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In the Kingdom of Saudi Arabia, there is an increasing demand for community pharmacists to provide the highest level of clinical knowledge and services. However, evidence regarding Saudi public awareness of the clinical services offered by community pharmacies (CPs) and the barriers to using them is limited. In this cross-sectional study, we used an online questionnaire developed by adapting the Consolidated Framework for Implementation Research. A total of 273 participants completed the survey. Half the participants were generally aware of the availability of some CP services but were not informed about the full range on offer, eg, medication reviews (84%) and online counseling (89%). Most of the participants (69.6%) did not identify differences in the care provided by community pharmacists versus hospital pharmacists (P = 0.02). A commonly reported barrier to using CP services was a general preference for other healthcare professionals to seek pharmaceutical help (85.7%). Many other barriers were also reported, impacting the participants' use of these services. The decision-making authorities should consider improvements to increase patients' awareness and utilization of clinical services and enhance community pharmacists' performance in clinical-oriented pharmaceutical care. [ABSTRACT FROM AUTHOR]

In this study, we characterize LP-Kenmotsu manifolds admitting *-Ricci-Yamabe solitons (*-RYSs) and gradient *-Ricci-Yamabe solitons (gradient *-RYSs). It is shown that an LP-Kenmotsu manifold of dimension n admitting a *-Ricci-Yamabe soliton obeys Poisson's equation. We also determine the necessary and sufficient conditions under which the Laplace equation is satisfied by LP-Kenmotsu manifolds. Finally, by using a non-trivial example of an LP-Kenmotsu manifold, we verify some results of our paper. [ABSTRACT FROM AUTHOR]

Background : Recent studies have suggested an association between sleep duration and cardiovascular diseases; however, the link to AF is inconclusive. This study aimed to explore the relationship between sleep duration and AF by conducting a systematic review and meta-analysis of primary studies to provide evidence of the link between insufficient sleep and AF. Methods: A review of the existing literature was conducted to identify the primary studies that examined the association between AF and sleep duration. The inquiry spanned databases, including PubMed, Embase, MEDLINE, and Google Scholar, from their inception through October 2023. Results: Meta-analysis revealed a statistically significant association (p < 0.01) between shorter sleep duration and the incidence of AF (hazard ratio (HR), 1.18; 95% CI, 1.03–1.34; I2 = 89%). Conversely, longer sleep duration did not exhibit a statistically significant association with the incidence of AF (HR, 1.03; 95% CI, 0.92–1.14; I2 = 66%, p = 0.02). The sensitivity analysis demonstrated reduced heterogeneity after excluding specific studies. Conclusion: Insufficient sleep duration was associated with an increased risk of AF, whereas a longer sleep duration did not show a significant correlation. Standardized methods for sleep assessment and AF diagnosis as well as adjustments for confounding factors are suggested for future studies to improve the clarity and understanding of these associations. [ABSTRACT FROM AUTHOR]

Since the end of the twentieth century, the world has observed a considerable upsurge in carbon emissions as several countries have surfaced as industrial centers and production monsters worldwide. The present study contributes to the existing literature examining the effects of carbon-based emissions, industrial value added, trade openness, transport services, railway lines, and globalization index on per capita GDP growth in China. The study covers a period of 40 years, from 1982 to 2021, introducing the impact of railway transport on GDP growth in contemporary environmental empirics. A vector error correction model (VECM) was applied to achieve the study's envisaged objectives. The findings of this study reveal that carbon emissions are responsible for the reduction of per capita GDP growth in China. On the contrary, industrial value added, transport services, railway lines, and globalization index positively support the per capita GDP growth-dependent variable. The study proposes that pragmatic policies are needed to control pollution resulting from carbon emissions. The eventual effect of maintaining greenhouse gases is expected to assist in achieving sustainable growth of per capita GDP leading to the accomplishment of sustainable development goals in the economy. [ABSTRACT FROM AUTHOR]

In the present paper, we investigate perfect fluid spacetimes and perfect fluid generalized Roberston-Walker spacetimes that contain a torse-forming vector field satisfying almost hyperbolic Ricci solitons. We show that the perfect fluid spacetimes that contain a torse-forming vector field satisfy an almost hyperbolic Ricci soliton, and we prove that a perfect fluid generalized Roberston-Walker spacetime satisfying an almost hyperbolic Ricci soliton (g, ζ, ..., µ) is an Einstein manifold. Also, we study an almost hyperbolic Ricci soliton (g, V, ..., µ) on these spacetimes when V is a conformal vector field, a torse-forming vector field, or a Ricci bi-conformal vector field. [ABSTRACT FROM AUTHOR]

Background: The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2DM on treatment outcomes of TB patients treated under the DOTS Programme. Methods: This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results. Results: In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56-0.83, p < .01 and HR 0.93, 95% CI 0.70-1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60-0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I² = 55.79%). Conclusions: A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB. [ABSTRACT FROM AUTHOR]

Our previous studies have revealed that L. acidophilus possesses inhibitory effects on PCV2 proliferation in vivo, although the underlying mechanisms remain elusive. Probiotics like L. acidophilus are known to exert antiviral through their metabolites. Therefore, in this study, non-targeted metabolomics was used to detect the changes in metabolites of L. acidophilus after 24  h of proliferation. Subsequently, high-throughput molecular docking was utilized to analyze the docking scores of these metabolites with PCV2 Cap and Rep, aiming to identify compounds with potential anti-PCV2 effects. The results demonstrated that 128 compounds such as Dl-lactate were significantly increased. The results of high-throughput molecular docking indicated that compounds such as ergocristine, and telmisartan formed complexes with Cap and Rep, suggesting their potential anti-PCV2 properties. Furthermore, compounds like vitamin C, exhibit pharmacological effects consistent with L. acidophilus adding credence to the idea that L. acidophilus may exert pharmacological effects through its metabolites. These results will provide a foundation for the study of L. acidophilus. [ABSTRACT FROM AUTHOR]

The ketogenic diet (KD), characterized by high-fat and low-carbohydrate intake, is currently gaining widespread popularity as a treatment for drug-resistant epilepsy (DRE). In addition to the traditional ketogenic diet, several variants have been introduced to enhance compliance and flexibility, such as the modified Atkins diet (MAD) and the low glycemic index diet (LGID). These adaptations aim to provide patients with more manageable and sustainable options while harnessing the potential therapeutic benefits of DRE. The objective of this study is to evaluate the efficacy and safety of the KD in pediatric patients who exhibit DRE. In this study, we conducted a thorough review of existing literature by searching Cochrane, Embase, Medline, and PubMed. Our approach involved predefined criteria for data extraction and the assessment of study quality. Eleven RCTs with 788 participants were included in this study. The pooled effect estimates revealed a significant association between dietary interventions and seizure frequency reduction of > 50% (OR 6.68, 96% CI 3.52, 12.67) and > 90% (OR 4.37, 95% CI 2.04, 9.37). Dietary interventions also increased the odds of achieving seizure freedom (OR 4.13, 95% CI 1.61, 10.60). The common adverse effects included constipation (39.07%) and vomiting (10%). In conclusion, dietary interventions, notably the KD, hold promise for pediatric DRE, reducing seizures and achieving freedom. These non-pharmacological options improve the quality of life of non-responsive and non-surgical patients. The KD has emerged as a potential therapeutic approach. Further research is needed to address the limitations and investigate their long-term effects. [ABSTRACT FROM AUTHOR]

Simple Summary: Canine mammary tumors are the most common tumor in female dogs. In this study, we obtained a metastatic key protein by comparing the proteomics data of in situ tumor and metastatic cell lines from the same individual. Our results not only help to compare the difference in metastasis processes between canine mammary tumors and human breast cancer but also provide a theoretical basis for the prevention of tumor metastasis and the improvement of prognosis in dogs and humans. Canine mammary tumors (CMTs) are the most common type of tumor in female dogs. In this study, we obtained a metastatic key protein, Fascin-1, by comparing the proteomics data of in situ tumor and metastatic cell lines from the same individual. However, the role of Fascin-1 in the CMT cell line is still unclear. Firstly, proteomics was used to analyze the differential expression of Fascin-1 between the CMT cell lines CHMm and CHMp. Then, the overexpression (CHMm-OE and CHMp-OE) and knockdown (CHMm-KD and CHMp-KD) cell lines were established by lentivirus transduction. Finally, the differentially expressed proteins (DEPs) in CHMm and CHMm-OE cells were identified through proteomics. The results showed that the CHMm cells isolated from CMT abdominal metastases exhibited minimal expression of Fascin-1. The migration, adhesion, and invasion ability of CHMm-OE and CHMp-OE cells increased, while the migration, adhesion, and invasion ability of CHMm-KD and CHMp-KD cells decreased. The overexpression of Fascin-1 can upregulate the Tetraspanin 4 (TSPAN4) protein in CHMm cells and increase the number of migrations. In conclusion, re-expressed Fascin-1 could promote cell EMT and increase lamellipodia formation, resulting in the enhancement of CHMm cell migration, adhesion, and invasion in vitro. This may be beneficial to improve female dogs' prognosis of CMT. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is a significant global health concern, and numerous studies have established a link between depression and an increased risk of stroke. While many investigations explore this link, some overlook its long-term effects. Depression may elevate stroke risk through physiological pathways involving nervous system changes and inflammation. This systematic review and meta-analysis aimed to assess the association between depression and stroke. Methodology: We conducted a comprehensive search of electronic databases (PubMed, Embase, Scopus, and PsycINFO) from inception to 9 April 2023, following the Preferred Reporting Items for Systemic Review and Meta-analysis (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. We included all articles assessing the association between different stroke types and depression, excluding post-stroke depression. Two investigators independently extracted data and assessed quality using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool, utilizing a random-effects model for data synthesis. The primary outcome was the association of depression with stroke, with a secondary focus on the association of antidepressants with stroke. Results: The initial search yielded 10,091 articles, and 44 studies were included in the meta-analysis. The pooled analysis revealed a significant association between depression and stroke risk, with an overall hazard ratio of 1.41 (95% CI 1.32, 1.50; p<0.00001), indicating a moderately positive effect size. Subgroup analyses showed consistent associations with ischemic stroke (HR=1.30, 95% CI 1.13, 1.50; p=0.007), fatal stroke (HR=1.39, 95% CI 1.24, 1.55; p<0.000001), and hemorrhagic stroke (HR=1.33, 95% CI 1.01, 1.76; p=0.04). The use of antidepressants was associated with an elevated risk of stroke (HR=1.28, 95% CI 1.05, 1.55; p=0.01). Conclusion and relevance: This meta-analysis indicates that depression moderately raises the risk of stroke. Given the severe consequences of stroke in individuals with depression, early detection and intervention should be prioritized to prevent it. Systematic review registration: Prospero (CRD42023472136). [ABSTRACT FROM AUTHOR]

In this paper, we study left-invariant cross curvature solitons on Lorentzian three-dimensional Lie groups and classify these solitons. [ABSTRACT FROM AUTHOR]

The demand for lightweight aggregates in concrete compositions for diverse structural and non-structural applications in contemporary building construction has increased. This is to achieve a controllable low-density lightweight concrete, which reduces the overall structural weight. However, the challenge lies in achieving an appropriate strength in lightweight concrete while maintaining a lower unit weight. This research aims to evaluate the performance of lightweight concrete by integrating expanded polystyrene (EPS) as a partial replacement for coarse aggregate. Test specimens were cast by blending EPS with coarse aggregate at varying proportions of 0%, 15%, 30%, and 45%, while maintaining a constant water-to-binder ratio of 0.60. To enhance the bonding and structural capabilities of the proposed lightweight concrete mixes, reinforcement with 2% and 4% steel fibers by volume of the total concrete mix was incorporated. Silica fume was introduced into the mix to counteract the water hydrophobicity of EPS material and enhance the durability of lightweight concrete, added at a rate of 10% by weight of cement in all specimens. A total of 60 samples, including cylinders and beams, were prepared and cured over 28 days. The physical and mechanical properties of the lightweight EPS-based concrete were systematically examined through experimental testing and compared against a standard concrete mix. The analysis of the results indicates that EPS-based concrete exhibits a controllable low density. It also reveals that incorporating reinforcement materials, such as steel fibers, enhances the overall strength of lightweight concrete. [ABSTRACT FROM AUTHOR]

We study the properties of Lorentzian para-Sasakian manifolds endowed with ∗-Ricci solitons and gradient ∗-Ricci solitons. Finally, the existence of ∗-Ricci soliton on a 4-dimensional Lorentzian para-Sasakian manifold is proved by constructing a non-trivial example. [ABSTRACT FROM AUTHOR]

SOX8 was linked in a genome-wide association study to human height heritability, but roles in chondrocytes for this close relative of the master chondrogenic transcription factor SOX9 remain unknown. We undertook here to fill this knowledge gap. High-throughput assays demonstrate expression of human SOX8 and mouse Sox8 in growth plate cartilage. In situ assays show that Sox8 is expressed at a similar level as Sox9 in reserve and early columnar chondrocytes and turned off when Sox9 expression peaks in late columnar and prehypertrophic chondrocytes. Sox8-/- mice and Sox8fl/flPrx1Cre and Sox9fl/+Prx1Cre mice (inactivation in limb skeletal cells) have a normal or near normal skeletal size. In contrast, juvenile and adult Sox8fl/flSox9fl/+Prx- 1Cre compound mutants exhibit a 15 to 20% shortening of long bones. Their growth plate reserve chondrocytes progress slowly toward the columnar stage, as witnessed by a delay in down-regulating Pthlh expression, in packing in columns and in elevating their proliferation rate. SOX8 or SOX9 overexpression in chondrocytes reveals not only that SOX8 can promote growth plate cell proliferation and differentiation, even upon inactivation of endogenous Sox9, but also that it is more efficient than SOX9, possibly due to greater protein stability. Altogether, these findings uncover a major role for SOX8 and SOX9 in promoting skeletal growth by stimulating commitment of growth plate reserve chondrocytes to actively proliferating columnar cells. Further, by showing that SOX8 is more chondrogenic than SOX9, they suggest that SOX8 could be preferred over SOX9 in therapies to promote cartilage formation or regeneration in developmental and degenerative cartilage diseases. [ABSTRACT FROM AUTHOR]

In this paper, we introduce the concepts of Riemannian warped-twisted product submersions and examine their fundamental properties, including total geodesicity, total umbilicity and minimality. Additionally, we investigate the Ricci tensor of Riemannian warped-twisted product submersions, specifically about the horizontal and vertical distributions. Finally, we obtain Einstein condition for base manifold if the horizontal and vertical distributions of the ambient manifold is Einstein. [ABSTRACT FROM AUTHOR]

The current study examined predictors of mental health treatment among Black men while incarcerated. Participants were 76 individuals who identified as Black Americans and were recruited from a correctional setting. Using secondary data analysis (Shaw, L. B., & Morgan, R. D. (2011). Inmate attitudes toward treatment: Mental health service utilization and treatment effects. Law and Human Behavior, 35(4), 249–261. https://doi.org/10.1007/s10979-010-9233-5.), results indicated that Black men with a mental health diagnosis were more likely than those without a diagnosis to report receiving mental health treatment while incarcerated. Additionally, linear regression analyses indicated that only expectations about treatment (i.e., personal commitment; not therapy fears or history of mental health diagnosis) significantly predicted the current use of mental health treatment. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

The aim of the present paper is to study the geometry of n-dimensional differentiable manifolds endowed with F(a0, a1, ...., aan)-structure satisfying anFn +an-1Fn-1+.......+a1V F+a0I = 0 and establish its existence. Also, it is proved that for the complex numbers, the dimension of a manifold M endowed with F(a0, a1, ...., aan)-structure is even. Furthermore, we study the Nijenhuis tensor of a tensor field F of type (1,1) satisfying the general quadratic equation, which is a particular case of the F(a0, a1, ......, aan)-structure. At last, we study the integrability conditions of an F(a0, a1, ......, aan)-structure. [ABSTRACT FROM AUTHOR]

Background: Critical illness is one of the most common causes of delirium in children which can be associated with increased morbidity and mortality. Delirium continues to be an overlooked aspect of the management of critically ill children. This study was conducted with the objective of determining the frequency and risk factors of delirium in critically ill children. Subjects and Methods: This prospective observational study included patients admitted for at least a period of 24 h of teaching in the pediatric intensive care unit (PICU) of a medical college of Pakistan from March 2022 to September 2022. Each patient was screened for developing delirium twice a day using the Cornell Assessment of Pediatric Delirium. Results: The median age of the patients was 19.5 months (interquartile range: 10.7–72). There were 64.6% (n = 106) of male children, and 97.2% (n = 143) were admitted due to medical conditions. Delirium was identified in 97 (59.1%) patients. Mortality was observed in 3 (1.8%) cases. The average length of stay and frequency of hypoxia was higher among the pediatric delirium group (P = 0.002 and P = 0.022, respectively). Independent predictors of delirium in PICU patients were length of stay (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.39–4.20), use of inotropes (OR, 3.32; 95% CI, 1.0.4–10.64), use of narcotics (OR, 8.78; 95% CI, 0.96–80.51), and hypoxia (OR, 3.02; 95% CI, 1.17–7.81). Conclusion: Delirium is common in children admitted to PICU. Length of PICU stay, use of narcotics, inotropes, and hypoxia were found as independent risk factors for delirium. [ABSTRACT FROM AUTHOR]

Diagnosing gastrointestinal cancer by classical means is a hazardous procedure. Years have witnessed several computerized solutions for stomach disease detection and classification. However, the existing techniques faced challenges, such as irrelevant feature extraction, high similarity among different disease symptoms, and the leastimportant features from a single source. This paper designed a new deep learning-based architecture based on the fusion of two models, Residual blocks and Auto Encoder. First, the Hyper-Kvasir dataset was employed to evaluate the proposed work. The research selected a pre-trained convolutional neural network (CNN) model and improved it with several residual blocks. This process aims to improve the learning capability of deep models and lessen the number of parameters. Besides, this article designed an Auto-Encoder-based network consisting of five convolutional layers in the encoder stage and five in the decoder phase. The research selected the global average pooling and convolutional layers for the feature extraction optimized by a hybrid Marine Predator optimization and Slime Mould optimization algorithm. These features of both models are fused using a novel fusion technique that is later classified using the Artificial Neural Network classifier. The experiment worked on the HyperKvasir dataset,which consists of 23 stomach-infected classes.At last, the proposedmethod obtained an improved accuracy of 93.90% on this dataset. Comparison is also conducted with some recent techniques and shows that the proposed method’s accuracy is improved. [ABSTRACT FROM AUTHOR]

In the era of globalization, financial development plays a key role in socioeconomic and environmental development. However, its adverse consequences on human life, environmental hazards, and high energy consumption cannot be ignored. Thus, this study investigates the non-linear relationship between globalization, financial development, and energy consumption for BRICS economies. In doing so, we have applied second-generation tests to identify cross-sectional dependence in the data. Cross-sectional augmented Dickey-Fuller (CADF) and Cross-sectional Im-Pesaran Shin (CIPS) have been performed to find the stationary level of variables. The long-term equilibrium link between the investigated variables has been established in continuance using the Westerlund Cointegration test. The Dynamic Seemingly Unrelated Regression (DSUR) indicates that U-shaped relationships exist for financial development and globalization with energy consumption. Conversely, there is an inverted U-shaped relationship exist between economic growth and energy consumption in BRICS. The Dumitrescu-Hurlin panel causality test findings show that a unidirectional link runs from energy consumption to financial development, economic growth to energy consumption, and globalization towards energy usage. Important policy implications have also been discussed. [ABSTRACT FROM AUTHOR]

Background: Chronic subdural hematoma (cSDH) is a collection of old blood in the subdural space and has a relatively high estimated incidence, especially among the elderly and men, possibly due to falls, anticoagulant use, or age as independent factors. The subdural evacuating port system (SEPS) offers a minimally invasive solution for cSDH treatment. Objective: The objective of our meta-analysis is to review the literature and assess the safety and efficacy of SEPS as a first-line treatment for cSDH. Method: We conducted an exhaustive literature search to explore outcomes resulting from the implementation of SEPS as the initial treatment for cSDH. The main focus was on treatment success, comprising both symptom improvement and the absence of additional operating room interventions. Supplementary outcomes encompassed factors such as discharge arrangements, length of hospital stay (LOS), recurrence of hematoma, and any associated complications. Result: A total of 15 studies, involving 1146 patients who underwent SEPS placement, satisfied the inclusion criteria. The combined rate of achieving a successful outcome stood at 0.79 (95% CI 0.75–0.83). The occurrence of delayed hematoma recurrence was found to be 0.155 (95% CI 0.101–0.208). Meanwhile, the aggregated inpatient mortality rate was 0.017 (95% CI 0.007–0.031). In terms of complications, the rates were 0.02 (95% CI 0.00–0.03) for any acute hemorrhage, 0.01 (95% CI 0.00–0.01) for acute hemorrhage necessitating surgery, and 0.02 (95% CI 0.01–0.03) for seizures. Notably, SEPS placement is associated with a success rate of 79% and exceptionally low incidences of acute hemorrhage and seizure. Conclusion: SEPS is a viable first-line treatment for cSDH, supported by its minimally invasive nature, avoidance of general anesthesia, high success rate, and favorable safety profile. [ABSTRACT FROM AUTHOR]

The supply chain systems in the food industry are complex, including manufacturers, dealers, and customers located in different areas. Currently, there is a lack of transparency in the distribution and transaction processes of online food trade. The global food supply chain industry has enormous hurdles because of this problem, as well as a lack of trust among individuals in the sector and a reluctance to share information. This study aims to develop a blockchain-based strawberry supply chain (SSC) framework to create a transparent and secure systemfor tracking themovement of strawberries fromthe farmto the consumer. Using Ethereum smart contracts, the proposed solution monitors participant interactions, triggers events, and logs transactions to promote transparency and informed decision-making. The smart contracts also govern interactions between vendors and consumers, such as monitoring the status of Internet of Things (IoT) containers for food supply chains and notifying consumers. The proposed framework can be extended to other supply chain industries in the future to increase transparency and immutability. [ABSTRACT FROM AUTHOR]

The inappropriate prescribing of antimicrobials increases antimicrobial resistance (AMR), which poses an appreciable threat to public health, increasing morbidity and mortality. Inappropriate antimicrobial prescribing includes their prescribing in patients hospitalized with COVID-19, despite limited evidence of bacterial infections or coinfections. Knowledge of current antimicrobial utilization in Saudi Arabia is currently limited. Consequently, the objective of this study was to document current antimicrobial prescribing patterns among Saudi hospitals during the COVID-19 pandemic. This study included patients with or without COVID-19 who were admitted to five hospitals in Makkah, Saudi Arabia. Data were gathered using the Global PPS methodology and analyzed using descriptive statistics. Out of 897 hospitalized patients, 518 were treated with antibiotics (57.7%), with an average of 1.9 antibiotics per patient. There were 174 culture reports collected, representing 36.5% of all cases. The most common indication for antibiotics use was community-acquired infections, accounting for 61.4% of all cases. 'Watch' antibiotics were the most commonly prescribed antibiotics, with the cephalosporins and carbapenems representing 38.7% of all antibiotics prescribed, followed by the penicillins (23.2%). Notably, Piperacillin/Tazobactam and Azithromycin were prescribed at relatively higher rates for COVID-19 patients. These findings highlight the need for continuous efforts to optimize the rational use of antibiotics through instigating appropriate antimicrobial stewardship programs in hospitals and, as a result, reduce AMR in the country. [ABSTRACT FROM AUTHOR]

X-Ray knee imaging is widely used to detect knee osteoarthritis due to ease of availability and lesser cost. However, the manual categorization of knee joint disorders is time-consuming, requires an expert person, and is costly. This article proposes a new approach to classifying knee osteoarthritis using deep learning and a whale optimization algorithm. Two pre-trained deep learning models (Efficientnet-b0 and Densenet201) have been employed for the training and feature extraction. Deep transfer learning with fixed hyperparameter values has been employed to train both selected models on the knee X-Ray images. In the next step, fusion is performed using a canonical correlation approach and obtained a feature vector that hasmore information than the original feature vector. After that, an improved whale optimization algorithm is developed for dimensionality reduction. The selected features are finally passed to the machine learning algorithms such as Fine-Tuned support vector machine (SVM) and neural networks for classification purposes. The experiments of the proposed framework have been conducted on the publicly available dataset and obtained the maximum accuracy of 90.1%. Also, the system is explained using Explainable Artificial Intelligence (XAI) technique called occlusion, and results are compared with recent research. Based on the results compared with recent techniques, it is shown that the proposed method's accuracy significantly improved. [ABSTRACT FROM AUTHOR]

In the present paper we study Ricci pseudo-symmetry, Z-Ricci pseudo-symmetry and concircularly pseudo-symmetry conditions on a mixed generalized quasi-Einstein spacetime MG(QE)4. Also, it is proven that if d ≠ Λ, then MG(QE)4 spacetime does not admit heat flux, where d and Λ are the function and the cosmological constant, respectively. In the end of this paper we construct a non-trivial example of MG(QE)4 to prove its existence. [ABSTRACT FROM AUTHOR]

Malaria is a major health problem and about half of the World population still at risk in 95 malaria endemic countries. Due to limited health facilities and high cost and unavailability of artemisinin-based combination therapies (ACTs), a fifth of malarial patients in these countries use traditional medicinal plant remedies. In current review, we have highlighted the antimalarials plants used in various societies across Pakistan. In Pakistan, a total of (77) species of (63) genera belonging to (35) families have been traditionally used for the treatment of malaria. Among these, several plants have been investigated phytochemically and pharmacologically across the globe for antiplasmodial activity and have shown a good antiplasmodial activity. In the other plants on chemotaxonomic basis, several plants need evaluation for antimalarial activity. In most of the ethnobotanical studies conducted across Pakistan, essential information about formulation, dosage, time and duration of use of remedies has not been documented. However, they can be investigated in order to claim their antimalarial potential. Although, these medicinal plants have been used over history for treatment of malaria but, evaluation of their pharmacological activities is essential in order to establish their mode of action, safety, quality, efficacy and to find novel antimalarials and to develop new drugs for resistance of Plasmodium species. [ABSTRACT FROM AUTHOR]

The aim of this paper is to characterize a Riemannian 3-manifold M 3 equipped with a semi-symmetric metric ξ -connection ∇ ˜ with ρ -Einstein and gradient ρ -Einstein solitons. The existence of a gradient ρ -Einstein soliton in an M 3 admitting ∇ ˜ is ensured by constructing a non-trivial example, and hence some of our results are verified. By using standard tensorial technique, we prove that the scalar curvature of (M 3 , ∇ ˜) satisfies the Poisson equation Δ R = 4 (2 − σ − 6 ρ) ρ . [ABSTRACT FROM AUTHOR]

Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj. [ABSTRACT FROM AUTHOR]

The purpose of this study is to examine the complete lifts from the symmetric and concircular symmetric n-dimensional Lorentzian para-Sasakian manifolds (briefly, (L P S) n ) to its tangent bundle T M associated with a Riemannian connection D C and a quarter-symmetric metric connection (QSMC) D ¯ C . [ABSTRACT FROM AUTHOR]

Urothelial carcinoma is a common malignancy that affects the urinary system, with bladder cancer being the most prevalent form. Although the management of early-stage disease has seen significant improvements, the treatment of locally advanced and metastatic urothelial carcinoma remains challenging. Over the past decade, there has been an explosion in the number of therapies available for the treatment of advanced disease, with immune checkpoint inhibitors and antibody-drug conjugates leading the way. Enfortumab vedotin is an antibody-drug conjugate that targets Nectin-4, a protein that is overexpressed in urothelial carcinoma cells. In clinical trials, it has shown promising outcomes for the treatment of advanced urothelial carcinoma that has progressed after chemotherapy or immunotherapy. The US Food and Drug Administration has granted expedited approval for enfortumab vedotin in the treatment of advanced urothelial carcinoma. This review provides an overview of the current and emerging treatments for urothelial carcinoma, with a particular focus on enfortumab vedotin. We discuss the mechanisms of action, clinical efficacy, safety, and ongoing research of enfortumab vedotin, along with the current landscape of other approved therapies and promising agents in development. The aim of this review is to provide a comprehensive and up-to-date summary of the available treatment options for urothelial carcinoma, including their limitations and future prospects. [ABSTRACT FROM AUTHOR]

Following ileostomy closing, wound infection is a frequent consequence. Preoperative infection or inflammation, obesity, poor diet, insufficient intraoperative antimicrobial prevention, inappropriate handling of the stoma site, and wound dehiscence are risk factors linked to increased rates of wound infection after ileostomy closure. Additionally, old age, inflammation, and elevated blood glucose levels can all impede wound recovery. The chance of skin infection may also be increased by additional elements like smoking, glucocorticoid use, and a history of radiation treatment. As a result, it's crucial that healthcare professionals take all of these risk factors into account when providing for individuals who have received ileostomy closure.. Material and Methods This Retrospective Analysis study conducted in department of surgery HMC Peshawar from January 2022 to july 2022 we examined 100 instances of ileostomy closure carried out at a solitary tertiary care facility over a period of six months, Age, gender, BMI, medical history, preoperative infection or inflammation, perioperative antibiotic prophylaxis, manipulation of the stoma site, wound dehiscence, blood glucose levels, immunosuppression, history of radiation therapy, smoking, and corticosteroid use were all taken into account when reviewing the patients' medical records. Any infection of the surgery incision as noted in the medical file was referred to as a wound infection. Results A wound infection followed ileostomy closing in 37 (or 37%) of the 100 cases. The patients' average age was 61.8 years. (range, 19-90). BMI average was 28.3 kg/m2. (range, 18.3- 40.2). Diabetes (n = 45, 45%), hypertension (n = 43, 43%), and obesity (n = 34, 34%) were the most prevalent conditions. 17 patients (17%) had preoperative infection or inflammation, 16 patients (16%) had insufficient postoperative antimicrobial protection, 8 patients (8%), extensive handling of the stoma site, and 4 patients (4%), wound dehiscence. In addition to these risk variables, 27 patients (27%), 9 patients (9%), and 17 patients (17%), respectively, had immunodeficiency, elevated blood sugars, and advanced age. There were 3 patients (3%), 10 patients (10%), and 5 patients (5%) with a history of smoking, glucocorticoid use, and radiation treatment, respectively. Conclusion The study showed that wound infection following ileostomy closing is a frequent consequence with numerous risk factors. The most frequent risk factors included obesity, poor diet, insufficient postoperative antimicrobial prevention, inappropriate handling of the stoma site, preoperative infection or inflammation, and wound dehiscence. Other elements like elevated blood sugar, inflammation, old age, smoking, glucocorticoid use, and The chance of skin infection may also be increased by a background of radiation treatment. Therefore, when providing for individuals who have received ileostomy closure, healthcare professionals must take all of these risk factors into account. [ABSTRACT FROM AUTHOR]

The research study was executed at Agricultural Research Station Swabi, during winter 2016 on "response of radish (Raphanus sativus L) to various doses of phosphorous and potassium fertilizers". This study was outlined as two factorial, split plot Randomized Complete Block design (RCBD) having three replications. The aim of this study was to observe the effect of macronutrients i.e. P and K on growth and yield of radish crop. Phosphorus at 0 kg ha-1, 25 kg ha-1, 50 kg ha-1, 75 kg ha-1 and potassium at 0 kg ha-1, 30 kg ha-1, 60 kg ha-1, 90 kg ha-1 were applied to radish crop. The effect of different levels on radish crop was evaluated for leaves plant-1, leaf dry matter (%), root dry matter (%), root diameter (mm) and root length (cm). It was observed that there was a significant effect of P and K levels on growth and yield of radish. Results revealed that maximum root diameter, root dry matter, leaf dry matter was recorded in plants fertilized with 25 kg ha-1 phosphorous while highest leaves plant-1 and root length was observed in control plots. Regarding potassium, highest root diameter, leaf dry matter, number of leaves plant-1 was recorded in plots provided with 60 kg ha-1 potassium while maximum root dry matter and root length was observed in 30 kg ha-1. Furthermore, good quality yield of radish can be achieved by providing 50 kg ha-1 phosphorous and 30 kg ha-1. [ABSTRACT FROM AUTHOR]

Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric therapy to be adjusted according to the result of culture sensitivity reports. Objective: Using culture sensitivity reports to optimize antibiotic prescribing in a teaching hospital in Pakistan. Methods: A retrospective observational study was undertaken in Ghurki Trust Teaching Hospital. A total of 465 positive cultures were taken from patients during the study period (May 2018 and December 2018). The results of pathogen identification and susceptibility testing from patient-infected sites were assessed. Additional data was collected from the patient's medical file. This included demographic data, sample type, causative microbe, antimicrobial treatment, and whether empiric or definitive treatment as well as medicine costs. Antimicrobial data was assessed using World Health Organization's Defined Daily Dose methodology. Results: A total of 497 isolates were detected from the 465 patient samples as 32 patients had polymicrobes, which included 309 g-negative rods and 188 g-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was Staphylococcus aureus (Methicillin-sensitive Staphylococcus aureus) (125) (25.1%) and the most common Gram-negative pathogen was Escherichia coli (140) (28.1%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the Acinetobacter baumannii isolates were resistant to carbapenems. Gram-positive bacteria showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics for empiric therapy were cefoperazone plus sulbactam, ceftriaxone, amikacin, vancomycin, and metronidazole whereas high use of linezolid, clindamycin, meropenem, and piperacillin + tazobactam was seen in definitive treatment. Empiric therapy was adjusted in 220 (71.1%) cases of Gram-negative infections and 134 (71.2%) cases of Gram-positive infections. Compared with empiric therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average cost of antibiotics in definitive treatment was less than seen with empiric treatment (8.2%) and the length of hospitalization also decreased. Conclusions: Culture sensitivity reports helped reduced antibiotic utilization and costs as well as helped select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs in hospitals and the development of hospital antibiotic guidelines to reduce unnecessary prescribing of broad-spectrum antibiotics. [ABSTRACT FROM AUTHOR]

Background and Objectives: The increase in antimicrobial resistance (AMR) across countries has seriously impacted the effective management of infectious diseases, with subsequent impact on morbidity, mortality and costs. This includes Pakistan. Antimicrobial surveillance activities should be mandatory to continually assess the extent of multidrug-resistant bacteria and the implications for future empiric prescribing. The objective of this retrospective observational study was to monitor the susceptibility pattern of microbes in Pakistan. Materials and Methods: Clinical samples from seven laboratories in Punjab, Pakistan were collected between January 2018 and April 2019, with Punjab being the most populous province in Pakistan. The isolates were identified and their antimicrobial susceptibility was tested using the Kirby-Bauer disc diffusion assay and micro broth dilution methods. The antibiotics assessed were those typically prescribed in Pakistan. Results: In total, 2523 bacterial cultural reports were studied. The most frequently isolated pathogens were Staphylococcus aureus (866, 34.3%), followed by Escherichia coli (814, 32.2%), Pseudomonas aeruginosa (454, 18.0%) and Klebsiella pneumoniae (269, 10.7%). Most pathogens were isolated from pus (1464, 58.0%), followed by urine (718, 28.5%), blood (164, 6.5%) and sputum (81, 3.2%). Conclusions: The findings suggest that current antimicrobial options are severally restricted in Pakistan due to the emergence of multidrug-resistant pathogens. This calls for urgent actions including initiating antimicrobial stewardship programs to enhance prudent prescribing of antibiotics. This includes agreeing on appropriate empiric therapy as part of agreed guidelines, in line with the WHO EML and AWaRe book, whilst awaiting culture reports. This is alongside other measures to reduce inappropriate antimicrobial prescribing and reverse the threat of rising AMR. [ABSTRACT FROM AUTHOR]

In the current era of globalization, cross-listing literature has been growing as a tool to achieve sustainable growth and provide policy implications for multinationals, international investors, and regulators. This research explores the three themes—influential aspects, intellectual structure, and conceptual structure—that underpin the growing cross-listing-based literature published in the Web of Sciences until July 2020. This study used bibliometric coupling to segregate the research front of cross-listing and then studied each theme's conceptual structure and influential aspects separately. The analysis revealed that the cross-listing literature could be divided into three clusters: (1) price discrepancies and stock returns related to asymmetric information and market efficiencies, (2) earnings quality, earnings management, and the adoption of accounting standards, and (3) cross-listing benefits covering the growth, informativeness, and liquidity. For instance, our analysis identifies the impact of cross-listing on local market developments regarding trading volume and liquidity, secondly the benefits of financial market liberalization for cross-listing, particularly regarding the cost of capital, and thirdly the variation in abnormal returns after cross-listing with changing risk exposure, shareholding base, and amount of money raised. This research also proposes a future research agenda for the advancement of each cluster of cross-listing identified. The outcomes of this literature review will provide valuable information to practitioners and researchers and help them to further understand the broad perspective and prospects of cross-listing. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is an increasing global concern, increasing costs, morbidity, and mortality. National action plans (NAPs) to minimize AMR are one of several global and national initiatives to slow down rising AMR rates. NAPs are also helping key stakeholders understand current antimicrobial utilization patterns and resistance rates. The Middle East is no exception, with high AMR rates. Antibiotic point prevalence surveys (PPS) provide a better understanding of existing antimicrobial consumption trends in hospitals and assist with the subsequent implementation of antimicrobial stewardship programs (ASPs). These are important NAP activities. We examined current hospital consumption trends across the Middle East along with documented ASPs. A narrative assessment of 24 PPS studies in the region found that, on average, more than 50% of in-patients received antibiotics, with Jordan having the highest rate of 98.1%. Published studies ranged in size from a single to 18 hospitals. The most prescribed antibiotics were ceftriaxone, metronidazole, and penicillin. In addition, significant postoperative antibiotic prescribing lasting up to five days or longer was common to avoid surgical site infections. These findings have resulted in a variety of suggested short-, medium-, and long-term actions among key stakeholders, including governments and healthcare workers, to improve and sustain future antibiotic prescribing in order to decrease AMR throughout the Middle East. [ABSTRACT FROM AUTHOR]

Global warming and greenhouse gas emissions pose severe threats to environmental sustainability. A sustainable environment is a prerequisite for long‐term socioeconomic growth and human survival. Green technology is brought about by a country's economic and financial openness, and education provides knowledge to the public and labor, contributing to environmental sustainability. Thus, this research aims to unveil the liaison between human capital, trade openness, and environmental quality for Russia, Brazil, India, China, and South Africa (BRICS) countries from 1998 to 2018. Several econometric methods, including the Driscoll–Kraay standard errors and the Dumitrescu–Hurlin causality approaches, reveal long‐run and causal relationships among the modelled indicators. The Driscoll–Kraay standard error results show that human capital is negatively related to carbon dioxide emissions (CO2 emissions). Imposing high tariffs and excise duties, changing tax structures, discouraging the inflow of polluted commodities, and encouraging green trade can help BRICS combat high environmental pollution. The results show that a one‐point increase in human capital in models 1 and 2 can reduce CO2 emissions by 1.5279 and 0.1538 points, respectively. In contrast, a 1% growth in trade can lead to a rise in CO2 emissions of 0.3731% and 0.2384%, respectively. Similarly, financial development and energy consumption result in high CO2 emissions in the long run. Moreover, a feedback effect of the human capital index on CO2 emissions is discovered. As a result of the findings, the government and responsible authorities should provide financial support and encourage investments in the region's energy‐resourceful and sustainable green projects. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the frequency of internet gaming addiction among undergraduate medical students of Karachi, its effect on their academic performance, and their overall health status. Methods: This cross-sectional study was conducted in selected government and private medical colleges of Karachi from November 2021 to March 2022. Medical students, who were enrolled in year 1 to year 5 of undergraduates health sciences programs of government and private sector of Karachi and had a smartphone and internet connection for past 1 year were included in the study. Internet gaming disorder scale (IGDS-9) was used to determine the proportion of addicted medical undergraduates. Results: Out of 400 medical students, 212 (53%) students were at risk of getting addicted and 13 (3.3%) students were found to be addicted to internet gaming. Male students were found significantly higher at risk of developing internet gaming addiction and were found to be more addicted as compared to female students i.e., 202 (50.5%) vs. 198 (49.5%) (p-value < 0.001) respectively. Students who had a higher-grade point average (GPA) 230 (57.5%) were significantly lesser at risk of developing internet gaming addiction as compared to 170 (42.5%) students who had a lower GPA (p-value 0.003). Conclusion: More than half of the study population with predominant males was at risk of developing gaming addiction and they exhibited more health-related effects. Their academic grades were also affected. It is imperative to counsel this cohort for reducing the effects of internet gaming addiction. [ABSTRACT FROM AUTHOR]

Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3–4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR. [ABSTRACT FROM AUTHOR]

Background: Dose optimization of vancomycin plays a substantial role in drug pharmacokinetics because of the increased incidence of obesity worldwide. This systematic review was aimed to highlight the current dosing strategy of vancomycin among obese patients. Methods: This systematic review was in concordance with Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The literature search was carried out on various databases such as Scopus, PubMed/MEDLINE, ScienceDirect and EMBASE using Keywords and MeSH terms related to vancomycin dosing among obese patients. Google Scholar was also searched for additional articles. The English language articles published after January, 2000 were included in this study. The quality of the study was assessed using different assessment tools for cohort, and case reports. Results: A total of 1,029 records were identified. After screening, 18 studies were included for the final review. Of total, twelve studies are retrospective and remaining six are case-control studies. A total of eight studies were conducted in pediatrics while remaining studies were conducted in adult population. Most of the studies reported the dosing interval every 6–8 h. Differences in target trough concentration exist with respect to target ranges. The administration of loading dose (20–25 mg/kg) followed by maintenance dose (15–25 mg/kg) of vancomycin is recommended in adult patients to target therapeutic outcomes. Moreover, a dose of 40–60 mg/kg/day appears appropriate for pediatric patients. Conclusion: The initial dosing of vancomycin based on TBW could be better predictor of vancomycin trough concentration. However, the clinical significance is uncertain. Therefore, more studies are needed to evaluate the dosing strategy of vancomycin in overweight or obese patients. [ABSTRACT FROM AUTHOR]

This study details the irradiation of pure (99.995%) and immaculate metallic Zinc using Nd: YAG laser (1064 nm, 10 mJ, 9–14 ns). The influence and impact of multiple laser shots on the formation of microstructures and crystal structure orientations is assessed. Arrays of ablated craters are machined on the whole surface of the target to probe the electrical and topographical characteristics of laser-treated surfaces. Irradiated samples are examined by multiple characterizing techniques such as scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray diffraction (XRD), and a four-point probe for electrical conductivity measurements. SEM and AFM analysis exhibited the formation of laser-induced ripple structures with periodicity sheerly dependent on laser shots. A comparison of surface topography of the virgin and treated samples disclosed a pronounced modification in surface texture. The XRD patterns of laser shined targets indicate no momentous structural change in the crystal structure, whereas the measurements on the electrical conductivity of the irradiated surfaces exhibit an exponential descending trend with an augmentation in laser shots. [ABSTRACT FROM AUTHOR]

Miniaturised piezoelectric devices are emerging energy harvesting sources that are appropriate for various implantable and wearable applications. However, these piezoelectric devices exhibit considerable internal resistance due to their internal impedance, which leads to self-start and low-energy conversion failures. This paper describes a dual-stage boost converter circuit by facilitating self-powering features and boosting the low voltage harvested by the piezoelectric devices into dc. The proposed circuit comprises conversion stages of ac-dc and dc-dc in Stages I and II, respectively. In addition, the proposed circuit does not require employing the auxiliary circuits to generate the train pulses by triggering the bidirectional switches to envelop the current being stored in Stage II and kick-start the self-powered circuit for piezoelectric energy harvesting systems. Theoretical assumptions and control strategies were tested and verified with ideal and impedance input sources. The proposed circuit could convert a low voltage of 3 Vac into 19 Vdc. The maximum attained output power by the proposed circuit was 3.61 mW. The outcome depicted that the proposed circuit boosted the low voltage and outperformed the existing literature circuits in terms of output voltage and power. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the curvature tensor and the Ricci tensor of a P-Sasakian manifold with respect to the quarter-symmetric metric connection on the tangent bundle T M . Certain results on a semisymmetric P-Sasakian manifold, generalized recurrent P-Sasakian manifolds, and pseudo-symmetric P-Sasakian manifolds on T M are proved. [ABSTRACT FROM AUTHOR]