A Preliminary Controlled Trial of Endoscopic Ultrasound-guided Fiducial Markers to Guide Pancreas Surgery.

OBJECTIVE: Endoscopic ultrasound (EUS) is routinely used for fiducial marker placement (FMP) to guide stereotactic radiation of pancreatic tumors, but EUS-FMP explicitly to guide surgery has not been studied in a prospective, controlled manner. Multipurpose EUS systems have been developed that facilitate simultaneous EUS-FMP at the time of biopsy. We aimed to evaluate the feasibility of EUS-FMP to guide pancreatic resection. METHODS: In this prospective trial, we enrolled patients with resectable pancreas masses undergoing tissue sampling and placed preloaded fiducials immediately after biopsy. Intraprocedure confirmation of carcinoma, neuroendocrine, and nonlymphomatous neoplasia by rapid on-site evaluation and lesion size <4 cm was required. The main outcomes were the feasibility and ease of preoperative placement and intraoperative detection of the markers using predefined Likert scales. RESULTS: In 20 patients, EUS-FMP was successful before planned surgery and placement was technically straightforward (Likert Scale: 9.1 ± 1.3; range: 1, most challenging to 10, most facile). Intraoperative detection was feasible and improved when compared with a pre-established comparator of 5 representing an equivalent lesion without a marker (Likert Scale: 7.8 ± 2.2; range: 1, most difficult to 10, most facile; P = 0.011). The mean tumor size on EUS was 1.7 ± 0.9 (range: 0.5 to 3.6) cm. CONCLUSION: EUS-FMP is feasible and safe for resectable pancreatic tumors before surgery and may assist in perioperative detection. Preloaded fiducials may be considered for placement at the time of initial referral for EUS-fine needle biopsy.

The Rising Scourge of Mental Illness and Infodemic: An Outcome of Social Media and COVID-19.

COVID-19 was accompanied with the increasing broadcast of fake news, misinformation and excessive information via social media platforms. This phenomenon has been termed "infodemic", to describe an overwhelming amount of mostly fake, false or inaccurate information which spreads rapidly and impacts negatively on achieving a solution. It would therefore be desirable to use a cautious approach which utilizes culturally sensitive and country specific measures to deal with this occurrence. We aim to raise awareness, likewise draw the attention of global scientific community on this topic of public and mental health concern and it calls for further comments on this issue.

Proliferative fasciitis arising from the abdominal wall: A rare tumour excised by laparoscopy.

Proliferative fasciitis (PF) is a rare pseudosarcomatous lesion arising from the subcutaneous fascia and the fibrous septa. Only few hundred cases have been reported in the literature. In the largest series of 53 patients, only two patients had PF lesion arising from the flank. The most common site of origin is extremities followed by abdomen and head and neck. Its origin from the abdominal wall layer and presentation as the fever has been rarely reported in the literature. A PF lesion larger than 5 cm dimension has been sparsely noted. We report the presence of this rare entity in a 68-year-old gentleman who presented to us with low-grade fever and the presence of large lump arising from the abdominal wall. In our patient, the lesion was arising from transervsalis fascia and was excised in toto laparoscopically without damaging the abdominal muscles. It is imperative to differentiate both these lesions from sarcoma on histopathological examination as the follow-up treatment protocols for both vary.

Association of CD 34 positive cell dose with engraftment kinetics in autologous peripheral blood stem cell transplant patients of multiple myeloma.

Background: Treatment with high-dose chemotherapy and stem cell transplantation has prolonged survival in patients of multiple myeloma (MM). A dose-response relationship between number of CD34+ cells infused and leukocyte and platelet recovery, exists. Patients receiving dose of <2.0 × 106 CD34+ cells/kg have delayed engraftment. The level of optimal cutoff for accelerated engraftment is yet to be validated. Hence, this study was undertaken to study the association of CD 34+ cell dose with engraftment kinetics in patients of MM who underwent autolgous peripheral blood stem cell transplant (PBSCT). Methods: We retrospectively analyzed 19 patients of MM who underwent PBSCT at our center between December 2016 to December 2018. Complete blood counts were carried out daily after transplantation to record neutrophil and platelet engraftment. Results: Based on the CD34+ cell dose given : <5 × 106/kg (category 1), 5-10 × 106/kg (category 2), >5 × 106/kg (category 3), the mean (SD) neutrophil engraftment time was 11.3 (0.5) days, 10.6 (0.9) days, and 10.2 (1.3) days respectively. Platelet engraftment time was 12.4 (2.60) days, 10.6 (1.14) days, and 11.2 (1.64) days for category 1, 2, and 3 patients, respectively. Correlation co-efficient between CD 34+cell dose and days for neutrophil and platelet engraftment was found to be -0.24 and -0.20, respectively. Time for neutrophil engraftment was found to be significantly associated with CD34+ cell dose category. Conclusion: CD 34+ cell dose appears as the strongest predictor of leukocyte and platelet engraftment. CD 34+ cell dose of >5.0 × 106 cells/kg leads to an accelerated neutrophil and platelet engraftment in patients of MM.

Synthesis of Hybrid Organic-Inorganic Hydrotalcite-Like Materials Intercalated with Duplex Herbicides: The Characterization and Simultaneous Release Properties.

In this study, a controlled-release formulation of duplex herbicides, namely, 2,4,5-trichlorophenoxybutyric acid (TBA) and 3,4-dichlorophenoxy-acetic acid (3,4D), was simultaneously embedded into Zn-Al-layered double hydroxides (LDHs). The resulting nanohybrid Zinc-Aluminium-3,4D-TBA (ZADTX) was composed of a well-ordered crystalline layered structure with increasing basal spacing from 8.9 Å to 20.0 Å in the Powder X-ray Diffraction (PXRD) with 3,4D and TBA anions located in the gallery of LDHs with bilayer arrangement. The release of 3,4D and TBA fit the pseudo-second-order model. This duplex nanohybrid possessed a well-controlled release property (53.4% release from TBA and 27.8% release from 3,4D), which was highly effective, requiring the use of a small quantity and, hence, environmentally safer.

Knowledge, attitude, and practices related to COVID-19 pandemic among social media users in J&K, India.

BACKGROUND: A series of measures have been suggested to reduce Covid-19 infection, including knowledge training for prevention and control, isolation, disinfection, classified protections at different degrees in infection areas, and protection of confirmed cases. OBJECTIVES: We conducted this study with an aim to assess the knowledge, attitude and practice among the general population regarding COVID-19. METHODS: This was a cross-sectional study carried out by the Department of Community Medicine, Government Medical College, Srinagar in the month of April 2020. The questionnaire had four segments to collect data regarding social-demographic details, knowledge regarding Covid-19, attitude and practice based questions. The questionnaire was shared via social media applications like face book and Whatsapp to reach the target population. Continuous variables were summarized as frequency and percentage. All the analysis was done using Microsoft Excel 2016. Among participants who responded, 1252 (82%) were in the age group of 18-40 years and 912 (60%) from urban areas. RESULTS: A total of 934 (61%) respondents had heard details on COVID-19 from the social media, 1358 (89%) knew all ways of coronavirus transmission, 602 (40%) felt that COVID-19 is a serious disease, 1184 (78%) responded that they totally agree with the lockdown decision, and 1296 (85%) responded that lockdown is helping in reducing the number of cases. The majority, i.e. 1318 (87%), followed advisories and reported washing hands with soap and water regularly, 1108 (73%) reported regularly wearing masks, 1344 (89%) reported following lockdown guidelines, and 1306 (87%) reported maintaining social distancing. The respondents exhibited good knowledge, positive attitude, and sensible practices regarding COVID-19. CONCLUSION: Our study showed that the respondents have exhibited good knowledge, positive attitude and sensible practices regarding covid-19 during the pandemic.

Perception of training in hepatopancreatobiliary surgery among general surgery residents in the Americas.

BACKGROUND: Hepatopancreatobiliary (HPB) surgery experience during residency in the Americas is limited. Residents interested in HPB surgery have different options available for further training. This study evaluated training in HPB surgery received during general surgery (GS) residency, and sought to determine the perception of fellowship training in HPB surgery. METHODS: An anonymous survey was distributed to all 259 GS residency programs in the United States. Questions evaluated demographics, program structure, overall training & HPB experience in particular during residency, plans for fellowship training and understanding of training in HPB surgery. RESULTS: Of the 340 respondents, 162 (48%) were from university programs, 145 (43%) from community hospitals and 48 (14%) from independent medical centers. 117 (34%) were residents in postgraduate year 4 or 5 (PGY4/PGY5). 275 (81%) respondents were planning to pursue fellowship training after finishing residency. Three quarters of all respondents did not feel comfortable about performing liver, biliary and pancreatic procedures. Fellowships accredited by the Americas Hepato-Pancreatico-Biliary Association (AHPBA) are the most common pathway considered by residents for HPB training. CONCLUSIONS: GS residents are not comfortable in considering performing complex HPB cases on completion of residency training. GS residents consider AHPBA accredited fellowships to be more suitable for advanced training in HPB surgery.

Referral Network Pathways of Care for Psychiatric Disorders in Kashmir - A Study from India. / Kesmir'de Psikiyatrik Bozukluklarin Tedavisine Yönelik Sevk Yollari - Hindistan'dan Bir Çalisma.

OBJECTIVE: Access to psychiatry services in Kashmir is challenging because of active enduring conflict, insecurity and a fundamental role played by the traditional health workers. We aimed to assess the main pathways to mental health services in Kashmir, India. METHODS: This cross-sectional hospital-based study was performed from March 2012 to June 2017 in the outpatient psychiatry department at a psychiatric disease hospital in Kashmir. A convenience sampling method was used to select newly referred patients to the services. A survey was developed to collect information on demographic data and the main pathways for patients when seeking care for mental disorders. RESULTS: A total of 518 patients were interviewed. About half of the respondents (48.8 %) attended clinical consultation from a general pathway like a physician or a neurologist, while 31.8% were visiting a psychiatrist for a significant psychiatric disorder. For some patients (17.8%), their initial pathway to mental health services is traditional healers. CONCLUSION: The current study revealed different pathways to seeking psychiatric care in Kashmir India. Further studies are needed to address the treatment gap and ways to improve access to mental health services for the Kashmir population.

Defect engineered magnetism induction and electronic structure modulation in monolayer MoS2.

The electronic, magnetic, and optical characteristics of a defective monolayer MoS2 were examined by employing density functional theory (DFT)-based first-principles calculations. The effects of several defects on the electrical, magnetic, and optical properties, including Mo vacancies, MoS3 vacancies, and the substitution of a single Mo atom by two S atoms were studied in this work. Our first-principles calculations revealed that different types of defects produced distinct energy states within the band gap, leading to a band gap reduction after the introduction of various types of defects, which caused a change from semiconducting to metallic behavior. The spin-up and spin-down states were separated in the case of MoS3 vacancy. The total magnetization was ∼ -0.83 µB/cell, and the absolute magnetization was ∼ 1.23 µB/cell. Moreover, spin-up states had a 0.45 eV band gap, whereas spin-down states were metallic. Consequently, it can be promising for spin filter applications. It was disclosed that the broadband part of the electromagnetic spectrum has a high absorption coefficient, which is necessary for applications including impurity detection, photodiodes, and solar cells. Designing spintronic and optoelectronic devices will benefit from the modification of the electrical, optical, and magnetic properties by defect engineering of MoS2 monolayers presented here.

Impact of Medicaid Expansion on Surgical Care and Outcomes for Hepatobiliary Malignancies.

BACKGROUND: As part of the Patient Protection and Affordable Care Act, some states expanded Medicaid eligibility to adults with incomes below 138% of the federal poverty line. While this resulted in an increased proportion of insured residents, its impact on the diagnosis and treatment of hepatopancreaticobiliary (HPB) cancers has not been studied. STUDY DESIGN: The National Cancer Database (NCDB) from 2010 to 2017 was used. Patients diagnosed with HPB malignancies in states which expanded in 2014 were compared to patients in non-expansion states. Subset analyses of patients who underwent surgery and those in high-risk socioeconomic groups were performed. Outcomes studied included initiation of treatment within 30 days of diagnosis, stage at diagnosis, care at high volume or academic center, perioperative outcomes, and overall survival. Adjusted difference-in-differences analysis was performed. RESULTS: A total of 345,684 patients were included, of whom 55% resided in non-expansion states and 54% were diagnosed with pancreatic cancer. Overall survival was higher in states with Medicaid expansion (HR .90, 95% CI [.88-.92], P < .01). There were also better postoperative outcomes including 30-day mortality (.67 [.57-.80], P < .01) and 30-day readmissions (.87 [.78-.97], P = .02) as well as increased likelihood of having surgery in a high-volume center (1.42 [1.32-1.53], P < .01). However, there were lower odds of initiating care within 30 days of diagnosis (.77 [.75-.80], P < .01) and higher likelihood of diagnosis with stage IV disease (1.09 [1.06-1.12], P < .01) in expansion states. CONCLUSION: While operative outcomes and overall survival from HPB cancers were better in states with Medicaid expansion, there was no improvement in timeliness of initiating care or stage at diagnosis.

Effects of Soaking and Germination Treatments on the Nutritional, Anti-Nutritional, and Bioactive Characteristics of Adzuki Beans (Vigna angularis L.) and Lima Beans (Phaseolus lunatus L.).

Lima beans (Phaseolus lunatus) and adzuki beans (Vigna angularis) are some of the most nutritious underutilized pulses that are significant in being used as basic ingredients for the preparation of various food products. The present study aimed to determine the impact of soaking and germination on nutritional and bioactive components, in vitro protein digestibility, reducing power, metal chelating capacity, antioxidant activity, and anti-nutritional components of lima and adzuki beans. The findings showed that during the germination treatment, the in vitro protein digestibility of lima and adzuki beans increased by 14.75 and 10.98%, respectively. There was an increase in the antioxidant activity of lima beans by 33.48% and adzuki beans by 71.14% after 72 h of germination, respectively. The reducing power assay of lima and adzuki beans indicated an increase of 49.52 and 36.42%, respectively, during germination. Similarly, the flavonoid and metal chelating activity increased in lima and adzuki beans after 72 h of germination. In contrast, the anti-nutrients, such as phytic acid, tannin content, and trypsin inhibitor activity, decreased significantly p < 0.05 after 72 h of germination. These results are encouraging and allow for utilizing the flour obtained from the germinated beans in functional bakery products, which can contribute to eradicating protein deficiency among some population groups. At the same time, promoting soaking and germination of the beans as a way to enhance the nutritional quality and reduce anti-nutrients can contribute to the interest in these underutilized pulses. They could be seen as an additional tool to improve food security.

Prevalence of Mental Disorders Among Patients with Multimorbidity Visiting Primary Care Settings in Slums of Karachi, Pakistan.

BACKGROUND: Anxiety and depression often exacerbate multimorbidity conditions, leading to increased disability rates among affected individuals. OBJECTIVE: The study aimed to assess the mental health status of individuals with multimorbidity belonging to the marginalized population of Karachi, Pakistan. Specifically, the prevalence of anxiety and depression was investigated. METHODS: A multicenter cross-sectional study was conducted between July 2022 and June 2023 in 10 primary healthcare clinics located in 4 peri-urban areas of Karachi. A total of 9331 participants were included in the study. The Patient Health Questionnaire 4 (PHQ-4), Generalized Anxiety Disorder 7 (GAD-7), and Patient Health Questionnaire 9 (PHQ-9) were used to assess symptoms of anxiety and depression. The data collected were analyzed using the statistical analysis system (SAS) version 9.4. RESULTS: Among the study participants, 2894 (31%) were men and 5534 (59.3%) were women. The prevalence of moderate to severe anxiety was 31% among men and 59.3% among women. The age group between 41 and 60 years exhibited the highest rates of moderate to severe anxiety, 19.3% as evaluated by GAD-7 and 34.6% by PHQ-9. The Pathan ethnic group had the highest prevalence of anxiety (11%) and depression (28.3%) in the neighborhoods. Unemployed participants showed moderate to severe anxiety in 21.3% of the cases and moderate to severe depression in 25.5% of the cases. CONCLUSION: The study revealed a significant cooccurrence of anxiety and depression among individuals with multimorbidity in the marginalized population of Karachi, Pakistan. Furthermore, the presence of anxiety symptoms in multimorbidity patients with depression indicates a more unfavorable health state. It is essential to explore the implementation of screening measures and therapeutic interventions for comorbid anxiety and depression in this population to improve clinical outcomes.

Next generation probiotics for human health: An emerging perspective.

Over recent years, the scientific community has acknowledged the crucial role of certain microbial strains inhabiting the intestinal ecosystem in promoting human health, and participating in various beneficial functions for the host. These microorganisms are now referred to as next-generation probiotics and are currently considered as biotherapeutic products and food or nutraceutical supplements. However, the majority of next-generation probiotic candidates pose nutritional demands and exhibit high sensitivity towards aerobic conditions, leading to numerous technological hurdles in large-scale production. This underscores the need for the development of suitable delivery systems capable of enhancing the viability and functionality of these probiotic strains. Currently, potential candidates for next generation probiotics (NGP) are being sought among gut bacteria linked to health, which include strains from the genera Bacteroids, Faecalibacterium, Akkermansia and Clostridium. In contrast to Lactobacillus spp. and Bifidobacterium spp., NGP, particularly Bacteroids spp. and Clostridium spp., appear to exhibit greater ambiguity regarding their potential to induce infectious diseases. The present review provides a comprehensive overview of NGPs in terms of their health beneficial effects, regulation framework and risk assessment targeting relevant criteria for commercialization in food and pharmaceutical markets.

Investigating the Effect of Supercritical Carbon Dioxide Treatment on the Rheological, Thermal, and Functional Properties of Plum (Prunus domestica L.) Kernel Protein Isolates.

Plum kernels are a promising source of dietary proteins that are irretrievably lost during processing. The recovery of these underexploited proteins could be eminently vital for human nutrition. Plum kernel protein isolate (PKPI) was prepared and exposed to a targeted supercritical carbon dioxide (SC-CO2) treatment to diversify its effectiveness in industrial applications. The impacts of SC-CO2 treatment at different processing temperatures (30-70 °C) on dynamic rheology, microstructure, thermal, and techno-functional characteristics of PKPI were investigated. The results revealed that the dynamic viscoelastic characteristics of SC-CO2-treated PKPIs showed higher storage modulus, loss modulus, and lower tan δ value than native PKPI, indicating greater strength and elasticity of the gels. Microstructural analysis showed that the proteins experienced denaturation at elevated temperatures and resulted in the formation of soluble aggregates, which increased the heat requirement for thermal denaturation of SC-CO2-treated samples. SC-CO2-treated PKPIs demonstrated a decline of 20.74% and 30.5% in crystallite size and crystallinity. PKPIs treated at 60 °C showed the highest dispersibility, which was 1.15-fold higher than the native PKPI sample. SC-CO2 treatment offers a novel path to improve the techno-functional properties of PKPIs and extend its use in food and non-food applications.

Structural modification of plum (Prunus domestica L) kernel protein isolate by supercritical carbon-dioxide treatment: Functional properties and in-vitro protein digestibility.

The effect of supercritical carbon dioxide (SC-CO2) treatment at different processing temperatures (30-70 °C) on the physico-functional properties, structural features, and in-vitro digestibility (IVPD) of plum kernel protein isolates (PKPI) was examined. The results revealed remarkable changes in the secondary structures of SC-CO2-treated PKPIs, including a decrease in α-helix proportion, a concomitant increase in ß-sheet content, and a considerable variation in random coils and ß-turn structures. The temperature rise increased the negative zeta potential to a maximum of 31.35 mV at 60 °C, exhibiting the colloidal stability of PKPI dispersions. SDS-PAGE analysis showed variations in the intensities of protein bands, indicating denaturation and aggregation at higher temperatures. These structural and molecular changes improved water-binding capacity (1.22-fold) and oil binding capacity (1.11-fold), wettability (1.12-fold), and the highest value in all the properties was recorded at 60 °C. Moreover, the highest IVPD value (21.58 %) and a distinguishable colour difference (∆E) of 8.11 was also obtained at 60 °C of the processing temperature. Therefore, SC-CO2 treatment-induced modification of PKPI contributed to the enhanced digestibility and techno-functional properties, which offered new prospects to extend its use in food applications.

High energy density storage, antifungal activity and enhanced bioimaging by green self-doped heteroatom carbon dots.

Self-heteroatom-doped N-carbon dots (N-CDs) with a 2.35 eV energy gap and a 65.5% fluorescence quantum yield were created using a one-step, efficient, inexpensive, and environmentally friendly microwave irradiation method. FE-SEM, EDX, FT-IR, XRD, UV-VIS spectroscopy, FL spectroscopy, and CV electrochemical analysis were used to characterise the produced heteroatom-doped N-CDs. The graphitic carbon dot surface is doped with heteroatom functional groups such (S, P, K, Mg, Zn) = 1%, in addition to the additional passivating agent (N), according to the EDX surface morphology and the spontaneous heteroatom doping was caused by the heterogeneous chemical composition of pumpkin seeds. These spontaneous heteroatom-doped N-CDs possess quasispherical amorphous graphitic structure with an average size of less than 10 nm and the interplaner distance of 0.334 nm. Calculations utilising cyclic voltammetry showed that the heteroatom-doped N-CDs placed on nickel electrodes had a high specific capacitance value of 1044 F/g at a scan rate of 10 mV/s in 3 M of KOH electrolyte solution. Furthermore, it demonstrated a high energy and power density of 28.50 Wh/kg and 3350 W/kg, respectively. The higher value of specific capacitance and energy density were attributed to the fact that the Ni/CDs electrode material possesses both EDLC and PC properties due to the sufficient surface area and the multiple active sites of the prepared N-CDs. Furthermore, the heteroatom N-CDs revealed the antifungal action and bioimaging of the "Cladosporium cladosporioides" mould, which is mostly accountable for economic losses in agricultural products. The functional groups of nitrogen, sulphur, phosphorus, and zinc on the surface of the CDs have strong antibacterial and antifungal properties as well as fluorescence enhanced bioimaging.

Navigating the infodemic: strategies and policies for promoting health literacy and effective communication.

The COVID-19 pandemic, with its vast impact illustrated by 770 million confirmed cases and 6.9 million deaths as of September 21, 2023, has exposed a critical challenge: the infodemic. Effective communication and health literacy are pivotal in addressing this crisis. This article emphasizes the urgency of combating health misinformation, highlighting its tangible impact on public health and social well-being. Trustworthy sources, especially government agencies and public health officials, played a central role in shaping public behavior. Clear, accurate, and consistent messaging became vital. Health literacy, a fundamental determinant of pandemic response, empowered individuals to understand and act upon health information. Approximately 36% of adults exhibited basic or below-basic health literacy skills, emphasizing its crucial role. Improving health literacy emerged as a strategic imperative, enabling informed choices and proactive health protection. The pandemic underscores the vital role of effective communication and health literacy in combating health misinformation, fostering informed decision-making, and safeguarding public health.

A Randomised Controlled Trial on the Efficacy of Topical Application of Autologous Platelet Rich Plasma (PRP) on Graft Uptake Rate in Adults Undergoing Type 1 Tympanoplasty for Inactive COM Mucosal Disease.

To assess the efficacy of topical use of autologous platelet rich plasma (PRP) as a packing material in type 1 tympanoplasty in Mucosal Inactive COM disease by conducting a Randomized Controlled Trial in 80 patients. Prospective Randomized Controlled Trial. Total 80 patients were enrolled for the study after fulfilling the inclusion and exclusion criterion. Written and informed consent was taken from all patients. After taking detailed clinical history, the patients were divided in to two groups of 40 patients each by block randomization. Group A was the interventional group where topical autologous platelet rich plasma was applied on the graft during type1 tympanoplasty. In Group B, PRP not applied. Graft uptake rate was observed postoperatively after 1 month and 6 months. Successful graft uptake at 1st month was noted in 97.5% patients in Group A and 92.5% in Group B with a corresponding failure rate of 2.5% and 7.5% respectively. Successful graft uptake at 6th month was noted in 95% patients in Group A and 90% in Group B with a corresponding failure rate of 5% and 10% respectively. As observed from our study status of graft uptake and reperforations at 1st and 6th months subsequent to surgery and rate of post-operative infections were similar in both the groups irrespective of the status of receiving autologous platelet rich plasma. Trial registration Trial registered with CTRI (Clinical Trial Registry -India) (Reg. no CTRI/2019/02/017468 dated 05/02/2019). Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03681-w.