Parents's knowledge and awareness about hepatitis B can influence the vaccination of their children.

BACKGROUND: Birth-dose (Hep-BD) followed by three additional doses (Hep-B3) of hepatitis B virus (HBV) vaccine are key to eliminating HBV by 2030. Unfortunately, Hep-BD and Hep-B3 coverage in our country is poor. AIM: To studied the parent's knowledge and awareness about HBV infection, its prevention, consequences and vaccination. METHODS: Parents of 6 months to 8 years old children were interviewed to assess their knowledge & awareness about hepatitis B, its transmission, prevention, illness caused by this, and vaccination. Eighteen close-ended questions were administered, and responses were recorded as 'yes', 'no', or 'not sure'. HBV knowledge score was calculated based on the sum of correct answers. Each correct response scored one point and incorrect, missing or 'not sure' responses received no points. Categorical data are presented as number (%) and numerical data are expressed as median. Data were compared using Chi2 tests and level of significance was kept as P < 0.05. RESULTS: Parents (58.3% mothers) of 384 children (89.9% age < 5 years; 82% age-appropriately vaccinated) were included. Three hundred and twenty-two (83.9%) children were Hep-B3 vaccinated. 94.3%, 87.5%, and 29.2% parents knew about polio, tetanus, and hepatitis B vaccine. Overall, 41.2%, 15.8%, and 23% parents knew about hepatitis B transmission, consequences of infection, and prevention respectively. Only 7.6% parents knew about three-dose schedule of hepatitis B vaccination. Only 23% parents believed that vaccine could prevent HBV, 15.7% knew that HBV affects liver. Parents of Hep-B3 vaccinated children were significantly more aware about HBV than the parents of unvaccinated children (P < 0.05 for 17/18 questions). CONCLUSION: The knowledge and awareness among the parents about hepatitis B is poor. The Increasing knowledge/awareness about HBV among parents may improve Hep-B3 vaccination coverage.

Exploring the Explosive Potential: Synthesis and Characterization of Ring-Fused Oxadiazolo[3,4-b]pyrazine 1-Oxide Polymorphs with Balanced Energetic Properties.

A novel fused-ring compound, 5-azido-6-oxo-6,7-dihydro-[1,2,5]oxadiazolo[3,4-b]pyrazine 1-oxide (3a), was synthesized for the first time with simple two-step process and characterized using various spectroscopic techniques such NMR, IR, EA and HRMS. Two polymorphs (α-3a and ß-3a) identified by SCXRD differ in crystal packing and noncovalent interactions, demonstrating high density, substantial heat of formation, and superior detonation properties with reduced mechanical sensitivity compared to TNT, TATB, and close to RDX, suggesting their potential as environmentally friendly high energy density materials.

Elevating the energetic capabilities of metal coordination compounds by incorporating nitrate anions.

In the realm of energetic materials research, there has been notable interest in energetic coordination compounds (ECCs) owing to their remarkable thermal stability and resistance to mechanical stimuli. This study successfully demonstrated the synthesis of an azole-based C-C bonded ECC1 under ambient conditions. A comprehensive characterization study, employing techniques such as IR, TGA-DSC, NMR and single-crystal X-ray diffraction analysis, was conducted. The bulk compound was investigated by PXRD analysis. In-depth exploration of its physicochemical and energetic performance revealed good detonation properties such as a detonation velocity (VOD) of 8553 m s-1 and a detonation pressure (DP) of 36.2 GPa, which surpass those of heat resistant explosives HNS and TATB. Due to its remarkable high melting and onset decomposition temperature (278/379 °C), it also outperforms the benchmark explosive HMX (279 °C) and the heat-resistant explosive HNS (318 °C) and shows a high impact sensitivity (IS) of 20 J and friction sensitivity (FS) of 360 N. The study also employed Hirshfeld surface and 2D fingerprint analysis to elucidate the close contact of atoms within the molecules. The combination of high detonation properties, thermal stability, and low sensitivity makes the synthesized ECC1 intriguing for further investigations and suggests its potential applications as a safe and high-energy-dense material.

Solvent Free Potassium 3,5-dinitro-6-oxo-1,6-dihydropyrazin-2-olate 3D EMOF as Thermally Stable Energetic Material.

Heat-resistant explosives play a vital role in indispensable applications. For this, we have synthesized a novel, three-dimensional, solvent-free energetic metal-organic framework (EMOF) potassium 3,5-dinitro-6-oxo-1,6-dihydropyrazin-2-olate (KDNODP) straightforwardly. The synthesized EMOF was characterized through IR, NMR spectroscopy, elemental analysis, and differential scanning calorimetry studies. Furthermore, single-crystal X-ray diffraction provided a complete description of KDNODP. It exhibits a three-dimensional EMOF structure with remarkably balanced properties such as high density (2.11 g cm-3), excellent thermal stability (291 °C), good detonation performance (8127 m s-1 and 26.94 GPa) and low mechanical sensitivity (IS=35 J; FS=360 N) than the commonly used heat-resistant explosives HNS (density=1.74 g cm-3; VOD=7164 m s-1, DP=21.65 GPa, IS=5 J) as well as the similar reported energetic potassium MOFs. To gain insights into the packing and intermolecular interactions, the Hirshfeld surface and a 2D fingerprint analysis were examined. Additionally, scanning electron microscopy was used to investigate the particle size and morphological characteristics of KDNODP. These outcomes highlight a successful method for creating 3D EMOF based on a six-membered heterocycle as a potential heat-resistant energetic material.

Simultaneous Liver Kidney Transplantation in a Primary Type 2 Hyperoxaluria With Corrected TOF and Severe Cardiomyopathy: A Case Report.

Background: Primary type 2 hyperoxaluria is a very rare genetic disorder,1,2 where in the progression to renal failure was assumed to be insidious and not very common.3 PH2 is due to deficient glyoxylate reductase/hydroxypyruvate reductase (GRHPR),1,2 which was thought to have extra-hepatic production also.4 The progression to renal failure in these patient subgroups is well documented in the Literature and the role of SLK (simultaneous liver and kidney transplantation) has not been clearly established.8. Method: We present a case report of a young girl with PH2, who successfully underwent SLK, with evidence of reduction in the urine oxalate levels post SLK. Results: PH2, though a rare genetic disease, has a proven potential to progress to chronic renal failure requiring transplantation, renal transplantation alone has not shown any benefit, these patients can be offered SLK as a primary treatment option, to improve the outcomes, this needs further validation with consensus and studies.

Isolated Inflammatory Necrosis of the Falciform Ligament: A Case Report with Review of Literature.

Inflammatory necrosis of the falciform ligament is an extremely rare cause of acute right upper quadrant pain. Due to overlapping symptoms with pathologies affecting the gall bladder and liver, this poses a diagnostic challenge with limited existing literature. Here, we report a case of a 62-year-old female patient presenting in the accident and emergency department with right upper quadrant pain. The patient underwent ultrasonography and revealed thickened and echogenic falciform ligament. Further, a computed tomography revealed swollen falciform ligament with associated fat stranding. The patient was kept under conservative management and improved over 2 weeks.

Relationship between number of prior lumbar spine surgeries and outcomes following spinal cord stimulator implantation: A multisite, retrospective pooled analysis.

OBJECTIVES: Lumbar spine surgery is a common procedure for treating disabling spine-related pain. In recent decades, both the number and cost of spine surgeries have increased despite technological advances and modification in surgical technique. For those patients that have continued uncontrolled back and/or lower extremity pain following lumbar spine surgery, spinal cord stimulation (SCS) has emerged as a viable treatment option. However, the impact of lumbar spine surgical history remains largely unstudied. Specifically, the current study considers the impact of number of prior lumbar spine surgeries on pain relief outcomes following SCS implantation. MATERIALS AND METHODS: We queried the electronic medical record of five separate pain practices for all patients who have undergone a SCS implant between January 1, 2017, and March 1, 2020. Inclusion criteria consisted of any patients with an SCS implant who underwent a prior lumbar spine surgery. The primary outcome was the mean calculated percentage pain relief in patients based on number of prior lumbar spine surgeries. RESULTS: There was a total of 1974 total SCS implant cases identified across five separate pain clinics. There was no difference in mean calculated pain relief in patients with one prior spine surgery versus those with two or more prior spine surgeries (28.2% vs. 25.8%, adjusted ß-coefficient -3.1, 95% CI -8.9 to 2.7, p = 0.290). Similarly, when analyzing number of spine surgeries as a continuous variable, there was no association between number of spine surgeries and calculated pain relief (adjusted ß-coefficient -1.5, 95% CI -4.0 to 1.1, p = 0.257). Additionally, after patients were stratified based on waveform, there was no association between number of prior lumbar spine surgeries (analyzed both as a categorical and continuous variable) and calculated percentage pain relief. CONCLUSIONS: This multicentered retrospective study found that there was no significant difference in pain scores in individuals who received SCS following one or more lumbar spine surgeries. Additionally, the waveform of the SCS device had no statistically significant impact on post-operative pain scores following one or more lumbar spine surgeries.

Topical delivery of insulin using novel organogel formulations: An approach for the management of diabetic wounds.

Diabetes mellitus is a growing chronic form of diabetes, with lengthy health implications. It is predicted as poor diabetic wound recovery affects roughly 25% of all diabetes mellitus patients, frequently resulting in lower traumatic injury and severe external factors and emotional expenses. The insulin-resistant condition increases biofilm development, making diabetic wounds harder to treat. Nowadays, medical treatment and management of diabetic wounds, which have a significant amputation rate, a high-frequency rate, and a high death rate, have become a global concern. Topical formulations have played a significant part in diabetic wound management and have been developed to achieve a number of features. Because of its significant biocompatibility, moisture retention, and therapeutic qualities, topical insulin has emerged as an appealing and feasible wound healing process effector. With a greater comprehension of the etiology of diabetic wounds, numerous functionalized topical insulins have been described and shown good outcomes in recent years, which has improved some diabetic injuries. The healing of wounds is a physiological phenomenon that restores skin integrity and heals damaged tissues. Insulin, a powerful wound-healing factor, is also used in several experimental and clinical studies accelerate healing of diverse injuries.

Technical Considerations, Applications, and Benefits of Organogels in Topical Drug Delivery Systems.

Organogels represent semi-solid systems where an organic liquid phase is entrapped within a three-dimensional network formed by self-assembled, crosslinked, or entangled gelator fibers. These versatile materials find applications in a wide range of fields, including chemistry, pharmaceuticals, cosmetics, biotechnology, and food technology. Notably, in pharmacology, they serve as valuable platforms for drug and vaccine delivery, facilitating the transport of active ingredients through various routes such as transdermal, oral, and parenteral. However, their previous utility as drug delivery systems was hindered by the toxicity associated with the organic solvents used. The pharmacokinetics of medications delivered via organogels are primarily influenced by the distinctive properties of these materials, specifically their "high permeability and poor aqueous solubility," which can impact the bioavailability of the drugs. Organogels can be employed topically or for the controlled release of medications through cutaneous administration and percutaneous absorption, expanding their scope of application beyond conventional drug delivery methods. Organogels hold significant promise as drug delivery vehicles due to their biocompatibility, non-irritating properties, and thermoremanent characteristics. They enable the formulation of diverse drug delivery systems by incorporating both hydrophilic and hydrophobic bioactive compounds within the gel matrix. This comprehensive review offers an overview of organogels, encompassing their nature, synthesis, characterization, and properties. Special attention is directed towards cutting-edge technologies employed in designing organogels as potential controlled delivery systems, with a focus on their emerging therapeutic applications.

Design, Development and In-Vitro Characterization of Insulin Loaded Topical Pluronic-Lecithin Based Organogel Formulation for the Management of Diabetic Wound.

AIM: To develop and characterize the topical insulin-loaded organogel formulation for the management of diabetic wounds. OBJECTIVES: To formulate and evaluate organogel of insulin that can serve as a topical administration for promoting enhanced wound healing in diabetic patients by providing sustained and localized delivery of drug to the wound site. METHODOLOGY: The insulin organogel formulated by the micro-emulsion method involves mixing the "aqueous and oil phases" at high shear. Physical and chemical properties, as well as an in vitro study with a Franz diffusion chamber, were used to evaluate the prepared organogel. RESULTS: All formulations proved to be off-white, homogeneous, washable, and had a pH between 6 and 6.5; moreover, they were non-irritating and skin-compatible. Formulations F1-F6 had viscosity ranging from 2058 to 3168 cps, spreadability ranges of 0.35 to 0.52 g*cm/s, and gel transition ranges of 28.33 to 35.33 °C. In formulations F1-F3, the concentration of lecithin was gradually increased, and in formulations F4-F6, the concentration of PF-127 was increased, resulting in a decrease in gel transition temperature, an increase in viscosity, and a gradual change in spreadability. The higher-viscosity formulations were much more stable and had better drug release. All formulations were fitted to a kinetic model belonging to first-order kinetics. However, after examining the parameter evaluation, it was found that the formulations F2 and F6 were better suited to the kinetic model and were consistent with the first-order and Higuchi models in Korsmeyer-Peppas F2 (r2 = 0.9544 and n = 1.0412); F6 (r2 = 0.9019 and n = 1.0822), which was a confirmation of the sustainability of the release system with matrix diffusion and drug delivery mechanisms that were based on the Super-Case II transport. CONCLUSION: Further research and clinical trials are needed to validate its efficacy, optimize the formulation, and establish its long-term safety. Topical insulin organogel has the potential to revolutionize diabetic wound management by improving healing outcomes, reducing complications, and raising the standard of living for those who have diabetes.

Efficient preparation of hybrid biofuels from biomass-derived 5-(acetoxymethyl)furfural and petroleum-derived aromatic hydrocarbons.

Fuel candidates containing both petroleum-derived and biomass-derived molecules in their structural motifs ensure both feedstocks are used optimally and coherently. This work reports a straightforward and efficient preparation of 5-(arylmethyl)furfurals (AMFFs), 2-(arylmethyl)furans (AMFs), and 2-(arylmethyl)-5-methylfurans (AMMFs) as hybrid biofuels (or fuel oxygenates) starting from carbohydrate-derived 5-(acetoxymethyl)furfural (AcMF) and petroleum-derived aromatic hydrocarbons. The AMFFs were prepared by Friedel-Crafts reaction between AcMF and aromatic hydrocarbons (e.g., BTX, mesitylene) by employing anhydrous ZnCl2 as the catalyst. AMFs were prepared by decarbonylation of AMFFs over the Pd(OAc)2 catalyst under solvent-free conditions. In contrast, AMMFs were produced by hydrogenating AMFFs in methanol using gaseous hydrogen and the 10% Pd/C catalyst. The catalytic transformations were optimized on various parameters, and all the biofuel candidates were obtained in good to excellent isolated yields (>80%) under moderate conditions.

Impact of a Preclinical Medical Student Anesthesiology Elective on the Attitudes and Perceptions of Medical Students Regarding Anesthesiology.

Purpose: First- and second-year medical students typically have limited exposure to the field of anesthesiology, yet recent match data shows growing interest in the specialty. Early, structured exposure to anesthesiology in the form of a preclinical elective may allow medical students to make more informed decisions on their specialty of choice. Methods: The anesthesiology preclinical elective, BIOL 6704: "Anesthesia: Much More than Putting you to Sleep", is a one-credit course taught at The Warren Alpert Medical School of Brown University. A survey consisting of fifteen questions assessing changes in attitudes, perceptions, and interest in anesthesiology was distributed to first- and second-year medical students before and after course participation. The results were analyzed using the Wilcoxon's signed-rank test for paired samples. Results: The biggest impact of the preclinical elective was observed in the students' subjective understanding of key aspects of the practice of anesthesiology. Statistically significant improvement was seen in the understanding of airway management, anesthetic pharmacology, basics of ultrasound, vascular access, anesthesiology subspecialties, and an understanding of anesthesiology residency. Overall, results were limited by our small sample size. Conclusion: Our elective allows medical students to explore anesthesiology early in their medical school career. After taking this course, students noted more familiarity with various topics in anesthesiology. Peer institutions lacking a similar course may consider using our experience to increase interest about the specialty of anesthesiology for future students.

Synthesis of Advanced Pyrazole and N-N-Bridged Bistriazole-Based Secondary High-Energy Materials.

In this work, we have synthesized 3,5-dihydrazinyl-4-nitro-1H-pyrazole (2), 9-nitro-1H-pyrazolo[3,2-c:5,1-c']bis([1,2,4]triazole)-3,6-diamine (3), and N-N-bonded N,N'-{[4,4'-bi(1,2,4-triazole)]-3,3'-diyl}dinitramide (5) and its stable nitrogen-rich energetic salts in one and two steps in quantitative yields from commercially available inexpensive starting material 4,6-dichloro-5-nitropyrimidine (1). Along with characterization via nuclear magnetic resonance, infrared, differential scanning calorimetry, and elemental analysis, the structures of 2 and 4-8 were confirmed by single-crystal X-ray diffraction. Interestingly, 5-8 show excellent thermal stability (242, 221, 250, and 242 °C, respectively) compared to that of RDX (210 °C). Detonation velocities of 2, 4, 6, and 7 range from 8992 to 9069 m s-1, which are better than that of RDX (8878 m s-1) and close to that of HMX (9221 m s-1). All of these compounds are insensitive to impact (10-35 J) and friction (360 N) sensitivity. These excellent energetic performances, stabilities, and synthetic feasibilities make compounds 2, 4, 6, and 7 promising candidates as secondary explosives and potential replacements for the presently used benchmark explosives RDX and HMX.

A Rare Case of Conservative Management of Multiple Aerodigestive Fistulas in a Patient.

Acquired aerodigestive fistulas include tracheoesophageal fistulas (TEF) and bronchoesophageal fistulas (BEF). Common causes of acquired fistulas are usually malignant in origin. Tubercular tracheoesophageal fistula and bronchoesophageal fistula are rare. The limited availability of literature often presents a challenge in the treatment of tubercular TEF. We present the case of a 47-year-old woman who presented with complaints of progressive dysphagia and epigastric pain. Preliminary investigation showed raised erythrocyte sedimentation rate (ESR) of 65 mm/h and further evaluation by esophagogastroduodenoscopy for dysphagia revealed multiple ulcerated lesions in the esophagus, computed tomography (CT) revealed the presence of tracheoesophageal and bronchoesophageal fistulas with lung consolidation, and histological examination revealed granulomatous inflammation. The symptoms were managed conservatively with anti-tubercular medicine alone and showed good response.

Isolation of Amyloid-like Protein Aggregates (APA) from white bread and their characterisation.

High temperature, acidic pH, and physical agitation are commonly observed during cooking or industrial food processing, which are often considered as favorable conditions, at least for some proteins, to misfold and form amyloid-like protein aggregates (APA). The proteins in various bakery products generally experience high temperatures that might lead to the formation of APA. To test this hypothesis, the presence of APA in white bread was examined in this study. The APA isolated from white bread displayed typical characteristics of amyloids, like bathochromic shift in Congo red (CR) absorbance maxima, increased fluorescence of Thioflavin T (ThT) & 8-anilino-1-naphthalene sulfonic acid (ANS), fibrillar morphology of >200 nm long with average diameter of 10-12 nm and negative minima at 223 nm in Circular Dichroism (CD) spectrum. The SDS- and native PAGE revealed the presence of gliadin and glutenin as the constituent proteins in the isolated protein aggregates. Although, the presence of amyloid-like structures in white bread is evident, further studies would be essential to establish their functional role and health implications.

Energetic coordination compounds: self-assembled from the nitrogen-rich energetic C-C bonded pyrazoles and triazoles.

In energetic materials research, energetic coordination compounds (ECCs) have received much attention due to their high thermal stability and insensitivity to mechanical stimuli. The energetic characteristics of ECCs can be modified by combining various metal cations, potent anions, and ligands. In this study, we have synthesized two energetic ligands, 5-(4-nitro-1H-pyrazol-3-yl)-1H-1,2,4-triazol-3-amine (NPTA) and (Z)-N-(5-(4-nitro-1H-pyrazol-3-yl)-2,4-dihydro-3H-1,2,4-triazol-3-ylidene)nitramide (NPTN), from a commercially viable starting material and reacted them with nitrate salts of various 3d metals (e.g., Ni, Co, Zn) to obtain six new ECCs, [Ni(NPTA)(H2O)3]2·2NO3 (1), [Co(NPTA)(H2O)3]2·2NO3 (2), [Zn(NPTA)(H2O)3]2·2NO3 (3), [Ni(NPTN)(H2O)3]2 (4), [Co(NPTN)(H2O)3]2 (5), and [Zn(NPTN)(H2O)3]2 (6) under ambient conditions. All the newly prepared ECCs were characterised through PXRD, IR, SEM, and TGA-DSC analysis. Furthermore, single crystal analysis proved that 1-6 are dimeric complexes. Moreover, 1-6 show excellent density ranges from 1.94 to 2.06 g cm-3 and remarkable thermal stability (216-352 °C), and are highly insensitive towards impact (>40 J) and friction (>360 N), describing their potential as high performing energetic materials. All the ECCs revealed good enthalpy of combustion (-6.3 to -9.94 kJ g-1). Additionally, the Hirshfeld surface and 2D fingerprint analysis were used to understand the close contact of atoms within the molecules. High crystal densities, thermal stabilities and low sensitivities make the synthesized ECCs interesting for further studies and potential applications as safe high-energy dense materials.

Straightforward Synthesis of Insensitive 2-(1-Hydroxy-2,2-dinitrovinyl)guanidine and Its Guanidinium Dinitromethanide Salt as a High Energy Density Material.

High energetic 2-(1-hydroxy-2,2-dinitrovinyl)guanidine and guanidinium dinitromethanide (GDNM) salt were synthesized in one and two steps using a simple and cost-effective methodology from commercially available inexpensive starting materials with a high yield. NMR, IR spectroscopy, elemental analysis, and differential scanning calorimetry studies were used to characterize compound 2a and GDNM salt. Single-crystal XRD, Hirshfeld surface analysis, and SEM analysis were used to study the crystal structure, hydrogen-bonding/noncovalent interactions, and morphology of the GDNM salt, respectively. The physicochemical and energetic properties of compound 2a and GDNM salt reveal their good energetic performance, specific impulse, and high mechanical insensitivity, which are better than that of propellants such as ADN and AP and close to that of the benchmark explosives such as RDX and FOX-7.