Advancements in medical treatment for pancreatic neuroendocrine tumors: A beacon of hope

This editorial highlights the remarkable advancements in medical treatment strategies for pancreatic neuroendocrine tumors (pan-NETs), emphasizing tailored approaches for specific subtypes. Cytoreductive surgery and somatostatin analogs (SSAs) play pivotal roles in managing tumors, while palliative options such as molecular targeted therapy, peptide receptor radionuclide therapy, and chemotherapy are reserved for SSA-refractory patients. Gastrinomas, insulinomas, glucagonomas, carcinoid tumors and VIPomas necessitate distinct thera-peutic strategies. Understanding the genetic basis of pan-NETs and exploring immunotherapies could lead to promising avenues for future research. This review underscores the evolving landscape of pan-NET treatment, offering renewed hope and improved outcomes for patients facing this complex disease.

Comparative outcome of single versus two double-pigtail stents for endoscopic drainage of pancreatic fluid collections with minimal necrosis: a retrospective analysis

Background

Endoscopic ultrasound (EUS)-guided cystogastrostomy is the treatment of choice for managing symptomatic pancreatic fluid collections (PFC). However, studies on the number of stents for optimal drainage of PFCs are limited. Hence, the present study was conducted to compare the outcome of single versus two double-pigtail stents for endoscopic drainage of PFCs.

Methods

This is a single-center, retrospective analysis of patients undergoing endoscopic drainage of PFCs with minimal necrosis (pseudocyst or walled-off necrosis with <30% solid content) at a tertiary center in South India from October 2020 to October 2022. Post-procedure, patients were followed up for clinical improvement, and stents were removed after documentation of cyst size reduction on imaging.

Results

Sixty-three patients (82.5% males, median age: 34 years) fulfilling the selection criteria were included. For single stent placement (n = 47), stents of size 8.5 Fr or 10 Fr were used, while for placement of two stents (n = 16), 7 Fr stents were used. The technical success rate was 100%. Intraprocedural and early postprocedural adverse events (all mild to moderate) were comparable between the groups (17.0% with single stent vs. 25.0% with two stents, p = NS). Clinical success was achieved in 93.6% of patients, with no difference between both groups. Three patients in the single stent group required additional procedures. All patients underwent successful stent removal after a median follow-up of 14 weeks.

Conclusion

A single pigtail stent of 8.5 Fr or 10 Fr size for EUSguided cystogastrostomy provides efficacy and safety similar to that of two stents.

Treatment on Nature’s lap: Use of herbal products in the management of hyperglycemia

Diabetes mellitus (DM) is characterized by persistently elevated blood glucose concentration that lead to multisystem complications. There are about 400 medicinal plants cited to have a beneficial effect on DM. We must choose products wisely based on data derived from scientific studies. However, a major obstacle in the amalgamation of herbal medicine in modern medical practices is the lack of clinical data on its safety, efficacy and drug interaction. Trials of these herbal products often underreport the side effects and other crucial intervention steps deviating from the standards set by Consolidated Standards of Reporting Trials. Due to a lack of knowledge of the active compounds present in most herbal medicines, product standardization is difficult. Cost-effectiveness is another issue that needs to be kept in mind. In this mini-review, we focus on the anti-hyperglycemic effect of herbal products that are commonly used, along with the concerns stated above.

Structural correlation to ferroelectric order, non-Griffiths like phase and magnetocaloric effect in YbCrO4

We report a ferroelectric order around ∼99 K (T_FE), which is considerably above the long range ferrimagnetic order at 25 K (T_N). The value of saturation electric polarization is considerable as ∼570μC m^-2for a poling field of 5 kV cm^-1. The ferroelectric order is associated with a significant magnetoelectric coupling below ∼90 K. A weak signature ofT_FEis observed in the dielectric constant, which is associated with a linear magnetodielectric response at 18 K(<TN). A transition to a polar structure has been correlated with the occurrence of ferroelectric order. A non-Griffiths like phase is observed around ∼48 K, which is also linked with the structural distortion. A reasonable value of the magnetic entropy change of 5.07 J Kg^-1 K^-1is noted atT_Nfor a change in field of 50 kOe, which involves a strong magnetoelastic coupling. The results indicate considerable structural instabilities, which is linked with the observed multifunctional properties of YbCrO₄.

180 NURSING HOMES DURING THE COVID-19 PANDEMIC: A NARRATIVE REVIEW OF CHALLENGES AND RESPONSES

Background

COVID-19 has caused unprecedented challenges in nursing homes. In this narrative review, we aimed to describe factors that contributed to the spread and mortality of COVID-19 in nursing homes and provide an overview of responses that were implemented to try to overcome such challenges.

Methods

The MeSH terms ‘Nursing homes’ and ‘COVID-19’ were searched in MEDLINE Ovid, and English language articles were retrieved that were published between 1 March 2020 and 31 January 2021. Article titles and abstracts were screened by two reviewers, and the results of included articles were grouped by themes.

Results

The search retrieved 348 articles, of which 76 were included in the thematic review. 8 articles related to COVID-19 disease characteristics (e.g. asymptomatic transmission), 24 to resident-related factors (e.g. comorbidities, nutrition, cognition), 13 to facility characteristics (e.g. physical space, occupancy, for-profit status), 21 to staffing (e.g. staffing levels, staff-to-resident ratio, staff multi-employment), and 10 to external factors (e.g. availability of personal protective equipment, prevailing health and social care policies). In terms of responses, identified themes included widespread testing, isolation and cohorting of residents, staff protection and support, promotion of residents’ well-being, and technological innovations.

Conclusion

COVID-19 exerted severe challenges on the nursing home population and its staff. Both internal and external factors predisposed nursing homes to an increased propensity of spread. Numerous strategies were employed to attempt to mitigate the negative impacts. Substantial learning occurred that may not only aid future pandemic preparedness but improve quality of care for nursing home residents at all times.

Use of personal protective equipment among waste workers of Sisdol landfill site of Nepal

Introduction: Solid waste management is a major issue in Nepal with Kathmandu valley generating the highest amount of solid waste. After recovery, the solid waste generated in Kathmandu valley is transferred to the Sisdol landfill site. There are waste workers in Sisdol landfill site who sustain their livelihood by collecting recyclables from those wastes. Personal protective equipment (PPE) is necessary to protect the frontline waste workers against infection. In addition, the waste workers need to know the proper usage of PPE in order to protect themselves from contamination. This study aimed to assess the awareness and proper usage of PPE along with the challenges faced by the waste workers at Sisdol landfill site. Methods: A descriptive cross-sectional study was conducted to collect data from landfill waste workers of Sisdol located at Kakani Rural Municipality in Nuwakot district of Nepal. A convenience sampling method was used based on the availability of landfill waste workers on that day and their willingness to participate. The data was collected using the structured questionnaire and personal interview of available waste workers. Results: The study comprised of 65% female and 35% male waste workers. The highest percentage of waste workers belong to 27-37 age group occupying 43% of total respondents.  Around 92% waste workers had participated in any orientation/training or session related to PPE and its usage. About 60% landfill waste workers were found only using mask and gloves. Conclusion: There is small number of waste workers who wish to wear full set of PPE. Most of them only like to wear mask and gloves. The gender, age group and the education level of waste workers had no association with the usage of PPE during the work.

Significant magneto-elastic coupling at Griffiths-like phase boundaries in low dimensional oxides,ASb2O6(ANi and Mn)

The compounds, NiSb₂O₆(NSO) and MnSb₂O₆(MSO) attract the community for the quasi one-dimensional and layered structure composed of Ni²⁺and Mn²⁺, which orders antiferromagnetically atT_N= 6.7 and 12 K, respectively. Here, we report the Griffiths-like phase much aboveT_Nin the range of 37-85 K and 25-80 K for NSO and MSO, respectively. The dc magnetization results indicate the Griffiths-like phase, following the modified Curie-Weiss law. The magneto-capacitive responses for both the compounds show anomalies at the onset of the Griffiths-like phase. Intriguingly, the low temperature synchrotron diffraction results are conclusive for determining the singularities for both the compounds. Interplay between the low-dimensionality, magnetic frustration, and magneto-elastic coupling correlates the observed short range ordered state, which is suggested as a Griffiths-like phase, aboveT_Nfor both the compounds.

Interplay between positive magnetoresistance and thermoelectric properties by tuning carrier concentration in Sb2-x Sn x Te3 (x ⩽ 0.05) crystals

We report transport properties of Sb2-x Sn x Te3 (x ⩽ 0.05) single crystals, where the tuning of the charge carrier densities via Sn doping significantly improves the magnetoresistance (MR) and the thermoelectric (TE) properties. The MR increases significantly at 2 K for x = 0.01, which reduces considerably with further Sn doping at x = 0.05. The MR results below 90 K for x = 0.01 satisfy the semi-classical two-band approach of Kohler's rule, which does not satisfy the MR results for x = 0.05. At 300 K, the Seebeck coefficient (S) is positive and small for x = 0.01 and it changes the sign with the further increase in Sn doping at x = 0.05 at 300 K. The value of |S| is considerable with an enhancement of the thermoelectric power factor compared to the value for x = 0.01 at 300 K. Analysis of the Hall conductivity indicates the interplay between carrier mobilities and densities, leading to the tuning of MR and TE properties with Sn doping. These results demonstrate that the p-type Sb2Te3 becomes n-type with a suitable doping engineering.

Unveiling spin-glass transition and antiferromagnetic order by μSR studies in spin-chain Sm2BaNiO5

We report the zero-field and longitudinal field muon spin relaxation studies in a spin-chain compound Sm₂BaNiO₅. Two magnetic transitions, that have not been previously detected by the heat capacity and magnetization measurements, are confirmed at 46 and 9 K. The antiferromagnetic order is suggested at 46 K. Analysis of the muon spin polarization unveils the spin-glass transition at 9 K. Time-field scaling relation of the muon spin polarization verifies the spin-spin autocorrelation function following the cut-off power law, which is approximated by the Ogielski form, as employed numerically for characterizing the spin-glasses.

Coexisting exchange bias effect and ferroelectricity in geometrically frustrated ZnCr2O4

Concomitant occurrence of exchange bias effect and ferroelectric order is revealed in antiferromagnetic spinel ZnCr₂O₄. The exchange bias effect is observed below antiferromagnetic Neél temperature (T _N) with a reasonable value of exchange bias field ([Formula: see text] Oe at 2 K). Intriguingly, the [Formula: see text] ratio is found unusually high as  ∼2.2, where H _C is the coercivity. This indicates that large H _C is not always primary for obtaining large exchange bias effect. Ferroelectric order is observed at T _N, where non-centrosymmetric magnetic structure with [Formula: see text] space group associated with the magnetoelectric coupling correlates the ferroelectric order, proposing that, ZnCr₂O₄ is an improper multiferroic material. Rare occurrence of exchange bias effect and ferroelectric order in ZnCr₂O₄ attracts the community for fundamental interest and draws special attention in designing new materials for possible electric field control of exchange bias effect.

Observation of short range order driven large refrigerant capacity in chemically disordered single phase compound Dy2Ni0.87Si2.95

In this work, we report the successful synthesis of a new intermetallic compound Dy2Ni0.87Si2.95 forming in single phase only with a chemically disordered structure. The random distribution of Ni/Si and crystal defects create a variation in the local electronic environment between the magnetic Dy ions. In the presence of both disorder and competing exchange interactions driven magnetic frustration, originating due to c/a ∼ 1, the compound undergoes spin freezing behaviour below 5.6 K. In the non-equilibrium state below the spin freezing behaviour, the compound exhibits aging phenomena and magnetic memory effects. In the magnetically short-range ordered region, much above the freezing temperature, an unusual occurrence of considerable magnetic entropy change, -ΔSmaxM ∼ 21 J kg-1 K-1 with large cooling power RCP ∼ 531 J kg-1 and adiabatic temperature change, ΔTad ∼ 10 K for a field change of 70 kOe, is observed for this short range ordered cluster-glass compound without any magnetic hysteresis loss.

Chemical disorder driven reentrant spin cluster glass state formation and associated magnetocaloric properties of Nd2Ni0.94Si2.94

In this work, we report the synthesis of a new ternary intermetallic compound, Nd₂Ni_0.94Si_2.94, that forms in single phase only in a defect crystal structure. The compound exhibits an antiferromagnetic transition below 7.2 K (T_N) followed by a spin cluster freezing behaviour below 2.85 K (T_f), which makes the compound a reentrant spin cluster glass system. The detailed studies of dc and ac magnetization, heat capacity, non-equilibrium dynamical behaviour, viz., aging effect, temperature and field dependent magnetic relaxation and magnetic memory effect establish the compound to be a cluster-glass material below freezing temperature. The interplay between competing exchange coupling (c/a ≃ 1.04 ⇒ J_NN ≃ J_NNN) and chemical disorder driven variation in the electronic environment among the Nd ions has been argued to be responsible for such a metastable state formation. A considerable value of MCE parameters (-ΔS ∼ 11.4 J kg^-1 K^-1, RCP ∼ 160 J kg^-1 and ΔT_ad ∼ 5.2 K for a field change of 70 kOe) is obtained for this magnetically frustrated glassy compound.

Initial experience with a dual-console robotic-assisted platform for training in colorectal surgery

BACKGROUND

Minimally invasive surgery is associated with several patient-related benefits, including reduced length of hospital stay and reduced blood loss. Robotic-assisted surgery offers many advantages when compared with standard laparoscopic procedures, including a stable three-dimensional binocular camera platform, motion smoothing and motion scaling, improved dexterity and ergonomics. There are limited data on the effectiveness of the dual-console DaVinci Xi platform for teaching resident surgeons. The goal of this study was to examine preliminary outcomes following the introduction of a dual-console robotic platform in our institution.

METHODS

A retrospective review of our prospectively maintained patient database was performed. The first ten dual-console resident-performed procedures in colorectal surgery were compared with matched cases performed on a single console by the trainer. Patient demographics, operative times and patient outcomes were compared.

RESULTS

Twenty patients were included in this study. There was no significant difference in console time (p = 0.46) or total operative time (p = 0.52) when residents and trainers were compared. Patient outcomes were equivalent, with no difference in length of stay, morbidity or mortality.

CONCLUSIONS

The DaVinci Xi dual-console platform is a safe and effective platform for training junior surgeons. The dual-console system has the potential to alter surgical training pathways.

Observation of ultrasharp metamagnetic jumps in polycrystalline Er2Cu2O5

The observation of ultrasharp metamagnetic jumps in the field variation of magnetization (M versus H) data for the highly insulating metal oxide Er₂Cu₂O₅ is investigated. The compound orders antiferromagnetically below about T _N1  =  28 K and shows conventional 'not-so-sharp' metamagnetism around 13 kOe on the field-increasing leg in the polycrystalline sample. The uniqueness of the ultrasharp jumps in Er₂Cu₂O₅ resides in the fact that they are only observed in the field-decreasing segment of the magnetization curve. We observe that the jumps are affected by the sweep rate of the magnetic field, similarly to several other systems that show such ultrasharp jumps. Er₂Cu₂O₅ shows a considerable amount of thermo-remanent magnetization when it is cooled in a field that is higher than the critical field of 13 kOe. Our analysis indicates that above 13 kOe the system remains phase separated, with the coexistence of antiferromagnetic and field-induced ferromagnetic-like phases. The jumps in the return leg occur because of the shear-dominated martensitic-like phase transition of the ferromagnetic-like phase to an antiferromagnetic phase, and interfacial strain plays a major role in the observed jumps.

Hypopituitarism presenting as congestive heart failure

Sheehan's syndrome (SS) develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and is characterized by various degrees of hypopituitarism. Although the occurrence of SS is now rare, it should still be considered in any woman with a history of peripartum hemorrhage who develops manifestations of pituitary hormone deficiency any time following the event. Appropriate hormone replacement therapy results in marked clinical improvement. We present an unusual case of SS in a young lady who continued to have normal menstruation after the index event, had two spontaneous pregnancies, and was diagnosed only 11 years later when she presented to us with acute heart failure.

Carbazole functionalized new bipolar ligand for monochromatic red light-emitting europium(iii) complex: combined experimental and theoretical study

Complete energy transfer observed from carbazole functionalized bipolar ligand as well as β-diketonate to Eu(iii) ion and Eu(iii) complex shows efficient PLQE (41.4%) with appropriate CIE color coordinates (x = 0.64, y = 0.36).

Universal institutional delivery among mothers in a remote mountain district of Nepal: what are the challenges?

Setting: Eight village development committees of Mugu District, a remote mountainous district of Nepal that has poor maternal health indicators. Objectives: 1) To assess the proportion of mothers who delivered in health facilities (institutional delivery); 2) among mothers who delivered at home, to understand their reasons for doing so; and 3) among mothers who delivered in health facilities, to understand their challenges. Design: Cross-sectional study involving semi-structured interviews with mothers conducted in 2015. Results: Of 275 mothers, 97 (35%) had an institutional delivery. Multivariate logistic regression analysis showed that women who resided within 1 h distance from the birthing centre, had adequate mass media exposure or had only one child were more likely to deliver in hospital. Reasons for non-institutional delivery (n = 178) were related to geographical access (49%), personal preferences (18%) and perceived poor quality care (4%). Mothers who accessed institutional delivery (n = 97) also reported difficulties related to travel (60%), costs (28%), dysfunctional health system (18%) and unfriendly attitudes of the health-care providers (7%). Conclusion: To improve access to institutional delivery, the government should establish a 24/7 emergency ambulance network, including air ambulance. Health system issues, including unfriendly staff attitudes, urgently need to be addressed to gain the trust of the mothers.

Non-communicable diseases at a regional hospital in Nepal: Findings of a high burden of alcohol-related disease

Recent global burden of disease reports find that a major proportion of global deaths and disability worldwide can be attributed to alcohol use. Thus, it may be surprising that very few studies have reported on the burden of alcohol-related disease in low income settings. The evidence of non-communicable disease (NCD) burden in Nepal was recently reviewed and concluded that data is still lacking, particularly to describe the burden of alcohol-related diseases (ARDs). Therefore, here we report on NCD burden and specifically ARDs, in hospitalized patients at a regional hospital in Nepal. We conducted a retrospective chart-review that included detailed information on all discharged patients during a four month period. A local database that included sociodemographic information and diagnoses at discharge was established. All doctor-assigned discharge diagnoses were retrospectively assigned ICD-10 codes. A total of 1,139 hospitalized adult patients were included in the study and one third of these were NCDs (n = 332). The main NCDs were chronic obstructive pulmonary disease (COPD) (n = 148, 45%) and ARDs (n = 57, 17%). Patients with ARD often presented with signs of liver cirrhosis and were typically younger men, with a median age at 43 years, from specific ethnic groups. These data demonstrate that severe alcohol-related organ failure in relatively young men contributed to a high proportion of NCDs in a regional hospital in Nepal. These findings are novel and alarming and warrant further studies that can establish the burden of ARDs and alcohol use in Nepal and other similar low-income countries.

Investigation of hydrogen induced fluorescence in C60 and its potential use in luminescence down shifting applications

Herein the photophysical properties of hydrogenated fullerenes (fulleranes) synthesized by direct hydrogenation utilizing hydrogen pressure (100 bar) and elevated temperatures (350 °C) are compared to the fulleranes C₆₀H₁₈ and C₆₀H₃₆ synthesized by amine reduction and the Birch reduction, respectively. Through spectroscopic measurements and density functional theory (DFT) calculations of the HOMO-LUMO gaps of C₆₀H_x (0 ≤ x ≤ 60), we show that hydrogenation significantly affects the electronic structure of C₆₀ by decreasing conjugation and increasing sp³ hybridization. This results in a blue shift of the emission maximum as the number of hydrogen atoms attached to C₆₀ increases. Correlations in the emission spectra of C₆₀H_x produced by direct hydrogenation and by chemical methods also support the hypothesis of the formation of C₆₀H₁₈ and C₆₀H₃₆ during direct hydrogenation with emission maxima of 435 and 550 nm respectively. We also demonstrate that photophysical tunability, stability, and solubility of C₆₀H_x in a variety of organic solvents make them easily adaptable for application as luminescent down-shifters in heads-up displays, light-emitting diodes, and luminescent solar concentrators. The utilizization of carbon based materials in these applications can potentially offer advantages over commonly utilized transition metal based quantum dot chromophores. We therefore propose that the controlled modification of C₆₀ provides an excellent platform for evaluating how individual chemical and structural changes affect the photophysical properties of a well-defined carbon nanostructure.