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Ultraviolet communication (UVC) is a promising technology due to its ability to operate in non-line-of-sight (NLOS) mode thereby eliminating the pointing acquisition and tracking (PAT) requirement as needed by infrared and visible light communications. However, NLOS UVC suffers from very high attenuation and turbulence-induced fading when operated over a long distance. Due to these limitations, the existing literature on the NLOS UVC is mostly restricted to short-distance communications only. Therefore, this paper addresses these challenges by proposing an outdoor subcarrier-intensity-modulation (SIM) based multi-relay cooperative communication system employing the best relay selection and decode-and-forward (DF) relaying protocol. The turbulence-induced fading is modelled using lognormal distribution under weak atmospheric turbulence conditions. We derive novel closed-form analytical expressions of outage probability and ergodic capacity. Correctness of the derived analytical expressions is validated through numerical simulations.

In this paper, we investigate the performance of multiple-input and multiple-output (MIMO) unmanned air vehicle (UAV) based multi-user communication systems over generalized Nakagami- $m$ fading channels subject to channel feedback delays. The impact of decode-and-forward (DF) based relaying and outdated channel state information is assessed at the receiver nodes. To reduce the complexity and retain the MIMO gains, the transmit antenna selection (TAS) strategy is used to select the best antenna at the source and UAV nodes. A generic framework in the form of closed-form analytical expressions for outage probability (OP), asymptotic OP, and the average symbol error rate of higher-order quadrature amplitude modulation (QAM) schemes such as hexagonal QAM, rectangular QAM, and cross QAM are derived. In addition, energy efficiency analysis is also performed for the considered system model. In this framework, altitude and location-dependent path loss modeling are considered for the air-to-ground links. Optimization of UAV location and altitude is performed through a limited-memory Broyden-Fletcher-Goldfarb-Shanno (LBFGS) algorithm to attain minimum OP (MOP). Results illustrate optimal performance dependent on the channel correlation parameters, antenna elements, and fading conditions. Monte-Carlo simulations are performed to validate the derived analytical results and compared with the existing works.

Elimination of heavy metals from contaminated water systems is of prime distress due to their capacity to prompt toxic impact on the flora and fauna. The usage of innovative nano-engineered materials predominantly opens up smart prospects for the treatment of persistent heavy metal adulterated water resources. This study presents an ultrasonic-assisted sol-gel production of Ru@Co3O4@g-C3N4 nanostructure that was utilized to remove Cu+2 and Cd+2 ions from aqueous solutions. The X-ray diffraction investigation revealed the development of RuO2, Co2O3 and g-C3N4 phases, and the relevant elemental composition was verified by the photoelectron spectroscopy and EDX. The dispersion of the metal oxides within the nitride sheets was evidenced by scanning and transmission electron microscopy. The initial metal ions concentration, pH, and contact time effects were investigated through batch experiments. The adsorption isotherm models matched the Langmuir isotherm well, whereas the kinetics model data perfectly fitted the pseudo-second-order model. The maximum adsorption capacities of Cu+2 and Cd+2 ions on the nanocomposite Ru@Co3O4@g-C3N4 were 696.9 and 564.5 mg/g, respectively. A mechanism based on a viable covalent type of bonding developed by the delocalized -conjugated electrons of the triazine ring and functional groups were efficiently involved in the metal ions anchoring and ultimate elimination. Thus, the suitability of the Ru@Co3O4@g-C3N4 nanocomposite for eradicating heavy metals, including Cu+2 and Cd+2, was established.

Introduction We aimed to assess persistence and adherence to basal insulin therapy, their association with all-cause healthcare resource utilization (HCRU) and direct medical costs, and predictors of persistence and adherence in adults with type 2 diabetes.Research design and methods A retrospective cohort study was conducted with US adults with type 2 diabetes initiating basal insulin therapy between January 1, 2016, and December 31, 2018, using IQVIA PharMetrics Plus claims data. Persistence and adherence were assessed during 1 year post-initiation per previous definitions. Demographic/clinical characteristics were assessed during the 1 year pre-initiation. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding variables. Post-IPTW, all-cause HCRU and direct medical costs were assessed during the first-year and second-year post-initiation by persistence and adherence status. Multivariable logistic regression was used to identify predictors of persistence and adherence.Results The final sample comprised 64,953 patients; 56.8% demonstrated persistence and 41.9% demonstrated adherence. Patients demonstrating persistence and adherence were significantly less likely to have a hospitalization than patients demonstrating non-persistence or non-adherence, respectively. In the second-year post-initiation, total mean all-cause direct medical costs per patient were lower for patients demonstrating persistence and significantly lower for patients demonstrating adherence. Prior use of both oral and injectable antidiabetic medication predicted persistence and adherence compared with patients with only prior oral antidiabetic medication use (persistence OR, 1.50 (95% CI, 1.44 to 1.57); adherence OR, 1.48 (95% CI, 1.42 to 1.55)).Conclusions Persistence and adherence to basal insulin was associated with fewer hospitalizations and lower direct medical costs.

Bucks reproductive performance can be improved by artificial insemination technique, that affected by many factors the most important one is semen quality, which is affected by the methods of semen preservation cooling and freezing. The goal of this study was to assess the effect of adding different concentrations of antioxidant as Nano-selenium to the diluted buck semen during preservation by cooling in both summer and winter seasons. Eight mature healthy Zaraibi bucks were used in the study. Semen samples were collected by an electro- ejaculator twice per week during summer 2021 (August, September) and winter (January, February). Samples were pooled and diluted by extender then divided to experimental groups: Group 1: Nano-selenium: 100 μL / 100 ml and Group 2: 200 μL / 100 ml.  Then the groups cooled for measuring some semen parameters and seminal antioxidant activities after 1 h from adding and at 8 hours then every 8 hrs up to 64 hr. Nano selenium 200 μL / 100 ml has a favorable impact on diluted buck semen during cooling preservation during summer and winter.

Summary: Background: The Fibrosis-4 Index (FIB-4) is used as a non-invasive tool for the presence of advanced liver fibrosis in metabolic dysfunction-associated steatotic liver disease and type 2 diabetes. However, evidence for an association between FIB-4 and risk of mortality and/or liver-related clinical outcomes is limited. The aim of this study was to investigate the association between FIB-4 and subsequent liver events, cardiovascular events, and all-cause mortality in individuals with obesity and/or type 2 diabetes examined in routine general practice. Methods: This was a longitudinal cohort study in which eligible adults had obesity and/or type 2 diabetes and ≥1 FIB-4 score calculable from UK Clinical Practice Research Datalink GOLD after 1 January 2001. No alcohol-related disorders and/or chronic liver diseases (except non-alcoholic fatty liver disease) and/or no prescriptions of drugs inducing liver disease were permitted. Individuals were followed until time of first event, 10 years, or 1 January 2020. Analyses were conducted using Aalen-Johansen cumulative incidence functions and Cox proportional hazards models. Findings: Among 44,481 included individuals (mean age 58·8 years; 54% female), there were 979 liver, 6002 cardiovascular, and 8971 mortality events during the 10 years of follow-up. At 10 years, the cumulative incidence of liver events in the high (>2·67), indeterminate (1·30–2·67), and low (

Abstract Neurofibromatosis type 1 (NF1) is a multisystemic hereditary disorder associated with an increased risk of benign and malignant tumor formation predominantly on the skin, bone, and peripheral nervous system. It has been reported that out of all the NF1 cases, more than 95% cases develop the disease due to heterozygous loss-of-function variants in Neurofibromin (NF1) gene. However, identification of NF1 causative variants by presently recommended method of gene-targeted Sanger sequencing is challenging and cost-intensive due to the large size of the NF1gene with 60 exons spanning about 350 kb. Further, conducting the genetic studies is difficult in low resource regions and among families with the limited financial capabilities, restricting them from availing diagnostic as well as proper disease management measures. Here, we studied a three-generation family from Jammu and Kashmir state in India, with multiple affected family members showing clinical indications of NF1. We combinedly used two applications, Whole Exome Sequencing (WES) and Sanger sequencing, for this study and discovered a nonsense variant NM_000267.3:c.2041C>T (NP_000258.1:p.Arg681Ter*) in exon 18 of NF1 gene in a cost effective manner. In silico analyses further substantiated the pathogenicity of this novel variant. The study also emphasized on the role of Next Generation Sequencing (NGS) as a cost-effective method for the discovery of pathogenic variants in disorders with known phenotypes found in large sized candidate genes. The current study is the first study based on the genetic characterization of NF1 from Jammu and Kashmir–India, highlighting the importance of the described methodology adopted for the identification and understanding of the disease in low resource region. The early diagnosis of genetic disorders would open the door to appropriate genetic counseling, reducing the disease burden in the affected families and the general population at large.

Introduction: The WHO 2021 data estimate that 2 million lives and 53 million disability-adjusted life-years were lost in 2019 due to exposures to selected chemicals. It is important to know the pattern and outcome of acute poisoning cases for proper planning, prevention and management. Knowing the pattern will also help in designing training modules for primary care physicians to make them aware about newer poisons and their management. Awareness regarding newer poisons consumed is necessary for early identification, initial management and timely referral to higher centres by primary care physicians. This study was performed to see the pattern and outcome of acute poisoning cases in North Indian population and various factors related to outcome. Materials and Methods: This study was conducted in department of medicine of a teaching institute in North India after approval by the Institutional Review Board. Patients admitted in the department during the study and fulfilling the inclusion criteria were enrolled in the study after obtaining consent. Results: A total of 417 patients with poisoning were recruited in the study. Out of 417 patients, majority were males (59.5%). Maximum number of patients were in the age group of 21–30 years (33.8%), and rural population (79.9%) was found to be more affected. Most of the patients were students and private employees. Most common types of poisoning were snakebite (n = 109, 26.1%), organophosphate (n = 49, 11.8%) and aluminium phosphide (n = 39, 9.3%). Out of 417 patients, 349 (83.69%) improved, while 68 (16.3%) expired. Requirement of ventilatory support was most commonly associated with aluminium phosphide poisoning (30.12%) followed by organophosphate poisoning (24.1%). Conclusion: Poisoning was more common in young males and more prevalent in rural population. Pesticides and snakebite were major causes of poisoning. Among suicidal cases, family conflict (problem/altercation with family members/marital discord) was main reason for the consumption of poison. There is need for creation of poison information centre along with separate toxicological units in tertiary care hospitals.

Abstract Conodonts are an extinct group of primitive jawless vertebrates whose elements represent the earliest examples of a mineralized feeding apparatus in vertebrates. Their relative relationship within vertebrates remains unresolved. As teeth, conodont elements are not homologous with the dentition of vertebrates, but they exhibit similarities in mineralization, growth patterns, and function. They clearly represent an early evolutionary experiment in mineralized dentition and offer insight into analogous dentition in other groups. Unfortunately, analysis of functional performance has been limited to a handful of derived morphologies and material properties that may inform ecology and functional analysis are virtually unknown. Here we applied a nanoscale approach to evaluate material properties of conodont bioapatite by utilizing Atomic Force Microscopy (AFM) nanoindentation to determine Young’s modulus (E) along multiple elements representing different ontogenetic stages of development in the coniform-bearing apparatus of Dapsilodus obliquicostatus. We observed extreme and systematic variation in E along the length (oral to aboral) of each element that largely mirrors the spatial and ontogenetic variability in the crystalline structure of these specimens. Extreme spatial variability of E likely contributed to breakage of elements that were regularly repaired/regrown in conodonts but later vertebrate dentition strategies that lacked the ability to repair/regrow likely required the development of different material properties to avoid structural failure.

Abstract This paper presents a novel passive tuning technique to mechanically tune the resonant frequency of a substrate integrated waveguide (SIW) slot antenna, by using cylindrical rods of different dielectric materials in the air holes. A full‐wave 3‐dimensional Electromagnetic simulator software is used to estimate tunability in the resonant frequency of the SIW slot antenna, which is then analysed using its equivalent circuit, and then verified experimentally. Tunability is obtained by changing relative permittivity of dielectric rods. Measurements show good frequency tunability even with a limited number of dielectric rods and gains over 5 dBi. The similarity in the radiation patterns with tuning, demonstrates a good characteristic for tunable antennas. The technique is simple but effective and does not require external direct current bias circuitry, which removes parasitic effects and less power consumption. The low field perturbation of dielectric rods provides better loss performance and a higher Q‐factor over a wider bandwidth. The initial design demonstrates a cost‐effective tuning technique achieving return loss (>10 dB) in the X‐band. This technique is also suitable for practically overcoming the performance deviation due to fabrication inaccuracies and temperature variation.

Noha Rashad,1 Mohamed Abdulla,2 Mohamed Farouk,3 Yasser Elkerm,4 Salem Eid Salem,5 Maha Yahia,5 Amr S Saad,6 Ahmed Hassan Abdel Aziz,6 Ghada Refaat,6 Ibrahim Awad,7 Maha ElNaggar,8 Khaled Kamal,6 Basel Refky,9 Mohamed Abdelkhalek,9 Ahmed Touny,10 Loay Kassem,2 Emad Shash,5 Abdelhay A Abdelhay,11 Bahaa Eldin Mahmoud,11 Karima Oualla,12 Nesrine Chraiet,13 Hussein AwadElkarim H Maki,14 Yasser Abdel Kader2 1Medical Oncology Department, Faculty of Medicine, Suez University, Suez, Egypt; 2Clinical Oncology and Nuclear Medicine Department, Kasr Al-Aini Medical School, Cairo University, Cairo, Egypt; 3Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Alexandria, Egypt; 4Department of Cancer Management and Research, Medical Research Institute Hospital, University of Alexandria, Alexandria, Egypt; 5Department of Medical Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt; 6Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 7Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 8Clinical Oncology Department, Assiut University Hospital, Assiut, Egypt; 9Department of Surgical Oncology, Oncology Center Mansoura University, Mansoura, Egypt; 10Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; 11Department of Diagnostic Radiology, Cairo University, Giza, Egypt; 12Medical Oncology Department, Hassan II University Hospital Sidi Mohamed Ben Abdellah University, Fes, Morocco; 13Medical Oncology Department, Salah Azaiez National Cancer Institute, Tunis, Tunisia; 14Clinical Oncology Department, Ahfad University for Women, Khartoum, SudanCorrespondence: Noha Rashad, Medical Oncology Department, Faculty of Medicine, Suez University, Faisal, Suez Governorate, Egypt, Tel +20 1225157339, Email Noha16880@gmail.comPurpose: Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide and the second cause of cancer related mortality. Treatment options for patients with metastatic CRC (mCRC) expanded during the last two decades, with introduction of new chemotherapeutic and targeted agents. Egypt is a lower middle-income country; Egyptian health care system is fragmented with wide diversity in drug availability and reimbursement policies across different health care providing facilities. We report the results of consensus recommendations for treatment of patients with metastatic colorectal cancer developed by Egyptian Foundation of Medical Sciences (EFMS), aiming to harmonize clinical practice through structured expert consensus-based recommendations consistent with the national status. EFMS recommendations could be utilized in other countries with similar economic status.Methods: EFMS recommendations were developed using a modified Delphi process, with three rounds of voting till the final recommendations were approved. A non-systematic review of literature was conducted before generating the provisional statements. Content experts were asked to vote on some recommendations in two different resource groups (restricted resources and non-restricted resources). External review board of experts from a low income and lower-middle countries voted on the applicability of EFMS recommendations in their countries.Results: The current recommendations highlighted the discrepancy in health care between restricted and non-restricted resources with expected survival loss and quality of life deterioration. Access to targeted agents in first line is very limited in governmental institutions, and no access to agents approved for third line in patients who failed oxaliplatin and irinotecan containing regimens for patients treated in restricted resource settings.Conclusion: Management of mCRC in developing countries is a challenge. The currently available resource-stratified guidelines developed by international cancer societies represent a valuable decision-making tool, adaptation to national status in each country based on healthcare system status is required.Keywords: colorectal cancer CRC, consensus recommendations, metastatic CRC, management in a lower-middle income country

Introduction: Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) comprise impairment of multiple cognitive domains and cause significant morbidity. International HIV Dementia Scale (IHDS) is a quite sensitive and specific method for screening for HAND, and Modified Mini-Mental State Examination (3MS), though nonspecific, contains more parameters for screening for neurocognition. Hence, we compared 3MS and IHDS as screening tools for HAND with an aim to find out which was a better screening tool for HAND. Methods: Using 3MS and IHDS, we assessed the cognitive status of 200 HIV-positive patients (65% males) and 84 controls, presenting to the Department of Medicine, King George's Medical University, Lucknow, India from September 2015 to September 2019. Results: According to 3MS, 42 (21%) HIV-positive patients were neurocognitively impaired (mean 76.24 ± 1.51), and 158 (79%) patients were not (mean 87.02 ± 4.16). As per IHDS, 185 (92.5%) HIV patients were neurocognitively impaired (mean 8.45 ± 0.88), and 15 (7.5%) patients were not (mean 11.13 ± 0.35). The mean 3MS score of controls was 87.56 ± 4.26, and the IHDS score was 9.73 ± 1.00. According to Patient Health Questionnaire-9 (PHQ-9), moderate depression occurred in only 3.5% of the patients, and the rest had only minimal or mild depression. In IHDS, psychomotor speed was the most affected parameter, whereas in 3MS, similarities were the most affected. Conclusion: IHDS may be over diagnosing neurocognitive impairment in HIV patients due to difficulty in understanding the test, especially psychomotor speed testing. 3MS may be more accurate for detecting neurocognitive impairment in HIV patients, and scale combining both these methods may be a still better choice.

A novel low profile mechanical tuning technique is introduced in this paper to change the center frequency of substrate integrated waveguide (SIW) based reconfigurable bandpass filters (BPF), by loading dielectric rods of different permittivity in resonant cavities and coupling apertures. The technique is simple, cost-effective (rods are machined from conventional substrates), and the same physical structure provides a wide frequency tuning. First, the tunability of center frequency of the SIW cavity resonator is theoretically explained and then estimated with the help of full-wave 3D EM simulator and electrical equivalent circuit. This concept is extended to the tuning of coupled resonator BPF loaded with dielectric rods followed by the analysis of maintaining constant bandwidth. Following the analysis technique, the tunability concept is studied for different arrangements of dielectric rods inside the SIW BPFs. The characteristics of the fabricated filters are experimentally validated. It is shown that center frequency tunability can be achieved by simply varying the permittivity of all the dielectric rods simultaneously. The proposed technique is further extended for obtaining wider tunability and constant bandwidth by using dielectric rods of dissimilar permittivities from a look up table. These designs demonstrate a simple and cost-effective passive tuning technique achieving high Q-factors in the range of 102–210.5, lowest insertion loss

Aim: Laparoscopic CBD exploration (LCBDE) for Common bile duct (CBD) stones with laparoscopic cholecystectomy (LC) is an alternative to open CBD exploration, in patients with failed endoscopic retrograde cholangio-pancreatography (ERCP). It is being performed at few centres with adequate surgical expertise. Herein, we present our experience of LCBDE with LC over a period of 10 years. Patients and Methods: A retrospective analysis of prospectively recorded data of 121 consecutive patients was performed from February 2010 to November 2019, who underwent LC and LCBDE by choledochotomy in a single surgical unit. These included all patients with failed pre-operative ERCP. Results: Out of 121 patients, LCBDE successfully cleared the CBD in 118, and three patients were converted to open surgery. All these patients underwent choledochotomy for adequate exploration of CBD. T-tube closure of CBD was performed in 103 patients and removed after a mean of 14.6 ± 2.4 days. Primary closure was performed in 15 patients. The mean hospital stay post-procedure was 3.4 ± 0.7 days. Complete ductal clearance was achieved in 115 patients, and residual stone fragments reported in three patients were removed by ERCP. None of the patients experienced biliary peritonitis, biliary fistula, pancreatitis or cholangitis. There was no 30-day mortality and no recurrent stones reported with a mean follow-up of 12.4 ± 3.9 months. Conclusion: With adequate surgical expertise, LCBDE is a feasible alternative to open surgery for CBD stones after failed ERCP with early recovery and low morbidity.

In the present investigation, we studied the structural stability and electronic properties of bare and various adsorbed gas molecules ZGaNNR-2, ZGaNNR-4 and ZGaNNR-6 configurations. The electronic properties of all considered ZGaNNR configurations exhibit the metallic behaviour and it is verified through their band structures and densities of states. Based on binding energy/adsorption calculations, Bare-ZGaNNR-6 and O2-ZGaNNR-6 configurations found the most thermostatic stable and energetically favoured configurations among all other considered ZGaNNRs. In transmission spectra, many distinct conductive states are observed in case of CO2-ZGaNNR-6. The selectivity of CO2/O2 ZGaNNR has emerged as the most preferred (24.6) one among all considered configurations. CO2-ZGaNNR-6 is emerged as the fast sensing device due to the lower recovery time (0.14 sec). The proposed device proves the high sensing capability towards the nano-scale devices.

Two Na(I) coordination polymers, namely, {Na(BA)2(μ-H2O)2}n{adp}n (1) and {[Na2(μ-BA)(μ-fum)(μ-H2O)4](BA)}n (2) (where, BA = boric acid, adp = adipic acid, fum = fumarate),were prepared and characterized using elemental analysis, TGA, FT-IR, and single-crystal X-ray diffraction techniques. Various unconventional supramolecular interactions, i.e., CH∙∙∙HC and parallel CO∙∙∙CO interactions, stabilize the layered assembly of compound 1. Interesting dual enclathration of BA molecules within the supramolecular host cavities formed by O-H∙∙∙O and C-H∙∙∙C interactions stabilizes the crystal structure of compound 2. The H-bonding interactions in 1 and 2 were further studied theoretically using the quantum theory of atoms in molecules (QTAIM) and the noncovalent interaction plot (NCI Plot) computational tools. The energy of the H-bonds was estimated using the potential energy density at the bond critical points. Theoretical calculations confirmed the presence of O-H∙∙∙O H-bonding interactions in both compounds, forming structure-guiding R22(8) synthons relevant for the stability of the compounds.

The possibility of observing negative Shapiro-like gravitational time delay (or time advancement) due to the Earth’s gravity employing interferometric experiments on the Earth’s surface is discussed. It is suggested that such a measurement may be realized in the near future with the help of modern versions of Michelson–Morley-type experiments.

Two multi-component coordination compounds of Mn(II), viz. [Mn(H2O)6](2-Mepy)2(4-NO2bz)2·2H2O (1) and [Mn(H2O)6][Mn(2,3-PDCH)3]2 (2) (where, 2-Mepy = 2-methylpyridine, 4-NO2bz = 4-nitrobenzoate, 2,3-PDC = 2,3-pyridinedicarboxylate), have been synthesized and characterized using elemental, spectroscopic (FT-IR and electronic), TGA and single-crystal X-ray diffraction analyses. Complex 1 is a co-crystal hydrate of Mn(II) involving uncoordinated 2-Mepy, 4-NO2bz and water molecules; while compound 2 is a multi-component molecular complex salt of Mn(II) comprising cationic [Mn(H2O)6]2+ and anionic [Mn(2,3-PDCH)3]−complex moieties. The uncoordinated 2-Mepy and 4-NO2bz moieties of 1 are involved in lone-pair (l.p)-π and C–H⋯π interactions which stabilize the layered assembly of the compound. The crystal structure of compound 2 has been previously reported. However, we have explored the unusual enclathration of complex cationic moieties within the supramolecular host cavities formed by the molecular assembly of complex anionic moieties. The supramolecular assemblies obtained in the crystal structure have been further studied theoretically using DFT calculations, quantum theory of atoms-in-molecules (QTAIM) and non-covalent interaction plot (NCI plot) computational tools. Theoretical studies reveal that the combination of π-staking interactions (l.p-π, π-π and C–H···π) have more structure-guiding roles compared to the H-bonds. The large binding energy of π-stacking interactions in 2 is due to the antiparallel orientation of aromatic rings and their coordination to the metal centers, thereby increasing the contribution of the dipole–dipole interactions.

In this paper, we consider cooperative horizontal and vertical underwater visible light communication (UWVLC) systems employing best relay selection. In the vertical UWVLC system, the source is placed at the sea surface and the destination is placed at a depth of 60 m. The link between the source and the destination is modeled as concatenated layers considering inhomogeneous environmental conditions. The underwater parameters change with depth, causing a variable refractive index, which leads to non-uniform optical turbulence. The horizontal communication link is analyzed for two different levels of turbulence at 10 m and 50 m depths. Turbulence is modeled using a log-normal distribution, whose statistical parameters depend on the temperature and salinity at different depths. We have also taken into account the path losses caused by absorption and scattering, and carried out a comprehensive performance comparison between the horizontal and the vertical UWVLC systems. Insights show that compared to horizontal links, vertical links need an extra relay in order to achieve the same level of matching performance. Moreover, it is shown that the horizontal system’s outage performance improves with depth.

Carbon dioxide is a waste product of human metabolism that is unwanted in the indoor atmosphere. Here we test advanced materials that could be used to pump away carbon dioxide and thereby improve indoor air quality. Metal-organic framework (MOF) structures have a variety of properties that make them attractive for direct air capture (DAC) of CO2. In this study, Mg2 (dobpdc4- = 4,4-dioxidobiphenyl-3,3-dicarboxylate) and m-2-m-Mg2(dobpdc) were evaluated for their ability to adsorb and desorb CO2 at ambient atmospheric conditions via a thermal swing. The Mg2(dobpdc) sample did not show appreciable interaction with CO2 in contrast to the diamine-appended version. The molar occupancy of CO2 on the active sites of m-2-m-Mg2 (dobpdc) (m-2-m = N,N-dimethylethylenediamine) during adsorption and desorption was in the range of 5.6–11.8%. These experiments showed the rapid ad- and de-sorption of CO2 by the MOF. Relative humidity was seen to be an important variable and the performance of the tested structures decreased slightly after several cycles of use.

Percentage mammographic breast density (MBD) is one of the most notable biomarkers. It is assessed visually with the support of radiologists with the four qualitative Breast Imaging Reporting and Data System (BIRADS) categories. It is demanding for radiologists to differentiate between the two variably allocated BIRADS classes, namely, “BIRADS C and BIRADS D.” Recently, convolution neural networks have been found superior in classification tasks due to their ability to extract local features with shared weight architecture and space invariance characteristics. The proposed study intends to examine an artificial intelligence (AI)-based MBD classifier toward developing a latent computer-assisted tool for radiologists to distinguish the BIRADS class in modern clinical progress. This article proposes a multichannel DenseNet architecture for MBD classification. The proposed architecture consists of four-channel DenseNet transfer learning architecture to extract significant features from a single patient's two a mediolateral oblique (MLO) and two craniocaudal (CC) views of digital mammograms. The performance of the proposed classifier is evaluated using 200 cases consisting of 800 digital mammograms of the different BIRADS density classes with validated density ground truth. The classifier's performance is assessed with quantitative metrics such as precision, responsiveness, specificity, and the area under the curve (AUC). The concluding preliminary outcomes reveal that this intended multichannel model has delivered good performance with an accuracy of 96.67% during training and 90.06% during testing and an average AUC of 0.9625. Obtained results are also validated qualitatively with the help of a radiologist expert in the field of MBD. Proposed architecture achieved state-of-the-art results with a fewer number of images and with less computation power.

Background: Children with acute febrile respiratory illnesses are commonly seen in the emergency department. Apart from the initial stabilization, they need to be assessed for the underlying cause, and clinicians should formulate differential diagnoses to start treatment. Radiological investigations including x-ray and ultrasonography are often used to narrow down the initial possibilities based on history and examination. A child presenting with an opaque hemithorax is one such scenario. Clinical Description: A 3-year-old boy presented with a short duration of fever, cough and respiratory distress. Examination showed rightward mediastinal shift with dull percussion note and reduced breath sounds over the left hemithorax, along with congested neck veins, stridor and left sided wheeze. Chest x-ray showed an opacified left hemithorax and ultrasonography suggested moderate pleural effusion. Management: Complicated pneumonia with parapneumonic effusion (or empyema) was considered, but a diagnostic pleural tap was dry. The possibilities were revised to include cystic space occupying lesions with mediastinal compression. Computed tomography of the chest confirmed a mass lesion with predominantly cystic components. The patient underwent surgical excision, and histopathology showed pleuropulmonary blastoma. Conclusion: Although respiratory infections are common in childhood, clinical evaluation and judicious use of imaging modalities can uncover less common conditions. Although bedside ultrasonography is a handy tool in the emergency department, it is not infallible.

Ultraviolet communication (UVC) is emerging as an attractive alternative to the existing optical wireless communication (OWC) technologies. UVC experiences negligible noise on the earth’s surface, and also has the ability to operate in non-line-of-sight (NLOS) mode, thereby making it a perfect choice for outdoor communication. However, due to strong interaction of ultraviolet waves with atmospheric particles, it suffers from a very high path loss and turbulence-induced fading, which limits UVC system’s performance. We consider a decode-and-forward based cooperative relaying technique to improve the performance of NLOS UVC system, and to extend its communication range. We consider the practical case of imperfect channel state information at the receiver and derive outage probability of the system. We also consider impact of elevation angles, receiver field-of-view (FOV), and turbulence strength on the system performance. We compute the relative diversity order of the system and demonstrate its convergence through asymptotic analysis. Next, we obtain the novel expression of probability density function of the end-to-end instantaneous signal-to-noise-ratio. We use single subcarrier intensity modulation employing quadrature amplitude modulation (QAM) and derive the novel generalized analytical expressions for rectangular QAM, cross QAM, and futuristic hexagonal QAM schemes. We carry out a detailed performance study considering different system configurations and several interesting insights are highlighted, which reinforces UVC as a futuristic OWC technology. Correctness of the derived analytical expressions is confirmed using Monte-Carlo simulations.

Lignin is one of the primary residues obtained after the processing of lignocellulosic biomass. However, most residual lignin is burnt directly to get rid of it, albeit one of the few biorenewable waste resources that can yield aromatics. Therefore, the present study investigates reductive depolymerization of Kraft lignin into aromatics in the presence of Pt/HZSM-23 catalyst. In this regard, the lignin conversion experiments were performed under mild reaction conditions at a temperature range of 100 °C to 200 °C for 1 h to 12 h in a high-pressure batch reactor. Besides, a comparative study was done on the effect of the supply of external hydrogen and in-situ hydrogenation. Eventually, 87.3% lignin conversion was measured yielding 65.1% bio-oil, primarily aromatics at optimized experimental conditions. It was observed that the mesopores in the Pt/HZSM-23 catalyst facilitate the transfer of larger molecules derived from the Kraft lignin, thus causing an overall improvement in the catalytic activity. A mechanistic study based on experimental conditions and products detected using GC-MS revealed that the in-situ hydrogen transfer route is more favorable for lignin depolymerization than externally supplied hydrogen.

Virus infections can cause tissue damage in many ways. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a cause of the current COVID-19 pandemic, has been extensively studied so far to investigate its pathophysiology and evaluate its impact on the metabolic system of human cells. This has given a lead to study the role of 2-deoxy-D-glucose (2DG) against COVID-19 disease. We hereby would like to briefly discuss the concept and rationale behind the use of 2DG COVID-19.

Background: Oral health is an integral part of general health and toothbrushes are the most commonly used oral hygiene aid. Unfortunately, proper care of toothbrush is often neglected and is kept in bathrooms which are a good place to harbor millions of microorganisms. Aim: To assess the bacterial contamination of toothbrushes for Streptococcus mutans, Staphylococcus aureus, Candida albicans, and Lactobacillus when kept in different sanitary settings before and after the use of disinfectant. Materials and Methods: A total of 60 volunteers were randomly selected between the age of 6–16 years. Toothbrushes were grouped into two categories: Group 1: Outside the bathroom. Group 2: Within the bathroom with attached toilet. Group 2 was further divided into two subgroups: Group 2 (i): Kept individually in separate containers. Group 2 (ii) kept with that of family members and siblings within the same container. The present study was carried for 3 months in two phases with the same participants both before and after the use of disinfectant. Results: Microbial contamination was highest in Streptococcus and least in Lactobacillus before and after the use of disinfectant when toothbrushes were kept outside the bathroom and microbial contamination was similar in both Streptococcus and Lacctobacilus when kept inside the bathroom with attached toilet in separate container and same container both before and after the use of disinfectant. Conclusion: A high level of pathogenic microorganisms were seen in toothbrushes kept in the bathroom for 3 months which were reduced by dipping them in 0.12-% chlorhexidine gluconate.

The paper presents the structural stability and electronic properties of Zigzag Gallium Nitride nano ribbons(ZGaNNR) by considering the lithium(Li) atom by employing density functional theory (DFT). Li atom has been considered as a passivating element at various symmetric sites. By using Li atoms, a significant impact has been observed on the structural and electronic characteristics of ZGaNNRs. Bare@edges_both structure emerged to be the most energetically stable among other structures. For Li-passivation@edge_Ga structures, the minimum band gap has been noticed for III-V group family of nanoribbons. Interestingly, other structures of ZGaNNRs turn metallic nature irrespective of the Li site. Further, Li-bare@edge_N structure possesses the highest Fermi velocity as compared to other structures. This is useful for designing high speed interconnect applications. Further, we investigated the effective mass of various Li-ZGaNNR structures using standard two probe models. The effective mass of H-bare@edge_N structure reveals the highest effective mass in both valence and conduction bands. The proposed work proves the high capability towards the designing of the nano-scale devices.

Virulent Enterobacterale strains expressing serine and metallo-β-lactamases (MBL) genes have emerged responsible for conferring resistance to hard-to-treat infectious diseases. One strategy that exists is to develop β-lactamase inhibitors to counter this resistance. Currently, serine β-lactamase inhibitors (SBLIs) are in therapeutic use. However, an urgent global need for clinical metallo-β-lactamase inhibitors (MBLIs) has become dire. To address this problem, this study evaluated BP2, a novel beta-lactam-derived β-lactamase inhibitor, co-administered with meropenem. According to the antimicrobial susceptibility results, BP2 potentiates the synergistic activity of meropenem to a minimum inhibitory concentration (MIC) of ≤1 mg/L. In addition, BP2 is bactericidal over 24 h and safe to administer at the selected concentrations. Enzyme inhibition kinetics showed that BP2 had an apparent inhibitory constant (Kiapp) of 35.3 µM and 30.9 µM against New Delhi Metallo-β-lactamase (NDM-1) and Verona Integron-encoded Metallo-β-lactamase (VIM-2), respectively. BP2 did not interact with glyoxylase II enzyme up to 500 µM, indicating specific (MBL) binding. In a murine infection model, BP2 co-administered with meropenem was efficacious, observed by the >3 log10 reduction in K. pneumoniae NDM cfu/thigh. Given the promising pre-clinical results, BP2 is a suitable candidate for further research and development as an (MBLI).

A mesoporous Zr-G-C3N4 nanomaterial was synthesized by a succinct-step ultrasonication technique and used for Cu2+ ion uptake in the aqueous phase. The adsorption of Cu2+ was examined by varying the operating parameters, including the initial metal concentration, contact time, and pH value. Zr-G-C3N4 nanosorbent displays graphitic carbon nitride (g-C3N4) and ZrO2 peaks with a crystalline size of ~14 nm, as determined by XRD analysis. The Zr-G-C3N4 sorbent demonstrated a BET-specific surface area of 95.685 m2/g and a pore volume of 2.16 × 10−7 m3·g−1. Batch mode tests revealed that removing Cu (II) ions by the mesoporous Zr-G-C3N4 was pH-dependent, with maximal removal achieved at pH = 5. The adsorptive Cu2+ ion process by the mesoporous nanomaterial surface is well described by the Langmuir isotherm and pseudo-second-order kinetics model. The maximum adsorption capacity of the nanocomposite was determined to be 2.262 mol·kg−1 for a contact time of 48 min. The results confirmed that the fabricated mesoporous Zr-G-C3N4 nanomaterial is effective and regenerable for removing Cu2+ and could be a potent adsorbent of heavy metals from aqueous systems.

Abstract The demand for purified water has been increasing day by day. More feasible technologies, including membrane filtration, adsorbents, and so forth have emerged out to be more efficient and cheaper over conventional industrial methods. Nanocellulose, being biodegradable, nontoxic, and sustainable nanofiller exhibits excellent mechanical properties, high aspect ratio, high surface area, and more importantly tunable surface chemistry; is a potential candidate to be employed for water purification. Composite membranes and films for water filtration, constituting of biopolymers have gathered immense interest lately. Compared with its unmodified form, the functionalized NC enhances the compatibility with the matrix and readily forming strong network structures; essential for the formation of channels for better adsorption of impurities and higher water flux. This review highlights some of the recent studies dedicated to making and testing of nanofiltration membranes prepared using nanocellulose and its different functionalized derivatives.

Various factors interplay when it comes to successful containment of pandemic. In last one year, we have witnessed various countries formulating and practicing their own unique ways to tackle coronavirus. We have seen the most developed countries failing terribly and unable to slow the COVID-19 spread, but at the same time also endorsed the comparatively less resourceful countries outperforming in terms of reduced disease morbidity and mortality. Current review is about two regions from India (Dharavi and Kerala) who were different in their approach as compared to rest of the country and were able to keep the COVID-19 cases to the minimum.

It has been recently argued that in semi-classical gravity, a minimal 2-sphere is not a horizon but a tiny throat of a wormhole, such as the Damour–Solodukhin wormhole (DSWH), with a free parameter λ≠0 separating it from a Schwarxzschild black hole (BH) (λ=0). As shown by DS, their horizonless WH can mimic many properties of a black hole (BH). Assuming that observing a BH mimicker is equivalent to observing a BH itself, we ask the question as to which identity of the object, a WH or a BH, an observer is likely to observe in a single experiment. To answer this, we introduce Tangherlini’s new concept of indeterminacy in the gravitational field by portraying the field as a refractive medium. We then postulate that the identity of the observed object will depend on the probabilistic outcome of photon motion probing the object. The probabilities will be described by Fresnel reflection (R) and transmission (T) coefficients derived by Tangherlini on the basis of a non-quantum statistical indeterminacy of photon motion in ordinary optical media. By adapting this approach to a gravitational “effective optical medium,” we obtain two intriguing results: (i) The Fresnel coefficients at the DSWH throat are independent of mass M but dependent solely on the parameter λ≠0. (ii) Depending on the location of the observer, what is a DSWH to one observer may appear as a BH to another observer for the same value of λ≠0.

The Harko, Kovács, and Lobo wormhole (HKLWH) metric contains two free parameters: one is the wormhole throat r0, and the other is a dimensionless deviation parameter γ with values 0<γ<1, the latter ensuring the needed violation of the null energy condition at the throat. In this paper, we study the energetics of the HKLWH and the influence of γ on the tidal forces in the Lorentz-boosted frame. Finally, we apply a new concept, namely, the probabilistic identity of the object observed by different external observers in terms of the Fresnel coefficients derived by Tangherlini. The intriguing result is that observations can differ depending on the location of the observer, i.e., there is a nonzero probability that the HKLWH will be identified as a black hole even when γ≠0.

One of the essential requirements for efficient performance and longer service life of machined components is a good surface finish. Though there are other traditional finishing processes like lapping, grinding, and honing. However, the major disadvantage associated with them is, they can process only simple geometry. Abrasive flow machining (AFM), due to its self-deforming characteristic, is used for finishing parts having predominantly irregular geometry. All AFM processes comprise a machine, fixture, and media (i.e., carrier/or putty mixed with abrasive particles) among which, media (viscoelastic polymer) plays a dominant role. The commercial abrasive, which is one of the constituents of the viscoelastic media for AFM, which provides the finishing action (abrasion), are very expensive and hence it is a major problem for the small industries. Also, the finishing cost per unit component (workpiece) with a commercial media having SiC/diamond abrasives turns out to be very high, which makes its use uneconomical for mass finishing. Therefore, in the present research work, an attempt has been made to develop an alternative low-cost AFM media by replacing commercial abrasives with waste coal fly-ash. The developed media are characterized through static and dynamic rheological tests, thermogravimetric analysis, and finishing experiments on aluminum and mild steel workpieces to judge the performance of newly developed media concerning the traditional one. The percentage improvement obtained in average surface roughness(ΔRa) through fully fly-ash-based media (68% fly-ash) is ~56% for the aluminum and ~49% for mild steel workpieces.

The development of salinity affects 7% of the world’s land surface, acting as a major constraint to crop productivity. This study attempted to use the co-evolving endophytes of peanut to alleviate salinity stress and enhance the yield of peanut. Diverse and different tissue colonizing endophytes were isolated from peanut and screened in vitro by seed germination bioassay imposing gradients of salinity, with two cultivars TG37A (susceptible) and GG2 (moderately resistant), in potted conditions using saline irrigation water. Finally, nine endophytes capable of producing IAA and ACC-deaminase, promoting root growth and yield in potted conditions were selected for further evaluation in field conditions. They were evaluated with saline water (1.5–2.0 dS/m) in saline soil with susceptible cultivar TG37A. Simultaneously, three endophytes (Bacillus firmus J22N; Bacillus tequilensis SEN15N; and Bacillus sp. REN51N) were evaluated with two cultivars, GG2 and TG37A, during rainy and post-rainy seasons with elevated salinity. The application of endophytes like Bacillus firmus J22N and Bacillus sp. REN51N enhanced the pod and haulm yield of peanuts by 14–19% across cultivars, salinity, and seasons. In addition, there was significant modulation in parameters like relative water content; production of enzymes like superoxide dismutase (SOD), glutathione reductase (GR), catalase (CAT), ascorbate peroxidase (APX), lipid peroxidase (POD), and H2O2 content in leaf; and uptake of potassium. The activities of the enzymes involved in scavenging reactive oxygen species (ROS) increased with salinity, and further increased with endophytes like Bacillus firmus J22N, Bacillus tequilensis SEN15N, and Bacillus sp. REN51N. There was an enhanced accumulation of proline, reduced level of phenol and H2O2, and enhanced uptake of potassium with the inoculation of endophytes. This improved scavenging capacity of plants by endophytic modulation of ROS scavengers, uptake of K, production of ACC deaminase and IAA, root and biomass growth, modulation in relative water content, and enhanced accumulation of osmoprotectant might be the reasons of alleviation of salinity stress. Endophytes could have alleviated salinity stress in peanuts, indicating the mechanisms and potential of peanuts at the field level. These endophytes could be applied to bring agricultural sustainability to salinity-affected areas in the future. Furthermore, few genera viz. Kocuria, Brevundimonas, Agrococcus, Dietzia, and Kytococcus were observed in peanut tissue for the first time.

Opportunistic infections affecting central nervous system (CNS) have high prevalence in developing countries and cryptococcosis is one of them. It is associated with myriad of signs symptoms and clinical behavior. Though commonly associated with AIDS/HIV infection, it has been reported to be pathogenic in immunocompetent patients. Leptomeningitis is most common presentation in CNS, but unusual tumor like mass lesions have been reported. Lungs are primary site of infection, but it can affect different organs with varied clinical presentations. Therefore, correct diagnosis and proper management is essential in such cases excluding the differentials as fatality rate can be quite high. We report such an unusual case of multiple cryptococcal mass lesions in brain in a healthy immune competent individual with bilateral pulmonary involvement.

Ao longo dos anos, desde que o Cazaquistão conquistou a independência, houve mudanças importantes na economia do país associadas ao influxo de investimentos estrangeiros. Essas mudanças exigem a implementação de experiência estrangeira na regulação das relações económicas e, em particular, instituições contratuais estrangeiras. O Centro Financeiro Internacional "Astana" começou a funcionar no Cazaquistão desde 2018. Os atos do Centro Financeiro Internacional são baseados nos princípios e normas de direito da Inglaterra e do País de Gales. Nesse sentido, foi lançada uma reforma em larga escala do direito privado da República do Cazaquistão, com o objetivo de identificar uma série de ideias e projetos de direito civil que podem ser medidos na legislação cazaque a partir da lei inglesa. Os autores desta pesquisa são participantes diretos da reforma. Este estudo tem como objetivo destacar uma das questões consideradas no âmbito da reforma do direito privado: o reforço do papel do princípio da liberdade contratual e do princípio da boa-fé no direito contratual da República do Cazaquistão.

Abstract Background Exploration of microbes isolated from north western Himalayas for bioactive natural products. Results A strain of Trichoderma lixii (IIIM-B4) was isolated from Bacopa monnieri L. The ITS based rDNA gene sequence of strain IIIM-B4 displayed 99% sequence similarity with different Trichoderma harzianum species complex. The highest score was displayed for Hypocrea lixii strain FJ462763 followed by H. nigricans strain NBRC31285, Trichoderma lixii strain CBS 110080, T. afroharzianum strain CBS124620 and Trichoderma guizhouense BPI:GJS 08135 respectively. Position of T. lixii (IIIM-B4) in phylogenetic tree suggested separate identity of the strain. Microbial dynamics of T. lixii (IIIM-B4) was investigated for small peptides. Medium to long chain length peptaibols of 11 residue (Group A), 14 residue (Group B) and 17 residue (Group C) were identified using Matrix Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) mass spectrometer. Optimization is undeniably a desideratum for maximized production of desirable metabolites from microbial strain. Here optimization studies were carried out on T. lixii (IIIM-B4) using different growth media through Intact Cell Mass Spectrometry (ICMS). A multifold increase was obtained in production of 11 residue peptaibols using rose bengal medium. Out of these, one of them named as Tribacopin AV was isolated and sequenced through mass studied. It was found novel as having unique sequence Ac-Gly-Leu-Leu-Leu-Ala-Leu-Pro-Leu-Aib-Val-Gln-OH. It was found to have antifungal activity against Candida albicans (25 μg/mL MIC). Conclusion In this study, we isolated a strain of T. lixii (IIIM-B4) producing medium and long chain peptaibols. One of them named as Tribacopin AV was found novel as having unique sequence Ac-Gly-Leu-Leu-Leu-Ala-Leu-Pro-Leu-Aib-Val-Gln-OH, which had antifungal properties.

Abstract The spinning regular black hole (spin a) metric proposed by Johannsen shares the Kerr horizon but contains independent dimensionless parameters marking deviation from the Kerr metric. Non-zero value of any of the parameters would indicate violation of the no-hair theorem. We shall find the influence of these parameters on the relative time delay (not Shapiro time delay) treated here as a diagnostic for no-hair theorem using aligned, finite, thin-lens approximation in realistic spinning astrophysical configurations. Precise measurement of this delay would then help us determine, from observational perspective, whether or not any of the parameters is really non-zero. We shall also point out that the aligned spinning lens is completely equivalent to a “static” lens with a fictitious lens geometry, which would enable us to re-express the relative time delay components in terms of the spin a. Numerical values are tabulated for three astrophysical lens systems. The advantage of the present treatment is that it can accommodate a variety of spinning lens systems that are likely to be detected in the near future.

The use of immune checkpoint inhibitors (ICIs) is rapidly increasing as more combinations and clinical indications are approved in the field of genitourinary malignancies. Most immunotherapeutic agents being approved are for the treatment of renal cell carcinoma and bladder cancer, which mainly involve PD-1/PD-L1 and CTLA-4 pathways. There is an ongoing need for recognizing and treating immunotherapy-related autoimmune adverse effects (irAEs). This review aims to critically appraise the recent literature on the mechanism, common patterns, and treatment recommendations of irAEs in genitourinary malignancies. We review the epidemiology of these adverse effects as well as general treatment strategies. The underlying mechanisms will also be discussed. Diagnostic considerations including differential diagnosis are also included in this review.

Planning to speak is a challenge for the brain, and the challenge varies between and within languages. Yet, little is known about how neural processes react to these variable challenges beyond the planning of individual words. Here, we examine how fundamental differences in syntax shape the time course of sentence planning. Most languages treat alike (i.e., align with each other) the 2 uses of a word like "gardener" in "the gardener crouched" and in "the gardener planted trees." A minority keeps these formally distinct by adding special marking in 1 case, and some languages display both aligned and nonaligned expressions. Exploiting such a contrast in Hindi, we used electroencephalography (EEG) and eye tracking to suggest that this difference is associated with distinct patterns of neural processing and gaze behavior during early planning stages, preceding phonological word form preparation. Planning sentences with aligned expressions induces larger synchronization in the theta frequency band, suggesting higher working memory engagement, and more visual attention to agents than planning nonaligned sentences, suggesting delayed commitment to the relational details of the event. Furthermore, plain, unmarked expressions are associated with larger desynchronization in the alpha band than expressions with special markers, suggesting more engagement in information processing to keep overlapping structures distinct during planning. Our findings contrast with the observation that the form of aligned expressions is simpler, and they suggest that the global preference for alignment is driven not by its neurophysiological effect on sentence planning but by other sources, possibly by aspects of production flexibility and fluency or by sentence comprehension. This challenges current theories on how production and comprehension may affect the evolution and distribution of syntactic variants in the world's languages.

Introduction Most patients with type 2 diabetes require sequential addition of glucose-lowering agents to maintain long-term glycemic control. In this retrospective, observational study, we compared intensification with a glucagon-like peptide-1 receptor agonist (GLP-1 RA), oral antidiabetic drugs (OADs), and insulin in patients receiving two OADs, using US electronic health records and claims data.Research design and methods For inclusion, patients in the IBM MarketScan Explorys database were required to have claims for two different OADs in the 180-day baseline period and ≥1 claim for a different OAD/GLP-1 RA/insulin at index date (treatment intensification). Changes in glycated hemoglobin (HbA1c) and weight from baseline were assessed at 180 days postindex. Patients were propensity score-matched by baseline characteristics and exact-matched by HbA1c category (HbA1c cohort and weight/composite outcomes cohort) and body mass index (BMI) category (weight/composite outcomes cohort only) to obtain balanced treatment arms. The primary endpoint was the percentage of patients reaching target HbA1c

Phytopharmaceuticals have been widely used globally since ancient times and acknowledged by healthcare professionals and patients for their superior therapeutic value and fewer side-effects compared to modern medicines. However, phytopharmaceuticals need a scientific and methodical approach to deliver their components and thereby improve patient compliance and treatment adherence. Dose reduction, improved bioavailability, receptor selective binding, and targeted delivery of phytopharmaceuticals can be likely achieved by molding them into specific nano-formulations. In recent decades, nanotechnology-based phytopharmaceuticals have emerged as potential therapeutic candidates for the treatment of various communicable and non-communicable diseases. Nanotechnology combined with phytopharmaceuticals broadens the therapeutic perspective and overcomes problems associated with plant medicine. The current review highlights the therapeutic application of various nano-phytopharmaceuticals in neurological, cardiovascular, pulmonary, and gastro-intestinal disorders. We conclude that nano-phytopharmaceuticals emerge as promising therapeutics for many pathological conditions with good compliance and higher acceptance.

Introduction. Paraneoplastic limbic encephalitis (PLE) is a rare disease that presents as rapid onset dementia characterized by short-term memory loss (STM), anxiety, and behavioral changes. Anti-NMDAR antibodies are unfrequently reported in PLE associated with small-cell lung cancer (SCLC). Given that PLE can precede the diagnosis of cancer, it is very important that once infectious, metabolic, nutritional, or structural disorders associated with short-term memory loss are ruled out that vigorous effort must be made to rule out underlying malignancy. Case. We report a rare case of PLE as the presenting symptom of SCLC. A 72-year-old male with history of COPD was brought to the ED by his wife after he was found to have short-term memory loss, including forgetfulness of his wedding anniversary the day before, and anxiety. Neurological exam showed impaired short-term recall on MOCA. CT head showed no evidence of infarct. Lumbar puncture was performed which showed lymphocytic pleocytosis, a nonspecific inflammatory change. CSF panel was negative for HSV, Neisseria, Hemophilus, E. coli, and HIV. Initial EEG was unremarkable, though a repeat EEG showed mild slowing of the posterior dominant rhythm consistent with mild encephalopathy. MRI showed equivocal increased FLAIR on T2-weighted images in the bilateral temporal lobes, left greater than right. CTA thorax showed bulky mediastinal and right hilar LAD. FNA of the R4 lymph node revealed SCLC. The NM bone scan showed no osteoblastic lesions. While the serum autoantibody panel was positive for anti-NMDAR, the CSF autoantibody panel returned entirely negative. Chemotherapy with etoposide and cisplatin was started on Day 4 of admission. The patient’s neurological symptoms showed improvement following chemotherapy. Conclusion. This case highlights the importance of recognizing short-term memory loss as a feature of PLE.

Background: There are no studies on pathways to psychiatric care in patients seeking help at private psychiatric hospitals in India. Aim: This study aims to study help-seeking behavior and pathways to care among patients-seeking treatment at a private psychiatric hospital in North India. Subjects and Methods: Fifty newly registered patients were assessed for their help-seeking behavior and pathways to care before seeking the current consultation. Descriptive analysis was performed. Results: Most of the patients sought help either as self-referral or on advice of their relatives, friends, and other patients. Eighty percent of patients had seen a care provider within 1 month of onset of their symptoms. Forty-eight percent patients approached a psychiatrist while 34% approached a faith healer or unqualified local practitioner as their first care provider. Conclusion: Patients with mental illnesses vary in their help-seeking behavior with regard to their choice of first care provider, time to reach a psychiatrist, and number of care providers sought for their mental health problems.