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The G protein-coupled receptor 40 (GPR40) is known to exert a significant influence on neurogenesis and neurodevelopment within the central nervous system of both humans and rodents. Research findings indicate that the activation of GPR40 by an agonist has been observed to promote the proliferation and viability of hypothalamus cells in the human body. The objective of the present study is to discover new agonist compounds for the GPR40 protein through the utilization of machine learning and pharmacophore-based screening techniques, in conjunction with other computational methodologies such as docking, molecular dynamics simulations, free energy calculations, and investigations of the free energy landscape. In the course of our investigation, we successfully identified five unreported agonist compounds that exhibit robust docking score, displayed stability in ligand RMSD and consistent hydrogen bonding with the receptor in the MD trajectories. Free energy calculations were observed to be higher than control molecule. The measured binding affinities of compounds namely 1, 3, 4, 6 and 10 were -13.9, -13.5, -13.4, -12.9, and -12.1 Kcal/mol, respectively. The identified molecular agonist that has been found can be assessed in terms of its therapeutic efficacy in the treatment of neurological diseases., Competing Interests: The authors declare they have no competing financial interests., (Copyright: © 2024 Siddiqui et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Depression among married women of reproductive age is on the rise in Pakistan, owing to post-COVID-19 phase, super-inflation, increasing poverty, deteriorating law and order situation and perpetuating the uncertain political situation in the country. This study aimed to investigate the factors associated with depression among married women of reproductive age in Pakistan, using a mixed methods approach. The quantitative phase utilized the Urdu version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression among 340 married women. Twelve women with higher scores on the PHQ-9 were selected for in-depth interviews in the qualitative phase. The quantitative analysis revealed a higher prevalence of depression among women with poor socioeconomic status, lower educational levels, larger family sizes, and recent deaths in the family. In the qualitative phase, the main themes identified were the impact of social conditions, such as societal expectations and gender roles, the influence of medical conditions on mental health, financial difficulties, the stress associated with caring for a larger number of children, and the emotional burden of recent deaths in the family. This study highlights the importance of addressing depression among married women of reproductive age in Pakistan. It is crucial to focus on early diagnosis and prompt treatment to mitigate the adverse effects of depression on the affected individuals and their families. Targeted interventions should consider the social determinants of depression, including improving socioeconomic conditions through safety nets, providing mental health support at the primary health care level, and addressing the specific health issues and needs of women in the reproductive age group. A multi-pronged approach and health system's thinking can reduce the burden of depression among women, ultimately enhancing their overall well-being, productivity and quality of life., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Abdullah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Breast cancer continues to be the most common malignancy and the leading cause of cancer-related deaths in Ethiopia. The poor prognosis and high mortality rate of breast cancer patients in the country are largely caused by late-stage diagnosis. Hence, understanding the epidemiology of late-stage diagnosis is essential to address this important problem. However, previous reports in Ethiopia indicated inconsistent findings. Therefore, this literature review was conducted to generate dependable evidence by summarizing the prevalence and determinants of late-stage diagnosis among breast cancer patients in Ethiopia., Methods: Pertinent articles were retrieved by systematically searching on major electronic databases and gray literature. Data were extracted into an Excel spreadsheet and analyzed using the STATA 17 statistical software. The pooled estimates were summarized using the random effect meta-analysis model. Heterogeneity and small study effect were evaluated using the I2 statistics and Egger's regression test in conjunction with the funnel plot, respectively. Meta-regression, sub-group analysis, and sensitivity analysis were also employed. Protocol registration number: CRD42024496237., Results: The pooled prevalence of late-stage diagnosis after combining reports of 24 studies with 8,677 participants was 65.85 (95% CI: 58.38, 73.32). Residence (adjusted OR: 1.92; 95% CI: 1.45, 2.53), patient delay at their first presentation (adjusted OR: 2.65; 95% CI: 1.56, 4.49), traditional medicine use (adjusted OR: 2.54; 95% CI: 1.89, 3.41), and breast self-examination practice (adjusted OR: 0.28; 95% CI: 0.09, 0.88) were significant determinants of late-stage diagnosis., Conclusion: Two-thirds of breast cancer patients in Ethiopia were diagnosed at an advanced stage. Residence, delay in the first presentation, traditional medicine use, and breast self-examination practice were significantly associated with late-stage diagnosis. Public education about breast cancer and its early detection techniques is crucial to reduce mortality and improve the survival of patients. Besides, improving access to cancer screening services is useful to tackle the disease at its curable stages., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Geremew et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Rising global migration levels have led to growing diaspora populations. There has been interest in the role of diaspora healthcare professionals (HCPs) from low- and middle-income countries (LMICs) in development aid to their origin countries, although there has been comparatively less focus on their educational activities. This study examined the stated educational priorities of LMIC medical diaspora organisations, with a particular focus on the tension between promoting professional opportunities afforded by medical migration and contributing to healthcare workforce shortages due to migration away from LMICs.We gathered a textual archive from webpages and public documents of 89 LMIC medical diaspora organisations in high income countries, predominantly the US and UK. We employed Foucauldian critical discourse analysis to examine presented rationales around educational policies and practices, with a focus on encouragement towards, and discouragement from, medical migration. Two discourses dominated this archive. The first was of preservation and framed the educational work of these organisations as a means of providing unity and social networks to diaspora HCPs, with a focus on maintaining their cultural identity and heritage, and medical connections with their origin countries. The second was of aspiration and framed their educational work as providing support to diaspora HCPs to advance their careers and maximise training opportunities, often through directly enabling and supporting migration to high income countries. There was a discursive absence around brain drain with no policies or practices that overtly sought to deter against, or offset the negative effects of, medical migration. Notwithstanding the valuable contributions that LMIC medical diaspora organisations make in global health, the discursive framings that shape their educational work are linked primarily to protecting and progressing diaspora HCPs rather than on LMIC workforce challenges. Further research is needed to examine potential impacts of these positions on HCP migratory behaviours., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hussain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Preterm birth is the leading cause of both infant and neonatal mortality. It also had long-term consequences for the physical and neurological development of a growing child. The majority of these and related problems occur in low- and middle-income countries, particularly in sub-Saharan Africa, due to resource scarcity to sustain the lives of premature babies. Despite this, there is a paucity of recent information on the pooled prevalence and factors associated with preterm birth in sub-Saharan Africa. Therefore, this study aimed to update the pooled prevalence and determinants of preterm birth in sub-Saharan Africa based on the most recent Demographic and Health Survey data., Methods: A cross-sectional study design using the most recent demographic and health survey data from eight sub-Saharan African countries was used. We included a total weighted sample of 74,871 reproductive-aged women who gave birth in the five years preceding the survey. We used a multilevel logistic regression model to identify associated factors of preterm birth in sub-Saharan Africa. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of <0.05 are declared statistically significant., Results: In this study, the pooled prevalence of preterm birth among reproductive-aged women in eight sub-Saharan African countries was 3.11% (95% CI: 2.98-3.25). Working mothers (AOR = 0.61; 95% CI: 0.38-0.97), being married (AOR = 0.63; 95% CI: 0.40-0.99), and having media exposure (AOR = 0.59; 95% CI: 0.36-0.96) decrease the odds of preterm birth. On the other hand, being low birth weight (AOR = 17.7; 95% CI: 10.7-29.3), having multiple pregnancies (AOR = 3.43; 95% CI: 1.82-6.45), having a history of terminated pregnancies (AOR = 1.56; 95% CI: 1.01-2.41), being un-educated (AOR = 3.16; 95% CI: 1.12-8.93), being of a maternal age above 35 (AOR = 1.63; 95% CI: 1.08-2.45), maternal alcohol use (AOR = 19.18; 95% CI: 13.6-38.8), and being in the low socio-economic status (AOR = 1.85; 95% CI: 1.11-3.07) of the community increase the odds of preterm birth., Conclusion: The burden of preterm birth among reproductive-age women in sub-Saharan Africa showed improvements as compared to previous findings. To further lessen the burden, policymakers and other pertinent organizations must prioritize maternal health, expand media access, educate and empower women, and promote a healthy lifestyle for reproductive-age women., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tekeba et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

When combating a respiratory disease outbreak, the effectiveness of protective measures hinges on spontaneous shifts in human behavior driven by risk perception and careful cost-benefit analysis. In this study, a novel concept has been introduced, integrating social distancing and mask-wearing strategies into a unified framework that combines evolutionary game theory with an extended classical epidemic model. To yield deeper insights into human decision-making during COVID-19, we integrate both the prevalent dilemma faced at the epidemic's onset regarding mask-wearing and social distancing practices, along with a comprehensive cost-benefit analysis. We explore the often-overlooked aspect of effective mask adoption among undetected infectious individuals to evaluate the significance of source control. Both undetected and detected infectious individuals can significantly reduce the risk of infection for non-masked individuals by wearing effective facemasks. When the economical burden of mask usage becomes unsustainable in the community, promoting affordable and safe social distancing becomes vital in slowing the epidemic's progress, allowing crucial time for public health preparedness. In contrast, as the indirect expenses associated with safe social distancing escalate, affordable and effective facemask usage could be a feasible option. In our analysis, it was observed that during periods of heightened infection risk, there is a noticeable surge in public interest and dedication to complying with social distancing measures. However, its impact diminishes beyond a certain disease transmission threshold, as this strategy cannot completely eliminate the disease burden in the community. Maximum public compliance with social distancing and mask-wearing strategies can be achieved when they are affordable for the community. While implementing both strategies together could ultimately reduce the epidemic's effective reproduction number ([Formula: see text]) to below one, countries still have the flexibility to prioritize either of them, easing strictness on the other based on their socio-economic conditions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nabi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Antibiotic resistance genes (ARGs) transfer rapidly among bacterial species all over the world contributing to the aggravation of antibiotic resistance crisis. Antibiotics at sub-inhibitory concentration induce horizontal gene transfer (HRT) between bacteria, especially through conjugation. The role of common non-antibiotic pharmaceuticals in the market in disseminating antibiotic resistance is not well studied., Objectives: In this work, we indicated the effect of some commonly used non-antibiotic pharmaceuticals including antiemetic (metoclopramide HCl) and antispasmodics (hyoscine butyl bromide and tiemonium methyl sulfate) on the plasmid-mediated conjugal transfer of antibiotic resistance genes between pathogenic E. coli in the gastric intestinal tract (GIT)., Methods: Broth microdilution assay was used to test the antibacterial activity of the tested non-antibiotic pharmaceuticals. A conjugation mating system was applied in presence of the studied non-antibiotic pharmaceuticals to test their effect on conjugal transfer frequency. Plasmid extraction and PCR were performed to confirm the conjugation process. Transmission electron microscopy (TEM) was used for imaging the effect of non-antibiotic pharmaceuticals on bacterial cells., Results: No antibacterial activity was reported for the used non-antibiotic pharmaceuticals. Plasmid-mediated conjugal transfer between isolates was induced by metoclopramide HCl but suppressed by hyoscine butyl bromide. Tiemonium methylsulfate slightly promoted conjugal transfer. Aggregation between cells and periplasmic bridges was clear in the case of metoclopramide HCl while in presence of hyoscine butyl bromide little affinity was observed., Conclusion: This study indicates the contribution of non-antibiotic pharmaceuticals to the dissemination and evolution of antibiotic resistance at the community level. Metoclopramide HCl showed an important role in the spread of antibiotic resistance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mohamed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The emergence of non-communicable diseases (NCDs) has been well documented in recent literature which constitute a significant global burden of disease. Qatar which has a significantly high prevalence of NCDs with early on set. Epidemiological and health service utilization information plays a central role in facilitating informed decision making and application of the fundamental principles of PHC in planning and delivery of healthcare with aim to prevent and control NCDs. To enable this, the Department of Clinical Research at Primary Health Care Corporation (PHCC), Qatar's publicly funded and largest primary care provider designed the Health Assessment Linking Trends in Health Status, Risks, and Healthcare Utilization (HEALTHSIGHT) study. This paper describes the HEALTHSIGHT study protocol., Methods: The proposed study will use a cross sectional study design involving a random sample of participants enrolled across all 31 PHCC health centers. Individuals aged 18 and above years old registered with PHCC and hold a valid health card and contact information on PHCC's electronic medical records (EMR) will be eligible for inclusion. A stratified random sample not proportional to size sampling technique will be employed to obtain a representative sample size of the PHCC population (N = 6000). Participants will be scheduled for an appointment at a PHCC health centre where a data collector will obtain informed consent, collect vital sign information and administer a questionnaire. A phlebotomist will collect a blood sample. Health service utilization data will be extracted from PHCC's EMR., Discussion: Epidemiological and health service utilization information is essential to plan and monitor primary care and public health services. The HEALTHSIGHT study, with the help of a randomly selected representative sample from Qatar's primary healthcare settings, provides a unique opportunity to capture this information. This study design will closely represent a real-world understanding of the health risk, status and utilisation and is likely to provide important data to guide primary care planning and delivery in Qatar. The proposed protocol provides an example of a robust nationwide study that be undertaken in short duration using limited resource which can be undertaken in other similar settings., Competing Interests: All authors are employees of Primary Healthcare Corporation (Qatar). This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare. The specific roles of each author are articulated in the ‘author contributions’ section., (Copyright: © 2024 Syed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: About 287,000 mothers lost their lives due to pregnancy and delivery in 2020 worldwide. Birth preparedness and complication readiness (BPCR) is an approach used to utilize the timely use of skilled maternal and neonatal services. Preparing mothers for childbirth and against its dangers has great importance in reducing maternal mortality. Little is known about BPCR and influencing factors in Hargeisa town, Somaliland., Objective: To assess the level of BPCR and its associated factors among recently delivered women in Hargeisa., Methods: A community-based cross-sectional study was carried out in September 2022 among 300 women who delivered in the one-year time interval before the study period. A census was done to identify the women, and then they were selected by simple random sampling. Face-to-face interviews were conducted using a pre-structured questionnaire. A woman was considered prepared for birth if she made preparations for at least three of the BPCR components. Data were cleaned, entered, and analyzed using SPSS V.25. Bivariate and multivariate logistic regression analyses were performed with a cut-point of 0.05 significance level., Results: From a total of 300 women, 38.3% had good knowledge of BPCR, and only one-fourth (25%) were prepared for birth and its complications. Access and media usage (AOR = 9.64, CI 1.09-82.248), receiving health education about BPCR (AOR = 3.75, CI 1.01-13.87), giving birth at health institutions (AOR = 6.02, CI 1.39-25.95), and good knowledge of key danger signs of pregnancy (AOR = 0.017, CI 0.004-0.069) were factors significantly associated with BPCR practice., Conclusion: The study identified that the BPCR level was very low compared to many other studies. Such a low BPCR level may have a negative impact on maternal health and lives, hindering interventions conducted to reduce maternal mortality rates. All concerned bodies should consider the importance of awareness creation regarding BPCR in their core interventions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Organic photovoltaic cells are a promising technology for generating renewable energy from sunlight. These cells are made from organic materials, such as polymers or small molecules, and can be lightweight, flexible, and low-cost. Here, we have created a novel mixture of magnesium phthalocyanine (MgPc) and chlorophenyl ethyl diisoquinoline (Ch-diisoQ). A coating unit has been utilized in preparing MgPc, Ch-diisoQ, and MgPc-Ch-diisoQ films onto to FTO substrate. The MgPc-Ch-diisoQ film has a spherical and homogeneous surface morphology with a grain size of 15.9 nm. The optical absorption of the MgPc-Ch-diisoQ film was measured, and three distinct bands were observed at 800-600 nm, 600-400 nm, and 400-250 nm, with a band gap energy of 1.58 eV. The current density-voltage and capacitance-voltage measurements were performed to analyze the photoelectric properties of the three tested cells. The forward current density obtained from our investigated blend cell is more significant than that for each material by about 22%. The photovoltaic parameters (Voc, Isc, and FF) of the MgPc-Ch-diisoQ cell were found to be 0.45 V, 2.12 μA, and 0.4, respectively. We believe that our investigated MgPc-Ch-diisoQ film will be a promising active layer in organic solar cells., Competing Interests: The authors state that they have no known competing financial interests or personal ties that could have influenced the research presented in this study., (Copyright: © 2024 Alsharif et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In this study, the variation of shear strength behavior and particle breakage (after shearing), as a function of moisture state and compaction level, is investigated for recycled concrete aggregate blended with recycled clay masonry. Recycled masonry was blended with concrete aggregate in percentages ranging from 0% to 30% by total weight. Tests include; basic engineering characteristics (particle size, modified compaction, hydraulic conductivity, and California Bearing Ratio, CBR) as well as unconsolidated undrained static triaxial testing. In triaxial tests, moisture levels ranged from 60% to 100% of optimum moisture content, but compaction levels ranged from 90% to 98% of maximum dry density. The hydraulic conductivity for blends is approximately 2x10-6 cm/s, which indicates a relatively low hydraulic conductivity. Results show a proportional linear relationship between the shear strength of blends and the level of compaction. Despite this, both apparent cohesion and shear strength exhibited reverse linear trends. As expected, more compaction effort resulted in more particle breakage. Strict control should be performed over the compaction process to achieve the required compaction level which resulting in pavement materials being stiffer., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yosri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Malaria eradication efforts in resource-limited areas require a rapid, economical, and accurate tool for detecting of the low parasitemia. The malaria rapid diagnostic test (mRDT) is the most suitable for on-site detection of the deadliest form of malaria, Plasmodium falciparum. However, the deletions of histidine rich protein 2 and 3 genes are known to compromise the effectiveness of mRDT. One of the approaches that have been explored intensively for on-site diagnostics is the loop-mediated isothermal amplification (LAMP). LAMP is a one-step amplification that allows the detection of Plasmodium species in less than an hour. Thus, this study aims to present a new primer set to enhance the performance of a colorimetric LAMP (cLAMP) for field application. The primer binding regions were selected within the A-type of P. falciparum 18S rRNA genes, which presents a dual gene locus in the genome. The test result of the newly designed primer indicates that the optimal reaction condition for cLAMP was 30 minutes incubation at 65°C, a shorter incubation time compared to previous LAMP detection methods that typically takes 45 to 60 minutes. The limit of detection (LoD) for the cLAMP using our designed primers and laboratory-grown P. falciparum (3D7) was estimated to be 0.21 parasites/μL which was 1,000-fold higher than referencing primers. Under optimal reaction condition, the new primer sets showed the sensitivity (100%, 95% CI: 80.49-100%) and specificity (100%, 95% CI: 94.64-100%) with 100% (95% CI: 95.70-100%) accuracy on the detection of dried blood spots from Malawi (n = 84). Briefly, the newly designed primer set for P. falciparum detection exhibited high sensitivity and specificity compared to referenced primers. One great advantage of this tool is its ability to be detected by the naked eye, enhancing field approaches. Thus, this tool has the potential to be effective for accurate early parasite detection in resource-limited endemic areas., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nguyen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Green technology innovation is an effective means to achieve high-quality economic development. The impact and mechanism of digital financial inclusion on regional green technology innovation are tested using a threshold regression model and the panel fixed effect model, based on China's provincial Panel data (provincial Panel data are regional annual report data) from 2011 to 2020. According to the study, there is a direct link between local green technology innovation and digital financial inclusion. This paper highlights the differences in their influence by location and usage depth and underscores the necessity of government engagement to improve these characteristics. Information infrastructure needs to be strengthened, especially in areas with gaps. Greater investment in research and development (R&D) indirectly supports regional green technology innovation since it is impacted by digital financial inclusion. Interestingly, a threshold effect becomes most noticeable when digital financial inclusion rises above a particular threshold. Promoting utilizing digital financial inclusion to lessen regional differences in green technology innovation is important., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Evaluating immune responses following COVID-19 vaccination is paramount to understanding vaccine effectiveness and optimizing public health interventions. This study seeks to elucidate individuals' immune status after administering a second dose of diverse COVID-19 vaccines. By analyzing immune responses through serological markers, we aim to contribute valuable insights into the uniformity of vaccine performance., Methods: A total of 80 participants were enrolled in this study, with demographic and COVID-19 infection-related data collected for categorization. Serum samples were acquired within a specified timeframe, and SARS-CoV-2 IgM/IgG rapid tests were conducted. Moreover, CTLA-4 levels were measured through ELISA assays, allowing us to assess the immune responses comprehensively. The participants were divided into eight groups based on various factors, facilitating a multifaceted analysis., Results: The outcomes of our investigation demonstrated consistent immune responses across the diverse types of COVID-19 vaccines administered in Iraq. Statistical analysis revealed no significant distinctions among the vaccine categories. In contrast, significant differences were observed in CTLA-4 among the control group (non-infected/non-vaccinated, infected/non-vaccinated) and infected/Pfizer, non-infected/Pfizer, and infected/Sinopharm, non-infected/sinopharm (P = 0.001, < 0.001, 0.023, respectively). This suggests that these vaccines exhibit comparable effectiveness in eliciting an immune response among the study participants., Conclusions: In conclusion, our study's results underscore the lack of discriminatory variations between different COVID-19 vaccine types utilized in Iraq. The uniform immune responses observed signify the equitable efficacy and performance of these vaccines. Despite minor quantitative discrepancies, these variations do not hold statistical significance, reaffirming the notion that the various vaccines serve a similar purpose in conferring protection against COVID-19., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Al-Kaif et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Emotional divorce occurs when physical, psychological, mental, and spiritual separation occurs between spouses despite the fact that they live in the same house and exercise their marital duties. Emotional divorce has adverse effects on the mental health of those involved, as evidenced by the higher incidence of depression, anxiety, and loneliness among such couples. Saudi women are particularly vulnerable to emotional divorce owing to social, legal, economic, and cultural factors. Therefore, it is important to examine the relationship between emotional divorce and mental health issues (depression, anxiety, and loneliness) in married women in Saudi Arabia. Using scales that assess emotional divorce, depression, anxiety, and loneliness, data were collected from 241 married Saudi women (Mage = 34.41 years; SDage = 5.23 years). Findings revealed a statistically significant correlation between emotional divorce, depression, anxiety, and loneliness. One-way ANOVA confirmed that those with high levels of emotional divorce concurrently scores higher on the depression, anxiety, and loneliness tools, followed by those with moderate and low emotional divorce scores, respectively. Linear regression analysis indicated that depression, anxiety, and loneliness were strong predictors of emotional divorce, explaining 61% of the variance in the emotional divorce scores in this sample. These findings highlight the need to focus on the mental health outcomes of individuals experiencing emotional divorce, especially in societies where legal divorce may not be acceptable or encouraged. The need for regular evaluation and timely interventions for individuals struggling with mental health problems, and for restoring a healthy marital relationship is also highlighted., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 AL-shahrani, Hammad. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

An effective approach to reverse multidrug resistance (MDR) is P-glycoprotein (P-gp, ABCB1) transport inhibition. To identify such molecular regulators, the SuperNatural II database, which comprises > 326,000 compounds, was virtually screened for ABCB1 transporter inhibitors. The Lipinski rule was utilized to initially screen the SuperNatural II database, identifying 128,126 compounds. Those natural compounds were docked against the ABCB1 transporter, and those with docking scores less than zosuquidar (ZQU) inhibitor were subjected to molecular dynamics (MD) simulations. Based on MM-GBA binding energy (ΔGbinding) estimations, UMHSN00009999 and UMHSN00097206 demonstrated ΔGbinding values of -68.3 and -64.1 kcal/mol, respectively, compared to ZQU with a ΔGbinding value of -49.8 kcal/mol. For an investigation of stability, structural and energetic analyses for UMHSN00009999- and UMHSN00097206-ABCB1 complexes were performed and proved the high steadiness of these complexes throughout 100 ns MD simulations. Pharmacokinetic properties of the identified compounds were also predicted. To mimic the physiological conditions, MD simulations in POPC membrane surroundings were applied to the UMHSN00009999- and UMHSN00097206-ABCB1 complexes. These results demonstrated that UMHSN00009999 and UMHSN00097206 are promising ABCB1 inhibitors for reversing MDR in cancer and warrant additional in-vitro/in-vivo studies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ibrahim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In the most recent era, the extensions of the probability models via trigonometry methods have received great attention. This paper also offers a novel trigonometric version of the Weibull model called a type-I cosine exponentiated Weibull (for short "TICE-Weibull") distribution. The identifiability properties for all three parameters of the TICE-Weibull model are derived. The estimators of the TICE-Weibull model are derived by implementing the maximum likelihood approach. To demonstrate the effectiveness of the TICE-Weibull model, two applications from real-world phenomena are analyzed. In addition, the proposed statistical model is established for an attribute control chart based on a time-truncated life test. The advantage of the developed charts is examined based on the average run length (ARL). The necessary tables of shift sizes and various sample sizes are offered for numerous values of the distribution parameters, as well as specified ARL and shift constants. Some numerical examples are discussed for various scheme parameters to study the performance of the new TICE-Weibull attribute control charts. According to our search and a brief study of the statistical literature, there is no published work on the development of a control chart using new probability models that are introduced using the cosine function. This is the key motivation of this work, which fills this amazing and interesting research gap., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Alomair et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Major depressive disorder (MDD) is a heterogeneous mental disorder having a very diverse course and causing a significant changes in daily life. Though the exact pathophysiology of depression is still not known, an alteration in the serum levels of cytokines and neurotrophic factors was seen in MDD subjects. In this study, we compared the serum levels of 'pro-inflammatory cytokine leptin and neurotrophic factor EGF' in healthy controls (HCs) and MDD patients. To make the findings more accurate, we eventually looked for a correlation between altered serum leptin and EGF levels and the severity of the disease condition., Methods: For this case-control study, about 205 MDD patients were enrolled from the Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, and about 195 HCs were enrolled from various parts of Dhaka. The DSM-5 was utilized to evaluate and diagnose the participants. The HAM-D 17 scale was used to measure the severity of depression. After collecting blood samples, they were centrifuged to produce clear serum samples. These serum samples were analyzed using enzyme-linked immunosorbent assay (ELISA) kits to measure serum leptin and EGF levels., Results: We observed lowered serum EGF levels in MDD patients compared to HCs (524.70 ± 27.25 pg/ml vs. 672.52 ± 49.64 pg/ml, p = 0.009), and HAM-D score was elevated in MDD patients compared to HCs (17.17 ± 0.56 vs. 2.49 ± 0.43, p<0.001). But no correlation was established between serum EGF levels and the severity of depression. However, no significant differences were observed between MDD patients and HCs in the case of serum leptin levels (p = 0.231)., Conclusion: Our study findings suggest that reduced serum EGF levels have an impact on the pathogenesis of depression. But as per our investigation, the severity of depression is not correlated with altered EGF levels. Our findings regarding the association of EGF with MDD would help to use EGF as a risk indicator of depression. We suggest further clinical investigations to determine the precise function of leptin and EGF in depression., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Sohan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Mpox (monkeypox) infection has become a global concern for healthcare authorities after spreading in multiple non-endemic countries. Following the sudden multi-country outbreak of Mpox, the World Health Organization (WHO) declared a public health emergency of international concern. We do not have any vaccines approved for the prevention of Mpox infection. Therefore, international healthcare authorities endorsed smallpox vaccines for the prevention of Mpox disease. Here we intended to perform this cross-sectional study among the adult males in Bangladesh to assess the Mpox vaccine perception and vaccination intention., Methods: We conducted this web-based survey among the adult males in Bangladesh from September 1, 2022, to November 30, 2022, using Google Forms. We assessed the Mpox vaccine perception and vaccination intention. We performed a chi-square test to compare vaccine perception and vaccination intention levels. Also, we performed multiple logistic regression analyses to determine the association between the study parameters and the sociodemographic profile of the participants., Results: According to the present study, the Mpox vaccine perception was high among 60.54% of the respondents. Also, 60.05% of respondents showed medium vaccination intention. Mpox vaccine perception and vaccination intention were strongly associated with the sociodemographic profiles of the participants. Furthermore, we discovered a significant association between the level of education and vaccination intention among the respondents. Also, age and marital status played a role in the Mpox vaccine perception and vaccination intention., Conclusion: Our findings showed a significant association between sociodemographic characteristics and the Mpox vaccine perception/vaccination intention. Along with the country's long experience in mass immunization, campaigns about Covid-19 vaccines and high vaccination rates might play a role in Mpox vaccine perception and vaccination intention. We recommend more social awareness and educational communications or seminars for the target population to bring more positive changes in their attitude towards Mpox prevention., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Islam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Toxoplasma gondii host cellular invasion factors such as the rhoptry proteins, micronemal antigens, or other subcellular compartment proteins have shown limited vaccine efficacies. T. gondii cyst wall protein (CST1) as a cyst persistence factor is critical for cyst wall integrity and bradyzoite persistence. Here, we generated influenza virus-like particles (VLPs) expressing the T. gondii CST1 and evaluated the mucosal as well as systemic immunities induced by VLPs. Intranasal immunization with the VLPs induced parasite-specific IgG and IgA antibody responses in sera and intestines. VLP immunization showed higher levels of germinal center B cell response and antibody-secreting cell (ASC) response upon challenge infection, indicating memory B cell response was induced. VLP-immunized mice showed a significant reduction of cyst counts and lower levels of pro-inflammatory cytokines (IFN-γ, IL-6) production in the brain upon T. gondii ME49 challenge infection compared to unimmunized control. Thus, VLP immunization protected mice from the lethal dose challenge infection with T. gondii ME49 and did not incur bodyweight loss. These results indicated that T. gondii CST1 containing VLPs can induce mucosal and systemic immunity and also suggest its developmental potential as an effective vaccine candidate against T. gondii infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Eom et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Coronavirus disease-19 emerged in December 2019. Healthcare workers were exposed to this highly infectious virus during the pandemic and suffered several social and psychological consequences, such as anxiety, psychological distress, and burnout., Objectives: To assess the psychological distress, anxiety, depression, coping strategies, risk perception, and attitude toward interprofessional teamwork among Egyptian healthcare workers during the COVID-19 pandemic., Methods: We conducted a cross-sectional online survey which consisted of five sections. The primary outcomes were anxiety (GAD-7), depression (PHQ-9), risk perception towards COVID-19, interprofessional teamwork attitude, and coping strategies during the Coronavirus disease-19 pandemic. The web-based questionnaire was distributed to Egyptian healthcare workers from the 20th of April 2020 to the 20th of May 2020. A snowball sampling method was used. Regression analysis was conducted to test the relationship between the socioeconomic characteristics and the previously mentioned outcomes., Results: A total of 403 participants responded to the online questionnaire. The majority were females (70.5%) and within the age group of 26-40 years (77.7%), with 2-5 years of work experience (43.2%). Most participants were pharmacists (33%) and physicians (22.1%). Eighty-two participants (21%) reported moderate to severe anxiety, and 79 participants reported (19.4%) moderate to severe depressive symptoms. In the univariate model, the marital status was associated with depression (OR 0.47, 95% CI 0.28-0.78), anxiety (OR 0.52, 95% CI 0.32-0.85), and an attitude toward interprofessional teamwork (β = -1.96 95% CI -2.72 to -1.2). Providing direct care to the patients was associated with lower anxiety symptoms (AOR 0.256, 95% CI 0.094-0.697). More severe anxiety and depressive symptoms were associated with difficulties in everyday life and the professional work environment (AOR 4.246 and 3.3, P = 0.003 and 0.01, respectively). Availability of mental health facilities at the workplace was associated with a lower risk perception towards COVID-19 (β = -0.79, 95% CI -1.24 to -0.34) and a more positive attitude towards teamwork (β = 2.77 95% CI 1.38-4.15)., Conclusions: According to our results, the COVID-19 pandemic was associated with mild anxiety and depression among healthcare workers in Egypt, especially pharmacists and physicians. We recommend more research targeting the mental health of healthcare workers in Egypt. If proven cost-effective and needed, wide-scale mental health screening and public health campaigns can facilitate effective prevention and treatment strategies. In addition, the availability of mental health facilities at the workplace could alleviate some of the risk perception associated with health emergencies and improve interprofessional teamwork., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Elsayed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Water is a vital, finite resource whose quantity and quality are deteriorating as the world population increases. The current study aims to investigate the concentration of heavy metals (HM) in surface water for irrigation purposes with associated human health risks and pollution sources near the marble industry in Malakand, Pakistan. Twenty-seven water samples were randomly collected and analyzed for HM concentration by inductively coupled plasma‒optical emission spectrometry (ICP‒OES). pH, electrical conductivity (EC), total dissolved solids (TDS), biological oxygen demand (BOD), and chemical oxygen demand (COD) were measured using standard methods of American Public Health Association (APHA). Irrigation suitability was assessed using specific water quality parameters. The associated health risks from ingestion and dermal exposure to heavy metals were calculated by USEPA health risk indices. Pollution sources and spatial distribution mapping were studied using compositional data analysis (CoDa) and the application of a geographic information system (GIS) to understand the changing behavior of heavy metals in surface waters. The concentrations of BOD (89%), COD (89%), Al (89%), Ca (89%), Cr (56%), Cu (78%), Fe (56%), K (34%) Mg (23%), Mn (56%), Na (89%), Ni (56%), P (89%), and Zn (11%) exceeded the safety limits of National Environmental Quality standards (NEQs) of Pakistan. The results of Kelly's ratio (KR) classified surface water as unsuitable for irrigation. The average daily doses (ADD, mg/kg/day) for Al, Cu, Cr, Fe, Mn, Ni, and Zn were higher in children than in adults. The hazard index (HI) for children and adults was above the threshold (HI > 1), indicating a significant risk of non-carcinogenic toxicity. The carcinogenic risk values for Cr and Ni were above the USEPA limit (1 × 10-6 to 1 × 10-4), suggesting a potential carcinogenic risk for the target population. Principal component analysis (PCA), biplot (CLR), and the CoDa-dendrogram allowed for the identification of elemental associations, and their potential source was anthropogenic rather than natural in origin. Regular monitoring and phytoremediation strategies are proposed to safeguard crops and human health., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Khan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The green peach aphid, Myzus persicae (Sulzer) is a generalist pest of various host plants, whose feeding preference and growth performance mainly depends on the quantity and quality of nutrients and defensive metabolites in host plants. Here, we studied the preference and performance of M. persicae on three major Brassicaceae vegetables in China and measured nutrient (amino acids) and defensive metabolites (glucosinolates) in these plants. We found that M. persicae preferred and performed better on Chinese cabbage than cabbage and radish, which may be due to the relatively higher concentration of amino acids and lower levels of indole glucosinolates in their leaves. The glucosinolates level in cabbage leaves was ten times higher than the other two plants, while the amino acid concentration in radish was only half of the cabbage or Chinese cabbage. The higher concentration of indole glucosinolates in cabbage and lower levels of amino acids in radish may account for the poorer preference and growth of M. persicae on these two plants. These results suggest that both amino acids and glucosinolates in plants may play important roles in the preference and performance of M. persicae, which provide new knowledge for the cultivation and breeding of Brassicaceae vegetables., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Major depressive disorder (MDD) is a complex mental health condition that results in several obstacles including disabilities, loss of productivity, and economic burdens on both patients and society. Etiopathogenesis of MDD involves several factors such as sociodemographic, genetic, and biological determinants. However, any suitable biomarkers for risk assessment of depression have not been established yet. Alterations of cytokine are assumed to be involved in the pathophysiology and severity of the depressive disorder. Therefore, we aimed to evaluate serum adiponectin and interleukin-8 (IL-8) among MDD patients in Bangladesh., Methods: We recruited a total of 63 MDD patients and 94 age-sex matched healthy controls (HCs) in the present study. MDD patients were enrolled from a tertiary care teaching hospital, Dhaka, Bangladesh, and HCs from surrounding parts of Dhaka city. A psychiatrist assessed all the study participants following the criteria mentioned in the DSM-5. We applied the Hamilton depression (Ham-D) rating scale to assess the depression severity. Serum adiponectin and IL-8 levels were determined using ELISA kits (BosterBio, USA)., Results: The mean serum concentration of adiponectin was decreased (30.67±4.43 μg/mL vs. 53.81±5.37 μg/mL), and the IL-8 level was increased (160.93±14.84 pg/mL vs. 88.68±6.33 pg/mL) in MDD patients compared to HCs. Sex-specific scatters plot graphs showed the distribution of adiponectin and IL-8 levels with Ham-D scores in MDD patients. Also, ROC curve analysis demonstrated good predictive performances of serum adiponectin and IL-8 for MDD with the area under the curve (AUC) as 0.895 and 0.806, respectively., Conclusion: The present study findings suggest that alterations of serum adiponectin and IL-8 levels in MDD patients might be involved in the disease process. Therefore, we can use these changes of cytokines in serum levels as early risk assessment tools for depression. The present study findings should be considered preliminary. We propose further interventional studies to evaluate the exact role of adiponectin and IL-8 in depression., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Islam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Very few previous studies have involved school students or their parents in the evaluation of virtual learning environment (VLE). Thus, this survey was performed to evaluate the satisfaction of both school students and their parents with the VLE in the Kingdom of Saudi Arabia during the COVID-19 pandemic., Methods: A cross-sectional questionnaire-based survey was distributed online for VLE evaluation. The questionnaire was based on previous studies and expert opinions from validated instruments for assessing distance education, integrative and literature reviews of VLE environment. A median value >3 indicated participant satisfaction in each of the 5 domains of the questionnaire as well as overall VLE satisfaction. The used questionnaire was checked after its implementation by all possible statistical means and it was found to be of acceptable validity and reliability., Results: Six hundred and ninety-three participants including 571 Saudi citizens and 122 non-Saudi residents participated in this survey. The number of school students who agreed or strongly agreed were significantly lower than the number of students who disagreed or strongly disagreed with preferring the VLE over traditional education (p<0.001). The participants evaluated the VLE experience as unsatisfactory with a median value ≤3 for 4 out of 5 questionnaire domains with an overall satisfaction value of 2.8. Among the 117 participants who gave further written opinions/comments, 42(35.9%) participants supported the VLE as an alternative to traditional classrooms, if equipment and internet are made available and for the safety of their children., Conclusions: This is one of few available adequate population-based studies for exploring the VLE satisfaction of both Saudi citizens and non-Saudi residents school students and their parents. This study showed the participants' unsatisfactory VLE experience. The VLE is accepted as an alternative to traditional classrooms to keep up with learning and to maintain the safety of children and it can be a supplementary learning method but many measures are still needed to develop the VLE., Competing Interests: The authors have declared that no competing interests exist.

This study examined the fear of COVID-19 pandemic and its impact on consumer behavioural intention to purchase green products. The data was collected from consumers of Malaysia in hypermarkets. A total of 491 respondents were analyzed using the partial least square technique. The results indicated that the fear of the COVID-19 epidemic has a significant impact on health concerns, social media information, intolerance of uncertainty, and personal relevance, which in turn affect consumers' behavioural intention to purchase green products. With a serial mediating effect the results identified that fear of COVID-19 epidemic is associated with behavioural intention to purchase the green product. The findings of this study are crucial for understanding the swings in the green product purchase behaviour due to the ongoing uncertainty of COVID-19 crisis., Competing Interests: NO authors have competing interests.

This paper aims to test whether agricultural insurance significantly impacts farmers' income increase or not. We have used the ordinary least squares method (OLS), panel fixed effects, and system generalized moment estimation (GMM) for the test. The results show that the increase in agricultural insurance density and the increase in agricultural insurance per capita compensation positively impact farmers' income growth significantly. Agricultural insurance density and per capita compensation are the indicators used in this article to measure agricultural insurance development. Therefore, it can be considered that the development of agricultural insurance in Guangdong Province (China) can effectively increase the income level of farmers. Based on the results of theoretical and empirical analysis, combined with the current situation of agricultural insurance development in Guangdong Province, this paper finally puts forward relevant countermeasures and suggestions. It provides some ideas for giving full play to the role of agricultural insurance in promoting farmers' income from the perspectives of pertinent system design, subsidy methods, insurance innovation, service level, and publicity., Competing Interests: The authors have declared that no competing interests exist.

This study aims to investigate how young Chinese consumers make purchase intentions towards Western brands under the influence of two conflicting values and CSR, which is insufficiently discussed in the current literature. Both value-attitude-behavior (VAB) and consumer cultural theories are adopted to construct the research framework. Data was collected from undergraduate students studying at a public university located in Guangzhou via WeChat and Tencent QQ. A total of 314 usable responses were analyzed by the partial least squares structural equation modeling (PLS-SEM). The empirical findings indicated that cosmopolitanism has a significantly positive effect on brand attitudes and purchase intentions; ethnocentrism has a significantly negative effect on purchase intentions, but no significant impact on brand attitudes; and corporate social responsibility (CSR) initiatives positively affect brand attitudes rather than purchase intentions. The results also revealed that brand attitudes mediate the relationship between cosmopolitanism/CSR and purchase intentions, but it does not have a mediating effect on the relationship between ethnocentrism and purchase intentions. These findings provide essential insights to the body of knowledge of international marketing in emerging markets and shed light on understanding how young Chinese consumers make purchase decisions towards Western brands. The results are useful for Western brands to effectively adjust their marketing strategies and advertising/promoting campaigns for business development purposes in the Chinese market., Competing Interests: The authors have declared that no competing interests exist.

Background: Many studies have predicted major depressive disorder (MDD) as the leading cause of global health by 2030 due to its high prevalence, disability, and illness. However, the actual pathophysiological mechanism behind depression is unknown. Scientists consider alterations in cytokines might be tools for understanding the pathogenesis and treatment of MDD. Several past studies on several inflammatory cytokine expressions in MDD reveal that an inflammatory process is activated, although the precise causes of that changes in cytokine levels are unclear. Therefore, we aimed to investigate resistin and G-CSF in MDD patients and controls to explore their role in the pathogenesis and development of depression., Methods: We included 220 participants in this study. Among them, 108 MDD patients and 112 age-sex matched healthy control (HCs). We used DSM-5 to evaluate study participants. Also, we applied the Ham-D rating scale to assess the severity of patients. Serum resistin and G-CSF levels were measured using ELISA kits (BosterBio, USA)., Results: The present study observed increased serum resistin levels in MDD patients compared to HCs (13.82 ± 1.24ng/mL and 6.35 ± 0.51ng/mL, p <0.001). However, we did not find such changes for serum G-CSF levels between the groups. Ham-D scores showed a significant correlation with serum resistin levels but not G-CSF levels in the patient group. Furthermore, ROC analysis showed a fairly predictive performance of serum resistin levels in major depression (AUC = 0.746)., Conclusion: The present study findings suggest higher serum resistin levels are associated with the pathophysiology of MDD. This elevated serum resistin level may serve as an early risk assessment indicator for MDD. However, the role of serum G-CSF in the development of MDD is still unclear despite its neuroprotective and anti-inflammatory effects., Competing Interests: The authors have declared that no competing interests exist.

Objective: The clinical benefits of simultaneous implant placement and soft tissue augmentation using different treatment modalities are unclear. The current meta-analysis aimed to compare the effect of simultaneous soft tissue augmentation using subepithelial connective tissue graft (SCTG) around immediate or delayed dental implant placement with other treatment modalities on the peri-implant tissue health and esthetic., Methods: Up to May 2021, four databases (PubMed, EMBASE, Cochrane Central, and Google Scholar) were searched. Randomized control trials with follow-up >3 months, evaluating simultaneous implant placement (immediate or delayed) and soft tissue augmentation using SCTG compared with other treatment modalities were included. The predictor variables were SCTG versus no augmentation with/without guided bone regeneration (GBR) or other augmentation techniques (Acellular dermal matrix (ADM), Xenogeneic collagen matrix (XCM). The outcome variables were buccal tissue thickness (BTT), mid-buccal gingival level (MGL), marginal bone loss (MBL), and pink esthetic scores (PES). Cumulative mean differences (MD) and 95% confidence interval (CI) were estimated., Results: Twelve studies were included. SCTG along with immediate implant placement (IIP) or delayed implant placement (DIP) showed a statistically significant improvement in BTT (Fixed; MD, 0.74; 95% CI, 0.51; 0.97), MGL (Fixed; MD, 0.5; 95% CI, 0.21; 0.80), PES (Fixed; MD, 0.79; 95% CI, 0.29; 1.29), and less MBL (Fixed; MD, -0.11; 95% CI, -0.14; -0.08) compared to no graft (P<0.05). A statistically insignificant differences in BTT (Random; MD, 0.62; 95% CI, -0.41; 1.65), MGL (Fixed; MD, -0.06; 95% CI, -0.23; 0.11), MBL (Fixed; MD, 0.36; 95% CI, -0.05; 0.77) and PES (Fixed; MD, 0.28; 95% CI, -0.10; 0.67) was observed when SCTG along with DIP was compared with no augmentation plus GBR. Similarly, no statistically significant difference was observed when comparing SCTG along with DIP with acellular dermal matrix (ADM) concerning BTT (MD:0.71, P = 0.18) and KMW (MD: 0.6, P = 0.19)., Conclusion: There is a very low quality of evidence to provide recommendations on whether simultaneous dental implant placement (IIP or DIP) and soft tissue augmentation using SCTG is superior to no augmentation or is comparable to the other tissue augmentation materials in improving the quality and quantity of peri-implant tissues. Therefore, further, well-designed RCTs with larger sample sizes and long follow-up times are still needed., Competing Interests: The authors reported no conflicts of interest related to this study.

The purpose of this study is to examine the awareness and perception of malaria and dengue fever in Multan Punjab, Pakistan while taking into account the important role of government policies and other variables. The goal of this study is to examine the awareness of students in Multan, Pakistan on malaria and dengue. This study is based on a quantitative approach of secondary evidence from scientific journals and questionnaire surveys. It is also based on observational evidence gathered in Multan Punjab Pakistan, in a field study. The survey with school children, teachers and healthcare professionals were both formal and semi-structuralize. Studies have found that malaria and dengue mainly affect children's schooling through their absence, but can also induce brain loss and cognitive disability. In questionnaires, students were seen to have different understanding of the illness, but also to be able to serve as agents of health reform only through teachers. A sample size of 500 respondents has been selected from different colleges of district Multan Punjab, Pakistan. Correlation technique is used for the data analysis. According to our results it is concluded that the students at college level are aware of malaria and dengue diseases, but they are not capable of engaging and serving as agents for health reform. On the basis of results it is recommended that students must teach about epidemics diseases regarding how to handle these diseases., Competing Interests: The authors have declared that no competing interests exist.

Background: Chronic kidney disease (CKD) is the severest form of kidney disease characterized by poor filtration. The magnitude of chronic kidney disease is trending upward in the last few years linked with the rapidly escalating cases of non-communicable chronic diseases, particularly diabetes mellitus. However, little is known about when this problem may occur, the incidence as well as predictors of chronic kidney disease among type-II diabetes mellitus patients. Thus, this study was conducted to determine the incidence, time to the occurrence, and predictors of chronic kidney disease in type-II diabetic patients attending the Amhara region referral hospitals, Ethiopia., Methods: A retrospective follow-up study was conducted involving 415 participants with type-II diabetes mellitus that enrolled in the chronic follow-up from 2012 to 2017. Multivariable shared Frailty Weibull (Gamma) survival model was employed considering the hospitals as a clustering variable. Model fitness was checked by both the Akaike information criteria (AIC) and log-likelihood. Factors having a p-value of ≤0.2 in the bi-variable analysis were considered to enter the multivariable model. Variables that had a p-value of <0.05 with its corresponding 95% confidence level were deemed to be significant predictors of chronic kidney disease., Results: The overall cumulative incidence of chronic kidney disease was 10.8% [95%; CI: 7.7-14.0%] with a median occurrence time of 5 years. The annual incidence rate was 193/10,000 [95%; CI: 144.28-258.78]. Having cardiovascular disease/s [AHR = 3.82; 95%CI: 1.4470-10.1023] and hypercholesterolemia [AHR = 3.31; 95% CI: 1.3323-8.2703] were predictors of chronic kidney disease., Conclusion: One out of every ten diabetic patients experienced chronic kidney disease. The median time to develop chronic kidney disease was five years. Hypercholesterolemia and cardiovascular diseases have escalated the hazard of developing CKD. Thus, health promotion and education of diabetic patients to optimize cholesterol levels and prevent cardiovascular disease is recommended to limit the occurrence of this life-threatening disease., Competing Interests: The authors have declared that no competing interests exist.

Gossypium hirsutum L. is also called upland cotton or Mexican cotton. It is the most widely cultivated species of cotton in the whole world. Globally, about 90% of all cotton production comes from the cultivars derived from this species. Some genetic parameters like monopodial branches per plant, sympodial branches per plant, sympodial branch length, bolls per plant, boll weight, sympo-boll distance, Ginning Out Turn%, staple length (rg = 0.9199**), and fiber strength along with seed cotton yield were evaluated for their potential utilization via selection in seed cotton yield improvement. Significant positive genetic correlations were estimated for monopodial branches per plant (rg = 0.9722**), sympodial branches per plant (rg = 0.7098**), sympodial branch length (rg = 0.617**), bolls per plant (rg = 0.8271**), boll weight (rg = 0.8065**), sympo-boll distance (rg = 0.6507**), Ginning Out Turn (GOT)% (rg = 0.7541**), staple length (rg = 0.9199**), and fiber strength (rg = 0.7534**) with seed cotton yield. A path analysis of all the yield traits under study revealed strong positive direct effects of monopodial branch length (1.1556), sympo-boll distance (0.8173) and staple length (0.7633), while plant height exerted a highly strong direct negative effect (-1.2096) on yield. It is concluded that a direct selection based on monopodial branch length and sympo-boll distance, and staple length is effective, whereas, monopodial branch length, and sympodial branch length are good selection indicators via bolls per plant for yield improvement in cotton., Competing Interests: The authors have declared that no competing interests exist.

Peristalsis, the coordinated contraction-relaxation of the muscles of the stomach is important for normal gastric motility and is impaired in motility disorders. Coordinated electrical depolarizations that originate and propagate within a network of interconnected layers of interstitial cells of Cajal (ICC) and smooth muscle (SM) cells of the stomach wall as a slow-wave, underly peristalsis. Normally, the gastric slow-wave oscillates with a single period and uniform rostrocaudal lag, exhibiting network entrainment. Understanding of the integrative role of neurotransmission and intercellular coupling in the propagation of an entrained gastric slow-wave, important for understanding motility disorders, however, remains incomplete. Using a computational framework constituted of a novel gastric motility network (GMN) model we address the hypothesis that engaging biological oscillators (i.e., ICCs) by constitutive gap junction coupling mechanisms and enteric neural innervation activated signals can confer a robust entrained gastric slow-wave. We demonstrate that while a decreasing enteric neural innervation gradient that modulates the intracellular IP3 concentration in the ICCs can guide the aboral slow-wave propagation essential for peristalsis, engaging ICCs by recruiting the exchange of second messengers (inositol trisphosphate (IP3) and Ca2+) ensures a robust entrained longitudinal slow-wave, even in the presence of biological variability in electrical coupling strengths. Our GMN with the distinct intercellular coupling in conjunction with the intracellular feedback pathways and a rostrocaudal enteric neural innervation gradient allows gastric slow waves to oscillate with a moderate range of frequencies and to propagate with a broad range of velocities, thus preventing decoupling observed in motility disorders. Overall, the findings provide a mechanistic explanation for the emergence of decoupled slow waves associated with motility impairments of the stomach, offer directions for future experiments and theoretical work, and can potentially aid in the design of new interventional pharmacological and neuromodulation device treatments for addressing gastric motility disorders., Competing Interests: The authors have declared that no competing interests exist.

This study has aimed to investigate the impact of sustainable project management on sustainable project planning and success in manufacturing firms. Data was collected from project management professionals in a manufacturing firm in Malaysia. A total of 231 responses were analyzed using the partial least square (PLS) method. The findings revealed that sustainable project management has a significant impact on sustainable project success and sustainable project planning. Sustainable project planning is positively correlated with sustainable project success. The results also indicated that sustainable project planning mediates the effect of sustainable project management on sustainable project success. The findings have significant insight into the body of knowledge of the project life cycle and indicated that sustainable project planning is a crucial tool attributed to project management towards the project success of the manufacturing firm. The results can be used as a guideline for organizations, providing direction in project management to achieve sustainable development for business., Competing Interests: The authors have declared that no competing interests exist.

Background: Despite the interdependence of general and periodontal health, there is paucity of national representative data on the prevalence of periodontal diseases and their associated risk factors in Egyptian population. This cross-sectional study, thus, aimed to assess the prevalence of periodontitis and tooth loss among Egyptian adults and investigate the association between potential risk factors and periodontal diseases., Methods: A total of 5,954 adults aged ≥ 20 years were included in this study as a subsample from Egypt's national oral health survey. Periodontitis was diagnosed with Community Periodontal Index 'CPI' scores ≥3 and tooth loss not due to caries was included in the analysis. Socio-demographic data and information on behavioral factors and history of diabetes were gathered in a face-to-face interview. Logistic regression was done to interpret the impact of potential predictors on the incidence of the two selected outcome variables., Results: The overall prevalence of periodontitis was 26% and regression analysis revealed that higher odds of periodontitis existed among illiterate participants (OR = 1.74; 95% CI: 1.40-2.17), smokers (OR = 1.93; 95% CI: 1.69-2.20) and rural residents (OR = 1.16; 95% CI: 1.03-1.30). On the other hand, old age, frequency of dental attendance and history of diabetes were the main predictive factors for tooth loss., Conclusions: Among Egyptian adults, periodontal diseases were strongly associated with a multitude of modifiable and non-modifiable risk factors and inequalities in distribution of periodontal treatment needs were determined mainly by age, gender, level of education and residency location., Competing Interests: On behalf of all authors I declare that we have no conflicts of interest to disclose. I also declare that the commercial affiliation at PennyPot Dental practice Ltd.of one of the authors does not alter our adherence to PLOS ONE policies on sharing data and materials.” The author started working there 3 years after survey completion.

Objective: An evidence regarding which bony flap for reconstruction of mandibular defects following tumour resection is associated with the highest survival rate is still lacking. This network meta-analysis (NMA) aimed to guide surgeons selecting which vascularized osseous flap is associated with the highest survival rate for mandibular reconstruction., Methods: From inception to March 2021, PubMed, Embase, Scopus, and Cochrane library were searched to identify the eligible studies. The outcome variable was the flap survival rate. The Bayesian NMA accompanied by a random effect model and 95% credible intervals (CrI) was calculated., Results: Twenty-two studies with a total of 1513 patients, comparing four osseous flaps namely fibula free flap (FFF), deep circumferential iliac artery flap (DCIA), scapula flap, and osteocutaneous radial forearm flap (ORFF) were included. The respective survival rates of FFF, DCIA, Scapula, and ORFF were 94.50%, 93.12%, 97%, and 95.95%. The NMA failed to show a statistically significant difference between all comparators (FFF versus DCIA (Odd ratio, 1.8; CrI, 0.58,5.0); FFF versus ORFF (Odd ratio, 0.57; CrI, 0.077; 2.9); FFF versus scapula flap (Odd ratio, 0.25; CrI, 0.026; 1.5); DCIA versus ORFF (Odd ratio, 0.32; CrI, 0.037; 2.1); DCIA versus scapula flap (Odd ratio, 0.14; CrI, 0.015; 1.1) and ORFF versus scapula flap (Odd ratio, 2.3; CrI, 0.16; 34))., Conclusion: Within the limitations of the current NMA, FFF, DCIA, Scapula, and ORFF showed a comparable survival rate for mandibular reconstruction. Although the scapula flap reported the highest survival rate compared to other osseous flaps for mandibular reconstruction; however, the decision making when choosing an osseous flap should be based on many factors rather than simply flap survival rate., Competing Interests: The authors reported no conflicts of interest related to this study.

Introduction: Armed conflicts result in greater vulnerability and socioeconomic inequality of populations besides risking their health and well-being. Conflict intensifies the health needs and risks the life and well-being of individuals at large through displacement. Therefore, our study aims to apprise the interventions to which children under-five living in Jordan are especially at risk for acute respiratory infections, diarrhea, and fever in the conflict circumstances., Materials and Methods: Secondary data analysis is used in the present study. We used a weighted sample of around 9650 children from Jordan Population and Family Health Survey (JPFHS), 2017-18. Bivariate analysis including prevalence rates were used to examine the distribution of socio-demographic characteristics of children. The study has also used multinomial logistic regression model, in order to evaluate the variations in the probability of nationality of under-five children living in Jordan., Results: "Syrian nationalist" children have a higher relative risk of ARI (RRR = 1.19, [1.08, 1.32]), and "Other-nationalist" children have two times greater risk of ARI compared to "Jordanian children." The relative risk of diarrhea is lower among "Syrian nationalist" and "Other-nationalist" children compared to "Jordanian children." Children belong "Other-nationalist" are found to be less relative risk of fever (RRR = 0.9, [0.80, 1.01]) than "Jordanian children.", Conclusions: Our study concludes that conflict-driven displacement has an immediate effect on child health through access, availability, and affordability of health care services, resulting in more significant health care risks. However, sufficient investment is required to address such adversities that affect the health care system due to uneven demand as experienced by the Jordanian health care system. Thus, collaborative efforts through global partners can play a significant role in the countries facing the challenges of managing these health care emergencies., Competing Interests: The authors have declared that no competing interests exist.

This study aims to explore the impact of the Covid-19 pandemic on tourists' travel risk and management perceptions. Driven on the effect of the pandemic, we investigate tourists' travel risk and management perceptions and its effect on society using a sample of 716 respondents. The data was collected through social media platforms using a representative sampling method and analyzed applying the PLS-SEM tool. The findings reveal that Covid-19 pandemic has greatly affected travel risk and management perceptions. Travel risk and management perception had a significant association with risk management, service delivery, transportation patterns, distribution channels, avoidance of overpopulated destinations, and hygiene and safety. The results also identified the mediating effect of travel risk and management perceptions. The finding of this study contributes to tourism crises and provides future research insights in the travel and tourism sector and response to change tourists' travel risk and management perceptions in the post-covid recovery period., Competing Interests: The authors have declared that no competing interests exist.

Background: The hematological abnormalities are assumed to be involved in the disease progression of COVID-19. However, the actual associations between specific blood parameters and COVID-19 are not well understood. Here we aimed to assess the correlations between hematological parameters and the severity of COVID-19., Methods: We included COVID-19 patients who were admitted to Evercare Hospital Ltd, Dhaka, Bangladesh, between November 10, 2020, to April 12, 2021, with a confirmed case of RT-PCR test. We recorded demographic information, clinical data, and routine hematological examination results of all COVID-19 patients. We performed statistical analyses and interpretation of data to compare severe COVID-19 patients (SCP) and non-severe COVID-19 patients (NSCP)., Results: The age and BMI of the admitted COVID-19 patients were 48.79±8.53 years and 25.82±3.75 kg/m2. This study included a total of 306 hospitalized COVID-19 patients. Among them, NSCP and SCP were 198 and 108, respectively. And we recorded 12 deaths from SCP. We observed the alterations of several hematological parameters between SCP and NSCP. Among them, we noticed the increased levels of C-reactive protein (CRP), d-dimer, and ferritin showed good indicative value to evaluate the severity of COVID-19. Also, there were positive correlations among these parameters. Moreover, we found correlations between the outcomes of COVID-19 patients with patient's demographics and comorbid diseases., Conclusion: Based on our results, CRP, d-dimer, and ferritin levels at admission to hospitals represent simple assessment factors for COVID-19 severity and the treatment decisions at the hospital setup. These blood parameters could serve as indicators for the prognosis and severity of COVID-19. Therefore, our study findings might help to develop a treatment protocol for COVID-19 patients at the hospital setup., Competing Interests: The authors have declared that no competing interests exist.

Context: Patients on maintenance dialysis are more susceptible to COVID-19 and its severe form. We studied the mortality and associated risks of COVID-19 infection in dialysis patients in the state of Qatar., Methods: This was an observational, analytical, retrospective, nationwide study. We included all adult patients on maintenance dialysis therapy who tested positive for COVID-19 (PCR assay of the nasopharyngeal swab) during the period from February 1, 2020, to July 19, 2020. Our primary outcome was to study the mortality of COVID-19 in dialysis patients in Qatar and risk factors associated with it. Our secondary objectives were to study incidence and severity of COVID-19 in dialysis patients and comparing outcomes between hemodialysis and peritoneal dialysis patients. Patient demographics and clinical features were collected from a national electronic medical record. Univariate Cox regression analysis was performed to evaluate potential risk factors for mortality in our cohort., Results: 76 out of 1064 dialysis patients were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). During the study period, 7.1% of all dialysis patients contracted COVID-19. Male dialysis patients had double the incidence of COVID-19 than females (9% versus 4.5% respectively; p<0.01). The most common symptoms on presentation were fever (57.9%), cough (56.6%), and shortness of breath (25%). Pneumonia was diagnosed in 72% of dialysis patients with COVID-19. High severity manifested as 25% of patients requiring admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes. The mean length of hospital stay was 19.2 ± -12 days. Mortality due to COVID-19 among our dialysis cohort was 15%. Univariate Cox regression analysis for risk factors associated with COVID-19-related death in dialysis patients showed significant increases in risks with age (OR 1.077, CI 95%(1.018-1.139), p = 0.01), CHF and COPD (both same OR 8.974, CI 95% (1.039-77.5), p = 0.046), history of DVT (OR 5.762, CI 95% (1.227-27.057), p = 0.026), Atrial fibrillation (OR 7.285, CI 95%(2.029-26.150), p = 0.002), hypoxia (OR: 16.6; CI 95%(3.574-77.715), p = <0.001), ICU admission (HR30.8, CI 95% (3.9-241.2), p = 0.001), Mechanical ventilation (HR 50.07 CI 95% (6.4-391.2)), p<0.001) and using inotropes(HR 19.17, CI 95% (11.57-718.5), p<0.001). In a multivariate analysis, only ICU admission was found to be significantly associated with death [OR = 32.8 (3.5-305.4), p = 0.002)]., Conclusion: This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high incidence of COVID-19 infection and related mortality compared to previous reports of the general population in the state of Qatar (7.1% versus 4% and 15% versus 0.15% respectively). We also observed a strong association between death related to COVID-19 infection in dialysis patients and admission to ICU., Competing Interests: All authors have declared that no competing interests exist.

Background: Pakistan's National AIDS Control Program has registered 44,000 HIV/AIDS patients to date, but the actual number of cases have been estimated to be as high as 150,000-170,000. The health care system has a very important role to play in this equation and must be reformed to improve the health care services in Pakistan, with regards to HIV/AIDS., Methods: It was a qualitative research employing a phenomenological approach. The principal researcher visited nine public and private health care facilities and conducted 19 key informant interviews with people working for providing preventive and curative services, in addition to the observations made on the site., Results: Pakistan's health system has a limited capacity to address the HIV spread in the country, with its current resources. There is an obvious scarcity of resources at the preventive, diagnostic and curative level. However, menace can be curtailed through measures taken at the service delivery level by checking the unsafe needles practices, unclean surgical procedures and an unregulated and untrained private health workforce which are dangerous potentials routes of transmission of the virus to the general population. Healthcare establishments carry the chances of nosocomial infections including HIV/AIDS. Poverty, illiteracy and stigma associated with the disease is compounding the overall situation., Conclusion: Improved accessibility to service delivery with a greater focus on prevention would be imperative to address the threat of HIV/AIDS in Pakistan. A health systems approach would help in identifying gaps at both strategic and operational levels, and concurrently find and implement solutions., Competing Interests: The authors have declared that no competing interests exist.

Geminiviruses are insect-transmissible, economically vital group of plant viruses, which cause significant losses to crop production and ornamental plants across the world. During this study, infectious clones of three devastating begomoviruses, i.e., Cotton leaf curl Multan virus (CLCuMuV), Ramie mosaic virus (RamV) and Corchorus yellow vein Vietnam virus (CoYVV) were constructed by following novel protocol. All infectious clones were confirmed by cloning and sequencing. All of the infectious clones were agro-inoculated in Agrobacterium. After the agro-infiltrations, all clones were injected into Nicotiana benthamiana and jute plants under controlled condition. After 28 days of inoculation, plants exhibited typical symptoms of their corresponding viruses. All the symptomatic and asymptomatic leaves were collected from inoculated plants for further analysis. The southern blot analysis was used to confirm the infection of studied begomoviruses. At the end, all the products were sequenced and analyzed., Competing Interests: The authors have declared that no competing interests exist.

The Coronavirus Disease 2019 (COVID-19) pandemic has been posing a substantial challenge to human survival and well-being, which rely on the actions and behaviors of individuals. It is essential that accurate information is distributed; however, misinformation has been spread via social media. Consequently, the resulting panic has to be addressed while putting essential public health measures in place. It is also important to explore the link between the social media exposure and well-being. Therefore, in the current study, we aimed to identify the levels of anxiety, depression, and social isolation among individuals during the COVID-19 pandemic. Additionally, we explored the relationship between exposure to misleading social media news and anxiety, depression, and social isolation. A cross sectional design was employed to collect data from 371 Saudi participants (aged 16-60 years), using the Generalized Anxiety Disorder-7, Centre for Epidemiological Studies Depression Scale, and de Jong Gierveld Loneliness Scale. Results showed that the prevalence of anxiety, depression, and social isolation was 47.82%, 47.57%, and 46.42%, respectively. Further, more than 83% of the participants reported using social media frequently during the pandemic. We found that exposure to misinformation via social media has a significant positive relationship with anxiety, depression, and social isolation. However, Due to the cross-sectional nature of this study it cannot be determined whether social media causes negative mental health outcomes, or if individuals experiencing greater depression, anxiety and social isolation turn to social media more than others, or if some third variable might explain both. Based on our findings, we present specific suggestions related to the COVID-19 pandemic to the government of Saudi Arabia. Minoring and filtering out misleading information with the cooperation of the World Health Organization (WHO) can promote the spread of accurate news in Saudi Arabia., Competing Interests: The authors have declared that no competing interests exist.

Background: Western dietary habits, coupled with a sedentary lifestyle, are potential contributors to the prevalence and rapid increase in the incidence of obesity in Saudi Arabia. This study aimed to investigate the association between students' weight status and their eating behaviors and practices. Another aim was to assess students' awareness of the health risks associated with obesity., Methods: A cross-sectional survey was conducted among a sample of 416 (53% male and 47% female) undergraduate students, aged 18-26 years old, between January 6 and April 6, 2019, from colleges of Health Sciences at Jazan University in the Kingdom of Saudi Arabia (K.S.A). Students completed a self-administered questionnaire and recorded their measured anthropometric parameters., Results: The prevalence of overweight (20.4%) and obesity (14.9%) were relatively high among the participants. There were statistically significant associations between Body Mass Index (BMI) and the different settings of food consumption (i.e., dining on a table (or) in the Islamic way: squatting on the ground) (p<0.001)). BMI was also associated with students' dietary habits regarding consuming food, snacks, and drinking carbonated beverages while watching television (p<0.001), as well as consuming the same pattern of food/drink while watching television, playing video games on mobile phones or computers (p<0.001). Nearly most of the students were oblivious to the fact that metabolic syndrome, reproductive disorders, respiratory disorders along with liver and gallbladder diseases are some of the health risks associated with obesity., Conclusion: The prevalence of obesity and overweight were reasonably high in our study sample and were affected by several factors related to students' eating behaviors and practices. This warrants the need for rigorous and frequent health education interventions on healthy eating behaviors, dietary practices, with an emphasis on the importance of adopting an active, healthy lifestyle., Competing Interests: The authors have declared that no competing interests exist.

Background: Antibiotics are regularly prescribed by dental professionals in their practice, for the purpose of dental treatment as well as for the prevention of infection. The inappropriate use of antibiotics is a significant factor in the rise of antibiotic resistance. There is an immediate need for the advancement of prescribing guidelines and instructive polices to encourage the rational and appropriate utilization of medications especially antibiotics in dentistry., Objective: The aim of this study was to identify the frequency of antibiotic prescription for treating dental infections in children among dentists in teaching institutions of Karachi, Pakistan and whether they are adhering to the prescribed international guidelines., Methods: A cross-sectional study was conducted in three private and two public colleges of Karachi. After taking written informed consent and checking the inclusion criteria, a total of 380 participants were interviewed using a pre-designed validated questionnaire which included demographic profile and clinical case scenarios. Data were entered and analyzed on SPSS version 20. Inferential analysis was performed using chi-square test. The significance level was set at 0.05., Results: Of the 380 subjects, a majority (71.3%) treated 15 or less children per month (n = 271) while 28.7% of dentists (n = 109) treated more than 15 children per month. Overall adherence to American Academy of Pediatric Dentistry guidelines was low from 26.1% to 44.2%. The difference between adherence of dentists with low and high volume of pediatric patients was significantly different for case scenarios 1, 3, 4 and 5 (p<0.001 for all) where dentists who treated 15 or less children per month were more likely to be adherent to standard antibiotic prescription guidelines than those who treated more than 15 children per month., Conclusions: This study shows that majority of dentists, particularly dentists with high volume of pediatric patients lacked adherence to professional guidelines for prescribing antibiotics for treating dental infection in children. There seem to be a lack of harmony between the recommended professional guidelines and the antibiotic prescribing pattern of dentists. Regular updates and continuing medical education for the health professionals regarding comprehensible and specific professional guidelines may lead to improved adherence of antibiotics prescription amongst dentists., Competing Interests: No competing interests.

Background: Breast cancer is the fifth most prevalent cause of death among women worldwide. It is also one of the most common types of cancer among Malaysian women. This study aimed to characterize and differentiate the proteomics profiles of different stages of breast cancer and its matched adjacent normal tissues in Malaysian breast cancer patients. Also, this study aimed to construct a pertinent protein pathway involved in each stage of cancer., Methods: In total, 80 samples of tumor and matched adjacent normal tissues were collected from breast cancer patients at Seberang Jaya Hospital (SJH) and Kepala Batas Hospital (KBH), both in Penang, Malaysia. The protein expression profiles of breast cancer and normal tissues were mapped by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The Gel-Eluted Liquid Fractionation Entrapment Electrophoresis (GELFREE) Technology System was used for the separation and fractionation of extracted proteins, which also were analyzed to maximize protein detection. The protein fractions were then analyzed by tandem mass spectrometry (LC-MS/MS) analysis using LC/MS LTQ-Orbitrap Fusion and Elite. This study identified the proteins contained within the tissue samples using de novo sequencing and database matching via PEAKS software. We performed two different pathway analyses, DAVID and STRING, in the sets of proteins from stage 2 and stage 3 breast cancer samples. The lists of molecules were generated by the REACTOME-FI plugin, part of the CYTOSCAPE tool, and linker nodes were added in order to generate a connected network. Then, pathway enrichment was obtained, and a graphical model was created to depict the participation of the input proteins as well as the linker nodes., Results: This study identified 12 proteins that were detected in stage 2 tumor tissues, and 17 proteins that were detected in stage 3 tumor tissues, related to their normal counterparts. It also identified some proteins that were present in stage 2 but not stage 3 and vice versa. Based on these results, this study clarified unique proteins pathways involved in carcinogenesis within stage 2 and stage 3 breast cancers., Conclusions: This study provided some useful insights about the proteins associated with breast cancer carcinogenesis and could establish an important foundation for future cancer-related discoveries using differential proteomics profiling. Beyond protein identification, this study considered the interaction, function, network, signaling pathway, and protein pathway involved in each profile. These results suggest that knowledge of protein expression, especially in stage 2 and stage 3 breast cancer, can provide important clues that may enable the discovery of novel biomarkers in carcinogenesis., Competing Interests: The authors have declared that no competing interests exist.

Human infections due to the monkey malaria parasite Plasmodium knowlesi are increasingly being reported from Malaysia. The parasite causes high parasitaemia, severe and fatal malaria in humans thus there is a need for urgent measures for its control. The MSP4 is a potential vaccine candidate, which is well studied in Plasmodium falciparum and Plasmodium vivax; however, no study has been conducted in the orthologous gene of P. knowlesi. In this study, we investigated the level of polymorphisms, haplotypes, natural selection and population structure of full-length pkmsp4 in 32 clinical samples from Malaysian Borneo along with 4 lab-adapted strains. We found low levels of polymorphism across the gene with exon I showing higher diversity than the exon II. The C- terminal epidermal growth factor (EGF) domains and GPI-anchored region within exon II were mostly conserved with only 2 non-synonymous substitutions. Although 21 amino acid haplotypes were found, the frequency of mutation at the majority of the polymorphic positions was low. We found evidence of negative selection at the exon II of the gene indicating existence of functional constraints. Phylogenetic haplotype network analysis identified shared haplotypes and indicated geographical clustering of samples originating from Peninsular Malaysia and Malaysian Borneo. High population differentiation values were observed within parasite populations originating from Malaysian Borneo (Kapit, Sarikei and Betong) and laboratory-adapted strains obtained from Peninsular Malaysia and Philippines indicating distinct population structure. This is the first study to genetically characterize the full-length msp4 gene from clinical isolates of P. knowlesi from Malaysia and thus would be very useful for future rational vaccine studies. Further studies with higher number of samples and functional characterization of the protein will be necessary., Competing Interests: The authors have declared that no competing interests exist.