Search

Background Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS. Methods A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus. Results The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient's situation and surgeon's experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively. Conclusion Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.

OBJECTIVE The objective of this study was to determine whether abrupt discontinuation vs gradual wean of nasal CPAP (NCPAP) in infants

Objectives: High rate of post-surgical infections are reported with scanty effort for controlling them. The objectives were to evaluate frequency of surgical site infections in patients undergoing general surgery. Study Design: Cross Sectional Observational Study. Setting: Naz Memorial Hospital. Period: March 2019 to March 2020. Material & Methods: This study was conducted in general surgery ward for 1 year. All patients over 18 years admitted in surgery ward either as elective or emergency case were included while patients having any wound infection, operated in other hospital or diabetic foot and all those operated for incision and drainage of abscess were excluded. All patients that were operated during the study period were followed for any wound infection development till one qAqmonth. SPSS was used for data entry and analysis keeping p-value of

Objective Test web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout. Design RCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (primary outcome: burnout). Cohort 1 received WISER while Cohort 2 acted as a waitlist control. Results Cohorts were similar, mostly female (83%) and nurses (62%). In Cohorts 1 and 2 respectively, 182 and 299 initiated WISER, 100 and 176 completed 1-month follow-up, and 78 and 146 completed 6-month follow-up. Relative to control, WISER decreased burnout (−5.27 (95% CI: −10.44, −0.10), p = 0.046). Combined adjusted cohort results at 1-month showed that the percentage of HCWs reporting concerning outcomes was significantly decreased for burnout (−6.3% (95%CI: −11.6%, −1.0%); p = 0.008), and secondary outcomes depression (−5.2% (95%CI: −10.8, −0.4); p = 0.022) and work-life integration (−11.8% (95%CI: −17.9, −6.1); p Conclusion WISER appears to durably improve HCW well-being. Clinical Trials Number NCT02603133; https://clinicaltrials.gov/ct2/show/NCT02603133

In this population-based study, the authors constructed age-specific and sex-specific hemoglobin percentiles from values reported for a defined healthy population in the Comprehensive National Nutrition Survey (CNNS). Age-specific and sex-specific 5th percentiles of hemoglobin derived for this healthy population was used as the study cut-off to define anemia. These were compared with the existing WHO cut-offs to assess significant differences between them at each year of age and sex for quantifying the prevalence of anemia in the entire CNNS sample. From the CNNS survey 41210 participants had a hemoglobin value, 8087 of whom were included in this study and comprised the primary analytical sample. Compared with existing WHO cut-offs, the study cut-offs for hemoglobin were lower at all ages, usually by 1–2 g/dL, but more so in children of both sexes aged 1–2 years and in girls aged 10 years or older. Anemia prevalence with the study cut-offs was 19·2 percentage points lower than with WHO cut-offs in the entire CNNS sample with valid hemoglobin values across all ages and sexes (10·8% with study cut-offs vs 30·0% with WHO cut-offs). The authors concluded that these findings support the re-examination of WHO hemoglobin cut-offs to define anemia.

Cryptosporidium is a water-borne zoonotic parasite worldwide, usually found in lakes and rivers contaminated with sewage and animal wastes, causing outbreaks of cryptosporidiosis. In this study, 300 water samples were collected from four designated places of flood-affected district Nowshera consist of different water sources to find out the prevalence of Cryptosporidium via polymerase chain reaction (PCR). The overall prevalence of Cryptosporidium was 30.33% (91/300) with more prevalent 44% in drain water and low 5% in bore/tube well water. The prevalence in open well and tap water was recorded 33% and 20%, respectively. The highest prevalence was recorded in summer (June–September). The result of this study ensures enormous contamination of drinking water that requires appropriate treatment, cleaning and filtration to provide safe drinking water. Preventing water-borne disease and proper treatment of water supplies is essential to public health.

Objective: To compare the effects of Intranasal Betamethasone and Beclomethasone in patients with Allergic Rhinitis. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Bahawalpur and Shahida Islam Medical and Dental College Lodhran, from Mar 2018 to Feb 2019. Methodology: A total of 200 patients who were between 22-55 years of age were included in this study. Half of them received Intranasal Betamethasone were compared with the other half who received Intranasal Beclomethasone. Clinical success was compared in both groups in terms of patients becoming a symptomatic. Results: Clinical symptoms were markedly reduced in both groups at the end of the study as 94 (94%) and 78 (78%) of patients who were on Intranasal Betamethasone and Intranasal Beclomethasone respectively showing that Intranasal Betamethasone is superior to Intranasal Beclomethasone in controlling Allergic Rhinitis symptoms. Chi square test is applied and p-value calculated (p=0.045) significant. Conclusion: Intranasal Betamethasone is far more effective drug as compare to Intranasal Beclomethasone in controlling allergic symptoms.

Introduction: Preventable harm continues to occur with critically ill neonates despite efforts by hospital neonatal intensive care units (NICUs) to improve processes and reduce harm. Attaining significant and sustainable improvements will require training including leadership support, mentoring, and patient family engagement to improve care processes. This paper describes the implementation of a robust process improvement (RPI) program in the NICU to reduce harm. Methods: Leaders, staff, and parents were trained in RPI concepts and tools. Multidisciplinary teams including parent members applied the training and received regular mentorship for their improvement initiatives. Results: Participants (N = 67) completed pretraining and post-training surveys. Training scores (0–10 scale) improved from an average of 4.45–7.60 (p < .001) for confidence in leading process improvement work, 2.36 to 7.49 (p < .001) for RPI knowledge, and 2.19 to 7.30 (p < .001) for confidence in using RPI tools; relative improvement of 71%, 217%, and 233% respectively. Participants applied their RPI training on improvement initiatives that resulted in improvements of central line blood stream infections, very low birth weight infant nutrition, and unplanned extubations. Conclusions: Implementing an RPI program in the NICU to reduce harm resulted in significant and sustainable improvements on their improvement initiatives.

All study designs in medical research, barring descriptive studies, involve comparative analysis to achieve its objective/s. Comparisons between groups based on outcomes, or risk factors, or interventions, are the basis of hypotheses in evidence-based medicine. Statistical tests support in making criterion-based decisions about the validity of the hypothesis. A basic knowledge of statistical comparisons helps medical researchers to apply valid statistical tests. Novice medical researchers struggle to decide when, and which statistical test must be applied. There is a need to further reduce the mathematical jargon in statistics related publications for medical researchers. In this article, we aim to provide the readers with practical pointers about the applied aspects of basic statistical comparisons in medical research.

Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China (December 2019). The disease rapidly crossed the barrier of countries, continents and spread globally. Non-pharmaceutical measures such as social distancing, face mask, frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease. OPD, IPD admissions, elective O. Ts were curtailed. Orthopedic care was only limited to emergency and semi-urgent procedures like necrotizing fasciitis, open fracture, and compartment syndrome. These measures were taken to preserve infrastructure and manpower to manage covid-19 pandemic. The children were thought to have a low susceptibility to covid-19 as compared to an adult. Deferring the patient during pandemic has led to high orthopedic disease burden, morbidity and disease-related sequelae, hence elective care must be resumed with modified hospital infrastructure. Resumption of elective/emergent orthopedic care should be slow, phasic and strategic, much similar to unlocking. Cases must be stratified depending on covid status and severity. Dedicated O.Ts with neutral/negative pressure and HEPA filter for covid positive and suspected patients are to be used. All symptomatic and suspected patients should be investigated for covid-19 by RT-PCR, blood counts and CT scan. Regional anaesthesia should be preferred to General anaesthesia. Power drill/saw/burr/pulse lavage should be minimized to avoid aerosol generation. Postoperatively continuous surveillance and monitoring to be done for covid related symptoms. Medical institutes rapidly shifted to the online mode of education. Blended learning (virtual & physical) and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years.

Introduction: Demography is the statistical and mathematical study of the size composition and spatial distribution of human populations. In this article we focused on some demographic data such as age, gender, education, caste, religion, marital status, occupation, addiction and dietary habits which may help to assess the socio economic and health status of the population. Methods: This is an observational and descriptive study, where data collected using a pretested, predesigned questionnaire/screening form to assess the demographic information i.e. age, gender, education, caste, religion, marital status, occupation, addiction and dietary habits, provided by Central Council for Research in Unani Medicine(CCRUM), Ministry of AYUSH, Govt. of India, Delhi. Sample size was not calculated as all the patients who were coming to OPD were included in the study and all patients were assured of confidentiality of the details collected and patients provided data willingly. Inclusion criteria for the study included all the patients of either sex of any age group attending OPDs in five adopted villages, i.e. Kurana, Kalkheda, Bagoniya, Toomda and Dhammarra during July 2019 to March 2020 at SCSP Mobile Healthcare Programme, Clinical Research Unit, Bhopal. Results and Conclusion: Collected and compiled data exhibits that the Scheduled Castes population visited the OPDs belongs to a low socio-economic group and are mainly small farmers and landless labourers. The percentage of the female population who visited the OPDs was more which reveals that due to the excessive burden of work and poor nutritional diet they are more susceptible to have an illness. Literacy level was fair among population with 19.16 % illiterate. Tobacco chewing is seen more prevalent among the participants. Poverty and less availability of food have led to unsatisfactory dietary habit, though literacy is considerable in these villages. How to cite this article:Khan AF, Qaiser A, Fatima Y, Khan AM, Raheem A, Nazli T, Parveen S. Demographic Data for SCSP Mobile Health Care Programme Conducted in the Rural Area of Bhopal District, Madhya Pradesh. Int J Preven Curat Comm Med. 2021;7(1):4-10. DOI: https://doi.org/10.24321/2454.325X.202101

Objective: To find out the pattern of CHD and associated risk factors among children presenting at a tertiary care hospital. Study Design: A case-control study. Place and Duration of the Study: The Department of Pediatrics and Department of Cardiology, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to June 2021. Material and Methods: A total of 207 children of both genders, screened by ECG along with chest x-ray and further confirmed with the diagnosis of CHD through echocardiography were enrolled as cases. Same number of healthy controls (n=207) were recruited from immunization center of the study institution. Among cases, types of CHD were noted. For cases and controls, demographic, antenatal and maternal risk factors including maternal age, gender of the child, history of consanguinity, history of febrile illness in pregnancy, use or multi-vitamin or folic acid in pregnancy, bad obstetrical history and maternal diabetes mellitus were noted. Results: In a total of 414 children (207 cases and 207 controls), there were 219 (53.8%) male. In terms of CHD types among cases, VSD was the most noted in 62 (30.0%), ASD 35 (16.9%), TOF 33 (15.9%) and PDA in 30 (14.5%). Cases were found to have significant association with younger age (78.3% cases below 1 year of age vs. 64.7% in controls, p=0.0085), bad obstetrical history (p=0.0002), history of febrile illness in 1st trimester of pregnancy (p=0.0229) and lack of multivitamins and folic acid in the 1st trimester of pregnancy (p=0.0147). Conclusion: Majority of the children with CHDs were male and aged below 1 year. VSD, ASD, TOF and PDA were the most frequent types of CHD. Younger age, bad obstetrical history, history of febrile illness in 1st trimester of pregnancy and lack of multivitamins and folic acid in the 1st trimester of pregnancy were found to have significant association with CHDs among children. Keywords: Congenital heart disease, echocardiography, ventricular septal defect.

Background: Acute subdural hematoma can occurs in different age group of patients in both male and female. Objective: The purpose of the present study was to observe the age and gender distribution among acute subdural hematoma patients. Methodology: This cross-sectional study was carried out in the Neurosurgery Department of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2011 to August 2012 for a period of one year and eight months. Patients with acute subdural hematoma who fulfil the inclusion criteria for surgery and got admitted were selected as study population. Acute Subdural hematoma patient of any age, both sex with GCS 5 to 13, thickness of hematoma more than l0 mm, midline shift more than 5 mm, pupil reacting to light and patient presented within 72 hours of injury were included for this study. At admission, a detailed history of the illness was taken from the patient or attendant, thorough general and neurological examinations were carried out and were recorded. Result: A total number of 48 patients were recruited for this current study. The mean age of the patients was 32.39±11.63 years and their age ranged from 10 to 56 years. The male and female ratio was 5:1. Out of 48 patients 17(31.25%) cases were fronto-temporal. Temporo-parietal were 16(33.3%) patients. Fronto-temporo-parietal were 7(14.5%) cases. Parietal were 5(10.41%) cases. Frontal were 3 (6.25%) case. Conclusion: In conclusion majority of the patients are male young adults presented with fronto-temporal and temporo-parietal region of shull. Journal of Science Foundation 2019;17(2):54-57

Purpose: The primary objective of this article is to conduct an in-depth analysis of the informal economy in Pakistan enabling money laundering and tax evasion in Pakistan. Furthermore, it also looks into the informal economy’s implications for the economic growth of Pakistan. Finally, this article recommends potential reforms for formalization of economy of Pakistan for prevention of such crimes. Methodology: A review regarding informal economy in Pakistan enabling money laundering and tax evasion with the help of prior studies has been conducted. Findings: The formalization of the informal sector, according to this article, is important not only for raising tax revenues, but also for digital, skilled-based improvement of business activities, ramping up the operations and maintenance size of small businesses, increasing and diversifying production, and enhancing the lot of low-wage earners. Implications: Lawmakers should focus on the implications of informal financial channels like hawala and hundi, which continue to operate beneath the radar of the informal sector. In order to identify money laundering, the Pakistani government must focus on strengthening and encouraging the digitization of the economy. The digitization of the economy is critical to the formalization of Pakistan's economy.

International audience

Background Staphylococcus aureus (S. aureus) is one of the leading causes of community and hospital acquired infections globally. The objective of the study was to assess the prevalence, study the carriage of antibiotic resistance genes and evaluate the molecular typing of S. aureus isolates from a tertiary care hospital in Islamabad. Methods A total of 1528 staphylococci isolates were included in this study. Standard microbiological procedures were applied to identify S. aureus. Antimicrobial susceptability was evaluated using the disk diffusion method and Minimum Inhibitory Concentrations (MICs) were determined using microbroth dilution method following Clinical and Laboratory Standards Institute (CLSI) guidelines. Multiplex PCR was used to detect antibiotic resistance genes, and molecular typing was performed using agr, SCCmec, spa, and Multi-Locus Sequence Typing (MLST) and clonal relatedness by Pulse Field Gel Electrophoresis (PFGE) methods. Results Overall 65% were MRSA and 35% were methicillin sensitive Staphylococcus aureus (MSSA). Among MRSA isolates, 83% were multi-drug resistant and mecA was found in 54% isolates, mecC was in 3% while 1 MRSA carried both mecA and mecC genes. agrI (22%) was most prevalent group in MRSA, while agrIII (16%) was observed in MSSA. SCCmec types I, II, III, IV, and VI were detected, with high prevalence of type III while type V was absent. The prevelant spa type in MRSA was t657 with SCCmecIII elelments while in MSSA it was t021. One NEW spa type identified in MSSA isolates. In a subset of isolates, ST772 with SCCmecIV, ST1 carrying PVL marker, and ST1535 was reported first time from Pakistan. Conclusions The study presents a comprehensive analysis of prevalent S. aureus types and their antibiotic resistance profiles. It also reports for the first time SCCmec type VI and clinical MRSA isolates with mecC alone and in combination with mecA from Islamabad, Pakistan. This calls for further detailed investigations in other hospital settings in the region.

BACKGROUND Breast milk has many benefits for infants, but initiating breastfeeding/pumping can be difficult for mothers of preterm infants, especially those who smoke (or live with individuals who smoke). The primary aim of this study was to identify risks for breastfeeding/pumping cessation with neonatal intensive care unit (NICU) infants' mothers who smoke or live with individuals who smoke, using a novel survival-analytic approach. METHODS/DESIGN Mothers (N = 360) were recruited for a secondhand smoke prevention intervention during infants' NICU hospitalizations and followed for ~6 months after infant discharge. Data were obtained from medical records and participant self-report/interviews. RESULTS The sample was predominantly ethnic/racial minorities; mean age was 26.8 (SD = 5.9) years. One-fifth never initiated breastfeeding/pumping (n = 67; 18.9%) and mean time-to-breastfeeding cessation was 48.1 days (SD = 57.2; median = 30.4 [interquartile range: 6.0-60.9]). Education, length of stay, employment, race/ethnicity, number of household members who smoke, and readiness-to-protect infants from tobacco smoke were significantly associated with breastfeeding cessation. Further, infants fed breast milk for ≥4 months had 42.7% more well-child visits (p

Introduction: Faculty development to implement competency-based medical education (CBME) is urgently needed as the Medical Council of India has implemented the competency-based curriculum this year onwards. Objectives: To evaluate a 2-day faculty development workshop in terms of: (a) increase in knowledge about CBME terminology and concepts, (b) self-reported capacity to develop and implement a competency-based module in their respective disciplines, and (c) satisfaction of the participants. Methodology: A single arm interventional study using mixed methods was carried out in which faculty members were purposively identified and requested to volunteer for a two-day faculty development workshop on the development and implementation of CBME. The workshop was evaluated (open-ended and Likert scored items) by the participants for self-reported gain in knowledge, gain in their confidence to develop and implement CBME, and level of satisfaction with respect to the components of the workshop. Quantitative data was analyzed by Wilcoxon signed rank test and Kruskal–Wallis test. Qualitative data was analyzed by doing content analysis and emerging themes have been presented. Results: Eleven faculty members attended a capacity building workshop for developing and implementing a competency-based curriculum for medical undergraduates. There was a significant improvement in their self-reported knowledge and attitude regarding the competency-based curriculum. New concepts learned fell into four domains: modification of the existing curriculum toward competency-based curriculum, knowledge of CBME, teaching-learning and assessment methods, and beneficial to the students. The participants were highly satisfied with the workshop in its current form. Conclusion: A two-day faculty development workshop can increase the knowledge and understanding of competency-based medical education and can be an important first step in the journey to more specialized training.

Coronavirus (COVID-19) pandemic spread in India is steeply rising A 21-day lockdown has been imposed by the Government of India, to curtail its spread This has impacted all walks of life, including availability of food and nutrition related services which would affect nutritional status of children throughout India The two major schemes, i e Integrated Child Development Services Scheme and Mid-day Meal Scheme have been affected leading to risk of worsening of child nutrition Some states have evolved their own strategies to mitigate the effect of lockdown Here we discuss the challenges and way forward for ensuring availability of food for child nutrition during this health crisis No single, optimal response to a public health emergency exists The government and non-government partners must coordinate and scale up child nutrition services in the community through strengthening of public distribution system and home delivery of food parcels wherever feasible for beneficiaries of child nutrition programs © 2020, Indian Association of Preventive and Social Medicine All rights reserved

Routine immunizations (RI) keep the infectious diseases under control in the community However, during the coronavirus pandemic, to prevent the associated exponential rise in the number of cases, it became necessary to stop routine health services across the country Routine Immunization also had to be discontinued It is to be realized however that the risk of vaccine-preventable diseases is gradually increasing in direct proportion to the delay in administering vaccinations to eligible children It’s likely that we will face outbreaks of VPD if we keep RI halted for weeks together Various dimensions of RI need to be examined from the perspective of the COVID-19 pandemic ranging from vaccine hesitancy to operationalization of services In this article, we highlight this hidden problem, which has the potential to further challenge our already challenged health and healthcare-related situation The domains which deserve careful consideration are discussed to supporting policymakers in making informed decisions in this regard © 2020, Indian Association of Preventive and Social Medicine All rights reserved

Coronavirus (COVID-19) pandemic has been declared by the World Health Organization after it has gripped many countries of the world The exponential increase in the number of cases has resulted in panic and confusion among healthcare workers and the vulnerable population Pregnant and lactating mothers are a vulnerable group and need evidence-based advice to protect the health of the mother and the child Healthcare workers can play an important role in dispelling the myths and misconceptions among pregnant and lactating mothers regarding COVID-19, if they are equipped with scientific information on antenatal care, care at birth, and breastfeeding This review attempts to summarize the published evidence related to antenatal care, care at birth and breastfeeding during the COVID-19 pandemic © 2020, Indian Association of Preventive and Social Medicine All rights reserved

Photoacoustic imaging is an emerging imaging modality that is based upon the photoacoustic effect. In photoacoustic tomography (PAT), the induced acoustic pressure waves are measured by an array of detectors and used to reconstruct an image of the initial pressure distribution. A common challenge faced in PAT is that the measured acoustic waves can only be sparsely sampled. Reconstructing sparsely sampled data using standard methods results in severe artifacts that obscure information within the image. We propose a modified convolutional neural network (CNN) architecture termed fully dense UNet (FD-UNet) for removing artifacts from two-dimensional PAT images reconstructed from sparse data and compare the proposed CNN with the standard UNet in terms of reconstructed image quality.

Background: The clinical presentation of head injury may vary. Objective: The purpose of the present study was to see the clinical features of patients presented with extra dural haematoma. Methodology: This cross-sectional study was conducted in the Department of Neurosurgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2010 to June 2011 for a period of one year and six months. All patients who underwent surgery with traumatic head injury having extradural haematoma were included in the study. The clinical features of the patients were recorded. Result: Eighty (80) patients of traumatic head injury within and after 24 hours of head injury were enrolled in this study. In this study unconsciousness was in 32(40.0%) cases. However, convulsion was found in 12 (15.0%). Vomiting was the most common presenting features which was 71(88.7%) cases. Headache was reported in 48(60.0%) cases. The normal pupillary response was found in 42(52.5%) cases. The rest 38(47.5%) cases were dilated pupil. Conclusion: In conclusion vomiting is the most common clinical features of patients presented with extra dura haematemases vomiting followed by unconsciousness and headache. Bang. J Neurosurgery 2020; 9(2): 126-129

Background Sarcopenia and inflammation have been associated with poor survival in patients with cancer. We explored the combined effects of these variables on survival in patients with cancer treated with immunotherapy. Methods We performed a retrospective review of 90 patients enrolled on immunotherapy‐based phase I clinical trials at Emory University from 2009 to 2017. Baseline neutrophil‐to‐lymphocyte ratio, monocyte‐to‐lymphocyte ratio, and platelet‐to‐lymphocyte ratio (PLR) were used as surrogates of inflammation. The skeletal muscle index (SMI) was derived from the skeletal muscle density calculated from baseline abdominal computed tomography images. Optimal cutoffs for continuous inflammation biomarkers and SMI were determined by bias‐adjusted log‐rank test. A four‐level risk stratification was used to create low‐risk (PLR, The interaction between chronic inflammation and body composition is particularly important in the era of immunotherapy, considering that immune checkpoint inhibitors rely on the host immune system for their efficacy. This article reports on the combined effects of inflammation and sarcopenia on clinical outcomes in patients with solid tumors treated with immunotherapy‐based regimens.

The smaller size of the Boron nitride quantum dots (BNQDs) leads to the quantization of energy due to the confinement of electrons and holes. As a result, it behaves like an artificial atom with higher quantum yield. Unlike, previously used complex and lengthy experimental procedures, a facile bottom-up technique based on nanoscale precursors and dual roles of ammonia gas has been developed to synthesize BNQDs in 25 min growth duration at 1200 °C. Shape and morphology of the synthesized BNQDs look like beads of different sizes. Fast Fourier transform (FFT) shows a hexagonal atomic structure of the synthesized BNQDs whereas XPS, Raman, and XRD confirms the Boron and Nitrogen elemental compositions and hexagonal phase of the synthesized sample. The as-synthesized BNQDs has excellent properties for a variety of potential applications in the fields of biomedical (for bioimaging and drug delivery), microelectromechanical systems (MEMS), catalysis, sensors, and solid-state neutron detectors.

There is a known association between Cornelia de Lange syndrome (CdLS) and congenital diaphragmatic hernia (CDH), with CDH being the cause of death in 5%-20% of CdLS cases. We aimed to identify and describe patients with CDLS and CDH. We hypothesized that CdLS would be associated with high-risk CDH and poor outcomes.CDH Study Group patients from 1995 to 2019 were included. Those with CdLS were reviewed retrospectively. Rates of repair and outcomes were compared between patients with and without CdLS.We identified 9,251 CDH patients. Of those, 21 had confirmed CdLS. CdLS patients had a lower birth weight (2.2±0.57 kg) than non-CdLS patients (2.9±0.64 kg) (p0.001). 5-min Apgar scores were lower in CdLS patients (6, 4-7) than non-CdLS patients (7, 5-8) (p=0.014). Only 33% of CdLS patients underwent diaphragmatic repair compared to 84.2% of non-CdLS patients (p0.001). Mortality was 76% for CdLS patients compared with 29% for non-CdLS patients (p0.001). Of the 7 CdLS patients who underwent repair, 5 survived to hospital discharge.Infants with CdLS and CDH have a poor prognosis. However, CdLS patients who undergo repair can survive to discharge; therefore, the concomitant diagnosis of CdLS and CDH is not necessarily a contraindication to repair. Early recognition of these anomalies can assist with counseling and prognostication.Retrospective comparative study LEVEL OF EVIDENCE: III.

Objective Tobacco residue, also known as third-hand smoke (THS), contains toxicants and lingers in dust and on surfaces and clothes. THS also remains on hands of individuals who smoke, with potential transfer to infants during visitation while infants are hospitalized in neonatal intensive care units (NICUs), raising concerns (e.g., hindered respiratory development) for vulnerable infants. Previously unexplored, this study tested handwashing (HW) and sanitization efficacy for finger-nicotine removal in a sample of adults who smoked and were visiting infants in an NICU. Study Design A cross-sectional sample was recruited to complete an interview, carbon monoxide breath samples, and three nicotine wipes of separate fingers (thumb, index, and middle). Eligible participants (n = 14) reported current smoking (verified with breath samples) and were randomly assigned to 30 seconds of HW (n = 7) or alcohol-based sanitization (n = 7), with the order of finger wipes both counterbalanced and randomly assigned. After randomization, the first finger was wiped for nicotine. Participants then washed or sanitized their hands and finger two was wiped 5 minutes later. An interview assessing tobacco/nicotine use and exposure was then administered, followed by a second breath sample and the final finger wipe (40–60 minutes after washing/sanitizing). Results Generalized linear mixed models found that HW was more effective than sanitizer for nicotine removal but failed to completely remove nicotine. Conclusions Without proper protections (e.g., wearing gloves and gowns), NICU visitors who smoke may inadvertently expose infants to THS. Research on cleaning protocols are needed to protect vulnerable medical populations from THS and associated risks. Key Points

Objective: The objective of this study was to compare the effectiveness of health education as an intervention to promote BSE among intervention and non-intervention group presenting in a low resource setting at North Karachi Methodology: This Quasi-experimental study was conducted from January-August 2018 in a charitable hospital in Karachi after taking ethical approval by the Institutional Review Board of Jinnah Sindh Medical University and relevant approvals from the hospital authorities. This study recruited 172 eligible women by dividing them into intervention (n=86) and control (n=86) groups from a low resource setting in Karachi. Demographic variables were collected through pretested questionnaire by interview. Intervention group then received health education regarding carcinoma of breast, importance of BSE and monthly motivation to perform BSE through cell phone. The questionnaire was again filled after 6 months of intervention. Control group was also given health education sessions upon completion of study. Results: Results revealed that both groups were similar initially. After 6 months females in intervention group showed significant (p=

Introduction Post-exposure prophylaxis using rabies immunoglobulin (RIG) is universal recommendation for category III exposures. This study was conducted to determine quantity of RIG used to infiltrate animal bite wounds in relation to longest dimension and area of wound. Methods Children aged 2–18 years reporting within 7 days of category III animal bite were included. eRIG (300 IU/ml) was used in all subjects. A predesigned proforma was filled for clinical and epidemiological details of subjects. Maximum length and width of wounds was measured by using non-stretchable measuring tape. RIG was infiltrated in wounds as per WHO recommendations and volume infiltrated was noted. Results and conclusion A total of 100 subjects were enrolled. The mean (±SD) volume of RIG infiltrated in wounds per unit length was 0.75 (±0.21) ml/cm and per unit area was 3.18 (±1.75) ml/cm2. Regression equations were calculated. Proposed equations y = 0.6x + 0.3, where y is the volume of RIG (ml) and x is the length of the wound (cm) and y = 0.9x + 1.1, where y is the volume of RIG (ml) and x is the area of the wound (cm2) can prove to be a useful tool in RIG volume calculation for primary health care providers.

The pandemic caused by the COVID 19 virus had a tremendous impact on the retail and tourism industry resulting in a loss of around two trillion dollars per year. Recovering completely from the pandemic may take several years and safety guidelines like social distancing will remain a norm for many years to come. Many governments have levied heavy fines for businesses that fail to implement social distancing guidelines. Implementing manual social distancing policies can be expensive and error prone. This paper proposes a smart system that uses cameras along with Artificial Intelligence Internet of Things (AIoT) edge devices like the Nvidia Nano GPU to automatically detect social distance violations on the edge. The system achieved an accuracy of 92.2% and an F1-Score of 0.851 using a single camera only. On an Nvidia Nano, the system has a very acceptable rate of 1.7 frames per second on the edge obviating the need for any expensive back-end transmission and processing. The system uses the MQTT protocol to instantly notify the manager or owner of the business via a mobile App and a Web application for necessary action.

BACKGROUND Body mass index (BMI) is used to define obesity, but it is an imperfect measure of body composition. In the current study, the authors explored the association between types of fat and survival in patients treated with immunotherapy. METHODS A retrospective analysis of 90 patients who were treated with immunotherapy on phase 1 clinical trials at the Winship Cancer Institute in Atlanta, Georgia, from 2009 through 2017 was performed. Overall survival (OS) and progression-free survival (PFS) were used to measure clinical outcomes. Baseline BMI and radiographic images at the middle of the third lumbar vertebrae were obtained. Fat densities were calculated and converted to indices (subcutaneous fat index [SFI], intermuscular fat index [IFI], and visceral fat index [VFI]) after dividing by height in meters squared. Risk groups were created using recursive partitioning and the regression trees method for SFI and IFI, which were selected by stepwise variable selection among all fat-related variables. The Cox proportional hazards model and Kaplan-Meier method were used for the association with OS and PFS. RESULTS The majority of patients (59%) were male and diagnosed with melanoma (33%) or gastrointestinal cancers (22%). The median BMI was 27.4 kg/m2 , the median SFI was 62.78, the median IFI was 4.06, and the median VFI was 40.53. Low-risk patients (those with an SFI ≥73) had a significantly longer OS (hazard ratio, 0.20; 95% CI, 0.09-0.46 [P

Background: Surgical management of Extradural Haematoma (EDH) in Closed Head Injury is an essential issue. Objective: The purpose of the present study was to compare the surgical outcome between early and delayed surgery of extradural haematoma (EDH) in closed head injury. Methodology: This comparative cross-sectional study was carried out from January 2010 to June 2011 for a period of one year and six months in the Department of Neurosurgery, Dhaka medical College Hospital, Dhaka, Bangladesh. All patients presented with traumatic head injury having extradural haematoma in any age with both sexes who were underwent surgical management were selected as study population. The patients were categorized into groups designated as group A or early surgery group where operation was done within 24 hours of head injury and group B or delayed surgery group where operation was done after 24 hours to 3 days of head injury. Inclusion of patients in group B was not intentional but due to delayed referral from primary and secondary hospitals of` different parts of' the country. Glasgow coma scale (GCS) was used for initial assessment and Glasgow outcome scale (GOS) was applied to assess outcome in terms of neurological recovery in all patients. General and neurological examinations and findings were recorded. Surgical outcome was noted and recorded in the data collection sheet. Result: Eighty (80) patients of traumatic head injury with EDH operation (EDH operated within 24 hours and after 24 hours of head injury) were enrolled in this study. Mean (±SD) age of the patients of group A and group B was 32.66±16.65 and 33.23±13.38 respectively. In this study the patient's age ranged from 3 years to 64 years. In group A, 6 patients were admitted with GCS (14-15) and 01 patient in group B. With GCS (9~13), 19 patients in group A and 22 patients in group B. With GCS (3-8), 15 patients were admitted in group A and 17 patients in group B. Out of all patients’ good recovery occurred in 80.0% in group A and 45.0% in group B. Moderate disability and severe disability in both group A and group B was 12.5% vs 30% and 7.5% vs 12.5% respectively. Furthermore 5.0% persistent vegetative state and 7.5% death occurred only among the patients of group B (p

To evaluate the role of serial newborn screening of congenital hypothyroidism using thyroxine (T4) in the neonatal intensive care unit (NICU). Newborn screen results were reviewed from a single academic NICU during 2007–2016 (n = 6100). Thyroid function levels were reviewed in patients treated for hypothyroidism during that period. Duration of treatment was followed after discharge. Overall incidence of treated hypothyroidism was 1:103 with increasing incidence inversely related to birth weight. Among treated infants (n = 59), initial newborn screen demonstrated sensitivity and specificity of 74.1% and 84.9%, respectively; second screen demonstrated rates of 85.7% and 76.1%, respectively. Based on follow-up data, prevalence of permanent congenital hypothyroidism in our NICU population was 1:870 (n = 7); two patients would have been missed with a single screen. Abnormal T4 on newborn screening is common for preterm neonates. Higher rates of permanent congenital hypothyroidism highlight the need for screening beyond the newborn screen.

Introduction: Hepatitis B (HBV) and C (HCV) are highly infectious and contagious which is a major cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma. They are considered as an important occupational hazards especially for dental surgeons and other health care workers as dental treatment often includes direct exposure to patients’ body fluids. Materials and Methods: A cross sectional- KAP survey was conducted from November 2017to February 2018 amongst undergraduates and graduates of Baqai dental college. The study population included undergraduates (third year BDS, Final year BDS) and graduates (house surgeons and faculty members) of Dental College. The sample size was calculated by using Open epi software version 3.01with estimated prevalence rate of 13%, margin of error 5% and 95% confidence interval. The calculated sample size was 165. Result: A total of 165 undergraduates and graduates participated in the study. Regarding Hepatitis B transmission through saliva, 25(83.3%) of third year students, 43(72.9%) of the final year students, 35(76.1%) of house surgeons and 23(76.7%) of faculty members were aware of salivary transmission. Conclusion: The present study was conducted to evaluate awareness regarding transmission of Hepatitis B and C amongst the dental students (third year and final year), dental house surgeon and faculty members. Keywords: Awareness, Hepatitis B virus, Hepatitis C virus, Infection control.

Objective Balance and mobility function worsen with age, more so for those with underlying chronic diseases. We recently found that asymptomatic carotid artery stenosis (ACAS) restricts blood flow to the brain and might also contribute to balance and mobility impairment. In the present study, we tested the hypothesis that ACAS is a modifiable risk factor for balance and mobility impairment. Our goal was to assess the effect of restoring blood flow to the brain by carotid revascularization on the balance and mobility of patients with high-grade ACAS (≥70% diameter-reducing stenosis). Methods Twenty adults (age, 67.0 ± 9.4 years) undergoing carotid endarterectomy for high-grade stenosis were enrolled. Balance and mobility assessments were performed before and 6 weeks after revascularization. These included the Short Physical Performance Battery, the Berg Balance Scale, the Four Square Step Test, the Dynamic Gait Index (DGI), the Timed Up and Go test, gait speed, the Mini-Balance Evaluation Systems Test (Mini-BESTest), and the Walking While Talking complex test. Results Consistent with our previous findings, patients demonstrated reduced scores on the Short Physical Performance Battery, Berg Balance Scale, DGI, and Timed Up and Go test and in gait speed. Depending on the outcome measure, 25% to 90% of the patients had scored in the impaired range at baseline. After surgery, significant improvements were observed in the outcome measures that combined walking with dynamic movements, including the DGI (P = .02) and Mini-BESTest (P = .002). The proportion of patients with Mini-BESTest scores indicating a high fall risk had decreased significantly from 90% (n = 18) at baseline to 40% (n = 8) after surgery (P = .02). We used Pearson's correlations to examine the relationship between balance and mobility before surgery and the change after surgery. Patients with lower baseline DGI and Mini-BESTest scores demonstrated the most improvement after surgery (r = −0.59, P = .006; and r = −0.70, P = .001, respectively). Conclusions Carotid revascularization improved patients' balance and mobility, especially for measures that combine walking and dynamic movements. The greatest improvements were observed for the patients who had been most impaired at baseline.

Introduction Mitral valve abnormalities in rheumatic heart disease commonly lead to functional tricuspid regurgitation. Tricuspid annuloplasty (TA) is often performed in these cases along with mitral valve replacement (MVR). Our aim was to compare the perioperative morbidity and mortality among those patients that underwent mitral valve replacement with tricuspid annuloplasty versus those that underwent isolated mitral valve replacement. Methods A retrospective analysis of 158 patients that underwent mitral valve replacement, with or without tricuspid annuloplasty, secondary to rheumatic heart disease between January 2017 and August 2020. Patients who underwent additional cardiothoracic surgical procedures (aortic valve replacement and coronary artery bypass grafting) were excluded to reduce confounders. Results The study group consisted of 158 patients (mean age 41; 73 male, 85 female) that underwent MVR with TA (n=22; 13.9%) or without TA (n=136; 86.1%). Both groups had similar comorbidity frequencies and medication history. Preoperative echocardiography showed a comparable degree of pulmonary hypertension and ejection fraction between the two groups. The TA+MVR group had similar intraoperative (81.8% vs 66.9%; p=0.161) and postoperative (45.5% vs 45.6%; p=0.991) blood products usage compared to the MVR only group. Concurrent TA resulted in similar in-hospital mortality (4.5% vs 4.4%; p=0.977) as well as early postoperative complications, namely, prolonged ICU stay (13.6% vs 10.3%; p=0.639), prolonged ventilation (0 vs 2.2%; p=0.482), re-intubation (9.1% vs 2.9%; p= 0.161), and reopening for bleeding tamponade (0 vs 5.1%; p=0.276). Conclusions TA concurrently with MVR does not appear to increase in-hospital mortality or early postoperative complications.

We present the calibration strategy for the 20 kton liquid scintillator central detector of the Jiangmen Underground Neutrino Observatory (JUNO). By utilizing a comprehensive multiple-source and multiple-positional calibration program, in combination with a novel dual calorimetry technique exploiting two independent photosensors and readout systems, we demonstrate that the JUNO central detector can achieve a better than 1% energy linearity and a 3% effective energy resolution, required by the neutrino mass ordering determination. [Figure not available: see fulltext.], 0, info:eu-repo/semantics/published

Aim: To observe the visual field changes in normal tension glaucoma Study design: Cross sectional study Study site: Department of Physiology, Khyber Medical College, Peshawar Study period: six months Sample size: 100 cases were included who fulfil the criteria. Results: There were 33(33%) males and 67(67%) females in the study. Visual fields of eyes were investigated. It was revealed that in cases with the right eye problem, 67(67%) had paracentral scotoma, 27(27%) had superior & inferior nasal steps, 1(1%) had scotoma closer to fixation and 5(5%) had arcuate scotoma, while in the left eye cases, 67(67%) had paracentral scotoma, 30 (30%) had superior & inferior nasal steps, 1(1%) had scotoma closer to fixation and 2(2%) had arcuate scotoma. Conclusion: Visual fields of eyes revealed that in cases with the right eye problem, 67(67%) had paracentral scotoma, 27(27%) had superior & inferior nasal steps, 1(1%) had scotoma closer to fixation and 5(5%) had arcuate scotoma, while in the left eye cases, 67(67%) had paracentral scotoma, 30(30%) had superior & inferior nasal steps, 1 (1%) had scotoma closer to fixation and 2(2%) had arcuate scotoma. Keywords: Visual field, open angle glaucoma, normal tension glaucoma

Aim: Prevalence of Open angle glaucoma with normal intraocular pressure in Peshawar Methodology: It is a cross sectional study. It is done at Physiology Department, Khyber Medical College, Peshawar in collaboration with Ophthalmology deptt. Khyber Teaching Hospital, Peshawar Study period: six months Sample size: 394 cases attended the department of Ophthalmology, Khyber Teaching Hospital Peshawar. Out of 394 patients, 100 patients were included in this study. Results: There were 33(33%) males and 67(67%) females in the study. There were 27(27%) patients lying in the age range of 35-45 years, 46(46%) were in 46-55 years and 27 (27%) patients of 56-65 years. The mean age of patients was 51.21±8.12. All patients were with normal tension glaucoma. There were 29(29%) cases who had a positive family history of glaucoma. The “mean IOP” of the eye on the right side was 17.15±1.78mmHg and the “mean IOP” of the eye on the left side was 17.30±1.94mmHg. Conclusion: Prevalence of normal tension glaucoma (NTG) was 25.4% in Peshawar and its surroundings. Most of the patients were elderly females and 29 (29%) cases had a positive family history of glaucoma. Keywords: Open angle glaucoma, normal tension glaucoma, prevalence

Aim: To determine the ophthalmoscopic findings of normal tension glaucoma. Study design: This is a cross sectional study Study site: Department of Physiology, Khyber Medical College, Peshawar. Study period: six months Sample size: One hundred cases were selected. Results: In this study, 33(33%) males and 67(67%) females. On direct ophthalmoscopy, in right eye glaucoma, there were 93(93%) cases with cupped discs, while 7(7%) had gross cupping of the discs. In left eye glaucoma, there were 98(98%) cases who had cupped discs, while 2(2%) had gross cupping of the discs. Conclusion: On direct ophthalmoscopy, there were 93(93%) cases who had cupped discs in right eye glaucoma. Keywords: Ophthalmoscope examination, open angle glaucoma, normal tension glaucoma

Purpose The majority of pregnancies affected by maternal coronavirus disease 2019 (COVID-19) do not result in fetal transmission. However, several studies have identified parenchymal changes in their placental tissues, suggesting a placental response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the maternal–fetal interface. Although many COVID-19 placental studies have focused on the expression of the canonical SARS-CoV-2 entry proteins angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2, further characterization of subcellular molecules involved in viral trafficking have not yet been investigated in these tissues. Of interest are Rab proteins, a family of small GTPase proteins that direct intracellular transport between different endocytic organelles. Rab5 and Rab7 in particular have previously been implicated in HIV and cytomegalovirus invasion of placental trophoblast cells in vitro; the localization of these molecules has not been fully characterized within the human maternal–fetal interface, however, or within placental tissues from SARS-CoV-2–infected pregnancies. Methods Using fluorescent immunohistochemistry, Rab5 and Rab7 placental localization and comparative fluorescence intensity were explored in a cohort of placental tissues from pregnancies affected by maternal COVID-19 disease (COVID, n = 15) compared with contemporary control subjects (Control, n = 10). Fluorescence intensity was quantified by using corrected total cell fluorescence values. Findings Within placental villi, Rab5 was consistently localized in syncytiotrophoblast and cytotrophoblast cells. Rab5 had significantly higher mean (SEM) fluorescence intensity in the COVID cohort (Control, 1.96 [0.16]; COVID, 2.62 [0.09]; P = 0.0014). In contrast, although Rab7 was also localized within placental villous syncytiotrophoblast and cytotrophoblast cells, mean (SEM) Rab7 fluorescence intensity was significantly downregulated in COVID vs Control placentas (Control, 35.9 [4.1]; COVID, 20.1 [0.52]; P = 0.0001). Implications This differential expression of Rab5 and Rab7 suggests that placental endocytic pathways may be altered at the maternal–fetal interface in pregnancies affected by maternal SARS-CoV-2 infection. As key molecules governing intracellular vesicle transport, including viral trafficking, Rab GTPase proteins may be of interest for ongoing studies examining placental responses to COVID-19 in pregnancy., Highlights • RabGTPase proteins are important cell trafficking proteins evaluate in placental tissues affected by COVID-19 disease. • Rab5 is comparatively upregulated in placentas from SARS-CoV-2 positive women. • Rab7 has comparatively low expression in placentas from SARS-CoV-2 positive women.

Introduction Thirdhand smoke (THS) is ultrafine particulate matter and residue resulting from tobacco combustion, with implications for health-related harm (eg, impaired wound healing), particularly among hospitalized infants. Project aims were to characterize nicotine (THS proxy) transported on neonatal intensive care unit (NICU) visitors and deposited on bedside furniture, as well as infant exposure. Methods Cross-sectional data were collected from participants in a metropolitan NICU. Participants completed a survey and carbon monoxide breath sample, and 41.9% (n = 88) of participants (n = 210) were randomly selected for finger-nicotine wipes during a study phase when all bedside visitors were screened for nicotine use and finger-nicotine levels. During an overlapping study phase, 80 mother–infant dyads consented to bedside furniture-nicotine wipes and an infant urine sample (for cotinine analyses). Results Most nonstaff visitors’ fingers had nicotine above the limit of quantification (>LOQ; 61.9%). Almost all bedside furniture surfaces (93.8%) and infant cotinine measures (93.6%) had values >LOQ, regardless of household nicotine use. Participants who reported using (or lived with others who used) nicotine had greater furniture-nicotine contamination (Mdn = 0.6 [interquartile range, IQR = 0.2–1.6] µg/m2) and higher infant cotinine (Mdn = 0.09 [IQR = 0.04–0.25] ng/mL) compared to participants who reported no household-member nicotine use (Mdn = 0.5 [IQR = 0.2–0.7] µg/m2; Mdn = 0.04 [IQR = 0.03–0.07] ng/mL, respectively). Bayesian univariate regressions supported hypotheses that increased nicotine use/exposure correlated with greater nicotine contamination (on fingers/furniture) and infant THS exposure. Conclusions Potential furniture-contamination pathways and infant-exposure routes (eg, dermal) during NICU hospitalization were identified, despite hospital prohibitions on tobacco/nicotine use. This work highlights the surreptitious spread of nicotine and potential THS-related health risks to vulnerable infants during critical stages of development. Implications THS contamination is underexplored in medical settings. Infants who were cared for in the NICU are vulnerable to health risks from THS exposure. This study demonstrated that 62% of nonstaff NICU visitors transport nicotine on their fingers to the NICU. Over 90% of NICU (bedside) furniture was contaminated with nicotine, regardless of visitors’ reported household-member nicotine use or nonuse. Over 90% of infants had detectable levels of urinary cotinine during NICU hospitalizations. Results justify further research to better protect infants from unintended THS exposure while hospitalized.

International audience; As renewable energy is intermittent in nature, its integration in to the power grid is challenging task. Hence remote monitoring and data acquisition of various performance parameters from the renewable energy systems has become of paramount importance. Round the clock monitoring of the system ensures the stable and reliable operation of the system, by proper management, in this way an individual at a remote location can know whether the system is producing sufficient energy or not which is essential for its stable operation. This feature can be ensured by the use of real-time performance monitoring. If it is observed the sources is not working properly then an immediate remedy can be done to it before it sets in a chain of events and make things worse. The proposed monitoring system formulates unified data acquisition standard for distributed RES and real-time monitoring of RES such as solar PV. The system is an IoT server based using an Arduino to send the real-time power production to the cloud for remote access by the operator or the owner.

Studies have shown that at all-India level, the share of Muslims in public sector employment is extremely low in comparison to their share in population. This chapter shows that in Telangana as well Muslim representation is disproportionately low both in the public and private sector employments and their absence is conspicuous in some important government departments like education, planning, and welfare. Their absence is also conspicuous in higher levels of administration and state bureaucracy like the all-India services—Indian Administration Service (IAS), Indian Police Service (IPS), and Indian Forest Service (IFS).

Acquired immunodeficiency syndrome (AIDS) has affected millions of people worldwide. The human immunodeficiency virus (HIV) which infects T cells by using CD4 as its main receptor. Currently different treatments are available against HIV infection which can improve life expectancy of the patient but still it remains incurable. CCR5, which is also required as a co-receptor by majority of HIV strains for entry into the target cells, is now being targeted for gene therapy to develop HIV resistance in patients. In this review, we discuss different strategies that are being adapted for CCR5-gene disruption in CD4+ T cells and in hematopoietic stem cells (HSCs) to generate a HIV-resistant immune system in infected individuals. If CCR5 gene that can shape HIV-resistant T cells, it will aim in new approaches in clinical trials. But these techniques have certain weaknesses and disadvantages, and will need to be paired with other strategies to form a full HIV remedy. There is also a need to establish methods to help deter HIV re-emergence following targeted CCR5 therapy. But ultimately, this brought us a better knowledge of the road to HIV treatment.

Background: Several techniques are under investigation to improve the immunogenicity of HIV-1 DNA vaccine candidates. DNA vaccines are advantageous due to their ease of design, expression of multiple antigens, and safety. Methods: The HVTN 098 trial assessed the PENNVAX®-GP DNA vaccine (encoding HIV env, gag, pol) administered with or without plasmid IL-12 at 0-, 1-, 3-, and 6-month timepoints via intradermal (ID) or intramuscular (IM) electroporation (EP) in healthy, adult participants. We report on safety, tolerability, and acceptability. Results: HVTN 098 enrolled 94 participants: 85 received PENNVAX®-GP and nine received placebo. Visual analog scale (VAS) pain scores immediately after each vaccination were lower in the ID/EP than in the IM/EP group (medians 4.1–4.6 vs. 6–6.5, p &lt, 0.01). IM/EP participants reported greater pain and/or tenderness at the injection site. Most ID/EP participants had skin lesions such as scabs/eschars, scars, and pigmentation changes, which resolved within 6 months in 51% of participants (24/55). Eighty-two percent of IM/EP and 92% of ID/EP participant survey responses showed acceptable levels of discomfort. Conclusions: ID/EP and IM/EP are distinct experiences, however, HIV-1 DNA vaccination by either route was safe, tolerable and acceptable by most study participants.

The current risk assessment for patients with carotid atherosclerosis relies primarily on measuring the degree of stenosis. More reliable risk stratification could improve patient selection for targeted treatment. We have developed and validated a model to predict for major adverse neurologic events (MANE; stroke, transient ischemic attack, amaurosis fugax) that incorporates a combination of plaque morphology, patient demographics, and patient clinical information.We enrolled 221 patients with asymptomatic carotid stenosis of any severity who had undergone computed tomography angiography at baseline and ≥6 months later. The images were analyzed for carotid plaque morphology (plaque geometry and tissue composition). The data were partitioned into training and validation cohorts. Of the 221 patients, 190 had complete records available and were included in the present analysis. The training cohort was used to develop the best model for predicting MANE, incorporating the patient and plaque features. First, single-variable correlation and unsupervised clustering were performed. Next, several multivariable models were implemented for the response variable of MANE. The best model was selected by optimizing the area under the receiver operating characteristic curve (AUC) and Cohen's kappa statistic. The model was validated using the sequestered data to demonstrate generalizability.A total of 62 patients had experienced a MANE during follow-up. Unsupervised clustering of the patient and plaque features identified single-variable predictors of MANE. Multivariable predictive modeling showed that a combination of the plaque features at baseline (matrix, intraplaque hemorrhage [IPH], wall thickness, plaque burden) with the clinical features (age, body mass index, lipid levels) best predicted for MANE (AUC, 0.79), In contrast, the percent diameter stenosis performed the worst (AUC, 0.55). The strongest single variable for discriminating between patients with and without MANE was IPH, and the most predictive model was produced when IPH was considered with wall remodeling. The selected model also performed well for the validation dataset (AUC, 0.64) and maintained superiority compared with percent diameter stenosis (AUC, 0.49).A composite of plaque geometry, plaque tissue composition, patient demographics, and clinical information predicted for MANE better than did the traditionally used degree of stenosis alone for those with carotid atherosclerosis. Implementing this predictive model in the clinical setting could help identify patients at high risk of MANE.