Bilateral Pregnancy Luteoma Presenting as Acute Abdomen in a Young Female: A Case Report.

Pregnancy luteoma (PL) is a rare, non-neoplastic ovarian lesion that can mimic malignant ovarian tumors, posing significant diagnostic challenges. PL typically presents as asymptomatic, unilateral, or bilateral ovarian masses and is often discovered incidentally. Its development is linked to hormonal fluctuations during pregnancy, particularly elevated human chorionic gonadotropin (hCG) levels. While PL generally resolves postpartum, complications such as torsion may necessitate surgical intervention. We report the case of a 23-year-old primigravida presenting with acute abdominal pain, vomiting, and abdominal distention at 13 weeks gestation. Imaging revealed large, bilateral multicystic ovarian masses. Elevated CA-125 levels raised suspicion for malignancy, leading to a laparotomy and bilateral oophorectomy. Histopathological analysis confirmed the diagnosis of pregnancy luteoma.

Neurosarcoidosis: Current Perspectives on Diagnosis, Management, and Future Directions.

Neurosarcoidosis, a manifestation of sarcoidosis affecting the central or peripheral nervous system, presents unique challenges in diagnosis and management. Neurosarcoidosis can manifest with a wide range of symptoms, including cranial neuropathies, seizures, meningitis, and cognitive impairments. The heterogeneity of presentations often leads to diagnostic delays and complications. Diagnosis relies on a combination of clinical features, neuroimaging, cerebrospinal fluid analysis, and evidence of systemic sarcoidosis. Recent advances in imaging techniques, including high-resolution MRI, positron emission tomography (PET) scans, and novel biomarkers, have improved diagnostic accuracy. However, distinguishing neurosarcoidosis from mimicking conditions such as multiple sclerosis remains challenging. Treatment typically begins with corticosteroids, often requiring long-term immunosuppression. Second-line agents such as methotrexate and mycophenolate mofetil are frequently used as steroid-sparing options. Biologic therapies, particularly Tumor necrosis factor-alpha (TNF-α) inhibitors like infliximab, have shown promise in refractory cases. The long-term management of neurosarcoidosis necessitates a multidisciplinary approach with regular monitoring of disease activity and treatment response. Despite advancements, significant knowledge gaps persist in understanding the etiology, pathophysiology, and optimal management of neurosarcoidosis. Future research directions include identifying specific biomarkers, developing targeted therapies, and exploring novel imaging techniques. The rarity and heterogeneity of neurosarcoidosis underscore the importance of multicenter studies and international collaborations to advance our understanding and improve patient outcomes. Emerging technologies and innovative therapeutic approaches offer promising avenues for enhancing diagnosis and treatment in the coming years.

Synergistic effect of biochar and intercropping on lead phytoavailability in the rhizosphere of a vegetable-grass system.

The effects of engineered steam exploded biochar on the phytoavailability of toxic elements in the shared- and nonshared-rhizosphere of vegetable-grass intercropping system have not been investigated yet. Therefore, we explored and elucidated the synergistic effect of pristine rape-straw biochar (BC), steam exploded BC (BCSE), KMnO4-modified BCSE (BCSEMn), and hydroxyapatite-modified BCSE (BCSEHA) on the solubility, fractionation and phytoavailability of lead (Pb) in a vegetable-grass intercropping system. In a rhizosphere box, Brassica chinensis L. (pakchoi; PC, as a vegetable) and Pennisetum polystachion L. (mission grass; MG, as a Pb hyperaccumulator), were grown in the biochar treated soil with (non-shared rhizosphere) or without (shared rhizosphere) root separation. Addition of BCSEMn and BCSEHA, particularly BCSEMn, significantly improved plant growth, photosynthetic pigment levels, and positively influenced the gas exchange attributes by suppressing oxidative stress and boosting antioxidant enzymes activities. Both biochars altered a proportion of Pb in the acid soluble to the immobile fraction and thus significantly decreased its leachability (TCLP-Pb) and bioavailability (CaCl2-extrcated Pb) by 32.7 %-33.9 % and 48.5 %-53.5 %, respectively, as compared to the control. Both biochars, particularly BCSEMn, reduced significantly the Pb content in shoots and roots of PC and MG with a significantly higher efficiency in the PC than in the MG; this was the case more in the shared than in the non-shared rhizosphere. These findings indicate the synergistic effect of BCSEMn and BCSEHA and intercropping for enhancing the grass phytostabilization capacity for Pb and reducing its uptake by edible plants in a vegetables-grass system, which could be used as a promising approach for the phytomanagement of Pb contaminated soils.

Minimally Invasive Surgery for Hirschsprung Disease: Current Practices and Future Directions.

Hirschsprung disease (HD) is a congenital disorder characterized by the absence of ganglion cells in the distal colon and rectum, leading to functional obstruction and severe constipation. Over the past decades, the surgical management of HD has significantly evolved, with minimally invasive surgery (MIS) techniques revolutionizing treatment approaches. This review explores recent innovations in MIS for HD, focusing on laparoscopic, transanal endorectal pull-through (TERPT), and robotic-assisted techniques. These approaches offer numerous advantages over traditional open procedures, including reduced surgical trauma, improved cosmesis, faster recovery times, and potentially lower complication rates. Laparoscopic surgery has become widely adopted, providing excellent visualization and precise dissection. TERPT has gained popularity for short-segment disease, offering a completely transanal approach with minimal scarring. Robotic-assisted surgery represents the cutting edge, enhancing surgical precision and dexterity. The review also examines emerging technologies and future directions, such as advanced imaging techniques, artificial intelligence applications, and potential developments in tissue engineering. While MIS techniques have shown promising outcomes, challenges remain in standardizing approaches, addressing long-segment disease, and optimizing long-term functional results. The future of HD surgery lies in personalized approaches that integrate genetic and molecular profiling with advanced surgical technologies. As the field continues to evolve, comprehensive long-term studies and efforts to improve access to specialized care will be crucial to further enhancing outcomes for patients with HD.

Assessing the Renal Outcomes of Semaglutide in Diabetic Kidney Disease: A Systematic Review.

Diabetic kidney disease (DKD) is a prevalent microvascular complication of diabetes, posing a significant health burden. Semaglutide, a glucagon-like peptide-1 receptor agonist, has shown promise in mitigating renal outcomes in DKD. This systematic review aimed to evaluate the renal effects of semaglutide in individuals with DKD. A comprehensive literature search identified six eligible studies, including two case reports and four cohorts, from diverse geographic locations. The primary outcomes assessed were changes in estimated glomerular filtration rate (eGFR) and albuminuria. Secondary outcomes included acute kidney injury (AKI) incidence and other renal biomarkers. The impact of semaglutide on eGFR was variable, with some studies reporting decreases and others showing improvements or no significant changes. Albuminuria, however, was more consistently reduced, particularly in patients with macroalbuminuria. Notably, the case reports described semaglutide-associated AKI, including acute interstitial nephritis, highlighting the need for careful monitoring during therapy. Beyond renal outcomes, semaglutide consistently improved glycemic control and promoted weight loss, with generally manageable gastrointestinal side effects. The findings suggest that semaglutide may effectively reduce albuminuria in DKD, potentially slowing disease progression. However, the risk of AKI and the variable impact on eGFR underscore the need for a personalized approach and vigilant monitoring, particularly in patients with advanced CKD. Future large-scale, long-term randomized controlled trials are warranted to definitively assess the renal benefits and risks of semaglutide in DKD.

Impact of Sociodemographic Characteristics on the Quality of Life of Frontline Nursing Staff During COVID-19 in Saudi Arabia.

Background The COVID-19 pandemic imposed unprecedented challenges on healthcare systems worldwide. The pandemic placed frontline nursing staff working in the ICU and ER at the epicenter of this global crisis. This study aimed to assess the multifaceted impact of sociodemographic characteristics on the quality of life (QOL) of nursing staff during the pandemic. Method A cross-sectional survey was conducted to evaluate the impact of sociodemographic characteristics on the QOL of 322 frontline nurses working in the ICU and ER of five Saudi hospitals from May to July 2022. Participants completed the electronic survey questionnaire including demographic characteristics and four domains of QOL from the World Health Organization Quality of Life Questionnaire (WHOQOL-BREFF). The data was evaluated using descriptive and inferential statistics. Results Among 322 nurse participants, the majority were female (84.8%), married (64.4%), and held a bachelor's degree (92.4%). Age (above 40 years), gender (male), and marital status (married) reported a higher individual domain and overall QOL scores which shows that these characteristics have a direct influence on QOL. Years of work experience, extra working hours, and direct contact with COVID-19 patients were additional significant factors. Pearson correlation coefficients among QOL domains ranged from 0.54 to 0.91, indicating a strong interrelation among these domains. The highest transformed score was in the social domain (70.10) while the lowest score was in the psychological domain (59.20). The overall QOL mean score (SD) was 3.49(0.14) and the mean score (SD) of general health was 3.46(0.15). Conclusion The findings of this study suggest that sociodemographic and work-related factors have a complex and multifaceted impact on the QOL of nurses during the COVID-19 pandemic in Saudi Arabia. It also presents an insight into developing specific interventions to enhance nurses' resilience and well-being amidst pandemic challenges and to improve their QOL.

IntelliGenes: Interactive and user-friendly multimodal AI/ML application for biomarker discovery and predictive medicine.

Artificial intelligence (AI) and machine learning (ML) have advanced in several areas and fields of life; however, its progress in the field of multi-omics is not matching the levels others have attained. Challenges include but are not limited to the handling and analysis of high volumes of complex multi-omics data, and the expertise needed to implement and execute AI/ML approaches. In this article, we present IntelliGenes, an interactive, customizable, cross-platform, and user-friendly AI/ML application for multi-omics data exploration to discover novel biomarkers and predict rare, common, and complex diseases. The implemented methodology is based on a nexus of conventional statistical techniques and cutting-edge ML algorithms, which outperforms single algorithms and result in enhanced accuracy. The interactive and cross-platform graphical user interface of IntelliGenes is divided into three main sections: (i) Data Manager, (ii) AI/ML Analysis, and (iii) Visualization. Data Manager supports the user in loading and customizing the input data and list of existing biomarkers. AI/ML Analysis allows the user to apply default combinations of statistical and ML algorithms, as well as customize and create new AI/ML pipelines. Visualization provides options to interpret a diverse set of produced results, including performance metrics, disease predictions, and various charts. The performance of IntelliGenes has been successfully tested at variable in-house and peer-reviewed studies, and was able to correctly classify individuals as patients and predict disease with high accuracy. It stands apart primarily in its simplicity in use for nontechnical users and its emphasis on generating interpretable visualizations. We have designed and implemented IntelliGenes in a way that a user with or without computational background can apply AI/ML approaches to discover novel biomarkers and predict diseases.

Risk Factors of Crimean-Congo Haemorrhagic Fever in Sindh Province, Pakistan.

OBJECTIVES: In Sindh Province, Pakistan, confirmed Crimean-Congo haemorrhagic fever (CCHF) increased from zero in 2008 to 16 in 2015-2016. To counter this increase, in 2016, we initiated structured CCHF surveillance to improve estimates of risk factors for CCHF in Sindh and to identify potential interventions. METHODS: Beginning in 2016, all referral hospitals in Sindh reported all CCHF cases to surveillance agents. We used laboratory-confirmed cases from CCHF surveillance from 2016 to 2020 to compute incidence rates and in a case-control study to quantify risk factors for CCHF. RESULTS: For the 5 years, CCHF incidence was 4.2 per million for the Sindh capital, Karachi, (68 cases) and 0.4 per million elsewhere. Each year, the onset of new cases peaked during the 13 days during and after the 3-day Eid-al-Adha festival, when Muslims sacrificed livestock, accounting for 38% of cases. In Karachi, livestock for Eid were purchased at a seasonal livestock market that concentrated up to 700,000 livestock. CCHF cases were most common (44%) among the general population that had visited livestock markets (odds ratio = 102). CONCLUSIONS: Urban CCHF in Sindh province is associated with the general public's exposure to livestock markets in addition to high-risk occupations.

GWAS advancements to investigate disease associations and biological mechanisms.

Genome-wide association studies (GWAS) have been instrumental in elucidating the genetic architecture of various traits and diseases. Despite the success of GWAS, inherent limitations such as identifying rare and ultra-rare variants, the potential for spurious associations, and in pinpointing causative agents can undermine diagnostic capabilities. This review provides an overview of GWAS and highlights recent advances in genetics that employ a range of methodologies, including Whole Genome Sequencing (WGS), Mendelian Randomization (MR), the Pangenome's high-quality T2T-CHM13 panel, and the Human BioMolecular Atlas Program (HuBMAP), as potential enablers of current and future GWAS research. State of the literature demonstrate the capabilities of these techniques in enhancing the statistical power of GWAS. WGS, with its comprehensive approach, captures the entire genome, surpassing the capabilities of the traditional GWAS technique focused on predefined Single Nucleotide Polymorphism (SNP) sites. The Pangenome's T2T-CHM13 panel, with its holistic approach, aids in the analysis of regions with high sequence identity, such as segmental duplications (SDs). Mendelian Randomization has advanced causative inference, improving clinical diagnostics and facilitating definitive conclusions. Furthermore, spatial biology techniques like HuBMAP, enable 3D molecular mapping of tissues at single-cell resolution, offering insights into pathology of complex traits. This study aims to elucidate and advocate for the increased application of these technologies, highlighting their potential to shape the future of GWAS research.

Physicochemical properties and performance of non-woody derived biochars for the sustainable removal of aquatic pollutants: A systematic review.

Biochar is a carbon-rich material produced from the partial combustion of different biomass residues. It can be used as a promising material for adsorbing pollutants from soil and water and promoting environmental sustainability. Extensive research has been conducted on biochars prepared from different feedstocks used for pollutant removal. However, a comprehensive review of biochar derived from non-woody feedstocks (NWF) and its physiochemical attributes, adsorption capacities, and performance in removing heavy metals, antibiotics, and organic pollutants from water systems needs to be included. This review revealed that the biochars derived from NWF and their adsorption efficiency varied greatly according to pyrolysis temperatures. However, biochars (NWF) pyrolyzed at higher temperatures (400-800 °C) manifested excellent physiochemical and structural attributes as well as significant removal effectiveness against antibiotics, heavy metals, and organic compounds from contaminated water. This review further highlighted why biochars prepared from NWF are most valuable/beneficial for water treatment. What preparatory conditions (pyrolysis temperature, residence time, heating rate, and gas flow rate) are necessary to design a desirable biochar containing superior physiochemical and structural properties, and adsorption efficiency for aquatic pollutants? The findings of this review will provide new research directions in the field of water decontamination through the application of NWF-derived adsorbents.

Cloning, expression and purification of cellobiohydrolase gene from Caldicellulosiruptor bescii for efficient saccharification of plant biomass.

Anthropogenic activities have led to a drastic shift from natural fuels to alternative renewable energy reserves that demand heat-stable cellulases. Cellobiohydrolase is an indispensable member of cellulases that play a critical role in the degradation of cellulosic biomass. This article details the process of cloning the cellobiohydrolase gene from the thermophilic bacterium Caldicellulosiruptor bescii and expressing it in Escherichia coli (BL21) CondonPlus DE3-(RIPL) using the pET-21a(+) expression vector. Multi-alignments and structural modeling studies reveal that recombinant CbCBH contained a conserved cellulose binding domain III. The enzyme's catalytic site included Asp-372 and Glu-620, which are either involved in substrate or metal binding. The purified CbCBH, with a molecular weight of 91.8 kDa, displayed peak activity against pNPC (167.93 U/mg) at 65°C and pH 6.0. Moreover, it demonstrated remarkable stability across a broad temperature range (60-80°C) for 8 h. Additionally, the Plackett-Burman experimental model was employed to assess the saccharification of pretreated sugarcane bagasse with CbCBH, aiming to evaluate the cultivation conditions. The optimized parameters, including a pH of 6.0, a temperature of 55°C, a 24-hour incubation period, a substrate concentration of 1.5% (w/v), and enzyme activity of 120 U, resulted in an observed saccharification efficiency of 28.45%. This discovery indicates that the recombinant CbCBH holds promising potential for biofuel sector.

Local surface warming assessment in response to vegetation shifts over arid lands of Central Asia (2001-2020).

The Northern Eurasia Earth Science Partnership Initiative (NEESPI) was established to address the large-scale environmental change across this region. Regardless of the increasingly insightful literature addressing vegetation change across Central Asia, the biogeophysical warming effects of vegetation shifts still need to be clarified. To contribute, the utility of robust satellite observation is explored to evaluate the surface warming effects of vegetation shifts across Central Asia, which is among NEEPSI's hotspots. We estimated an average increase of +1.9 °C in daytime local surface temperature and + 1.5 °C in the nighttime due to vegetation shift (2001-2020). Meanwhile, the mean local latent heat increased by 4.65Wm-2, following the mild reduction of emitted longwave radiation (-0.8Wm-2). We found that vegetation shifts led to local surface warming with a bright surface, noting that the average air surface temperature was revealed to have increased significantly (2001-2020). This signal was driven mainly by agricultural expansion in western Kazakhstan stretching to Tajikistan and Xinjiang, then deforestation confined in Tajikistan, southeast Kazakhstan, and the northwestern edge of Xinjiang, and finally, grassland encroachment occurred massively in the west to central Kazakhstan. These findings address the latest information on Central Asia's vegetation shifts that may be substantial in landscape change mitigation plans.

Does perioperative hydrocortisone or indomethacin improve pancreatoduodenectomy outcomes? A triple arm, randomized placebo-controlled trial.

Backgrounds/Aims: This trial evaluated whether anti-inflammatory agents hydrocortisone (H) and indomethacin (I) could reduce major complications after pancreatoduodenectomy (PD). Methods: Between June 2018 and June 2020, 105 patients undergoing PD with > 40% of acini on the intraoperative frozen section were randomized into three groups (35 patients per group): 1) intravenous H 100 mg 8 hourly, 2) rectal I suppository 100 mg 12 hourly, and 3) placebo (P) from postoperative day (POD) 0-2. Participants, investigators, and outcome assessors were blinded. The primary outcome was major complications (Clavien-Dindo grades 3-5). Secondary outcomes were overall complications (Clavien-Dindo grades 1-5), Clinically relevant postoperative pancreatic fistula (CR-POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), surgical site infections (SSI), length of stay, POD-3 serum amylase, readmission rate, and mortality. Results: Major complications were comparable (8.6%, 5.7%, and 8.6% in groups H, I, and P, respectively). However, overall complications were significantly lower in group H than in group P (45.7% vs. 80.0%, p = 0.006). CR-POPF (14.3% vs. 25.7%, p = 0.371), PPH (8.6% vs. 14.3%, p = 0.710), DGE (8.6% vs. 22.9%, p = 0.188), and SSI (14.3% vs. 25.7%, p = 0.371) were comparable between groups H and P. Major complications and overall complications in group I were 5.7% and 60.0%, respectively, which were comparable to those in groups P and H. CR-POPF rates in groups H, I, and P were 14.3%, 17.1%, and 25.7%, respectively, which was comparable. Conclusions: H and I did not decrease major complications in PD.

Plant root mechanisms and their effects on carbon and nutrient accumulation in desert ecosystems under changes in land use and climate.

Deserts represent key carbon reservoirs, yet as these systems are threatened this has implications for biodiversity and climate change. This review focuses on how these changes affect desert ecosystems, particularly plant root systems and their impact on carbon and mineral nutrient stocks. Desert plants have diverse root architectures shaped by water acquisition strategies, affecting plant biomass and overall carbon and nutrient stocks. Climate change can disrupt desert plant communities, with droughts impacting both shallow and deep-rooted plants as groundwater levels fluctuate. Vegetation management practices, like grazing, significantly influence plant communities, soil composition, root microorganisms, biomass, and nutrient stocks. Shallow-rooted plants are particularly susceptible to climate change and human interference. To safeguard desert ecosystems, understanding root architecture and deep soil layers is crucial. Implementing strategic management practices such as reducing grazing pressure, maintaining moderate harvesting levels, and adopting moderate fertilization can help preserve plant-soil systems. Employing socio-ecological approaches for community restoration enhances carbon and nutrient retention, limits desert expansion, and reduces CO2 emissions. This review underscores the importance of investigating belowground plant processes and their role in shaping desert landscapes, emphasizing the urgent need for a comprehensive understanding of desert ecosystems.

Non-Ketotic Hyperglycinemia: A Rare Presentation with Neurological and Skeletal Abnormalities.

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Association of Postoperative Hyperamylasemia With Clinically Relevant Postoperative Pancreatic Fistula in Pancreatoduodenectomy.

Background In this study, we aimed to determine the association between postoperative hyperamylasemia (POH) and clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD). Methodology A prospective observational study of 140 consecutive PDs between March 2020 and March 2022 was conducted. POH was defined as an elevation in serum pancreatic amylase levels above the institutional upper limit of normal on postoperative day (POD) 1 (>100 U/L). CR-POPF was defined as the International Study Group of Pancreatic Surgery Grade B or C POPF. The primary outcome was the rate of CR-POPF in the study population. The trial was prospectively registered with Clinicaltrials.gov (NCT04514198). Results In our study, 93 (66.42%) patients had POH (serum amylase >100 U/L). CR-POPF developed in 48 (34.28%) patients: 40 type B and 8 type C. CR-POPF rate was 43.01% (40/93) in patients with POH compared to 17.02% (8/47) in patients without POH (p = 0.0022). Patients with POH had a mean serum amylase of 422.7 ± 358.21 U/L on POD1 compared to 47.2 ± 20.19 U/L in those without POH (p < 0.001). Serum amylase >100 U/L on POD1 was strongly associated with developing CR-POPF (odds ratio = 3.71; 95% confidence interval = 1.31-10.37) on logistic regression, with a sensitivity and specificity of 83.3% and 42.4%, respectively. Blood loss >350 mL, pancreatic duct size <3 mm, and elevated POD1 serum amylase >100 U/L were predictive of CR-POPF on multivariate analysis (p < 0.001). Conclusions An elevated serum amylase on POD1 may help identify patients at risk for developing POPF following PD.

Retraction: Molecular Characterization and Antibiotic Susceptibility Pattern of Bacterial Strains Isolated From Wound of Patients With Diabetes.

[This retracts the article DOI: 10.7759/cureus.47681.].

Recent trends and economic significance of modified/functionalized biochars for remediation of environmental pollutants.

The pollution of soil and aquatic systems by inorganic and organic chemicals has become a global concern. Economical, eco-friendly, and sustainable solutions are direly required to alleviate the deleterious effects of these chemicals to ensure human well-being and environmental sustainability. In recent decades, biochar has emerged as an efficient material encompassing huge potential to decontaminate a wide range of pollutants from soil and aquatic systems. However, the application of raw biochars for pollutant remediation is confronting a major challenge of not getting the desired decontamination results due to its specific properties. Thus, multiple functionalizing/modification techniques have been introduced to alter the physicochemical and molecular attributes of biochars to increase their efficacy in environmental remediation. This review provides a comprehensive overview of the latest advancements in developing multiple functionalized/modified biochars via biological and other physiochemical techniques. Related mechanisms and further applications of multiple modified biochar in soil and water systems remediation have been discussed and summarized. Furthermore, existing research gaps and challenges are discussed, as well as further study needs are suggested. This work epitomizes the scientific prospects for a complete understanding of employing modified biochar as an efficient candidate for the decontamination of polluted soil and water systems for regenerative development.