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The article presents a study on groundwater quality assessment and the interrelationship between various physico-chemical parameters and potentially toxic element sin low-hills of Himachal Pradesh, India. Topics discussed include sampling of groundwater and analysis, seasonal groundwater quality parameters in district Sirmaur, and groundwater quality parameters in district Una.

The article discusses the rising trend of health tourism in bariatric surgery, particularly among UK residents. It explores the factors driving patients to seek bariatric surgery abroad, such as limited availability, accessibility, and affordability of the procedure in the UK. The article also highlights the potential health and financial implications of undergoing surgery abroad, including the risk of complications and the challenges of postoperative care. It discusses the impact of health tourism on the NHS, both in terms of alleviating the burden by redirecting patients to international providers and adding to the strain by increasing demand for obesity-related treatments. The article emphasizes the need to address underlying issues in the NHS, improve patient education, and promote ethical and sustainable practices in medical tourism. [Extracted from the article]

Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of rare systemic autoimmune diseases including dermatomyositis (DM), polymyositis (PM), and inclusion body myositis. PM includes clinically distinct and recognized IIM subtypes of necrotizing myopathy and anti-synthetase syndrome. First-line treatment for IIM is glucocorticoids (GC) alone or combined with immunosuppressants and/or immunoglobulins. GC use is associated with toxicity and low efficacy in many patients. Overall, there is a significant need for effective and safe IIM therapies. Enpatoran, a potent selective toll-like receptor 7/8 (TLR7/8) inhibitor, may reduce inflammation and the pathogenicity of autoantibodies that drive IIM. Enpatoran was well tolerated with no safety signals in healthy volunteers or patients with COVID-19 pneumonia. NEPTUNIA, a Phase IIa randomized, parallel, double-blind, placebo-controlled study (NCT05650567) is the first to assess a TLR7/8 inhibitor in IIM. Eligible patients aged 18‒75 years with DM or PM, moderate-to-severe myopathy, and active disease on standard of care, will be randomized 1:1 to oral enpatoran twice daily (BID) or placebo for 24 weeks. Patients completing treatment will be offered enpatoran in a 24-week open-label extension. A 2-week safety period will follow treatment. The primary efficacy endpoint is the ACR/EULAR Total Improvement Score at 24 weeks, a weighted composite endpoint derived from percent change from baseline in the International Myositis Assessment and Clinical Studies core set measures. Primary safety/tolerability endpoints are treatment-emergent adverse events, serious adverse events, adverse events of special interest during treatment, and changes in laboratory parameters, vital signs and 12-lead ECG. GC tapering to ≤5 mg/day will begin at Week 8 and GC sparing efficacy will be evaluated as an exploratory endpoint. Planned enrolment is 40 patients. NEPTUNIA started on January 19, 2023 and is ongoing. [ABSTRACT FROM AUTHOR]

Introduction: Depression is a widespread problem that affects individuals of all ages. This study looks at the use of omega-3 polyunsaturated fatty acids (PUFAs) as an additional therapy for depression in people of different ages. Depression has an impact on everyone, from youth to the elderly, causing therapeutic concerns such as treatment resistance and recurrence. Omega-3 PUFAs, which may be found in fish and flaxseed, are important because of their impact on neurochemistry, inflammation, and neuroprotection. While pharmacotherapy, including antidepressants, has proven beneficial for many, the likelihood of remission and recurrence remains substantial. In recent years, there has been a growing interest in the potential role of omega-3 polyunsaturated fatty acids (n-3 PUFAs) in mitigating depressive symptoms. The primary constituents of n-3 PUFAs are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Understanding the potential of omega-3 PUFAs across the lifespan can help address the multifaceted challenges posed by depression and improve mental health outcomes for diverse age groups. Objectives: This review aims to assess the role of omega-3 fatty acids in depression treatment across different age groups: children and adolescents, adults (18–60), and the elderly (60+). It investigates the effectiveness and potential differences in omega-3 supplementation among these age cohorts. Methods: A comprehensive literature search was conducted from 2003 to 2023 using PubMed, Google Scholar, and EMBASE, using specific keywords. Studies with inadequate age group information or Omega-3 intervention were excluded. Results: In children and adolescents, several studies indicate a positive association between omega-3 supplementation and improved depressive symptoms. In adults, results are mixed, with some studies showing benefits while others do not. In the elderly, omega-3 PUFAs appear to have a more consistent positive effect on depression. In contrast, a consistent positive association was observed in the geriatric population, suggesting that Omega-3 PUFAs may hold particular promise in the treatment of depression among older adults. However, variations in methodology, dosage, and study populations contribute to these mixed findings. Conclusions: Omega-3 PUFAs show promise as an adjunct therapy for depression across different age groups. Further research with standardized methodologies and larger sample sizes is needed to clarify their role and establish optimal dosage guidelines. Omega-3 PUFAs should be considered as a potential complement to conventional depression treatments, emphasizing the need for personalized approaches in depression management. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare that they have no conflict of interest.

Objective: To evaluate the efficacy and safety of subcutaneous (SC) abatacept and standard of care (SOC) for the treatment of idiopathic inflammatory myopathy (IIM) over 52 weeks., Methods: In this randomised, double-blind, placebo-controlled phase III trial, patients with treatment-refractory IIM received SC abatacept (125 mg weekly) + SOC (abatacept group) or placebo + SOC (placebo group) (NCT02971683). A 24-week double-blind period was followed by an open-label period to assess outcomes from continued therapy with abatacept and initiation with abatacept (placebo-to-abatacept switch group) from 24 to 52 weeks. The primary endpoint was International Myositis Assessment and Clinical Studies definition of improvement (IMACS DOI) at week 24. Secondary efficacy and safety endpoints were assessed., Results: Overall, 148 (double-blind) and 133 (open-label) patients were treated. Baseline demographics were well-balanced between treatment groups and disease subtypes. At 24 weeks, improvement per IMACS DOI was 56.0% for the abatacept group and 42.5% for the placebo group (p=0.083); at 52 weeks, improvement was 69.8% (continued abatacept) and 69.0% (placebo-to-abatacept switch). IMACS DOI rate at 24 weeks was greater in the non-dermatomyositis (DM) group (abatacept: 57.1%; placebo: 32.3%; p=0.040) than the DM group (abatacept: 55.0%; placebo: 50.0%; p=0.679). The observed safety profile was similar in both groups., Conclusion: The proportion of patients who met improvement criteria after 24 weeks was similar between abatacept and placebo groups. However, analysis by IIM subtype suggested there may be sustained benefit of SC abatacept for patients with non-DM subtypes., (This article is protected by copyright. All rights reserved.)

Objectives: To explore the association between the extent of CT abnormalities by quantitative imaging analysis (QIA) and clinical/physiological disease parameters in patients with antisynthetase syndrome associated interstitial lung disease (ARS-ILD)., Methods: We analysed 20 patients with antisynthetase antibodies and active ILD enrolled in the Abatacept in Myositis-Associated Interstitial Lung Disease study. High-resolution chest CT was obtained at weeks 0, 24 and 48 and QIA scored the extent of ground glass (quantitative score for ground glass), fibrosis (quantitative score for lung fibrosis, QLF) and total ILD (quantitative ILD, QILD). Mixed-effects models estimated longitudinal QIA scores over time. Associations between QIA scores with clinical/physiological parameters were analysed longitudinally using repeated-measures mixed-effects models., Results: Patients were median age 57 years, 55% males and 85% white. Higher (worse) baseline QIA scores correlated with lower baseline forced vital capacity (FVC) and diffusing capacity adjusted for haemoglobin (DLCO). Longitudinal QIA trajectories trended towards improving scores during the trial, and patients on O 2 at baseline had worsening QIA trajectories which were different from patients who were not on O 2 . Longitudinal QIA scores demonstrated strong associations with both FVC and DLCO over time. Higher QILD scores over time were also associated with worse dyspnoea scores, pulmonary visual analogue scale, physician and patient global disease activity, health status in 6/8 domains of the Short Form-36 and higher oxygen requirements. Patients with significant radiographic improvement at 48 weeks had higher baseline QLF, QILD and worse DLCO., Conclusions: Longitudinal QIA scores associate with lung physiology, patient perception of respiratory status, overall disease activity and quality of life over time in ARS-ILD. QIA may allow reproducible monitoring of disease progression and response to therapy over time., Trial Registration Number: NCT03215927., Competing Interests: Competing interests: GK and JG are on the UCLA patent for the quantitative imaging analysis. RA has received research grants from Boehringer Ingelheim, Bristol Myers Squibb, EMD Serono, Janssen, Mallinckrodt, Pfizer and Q32, and serves as a consultant for Actigraph, Alexion, ANI Pharmaceuticals, Argenx, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Cabaletta Bio, Capella Bioscience, Corbus, CSL Behring, EMD Serono, Galapagos, Horizon Therapeutics, I-Cell, Janssen, Kezar, Kyverna, Merck, Novartis, Nuvig Therapeutics, Octapharma, Pfizer, Regeneron, Roivant, Sanofi, Teva, Artsome, Capstanx and Manta. CC-S has received research grants from Priovant, CSL Behring, Janssen, Octapharma, Pfizer, AbbVie and Bristol Myers Squibb, and serves as a consultant for Boehringer Ingelheim, Recludix, Octapharma, Pfizer, AbbVie and Bristol Myers Squibb. PFD is editor of UpToDate and a member of the FDA Advisory Committee. TJD has received support from Bayer and has been part of a clinical trial funded by Genentech, all unrelated to this study. GMH receives grant support from the NIH including R01 HL111024, R01 HL135142 and R01130974. He has performed consulting work for Boehringer Ingelheim and the Gerson Lehrman Group., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Lineage plasticity and histologic transformation from prostate adenocarcinoma to neuroendocrine prostate cancer (NEPC) occurs in up to 15-20% of patients with castration-resistant prostate cancer (CRPC) as mechanism of treatment resistance and is associated with aggressive disease and poor prognosis. NEPC tumors typically display small cell carcinoma morphology with loss of androgen receptor (AR) expression and gain of neuroendocrine (NE) lineage markers. However, there is a spectrum of phenotypes that are observed during the lineage plasticity process, and the clinical significance of mixed histologies or those that co-express AR and NE markers or lack all markers is not well defined. Translational research studies investigating NEPC have used variable definitions making clinical trial design challenging. Here we discuss the diagnostic workup of metastatic biopsies to help guide the reproducible classification of phenotypic CRPC subtypes. We recommend classifying CRPC tumors based on histomorphology (adenocarcinoma, small cell carcinoma, poorly differentiated carcinoma, other morphologic variant, or mixed morphology) and immunohistochemical markers with a priority for AR, NKX3.1, INSM1, synaptophysin and cell proliferation based on Ki-67 positivity, with additional markers to be considered based on the clinical context. Ultimately, a unified workup of metastatic CRPC biopsies can improve clinical trial design and eventually practice.

Diabetes poses a significant global health challenge, driving the search for effective management strategies. In the past years, α-amylase inhibitors have emerged as promising candidates for regulating blood sugar levels. In this concern, we have synthesized a series of novel 3-methyl-2-aroylthiazolo[3',2':2,3][1,2,4]triazino[5,6- b ]indole derivatives via the regioselective reaction of 2,5-dihydro-3 H -[1,2,4]triazino[5,6- b ]indole-3-thione and 1,3-diketones in the presence of NBS under solvent-free conditions. Subsequently, the inhibitory potential of the newly synthesized 3-methyl-2-aroylthiazolo[3',2':2,3][1,2,4]triazino[5,6- b ]indole derivatives was assessed against the α-amylase enzyme to probe their antidiabetic properties. In vitro studies revealed moderate to excellent α-amylase inhibitory activity, with IC 50 values ranging from 16.14 ± 0.41 to 27.69 ± 0.58 μg ml -1 . Furthermore, SAR analysis showed that compounds containing halogen groups exhibited superior inhibition potential, surpassing the standard drug Acarbose (IC 50 = 18.64 ± 0.42 μg ml -1 ), particularly derivatives substituted with 4-fluoro and 2,4-dichloro groups, with IC 50 values of 16.14 ± 0.41 μg ml -1 and 17.21 ± 0.15 μg ml -1 , respectively. Additionally, molecular docking unveiled the binding modes of ligands with the active site of A. oryzae α-amylase. Encouragingly, the theoretical analyses closely mirrored the experimental findings, further underlining the promise of these synthetic molecules as potent α-amylase inhibitors.

The Immunization and Vaccines-related Implementation Research Advisory Committee (IVIR-AC) is the primary advisory body of the World Health Organization conducting independent reviews of immunization-related implementation research, with a primary focus on transmission and economic modeling analyses that estimate the value and impact of vaccines. From 10 to 13th September 2024, IVIR-AC convened virtually for its second of two semi-annual meetings to provide feedback and recommendations across six sessions including: pneumococcal vaccination strategies that rely on indirect protection; vaccine impact modeling for chikungunya; The Lancet Commission on strengthening the use of epidemiological modeling of emerging and pandemic infectious diseases; methods for immunization coverage estimation; setting immunization research priorities in the South-East Asian Region; and modeling evidence related to typhoid conjugate vaccine schedules. This report summarizes the sessions, proceedings, and recommendations from that meeting., Competing Interests: Declaration of competing interest P. L. is supported financially by the Bill & Melinda Gates Foundation. S. S. was supported by the World Health Organization for this work. A. N. S. was financially supported by the World Health Organization for this work, and is additionally supported by the Bill & Melinda Gates Foundation, Gavi, the Vaccine Alliance, and the National Institutes of Health. M. K. is supported by the Bill & Melinda Gates Foundation. A. B. H. was supported by the Australian National Health and Medical Research Council for this work, is additionally supported by PATH, the World Health Organization, and Gavi, the Vaccine Alliance, and has received consulting fees from the Australian NSW Ministry of Health, WHO Europe and Asian Development Bank. A. P. is supported by Gavi, the Vaccine Alliance, Imperial College London, the Bill & Melinda Gates Foundation, and the World Health Organization. A. N. S. and A. B. H. report travel related support from the World Health Organization to attend previous IVIR-AC meetings. All other authors have no declarations., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The present study reports some fascinating results of Hantzsch's [3 + 2] cyclic condensation of α-bromo-1,3-diketones, a tri-electrophilic synthon generated in situ by bromination of 1,3-diketones using the mild brominating reagent NBS with trinucleophilic N -substituted thioureas. Interestingly, out of a total of 20 combinations, 10 resulted in the exclusive formation of the desired 2-( N -arylamino)-5-acyl-4-methylthiazoles regioselectively, seven led to the formation of unexpected 2-( N -acylimino)-3- N -aryl-4-methylthiazoles through an interesting C-N acyl migration, and three furnished a mixture consisting of both products. The regioselectivity pattern of the two products may be attributed to a greater electrophilicity of the carbonyl carbon of the acetyl group than that of the acyl group towards both nitrogens of thiourea. The structures of the thiazole derivatives were unambiguously assigned using 1 H-NMR, 13 C-NMR, and rigorous heteronuclear 2D-NMR [( 1 H- 13 C) HMQC and ( 1 H- 13 C) HMBC] spectroscopic techniques. The outcomes of the spectroscopic experiments were further concurred through X-ray crystallographic studies, and a plausible mechanism for acyl migration was proposed for the formation of the unexpected rearranged product., Competing Interests: The authors declare no competing interest., (This journal is © The Royal Society of Chemistry.)

Purpose: Evidence surrounding swallowing impairment in sporadic inclusion body myositis (IBM) is based on nonstandardized and nonvalidated assessment methods. We investigated (a) IBM's impact on swallowing function and oral intake status using well-tested assessment frameworks; (b) changes in swallowing over time; and (c) age, sex, and swallowing impairment severity's influence on oral intake status., Method: We conducted a secondary analysis of Modified Barium Swallow Impairment Profile (MBSImP) and Functional Oral Intake Scale (FOIS) data from 13 patients with IBM (seven females; M age = 60.2 [±13.6] years) and 13 age- and sex-matched healthy controls. We compared MBSImP Overall Impression (OI), Oral Total (OT), Pharyngeal Total (PT), and FOIS scores between groups. Specific to the IBM cohort, we analyzed repeated OT and PT scores and calculated whether age, sex, and OT and PT scores predicted FOIS scores., Results: The IBM cohort demonstrated poorer OI scores across six swallowing components than healthy controls (each p < .05). Unlike OT scores ( p = .84), PT ( p = .033) and FOIS ( p < .001) scores were worse in the IBM cohort. Repeated OI scores revealed changes in three swallowing components (each p < .05), but repeated OT ( p = .16) and PT ( p = .30) scores did not significantly change. Age, sex, and OT and PT scores did not influence FOIS scores (each p > .05)., Conclusions: Pharyngeal impairments were most prominent in the IBM cohort, and their oral intake status was adversely affected. Our preliminary data showcase the application of robust assessment methods to investigate swallowing function in IBM, enhancing standardization and comparability across studies., Supplemental Material: https://doi.org/10.23641/asha.27165450.

Background: Dravet syndrome is an infantile-onset developmental and epileptic encephalopathy with limited data on the frequency of SCN1A in Indian children. The study aimed to identify and characterize the burden of SCN1A pathogenic variants associated with the Dravet syndrome phenotype through genetic testing in the North Indian population., Method: In this prospective, cross-sectional study from March 2015 to February 2019, we enrolled 52 children with Dravet syndrome phenotype who underwent genetic testing for SCN1A gene pathogenicity. We assessed variant effect using multiple algorithms, and genetic test results were reported based on recommendations from the American College of Medical Genetics and Genomics guidelines. Additionally, we performed multiplex-ligation dependent probe amplification (MLPA) to detect copy number variations of the SCN1A gene in children without identified genetic pathogenicity (n = 22) and analysed the results using Coffalyser.net., Results: Of the 52 probands studied, pathogenic variants in the SCN1A gene were identified in 30 children. Among these variants, 11 truncating variants (3 frame-shift variants, 3 intronic variants in splice site regions, and 5 nonsense variants) in 12 unrelated probands, and 17 missense variants in 18 unrelated probands were found. The genetic yield of SCN1A pathogenicity in our cohort (n = 52) was 58 %. Additionally, two of the identified variants were novel. Furthermore, MLPA analysis of the SCN1A gene in 22 children without pathogenic variants yielded no results., Conclusion: This work represents a genetic analysis of a Dravet syndrome cohort, revealing a 58 % burden of SCN1A variants in children with the Dravet syndrome phenotype from the North Indian population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Anti-synthetase syndrome constitutes a dynamically evolving subset of Idiopathic Inflammatory Myopathy, however, the nomenclature and abbreviations for this syndrome are plagued by heterogeneity, leading to lack of consistency in literature. The objective of this study is to evaluate existing diversity in disease names and abbreviations, with a future goal to develop consensus on the nomenclature. A scoping review format was used for analysis. A comprehensive PUBMED search was conducted from January 1, 1984 (the initial description of anti-synthetase autoantibodies) to November 30, 2023, encompassing all pertinent articles published within this timeframe. Search terms included, ((antisynthetase syndrome) OR (anti synthetase syndrome)) OR (anti-synthetase syndrome)). The articles were screened for presence of terminology and abbreviations used. The search yielded 936 items with the specified terms. After excluding 303 irrelevant articles and 58 non-English publications, the remaining n = 575 articles underwent detailed review of the abstract and full article. Out of n = 575, 54.7% (n = 314) used 'antisynthetase syndrome' and 43.4% (n = 249) preferred 'anti-synthetase syndrome' with few novel names also. Among these, 394 articles used abbreviations while 181 did not. Most utilized term was ASS; in 64.7% (n = 255), followed AS in 11.9% (n = 47), ASSD in 9.9% (n = 39) and ASyS in 7.6% (n = 30). A discordance in nomenclature is evident, with about half using antisynthetase syndrome and other half using anti-synthetase syndrome. Moreover, significant heterogeneity exists in abbreviation use aswell. There is a pressing need to bridge this disparity and establish a uniform identifier for the disease with an objective to develop greater coherence in future research, educational initiatives, and interdisciplinary collaboration., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

We present an interesting and rare case of Capillaria hepatica infection in a 2-year-old boy, who presented with fever, rash, hepatomegaly and peripheral eosinophilia. FNAC of hepatic lesion showed parasitic eggs and PCR from the aspirate confirmed the diagnosis. We describe the cytomorphological features and provide educational multiple-choice questions related to the topic., (© 2024 John Wiley & Sons Ltd.)

The present study describes an eco-friendly NBS-assisted regioselective synthesis of new 5-acylfunctionalized 5-acylfunctionalized 2-(1H-pyrazol-1-yl)thiazoles by condensation of 3,5-dimethyl-1H-pyrazole-1-carbothioamide with unsymmetrical 1,3-diketones under solvent-free conditions. The structural elucidation of the newly synthesized compounds was accomplished using various spectroscopic techniques viz. FTIR, NMR and mass spectrometry. All the newly synthesized compounds were examined for their in vitro antimicrobial potential against both pathogenic gram positive and gram negative bacterial and fungal species as well as anthelmintic activity against Pheretima posthuma earthworms. The results of antimicrobial activity revealed that all tested compounds 3 a-j showed excellent antimicrobial potential particularly against S. aureus. It was also observed that compounds 3 e and 3 i (MIC=62.5 μg/mL) showed greater potency against E. coli, whereas compounds 3 a and 3 h (MIC=50 μg/mL and 62.5 μg/mL) demonstrated better activity against P. aeruginosa and compound 3 i (MIC=62.5 μg/mL) exhibited superior activity against S. pyogenus when compared to standard drug Ampicillin (MIC=100μg/mL). Compound 3 e and 3 j revealed remarkable antifungal and anthelmintic activities. To find out binding interactions of target compounds with target proteins and pharmacokinetic parameters of the compounds, in silico investigations involving molecular docking studies and ADMET predictions were also performed., (© 2024 The Authors. ChemistryOpen published by Wiley-VCH GmbH.)

We have functionally characterized the high-affinity phosphate transporter (PiPT) from the root endophyte fungus Piriformospora indica. PiPT belongs to the major facilitator superfamily (MFS). PiPT protein was purified by affinity chromatography (Ni-NTA) and Size Exclusion Chromatography (SEC). The functionality of solubilized PiPT was determined in detergent-solubilized state by fluorescence quenching and in proteoliposomes. In the fluorescence quenching assay, PiPT exhibited a saturation concentration of approximately 2 μM, at a pH of 4.5. Proteoliposomes of size 121.6 nm radius, showed transportation of radioactive phosphate. V max was measured to be 232.2 ± 11 pmol/min/mg protein. We have found K m to be 45.8 ± 6.2 μM suggesting high affinity towards phosphate., Competing Interests: Declaration of competing interest The authors declare that there are no competing interests associated with the manuscript., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury., Method: A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q 1 , Q 3 ) as indicated. χ 2 or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance., Results: Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention., Conclusion: As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Chinese Medical Association. Published by Elsevier B.V. All rights reserved.)

Background: The Myositis Interstitial Lung Disease Nintedanib Trial (MINT) is a hybrid trial, which is enrolling patients both at local sites and remotely via a decentralised site. The trial will investigate the efficacy and safety of nintedanib in patients with progressive myositis-associated interstitial lung disease (MA-ILD)., Methods/design: MINT is an exploratory, prospective randomised placebo-controlled trial. Eligible patients will have myositis and evidence of fibrosing ILD on high-resolution computed tomography (HRCT), be taking standard of care medications for myositis, and meet criteria for ILD progression within the prior 24 months based on decline in FVC, worsened fibrosis on HRCT, and/or worsened dyspnoea. Patients will be randomised 1:1 to receive nintedanib 150 mg twice daily or placebo for 12 weeks then open-label nintedanib for 12 weeks. Patients will be enrolled at local sites and a decentralised site. Most study visits will be completed remotely using telemedicine or digital health technologies. The primary endpoint is the change in Living with Pulmonary Fibrosis (L-PF) questionnaire dyspnoea domain score at week 12. Other endpoints include changes in other L-PF questionnaire domains, lung function, imaging, and physical activity, and assessment of adverse events. Data collected using remote versus clinic enrolment, and using home versus clinic spirometry, will be compared., Discussion: MINT is an innovative, hybrid trial that will evaluate the effects of nintedanib on symptoms, quality of life, and ILD progression in patients with progressive MA-ILD and provide valuable information on the utility of decentralised recruitment and remote data collection in clinical trials., Trial Registration: Clinicaltrials.gov NCT05799755 (date of registration: 05/04/2023)., (© 2024. The Author(s).)

Background: Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor dysfunctions and nonmotor symptoms. Current treatments do not alter disease progression, highlighting the need for alternative therapies. Music, dance, and mindfulness meditation have shown the potential to improve symptoms and quality of life in patients with PD., Objective: This study aims to evaluate the effectiveness of dance or music and meditation on PD progression, cognitive functions, mood, behavior, and caregiver burden., Methods: This study is a single-blinded, longitudinal, parallel, randomized controlled trial. The participants consist of 30 patients with mild to moderate PD residing in Mumbai, India, who can physically participate in the activities. The exclusion criteria include advanced PD, severe balance issues, age >80 years, and other movement disorders. Participants in the intervention group will engage in dance or music sessions and guided meditation thrice weekly for 6 months. The control group will continue their usual activities and medication. The primary outcome is the progression of PD symptoms, measured using the Unified Parkinson's Disease Rating Scale I-III, and quality of life, measured using the Parkinson's Disease Questionnaire-39. The secondary outcomes include cognitive functions (Mini-Mental State Examination), mood (Beck Depression Inventory and Parkinson Anxiety Scale), mobility (timed up and go and Berg Balance Test), behavioral disorders (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale), and caregiver burden (Zarit Burden Interview and Parkinson's Disease Questionnaire-Carer)., Results: Data collection was completed in February 2024, with 28 participants finishing the study (intervention group: n=15, 54% and control group: n=13, 46%). Data analysis is underway, with results expected to be published in December 2024., Conclusions: This study aims to provide significant insights into the effectiveness of dance or music and meditation in improving the quality of life and slowing the progression of PD. The findings are anticipated to support using these nonpharmaceutical therapies as complementary approaches to managing PD., Trial Registration: CTRI/2023/03/051064; https://tinyurl.com/2xdus53j., International Registered Report Identifier (irrid): DERR1-10.2196/59018., (©Bhagyashree Mehrotra, Neha Rai, Rajani MR, Aparna Budhakar, Ritika Aggarwal, Raj Vinodkumar Agarbattiwala, Mona Thomas, Sampada Patole, Paresh Doshi. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 29.10.2024.)

Objective: Anti-synthetase syndrome (ASSD) is a rare systemic autoimmune rheumatic disease (SARD) with significant heterogeneity and no shared classification criteria. We aimed to identify clinical and serological features associated with ASSD that may be suitable for inclusion in the data-driven classification criteria for ASSD., Methods: We utilized a large, international, multi-center "Classification Criteria for Anti-synthetase Syndrome" (CLASS) project database, which includes both ASSD patients and controls with mimicking conditions, namely SARDs and/or interstitial lung disease (ILD). The local diagnoses of ASSD and controls were confirmed by project team members. We employed univariable logistic regression and multivariable Ridge regression to evaluate clinical and serological features associated with an ASSD diagnosis in a randomly selected subset of the cohort., Results: Our analysis included 948 ASSD cases and 1077 controls. Joint, muscle, lung, skin, and cardiac involvement were more prevalent in ASSD than in controls. Specific variables associated with ASSD included arthritis, diffuse myalgia, muscle weakness, muscle enzyme elevation, ILD, mechanic's hands, secondary pulmonary hypertension due to ILD, Raynaud phenomenon, and unexplained fever. In terms of serological variables, Jo-1 and non-Jo-1 anti-synthetase autoantibodies, antinuclear antibodies with cytoplasmic pattern, and anti-Ro52 autoantibodies were associated with ASSD. In contrast, isolated arthralgia, dysphagia, electromyography/MRI/muscle biopsy findings suggestive of myopathy, inflammatory rashes, myocarditis, and pulmonary arterial hypertension did not differentiate between ASSD and controls or were inversely associated with ASSD., Conclusion: We identified key clinical and serological variables associated with ASSD, which will help clinicians and offer insights into the development of data-driven classification criteria for ASSD., (This article is protected by copyright. All rights reserved.)

Introduction Diabetes mellitus is characterized by chronic hyperglycemia due to insulin deficiency, leading to complications in vital organs. Among these, dyslipidemia is common, presenting as low high-density lipoprotein cholesterol (HDL-c), high triglycerides (TG), Apolipoprotein-B (Apo-B), and small dense low-density lipoprotein (sdLDL) predominance, collectively known as diabetic dyslipidemia. To assess the atherogenic risk in individuals with type 2 diabetes, the atherogenic index of plasma (AIP) and atherogenic coefficient (AC) provide valuable insights beyond routine lipid tests. AIP, calculated as log (serum TG/serum HDL-c), correlates positively with the occurrence and severity of diabetic microvascular complications. The AC ((total cholesterol (TC)-HDL-c)/HDL-c) serves as an atherogenicity marker. Waist circumference (WC), reflecting central adiposity and body mass index (BMI), are directly related to both AIP and AC, making them useful non-invasive tools to monitor atherogenicity and predict cardiovascular disease (CVD) risk independently of each other in subjects with type 2 diabetes mellitus. Material and methods This was an observational cross-sectional study conducted in the Department of Medicine of a tertiary care hospital. It included 100 type 2 diabetes mellitus patients more than 18 years of age, including both males and females. Observation and results In our study, there were 42 (42%) males and 58 (58%) females. The mean WC of males and females were 105.40 and 100.98 cm, respectively. The mean for BMI, glycated hemoglobin (HbA1c), and urine albumin-to-creatinine ratio (UACR) was 28.83 kg/m 2 , 8.58%, and 100.62 mg/g, respectively. There was positive Pearson's correlation between AIP and WC of males and females (r = 0.324 and 0.269), AC and WC of males and females (r = 0.139 and 0.097), BMI and AIP (r = 0.350), BMI and AC (r = 0.214), HbA1c and AIP (r = 0.207), HbA1c and AC (r = 0.216), UACR and AIP (r = 0.218), and UACR and AC (r = 0.237). Conclusion This study concludes that there is a positive correlation between anthropometric measures, such as WC and BMI, and plasma atherogenicity indexes, including the AIP and AC. This finding suggests that clinicians can effectively use these non-invasive measurements (BMI and WC) to estimate the presence of dyslipidemia and atherogenicity in patients with type 2 diabetes mellitus during routine outpatient care. Early identification of these risk factors allows for timely lifestyle interventions such as dietary modifications and increased physical activity, which could potentially reduce the risk of future cardiovascular diseases., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, Lady Hardinge Medical College and Associated Hospitals issued approval LHMC/IEC/2022/PG Thesis/44. The abovementioned thesis research protocol is "Approved" for conduct by Dr. Jayant Kumar Sahani as a PG Thesis work under your guidance under the jurisdiction of Lady Hardinge Medical College and Associated Hospitals, New Delhi. The study should be conducted in accordance with the provisions of New Drugs and Clinical Trial Rules 2019, Good Clinical Practices, and the ICMR Guidelines for Biomedical Research on Human Participants (2017). You are required to inform Member Secretary, IEC, LHMC, about any serious adverse events or death of study participants within 24 hours of the incident. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sahani et al.)

Background: Community pharmacies in England offer convenient and safe disposal of unwanted medicines, including antimicrobials, and better uptake of this service could limit environmental antimicrobial resistance. However, there is limited information on the extent and nature of antibiotic returns to community pharmacies. The impact of an antibiotic amnesty campaign promoting antibiotic disposal through community pharmacies was evaluated with the intention of collecting detailed information on the antibiotics returned., Methods: An antibiotic amnesty campaign was delivered by community pharmacies in the Midlands (England) with an audit of returned antibiotics conducted in 19 community pharmacies in Leicestershire. Detailed information on antibiotics returned for disposal was gathered during the month-long amnesty campaign and again 3 months later in the same pharmacies., Results: Antibiotics accounted for 3.12%-3.35% of all returned medicines. The amnesty campaign led to a significant increase in defined daily doses of returned antibiotics compared to the post-amnesty period ( P  = 0.0165), but there was no difference in the overall number of returned medicines. Penicillins were the most commonly returned antibiotics in both periods (29.3% and 42.5% of packs, respectively), while solid oral dose formulations predominated. A total of 36.6% of antibiotics returned during the amnesty period were expired, increasing to 53.4% in the post-amnesty period. Amnesty conversations had a significant impact on the number of antibiotic returns but campaign posters did not., Conclusions: Antibiotic conversations can increase the amount of antibiotics returned to community pharmacies for safe disposal, and passive campaign materials had limited impact. More research is needed to identify the most effective interventions to increase returns., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)