Service-learning is one way to engage students in health professions and promote health literacy in the community. This paper describes developing and delivering a service-learning course designed to improve diabetes literacy and diabetes outcomes among a medically underserved population. The didactic component of the course introduced topics such as health literacy, health education techniques, and diabetes pathophysiology, prevention, and treatment. Later, students designed and delivered community diabetes education classes at a local free clinic. After the classes were offered, diabetes knowledge and self-efficacy scores improved for community members and students leading the classes. A subset of community members also had lower body mass index at a 6-month follow-up. Though COVID-19 interfered with student's ability to offer in-person education sessions in the last semester this course was offered, it provided an opportunity to examine differences in diabetes knowledge and self-efficacy scores between students who offered in-person courses versus those who were unable to go out to the community and developed an online class instead. Self-efficacy was significantly higher at the end of the semester compared to at the end of the didactic component of the class for only those students who delivered in-person community education and not for those who developed the online class, providing further evidence of the benefit of engaging with community members on student outcomes. Community members and students alike were delighted with the program. Student-led community classes can be a financially sustainable solution to improving health literacy that benefits community members and students alike.

not-yet-known not-yet-known not-yet-known unknown Unexpected Guillain-Barré Syndrome After Hysterectomy: A Clinical Case Report

Successful Management of Severe Unknown Snake Bite with Coagulopathy in an Intensive Care Unit (ICU) of a peripheral district hospital: A Case Report S Bijukchhe1, S Adhikari21.      Department of Anesthesia and Critical CareHetauda Hospital, Madan Bhandari Academy of Health Sciences2. Pharmacy Officer, Health Logistic Management Center, Hetauda.

IntroductionDepressive disorders are characterized by recurrent episodes and a substantial disease burden, often leading to chronic functional impairment and reduced quality of life [1, 2]. Approximately one-third of patients fail to achieve satisfactory remission despite appropriate treatment, including antidepressant medications, electroconvulsive therapy(ECT), and psychotherapy[3-5]. This results in TRD, a severely disabling psychiatric disorder that is often refractory to conventional treatments. Patients face increased treatment costs, complications, and the heightened risk of recurrent hospitalizations. TRD poses a major clinical challenge within psychiatric practice due to delayed onset of action and low remission rates following multiple antidepressant doses[6, 7].Treatment options remain limited due to the prevalence of adverse effects tied to pharmacological therapies, low accessibility to psychotherapy, and high tolerance levels for electroconvulsive therapy. New neuromodulation techniques, such as rTMS, may offer potential solutions to these limitations[8, 9]. The U.S. Food and Drug Administration (FDA) approved rTMS for TRD in 2008, and it is recognized in the latest Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines [10, 11]. However, not all patients benefit from standard rTMS regimens[10], with meta-analytic evidence indicating an average effectiveness of 29.3% for the left dorsal lateral prefrontal cortex (lDLPFC) using high-frequency rTMS [10]. The FDA-approved rTMS regimen for TRD operates at 10 Hz, with a minimum of 60,000 total pulses; higher doses of 15 Hz or 20 Hz may achieve more favorable outcomes[12].Various classes of antidepressants, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been utilized in the treatment of depression [13]. However, the estimated rate of TRD persists above 30% after treatment with multiple antidepressant classes [4]. Currently available antidepressants are effective for treating depression; however, they are often accompanied by notable limitations. These include delayed onset of action, limited therapeutic efficacy (yielding moderate effectiveness ranging from 50% to 70%), and a lack of cognitive improvement. Consequently, there is a growing clinical need for safer and more effective antidepressant options [14, 15]. In recent years, the triple monoamine reuptake inhibition hypothesis has gained significant recognition as a potentially effective strategy for treating depression. Toludesvenlafaxine, also known as Ansofaxine, LY03005, or LPM570065, is a triple reuptake inhibitor (TRI) that has been integrated into clinical settings. It functions by inhibiting the reuptake of serotonin, dopamine, and norepinephrine in the central nervous system. The simultaneous activation of all three monoamine systems is believed to have a favorable impact on mood by alleviating symptoms such as loss of pleasure, irritability, and depressive symptoms. It also supports cognitive improvement, including better attention span, learning abilities, and memory, and addresses somatic symptoms by reducing fatigue, increasing energy, and addressing insomnia in individuals with depressive disorders. Preclinical studies suggest that toludesvenlafaxine exhibits superior efficacy and a favorable safety profile compared to traditional monoamine reuptake inhibitors. It shows promise for addressing the unmet needs in the treatment of TRD by alleviating symptoms that are resistant to current standard therapies. Toludesvenlafaxine is noted for its rapid antidepressant-like effects and is considered a promising treatment option[15-18].On the other hand, previous studies have demonstrated that DTMS demonstrates beneficial therapeutic outcomes on depressed patients who are already on medication[19, 20]. Additionally, there is an urgent need for a safe and effective treatment for TRD. Therefore, this study aims to utilize a newer rTMS regimen, such as DTMS, in combination with a novel triple monoaminergic reuptake inhibitor (toludesvenlafaxine) to augment efficacy and achieve the therapeutic remission of TRD patients. By focusing on novel treatment combinations and techniques, this approach seeks to provide a safe and effective treatment strategy for managing patients with TRD who have experienced limited success with traditional treatment trials.

The analysis of natural abundance isotopes in biogenic N 2O molecules can give precious information such as the nature of their precursor. However, many uncertainties exist and further validations are necessary to confirm this method as a reliable tracer of biogeochemical cycles. In particular, current methodologies (such as the isotopocule map approach) can only estimate the combined contributions of several processes at once. In this study, we aimed to develop a new methodology capable of individually discriminating the main sources of N 2O production in soil by combining natural abundance isotopes with the use of a 15N tracer ( 15N Gas Flux method). To achieve this, we conducted parallel laboratory incubations of an agricultural soil, during which we optimized the denitrification conditions through increase of moisture and amendment of nitrate; where this nitrate was either labelled or unlabeled with 15N atoms. A new linear system combined with Monte Carlo simulation enabled the determination of N 2O source partitioning, where bacterial denitrification was identified as the dominant process (87.6%), compared to fungal denitrification (9.4%), nitrification (1.5%) and nitrifier denitrification (1.6%). This new system has been compared to a recently developed stable isotope modelling tool applying Bayesian statistics (FRAME). The results agreed generally well at the exception of lower bacterial denitrification (80%) and higher nitrifier-denitrification (9%) contributions found with the FRAME model. This new approach provides a perspective for a wider application, potentially enabling the source partitioning of nitrous oxide emissions in agroecosystems.

Protein farming, or molecular farming, is an innovative approach that utilizes plants/animals/microorganisms as biofactories to produce valuable pharmaceutical proteins, antibodies, vaccines, and other high-value bio-active molecules. This emerging field has gained significant attention due to its potential to address the growing demand for affordable and scalable biopharmaceutical production platform. Correspondingly, plants offer several advantages over traditional expression systems, including low production costs, scalability, ease of manipulation, and reduced risk of contamination by pathogens. This review provides an overview of principles underlying protein farming in plants (P-farm), including the identification and selection of host, optimization of transgene expression, and downstream processing techniques for protein purification. It also discusses recent advancements in plant biotechnology and the development of transient expression systems to use genetically modified plants (transgenic plants) in the enhancement of protein production. Additionally, the potential applications and challenges associated with molecular farming in plants are considered, including prospects of commercialization and novel opportunities to meet the growing demands of global healthcare markets.

In this paper, we conduct a thorough analysis for a group of stochastic Hilfer fractional delay differential equations (SHFDDEs) with Lipschitz parameters. By introducing innovative theoretical conditions, we successfully establish the existence and uniqueness solutions using the Carath e ̵́ odory approximation approach. Furthermore, we deduce the average principle for accordingly system by employing H o ̵̈ lder’s inequality, Jensen’s inequality, It o ˆ isometric distance, and Gronwall’s inequality. Ultimately, two demonstrative examples are undertaken to substantiate the efficacy and practical applicability of our findings.

not-yet-known not-yet-known not-yet-known unknown Case report Title: Cornerstones as treatment of brown tumour and low turnover in peritoneal dialysis patient: Case Report. Authors: Hernandez P, Mariel1; Enos, Daniel1.

A document by Hem Prajapati. Click on the document to view its contents.

To Lyse or Not: The Role of Half-Dose Thrombolysis in Right Ventricular Clot Associated with Sub-Massive Pulmonary EmbolismNasreldin A. Hamza1, Wasfy J. Hamad1, Shamim K. Vakkulathil1, Vimalraj Sundaram1, Haidar M. Hadi2, Abdulqadir J. Nashwan3*1 Critical Care Department, Al-Khor General Hospital, Hamad Medical Corporation, Doha 3050, Qatar2 Cardiology Department, Al-Khor General Hospital, Hamad Medical Corporation, Doha 3050, Qatar3 Nursing Department, Hamad Medical Corporation, Doha 3050, Qatar*Corresponding author:Mr. Abdulqadir J. Nashwananashwan@hamad.qaMob: (+974) 66473549, P.O. Box 3050 Doha, QatarORCID: https://orcid.org/0000-0003-4845-4119E-mails: nhamza@hamad.qa; whamad1@hamad.qa; SVakkulathil@hamad.qa; VSundaram@hamad.qa; HHadi3@hamad.qa; Anashwan@hamad.qa

A document by Dharaneswari Hari Narayanan. Click on the document to view its contents.

As Internet middleboxes become increasingly prevalent, their influence on traffic streams presents significant challenges and opportunities for network management. Among these devices, transparent middleboxes are particularly difficult to detect, as they can modify traffic patterns without altering content, thereby preserving the appearance of normal routing. This paper addresses the challenge of detecting such transparent middleboxes by proposing a generalized detection framework capable of identifying a broad range of middlebox behaviors, including those that operate transparently. In contrast to existing ad hoc approaches that target specific middlebox types, our framework is novel in its ability to detect a wide variety of middleboxes instead. We validate the effectiveness of our approach through a combination of analytical methods, network simulations, and live Internet experiments. Our results demonstrate the framework's capability to accurately detect widely employed middlebox behaviors, such as network compression, traffic prioritization, and traffic shaping.

Neonatal hyperammonemia is usually due to a reduction in the metabolic capacity of the urea cycle. However, critically ill infants often present with several risk factors leading to high blood ammonia levels, including increased production and/or decreased elimination of ammonia. We present a rare case of an 11-day-old female infant with

Huge hepatic cysts cause congestive heart failure

Case Report：Oesophageal Perforation Caused by Late Screw Displacement After Anterior Cervical PlatingHaoran Chen 1, Qianliang Wang 1,Fengxian Jiang 1*1. 1Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P. R. China2.*Corresponding author:Fengxian Jiang, Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P. R. ChinaE-mail: jiangfengxian@suda.edu.cn

Eagle’s syndrome a rare cause of neck pain: a case report

Hypereosinophilia Associated With Antisynthetase Syndrome With anti-Ro52/PL12 Co-Positivity: An Unusual PresentationKapuczinski A.1, Demeulenaere N.1, Rossi C.2, Bondue B.3, Léon M.11Rheumatology Department, CHU HELORA site Kennedy, Mons, Belgium; 2Infectious Disease Department, CHU HELORA site Kennedy, Mons, Belgium, 3Pneumology Department, Hôpital Erasme, Bruxelles, Belgium.Correspondence : Abeline Kapuczinski; Abeline.k@gmail.com

To study on the proteome and to investigate the immune response mechanisms in P. skrjabini infection. Serum samples were randomly collected from patients with P. skrjabini infection and healthy individuals in Guizhou Province. ITRAQ (Isobaric Tags for Relative and Absolute Quantitation) assays were utilized for the analysis of protein catalogs in serum samples. Bioinformatics analysis on the differed proteins was performed. River crabs were sampled from the patients’ habitats, Paragonimus metacercariae were isolated for subsequent rat experimental infection. White blood cells and serum were collected at 42 days post-infection, changes in the expression of IL-4 were assessed. In result, a total of 50 proteins were identified. Typically, increased expression neutrophil defensin 3, protein S100-A9 (S100A9) and serum amyloid A-1 protein (SAA1) were found. S100A9 and SAA1 were involved in the main network but DEFA3 was not. The interaction networks were constituted with the core of Apolipoproteins family and the interactions with the fibrinogen and fibrinolytic system. Through subsequent experimental infections in rats, the expression of Th2 cytokines IL-4 remains unaltered. In conclusion, neutrophils may play a pivotal role in the elimination of parasites, whereas host Th2 cell immune response is suppressed in eliminating worms.