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A bstract In this work, we have extensively investigated the dynamics of circular geodesic (chargeless massive particle) followed by the investigation of the pulsating classical string in the p-brane background. This study is a continuation of our previous work JHEP10(2023)189 , in which we numerically identified the presence of chaos for a classical string hovering near generic p-branes ( p < 7). Here, for a particle probe, we have found evidence of chaos in the vicinity of the horizon. Furthermore, we observed a violation of the well-known MSS bound in specific extremal p-branes; however, no such violation is seen in the non-extremal cases. Similar observations were made for the classical string, where the violation of the bound is significant near the horizon. Thus, our semi-analytical arguments demonstrate that chaotic dynamics in black p-branes exhibit the (generalized) universal bound with notable violations, regardless of whether a particle or classical string is used as a probe.

IntroductionPrimary hyperparathyroidism (PHPT) in India is mostly symptomatic with renal and skeletal complications. Evidence on mortality outcomes following parathyroidectomy from India, where the disease is predominantly symptomatic is limited.Material and methodsThis was a prospective study to evaluate mortality outcomes in the Indian PHPT registry over the past 25 years (n = 464). Pre- and postoperative parameters and mortality data were obtained from medical records and/or by verbal autopsy, a method validated by WHO for data collection in settings where several deaths are noninstitutional. Patients were divided into survivor (SG) and nonsurvivor groups (NSG) to ascertain differences in presentation and the effect of parathyroidectomy.ResultsThe overall mortality was 8.8% at a median follow-up of 8 years (IQR 1–13) after parathyroidectomy. Chronic kidney disease was the most common background cause of death (43.5%), followed by pancreatitis (28.2%). NSG had significantly more frequent renal dysfunction (91.9% vs 73.9%), anaemia (50 vs 16.6%) and pancreatitis (24.3 vs 6.4%). PTH (61.9 vs 38.3 pmol/l) and baseline creatinine (97.2 vs 70.7 µmol/l) were significantly higher and eGFR lower (66.7 vs 90.7 ml/min/1.73m2) in the NSG than SG. By Cox proportional modelling, renal dysfunction [HR 2.88 (1.42–5.84)], anaemia [HR 2.45 (1.11–5.42)] and pancreatitis [HR 2.65 (1.24–5.66)] on univariate and renal dysfunction [HR 3.33 (1.13–9.77)] on multivariate analysis were significant for mortality. Survival curves demonstrated a significantly higher mortality with lower eGFR values.ConclusionsNonsurvivors in PHPT had greater prevalence and more severe baseline renal dysfunction than survivors. Survival after parathyroidectomy was significantly associated with estimated glomerular filtration rate at baseline.

A bstract We consider a pulsating string near a non-extremal black p-brane (p=5 and p=6) and investigate the chaos in the corresponding string dynamics by examining the Fast Lyapunov indicator(FLI) and Poincare section. In our system, the energy and the charge play the role of control parameters. For generic values of these parameters, the numerical results show that the dynamics primarily fall into three modes: capture, escape to infinity, and quasiperiodic depending on the initial location (near to or far away from the black brane horizon) of the string. Finally, probing for different values of the winding number ( n ) the dynamics turns out to be sensitive to n . In particular, we observe the point particle ( n = 0) scenario to be integrable whereas at higher n the dynamics seems to be chaotic.

Background: The role and benefits of lipid-lowering drugs in active management of dyslipidemia are well established. However, a little is known about whether these drugs are prescribed as per the recent guidelines and the desired effect is achieved or not in routine clinical practice. The aim of this study was to evaluate the prescription patterns and adequacy of use of statins at a tertiary care hospital. Patients and Methods: Patients aged ≥18 years eligible to receive statin therapy for primary or secondary prevention according to the American Heart Association 2018 guidelines were included in the study. Clinical records of all the cases were reviewed for indications of statins, and lipid profile was done at baseline and after 3 months of statin therapy. Results: There were 140 men and 103 women with a mean age of 52.24 ± 12.01 years. 109 (44.9%) patients received statins for primary prevention, whereas 134 (55.1%) patients received statins for secondary prevention. A total of 179 (73.7%) and 64 (26.3%) patients each received atorvastatin and rosuvastatin. 81.9% of the study population received statins according to the guidelines. After 3 months of statin therapy, there was a statistically significant change in the lipid profile in both primary and secondary prevention groups. Conclusions: There are some irrational prescribing practices among physicians affecting the performance of statin therapy in primary and secondary prevention of atherosclerotic cardiovascular disease. A need to rationalize the prescription practices by keeping abreast with the latest recommendations as well as effective patient counseling and education seems warranted.

Oral mucositis (OM) is a painful and debilitating side effect that affects 80%-100% of patients undergoing radiation therapy for head and neck cancer. This dose-limiting side effect may potentially lead to pain, dehydration, malnutrition, infection, and treatment breaks. Treatment breaks can lead to decreased disease control and suboptimal patient outcomes. No primary prevention exists for OM, and management is focused on pain control. Compelling evidence exists that OM pain has somatic and neuropathic components. This article reviews the existing literature on the use of gabapentin (Neurontin®) as a co-analgesic in treating the neuropathic pain in OM. A literature search was performed using CINAHL® and PubMed with the search terms gabapentin and oral mucositis. The selected articles were briefly screened for relevance, and three were included in this review. No systematic reviews exist on the role of gabapentin for neuropathic pain in radiation-induced OM. Two retrospective studies concluded that gabapentin reduced escalation of opioid doses and unplanned treatment breaks. One retrospective study demonstrated favorable swallowing outcomes. Pain and OM are nursing-sensitive outcomes that can be significantly affected by evidence-based nursing interventions.

What is already known on this topic? Herein, we report two cases of adolescent PHPT presenting as PRES. We propose that serum calcium levels should be checked in all patients with PRES and that PHPT be regarded as a differential diagnosis in those with underlying hypercalcemia.

This retrospective study included 52 euthyroid women (with TAI, n  = 26; without TAI, n  = 26) undergoing ART. Based on E2 levels on the day of final oocyte maturation (DFOM) they were subdivided into Group A1 (TAI, E2 < 7,000 pmol/l), Group A2 (TAI, E2 > 7,000 pmol/l), Group B1 (no TAI, E2 < 7,000 pmol/l), and Group B2 (no TAI, E2 > 7,000 pmol/l), to compare outcomes related to oocytes, embryos, and pregnancy. Group A2 had significantly more retrieved oocytes than A1, but no difference in good-quality oocytes, retrieved embryos, top-quality embryos, or pregnancy outcomes. Group B2 had a significantly higher number of retrieved oocytes [11 (8.25, 15.5) vs. 6.50 (3.75, 8.25), p  = 0.001], good-quality oocytes [8.5 (6.25, 10.5) vs. 5 (1.75, 6), p  = 0.001], retrieved embryos [5 (4, 8.5) vs. 3.75 (1.75, 4.25), p  = 0.011] and top-quality embryos [4.5 (3, 6) vs. 3 (1, 4), p  = 0.023], compared to Group B1, respectively. The positive correlation between high E2 levels and ART outcomes persisted after adjusting for potential confounders. Higher E2 levels on DFOM are linked to better oocyte and embryo outcomes, especially in patients without TAI, but don’t correlate with improved pregnancy outcomes.

To evaluate quality of life (QoL) in patients with type 2 diabetes mellitus (T2DM). A cross-sectional study included 151 T2DM patients at the Clinical Centre of Montenegro. The Ferrans and Powers Quality of Life Index (QLI), validated for the Montenegrin population, assessed QoL across five domains. Participants rated items on a Likert scale from 1 (very dissatisfied) to 5 (very satisfied). Data were analysed using SPSS version 22. The cohort included 51% women, with a mean age of 60.05 ±  11.63 years. Of the patients, 42% had diabetes for over a decade, and 64% had no additional health conditions. Overall, patients reported satisfactory QoL, especially in self-care and glucose management, though dissatisfaction was high regarding sexual life. Emotional support from family, housing, and friendships significantly contributed to life satisfaction, while financial concerns and job dissatisfaction were common. QoL showed no significant gender differences but declined with age and was notably lower in patients with comorbidities. Patients with T2DM report generally satisfactory QoL, with notable concerns in socio-economic and health-related areas. Routine QoL assessments in clinical practice can improve communication, aid in early complication detection, and enable timely interventions to enhance patient outcomes.

The premise for effective prevention and treatment of obesity is the availability of accurate prevalence figures. However, the prevalence of pediatric obesity and overweight in South Asian countries has seldom been analyzed. This article provides a comprehensive review and meta-analysis of studies on overweight and obesity to provide a more precise prevalence estimate. The study protocol was registered on PROSPERO (CRD42022320625). PubMed and Embase databases were comprehensively searched from inception till September 2023. The random-effects model was utilized to derive the pooled prevalence of obesity and overweight. Subgroup meta-analysis was used to assess variations in prevalence estimates across subgroups. A meta-regression analysis was also performed to assess the trend of overweight and obesity over the years. 152 studies were included with 489,525 participants. The pooled prevalence was 12.4 (95% CI 11.1–13.6) for overweight, 6.6% (95% CI 5.6–7.8) for obesity, and 19.3% (95% CI 17.1–21.7) for obesity and overweight. In subgroup analysis, Bangladesh reported a higher prevalence for both obesity (8.9%; 95% CI 4.9–13.9) and overweight (13.6%; 95% CI 9.2–18.8). Meta-regression analysis found a significant association between obesity prevalence and the publication year (β = 0.004; p = 0.03; R 2  = 2.74%). The results of this study indicate a relatively higher prevalence of childhood obesity in South Asia, emphasizing the necessity for large-scale awareness efforts and context-specific preventative methods.

Abstract Background Corticotrophin-releasing hormone (CRH) is the major regulator of adrenocorticotrophic hormone (ACTH) secretion from the anterior pituitary and acts via CRH-1 receptors (CRH-1R). Corticotropinoma though autonomous, still retain their responsiveness to CRH and hence, we hypothesize that in vivo detection of CRH-1 receptors on pituitary adenoma using Gallium-68 (68Ga)-tagged CRH can indicate the functionality of adenoma, and combining it with positron emission tomography-computed tomography (PET-CT) can provide requisite anatomical information. Methods Subjects with ACTH-dependent Cushing’s syndrome (CS) (n = 27, 24 with Cushing’s disease [CD], 3 with ectopic CS [ECS]) underwent 68Ga CRH PET-CT. Two nuclear medicine physicians read these images for adenoma delineation and superimposed them on magnetic resonance imaging (MRI) sella. The information provided was used for intraoperative navigation and compared with operative and histopathological findings. Findings 68Ga CRH PET-CT correctly delineated corticotropinoma in all the 24 cases of CD, including the 10 cases with adenoma size < 6mm (4 cases were negative on MRI). Corticotropinoma location on 68Ga CRH PET fusion images with MRI were concordant with operative findings and were further confirmed on histopathology. There was no tracer uptake in the pituitary in 2 patients with ECS, while, in another, the diffuse uptake in pituitary suggested ectopic CRH production. Conclusion 68Ga CRH PET-CT represents a novel, noninvasive molecular imaging, targeting CRH receptors that not only delineate corticotropinoma and provides the surgeon with valuable information for intraoperative tumor navigation, but also helps in differentiating a pituitary from an extra-pituitary source of ACTH-dependent CS. Funding None.