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This paper analyses the effect of bank lending and fee income on Islamic and conventional bank's performance. The paper builds a theoretical model and provides empirical evidence to show that Islamic banks as compared to conventional banks can have a greater reliance on fee-based income than returns from loans to increase their profitability. Using data from a sample of 20 countries for the period from 2000 to 2015 for Islamic and conventional banks, we find that the bank fee is an important determinant of the profitability of an Islamic bank. Interestingly, many commonly used measures such as loan to deposit ratio do not affect the Islamic banks' profitability as much as they do for conventional banks. Our findings imply that Islamic banks' lower sensitivity to loan to deposit ratio may contribute to lower credit risk. However, an over-reliance on fee-based income may affect their growth, profitability and sustainability in the long run.

Purpose To describe the use of glycerine in improving media clarity in cases with edematous cornea. Methods Retrospective case-series including patients with posterior segment pathologies needing surgical invention and having corneal edema. Each case was studied for the role of topical application of glycerine instead of viscoelastic agents and the course of surgery. The cases were followed up for minimum 3-months duration. Results Six cases with corneal edema having posterior segment pathology underwent surgery with intraoperative topical application of glycerine. The corneal edema was seen to clear with progression of surgery and was maintained until the end of surgery. Procedures like vitreoretinal surgery, identification of break, internal limiting membrane peeling, intraocular lens explantation, scleral indentation, DSEK graft removal, and subretinal band removal could be performed in these cases. Conclusion Intraoperative glycerine use during vitreoretinal surgeries is helpful in improving the corneal clarity and maintaining it till the end of surgery.

Background: Management of scaphoid nonunions with bone loss varies substantially. Commonly, internal fixation consists of a single headless compression screw. Recently, some authors have reported on the theoretical benefits of dual-screw fixation. We hypothesized that using 2 headless compression screws would impart improved stiffness over a single-screw construct. Methods: Using a cadaveric model, we compared biomechanical characteristics of a single tapered 3.5- to 3.6-mm headless compression screw with 2 tapered 2.5- to 2.8-mm headless compression screws in a scaphoid waist nonunion model. The primary outcome measurement was construct stiffness. Secondary outcome measurements included load at 1 and 2 mm of displacement, load to failure for each specimen, and qualitative assessment of mode of failure. Results: Stiffness during load to failure was not significantly different between single- and double-screw configurations ( P = .8). Load to failure demonstrated no statistically significant difference between single- and double-screw configurations. Using a qualitative assessment, the double-screw construct maintained rotational stability more than the single-screw construct ( P = .029). Conclusions: Single- and double-screw fixation constructs in a cadaveric scaphoid nonunion model demonstrate similar construct stiffness, load to failure, and load to 1- and 2-mm displacement. Modes of failure may differ between constructs and represent an area for further study. The theoretical benefit of dual-screw fixation should be weighed against the morphologic limitations to placing 2 screws in a scaphoid nonunion.

Peer reviewed: True, Good vaccine safety and reliability are essential for successfully countering infectious disease spread. A small but significant number of adverse reactions to COVID-19 vaccines have been reported. Here, we aim to identify possible common factors in such adverse reactions to enable strategies that reduce the incidence of such reactions by using patient data to classify and characterise those at risk. We examined patient medical histories and data documenting postvaccination effects and outcomes. The data analyses were conducted using a range of statistical approaches followed by a series of machine learning classification algorithms. In most cases, a group of similar features was significantly associated with poor patient reactions. These included patient prior illnesses, admission to hospitals and SARS-CoV-2 reinfection. The analyses indicated that patient age, gender, taking other medications, type-2 diabetes, hypertension, allergic history and heart disease are the most significant pre-existing factors associated with the risk of poor outcome. In addition, long duration of hospital treatments, dyspnoea, various kinds of pain, headache, cough, asthenia, and physical disability were the most significant clinical predictors. The machine learning classifiers that are trained with medical history were also able to predict patients with complication-free vaccination and have an accuracy score above 90%. Our study identifies profiles of individuals that may need extra monitoring and care (e.g., vaccination at a location with access to comprehensive clinical support) to reduce negative outcomes through classification approaches.

In the last few years, there has been a significant growth in the amount of data published in RDF and adoption of Linked Data principles. Every day, a large number of people and communities contribute to the publication of datasets as Linked Data on Linked Open Data (LOD) cloud. Due to a large size of LOD cloud on the Web and the RDF representation of linked dataset, searching and retrieving relevant data on the Web is a major challenge. Because the data is published in RDF triple format, i.e. an interlinked structure, traditional search engines are unable to perform searches on Linked Data. This article introduces LOD search engine, a novel semantic search engine that searches on Semantic Web documents (such as Linked Data or triples) to retrieve a set of relevant information based on user queries. For searching over triples, we proposed two semantic search methods: Forward Search and Backward Search. To improve search results, two new ranking methods have also been introduced: Domain Ranking and Triple Ranking. The proposed LOD search engine produced remarkable results and outperformed other semantic search engines. In the best-case scenario, the proposed LOD search engine outperforms the swoogle and falcons by 22.35%, 43.38% and 33.18% in terms of precision, recall, and F-Measure respectively.

Blood stream infection (BSI) is a potentially lethal complication in patients receiving extracorporeal membrane oxygenation (ECMO). It may be particularly common in patients with veno-venous ECMO due to their long hospitalization in the intensive care unit. Given that these patients have concurrent indwelling central venous catheters (CVC), it is unclear whether the ECMO circuit, CVC, or both, contribute to BSI. This study evaluated the risk factors associated with BSI in patients receiving veno-venous ECMO in a single institution study of 61 patients from 2016 through 2019. All ECMO catheters and the circuit oxygenator fluid were aseptically collected and analyzed for microorganisms at the time of decannulation. New BSI was diagnosed in 15 (24.6%) patients and increased mortality by threefold. None of the ECMO catheters or oxygenator fluid were culture positive. BSI increased with CVC use of over 8 days and was significantly lowered when CVC were exchanged by day 8 compared with patients with exchanges at later points (15.0% vs. 42.8%, p = 0.02). Median length of CVC use in the BSI-negative and BSI-positive group were 6.3 ± 5.0 and 9.4 ± 5.1, respectively (p = 0.04). In summary, BSI is a potentially lethal complication in patients receiving ECMO. Indwelling CVC, not the ECMO circuitry, is the likely contributor for BSI, and exchanging CVC by day 8 can reduce the incidence of BSI.

Background: Proper diagnosis plays key roles in the treatment and prognosis of all diseases. Although histopathological diagnosis is still known as the gold standard, final diagnosis becomes difficult unless precise clinical descriptions are obtained. So, this study aimed to evaluate the consistency of the clinical and histopathological diagnoses of all oral and maxillofacial biopsy specimens in a 12–year duration.Methods: After receiving the ethical approval from Shiraz University of Medical Sciences, archive files and clinical findings related to 3001 patients who had been referred to the Department of Oral Pathology during a 12-year period, were reviewed. The recorded information in files included age, sex, lesion’s location, clinical and histopathological diagnoses, and specialty of dentists.Results: Out of 3001 cases included and reviewed in this study, 2167 cases (72.2%) were consistent between clinical and histopathologic diagnoses. The highest frequency of oral lesions was found in the mandibular bone and the lowest one was in the floor of mouth. Age, sex, and clinician’s specialty were indicated to have no significant effect on diagnosis (p> 0.05), but location and type of lesion affected that (p Conclusions: The results of the present study show that the consistency of clinical and histopathological diagnoses was three times more than their inconsistency, and the accuracy of the clinicians was largely acceptable.

The coronavirus disease 2019 (COVID-19) pandemic requires the continued development of safe, long-lasting, and efficacious vaccines for preventive responses to major outbreaks around the world, and especially in isolated and developing countries. To combat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we characterize a temperature-stable vaccine candidate (TOH-Vac1) that uses a replication-competent, attenuated vaccinia virus as a vector to express a membrane-tethered spike receptor binding domain (RBD) antigen. We evaluate the effects of dose escalation and administration routes on vaccine safety, efficacy, and immunogenicity in animal models. Our vaccine induces high levels of SARS-CoV-2 neutralizing antibodies and favorable T cell responses, while maintaining an optimal safety profile in mice and cynomolgus macaques. We demonstrate robust immune responses and protective immunity against SARS-CoV-2 variants after only a single dose. Together, these findings support further development of our novel and versatile vaccine platform as an alternative or complementary approach to current vaccines., Graphical abstract, To combat SARS-CoV-2, we characterize a novel vaccine candidate (TOH-Vac1) that uses a replication-competent, attenuated vaccinia virus as a vector to express a membrane-tethered spike receptor binding domain antigen. We evaluate the effects of dose escalation and administration routes on vaccine safety, efficacy, and immunogenicity in mice and cynomolgus macaques.

A 38-year-old woman who had previously been diagnosed and treated for unilateral Vogt-Koyanagi-Harada syndrome (VKH) and had undergone multiple intravitreal bevacizumab injections to manage inflammatory choroidal neovascularisation in her right eye, presented 2 years later with visual complains in left eye. Clinical examination, fluorescein angiography, indocyanine green angiography (ICGA) and enhanced depth imaging optical coherence tomography (EDI-OCT) assisted evaluation confirmed active inflammation of left eye along with absence of any inflammation in the right eye. Unilateral active inflammation can be seen in the setting of VKH. To our best knowledge, ours is the first case of VKH in which unilateral active inflammation has been proven based on ICGA and EDI OCT analysis.

Smartphone applications have gained popularity in recent years due to the large footprint of mobile phone usage and availability of a large number of value-added applications. The official app stores (google, IOS, Microsoft, Amazon) provide a platform for hosting, publishing, distributing, and managing the mobile applications developed by companies and individuals. This mobile application ecosystem could be used to distribute the malicious apps which are specifically designed to track behaviour of users, spy on the activities of users, and could be a threat to the privacy, confidentiality, and integrity of the users. In this paper, we present a novel approach called DEEPSEL (Deep Feature Selection), a deep learning-based method for the identification of malware and malicious codes within android applications. DEEPSEL uses a set of features to characterize the behaviour of android applications and classify them as legitimate and malicious. The main contribution is characterized by the usage of particle swarm optimization for performing feature selection. We evaluated our approach on a public malware data-set which is composed of samples collected from 39 unique malware families. Our results show that the proposed method can achieve very good results with an accuracy of around 83.6% and an F-measure of around 82.5%.

Background Immune checkpoint inhibitor monotherapy in metastatic castration-resistant prostate cancer (mCRPC) has produced modest results. High-dose radiotherapy may be synergistic with checkpoint inhibitors. Objective To evaluate the efficacy and safety of the PD-L1 inhibitor avelumab with stereotactic ablative body radiotherapy (SABR) in mCRPC. Design, setting, and participants From November 2017 to July 2019, this prospective phase 2 study enrolled 31 men with progressive mCRPC after at least one prior androgen receptor–directed therapy. Median follow-up was 18.0 mo. Intervention Avelumab 10 mg/kg intravenously every 2 wk for 24 wk (12 cycles). A single fraction of SABR (20 Gy) was administered to one or two disease sites within 5 d before the first and second avelumab treatments. Outcomes measurements and statistical analysis The primary endpoint was the disease control rate (DCR), defined as a confirmed complete or partial response of any duration, or stable disease/non–complete response/non–progressive disease for ≥6 mo (Prostate Cancer Clinical Trials Working Group 3–modified Response Evaluation Criteria in Solid Tumours version 1.1). Secondary endpoints were the objective response rate (ORR), radiographic progression-free survival (rPFS), overall survival (OS), and safety. DCR and ORR were calculated using the Clopper-Pearson exact binomial method. Results and limitations Thirty-one evaluable men were enrolled (median age 71 yr, 71% with ≥2 prior mCRPC therapy lines, 81% with >5 total metastases). The DCR was 48% (15/31; 95% confidence interval [CI] 30–67%) and ORR was 31% (five of 16; 95% CI 11–59%). The ORR in nonirradiated lesions was 33% (four of 12; 95% CI 10–65%). Median rPFS was 8.4 mo (95% CI 4.5–not reached [NR]) and median OS was 14.1 mo (95% CI 8.9–NR). Grade 3–4 treatment-related adverse events occurred in six patients (16%), with three (10%) requiring high-dose corticosteroid therapy. Plasma androgen receptor alterations were associated with lower DCR (22% vs 71%, p = 0.13; Fisher’s exact test). Limitations include the small sample size and the absence of a control arm. Conclusions Avelumab with SABR demonstrated encouraging activity and acceptable toxicity in treatment-refractory mCRPC. This combination warrants further investigation. Patient summary In this study of men with advanced and heavily pretreated prostate cancer, combining stereotactic radiotherapy with avelumab immunotherapy was safe and resulted in nearly half of patients experiencing cancer control for 6 months or longer. Stereotactic radiotherapy may potentially improve the effectiveness of immunotherapy in prostate cancer.

In this article, thermodynamic modeling of a cogeneration system consisting of a series two-stage organic Rankine cycle (STORC) and a proton exchange membrane (PEM) fuel cell is conducted. The fuel cell dissipated heat is utilized as STORC plant input. In order to gain a higher efficiency for the proposed cogeneration system, the condenser of the organic Rankin cycle is replaced by a thermoelectric generator (TEG) to minimize heat loss. Moreover, zeotropic mixtures have been employed due to their lower irreversibility compared to single working fluid. Simulation code is developed in MATLAB software linked with the REFPROP software to extract the thermodynamic properties. This simulation code calculates the exergy efficiency and system's total cost rate. Since the performance of the system is affected by the working fluid, three zeotropic mixtures are compared with R123. The parametric study shows that high pressure (HP) and low pressure (LP) evaporator temperature, current density, and PEM operating pressure significantly affect the total cost rate and the second law efficiency. The results indicate that Ipentane-cis Butane has better efficiency among the selected zeotropic mixtures. Furthermore, the genetic algorithm multi-objective optimization is applied to determine the optimal design parameters of the system in a scatter distribution schematic. Finally, the normalized Pareto frontier of Ipentane-cis Butane is given and the related best point of working as a higher exergy efficiency and lower cost rate are specified. Eventually, it is concluded that the integration of STORC with primary PEM fuel cell improves overall exergy efficiency by 1.9%. The total cost rate for optimum point can be in a range of 1.36–14.94 ($/h), depending on the hydrogen production process.

A 58-year-old man gave a history of injury with chisel while hammering 16 years ago for which he did not seek any form of treatment and had no vision loss at the time. On examination, he had a self-sealed corneal perforation with a localised iris defect ([figure 1A][1]). On pupillary dilatation, a

Background Accurate estimates of gestational age (GA) at birth are important for preterm birth surveillance but can be challenging to obtain in low income countries. Our objective was to develop machine learning models to accurately estimate GA shortly after birth using clinical and metabolomic data. Methods We derived three GA estimation models using ELASTIC NET multivariable linear regression using metabolomic markers from heel-prick blood samples and clinical data from a retrospective cohort of newborns from Ontario, Canada. We conducted internal model validation in an independent cohort of Ontario newborns, and external validation in heel prick and cord blood sample data collected from newborns from prospective birth cohorts in Lusaka, Zambia and Matlab, Bangladesh. Model performance was measured by comparing model-derived estimates of GA to reference estimates from early pregnancy ultrasound. Results Samples were collected from 311 newborns from Zambia and 1176 from Bangladesh. The best-performing model accurately estimated GA within about 6 days of ultrasound estimates in both cohorts when applied to heel prick data (MAE 0.79 weeks (95% CI 0.69, 0.90) for Zambia; 0.81 weeks (0.75, 0.86) for Bangladesh), and within about 7 days when applied to cord blood data (1.02 weeks (0.90, 1.15) for Zambia; 0.95 weeks (0.90, 0.99) for Bangladesh). Conclusions Algorithms developed in Canada provided accurate estimates of GA when applied to external cohorts from Zambia and Bangladesh. Model performance was superior in heel prick data as compared to cord blood data.

Objectives: To assess the concepts of complete denture occlusion among dental fraternity. Study Design And Setting: Cross-sectional study conducted at various dental hospitals and institutes of Karachi, for a period of six months, from 1st June’2019 to 30th November’2019 Methodology: Total 849 dental practitioners who are currently practising were included. A well-structured and validated questionnaire was used for data collection. SPSS version 25 was used. Results: Bilateral balanced occlusion was an ideal occlusion by majority subjects i.e, 530(62.4%) in patients with wellformed ridges, followed by 464(54.7%) candidates with skeletal class 1, total 376(44.3%) chose it with uncontrolled diabetes mellitus, 365(43%) in single complete denture cases, 339(39.9%) with increased inter-arch space, 298(35.1%) with parafunction habits, 296(34.9%) in patients with history of neuromuscular disorder and 271(31.9%) where a complete denture opposes a removable partial denture. Furthermore, Lingualized occlusion was preferred by 341(40.25%) participants for patients with skeletal class 3. Total 316(37.2%) candidates chose it for patients with displaceable supporting tissue followed by 264(31.1%) who chose it for skeletal 2 and 260(30.6%) for cases of highly resorbed ridges. Lastly, 311(36.6%) chose canine guided occlusion with highly resorbed ridges accompanied by high aesthetic demand A significant difference between education level and knowledge of occlusal schemes was also found. Chi-square (73.87), df 6, p-value =0.000. Conclusion: Dental practitioners lack adequate knowledge of occlusal schemes in terms of prescription in complete denture patients. A significant difference between the education level and knowledge of occlusal schemes was found. Therefore, awareness of various occlusal schemes should be increased at undergraduate level.

BACKGROUND & OBJECTIVE: Missed root/canal is one of the main causes of endodontic failure. Permanent mandibular canine is considered to be a single rooted tooth. The complex pattern of root canal system poses difficulty in the root canal treatment and the prognosis becomes uncertain if the debridement and obturation of the root canals is not satisfactory therefore our objective of the study is to assess frequency of two roots in permanent mandibular canine of Pakistani population using CBCT scan. METHODOLOGY: A descriptive; retrospective study was planned by using Cone Beam Computerized Tomography (CBCT) images of the past 02 year, i.e. December 2017 till November 2018. Images were assessed for the number of roots in permanent mandibular canines using software NNTVIEWER NewTOM. Data was entered and analyzed using SPSS 21. RESULTS: 134 permanent mandibular canines of 67 patients were studied. 64.2% of the images were of male patients while 35.8% were of females. Mean age of the patients was 48.12 ± 15.92 years. 7 (5.22%) out of 134 canines had two roots. 4 patients (5.97%) had canines with 2 roots of which 3 patients (4.48%) had bilateral two-rooted canines and 1 patient (1.49%) had unilateral two-rooted canines. Frequency of two roots in mandibular canines had no association with gender (p= 0.127). CONCLUSION: All mandibular permanent canines were single rooted but 5.2% of the permanent mandibular canines had two roots.

The pathogenesis of SARS-CoV-2 infection, causative pathogen of the known COVID-19 pandemic is not well clarified. In this regard oxidative stress is one of the topics that need to be investigated. Therefore, the present research was performed to explore the relationship between the oxidant/antioxidant system and COVID-19 exacerbation. Sera were collected from 120 patients with COVID-19 infection and 60 healthy volunteers as the control group. The patient group consisted of 60 cases with mild disease and 60 severely ill patients. Serum levels of total antioxidant capacity (TAC) and nitric oxide (NO) as well as serum activities of the two main antioxidant defense enzymes, superoxide dismutase (SOD) and catalase (CAT), were measured. TAC levels were considerably lower in patients compared with healthy individuals (p 0.05) and also between patients with mild and severe diseases (p 0.05). A rather decreasing trend was also found in NO concentration as well as SOD and CAT activity, though, the observed differences were not statistically significant (p 0.05). These findings suggest that COVID-19 patients may be susceptible to depleted total antioxidant capacity. Moreover, showing such variations in blood samples of infected individuals could be considered as a predictive marker of COVID-19 severity.

In this paper, we propose a multi-objective learning approach for online recruiting. Online recruiting and online dating are the most known reciprocal recommendation problems. However, the reciprocal recommendation has gained little attention in the literature due to the lack of public datasets consisting of reciprocal preferences of users in a network. We aim to resolve this shortage in our study. Since the satisfaction of both candidates and companies is indispensable for successful hiring as opposed to traditional recommenders, online recruiting should respect to expectations of all parties and meet their common interests as much as possible. For this purpose, we integrated our multi-objective learning approach into various state-of-the-art methods, whose success has been proven on similar prediction problems, and we achieved encouraging results. We named and proposed one of the prominent architectures that we've tested on the problem as a prototype of our multi-objective learning approach however our approach is applicable to any recommender system employing neural networks as its final decision-maker. (C) 2021 Karabuk University. Publishing services by Elsevier B.V.

Background Trials of lutetium prostate specific membrane antigen (PSMA) in men with metastatic castration-resistant prostate cancer (mCRPC) have demonstrated good safety and efficacy, but combination strategies may improve outcomes. Idronoxil is a synthetic flavonoid derivative with radiosensitising properties. Objective To evaluate the safety and activity of 177Lu PSMA 617 (LuPSMA-617) in combination with idronoxil suppositories (NOX66) in patients with end-stage mCRPC. Design, setting, and participants Thirty-two men with progressive mCRPC previously treated with taxane-based chemotherapy (91% treated with both docetaxel and cabazitaxel) and abiraterone and/or enzalutamide were enrolled in this phase I dose escalation study with phase II dose expansion. Intervention Screening with 68Ga PSMA and 18F-fludeoxyglucose positron emission tomography (PET)/computed tomography (CT) was performed. Men received up to six cycles of LuPSMA-617 (7.5 GBq) on day 1, with escalating doses of NOX66 on days 1–10 of a 6-wk cycle. Cohort 1 (n = 8) received 400 mg and cohort 2 (n = 24) 800 mg of NOX66. Outcome measurements and statistical analysis Adverse events (AEs), pain inventory scores, prostate-specific antigen (PSA) response, progression-free survival, and overall survival were evaluated. Results and limitations Fifty-six men were screened and 32 (57%) were enrolled with a screen failure rate of 21% for PET imaging criteria. Dosing was as follows: 97% (31/32) received two or more doses and 47% (15/32) completed six doses. Common AEs included xerostomia, fatigue, and anaemia. Anal irritation attributable to NOX66 occurred in 28%. PSA responses were as follows: 91% (29/32) had any PSA response (median –74%; 95% confidence interval [CI] 76–97) and 62.5% (20/32) had a PSA fall of >50% (95% CI 45–77). The median PSA progression-free survival was 6.1 mo (95% CI 2.8–9.2) and median overall survival was 17.1 mo (95% CI 6.5–27.1). Conclusions NOX66 with LuPSMA-617 is a safe and feasible therapeutic strategy in men treated with third-line therapy and beyond for mCRPC. Patient summary Addition of NOX66 to 177Lu prostate-specific membrane antigen 617 is safe, and further studies are needed to assess its potential to augment the anticancer effects of LuPSMA-617.

INTRODUCTION Despite increased prevalence and identification of pediatric behavioral health concerns, families face many barriers when attempting to access behavioral health services. System navigators, or individuals experienced in navigating the health system, help to engage families in services by helping individuals overcome barriers for accessing care. However, limited research to date has systematically reviewed the implementation and effectiveness of navigation models in pediatric populations. METHOD We systematically reviewed published studies examining navigation models for pediatric populations (up to age 18) referred to behavioral health services. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO for studies that evaluated a navigation model and included service use outcomes. We aggregated data pertaining to characteristics of the study and navigation model, service use outcomes, and implementation outcomes. RESULTS Eight studies met inclusion criteria. Families who participated in navigation services were more likely to complete diagnostic assessments and received an increased dosage (e.g., time spent, services completed) of behavioral health treatments. There was notable variability across studies in terms of processes involved in the navigation models. DISCUSSION Findings indicate that system navigation is a promising method for improving service use for pediatric populations referred to behavioral health services. Future research may continue to examine the effectiveness and implementation of the model, to best understand its benefits and what processes may contribute to improved service outcomes. Public Significance Statement: This paper reviews the effectiveness of system navigator models, which are designed to engage children and families in behavioral health services. The interventions reviewed are associated with increased behavioral health service use in children and show promise as a method of overcoming barriers to accessing behavioral health care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: Organophosphorus compound (OPC) poisoning is an important clinical problem in the developing world and kills an estimated 3,00,000 people every year. In spite of high case fatality rate early and proper management is crucial to save the lives and alleviate the sufferings. Amylase level is an important biochemical marker, which is closely related to severity of acute OPC poisoning. Therefore, to assess Serum amylase level in acute organophosphorus compound poisoning in a tertiary level hospital was the objective of the study. Methods: This research was a hospital based descriptive cross-sectional study and was conducted at the inpatient department of Medicine in Dhaka Medical College. 50 Patient admitted in medicine department due to OPC poisoning and evidenced by history taking and physical examination were included in the study. Ethical issues were ensured properly. After written informed consent history and physical examination were done. Rest of the data were collected by interviewing each patient or from attendant of the patient by using a semi-structured questionnaire. Scoring of the severity were done by researcher himself by Peradeniya Organophosphorus Poisoning (POP) scale (Score range 0 to 11). Values of amylase level were collected from patient record file. All the Data was analysed by computer with the help of SPSS 16. Results: Out of a total of 50 patients, 24 (48%) were males and 26 (52%) were females. OPC poisoning was most frequent (52%) in age group 21-30 years. Mean age was 23.96 ± 6.071 SD. 96% (48) study population were Muslim and rest 4 % (2) were Hindus with diverse occupation. 86% population came from rural area whereas only 14% population reside in urban area. Among them suicidal attempts were seen significantly which was 96% and rest of them were accidental ingestion. Amylase level estimation were done in each case and 32 % (16) patient had elevated amylase level (>100U/L) and 68% (34) patient had amylase level within normal limit. Mean amylase concentration was 62.2U/L (SD±18.77) and among the 16 patients who had elevated serum amylase level mean concentration was 376.56U/L (SD±266.124). Mean amylase level differed significantly between these two groups (p value < 0.0001) estimated by one way ANOVA. Spearman Correlation and One way ANOVA both showed significant association between severity (assessed by POP scale) and elevated level of serum amylase (p value

This study identifies efficient earthquake intensity measures (IMs) for seismic performances and fragility evaluations of the reactor containment building (RCB) in the advanced power reactor 1400 (APR1400) nuclear power plant (NPP). The computational model of RCB is constructed using the beam-truss model (BTM) for nonlinear analyses. A total of 90 ground motion records and 20 different IMs are employed for numerical analyses. A series of nonlinear time-history analyses are performed to monitor maximum floor displacements and accelerations of RCB. Then, probabilistic seismic demand models of RCB are developed for each IM. Statistical parameters including coefficient of determination (R2), dispersion (i.e. standard deviation), practicality, and proficiency are calculated to recognize strongly correlated IMs with the seismic performance of the NPP structure. The numerical results show that the optimal IMs are spectral acceleration, spectral velocity, spectral displacement at the fundamental period, acceleration spectrum intensity, effective peak acceleration, peak ground acceleration, A95, and sustained maximum acceleration. Moreover, weakly related IMs to the seismic performance of RCB are peak ground displacement, root-mean-square of displacement, specific energy density, root-mean-square of velocity, peak ground velocity, Housner intensity, velocity spectrum intensity, and sustained maximum velocity. Finally, a set of fragility curves of RCB are developed for optimal IMs.

Molibresib is an orally bioavailable, selective, small molecule BET protein inhibitor. Results from a first time in human study in solid tumors resulted in the selection of a 75 mg once daily dose of the besylate formulation of molibresib as the recommended Phase 2 dose (RP2D). Here we present the results of Part 2 of this study, investigating safety, pharmacokinetics, pharmacodynamics, and clinical activity of molibresib at the RP2D for nuclear protein in testis carcinoma (NC), small cell lung cancer, castration-resistant prostate cancer (CRPC), triple-negative breast cancer, estrogen receptor-positive breast cancer, and gastrointestinal stromal tumor. The primary safety endpoints were incidence of adverse events (AEs) and serious AEs; the primary efficacy endpoint was overall response rate. Secondary endpoints included plasma concentrations and gene set enrichment analysis (GSEA). Molibresib 75 mg once daily demonstrated no unexpected toxicities. The most common treatment-related AEs (any grade) were thrombocytopenia (64%), nausea (43%), and decreased appetite (37%); 83% of patients required dose interruptions and 29% required dose reductions due to AEs. Anti-tumor activity was observed in NC and CRPC (one confirmed partial response each, with observed reductions in tumor size), although predefined clinically meaningful response rates were not met for any tumor type. Total active moiety median plasma concentrations after single and repeated administration were similar across tumor cohorts. GSEA revealed that gene expression changes with molibresib varied by patient, response status, and tumor type. Investigations into combinatorial approaches that use BET inhibition to eliminate resistance to other targeted therapies are warranted. This article is protected by copyright. All rights reserved.

PURPOSE: The aim of our study was to evaluate the availability of magnetic resonance spectroscopy (MRS) for the differentiation of benign or malignant pulmonary nodules and masses. METHODS: A total of 59 patients (45 male, 14 female) with pulmonary nodules and masses were included in this prospective study. MRS was applied to the pulmonary lesions of the patients and choline levels were determined. Afterwards CT-guided percutaneous needle biopsy was performed. According to the biopsy results, pulmonary lesions were benign in 25 patients and malignant in 34 patients. RESULTS: Choline levels were significantly higher in malignant lesions compared with benign lesions (p < 0.001). When the other conditions were kept constant, the probability of malignancy significantly increased by 17.38-fold (95% CI, 3.78–79.93) in those with choline levels >1.65 μmol/g compared to those with choline levels ≤1.65 μmol/g (p < 0.001). CONCLUSION: MRS is a noninvasive method that can be used in the differential diagnosis of pulmonary nodules and masses.

Introduction: Bell’s palsy is a common cranial neuropathy causing acute onset of unilateral lower motor neuron type of seventh cranial nerve palsy that result in ipsilateral facial muscle weakness. The aim of this study was to determine the possible correlation of Bell’s palsy and seasonal influence in a district area of Bangladesh. Materials & Methods: This is an observational study in which we collect, compiled and analyzed the patients information who attended in outpatient department of neuromedicine unit at Cumilla medical college hospital Cumilla from January 2018 to December 2019. Results: In our study, out of 214 patients male were 117(54.7%) and female were 97(45.3%). Age range from 4 to 90 yrs, median age was 40.0±17.6 Number of patients with Bell’s palsy presented in various seasons include 44% during winter, 35% during summer, 9% during fall monsoon and 12% during autumn period. We analyzed the data by using Mean±SD and chi-square test. A significant association was evident in winter and summer season (P=0.04 and P=0.045) respectively. Conclusion: In our present study we found significant relation between seasonal variation and occurrence of Bell’s palsy. Medicine Today 2021 Vol.33(2): 129-132

BACKGROUND AND OBJECTIVES The use of group A thawed 24-h plasma when resuscitating haemorrhagic shock patients has become more common; however, limited data exist on the clinical use of liquid plasma (LP). Our aim is to determine whether LP is of clinical benefit to patients requiring massive transfusion. MATERIALS AND METHODS The objective of this retrospective study was to detect any difference in 24-h survival between patients receiving liquid or thawed plasma (TP) during their massive transfusion activation. Other objectives were to report any difference in hospital length of stay (LOS), intensive care unit (ICU) LOS and in-hospital survival. Data collected included gender, age, mechanism of injury, Injury Severity Score, Revised Trauma Score and Trauma Injury Severity Score. RESULTS A total of 178 patients received 1283 units of LP, median 4 and range (1-56), whereas 270 patients received 2031 units of TP, median 5 and range (1-87). The two study groups were comparable in terms of gender, age, mechanism of injury, whole blood, red blood cells, platelets and cryoprecipitate transfused. The use of LP during the massive transfusion activation in traumatically injured patients was not associated with increased 24-h survival compared to when using TP, p = 0.553. CONCLUSION Our study did not show a difference in 24-h or 30-day survival between the use of LP compared to TP in trauma patients. LP should be considered an alternative to TP in trauma patients requiring immediate plasma resuscitation.

Today's smartphones are equipped with a large number of powerful value-added sensors and features, such as a low-power Bluetooth sensor, powerful embedded sensors, such as the digital compass, accelerometer, GPS sensors, Wi-Fi capabilities, microphone, humidity sensors, health tracking sensors, and a camera, etc. These value-added sensors have revolutionized the lives of the human being in many ways, such as tracking the health of the patients and the movement of doctors, tracking employees movement in large manufacturing units, monitoring the environment, etc. These embedded sensors could also be used for large-scale personal, group, and community sensing applications especially tracing the spread of certain diseases. Governments and regulators are turning to use these features to trace the people's thoughts to have symptoms of certain diseases or viruses, e.g., COVID-19. The outbreak of COVID-19 in December 2019, has seen a surge of the mobile applications for tracing, tracking, and isolating the persons showing COVID-19 symptoms to limit the spread of the disease to the larger community. The use of embedded sensors could disclose private information of the users, thus potentially bring a threat to the privacy and security of users. In this article, we analyzed a large set of smartphone applications that have been designed to contain the spread of the COVID-19 virus and bring the people back to normal life. Specifically, we have analyzed what type of permission these smartphone apps require, whether these permissions are necessary for the track and trace, how data from the user devices are transported to the analytic center, and analyzing the security measures these apps have deployed to ensure the privacy and security of users.

INTRODUCTION: Bone metastases occur frequently in castration-resistant prostate cancer (CRPC) and may lead to skeletal-related events (SREs), including symptomatic skeletal events (SSEs). Bone-modifying agents (BMAs) delay SREs and SSEs. However, the real-world use of BMAs is debated given the absence of demonstrated survival advantage and potential adverse events (AEs). Our retrospective study examined BMA use and SSE rates in Australian patients with CRPC. METHODS: Patients with CRPC and bone metastases were identified from the electronic CRPC Australian Database. Patient characteristics, treatment patterns and AEs were analysed. Descriptive statistics reported baseline characteristics, SSE rates and BMA use. Comparisons between groups used t-tests and Chi-square analyses. Overall survival was calculated by the Kaplan-Meier method. RESULTS: A total of 532 eligible patients were identified with a median age of 73 years (range: 44-97 years). BMAs were prescribed in 232 men (46%), 183 of whom received denosumab. Patients receiving first-line docetaxel for CRPC were more likely to commence BMAs than those receiving abiraterone or enzalutamide (51% vs 31% vs 38%; p = 0.004). SSEs occurred in 148 men (28%), most commonly symptomatic lesions requiring intervention (75%). At the time of initial SSEs, only 28% were receiving BMAs. Patients treated at sites with lower BMA use (

Purpose: To evaluate risk factors and outcomes of preferred practice for infants with aggressive posterior retinopathy of prematurity (APROP) at a tertiary eye center in India. Methods: This was an observational study of infants with APROP where patients were divided into three groups after 2 weeks of initial treatment depending on the treatment received: anti-VEGF only, laser only, and combination of anti-VEGF injection followed by laser within 2 weeks of anti-VEGF injection (combined group). All infants were evaluated for risk factors and followed up at 1, 2, 4, 8, and 12 weeks to determine treatment outcomes in terms of regression, vascular re-growth, progression, and recurrence of the disease. Results: Sixty eyes of 31 infants were included in the study, with 26 eyes in the anti-VEGF only group, 19 eyes in the laser-only group, and 15 eyes in the combined group. Infants in the combined group presented late with lower birth weight (BW), smaller gestational age (GA), and a history of longer duration of ventilatory support. After 3 months of follow-up, regression occurred in 73.08% in the anti-VEGF only group, 89.5% in the laser-only group, and 86.66% in the combined group ( P = .07). Zone of vascularization was greater in the anti-VEGF only group and the combined group compared to the laser-only group. Disease recurrence was seen in 27% in the anti-VEGF group, none in the laser-only group, and 13.33% in the combined group ( P < .001). However, progression to stage 4 ROP requiring surgery was noted in 2 eyes in the laser-only group. Conclusions: Infants with APROP who have a lower GA or BW or require longer ventilatory support are possibly a subset best suited for planned combination therapy. A combination of anti-VEGF therapy followed by laser treatment within 2 weeks allows for early regression, a stable course, lower recurrence, and a larger area of retinal vascularization. [ J Pediatr Ophthalmol Strabismus . 2021;58(6):370–376.]

PURPOSE Tumor tissue from metastatic castration-resistant prostate cancer (mCRPC) harbors frequent copy number variations (CNVs) in the PTEN-PI3K-AKT pathway. However, identifying CNVs in plasma cell–free DNA (cfDNA) has proven to be challenging. With emerging data supporting Akt inhibition in PTEN-deficient mCRPC, we profiled PTEN-PI3K-AKT pathway aberrations in patients with mCRPC using a novel cfDNA assay optimized for CNV detection. METHODS A next-generation sequencing–based cfDNA assay was used to profile 231 patients with mCRPC from two independent cohorts (Australian, n = 78; United States, n = 153). PTEN-PI3K-AKT pathway genomic aberrations were correlated with clinical outcomes, including progression-free survival and overall survival (OS). RESULTS PTEN loss and PIK3CA gain were detected in 37% (85 of 231) and 17% (39 of 231) of patients, respectively. Poorer outcomes were observed in patients with PTEN-PI3K-AKT pathway aberrations, including those with dual PTEN loss and PIK3CA gain (hazard ratio 2.3, 95% CI 1.2 to 4.4). Cumulative CNV burden in the PTEN-PI3K-AKT and androgen receptor (AR) pathways was associated with significantly worse clinical outcomes (0 v 1 v ≥ 2 CNVs in Australian cohort: median OS 33.5 v 17.2 v 9.7 months, P < .001; 0 v 1 v ≥ 2 CNVs in US cohort: median OS 35.5 v 14.3 v 9.2 months, P < .001). Notably, 21% (31 of 146) of PTEN-neutral patients harbored alternative PTEN-PI3K-AKT pathway aberrations. CONCLUSION PTEN-PI3K-AKT pathway CNVs were readily detected using our cfDNA assay, with the prevalence of PTEN loss comparable with tissue-based studies. Additional PTEN-PI3K-AKT pathway aberrations were found in one fifth of PTEN-neutral cases. Concurrent CNVs in the PTEN-PI3K-AKT and AR pathways portended poor survival, and identifying this high-risk patient subset for dual AR/Akt inhibition may optimize precision treatment with Akt inhibitors in mCRPC.

Objective: To determine the association of perceived stress and coping strategies with depressive symptoms in students at a private medical college in Islamabad. Study Design: Correlational study. Place and Duration of Study: Foundation University Medical College, Islamabad, from Jun to Dec 2019. Methodology: Fourth and Final year medical students of Foundation university medical college were enrolled in the study. Beck’s Depression Inventory was used to assess the depressive symptoms, perceived stress scale (PSS) was the tool used to look for the perceived stress and the coping strategies were assessed using the Brief Coping Orientation to Problems experienced (Brief COPE) Inventory. The association of perceived stress and coping strategies with depressive symptoms and other sociodemographic factors was established with the help of the chi-square test. Results: Out of 262 medical students included in the study, 211 (80.5%) had none or mild depressive symptoms while 51 (19.5%) had moderate to severe depressive symptoms. Sixty-six (25.2%) had low stress, 127 (48.4%) had moderate stress while 69 (26.3%) reported high stress levels. Pearson chi-square test revealed that perceived stress and the coping strategies used including self-distraction, active coping, denial, substance use, behavioural disengagement, positive reframing, acceptance, religion/spirituality and self-blaming had a statistically significant relationship with the presence of depressive symptoms among the target population. Conclusion: Considerable number of medical students had the presence of moderate to severe depressive symptoms in our study. Perceived stress and some specific kinds of coping strategies had a significant association with the presence of depressive symptoms among the target.......

Left atrial appendage aneurysm is a rare heart defect; Most often diagnosed incidentally but may be potentially hazardous when presented with a systemic embolization or arrhythmia. So early diagnosis and treatment is indicated. We have successfully operated two cases of left atrial aneurysm in recent past and sharing our experiences through this case reports. Bangladesh Heart Journal 2021; 36(2): 158-163

Background: Corona Virus Disease (COVID -19) patients present mainly with respiratory manifestations and viral pneumonia. The cardiovascular presentation includes early signs of acute myocardial injury. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or nonspecific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities and mortality. Methods and materials: It was a prospective observational study, conducted in four tertiary care Private Hospitals of Chattogram City of Bangladesh. The study enrolled 181 consecutive patients admitted to hospital from June 01, 2020 to December 31, 2020 due to Covid-19 disease on the basis of presentation of signs and symptoms severity. Upon admission, routine investigations cTnI and ECG were carried out. Results: Mean age of the patients was 54.3±7.3 years with 63.5% male. Hypertension was the most common comorbidity followed by diabetes and obesity. 57.1% of the patients had abnormal ECG. Abnormal axis deviation [26 % (left axis deviation 23.9% vs right axis deviation 2.0%)], Poor R wave progression (22.9%), T inversion (14.5%), left ventricular hypertrophy (LVH) (11.4%) followed by ST segment depression (8.3%) were major findings observed in the study population. Presence of LVH (p=0.008), ST segment elevation (p≤0.001), ST segment depression (p≤0.001) and T inversion (p=0.003) showed statistically significant association with Severe COVID-19 disease. 48.2% had raised cTnI level. Thirteen (7.2%) patients expired in hospital. The mortality rate increased with incrementally higher troponin group: 12/18 than mildly elevated troponin 1/63 (p < 0.01). The presence of an abnormal ECG finding resulted in significant in the intermediate Troponin elevation group (0.05-1 ng/ml) but not in the low ( 1 ng/ml) Troponin elevation groups. There were statistically significant association between between cTnI level and death; and between ECG findings and death. Conclusion: Study conclude that Troponin-I level and ECG are a prognostic factor for mortality in hospitalized COVID-19 patients. Bangladesh Heart Journal 2021; 36(2): 105-112

Beckground: This is often difficult to achieve optimal pain relief after coronary artery bypass surgery and also great challenge to choice appropriate analgesics with minimize the duration of mechanical ventilation. In the postoperative period inadequate analgesia may increase morbidity by causing adverse haemodynamic, metabolic, immunologic and haemostatic attentions and prolong mechanical ventilation with more ICU stay. High Thoracic Epidural Anaesthesia (HTEA) as an adjunct to general anaesthesia has been shown to be potentially beneficial in postoperative pain relief and the requirement of mechanical ventilationin patients with off-pump coronary artery bypass surgery (OPCAB). HTEA provides good protection from stress response, ensures hemodynamic stability, improves distribution of coronary blood flow with reducing demand of oxygen, less requirement of postoperative analgesia , mechanical ventilation and ICU stay. Objective: This study has been undertaken with a view to compare requirement of postoperative mechanical ventilation and analgesics in OPCAB surgery between HTEA with GA and GA alone. Methods: This prospective, randomized case control comparative study was carried out in sixty patients without having left main coronary artery disease, left ventricular ejection fraction 0.05). The mean extubation hours were 7.4±1.09 hours in group A and 5.3±0.81 hours in group B. The mean ICU stay was 72.9±9.2 hours in group A and 57.1±12.0 hours in group B and the difference was statistically significant (p

Coronavirus is affecting millions of people world-wide. Coronavirus disease 2019 (COVID-19) is declared a pandemic by WHO. Severe acute respiratory syndrome corona virus 2(SARS-CoV-2) is the causative agent. The clinical presentations of SARS-CoV-2 infection range from febrile illness to pneumonia, ARDS and multi organ failures. Increasing scientific evidences have shown that abnormalities in routine laboratory test, particularly haematological parameters influence the outcome of the disease. Here variations in WBC profile in several clinical forms of COVID-19 patients are observed, The clinical course of the disease may change with haematological parameters such as lower total count of WBC, lymphocyte, higher neutrophil count, eosinophil count etc. By investigating haematological parameters of different clinical stage of RT-PCR positive 100 COVID-19 patients, statistically significant association (p value 0.001) of lymphocyte count with disease severity was found. It is also found that higher level of total count WBC, neutrophil count in severe group in comparison to mild and moderate groups but failed to reach any statistical significance. Moreover total count WBC and neutrophil count showed positive correlations but lymphocyte count, eosinophil count and monocyte count showed negative correlation with severity of disease. So, complete analysis of the haematological parameters will be very much helpful for early detection of complications & better control of the disease.

Background: Although High body mass index is associated with many cardiovascular diseases including coronary artery disease. Its effect on in-hospital death in patients with acute ST-segment elevation myocardial infarction (STEMI) is still a subject of controversy. Objective: To determine the correlation between body mass index (BMI) and in-hospital mortality in those patients. Patients and Methods: In this cross-sectional study, 180 adult patients with acute STEMI were enrolled and their BMI was measured. The participants were classified according to BMI into three groups as normal, overweight, and obese. A correlation between in-hospital mortality due to STEMI and BMI was evaluated. Results: Of the total participants, 62 (34.4%) were normally weighted, 61(33.8%) were over-weighted, and 57(31.6%) were obese. There was a significant difference (p=

Purpose This paper aims to examine literature on corporate governance from the gender perspective adopting the two novel approaches: bibliometric analysis and content analysis. Design/methodology/approach For citation mapping and comprehensive content analysis, total 393 Web of Science indexed journal articles were selected. Initially, this study identifies the most productive authors, journal sources, countries and affiliation within the study topic. Findings Findings from the intellectual structure explore four underlying research stems in the corporate governance and gender literature: participation of women on corporate boards and their characteristics, women directors and their roles in board across different countries, gender diversity in the board and corporate social responsibility and firm financial performances, risks and stock prices. Originality/value From the content analysis, it is revealed that corporate governance and gender studies have predominantly investigated the gender diversity issues as a catalyst of corporate governance, with a focus on women on corporate boards and firm financial performance, risks and stock price, while the area of board gender diversity and corporate social responsibility remains relatively under-researched.

Alimentary tract duplications may be symptomatic or may be discovered incidentally. They are named for the organ with which they are associated.1 Congenital gastrointestinal (GI) tract duplication cysts are commonly located in the ileum (53%), mediastinum (18%), colon (13%), stomach (7%), duodenum (6%), rectum (4%), or oesophagus (2%)2. A single theory is insufficient to explain all types of duplications.3 Children may present with symptoms like vomiting, abdominal pain, lumps, or weight loss.4 The presence of ectopic gastric mucosa and the potential for malignancy remain matters of concern.2 Surgical management is essential for these rare cysts.5 We encountered a Bangladeshi boy with a gastric duplication cyst (GDC) that was pre-operatively diagnosed as a pancreatic cyst. A variety of imaging modalities failed to indicate GDC before the operation. Here we present the clinical course of the case and discuss the difficulties and problems in diagnosing GDC.

Objectives: To validate and recalibrate the CURB-65 and pneumonia severity index (PSI) in predicting 30-day mortality and critical care intervention (CCI) in a multiethnic population with COVID-19, along with evaluating both models in predicting CCI. Methods: Retrospective data was collected for 1181 patients admitted to the largest hospital in Qatar with COVID-19 pneumonia. The area under the curve (AUC), calibration curves, and other metrics were bootstrapped to examine the performance of the models. Variables constituting the CURB-65 and PSI scores underwent further analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) along with logistic regression to develop a model predicting CCI. Complex machine learning models were built for comparative analysis. Results: The PSI performed better than CURB-65 in predicting 30-day mortality (AUC 0.83, 0.78 respectively), while CURB-65 outperformed PSI in predicting CCI (AUC 0.78, 0.70 respectively). The modified PSI/CURB-65 model (respiratory rate, oxygen saturation, hematocrit, age, sodium, and glucose) predicting CCI had excellent accuracy (AUC 0.823) and good calibration. Conclusions: Our study recalibrated, externally validated the PSI and CURB-65 for predicting 30-day mortality and CCI, and developed a model for predicting CCI. Our tool can potentially guide clinicians in Qatar to stratify patients with COVID-19 pneumonia.

To examine the mediating role of adiposity on the associations of diet quality with longitudinal changes in insulin sensitivity and beta-cell function.Adults at-risk for type 2 diabetes (T2D) in the PROMISE cohort had 4 assessments over 9 years (n = 442). Alternate Healthy Eating Index (AHEI) scores were used to assess diet quality. Generalized Estimating Equations (GEE) evaluated the associations between the AHEI and longitudinal changes in insulin sensitivity (HOMA2-%S and ISI) and beta-cell function (IGI/HOMA-IR and ISSI-2). The proportion of the mediating effect of waist circumference changes was estimated using the difference method. In the primary longitudinal analysis, AHEI was positively associated with insulin sensitivity and beta-cell function over time (% difference per standard deviation increase of AHEI for HOMA2-%S (β = 11.0, 95%CI 5.43-17.0), ISI (β = 10.4, 95%CI 4.35-16.8), IGI/HOMA-IR (β = 7.12, 95%CI 0.98-13.6) and ISSI-2 (β = 4.38, 95%CI 1.05-7.80), all p 0.05). There was no significant association between AHEI and dysglycemia incidence (OR = 0.95, 95%CI 0.77-1.17). Adjustments for longitudinal changes in waist circumference substantially attenuated all associations of AHEI with insulin sensitivity and beta-cell function. Mediation analysis indicated that waist circumference mediated 73%, 70%, 83% and 81% of the association between AHEI and HOMA2-%S, ISI, IGI/HOMA-IR, and ISSI-2, respectively (all p 0.01).In a Canadian population at-risk for T2D, AHEI score was positively associated with changes in insulin sensitivity and beta-cell function. These associations were substantially mediated by waist circumference, suggesting that changes in adiposity may represent an important pathway linking diet quality with risk phenotypes for T2D.

BACKGROUND: The present study aimed to compare serum total IgA levels between severe and mild COVID-19 patients' groups and the control group. METHODS: In this cross-sectional study, 216 definite severe COVID-19 patients (as the inpatient group), 183 subjects with positive specific COVID-19 IgG with mild or no symptoms as the (outpatient group), and 203 healthy subjects with negative specific serology, as the control group were investigated. The cases' laboratory data were collected, and thereafter, statistical tests, including independent samples t test, ANOVA test, and post hoc test, were performed using SPSS software version 22. RESULT: The mean ± SD of IgA in all the included subjects was 2.23 ± 0.78 (g/L). According to the obtained results, there were statistically significant changes in IgA among the three study groups (P value < 0.05). This difference was significant between both outpatient and inpatient groups (P value < 0.05). The mean ± SD of serum IgG in all the subjects was calculated as 15.83 ± 5.73 (g/L). A strong statistically significant change was also seen in IgG among all three groups (P value < 0.001). Of note, there was a significant negative correlation between IgG and IgA total titers of the outpatient group (P value = 0.011*r = - 0.188). CONCLUSION: It was shown that the total serum IgA and IgG levels are significantly associated with the severity of COVID-19 infection. As well, we found that total serum IgA and IgG are associated with the severity of illness. Since a low level of IgA is asymptomatic and high frequent in Iran and other countries, we suggest the evaluation of serum IgA levels in high-risk people and strengthening immune system in subjects with a low level of IgA, in order to reduce the rate of death. In this regard, oral or nasal mucosal vaccines in combination with parenteral vaccination are recommended due to increasing immunity versus COVID-19 by further secretion of the IgA antibody and preventing virus transmission.

Multiple active vaccination approaches have proven ineffective in reducing the substantial morbidity and mortality caused by respiratory syncytial virus (RSV) in infants and older adults (aged ≥65 years). A vaccine conferring a substantial and sustainable boost in neutralising activity is required to protect against severe RSV disease. To that end, we evaluated the safety and immunogenicity of DS-Cav1, a prefusion F subunit vaccine.In this randomised, open-label, phase 1 clinical trial, the stabilised prefusion F vaccine DS-Cav1 was evaluated for dose, safety, tolerability, and immunogenicity in healthy adults aged 18-50 years at a single US site. Participants were assigned to receive escalating doses of either 50 μg, 150 μg, or 500 μg DS-Cav1 at weeks 0 and 12, and were randomly allocated in a 1:1 ratio within each dose group to receive the vaccine with or without aluminium hydroxide (AlOH) adjuvant. After 71 participants had been randomised, the protocol was amended to allow some participants to receive a single vaccination at week 0. The primary objectives evaluated the safety and tolerability at every dose within 28 days following each injection. Neutralising activity and RSV F-binding antibodies were evaluated from week 0 to week 44 as secondary and exploratory objectives. Safety was assessed in all participants who received at least one vaccine dose; secondary and exploratory immunogenicity analysis included all participants with available data at a given visit. The trial is registered with ClinicalTrials.gov, NCT03049488, and is complete and no longer recruiting.Between Feb 21, 2017, and Nov 29, 2018, 244 participants were screened for eligibility and 95 were enrolled to receive DS-Cav1 at the 50 μg (n=30, of which n=15 with AlOH), 150 μg (n=35, of which n=15 with AlOH), or 500 μg (n=30, of which n=15 with AlOH) doses. DS-Cav1 was safe and well tolerated and no serious vaccine-associated adverse events deemed related to the vaccine were identified. DS-Cav1 vaccination elicited robust neutralising activity and binding antibodies by 4 weeks after a single vaccination (p0·0001 for F-binding and neutralising antibodies). In analyses of exploratory endpoints at week 44, pre-F-binding IgG and neutralising activity were significantly increased compared with baseline in all groups. At week 44, RSV A neutralising activity was 3·1 fold above baseline in the 50 μg group, 3·8 fold in the 150 μg group, and 4·5 fold in the 500 μg group (p0·0001). RSV B neutralising activity was 2·8 fold above baseline in the 50 μg group, 3·4 fold in the 150 μg group, and 3·7 fold in the 500 μg group (p0·0001). Pre-F-binding IgG remained significantly 3·2 fold above baseline in the 50 μg group, 3·4 fold in the 150 μg group, and 4·0 fold in the 500 μg group (p0·0001). Pre-F-binding serum IgA remained 4·1 fold above baseline in the 50 μg group, 4·3 fold in the 150 μg group, and 4·8 fold in the 500 μg group (p0·0001). Although a higher vaccine dose or second immunisation elicited a transient advantage compared with lower doses or a single immunisation, neither significantly impacted long-term neutralisation. There was no long-term effect of dose, number of vaccinations, or adjuvant on neutralising activity.In this phase 1 study, DS-Cav1 vaccination was safe and well tolerated. DS-Cav1 vaccination elicited a robust boost in RSV F-specific antibodies and neutralising activity that was sustained above baseline for at least 44 weeks. A single low-dose of pre-F immunisation of antigen-experienced individuals might confer protection that extends throughout an entire RSV season.The National Institutes of Allergy and Infectious Diseases.

Organizational context (e.g., climate, culture, resources) can impede or enhance implementation of evidence-based practices in general education settings or special education settings serving students with autism spectrum disorder. We examined the relations between organizational context and individual (i.e., implementation leadership, administrator- or service provider-role) or school (i.e., enrollment size, public/nonpublic school type) characteristics. Participants were administrative or service providing leaders (n = 34) from 11 schools in one state on the East Coast of the United States. School leaders’ average ratings of the organizational context were generally more positive for special education than general education; however, greater culture stress was reported for special education. Correlation analyses indicated being an administrator and implementation leadership were positively associated with implementation climate in both education settings. Being an administrator was also positively associated with cultural effort (i.e., how hard people work towards achieving goals) in special education, but negatively associated with culture stress in general education. In special education, nonpublic schools had better climates (both learning and implementation), but more culture stress. Additionally, school enrollment size was negatively related to available resources and implementation climate in special education. Investigating the similarities and differences in organizational context across educational settings is needed in future research.

Interpersonal violence, such as physical and sexual abuse, eve-teasing, bullying, and taking hostages, is a growing concern in our society. The criminals who directly or indirectly committed the crime often do not go into the trial for the lack of proper evidence as it is very tough to collect photographic proof of the incident. A subject's corneal reflection has the potentiality to reveal the bystander images. Motivated with this clue, a novel approach is proposed in the current paper that uses a convolutional neural network (CNN) along with transfer learning in identifying crime as well as recognizing the criminals from the corneal reflected image of the victim called the Purkinje image. This study found that off-the-shelf CNN can be fine-tuned to extract discriminative features from very low resolution and noisy images. The procedure is validated using the developed datasets comprising six different subjects taken at diverse situations. They confirmed that it has the ability to recognize criminals from corneal reflection images with an accuracy of 95.41%.

Increasing prevalence of diabetes mellitus warrants recognition of factors related to asymmetric diabetic retinopathy (DR). This thematic synthesis based on an iterative literature review conducted in Medline and Google Scholar pertaining to diabetes with coexistent asymmetry of retinopathy included 45 original articles, 21 case reports and series, and 18 review articles from 1965 to 2020. Asymmetric DR is defined as proliferative DR (PDR) in one eye and nonproliferative, preproliferative, background, or no DR in the other eye lasting for at least 2 years. It is observed in 5%-10% of patients with PDR. Associated factors can be divided into (i) vascular: carotid obstructive disease, ocular ischemic syndrome, and retinal vascular diseases; (ii) Inflammatory: uveitis, endophthalmitis, and Fuchs' heterochromic cyclitis; (iii) degenerative: posterior vitreous detachment, high myopia and anisometropia, uveal coloboma, retinal detachment, retinitis pigmentosa, and chorioretinal atrophy and scarring; (iv) cataract surgery and vitrectomy; and (v) miscellaneous: elevated intraocular pressure, glaucoma, amblyopia, retinal detachment, and optic atrophy. The gamut of diagnostic modalities for asymmetric DR includes thorough ocular examination, slit-lamp biomicroscopy, fundus photography, fundus fluorescein angiography, optical coherence tomography, and newer modalities such as ultra-widefield fluorescein angiography and optical coherence tomography angiography, along with a complete systemic evaluation and carotid Doppler studies. The differential diagnosis includes other causes of retinal neovascularization that may present in an asymmetric manner, such as sickle cell retinopathy, retinal vein occlusions, and featureless retina. This review discusses in detail the aforementioned considerations and draws a comprehensive picture of asymmetric DR in order to sensitize ophthalmologists to this important condition.