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Abstract Lactones play crucial roles in various fields, such as pharmaceuticals, food, and materials science, due to their unique structures and diverse biological activities. However, certain lactones are difficult to obtain in large quantities from natural sources, necessitating their synthesis to study their properties and potential. In this study, we investigated the photocatalytic conversion of D-fructose, a biomass-derived and naturally abundant sugar, using a TiO2 photocatalyst under light irradiation in ambient conditions. The resulting products were identified using HPLC, LCMS, MALDI TOF MS, and 1H NMR. The results confirmed the successful production of D-arabino-1,4-lactone as a key product, along with the formation of other valuable compounds, including rare sugars such as erythrose and glyceraldehyde. Analysis of the reaction mechanism revealed that D-arabino-1,4-lactone can be directly produced by the α scission (C1-C2 position cleavage) of D-fructose. Furthermore, erythrose and glyceraldehyde, as rare sugars, can be produced from the decomposition of D-arabino-1,4-lactone, which means that D-arabino-1,4-lactone can be used as a source of rare sugars. Furthermore, to investigate the biological activity of D-arabino-1,4-lactone, it was administered to Bifidobacterium. The results showed that Bifidobacterium proliferated and produced more lactic acid than when cultured in a medium without D-arabino-1,4-lactone, suggesting that Bifidobacterium can utilize D-arabino-1,4-lactone.

Background: Cognitive deficits are an integral part of schizophrenia, with negatively impacting functionality. Current treatments, primarily pharmacological, do not adequately address these cognitive impairments. Cognitive remediation (CR) interventions, designed to improve cognitive functions, have shown promising outcomes. However, most research has been conducted in western contexts, necessitating a review of CR effectiveness in the Asian populations. This systematic review aims to provide comprehensive update on the effectiveness of CR interventions in improving cognition among individuals with schizophrenia in Asian countries. The meta-analysis aims to synthesize and summarize the relevant CR studies to obtain a pooled estimate of effectiveness. Methods: A systematic search of three databases, PubMed, Ovid MEDLINE, and EMBASE, was conducted from the date of inception to March 19, 2024, for eligible records using prespecified search criteria. Primary studies with a randomized controlled trial (RCT) design, conducted on individuals aged 18–65 years, diagnosed with schizophrenia in Asian countries, comparing CR interventions with other non-pharmacological interventions or treatment as usual, reporting cognitive outcomes, using standardized tools, and published in English were included in the study. The review excluded unpublished RCTs, low-quality studies, open-label studies, cohort studies, studies focusing on noncognitive outcomes, and those lacking a clear comparison arm. The quality of the studies was assessed using the Cochrane risk of bias 2 (RoB2) tool by two independent reviewers. Meta-analyses were performed using R version 4.3.0 software using meta package to synthesize the overall impact of CR interventions on cognitive outcomes. Results and Discussion: This systematic review included 17 studies with 1272 participants, conducted in China, Japan, Hong Kong, Taiwan, Iran, Korea, and Singapore. The interventions varied in type and format. These were delivered through group and individual sessions, both in-person and computer-based, with varied duration. Quality assessment done with RoB2 tool indicated high-risk concerns in 14 of the studies. The meta-analysis of four studies on composite cognitive scores using the brief assessment of cognition in schizophrenia showed a significant positive effect of CR interventions (standardized mean difference [SMD] = 0.89, 95% confidence interval [CI]: 0.35 to 1.43). For executive functioning, the meta-analysis of three studies indicated no significant improvement (SMD = 0.75, 95% CI: −0.11 to 1.61). Conclusion: CR is an effective intervention for improving cognitive functions in individuals with schizophrenia in Asia based on the meta-analysis conducted, akin to evidence from western countries. However, quality concerns and high heterogeneity among the included studies underscore the need for standardized protocols and uniform outcome measures to enhance the reliability of future research.

Accurate characterization of crude oils by determining the composition of saturates, aromatics, resins and asphaltenes (SARA) has always been a challenging task in the petroleum industry. However, conventional experimental methods for determination of SARA composition are labour intensive, time-consuming and expensive. In the present study, artificial neural network (ANN) models were developed to predict the SARA composition from easily measurable parameters like density and viscosity. A dataset of 216 crude oil samples covering wide range of geographical locations was compiled from various literature sources. The ANN models with one hidden layer and six neurons are trained, tested and validated using MATLAB neural network toolbox. Results obtained on analysis revealed reasonably good accuracy of prediction of SARA components except for aromatics. The performance of developed ANN models was compared with various correlations reported in literature and found to be better in terms of mean squared error and coefficient of determination. The developed models hence provide a cost-effective and time-efficient alternative to the conventional SARA characterization techniques.

Abstract Background Polycomb group proteins, known for their role in epigenetic gene silencing, are critical regulators of cell fate and tissue development across species. These highly conserved proteins are assembled into two multi-protein complexes: Polycomb Repressive Complex 1 and Polycomb Repressive Complex 2. Main body In zebrafish, a prominent vertebrate model, the roles of PRC1 and PRC2 have been extensively studied, particularly in the context of organogenesis. This review focuses on the emerging functions of PcG proteins in zebrafish development, with an emphasis on the involvement of PRC1 and PRC2 in the formation and differentiation of the heart and pectoral fins. By integrating findings from recent studies, we aim to provide a comprehensive overview of how PcG function contributes to the intricate processes underlying zebrafish heart and pectoral fin development. Conclusion This review highlights the zebrafish model as a powerful system for unravelling the complex roles of PcG proteins in vertebrate development.

Objective: To assess One Health risk perception and local knowledge concerning threats arising from the interaction of humans, animals, and the environment at the community level with a particular emphasis on zoonotic disease transmission at Ahmedabad and Gandhinagar City, Gujarat, India, where the majority are vegetarians. Methods: A cross-sectional design with cluster sampling was employed with 387 participants participated in a quantitative survey, comprising 192 livestock handlers and 195 non-livestock handlers. Additionally, 20 in-depth interviews explored qualitative insights. Data were processed using MS Excel and analysed using Stata version 14. Results: In our study, we observed varied risk perceptions among predominantly female participants. Among livestock handlers, 23.4% acknowledged the potential for zoonotic transmission, while this awareness increased to 41.0% among non-livestock handlers. Although handwashing after animal contact and work was common among livestock handlers, only 20.3% recognized the pivotal role of hygiene in preventing zoonotic diseases. Similarly, 37.0% of livestock handlers and 47.2% of non-livestock handlers understood the risks associated with consuming raw milk and meat, which reveals a statistical difference between these two groups (P=0.000). Another significant difference was observed in the perception on animal waste disposal sites with 58.9% of livestock keepers and 80.0% of non-livestock keepers considering such sites as risky factors (P=0.000). Furthermore, vaccination awareness was high, with 85.4% of livestock handlers and 88.7% of non-livestock handlers being aware of vaccination as a preventive measure against zoonotic diseases. Interestingly, nonlivestock individuals demonstrated a higher level of awareness regarding zoonotic diseases compared to their livestock counterparts. Conclusions: This study emphasizes the urgent need for collaborative One Health interventions to address zoonotic disease risks among livestock handlers in India. By bridging knowledge gaps and promoting proactive measures, we can effectively safeguard public health and well-being in the face of emerging zoonotic threats.

Small cell carcinomas are very aggressive malignancies that are most often linked with lung cancer, although they may also develop in the pancreas, colon, rectum, skin, and cervix. SCC of the pancreas accounts for about 1% of these neoplasms. An 88-year-old male with several comorbidities who presented with significant weight loss was diagnosed with metastatic pancreatic neuroendocrine carcinoma after complaining of persistent epistaxis and back pain. This case underscores the significance of using atypical tumor markers, such as thyroid transcription factor 1, to diagnose small-cell pancreatic cancer. It also emphasizes the importance of a multidisciplinary, patient-centered approach to managing these aggressive tumors.

Abstract Background Cognitive deficits are the core component in persons with schizophrenia which impacts their socio-occupational functioning. Also, cognitive deficits cause significant impairment with the person’s quality of life [3]. Hence, targeting such a pivotal aspect in persons with schizophrenia through suitable interventions is very important. Developed countries have designed various cognitive remediation programs using computers involving high-end software which cannot be generalized to low-resource settings, like India, due to various factors including sociocultural factors, educational standards, and living standards of the patient population. Compensatory cognitive training (CCT) was developed to be “brief, practical, low-tech” and found to be effective in the west [9]. As there are no structured cognitive intervention modules in India, we have adapted the English CCT manual to be used for an urban population in Chennai, India. CCT was found to be feasible in face-to-face group sessions in our setting [12] and is found to be feasible and acceptable as virtual one–one intervention (unpublished data). Therefore, this study aims to evaluate the effectiveness of V-CCT in enhancing cognition and socio-occupational functioning. Methods The proposed study will be a multicenter assessor-blinded randomized controlled trial at two clinical sites in Chennai, India. The preparatory phase of the study would include translation of the manual to the local language, recruitment and training of research assistants, and pilot testing using the translated manual. The second phase will be the main randomized controlled trial (RCT), during which a total of 160 persons diagnosed with schizophrenia will be recruited from both sites. After obtaining informed consent, baseline assessments will be conducted on cognition, functioning, self-esteem, and quality of life. Participants will be randomly assigned to either the virtual CCT group or the control group using a computer-generated randomization table. End-line assessments will be conducted 6 weeks after the baseline by research assistants who are blinded to the randomization post-intervention. Discussion If V-CCT is found to be effective, it will be available for use in Tamil for persons with schizophrenia, and it will have an effect on their functioning, quality of life, and self-esteem. Trial registration The study is registered under Clinical trial registry-India (CTRI), and the registration number is CTRI/2024/04/065267. Registered on April 2024.

Reactive oxygen species (ROS) are widely regarded as signaling molecules and play essential roles in various cellular processes, but when present in excess, they can lead to oxidative stress (OS). Growing evidence suggests that the OS plays a critical role in the pathogenesis of HIV infection and is associated with several comorbidities in HIV-infected individuals. ROS, generated both naturally during mitochondrial oxidative metabolism and as a response to various cellular processes, can trigger host antiviral responses but can also promote viral replication. While the multifaceted roles of ROS in HIV pathophysiology clearly need more investigation, this review paper unravels the mechanisms of OS generation in the context of HIV infections, offering insights into HIV viral protein-mediated and antiretroviral therapy-generated OS. Though the viral protein Tat is significantly attributed to the endogenous cellular increase in ROS post HIV infection, this paper sums up the contribution of other viral proteins in HIV-mediated elicitation of ROS. Given the investigations recognizing the significant role of ROS in the onset and progression of diverse pathologies, the paper also explores the critical function of ROS in the mediation of an of array of pathologies associated with HIV infection and retroviral therapy. HIV patients are observed with disruption to the antioxidant defense system, the antioxidant therapy is gaining focus as a potential therapeutic intervention and is well discussed. While ROS play a significant role in the HIV scenario, further exploratory studies are imperative to identifying alternative therapeutic strategies that could mitigate the toxicities and pathologies associated with ART-induced OS.

Background and Aims: Goal directed fluid therapy (GDFT) in parturients helps to prevent spinal anesthesia induced hypotension (SAIH) and volume overload. This interventional study compared the inferior vena cava collapsibility index (IVCCI) and the internal jugular vein collapsibility index (IJVCI) guided preloading for prevention of SAIH during lower segment ceserean section (LSCS) in terms of the incidence of SAIH as the primary outcome and the total amount of fluid, mean dose of the vasopressor, the number of boluses of vasopressor required, and the incidence of intra-operative complications as secondary outcomes. Methodology: A total of 144 full-term parturients aged 20–40 years with American society of anaesthesiologists (ASA) grade II, height (140–165 cms), weight (40–70 kgs), those who were fluid responders, and those who had a window period of 1 hour before surgery under spinal anesthesia (SA) undergoing LSCS were allocated into two groups (n = 72): group IJV and group IVC. Ultrasonography (USG) guided Internal jugular vein (IJV) and Inferior vena cava (IVC) collapsibility index (CI) was recorded an hour before spinal anesthesia (SA) as per the groups assigned and preloaded accordingly. After SA, the incidence of SAIH, the requirement of vasopressor, and fluid were recorded, and side effects were managed. Results: In group IVC, the incidence of SAIH (36.84%), mean dose (3.51 ± 5.02 µg), and mean boluses (0.44 ± 0.63) of norepinephrine required to manage hypotension were significantly lower than in group IJV, and the mean goal directed fluid administered before LSCS (504.46 ± 181.48 ml) and overall mean total fluid (1104.39 ± 160.99 ml) administered were significantly higher than in group IJV. Except for shivering, the incidence of all other complications was significantly lower in group IVC (p < 0.05). Conclusion: Both IVCCI and IJVCI guided preloading are effective in combating SAIH during LSCS, but IVCCI is comparatively better than IJVCI for CI guided preloading.

Introduction: Conventional cytology smear method and cell block method are two important methods used for cytological diagnosis. Limitations of conventional smears have to be dealt with daily while reporting cytology. Despite the many advantages of the cell block method, it has been an underestimated diagnostic tool. The purpose of this study is to compare conventional smears and cell block preparations with different parameters and find out which one is more effective in evaluating body fluids. Materials and Methods: Sixty body fluids were studied by the conventional smear method and cell block method. Data were tabulated and analyzed. Results: The cell block method showed a significant increase in cellularity (83.3%) compared to the conventional method (50%) [P = 0.0001, significant]. The limitation of low cellularity was significantly reduced by the cell block method (8.3%) as compared to conventional smears (33.3%) [P = 0.0007, significant]. Morphology preservation was significantly more by cell block method (95%) versus conventional smears (60%) [P = 0.00001, significant]. The yield of malignancy increased by 3.33% in the present study. Suspicious cases on conventional smears could be confidently segregated as malignant or benign by the cell block method. Conclusion: The cell block technique should be routinely used along with conventional smears to improve diagnostic accuracy and resolve diagnostic dilemmas on conventional smears.

Background: Chronic kidney disease (CKD) is a global health issue, affecting 13.4% of the population. Many CKD patients progress to end-stage renal disease, necessitating lifelong renal replacement therapy like dialysis. Hemodialysis significantly alters patients’ lifestyles, causing social isolation, work–life changes, financial strain, and family role shifts. These challenges lead to fatigue, pain, depression, and sleep disturbances, severely impacting patients’ quality of life and daily activities. Among these symptoms, fatigue is one of the most common and disruptive. Aim: To assess the effectiveness of video-assisted teaching on knowledge regarding the management of post-hemodialysis fatigue among patients attending hemodialysis. Material and Method: This study was based on a quantitative research approach and one group pretest and post-test research design. This study includes 200 patients attending hemodialysis from Acharya Vinoba Bhave Rural Hospital Wardha with the nonprobability convenience sampling technique. A questionnaire was used to assess the knowledge of the patient. Result: After the educational program, the knowledge score improved significantly. The poor category decreased to 50 participants (25.0%), while the average category dropped to participants (5.0%). The good category increased substantially to 110 participants (55.5%), and 30 participants (15.0%) achieved an excellent level of knowledge. Conclusion: Results suggest that after applying intervention, the knowledge regarding post-hemodialysis fatigue is increased in patients attending hemodialysis.

Background: Virtual reality (VR) technology has emerged as a promising tool in dental education, offering immersive and interactive environments for students to practice clinical skills. Materials and Methods: A randomized controlled trial was conducted with 60 dental students. Participants were randomly assigned to either a VR-based simulation training group (n = 30) or a control group receiving traditional training (n = 30). The VR group utilized a VR simulation platform that included various clinical scenarios, while the control group engaged in conventional hands-on practice with dental models. Clinical skills were assessed using a standardized checklist, and student confidence was measured through a validated questionnaire before and after the training. Results: The VR-based simulation group demonstrated a significant improvement in clinical skills, with an average score increase from 65% to 85% (P < 0.01), compared to the control group, which showed an increase from 64% to 72% (P < 0.05). Additionally, students in the VR group reported a substantial boost in confidence levels, with mean scores rising from 3.2 to 4.5 out of 5, compared to the control group’s increase from 3.1 to 3.8 (P < 0.01). Conclusion: VR-based simulation training significantly enhances dental students’ clinical skills and confidence compared to traditional methods. This innovative approach has the potential to supplement conventional training, providing a more effective and engaging learning experience.

Background Globally, every year, approximately 1 million foetal deaths take place during the intrapartum period, fetal heart monitoring (FHRM) and timely intervention can reduce these deaths. Objective This study evaluates the implementation barriers and facilitators of a device, Moyo for FHRM. Methods The study adopted a qualitative study design in four hospitals in Nepal where Moyo was implemented for HRM. The study participants were labour room nurses and convenience sampling was used to select them. A total of 20 interviews were done to reach the data saturation. The interview transcripts were translated to English, and qualitative content analysis using deductive approach was applied. Results Using the deductive approach, the data were organised into three categories i) changes in practice of FHRM, ii) barriers to implementing Moyo and iii) facilitators of implementing Moyo. Moyo improved adherence to intermittent FHRM as the device could handle higher caseloads compared to the previous devices. The implementation of Moyo was hindered by difficulty to organise training ondevice during non-working hours, technical issue of the device, nurse mistrust towards the device and previous experience of poor implementation to similar innovations. Facilitators for implementation included effective training on how to use Moyo, improvement in intrapartum foetal monitoring and improvement in staff morale, ease of using the device, Plan Do Study Act (PDSA) meetings to improve use of Moyo and supportive leadership. Conclusion The change in FHRM practice suggests that the implementation of innovative solution such as Moyo was successful with adequate facilitation, supportive staff attitude and leadership.

Vaccine safety and immunogenicity data in human immunodeficiency virus (HIV)-exposed uninfected (HEU) children are important for decision-making in HIV and typhoid co-endemic countries. In an open-label study, we recruited Malawian HEU and HIV unexposed uninfected (HUU) infants aged 9 – 11 months. HEU participants were randomized to receive Vi-tetanus toxoid conjugate vaccine (Vi-TT) at 9 months, Vi-TT at 15 months, or Vi-TT at 9 and 15 months. HUU participants received Vi-TT at 9 and 15 months. Safety outcomes included solicited and unsolicited adverse events (AE) and serious AEs (SAEs) within 7 days, 28 days, and 6 months of vaccination, respectively. Serum was collected before and at day 28 after each vaccination to measure anti-Vi IgG antibodies by enzyme-linked immunosorbent assay (ELISA). Cohort 1 (66 participants) enrollment began 02 December 2019, and follow-up was terminated before completion due to the COVID-19 pandemic. Cohort 2 (100 participants) enrollment began 25 March 2020. Solicited AEs were mostly mild, with no significant differences between HEU and HUU participants or one- and two-dose groups. All six SAEs were unrelated to vaccination. Anti-Vi geometric mean titers (GMT) increased significantly from 4.1 to 4.6 ELISA units (EU)/mL at baseline to 2572.0 – 4117.6 EU/mL on day 28 post-vaccination, and similarly between HEU and HUU participants for both one- and two-dose schedules. All participants seroconverted (>4-fold increase in GMT) by the final study visit. Our findings of comparable safety and immunogenicity of Vi-TT in HUU and HEU children support country introductions with single-dose Vi-TT in HIV-endemic countries.

Introduction: Nearly three quarters of the suicides occur in developing world, however few evidenced-based health systems strategies exist to detect and prevent suicide in these contexts. This pilot study evaluates the feasibility of implementing a universal suicide risk screening program in a Nepalese emergency department. Methods: This study reports the preliminary training phases of a pilot implementation trial in the emergency department to evaluate the program. The approval was obtained from the Nepal Health Research Council (Approval no. 447/2021 P), and the Kathmandu University School of Medical Sciences Institutional Ethical Review Board (Approval no. 237/2021) and Yale University IRB (Protocol ID 2000029480). Implementation assessments included suicide screening acceptability, appropriateness, confidence, system priority, and myth knowledge of staff. Implementation strategies were selected, decolonized, and preliminarily trained followed by phased supportive coaching to initiate the screening package. We designed the implementation package through co-design staff focus groups and embedded ethnography. Results: Co-design focus groups (n=8) occurred with staff and leadership. We trained 26 (76.47%) the staff on the Nepali suicide screening tool followed by supported phased initial screening over two months. Implementation assessments demonstrated increased scores on appropriateness, confidence, system priority, and myth knowledge. The implementation package included key strategies to be deployed over six months. The embedded ethnographic observations revealed barriers to effective implementation, such as anticipated stigma, reluctance to engage families, and distrust in referral processes. Conclusions: The pilot study demonstrated that training improves staff appropriateness, confidence, system priority, and myth knowledge. Despite initial barriers, co-designed strategies and phased coaching facilitates screening uptake, highlighting the program's potential for sustainable implementation.

Tuberculosis (TB), caused by Mycobacterium tuberculosis , is a leading infectious disease with varied manifestations. We report a rare presentation of gastric TB in a 50-year-old immunocompetent woman from the Middle East with no prior medical history. The patient presented with persistent epigastric pain, weight loss, nausea, and vomiting over a 2-month duration. Imaging studies and an infectious disease panel were inconclusive. However, upper endoscopy revealed a subepithelial lesion at the pylorus, with biopsies demonstrating caseating granuloma and multinucleated giant cells. A QuantiFERON test was subsequently positive for TB. The patient was successfully treated with standard TB quadruple therapy, resulting in significant improvement in symptoms during follow-up. This case underscores the importance of considering extrapulmonary TB in immunocompetent patients with atypical gastrointestinal symptoms and highlights the efficacy of prompt antitubercular therapy.

Radiation therapy is often utilised for the treatment of pelvic malignancies. Radiation-induced haemorrhagic cystitis can occur in such patients and may sometimes lead to uncontrolled haematuria. Various treatment modalities for managing this condition include urinary bladder irrigation, cystoscopy-guided procedures, hyperbaric oxygen therapy, fulguration, and other surgical techniques. Transarterial super-selective vesical artery embolisation has emerged as a modern management technique for patients with refractory radiation-induced haemorrhagic cystitis. Hereby, the authors present a case report of a 62-year-old elderly female patient diagnosed with radiation-induced haemorrhagic cystitis, which was refractory to continuous urinary bladder irrigation and medical management. She was successfully treated with super-selective vesical artery embolisation, resulting in complete resolution of haematuria, even on follow-up. This minimally invasive and effective modality can be utilised as a first-line therapy as well as in cases where other treatment options have failed.

Purpose To emphasize the severity of the issue, it is crucial to recognize that diabetic retinopathy (DR) is not only the biggest contributor to blindness in India, but it is also becoming increasingly prevalent with each passing day. This study offers information from a matched case-control study conducted in an Indian tertiary care hospital on several risk factors for DR. The objective of the investigation is to identify the primary diabetes mellitus (DM) risk factors and the amount by which they influence diabetes pathogenesis. Methods The outpatient and inpatient departments participated in a matched research study. Diabetics with DR were included among the patients, while diabetics without DR were included in the controls. Before performing structured interviews, a total of 252 people (126 cases and 126 controls) were recruited and matched for age (±2 years) and sex. Results The average age in the DR and non-DR categories was 63.7 9.5 years and 63.3 10.4 years, respectively. Smoke (OR=1.92, P=0.02), alcoholism (OR=2.62, P=0.03), a poor diet (OR=2.72, P=0.0008), nonadherence to dietary advice (OR=4.41, P=0.0001), other microvascular disorders (OR=3.79, P=0.0001), dyslipidaemia (OR=1.85, P=0.0), and hypertension (OR=5.91, P=0.0001). Drug abnormalities (adjusted odds ratio (AOR)=7.89, P=0.0001) and hypertension (AOR=1.16, P=0.0001) were indicated as risk factors for the development of DR in multivariate regression research. Conclusion According to our findings, DM with inconsistent anti-diabetic drug use and hypertension are more likely to acquire DR. Modifiable risk factors for DR include insulin, physical inactivity, dyslipidemia, alcoholism, and smoking. With the increasing frequency of DR educating DM about lifestyle changes that may minimize their risk of developing DR is more critical than ever.

Familial Hypercholesterolemia (FH) is a hereditary disorder characterised by elevated blood cholesterol levels, predominantly Low-density Lipoprotein Cholesterol (LDL-C). This condition poses a significant risk for early-onset atherosclerotic cardiovascular diseases. A critical step toward effective clinical management is the precise identification of pathogenic variants responsible for FH. The present study aimed to unravel the genetic cause of FH through comprehensive variant effect prediction and comparison with clinical manifestations in a nine-year-old girl with hyperlipidemia. Whole Exome Sequencing (WES) was performed on the proband, and a set of three key genes associated with hyperlipidemia {Apolipoprotein E (APOE), Low -density Lipoprotein Receptors (LDLR), Proprotein Convertase Subtilisin /Kexin type 9 (PCSK9)} were evaluated for the presence of pathogenic mutations. The data were meticulously analysed based on the American College of Medical Genetics (ACMG) guidelines for variant classification. The analysis revealed two pathogenic variations in the LDLR gene: c.1A>C (p.Met1Leu) in exon 1 and a splice site variant c.1187-10G>A in intron 8. Sanger sequencing of family members confirmed the presence of one mutation each in the father and mother, while a younger sibling also carried both pathogenic variants. Genetic testing confirmed Heterozygous FH (HeFH) in the parents and Homozygous FH (HoFH) in both siblings. Proper classification of genetic variants is crucial for informed clinical decision-making and patient management. The study provides valuable insights into the molecular basis of FH in an Indian patient and contributes to the growing knowledge of the LDLR gene mutation spectrum.

Abstract Background International guidelines recommend early intervention to all children at risk of cerebral palsy, but targeted screening programs are often lacking in low- and middle-income settings with the highest burden of disease. Smartphone applications have the potential to improve access to early diagnostics by empowering parents to film their children at home followed by centralized evaluation of videos with General Movements Assessment. We explored mothers’ perceptions about participating in a smartphone aided cerebral palsy screening program in Kathmandu, Nepal. Methods This is an explorative qualitative study that used focus group discussions (n = 2) and individual interviews (n = 4) with mothers of term-born infants surviving birth asphyxia or neonatal seizures. Parents used the NeuroMotion™ smartphone app to film their children at home and the videos were analysed using Precthl’s General Movements Assessment. Sekhon et al.’s framework on the acceptability of health care interventions guided the design of the group discussions and interviews, and the deductive qualitative content analysis. Results Mothers were interested in engaging with the programme and expressed hope it would benefit their children. Most felt using the app was intuitive. They were, however, unclear about the way the analysis was performed. Support from the research team was often needed to overcome an initial lack of self-confidence in using the technology, and to reduce anxiety related to the follow-up. The intervention was overall perceived as recommendable but should be supplemented by a face-to-face consultation. Conclusion Smartphone aided remote screening of cerebral palsy is acceptable in a lower middle-income population but requires additional technical support.

Objectives: The Chepang people, an indigenous ethnic group in Nepal, experience substantial marginalization and socioeconomic disadvantages, making their communities among the most vulnerable in the region. This study aimed to determine the prevalence and factors associated with adolescent pregnancy in the Chepang communities of Raksirang Rural Municipality, Makwanpur District, Bagmati Province, Nepal. Methods: A cross-sectional study was conducted from October 2022 to April 2023 among 231 Chepang women selected using simple random sampling from Raksirang Rural Municipality. A semi-structured questionnaire was used for interviewing the mothers. Bivariate and multivariate logistic regression analyses were performed, using odds ratios with 95% confidence intervals (CIs). Variables with a variation inflation factor of more than 2 and a p-value of more than 0.25 were excluded from the final model. Results: The study revealed that the prevalence rate of adolescent pregnancy among Chepang women was 71.4% (95% CI, 65.14 to 77.16). A large percentage of participants (72.7%) were married before the age of 18 years. Poor knowledge of adolescent pregnancy (adjusted odds ratio [aOR], 10.3; 95% CI, 8.42 to 14.87), unplanned pregnancy (aOR, 13.3; 95% CI, 10.76 to 19.2), and lack of sex education (aOR, 6.57; 95% CI, 3.85 to 11.27) were significantly associated with adolescent pregnancy. Conclusions: The prevalence of adolescent pregnancy among the Chepang community was high. These findings highlighted the importance of raising awareness about the potential consequences of adolescent pregnancy and implementing comprehensive sexuality education programs for preventing adolescent pregnancies within this community.

BACKGROUND: This study was undertaken to determine the amount and type of microplastics in different milk samples. MATERIAL AND METHODS: Sample collection was done from branded, dairy, and directly from the cow shed and was then transferred to a conical flask. Containers were wrapped with aluminum foil to avoid contamination of the samples. A total of 100 mL of 5% sodium chloride solution was added to 200 mL of milk sample, rotated for 2 min, and was kept to undergo density separation for 15 min in a water bath. Whatman filter paper Grade I of pore size 11 µm is used for filtration. The samples were filtered using a vacuum filtration setup with a vacuum pressure of 0.5 bar pressure and stored in clean Petri dishes. These were kept in a hot air oven for drying at 60°C for 3 h and at room temperature for 24 h for complete drying of the filter paper. RESULTS: Fourier transform infrared analyses determined that the polystyrene type of microplastics was higher, showing red, blue, violet, and green colors by microscopic analysis. CONCLUSION: Three categories of milk samples (branded, dairy, and cowshed) were taken and analyzed, the results showed more microplastics in branded milk packets than in dairy and fresh cowshed milk samples which are lower than other food products.

Summary: Research activities in the field of superconducting nanowire single photon detectors (SNSPDs) have exhibited major progress over the last two decades. The low dark count rate, low jitter time, low recovery time, and ultrafast response time in an extended wavelength range, along with several improvements in the material parameters, cryogenic environment, and associated electronics make SNSPDs a superior choice over other photo-detectors. The struggle in simultaneously optimizing these parameters made the pace of SNSPD research steady, until the report of unit system detection efficiency at low temperatures for WSi SNSPD. Due to the difficulty in maintaining the low temperature for a long time, researchers are currently focusing on using high transition temperatures cuprate-based superconductors. These have the added advantages of making a portable SNSPD combined with faster response dynamics required for commercial SNSPD applications. In this review, we have discussed different models for single photon detection, followed by research activities carried out employing different superconducting materials over the last 20 years. The ongoing research toward utilizing oxide-based superconductors as photon detection devices along with a few suggestions for improving the device performance is discussed. This review will fill the gap required for a detailed study of different classes of superconductors for SNSPD applications.

Asparagusracemosus (AR), an Ayurvedic botanical, possesses various biological characteristics, yet its impact on HIV-1 replication remains to be elucidated. This study aimed to investigate the inhibitory effects of AR root extracts and its principal bioactive molecule, Shatavarin IV (Shatavarin), on HIV-1 replication and their role in mitigating mitochondrial dysfunction during HIV-1 infection, utilizing both in vitro and in silico methodologies. The cytotoxicity of the extracts was evaluated using MTT and ATPlite assays. In vitro anti-HIV-1 activity was assessed in TZM-bl cells against X4 and R5 subtypes, and confirmed in peripheral blood mononuclear cells using HIV-1 p24 antigen capture ELISA and viral copy number assessment. Mechanistic insights were obtained through enzymatic assays targeting HIV-1 Integrase, Protease and Reverse Transcriptase. Shatavarin’s activity was also validated via viral copy number and p24 antigen capture assays, along with molecular interaction studies against key HIV-1 replication enzymes. HIV-1 induced mitochondrial dysfunction was evaluated by detecting mitochondrial reactive oxygen species (ROS), calcium accumulation, mitochondrial potential, and caspase activity within the infected cells. Non-cytotoxic concentrations of both aqueous and hydroalcoholic extracts derived from Asparagus racemosus roots displayed dose-dependent inhibition of HIV-1 replication. Notably, the hydroalcoholic extract exhibited superior Reverse Transcriptase activity, complemented by moderate activity observed in the Protease assay. Molecular interaction studies revealed that Shatavarin IV, the key bioactive constituent of AR, formed hydrogen bonds within the active binding pocket site residues crucial for HIV replication enzyme catalysis, suggesting its potential in attenuating HIV-1 infection. Mitochondrial dysfunction induced by HIV-1 infection, marked by increased oxidative stress, mitochondrial calcium overload, loss of mitochondrial membrane potential, and elevated caspase activity, was effectively mitigated by treatment with AR extracts and Shatavarin IV. These findings underscore the potential of AR extracts and Shatavarin IV as antiviral agents, while enhancing mitochondrial function during HIV-1 infection. In conclusion, Asparagus racemosus extracts, particularly Shatavarin IV, demonstrate promising inhibitory effects against HIV-1 replication while concurrently ameliorating mitochondrial dysfunction induced by the virus. These findings suggest the therapeutic potential of AR extracts and Shatavarin in combating HIV-1 infection and improving mitochondrial health.

Employee turnover is an important problem in the IT sector. However, there are still few comprehensive discussions on the current trends in employee turnover research. This study aims to comprehensively investigate relevant literature from 2019 to 2023 by bibliometric analysis to facilitate detailed exploration. The study has collected many academic documents and provided a comprehensive overview of recent research landscapes. Using the Scopus database, we used library analysis to examine the publication on employee turnover intentions between 2019 and 2023. The results showed a significant increase in research on turnover intentions, which highlighted their continued relevance in organizational research. In addition, the study identified and mapped a group of academic research focusing on employee turnover intentions, job satisfaction, employee management, and employee turnover. Key themes, influential works, and outstanding contributions were highlighted, showing the main contributors and key publications in this area. The information obtained from this study provides a valuable basis for future research and guides researchers to the most important research areas. The recommendations proposed will contribute to the development of effective retention strategies and promote better working conditions, ultimately contributing to the success and well-being of organizations and employees.

Human mastitis is an infection that affects the mammary glands of females and mainly occurs during the puerperium, a common condition brought on by improper breastfeeding technique. Mastitis is differentiated into lactational and non-lactational types according to its symptoms. Based on the available data, the pooled incidence of mastitis across countries like the USA, UK, Australia, Denmark, Turkey, Finland and New Zealand is estimated to be 13.45%. Poor hygiene, sore and cracked nipples, nipple piercing, smoking and fitted innerwear are reported risk factors. Staphylococcus aureus and Staphylococcus epidermidis are predominant pathogens, with a prevalence range between 50 to 87%, respectively. Mastitis management is essential to reduce infection rates and discover alternate treatments. Studies indicate that antibiotic treatment may be substituted for herbal and probiotic therapies. In addition, if mastitis is not adequately diagnosed in females, there is a high risk of breast cancer. Mastitis is a significant health issue, but it is often overlooked in the field of human medicine. In this review, we have focused on the risk factors, the alternative therapeutic approaches, and the relationship of breast cancer associated with mastitis.

Introduction The COVID-19 pandemic caused disruptions in global health and economic stability. In Nepal, before the pandemic, more than 50% of healthcare costs were out-of-pocket expenditure (OOPE). This study aimed to assess the OOPE for maternity care during before and during the COVID-19 pandemic in nine hospitals in Nepal.Method We conducted a before-and-after study between March 2019 and December 2020 with 13 months of prepandemic period and 9 months of pandemic period. OOPE was assessed using a semistructured interview with 53 864 women. Bivariate (unadjusted) and multivariate (adjusted) linear regression modelling was conducted to assess the change in OOPE in US dollar between the periods. Adjustment in linear regression model was done for population characteristics different between the periods.Result The OOPE for childbirth increased by 28.1% during pandemic, with an increase of OOPE from US$19.2 to S$23.9 (adjusted-β coefficient 5.4; 95% CI 4.5 to 5.7; p

Vascular malformations are rare congenital abnormalities of blood vessels that persist throughout life. Large vascular malformations affecting the facial region can be distressing and require meticulous management to achieve satisfactory outcomes and prevent recurrence. Here, we present a case of a 40-year-old man with a progressively growing tumor-like mass on the right side of his face, extending from the periorbital region to the chin. He was diagnosed with vascular malformations, which was further confirmed with contrast-enhanced magnetic resonance imaging. Eventually, he underwent surgical excision of the lesion with a split-thickness skin graft. The surgical management of this case was challenging due to the large size and complexity of the lesion, particularly because it was located in the facial region. This unique case report highlights the importance of diagnostic imaging techniques and effective surgical management in addressing large vascular malformations, especially those affecting the facial region while prioritizing desirable cosmetic outcomes.

Background: A common sleep problem linked to poor cardiovascular outcomes and death is “sleep apnea (SL).” Nevertheless, little is known about how SL affects cardiovascular health in the long run. The purpose of this research was to investigate the relationship between a tertiary care center’s long-term cohort’s cardiovascular morbidity and mortality and the severity of their SL. Methods: Between January 1, 2010, and December 31, 2020, 500 individuals at a tertiary care facility who had been diagnosed with SL participated in this retrospective cohort research. Electronic medical records were used to collect patient data, which were then examined for cardiovascular outcomes, treatment methods, comorbidities, sleep research findings, and demographics. Heart failure, myocardial infarction, stroke, and cardiovascular-related mortality were among the cardiovascular events that were noted throughout the follow-up period, and the severity of SL was classified using the “apnea–hypopnea index.” Findings: Of the 500 patients in the cohort, 60% were men and the mean age was 55.7 years. Fifty percent of people had one or more cardiovascular risk factors, including diabetes, high blood pressure, and smoking. During the course of the follow-up, 100 cardiovascular-related fatalities were reported, and 40% of patients had at least one cardiovascular event. The severity of SL was shown to be positively correlated with the occurrence of cardiovascular events (16.7% in mild, 25% in moderate, and 40% in severe SL, P < 0.05). Conclusion: In a cohort of patients receiving tertiary care, this research shows a substantial correlation between the severity of SL and cardiovascular morbidity and death. It is crucial to identify and treat SL early on to reduce cardiovascular risks and enhance patient outcomes. To further understand the underlying processes and develop treatment approaches for people with cardiovascular comorbidities and SL, more research is necessary.

Background: Effective management of child behavior during dental procedures is crucial for successful treatment outcomes and promoting oral health. Parental involvement has been recognized as a key factor influencing child compliance in various healthcare settings, but its specific impact on child compliance during dental appointments remains understudied. Methods: A cross-sectional clinical research involving 100 children scheduled for routine dental treatments. Parental involvement was categorized as high, moderate, or low based on the level of parental presence and interaction during the dental appointment. Child compliance was assessed using a validated behavior rating scale, evaluating factors such as cooperation, anxiety, and disruptive behavior during the dental procedure. Statistical analysis, including correlation analysis and ANOVA, was performed to determine the association between parental involvement and child compliance. Results: The results revealed a significant correlation between parental involvement and child compliance (P < 0.05). Children with high levels of parental involvement demonstrated greater compliance during dental procedures compared to those with moderate or low levels of parental involvement. Specifically, children with high parental involvement exhibited lower levels of anxiety, reduced disruptive behavior, and greater cooperation with the dental team. Conclusion: This research provides evidence of the positive impact of parental involvement on child compliance during dental procedures in pediatric patients. Higher levels of parental presence and interaction were associated with improved child behavior and cooperation, highlighting the importance of parental involvement in promoting positive oral health behaviors and facilitating successful dental treatments. These findings underscore the need for tailored interventions targeted at enhancing parental involvement and optimizing child compliance in the dental setting.

Sebaceous carcinoma is a rare variety of malignant tumor involving sebaceous glands. Compared to its ocular counterpart, the extraocular variant is even more rare, accounting for only one-fourth of all cases. It is a great mimicker of a plethora of benign and malignant tumors, hence often misdiagnosed. Surgical excision is the preferred mode of treatment in most cases. Here, we present the case of a 72-year-old male with airborne-contact dermatitis who was initially misdiagnosed with acrochordon, which was later found to be a case of sebaceous carcinoma on histopathology. There is a paucity of literature regarding sebaceous gland carcinomas located outside the head-and-neck region, which makes this case even more interesting.

Non-Hodgkin lymphomas are malignant tumor that arises from the lymphoreticular system. Anaplastic large cell lymphoma (ALCL) is a type of non-Hodgkin lymphoma distinguished by the proliferation of pleomorphic large lymphoid cells expressing CD30 antigen. This case report is about a 55-year-old patient who had pain and swelling in her lower front teeth region. The immunohistochemistry report confirmed the diagnosis of high-grade non-Hodgkin’s lymphoma of the anaplastic null cell type.

Abstract Additive manufacturing of thermoplastic elastomeric material (TPE) using direct ink writing (DIW) based printing technique opens new horizons for various applications. However, the most crucial process in DIW 3D printing is the optimization of printing parameters to obtain high-quality products both in terms of aesthetics and strength. In this work, statistical models were developed considering layer height, print speed, and, ink concentration to obtain the optimized print quality product from the blend of thermoplastic polyurethane (TPU)/ epichlorohydrin − ethylene oxide − allyl glycidyl ether elastomer (GECO) based TPE materials. Experiments were designed according to the central composite design (CCD) scheme and the influence of input printing parameters on shrinkage and tensile strength was analyzed. The significance of each parameter was systematically studied using the response surface method. For both responses, shrinkage, and tensile strength, printing speed was found to be the most significant parameter. Ink concentration significantly affected tensile strength with a contribution of ∼ 34%. On the other hand, the layer height, with a contribution of ∼ 22% significantly affected the shrinkage behaviour of the 3D printed sample. Finally, multi-objective optimization was performed using a genetic algorithm to identify the optimal 3D printing parameters of the developed TPE materials.

In a span of 4 months, there were 7 cases of meningococcal meningitis who presented with diagnostic dilemma and also a few atypical manifestations. A retrospective data analysis was carried out in children diagnosed with meningococcal meningitis who were admitted from October 2022 to January 2023. There were 7 confirmed cases of Neisseria meningitidis infections during the study period. The median age of presentation was 6 years (range: 4.5 months–9 years) with four males and three females. All the children presented with fever, but none had signs of meningeal irritation as such. Routine blood and cerebrospinal fluid (CSF) analysis were also near normal. Reverse transcriptase polymerase chain reaction (RT-PCR) for N. meningitidis was positive in the CSF samples of all the seven cases. All of the patients recovered completely, except that there were residues of neurodeficit in one patient. In endemic areas, pediatricians should have a low threshold of suspicion for N. meningitidis in children presenting with signs and symptoms involving the central nervous system and consider an RT-PCR of the CSF sample even if routine blood and CSF studies are near normal.

The study analysed the impact of financing patterns (FPs) on the financial performance of 226 listed small and medium enterprises (SMEs). Firm size, age, liquidity, sales growth (SG), and asset tangibility (AT) are treated as firm-specific control variables. The result indicates that total debt financing (TDF), short-term financing, and trade credit financing have a significant relationship with Return on Asset (ROA), whereas long-term debt financing (LTDF) does not. Further, Return on Equity (ROE) is used to confirm the robustness of the result and demonstrate the same direction of the relationship with financing. Thus, the study provides an illustrative description of relationships and helps in developing an understanding of accessing the future financial needs of SMEs.

Pulmonary arteriovenous malformation (PAVM) is a rare vascular anomaly characterized by abnormal communication between the pulmonary artery and vein. It is a rare cause of hemoptysis. Computed tomographic angiography (CTA) has become the preferred and dependable diagnostic approach for identifying PAVM. PAVM embolization is the primary recommended treatment for this condition. We present a case of a 43-year-old male with a complex PAVM in the left lower lobe presenting with hemoptysis treated with an endovascular approach. Following the procedure, the patient's symptoms resolved.

Abstract Red blood cells (RBCs) become sickle‐shaped and stiff under hypoxia as a consequence of hemoglobin (Hb) polymerization in sickle cell anemia. Distinguishing between sickle cell disease and trait is crucial during the diagnosis of sickle cell disease. While genetic analysis or high‐performance liquid chromatography (HPLC) can accurately differentiate between these two genotypes, these tests are unsuitable for field use. Here, we report a novel microscopy‐based diagnostic test called ShapeDx™ to distinguish between disease and trait blood in less than 1 h. This is achieved by mixing an unknown blood sample with low and high concentrations of a chemical oxygen scavenger and thereby subjecting the blood to slow and fast hypoxia, respectively. The different rates of Hb polymerization resulting from slow and fast hypoxia lead to two distinct RBC shape distributions in the same blood sample, which allows us to identify it as healthy, trait, or disease. The controlled hypoxic environment necessary for differential Hb polymerization is generated using an imaging microchamber, which also reduces the sickling time of trait blood from several hours to just 30 min. In a single‐blinded proof‐of‐concept study conducted on a small cohort of clinical samples, the results of the ShapeDx™ test were 100% concordant with HPLC results. Additionally, our field studies have demonstrated that ShapeDx™ is the first reported microscopy test capable of distinguishing between sickle cell disease and trait samples in resource‐limited settings with the same accuracy as a gold standard test.

Rice False Smut (RFS) caused by Ustilaginoidea virens is a major emerging disease of rice due to expanded area of hybrid rice cultivars, increasing use of nitrogenous fertilizers and change in climate. Due to the increasing incidences of this disease across the globe, there is a pressing need to develop techniques for false smut management. The application of fungicides with high efficiency, low toxicity, and low residue is currently the best option to control RFS. Therefore, current research was conducted to determine the effectiveness of fungicides to manage RFS. The experiments were conducted in a completely randomized block design with three replications of seven treatments at RFS-prone subtropical hills of Nepal in the main rice growing season, during 2020 and 2021. The fungicides include trifloxystrobin 25 % + tebuconazole 50 %, chlorothalonil 75 %, carbendazim 12 % + mancozeb 63 %, propiconazole 25 %, azoxystrobin 50 %, carbendazim 50 % and untreated control. Fungicides were applied as two foliar sprays, one at booting and the other at flowering. Fungicide spray significantly increased number of tillers per plant (P ≤ 0.01) and reduced the number of false smut-infected tillers per plant (P ≤ 0.05), false smut severity (P ≤ 0.05), and incidence (P ≤ 0.05). False smut incidence percentages were significantly reduced by all the fungicides except mancozeb + carbendazim compared to the non-treated control. The reduction in RFS incidence was 70 % in propiconazole, 71 % in trifloxystrobin + tebuconazole sprayed plots compared to the non-treated control plots. Thus, the application of suitable fungicide at the appropriate stage would give the satisfactory suppression of RFS in a farmers' field in Nepal.

Over the last two decades, researchers have paid more attention to magnetic nanosystems due to their wide application in diverse fields. The metal nanomaterials' antimicrobial and biocidal properties make them an essential nanosystem for biomedical applications. Moreover, the magnetic nanosystems could have also been used for diagnosis and treatment because of their magnetic, optical, and fluorescence properties. Superparamagnetic iron oxide nanoparticles (SPIONs) and quantum dots (QDs) are the most widely used magnetic nanosystems prepared by a simple process. By surface modification, researchers have recently been working on conjugating metals like silica, copper, and gold with magnetic nanosystems. This hybridization of the nanosystems modifies the structural characteristics of the nanomaterials and helps to improve their efficacy for targeted drug and gene delivery. The hybridization of metals with various nanomaterials like micelles, cubosomes, liposomes, and polymeric nanomaterials is gaining more interest due to their nanometer size range and nontoxic, biocompatible nature. Moreover, they have good injectability and higher targeting ability by accumulation at the target site by application of an external magnetic field. The present article discussed the magnetic nanosystem in more detail regarding their structure, properties, interaction with the biological system, and diagnostic applications.

Abstract The targeted drug delivery field is rapidly advancing, focusing on developing biocompatible nanoparticles that meet rigorous criteria of non‐toxicity, biocompatibility, and efficient release of encapsulated molecules. Conventional synthetic nanoparticles (SNPs) face complications such as elevated immune responses, complex synthesis methods, and toxicity, which restrict their utility in therapeutics and drug delivery. Extracellular vesicles (EVs) have emerged as promising substitutes for SNPs, leveraging their ability to cross biological barriers, biocompatibility, reduced toxicity, and natural origin. Notably, mesenchymal stem cell‐derived EVs (MSC‐EVs) have garnered much curiosity due to their potential in therapeutics and drug delivery. Studies suggest that MSC‐EVs, the central paracrine contributors of MSCs, replicate the therapeutic effects of MSCs. This review explores the characteristics of MSC‐EVs, emphasizing their potential in therapeutics and drug delivery for various diseases, including CRISPR/Cas9 delivery for gene editing. It also delves into the obstacles and challenges of MSC‐EVs in clinical applications and provides insights into strategies to overcome the limitations of biodistribution and target delivery.

Introduction: Breast cancer is one of the most frequent malignancies in women worldwide, and it is the leading cause of cancer mortality. Early detection is key to a better prognosis. In India, many patients are diagnosed in later stages due to the absence of screening programs and less awareness in certain regions of the country. MRI is a highly sensitive investigation that can detect small and sometimes hidden or occult lesions not visible on mammography. The diffusion-weighted sequence has the potential to be used in conjunction with mammography, thereby improving diagnostic accuracy. Aim: To evaluate the utility of multiparametric MRI (mpMRI) of the breast, combining high b-value Diffusion-Weighted Imaging (DWI) and Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI), in differentiation benign and malignant lesions. Materials and Methods: This cross-sectional study was conducted at a Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India from Jan 2017 - Dec 2020. A total of 254 women with 272 breast lesions were included. All cases underwent mpMRI on a 3Tesla scanner, which included T2- weighted imaging, dynamic post-contrast study, and DWI with a b-value of 1500 sec/mm² . Sensitivity, specificity, diagnostic accuracy, and area under the curve were calculated using the results of different parameters. Comparative Receiver Operating Characteristic (ROC) curves were plotted for DCE-MRI, DWI, and mpMRI. Histopathologic diagnosis was considered the standard of reference. Results: The mean age was 43.73±13.56 years, with an age range of 18-82 years. Both benign and malignant breast lesions were most common in the 40-49 years age group, accounting for a total of 80 (31.4%) lesions. Out of the 272 lesions, 141 (52.03%) were malignant and 131 (47.97%) were benign. DCE-MRI showed 97.87% sensitivity, 80.15% specificity, and 89.33% diagnostic accuracy. Diffusion-weighted MRI showed 97.16% sensitivity, 87.02% specificity, and 92.27% diagnostic accuracy. The ROC analysis for Apparent Diffusion Coefficient (ADC) values of the 272 lesions revealed an area under the curve of 0.985 (p

Background: Verruca vulgaris (VV) is caused by human papillomavirus affecting both keratinized and nonkeratinized epithelium. Different treatment modalities are available leading to scarring, pain, and ineffectiveness. Injection of measles, mumps, and rubella (MMR) not only clears treated warts but also distant warts by stimulating cell-mediated immunity. Objectives: The objective of this study was to study the efficacy of adjuvant zinc with injectable MMR vaccine in treatment with side effects of treatments, the pattern of regression, the number of injections required for clearance, and the recurrence of verruca. Materials and Methods: Fifty patients having verruca were divided into groups A and B with 25 patients each. Group A received an injection of MMR and tablet of zinc whereas group B only injection MMR. A total of five injections were given in the largest wart at intervals of 2 weeks i.e., 0, 2, 4, 6, and 8 weeks. Follow-up was done at 3rd month and 6th months following 1st dose. Improvement in warts and patient satisfaction were assessed using visual analog scale and Likert scale, respectively. Results: Mean age of patients in groups A and B was 30.36 and 32.68 with male-to-female ratio 5.28:1 (21:4) and 1.77:1 (16:9), respectively. Mean numbers and size of lesions in group A and B were 2.24 (±1.59), 1.84 (±1.40) and 5.52 mm, 5.08 mm, respectively. Eighty-four percentage of patients in both groups needed five injections for complete clearance. Pain was the most common side effect in all patients of both groups whereas gastritis, fever, and lymphadenopathy were observed only in one patient of Group A. Patients in both groups were strongly satisfied on Likert's scale. Conclusion: Oral zinc as an adjuvant with MMR vaccine for the treatment of VV was equally safe but did not prove to be of higher efficacy in our study.

Prenatal supplements are commonly used to support maternal health and fetal development during pregnancy. However, there are concerns regarding their efficacy and safety. This review article provides a critical evaluation of prenatal supplements, including their types, benefits, criticisms, factors affecting their efficacy, and popular brands. It also offers recommendations for their use and identifies future research directions. Our analysis suggests that while prenatal supplements can offer important benefits, including reduced risk of birth defects and improved fetal growth and development, there are also concerns regarding their regulation, dosages, and potential harm to the mother and fetus. Pregnant women should carefully evaluate the ingredients, dosages, efficacy, and safety of prenatal supplements with the guidance of their healthcare provider. Future research should focus on standardizing dosages and regulation of prenatal supplements to ensure consistent quality, safety, and efficacy.

The soft tissue lesions around the knee range from congenital, traumatic, and vascular to neoplastic in aetiology. The various imaging modalities employed for diagnostic work-up include plain radiographs, ultrasonography, Computed Tomography (CT) scan, and Magnetic Resonance Imaging (MRI). Based on the peculiar imaging findings, the differential diagnosis can be narrowed down; however, the final diagnosis relies on histopathological findings. Some of the highly vascular lesions are arteriovenous malformation, malignant fibrous histiocytoma, haemangiopericytoma, and synovial sarcoma. The abundant neovascularity within these lesions poses a major problem during surgery due to potential blood loss. Presurgical interventional management in the form of endovascular embolisation significantly reduces intraoperative blood loss. Here, four different cases, one of each type, presenting as highly vascular lesions around the knee joint, were successfully managed with endovascular embolisation.

Abstract Background Improving the healthcare providers (HCP) basic resuscitation skills can reduce intrapartum related mortality in low- and middle-income countries. However, the resuscitation intervention’s successful implementation is largely dependent on proper facilitation and context. This study aims to identify the facilitators and barriers for the implementation of a novel resuscitation package as part of the quality improvement project in Nepal. Methods The study used a qualitative descriptive design. The study sites included four purposively chosen public hospitals in Nepal, where the resuscitation package (Helping Babies Breathe [HBB] training, resuscitation equipment and NeoBeat) had been implemented as part of the quality improvement project. Twenty members of the HCP, who were trained and exposed to the package, were selected through convenience sampling to participate in the study interviews. Data were collected through semi-structured interviews conducted via telephone and video calls. Twenty interview data were analyzed with a deductive qualitative content analysis based on the core components of the i-PARiHS framework. Results The findings suggest that there was a move to more systematic resuscitation practices among the staff after the quality improvement project’s implementation. This positive change was supported by a neonatal heart rate monitor (NeoBeat), which guided resuscitation and made it easier. In addition, seeing the positive outcomes of successful resuscitation motivated the HCPs to keep practicing and developing their resuscitation skills. Facilitation by the project staff enabled the change. At the same time, facilitators provided extra support to maintain the equipment, which can be a challenge in terms of sustainability, after the project. Furthermore, a lack of additional resources, an unclear leadership role, and a lack of coordination between nurses and medical doctors were barriers to the implementation of the resuscitation package. Conclusion The introduction of the resuscitation package, as well as the continuous capacity building of local multidisciplinary healthcare staff, is important to continue the accelerated efforts of improving newborn care. To secure sustainable change, facilitation during implementation should focus on exploring local resources to implement the resuscitation package sustainably. Trial Registration Not applicable.

Objective: To study the levels of β-hCG, urea and creatinine in vaginal fluid for diagnosis of prelabour rupture of membranes (PROM). Methodology: This was observational cross sectional comparative study divided into two groups. Group A (cases)- Pregnant women with gestational age 28-40 weeks presenting with history of leaking per vaginum without onset of labor pains, and who are clinically diagnosed as prelabor rupture of membranes. Group B (control) - Pregnant women with gestational age 28-40 weeks without PROM. T-test and chi-square test was used to calculate and to measure a quantitative and qualitative variables. Receiver operating characteristic curve was be used to determine a cut-off value. Cut-off point was set at highest optimal sensitivity and specificity. Results: Demographic data of both groups were comparable. Vaginal fluid value of β-hCG, urea and creatinine was significantly higher in study group. The sensitivity, specificity and cut-off value of vaginal fluid β-hCG 95%, 83.3% and >9 mg/dl respectively. The sensitivity, specificity and cut-off value of vaginal fluid urea/creatinine were 63.33/86.67%, 98.3/48.3% and >3.4/>0.08 IU/L respectively. The area under curves was 0.967 for β-hCG, 0.849 for urea, 0.742 for creatinine and 0.838 for AFI. Conclusions: Detection of vaginal fluid β-hCG, urea and creatinine to diagnose PROM is a simple, reliable and rapid test. So, introduction of these methods into routine use even in low resources community settings is feasible, practical and cost-effective.

The glymphatic system is a newly discovered waste-clearing system that is analogous to the lymphatic system in our central nervous system. Furthermore, disruption in the glymphatic system has also been associated with many neurodegenerative disorders (e.g., Alzheimer’s disease), traumatic brain injury, and subarachnoid hemorrhage. Thus, understanding the function and structure of this system can play a key role in researching the progression and prognoses of these diseases. In this review article, we discuss the current ways to map the glymphatic system and address the advances being made in preclinical mapping. As mentioned, the concept of the glymphatic system is relatively new, and thus, more research needs to be conducted in order to therapeutically intervene via this system.

Abstract Background Several anti-retroviral drugs are available against Human immunodeficiency virus type-1, but have multiple adverse side effects. Hence, there is an incessant compulsion for effectual anti-retroviral agents with minimal or no intricacy. Traditionally, natural products have been the most successful source for the development of new medications. Withania somnifera, also known as Ashwagandha, is the utmost treasured medicinal plant used in Ayurveda, which holds the potential to give adaptogenic, immunomodulatory, and antiviral effects. However, its effect on HIV-1 replication at the cellular level has never been explored. Herein, we focused on the anti-HIV-1 activity and the probable mechanism of action of hydroalcoholic and aqueous extracts of Withania somnifera roots and its phytomolecules. Methods The cytotoxicity of the extracts was determined through MTT assay, while the in vitro anti-HIV-1 activity was assessed in TZM-bl cells against the HIV-1 strains of X4 and R5 subtypes. Results were confirmed in peripheral blood mononuclear cells, using the HIV-1 p24 antigen assay. Additionally, the mechanism of action was determined through the Time of Addition assay, which was further validated through the series of enzymatic assays, i.e. HIV-1 Integrase, Reverse transcriptase, and Protease assays. To explore the role of the identified active metabolites of Withania somnifera in antiretroviral activity, molecular docking analyses were performed against these key HIV-1 replication enzymes. Results The hydroalcoholic and aqueous extracts of Withania somnifera roots were found to be safer at the sub-cytotoxic concentrations and exhibited their ability to inhibit replication of two primary isolates of HIV-1 through cell-associated and cell-free assays, in dose-dependent kinetics. Several active phytomolecules found in Withania somnifera successfully established hydrogens bonds in the active binding pocket site residues responsible for the catalytic activity of HIV replication and therefore, signifying their role in the attenuation of HIV-1 infection as implied through the in silico molecular docking studies. Conclusions Our research identified both the hydroalcoholic and aqueous extracts of Withania somnifera roots as potent inhibitors of HIV-1 infection. The in silico analyses also indicated the key components of Withania somnifera with the highest binding affinity against the HIV-1 Integrase by 12-Deoxywithastramonolide and 27-Hydroxywithanone, HIV-1 Protease by Ashwagandhanolide and Withacoagin, and HIV-1 Reverse transcriptase by Ashwagandhanolide and Withanolide B, thereby showing possible mechanisms of HIV-1 extenuation. Overall, this study classified the role of Withania somnifera extracts and their active compounds as potential agents against HIV-1 infection.

This study attempts to isolate a candidate growth promoter from the ovine paunch waste and scrutinize its effects on the production performance of broiler chickens as compared to mannan-oligosaccharide (MOS), a prebiotic, and lincomycin, an antibiotic growth promoter (AB). The paunch waste collected from slaughtered sheep was processed to remove particulate matter. The clarified liquid was then added to an excess of ethanol (1:9 ratio), and the resultant precipitate {(novel growth-promoting paunch extract (NGPE)} was collected, dried, and stored. In vitro increase in cell density for probiotic bacteria viz. Lactobacillus rhamnosus and Enterococcus faecalis (Log10 CFU/ml) were significantly higher (P