The relationship of environmental (ED) or habitat (HD) diversity of a landscape with its species richness (S) is of much interest. Based on underlying speciesarea (SA) curves, we show that the standard linear relationship lacks theoretical support. The SED relationship is the product of numerous SA curves per habitat and number of distinct habitats in the landscape. We recognize three basic SED patterns: convex, unimodal, concave, based on three fundamental SA curves: power, logarithmic and sigmoid. The preponderance of positive linear or absence of SED/HD relationships reported so far can be attributed to six causes. These include: only testing for linear relationships; limited data sets that exclude small, unique or isolated habitats; regressions are against non-causal variables; and use of biased data that have not been ground-truthed. Hump-backed SED curves should apply widely in regions with species-rich biota and need to resurrected, provided data collected are sufficiently comprehensive and accurate.

Adaptations of organisms to different environments may be important in view of different stressors caused by climate change. Antarctic lichens provide a good model for studying resistance to environmental extremes. Our goal was to compare changes in water storage of Caloplaca regalis from two different localities in Antarctica. King George Island (KGI) and Deception Island (DI). DI is of particular interest owing to the unique microclimate of the volcanic island. The molecular dynamics of the residual water was monitored by 1H-NMR relaxometry, spectroscopy, and sorption isotherm analysis. Hydration kinetics for both samples distinguished three water fractions, (i) very tightly bound, (ii) tightly bound, and (iii) loosely bound water. However, hydration kinetics for C. regalis from KGI are faster than those from DI. Only one, averaged, water fraction was fitted for the 1H-NMR signal of mobile protons. Lichens from both environments contain a solid water-soluble fraction. The dissolution effect is detected with the saturation concentration varying around cs = 0,6(1) corresponding to sucrose, galactose or xylose for the KGI sample and cs = 0.3(1) corresponding to mannitol or galactitol for the DI sample. This suggests that C. regalis employs similar defensive strategies against desiccation but uses different substances for them.

An emergency occurrence is an uncertain event, and the risk of losing a single soul or life is a concern to many health managers and other related healthcare agencies. Over the past few years, many health concerns have focused on bridging the gap between patients and their caregivers. In this regard, the research interest is to perform a survival analysis of the sick and injured in the era of pre-hospital care in the Upper East Region, and the method used was survival analysis for the occurrence of life events. A total of four thousand, five hundred and sixty-two (4,562) patients were involved, covering 18 operational months. The results showed that there was a higher probability of a patient surviving within the first ten minutes than in the last 30 minutes to an hour. The study found that an EMS-transported patient has a 97.58% chance of surviving given that the incident has not occurred beyond 10 minutes of onset and a 94.53% survival rate for persons whose incident occurred between 30 and 60 minutes from the onset, which is below the average survival rate of 94.98%. The Gamma AFT model fits the survival dataset well and has better predictive power than any other distribution under the AFT model. The study concludes that the survival of pre-hospital patients is higher within the first 10 minutes, as are patient location, incident type, age of the patient, and other factors that affect patient survival.

This reviews the variety, chemical composition, pharmacological effects, toxicology, and clinical research of coral used in traditional medicine in the past two decades. At present, there are 56 formulas such as traditional Chinese medicine, Tibetan medicine, Mongolian medicine, and Uyghur medicine. 34 families and 99 genera of corals are involved in medical research, with the Alcyconiidae family and Sarcophyton genus being the main research object. The compounds extrate from coral includ terpenoids, steroids, nitrogen-containing compounds and others. The biological activities of coral include cytotoxicity, anti-inflammatory and analgesic, antibacterial, antiviral, immunosuppressive, antioxidant, neurological, and other aspects, and a detailed summary of its related mechanisms or target targets is provided. Coral toxicity mostly occurs in the marine ornamental soft coral Zoanthidae genus, with Palytoxin as the main toxic component. At the same time, non peptide neurotoxins are extracted from aquatic corals. The compatibility of coral related preparations did not show significant acute toxicity, but if used for a long time, it will still cause toxicity to the liver, kidneys, lungs and others in a dose-dependent manner. In clinical applications, individual application of coral is often used as a substitute for orthopedic materials to treat bone diseases. Secondly, it mainly appears in the form of compound preparations which contain coral, such as Ershiwuwei Shanhu Pills, which are widely used in neurological diseases such as migraine, epilepsy. This article is expected to provide some reference for the research of coral chemical composition, biological activity, chemical ecology and the discovery of marine drug lead compound.

People with mpox are likely to be stigmatized because of analogies to other sexually transmitted infections. Stigma is driven by beliefs about the perceived severity of the condition and perceived responsibility for acquiring the condition, both in broader society and individual responsibility. We explored these beliefs and compared them across mpox, HIV, syphilis, gonorrhoea, and chlamydia in an online survey, conducted in July, 2022, with 394 men-who-have-sex-with-men (MSM) in the Netherlands. We compared mean scores between infections using repeated measures ANOVA and conducted hierarchical regression analyses to identify determinants of both mpox perceived responsibility endpoints. Results showed that participants expected that mpox would be seen as a ‘gay disease’ and will be used to blame gay men. Compared to other infections, mpox was considered less severe than HIV, but more severe than syphilis, gonorrhoea, and chlamydia. Perceived responsibility was comparable across infections, but, for each infection, participants perceived attributed responsibility for infection to be higher in society than individual responsibility. Both perceived responsibility endpoints were highly correlated with each other and with other stigma beliefs. These results provide insight on the underlying determinants of mpox stigma, and demonstrate that mpox stigma is present in the Netherlands.

This paper disrupts mistaken applications of multifractal approaches in financial time series. Specifically, we have examined the non-linear cross-correlation between the São Paulo time series of the weekly price of ethanol and the other 14 Brazilian capitals' time series of the weekly price of the same biofuel using the Multifractal Detrended Cross-Correlation Analysis (MF-DCCA). Given the statistical peculiars of stationary and non-stationary financial time series, we suggest two possibilities for employing multifractal approaches to these time series. Our findings shed light and promote alignment between basic time series analysis techniques and multifractal dynamics. Also, we discover that the use of MF-DCCA is highly impacted by choice of time series (stationary or non-stationary).

When the original tissues or organs are severely damaged or injured, the ideal treatment is to replace the affected tissues with other tissues that function both structurally and biologically. The current research aims to produce high-precision webs of polymers dissolved in water, acids, or solvents, as well as work to improve their structure and morphology by using a rotary needleless electro-spinning technique, to be used in different fields. The Nano-fibers were made of polycaprolactone polymer, and that is highly reflected on the diameter of the fibers and their spin-ability. Adjusting the concentration, polymerization, viscosity, and density have a great role in overcoming the surface tension strength and thus starting the production process and obtaining bio-Nano-fiber webs. As a result, a mechanism to form medical scaffolds directly on the body was developed using the electro-spinning technique, with the possibility of applying several layers on top of each other which helps stop bleeding that occurs during surgeries and other applications.

Summary: This paper proposes a 1/f noise optimized correlated multiple sampling (NOCMS) technique based on differentiated sampling weights for CMOS image sensor. Transfer functions of standard CMS and NOCMS for analyzing the suppression effect of random noise respectively are derived based on the Fourier Transform theory. NOCMS shows a dramatic advantage in the suppression of 1/f noise. For implementing NOCMS, the ramp generator provides multiple sets of ramps with different slopes to quantize the reset and signal voltages. Sampling weights are increased with the decrease of ramp slopes. The last reset and first signal values are weighted more due to their potentially higher correlations. Simulation results under 110nm CMOS technology illustrate that the ADC achieves DNL of −0.80/+0.70LSB and INL of −0.70/+0.90LSB after the NOCMS operation. The input-referred random noise is 142.9µV rms under standard CMS and 120.9µV rms under NOCMS when the number of samples equals 8. The noise reduction effect is improved by 15%. NOCMS makes it possible to further reduce 1/f noise of CMOS image sensor.

Pre-flexion stages of Atlantic bluefin tuna (Thunnus thynnus) larvae were collected in 2014 during the peak of spawning in the two main spawning areas: Gulf of Mexico (GOM) and Mediterranean Sea (MED). We examined daily growth, otolith biometry, and stable isotopes and found that the GOM grew at a faster rate, had larger otoliths, wider daily increments, and significantly lower values of δ15N when compared to the MED. In addition, an intra-population comparative analysis between slow- and fast-growing individuals (deficient vs. optimal growth groups, respectively) showed that optimal growth groups had significantly lower δ15N within each spawning area, implying a direct relationship between growth potential, development, and maternal transmission of isotopic signatures. A third pre-flexion larval group that was aquaculture-reared also exhibited the same pattern to the wild larval groups. In addition, for the first time, we estimated the maternal trophic niches using models developed with field-captured pre-flexion larvae. The estimated maternal trophic niches for the GOM were narrower than the MED, implying differences in the maternal trophodynamics from each nursery area. Overall, the inter-population (GOM vs. MED) and intra-population growth groups (deficient vs. optimal) grew faster and had narrower maternal niches. This study shows the advantages that larval SIA research can aid in the understanding of the trophodynamics of their breeders by examining the trophic relationship of a spawning stock jointly with the development of growth potential in offspring within the same breeding season.

Cardiovascular diseases (CVDs) are complex, encompassing many types of heart pathophysiologies and associated etiologies. It has been shown that fractionated radiation exposure at high doses (3-17 Gy) to the heart increases the incidence of CVD, as evident from radiotherapy studies. However, the effects of low doses of radiation on the cardiovascular system or the effects from space travel, where radiation and microgravity are important contributors to damage, are not clearly understood. Herein, the adverse outcome pathway (AOP) framework was applied to develop an AOP to vascular remodeling from the deposition of energy. Following the creation of a preliminary pathway with the guidance of field experts and authoritative reviews, a scoping review was conducted which informed final key event (KE) selection and facilitated evaluation Bradford Hill criteria of the key event relationships (KERs). The AOP begins with a molecular initiating event of deposition of energy; ionization events increase oxidative stress, which concurrently causes the release of pro-inflammatory mediators and alters signaling pathways. These KEs alter nitric oxide levels leading to endothelial dysfunction and subsequent vascular remodeling (the adverse outcome). The work identifies evidence needed to strengthen understanding of the causal associations for the KERs, emphasizing where there are knowledge gaps and uncertainties in both qualitative and quantitative understanding. The AOP is anticipated to direct future research to better understand the effects of space on the human body and potentially develop countermeasures to better protect future space travelers.

{The use of state estimation techniques offers a means of inferring rotor effective wind speed from standard measurements of wind turbines. Typical wind speed estimators rely upon a pre-computed quasi-steady aerodynamic mapping, which describes the relationship between pitch angle and tip-speed ratio and the power coefficient. In practice, the static mapping does not capture the influence of turbine structural dynamics and atmospheric turbulence, inevitably resulting in poor performance of the wind speed estimation. In addition, the turbine aerodynamic properties might not be easily accessible. Thus, this paper presents a rotor effective wind speed estimation method that obviates the requirement for prior knowledge of turbine power coefficients. Specifically, the proposed method exploits a simple actuator disc model, where the aerodynamic power and thrust coefficients can be characterised in terms of axial induction factors. Based on this insight and standard turbine measurements, real-time estimation of rotor effective wind speed and axial induction factors can then be achieved using a simplified turbine drive-train model and an extended Kalman filter. In addition, the actuator disc model can be updated easily over time by calibrating solely two correction factors. Thus, the proposed algorithm presents an alternative for estimating the rotor effective wind speed, which is valuable for numerous applications, for example, LiDAR-assisted control and coherence studies.

Stanford type A acuteaortic dissection associated with aircraft depressurization: Cause or coincidence? Mauer A.A. Gonçalves1,2; Humberto Morais2,3; Valdano Manuel4; Fernando Coelho1, Sheila Nunes1, Fernando Flora1.1Luanda Medical Center, Angola;2Centro de Estudos Avançados em Educação e Formação Médica, Faculdadede Medicina, Agostinho Neto University, Luanda, Angola3Hospital militar Principal/Instituto Superior4Centro cardiotorácico, Hospital de Doenças Cardiopulmonares Don Alexandre do NascimentoCorresponding Author: *Humberto Morais – Hospital Militar Principal/Instituto Superior,Rua Pedro Miranda 40-42 Maianga Luanda Republic of AngolaEmail: hmorais1@gmail.com Telephone: +244923520937We declare that the patient approved the study by signing an informed consent form and the study followed the ethical guidelines established by the Declaration of Helsinki.

Delayed cerebellar ataxia induced by Plasmodium falciparum malaria: A rare complicationEmmanuel Edwar Siddig1,2,*, Sarah Misbah EL-Sadig3, Hala Fathi Eltigani1, Ahmed Mudawi Musa4, Nouh Saad Mohamed5, Ayman Ahmed4,6,71 Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan2 Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan.3 Faculty of Medicine, University of Khartoum, Khartoum, Sudan4 Institute of Endemic Disease, University of Khartoum, Khartoum, Sudan5 Molecular Biology Unit, Sirius Training and Research Centre, Khartoum, Sudan6 Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil 4123, Switzerland7 University of Basel, Petersplatz 1, Basel 4001, Switzerland* Correspondance: Emmanuel Edwar Siddig; University of Khartoum, Khartoum, Sudan.Email: emanwelleds389@gmail.comORCID: 0000-0001-6314-7374

A document by Shyam Duvuru. Click on the document to view its contents.

Background: Sickle cell disease (SCD) is characterized by vaso-occlusive crises (VOCs), that impair the health-related quality of life (HRQoL). The aim of this study is to evaluate the impact of hospitalization for VOCs on HRQoL in children with SCD over time. Methods: In this longitudinal cohort study, children aged 8-18 years diagnosed with SCD at the Amsterdam UMC were included between 2012 and 2021. HRQoL was annually measured as part of standard care using the Pediatric Quality of Life Inventory. The impact of hospitalization for VOC on HRQoL was evaluated using linear mixed models 3, 6, 9 and 12 months after hospitalization. The effect of frequency of hospitalization for VOC on HRQoL was evaluated over the last 12 months. Results: In total , 94 children with SCD were included with a median age of 11.8 years (IQR 9-14). Thirty-seven patients (39%) had been hospitalized for a VOC. Hospitalization for VOC led to a decrease of 3.2-4.8 points in total HRQoL compared to patients without hospitalization, most pronounced 3 months after hospitalization. Recurrent admission for VOC in the last 12 months was associated with a decrease of 2.3 points in total HRQoL (p=0.04). The most affected subscale was physical functioning. Conclusion: The adverse effects of hospitalization for VOC in children with SCD persist up to 12 months after hospitalization. After hospitalization for VOC, extra attention and support for its negative impact on HRQoL are recommended. This study also underlines the importance of systematically measuring HRQoL allowing clinicians to intervene accordingly.

The genus Orthoflavivirus integrates several arboviruses of great im- portance in public health, including West Nile virus (WNV). The search for new bioactive compounds of natural origin has become a very important line of research. The species Inga edulis Martius is used in folk medicine as an antidiarrheal and anti-inflammatory agent. In silico analyses were performed to predict the pharmacokinetics and toxicodynamics of the main compounds present in the extract, followed by in vitro analyses. A time-of-addition assay was carried out to evaluate the antiviral effect of the extract at different stages of infection. The results demonstrate the main compounds of the extract did not retain the blood-brain barrier permeability and their bioavailability complied with what is expected for a good drug in some parameters. The CC50 obtained was 144.6 µg/mL, with the highest concentrations used (25 and 50 µg/mL) not significantly cytotoxic to the cells. The concentration of 25 µg/mL showed anti-WNV action when added before or during the infection procedure. It is therefore concluded that the compounds from the crude extract of I. edulis leaves have an inhibitory activity in WNV infection in neuroblastoma cells and can be further explored for the development of antiviral drugs.

Background: The S5-methylation test, as an alternative classifier to cytology and HPV16/18 genotyping to triage cervical squamous intraepithelial lesions, has not been widely validated in Asian countries. Herein, we compared S5 methylation to HPV16/18 and cytology to detect cervical high-grade squamous intraepithelial lesion (HSIL) in a screening population who with either HPV infection or abnormal cytology results or both of them, derived from a multi-central clinical trial of 2246 Chinese participants. We matched all ≥HSIL+ cases (n=468) with ≤LSIL controls (n=468) to analyze the effectiveness of methylation. Methylation of S5 was quantified by pyrosequencing, blinded to cytology, histological and initial HPV results. Results: The S5 methylation could distinguish women with ≥HSIL+ from women with ≤LSIL at a high area under the curve (AUC) of 0.80 (95% CI 0.74-0.85). The sensitivity of S5 methylation (at 2.85 cutoff) for ≥HSIL+ was 76.1% (95% confidence interval [CI] 71.7-79.2) was higher than HPV16/18 sensitivity (64.9%, 95% CI 58.3-71.7, P = 0.039) or cytology (48.9%, 95% CI 42.8-53.2, P < 0.001). At this cutoff, the specificity of S5 for ≥HSIL+ was (79.9%, 95% CI 76.2-84.9), higher than HPV16/18 (44.8%, 95% CI 40.1-49.4, P < 0.001) and cytology (54.6%, 95%CI 50.7-57.9, P < 0.001). In addition, S5 methylation could provide predictive information about progression in specific population in follow-up period. Conclusion: S5 methylation classifier with high sensitivity and specificity exceeded HPV16/18 or cytology for detecting women with ≥HSIL+ in a screening Chinese population with HPV infection and/or abnormal cytology results. Furthermore, S5 methylation is a potential classifier for predicting progression.

In this paper, we investigate the application of Hybrid Representation in Wide-Angle Synthetic Aperture Radar (WASAR) imaging, addressing the challenges of achieving sparse representation in the presence of complex electromagnetic scattering characteristics and highly anisotropic targets. We utilize a Convolutional Neural Network (CNN) to represent two-dimensional data within the same subaperture, while employing dictionary learning for sparse representation across different subapertures. Convolutional Neural Networks (CNNs) excel at learning spatial hierarchies and local dependencies in two-dimensional data, but require a large amount of training data. Isotropic targets within subapertures can be used for training with conventional SAR data, whereas anisotropic targets present challenges in obtaining training samples. To address this, a dictionary for different subapertures is generated from measurements using dictionary learning, eliminating the need for additional training data. By integrating these methods, we propose a novel approach, Hybrid-WASAR, which incorporates two regularization terms into WASAR imaging and employs the Alternating Direction Method of Multipliers (ADMM) to iteratively solve the imaging model. Compared to traditional WASAR imaging techniques, Hybrid-WASAR not only enhances the accuracy of the reconstructed target backscatter coefficients, but also effectively reduces sidelobes and noise, resulting in a significant improvement in overall imaging quality.

Runoff erosion response associated with sediment transport as influenced by erosive energy variability is a highly scale-dependent process. It is of great significance to effectively identify the spatial scale effect on erosive runoff energy for understanding the spatial pattern of sediment flow behavior across various sites. To address this issue, thresholds for erosive runoff were established based on frequency analysis and four selected threshold parameters including runoff duration ( T), stream power ( ω), stream energy factor ( SE) and area-specific sediment yield ( SSY). Based on these thresholds, 77 erosive events were identified and separated from non-erosive events for further analysis. The threshold for T was roughly constant at hillslope but rapidly increased at entire slope. Thresholds for ω and SE was linearly and positively related to the plot area. A general increasing trend was observed in the threshold for SSY from the upper hillslope to the entire slope. The sediment delivery capacity of erosive runoff varied from 0.075 to 0.115 kg·m·J -1, while the sediment increments capacity of erosive runoff ranged from 0.43 to 4.47 kg·m -2·W -1. The sediment reduction benefit by regulation unit stream energy factor varied from 5% to 65%. Overall, erosive runoff events were characterized by longer runoff duration and larger erosive energy, as well as greater sediment delivery capacity compared to non-erosive events. Therefore, the runoff regulation on slopes should be mainly orientated at the erosive energy control and the conversion of slope runoff from erosivity to non-erosivity.

Class-level complexity is a significant component of software complexity, and measuring software complexity is essential for software development and maintenance. Although the Weighted Class Complexity (WCC) metric has a long history of use, it has some drawbacks, including the equal weighting of complexity components and the exclusion of some complexity elements,. In this paper, we present a novel metric, the Enhanced Weighted Class Complexity (EWCC) metric, which extends the WCC metric by adding more complexity variables and weighting them according to their relative relevance. Data access patterns, method call chains, and control structure complexity are among the other variables. In order to compare the EWCC metric’s output to the WCC metric’s output, we apply it to a number of software systems. We assess the EWCC metric’s performance in locating potential error and bug sources. The findings indicate that, compared to the WCC metric, the EWCC metric offers a more thorough and precise evaluation of class-level complexity. According to the results, software developers and maintainers may find the EWCC measure to be a useful tool for controlling software complexity.

Mobile edge computing (MEC) seems to be highly efficient to process the generated data from IoT devices by providing computational resources locating in close range to network edge. MEC can be promising in reduction of latency and consumption of energy from data transmissions from offloading computational tasks from IoT devices to nearby edge servers. In this paper, a computation offloading optimization algorithm is proposed which is based on deep deterministic policy gradient for realistic Aurelia X6 Pro unmanned aerial vehicle (UAV)-assisted MEC systems. The proposed algorithm optimizes the offloading decision for UAVs by taking task characteristics and the communication environment into consideration. The simulation yields outcomes indicating that the suggested algorithm can considerably enhance the competency of MEC systems.

The spatiotemporal variability of groundwater level (GWL) is an important property of peatland hydrology that directly affects fluctuations of water storage. Nonetheless, current understanding of the variations of GWL in different time scales still remains unclear. In this study, two peatland watersheds (0.151 km 2 for W1 and 0.844 km 2 for W2) in the Zoige Basin in the Source Region of the Yellow River (SRYR) were selected for monitoring the temporal variability of GWL using self-recorded water loggers during 2017-2021. The main results demonstrate that: (1) GWL variations tended to be controlled by gully drainage in sites adjacent to the gully and be more synchronized with rainfall in sites distant from the gully. The GWL near the gully that cuts through the peat layer was lower than that near the gully without cutting through the peat layer, with a maximum difference between the former and the latter of 58.3 cm, indicating the effect of longitudinal attenuation of the GWL in W1. (2) Because rainfall had a lag effect on the GWL, the length of lag gradually decreased with increased rainfall intensity (i.e., the lag time of sites far away from the gully was about 18 min shorter than that of sites close to the gully in W1). (3) The peak values of the GWL occurred simultaneously with the maximum and minimum rainfall in W2, and the peak occurrence time was related to the ratio of precipitation to evaporation. In the downstream sites, GWL fluctuated more intensively than the upstream ones in W2. Moreover, the average GWL of the upstream sites was 14.3 cm higher than that of the middle ones, indicating a decreasing trend of water storage along the gully. (4) The GWL discrepancy between wet and dry seasons was explicit, but the difference was smaller in the upstream sites due to limited gully incision and higher water storage within the peat layer. Additionally, rainy days dominate the GWL change in wet and dry seasons, but the different rainfall intensity resulted in a stable GWL in the dry season and an oscillating GWL in the wet season in W2. This study uncovers the spatio-temporal variation of groundwater level in two peatland watersheds, which is of great significance for understanding runoff variation, ecohydrological processes, and wetland shrinkage in the SRYR.

NAD +-dependent formate dehydrogenase from the bacterium Staphylococcus aureus (SauFDH) plays an important role in the vital activity of these bacteria. The gene encoding SauFDH was successfully cloned and expressed in our laboratory. Since this enzyme has the highest k cat value among the described FDHs and also has a high temperature stability compared to other proteins, it can be considered as a promising catalyst for regeneration of NAD(P)H. The main disadvantage of this enzyme are high K M values. In this work, the principle of rational design was used to reduce K M. As a result, 9 catalytically significant positions 119, 194, 196, 217-219, 246, 303, and 323 were identified, and 16 new mutant forms of SauFDH were obtained and fully characterized. Substitutions in positions 119 and 194 lead to an increase of K M NAD+. In the Ile-Val-Ala-Gly line, position 119 tends to improve NAD + binding. K M NAD+ of SauFDH V119G decreased by 27 times compared to the wild-type enzyme. K M NAD+ Phe194Val decreased by 3.5 times. The catalytic constant for this mutant form practically did not change. The use of a complex buffer increased the catalytic efficiency 6 times for the mutant with the Phe194Val substitution compared to wt-SauFDH in a single-component buffer.

LATE-ONSET GENERALIZED ERUPTIVE SYRINGOMA: A RARE CASE REPORTSandesh Shah MDa, Ejaz Khan MDb , Ujwal Rautc, Garima Shresthad, Radhika Maharjanc,Author details:a Department of Dermatology and Venerology, KIST Medical College and Teaching Hospital, Lalitpur, Postal Address:44700, Nepal.b Department of Dermatology and Venerology, Mahakali Provincial Hospital, Mahendranagar, Postal Address: 10400, Nepal.c B. P. Koirala Institute of Health Sciences, Dharan, Postal Address: 56700, Nepal.d KIST Medical College and Teaching Hospital, Lalitpur, Postal Address:44700, Nepal.Corresponding AuthorSandesh Shah MDDepartment of Dermatology and Venerology, KIST Medical College and Teaching Hospital, Lalitpur, Postal Address:44700, Nepal.Email: shahsandy5745@gmail.comMobile: +977-9849552682