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Allogeneic hematopoietic stem cell transplant (alloHSCT) is a curative treatment for many hematologic malignancies. Unfortunately, about 30-50% of all recipients undergoing alloHSCT develop acute graft-versus-host-disease (aGVHD), which is associated with high morbidity and mortality [1,2]. Treatment of aGVHD involves the use of immune suppressive drugs such as high dose of steroids that leads to further immunosuppression and risk for opportunistic infections. Often patients are refractory to steroids therapy making the prognosis dismal. Thus, it is critical to identify robust biomarkers to detect aGVHD before onset of clinical symptoms so that therapeutic strategies can be implemented that may result in better treatment responses and less toxicity. 

A 37-year-old woman suffered from a painful and swelling lesion of the base of the tongue, with no history of smoking or medical history of tumours.

Cotton crop is infested with different kinds of insects in the production cycle. Jassids, thrips, aphids and whiteflies are among the sucking pests, and bollworms (American and spotted) and Spodoptera caterpillars attack leaves and bolls. Bollworms can cause up to 40% - 50% crop losses in severe incidences.

The dynamics of the glucose-insulin regulatory system are highly nonlinear and must be understood to be controlled effectively. Bifurcation analysis and multiobjective nonlinear model predictive control (MNLMPC) are performed on a glucose-insulin dynamic model. MATCONT was used for the bifurcation analysis, and for the MNLMPC calculations, the optimization language PYOMO is used in conjunction with the solvers IPOPT and BARON. The bifurcation analysis revealed a Hopf bifurcation point and a limit point. A Hopf bifurcation point is a tipping point where a system that was behaving steadily suddenly starts to oscillate or cycle on its own, like a machine that begins to vibrate instead of staying still. A limit point is a tipping point at which pushing a system a little further suddenly causes it to jump to a completely different state, rather than changing smoothly. MNLMC converged on the Utopia solution. The Hopf bifurcation point, which leads to an unwanted limit cycle, is eliminated by an activation factor. A limit cycle is a repeating pattern of behavior that a system naturally settles into over time, like a steady heartbeat or a clock that keeps ticking. The limit point (which causes multiple steady-state solutions from a singular point enables the Multiobjective nonlinear model predictive control calculations to converge to the Utopia point (the best possible solution) in the model. A Utopia solution in multi-objective nonlinear model predictive control is an ideal operating point at which all goals are simultaneously perfectly optimized.

Primary myelofibrosis (PMF) is a distinct clinicopathological myeloproliferatve disease (MPD) not preceded by any other MPD ET, PV, CML,... Combined use of bone marrow histology and increased erythrocyte counts above 5.8x1012/L can replace increased red cell mass at time of presentation as the pathognomonic clue for the correct diagnosis of hetero/homozygous or homozygous mutated PV. Erythrocyte counts are in the normal range below 5.8x1012/L in heterozygous JAK2V617F mutated ET and prodromal PV but above 5.8x1012/L in heterozygous-homozygous or homozygous mutated PV. The bone marrow cellularity and morphology in pre-fibrotic ET, prodromal PV and PV carrying the JAK2V617F mutation are overlapping showing clustered increase of large mature pleomorphic megakaryocytes (M) with no increase of cellularity (<60%) in ET. The bone marrow is hypercellular (60%-80%) due to increased erythropoiesis megakaryopoiesis (EM) in prodromal and classical PV and trilinear hypercellular (80%-100% due increased megakaryopoiesis, erythropoiesis and granulopoiesis (EMG) in advanced PV and masked PV. Bone marrow cellularity ranging from normal (<60%) in ET to increased erythropoiesis (EM) in prodromal PV to hypercellular (80-100%) in advanced PV and masked PV largely depends on increasing JAK2V617F mutation load from low to high on top of other biological MPN variables like constitutional symptoms during long-term follow-up. MPL515 mutated ET is featured by an increase of clustered small and giant megakaryocytes with hyper-lobulated staghorn-like nuclei in a normal cellular bone marrow. The third entity of pronounced JAK2/MPL wild type ET associated with primary megakaryocytic granulocytic myeloproliferation (PMGM) without PV features proved to be caused by calreticulin (CALR) mutation. CALR mutated thrombocythemia is characterized by dual proliferation of megakaryocytic and granulocytic bone marrow proliferation of dense clustered large to giant immature dysmorphic megakaryocytes with bulky (bulbous) hyperchromatic nuclei, which are not seen in MPL515-mutated Thrombocythemia and JAK2V617F-Thrombocythemia, prodromal PV and classical PV. 

Spinal muscular atrophy is an autosomal recessive neuromuscular disorder characterized by progressive muscle weakness and atrophy. It is one of the most common single-gene disorders with an incidence rate of approximately 1 in 10,000 live births. The clinical manifestations are progressive hypotonia and muscle weakness due to the degeneration of alpha neurons in the anterior horn cells of the spinal cord and motor nuclei in the lower brain stem. Depending on the severity of the symptoms, SMA has five subtypes. Supportive measures can be offered for respiratory, gastrointestinal, and musculoskeletal complications. Carrier testing for all couples is recommended and this can be done by Multiplex Ligation-dependent Probe Amplification (MLPA). Prenatal diagnosis can be offered to carrier couples. Therapies must be given within the newborn period for maximum benefit and before the loss of motor neurons. It is achieved by identifying the SMA babies through Newborn screening. Several new FDA-approved drugs can reduce the progression of symptoms in SMA. However, they cannot offer a definite cure. Clinical follow-up and Neurological assessment demonstrate that SMA children can attain developmental milestones after receiving treatment, which is never normally attained in untreated cases. In utero SMA treatment with Zolgensma would enhance the survival rate and favorable neurological outcomes in the future. Base editing and Gene editing with CRISPR-Cas technologies to target the mutations and restore functional and stable SMN protein levels are the future hopes for a permanent cure of SMA.

Purpose: The role of healthcare workers in cervical cancer prevention is pivotal because healthcare workers’ recommendations have been reported to be a key motivational factor for cervical cancer screening among women in Nigeria. Assessing their knowledge, attitudes, and practices on cervical cancer prevention is necessary.Patients and methods: This is a cross-sectional survey involving healthcare workers in Ekiti State, Nigeria. A questionnaire designed for the study was used to obtain data about the knowledge, attitudes, and practices of the healthcare workers. Logistic regression was used to assess the determinants of practice and a p - value of less than 0.05 was taken as statistically significant.Results: Out of 188 participants that completed the study, 165(90.7%) had good knowledge about the prevention of cervical cancer while 24(13.2%) had good practice concerning the prevention of cervical cancer. positive attitude (Odds ratio 1.24, 95% CI 1.14 - 1.35, p < 0.001) increased the odds of good practice.Conclusion: There was no association between the knowledge of cervical cancer prevention and the practice of the healthcare workers. Further research is required to explore the incongruence between knowledge and practice of cervical cancer prevention and its practice.

Considering the geographical complexity and adversity, online communication and consultation are viable method in Nepal. The COVID-19 pandemic has accelerated the already starting trend of use of these technologies in medicine. In BPKIHS, telemedicine efforts were already initiated; lockdown rather warranted its maximum use. Here is an account of the observation made in telepsychiatry service provided by a consultant psychiatrist of its department of psychiatry. It is an institute-based observation noted for all the telepsychiatry consultations in 9 random duty days of the COVID-19 pandemic. Basic necessary information was noted down in a semi-structured proforma, like: socio-demographic, clinical information and advice provided. There were 104 subjects; 73 follow-up and 31 new: 60 male and 44 female cases. Clients of multi-ethnic groups were the most from urban, then semi-urban and least from rural areas. More consultations were for young age-groups and from nearby districts of Sunsari. Mood, somatic (sleep), anxiety were the top presenting complaints and 8/104 clients had suicidal symptoms. Maximum follow-up cases were improving. The most common diagnoses were: Mood (Depression and Bipolar), Anxiety, Psychosis and Substance use disorders. Most common treatment advices included: Antidepressants, Antipsychotics, Benzodiazepines and Counseling/psycho-education. Telepsychiatry is a viable method of delivering service even during the pandemic. 

Sarcoidosis is a multisystem disease of unknown origin that is characterized by non-caseating epithelioid granuloma formation within various organs, mainly the lungs [1]. The objective of this study is the analysis of sarcoidosis patients affected by pulmonary manifestation alone or extrapulmonary expression.

Introduction: Busulfan (Bu)-based regimens are crucial for myeloablative conditioning in pediatric allogeneic stem cell transplantation. Despite its efficacy, Intravenous Bu has a narrow therapeutic index and variable pharmacodynamics especially in children, heightening the risk of adverse events. This study explores Bu dosing and related organ toxicities in pediatric patients at a tertiary center in Saudi Arabia.Methodology: This retrospective study at King Fahad Specialist Hospital in Dammam (KFSH-D), Saudi Arabia, included pediatric patients (≤16 years) treated with intravenous Bu before bone marrow transplantation from 2010 to 2022. Pharmacokinetic dose adjustments were based on AUC targets of 900-1350 µMol-min. Descriptive measures included mean, Standard Deviation (SD), median, minimum-maximum values, counts, and percentages. Statistical analyses used Kruskal-Wallis, Chi-square, and Fisher’s exact tests. Ethical approval was obtained from KFSH-D.Results: We identified 44 pediatric patients who underwent Bu prior to HSCT. Mean age was 4.95 ± 2.49 years, with a female majority (56.8%). Primary diseases included Beta Thalassemia (34.09%), Neuroblastoma (29.55%) among others. There was no significant difference in the cohort’s demographic and clinical features of the cohort. Nonetheless, higher infections were found in the Low-AUC group (66.7%) compared to the Target-AUC (40.0%) and Higher-AUC groups (0.0%) (p = 0.015).Conclusion: This study emphasizes the need for therapeutic drug monitoring and individualized Bu dosing in pediatric HSCT to minimize toxicity and improve outcomes. Larger multicenter studies are recommended to refine dosing strategies and enhance the safety and efficacy of Bu-based regimens.