PPP1R21-related neurodevelopmental disorder (PPP1R21-NDD) is an ultra-rare autosomal-recessive encephalopathy caused by dysfunction of the Five-subunit Endosomal Rab5 and RNA/ribosome intermediarY (FERRY) complex. To delineate the clinical, neuroimaging, and molecular spectrum of PPP1R21-NDD and outline diagnostic and research priorities. Targeted searches of PubMed, EMBASE, Scopus, Web of Science, and Google Scholar through January 2026 were performed. Eligible reports included molecularly confirmed biallelic PPP1R21 cases and related functional studies. Two researchers independently extracted individual-level data following narrative review quality criteria. Twenty-five individuals from 21 families harbored 17 distinct variants (15 loss-of-function, 2 missense), all homozygous, reflecting high consanguinity. Profound global developmental delay/intellectual disability was universal; hypotonia near-universal (22/25, 88%). Ambulation was delayed and ataxic when achieved; expressive language was minimal or absent. A recognizable coarse facial gestalt was observed with thick eyebrows, broad nasal bridge, thick lips, and low-set ears. Systemic features included feeding dysfunction and respiratory morbidity requiring gastrostomy or tracheostomy in severe cases. Mortality was 17% (4/24). Neuroimaging showed callosal thinning, white-matter volume loss, ventricular enlargement, and vermian hypoplasia. Patient fibroblasts showed delayed transferrin clearance and elevated proteasome activity, suggesting endosomal dysfunction and proteasome hyperactivation. PPP1R21-NDD is a severe recessive encephalopathy with a convergent phenotype and evidence of endo-lysosomal dysfunction. Diagnosis should be pursued with exome or genome sequencing in patients with characteristic clinical and neuroimaging features, particularly in consanguineous families. Research priorities include natural history studies, standardized magnetic resonance imaging (MRI) protocols, neural disease models, and therapeutic strategies targeting endosomal trafficking.
Leprosy patients with grade 2 disability (G2D) in Bangladesh continue to experience diminished well-being despite effective multidrug therapy. Community-based rehabilitation (CBR) integrated with primary health care could offer accessible, comprehensive services addressing their needs, but its acceptability and implementation challenges in Bangladesh remain poorly documented. This mixed-methods study, conducted February-July 2023, examined CBR acceptability and delivery barriers among leprosy patients with G2D. The quantitative component used a cross-sectional design, conveniently sampling 356 leprosy patients with G2D from government and private hospitals across three divisions; face-to-face interviews captured sociodemographic characteristics, disability status, CBR acceptability, and service challenges. The qualitative component comprised 15 key informant interviews with leprosy service personnel and five focus group discussions involving 8-10 G2D patients each, analyzed using deductive thematic analysis. Participants were predominantly male (65.2%) (mean age: 48.0 ± 13.7 years) with majority having foot disability (50.8%). CBR acceptability was remarkably high, with universal agreement on rehabilitation services at health complexes and community clinics, assistive technology, counseling facilities, and self-help groups. Nearly all agreed counseling would improve quality of life (99.4% [95%CI: 97.9-99.9]) and community awareness would reduce emotional distress (99.7% [98.4-99.9]), though only 67.4% [62.3-72.3] could independently perform ulcer self-care despite disability management training. Major challenges included healthcare workers' reluctance (78.4% [73.7-82.5]), inadequate equipment (59.5% [54.3-64.7]), and insufficient training (5.6% [3.5-8.5]). Qualitative findings corroborated these results, highlighting infrastructural deficiencies, discontinuous training, competing health priorities, long travel distances, poor coordination with social welfare authorities, resource constraints, and misconceptions about transmission. Both patients and providers strongly supported CBR integration into primary health care, citing grassroots accessibility, peer learning, and stigma reduction, and recommended multi-level strategies engaging local government, religious institutions, media, and schools. Strong community acceptability supports CBR integration into primary health care, though achieving zero disability goals requires stigma reduction, healthcare worker capacity building, resource allocation, and intersectoral coordination.
A partial-active-space (PAS) multistate (MS) multireference second-order perturbation theory (MRPT2) for the electronic structure of strongly correlated systems of electrons, dubbed PASPT2, is formulated by linearizing the intermediate normalization-based general-model-space state-universal coupled-cluster theory with singles and doubles [IN-GMS-SU-CCSD; J. Chem. Phys. 119, 5320 (2003)]. In contrast to the existence of disconnected terms in the IN-GMS-SU-CCSD amplitude equations, the disconnected terms in the PASPT2 amplitude equations can be avoided completely by choosing a special reference-specific zeroth-order Hamiltonian. The corresponding effective/intermediate Hamiltonian can also be made connected and closed, rendering the energies obtained by diagonalization fully connected. As such, PASPT2 is strictly size-extensive, in sharp contrast with the parent IN-GMS-SU-CCSD. It is also size-consistent when the PAS of a supermolecule is chosen to be the direct product of those of the physically separated, noninteracting fragments. Prototypical systems are taken as showcases to reveal the efficacy of PASPT2.
Mild cognitive impairment (MCI) is a stage between normal cognition and dementia, and timely diagnosis of this condition offers the opportunity for effective interventions to slow down the progression to dementia. The Mini-Mental Status Exam (MMSE) and the Montreal Cognitive Assessment (MoCA) are widely used tests for MCI screening. The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a computer-based cognitive battery designed to reduce the influence of language and the possibility of examiner error. This study aimed to investigate the diagnostic accuracy of CANTAB in patients with MCI. Patients with a MoCA score of 25 or less were considered to be in the MoCA-defined MCI group, which comprised 23.1% of participants (15 out of 65). The Paired Associates Learning (PAL)-mean-error-to-success had the most area under the curve in the ROC curve (0.80; 95%CI: 0.66-0.95; p-value<0.01) and optimum cut-off for MCI diagnosis was 5.8 (Sensitivity: 77%; Specificity: 74%) based on the Youden index. Although the small sample size may have influenced the results, the findings suggest that the PAL demonstrated good diagnostic accuracy for distinguishing participants with MoCA-defined MCI.
Sustained and selective generation of singlet oxygen (1O2) in Fenton-like catalytic systems is highly desirable for diverse applications, from freshwater resource management to green chemical synthesis. Despite advances in advanced oxidation processes, there remains a lack of generalizable methods that reliably modulate 1O2 selectivity. Here, we propose a descriptor-assisted coordination modulation strategy, in which machine-learning analysis identifies the d-band center as an important electronic descriptor associated with 1O2 selectivity. Through N-coordination modulation, the CoN5 catalyst exhibited near-complete 1O2 selectivity among the quantified reactive oxygen species (ROS) with a steady-state concentration of 394 µM, outperforming recent reports. As an internal-circulation pre-oxidation module, the CoN5/peroxymonosulfate (CoN5/PMS) system continuously raised wastewater biochemical oxygen demand/chemical oxygen demand (BOD/COD) to above 0.5 over 192 h, increased bioavailable dissolved organic matter (DOM), and showed high microbiome compatibility, evidenced by reduced Vibrio fischeri inhibition and microbial diversity ordination clustering near the background with greater shared-taxa overlap. This system also enabled selective thioanisole oxidation, achieving 90.6% conversion and 99.5% selectivity, with green synthesis potential demonstrated in a three-chamber continuous single-pass reactor. These results establish a generalizable coordination principle for steering ROS pathways and provide a deployable, low-ecological-risk route for both mixed wastewater treatment and green chemical synthesis.
Socioeconomic status (SES) is associated with disparities in cancer outcomes. The relationship between SES and postoperative outcomes after esophagectomy is inconsistent, especially within low-threshold universal healthcare systems. We hypothesized that lower SES would be associated with higher rates of postoperative complications, and longer length of hospital stay (LOS). This retrospective nationwide cohort study used Dutch Upper Gastrointestinal Cancer Audit (DUCA) data. All patients aged ≥18 years undergoing esophagectomy between 2014 and 2023 were included. SES was based on neighbourhood-level data derived from Statistics Netherlands (CBS). Patients were assigned to three SES groups (low, middle, high). Outcomes included severe postoperative complications and other postoperative outcomes, including length of stay (LOS) and mortality. Multivariable regression adjusted for confounders. Among 6658 patients, lower SES groups had a higher comorbidity burden, with American Society of Anaesthesiologists (ASA) physical status ≥ III in 32·3% of low SES patients, compared with 27·2% and 26·0% in middle and high SES groups. In univariable analysis, high SES was associated with a lower risk of prolonged intensive care unit (ICU) stay (OR 0·78, 95% CI 0·67-0·91) and LOS (β -1·60 days, 95% CI -2·90 to -0·34). After adjustment, SES was not independently associated with postoperative outcomes. SES was not associated with postoperative outcomes after esophagectomy. Lower SES groups had higher comorbidity burden, which may explain the attenuation of the association after adjustment for clinical risk factors. These findings suggest that within a low-threshold universal healthcare system, postoperative outcomes after esophagectomy may be primarily determined by clinical factors rather than SES.
Bacterial ribosomal protein bL27 is universally conserved, and its amino terminus is adjacent to the peptidyl transfer center, yet its roles in translation remain unclear. Combining genetics, biochemistry, and molecular dynamics, we show that bL27 has an unexpected role in preventing transfer-messenger RNA (tmRNA)-small protein B (SmpB), molecules involved in the trans-translation bacterial ribosome rescue mechanism, from interfering with protein synthesis. Deletion of the bL27 gene causes a 10,000-fold decrease in viability, and this defect is partially rescued by deletion of the gene encoding tmRNA. Addition of tmRNA-SmpB to in vitro translation reactions decreases the rate of protein synthesis by ribosomes lacking bL27 but has no effect on wild-type ribosomes. Molecular dynamics simulations also indicate that bL27 can slow the movement of tmRNA on the ribosome. These data link trans-translation and bL27 and support a model in which the amino terminus of bL27 acts as a gatekeeper to prevent tmRNA from sterically interfering with tRNA (transfer RNA) on the ribosome.
Acute kidney injury (AKI) is a life-threatening syndrome with high morbidity and mortality, yet its early diagnosis and underlying mechanisms remain poorly defined. Emerging evidence implicates gut dysbiosis and microbial metabolic dysfunction in AKI pathogenesis via the gut-kidney axis, yet a comprehensive, multi-omics characterization of microbial functional alterations in general AKI populations remains lacking. We conducted a prospective multi-omics study including 16 patients with acute kidney injury (AKI) and 16 age- and sex-matched healthy controls (HCs). Plasma metabolomic profiling was performed using ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-QTOF/MS). Gut microbiome composition and function were characterized through whole-metagenome sequencing of stool samples. Differential taxonomic and metabolite features were identified using multivariate and univariate statistical analyses. Microbial functional potential was assessed across four hierarchical layers: Kyoto Encyclopedia of Genes and Genomes (KEGG) Orthologs (KOs) genes, pathways, gut-metabolite modules (GMMs), and gut-brain modules (GBMs), to achieve high-resolution mapping of metabolic pathways and taxon-specific functional contributions. Integrated microbe-metabolite-phenotype relationships were evaluated using Spearman correlation analysis. Metabolomic profiling identified 65 differentially abundant metabolites between AKI patients and healthy controls (HCs), including 53 upregulated and 12 downregulated metabolites. These metabolites were mainly enriched in carbohydrate metabolism (e.g., starch and sucrose metabolism, fructose and mannose metabolism) and amino acid metabolism pathways. Among them, Maltol (C11918, AUC = 0.961), D-Quinovose (C02522, AUC = 0.926), and L-fucose (CO1019, AUC = 0.926) demonstrated the most robust diagnostic potential. Further feature selection using a random forest model identified an optimal panel of three metabolites, which achieved good discriminative performance (AUC = 0.859, 95% CI: 0.7073-1). Metagenomic analysis revealed significant gut microbiota dysbiosis in AKI, characterized by reduced α-diversity and distinct β-diversity compared to HCs. Taxonomic profiling showed depletion of key short-chain fatty acid-producing bacteria, including Faecalibacterium prausnitzii, along with enrichment of taxa such as Phocaeicola and Bifidobacterium pseudocatenulatum, as well as Phocaeicola vulgatus at the species level. Functional analysis indicated that AKI was associated with enhanced amino acid and carbohydrate metabolism, increased xenobiotic degradation, and alterations in neuroactive metabolic pathways. Integrated analysis further revealed significant correlations between altered microbial taxa, metabolic pathways, and clinical indicators. Specifically, health-associated taxa were negatively correlated with systemic inflammation markers (IL-6, IL-8) and renal injury markers (SCr, BUN), whereas Bacteroides uniformis showed positive associations with metabolic alterations in AKI. This multi-omics study reveals coordinated gut microbial dysbiosis and systemic metabolic reprogramming in AKI. The depletion of key commensals, rather than pathogen overgrowth, appears central to AKI-associated functional disruption. These findings highlight potential microbial and metabolic biomarkers and offer mechanistic insights into AKI pathogenesis.
Conventional removable partial dentures (RPDs) involve a process that is often susceptible to errors and demands a significant investment of time. The introduction of computer-aided design and computer-aided manufacturing (CAD/CAM) technology and materials witnessed significant advancements in recent years to produce accurate removable partial dentures. This study evaluated the retention and wear of PolyEtherKetoneKetone (PEKK) compared to Cobalt-Chromium (CoCr) in digitally fabricated double crown removable partial dentures for lower Kennedy Class I cases. The study was performed on 3D digital models of mandibular Kennedy Class I with prepared premolars bilaterally. The double crown RPDs were designed and fabricated digitally to get 14 copies of RPDs. Two groups were defined (n = 7); the first group were milled from Co-Cr discs, and the other's from PEKK blanks. Initial retention was measured using a universal testing machine. RPDs were then subjected to dynamic loading in a chewing simulator over 100,000 cycles followed by 540 manual insertion and removal cycles and were remounted on the testing machine to measure final retention simulating six months. Wear was assessed using Geomagic Control X software, where negative deviations highlighted areas of degradation. Data was collected and analyzed for statistical analysis. Two Sample t-test was used to compare between the two groups and Paired t test to study the changes within each group. The significance level was set at P ≤ 0.05. PEKK group showed a statistically significantly higher final retentive values after 6 months (11.6 N) than Co-Cr (2 N). Moreover, results showed higher retention loss in Co-Cr group (16.9 N) compared to PEKK (3.7 N). Additionally, wear assessment of primary copings indicated a higher deviation in the Co-Cr group (-0.25 mm) compared to PEKK (-0.096 mm), with a notable correlation (0.651, P-value = 0.011) between retention loss and wear. Within the limitation of this study, it could be concluded that PEKK provided digitally fabricated double crown RPDs with higher retention values and less wear than Co-Cr after simulation of 6 months of RPD use.
This series of Fact Finders presents a brief summary of the evidence and outlines recommendations regarding the injection of preservative-containing steroid formulations in the epidural space and the practice of swabbing newly opened vial tops before drawing up injectate. The evidence in support of the following facts is presented: (1) No adverse events have been documented from the administration of preservative-containing steroids into the epidural space; however, neurological injuries have been reported following intrathecal injection of these preservatives. (2) Swabbing newly opened vial tops before drawing up an injectate has been a standard procedure in healthcare settings. However, the evidence supporting its efficacy is mixed. While a recent study has found no significant benefit, guidelines from the American Society of Anesthesiologists (ASA), Centers for Disease Control and Prevention (CDC), and World Health Organization (WHO) still recommend this practice. (3) Greater than 60% isopropyl alcohol is not universally effective against all pathogens.
The escalating prevalence of obesity necessitates a deeper molecular understanding of how high-fat diets disrupt lipid metabolism. This study aimed to elucidate the potential mechanisms by which dietary fatty acids (FAs) modulate the key lipolytic enzymes, lipoprotein lipase (LPL) and hormone-sensitive lipase (HSL). An integrated in vivo and in silico approach was employed: Wistar rats were fed a standard or hypercaloric cafeteria diet for 8 weeks, after which physiological parameters, tissue lipid content, and enzyme activities were assessed. Molecular docking was used to characterize interactions between diet-specific FAs and enzyme crystal structures. The cafeteria diet induced significant obesity (+32.8% body weight, p < 0.001), adipose expansion (+137%, p < 0.001), pro-atherogenic dyslipidemia (+50.5% plasma triglycerides, p < 0.001), and hepatic steatosis (+56% triglycerides, p < 0.001). Paradoxically, both LPL and HSL activities were significantly upregulated in adipose tissue (+28.6%, p < 0.01 and + 89.7%, p < 0.001, respectively). Docking simulations suggested a potential mechanistic segregation: saturated FAs from the cafeteria diet were predicted to bind a putative allosteric site on LPL chain B, while polyunsaturated FAs from standard chow preferentially docked to the canonical active site on chain A. For HSL, all dietary FAs were predicted to bind with high affinity to an exosite on chain A, distinct from the inhibitor site. Together, these findings propose that dietary FAs may act as allosteric and exosite modulators of lipolytic enzymes, providing a candidate molecular link between diet composition and lipid dysregulation in obesity. This repositioning of dietary lipids as potential regulatory molecules opens new avenues for precision nutrition. However, given the multifaceted compositional differences between the cafeteria and control diets, the observed in vivo effects cannot be attributed solely to saturated versus polyunsaturated fatty acid differences, and these findings require further validation using purified diets and targeted structural approaches.
Parkinson's disease (PD) is an emerging global public health concern, particularly in low- and middle-income countries (LMICs), yet it remains under-recognized in Cambodia. The absence of reliable epidemiological data, limited specialist workforce, delayed diagnosis, and inadequate access to essential medicines contribute to a substantial but largely hidden disease burden. Health system limitations, such as inadequate primary care capacity, rehabilitation services, and insufficient community-based support, further exacerbated disparities in PD care. This article highlights critical gaps in PD management in Cambodia and calls for urgent, coordinated action. Key priorities include establishing national surveillance systems, strengthening primary healthcare, expanding the neurology workforce, building local capacity, promoting cross-cultural education, leveraging digital health and telemedicine, improving access to essential medicines, and integrating PD into national health policies as core components of Cambodia's long-term strategy for enhancing PD care. Addressing these challenges is essential to ensure equitable and effective care for individuals living with PD and to align Cambodia's health system with universal health coverage (UHC) goals.
The pH meter is a commonly used instrument in research and industries to test and monitor the pH of a process or material. However, its application in the concrete industry is not well explored. pH measurement for cement-based materials (CBMs) by using a pH meter is challenging because of these materials' high alkalinity, the fact that they do not exist as aqueous solutions, limited sample size availability, and susceptibility to carbonation. A pH electrode responds to hydrogen (H+) ions, but CBMs contain very few H+ ions because of their high alkalinity. As a result, accurate pH measurement in these materials requires a high-pH application electrode that is properly maintained to ensure reliable readings, especially for the comparing samples with small pH variation. The aim of this study is to propose guidelines and procedures for pH measurement of hardened CBMs that can be applied universally, reliably, and economically. The variables affecting the sample preparation and pH measurement stages in relation to sample processing, pH meter, and environmental factors are discussed. To accommodate different applications, this study proposes two pH measurement approaches: basic and comprehensive methods. The basic method reports the pH of the solution at the measured temperature and is suitable for the comparison of samples with a pH difference of more than 1. The comprehensive method eliminates the influence of solution temperature and generates a solution temperature-compensated pH (pHSTC) that represents pH at 25 °C. This method is suitable for the comparison of samples with a pH difference of less than 1 and for pH monitoring across different seasons. Test demonstrations using the developed methods is performed for validation purposes.
In Taiwan's post-COVID-19 context, universal National Health Insurance (NHI) and broad provider choice may contribute to information asymmetries that influence how older adults seek and navigate care. This cross-sectional study examined the associations among social network support (SNS), intergenerational relationships (IRs), healthcare-seeking behavior attitudes (HSBA), and quality of life (QoL) in community-dwelling older adults in northern Taiwan. A total of 150 participants (mean age = 73.5 ± 5.9 years) completed a newly developed and validated HSBA scale, a validated SNS instrument culturally adapted for older adults, a culturally adapted and validated IR measure, and a Taiwan-specific QoL measure. Analyses included descriptive statistics, Pearson correlations, prespecified subgroup comparisons, and multivariable linear regression analyses (two-tailed α = .05). All variables were positively correlated. QoL showed the strongest association with SNS (r = 0.64, p < .001), followed by IRs (r = 0.51) and HSBA (r = 0.29). In the multivariable models, regular exercise independently predicted higher HSBA, SNS, and QoL, whereas stronger IRs were associated with having more grandchildren and receiving daily telephone contact from non-cohabiting children. Among community-dwelling older adults in northern Taiwan, SNS was the strongest correlate of QoL. The findings support the inclusion of social connectedness, exercise participation, and intergenerational contact in routine gerontological nursing assessment. Because this study used a cross-sectional design, no causal or intervention-related interpretations can be made.
Membrane bioreactors (MBRs) are central to low-carbon wastewater treatment, yet membrane fouling control consumes the majority of aeration energy. Classical bubble dynamics (Clift diagram) fail in the shear-thinning non-Newtonian fluids typical of high-MLSS mixed liquor, leaving the definition of "large bubbles" ambiguous and aeration design empirical. Here, we report a previously unrecognized second growth regime in the bubble diameter-velocity relationship. High-frame-rate imaging and dimensionless analysis revealed that bubble rise velocity exhibits a sharp rheological decoupling at a critical equivalent diameter of ∼10 cm. Below this threshold, shear-thinning rheology (0-1.0% CMC) strongly modulates velocity in a non-monotonic manner; above it, buoyancy and inertia dominate, rendering velocities insensitive to fluid viscoelasticity and converging toward a universal scaling law shared with Newtonian systems. This transition arises from inertial forces overwhelming the local reduction in viscosity at the bubble rim. These findings establish a physically based criterion for defining large bubbles in shear-thinning fluids and provide a rational framework for designing energy-efficient large-bubble aeration strategies that may reduce scouring-related aeration demand in MBRs. The underlying hydrodynamic mechanism may also inform the design and optimization of gas-liquid multiphase systems involving shear-thinning non-Newtonian fluids, such as chemical reactors, fermentation systems, and polymer-processing operations.
Fast-ion conductors (FICs) are key components for next-generation high-performance batteries, yet predicting ion mobility remains challenging because of the unclear transport mechanisms. This difficulty is further compounded by experimental datasets that lack precise crystal structures. Here, we present a descriptor-guided transfer learning framework, named IonNet, to predict ion mobility for compounds, regardless of structure accessibility. IonNet adopts a multichannel subnetwork architecture that captures universal representations by integrating static and statistical descriptors of compounds. We demonstrate the exceptional performance of IonNet in predicting ion mobility, consistently outperforming 16 ablation study combinations and previous deep learning models. Leveraging the universal adaptability of chemical representations, IonNet not only uncovers 87 FICs among ∼4500 stable perfectly stoichiometric compounds but also efficiently pinpoints ∼63,000 prospective FICs from ∼5 million substituted compounds. This study not only presents a full-chain artificial intelligence tool for identifying FICs but also offers compositional principles governing ion mobility, thereby accelerating the development of energy storage and conversion.
Peroxydisulfate (PDS) is widely used in environmental engineering and chemical industry due to its high oxidation potential and excellent universality. Electrochemical synthesis of PDS using sulfate-containing wastewater can effectively realize the conversion of pollutants into high-value-added products. Nevertheless, the underlying mechanism of typical monovalent cations in sulfate-containing wastewater on PDS formation remains under discussion, resulting in a lack of targeted regulation guidelines. This work investigated the effects of different cations only through the outer-sphere oxidation pathway of electrochemical PDS synthesis. In the dilute electrolyte with NH4SCN added, the yield and Faradaic efficiency of PDS synthesis both followed the order of K+ > NH4+ > Na+. Experimental and theoretical studies revealed that this trend could be attributed to the fact that K+ is more prone to form clusters with ·OH and delocalize its spin density, thereby increasing the conversion probability of ·OH to SO4-·. This work uncovers the atomic-scale mechanism of cation regulation of ·OH affecting outer-sphere reactions, and provides a theoretical basis for improving the economic efficiency of sulfate-containing wastewater resource utilization through ion regulation.
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain a significant public health concern. Achieving the World Health Organization (WHO) elimination targets by 2030 requires more effective detection strategies than risk factor-based screening. This study evaluates an opportunistic screening program implemented in Primary Care, incorporating an automated diagnostic and referral pathway. Prospective study of universal HBsAg and anti-HCV screening conducted in a Primary Care center in Barcelona. Adults requiring a blood test for any reason between February 2023 and February 2025 were included. Positive cases were directly referred to the Hepatology Department through an automated care pathway. A total of 3,103 individuals were screened (41% male; mean age 51 years). The prevalence of anti-HCV positivity was 2.0%, with 0.35% having active infection; 82% of viremic patients initiated antiviral treatment. HBsAg prevalence was 0.8%, and 92% of referred cases attended specialist care; 17% initiated treatment. A higher number of risk factors was associated with anti-HCV positivity, whereas no predictors of HBsAg positivity were identified. Notably, 45% of patients with detectable HCV RNA and 44% of HBsAg-positive individuals had neither recognized risk factors nor elevated ALT levels. Automated opportunistic screening in Primary Care is feasible and effective, identifying HBV and HCV infections that would likely remain undetected using risk factor-based screening strategies. This integrated approach may contribute substantially to the micro-elimination of viral hepatitis.
Submucous fibrosis (SMF) is an oral potentially malignant disorder with a high risk of malignant transformation, primarily associated with areca nut use and tobacco consumption. This study aimed to evaluate the correlation of nicotine dependence and nutritional status with disease severity in patients with SMF. This observational study was conducted among 70 SMF patients subdivided on clinical and histological classification. Habit index was calculated and Nicotine dependence was measured using Fagerstrom test for nicotine dependence (FTND). Body mass index (BMI) and mid upper arm circumference (MUAC) was recorded. Haematological assessment, including serum iron, vitamin B12, and folate levels was conducted. Malnutritional universal screening tool (MUST) was used to score the risk of malnutrition. Chi-square, Pearson's correlation and Spearman's correlation tests were used for group comparisons of categorical, numerical, and ordinal data, respectively. Level of statistical significance was set at a P value less than 0.05. Clinical and histological staging showed a positive correlation with habit index and nicotine dependence (P value = 0.001). BMI, MUAC and serum iron levels showed inverse correlation with severity of the disease. MUST scores revealed increase (P value = 0.001) with advancing stages of SMF. FTND showed significant correlation with BMI, MUAC, MUST and serum iron values. Nicotine dependence and nutritional status are important indicators of the severity of the disease in patients with SMF. Routine assessment of these parameters' aids in the identification of high-risk groups and to plan a targeted treatment strategy.