Extensive Treatment Research Articles

Inhalable Anti-EGFR Antibody-Conjugated Osimertinib Liposomes for Non-Small Cell Lung Cancer

Background: Non-small cell lung cancer (NSCLC) is a leading cause of cancer deaths globally. The most extensive treatment is Tyrosine Kinase Inhibitors (TKIs) that target epidermal growth factor receptor (EGFR) overexpression. Osimertinib, a third-generation TKI is approved to target EGFR exon 19 deletions or exon 21 L858R mutations. However, resistance is inevitable due to emergence of triple mutations (sensitizing mutations, T790M and C797S). To overcome this challenge, a combinatorial approach was used wherein Osimertinib liposomes were conjugated with cetuximab (CTX), an anti-EGFR monoclonal antibody, to improve drug efficacy and delivery. Additionally, pulmonary administration was employed to minimize systemic toxicity and achieve high lung concentrations. Methods: Osimertinib liposomes (OB-LPs) were prepared using thin film hydration method and immunoliposomes (CTX-OB-LPs) were prepared by conjugating the OB-LPs surface with CTX. Liposomes were characterized for particle size, zeta-potential, drug loading, antibody conjugation efficiency, in vitro drug release, and aerosolization performance. Further, the in vitro efficacy of immunoliposomes was evaluated in H1975 cell line. Results: Immunoliposomes exhibited a particle size of 150 nm, high antibody conjugation efficiency (87%), efficient drug release, and excellent aerosolization properties with an aerodynamic diameter of 3 μm and fine particle fraction of 88%. Furthermore, in vitro studies in H1975 cells showed enhanced cytotoxicity with CTX-OB-LPs displaying 1.7-fold reduction and 1.2-fold reduction in IC50 compared to Osimertinib and OB-LPs, respectively. The CTX-OB-LPs also significantly reduced tumor cell migration and colonization compared to Osimertinib and OB-LPs. Conclusions: These successful results for EGFR-targeting inhalable immunoliposomes exhibited potential for contributing to greater anti-tumor efficacy for the treatment of non-small cell lung cancer.

Психотерапевтический потенциал психообразования в реабилитации пациентов с расстройствами шизофренического спектра

<p><strong>Relevance</strong>. Having arisen in routine psychiatric practice to help a patient with schizophrenia spectrum disorders (SSDs), and then his relatives, in building understanding of the illness and ways of coping with it, psychoeducation not only approved the status of a stand-alone method of therapy, but also proved its effectiveness and expediency of use. Gradually, sдeveral models of psychoeducation emerged: informational, supportive, motivational, and a model of teaching skills to cope with illness. <strong>The aim</strong>. The article contains descriptions of these models, examples of programs and data on their effectiveness. <strong>Results. </strong>Psychoeducation in modern conditions has become a mandatory element of extensive treatment and rehabilitation programs for patients with SSDs; it is combined with other types of psychotherapeutic interventions, equipped with new and unexpected practices, and is actively developing. <strong>Conclusion.</strong> The article substantiates the conclusion that improving and developing program options and increasing their accessibility largely determines the effectiveness of mental health services and provides a personalized approach to patients with SSDs.</p>

Covid-associated osteonecrosis of the midface

The purpose of our study the features of clinical manifestations and treatment of Covid-associated osteonecrosis of the midface (rhinocerebral form of mucormycosis). An analysis of the clinical features and results of surgical treatment of 35 patients with Covid-associated osteonecrosis of the midface was carried out. Difficulties in diagnosing of Covid-associated osteonecrosis led to late hospitalization and extensive surgical treatment with the huge defects formation. Due to the nonspecificity of clinical symptoms and the difficulties of early diagnosis and differential diagnosis of invasive rhinocerebral forms of mucormycosis, the aggressive clinical course with the formation of extensive defects in the midface, long and complex rehabilitation of patients with Covid-associated osteonecrosis of the midface, the vigilance of general practitioners is necessary and specialists: dental surgeons, maxillofacial surgeons, ophthalmologists, otolaryngologists, neurologists, regarding the possibility of developing invasive aggressive forms of mycoses in immunocompromised patients who have suffered a new coronavirus infection COVID-19.

Applying integrated enhanced cognitive behaviour therapy (I-CBTE) to severe and longstanding eating disorders (SEED) Paper 2: An in-depth case study for clinicians

BackgroundThis case study examines the application of Integrated Enhanced Cognitive Behavioural Therapy (I-CBTE) for a patient with severe, longstanding anorexia nervosa and multiple comorbidities, including organic hallucinosis, complex post-traumatic stress disorder (CPTSD), and severe self-harm. Such complex presentations often result in patients falling between services, which can lead to high chronicity and increased mortality risk. Commentaries from two additional patients who have recovered from severe and longstanding anorexia nervosa are included.Case studyThe patient developed severe anorexia nervosa and hallucinosis after a traumatic brain injury in 2000. Despite numerous hospitalisations and various psychotropic medications in the UK and France, standard treatments were ineffective for 17 years. However, Integrated Enhanced Cognitive Behaviour Therapy (I-CBTE) using a whole-team approach and intensive, personalised psychological treatment alongside nutritional rehabilitation proved effective.MethodsIn this paper, we describe the application of the I-CBTE model for individuals with severe, longstanding, and complex anorexia nervosa, using lived experience perspectives from three patients to inform clinicians. We also outline the methodology for adapting the model to different presentations of the disorder.OutcomesThe patient achieved and maintained full remission from her eating disorder over the last 6 years, highlighting the benefit of the I-CBTE approach in patients with complex, longstanding eating disorder histories. Successful treatment also saved in excess of £360 k just by preventing further hospitalisations and not accounting for the improvement in her quality of life. This suggests that this method can improve outcomes and reduce healthcare costs.ConclusionThis case study, with commentaries from two patients with histories of severe and longstanding anorexia nervosa, provides a detailed description of the practical application of I-CBTE for patients with severe and longstanding eating disorders with complex comorbidities, and extensive treatment histories. This offers hope for patients and a framework for clinicians to enhance existing treatment frameworks, potentially transforming the trajectory of those traditionally deemed treatment resistant.RecommendationsWe advocate the broader integration of CBT for EDs into specialist services across the care pathway to help improve outcomes for patients with complex eating disorders. Systematic training and supervision for multidisciplinary teams in this specialised therapeutic approach is recommended. Future research should investigate the long-term effectiveness of I-CBTE through longitudinal studies. Patient feedback on experiences of integrated models of care such as I-CBTE is also needed. In addition, systematic health economics studies should be conducted.

Ameliorative Potency of Iridoid Glucoside Compound Catalpol on Inhibiting NF-κB-mediated Inflammation in Allergic Rhinitis-induced Mice

Background Over time, the prevalence of allergic rhinitis (AR) has surged due to various risk factors, notably attributed to global urbanization, rendering heightened levels of pollutants, including traffic-related emissions and particulate matter. About 25% of the global children population and 40% of the adult population were reported with AR. Even though AR is recognized as a systemic inflammatory disease, it often results in diverse other comorbidities, such as dermatitis, sinusitis, conjunctivitis, and otitis, requiring extensive and expensive treatment. Purpose We assessed the effectiveness of iridoid glucoside catalpol against AR in a mouse model. Catalpol is recommended in traditional Chinese medicine to treat diverse acute and chronic diseases. Methods AR was induced in mice with an ovalbumin-sensitized AR model and treated with 10 and 20 mg of catalpol. Nasal severity scoring was performed to confirm the AR induction in mice. Allergic mediators immunoglobulin E (IgE) and histamine were quantified in the serum to assess the anti-allergic response of catalpol. In nasal lavage fluid (NALF), the inflammatory mediators IgE Ab, prostaglandin D2, leukotriene C4, eosinophil cationic protein (ECP), and pro-inflammatory cytokines were measured to analyze the anti-inflammatory potency of catalpol. The binding capacity of nuclear factor-kappa B (NF-κB) to DNA was evaluated to assess the catalpol inhibitory potency against NF-κB-mediated inflammation in AR mice. To confirm the ameliorative potency of catalpol in AR mice, a histopathological analysis of nasal mucosa was performed. Results Catalpol treatment significantly decreased the nasal symptoms and reduced the allergic mediators in the serum of experimental animals. It effectively inhibited the synthesis of inflammatory mediators, ECP, and pro-inflammatory cytokines in the NALF, and also suppressed the NF-κB DNA-binding activity in AR mice. The decrease in ciliary loss, goblet cells, eosinophil infiltration, and vascular congestion observed with our nasal mucosa histopathological analysis confirmed the ameliorative potency of catalpol. Conclusion Our findings have proven catalpol inhibits NF-κB-mediated inflammatory response in AR mice. With further analysis, a potent natural compound, catalpol, can be formulated as a drug to treat AR.

Leveraging extensive soil, vegetation, fire, and land treatment data to inform restoration across the sagebrush biome

ContextWidespread ecological degradation has prompted calls for massive global investments in ecological restoration, yet limited resources necessitate efficient application of restoration efforts. In western North America, altered fire regimes are increasing the scale of restoration needed to preserve the sagebrush (Artemisia species) biome but prioritizing and implementing effective restoration is complicated by the vast and heterogeneous sagebrush landscape, which includes gradients in climate, disturbance, and species composition.ObjectivesTo develop spatially explicit and context-dependent estimates of treatment efficacy and sagebrush recovery rates.MethodsWe leveraged a suite of spatio-temporally extensive datasets to evaluate the influence of restoration treatments and environmental conditions on trends in post-disturbance sagebrush cover, with an emphasis on understanding differences between sites recovering naturally and sites receiving restoration treatments. We used estimates from these models to develop spatially explicit projections for sagebrush recovery, conditional on disturbance, restoration practice, and environmental conditions.ResultsWe found seeding Artemisia spp. increased sagebrush cover over time relative to natural recovery, but this relationship depended on spring soil moisture availability and treatment methods. Natural recovery was positively influenced by soil moisture and sagebrush cover and negatively influenced by cumulative burns and annual herbaceous cover, while the influence of perennial herbaceous cover varied with soil moisture.ConclusionsOur results provide biome-wide insights and spatially explicit tools that can inform economic cost-effectiveness analyses, restoration prioritization tools, and other scientific endeavors to ensure managers have the tools and information needed to effectively steward the sagebrush biome in a rapidly changing world.

Fluorescent polymers for environmental monitoring: Targeting pathogens and metal contaminants with naphthalimide derivatives

Monitoring Hg2+ levels in aqueous environments is crucial to assess the potential methylmercury contamination via bacterial conversion, however, existing methods often require extensive sample treatment and expensive equipment. To mitigate this issue, this study examines the synthesis and application of three naphthalimide-based compounds, with significant fluorescent and solvatochromic behavior (C1, C2, and C3). Compounds C1 and C2 demonstrated a strong affinity for Hg2+ metal ions, with C2 showing selectivity and a strong antibacterial profile, particularly against S. aureus (MIC50 (C2) = 0.01 µg/mL). Moreover, these compounds were incorporated into three polymeric matrices, namely polyvinyl chloride (PVC), poly (methyl methacrylate-co-methacrylic acid) (PMMMA), and Starch, allowing for the development of solid-support sensors/surfaces with a strong antibacterial profile, highlighting the inherent dual-functionality of the compounds. Interestingly, the C2-doped Starch biopolymer detected low concentrations of Hg2+ ions, such as 23 nM in tap water (value within the WHO standards for drinking water), through a rapid spectroscopic evaluation without sample treatment. This biopolymer was generated via a sustainable, green-chemistry-oriented, temperature-dependent water/Starch synthetic route, without the addition of plasticizers and any associated ecotoxicity. The study used sustainable methods for environmental monitoring and antibacterial applications, advancing material science to offer effective, accessible, and eco-friendly solutions for detecting and mitigating mercury pollution and bacterial contaminations, enhancing environmental and health safety.

Evaluating alternative compounds for strongyloidiasis therapy: Novel insights from larval migration inhibition test.

Strongyloidiasis is a neglected tropical disease estimated to affect more than 600 million people worldwide. Recently, the World Health Organization road map on neglected tropical diseases 2021-2030 has put the focus on strongyloidiasis, including this disease within its mass drug administration campaigns. With the use of ivermectin in extensive treatment of all populations at-risk, identifying effective therapeutic alternatives is crucial in case ivermectin resistance arises. The objective of the present study was the development of a larval migration inhibition assay to evaluate the anthelmintic efficacy of commercial drugs and diamine and aminoalcohol derivatives against infective Strongyloides ratti third stage larvae. Through this technique, we successfully screened and estimated the in vitro anthelmintic efficacy of six commercial drugs, seven diamine derivatives and eight aminoalcohol derivatives. Unexpectedly, the half-maximal effective concentration of ivermectin and moxidectin (2.21 and 2.34 μM, respectively) were observed as the highest value obtained among all commercial drugs tested by this in vitro technique. Moreover, some diamine and aminoalcohol derivatives showed superior efficacy inhibiting S. ratti motility compared to ivermectin, with five compounds (AA23, AA34, AO2 AO7 and AO14b) also displaying selectivity indexes on HepG2 and Caco2 higher than 1. These findings underscore the potential of these derivatives as promising alternatives for strongyloidiasis treatment, warranting further investigation and in vivo efficacy assessment.

Caregiver, community health worker, and dentist feedback on a behavioral intervention for caregivers of children with severe early childhood caries.

Severe early childhood caries (S-ECC) is a common disease within marginalized pediatric populations. S-ECC is often treated under general anesthesia to facilitate extensive treatment in young children, but treatment does not address etiology of an infectious disease that is rooted in health behaviors. Without behavior changes related to toothbrushing and sugar consumption, many children experience recurrent disease and some require subsequent surgeries. To improve post-surgery oral health, we developed PROTECT (Preventing Recurrent Operations Targeting Early Childhood Caries Treatment), a community health worker (CHW)-delivered behavioral intervention for caregivers that focuses on children's oral health behaviors. The purpose of this study was to use qualitative research methods to receive feedback on the planned protocol for a pilot study of PROTECT, a six-month intervention initiated at the time of a child's surgery to treat severe early childhood caries. Study participants included caregivers of children presenting for surgery [n = 12], CHWs [n = 8] and dentists [n = 8] in a series of audio-video recorded semi-structured interviews. Five coders used Braun and Clarke's six-phase framework for data analysis. Participant feedback on the pilot study protocol yielded the following themes: (1) right time, population, and type of support; (2) flexible intervention delivery and content; (3) inclusion of other social determinants of health; and (4) cultural considerations. Implementing a behavioral intervention for caregivers in the immediate time during a child's surgery for treating dental caries was widely deemed important and timely in order to affect post-surgical behavioral and clinical outcomes. Flexibility in content, timing, and communication were all named as facilitators to participant engagement and study retention. Caregivers and CHWs emphasized the relevance of addressing other social determinants of health. CHWs emphasized the importance of training in becoming aware of culture and practicing with understanding and humility, given the influence on health beliefs, behaviors, and family dynamics. Cultural considerations in intervention delivery were deemed an important factor for participant retention and engagement. Participant feedback led to critical modifications of the pilot study protocol, specifically in intervention content and CHW-led delivery.

A Mini Review on the Opportunities for Membrane Pervaporation Technology for Energy-efficient Removal of Dispersed Oil and Dissolved Hydrocarbons from Produced Water

: Produced water is reported to have the largest volume of waste stream associated with hydrocarbon recovery. It was estimated to increase from 250 million B/D in 2007 to more than 300 million B/D between 2010 and 2012. Market research conducted by Adroit put the globally produced water treatment market at a value of USD 5.10 billion in 2022. This value is anticipated to be USD 9.80 billion in 2032 at a compound annual growth rate (CAGR) of 5.80% over the prediction period. Oil and gas companies have been mandated to comply with the newly enacted environmental regulations that require extensive treatment of this water before discharge or reuse. The limited quantity of freshwater resources coupled with the increasing oil and gas production activities has made it necessary for all stakeholders to look for sustainable management of this water. Presently, a certain percentage of produced water is reused while the rest is discharged into the ocean. In both cases, the water needs to be thoroughly treated. The choice of technologies for produced water treatment depends on numerous factors, such as the chemical composition of the water and the level of purity that must be attained before disposal, recycling, or re-use. Some of the technologies used for produced water treatment include physical separation methods such as gravity, adsorption, filtration, coalescence, cyclones, flotation, centrifuges, membranes, and oxidation. There are also chemical and biological separation methods. Contaminants such as small droplets of dispersed oil and dissolved hydrocarbons (DODHs) are very challenging to remove using the above-listed water treatment technologies. Moreover, the use of membrane technology has been limited only to the use of reverse osmosis and membrane filtration for removing salinity, metals, and other inorganics. This article highlights the opportunities for the use of membrane vapor permeation and pervaporation for the removal of the small droplets of DODHs, which have been reported to be very challenging contaminants to remove. The use of 3D printing technology for the fabrication of membrane materials was reviewed. The 3D membrane development method can be used to fabricate almost any shape of the material in a highly customized manner using computer-aided design. The information presented in this article will serve as a useful reference for the technologies used for a sustainable water treatment strategy in the oil and gas industry.

Evaluation of Water Quality and Scarcity Issues for Sustainable Water Management Strategy in Twin Cities of Rawalpindi/ Islamabad, Pakistan.

Today's water world is pebbledashed with two main trepidations of water security/ scarcity, which need in-depth elaboration. Developing countries are particularly facing the impacts of water contamination and scarcity but lack the required impetus and technical infrastructure, thus necessitating swift actions to evaluate the effects of water security/ scarcity on the environment and water resources. In this study, an effort has been made to assess the water security/ scarcity situation in the twin cities of Rawalpindi/ Islamabad, elucidating the water quality/ quantity parameters in the Rawal Lake reservoir in Pakistan by analysing the contamination. The samples were collected/ tested during spring/ monsoon seasons to analyse temporal/fluvial impacts on water discharge. The results were compared with Pakistan's and WHO's drinking water standards before and after the water treatment. Almost all the testing parameters of the raw water samples from the Rawal Lake reservoir feeding streams exceeded the standard limits or fell close to the upper threshold limits, suggesting that this water was unsuitable for drinking without extensive treatment and an efficient distribution system. The contamination, untreated sewage disposal, non-regulated water utilisation, drawdown and supply/ demand gaps are the grave factors causing the water security/ scarcity in the capital/ twin cities of Islamabad/ Rawalpindi. Pakistan has already entered the water scarcity threshold of 1014 m3/ person/ annum in 2018, reduced from water availability of 5260 m3/ person/ annum in 1950 and will likely reach a drought level by 2050 due to increased population and reduced water resources. The study proposes an organisational implementation model for catchment-level river management to ensure good quality of water, construction of 5-10 small dams, and the provision of water from Terbella Dam suggested as the long-term strategy to prevent water scarcity.

Vasovagal syncope with asystole.

Although vasovagal episodes are a common cause of syncope, vasovagal syncope can be cardioinhibitory in nature, resulting in a severe heart block or asystole. This case report focuses on a young man with a history of seizures and frequent syncopal episodes who required an extensive clinical workup and treatment for cardioinhibitory syncope.

Xylazine-induced Skin Necrosis, Emerging Public Health Crisis and the Ethical Considerations in Surgical Reconstruction: A Case Report

Xylazine, a non-opioid veterinary sedative, is increasingly being used to adulterate illicit fentanyl. Injection into the extremities causes progressive necrotic wounds, resulting in a compromised limb and life. Managing xylazine-induced skin necrosis may require extensive surgical intervention, including serial debridements and soft tissue reconstruction. Moreover, managing these complex wounds requires a multi-disciplinary approach, including hospital medicine, infectious disease, psychiatry, addiction medicine, pain/palliative care, ethics, wound care, orthopedic surgery, and plastic surgery. A 38-year-old female with a history of intravenous drug use presented with severe bilateral dorsal forearm wounds, and despite initial non-compliance with surgical debridement, she eventually underwent successful skin grafting after extensive treatment, including antibiotics and negative pressure therapy, but was later lost to follow-up. She relapsed into fentanyl use, leading to severe bilateral lower extremity wounds requiring further debridement and skin grafting, and later returned with new forearm wounds, at which point further reconstruction was deemed inappropriate without addressing her addiction; she refused inpatient rehabilitation and ultimately being lost to follow-up again.

Farmers’ pesticide use and knowledge of aquatic ecosystem contamination with its perceived health risk from contaminated fish consumption in northern Ghana

Pesticide residues in agricultural environments pose significant threats to aquatic ecosystems and human health. Most studies investigate the quantity, environmental, and risk assessment of pesticides in agricultural landscapes. However, farmers’ pesticide use and their knowledge on aquatic ecosystem contamination remain limited and poorly documented. This study evaluated pesticide residue concerns in agricultural settings, focusing on farmers’ uses and knowledge. It addressed pesticide application methods and their effects on aquatic ecosystems and human health through fish consumption. A cross-sectional design was employed and 300 farmers were selected using a multi-stage sampling technique from two agricultural districts – Savelugu Municipal and Tamale Metropolis. The study revealed that maize was most cultivated (29.6 %) with extensive pesticide treatment, particularly herbicides in the study setting. Findings revealed pesticide overuse (22.3 %), mixing of pesticides at the water bodies (24.7 %), improper leftover pesticide disposal methods (39.0 %) and inadequate storage practices (63.0 %) among farmers. About 21.3 % and 74.0 % of farmers have insufficient knowledge of the resulting consequences and the discharge of pesticides into the aquatic environment, respectively. Though the farmers are aware of the detrimental impact of pesticides on human health, there is still a lack of comprehension regarding the indirect consequences for aquatic ecosystems and non-target species. In the study setting, extension services may be important sources of knowledge. Thus, emphasizes the significance of improving extension programmes and utilizing peer-to-peer communication channels to support the adoption of best practices in pesticide management such as licenced high-temperature incinerators and cement kilns with sufficient emission controls. Focused training and outreach programmes designed to enhance farmers' knowledge and implementation of pesticide management plans are urgently needed. These interventions would help in reducing the dangers of pollution to aquatic ecosystems and human health.

Postoperative exacerbated cough hypersensitivity syndrome induces dramatic respiratory alkalosis, lactatemia, and electrolyte imbalance

BackgroundThe perioperative management of patients with chronic cough or cough hypersensitivity syndrome and its sometimes severe effects is currently under-researched and under-reported.Case presentationA 46-year-old female patient with a history of chronic cough and Cough Hypersensitivity Syndrome. After laparoscopic hiatoplasty and anterior fundoplication under general anesthesia, experienced a pronounced exacerbation of coughing symptoms. Despite prompt and extensive treatment involving antitussives, inhalants, anxiolytics, and sedatives, the symptoms remained uncontrollable. Within a few hours, the patient developed a respiratory alkalosis with severe and life-threatening electrolyte shift (pH 7.705, pCO2 1.72 kPa, K+ 2.1 mmol/l). Lactatemia lasted for more than 12 hours with values up to 6.6 mmol/l. Acute bleeding, pneumothorax, and an acute cardiac event were ruled out. Deep analgosedation and inhalation of high-percentage local anesthetics were necessary to manage the clinical symptoms.ConclusionsThis case highlights the challenging nature of chronic cough and hypersensitivity syndrome perioperatively. A tailored anesthesiologic approach, exclusion of other provoking medical problems, and knowledge of possible management and treatment options are key.

Design and implementation of a home-based online exercise program for individu-als surviving cancer

Starting point: Pediatric individuals with acute lymphoblastic leukemia undergo extensive chemotherapy treatment and, as a result, suffer from fatigue and, therefore, a decrease in their daily physical activity level, even after the cessation of the treatment. The symptoms of post-treatment thus disable the participation of the children in sports and games, which play a major role in childhood and adolescence. Group: Thirteen 5- to 15-year-old individuals surviving cancer with acute lymphoblastic leukemia (1 and 3 years after cancer treatment) were recruited to an 8-week home-based exercise program. Methods: This study aims to present the design and possibilities of implementing a home-based online exercise program for children who have overcome cancer, taking into account their age and the logistical availability of such physical therapy. Results: Thirteen individuals completed the home-based online exercise program, and the success rate of participation ranged from 79.2% to 95.8%. The overall success rate was 85.6%. The design and implementation of a home-based online exercise program in our conditions proved to be advantageous and often the only way to allow individuals surviving cancer to exercise in real-time, as the distance of many families from exercise centers proved to be a significant obstacle in creating habits of regular exercise in children. Conclusions: We demonstrated that individuals surviving cancer and their parents are interested in physical activity interventions and a home-based online exercise program is available and convenient.

AYURVEDIC MANAGEMENT OF PRE-MACULAR HAEMORRHAGE: A CASE STUDY

Pre-macular haemorrhage (PMH) is a condition characterized by bleeding between hyaloid and retina leading to visual impairment. Ayurveda offers extensive treatment protocols for managing such posterior segmental disorders. This case study presents the successful Ayurvedic management of PMH in a 54-year-old female patient who is a known hypertensive. The patient presented with a sudden onset of blurred vision in the right eye and black patches in the vision. After a thorough Ayurvedic assessment, a treatment plan including Netra kriyakalpas and panchakarma procedures was adopted along with oral medications. For one month, the patient experienced significant improvement in visual acuity, and the resolution of the haemorrhage was confirmed by ophthalmological examination and imaging studies. This case highlights the potential of Ayurveda as an effective approach to managing pre-macular haemorrhage.

Engineering the S-scheme heterojunction between NiFeAl - LDH and BiOCOOH nanoflower by constructing an interfacial electric field for efficient degradation of levofloxacin under visible light

The antibiotic levofloxacin (LVF), utilized across the world during the COVID-19 pandemic, presents a notable concern in environmental safety owing to its deposition in water bodies. This work reports the engineering of S-scheme heterojunction, NiFeAl LDH coupled with BiOCOOH nanoflower by constructing an interfacial electric field for efficient degradation of LVF under visible light. The scanning electron microscope (SEM) and transmission electron microscope (TEM) analysis reveal the uniform decoration of NiFeAl LDH flakes over flowers like BiOCOOH and the high crystallinity is confirmed with SAED pattern distribution. The construction of an interfacial electric field was confirmed by X-ray photoelectron microscope (XPS) analysis. The X-ray diffraction (XRD), XPS, and Raman spectroscopy studies were conducted to confirm the purity and chemical bonding nature of the BiOCOOH-NiFeAl LDH nanocatalyst (NFB NCs). The band gap of materials was calculated to be 3.38 and 2.03 eV for BiOCOOH and NiFeAl LDH respectively. The NFB NCs showed remarkable performance of 95.2 % than its pristine BiOCOOH (35.4 %) and NiFeAl LDH (18 %). ESR and scavenging studies identified the major involvement of •OH, O2•- and h+ in the process. The intermediates formed during the degradation were examined by using GC–MS and a possible degradation pathway was proposed. Furthermore, the toxicity analysis using the ECOSAR program demonstrates NFB NCs safety level for extensive wastewater treatment. The stability of the NCs over six cycles and magnetic removal properties showcased their potential for large-scale wastewater treatment applications. This comprehensive study highlights the importance of LDH in advancing photocatalytic materials for environmental remediation and paves a way for manufacturing innovation.

Factors predictive of extensive use of CPAP treatment in obstructive sleep apnoea.

In patients with obstructive sleep apnoea (OSA), the benefits of continuous positive airway pressure (CPAP) therapy are increased for every additional hour of daily CPAP usage. However, the data of predictors of extensive usage is scarce, if any. Therefore, we evaluated potential predictors affecting extensive treatment usage. In this retrospective study, we compiled an institutional cohort of consecutive patients diagnosed with who started CPAP therapy 1999-2022 and were included in a wireless telemonitoring system in May 2022 (N = 14,394). Patients using CPAP device ≥ 9h/d were stratified into a younger (< 65 years; N = 124) and an older group (≥ 65 years; N = 131). We found 255 patients (male 61%) eligible for our study, with a median age of 65 (interquartile range, IQR 55-73) years, and mean body mass index (BMI) of 36 ± 6.9kg/m2. Median CPAP use was 10h/d (IQR 10-11). BMI and depressive symptoms (DEPS) in the younger group were higher than in the older group (37.9 ± 7 vs. 34.6 ± 6.4kg/m2, p < 0.001 and 11 (IQR 5-20) vs. 7 (IQR 5-14), p = 0.01, respectively). During follow-up, the BMI of the younger group increased (39.9 ± 12.5kg/m2 vs. 37.9 ± 7kg/m2, p = 0.009). DEPS values decreased in the younger group and became comparable between the groups. In multivariate models, the baseline BMI independently predicted extensive CPAP use among the younger age group, and the mask leak among the older group. BMI at baseline in the younger and mask leak in the older group could be independent predictive factors for extensive use of CPAP.

Advances in Diagnostic and Interventional Catheterization in Adults with Fontan Circulation.

Over the past five decades, the Fontan procedure has been developed to improve the life expectancy of patients with congenital heart defects characterized by a functionally single ventricle. The Fontan circulation aims at redirecting systemic venous return to the pulmonary circulation in the absence of an impelling subpulmonary ventricle, which makes this physiology quite fragile and leads to several long-term complications. Despite the importance of hemodynamic assessment through cardiac catheterization in the management and follow-up of these patients, a thorough understanding of the ultimate functioning of this type of circulation is lacking, and the interpretation of the hemodynamic data is often complex. In recent years, new tools such as combined catheterization with cardiopulmonary exercise testing have been incorporated to improve the understanding of the hemodynamic profile of these patients. Furthermore, extensive percutaneous treatment options have been developed, addressing issues ranging from obstructive problems in Fontan pathway and acquired shunts through compensatory collaterals to the percutaneous treatment of lymphatic circulation disorders and transcatheter edge-to-edge repair of atrioventricular valves. The aim of this review is to detail the various tools used in cardiac catheterization for patients with Fontan circulation, analyze different percutaneous treatment strategies, and discuss the latest advancements in this field.