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Background: This study aimed to demonstrate the association between smartphone use and De Quervain’s syndrome in Saudi Arabian teenagers, as well as to establish the length of phone use among these patients in order to evaluate whether it was connected to the emergence of De Quervain’s tenosynovitis. Methodology: This cross-sectional observational study was conducted among teenagers in Saudi Arabia studying in public and private schools. Most of the inquiries were closed-ended and sought information regarding the students’ use of various mobile phone sizes, regular text messaging, discomfort in the wrist or thumb, swelling or a snapping sound over the thumb, and limitations or pain aggravation when handling various objects. Results: The total number of teenagers that participated in the study was 200; 111 (55.5%) of them were males, while the remaining 89 (44.5%) were females. Out of 200 participants, 135 (67.5%) tested positive for Finkelstein disease; of these, 21 (15.5%) used smartphones for under 4 hours, 53 (39.2%) used smartphones for 5–7 hours, and 21 (15.5%) used smartphones more than 10 hours with P value of 0.008, which is significant and hence concluded that duration of using mobile phones had impact on De Quervain’s disease. Conclusion: In conclusion, Finkelstein’s sign, a marker that De Quervain’s illness is widespread, was present in 67.5% of the patients. Current findings suggest that De Quervain cannot be completely ruled out because of this population’s propensity to develop it.

ObjectiveTo assess the demographic, clinical, and survival profile of people living with HIV.MethodsA retrospective cohort study was conducted among patients enrolled at a single antiretroviral therapy center in North Karnataka. A total of 11,099 were recruited from April 2007 to January 2020, out of which 3,676 were excluded and the final 7,423 entries were subjected to analysis. The outcome of interest was the time to death in months of people living with HIV on antiretroviral therapy (ART). The clinical and demographic characteristics were examined as potential risk factors for survival analysis. To investigate the factors that influence the mortality of patients using ART, univariate and multivariate Cox regression were performed. Hazard ratio (HR), 95% confidence interval (CI), and p-values were presented to show the significance. The log-rank test was used to determine the significance of the Kaplan–Meier survival curve.ResultsOut of 7,423 HIV-positive people, majority were female (51.4%), heterosexual typology (89.2%), and in the age group 31–45 years (45.5%). The risk of death in male patients was 1.24 times higher (95% CI: 1.14–1.35) than female patients. Patients with age >45 were 1.67 times more likely to die than patients ≤30 (95% CI: 1.50–1.91). In the multivariable analysis, the hazards of mortality increased by 3.11 times (95% CI: 2.09–2.79) in patients with baseline CD4 count ≤50 as compared to those who had baseline CD4 count >200. The risk of death in patients who were diagnosed with TB was 1.30 times more (95% CI: 1.19–1.42) than in those who did not have TB. The survival probabilities at 3 and 90 months were more in female patients (93%, 70%) compared with male patients (89, 54%), respectively.ConclusionThis study proved that age, sex, baseline CD4 count, and tuberculosis (TB) status act as risk factors for mortality among people with HIV. Prevention strategies, control measures, and program planning should be done based on the sociodemographic determinants of mortality.

Introduction: The continued explosive spread of severe acute respiratory syndrome coronavirus-2 worldwide is a crucial problem for all countries. Even though it is becoming increasingly difficult to stop the spread of the virus according to the World Health Organisation, countries need to enforce strict measures to minimise its effects. This study attempts to assess the awareness and compliance of the local population for following the precautionary measures against. Materials and Methods: A cross-sectional study was carried out at different districts of Majmaah city, Saudi Arabia. A cross-sectional survey study was carried out at different districts of Majmaah city, Saudi Arabia, and 502 individual's respondents were included in the study. Data were collected using a self-↱administered questionnaire for noting compliance towards protective measures. All participants were informed about the nature of the study and given an informed consent form. Data were collected and analysed using SPSS@ 25 (SPSS Version 25.0. Armonk, Newyork: IBM Corp). Categorical variables were expressed as frequencies and percentages. t-test was applied to compare mean scores.Results: There were 502 people who participated in this study, among them 260 (51.8%) were males and 242 (48.2%) females. This study highlighted that the population awareness was good and residents showed strong commitment towards coronavirus disease-2019 (COVID-19) precautionary measures. The overall mean scores for awareness and commitment levels were 6.68 ± 1.04 and 4.00 ± 1.13. Conclusions: Most participants in the study had a positive perception of COVID-19 prevention and control. Residents of Saudi Arabia responded well to the threat imposed by COVID-19 and are following their government and health regulatory body's instructions. It is therefore suggested that this would also be a valuable resource for policymakers of Saudi Arabia

The objective of this study is to assess the frequency and severity of adverse events following immunization (AEFI) in Indian children aged 5–17 years who received the Pfizer-BioNTech mRNA COVID-19 vaccine, as well as to investigate for predictors of AEFI. To examine AEFI following the first and second doses of Pfizer’s vaccine, semi-structured questionnaires were distributed as Google forms at Indian schools in Saudi Arabia. The 385 responses included 48.1% male and 51.9% female children, with 136 responses of children aged 5–11 years (group A) and 249 responses from children aged 12–17 years (group B). Overall, 84.4% of children had two shots. The frequency of AEFI was reported to be higher after the first dose than after the second (OR = 2.12, 95% CI = 1.57–2.86). The reported AEFIs included myalgia, rhinitis, local reaction with fever, a temperature of 102 °F or higher, and mild to moderate injection site reactions. While group B frequently reported multiple AEFIs, group A typically reported just one. Local reaction with low grade fever was more frequently reported in group B after the first dose (24.1%) and second dose (15.4%), while local reaction without low grade fever was most frequently observed in group A after the first (36.8%) and second dose (30%). Only prior COVID-19 infection (OR = 2.98, 95% CI = 1.44–6.2) was associated with AEFI after the second dose in the study sample, whereas male gender (OR = 1.71, 95% CI = 1.13–2.6) and prior COVID-19 infection (OR = 2.95, 95% CI = 1.38–6.3) were predictors of AEFI after the first dose. Non-serious myocarditis was reported by only one child. According to the analysis conducted, the Pfizer’s mRNA COVID-19 vaccination was found to be safe in Indian children.

The world has taken proactive measures to combat the pandemic since the coronavirus disease 2019 (COVID-19) outbreak, which was caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). These measures range from increasing the production of personal protective equipment (PPE) and highlighting the value of social distancing to the emergency use authorization (EUA) of therapeutic drugs or antibodies and their appropriate use; nonetheless, the disease is still spreading quickly and is ruining people’s social lives, the economy, and public health. As a result, effective vaccines are critical for bringing the pandemic to an end and restoring normalcy in society. Several potential COVID-19 vaccines are now being researched, developed, tested, and reviewed. Since the end of June 2022, several vaccines have been provisionally approved, whereas others are about to be approved. In the upcoming years, a large number of new medications that are presently undergoing clinical testing are anticipated to hit the market. To illustrate the advantages and disadvantages of their technique, to emphasize the additives and delivery methods used in their creation, and to project potential future growth, this study explores these vaccines and the related research endeavors, including conventional and prospective approaches.

Background: While mutations in the cardiac type 2 ryanodine receptor (RyR2) have been linked to exercise-induced or catecholaminergic polymorphic ventricular tachycardia (CPVT), its association with polymorphic ventricular tachycardia (PMVT) occurring at rest is unclear. We aimed at constructing a patient-specific human-induced pluripotent stem cell (hiPSC) model of PMVT occurring at rest linked to a single point mutation in RyR2. Methods: Blood samples were obtained from a patient with PMVT at rest due to a heterozygous RyR2-H29D mutation. Patient-specific hiPSCs were generated from the blood samples, and the hiPSC-derived cardiomyocytes (CMs) were generated via directed differentiation. Using CRIPSR/Cas9 technology, isogenic controls were generated by correcting the RyR2-H29D mutation. Using patch-clamp, fluorescent confocal microscopy and video-image-based analysis, the molecular and functional properties of RyR2-H29D hiPSCCMs and control hiPSCCMs were compared. Findings: RyR2-H29D hiPSCCMs exhibit intracellular sarcoplasmic reticulum (SR) Ca2+ leak through RyR2 under physiological pacing. RyR2-H29D enhances the contribution of inositol 1,4,5-trisphosphate receptors to excitation-contraction coupling (ECC) that exacerbates abnormal Ca2+ release in RyR2-H29D hiPSCCMs. RyR2-H29D hiPSCCMs exhibit shorter action potentials, delayed afterdepolarizations, arrhythmias and aberrant contractile properties compared to isogenic controls. The RyR2-H29D mutation causes post-translational remodeling that is fully reversed with isogenic controls. Interpretation: To conclude, in a model based on a RyR2 point mutation that is associated with short-coupled PMVT at rest, RyR2-H29D hiPSCCMs exhibited aberrant intracellular Ca2+ homeostasis, shortened action potentials, arrhythmias and abnormal contractile properties. Funding: French Muscular Dystrophy Association (AFM; project 16,073, MNM2 2012 and 20,225), “Fondation de la Recherche Médicale” (FRM; SPF20130526710), “Institut National pour la Santé et la Recherche Médicale” (INSERM), National Institutes of Health (ARM; R01 HL145473) and New York State Department of Health (NYSTEM C029156).

An amendment to this paper has been published and can be accessed via the original article.

Activation-induced Cytidine Deaminase (AID) is an essential regulator of B cell diversification, but its full range of action has until recently been an enigma. Based on homology, it was originally proposed to be an RNA-editing enzyme, but so far, no RNA substrates are known. Rather, it functions by deaminating cytidine, and in this manner, coupled with base-excision repair or mismatch repair machinery, it is a natural mutator. This allows it to play a central role in adaptive immunity, whereby it initiates the processes of class switch recombination and somatic hypermutation to help generate a diverse and high-affinity repertoire of immunoglobulin isotypes. More recently, it has been appreciated that methylated cytidine, already known as a key epigenetic mark on DNA controlling gene expression, can also be a target for AID modification. Coupled with repair machinery, this can facilitate the active removal of methylated DNA. This activity can impact the process of cellular reprogramming, including transition of a somatic cell to pluripotency, which requires major reshuffling of epigenetic memory. Thus, seemingly disparate roles for AID in controlling immune diversity and epigenetic memory have a common mechanistic basis. However, the very activity that is so useful for B cell diversity and cellular reprogramming is dangerous for the integrity of the genome. Thus, AID expression and activity is tightly regulated, and deregulation is associated with diseases including cancer. Here, we review the range of AID functions with a focus on its mechanisms of action and regulation. Major questions remain to be answered concerning how and when AID is targeted to specific loci and how this impacts development and disease.

PROBLEM: Harm reduction packages for people who inject illicit drugs, including those infected with human immunodeficiency virus (HIV), are cost-effective but have not been scaled up globally. In the north-eastern Indian states of Manipur and Nagaland, the epidemic of HIV infection is driven by the injection of illicit drugs, especially opioids. These states needed to scale up harm reduction programmes but faced difficulty doing so. APPROACH: In 2004, the Bill & Melinda Gates Foundation funded Project ORCHID to scale up a harm reduction programme in Manipur and Nagaland. LOCAL SETTING: In 2003, an estimated 10 000 and 16 000 people were injecting drugs in Manipur and Nagaland, respectively. The prevalence of HIV infection among people injecting drugs was 24.5% in Manipur and 8.4% in Nagaland. RELEVANT CHANGES: By 2012, the harm reduction programme had been scaled up to an average of 9011 monthly contacts outside clinics (80% of target); an average of 1709 monthly clinic visits (15% of target, well above the 5% monthly goal) and an average monthly distribution of needles and syringes of 16 each per programme participant. Opioid agonist maintenance treatment coverage was 13.7% and retention 6 months after enrolment was 63%. Antiretroviral treatment coverage for HIV-positive participants was 81%. LESSONS LEARNT: A harm reduction model consisting of community-owned, locally relevant innovations and business approaches can result in good harm reduction programme scale-up and influence harm reduction policy. Project ORCHID has influenced national harm reduction policy in India and contributed to the development of harm reduction guidelines.

In this article, we present the first case of necrotizing fasciitis affecting the abdominal wall caused by Serratia marcescens and share results of a focused review of S. marcescens induced necrotizing fasciitis. Our patient underwent aorto-femoral bypass grafting for advanced peripheral vascular disease and presented 3 weeks postoperatively with pain, erythema and discharge from the incision site in the left lower abdominal wall and underwent multiple debridement of the affected area. Pathology of debrided tissue indicated extensive necrosis involving the adipose tissue, fascia and skeletal muscle. Wound cultures were positive for Serratia marcescens. She was successfully treated with antibiotics and multiple surgical debridements. Since necrotizing fasciitis is a medical and surgical emergency, it is critical to examine infectivity trends, clinical characteristics in its causative spectrum. Using PubMed we found 17 published cases of necrotizing fasciitis caused by Serratia marcescens, and then analyzed patterns among those cases. Serratia marcescens is prominent in the community and hospital settings, and information on infection presentations, risk factors, characteristics, treatment, course, and complications as provided through this study can help identify cases earlier and mitigate poor outcomes. Patients with positive blood cultures and those patients where surgical intervention was not provided or delayed had a higher mortality. Surgical intervention is a definite way to establish the diagnosis of necrotizing infection and differentiate it from other entities.

BACKGROUND:Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. METHODS & FINDINGS:In 2010-2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2-8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77-95% alive and on treatment). CONCLUSIONS:This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation.

BACKGROUND: Predictors of adverse events (AE) associated with nevirapine use are needed to better understand reports of severe rash or liver enzyme elevation (LEE) in HIV+ women. METHODOLOGY: AE rates following ART initiation were retrospectively assessed in a multi-site cohort of 612 women. Predictors of onset of rash or LEE were determined using univariate and multivariate analyses. PRINCIPAL FINDINGS: Of 612 subjects, 152 (24.8%) initiated NVP-based regimens with 86 (56.6%) pregnant; 460 (75.2%) initiated non-NVP regimens with 67 (14.6%) pregnant. LEE: No significant difference was found between regimens in the development of new grade ≥2 LEE (p = 0.885). Multivariate logistic regression demonstrated an increased likelihood of LEE with HCV co-infection (OR 2.502, 95% CI: 1.04 to 6, p = 0.040); pregnancy, NVP-based regimen, and baseline CD4 >250 cells/mm(3) were not associated with this toxicity. RASH: NVP initiation was associated with rash after controlling for CD4 and pregnancy (OR 2.78; 95%CI: 1.14-6.76), as was baseline CD4 >250 cells/mm(3) when controlling for pregnancy and type of regimen (OR 2.68; 95% CI: 1.19-6.02 p = 0.017). CONCLUSIONS: CD4 at initiation of therapy was a predictor of rash but not LEE with NVP use in HIV+ women. Pregnancy was not an independent risk factor for the development of AEs assessed. The findings from this study have significant implications for women of child-bearing age initiating NVP-based ART particularly in resource limited settings. This study sheds more confidence on the lack of LEE risk and the need to monitor rash with the use of this medication.

ABSTRACT: Background: This study aimed to demonstrate the association between smartphone use and De Quervain's syndrome in Saudi Arabian teenagers, as well as to establish the length of phone use among these patients in order to evaluate whether it was connected to the emergence of De Quervain's tenosynovitis. Methodology: This cross-sectional observational study was conducted among teenagers in Saudi Arabia studying in public and private schools. Most of the inquiries were closed-ended and sought information regarding the students' use of various mobile phone sizes, regular text messaging, discomfort in the wrist or thumb, swelling or a snapping sound over the thumb, and limitations or pain aggravation when handling various objects. Results: The total number of teenagers that participated in the study was 200; 111 (55.5%) of them were males, while the remaining 89 (44.5%) were females. Out of 200 participants, 135 (67.5%) tested positive for Finkelstein disease; of these, 21 (15.5%) used smartphones for under 4 hours, 53 (39.2%) used smartphones for 5–7 hours, and 21 (15.5%) used smartphones more than 10 hours with P value of 0.008, which is significant and hence concluded that duration of using mobile phones had impact on De Quervain's disease. Conclusion: In conclusion, Finkelstein's sign, a marker that De Quervain's illness is widespread, was present in 67.5% of the patients. Current findings suggest that De Quervain cannot be completely ruled out because of this population's propensity to develop it. [ABSTRACT FROM AUTHOR]

Human breast milk is the optimal source of nutrition for newborns, but the potential transfer of contaminants like mycotoxins, particularly ochratoxin A (OTA), from maternal blood to milk remains a concern. This systematic review aims to provide a comprehensive analysis of global OTA levels in human breast milk and assess the associated health risks. We conducted a thorough search of scientific databases, including Web of Science, ScienceDirect, Scopus, Google Scholar and PubMed, using keywords related to OTA in human breast milk. A total of 39 studies met the inclusion criteria for this review. OTA levels compared to limits, estimated infant intake at various ages and health risks assessed using Margin of Exposures (MOEs) and Hazard quotient (HQ). Our findings reveal the widespread presence of OTA in breast milk across different regions, with notably higher levels detected in Africa compared to Asia, South America and Europe. The higher concentrations observed in warmer, humid climates suggest that environmental factors significantly influence OTA contamination. Mature breast milk samples generally exhibited greater OTA exposure. The neoplastic and non-neoplastic effects demonstrate generally low risks globally. The regional differences in OTA levels and associated health risk assessments underscore the need for continued research into the health impacts of OTA exposure in infants. This includes further investigation into multiple sources of exposure, such as infant formula, within the broader context of the exposome framework. [ABSTRACT FROM AUTHOR]

This study reviews global levels of ochratoxin A (OTA) in infant formula and cereal-based foods, using Monte Carlo simulation to assess risks. The review found 24 studies on global OTA levels in infant food and cereal-based products, using databases including PubMed, Scopus, Web of Science and Embase until March 2024. We estimated OTA exposure in infant food based on concentration, intake and body weight. The exposure and hazard quotient margin were calculated using BMDL10 and TDI values. Monte Carlo simulation evaluated human health risks from OTA in infant formula and cereal-based foods. A global study from 14 countries shows varying levels, surpassing EU limits in Tunisia, Ecuador, the USA, and generally in Africa, notably in infant cereals, which had higher levels than formula. Globally, OTA was present in 29.3% of the 3348 samples analyzed, with Lebanon at 95.2% and Brazil at 0%. Analysis indicates only non-carcinogenic risk for infants. While health risks for infants are mostly low, ongoing research and monitoring are vital to minimize OTA exposure in infant food. [ABSTRACT FROM AUTHOR]

This study demonstrates the hydrothermal synthesis of 3D flower-like MoS2 nanostructures by varying the heating ramp rate ranging from 1.5 to 5 °C/min. These nanostructures were evaluated for the adsorption and photocatalytic degradation of Rhodamine B (RhB), Methylene Blue (MB), and Tetracycline (TC). Structural and optical properties were characterized using XRD, Raman spectroscopy, FESEM, UV–Vis–NIR spectrophotometry, and XPS. The BET technique assessed surface area, pore size, and volume. Notably, materials synthesized at the slowest heating rate (1.5 °C/min) exhibited superior performance, achieving 98 % degradation of RhB and MB, and 93 % for TC. High adsorption and photocatalytic efficiency were attributed to nanosheets' high density, large specific surface area, zeta potential, and suitable band gap. The study also analyzed the effects of dye concentration and catalyst dosage on RhB degradation, highlighting the synergistic effect of adsorption and photocatalysis in wastewater treatment.

Abiotic stress, which includes salinity, drought, heat, and cold, as well as their many combinations, severely reduces crop productivity across the globe each year. Considering the intensified worldwide climatic changes, the effects of these conditions on plant productivity become increasingly more concerning. Sulfur is essential for several metabolic processes, including the organization and control of electron transport. Reductive assimilation and integration into cysteine and methionine, sulfate absorption, and reductive assimilation and integration are the key methods that oxidized and reduced forms of organically bound sulfur get to their different roles. Protective compounds with sulfur, such as glutathione, phytochelatins, S-rich proteins, and several secondary metabolites, are essential for plants to survive abiotic stress, such as dihydroasparagusic acid, hydrogen sulfide, etc. This thorough review covered the regulation of sulfur at the protein and gene transcription levels in response to abiotic stress.

Our retrospective study aimed to evaluate the effectiveness of monoclonal antibodies (casirivimab and imdevimab) on mild cases of coronavirus disease 2019 patients admitted to the tertiary care center. A total of 161 patients were evaluated of which the test group consisted of 79 and the control group of 82. In the test group the patients had been administered with diluted 250 ml of 0.9 % sodium chloride along with co-formulated casirivimab (600 mg) and imdevimab (600 mg) solution intravenously and in the control group the patients were administered standard coronavirus disease 2019 treatment protocol. The monitoring of patients in both groups was done at least 1 h after drug infusion in the designated room. Post-treatment designed interviews were taken to evaluate the effectiveness of treatment. This retrospective analysis discovered a significant association of symptoms with the group at 48 h for injected and non-injected patients and 1 mo from the chi-square test after injecting monoclonal antibodies. There is no significant association of symptoms with the groups at 3 mo. A significant difference in the symptom distribution through different time points in the injected group and not injected group was observed. From the pairwise McNemar’s test, a significant difference in the symptoms between each time in 48 h, the difference was p=0.0075 and after 1 mo, p<0.001 points in both groups. The combination of casirivimab and imdevimab could be considered a treatment of choice for vaccinated, non-vaccinated and mild to highrisk coronavirus disease 2019 patients. [ABSTRACT FROM AUTHOR]

Background: Psychiatric and mental disorders are more prevalent than recorded. Severe cases of these conditions require rehabilitation services to reach optimal social and occupational wellbeing. This study was carried out to evaluate the characteristics of patients seeking care in one rehabilitation center in Saudi Arabia and to evaluate the impact of these services on the patients' GAF scores. Design: Ac. Method: This cross-sectional observational study was carried out in rehabilitation center in Majmaah, Saudi Arabia over a period of 3 months from Jan 2021 to March 2021. Following administration and ethical approval, medical students recruited patients who sought care from a rehabilitation center in Majmaah Hospital. Patients were screened for eligibility for inclusion and data were collected from medical records and through observation of the participants when they visited the facility. Data collection took place over a 6-month period. Results: A total of 147 responders participated in the study with the majority being male participants (53.1%) aged between 21-30 years of age (41.5%) with 66% were chronic care seekers of the facility. Causes for admission to the facility were mainly to control anti-epileptic medication intake (31.4%), control epilepsy (26.5%) and ADHD (11.6%). In terms of follow up, 78.9% visited a psychologist and 78.9% visited a social worker. On the social level, 30.6% visited a family member once a month and 86.4% did recreational activities once in 4 weeks although a large number (87.1%) did not approach any teaching facilities. The highest frequency in GAF range was than between 21-30 with 37.4% of the study population followed by the range between 1-10 with 18.4%. More male participants scored 21-30 than females (n=13, 8.8% vs. n=3, 2%; p=0.00). Those who reported good social skills in terms of smiles scored significantly higher on the GAS score than those with poorer social skills (n=36, 90% vs. n=4, 10%; p=0.002). Similarly for conversation skills (n=29, 72.5% vs. n=11, 27.5%; p=0.00) and speech (n=26, 65% vs. n=14, 35%; p=0.00). Additionally, significantly more females scored higher than 40 on the GAF scale when compared to male participants (n=31, 77.5% vs. n=9, 22.5%; p=0.00). Conclusion: Rehabilitation services were seen to be provided for both genders but perceived differently between male and female participants. This was evident in the differences in visits to the health care professionals. Additionally, more care can be given to those that lack proper hygiene practices and communications and interaction skills. These weak practices should be tackled through educational and behavioral interventions. Finally, inclusion of the most common mental and psychiatric disorders is necessary to provide generalizability. [ABSTRACT FROM AUTHOR]

Background and Aims: The incidence of tracheal extubation failure in high-risk patients is higher, and non-invasive ventilation is suggested to avoid tracheal reintubation. This study compares the effectiveness of bilevel positive airway pressure (BiPAP) and high flow nasal cannula (HFNC) to reduce the rate of reintubation in intensive care unit (ICU) patients with increased risk of extubation failure. Methods: This randomised comparative trial was conducted on 60 high-risk patients on mechanical ventilators admitted to the ICU, ready for weaning after a spontaneous breathing trial. They were randomised to Group H for HFNC and Group B for BiPAP therapy. Designated therapy was administered in these high-risk patients for up to 48 hours after tracheal extubation. Haemodynamic parameters [mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), a saturation of peripheral oxygen (SpO2), electrocardiogram (ECG)], arterial blood gas analysis (ABG) parameter [potential of hydrogen (pH), partial pressure of carbon dioxide (pCO2), partial pressure of oxygen/fraction of inspired oxygen (paO2/FiO2) ratio], the effectiveness of cough, comfort level was recorded and continuous monitoring for signs of respiratory distress and failure was done. Results: Most of the patients were obese and had more than two risk factors for extubation failure. Several patients in Group B have significantly higher successful extubation than in Group H (P = 0.044). Most of the reintubation took place within 24 hours. The HFNC therapy was more comfortable and acceptable to patients. Conclusion: BiPAP therapy was more efficient than HFNC in preventing tracheal reintubation among patients with a high risk of extubation failure.

Background: Acute cholecystitis was initially thought to be a contraindication for laparoscopic cholecystectomy. Now, as the experience is increasing, laparoscopic surgeons are gradually undertaking laparoscopic cholecystectomy as the preferred procedure even in an acute setting. Early surgery in acute presentation has better surgical outcome with lesser and cheaper hospital stay and predictive of better quality of life as compared to delayed treatment. Aims and Objectives: The objectives of this study were to study the perioperative complications during early laparoscopic cholecystectomy. Materials and Methods: One hundred and five patients with acute calculus cholecystitis visiting Fortis Escorts Hospital, Faridabad from June 2017 to November 2018 were studied. All patients underwent laparoscopic cholecystectomy and subsequently compared for the following intraoperative parameters: Presence of adhesions, calot’s anatomy, need for decompression of gallbladder, difficulty in dissecting the gallbladder from liver bed, retrieval of gallbladder, time taken to complete surgery, need of placement of drain, and need for conversion to open cholecystectomy. Complications studied were massive bleed, bile spillage during dissection, stone spillage, duodenal injury, and common bile duct [CBD] injury. Results: Decompression of the acute inflamed gallbladder facilitates laparoscopic cholecystectomy in acute cholecystitis with low conversion rate of 2.86%. Bleeding, CBD injury and duodenal injury are uncommon complications but major factors for conversion. Conclusion: Most common reasons for difficulty in laparoscopic cholecystectomy for acute cholecystitis were found to be adhesions in Calot’s triangle and adhesion of gallbladder with surrounding structures (duodenum/transverse colon).