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Background Excessive and irrational use of antibiotics as growth promoters in poultry has been one of key factors contributing to increased emergence of antibiotics resistant bacteria. Several alternatives for antibiotic growth promoters are being sought, and the search for effective probiotics to be used as feed additives is amongst the promising ones. Our study aimed to isolate and test potential probiotics bacteria from cloacal swabs of various indigenous chicken (Gallus domesticus) breeds from rural outskirts of the Kathmandu valley (Nepal). Methods Selective isolation of probiotics was conducted by micro-aerophilic enrichment of sample in MRS Broth at 37°C, followed by culturing on MRS agar supplemented with 5 g/L of CaCO3. Isolated bacterial colonies producing transparent halo were selected as potential lactic acid bacteria (LAB), and tested for their antibacterial activity, phenotypic and biochemical characteristics, acidic yield, and tolerance to acid and bile. Results A total of 90 potential LAB were isolated from cloacal samples collected from 41 free-ranging chickens of indigenous breeds. Of these, 52 LAB isolates (57%) showed variable antibacterial activity to at least one bacterial pathogen. Of 52 LAB, 46 isolates fulfilled phenotypic and biochemical criteria of Lactobacillus spp. Of these, 37 isolates produced varying percentage yields of lactic acid, 27 isolates showed survival at pH 3.0, and 17 isolates showed survival tolerances in the presence of 0.3% and 0.5% bile salts for 24 hours. Phylogenetic analysis of 16S rDNA sequencing of LAB isolates fulfilling in vitro probiotics properties showed that 3 isolates had genetic identity of 99.38% with Lactobacillus plantarum, while one isolate was genetically similar (99.85%) with the clade of L. reuteri, L. antri and L. panis. Conclusion Our study identified four Lactobacillus spp. strains having potential probiotics properties. Further investigations are needed to evaluate these isolates to be used as poultry probiotics feed supplement.

Oral ulcerative lesions are very common and a proper diagnosis is required of the nonresponsive lesions to common antiseptic and analgesic creams which do not work on those ulcers. Specific local potent steroids work faster with given soft trays to apply, which holds the medicine for local action, as it does not get washed away with the mouth saliva. Lupus Erythematosus lesions respond slowly with medicine as this is an autoimmune disease. Systemic lupus erythematosus, it occurs, is a cutaneous autoimmune disease and can affect the skin and various internal organs. Thus, proper observation of oral ulcers is important and if there are any indications of such skin infections, then it requires a Dermatologist to handle for life-saving management as the disease is sometimes fatal. A general warning signal of recurrence can help the patient with history of oral lesion for the proper management even later in life by a Dermatologist. Oral lesions are very important in diagnosing systemic disease in many cases. Oral lesions are thus the mirror of general health.

The purpose of this study was to evaluate the reproducibility and magnitude of shift of tumor position by using active breathing control and iView-GT for patients with lung cancer with moderate deep-inspiration breath-hold (mDIBH) technique. Eight patients with 10 lung tumors were studied. CT scans were performed in the breath-holding phase. Moderate deep-inspiration breath-hold under spirometer-based monitoring system was used. Few important bony anatomic details were delineated by the radiation oncologist. To evaluate the interbreath-hold reproducibility of the tumor position, we compared the digital reconstruction radiographs (DRRs) from planning system with the DRRs from the iView-GT in the machine room. We measured the shift in x, y, and z directions. The reproducibility was defined as the difference between the bony landmarks from the DRR of the planning system and those from the DRR of the iView-GT. The maximum shift of the tumor position was 3.2 mm, 3.0 mm, and 2.9 mm in the longitudinal, lateral, and vertical directions. In conclusion, the moderated deep-inspiration breath-hold method using a spirometer is feasible, with relatively good reproducibility of the tumor position for image-guided radiotherapy in lung cancers.

Rockfalls in mines represent one of the most hazardous events for miners, posing significant risks to safety, equipment, and operations. These incidents occur when rock or debris falls from the walls of a mine, often without warning, and can be triggered by geological factors, blasting practices, ground vibration, water infiltration, stress redistribution and timedependent behaviour of rock. Apart from this, the bench parameters, such as the slope angle of the bench, the friction angle of the material, bench height and width, affect the rockfall. The rockfall incidents history that occurred in the past several years suggest that rockfalls in opencast mines led to the fatal injuries of many individuals. The problems faced due to rockfalls are not repetitive, but they are disastrous in opencast mines once they occur. So, it is necessary to investigate the rockfall in an opencast mining industry. It is also observed from the literature that the kinetic energy of a rockfall helps determine the intensity of rockfall in a mine. Understanding these factors and implementing preventive measures and rapid response strategies is crucial in mitigating rockfall risks. Hence, this study investigates rockfall phenomena in a high wall open cast by determining the kinetic energy of a rockfall. A parametric study has been conducted to determine the effect of various bench parameters on the kinetic energy of rockfall. A predictive model is developed to determine the kinetic energy of rockfall concerning various factors affecting rockfall. The predictive model is also validated using three case studies of high opencast mines. The results from the predictive model and the numerical model for the case study mines match the predictive model that can predict the rock fall intensity for opencast mines. The study also aims to assess the potential risks posed to workers, equipment, and infrastructure in highwall opencast mines. The findings provide valuable insights for implementing appropriate safety measures and developing effective strategies to mitigate rockfall hazards. [ABSTRACT FROM AUTHOR]

Abstract Background Despite South Africa’s well-established Civil Registration and Vital Statistics system (CRVS) and good completeness of death registration, challenges persist in terms of the quality of cause of death information and the delayed availability of mortality statistics. The introduction of an electronic medical certification of cause of death (eMCCD) system may offer opportunities to improve both the quality and timeliness of this information. Methods This study used an exploratory mixed methods design to investigate perceptions surrounding an electronic solution for registering deaths in South Africa. We conducted 14 key informant interviews from 23 key informants invited, surveyed 208 out of 250 targeted health workers and engaged with more than 500 South African health professionals in a participatory workshop about the acceptability of introducing an eMCCD. Mentimeter was used to obtain feedback from the participants. Rapid qualitative analysis methods were used to analyse the key informant interviews and descriptive statistics for the survey and workshop data. During the interpretation phase, qualitative and quantitative data were integrated according to key themes that emerged from the data. Results During the qualitative interviews, the underlying factors mentioned as contributing to inadequate mortality data quality included insufficient MCCD training, diseases subjected to stigma, limited access to and quality of patient health information, and a significant proportion of deaths occurring outside medical facilities. More than 80.8% of the surveyed health professionals (168/208) rated the importance of mortality statistics as high, but the current quality was rated as low or very low by 29.3% (61/208). An eMCCD appeared to be acceptable to most workshop participants who registered on Mentimeter and was perceived as a means to strengthen the timeliness of mortality information. However, 43.0% (68/158) of the workshop participants who responded to this question on Mentimeter saw poor internet use as the main barrier to introducing an online system. Conclusions Our results shed light on critical aspects surrounding cause of death information in South Africa, as well as the challenges faced in maintaining the quality of such data. The findings suggest that the implementation of an eMCCD system could provide opportunities to strengthen the cause of death information in South Africa if it is designed to integrate into the current system and provide supplementary functionalities.

Key Clinical Message Chronic ketamine use can lead to sphincter of oddi dysfunction (SOD), causing various hepatobiliary complications. Recognizing substance abuse history is vital for early detection. Timely intervention can prevent irreversible liver and pancreas damage. Abstract Ketamine is commonly abused as a recreational drug worldwide due to its ability to induce euphoria‐like effects. Ketamine abuse is associated with many hepatobiliary side effects ranging from cholestasis to biliary sepsis and death. Here we present a case of a young 29‐year female with upper abdominal pain due to SOD resulting from chronic use of ketamine. SOD can result in obstruction or dysfunction of the bile and pancreatic ducts. Ketamine induces SOD by activation of the muscarinic receptors in the sphincter of oddi. Detail history of substance abuse is crucial for early identification of ketamine‐induced SOD. Early identification and treatment of this rare condition can prevent permanent injury to the liver and pancreas.

Key Clinical Message Immune checkpoint inhibitors can rarely lead to occurrence of myositis, myocarditis, and myasthenia gravis (MG). Early recognition and multidisciplinary management are crucial for optimal outcomes. Vigilance for overlapping toxicities is essential in patients receiving combination immunotherapy. Abstract The use of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, but it is associated with immune‐related adverse events (IRAEs) affecting various organ systems. The simultaneous occurrence of MG, myocarditis, and myositis highlights the complex nature of IRAEs. Early recognition and comprehensive multidisciplinary management are crucial for optimal patient outcomes. We present a unique case report of a 76‐year‐old male patient with advanced melanoma who developed concurrent myositis, myocarditis, and MG while receiving combination immunotherapy with Nivolumab and Ipilimumab. This case underscores the significance of recognizing and addressing the “Terrible Triad” of IRAEs in patients receiving ICIs. Healthcare providers should maintain a high index of suspicion for overlapping toxicities and promptly initiate appropriate interventions.

The transportation industry is one of the greatest contributors to a growing carbon footprint. As the world increasingly prioritizes a greener and cleaner future, the transition from ICEs to EVS offers significant benefits as EVs are zero-emission vehicles. However, considering the production and disposal stages of EVs, they cannot be considered entirely emission-free. But in comparison to ICEs, they still have a much smaller carbon footprint. Moreover, studying EV technology is essential to bringing this to the lowest possible extent. However, these advancements come with challenges. In this review article, we have taken an in-depth look into the various challenges, namely the economic challenges, technological challenges, and environmental challenges, faced by EV technology today and the various solutions proposed by researchers, their limitations, and future potential in EV technology advancement. Within this context, we discuss the influence of governmental policies, accessibility and affordability of EVs to the masses, natural and man-made disasters, economic instability, technological limitations posed by the vehicle technology, and limitations posed by battery technology with batteries being the central element for EVs, limitations associated with the existing infrastructure and its ability to support widescale use of EVs, and environmental factors like carbon footprint, among other factors, on EVs technology and the opportunities this technology can make use of in the future. This paper discusses these concerns in detail and gives extensive insight into the challenges, solutions, and future trends pertaining to economic impacts, vehicle technology, battery technology, power grids and charging infrastructure, and environmental impact, of EVs and EV technology.

Key Clinical Message Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a necrotizing vasculitis characterized by small‐to‐medium‐sized vessel involvement and the presence of antineutrophil cytoplasmic antibodies (ANCA). We present a case of a 26‐year‐old Asian woman who was transferred to our center from a nearby hospital, where she presented with shortness of breath, tested positive for COVID‐19, and was being managed for COVID‐19 pneumonia. She also had hemoptysis, skin lesions, and left foot numbness. Serological markers and VATS‐guided lung biopsy confirmed the diagnosis. Treatment with methylprednisolone and rituximab led to stabilization, despite complications of subcutaneous emphysema and lower extremity neuropathic symptoms. Early recognition and appropriate management of GPA are crucial for optimal outcomes.