Synergy Health

Anti-neurofascin (Nf) -associated neuropathies represent a distinct subset of immune neuropathies. While literature on this entity is evolving, there is currently no published data on these disorders from India. The study aims to characterize Indian patients presenting with anti-Nf-associated neuropathies. A retrospective chart review (January 2019-April 2024) of patients who had tested positive for one or more anti-Nf antibodies in a tertiary university teaching hospital was carried out. Their clinical, investigative, and therapeutic data were documented and analyzed. 38 patients with varied clinical presentations were studied. Acute and chronic forms were equally common. Sensorimotor weakness, sensory ataxia, tremors, and fluctuating course were common in the chronic group. Acute presentations were typically motor predominant, severe at onset, with rapid progression to nadir. Four patients with recurrent acute presentations were noted. A demyelinating predominant pattern was seen in 19, axonal predominant pattern in 16, and features of chronic immune radiculopathy in 3 patients. Nodal antibodies were more frequent than paranodal antibodies. About two-thirds of patients required more than two immunotherapeutic agents. A favorable response to rituximab was observed in 16/21 patients. Patients with both nodal and paranodal antibodies (Pan Nf neuropathies) were more severe and resistant to therapy. Anti-Nf-associated neuropathies in this Indian cohort were clinically heterogeneous, spanning acute, chronic, and recurrent phenotypes. Tremors, sensory ataxia, pain, and fulminant onset are valuable diagnostic clues. Pan-Nf-associated neuropathies were consistently severe and treatment-resistant. Rituximab demonstrated significant benefit in most cases, supporting its use in refractory and relapsing disease.

This research paper explores the current state of user experience and digital system design in Uzbekistan, focusing on the challenges users face when interacting with public and private digital platforms. With the growing adoption of e-government services, mobile applications, and digital healthcare tools, the importance of effective human-computer interaction has become increasingly evident. Drawing on global examples, particularly from Scandinavian countries known for citizen-centric digital solutions, this study highlights how human-computer interaction principles such as usability, accessibility, and user-centered design can significantly enhance the efficiency and acceptance of digital systems in Uzbekistan. The research serves two primary goals: to assess existing user experience limitations in widely used Uzbek digital platforms and to evaluate how incorporating human-computer interaction methods can improve system effectiveness and user satisfaction. The study argues that well-designed interfaces and intuitive system interactions are essential for digital transformation, social inclusion, and the successful modernisation of digital infrastructure in Uzbekistan.

Background and Clinical Significance: Psoriasis, a chronic immune-mediated inflammatory disease, can affect musculoskeletal structures, including the Achilles tendon. Achilles pain in psoriasis patients may arise from tendinitis or neuropathic pain due to peripheral nerve dysfunction, such as sural nerve (SN) involvement, a condition frequently misdiagnosed due to limitations in conventional diagnostics. Fascial tissues are critical in nerve compression syndromes. This case explores the application of a novel quantitative Sonoguide Digital Palpation (SDP) protocol and ultrasound (US)-guided hydrodissection (HD) for SN dysfunction mimicking Achilles tendinopathy in a psoriasis patient. Case Presentation: A 41-year-old male with psoriasis presented with acute onset of right heel stiffness and paresthesia. Physical examination, radiographs, and ultrasound were performed. SDP, employing a validated four-criterion diagnostic framework (including fascial mobility quantification and concordant pain provocation), identified crural fascia restriction affecting SN and reproduced patient’s concordant Achilles pain. High-resolution ultrasonography provided key morphological evidence, revealing a 2.6-fold enlargement of the sural nerve’s cross-sectional area (CSA) on the affected side (13 mm2) compared to the asymptomatic side (5 mm2). Notably, a positive Tinel’s sign was elicited over the psoriatic plaque. US-guided HD was performed using 50 cc of 5% dextrose in water (D5W) without local anesthetic below the psoriatic lesion. Post-HD, the patient reported immediate and significant pain relief (Numeric Pain Rating Scale (NPRS) score reduction from 8 to 2), confirming the prompt correction of a clinically important fascial restriction, associated with improved SN mobility, objectively verified by a post-procedure SDP assessment. At 24-month follow-up, sustained symptom relief and complete functional recovery were reported. Conclusions: This case highlights SDP’s ability to objectively visualize and confirm fascial restriction as a cause of nerve dysfunction by quantitatively reproducing concordant pain. The objective finding of nerve swelling provides sonographic substantiation for the functional diagnosis of nerve dysfunction. This integrated diagnostic approach, combining dynamic functional assessment with morphological confirmation, offers a novel paradigm for evaluating peripheral nerve disorders. US-guided HD of the SN with D5W without local anesthetic shows promise as both a diagnostic confirmatory tool and therapeutic intervention for neuropathic Achilles pain in psoriasis patients with SN involvement, aligning with its efficacy in other peripheral neuropathies. The significant nerve swelling (13 mm2) provides robust morphological corroboration of the functional impairment diagnosed by SDP, offering a more comprehensive diagnostic paradigm.

Many low-income and middle-income countries have introduced public health insurance systems, whereby, thanks to government subsidies, selected groups are entitled to receive insurance coverage even if not paying direct contributions into the system. These efforts towards achieving universal health coverage were often undermined by difficulties in enrolment and registration, barriers to health service utilisation or complicated rules around service packages. Governmental and non-governmental accountability initiatives have been established to overcome these barriers in order to make health insurance programmes responsive and to empower citizens. This paper examines evidence and synthesizes lessons from 20 accountability initiatives in six selected countries to understand how these achieved (or not) these goals. We systematically analysed six final reports and five published papers which were part of a multicountry research programme from 2019 to end of 2022 studying accountability initiatives. Between June 2023 and September 2024, we systematically extracted data and synthesised findings from the reports and papers based on a conceptual framework, adapted from a framework developed by Molyneux, which had been adopted by the country teams to guide their studies. We coded the extracted data and identified the content, context and process factors that enabled or hindered the accountability initiatives in achieving their intended goals. We present and discuss factors that were present in at least two initiatives. Governmental initiatives were in most instances established in conjunction with the health reforms that introduced the health insurance programmes they address. Whereas some of these initiatives were effective, many were undermined by poor outreach to citizens, inadequacy of resources, conflicts of interest and power imbalances and lack of fidelity to original design. Non-governmental initiatives often emerged to fill existing gaps in government services and programmes. Many of the non-governmental initiatives had several features which helped them in contributing to citizen empowerment, and these included embeddedness in and being trusted by the local communities, flexibility in operating and reaching out to people and the underlying motivation of people working in them. The effective implementation of accountability initiatives requires transparency, trust-building measures, active outreach and community engagement and adequate resources. These elements can ensure that initiatives achieve their intended goal of enhancing citizens' access to their health insurance entitlements. Further research is needed to understand how best collaboration between governmental and non-governmental initiatives can be fostered to build synergies between the two toward the achievement of common goals.

This research investigates the effect of different particle sizes of recovered carbon black (rCB) on the electrical conductivity, flexural and fractured toughness properties and morphology of epoxy/rCB conductive composites. The rCB powder was a product from the pyrolysis process of waste rubber tires. This research aims for the application of tray production in semiconductor packaging. In this study, the composite was prepared by using a simple mechanical stirring method. The testing and characterizations carried out included electrical conductivity test, flexural test, fracture toughness test, Scanning Electron Microscopy (SEM) and viscosity. The epoxy/rCB conductive composite shows significant differences in electrical conductivity and mechanical properties when incorporated with different particle sizes of rCB. The conductivity percolation threshold was found at 1000 mesh with enhanced mechanical and electrical conductivity properties simultaneously.

This paper explores the critical role of collaboration between small and medium-sized enterprises (SMEs) and startups in accelerating clean energy innovation in emerging markets. It reviews various collaboration models, including strategic partnerships, incubation and acceleration programs, supply chain integration, and joint research and development (R&D), highlighting their impact on technology development and commercialization. The paper also examines the specific challenges SMEs and startups face, such as funding limitations, intellectual property (IP) concerns, and market access barriers, and analyzes the opportunities presented by new trends like digital platforms, impact investment, and public-private partnerships. The findings emphasize that collaborative efforts are essential for fostering sustainable growth and enabling the successful deployment of clean energy technologies in emerging markets. The paper concludes by discussing future directions and the importance of continued cooperation, supported by favorable policies and regulatory frameworks, in driving the clean energy transition. Keywords: Clean Energy Innovation, SME-Startup Collaboration, Emerging Markets, Sustainable Growth, Commercialization.

Chronic pain is a complex condition that often poses diagnostic and management challenges due to its multifactorial etiology. This case report describes a 49-year-old pastor who presented with a three-year history of chronic pain affecting multiple sites, including the neck, bilateral shoulders, thoracic region, lower back, and bilateral knees.Additionally, he experienced shortness of breath on mild exertion, which adversely affected his ability to converse and speak publicly. The patient had a rapid resting heart rate of 100-120 beats per minute, occasional palpitations, and a 24-hour electrocardiogram that confirmed 15% premature ventricular complexes with bigeminy and trigeminy.He complained of limited appetite with early satiety, intermittent nausea, and regurgitation. Despite consultations with multiple specialists, no underlying causes were identified in the cardiac, respiratory, gastrointestinal, or psychological domains. Ultrasound-guided bilateral vagus nerve hydrodissection using 5% dextrose without local anesthetics was administered three times at monthly intervals, resulting in remarkable pain relief within three months and the effects persisted at the nine-month follow-up. Tachycardia was no longer perceived, resting heart rate slowed to 70-80 beats per minute, shortness of breath improved, and public speaking ability was restored.The patient's early satiety, nausea, and reflux complaints were resolved. This case report highlights the potential effectiveness of this novel intervention for chronic pain. Further research is warranted to validate these findings and explore the mechanism of action.