Dysregulation of phosphorus homeostasis resulting in hypophosphatemia is common in cancer patients and can result in serious complications and impact outcomes. Several factors, including critical illness, nutritional status, cancer type, and therapy, influence the development of hypophosphatemia. Hypophosphatemia can develop as a result of phosphaturic mesenchymal tumors or as a paraneoplastic phenomenon. The clinical presentation for hypophosphatemia varies depending on the duration and severity of the hypophosphatemia and affects several organ systems. Among other serious effects, hypophosphatemia can impair tissue oxygenation, cause hemolysis, leukocyte and platelet dysfunction, encephalopathy, seizures, arrhythmias, cardiomyopathy, rhabdomyolysis, and coma. Multiple studies have demonstrated that hypophosphatemia is an adverse prognostic marker in inpatients with increased in-hospital stay, mortality, and postoperative complications. The phosphate level is homeostatically regulated and maintained in a narrow range by 3 main hormones: PTH, FGF-23, and 1,25 (OH)2 Vitamin D3. Together, these hormones regulate how the intestine, kidneys, and bones traffic phosphorus. Several hematological malignancies and cancer therapies are associated with proximal tubular dysfunction (Fanconi syndrome), resulting in phosphaturia. Caution should be taken with parenteral administration of phosphate salts because secondary complications can develop principally due to hypocalcemia. The general approach to hypophosphatemia should target the underlying cause. Early recognition and prevention are essential, and the approach to hypophosphatemia in the cancer patient because of the nuances and complexity should be multidisciplinary.

Background: Mortality of critically ill acute kidney injury (AKI) initiated on renal replacement therapy (RRT) is very high. Identifying modifiable and unmodifiable clinical variables at dialysis start that are associated with hospital survival can help, not only in prognostication, but also in clinical triaging. Methods: A retrospective observational study was done on AKI-D patients who were initiated on RRT in medical and surgical intensive care units (ICU)s of a high-acuity academic medical center from January 2010 through December 2015. We excluded patients with suspected poisoning, End Stage Renal Disease, Stage 5 CKD not on dialysis or AKI-D patients initiated on RRT outside of ICU setting. Primary outcome was in-hospital mortality. Results: Of the 416 critically ill AKI-D patients admitted to the medical (38%), surgical (40.9%) and cardiac (21.1%) ICUs, with nearly 75% on artificial organ support, mean age 62.1 +/-14.8 years, mean SOFA scores of 11.8+/-4.3, dialysis was initiated using continuous RRT in 261(62.7%) and intermittent hemodialysis in 155 (37.3%) patients. Incidence of survival to hospital discharge was 47.6%. Using multivariable logistic regression with stepwise backward elimination, a prognostic model was created which included the variables age, CKD, COPD, admission and within 24 hour of start SOFAscore, refractory hyperkalemia and uremic encephalopathy as dialysis indications, BUN > 100mg/dl, serum creatinine, serum lactate, serum albumin, CRRT as initial modality, severe volume overload and abdominal surgery. The model exhibited good calibration (goodness of fit test, p =0.8315) and excellent discrimination (optimism-corrected c-statistic 0.9287). Conclusions: In this single-center, diverse, critically-ill AKI-D population, a novel prognostic model which combined widely used ICU scores, clinical and biochemical data at dialysis start as well as dialysis indication and modality, robustly predicted short-term survival. External validation is needed to prove generalizability of study findings.

This paper tries to unravel the cross-cutting dimensions of ecology and feminism for holistic analysis of "A White Heron." The theoretical insights drawn from both schools combine to form the critical lens of ecofeminism to find out the underpinning operational ideology and interpret literaty texts. Greta Gaard and Lori Gruen state: "Standing at the crossroads of environmentalism and feminism, ecofeminist theory is uniquely positioned to undertake a holistic analysis of these problems in both their human and natural contexts" (277). The evolution of interdisciplinary approach and critical practices has led to re-reading and reinterpreting the literary texts ever exploring and widening their dimensions.

Contrast is considered as a powerful tool that researchers used to identify and describe differences they encounter in the world. It is a literary device that explores differences between two or more things, ideas, and persons. It is also used to evaluate differences. The present study makes an attempt to examine contrasts as literary device in Balkrishna Sama's drama, Prahlad. The purpose of this study is to explore a cultural/social contrast that has been expressed through speech and action of the characters as Hiranya Kashyapu and Prahlad. The contrast is used in literary works in order to emphasise on intended meaning of literary works. Qualitative research methodology has been used for the study. The original text, Prahlad, has been primarily analysed using the technique of social/cultural contrast. As a supportive technique, antithesis has also been used. The close textual analysis has shown many layers of contrasts in the drama.  Analysis reveals the significant role of literary contrasts in portraying interaction between characters and their surroundings including human beings, nature, and society. Tracing the contrasting personalities and perspectives of the characters, one can discern a variety of messages about human experiences. Of special significance is Sama's skill in showing how interaction between Hiranya and Prahlad reveal true nature of human beings, nature and society. The contrast used in the play, Prahlad sends strong messages of thinking spiritually and materially. There is struggle between spiritualism and materialism, religion and science, path of devotion and thirst of temporal, service and business and so on. The study has highlighted on new approach of interpreting to the ancient literature.

This research article investigates the effects of verbal communication strategies in the marketing of fruit items in Nepalganj, Nepal. The study aimed to identify the most effective verbal communication strategies that can be used to promote fruit items in Nepalgunj's local market. To achieve this objective, a survey questionnaire was administered to 150 respondents, including customers and vendors of fruit items in Nepalgunj. The study found that verbal communication strategies such as persuasive language, use of humor, and the use of local dialects were the most effective in promoting fruit items in the local market. Additionally, the study revealed that the age and educational level of customers significantly influenced their preferences for verbal communication strategies.