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Abstract Background Penicillin has remained the most effective treatment for syphilis for several decades. Syphilitic retinal manifestations may persist following treatment and cause visual problems. In this case series, we describe three syphilis patients with persistent posterior segment manifestations due to chronic inflammation, incomplete treatment, and reinfection. Case series Recommended initial treatment for all patients was 14 days of intravenous penicillin. Oral prednisone was added 48 h after initiation of penicillin therapy. Case 1: A 48-year-old female presented with gradual vision loss for two months. Fundus imaging revealed syphilitic outer retinopathy (SOR), papillitis, and acute syphilitic posterior placoid chorioretinopathy (ASPPC). After treatment, she had persistent cystoid macular edema (CME) and was treated with intravitreal triamcinolone injections and ketorolac drops. Case 2. A 24-year-old male presented with sudden vision loss for two days. On imaging, he had ASPPC, papillitis, and SOR. IV penicillin treatment was given for 10 days only. He had persistent SOR and was retreated with doxycycline and prednisone. Case 3: A 52-year-old male presented with eye pain and visual loss for one week. There was evidence of ASPPC and papillitis on imaging. One month after treatment, he had persistent papillitis and was restarted on oral prednisone. One year later, he was found to have recurrent ASPPC and was confirmed to be reinfected with syphilis, for which he was retreated. Conclusion When treating persistent syphilitic ocular manifestations, we recommend checking that the penicillin treatment was complete and the RPR titers are declining. If both hold true, then the affected eye should be treated with anti-inflammatory therapy. Other factors that contribute to poor visual prognosis include treatment delay, poor initial visual acuity, macular edema, and HIV coinfection.

Abstract Electrochemical energy systems mark a pivotal advancement in the energy sector, delivering substantial improvements over conventional systems. Yet, a major challenge remains the deficiency in storage technology to effectively retain the energy produced. Amongst these are batteries and supercapacitors, renowned for their versatility and efficiency, which depend heavily on the quality of their electrode materials. Metal oxide composites, in particular, have emerged as highly promising due to the synergistic effects that significantly enhance their functionality and efficiency beyond individual components. This review explores the application of metal oxide composites in the electrodes of batteries and SCs, focusing on various material perspectives and synthesis methodologies, including exfoliation and hydrothermal/solvothermal processes. It also examines how these methods influence device performance. Furthermore, the review confronts the challenges and charts future directions for metal oxide composite-based energy storage systems, critically evaluating aspects such as scalability of synthesis, cost-effectiveness, environmental sustainability, and integration with advanced nanomaterials and electrolytes. These factors are crucial for advancing next-generation energy storage technologies, striving to enhance performance while upholding sustainability and economic viability.

The hybrid composite plate is increasingly used in marine, robotic arm, and other applications. Edge crack is the greatest common fault in the structural systems during its working time. In this research, the successful fabrications of a hybrid composite of epoxy-based composites reinforced with bamboo and glass fibers have been done to examine the vibration characteristics under free vibration. First-order shear deformation theory is used to study the fundamental natural frequencies of asymmetrically hybrid composite beam with edge cracks for cantilever beam boundary conditions. Both numerical (FEM) using ABAQUS software and experimental investigations are done for the vibration analysis of unidirectional bamboo/glass fiber epoxy hybrid composite (BGHC) beam with edge cracks using fracture mechanics theory. It is observed that implications edge crack with different crack depth and various fiber weight ratio parameters have a major effect on vibration analysis. Also, it is clear that the natural frequencies of the hybrid composite are significantly affected due to the fiber weight ratio and crack depth of the hybrid composite materials. So, crack lengths are playing a vital role in the dynamic or vibration characteristics of the hybrid composite materials. The results of natural frequencies have been shown that they are decreased with an increase in crack depth and an increase in the bamboo fiber weight. Thus, BGHC-2 made from 30% bamboo and 10% glass fiber can be a viable candidate for applications that will produce good vibration properties. Generally, the first-third natural frequency of the hybrid composite beam decreases within the increase of bamboo fiber and decreases in glass fiber. The composite materials having 60% of epoxy with 20% bamboo and 20% glass fiber, and 60% of epoxy with 10% glass and 30% bamboo fibers, are observed with a gradual decrease in the values of natural frequencies with respect to increasing in crack depth. A fine agreement was accomplished between the simulation and experimental results. Therefore, the present approach can be used to identify cracks for mechanical health monitoring by linking the variation in natural frequencies of the hybrid composite beams.

Background: Appendiceal neuroendocrine tumors (NETs) rank as the third most frequent neoplasm affecting the appendix, originating from enterochromaffin cells. This study aims to evaluate the influence of various prognostic factors on the mortality rates of patients diagnosed with NETs of the appendix. Methods: Conducted retrospectively, the study involved 3346 patients, utilizing data sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis centered on investigating demographic characteristics, clinical features, overall mortality (OM), and cancer-specific mortality (CSM) among the cohort. Variables showing a p-value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox regression analysis. A Hazard Ratio (HR) > 1 indicated an unfavorable prognosis. Results: In the multivariate analysis, higher OM and CSM were observed in males, older age groups, tumors with distant metastasis, poorly differentiated tumors, and those who underwent chemotherapy. Non-Hispanic Black individuals showed elevated mortality rates. Conclusion: Delayed diagnosis may contribute to the increased mortality in this community. Improved access to healthcare and treatment is crucial for addressing these disparities. Larger prospective studies are needed to pinpoint the underlying causes of elevated mortality in non-Hispanic Black populations, and randomized controlled trials (RCTs) are warranted to evaluate therapies for advanced-stage appendix NETs.

Backgrounds: Data on the association between comorbid diabetes mellitus (DM) and acute pancreatitis (AP) remains limited. Utilizing a large, nationwide database, we aimed to examine the impact of comorbid diabetes mellitus on patients admitted for acute pancreatitis. Methods: This was a retrospective case-control study of adult patients with AP utilizing the National Inpatient Sample from 2015–2018, using ICD–10 codes. Hospitalization outcomes of patients admitted for AP with comorbid DM were compared to those without comorbid DM at the time of admission. The primary outcome was a mortality difference between the cohorts. Multivariable-adjusted cox proportional hazards model analysis was performed. Data was analyzed as both sex aggregated, and sex segregated. Results: 940,789 adult patients with AP were included, of which 256,330 (27.3%) had comorbid DM. Comorbid DM was associated with a 31% increased risk of inpatient mortality (aOR: 1.31; p = 0.004), a 53% increased risk of developing sepsis (aOR: 1.53; p = 0.002), increased hospital length of stay (LOS) (4.5 days vs. 3.7 days; p < 0.001), and hospital costs (8486; p < 0.001). Whites admitted for AP with comorbid DM were at a 49% increased risk of mortality as compared to Hispanics ($9934 vs. $8486; p < 0.0001). Different comorbidities had sex-specific risks; men admitted for AP with comorbid DM were at a 28% increased risk of mortality (aOR: 1.28; p < 0.0001) as compared to women. Men with comorbid DM plus obesity or hypertension were also at increased risk of mortality as compared to women, whereas women with comorbid DM plus renal failure were at greater risk of mortality as compared to men. Conclusions: Comorbid DM appears to be a risk factor for adverse hospitalization outcomes in patients admitted for AP with male sex and race as additional risk factors. Future prospective studies are warranted to confirm these findings to better risk stratify this patient population.

Patients who undergo heart valve replacements with mechanical valves need to take Vitamin K Antagonists (VKA) drugs (Warfarin, Nicoumalone) which has got a very narrow therapeutic range and needs very close monitoring using PT-INR. Accessibility to physicians to titrate drugs doses is a major problem in low-middle income countries (LMIC) like India. Our work was aimed at predicting the maintenance dosage of these drugs, using the de-identified medical data collected from patients attending an INR Clinic in South India. We used artificial intelligence (AI) - machine learning to develop the algorithm. A Support Vector Machine (SVM) regression model was built to predict the maintenance dosage of warfarin, who have stable INR values between 2.0 and 4.0. We developed a simple user friendly android mobile application for patients to use the algorithm to predict the doses. The algorithm generated drug doses in 1100 patients were compared to cardiologist prescribed doses and found to have an excellent correlation.

Allogeneic stem cell transplantation (Allo-SCT) implies that a donor and a recipient are not genetically identical. Allo-SCT is used to cure a variety of conditions, including hematologic malignancies using the graft versus tumor effect, nonmalignant hematologic, immune deficiencies, and, more recently, genetic disorders and inborn errors of metabolism. Given the immunosuppressive and myeloablative nature of some of the conditioning chemotherapy regimens used during the Allo-SCT, patients are often at high risk of infection, including viral infections affecting the gastrointestinal tract, following the transplant. Furthermore, other complications such as hepatic sinusoidal obstruction syndrome (SOS) or graft-versus-host disease may occur post-transplant and may require endoscopy to assist in the diagnosis. This review will provide newer insights into the importance of endoscopic techniques in the diagnosis of post-Allo-SCT complications with a focus on safety and timing. [ABSTRACT FROM AUTHOR]

Sheath blight (ShB) disease, caused by Rhizoctonia solani, is one of the major biotic stress-oriented diseases that adversely affect the rice productivity worldwide. However, the regulatory mechanisms are not understood yet comprehensively. In the current study, we had investigated the potential roles of miRNAs in economically important indica rice variety Pusa Basmati-1 upon R. solani infection by carrying out in-depth, high-throughput small RNA sequencing with a total data size of 435 million paired-end raw reads from rice leaf RNA samples collected at different time points. Detailed data analysis revealed a total of 468 known mature miRNAs and 747 putative novel miRNAs across all the libraries. Target prediction and Gene Ontology functional analysis of these miRNAs were found to be unraveling various cellular, molecular, and biological functions by targeting various plant defense-related genes. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was performed to validate the miRNAs and their putative target genes. Out of the selected miRNA-specific putative target genes, miR395a binding and its cleavage site on pentatricopeptide were determined by 5’ RACE-PCR. It might be possible that R. solani instigated chloroplast degradation by modulating the pentatricopeptide which led to increased susceptibility to fungal infection.

Due largely to economic development, industrialization, and changing lifestyles, quantity of hazardous waste in India is rising significantly. This is particularly true in mega cities, where populations are large and growing. Due to a range of factors including limitations in governance systems, inadequate treatment facilities, limitations in compliance and regulation, and limited trained and skilled stakeholders, the management of hazardous solid waste in the country is largely ineffective. One exception to this is the State of Gujarat, which has sought to implement a number of strategies to better manage the rising quantities of hazardous solid waste being produced. This article highlights the management of solid waste in the country for an effective mitigation of various hazards. Further, this article focused on adaptive technologies for the hazardous waste management all over the country more specifically in the state of Gujarat.