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Griscelli syndrome is a rare autosomal recessive disorder characterised by pigmentary dilution of skin and hair, recurrent skin and pulmonary infections, neurological manifestations, and immunodeficiency. We present a four-month-old female child with hypopigmented silvery hair and a history of recurrent hospitalisations for respiratory illness. The child was extensively evaluated for inborn errors of immunity (IEI), and the final diagnosis of type 2 Griscelli syndrome was made only after genetic testing. Antibiotic and antifungal prophylaxis was initiated, and the child is currently in good health. The family was counselled regarding haematopoietic stem cell transplant (HSCT) as the only curative option and the need for prenatal testing in further pregnancies. This case emphasises the need for a high index of clinical suspicion in diagnosing IEI and also highlights the limited therapeutic options and the role of genetic counselling., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kundavaram et al.)

Investigation of the secondary metabolites of the filamentous fungus Talaromyces stipitatus led to the isolation of two new phenalenone dimers, talarohemiketal A ( 1 ) and talaroazasone A ( 2 ), and one new macrolide polyester, talaromacrolactone A ( 3 ), along with the reported oxyphenalenone dimers talaromycesone A ( 4 ), bacillisporin A ( 5 ), bacillisporin B ( 6 ), bacillisporin C ( 7 ), epi -bacillisporin F ( 8 ), and bacillisporin J ( 9 ), the phenalenone monomer funalenone ( 10 ), the polyesters 15G256α ( 11 ) and 15G256ν ( 12 ), and 6-hydroxymellein ( 13 ). Detailed analysis of 2D NMR correlations, supported by TDDFT calculations, led to the structural revision of talaromycesone A as 4 from previously reported structure 14 . In addition, the previously misassigned NMR spectra of compound 8 have been corrected.

Background Doxorubicin is an important drug used in the treatment of children with acute leukemia, and cardiotoxicity is the most serious complication due to its use. The cardiac dysfunction due to doxorubicin can be acute, early, or late. Echocardiography is a non-invasive tool and can be employed to detect clinical and subclinical cardiac dysfunction and plan treatment strategies accordingly. Materials and methods Twenty-eight children with acute lymphoblastic leukemia were enrolled. Echocardiography was done at baseline and 72 h after induction dose of doxorubicin. Conventional and tissue Doppler imaging parameters were obtained and compared. Results After the induction dose of doxorubicin, both ventricles developed systolic and diastolic dysfunction. Tricuspid annular plane systolic excursion significantly decreased after doxorubicin (20.0±4.95 mm vs. 19.40±4.90 mm). Right ventricular myocardial performance index and isovolumetric relaxation times increased after doxorubicin (0.38±0.08 vs. 0.41±0.08 and 41.4±1.8 ms vs. 43.1±12.6 ms, p<0.05, respectively). Tricuspid E velocity decreased (62.3±8.35 cm/s vs. 60.1±7.34 cm/s, p<0.01) as well as tricuspid E/A ratio after doxorubicin (1.54±0.26 vs. 1.40±0.23, p<0.01). The left ventricular fractional shortening and ejection fraction decreased after doxorubicin (32.1±2.26% vs. 31.4±2.27% and 64.60±4.69% vs. 63.10±4.63%, respectively). Left ventricular myocardial performance index and isovolumetric relaxation times were increased after doxorubicin (0.44±0.05 vs. 0.46±0.06 and 58.6±8.75 ms vs. 60.3±10.1 ms, respectively). Mitral E velocity is reduced (85.6±11.3 cm/s vs. 83±11.9 cm/s) and tricuspid E/A ratio is also reduced after doxorubicin (1.78±0.43 vs. 1.63±0.39). Conclusion Both systolic and diastolic dysfunctions are seen after doxorubicin. Echocardiography should be employed for early diagnosis of clinical and subclinical cardiac dysfunction and timely initiation of management to prevent progression., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Human Ethics Committee-Student Research (IHEC-SR) of All India Institute of Medical Sciences, Bhopal issued approval #IHEC/SR/2024/116. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kundavaram et al.)

Aquifer pollution by metal-antibiotic complexes is a rising environmental and public health concern owing to their enhanced mobility and persistence in groundwater. The purpose of this review is to examine the origins, transport dynamics, and ecological impacts of complexes formed through interactions between metal ions and antibiotics in agricultural runoff, pharmaceutical effluents, and wastewater discharge. Metal-antibiotic complexes are more resistant to degradation and are more soluble than their components. This complicates the conventional water purification efforts. These complexes disrupt microbial ecosystems, facilitate the spread of antibiotic-resistance genes, and negatively affect aquatic organisms. The entry of pollutants into drinking water sources poses notable health risks, including chronic exposure to contaminants and the emergence of antibiotic-resistant pathogens. This review emphasizes both preventative and remedial strategies to mitigate these impacts. Preventative measures emphasize the regulation of antibiotic and metal use in agriculture and industry and promote green chemistry alternatives. Remediation approaches include advanced treatment technologies such as membrane filtration, oxidation, and bioremediation. Integrated management practices and ongoing monitoring were discussed to address this complex issue. To protect water quality and public health, metal-antibiotic complexes in aquifers require stringent regulatory measures, innovative treatment solutions, and heightened public awareness. This review highlights the importance of coordinated efforts to prevent and remediate the emerging pollution problem., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Wound healing is a complex, highly regulated process that is important in sustaining the skin barrier function. The etiologic relation of specific metals is not adequately described for chronic non-healing wounds. The aim of this study was to estimate heavy and trace metals in chronic non-healing wound and their association with wound healing . The levels of zinc, selenium, copper, magnesium, chromium, cadmium, iron, and lead were estimated in serum of chronic non-healing wound patients using atomic absorption spectrophotometry. The tests were carried out in 50 patients with chronic non-healing wound and thirty healthy volunteers as control. The serum levels of elements namely zinc, selenium, copper, magnesium, and chromium were significantly reduced in chronic non-healing wounds ( P  < .001) as compared to control. Lead and cadmium levels had shown the significantly increasing trend in chronic non-healing wound cases ( P  < .001). The present study demonstrated a significant decrease in serum, levels of selenium, zinc, copper, magnesium, iron, and chromium levels in patients with chronic non-healing wound indicating an association between these elements and wound healing. To summarize the findings of our research, hence trace elements were decreasing in chronic non-healing wound patients suggesting their role in wound healing., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Plant-mediated synthesis of silver nanoparticles (AgNPs) is an eco-friendly and convenient alternative to conventional methods. Brassaiopsis hainla (B. hainla) leaf extract (BHE) was used in this study to reduce metal salts and cap and stabilize nanoparticles (NPs), which were characterized and tested for antibacterial and anti-corrosion properties. Stirring the B. hainla extract with AgNO 3 led to a color change, indicating nanoparticle formation. The absorption peak at 428 nm in the UV-visible spectrum further validated its formation. The AgNPs were characterized using various techniques such as FTIR, UV-visible, PXRD, HRTEM, SEM, and EDX. Powder X-ray diffraction analysis confirmed its nanocrystalline nature, with an average crystallite size of 17.92 nm. The FTIR spectrum showed hydroxyl, amine, amide, and carbonyl groups as capping and reducing agents for the AgNPs. SEM analysis revealed poly-dispersed NPs of various sizes, while EDX showed an intense peak for Ag, and TEM images revealed mostly hexagonal and triangular NPs. Antibacterial activity was tested against three human pathogens: Staphylococcus aureus (S. aureus), Pseudomonas, and Klebsiella oxytoca (K. oxytoca). Significant antibacterial activity was observed specifically against K. oxytoca , with an 11 mm inhibition zone. Both plant extracts and AgNPs inhibited acid-induced corrosion, with the highest inhibition efficiencies of 81.69 % and 69.54 % at 1000 ppm, respectively. With rising concerns over bacterial resistance and metal corrosion, this study addresses global challenges related to new antimicrobial agents, which are crucial for combating antibiotic resistance and protecting metals in various industries., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: The high prevalence of osteoporosis has increased the economic burden on the health system globally. The burden of osteoporosis and its associated factors have not been adequately assessed in community settings in the Nepalese context thus far. Therefore, this study aimed to assess the prevalence of osteoporosis and its associated factors, lifestyle behaviors, and dietary calcium intake., Methods: A community-based cross-sectional study was conducted among 395 people aged 50 years and older in the Madhesh Province of Nepal between July 2022 and August 2023. The Osteoporosis Self-assessment Tools for Asians (OSTA) index was used to measure osteoporosis. A structured questionnaire was used to collect sociodemographic information, anthropometric data, lifestyle behavior, daily dietary calcium intake, and frequency of calcium-rich food consumption. A food frequency questionnaire and 24-hour recall methods were used to assess dietary intake. The chi-square test, binary logistic regression and Mann‒Whitney U test were applied to measure the association between predictors and the outcome of interest., Results: The prevalence of no risk, moderate risk and high risk of osteoporosis were 38.7%, 39%, and 22.3% respectively. The risk of osteoporosis was higher in females (aOR = 5.18, CI: 2.10-12.75, p < 0.001) and increased risk with advancing age (aOR = 32.49, CI: 14.02-75.28, p < 0.001). Similarly, underweight was associated with increased odds of having osteoporosis (aOR = 13.42, CI = 4.58-39.30, p < 0.001). The incidence of osteoporosis was strongly associated with daily calcium intake of 225 mg (100, 386)., Conclusion: This study revealed a high prevalence of osteoporosis among people aged 50 years and older due to the combined effect of being underweight and having inadequate calcium intake. Nutritional counselling services encourage people to consume sufficient calcium-rich food and adopt an appropriate lifestyle behaviours to maintain healthy body weight so that osteoporosis and osteoporotic fractures could be prevented. Further research can explore the impact of socioeconomic status and medical comorbidities on a large scale., (© 2024. The Author(s).)

Background: Sickle cell disease (SCD) is the commonest inherited blood disorder leading to complications occurring due to vaso-occlusion including sight-threatening retinopathy. Retinopathy can be managed if diagnosed early and vision loss can be prevented. Since, very less data are available from India, hence, this study was conducted in children (7-18 years) with SCD to diagnose retinopathy by using ocular coherence tomography (OCT) in subclinical stages., Methods: This cross sectional single-center study was performed in 7-18 years age group children with SCD without any visual symptoms. Enrolled participants underwent complete ophthalmological examination including macula and optic disc thickness measurements using Cirrus HD-OCT and results were analyzed., Results: Among 55 participants, none had visual impairment. Significant fundoscopy finding (nonproliferative sickle cell retinopathy/NPSR) was found in three patients (5.4%), thinning of central macula in four patients (7.27%), inner macula thinning in eight patients (14.5%), outer macula thinning in one patient (1.81%), retinal nerve fiber layer thinning in five patients (9%), ganglion cell layer to inner plexiform layer thinning in eight patients (14.54%). Overall NPSR was found in 5.4% patients detected with fundoscopy, whereas retinal layer thinning was found in 14 patients (25.4%) using OCT., Conclusion: Despite of the significant prevalence of SCR, it is still underdiagnosed complication, leading to thinning of the retina from early ages; thus, its early diagnosis by regular screening using newer diagnostic methods can prevent progression to sight-threatening complications and provide better quality of life for these patients., (© 2024 Wiley Periodicals LLC.)

A case-control study of sporadic amyotrophic lateral sclerosis (ALS) in a mountainous village in the French Alps discovered an association of cases with a history of eating wild fungi (false morels) collected locally and initially identified and erroneously reported as Gyromitra gigas . Specialist re-examination of dried specimens of the ALS-associated fungi demonstrated they were members of the G. esculenta group, namely G. venenata and G. esculenta , species that have been reported to contain substantially higher concentrations of gyromitrin than present in G. gigas . Gyromitrin is metabolized to monomethylhydrazine, which is responsible not only for the acute oral toxic and neurotoxic properties of false morels but also has genotoxic potential with proposed mechanistic relevance to the etiology of neurodegenerative disease. Most ALS patients had a slow- or intermediate-acetylator phenotype predicted by N - acetyltransferase-2 ( NAT2 ) genotyping, which would increase the risk for neurotoxic and genotoxic effects of gyromitrin metabolites., Competing Interests: None., (© 2024 The Authors. Published by Elsevier B.V.)

Autoimmune hemolytic anemia (AIHA) is an acquired hemolysis caused by one's immune system targeting red blood cell surface antigens, resulting in a shortening of the normal red-cell lifespan of 120 days. In this case report, we present an unusual case of a middle-aged woman with no known autoimmune diseases. After ruling out all other possible etiologies, she was later diagnosed with AIHA about two months after receiving her first dose of the Oxford-AstraZeneca COVID-19 vaccine (COVISHIELD). We discuss the possible underlying cause, the COVID-19 vaccine, for the precipitation of AIHA. The importance of identifying rare adverse events that could occur during mass vaccination is highlighted in this case. The patient was treated with oral steroids and received three blood transfusions. She was discharged after 21 days from the hospital and followed up after six months with no relapse., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Chaudhary et al.)

Background: Human oral cavity contains many microorganisms, the habitat of which may be changed by complete denture among edentulous people. The complete dentures favor aggregation of microorganism. The aim of this study was to identify the microorganisms present in the complete dentures of old age people of Chitwan and assess the sensitivity pattern of the microorganisms to the common antibiotics., Methods: A descriptive cross-sectional study was conducted at Chitwan Medical College, Chitwan, Nepal among 45 old age people who have been wearing dentures above one year. The duration of the study was from 18th Nov 2021 to 12th May 2022. Swab was taken from the polished and tissue surfaces of both maxillary and mandibular dentures in the Department of Prosthodontics while the laboratory-based experiments were conducted in the Department of Microbiology. Antibiotic sensitivity was also done. The data was analyzed using Statistical Package for Social Science (SPSS) version 16.0. Descriptive statistics were used. The data was presented in form of frequency, percentage, mean and standard deviation., Results: Streptococcus spp. was predominant microorganism followed by Coagulase-negative Staphylococci and Staphylococcus aureus. The highest sensitivity pattern was observed to Amikacin, Nalidixic acid and Ciprofloxacin while the most resistant antibiotics were Amoxicillin/clavulanic acid and Cefixime. Escherichia coli was sensitive to all the tested antibiotics., Conclusions: In this study, Streptococcus spp. followed by Coagulase-negative Staphylococci and Staphylococcus aureus were the most frequently identified microorganisms from the dentures of old age people. Amikacin, Nalidixic acid and Ciprofloxacin were highly sensitive among the people of old age.

This manuscript reports a dataset for the scanning electron microscopy with energy dispersive X-ray analysis (SEM-EDX), surfactant properties, thermokinetics, and corrosion inhibition activity of [[Co(HL) 2 .2H 2 O] Cl 2 .H 2 O]] ( 1 ) and [[Zn(HL) 2 .Cl] Cl.3H 2 O]] ( 2 ) complexes with surfactant-based Schiff base ligand ( HL ). It contains analyzed data related to thermokinetics, such as the activation energy ( E* ), entropy change (∆ S* ), enthalpy change (∆ H* ), and free energy change (∆ G* ) of HL and metal complexes. It also contains the SEM micrographs and EDX images of the studied ligand and metal complexes. A detailed analysis of the critical micelle concentration (CMC) data and figures illustrating the surfactant behavior of the synthesized complexes are presented in this article. The data for the corrosion inhibition activity of all synthesized compounds are also included. The dataset is related to the research article entitled "Bioinorganic interest on Co(II) and Zn(II) complexes of pyrrole-based surfactant ligand: Synthesis, characterization, and in silico-ADME study"., Competing Interests: The authors declare no competing financial interests or personal relationships that could influence the study reported in this article., (© 2023 The Author(s).)

Background: Plantar fasciitis (PF) is a common orthopaedic problem, with heel pain worsening the quality of life. Although steroid injection is often used if the conservative treatment fails, Platelet-Rich Plasma (PRP) injection is gaining popularity due to its safety and long-lasting effect. However, the effect of PRP versus steroid injection in PF has not been studied yet in Nepal. Therefore, this study aimed to assess the effect of PRP compared with steroid injection in the treatment of PF., Methods: This study was a single-center, hospital-based, open-label, parallel-group randomized clinical trial to compare the effect of PRP injection with steroid injection in plantar fasciitis between August 2020 and March 2022. A total of 90 randomly selected participants aged 18 to 60 years suffering from plantar fasciitis with failed conservative treatment were intervened. The American Orthopaedic Foot and Ankle Society (AOFAS) and the Visual Analog Scale (VAS) scoring system were used to evaluate functional mobility and pain before and after the intervention for three and six months, respectively. Statistical analyses were performed using a Student's two-sample t-test. P-value < 0.05 was considered statistically significant., Results: The PRP injection showed a better outcome than the steroid injection in six months follow-up. The mean (± SD) VAS score was significantly decreased in the PRP group (1.97 + 1.13) than in the steroid group (2.71 ± 0.94) with the group difference of -0.73 (95% CI: -1.18 to -0.28) at six months. Similarly, there was a significant increase in the AOFAS scores in the PRP group (86.04 ± 7.45) compared to the steroid group (81.23 ± 9.60) at six months of follow-up with a group difference of 4.80 (95% CI: 1.15 to 8.45). There was also a significant reduction of plantar fascia thickness in the PRP group compared to that of the steroid group (3.53 ± 0.81 versus 4.58 ± 1.02) at six months of follow-up with the group difference of -1.04 (95% CI: -1.44 to -0.65)., Conclusion: The PRP injection showed better outcomes than steroid injection in plantar fasciitis treatment over the course of six months. Further research with a larger population and longer follow-up than six months is needed to generalize the findings and their long-term efficacy., Trial Registration: NCT04985396. First registered on 02 August 2021. ( https://clinicaltrials.gov/ct2/show/NCT04985396 )., (© 2023. The Author(s).)

Background: Child feeding practices during the first two years of life are crucial to ensure good health and nutrition status. This study aimed to assess the factors influencing inappropriate child feeding practices in children aged 6 - 23 months in families receiving nutrition allowance in the remote Mugu district, Nepal., Methods: A community-based cross-sectional study was conducted among 318 mothers who had children aged 6 - 23 months of age in the seven randomly selected wards. Systematic random sampling technique was used to select the desired number of respondents. Data were collected using pre-tested semi-structured questionnaire. Bivariate and multivariable binary logistic regression was used to estimate crude odds ratio (cOR), and adjusted odds ratio (aOR), and 95% confidence intervals (CIs) to understand factor associated with child feeding practices., Results: Almost half of the children aged 6 - 23 months were not consuming a diverse diet (47.2%; 95% CI: 41.7%, 52.7%), did not meet the recommended minimum meal frequency (46.9%; 95% CI: 41.4%, 52.4%) and did not consume minimum acceptable diet (51.7%; 95% CI: 46.1%, 57.1%). Only 27.4% (95% CI: 22.7%, 32.5%) of children met the recommended complementary feeding practices. Multivariable analysis showed maternal characteristics such as mothers who gave birth at home (aOR = 4.70; 95% CI: 1.03, 21.31) and mothers in unpaid employment (aOR = 2.56; 95% CI: 1.06, 6.19) were associated with increased odds of inappropriate child feeding practices. Household economy (i.e. family with < 150 USD monthly income) was also associated with increased odds of inappropriate child feeding practices (aOR = 1.19; 95% CI: 1.05, 2.42)., Conclusion: Despite the receipt of nutritional allowances, child feeding practices among 6 - 23 months children were not optimal. Additional context-specific behavior change strategies on child nutrition targeting mothers may be required., (© 2023. The Author(s).)

Background: Maternal hemoglobin during pregnancy is an important predictor of neonatal outcomes such as birth weight. The newborn weight of an infant is considered a crucial factor for morbidity and mortality. This study aimed to assess the association between maternal hemoglobin concentration and newborn weight at term pregnancy., Methods: A hospital-based cross-sectional study was conducted at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from 14 th April 2018 to 13 th April 2019. Term singleton pregnant women who were admitted for delivery in the labor room of TUTH were included in this study. Maternal characteristics such as age, parity, birth space, ethnicity, education level, dietary habit, body mass index (BMI), and hemoglobin level were recorded. The newborn weight was taken immediately after delivery. The main outcome of this study was the birth weight. The association between hemoglobin level and newborn weight was analyzed using bivariate and multivariable logistic regression analysis., Results: Of 2,418 term pregnant women, the prevalence of low hemoglobin and high hemoglobin levels were 24% (95% CI: 22-25.4), and 17% (95% CI: 15.7-18.7), respectively. The prevalence of low birth weight (LBW) was 12.9% (95% CI: 11.7-14.4). Multivariable logistic regression analysis showed that those mothers who had low hemoglobin concentration (adjusted Odds Ratio/aOR = 3.77, 95% CI: 2.84-5.01), and high hemoglobin concentration (aOR = 3.07, 95% CI: 2.23-4.24) had higher odds of having LBW compared to mothers having normal hemoglobin level. Mothers with both young age pregnancy (aged 16-20 years) and older pregnancy (aged ≥31 years) (aOR = 1.60, 95% CI: 1.01-2.52) and (aOR = 1.60, 95% CI: 1.06-2.41), respectively had higher odds of LBW compared to mothers aged 21-25 years. Those mothers who attended a primary level of education had higher odds of (aOR = 1.93, 95% CI: 1.05-3.55) LBW compared to those mothers with a higher level of education. Moreover, mothers who belonged to Janajati ethnic group (aOR = 0.47, 95% CI: 0.34-0.65) compared to the Brahmin/Chhetri ethnic group, and mothers with a birth space of more than three years (aOR = 0.63, 95% CI: 0.41-0.97) compared to those who had less than three years of birth spacing and mothers who were overweight/obese (aOR = 0.74, 95% CI: 0.55-0.99) compared to normal nutritional status had lower odds of having LBW., Conclusions: Our study concludes that both low and high hemoglobin had an increased risk of having low birth weight. Policies and programs can benefit by adopting the findings of this study. More empirical research is critical to understanding the impact of hemoglobin levels on birth weight., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Bi-maxillary protrusion is a condition with protrusive and proclined upper and lower incisors and the patient is not able to close lips without strain. The presented case reported with the chief complaint of forwardly placed teeth, with skeletal class II malocclusion, and Angle's class I malocclusion with protrusive and forwardly placed upper and lower incisors. The treatment was performed with the extraction of all first premolars and retraction under absolute anchorage. The retraction of upper and lower lips of about 3 mm and 3.5 mm was achieved respectively and the patient was able to close lips without strain. With proper anchorage preparation, bi-maxillary protrusion can be successfully managed orthodontically.

Background: Femur fracture is a major burden among elderly people, leading patients to be bedridden for a long time in the hospital. The body is more likely to be in a catabolic state as a result of the prolonged fasting period required for surgery, leading to an increase in insulin resistance. Pre-operative carbohydrate loading has been shown to improve postoperative outcomes in several countries. The study aimed to evaluate the effect of pre-operative carbohydrate loading in femur fracture surgery., Methods: This study was single-center, hospital-based, open-label, parallel-group randomized controlled trial conducted between August 2020 and November 2021. A total of 66 participants, aged 50 years and above having femur fractures planned for surgery were included in this study and assigned to the control (n = 33) and study (n = 33) groups through computer-generated random numbers. The control group was kept fasting from midnight to the next morning as in existence while the study group was intervened with carbohydrate loading according to the Enhanced Recovery After Surgery (ERAS) protocol. The pre-operative nutritional status was identified and the postoperative outcomes were measured using the Visual Analogue Score (VAS), Cumulative Ambulatory Score (CAS), and Modified Barthel Index (MBI) scoring systems. Statistical analyses were performed using the Chi-square test and the Student's two-sample t-test to compare the outcomes between the two groups., Results: All the participants completed the study. There was a significant reduction in the average postoperative pain in the carbohydrate loading group (VAS: 4.8 (SD ± 1.8), 95% CI: 4.7-5.4) as compared to the control group (VAS: 6.1 (SD ± 2.1), 95% CI: 5.3-6.8). The average CAS showed a significant improvement in regaining the mobility function of participants in the study group (CAS: 8.1 (SD ± 2.8), 95% CI: 7.1-9.1) than that of the control group (CAS: 6.8 (SD ± 2.8), 95% CI: 5.8-7.8). The mean MBI score of the participants at the time of discharge from the hospital was higher in the study group (MBI:13.1 (SD ± 2.3), 95% CI: 12.2-13.9) compared to the control group (MBI: 11.8 (SD ± 3.1), 95% CI:10.6-12.9). Similarly, the length of hospital stay after surgery had decreased in the study group than in the control group., Conclusions: The uptake of carbohydrate loading showed reduced post-operative pain, enhanced functional mobility, and decreased length of hospital stay. This study warrants larger trials to show the effect of pre-operative carbohydrate loading in a clinical setting., Trial Registration: NCT04838366, first registered on 09/042021 ( https://clinicaltrials.gov/ct2/show/NCT04838366 )., (© 2022. The Author(s).)

The structures of five new natural products (GB 27-GB 31, 1 - 5 ), isolated as minor components from the bark of Galbulimima baccata , have been determined by 2D NMR spectroscopy in combination with DFT calculations. Among the alkaloids, GB 31 ( 5 ) belongs to Class I, GB 27 ( 1 ) and 28 ( 2 ) belong to Class II, and GB 30 ( 4 ) belongs to Class III GB alkaloids. GB 31 is the first non-nitrogen-containing GB "alkaloid", being a biosynthetic oxidation product of himbacine, himandravine, or himbeline. GB 29 ( 3 ) has an entirely new natural product scaffold but belongs to Class IV (miscellaneous alkaloids). The isolation of a new Galbulimima scaffold has revealed a new pathway in the biosynthesis of the GB alkaloids. The new molecules isolated have shed further light on the biogenetic relationship among these structurally unique and complex groups of alkaloids. We present, for the first time, a unified biogenesis for the GB alkaloids that were first isolated in the 1950s and now number over 40 examples. This work also brings full circle the story of Galbulimima alkaloids. A life-long project of Wal Taylor involving one of his first students (Lew Mander) and one of his last students (Peter Karuso), a story stretching over six decades, has come to a final conclusion.

Background: Stroke related studies in Nepal are primarily hospital-based and mainly from the capital city., Objectives: We aimed to estimate the prevalence of stroke and stroke risk factors in the South-Western community of Nepal., Methods: A cross-sectional study was conducted from May to August 2018 among 549 randomly selected Nepalese participants from diverse ethnicity, aged ≥15 years, in a region with the availability of neurological support facilities. Data were collected using a stroke questionnaire designed for the purpose. Stroke was identified by enumerators using the Balance-Eyes-Face-Arms-Speech-Time (BEFAST) scale, and a senior neurologist confirmed it. We assessed the presence of major risk factors associated with stroke., Results: The crude and age-standardised prevalence of stroke were 2368 and 2967 per 100,000 respectively. Of all the surveyed participants, 61% (n=335) reported consumption of full-fat dairy products >3 days per week, 87.6% (n=481) reported a high intake of salt (>5 g/day), 83.6% (n=459) with a low intake of fruits and vegetables (<400 g/day), 45.2% (n=248) with perceived stress related to work or home, 51.6% (n=283) with financial stress (283, 51.6%), 86.7% (n=457) with low high-density lipoprotein, 96.2% (n=507) with high blood urea nitrogen, 47.1% (n=356) were either overweight or obese 20.4% (n=112) with hypertension and 6.2% (n=34) with diabetes., Conclusions: The prevalence of stroke in the community of the South-Western part of Nepal is relatively higher than that estimated in South-Asia and global context. Our findings suggest an urgent community intervention, particularly with healthy lifestyles changes for future stroke prevention in the high-risk group., Competing Interests: Declaration of Competing Interest The authors declared no conflict of interest concerning the research, authorship, and/or publication of this article, (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: Scrub typhus is an emerging neglected tropical disease, reported from many parts of Asia including Nepal. This study aims to determine the seroepidemiology of scrub typhus among febrile patients attending Chitwan Medical College Teaching Hospital (CMC-TH), Bharatpur, Nepal., Study Design and Setting: This was a hospital laboratory-based prospective study conducted in CMC-TH (a 750-bed hospital) located in Bharatpur, Chitwan district of Nepal., Participants: A total of 1797 patients visiting CMC-TH with acute febrile illness (temperature more than 38°C) were enrolled in this study., Methods: A total of 1797 blood samples were collected from patients presenting with acute febrile illness. The samples were processed for detection of antibody for scrub typhus by ELISA for specific IgM antibody and Weil-Felix test., Results: Out of 1797 serum sample of febrile patients, 524 (29.2%) were scrub typhus positive. Maximum seropositive cases were from Chitwan district, 271 (51.7%) with predominance among women, 314 (35.9%). Scrub typhus was common among age group 51-60 years (37.2%) and farmers, 182 (37.8%). Highest seropositivity was found in July, 60 (57.7%). Fever was common clinical symptom. Thrombocytopenia was seen in 386 (73.7%) and raised transaminase aspartate aminotransferase, 399 (76.1%) among seropositive cases. Weil-Felix test positive were 397 (22.1%) and IgM ELISA positive were 524 (29.2%). The correlation between IgM ELISA and Weil-Felix test showed statistically significant association (r=0.319, p<0.001)., Conclusion: High prevalence of scrub typhus implies that patients with acute febrile illness should be investigated for scrub typhus with high priority. There is utmost need of reliable diagnostic facilities at all levels of healthcare system in Nepal. Infection with scrub typhus was found high and this calls for an urgent need to introduce vaccine against scrub typhus. More sustain and vigorous awareness programmes need to be promoted for early diagnosis, treatment and control., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Anemia remains a major public health challenge with high prevalence among women in South and Southeast Asian countries. Reductions in anemia rates have been stalled, despite the implementation of different maternal health and nutrition programs. This study aimed to assess the prevalence and factors associated with anemia among women of reproductive age in seven selected South and Southeast Asian countries., Methods: This cross-sectional analysis utilized data from the most recent demographic and health surveys from seven selected South and Southeast Asian countries (Bangladesh, Cambodia, India, Maldives, Myanmar, Nepal, and Timor-Leste) between 2011 and 2016. This study included 726,164 women of reproductive age. Multiple logistic regression was performed to assess the factors associated with anemia among women for each country separately., Results: The combined prevalence of anemia was 52.5%, ranged from 22.7% in Timor-Leste to 63% in the Maldives. Results from multiple logistic regression suggest that likelihood of anemia is significantly higher among younger women (15-24 years), women with primary or no education, women from the poorest wealth quintile, women without toilet facilities and improved water sources, underweight women, and women with more than one children born in last five years in most of the countries., Conclusions: The prevalence of anemia is high among women of reproductive age in the seven selected South and Southeast Asian countries. The results of this study suggest that various household, environmental and individual factors contribute to the increased likelihood of anemia. Evidence-based, multidisciplinary policies and programs targeting mothers' health and nutrition status, in addition to scaling-up women's education and socioeconomic status, are warranted to combat anemia., Competing Interests: The authors have declared that no competing interests exist

Objectives: Gastric cancer (GC) is one of the most prevalent neoplasms and a leading cause of mortality globally. To our knowledge, its relationship with dietary factors is not adequately studied and understood in the Nepalese context. This study is aimed at exploring the relationship between the possible dietary risk factors responsible for gastric cancer in Nepal., Methods: A hospital-based matched case-control study was conducted in two specialized cancer hospitals in Nepal. A total of 237 participants (79 cases and 158 controls) were included in the study. Patients diagnosed within one year (incidence case) with histologically confirmed gastric cancer were taken as cases, and healthy visitors of gastric and nongastric cancer patients without past and present history or not a suspected information of gastric cancer were included as controls. A face-to-face interview was conducted using a semi-structured food frequency questionnaire. Backward stepwise conditional logistic regression was used to estimate the magnitude of the association between the independent variables and gastric cancer. Results were presented as the crude odds ratio (COR) and adjusted odds ratio (AOR) with 95% confidence intervals (CI). A P value < 0.05 was considered statistically significant., Results: In the adjusted multivariable conditional logistic regression model, an increased risk of gastric cancer was more likely to have higher odds among those respondents who had a high consumption of processed meat (AOR = 3.99, 95% CI: 0.90-17.66), preferences of a high amount of fats/oil (AOR = 4.64, 95% CI: 1.56-13.72), and preferences of high amounts of salts (AOR = 4.18, 95% CI: 1.30-13.44). Conversely, those respondents who consumed higher amounts of fruits (AOR = 0.21, 95% CI: 0.07-0.65) were seen to have lower odds of gastric cancer., Conclusions: Our study found an increased risk of gastric cancer with frequent consumption of red meat, processed meat, high preferences of salt, fats/oil, and condiments. Regular consumption of fruits had a protective effect against gastric cancer. Providing nutrition education, public awareness, and lifestyle modification are primary steps to promote the avoidance of risk factors and change unhealthy dietary habits to prevent gastric cancer in Nepal., Competing Interests: The authors declare that they have no conflicts of interest exists., (Copyright © 2020 Sunil Kumar Shah et al.)

Cultivation and extraction of the fungus Talaromyces stipitatus led to the isolation of five new oxyphenalenone-amino acid hybrids, which were named talauxins E, Q, V, L, and I based on the corresponding one-letter amino acid codes, along with their putative biosynthetic precursor, duclauxin. The rapid reaction of duclauxin with amino acids to produce talauxins was demonstrated in vitro and exploited to generate a small library of natural and unnatural talauxins. Talauxin V was shown to undergo spontaneous elimination of methyl acetate to yield the corresponding neoclauxin scaffold. This process was modeled using density functional theory calculations, revealing a dramatic change in conformation resulting from the syn elimination of methyl acetate.

Background: Bone mineral density (BMD) is the measure of the minerals, mostly calcium and phosphorous, contained in certain volume of bone to diagnose osteoporosis. The aim of the study was to find out the association of lifestyle and food consumption with BMD., Methods: An analytical cross-sectional study was conducted among 169 people of age 50 years and above who underwent Dual Energy X-Ray Absorptiometry (DEXA or DXA) scan in the hospitals of Kathmandu valley of Nepal. Food frequency questionnaire and 24-hour recall methods were followed. The DXA reports of the participants were observed to identify osteoporosis. Chi-square test, independent sample t-test, and binary logistic regression were applied to explore the association of BMD with different variables., Result: The prevalence of osteoporosis, osteopenia, and normal BMD was 37.3%, 38.5%, and 24.2%, respectively. The prevalence of osteoporosis increased with sex and age (AOR 3.339, CI: 1.240-8.995, p-value 0.017; AOR 3.756, CI: 1.745-8.085, p-value 0.001), respectively. Higher BMI was associated with lower odds of osteoporosis (AOR 0.428, CI: 0.209-0.877, p-value 0.020). Smoking had bad effect on the health of bone (AOR 3.848, CI: 1.179-12.558, p-value 0.026). Daily dietary calcium intake had negative association with osteoporosis with the p-value of 0.003; however, the daily consumption of vitamin D rich food had no association with osteoporosis., Conclusion: High prevalence of osteoporosis and osteopenia was found in older people. Osteoporosis was found to be significantly associated with sex, age, lower BMI, smoking habit, and daily calcium consumption. Further research can be conducted by making the relationship of calcium consumption with the numerical T-value of scanned body parts.

Palonosetron (PG) is a newer, safe, and effective long-acting 5-HT3 antagonist commonly used in adults, but data in children are limited. A randomized controlled trial was carried out among children with cancer during their first cycle of moderate or highly emetogenic chemotherapy to receive either PG or ondansetron (OG) with the aim of comparing their efficacy, safety, and cost-effectiveness. In total, 200 children (mean age, 8 y, male:female=1.8:1) were recruited, 100 in each arm. Complete response, defined as no vomiting, in acute (<24 h), delayed (24 to 120 h), and overall phases (0 to 120 h) was observed in 88%, 88%, and 81% of cases, respectively, for PG versus 84%, 79%, and 72%, respectively, for OG (P=0.42, 0.09 and 0.21, respectively). Complete protection rates, defined as no nausea and vomiting in children above 6 years of age, in acute, delayed, and overall phases were 84%, 81%, and 73%, respectively, for PG versus 79%, 67%, and 60%, respectively, for OG (P=0.44, 0.06 and 0.10, respectively). Overall, the efficacy and safety of PG in the prevention of chemotherapy-induced nausea and vomiting was comparable with OG, but PG was a more cost-effective and suitable choice for busy centers in resource-limited countries.

Background: Anemia during pregnancy is a major public health problem globally with multiple causes including inadequate dietary intakes. The aim of the study was to assess the effect of nutrition education on nutritional knowledge, hemoglobin level and dietary intake of anemic pregnant women., Materials and Methods: A quasi-experimental study was conducted among 115 mild to moderately anemic pregnant women attending ante natal clinics. Pregnant women were consecutively enrolled and assigned to receive nutrition education and diet plan in intervention group (n = 58) and general education only in control group (n = 57). The nutrition education was given to pregnant women on individual basis at the time of enrollment and follow-ups were done through biweekly phone calls and every 4 weeks during ANC visits. Baseline data were collected using semi-structure questionnaire for interview and hemoglobin level was also measured. Data were collected after 10 weeks of nutrition education intervention. Independent sample t-test was used to compare differences between the two groups., Results: Out of 115 pregnant women enrolled, 107 completed the study (Intervention: 53; Control: 54). At the end of the nutrition education intervention and iron rich food based diet plan, the change in hemoglobin level was significantly high in the intervention over control group [0.56±0.40gm/dl vs. 0.16±0.82gm/dl, p = 0.002]. The change in the maternal nutritional knowledge score on anemia and iron rich foods was significantly high in the intervention over control group [8.26±4.57 vs. 1.05±6.59, p<0.001].Consumption of iron rich food was significantly high in the intervention group (P<0.05)., Conclusion: Provision of nutrition education and iron rich food based diet plan was significantly associated with improved hemoglobin levels, improved dietary intake and nutritional knowledge on anemia and iron rich foods., Competing Interests: The authors have declared that no competing interests exist.

Introduction: An increase in distracted driving has been suggested as a factor contributing to the 15% increase in fatal crashes from 2014 to 2016, but objective information about the prevalence of distracted driving in recent years is incomplete or lacking. The current study replicated a 2014 observation study conducted in Northern Virginia to examine whether the prevalence of distracted driving overall and of individual secondary behaviors has changed., Method: Drivers of moving or stopped vehicles were observed at 12 locations across 4 Northern Virginia communities during the daytime. The presence of 12 different secondary behaviors was recorded., Results: In 2018, about 23% of drivers were engaged in at least one secondary behavior, which was not significantly different from 2014. Overall phone use was not significantly different between 2014 and 2018. However, the likelihood of holding a cellphone significantly decreased while the likelihood of manipulating a cellphone significantly increased in 2018 relative to 2014. About 14% of drivers were engaged in noncellphone secondary behaviors in 2014 and 2018, which exceeded the proportion using phones in both years., Conclusions: There was no evidence that distracted driving has become more common in recent years, but the prevalence of some secondary behaviors has changed. Most concerning was the 57% increase in the likelihood of cellphone manipulation in 2018 relative to 2014, a behavior that has been consistently linked to increased crash risk; however, because the behavior is uncommon overall, the increased prevalence would be expected to only slightly increase crash rates. Practical applications: Although cellphone use was frequently observed in 2014 and 2018, collectively, other noncellphone secondary behaviors were more prevalent. Practitioners and policymakers should continue targeting cellphone use, but also must target other common secondary behaviors to fully address distracted driving., (Copyright © 2018 National Safety Council and Elsevier Ltd. All rights reserved.)

Competing Interests: There are no conflicts of interest.

Chemical investigation of an Australian fungus, Aspergillus banksianus, led to the isolation of the major metabolite banksialactone A (1), eight new isochromanones, banksialactones B-I (2-9), two new isocoumarins, banksiamarins A and B (10 and 11), and the reported compounds, clearanol I (12), dothideomynone A (13), questin (14), and endocrocin (15). The structures of 1-11 were established by NMR spectroscopic data analysis, and the absolute configurations were determined from optical rotations and ECD spectra in conjunction with TD-DFT calculations. The secondary metabolite profile of A. banksianus is unusual, with the 11 most abundant metabolites belonging to a single isochromanone class. Conjugation of 1 with endocrocin, 5-methylorsellinic acid, 3,5-dimethylorsellinic acid, mercaptolactic acid, and an unknown methylthio source gave rise to five unprecedented biosynthetic hybrids, 5-9. The isolated compounds were tested for cytotoxicity, antibacterial, and antifungal activities, with hybrid metabolites 7-9 displaying weak cytotoxic and antibiotic activities.

Competing Interests: There are no conflicts of interest.

A novel Schiff base ligand of type HL was prepared by the condensation of amoxicillin trihydrate and nicotinaldehyde. The metal complexes of Co +2 , Ni +2 , Cu +2 , and Zn +2 were characterized and investigated by physical and spectral techniques, namely, elemental analysis, melting point, conductivity, 1 H NMR, IR, UV-Vis spectra, ESR, SEM, and mass spectrometry measurements. They were further analyzed by thermal technique (TGA/DTA) to gain better insight about the thermal stability and kinetic properties of the complexes. Thermal data revealed high thermal stability and nonspontaneous nature of the decomposition steps. The Coats-Redfern method was applied to extract thermodynamic parameters to explain the kinetic behavior. The molar conductance values were relatively low, showing their nonelectrolytic nature. The powder XRD pattern revealed amorphous nature except copper complex (1c) that crystallized in the triclinic crystal system. The EPR study strongly recommends the tetrahedral geometry of 1c. The structure optimization by MM force field calculation through ArgusLab 4.0.1 software program supports the concerned geometry of the complexes. The in vitro antibacterial activity of all the compounds, at their two different concentrations, was screened against four bacterial pathogens, namely, E. coli, P. vulgaris, K. pneumoniae, and S. aureus, and showed better activity compared to parent drug and control drug.

Unlabelled: Broadly neutralizing antibodies isolated from infected patients who are elite neutralizers have identified targets on HIV-1 envelope (Env) glycoprotein that are vulnerable to antibody neutralization; however, it is not known whether infection established by the majority of the circulating clade C strains in Indian patients elicit neutralizing antibody responses against any of the known targets. In the present study, we examined the specificity of a broad and potent cross-neutralizing plasma obtained from an Indian elite neutralizer infected with HIV-1 clade C. This plasma neutralized 53/57 (93%) HIV pseudoviruses prepared with Env from distinct HIV clades of different geographical origins. Mapping studies using gp120 core protein, single-residue knockout mutants, and chimeric viruses revealed that G37080 broadly cross-neutralizing (BCN) plasma lacks specificities to the CD4 binding site, gp41 membrane-proximal external region, N160 and N332 glycans, and R166 and K169 in the V1-V3 region and are known predominant targets for BCN antibodies. Depletion of G37080 plasma with soluble trimeric BG505-SOSIP.664 Env (but with neither monomeric gp120 nor clade C membrane-proximal external region peptides) resulted in significant reduction of virus neutralization, suggesting that G37080 BCN antibodies mainly target epitopes on cleaved trimeric Env. Further examination of autologous circulating Envs revealed the association of mutation of residues in the V1 loop that contributed to neutralization resistance. In summary, we report the identification of plasma antibodies from a clade C-infected elite neutralizer that mediate neutralization breadth via epitopes on trimeric gp120 not yet reported and confer autologous neutralization escape via mutation of residues in the V1 loop., Importance: A preventive vaccine to protect against HIV-1 is urgently needed. HIV-1 envelope glycoproteins are targets of neutralizing antibodies and represent a key component for immunogen design. The mapping of epitopes on viral envelopes vulnerable to immune evasion will aid in defining targets of vaccine immunogens. We identified novel conformational epitopes on the viral envelope targeted by broadly cross-neutralizing antibodies elicited in natural infection in an elite neutralizer infected with HIV-1 clade C. Our data extend our knowledge on neutralizing epitopes associated with virus escape and potentially contribute to immunogen design and antibody-based prophylactic therapy., (Copyright © 2016, American Society for Microbiology. All Rights Reserved.)

Background and Objectives: Epidemiology and transmission of malaria vary within the tribal areas with the variation in topography, forest cover and type of forest. For the control of disease, understanding of the dynamics of transmission in the varied ecological situation is essential. This study was carried out in the two distinct tribal areas- Baiga Chak (thick forested area) of Dindori district and Bichhia block (forest fringe area) of Mandla district, Madhya Prasdesh, India, to understand the epidemiology and transmission dynamics of malaria., Methods: Mosquitoes were collected using hand catch and whole night collections to determine the proportion of vectors, their density and seasonality. Vector incrimination was done by sporozoite ELISA and feeding preferences of vector by gel diffusion method. Active fever surveys were carried out fortnightly to determine the age specific malaria parasite rates among the inhabitants of two areas., Results: Density of Anopheles culicifacies was significantly higher in Bichhia while the density of An. fluviatilis was higher in Baiga Chak. An. culicifacies was incriminated from both the areas while An. fluviatilis was incriminated from Baiga Chak only. Malaria slide positivity rate (SPR) was significantly higher (OR=3.7 95%CI, 3.1-4.4) in Baiga Chak (28.2%) than Bichhia (9.6%)., Interpretation & Conclusions: The features of malaria transmission in tribal areas differed from those reported in rural or semirural population. Site-specific and region-specific studies are required to develop appropriate intervention measures to control malaria.

Cavernous hemangiomas of the spleen are small benign lesions found incidentally, majority of times while patients are being investigated for some other disease and patients remain asymptomatic otherwise for this condition. The natural history of cavernous hemangiomas of spleen is slow, symptoms or complications, when present, occur late, they are rarely large and can manifest as a palpable non-tender mass in the left upper quadrant. A very rare syndrome is associated with this condition called Kasabach-Merritt syndrome (KMS), which is defined as diffuse cavernous hemangioma of the spleen alongwith anemia, thrombocytopenia, and coagulopathy. Perioperative diagnosis can be confirmed by imaging study which can be CT, MRI, or ultrasound. Splenectomy is considered the treatment of choice for such patients with symptoms. To our knowledge, a very few cases have been reported so far. The purpose of writing this review article is the reporting of this rare case and to provide some experience related to the management of this condition in a patient with KMS.

Background: The United States has a high rate of death due to firearms, and gun buyback programs may mitigate these high death rates. Understanding the demographics, motivation, and geographic region of participants may improve program efficacy., Methods: Three Injury Free Coalition for Kids gun buyback programs, in collaboration with the local police, were studied: Phoenix, Arizona; Worcester, Massachusetts; and New Haven, Connecticut. Participants were defined as those who relinquished a firearm. A self-administered, anonymous, paper survey elicited information from participants regarding demographic data, formal training on the use of the firearm, how the firearm was acquired, potential child access, knowledge of others injured by a firearm, whether the firearm was stored unlocked, factors motivating the surrender of the firearm, and other factors. Survey results were entered into a composite database and analyzed for differences in location, race, sex, and other factors., Results: Participants (n = 301) were predominantly male (73.5%), white (80.9%), and older than 55 years (59.0%). They lived an average of 19.0 miles from the event by zip codes and had an average median household income of $65,731. More than half (54.5%) did not purchase the firearm, acquiring it through inheritance, gift, or random find. Most (74.8%) had previous firearms training and were relinquishing for safety reasons (68.3%). Those relinquishing firearms for safety reasons were less likely to have purchased the firearm (odds ratio [OR], 2.46, p <0.05), less likely to have any formal training (OR, 5.92; p < 0.01), and less likely to keep the firearm locked (OR, 3.50; p < 0.01). Women were less likely to have purchased the firearm (OR, 0.50; p < 0.05). Fifty-three percent of those turning in firearms reported having at least one more firearm at home; designated themselves to be white, compared with all other groups combined (OR, 2.55; p < 0.05); more likely to report locking the firearm (OR, 0.11; p < 0.001); more interested in receiving a gun lock (OR, 0.15; p < 0.001); and more likely to know others who also own firearms (OR, 0.17; p < 0.001). In at least one of the cities participating in this study, as many as 30 percent of the weapons used in gun-wielding criminal acts were burglarized from the home of legal gun owners that had failed to secure them properly., Conclusion: The gun buyback program is solely one prong of a multipronged approach in reducing firearm-based interpersonal violence. Additional research is necessary to determine effective methods to target individuals who would have the greatest impact on gun violence if they relinquished their weapons. Through the forging of relationships and enhancement of firearm knowledge among medical, law enforcement, judicial, and school communities, the prevention of intentional and unintentional firearm-related injuries will be able to be managed more effectively.

In the present study by examining pseudoviruses expressing patient chimeric envelopes (Envs) made between an IgG1b12 (b12)-sensitive (2-5.J3) and a b12-resistant (4.J22) HIV-1 clade C envelope, we identified determinants in the V2C2 region that governed susceptibility to b12 monoclonal antibody, but not to other CD4 binding site antibodies. Interestingly, when the V2C2 sequence of the 2-5.J3 Env was transferred to other b12-resistant primary clade C Envs, their susceptibility to b12 varied, indicating that this effect was context dependent. In addition, we identified determinants within the V2 region in the b12-resistant envelope that significantly modulated the neutralization of Env-pseudotyped viruses to PG9/PG16 MAbs. The enhanced neutralization susceptibilities of Envs to b12 and PG9 MAbs were correlated with increased exposure of their corresponding epitopes highlighting vulnerabilities in the V2C2 region that altered Env conformation necessary for the efficient accessibility of b12 and PG9 antibodies., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To determine the association between passenger presence and risk of fatal crash involvement in relation to driver and passenger age and gender, focusing especially on drivers ages 65 and older., Methods: Data on US fatal crashes were obtained for 2002-2009. Using the quasi-induced exposure methodology, logistic regression analysis was used to predict the odds of fatal crash involvement as a function of driver age and gender as well as passenger age and gender., Results: Overall, risk of fatal crash involvement with passengers was 43 percent lower for drivers ages 65-74 and 38 percent lower for drivers 75 and older. Older drivers' risk of fatal crash involvement was lower with almost all combinations of passenger age and gender; there was no reduction in risk with passengers ages 75 and older. Effects were stronger at nonintersection locations than at intersection locations., Conclusion: Older drivers' crash risk is lower with almost every combination of passenger age group and gender. It is unclear whether the presence of passengers lowers older driver crash risk or whether safer drivers tend to ride with passengers.

A 23-year-old man presented with history of fever and pain in the right lower abdomen. He was diagnosed to have acute appendicitis with perforation and was taken up for emergency laparotomy after resuscitation. There was pus in the right iliac fossa and a tumor at the fundus of Meckel's diverticulum, which had perforated. Appendix was found to be normal. The histopathology examination showed it to be gastrointestinal stromal tumor of Meckel's diverticulum. The gastrointestinal stromal tumor causing Meckel's diverticulum perforation and peritonitis is very rare, and prior to this indexed case, only two such cases have been reported in the literature.