Potential of E-Learning Interventions and Artificial Intelligence-Assisted Contouring Skills in Radiotherapy: The ELAISA Study.

PURPOSE: Most research on artificial intelligence-based auto-contouring as template (AI-assisted contouring) for organs-at-risk (OARs) stem from high-income countries. The effect and safety are, however, likely to depend on local factors. This study aimed to investigate the effects of AI-assisted contouring and teaching on contouring time and contour quality among radiation oncologists (ROs) working in low- and middle-income countries (LMICs). MATERIALS AND METHODS: Ninety-seven ROs were randomly assigned to either manual or AI-assisted contouring of eight OARs for two head-and-neck cancer cases with an in-between teaching session on contouring guidelines. Thereby, the effect of teaching (yes/no) and AI-assisted contouring (yes/no) was quantified. Second, ROs completed short-term and long-term follow-up cases all using AI assistance. Contour quality was quantified with Dice Similarity Coefficient (DSC) between ROs' contours and expert consensus contours. Groups were compared using absolute differences in medians with 95% CIs. RESULTS: AI-assisted contouring without previous teaching increased absolute DSC for optic nerve (by 0.05 [0.01; 0.10]), oral cavity (0.10 [0.06; 0.13]), parotid (0.07 [0.05; 0.12]), spinal cord (0.04 [0.01; 0.06]), and mandible (0.02 [0.01; 0.03]). Contouring time decreased for brain stem (-1.41 [-2.44; -0.25]), mandible (-6.60 [-8.09; -3.35]), optic nerve (-0.19 [-0.47; -0.02]), parotid (-1.80 [-2.66; -0.32]), and thyroid (-1.03 [-2.18; -0.05]). Without AI-assisted contouring, teaching increased DSC for oral cavity (0.05 [0.01; 0.09]) and thyroid (0.04 [0.02; 0.07]), and contouring time increased for mandible (2.36 [-0.51; 5.14]), oral cavity (1.42 [-0.08; 4.14]), and thyroid (1.60 [-0.04; 2.22]). CONCLUSION: The study suggested that AI-assisted contouring is safe and beneficial to ROs working in LMICs. Prospective clinical trials on AI-assisted contouring should, however, be conducted upon clinical implementation to confirm the effects.

A Review on the Mechanisms, Applications, and Clinical Trials of Advanced Technologies in the Transdermal Drug Delivery System.

Transdermal Drug Delivery Systems (TDDS) have emerged as a promising method for administering therapeutic agents due to their non-invasive nature and patient-friendly approach. However, the effectiveness of this system is limited to drugs with specific physicochemical properties that allow for transdermal delivery as the skin acts as a barrier. To address this limitation, researchers have been exploring alternative approaches to improve drug delivery through the stratum corneum, ensuring consistent drug distribution at controlled rates. Thirdgeneration delivery systems have been developed to facilitate the delivery of various drugs across the skin barrier by disrupting the stratum corneum while protecting deeper skin tissues from injury. This review has explored various approaches that have gained popularity in enhancing drug delivery through TDDS, including microneedle-mediated, nanoparticle-enabled, thermal ablation-enhanced, and electroporation-driven delivery systems. It has discussed the mechanisms of drug delivery and potential applications for different types of drugs and detailed the clinical studies. This review has also highlighted the significant advancements in TDDS, offering valuable insights into both the pharmaceutical field and biomedical applications. The continued exploration and refinement of these delivery systems, particularly with the incorporation of Internet-of-Things (IoT) technology, Artificial Intelligence (AI), and machine learning, hold promise for expanding the scope of therapeutic interventions.

Uniqueness of lung cancer in Southeast Asia.

Lung cancer varies between Caucasians and Asians. There have been differences recorded in the epidemiology, genomics, standard therapies and outcomes, with variations according to the geography and ethnicity which affect the decision for optimal treatment of the patients. To better understand the profile of lung cancer in Southeast Asia, with a focus on India, we have comprehensively reviewed the available data, and discuss the challenges and the way forward. A substantial proportion of patients with lung cancer in Southeast Asia are neversmokers, and adenocarcinoma is the common histopathologic subtype, found in approximately a third of the patients. EGFR mutations are noted in 23-30% of patients, and ALK rearrangements are noted in 5-7%. Therapies are similar to global standards, although access to newer modalities and molecules is a challenge. Collaborative research, political will with various policy changes and patient advocacy are urgently needed.

Fertilizer management practices in potato cultivation: a baseline study for the introduction of GE potato in Bangladesh.

Genetically engineered (GE) crops have the potential to contribute to agricultural sustainability, food security, and nutritional enrichment. However, these crops cannot be released for commercial cultivation without undergoing environmental risk assessments (ERA), thus biosafety evaluation. ERA assessments are performed comparatively with their natural non-GE counterparts. As Bangladesh is progressing with GE potato research, the present study aims to collect baseline information on non-GE potato cultivation with an emphasis on current agronomic practices focusing on fertilizer management and farmers' knowledge base. The survey had three parts, including information on the farmers, information on potato cultivation practices, especially fertilizer use, and lastly, the farmer's view on GE potato. From 2020 to 2021, data were collected through interviews with experienced growers in four potato-growing regions, the Central and Mid-East, North-West, Mid-West, and South-East regions (n = 1757) of the country. The study revealed that farmers of all regions used more than the recommended amounts of fertilizer; for instance, 67.1% more nitrogen fertilizer was applied as an extra dose during potato cultivation in Munshiganj (Central and Mid-East) than in the Dinajpur region (North-West). This overuse of nitrogen fertilizer can enhance plant vigor but makes the plants more susceptible to insect attraction and allows pests easier access to the plants. As a result, the excess dose of nitrogen fertilizer in Munshiganj may act as a catalyst to increase the probability of late blight. The findings also showed that 73.6% of farmers observed unexpected flowering in certain potato cultivars, which corresponded to the higher application of phosphate and potassium fertilizers aimed at late blight control. Furthermore, this study reported infestations of Solanaceous weeds, specifically Solanum torvum and Physalis heterophylla, in potato fields. Finally, our findings demonstrated that more than 68.7% of the potato growers intend to adopt disease-resistant GE potato as that may reduce the need for excess fertilizer use and thus reduce cultivation costs.

Dataset describing the influence of preharvest gibberellic acid application on fruiting behavior, yield and fruit biochemical properties of rambutan (Nephelium lappaceum L.).

Rambutan (Nephelium lappaceum L.), an exotic non-climacteric tropical fruit in Bangladesh, has got wide acceptance to consumers as well as growers due to its attractive appearance, taste and nutrition, but the demerits of inadequate fruiting and yield as well as low edible properties at the farmers field requires to be addressed. Hence, an experiment was performed with gibberellic acid (GA3) and the obtained dataset demonstrates how GA3 application augmented the fruit set and retention, fruit yield and post-harvest biochemical properties of rambutan. Gibberellic acid was sprayed at seven various concentrations from 0 ppm (control) to 500 ppm at the mature panicles (inflorescence) during the pre-flowering and the early fruiting stages (three weeks after fruit set). The study was conducted in two sequential growing years (2020 and 2021) following a randomized complete block design (RCBD). Results revealed that 200-300 ppm doses had superiority over the lower (50-100 ppm) and higher (400-500 ppm) doses for promoting the fruit yield and quality. More specifically, fruit set and retention, fruit size and weight, pulp weight and thickness, pulp:peel ratio, edible portion and fruit yield as well as total soluble solids and total sugars contents in fruit were exhibited the best at 300 ppm being consonant with 200 ppm at majority cases, whereas GA3 doses from 200 ppm to 500 ppm performed similarly to enhance fruit physico-chemical qualities and shelf life of rambutan. Control treatment along with 50 ppm gibberellic acid dose demonstrated inferior results for yield and fruit quality promotion of rambutan. Thus, use of plant growth regulator at appropriate dose and time is imperative to rambutan improvement.

Toxoplasmosis in animals and humans: a neglected zoonotic disease in Bangladesh.

Toxoplasmosis, caused by Toxoplasma gondii, is a zoonotic disease that affects a wide range of warm-blooded animals, including humans. The parasite undergoes both sexual and asexual reproduction in intermediate hosts (humans and animals) and definitive hosts (cats). Transmission in humans occurs through consuming oocyst-contaminated water, fruits, vegetables, and raw or undercooked meats. In Bangladesh, several factors contribute to an increased risk of contracting toxoplasmosis. The parasite is reported to cause diseases among livestock such as goats and sheep in this country, and it has also been associated with some human illnesses. Toxoplasmosis prevalence varies significantly worldwide, with developing countries like Bangladesh experiencing higher rates. Diagnostic methods include both conventional non-DNA-based tests and molecular detection techniques, while treatment options involve using antiparasitic drugs like sulfadiazine and pyrimethamine. To control toxoplasmosis, essential steps include improving sanitation, promoting safe food handling, and educating the public about risks related to cat ownership and undercooked meat consumption. Implementing prenatal screening and treatment is also important. With the growing popularity of pet ownership in urban areas, it becomes essential to emphasize the veterinary and public health significance of toxoplasmosis in Bangladesh. This article comprehensively reviews various aspects of toxoplasmosis, with a specific focus on the situation in Bangladesh.

A review on Mitragyna speciosa (Rubiaceae) as a prominent medicinal plant based on ethnobotany, phytochemistry and pharmacological activities.

Mitragyna speciosa Korth (kratom) is a tropical indigenous tree of Southeast Asia. It is commonly consumed by the people due to its various pharmacological properties. The leaves of this plant are traditionally used for the treatment of several diseases including pain, fever, cough, anxiety, depression, obesity, diarrhoea, wound healing, diabetes, hypertension as well as for the prevention of cancer and improvement of sexual performance. Phytochemical investigations have confirmed the presence of more than forty alkaloids along with the presence of other bioactive secondary metabolites. Among the alkaloids isolated, mitragynine and 7-hydroxymitragynine along with their derivatives have been widely evaluated and reported to possess various pharmacological effects. Hence, the aim of this review is to shed light on the traditional uses of kratom and the scientific studies to justify the folkloric claims and active principles responsible for the various medicinal effects associated with the leaves of this plant. This review highlights the potential benefits and toxicities associated with M. speciosa leaves along with the phytochemistry. Moreover, the existing gaps in the field of M. speciosa study have been identified along with the future directions to further avail the benefits of this plant species.

Colon and lung cancer classification from multi-modal images using resilient and efficient neural network architectures.

Automatic classification of colon and lung cancer images is crucial for early detection and accurate diagnostics. However, there is room for improvement to enhance accuracy, ensuring better diagnostic precision. This study introduces two novel dense architectures (D1 and D2) and emphasizes their effectiveness in classifying colon and lung cancer from diverse images. It also highlights their resilience, efficiency, and superior performance across multiple datasets. These architectures were tested on various types of datasets, including NCT-CRC-HE-100K (set of 100,000 non-overlapping image patches from hematoxylin and eosin (H&E) stained histological images of human colorectal cancer (CRC) and normal tissue), CRC-VAL-HE-7K (set of 7180 image patches from N = 50 patients with colorectal adenocarcinoma, no overlap with patients in NCT-CRC-HE-100K), LC25000 (Lung and Colon Cancer Histopathological Image), and IQ-OTHNCCD (Iraq-Oncology Teaching Hospital/National Center for Cancer Diseases), showcasing their effectiveness in classifying colon and lung cancers from histopathological and Computed Tomography (CT) scan images. This underscores the multi-modal image classification capability of the proposed models. Moreover, the study addresses imbalanced datasets, particularly in CRC-VAL-HE-7K and IQ-OTHNCCD, with a specific focus on model resilience and robustness. To assess overall performance, the study conducted experiments in different scenarios. The D1 model achieved an impressive 99.80 % accuracy on the NCT-CRC-HE-100K dataset, with a Jaccard Index (J) of 0.8371, a Matthew's Correlation Coefficient (MCC) of 0.9073, a Cohen's Kappa (Kp) of 0.9057, and a Critical Success Index (CSI) of 0.8213. When subjected to 10-fold cross-validation on LC25000, the D1 model averaged (avg) 99.96 % accuracy (avg J, MCC, Kp, and CSI of 0.9993, 0.9987, 0.9853, and 0.9990), surpassing recent reported performances. Furthermore, the ensemble of D1 and D2 reached 93 % accuracy (J, MCC, Kp, and CSI of 0.7556, 0.8839, 0.8796, and 0.7140) on the IQ-OTHNCCD dataset, exceeding recent benchmarks and aligning with other reported results. Efficiency evaluations were conducted in various scenarios. For instance, training on only 10 % of LC25000 resulted in high accuracy rates of 99.19 % (J, MCC, Kp, and CSI of 0.9840, 0.9898, 0.9898, and 0.9837) (D1) and 99.30 % (J, MCC, Kp, and CSI of 0.9863, 0.9913, 0.9913, and 0.9861) (D2). In NCT-CRC-HE-100K, D2 achieved an impressive 99.53 % accuracy (J, MCC, Kp, and CSI of 0.9906, 0.9946, 0.9946, and 0.9906) with training on only 30 % of the dataset and testing on the remaining 70 %. When tested on CRC-VAL-HE-7K, D1 and D2 achieved 95 % accuracy (J, MCC, Kp, and CSI of 0.8845, 0.9455, 0.9452, and 0.8745) and 96 % accuracy (J, MCC, Kp, and CSI of 0.8926, 0.9504, 0.9503, and 0.8798), respectively, outperforming previously reported results and aligning closely with others. Lastly, training D2 on just 10 % of NCT-CRC-HE-100K and testing on CRC-VAL-HE-7K resulted in significant outperformance of InceptionV3, Xception, and DenseNet201 benchmarks, achieving an accuracy rate of 82.98 % (J, MCC, Kp, and CSI of 0.7227, 0.8095, 0.8081, and 0.6671). Finally, using explainable AI algorithms such as Grad-CAM, Grad-CAM++, Score-CAM, and Faster Score-CAM, along with their emphasized versions, we visualized the features from the last layer of DenseNet201 for histopathological as well as CT-scan image samples. The proposed dense models, with their multi-modality, robustness, and efficiency in cancer image classification, hold the promise of significant advancements in medical diagnostics. They have the potential to revolutionize early cancer detection and improve healthcare accessibility worldwide.

Unveiling therapeutic efficacy of extract and multi-targeting phytocompounds from Christella dentata (Forssk.) Brownsey & Jermy against multidrug-resistant Pseudomonas aeruginosa.

Christella dentata (Forssk.) Brownsey & Jermy has been commonly used in traditional medicinal practices but its effects on multi-drug-resistant (MDR) bacteria have remained unexplored. We aimed to assess the in vitro antibacterial potential of the ethanol extract of Christella dentata (EECD) against MDR Pseudomonas aeruginosa and to identify potential multi-targeting antibacterial phytocompounds through computer-aided drug design focusing on the LasR and LpxC proteins. PPS, FT-IR and GC-MS were used for profiling of the phytocompounds in EECD. The antimicrobial activity of EECD was assessed using in vitro agar well diffusion, disc diffusion, MIC and MBC. Computer-aided drug design was used to identify multi-targeting leads from GC-MS-annotated phytocompounds. EECD exhibited dose-dependent antibacterial activity and revealed the presence of 51 phytocompounds in GC-MS analysis. Among these, three phytocompounds; (2E,4E)-N-isobutylhexadeca-2,4-dienamide (CID 6442402), bicyclo[4.3.0]nonane, 2,2,6,7-tetramethyl-7-hydroxy- (CID 536446) and 1,4-diethylbenzene (CID 7734) were identified as promising antibacterial phytocompounds as they strongly bonded with LasR and LpxC. Of them, CID 536446 and CID 7734 exhibited multiple targeting abilities with LasR and LpxC. On further screening, both CID 536446 and CID 7734 exhibited favorable drug-able, pharmacokinetics and toxicity properties. Finally, molecular dynamics (MD) simulation proved the binding stability of bicyclo[4.3.0]nonane, 2,2,6,7-tetramethyl-7-hydroxy- and 1,4-diethylbenzene to active pockets of LasR and LpxC. The results of this study offer scientific validation for the traditional use of Christella dentata in bacterial infection-related diseases. It also suggests that bicyclo[4.3.0]nonane, 2,2,6,7-tetramethyl-7-hydroxy- and 1,4-diethylbenzene from Christella dentata might be responsible for the antibacterial activity and could act as phytopharmacological leads for the development of LasR and LpxC inhibitors against MDR P. aeruginosa.

Neuropharmacological assessment and identification of possible lead compound (apomorphine) from Hygrophila spinosa through in-vivo and in-silico approaches.

The aim of this research is to examine possible neurological activity of methanol, ethyl acetate, and aqueous extracts of Hygrophila spinosa and identify possible lead compounds through in silico analysis. In vivo, neuropharmacological activity was evaluated by using four distinct neuropharmacological assessment assays. Previously reported GC-MS data and earlier literature were utilized to identify the phytochemicals present in Hygrophila spinosa. Computational studies notably molecular docking and molecular dynamic simulations were conducted with responsible receptors to assess the stability of the best interacting compound. Pharmacokinetics properties like absorption, distribution, metabolism, excretion, and toxicity were considered to evaluate the drug likeliness properties of the identified compounds. All the in vivo results support the notion that different extracts (methanol, ethyl acetate, and aqueous) of Hygrophila spinosa have significant (*p = 0.05) sedative-hypnotic, anxiolytic, and anti-depressant activity. Among all the extracts, specifically methanol extracts of Hygrophila spinosa (MHS 400 mg/kg.b.w.) showed better sedative, anxiolytic and antidepressant activity than aqueous and ethyl acetate extracts. In silico molecular docking analysis revealed that among 53 compounds 7 compounds showed good binding affinities and one compound, namely apomorphine (CID: 6005), surprisingly showed promising binding affinity to all the receptors . An analysis of molecular dynamics simulations confirmed that apomorphine (CID: 6005) had a high level of stability at the protein binding site. Evidence suggests that Hygrophila spinosa has significant sedative, anxiolytic, and antidepressant activity. In silico analysis revealed that a particular compound (apomorphine) is responsible for this action. Further research is required in order to establish apomorphine as a drug for anxiety, depression, and sleep disorders.Communicated by Ramaswamy H. Sarma.

Development of a novel direct compressible co-processed excipient and its application for formulation of Mirtazapine orally disintegrating tablets.

INTRODUCTION: Orally disintegrating tablets (ODTs) are designed to dissolve in the oral cavity within 3 min, providing a convenient option for patients as they can be taken without water. Direct compression is the most common method used for ODTs formulations. However, the availability of single composite excipients with desirable characteristics such as good compressibility, fast disintegration, and a good mouthfeel suitable for direct compression is limited. OBJECTIVE: This research was proposed to develop a co-processed excipient composed of xylitol, mannitol, and microcrystalline cellulose for the formulation of ODTs. METHODS: A total of 11 formulations of co-processed excipients with different ratios of ingredients were prepared, which were then compressed into ODTs, and their characteristics were thoroughly examined. The primary focus was on evaluating the disintegration time and hardness of the tablets, as these factors are important in ensuring the ODTs meet the desired criteria. The model drug, Mirtazapine was then incorporated into the chosen optimized formulation. RESULTS: The results showed that the formulation comprised of 10% xylitol, 10% mannitol and 80% microcrystalline cellulose demonstrated the fastest disintegration time (1.77 ± 0.119 min) and sufficient hardness (3.521 ± 0.143 kg) compared to the other formulations. Furthermore, the drug was uniformly distributed within the tablets and fully released within 15 min. CONCLUSION: Therefore, the developed co-processed excipients show great potential in enhancing the functionalities of ODTs, offering a promising solution to improve the overall performance and usability of ODTs in various therapeutic applications.

Synthesis of a novel hydrazone-based compound applied as a fluorescence turn-on chemosensor for iron(iii) and a colorimetric sensor for copper(ii) with antimicrobial, DFT and molecular docking studies.

Hydrazone-hydrazide-based linkers perform a crucial role in environmental as well as biological fields. Such linkers are employed to detect exact metal ions at a minute level; hence, numerous probes are available. Even though thiophene-based molecules have a unique position in the medicinal arena, only very few chemosensors are reported based on such a moiety. In this current work, a novel hydrazide-hydrazone-based fluorogenic molecule 5-bromo-2-hydroxy-N'-[(1E)-1-(thiophen-2-yl)ethylidene]benzohydrazide (L) has been successfully designed and synthesized. The sensing studies of L demonstrated a ratio metric as well as turn-on-enhanced fluorescence and colorimetric response toward Fe3+ and Cu2+ ions, respectively and it was observed to be insensitive toward various metal ions. The Job plots revealed that the binding stoichiometry of L and metal ions is 2 : 1. In addition, density functional theory (DFT) results strongly suggested that L can be used as a powerful colorimetric sensor for the detection of Cu2+ ions. In vitro antimicrobial activities of L were evaluated by disk diffusion and results revealed good antibacterial activities against E. coli. Further, molecular docking was executed with DNA gyrase (PDB ID: 1KZN) of E. coli and the calculated interaction energy value was found to be -7.7 kcal mol-1. Finally, molecular docking, fluorescence, colorimetry and the HOMO-LUMO energy gap of the compound can provide new insights into developing drugs and detecting metals in biomolecules.

Application of Exogenous GnRH in Food Animal Production.

Over several decades, exogenous GnRH and agonists have been employed for controlling reproductive cascades in animals, and treating some reproductive morbidities. The administration of GnRH is used in animals to counter ovarian dysfunction, induce ovulation, and to increase conception and pregnancy rates. GnRH and its agonists are used in the treatment of cystic ovarian degeneration and repeat breeder syndrome. The development of protocols for GnRH administration by intramuscular injection, intramuscular or subcutaneous implants, and intravaginal deposition has empowered their clinical use worldwide. Currently, exogenous GnRH products are a central part of several pre- and post-breeding programs for the enhancement of fertility, including the control of estrous cycles and timing of ovulation, development of fixed-time artificial insemination protocols, improved embryo survival, and the treatment of reproductive morbidity. The aim of the present review is to summarize the application of exogenous GnRH agonists in food animal production.

Comparative Assessment of Three Medicinal Plants against Diabetes and Oxidative Stress Using Experimental and Computational Approaches.

The hilly and rural areas' people of Bangladesh have a great history of putting into use numerous traditional medicinal plants to cure diseases. Therefore, with ethanol extract of Molineria capitulata (EEMC), methanol extract of Trichosanthes tricuspidata (METT), and methanol extract of Amorphophallus campanulatus (MEAC), we mandate evaluation of in vitro α-amylase inhibition, antioxidants, and molecular docking, and ADMET/T analysis. According to iodine starch methods, α-amylase inhibition was performed, and quantitative total phenolic and flavonoid content was determined by established methods, whereas DPPH free radical scavenging and reducing power assays were performed in previously established protocols, respectively. A comparative study among three plants (EEMC, METT, and MEAC) possessed a significant (p < 0.01) effect but EEMC showed the highest impact on enzyme inhibition. Plants in the measuring phenolic content METT and flavonoid measurement MEAC displayed most potent in the same way in the DPPH test was METT, and in reducing power capability MEAC has showed the highest effect between three extracts. Docking's study also reveals the compounds of METT (Cyclotricuspidoside A and Cyclotricuspidoside C) exhibit the superior score among all the compounds. This finding indicates that EEMC, METT, and MEAC substantially impact α-amylase inhibition along with antioxidants. In silico study also reveals the potency of these plants, but further in-depth, precise molecular studies are needed.

Multidrug-resistant non-typhoidal Salmonella of public health significance recovered from migratory birds in Bangladesh.

Non-typhoidal Salmonella provides an exemplar for the One Health approach as it encompasses public and animal health, food safety, and environmental considerations. The contribution of environmental aspects is currently less well-defined. The purpose of this study was to determine the carriage occurrence of non-typhoidal Salmonella in migratory birds in Bangladesh and assess the potential significance to public and animal health. Cloacal swabs (N = 453) were collected in the years 2018-2020 from Tanguar and Hakaluki Haors, important wetland ecosystems in Northeastern Bangladesh. The prevalence of Salmonella was 13.5% (61 positive swabs). Classical serotyping identified six serovars: Salmonella enterica subsp. enterica serovars Perth, Kentucky, Albany, Infantis, Weltevreden, and Brancaster. Resistance towards 14 antimicrobials was assessed by broth microdilution minimum inhibitory concentration determination and the antimicrobial resistance (AMR) genotype established by whole-genome sequencing. S. Perth and S. Weltevreden isolates were susceptible and harbored no acquired AMR genes. Isolates from the remaining serovars were multidrug resistant, commonly possessing resistance to tetracycline, ampicillin, chloramphenicol, sulfamethoxazole, trimethoprim, and ciprofloxacin. Salmonella resistant to ciprofloxacin meets WHO criteria for priority pathogens. There was excellent concordance between resistance phenotype and the presence of corresponding AMR genes, many of which reside on Salmonella Genomic Islands. High-level ciprofloxacin resistance correlated with the presence of mutations in the chromosomal gyrB and/or parC genes. The S. Kentucky isolates were ST198, a widely distributed multidrug-resistant lineage reported in humans and animals, and constituting an ongoing risk to public health worldwide. We have demonstrated that multidrug-resistant non-typhoidal Salmonella of public health significance can be recovered from migratory birds. A potential for risk can manifest through direct interaction, transmission to food-producing livestock on farms, and dissemination via the long range migratory movements of birds. Risks can be mitigated by measures including continued surveillance and implementation of good farm biosecurity practices.

Piriformis Syndrome in Pre-monsoon, Monsoon, and Winter: An Observational Pilot Study.

INTRODUCTION:  Piriformis syndrome (PS) is a rare focal soft tissue rheumatic disease. Due to heavy rural work, we questioned whether PS was more prevalent in the rainy monsoon than in other seasons. In this pilot research, we studied the pattern of PS, the frequency of PS over the seasons, and whether there were typical preceding events.  Methods: In this time-series descriptive study, PS cases diagnosed in a community-based clinic between January 2018 and December 2019 were enrolled. PS was diagnosed by clinical features and a 50% immediate pain relief from ultrasonogram-guided lidocaine (2%) injection in the piriformis muscle (PM). PS mimics were excluded. RESULTS:  A total of 38 PS cases (11 males) were enrolled consecutively. In 2018, during dry winter (November-February), pre-monsoon (March-May), and rainy monsoon (June-October), nine, seven, and one PS cases were diagnosed, respectively; in 2019, the numbers were three, eight, and seven, respectively. Thus, over two years, 12 PS patients were diagnosed in dry winter, 15 in pre-monsoon, and eight in rainy monsoon. There was no correlation with the type of preceding events. There were no differences in the pattern of PS between the seasons. CONCLUSIONS:  In this pilot study, over two years more new PS cases were observed in the pre-monsoon and dry winter than in the rainy season; this was not supporting our research question. There was no association with specific preceding events.

Taking a Pulse on Community Participation in Maternal Health through Community Clinics in Bangladesh.

Bangladesh started institutionalising community participation by setting-up community clinics (CCs) during the mid-90 s. This paper presents the genealogy of CCs, the community participation mechanism embedded within CCs, and the case of 54 CCs in Brahmanbaria, through the lens of maternal health. We undertook a desk review to understand the journey of CCs. In 2018, we assessed the accessibility, readiness and functionality of CCs, and a household survey to know recently delivered women's perceptions of CC's community groups (CGs) and community support groups (CSGs). We performed multiple logistic regression to determine the association between the functionality of these groups and women's perception regarding these groups' activities on maternal health. The integration of community participation involving CCs started to roll out through the operationalisation of the Health and Population Sector Programme 1998-2003. In 2019, 13,907 CCs were operational. However, per our CC assessment, their accessibility and readiness were moderate but there were gaps in the functionality of the CCs. The perception of women regarding these groups' functionality was significantly better when the group members met regularly. The gaps in CCs are primarily induced by the shortcomings of its community participation model. Proper understanding is needed to address this problem which has many facets and layers, including political priorities, expectations, and provisions at a local level.

Cervical Cancer in SAARC Countries.

Purvish M. ParikhIn the year 2020, a total of 342 000 women were estimated to die of cervical cancer, of which 90%) were expected amongst low- and middle-income countries (LMIC). Globally incidence of cervical cancer has reduced as a result of improved personal hygiene, better living conditions and higher application of opportunistic screening programs. Yet GLOBOCAN shows that absolute number of cases are still increasing. We therefore conducted a 21 question multiple choice questionnaire online survey in Jan 2023 amongst 9 SAARC countries. A total of 367 replies were received and the representative answers for each country are being reported in this manuscript. A good possibility of achieving World Health Assembly target (Nov 17, 2020) was felt only by Bhutan and Nepal. For screening, most countries (Bhutan, India, Myanmar, Nepal, Pakistan and Sri Lanka) recommend for all asymptomatic eligible patients. Public health experts have suggested VIA / VILI as the best solution for LMICs. However, a dual screening strategy (HPV DNA plus) cytology was preferred by doctors in Afghanistan, Bhutan, India, Myanmar, Pakistan and Sri Lanka. Screening, triage and then treatment was the preferred by Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka. HPV vaccination was recommended in all girls between ages 10 to 26 years in Bangladesh, India, Myanmar, Nepal, Pakistan and Sri Lanka. All the 9 countries would use HPV vaccination to all eligible patients if the cost of the vaccine was reasonably low. Our survey clearly outlines challenges faced in tackling cervical cancer in SAARC countries. We also provide consensus regarding several potential solutions that can be used in both public and private cervical cancer control programs.