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S Abbas Raza,1,* Morton Brian Keith,2,* Kar Chai Koh3,* 1Shaukat Khanum Cancer Hospital & Research Center and National Hospital, Lahore, Pakistan; 2Northbridge Medical Practice, Northbridge, New South Wales, Australia; 3Poliklinik Kepong Baru, Kuala Lumpur, Malaysia*These authors contributed equally to this workCorrespondence: Kar Chai Koh, Poliklinik Kepong Baru, Jalan Ambong Kiri Satu, Kepong Baru, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 52100, Malaysia, Email drcaseysurf@gmail.comPurpose: Pain is considered a major clinical and socioeconomic problem worldwide. Delayed gastric emptying rates allegedly influence the suitability of pain-relief medications in patient populations such as the elderly and individuals with diabetes. Faster pain relief was reportedly achieved by using a fast-dissolving paracetamol (FD-APAP) formulation. This study aims to gain insights to healthcare professionals’ (HCPs) perspectives towards using FD-APAP in addressing barriers of pain relief in patient populations susceptible to delayed gastric emptying rates.Patients and Methods: A two-step modified Delphi consensus study was conducted among a panel of 10 general practitioners (GPs) and four endocrinologists. The first step comprises in-depth discussions around evidence relevant to FD-APAP for pain management in patient populations with delayed gastric emptying rates (elderly/diabetics). The second step (a survey) was based on the summarized input from the first step. Consensus was accepted upon ≥ 70% agreement. Perspectives on pain management by FD-APAP for elderly patients were explored among GPs, while those for diabetic patients were explored among GPs and endocrinologists.Results: Consensus was achieved, whereby all panel members found FD-APAP to be favorable and relevant for pain management in the elderly and the diabetic patient populations. GPs additionally raised the consensus on the importance of considering comorbidities associated with diabetes while having minimal complications during pain management.Conclusion: The panel found the faster disintegration and absorption of FD-APAP relevant and useful for patients with delayed gastric emptying, wherein, pain in the elderly and those with diabetes could be treated effectively with limited side-effects.Keywords: fast-dissolving paracetamol, consensus, delayed gastric emptying, pain relief, elderly, diabetics

Immunotherapy related adverse events are commonly seen with immune check point inhibitors therapy. We report the case of a 40-year-old female diagnosed with stage IVB endometroid grade III endometrial cancer, on pembrolizumab immunotherapy, an anti-programmed-death-receptor-1 (PD-1) antibody. Patient was referred for 18F-FDG PET/CT for restaging. 18F-FDG PET/CT demonstrated diffuse increased FDG uptake throughout the body of the pancreas associated with fat stranding in the peripancreatic region, suggestive of pembrolizumab-induced pancreatitis. The diagnosis was confirmed by elevated amylase and lipase levels. Immune-related adverse events are frequently identified on 18F-FDG PET-CT, which may lead to early diagnosis, close clinical follow-up, and appropriate clinical management of immune-related adverse events. Key Words: 18F-FDG PET/CT; pembrolizumab; pancreatitis; anti-programmed-death-receptor-1 (PD-1) antibody

We present the quantum simulation of the frustrated quantum spin-1/2 antiferromagnetic Heisenberg spin chain with competing nearest-neighbor (J_{1}) and next-nearest-neighbor (J_{2}) exchange interactions in the real superconducting quantum computer with qubits ranging up to 100. In particular, we implement the Hamiltonian with the next-nearest neighbor exchange interaction in conjunction with the nearest-neighbor interaction on IBM's superconducting quantum computer and carry out the time evolution of the spin chain by employing the first-order Trotterization. Furthermore, our implementation of the second-order Trotterization for the isotropic Heisenberg spin chain, involving only nearest-neighbor exchange interaction, enables precise measurement of the expectation values of staggered magnetization observable across a range of up to 100 qubits. Notably, in both cases, our approach results in a constant circuit depth in each Trotter step, independent of the number of qubits. Our demonstration of the accurate measurement of expectation values for the large-scale quantum system using superconducting quantum computers designates the quantum utility of these devices for investigating various properties of many-body quantum systems. This will be a stepping stone to achieving the quantum advantage over classical ones in simulating quantum systems before the fault tolerance quantum era.

There are numerous problems in the world, but environmental pollution is the biggest threat to life. Air pollution is the most critical form of environmental pollution because air is the most essential need of life. However, industrialization, population growth, and fossil fuel use increase hazardous and greenhouse gas concentrations daily. Greenhouse gases like carbon dioxide (CO2) contribute to global warming; hence, efficient, inexpensive, sustainable, and ecologically friendly air purification solutions are required. This study proposed a new method for synthesizing N- and P-rich polyphosphazene-based hyper cross-linked polymer (HCP) for CO2 adsorption. Due to their persistent porosity, low density, and high surface area, hyper cross-linked porous organic–inorganic hybrid phosphorus and nitrogen-rich polymers are cost-effective and promising gas adsorption materials. We synthesized hybrid organic and inorganic polyphosphazenes with nitrogen and phosphorus backbones and aromatic side groups cross-linked by the Friedel–Crafts alkylation process. HCP-A and HCP-B were cross-linked phosphazene-based microporous hybrid organic–inorganic polymers. HCP-A and HCP-B were produced in two stages. Hexachlorocyclotriphosphazene reacts with 1-napthylamine to form naphthyl amino phosphazene, which is cross-linked under optimum conditions to make cyclic HCP-A. Phosphorous dichlorophosphazene reacts with 1-naphthylamine to form poly[bis(1-naphthylamino) phosphazene] and is cross-linked to form linear HCP-B. HCP-A and HCP-B porous networks were studied with Brunauer–Emmett–Teller surface areas of 170.89 and 492.03 m2 g−1 and narrow pore sizes of 0.8–1.18 nm. These polymers are promising CO2 adsorbents due to their easy and cost-effective production, thermal stability, surface area, and CO2 absorption capacity.

Abstract The non-singlet helicity quark parton distribution functions (PDFs) of the nucleon are determined from lattice QCD, by jointly leveraging pseudo-distributions and the distillation spatial smearing paradigm. A Lorentz decomposition of appropriately isolated space-like matrix elements reveals pseudo-distributions that contain information on the leading-twist helicity PDFs, as well as an invariant amplitude that induces an additional z 2 contamination of the leading-twist signal. An analysis of the short-distance behavior of the space-like matrix elements using matching coefficients computed to next-to-leading order (NLO) exposes the desired PDF up to this additional z 2 contamination. Due to the non-conservation of the axial current, we elect to isolate the helicity PDFs normalized by the nucleon axial charge at the same scale μ 2. The leading-twist helicity PDFs as well as several sources of systematic error, including higher-twist effects, discretization errors, and the aforementioned z 2 contaminating amplitude are jointly determined by characterizing the computed pseudo-distribution in a basis of Jacobi polynomials. The Akaike Information Criterion is exploited to effectively average over distinct model parameterizations and cuts on the pseudo-distribution. Encouraging agreement is observed with recent global analyses of each non-singlet quark helicity PDF, notably a rather small non-singlet anti-quark helicity PDF for all quark momentum fractions.

Dear Editor, Clinical auditing is a widely accepted practice world wide to assess the quality of health care given by a provider (1). It is described as a quality improvement approach that aims to enhance patient care and outcomes by systematically examining of treatment against stated criteria and implementing change (2). A clinical audit provides a service with the capacity to identify deficiencies, areas of excellence, and generate relevant suggestions that would drive change. It enhances the practice of evaluating against established standards (1). In developed countries, it is an essential component of clinical practice; nevertheless, it has yet to achieve equal status in developing countries. As a result, the demand for a structured Clinical Audit program is long overdue. Surprisingly, a thorough online literature search from 2021 till date was conducted on PakMediNet and PubMed that yielded only three clinical audit studies in Pakistan as shown in Table - 1. All these studies are closed-loop audits that follow accurate guidelines and reported significant improvement after intervention in the re-audit cycle. Ashraf M et al. reported that operative notes can be improved, by using audits to identify poor areas (3). According to Shah MH et al. standard venous thromboembolism (VTE) risk assessment and prophylactic prescription guidelines were not followed, but after intervention and re-audit, it was discovered that a simple and effective educational intervention improved VTE risk assessment and prophylactic prescribing practices (4). Similarly, Rabbani RA et al. emphasize the need for clinical audits in improving standard surgical procedures (5). No doubt that clinical audits are a tool that, when used correctly, can result in a change in the quality of care provided by a service (1). New research and clinical audit programs are crucial to the future of quality care in Pakistan (2). As a result, it is critical that our future healthcare workers understand how to conduct clinical audits and lead them during their training (2). Continuous improvement can be achieved by a healthcare unit that incorporates frequent audits with clinical practice in its curriculum. Clinical auditing will help to strengthen and increase their clinical knowledge and communication abilities. At the end of the day, it will result in improved patient care and outcomes. Therefore, the need of the hour is to promote clinical audit studies among healthcare workers.

To assess the effects of excessive screen time on the health of medical and dental students due to online teaching during the Covid-19 pandemic. It was a descriptive cross-sectional study, conducted in Bahria University of Health Sciences from June 2022 to September 2022 after getting ethical approval. A total of 200 students who attended online teaching modules for at least one year through online teaching Apps, were included. A structured questionnaire was distributed using google forms. The results revealed that factors including strain on the eyes, restlessness, declined academic performance and exercise during lockdown, along with feeling connected as a group had a significant association with increased screen time. Excessive screen time has various adverse effects on the physical and mental health of medical and dental students. For improving students’ physical and mental health during online teaching we need to change teaching strategies and support the introduction of flipped classroom.

Fracture and migration of port-a-catheter, following long term access into the central venous vasculature is a rare clinical scenario. The consequences of fracture and migration includes fragmented device relocating into the right atrium or ventricle, eventually causing life threatening complications such as arrhythmias, pseudoaneurysms, perforations or very rarely embolization. We report a case of a 67-year-old female with a broken port-a-catheter which had been placed initially for chemotherapy for bilateral breast cancer. Chest radiograph showed the fragmented catheter had migrated to the right atrium; which was successfully removed via percutaneous radiological endovascular intervention. No immediate post procedure complication was noted.

Objective:. This Delphi exercise aimed to gather consensus surrounding risk factors, diagnosis, and management of chyle leaks after esophagectomy and to develop recommendations for clinical practice. Background:. Chyle leaks following esophagectomy for malignancy are uncommon. Although they are associated with increased morbidity and mortality, diagnosis and management of these patients remain controversial and a challenge globally. Methods:. This was a modified Delphi exercise was delivered to clinicians across the oesophagogastric anastomosis collaborative. A 5-staged iterative process was used to gather consensus on clinical practice, including a scoping systematic review (stage 1), 2 rounds of anonymous electronic voting (stages 2 and 3), data-based analysis (stage 4), and guideline and consensus development (stage 5). Stratified analyses were performed by surgeon specialty and surgeon volume. Results:. In stage 1, the steering committee proposed areas of uncertainty across 5 domains: risk factors, intraoperative techniques, and postoperative management (ie, diagnosis, severity, and treatment). In stages 2 and 3, 275 and 250 respondents respectively participated in online voting. Consensus was achieved on intraoperative thoracic duct ligation, postoperative diagnosis by milky chest drain output and biochemical testing with triglycerides and chylomicrons, assessing severity with volume of chest drain over 24 hours and a step-up approach in the management of chyle leaks. Stratified analyses demonstrated consistent results. In stage 4, data from the Oesophagogastric Anastomosis Audit demonstrated that chyle leaks occurred in 5.4% (122/2247). Increasing chyle leak grades were associated with higher rates of pulmonary complications, return to theater, prolonged length of stay, and 90-day mortality. In stage 5, 41 surgeons developed a set of recommendations in the intraoperative techniques, diagnosis, and management of chyle leaks. Conclusions:. Several areas of consensus were reached surrounding diagnosis and management of chyle leaks following esophagectomy for malignancy. Guidance in clinical practice through adaptation of recommendations from this consensus may help in the prevention of, timely diagnosis, and management of chyle leaks.

Summary: Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p

Abstract We present a determination of the neutral current weak axial charge G A Z 0 = − 0.654 3 stat 5 sys $$ {G}_A^Z(0)=-0.654{(3)}_{\mathrm{stat}}{(5)}_{\mathrm{sys}} $$ using the strange quark axial charge G A s 0 $$ {G}_A^s(0) $$ calculated with lattice QCD. We then perform a phenomenological analysis, where we combine the strange quark electromagnetic form factor from lattice QCD with (anti)neutrino-nucleon scattering differential cross section from MiniBooNE experiments in a momentum transfer region 0.24 ≲ Q 2 ≲ 0.71 GeV2 to determine the neutral current weak axial form factor G A Z Q 2 $$ {G}_A^Z\left({Q}^2\right) $$ in the range of 0 ≲ Q 2 ≤ 1 GeV2. This yields a phenomenological value of G A Z 0 $$ {G}_A^Z(0) $$ = −0.687(89)stat(40)sys. The value of G A Z 0 $$ {G}_A^Z(0) $$ constrained by the lattice QCD calculation of G A s 0 $$ {G}_A^s(0) $$ , when compared to its phenomenological determination, provides a significant improvement in precision and accuracy and can be used to provide a constraint on the fit to G A Z Q 2 $$ {G}_A^Z\left({Q}^2\right) $$ for Q 2 > 0. This constrained fit leads to an unambiguous determination of (anti)neutrino-nucleon neutral current elastic scattering differential cross section near Q 2 = 0 and can play an important role in numerically isolating nuclear effects in this region. We show a consistent description of G A Z Q 2 $$ {G}_A^Z\left({Q}^2\right) $$ obtained from the (anti)neutrino-nucleon scattering cross section data requires a nonzero contribution of the strange quark electromagnetic form factor. We demonstrate the robustness of our analysis by providing a post-diction of the BNL E734 experimental data.

Possibly the most critical phase of an Unmanned Air Vehicle (UAV) flight is landing. To reduce the risk due to pilot error, autonomous landing systems can be used. Environmental disturbances such as wind shear can jeopardize safe landing, therefore a well-adjusted and robust control system is required to maintain the performance requirements during landing. The paper proposes a loop-shaping-based Model Predictive Control (MPC) approach for autonomous UAV landings. Instead of conventional MPC plant model augmentation, the input and output weights are designed in the frequency domain to meet the transient and steady-state performance requirements. Then, the H∞ loop shaping design procedure is used to synthesize the state-feedback controller for the shaped plant. This linear state-feedback control law is then used to solve an inverse optimization problem to design the cost function matrices for MPC. The designed MPC inherits the small-signal characteristics of the H∞ controller when constraints are inactive (i.e., perturbation around equilibrium points that keep the system within saturation limits). The H∞ loop shaping synthesis results in an observer plus state feedback structure. This state estimator initializes the MPC problem at each time step. The control law is successfully evaluated in a non-linear simulation environment under moderate and severe wind downburst. It rejects unmeasured disturbances, has good transient performance, provides an excellent stability margin, and enforces input constraints.

The increase of social media (SM) has led to continuous deviations in how day-to-day entrepreneurial activities can be carried out. Additionally, studies devoted to SM entrepreneurship and SM are relatively limited and fragmented in their focus. However there is growing interest from scholars, practitioners and academia for upcoming studies and exploration within small and medium-sized enterprises (SMEs) context. This research explores the impact of entrepreneurial orientation (EO) on SM adoption and SME performance in developing countries. We employed the resource-based view (RBV) as the foundation for developing the conceptual framework The present study employed a closed-ended questionnaire to collect data from SMEs located in Pakistan. Partial-least-squares-structural equation-modeling (PLS-SEM) was utilized for the analysis of 423 responses. The results proved a direct positive link between EO-SMEs performance, EO-SM adoption, SM adoption-SMEs performance, innovation capabilities (IC), and SME performance. Partial mediation was found between EO and SME performance, and the significant moderation effect of IC was found between SM adoption and SME performance. This paper has implications for practitioners and researchers regarding SM adoption in the SMEs. It builds an empirical, multi-dimensional hypothesized model, including mediating and moderating roles affecting the relationships.

Abstract Management of endogenous Cushing syndrome is based on its aetiology. Increased Adrenocorticotropic Hormone (ACTH) levels are the most common cause of this disorder and, therefore, it is critical to determine the source of ACTH before further management. Dynamic post contrast MRI is currently the most common investigation implied to diagnose pituitary adenoma; however, it comes with the drawback of low specificity and high false positive results. Inferior petrosal sinus sampling (IPSS) is an established invasive procedure performed to differentiate central versus peripheral source of ACTH which, in turn, results in hypercortesolaemia. This is a series of 14 patients who underwent IPSS at the Department of Radiology, Aga Khan University Hospital, Karachi, from January 2006 to December 2018. The case series emphasises the role of IPSS in the management of ACTH-dependent Cushing syndrome and combined efficacy of Dynamic post-contrast MRI and the procedure under focus. Continuous....

We present the first lattice QCD calculation of the charm quark contribution to the nucleon electromagnetic form factors GE,Mc(Q2) in the momentum transfer range 0≤Q2≤1.4 GeV2. The quark mass dependence, finite lattice spacing and volume corrections are taken into account simultaneously based on the calculation on three gauge ensembles including one at the physical pion mass. The nonzero value of the charm magnetic moment μMc=−0.00127(38)stat(5)sys, as well as the Pauli form factor, reflects a nontrivial role of the charm sea in the nucleon spin structure. The nonzero GEc(Q2) indicates the existence of a nonvanishing asymmetric charm-anticharm sea in the nucleon. Performing a nonperturbative analysis based on holographic QCD and the generalized Veneziano model, we study the constraints on the [c(x)−c¯(x)] distribution from the lattice QCD results presented here. Our results provide complementary information and motivation for more detailed studies of physical observables that are sensitive to intrinsic charm and for future global analyses of parton distributions including asymmetric charm-anticharm distribution.

Background: Neuroimaging methods have become important techniques for exploring the neurobiology of neuropsychiatric disorders before and after treatment. Diffusion Tensor Imaging (DTI), has emerged as a propitious tool for the detection of neurological pathology in a variety of psychiatric syndromes. DTI measures the dispersion of water molecules, giving insight into white matter (WM) integrity. We conducted a selective review of the literature to determine WM pathology across major psychiatric brain disorders, as measured by DTI. Methods: An online search was conducted to identify systematic reviews and metaanalysis published from January 2010 to September 2019 that assessed the WM integrity in several neuropsychiatric disorders. We examined the WM pathologies in different brain regions to detect patterns that may be common among those disorders. Results: Studies in schizophrenia, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, borderline personality, post-traumatic stress disorder, and Alzheimer’s disease all demonstrate decreased diffusivity as measured by fractional anisotropy (FA). A common location for WM pathology in all disorders was found within the commissural fibers of the corpus callosum (CC). Nonetheless, the heterogeneity of these disorders is highlighted, as patients present with different locations for WM pathology. Conclusions: Our selective review suggests that many neuropsychiatric disorders have underlying WM pathology on DTI, specifically a decrease in diffusivity. Measuring WM pathology using DTI is emerging as a useful tool for identifying individuals with various psychopathologies and may lead to early diagnosis and treatment. Finally, the mechanisms by which WM pathology may contributes to the generation of psychiatric signs and symptoms requires further investigation.

BACKGROUND: In Pakistan, there is a lack of information about the work environment of residency programs. This lack is a major impediment in their improvement. One of the approaches for improvement in these programs can be directed through the residents' own perception of their working conditions. Therefore, we collected data which would reflect working conditions of residents. AIM: To assess the perceived status of 'work environment' in different specialities. MATERIALS AND METHODS: A cross-sectional survey was conducted in four teaching hospitals of Karachi from July 1999 to January 2000. Residents from selected programs were grouped into four broad groups: specialist, medical, surgical and multidisciplinary. Responses of residents were obtained on a Likert scale of 0 to 4. Indices were formed for two components of work environment: academic and mistreatment. STATISTICAL ANALYSIS: Differences between residents' groups were assessed through analysis of variance (ANOVA) at 5% significance. RESULTS: A total of 341 registered residents responded (response rate: 75%). Surgical residents were working more than 80 h/week and this was more than the other three groups. Medical residents were spending the highest actual time on research and teaching activities (10% and 14%, respectively). Academic index score was highest for surgical group (15.81, SD = 4.69) and lowest for multidisciplinary group (11.82, SD = 4.80). Medical group had the highest perceived mistreatment index score (5.56, SD = 4.57). CONCLUSIONS: In a study of work environment of residency programs, differential impact was found for the four groups on work environment perceptions. Most of the residents recognized undergraduate teaching, grand rounds, patient rounds and seminars or workshops as contributing to their academic learning. Reporting of sexual harassment was low, indicating either underreporting or cultural dynamics of our setting. [ABSTRACT FROM AUTHOR]

BACKGROUND: The importance of communication skills in postgraduate medical training is likely to be highlighted given the convergence of research and educational forces. Assessment of these skills in residency training is vital since it can provide basis for policy undertaking among Pakistani medical academia for improving postgraduate training programs. AIM: To assess the perceived status of communication skills of residents in different specialties. MATERIALS AND METHODS: A cross sectional survey was conducted in four teaching hospitals of Karachi between July 1999 and January 2001. A total of 455 residents in different residency programs were contacted. Residents registered both with College of Physicians and Surgeons of Pakistan and Postgraduate Medical Education office of selected hospitals were included in this study. Responses of residents were obtained on 5-point Likert scale. Indices were formed for three components of communication skills: informative, affective and professional communication. STATISTICAL ANALYSIS: Differences between residents' groups were assessed through analysis of variance. RESULTS: Total informative communication index was lowest for multi-disciplinary (12.05, SD = 4.87) and highest for surgical (15.27, SD = 2.51) residents. Total affective index was lowest for multi-disciplinary (12.58, SD = 5.68) and highest for medical (15.74, SD = 3.59) residents. The group differences for four groups of residency programs were not statistically significant for either professional attributes separately or for the total professional index. CONCLUSIONS: The residency programs must establish goals, process and outcomes to incorporate communication skills in postgraduate medical training since this can enhance residents' performance as effective health care providers. Accomplishment of better communication skills can be achieved if the importance of its teaching and training is valued by residency program coordinators. [ABSTRACT FROM AUTHOR]

BACKGROUND: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion. However, there is a need to devise a risk-scoring system based on the identified risk factors to (a) predict the risk of conversion preoperatively for selected patients, (b) prepare the patient psychologically, (c) arrange operating schedules accordingly, and (d) minimize the procedure-related cost and help overcome financial constraints, which is a significant problem in developing countries. AIM: This study was aimed to evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy in our setting. SETTINGS AND DESIGNS: A case control study of patients who underwent laparoscopic surgery from January 1997 to December 2001 was conducted at the Aga Khan University Hospital, Karachi, Pakistan. MATERIALS AND METHODS: All those patients who were converted to open surgery (n = 73) were enrolled as cases. Two controls who had successful laparoscopic surgery (n = 146) were matched with each case for operating surgeon and closest date of surgery. STATISTICAL ANALYSIS USED: Descriptive statistics were computed and, univariate and multivariate analysis was done through multiple logistic regression. RESULTS: The final multivariate model identified two risk factors for conversion: ultrasonographic signs of inflammation (adjusted odds ratio [aOR] = 8.5; 95% confidence interval [CI]: 3.3, 21.9) and age > 60 years (aOR = 8.1; 95% CI: 2.9, 22.2) after adjusting for physical signs, alkaline phosphatase and BMI levels. CONCLUSION: Preoperative risk factors evaluated by the present study confirm the likelihood of conversion. Recognition of these factors is important for understanding the characteristics of patients at a higher risk of conversion. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous studies have identified various risk factors for neonatal tetanus (NNT) in rural areas of Pakistan. The present matched case control study was conducted to further evaluate these risk factors in an urban setting. AIM: The study was carried out to identify risk factors for NNT in Karachi. MATERIALS AND METHODS: Patients of NNT (n = 125) diagnosed from January 1998 to February 2001 were recruited through a surveillance system of Expanded Programme on Immunization (EPI). Two neighbourhood controls (n = 250) were matched for each case for gender and date of birth of the case. STATISTICAL ANALYSIS: Conditional logistic regression was performed to assess the independent effect of factors associated with NNT. RESULTS: The final multivariable model identified subsequent application of substances on the umbilical cord (adjusted matched odds ratio [adj. mOR] = 5.1 [2.7-9.7]), home delivery (adj. mOR = 1.8; 95% CI: 1.1- 3.1) and illiterate mother (adj. mOR = 1.6; 95% CI: 1.0- 2.0) as risk factors for NNT after adjusting for other variables in the model. Population attributable risk per cent (PAR %) for subsequent cord application was 69% and PAR % for home delivery was 31%. CONCLUSION: Health planners, while formulating control strategies through immunization programmes should also take into account the impact of post-delivery practices, such as 'subsequent cord application' along with pre-delivery practices. Health awareness regarding appropriate post-delivery practices should be promoted and counselling of pregnant women for giving preference to health care setting for delivery is also crucial. [ABSTRACT FROM AUTHOR]

Introduction: Glanzmann’s thrombasthenia (GT) is a rare, genetically inherited, functional disorder of platelets. The pathology is deficient or dysfunctional platelet glycoprotein IIb/IIIa (GP IIb/IIIa) complex resulting in bleeding diathesis. Case Report: Here in, we report the effectivity of angioembolization with factor VII in a patient with Glanzmann’s thrombasthenia (GT), who presented with recurrent bleeding from duodenal ulcer. Conclusion: Angioembolization with added infusion of factor VII, can be considered an equally effective alternate to platelet transfusion in patients of GT, who present with recurrent bleeding.

Purpose: Aberrant hepatic arterial anatomy poses a challenge for surgeon during pancreaticoduodenectomy (PD). These anomalies are best picked up on pre-operative imaging to avoid inadvertent injury to the aberrant vasculature resulting in liver ischaemia or biliary-enteric anastomotic failure. We present our experience of dealing with aberrant hepatic vessels during PD. Methods: Patients with aberrant hepatic vasculature who underwent PD between September 2014 and August 2015 were included in the study. We used artery rst technique for dissection in cases identified on pre operative imaging. Aberrations were classed according to Hiatt classi cation. Results: A total of 23 PD were performed with aberrant arterial anatomy in 10 (43%) cases. These vessels were recognised and preserved in nine cases. In one patient, the replaced right hepatic artery (RRHA) arising from superior mesenteric artery (SMA) was coursing through pancreatic parenchyma needing resection and reconstruction with uneventful post-operative recovery. We also identified one RRHA arising from SMA coursing lateral to common bile duct and entering liver parenchyma in gallbladder fossa. Conclusion: Aberrant hepatic arterial anomalies are common and should ideally be picked up by pre-operative imaging. It is possible to preserve these vessels in most cases with careful surgical dissection using artery first technique. Surgeons performing PD should be well versed with the aberrant vascular anatomy to minimise any inadvertent damage. Key words: Aberrant hepatic artery, artery first technique, pancreaticoduodenectomy

Purpose: Specialisation in hepatopancreatobiliary (HPB) surgery has evolved over the past few decades based on better understanding of the biology and the behaviour of the diseases. In this review from a specialised HPB service, we aim to provide an overview of the HPB oncological cases managed in a tertiary care cancer hospital. Methods: All cases of HPB malignancies treated in our hospital between October 2014 and September 2015 were included in the study. Clinical findings, operative details and short-term post-operative outcomes were assessed from a prospectively managed database. Results: A total of 65 oncological procedures were performed over 1 year. These included 23 hepatic resections, 27 pancreaticoduodenectomies, 5 radical surgeries for gallbladder cancer, 2 distal pancreatectomy and 8 nephrectomies with exploration of the inferior vena cava. One patient successfully underwent Associated Liver Partition with Portal vein ligation and staged hepatectomy (ALPPS Procedure), which to our knowledge was the rst ALPPS procedure carried out in Pakistan. Conclusion: The short-term experience of patients managed in specialised HPB unit has shown good outcomes.There is a need for establishing HPB units in most tertiary care hospitals in the country. Key words: Associated liver partition with portal vein ligation and staged hepatectomy procedure, hepatic resections, hepatopancreatobiliary surgery, pancreaticoduodenectomy

Purpose: Phyllodes tumours are rare breast tumours that comprise almost 1% of breast tumours. The outcome for these tumours is generally considered better than breast cancers. We review the cases of phyllodes tumour presenting to a specialised cancer centre over a 14 year period. Materials and Methods: All case records with the diagnosis of phyllodes tumour between 1999 and 2012 were retrieved from the cancer registry. Patient demographics, tumour site, size, axillary lymph node status, whether primary or recurrent, metastatic status, histological type, type of surgery, any complication, margin positivity, post-operative radiation therapy, local or distant recurrence, morality and follow-up duration were recorded. Data were analysed using SPSS. Results: A total of 77 cases of phyllodes tumour were seen between 1999 and 2012. All patients were female with a mean age of 39.9 years. All patients presented with a breast lump with median duration of 8 months. Almost two-thirds (65%) of the patients presented with primary tumour compared to 10% recurrent tumours and the rest were referred after surgery outside. Median size on histopathology was 5 cm (IQR 3.5–8.5 cm). Over a median follow-up duration of 31 months (IQR 9–48 months), 69 patients (89.6%) were alive, while 3 patients (3.9%) did not survive and 5 patients (6.4%) were lost to follow-up. Recurrence was seen in 10 (13%) patients with median time to recurrence of 12 months (IQR 7–24). Involved axillary lymph nodes and borderline or malignant histopathology were found to be signi cantly associated with recurrence (P = 0.04), while margin positivity, post operative radiation therapy and histopathology were not signi cantly associated with recurrence. Conclusion: Phyllodes tumour is an uncommon breast tumour that is predominantly treated with surgical excision. Although survival with these tumours is better compared to breast cancers, involvement of axillary nodes and borderline or malignant histopathology confer an increased risk of recurrence in these patients. Key words: Breast cancer, phyllodes tumours, survival

Objective. To evaluate the technical success, safety, and outcome of endovascular embolization procedure in management of visceral artery pseudoaneurysms. Materials and Methods. 46 patients were treated for 53 visceral pseudoaneurysms at our institution. Preliminary diagnostic workup in all cases was performed by contrast enhanced abdominal CT scan and/or duplex ultrasound. In all patients, embolization was performed as per the standard departmental protocol. For data collection, medical records and radiology reports of all patients were retrospectively reviewed. Technical success, safety, and outcome of the procedure were analyzed. Results. Out of 46 patients, 13 were females and 33 were males. Mean patient age was 44.79±13.9 years and mean pseudoaneurysm size was 35±19.5 mm. Technical success rate for endovascular visceral pseudoaneurysm coiling was 93.47% (n=43). Complication rate was 6.52% (n=3). Followup was done for a mean duration of 21±1.6 months (0.5–69 months). Complete resolution of symptoms or improvement in clinical condition was seen in 36 patients (80%) out of those 45 in whom procedure was technically successful. Conclusion. Results of embolization of visceral artery pseudoaneurysms with coils at our center showed high success rate and good short term outcome.

Purpose. To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute nonvariceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute nonvariceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% postembolization ischemia in our series. In 89% of cases it was definitive without any further intervention.

We report a 62-year-old female who had surgical repair of abdominal aortic aneurysm with a bifurcated graft 2 years ago. She presented with a distal anastomotic pseudoaneurysm which was successfully embolized with histoacryl glue. Only one such similar case has been reported in the literature so far (Yamagami et al. (2006)).

Abstract Background Inflammation is commonly associated with lung tumors. Since inflammatory mediators, including members of the interleukin-6 (IL-6) cytokine family, suppress proliferation of normal epithelial cells, we hypothesized that epithelial cells must develop mechanisms to evade this inhibition during the tumorigenesis. This study compared the cytokine responses of normal epithelial cells to that of premalignant cells. Methods Short-term primary cultures of epithelial cells were established from bronchial brushings. Paired sets of brushings were obtained from areas of normal bronchial epithelium and from areas of metaplastic or dysplastic epithelium, or areas of frank endobronchial carcinoma. In 43 paired cultures, the signalling through the signal transducer and activator of transcription (STAT) and extracellular regulated kinase (ERK) pathways and growth regulation by IL-6, leukemia inhibitory factor (LIF), oncostatin M (OSM), interferon-γ (IFNγ) or epidermal growth factor (EGF) were determined. Inducible expression and function of the leukemia inhibitory factor receptor was assessed by treatment with the histone deacetylase inhibitor depsipeptide. Results Normal epithelial cells respond strongly to OSM, IFNγ and EGF, and respond moderately to IL-6, and do not exhibit a detectable response to LIF. In preneoplastic cells, the aberrant signaling that was detected most frequently was an elevated activation of ERK, a reduced or increased IL-6 and EGF response, and an increased LIF response. Some of these changes in preneoplastic cell signaling approach those observed in established lung cancer cell lines. Epigenetic control of LIF receptor expression by histone acetylation can account for the gain of LIF responsiveness. OSM and macrophage-derived cytokines suppressed proliferation of normal epithelial cells, but reduced inhibition or even stimulated proliferation was noted for preneoplastic cells. These alterations likely contribute to the supporting effects that inflammation has on lung tumor progression. Conclusion This study indicates that during the earliest stage of premalignant transformation, a modified response to cytokines and EGF is evident. Some of the altered cytokine responses in primary premalignant cells are comparable to those seen in established lung cancer cell lines.

Aim: To determine the T(2) relaxation time of colorectal hepatic metastases and changes in T(2) relaxation times following chemotherapy.Materials and Methods: 42 patients with 96 hepatic colorectal metastases underwent baseline MRI. Axial T(1), T(2) and multi-echo GRASE sequences were acquired. ROIs were drawn on T(2) relaxation maps, obtained from GRASE images, encompassing metastasis and normal liver to record T(2) relaxation time values. In 11 patients with 28 metastases, MRI was repeated using same protocol at 6 weeks following chemotherapy. The median pre-treatment T(2) values of metastases and normal liver were compared using the Mann-Whitney test. The pre- and post-treatment median T(2) values of metastases were compared using the Wilcoxon-Rank test for responding (n=16) and non-responding (n=12) lesions defined by RECIST criteria. The change in T(2) values (ΔT(2)) were compared and correlated with percentage change in lesion size.Results: There was no difference in the pre-treatment median T(2) of metastases between responding (67.3±8.6) and non-responding metastases (71.4±16.5). At the end of chemotherapy, there was a decrease in the median T(2) of responding lesions (61.6±12.6) p=0.83, and increase in non-responding lesions (76.2±18.4) p=0.03, but these were not significantly different from the pre-treatment values. There was no significant difference in ΔT(2) of responding and non-responding lesions (p=0.18) and no correlation was seen between size change and ΔT(2) (coefficient=0.3).Conclusion: T(2) relaxation time does not appear to predict response of colorectal liver metastasis to chemotherapy. [ABSTRACT FROM AUTHOR]

The incidence of melanoma is increasing. We ascertained perceptions regarding sunscreen and factors influencing choice in patients with melanoma. A survey was distributed to all members of a support group for people with melanoma. In total, 571 responses were received across 6 weeks. Most respondents (n = 452/571; 79.2%) indicated that they knew how much sunscreen to apply; the most popular frequency of application was once daily (n = 180/571; 31.5%). The most popular cosmetic benefit respondents indicated was reduced redness on sun-exposed areas of the skin (n = 418/571; 73.2%). Most respondents (n = 552/571; 96.7%) agreed that more education is needed regarding the importance of wearing sunscreen. The three most popular factors influencing sunscreen choice were a sun protection factor (SPF) > 50 (n = 299/571; 52.4%), dermatologist recommendation (n = 267/571; 46.8%) and price (n = 262/571; 45.9). Sustainable packaging (n = 45/571; 7.9%) and ethical sourcing of ingredients (n = 65/571; 11.4%) were not ranked highly. Given that 42.0% (n = 240/571) only applied sunscreen on sunny days, an education campaign is required. Industry should consider public education regarding sustainability. A further study ascertaining the views and perceptions of sunscreen in a cohort of people without melanoma is strongly encouraged., Competing Interests: Conflicts of interest F.R.A. has received honoraria for advisory work and speaker fees from L’Oréal and Galderma. The other authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Purpose: To compare the deviation in cases of horizontal strabismus as assessed from photographs with the measurements as obtained in the strabismus clinic., Methods: After obtaining informed consent, we recruited subjects with manifest horizontal strabismus. We took a frontal flash photograph from a distance of 50 cm using smart-phone-based cameras with the flash light vertically aligned with the lens. After projecting the photograph on a laptop and using a vernier caliper, we measured the horizontal corneal diameter of the non-strabismic eye and the decentration of reflex in the strabismic eye taking limbus as the reference point. We converted these values to degrees by using a conversion factor of 7.5°/mm and further to prism diopters (PD) by the standard mathematical formula 100*tanθ., Results: We included 74 subjects aged between 5 and 40 years with manifest horizontal deviation from 20 to 85 PD. We found a statistically significant correlation of 82.6% (P value < 0.001) between the clinic and photographic measurements. Agreement analysis suggested that the photographic measurements measured on average 7 PD less (95% confidence interval: 4.6 to 9.2) than clinical measurements along all values of misalignment, although the difference between the two methods decreased as the quantum of deviation increased. Linear regression revealed an r2 of 68% and provided a predictive equation to derive clinic equivalent measurements from photographic estimates., Conclusion: We believe our simple method provides robust evidence that a photographic estimation can provide the basic information of the size of the deviation to plan possible surgeries, especially in situations of a tele-consultation. This is an easy approach to both understand and master and should form the armamentarium of most orthopticians and strabismologists., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

This case presents a somewhat unique and different phenotype of hereditary spastic paraplegia from previously reported kinase D-interacting substrate of 220 kDa ( KIDINS220 ) gene mutation-related disease. We report a unique putative causative heterozygous mutation in KIDINS220 in a pure hereditary spastic paraplegia (HSP) patient expanding the HSP group further. We also deliberate on how our case was different from prior KIDINS220 -related pathologies including spastic paraplegia, intellectual disability, nystagmus, and obesity (SINO) syndrome, and the observation of KIDINS220 and aquaporin-4 ( AQP4 ) downregulation in the ventricular ependymal lining of idiopathic normal pressure hydrocephalus (iNPH) patients. These findings warrant further investigations of the biology of KIDINS220 . With the advent of new gene editing technologies like Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/CRISPR-associated protein 9 (Cas9), variants such as ours provide an opportunity for targeted precision medicine., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al Hussein et al.)

Introduction: Smoking in people with diabetes markedly elevates their risk of developing complications and increases the likelihood of cardiovascular mortality. This review is the first to specifically provide evidence-based analysis about the influence of quitting smoking on diabetes-related complications in people with type 2 diabetes., Method: The present review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. All human clinical studies assessing the effects of stopping smoking cessation on diabetes-related complications were included. PubMed and Embase were screened until January 2024. References of primary studies and principal peer-reviewed scientific journals in the field were manually screened., Results: We identified a total of 1023 studies. Only 26 met the criteria for eligibility. In general quitting smoking is associated with decreased risks of myocardial infarction and ischemic stroke. Regarding microvascular complications, the strongest evidence for the beneficial effects of smoking cessation is observed in diabetic nephropathy. However, the relationship between smoking cessation and retinopathy, neuropathy, diabetic foot complications and diabetic-related erectile dysfunction, is poorly investigated., Conclusion: Quitting smoking offers significant advantages in managing diabetes-related complications, significantly lowering the risks of myocardial infarction, ischemic stroke, and diabetic nephropathy. This underscores the importance of cessation. Providing evidence-based information on the benefits of stopping smoking for people with type 2 diabetes who smoke, can bolster smoking cessation efforts in the context of diabetes management., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Magdalena Walicka reports a relationship with Sanofi that includes: speaking and lecture fees and travel reimbursement. Magdalena Walicka reports a relationship with AstraZeneca that includes: speaking and lecture fees. Magdalena Walicka reports a relationship with Novo Nordisk that includes: travel reimbursement. Magdalena Walicka reports a relationship with Berlin-Chemie that includes: travel reimbursement. Arkadiusz Krysinski reports a relationship with Eclat SRL that includes: funding grants. Arkadiusz Krysinski reports a relationship with Berlin-Chemie that includes: travel reimbursement. Giusy Rita Maria La Rosa reports a relationship with ECLAT SRL that includes: funding grants. Ang Sun reports a relationship with ECLAT SRL that includes: travel reimbursement. Ang Sun reports a relationship with University of Catania that includes: travel reimbursement. Ang Sun reports a relationship with Sbarro Institute of Health that includes: non-financial support. Riccardo Polosa reports a relationship with Elsevier, EDRA, Pfizer, Boehringer Ingelheim, Duska Therapeutics, Forest Laboratories, CV Therapeutics, Sermo Inc., GRG Health, Clarivate Analytics, Guidepoint Expert Network, and GLG Group. That includes: consulting or advisory. Riccardo Polosa reports a relationship with European Technical Committee for Standardization that includes: board membership. Riccardo Polosa reports a relationship with Center for Tobacco Prevention and Treatment (CPCT) that includes: board membership. Riccardo Polosa reports a relationship with Foundation for a Smoke-Free World, Pfizer, GlaxoSmithKline, CV Therapeutics, Sandoz, Merk Sharp & Dohme, Boehringer Ingelheim, Novartis, Arbi Group Srl., Duska Therapeutics, and Forest Laboratories that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Global warming and endocrine disorders are intertwined issues posing significant challenges. Greenhouse gases emanating from human activities drive global warming, leading to temperature rise and altered weather patterns. South Asia has experienced a noticeable temperature surge over the past century. The sizable population residing in the region heightens the susceptibility to the impact of global warming. In addition to affecting agriculture, water resources, and livelihood, environmental changes interfere with endocrine functioning. Resulting lifestyle changes increase the risk of metabolic and endocrine disorders. Individuals with diabetes face heightened vulnerability to extreme weather due to impaired thermoregulation. A high ambient temperature predisposes to heat-related illnesses, infertility, and nephropathy. Additionally, essential endocrine drugs and medical devices are susceptible to temperature fluctuations. The South Asian Federation of Endocrine Societies (SAFES) calls for collaboration among stakeholders to combat climate change and promote healthy living. Comprehensive approaches, including the establishment of sustainable food systems, promotion of physical activity, and raising awareness about environmental impacts, are imperative. SAFES recommends strategies such as prioritizing plant-based diets, reducing meat consumption, optimizing medical device usage, and enhancing accessibility to endocrine care. Raising awareness and educating caregivers and people living with diabetes on necessary precautions during extreme weather conditions are paramount. The heat sensitivity of insulin, blood glucose monitoring devices, and insulin pumps necessitates proper storage and consideration of environmental conditions for optimal efficacy. The inter-connectedness of global warming and endocrine disorders underscores the necessity of international collaboration guided by national endocrine societies. SAFES urges all stakeholders to actively implement sustainable practices to improve endocrine health in the face of climate change., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Endocrinology and Metabolism.)

Background: Ulcerative colitis is a chronic immune-mediated inflammatory bowel disease that involves inflammation and ulcers of the colon and rectum. To date, no definite cure for this disease is available. Objective: The objective of the current study was to assess the effect of Calliandra haematocephala on inflammatory mediators and oxidative stress markers for the exploration of its anti-ulcerative colitis activity in rat models of acetic acid-induced ulcerative colitis. Methods: Methanolic and n-hexane extracts of areal parts of the plant were prepared by cold extraction method. Phytochemical analysis of both extracts was performed by qualitative analysis, quantitative methods, and high-performance liquid chromatography (HPLC). Prednisone at 2 mg/kg dose and plant extracts at 250, 500, and 750 mg/kg doses were given to Wistar rats for 11 days, which were given acetic acid on 8th day through the trans-rectal route for the induction of ulcerative colitis. A comparison of treatment groups was done with a normal control group and a colitis control group. To evaluate the anti-ulcerative colitis activity of Calliandra haematocephala , different parameters such as colon macroscopic damage, ulcer index, oxidative stress markers, histopathological examination, and mRNA expression of pro and anti-inflammatory mediators were evaluated. mRNA expression analysis was carried out by reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). Results: The phytochemical evaluation revealed polyphenols, flavonoids, tannins, alkaloids, and sterols in both extracts of the plant. Results of the present study exhibited that both extracts attenuated the large bowel inflammation and prevented colon ulceration at all tested doses. Macroscopic damage and ulcer scoreswere significantly decreased by both extracts. Malondialdehyde (MDA) levels and nitrite/nitrate concentrations in colon tissues were returned to normal levels while superoxide dismutase (SOD) activity was significantly improved by all doses. Histopathological examination exhibited that both extracts prevented the inflammatory changes, cellular infiltration, and colon thickening. Gene expression analysis by RT-qPCR revealed the downregulation of pro-inflammatory markers such as tumor necrosis factor-alpha (TNF-α) and cyclooxygenase-2 (COX-2) whereas the anti-inflammatory cytokines including Interleukin-4 (IL-4) and Interleukin-10 (IL-10) were found to be upregulated in treated rats. Conclusion: It was concluded based on study outcomes that methanolic and n-hexane extracts of Calliandra haematocephala exhibited anti-ulcerative colitis activity through modulation of antioxidant defense mechanisms and the immune system. In this context, C. haematocephala can be considered as a potential therapeutic approach for cure of ulcerative colitis after bioassay-directed isolation of bioactive phytochemicals and clinical evaluation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rehman, Saleem, Raza, Bashir, Muhammad, Asghar, Qamar, Shah, Bin Jardan, Mekonnen and Bourhia.)

Competing Interests: F.R. Ali is a Medical Advisor to Melanoma UK and D. Cannon was Consultant for Melanoma UK. [Correction added on 5‐March‐2024, after first online publication, CONFLICT OF INTEREST STATEMENT was updated.]

IN939 is a modern class of nickel-based superalloys designed for continuous operational sustenance at elevated temperatures owing to their excellent combination of fatigue, creep, and corrosion resistance. This unique performance of IN939 is associated with the composition of this alloy, along with specific post-processing treatments such as solution treatment and aging, giving rise to features such as the presence of γ' residues, as well as the presence of MC and M 23 C 6 carbides. This also includes the absence of the eutectic and incipient melting phases. For this alloy, the primary part development is by the powder bed fusion process using a laser powder bed fusion machine. At the same time, a solo study highlights the use of an EB-PBF machine for the synthesis. The AM development process of these alloys is hindered by machine parameters, which have been found ineffective in isolation to obtain a fully dense structure with desired properties. The purpose of these parameters is to improve their core properties while minimizing defects associated with powder metallurgy routes, such as porosity, detrimental precipitates, grain anisotropy, etc. This study aims to provide an overview of the advancements in research related to IN939, explicitly focusing on the benchmarks achieved through additive manufacturing techniques. We have discussed the work performed in this area, compared the results of different studies, and identified the gaps in current research. By doing so, we aim to provide a comprehensive understanding of the potential of IN939 and its applications in extreme environments., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Prof. Olcay Ersel Canyurt reports financial support was provided by 10.13039/501100000780European Commission. Prof. Olcay Ersel Canyurt reports financial support was provided by 10.13039/501100004410Scientific and Technological Research Council of Turkey. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Polycystic ovarian syndrome (PCOS) is an endocrinological disorder aroused due to hormonal disturbances. It is characterized by anovulation due to an excess of androgen and estrogen hormones, thus leading to the formation of multiple cysts, imposing life-threatening conditions. This manuscript aimed to introduce a natural estrogen receptor (ESR) inhibitors that can provide protection against PCOS. The computational analysis of Linum usitatissimum seeds  compounds against ESR alpha receptor was performed, and the binding affinities of the ligand compounds and receptor proteins were scrutinized. Nine lignin compounds were docked, and the results were compared with that of reference estrogen receptor inhibitors, clomiphene, and tamoxifen. The binding affinity scores for pinoresinol, lariciresinol, secoisolariciresinol, and matairesinol were -10.67, -10.66, -10.91, and -10.60 kcal mol -1 , respectively. These were comparable to the binding affinity score of reference compounds -11.406 kcal mol -1 for clomiphene and -10.666 kcal mol -1 for tamoxifen. Prime MM-GBSA studies showcased that Linum usitatissimum seeds compounds exhibit significant efficacy and efficiency towards receptor protein. Moreover, MD-simulation studies were performed and the results depict that the lignin compounds form stable complexes at 300 K throughout the simulation time. For further clarity, in-vitro experiments were carried out. The results exhibit the decline in cell proliferation in a concentration-dependent manner by extract 1 (ethyl acetate) EX1 and extract 2 (petroleum ether) EX2. Hence, providing evidence regarding the anti-estrogenic activity of the sample extracts. Collectively, these results showed that flax seed can reduce the levels of estrogen, which can induce ovulation and prevent cyst formation, and ultimately can provide protection against PCOS., (© 2023 John Wiley & Sons Ltd.)

Background: Gastric cancer (GC) incidence rates overall in the United States have declined over recent decades and are predicted to continue declining. However, there have been mixed recent findings regarding the potential stabilization of rates and potential divergent trends by age group. We used the most recent cancer data for the United States and examined trends in GC between 1992 and 2019, overall and in important subgroups of the population., Methods: Age-adjusted GC incidence rates and trends in adults 20 years or older were calculated using data from the Surveillance, Epidemiology, and End Results (SEER) 12 program. Secular trends were examined overall and by age group, sex, race/ethnicity, SEER registry, and tumor location. We used joinpoint regression to compute annual percent changes, average annual percent changes, and associated 95% CI., Results: GC rates decreased by 1.23% annually from 1992 to 2019. Despite overall decreases, GC incidence rates increased for age groups below 50 years, predominately driven by noncardia GC (74.3% of all GCs). Cardia GC (26.7% of GC) rates decreased in all age groups except for 80 to 84 years. Overall GC rates decreased for both sexes, all races, and for all SEER registry regions, with the largest decreases occurring in males, Asians and Pacific Islanders, and in Hawaii. Age-period-cohort analysis revealed that birth cohorts before 1940 and after 1980 both had increased rates of GC compared with the reference birth cohort of 1955., Conclusion: GC rates overall have continued to decline through 2019, despite increases in the rate of noncardia GC for younger age groups., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Cycloplegic refraction is mandatory for children to know the eye's refractive status. In this study, we compared cycloplegia induced by cyclopentolate 1% to that induced by atropine 1% by means of retinoscopy., Methods: In this parallel-designed interventional study, we included 67 children aged between 4 and 17 years. After the initial retinoscopy under cyclopentolate 1% (used twice in each eye), we repeated it a week later under atropine ointment 1% (used twice a day for 3 days); both were done by the same trained optometrist masked to the drug. Each eye's refraction was converted to spherical equivalents (SEs), and the values averaged between the two eyes of each child under each drug. We compared SE with paired t-test (JASP 16.4). In addition, we performed correlational analysis, and looked for agreement using the Bland-Altman plot. Significance was set at P < 0.05. Wherever possible, 95% confidence intervals (CIs) are quoted., Results: The mean SE with atropine was +1.93 ± 2.0 D, compared to +1.75 ± 1.95 D under cyclopentolate. On average, atropine induced greater cycloplegia by a mere 0.18 D (95% CI: 0.07 to 0.29 D, P value 0.002). The two cycloplegic refractions correlated significantly (Pearson's r: 0.975, P < 0.001). The Bland-Altman plot revealed the limits of agreement as 1.06 and -0.71 D., Conclusion: Our study suggests that cyclopentolate works for the most part as well as atropine to attain cycloplegia. Atropine may be considered for children less than 15 years of age with greater than 5.0 D of hyperopia. Cycloplentolate, with its advantages of quick action and short duration, should form the first go-to topical cycloplegic in busy outpatient clinics., (Copyright © 2023 Copyright: © 2023 Indian Journal of Ophthalmology.)

Objectives: To investigate the prevalence of non-suicidal self-injury among Pakistani medical students, its association with demographic variables, and the distribution of its methods and functions., Methods: The cross-sectional study was conducted from April 2021 to March 2022 at Rawalpindi Medical University, Rawalpindi, Pakistan, and comprised medical students regardless of gender and year of study. Data was collected using the inventory of statements about self-harm scale to assess their socio-demographics, non-suicidal self- injury behaviors and functions. Data was analyzed using SPSS 28., Results: Of the 411 subjects approached, 386(94%) correctly filled the forms; 170(44%) males and 216(55.9%) females. The overall mean age was 19.7 ±1.5 (range: 17-27 years). There were 132(34.1%) students from first year, 146(37.8%) second year, 44(11.3%) third year, 54(13.9%) fourth year and 10(2.5%) from the final year. There were 110(28.4%) with non-suicidal self-injury; 60(54.5%) males and 50(45.4%) females (p=0.008). There were 18 (4.7%) subjects aged 18 years, and, of them, 14(77.7%) exhibited self-harm behaviour. Among specific non-suicidal selfinjury behaviours, 'interfering with scabs and wound healing' was the most common method 80(72.7%). As for the functions of non-suicidal self-injury behaviour, there was a significant difference between intrapersonal and interpersonal functions (p<0.05)., Conclusions: Non-suicidal self-injury was highly prevalent among the young subjects, and it needs proper intervention for timely management.

The phenomenon of climate change has become a global challenge that affects human activities in many ways. Exploring the sustainability and innovativeness of digital education is an important reference for the further implementation of science and education strategies and positive effects on climate change mitigation. This study designed two questionnaires for basic and tertiary education to address variability in education and collected 523 samples for basic education and 412 samples for tertiary education respectively. Using digital teaching practices and digital teaching quality as mediators, structural equation modelling (SEM) was used to examine the impact of digital education on sustainability and innovation in education. Research shows that digital teaching and learning in basic and higher education can significantly contribute to the two-way development of educational sustainability and innovation, through digital teaching and learning practices. Digital teaching practice and digital teaching quality in higher education play a complete mediating role, while basic education only plays a partial mediating role. Higher education emphasizes digital teaching and learning practice processes and teaching quality, and most students hope that online teaching and learning can be further integrated with offline education to form a new model of education. This study will help government departments understand the pedagogical reality of digital education at a deeper level and provide ideas for the subsequent sustainable development and educational innovation of digital teaching. It can also provide new ideas for climate change mitigation and sustainable development., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)