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Introduction: Soft tissue defects around the ankle and posterior heel need stable flap coverage for proper healing and satisfactory recovery of function. Constant and reliable vascular supply of reverse sural island flap (RSIF) have made it a popular choice for reconstruction of these defects. In this study, the outcome of RSIF with few modifications in the pedicle area were discussed. Methods: This prospective study was carried out in National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka duing April 2019 to June 2020. Total 31 patients with soft tissue defect around ankle and posterior heel were reconstructed with reverse sural artery island flap. The soft-tissue defects were located, infront of ankle in 3 cases, over lateral malleolus in 7 cases, over medial malleolus in 5 cases, over tendoachilles in 12 cases, involving two or more areas of posterior heel, tendoachilles and lateral malleolus in 4 cases. Average Flap length and width were 9.67(+1.60) cm & 6.38(+0.76) cm respectively. Pedicle area of flap was modified by including a 2 cm skin extension in the middle along with additional adipofascial tissue on both sides to improve venous return. Pedicle length to width ratio was maximum of 3:1. Average length of pedicle was 7.2 + 1.7 cm. Results: All flaps except three survived completely without any complications. One patient (3%) had partial necrosis and another one (3%) had marginal necrosis of flap due to venous congestion. Epidermolysis was observed in 3% cases. Conclusions: The distally based superficial sural artery island flap is a versatile, reliable procedure useful in reconstruction of the lower extremity. Modifying the design of pedicle area increases safety by reducing venous congestion which ultimately leads to increase flap survivability. [ABSTRACT FROM AUTHOR]

Using first-principles calculations based on density functional theory, this work investigated the mechanical, magnetic, elastic, electrical, and optical characteristics of the halide-based perovskite FrGeX3 (X = Cl, Br, I) at different hydrostatic pressures ranging from 0 to 9 GPa. It was determined that the compound FrGeX3 (X = Cl, Br, I) is stable and ductile in nature by calculating its thermodynamic and mechanical stability using the parameters of its formation enthalpy and elastic constant. When no hydrostatic pressure is applied, the band computations reveal that FrGeCl3, FrGeBr3, and FrGeI3 all remain in the semiconductor region with bandgaps of 1.14, 0.8, and 0.645 eV, respectively. The study examined how increasing induced pressure affects the bandgap and density of states of the structure for all three halides. The bandgap of FrGeCl3, FrGeBr3, and FrGeI3 fell to 0 eV at 9, 6, and 5 GPa, respectively. In addition, the optical absorption, reflectivity, refractive index, and imaginary and real components of dielectric functions were all studied in detail for cubic perovskites FrGeX3 (X = Cl, Br, I) under varying hydrostatic pressures, from 0 to 9 GPa. Due to increased pressure, the compound transitioned into a conductor and improved its absorption capabilities for all compounds within the 8–14 eV range, making it suitable for use in the UV spectrum. Cl has the largest absorption among all compounds, whereas I displays the lowest. Reflectivity ranges from around 14% to 18% for all compounds and increases w%ith pressure. The actual component of the refractive index ranges from around 2.25 to 2.7 at 0 eV and increases with pressure. Chlorine has a low refractive index, whereas iodine demonstrates the greatest. The highest fluctuation is shown for Br. The dielectric characteristics vary from around 5 to 7.5 F/m. Chlorine (Cl) has the least charge storage capacity, while iodine (I) demonstrates the most, of which both increase with pressure in all compounds. Structure FrGeX3 (X = Cl, Br, I) is hardened and made more ductile by applying hydrostatic pressure, as seen by the increasing bulk, Young's, and shear modulus values, as well as the elastic constants (C11 and C12). While the electrons were in a co-linear position, the magnetic property was also studied by optimizing the band structure and density of states. The diamagnetic property of the combination FrGeX3 (where X = Cl, Br, I) remained unchanged even when subjected to increased pressure. According to the findings, this perovskite material has remarkable absorption properties, which point to a change in its behavior from semiconductor to metal. Their potential uses in solar cells, UV absorbers, and optoelectronic devices are highlighted by these computational results. [ABSTRACT FROM AUTHOR]

The present experiment was conducted from November 2020 to March 2021 at Sher-e-Bangla Agricultural University's Horticulture Farm in Dhaka, Bangladesh. The investigation included four levels of vermicompost (T0 = control, T1=3 t.ha-1, T2=6 t.ha-1 and T3=9 t.ha-1) and biofertilizer (F0=control, F1=3 kg.ha-1, F2=5 kg.ha-1 and F3=7 kg.ha-1) which was carried out by factorial randomized complete block design with three replications. The broccoli variety 'Green Carpet' was used as planting material. The application of the treatment T3F3 (vermicompost at 9 t.ha-1 and biofertilizer at 7 kg.ha-1) resulted in the highest plant height (67.85 cm), number of leaves per plant (22.76), leaf length (60.57 cm), leaf breadth (23.23 cm) and chlorophyll (SPAD index) (54.90). However, statistically similar results were also observed for T2F3 in most cases (vermicompost at 6 t.ha-1 and biofertilizer at 7 kg.ha-1). The maximum stem diameter (4.98 cm) was recorded in T2F3. Fewest days to achieve 100% curd initiation (54 days), maximum curd diameter (13.19 cm), yield (15.84 t.ha-1) and vitamin C (64.34 mg 100 g-1) content were recorded in T3F3. With the exception of the fewer days required to initiate curd formation, all other parameters were statistically similar to those observed in the T2F3 treatment combination. [ABSTRACT FROM AUTHOR]

Recently, an approximation technique was presented for solving strong nonlinear oscillators modeled by second-order differential equations. Due to the arising of an algebraic complicity, the method fails to determine suitable solution of some important nonlinear problems such as quadratic oscillator, cubical Duffing oscillator of softening springs, and pendulum equation. However, suitable solutions of these oscillators are found by rearranging only an algebraic equation related to amplitude and frequency. The determination of solutions is simpler than the original version. [ABSTRACT FROM AUTHOR]

This work investigated the morphology of the root canal system of the mandibular first molar in a Malaysian subpopulation. Using micro-computed tomography with an isotropic resolution of 22 mm, 140 mandibular first molars were scanned. MIMICS software was used for segmentation, 3-D reconstruction and analysis of the acquired images. The canal configuration was described using Vertucci [supported by the supplementary configurations proposed by Sert & Bayirli (2004)] and Ahmed et al. (2027), coding systems. The chi-square test was used to assess the association between qualitative variables. By non-considering intercanal communications, Vertucci types IV (17.1%) and I (76.4%) were the most frequently reported configurations in the mesial and distal roots, respectively. Of the reported configurations, 24.3% and 4.3% were non-classifiable by Vertucci system in the mesial and distal roots, respectively. Up to 63.6% and 9.3% of the reported configurations were non-classifiable, and type I was the most frequent when considering intercanal communications (7.1% and 76.4% in the mesial and distal roots, respectively). According to Ahmed et al., system, almost half of the sample had more than four digits (47.9%), followed by the 3-digits category (20.71%). In both systems, a significant association was found between the canal configuration and the root type (p<0.001). The mandibular first molar of this Malaysian subpopulation demonstrated a wide range of root canal morphology. When compared to the Vertucci system, the system developed by Ahmed et al., successfully classified all molars configurations despite their level of complexity. The complex canal anatomy of mandibular first molars in this subpopulation warrants special attention during root canal treatment procedures. [ABSTRACT FROM AUTHOR]

Foot-and-mouth disease (FMD) is a devastating viral infection of cloven-hoofed animals. The disease turned into an endemic in Bangladesh causing prodigious impairment to the nation's economy and livestock population. For further usage, developing a detailed summary of the disease condition in Bangladesh is imperative. Hence, this study identified the prevalence of FMD among cattle populations accompanying by potential risk factors and climatic variables. Using the Jamvoi 1.2.27 software, the authors analysed 30 studies for estimating the random model effect function. Based on the meta-analysis, the overall pooled prevalence of FMD was 25% (95% confidence interval [CI]: 15-35%). The research professed a significant difference between the prevalence rate of males (33%, CI: 22-45%) and females (26%, CI: 14-39%). Moreover, the study reported a noteworthy line of the tendency for the increasing rate of prevalence in adult and old animals than in young individuals. Furthermore, the results showed high prevalence rates in dry season compared to wet season. Thus, this study will permit the government to implement an immediate control program. Moreover, each data gathered will help the prevention of FMD. [ABSTRACT FROM AUTHOR]

In this research, some new 1,2,3-triazole derivatives of dapsone, have been prepared. The first step includes the preparation of Azo derivative by reaction of dapsone with the 4-Aminoacetophenone to produce azo compounds (A), then, the amino group of dapsone is converted to a diazonium salt and reacted with sodium azide to obtain the compound (B) Then, Chalcones (D1-D3); has been prepared through the reaction of an aromatic ketone with different aldehydes. The second step involves the reaction of chalcones derivatives (D1-D3) with compound (B) in the presence of copper (I) to obtain a 1,2,3-triazoline compound (H5 - H7). Different spectroscopy methods, such as FT-IR, ¹H-NMR, and 13C-NMR, were used to identify synthesized compounds. The potential antibacterial activity of the synthesized heterocyclic derivatives has been finally tested as a third stage, using two types of bacteria (Staphylococcus aureus and Escherichia coli). [ABSTRACT FROM AUTHOR]

A novel, sensitive, economical, and environmentally friendly method is described for the quantitative determination of diphenhydramine hydrochloride (DPH). The method is based on the preparation of silver nanoparticles (AgNPs) from the extract of Capparis spinosa L. (CPL) fruits to determine DPH as one of the antihistamine drugs. The colour intensity of the solution increases with increasing DPH concentrations due to the interaction of AgNPs with DPH. FTIR, X-ray, EDX, SEM, and UV-Vis techniques characterised the prepared nanoparticles. The current method presented a linear relationship over the concentration range of 2–45 µg/mL at a wavelength of 415 nm. The detection limit (LOD) and quantitation limit(LOQ) are studied, and the values ​​are 0.36 and 1.19 µg/mL, respectively. The recovery percentage (accuracy function) is more than 99.5%, and the relative standard deviation (RSD%, as a precision function) was 0.73%. The molar absorptivity and Sandel's sensitivity index are 5.14 × 103 L.mol−1.cm−1 and 0.057 µg.cm−2, respectively. The data were compared to those from other previous approaches using t-test and F-test with a 95% confidence level and found to be 2.107 and 3.18, respectively. According to the ICH guidelines (2005), the proposed method has been validated and provides promising results for determination of DPH in pure form and pharmaceutical preparations. [ABSTRACT FROM AUTHOR]

Background: Stage 4 and 5 retinopathy of prematurity (ROP) is a serious condition that may require surgical intervention at some point. Timely intervention is a key element and, with the peculiarity of eyes among this group that necessities a certain level of surgical standards, operations cannot be undertaken in any surgical eye center.Aim of the Study: To recognize the outcomes of vitrectomy in Iraqi preterm babies with stage 4 and 5 ROP, and to study factors that might increase the risk of re-detachment in operated eyes.Methods: A prospective cohort study undertaken from November 2020 to June 2023 for Iraqi preterm babies presenting with stage 4 and 5 ROP requiring surgical intervention. Each patient had a follow-up duration of 9 months. The primary follow-up outcome was anatomical success rate (flat versus detached), and the secondary outcome was to identify the postoperative complications.Results: This study enrolled 19 children; 11 males and eight females (number of eyes operated on was was 31), with a mean gestational age of 29.4± 2.1 weeks. There were six (19.4%) eyes that did not develop any complications, five (16.1%) eyes developed postoperative vitreous hemorrhage, five (16.1%) eyes developed cataract, three (9.7%) eyes underwent a second vitrectomy, and seven (22.6%) eyes developed secondary glaucoma. The surgical success rates were 90.9% for stage 4a, 57.1% for stage 4b, and 33.3% for stage 5a.Conclusion: This study presented the first surgical experience for vitrectomy in children with retinopathy of prematurity in our country, and the results were encouraging with an overall surgical success rate of 64.5%, and 19.4% of eyes did not develop any complication until the 1-year of follow-up. [ABSTRACT FROM AUTHOR]

In this paper, a nice theoretical scheme is presented to investigate resonant and bound states in weakly bound nuclear systems by the use of isospectral potentials together with hyperspherical harmonics expansion. In this scheme, a new potential is constructed which is strictly isospectral with the original shallow potential and has properties that are desirable to calculate resonances more accurately and elegantly. The effectiveness of the method has been checked in terms of its application to the 0+ resonances in the neutron-rich isotopes 18,20C in the two-neutron plus core three-body cluster model. The results are in excellent agreement with the available data. [ABSTRACT FROM AUTHOR]

The goal of this review is to offer an all-encompassing evaluation of an integrated solar energy system within the framework of solar energy utilization. This holistic assessment encompasses photovoltaic technologies, solar thermal systems, and energy storage solutions, providing a comprehensive understanding of their interplay and significance. It emphasizes the importance of solar energy as a renewable resource and its role in addressing global energy demand and mitigating climate change. The review highlights the significance of advancements in various solar energy technologies, focusing on their environmental benefits, including greenhouse gas emissions reduction and air and water pollution mitigation. It explores the evolution of photovoltaic technologies, categorizing them into first-, second-, and third-generation photovoltaic cells, and discusses the applications of solar thermal systems such as water heaters, air heaters, and concentrators. The paper examines key advancements in energy storage solutions for solar energy, including battery-based systems, pumped hydro storage, thermal storage, and emerging technologies. It references recent published literature to present findings on energy payback time, carbon footprint, and performance metrics. Challenges to widespread adoption are discussed, including cost and economic viability, intermittency, environmental impacts, and grid integration. Strategies to overcome these challenges, such as cost reduction, policy support, energy storage integration, and sustainable practices, are presented based on published literature. By bridging gaps in existing literature, this comprehensive resource aims to equip researchers, policymakers, and industry professionals with insights into forging a sustainable and renewable energy future. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Mechanical and functional intestinal obstruction are serious postoperative complications. Acute colonic pseudo-obstruction (Ogilvie's syndrome) is an acute functional obstruction of the large intestine with various causes, including electrolyte disturbances, certain drugs, trauma, hypothyroidism, and, less often, certain procedures, such as abdominal, pelvic, orthopedic, cardiac, and, rarely, thoracic surgeries. It presents with abdominal distension without evidence of mechanical obstruction. This report is of a 66-year-old man with postoperative Ogilvie's syndrome 1 day after diaphragmatic plication surgery. Case Report: We present a case of a 66-year-old man with no pre-existing chronic diseases who underwent diaphragmatic plication surgery performed to treat symptomatic diaphragmatic eventration, which was associated with chronic colonic dilation. One day after the procedure, the patient experienced hemodynamic instability, abdominal tenderness and distention, leukocytosis, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). An abdominal CT scan revealed massive colonic dilation with interposition of the splenic flexure into the diaphragm. Consequently, the patient underwent emergency exploratory laparoscopy, which was later converted to upper laparotomy, during which colonic decompression was performed without identifying any evidence of incarceration. Subsequently, colonic decompression was repeated via sigmoidoscopy, and no mechanical obstruction was found. Lastly, medical treatment was effective in improving the patient's condition. Conclusions: In this complicated case, identifying the definite diagnosis was challenging due to the unusual presentation. This rare case might contribute to recognizing a new risk factor for postoperative colonic obstruction, which is preoperative colonic dilation. Also, this case has highlighted the importance of promptly diagnosing postoperative Ogilvie's syndrome to prevent large-bowel perforation. [ABSTRACT FROM AUTHOR]

Background: Inflammatory markers like tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hsCRP) have been thought to be associated with diabetes mellitus (DM). But their role in the development of diabetes in young is yet to be established. Aims: To compare the concentrations of serum TNF-α and hsCRP between young subjects with normal glucose tolerance (NGT) and DM. Methods: This cross-sectional study was performed with young subjects under 30 years of age consisting of 40 newly detected DM cases and an equal number of subjects with NGT diagnosed on the basis of the American Diabetes Association (ADA) criterion-2017 to see TNF-α and hsCRP levels. Glucose was measured by the glucose oxidase method, hsCRP by immunonephelometry, and TNF-α by enzyme-linked immunosorbent assay (ELISA). Results: hsCRP was higher in DM than that of NGT [DM vs NGT: 3.41 (1.37–9.98) vs. 1.29 (0.68–2.65) pg/ml, median (IQR); p=0.003] but TNF-α was similar in both the groups (DM vs. NGT: 16.30±12.95 vs. 14.55±9.84 mg/L, mean±SD; p=0.201). Both body mass index (BMI) and waist circumference (WC) were positively correlated with hsCRP (BMI: r=0.501, p=0.001; WC: r=0.409, p=0.009) in NGT but not in DM (BMI: r=0.287, p=0.072; WC: r=0.281, p=0.078). Multiple regression analysis revealed BMI (p=0.020), WC (p=0.022), and hsCRP (p=0.041) as independent predictors for DM. Conclusions: This study observed that serum hsCRP but not serum TNF-α was significantly higher in DM in young than that of NGT. [ABSTRACT FROM AUTHOR]

Background: Protein intake is recommended in critically ill patients to mitigate the negative effects of critical illness-induced catabolism and muscle wasting. However, the optimal dose of enteral protein remains unknown. We hypothesize that supplemental enteral protein (1.2 g/kg/day) added to standard enteral nutrition formula to achieve high amount of enteral protein (range 2–2.4 g/kg/day) given from ICU day 5 until ICU discharge or ICU day 90 as compared to no supplemental enteral protein to achieve moderate amount enteral protein (0.8–1.2 g/kg/day) would reduce all-cause 90-day mortality in adult critically ill mechanically ventilated patients. Methods: The REPLENISH (Replacing Protein Via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients) trial is an open-label, multicenter randomized clinical trial. Patients will be randomized to the supplemental protein group or the control group. Patients in both groups will receive the primary enteral formula as per the treating team, which includes a maximum protein 1.2 g/kg/day. The supplemental protein group will receive, in addition, supplemental protein at 1.2 g/kg/day starting the fifth ICU day. The control group will receive the primary formula without supplemental protein. The primary outcome is 90-day all-cause mortality. Other outcomes include functional and quality of life assessments at 90 days. The trial will enroll 2502 patients. Discussion: The study has been initiated in September 2021. Interim analysis is planned at one third and two thirds of the target sample size. The study is expected to be completed by the end of 2025. Trial registration: ClinicalTrials.gov Identifier: NCT04475666. Registered on July 17, 2020. [ABSTRACT FROM AUTHOR]

Background: Chronic constipation is common among children worldwide. Constipation includes functional constipa tion (FC) and organic constipation (OC). The early recognition of the causes of childhood constipation and its subsequent complications is important. Purpose: This study aimed to evaluate the prevalence and causes of childhood constipation and compare the clinical characteristics, treatment, and outcomes of children with FC versus OC to identify the predictive factors. Methods: This retrospective crosssectional study analyzed children with FC or OC diagnosed in pediatric gastroenterology clinics, Salmaniya Medical Complex, Bahrain, 2017-2021. The Rome IV criteria were used to define FC. Results: A total of 7,287 gastroenterology appointments were attended by 4,346 children during the study period. Of the 639 children (14.7%) with constipation, 616 (96.4%) were included in the study. Most patients had FC (n=511, 83%), whereas 17% (n=105) had OC. FC was more common in females than in males. Children with OC were younger (P<0.001) and had lower body weights (P<0.001), more stunted growth (P<0.001), and more associated diseases (P= 0.037) than those with FC. Enuresis was the most associated disease (n=21, 3.4%). Organic causes included neurological, allergic, endocrine, gastrointestinal, and genetic diseases. Allergies to cow milk protein were the most common (n=35, 5.7%). The presence of mucus in the stool was more common in OC than in FC (P=0.041), but no other symptoms or physical findings differed. A total of 587 patients (95.3%) received medication, among which lactulose was commonly prescribed (n=395, 64.1%). There were no intergroup differences in nationality, sex, body mass index, seasonal variation, laxative type, or treatment response. A good response was observed in 114 patients (90.5%). Conclusion: Chronic constipation represented a significant proportion of outpatient gastroenterology visits. FC was the most common type. Young children with a low body weight, stunted growth, mucus in the stool, or associated diseases should be assessed for an underlying organic cause. [ABSTRACT FROM AUTHOR]

In Bangladesh, the incidence of dengue infection continues to rise, and it has been related to severe maternal and infant morbidity during pregnancy. After presenting with an initial onset of fever at 37 weeks' gestation, an 18-year-old pregnant woman ended up being diagnosed with dengue fever. The rapidly declining platelet count, 18,000/mm³ on the third day, necessitated a blood transfusion. On day six of her illness, while her platelet count was 23,000/mm³, she developed pre-labor rupture of membranes with labor pain. The labor became prolonged, with signs of obstruction. A prompt caesarian section was carried out under general anesthesia. She was discharged from the hospital on the 4th Journal of Bangladesh College of Physicians and Surgeons Vol. 41, Dengue Fever Supplement Issue, October 2023 post-operative day without any negative sequelae. After birth, the newborn was diagnosed with dengue IgG by potential vertical transmission. Early detection and treatment are necessary for dengue during pregnancy. However, physicians must exercise extra caution when treating a pregnant dengueinfected patient by maintaining their physiological state, preventing shock, and, at the same time, taking care of the fetus, which may develop distress. [ABSTRACT FROM AUTHOR]

Background. Intravenous infusions of neuromuscular blocking agents (NMBAs) and prone positioning are recommended for acute respiratory distress syndrome (ARDS) due to COVID-19. The safety of enteral nutrition (EN) during these treatments is unclear. This study assessed EN tolerance and safety during NMBA infusion in proned and nonproned patients with ARDS due to COVID-19. Methods. This retrospective study evaluated patients who were admitted to a tertiary-care ICU between March and December 2020, had ARDS due to COVID-19, and received NMBA infusion. We assessed their EN data, gastrointestinal events, and clinical outcomes. The primary outcome was gastrointestinal intolerance, defined as a gastric residual volume (GRV) ≥500 ml or 200–500 ml with vomiting. We compared proned and nonproned patients. Results. We studied 181 patients (mean age 61.2 ± 13.7 years, males 71.1%, and median body mass index 31.4 kg/m2). Most (63.5%) patients were proned, and 94.3% received EN in the first 48 hours of NMBA infusion at a median dose <10 kcal/kg/day. GRV was mostly below 100 ml. Gastrointestinal intolerance occurred in 6.1% of patients during NMBA infusion and 10.5% after NMBA discontinuation (similar rates in proned and nonproned patients). Patients who had gastrointestinal intolerance during NMBA infusion had a higher hospital mortality (90.9% versus 60.0%; p = 0.05) and longer mechanical ventilation duration and ICU and hospital stays compared with those who did not. Conclusion. In COVID-19 patients on NMBA infusion for ARDS, EN was provided early at low doses for most patients, and gastrointestinal intolerance was uncommon in proned and nonproned patients, occurred at a higher rate after discontinuing NMBAs and was associated with worse outcomes. Our study suggests that EN was tolerated and safe in this patient population. [ABSTRACT FROM AUTHOR]

Background: The liberal use of remifentanil in spine surgery has been associated with an increased incidence of postoperative hyperalgesia. Nevertheless, controversies remain as the existing evidence is inconclusive to determine the relationship between remifentanil use and the development of opioid-induced hyperalgesia. We hypothesized that intraoperative infusion of higher dose remifentanil during scoliosis surgery is associated with postoperative hyperalgesia, manifesting clinically as greater postoperative morphine consumption and pain scores. Methods: Ninety-seven patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion surgery at a single tertiary institution from March 2019 until June 2020 were enrolled in this retrospective study. Anesthesia was maintained using a target-controlled infusion of remifentanil combined with volatile anesthetic desflurane in 92 patients, while five patients received it as part of total intravenous anesthesia. Intravenous ketamine, paracetamol, and fentanyl were administered as multimodal analgesia. All patients received patient-controlled analgesia (PCA) morphine postoperatively. Pain scores at rest and on movement, assessed using the numerical rating scale, and the cumulative PCA morphine consumption were collected at a six-hourly interval for up to 48 h. According to the median intraoperative remifentanil dose usage of 0.215 µg/kg/min, patients were divided into two groups: low dose and high dose group. Results: There were no significant differences in the pain score and cumulative PCA morphine consumption between the low and high dose remifentanil group. The mean duration of remifentanil infusion was 134.9 ± 22.0 and 123.4 ± 23.7 min, respectively. Conclusion: Intraoperative use of remifentanil as an adjuvant in AIS patients undergoing posterior spinal fusion surgery was not associated with postoperative hyperalgesia. [ABSTRACT FROM AUTHOR]

• Generalised inverse differential quadrature method (iDQM) for analysis of arbitrary shaped plate structures. • Inverse differential quadrature solutions for free vibration of general laminated plate structures. • Moore-Penrose pseudoinverse preconditioning of underdetermined eigenvalue system. • Refined parametric studies for iDQM solutions of skew and annular sector plates under the influence of changing geometries. An essential aspect of design of laminated plate structures in many engineering applications is the analysis of free vibration behaviour in order to model the structure for random excitations. In this regard, numerical solutions to the systems of high-order partial differential equations governing free vibration response of the structure become important. Direct approximation of such high-order systems are prone to error arising from the sensitivity of high-order numerical differentiation to noise necessitating the demand for improved solution techniques. In this work, a novel generalised inverse differential quadrature method is developed to study the dynamic behaviour of first-order shear deformable arbitrary-shaped laminated plates. The ensuing underdetermined system is operated upon by Moore-Penrose pseudo-inverse preconditioning to form a squared eigenvalue system. Free vibration solutions of square, skew, circular, and annular sector plates for different boundary conditions are obtained and validated against exact and numerical solutions in the literature and ABAQUS. It is demonstrated with numerous examples that iDQM solutions are in excellent agreement with exact solutions for square plates and the results for arbitrary shaped plates are comparable with solutions in the literature while saving up to 96% degrees of freedom required for ABAQUS solution. Finally, refined parametric studies conducted reveal that, subject to varying geometric configurations, iDQM solutions are numerically stable and potentially converge faster than DQM. [ABSTRACT FROM AUTHOR]

Objectives: Though the prevalence of biliary atresia (BA) in the Middle East is low, its role in causing life-threatening liver diseases is disproportionately high. This study aimed to assess the prevalence, clinical presentations, diagnosis, surgical interventions, and long-term outcomes including survival rate, and to analyze prognostic factors affecting the survival of infants with BA in Bahrain. Methods: A retrospective cohort review of cases of infants diagnosed with BA between January 1993 and December 2021 at Salmaniya Medical Complex, Bahrain, was conducted. Demographic, clinical, laboratory, imaging, and histopathological data were analyzed. Outcomes measured included 5-year native liver survival (NLS) and overall liver survival (OLS) rates. Results: Out of 27 infants diagnosed with BA, 26 were included in the study. The overall prevalence was 0.007% and was significantly higher among Bahraini (0.006%) compared to the non-Bahraini population (0.001%), p < 0.001. Most patients had clay-colored stool (19 of 22; 86.4%) and hepatomegaly (18; 81.8%). Kasai procedure was performed in 23 (88.5%) patients and primary liver transplant (LT) in three. Ten (38.5%) infants required LT after the Kasai procedure. The median age at diagnosis was 56 days with interquartile range (IQR) of 30-90, and the median age at the Kasai procedure was 61 days (IQR = 56-90). NLS and OLS rates were 53.8% and 65.4%, respectively. The overall mortality rate was 34.6%. Six of the 13 (46.2%) patients who were subjected to Kasai procedure alone died awaiting LT donors. Infants with lower birth weight and older age at diagnosis had significantly better odds of survival (p < 0.029 and p < 0.044, respectively). Conclusions: BA is uncommon among infants in Bahrain. Despite effective treatment options, late diagnosis can lead to significant morbidity and mortality. Our study found a relatively low prevalence of NLS (53.8%) and OLS (65.4%). Since the majority of the diagnosed patients had presented with clay-colored stools, implementing an infant stool card for screening may be beneficial in raising parental awareness and detecting BA early. Early detection and treatment using novel therapies are likely to improve the survival rates. [ABSTRACT FROM AUTHOR]

Objective. Pulmonary barotrauma has been frequently observed in patients with COVID-19 who present with acute hypoxemic respiratory failure. This study evaluated the prevalence, risk factors, and outcomes of barotrauma in patients with COVID-19 requiring ICU admission. Methods. This retrospective cohort study included patients with confirmed COVID-19 who were admitted to an adult ICU between March and December 2020. We compared patients who had barotrauma with those who did not. A multivariable logistic regression analysis was performed to determine the predictors of barotrauma and hospital mortality. Results. Of 481 patients in the study cohort, 49 (10.2%, 95% confidence interval: 7.6–13.2%) developed barotrauma on a median of 4 days after ICU admission. Barotrauma manifested as pneumothorax (N = 21), pneumomediastinum (N = 25), and subcutaneous emphysema (N = 25) with frequent overlap. Chronic comorbidities and inflammatory markers were similar in both patient groups. Barotrauma occurred in 4/132 patients (3.0%) who received noninvasive ventilation without intubation, and in 43/280 patients (15.4%) who received invasive mechanical ventilation. Invasive mechanical ventilation was the only risk factor for barotrauma (odds ratio: 14.558, 95% confidence interval: 1.833–115.601). Patients with barotrauma had higher hospital mortality (69.4% versus 37.0%; p < 0.0001) and longer duration of mechanical ventilation and ICU stay. Barotrauma was an independent predictor of hospital mortality (odds ratio: 2.784, 95% confidence interval: 1.310–5.918). Conclusions. Barotrauma was common in critical COVID-19, with invasive mechanical ventilation being the most prominent risk factor. Barotrauma was associated with poorer clinical outcomes and was an independent predictor of hospital mortality. [ABSTRACT FROM AUTHOR]

One of the major health challenges of the century is the prevalence of chronic diseases in young adults. The aim of the study was to identify the risk factors for chronic disease and the prevalence of chronic disease in individuals aged 18 to 39. The outcome variable was chronic diseases, and potential predictors included sex, age, education, work status, division, region, smoking status, and respondent's income. Of the 5490 young people, 1782 (32.5 %) had at least one chronic illness. Age, work status, division, geography, and smoking status were significant predictors of chronic illnesses in the multivariate model. Compared to younger young adults, those aged 30-39 had greater odds of developing chronic diseases (OR = 1.57, 95 % CI: 1.16-2.13). Residents in socioeconomically disadvantaged areas are more likely to have chronic illnesses than their more affluent counterparts. Young men are more likely than women to experience chronic illness (OR = 1.06, 95 % CI: 0.92-1.21), although this difference wasn't statistically significant. The highly educated group reports chronic disease more frequently than other groups. These findings, particularly those pertaining to decisionmakers, can aid in the justification, direction, and support of programs required to address these altering epidemiological trends. [ABSTRACT FROM AUTHOR]

One of the quantum theory concepts on which quantum information processing stands is superposition. Here we provide experimental evidence for the existence of classical analogues to the coherent superposition of energy states, which is made possible by the Hertz-type nonlinearity of the granules together with the external driving field. The granules' nonlinear vibrations are projected into the linear modes of vibration, which depend on one another through the phase and form a coherent superposition. We show that the amplitudes of the coherent states form the components of a state vector that spans a two-dimensional Hilbert space, and time enables the system to span its Hilbert space parametrically. Thus, the superposition of states can be exploited in two-state quantum-like computations without decoherence and wave function collapse. Finally, we demonstrate the experimental realization of applying a reversible Hadamard gate to a pure base state that brings the state into a superposition. [ABSTRACT FROM AUTHOR]

The rare earth (Yb3+) substituted W-type hexagonal ferrites with composition CaPb 2-x Yb x Fe 16 O 27 (x = 0.0, 0.5, 1.0, 1.5, 2.0) were synthesized by a facile and cost-effective sol-gel auto combustion method with post heat treatment. The synthesized hexagonal ferrites were characterized by a variety of analytical techniques, and an impedance analyzer was used to investigate the effects of Ytterbium on structural, magnetic, spectral and dielectric properties. The relationship between their impedance, structure and dielectric properties was investigated. The X-ray diffraction patterns verify the presence of single-phase W-type hexagonal ferrites. Physical properties such as D bulk (bulk density), D xrd (X-ray density), and P (porosity) of the CaPb 2-x Yb x Fe 16 O 27 W-type hexagonal ferrites were calculated. The bulk density of all the samples was decreased, and X-ray intensity was increased with the Ytterbium replacement in the W-type hexaferrite. By adding Yb3+ ions, the lattice parameters, cell volume and X-ray density were reduced due to the substitution of ytterbium with smaller ionic radii compared to the lead ion with large ionic radii. The AC-conductivity was increased from (1.523 × 10−5 to 6.699 × 10−5) Ωcm−1. The dielectric constant and tangent loss was found to decrease substantially. The magnetic properties were found to enhance by the substitution of Yb3+. The low coercivity value of Yb3+ substituted W-type hexagonal ferrites are suitable for magnetic recording media operated at a high-frequency regime. The enhancement of electrical, dielectric and magnetic characteristics suggests these materials as promising for multi-layer chip inductors (MLCIs) circuit applications. [ABSTRACT FROM AUTHOR]

Indigenous people face numerous challenges to their mental health across the world. We consider the situation in Bangladesh, where those living in the remote hill tracts areas of Eastern Bangladesh experience widespread difficulties. Few seek attention for their problems from professional services, in part because of stigma or a lack of awareness that help could be made available, but also because in these remote areas few resources are available. We make recommendations to improve this situation, which could be implemented with the assistance of primary healthcare services and traditional healers. [ABSTRACT FROM AUTHOR]

The kinetics of polyphenol release from active films made from sago starch and chitosan with the addition of EVOO have been studied. The purpose of this study is to determine the release kinetics of polyphenols from EVOO added to the active film. Total phenol content of 1%, 2%, and 5% EVOO added to the film was determined by the Folin- Ciocalteu method of 0.1757, 0.1868, and 0.11 mgGAE/g. The kinetic release of polyphenols was tested using three kinetic models, such as zero order, first order, and Higuchi, by comparing the active films in two solvents, namely water and 10% (v/v) aqueous ethanol solution. The highest release occurred in the active film with 2% EVOO (CHSS2) in the two solvents. The release of Polyphenol active film in 10% ethanol followed the release of Higuchi, while CHSS1 and CHSS5 in H2O solvent followed the first-order release. [ABSTRACT FROM AUTHOR]

Sol-gel auto combustion was used to create a sequence of soft ferrites, NixMg1-xFe1.9Sm0.1O4(x = 0.0, 0.2, 0.4 & 0.6). The XRD, FTIR, UV-vis, & four probe I-V techniques, respectively, were used to evaluate the structural, optical, and electrical properties. The cubic crystal structure was confirmed by the XRD pattern. The range of 25.71 - 33.67 nm was found to be the average crystallite size. FTIR spectra provided evidence of the tetrahedral band's existence. With the enhancement of Ni2+ concentration, Eg was determined from 2.28-3.21 eV. It was confirmed by the ranges of DC electrical resistivity that materials might be used in transformers to lessen eddy current losses. [ABSTRACT FROM AUTHOR]

Background and Objectives. Jaundice is a common cause of hospital admission in infants presenting within the first month of life. This study is aimed at determining neonatal and maternal risk factors of indirect hyperbilirubinemia, at comparing neonates with risk factors and those without, and at assessing the type of management according to hyperbilirubinemia severity. Material and Methods. In this retrospective cross-sectional study, medical records of neonates with indirect hyperbilirubinemia who were admitted to the Pediatric Department, Salmaniya Medical Complex, Bahrain, between January 2020 and December 2020 were reviewed. Neonatal demographic data, antenatal history, birth weight, feeding type, maternal and neonatal laboratory evaluations, management, and length of hospital stay were collected and compared. Results. Out of 555 records, 404 neonates were included. Among those, 209 (51%) were males and 275 (68.1%) were Bahraini. The median indirect bilirubin level at presentation was 218 (interquartile range, 174-270) μmol/L. ABO incompatibility was the commonest risk factor for neonatal indirect hyperbilirubinemia (n = 152 , 37.6%) followed by glucose-6-phosphate dehydrogenase (G6PD) deficiency (n = 130 /400, 32.5%). Age (>25 years) was the commonest maternal risk factor (n = 331 , 81.9%) followed by cesarean delivery (n = 137 , 33.9%). Neonates with ABO incompatibility had a significantly higher mean indirect bilirubin level compared to those with other risk factors (234.9 ± 68.5 versus 225 ± 82.2 mmol/L, respectively) (P = 0.04). Phototherapy use significantly increased along with the rise of bilirubin level (P < 0.0001). Intravenous immunoglobulins (IVIG) and exchange transfusion were used in 44 (10.9%) and 14 (3.5%) patients, respectively. Neonates who received IVIG had significantly higher bilirubin levels than those who did not (P = 0.005). Male newborns (P = 0.008), Bahrainis (P = 0.001), those with reticulocytosis (P = 0.001), and those who received IVIG (P = 0.001) were more prone to have associated risk factors. Conclusion. ABO incompatibility, G6PD deficiency, and older maternal age were the commonest neonatal and maternal risk factors for developing neonatal indirect hyperbilirubinemia. Bahraini, male newborns, reticulocytosis, and IVIG use were associated with these factors. Early detection of such factors through screening can aid in immediate management to prevent serious complications of this common condition. [ABSTRACT FROM AUTHOR]

Ectopia cordis is a rare type of malformation where the heart is not located normally. It may be partially or completely located outside the thoracic cavity and can be associated with other congenital abnormalities. It results from failure of maturation of midline mesoderm and ventral body formation during embryogenic formation. The exact etiology remains unknown. The literature review reveals the prognosis for infants with ectopia cordis is very poor. Here, we are reporting the first case of a fetus that was prenatally diagnosed with ectopia cordis that was associated with omphalocele documented in our country. Considering the poor prognosis for the fetus, conservative management during the prenatal period was chosen. [ABSTRACT FROM AUTHOR]

The Controlled-NOT (CNOT) gate is the key to unlock the power of quantum computing as it is a fundamental component of a universal set of gates. We demonstrate the operation of a two-bit C-NOT quantum-like gate using classical qubit acoustic analogues, called herein logical phi-bits. The logical phi-bits are supported by an externally driven nonlinear acoustic metamaterial composed of a parallel array of three elastically coupled waveguides. A logical phi-bit has a two-state degree of freedom associated with the two independent relative phases of the acoustic wave in the three waveguides. A simple physical manipulation involving the detuning of the frequency of one of the external drivers is shown to operate on the complex vectors in the Hilbert space of pairs of logical phi-bits. This operation achieves a systematic and predictable C-NOT gate with unambiguously measurable input and output. The possibility of scaling the approach to more phi-bits is promising. [ABSTRACT FROM AUTHOR]

The computational fluid dynamics of hurricane rapid intensification (RI) is examined through idealized simulations using two codes: a community‐based, finite‐difference/split‐explicit model (WRF) and a spectral‐element/semi‐implicit model (NUMA). The focus of the analysis is on the effects of implicit numerical dissipation (IND) in the energetics of the vortex response to heating, which embodies the fundamental dynamics in the hurricane RI process. The heating considered here is derived from observations: four‐dimensional, fully nonlinear, latent heating/cooling rates calculated from airborne Doppler radar measurements collected in a hurricane undergoing RI. The results continue to show significant IND in WRF relative to NUMA with a reduction in various intensity metrics: (a) time‐integrated, mean kinetic energy values in WRF are ∼20% lower than NUMA and (b) peak, localized wind speeds in WRF are ∼12 m/s lower than NUMA. Values of the eddy diffusivity in WRF need to be reduced by ∼50% from those in NUMA to produce a similar intensity time series. Kinetic energy budgets demonstrate that the pressure contribution is the main factor in the model differences with WRF producing smaller energy input to the vortex by ∼23%, on average. The low‐order spatial discretization of the pressure gradient in WRF is implicated in the IND. In addition, the eddy transport term is found to have a largely positive impact on the vortex intensification with a mean contribution of ∼20%. Overall, these results have important implications for the research and operational forecasting communities that use WRF and WRF‐like numerical models. Plain Language Summary: The intensity of a hurricane is primarily a balance between energy production and dissipation from various physical processes. Numerical models calculate this energy balance by solving complicated equations that attempt to capture these physical processes. Previous research has shown that the methods used to solve these equations can introduce additional dissipation into the system that affects the prediction of the storm intensity. In this paper, we examine this "numerical dissipation" idea more closely by conducting carefully designed comparisons between the community numerical model (WRF) and an advanced, research model (NUMA). Using observational estimates of heating in clouds, which feed the production of energy, we find that the WRF model produces significantly more numerical dissipation relative to NUMA that results in a reduced intensity of the storm. Our analysis indicates that the reason for the anomalous numerical dissipation in WRF is due to how the pressure gradient is computed. These results can have potentially important consequences for operational forecasts, especially the rapid intensification (RI) process. For example, the under‐prediction or low bias of RI forecasts may be partly due to excessive numerical dissipation. Key Points: The Weather Research and Forecasting (WRF) dynamic core dissipates ∼20% more kinetic energy than Non‐hydrostatic Unified Model of the Atmosphere (NUMA) for a dry vortex forced by four‐dimensional latent heating observationsValues of the eddy diffusivity in WRF need to be reduced by ∼50% from those in NUMA in order to produce a similar intensity time seriesBudgets and sensitivity tests indicate that the low‐order approximation of the pressure gradient is the source of the dissipation in WRF [ABSTRACT FROM AUTHOR]

Introduction: Shoulder pain comes next to back and knee pain, considering the frequency of musculoskeletal ailments. The Shoulder Pain and Disability Index (SPADI) is considered a highly specific questionnaire for assessing shoulder pain and functions. The objective of the study was to assess the validity and reliability of the Bangla version of SPADI (B-SPADI) among the Bangla-speaking patients. Materials and Methods: The B-SPADI was developed using a designed process that included forward translation and backward translation, authentication, response, and final rectification. Validity and reliability were conducted in 48 patients with shoulder pain. The reliability was appraised by executing internal consistency and test-retest analyses. Its validity was assessed by comparing the SPADI with the SF- 36, Disabilities of the Arm, Shoulder, and Hand (DASH), and American Shoulder and Elbow Surgeons (ASES) questionnaire. Results: The cross-cultural adaptation method was flawlessly aligned with the content or language. Internal consistency (Cronbach’s alpha) was 0.97 for the total SPADI score. Intraclass Correlation Coefficient (ICC) was 0.95 for the total SPADI with 0.92 for pain subtotal and 0.96 for disability subtotal. The SPADI total score showed a correlation of 0.63–0.71 with the SF-36 physical scales, of 0.89 with the DASH and of 0.94 with the ASES. All of the items were statistically significant (P<0.001). Conclusion: The B-SPADI came out as an appropriate valid, and reliable instrument for measuring pain and disability in patients with shoulder afflictions. [ABSTRACT FROM AUTHOR]

Cyst nematodes (CNs) are an important group of root‐infecting sedentary endoparasites that severely damage many crop plants worldwide. An infective CN juvenile enters the host's roots and migrates towards the vascular cylinder, where it induces the formation of syncytial feeding cells, which nourish the CN throughout its parasitic stages. Here, we examined the role of glutathione (l‐γ‐glutamyl‐l‐cysteinyl‐glycine) in Arabidopsis thaliana on infection with the CN Heterodera schachtii. Arabidopsis lines with mutations pad2, cad2, or zir1 in the glutamate–cysteine ligase (GSH1) gene, which encodes the first enzyme in the glutathione biosynthetic pathway, displayed enhanced CN susceptibility, but susceptibility was reduced for rax1, another GSH1 allele. Biochemical analysis revealed differentially altered thiol levels in these mutants that was independent of nematode infection. All glutathione‐deficient mutants exhibited impaired activation of defence marker genes as well as genes for biosynthesis of the antimicrobial compound camalexin early in infection. Further analysis revealed a link between glutathione‐mediated plant resistance to CN infection and the production of camalexin on nematode infection. These results suggest that glutathione levels affect plant resistance to CN by fine‐tuning the balance between the cellular redox environment and the production of compounds related to defence against infection. [ABSTRACT FROM AUTHOR]

Craniopagus is a condition of conjoined twins that are fused at the cranium. After birth, 25% of craniopagus twins survive and can be considered for surgical separation. It is a complex multistage, multidisciplinary team involvement exercise needing detailed evaluation, planning and preparation beforehand. A harmonious collaboration from the clinical, administrative as well as logistic point of view is mandatory for successful management of such complex condition. The honorable prime minister of Bangladesh picked up "Rabeya and Rukaiya", a craniopagus twins, the first ever case in the history of Bangladesh and handed them over to an expert team from Hungary and Bangladesh for successful management. The noble joint exercise known as "Operation Freedom" took place in home and abroad through multiple procedures/interventions in different institutions by a group of experienced panels of medical and non-medical professionals. In this article we will highlight the events of this monumental achievement. [ABSTRACT FROM AUTHOR]

Background and Objectives. Acute bronchiolitis is a common respiratory disease in children. C-reactive protein (CRP) is an indicator of bacterial coinfection. This study is aimed at assessing the frequency of elevated CRP in children with acute bronchiolitis and at comparing the clinical characteristics, laboratory and radiological findings, antibiotics use, and outcome according to CRP levels. Material and Methods. We retrospectively reviewed medical records of children with acute bronchiolitis admitted to Pediatric Department, Salmaniya Medical Complex, Bahrain, in 2019-2020. Demographic, clinical, laboratory and radiological data, and outcomes were collected. Patients with high CRP were compared with those with normal levels. Results. Of 287 patients, 229 (79.2%) were included. 132 (57.6%) were males. Median presentation age was 3.7 (interquartile range (IQR), 1.27-12.33) months. Median CRP level was 10.4 (IQR, 2.8-35.1) mg/L. CRP was high in 167 (72.9%) patients. 17.6% (33/187 patients) had confirmed bacterial coinfection. Respiratory syncytial virus (RSV) was detected in 84 (36.7%) patients. Mean CRP level was higher in RSV-negative compared to RSV-positive patients, 31.3 ± 44.3 versus 21.5 ± 27.7 mg / L , respectively (P = 0.042). Respiratory viral serology profile was positive in 34.7% (17/49 patients). 66.9% (107/160 patients) had positive chest X-ray. Antibiotics were used in 78.1% (179/227 patients). Thirteen (5.7%) patients required intensive care, five (2.2%) had surgical intervention, four (1.8%) required endotracheal intubation, and four (1.8%) died. Patients with high CRP were older at presentation (P < 0.0001) and had more fever (P < 0.0001) and cough (P = 0.002), but lower hemoglobin level (P < 0.0001) compared to those with normal CRP. Fever (P = 0.016) and hemoglobin level (P = 0.002) were independent factors. Conclusion. Most children with acute bronchiolitis had high rate of elevated CRP values that did not correlate with the rate of bacterial coinfection. High CRP levels were found in older children, those presented with more fever and cough, and had a lower hemoglobin level despite that those factors were previously reported to be associated with disease severity and bacterial coinfection. This study also showed a high overall rate of antibiotic prescriptions in mostly viral disease. [ABSTRACT FROM AUTHOR]

There are contradictory data regarding the effect of intermittent pneumatic compression (IPC) on the incidence of deep-vein thrombosis (DVT) and heart failure (HF) decompensation in critically ill patients. This study evaluated the effect of adjunctive use of IPC on the rate of incident DVT and ventilation-free days among critically ill patients with HF. In this pre-specified secondary analysis of the PREVENT trial (N = 2003), we compared the effect of adjunctive IPC added to pharmacologic thromboprophylaxis (IPC group), with pharmacologic thromboprophylaxis alone (control group) in critically ill patients with HF. The presence of HF was determined by the treating teams according to local practices. Patients were stratified according to preserved (≥ 40%) versus reduced (< 40%) left ventricular ejection fraction, and by the New York Heart Association (NYHA) classification. The primary outcome was incident proximal lower-limb DVT, determined with twice weekly venous Doppler ultrasonography. As a co-primary outcome, we evaluated ventilation-free days as a surrogate for clinically important HF decompensation. Among 275 patients with HF, 18 (6.5%) patients had prevalent proximal lower-limb DVT (detected on trial day 1 to 3). Of 257 patients with no prevalent DVT, 11/125 (8.8%) patients in the IPC group developed incident proximal lower-limb DVT compared to 6/132 (4.5%) patients in the control group (relative risk, 1.94; 95% confidence interval, 0.74–5.08, p = 0.17). There was no significant difference in ventilator-free days between the IPC and control groups (median 21 days versus 25 days respectively, p = 0.17). The incidence of DVT with IPC versus control was not different across NYHA classes (p value for interaction = 0.18), nor across patients with reduced and preserved ejection fraction (p value for interaction = 0.15). Ventilator-free days with IPC versus control were also not different across NYHA classes nor across patients with reduced or preserved ejection fraction. In conclsuion, the use of adjunctive IPC compared with control was associated with similar rate of incident proximal lower-limb DVT and ventilator-free days in critically ill patients with HF. Trial registration: The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103 (registered on 3 November 2013, https://clinicaltrials.gov/ct2/show/study/NCT02040103) and Current controlled trials, ID: ISRCTN44653506 (registered on 30 October 2013). [ABSTRACT FROM AUTHOR]

Background and Objectives. Gastrointestinal (GI) endoscopy is a medical field that has been evolving in the last decades. Innovative advances in pediatric endoscopy led to more accurate diagnosis of various GI diseases. This study aimed to assess the appropriateness of endoscopic procedures' indications and to evaluate the diagnostic and therapeutic yield of pediatric GI endoscopy, considering the limitations to access this facility. Material and Methods. Retrospective, cross-sectional, and analytical chart review was performed for children who underwent GI endoscopy at Salmaniya Medical Complex, Bahrain, from 1995 to 2020. Demographic data, endoscopic indications, and findings were collected and compared. Results. Of 1,111 patients, 1,101 (99.1%) were included in the study. 589 (53.6%) patients were males. Median age at the time of endoscopy was 8 (interquartile range 3, 11) years. 1534 endoscopies were performed (1193 upper GI endoscopies (UGIE) and 341 colonoscopies) in 1296 sessions. The mean number of endoscopies per year was 59 ± 30.9 procedures with 81.4% reduction noted after coronavirus pandemic (P < 0.0001). Ratio between UGIE to colonoscopy was 3.5 : 1. Median number of endoscopies per patient was one, ranging from one to eight procedures. 1153 (89%) sessions were diagnostic, and 143 (11.0%) were therapeutic. Main endoscopic indication was chronic abdominal pain (451 (40.9%) patients) followed by upper GI bleeding (302 (27.4%) patients). Overall positive yield was 68.1% (716/1052 procedures). Endoscopic yield varies according to the type of procedure (P = 0.003). Colonoscopy alone gave a higher yield (82.6%, 38/46 procedures) compared to combined procedures (75.4%, 141/187) and UGIE alone (65.6%, 537/819). Conclusions. This study emphasizes a careful selection of the type of endoscopic procedures, based on the expected endoscopic yield, to diagnose and treat pediatric GI diseases. In patients with chronic abdominal pain, endoscopy should be reserved as a second-line tool to avoid unnecessary use of invasive procedures. [ABSTRACT FROM AUTHOR]

Background and Objectives. Gastrointestinal (GI) endoscopy is a medical field that has been evolving in the last decades. Innovative advances in pediatric endoscopy led to more accurate diagnosis of various GI diseases. This study aimed to assess the appropriateness of endoscopic procedures' indications and to evaluate the diagnostic and therapeutic yield of pediatric GI endoscopy, considering the limitations to access this facility. Material and Methods. Retrospective, cross-sectional, and analytical chart review was performed for children who underwent GI endoscopy at Salmaniya Medical Complex, Bahrain, from 1995 to 2020. Demographic data, endoscopic indications, and findings were collected and compared. Results. Of 1,111 patients, 1,101 (99.1%) were included in the study. 589 (53.6%) patients were males. Median age at the time of endoscopy was 8 (interquartile range 3, 11) years. 1534 endoscopies were performed (1193 upper GI endoscopies (UGIE) and 341 colonoscopies) in 1296 sessions. The mean number of endoscopies per year was 59 ± 30.9 procedures with 81.4% reduction noted after coronavirus pandemic (P < 0.0001). Ratio between UGIE to colonoscopy was 3.5 : 1. Median number of endoscopies per patient was one, ranging from one to eight procedures. 1153 (89%) sessions were diagnostic, and 143 (11.0%) were therapeutic. Main endoscopic indication was chronic abdominal pain (451 (40.9%) patients) followed by upper GI bleeding (302 (27.4%) patients). Overall positive yield was 68.1% (716/1052 procedures). Endoscopic yield varies according to the type of procedure (P = 0.003). Colonoscopy alone gave a higher yield (82.6%, 38/46 procedures) compared to combined procedures (75.4%, 141/187) and UGIE alone (65.6%, 537/819). Conclusions. This study emphasizes a careful selection of the type of endoscopic procedures, based on the expected endoscopic yield, to diagnose and treat pediatric GI diseases. In patients with chronic abdominal pain, endoscopy should be reserved as a second-line tool to avoid unnecessary use of invasive procedures. [ABSTRACT FROM AUTHOR]

This study investigates the performance of structural lightweight geopolymer concrete (SLWGC) exposed to chemical attack. The objective of this study is validation the ability of using light weight geopolymer concrete for structural purpose under hard conditions. The alkali activator was produced using sodium silicate, sodium hydroxide and water. Flay ash and slage as waste materials were replaced by 90% of ordinary Portland cement to produce the geopolymer concrete. Also, ordinary cement concrete produced to comparison. Three types of lightweight aggregate were used instead of normal aggregate represented by pumice stone, expanded clay and construction waste clay brick to produce SLWGC. The unit weight of produced SLWGC were in the range (1800–2100) kg/m3. Normal weight geopolymer concrete and SLWGC were produced simultaneously to compare their performance each with other. The geopolymer concrete mixes treated by heat curing at 65 °C for 24 h after removing the molds. The specimens of all mixes exposed to sulfuric acid with concentration 5% and 10% for 8 weeks. The investigated mechanical properties represented by compressive strength and flexural tensile strength. The results indicate that the geopolymer concrete exhibit better resistance for acid attack compared to OPC concrete where the strength deterioration for SLWGC lower than ORC light weight concrete after exposed to acid, crushed clay bricks exhibit superior mechanical and durability performance compared to other LWA. Finally, the results proved the ability of producing light weight geopolymer concert for structural purposed with acceptable performance of strength and durability under hard chemical conditions. [ABSTRACT FROM AUTHOR]

Objectives: In addition to risking their physical well-being, frontline physicians are enduring significant emotional burden both at work and home during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to investigate the levels of anxiety and depressive symptoms and to identify associated factors among Bangladeshi physicians during the COVID-19 outbreak. Methods and design: A cross-sectional study using an online survey following a convenience sampling technique was conducted between April 21 and May 10, 2020. Outcomes assessed included demographic questions, COVID-19 related questions, and the Hospital Anxiety and Depression Scale (HADS). Results: The survey was completed by 412 Bangladeshi physicians. The findings revealed that, in terms of standardized HADS cut-off points, the prevalence of anxiety and depressive symptoms among physicians was 67.72% and 48.5% respectively. Risk factors for higher rates of anxiety or depressive symptoms were: being female, physicians who had experienced COVID-19 like symptoms during the pandemic, those who had not received incentives, those who used self-funded personal protective equipment (PPE), not received adequate training, lacking perceived self-efficacy to manage COVID-19 positive patients, greater perceived stress of being infected, fear of getting assaulted/humiliated, being more connected with social media, having lower income levels to support the family, feeling more agitated, less than 2 h of leisure activity per day and short sleep duration. All these factors were found to be positively associated with anxiety and depression in unadjusted and adjusted statistical models. Conclusions: This study identifies a real concern about the prevalence of anxiety and depressive symptoms among Bangladeshi physicians and identifies several associated factors during the COVID-19 pandemic. Given the vulnerability of the physicians in this extraordinary period whilst they are putting their own lives at risk to help people infected by COVID-19, health authorities should address the psychological needs of medical staff and formulate effective strategies to support vital frontline health workers. [ABSTRACT FROM AUTHOR]

M-type hexagonal ferrites have been getting considerable attention owing to their promising application in electronic fields. Though, the growth of nanosized M-type hexagonal ferrites is still a big challenge. Herein the fabrication of M-type hexaferrite with nominal composition Ca 1-x Bi x Fe 12-x Co x O 19 (x=0.00, 0.05, 0.10, 0.15, 0.20) with high quality is reported by the sol-gel auto combustion route. The objective of the study is to improve the structural, spectral, dielectric, and magnetic characteristics of M-type hexagonal ferrite which was achieved through the variation of concentration of Cobalt and Bismuth. X-ray diffraction (XRD) patterns confirmed the single-phase M-type hexagonal structure. The crystallite size of all samples was found to be in the range of 42–49 nm. Other parameters such as lattice parameters a & c, unit cell volume, crystallite size, X-ray density, Bulk density, and porosity were also calculated. The doping contents were found to decrease the bulk and X-ray densities while increasing the porosity. Fourier-transform infrared (FTIR) spectra showed the formation of metal-oxygen stretching vibrations that confirmed the formation of hexagonal ferrites. The scanning electron microscopy (SEM) images revealed a regular platelet hexagonal structure and homogeneously distributed grains were examined. The dielectric constant was high at low frequency and then decreased with increasing frequency, while the dielectric loss was decreased appreciably with doping. The saturation magnetization ranged from 15.51 to 38.27 emu/g, coercivity increased from 207.93 to 1359.69 Oe, and the squareness ratio was found to be in the range of 0.19–0.78. The dielectric and magnetic properties of Ca 1-x Bi x Fe 12-x Co x O 19 (x=0.00, 0.05, 0.10, 0.15, 0.20) with the variation of Co and Bi revealed that these materials are good candidates for modern devices. • The samples Ca 1-x Bi x Fe 12-x Co x O 19 results in enhanced structural, dielectric and magnetic properties. • XRD patterns of samples indicate that the peaks match well with the standard patterns of the M-type hexaferrites. • Crystallite size lies in the range of 42–49 nm • At room temperature the conductivity is due to impurity, at higher temperature conductivity is due to polaron hopping. • According to Maxwell–Wagner model the dielectric substance contains heterogeneous structure separated by highly resistant thin grain boundaries [ABSTRACT FROM AUTHOR]

The possibility of achieving and controlling scalable classically entangled, i.e., inseparable, multipartite states, would fundamentally challenge the advantages of quantum systems in harnessing the power of complexity in information science. Here, we investigate experimentally the extent of classical entanglement in a 16 acoustic qubit-analogue platform. The acoustic qubit-analogue, a.k.a., logical phi-bit, results from the spectral partitioning of the nonlinear acoustic field of externally driven coupled waveguides. Each logical phi-bit is a two-level subsystem characterized by two independently measurable phases. The phi-bits are co-located within the same physical space enabling distance independent interactions. We chose a vector state representation of the 16 -phi-bit system which lies in a 2 16 -dimensional Hilbert space. The calculation of the entropy of entanglement demonstrates the possibility of achieving inseparability of the vector state and of navigating the corresponding Hilbert space. This work suggests a new direction in harnessing the complexity of classical inseparability in information science. [ABSTRACT FROM AUTHOR]

This is the second of a two-part profile on mental healthcare in Bangladesh. It describes the state of mental health research in the country and presents a set of priorities for addressing improvements to the fundamental gaps in mental healthcare highlighted in part 1. Focus on building infrastructure for public mental health facilities, training skilled mental health professionals, adequate distribution of financial resources and addressing stigma are all priorities that will contribute to significantly improving mental healthcare in Bangladesh. [ABSTRACT FROM AUTHOR]

Mental health is a significant factor for a sound and productive life; nevertheless, mental disorders do not often receive adequate research attention and are not addressed as a serious public health issue in countries such as Bangladesh. Part 1 of this two-part profile describes the current situation of mental health in Bangladesh in its wider sociocultural context, outlining existing policies and highlighting mental illness as a neglected healthcare problem in the country using a narrative synthesis method. The prevalence of mental disorders is very high and augmented in nature among different population groups in Bangladesh. A lack of public mental health facilities, scarcity of skilled mental health professionals, insufficient financial resource distribution, inadequately stewarded mental health policies and stigma contribute to making current mental healthcare significantly inadequate in Bangladesh. The country has few community care facilities for psychiatric patients. Furthermore, the current mental health expenditure by the Bangladeshi government is only 0.44% of the total health budget. Less than 0.11% of the population has access to free essential psychotropic medications. [ABSTRACT FROM AUTHOR]

This paper reports the effect of core diameter of optical fiber cables on stimulated Brillouin scattering loss, which is one of the major loss characteristics of an optical fiber communication system. Analysis of this loss characteristic at three windows of the operating wavelength of a laser has been carried out through a numerical approach. Among different types of optical fiber cables, multi-mode step index silica fiber, multimode graded index silica fiber and plastic fibers have been considered for the numerical analysis. The numerical analysis has been performed using MATLAB in this research work. Through the comparative analysis, it has been ascertained that the Brillouin scattering loss is not only affected by the operating wavelength, but also by the core diameter of the different type of the cable. From the investigation of the comparative analysis, it is revealed that Brillouin scattering loss declines with the application of multimode graded index silica fiber. However, in the plastic fiber category, plastic step index fiber offers better performance. [ABSTRACT FROM AUTHOR]

Summary: Reactive oxygen species (ROS) generated in response to infections often activate immune responses in eukaryotes including plants. In plants, ROS are primarily produced by plasma membrane‐bound NADPH oxidases called respiratory burst oxidase homologue (Rboh). Surprisingly, Rbohs can also promote the infection of plants by certain pathogens, including plant parasitic cyst nematodes.The Arabidopsis genome contains 10 Rboh genes (RbohA–RbohJ). Previously, we showed that cyst nematode infection causes a localised ROS burst in roots, mediated primarily by RbohD and RbohF. We also found that plants deficient in RbohD and RbohF (rbohD/F) exhibit strongly decreased susceptibility to cyst nematodes, suggesting that Rboh‐mediated ROS plays a role in promoting infection. However, little information is known of the mechanism by which Rbohs promote cyst nematode infection.Here, using detailed genetic and biochemical analyses, we identified WALLS ARE THIN1 (WAT1), an auxin transporter, as a downstream target of Rboh‐mediated ROS during parasitic infections. We found that WAT1 is required to modulate the host's indole metabolism, including indole‐3‐acetic acid levels, in infected cells and that this reprogramming is necessary for successful establishment of the parasite.In conclusion, this work clarifies a unique mechanism that enables cyst nematodes to use the host's ROS for their own benefit. [ABSTRACT FROM AUTHOR]

Background: Bangladesh, one of the most densely populated countries in the world has been ranked 9th on the Climate Risk Index for 2017: the 10 most affected countries & 7th on the Long-Term Climate Risk Index: the 10 countries most affected from 1998 to 2017. Every year it is afflicted with various climatic disasters including floods, hurricanes and cyclones. Apart from the obvious devastation of lives and property, there is a huge increase in clinical diseases when these disasters occur. Mental health of affected persons after these disasters is a topic that is often neglected by local and national level. Methods: A qualitative case study was conducted on perceived need on mental health support & availability of such services in a cyclone affected area in rural Bangladesh. Ten (10) key informant interviews (KIIs) with different stakeholders and ten (10) in-depth interviews (IDIs) with affected people were taken. Findings: We found that cyclones had numerous psychosocial impacts on the population including acute stress disorder, sleep disorder, post-traumatic stress disorders (PTSDs), generalized anxiety disorders, suicidal ideation and depression. The survivors had specific needs for receiving support. Children, elderly and women were perceived to be more vulnerable. The government and NGOs had no specific action plans and initiatives to address these issues and support the mental health of affected population. There was a visible gap in finding effective ways to provide affected people with the required mental health & psycho-social services (MHPSS). Conclusion: Resilient, responsive and self-sustaining health systems for this vulnerable population are required. Implementation of effective mental health programs and strong mental health policies remain a challenge in Bangladesh where there is a cultural fatalistic acceptance of mental health issues. [ABSTRACT FROM AUTHOR]

Background and Objectives. Benign strictures are the main cause of esophageal strictures in children. They can be managed by different modalities but endoscopic dilatation is the standard therapy. This study is aimed at reviewing the efficacy and safety of endoscopic dilatations in children with esophageal strictures. Materials and Methods. In this retrospective cross-sectional single center study, records of patients with esophageal strictures presented to the pediatric department, Salmaniya Medical Complex, Bahrain, in the period between 1995 and 2019 were reviewed. Demographic data, indications of endoscopic dilatations, the procedure success rate, and possible complications were assessed. Results. Forty-six children were found to have esophageal strictures. Twenty-five (54.3%) patients were males. Most patients presented during infancy (86.5%, 32/37 patients). Twenty-six (56.5%) patients required 88 dilatation sessions, while the remaining 20 (43.5%) patients did not require dilatations. The median number of dilatation sessions per patient was three (interquartile range = 2 –5). Savary-Gilliard bougienages were the main dilators used (80.8%, 21/26 patients). Anastomotic stricture (post esophageal atresia/tracheoesophageal fistula repair) was the main cause of esophageal strictures and was found in 35 (76.1%) patients. Patients with nonanastomotic strictures had more frequent dilatations compared to those with anastomotic strictures (P = 0.007). The procedure success rate was 98.8%. Yet, it was operator dependent (P = 0.047). Complete response to dilatation was found in 18 (69.2%) patients, satisfactory in seven (26.9%), and an inadequate response in one (3.9%). Those with satisfactory responses still require ongoing dilatations based on their symptoms and radiological and endoscopic findings. No perforation or mortality was reported. Patients with dilatations had more recurrent hospitalization (P < 0.0001), more dysphagia (P = 0.001), but shorter hospital stay (P = 0.046) compared to those without dilatations. Surgical intervention was required in one patient with caustic strictures. The median follow-up period was six years (interquartile range = 2.25 –9.0). Conclusions. Endoscopic esophageal dilatation in children with esophageal strictures is effective and safe. Yet, it was operator dependent. Nonanastomotic strictures require more dilatations compared to anastomotic strictures. Findings of this study are comparable to those reported worldwide. [ABSTRACT FROM AUTHOR]

Introduction: Budd-Chiari syndrome (BCS) is a rare condition affecting one in a million adults. BCS involves outflow obstruction in the hepatic venous system, which can occur anywhere between the small hepatic veins and the atrio-caval junction and cannot be due to heart, pericardial, or hepatic veno-occlusive disease. Case Presentation: We report an exceedingly rare form of BCS with less common initial clinical features in a young poor adult male patient which ignited a diagnostic uncertainty and a therapeutic challenge. The presence of the classical triad of BCS in the absence of major hepatic vein obstruction prompted the medical team to consider that the patient had a rare form of BCS. In this case, the financial condition of the patient and limited resources available restricted our ability to advance into the specific investigations. However, the patient was given symptomatic medical treatment and was followed up monthly. We also provided the patient with a statement that reaffirmed our inability to provide affordable surgical management options and called for an optimized national clinical guideline that could help the physicians deal with the challenges. Conclusion: An uncommon form of BCS in this patient provided a diagnostic challenge and therapeutic uncertainty in the low-resource settings. Primary care physicians should commence evidenced medical management based on clinical suspicion acknowledging the fact that obstruction of small hepatic veins is often not detected on an ultrasound. [ABSTRACT FROM AUTHOR]