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Background The administration of 5-fluorouracil (5FU) in the treatment of gastrointestinal (GI) malignancies is associated with common side effects such as mucositis, diarrhoea, and myelosuppression, which are easily managed with supportive measures and dose adjustments. Cardiotoxicity and neurotoxicity are rare but reversible side effects of 5-FU and are treated with withdrawal of the drug and conservative measures. The presenting symptoms of 5-FU-induced leukoencephalopathy are often confusing and pose a diagnostic dilemma in routine clinical practice. Methods We report a series of five patients with GI malignancies who developed 5-FU-induced leukoencephalopathy. Results All (n = 5) had Naranjo scores of 6-7, predictive of 5-FU-related adverse effects, with clinical and radiological findings suggestive of 5-FU-induced encephalopathy as described in prior literature. The median time to onset of symptoms from initiation of 5FU was 3 days (range: 2-4 days). All patients improved after conservative management with complete neurological recovery. Conclusion Prompt recognition of this rare yet severe adverse effect of 5-FU-based chemotherapy aids early withdrawal of the offending agent (5-FU) and timely initiation of supportive measures and helps plan alternative oncological interventions.

Surgical site infection (SSI) is the most common postoperative complication worldwide. WHO guidelines to prevent SSI recommend alcoholic chlorhexidine skin preparation and fascial closure using triclosan-coated sutures, but called for assessment of both interventions in low-resource settings. This study aimed to test both interventions in low-income and middle-income countries. FALCON was a 2 × 2 factorial, randomised controlled trial stratified by whether surgery was clean-contaminated, or contaminated or dirty, including patients undergoing abdominal surgery with a skin incision of 5 cm or greater. This trial was undertaken in 54 hospitals in seven countries (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa). Patients were computer randomised 1:1:1:1 to: (1) 2% alcoholic chlorhexidine and non-coated suture, (2) 2% alcoholic chlorhexidine and triclosan-coated suture, (3) 10% aqueous povidone–iodine and non-coated suture, or (4) 10% aqueous povidone–iodine and triclosan-coated suture. Patients and outcome assessors were masked to intervention allocation. The primary outcome was SSI, reported by trained outcome assessors, and presented using adjusted relative risks and 95% CIs. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03700749. Between Dec 10, 2018, and Sept 7, 2020, 5788 patients (3091 in clean-contaminated stratum, 2697 in contaminated or dirty stratum) were randomised (1446 to alcoholic chlorhexidine and non-coated suture, 1446 to alcoholic chlorhexidine and triclosan-coated suture, 1447 to aqueous povidone–iodine and non-coated suture, and 1449 to aqueous povidone–iodine and triclosan-coated suture). 14·0% (810/5788) of patients were children and 66·9% (3873/5788) had emergency surgery. The overall SSI rate was 22·0% (1163/5284; clean-contaminated stratum 15·5% [454/2923], contaminated or dirty stratum 30·0% [709/2361]). For both strata, there was no evidence of a difference in the risk of SSI with alcoholic chlorhexidine versus povidone–iodine (clean-contaminated stratum 15·3% [223/1455] vs 15·7% [231/1468], relative risk 0·97 [95% CI 0·82–1·14]; contaminated or dirty stratum 28·3% [338/1194] vs 31·8% [371/1167], relative risk 0·91 [95% CI 0·81–1·02]), or with triclosan-coated sutures versus non-coated sutures (clean-contaminated stratum 14·7% [215/1459] vs 16·3% [239/1464], relative risk 0·90 [95% CI 0·77–1·06]; contaminated or dirty stratum 29·4% [347/1181] vs 30·7% [362/1180], relative risk 0·98 [95% CI 0·87–1·10]). With both strata combined, there were no differences using alcoholic chlorhexidine or triclosan-coated sutures. This trial did not show benefit from 2% alcoholic chlorhexidine skin preparation compared with povidone–iodine, or with triclosan-coated sutures compared with non-coated sutures, in preventing SSI in clean-contaminated or contaminated or dirty surgical wounds. Both interventions are more expensive than alternatives, and these findings do not support recommendations for routine use. National Institute for Health Research (NIHR) Global Health Research Unit Grant, BD.

The administration of 5-fluorouracil (5FU) in the treatment of gastrointestinal (GI) malignancies is associated with common side effects such as mucositis, diarrhoea, and myelosuppression, which are easily managed with supportive measures and dose adjustments. Cardiotoxicity and neurotoxicity are rare but reversible side effects of 5-FU and are treated with withdrawal of the drug and conservative measures. The presenting symptoms of 5-FU-induced leukoencephalopathy are often confusing and pose a diagnostic dilemma in routine clinical practice. We report a series of five patients with GI malignancies who developed 5-FU-induced leukoencephalopathy. All (n = 5) had Naranjo scores of 6-7, predictive of 5-FU-related adverse effects, with clinical and radiological findings suggestive of 5-FU-induced encephalopathy as described in prior literature. The median time to onset of symptoms from initiation of 5FU was 3 days (range: 2-4 days). All patients improved after conservative management with complete neurological recovery. Prompt recognition of this rare yet severe adverse effect of 5-FU-based chemotherapy aids early withdrawal of the offending agent (5-FU) and timely initiation of supportive measures and helps plan alternative oncological interventions.

Pulmonary diseases due to mycobacteria cause significant morbidity and mortality to human health. In addition to tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), recent epidemiological studies have shown the emergence of non-tuberculous mycobacteria (NTM) species in causing lung diseases in humans. Although more than 170 NTM species are present in various environmental niches, only a handful, primarily Mycobacterium avium complex and M. abscessus , have been implicated in pulmonary disease. While TB is transmitted through inhalation of aerosol droplets containing Mtb, generated by patients with symptomatic disease, NTM disease is mostly disseminated through aerosols originated from the environment. However, following inhalation, both Mtb and NTM are phagocytosed by alveolar macrophages in the lungs. Subsequently, various immune cells are recruited from the circulation to the site of infection, which leads to granuloma formation. Although the pathophysiology of TB and NTM diseases share several fundamental cellular and molecular events, the host-susceptibility to Mtb and NTM infections are different. Striking differences also exist in the disease presentation between TB and NTM cases. While NTM disease is primarily associated with bronchiectasis, this condition is rarely a predisposing factor for TB. Similarly, in Human Immunodeficiency Virus (HIV)-infected individuals, NTM disease presents as disseminated, extrapulmonary form rather than as a miliary, pulmonary disease, which is seen in Mtb infection. The diagnostic modalities for TB, including molecular diagnosis and drug-susceptibility testing (DST), are more advanced and possess a higher rate of sensitivity and specificity, compared to the tools available for NTM infections. In general, drug-sensitive TB is effectively treated with a standard multi-drug regimen containing well-defined first- and second-line antibiotics. However, the treatment of drug-resistant TB requires the additional, newer class of antibiotics in combination with or without the first and second-line drugs. In contrast, the NTM species display significant heterogeneity in their susceptibility to standard anti-TB drugs. Thus, the treatment for NTM diseases usually involves the use of macrolides and injectable aminoglycosides. Although well-established international guidelines are available, treatment of NTM disease is mostly empirical and not entirely successful. In general, the treatment duration is much longer for NTM diseases, compared to TB, and resection surgery of affected organ(s) is part of treatment for patients with NTM diseases that do not respond to the antibiotics treatment. Here, we discuss the epidemiology, diagnosis, and treatment modalities available for TB and NTM diseases of humans.

Helminthiasis is a major public health concern and in developing nations, this leads to the prevalence of pneumonia, malnutrition, eosinophilia and anaemia. In current research, the development of resistance to anthelmintics has led to the evaluation of the alternative source of medicinal plants as an anthelmintic drug. Methanol and aqueous extracts of Lannea coromandelica bark were evaluated at various concentration levels of 10, 25 and 50mg/ml for in-vitro anthelmintic activity against Pheretima posthuma and Ascardia galli obtained from soil. Results were reported in paralysis time and worm death time in minutes. As a reference standard, piperazine citrate was used (15mg/ml). In both extracts, activity based on dose was observed. The result revealed that the extract of methanol (MELC) is more active than the aqueous extract (AELC) and can therefore be useful as anthelmintics. From these observations, it was concluded that the anthelmintic activity observed due to the presence of secondary metabolites such as flavanoids, saponins, tannins, alkaloids and terpenoids. Our results report for the first time that Lannea coromandelica bark extracts have therapeutic values with prominent anthelmintic properties.

The metal matrix composite of Al-6.7Si-0.2Mg alloy reinforced with measured amount of coconut shell ash with dimensions 146 mm in length and 32 mm in diameter was fabricated using stir casting followed by heat treatment of the composite involving solutionizing, water quenching and aging. The metal matrix composites were aged at 4 h, 8 h and 12 h at a temperature of 180 °C. A comprehensive analysis of the microstructure and mechanical properties of the cast metal matrix composites (MMCs) was conducted using optical microscopy, scanning electron microscopy, X ray diffraction technique, micro hardness test and tensile test. In comparison to as cast, MMC and MMCs aged at 12 h, MMCs aged at 4 h and 8 h presented a finer microstructure showing progressive refinement of the eutectic silicon phase. The maximum hardness value of approximately 130 HV was also observed for MMC aged at 8 h. The ultimate tensile strength and yield strength was highest at approximately 165 MPa and 52 MPa respectively for the MMC aged at 8 h. Density measurements showed minimal porosity for the aged MMCs. The fractography results confirmed ductile fracture for the 4 h and 8 h aged MMCs whereas prolonged aging to 12 h can lead to mixed ductile brittle behaviour.

Objectives This study aims to evaluate the utility of F-18 FDG PET/CT in the non-invasive diagnosis of autoimmune pancreatitis (AIP) and differentiating it from pancreatic cancer (CaP) based on the amount and pattern of FDG uptake, as well as involvement of extra-pancreatic sites. Methods A systematic search was conducted using PubMed, Scopus, Cochrane Library and Google Scholar. Only those studies that compared the findings of F-18 FDG PET/CT in terms of SUVmax, pattern of FDG uptake and presence of FDG-avid extra-pancreatic sites in both AIP and CaP were included. Studies were qualitatively assessed for risk of bias and publication bias. The diagnostic performance of parameters on PET/CT was examined through pooled sensitivity, specificity, diagnostic odd’s ratio (DOR) and summary receiver operator characteristic (SROC) curve analysis. Results Six studies were included with a total of 580 patients. 178 patients had AIP (Age 18–90 years, male, M: female, F ratio—8.4:1) and 402 patients had CaP (Age 22–88 years, M:F ratio-1.5:1). Type of AIP was reported in only 3 studies, with the included cases predominantly being type 1 AIP. All studies were retrospective with heterogeneity and a risk on patient selection and index test. The FDG uptake, expressed as SUVmax, was lower in AIP with a weighted mean difference of −3.11 (95% confidence interval, CI: −5.28 to −0.94). To diagnose AIP, the pooled sensitivity, specificity and DOR of diffuse pattern of FDG uptake were 0.59 (95% CI: 0.51–0.66), 0.89 (95% CI: 0.86–0.92) and 21.07 (95% CI: 5.07–88.32), respectively, with an area under curve (AUC) of 0.717 on SROC analysis. The pooled sensitivity, specificity and DOR of FDG-avid extra pancreatic sites were 0.55 (95% CI: 0.45–0.65), 0.58 (95% CI: 0.52–0.64) and 2.33 (95% CI: 1.40–3.89), respectively, with an AUC of 0.632. Conclusion On F-18 FDG PET/CT, a pancreatic lesion of AIP has a lower SUVmax value than CaP. A diffuse pattern of FDG uptake and presence of an extra-pancreatic FDG-avid site are nearly 21 times and twice more likely in AIP than CaP, respectively.

Additive manufacturing has been prominent for making complicated polymeric structures, with PLA being preferred for its biodegradability, ease of use, and wide 3D printing compatibility. The present study aims to explore the effects of graphene-integrated adhesive on shear properties, failure modes, and vibrational response of adhesively joined bonded joints prepared with 3D printed short glass fibre-reinforced polylactic acid (PLA) adherents. Field emission scanning electron microscopy (FESEM) was used to analyse fracture surfaces, while artificial neural networks (ANN) predicted failure modes using a backpropagation algorithm. Tensile testing of bulk samples indicated that samples printed with 0º raster orientation have higher tensile strength (30.7 MPa) than samples printed with 45º (26.7 MPa) and 90º (23.4 MPa) raster orientations. Shear test results demonstrate that incorporating 1.0 wt.% of graphene into the adhesive enhances the adhesive joint’s shear properties, leading to a 19.51% increase in shear strength compared to neat samples. The free vibrational analysis avowed that the addition of graphene up to 1.0 wt.% increases natural frequencies due to improved stiffness from its well-dispersed state within the epoxy matrix. Furthermore, the failure load was accurately predicted using an artificial neural network trained on data from stress–strain curves. The R 2 value of 0.9861 indicates that the results are reliable and show a good correlation. Thereby, this study demonstrated how graphene-integrated epoxy adhesives enhance the mechanical and vibrational properties of adhesively bonded lap joints prepared with 3D printed short glass fibre-reinforced PLA adherents, while also using artificial neural networks to predict failure modes, providing a novel approach to optimise the performance of adhesively joined 3D printed components.

In Kerala, human-elephant conflicts (HEC) are reported in almost all parts of the Western Ghats region, exceptionally high in Wayanad. In recent years, there has been a notable surge in HEC occurrences throughout the state, leading to the loss of property, animals, and life. The dependency of humans on enclosures, the transformation of natural areas into plantations, and the fragmentation of natural ecosystems are the main reasons for the escalating conflict between people and elephants. As a result, it is necessary to study the suitability of habitat for elephants and ensure their conservation. The study aims to identify suitable elephant habitats in the Wayanad Wildlife Sanctuary using geospatial data based on their known association with environmental variables. This study employs the Analytic Hierarchy Process (AHP), an approach to determining the weightings of individual parameters in assessing habitat suitability. The analysis findings indicated that the central portion of the study area within the Sultan Bathery (43.63 sq. km), range represents the most suitable area for elephant habitat followed by Kurichat (33.59 sq. km) and Tholpetti (19.45 sq. km). The final output of the study, the Habitat Suitability Map was validated by adding the human-elephant conflict locational data, which illustrates that the Kurichiat range recorded the highest HEC conflict (50%), followed by Muthanga (29%), Sulthan Bathery (12%), and Tholpetti (9%). The map could assist in managing, conserving, and protecting forest resources and aid in decision-making activities.