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Objective To evaluate the impact of coadministering statins with direct oral anticoagulants (DOACs) on the risk of major bleeding events in patients with venous thromboembolism (VTE).Design Observational cohort analysis based on a multicentre international registry.Setting Data were extracted from the Registro Informatizado de Enfermedad TromboEmbolica Registry, which involves 205 centres across 27 countries.Participants A total of 73 659 patients diagnosed with VTE were classified based on their anticoagulant therapy (DOACs) versus low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKAs) and concurrent use of statins.Methods Multivariable Cox proportional hazards models adjusted for confounding variables to assess the risk of major bleeding events stratified by the type of anticoagulant use and statin use.Results From October 2013 to February 2023, 73 659 patients were recruited: 2573 were statin users on DOACs, 14 090 were statin users on LMWH or VKA therapy, 10 088 were non-statin users on DOACs and 46 908 were non-statin users on LMWH or VKA therapy. Statin users were 10 years older and more likely to have hypertension, diabetes, renal failure or prior artery disease. During anticoagulation (median, 187 days), 1917 patients (2.6%) suffered major bleeding. Rates of major bleeding per 100 patient-years were 2.33 (95% CI 1.72 to 3.09), 3.75 (95% CI 3.43 to 4.10), 1.39 (95% CI 1.13 to 1.69) and 3.10 (95% CI 2.93 to 3.27), respectively. On multivariable analysis, patients treated with DOACs had a significantly lower risk of major bleeding compared with those on LMWH or VKA therapy (adjusted HR 0.59; 95% CI 0.48 to 0.74). The adjusted HR in statin users versus non-users was 1.03 (95% CI 0.92 to 1.14), while in statin users on DOACs versus the rest of patients, it was 1.18 (95% CI 0.79 to 1.76).Conclusions In patients with VTE receiving statins, long-term anticoagulation with DOACs was associated with a reduced risk of major bleeding, regardless of the statin use. These findings support the safety profile of DOACs over VKAs or LMWH in the management of VTE in patients requiring statins.

Até recentemente, o tratamento da hemofilia A consistia em repor fator VIII ou agentes de by-pass (se inibidor positivo) para tratar (demanda) ou evitar (profilaxia) sangramentos, baseado em infusões intravenosos várias vezes por semana. O emicizumabe surgiu como uma alternativa na profilaxia, mostrando superioridade frente aos produtos anteriores para evitar sangramentos em pessoas com hemofilia A (PcHA) sem e com inibidores. A administração é subcutânea com doses semanais a mensais. Essa mudança na efetividade e na posologia tem sido acompanhada de uma readaptação das orientações às PcHA acerca da doença e do manejo terapêutico. O objetivo deste estudo foi compreender a percepção de enfermeiros, psicólogos e assistentes sociais, aqui descritos como equipe de suporte biopsicossocial (esBPS), que atendem PcHA em diversos centros de tratamento de hemofilia do Brasil, a respeito das mudanças de mentalidade e comportamento relacionadas à introdução do emicizumabe. Este estudo exploratório e quantitativo começou em julho/2021. A partir da discussão da literatura sobre o tema, uma esBPS (n = 5) enumerou os principais pontos do suporte biopsicossocial prestado à PcHA que poderiam ser impactados com a introdução da profilaxia com emicizumabe. Em janeiro/2024, após maior experiência com a terapia, esses pontos foram mantidos e transformados em afirmativas validadas por profissionais não envolvidos com o projeto. Entre 5 e 30/07/2024, profissionais das esBPS foram convidados para participar e, mediante aceite, receberam um formulário envolvendo 26 afirmativas para serem avaliadas quanto à concordância em uma escala de Likert: discordo totalmente e discordo parcialmente (agrupados como discordo), não discordo nem concordo (neutro), e concordo parcialmente e concordo totalmente (agrupados como concordo). Uma pergunta alternativa solicitou que selecionassem o desfecho mais adequado para ser avaliado na profilaxia com emicizumabe.Dos 44 profissionais convidados, 17 (39%) completaram a enquete, com representatividade semelhante entre enfermeiros, psicólogos e assistentes sociais. A mediana de tempo de atendimento às PcHA foi 10 anos (amplitude 2-42), com média mediana de 15 atendimentos/semana (amplitude 1-57). Todos concordaram que é importante que a PcHA em uso de emicizumabe tenha autonomia e liberdade para participar da decisão da melhor terapia a ser instituída. A maior parte (94%) concordou que a frequência de consultas (rotina e urgência) foi reduzida e que um modelo alternativo (por exemplo, consultas online ) junto com o convencional seria importante para garantir a autonomia e a liberdade que o tratamento proporciona. A maioria também concordou que a equipe interdisciplinar deva elaborar novos métodos de garantir o treinamento e a compreensão pela PcHA sobre reconhecimentos de sangramentos (88%), mantendo-se o treinamento de obtenção de acesso venoso para tratar sangramentos (76%). O indicador mais importante foi qualidade de vida (65%). Finalmente, todos concordaram que a PcHA deva ser instruída quanto ao risco da associação do emicizumabe com medicamentos (por exemplo, complexo protrombínico parcialmente ativado). Em conclusão, existe uma necessidade de adaptação de modelo assistencial atual à PcHA após a introdução da profilaxia com emicizumabe.

Soil erosion remains a persistent menace to the sustainability of agriculture and the environment in tropical mountainous regions. Soil erosion assessment is therefore necessary to identify degraded land areas for implementing effective conservation and management strategies. Hence, this study focuses on estimating potential soil erosion and analyzing their spatial patterns in the Chite watershed, situated in the Eastern Himalayas, India, using the Revised Universal Soil Loss Equation (RUSLE) model in Geographic Information System (GIS) platform. Various datasets encompassing remote sensing, ground observations, and laboratory analysis were employed to prepare the model’s input factors. The estimated mean erosion rate of the study area is 6.10 t ha-1 year-1, which produces a total soil loss of about 357580.90 t year-1. Spatial analysis reveals that about 5.79% of the watershed is under a relatively severe erosion category, contributing 70.13% of the total soil loss. Soil erosion appraisal with respect to the land use/ land cover (LULC) indicates a considerable consequence of various anthropogenic activities in the watershed. Higher rates of soil erosion are mainly observed on the bare land, cropland, and settlement areas which are characterized by steep and continuous slopes. The present findings were also validated with previous work undertaken in some comparable regions. This research can serve as a reliable tool towards the development of successful soil conservation measures and for promoting sustainable land use planning in this ecologically sensitive tropical mountainous region.

Introduction Tuberculosis (TB) continues to be one of the deadliest infectious diseases over the centuries, killing more people worldwide than any other single infectious disease. There is an urgent need for additional strategies which can expedite efforts to combat TB including a preventive vaccine. In this endeavour, we have developed a protocol for a multisite, double-blind, placebo-controlled clinical trial in India that aims to evaluate the efficacy and safety of two TB vaccines; namely, VPM1002 and Immuvac (M.w) (Mycobacterium Indicus Pranii) (MIP) among healthy household contacts (HHCs) of sputum smear-positive pulmonary TB (PTB) patients.Methods and analysis In the three-arm randomised double-blind placebo-controlled trial study protocol, a total of 12 000 HHCs (aged 6−99 years) of sputum smear-positive PTB patients will be randomised to receive either of the two vaccine candidates VPM1002 and MIP or placebo. The primary efficacy endpoint is the prevention of microbiologically confirmed TB. Secondary endpoints will include (1) prevention against Latent TB infection, (2) incidence of adverse events and serious adverse events in study participants, (3) efficacy of vaccine in prevention of PTB/extra PTB in different age groups (6–18 years, 19–35 years, 36–60 years and above 60 years) and (4) immunogenicity of VPM1002 and MIP at month 2 and month 6 after first vaccination in terms of flow cytometric analysis of M.Tb specific CD4+ and CD8+ T cells secreting cytokines and Luminex assays for the presence of different cytokines in the sera and supernatants of peripheral blood mononuclear cells cultures stimulated with whole cell lysates of M.Tb and subsequently similar analysis for the cases who develop TB postvaccination during the follow-up period.Ethics and dissemination Ethics committees’ approvals have been granted by the Institutional Human Ethics Committees of all participating centres in this study and the names of the ethics committees and approvals are as follows: (1) National Institute for Research in Tuberculosis (NIRT)-Chennai (including subsites): ECR/135/Inst/TN/2013/RR-19, Approval No. 390/NIRT-Institutional Ethics Committee (IEC)/2018 dated 5 December 2018 (NIRT-Madurai-ECR/1365/Inst/TN/2020; approval dated 8 June 2020; NIRT, Vellore: ECR/1215/Inst/TN/2019; approval dated 26 September 2020); (2) All India Institute of Medical Sciences (AIIMS), Delhi (including subsites)-Institute Ethics Committee, ECR/547/Inst/DL/2014/RR-17 ECR/538/Inst/DL/2014/RR-20; approval No.IEC-385/06-07-2018, approval OP-28/05.04.2019 and SFH- ECR/593/Inst/DL/2014/RR-20 IEC/VMMC/SJH/project/2019-05/25 ; 23 May 2019; (3) National Institute of Tuberculosis and Respiratory Diseases (NITRD), Delhi: ECR/315/Inst/DL/2013/RR-19; approval IEC-No-NITRD/EC/2019/9004; 8 January 2019; (4) Pune-National AIDS Research Institute (NARI) and subsite-ECR/23/Inst/MH/2013/RR-19; IEC-NARI/EC/approval/2018/196; 29 May 2018; (5) Regional Medical Research Centre-Bhubaneshwar-ECR/911/Inst/OR-2017/RR-21; approval, dated 25 April 2018; Subsites- AIIMS, Bhubaneshwar ECR/534/Inst/OD/2014/RR-17 and 20 approval No. T/EMF/Pulm. Med/19/01 dated 13 May 2019; SCB, Cuttack No. No.ECR/84/Inst/OR/2013/RR-20; approval no.186 dated 7 February 2020; (6) NTI-Bengaluru: Ethics Committee-No-ECR/1819/Inst/KA/2019; approval No NTI-IEC/1.2019/principal investigator, dated 31 January 2019; (7) BMMRC, Hyderabad- ECR/450/Inst/AP/2013/RR-16 approval No. 779/BMMRC/2018/IEC, dated 11 June 2018 (Subsite Share India- Mediciti Ethics Committee-ECR/283/Inst/AP/2013/RR-20; Approval no. EC/11/VII/2K20(1) dated 11 July 2020) and (8) SJMC-Bengaluru: ECR/238/Inst/KA/2013/RR-19; approval IEC/1/491/2020; 7 August 2020.The trial findings will be published in accordance with the Consolidated Standards of Reporting Trials guidance. The results of this clinical trial will be presented at scientific conferences and disseminated through publications in peer-reviewed journals, conference presentations and shared with Ministry of Health and Family Welfare, policy-makers and other stakeholders.Trial registration number CTRI/2019/01/017026.

Purpose: To compare the effect of prostaglandin analogs (PGA) against other glaucoma medications (non-PGA) on the intraocular pressure (IOP) outcomes of combined trabeculectomy with phacoemulsification, and the conjunctival cell profile in persons with primary open-angle (POAG) and pseudoexfoliation glaucoma (PXFG). Methods: A prospective cohort study was conducted among 116 patients with POAG or PXFG on glaucoma medications for a minimum of 3 months undergoing glaucoma triple procedure. Patients were divided into two groups (PGA and non-PGA) based on preoperative exposure to PGA. IOP outcomes were assessed for up to 2 years. Conjunctival biopsy specimens were obtained at the time of surgery, and histopathological analysis was performed. Results: Forty-two patients were in the PGA group, 67 were in the non-PGA group, and seven were lost to follow-up. The non-PGA group had lesser mean postoperative IOP and needed fewer postoperative medications compared to the PGA group in all visits up to 2 years. The non-PGA group had better complete success rate (50.7% vs. 14.3%, P < 0.001). Kaplan–Meier survival estimates showed a significant difference in cumulative complete success rate between non-PGA (67%) and PGA (26%) by 24 months (P < 0.001). The Cox proportional model showed the type of drug to be significantly associated with surgical failure. Histopathological analysis revealed that the PGA group had higher numbers for each type of inflammatory cell (except mast cells) compared to the non-PGA group. Conclusion: Patients on PGA are likely to have a higher postoperative IOP and may need more medications for IOP control after a glaucoma triple procedure.

Background Pre-existing cardiovascular disease (CVD) or cardiovascular risk factors have been associated with an increased risk of complications following hospitalisation with COVID-19, but their impact on the rate of recovery following discharge is not known.Objectives To determine whether the rate of patient-perceived recovery following hospitalisation with COVID-19 was affected by the presence of CVD or cardiovascular risk factors.Methods In a multicentre prospective cohort study, patients were recruited following discharge from the hospital with COVID-19 undertaking two comprehensive assessments at 5 months and 12 months. Patients were stratified by the presence of either CVD or cardiovascular risk factors prior to hospitalisation with COVID-19 and compared with controls with neither. Full recovery was determined by the response to a patient-perceived evaluation of full recovery from COVID-19 in the context of physical, physiological and cognitive determinants of health.Results From a total population of 2545 patients (38.8% women), 472 (18.5%) and 1355 (53.2%) had CVD or cardiovascular risk factors, respectively. Compared with controls (n=718), patients with CVD and cardiovascular risk factors were older and more likely to have had severe COVID-19. Full recovery was significantly lower at 12 months in patients with CVD (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.89) and cardiovascular risk factors (aOR 0.66, 95% CI 0.50 to 0.86).Conclusion Patients with CVD or cardiovascular risk factors had a delayed recovery at 12 months following hospitalisation with COVID-19. Targeted interventions to reduce the impact of COVID-19 in patients with cardiovascular disease remain an unmet need.Trail registration number ISRCTN10980107.

Background. Cystic echinococcosis (CE) is a zoonotic disease with an Africa-wide prevalence of 1.7%. CE is caused by the tapeworm Echinococcus granulosus sensu lato, with the liver being the most commonly affected organ. In South Africa (SA), there is a paucity of data on liver CE demographics and management. Objectives. To describe the demographics and clinical profile of patients with liver CE in a single tertiary hospital in Eastern Cape Province, SA. Methods. A 4-year (2019 - 2022) retrospective clinical record review study was conducted on patients presenting with liver CE to the Department of Surgery at Frere Hospital. The demographics, clinical characteristics and management of patients with liver CE are reported. Results. A total of 56 patients diagnosed with and managed for liver CE were included in the study. The mean age of the patients was 37.5 years. Abdominal pain (n=39; 69.6%) was the most common presenting symptom, and a palpable abdominal mass (n=36; 64.3%) was the predominant presenting sign. Most patients had disease confined to the liver (n=35; 62.5%). The right lobe of the liver was most commonly affected (n=38; 67.9%), and most patients had a single liver cyst on imaging (n=32; 57.1%). The majority of the patients (n=36; 64.3%) were managed with surgical partial cystectomy, with a perioperative bile leak being the most common complication. Conclusion. In our setting, liver CE contributes to a significant local burden of the disease. The disease often has a nonspecific clinical presentation, necessitating imaging for the diagnosis. We observed good short-term outcomes in patients managed with combined partial cystectomy and medical therapy, although there is a risk of perioperative bile leak.

Background. Although leprosy, a neglected tropical disease, has been eliminated (

[This corrects the article DOI: 10.1371/journal.ppat.1008307.].

Schwannomas are benign, slow-growing, and noninvasive tumors. They account for 1% of all orbital tumors. A 32-year-old female patient presented with a large mass and proptosis of the right eye for 4 years. On imaging, a large well-defined mass, heterogeneous mass of the right orbit with the evidence of cystic degeneration, was present. On incisional biopsy, fusiform cells arranged in intertwine bundles with characteristic Verocay bodies (Antoni A) and multiple cystic regions (Antoni B patterns) were found. S-100 was found positive on IHC, and a diagnosis of schwannoma was made. Cystic degeneration in orbital schwannoma has also been reported but very rarely.

Conditions affecting the upper digestive system are often seen in clinical practice and are associated with a high rate of death and disability. Histopathological confirmation is one of the foundations for good treatment planning and the definite diagnosis of illnesses of the upper gastrointestinal tract. The numerous methods employed in the diagnosis of gastrointestinal lesions have come a long way in the previous 25 years. The identification and diagnosis of gastrointestinal lesions have been substantially aided by the development of endoscopy, endoscopic biopsy, and other surgical techniques. This research aimed to examine the variety of gastrointestinal tract (GI) lesions and to draw connections between the clinical and pathological manifestations of these conditions. Materials and Methods: A two-year cross-sectional study was conducted in the Department of Pathology, from June 2018 to May 2020, which included surgical specimens of 140 cases from the upper gastrointestinal tract, of which 111 cases were biopsy, and 29 cases were resected surgical specimens. The data were analyzed using SPSS software. Furthermore, P values, sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results: This study was a two-year cross-sectional study conducted in the Department of Pathology during the period of June 2018–May 2020.

Since ChatGPT exploded onto the scene in October 2022, the media has been breathless with their discussion about how it is going to impact many aspects of life and work. In order to bring this new reality of generative AI into the "Introduction to Management Information Systems" classroom at both the undergraduate and graduate levels, we have developed two short cases that can be completed in or out of the classroom. These cases allow students to use generative AI for an interesting and useful purpose and develop prompts to deliver the output. Students can begin to learn what generative AI can do for them, and how it can shape their future careers. We tested the perceived effectiveness of the project on students using a pre/post survey. The results are analyzed using a paired t-test and demonstrate that students increased their understanding of generative AI and prompt engineering.

Abstract This proposed work deals with the implementation of a single-phase topology with using hybrid for multilevel inverters. It is observed that the proposed structure improves the performance of the hybrid multilevel inverter with high-frequency switches for positive levels and reverse voltage with negative levels. This paper studies a novel construction for an asymmetrical hybrid single-phase multilevel inverter. This paper also studies the operation of multi level inverter under depreciating sources condition due to fluctuation in input. The PWM method, i.e. APOD and CO, has been incorporated into the simulation of single-phase 7-level, 9-level, and the 11-level hybrid inverter. These two methods are compared to one another and to standard methods in terms of THD for different values of the modulation index, and they are found to be superior. Overall loss of 50% of the THD is almost equal to rated output voltage, it is observed in cascaded multilevel inverters. The working and performance of the proposed model are simulated in MATLAB Simulink software and the results are discussed in detail.

This research addresses the pressing challenge of intrusion detection and prevention in Wireless Sensor Networks (WSNs), offering an innovative and comprehensive approach. The research leverages Support Vector Regression (SVR) models to predict the number of barriers necessary for effective intrusion detection and prevention while optimising their strategic placement. The paper employs the Ant Colony Optimization (ACO) algorithm to enhance the precision of barrier placement and resource allocation. The integrated approach combines SVR predictive modelling with ACO-based optimisation, contributing to advancing adaptive security solutions for WSNs. Feature ranking highlights the critical influence of barrier count attributes, and regularisation techniques are applied to enhance model robustness. Importantly, the results reveal substantial percentage improvements in model accuracy metrics: a 4835.71% reduction in Mean Squared Error (MSE) for ACO-SVR1, an 862.08% improvement in Mean Absolute Error (MAE) for ACO-SVR1, and an 86.29% enhancement in R-squared (R2) for ACO-SVR1. ACO-SVR2 has a 2202.85% reduction in MSE, a 733.98% improvement in MAE, and a 54.03% enhancement in R-squared. These considerable improvements verify the method's effectiveness in enhancing WSNs, ensuring reliability and resilience in critical infrastructure. The paper concludes with a performance comparison and emphasises the remarkable efficacy of regularisation. It also underscores the practicality of precise barrier count estimation and optimised barrier placement, enhancing the security and resilience of WSNs against potential threats.

In elephant foot yam [Amorphophallus paeoniifolius (Dennst.) Nicolson], weeds are the major constraints cause yield reduction up to 100% due to its very slow initial sprouting, establishment and plant growth. Information on proper weed management in elephant foot yam in India is limited as its commercial cultivation started very recently. For arriving at suitable and better weed control, field experiments were conducted for 3 growing seasons (2019 to 2021) at ICAR-Central Tuber Crops Research Institute, Thiruvananthapuram, Kerala with 8 treatments in 6 different agro-climatic zones of India. The treatments included a combination of pre emergence (PE) and post emergence (POE) herbicides, PE followed by hand weeding (HW), intercropping followed by POE, HW with POE, POE alone, and weed control ground cover cloth mulch (WCGCC), three HW, and a weedy check were included for comparison. Weed flora was dominated by broad-leaf weeds, Digera arvensis (L.), Commelina benghalensis (L.); grasses, Pennisetum pedicellatum Trin., Cynodon dactylon (L.) pers.; and the sedge, Cyperus rotundus (L.), in most of the locations. Pooled analysis of data collected over different locations indicated that the lower mean weed biomass (21.24 g/m) and higher mean corm yield (35.13 t/ha), higher mean net income (`0.326 million/ha) were recorded with weed control ground cover mulch and higher mean B:C ratio (2.39) by application of post emergence herbicide at 30, 60 and 90 days after planting (DAP).

AbstractThe rapid urbanization and industrialization in many parts of the world have made air pollution a global public health problem. A study conducted by the Swiss organization IQAir indicated that 22 of the top 30 most polluted cities in the world are in India. This creates the problem of air pollution, which is very relevant to India as well. Exposure to air pollutants has both acute (short-term) and chronic (long-term) impacts on health. Among the major air pollutants, particulate matter 2.5 (PM2.5) is the most harmful, and its long-term exposure can impair lung functions. Pollutant concentrations vary temporally and are dependent on the local meteorology and emissions at a given geographic location. PM2.5 forecasting models have the potential to develop strategies for evaluating and alerting the public regarding expected hazardous levels of air pollution. Accurate measurement and forecasting of pollutant concentrations are critical for assessing air quality and making informed strategic decisions. Recently, data-driven machine learning algorithms for PM2.5 forecasting have received a lot of attention. In this work, a spatio-temporal analysis of air quality was first performed for Hyderabad, indicating that average PM2.5 concentrations during the winter were 68% higher than those during the summer. Following that, PM2.5 modelling was done using three different techniques: multilinear regression, K-nearest neighbours (KNN), and histogram-based gradient boost (HGBoost). Among these, the HGBoost regression model, which used both pollution and meteorological data as inputs, outperformed the other two techniques. During testing, the model acquired an amazing R2 value of 0.859, suggesting a significant connection with the actual data. Additionally, the model exhibited a minimum Mean Absolute Error (MAE) of 5.717 μg/m3 and a Root Mean Square Error (RMSE) of 7.647 μg/m3, further confirming its accuracy in predicting PM2.5 concentrations. In our investigation, we discovered that the HGBoost3 model beat other PM2.5 modelling models by having the lowest error and the highest R2 value. This study made a substantial addition by incorporating the spatiotemporal relationship between air pollutants and meteorological variables in predicting air quality. This method has the potential to improve the creation of more precise air pollution forecast models.

IntroductionMeasuring attitudes towards disability is meant to assess which interventions are most likely to create changes in population attitudes. Physical activities, such as Traditional Sports Games, are an excellent methodology to fight against the stigma of disabled people. Thus, the main aim of this study was to validate the Chedoke-McMaster Attitudes towards Children with Handicaps Scale (CATCH) adapted to a physical activity environment.MethodsAdditionally, we implemented this process in a combined way, 7 languages and 2 versions (adult and youth) at the same time.ResultsThe results showed that the CATCH-TSG scale provides the scientific community with a valid and reliable tool for professionals who want to assess the change in attitudes towards people with disabilities after receiving a psychoeducational intervention that includes physical activity (TSG).DiscussionResearchers will compare respective results from different countries and ages using different versions of the scale, jointly validated.

Xanthogranulomatous inflammation is an uncommon chronic inflammation in affected organ in which there replacement number of lipid containing macrophages and admixture of lymphocytes, plasma cells and multinucleated giant cells. We report a case of 30 year old female who presented with lower abdominal pain and tenderness since 5 months. She also had difficulty in passing stool since 15 days. USG showed a large heterogeneous cystic lesion in left lower abdomen and left sided mild hydroureteronephrosis. A plain CT with rectal contrast revealed fistula formation between left ovarian lesion and colon.

The clinical entity termed as long COVID has gained importance in the recent past. As this phenomenon is still evolving, it is important to document the magnitude of the syndrome during different time periods. This scoping review attempts to synthesize evidence generated from longitudinal studies which have follow-up periods beyond 3 months, up to 12 months. The review also documents the reported prevalence of long COVID for the different regions of the World Health Organization. Longitudinal studies published till March 2022 were systematically searched on PubMed, Google Scholar, and medRxiv. Among the identified 594 studies, 48 were included in this review. Data from selected studies were synthesized. The overall pooled prevalence of long COVID was 49% (40%–58%). The pooled estimates after 3 months, 4–6 months, 7–9 months, and 10–12 months were 44% (32%–57%), 50% (43%–57%), 49% (37%–62%), and 54% (46%–62%), respectively. Eastern Mediterranean Region (EMR) had the highest pooled prevalence of 63% (34%–92%] and the South East Asian Region (SEAR) had the least pooled estimate of 15% (10%–21%). The study brings out the high prevalence of long COVID even after 12 months of follow-up. It also shows the regional differences in the reported prevalence of the syndrome. This review highlights the need for well-planned follow-up studies, especially in developing nations to understand the magnitude and the pattern of long COVID-related symptoms as they emerge.

Background: The stromal vascular fraction (SVF) is an aqueous fraction isolated from the adipose tissue that constitutes different kinds of cells and extracellular matrix components. Hyaluronic acid (HA) is a linear polysaccharide in vertebrate tissues and is considered a potential tissue engineering scaffold due to its biocompatible nature. In this study, we have evaluated the cytotoxicity of xenofree HA in combination with an acellular component of adipose SVF (HA–aSVF) to propose it as a candidate biomaterial for future applications. Materials and Methods: 3-(4,5-dimethyl thiazolyl-2)-2,5-diphenyltetrazolium bromide assay of L-929 cells treated with HA–aSVF was used in our study. Data were normalized to cell control (untreated) and extracts of copper and ultra-high molecular weight polyethylene were used as positive (PC) and negative controls (NC). Results: Fibroblast cells retained the morphology after 24 h of treatment with HA–aSVF mixture and exhibited a similar percentage of cell activity compared to NC. PC showed a positive cytotoxic response as expected. The cells incubated with HA–aSVF showed a linear increase in cell activity indicating proliferation. Conclusion: The mixture of HA and acellular SVF in its flowable form is non-cytotoxic and showed improved cell proliferation. Hence the mixture can be proposed as a biomaterial and can be further explored for specific tissue engineering applications.

Background and Aims: The method of blocking the brachial plexus at the level of the upper trunk has been gaining popularity as a phrenic nerve–sparing alternative for interscalene block. We aimed to measure the distance of the phrenic nerve from the upper trunk and compare it with the distance between the phrenic nerve and the brachial plexus at the classic interscalene point by using ultrasound. Method: In this study, after ethical approval and trial registration, 100 brachial plexus of 50 volunteers were scanned from the emergence of the ventral rami and its course was traced to the supraclavicular fossa. The distance of the phrenic nerve from the brachial plexus was measured at two levels: the interscalene groove along the cricoid cartilage (classic interscalene block point) and from the upper trunk. The presence of anatomical variations of the brachial plexus, the classic traffic light sign, vessels across the plexus, and the location of the cervical oesophagus were also noted. Results: At the classic interscalene point, the C5 ventral ramus was observed to be just emerging or to have fully emerged from the transverse process. The phrenic nerve was identified in 86/100 (86%) of scans. The median (IQR) distance of the phrenic nerve from the C5 ventral ramus was 1.6 (1.1-3.9) mm and that of the phrenic nerve from the upper trunk was 17 (12-20.5) mm. Anatomical variations of the brachial plexus, the classic traffic light sign, and vessels across the plexus were seen in 27/100, 53/100, and 41/100 scans respectively. The oesophagus was consistently located on the left side of the trachea. Conclusions: There was a 10-fold increase in the distance of the phrenic nerve from the upper trunk when compared to that from the brachial plexus at the classic interscalene point.

Introduction/Objectives: To report the findings of extended follow-up and biweekly administration of elranatamab monotherapy in patients (pts) with relapsed/refractory multiple myeloma (RRMM) naïve to BCMA-directed therapies enrolled in Cohort A of MagnetisMM-3. Materials and methods: MagnetisMM-3 (NCT04649359) is an open-label, multicenter, registration phase 2 study evaluating the efficacy and safety of elranatamab monotherapy in pts with RRMM. Eligible pts were refractory to at least 1 proteasome inhibitor, 1 immunomodulatory drug, and 1 anti-CD38 antibody. Pts received subcutaneous elranatamab in 28-d cycles with step-up doses of 12 mg on cycle 1 day 1 (C1D1) and 32 mg on C1D4 followed by 76 mg once-weekly beginning C1D8. Pts treated for 6 cycles and achieving partial response (PR) or better, lasting ≥2 mo, were switched to 76 mg once every two weeks (Q2W). Results: Overall, 123 pts received elranatamab. Median pt age was 68.0 y (range, 36-89); 63.4% of pts had an ECOG PS ≥1. The median number of prior lines of therapy was 5.0 (2-22), with 96.7% and 42.3% of pts having triple-class- and penta-drug refractory disease, respectively. At data cutoff (≍12 mo after last pt initial dose), the median follow up was 12.8 mo (0.2-22.7); 34.1% of pts remained on treatment. The most common reasons for treatment discontinuation were progressive disease (39.0%) and adverse events (AE; 13.8%). Objective response rate per blinded independent central review (BICR) was 61% (95% CI 51.8-69.6), with 39 (31.7%) pts with complete response (CR) or stringent CR (sCR); very good partial response (VGPR) and PR were achieved in 29 (23.6%) and 7 (5.7%) pts, respectively. MRD-negativity (threshold 10−−5) was achieved by 92.0% (n = 23/25) of evaluable pts. Median duration of response (mDOR) has not been reached (95% CI 12.9-NE), and DOR at 12 mo was 74.1% (95% CI 60.5-83.6). In pts with CR/sCR or VGPR, mDOR was not reached by 12 mo; in pts with PR, mDOR was 5.2 mo (95% CI 1.6-NE). There were 46 responders by BICR who switched to Q2W dosing ≥24 wk prior to the data cutoff; among these pts, 80.4% maintained/improved their response ≥24 wk after the switch. Median progression-free and overall survival have not been reached by 12 mo, and the respective rates (95% CI) at 12 mo were 57.1% (47.2-65.9) and 62.0% (52.8-70.0). Most common grade 3/4 treatment emergent AEs were hematologic; grade 3/4 nonhematologic events reported in ≥5% of pts were COVID-pneumonia (10.6%), hypokalemia (9.8%), pneumonia (7.3%), sepsis (6.5%), hypertension (6.5%), ALT increased (5.7 %), and SARS-COV-2 test positive (5.7%). Among pts who switched to Q2W dosing (n = 58), the incidence of grade 3/4 AEs decreased by >10% after the switch. Discussion: Elranatamab remains efficacious and well tolerated in pts with RRMM after >1 y of follow-up. Updated analysis with a median follow-up of ≍15 mo, the longest of all phase 2 BCMA-CD3 bispecific antibody studies, including the outcome of pts who switched to the Q2W dosing, will be presented. Conclusion: These results support continued elranatamab development for pts with MM.

A pseudoaneurysm is a rare complication involving the vasculature and may be limb threatening if not treated. Pseudoaneurysm typically occurs when there is a breach in the vessel wall such that the blood leaks through the inner wall but is contained by the adventitia or surrounding perivascular soft tissue. These may be caused due to trauma to the vessel (either due to fractures, bony fragments), following endovascular therapy , or infective etiology, or other causes. Tibial and pedal artery aneurysms occur in the setting of penetrating trauma, fractures, or iatrogenic injury during orthopaedic surgery or peripheral interventions. Those causing significant symptoms must be repaired with autologous vein bypass grafts if there is distal ischemia. If other tibial arteries are patent, a simple ligation will also suffice. Coil embolization and conservative management resulting in spontaneous thrombosis of small pseudoaneurysms, have also been reported. We report a case of a 51 year old male with right Anterior Tibial Artery pseudoaneurysm which had developed over several years after a trauma with the patient presenting to us only after he started having symptoms of distal ischemia.

BACKGROUND AND OBJECTIVES: Disability has been drastically increasing globally among elderly population and contributing significantly to morbidity and mortality. This study was planned to assess the prevalence of functional disability and to assess its determinants among elderly population of Davangere city in Karnataka. MATERIALS AND METHODS: This was a cross-sectional study carried out between July 2019 and June 2020 in Davangere city, involving 600 elderly aged ≥60 years. Participants were selected using 30 cluster sampling technique. Approval from the institutional ethics committee review board was obtained. The study was done by interview method. Consent was taken before conducting the interview. Questionnaire consisted of sociodemographic details, personal history, h/o chronic illness, and components of functional disability (activities of daily living [ADL], mobility, vision, and hearing). ADL was assessed by Barthel's scale of 10 items, mobility was assessed using “get up and go test,” vision was assessed by Snellen's vision chart, hearing was assessed by whisper test followed by Rinne's and weber's test. RESULTS: The mean age of the elderly was 71.31 years ± 6.8 years, ranges from 60 years to 95 years. The prevalence of functional disability was found to be 38.2%. It was increased with the advancing age (≥80 years), socioeconomic status, disturbed sleep, and chronic illnesses found to be having significant association. CONCLUSION: Nearly half of the elderly were suffering from functional disability, this can be improved by lifestyle modification, early diagnosis, and treatment of chronic illnesses.

The study aims to assess clinically and radiographically the success of zinc oxide eugenol, metapex, and endoflas as root canal obturating materials in primary teeth over 3, 6, and 9 months of time intervals. The randomized controlled trial was performed in 60 primary molars of 36 children aged between 4 and 9 years. Permanent restorations were given and stainless steel crowns were placed for the treated tooth. Comparing the survival proportion between the three groups was done using the Wilcoxon (Gehans) statistical test. The clinical survival variable showed 100% survival proportion for zinc oxide eugenol and endoflas, while for metapex it was 69% at the end of 9 months. The radiographical survival proportion was 100% for zinc oxide eugenol, followed by endoflas at 92% and 58% for metapex group.

Aim: The aim of this study was to assess the sleep practices of children and their association with early childhood caries (ECC) at three different age periods. Methodology: A cross-sectional study was conducted to assess the sleep practices, feeding practices, and oral hygiene practices of children during nighttime from 0 to 2 years of age. A survey among 550 mothers of children aged 3–4 years with ECC (n = 275) and without ECC (n = 275) was conducted using a pretested and validated questionnaire. The three practices (sleep practices, feeding practices, and oral hygiene practices) of children at 0–3 months, 4–11 months, and 1–2 years of age were recorded and analyzed. Results: Risk factors associated with ECC at 0–3 months of age were gender (odds ratio [OR]: 0.59, 0.36–0.98), no previous dental visit (OR: 2.30, 1.15–4.59), bedtime (OR: 3.54, 2.01–6.25), and intentional feeding practice at night (OR: 1.83, 1.0–3.35). At 4–11 months of age, no previous dental visit (OR: 3.28, 1.66–6.49), mother's education (OR: 0.42, 0.23–0.76), frequent night wakes (OR: 5.98, 1.89–19.21), and intentional feeding practice at night (OR: 111.09, 32.25–382.68) and, at 1–2 years of age, no previous dental visit (OR: 2.37, 1.45–3.88), intentional feeding practice at night (OR: 19.12, 9.09–40.21), and breastfeeding for more than 2 years (OR: 14.56, 7.17–29.56) were associated with ECC. Conclusion: Lack of previous dental visit and intentional feeding at night were the common risk factors associated with ECC in children.

In undergraduate life sciences education, open educational resources (OERs) increase accessibility and retention for students, reduce costs, and save instructors time and effort. Despite increasing awareness and utilization of these resources, OERs are not centrally located, and many undergraduate instructors describe challenges in locating relevant materials for use in their classes. To address this challenge, we have designed a resource collection (referred to as Open Resources for Biology Education, ORBE) with 89 unique resources that are primarily relevant to undergraduate life sciences education. To identify the resources in ORBE, we asked undergraduate life sciences instructors to list what OERs they use in their teaching and curated their responses. Here, we summarize the contents of the ORBE and describe how educators can use this resource as a tool to identify suitable materials to use in their classroom context. By highlighting the breadth of unique resources openly available for undergraduate biology education, we intend for the ORBE to increase instructors' awareness and use of OERs.

Winogradsky columns were invented by Sergei Winogradsky in the 1880s and have commonly been used as a microbiology classroom learning tool in K-12 and collegiate education. However, they can be challenging to examine with microscopy. We scaled down Winogradsky columns into nuclear magnetic resonance (NMR) tubes and replaced the natural sediment with a transparent soil substitute toward the goal of observing the microbial growth under a bright-field microscope without column disassembly. Using this "Mini Winnie" approach, students can practice their microscopy skills while observing microbial growth inside the column after only days of incubation on the laboratory windowsill. Overall, we believe that the Mini Winnies provide a simple method for maximizing student engagement while giving them a greater understanding of how microorganisms interact in the environment.

The complexity of modern biology poses challenges in fostering interdisciplinary understanding, particularly between practicing scientists and the public. Furthermore, scientists often lack formal training in science communication, despite various motivations to engage the public. The science literacy of the public in the biological sciences can also vary across socio-economic and cultural backgrounds. Leveraging popular culture and informal learning practices to promote active learning offers promising avenues to enhance public understanding of biological systems. Organized sports hold collective recognition across various communities and cultures, serving as a means to bring people together. Notably, the NCAA March Madness event holds widespread national and international popularity, presenting an opportunity to laterally apply this concept to promote science communication within STEM and biology education. An educational social media and web-based contest tool was developed integrating NCAA-inspired brackets with animal biological systems concepts. The tool featured tournament-style matchups based on animal biological systems, interesting animal facts, and a voting system, all housed within a user-friendly interface. To encourage regular user access to the tool, graphic designs were developed for all social media posts to aid in visual recruitment to the voting website. Based on online metrics, the use of social media garnered repeat users across both the public and educators. The latter noted the tool's simplicity and informative content. Application of this social media and web-based bracket contest tool, which leverages informal settings for active learning for use in biology education, can foster science communication to engage audiences, improve comprehension, and promote interdisciplinary biology education.

This study uses Panadero et al.'s (2021) Deep Learning Strategies Questionnaire to discover EFL learners' strategies from a new perspective. The questionnaire is a newly designed self-report instrument with ground-breaking features constructed with validity and reliability to measure students' actual strategies in real situations. The current study is the first in an EFL context to use this innovative tool. It investigates self-regulation strategies for learning English as a foreign language (EFL) among 430 male EFL college students in Saudi Arabia. The questionnaire enabled us to adopt a micro-level inspection of strategy functions based on an innovative model that can help identify possible avenues for strategy interventions. The results mostly showed a high use of deep language learning strategies in all four questionnaire categories: basic learning, visual elaboration and summarizing, deep information processing, and social learning. Consequently, all the categories had a strong, positive, and significant correlation. In addition, the most used strategies were basic learning strategies, whereas the least used were visual elaboration and summarizing. Our findings provide useful pedagogical implications for promoting EFL learning strategies and strategy instruction. Successfully replicating the Deep Learning Strategies Questionnaire scrutinizes this methodological instrument's validity and reliability and encourages other researchers to use it.

In this paper we describe a framework for teaching students when they should, or should not use generative AI such as ChatGPT. Generative AI has created a fundamental shift in how students can complete their class assignments, and other tasks such as building resumes and creating cover letters, and we believe it is imperative that we teach students when the use of generative AI is appropriate, and when it is not appropriate (i.e., considered cheating). Framework development is based off the 2x2 Product-Market matrix introduced by Ansoff in 1965. Our initial pass at the framework was piloted with colleagues, and then followed with a focus group of students to refine the framework. We then used the framework in an MBA class to test its efficacy and gather qualitative feedback. Using the results, we further refined the framework and then used it to teach two general undergraduate business classes as a rudimentary test of generalizability across students. The qualitative results were positive. The framework helps educators understand when to use, or not use ChatGPT, and provides a way to teach students about the same. We have found that using the framework in class generates interesting discussions about the use of generative AI.

Simon Fraser University in Vancouver, Canada offers two introductory calculus courses designed for students enrolled in science and engineering programs. Students identified as needing additional support based on their admission grades take the version of the course where students meet weekly for four hours instead of three. A new approach for the fourth hour was introduced in Fall 2019 splitting the class into smaller sections of 20-40 students to work in small groups on vertical whiteboards under the supervision of the instructor, complemented by peer tutors. This format introduces an active learning element that improves student performance and attitude. The project was first implemented in Fall 2019, although interrupted due to COVID-19. After returning to the in-person classroom, the whiteboard seminar program was reinstated. In Fall 2022 and Spring 2023, survey feedback was collected from both students and peer tutors for a more holistic perspective on the program. In this study, the results of these surveys are analyzed, focussing on four areas of measurement: students' satisfaction, learning calculus concepts and problem-solving techniques, the contribution of the instructor, and the contribution of the peer tutors. Exploratory factor analysis revealed three latent variables underlying student survey responses. The survey results suggest that interactions with the instructor, peer tutors, and active learning activities all contributed to students' enjoyment of the course and their perceptions of their own learning. We compared students' final course grades from Fall 2018, where the fourth hour was devoted to lecture before the program was implemented, to Fall 2019 and 2022. The data shows a decrease in the percentage of students failing the course and an increase in those earning A's and B's since the program's implementation. Additionally, survey results show that replacing a typical lecture-style hour with a whiteboard seminar improved students' attitudes and perceptions of the course.