Sustainable poultry farming practices: a critical review of current strategies and future prospects.

As global demand for poultry products, environmental sustainability, and health consciousness rises with time, the poultry industry faces both substantial challenges and new opportunities. Therefore, this review paper provides a comprehensive overview of sustainable poultry farming, focusing on integrating genetic improvements, alternative feed, precision technologies, waste management, and biotechnological innovations. Together, these strategies aim to minimize ecological footprints, uphold ethical standards, improve economic feasibility, and enhance industry resilience. In addition, this review paper explores various sustainable strategies, including eco-conscious organic farming practices and innovative feed sources like insect-based proteins, single-cell proteins, algal supplements, and food waste utilization. It also addresses barriers to adoption, such as technical challenges, financial constraints, knowledge gaps, and policy frameworks, which are crucial for advancing the poultry industry. This paper examined organic poultry farming in detail, noting several benefits like reduced pesticide use and improved animal welfare. Additionally, it discusses optimizing feed efficiency, an alternate energy source (solar photovoltaic/thermal), effective waste management, and the importance of poultry welfare. Transformative strategies, such as holistic farming systems and integrated approaches, are proposed to improve resource use and nutrient cycling and promote climate-smart agricultural practices. The review underscores the need for a structured roadmap, education, and extension services through digital platforms and participatory learning to promote sustainable poultry farming for future generations. It emphasizes the need for collaboration and knowledge exchange among stakeholders and the crucial role of researchers, policymakers, and industry professionals in shaping a future where sustainable poultry practices lead the industry, committed to ethical and resilient poultry production.

Sarcoidosis in a young adult: A rare sequelae of COVID-19 infection.

Key Clinical Message: This case illustrates sarcoidosis as a potential complication of COVID-19, highlighting the need for a comprehensive diagnostic approach, including histopathology and prolonged monitoring, to distinguish it from post-COVID fibrosis. Further research is crucial to elucidate these associations and understand their underlying mechanisms. Abstract: Severe Acute Respiratory Syndrome Coronavirus- 2 (SARS-CoV-2), a positive-sense single-stranded RNA virus, causes COVID-19 and has been linked to autoimmune disorders. Sarcoidosis is a multi-system disease that is frequently triggered by infections. It is characterized by non-necrotizing granulomas in multiple organs. We present a case of sarcoidosis as rare sequelae of COVID-19. A 26-year-old man presented with mild COVID-19 symptoms, followed by prolonged fever and cough despite initial therapy, prompting a provisional diagnosis of post-COVID fibrosis. A subsequent assessment at a tertiary hospital revealed dyspnea, weight loss, and abnormal chest imaging, all of which were consistent with pulmonary sarcoidosis with pulmonary tuberculosis as a differential diagnosis. A biopsy taken during bronchoscopy confirmed pulmonary sarcoidosis and treatment with inhalation steroids resulted in symptom relief, which was followed by remission with oral steroid therapy. Sarcoidosis is a systemic disease of unknown etiology, characterized by non-necrotizing granulomas in multiple organs. It may be triggered by infections and involves an abnormal immune response. COVID-19 can potentially initiate sarcoidosis, with both sharing common immune mechanisms. Diagnosis involves imaging and biopsy, and treatment typically includes glucocorticoids and regular monitoring. This case report emphasizes the potential link between COVID-19 and autoimmune conditions like sarcoidosis, highlighting the need for a comprehensive diagnostic approach and long-term observation to distinguish between sarcoidosis and post-COVID fibrosis.

Middle East Respiratory Syndrome Coronavirus Could be a Priority Pathogen to Cause Public Health Emergency: Noticeable Features and Counteractive Measures.

Middle East respiratory syndrome (MERS) is caused by a specific strain of the 6 types of human coronaviruses (HCoV). MERS-CoV has spread unchecked since it was first discovered in Saudi Arabia in 2012. The virus most likely spreads through nosocomial and zoonotic channels. Genetic analyses suggest that bats were the initial hosts and that the disease spread to camels. Person-to-person transmission occurs with varying frequency, being most prevalent in clinical settings and the least common among the general population and among close relatives. Due to the severity of the illness, high fatality rate, potential for epidemic spread, and lack of adequate medical countermeasures, the World Health Organization (WHO) continues to list MERS-CoV as a priority pathogen. While no specific antiviral medicines exist, a combination of antivirals has shown promise in recent clinical trials. Vaccines against MERS-CoV are critically needed and are currently being developed. Early diagnosis and implementing appropriate infection control measures are keys to preventing hospital-associated outbreaks. Preventive measures include avoiding raw or undercooked meats and other animal products, ensuring proper hand hygiene in healthcare settings and around dromedaries, educating the public and healthcare personnel about the disease, and adhering to other recommended practices. Countries with a high prevalence of MERS should adhere to regulations designed to limit the transmission of the virus. The recent spread of MERS-CoV highlights the importance of public awareness regarding the significance of reporting symptoms so that appropriate control measures can be adopted. The narrative review discusses the incidence of MERS, its clinical presentation, potential transmission routes, recent reports, preventative and control measures, and current therapeutic options.

Molecular detection of avian pathogenic Escherichia coli (APEC) in broiler meat from retail meat shop.

Avian pathogenic Escherichia coli (APEC) is a major bacterial pathogen responsible for the most widespread form of colibacillosis, resulting in substantial economic losses within the poultry sector and posing a potential public health risk. From July to September 2021, our study investigated the antibiotic resistance pattern of Escherichia coli (E. coli) and the presence of virulence-associated genes (iucD, iutA, iss, and ompT) linked to APEC using 105 broiler meat samples comprising liver, thigh, and breast muscle, in Chitwan, Nepal. E. coli was isolated and identified by culturing samples on MacConkey's agar, Eosin-methylene blue (EMB) agar and performing different biochemical tests. Antibiotic resistance patterns of E. coli were determined by the Kirby-Bauer disc diffusion method. Following the isolation of E. coli, the molecular detection of APEC was performed using conventional polymerase chain reaction (PCR). Out of the 105 samples analyzed, 61 (58.1 %) tested positive for E. coli. In antibiotic susceptibility test (AST), gentamicin and tetracycline exhibited the highest resistance rates, with 90.2 % and 67.2 %, respectively and 29.5 % of the E. coli isolates displayed multidrug-drug resistance. Out of 61 confirmed E. coli isolates, iutA was detected in 47 (77.0 %) samples, iucD in 46 (75.4 %), iss in 53 (86.8 %), and ompT in 39 (63.9 %) samples. This study reports the occurrence of MDR E. coli in meat samples, together with virulence genes associated with APEC which poses a public health threat. Continuous surveillance is vital for monitoring APEC transmission within poultry farms, coupled with efforts to raise awareness of food safety among consumers of broiler meat.

Achalasia cardia: A case report in young female.

Key Clinical Message: This case emphasizes the need for early recognition and accurate diagnosis of achalasia in young adults to avoid exacerbation of the condition and misdiagnosis as GERD. Patient outcomes and quality of life are greatly enhanced by suitable diagnostic techniques, appropriate therapy, interdisciplinary care, and comprehensive patient education along with frequent follow-ups. Abstract: Achalasia results from the degeneration of inhibitory ganglion cells within the esophageal myenteric plexus and the lower esophageal sphincter (LES), leading to a loss of inhibitory neurons and resulting in the absence of peristalsis with failure of LES relaxation. Its origins are multifactorial, potentially involving infections, autoimmune responses, and genetics, with equal incidence in males and females. The hallmark symptoms include progressive dysphagia for solids and liquids, along with regurgitation, heartburn, and non-cardiac chest pain. A 22-year-old female patient initially diagnosed with gastroesophageal reflux disease (GERD) received proton pump inhibitors and antacid gel for persistent dysphagia and regurgitation. Subsequent tests including barium esophagogram and manometry indicated Type II Achalasia Cardia. The patient showed clinical improvement with relief of dysphagia, regurgitation, and heartburn symptoms after pneumatic balloon dilatation (PBD). She was advised to follow up after 6 months with upper gastrointestinal (UGI) endoscopy and manometry in the outpatient clinic for regular endoscopic surveillance as there is a risk of transformation to esophageal carcinoma. Diagnosing achalasia in young adults poses challenges due to its diverse presentation and resemblance to other esophageal disorders like GERD. Diagnosis relies on clinical symptoms and imaging studies such as barium esophagogram revealing a bird's beak appearance and esophageal manometry showing absent peristalsis. UGI endoscopy is needed to rule out malignancy. Treatment options include non-surgical approaches like medication and Botox injections, as well as surgical methods such as pneumatic balloon dilation, laparoscopic Heller myotomy, and per-oral endoscopic myotomy (POEM). The treatment options depend upon the patient's condition at presentation and their individual choices. This case report emphasizes that it is crucial to consider achalasia as a potential differential diagnosis in young adults with dysphagia, especially if conventional treatments for acid peptic disorder do not alleviate symptoms. Prompt diagnosis and appropriate management can lead to significant clinical improvement and better patient outcomes.

Comparative Profiles of the WATCHMAN™ and Amplatzer™ Cardiac Plug/Amplatzer™ Amulet™ Devices for Left Atrial Appendage Closure in Non-valvular Atrial Fibrillation: A Comprehensive Systematic Review and Meta-analysis.

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia marked by irregular and frequent tachycardic rhythms in the atria, affecting 1%-2% of the general population. The WATCHMAN™ device from Boston Scientific (Marlborough, MA, USA) and the Amplatzer™ Amulet™ device from Abbott (Chicago, IL, USA) are two devices used globally for left atrial appendage closure (LAAC) in non-valvular AF. A systematic search was conducted in PubMed, the Cochrane Library, and Elsevier's ScienceDirect literature databases to identify studies comparing the WATCHMAN™ procedure with Amulet™ device implantation for LAAC in patients with AF. The analyses were conducted using the random-effects model. A total of 20 studies were identified, with 18 falling into the category of observational studies and 2 being randomized controlled trials. A total of 6310 participants were included in this meta-analysis, with 3198 individuals (50.68%) assigned to the WATCHMAN™ procedure group and 3112 individuals (49.32%) allocated to the Amplatzer™ Cardiac Plug (ACP) group. The analysis revealed a higher risk of stroke associated with the WATCHMAN™ technique (relative risk [RR], 1.14), albeit without statistical significance. Conversely, the WATCHMAN™ approach led to a significantly lower risk of cardiac death (RR, 0.44; P = .04). Notably, the risks of all-cause mortality (RR, 0.89; 95% confidence interval [CI], 0.73-1.08; I 2 = 0%; P = .25) and major bleeding (RR, 0.93; 95% CI, 0.65-1.33; I 2 = 31%; P = .70) were clinically reduced with the WATCHMAN™ procedure, although statistical significance was not achieved. Compared to Amulet™ device implantation, WATCHMAN™ device implantation decreased the risk of cardiac mortality, while the risks of stroke, systemic embolism, all-cause mortality, and major bleeding were not statistically significant.

Exploring the effects of non-thermal plasma pre-treatment on coriander (Coriander sativum L.) seed germination efficiency.

This study investigates the effects of non-thermal plasma (NTP) treatment on the germination characteristics of coriander seeds (Coriandrum sativum L.). Different germination factors, water imbibition rate and changes in mass, were analyzed. The results indicate that a suitable duration of NTP treatment (180 s and 300 s) enhances seed germination characteristics, whereas prolonged exposure (420 s) leads to adverse effects. Furthermore, shorter NTP exposures (180 s) improved water absorption and surface properties of seeds, while longer exposures (420 s) caused mass loss and compromised seed vigor. Overall, the findings demonstrate the significance of optimizing NTP treatment conditions for enhancing seed germination characteristics.

Systemic lupus erythematosus associated with erythema multiforme: A rare case report of Rowell's syndrome.

Key Clinical Message: Although it is very uncommon, SLE may initially present with recurrent episodes of EM-like rash. Despite the various possibilities underlying their association, prompt identification, and treatment of SLE in patients presenting with EM is important to prevent death or serious organ damage. Abstract: Rowell's syndrome (RS) is an uncommon presentation of systemic lupus erythematosus (SLE) with erythema multiforme (EM)-like lesions associated with specific serological changes, including positive rheumatoid factor (RF), speckled antinuclear antibody (ANA), positive rheumatoid factor, or anti-La antibodies in the serum. Our case, a 41-year-old male, presented with features of EM. Upon investigation, we identified underlying systemic lupus erythematosus, marking a rare instance of SLE presenting for the first time as EM. Classical or true EM is precipitated by trigger factors such as infective agents like the herpes simplex virus, Mycoplasma pneumoniae, drugs like anticonvulsants, antibiotics, and non-steroid anti-inflammatory drugs, any underlying malignancy, or connective tissue disorders, and is not associated with any specific serological abnormalities. EM cases associated with LE lesions where an EM trigger factor is missing are considered an RS diagnostic criterion. In this case report, the importance of considering SLE in patients presenting initially with recurrent episodes of EM-like rash is emphasized. RS should be considered, especially when there is no evidence of triggering factors. Early diagnosis and prompt treatment of SLE are crucial to preventing death and irreversible organ damage.

Randomised trial of genetic testing and targeted intervention to prevent the development and progression of Paget's disease of bone.

INTRODUCTION: Paget's disease of bone (PDB) frequently presents at an advanced stage with irreversible skeletal damage. Clinical outcomes might be improved by earlier diagnosis and prophylactic treatment. METHODS: We randomised 222 individuals at increased risk of PDB because of pathogenic SQSTM1 variants to receive 5 mg zoledronic acid (ZA) or placebo. The primary outcome was new bone lesions assessed by radionuclide bone scan. Secondary outcomes included change in existing lesions, biochemical markers of bone turnover and skeletal events related to PDB. RESULTS: The median duration of follow-up was 84 months (range 0-127) and 180 participants (81%) completed the study. At baseline, 9 (8.1%) of the ZA group had PDB lesions vs 12 (10.8%) of the placebo group. Two of the placebo group developed new lesions versus none in the ZA group (OR 0.41, 95% CI 0.00 to 3.43, p=0.25). Eight of the placebo group had a poor outcome (lesions which were new, unchanged or progressing) compared with none of the ZA group (OR 0.08, 95% CI 0.00 to 0.42, p=0.003). At the study end, 1 participant in the ZA group had lesions compared with 11 in the placebo group. Biochemical markers of bone turnover were significantly reduced in the ZA group. One participant allocated to placebo required rescue therapy with ZA because of symptomatic disease. The number and severity of adverse events did not differ between groups. CONCLUSIONS: Genetic testing for pathogenic SQSTM1 variants coupled with intervention with ZA is well tolerated and has favourable effects on the progression of early PDB. TRIAL REGISTRATION NUMBER: ISRCTN11616770.

From seed to sprout: Unveiling the potential of non-thermal plasma for optimizing cucumber growth.

Background and aims: Numerous strategies for enhancing seed germination and growth have been employed over the decades. Despite these advancements, there continues to be a demand for more effective techniques, driven by the growing global population. Recently, various forms of non-thermal atmospheric pressure plasma have garnered attention as environmentally friendly, safe, and cost-effective methods to enhance the agricultural and food sectors. This study explores the remarkable impact of non-thermal plasma (NTP) treatment on cucumber (Cucumis sativus L.) seed germination. Methods: A cost-effective, custom-designed power supply operating at line frequency was used for treating seeds, with exposure times ranging from 1 to 7 min. Various germination parameters, including water contact angle measurements, mass loss, water imbibition rate, and seedling length, were evaluated to assess the impact of plasma treatment on seed germination. Results: Cucumber seeds exposed to NTP treatment for 3 min and 5 min durations showed significant germination improvements, notably a 57.9 ± 4.25 % higher final germination percentage, 14.5 ± 3.75 % reduced mean germination time, and a remarkable 90.6 ± 4.64 % increase in germination index compared to the control. These results suggest that NTP treatment enhanced seed coat permeability, triggered essential biochemical processes, and expedited water absorption and nutrient assimilation, ultimately fostering faster and more synchronized germination. Conclusions: Our findings underscore the potential of NTP as an innovative approach to improving seed germination in agricultural practices.

A case of Lemierre's syndrome causing panhypopituitarism, cavernous sinus thrombosis, ischaemic stroke and pulmonary embolism.

Infection is a rare cause of panhypopituitarism and has not been reported in the context of Lemierre's syndrome. We present the case of a previously well 19-year-old man, who presented acutely unwell with meningitis and sepsis. Fusobacterium necrophorum was isolated from peripheral blood cultures and identified on cerebrospinal fluid with 16S rDNA Polymerase Chain Reaction (PCR). Imaging demonstrated internal jugular vein thrombosis with subsequent cavernous venous sinus thrombosis. Pituitary function tests were suggestive of panhypopituitarism. The patient was diagnosed with Lemierre's syndrome complicated by meningitis, cavernous sinus thrombosis, base of skull osteomyelitis, ischaemic stroke and panhypopituitarism. He was treated with 13 weeks of intravenous antibiotics followed by 3 weeks of oral amoxicillin, and anticoagulated with dalteparin then apixaban. His panhypopituitarism was managed with hydrocortisone, levothyroxine and desmopressin.

Knowledge, Attitude, and Practice of Antibiotic Use and Resistance among Poultry Farmers in Nepal.

The abuse and misuse of antibiotics is one of the main drivers of antimicrobial resistance (AMR). Globally, AMR in food-producing animals is a significant public health concern. This study, therefore, assessed the knowledge, attitudes, and practices related to antibiotic usage (AMU) and AMR among poultry farmers in Nepal. We conducted a cross-sectional survey of 605 poultry farmers from six districts of Nepal from May to June 2022 to assess the status of knowledge, attitude, as well as practices toward prudent antibiotic usage (AMU) and AMR. The majority of the participants in our study were from the Chitwan district (31.6%; n = 191/605), aged 30-44 (54.2%; n = 328/605), males (70.4%; n = 426/605), and farmers with a higher secondary (28.76%; n = 174/605) level of education. The tetracyclines (28%, n = 228/828), aminoglycosides (23%, n = 188/828), and fluoroquinolones (15%, n = 126/828) were the most used antibiotics classes among poultry farmers. Although 87.8% (n = 531/605) of poultry farmers used antibiotics, 49.8% (n = 301/605) of them were aware of AMR, and 55.7% (n = 337/605) knew that the misuse of antimicrobials could affect human and environmental health. There were significant differences in the knowledge, attitude, and practices toward prudent AMU and AMR among farmers who reared different birds. The mean knowledge, attitude, and practice score of the respondents were 7.81 ± 3.26, 5.8 ± 2.32, and 7.59 ± 3.38 when measured on a scale of 12, 10, and 15, respectively. Based on a cut-off of 75% of the maximum score, 49.4% (n = 299/605), 62.8% (n = 380/605), and 12.73% (n = 77/605) of the respondents had good knowledge, attitude, and practices toward prudent AMU and AMR, respectively. The multivariable logistic regression analyses revealed that the positive predictors of good knowledge and attitude were male gender, higher level of education, district, and the types of birds (layers). Similarly, those of the male gender (OR: 3.36; 95% CI: 1.38-8.20; p = 0.008) and those that rear layers (OR: 4.63; 95% CI: 1.75-12.25; p = 0.003) were more likely to practice prudent usage of antimicrobials. The findings of this study show poor practice toward prudent antibiotic usage despite good knowledge of AMR. This study provides essential baseline data on the knowledge, attitudes, and practices of poultry farmers in Nepal and offers valuable insights that could help in the design of interventions and policies aimed at addressing illicit AMU and AMR in poultry in Nepal.

Ecological and Socioeconomic Factors in the Occurrence of Rabies: A Forgotten Scenario.

In many third world countries, where rabies is endemic in dog populations, humans continue to be at risk of contracting the disease. Vaccination is the most effective form of prophylaxis for people, yet it often fails to adequately protect dogs. The most major implications are the costs of post-exposure prophylaxis (PEP) after an exposure occurs and the loss of human life and productivity due to early mortality from rabies (about 60,000 deaths annually). The largest rabies death tolls can be found in the world's poorest regions, where rabies vaccinations for domestic dogs are uncommon and PEP is scarce. Mass vaccination of dogs, neutering programs, patient PEP, strengthening laboratory and human resources, education and awareness, and animal and human rabies surveillance are all common methods used to prevent, control, and ultimately eradicate dog-mediated human rabies. Current rabies control initiatives, however, pay little attention to the role that ecological and socioeconomic variables play in the disease's occurrence and spread. To help better inform rabies control strategies, we address in this work the ways in which ecological and socioeconomic factors affect the occurrence and spread of rabies.

Risk Factors Associated with Avian Influenza Subtype H9 Outbreaks in Poultry Farms of Central Lowland Nepal.

Low pathogenic avian influenza (LPAI) of subtype H9 outbreaks have been frequently occurring in major commercial hubs of Nepal including Chitwan, a central lowland area, causing substantial economic losses to the farmers. However, the risk factors associated with these outbreaks have been poorly understood, and hence, this case-control study was conducted in Chitwan, Nawalpur, and Makawanpur districts of Nepal from October 2019 to March 2020. A total of 102 farms were selected in which 51 were case farms, and 51 were controls. Case farms were avian influenza (AI)-subtype-H9-confirmed farms through polymerase chain reaction (PCR) assays on poultry samples. Control farms included farms that were AI-negative in the antigen test brought to the National Avian Disease Investigation Laboratory, Chitwan, for diagnosis during the study period. Each farm was visited to collect information using a semi-structured questionnaire. A total of 25 variables representing farm characteristics and biosecurity measures were considered as potential risk factors. The final multivariable model showed that distance of less than 0.5 km from the main road (OR = 4.04, 95% CI = 1.20-13.56, p = 0.023), distance of less than 1 km from a nearest infected farm (OR = 76.42, 95% CI = 7.17-814.06, p = 0.0003), and wild birds coming around the farm (OR = 6.12, 95% CI = 1.99-18.79, p = 0.0015) were risk factors for avian influenza type H9, whereas using apron or separate cloth inside the shed (OR = 0.109, 95% CI = 0.020-0.577, p = 0.0092) was shown to reduce the risk of farms being positive for AI subtype H9. These findings suggest that due consideration should be given to site selection while establishing the farms and the importance of implementing appropriate biosecurity measures, such as using separate cloth inside the shed and preventing the entry of wild birds inside the farm to reduce the potential risk of introduction of avian influenza type H9 to their poultry farms.

Knowledge, risk perception, and prevention preparedness towards COVID-19 among a cross-section of animal health professionals in Nigeria.

Introduction: the on-going COVID-19 pandemic caused by the SARS-CoV-2 virus has imposed serious public health and economic threats on the entire world population. The SARS-CoV-2 has been identified from both domestic and wild animals constituting a threat to humans since most apparently healthy animals may potentially infect and cause the disease in humans, especially Animal Health Professionals (AHPs) who come directly in contact with animals. These professionals such as veterinarians play important roles among the One Health team in controlling the pandemic. This survey was conducted to assess the knowledge, risk perception, and prevention behaviors of AHPs in Nigeria who are important personnel in the control of emerging and re-emerging zoonotic and infectious diseases. Methods: an online-based epidemiological cross-sectional pre-tested questionnaire survey was carried out from April to May 2020. A total of 427 AHPs joined this survey. Descriptive statistics, chi-square test, and binary logistic regression model were used to analyze the data collected. Results: the respondents have a mean knowledge score of 7.34 ± 2.05 (from a total possible score of 11) with the majority (66.7%, n = 285) having satisfactory knowledge scores on COVID-19. A high proportion (240/353) of respondents reported bats to be the major wildlife incriminated in the transmission of the COVID-19 virus though other animals reported were tiger, monkey, lion, and pangolin. At least, a quarter 131 (30.7%) of respondents perceived that visiting live animal markets is of high zoonotic risk to the spread of coronavirus. Most respondents reported hands washing and sanitizing after handling animals, and using personal protective equipment when handling suspected animals. At p<0.05; respondents' age, marital status, professional status, and geopolitical zone were significantly linked with satisfactory knowledge. Veterinarians (OR=0.40; 95%CI: 0.22-0.75) were thrice less likely to possess unsatisfactory knowledge of COVID-19 than laboratory technologists. Conclusion: participants in this survey have a satisfactory level of COVID-19 knowledge and good mitigation measures instituted while working at their stations. However, AHPs need more enlightenment about the various zoonotic risk pathway contributing to the transmission of COVID-19.

Analysis of the interactions between small pulmonary nodules, clinical factors and the risk of malignancy in the chest following diagnosis of head and neck cancer.

BACKGROUND: This study aims to investigate radiological and clinical factors which predict malignancy in indeterminate pulmonary nodules in patients with head and neck cancer (HNC). METHODS: Prospective data were collected in 424 patients who were reviewed in the NHS Lothian HNC multidisciplinary meeting from May 2016 to May 2018. Staging and follow-up CT chest imaging were reviewed to identify and assess pulmonary nodules in all patients. RESULTS: About 61.8% of patients had at least one pulmonary nodule at staging CT. In total, 25 patients developed malignancy in the chest. Metastatic disease in the chest was significantly associated with unknown or negative p16 status (p < .0005). Pleural indentation and spiculation were associated with indeterminate nodules, subsequently being shown to represent metastatic disease (p > .0005 and p = .046, respectively). CONCLUSION: Negative or unknown p16 status was associated with an increased propensity to develop metastatic disease in the chest in patients with HNC.

The COVID-19 pandemic: A multi-regional cross-sectional survey of public knowledge, attitudes, and perceptions.

With over twelve months since the start of the COVID-19 pandemic, its morbidity and mortality continue to be a critical health threat despite various instituted preventive and control efforts. Information on the multi-regional public perspective of the diseases is limited. Therefore, this study investigated public knowledge, attitudes, and practices towards COVID-19 across Sub-Saharan Africa (SSA), Middle East and North Africa (MENA), and South Asia (SA) regions of the world. In an online pretested questionnaire-based cross-sectional survey, respondents (n = 2738) were recruited using a convenience sampling technique and data obtained were subjected to descriptive and inferential statistics. The majority of respondents had bachelor's degrees or higher (91.1%) and were aged between 18 and 39 years (88%). Most of the respondents had satisfactory knowledge (73%, 15.4 ± 2.5), attitudes 76.8%, 7.1 ± 1.1, and perceptions (73.4%, 11±2.8). Participants with higher educational levels and scientific backgrounds were 1.71 times (95% CI: 1.44; 2.03; p < 0.001) more likely to have a better knowledge of COVID-19. Respondents from the SA region were significantly more likely (OR: 1.4; 95% CI: 1.16, 1.68; p < 0.001) to possess satisfactory knowledge of COVID-19. Meanwhile, respondents from the MENA region (OR: 7.81; 95% CI: 6.12, 9.97; p < 0.001) have better attitudes and are more optimistic about ending the pandemic than those from the SSA. Despite the satisfactory knowledge, attitudes, and perceptions towards the regional efforts observed, we emphasize continued adherence by the public to the health regulations and safety measures of countries in these regions. There is a need for the low and middle-income countries to improve awareness of COVID-19 preventive practices.

Perceptions towards COVID-19 Vaccines and Willingness to Vaccinate in Nepal.

Vaccination is the most effective preventive measure of COVID-19 available at present, but its success depends on the global accessibility of vaccines and the willingness of people to be vaccinated. As the vaccination rollouts are increasing worldwide, it is important to assess public perception and willingness towards vaccination, so that the aim of mass vaccination will be successful. This study aimed to understand public perception towards COVID-19 vaccines and their willingness to get vaccinated in Nepal. This cross-sectional online survey was conducted among 1196 residents of Nepal in August 2021; most of the participants of this online survey were young adults (18-47 years) with university-level education. A total of 64.5% (771/1196) of the participants perceived COVID-19 vaccines to be safe and risk-free, while 68.6% (820/1196) agreed that vaccination would be efficient in the fight against this pandemic. Most of the participants (841/1196, 70.3%) disagreed that people are getting COVID-19 vaccines easily in Nepal, while they agree with the prioritization of older adults and healthcare workers for vaccination. A total of 61.1% (731/1196) of the participants had received at least one dose of the vaccine. Among the unvaccinated, 93.3% (434/465) were willing to get vaccinated when their turn came. The higher confidence of younger adults in vaccines and the vaccination process is encouraging, as that can help educate others who are hesitant or are not positive towards the idea of receiving vaccines. Dissemination of correct and current information, acquisition of enough doses of vaccines, and equitable distribution of vaccines will be required to achieve successful completion of the COVID-19 vaccination campaign in Nepal.