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Background: Maternal mortality is a very sensitive indicator of our health system and services. Epidemiological data about maternal mortality is a vital requirement in every setting not only to design interventional programs but also to identify gaps in the existing structures, to reduce the ratio favorably. This study was an attempt to shed light on the mortality rate in our hospital, to analyze the epidemiological aspects, causes of maternal mortality, and types of delay, and to suggest recommendations for improvement. Methods: A retrospective study was done at a tertiary care center at the district level from January 2022 to December 2022. Demographic data and details of selected parameters were obtained from maternal death review forms and case records. Data analyzed and presented.Results: The majority of the maternal deaths could be attributed to direct obstetric causes like Eclampsia (29.41%), Pre-eclampsia (20.59%), and anemia (20.59%) followed by hemorrhage (14.71%), and septicemia (11.76%). Medical conditions contributing to death included liver disorders (5.8%), COVID-19 infection (5.8%), and cardiac disorders (2.9%). Conclusion: It is evident that the maternal mortality ratio is significantly high, with a majority of the deaths occurring due to avoidable causes. Leading contributory factors were due to delay in seeking help or delay in referral. High-risk cases must be identified at the earliest and referred to higher centers for management from the first trimester itself. Generating awareness among the common public and counseling the gravidas and their caretakers throughout pregnancy is equally important to prevent maternal mortality and near-miss cases.

This paper investigates the effect of coating concentration (ppm), and coating thickness (µm) on the anti-microbial properties of polycarbonate sheets using a variety of anti-microbial agents (Cu-infused Mg(OH)2, Mg(OH)2, Cu(OH)2, MgO, CuCl2.2H2O, and ZnO). In addition, a complete analysis was performed for all agents to rank the best agent in terms of the highest anti-microbial performance against E. coli K-12 MG1655 in two time intervals (4 and 24 hours). The coating concentration (ppm) was found to be a significant factor in the anti-microbial characteristics for Cu-infused Mg(OH)2, Mg(OH)2, Cu(OH)2, MgO, CuCl2.2H2O, and ZnO (p = 0.004, p < 0.0001, p < 0.0001, p = 0.0297, p = 0.0011, and p = 0.0130 respectively). The coating thickness (µm), on the other hand, was found to be a major contributor to the anti-microbial properties of Cu-infused Mg(OH)2, Mg(OH)2, Cu(OH)2, MgO, and CuCl2.2H2O (p < 0.0001, p = 0.0004, p = 0.0011, p = 0.0310, and p < 0.0001 respectively). The analysis determined that the coating did not influence the anti-microbial properties of ZnO. The interaction between the coating concentration (ppm), and the coating thickness (µm) was found to be a significant factor for Cu-infused Mg(OH)2, Cu(OH)2, MgO, CuCl2.2H2O, and ZnO (p < 0.0001, p = 0.0001, p = 0.0004, p < 0.0001, and p < 0.0001 respectively), however, this was not a significant factor for Mg(OH)2.Highlights•    The anti-microbial activity of the inorganic material is dependent on the particle shape and size.•    Particles with sharp edges will provide additional physical injuries to the microorganisms.•    Smaller particle size will provide higher surface area therefore better interaction with microorganisms.•    The coating concentration and coating thickness will be crucial to the anti-microbial activity.•    The thermal embossing techniques demonstrate good adhesion to the surface.

Cerebrotendinous Xanthamatosis (CTX) is a rare autosomal recessive disorder caused by a mutation in the CYP27A1 gene leading to impaired metabolism of cholesterol and accumulation of cholestenol and the cholesterol in various tissues such as the brain, eyes, lungs and bones and reduced formation of cheno-deoxycholic acid (CDCA). The clinical presentation is diverse, starting in the early neonatal period and progressing till adulthood unless treated early. A common neurological manifestation is a spino-cerebellar ataxia followed by spastic paraparesis. Tendon xanthoma is a classical finding that usually helps in clinching the diagnosis but may not be present in all cases. Brain MRI also reveals characteristic abnormalities with cerebellar atrophy and hyper-intensities in the dentate nucleus and surrounding cerebellar white matter on T1weighted images. It is a rare cause of treatable ataxia in young individuals. Treatment is by replacement by CDCA or Urso-deoxycholic acid (UDCA). Supplemented with statins these individuals also have premature atherosclerosis causing death due to athero-sclerotic coronary artery disease. Here a rare case of symptomatic heterologous CYP27A1 mutation is reported with syndrome of spino-cerebellar ataxia treated with UDCA.

Introduction: Inflammatory or suppurative ringworm is a rare form of dermatophyte damage to the hair scalp. The aim is to describe the epidemioclinical profile of inflammatory ringworm in children at the Koulikoro Reference Health Centre (Csref).Methodology: This was a 12-month descriptive cross-sectional study of all cases of Kerions diagnosed in children at the Koulikoro Csref.Results: Over 12 months, 25 cases were recorded among 1,200 consulting patients, representing a hospital frequency of 2%.Males were 22 and females three, with a sex ratio of 7.33. The mean age was 7 years, ranging from 2 to 13 years.Conclusion: Celse kerions appear to be common in school-age boys, and contact with domestic animals is described in the majority of cases. Further work is needed to describe the fungi responsible and the risk factors.

The article deals with such issues as storage of industrial waste, causes, examples and prevention of accidents, NGO operation and reclamation, and methods of dealing with the consequences of accidents. When storing industrial waste in large volumes, various complications arise, including accidents in waste storage facilities. The article provides examples of accidents for specific objects and analyzes their causes and consequences. The methods of dealing with the consequences of accidents and their prevention are considered. The materials of the article can help specialists improve the design and operation of waste storage facilities.

The mainstays of nuclear substance radiation and isotopic synthesis are nuclear-powered power plants, however effective safety evaluation is made tougher by the complicated construction topologies and physical connection effects. This work proposes a multiphysics-linked technique for evaluating both the kinetic and steady-state behaviors of the MPRR and LVR-15 laboratory reactors. To represent complicated member geometries, homogenized assembling sections are generated using two-dimensional whole-core computational simulations. It is discovered that the steady-state findings and the so-called Monte Carl solution comparisons correspond quite nicely. The greatest assemble power mistakes for LVR-15 and MPRR are 6.49%/10%, and the highest command rod value mistakes are 31 pcm/136 pcm, and the mistakes are 377 pcm/383 pcm, accordingly. Meanwhile, the study is done on transitory procedures, such as reactivity-initiated disasters and exposed loss-of-flow mishaps. Both units' modeling findings show plausible adverse feedback events. Furthermore, it is shown that the two reactors' accident-related behaviors are comparable though having different core architectures since they employ the exact same kinds of water as a fluid. The technique for studying nuclear power plant kinetics known as Multi-Physics Simulation (MPM) is explained. Drawing on many research and verification efforts conducted at Politecnico di Milan, Italy, MPM is shown to be a valuable instrument for managing reactors' security and oversight. It may be viewed as a holistic analytical tool that is implemented during the reactor architecture design phase. The capacity to concurrently answer the interrelated equations that control the many physical processes taking place in a nuclear plant inside the same simulated setting is a core characteristic of MPM.

Aim: To evaluate the effectiveness of an ayurvedic gel in tooth pain reduction due to dental caries. Materials and methods: This in vivo cross-over design study enrolled adults with at least one tooth with caries and a symptom of pain after the application of an ice stimulus. Two hundred patients were screened and eligible patients were enrolled in the study. Forty-five subjects completed washout phases before each recall visit. During each recall visit, subjects evaluated pain relief following an ice bar stimulus and one random finger-tip application of a treatment i.e. Ayurveda Herbal gel containing clove oil, camphor, and menthol (Ayurveda Herbal Gel Group), and two control formulations: a gel without active ingredients and commercial olive oil as a surrogate of home remedy. At each assessment, subjects used a stopwatch to record the onset of pain relief and tooth pain using visual analog scores (VAS), dental pain scores (DPS), and relief from tooth pain by dental pain relief scores (DPRS). After each treatment, subjects recorded their satisfaction with the provided treatment using a four-point satisfaction index. Data were tabulated and statistical analysis was performed with (ANCOVA) and two-way ANOVA with a p - value of 0.05 considered statistically significant. Results: Forty-five subjects (28 males and 17 females) completed the entire study without any adverse events. Application of the Ayurveda gel resulted in a significantly faster onset of pain relief (2.47 min) in comparison to the onset of pain relief after 4 minutes recorded with the controls (p < 0.05). Subjects reported lower VAS and DPS scores over the study period of evaluation when using the Ayurveda gel compared to the application of each control formulation. Subjects also reported greater relief of pain and greater satisfaction after the application of the Ayurveda gel as compared to the controls. Conclusion: Significantly better tooth pain relief from caries was observed from an Ayurveda Herbal gel than from controls.

Introduction: We aim to evaluate the performance of pre-treatment MRI-based habitat imaging to segment tumor micro-environment and its potential to identify patients with esophageal cancer who can achieve pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT).Material and methods: A total of 18 patients with locally advanced esophageal cancer (LAEC) were recruited into this retrospective study. All patients underwent MRI before nCRT and surgery using a 3.0 T scanner (Ingenia 3.0 CX, Philips Healthcare). A series of MR sequences including T2-weighted (T2), diffusion-weighted imaging (DWI), and Contrast Enhance-T1 weighted (CE-T1) were performed. A clustering algorithm using a two-stage hierarchical approach groups MRI voxels into separate clusters based on their similarity. The t-test and receiver operating characteristic (ROC) analysis were used to evaluate the predictive effect of pCR on habitat imaging results. Cross-validation of 18 folds is used to test the accuracy of predictions.Results: A total of 9 habitats were identified based on structural and physiologic features. The predictive performance of habitat imaging based on these habitat volume fractions (VFs) was evaluated. Students’ t-tests identified 2 habitats as good classifiers for pCR and non-pCR patients. ROC analysis shows that the best classifier had the highest AUC (0.82) with an average prediction accuracy of 77.78%.Conclusion: We demonstrate that MRI-based tumor habitat imaging has great potential for predicting treatment response in LAEC. Spatialized habitat imaging results can also be used to identify tumor non-responsive sub-regions for the design of focused boost treatment to potentially improve nCRT efficacy.

The psychological burden of physicians has been the focus of many researchers since the 1950s, and some papers have found a high prevalence of anxiety and depressive disorders among medical staff. Recent studies have shown that the coronavirus pandemic didn’t go easy on healthcare workers. The fact that it has been three years since the outbreak, has motivated our study. Which aims to evaluate the intensity of anxiety among medical personnel and the risk factors that could be incriminated post-COVID pandemic and if the level of anxiety is back to normal. This is a cross-sectional study, carried out with a survey split into 2 parts sociodemographic and work-related data, and the French version of the Hamilton anxiety scale, Statistical analysis was performed using Jamovi et Microsoft Excel. About half of the 116 physicians in our study had no anxiety (55.2%), while 21.6% had mild anxiety, 10.3% had moderate anxiety, and 12.9% had severe anxiety. The identified risk factors for anxiety were female gender, personal and family history of anxiety disorder, doing night shifts, and being a general practitioner. The anxiety rate of physicians is back to normal post-COVID pandemic. But we shouldn’t stop there. The mental health status of medical personnel depends on several of the factors listed above. Determining them would imply a call for the implementation of preventive measures for anxiety and depressive disorders among physicians. Because taking care of physicians is taking care of patients.

Non-small-cell lung cancer (NSCLC) accounts for 85% of lung cancer cases and is associated with different risk factors (smoking habits, gender, and age). In this scenario, many studies have been conducted to pursue improvement of survival, faster and better therapy response, reduced adverse events, and expanded available therapies and treatments against tumor resistance to drugs. These studies have focused on defining the most prevalent NSCLC biomarkers (EGFR, HER2, ALK, MET, ROS1, BRAF, KRAS G12C, HER3, NTRK, and NRG1) and their actionability. It is noteworthy that expressed kinase receptors can have overlapping mechanisms of activation of different pathways (JAK-STAT, MAPK, PI3K-AKT-mTOR, and PLC-c), which can lead to the same outcome of cell proliferation, migration, and survival resulting in increased tumor resistance to treatment. This review provides an overview of the latest findings regarding NSCLC treatment, emphasizing particular biomarkers and potential molecularly altered pathways implicated as targeted therapies. Additionally, it explores the clinical significance of the proposed treatments, their implication on progression-free survival, ongoing clinical trials, and their perspective of evolution so far.

Numerous studies relate differences in microbial communities to humans. The microbiome is fundamental for the human turn of events, invulnerability, and nourishment. The ordinary microbiota has explicit capability in supplement digestion, xenobiotic and drug digestion, upkeep of underlying trustworthiness of the stomach mucosal boundary, immunomodulation, and assurance against microorganisms. Out of nowhere, it assumes a significant part in criminology. In a few criminal examinations, such perceptible changes in the microbiome and mycobiome can decide the reason or the genuine spot of death. The microbial follows found at the crime location can likewise give obvious proof of responsibility. The point of this audit was to study the microbiome and its applications in scientific sciences and to decide the primary lines of examination that are emerging, as well as its potential commitments to the scientific field.’

This paper reviews the transformative impact of Artificial Intelligence (AI) on civil engineering. It explores AI's fundamental concepts and its applications across structural analysis, construction management, transportation, geotechnical engineering, and sustainability. The review highlights AI's role in automating tasks, predicting outcomes, and optimizing designs throughout project lifecycles. Recent advancements in AI-driven technologies for structural health monitoring, predictive maintenance, and risk assessment are discussed, along with challenges like data quality and model interpretability. Future trends such as autonomous construction and digital twins are examined, emphasizing the need for continued research and interdisciplinary collaboration. In conclusion, this paper offers insights for leveraging AI to address evolving challenges and opportunities in civil engineering, fostering innovation, sustainability, and resilience in infrastructure development.

Based on the results obtained in the study of the interaction of geological and biosphere processes, we found out that there is a close relationship between them. It was also found that the gravity of the bodies of the solar system on the Earth plays a significant role in the above relationship. The effect of gravity was demonstrated on the movement of lithosphere plates, on the processes in the atmosphere and hydrosphere, on related climatic cycles, and the biosphere processes, including "living" organisms' evolution and their mass extinctions. The periodicity of these processes due to gravity is shown. It is expressed in the alternation of short-term orogenic periods of the beginning of the processes with long-term geosynclinal periods of their development and completion. Both periods constitute the repetitive orogenic cycles. The relationship of the cycles with the evolution of photosynthesis, as well as with related Organic Matter (OM) accumulation in sediments after mass extinction of organisms, including OM transformation leading to the formation of Hydrocarbon (HC) accumulations, is shown. Biogenic processes accounting for the accumulation and transformation of organic matter in sediments constitute the biogenic pathway of the formation of hydrocarbon accumulations. It is shown that the influence of gravity extends to the processes in the inner geospheres, including the movement of magma in the asthenosphere under the lithosphere shell, to the movement of hydrogen gas coming from the Earth's core, combining with volatile compounds of elements present in magma, as well as to the rifting process. It is shown that rifting processes lead to the formation of gaseous HC accumulations and constitute a pathway called abiogenic. The obtained results shed light on the peculiarities of the formation of HC accumulations by biogenic and abiogenic pathways, allowing prediction of their chemical characteristics. This is essential when searching for oil and gas and planning exploration works.

Nutrition is the process of supplying the organism with substances that have certain useful characteristics for the organism. It is through the process of nutrition that the organism receives the necessary amount of energy required for normal life activity. The cell is a structural and functional unit of the human body, and it is from a set of similar formations that tissue, organ, and organ systems are formed. Consequently, each cell of the body must receive the necessary supply of nutrients in order to continue its normal functioning. Cellular nutrition is the ability of each cell of the human body to consume nutrient molecules in the amount they need. In this case, the object of the study is just that nutrition, which begins with the nourishment of an individual cell. This article presents the results obtained by analyzing the data regarding the process of making the cell's consumption of the right nutrients while taking into account how the transition to cellular nutrition affects the environment and its constituents.

Severe alcoholic hepatitis is an ethical and clinical conundrum, wherein a liver transplant is often recommended. The adequacy of medical treatment versus the risk of recidivism after transplant is often debated. Complete recovery in 26 of 27 patients with severe alcoholic hepatitis was observed, and hence the data was retrospectively analysed.Methods: 27 patients, with severe alcoholic hepatitis, with Maddrey's discriminant function between 59.7 to 165.2 (mean 107.53), from June 2017 to May 2022, were followed up for between 11 months to 6 years. INR ranged from 1.99 to 3.7 (mean 2.709), and bilirubin was between 7.6 to 37.01, (mean 20.859). 8 patients had pre-existing liver cirrhosis. All patients received probiotics, nutritional support, physical rehabilitation, saturated fat (clarified butter/ desi ghee) supplementation, and anti-oxidant support. At 90 days, total bilirubin improved to between 1.0 to 6.8 (mean 2.625). ALT (Alanine Transaminase/ SGPT) ranged from 65 to 550 (mean ALT – 197); and AST (Aspartate Transaminase / SGOT) ranged from 58 to 810 (mean AST – 271.51). Both the AST and ALT were near normal after 90 days. One patient died due to bacterial pneumonia and sepsis; the remaining 26 patients made a complete recovery. All patients including those with diagnosed liver cirrhosis, had complete resolution of their ascites, and near-normal liver function. At the last outpatient visit, none had ascites, edema, or encephalopathy, and had normal albumin levels and INR values. Conclusion: Probiotics, nutrition, a saturated fat diet, and exercise; all have shown benefits in patients with severe alcoholic hepatitis when tested individually. Concomitant use of all the above has not been reported in the treatment of alcoholic hepatitis. The role of nutrition alone versus the contribution of nutritional deficiencies and the role of gut-derived endotoxemia need to be studied in detail. How to identify patients who need a transplant, if it is needed at all, remains a challenge.

Iatrogenic femoral pseudoaneurysms are a rare complication of transfemoral vascular access. We present a case of a 65-year-old woman with a mechanical mitral valve requiring warfarin, who developed a femoral pseudoaneurysm four days after cardiac catheterization with femoral access. The patient developed a 17 x 10 x 17 cm rectus sheath hematoma and was treated with ultrasound-guided thrombin injection. Anticoagulation was held for three days while the patient was monitored for further bleeding and later restarted based on shared decision-making, given the risk of valve thrombosis. There are few guidelines regarding the re-initiation of anticoagulation in high-risk bleeding patients with mechanical mitral valves. Non-invasive coronary computed tomography angiography should be considered in patients on anticoagulation who require non-emergent cardiac ischemic evaluation.

Alpha-1 antitrypsin deficiency is a genetic disorder that can lead to chronic obstructive pulmonary disease and emphysema. Although it is the most well-studied genetic risk factor for emphysema, data is still scarce. Traditionally, medical therapy is similar to standard chronic obstructive pulmonary disease patients. Over the past several decades, enzyme augmentation therapy has emerged as a highly utilized alpha-1 antitrypsin-specific therapy. It has become the standard of care for severe alpha-1 antitrypsin deficiency despite unclear effects on a multitude of clinical outcomes. Significant data supports interventional therapies, including lung volume reduction surgery and bronchoscopic lung volume reduction, for chronic obstructive pulmonary disease patients without alpha-1 antitrypsin deficiency. These interventions have less robust data in the treatment of alpha-1 antitrypsin-induced chronic obstructive pulmonary disease. This review will explore the data regarding various treatment options for severe alpha-1 antitrypsin deficiency associated with chronic obstructive pulmonary disease and emphysema.

Chronic infection with the hepatitis C virus (HCV) is estimated to affect 58 million people worldwide and around 700,000 individuals in Brazil. Various non-invasive markers of hepatic fibrosis have been proposed, such as transient hepatic elastography (THE) using FibroScan®. However, the reliability of the performance, by operators in the training phase is undetermined, which hinders its applicability in clinical practice. Objectives: The present study aimed to evaluate the impact of training an inexperienced operator to perform the examinations using FibroScan® in patients with chronic hepatitis C. Specifically, the frequency of unreliable results throughout the training was assessed. Methods: This is a cross-sectional study with retrospective data collection including compensated chronic hepatitis C patients who underwent the examinations using FibroScan® between March 2014 and December 2016, performed by two researchers. Included patients were divided into two groups based on the operator's experience in the examination: the Experienced Examiner (EE) group and the Examiner in Training (ET) group, with the latter divided into two phases: phase 1, consisting of the first 100 examinations, and phase 2, comprising subsequent examinations. For the reliability analysis, parameters such as success rate (SR), interquartile range (IQR) to median (Md) ratio (IQR/Md), and reliability criteria of Castéra, et al. and Boursier, et al. were used. Results: Between March 2014 and December 2016, 771 adult HCV-infected individuals were evaluated and divided into EE group (n = 161), ET phase 1 (n = 100), and ET phase 2 (n = 158), showing similar demographic, clinical, and laboratory characteristics. SR and IQR/Md ratios were similar among EE, ET phase 1, and ET phase 2 groups. The proportion of reliable results was comparable in all three groups, using Castéra, et al. reliability criteria (92.5%, 92.0%, and 97.5%, respectively) and Boursier, et al. criteria (96.9%, 95.0%, and 98.1%, respectively). Conclusion: A short training period (up to 100 examinations) seems to be sufficient for them to have good clinical applicability in the hands of an operator with initial experience in the method

This study assesses air pollution in Sichuan Province, China, from January 2019 to December 2023 using Copernicus Sentinel-5P satellite data. The analysis reveals distinct seasonal variations in levels of Carbon Monoxide (CO), Nitrogen Dioxide (NO₂), Sulfur Dioxide (SO₂), and Ozone (O₃), with urban areas experiencing higher concentrations due to industrial and vehicular emissions. CO and O₃ frequently exceeded WHO guidelines, particularly in winter and summer, indicating significant health risks. While most pollutant levels remained within safety limits, the findings highlight the importance of continuous monitoring and targeted mitigation strategies to improve air quality and safeguard public health, especially in urban environments.

The study is based on the characterization of different AI models applied in the public furniture design analyzing the conditions of risk, materiality, and integration of variables in two AI generative modeling algorithms. As risky since they contain flood-prone areas, low vegetation coverage, and underdevelopment of infrastructure; therefore, these characterizations are tested through artificial simulation. The experimental method is applied through laboratory tests of various material components and their structuring in 3D simulators to check their resistance and risk scenarios. The case study of one of the most risky and populated areas of the informal settlement area of the Northwest of Guayaquil, such as the Coop, is analyzed. Sergio Toral is the focal point for on-site testing. It is concluded that the generation of a planned scheme of ecological furniture with different materials responds more effectively to the territory and that through artificial simulation an advantage can be obtained in terms of execution time and results, thus demonstrating that artificial intelligence is an ideal tool. To generate furniture design proposals that are more diverse, innovative, and functional with the environment, but it generates a minimum level of error for specific designs in the experimental model_01 of 0.1% to 3% and a high level in the experimental model_02 with an increasing error from 20% to 70%. As a future line of research, it is proposed to generate a simulated system of all the new informal settlements in Guayaquil and establish focal points for the implementation of new ecological furniture.