Exploring typical and atypical variants of celiac disease: a narrative review

There are many different clinical manifestations of celiac disease (CD), including the classical form, in which intestinal symptomatology predominates on the contrary there is atypical forms, in which extra-intestinal clinical features predominate, and the silent form, in which there are no clinical symptoms. Few or no gastrointestinal symptoms and a predominance of extra-intestinal features, including liver, kidney, skeletal, psychiatric, neurologic, dermatologic, hematologic, endocrinological, and reproductive involvements, define the atypical forms of the disease. Through screening high-risk groups, silent presentations of CD may be found. It is crucial for healthcare professionals to have a high level of suspicion for the atypical presentations of CD because it is now well known that CD may account for a number of chronic health issues

Examining folic acid intake: a cross-sectional study of pregnancy-related practices

Background: Folic acid supplementation during the periconceptional period is critical in preventing neural tube defects (NTDs) in the developing fetus. In Pakistan, a profound lack of awareness is seen regarding preventable pregnancy-related illnesses and the consequential high maternal and fetal mortality and morbidity rates. However, data from the surveys in the region of Sindh lacks inquiries regarding the baseline characteristics of the surveyed participants. Therefore, this study endeavoured to address this gap. Methods: Between October 2022 and April 2023, a cross-sectional study was conducted at two major tertiary care hospitals in Hyderabad and Jamshoro, Pakistan. A total of 374 participants, chosen by non-probability consecutive sampling, comprised the sample size. The association of demographic variables and knowledge, attitude, and practice of consumption of folic acid during pregnancy was determined using the χ2 test. A p value of less than 0.5 was considered statistically significant. Results: The mean age of the participants was 26.4±5.7 years. A total of 199 (53.20%) participants were literate, compared to 175 (46.79%) participants who were illiterate. Literate women fared better than illiterate women in all the metrics with a p-value of <0.001 and a Pearson correlation coefficient (r) of >0.7. Moreover, folic acid was consumed by only 38% of pregnant women during the periconceptional period. Conclusions: A substantial lack of knowledge regarding folic acid was found in the surveyed sample, significantly more marked in the illiterate faction. Additionally, the practice was rather unsatisfactory. However, the attitude remained encouraging

Immersive horizons: navigating ethical terrain and practical boundaries in the use of virtual reality for cancer symptom management – a comprehensive narrative review

Cancer is a significant healthcare problem. However, advancements in diagnostic procedures and therapeutic modalities have led to a decline in cancer mortality rates by 1% annually in most countries. Cancer patients often experience symptoms such as pain, cancer-related fatigue, anxiety, and lymphedema. To counter these side effects, there have been tremendous efforts. One such effort is the use of virtual reality (VR) technology, which is an interactive technology. VR has played a significant role in managing disorders such as phobias and anxiety disorders, and support for patients with cognitive and physical rehabilitation, acute and chronic pain management, and emotional support in different settings such as during hospitalizations. Our team conducted an extensive search for electronic literature on virtual reality in various databases, such as Medline, PubMed, Google Scholar, and Psych INFO, up to July 2023. We used keywords like "virtual reality," "cancer care," "depression," "cognition," "pain," "telemedicine," "rehabilitation care," "physical therapy," "radiotherapy," "telerehabilitation," "avatar," "video games," and "visual aid" as our search criteria. VR interventions for cancer patients include exposure therapy, psycho-education, and relaxation techniques, which have been shown to reduce symptoms significantly. VR distraction can also mitigate pain during medical procedures. Studies suggest that VR holds promise in rehabilitation and oncologic treatment, as it can improve function metrics, range of motion, and motivation for treatment. The review scrutinizes the use of digital information and virtual reality technology to alleviate cancer-related distress by providing remote care.

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Impact Assessment of Climate Mitigation Finance on Climate Change in South Asia

Climate change is considered the greatest threat to human life in the 21st century, bringing economic, social and environmental consequences to the entire world. Environmental scientists also expect disastrous climate changes in the future and emphasize actions for climate change mitigation. The objective of this study was to explore the influence of climate mitigation finance on climate change in the region most vulnerable to climate shock, i.e., South Asia, in the period from 2000 to 2019. The panel autoregressive distributed lag model was used to estimate the influence of climate mitigation finance on climate change. The findings of this study demonstrate that, in the long-run, climate mitigation finance has a significant role in mitigating climate change, while in the short-run, climate mitigation finance has an insignificant effect on climate change. The result also shows that, in the long-run, climate change has a negative causal relation with GDP and globalization, but it has a positive causal relationship with energy consumption. The short-term effects of all independent variables are insignificant. Finally, based on the outcome of this study, several policy measures are recommended in order to mitigate climate change

Pesticides impact on protein in fish (<i>Oreochromis mossambicus) </i> tissues

1864-1868Indiscriminate use of agrochemicals to control pests in agriculture to increase the yield of crop causes chemical pollution. The pesticides are extremely toxic to non-target organisms, like fish and affect fish health through impairment of metabolism, sometimes leading to mortality, adversely affecting the complex food-web and population dynamics. In the present study, an attempt has been made to investigate the acute toxicity of organophosphate pesticides (chlorpyrifos and malathion), synthetic pyrethroid pesticides (cypermethrin, lambda-cyhalothrin) and herbicide (buctril) on total protein content of the fish (Oreochromis mossambicus). For this regard fish were treated for 24 and 48 hrs with different concentrations of pesticides. Total protein content in fish tissues were determined by Biuret method. The present study show that total protein content was inhibited in Oreochromis mossambicus after exposure to organophosphate pesticides (chlorpyrifos, malathion), synthetic pyrethroids (lambda-cyhalothrin, malathion) and herbicide (buctril). The levels of total protein content showed decrease for pesticide treated fish in the order of cypermethrin, malathion, chlorpyrifos, lambda-cyhalothrin and buctril respectively at 48 hrs. The present study reports metabolic dysfunction in response to pesticide toxicity in the fish. Pesticide acts as stress inducing agents which affect the functional state of tissues of the exposed organisms

The Effects of Time Lag and Cure Rate on the Global Dynamics of HIV-1 Model

In this research article, a new mathematical model of delayed differential equations is developed which discusses the interaction among CD4 T cells, human immunodeficiency virus (HIV), and recombinant virus with cure rate. The model has two distributed intracellular delays. These delays denote the time needed for the infection of a cell. The dynamics of the model are completely described by the basic reproduction numbers represented by R0, R1, and R2. It is shown that if R0<1, then the infection-free equilibrium is locally as well as globally stable. Similarly, it is proved that the recombinant absent equilibrium is locally as well as globally asymptotically stable if 1<R0<R1. Finally, numerical simulations are presented to illustrate our theoretical results. Our obtained results show that intracellular delay and cure rate have a positive role in the reduction of infected cells and the increasing of uninfected cells due to which the infection is reduced

Genotoxic effect of pesticides on gill tissues of green-lipped mussel <em>Perna viridis</em> (L.)

611-615The marine ecosystem is constantly threatened by a wide variety of anthropogenic hazardous chemicals, such as, heavy metals, pesticides, oil, petroleum hydrocarbons, etc., from industries, agricultural sources and sewage disposal. Pakistan, being a country with agriculture prominence, uses pesticides widely for crop protection, and thereby suffers from pollution. In the present study, we assessed a few biomarkers as indicators of the genotoxic chemicals, pesticides and herbicides. We inducted micronucleus (MN) in the gill tissues of green mussel Perna viridis (L.) exposed to different concentrations of organo-phosphate pesticides (chlorpyrifos, malathion) and synthetic pyrethroid pesticides (cypermethrin, lambda-cyhalothrin) and a herbicide (buctril). The MN frequencies of the pesticides treated mussels were observed to increase significantly (P th day (10, 11.5 and 13.5‰ at 0.5, 1 and 1.5 ppm, respectively). The genotoxic effect of pesticides on Perna viridis (gill tissue) was in the following order cypermethrin > chlorpyrifos > malathion > lambda-cyhalothrin > buctril