Foraging for the future: traditional culinary uses of wild plants in the Western Himalayas-Kashmir Valley (India).

BACKGROUND: In the intricate tapestry of food security, wild food species stand as pillars, nourishing millions in low-income communities, and reflecting the resilience and adaptability of human societies. Their significance extends beyond mere sustenance, intertwining with cultural traditions and local knowledge systems, underscoring the importance of preserving biodiversity and traditional practices for sustainable livelihoods. METHODS: The present study, conducted between February 2022 and August 2023 along the Line of Control in India's Kashmir Valley, employed a rigorous data collection encompassing semi-structured interviews, focus group discussions, and specific field observations facilitated through a snowball sampling technique. RESULTS AND DISCUSSION: The comprehensive inventory includes 108 edible plant and fungal species from 48 taxonomic families, with Rosaceae (N = 11) standing out. Young and soft leaves (N = 60) are an important component of various culinary preparations, with vegetables (N = 65) being the main use, followed by fruits (N = 19). This use is seasonal, with collection peaks in March-April and June-August (N = 12). The study also highlights the importance of use value (UV), with Portulaca oleracea standing out as the plant taxon (UV = 0.61), while Asyneuma thomsoni has the lowest use value (UV = 0.15). Many species such as Senecio chrysanthemoides, Asperugo procumbens, Asyneuma thomsoni, and Potentilla nepalensis were classified as new for gastronomic use. Furthermore, the study underlines the great cultural importance of mushrooms such as Morchella esculenta and Geopora arenicola in influencing social hierarchies within the community. However, the transmission of traditional knowledge across generations is declining in the region. At the same time, the conservation of endangered plant species on the IUCN Red List, such as Trillium govanianum, Taxus wallichiana, Saussurea costus, and Podophyllum hexandrum, requires immediate attention. CONCLUSION: Conservation measures should be prioritized, and proactive remedial action is needed. Further research into the nutritional value of these edible species could pave the way for their commercial cultivation, which would mean potential economic growth for local communities, make an important contribution to food security in the area under study, and contribute to scientific progress.

Mathematical and sensitivity analysis for chemical species in multistep dynamical system: A computational study.

This study presents a significant contribution to the field of chemical kinetics by providing a detailed analysis of a multi-step chemical kinetic process using ordinary differential equations (ODEs). The aim is to describe complex chemical processes' kinetics and the steady-state behavior of chemical species. The research employs reduction techniques to simplify the model by separating fast and slow processes based on their time scales, with a focus on a two-step reversible reaction mechanism. Special consideration is given to the phase flow of solution trajectories near equilibrium points, providing a clear depiction of system behavior. MATLAB simulations demonstrate the physical properties of observed data, while sensitivity analysis reveals parameters' impact on species behavior. Overall, this study enhances our understanding of chemical kinetics and offers insights into modeling complex reaction processes, with implications for various applications in chemistry and related fields.

Cooperative Communication Based Protocols for Underwater Wireless Sensors Networks: A Review.

Underwater wireless sensor networks are gaining popularity since supporting a broad range of applications, both military and civilian. Wireless acoustics is the most widespread technology adopted in underwater networks, the realization of which must face several challenges induced by channel propagation like signal attenuation, multipath and latency. In order to address such issues, the attention of researchers has recently focused on the concept of cooperative communication and networking, borrowed from terrestrial systems and to be conveniently recast in the underwater scenario. In this paper, we present a comprehensive literature review about cooperative underwater wireless sensor networks, investigating how nodes cooperation can be exploited at the different levels of the network protocol stack. Specifically, we review the diversity techniques employable at the physical layer, error and medium access control link layer protocols, and routing strategies defined at the network layer. We also provide numerical results and performance comparisons among the most widespread approaches. Finally, we present the current and future trends in cooperative underwater networks, considering the use of machine learning algorithms to efficiently manage the different aspects of nodes cooperation.

Methyl jasmonate advances fruit ripening, colour development, and improves antioxidant quality of 'Yoho' and 'Jiro' persimmon.

Methyl jasmonate (MJ) has potential to regulate fruit ripening and quality. 'Yoho' and 'Jiro' persimmons were sprayed with MJ (0, 2, 4, and 6 mM), four weeks before anticipated harvest to evaluate its effects on fruit colour and bioactive compounds. Preharvest MJ application significantly improved fruit colour with increased a*, b*, chroma, and colour index. The MJ 6 mM application had significantly enhanced soluble solids content (SSC), reduced total chlorophyll content in peel and pulp, and soluble and total tannins in persimmons. MJ treatments exhibited higher contents of total phenolics, flavonoids, carotenoids, and antioxidant activities. Additionally, MJ treatments enhanced the activities of shikimate dehydrogenase (SKDH), phenylalanine ammonia-lyase (PAL), catalase (CAT), superoxide dismutase (SOD), peroxidase (POD) and lipoxygenase (LOX) enzymes. Overall, pre-harvest MJ application at 6 mM four weeks before anticipated harvest could be useful for advancing colour and improving bioactive compounds in 'Yoho' and 'Jiro' persimmons.

High-frequency harmonics suppression in high-speed railway through magnetic integrated LLCL filter.

The traction converter modulation generates switching-frequencies current harmonics. The trapped filters can eliminate these switching harmonics, reducing total inductance and filter size. Nonetheless, in comparison with the typical inductor-capacitor-inductor (LCL) filter, the trap inductor needs a larger magnetic core. Moreover, the trapped filter has not been analyzed in the traction systems. This paper proposes a magnetic integrated inductor-trap-inductor (LLCL) filter to decrease the filter's size and investigate its application in traction converters. In fact, the application range of this filter is quite broad, and it can be used in various electrical power systems, including industrial power systems, renewable energy systems, transportation systems, and building power systems. The LC-trap may be formed by connecting the equivalent trap inductor, introduced through the magnetic coupling between inverter-side and grid-side inductors, in series with the filter capacitor. Furthermore, for H-bridge unipolar pulse width modulation (PWM) traction converters, the prominent switching harmonics are concentrated at the double switching frequencies. Therefore, the stability zone is expanded by moving the resonance above the Nyquist frequency. The presented filter's features and design are thoroughly analyzed. The proposed method is finally validated by the MATLAB/Simulink simulation and hardware-in-the-loop (HIL) experimental results. Compared to the discrete windings, the integrated ones can save two magnetic cores. Furthermore, the proposed filter can meet IEEE criteria with 0.3% for all the harmonics and total harmonic distortion (THD) of 2.15% of the grid-side current.

An automated information extraction system from the knowledge graph based annual financial reports.

This article presents a semantic web-based solution for extracting the relevant information automatically from the annual financial reports of the banks/financial institutions and presenting this information in a queryable form through a knowledge graph. The information in these reports is significantly desired by various stakeholders for making key investment decisions. However, this information is available in an unstructured format making it much more complex and challenging to understand and query manually or even through digital systems. Another challenge that makes the understanding of information more complex is the variation of terminologies among financial reports of different banks or financial institutions. The solution presented in this article signifies an ontological approach to solving the standardization problems of the terminologies in this domain. It further addresses the issue of semantic differences to extract relevant data sharing common semantics. Such semantics are then incorporated by implementing their representation as a Knowledge Graph to make the information understandable and queryable. Our results highlight the usage of Knowledge Graph in search engines, recommender systems and question-answering (Q-A) systems. This financial knowledge graph can also be used to serve the task of financial storytelling. The proposed solution is implemented and tested on the datasets of various banks and the results are presented through answers to competency questions evaluated on precision and recall measures.

Genus Berberis: A comprehensive and updated review on ethnobotanical uses, phytochemistry and pharmacological activities.

Genus Berberis is an excellent choice for research due to its history in traditional medicine, diverse pharmacological properties, and it has potential for drug discovery. This review presents information on the ethnobotany, pharmacological activities, and many phytochemicals identified from Berberis species. It examines the existing literature on the genus Berberis, drawn from online databases, including PubMed, Web of Science, Science Direct, Elsevier, and Google Scholar, etc encompassing the data from 1960 to 2023. This review focuses on the structural details of reported phytochemicals of Berberis species and pharmacological actions. Different extraction techniques were evaluated for extracts preparation. According to literature review, phytochemical analysis exhibited the presence of alkaloids, flavonoids, and phenolic compounds. A major bioactive alkaloid, berberine exhibits its main role in treatment of many gastric, infectious, and chronic disorders. This literature indicates that Berberis genus exhibits a variety of biological activities, i.e anti-inflammatory, cytotoxic, hepatoprotective, antimicrobial, antidiabetic and antioxidant activities and utilization of these effects in the treatment and management of various diseases, like diabetes, microbial infections, inflammation, liver disorders, and cancer. However, conventional medicines, validation of traditional uses, and in-depth phytochemical analysis are areas of research in genus Berberis.

2023 Management Recommendations of Bangladesh Rheumatology Society on Pharmacological Treatment of Rheumatoid Arthritis With Synthetic and Biologic Disease-Modifying Drugs.

Rheumatoid arthritis (RA) is the most common inflammatory polyarthritis in Bangladesh. Bangladesh Rheumatology Society (BRS) proposes these management recommendations to treat the considerable burden of RA in the resource-constrained situation based on the best current evidence combined with societal challenges and opportunities. BRS formed a task force (TF) comprising four rheumatologists. The TF searched for all available literature, including updated American College of Rheumatology (ACR), European Alliance of Associations for Rheumatology (EULAR), and Asia-Pacific League of Associations for Rheumatology (APLAR) and several other guidelines, and systematic literature reviews until October 2023, and then a steering committee was formed, which included rheumatologists and internists. We followed the EULAR standard operating procedures to categorize levels of evidence and grading of recommendations. This recommendation has two parts -- general (diagnosis of RA, nomenclature of disease-modifying anti-rheumatic drugs [DMARDs], disease activity indices) and management portion. The TF agreed on four overarching principles and 12 recommendations. Overarching principles deal with early diagnosis and disease activity monitoring. Recommendations 1-5 discuss using glucocorticoids, NSAIDs, and conventional synthetic DMARDs (csDMARD). Recommendations 6-9 stretch the use of targeted synthetic DMARDs (tsDMARDs) and biological DMARDs (bDMARDs). The suggested DMARD therapy includes initiation with methotrexate (MTX) or another csDMARD (in case of contraindication to MTX) in the first phase and the addition of a tsDMARD in the second phase, switching to an alternative tsDMARDs or bDMARDs in the subsequent phases. The TF included the Padua prediction score for the thromboembolism risk estimation. Recommendations 10-12 cover infection screening, vaccination, and DMARD tapering. Bangladesh has a higher prevalence of RA. This recommendation will serve as a tool to treat this high burden of patients with RA scientifically and more effectively.

Magnetic integrated double-trap filter utilizing the mutual inductance for reducing current harmonics in high-speed railway traction inverters.

Current harmonics are generated at the switching frequency and its multiples when the traction converters are modulated. To address this, multi-trap filters are introduced, which are capable of selectively eliminating these specific harmonics to the limits set by IEEE 519-2014. This targeted removal significantly reduces the need for high total inductance, thereby allowing for a more compact filter design. Comparatively, to traditional inductor-capacitor-inductor (LCL) filters, more magnetic cores are needed for trap inductors. Furthermore, the traction systems have not been examined in conjunction with multi-trap filters. To reduce the filter size and investigate its application in traction converters, this paper presents an integrated double-trap LCL (DTLCL) filter. A tiny capacitor is connected in parallel with the grid-side inductor to form one LC-trap. In addition, another LC-trap is formed by connecting the equivalent trap inductor, introduced through the magnetic coupling between inverter-side and grid-side inductors, in series with the filter capacitor. The presented filters' features are thoroughly analyzed, and the design method has been developed. Finally, the simulation and hardware-in-the-loop (HIL) experiment results validate the proposed method's viability and efficacy. Compared to the discrete windings, the integrated ones enable a size decrease of two cores. Furthermore, the proposed filters can meet IEEE 519-2014 criteria with 0.3% for all the current switching harmonics and total harmonic distortion (THD) of 2.36% of the grid-side current.

Ethnomedicinal Plants and Herbal Preparations Used by Rural Communities in Tehsil Hajira (Poonch District of Azad Kashmir, Pakistan).

The present study emphasizes the importance of documenting ethnomedicinal plants and herbal practices of the local rural communities of Tehsil Hajira (Pakistan). The aim was to document, explore and quantify the traditional ethnomedicinal knowledge. Ethnobotanical data were collected using semi-structured questionnaires and analyzed using various quantitative indices. The results showed that 144 medicinal plant species from 70 families and 128 genera play an important role in herbal preparations. The most common type of preparation was powder (19.0%), followed by paste (16.7%), aqueous extract (15.7%), decoction (14.7%) and juice (11.0%). Fragaria nubicola (0.94) and Viola canescens (0.93) had the highest relative frequency of mention (RFC), while Berberis lycium (1.22) and Fragaria nubicola (1.18) had the highest use value (UV). Geranium wallichianum (85.5), Ligustrum lucidum (83) and Indigofera heterantha (71.5) were the most important species in the study area with the highest relative importance (RI) value. The diseases treated were categorized into 17 classes, with diseases of the digestive system and liver having the highest Informant Consensus Factor (ICF) value, followed by diseases of the oropharynx and musculoskeletal system. Important plants mentioned for the treatment of various diseases of the gastrointestinal tract are Zanthoxylum alatum, Berberis lycium, Mentha longifolia, Punica granatum, Rubus ellipticus and Viola canescens. New applications of rarely documented plants from this area are: Oxalis corniculata paste of the whole plant to treat vitiligo, Carthamus tinctorius flowers to treat chicken pox, Dioscorea deltoidea tuber powder to treat productive cough, Inula cappa root decoction to treat miscarriage, Habenaria digitata tuber juice for the treatment of fever, Viola canescens leaves and flowers for the treatment of sore throat and Achillea millefolium root and leaf juice for the treatment of pneumonia. These plants may contain interesting biochemical compounds and should be subjected to further pharmacological studies to develop new drugs. Traditional medicinal knowledge in the area under study is mainly limited to the elderly, traditional healers and midwives. Therefore, resource conservation strategies and future pharmacological studies are strongly recommended.

Corrigendum: Invertebrates and herptiles for livelihoods-ethnozoological use among different ethnic communities in Jammu and Kashmir (Indian Himalayas).

[This corrects the article DOI: 10.3389/fphar.2022.1043155.].

Correction: Sarwer et al. Green Synthesis and Characterization of Silver Nanoparticles Using Myrsine africana Leaf Extract for Their Antibacterial, Antioxidant and Phytotoxic Activities. Molecules 2022, 27, 7612.

The authors wish to make the following corrections to this paper [...].

Reduction of bitter taste receptor gene family in folivorous colobine primates relative to omnivorous cercopithecine primates.

Bitter taste perception is important in preventing animals from ingesting potentially toxic compounds. Whole-genome assembly (WGA) data have revealed that bitter taste receptor genes (TAS2Rs) comprise a multigene family with dozens of intact and disrupted genes in primates. However, publicly available WGA data are often incomplete, especially for multigene families. In this study, we employed a targeted capture (TC) approach specifically probing TAS2Rs for ten species of cercopithecid primates with diverse diets, including eight omnivorous cercopithecine species and two folivorous colobine species. We designed RNA probes for all TAS2Rs that we modeled to be intact in the common ancestor of cercopithecids ("ancestral-cercopithecid TAS2R gene set"). The TC was followed by short-read and high-depth massive-parallel sequencing. TC retrieved more intact TAS2R genes than found in WGA databases. We confirmed a large number of gene "births" at the common ancestor of cercopithecids and found that the colobine common ancestor and the cercopithecine common ancestor had contrasting trajectories: four gene "deaths" and three gene births, respectively. The number of intact TAS2R genes was markedly reduced in colobines (25-28 detected via TC and 20-26 detected via WGA analysis) as compared with cercopithecines (27-36 via TC and 19-30 via WGA). Birth or death events occurred at almost every phylogenetic-tree branch, making the composition of intact genes variable among species. These results show that evolutionary change in intact TAS2R genes is a complex process, refute a simple general prediction that herbivory favors more TAS2R genes, and have implications for understanding dietary adaptations and the evolution of detoxification abilities.

Ethnopharmacological uses of fauna among the people of central Punjab, Pakistan.

Introduction: The utilization of fauna and fauna-based byproducts in ethnomedicinal usages has been a longstanding human activity, practiced across various cultures worldwide. This study focuses on investigating the utilization of animal-based traditional medicine by the people of Pakistan, specifically in the Gujranwala area. Methods: Data collection took place from January to September 2019 through interviews with local communities. Ethnomedicinal applications of animal products were analyzed using several indices, including Relative Frequency of Citation (RFC), Relative Popularity Level (RPL), Folk Use Value (FL), and Relative Occurrence Percentage (ROP). Results: The study identified the use of different body parts of 54 species of animals in treating various diseases and health issues. These include but are not limited to skin infections, sexual problems, pain management (e.g., in the backbone and joints), eyesight issues, immunity enhancement, cold, weakness, burns, smallpox, wounds, poisoning, muscular pain, arthritis, diabetes, fever, epilepsy, allergies, asthma, herpes, ear pain, paralysis, cough, swelling, cancer, bronchitis, girls' maturity, and stomach-related problems. Certain species of fauna were noted by informers with high "frequency of citation" (FC), ranging from 1 to 77. For instance, the black cobra was the most frequently cited animal for eyesight issues (FC = 77), followed by the domestic rabbit for burn treatment (FC = 67), and the Indus Valley spiny-tailed ground lizard for sexual problems (FC = 66). Passer domesticus and Gallus gallus were noted to have the highest ROP value of 99. Discussion: The findings of this study provide valuable preliminary insights for the conservation of fauna in the Gujranwala region of Punjab, Pakistan. Additionally, screening these animals for medicinally active compounds could potentially lead to the development of novel animal-based medications, contributing to both traditional medicine preservation and modern pharmaceutical advancements.

Shaping sustainable pathways: Enhancing mechanical properties of biocomposite through tannic acid treatment of flax fabrics.

Biocomposites developed using natural fibers serve as a sustainable alternative to synthetic composite materials. However, narrowing the performance gap between synthetic composites and biocomposites requires serious efforts. A promising approach is the modification of natural fibers using various chemical treatments. This paper investigates the potential of tannic acid (TA) treatment as a sustainable approach to enhance mechanical performance and reduce moisture absorption of flax fabric-reinforced biocomposites. The methodology involves the treatment of flax woven fabric with tannic acid, a naturally occurring polyphenolic compound, followed by the fabrication of biocomposite using a green epoxy matrix. The variables studied during treatment are TA concentration and processing time. Characterization of untreated and treated flax fabric and its composites was done using various analytical techniques such as FTIR spectroscopy, moisture absorption and mechanical testing (tensile strength, flexural strength, and impact resistance). FTIR spectroscopy of TA-treated flax confirmed attachment of aromatic rings and carbon double bond formation, thus serving for properties enhancement. The mechanical characterization of composites showed that properties are enhanced up to an optimum limit of concentration and processing time i.e., 1 % concentration and 30 min of processing. Moisture absorption of the TA-treated composite also reduced significantly as compared to untreated composites. These findings contribute towards the advancement in sustainable biocomposites and pave the way for their utilization in various applications.

Kappa-carrageenan and sodium alginate-based pH-responsive hydrogels for controlled release of methotrexate.

Despite remarkable progress in medical sciences, modern man is still fighting the battle against cancer. In 2022, only in the USA, 640 000 deaths and 2 370 000 patients were reported because of cancer. Chemotherapy is the most widely used for cancer treatments. However, chemotherapeutics have severe physicochemical side effects. Therefore, we have prepared poly(amididoamine) dendrimeric carrageenan (CG), sodium alginate (SA) and poly(vinyl alcohol) (PVA) hydrogels by using solution casting methodology. The constituents of hydrogels were cross-linked by mutable quantity of 3-aminopropyl(diethoxy)methyl silane (APDMS). Hydrogels were characterized by Fourier transform infrared spectroscopy, thermal gravimetric analysis, scanning electron microscope and atomic force microscopy. Hydrogels exhibited higher swelling volumes in 5-7 pH range. In vitro biodegradation in ribonuclease-A solution and cytocompatibility analysis against DF-1 fibroblasts established their biodegradable and non-toxic nature, which enables them as a suitable carrier for chemotherapeutic compounds. Hence, methotrexate (MTX) as a model drug was loaded on CAP-8 hydrogel and its release was detected by the UV-visible spectrophotometer in phosphate-buffered saline (PBS) solution. In 13.5 h, 81.25% and 77.23% of MTX were released at pH 7.4 (blood pH) and 5.3 (tumour pH) in PBS, respectively. MTX was released by super case II mechanism and best fitted to zero-order and Korsmeyer-Peppas model. The synthesized APDMS cross-linked CG/SA/PVA dendrimeric hydrogels could be an efficient model platform for the effective delivery of MTX in cancer treatments.

Green-fabricated silver nanoparticles from Quercus incana leaf extract to control the early blight of tomatoes caused by Alternaria solani.

BACKGROUND: Early blight (EB) of Tomatoes, caused by Alternaria solani, is a serious fungal disease that adversely affects tomato production. Infection is characterized by dark lesions on leaves, stems, and fruits. Several agrochemicals can be used to control infection, these chemicals may disrupt environmental equilibrium. An alternative technology is needed to address this significant fungal threat. This study was designed to control the growth of EB in tomatoes caused by A. solani, using green-fabricated silver nanoparticles (Ag-NPs). RESULTS: Ag-NPs were synthesized through an environmentally friendly and cost-effective approach using leaf extract of Quercus incana Roxb. (Fagaceae). The physico-chemical characterization of the Ag-NPs was conducted through UV-visible spectroscopy, scanning electron microscopy, X-ray diffraction analysis, and Fourier transform infrared spectrometry. The Ag-NPs produced were round with a mean diameter of 27 nm. The antifungal activity of these Ag-NPs was assessed through in vitro Petri plate and in vitro leaflet assays against A. solani. The green fabricated Ag-NPs exhibited excellent antifungal activity in vitro at a concentration of 100 mg/l against A. solani, inhibiting growth by 98.27 ± 1.58% and 92.79 ± 1.33% during Petri plate and leaflet assays, respectively. CONCLUSION: In conclusion, this study suggests the practical application of green-fabricated Ag-NPs from Q. incana leaf extract against A. solani to effectively control EB disease in tomatoes.

Fractional epidemic model of coronavirus disease with vaccination and crowding effects.

Most of the countries in the world are affected by the coronavirus epidemic that put people in danger, with many infected cases and deaths. The crowding factor plays a significant role in the transmission of coronavirus disease. On the other hand, the vaccines of the covid-19 played a decisive role in the control of coronavirus infection. In this paper, a fractional order epidemic model (SIVR) of coronavirus disease is proposed by considering the effects of crowding and vaccination because the transmission of this infection is highly influenced by these two factors. The nonlinear incidence rate with the inclusion of these effects is a better approach to understand and analyse the dynamics of the model. The positivity and boundedness of the fractional order model is ensured by applying some standard results of Mittag Leffler function and Laplace transformation. The equilibrium points are described analytically. The existence and uniqueness of the non-integer order model is also confirmed by using results of the fixed-point theory. Stability analysis is carried out for the system at both the steady states by using Jacobian matrix theory, Routh-Hurwitz criterion and Volterra-type Lyapunov functions. Basic reproductive number is calculated by using next generation matrix. It is verified that disease-free equilibrium is locally asymptotically stable if R 0 < 1 and endemic equilibrium is locally asymptotically stable if R 0 > 1 . Moreover, the disease-free equilibrium is globally asymptotically stable if R 0 < 1 and endemic equilibrium is globally asymptotically stable if R 0 > 1 . The non-standard finite difference (NSFD) scheme is developed to approximate the solutions of the system. The simulated graphs are presented to show the key features of the NSFD approach. It is proved that non-standard finite difference approach preserves the positivity and boundedness properties of model. The simulated graphs show that the implementation of control strategies reduced the infected population and increase the recovered population. The impact of fractional order parameter α is described by the graphical templates. The future trends of the virus transmission are predicted under some control measures. The current work will be a value addition in the literature. The article is closed by some useful concluding remarks.

Safety and Efficacy of Percutaneous Nephrolithotomy in Solitary Functioning Kidneys: A Retrospective Cohort Study in an Asian Population.

Objective The aim of the study was to assess the safety of preserved renal function after standard percutaneous nephrolithotomy (PCNL) in patients with a single functional kidney. The main parameters to focus on were serum creatinine levels and any associated complications. Materials and methods This retrospective cohort study was conducted in an Eastern population in a single center from 2016 through 2023 at The Kidney Centre Postgraduate Training Institute, Karachi, Pakistan. Results Out of the total 1,550 PCNL procedures performed on adult patients, 47 patients had a solitary functioning kidney with stones, which were evaluated. The stone clearance rate was 95.74% (45 patients), with a mean operative time of 85.96 minutes. Most patients, i.e., 33 (70.21%), had an infracostal approach, and single tract management was sufficient for 45 (95.74%) patients. The most common complication was transfusion, which was required in five (10.64%) patients. Mean preoperative hemoglobin dropped by 1.43mg/dL postoperatively, and mean serum creatinine decreased from 2.45mg/dL to 1.97mg/dL. Among the 24 (51.06%) analyzed stones, all were calcium oxalate. Conclusion In challenging situations such as a solitary kidney with a large stone, PCNL is the procedure of choice. However, the refined technique is of paramount importance. Overall, the use of PCNL in these unique conditions is safe and rewarding.

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma.

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26, 2023, at the Pakistan Kidney and Liver Institute & Research Centre (PKLI & RC) after initial consultations with the experts. The Pakistan Society for the Study of Liver Diseases (PSSLD) and PKLI & RC jointly organised this meeting. This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma (hCCA). The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients. This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation. The diagnostic and staging workup includes high-quality computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography. Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis. However, histopathologic confirmation is not always required before resection. Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging. The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification. Selected patients with unresectable hCCA can be considered for liver transplantation. Adjuvant chemotherapy should be offered to patients with a high risk of recurrence. The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions. Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage. Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.