sedation, and dizziness. We conducted a random effects meta-analysis and meta-regression of potential moderators. Publication bias was assessed with funnel plots. Results Data from Eleven studies was meta-analyzed (Total n= 474, mean age=12.87 years, male= 68..37%) that reported the use of Ziprasidone in children and adolescents with Psychosis, Bipolar, Autism spectrum disorders and Tourettes syndrome. Mean Ziprasidone dose = 84.40 mg and mean study duration = 2.85 months). We found that Ziprasidone was not found to cause any significant weight gain (1.72, p>0.05) or change in BMI (0.58 , p>0.05). QTc prolongation was found to be significant (11.9 , p

A 48-year-old woman without obvious environmental risk factors was diagnosed with metastatic urothelial carcinoma harboring a mutation in EGFR typical of driver mutations for non-small cell lung cancer. Within a year, her cancer progressed on four standard therapies for urothelial cancer, including cancer in lungs, liver, bone, and brain. As fifth-line therapy, she received osimertinib, leading to a complete response in the brain and improvement elsewhere, and the cancer remained controlled for six months. Targeted therapy for rare driver mutations can be effective in urothelial cancer and should be considered prior to exhausting standard therapies.

BACKGROUND AND OBJECTIVES: Peri-urban land development is crucial to achieving the UN Sustainable Development Goal of equitable and sustainable urban areas. Fair land, infrastructure, and resource management improves land management services and reduces social and economic inequities. However, the peri-urban land management system has contributed to unequal rapid urbanisation in neighbouring regions. This study examines the complex relationships between peri-urban land development barriers in India. The goal is to understand how these barriers induce unequal urbanization transcending the city, resulting in uncontrolled growth, urban sprawl, and inadequate services in peri-urban areas. The main goal is to improve decision-making and promote fair peri-urban growth in Indian cities using a multi-criteria decision-making tool. This application gives experts a new perspective on peri-urban issues.METHODOLOGY: A questionnaire-based survey was conducted from 122 planners and academicians from north Indian cities using snowball sampling techniques. The study collects expert perspectives to create a causal map, using DEMATEL ISM method, classifying these barriers as "determinants or causes," "dependent barriers," "independent barriers," and "effects," presenting a new perspective on peri-urban development complexity. that depicts these roadblocks and highlights the most significant drivers impeding peri-urban land development.FINDINGS: Findings revealed four interdependent challenges as the leading ‘causes’ on the basis of DEMATEL Weight; Imprecise spatial policies with 0.10119, undemarcated land boundaries with 0.10082, weak institutions with 0.10003, and absence of planning regulations with 0.09945 weight. Within these barriers, addressing the governance capability and spatial policies would have a beneficial cascading effect on catering to other challenges. Findings have valuable insights for policymakers, aiding in the formulation and prioritization of effective policies and resource allocation.CONCLUSION: This study extensive analysis of causal linkages among Indian city peri-urban land development challenges. Beyond identifying barriers, it explains their causes, interdependencies, and hierarchical links. This study's holistic approach to peri-urban development issues and inventive barrier categorization and prioritisation make it distinctive.

Abstract Background Vitamin A deficiency (VAD) is a major public health problem in India, where approximately 62% of children under five have low retinol levels (

Abstract Amyotrophic Lateral Sclerosis (ALS), like many other neurodegenerative diseases, is highly heritable, but with only a small fraction of cases explained by monogenic disease alleles. To better understand sporadic ALS, we report epigenomic profiles, as measured by ATAC-seq, of motor neuron cultures derived from a diverse group of 380 ALS patients and 80 healthy controls. We find that chromatin accessibility is heavily influenced by sex, the iPSC cell type of origin, ancestry, and the inherent variance arising from sequencing. Once these covariates are corrected for, we are able to identify ALS-specific signals in the data. Additionally, we find that the ATAC-seq data is able to predict ALS disease progression rates with similar accuracy to methods based on biomarkers and clinical status. These results suggest that iPSC-derived motor neurons recapitulate important disease-relevant epigenomic changes.

Patients born with complex congenital heart defects, not amenable for surgical repair establishing normal bi-ventricular circulation are palliated with the Fontan Circulation (FC). Here, we report new iPSC line from a patient with tricuspid and pulmonary atresia. The patient underwent series of surgeries leading to completion of Fontan circulation at the age of 13yr., and this line was generated when she was 38yr. old. The exact genetic cause of this patient’s congenital heart defect is unknown, and this line will be used for studying molecular and cellular mechanisms responsible for cardiac dysfunction, along with screening for future potential therapeutic avenues.

Objective Little is known about the children of parents who experience homelessness. The At Home/Chez Soi (AHCS) Research Demonstration Project, launched in 2009, was a Canadian multi-site, multi-year study that tested the effectiveness of Housing First. In Winnipeg, 513 people were enrolled, of whom 47% were parents. Our objective was to determine how the children were faring with respect to their health and social situations at a time their parent was experiencing homelessness. Approach The cohort, created using the Manitoba Centre for Health Policy’s familial linkage methodology, consisted of 405 individuals (< 30 years old) who were the offspring of the Winnipeg AHCS cohort. We descriptively summarized the socioeconomic characteristics and indicators of their involvement (or lack thereof) in various government systems at or in a period up to their parent’s study enrolment date. Results Approximately half of the cohort were female (51%) and under 13 years (52%). Most (76%) resided in a household that had received income assistance. At least 50% had been placed into care at or near birth and only 17% had not been involved with the child welfare system. Of those school aged, 81% were enrolled in school and of those older than school aged, 53% had graduated. Nearly half (49%) had been diagnosed with a mental health disorder and/or with asthma (47%). Conclusions and Implications This study is the first in a series seeking to identify ways to prevent multigenerational experiences of homelessness. Findings will generate valuable insights for upstream intervention across various systems.

Summary: Early childhood caries (ECC) is influenced by microbial and host factors, including social, behavioral, and oral health. In this cross-sectional study, we analyze interkingdom dynamics in the dental plaque microbiome and its association with host variables. We use 16S rRNA and ITS1 amplicon sequencing on samples collected from preschool children and analyze questionnaire data to examine the social determinants of oral health. The results indicate a significant enrichment of Streptococcus mutans and Candida dubliniensis in ECC samples, in contrast to Neisseria oralis in caries-free children. Our interkingdom correlation analysis reveals that Candida dubliniensis is strongly correlated with both Neisseria bacilliformis and Prevotella veroralis in ECC. Additionally, ECC shows significant associations with host variables, including oral health status, age, place of residence, and mode of childbirth. This study provides empirical evidence associating the oral microbiome with socioeconomic and behavioral factors in relation to ECC, offering insights for developing targeted prevention strategies.

Recently, it has been discovered that one of the primary causes of a variety of inflammatory illnesses, including periodontitis, is an excess of Reactive Oxygen Species (ROS). It is recognised that the host’s response to pathogens plays an equal or even bigger part in determining how connective tissue breaks down. The process of Polymorphonuclear (PMN) phagocytosis greatly increases ROS formation through the metabolic pathway known as the “respiratory burst.” Because the antioxidant defense system is unable to neutralise these high levels or activities of ROS, Oxidative Stress (OS) and tissue damage ensue. ROS can directly affect tissue through Lipid Peroxidation (LPO), Deoxyribonucleic Acid (DNA) damage, protein breakdown, and the oxidation of essential enzymes. Numerous aldehydes can be produced as byproducts of LPO, including Malondialdehyde (MDA), propanal, hexanal, and 4-Hydroxynonenal (4-HNE). They can be detected in bodily fluids and suggest a pro-oxidant state. MDA is a by-product created by the enzymatic or non enzymatic breakdown of Arachidonic Acid (AA) and larger Polyunsaturated Fatty Acids (PUFAs). MDA is the most studied OS tissue damage indicator. After it is formed, MDA can either be broken down by enzymes or combine with DNA or proteins in cells and tissues to form adducts that can cause harm to biological molecules.

Self-Talk: Musings on Distance Education is a compilation of blogs and a series of reflective writings written by the author on open and distance learning (ODL) and online learning, accounting for over three decades of his experience. The cornucopia of his ideas and anecdotes pertains to the key innovations that hallmarked developments in ODL and online learning. The book shares much-needed pathways to re-imagine compromised education in the post-pandemic world. At the time of writing this book, Dr. Sanjaya Mishra worked as the director of education at the Commonwealth of Learning (CoL) in British Columbia, Canada. The book is primarily based on his prior trove of experiences as a distance educator at the sole centrally-funded open university in India, the Indira Gandhi National Open University (IGNOU). The goal of this book is to understand the developments in distance education, including the changing roles of teachers and students, with critical discourse centred around IGNOU, based on lessons learned globally and specifically from engagements at the CoL. The book comprises six sections, encompassing 45 chapters.

Objective To assess the experience of virtual care among both patients and physicians across a range of clinical scenarios during the COVID-19 pandemic. Methods A web-based survey was disseminated to patients and physicians through a variety of media and healthcare communications from May 2020 to July 2021. Demographic details and attitudes across a range of virtual care domains were collected. Quantitative responses were analyzed descriptively. Open-text responses were gathered to contrast when a virtual visit was superior or inferior to an in-person one, and a thematic content analysis was used. Results There were 197 patients and 93 physician respondents, representing a range of demographic and practice characteristics. Patients noted several benefits of virtual care and felt it should continue to be available. Physicians felt they could do a lot of their care virtually. Common themes related to the superiority of virtual care were for “quick” visits, reviewing test results, chronic disease monitoring, and medication needs. Virtual care was less ideal when a physical exam was needed, and was not perceived as a good fit for an individual's cultural, language, or emotional needs. Certain conditions were identified as both ideal and non-ideal for the virtual format (e.g. mental healthcare). Discussion Certain situations are more amenable to virtual care with personal preferences among both patients and physicians. Future priorities should ensure that virtual care is effective across the range of clinical situations in which it may be used and that both virtual and in-person options are equally available to those who want them.

Objective(s): Despite significant progress in the field of nuclear medicine, basic nuclear medicine awareness and understanding among clinicians remains unsatisfactory, leading to under utilization of nuclear medicine modalities. To evaluate the awareness and knowledge regarding nuclear medicine and appropriate use of Nuclear medicine modalities, among medical students and faculty members.Method: In this descriptive cross sectional study, a self timer limited objective questionnaire based on Google forms was distributed to the study population and scores obtained by the participants were analyzed.Results: Percent scores range for intern, residency trainees, and senior resident/faculty groups for general awareness were 16-46%, 37-58% and 62-91% and for knowledge and appropriate use were 7-21%, 28-43%, and 35-85% respectively. Overall, 61% of the participants had poor awareness and knowledge regarding nuclear medicine modalities. None of the participants had received nuclear medicine exposure or education during their academics or training. Only 49% of the participants considered utilizing nuclear medicine modalities for their patient management.Conclusion: Undergraduate interns and residency trainees had a poor to fair level of awareness and knowledge regarding nuclear medicine. Hence creating more awareness in early stages of their career by incorporating Nuclear medicine basic education in medical undergraduate curriculum is required. The senior residents/faculty members had a moderate to good level of awareness and knowledge but still improvement in their knowledge would lead to a more appropriate and better utilization of nuclear medicine modalities for optimum patient management in a variety of clinical settings.

Aim: This study aimed to evaluate the clinical efficacy of posterior resin implant-supported fixed partial dentures (FPDs) made from two different computer-aided design and computer-aided manufacturing (CAD–CAM) materials: polymethylmethacrylate (PMMA) and polyoxymethylene (POM). Materials and Methods: Twenty-one patients received a total of 49 interim implant-supported FPDs. The same participant received PMMA and POM as part of the control and experimental groups, respectively. The restorations were evaluated 1 week, 3 months, and 6 months after placement. In addition, their functional wear and color stability were assessed. Nonparametric statistics (α = 0.05) were used to analyze the data. Results: The study found that PMMA outperformed POM in surface and color parameters, with more fractures occurring with internal conical connection implants. The color stability analysis showed ΔE*ab values of 7.18 for PMMA and 8.8 for POM, with no significant differences. After 6 months of operation, both materials showed a significant increase in wear, but no significant differences were found within the materials. Conclusion: The study found that PMMA interim implant-supported FPDs outperformed POM in surface and color parameters, while polymer posterior implant-supported FPDs with internal conical connection implants were more fracture-prone.

Introduction: Low Back Pain (LBP) caused by Lumbar Disc Herniation (LDH) is a major cause of chronic disability worldwide. The management of LDH depends on clinical assessment and Magnetic Resonance Imaging (MRI) findings. Atrophy or fatty replacement of paraspinous muscles has a negative impact on the outcomes of both conservative and surgical treatment for LBP due to LDH. Aim: To analyse the morphological changes in paraspinous muscles using MRI in patients with chronic LBP and unilateral LDH. Materials and Methods: A cross-sectional study was conducted at Vardhman Mahavir Medical College and Safdarjung Hospital in New Delhi, India, from December 2020 to May 2022. A total of 59 patients, aged 21-65 years, with chronic LBP and unilateral LDH on MRI, were included in the study. The morphological changes in the Multifidus Muscle (MM) and Erector Spinae Muscle (EM) were analysed. The Cross-Sectional Area (CSA) of MM and EM, as well as the Signal Intensity (SI) of MM on the herniated side of the lumbar disc, were recorded and compared to the contralateral side at the same level. Continuous variables were expressed as mean±SD, median, and interquartile range, while categorical variables were presented as numbers and percentages. The Mann-Whitney test was used to compare continuous variables, and a p-value of