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Background: Absence of nocturnal decrease in Blood Pressure (BP) (“non-dipping”) has been shown to be a strong and independent predictor of cardiovascular events, target organ damage, cardiovascular sequela and cardiovascular mortality. Obstructive Sleep Apnea (OSA) has been associated with non-dipping with an estimated prevalence of approximately 50%, but factors associated with non-dipping in OSA patients remain poorly understood. In this study, we examined clinically relevant variables associated with non-dipping in OSA.Methods: Patients (n = 35) undergoing overnight valuation for OSA, laboratory-based polysomnography, structured clinical interviews, and comprehensive metabolic and anthropometric evaluations, and ambulatory BP monitoring for 24 hours. Patients were classified into a) dipping BP group or b) non-dipping BP group, based on (a) a nocturnal systolic BP decrease of 10% - 20% or (b) a systolic BP decrease of < 10%. Results: Patients had moderate and severe OSA (AHI = 34.8 ± 29.1), and 42.9% demonstrated a non-dipping BP pattern. The severity of OSA measures did not differ between dipping group and non-dipping group. However, Wake after Sleep Onset (WASO) and chronicity of insomnia predicts non-dipping BP independent of demographics, sleep stages, anthropometrics, metabolic measures, or arterial stiffness. Conclusion: These findings contribute to a better understanding of the cardiovascular impacts of OSA and indicate that sleep quality should be incorporated into clinical assessments and management of OSA patients.

This study explores the dynamics of social exclusion in healthcare settings within the rural Ganderbal district of Kashmir, focusing on the availability of health facilities and the health-seeking behaviors of socially disadvantaged populations. Through a mixed-methods approach, combining quantitative data from interviews and qualitative insights from observation, the research reveals significant disparities in healthcare access between rural and urban areas. Key findings indicate that rural residents face exclusion due to a scarcity of hospitals, unavailability of 24-hour medical staff, inadequate infrastructure, staffing shortages, and systemic biases, compounded by environmental and occupational challenges. Communicable diseases predominate, with majority of respondents affected, and traditional healers and medical shops serve as primary care sources over formal institutions like government hospitals. Socio-economic factors, including low literacy, reliance on agriculture, and poverty, exacerbate these issues. The study highlights higher infant mortality and malnutrition rates in rural areas compared to urban centers, underscoring the need for attitudinal shifts among healthcare providers and systemic improvements in infrastructure and policy to enhance health equity. By addressing an underexplored gap in rural health research in India, this work aims to inform strategies for inclusive healthcare delivery, potentially yielding broader societal benefits through improved well-being and demographic dividends.

Custard apple is a tropical fruit that is cultivated all over India. The seeds of this fruit are found to have medicinal properties as they contain active compounds such as alkaloids, cyclohexapeptides, and acetogenins. It has been used in powdered form for the treatment of scalp lice and dandruff in our part of the world as a native medicine for a long time. We report a case of bilateral severe toxic keratoconjunctivitis following accidental exposure to custard apple seed powder.

Desensitization allows successful transplantation of patients with a positive crossmatch (PXM) against their live donor. We evaluated outcomes following PXM renal transplant despite failure to convert to negative flow cytometric crossmatch (FCXM) after desensitization. Patients that underwent desensitization before PXM transplant between 1/1/00 and 11/1/11 were identified for analysis. Patients who received a transplant despite failure to convert to negative FCXM were identified as the not converted group. Patients who converted to negative FCXM after desensitization comprised the converted group control arm. 108 patients were desensitized before PXM transplant, (not converted group=42; converted group=66). Mean eGFR was comparable between groups at all time points, and 3-year eGFR was 57.8 mL/min vs. 57.1 mL/min, p=0.91. Patients with eGFR < 30mL/min at 3 years did not differ significantly (28% vs. 14%, p=0.15). Biopsy-proven rejection rates were numerically higher within the not converted group for each type of rejection and time point, but the values did not differ significantly. Opportunistic infections rates were comparable. Patient survival (95% vs. 91%) and death-censored allograft survival (84% vs. 95%, p=0.07) were similar between arms at 3 years post-transplant.

Pseudotumoral calcinosis (CPT) is a condition characterized by the deposition of calcium phosphate crystals in the periarticular tissues, forming large calcified masses. Although the pathophysiology of CPT is not fully understood, an increase in the calcium-phosphate product beyond the precipitation threshold and severe hyperparathyroidism appear to play a significant role. Treatment remains controversial, with surgical excision often recommended. We report a case of CPT in a 74-year-old diabetic patient undergoing chronic hemodialysis who experienced progressively worsening pain in the left hip for six months, along with mobility difficulties. A CT scan revealed a calcified mass on the posterior thigh, likely explaining the electric shock-like pain, as well as compression of the superficial femoral artery causing decubitus pain resembling critical limb ischemia. The biological assessment showed elevated calcium-phosphate levels and hyperparathyroidism. Surgical excision is not indicated due to the mass’s proximity to vascular and nerve structures. This case highlights the diagnostic and therapeutic challenges of CPT, emphasizing the need for iterative angioplasties, considering that this condition is rare in chronic hemodialysis patients with calcified periarticular masses.

Endoscopic procedures in patients with comorbidities such as Ischemic Heart Disease (IHD), respiratory compromise, or anticipated difficult airways present considerable anaesthetic challenges. Intubation and positive pressure ventilation, although standard, can be detrimental in such patients due to risks of sympathetic stimulation, barotrauma, or prolonged recovery. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) is gaining attention as a method to maintain oxygenation without intubation. We share our clinical experience using THRIVE during upper endoscopic procedures to avoid intubation in 10 high-risk patients, demonstrating its feasibility, safety, and clinical benefits.

The role of physical exercise in cancer treatment is gaining increasing recognition as part of a holistic approach to patient care. Traditionally, cancer treatment has focused on surgical, hormonal, chemotherapeutic, as well as radiotherapeutic interventions. However, recent studies underscore the significant benefits of integrating physical exercise into treatment plans, not merely as a supplementary activity but as a core component of cancer care [1].

The global energy transition necessitates a shift to renewables to mitigate climate change and ensure energy security. For developing nations like Ethiopia, this presents a critical opportunity to leverage abundant domestic resources for suitable development. Ethiopia, with over 45% of its population lacking electricity, faces a paradox of energy poverty and immense renewable potential. Its grid is 90% hydropower-dependent, making it vulnerable to climate-induced droughts. Previous studies have individually assessed Ethiopia’s hydropower, geothermal, wind, and solar potential. However, a holistic analysis integrating all sectors with current policy and investment frameworks is needed. This article provides a comprehensive analysis of Ethiopia’s renewable energy landscape. We synthesize the potential of hydropower, geothermal, wind, and solar resources, and propose integrated policy and investment pathways to achieve universal electrification by 2030 and position Ethiopia as a regional renewable energy exporter.

A survey was carried out to determine the prevalence and seasonal variations of eggs of gastrointestinal nematodes in goats in four provinces of Mozambique, from November 2016 to October 2017 in Tete and Cabo Delgado, and from November 2016 to October 2018 in Maputo and Gaza. In each province, flocks were selected from both lowlands, located within the valleys of the rivers, and uplands which are located outside the valleys. Faecal samples were collected at monthly intervals to monitor faecal egg counts fluctuations. The modified McMaster technique was used for quantitative analysis of nematode eggs and for detecting cestode eggs in faecal samples. The sedimentation technique for detecting trematode eggs in faecal samples was used. A total of 2 703 samples were examined for nematode eggs and 2 587 for trematode eggs. Faecal examination indicated that between 18% and 100% of goats sampled were infected with gastro-intestinal nematodes. The prevalence varied according to the season of the year and the ecological conditions. The highest prevalence and worm egg counts were recorded at about the peak of the rainy season. Strongyloides papillosus, Calicophoron spp., Fasciola spp. and Schistosoma mattheei eggs were also found. Moniezia expansa and Moniezia benedeni eggs were found in all the four study areas but its prevalence was low and irregular. Based on the results of this study, which showed a clear seasonal pattern, strategic anthelmintic medications to effectively control helminth infections in goats in the different ecological zones of Mozambique are suggested.

Respiratory tract infections in dogs pose a significant problem and often require prolonged treatment. The effectiveness of pharmacological therapy can be improved through the administration of nebulized compounds to liquidize mucus and promote its evacuation from the respiratory tract. The aim of this study was to evaluate the effectiveness of nebulized 0.9% NaCl in dogs with respiratory tract infections. Respiratory functions were assessed based on the results of arterial blood gas analyses, and the patients’ clinical status was determined by evaluating the severity of symptoms on a point grading scale. Inhalation of nebulized 0.9% NaCl significantly accelerated improvement in the patents’ clinical status (normalization of body temperature, decreased cough frequency, decrease/elimination of nasal and ocular discharge, improved appetite) and improved pulmonary gas exchange by reducing partial pressure and total content of carbon dioxide and increasing partial pressure and total content of oxygen in blood.