Current perspective in research and industrial applications of microbial cellulases

The natural interactions between various bacteria, fungi, and other cellulolytic microorganisms destroy lignocellulosic polymers. The efficacy of this process is determined by the combined action of three main enzymes: endoglucanases, exo-glucanases, and β-glucosidase. The enzyme attacks the polymeric structure's β-1,4-linkages during the cellulose breakdown reaction. This mechanism is crucial for the environment as it recycles cellulose in the biosphere. However, there are problems with enzymatic cellulose breakdown, including complex cellulase structure, insufficient degradation efficacy, high production costs, and post-translational alterations, many of which are closely related to certain unidentified cellulase properties. These issues impede the practical use of cellulases. A developing area of research is the application of this similar paradigm for industrial objectives. Cellulase enzyme exhibits greater promise in many critical industries, including biofuel manufacture, textile smoothing and finishing, paper and pulp manufacturing, and farming. However, the study on cellulolytic enzymes must move forward in various directions, including increasing the activity of cellulase as well as designing peptides to give biocatalysts their desired attributes. This manuscript includes an overview of current research on different sources of cellulases, their production, and biochemical characterization.

Oxidative treatment of micropollutants present in wastewater: A special emphasis on transformation products, their toxicity, detection, and field-scale investigations

Micropollutants have become ubiquitous in aqueous environments due to the increased use of pharmaceuticals, personal care products, pesticides, and other compounds. In this review, the removal of micropollutants from aqueous matrices using various advanced oxidation processes (AOPs), such as photocatalysis, electrocatalysis, sulfate radical-based AOPs, ozonation, and Fenton-based processes has been comprehensively discussed. Most of the compounds were successfully degraded with an efficiency of more than 90%, resulting in the formation of transformation products (TPs). In this respect, degradation pathways with multiple mechanisms, including decarboxylation, hydroxylation, and halogenation, have been illustrated. Various techniques for the analysis of micropollutants and their TPs have been discussed. Additionally, the ecotoxicity posed by these TPs was determined using the toxicity estimation software tool (T.E.S.T.). Finally, the performance and cost-effectiveness of the AOPs at the pilot scale have been reviewed. The current review will help in understanding the treatment efficacy of different AOPs, degradation pathways, and ecotoxicity of TPs so formed.

Differential impact of COVID-19 on mental health and burnout

BACKGROUND

There may be differential impact of the COVID-19 pandemic on mental health and burnout rates of healthcare professionals (HCPs) performing different roles.

AIMS

To examine mental health and burnout rates, and possible drivers for any disparities between professional roles.

METHODS

In this cohort study, online surveys were distributed to HCPs in July-September 2020 (baseline) and re-sent 4 months later (follow-up; December 2020) assessing for probable major depressive disorder (MDD), generalized anxiety disorder (GAD), insomnia, mental well-being and burnout (emotional exhaustion and depersonalization). Separate logistic regression models (at both phases) compared the risk of outcomes between roles: healthcare assistants (HCAs), nurses and midwives (nurses), allied health professionals (AHPs) and doctors (reference group). Separate linear regression models were also developed relating the change in scores to professional role.

RESULTS

At baseline (n = 1537), nurses had a 1.9-fold and 2.5-fold increased risk of MDD and insomnia, respectively. AHPs had a 1.7-fold and 1.4-fold increased risk of MDD and emotional exhaustion, respectively. At follow-up (n = 736), the disproportionate risk between doctors and others worsened: nurses and HCAs were at 3.7-fold and 3.6-fold increased risk of insomnia, respectively. Nurses also had a significantly increased risk of MDD, GAD, poor mental well-being and burnout. Nurses also had significantly worsened anxiety, mental well-being and burnout scores over time, relative to doctors.

CONCLUSIONS

Nurses and AHPs had excess risk of adverse mental health and burnout during the pandemic, and this difference worsened over time (in nurses especially). Our findings support adoption of targeted strategies accounting for different HCP roles.

Combination of advanced biological systems and photocatalysis for the treatment of real hospital wastewater spiked with carbamazepine: A pilot-scale study

Over the past few decades, the increase in dependency on healthcare facilities has led to the generation of large quantities of hospital wastewater (HWW) rich in chemical oxygen demand (COD), total suspended solids (TSS), ammonia, recalcitrant pharmaceutically active compounds (PhACs), and other disease-causing microorganisms. Conventional treatment methods often cannot effectively remove the PhACs present in wastewater. Hence, hybrid processes comprising of biological treatment and advanced oxidation processes have been used recently to treat complex wastewater. The current study explores the performance of pilot-scale treatment of real HWW (3000 L/d) spiked with carbamazepine (CBZ) using combinations of moving and stationary bed bio-reactor-sedimentation tank (MBSST), aerated horizontal flow constructed wetland (AHFCW), and photocatalysis. The combination of MBSST and AHFCW could remove 85% COD, 93% TSS, 99% ammonia, and 30% CBZ. However, when the effluent of the AHFCW was subjected to photocatalysis, an enhanced CBZ removal of around 85% was observed. Furthermore, the intermediate products (IPs) formed after the photocatalysis was also less toxic than the IPs formed during the biological processes. The results of this study indicated that the developed pilot-scale treatment unit supplemented with photocatalysis could be used effectively to treat HWW.

Insights into the performance of binary heterojunction photocatalysts for degradation of refractory pollutants

The uncontrolled discharge of industry- and consumer-derived micropollutants and synthetic contaminants into freshwater bodies represents a severe threat to human health and aquatic ecosystem. Inexpensive and highly efficient wastewater treatment methods are, therefore, urgently required to eliminate such non-biodegradable, recalcitrant, and toxic organic pollutants. In this context, advanced oxidation processes, particularly heterogenous photocatalysis, have received enormous attention over the past few decades. Among the different classes of photocatalysts explored by the scientific community, heterojunction photocatalysts, in general, and binary heterojunction photocatalysts, in particular, have shown tremendous promise, attributed to their many distinct advantages. As such, the present review highlights the application of diverse array of binary heterojunction photocatalysts for eliminating water-borne contaminants. Specifically, a bibliometric analysis has been conducted to identify the ongoing research trend and future prospects of heterojunction photocatalysts. It appears that metal oxide/metal oxide-based heterojunctions have superior thermal and mechanical stability compared to other heterojunction photocatalysts. In contrast, metal oxide/non-metal semiconductor-based heterojunctions are extremely effective in pollutant degradation without significant leaching of metal ions. The review concludes by proposing novel strategic research guidelines in order to make further advances in this rapidly evolving cross-disciplinary field of topical interest.

Sulfamethoxazole removal from wastewater via anoxic/oxic moving bed biofilm reactor: Degradation pathways and toxicity assessment

The effects of sulfamethoxazole (SMZ), an antibiotic commonly detected in the water environment, on the performance of a single staged anoxic/oxic moving bed biofilm reactor (A/O MBBR), was investigated. The anoxic zone played a key role in the removal of SMZ with a percentage of contribution accounting for around 85% in the overall removal. Denitrifying heterotrophic microbes present in the anoxic zone showed relatively more resistance to higher SMZ loads. It was found that in extracellular polymeric substances, protein content was increased consistently with the increase in SMZ concentration. Based on the detected biotransformation products, four degradation pathways were proposed and the toxicity was evaluated. Metagenomic analysis revealed that at higher SMZ load the activity of genera, such as Proteobacteria and Actinobacteria was significantly affected. In summary, proper design and operation of staged A/O MBBR can offer a resilient and robust treatment towards SMZ removal from wastewater.

Visible Light-Assisted Degradation of Sulfamethoxazole on 2D/0D Sulfur-Doped Bi2O3/MnO2 Z-Scheme Heterojunction Immobilized Photocatalysts

Retrieving the spent photocatalysts from the reaction system is always a challenging task. Therefore, the present work is focused on immobilizing sulfur-doped-Bi2O3/MnO2 (S-BOMO) heterojunction photocatalysts over different support matrices and evaluating their performance for the removal of sulfamethoxazole (SMX) in water under visible light. Our findings revealed S-BOMO coated clay beads (S-BOMO CCB) achieving more than 86% (240 min) SMX degradation ∼3, ∼1.3, and ∼2 times higher compared to S-BOMO coated on the different substrates, including glass beads, floating stones, and polymer material substrates, respectively. Mott-Schottky measurements confirmed the construction of the Z-scheme heterojunction involving MnO2 and 2S-Bi2O3. This Z-scheme mechanism, along with its narrow band gap of 1.58 eV, resulted in a rapid spatial transfer of the photogenerated charge carriers between the semiconductors and is believed to enhance the overall photocatalytic activity of the nanocomposite. Radical trapping and electron paramagnetic resonance results clearly established the active role of hydroxyl radicals and hydrogen peroxide in the degradation of SMX. Further, the 2S-BOMO CCB demonstrated excellent stability and photocatalytic activity over multiple runs. According to the sensitivity analysis and the results of anion effect experiments, phosphate and sulfate ions exhibit a significant impact on sulfamethoxazole degradation. Toxicity analysis revealed that 2S-BOMO CCB and sulfamethoxazole degradation byproducts were apparently innocuous. Additionally, the practical applicability of 2S-BOMO CCB was examined in various real water matrices, with the degradation efficiency followed the order: tap water < groundwater < surface water < hospital wastewater < municipal wastewater < pharmaceutical industry wastewater. The economic assessment revealed the reduction in the overall cost of the immobilized 2S-BOMO following the recovery process. Overall, the findings of this work provided critical insights into the synthesis and performance of incredibly effective and stable immobilized photocatalysts for the degradation of pharmaceutical pollutants.

Synergistic mechanisms for the superior sorptive removal of aquatic pollutants via functionalized biochar-clay composite

This study investigated the successful synthesis of functionalized algal biochar-clay composite (FBKC). Subsequently, the sorption performance of FBKC towards norfloxacin (NFX) antibiotic and crystal violet dye (CVD) from water was extensively assessed in both batch and continuous flow systems. A series of characterization techniques were carried out for FBKC and the utilized precursors, indicating that the surface area of FBKC was increased thirty-fold with a well-developed pore structure compared to the original precursors. FBKC demonstrated a maximum sorption capacity of 192.80 and 281.24 mg/g for NFX and CVD, respectively. The suited fitting of the experimental data to Freundlich and Clark models suggested multi-layer sorption of NFX/CVD molecules. The mechanistic studies of NFX/CVD sorption onto FBKC unveiled multiple mechanisms, including π-π interaction, hydrogen bonding, electrostatic attraction, and surface/pore filling effect. The estimated cost of 5.72 €/kg and superior sorption capacity makes FBKC an efficient low-cost sorbent for emergent water pollutants.

Life cycle assessment of municipal solid waste generated from hilly cities in India - A case study

Improper disposal of waste poses a grave environmental threat, contributing to pollution of air, water, and soil. It is necessary to address this issue in order to mitigate the adverse effects of solid waste on both the environment and public health. In many developing nations, municipal authorities of bigger cities are enduring significant challenges in proper management of waste. The present study evaluates the impacts of various waste management alternative scenarios for environmental impacts for the selected study locations using Life Cycle Assessment (LCA) methodology. The methodology comprised of five different scenarios of waste management including an existing baseline scenario. In this context, the environmental impact categories analyzed were Global Warming potential (GWP), Acidification potential (AP), Eutrophication potential (EP) and Human Toxicity potential (HTP). The results indicated that amongst all the proposed scenarios, Scenario 1 and 4 exhibited the maximum and minimum environmental impacts respectively. The study revealed that least greenhouse gas emissions, acidification potential, eutrophication potential and human toxicity potential were comparatively lesser for scenario 4 varying from 5.65 to 11.36 kg CO2eq t-1; 1.24-3.345 kg SO2eq t-1, EP 0.19-0.68 kg PO4eq t-1, and 0.35-4.22 kg 1,4-DBeq t-1 respectively. Further, a sensitivity analysis was also performed to evaluate the influence of recycling rate of valuable resources in all the considered scenarios. The sensitivity analysis indicated an inversely proportional relation between change in recycling rate and total environmental burdens.

The spatio-temporal dynamics of suspended sediment sources based on a novel indexing approach combining Bayesian geochemical fingerprinting with physically-based modelling

Applications of sediment source fingerprinting continue to increase globally as the need for information to support improved management of the sediment problem persists. In our novel research, a Bayesian fingerprinting approach using MixSIAR was used with geochemical signatures, both without and with informative priors based on particle size and slope. The source estimates were compared with a newly proposed Source Sensitivity Index (SSI) and outputs from the INVEST-SDR model. MixSIAR results with informative priors indicated that agricultural and barren lands are the principal sediment sources (contributing ∼5-85% and ∼5-80% respectively during two sampling periods i.e. 2018-2019 and 2021-2022) with forests being less important. The SSI spatial maps (using % clay and slope as informative priors) showed >78% agreement with the spatial map derived using the INVEST-SDR model in terms of sub-catchment prioritization for spatial sediment source contributions. This study demonstrates the benefits of combining geochemical sediment source fingerprinting with SSI indices in larger catchments where the spatial prioritization of soil and water conservation is both challenging but warranted.

Development of microbial fuel cell integrated constructed wetland (CMFC) for removal of paracetamol and diclofenac in hospital wastewater

Hospital wastewater management has become a significant concern across the globe due to the presence of pharmaceutically active compounds (PhACs) and other toxic substances, which can potentially disrupt ecosystems. The presence of recalcitrant PhACs in hospital wastewater increases the difficulty level for conventional wastewater treatment systems. Furthermore, incorporating advanced oxidation-based treatment systems increase capital and operation costs. To reduce treatment costs, low-cost innovative technology, i.e., composite constructed wetland and microbial fuel cell system (CMFC), has been developed for higher treatment efficiency of PhACs in hospital wastewater along with simultaneous bioelectricity generation as an additional outcome. In this study, influencing operating parameters, such as initial chemical oxygen demand (COD), electrode spacing, and substrate-to-water-depth ratio, were optimized for two plant species: water hyacinth (WH) and duckweed (DW). The optimized systems were run in batch and continuous mode for WH-CMFC and DW-CMFC to treat synthetic hospital wastewater with paracetamol and diclofenac, and the bioelectricity generation was monitored. DW-CMFC system depicted better treatment efficiency and voltage generation as compared to WH-CMFC. In continuous mode, the DW-CMFC system exhibited a removal of 95.3% COD, 97.1% paracetamol, and 87.5% diclofenac. WH-CMFC and DW-CMFC achieved power densities of around 21.26 mW/m2 and 42.93 mW/m2, respectively. The fate of PhACs during and after treatment and toxicity analysis of the transformation products formed were also carried out. Higher bio-electricity generation and efficient wastewater treatment of the DW-CMFC make it a sustainable option for hospital wastewater management.

Sustainable functionalized smectitic clay-based nano hydrated zirconium oxides for enhanced levofloxacin sorption from aqueous medium

In this study, the functionalized smectitic clay (SC)-based nanoscale hydrated zirconium oxide (ZrO-SC) was successfully synthesized and utilized for the adsorptive removal of levofloxacin (LVN) from an aqueous medium. The synthesized ZrO-SC and its precursors (SC and hydrated zirconium oxide (ZrO(OH)₂)) were extensively characterized using various analytical methods to get insight into their physicochemical properties. The results of stability investigation confirmed that ZrO-SC composite is chemically stable in strongly acidic medium. The surface measurements revealed that ZrO impregnation to SC resulted in an increased surface area (six-fold higher than SC). The maximum sorption capacity of ZrO-SC for LVN was 356.98 and 68.87 mg g^-1 during batch and continuous flow mode studies, respectively. The mechanistic studies of LVN sorption onto ZrO-SC revealed that various sorption mechanisms, such as interlayer complexation, π-π interaction, electrostatic interaction, and surface complexation were involved. The kinetic studies of ZrO-SC in the continuous-flow mode indicated the better applicability of Thomas model. However, the good fitting of Clark model suggested the multi-layer sorption of LVN. The cost estimation of the studied sorbents was also assessed. The obtained results indicate that ZrO-SC is capable of removing LVN and other emergent pollutants from water at a reasonable cost.

A critical assessment of SARS-CoV-2 in aqueous environment: Existence, detection, survival, wastewater-based surveillance, inactivation methods, and effective management of COVID-19

In early January 2020, the causal agent of unspecified pneumonia cases detected in China and elsewhere was identified as a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was the major cause of the COVID-19 outbreak. Later, the World Health Organization (WHO) proclaimed the COVID-19 pandemic a worldwide public health emergency on January 30, 2020. Since then, many studies have been published on this topic. In the present study, bibliometric analysis has been performed to analyze the research hotspots of the coronavirus. Coronavirus transmission, detection methods, potential risks of infection, and effective management practices have been discussed in the present review. Identification and quantification of SARS-CoV-2 viral loads in various water matrices have been reviewed. It was observed that the viral shedding through urine and feces of COVID-19-infected patients might be a primary mode of SARS-CoV-2 transmission in water and wastewater. In this context, the present review highlights wastewater-based epidemiology (WBE)/sewage surveillance, which can be utilized as an effective tool for tracking the transmission of COVID-19. This review also emphasizes the role of different disinfection techniques, such as chlorination, ultraviolet irradiation, and ozonation, for the inactivation of coronavirus. In addition, the application of computational modeling methods has been discussed for the effective management of COVID-19.

Real-world healthcare costs and resource utilization in patients with von Willebrand disease and angiodysplasia

OBJECTIVE

To describe the economic burden among VWD patients with angiodysplasia compared to VWD patients without angiodysplasia and the general population.

METHODS

This was a retrospective analysis using the Merative MarketScan Commercial and Medicare Databases® (January 2011-September 2020). Selected patients had ≥1 medical claim for VWD or low VWF, ≥1 medical claim for AGD, and ≥3 GI-related bleeding episodes within a year. HCRU and all-cause costs were compared with the VWD (only) and the general cohorts.

RESULTS

The mean total all-cause costs were $150,101 among patients with VWD and angiodysplasia (n = 34), higher compared to $48,249 among matched VWD patients without angiodysplasia (n = 136) and $31,029 among matched individuals of the general population [n = 136; p-value < 0.0001]. The differences in costs between groups were primarily due to inpatient care. During the 12-month follow-up, VWD patients with symptomatic (n = 35), asymptomatic (n = 81), and suspected (n = 378) angiodysplasia had an average of 4.1, 0.6, and 3.8 gastrointestinal (GI) bleeds, respectively. Desmopressin, VWF concentrates, and aminocaproic acid were the most frequent treatments used. The most frequent procedures to treat GI-related bleeding and underlying lesions were blood transfusion and laser therapy.

CONCLUSIONS

Despite recent therapeutic advances, there is room for considerable reduction of the disease burden in patients with VWD and angiodysplasia.

Current trends in management of bacterial pathogens infecting plants

Plants are continuously challenged by different pathogenic microbes that reduce the quality and quantity of produce and therefore pose a serious threat to food security. Among them bacterial pathogens are known to cause disease outbreaks with devastating economic losses in temperate, tropical and subtropical regions throughout the world. Bacteria are structurally simple prokaryotic microorganisms and are diverse from a metabolic standpoint. Bacterial infection process mainly involves successful attachment or penetration by using extracellular enzymes, type secretion systems, toxins, growth regulators and by exploiting different molecules that modulate plant defence resulting in successful colonization. Theses bacterial pathogens are extremely difficult to control as they develop resistance to antibiotics. Therefore, attempts are made to search for innovative methods of disease management by the targeting bacterial virulence and manipulating the genes in host plants by exploiting genome editing methods. Here, we review the recent developments in bacterial disease management including the bioactive antimicrobial compounds, bacteriophage therapy, quorum-quenching mediated control, nanoparticles and CRISPR/Cas based genome editing techniques for bacterial disease management. Future research should focus on implementation of smart delivery systems and consumer acceptance of these innovative methods for sustainable disease management.

Elucidating the performance of integrated anoxic/oxic moving bed biofilm reactor: Assessment of organics and nutrients removal and optimization using feed forward back propagation neural network

A lab-scale integrated anoxic and oxic (A/O) moving bed biofilm reactor (MBBR) was investigated for the removal of organics and nutrients by varying chemical oxygen demand (COD) to NH₄-N ratio (C/N ratio: 3.5, 6.75, and 10), hydraulic retention time (HRT: 6 h, 15 h, and 24 h), and recirculation ratio (R: 1, 2, and 3). The use of activated carbon coated carriers prepared from waste polyethylene material and polyurethane sponges attached to a cylindrical frame in the integrated A/O MBBR increased the attached growth biomass significantly. >95 % of COD removal was observed under the C/N ratio of 10 at an HRT of 24 h. While the low C/N ratio favored the removal of NH₄-N (∼98 %) and PO₄^3--P (∼90 %) with an optimal R of 1.75. Using the experimental dataset, to predict and forecast the performance of integrated A/O MBBR, a feed-forward-backpropagation-neural-network model was developed.

Application of a new baffled horizontal flow constructed wetland-filter unit (BHFCW-FU) for treatment and reuse of petrochemical industry wastewater

The shortage of water resources and generation of large quantum of wastewater has posed a significant concern to the environment and public health. Recent research on wastewater treatment has started to focus on reusing wastewater for different activities to reduce the stress on natural water resources. Constructed wetland (CWs) is a low-cost wastewater treatment option. However, some drawbacks include large areal requirements and the need for tertiary treatment units for reusable effluent. In this study, a novel composite baffled horizontal flow CW filter unit (BHFCW-FU) was developed to overcome the drawbacks of the conventional CW. The BHFCW-FU planted with Chrysopogon zizanioides provided a nine times longer flow path, and the adjoined variable depth dual media filter reduced the total area requirement and served as a polishing unit. On average, the BHFCW-FU with horizontal sub-surface flow regime could efficiently remove around 93.93%, 87.20%, and 66.25% of turbidity, phenol, and COD, respectively, from real petrochemical wastewater (initial turbidity: 29.6 NTU, phenol: 4.52 mg/L, and COD: 381 mg/L) and rendered the effluent quality reusable for irrigation, industrial, and other environmental purposes. In synthetic wastewater (initial turbidity: 754 NTU, phenol: 10.87 mg/L, and COD: 1691 mg/L), the removal efficiency of turbidity, phenol, and COD were 99.50%, 93.73%, and 87.05%, respectively. In-depth substrate characterization was done to study the removal mechanism. The developed BHFCW-FU required less space and maintenance, provided reusable effluent, and overcame the drawbacks of conventional CWs. Hence, it may show immense potential as an effective wastewater treatment.

The Impacts and Changes Related to the Cancer Drug Resistance Mechanism

BACKGROUND

Cancer drug resistance remains a difficult barrier to effective treatment, necessitating a thorough understanding of its multi-layered mechanism.

OBJECTIVE

This study aims to comprehensively explore the diverse mechanisms of cancer drug resistance, assess the evolution of resistance detection methods, and identify strategies for overcoming this challenge. The evolution of resistance detection methods and identification strategies for overcoming the challenge.

METHODS

A comprehensive literature review was conducted to analyze intrinsic and acquired drug resistance mechanisms, including altered drug efflux, reduced uptake, inactivation, target mutations, signaling pathway changes, apoptotic defects, and cellular plasticity. The evolution of mutation detection techniques, encompassing clinical predictions, experimental approaches, and computational methods, was investigated. Strategies to enhance drug efficacy, modify pharmacokinetics, optimizoptimizee binding modes, and explore alternate protein folding states were examined.

RESULTS

The study comprehensively overviews the intricate mechanisms contributing to cancer drug resistance. It outlines the progression of mutation detection methods and underscores the importance of interdisciplinary approaches. Strategies to overcome drug resistance challenges, such as modulating ATP-binding cassette transporters and developing multidrug resistance inhibitors, are discussed. The study underscores the critical need for continued research to enhance cancer treatment efficacy.

CONCLUSION

This study provides valuable insights into the complexity of cancer drug resistance mechanisms, highlights evolving detection methods, and offers potential strategies to enhance treatment outcomes.

Robust sensor placement for sustainable leakage management in water distribution networks of developing economies: A hybrid decision support framework

Urban water distribution networks (WDNs) in developing economies often refrain from investing in sensor-based leakage management technologies due to financial constraints and other techno-managerial issues. Thus, this study proposes a generalized decision support framework based on network sensitivity analysis (NSA) and multi-criteria decision-making (MCDM) to assess the prospect of effective leakage control through robust sensor placement in existing deficient WDNs. Four sensitivity parameters are formulated for NSA to ascertain the pressure response of the potential sensor positions for diverse hydraulic and leak scenarios. Subsequently, selecting the optimal number of sensors and their relative positions within the WDN is framed as an MCDM problem that entails the simultaneous maximization of Euclidean distances among the potential sensor positions and the leak-induced pressure residuals obtained at these sensors. The proposed methodology is developed on a numerical benchmark network assuming ideal conditions, and its applicability is verified on a sensor-equipped experimental network considering realistic system uncertainties. The outcome of this study aims to provide an insightful understanding of the system behavior that governs its leak localization potential and ascertain the practical challenges of sensor-based leakage monitoring in existing WDNs. Decision-makers of resource-strained utilities can beneficially utilize the proposed framework to assess the environmental and cost trade-offs of employing sensor-based technologies for leakage management and proactive decision-making before its actual implementation.

Knowledge, Attitude, and Practices among HIV/Leishmaniasis Co-Infected Patients in Bihar, India

Visceral leishmaniasis (VL) is a serious public health concern in the Indian state of Bihar, which has been exacerbated by an increasing HIV/AIDS incidence that has resulted in poor clinical outcomes. So far, there has been no investigation into the knowledge, attitude, and practices (KAP) of people who have been subjected to hospital-based supervision for VL or HIV/VL co-infection. This study assessed the KAP toward VL infection among 210 VL-infected patients (126 participants with VL and 84 participants with HIV/VL) using a pretested standard questionnaire. The findings are summarized descriptively and KAP scores are classified dichotomously (good/poor). Multivariable logistic regression and bivariate correlation were used in the analysis. The study showed that both VL-infected and co-infected patients exhibited similar deficits in KAP scores toward VL. The HIV/VL participants who had a personal or family history of VL were more likely to have appropriate awareness of and preventive practices toward VL. The independent predictors of attitude index in HIV/VL participants were education, VL family history, and marital status. There was a weak but significant positive correlation between knowledge and practice (rs = 0.321, p<0.001), and attitude and practice (rs = 0.294, p<0.001), while knowledge was strongly correlated with attitude (rs = 0.634, p<0.001). Based on the study findings, it is recommended that treatment programs in Bihar should concentrate on strengthening KAP among VL and HIV/VL co-infected patients to prevent reinfection-related complications. Behavior change communication intervention is ideal for tackling this problem. This proposal entails building a comprehensive public health program in endemic regions.

Advancements of sequencing batch reactor for industrial wastewater treatment: Major focus on modifications, critical operational parameters, and future perspectives

Industrial wastewater discharge has increased manifolds over the last few decades. Efficient industrial wastewater treatment is mandatory to meet stringent discharge regulations. Biological treatment systems, such as the sequencing batch reactor (SBR) are generally employed for domestic wastewater treatment. However, low infrastructure and energy requirements, as well as low footprint, make SBR a prominent technique to treat industrial wastewater. In the present review, the feasibility of SBR to treat wastewater generated from industries, such as textile, pulp and paper, pharmaceutical, tannery, etc., has been discussed. The factors affecting the treatment efficacy of the SBR in terms of organics and nutrient removal have also been investigated. It has been observed that the SBR system is effective for industrial wastewater treatment as it is easy to operate, resistant to shock loads, and can retain high biomass concentrations. The modifications to the conventional SBR, such as sludge granulation, the addition of bio-film carriers, and the incorporation of adsorbents, salt-tolerant microbes, and coagulants have been discussed. Further, various novel combinations of SBR with the other advanced treatment technologies, such as Fenton, membrane-based process, and electrochemical process have shown enhanced removal of various conventional and recalcitrant pollutants. The current review also accentuates the sustainability aspects of SBR technology to treat industrial wastewater which may be beneficial for researchers and engineers working in this field.

Comparison of oral minoxidil, finasteride, and dutasteride for treating androgenetic alopecia

Background Androgenetic alopecia (AGA) is the most common cause of hair loss, often challenging to treat. While oral finasteride (1 mg/day) is an FDA-approved treatment for male AGA, oral minoxidil and oral dutasteride are not approved yet. However, clinicians have been increasingly using these two drugs off-label for hair loss. Recently, Japan and South Korea have approved oral dutasteride (0.5 mg/day) for male AGA.Efficacy and safety A probable efficacy ranking, in decreasing order, is- dutasteride 0.5 mg/day, finasteride 5 mg/day, minoxidil 5 mg/day, finasteride 1 mg/day, followed by minoxidil 0.25 mg/day. Oral minoxidil predominantly causes hypertrichosis and cardiovascular system (CVS) symptoms/signs in a dose-dependent manner, whereas oral finasteride and dutasteride are associated with sexual dysfunction and neuropsychiatric side effects.Pharmacokinetics and pharmacodynamics The average plasma half-lives of minoxidil, finasteride, and dutasteride are ∼4 hours, ∼4.5 hours, and ∼5 weeks, respectively. Minoxidil acts through multiple pathways to promote hair growth. It has been shown as a vasodilator, an anti-inflammatory agent, a Wnt/β-catenin signaling inducer, and an antiandrogen. Finasteride inhibits 5 α-reductase (5AR) type II isoenzyme, while dutasteride inhibits both type I and type II. Thus, dutasteride suppresses DHT levels more than finasteride in the serum and scalp.

A review on the treatment of septage and faecal sludge management: A special emphasis on constructed wetlands

The global concern of the pollution of freshwater resources is associated with faecal sludge (FS) disposal, which is an inevitable component of onsite wastewater management mostly in developing countries. The difficulties with its treatment facilities lies in its higher organic content and low dewaterability of various available treatment systems. Moreover, the higher variability in characteristics and quantity of FS generated at different locations creates hindrances in designing the treatment system. Among the several treatment options, the constructed wetlands (CW) are an organic/green approach towards sanitation of FS with low cost and higher efficiency. The present study is an in-depth literature review on the quality and quantity of FS and septage (stabilized FS) in different regions attributed to the wide variability of its characteristics. This paper highlights the treatment of FS in different systems with a special emphasis on CW systems. Different mechanisms and factors affecting the FS treatment efficacy in CW, such as DO/aeration, macrophytes, substrate, CW configuration, and other environmental parameters, have been studied meticulously. The cost analysis revealed CW to be an economic system, and it can enable hybridization with other technologies to develop a complete treatment system with pronounced efficiencies. Several process modifications, such as augmentation with aeration, recirculation, micro-organisms, and earthworms, can enhance the treatment efficacies of CWs. The present review exhibited that the widely used plant species is Phragmites, and the optimum solid loading rate (SLR) range is 50-250 kg TS/m²/yr. The various factors to construct an optimized CW system for FS treatment were attempted, which may bolster the necessary guidelines for field-scale applications.

Potential use of microwave technology in dermatology

BACKGROUND

Microwaves are used in medicine for diagnostics, and treatment of cancer. Recently, novel microwave devices (Swift^®, Emblation Ltd, UK and miraDry^®, Miramar Labs Inc., CA) have been cleared by the FDA and Health Canada for various dermatological conditions.

OBJECTIVE AND METHODS

To review the dermatological use of microwave-based treatments (plantar warts, corns, actinic keratosis, dermatophytosis, axillary hyperhidrosis, osmidrosis, and hidradenitis suppurativa). Clinical trials, case reports, or in vitro studies for each condition are summarized.

RESULTS AND CONCLUSION

Microwaves are a promising alternative therapy for cutaneous warts, actinic keratosis, axillary hyperhidrosis, and osmidrosis, with favorable safety profiles. However, patients with hidradenitis suppurativa have had negative clinical outcomes. Limited treatment of corns showed good pain reduction but did not resolve hyperkeratosis. A preliminary in vitro study indicated that microwave treatment inhibits the growth of T. rubrum. We present the first case of toenail onychomycosis successfully treated with microwaves. Despite the advancements in the use of microwaves, the mechanism of action in non-ablative treatment is not well understood; further research is needed. More high-quality randomized clinical trials with larger groups and long follow-up periods are also required to evaluate the clinical benefits and possible adverse effects of microwaves in treating dermatological conditions.

An assessment of hospital wastewater and biomedical waste generation, existing legislations, risk assessment, treatment processes, and scenario during COVID-19

Hospitals release significant quantities of wastewater (HWW) and biomedical waste (BMW), which hosts a wide range of contaminants that can adversely affect the environment if left untreated. The COVID-19 outbreak has further increased hospital waste generation over the past two years. In this context, a thorough literature study was carried out to reveal the negative implications of untreated hospital waste and delineate the proper ways to handle them. Conventional treatment methods can remove only 50%-70% of the emerging contaminants (ECs) present in the HWW. Still, many countries have not implemented suitable treatment methods to treat the HWW in-situ. This review presents an overview of worldwide HWW generation, regulations, and guidelines on HWW management and highlights the various treatment techniques for efficiently removing ECs from HWW. When combined with advanced oxidation processes, biological or physical treatment processes could remove around 90% of ECs. Analgesics were found to be more easily removed than antibiotics, β-blockers, and X-ray contrast media. The different environmental implications of BMW have also been highlighted. Mishandling of BMW can spread infections, deadly diseases, and hazardous waste into the environment. Hence, the different steps associated with collection to final disposal of BMW have been delineated to minimize the associated health risks. The paper circumscribes the multiple aspects of efficient hospital waste management and may be instrumental during the COVID-19 pandemic when the waste generation from all hospitals worldwide has increased significantly.

Enhancement of wastewater treatment performance using 3D printed structures: A major focus on material composition, performance, challenges, and sustainable assessment

In order to enhance the performance and sustainability of wastewater treatment technologies, researchers are showing keen interest in the development of novel materials which can overcome the drawbacks associated with conventional materials. In this context, 3D printing gained significant attention due to its capability of fabricating complex geometrics using different material compositions. The present review focuses on recent advancements of 3D printing applications in various physicochemical and biological wastewater treatment techniques. In physicochemical treatment methods, substantial research has been aimed at fabricating feed spacers and other membrane parts, photocatalytic feed spacers, catalysts, scaffolds, monoliths, and capsules. Several advantages, such as membrane fouling mitigation, enhanced degradation efficiency, and recovery and reusability potential, have been associated with the aforementioned 3D printed materials. While in biofilm-based biological treatment methods, the use of 3D printed bio-carriers has led to enhanced mass transfer efficiency and microbial activities. Moreover, the application of these bio-carriers has shown better removal efficiency of chemical oxygen demand (∼90%), total nitrogen (∼73%), ammonia nitrogen (95%), and total phosphorous (∼100%). Although the removal efficiencies were comparable with conventional carriers, 3D printed carriers led to ∼40% reduction in hydraulic retention time, which could significantly save capital and operational expenditures. This review also emphasizes the challenges and sustainability aspects of 3D printing technology and outlines future recommendations which could be vital for further research in this field.

A phase 3, randomized, open-label, multicenter, global study of the efficacy and safety of durvalumab (D) + tremelimumab (T) + enfortumab vedotin (EV) or D + EV for neoadjuvant treatment in cisplatin-ineligible muscle-invasive bladder cancer (MIBC) (VOLGA)

TPS579

Background: The standard management of MIBC involves neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy and pelvic lymph node dissection. Approximately 40% of patients with MIBC are cisplatin ineligible, the standard of care (SoC) for these patients is to proceed directly to cystectomy as there are no effective or approved neoadjuvant therapies in this setting. Only nivolumab has been approved as adjuvant treatment for patients who are at high risk of recurrence after radical resection. Given this, there remains an unmet need. D (anti–PD-L1 antibody) +T (anti–CTLA-4 antibody) have demonstrated a manageable safety profile with clinical activity in metastatic urothelial carcinoma and in a phase 2 neoadjuvant trial, D+T showed anti-tumor activity, including meaningful pathologic complete responses (pCR), in cisplatin-ineligible MIBC with high-risk features. Targeted cytotoxic antibody drug conjugates (ADCs) are known to have the potential to induce immunogenic tumor cell death, which promotes activation and recruitment of immune cells. EV is a vedotin ADC comprising an antibody against Nectin-4 linked to a microtubule-disrupting agent MMAE that has demonstrated efficacy in, and is approved for, advanced urothelial cancer. Thus, we hypothesize that EV in combination with PD-L1 inhibition, with or without CTLA-4 inhibition, may improve outcomes in patients with MIBC by downstaging of disease before cystectomy and that adjuvant therapy with D or D+T may further improve time to disease relapse. Methods: VOLGA (NCT04960709) is a phase 3, randomized, open-label, multicenter, international trial that will enroll ̃830 patients with MIBC. Eligible patients include those aged ³18 years with histologically or cytologically documented MIBC (transitional and mixed transitional cell histology), who are cisplatin ineligible and with a clinical stage of T2-4aN0-N1M0. Patients will be randomized to 3 arms to receive 3 cycles of neoadjuvant therapy Q3W as follows: (Arm 1) D (1500 mg day 1) +T (75 mg day 1) +EV (1.25 mg/kg Days 1 & 8); (Arm 2) D (1500 mg day 1) +EV (1.25 mg/kg Days 1 & 8); or (Arm 3) no neoadjuvant treatment (SoC). A safety run-in study is included. Following radical cystectomy, patients will then receive: (Arm 1) 1 cycle of T on Day 1 plus 9 cycles of D Q4W; (Arm 2) 9 cycles of D Q4W; or (Arm 3) either no adjuvant treatment (observation only) or adjuvant nivolumab in high-risk patients where available and approved (planned amendment). The dual primary endpoints are pCR and event-free survival. Secondary endpoints include overall survival, disease-free survival, pathologic downstaging rate to < pT2, disease-specific survival, quality of life, immunogenicity, and pharmacokinetics. The study is actively enrolling. Clinical trial information: NCT04960709.

Modeling defluoridation of real-life groundwater by a green adsorbent aluminum/olivine composite: Isotherm, kinetics, thermodynamics and novel framework based on artificial neural network and support vector machine

The kinetic, isotherm, and thermodynamics of adsorptive removal of fluoride from the real-life groundwater was evaluated to assess the applicability of a green adsorbent, aluminum/olivine composite (AOC). The isotherm and kinetics were demonstrated by the Freundlich and Elovich model indicating significant surface heterogeneity of AOC in favouring the fluoride sorption. The fluoride removal efficiency of AOC was achieved as 87.5% after 240 min of contact time. The diffusion kinetic model exhibited that both the intra-particle and film diffusion together control the rate-limiting step of fluoride adsorption. A negative value of ΔG⁰ (-19.919 kJ/mol) at 303 K confirmed the spontaneous adsorption reaction of fluoride, and its endothermic nature was supported by the negative value of ΔH⁰ (39.504 kJ/mol). A novel framework for a predictive model by artificial neural network (ANN), and support vector machine (SVM) considering the real and synthetic fluoride-containing water was developed to assess the efficiency of adsorbent under different scenarios. ANN model was observed to be statistically significant (RMSE: 1.0955 and R²: 0.9982) and the proposed method may be instrumental in a similar area for benchmarking the synthetic and real-life samples. The low desorption potential of the spent adsorbent exhibited safe disposal of sludge and the secondary-pollutant-free treated water by the efficient and green adsorbent AOC enhanced the field-scale applicability of the green technology.

Photocatalytic performance of 3D engineered chitosan hydrogels embedded with sulfur-doped C3N4/ZnO nanoparticles for Ciprofloxacin removal: Degradation and mechanistic pathways

Ciprofloxacin, a biotoxic micropollutant, is ubiquitously found in the water environment, which is a global concern. This study developed polymeric S-C₃N₄/ZnO-Chitosan (indexed as SCZ-CH) hydrogels for degrading Ciprofloxacin. The SCZ-CH hydrogels provided the Ciprofloxacin degradation efficiencies of ~93% and ~69% in UV and visible lights, respectively, at optimum conditions (SCZ-CH hydrogels with 2 g/L SCZ, 20 mg/L initial concentration, pH 5, and room temperature). In addition, immobilized SCZ-CH hydrogels structures enable easy separation of the SCZ catalyst from water. The spectroscopic and microscopic analyses of SCZ-CH hydrogels show multifaceted properties, like high oxygen concentrations, crystallinity, stacked structure, high roughness, and improved bandgap energy, which are responsible for the enhanced photocatalytic activity. The effects of water matrix and experimental conditions on Ciprofloxacin degradation were also studied, which suggested that the catalyst dose and solution pH have significant effects on photocatalytic activity. SCZ-CH hydrogels have shown good mineralization efficiency (~98%) and reusability (up to 10 cycles) for Ciprofloxacin removal. Superoxide radicals played an essential role in the degradation of Ciprofloxacin. The Ciprofloxacin molecules get degraded by driving radicals through oxidation, defluorination, substitution, and breaking of the rings. The proposed SCZ-CH hydrogels can be effectively used at a large scale to treat micropollutants.

Mucormycosis: A triple burden in patients with diabetes during COVID-19 Pandemic

With the upsurge in the cases of COVID-19 around the world, plenty of potential COVID-19 complications are becoming more prevalent, including a higher risk of secondary bacterial and fungal infections. Mucormycosis is one such condition which has high prevalence among individuals with diabetes who were infected with COVID-19.The usage of steroids in the treatment further inflates the risk of infection and exacerbation of disease in pre-existent mucormycosis patients. Generally, Corticosteroid-induced diabetes can arise on long-term steroid medication, increasing the likelihood of mucormycosis. In patients with COVID-19, the indications and dose of corticosteroids should be properly regulated, and persons with diabetes who take insulin or oral anti-diabetic medicines should be cautious. To avoid poor outcomes, strategies to improve glycemic management should be emphasized. This narrative review elucidates different disciplines on rampant use of steroids, iron and zinc supplements as well as the methods utilized as primary or adjunctive treatment of this fatal condition. This article may help to pave the way for robust research that needs to be done to tackle the deadly triple burden of the disease.

Hydraulic performance benchmarking for effective management of water distribution networks: An innovative composite index-based approach

Hydraulic performance assessment and benchmarking of water distribution networks (WDNs) impose a major challenge to water utilities worldwide. Presently, benchmarking strategies for WDNs are not fully developed, especially for analyzing intermittent systems commonly encountered in non-developed nations. To overcome these limitations, this paper proposes an index-based benchmarking strategy for WDNs, comparing their actual hydraulic performance and expected serviceability. A robust Hydraulic Performance Index (HPI) is developed as a global metric to account for the combined impact of multiple hydraulic outputs, concerning their benchmark values. The applicability of this index is verified on a numerical benchmark network, and its usefulness is demonstrated on a real-world intermittent WDN located in Kolkata (India) by coupling the HPI-based framework with hydraulic models using the EPANET-MATLAB programmer's toolkit. A scenario-based analysis is conducted using extended-period simulation to obtain the HPI for diverse service levels and leakage conditions of the WDN models. The HPI is designed to effectively capture the localized pressure reduction during peak flow, prioritize hydraulic outputs based on regional constraints, and penalize systems with unsustainably high hydraulic output. The developed strategy is also effective in performance benchmarking of WDNs of different nations with diverse serviceability and threshold parameters on a common platform. Finally, the practical efficacy and generalizability of the HPI-based results in the context of case-specific performance management of WDNs, along with limitations, recommendations and future perspectives are elucidated upon.

Hollow Polyaniline Microsphere/MnO2/Fe3O4 Nanocomposites in Adsorptive Removal of Toxic Dyes from Contaminated Water

Dyes are considered as recalcitrant compounds and are not easily removed through conventional water treatment processes. The present study demonstrated the fabrication of polyaniline hollow microsphere (PNHM)/MnO₂/Fe₃O₄ composites by in situ deposition of MnO₂ and Fe₃O₄ nanoparticles on the surface of PNHM. The physicochemical characteristics and adsorption behavior of the prepared PNHM/MnO₂/Fe₃O₄ composites towards the removal of toxic methyl green (MG) and Congo red (CR) dyes have been investigated. The characterization study revealed the successful synthesis of the prepared PNHM/MnO₂/Fe₃O₄ adsorbent with a high Brunauer-Emmett-Teller (BET) surface area of 191.79 m²/g. The batch adsorption study showed about 88 and 98% adsorption efficiencies for MG and CR dyes, respectively, at an optimum dose of 1 g/L of PNHM/MnO₂/Fe₃O₄ at pH ∼6.75 at room temperature (303 ± 3 K). The adsorption phenomena of MG and CR dyes were well described by the Elovich and pseudo-second-order kinetics, respectively, and Freundlich isotherm model. The thermodynamics study shows that the adsorption reactions were endothermic and spontaneous in nature. The maximum adsorption capacity (Q_max) for MG and CR dyes was observed as 1142.13 and 599.49 mg/g, respectively. The responsible adsorption mechanisms involved in dye removal were electrostatic interaction, ion exchange, and the formation of the covalent bonds. The coexisting ion study revealed that the presence of phosphate co-ion considerably reduced the CR dye removal efficiency. However, the desorption-regeneration study demonstrated the successful reuse of the spent PNHM/MnO₂/Fe₃O₄ material for the adsorption of MG and CR dyes for several cycles. Given the aforementioned findings, the PNHM/MnO₂/Fe₃O₄ nanocomposites could be considered as a promising adsorbent for the remediation of dye-contaminated water.

Analysis of Clinical Trial Registry of India for Evidence of Anti-Arthritic Properties of Withania somnifera (Ashwagandha)

BACKGROUND

Withania somnifera (Ashwagandha) is an herb with anti-inflammatory properties used in managing arthritis. There is significant clinical data in the public domain on the effects of Ashwagandha and this study was aimed at compiling and analysing these data in a structured manner. The major sources of evidence data were clinical trials and systematic review of extant literature.

METHODOLOGY

Retrospective database search was conducted in the Clinical Trial Registry of India for trials registered from April 2008 to March 2020, and published literature related to the anti-arthritic effects of Withania somnifera were reviewed.

RESULTS

In all, 77 registered clinical trials were analysed and common among them were interventional, single-centre, randomized, double-blind, two-arm studies with Placebo being the comparator. Similar findings were observed in the 10 published clinical trials on arthritis evaluated for this study. While industry- and government-sponsored trials were identified, government funded sites with approvals from Institutional Ethics Committees were preferred. Most trials were registered as Phase 2 with the highest number of sites in the state of Maharashtra. The solid dosage form was most preferred.

CONCLUSION

While the effects of Withania somnifera on various disorders are being investigated by several clinical trials, the ones evaluated for this study provide insight on its potential in managing arthritis when given for a specific duration. Evidence shows a dosage of 6 gm in powder form or extracts in tablets, or 500 -1000 mg capsule consumed for a duration of 8 - 12 weeks may be useful in managing symptoms of arthritis in patients.

COVID-19-associated psychosis in Indian settings: A retrospective descriptive study

BACKGROUND

The coronavirus-19 (COVID-19) pandemic has affected millions of people across the world since early 2020. Besides the large number of case fatalities, this virus has produced significant health-related sequelae involving multiple systems of the body. As with previous coronavirus infections, this was also found to be associated with various neuropsychiatric symptoms. Psychosis has been uncommon, and the few reported cases across the world have forwarded association with either raised inflammatory markers or the consequences of social isolation.

MATERIALS AND METHODS

This is a retrospective descriptive study of 12 patients, who were admitted with COVID-19 infection and psychosis, between March 2020 and December 2020. Cases of head injury, any neurological or metabolic illnesses, and substance use disorders were excluded.

RESULTS

Cases with psychosis formed only 0.19% of all cases of COVID-19 admissions. All of them were young male and employed. Most of them had abrupt onset of psychosis with confusion, delusions, hallucinations, agitation, and sleep disturbances. Investigations including inflammatory markers (C-reactive protein) and computerized tomography scans were largely normal. Medications used were mainly benzodiazepines and antipsychotics. Most of the cases resolved within the second week, and follow-up after a month did not elicit any residual symptoms in majority. Diagnosis was acute and transient psychotic disorder (about 75%), bipolar affective disorder (2 cases), and schizophrenia (one).

CONCLUSIONS

The major findings included nonreactive inflammatory markers, quick resolution of symptoms, requirement of low doses of antipsychotic drugs, and no long-term sequelae.

Predicting the trend and utility of different photocatalysts for degradation of pharmaceutically active compounds: A special emphasis on photocatalytic materials, modifications, and performance comparison

The rapid rise in the healthcare sector has led to an increase in pharmaceutically active compounds (PhACs) in different aqueous bodies. The toxicity of the PhACs and their ability to persist after conventional treatment processes have escalated research in the field of photocatalytic treatment. Although different photocatalysts have been successful in degrading PhACs, their inherent drawbacks have severely limited their application on a large scale. A substantial amount of research has been aimed at overcoming the high cost of the photocatalytic material, low quantum yield, the formation of toxic end products, etc. Hence, to further research in this field, researchers must have a fair idea of the current trends in the application of different photocatalysts. In this article, the trends in the use of various photocatalysts for the removal of different PhACs have been circumscribed. The performance of different groups of photocatalysts to degrade PhACs from synthetic and real wastewater has been addressed. The drawbacks and advantages of these materials have been compared, and their future in the field of PhACs removal has been predicted using S-curve analysis. Zinc and titanium-based photocatalysts were efficient under UV irradiation, while bismuth and graphene-based materials exhibited exemplary performance in visible light. However, iron-based compounds were found to have the most promising future, which may be because of their magnetic properties, easy availability, low bandgap, etc. Different modification techniques, such as morphology modification, doping, heterojunction formation, etc., have also been discussed. This study may help researchers to clarify the current research status in the field of photocatalytic treatment of PhACs and provide valuable information for future research.

Multifocal electroretinography-assisted anatomical and functional evaluation of subthreshold green laser in acute central serous chorioretinopathy

Purpose:

To compare observation versus subthreshold green laser (STL) in acute central serous chorioretinopathy (CSC) in terms of anatomical and functional outcomes.

Methods:

Prospective randomized interventional study. 30 eyes with the first episode of acute CSC underwent complete ophthalmologic examination, measurement of best-corrected Snellen visual acuity (BCVA), contrast sensitivity (CS), fundus fluorescein angiography (FFA), spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinography (mfERG) at baseline. Patients were randomized equally to group A (observation) or group B (STL using 532 nm wavelength applied to the leakage point). Outcome measures included BCVA, CS, central foveal thickness (CFT), and mean macular thickness (MMT) on SD-OCT and P1 amplitude and implicit time (IT) on mfERG. Patients were followed up for 6 months.

Results:

Mean BCVA was comparable between the two groups on follow up; however, mean CS was significantly higher in group B at 6 months (P = 0.032). CFT was significantly lower in group B at 1 month (P = 0.001) and 3 months (P = 0.049); however, this difference was not maintained at 6 months (P = 0.265). P1 amplitude and IT in all 5 rings were comparable between the two groups at baseline. On follow up, P1 amplitude of ring 1 became significantly higher in group B at 3 months (P = 0.036) and 6 months (P = 0.022).

Conclusion:

Immediate treatment of acute CSC with STL, as compared to conservative management, leads to more rapid resolution on SD-OCT and superior functional outcomes as evidenced by CS and mfERG.

Knowledge, attitude and practices towards visceral leishmaniasis among HIV patients: A cross-sectional study from Bihar, India

Background

In the Indian state of Bihar, visceral leishmaniasis (VL) is a major public health issue that has been aggravated by the rising incidence of new Human immunodeficiency virus (HIV) infections. In endemic areas, the risk of VL infections in patients living with HIV (PLHIV) is higher. It is important to investigate the disease-related knowledge, attitude, and practices (KAP) of PLHIV in Bihar in order to monitor HIV/VL co-infection. Adequate knowledge, a positive attitude, and good practices for VL control are essential to stamp out the disease. This study investigated the KAP towards VL in HIV patients attending antiretroviral therapy (ART) clinic at ICMR-RMRIMS, Patna.

Methods

A questionnaire based cross-sectional study was performed among 120 HIV patients aged ≥18 years, to evaluate their KAP regarding visceral leishmaniasis. For the KAP indicators, each correct answer received a score of 1, while unsure and incorrect responses received a score of 0. Descriptive statistics and logistic regression were used for the analysis. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.

Results

The study population had a male (68.30%) preponderance with a mean age of 37.03 years ± 9.80 years of standard deviation. The majority (93.30%) of the study participants had previously heard about VL. Only 32.10% of those who had heard about VL knew that the disease was transmitted by the sandfly. Most (80.40%) of the study respondents were ignorant of the sandfly breeding grounds. The vast majority (75.90%) had no idea how to recognize sandflies and were unaware of their biting time, leishmaniasis transmission season, and preventive practices. Although PLHIV are vulnerable to VL, only 27.70% of them agreed that VL is a fatal disease if untreated, and 42.90% believed they wear not at risk of developing the disease. Regarding the control methods of sandflies, 28.60% of participants did not use any methods to avoid sandfly bites. The multivariable analysis revealed that occupation and family history were the two independent predictor variables of the knowledge index. Age and gender were significantly associated with attitude towards VL. Participants working as laborers had significantly lesser odds (AOR: 0.248, 95% CI: 0.073–0.844) to follow good preventive practices. There were significantly higher odds of having good practice among participants aged 18–40 years (AOR: 6.866, 95% CI: 1.694–27.834) and those residing in urban areas (AOR: 4.159, 95% CI: 1.317–13.139) than their peers. Overall, 27.7% of respondents were knowledgeable, 41.1% had a positive mindset, and 33.9% had strong VL preventive habits, according to the study.

Conclusion

The study determined a remarkable gap in the knowledge attitude and practices towards VL among PLHIV. This underscores the need of augmented health education initiatives for PLHIV in endemic areas for good VL awareness and preventive practices.

The impact of tooth colour on the perceptions of age and social judgements

OBJECTIVE

Psychological research has established that the presence of dental anomalies negatively impact social judgements. This study sought to determine the effects of tooth colour on the subjective ratings of social judgements in a group of Caucasian adults.

METHODS

A cross sectional experimental analogue design comprised fifty Caucasian adults: 25 women and 25 men. A total of 54 digitally modified photographs of Caucasian males and females (darkened, natural, whitened teeth) were evaluated. All participants evaluated each of the images on 12 characteristics: popularity, friendliness, social life, success, graduation, happiness, intelligence, perceived age, introversion/extraversion, self-confidence, attractiveness and satisfaction with the tooth shade. Analysis of variance (ANOVA) was used to compare ratings.

RESULTS

Participants associated darkened teeth with poorer subjective ratings, with the highest ratings been given to whitened teeth, and natural teeth being intermediate. These trends were similar across all participant age groups and gender. Further, the gender and age groups of the images had a significant effect on the appraisals. Faces of younger models received higher ratings than the faces of older models and female images were rated higher than the males.

CONCLUSION

In the absence of other information, tooth colour exerts an influence upon the appraisals made in social situations. It appears that whitened tooth appearance is preferred to natural tooth appearance, irrespective of age and gender of the judge. The faces with more whitened dentition are perceived to be younger across all age groups and gender of the judges. Participants dissatisfied with their own tooth shade drew out more stereotypic behaviour.

CLINICAL SIGNIFICANCE STATEMENT

This research used standardised tooth colour as a basis to investigate perceived age and social functioning. As clinicians face daily challenges to achieve patient satisfaction with respect to dental aesthetics, standardizing the colour may enhance the patients' satisfaction. Further, participants dissatisfied with their own tooth shade drew out more stereotypic behaviour. The whitened dentition may impair the psychological well-being of the individuals and is probably a reason for the increasing demand for cosmetic dental procedures. These results may be instructive for the development of a psycho-educational intervention to prevent any unrealistic expectations.

Finasteride for hair loss: a review

BACKGROUND AND OBJECTIVES

Finasteride 1 mg/day is indicated for androgen-dependent conditions such as male androgenetic alopecia (AGA).

METHODS

The literature is comprehensively summarized on the pharmacodynamics, pharmacokinetics, mechanism of action, and metabolism of finasteride. Pairwise and network meta-analyses were performed to assess the efficacy of finasteride reported in clinical trials. The adverse events profile is described along with the post-marketing reports.

RESULTS AND CONCLUSION

Finasteride 1 mg/day significantly increased total hair count compared to placebo after 24 weeks (mean difference = 12.4 hairs/cm², p < .05), and 48 weeks (mean difference = 16.4 hairs/cm², p < .05). The efficacy of the two doses of finasteride (5 mg/day and 1 mg/day) and topical finasteride (1% solution) were not significantly different. The most commonly reported sexual events include erectile dysfunction and decreased libido. Increasing patient complaints and analysis of the FAERS database led to the inclusion of depression in the FDA label in 2011, as men were found to be at a risk of suicide due to the persistent sexual side effects, commonly termed as post-finasteride syndrome. Finasteride is shown to be reasonably tolerated in both men and women; however, patients need to be educated about the possible short- and long-term side-effects.

Endovascular coiling of ruptured internal iliac artery aneurysm in a leukemia patient-a case report

Endovascular occlusion of isolated internal iliac artery aneurysm is a safe and effective procedure. We report a case of coiling of a ruptured Internal Iliac artery aneurysm in a leukaemia patient with intramuscular haematoma achieving an excellent immediate result and no recanalisation on 6 month follow up.

Utility of diffusion weighted imaging in diagnosing subdiaphragmatic endometriosis presenting as shoulder pain

Extrapelvic endometriosis (EPE) is a rare entity which may potentially occur at any site. Symptomatic EPE is now increasingly being managed laparoscopically. Imaging is imperative in diagnosis as well as extent delineation prior to surgery. In addition to increasing the success rate of diagnostic laparoscopy, prior knowledge of EPE at certain sites may modify the standard surgical technique. We present here an unusual case of chronic pain in the right shoulder in a 26-year-old female caused by subdiaphragmatic endometriosis (SDE). It was noticed on conventional magnetic resonance imaging (MRI) sequences; however, due to the lack of the characteristic signal intensity, imaging findings were noncontributory. Diffusion-weighted imaging (DWI) facilitated its characterization and precisely mapped the extent of involvement. SDE should be suspected in young females presenting with cyclical shoulder pain. Due to nonspecific clinical features, it may remain undiagnosed. MRI is the imaging modality of choice in evaluation of EPE. Including DWI sequence in the MR protocol increases the diagnostic precision besides delineating the extent of involvement noninvasively.

Minoxidil: a comprehensive review

Topical minoxidil (5% foam, 5% solution, and 2% solution) is FDA-approved for androgenetic alopecia (AGA) in men and women.Mechanism of action: Minoxidil acts through multiple pathways (vasodilator, anti-inflammatory agent, inducer of the Wnt/β-catenin signaling pathway, an antiandrogen), and may also affect the length of the anagen and telogen phases.Pharmacokinetics: Approximately 1.4% of topical minoxidil is absorbed through the skin. Minoxidil is a prodrug that is metabolized by follicular sulfotransferase to minoxidil sulfate (active form). Those with higher sulfotransferase activity may respond better than patients with lower sulfotransferase activity.Clinical efficacy (topical minoxidil): In a five-year study, 2% minoxidil exhibited peak hair growth in males at year one with a decline in subsequent years. Topical minoxidil causes hair regrowth in both frontotemporal and vertex areas. The 5% solution and foam were not significantly different in efficacy from the 2% solution.Oral and Sublingual minoxidil (not FDA approved; off-label): After 6 months of administration, minoxidil 5 mg/day was significantly more effective than topical 5% and 2% in male AGA. Low-dose 0.5-5 mg/day may also be safe and effective for female pattern hair loss and chronic telogen effluvium. Sublingual minoxidil may be safe and effective in male and female pattern hair loss.

Development of a schwarzite-based moving bed 3D printed water treatment system for nanoplastic remediation

The impact of micro and nanoplastic debris on our aquatic ecosystem is among the most prominent environmental challenges we face today. In addition, nanoplastics create significant concern for environmentalists because of their toxicity and difficulty in separation and removal. Here we report the development of a 3D printed moving bed water filter (M-3DPWF), which can perform as an efficient nanoplastic scavenger. The enhanced separation of the nanoplastics happens due to the creation of a charged filter material that traps the more surface charged nanoparticles selectively. Synthetic contaminated water from polycarbonate waste has been tested with the filter, and enhanced nanoplastic removal has been achieved. The proposed filtration mechanism of surface-charge based water cleaning is further validated using density function theory (semi-empirical) based simulation. The filter has also shown good structural and mechanical stability in both static and dynamic water conditions. The field suitability of the novel treatment system has also been confirmed using water from various sources, such as sea, river, and pond. Our results suggest that the newly developed water filter can be used for the removal of floating nanoparticles in water as a robust advanced treatment system.

The impact of micro and nanoplastic debris on our aquatic ecosystem is among the most prominent environmental challenges we face today.

Determination of clinical benefit among patients with radiological stable disease to immune checkpoint inhibitors

9041

Background: SD is a common but ambiguous outcome in patients receiving immune checkpoint inhibitors (ICIs) and likely represents a heterogenous mix of responders and non-responders. This study aimed to characterize SD and identify the subset of patients with SD who are benefiting from treatment. The ability to distinguish whom among patients with SD is actually benefiting from treatment would facilitate drug development and improve precision in correlative research. Methods: A systematic review was performed to characterize SD in ICI trials. SD and objective response was compared to proliferation index using TCGA gene expression data. To identify a subgroup of SD with outcomes mirroring responders, we examined a discovery cohort of NSCLC treated with ICIs and had RECIST assessment. In patients with best overall response (BOR) of SD, serial cutpoints of two variables, % BOR and PFS, were tested to define a subgroup with similar survival as PR-minor (patients with partial response [PR] and % shrinkage < median among responders). Results were then tested in two external validation cohorts (n = 326, n = 381). Results: Among trials of ICIs (59 studies, 14,280 patients), SD ranged from 16-42% in different tumor types and was associated with disease-specific proliferation index (Spearman rho = -0.75, p = 0.03), a proxy of tumor kinetics, rather than relative response to ICIs. In a discovery cohort of 1220 patients with NSCLC who were treated with ICIs, 26% had SD, 19% had PR/CR, and 55% had PD. Outcomes among those with SD ranged widely (OS range 0.5-76 months, PFS range 0.2-49 months). The subset of SD with PFS > 6 months and no tumor growth mirrored PR-minor (OS HR 1.0) and was proposed as the definition of “SD-responder”. SD-responders (n = 87) represented 7% (95% CI 6-9%) of the overall population and 28% (95% CI 23-33%) of the SD population. This definition was confirmed in two validation cohorts from trials of NSCLC treated with durvalumab. Conclusions: RECIST-defined SD to immunotherapy is common, heterogenous, and may largely reflect tumor growth rate rather than ICI response. In patients with NSCLC and SD to ICIs, PFS > 6 months and no tumor growth (̃1/3 of SD) may be considered “SD responders.” This definition may improve the efficiency of and insight derivable from clinical and translational research.