Sterling Hospitals

Background: Helminth infections remain a significant global health issue, necessitating effective and accessible treatment options. Polyherbal formulations offer a promising alternative to conventional anthelmintic drugs, particularly in syrup form for easier administration to pediatric and geriatric populations. Objective: This study aims to explore the potential of polyherbal syrups as alternative anthelmintic agents. It focuses on the formulation, phytochemical screening, and comparative efficacy of these syrups against standard treatments such as Albendazole. Methods: Polyherbal syrup formulations were prepared and evaluated for their anthelmintic activity using standard in vitro assay. The study focused on identifying plants containing bioactive compounds specifically phenolic compounds, tannins, and flavonoids known for their anthelmintic potential. Bioactive components were identified using UV spectrophotometry, and phytochemical screening was conducted to determine the presence of key compounds. The anthelmintic efficacy of the polyherbal syrups was compared to that of Albendazole. Results: The study found that certain polyherbal syrup formulations exhibited significant anthelmintic activity, comparable to or exceeding that of Albendazole. The presence of phenolic compounds, tannins, and flavonoids in the selected plants was confirmed, contributing to their observed efficacy. Conclusion: Polyherbal syrups demonstrate potential as effective alternatives to standard anthelmintic treatments. These formulations, particularly those derived from plants with high concentrations of bioactive compounds, could offer a viable option for managing helminth infections, especially in populations with limited access to conventional medications. Further research could focus on optimizing these formulations and validating their efficacy in clinical settings.

IntroductionStroke is a major cause of global morbidity and mortality. Readability of educational material is critical for rapid clinical decision-making among healthcare professionals. UpToDate (UpToDate, Inc., Waltham, MA) is a widely used, peer-reviewed point-of-care clinical resource, while ChatGPT (OpenAI, San Francisco, CA) is an emerging AI-based educational support tool. However, a formal comparison of their linguistic accessibility has not been performed.ObjectiveTo compare the readability and linguistic complexity of educational material on stroke generated by ChatGPT (GPT-4o) versus content retrieved from UpToDate, using validated readability metrics.Design, setting, and participantsThis cross-sectional study was conducted between May 27 and June 4, 2025. ChatGPT (GPT-4o, accessed May 27, 2025) was prompted to generate educational content on stroke. A corresponding section from UpToDate (accessed May 27, 2025) was extracted. Only prose content was analyzed. Readability parameters assessed included total word count, sentence count, word/sentence ratio (average words per sentence), Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index, difficult word count, and difficult word percentage. Data were analyzed using IBM SPSS v25 (IBM Corp., Armonk, NY) and R v4.3.2 (R Foundation for Statistical Computing, Vienna, Austria). The Mann-Whitney U test was used. P < 0.05 was considered statistically significant.ResultsUpToDate content was substantially longer (median = 2772 vs. 304 words; p = 0.008) and used more sentences (median = 134 vs. 23; p = 0.032) and difficult words (median = 857 vs. 88; p = 0.008) compared to ChatGPT. The word/sentence ratio (average words per sentence) was also higher (21.7 vs. 13.2; p = 0.008). However, no statistically significant differences were observed for FRE (p = 1.000), FKGL (p = 0.222), SMOG Index (p = 0.151), or difficult word percentage (p = 0.690).ConclusionsChatGPT produces shorter and more concise educational content on stroke while maintaining comparable readability to UpToDate. The lower linguistic density may enhance rapid orientation for trainees; however, the reduced depth indicates ChatGPT should supplement, not replace, established peer-reviewed resources. Future research should explore multiple medical topics, additional AI models, and assess the clinical applicability and accuracy of AI-generated content.

Autoimmune polyglandular syndrome type 2 (APS 2) is a rare endocrinopathy characterized by primary adrenal insufficiency associated with autoimmune thyroiditis or type 1 diabetes. The diagnosis is usually delayed, and it has high mortality if undetected. Hashimoto’s thyroiditis is the commonest thyroid disease associated with APS 2, while structural thyroid abnormalities or neoplasms are rarely reported. Hurthle cell adenoma (HCA) is a rare benign oncocytic tumor and may arise from long-standing chronic autoimmune thyroiditis. To date, there is no documented case of APS 2 with Hurthle cell adenoma, making this case a rarity.We present a case of a 44-year-old man with gastrointestinal symptoms, fatigue, hyperpigmentation, and weight loss for six months. The critical findings were generalized hyperpigmentation with orthostatic hypotension and electrolyte imbalance, especially hyponatremia and hyperkalemia, with low cortisol and elevated adrenocorticotropic hormone levels. These, along with bilateral adrenal atrophy on imaging and high anti-thyroid peroxidase antibodies, established a diagnosis of primary adrenal insufficiency and autoimmune thyroiditis, findings consistent with APS 2. HCA was detected on fine needle biopsy subsequently, which is a rare association in APS 2. The patient responded well to adrenal and thyroxine replacement therapy. The patient’s tumor, although small and asymptomatic, was excised via hemithyroidectomy as per the American Thyroid Association guidelines. Histopathology confirmed HCA with no capsular invasion. Postoperative recovery was uneventful, and on follow-up, the patient showed significant improvement.There are two major learning points from this case. Firstly, it emphasizes the need for high clinical suspicion in diagnosing APS 2 in patients with nonspecific constitutional symptoms. Secondly, it highlights the rare but clinically significant co-occurrence of HCA with APS 2. HCA, while benign, can mimic malignancy on cytology and requires histopathological confirmation. In view of the possibility of progression of HCA to Hurthle cell carcinoma, surgical excision is the standard of care.

Rett Syndrome (RTT) is a debilitating neurodevelopmental disorder primarily affecting females, characterized by severe cognitive, motor, and autonomic impairments. The complexity of Rett syndrome and the blood-brain barrier (BBB) significantly limits the effectiveness of conventional treatments. Emerging strategies for targeted drug delivery to the central nervous system (CNS) offer promising avenues for more effective therapies. Among these, the use of Toxoplasma gondii- a neurotropic parasite known for its ability to cross the BBB has garnered attention as a potential vector for targeted drug delivery in RTT. This review explores the potential of Toxoplasma gondii as a novel therapeutic vector for RTT, focusing on its unique biological mechanisms, which enable it to invade and persist within the CNS. The review discusses advancements in genetic engineering that could allow for the safe and controlled delivery of therapeutic agents using this organism. Additionally, the challenges associated with using a live pathogen as a delivery vector, including issues related to safety, immune response, and specificity, are critically examined. Furthermore, the paper highlights the current limitations in preclinical and clinical research, identifies key areas that require further investigation, and proposes future directions for the development of Toxoplasma gondii-based therapies. By assessing both the potential and challenges, this review aims to provide a comprehensive overview of the current state of research and the future possibilities for utilizing Toxoplasma gondii in targeted drug delivery for Rett Syndrome.

e22504 Background: Brain and central nervous system (CNS) cancer poses a significant public health challenge, particularly in high-income countries (HIC) where aging populations and advanced diagnostic capabilities contribute to rising incidence rates. Despite improvements in treatment, the disease remains associated with high morbidity and mortality, necessitating ongoing research into its epidemiological trends, risk factors, and healthcare disparities to inform targeted interventions. Methods: We estimated incidence, prevalence, deaths, and disability adjusted life years (DALYs) due to brain and CNS cancer by age, sex, year and location across the HIC from 1990-2021 using global burden of disease study 2021 standardized tool. Results: The total prevalence count of brain and CNS cancer increased from 189,483 (185,084-193,201) in 1990 to 371,604 (351,197-387,196) in 2021. The number of deaths rose from 40,918 (39,726-41,750) in 1990 to 66,574 (62,329-69,082) in 2021, while the total DALYs increased from 1.3 (1.3-1.4) million to 1.8 (1.7-1.9) million over the same period. The highest annual percentage change (APC) in total prevalence count was observed in High-income Asia Pacific (4.34%), Southern Latin America (3.26%), and Australasia (2.04%). In terms of mortality, the highest APC was recorded in Southern Latin America (2.56%), High-income Asia Pacific (2.48%), and Australasia (1.84%) between 1990 and 2021. At the national level, the highest APC in age-standardized incidence rate (ASIR) was observed in Chile (2.4%), followed by Singapore (2.03%) and Japan (1.92%). Regarding the age-standardized mortality rate (ASMR), the highest APC was recorded in Chile (1.9%), Japan (1.42%), Switzerland (0.97%), and Monaco (0.92%) from 1990 to 2021. Age-wise, the highest incidence count in 2021 was observed in individuals aged 70-74 years, with 13,052 cases (12,088-13,748). The highest number of deaths occurred in the same age group, with 9,749 deaths (9,091-10,165). The greatest burden of DALYs was recorded in individuals aged 60-64 years, reaching 228,721 (220,464-235,397) in 2021. Conclusions: The global burden of brain and CNS cancer has significantly increased from 1990 to 2021, with a notable rise in prevalence, deaths, and DALYs. The highest growth rates were observed in High-income Asia Pacific, Southern Latin America, and Australasia, with Chile, Singapore, and Japan experiencing the steepest national increases in incidence. The disease burden was most pronounced in older age groups, highlighting the need for targeted interventions and improved healthcare strategies to mitigate its impact.

e22518 Background: The burden of tracheal, bronchus and lung cancer (TBLc) attributable to residential radon (RR) in Southeast Asia (SEA), East Asia (EA), and Oceania is under investigation due to significant regional variations in geological and residential environments, which influence radon exposure levels. Given the elevated risks associated with volcanic activity in SEA, granitic regions in East Asia, and uranium-rich soils in Oceania, this study aims to understand the burden of TBLc attributable to RR in SEA, EA, and Oceania. Methods: Using, standardized global burden of disease study 2021, we estimated death and disability adjusted life years (DALYs) due to TBLc attributable to RR by age, sex, year and location across the SEA, EA and Oceania from 1990-2021. Results: The total number of deaths due to TBLc attributable to RR increased from 11,512 (95% uncertainty interval: -5,615 to 30,454) in 1990 to 33,123 (-17,228 to 88,947) in 2021. Similarly, DALYs rose from 322,145 (-159,084 to 850,661) in 1990 to 781,174 (-407,077 to 2,099,185) in 2021. The highest annual percentage change (APC) in age-standardized mortality rate (ASMR) was observed in Indonesia (1.09%), followed by Niue (0.63%), Marshall Islands (0.5%), Kiribati (0.47%), China (0.36%), Vietnam (0.35%), and Malaysia (0.26%) from 1990 to 2021. Regionally, East Asia recorded the highest APC in ASMR (0.36%), followed by Southeast Asia (0.18%) and Oceania (0.14%). For age-standardized disability-adjusted life year rates (ASDALR), Oceania showed the highest APC (0.1%), followed by Southeast Asia (0.05%) and East Asia (0.04%). By age group, the APC in total death counts increased by 1.59% annually among individuals aged 20–54 years and by 1.52% among those aged 55 years and older. In terms of DALYs, the APC rose by 3.44% for individuals aged 55 years and older and by 1.47% for those aged 20–54 years. By gender, the APC in ASMR was higher in females (0.62%) compared to males (0.32%). Conversely, ASDALR showed a slight annual decline in males (-0.03%) but increased in females by 0.26% from 1990 to 2021. Conclusions: Deaths due to TBLc attributable to RR accounted for 4.36% of all TBLc attributable risk factors in 2021. Regional disparities, higher risks in older populations, and significant gender differences highlight the importance of targeted strategies, such as public education on radon exposure, implementation of mitigation measures like improved ventilation and radon testing, and prioritization of high-risk regions. Clinicians play a vital role by integrating environmental exposure assessments into routine care and advocating for early detection and management of radon-related TBLc.

The term "big data analytics (BDA)" defines the computational techniques to study complex datasets that are too large for common data processing software, encompassing techniques such as data mining (DM), machine learning (ML), and predictive analytics (PA) to find patterns, correlations, and insights in massive datasets. Cardiovascular diseases (CVDs) are attributed to a combination of various risk factors, including sedentary lifestyle, obesity, diabetes, dyslipidaemia, and hypertension. We searched PubMed and published research using the Google and Cochrane search engines to evaluate existing models of BDA that have been used for CVD prediction models. We critically analyse the pitfalls and advantages of various BDA models using artificial intelligence (AI), machine learning (ML), and artificial neural networks (ANN). BDA with the integration of wide-ranging data sources, such as genomic, proteomic, and lifestyle data, could help understand the complex biological mechanisms behind CVD, including risk stratification in risk-exposed individuals. Predictive modelling is proposed to help in the development of personalized medicines, particularly in pharmacogenomics; understanding genetic variation might help to guide drug selection and dosing, with the consequent improvement in patient outcomes. To summarize, incorporating BDA into cardiovascular research and treatment represents a paradigm shift in our approach to CVD prevention, diagnosis, and management. By leveraging the power of big data, researchers and clinicians can gain deeper insights into disease mechanisms, improve patient care, and ultimately reduce the burden of cardiovascular disease on individuals and healthcare systems.

A BSTRACT This comprehensive review presents recent advancements in drying technologies, a fundamental aspect of drug delivery systems (NDDS) in pharmaceutical sciences. Representative drying technologies that improve the solubility, stability, and bioavailability of active pharmaceutical ingredients include spray drying, freeze-drying, supercritical fluid drying, vacuum drying, microwave drying, infrared drying, and fluidized bed drying. Spray drying excels among the mentioned technologies for lipidic drug delivery systems production, generating amorphous solid dispersion and inhalation formulations. Freeze-drying possesses well-founded benefits of maintaining the integrity of thermolabile compounds. Supercritical fluid techniques also provide a solvent-less approach to nanoparticle formulations. Newer technologies, such as microwave drying and fluidized bed drying, have improved the process efficiency, production speed, and product quality of the resulting NDDS. Finally, we sought to briefly review how and what benefits from drying technologies would be improved by integrating with other NDDS approaches, specifically through self-microemulsifying drug delivery systems to help address drug solubility or targeted therapy. Overall, the culmination and adoption of these technological advances reflect an essential change in pharmaceutical and NDDS practices; it presents opportunities for future research and engineering of NDDS developments.

Abstract Background: Worsening heart failure (WHF) is characterized by the progression of symptoms in patients with established HF, necessitating intensified treatment, typically with diuretics. Outpatient (OP) management of WHF offers an alternative to hospitalization, as many patients experience a gradual onset of symptoms, allowing timely intervention. However, OP WHF is often underrecognized and excluded from clinical trials, highlighting the need for structured guidance. This expert consensus aims to address this gap by providing clinical practice recommendations for OP WHF management. Methodology: A panel of Indian cardiologists convened for an expert meeting moderated by a leading cardiologist. Based on clinical evidence, expert insights, and live polling, consensus recommendations were developed. Results: Experts agreed that WHF is defined by symptom worsening despite standard HF therapy, decompensation in chronic HF, and an increase in oral or intravenous diuretic dose. Vericiguat was recognized as suitable for patients with reduced eGFR (&lt;30 mL/min/1.73 m²), unlike angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker/angiotensin receptor-neprilysin inhibitor (ACEi/ARB/ARNi) and digoxin. While ACEi/ARB/ARNi doses may be reduced in WHF with worsening renal function, beta-blockers should be maintained as long as possible. OP management should prioritize early vericiguat initiation alongside rapid HF therapy optimization. About 44% of experts recommended initiating vericiguat at the first follow-up (3–7 days postdischarge), whereas 33.3% preferred it as a last-line option. Management of end-stage heart failure with advanced options like assist devices and transplants is needed with failure of drug therapy, persisting end-organ failure, and repeated hospitalization. Conclusion: This consensus highlights early OP department (OPD)-based recognition of WHF, OPD-based structured HF therapy optimization, and early vericiguat initiation to improve WHF management in outpatient settings.