The contribution of homestead pond fish culture to household food security and dietary diversity in central coast of a developing country.

Fish farming in homestead ponds help alleviate poverty, provide animal source food, micronutrients, and indirect income and various jobs in developing nations. This study investigated the impact of homestead pond fish farming on dietary diversity (HDDS and MDD-W), food security (HFIAS and ELCSA), income, and women's engagement. A total of 185 households were selected randomly for data collection through well-structured questionnaire interviews in the central coast of Bangladesh. HDDS revealed significant dietary diversity (73.3%) among beneficiary farmers, surpassing controls and nearly doubling that of non-aquaculture farmers (41.1%). Additionally, this study found that 86.7% and 74.3% of women in beneficiary and homestead pond farmers exhibited high dietary diversity (MDD-W ≥ 5), whereas 48.6% of women in non-aquaculture farmers' households had low dietary diversity (MDD-W ≥ 5). Based on both ELCSA and HFIAS, higher prevalence of food security was observed among the beneficiary farmers that was about 60% and 63.3%, respectively compared with the control farmers. Most non-aquaculture farmers (62.9%) indicated their family consumed fish for one week before the research. More than half of the homestead pond culture (55.7%) and more than 90% of the beneficiary farmers, aquaculture farmers and non-aquaculture farmers had gross income (<$ 500). Pertaining to women's participation in homestead pond was positively correlated to productivity while male dominated tasks was negatively correlated with productivity. The results offer insights into how homestead pond fish farming can enhance food security by supplying direct animal protein, addressing protein and micronutrient deficiencies, and boosting income. The study emphasizes the urgent necessity for training and promoting homestead pond culture, increasing female participation, and advocating comprehensive support from governmental organizations (GOs) and non-governmental organizations (NGOs) to optimize production, improve micronutrient adequacy, and guarantee household food security. Keywords: Fish farming, food security, dietary diversity, women's participation.

Transient 2:1 Atrioventricular Block with Peri-Conduction System Pacing After Leadless Pacemaker Implantation.

This report discusses a case of transient 2:1 atrioventricular block with conduction system pacing 4 hours after leadless right ventricular pacemaker implantation in a 19-year-old patient with a history of cardioinhibitory syncope and asystole cardiac arrest but without preexisting atrioventricular block. The atrioventricular block was resolved spontaneously. Pacing morphology was suggestive of right bundle branch pacing. Neither 2:1 atrioventricular block nor conduction system pacing has previously been a reported outcome of right ventricular leadless pacemaker implantation. The report demonstrates that conduction system pacing with leadless devices is achievable. Further study of techniques, limitations, and complications related to intentional right ventricular leadless conduction system pacing is warranted.

Diaporthe sp. F18; a new source of camptothecin-producing endophytic fungus from Nothapodytes nimmoniana growing in Sri Lanka.

An endophytic fungus producing camptothecin (CPT) was isolated from the leaf of Nothapodytes nimmoniana (Sri Lanka), and culture conditions were optimised to enhance the yield of CPT. The TLC, HPLC-PDA, LC-MS/MS and spectroscopic data were used to identify and quantify CPT. Solvent extraction (chloroform: methanol 4:1 v/v) of submerged cultures in Sabouraud Dextrose Broth (SDB) detected CPT in the mycelial extract but not in the culture broth. The fungus was (KX212080) closely related to Diaporthe guangxiensis (MK335772) with 99% sequence similarity, thus tentatively identified as Diaporthe sp. F18. A significantly high CPT content (72.0 ± 0.2 µg/g) was produced in SDB, pH, 5.6 incubated at 30 °C under shake flask condition (150 rpm) for 14 days. Tryptophan significantly (p > 0.05) enhanced CPT production while ethanol increased it by 8-fold. This endophytic source produced higher CPT content than what has been reported hitherto in the literature, with fairly stable production up to sixth subculture generations.

Innovations in ventricular tachycardia ablation.

Catheter ablation of ventricular arrhythmias (VAs) has evolved significantly over the past decade and is currently a well-established therapeutic option. Technological advances and improved understanding of VA mechanisms have led to tremendous innovations in VA ablation. The purpose of this review article is to provide an overview of current innovations in VA ablation. Mapping techniques, such as ultra-high density mapping, isochronal late activation mapping, and ripple mapping, have provided improved arrhythmogenic substrate delineation and potential procedural success while limiting duration of ablation procedure and potential hemodynamic compromise. Besides, more advanced mapping and ablation techniques such as epicardial and intramyocardial ablation approaches have allowed operators to more precisely target arrhythmogenic substrate. Moreover, advances in alternate energy sources, such as electroporation, as well as stereotactic radiation therapy have been proposed to be effective and safe. New catheters, such as the lattice and the saline-enhanced radiofrequency catheters, have been designed to provide deeper and more durable tissue ablation lesions compared to conventional catheters. Contact force optimization and baseline impedance modulation are important tools to optimize VT radiofrequency ablation and improve procedural success. Furthermore, advances in cardiac imaging, specifically cardiac MRI, have great potential in identifying arrhythmogenic substrate and evaluating ablation success. Overall, VA ablation has undergone significant advances over the past years. Innovations in VA mapping techniques, alternate energy source, new catheters, and utilization of cardiac imaging have great potential to improve overall procedural safety, hemodynamic stability, and procedural success.

Device Closure of Superior Sinus Venosus Atrial Septal Defects: A single centre experience.

Sinus venosus atrial septal defects present a wide variety of anatomical features and are frequently associated with partial anomalous pulmonary venous drainage of one or more right pulmonary veins. Surgical correction used to be the standard treatment. In recent times, transcatheter correction of superior sinus venosus atrial septal defects has come into vogue. The transcatheter closure of these defects with covered stents at a tertiary care centre in Oman between 2018 and 2023 is reported.

The Sinus Venosus Veno-Venous Bridge: Not a septal defect.

This review provides an update on the morphology of the sinus venosus defect. It was earlier believed that a 'common wall' separated the right pulmonary veins from the superior caval vein. In the sinus venosus defects, this wall was absent. Current evidence shows that the superior rim of the oval fossa, rather than forming a second septum or representing a common wall, is an infolding between the walls of the caval veins and the right pulmonary veins. The sinus venosus defect is caused by the anomalous connection of one or more pulmonary veins to a systemic vein. However, the pulmonary vein(s) retain their left atrial connections, leading to a veno-venous bridge that allows interatrial shunting outside the oval fossa. True atrial septal defects are located within the oval fossa or in the anteo-inferior buttress, while sinus venosus defects, ostium defects and coronary sinus defects are morphologically distinct from them.

Relation of T Wave Positivity in Lead aVR to Ischemic Etiology of Cardiomyopathy.

Identifying ischemic etiology of cardiomyopathy carries prognostic and therapeutic significance. Clinical and electrocardiographic parameters can predict ischemic cardiomyopathy. Positive T wave polarity in lead aVR (TPaVR) has been associated with adverse cardiac events and severity of coronary artery disease. Medical records of adults evaluated in an advanced heart failure referral clinic for cardiomyopathy with systolic dysfunction (ejection fraction ≤ 40%) were retrospectively reviewed. Patients with ventricular pacing were excluded. Significant predictors of ischemic cardiomyopathy from a univariate logistic regression model were entered simultaneously into a multivariate logistic regression model. A total of 180 patients met study inclusion criteria. Mean age of the population was 52.5 ± 15.3 years old and 65% were men. Ischemic cardiomyopathy was present in 52 patients (29%). Positive TPaVR was present in 57 patients (32%). Ischemic cardiomyopathy was more common in patients with positive TPaVR (63% vs 13%, p < 0.001). Ischemic cardiomyopathy was independently predicted by male gender, diabetes, hyperlipidemia, absence of family history of cardiomyopathy, echocardiographic regional wall motion abnormality, and positive TPaVR. The strongest association was with positive TPaVR (odds ratio 30.5, 95% confidence interval 6.47 to 214; p < 0.001). T wave amplitude of +0.025 mV in lead aVR was the optimal cutoff to distinguish ischemic and nonischemic cardiomyopathy in receiver operating characteristic analysis (sensitivity 69.2%, specificity 83.6%, area under curve = 0.747, 95% confidence interval 0.658 to 0.836). In conclusion, positive TPaVR was a strong predictor of ischemic etiology of cardiomyopathy.

Ocular co-morbidities in patients with atopic dermatitis - a cross-sectional study from a tertiary referral hospital, Malaysia.

INTRODUCTION: Atopic dermatitis (AD) is a chronic relapsing pruritic inflammatory skin disease that commonly occurs among children as well as adults. AD patients were reported to have high prevalence of ocular manifestations, which may be due to the disease nature or drug complications. This study aimed to determine the prevalence of ocular manifestations in patients with AD. MATERIALS AND METHODS: Eighty patients who fulfilled the UK Working Party's Diagnostic Criteria for Atopic Dermatitis were included in the cross-sectional study. A standardized case report form was formulated to collect the demographic data and disease profile of the participants. AD severity was evaluated using the EASI and SCORAD score. All patients underwent a complete ophthalmological evaluation. RESULTS: The prevalence of ocular manifestations among the patients with AD was 48.8%. Fifty-four (67.5%) patients had facial dermatitis and 37 (46.2%) showed periorbital signs. The mean AD disease duration was 10.99 ± 11.20 years. Majority of the patients had mild to moderate AD. The most frequent ocular manifestation was allergic conjunctivitis (18.75%) followed by cataract (8.75%) and ocular hypertension (8.75%). Among the patients with ocular manifestations, 27 (69.2%) patients regularly applied topical corticosteroids on the face. The use of systemic corticosteroids was seen in 19 (42.2%) patients. Prolonged AD duration was significantly associated with the development of ocular manifestations. CONCLUSIONS: Nearly half of the patients with AD were complicated with ocular disease regardless of the AD severity, facial dermatitis and presence of periorbital signs. Long disease duration is associated with ocular manifestations, especially steroid related complications.

An In-Vitro Assessment of Operator Accuracy and Inter-Operator Agreement in Recording Shade and Shade Characteristics.

Color assessment remains a challenging aspect of esthetic dentistry. This study aimed to evaluate inter-operator agreement and accuracy in assessing shade parameters and to investigate the effect of different clinical backgrounds of the operators under different lighting conditions. Three veneers with a single shade (VITA VM7, shade 2M2: VITA Zahnfabrik, Bad Säckingen) and different shade characteristics (lustre, translucency and opacity) were assessed by 24 operators with different backgrounds using natural and color-corrected light (Trueshade, Interempresas Media, S.L.U. - Grupo Nova Àgora, Spain). Shade assessment accuracy was only 5.5% using natural light and 9.7% using Trueshade. The majority of operators identified value and hue correctly, although chroma was mostly identified incorrectly. The most accurate assessments were recorded by technicians, and translucency was the characteristic to be least accurately recorded. Inter-operator agreement of shade was better with Trueshade compared without Trueshade, although group agreements of shade characteristics were higher without Trueshade for lustre and opacity, but not for translucency. Operators showed limited agreement and poor accuracy in assessing shade and shade characteristics and the clinical background had an effect on shade selection. Technicians were more reliable in shade assessment. Trueshade could be a promising tool to improve shade assessment outcomes.

Reconstruction of Congenital Arhinia With Stereolithographic Modeling: Case Correlate and Literature Review.

Complete congenital arhinia is a rare defect of embryogenesis leading to the absence of the external nose and airway. We report our novel multistaged reconstructive approach and literature review. Nasal methyl methacrylate prosthesis was created from a stereolithographic model for use as a temporary prosthesis and tissue expander. Lefort 1 with cannulization was utilized for midface advancement and airway formation. External framework was reconstructed with bilateral conchal bowl cartilage and rib osteocartilagenous grafts. Patient was pleased with the aesthetics and had safe decannulation with the ability to breathe through the nose and airway.

Chromogenic in Situ-Hybridization of HPV16/18 DNA in Relation to the Over-Expressed Protein of P73-Gene in Tissues from a Group of Thyroid Carcinoma.

Thyroid cancer has been related to many environmental, genetic, and viral factors. Human Papilloma Viruses (HPV) are epitheliotropic viruses infecting cutaneous and mucosal tissues, leading to a variety of benign and malignant tumors. The p73-gene expresses two important isoforms from the N-terminal end with two opposite activities in the regulation of cell fate. The present study aimed to assess the histopathological expression of tissues from thyroid cancers in relation to the over-expression of the p73 gene with HPV 16/18 infection. A total of 116 thyroid tissues were examined for HPV 16/18-DNA and P73-gene protein expression. The samples belonged to 36 patients diagnosed with thyroid carcinoma, 40 thyroid adenoma tissues blocks, and 40 apparently normal thyroid tissues. The detection of HPV 16/18-DNA was performed by in situ hybridization (ISH), whereas P73 gene expression was carried out by immunohistochemistry (IHC). The HPV16/18 DNA-ISH reactions in thyroid cancers were found in 72.2% tissues, 35% HPV16/18- positivity was detected in the thyroid adenoma tissues group, and 27.5% of healthy thyroid tissues revealed ISH reactions. Statistically, the difference of the HPV16/18 in thyroid cancers and control was highly significant. The p73 was detected in 66.7% and 57.5% of thyroid cancer and adenoma thyroid tissues, respectively, while 45% of the examined healthy thyroid tissues revealed IHC-reactions. The difference between the p73-protein expression percentages detected in tissues of thyroid tumors and the control group was non statistically significant. The presence of HPV16/18, as well as an over-expressed p73-gene, in thyroid cancer patients, suggests that the virus, as well as this protein, may play an etiologic role in thyroid carcinogenesis.

Parental perception and acceptance of silver diamine fluoride treatment among Syrian refugees.

OBJECTIVE: Silver diamine fluoride (SDF) is an effective cariostatic agent, although staining associated with treatment is a significant impediment to its acceptability. BASIC RESEARCH DESIGN: A cross-sectional study of Syrian refugees to identify acceptance of SDF treatment. METHODS: Information was collected on: sociodemographics, medical/dental child history, dental status (dmft/DMFT), andperceptions of photographs of SDF-treated teeth. Associations between clinical findings and the acceptability were assessed. RESULTS: Of 258 parents or guardians, 37.8% accepted SDF treatment for their children. Acceptance was related to the location and type of teeth, being higher for primary than permanent teeth, and posterior than anterior teeth in both dentitions. Uncooperative behavior during previous dental treatment, the presence of dental discoloration, history of child dental pain, and number of filled teeth were all associated with better parental acceptance. Acceptance was also related to parental age, level of education, and their relation to the child. CONCLUSION: Parents' acceptance of SDF treatment is low. However, staining on posterior teeth was more acceptable than staining on anterior teeth and on primary more than permanent teeth.

Blindness Secondary to Orbital Giant Cell Granuloma Mass-Effect in Noonan Syndrome With Return of Vision Following Surgical Decompression.

ABSTRACT: Noonan syndrome is a rare, autosomal dominant disorder encompassing multiple congenital defects, as well as association with solid tumor and lesion development. The authors present a 26-year-old female with known Noonan syndrome and ongoing complaint of worsening unilateral vision, progressing to vision loss due to lesion mass effect. Decompressive surgery was performed, restoring patient's vision to baseline immediately postoperative. The lesion was confirmed to be giant cell granuloma. In this paper we discuss the unique presentation of vision loss due to orbital giant cell granuloma in Noonan syndrome with postoperative return of vision; the importance of a multi-disciplinary team evaluation, thorough preoperative clinical and image-based work up, intraoperative findings, postoperative outcome, and complexity of definitive management.

Migrant and refugee Oral Health.

This issue contains two papers on the oral health of migrant people. The oral health of migrants, refugees, and asylum seekers is often worse than the general oral health of the host country's population (Crespo, 2019; Davidson et al., 2006). Poor oral health outcomes in migrants are due to a combination of upstream, psychosocial, and behavioral factors. Migrant communities might then have vital priorities that compete with oral health. Consequently, they may express lower needs and may not focus on oral health; all these factors lead to a higher risk of developing dental diseases. Lack of oral health services is commonly seen due to limited fi nancial resources or lack of dental providers in the vicinity of migrant communities or refugee camps. They face ad- ditional cultural and linguistic barriers in navigating the health care system of a new country.

Oral health status and risk determinants in adult Syrian refugees in Jordan.

OBJECTIVES: Lack of data regarding the oral health of Syrian refugees represents a crucial gap in the literature. This study aimed to investigate the oral health status of Syrian refugees and related socio and behavioral factors. BASIC RESEARCH DESIGN: Cross-sectional study from June to September 2019 at Zaatari refugee camp, Jordan. METHODS: An experienced, calibrated field investigator performed an oral clinical examination of 505 Syrian refugees (18-60 years) using the WHO criteria. DMFT, SiC, oral health indices and socio-demographic variables were recorded. RESULTS: A total of 264 males and 241 females were included. The prevalence of caries was 96.0%, of which 76.0% had 4-17 carious lesions. The mean number of decayed, missing and filled teeth was 5.76, 2.55 and 1.88 respectively. The mean DMFT score was 10.19 (100% had DMFT⟩0), SiC was 17.09, and the mean simplified Oral hygiene index score was 2.18. The most common chief complaint was pain (92.7%). Nearly half of the participants were smokers (45.7%). There was a negative association between level of education and oral health (P=0.011). Most participants did not brush their teeth regularly (87.5%). Females had better oral hygiene practices than males (P=0.015). CONCLUSIONS: Syrian refugees had a high prevalence of caries, high unmet dental treatment needs and poor oral hygiene practices. Preventive programs and focused interventions may reduce the burden of disease in this underprivileged population, on funding agencies and host countries as well.

Early Detection of In-Patient Deterioration: One Prediction Model Does Not Fit All.

OBJECTIVES: Early detection of subacute potentially catastrophic illnesses using available data is a clinical imperative, and scores that report risk of imminent events in real time abound. Patients deteriorate for a variety of reasons, and it is unlikely that a single predictor such as an abnormal National Early Warning Score will detect all of them equally well. The objective of this study was to test the idea that the diversity of reasons for clinical deterioration leading to ICU transfer mandates multiple targeted predictive models. DESIGN: Individual chart review to determine the clinical reason for ICU transfer; determination of relative risks of individual vital signs, laboratory tests and cardiorespiratory monitoring measures for prediction of each clinical reason for ICU transfer; and logistic regression modeling for the outcome of ICU transfer for a specific clinical reason. SETTING: Cardiac medical-surgical ward; tertiary care academic hospital. PATIENTS: Eight-thousand one-hundred eleven adult patients, 457 of whom were transferred to an ICU for clinical deterioration. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We calculated the contributing relative risks of individual vital signs, laboratory tests and cardiorespiratory monitoring measures for prediction of each clinical reason for ICU transfer, and used logistic regression modeling to calculate receiver operating characteristic areas and relative risks for the outcome of ICU transfer for a specific clinical reason. The reasons for clinical deterioration leading to ICU transfer were varied, as were their predictors. For example, the three most common reasons-respiratory instability, infection and suspected sepsis, and heart failure requiring escalated therapy-had distinct signatures of illness. Statistical models trained to target-specific reasons for ICU transfer performed better than one model targeting combined events. CONCLUSIONS: A single predictive model for clinical deterioration does not perform as well as having multiple models trained for the individual specific clinical events leading to ICU transfer.

Preserving the Knee in the Setting of High Segmental Tibial Bone and Massive Soft-Tissue Loss Using Vascularized Distal Tibial Bone Docking and a Foot Fillet Flap: A Case Report.

CASE: We discuss our reconstructive approach to avoid an above-knee amputation in a 33-year-old man presenting after lower extremity crush injury. We used a vascularized tibial bone flap and a foot fillet flap to restore length and joint functionality to the residual limb. The patient ambulates with good prosthetic fit on durable heel pad skin and 100° active knee motion. CONCLUSION: This pairing of intramedullary nail with vascularized bone flap and fillet flap to address soft-tissue coverage and retain limb length is a useful tool in traumatic lower extremity injury management, providing an alternative technique for tibial bone graft stabilization with robust, sensate tissue coverage.

Challenges in the Provision of End-of-Life and Palliative Care to Ethnic Nepali Refugees.

After over a decade of resettlement of ethnic Nepali refugees in the U.S., a significant population of seriously ill refugees will require palliative care and hospice care. The refugee experience and culturally specific factors affect the end-of-life care of this population. Challenges in the end-of-life care of Nepali refugees include challenges related to social and health inequities, such as significant chronic respiratory disease burden; lack of protocols for deferral of illness disclosure; lack of support for group decision making; unfamiliarity with spiritual, religious, and traditional health practices; and difficulty with cross-cultural communication. Culturally competent care of ethnic Nepali refugees can be accomplished through respectful exploration of patients' and families' preferences regarding the challenges identified. This article presents recommendations that can guide primary and specialist palliative care for this population.