Abstract Introduction Puerperium is defined as the period of about 6 weeks after childbirth during which the mother's reproductive organs return to their original nonpregnant condition. Perianal problems, including constipation, hemorrhoids, and fissure, are among the most common digestive complications among women in puerperium, observed in about 30 to 50 percent of women. Considering this great prevalence and the paucity of similar research in this aspect in an Indian population, the present study was done to assess the prevalence of perianal problems seen in puerperium and the risk factors associated with it. Methods This was a prospective observational cohort study done over the span of 3 years on 902 puerperal women. A self-structured questionnaire covered detailed history and per-rectal and proctoscopy examination. Patients were followed up telephonically for regression of perianal problems post management. Results The total prevalence of all the perianal problems in puerperium encountered in the present study, out of 902 subjects, was 36.3% (327 subjects). The perianal problems encountered were fissure in 185 patients (20.5%) followed by hemorrhoids in 110 patients (12.2%), perianal episiotomy infections in 25 patients (2.8%), and perineal tears in 7 patients (0.8%). On comparative analysis, positive family history, macrosomia, past history of perianal diseases, and second stage of labour > 50 minutes showed a higher prevalence in the perianal disease group as compared with the healthy group. Out of these, positive family history of perianal diseases (p= 0.015) and past history of perianal diseases (p= 0.016) were statistically significant. The percentage of multipara with hemorrhoids was more when compared to primipara (p= 0.01), patients who had a past history of any perianal disease have a higher chance of hemorrhoids during puerperium (p= 0.00). Patients with constipation in pregnancy have higher chance of hemorrhoids in pregnancy (p= 0.00). Patients who had a past history of any perianal disease had higher chance of fissure during puerperium (p= 0.00). A total of 27.74% of the study subjects with macrosomic babies had fissure in their puerperal period which on comparison with patients with non macrosomic babies was only 19.22%, which was statistically significant (p= 0.02). Conclusion Constipation, hemorrhoids, and anal fissures are the most common perianal problems in postpartum period causing significant reduction in the quality of life of those afflicted with them.

The Covid-19 pandemic has wreaked havoc globally and has forced people to change their outlook and do things differently. The pandemic has also affected the education sector. It has brought classes to a halt and forced universities to shut down at times. Significantly, the pandemic has also forced law schools to move away from traditional methods and practices and look for creative ways in which to save the academic year. Inadvertently, it has provided an opportunity to revolutionise and revitalise legal education. As technology becomes ever-present and user-friendly, law schools should embrace the potential of online learning to enhance the value of teaching, expand the learning potential of students and, most importantly, equip students for the challenge of lawyering in the twenty-first century. There are risks and rewards to online learning, but key to education in the new millennium is for law schools to adapt to and embrace online learning with all its challenges. The article provides a cursory general overview of online learning in law schools with specific focus on how law schools have been adapting to online education in recent times. Crucially, the article explores ways in which law schools can overcome key challenges in transitioning to online learning. Going forward, the article looks at how law schools can design and implement online education in a manner that takes advantage of the new modality's potential.

Abstract Plants are the major sources of food and medicine for humans. Streblus asper Lour is a small tree belonging to the Moraceae family and is commonly found in tropical countries. S. asper plant is used in several folk medicines, especially Ayurveda and Siddha, to treat several diseases and disorders. This review summarizes the medicinal and economical properties of this medicinal plant. Scientific literature dealing with S. asper was collected from scientific databases without any year limit and was included in this review. About twenty potential active compounds were isolated from S. asper. The study revealed that S. asper is an important medicinal plant with several proven therapeutic potentials in vitro and in vivo, including anti-cancer, antibacterial, anti-fungal, anti-diarrhoeal, anti-macrofilaricidal, anti-diabetic, anti-inflammatory, anti-aging, and neuroprotective effects. Additionally, the plant can be used as animal feed and bio-insecticide. It also helps in the coagulation of skimmed milk and cheese production. Further, it has some economic uses, including vermicompost production and papermaking and its use as a fuel. However, there are no prescribed S. asper-based therapeutic agents to manage any disease condition, and some adverse effects were observed in human trials. Enough studies are available to prove the potential of S. asper in vitro and in vivo models; however, further clinical studies are required to develop safe therapeutic agents using the phytoconstituents of S. asper.

Resumo: A necrose pancreática infectada walled-off (WOPN) é uma complicação grave da pancreatite aguda (PA). A cirurgia nestes doentes críticos pode associar-se a um aumento da morbimortalidade. Assim, técnicas minimamente invasivas surgiram como alternativa à cirurgia. Reportamos um caso de PA grave com WOPN que foi tratada de forma percutânea com um endoscópio flexível através de uma prótese metálica auto-expansível usando uma abordagem totalmente retroperitoneal. A necrosectomia retroperitoneal endoscópica direta (p-DEN) usando a via retroperitoneal melhorou os parâmetros do doente significativamente com resolução da sépsis sem necessidade de cirurgia. p-DEN usando um endoscópico flexível que passa através uma prótese metálica de grande diâmetro parece ser uma técnica promissora em alguns doentes com WOPN, podendo ser utilizada em doentes que não são candidatos ideais para uma drenagem transmural ou cirúrgica.

Abstract: Infected walled-off pancreatic necrosis (WOPN) is a severe complication of acute pancreatitis. Surgery in these critically ill patients can be associated with increased morbidity and mortality. Hence, minimally invasive therapies have emerged as an alternative to surgery. Herein, we report a case of severe acute pancreatitis with WOPN which was treated percutaneously with a flexible endoscope through an esophageal self-expanding metal stent using a total retroperitoneal approach. Percutaneous direct endoscopic necrosectomy (p-DEN) using the retroperitoneal route improved the patient’s parameters dramatically with resolution of sepsis without the need for surgery. p-DEN using a flexible endoscope passed through a large bore metal stent shows promise in selected patients with WOPN and can be used in patients who are not ideal candidates for transmural or surgical drainage.

Abstract In treating various diseases, natural therapies are widely preferred in the modern era to synthetic drugs as they offer little or no side effects, in contrast to synthetic drugs. However, there is limited scientific knowledge about plants that have a broad range of medicinal properties. Cleistocalyx nervosum var. paniala, native to Thailand and generally known as Ma-kiang in Thai, is one of the least documented plant species. Due to its richness in phenolic compounds, especially anthocyanins, C. nervosum var. paniala has been used in traditional medicine to treat several health complications. The fruits, seeds, and leaves of C. nervosum var. paniala have been reported to exhibit antioxidant, antimicrobial, anti-mutagenic, anti-carcinogenic, anti-aging, and neuroprotective properties. The extracts of C. nervosum var. paniala are non-toxic to living systems, and they also can activate the immune system. Moreover, they are widely used in industrial applications, such as in functional food products and in many health products, due to the colored anthocyanin pigments and the anthocyanin benefits of C. nervosum var. paniala. However, there is a need to conduct research in this berry species to identify the mechanism behind its medicinal properties. The present review summarizes the functional properties and bioactivities of C. nervosum var. paniala based on available scientific information.

A deiscência anastomótica (DA) após a cirurgia colorretal contribui para piores resultados, resultando em múltiplas complicações pós-operatórias. A terapêutica convencional passa por repetir a laparotomia e uma sutura de tensão. Mas devido às condições locais perto das linhas de sutura há um risco significativo de falência técnica, o que aumenta ainda mais a morbimortalidade destes doentes. Neste caso um homem de 60 anos com história de hipertensão e cardiopatia isquémica com angioplastia coronária percutânea prévia foi submetido a colectomia do sigmóide com anastomose colorretal, devido a uma diverticulite do sigmóide complicada. Verificou-se deiscência da anastomose pelo que uma ileostomia foi realizada. Antes do encerramento da ileostomia o doente realizou colonoscopia que evidenciou persistência parcial da DA. Foi decidido encerramento endoscópico da DA utilizando o sistema de sutura Apollo OverStitch. O tecido foi inicialmente preparado através da criação de uma superfície cirúrgica utilizando coagulação com argon plasma dos bordos da DA. Foi utilizado um endoscópio terapêutico de duplo canal montado já com o sistema de OverStitch de forma a possibilitar suturas continuas transmurais, facilitando o encerramento da fístula. A área intervencionada mostrou uma boa aproximação dos bordos da sutura e um encerramento completo. O procedimento foi um sucesso, sem complicações imediatas ou tardias. A endoscopia de reavaliação duas semanas depois mostrou os bordos bem aproximados com linhas de sutura intactas com resolução completa de DA. A revisão cirúrgica foi efetuada um mês depois e o doente está clinicamente bem. O sistema de sutura Apollo OverStitch abre novas possibilidades na cirurgia endoscópica flexível, sendo necessários mais estudos exploratórios a acrescentar evidência aos promissores resultados já existentes.

Anastomotic dehiscence (AD) after colorectal surgery contributes to poor outcomes resulting in multiple postoperative complications. Conventional management would be a repeat laparotomy and tension suturing. But owing to the unhealthy vicinities near the suture lines, there is a significant risk of technical failure which further increases postoperative morbidity and mortality. A 60-year-old male, with a history of hypertension, ischemic heart disease, and previous percutaneous transluminal coronary angioplasty, underwent sigmoid colectomy with colorectal anastomosis for complicated sigmoid diverticulitis. He then developed anastomotic site leak for which an ileostomy was done. Prior to the ileostomy revision, he was referred for colonoscopic evaluation which showed the persistence of a partial AD. We decided to close the defect endoscopically with the Apollo OverStitch device. Initial tissue preparation was done by creating a surgical surface using argon plasma coagulation at the perimeter of the leak site. A double channel therapeutic endoscope with the OverStitch assembly was passed to take full-thickness running sutures across the rent to facilitate full closure. The area examined showed good suture approximation and complete closure. The procedure was successful with no immediate or delayed postprocedural complications. Repeat endoscopic evaluation at about two weeks showed well-approximated edges with intact suture lines, and there was complete resolution of the leak. The patient subsequently underwent revision surgery after a month. The patient is under close follow-up and doing well. The Apollo OverStitch device has certainly opened new avenues in flexible endoscopic surgery which need further exploratory studies to add to existing promising results.

Educational transformation is an ongoing process. However, in 2020 the transformation in South Africa was accelerated by the COVID-19 pandemic. This global health threat was inadvertently a catalyst for considerable change within the field of education. Considering that the nature of COVID-19 was infectious, the best mode of delivery for education to students during the pandemic was digital platforms. For the History Education department at the University of KwaZulu-Natal (UKZN), this was a significant transition from the conventional contact methods. While digital platforms were used under normal conditions to complement contact lectures, the transition meant that all teaching was completely dependent on digital platforms. Navigating this change was both interesting and challenging for me as a teacher and supervisor of History Education. This paper is a self-study of my experiences of engaging with online History Education at postgraduate and undergraduate levels within Higher Education. History Education modules had to be re-engineered, and pedagogical considerations had to be explored to align with the use of digital software. The online transition was not seamless and was accompanied by challenges that ranged from technological inaccessibility and teacher training for online education to academic disparities. At the onset of the transition, technology proved to exacerbate existing geo-social and educational inequalities within the learning community at the UKZN's History Education department. It undeniably took a considerable amount of time to acclimatise to the new digital platforms for online education. Eventually, there were visible successes. For instance, new online pedagogies proved effective in traversing History Education modules via online education. Training in the use of software and applications was also useful in achieving the learning objectives of History Education modules. Online resources, such as multimedia, were easier to incorporate into History Education lectures. This provided an integrative shift between theory and real-life experiences. Arguably, the COVID-19 pandemic served as a catalyst for embracing digital platforms, which we, as educationalists, may not have otherwise implemented were it not a necessity.

A comparative study of the corrosion behavior of pure magnesium and AZ91D anodes in reinforced cement concrete was undertaken in the present work. The steel reinforcements were electrochemically kept in contact with these anodes in a chloride atmosphere, and the half-cell potential drop was observed. Bare steel reinforcements were tied to the anodes and were also kept in a high chloride atmosphere to test the mechanical properties. The yield stress and ultimate tensile stress were found to decrease by approximately 50 MPa, while the reduction in percentage elongation was approximately 25% for reinforcements tied to AZ91D and pure Mg, at the end of 80 days, compared to the fresh steel reinforcement. The rate of corrosion of pure Mg was reportedly slightly higher compared to AZ91D, due to the presence of inter-metallics, as inferred through micro-graphs.

ABSTRACT The classical and the most commonly used approach for the prevention of coccidiosis in chickens is the incorporation of synthetic coccidiostats into their feed during the first weeks of their life. This approach has been challenged by consumers, objecting against residual antimicrobials and drug resistant microorganisms that may contaminate poultry products. Moreover, the coccidiostat application approach has been challenged in the last decade by the emerging regulations in the developed world, targeting the cessation of such a practice. The pressures from the consumers as well as from regulation agencies resulted in a great need for alternative methods to reduce, or completely replace the use of coccidiostats in modern chicken production. This replacement requires seeking for safer products that do not have any negative impact on the consumer's health. Such products are very much in demand, especially in organic poultry farming. The purpose of this review is to present approaches for the replacement of coccidiostat application in chickens through improvements in poultry house management, research in vaccine developments, and application of holistic natural products for the prevention of the economic losses resulting from coccidiosis.

AbstractAs Machado de Assis's The Posthumous Memoirs of Brás Cubas (1881) reflects on the life of a single man, two dominant forces emerge within the narrative: Brás Cubas's desire for a family and his quest for political office. These parallel efforts coincide in the form of the political wife, the woman who enables both domestic and public glory. Using the encounter of public and private spaces as a point of departure, this essay considers female forms as circumscribed by their private and public duties. Evaluating Virgília and Marcela, we explore the significance of materiality and promiscuity in the reading of women's bodies within the text.

摘要 丙型肝炎是一种全球性流行病。据估计，全世界约有 1.85 亿人受到感染，其中大多数人居住在中低收入国家。目前，抗病毒药物研制取得了新进展，推出了新疗法，该疗法比现有的疾病疗法更加有效、安全且耐受性更高。如果这些疗法价格实惠、这些药物的仿制药生产规模扩大并且公众意识和筛查项目增强，此类疗法就为抑制该流行病提供了一种可能。 制药公司在其中发挥着核心作用。 我们调查了世界上最大的 20 家制药公司销售的产品、渠道和药物可及性策略。其中六家公司正在研制丙型肝炎药物：艾伯维 (AbbVie)、百时美施贵宝 (Bristol-Myers Squibb)、吉利德 (Gilead)、美国强生 (Johnson & Johnson)、默克集团 (Merck & Co) 和罗氏 (Roche)。这些公司采用一系列的方法支持丙型肝炎治疗，包括定价策略、自愿授权、能力建设和药物捐赠。我们概述了这些公司在解决丙型肝炎产品可及性方面的承诺。我们为这些公司推荐了以下可行措施，它们可采取这些措施在抑制该流行病中发挥更大的作用：一、将负担能力评估放在首位；二、在产品生命周期中及早制定药物可及性策略；三、向仿制药制造商提供授权。

L'hépatite C est une épidémie mondiale. On estime à 185 millions le nombre d'individus infectés par ce virus dans le monde, la plupart vivant dans des pays à revenu faible ou intermédiaire. Les récents progrès dans la mise au point de médicaments antiviraux ont conduit à des traitements plus efficaces, plus surs et mieux tolérés que les traitements existants pour soigner cette maladie. Ces traitements permettraient de freiner l'épidémie, à condition que leur coût soit abordable, que la production de médicaments génériques soit intensifiée et que les programmes de sensibilisation et de dépistage soient renforcés. Les sociétés pharmaceutiques ont, à cet égard, un rôle central à jouer. Nous avons examiné les produits commercialisés, les produits à l'étude et les stratégies d'accès aux médicaments de 20 des plus importantes sociétés pharmaceutiques mondiales. Six de ces sociétés développent des médicaments pour soigner l'hépatite C: AbbVie, Bristol-Myers Squibb, Gilead, Johnson & Johnson, Merck & Co. et Roche. Ces sociétés adoptent diverses approches pour faciliter le traitement de l'hépatite C, qui reposent notamment sur des stratégies de fixation des prix, l'octroi volontaire de licences, un renforcement des capacités et des dons de médicaments. Nous donnons un aperçu des efforts déployés par ces sociétés pour faciliter l'accès aux médicaments permettant de soigner l'hépatite C, et proposons des actions que peuvent mener ces sociétés afin de jouer un plus grand rôle dans l'enraiement de cette épidémie: (i) donner un degré de priorité élevé aux évaluations de l'accessibilité économique; (ii) développer des stratégies d'accès au début du cycle de vie du produit; et (iii) octroyer des licences aux fabricants de médicaments génériques.

Hepatitis C is a global epidemic. Worldwide, 185 million people are estimated to be infected, most of whom live in low- and middle-income countries. Recent advances in the development of antiviral drugs have produced therapies that are more effective, safer and better tolerated than existing treatments for the disease. These therapies present an opportunity to curb the epidemic, provided that they are affordable, that generic production of these medicines is scaled up and that awareness and screening programmes are strengthened. Pharmaceutical companies have a central role to play. We examined the marketed products, pipelines and access to medicine strategies of 20 of the world's largest pharmaceutical companies. Six of these companies are developing medicines for hepatitis C: AbbVie, Bristol-Myers Squibb, Gilead, Johnson & Johnson, Merck & Co. and Roche. These companies employ a range of approaches to supporting hepatitis C treatment, including pricing strategies, voluntary licensing, capacity building and drug donations. We give an overview of the engagement of these companies in addressing access to hepatitis C products. We suggest actions companies can take to play a greater role in curbing this epidemic: (i) prioritizing affordability assessments; (ii) developing access strategies early in the product lifecycle; and (iii) licensing to manufacturers of generic medicines.

إن التهاب الكبد الفيروسي "سي" وباء منتشر على مستوى العالم. وتشير تقديرات عدد المصابين بهذا المرض في أنحاء العالم إلى ما يقارب 185 مليون شخص، يقيم معظمهم بالدول منخفضة ومتوسطة الدخل. وقد أثمر التقدم الذي تم إحرازه مؤخرًا في تطوير العقاقير المضادة للفيروسات عن علاجات أكثر فاعلية وأمانًا مع قابلية أعلى لتحملها من جانب المريض مقارنةً بالعلاجات الحالية لهذا المرض. وتتيح هذه العلاجات فرصة الحد من ذلك الوباء، شريطة أن تتوفر بأسعار معقولة، وأن يزداد معدل إنتاج هذا النوع من الأدوية، بالإضافة إلى تعزيز برامج التوعية والفحص. وتلعب شركات المستحضرات الطبية دورًا محوريًا في ذلك. وقد بحثنا في المنتجات التي تم تسويقها وقنوات توفير الأدوية، واستراتيجيات تيسير الحصول عليها لدى 20 شركة من ضمن أكبر شركات المستحضرات الطبية في العالم، فوجدنا ست شركات منها تعمل حاليًا على تطوير أدوية علاج التهاب الكبد الفيروسي "سي"، وهي AbbVie، وBristol-Myers Squibb، وGilead، وJohnson & Johnson، وMerck & Co.، وRoche. وتتبنى هذه الشركات مجموعة من المناهج لدعم علاج التهاب الكبد الفيروسي "سي"، بما يشمل استراتيجيات التسعير، ومنح التراخيص الاختيارية، وبناء القدرات، والتبرع بالعقاقير. كما نُجري مراجعة لمدى مشاركة تلك الشركات في توفير سبل الحصول على المنتجات المتعلقة بالتهاب الكبد الفيروسي "سي". وفي هذا الصدد، فإننا نقترح بعض الإجراءات التي يمكن أن تتخذها الشركات كي تلعب دورًا أكثر أهمية في الحد من هذا الوباء: (1) إعطاء الأولوية للتقييمات المتعلقة بمعقولية الأسعار؛ و(2) وضع استراتيجيات لتيسير الحصول على الأدوية في مرحلة مبكرة من دورة حياة المنتج؛ و(3) منح التراخيص للجهات المصنِّعة لهذه الأنواع من الأدوية.

La hepatitis C es una epidemia global. Se estima que, en todo el mundo, hay 185 millones de personas infectadas, la mayoría de las cuales viven en países de ingresos bajos y medios. Los recientes avances en el desarrollo de antivirales han producido terapias más efectivas, seguras y de mejor tolerancia que los tratamientos para la enfermedad existentes. Estas terapias presentan una oportunidad para poner freno a la epidemia, siempre y cuando sean asequibles, aumentar la producción genérica de dichos medicamentos y reforzar los programas de sensibilización y detección. Las empresas farmacéuticas juegan un papel central. Se examinaron los productos comercializados, tuberías y estrategias de acceso a los medicamentos de veinte de las mayores empresas farmacéuticas del mundo. Seis de estas empresas están desarrollando medicamentos para tratar la hepatitis C: AbbVie, Bristol-Myers Squibb, Gilead, Johnson & Johnson, Merck & Co. y Roche. Estas empresas emplean una gama de enfoques para apoyar el tratamiento para la hepatitis C, incluyendo las estrategias de fijación de precios, la concesión voluntaria de licencias, la creación de capacidad y las donaciones de medicamentos. Ofrecemos una visión general del compromiso de estas empresas a la hora de ofrecer acceso a los productos para tratar la hepatitis C. Sugerimos acciones que las empresas pueden llevar a cabo para tener un papel más importante a la hora de frenar esta epidemia: (i) dar prioridad a los criterios de asequibilidad; (ii) desarrollar estrategias de acceso al principio del ciclo de vida del producto; y (iii) ofrecer licencias a los fabricantes de medicamentos genéricos.

Dendritic cells (DCs) play a pivotal role in the connection of innate and adaptive immunity of hosts to mycobacterial infection. Studies on the interaction of monocyte-derived DCs (MO-DCs) using Mycobacterium leprae in leprosy patients are rare. The present study demonstrated that the differentiation of MOs to DCs was similar in all forms of leprosy compared to normal healthy individuals. In vitro stimulation of immature MO-DCs with sonicated M. leprae induced variable degrees of DC maturation as determined by the increased expression of HLA-DR, CD40, CD80 and CD86, but not CD83, in all studied groups. The production of different cytokines by the MO-DCs appeared similar in all of the studied groups under similar conditions. However, the production of interleukin (IL)-12p70 by MO-DCs from lepromatous (LL) leprosy patients after in vitro stimulation with M. leprae was lower than tuberculoid leprosy patients and healthy individuals, even after CD40 ligation with CD40 ligand-transfected cells. The present cumulative findings suggest that the MO-DCs of LL patients are generally a weak producer of IL-12p70 despite the moderate activating properties of M. leprae. These results may explain the poor M. leprae-specific cell-mediated immunity in the LL type of leprosy.