Obesity is associated with adverse outcomes in primary immune thrombocytopenia - a retrospective single-center study.

The pathophysiology of immune thrombocytopenia (ITP) involves immune-mediated platelet destruction. The presence of adipose tissue in obese individuals creates an inflammatory environment that could potentially impact the clinical course and outcomes of ITP. However the relationship between obesity and ITP outcomes has not been well described. We evaluated ITP outcomes in 275 patients diagnosed with primary ITP from 2012 to 2022. Patients were categorized into four groups based on their body mass index (BMI) at diagnosis. Female gender was associated with a lower platelet count at the time of diagnosis at any BMI. Patients with high BMI had lower platelet counts at diagnosis and at platelet nadir (p < 0.001), an increased likelihood of requiring therapy (p < 0.001) and requiring multiple lines of therapy (p = 0.032). Non-obese patients who required corticosteroid treatment experienced a longer remission duration compared to obese patients (p = 0.009) and were less likely to be steroid-dependent (p = 0.048). Our findings suggest that obesity may be a significant risk factor for developing ITP and for ITP prognosis. Future studies are needed to evaluate the role of weight loss intervention in improving ITP outcomes.

Biofilm forming, exopolysaccharide producing and halotolerant, bacterial consortium mitigates salinity stress in Triticum aestivum.

Biofilm and EPS characterization of a rhizobacterial isolate BC-II-20 was done using biophysical techniques. SEM revealed surface morphology of EPS powder to be irregular porous web-like structure. FTIR spectra showed peaks of the polymeric carbohydrate functional groups with probable role in imparting biological properties to EPS. XRD analysis showed signal at 220 (2θ) and confirms its amorphous or semi-crystalline nature. EPS derived from bacterial consortium gradually increased under 200 mM, 400 mM, 600 mM and 800 mM NaCl and SEM-EDAX analysis of EPS showed increase in Na & Cl peaks under the above salt concentrations, depicting EPS-NaCl binding. Triticum aestivum plants under 200 mM NaCl stress with different combinations of treatments showed that bacterial consortium provides tolerance. Under 200 mM salt stress the shoot length was 7.74 cm and total chlorophyll was 4.16 mg g-1Fw of the uninoculated plants whereas inoculated ones were 9.94 cm and 5.62 mg g-1Fw respectively. Under salinity stress, membrane stability index was increased from 47 % to 61 % and electrolyte leakage was decreased to 48 % from 64 %, after inoculation with bacterial consortium. Therefore, consortium comprising of these halotolerant and biofilm forming, EPS producing bioinoculants provides salt tolerance and can be exploited as a sustainable alternative for stress tolerance.

Patent landscaping and citation network analysis to reveal the global research trends in biopriming using microbial inoculants: an insight toward sustainable agriculture.

As an alternative to harmful chemical fertilizers and toward fulfilling Sustainable Development Goals (SDGs) of the United Nations, growth promoting rhizobacterial bioinoculants, emerged as potential players. These act in multifunctional ways, including seed colonization, seed germination, stress tolerance and many more, leading to proper growth and development of plants. Biopriming seeds with these beneficial multi-trait microbes is an effective way to introduce them in the soil, and this is an example of bottom-up approach of rhizosphere engineering. Using such sustainable approach is promising and, to investigate and analyze, their research trends are of prime importance. Thus, data were retrieved using Lens and Scopus databases and used for patent landscaping and citation network analysis, respectively. For patent landscaping, documents obtained using customized keyword search were broadly from the past 35 years (1987-2022) and yielded 114 patents which were manually curated in title, abstract and claims (TAC). From the year 2000, interest in this area was observed which further gained momentum from the year 2008, and a maximum peak was observed in the year 2021. Patent profile (filed, granted and published) showed an upward trend during this tenure (1987-2022). In this research article, we aim to provide an overview of current research in this field, identify research hotspots, project future development prospects and make recommendations for further research. Patent landscaping and citation network analysis were used to analyze the recent trends in biopriming approaches using microbial bioinoculants for the first time to identify progress and hotspots in the field of seed priming with PGPRs.

Rasburicase-induced hemolytic anemia and methemoglobinemia: a systematic review of current reports.

Since the FDA's approval of rasburicase use for treatment of tumor lysis syndrome (TLS), multiple cases of rasburicase-induced methemoglobinemia and hemolytic anemia have been reported among patients with G6PD deficiency. This study aims to provide a systematic review of cases reporting such adverse reactions to rasburicase. A literature review of published cases in PubMed, Embase, Cochrane, and Web of Science was conducted. Descriptive studies reporting cases of rasburicase-induced methemoglobinemia and/or hemolytic anemia in English were analyzed and summarized in this study. Forty-three cases, including a case from our institution, were included in this study. Most cases (60.5%) received rasburicase for TLS treatment. Almost all patients (93.8%) were tested for G6PD after rasburicase administration. The median time to symptom onset was 24 h. The median methemoglobin level was 10%, peaking after a median of 24 h. The median hemoglobin nadir was 6.1 g/dL, and most patients (n = 32) required blood transfusion. Out of 39 cases with reported outcomes, 35 patients (89.7%) recovered, while four patients (three females and one male) died. The median time to recovery was 4.5 days while the median time to death was 8 days. Screening for G6PD deficiency among high-risk patients is important but not practical in acutely severe settings. When prior screening for G6PD deficiency is not feasible, close monitoring for methemoglobinemia and hemolytic anemia is recommended. Exchange transfusion is increasingly reported as a potentially successful therapeutic modality. Ascorbic acid may provide limited benefits. Methylene blue should be avoided as it may exacerbate hemolysis among these patients.

Role of innate immunological/inflammatory pathways in myelodysplastic syndromes and AML: a narrative review.

Dysregulation of the innate immune system and inflammatory-related pathways has been implicated in hematopoietic defects in the bone marrow microenvironment and associated with aging, clonal hematopoiesis, myelodysplastic syndromes (MDS), and acute myeloid leukemia (AML). As the innate immune system and its pathway regulators have been implicated in the pathogenesis of MDS/AML, novel approaches targeting these pathways have shown promising results. Variability in expression of Toll like receptors (TLRs), abnormal levels of MyD88 and subsequent activation of NF-κß, dysregulated IL1-receptor associated kinases (IRAK), alterations in TGF-ß and SMAD signaling, high levels of S100A8/A9 have all been implicated in pathogenesis of MDS/AML. In this review we not only discuss the interplay of various innate immune pathways in MDS pathogenesis but also focus on potential therapeutic targets from recent clinical trials including the use of monoclonal antibodies and small molecule inhibitors against these pathways.

Challenges with the use of Xpert HPV as a screening tool for oral HPV among people living with HIV (PLHIV): experiences from Pune, India.

BACKGROUND: People living with HIV (PLHIV) are at higher risk for human papillomavirus (HPV)-related oropharyngeal cancers compared to the general population. Xpert HPV test is a polymerase chain reaction (PCR) assay capable of rapid HPV detection. Performing the assay requires minimal intervention by laboratory personnel. Its use could improve oropharyngeal cancer screening among PLHIV living in low-and middle-income countries (LMICs) with limited diagnostic capacities. However, Xpert HPV performance for oral samples has not been evaluated. Here, we describe our experience with Xpert HPV and compare its results with traditional PCR, for oral samples. METHODS: Oral samples from 429 PLHIV receiving care at a tertiary care hospital affiliated antiretroviral therapy center in Pune, India were used. Samples were collected either after a 30s oral rinse and gargle (n = 335) or in combination with cytobrush scraping of the oral mucosa (n = 91). Unsuccessful tests were those that generated an invalid or error result on Xpert HPV. Successful tests were those that generated a positive or negative result. Kappa statistic was used to compare concordance between Xpert HPV and traditional real-time PCR results. RESULTS: There were 29.8% (n = 127) unsuccessful tests, of which 78.7% (n = 100) were invalid and 21.3% (n = 27) were error results. Adding cytobrush scraping to oral rinse as a collection procedure did not significantly reduce the proportion of unsuccessful tests (p = 0.9). For successful tests, HPV positivity on Xpert was 0.3% (n = 1/299). Kappa statistic was 0.11, indicating poor agreement between Xpert HPV and traditional PCR results. CONCLUSIONS: Presently, Xpert HPV appears to have limited use for oral HPV detection among PLHIV using oral samples. More research to improve the diagnostic capabilities of Xpert HPV for oral samples among PLHIV is needed.

Prevalence, Associated Factors, and Impact of Workplace Violence among Physicians.

BACKGROUND: There is a dearth of objective data and studies pertaining to the prevalence and consequences of workplace violence against physicians in Nepal. This study aims to assess the prevalence, associated factors, and implications of workplace violence on Nepalese physicians. METHODS: We conducted a cross-sectional study from March 2021 to August 2021. Nepal Medical Council-certified physicians currently working in Nepal were included in the study. Baseline characteristics, types of violence experienced, patterns, psychosocial impacts, and changes in patient management were collected. RESULTS: Out of 318 responses received, 302 responses met the inclusion criteria and were included in the final analysis. One-hundred and ninety (62.9%) respondents had ever faced workplace violence. Madhesh Province had the highest prevalence (81.5%). Verbal abuse (93.2%) was the most common type of violence encountered. We found a significant association between workplace violence and hours worked each week. We also found an association between workplace violence and years of experience. Our study found a significant increase in stress/depression/anxiety/idea of persecution, sense of defeat, job turnover, and loss of productivity/income with the increase in severity of workplace violence. CONCLUSIONS: Workplace violence is largely prevalent among Nepalese physicians. In the aftermath of workplace violence, a physician can undergo a multitude of adverse psychosocial consequences leading to a further decrease in productivity. More insights through research, formal training, and policy implementation are necessary to overcome this largely ignored problem of the medical fraternity in Nepal.

Strengthening microbial cell factories for efficient production of bioactive molecules.

High demand of bioactive molecules (food additives, antibiotics, plant growth enhancers, cosmetics, pigments and other commercial products) is the prime need for the betterment of human life where the applicability of the synthetic chemical product is on the saturation due to associated toxicity and ornamentations. It has been noticed that the discovery and productivity of such molecules in natural scenarios are limited due to low cellular yields as well as less optimized conventional methods. In this respect, microbial cell factories timely fulfilling the requirement of synthesizing bioactive molecules by improving production yield and screening more promising structural homologues of the native molecule. Where the robustness of the microbial host can be potentially achieved by taking advantage of cell engineering approaches such as tuning functional and adjustable factors, metabolic balancing, adapting cellular transcription machinery, applying high throughput OMICs tools, stability of genotype/phenotype, organelle optimizations, genome editing (CRISPER/Cas mediated system) and also by developing accurate model systems via machine-learning tools. In this article, we provide an overview from traditional to recent trends and the application of newly developed technologies, for strengthening the systemic approaches and providing future directions for enhancing the robustness of microbial cell factories to speed up the production of biomolecules for commercial purposes.

Posterior Nasal Nerve Resection-A Novel and Effective Way to Surgically Treat Refractory Allergic and Vasomotor Rhinitis.

This study focused on outcomes of endoscopic posterior nasal neurectomy and turbinate reduction with regard to the common symptoms of allergic and vasomotor rhinitis. This randomized experimental study conducted between December 2018 to November 2020 included 60 patients, aged 18-50 years with allergic or vasomotor rhinitis with/ without deviated nasal septum of grade 3 and 4, not responding to conservative management. Patients were divided into two groups. 30 patients were operated for Posterior nasal nerve resection and 30 patients underwent turbinate reduction. SNOT 22 (Sino-nasal outcome test) questionnaire was given to every patient and they were asked four major symptoms of nasal obstruction, rhinorrhoea, sneezing and post nasal discharge and were told to rate their symptom in 1 to 5 severity scale before surgery and in postoperative follow up. Mean ± SD(standard deviation) of percentage change in SNOT 22 score in Posterior Nasal Nerve resection was 88.09 ± 4.38 which was significantly higher than turbinate reduction (82.95 ± 5.33) (p value = 0.0001). Distribution of post-operative complications was comparable in turbinate reduction and Posterior Nasal Nerve resection (Both synechia and crusting:10 versus 6.67% respectively) (p value = 1). No patient had bleeding in both groups. Though skill demand is high, posterior nasal neurectomy is highly safe and effective, as there was no bleeding post-operatively in spite of handling the sphenopalatine artery. Symptom relief with this surgery was 88.09% which was significantly higher as compared to submucosal resection of inferior turbinate with microdebrider (82.95%).

Smokeless tobacco use and oral potentially malignant disorders among people living with HIV (PLHIV) in Pune, India: Implications for oral cancer screening in PLHIV.

INTRODUCTION: In India, smokeless tobacco (SLT) is a predominant form of tobacco used among people living with HIV (PLHIV). Despite SLT being a risk factor for oral potentially malignant disorders (OPMDs), no prior studies have quantified the association of OPMDs with SLT use among PLHIV. This limits the planning of preventive and control strategies for oral cancer among PLHIV, who are at higher risk for the disease. METHODS: We enrolled 601 PLHIV and 633 HIV-uninfected individuals in an oral cancer screening study at BJ Government Medical College, Pune, India. Oral cavity images were collected using an m-Health application and reviewed by three clinicians. Participants with two clinician positive diagnoses were deemed to have suspected OPMDs. Prevalence ratios (PRs) were used to quantify the association between suspected OPMDs and SLT use among PLHIV. PRs for current SLT users, across HIV status and use duration were also estimated. Corrected PRs were obtained by modifying the maximum likelihood estimation. Models were adjusted for age, smoking, alcohol use and CD4 counts. RESULTS: Of those enrolled, 61% were men, median age was 36 years (IQR: 28-44), and 33% currently use SLT. Proportion of current SLT users was similar across PLHIV and HIV-uninfected groups but use duration for current SLT use was higher among PLHIV(p<0.05). Among PLHIV, current SLT users had a 5-times (95% CI:3.1-7.0) higher prevalence of suspected OPMDs, compared to non-users. Relative to HIV uninfected individuals with the same SLT use duration, significant associations with suspected OPMDs were seen for PLHIV with<10 use years (PR: 3.5, 95% CI: 1.5-8.1) but not for PLHIV with≥10 use years (PR: 1.3, 95% CI: 0.9-1.8). CONCLUSION: PLHIV that are current SLT users are at high risk of OPMDs and potentially oral cancer. The development of strategies for screening, early detection, and management of OPMDs must be considered for this group.

Protective effects of cyclosporine A on neurodegeneration and motor impairment in rotenone-induced experimental models of Parkinson's disease.

The development of neuroprotective drugs targeting mitochondria could be an important strategy in combating the progressive clinical course of Parkinson's disease. In the current study, we demonstrated that in SH-SY5Y cells (human dopaminergic neuroblastoma cell line), rotenone caused a dose-dependent (0.25-1 µM) and time-dependent (up to 48 h) loss of cell viability and a loss of cellular ATP content with mitochondrial membrane depolarization and an increased formation of reactive oxygen species; all these processes were markedly prevented by the mitochondrial permeability transition pore blocker cyclosporine A, which did not affect complex I inhibition by rotenone. The nuclear morphology of rotenone-treated cells for 48 h indicated the presence of both necrosis and apoptosis. We then examined the effects of cyclosporine A on the rotenone-induced model of Parkinson's disease in Wistar rats. Cyclosporine A significantly improved the motor deficits and prevented the loss of nigral dopaminergic neurons projecting into the striatum in rotenone-treated rats. Being a marketed immuno-suppressive drug, cyclosporine A should be further evaluated for its putative neuroprotective action in Parkinson's disease.

Food fermentation - Significance to public health and sustainability challenges of modern diet and food systems.

Current modern dietary patterns throughout the world have resulted in adverse health implications. On the other hand, current agricultural practices and methods employed in food industries lead to the exploitation of the environment and generate nutrient-rich waste, which is underutilized. The simple answer to both these problems could be the adoption of fermentation technology. Due to the presence of functional microorganisms, fermented foods possess unique properties like probiotics properties, antimicrobial, antioxidant, peptide production, etc., imparting health benefits to consumers. Moreover, agricultural and food processing waste fermentation could generate value-added healthy foods and sustainable food sources. Not only this, fermented food products can be an essential source of generating livelihoods by producing necessary food ingredients through fermentation of commonly generated organic wastes in rural areas and encouraging and promoting traditional fermented recipes that are also healthy. This review discusses how reviving and promoting food fermentation technology can help reduce these two problems related to health and sustainability. Furthermore, the role of lactic acid bacteria and fungi like yeast, Penicillium, Acetobacter etc., in producing beneficial metabolites and their impact on controlling various lifestyle disorders and aging have been discussed. In addition, fermented foods also enrich gut microbiota, which imparts health benefits.

Diagnosis and Management of Global Development Delay: Consensus Guidelines of Growth, Development and Behavioral Pediatrics Chapter, Neurology Chapter and Neurodevelopment Pediatrics Chapter of the Indian Academy of Pediatrics.

JUSTIFICATION: Global developmental delay (GDD) is a relatively common neurodevelopmental disorder; however, paucity of published literature and absence of uniform guidelines increases the complexity of clinical management of this condition. Hence, there is a need of practical guidelines for the pediatrician on the diagnosis and management of GDD, summarizing the available evidence, and filling in the gaps in existing knowledge and practices. PROCESS: Seven subcommittees of subject experts comprising of writing and expert group from among members of Indian Academy of Pediatrics (IAP) and its chapters of Neurology, Neurodevelopment Pediatrics and Growth Development and Behavioral Pediatrics were constituted, who reviewed literature, developed key questions and prepared the first draft on guidelines after multiple rounds of discussion. The guidelines were then discussed by the whole group in an online meeting. The points of contention were discussed and a general consensus was arrived at, after which final guidelines were drafted by the writing group and approved by all contributors. The guidelines were then approved by the Executive Board of IAP. Guidelines: GDD is defined as significant delay (at least 2 standard deviations below the mean with standardized developmental tests) in at least two developmental domains in children under 5 years of age; however, children whose delay can be explained primarily by motor issues or severe uncorrected visual/hearing impairment are excluded. Severity of GDD can be classified as mild, moderate, severe and profound on adaptive functioning. For all children, in addition to routine surveillance, developmental screening using standardized tools should be done at 9-12 months,18-24 months, and at school entry; whereas, for high risk infants, it should be done 6-monthly till 24 months and yearly till 5 years of age; in addition to once at school entry. All children, especially those diagnosed with GDD, should be screened for ASD at 18-24 months, and if screen negative, again at 3 years of age. It is recommended that investigations should always follow a careful history and examination to plan targeted testing and, vision and hearing screening should be done in all cases prior to standardized tests of development. Neuro-imaging, preferably magnetic resonance imaging of the brain, should be obtained when specific clinical indicators are present. Biochemical and metabolic investigations should be targeted towards identifying treatable conditions and genetic tests are recommended in presence of clinical suspicion of a genetic syndrome and/or in the absence of a clear etiology. Multidisciplinary intervention should be initiated soon after the delay is recognized even before a formal diagnosis is made, and early intervention for high risk infants should start in the nursery with developmentally supportive care. Detailed structured counselling of family regarding the diagnosis, etiology, comorbidities, investigations, management, prognosis and follow-up is recommended. Regular targeted follow-up should be done, preferably in consultation with a team of experts led by a developmental pediatrician/ pediatric neurologist.

Air under the diaphragm-perforation or Chilaiditi sign?

Chilaiditi sign is a rare radiological finding in which the colon is interposed between the liver and the abdominal wall. Once patients become symptomatic, the condition is called Chilaiditi syndrome. We discuss a unique patient who presented with intermittent abdominal pain for 2 years that worsened 6 months before presentation. Her radiological evaluation revealed Chilaiditi sign. She was treated conservatively and the sign resolved. We emphasize the importance of conservative management in Chilaiditi syndrome.

Neurosarcoidosis Presenting as Young-Onset Chronic Headache: A Case Report.

Sarcoidosis causes granulomatous inflammation in multiple organ systems. Lungs are the most commonly affected organs. In 50% of the cases with lung involvement, other organs are also involved. The central nervous system is one of the rarer organ systems involved - comprising 5-15% of all the cases. Neurological involvement, when present, can affect virtually every part of the central and peripheral nervous system. We present an interesting case of a 30-year-old nonalcoholic, nonsmoker man who presented with a chronic headache of 6 years. He had a recent swaying of the body for 6 months and mild forgetfulness for 4 months. The patient had 2 episodes of facial nerve palsy in the past - which had responded to the treatment of Bell's palsy; however, the patient had some residual findings on presentation. While CSF findings suggested meningeal tuberculosis, the radiological evidence and biopsy confirmed the diagnosis of neurosarcoidosis. On follow-up after 6 weeks of steroid therapy, the patient displayed a marked improvement in headache, cognitive function, and a good response on imaging studies. Our case emphasizes that neurosarcoidosis should be considered in the differential diagnosis of chronic headaches and recurrent facial nerve palsy despite being very rare.

Cancer burden in Nepal, 1990-2017: An analysis of the Global Burden of Disease study.

INTRODUCTION: Cancer is the second leading cause of death and a major public health problem in the world. This study reports the trend and burden of cancer from 1990 to 2017 along with its risk factors in Nepal. METHODS: This study used the database of the Institute of Health Metrics and Evaluation's Global Burden of Diseases on cancer from Nepal to describe the most recent data available (2017) and trends by age, gender, and year from 1990 to 2017. The data are described as incidence, prevalence, disability-adjusted life years (DALY), and percentage change. RESULTS: In 2017, the age-standardized cancer incidence and mortality rates were 101.8/100,000 and 86.6/100,000 respectively in Nepal. Cancer contributed to 10% of total deaths and 5.6% of total DALYs in Nepal. The most common cancers were the breast, lung, cervical, stomach and oral cavity cancers. The number of new cancer cases and deaths in Nepal have increased from 1990 to 2017 by 92% and 95% respectively. On the other hand, age-standardized incidence and mortality rates decreased by 5% and 7% respectively. The leading risk factors of cancer were tobacco use, dietary factors, unsafe sex, air pollution, drug use, and physical inactivity. CONCLUSIONS: This study highlighted the burden of cancer in Nepal, contributing to a significant number of new cancer cases, deaths and DALY. A comprehensive approach including prevention, early diagnosis and treatment, and rehabilitation should be urgently taken to reduce the burden of cancer.

Effect of natural deep eutectic solvents on thermal stability, syneresis, and viscoelastic properties of high amylose starch.

This work aimed to use natural deep eutectic solvents to modify the thermal, textural, freeze-thaw, and rheological properties of high amylose rice starch. Three different natural deep eutectic solvents (NADES) composed of sugar and organic acids were applied to modify the properties of starch dispersion. In presence of NADES, the onset temperature of starch was decreased, in comparison with starch in aqueous and glycerol medium. During thermal decomposition, starch with the aqueous and glycerol systems showed two-step weight losses whereas with NADES starch showed single-stage weight losses or decomposition. Moreover, negligible syneresis was observed for starch-NADES dispersion after 3rd cycle of the freeze-thaw process. The flow behavior of starch-NADES dispersion follows Herschel-Bulkley models as R2 (0.996 ≤ R2 ≤ 0.999) are higher than the Mizrahi-Berk model. The flow behavior index (n) of starch-NADES dispersion was closer to 1, indicated a nearly Newtonian fluid. The loss modulus (G″) value of starch-NADES dispersions was markedly higher than the corresponding storage modulus (G') value and thus materials behaved like viscoelastic liquid. The present study manifested a green way to modify the properties of the high amylose starch to improve the processing stability.

Endophytic Microbial Diversity: A New Hope for the Production of Novel Anti-tumor and Anti-HIV Agents as Future Therapeutics.

Cancer is a collective name for a variety of diseases that can begin in virtually every organ or body tissue as abnormal cells develop uncontrollably and ten million new cancer cases are diagnosed all over the world at present. Whereas HIV is a virus that makes people susceptible to infection and contributes to the condition of acquired immune deficiency syndrome (AIDS). Almost 37 million people are currently diagnosed with HIV and 1 million people die every year, which is the worst-case scenario. Potential medicinal compounds have played a crucial role in the production of certain clinically beneficial novel anti-cancer and anti-HIV agents that are produced from natural sources especially from plants. These include Taxol, Vinblastine, Podophyllotoxin, Betulinic acid, Camptothecin, and Vincristine, etc. In the past decades, bioactive compounds were extracted directly from the plant sources which was more time consuming, led to low yield productivity, high cost, and bad impact on biodiversity. Endophytes, the microorganisms that reside inside the host plant by not causing any kind of harm to them and have potential applications in agriculture, medicine, pollution, and food industries. Therefore, by isolating and characterizing novel endophytes from medicinal plants and extracting their secondary metabolites to produce useful bioactive compounds can be beneficial for well-being and society as a future therapeutics. This approach is not harmful to biodiversity economical, timesaving, low cost, and can lead to the discovery of various industrial and commercially important novel anti-tumor and anti-HIV agents in the future. The Himalayas are home to several medicinal plants and the endophytic microbial biodiversity of the Himalayan region is also not much explored yet. However, the effect of compounds from these endophytes on anticancer and antiviral activity, especially anti-HIV has been largely unexplored. Hence, the present review is designed to the exploration of endophytic microbial diversity that can give rise to the discovery of various novel potential industrially valuable bioactive compounds that can lessen the rate of such type of pandemic diseases in the future by providing low-cost future therapeutics in future.

Experiences of cervical cancer survivors in Chitwan, Nepal: A qualitative study.

INTRODUCTION: Cervical cancer is a global leading cause of morbidity and mortality. The majority of cervical cancer deaths occur in developing countries including Nepal. Though knowledge of cervical cancer is an important determinant of women's participation in prevention and screening for cervical cancer, little is known about this topic in Nepal. This study explores the experiences of cervical cancer survivors and assesses the attitude of family and community towards it and stigma related to this disease in Bharatpur, Nepal. METHODS: The study design was qualitative methods involving two focus-group discussions. A total of 17 cervical cancer survivors, who have completed two years of cancer treatment were selected purposively from Chitwan. All qualitative data were transcribed and translated into English and were thematically analyzed. RESULTS: The majority of the participants had scant knowledge about cervical cancer, its causative agent, showed less cervical cancer screening, delayed healthcare-seeking behavior despite having persistent symptoms before the diagnosis. The main reasons identified for not uptaking the cervical screening methods were an embarrassment and having no symptoms at all. Most of them endured social stigma related to cervical cancer in the form of physical isolation and verbal abuse. CONCLUSIONS: There is an urgent need for interventions to make women and the public aware of cervical cancer and launch effective health education campaigns, policies for cervical cancer prevention programs. This implementation can save the lives of hundreds of women and help them avoid going through all the negative experiences related to cervical cancer. More studies are required to gain the perspectives, knowledge, experiences, and attitudes of cervical cancer survivors to add to the research.

An Unusual Case of Tetanus Masquerading as an Acute Abdomen: A Case Report.

INTRODUCTION: Tetanus is an acute onset neurological disease that is often lethal. It has a high disease burden in low and middle-income countries. Tetanus is caused by a toxin made by spores of the bacterium Clostridium tetani, which are found in soil, dust, and animal feces. The toxin impairs the motor neurons leading to muscle stiffness. However, with the development of a toxoid vaccine, the incidence has sharply declined and is now categorized as a vaccine-preventable disease. The treatment of tetanus is primarily supportive and focuses on managing the complications until the effects of toxins resolve. CASE REPORT: We report the case of a 67-year-old farmer who previously sustained a laceration injury approximately 45 days prior to presenting to the emergency department with abdominal pain and rigidity. After a comprehensive evaluation to rule out other items in the differential diagnoses, he was diagnosed with tetanus based on clinical symptoms and ultimately required mechanical ventilation. The patient was then managed in the intensive care unit and later made an uneventful recovery. CONCLUSION: This case illustrates an uncommon presentation of tetanus and the latency of the infectious process. Often when patients present with atypical symptoms, it poses a diagnostic dilemma to the clinicians. Thus, it is very important to carefully elicit a history of contaminated injury. This case also highlights the importance of prophylactic vaccine in low and middle-income countries, which can reduce disease-related mortality and morbidity.