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Abstract The superconducting systems emerging from topological insulators upon metal ion intercalation or application of high pressure are ideal for investigation of possible topological superconductivity. In this context, Sr-intercalated Bi $$_2$$ 2 Se $$_3$$ 3 is specially interesting because it displays pressure induced re-entrant superconductivity where the high pressure phase shows almost two times higher $$T_c$$ T c than the ambient superconducting phase ( $$T_C\sim 2.9$$ T C ∼ 2.9 K). Interestingly, unlike the ambient phase, the pressure-induced superconducting phase shows strong indication of unconventional superconductivity. However, since the pressure-induced phase remains inaccessible to spectroscopic techniques, the detailed study of the phase remained an unattained goal. Here we show that the high-pressure phase can be realized under a mesoscopic point contact, where transport spectroscopy can be used to probe the spectroscopic properties of the pressure-induced phase. We find that the point contact junctions on the high-pressure phase show unusual response to magnetic field supporting the possibility of unconventional superconductivity.

Abstract Discharging the gold-contained wastewater is an economic loss. In this work, a set of ZnO/WO3 was facile synthesized by hydrothermal method in order to recover gold from the industrial cyanide-based gold plating wastewater by photocatalytic process. Effect of ZnO contents coupled with WO3 was first explored. Then, effects of operating condition including initial pH of wastewater, type of hole scavenger, concentration of the best hole scavenger and photocatalyst dose were explored. A series of experimental results demonstrated that the ZnO/WO3 nanocomposite with 5 wt% ZnO (Z5.0/WO3) depicted the highest photocatalytic activity for gold recovery due to the synergetic effect of oxygen vacancies, a well-constructed ZnO/WO3 heterostructure and an appropriate band position alignment with respect to the redox potentials of [Au(CN)2]− and hole scavengers. Via this ZnO/WO3 nanocomposite, approximately 99.5% of gold ions was recovered within 5 h using light intensity of 3.57 mW/cm2, catalyst dose of 2.0 g/L, ethanol concentration of 20 vol% and initial pH of wastewater of 11.2. In addition, high stability and reusability were observed with the best nanocomposite even at the 5th reuse. This work provides the guidance and pave the way for designing the ZnO/WO3 nanocomposite for precious metal recovery from a real industrial wastewater.

Abstract Background The number of older adults with a high risk of frailty and severe illness continues to increase. Moreover, physiological change and multiple comorbidities are challenging to triage in geriatrics. Therefore, we aimed to evaluate variables to predict 28-day mortality and develop a screening tool to predict mortality and lifesaving intervention among geriatric patients in the emergency department (ED). Methods This study was a retrospective, single-center, observational study at the ED of Ramathibodi Hospital, Bangkok. Patients aged ≥ 65 years who visited the ED between January 2018 and December 2019 were enrolled. In the development cohort, univariable logistic regression was used to identify predictors of 28-day mortality in older patients. A predictive model for mortality and the need for lifesaving intervention was developed by multivariable logistic regression. In addition, the score was validated with internal validation and compared between development and validation set by chi-square. Results We enrolled 1393 patients. In the development cohort, among these 1002 patients, 103 (10.3%) of whom died within 28 days. Malignancy, shock index (SI), systolic blood pressure (SBP) 22 breaths/min), the ratio of pulse oximetric saturation to the fraction of inspired oxygen ( 1, 0.6–0.99), SBP 37.5 °C), and mental change. The area under a receiver operating characteristic (ROC) curve of the S-TRIAGE score in the validation cohort was 0.826 [95% confidence interval (95%CI) 0.773–0.879] in predicting mortality and lifesaving intervention, and the clinical score classified patients into five groups. Conclusion This study showed malignancy, hypotension, increased SI, and mental status change were predictive factors for 28-day mortality in older adults in the ED. The screening tool risk score for geriatrics used in this study is potentially a good predictor of mortality and lifesaving intervention in high-risk older patients in the ED.

Abstract Background Diaphragm dysfunction is common in critically ill patients and associated with poorer outcomes. The function of the diaphragm can be evaluated at the bedside by measuring diaphragmatic excursion using ultrasonography. In this study, we investigated the ability of right-sided diaphragmatic excursion (RDE) to predict the need for invasive mechanical ventilation (IMV). Methods Critically ill patients aged 18 years and older who presented to our emergency department between May 20, 2021 and May 19, 2022 and underwent measurement of RDE within 10 min of arrival were enrolled in this prospective study. The ability of RDE to predict the need for IMV was assessed by multivariable logistic regression and analysis of the area under the receiver-operating characteristic curve (AUROC). Results A total of 314 patients were enrolled in the study; 113 (35.9%) of these patients required IMV. An increase of RDE value per each 0.1 cm was identified to be an independent predictor of IMV (adjusted odds ratio 0.08, 95% confidence interval [CI] 0.04–0.17, p

Abstract A series of Au x /TiO2 nanoparticles (NPs) with different gold loadings (x = 0.1–1.0 wt%) was synthesized by the photodeposition and then employed as photocatalysts to recover precious component from the industrial gold-cyanide plating wastewater. Effects of Au loading, catalyst dosage and types of hole scavenger on the photocatalytic gold recovery were investigated under ultraviolet–visible (UV–Vis) light irradiation at room temperature. It was found that different Au loadings tuned the light absorption capacity of the synthesized photocatalysts and enhanced the photocatalytic activity in comparison with the bare TiO2 NPs. The addition of CH3OH, C2H5OH, C3H8O, and Na2S2O3 as a hole scavenger significantly promoted the photocatalytic activity of the gold recovery, while the H2O2 did not. Among different hole scavengers employed in this work, the CH3OH exhibited the highest capability to promote the photocatalytic gold recovery. In summary, the Au0.5/TiO2 NPs exhibited the best photocatalytic activity to completely recover gold ions within 30 min at the catalyst dosage of 0.5 g/L, light intensity of 3.20 mW/cm2 in the presence of 20 vol% CH3OH as hole scavenger. The photocatalytic activity slightly decreased after the 5th cycle of recovery process, indicating its high reusability.

Abstract Background Administration of antibiotics to septic patients within 1 h was recommended in 2018 by the Surviving Sepsis Campaign (SSC) as a strategy to improve survival outcomes. The use of sepsis screening tools in emergency departments (EDs) is important for early diagnosis and initiation of sepsis care. This study aimed to assess the impact of the Ramathibodi early warning score (REWs) on the administration of antibiotics within 1 h of presentation. Methods This was an observational retrospective cohort study with propensity score matching between the sepsis-3 criteria (pre-period) and the REWs (post-period) as screening tools in adult patients with sepsis in EDs. The primary outcome was the proportion of receiving antibiotics within 1 h of presentation in the pre- and post-periods. Results A total of 476 patients were analyzed without propensity matching. The proportion of antibiotic administration within 1 h was higher in patients screened using the REWs compared with standard of care in the total study population (79.5% vs. 61.4%, p < 0.001). After propensity score matching, 153 patients were included in both groups. The proportion of antibiotic administration within 1 h was similar in patients screened using the REWs and those receiving standard of care (79.7% vs. 80.4%, p = 0.886). However, time to intensive care unit (ICU) admission was faster in patients screened using the REWs. Delays in receiving antibiotics of longer than 3 h were associated with increased mortality (adjusted hazard ratio 7.04, 95% confidence interval 1.45 to 34.11, p = 0.015). Conclusions Implementing the REWs as a tool in sepsis screening protocols in EDs did not improve rates of antibiotic administration within 1 h as recommended by the SSC. However, time to ICU admission was improved after implementation of the REWs.

Abstract Background Appropriate antibiotics prescribing is key to treatment and to preventing mortality in patients with sepsis. The aim of this study was to determine the effect of the appropriate timing, spectrum, and dose of antibiotics on 28-day mortality in patients with sepsis. Methods We performed a retrospective cohort observational study. We enrolled patients with sepsis in the emergency department of a tertiary care hospital between 1 March and 31 July 2019. Patients were coded into an appropriate antibiotics group (time, spectrum, dose) and an inappropriate antibiotics group. We collected information of patient characteristics, comorbidities, vital signs, laboratory test results, and initial treatment. We followed patient outcomes, 28-day mortality, hospital deaths, 28-day ventilator-free days, and 28-day hospital-free days. Results A total of 593 patients were enrolled, with 323 (54.46%) in the appropriate antibiotics group. We used multivariate logistic analyses to assess factors for mortality. Primary outcomes of appropriate antibiotics (administration within 60 min of triage, appropriate spectrum and dose) did not affect 28-day mortality (adjusted odds ratio [OR], 0.57; 95% confidence interval [CI] 0.22–1.144; P=0.23). Subgroup analysis showed that appropriate spectrum alone influenced 28-day mortality (adjusted OR, 0.38; 95% CI, 0.15–0.99; P=0.047). Appropriate antibiotics was not associated with in-hospital mortality (adjusted OR, 0.62; 95% CI, 0.29–1.30; P=0.21). Conclusion Appropriate antibiotics included timing less than 60 min, spectrum and the dose was not significantly affected in 28-day mortality in emergency sepsis patients. Trial registration The trial was retrospectively registered in the Thai Clinical Trial Registry, identification number TCTR20211216003 .

Introduction: Sepsis has a mortality rate of 10–40% worldwide. Many screening tools for sepsis prediction and for emergency department (ED) triage are controversial. This study compared the accuracy of the scores for predicting 28-day mortality in adult patients with sepsis in the triage area of the ED. Methods: Adult patients who presented to the ED of a tertiary-care university hospital from January–December 2019 with an initial diagnosis of sepsis or other infection-related conditions were enrolled. We calculated predictive scores using information collected in the ED triage area. Prognostic accuracy was measured by the area under the receiver operating characteristic curve (AUROC) for predicting 28-day mortality as a primary outcome. The secondary outcomes included mechanical ventilation usage and vasopressor usage for 28 days. Results: We analyzed a total of 550 patients. The 28-day mortality rate was 12.4% (n = 68). The 28-day mortality rate was best detected by the National Early Warning Score (NEWS) (AUROC = 0.770; 95% confidence interval [CI]: 0.705–0.835), followed by the quick Sequential Organ Failure Assessment (qSOFA) score (AUROC = 0.7473; 95% CI: 0.688–0.806), Search Out Severity (SOS) score (AUROC = 0.749; 95% CI: 0.685–0.815), Emergency Severity Index (ESI) triage (AUROC = 0.599; 95% CI: 0.542–0.656, and the Systemic Inflammatory Response System (SIRS) criteria (AUROC = 0.588; 95% CI: 0.522–0.654]). The NEWS also provided a higher AUROC and outperformed for 28-day mechanical ventilator usage and 28-day vasopressor usage. Conclusion: The NEWS outperforms qSOFA, SOS, SIRS, and ESI triage in predicting 28-day mortality, mechanical ventilator, and vasopressor usage of a patient with sepsis who is seen at ED triage.

Background: The long-term success of root canal therapy depends on the effective debridement and removal of smear layer and debris from the canal. Root canals with difficult anatomy and complex systems pose great challenge to achieve this. Mechanical therapy alone cannot achieve this goal, various intracanal chemicals also have their own limitations along with the difficulty in reaching the farfetched and difficult areas, and hence, introduction of ultrasonic bypass system has been a boon for the endodontic therapy. Objectives: The aim of this study is to compare the various root canal medicaments along with ultrasonic bypass system in effectively cleaning the debris and smear layer from the various parts of the root canal system. Materials and Methods: Forty single-rooted anterior maxillary and mandibular human teeth were collected for this study, after disinfection, they were sectioned into three equal parts coronal, middle, and apical and these parts were later studies under SEM (Scanning Electron Microscope) and scoring as per the scoring criteria set before the study was done and results were then compared statistically. Results: Group with both ethylenediaminetetraacetic acid (EDTA) and NaOCl with ultrasonic bypass system was the most effective one, when compared with sterile water, NaOCl + ultrasonic bypass system, EDTA + ultrasonic bypass system. NaOCl + ultrasonic bypass system was more effective as compared with the EDTA + ultrasonic bypass system. Conclusion: Ultrasonic bypass system is a useful tool for debris and smear layer removal from a root canal system, but its effectiveness increases when both EDTA and NaOCl are used along with it.

OBJECTIVES: Endotracheal tube (ETT) displacement occurs by improper fixation. To fix an ETT, many types of fixation tools are employed. Thomas tube holder is one of the fixation tools widely used in many countries. This study aims to compare the ETT fixation using the Thomas tube holder with the conventional method (adhesive tape) in a mannequin model. METHODS: The fixation tools were random, using the box of six randomizes to Thomas tube holder and conventional method. After fixation, the mannequin model was being logged roll, chest compression by automated chest compression machine, and transported by the paramedic. The time to ETT fixation and displacements were recorded. RESULTS: The mean time (standard deviation) to fixate an ETT was shorter (33.0 s [7.3]) with a Thomas tube holder compared to adhesive tape (52.6 s [7.3], P < 0.001). The number and proportion of the ETT displacements were significantly less with Thomas tube holder compared to adhesive tape during log roll (16, 35.6% vs. 29, 64.4%, P = 0.011), chest compression with automated machine (23, 51.1% vs. 37, 82.2%, P = 0.003), and transport (26, 57.8% vs. 40, 88.9%, P = 0.002). CONCLUSION: The Thomas tube holder is more effective than adhesive tape in preventing ETT displacement in a mannequin subjected to log roll, chest compressions, and transportation.

Introduction: Application of a rigid cervical collar may interfere with the laryngeal view, and potentially lead to failed endotracheal intubation (ETI). This study aimed to compare intubation success rates while performing inline stabilization with and without cervical hard collar. Methods: This randomized prospective comparative study included paramedics working in the Department of Emergency Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand to compare the success rates of endotracheal intubation on manikin using inline stabilization with and without cervical hard collar. Results: 125 participants were evaluated; 63 in the rigid cervical collar and 62 in the non-cervical hard collar group. The rate of successful intubation was significantly higher using manual stabilization without cervical hard collar (61 (96.8%) vs. 55 (88.7%); p=0.048). The time required to successfully perform intubation was also shorter, with manual stabilization only (14.1 ±20.9 vs. 18.9±29.0; p = 0.081). Conclusion: It seems that, removal of the rigid cervical collar during ETI in patients with suspected traumatic spine injury could increase the intubation success rate.

Spontaneous pneumothorax in pregnancy is a rare and life-threatening condition. In this report, a case of spontaneous pneumothorax occurring at 34 weeks’ gestation in a healthy 34-year-old primigravida is described. She had typical complaints of chest pain and dyspnoea and diagnosis was made by chest X-ray which showed an extensive pneumothorax in the right side. Pneumothorax recurred twice over approximately three weeks. A caesarean section secondary to small pelvic parameters was scheduled with the chest tube in situ and a healthy 2.5 kg female infant was delivered. We discuss spontaneous pneumothorax during pregnancy and review the literature.

Focuses on a field survey that was conducted on four slum, squatter and pavement dweller communities of Mumbai City, India with a total sample size of 1,070 households. How the study revealed extremely low water consumption pattern averaging merely 30 l/c.d, no sewerage and safe excreta disposal facilities manifested by high occurrence of water-borne diseases.

Background Deep venous thrombosis (DVT) is more common in the hospital population and has an estimated annual incidence of 67 per 100,000. Surgery is a risk factor for DVT and has been proven to cause morbidity and mortality in the postoperative period. The correlation between the frequency of DVT and major surgical procedures has been demonstrated. However, few studies have been conducted on the relationship between emergency surgeries and the incidence of DVT. Our study aims to determine the prevalence of postoperative DVT in patients undergoing emergency laparotomies. Methods This prospective observational study was conducted over 18 months, from January 2021 to July 2022. Patients who underwent emergency exploratory laparotomies were included in this study. Duplex ultrasonography was done preoperatively to exclude patients with DVT. A serial duplex ultrasound was performed to detect DVT until the seventh postoperative day. All the clinicopathological and surgical information of patients relevant to this study was collected and analyzed. Results Out of 146 patients, one developed DVT in the postoperative period. The patient who experienced DVT had no other known risk factors; however, his age of 60 was a risk factor for DVT. So, the reported prevalence of DVT in our study population was just 0.68% of emergency exploratory laparotomy patients. Conclusion Our study reports DVT in only one case out of 146 patients who underwent emergency exploratory laparotomy without routine pharmacological prophylaxis. We might, therefore, conclude that emergency exploratory laparotomy may be a separate risk factor for the emergence of DVT. More prospective studies with large sample sizes should be done to evaluate the prevalence of DVT in emergency exploratory laparotomies., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee of All India Institute of Medical Sciences, Rishikesh issued approval AIIMS/IEC/21/120. 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, Acharya et al.)

Background: Noncommunicable diseases (NCDs) contribute significantly to global morbidity and mortality, with cancer being one of the leading causes. In this prospective observational study, we aimed to investigate the prevalence and impact of endocrine disorders, specifically diabetes and thyroid dysfunction, in patients with advanced metastatic cancer undergoing cancer-directed therapy., Methods: Over 15 months, we recruited 100 histologically proven advanced metastatic cancer patients from the Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, and conducted institutional-based prospective observational study. All participants over 18 years of age, treatment-naive, and potential candidates for systemic chemotherapy with an expected clinical survival of at least 6 months were included in the study. Patients with prior therapy, secondary neoplasms, and those unable to complete 3 months of palliative chemotherapy were excluded. Patients were assessed for diabetes and thyroid function at presentation, after 3 and 6 months of cancer-directed standard therapy. These data were analyzed, processed, and presented as results., Results: The mean age of participants was 50.45 years, with a near-equal distribution of males and females. At baseline, 10% of the study population had preexisting endocrine disorders (2% hypothyroidism, 8% diabetes). By the end of 6 months, the prevalence increased to 18%, with females being more affected. Notably, the prevalence of new-onset endocrine disorders during cancer-directed therapy was only 3% for diabetes and 4% for thyroid dysfunction., Conclusion: Analysis of sociodemographic and cancer-related characteristics showed no significant association with changes in diabetic and thyroid status at 3 and 6 months. However, substance use, particularly smoking, was associated with an increased risk of diabetes development (p < .05). Cancer type and treatment regimen did not show statistically significant correlations with endocrine dysfunction., Implications: Our study highlights the importance of considering endocrine disorders in advanced metastatic cancer patients undergoing therapy. The prevalence of diabetes and thyroid dysfunction increased during cancer-directed therapy, particularly in females. Careful monitoring and timely intervention are essential to improve the quality of life for these patients. Further research is warranted to explore the long-term effects of cancer-directed therapy on endocrine health and develop tailored management strategies for this vulnerable population., (© 2024 The Authors. Cancer Reports published by Wiley Periodicals LLC.)

Male breast cancer (MBC) is a rare entity, underrepresented in population studies and clinical trials, resulting in management of MBC to be informed by current research on female breast cancer (FBC). A literature review was conducted by accessing relevant articles on 2 databases, by searching keywords "male breast cancer". A total of 29 articles from year 2011 to 2022 were selected for this review. The authors found that male breast cancer generally occurs later in life with higher stage, higher grade, and more estrogen receptor (ER) positive tumours. Most of the studies noted the mean age for MBCs at the time of presentation as >60 years. Risk factors for male breast cancer include family history, obesity, lower physical activity, and syndromes like the Klinefelter syndrome. Positive family history is much higher in MBC compared to FBC (30.9 vs. 18.4%). BRCA 2 cancers constitute a higher proportion compared to FBCs. A lot of genetic mutations have been observed. Some show promise to assess disease-specific survival and proliferative rate like TWIST1 and RUNX3 , among others. MBCs usually present with a palpable lump in central region, with a bigger size and chance of nodal involvement and metastasis compared to FBCs. They are mostly infiltrating ductal type and hormone receptor positive, with worse histological grade. Treatment usually follows the same principles as FBCs (systemic therapy, surgical excision, and radiotherapy), with poorer prognosis to same treatment approach, possibly owing to its advanced stage at presentation. This is a rare entity which requires further research to ascertain need for different management approach than FBCs., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Vidhu Shekhar Khare et al.)

Despite the significant advancement of new tools and technology in the field of medical biology and molecular biology, the challenges in the treatment of most cancer types remain constant with the problem of developing resistance toward drugs and no substantial enhancement in the overall survival rate of cancer patients. Immunotherapy has shown the most promising results in different clinical and preclinical trials in the treatment of various cancer due to its higher efficacy and minimum collateral damage in many cancer patients as compared to conventional chemotherapy and radiotherapy. An oncolytic virus is a new class of immunotherapy that can selectively replicate in tumor cells and destroy them by the process of cell lysis while exerting minimum or no effect on a normal cell. Besides this, it can also activate the host's innate immune system, which generates an anti-tumor immune response to eliminate the tumor cells. Several wild types and genetically modified viruses have been investigated to show oncolytic behavior. Vaccinia virus has been studied extensively and tested for its promising oncolytic nature on various model systems and clinical trials. Recently, several engineered vaccinia viruses have been developed that express the desired genes encoded for selective penetration in tumor cells and enhanced activation of the immune system for generating anti-tumor immunity. However, further investigation is required to prove their potential and enhance their therapeutic efficacy., (© 2024. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Historically, biological agents have been used to target various populations. One of the earliest examples could be the catastrophic effect of smallpox in Australia in the eighteenth century (as alleged by some historians). Modern biological techniques can be used to both create or provide protection against various agents of biological warfare. Any microorganism (viruses, bacteria, and fungi) or its toxins can be used as biological agents. Minnesota Department of Health has listed Smallpox (variola major) as a category A bioterrorism agent, even though it has been eradicated in 1980 through an extensive vaccination campaign. Category A agents are considered the highest risk to public health. Laboratory-associated outbreaks of poxviruses could cause unprecedented occupational hazards. Only two WHO-approved BSL-4 facilities in the United States and Russia are allowed to perform research on the variola virus. So, poxviruses present themselves as a classical case of a dual-use dilemma, since research with them can be used for both beneficial and harmful purposes. Although the importance of ethics in scientific research requires no further elaboration, ethical norms assume greater significance during experimentation with poxviruses. In this chapter, we will update the readers on the sensitive nature of conducting research with poxviruses, and how these viruses can be a source of potential biological weapons. Finally, specified ethical guidelines are explored to ensure safe research practices in virology., (© 2024. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Background: Nonketotic hyperglycemic hemichorea is a rare complication of diabetes mellitus seen in the emergency department. It is most commonly reported in elderly women, predominantly of Asian race, with poorly controlled diabetes mellitus. Patients present with a triad of nonketotic hyperglycemia, hemichorea, and contralateral basal ganglia abnormality on imaging. Its exact pathophysiology is still not known. However, it has a very good prognosis with early diagnosis and treatment., Case Report: We report a case of hemichorea involving the right upper and lower limbs due to nonketotic hyperglycemia. The patient's symptoms resolved after normalization of blood glucose. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Nonketotic hyperglycemic hemichorea should be included in the differential of a patient presenting with chorea and high blood glucose levels. It has an excellent prognosis with both symptoms and imaging abnormalities typically resolving completely with restoration of normoglycemia., Competing Interests: Declaration of Competing Interest We have no conflicts of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background Burns continue to be a serious public health problem in India. It persists as an endemic disease in spite of implementing various preventive measures at the individual and community levels. Etiology and factors influencing burns are varied. There is a paucity of data regarding the clinico-demographic profile of burns disease, especially from emergency tertiary care settings in India. Objective To assess the proportion of burn patients having longer hospital stays (>1 week) and the influence of clinico-demographic factors associated with it among the burn patients presenting to the emergency department of a tertiary care institute in south India. Methodology An institution-based cross-sectional analytical study was conducted among burns patients attending the Emergency Medicine Department (EMD) of a tertiary care center between January 2017 and December 2017. Information on clinico-demographic profile and duration of hospital stay were captured using semi-structured data collection proforma. Results All the 327 burns injury patients who presented to our EMD during the study period were included. Among the 327 patients, 259 (79%) were admitted to the EMD. Among 259 admitted patients, 142 (55%) patients were discharged home. Among these 142 patients, 106 (74.6%; 95%CI 66.8-81.2) had longer hospital stays (more than one week). Female gender and facial/inhalational burns were found to have an independent effect on the length of hospital stay even after adjusted analysis. Conclusion Length of hospital stay is independently influenced by female gender and facial/inhalational burns. This study also identified the need for better home safety, child-proofing, proper pre-hospital care, and dedicated burns units in the community., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mahalingam et al.)

Background: When health systems worldwide grapple with the coronavirus disease 2019 (COVID-19) pandemic, its effect on the global environment is also a significant consideration factor. It is a two-way process where the pre-COVID climate factors influenced the landscape in which the disease proliferates globally and the consequences of the pandemic on our surroundings. The environmental health disparities will also have a long-lasting effect on public health response., Main Body: The ongoing research on the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 must also include the role of environmental factors in the process of infection and the differential severity of the disease. Studies have shown that the virus has created positive and negative ramifications on the world environment, especially in countries most critically affected by the pandemic. Contingency measures to slow down the virus, such as self-distancing and lockdowns have shown improvements in air, water, and noise quality with a concomitant decrease in greenhouse gas emissions. On the other hand, biohazard waste management is a cause for concern that can result in negative effects on planetary health. At the peak of the infection, most attention has been diverted to the medical aspects of the pandemic. Gradually, policymakers must shift their focus to social and economic avenues, environmental development, and sustainability., Conclusion: The COVID-19 pandemic has profoundly impacted the environment, both directly and indirectly. On the one hand, the sudden halt in economic and industrial activities led to a decrease in air and water pollution, as well as a reduction in greenhouse gas emissions. On the other hand, the increased use of single-use plastics and a surge in e-commerce activities have had negative effects on the environment. As we move forward, we must consider the pandemic's long-term impacts on the environment and work toward a more sustainable future that balances economic growth and environmental protection. The study shall update the readers on the various facets of the interaction between this pandemic and environmental health with model development for long-term sustainability., Competing Interests: Competing interestsThe authors have no competing interests to declare relevant to this article's content., (© The Author(s) 2023.)

Type 2 diabetes (T2D) is a well-known disease that impaired bone mechanical properties and increases the risk of fragility fracture. The bone tissue is a viscoelastic material that means the loading rate determines its mechanical properties. This study investigates the impact of T2D on the viscoelastic properties of human bone and its association with microstructure and biochemical properties., Introduction: Viscoelasticity is an important mechanical property of bone and for this the interaction of individual constituents of bone plays an important role. The viscoelastic nature of bone can be affected by aging and diseases, which can further influence its deformation and damage behavior., Methods: The present study investigated the effects of T2D on the viscoelastic behavior of trabecular bone. The femoral heads of T2D (n = 26) and non-T2D (n = 40) individuals with hip fragility fractures were collected for this investigation. Following the micro-CT scanning of all bone samples, the stress relaxation and dynamic mechanical analysis (DMA) tests were performed to quantify the viscoelasticity of bone. Further, a correlation analysis was performed to investigate the effects of alteration in bone microstructural and biochemical parameters on viscoelasticity., Results: The stress relaxation and frequency sweep responses of T2D and non-T2D trabecular bone specimens were not found significantly different. However, the storage modulus, initial stiffness, and initial stress were found lower in T2D bone. The significant correlation of percentage stress relaxed is obtained between the mineral content (r= - 0.52, p-value = 0.003), organic content (r = 0.40, p-value = 0.02), and mineral-to-matrix ratio (r = - 0.43, p-value = 0.009). Further, storage and loss modulus were correlated with bone volume fraction (BV/TV) for both groups. The stress relaxation and frequency sweep characteristics were not found significantly connected with the other chemical, structural, or clinical parameters., Conclusion: This study suggests that T2D does not affect the time-dependent response of human femoral trabecular bone. The viscoelastic properties are positively correlated with organic content and negatively correlated with mineral content., (Copyright © 2022 IPEM. Published by Elsevier Ltd. All rights reserved.)

Type 2 diabetes mellitus (T2DM) adversely affects the normal functioning, intrinsic material properties, and structural integrity of many tissues, including bone. It is well known that the clinical utility of areal bone mineral density (aBMD) is limited to assess bone strength in individuals with T2DM. Therefore, there is a need to explore new diagnostic techniques that can better assist and improve the accuracy of assessment of bone tissue quality. The present study investigated the link between bone and fingernail material/compositional properties in type 2 diabetes mellitus (T2DM). For that, femoral head and fingernail samples were obtained from twenty-five adult female patients (with/without T2DM) with fragility femoral neck fractures undergoing hemi/total hip arthroplasty. Cylindrical cores of trabecular bone were subjected to micro-CT, and lower bone volume fraction was observed in the diabetic group than the non-diabetic group due to fewer and thinner trabeculae in individuals with T2DM. The material and compositional properties of bone/fingernail were estimated using nanoindentation and Fourier Transform Infrared Spectroscopy, respectively. Both bone/fingernails in T2DM had lower reduced modulus (Er), hardness (H), lower Amide I and Amide II area ratio (protein content), higher sugar-to-matrix ratio, and relatively high carboxymethyl-lysine (CML) content compared with non-diabetic patients. Sugar-to-matrix ratio and relative CML content were strongly and positively correlated with HbA1c for both bone/fingernail. There was a positive correlation between bone and fingernail glycation content. Our findings provide evidence that the degradation pattern of bone and fingernail properties go hand-in-hand in individuals with T2DM. Hence, the fingernail compositional/material properties might serve as a non-invasive surrogate marker of bone quality in T2DM; however, further large-scale studies need to be undertaken., Competing Interests: The authors have declared that no competing interests exist.