Back Bone Research Articles

Abstract 4147627: A Pharmacovigilance Study of Bempedoic Acid: Balancing Risks and Benefits

Introduction: Bempedoic acid has been approved by FDA since Feb 2020 as an adjunct to maximally tolerated statin therapy for the reduction of LDL-C, specifically in individuals afflicted by atherosclerotic cardiovascular disease (ASCVD) and heterozygous familial hypercholesterolemia (HeFH). Bempedoic acid is also a viable alternative for patients intolerant to statins. Most recently, it has been approved to use for primary prevention of hyperlipidemia, alone or in combination with a statin. It is important to study its side effect profile as it is anticipated to be used more frequentlynin the future. Methods: We explored reported adverse events (AEs) of bempedoic acid using FDA Adverse Event Reporting System (FAERS). A total of 1202 adverse effects were reported until March 31, 2024. 69.97% AEs were reported by healthcare professionals (HCPs), which were further analyzed. AEs were analyzed in men (32.53%) vs women (53.24%) and in three age groups of 18-64, 65-85, and >85 years. Results: A total of 586 (48.7%) events were serious adverse effects. Most common side effects were myalgia which included muscle pain, extremity pain and muscle spasm (25.04%), arthralgia including back pain and bone pain (18.47%), nausea (6.6%), headache(5.5%), gout (4.4%). Among the patients with adverse effects, 4.75% had cardiac side effects which included atrial fibrillation (12%), palpitation (29%), angina pectoris (18%), Myocardial Infarction (5%). Discussion: A thorough understanding of bempedoic acid's complex pharmacology empowers healthcare professionals to tailor treatment plans based on individual patient requirements. This enables informed decision-making in prescribing, optimizing dosage regimens, and mitigating potential adverse reactions. Most studies have been relatively short term in order to confirm the long term side effect profile. It would be beneficial to be cautious in using this medication for patients with above mentioned clinical conditions like myalgia, arthralgia, gout, rhabdomyolysis, atrial fibrillation, angina pectoris. Conclusion: Long term pharmacovigilance is needed to assess the safety profile of bempedoic acid over extended use. With the current increasing use of bempedoic acid, there is a need for more data on safety profiles. In future, further randomized trials are required to better assess the safety profile.

A Look at Challenges to the Effective Implementation of Safeguard to Fair Trial and Justice under the Cameroonian Criminal Justice System

Fair trial as a principle which ensures the administration of justice is guaranteed in the constitutions of every democratic society. The right to fair trial is an essential right in all countries respecting the rule of law. Fair trial and justice constitute the back bone of all applicable procedures and substantial laws almost in every legal culture. This means that fair trial should be perceived as a “human right” issue and therefore an international concern which should comply and be measured by international norms. This paper aims at analyzing the challenges faced in the effective implementation of the safeguard to fair trial and Justice in Cameroon. The Cameroon criminal justice system has all necessary provisions aimed at safeguarding fair trial and ensuring a horizontal playing field where justice is been maintained. However, the question remains how effective does these laws safeguard the right to fair trial and Justice. The mechanisms put in place to ensure the safeguard to fair trial and justice is insufficient, ineffective and unsuitable in guaranteeing the safeguard to fair trial and justice. In the absence of fair trial and justice, the rule of law, human rights and consequently the idea of justice becomes illusionary.

In silico, in vitro, and in vivo acute and sub-acute toxicity profiling of whole plant methanol extract of Equisetum diffusum D. Don from the sub-Himalayan West Bengal, India, having ethnobotanical uses

BackgroundEquisetum diffusum D. Don commonly known as ‘Himalayan horsetail’, has been traditionally used in the treatment of back pain, bone fracture and dislocation, and arthritis by various tribal communities of India. Our previous study confirmed the anti-inflammatory efficacy of the plant through in silico, in vitro, and in vivo model studies. Therefore, the current research is focused on safety dose evaluation for the first-time of the whole-plant methanol extract (EDME) of E. diffusum through appropriate in silico, in vitro, and in vivo approaches.MethodThe whole plant, along with its rhizomes, was collected, and the methanol extract was prepared. The in silico ADMET study was performed to predict the pharmacokinetics profile and toxicity of all the identified phyto-compounds of EDME previously screened by GC–MS study. In vitro cytotoxicity study of EDME was performed using two cell lines: kidney (HEK293) and liver (Huh7) cell lines. The in vivo toxicity study of EDME was validated by the acute toxicity (OECD 423, 2002) and sub-acute toxicity assays (OECD 407, 2008) in the Wistar Albino rat model.ResultsThe in silico ADMET study of all 47 bioactives predicted good pharmacokinetic and low toxicity profiles. In vitro cytotoxicity showed higher IC50 values of EDME viz., 672 ± 15.7 μg/mL and 1698 ± 6.54 μg/mL for both kidney (HEK293) and liver (Huh7) cell lines, respectively, which were considered as low-toxic. Based on acute oral toxicity, the LD50 value of the extract was considered “non-toxic” up to a feeding range of 2000 mg/kg of body weight. The regular consumption of the extract for an extended period (28 days) was also qualified as safe based on the body and organ weight, hematological, biochemical, and histoarchitecture results in the sub-acute toxicity assay.ConclusionThe detailed in silico, in vitro, in vivo (acute and sub-acute oral toxicity) studies gave us a new insight to the safety dose evaluation of Equisetum diffusum, which may serve as a reliable documentation for undertaking the experimental validation of the ethnobotanical uses of the plant which would help in the field of drug development for the treatment of inflammation related complications.

Prevalence, response and associated factors of needlestick injury among health care workers in Orotta National Referral Hospital, Eritrea

BackgroundHealthcare workers are at risk of occupational exposure to blood and other body fluids after sustaining needlestick injury which constitutes a risk for transmission of blood-borne pathogens such as Hepatitis B virus, Hepatitis C virus or Human Immune-deficiency Virus.ObjectivesTo assess the prevalence, response, and associated factors of needlestick injury by medical sharps among healthcare workers in Orotta National Referral Hospital, Asmara, Eritrea.MethodsCross sectional study was conducted between September and December 2017 among healthcare workers. This was a census study whereby a total of 383 healthcare workers who had contact with sharp medical equipment were taken as study population. An aided self-administered questionnaire, checklist and key informant interviews were used as data collection tools. Analysis was done using Statistical Package for Social Sciences, version 22. Bivariate and binary logistic regression analyses were carried out and the level of significance was set at P < .05.ResultsThe prevalence of needlestick injury 12 months preceding the study was 37.1% (134/361). Midwives had the highest occurrence (45%) among others while adult intensive care unit were found to have higher prevalence of needlestick injury (61.5%) as compared to the other sections. As an immediate response to needlestick injury, only 15.7% washed the injured part with soap and water. The factors associated with needlestick injury include age > 40 years (AOR = .314, p = .05), marital status (married (AOR = 0.595, p = .05)), additional duty that made healthcare workers rush during working hours (AOR = 2.134, p = .002) and back bone problem (AOR = 2.239, p = .002).ConclusionThe overall finding of the study indicated that there was a great risk of contracting blood-borne infections among the healthcare workers especially midwives. Therefore, there is need for adequate supply of safety engineered devices, Hepatitis B vaccine, better reporting, and surveillance of needlestick injury cases at the hospital. Moreover, further research on assessment of the knowledge, attitude, and practice of healthcare workers toward occupational safety and health, particularly needlestick injury, is necessary.

Benthic Macroinvertebrates as Indicators of Organic Pollution in Upstream Batena River, Hossana, Central Ethiopia

Benthic macro invertebrates are insects and other organism without a back bone that can be seen without magnification and that live in the bottom of all water bodies. They are bio monitor species in determining the water quality in fresh water and other aquatic ecosystems as they are indicator of environmental change of aquatic ecosystem and fresh water ecosystem. The aim of this study was to assess Organic pollution by using benthic macro invertebrate as indicator in upstream parts of Batena River and implication to the water quality of the river. Benthic Macro invertebrates were collected using Scrubber net and sieve with mesh size of 1mm. A total of 57 individual within 4 families belong to 4 orders and one class was identified during the study period. Most dominant group was Hemiptera 29(50.8%), Diptera14 for Chironomidae (Red) (24.56%) and for Diptera family chironomidae (Pale) (19.3%). Sphendiea, Psephyendiea and class of Turbilaria accounts the same percentage (1.75%) and their total abundance was also similar. The pollution level of the river was assessed using Hillsenhoff Family Biotic Index (HFBI) and the value was 7.96. Over all study showed that the river is polluted and have poor water quality as result of diverse Organic pollutant agents. Therefore, the local people and administration of the river should work hard to prevent further deterioration of the river quality by raising public awareness, prevention of waste disposal and treat the waste water before discharging it directly to the river.

Captain Ahab as a Hero in Melville’s Moby-Dick

Herman Melville’s Moby-Dick tells the story of Ishmael, a sailor who joins the whaling ship Pequod, captained by the obsessed and vengeful Captain Ahab. Ahab’s sole mission is to hunt down and kill the legendary white whale, Moby-dick, who had previously bitten off Ahab’s leg at the knee. As a towering masterpiece of American literature, Moby-Dick is a novel that defies simple categorization and is renowned for its rich narrative complexity and profound thematic depth. Central to the novel is the character of Captain Ahab, whose quest to vanquish the white whale, Moby-dick, forms the back bone of the story. On the one hand, Ahab embodies various heroic qualities; on the other, Ahab is also perceived as a monomaniacal villain due to his apparent flaws and descent into madness. Through an examination of Ahab’s actions, motivations and interactions, this essay argues that Ahab’s heroism is multifaceted, encompassing elements of classical heroism as well as tragic heroism by exploring Ahab’s heroic traits and their implications in the broader context of Melville’s masterpiece.

Lumpy Skin Disease: A Review on Etiopathogenesis, Transmission, Diagnosis and Treatment

Lumpy Skin Disease: A Review on Etiopathogenesis, Transmission, Diagnosis and Treatment

The academic achievement of B.Ed. colleges in Manipur: A comparative study

Teacher Education is the back bone of School Education, which will reform the school education system in the country. In order to check the quality of teacher education being provided in the different Teacher Educational Institutions in Manipur is the need of hour as the academic achievement is the outcomes of educational facility being provided in the colleges. The study will find out the best college, where the quality teacher education being provided, but also, it will suggest the remedial measures in order to improve the quality of teacher education being provided in Manipur.

Density functional study of electrode material for magnetic tunnel junction designed using Co2TiZ (Z = Ge, Si) Heusler alloys

Some of the important applications in the field of spintronics are spin current driven logic devices having logic gates and in read heads in the hard disk drives, magnetic random access memory (MRAM) containing non-volatile memory units and extremely complex magnetic sensor. In spintronic applications, a magnetic tunnel junction (MTJ) is considered the back bone of all such devices. With this motivation, in present study we have predicted very low resistance area (RA) product value and high tunnel magneto resistance (TMR) of two designed MTJs by using full Heusler alloys (FHA) Co2TiZ (Z = Ge, Si) as electrode and MgO as barrier layer. These used half metallic (HM) Heusler alloys (HA), have been investigated using Wien2K code, via primary standard calculations and studied electronic and magnetic properties followed by structural and magnetic phase stability. Spin based band structure along with density of state (DOS) profiles are determined by considering both generalized gradient approximation (GGA) + modified Becke–Johnson functional (mBJ) functional and GGA potentials. For the estimation of the Curie temperature (Tc) mean field approximation (MFA) was considered. After determining physical properties of considered FHAs, spin polarised transport properties are calculated by using PWCOND code embedded in Quantum ESPRESSO (QE) for designed MTJs and obtained extremely low resistance-area product (RA) product and a high value of TMR which is found very suitable for spintronic device applications.

Laser-cavity locking utilizing beam ellipticity: accessing the 10−7 instability scale relative to cavity linewidth

Frequency-stable lasers form the back bone of precision measurements in science and technology. Such lasers typically attain their stability through frequency locking to reference cavities. State-of-the-art locking performances to date had been achieved using frequency modulation based methods, complemented with active drift cancellation systems. We demonstrate an all passive, modulation-free laser-cavity locking technique (squash locking) that utilizes changes in spatial beam ellipticity for error signal generation, and a coherent polarization post-selection for noise resilience. By comparing two identically built proof-of-principle systems, we show a frequency locking instability of 5×10−7 relative to the cavity linewidth at 10 s averaging. The results surpass the demonstrated performances of methods engineered over the last five decades, potentially enabling an advancement in the precision control of lasers, while creating avenues for bridging the performance gaps between industrial grade lasers with scientific ones due to the afforded simplicity and scalability.

Judicial Approach Towards Rights of Accused

The main purpose of Criminal Law is to provide safety of the society from the offenders. For approving this purpose court make some laws regarding the ending of crime from the society, there are several punishment also given. This abstract is mainly just for the based on the right of accused under Criminal Law. With the help of this paper, I want to show the rights of accused and presumption of innocent until he or she found guilty. At the end of trial on proper evidence, rights of accused are secured, that is laid down under constitutional law or criminal law or secured under many laws. For imposing the legal or Fundamental Right, basically should know the statutes where they are prescribed. The criminal procedures have to inspired by ideals relating security or social bond, if there is not Social Solidatory. Under criminal law to be a fair trial is a back bone of criminal justice system. The objective of criminal justice system is to do justice with public.

Identification of novel inhibitors against VP40 protein of Marburg virus by integrating molecular modeling and dynamics approaches

Marburg virus (MV) is a highly etiological agent of haemorrhagic fever in humans and has spread across the world. Its outbreaks caused a 23–90% human death rate. However, there are currently no authorized preventive or curative measures yet. VP40 is the MV matrix protein, which builds protein shell underneath the viral envelope and confers hallmark filamentous. VP40 alone is able to induce assembly and budding of filamentous virus-like particles (VLPs), which resemble authentic virions. As a result, this research is credited with clarifying the function of VP40 and leading to the discovery of new therapeutic targets effective in combating MV disease (MVD). Virtual screening, molecular docking and molecular dynamics (MD) simulation were used to find the putative active chemicals based on a 3D pharmacophore model of the protein’s active site cavity. Initially, andrographidine-C, a potent inhibitor was selected for the development of the pharmacophore model. Later, a library of 30,000 compounds along with the andrographidine-C was docked against VP40 protein. Three best hits including avanafil, diuvaretin and macrourone were subjected to further MD simulation analysis, as these compounds had better binding affinities as compared to andrographidine-C. Furthermore, throughout the 100 ns simulations, the back bone of VP40 protein in presence of avanafil, diuvaretin and macrourone remained stable which was further validated by MM-PBSA analysis. Additionally, all of these compounds depict maximum drug-like properties. The predicted drugs based on the ligand, avanafil, diuvaretin and macrourone could be exploited and developed as an alternative or complementary therapy for the treatment of MVD. Communicated by Ramaswamy H. Sarma

Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review.

Extracorporeal shock waves have been used for pain treatment for various sub-acute and chronic musculoskeletal (MSK) problems since 2000. The aim of this article is to update information on the role of extracorporeal shock wave therapy (ESWT) in the treatment of various pathologies that cause MSK pain. Given that in the last two years, articles of interest (including systematic reviews and meta-analyses) have been published on less known indications, such as low back pain, nerve entrapments, osteoarthritis and bone vascular diseases, a literature search was conducted in PubMed, the Cochrane Database, EMBASE, CINAHL and PEDro, with the aim of developing a narrative review of the current literature on this topic. The purposes of the review were to review possible new mechanisms of action, update the level of evidence for known indications and assess possible new indications that have emerged in recent years. Although extracorporeal shock waves have mechanical effects, their main mechanism of action is biological, through a phenomenon called mechanotransduction. There is solid evidence that supports their use to improve pain in many MSK pathologies, such as different tendinopathies (epicondylar, trochanteric, patellar, Achilles or calcific shoulder), plantar fasciitis, axial pain (myofascial, lumbar or coccygodynia), osteoarthritis and bone lesions (delayed union, osteonecrosis of the femoral head, Kienbock's disease, bone marrow edema syndrome of the hip, pubis osteitis or carpal tunnel syndrome). Of the clinical indications mentioned in this review, five have a level of evidence of 1+, eight have a level of evidence of 1-, one indication has a level of evidence of 2- and two indications have a level of evidence of 3. The current literature shows that ESWT is a safe treatment, with hardly any adverse effects reported. Furthermore, it can be used alone or in conjunction with other physical therapies such as eccentric strengthening exercises or static stretching, which can enhance its therapeutic effect.

Crack segmentation in the wild using convolutional neural networks and bootstrapping

AbstractComputer vision and deep learning methods have found numerous practical applications over the last decade. The field of structural health monitoring has greatly benefited from such advancements. Accurate crack detection and segmentation are a critical part of structural health monitoring and assessment. In the past decade, researchers have developed different computer vision and deep learning methods to address this challenging task. In this article, we propose to use convolutional neural networks and bootstrapping to improve crack segmentation in the wild. Specifically, we investigate fully convolutional network (FCN) and DeepLabV3 with different ResNet architectures as the back bone and assess their performance. A unique feature of this work is the use of bootstrapping with a segmentation network and image augmentation. Bootstrapping is an important component of our proposed methodology for better extracting features from the datasets. We also incorporate superpixel pooling for FCN which improves performance. We assess the performance of our method using five publicly available datasets, which include a wide variety of crack images such as thin pavement cracks, tree shadows on cracks, cracks in asphalt roads, concrete wall cracks, wide cracks on concrete surfaces, and so on. A comparative study is also performed with several established methods in the literature. Results indicate that overall, our proposed method outperforms other state‐of‐the‐art methods for crack segmentation.

A literary review of Tamra (copper) w.s.r. to its role in Hepatomegaly

Rasashastra is a branch of Ayurveda dealing with metal &amp; minerals. The Rasa Aushadhi are the back bone of Ayurvedic medicine. Metal and mineral are the integral part of therapeutics in Ayurveda and Tamra is one such metal which is highly poisonous &amp; several times more poisonous than poison itself because one poison cause only one Dosha (toxic effect) while unpurified and unreduced Tamra may have eight Dosha.[1] Which has been described as Ashtamahadosa in classical text book. but if this Tamra is well processed through all pharmaceuticals process, it can be converted into one of the best and effective medicine. Tamra Bhasma is useful in treatment in various disease condition like Udar Vyadhi, Pandu[2] etc. In this study a descriptive study of Tamra and its therapeutic potential basis which are mentioned in our classical Ayurveda textbook with special reference to its role in Hepatomegaly is studied by searching and analyzing all Ayurvedic and all modern perspective.

Knowledge of Osteoporosis among women of 40 years and above in Nepalgunj sub-Metropolitan City

Background: Osteoporosis is a global problem with a lifetime risk of osteoporotic fractures in women. It is the condition that reduces bone mass per unit volume of normally mineralized bone resulting in fractures, even minor trauma which increases as an increase in age. Objectives: The study aimed to assess the osteoporosis knowledge among women of 40 years and above residing in Muktipur-12, Nepalgunj, Banke. Methods: A quantitative cross-sectional study was carried out in Muktipur-12, Nepalgunj Sub Metropolitan city among 150 women of 40 years and above. Face to face interview was conducted during July-August, 2018. Statistical Package for the Social Sciences (SPSS) version-16 was used for descriptive and inferential statistics. Results: Study showed 61.3% women of 40 years and above had fair knowledge of osteoporosis. Personal presence of osteoporosis was reported by 26% of respondents. Diet low in calcium (79.3%), lack of exercise (57.3%) and personal history of fracture as an adult (44.7%) were the major reported causes of osteoporosis. Regarding knowledge on symptoms, lower back pain (78%), stooped position (64.7%) and bone fracture (42.7%) were reported. More than three fourth (84%) answered adequate calcium intake as preventive measures for osteoporosis. Knowledge of osteoporosis was found to be significantly associated with age (p&lt;0.001), literacy (p=0.028) and occupation (p=0.019) of the participants. Conclusion: Study concluded fair level of knowledge regarding osteoporosis. Osteoporosis awareness program need to be continued and expanded covering young age women which could minimize the future risk of osteoporosis.

Fragmentation aware heuristic algorithm for routing and wavelength assignment in optical networks

Wavelength division multiplexing (WDM) is one of the dominating technologies with high-capacity back bone networks. The cost associated with the high-capacity networks given more importance. The major issue is allocating and managing the available resources. To achieve this most efficient algorithms has to be used. We are considering the routing of lightpath and wavelength assignment problem, called as the routing and wavelength assignment (RWA) problem. The optimization of wavelength fragmentation in the WDM network is very much important in resource utilization. Wavelength fragmentation is one of the most important challenges in the area of the WDM network. Where it leads to some serious issues for the operators, such as the rejection of new requests. We are using integer linear program (ILP), here the problem is based on the node link formation. It is based on the multilayer concept and the original WDM network consists of several layers. We propose an efficient heuristic approach to solve this problem of finding the shortest path and assigning a wavelength without wavelength conversion. The model achieves better performance with fragmentation aware wavelength allocation strategy that minimizes fragmentation.

#5300 HUMANISTIC BURDEN OF RARE KIDNEY DISEASES: UNDERSTANDING THE IMPACT OF IGAN AND FSGS ON PATIENTS AND CARE-PARTNERS STUDY (HONUS): A US IGAN RESULTS UPDATE

Abstract Background and Aims While immunoglobulin A nephropathy (IgAN) has been shown to be associated with clinical and economic burden, the humanistic burden associated with IgAN is less understood. HONUS is a multi-national, cross-sectional survey study to evaluate the humanistic burden associated with rare kidney diseases, including IgAN, from the patient and caregiver perspectives in the US and Europe. Method The study recruited adult patients (≥18 years old) with their care-partners and parents/care-partners of youth (8-17 years old) with IgAN or focal segmental glomerulosclerosis (FSGS). Participants completed an online survey with questions on demographic and clinical characteristics, health-related quality of life (HRQoL) (ie, 12-Item Short Form Survey [SF-12]), anxiety and depression (ie, Generalized Anxiety Disorder Assessment [GAD-7], Patient Health Questionnaire [PHQ-9]), most burdensome symptoms, fear and uncertainty for the future, and disease impact on work productivity (ie, Work Productivity and Activity Impairment [WPAI]). The current analysis is based on information from adults with IgAN and their care-partners in the US before September 2022. Descriptive analyses were conducted, with continuous variables summarized using means, medians, and standard deviations (SD), and categorical variables summarized using frequency counts and percentages. Results A total of 96 pairs of adults with IgAN and their care-partners in the US were included in the analysis. The mean age of adult patients was 37.5 and the majority were Caucasian (86.5%) and female (53.1%). Median time since diagnosis was 5.6 years. More than half of patients (59.4%) were in chronic kidney disease stage 3 or 4, while 5.2% were in end-stage renal disease and had received a kidney transplant. Hypertension (31.3%), anemia (25.0%), and depression (18.8%) were the most common comorbidities. In terms of HRQoL, patient's mean (SD) SF-12 physical and mental component scores (PCS, MCS) were reported at 46.9 (7.4) and 41.1 (9.1), respectively, reflecting worse HRQoL (lower score) than previously published US general population scores (PCS and MCS of 50 [10]). Moderate and severe anxiety was reported by 28.1% and 1.0% of patients, respectively; moderate, moderately severe, and severe depression was reported by 51.0%, 2.1% and 1.0% of patients, respectively. The most burdensome symptoms reported by patients were constipation (82.3%), lower back pain (79.2%), and bone or joint pain (77.1%). Based on a 4-week recall period, 25.0% of adult patients reported being ‘very much bothered’ or ‘extremely bothered’ by bone or joint pain (22.9% for lower back pain, 10.4% for constipation). Most patients (96.9%) reported feeling fear and uncertainty for the future due to their disease, of which 52.1% reported the frequency of fear and uncertainty to be ‘often’. Among employed patients (72.9%), percent absenteeism was reported in 6.9%, presenteeism in 27.1%, overall work productivity loss in 31.4%, and activity impairment in 36.2% because of IgAN-related reasons. Most paired care-partners (87.5%) were partners of patients, with a mean age of 39.5 years. The mean SF-12 PCS and MCS of care-partners were 50.4 and 43.6, respectively. Moderate anxiety was reported in 13.5% of care-partners, with none reporting severe anxiety; moderate and moderately severe depression was reported in 35.4% and 5.2% of care-partners, respectively. Almost all care-partners (99.0%) reported feeling fear and uncertainty for the future due to the disease of their cared ones, of which 39.6% reported the frequency of this worry to be ‘often’. Among employed care-partners (93.8%), 9.8% reported absenteeism, 27.3% reported presenteeism, 33.2% reported overall work productivity loss, and 31.9% reported activity impairment due to IgAN-related reasons. Conclusion Patients with IgAN experience impaired HRQoL, depression, anxiety, and poor productivity, compared to previously reported US general population estimates. This also impacts the HRQoL, in terms of mental components, and productivity of care-partners. Both patients with IgAN and their care-partners also report widespread fear and uncertainty for the future.

E031 A rare case of diffuse osteosclerosis

Abstract Background/Aims Diffuse skeletal fluorosis is a common condition in countries with high content of fluoride in the ground water like India and China. Skeletal fluorosis in the UK is rare and presents with non-specific findings such as back pain, elevated ALP or bone sclerosis. We describe a case referred from haematology for investigation of osteosclerosis. Methods 74-year-old female presented to the emergency department on several occasions with recurrent abdominal pain, severe low back pain and swelling of her lower limbs. Her mobility had been reduced due to previous femoral nerve injury. Blood tests on admission showed mild macrocytic anaemia. Alkaline phosphatase, renal, liver function tests and electrolytes were within normal range. Furthermore, calcium, phosphate, vitamin D and parathyroid hormone levels were within normal limits. CT CAP was done and no obvious or sinister cause for abdominal pain was found. However, it showed diffuse bony sclerosis. Bone densitometry DXA scan results as follows: T-score of + 1.6 in the hip and +1.7 in the neck of femur, they were unable to scan the lumbar spine as the patient was unable to tolerate positioning for the scan. This confirmed relatively raised bone density for patient’s age despite having risk factors for osteoporosis like previous wrist fracture, strong family history of osteoporosis, early menopause following total hysterectomy at age 41, coeliac disease and multiple falls due to poor mobility. Results A bone marrow aspirate and trephine biopsy and immunophenotyping were carried out and did not demonstrate any evidence of myeloid or lymphoid neoplasm. The next line of investigations included an isotope bone scan and blood tests including serum tryptase, uric acid and fluoride levels. Fluoride level came back as 411 which is 8-times more than the normal value. Patient mentioned that she uses fluoride toothpaste and brushed her teeth at least 10-14 times/day. X-ray of the hands showed no evidence of periosteal reactions or sclerosis. We recommended that she use fluoride free toothpaste and referred her for a dental opinion. While there is no effective therapeutic agent to reduce fluoride levels, patient was encouraged to use fluoride free toothpaste and also consult with her dentist for further evaluation. Conclusion This case emphasises the need for a comprehensive history and maintaining a high index of suspicion of skeletal fluorosis when encountered with a patient with a high bone mineral density (BMD) score on the DXA scan or diffuse skeletal sclerosis. The increase in bone mineral density is thought to be related to fluoride’s enhanced osteoblastic activity. Disclosure S. Mohamed: None. A. Phillips: None. J. Thomas: None. D. Makkuni: None.

Design and Fabrication of Solar and Wind Pesticide Sprinkling Machine

Agriculture is a global industry and is referred to as the "BACK BONE OF INDIA." We may live a healthy life thanks to agriculture and plant production, which provides us with wholesome foods and vegetables. In comparison to the agricultural product, machinery also contributes significantly. To chop cultivated plants, etc., machines are used to spray insecticides. Spraying pesticides is essential to maintaining the health of crops, plants, and vegetable plants. Moreover, illnesses are used to protect crops from pests. In agriculture, machine-applied pesticides like drones, backpacks, and manually sprayed types are more common. Automatic and semi-automatic machinery may result in good cost efficiency in this equipment. This will have an impact on the farmer's cost-effectiveness. We are manually typing.