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Abstract Alzheimer’s disease (AD), a progressive neurodegenerative disorder, is characterized by neurological impairments such as visual and sensory difficulties, motor dysfunction, sphincter issues, incoordination, gait abnormalities, and cognitive decline. Despite advances in understanding AD pathophysiology and the expansion of therapeutic options over the past three decades, the disease remains incurable. Current therapies, even those specifically targeting AD, often fail to significantly alter its progression, underscoring the need for innovative treatment approaches beyond symptomatic relief. This calls for a re-examination of AD pathology to identify potential therapeutic targets that go beyond conventional strategies. This review highlights four of the most promising non-canonical therapeutic targets: oligodendrocytes, the blood–brain barrier (BBB), neuroimmunometabolism, and the coagulation system. These components are crucial for maintaining the integrity and proper function of neurons and the brain, playing key roles in the progression of AD. Oligodendrocytes, for example, are essential for myelination and neuronal support, while BBB dysfunction can lead to impaired clearance of toxic proteins. Neuroimmunometabolism offers insights into how metabolic processes influence immune responses in the brain and dysregulation of the coagulation system has been linked to increased neuroinflammation and vascular abnormalities in AD. Recent discoveries in these fields provide new avenues for understanding the disease and identifying potential therapeutic targets. By exploring these non-canonical pathways, future research may offer breakthroughs in treating AD, moving beyond symptomatic management towards disease-modifying strategies.

The combination of lightweight, durable, and flexible elastomer nanocomposites presents a unique set of features that make them highly promising for a range of several engineering applications. Present work investigates the performance of the mechanical and electrical characteristics of a nanocomposite produced by combining silicon rubber (SR) with nano-Graphene, copper oxide (CuO). Two roll mixing followed by compression moulding is used to manufacture different configurations of Graphene/CuO/SR nano composite. Nano composites specimens are fabricated with 1, 2, 4, and 8 wt % of graphene with fixed 1 % CuO. There has been a discernible improvement of 146.52 % in the mechanical properties and 18.1 % in electrical performance. This improvement is supported by the FESEM morphological analysis of fractured surfaces. It has been observed that the optimized loading of 8 wt % of Graphene gives the best performance. The strong interfacial interaction between the Graphene/CuO and SR is responsible for the performance gain.

Abstract Background The 4 serotypes of dengue virus (DENV1-4) can each cause potentially deadly dengue disease, and are spreading globally from tropical and subtropical areas to more temperate ones. Nepal provides a microcosm of this global phenomenon, having met each of these grim benchmarks. To better understand DENV transmission dynamics and spread into new areas, we chose to study dengue in Nepal and, in so doing, to build the onsite infrastructure needed to manage future, larger studies. Methods and results During the 2022 dengue season, we enrolled 384 patients presenting at a hospital in Kathmandu with dengue-like symptoms; 79% of the study participants had active or recent DENV infection (NS1 antigen and IgM). To identify circulating serotypes, we screened serum from 50 of the NS1+ participants by RT-PCR and identified DENV1, 2, and 3 – with DENV1 and 3 codominant. We also performed whole-genome sequencing of DENV, for the first time in Nepal, using our new on-site capacity. Sequencing analysis demonstrated the DENV1 and 3 genomes clustered with sequences reported from India in 2019, and the DENV2 genome clustered with a sequence reported from China in 2018. Conclusion These findings highlight DENV’s geographic expansion from neighboring countries, identify China and India as the likely origin of the 2022 DENV cases in Nepal, and demonstrate the feasibility of building onsite capacity for more rapid genomic surveillance of circulating DENV. These ongoing efforts promise to protect populations in Nepal and beyond by informing the development and deployment of DENV drugs and vaccines in real time.

Splenic Lymphoma (SL) is a lymphoproliferative disorder characterised by involvement of the spleen, with or without bone marrow involvement. However, advancements in imaging modalities have led to more frequent diagnosis of isolated splenic lesions. There is always a dilemma in diagnosis as to whether the pathology truly originates from the spleen or if it is part of systemic involvement in Non-Hodgkin Lymphoma (NHL). Clinical manifestations vary widely, and treatment outcomes for SL depend on accurate diagnosis. However, prognosis still remains poor in these cases compared to systemic NHL. The present case series provide a comprehensive overview of patients diagnosed with SL, focusing on their clinicopathological characteristics, therapeutic details, prognosis and outcomes. Previously isolated case reports have been published, and there is still a lack of consensus on the management of this entity. The present case series included seven cases over a two-year period, from January 2022 to December 2023. In the current case series, authors have highlighted the heterogeneity and variability in the presentation of SL and how the clinical behaviour ranges from indolent to highly aggressive. Nevertheless, the presenting clinical, laboratory and pathological features of these diseases often display significant overlaps and pose confusion in arriving at an exact diagnosis. The authors emphasise how flow cytometry helps facilitate the diagnosis and systemic therapy is the modality of choice for treatment decided based on the histology type; however, outcomes still remain dismal, highlighting the unmet need to improve accurate diagnosis and explore newer treatment options. The novelty in this series lies in the detailed analysis and comparison of different subtypes of SL, a rare group of lymphomas primarily originating in the spleen. The present case series discusses the latest World Health Organisation (WHO) classification, which redefines the Hairy Cell Leukaemia (HCL) variant as Splenic B-cell Leukaemia/Lymphoma with Prominent Nucleoli (SBLPN). Detailed molecular and genetic characteristics of various SLs are highlighted, such as the presence of the v-raf murine sarcoma viral oncogene homolog B1 (BRAF) p.V600E mutation in HCL, Mitogen-activated Protein Kinase 1 (MAP2K1) and Immunoglobulin Heavy Variable 4-34 (IGHV4-34) mutations in the HCL-variant, and 7q distortion in Splenic Marginal Zone Lymphoma (SMZL). Emphasis is placed on the individualised treatment approach based on specific patient profiles, genetic markers and disease characteristics. The study underscores the need for further research and clinical trials to validate emerging therapies, such as the use of Rituximab plus Doxorubicin, Bleomycin, Vinblastine and Dacarbazine (R-ABVD) in Hodgkin lymphoma and combinations of novel agents in aggressive SLs like HCL-variant and CD20-negative B-cell NHL.

Abstract Protein kinases are critical components of a myriad biological processes and strongly associated with various diseases. While kinase research has been a point of focus in biomedical research for several decades, a large portion of the kinome is still considered understudied or “dark,” because prior research is targeted towards a subset of kinases with well-established roles in cellular processes. We present an empirical and in-silico hybrid workflow to extend the functional knowledge of understudied kinases. Utilizing multiplex peptide activity arrays and robust in-silico analyses, we extended the functional knowledge of five dark tyrosine kinases (AATK, EPHA6, INSRR, LTK, TNK1) and explored their roles in schizophrenia, Alzheimer’s dementia (AD), and major depressive disorder (MDD). Using this hybrid approach, we identified 195 novel kinase-substrate interactions with variable degrees of affinity and linked extended functional networks for these kinases to biological processes that are impaired in psychiatric and neurological disorders. Biochemical assays and mass spectrometry were used to confirm a putative substrate of EPHA6, an understudied dark tyrosine kinase. We examined the EPHA6 network and knowledgebase in schizophrenia using reporter peptides identified and validated from the multi-plex array with high affinity for phosphorylation by EPHA6. Identification and confirmation of putative substrates for understudied kinases provides a wealth of actionable information for the development of new drug treatments as well as exploration of the pathophysiology of disease states using signaling network approaches.

Granular cell tumors of breast are rare neoplasms, majority of which are benign. Their imaging appearances are often indistinguishable from breast cancer. They may demonstrate a few differentiating features and unlike breast cancer, typically follow a benign course. Histopathology and immunochemistry form the cornerstone of diagnosis of granular cell tumor. In this article, we presented a series of three cases of granular cell tumors with variable presentations. Our goal is to increase familiarity for these neoplasms and for the readers to be able to distinguish them from the more common entity of breast cancer, as their prognosis and management differ.

Objective Accurate preoperative characterization of adnexal masses is essential for optimal patient management. Two-dimensional ultrasonography (USG) based “International Ovarian Tumuor Analysis Simple Rules (IOTA-SR)” are used primarily in clinical practice. Three-dimensional (3D) USG is an emerging modality. The authors conducted this study to compare the performance of 3D USG with IOTA-SR for preoperative differentiation of benign and malignant adnexal masses.

AIM: The aim of this study was to compare the efficacy of sub-Tenon and peribulbar anesthesia in vitreoretinal surgeries. Methods: This was a retrospective study where patients who received peribulbar or sub-Tenon anesthesia during vitreoretinal surgeries between July 2023 and September 2023 were included. Lid movements, subconjunctival hemorrhage, chemosis, and akinesia were evaluated after anesthesia was injected in the two groups. Pain score was evaluated at the time of anesthesia, intraoperatively, and postoperatively after 1 h. Results: We included 108 patients, of which 58 were given peribulbar and 50 had sub-Tenon anesthesia and had mean ± standard deviation age of 56.8 ± 12.6 years and 57.90 ± 13.0 years, respectively (P = 0.67). Baseline, intraoperative, and postoperative (at 1 h after surgery) systolic blood pressure (BP), diastolic BP, and pulse rate were similar in both groups. None of the patients had any systemic complications in both the peribulbar and sub-Tenon groups. The mean pain score at postoperative 1 h was similar in both groups (P = 0.58). At postoperative 1 day, two patients had ecchymosis in the peribulbar group. Eighteen cases had lid edema in the peribulbar group compared to no lid edema in the sub-Tenon group (P < 0.001). Conclusion: Sub-Tenon anesthesia is a simple, safe, and less traumatic technique that is as good as peribulbar in terms of providing analgesia. Although sub-Tenon could not produce total akinesia in most of the cases, the surgeon was able to operate comfortably with negligible chance of anesthesia-related complications. However, the anesthetist also plays an important role in a multidisciplinary approach in the management of vitreoretinal surgeries.

Alzheimer’s disease is a neurological disorder marked by the accumulation of amyloid beta (Aβ) aggregates, resulting from mutations in the amyloid precursor protein. The enzyme β-secretase, also known as β-site amyloid precursor protein cleaving enzyme 1 (BACE1), plays a crucial role in generating Aβ peptides. With no targeted therapy available for Alzheimer’s disease, inhibiting BACE1 aspartic protease has emerged as a primary treatment target. Since 1999, compounds demonstrating potential binding to the BACE1 receptor have advanced to human trials. Structural optimization of synthetically derived compounds, coupled with computational approaches, has offered valuable insights for developing highly selective leads with drug-like properties. This review highlights pivotal studies on the design and development of BACE1 inhibitors as anti-Alzheimer’s disease agents. It summarizes computational methods employed in facilitating drug discovery for potential BACE1 inhibitors and provides an update on their clinical status, indicating future directions for novel BACE1 inhibitors. The promising clinical results of Elenbecestat (E-2609) catalyze the development of effective, selective BACE1 inhibitors in the future.

Background and objectives: COVID-19 vaccination program has become a global priority to combat the worldwide pandemic. Studies claimed that severity and case fatality could be minimized by vaccination. The durability of antibodies developed after vaccination is crucial for preventing COVID-19. The purpose of this study was to investigate the dynamics of antibody responses to an inactivated SARS-CoV-2 virus vaccine over time. Materials and method: The study was conducted from November 2021 to November 2022 among young adults. A pre-tested structured questionnaire was used to record the socio-demographic and clinical data of all the participants. All the participants were vaccinated with two doses of Sinopharm COVID-19 vaccine. Blood samples were collected for estimation of IgG antibodies to SARS-CoV-2 spike S1 protein by indirect ELISA. Biochemical parameters namely random blood sugar (RBS), lipid profile, total protein, thyroid stimulating hormone (TSH), FT4 (free thyroxin) and vitamin D levels were determined in baseline samples by standard methods. Result: Total 348 adults, aged 18-28 years, were enrolled and of which 35.3% and 64.7% were male and female respectively. Out of 348 participants, 51.7% was seropositive for anti- SARS-CoV-2 antibodies before receiving vaccination. Seropositivity was not significantly (p >0.05) different in male and female participants before and after vaccination. Seropositivity at 1 month after 1st dose and 4 and 7 months after 2nd dose of vaccination increased significantly (p 0.05) different before and after vaccination in participants having adequate and insufficient/deficient vitamin D levels. Conclusion: The study revealed that a good proportion of young adults possessed anti- SARS-CoV-2 antibody before vaccination and the seropositivity increased to over 90% following vaccination with Sinopharm COVID-19 vaccine. High level of anti- SARS-CoV-2 antibody persisted 7 months after 2nd dose of vaccine. July 2024; Vol. 18(2):012. DOI:https://doi.org/10.55010/imcjms.18.024 *Correspondence: Nehlin Tomalika, Department of Community Medicine & Public Health, Ibrahim Medical College, 1/A, Ibrahim Sarani, Segunbagicha, Dhaka 1000, Bangladesh. Email: nehlintomalika@gmail.com

The acetylation of proteins' N-terminal amino groups by the N-acetyltransferase complexes plays a crucial role in modulating the spatial stability and functional activities of diverse human proteins. Mutations disrupting the stability and function of NAA10 result in X-linked rare genetic disorders. In this study, we conducted a global analysis of the impact of fifteen disease-associated missense mutations in NAA10. The analyses revealed that mutations in specific residues, such as Y43, V107, V111, and F128, predictably disrupted interactions essential for NAA10 stability, while most mutations (except R79C, A111W, Q129P, and N178K) expectedly led to structural destabilization. Mutations in many conserved residues within short linear motifs and post-translational modification sites were predicted to affect NAA10 functionality and regulation. All mutations were classified as pathogenic, with F128I and F128L identified as the most destabilizing mutations. The findings show that the F128L and F128I mutations employ different mechanisms for the loss of catalytic activities of NAA10F128L and NAA10F128I due to their structural instability. These two mutations induce distinct folding energy states that differentially modulate the structures of different regions of NAA10F128L and NAA10F128I. Specifically, the predicted instability caused by the F128I mutation results in decreased flexibility within the substrate-binding region, impairing the substrate peptide binding ability of NAA10F128I. Conversely, F128L is predicted to reduce the flexibility of the region containing the acetyl-CoA binding residues in NAA10F128L. Our study provides insights into the mechanism of catalytic inactivation of mutants of NAA10, particularly elucidating the mechanistic features of the structural and functional pathogenicity of the F128L and F128I mutations.

In this paper the authors present three different Lyapunov-type inequalities for a higher-order Caputo fractional differential equation with identical boundary conditions marking the inaugural instance of such an approach in the existing literature. Their findings extend and complement certain prior results in the literature.

Background: Frailty, rather than age, is associated with postoperative morbidity and mortality. We sought to determine whether preoperative frailty as defined by a novel scoring system could predict the outcomes among older patients undergoing esophagectomy. Methods: We identified patients 65 years or older who underwent esophagectomy between 2011 and 2021 at our institution. Frailty was assessed using the MSK-FI, which consists of 1 component related to functional status and 10 medical comorbidities. We used a multivariable logistic regression model to test for the associations between frailty and short-term outcomes, with continuous frailty score as the predictor and additionally adjusted for age and Eastern Cooperative Oncology Group performance status. Results: In total, 447 patients were included in the analysis (median age of 71 years [interquartile range, 68–75]). Most of the patients underwent neoadjuvant treatment (81%), an Ivor Lewis esophagectomy (86%), and minimally invasive surgery (55%). A total of 22 patients (4.9%) died within 90 days of surgery, 144 (32%) had a major complication, 81 (19%) were readmitted, and 31 (7.2%) were discharged to a facility. Of the patients who died within 90 days, 19 had a major complication, yielding a failure-to-rescue rate of 13%. The risk of 30-day major complications (OR, 1.24 [95% CI, 1.09–1.41]; p = 0.001), readmissions (OR, 1.31 [95% CI, 1.13–1.52]; p < 0.001), and discharge to a facility (OR, 1.86 [95% CI, 1.49–2.37]; p < 0.001) increased with increasing frailty. Frailty and 90-day mortality were not associated. Conclusions: Frailty assessment during surgery decision-making can identify patients with a high risk of morbidity.

Background: A community-based study on childhood injuries would provide valuable information on the epidemiology of injuries to undertake appropriate preventive measures. Therefore, the current study was conducted in urban poor resettlements of Rishikesh to estimate the prevalence of unintentional injuries and to document the sociodemographic risk factors associated with unintentional injuries among under-five children. Aims and Objectives: Estimation of the prevalence of unintentional injuries and their risk factors among under-five children of urban poor resettlements in Rishikesh. Materials and Methods: A community-based cross-sectional study was conducted in urban poor resettlement areas of Rishikesh for a period of 1 year. It included 300 children selected using a simple random sampling technique to collect data on injury status. Results: The prevalence of unintentional injury among study participants was 16%. Falls were (64.6%) the major cause of injury, followed by dog bites (12.5%). The major sites of the injury were the head (25%), face (22.9%), upper limb (27.1%), and lower limb (18.8%).75% of the injuries happened at home. 66% of injuries happened when the child was playing alone or playing with peers. About 20.8% of injuries were bruises or superficial injuries. 39.6% of children had cut/bite/open wound injuries. Fractures happened in 14.6% of injured children. More than half (54.2%) of children did not develop any physical disability due to injury. Among children who developed a disability, more than 90% are able to recover completely. The majority of study participants were taken to nearby hospitals (66.6%) or health centers (10.4%). Only one of them went to a traditional bone setter, rest all visited either a general practitioner or pharmacy. The median expenditure for the treatment of the injured child was INR 425 (175-2750). The age of the child and unintentional injury showed a statistically significant association. Conclusion: The prevalence of the injury was 16% (12–20.7%) similar to a number of similar studies. Although the majority of the injuries were mild in severity, injuries have also contributed to temporary disability among children and have led to loss of school days.

Abstract Objectives To explore how to reach immigrant women through community agencies to raise awareness of the role of physical activity (PA) in reducing cancer risk. Study design Qualitative description. Methods We conducted semi-structured telephone interviews with immigrant women and community agency managers to discuss the ideal design of an education session on PA and cancer risk, and identified themes using content analysis. Results Participants included 22 women (6 African or Caribbean Black, 4 Chinese, 3 Filipino, 5 Indian, 4 Pakistani) and 16 agency managers from across Canada. Women were not familiar with Canada’s PA guidelines, and few were aware that PA reduces the risk of cancer. All expressed interest in education about PA and cancer. Diverse women and managers expressed similar preferences for education session design including content (e.g. PA amount/type), format (e.g. in person preferred but virtual more practical), personnel (external expert plus agency staff), cultural tailoring (e.g. translated supplemental take home information) and reinforcing (e.g. follow-up with participants) strategies. Women and managers identified few barriers to participating in education sessions, chiefly, that women lacked time due to work and family responsibilities; and noted several enablers of participation (e.g. emphasize social aspect, provide gift cards or recreation centre passes). Conclusions We generated insight on the ideal characteristics of a community-based education session that could raise awareness among immigrant women of the importance of PA in reducing cancer risk. Further research is needed to assess the feasibility and impact of PA education sessions designed based on these findings.

Abstract Flue gas emissions are the waste gases produced during the combustion of fuel in industrial processes, which are released into the atmosphere. These identical processes also produce a significant amount of wastewater that is released into the environment. The current investigation aims to assess the viability of simultaneously mitigating flue gas emissions and remediating wastewater in a bubble column bioreactor utilizing bacterial consortia. A comparative study was done on different growth media prepared using wastewater. The highest biomass yield of 3.66 g L−1 was achieved with the highest removal efficiencies of 89.80, 77.30, and 80.77% for CO2, SO2, and NO, respectively. The study investigated pH, salinity, dissolved oxygen, and biochemical and chemical oxygen demand to assess their influence on the process. The nutrient balance validated the ability of bacteria to utilize compounds in flue gas and wastewater for biomass production. The Fourier Transform–Infrared Spectrometry (FT–IR) and Gas Chromatography–Mass Spectrometry (GC–MS) analyses detected commercial-use long-chain hydrocarbons, fatty alcohols, carboxylic acids, and esters in the biomass samples. The nuclear magnetic resonance (NMR) metabolomics detected the potential mechanism pathways followed by the bacteria for mitigation. The techno-economic assessment determined a feasible total capital investment of 245.74$ to operate the reactor for 288 h. The bioreactor’s practicability was determined by mass transfer and thermodynamics assessment. Therefore, this study introduces a novel approach that utilizes bacteria and a bioreactor to mitigate flue gas and remediate wastewater.

Abstract Background This overview of reviews aims to identify evidence on the benefits (i.e. tobacco use abstinence and reduction in smoking frequency) and harms (i.e. possible adverse events/outcomes) of smoking cessation interventions among adults aged 18 years and older. Methods We searched Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the CADTH Health Technology Assessment Database and several other websites for grey literature. Searches were conducted on November 12, 2018, updated on September 24, 2020, with publication years 2008 to 2020. Two reviewers independently performed title-abstract and full-text screening considering pre-determined inclusion criteria. Data extraction and quality assessments were initially completed by two reviewers independently (i.e. 73% of included studies (n = 22)) using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR 2), and the remainder done by one reviewer and verified by another due to resources and feasibility. The application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) was performed by one independent reviewer and verified by another. Results A total of 22 Cochrane systematic reviews evaluating the impact of smoking cessation interventions on outcomes such as tobacco use abstinence, reduction in smoking frequency, quality of life and possible adverse events were included. Pharmaceutical (i.e. varenicline, cytisine, nicotine replacement therapy (NRT), bupropion) and behavioural interventions (i.e. physician advice, non-tailored print-based self-help materials, stage-based individual counselling, etc.) showed to have increased smoking cessation; whereas, data for mobile phone-based interventions including text messaging, hypnotherapy, acupuncture, continuous auricular stimulation, laser therapy, electrostimulation, acupressure, St John’s wort, S-adenosyl-L-methionine (SAMe), interactive voice response systems and other combination treatments were unclear. Considering harms related to smoking cessation interventions, small/mild harms (i.e. increased palpitations, chest pain, nausea, insomnia, headache) were observed following NRT, varenicline and cytisine use. There were no data on harms related to behavioural therapies (i.e. individual or group counselling self-help materials, internet interventions), combination therapies or other therapies (i.e. laser therapy, electrostimulation, acupressure, St John’s wort, SAMe). Conclusion Results suggest that pharmacological and behavioural interventions may help the general smoking population quit smoking with observed small/mild harms following NRT or varenicline. Consequently, evidence regarding ideal intervention strategies and the long-term impact of these interventions for preventing smoking was unclear. Systematic review registration PROSPERO CRD42018099691

Introduction: Audiovisual Distraction (AVD), as a behaviour management technique, has gained significant importance in aiding patient cooperation during routine dental procedures. However, the scale at which it makes a difference needs to be evaluated. Objective approaches like measuring heart rate and pulse rates are unreliable methods. The quantification can be done using salivary Chromogranin A (CgA), a stress marker. Aim: To evaluate the use of AVD for reducing stress in children aged 4-7 years during dental treatment using salivary CgA. Materials and Methods: The present quasi-experimental study was conducted within the Department of Paediatric and Preventive Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India, from January 2022 to March 2022 after obtaining ethical clearance from the Institute and consent from parents. Six uncooperative children who required two Class-I restorative treatments for occlusal caries involving enamel and dentin were included in the study. The sample size was estimated using G*Power software v3.1.9.2 and calculated using t-tests. The treatment plan was divided into two appointments. In the first appointment, the cavity was prepared without the use of AVD. In the second appointment, AVD was incorporated during the dental procedure using the patient’s favourite cartoon. Unstimulated salivary samples were collected during both appointments, before and immediately after the procedure, which were sent to the laboratory for evaluation of CgA levels to gauge the stress levels during each appointment and the effect AVD has on the same. Results: Within the group without AV aids used, the mean salivary CgA levels showed a significant increase from 0.23 pmol/mg pretreatment to 1.26 pmol/mg protein after treatment. Within the group with AV aids, salivary CgA levels showed a significant reduction (p≤0.05) from 1.08 pmol/mg before treatment to 0.43 pmol/mg protein after treatment. There was also a significant difference in the change in salivary CgA levels from pre- to post-treatment between the two study groups. Conclusion: The study shows quantitatively that AVD reduced stress levels during dental treatment and therefore can be used as an adjunct for behaviour management. It can also be seen that Salivary CgA is a reliable short-term stress marker and can be used objectively to evaluate and quantify stress levels in children.

Tumor-to-tumor metastasis is a known but rare occurrence and is characterized as 2 distinct tumor types in same anatomic location. We present a rare case of intracranial tumor-to-tumor metastasis of esophageal adenocarcinoma into meningioma. Our case emphasizes the rare occurrence of intracranial tumor-to-tumor metastasis and importance of histology and immunohistochemical analysis in distinguishing between metastasis and meningioma, especially when faced with ambiguous demarcation. Awareness of this occurrence is crucial, given that metastases might be the initial indication of an underlying tumor and it can impact the clinical management decisions.

The aim of direct pulp caping (DPC) is to support the formation of mineralized tissue and encourage pulp healing by placing a dental biomaterial directly over the exposed pulp. The era of vital pulp therapy has been influenced by the introduction of various pulp-capping materials. Emphasis has shifted from the “doomed” organ concept of an exposed pulp to one of hope and recovery; this comprehensive review thus discusses the ability of different direct pulp-capping materials to form a dentin bridge. Furthermore, this review will discuss the quality and quantity of dentinal bridge formation by different pulp-capping agents.

This study examines AI's role in enhancing guest satisfaction and efficiency in the hotel industry. Employing a mixedmethods approach, it analyzes guest feedback and interviews staff at AI-integrated hotels. The findings aim to identify key AI applications that boost satisfaction and efficiency, and outline challenges and best practices for AI implementation. This research offers a holistic view of AI's influence on hospitality, enriching understanding and guiding industry practices. As the hotel industry continues to evolve, the integration of artificial intelligence (AI) technologies has become increasingly prevalent, aiming to enhance guest experience. This research investigates the impact of AI integration on guest experience enhancement within the hotel industry. The purpose of this study is to comprehensively explore how AI technologies influence various aspects of guest satisfaction in hotels. A mixed-methods approach is employed, combining quantitative analysis of guest feedback data with qualitative methods by interviewing the guests staying in the hotel. Data is collected from a diverse range of hotels that have implemented AI technologies, allowing for a nuanced understanding of the impacts across their establishments. This research is expected to provide valuable insights into the multifaceted effects of AI integration in the hotel industry. Specifically, it aims to identify the specific AI applications that most significantly contribute to guest satisfaction levels. Additionally, the study seeks to uncover potential challenges and limitations associated with AI implementation, as well as best practices for successful integration. This topic lies in its comprehensive examination of AI's impact on both guest experience within the hotel industry. While previous research has explored AI's role in hospitality, few studies have undertaken such a holistic analysis, considering its implications for guests. By addressing this gap, this research contributes to a deeper understanding of the transformative effects of AI in the hotel sector, providing practical insights for industry practitioners and stakeholders.

Increased levels of the non-essential hazardous metalloid arsenic (As) in rice grains pose a threat to human health and the sustainability of the rice industry. In several counties, the average As contamination in polished rice has been detected to range from 0.002 to 0.39 mg/kg, which is above the safe limit of 1 mg/kg as recommended by the World Health Organisation. Beyond this limit, the digestive tract, circulatory system, skin, liver, kidney, nervous system and heart can be affected. Humans can develop cancer from consuming or inhaling As. In addition, long-term exposure to drinking water contaminated with arsenic has also been linked to a dose-response relationship with an increased risk of hypertension and diabetes mellitus. Rice has been shown to be an indirect source of arsenic accumulation in human bodies. Under flooded paddy soil, trivalent arsenate (AsIII) occupies 87-94% of the total As, while under non-flooded soil, pentavalent arsenate (AsV) predominates (73-96% of the total As). This review aims to provide a thorough and interdisciplinary understanding of the behaviour of As in the paddy soil and transportation to rice grain and further investigate efficient ways to limit arsenic contamination. Supplementation of soil with specific mineral nutrients such as iron (Fe), sulphur (S) and silicon (Si) can significantly decrease the arsenic accumulation in rice grain by minimising its uptake and translocation. The hydrogen bonding potentials of uronic acids, proteins and amino sugars on the extracellular surface of soil microorganisms facilitate the detoxification of arsenic species. Further, rice is absorbed less when exposed to aerobic water management practices than anaerobic ones since it reduces the build-up of As in rice, and the solution is immobilised as in the soil.

Abstract Background This systematic review aims to identify the benefits and harms of electronic cigarettes (e-cigarettes) as a smoking cessation aid in adults (aged ≥ 18 years) and to inform the development of the Canadian Task Force on Preventive Health Care’s (CTFPHC) clinical practice guidelines on e-cigarettes. Methods We searched Ovid MEDLINE®, Ovid MEDLINE® Epub Ahead of Print, In-Process & Other Non-Indexed Citations, PsycINFO, Embase Classic + Embase, and the Cochrane Library on Wiley. Searches were conducted from January 2016 to July 2019 and updated on 24 September 2020 and 25 January 2024. Two reviewers independently performed title-abstract and full-text screening according to the pre-determined inclusion criteria. Data extraction, quality assessments, and the application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) were performed by one independent reviewer and verified by another. Results We identified 18 studies on 17 randomized controlled trials that compared e-cigarettes with nicotine to e-cigarettes without nicotine and e-cigarettes (with or without nicotine) to other interventions (i.e., no intervention, waitlist, standard/usual care, quit advice, or behavioral support). Considering the benefits of e-cigarettes in terms of smoking abstinence and smoking frequency reduction, 14 studies showed small or moderate benefits of e-cigarettes with or without nicotine compared to other interventions; although, with low, very low or moderate evidence certainty. With a focus on e-cigarettes with nicotine specifically, 12 studies showed benefits in terms of smoking abstinence when compared with usual care or non-nicotine e-cigarettes. In terms of harms following nicotine or non-nicotine e-cigarette use, 15 studies reported mild adverse events with little to no difference between groups and low to very low evidence certainty. Conclusion The evidence synthesis on the e-cigarette’s effectiveness shows data surrounding benefits having low to moderate evidence certainty for some comparisons and very low certainty for others, indicating that e-cigarettes may or probably increase smoking cessation, whereas, for harms, there is low to very low evidence certainty. Since the duration for outcome measurement varied among different studies, it may not be long-term enough for Adverse Events (AEs) to emerge, and there is a need for more research to understand the long-term benefits and potential harms of e-cigarettes. Systematic review registration PROSPERO CRD42018099692

Abstract Mitochondrial transcription factor A (TFAM) employs DNA bending to package mitochondrial DNA (mtDNA) into nucleoids and recruit mitochondrial RNA polymerase (POLRMT) at specific promoter sites, light strand promoter (LSP) and heavy strand promoter (HSP). Herein, we characterize the conformational dynamics of TFAM on promoter and non-promoter sequences using single-molecule fluorescence resonance energy transfer (smFRET) and single-molecule protein-induced fluorescence enhancement (smPIFE) methods. The DNA-TFAM complexes dynamically transition between partially and fully bent DNA conformational states. The bending/unbending transition rates and bending stability are DNA sequence-dependent—LSP forms the most stable fully bent complex and the non-specific sequence the least, which correlates with the lifetimes and affinities of TFAM with these DNA sequences. By quantifying the dynamic nature of the DNA-TFAM complexes, our study provides insights into how TFAM acts as a multifunctional protein through the DNA bending states to achieve sequence specificity and fidelity in mitochondrial transcription while performing mtDNA packaging.

Abstract Background Mentoring is vital to career development in academic medicine, and communication underlies all aspects of the mentoring relationship. Although training research mentors has been shown to be effective, few academic medicine faculties have received training in how to mentor. The investigators developed a novel intervention, the Mentor Communication Skills Training for Oncology Faculty (“Comskil Mentor Training”) and examined feasibility and preliminary efficacy. Methods The study was a single arm pre-post intervention design. The intervention (Comskil Mentor Training) was offered in one virtual 3-hour session and included a didactic lecture with exemplary skill demonstration videos, facilitator-led small group role plays with trained actors, and evaluation. 19 faculty members from 12 departments participated in the training. Results All participants completed the training. Overall, the training was rated favorably, with more than 80% of participants indicating that they “agreed” or “strongly agreed” with training evaluation. From pre- to post-training, significant improvement was seen in participants’ overall self-efficacy to communicate with mentees, as well as participants’ overall use of communication skills and mentoring-specific language. Conclusions Our findings support the feasibility and preliminary efficacy of a virtually delivered experiential mentor communication skills training program for multidisciplinary clinical and research faculty in oncology.

Abstract Contract governance ensures that the agreed outcomes between customers and vendors are fulfilled. Information Technology (IT) outsourcing organizations enter thousands of contractual relationships each month leading to a high volume of business-critical contractual text that must be reviewed and deciphered for effective governance. The key to effective governance of contracts is a model that facilitates assigning ownership of the obligations to the right departments in an organization and allocating their accountability to the right stakeholders. For this, the contractual obligations need to be identified and classified so that details such as actions to be taken by departments in an organization and their ownership as per a given clause are brought out for the purpose of governance. In this paper, we present our work on automated extraction and classification of obligations present in Software Engineering (SE) contracts for the purpose of contracts governance. We propose a novel data decomposition-based hierarchical classification method for a multi-label classification of contractual obligations. We conducted experiments for a fine-grained automated classification of more than 55,000 statements from 50 large real-life SE contract documents received from a large vendor organization into 152 governance-specific classes. The results indicate that the proposed method can bring about a 7–8% improvement in accuracies when compared to state-of-the-art classification baselines such as BERT, RoBERTa, and generative models such as GPT-2.

Abstract Background Low skeletal muscle mass (LSMM) and/or, function associated with an increased risk of treatment‐related toxicities and inferior overall survival (OS) among adults with solid malignancies. However, the association between LSMM and treatment‐related toxicities among adults with haematologic malignancies remains unclear. Methods Using a pre‐published protocol (CRD42020197814), we searched seven bibliographic databases from inception to 08/2021 for studies reporting the impact of LSMM among adults ≥18 years with a known haematologic malignancy. The primary outcome of interest was OS, and secondary outcomes included progression free survival (PFS) and non‐relapse mortality (NRM). These effect sizes were quantified in terms of hazards ratio (HR) along with 95% confidence interval (CI) and pooled across studies using a DerSimonian–Laird random‐effects model. Heterogeneity was assessed using the Cochran's Q and the I2 statistic. All hypothesis testing was two‐sided with an alpha of 0.05. Results Of 3791 studies screened, we identified 20 studies involving 3468 patients with a mean age of 60 years; 44% were female and the most common malignancy was diffuse large B‐cell lymphoma (42%). Most studies measured muscle mass using single slice computed tomography imaging at the L3 level. The presence of LSMM was associated with worse OS (pooled HR = 1.81, 95% CI = 1.48–2.22, P

Pseudoaneurysm development is a well-recognized consequence of arterial injury, frequently observed in procedures involving arterial groin access. Breast emergencies are infrequent but need prompt attention. We present a notable case of breast pseudoaneurysm postcore needle biopsy, incidentally, identified through subsequent magnetic resonance imaging. Remarkably, the patient's lactating status emerged as a unique risk factor. Our report thoroughly explores the pathogenesis, etiology, preventive measures, and treatment strategies specific to breast pseudoaneurysms. A comprehensive understanding of this phenomenon is essential for radiologists at large, with particular importance for specialists in breast imaging.

Caste determines the life worlds of people in India in particular and South Asia in general. Historically, it is observed that caste has conditioned the nature of public spaces. Upper castes can appropriate the public spaces legitimized by caste ideology and practice. However, colonial and post-colonial India witnessed changes in the caste system due to its (modern) legal interventions. Paradoxically, caste persists in its crude and subtle forms. It has also acquired new forms in post-independent public spaces. Caste determines certain bodily dispositions within the so-called public spaces. The ambiguous nature of modernity and the weight of tradition have drastically transformed the public space. A socially regulated economy and public institutions are determining the people, space, and mobility of the castes, too. This article investigates the nature of the stigmatized labour of Dalit women sanitation workers (who come under the manual scavenging community) within diverse public urban spaces. It analyses the various questions related to the Dalit women sanitation workers who work in select public universities, urban housing colonies, and slums in Delhi, India. It probes the Dalit women sanitation workers’ day-to-day life in caste-ridden spaces of urban- “public” spaces. One of the central questions that needs to be addressed is whether the socioeconomic space of these Dalit women workers has changed in contemporary India. Why do Dalit women have to do stigmatized work in public spaces? How are purity and pollution reinforced in elusive ways? Thus, it initiates a critique of the Indian feminist understanding of public spaces. This article acts as a way to engage with the epistemic priority of women sanitation workers to problematize Brahmanic feminism in India. Can there be any social-political engagement with the public space in the case of Dalit women sanitation workers? At the level of theory, this article critiques the dominant-Habermasian idea of the public sphere and Nancy Fraser’s counter-public to reflect on conceptual practice grounded in the Dalit women sanitation workers and public space.

The incidence of Acute Pancreatitis is rising among the pediatric population. The most common causes in children are cholelithiasis and choledochal cyst. Anomalies of biliary tract and pancreatic duct are other rare causes of the same. However these anomalies are suspected and detected after repeated episodes of pancreatitis and later in life. We report a case of a 4 year old female child who presented with acute Pancreatitis due to cholelithiasis resulting from a rare anomalous insertion of Common Bile Duct and Pancreatic Duct.

Herbal products and their formulations have a large market at the global level. A significant portion of the worldwide population relies upon herbal treatment. Their apparent non-toxic and cost-effective nature appeals to the population and drives researchers to pursue them for drug development. However, due to the lack of scientific evidence, their conventional preparation, poor regulation and control make these an unseen threat to the people. There has been a long-standing argument that allopathic medicines are better than herbal medicines due to their specificity and precision. To compete with modern medicines, a concept of science-based phytopharmaceutical drugs was introduced through a draft amendment notified to the Drugs and Cosmetics 1940 and Rules 1945. The amendment has introduced a definition for botanicals and their scientific evaluation for quality safety and efficacy by the Central Drugs Standard and Control Organization (CDSCO) office as a marketing authorization requirement. The present article discusses the advantages and challenges faced in the development of phytopharmaceuticals, and how they differ from dietary supplements and herbal drugs. It also gives consolidated information on Phytopharmaceuticals and their regulatory and Pharmacopoeial status with an exemplary PPI monograph – Aegle marmelos. The plant selection was done based on extensive research using the PRISMA approach. A detailed view of the opportunities and challenges provided by phytopharmaceuticals is explained in the present review.

BACKGROUND: An individual experiencing tetraplegia faces functional limitations due to impaired hand function. The use of an affordable tenodesis wrist-hand orthosis (WHO) can enable finger flexion with active wrist extension, thereby enhancing the three-jaw chuck grasp and overall hand functionality. OBJECTIVES: To assess hand function and satisfaction in patients with tetraplegia using a modified tenodesis wrist-hand orthosis (WHO), utilizing the Duruöz Hand Index (DHI) and the Orthotics and Prosthetics User Survey (OPUS) satisfaction with device and services subscales. METHODOLOGY: The study was conducted at a tertiary care center in central India, enrolling patients with tetraplegia admitted to the Department of Physical Medicine and Rehabilitation. A modified tenodesis wrist-hand orthosis (WHO) was designed using low-temperature thermoplastic components. Twenty-two individuals with a minimum wrist extensor power of grade 3/5 were included in the study. These patients were provided with the modified tenodesis WHO and underwent daily training sessions for a period of 2 weeks. Duruöz Hand Index (DHI) scores were assessed at baseline, 6 weeks, and 12 weeks post-enrolment. Patient satisfaction was evaluated using the Orthotics and Prosthetics User’s Survey (OPUS) satisfaction with device and services subscales. FINDINGS: The analysis of the DHI scores indicated a significant enhancement in functional abilities at both 6-week and 12-week follow-ups compared to the baseline assessment. Notably, the most substantial progress at 6 weeks follow-up was observed in tasks such as buttoning a shirt, while significant improvement at the 12-week mark was noted in activities like turning a key in a lock. The median OPUS device satisfaction score was 50, corresponding to a Rasch score of 68.8. Additionally, the median OPUS satisfaction score for services stood at 46, with a Rasch score of 72.7. Patients expressed the highest satisfaction levels with the courteous demeanor of the staff, prompt scheduling of appointments, and accurate fitting of the orthosis. CONCLUSION: The study findings indicate that the modified tenodesis WHO is an effective and satisfactory therapeutic device for improving hand function in patients with tetraplegia. The findings encourage further investigation and application of the modified tenodesis WHO in clinical practice. Layman's Abstract Individuals who are affected due to spinal cord injury (SCI) are often unable to perform the basic daily activities of life due to weakness. The hands are one of the most specialized parts of the human body and loss of its function can be incapacitating. Certain wrist hand orthoses (WHO) can aid such individuals by assisting the weak hand muscles. One such WHO is a tenodesis wrist hand orthosis. Modifications to the previously available tenodesis wrist hand orthosis were made to make it cheaper, lighter, and easier to manufacture. The effectiveness of this modified tenodesis WHO on improving hand activity and satisfaction in the individuals using it was assessed in this study which was conducted in a tertiary care center in central India. Twenty-two individuals with cervical SCI, who had some ability to extend their wrists against gravity, were admitted to the Physical Medicine and Rehabilitation department and enrolled in this study. Notable improvements were observed in functional tasks such as buttoning a shirt, opening a lock, eating with a fork, brushing teeth, and writing, with considerable satisfaction in those trained with the modified tenodesis WHO. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/42879/33253 How To Cite: Sonune S.P, Saha A, Joshi N.G, Pathak S, Bhadra P, Goel G. The effect of a modified tenodesis wrist-hand orthosis on hand function in patients with tetraplegia. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.8. https://doi.org/10.33137/cpoj.v7i1.42879 Corresponding Author: Dr. Anyesha Saha, Affiliation: Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Saket Nagar, Bhopal (M.P.), India. E-Mails: saha.anyesha@gmail.com; anyesha.sr2023@aiimsbhopal.edu.in ORCID ID: https://orcid.org/0009-0004-1574-0519

Abstract Introduction Due to the increased effectiveness of and access to antiretroviral therapy (ART), people with HIV (PWH) are living longer. As a result, the population of older PWH has increased. Mental and substance use disorders (MSDs) are common and frequently co‐occurring among PWH and are associated with poor HIV care outcomes. Research into the prevalence and co‐occurrence of MSDs among ageing PWH remains limited, particularly in low‐ and middle‐income countries (LMICs). Methods We analysed data collected between 2020 and 2022 from the International epidemiology Databases to Evaluate AIDS (IeDEA) Sentinel Research Network cohort of PWH aged 40 years or older on ART at 11 HIV clinics in Brazil, Côte d'Ivoire, India, Kenya, Mexico, Uganda, Rwanda, Togo, Vietnam, Zambia and Zimbabwe. We estimated the prevalence and co‐occurrence of unhealthy alcohol use (AUDIT‐C ≥3 for women, ≥4 for men), unhealthy drug use (ASSIST >3 for cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens and/or opioids), and moderate to severe symptoms of depression (PHQ‐9 ≥10), anxiety (GAD‐7 ≥10) and post‐traumatic stress disorder (PTSD) (PCL‐5 ≥33). Psychiatric multimorbidity was defined as having symptoms of two or more disorders assessed. Log binomial models assessed the association between socio‐demographic and HIV care characteristics and symptoms of anxiety, depression, PTSD or unhealthy substance use. Results Of 2821 participants, the prevalence of unhealthy alcohol and drug use was 21% and 5%, respectively. The prevalence of moderate to severe symptoms of depression, anxiety and PTSD was 14%, 9% and 6%, respectively. Overall, the prevalence of psychiatric multimorbidity was 11%. Among those with symptoms of at least one mental health or substance use outcome assessed (n = 1036), the prevalence of psychiatric multimorbidity was 31%. In binomial models, the prevalence of symptoms of depression and anxiety was higher, while the prevalence of unhealthy alcohol and drug use was lower among women than men. Conclusions Unhealthy alcohol use and symptoms of depression were most commonly reported, among this cohort of PWH aged 40 or older across 11 LMICs. Integration of MSD screening and treatment into HIV care should be prioritized. The effectiveness and implementation of transdiagnostic or multi‐focus mental health treatment approaches in HIV care settings should be examined.

Voltage-gated potassium channel (VGKC) complex autoimmunity associated with nerve hyperexcitability is an uncommon clinical spectrum. It is mostly characterized by limbic encephalitis, continuous neuromyotonia, and dysautonomia. Pain, however, has rarely been reported as the first symptom. The present study describes a case of persistent neuropathic pain as the only symptom associated with a positive serum contactin-associated protein-like 2 (CASPR2) auto-antibody in a 41-year-old female patient. Her pain was completely relieved with steroids and intravenous immunoglobulin (IVIG) therapy. Nevertheless, the pain recurred 1 year later, consistent with an immunofluorescence titer of the CASPR2 antibody. Our case shows that neuropathic pain may occur as the first and only manifestation of a VGKC complex autoimmunity disorder. VGKC antibody titers might be an indication of pain severity. Steroids coupled with IVIG are effective, but relapse may still occur.

BackgroundOsteoarthritis is more prevalent and severe among women than among men, but women are less likely to access early diagnosis and first-line management, particularly racialized immigrant women. Previous research advocated for greater access to culturally safe osteoarthritis information for both diverse women and health care professionals. The internet can reduce disparities by facilitating access to health information, but online materials can vary in quality. ObjectiveThis study aimed to assess the quality and cultural safety of online osteoarthritis materials for persons affected by osteoarthritis and health care professionals. MethodsContent analysis was used to describe publicly available materials on osteoarthritis first-line management developed by Canadian organizations for affected persons or health care professionals. Searching, screening, and data extraction were performed in triplicate. We identified materials by searching Google, MEDLINE, and references of osteoarthritis-relevant guidelines and policies, and consulting our research team and collaborators. We assessed quality using DISCERN (University of Oxford) and a compiled framework for affected persons and health care professionals. We compiled frameworks to assess cultural safety. We derived an overall score, categorized as low (

The demography and eating behaviour of the marginalized communities residing in the Almora district of Uttarakhand, India, was investigated. It was observed that agriculture was the main income source along with other work such as labourer, black-smith, etc. Food consumption was mainly dependent upon either the Government Public Distribution System or on traditional coarse grains which were being produced only for their own consumption. Traditional food crops were being neglected in the Himalayan region due to the deterioration of local food systems, changing food habits, and lack of awareness of the uses and nutritional value of traditional crops.

IntroductionSoft rot Pectobacteriaceae (SRP) bacteria are globally dispersed pathogens that cause significant economic loss in potato and other crops. Our understanding of the SRP species diversity has expanded in recent years due to advances and adoption of whole-genome sequence technologies. There are currently 34 recognized SRP species that belong to the Dickeya and Pectobacterium genera.MethodsWe used whole-genome sequencing based analysis to describe the current distribution and epidemiology of SRP isolated from diseased potato samples obtained from commercial potato cropping systems in the United States. Our primary objectives in the present study were to: (1) identify the species of these SRP isolates recovered from potato samples across 14 states in the US, (2) describe the variation among SRP isolates from various US locations and track their temporal changes, and (3) evaluate the evolutionary relationships among these SRP isolates to deduce their source. We collected 118 SRP strains from diseased potato plants and tubers in 14 states between 2015 and 2022.ResultsWe identified three Dickeya and eight Pectobacterium species from diseased potato samples. Dickeya dianthicola, Pectobacterium parmentieri, P. carotovorum, and P. versatile appeared to be the predominant species, constituting 83% of the isolates. Furthermore, all D. dianthicola strains studied here as well as 90% of US D. dianthicola isolates sequenced to date exhibit significant clonality.DiscussionThe prevalence of this specific group of D. dianthicola, temporally and geographically, aligns with the occurrence of blackleg and soft rot outbreaks in the northeastern US after 2014. The genomic diversity observed in P. parmentieri implies multiple introductions to the US from at least four distinct sources, earlier than the arrival of the predominant group of D. dianthicola. In contrast, P. carotovorum and P. versatile appear to be widespread, long-term endemic strains in the US.

Background Implementing guidelines for chronic opioid management during a clinic merger posed significant challenges. Our aim was to increase the percentage of chronic pain evaluations and urine toxicology tests in patients on chronic opioid therapy from the baseline rate of less than 20% to 50% within 1 year at an academic, primary care clinic.Methods We applied the Define, Measure, Analyze, Improve, Control (DMAIC) approach of Lean Six Sigma for this quality improvement (QI) project. The QI tools included the creation of stakeholder mapping, root cause analysis, process flow mapping and a driver diagram. Lack of patient and provider education emerged as a significant barrier. The outcome measures were percentage of chronic pain evaluations and urine drug toxicology with an increase in controlled substance agreement completion rates as our process measures. Major interventions included patient and provider education, leveraging health information technology, care coordination and implementing new clinic protocols. Data analysis was performed by monthly run charts. Descriptive statistics were used to summarise clinical variables, while χ2 analyses were employed to determine statistically significant differences between preintervention and postintervention measures.Results We observed an increase in completion rates of clinic visits for chronic pain, rising from 19.0% to 51.9% (p

BackgroundCommon Variable Immunodeficiency Disorders (CVID) encompass a spectrum of immunodeficiency characterised by recurrent infections and diverse non-infectious complications (NICs). This study aimed to describe the clinical features and variation in NICs in CVID with and without interstitial lung disease (ILD) from a large UK national registry population.MethodsRetrospective, cross-sectional data from a UK multicentre database (previously known as UKPIN), categorising patients into those with CVID-ILD and those with NICs related to CVID but without pulmonary involvement (CVID-EP; EP= extra-pulmonary involvement only).Results129 patients were included. Chronic lung diseases, especially CVID-ILD, are prominent complications in complex CVID, occurring in 62% of the cohort. Bronchiectasis was common (64% of the cohort) and associated with greater pulmonary function impairment in patients with CVID-ILD compared to those without bronchiectasis. Lymphadenopathy and the absence of gastrointestinal diseases were significant predictors of ILD in complex CVID. Although the presence of liver disease did not differ significantly between the groups, nearly half of the CVID-ILD patients were found to have liver disease. Patients with CVID-ILD were more likely to receive immunosuppressive treatments such as rituximab and mycophenolate mofetil than the CVID-EP group, indicating greater need for treatment and risk of complications.ConclusionThis study highlights the significant burden of CVID-ILD within the CVID population with NICs only. The lungs emerged as the most frequently affected organ, with ILD and bronchiectasis both highly prevalent. These findings emphasise the necessity of a comprehensive and multidisciplinary approach in managing CVID patients, considering their susceptibility to various comorbidities and complications.

Modern cancer diagnostics and treatment options have greatly improved survival rates; the illness remains a major cause of mortality worldwide. Current treatments for cancer, such as chemotherapy, are not cancer-specific and may cause harm to healthy cells; therefore, it is imperative that new drugs for cancer be developed that are both safe and effective. It has been found that lactic acid bacteria (LAB) have the potential to produce bacteriocins, which could potentially offer a promising alternative for cancer treatment. They have been shown in several studies to be effective against cancer cells while having no effect on healthy cells. More research is needed to fully understand the potential of LAB bacteriocins as anti-cancer medicines, to find the appropriate dose and delivery route, and to conduct clinical trials to evaluate the effectiveness and safety of the products in human patients, as is suggested by this work. Furthermore, LAB bacteriocins may evolve into a significant new class of anti-cancer drugs and food products. Patients with cancer may have a safe and effective alternative treatment option in the form of anti-cancer foods and drugs. Therefore, the aim of this study is to provide an in-depth analysis of the recent breakthroughs and potential future technical advancements of significant bacteriocins that are produced by LAB, how these bacteriocins function, and how these bacteriocins may be utilized as an anti-cancer agent. In addition, the current analysis emphasizes the significant constraints and boundaries that bacteriocins face when they are used as an anti-cancer factor.

Segmentation of retinal blood vessels from fundus images is vital to assist ophthalmologists in diagnosing different eye diseases like Arteriosclerosis, Glaucoma, Diabetic Retinopathy, Hypertension, and Choroidal Neovascularization. Accurate detection and timely treatment of these eye diseases can prevent irreversible impairment of vision. In computer-aided automatic diagnosis, Preprocessing of fundus images is necessary to reduce the uneven retinal image illumination, as well as the undesirable effect arising from the contrast differences between the retinal blood vessels and the background. In this study, the Hessian-based Frangi vesselness filter is proposed to enhance vasculature in fundus images. This approach seeks to extract thin vessels to diminish the intensity disparity between thick and thin vessels. Its accuracy has never, however, been thoroughly evaluated. To verify the effectiveness of the suggested filter for boosting vessel-like structures in the fundus images, an experimental approach is presented in this paper. The ability of the filter to improve vessel-like structures in fundus images is validated, and an experimental technique for evaluating filter performance using the U-Net model is described. Five quantitative performances, namely Accuracy, Recall, Specificity, Precision, and F1 Score measures on the DRIVE, HRF, DIARETDB1, DIARETDB0, CHASEDB1, ORIGA, DRISHTI GS, DRIONS DB, FIRE, and FIOT datasets, were evaluated and quantified in these experiments to validate the efficacy of the proposed filter. The results demonstrated a noteworthy improvement by achieving an Accuracy of 99.79 %, 99.84 %, 99.64 %, 99.72 %, 99.57 %, 99.48 %, 99.77 %, 99.05 %, 99.93 %, and 99.40 % respectively. Empirical evidence supports the advantages of this approach.

The most common primary liver tumour in children is hepatoblastoma, which is often diagnosed in the first three years of life. While the majority of hepatoblastomas are sporadic, some associations are reported with genetic disorders like Beckwith-Wiedemann syndrome and familial adenomatous polyposis. The annual incidence of hepatoblastoma in children has gradually increased during the past three decades. Babies born prematurely, weighing

Rehabilitation of partially edentulous arches with a cast partial denture is a commonly opted treatment modality where fixed prosthesis is not indicated. However, due to the aesthetic compromise of the various metal components when placed in the esthetic zone, different modifications have been considered for its fabrication. This case report describes a novel way of restoring partially edentulous arches with increased masticatory efficiency and good emergence profile without compromising the patient’s esthetic desires. The report describes an aesthetic alternative using thermoplastic denture base clasp like extension for anterior abutment teeth while restoring the missing teeth with a cast partial denture.

The frozen shoulder (FS) also known as adhesive capsulitis is one of the most common causes of shoulder pain and disability. It is marked by pain and limitation of movement resulting in progressive deterioration of quality of life. Although a few patients with an FS recover without any intervention, the majority of patients have persistent pain with or without movement restriction. Ultrasound (USG)-guided hydrodistension of the shoulder joint is an upcoming mode of treatment for FS which can theoretically lead to pain relief, functional improvement, and a better quality of life, especially if combined with the anti-inflammatory effects of intra-articular corticosteroids. Here, we are presenting our experience with USG-guided hydrodistention of the shoulder joint along with intra-articular corticosteroid in cases of FS both in terms of objective indices of shoulder functionality and subjective outcomes of pain. Eight patients who presented to the outpatient department of pain medicine in our hospital having FS (stage 2/3) were selected. Outcome measures included pain score, Shoulder Pain and Disability Index (SPADI) and Shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Visual Analogue Scale, and range of movement. Data were collected at baseline, as well as at 6 weeks, 12 weeks, and 6 months. We performed hydrodistension with 30 ml of volume constituted by adding lignocaine and triamcinolone acetate to normal saline immediately, followed by physiotherapy of the shoulder joint and cryotherapy. We found promising results with all our patients both in the short term as well as long term with both SPADI and QuickDASH scores as well as the range of motion of the shoulder joint improving significantly in all eight patients at 6 weeks and 12 weeks. This improvement notably persisted in all the patients when reassessed at 6 months indicating a long-term benefit of the intervention.

Introduction: Research conducted during the first wave of COVID-19 in India and world over has highlighted its psychological impact among health-care workers (HCWs), which kindled the current study of the aftermath of the second wave among HCWs. Objectives: The objective was to study the correlation between demographic factors, resilience, burnout, and stress among doctors and nurses working at a dedicated COVID-19 hospital (DCH) during the second wave. Methodology: The DCH doctors (residents and faculty) and nurses willing to participate in the online survey using Google forms were assessed cross-sectionally using a semi-structured questionnaire for demographic factors and psychometric scales – abbreviated Nicholson McBride Resilience Questionnaire, abbreviated Maslach Burnout Inventory, and Perceived Stress Scale-10 to measure resilience, burnout, and stress, respectively. The data were analyzed using Chi-square test and Pearson’s coefficient for correlation. Results: Out of 169 voluntary participants, 24.9% had severe perceived stress, 21% had moderate-to-severe burnout, and 49.7% had exceptional level of resilience. Severe perceived stress was seen in the lower age group (P = 0.018) and more in graduates than in postgraduates (P = 0.044). Moderate-to-severe burnout was seen in unmarried (P = 0.02), in junior doctors (P = 0.021), in those working in intensive care unit, fever clinic, and triage area (P = 0.038), and in those living away from family (P = 0.014). Exceptional level of resilience was statistically significant in nursing staff (P = 0.026). There was a statistically significant correlation between perceived stress and burnout (P < 0.001). Conclusion: The psychological impact of second wave was less among HCWs as compared to the first wave of COVID-19 pandemic.

Objectives: Vault closure is the final step to hysterectomy, protecting the abdominal cavity from the exterior environment. Thus, closure becomes crucial in preventing ascend of infection to the peritoneal cavity. Our study aims to compare vault closure between laparoscopic and vaginal routes, their operating time, and postoperative complications. Materials and Methods: The ambispective comparative study was done in a tertiary care teaching center from June 2016 to December 2022. Three hundred and forty-four patients were included in the study that underwent a total laparoscopic hysterectomy. Interventions – Patients who had laparoscopic vault closure were in Group 1 (N = 198) and those who had vaginal closure were in Group 2 (N = 146). The results were compared. It included age, body mass index of the patient, the indication of surgery, intraoperative blood loss, size of the uterus, time taken during vault closure, and postoperative complications. Results: The time taken by laparoscopic vault repair was significantly less than vaginal repair (19.7 ± 13.3 min vs. 30.1 ± 6.6 min, P < 0.001). There was postoperative vault infection (2.7%), vault hematoma (1.3%), and no vault prolapse seen in vaginal repair. The organisms isolated were mainly Pseudomonas aeruginosa, Escherichia coli, and Klebsiella. Conclusion: Laparoscopic vault closure has shown significantly improved results compared to vaginal route repair.

Aim: The aim is to study the various histopathological changes in the liver in pediatric patients with choledochal cyst (CC) and correlate with the presentation and type of cyst. Methods: In a prospective observational study including all pediatric patients who underwent CC excision, histopathological changes of the liver in the form of cholestasis (CHS), portal inflammation (PI), bile duct proliferation (BDP), and fibrosis were studied and graded using a scoring system. They were analyzed in relation to age, sex, symptoms, and type of the cyst. Results: All 30 patients of CC showed various degrees of histopathological changes in the liver in the form of CHS, PI, BDP, and liver fibrosis. Patients 1 years had 17/17 (100%) fusiform variety of CC (P < 0.001). Patients 1 years presented with pain abdomen (P < 0.002). Higher grades of liver fibrosis and BDP were seen in the cystic variety compared to the fusiform variety (P < 0.001). However, no significant association was found with CHS and PI (P > 1.23). Conclusions: Histopathological changes in the liver of varying grades are seen in all patients of CC. Patients of CC