Sigmoid Volvulus in the Setting of Type 4 Hiatal Hernia: An Uncommon Presentation and Literature Review.

Hiatal hernias occur when intra-abdominal contents protrude into the diaphragmatic opening. Of the four classifications, Type 4 hiatal hernias are the most rare and severe. They develop from herniation of the gastroesophageal junction and abdominal viscera other than the stomach into the thoracic cavity. The resulting increase in intrathoracic pressure can cause a wide variety of symptoms on presentation and potentially lead to misdiagnosis. We present a rare case in which a 78-year-old woman presented with nonspecific symptoms and was diagnosed with incarcerated Type 4 hiatal hernia with sigmoid volvulus. We also report a literature review from 2015 to emphasize the importance of recognizing diverse symptomatic presentations in complex Type 4 hiatal hernias and the need for a comprehensive evaluation, as early detection and prompt intervention are essential in preventing life-threatening complications.

Mild Cognitive Impairment: Clinical Presentation and Short-Term Comparative Outcome of Patients With Potentially Modifiable and Nonmodifiable Risk Factors.

Objective: To estimate the prevalence and study the clinical presentation of mild cognitive impairment (MCI), assess its outcome in terms of cognition and quality of life, identify factors for reversion to baseline, and compare these factors in the modifiable and nonmodifiable risk factor groups.Methods: Individuals aged >50 years with memory/cognitive complaint(s) were screened using the Mini-Cog over 1 year (August 2018-August 2019). Those meeting the DSM-5 criteria for MCI were enrolled, and risk factors (modifiable and nonmodifiable) were noted. Assessments were done using the Hindi version of the Montreal Cognitive Assessment (H-MoCA), the Clinical Dementia Rating (CDR)-Hindi version, and the World Health Organization Quality of Life-Brief Hindi version. Treatment outcome was assessed at 6 months and compared between the risk factor groups. Factors for reversion of MCI were assessed.Results: A total of 124 patients (22.1% of 561 with cognitive complaints) had MCI, and 100 patients (50 patients from the modifiable group and 50 patients from the nonmodifiable group) completed the study. Depression (52%) and hypertension (48%) were common risk factors. End point cognition scores were similar in both groups, with quality of life better in the modifiable group (P = .023). Age was negatively correlated with cognition in total patients and the nonmodifiable group (r =0.283-0.420; P = .002-.004). In total patients, cognition moderately correlated with education and somewhat with quality of life; 31% and 57% reverted to normal on the MoCA and CDR scales, respectively, while 1 progressed to dementia. Reverters had higher baseline H-MoCA scores (odds ratio [OR] = 6.996; P < .001) and were treated with cholinesterase inhibitors + vitamin E (OR = 28.999; P = .007).Conclusion: Short-term outcome for both the modifiable and nonmodifiable risk factor groups was favorable. Higher education positively correlated with cognition, which itself predicted a better quality of life. Reverters of MCI had better baseline cognition and were treated with cholinesterase inhibitors + vitamin E.Prim Care Companion CNS Disord 2024;26(4):24m03708. Author affiliations are listed at the end of this article.

Global geoepidemiology of gastrointestinal surgery rates in Crohn's disease.

BACKGROUND: Data regarding the worldwide gastrointestinal surgery rates in patients with Crohn's disease (CD) remains limited. AIM: To systematically review the global variation in the rates of surgery in CD. METHODS: A comprehensive search analysis was performed using multiple electronic databases from inception through July 1, 2020, to identify all full text, randomized controlled trials and cohort studies pertaining to gastrointestinal surgery rates in adult patients with CD. Outcomes included continent based demographic data, CD surgery rates over time, as well as the geoepidemiologic variation in CD surgery rates. Statistical analyses were conducted using R. RESULTS: Twenty-three studies spanning four continents were included. The median proportion of persons with CD who underwent gastrointestinal surgery in studies from North America, Europe, Asia, and Oceania were 30% (range: 1.7%-62.0%), 40% (range: 0.6%-74.0%), 17% (range: 16.0%-43.0%), and 38% respectively. No clear association was found regarding the proportion of patients undergoing gastrointestinal surgery over time in North America (R 2 = 0.035) and Europe (R 2 = 0.100). A moderate, negative association was seen regarding the proportion of patients undergoing gastrointestinal surgery over time (R 2 = 0.520) in Asia. CONCLUSION: There appears to be significant inter-continental variation regarding surgery rates in CD. Homogenous evidence-based guidelines accounting for the geographic differences in managing patients with CD is prudent. Moreover, as a paucity of data on surgery rates in CD exists outside the North American and European continents, future studies, particularly in less studied locales, are warranted.

Investigating extrusion impact on functional, textural properties, morphological structure, and molecular interactions in hulless barley-based extruded snacks supplemented with mung bean.

The effect of varying extrusion conditions on the functional properties of hulless barley-mung bean (70:30) extruded snacks was investigated using response surface methodology with feed moisture (FM), barrel temperature (BT), and screw speed (SS) as process variables. Results revealed significant impacts on functional characteristics with varying extrusion conditions. Bulk density (BD) of extruded snacks ranged from 0.24 to 0.42 g/cm3, showing that lower FM and higher BT results in lower BD while it increased with increasing FM, SS, and BT. The expansion ratio (ER) of extruded snacks ranged between 2.03 and 2.33, showing BT and SS had a desirable positive effect, whereas increasing FM led to decreased ER. Increasing BT and SS depicted a negative effect on water absorption index, whereas FM showed positive effect, which ranged between 4.21 and 4.82 g/g. A positive effect on water solubility index was depicted by BT and SS, which ranges between 9.01% and 13.45%, as higher SS and BT led to starch degradation and increased solubility suggesting better digestibility. The hardness of extruded snacks ranged from 32.56 to 66.88 Newton (N), showing increasing FM increased hardness, whereas higher SS and BT resulted in lowering the hardness. Scanning electronic microscope (SEM) analysis revealed structural changes in extrudates in comparison with nonextruded flour, indicating starch gelatinization and pore formation affected by varying processing parameters. Shifts in absorption bands were observed in Fourier transform infrared spectroscopy (FT-IR), suggesting structural changes in starch and protein. Understanding the effects of extrusion parameters on product properties can help tailored production to meet consumers' preferences and the development of functional snacks with improved nutritional quality.

Factors associated with treatment adherence among pulmonary tuberculosis patients in New Delhi.

BACKGROUND: TB is treated with a six-month course of four antimicrobial drugs, and nearly all cases of TB can be cured if the medications are given and taken correctly. Due to its prolong treatment plans, there can be reasons associated with non-adherence to treatment by TB patients. Hence, the present study aimed to explore the factors associated with medication adherence among TB patients. METHOD: A cross-sectional descriptive survey was conducted among adult pulmonary tuberculosis patients enrolled under RNTCP (now NTEP) in New Delhi among 27 functional RNTCP districts. Around 200 TB patients who are enrolled in the Nikshay App and are also on treatment were considered. A structured questionnaire was prepared for the interview guide. Analysis was done using bivariate analysis, chi-square tests, and Fisher's exact tests. RESULTS: Among the total participants, 173 (86.5%) were adherent and the remaining 27 (13.5%) participants were non-adherent. The majority of the participants (91%) said they were able to follow the routine to the DOTS center, and 9% said they find it difficult to report to the DOTS center as per their schedule. Only 12.35% of non-adherent participants were seen among those who get regular reminders from their families to take medicines, as compared to 18.42% among those who did not get regular reminders from their families. More than one-fourth of the participants (25.9%) who report not getting necessary motivation from healthcare providers were non-adherent. Motivation by healthcare workers to follow drug schedules was found statistically significant to treatment compliance with a P-value of 0.0422. CONCLUSION: TB is a curable disease; this belief has turned out to be a motivational factor for patients suffering from this disease. Studies have shown that faith in the efficacy of treatment helps adherence to TB treatment while other studies describe how patient adherence was adversely affected by the belief that TB is incurable or the treatment is inefficient or that alternative treatment such as traditional medicine is better.

MoS2, WS2, and MoWS2 Flakes as Reversible Host Materials for Sodium-Ion and Potassium-Ion Batteries.

Transition-metal dichalcogenides (TMDs) and their alloys are vital for the development of sustainable and economical energy storage alternatives due to their large interlayer spacing and hosting ability for alkali-metal ions. Although the Li-ion chemically correlates with the Na-ion and K-ion, research on batteries with TMD anodes for K+ is still in its infancy. This research explores TMDs such as molybdenum disulfide (MoS2) and tungsten disulfide (WS2) and TMD alloys such as molybdenum tungsten disulfide (MoWS2) for both sodium-ion batteries (NIBs) and potassium-ion batteries (KIBs). The cyclic stability test analysis indicates that in the initial cycle, the MoS2 NIB demonstrates exceptional performance, with a peak charge capacity of 1056 mAh g-1, while retaining high Coulombic efficiency. However, the WS2 KIB underperforms, with the least charge capacity of 130 mAh g-1 in the first cycle and exceptionally low retention at a current density of 100 mA g-1. The MoWS2 TMD alloy exhibits a moderate charge capacity and cyclic efficiency for both NIBs and KIBs. This comparison study shows that decreasing sizes of alkali-metal ions and constituent elements in TMDs or TMD alloys leads to decreased resistance and slower degradation processes as indicated by cyclic voltammetry and electrochemical impedance spectroscopy after 10 cycles. Furthermore, the study of probable electrochemical intercalation and removal processes of Na-ions and K-ions demonstrates that large geometrically shaped TMD flakes are more responsive to intercalation for Na-ions than K-ions. These performance comparisons of different TMD materials for NIBs and KIBs may promote the future development of these batteries.

Narrow-linewidth Fano microcavities with resonant subwavelength grating mirror.

We report on the theoretical and experimental investigations of optical microcavities consisting in the plane-plane arrangement of a broadband high-reflectivity mirror and a suspended one-dimensional grating mirror possessing a high-quality factor Fano resonance. By varying the length of these cavities from the millimeter to the few-micron range, we observe at short lengths the reduction of the spectral linewidth predicted to occur for such a Fano cavity as compared to a conventional broadband mirror cavity with the same length and internal losses. Such narrow linewidth and small modevolume microcavities with high-mechanical quality ultrathin mirrors will be attractive for a wide range of applications within optomechanics and sensing.

The effect of synthetic grass sports surfaces on the thermal environment: A systematic review.

There are concerns regarding high surface temperatures on synthetic grass sports surfaces influencing the surrounding thermal environment, potentially increasing heat stress and impacting athlete safety. As such, studies have investigated changes to the thermal environment surrounding synthetic grass surfaces in comparison to both natural grass, and synthetic surfaces with different features, but this body of research has not been systematically reviewed. Therefore, this systematic review aimed to (i) determine if there are differences in the thermal environment surrounding synthetic grass surfaces compared with natural grass surfaces, and (ii) determine if there are differences in the thermal environment between different types of synthetic grass surfaces. A systematic review adhering to the PRISMA guidelines was performed. The eligibility criteria required investigations to report at least one of the following environmental parameters on or directly above both a synthetic surface and a comparator group of either natural grass or an alternative synthetic grass surface used in sport: Air temperature, mean radiant temperature, humidity, wind velocity, unified heat stress indices (i.e. wet-bulb-globe temperature and heat index) and/or surface temperature. Twenty-three studies were identified. The only parameters that were consistently higher on synthetic grass compared to natural grass were the air temperature (range: 0.5-1.2 °C) and surface temperature (range: 9.4-33.7 °C), while the mean radiant temperature, humidity, wind velocity and wet-bulb-globe temperature remained similar or required more data to determine if any differences exist. Synthetic grass surfaces consisting of styrene butadiene rubber infill or a shock pad had increased surface temperatures, whereas surfaces with thermoplastic elastomer infill, Cool climate turf fibres or HydroChill had lower surface temperatures. This systematic review has demonstrated that air and surface temperatures can be increased on synthetic sports surfaces, compared to natural grass surfaces. However, it is uncertain whether the differences are enough to increase an individual's heat stress risk and cause concern for athlete safety. While modifications to the turf infill or fibres can reduce synthetic surface temperatures, the effect of these features on the thermal environment as a whole is unclear. This review was prospectively registered with the Open Science Framework (Open Science Framework registration   https://doi.org/10.17605/OSF.IO/BTKGE ).

Biodiversity of endosymbiont fungi associated with a marine sponge Lamellodysidea herbacea and their potential as antioxidant producers.

This study aims to isolate endosymbiontic fungi from the marine sponge Lamellodysidea herbacea and to explore their antioxidant potential. Marine-derived fungi, with their vast biodiversity, are considered a promising source of novel antioxidants which can replace synthetic ones. Marine sponges have previously reported bioactive properties that could ameliorate oxidative stress, particularly their associated fungi, producing high-frequency bioactive molecules (adaptogenic molecules) in response to stressors. 19 endosymbiont fungi associated with marine sponges were isolated, and their extracts were evaluated for their antioxidant capacities. Extract of an endosymbiont fungus, isolate SPG6, identified as Alternaria destruens, through surface electron microscopy (SEM) and ITS gene sequencing, showed broad range antioxidant activities (EC50 values) (free radical scavenging 32.54 mg L-1, Hydroxyl radical scavenging activity < 0.078 g L-1, total reducing power 0.114 g L-1, Chelating power 0.262 g L-1, H2O2 scavenging activity < 0.078 g L-1, and Superoxide radical scavenging activity > 5.0 g L-1). The extract of isolate SPG6 was fractioned and analyzed through GC-MS. Marine sponge-associated endosymbiont fungi are a rich source of antioxidant molecules. Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-024-03972-1.

Neuroprotective role of Carvacrol via Nrf2/HO-1/NLRP3 axis in Rotenone-induced PD mice model.

Parkinson's disease (PD) is a multifactorial neurodegenerative disorder whose cause is unclear. Neuroinflammation is recognized as one of the major pathogenic mechanisms involved in the development and progression of PD. NLRP3 inflammasome is the most widely studied inflammatory mediator in various diseases including PD. Several phytoconstituents have shown neuroprotective role in PD. Carvacrol is a phenolic monoterpene commonly found in the essential oils derived from plants belonging to Lamiaceae family. It is well known for its anti-inflammatory and antioxidant properties and has been widely explored in several diseases. In this study, we explored the role of Carvacrol in suppressing neuroinflammation by regulating NLRP3 inflammasome through Nrf2/HO-1 axis and subsequently, inflammatory cytokines like IL-1ß, IL-18 in Rotenone induced PD mice model. Three doses (25 mg/kg, 50 mg/kg, 100 mg/kg p.o.) of Carvacrol were administered to, respectively, three groups (LD, MD, HD), one hour after administration of Rotenone (1.5 mg/kg, i.p.), every day, for 21 days. Treatment with Carvacrol ameliorated the motor impairment caused by Rotenone. It alleviated neurotoxicity and reduced inflammatory cytokines. Further, Carvacrol also alleviated oxidative stress and increased antioxidant enzymes. From these results, we show that Carvacrol exerts neuroprotective effects in PD via anti-inflammatory and antioxidant mechanisms and could be a potential therapeutic option in PD.

Addressing Irreversibility and Structural Distortion in WS2 Inorganic Fullerene-Like Nanoparticles: Effects of Voltage Cutoff Experiments in Beyond Li+-Ion Storage Applications.

Large interlayer spacing beneficially allows Na+- and K+-ion storage in transition-metal dichalcogenide (TMD)-based electrodes, but side reactions and volume change, which pulverize the TMD crystalline structure, are persistent challenges for the utilization of these materials in next-generation devices. This study first determines whether irreversibility due to structural distortion, which results in poor cycling stability, is also apparent in the case of inorganic fullerene-like (IF) tungsten disulfide (WS2) nanocages (WS2IF). To address these problems, this study proposes upper and lower voltage cutoff experiments to limit specific reactions in Na+/WS2IF and K+/WS2IF half-cells. Three-dimensional (3D) differential capacity curves and derived surface plots highlight the continuation of reversible reactions when a high upper cutoff technique is applied, thereby indirectly suggesting restricted structural dissolution. This resulted in improved capacity retention with stable performance and a higher Coulombic efficiency, laying the ground for the use of TMD-based materials beyond Li+-ion storage devices.

Cognitive Functional Therapy compared with usual physiotherapy care in people with persistent low back pain: a mixed methods feasibility randomised controlled trial in the United Kingdom National Health Service.

OBJECTIVES: To determine the feasibility of completing a definitive randomised controlled trial (RCT), evaluating the clinical and cost-effectiveness of Cognitive Functional Therapy (CFT) in comparison to usual physiotherapy care (UPC), for people with persistent low back pain (LBP). DESIGN AND SETTING: A two-arm parallel feasibility RCT completed in a United Kingdom (UK) Secondary Care National Health Service (NHS) physiotherapy service. PARTICIPANTS: Sixty adult participants who reported LBP lasting for more than three months, that was not attributable to a serious (e.g. cancer) or specific (e.g. radiculopathy) underlying cause, were invited to participate. Participants were allocated at random to receive CFT or UPC. INTERVENTIONS: Cognitive Functional Therapy and Usual Physiotherapy Care for persistent LBP. MAIN OUTCOME MEASURES: The primary outcome was the feasibility of completing a definitive RCT, defined by recruitment of at least 5 participants per month, delivery of CFT per protocol and securing relevant and acceptable outcome measures. Data concerning study processes, resources, management and participant reported outcome measures were collected at baseline, 3, 6 and 12-month follow-up. RESULTS: Sixty participants (n = 30 CFT and n = 30 UPC) were recruited with 80% (n = 48), 72% (n = 43) and 53% (n = 32) retained at 3, 6 and 12-month follow-up respectively. NHS physiotherapists were trained to competence and delivered CFT with fidelity. CFT was tolerated by participants with no adverse events. Relevant and clinically important outcome data were collected at all time points (0.4%, 3%, 1% and 0.8% of data was missing from the returned outcome measure booklets at baseline and 3, 6 and 12-month follow-up respectively). The Roland-Morris disability questionnaire was considered the most suitable primary outcome measure with a proposed sample size of 540 participants for a definitive cluster RCT. CONCLUSION: It is feasible to conduct a randomised study of CFT in comparison to UPC for NHS patients. A future study should incorporate an internal pilot to address aspects of feasibility further, including participant retention strategies. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN12965286 CONTRIBUTION OF THE PAPER.

Analytical investigations of propagation of ultra-broad nonparaxial pulses in a birefringent optical waveguide by three computational ideas.

This paper mainly concentrates on obtaining solutions and other exact traveling wave solutions using the generalized G-expansion method. Some new exact solutions of the coupled nonlinear Schrödinger system using the mentioned method are extracted. This method is based on the general properties of the nonlinear model of expansion method with the support of the complete discrimination system for polynomial method and computer algebraic system (AS) such as Maple or Mathematica. The nonparaxial solitons with the propagation of ultra-broad nonparaxial pulses in a birefringent optical waveguide is studied. To attain this, an illustrative case of the coupled nonlinear Helmholtz (CNLH) system is given to illustrate the possibility and unwavering quality of the strategy utilized in this research. These solutions can be significant in the use of understanding the behavior of wave guides when studying Kerr medium, optical computing and optical beams in Kerr like nonlinear media. Physical meanings of solutions are simulated by various Figures in 2D and 3D along with density graphs. The constraint conditions of the existence of solutions are also reported in detail. Finally, the modulation instability analysis of the CNLH equation is presented in detail.

Studies on photocatalytic mineralization of organic pesticides by bimetallic Cu-Zn nanoparticles derived from Zingiber officinale Roscoe (ginger) using green chemistry approach.

Compared to monometallic nanoparticles, bimetallic nanoparticle synthesis and characterization have attracted more attention due to their superior environmental protection properties. In this study, we discuss the preparation and characterization of Cu-Zn bimetallic nanoparticles using Zinger extract, as well as their potential role in photocatalytic degradation of carbendazim, chlorpyrifos, monocrotophos, and cypermethrin. Surface properties were assessed with SEM and TEM, while UV-VIS, XRD, FTIR, and fluorescence spectroscopy were used to characterize the materials. It was observed that higher pH conditions were more conducive to the development of stable Cu-Zn BMNPs with diameters ranging from 60 to 100 nm. UV-VIS spectroscopy showed that the Cu-Zn bimetallic nanoparticles photodegraded 53-95% of the pesticides, monocrotophos, chlorpyrifos, and carbendazim during the 24-72-h incubation period. A number of pesticides may be photocatalytically degraded by primary reactive radicals produced by nanoparticles. We propose that the use of bimetallic nanoparticles could be one alternative strategy for pesticide mineralization.

Exosome-mediated delivery and regulation in neurological disease progression.

Exosomes (EXOs), membranous structures originating from diverse biological sources, have recently seized the attention of researchers due to their theranostic potential for neurological diseases. Released actively by various cells, including stem cells, adipose tissue, and immune cells, EXOs wield substantial regulatory influence over the intricate landscape of neurological complications, exhibiting both positive and negative modulatory effects. In AD, EXOs play a pivotal role in disseminating and breaking down amyloid-ß protein. Moreover, EXOs derived from mesenchymal stem cells showcase a remarkable capacity to mitigate pro-inflammatory phenotypes by regulating miRNAs in neurodegenerative diseases. These vesicles possess the unique ability to traverse the blood-brain barrier, governing the aggregation of mutant huntingtin protein. Understanding the exosomal functions within the CNS holds significant promise for enhancing treatment efficacy in neurological diseases. This review intricately examines the regulatory mechanisms involving EXOs in neurological disease development, highlighting therapeutic prospects and exploring their utility in exosome-based nanomedicine for various neurological complications. Additionally, the review highlights the challenges associated with drug delivery to the brain, emphasizing the complexities inherent in this critical aspect of neurotherapeutics.

A Young Female With Takayasu Arteritis Involving the Coronary Arteries.

A rare form of large vessel vasculitis, Takayasu arteritis (TA) typically affects the aorta and its primary branches and rarely involves the coronary arteries. We present a case study of a female patient who had refractory hypertension and coronary artery disease for which she underwent percutaneous transluminal angioplasty. Subsequently, she was diagnosed with Takayasu arteritis. We wish to underscore the significance of timely identification and intervention as pivotal factors in improving patient outcomes and optimizing the effectiveness of therapeutic strategies in managing TA.

Cancer associated fibroblasts modulate the cytotoxicity of anti-cancer drugs in breast cancer: An in vitro study.

BACKGROUND: Tumour microenvironment (TME) contributes to resistance to anti-cancer drugs through multiple mechanisms including secretion of pro-survival factors by cancer associated fibroblasts (CAFs). In this study, we determined the chemotherapy resistance producing potential of CAFs in molecular subtypes of breast cancer. METHODS: The CAFs were isolated from fresh lumpectomy/mastectomy specimens of different molecular subtypes of breast cancer. The CAFs were cultured and secretome was collected from each breast cancer subtype. Breast cancer cell lines MCF-7, SK-BR3, MDA-MB-231, and MDA-MB-468 were treated with different doses of tamoxifen, trastuzumab, cisplatin, and doxorubicin alone respectively and in combination with secretome of CAFs from respective subtypes. MTT assay was done to check cell death after drug treatment. Liquid chromatography-mass spectrometry (LCMS) analysis of CAF secretome was also done. RESULTS: MTT assay showed that anti-cancer drugs alone had growth inhibitory effect on the cancer cells however, presence of CAF secretome reduced the anti-cancer effect of the drugs. Resistant to drugs in the presence of secretome, was determined by increased cell viability i.e., MCF-7, 51.02% to 63.02%; SK-BR-3, 34.22% to 44.88%; MDA-MB-231, 52.59% to 78.63%; and MDA-MB-468, 48.92% to 55.08%. LCMS analysis of the secretome showed the differential abundance of CAFs secreted proteins across breast cancer subtypes. CONCLUSIONS: The treatment of breast cancer cell lines with anti-cancer drugs in combination with secretome isolated from molecular subtype specific CAFs, reduced the cytotoxic effect of the drugs. In addition, LCMS data also highlighted different composition of secreted proteins from different breast cancer associated fibroblasts. Thus, TME has heterogenous population of CAFs across the breast cancer subtypes and in vitro experiments highlight their contribution to chemotherapy resistance which needs further validation.

An Assessment of Sikh Turban's Head Protection in Bicycle Incident Scenarios.

Due to religious tenets, Sikh population wear turbans and are exempted from wearing helmets in several countries. However, the extent of protection provided by turbans against head injuries during head impacts remains untested. One aim of this study was to provide the first-series data of turbans' protective performance under impact conditions that are representative of real-world bicycle incidents and compare it with the performance of bicycle helmets. Another aim was to suggest potential ways for improving turban's protective performance. We tested five different turbans, distinguished by two wrapping styles and two fabric materials with a size variation in one of the styles. A Hybrid III headform fitted with the turban was dropped onto a 45 degrees anvil at 6.3 m/s and head accelerations were measured. We found large difference in the performance of different turbans, with up to 59% difference in peak translational acceleration, 85% in peak rotational acceleration, and 45% in peak rotational velocity between the best and worst performing turbans. For the same turban, impact on the left and right sides of the head produced very different head kinematics, showing the effects of turban layering. Compared to unprotected head impacts, turbans considerably reduce head injury metrics. However, turbans produced higher values of peak linear and rotational accelerations in front and left impacts than bicycle helmets, except from one turban which produced lower peak head kinematics values in left impacts. In addition, turbans produced peak rotational velocities comparable with bicycle helmets, except from one turban which produced higher values. The impact locations tested here were covered with thick layers of turbans and they were impacted against flat anvils. Turbans may not provide much protection if impacts occur at regions covered with limited amount of fabric or if the impact is against non-flat anvils, which remain untested. Our analysis shows that turbans can be easily compressed and bottom out creating spikes in the headform's translational acceleration. In addition, the high friction between the turban and anvil surface leads to higher tangential force generating more rotational motion. Hence, in addition to improving the coverage of the head, particularly in the crown and rear locations, we propose two directions for turban improvement: (i) adding deformable materials within the turban layers to increase the impact duration and reduce the risk of bottoming out; (ii) reducing the friction between turban layers to reduce the transmission of rotational motion to the head. Overall, the study assessed Turbans' protection in cyclist head collisions, with a vision that the results of this study can guide further necessary improvements for advanced head protection for the Sikh community.