Whole exome sequencing identifies a novel variant causing cockayne syndrome type I in a consanguineous Pakistani family

BACKGROUND

Cockayne syndrome (CS) is a rare neurodegenerative disorder characterized by impaired neurological functions, cachectic dwarfism, microcephaly and photosensitivity. Complementation assays identify two groups of this disorder, CS type I (CSA) and CS type II (CSB), caused by mutations in ERCC8 and ERCC6, respectively.

OBJECTIVES

This study aimed to investigate the genetic basis of a consanguineous Pakistani family with three affected individuals presenting with typical clinical symptoms of CS.

METHODS

We employed whole exome sequencing of the proband and then Sanger sequenced all the family members to confirm its segregation in the family. Different bioinformatics tools were used to predict pathogenicity of this variant.

RESULTS

Variants were filtered according to the pedigree structure. We identified a novel homozygous variant (c.202A>T; p.Ile68Phe) in ERCC8 gene in the proband. The variant was found to segregate in the family.

CONCLUSIONS

These findings add to the genetic heterogeneity of ERCC8 and expands the mutation spectrum. Also, identification of this variant can facilitate prenatal diagnosis/genetic counselling set ups in Pakistan where this disease largely remains undiagnosed.

Enhancement in the dielectric and magnetic properties of Ni2+-Cu2+ co-doped BaFe11Cu1-xNixO19 hexaferrites (0.0 ≤ x ≤ 1.0)

Herein, Ni2+-Cu2+ co-doped barium hexaferrites (BaFe11Cu1-xNixO19, 0.0 ≤ x≤ 1.0 with an interval of 0.25) were successfully synthesized using a co-precipitation method. The formation of a magnetoplumbite structure with the P63/mmc space group was confirmed by Rietveld refinement of the obtained X-ray diffraction patterns. Microstructural investigations revealed grains in the shape of hexagonal plates, while co-doping resulted in a variation in the grain sizes of the prepared samples. X-ray photoelectron spectroscopy was performed to determine the valence state of iron in the prepared hexaferrites. Impedance spectroscopy analysis revealed that dielectric permittivity initially decreased with an increase in the co-dopant content up to x = 0.5 and then increased by two orders of magnitude for x = 1.0. Alternatively, resistive properties showed microstructural resistance values in the range 105-108 Ω, with the highest value obtained for the sample with x = 0.5. Furthermore, magnetic measurements indicated that all the prepared samples exhibited ferrimagnetic behaviour. Saturation magnetization and magnetic anisotropy values were found to be the highest for the sample with x = 1.0, which also had the lowest coercivity among the prepared samples. Herein, the observed variations in the obtained results can be explained by the variations in grain sizes and the Fe2+/Fe3+ ratio associated with the preferential occupation of co-dopants at octahedral sites. Based on our findings, the BaFe11Ni1O19 (x = 1.0) composition appears to be the most promising choice as a microwave absorption material among the prepared samples owing to the coexistence of high dielectric permittivity (>103 at 107 Hz) and saturation magnetization (73 emu g-1).

Biallelic MED27 variants lead to variable ponto-cerebello-lental degeneration with movement disorders

MED27 is a subunit of the Mediator multiprotein complex, which is involved in transcriptional regulation. Biallelic MED27 variants have recently been suggested to be responsible for an autosomal recessive neurodevelopmental disorder with spasticity, cataracts and cerebellar hypoplasia. We further delineate the clinical phenotype of MED27-related disease by characterizing the clinical and radiological features of 57 affected individuals from 30 unrelated families with biallelic MED27 variants. Using exome sequencing and extensive international genetic data sharing, 39 unpublished affected individuals from 18 independent families with biallelic missense variants in MED27 have been identified (29 females, mean age at last follow-up 17 ± 12.4 years, range 0.1-45). Follow-up and hitherto unreported clinical features were obtained from the published 12 families. Brain MRI scans from 34 cases were reviewed. MED27-related disease manifests as a broad phenotypic continuum ranging from developmental and epileptic-dyskinetic encephalopathy to variable neurodevelopmental disorder with movement abnormalities. It is characterized by mild to profound global developmental delay/intellectual disability (100%), bilateral cataracts (89%), infantile hypotonia (74%), microcephaly (62%), gait ataxia (63%), dystonia (61%), variably combined with epilepsy (50%), limb spasticity (51%), facial dysmorphism (38%) and death before reaching adulthood (16%). Brain MRI revealed cerebellar atrophy (100%), white matter volume loss (76.4%), pontine hypoplasia (47.2%) and basal ganglia atrophy with signal alterations (44.4%). Previously unreported 39 affected individuals had seven homozygous pathogenic missense MED27 variants, five of which were recurrent. An emerging genotype-phenotype correlation was observed. This study provides a comprehensive clinical-radiological description of MED27-related disease, establishes genotype-phenotype and clinical-radiological correlations and suggests a differential diagnosis with syndromes of cerebello-lental neurodegeneration and other subtypes of 'neuro-MEDopathies'.

Natural history of occult hernias in adults at a safety-net hospital

PURPOSE

Occult hernias, hernias seen on radiologic imaging but not felt on physical exam, are common. Despite their high prevalence, little is known about the natural history of this finding. Our aim was to determine and report on the natural history of patients with occult hernias including the impact on abdominal wall quality of life (AW-QOL), need for surgery, and risk of acute incarceration/strangulation.

METHODS

This was a prospective cohort study of patients who underwent a computed tomography (CT) abdomen/pelvis scan from 2016 to 2018. Primary outcome was change in AW-QOL using the modified Activities Assessment Scale (mAAS), a hernia-specific, validated survey (1 = poor, 100 = perfect). Secondary outcomes included elective and emergent hernia repairs.

RESULTS

A total of 131 (65.8%) patients with occult hernias completed follow-up with a median (IQR) of 15.4 (22.5) months. Nearly half of these patients (42.8%) experienced a decrease in their AW-QOL, 26.0% were unchanged, and 31.3% reported improvement. One-fourth of patients (27.5%) underwent abdominal surgery during the study period: 9.9% were abdominal procedures without hernia repair, 16.0% involved elective hernia repairs, and 1.5% were emergent hernia repairs. AW-QOL improved for patients who underwent hernia repair (+ 11.2 ± 39.7, p = 0.043) while those who did not undergo hernia repair experienced no change in AW-QOL (- 3.0 ± 35.1).

CONCLUSION

When untreated, patients with occult hernias on average experience no change in their AW-QOL. However, many patients experience improvement in AW-QOL after hernia repair. Additionally, occult hernias have a small but real risk of incarceration requiring emergent repair. Further research is needed to develop tailored treatment strategies.

Biallelic missense variants in COG3 cause a congenital disorder of glycosylation with impairment of retrograde vesicular trafficking

Biallelic variants in genes for seven out of eight subunits of the conserved oligomeric Golgi complex (COG) are known to cause recessive congenital disorders of glycosylation (CDG) with variable clinical manifestations. COG3 encodes a constituent subunit of the COG complex that has not been associated with disease traits in humans. Herein, we report two COG3 homozygous missense variants in four individuals from two unrelated consanguineous families that co-segregated with COG3-CDG presentations. Clinical phenotypes of affected individuals include global developmental delay, severe intellectual disability, microcephaly, epilepsy, facial dysmorphism, and variable neurological findings. Biochemical analysis of serum transferrin from one family showed the loss of a single sialic acid. Western blotting on patient-derived fibroblasts revealed reduced COG3 and COG4. Further experiments showed delayed retrograde vesicular recycling in patient cells. This report adds to the knowledge of the COG-CDG network by providing collective evidence for a COG3-CDG rare disease trait and implicating a likely pathology of the disorder as the perturbation of Golgi trafficking.

Kenyan palliative care providers' and leaders' perceptions of palliative care research needs and support to facilitate rigorous research

BACKGROUND

Palliative care (PC) can reduce symptom distress and improve quality of life for patients and their families experiencing life-threatening illness. While the need for PC in Kenya is high, PC service delivery and research is limited. Qualitative research is needed to explore potential areas for PC research and support needed to enable that research. This insight is critical for informing a national PC research agenda and mobilizing limited resources for conducting rigorous PC research in Kenya.

OBJECTIVES

To explore perceptions of priority areas for PC research and support needed to facilitate rigorous research from the perspective of Kenyan PC providers and leaders.

METHODS

Focus groups (FGs) were conducted in November and December of 2018 using a semi-structured interview guide. FGs were audio-recorded, transcribed, and analyzed using a thematic content analysis approach.

RESULTS

Three FGs were conducted (n = 22 participants). Ten themes related to PC research emerged, including research on: 1) beliefs about death, disease, and treatment to inform PC; 2) awareness about PC, 3) integration of PC within the health system; 4) understanding caregiver experiences and needs; 5) community health volunteers (CHVs) and volunteer programs; 6) evaluation of costs and benefits of PC; 7) treatment approaches, including complementary and alternative medicine (CAM) and advanced diagnostics at end of life; 8) other suggestions for research, 9) populations in need of PC research; and 10) resources for enabling research.

CONCLUSIONS

Kenyan PC providers and leaders identified key areas requiring increased scientific inquiry and critical resources needed to enable this research. These findings can help to focus future PC research in Kenya and encourage funding agencies to prioritize the issues identified.

Comparison of Rapid Antigen Detection Test with Reverse Transcription Polymerase Chain Reaction in Highly Suspected COVID-19 Patients

OBJECTIVE

To compare Rapid Antigen Test (RAT) with Reverse Transcription Polymerase Chain Reaction (RT-PCR) in highly suspected COVID-19 patients and to determine its diagnostic parameters.

STUDY DESIGN

Hospital-based, descriptive/observational study. Place and Duration of the Study: Department of Medicine/COVID Complex, Medical Teaching Institution/Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan, from October 2021 to April 2022.

METHODOLOGY

A total of 300 highly suspected cases of COVID-19 of either gender admitted in the COVID Complex of the hospital, were included. Data from the patients, including RAT and RT-PCR for COVID-19, were collected retrospectively. RT-PCR was used as the reference test and compared with RAT. Diagnostic statistics of RAT, with their respective 95% confidence intervals were calculated for RAT in diagnosing COVID-19, with significance at p ≤0.05.

RESULTS

Among the 300 patients, 137 (45.7%) were males and 163 (54.3%) were females. The mean age was 56.80 ± 13.72 years. On screening, 138 (46%) patients tested positive and 162 (54%) were negative by RAT; whereas 213 (71%) tested positive and 87 (29%) were negative on RT-PCR. The sensitivity and specificity of RAT were 54.5% (95% CI: 47.52%-61.28%) and 74.7% (95% CI: 64.25%-83.42%), respectively. Positive predicted value was 84.1% (95% CI: 78.26%-88.53%) and negative predictive value was 40.1% (95% CI: 35.63%-44.79%). The positive likelihood ratio was 2.15 (95% CI: 1.47-3.15). The negative likelihood-ratio was 0.61(95% CI: 0.50-0.74). The overall accuracy was 60.33% (95% CI: 54.55%-65.91%).

CONCLUSION

There was a low sensitivity and specificity of the RAT for COVID-19, with an overall accuracy of 60.33%, compared with RT-PCR.

KEY WORDS

COVID-19, Rapid Antigen Test, Sensitivity, Specificity, RT-PCR.

Association of different blood groups in patients with Dengue fever and their relationship with the severity of the illness

Objective

To determine the association of different blood groups in patients with Dengue fever and their relationship with the severity of the illness.

Methods

A hospital-based descriptive study was conducted in the Dengue Isolation Ward of Lady Reading Hospital Peshawar from March 2020 to September 2020. Patients with Dengue fever were included in the study. The severity of the illness was categorized as "Dengue fever (DF)", "Dengue hemorrhagic fever (DHF)", and "Dengue shock syndrome (DSS)". The patients' blood groups were determined as A, B, AB, and O groups. All the data were recorded and analyzed using SPSS® version 23. Chi-square (χ2) and student t-test were applied, and a p-value of ≤0.05 was considered significant.

Results

Out of 160 patients, 119(74.4%) were males; the patient's mean age was 38.09±15.68 SD, IQR=25 years. Greater proportion (28%) of the young men (up to 40 years) was affected compared to 9% young women. Fever (99%) and body aches (96%) were the most common presentation of DF, complicated by bleeding in 30.6% and shock in 9.4% of the patients. The majority (63.1%) of the patients had DF; 27.5% had DHF, and 9.4% had DSS. Sixty three (39.4%) patients had blood Group-B and 5.6% had Group-AB (p=0.97). The proportion of patients with different blood groups and the type/severity of the DF were almost identical except the fact that none of the patient with group AB had DSS. There was significant gender difference of hemoglobin (p=0.008, 95%CI=0.439, 2.844), hematocrit (p=0.012, 95%CI=0.00974, 0.07946); and Alanine Aminotransferase levels (p=0.002, 95%CI=-332.032, -72.233).

Conclusion

Patients with blood Group-B were more frequent and AB was least commonly affected by the Dengue-virus infections. However, no association was found between a particular blood group and disease severity. Greater proportions of the younger men had Dengue infections.

Structural insights into the effect of mutations in the spike protein of SARS-CoV-2 on the binding with human furin protein

The SARS COV-2 and its variants are spreading around the world at an alarming speed, due to its higher transmissibility and the conformational changes caused by mutations. The resulting COVID-19 pandemic has imposed severe health consequences on human health. Several countries of the world including Pakistan have studied its genome extensively and provided productive findings. In the current study, the mCSM, DynaMut2, and I-Mutant servers were used to analyze the effect of identified mutations on the structural stability of spike protein however, the molecular docking and simulations approaches were used to evaluate the dynamics of the bonding network between the wild-type and mutant spike proteins with furin. We addressed the mutational modifications that have occurred in the spike protein of SARS-COV-2 that were found in 215 Pakistani's isolates of COVID-19 patients to study the influence of mutations on the stability of the protein and its interaction with the host cell. We found 7 single amino acid substitute mutations in various domains that reside in spike protein. The H49Y, N74K, G181V, and G446V were found in the S1 domain while the D614A, V622F, and Q677H mutations were found in the central helices of the spike protein. Based on the observation, G181V, G446V, D614A, and V622F mutants were found highly destabilizing and responsible for structural perturbation. Protein-protein docking and molecular simulation analysis with that of furin have predicted that all the mutants enhanced the binding efficiency however, the V622F mutant has greatly altered the binding capacity which is further verified by the K_D value (7.1 E^-14) and therefore may enhance the spike protein cleavage by Furin and increase the rate of infectivity by SARS-CoV-2. On the other hand, the total binding energy for each complex was calculated which revealed -50.57 kcal/mol for the wild type, for G181V -52.69 kcal/mol, for G446V -56.44 kcal/mol, for D614A -59.78 kcal/mol while for V622F the TBE was calculated to be -85.84 kcal/mol. Overall, the current finding shows that these mutations have increased the binding of Furin for spike protein and shows that D614A and V622F have significant effects on the binding and infectivity.

Deep Learning for Medication Recommendation: A Systematic Survey

Making medication prescriptions in response to the patient's diagnosis is a challenging task. The number of pharmaceutical companies, their inventory of medicines, and the recommended dosage confront a doctor with the well-known problem of information and cognitive overload. To assist a medical practitioner in making informed decisions regarding a medical prescription to a patient, researchers have exploited electronic health records (EHRs) in automatically recommending medication. In recent years, medication recommendation using EHRs has been a salient research direction, which has attracted researchers to apply various deep learning (DL) models to the EHRs of patients in recommending prescriptions. Yet, in the absence of a holistic survey article, it needs a lot of effort and time to study these publications in order to understand the current state of research and identify the best-performing models along with the trends and challenges. To fill this research gap, this survey reports on state-of-the-art DL-based medication recommendation methods. It reviews the classification of DL-based medication recommendation (MR) models, compares their performance, and the unavoidable issues they face. It reports on the most common datasets and metrics used in evaluating MR models. The findings of this study have implications for researchers interested in MR models.

Fabrication of La3+ doped Ba1-x La x TiO3 ceramics with improved dielectric and ferroelectric properties using a composite-hydroxide-mediated method

Lanthanum (La³⁺) doped Ba_1-x La _x TiO₃ (x = 0.0, 0.0025, 0.005, 0.0075) ceramics were synthesized by the composite-hydroxide-mediated method. Rietveld refinement of the XRD patterns confirmed the formation of a perovskite crystal structure that transforms from tetragonal to pseudo-cubic with La³⁺ doping content (x). Scanning electron microscopy displayed a dense and homogeneous microstructure with reduced grain size on La³⁺ doping. The frequency and temperature-dependent dielectric measurements showed an improvement in the dielectric permittivity, a decrease in the ferroelectric-paraelectric transition temperature, and an increase in the dielectric diffusivity with increasing La³⁺ doping content. Complex impedance analysis indicated the semiconducting behavior with a positive temperature coefficient of resistance effect, which could be explained in terms of a charge compensation mechanism in the donor doped BaTiO₃. The ferroelectric hysteresis loops revealed that these ceramics are ferroelectric in nature, while an improvement in the energy storage density and energy storage efficiency was observed for the doped samples due to reduced grain size on La³⁺ doping. Here, the sample with x = 0.005 has a high dielectric permittivity, a low dielectric tangent loss, and the highest energy storage efficiency. This makes this composition interesting for energy storage applications.

A Case of Gastric Mucormycosis in a 21-Year-Old Patient With Hemophagocytic Lymphohistiocytosis

Mucormycosis is an angioinvasive, opportunistic infection. Diabetes Mellitus and immunosuppression are the most common risk factors for fungal infection. Without prompt treatment, the infection can be fatal. A 21-year-old male patient presented with gastritis-like symptoms refractory to proton pump inhibitor (PPI) therapy. He recently received treatment for Hemophagocytic Lymphohistiocytosis (HLH), confirmed by bone marrow biopsy and fungal sinusitis. Esophagogastroduodenoscopy (EGD) revealed extensive gastric involvement by Mucormycosis. The patient was given antifungal drugs and a resection of necrotic stomach tissue. Gastric mucormycosis is a rare presentation of the angioinvasive fungus. The patient's young age and lack of distinguishing risk factors such as diabetes or immunosuppression are also unusual. Furthermore, the patient's unique presentation with gastric mucormycosis compounded by a recent diagnosis of Hemophagocytosis lymphohistiocytosis produces a valuable case study in management.

Syntheses and Structural Characterization of Divalent Metal Complexes (Co, Ni, Pd and Zn) of Sterically Hindered Thiourea Ligand and A Theoretical Insight of their Interaction with SARS-CoV-2 Enzyme

Reacting two equivalents of sterically hindered 1,3-bis(2,6-diethylphenyl)thiourea ligand (L) with CoCl₂, NiBr₂, PdX₂ (X = Cl; Br) and ZnI₂ in acetonitrile afforded the corresponding bulky thiourea ligand stabilized four coordinated monomeric [L₂CoCl₂] (1), [L₂NiBr₂] (2), [L₂PdX₂] (3a: X = Cl; 3b: X = Br) and [L₂ZnI₂] (4.2CH₃CN) complexes. Compound 1, 2 and 4.2CH₃CN are tetrahedral whereas Pd complexes (3a and 3b) are square planar. In solution, palladium complexes are dominated by cis-isomers. Structural characterization shows inter- and intramolecular hydrogen bonding. Hirshfeld surface and fingerprint plots indicated significant intermolecular interactions in the crystal network. Molecular docking analysis revealed relatively higher SARS-CoV-2 enzyme interacting abilities of the synthesized complexes compared to the free ligand. All compounds have been characterized by elemental analyses, NMR spectroscopy and single-crystal X-ray diffraction.

A Novel Nonsense Variant in GRM1 Causes Autosomal Recessive Spinocerebellar Ataxia 13 in a Consanguineous Pakistani Family

Background and objectives: Autosomal recessive spinocerebellar ataxia-13 (SCAR13) is an ultra-rare disorder characterized by slowly progressive cerebellar ataxia, cognitive deficiencies, and skeletal and oculomotor abnormalities. The objective of this case report is to expand the clinical and molecular spectrum of SCAR13. Methods: We investigated a consanguineous Pakistani family with four patients partially presenting with clinical features of SCAR13 using whole exome sequencing. Segregation analysis was performed by Sanger sequencing in all the available individuals of the family. Results: Patients presented with quadrupedal gait, delayed developmental milestones, non-progressive peripheral neuropathy, and cognitive impairment. Whole exome sequencing identified a novel pathogenic nonsense homozygous variant, Gly240*, in the gene GRM1 as a cause of SCAR13 that segregates with the recessive disease. Discussion: We report a novel homozygous nonsense variant in the GRM1 gene in four Pakistani patients presenting with clinical features that partially overlap with the already reported phenotype of SCAR13. In addition, the family presented quadrupedal gait and non-progressive symptoms, manifestations which have not been recognized previously. So far, only four variants in GRM1 have been reported, in families of Roma, Iranian, and Tunisian origins. The current study adds to the mutation spectrum of GRM1 and provides a rare presentation of SCAR13, the first from the Pakistani population.

MCNN: a multi-level CNN model for the classification of brain tumors in IoT-healthcare system

The classification of brain tumors is significantly important for diagnosing and treating brain tumors in IoT healthcare systems. In this work, we have proposed a robust classification model for brain tumors employing deep learning techniques. In the design of the proposed method, an improved Convolutional neural network is used to classify Meningioma, Glioma, and Pituitary types of brain tumors. To test the multi-level convolutional neural network model, brain magnetic resonance image data is utilized. The MCNN model classification results were improved using data augmentation and transfer learning methods. In addition, hold-out and performance evaluation metrics have been employed in the proposed MCNN model. The experimental results show that the proposed model obtained higher outcomes than the state-of-the-art techniques and achieved 99.89% classification accuracy. Due to the higher results of the proposed approach, we recommend it for the identification of brain cancer in IoT-healthcare systems.

Adults with concomitant atopic dermatitis and asthma have more frequent urgent health care utilization and less frequent scheduled follow-up visits than adults with atopic dermatitis or asthma only: A nationwide cohort study

BACKGROUND

Atopic dermatitis (AD) and asthma often co-occur in the same patient, and health care utilization is related to disease severity of these diseases.

OBJECTIVE

To investigate differences in healthcare utilization in adults with concomitant AD and asthma compared to patients with asthma or AD only.

METHODS

All Danish adults with a hospital-diagnosis of AD, asthma or concomitant AD and asthma recorded in national registries were included. Health care utilization data were obtained in 3-month intervals from two year prior to index date (the date of the first hospital diagnosis), and to five years after.

RESULTS

A total of 12,409 patients with AD were included (11,590 with AD only and 819 with concomitant AD and asthma), and 65,539 with asthma only. Adults with concomitant AD and asthma had higher risk of hospitalization for AD (OR 1.38, 95% CI (1.15-1.67), p=0.001) and asthma (OR 1.16, 95% CI (1.00-1.35), p=0.047) compared to patients with only AD and asthma, respectively. These patients also had fewer visits in outpatient clinics for AD (OR 0.10, 95% CI (0.08-0.12), p<0.001) and asthma (OR 0.34, 95% CI (0.29-0.39), P<0.001) compared to patients with only AD or asthma. Outpatient clinic visits for rhinitis were more frequent among patients with concomitant AD and asthma compared to patients with only AD or asthma.

CONCLUSION

Adults with concomitant AD and asthma had different patterns of healthcare utilization compared to adults with AD or asthma alone, suggesting that improvements in management and monitoring may reduce unscheduled health care visits, and lower healthcare costs.

P-738 Impact of limited reproductive health awareness on PCOS diagnosis timelines and the need for improved patient education

Study question

Does the lack of awareness of Polycystic ovary syndrome (PCOS) symptoms contribute to a delay in diagnosis?

Summary answer

Limited awareness regarding reproductive health symptoms can negatively impact help-seeking behaviour, delaying diagnostic timelines.

What is known already

PCOS is a common endocrine condition estimated to affect up to 20% of women worldwide. Frequently observed symptoms include oligomenorrhea or amenorrhea, clinical features of hyperandrogenism, metabolic dysfunction, infertility and poor mental health.

Despite its prevalence and the debilitating impact of symptoms on quality of life, it takes an average of two years and over three clinical consultations to diagnose. Delayed diagnosis may be influenced by a lack of standardised screening guidelines, poor understanding of how PCOS manifests in ethnic minorities and hesitancy from the general public to seek help for their reproductive health symptoms.

Study design, size, duration

A cross-sectional study investigating the barriers to diagnosis of PCOS.

Participants aged 18 or older with an existing or suspected diagnosis of PCOS were invited to complete an online survey across five days in January 2022.

The survey assessed general demographic information, the influence of symptoms on their daily life and their experiences with receiving a diagnosis.

Of the 200 responses, 143 responses were analysed and 99 were included in the results.

Participants/materials, setting, methods

Participants were aged between 18 - 45 and provided informed consent after reading a patient information leaflet detailing the background of the study.

75 (52.44%) participants were UK-based, while 68 (47.55%) were based abroad.

Ethical approval of all study-related documents was given by the Hertility Health Research Ethics Committee.

The online survey was presented on Typeform and disseminated via the social media platforms Instagram, Twitter and LinkedIn.

Descriptive statistics are presented.

Main results and the role of chance

Of the 143 participants, 99 (69.2%) reported a PCOS diagnosis. Anxiety (71.4%), irregular menstrual cycles (69.4%) and weight-related concerns (64.3%) were the most commonly reported symptoms.

Despite the majority reporting that their symptoms impacted daily life (80.8%), mental health (82.8%), and educational or work performance (70.7%), only 10.2% had sought medical help immediately while 75.5% waited for up to 2 years.

Not realising their symptoms required medical help (73.2%), lack of information regarding routes to care (18.3%) and stigma from family members (18.3%) were the most common reasons why medical help was not sought immediately.

Following clinical consultations, 54.7% of participants were not satisfied with the information provided to manage their diagnosis. Although mental health-related symptoms were most frequently reported (75.5%), only 4.8% reported that management strategies for mental health were referenced in their consultations.

Of the 93.2% of those looking for extra information online, only 52.3% used official websites such as the National Health Service (NHS) website. Many participants also chose to use social media sources such as Instagram and Tik Tok for information (52.3%) and support (59.3%).

Limitations, reasons for caution

Although there was a global uptake, the study needs to be carried out on a larger scale with an emphasis on minority ethnicities.

Recall bias could have also impacted findings as the participants were required to provide details on their entire diagnosis experience.

Wider implications of the findings

It is evident that limited awareness regarding reproductive health can delay the diagnosis of PCOS.

Due to unsatisfactory management by healthcare providers, patients heavily rely on unregulated channels such as social media to obtain reproductive health information, highlighting the need for better Sex and Fertility Education programs and improved accessibility.

Trial registration number

NA

Synthesis, Characterization, Biological Activity and Molecular Docking Studies of Novel Organotin(IV) Carboxylates

Four new carboxylates complexes with general formula R₂SnL₂ and R₃SnL, where R = n-butyl (1, 3), methyl (2, 4) and L = 4-Chlorophenoxyacetate, were synthesized in significant yields. FT-IR analysis revealed a chelating (1 and 2) and a bridging bidentate (3 and 4) coordination modes for the carboxylate ligand in solid state which was further confirmed by the single crystal X-ray analysis of complex 4. The NMR data (¹H, ¹³C and ¹¹⁹Sn) revealed a higher coordination number around the tin center in R₂SnL₂ (1 and 2) compared to R₃SnL (3 and 4). A close matching was observed between the experimental and calculated structures (obtained at B3LYP/6-31G* + LANL2DZ basis set). Quantum chemical analysis indicates that the carboxylate moiety has the major contribution in the formation of filled and unfilled orbitals as well as in ligand to ligand intramolecular charge transfer during the electronic transitions. The cytotoxicity data of the screened compounds evaluated against lung cancer cell line (A549) and normal lung fibroblast cell line (MRC-5) revealed that 1, 3 and 4 have shown dose dependent cytotoxic effects while HL and 2 have shown steady and low cytotoxic activities. The antibacterial activity of complexes 1–4 is higher than that of HL. Molecular docking study showed an intercalation binding mode for complex 3 with DNA (docking score = −3.6005) involving four polar interactions. Complex 3 docking with tubulin (PDB ID 1SA0) with colchicine as a target protein resulted in three polar interactions (docking score −5.2957). Further, the docking analysis of the HL and 1–4 has shown an adequate interactions with the coronavirus SARS-CoV-2 spike protein, nucleocapsid protein and human angiotensin converting enzyme (ACE2).

Unusual semiconductor-metal-semiconductor transitions in magnetite Fe3O4 nanoparticles

Magnetite (Fe₃O₄) nanoparticles were successfully prepared by a co-precipitation method. Rietveld refinement on the X-ray diffraction pattern confirmed the development of a single-phase cubic spinel structure with space group Fd3̄m. However, ⁵⁷Fe Mössbauer spectroscopy suggested the presence of Fe³⁺ and Fe^2.5+ (mixed Fe³⁺ and Fe²⁺) ions at the tetrahedral and octahedral sites of the inverse spinel structure, respectively. Impedance spectroscopy measurements showed a discontinues variation in the temperature dependence of the sample's resistive behavior, indicating the appearance of semiconductor–metal–semiconductor like transitions between the temperature range of 293 and 373 K. A similar dual transition was also observed from the dielectric and conductivity measurements around the same temperature regions. The observed unusual transition is explained in term of the competitive effects among the hopping of localized/delocalized and short-range/long-range charge carriers present in the sample. Moreover, the prepared sample exhibits colossal dielectric permittivity (∼10⁶), reduced tangent loss (∼0.2) and moderate conductivity (>10⁻⁶ S cm⁻¹) values, making Fe₃O₄ nanoparticles a potential candidate for electromagnetic absorbing materials.

Herein, we report the existence of a novel semiconductor–metal–semiconductor type transition in Fe₃O₄ nanoparticles by employing impedance spectroscopy techniques.

Synthesis, characterization, antioxidant, antileishmanial, anticancer, DNA and theoretical SARS-CoV-2 interaction studies of copper(II) carboxylate complexes

Copper(II) carboxylate complexes [Cu₂(OOCR)₄L₂] (1) and [Cu₂(OOCR`)<sub>4</sub>OCO(R`)CuL₂]_n (2), where L = 2-methyl pyridine, R = 2-chlorophenyl acetate and R` = 2-fluorophenyl acetate were synthesized and characterized by FT-IR spectroscopy and single crystal X-ray analysis. Complex 1 exhibits the typical paddlewheel array of a dinuclear copper(II) complex with carboxylate ligands. In complex 2, this scaffold is further extended into a polymeric arrangement based on alternate paddlewheel and square planar moieties with distinct coordination spheres. The complexes showed better 2,2-diphenyl-1-picrylhydrazyl (DPPH) and hydroxyl radical scavenging activities and have been found to be more potent antileishmanial agents than their corresponding free ligand acid species. UV-Vis absorption titrations revealed good DNA binding abilities {Kb = 9.8 × 10⁴ M^-1 (1) and 9.9 × 10⁴ M^-1 (2)} implying partial intercalation of the complexes into DNA base pairs along with groove binding. The complexes displayed in vitro cytotoxic activity against malignant glioma U-87 (MG U87) cell lines. Computational docking studies further support complex-DNA binding by intercalation. Molecular docking investigations revealed probable interactions of the complexes with spike protein, the nucleocapsid protein of SARS-CoV-2 and with the angiotensin converting enzyme of human cells.

Pathological Spectrum of Solitary Fibrous Tumours: A Study of 25 Cases Diagnosed at a Tertiary Care Institute

ABSTRACT Objective:  To evaluate the clinicopathological and immunohistochemical features of Solitary Fibrous Tumor (SFT) in our hospital. Materials and Methods: This is a retrospective descriptive study. All cases of solitary fibrous tumor diagnosed on morphology from January 2012 till June 2018 were retrospectively retrieved from the histopathology department of a tertiary care hospital. The hematoxylin and eosin (H&E) stained slides as well as IHC slides were reviewed. Diagnosis was established on current standard histopathological and IHC criteria provided by World Health Organization (WHO) Classification of soft tissue tumors.8 Four micron thick sections from paraffin blocks were made of each sample and mounted onto glass slides. IHC staining for anti-STAT6 antibody (BioSB antibody, Roche kit) was available in our hospital from 2018 onwards. It was performed on all suspected cases of SFT using manufacturer’s instructions. The quality of expression was graded and interpreted as absent staining, weak expression or strong expression. The samples were graded based on diffuse (>50%) versus localized (<50% of tumor cells) staining, as well as localization of the stain within the cell (nuclear only, cytoplasmic only or both nuclear and cytoplasmic). Approval for acquisition of the tissue specimens and supporting case information and retrieval of glass slides was obtained by Institutional Review Board & Ethics Committee. Results: There were 25 cases of SFT in our study involving 12 males and 13 females. According to WHO 2013 criteria, eleven cases in our study were classified as malignant (44%) while 14 cases were in the benign group (56%). STAT6 was available in our hospital in 2018 and since then all the subsequent cases of SFT in the present study (seven in number) came positive for STAT6 (sensitivity 100%) while CD34 which was done throughout the duration of this study (January 2012-June 2018) was positive in 20 cases (86.9%) and negative in three cases (13%). Follow-up of 16 cases is available. Out of a total 14 benign cases, follow-up of only seven (50%) cases could be traced and from a total of 11 malignant cases, follow-up of nine (81%) cases could be sought. All benign cases remained disease free while among the nine malignant cases: three (33.3%) patients died, recurrence was reported in four (44.4%) patients. One (11.1%) patient remained disease free while one (11.1%) patient is alive and on treatment. Conclusion Malignancy in SFT is common and must be evaluated meticulously. STAT6 is a highly sensitive marker for the diagnosis of SFTs.  Immunohistochemical panel including STAT6, CD34, CD99 and bcl-2 support morphology. Malignant behavior is common and is evaluated by meticulous analysis of gross/microscopic features and close follow-up of the patient. However further advances in the genetics and new tumor markers is in progress and must be followed for definitive decision of tumor behavior and its subsequent treatment. Keywords: solitary fibrous tumor, STAT6, CD34

In Vivo Analgesic, Anti-Inflammatory, and Anti-Diabetic Screening of Bacopa monnieri-Synthesized Copper Oxide Nanoparticles

In this work, an ecofriendly approach for biogenic production of copper oxide nanoparticles (CuO-NPs) was proposed by utilizing the Bacopa monnieri leaf extract as a reducing and stabilizing agent. The synthesis of CuO-NPs was instantly confirmed by a shift in the color of the copper solution from blue to dark gray. The use of UV-visible spectroscopy revealed a strong narrow peak at 535 nm, confirming the existence of monoclinic-shaped nanoparticles. The average size of CuO-NPs was 34.4 nm, according to scanning electron microscopy and transmission electron microscopy studies. The pristine crystalline nature of CuO-NPs was confirmed by X-ray diffraction. The monoclinic form of CuO-NPs with a crystallite size of 22 nm was determined by the sharp narrow peaks corresponding to 273, 541, 698, 684, and 366 Bragg's planes at different 2θ values. The presence of different reducing metabolites on the surface of CuO was shown by Fourier transform infrared analysis. The biological efficacy of CuO-NPs was tested against Helicobacter felis, Helicobacter suis, Helicobacter salomonis. and Helicobacter bizzozeronii. H. suis was the most susceptible strain with an inhibition zone of 15.84 ± 0.89 mm at 5 mg/mL of NPs, while the most tolerant strain was H. bizzozeronii with a 13.11 ± 0.83 mm of inhibition zone. In in vivo analgesic activity, CuO-NPs showed superior efficiency compared to controls. The maximum latency time observed was 7.14 ± 0.12 s at a dose level of 400 mg/kg after 90 min, followed by 5.21 ± 0.29 s at 400 mg/kg after 60 min, demonstrating 65 and 61% of analgesia, respectively. Diclofenac sodium was used as a standard with a latency time of 8.6 ± 0.23 s. The results observed in the rat paw edema assays showed a significant inhibitory activity of the plant-mediated CuO-NPs. The percentage inhibition of edema was 74% after 48 h for the group treated with CuO-NPs compared to the control group treated with diclofenac (100 mg/kg) with 24% edema inhibition. The solution of CuO-NPs produced 82% inhibition of edema after 21 days when compared with that of the standard drug diclofenac (73%). CuO-NPs vividly lowered glucose levels in STZ-induced diabetic mice, according to our findings. Blood glucose levels were reduced by about 33.66 and 32.19% in CuO-NP and (CuO-NP + insulin) groups of mice, respectively. From the abovementioned calculations, we can easily conclude that B. monnieri-synthesized CuO-NPs will be a potential antibacterial, anti-diabetic, and anti-inflammatory agent on in vivo and in vitro basis.

Primary Kaposiform Hemangioendothelioma of the Humerus: A Case Report

Kaposiform hemangioendothelioma (KHE) is a neoplasm originating mainly from vessels and has a mild proclivity for malignancy. This neoplasm mainly involves somatic soft tissue and retroperitoneum. Histological findings include a nodular arrangement of oval-to-spindle cells containing pale cytoplasm. Vascular spaces are in the form of slit-like channels in which red blood cells are evident. Here, we report the case of a two-year-old male who presented with Erb’s palsy and a mass lesion in the right humerus. Tissue biopsy features were compatible with KHE.

StackBC: Deep learning and transfer learning techniques based stacking approach for accurate Invasive Ductal Carcinoma classification using histology images

Artificial intelligence (AI) based computer-aided diagnostic (CAD) systems can effectively diagnose critical disease. AI-based detection of breast cancer (BC) through images data is more efficient and accurate than professional radiologists. However, the existing AI-based BC diagnosis methods have complexity in low prediction accuracy and high computation time. Due to these reasons, medical professionals are not employing the current proposed techniques in E-Healthcare to effectively diagnose the BC. To diagnose the breast cancer effectively need to incorporate advanced AI techniques based methods in diagnosis process. In this work, we proposed a deep learning based diagnosis method (StackBC) to detect breast cancer in the early stage for effective treatment and recovery. In particular, we have incorporated deep learning models including Convolutional neural network (CNN), Long short term memory (LSTM), and Gated recurrent unit (GRU) for the classification of Invasive Ductal Carcinoma (IDC). Additionally, data augmentation and transfer learning techniques have been incorporated for data set balancing and for effective training the model. To further improve the predictive performance of model we used stacking technique. Among the three base classifiers (CNN, LSTM, GRU) the predictive performance of GRU are better as compared to individual model. The GRU is selected as a meta classifier to distinguish between Non-IDC and IDC breast images. The method Hold-Out has been incorporated and the data set is split into 90% and 10% for training and testing of the model, respectively. Model evaluation metrics have been computed for model performance evaluation. To analyze the efficacy of the model, we have used breast histology images data set. Our experimental results demonstrated that the proposed StackBC method achieved improved performance by gaining 99.02% accuracy and 100% area under the receiver operating characteristics curve (AUC-ROC) compared to state-of-the-art methods. Due to the high performance of the proposed method, we recommend it for early recognition of breast cancer in E-Healthcare.

Improving and Sustaining the Quality of Discharge Summaries

High quality discharge information communication has been linked to a reduction in the incidence of adverse events, decreasing the risk of prescription errors and lost follow up. In this paper we describe how our trust-wide quality improvement project, led by acute physicians, successfully improved discharge documentation. We demonstrate how we identified obstacles to continued success, and the interventions we implemented. We recommend how discharge summary quality can be optimised through training of junior doctors, recruitment of local champions, and use of novel methods to preserve engagement, such as gamification.

The interplay of saliva, erosion and attrition on enamel and dentine

Purpose

This investigation aimed to compare the protective role of saliva against erosion and attrition challenges.

Method

Polished enamel and dentine samples (n = 160) were prepared and randomly assigned to either the saliva or saliva-free group (n = 40 enamel and n = 40 dentine/group). Within each subgroup, they were allocated to four subgroups: negative control (deionized water exposure 10 min), erosion (0.3% citric acid 10 min), attrition (120 S of 300 g force), or combined erosion/attrition (0.3% citric acid 10 min then 120 S of 300 g force). Experimental cycles were repeated three times. Data analysis was performed using SPSS.

Results

The mean and standard deviation (SD) of step heights produced by the attrition and erosion/attrition groups in enamel in the saliva-free group were 5.6 µm (2.4) and 13.4 µm (2.8), respectively, while they were 2.4 µm (3.8) and 12.9 µm (3.5) in the saliva group, with no significant difference between the saliva and saliva-free groups. For dentine, the corresponding step heights were 25.2 µm (5.5) and 35.9 µm (7.9) for the saliva-free group, but 21.8 µm (5.3) and 27.3 µm (6.4) for the saliva group (p < 0.001).

Conclusion

There was a trend that saliva decreased wear, but this was only statistically significant for erosion/attrition dentine wear.

Development of laser induced breakdown spectroscopy technique to study irrigation water quality impact on nutrients and toxic elements distribution in cultivated soil

This study is focused mainly on impact of irrigation water quality in cultivated soil on distribution of essentials nutrients (Al, Mg, Ca, Fe, S, Si, Na, P, and K) and relatively toxic metals (As, Ba, Cr, Cu, Ti, Sn, Mn, Ni, and Zn) using an elegant Laser induced breakdown spectroscopy (LIBS) technique. A pulsed Nd:YAG laser operating at 1064 nm in conjunction with suitable detector was applied to record soil emission spectra. The abundance of these elements were evaluated via standard calibration curve Laser Induced Breakdown Spectroscopy (CC-LIBS) and calibration free Laser Induced Breakdown Spectroscopy (CF-LIBS) approaches. Quantitative analyses were accomplished under conjecture of local thermodynamic equilibrium (L.T.E) and optically thin plasma. The average electron temperatures were estimated by Boltzmann plot method for cultivated soil samples in 7800 to 9300 K range. The electron number density was ~ 1.11 × 1017 cm − 3 to 1.60 × 1017 cm − 3. Prior to application on soil samples, the experimental setup was optimized at the following parameters: pulsed energy = 60 mJpulse-1, sample to lens distance of 9.0 cm, and the gate delay of 3.5 μs. It is noteworthy that nutritional elements content of cultivated soils were found strongly dependent upon the irrigation water quality. The cultivated soil from industrial area was found rich of toxins while the cultivated land using tube well water contains toxins in least amount. Our LIBS findings were also validated by comparing its results with contents measured using a standard inductively coupled plasma optical emission spectroscopy (ICP-OES) method and both were found in excellent agreement. The present study could be highly beneficial for agricultural applications and for farmers to produce safe food products and higher crops yield.

Identification of a novel variant in GPR56/ADGRG1 gene through whole exome sequencing in a consanguineous Pakistani family

GPR56 gene is best known for its pivotal role in cerebral cortical development. Mutations inGPR56give rise to cobblestone-like brain malformation, white matter changes and cerebellar dysplasia. This study aimed to identify causative variant in a consanguineous family having five individuals affected with developmental delay, mild to severe intellectual disability, speech impairment, strabismus and seizures. Whole exome sequencing was performed to identify mutation in affected individuals. Variants were filtered and further validated by Sanger sequencing and segregation analysis. A novel frameshift variant c.1601dupT leading to p.Ala535GlyfsTer17) was identified in GPR56 gene by whole exome sequencing and subsequent filtering. All five affected individuals were homozygous for the mutant allele while four asymptomatic individuals carried the variant in heterozygous state. Radiological findings of a representative patient presented features of GPR56-associated cobblestone like brain malformation. MRI findings suggested paucity of sulci, dilated ventricular system and brainstem atrophy. The microgyria were observed in a simplified gyral pattern (cobblestone). This single bp insertion, and the consequent frameshift, results in the truncation of GPR56 protein. This could result in a malformed cortex giving the brain a cobblestone like shape. Our study identified a 7^th novel frameshift variant from Pakistani population in GPR56 gene, thus broadening mutation spectrum.

Rare Pathogenic Variants in Genes Implicated in Glutamatergic Neurotransmission Pathway Segregate with Schizophrenia in Pakistani Families

Schizophrenia is a disabling neuropsychiatric disorder of adulthood onset with high heritability. Worldwide collaborations have identified an association of ~270 common loci, with small individual effects and hence weak clinical implications. The recent technological feasibility of exome sequencing enables the identification of rare variants of high penetrance that refine previous findings and improve risk assessment and prognosis. We recruited two multiplex Pakistani families, having 11 patients and 19 unaffected individuals in three generations. We performed genome-wide SNP genotyping, next-generation mate pairing and whole-exome sequencing of selected members to unveil genetic components. Candidate variants were screened in unrelated cohorts of 508 cases, 300 controls and fifteen families (with 51 affected and 47 unaffected individuals) of Pakistani origin. The structural impact of substituted residues was assessed through in silico modeling using iTASSER. In one family, we identified a rare novel microduplication (5q14.1_q14.2) encompassing critical genes involved in glutamate signaling, such as CMYA5, HOMER and RasGRF2. The second family segregates two ultra-rare, predicted pathogenic variants in the GRIN2A (NM_001134407.3: c.3505C>T, (p.R1169W) and in the NRG3 NM_001010848.4: c.1951G>A, (p.E651K). These genes encode for parts of AMPA and NMDA receptors of glutamatergic neurotransmission, respectively, and the variants are predicted to compromise protein function by destabilizing their structures. The variants were absent in the aforementioned cohorts. Our findings suggest that rare, highly penetrant variants of genes involved in glutamatergic neurotransmission are contributing to the etiology of schizophrenia in these families. It also highlights that genetic investigations of multiplex, multigenerational families could be a powerful approach to identify rare genetic variants involved in complex disorders.

Biallelic variants in PCDHGC4 cause a novel neurodevelopmental syndrome with progressive microcephaly, seizures, and joint anomalies

PURPOSE

We aimed to define a novel autosomal recessive neurodevelopmental disorder, characterize its clinical features, and identify the underlying genetic cause for this condition.

METHODS

We performed a detailed clinical characterization of 19 individuals from nine unrelated, consanguineous families with a neurodevelopmental disorder. We used genome/exome sequencing approaches, linkage and cosegregation analyses to identify disease-causing variants, and we performed three-dimensional molecular in silico analysis to predict causality of variants where applicable.

RESULTS

In all affected individuals who presented with a neurodevelopmental syndrome with progressive microcephaly, seizures, and intellectual disability we identified biallelic disease-causing variants in Protocadherin-gamma-C4 (PCDHGC4). Five variants were predicted to induce premature protein truncation leading to a loss of PCDHGC4 function. The three detected missense variants were located in extracellular cadherin (EC) domains EC5 and EC6 of PCDHGC4, and in silico analysis of the affected residues showed that two of these substitutions were predicted to influence the Ca2+-binding affinity, which is essential for multimerization of the protein, whereas the third missense variant directly influenced the cis-dimerization interface of PCDHGC4.

CONCLUSION

We show that biallelic variants in PCDHGC4 are causing a novel autosomal recessive neurodevelopmental disorder and link PCDHGC4 as a member of the clustered PCDH family to a Mendelian disorder in humans.

Correlation of Hepatic Steatosis Among Cohabitants Using Hounsfield Unit From Coronary Computed Tomography

Background

Individuals living in the same household are exposed to common risk factors. We hypothesized that living with someone who has fatty liver disease increases the risk of having the same disease.

Methods

This was a retrospective study that included pairs of men and women who shared the same residential addresses, underwent screening non-contrast computed tomography for coronary calcium scoring and had Hounsfield Unit density for liver and spleen in the field of view available for measurement. The primary goal was to determine the association between hepatic steatosis and living in the same household. Secondary end-points compared to body mass index, triglyceride levels, type 2 diabetes mellitus (T2DM) and hypertension.

Results

Out of 1,362 cohabitant pairs, there were 202 couples with either the male or female having hepatic steatosis and 10 cohabitant pairs with both the male and female having hepatic steatosis. In 1,150 cohabitant pairs out of 1,362, neither man nor woman had hepatic steatosis. Pearson correlation coefficient (r) for hepatic steatosis between cohabitant pairs was 0.122 (p-value: < 0.001), suggesting that no correlation was found. Elevated triglyceride levels were prevalent among cohabitant pairs with hepatic steatosis, when compared to pairs without hepatic steatosis (p-value < 0.05). Female gender and having a diagnosis of hepatic steatosis also showed a strong association with higher body mass index, T2DM and hypertension (p-value < 0.05).

Conclusion

Despite the assumption of exposure to similar environmental factors, our results did not show any correlation of hepatic steatosis among the cohabitants.

Cladophialophora Bantiana as a Cause of Rare Fungal Brain Abscess

Cerebral phaeohyphomycosis refers to central nervous system infection caused by dematiaceous molds, which have many genuses. Cladophialophora bantiana is a member of the phylum ascomycota, which is found in soil samples from all over the world. This organism typically infects immunocompromised patients and associated with 70% mortality rate even after weeks of antifungal agent administration and surgical debridement. Two such cases of fungal brain abscess caused by cladophialophora bantiana were presented here. Both patients presented with complaints of headache, vomiting, drowsiness and impaired cognition. A brain biopsy together with microbiological culture and VITEK 2 helped in reaching to a final diagnosis. Key Words: Cladophialophora bantiana, Dematiaceous, Intracerebral, Phaeohyphomycosis.

Comorbid mental health issues in patients with pemphigus vulgaris and pemphigus foliaceus

The term 'pemphigus' refers to chronic autoimmune skin disorders that cause blistering erosions on the skin and oral mucosa. The two major clinical forms are pemphigus vulgaris and pemphigus foliaceus. Although rare, they confer a stark symptomatic burden upon patients that significantly impacts daily life. Comorbid mental health issues are not routinely screened for in patients with pemphigus, and current UK guidance provides no formal provision for the identification and treatment of psychological issues. This review is the first of its kind, to our knowledge, to systematically examine the available evidence on mental health issues in pemphigus. Published work suggests that the incidence of anxiety and depression is much higher in patients with pemphigus compared with both the general population and with patients having other chronic skin disorders. Disease severity appears to be closely linked to mental health, with worsening of pemphigus associated with deteriorations in psychological wellbeing. Corticosteroids, which are associated with depression in chronic use, are the current first-line therapy for pemphigus and have been identified as a potential confounder and independent risk factor for mental health comorbidity in pemphigus. Current evidence is unclear whether a bidirectional relationship exists between mental health and pemphigus severity, and more thorough research is required to develop understanding of this issue. In conclusion, we have identified a high incidence of mental health comorbidity in pemphigus, and recommend routine screening of patients with pemphigus for mental health issues and signposting toward mental health services as an initial measure to address this.

Immunotherapy and Systemic Therapy in Metastatic/Recurrent Endometrial and Cervical Cancers

Despite advances in the treatment of gynaecological malignancies, both recurrent endometrial and cervical cancers when not amenable to localised therapy (surgery or radiotherapy), remain incurable with limited prognosis and effective treatment options. Chemotherapy remains the standard of care for women with metastatic endometrial or cervical cancers. The addition of bevacizumab to first-line chemotherapy for metastatic cervical cancer patients represents a significant step forward in improving survival. More recently, immunotherapeutic strategies targeting the PD-1/-L1 pathway have shown clinical activity in both endometrial and cervical cancers. The increased understanding of the molecular biology of these cancers is shaping target-specific treatments. Here we summarise current treatment options and results from clinical trials of immunotherapy and other targeted therapies that have already changed, or have the potential to change, clinical practice in metastatic/recurrent endometrial and cervical cancer.

Development, Characterization, and Evaluation of SLN-Loaded Thermoresponsive Hydrogel System of Topotecan as Biological Macromolecule for Colorectal Delivery

BACKGROUND

Chemotherapeutic drugs cause severe toxicities if administered unprotected, without proper targeting, and controlled release. In this study, we developed topotecan- (TPT-) loaded solid lipid nanoparticles (SLNs) for their chemotherapeutic effect against colorectal cancer. The TPT-SLNs were further incorporated into a thermoresponsive hydrogel system (TRHS) (TPT-SLNs-TRHS) to ensure control release and reduce toxicity of the drug. Microemulsion technique and cold method were, respectively, used to develop TPT-SLNs and TPT-SLNs-TRHS. Particle size, polydispersive index (PDI), and incorporation efficiency (IE) of the TPT-SLNs were determined. Similarly, gelation time, gel strength, and bioadhesive force studies of the TPT-SLNs-TRHS were performed. Additionally, in vitro release and pharmacokinetic and antitumour evaluations of the formulation were done.

RESULTS

TPT-SLNs have uniformly distributed particles with mean size in nanorange (174 nm) and IE of ~90%. TPT-SLNs-TRHS demonstrated suitable gelation properties upon administration into the rat's rectum. Moreover, drug release was exhibited in a control manner over an extended period of time for the incorporated TPT. Pharmacokinetic studies showed enhanced bioavailability of the TPT with improved plasma concentration and AUC. Further, it showed significantly enhanced antitumour effect in tumour-bearing mice as compared to the test formulations.

CONCLUSION

It can be concluded that SLNs incorporated in TRHS could be a potential source of the antitumour drug delivery with better control of the drug release and no toxicity.

Modifier Genes in Microcephaly: A Report on WDR62, CEP63, RAD50 and PCNT Variants Exacerbating Disease Caused by Biallelic Mutations of ASPM and CENPJ

Congenital microcephaly is the clinical presentation of significantly reduced head circumference at birth. It manifests as both non-syndromic-microcephaly primary hereditary (MCPH)-and syndromic forms and shows considerable inter- and intrafamilial variability. It has been hypothesized that additional genetic variants may be responsible for this variability, but data are sparse. We have conducted deep phenotyping and genotyping of five Pakistani multiplex families with either MCPH (n = 3) or Seckel syndrome (n = 2). In addition to homozygous causal variants in ASPM or CENPJ, we discovered additional heterozygous modifier variants in WDR62, CEP63, RAD50 and PCNT-genes already known to be associated with neurological disorders. MCPH patients carrying an additional heterozygous modifier variant showed more severe phenotypic features. Likewise, the phenotype of Seckel syndrome caused by a novel CENPJ variant was aggravated to microcephalic osteodysplastic primordial dwarfism type II (MOPDII) in conjunction with an additional PCNT variant. We show that the CENPJ missense variant impairs splicing and decreases protein expression. We also observed centrosome amplification errors in patient cells, which were twofold higher in MOPDII as compared to Seckel cells. Taken together, these observations advocate for consideration of additional variants in related genes for their role in modifying the expressivity of the phenotype and need to be considered in genetic counseling and risk assessment.