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Abstract The incidence of extrapulmonary tuberculosis (EPTB) in low- and middle-income countries, as well as, high-income countries has increased over the last two decades. The acid-fast bacillus (AFB) smear test is easy to perform and cost-effective with a quick turnaround time but the test has low sensitivity. Culture remains the gold standard for detecting TB; however, it has low sensitivity and slow bacterial growth patterns, as it may take up to 6 to 8 weeks to grow. Therefore, a rapid detection tool is crucial for the early initiation of treatment and ensuring an improved therapeutic outcome. Here, the Xpert Ultra system was developed as a nucleic acid amplification technique to accelerate the detection of MTB in paucibacillary clinical samples and endorsed by the World Health Organization. From March 2020 to August 2021, Xpert Ultra was evaluated for its sensitivity and specificity against EPTB and compared with those of the routinely used Xpert, culture, and AFB tests in 845 clinical samples in Saudi Arabia. The results indicate the overall sensitivity and specificity of Xpert Ultra to be 91% and 95%, respectively, compared with the Xpert (82% and 99%, respectively) and AFB smear (18% and 100%, respectively) tests. The results also indicated that despite the low microbial loads that were categorized as trace, very low, or low on Xpert Ultra, yet, complete detection was achieved with some sample types (i.e., 100% detection). Consequently, Xpert Ultra has great potential to replace conventional diagnostic approaches as a standard detection method for EPTB.

Muna Al Musawi,1 Hassan Zainaldeen,2 Fakrudeen Shafi,3 Sameh Anis,4 Rodrigo DeAntonio51Public Health Directorate, Ministry of Health, Manama, the Kingdom of Bahrain; 2Pediatric Department, Salmaniya Medical Complex, the Kingdom of Bahrain, Manama; 3GlaxoSmithKline Pharmaceuticals, Bangalore, India; 4GlaxoSmithKline Pharmaceuticals, Middle East and North Africa; 5GlaxoSmithKline Vaccines, Wavre, BelgiumPurpose: Rotavirus (RV) is the leading cause of morbidity and mortality in children under 5 years of age worldwide. This study assessed the role of RV as a cause of gastroenteritis (GE)-associated hospitalization in children, generating baseline information to evaluate the potential impact of the RV vaccine in reducing RVGE disease burden in the Kingdom of Bahrain.Methods: This single, pediatric hospital-based surveillance study was conducted over a period of 12 months beginning April 1, 2006. A total of 314 children aged under 5 years and hospitalized due to GE were enrolled in the study, following collection of written informed consent from parents/guardians. Stool samples were tested for the presence of RV using enzyme immunoassay, and a random subset of RV-positive samples was further genotyped using reverse transcriptase-polymerase chain reaction and reverse hybridization assay.Results: Of 314 enrolled children, 239 were included in the final analysis. RV was detected in 107 children (44.8%), mostly in the 6–23 months age group (82/107; 76.6%). RVGE occurred throughout the year, with the highest proportion occurring during April (26/42; 61.9%). G1P[8] was the most commonly detected RV strain (10/17; 58.8%) in the limited number of samples analyzed. Vomiting and severe RVGE were more commonly observed in RV-positive than RV-negative children before hospitalization (P = 0.0008 and 0.0204, respectively).Conclusion: In our study, RV accounted for over 40% of GE-associated hospitalizations and particularly affected children under 2 years of age. These data will serve as a baseline for assessing the potential changes in the epidemiology of RV disease and for evaluating the potential impact of the introduction of RV vaccination.Keywords: rotavirus, gastroenteritis, epidemiology, Kingdom of Bahrain

The 'third gender' or 'hijra' people, who identify themselves to be neither male nor female, are largely socially excluded. This article followed the qualitative method of research. Four focus group discussions (FGDs) were conducted with 28 hijra respondents, and three interviews were conducted with key informants. The purposive sampling method was used to select the required respondents. Very few of the previous research focused on the aspects of social exclusion of the hijra people and their current situation in a society. This will be a significant study on exploring the dimensions of social exclusion of the hijra people after being recognized as a 'third gender' in Bangladesh. This article examines the exclusion from the perspectives of social, economic, cultural, and political participation of the hijra community in Dhaka city, the capital city of Bangladesh. The research findings expressed that the official recognition of hijra as a third gender has not actually brought any changes in their situations. The results concluded that they are still excluded from social, economic, cultural, and political participation. There is a need for interventions from government and non-governmental organizations (NGOs) to minimize the vulnerability of hijra people to ensure better living standards. Future studies should focus on the living conditions of the hijra population based on the social exclusion they face in all other areas in Bangladesh. [ABSTRACT FROM AUTHOR]

Considerable empirical evidence suggests early recognition of autism and access to support result in long-term positive outcomes for children and youth on the spectrum and their families. However, children of racialized families are often diagnosed at later ages, are more likely to be misdiagnosed, and experience many barriers to service access. There is also a paucity of research exploring the experiences of parents from specific immigrant groups caring for their children on the spectrum in Canada, many of whom identify as members of racialized communities. As such, the main aim of the study was to examine how South Asian immigrant parents in Canada are experiencing available care programs and support. Another aim was to examine their perceptions of social stigma associated with autism. We conducted an inductive thematic analysis of qualitative data from nine interviews with South Asian parents living in Ontario, Canada. Findings confirmed barriers to an autism diagnosis and to service access. Additionally, parents reported pronounced autism stigma, which enacted impediments to timely diagnosis, service access, and health-promoting behaviors. Findings also revealed that parents experience considerable caregiver stress and psychological distress. The generated evidence is anticipated to inform equitable policy, programming, and practices that better support the needs of children on the spectrum and their immigrant families.

This study aims to review ophthalmic injuries sustained during of robotic-assisted laparoscopic prostatectomy (RALP). A search of Medline, Embase, Cochrane and grey literature was performed using methods registered a priori. Eligible studies were published 01/01/2010-01/05/2023 in English and reported ophthalmic complications in cohorts of > 100 men undergoing RALP. The primary outcome was injury incidence. Secondary outcomes were type and permanency of ophthalmic complications, treatments, risk factors and preventative measures. Nine eligible studies were identified, representing 100,872 men. Six studies reported rates of corneal abrasion and were adequately homogenous for meta-analysis, with a weighted pooled rate of 5 injuries per 1000 procedures (95% confidence interval 3-7). Three studies each reported different outcomes of xerophthalmia, retinal vascular occlusion, and ophthalmic complications unspecified in 8, 5 and 2 men per 1000 procedures respectively. Amongst identified studies, there were no reports of permanent ophthalmic complications. Injury management was poorly reported. No significant risk factors were reported, while one study found African-American ethnicity protective against corneal abrasion (0.4 vs. 3.9 per 1000). Variables proposed (but not proven) to increase risk for corneal abrasion included steep Trendelenburg position, high pneumoperitoneum pressure, prolonged operative time and surgical inexperience. Compared with standard of care, occlusive eyelid dressings (23 vs. 0 per 1000) and foam goggles (20 vs. 1.3 per 1000) were found to reduce rates of corneal abrasion. RALP carries low rates of ophthalmic injury. Urologists should counsel the patient regarding this potential complication and pro-actively implement preventative strategies., (© 2024. Crown.)

Competing Interests: There are no conflicts of interest.

Background: Rice is a key food grain contributor to the global food grain basket and is considered the main food crop in India with a large number of varieties released every year. SSR markers have proven to be an excellent tool for studying genetic diversity. As a result, the present study was done to characterize and assess genetic diversity as well as population structural aspects., Methods and Results: Fifty genotypes of rice were characterized using 40 SSR markers to assess the genetic diversity and genetic relationship. A total of 114 alleles were amplified with an average of 2.85 alleles per locus. The Polymorphism Information Content (PIC) values varied from 0.30 (RM162) to 0.58 (RM413) with an average of 0.44. Gene diversity was in the range of 0.35 (RM162) to 0.66 (RM413), with an average value of 0.52, while heterozygosity ranged from 0.18 (RM27) to 0.74 (RM55), with an average of 0.39. The population structure revealed a narrow genetic base with only three major subpopulations. Analysis of molecular variance revealed that 74% of the variation was attributed within individuals, 23% was among individuals, and 3% was among populations. Pairwise Fst value of population A & B is 0.024, population B & C is 0.120 and population A & C is 0.115. Dendrogram grouped the genotypes into three clusters with wide variation among the accessions., Conclusion: Genotyping combined with phylogeny and population structure analysis proved to be a powerful method for characterizing germplasm in this study. There is significant gene flow within populations, as well as the presence of different combinations of alleles, and that allelic exchange rates within the populations are higher than among the populations. Assessing the genetic diversity among individual genotypes within populations is quite useful in selecting candidate parents for future breeding programs to improve the target traits in rice for the Himalayan region., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

The effects of three different hulling methods wiz natural heaping/traditional (T1), steeping (T2), and spraying (T3), on moisture, colour, fat, free amino acids, fatty acids, antioxidant activities, flavonoids, tannins, total phenolic content, and organoleptic qualities of walnut kernels were examined in this study. The kernels extracted from walnuts subjected to T3 method recorded significantly (p ≤ 0.05) highest DPPH inhibition (68.61 %), ABTS (54.56 %inhibition) and FRAP (0.106 μM trolox/100 g); flavonoids (1993.08 mg QE/100 g), tannin content (0.312 %) and phenols (0.736 mg GAE/g) compared to T1 and T2. Walnut kernels of T3 treatment group were rated better in terms of taste (3.8), odour (3.6) and overall acceptability (3.78) Furthermore, walnut kernels obtained from T3 treatment group exhibited the highest percentage of unsaturated fatty acids (UFAs) and sweet free amino acids. The outcome of the present study offers a fresh viewpoint regarding the hulling processes of green walnuts to meet the quality requirements of walnut kernels., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Ventilators have always been common in medical scenarios but are very expensive to procure or develop. One of the main reasons for these is the components that are being used are expensive and require precise instrumentation, research, and development. This paper attempts to mitigate that problem by proposing a novel way to rapidly develop a portable ventilator that uses common 3D printing technology and off-the-shelf components. This turbine and valve-based ventilator feature most of the modes that are commonly used by healthcare professionals. A unique servo-based pressure release mechanism has been designed that makes the system around 36 times more efficient than solenoid-based systems. Reliability and efficiency have been increased further through the use of a novel positive end-expiratory pressure (PEEP) valve that does not contain any electromechanical component. Effective algorithms such as feed-forward and proportional-integral-derivative (PID) controllers were used alongside the unique 'Sensor data filtration methodology'. The system also provides an interactive graphical user interface (GUI) via an android application that can be installed on any readily found tabs while the firmware manages the breathing detection algorithm using a flow meter and pressure sensor. This modular and portable ventilator also features a replaceable battery and holds the ability to run on solar power. This energy-efficient low-noise system can run for 5 to 6 h at a stretch without needing to be connected to the main's supply., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

High amylose rice (HAR) and carboxymethyl cellulose (CMC) are the preferred choices for enhancement of resistant starch content and lowering of glycemic index in dairy desserts. The effects of different levels of skimmed milk powder (SMP): HAR flour (45:55 to 75:25) and CMC (0.1 to 1%) were investigated on physical characteristics of dry-mix and on texture profile parameters, resistant starch (RS), predicted glycemic index (pGI), glycemic load (GL) and overall acceptability of phirni (a traditional milk pudding). Design expert predicted SMP (70): HAR (30) and CMC (0.8%) as optimum levels for reducing the pGI and maximizing the RS content and other quality characteristics in phirni. RS content of phirni (4.38%) prepared from optimized dry-mix (ODM) was higher while pGI (48.12) and GL (7.50) were lower as compared to phirni prepared from market dry-mix (MDM). The visco-thermal properties of ODM and MDM also showed significant variations. Storage modulus (G') and loss modulus (G'') indicated that ODM phirni was less solid than MDM phirni. Scanning electron micrographs showed fused structures in ODM, while coarse sheet like structures were observed across the surface of MDM. Thus, ODM can be a promising substitute for the available milk desserts for diabetic patients., (© 2022. The Author(s).)

Background: Sea buckthorn (Hippophae) is in the focus of interest mainly for its positive effects on health of both human and animal organisms. Due to the similarities in vegetative morphology, Hippophae species are often misidentified. Therefore, current study was focused on ITS based sequence characterization of sea buckthorn species and comparative biochemical evaluation for its antioxidant properties., Methods and Results: DNA was extracted from leaf samples. Primer pairs K-Lab-SeaBukRhm-ITS1F1- K-Lab-SeaBukRhm-ITS1R1 and K-LabSeaBukTib- ITSF1- K-LabSeaBukTib-ITSR1 were used for PCR amplification. The purified PCR products were outsourced for sequencing. Phylogenetic tree was constructed based on neighbor-joining (NJ) method. Moreover, comparison of antioxidant potential of leaves of two sea buckthorn species (Hippophae rhamnoides and Hippophae tibetana) collected from different regions of Ladakh viz., Stakna, Nubra, DRDO Leh and Zanskar was determined by 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2-azino-bis (3- ethylbenzothiazoline-6-sulphonic acid) diammonium salt (ABTS), and Total antioxidant capacity (TAC) by phosphomolybdenum assays. The present investigation led to the differentiation of two sea buckthorn species viz., H. rhamnoides and H. tibetana based on Internal Transcribed Spacer (ITS) region. Moreover, significant variation was observed in antioxidant potential of leaf extracts collected from different regions., Conclusions: Primary ITS sequence analysis was found to be powerful tool for identification and genetic diversity studies in sea buckthorn. Leaves of sea buckthorn have pronounced antioxidant properties and can be used in food, neutraceuticals and pharmaceutical industries etc. The current study will pave the way to discover small bioactive molecules responsible for antioxidant and anticancer properties in sea buckthorn., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

No-shows in primary care clinics prevent patients from receiving essential care and decrease clinic productivity. The COVID-19 pandemic forced physicians to adjust to telemedicine as a necessary method to provide care. In this study no-show patients were converted to telehealth visits thereby allowing physicians to care for their patients and maintain hospital revenue. The most common reasons for "no-shows" were found to be forgetting appointments and transportation issues., Competing Interests: Disclosure None reported., (Copyright 2022 by the Missouri State Medical Association.)

Aging is associated with several changes in sleep patterns. Older adults have increased prevalence of primary sleep disorders including insomnia, sleep disordered breathing, restless legs syndrome, REM sleep behavior disorder, and circadian rhythm disturbances. These can be further compromised by sleep disturbances secondary to medical or psychiatric disorders, and medication side effects. This review discusses age-related changes in sleep architecture, etiology, clinical presentation, and treatment options of various sleep disorders in the elderly., (Copyright 2020 by the Missouri State Medical Association.)

Purpose: We describe the planning and outcomes of the first 'Blepharospasm Day' in the UK. Blepharospasm is a distressing condition for patients and carers. Our 'patient and public involvement' event aimed to: cultivate a more informed patient group via active dialogue, help clinicians more effectively prioritise research and to facilitate peer-to-peer support for affected patients and public., Design: A national one-day event was organised by the oculoplastics department at Moorfields Eye Hospital. The event was divided into informative lectures delivered by professionals and a patient panel, during which patients shared their experiences and expectations., Methods: Data were collected from a variety of sources including: an interactive voting "LiveWall" poster, a pre-event questionnaire; "living with Blepharospasm", transcripts from patient panel discussions; and a feedback questionnaire., Results: The event was well-received with 100% of respondents rating it good or excellent. Four research themes were identified: "aetiology", "alternative treatments", "faster, more accurate diagnosis", and "symptom control". Delegates' self-reported knowledge of blepharospasm increased significantly after the event. Limitations of the BdSI severity-assessment tool were noted with 22% of respondents failing to utilise it appropriately., Conclusion: Through our innovative "Blepharospasm Day", patient's priorities for research were identified, delegates understanding of blepharospasm increased and an independent blepharospasm patients-representatives' group was established; a first in the UK. Furthermore, short-fallings identified in the BdSI tool highlight the need for better severity-assessment tools. We demonstrate the benefits of the 'patient and public involvement' approach in the management of complex conditions such as blepharospasm., Abbreviations: PPI: Patient and public involvement; SLV-PSP: sight loss and vision sector - priority setting partnership; BRC: Biomedical Research Centre; NIHR: National Institute for Health Research; BsDI: Blepharospasm Disability Index.

Competing Interests: There are no conflicts of interest

Background: Few studies describe the community-acquired pneumonia (CAP) burden in children in Asia. We estimated the proportion of all CAP hospitalizations in children from nine hospitals across the Republic of Korea (high-income), Indonesia, Malaysia (middle-income), and Vietnam (low/middle-income)., Methods: Over a one or two-year period, children <5 years hospitalized with CAP were identified using ICD-10 discharge codes. Cases were matched to standardized definitions of suspected (S-CAP), confirmed (C-CAP), or bacterial CAP (B-CAP) used in a pneumococcal conjugate vaccine efficacy study (COMPAS). Median total direct medical costs of CAP-related hospitalizations were calculated., Results: Vietnam (three centers): 7591 CAP episodes were identified with 4.3% (95% confidence interval 4.2;4.4) S-CAP, 3.3% (3.2;3.4) C-CAP and 1.4% (1.3;1.4) B-CAP episodes of all-cause hospitalization in children aged <5 years. The B-CAP case fatality rate (CFR) was 1.3%. Malaysia (two centers): 1027 CAP episodes were identified with 2.7% (2.6;2.9); 2.6% (2.4;2.8); 0.04% (0.04;0.1) due to S-CAP, C-CAP, and B-CAP, respectively. One child with B-CAP died. Indonesia (one center): 960 CAP episodes identified with 18.0% (17.0;19.1); 16.8% (15.8;17.9); 0.3% (0.2;0.4) due to S-CAP, C-CAP, and B-CAP, respectively. The B-CAP CFR was 20%. Korea (three centers): 3151 CAP episodes were identified with 21.1% (20.4;21.7); 11.8% (11.2;12.3); 2.4% (2.1;2.7) due to S-CAP, C-CAP, and B-CAP, respectively. There were no deaths., Costs: CAP-related hospitalization costs were highest for B-CAP episodes: 145.00 (Vietnam) to 1013.3 USD (Korea) per episode., Conclusion: CAP hospitalization causes an important health and cost burden in all four countries studied (NMRR-12-50-10793).