Management of Unintentional Acute Organophosphate Poisoning After Dermal Exposure in Primary Health Care Setting: A Rare Case ReportBishal Koirala1, Priyanka Devkota2, Raghu Devkota31Medical Officer, Dangisharan Basic Hospital, Dang, 22400, NepalEmail: [email protected]: 0009-0008-3663-997XContact number: +97798455675411Corresponding Author2Lab Research Analyst, Duke Human Vaccine Institute, North Carolina, 27710, USAEmail: [email protected]: 0009-0003-4882-114XContact number: +166249702363GP Registrar, Clocktower medical centre, Sale, Victoria, 3850, AustraliaEmail: [email protected] number: +61431407427

not-yet-known not-yet-known not-yet-known unknown A Case of Pneumocystis Pneumonia in an HIV/AIDS Patient from Sudan Emmanuel Edwar Siddig1, Alaa Tajeldeen Habeeb2, Claude Mambo Muvunyi3 , Ayman Ahmed3,4,5 1 Faculty of Medical Laboratory sciences, University of Khartoum, Khartoum, Sudan 2 Rufa’a Teaching Hospital, Aljazeira state, Sudan 3 Rwanda Biomedical Centre, Kigali, Rwanda. 4 Institute of Endemic diseases, University of Khartoum, Khartoum, Sudan 5 Pan-Africa One Health Institute (PAOHI), Kigali 11KG ST203, Rwanda

Aimed to comprehensively investigate the presence of neural autoantibodies in the cerebrospinal fluid (CSF) and plasma of COVID-19 patients experiencing neurological complications during the Omicron wave in China. Forty consecutive COVID-19 patients with severe neurological complications and 15 disease controls (DC) were enrolled in the study. Neural autoantibodies were detected using both the indirect immunofluorescence assay (IFA) on mouse brain tissue and the Brain-neuronal-antigen microarray. A bioinformatics analysis was conducted to evaluate the similarity between SARS-CoV-2 proteins and the specific antigens identified by the microarray. Our results showed a markedly elevated prevalence of neural autoantibodies in CSF (62.16% vs. 0.0%) and in plasma of COVID-19 patients compared to DC using IFA. Additionally, we identified 12 upregulated intrathecal IgG autoantibodies with differential levels between COVID-19 patients and DC, as well as 51 upregulated IgG autoantibodies in plasma. Anti-mGluR2 antibodies exhibited the highest positivity rate in COVID-19 patients, a finding further confirmed by cell-based assays (CBA). Moreover, we discovered a shared peptide similarity between the SARS-CoV-2 N, S protein and mGluR2. Among two COVID-19 patients with positive anti-mGluR2 antibodies, there were specific and prominent bindings to both the RBD-Fc of S and mGluR2, while only weak binding was observed to N.

not-yet-known not-yet-known not-yet-known unknown Opercular Syndrome as a Sequelae of Herpes Simplex Virus Infection: A Case Report Nischal Neupane1, Devansh Upadhyay1*, Gehendra Jung Kunwar1, Prajjwol Luitel1, Sujan Paudel1, Bibek Koirala2, Sunil Babu Khanal3, Pradeep Panthi4, Ragesh Karn4, Rajeev Ojha4 1 Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine Kathmandu, Nepal. 2 Department of Radio-diagnosis and Interventional radiology, Tribhuvan University, Institute of Medicine Kathmandu, Nepal 3 Department of Internal Medicine, Tribhuvan University, Institute of Medicine Kathmandu, Nepal 4 Department of Neurology, Tribhuvan University, Institute of Medicine Kathmandu, Nepal. *Corresponding Author: Devansh Upadhyay [email protected] Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine Kathmandu, Nepal. Orcid: 0000-0002-1186-7844

Haploblocks are regions of the genome that coalesce to an ancestor as a single unit. Differentiated haplotypes in these regions can result from the accumulation of mutational differences in low-recombination chromosomal regions, especially when selective sweeps occur within geographically structured populations. We introduce a method to identify large well-differentiated haploblock regions (LHBRs), based on the variance in standardized heterozygosity (ViSHet) of single nucleotide polymorphism (SNP) genotypes among individuals, calculated across a genomic region (500 SNPs in our case). We apply this method to the greenish warbler (Phylloscopus trochiloides) ring species, using a newly assembled reference genome and genotypes at more than 1 million SNPs among 257 individuals. Most chromosomes carry a single distinctive LHBR, containing 4-6 distinct haplotypes that are associated with geography, enabling detection of hybridization events and transition zones between taxa. LHBRs have exceptionally low within-haplotype nucleotide variation and moderately low between-haplotype nucleotide distance, suggesting their establishment through recurrent selective sweeps at varying geographic scales. Meiotic drive is potentially a powerful mechanism of producing such selective sweeps, and the LHBRs are likely to often represent centromeric regions where recombination is restricted. Links between populations enable introgression of favored haplotypes and we identify one haploblock showing a highly discordant distribution compared to the rest of the genome, being present in two distantly separated geographic regions that are at similar latitudes in both east and west Asia. Our results set the stage for detailed studies of haploblocks, including their genomic location, gene content, and contribution to reproductive isolation.

Nisin is an antimicrobial peptide widely used as a biopreservative to extend shelf life and control foodborne pathogens, particularly Gram-positive bacteria such as Listeria monocytogenes. However, its efficacy against Gram-negative bacteria is limited due to its inability to penetrate their outer membrane and reach its target, lipid II, in the inner membrane. Agents that alter the outer membrane’s permeability can overcome this limitation, enabling nisin to access the periplasm and expand its antimicrobial spectrum. In this study, we aimed to extend nisin’s spectrum of action towards Gram-negative bacteria by fusing it with salmochelin, a siderophore produced by Salmonella.Siderophores capture extracellular iron and enter cells through specific receptors. The nisin-salmochelin conjugate was synthesized through an external chemical reaction, yielding a compound with activity against Gram-positive and Gram-negative bacteria. Among the Gram-negative bacteria, notable strains include S. enterica Newport, S. entericaTyphimurium, E. coli O157, E. coli EC3 (uropathogenic isolate), and Providencia rettgeri. This novel conjugate exhibits broad-spectrum activity against foodborne pathogens, significantly enhancing nisin’s potential as a food biopreservative and expanding its clinical applications.

This paper presents a blended learning framework designed to cultivate computational thinking skills within the context of the "Introduction to Computer Science and Programming" course. By combining online and offline instructional approaches, the proposed model establishes a cohesive educational paradigm that seamlessly integrates computational thinking principles throughout the curriculum. Additionally, an evaluative model is introduced to assess proficiency levels in computational thinking. Through a meticulous analysis of empirical teaching data, the study confirms that the blend of instructional modalities is both a feasible and effective strategy for enhancing computational thinking competencies.

This article presents a circular array using four-elements dipole with beam-switching capabilities for 5G communications. The beam can switch in four directions by controlling the switch states implemented in the arms of each dipole. The different antenna modes lead to different radiation behaviors. The first is a directional behavior containing 4 radiation modes depending on the dipole fed into the network. The second type of radiation has a double beam pattern according to the two fed dipoles. According to the simulated results, a corresponding overall bandwidth of 932.3 MHz (S11 < - 10 dB) can be obtained with a peak gain of 3.15 dBi and an overall efficiency of 80%. The proposed antenna is fabricated and measured to verify the simulation results. This low-cost, efficient, and easy-to-design antenna array can be very useful for 5G beam switching applications.

Medications selected to treat problems of pregnancy in the mare must be simultaneously safe for the mare, safe for the developing fetus, and able to penetrate the placental barrier. With consideration of these factors, the practitioner must determine when and for how long to administer therapy. Monitoring equine pregnancy can be challenging, owing to the size of the equine abdomen (precluding visualization of the entire fetoplacental unit), individual variation in appearance of the reproductive tract, and (typically) minimal clinical signs of pregnancy compromise until late in a disease process. This paper is an extension of an article originally prepared for the 2023 Proceedings of the American Association of Equine Practitioners, produced with permission.

Kaposi’s sarcoma (KS) is an AIDS-defining cancer and a significant global health challenge caused by Kaposi’s sarcoma-associated herpesvirus (KSHV). NGS-based approaches have profiled KS lesions in a minimal number of studies compared with other neoplastic diseases. Here we present a compiled and harmonized dataset of 131 KS and non-tumor cutaneous samples in the context of their predicted pathway activities, immune infiltrate, KSHV and HIV gene expression profiles, and their associated clinical data representing patient populations from Argentina, United States (USA), and Sub-Saharan Africa cohorts. RNA-seq data from 9 Argentinian KS lesions were generated and integrated with previously published datasets derived from the USA and sub-Saharan African cohorts from Tanzania, Zambia, and Uganda. Unsupervised analysis of 131 KS-related samples allowed us to identify four KS clusters based on their host and KSHV gene expression profiles, immune infiltrate, and the activity of specific signaling pathways. The compiled RNA-seq profile is shared with the research community through the UCSC Xena browser for further visualization, download, and analysis ([https://kaposi.xenahubs.net/](https://kaposi.xenahubs.net/)). These resources will allow biologists without bioinformatics knowledge to explore and correlate the host and viral transcriptome in a curated dataset of different KS RNA-seq-based cohorts, which can lead to novel biological insights and biomarker discovery.

Author names and Affiliations: Joshana Shrestha1, Mohan Bhusal2, Smriti Piya1, Rabin Baniya1, Sanjay Dhungana3.Resident Doctor, Department of Dermatology, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal.Lecturer, Department of Dermatology, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal.MBBS Student, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal.Corresponding author:Joshana Shrestha,Nepal Medical College and Teaching Hospital, Kathmandu, NepalEmail: [email protected] ID: https://orcid.org/0009-0000-5570-189XOther Author Details:Mohan Bhusal, Email id: [email protected] , Orcid id: https://orcid.org/0000-0003-3122-2346Smriti Piya, Email id: [email protected], Orcid id: https://orcid.org/0009-0002-8408-7547Rabin Baniya, Email id: [email protected], Orcid id: https://orcid.org/0009-0009-7761-6552Sanjay Dhungana, Email id: [email protected], Orcid id: https://orcid.org/0009-0000-9776-0361Total number of pages: 18Total number of photographs: 7Total number of tables: 1

The Uncommon ECG Signature of Hypokalemia: Left Main Coronary Equivalent

Progressive balance exercises may change corticomotor excitability during the learning process of postural stability control. The primary purpose of the present study was to assess corticomotor excitability corresponding to the peroneus longus muscle under transcranial magnetic stimulation following 6 weeks of progressive balance exercises in individuals suffering from functional ankle instability. Eligible volunteers with functional ankle instability were randomly and equally assigned to either the intervention or control groups. The intervention group participated in progressive balance exercises every other day for 6 weeks, while the control group continued their daily activities and refrained from new physical activities. The variables were measured in the intervention group before and after the progressive balance exercises, and in the control group twice at an interval of 6 weeks. The primary variables included the active and resting corticomotor thresholds, motor evoked potential, and cortical silent period, which were measured using an electromyography device under a transcranial magnetic stimulator. The corticomotor thresholds and cortical silent period of the peroneus longus muscle significantly decreased in the intervention group following progressive balance exercises (p-value < 0.001), whereas the normalized motor evoked potential significantly increased in the same group (p-value < 0.001). Conversely, no significant changes were detected in the control group (p-value > 0.086). The present study revealed, for the first time, that 6 weeks of progressive balance exercises significantly increased corticomotor excitability corresponding to the peroneus longus muscle and improved balance control in individuals suffering from functional ankle instability.

Case Report：Psoas Abscess Caused by Carbapenem-Resistant Enterobacteriaceae in a CO Poisoning PatientXinyue Ma1; Chengxin Song1;Lijun Ma2; Jiacui Zhang3*;Ling Li3;Fengmei Zou3;1 Gansu University of Chinese Medicine, Lanzhou, Gansu, China.2 The NO.2 People’s Hospital of Lanzhou,Lanzhou, Gansu, China.3 Gansu Provincial People’s Hospital, Lanzhou, Gansu, China.*Corresponding author: Jiacui Zhang; Address: Gansu Provincial People’s Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, Gansu, China; E-mail: [email protected]

TitleRole of cholesterol crystals in the etiological diagnosis of two episodes of middle cerebral artery occlusion: A case report

Purpose: To assess the prevalence and severity of transfusion-associated iron overload in survivors of childhood cancer. Patients and Methods: Serum iron, total iron binding capacity, percent iron saturation and ferritin were measured in 75 survivors of childhood cancer. In addition, blood bank records were reviewed to determine the volume of packed red blood cells (pRBCs) administered during cancer therapy. Patients who received > 120ml/kg of pRBCs or had a ferritin > 1,000mcg/L underwent hepatic R2 and cardiac T2* MRI for iron quantification, echocardiogram, assessment of liver and endocrine function, and genetic analysis for hereditary hemochromatosis. Results: Forty-nine patients qualified for second level studies. Of these, 35 completed the MRI scans. Fifteen patients had a liver iron concentration (LIC) >3mg iron/g (moderate hepatic iron overload), including eight patients who had an LIC greater than 7 mg iron/g (severe hepatic iron overload), with a mean LIC of 4.3 mg iron/g (0-15.6mg iron/g). LIC correlated with both total volume of pRBCs and ferritin. No patient had cardiac iron loading by MRI. Eleven patients were heterozygous and one was homozygous for mutations associated with hereditary hemochromatosis. There was no correlation between iron overload and hereditary hemochromatosis gene status. Conclusion: There is a high prevalence of transfusion-associated iron overload among survivors of childhood cancer. This is concerning given the overlap between organ toxicities associated with cancer treatment and those known to be associated with iron overload. The tight correlation between LIC and ferritin suggests ferritin may be a reliable indicator of iron load in this patient population.

Spatial visual attention prioritizes specific locations while disregarding others. The location of spatial attention can be deployed without overt movements (covertly). Spatial dynamics of covert attention is exceptionally difficult to measure due to its hidden nature. One way to implicitly index the location of covert attention is via pupillary light responses (PLR), as the strength of PLR is modulated by where attention is allocated. However, this method has so-far necessitated simplistic stimuli. Here we report on a novel pupillometric method that allows to track covert attention even with highly complex stimuli. Participants (n = 36) watched movie clips while they either passively viewed the movie, or they top-down shifted covert attention to targets in the left, right, or both sides of the visual field. Using a recent toolbox (Open-DPSM), we evaluated whether luminance changes in regions presumably receiving more attention contribute more strongly to the pupillary responses – and thereby reveal covert attention. Three independent and established effects of covert attention on pupil responses were found: (1) a bottom-up effect suggesting more attention drawn to more dynamic regions in the movie, (2) a top-down effect suggesting more attention towards the instructed direction, and (3) an overall tendency to attend the left side (i.e., pseudoneglect). These findings show that pupil responses can physiologically index covert attention with our approach, even in highly dynamic and complex environments. We see considerable potential in measuring covert attention with our method in many real-life scenarios that were impossible to study before.

Multispecific antibodies are increasingly being explored in the pharmaceutical industry for unmet patient needs. This work focuses on generating these molecules through an electrostatic-steering strategy, where two separate parent homodimer antibodies are expressed and purified, then combined into the heterodimer multispecific through reduction and oxidation chemistry. Traditional operations for electrostatic steering multispecifics can include complex processing steps. Therefore, a novel redox process to generate the multispecific has been explored. This process involves a column-based reduction reaction and a spike of oxidant in the elution pool to form the heterodimer. This new strategy can simplify the downstream purification process for electrostatic-steering based molecules. The method consists of simultaneously binding two separate parental homodimers to the protein A chromatography resin and applying a reductant wash to reduce the interchain disulfide bonds. The molecules are then eluted, neutralized, and oxidized to form the intact heterodimer. The mechanism and rates of reduction, heterodimerization, and oxidation have been characterized to maximize conversion and product quality. This strategy has been demonstrated successfully for five multispecifics with diverse specificity and IgG subclasses. Implementing this method for pharmaceutical bioprocesses in the production of multispecific molecules offers the potential for the reduction in manufacturing complexity while maintaining acceptable product quality and yield.