Hemangiomas are known as congenital vascular malformations that can affect almost any organ or tissue, with the liver being the most common intra-abdominal organ to be involved. It is well known that hemangiomas are the most common benign tumours of the liver, and develop in about 4-20% of people, mainly young adult females. Recently, due to the dramatic rise in the use of imaging studies for different purposes, a parallel increase in the incidence of these tumours has been noticed. Most liver hemangiomas are small (less than 4cm in diameter), asymptomatic and found incidentally during abdominal operation for other indication or on radiologic studies. Giant liver hemangioma is defined as hemangioma with a diameter of more than 5cm. This unique and uncommon type of haemangioma usually poses therapeutic challenges for the treating physician, especially hepatic surgeons, due to the unclear natural history, and due to the risk of life threatening complications is yet to be established. While it is already proved by several studies that conservative management of giant hepatic hemangioma is safe, it is not known whether observation of the extremely large hepatic hemangioma (tumours larger than 10cm) is safe as well. The aim of this article is to review the English literature to find out if conservative management of the extremely giant liver hemangioma is safe and can be recommended.

Anasarca is generalized swelling of the body following accumulation of fluid in the extracellular compartments. It may result from multiple aetiology mainly of renal, hepatic or cardiovascular origin. The aim of this case report is to highlight the challenges encountered in making diagnosis in a patient with anarsaca. We report a case of a 34 year old transporter who presented with anasarca. He had clinical features and risk factors suggestive of renal, hepatic and cardiovascular disease. However investigations ruled out renal, hepatic or cardiovascular diseases as the aetiology of the anarsaca. The anarsarca was also noted to be unresponsive to diuretics. The diagnosis of the disease causing the anarsaca was therefore a dilemma.

Background: The rapid spread of “Coronavirus Disease 2019’ (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-type 2 (SARS-CoV-2) significantly impacted health care facilities all across the globe. To assess impact on urology practice in our country, we developed a questionnaire based on relevant questions in current scenario for information regarding challenges and changes urologists were facing in their practices. Material and methods: We conducted an online survey to find out the impact of COVID-19 on urology practice in Indian scenario. The questionnaire comprised of total 18 questions, which were relevant to day to day practice. Results: Total 310 urologists across the India participated and consented to being part of the study. The majority admits change in their practice due to the recent COVID-19 outbreak. The majority admitted to attend fixed numbers of patients per day with prior appointment and to keep detailed records. The majority responded in positive that attendees will not be allowed, opted to wear N-95 mask in OPD, opted to take the relevant history, opted for thermal screening, opted for patients to wear a mask before entering OPD room, opted for using the new prescription at new visit and opted to avoid physical examination unless very necessary. The majority wanted to take consent from the patients that they may get infected by COVID-19 in the hospital and agreed on performing COVID-19 testing for every patient posted for surgery. The majority agreed to assign a separate operation theatre to operate patients with positive COVID-19 test and also preferred open surgery over minimal invasive surgery. Conclusion: Our survey revealed that the recent pandemic led to significant impacts on urology practice in our country. The urologists working in different setups are facing different challenges in this difficult condition. They have made certain changes in their practice to safely provide effective care to their patients.

Rubella remains an important pathogen worldwide, with many cases of congenital rubella syndrome per year. Rubella vaccination is included in the vaccination program of many countries. WHO has set goals for the elimination of measles and rubella and prevention of congenital rubella syndrome by 2020. Worldwide, the rubella vaccine is highly effective and safe, and as a result, endemic rubella transmission has been halted in the Americas since 2009. Incomplete rubella vaccination programs result in continuous disease transmission, as evidenced by major recent outbreaks in some countries around the world. In this review, we present the rubella control, elimination and eradication policies and a brief review of the rubella laboratory diagnosis.

Introduction: SARS-CoV-2 life cycle: The disease which reportedly began in Chinese city Wuhan in November-December 2019 manifesting as severe respiratory illness, soon spread to various parts of the world, and was named COVID-19, and declared a pandemic by WHO. The life cycle of SARS-CoV-2 begins with membrane fusion mediated by Spike (S) protein binding to the ACE2 receptors. Following viral entry and release of genome into the host cell cytoplasm there occurs replication and transcription to generate viral structural and non-structural proteins. Finally, VLPs are produced and the mature virions are released from the host cell. Immunogenicity of the spike protein: The S protein is considered the main antigenic component among structural proteins of SARS-CoV-2 and responsible for inducing the host immune response. The neutralising antibodies (nAbs) targeting the S protein are produced and may confer a protective immunity against the viral infection. Further, the role of the S protein in infectivity also makes it an important tool for diagnostic antigen-based testing and vaccine development. The S-specific antibodies, memory B and circulating TFH cells are consistently elicited following SARS-CoV-2 infection, and COVID-19 vaccine shots in clinical trials. The emerging SARS-CoV-2 variants: The early genomic variations in SARS-CoV-2 have gone almost unnoticed having lacked an impact on disease transmission or its clinical course. Some of the recently discovered mutations, however, have impact on transmissibility, infectivity, or immune response. One such mutation is the D614G variant, which has increased in prevalence to currently become the dominant variant world-over. Another, relatively new variant, named VUI-202012/01 or B.1.1.7 has acquired 17 genomic alterations and carries the risk of enhanced infectivity. Further, its potential impact on vaccine efficacy is a worrisome issue. Conclusion: THE UNMET CHALLENGES: COVID-19 as a disease and SARS-CoV-2 as its causative organism, continue to remain an enigma. While we continue to explore the agent factors, disease transmission dynamics, pathogenesis and clinical spectrum of the disease, and therapeutic modalities, the grievous nature of the disease has led to emergency authorizations for COVID-19 vaccines in various countries. Further, the virus may continue to persist and afflict for years to come, as future course of the disease is linked to certain unknown factors like effects of seasonality on virus transmission and unpredictable nature of immune response to the disease.

Introduction - the perennial pandemic: It is being increasingly realised that the COVID-19 may have become the new reality associated with human existence world over and the mankind may have to live with it for years or even decades. Further, the grievous nature of the disease is evolving further with the genomic changes in the virus in form of mutations and evolution of variants, with enhanced infectivity and probably virulence. There are serious challenges posed by the SARS-CoV-2 virus and COVID-19 as the disease. COVID-19 as acute and chronic disease: On exposure to the SARS-CoV-2 virus, not all patients develop a disease. Further, for those who develop the disease, there is a large variation in disease severity. The known factors including the constituent factors and several still unknown factors influence the disease manifestations, its course, and later the convalescent phase as well. In fact, substantial continuing morbidity after resolution of the infection indicates persisting multisystem effects of COVID-19. The ‘long COVID-19’ or ‘long haulers’: The patients who continue to suffer with persisting symptoms have been described as long haulers and the clinical condition has been called post-COVID-19 or ‘long COVID-19’. The diagnosis should be entertained if various symptoms and signs linger well beyond the period of convalescence in COVID-19. With the chronicity, there occur inflammatory changes and damage in various organs, and the extent of organ damage determines the long-term effects. Management of ‘long COVID’ syndrome: The ‘long COVID’ syndrome has multi-system involvement, variable presentation, and unpredictable course. Following clinical and investigational assessment, the patients should be managed as per clinical manifestations, extent of organ damage and associated complications. The findings from various studies indicate that preventing further organ damage in ‘long COVID’ is crucial. The long COVID’s prognostic challenges: As apparent, the ‘long COVID’ afflictions are more common than realized earlier. The symptoms can escalate in patients with co-morbid conditions. The persistent symptoms among COVID-19 survivors pose new challenges to the healthcare providers and may be suitably managed with a combination of pharmacological and non-pharmacological treatments, and holistic healthcare. 

Many agriculturally important properties such as heterosis, inbreeding depression, phenotypic plasticity, and resistance for biotic and abiotic stresses are thought to be affected with epigenetic components. New discoveries related with epigenetics are likely to have a major impact on strategies for crop improvement in rice breeding. However, assessing the contribution of epigenetics to heritable variation in plant species still poses major challenges. Methylation of cytosine in DNA is one of the most important epigenetic mechanisms in plants. DNA methylation not only plays significant roles in the regulation of gene activity, but also it is related with genomic integrity. Although most of next generation sequencing (NGS) technologies do not require the use of target specific primer pairs to identify and study DNA cytosine methylation, validation studies of NGS uses selective primer pairs. Bisulfite sequencing technique is a gold method for DNA cytosine methylation studies. However, bisulfite sequencing requires the development of bisulfite primer pairs to selectively study DNA sequences of interest. In this study 9 bisulfite specific primer pairs were identified and validated. These primer pairs successfully amplified bisulfite converted and unconverted genomic DNA extracted from radicle and plumule of rice (Oryza sativa L.) seedlings. Results of the present study clearly revealed the occurrence of CG, CHG and CHH (H stands for C. T or A nucleotides) contents in studied DNA sequence targets were different indicating potential role of DNA cytosine methylation in these genes. Primer pairs reported in this study could be used to detect DNA methylation which is one of the most important epigenetic mechanisms affecting the development, differentiation or the response to biotic and abiotic stress in rice (Oryza sativa L.).

According Sustainable Development goals until 2030 we should have zero hunger and undernourished people in the world. But to achieve this goal plant breeders must improve plants in order to produce at least the double than is produced now. This is not a easy pathway because we have only few years, but considering that plant breeding programs normally take several years to produce improved genotypes, also the further improved plants should face with pest, disease and other abiotic factors that are increasing with the current climate changes. In this review we will discuss the situation of hunger in the world and the remaining available land to increase food production, point out effects of biotic and abiotic factors on the food production and present some ways that can be used to fastening plant breeding.

Background: Although illegal, Ghana has a long history of cannabis use. With changing perceptions, advocacy for legalization has increased globally. This study exams pharmacological evidence on the prospects and challenges of decriminalization and /or legalization of cannabis in Ghana. Results: Cannabis and cannabinoids are a “pharmacological enigma” with unique ability to activate at least 3 of the 4 drug receptor super families. This include; inotropic Transient Receptor Potential Vanilloid 1 (TRPV1), metabotropic Cannabinoid Receptors (CB) and nuclear Peroxisome Proliferator Activator Receptors (PPAR). Cannabinoid receptors also dimerize with other receptors creating distinctly new signaling pathways. Cannabis and cannabinoids show good anti- nociceptive, anti-inflammatory, immunosuppressant anti-emetogenic activity and variable anticonvulsant activity. It can play important role in palliative care, some rare intractable epilepsy, multiple sclerosis, cachexia and Opioid Use Disorder. Cannabis precipitates psychosis in individuals with underlying genetic susceptibility. Chronic cannabis use alter the neurobiology of adolescent brain, predisposing them to amotivational syndrome characterized by depersonalization and inhibited motivation for goal directed behavior. Cannabis is also a “gateway drug”; ushering users to “harder” substances of abuse and reinstating extinguished drug seeking behaviours. The recent tramadol abuse in Ghana may have been precipitated by previous and concurrent cannabis use. Furthermore, Ghana’s cannabis may have a higher propensity to induce detrimental effects because of preferential accumulation the psychotropic delta-9-Tetrathydrocannabinol as a result of the high tropical temperature and humidity. Conclusion: There is not sufficient pharmacological evidence supporting criminalization of medical cannabis in Ghana. However, the same evidence does not support legalization of recreational cannabis.

Objective: To examine the association between adverse social determinants of health (SDH) and missed well-child visits and the interaction with the level of caregiver social support. Methods: This is a secondary data analysis of data collected from a SDH screening program conducted during well-child visits with referral, navigation and follow-up services for patients. We included 573 adult caregivers who accompanied patients aged 0-5 years to well-child visits and completed the screening from August 2017 to May 2018. The caregivers reported financial hardship, food insecurity, housing challenges, childcare difficulty, transportation issues, insurance difficulty, job difficulty, and education needs. Our primary outcome was a no-show (i.e., missed) to a well-child visit. Social support was dichotomized as low or high. Results: Among 573 patients who completed the screening, 335 patients (76.4%) had at least one social need. Financial hardship (p = 0.006), housing instability (p = 0.002), and no/poor childcare (p = 0.03) were associated with missed well-child visits. In multivariable regression analysis, having Medicaid (aOR = 1.91 [1.17-3.10]) and unstable housing (aOR = 6.79 [1.35-34.70]) were both associated with missed well-child visits. However, when social support was added to the multivariable logistic model, both Medicaid and unstable housing were no longer associated with missed well-child visits. Conclusion: Adverse SDH such as financial hardship, housing instability, and childcare difficulty were associated with missed well-child visits. However, with the addition of social support, this association was no longer significant. This study supports the hypothesis that high social support may mitigate the association between well-child visits among families experiencing adverse SDH.

Two major challenges face the practicing physicians and medical community regarding the management of hypertension. First is accurate diagnosis and finding who is the truly hypertensive patient in need of life-long treatment. Second is to improve blood pressure control through addressing hypertension risk factors, adherence to treatment and frequent monitoring. - Current Challenges in Management o Accurate diagnosis of hypertension o Improving blood pressure control - What Do We Need For The Future?

Aims and objectives: By reporting the use of therapeutic nursing interventions to facilitate the process of change in a depressive elderly caregiver, this paper seeks to underline the importance of fitting interventions to individual clients. Background: In assisting families of chronic illness sufferers, it must be remembered that the perceptions and functions of both clients and families are determined by family members, and that changes, if any, are made by those clients and families, rather than by nurses. However, nurses do play an important role in facilitating the process of change. Design: This is a case report. Methods: A case study of a depressive elderly caregiver is used to examine the use of therapeutic nursing interventions to facilitate the process of change with problem analysis, case conceptualisation and specific skills employed documented. Results: The change from one therapeutic approach (Cognitive-behavioural therapy) to another (Narrative Therapy) facilitates enlisting the caregiver’s unique strengths, resources and competence to overcome the difficulties and challenges identified during the process of change. In dealing with depression in family caregivers, nurses should not only be flexible but also remain sceptical in using different approaches, with heightened awareness of the client’s circumstances.

Circular Economy, Sustainability, Design for Environment are some of the keywords that identify new formidable challenges to be faced in the next years. Raw materials have a dominant role in reaching that goal. Green energy, electric vehicles, communication, etc. depends on raw materials labeled as critical because of their economic importance coupled with high supply risk. For this reason, mitigating actions need to be used in materials selection and design such as material substitution, improved materials efficiency and recycling. In this technical communication, a method to implement raw materials criticality issues in materials selection is described according to the recent literature. The strategy is based on Ashby’s approach and the definition of the alloy criticality index quantifying the criticality per unit of mass of the material.

Since the discovery of the dystrophin gene (DMD gene) thirty years ago, several therapeutic approaches have been investigated to treat Duchenne muscular dystrophy (DMD). This includes cell therapy, exon jumping, exonic knockout, and the CinDel method. In this article, we present the challenges of developping a treatment for DMD and the advances of these various approaches. We included the new CRISPR-Cas9 system, which permits not only major progress in the development of new treatments based on genome editing but also the production of new animal models.

We interviewed 207 pig raisers from seven different districts of Bangladesh to explore their practices related to their pig farming. We used structured questionnaires to interview the pig raisers and used descriptive statistics for analysis. Most of the pig raisers (54%) were illiterate. 50% (104) of them had a monthly income of less than 10000 BDT and 60% (124) were landless. Most of the pig raisers (92%, 191) were rearing local breed and 67% of them were practicing semi-scavenging system. As feed source 55% (114) pig owners used kitchen waste and 54% (111) used rice husk. The pig raisers mentioned different types of challenges such as social problem (16%), disease (50%), less profitable (20%) and unavailability of feed (19%). In our study, we found that 31% respondents visited veterinarians, 28% visited quack and 21% do not take any action when their pigs were sick. Only 16% pig raisers used vaccines against different infectious diseases and 36% used anthelmintics against parasitic diseases. Awareness buildup of the pig raisers may help them raising pigs in a better way which will improve the farming system and reduce the probability of disease transmission.

Marijuana is considered illicit in much of the world, and is classified as a drug for recreational use, in recent decades the medicinal use of Cannabis sativa L. has grown and diversified, being considered the only therapeutic alternative in the control of serious and incurable diseases such as syndrome of Dravet. The world panorama has shown a more liberal position, since in several countries such as the United States of America, Holland, Australia, Italy, and more recently in Canada, the use of medications, or even the recreational use of this plant, have been regulated. In this context, the investigation of the modifying effects on physical activity of empirically used cannabinoids is fundamental nowadays, mainly due to the regulatory recognition of Cannabis sativa L. as a medicinal plant in a large part of the world. Therefore, the objective of this review was to verify the evidence related to the effect of cannabis on physical performance and to identify and highlight the challenges in the interpretation of information regarding the performance of practitioners of physical activity, as well as athletes, presenting new trends in this area of research to be addressed. To carry out the systematic review, a bibliographic survey of case reports was obtained through Pubmed, Science Direct and Google Academic databases. The following keywords were used to perform the research: cannabis, performance, pain, competition. The following filters were used as inclusion criteria a languages used english; species: humans; types of articles: original articles and reviews and period of publication of articles: 1981 to 2021.

One of the major challenges for vaccine producing companies is having favourable conditions for efficient expression system for living organisms in order to produce biologicals. Several companies across the globe looking for several alternative sources for better yield through efficient expression based system.

There are global concerns in the dissemination and transmission dynamics of emerging and reemerging infectious diseases and the underlying features of gain-of-function research and geopolitics within and across borders. These concerns have become pertinent in the management of local and global health because the disease is perspicuously a geopolitical issue ostensibly linked to gain-of-function research where health diplomacy focuses on the present and future global emergence and re-emergence of infectious diseases, pandemics, and microbiome variants. These have generated vehement reactions with a propensity for extreme geopolitics and gain-of-function natural and anthropogenic activities. Geopolitical parameters and gain-of-function issues impact the social determinants of health and vice versa. The convening and convergence of countries for unprecedented epidemic or pandemic treaty settings or other formulations to confront emerging and reemerging infectious diseases will afford considerable opportunities concerning challenges in action, preparedness, and response. Provisions are pertinent for legal instruments, effective and efficient systems to curb future threats and outbreaks of infectious diseases. 

Antibiotic-resistant bacteria are emerging pathogens whose resistance profiles generate a serious health crisis by holding their impact on human health. Misuse of antibiotics has directed the emergence of microbes immune to presently accessible drugs. Pathogenic bacteria become resistant by employing various mechanisms, such as; antibiotic modification, target site alteration, and biofilm formation, increasing the time they spend in the intracellular environment where antibiotics are unable to succeed at therapeutic levels. Due to this, attempts are being made to develop new alternative nanoantibiotics as a promising approach to treat multidrug resistance disease-causing bacteria. Accordingly, there is considerable contemporary attention to the use of nanoparticles (NPs) as antibacterial agents against different pathogens and as target drug delivery toward specific tissues therefore microbes are eliminated by the biocidal properties of nanoantibiotics. Additionally, the utilization of nanoencapsulation systems can help to beat the issues of, those with toxicity natures, and target drug delivery problems. This review encompasses the antibiotic resistance prevalence, mechanisms, and therefore the use of nanoparticles as antibacterial and drug delivery systems to overcome the antibiotic resistance challenges of bacteria. Overall, this review paper provides a conceptual framework for understanding the complexity of the matter of emergence of antibiotic resistance bacteria even for brand spanking new synthesized antibiotics. Therefore the availability of such knowledge will allow researchers to supply detailed studies about the applications of nanoparticles in the treatment of multidrug-resistant bacteria. 

Genome-wide association studies (GWAS) have uncovered thousands of single nucleotide polymorphism (SNP) loci that are associated with complex traits. However, the majority of GWAS discoveries are located in non-coding regions and the biological mechanisms behind these associations are not well understood. Transcriptome-wide association studies (TWAS) have gained popularity in recent years by generating biological interpretable discoveries and facilitating the identification of novel associations that have been missed by GWAS. TWAS has identified more than hundreds of susceptibility genes for many complex diseases and traits, including cancers. Here, in this review, we first summarize TWAS methods, then discuss the opportunities for cancer studies and finally review current challenges and future directions for this method.