Novel 3-substituted coumarins inspire a custom pharmacology prediction pipeline: an anticancer discovery adventure.

Aim: This research aims to expand the established pharmacological space of tumor-associated carbonic anhydrases (TACAs) by exploring the synthetically accessible chemical space of 3-substituted coumarins, with the help of in silico pharmacology prediction.Materials & methods: 52 novel 3-substituted coumarins were sketched, prioritizing synthetic feasibility. Their pharmacological potentials were estimated using a custom machine-learning approach. 17 compounds were predicted as cytotoxic against HeLa cells by interfering with TACAs. Those compounds were synthesized and biologically tested against HeLa cells. The three most potent compounds were assayed against multiple carbonic anhydrases, and their enzyme binding mechanism(s) were studied using molecular docking.Results: Experimental results exhibited pronounced consensus with in silico pharmacology predictions.Conclusion: Novel 3-substituted coumarins are herein dispatched to the cancer therapeutics space.

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Global Trial Representation and Availability of Tyrosine Kinase Inhibitors for Treatment of Chronic Myeloid Leukemia.

Background: Evaluating clinical trial representation for countries with different socio-demographic index (SDI) and tyrosine kinase inhibitor (TKI) availability for chronic myeloid leukemia (CML). Methods: CML incidence rates (IRs) and disability-adjusted life years (DALYs) (1999-2019) from the Institute of Health Metrics and Evaluation were analyzed. Trials investigating TKI use in CML were obtained from ClinicalTrials.gov. Site data for eligible trials (N = 30) and DALYs were analyzed. TKI approvals, DALYs, and IRs were summarized by SDI. Results: North America (NA) had significant decreases in annual percent change (APC) in DALYs and incidence rates from 1999 to 2004. IRs were highest in Europe and Central Asia (ECA) and NA, while DALYs were highest in South Asia (SAsia) and Sub-Saharan Africa (SSA). Countries in the high-SDI quintile were likely to have lower DALYs than lower-SDI quintiles. Differences in regional DALYs vs. sites in TKI trials were significant for SAsia, SSA, and ECA. High-SDI countries were included in all 30 trials, and TKI approvals were prominent in high-SDI (142) vs. low-SDI (14) countries. Conclusions: The inclusion of disproportionately affected countries during the design of and recruitment into clinical trials should occur, as should TKI availability. The lack of representation demonstrates healthcare disparities.

Salinity negatively correlates with the production and immunity of chicken: A molecular insight for food security and safety issues.

Salinity intrusion into the freshwater system due to climate change and anthropogenic activities is a growing global concern, which has made humans and domesticated animals more susceptible to diseases, resulting in less productivity. However, the effects of salinity on domesticated and wild birds, especially in terms of production and immunity, have not been fully elucidated yet. Therefore, this study was designed to examine the effects of salinity on the production and immunity of birds and the mechanisms by which immunity is compromised. Broiler chicks were subjected to different concentrations of salty water (control = normal water, treatment = 5 g/L, treatment = 10 g/L, and treatment = 15 g/L). The collected blood and organs from different groups of broilers were biochemically and histopathologically examined. Birds in salt-treated groups consumed significantly less feed than the control group, while the feed conversion ratio (FCR) was significantly higher. Body weight gain was significantly lower in salt-treated groups compared to control. Serum analysis revealed a lower systemic antibody titer in the salt-treated groups compared to the control. Primary lymphoid organs (thymus and bursa of Fabricius) were reduced in size in the salt-treated group due to cellular migration and depletion from these organs. Importantly, most of the parenchyma of lymphoid organs was replaced with fibrotic tissue. Gut microbes, Escherichia coli (E. coli) and Salmonella spp., from salt-treated groups, showed less viability but developed antibiotic resistance. Levels of salinity were significantly and negatively correlated with feed intake, body weight gain, antibody titer, lymphoid organ size, and viable count of gut microbes, while FCR, fibrosis of lymphoid organs, and antibiotic resistance were significant positively correlated. In conclusion, increased salinity is a possible threat to food security and safety as it decreases body weight gain, reduces immunity, and influences the development of multi-drug resistance in gut microbes.

Meteorological gaps in audits of pedestrian environments: a scoping review.

BACKGROUND: Weather and season are determinants of physical activity. Therefore, it is important to ensure built environments are designed to mitigate negative impacts of weather and season on pedestrians to prevent these losses. This scoping review aims to identify built environment audits of pedestrian environments developed for use during a specific weather condition or season. Secondly, this review aims to investigate gaps in the inclusion of relevant weather mitigating built environment features in pedestrian environment audit tools. METHODS: Following a standard protocol, a systematic search was executed in CINAHL, Medline and Web of Science to identify built environment audit tools of pedestrian spaces. These databases were chosen since they are well-known to comprehensively cover health as well as multi-disciplinary research publications relevant to health. Studies were screened, and data were extracted from selected documents by two independent reviewers (e.g., psychometric properties and audit items included). Audit items were screened for the inclusion of weather mitigating built environment features, and the tool's capacity to measure temperature, precipitation, seasonal and sustainability impacts on pedestrians was calculated. RESULTS: The search returned 2823 documents. After screening and full text review, 27 articles were included. No tool was found that was developed specifically for use during a specific weather condition or season. Additionally, gaps in the inclusion of weather mitigating items were found for all review dimensions (thermal comfort, precipitation, seasonal, and sustainability items). Poorly covered items were: (1) thermal comfort related (arctic entry presence, materials, textures, and colours of buildings, roads, sidewalk and furniture, and green design features); (2) precipitation related (drain presence, ditch presence, hazards, and snow removal features); (3) seasonal features (amenities, pedestrian scale lighting, and winter destinations and aesthetics); and (4) sustainability features (electric vehicle charging stations, renewable energy, car share, and bike share facilities). CONCLUSIONS: Current built environment audit tools do not adequately include weather / season mitigating items. This is a limitation as it is important to investigate if the inclusion of these items in pedestrian spaces can promote physical activity during adverse weather conditions. Because climate change is causing increased extreme weather events, a need exists for the development of a new built environment audit tool that includes relevant weather mitigating features.

The impact of the mesoprefrontal dopaminergic system on the maturation of interneurons in the murine prefrontal cortex.

The prefrontal cortex (PFC) undergoes a protracted maturation process. This is true both for local interneurons and for innervation from midbrain dopaminergic (mDA) neurons. In the striatum, dopaminergic (DA) neurotransmission is required for the maturation of medium spiny neurons during a critical developmental period. To investigate whether DA innervation influences the maturation of interneurons in the PFC, we used a conditional knockout (cKO) mouse model in which innervation from mDA neurons to the mPFC (mesoprefrontal innnervation) is not established during development. In this mouse model, the maturation of parvalbumin (PV) and calbindin (CB) interneuron populations in the PFC is dysregulated during a critical period in adolescence with changes persisting into adulthood. PV interneurons are particularly vulnerable to lack of mesoprefrontal input, showing an inability to maintain adequate PV expression with a concomitant decrease in Gad1 expression levels. Interestingly, lack of mesoprefrontal innervation does not appear to induce compensatory changes such as upregulation of DA receptor expression in PFC neurons or increased innervation density of other neuromodulatory (serotonergic and noradrenergic) innervation. In conclusion, our study shows that adolescence is a sensitive period during which mesoprefrontal input plays a critical role in promoting the maturation of specific interneuron subgroups. The results of this study will help to understand how a dysregulated mesoprefrontal DA system contributes to the pathophysiology of neurodevelopmental disorders.

Forty-two years impact of chemical fertilization on soil phosphorus partition and distribution under rice-based cropping systems.

Understanding of soil phosphorus (P) transformation is crucial to minimize its edge-of-field loss associated with ecosystem disservices. A sequential chemical extraction procedure was used to assess the impact (42 years) of organic and chemical fertilizations on soil P partition and distribution under subtropical rice based cropping systems. Experimental treatments were control, N, NP, NK, NS, NZn, NPK, NSZn, NPKSZn, and N+FYM (farmyard manure). Composite soils were collected from 0-5, 20-25 and 40-45 cm depths, extracted, and analyzed for soluble P, NaHCO3-P (inorganic and organic), NaOH-P (inorganic and organic), acid soluble (H2SO4), and residual P fractions. The NPKSZn significantly increased the concentration of soil inorganic P compared to other treatments. When FYM was applied together with N fertilizer, the organic P concentration increased, which was statistically identical to NPKSZn and NPK treatments. While the labile (NaHCO3-Pi, NaOH-Po), residual, and total P concentrations were stratified at 0-5 cm depth, the concentration of NaHCO3-Po, NaOH-Pi, and acidic P fractions increased with soil depth. The soluble, NaHCO3 (Pi and Po), NaOH-Pi and NaOH-Po, acidic, and residual P fractions constituted about 0.4, 6.6, 1.7, 21.3, 37.7, and 8.3%, respectively, of the total P. A higher concentration of the labile P at the surface soil indicated that the impact of chemical fertilization stratified the available P for plant uptake or susceptible to edge-of-field loss. The NPKSZn and N+FYM both had higher NaHCO3-Po and NaOH-Po concentrations within 40-45 cm and 0-25 cm depths, suggesting that N+FYM could promote the transformation of non-labile P into labile P pool, by reducing P fixation by soil and transport them at 20-45 cm depth. It is concluded that long-term fertilization increased the concentration of P pools especially labile P by saturating the soil adsorption sites especially in surface soil.

Role of Social Support in Screening Colonoscopy/Sigmoidoscopy Uptake among U.S. Adults.

Colorectal cancer (CRC) is a major clinical and public health burden. Screening has been shown to be effective in preventing CRC. In 2021, less than 72% of adult Americans had received CRC screening based on the most recent guidelines. This study examined the relationship between social support and screening colonoscopy or sigmoidoscopy uptake among U.S. adults and the socioeconomic factors that impact the relationship. We conducted a cross-sectional study using the 2021 National Health Interview Survey (NHIS) data for 20,008 U.S. adults to assess the weighted rates of screening colonoscopy or sigmoidoscopy among individuals with strong, some, and weak social support. Adjusted binary logistic regression models were utilized to obtain the weighted odds of receiving a screening colonoscopy or sigmoidoscopy among adults with different levels of social support and socioeconomic status. About 58.0% of adults who reported having colonoscopy or sigmoidoscopy had strong social support, compared to 52.0% who had some or weak social support. In addition, compared to adults with weak social support, the weighted adjusted odds of having colonoscopy or sigmoidoscopy were 1.0 (95% C.I. = 0.994, 0.997; p < 0.001) and 1.3 (95% C.I. = 1.260, 1.263; p < 0.001) for adults with some and strong social support, respectively. Socioeconomic differences were observed in the odds of colonoscopy or sigmoidoscopy uptake based on having strong social support. Having strong social support is an important factor in increasing colonoscopy or sigmoidoscopy screening uptake. Policies and interventions that enhance social support among adults for screening colonoscopy or sigmoidoscopy are warranted.

Assessment of Final Year Nursing Students' Willingness and Readiness to Work With Patients With COVID-19 During the Pandemic: A Cross-Sectional Survey.

Introduction: During the COVID-19 pandemic, Indonesia faced shortages of medical supplies and healthcare workers. With a limited supply of healthcare workers, we examined the possibility of bringing final-year nursing students into COVID-19 patient care. Methods: We conducted a cross-sectional survey among final-year nursing students to assess their willingness and readiness to work with patients with COVID-19 in Indonesia. We recruited 1,028 final-year nursing students in East Java, Indonesia, during October 7-20, 2021. Data were collected using an online questionnaire designed for this study using Google Forms. Response data were extracted from Google Forms to MS Excel 2016 for analysis. We performed univariate analysis for descriptive statistics, followed by multivariate analysis using binary logistic regression to analyze the effect of independent variables on study outcomes. Results: The characteristics of the study participants showed that most respondents were female (97.1%) and of Javanese ethnicity (75.3%). More than 90% of participants reported no chronic diseases (96.2%) and were vaccinated (81.4%). Most participants were willing to work (84.3%) and ready to work (94.4%) with patients with COVID-19. Adjusted analysis showed that sex, type of institution, ethnicity, household condition, and history of chronic diseases were independent determinants of willingness to work with patients with COVID-19. Male and private university students were significantly more willing to work with patients with COVID-19. Conclusions: Nursing students were willing to work with patients with COVID-19 during the pandemic; however, a longitudinal study is recommended for trend analysis.

Relationship between greenfield investment and economic growth: Evidence from Bangladesh.

The key purpose of the study is to investigate the relationship between Greenfield investment and economic growth of Bangladesh using annual time series data during the period 2003-2020. The study employs Toda-Yamamoto (T-Y) tests of Granger causality method that performs Modified Wald Test (MWALD) in order to establish causal relation among different variables. There are three steps in implementing the T-Y procedure. The first step involves using different tests (ADF, PP, and KPSS test) to identify the maximum order of integration of the variable. The second step requires selecting the optimal lag length (p) based on several lag length selection criteria. In the third step, MWALD approach is used for testing the vector auto regression model for causality. The results of the tests (ADF, PP, and KPSS) concluded that the maximum order of integration of the variables is two. Then, the optimal lag length of two (p = 2) has been selected based on several lag length selection criteria. Finally, the findings reveal the evidence of unidirectional causality from Real Greenfield Foreign Direct Investment (RGFDI) to Real Gross Domestic Product (RGDP). The key contribution of this study is to investigate the Greenfield investments-growth relationship for a country like Bangladesh.

Association between dietary fatty acid patterns and obesity indices in Jordanian adults: A cross-sectional study.

Background: The ratios of fatty acids in different diets and their connection to chronic diseases including obesity and CVD have been researched. The current study set out to detect the dietary fatty acid patterns among Jordanian adults and their relationships with obesity indices. Methods: The data of 1096 adults were extracted from a household food consumption patterns survey study. Food intake was analyzed, and fatty acid patterns were determined. After anthropometric measurements, obesity indices were calculated. Results: Two fatty acid patterns were determined (High fatty acids from Protein and Olive Oil sources pattern, and the low Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) pattern), explaining an overall variance of 41.78% and 24.31%, respectively. A significant difference in obesity scores through fatty acids pattern quartiles was only seen among female participants. Q4 of the "High fatty acids from Protein and Olive Oil sources" pattern had a significantly higher means of body mass index (25.12 ± 0.46; p = 0.015), waist-to-height-ratio (0.51 ± 0.01; p = 0.002), weight-adjusted waist index (10.13 ± 0.09; p = 0.021) and body roundness index (3.61 ± 0.15; p = 0.007) compared to Q1, while Q4 of "Low EPA and DHA" pattern had significantly higher means of waist circumference (WC) (86.28 ± 1.34) and a body shape index (ABSI) (10.12 ± 0.30) in comparison to Q1 (WC = 81.55 ± 1.08 and ABSI = 9.07 ± 0.22; p = 0.025, 0.013; respectively). In females, there was a significant association between the "High fatty acids from Protein and Olive Oil sources" pattern and all the obesity indices. Conclusion: Our results suggest that an increase in the high fatty acids from Protein and Olive Oil sources pattern is associated with a reduction in obesity indices, which is opposite to the low EPA and DHA pattern. This was a sex-specific association.

Role of perceived social support in COVID-19 vaccine uptake among U.S. adults.

Background: Vaccine uptake concerns in the Unites States were at the forefront of public health discussions during the COVID-19 pandemic. By the end of 2022, approximately 80% of the U.S. population was vaccinated against the virus. This study examined the relationship between perceived social support and COVID-19 vaccine uptake among U.S. adults. Methods: Using nationally representative cross-sectional data on 21,107 adults from the 2021 National Health Interview Survey, we assessed the COVID-19 vaccination rates across individuals with strong, some, and weak levels of social support. Multivariable logistic regression models were estimated to obtain the odds of being vaccinated in adults with different levels of perceived social support for the full sample and sub-samples of age groups. Results: We found that compared to adults with perceived strong social support, adults with weak social support were 21.1% less likely to be vaccinated against COVID-19. Apart from the age 18-24 years group, the lower likelihood of being vaccinated for adults with weak social support was evident in age 24-49 years (AOR=0.66, 95% CI: 0.52-0.85), age 50-64 years (AOR=0.67, 95% CI: 0.50-0.90), and age 65+ years (AOR=0.56, 95% CI: 0.41-0.75) groups. Conclusions: These findings are consistent with a broader literature indicating that social support increases the likelihood of healthy behaviors and decreases risky behaviors. Interventions designed to improve the perception of social support, particularly among those at high risk of mortality from COVID-19 may be a promising tactic for increasing COVID-19 vaccine uptake.

Representation of the population in need for pivotal clinical trials in lymphomas.

Despite the advances in cancer outcomes, significant health disparities persist. Several new agents have been recently approved for treatment of lymphomas, leading to improved outcomes. Extending the benefits of these new agents starts by adequate enrollment of all affected patient populations. This study aimed to evaluate the extent to which randomized controlled trials (RCTs) match the demographic and geographic diversity of the population affected by lymphoma. Two Food and Drug Administration databases, clinicaltrials.gov, and relevant primary manuscripts were reviewed for drug approval data and demographic representation in RCTs for classical Hodgkin lymphoma (cHL) and non-Hodgkin lymphoma. Maps showing the distribution and frequency of trial participation relative to disease burden, insurance status, and racial representation were created. Black, Hispanic, and female patients were significantly underrepresented in the RCTs for lymphoma compared with that for the disease burden (3.6% [95% confidence interval (CI), 2.8-5.4] vs 14.6% [95% CI, 13.8-15.3]; 6.7% [95% CI, 5.5-7.9] vs 16.3% [95% CI, 15.5-17.1]; and 39.1% [95% CI, 37.3-40.9] vs 42.7% [95% CI, 42.3-43.1], respectively). White and male patients were overrepresented. More counties with higher mortality rates and racial minority representation had low access to the trials, particularly for cHL in the southern region of the United States. There are significant racial misrepresentations in pivotal RCTs in the United States, and geographic distribution of these trials may not provide easy access to all patients in need. Disparities in enrollment should be corrected to make results applicable to all populations.

Genomic characterization of SARS-CoV-2 in Egypt: insights into spike protein thermodynamic stability.

The overall pattern of the SARS-CoV-2 pandemic so far has been a series of waves; surges in new cases followed by declines. The appearance of novel mutations and variants underlie the rises in infections, making surveillance of SARS-CoV-2 mutations and prediction of variant evolution of utmost importance. In this study, we sequenced 320 SARS-CoV-2 viral genomes isolated from patients from the outpatient COVID-19 clinic in the Children's Cancer Hospital Egypt 57357 (CCHE 57357) and the Egypt Center for Research and Regenerative Medicine (ECRRM). The samples were collected between March and December 2021, covering the third and fourth waves of the pandemic. The third wave was found to be dominated by Nextclade 20D in our samples, with a small number of alpha variants. The delta variant was found to dominate the fourth wave samples, with the appearance of omicron variants late in 2021. Phylogenetic analysis reveals that the omicron variants are closest genetically to early pandemic variants. Mutation analysis shows SNPs, stop codon mutation gain, and deletion/insertion mutations, with distinct patterns of mutations governed by Nextclade or WHO variant. Finally, we observed a large number of highly correlated mutations, and some negatively correlated mutations, and identified a general inclination toward mutations that lead to enhanced thermodynamic stability of the spike protein. Overall, this study contributes genetic and phylogenetic data, as well as provides insights into SARS-CoV-2 viral evolution that may eventually help in the prediction of evolving mutations for better vaccine development and drug targets.

Investigating the prospect of cleaner production in informal enterprises: A scientific assessment of environmental burdens and economic efficiency.

The present study aims to assess the prospects for cleaner production (CP) and sustainable development (SD) of informally operated small manufacturing enterprises, which are frequently blamed for uncontrolled waste disposal and causing pollution to the environment. The economic efficiency level of these firms has been explored to this end, and the metallic pollution loads in the surrounding environment have been scientifically analyzed to investigate the nexus between these two. DEA (Data Envelopment Analysis)-Tobit analysis has been employed, and a pollution load index (PLI) of heavy metal pollution comprising two environmental compartments (soil and water) has been constructed based on the concentration level of metalloid pollutants in the samples collected from the surrounding areas of the studied informal firms in Bangladesh. The study disproves CP practice in majority of the informal firms in Bangladesh by observing a positive relationship between firm-level efficiency and pollution load sourced from their production activities. Afterwards, this study estimates the eco-efficiency level of firms by considering pollution load as an undesirable output and minimizing its impact in an input-oriented DEA model. Applying the eco-efficiency scores in censored Tobit regression analysis, the outcome endorses the prospect of CP for informally operated enterprises in Bangladesh. However, the CP prospect can only materialize if and only if firms are provided with adequate technical, financial, and strategic support for achieving eco-efficiency in their production. The informal and marginal nature of the studied firms restricts them from getting access to the facilities and support services needed for implementing CP and moving towards sustainable manufacturing. Therefore, this study recommends green practices in informal manufacturing and limiting the informal firms by bringing them gradually under the coverage of formalization, which is in line with the achievement of the targets mentioned in Sustainable Development Goal 8.

Compounds from the Petroleum Ether Extract of Wedelia chinensis with Cytotoxic, Anticholinesterase, Antioxidant, and Antimicrobial Activities.

Wedelia chinensis is a folk medicine used in many Asian countries to treat various ailments. Earlier investigations reported that the petroleum ether extract of the plant has potential biological activity, but the compounds responsible for activity are not yet completely known. Therefore, the current work was designed to isolate and characterize the compounds from the petroleum ether extract and to study their bioactivities. Four compounds including two diterepenes (-) kaur-16α-hydroxy-19-oic acid (1) and (-) kaur-16-en-19-oic acid (2), and two steroids ß-sitosterol (3), and cholesta-5,23-dien-3-ol (4) were isolated and characterized. Among the compounds, the diterpenes were found to have more biological activities than the steroidal compounds. Compound 1 showed the highest cytotoxicity with LC50 of 12.42 ± 0.87 µg/mL. Likewise, it possesses good antioxidant activity in terms of reducing power. On the contrary, compound 2 exerted the highest antiacetylcholinesterase and antibutyrylcholinesterase activity. Both the diterpenes showed almost similar antibacterial and antifungal activity. The identification of diterpenoid and steroid compounds with multifunctional activities suggests that W. chinensis may serve as an important source of bioactive compounds which should be further investigated in animal model for therapeutic potential in the treatment of different chronic diseases.

Food consumption and adherence to dietary guidelines among Jordanian children and adolescents.

Background: Early-life food consumption patterns may affect children's health by increasing susceptibility to developing non-communicable chronic diseases (NCDs) in adulthood. Aims: To evaluate Jordanian children and adolescents' energy and macronutrient intake and how closely they adhere to dietary recommendations. Methods: This cross-sectional study used data from Jordan's Population-based Food Consumption Survey, a household population-based study conducted in Jordan between 2021 and 2022 (561 children and adolescents 8-19 years). Dietary intake was assessed using the two non-consecutive 24-hour dietary recall methods (24-h DR). The estimated food group and nutrient intakes were compared to nutritional recommendations, including MyPlate dietary guidelines. Results: The prevalence of overweight/obese individuals based on body mass index (BMI) was 44%, and the average waist-to-height ratio (WHtR) was 24.7%. Compared to MyPlate dietary guidelines, children and adolescents had a higher added sugar intake (57g/day). Also, consuming vegetables, fruits, and dairy fell short of MyPlate dietary guidelines. The total discretionary calorie intake in children and adolescents was approximately one-third of the total energy intake. Conclusion: The food consumption of Jordanian children and adolescents includes high intakes of discretionary calories, with a low intake of fruits, vegetables, and dairy products. The prevalence of overweight/obesity was elevated compared to international norms.

Association Among Cystic Volume, Intracystic Pressure, and Histopathological Changes in the Liver in Patients With Choledochal Cyst.

Background Choledochal cyst is a congenital cystic dilatation of the biliary tree. Various aspects of pathophysiology are unclear, particularly with reference to intracholedochal cystic pressure (ICCP) and liver histopathology. This study aimed to determine the relationship among cystic volume, ICCP, and histopathological changes in the liver in patients with choledochal cysts. Methods This cross-sectional study was carried out among 21 patients diagnosed with choledochal cysts, who attended the Department of Pediatric Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU) from April 2021 to August 2022. Cystic volume was measured pre-operatively using ultrasonography, while ICCP was measured per-operatively with a pressure gauge. Liver histology was assessed through an intraoperative liver biopsy and graded using the meta-analysis of histological data in viral hepatitis (METAVIR) scoring system. The data were analyzed using SPSS version 25.0 (IBM Corporation, Armonk, New York). Frequency and percentages were calculated to present categorical variables, and for quantitative variables, mean, standard deviation (SD), median, and interquartile range (IQR) were calculated. Fisher's exact tests were performed to determine the association between cystic volume, ICCP, and the grading of hepatic fibrosis. A p-value of <0.05 was considered statistically significant. Results The age of the patients ranged from 1 to 12 years, with a mean of 5.0±3.4 years. The male-to-female ratio was 1:4.3. Type I cysts were the most prevalent (71.4%). The median and IQR for cystic volume were 3.4 ml and 1.1-8.2 ml, respectively. The median and IQR for ICCP were 7.46 mmHg and 4.67-9.33 mmHg, respectively. The most frequent grade of fibrosis was F1 (38.1%), followed by F2 (23.8%) and F3 (23.8%). A negative relationship between cystic volume and ICCP was observed, which was statistically significant (p=0.008). A positive relationship was also observed between ICCP and the grading of liver fibrosis, which was statistically significant (p=0.002). Although a negative correlation between cystic volume and grading of liver fibrosis was noted, it was not statistically significant (p=0.198). Conclusions This study reveals significant associations between cystic volume, ICCP, and the grading of liver fibrosis in patients with choledochal cysts. Smaller volume cysts may exhibit higher ICCP, resulting in more pronounced fibrotic changes in the liver.

Evaluation of Colonoscopy and Sigmoidoscopy Utilization for Colorectal Cancer Screening in Georgia, USA.

Colorectal cancer (CRC) is the third most prevalent cancer, and the second most common cancer-related cause of death in the United States (USA). Timely screening reduces both CRC incidence and mortality. Understanding population behaviors and factors that influence CRC screening is important for directing interventions targeted at reducing CRC rates. The 1997-2018 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed for trends in colonoscopy and sigmoidoscopy utilization for CRC screening among adults in Georgia, USA. Overall, in Georgia, there has been an increase in the prevalence of colonoscopy and sigmoidoscopy utilization from 48.1% in 1997 to 71.2% in 2018 (AAPC = 2.30, p < 0.001). Compared nationally, this increase was less pronounced (from 41.0% in 1997 to 73.7% in 2018 (AAPC = 2.90, p < 0.001) overall for USA). Logistic regression analysis of the 2018 BRFSS data, adjusting for sociodemographic factors, shows that sex (female vs. male [aOR = 1.20, C.I. = 1.05, 1.38]); marital status (couple vs. single [aOR = 1.20, C.I. = 1.04, 1.39]); healthcare coverage (yes vs. no [aOR = 3.86, C.I. = 3.05, 4.88]); age (60-69 years [aOR = 2.38, C.I. = 2.02, 2.80], 70-79 [aOR = 2.88, C.I. = 2.38, 3.48] vs. 50-59 years); education (high school [aOR = 1.32, C.I. = 1.05, 1.65], some post high school [aOR= 1.63, C.I. = 1.29, 2.06], college graduate [aOR = 2.08, C.I. = 1.64, 2.63] vs. less than high school); and income ($25,000-$49,999 [aOR = 1.24, C.I. = 1.01, 1.51], $50,000+ [aOR = 1.56, C.I. = 1.27, 1.91] vs. <$25,000) were all significantly associated with colonoscopy and sigmoidoscopy utilization. In Georgia, a significant increase over time in colonoscopy and sigmoidoscopy utilization for CRC screening was observed pertaining to the associated sociodemographic factors. The findings from this study may help guide tailored programs for promoting screening among underserved populations.

Encephalitis in Children: Viruses and Beyond.

Encephalitis is commonly caused by viruses. But beyond viruses there are so many causes of encephalitis. Encephalitis is the inflammation of the brain parenchyma due to any reason. As there are so many causes of encephalitis presentations are also variable. So to diagnose encephalitis a set of clinical, laboratory, electroencephalographic and neuroimaging criteria is used. Any children attend medical facility with sudden onset altered mental status along with any of the following features like fever, seizure, focal neurological signs should be evaluated as encephalitis. Viruses are the common cause of encephalitis. Along with infectious etiologies a vast group of noninfectious like autoimmune causes encephalitis also established. When children presented with above mentioned features along with behavior problem and or movement disorder there is a high suspicion of autoimmune etiology. Any suspected case of encephalitis should initiated treatment with antiviral along with supportive treatment; then step wise evaluation should be done to reach an etiological diagnosis. If infectious etiology could not be established or no significant improvement is found with antiviral therapy; immunomodulating therapy should be considered along. In all cases CSF analysis including biochemistry, cytology, viral PCR along with MRI and EEG should do; further investigations depend upon initial reports and clinical and epidemiological background. Dose and duration of antiviral depends on patient's age and response to treatment and comorbidity. Acyclovir 500mg/m²/BSA per dose 3 times daily for 21 days are adequate for HSV encephalitis. Monitoring of renal function is the essential. Adjuvant treatment with steroid and or manitol for cerebral edema and antiseizure drugs for convulsion is used where necessary. Meticulous fluid and nutritional support as well good general care improve outcome. In spite of adequate treatment of encephalitis mortality and morbidity was found a significant number of cases; among the morbidity behavior problem, seizure focal deficit are common.