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Introduction: The injudicious use of Topical corticosteroid (TC) over the face has resulted in various complications, encountered day to day. Indian market is flooded with more than 18 different steroid molecules. Methodology: A hospital-based cross-sectional study was conducted on 170 patients at a tertiary care centre. A pre-structured proforma was used to collect socio-demographic details of the subjects with facial dermatoses due to TC misuse for more than 2 weeks. Results: The commonest age group affected was 20-21 years (78.2%) with mostly females (70.6%). Frequent indication for application of TC was melasma (50.0%), Acne (24.1%) and others. Subjects (40.6%) brought a combination of TCs over the counter as a suggestion from friends & relatives. Cutaneous findings of TSDF were exacerbation of pre-existing melasma (41.2%). Conclusion: The results of this study underline the need of strict laws. Futher, awareness creation among patients and primary care physicians should be given prime importance to prevent the epidemic.

Background: It was reported that those who practice chanting of the Shiva panchakshari mantra can overcome stress, attain prosperity, and get stability in life. However, there are no research studies in this area in the PubMed literature to support scientific evidence. Aims and Objectives: The present study was undertaken to observe the effectiveness of 8 weeks of Panchakshari mantra chanting on cognitive and psychological parameters in young adults. Materials and Methods: A total of 60 young adults were part of the study after obtaining the written informed consent. After recruiting, they were randomly assigned to two groups, control and experimental groups with 30 participants in each group. After recording the baseline, the participants in the experimental group were trained in chanting the panchakshari mantra for a week under the supervision of Vedic teachers. The participants in the control group were not allowed to chant during the study period. All the parameters were recorded in both groups after 8 weeks of the intervention. Results: There was a significant decrease in the depression, anxiety, and stress scores of the participants of the experimental group after the intervention. There was a significant improvement in the scores of spatial and verbal memory in the participants of the experimental group followed by the intervention. Conclusion: There was a significant improvement in the verbal memory scores in the participants of the experimental group. There was a significant decrease in the depression, anxiety, and stress scores of the participants followed by the chanting. The study recommends further detailed studies in this area to provide further scientific evidence.

Introduction: Diabetes mellitus is a global health burden, and India is regarded as the diabetes capital of the world. Glycaemic variability (GV) is an established risk factor for hypoglycaemia (plasma glucose concentration

Abstract The biofloc environment needs specific heterotrophic nitrifying bacteria for optimal system performance, hence screening perfect bacterial strains is crucial. Enterobacter cloacae sp. was identified as a novel heterotrophic bacterium isolated from freshwater pond sediment during July, 2022. Through high-throughput sequencing, the isolated bacterium was identified as E. cloacae CAUCoF_BF_01, which demonstrated potential nitrogen removal via heterotrophic nitrification and aerobic denitrification, as well as a preference for different C/N ratios (C/N10, 15, 20, and 25) for consuming nitrogen sources. The bacteria performed superior (p

Background Dental caries occurs as a result of phasic demineralization and remineralization of dental hard tissues. In recent years, minimal invasive dentistry (MID) has replaced conventional treatment procedures. As part of MID, silver diamine fluoride (SDF) is being used to manage dental caries. However, little research has explored how informed dental postgraduates are about SDF. Aim To determine the knowledge, practice, and attitude of dental postgraduate students regarding SDF. Materials and Methods A questionnaire containing a total of 25 questions was drafted and distributed through Google Forms to postgraduates studying in the Department of Pedodontics and Preventive Dentistry within the state of Karnataka. The Chi-square (χ2) test was used to statistically analyze the obtained data. Results A total of 165 responses were obtained. Among the participants, 94.5% reported that they were aware of SDF. However, majority of the respondents were not able to correctly answer the questions assessing knowledge. Knowledge was higher among 3rd year followed by 2nd and 1st years (P ≤ 0.001). Only 59.4% of the respondents stated that they use SDF in their patients. However, nearly all respondents stated that this survey encouraged them to improve their understanding of SDF. Conclusion Awareness about SDF among postgraduates treating pediatric patients is quite high. Knowledge with regard to few aspects of SDF use is lacking. The attitude among the participants was positive.

Introduction: Infraorbital nerve is the largest and terminal branch of the maxillary nerve. A lack of knowledge of variations in its course, such as Infraorbital Canal Protrusion (ICP)-which refers to the extension of the nerve from the infraorbital foramen into the maxillary sinus, could lead to iatrogenic injuries during procedures of the maxilla and antrum. Aim: To analyse and determine the morphometric variations of the infraorbital canal and its association with nearby structures utilising Cone Beam Computed Tomography (CBCT). Materials and Methods: A retrospective observational study was conducted in the Department of Oral Medicine and Radiology at Bhimavaram, Andhra Pradesh, India. The data obtained was between November 2019 to May 2023, during which 114 CBCT scans {228 Infra Orbital Canal (IOC)} were analysed retrospectively. IOC was divided into type 1, type 2 and type 3 Measurements taken for type 3 infraorbital canals included the distance from the IOC to the Infraorbital Rim (IOR), the horizontal distance from the IOC to the long axis of the canine, the maximum length of the nerve protruding into the sinus, and the maximum distance from the center of the canal to the roof of the sinus. The association between the types of infraorbital canals and variations in adjacent anatomical structures was evaluated using independent sample t-tests, Fisher’s-exact test, One-way Analysis of Variance (ANOVA), and Pearson’s Chi-square test. Results: Out of 228 IOC types, 78 were classified as type 1, 23 as type 2, and 13 as type 3 on the right side and 73 were type 1 , 36 were type 2, 5 were type 3 on the left-side. Type 1 was higher in number both females and males on both sides, followed by type 2. The mean horizontal distance from IOC to the long axis of the canine {(IOC-Long axis of canine (LCR)} was statistically significant across different types on both the right and left-sides. The prevalence of Haller cells, mucosal thickening, pneumatisation of the middle concha, and maxillary sinus septa was present in 31 (27.19%), 44 (38.6%), 41 (36%), and 29 (25.4%) of the 114 individuals, respectively. Conclusion: A preoperative 3D assessment of IOC is crucial to preventing surgical complications by identifying potential anatomical variations, thereby minimise iatrogenic injuries.

Exposure to environmental pollutants increases the risk for metabolic dysfunction. Dietary and lifestyle interventions may reduce the risks associated with this toxicity. We conducted this 4-week, observational, clinical study to explore the safety and efficacy of a proprietary dietary program formulated to enhance cardiometabolic functioning, metabolic transformation, and gut health. Thirty-eight generally healthy overweight subjects were assigned a low-glycemic load, Mediterranean-style food plan with targeted nutraceutical supplementation and a physical activity regimen. Subjects expressed positive subjective health and symptom changes coincident with improvements in anthropomorphic variables, lipid profiles, glycemic measures, vascular biomarkers, cardiovascular risk, systemic inflammation, hepatic function, urinary heavy metal excretion, and gut health. Thus combining targeted nutraceutical supplementation with a low-glycemic load food plan and exercise may represent a novel nutritional approach to improving the body's ability to modulate the toxicity of pollutants and reducing cardiometabolic risk factors in generally healthy overweight persons.

Abstract Background In 2020, during the COVID-19 pandemic, Médecins Sans Frontières (MSF) initiated three cycles of dihydroartemisin-piperaquine (DHA-PQ) mass drug administration (MDA) for children aged three months to 15 years within Bossangoa sub-prefecture, Central African Republic. Coverage, clinical impact, and community members perspectives were evaluated to inform the use of MDAs in humanitarian emergencies. Methods A household survey was undertaken after the MDA focusing on participation, recent illness among eligible children, and household satisfaction. Using routine surveillance data, the reduction during the MDA period compared to the same period of preceding two years in consultations, malaria diagnoses, malaria rapid diagnostic test (RDT) positivity in three MSF community healthcare facilities (HFs), and the reduction in severe malaria admissions at the regional hospital were estimated. Twenty-seven focus groups discussions (FGDs) with community members were conducted. Results Overall coverage based on the MDA card or verbal report was 94.3% (95% confidence interval (CI): 86.3–97.8%). Among participants of the household survey, 2.6% (95% CI 1.6–40.3%) of round 3 MDA participants experienced illness in the preceding four weeks compared to 30.6% (95% CI 22.1–40.8%) of MDA non-participants. One community HF experienced a 54.5% (95% CI 50.8–57.9) reduction in consultations, a 73.7% (95% CI 70.5–76.5) reduction in malaria diagnoses, and 42.9% (95% CI 36.0–49.0) reduction in the proportion of positive RDTs among children under five. A second community HF experienced an increase in consultations (+ 15.1% (− 23.3 to 7.5)) and stable malaria diagnoses (4.2% (3.9–11.6)). A third community HF experienced an increase in consultations (+ 41.1% (95% CI 51.2–31.8) and malaria diagnoses (+ 37.3% (95% CI 47.4–27.9)). There were a 25.2% (95% CI 2.0–42.8) reduction in hospital admissions with severe malaria among children under five from the MDA area. FGDs revealed community members perceived less illness among children because of the MDA, as well as fewer hospitalizations. Other indirect benefits such as reduced household expenditure on healthcare were also described. Conclusion The MDA achieved high coverage and community acceptance. While some positive health impact was observed, it was resource intensive, particularly in this rural context. The priority for malaria control in humanitarian contexts should remain diagnosis and treatment. MDA may be additional tool where the context supports its implementation.

Agriculture is the main source of livelihood for most of the population across the globe. Plants are often considered life savers for humanity, having evolved complex adaptations to cope with adverse environmental conditions. Protecting agricultural produce from devastating conditions such as stress is essential for the sustainable development of the nation. Plants respond to various environmental stressors such as drought, salinity, heat, cold, etc. Abiotic stress can significantly impact crop yield and development posing a major threat to agriculture. SNARE proteins play a major role in pathological processes as they are vital proteins in the life sciences. These proteins act as key players in stress responses. Feature extraction is essential for visualizing the underlying structure of the SNARE proteins in analyzing the root cause of abiotic stress in plants. To address this issue, we developed a hybrid model to capture the hidden structures of the SNAREs. A feature fusion technique has been devised by combining the potential strengths of convolutional neural networks (CNN) with a high dimensional radial basis function (RBF) network. Additionally, we employ a bi-directional long short-term memory (Bi-LSTM) network to classify the presence of SNARE proteins. Our feature fusion model successfully identified abiotic stress in plants with an accuracy of 74.6%. When compared with various existing frameworks, our model demonstrates superior classification results.

Objective: The purpose of this retrospective study was to assess the variables affecting endodontic retreatment technique success. Methods: A 5-year period of 500 patient records from a dental clinic were examined. Pre-operative factors, procedure specifics, post-operative results, and demographic information were all documented. The study employed statistical analysis to determine the important factors that influence retreatment success. Findings: The average age of the study group was 45.2 years, and 56% of the participants were female. Sixty-four percent of patients had multiple root canals, and the most frequent initial diagnosis (60%) was apical periodontitis. The results of the surgery varied: 50% of patients had full healing, 30% had partial healing, and 20% had no improvement at all. Significant indicators of retreatment success were found to include age, initial diagnosis, and root canal morphology (P < 0.05). Conclusion: The effectiveness of endodontic retreatment operations is mostly influenced by age, apical periodontitis, and root canal morphology. Optimizing treatment results requires individualized treatment techniques based on each patient’s unique features. Clinicians can benefit greatly from these findings in terms of increasing endodontic retreatment success rates and enhancing patient care.

Appendiceal mucinous neoplasms, particularly Low-grade Appendiceal Mucinous Neoplasms (LAMN), are rare but important diagnostic entities as they are potential causes of a surgical abdomen. The clinical manifestations of this lesion are obscure and ill-defined, and these lesions are commonly misdiagnosed as acute appendicitis, adnexal masses, or retroperitoneal tumours. This lesion can rupture and seed mucin and neoplastic epithelium into the peritoneum, leading to Pseudomyxoma Peritonei (PMP), a serious complication with a high morbidity and mortality rate. Therefore, timely identification and treatment of LAMN are crucial for reducing the risk of PMP and improving prognosis and outcomes. Ultrasonography (USG) and Computed Tomography (CT) scans are useful methods for diagnosis; however, the diagnosis is often incidental or found intraoperatively during resection for suspected acute appendicitis. Clinical awareness of the misleading presentations of LAMN should be present in cases of a surgical acute abdomen to prevent performing a dissimilar treatment intervention. Considering the rarity of this lesion and its varied presentation, it is important to study and document this type of neoplasia in the literature. Hereby, authors report a rare case of LAMN in a 33-year-old male patient with a primary diagnosis of acute appendicitis. This case highlights the importance of having a high index of clinical suspicion of appendiceal malignancy and mucocele rupture in patients planned for appendectomy. This also emphasises the fact that all excised appendicectomy tissues should be sent for histopathological examination as they can harbor pathological changes like LAMN.

Recently, there has been growing interest in the hierarchical assemblies of zwitterionic betaine amphiphiles across various fields due to their utility as stimuli-responsive materials. Herein, we systematically investigate the binary supramolecular assembly of zwitterionic amido betaines and diamines to determine how alkyl chain length of amido betaines (CnDAB) and amine degree of diamines influence their relaxation dynamics of the resultant coacervates. To this end, we synthesized five CnDAB molecules with systematically varying carbon chain lengths (n = 12, 14, 16, 18, and 20) and conjugated them with three different diamines (ethylenediamine, EDA; n,n'-dimethylethylenediamine, DMEDA; and n,n,n',n'-tetramethylethylenediamine,TMEDA). We employed rheology to compare the bulk properties and relaxation dynamics of these assemblies as well as to gain insight into their responsiveness to pH stimulus. All betaine/diamine co-assemblies for all pH values showed shear-thinning behavior while the onset of shear thinning behavior showed some variation for the shear rate inducing such an onset. By changing molecular architecture of co-assembling pairs, zero-shear viscosity values varied from ∼10−1 Pa s to ∼103 Pa s at a concentration of 100 mM CnDAB and 50 mM diamine in water. Four-order-of-magnitude difference in viscosity with small changes in molecular architecture and pH indicates that precise tuning of the rheological properties is possible simply by controlling the self-assembly tendencies and nano-to-micro scale aggregation morphologies through bi-molecular design. Out of 15 different combinations of betaine and diamine pairs studied, the primary amine EDA conjugated with C18DAB resulted in the highest degree of pH-controlled viscosity changes (i.e., highest pH-responsivity). Below 16-carbon alkyl chains on the betaines, pH responsiveness mostly disappeared. Overall, this systematic study brings new insights into the molecular structure-property relationships of amido betaine/diamine systems, which are widely used in diverse sets of applications and fields.

Introduction: Climate change's severe impact on human health is becoming increasingly evident, particularly for vulnerable populations with serious illnesses. Climate-related extreme weather events are expected to increase demand for hospice and palliative care due to rising respiratory illnesses, heat-related issues, waterborne diseases, and aggravated chronic conditions. Our scoping review aimed to investigate the existing literature on climate change's impact on hospice and palliative medicine (HPM). Methods: We conducted a comprehensive literature search across various databases (e.g., Medline, EMbase, Web of Science, and Cochrane) using predefined climate change and HPM terms, resulting in 382 records. Following predetermined inclusion and exclusion criteria, 44 articles were selected for full-text review, and 20 were included for final analysis. In light of the limited literature on climate change's impact on HPM, we also sought narratives from HPM practitioners from across the world on their experiences in a changing climate. Results: Six major themes emerged: 1) The impact of climate change on HPM in low-income countries; 2) Descriptive pieces on climate change, climate disasters, and HPM; 3) Morbidity and mortality after climate disasters in the seriously ill population; 4) Discussion of euthanasia during climate disasters; 5) Recommendations and frameworks for disaster response in the field of HPM; 6) Carbon footprint of hospices. Additionally, narratives from HPM practitioners highlighted the disruptive effects of climate disasters on seriously ill patients and their caregivers as disasters caused care interruptions, reduced access to crucial health infrastructure, exacerbations of illness, accelerated disease progression, and increased morbidity and mortality. Conclusion: Existing research on climate change's impact on HPM is primarily anecdotal and descriptive, with a focus on climate-related disasters. Narratives from HPM practitioners worldwide underscore the disproportionate impact of climate disasters on seriously ill patients. Further research is necessary to comprehensively understand climate's intricate effects on HPM and to assess adaptable, mitigative, and resilient solutions against its adverse impacts.

Fish, as vertebrates, secrete various antimicrobial peptides (AMPs)—short, positively charged amino acid chains that are integral components of the innate immune systems across numerous species. AMPs exhibit a broad spectrum of inhibitory activities against viruses, fungi, bacteria, and parasites. The rise of antibiotic-resistant microorganisms and concerns over excessive antibiotic use has spurred interest in AMPs for their potential applications in aquaculture, medicine, food, agriculture, and animal husbandry. This study elucidates the potential of fish-derived AMPs as antibacterial, antiviral, anti-parasitic, and antifungal agents, as well as their roles as vaccine adjuvants, components of inactivated vaccines, anticancer agents, and methods for AMP isolation. The review concisely addresses the application-oriented properties of fish AMPs, emphasizing their broad-spectrum antimicrobial efficacy and practical utility.

The study of fluid flow over curved surfaces is crucial in various engineering applications, such as designing aircraft wings, turbines, and submarines. Curved surfaces are being explored in various biomedical applications, such as designing stents for blood vessels and implants for bones and joints. Concerning the present applications of curved stretching sheets on fluid dynamics along with trihybrid nanofluids, this study is unique and fills the research gaps and offers solutions to several issues. This work looks at the flow through the boundary layer of an electrically conductive trihybrid nanofluid and the convection heat exchange of a Casson fluid across a curved stretched surface encircled within a circle of radius R. The study considers the effects of thermal radiation using the non-linearized Rosseland approximation, as well as a magnetic field, and hydromagnetic slip. The flow as well as the transfer of heat problem is mathematically described by curvilinear coordinates. Using the combination of the shooting technique and the Runge-Kutta method, similar solutions to the modeled partial differential equations are produced, and the set of non-linear ordinary differential equations with a boundary value solver is implemented through the MATLAB program. The study finds the influence of several limits on critical characteristics such as fluid velocity, coefficient of skin friction, pressure, temperature, and rate of heat exchange over a surface. The findings are shown in tables and graphs. Additionally, a comparative analysis between the current findings and those found in the literature is provided. Blood-containing nanoparticles (GO-SWCNTs-MWCNTs) on curved surfaces could improve drug delivery effectiveness, growth of synthetic tissues or organs with complex structures and effective cancer therapy treatment.

Abstract Climate change majorly impacts biodiversity in diverse regions across the world, including South Asia, a megadiverse area with heterogeneous climatic and vegetation regions. However, climate impacts on bats in this region are not well‐studied, and it is unclear whether climate effects will follow patterns predicted in other regions. We address this by assessing projected near‐future changes in climatically suitable areas for 110 bat species from South Asia. We used ensemble ecological niche modelling with four algorithms (random forests, artificial neural networks, multivariate adaptive regression splines and maximum entropy) to define climatically suitable areas under current conditions (1970–2000). We then extrapolated near future (2041–2060) suitable areas under four projected scenarios (combining two global climate models and two shared socioeconomic pathways, SSP2: middle‐of‐the‐road and SSP5: fossil‐fuelled development). Projected future changes in suitable areas varied across species, with most species predicted to retain most of the current area or lose small amounts. When shifts occurred due to projected climate change, new areas were generally northward of current suitable areas. Suitability hotspots, defined as regions suitable for >30% of species, were generally predicted to become smaller and more fragmented. Overall, climate change in the near future may not lead to dramatic shifts in the distribution of bat species in South Asia, but local hotspots of biodiversity may be lost. Our results offer insight into climate change effects in less studied areas and can inform conservation planning, motivating reappraisals of conservation priorities and strategies for bats in South Asia.

Background: Pseudoexfoliation is one of the most common causes of secondary open-angle glaucoma worldwide. The current investigation is being carried out to investigate the clinical characteristics associated with pseudoexfoliation syndrome. Aims and Objectives: The current study was conducted with the goal of documenting the prevalence of the ocular clinical profile of patterns in patients with pseudo-exfoliative material attending a tertiary care hospital’s general ophthalmology outpatient department. Materials and Methods: In the current study, 100 individuals were explored who were diagnosed with pseudoexfoliation and attended the outpatient department of ophthalmology, medical college, and hospital. The Snellen chart for visual acuity was used to test visual acuity. Pseudoexfoliation glaucoma was identified based on slit lamp examination of pseudoexfoliative material, intraocular pressure (IOP) >21 mmHg, glaucomatous cupping on fundus examination, pigmentation of trabecular meshwork on gonioscopy, and glaucomatous field abnormalities on perimetry. Results: The age range of 61–70 years had the most cases of pseudoexfoliation, accounting for 23, followed by 51–60 years with 17 occurrences. The current study comprised 48 patients, 20 of whom had bilateral pseudoexfoliation and 28 of whom had unilateral pseudoexfoliation. Our findings revealed that 17 patients had high IOP. We discovered 15 cases of open-angle glaucoma and 2 cases of narrow-angle glaucoma after analyzing 48 patients. The sample of 15 individuals with open-angle glaucoma included 11 men and 4 women. Conclusion: Pseudoexfoliation becomes more common as people age, and it is often unilateral at first but progressively progresses to bilateral pseudoexfoliation, necessitating frequent follow-up in unilateral cases. Pseudoexfoliation is associated with an increased risk of glaucoma, and the majority of cases have open angles.

Aim: This study aimed to evaluate the effect of 5.25% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA) and sterilization on the nanostructural alteration of nickel titanium (Ni-Ti) rotary file systems in endodontics using the atomic force microscopy (AFM). Materials and Methods: The study was performed on four commercially available rotary Ni-Ti files: group I—Vortex Blue (Dentsply), group II—ProTaper Next (Dentsply), group III—Mtwo (VDW), and group IV—iRaCe (FKG). Each group was divided into four subgroups (n = 4), that is, subgroup A—control (new rotary file), subgroup B—subjected for five cycles of autoclave, subgroup C—immersed in 5.25% NaOCl for 5 minutes, and subgroup D—immersed in 17% EDTA solutions for 5 minutes. All the specimens were evaluated with AFM using roughness average (RA) and root-mean-square (RMS) values for surface roughness. Results: Among control groups, Vortex Blue showed the least RA and RMS values; the highest surface roughness was seen with Mtwo files. All the Ni-Ti rotary files showed a statistically significant (P

ABO is the most widely utilized blood group system. Bombay blood group is a rare subtype of autosomal recessive group with absence of H antigen and presence of anti-H, anti-Aand anti-B antibodies. We present a case of a 51-yearold lady posted for hemithyroidectomy and incidentally detected to be of Bombay blood group when a blood unit was reserved for surgery. She was a non-secretor for H substance on saliva inhibition test. History of consanguineous marriage was present. We wish to reaffirm that ardent effort has to be undertaken to confirm all 'O' group individuals with reverse grouping during routine testing for blood groups, failing which the rare Bombay blood group can be misdiagnosed as 'O' resulting in an acute haemolytic reaction if any unit other than that of Bombay blood group is transfused. Individuals with this group need to be counselled about rarity and clinical implications of the same.

Background: Acute Kidney Injury (AKI) is a common yet serious illness with significant complications having high incidence and prevalence rates. Various studies have been conducted to understand the causes and risk factors of AKI and its outcomes. Aim and Objectives: The present research aimed to assess the etiology, risk factors and outcome of AKI in Medical Intensive Care Unit (MICU). Material and Methods: In this longitudinal study, 100 participants were recruited between the age group 20-80 years and diagnosed with AKI either at the time of admission or during their stay in MICU. Results: Mean age was 61.3 ± 15.43 years. The study participants included 68 male (68%) and 32 female participants (32%). Majority of the participants had diabetes mellitus as a co-morbidity (49%) followed by systemic hypertension (36%). The commonest etiology of AKI in our study, was infections (61.22%). Thirteen individuals progressed to Chronic Kidney Disease (CKD) and 27 succumbed to AKI. The negative outcome with respect to progression to CKD and death was significantly associated with invasive ventilation status (p = 0.0005), requirement of dialysis (p = 0.0365) and exposure to nephrotoxic drugs (p = 0.0135).Conclusion: In the present study, infection was the commonest etiology for AKI. Diabetes as well as hypertension were significant risk factors for AKI. A significant number of individuals progressed to CKD and 27 out of 100 individuals succumbed to AKI.

Abstract[Formula: see text] (MXene) is prone to surface oxidation because of the presence of oxygen surface terminals in its surfaces. In this work, the effect of oxygen surface terminals has been reduced by replacing it with other surface terminals or thin layers of heteroatom at the interlayers. These resulted in increasing the interlayer spacing from 9.3 Å up to 12.5 Å with better flexibility properties, thereby facilitating electron/mass transports by exposing enough active surface areas. The carbon nanoplated MXene showed enhanced specific capacitance of 110 F/g at 2 mV/s in LiOH electrolytes for superior supercapacitor applications.

Introduction: Acute thoracic aortic syndromes are among the most concerning presentations in emergency medicine and are associated with significant morbidity and mortality. Thoracic aortic dissection is most common, followed by penetrating aortic ulcer and, least commonly, intramural hematoma. Case Report: A 67-year-old woman presented to the emergency department with chest and back pain, and sudden onset of paraparesis. Aortic intramural hematoma was diagnosed, and she underwent spinal drain placement with blood pressure control to optimize spinal cord perfusion. Discussion: When neurological deficits are present, rapid diagnosis of spinal ischemia and blood pressure optimization is vital. Spinal drains may be considered as an adjunctive treatment.

Abstract Objective The objective of this study is to investigate the effects of an ethanolic extract derived from Agaricus subrufescens on rat models exhibiting Polycystic Ovarian Syndrome (PCOS) induced by Letrozole. Methods A total of thirty female Wistar rats were divided into five groups, each consisting of six rats. The negative control group was administered a volume of 1 mL of a 0.5% solution of carboxy methylcellulose (CMC). Letrozole (1 mg/kg) was administered to additional groups for a duration of 21 days in order to induce polycystic ovary syndrome (PCOS). Animals designated as positive controls were euthanized on the 22nd day. Both the test group and the standard group were subjected to treatment from the 22nd day to the 36th day. The experimental group was administered ethanolic extract of Agaricus subrufescens at doses of 200 mg/kg and 400 mg/kg p.o, while the control group received clomiphene citrate at a dose of 1 mg/kg. The study observed various physiological markers in individuals with polycystic ovarian disease, including estimated blood glucose levels, total cholesterol levels, triglyceride levels, and hormonal fluctuations such as increased testosterone and estrogen levels, as well as decreased progesterone levels. The presence of menstrual irregularities was confirmed through the examination of vaginal smears and histopathological changes in the ovaries. Results The consumption of Agaricus subrufescens was found to have a significant impact on various physiological parameters, including blood glucose levels, testosterone levels, anovulation, and menstrual irregularity. All therapeutic interventions significantly normalized the levels of serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT). The rats with polycystic ovary syndrome (PCOS) that were induced by Letrozole exhibited increased levels of urea and creatinine. The findings of this study indicate that the administration of Agaricus subrufescens therapy has a protective effect on renal function, as evidenced by a reduction in serum levels of urea and creatinine. In rats with polycystic ovary syndrome (PCOS) induced by Letrozole, the inhibition of hepatic synthesis, promotion of ovarian follicle immaturity, and elevation of androgen secretions result in an increase in the weight of the liver and ovaries. The weight of endocrine organs exhibited a decrease across all treatment groups. The histopathological examination of PCOS specimens revealed an increased presence of cysts and theca lutein cells. The group of rats with polycystic ovary syndrome (PCOS) that did not receive treatment exhibited a higher number of cysts compared to the groups that received treatment. Conclusion This study demonstrated that the administration of Letrozole orally resulted in the development of polycystic ovarian disease. The results indicated heightened levels of blood glucose, total cholesterol, and triglycerides, as well as alterations in hormone levels such as increased testosterone and estrogen, and decreased progesterone. These hormonal changes were accompanied by menstrual irregularities, which were confirmed through the examination of vaginal smears and histopathological analysis of the ovaries in the control group with polycystic ovarian disease. The treatment groups that received Agaricus subrufescens exhibited a decrease in blood glucose, total cholesterol, and testosterone levels.

Cloud computing is an immensely complex, huge-scale, and highly diverse computing platform that allows the deployment of highly resource-constrained scientific and personal applications. Resource provisioning in cloud computing is difficult because of the uncertainty associated with it in terms of dynamic elasticity, rapid performance change, large-scale virtualization, loosely coupled applications, the elastic escalation of user demands, etc. Hence, there is a need to develop an intelligent framework that allows effective resource provisioning under uncertainties. The Indetermsoft set is a promising mathematical model that is an extension of the traditional soft set that is designed to handle uncertain forms of data. The D* extra lite algorithm is a dynamic heuristic algorithm that makes use of the history of knowledge from past search experience to arrive at decisions. In this paper, the D* extra lite algorithm is enabled with the Indetermsoft set to perform proficient resource provisioning under uncertainty. The experimental results show that the performance of the proposed algorithm is found to be promising in performance metrics such as power consumption, resource utilization, total execution time, and learning rate. The expected value analysis also validated the experimental results obtained.

Task scheduling is a critical challenge in cloud computing systems, greatly impacting their performance. Task scheduling is a nondeterministic polynomial time hard (NP-Hard) problem that complicates the search for nearly optimal solutions. Five major uncertainty parameters, i.e., security, traffic, workload, availability, and price, influence task scheduling decisions. The primary rationale for selecting these uncertainty parameters lies in the challenge of accurately measuring their values, as empirical estimations often diverge from the actual values. The integral-valued Pythagorean fuzzy set (IVPFS) is a promising mathematical framework to deal with parametric uncertainties. The Dyna Q+ algorithm is the updated form of the Dyna Q agent designed specifically for dynamic computing environments by providing bonus rewards to non-exploited states. In this paper, the Dyna Q+ agent is enriched with the IVPFS mathematical framework to make intelligent task scheduling decisions. The performance of the proposed IVPFS Dyna Q+ task scheduler is tested using the CloudSim 3.3 simulator. The execution time is reduced by 90%, the makespan time is also reduced by 90%, the operation cost is below 50%, and the resource utilization rate is improved by 95%, all of these parameters meeting the desired standards or expectations. The results are also further validated using an expected value analysis methodology that confirms the good performance of the task scheduler. A better balance between exploration and exploitation through rigorous action-based learning is achieved by the Dyna Q+ agent.

To effectively apply various soil types for embankments, understanding their compaction characteristics is crucial. One crucial factor affecting compaction is suction, which plays a significant role as it is typically performed under unsaturated conditions. Suction varies with soil density, water content, and fines content. This study directly measures suction after soil compaction using the triaxial apparatus, unlike the Soil water characteristic curve (SWCC), assessing its impact on compaction characteristics. Immediate suction measurement after compaction provides apparent suction, resembling on-site conditions with open pore air pressure. Comparing SWCC with apparent suction at each compacted state reveals that suction and air entry value increase with initial density, positively impacting compaction. Notably, apparent suction aligns better with wetting process suction from the SWCC due to added water during specimen preparation. Empirical equations are derived to obtain suction contours across various density and saturation ranges, aiding in understanding suction variations on the compaction curve. Even slight variations in saturation causes noticeable changes in apparent suction during higher compaction efforts, affecting soil compaction characteristics. Therefore, the precise control of saturation control is needed to achieve desired properties of compacted soil, especially at higher compaction efforts and with various soil types. This understanding significantly impacts the mechanical behavior of unsaturated soils.

Abstract Background Autism spectrum disorder (ASD) affects 1 in 100 children globally with a rapidly increasing prevalence. To the best of our knowledge, no data exists on the genetic architecture of ASD in India. This study aimed to identify the genetic architecture of ASD in India and to assess the use of whole exome sequencing (WES) as a first-tier test instead of chromosomal microarray (CMA) for genetic diagnosis. Methods Between 2020 and 2022, 101 patient-parent trios of Indian origin diagnosed with ASD according to the Diagnostic and Statistical Manual, 5th edition, were recruited. All probands underwent a sequential genetic testing pathway consisting of karyotyping, Fragile-X testing (in male probands only), CMA and WES. Candidate variant validation and parental segregation analysis was performed using orthogonal methods. Results Of 101 trios, no probands were identified with a gross chromosomal anomaly or Fragile-X. Three (2.9%) and 30 (29.7%) trios received a confirmed genetic diagnosis from CMA and WES, respectively. Amongst diagnosis from WES, SNVs were detected in 27 cases (90%) and CNVs in 3 cases (10%), including the 3 CNVs detected from CMA. Segregation analysis showed 66.6% (n = 3 for CNVs and n = 17 for SNVs) and 16.6% (n = 5) of the cases had de novo and recessive variants respectively, which is in concordance with the distribution of variant types and mode of inheritance observed in ASD patients of non-Hispanic white/ European ethnicity. MECP2 gene was the most recurrently mutated gene (n = 6; 20%) in the present cohort. Majority of the affected genes identified in the study cohort are involved in synaptic formation, transcription and its regulation, ubiquitination and chromatin remodeling. Conclusions Our study suggests de novo variants as a major cause of ASD in the Indian population, with Rett syndrome as the most commonly detected disorder. Furthermore, we provide evidence of a significant difference in the diagnostic yield between CMA (3%) and WES (30%) which supports the implementation of WES as a first-tier test for genetic diagnosis of ASD in India.

Abstract Background Breast cancer has been reported to occur synchronous with ovarian, endometrial and even colon cancers. A synchronous renal cancer is rare. And its association with RAD 50 mutation is not known. Case presentation We are reporting a 42 year old lady who was evaluated for a breast lump and was incidentally found to have a renal lesion. She underwent surgery for both and was found to have a T1c breast tumour and a renal cell carcinoma-clear cell variant. She was advised germline testing with next generation sequencing and multiplex ligation—dependent probe amplification due to synchronous tumours and age at diagnosis. It revealed a likely pathogenic variant in the RAD 50 gene. Conclusion The RAD 50 gene is part of the MRN complex (Mre11, Rad50 and Nbs1 also known as nibrin), which is essential for DNA repair. The recommendations for follow-up and screening are not clear for patients with a pathogenic variant of the gene. This case is presented for its rarity.

Abstract Introduction The COVID‐19 pandemic revealed numerous barriers to effectively managing public health crises, including difficulties in using publicly available, community‐level data to create learning systems in support of local public health decision responses. Early in the COVID‐19 pandemic, a group of health care partners began meeting to learn from their collective experiences. We identified key tools and processes for using data and learning system structures to drive equitable public health decision making throughout different phases of the pandemic. Methods In fall of 2021, the team developed an initial theory of change directed at achieving herd immunity for COVID‐19. The theoretical drivers were explored qualitatively through a series of nine 45‐min telephonic interviews conducted with 16 public health and community leaders across the United States. Interview responses were analyzed into key themes to inform potential future practices, tools, and systems. In addition to the interviews, partners in Dallas and Cincinnati reflected on their own COVID‐19 experiences. Results Interview responses fell broadly into four themes that contribute to effective, community driven responses to COVID‐19: real‐time, accessible data that are mindful of the tension between community transparency and individual privacy; a continued fostering of public trust; adaptable infrastructures and systems; and creating cohesive community coalitions with shared alignment and goals. These themes and partner experiences helped us revise our preliminary theory of change around the importance of community collaboration and trust building and also helped refine the development of the Community Protection Dashboard tool. Conclusions There was broad agreement amongst public health and community leaders about the key elements of the data and learning systems required to manage public health responses to COVID‐19. These findings may be informative for guiding the use of data and learning in the management of future public health crises or population health initiatives.

Purpose Present work aims at studying the influence of active (using external aerator) and passive (natural) aeration on composting of household biodegradable wastes. Methods To study the suitability of these reactors to household conditions, continuous loading was carried out for a period of 60 days. Both the reactors were loaded with cooked as well as raw vegetable and fruit waste. Physico-chemical parameters such as temperature, pH, C/N ratio, moisture content, total organic content, Total Kjeldahl Nitrogen and seed-germination parameters such as Germination Index (GI) and Root Length Index (RLI) of the mulch were analyzed at different stages of the composting process. Results Results confirmed that, although both types of aeration seem to have performed well under continuous loading, the maturation period required for actively aerated reactor was 37.30% lesser than that of naturally aerated reactor. Conclusion Active aeration found to be more suitable to household conditions as odor and fly nuisance was relatively less.

Background. Amoxicillin trihydrate possesses poor solubility, compressibility, and flow behavior. Amorphous solid dispersion prepared by spray drying could solve all three problems at the same time. Objective. To prepare amorphous solid dispersion after screening of polymers by solvent casting method using a spray drying method. Methods. The solvent casting method was used to screen polymers, PVP/VA S-630, PVP K30, Soluplus, PEG 4000, HPMC AS, and HPMC HP55, in 1 : 1 and 2 : 3 ratios and followed by spray drying after polymer selection. Results. The dissolution performance of the formulation improved with time. The optimum feed rate and feed concentration were found to have an impact on the flow properties and particle size of spray-dried formulations, and they were selected as independent variables in a 32 full factorial statistical design. The ANOVA and regression analysis suggest that the developed regression model has a significant overall fit to the data and can explain a substantial proportion of the variability in the dissolution at 10 minutes. The optimized batch was selected based on the decisive factors of minimum and maximum values of response variables. Overall, the optimized batch demonstrated improved characteristics in terms of percentage yield (32.81%), dissolution at 10 min (49.70%), and angle of repose at 31.42°. Conclusion. This study provides valuable insights into optimizing formulation strategies for preserving the amorphous state of drugs and contributes to the development of stable pharmaceutical formulations.

ABSTRACTNeutrophil dysregulation is well established in COVID-19. However, factors contributing to neutrophil activation in COVID-19 are not clear. We assessed if N-formyl methionine (fMet) contributes to neutrophil activation in COVID-19. Elevated levels of calprotectin, neutrophil extracellular traps (NETs) and fMet were observed in COVID-19 patients (n = 68), particularly in critically ill patients, as compared to HC (n = 19, p

Fog computing is one of the emerging forms of cloud computing which aims to satisfy the ever-increasing computation demands of the mobile applications. Effective offloading of tasks leads to increased efficiency of the fog network, but at the same time it suffers from various uncertainty issues with respect to task demands, fog node capabilities, information asymmetry, missing information, low trust, transaction failures, and so on. Several machine learning techniques have been proposed for the task offloading in fog environments, but they lack efficiency. In this paper, a novel uncertainty proof Type-2-Soft-Set (T2SS) enabled apprenticeship learning based task offloading framework is proposed which formulates the optimal task offloading policies. The performance of the proposed T2SS based apprenticeship learning is compared and found to be better than Q-learning and State-Action-Reward-State-Action (SARSA) learning techniques with respect to performance parameters such as total execution time, throughput, learning rate, and response time.

Software Defined Networking (SDN) has been a prominent technology in the last decade that increases networking programmability. The SDN philosophy decouples the application, control, and data plane to increase the network programmability. The data plane is an essential but unsolved component that receives less attention than control and application planes. Traditionally, the data plane uses fixed functions that forward packets using a limited number of protocols. The P4 (Programming Protocol-independent Packet Processors) language makes it possible to program SDN data plane, which push the SDN to the next level. In the research community and industry, programming the data plane has garnered significant attention. Surprisingly, there has been no comprehensive reviews of programmable data-plane switches, which have many advantages in today’s networks. The authors reviewed the evolution of networks from legacy to programmable data planes, explained the fundamentals of programmable switches, and summarized the network generation from traditional to programmable networks. In this paper, SDN is described from a P4-centric standpoint and discusses over 75 related research papers. Several taxonomies for the field are provided, outline potential research areas, and provide greater details regarding the patterns that have led to the development of this technology.

The prevalence of coronavirus disease-2019 (COVID-19) is about 2% in children. Varied manifestations including pneumonia, myocarditis, and multisystem inflammatory syndrome, namely is commonly seen in children. Aortic pseudoaneurysm due to COVID-19 is rare and carries a poor prognosis. We came across a 5-year-girl who had presented with heart failure due to a large ascending aortic pseudoaneurysm associated with COVID-19 during the first wave of the pandemic. The patient underwent successful surgical repair.

Background: Lumbar discectomy is performed for symptomatic lumbar disc herniation and is one of the most widely performed spinal surgical procedures worldwide in a variety of ways. This survey aimed at providing an overview/perspective of different practice patterns and the impact of lumbar discectomy on axial back pain with or without sciatica. Methods: An online survey was performed using the application “Google Forms.” The link to the questionnaire was distributed to neurosurgeons through personal E-mail and social media platforms. Results: We received 333 responses. The largest percentage of responses across five continents was from Asia (66.97%, n = 223). The mean age of the respondents was 40.08 ± 10.5 years. A total of 66 respondents (20%) had a spine practice of 7%–90%, and 28 respondents had a spine practice of 90%–100% (8.4%). The number of respondents who practiced microscopic discectomy using a tubular retractor (n = 143 respondents, 42.9%) was nearly equal to the number of respondents who practiced open discectomy (n = 142 respondents, 42.6%). An almost equal proportion of respondents believed discectomy does not help in relieving axial back pain. Only 20.4% (n = 68) of respondents recommend bed rest for a longer duration postoperatively. Conclusions: Our survey revealed that only 22.2% of spine surgeons recommended discectomy in patients with radiological disc herniation with axial back pain alone and preferred a minimally invasive method of discectomy. Almost half of them believed discectomy to be ineffective for axial low back pain and only a few recommended prolonged bed rest postoperatively.

Objective. The present study was directed to assess the correlation between leukocyte and platelet indices and microvascular complications in patients with type 2 diabetes mellitus (T2DM).

Objective: The objective of the study is to demonstrate that with the use of artificial intelligence (AI) in computed tomography (CT), radiation doses of CT kidney-ureter-bladder (KUB) and CT urogram (CTU) can be reduced to less than that of X-ray KUB and CT KUB, respectively, while maintaining the good image quality. Materials and Methods: We reviewed all CT KUBs (n = 121) performed in September 2019 and all CTUs (n = 74) performed in December 2019 at our institution. The dose length product (DLP) of all CT KUBs and each individual phase of CTU were recorded. DLP of each scan done with new scanner (Canon Aquilion One Genesis with AiCE [CAOG]) which uses AI and deep learning reconstruction (DLR) were compared against traditional non-AI scanner (GE OPTIMA 660 [GEO-660]). We also compared DLPs of both scanners against the United Kingdom, National Diagnostic Reference Levels (NDRL) for CT. Results: One hundred and twenty-one patient's CT KUBs and 74 patient's CTUs were reviewed. For CT KUB group, the mean DLP of 81/121 scans done using AI/DLR scanner (CAOG) was 77.8 mGy cm (1.16 mSv), while the mean DLP of 40/121 CT KUB done with GEO-660 was 317.1 mGy cm (4.75 mSv). For CTU group, the mean DLP for 46/74 scans done using AI/DLR scanner (CAOG) was 401.9 mGy cm (6 mSv), compared to mean DLP of 1352.6 mGy cm (20.2 mSv) from GEO-660. Conclusion: We propose that CT scanners using AI/DLR method have the potential of reducing radiation doses of CT KUB and CTU to such an extent that it heralds the extinction of plain film XR KUB for follow-up of urinary tract stones. To the best of our knowledge, this is the first study comparing CT KUB and CTU doses from new scanners utilizing AI/DLR technology with traditional scanners using hybrid iterative reconstruction technology. Moreover, we have shown that this technology can markedly reduce the cumulative radiation burden in all urological patients undergoing CT examinations, whether this is CT KUB or CTU.

Light chain (AL) amyloidosis is a lethal form of systemic amyloidosis that arises from the clonal expansion of CD38+ plasma cells. Organ damage occurs when these plasma cells produce misfolded immunoglobulin light chains, which form amyloid fibrils and deposit in tissues. A minority of patients with AL amyloidosis show “raccoon eyes” caused by increased vascular fragility from accumulation of amyloid fibrils. Amyloidosis can be directly associated with bleeding diathesis due to factor X deficiency as factor X binds to amyloid fibrils primarily in the liver and spleen. A 65-year-old Caucasian male presented with random bruising in the upper chest and around the eyes for 1.5 years. Physical examination was unremarkable, except for neck bruising. Pertinent workup showed protein electrophoresis with a faint M spike, increased serum lambda light chains, a kappa to lambda ratio of 0.06, increased Bence-Jones proteins, reduced factor X activity, elevated NT-proBNP. The bone marrow biopsy was positive for Congo red stain for amyloid protein. Magnetic resonance imaging revealed diffuse enhancement of the right and left ventricle subendocardial late gadolinium, consistent with cardiac amyloidosis. The patient started systemic therapy with a regimen of daratumumab, cyclophosphamide, bortezomib, and dexamethasone. After one cycle of therapy, lambda light chains normalized with an improvement in bruising. Diagnostic delays for cardiac patients are concerning as the median survival rate among these patients, when not treated, is approximately 6 months after the onset of symptoms. Since timely treatment can prevent organ damage, clinicians should be aware of specific clinical signs such as raccoon eyes and the importance of systemic evaluation for a prompt diagnosis.

Abstract Additive manufacturing, also called 3D printing, has the potential to enable the development of flexible, wearable and customizable batteries of any shape, maximizing energy storage while also reducing dead-weight and volume. In this work, for the first time, three-dimensional complex electrode structures of high-energy density LiNi1/3Mn1/3Co1/3O2 (NMC 111) material are developed by means of a vat photopolymerization (VPP) process combined with an innovative precursor approach. This innovative approach involves the solubilization of metal precursor salts into a UV-photopolymerizable resin, so that detrimental light scattering and increased viscosity are minimized, followed by the in-situ synthesis of NMC 111 during thermal post-processing of the printed item. The absence of solid particles within the initial resin allows the production of smaller printed features that are crucial for 3D battery design. The formulation of the UV-photopolymerizable composite resin and 3D printing of complex structures, followed by an optimization of the thermal post-processing yielding NMC 111 is thoroughly described in this study. Based on these results, this work addresses one of the key aspects for 3D printed batteries via a precursor approach: the need for a compromise between electrochemical and mechanical performance in order to obtain fully functional 3D printed electrodes. In addition, it discusses the gaps that limit the multi-material 3D printing of batteries via the VPP process.

Effective load balancing is tougher in grid computing compared to other conventional distributed computing platforms due to its heterogeneity, autonomy, scalability, and adaptability characteristics, resource selection and distribution mechanisms, and data separation. Hence, it is necessary to identify and handle the uncertainty of the tasks and grid resources before making load balancing decisions. Using two potential forms of Hidden Markov Models (HMM), i.e., Profile Hidden Markov Model (PF_HMM) and Pair Hidden Markov Model (PR_HMM), the uncertainties in the task and system parameters are identified. Load balancing is then carried out using our novel Fuzzy Neutrosophic Soft Set theory (FNSS) based transfer Q-learning with pre-trained knowledge. The transfer Q-learning enabled with FNSS solves large scale load balancing problems efficiently as the models are already trained and do not need pre-training. Our expected value analysis and simulation results confirm that the proposed scheme is 90 percent better than three of the recent load balancing schemes.