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Aim: The present study aimed to describe health care professionals’ quality of life during COVID-19 pandemic Saudi Arabia. Methodology: The cross-sectional study included a survey that was prepared using the world health organization quality of life assessment instrument (WHOQOL). To provide a good quality of care and to achieve patient satisfaction on the care received, it is important to know how satisfied health care personnel are with their quality of life and job because the personnel with a good quality of life offer better services than those with poor quality of life. Results: The present study showed that the quality of life of about two third of the health care providers was good. Nonetheless, about one third of them had a poor quality of life. Conclusion: There is a need to implement long term programs aimed at improving the emotional well-being of health care specialists and improving their quality of life.

International trends in traditional diabetes complications (cardiovascular, renal, peripheral vascular, ophthalmic, hepatic or neurological diseases) and mortality rates are poorly characterised. An earlier review of studies published up to 2015 demonstrated that most data come from a dozen high-income countries (HICs) in North America, Europe or the Asia–Pacific region and that, in these countries at least, rates of acute glycaemic fluctuations needing medical attention and amputations, myocardial infarction and mortality were all declining over the period. Here, we provide an updated review of published literature on trends in type 2 diabetes complications and mortality in adults since 2015. We also discuss issues related to data collection, analysis and reporting that have influenced global trends in type 2 diabetes and its complications. We found that most data on trends in type 2 diabetes, its complications and mortality come from a small number of HICs with comprehensive surveillance systems, though at least some low- and middle-income countries (LMICs) from Africa and Latin America are represented in this review. The published data suggest that HICs have experienced declines in cardiovascular complication rates and all-cause mortality in people with diabetes. In parallel, cardiovascular complications and mortality rates in people with diabetes have increased over time in LMICs. However, caution is warranted in interpreting trends from LMICs due to extremely sparse data or data that are not comparable across countries. We noted that approaches to case ascertainment and definitions of complications and mortality (numerators) and type 2 diabetes (the denominator) vary widely and influence the interpretation of international data. We offer four key recommendations to more rigorously document trends in rates of type 2 diabetes complications and mortality, over time and worldwide: (1) increasing investments in data collection systems; (2) standardising case definitions and approaches to ascertainment; (3) strengthening analytical capacity; and (4) developing and implementing structured guidelines for reporting of data. Graphical abstract

Blockchain is a technology new technology implemented for the first time in 2008 for the bitcoin cryptocurrency [1]. Blockchain technology is an innovative, distributed, and immutable ledger technology providing a decentralized management solution for transaction data [2]. The purpose of this article was to review the growth of the use of blockchain technology in the healthcare data. In this article, an analysis of the existing blockchain technology research and findings in the health care domain was conducted. The goal was to find relevant implementation of the blockchain technology in the healthcare domain and highlight the challenges and potential methodologies. This article covers an overarching introduction and Background about blockchain in the healthcare domain. Furthermore, the research methodology, an analysis of the information and the results found. The results show that Blockchain still has many challenges such as scalability and security problem [3], however the usage of blockchain is increasing in different scientific research areas [4-7] in general and in healthcare area in particular is growing exponentially [8].

Rehabilitation needs are increasing globally due to population growth, aging population, high survival rates for people with disability, and severe health conditions. In the past few years, new telecommunication-based practices, including various forms of e-rehabilitation have gained attention all over the world, including the Kingdom of Saudi Arabia (KSA). Telerehabilitation is an alternative way of delivering rehabilitation services in which information and communication technologies are used to expedite communication between the health care professional and the patient at a distant location. It can be beneficial to people in rural areas, especially individuals in isolated communities. At present, the COVID-19 pandemic has forced speedy adoption of telerehabilitation due to restricted traditional in-person visits all over the world, including KSA; however, no telerehabilitation guidelines are available in the country. Since specialized rehabilitation services are limited to main cities of the country, the provision of care by reaching out the underserved areas using telemedicine technology is deemed important. These guidelines were established collaboratively by panel of various rehabilitation experts with input from other practitioners in the field and strategic stakeholders. It will facilitate rehabilitation clinicians practicing in KSA providing consultation, counseling, education, assessment, monitoring, therapy, or follow-up to a patient remotely using telemedicine communication technologies. This document includes administrative, clinical, and technical guidelines, which are aimed to standardize telerehabilitation practice across the country. The core principles are based on standards set forth by American Telemedicine Association and are guided by telemedicine policy in KSA. Additionally, ethical considerations of telerehabilitation practice pertinent to Saudi culture and health care system are elaborated as well. This document serves as a general guide for the provision of telerehabilitation services and do not describe a specialty-specific clinical practice guideline.

Aims/hypothesis We aimed to estimate the lifetime risk of diabetes and diabetes-free life expectancy in metropolitan cities in India among the population aged 20 years or more, and their variation by sex, age and BMI. Methods A Markov simulation model was adopted to estimate age-, sex- and BMI-specific lifetime risk of developing diabetes and diabetes-free life expectancy. The main data inputs used were as follows: age-, sex- and BMI-specific incidence rates of diabetes in urban India taken from the Centre for Cardiometabolic Risk Reduction in South Asia (2010–2018); age-, sex- and urban-specific rates of mortality from period lifetables reported by the Government of India (2014); and prevalence of diabetes from the Indian Council for Medical Research INdia DIABetes study (2008–2015). Results Lifetime risk (95% CI) of diabetes in 20-year-old men and women was 55.5 (51.6, 59.7)% and 64.6 (60.0, 69.5)%, respectively. Women generally had a higher lifetime risk across the lifespan. Remaining lifetime risk (95% CI) declined with age to 37.7 (30.1, 46.7)% at age 60 years among women and 27.5 (23.1, 32.4)% in men. Lifetime risk (95% CI) was highest among obese Indians: 86.0 (76.6, 91.5)% among 20-year-old women and 86.9 (75.4, 93.8)% among men. We identified considerably higher diabetes-free life expectancy at lower levels of BMI. Conclusions/interpretation Lifetime risk of diabetes in metropolitan cities in India is alarming across the spectrum of weight and rises dramatically with higher BMI. Prevention of diabetes among metropolitan Indians of all ages is an urgent national priority, particularly given the rapid increase in urban obesogenic environments across the country.

For drug resistance patients, removal of a portion of the brain as a cause of epileptic seizures is a surgical remedy. However, before surgery, the detailed analysis of the epilepsy localization area is an essential and logical step. The Electroencephalogram (EEG) signals from these areas are distinct and are referred to as focal, while the EEG signals from other normal areas are known as nonfocal. The visual inspection of multiple channels for detecting the focal EEG signal is time-consuming and prone to human error. To address this challenge, we propose a novel method based on differential operator and Tunable Q-factor wavelet transform (TQWT) to distinguish the focal and nonfocal signals. For this purpose, first, the EEG signal was differenced and then decomposed by TQWT. Second, several entropy-based features were derived from the TQWT subbands. Third, the efficacy of the six binary feature selection algorithms, binary bat algorithm (BBA), binary differential evolution (BDE) algorithm, firefly algorithm (FA), genetic algorithm (GA), grey wolf optimization (GWO), and particle swarm optimization (PSO), was evaluated. In the end, the selected features were fed to several machine learning and neural network classifiers. We observed that the PSO with neural networks provides an effective solution for the application of focal EEG signal detection. The proposed framework resulted in an average classification accuracy of 97.68%, a sensitivity of 97.26%, and a specificity of 98.11% in a tenfold cross-validation strategy, which is higher than the state of the art used in the public Bern-Barcelona EEG database.

Purpose Roux-en-Y gastric bypass (RYGB) surgery is currently the most efficient treatment to achieve long-term weight loss in individuals with severe obesity. This is largely attributed to marked reductions in food intake mediated in part by changes in gut-brain communication. Here, we investigated for the first time whether weight loss after RYGB is associated with alterations in central noradrenaline (NA) neurotransmission. Materials and Methods We longitudinally studied 10 individuals with severe obesity (8 females; age 43.9 ± 13.1 years; body mass index (BMI) 46.5 ± 4.8 kg/m2) using (S,S)-[11C]O-methylreboxetine and positron emission tomography to estimate NA transporter (NAT) availability before and 6 months after surgery. NAT distribution volume ratios (DVR) were calculated by volume-of-interest analysis and the two-parameter multilinear reference tissue model (reference region: occipital cortex). Results The participants responded to RYGB surgery with a reduction in BMI of 12.0 ± 3.5 kg/m2 (p p = 0.019) and a general tendency towards reduced DVR throughout the brain. Furthermore, we found a strong positive correlation between pre-surgery DVR in hypothalamus and the change in BMI (r = 0.78; p = 0.01). Conclusion Reductions in BMI after RYGB surgery are associated with NAT availability in brain regions responsible for decision-making and homeostasis. However, these results need further validation in larger cohorts, to assess whether brain NAT availability could prognosticate the outcome of RYGB on BMI. Graphical abstract

Background: data on vaccine immunogenicity against SARS-CoV-2 are needed for the 40 million people globally living with HIV who might have less functional immunity and more associated comorbidities than the general population. We aimed to explore safety and immunogenicity of the ChAdOx1 nCoV-19 (AZD1222) vaccine in people with HIV. Methods: in this single-arm open-label vaccination substudy within the protocol of the larger phase 2/3 trial COV002, adults aged 18–55 years with HIV were enrolled at two HIV clinics in London, UK. Eligible participants were required to be on antiretroviral therapy (ART), with undetectable plasma HIV viral loads (0·05 for all analyses). Interpretation: in this study of people with HIV, ChAdOx1 nCoV-19 was safe and immunogenic, supporting vaccination for those well controlled on ART. Funding: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca.

Objective: We set up a U.S. registry to examine prescription patterns and patient outcomes of repository corticotropin injection (Acthar® Gel) for childhood nephrotic syndrome. Methods: 18 participating U.S. pediatric centers performed retrospective review and prospective observation of patients < 21 years old with nephrotic syndrome treated with Acthar Gel. We captured baseline characteristics, drug regimen and duration, and disease response following treatment. Results: 46 patients, enrolled from 2015 to 2020 were included. 27 (58.7%) were male. 18 patients (39.1%) had a diagnosis of minimal change followed by focal segmental glomerulosclerosis in 16 patients (34.7%). Median age at start of treatment was 12.5 years (IQR 8.5-17.4) compared to 5.3 years at diagnosis (IQR 2.7-10.5 years). 52% were resistant to corticosteroids. The most common Acthar Gel regimen was 80IU twice a week with a median duration of 199 days (IQR 88-365). Among 37 patients with active disease, 18 (49%) were able to achieve partial or complete remission, though all patients that had a positive response were on other immunosuppressants concomitantly. Conclusion: We report the findings of the largest registry cohort of pediatric patients in the U.S. treated with Acthar Gel for clinically challenging cases of nephrotic syndrome. Acthar Gel was successful in inducing remission in approximately half of the patients with active disease at time of treatment. No predictors of response with respect to demographic data, age at start of Acthar Gel therapy, etiology of nephrotic syndrome, presence or absence of comorbidities, or steroid responsiveness was noted.

Summary Background The prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings. Methods In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA1c]); and contained data on height and weight. Diabetes was defined biologically as a fasting plasma glucose concentration of 7·0 mmol/L (126·0 mg/dL) or higher; a random plasma glucose concentration of 11·1 mmol/L (200·0 mg/dL) or higher; or a HbA1c of 6·5% (48·0 mmol/mol) or higher, or by self-reported use of diabetes medication. We included individuals aged 25 years or older with complete data on diabetes status, BMI (defined as normal [18·5–22·9 kg/m2], upper-normal [23·0–24·9 kg/m2], overweight [25·0–29·9 kg/m2], or obese [≥30·0 kg/m2]), sex, and age. Countries were categorised into six geographical regions: Latin America and the Caribbean, Europe and central Asia, east, south, and southeast Asia, sub-Saharan Africa, Middle East and north Africa, and Oceania. We estimated the association between BMI and diabetes risk by multivariable Poisson regression and receiver operating curve analyses, stratified by sex and geographical region. Findings Our pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6–27·8), of obesity was 21·0% (19·6–22·5), and of diabetes was 9·3% (8·4–10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m2 or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5–22·9 kg/m2. Diabetes risk also increased steeply in individuals aged 35–44 years and in men aged 25–34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m2 among men in east, south, and southeast Asia to 28·3 kg/m2 among women in the Middle East and north Africa and in Latin America and the Caribbean. Interpretation The association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines. Funding Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.

The present study has proposed three novel hybrid models by integrating three traditional ensemble models, such as random forest, logitboost, and naive bayes, and six newly developed ensemble model...

BackgroundThe world witnessed a highly contagious and deadly disease, COVID-19, toward the end of 2019. India is one of the worst affected countries. We aimed to assess anxiety and depression levels among adult tobacco users and people who recently quit tobacco during COVID-19 lockdown in India.Materials and methodsThe study was conducted across two Indian cities, Delhi and Chennai (July-August, 2020) among adult tobacco users (n = 801). Telephonic interviews were conducted using validated mental health tools (Patient Health Questionnaire-PHQ-9 and Generalized Anxiety Disorder-GAD-7) to assess the anxiety and depression levels of the participants. Descriptive analysis and multiple logistic regression were used to study the prevalence and correlates of depression and anxiety.ResultsWe found that 20.6% of tobacco users had depression symptoms (3.9% moderate to severe); 20.7% had anxiety symptoms (3.8% moderate to severe). Risk factors associated with depression and anxiety included food, housing, and financial insecurity.ConclusionDuring COVID-19 lockdown, mental health of tobacco users (primarily women) was associated with food, housing and financial insecurity. The Indian Government rightly initiated several health, social and economic measures to shield the most vulnerable from COVID-19, including a ban on the sale of tobacco products. It is also necessary to prioritize universal health coverage, expanded social security net, tobacco cessation and mental health services to such vulnerable populations during pandemic situations.

OBJECTIVES To assess in-hospital mortality, length of stay, and costs associated with interhospital fragmentation in 30-day readmissions and to determine whether these associations were more or less pronounced for patients with specific high-prevalence conditions. STUDY DESIGN Cross-sectional analysis using the Agency for Healthcare Research and Quality's National Readmissions Database for 2013 and 2014. METHODS All patients 18 years and older with a 30-day readmission in 2014 were included. We assessed if readmission to a hospital different from that of the index admission was associated with in-hospital mortality, length of stay, and costs of readmission, separately by whether the readmission occurred for the same or different major diagnostic category. Patients with 1 of 3 common diagnoses (congestive heart failure [CHF], chronic obstructive pulmonary disease [COPD], or myocardial infarction) were studied for disease-specific trends. The same analyses were performed on 2013 data as a sensitivity analysis. RESULTS In 2014, among 792,596 patients with a 30-day readmission, 22.2% experienced fragmentation. Compared with patients whose readmission occurred at the index hospital, patients readmitted to a different hospital experienced 20% higher odds of dying in hospital (P = .02 for same diagnosis readmission; P = .03 for different diagnosis readmission), a half-a-day longer length of stay (P

For the last 20 years, undergraduate medical education has seen a major curricular reform movement toward integration of basic and clinical sciences. The rationale for integrated medical school curricula focuses on the application of knowledge in a clinical context and the early ability to practice key skills such as critical thinking and clinical problem-solving. The method and extent of discipline integration can vary widely from single sessions to entire programs. A challenge for integrated curricula is the design of appropriate assessments. The goal of this review is to provide a framework for clinical anatomy educators with definitions of integration, examples of existing integration models, strategies, and instructional methods that promote integration of basic and clinical sciences.

The study aims to determine the impact of environmental taxes on sustainable development and to achieve the objectives of the study, the researchers used the introspective method and descriptive analytical approach in the theoretical aspect of the study, but the field side conducted a field study and distributed the questionnaire form to a number (255) individually and used statistical analysis to confirm the validity of study tasks in the field of study. The most important results include: 1. Environmental taxes on factory emissions achieve sustainable development. 2.Develop environmental awareness and provide training-capable employment for sustainability. 3.The tax system can eliminate or reduce negative environmental impacts, both in terms of an environmental tax, incentives, and accelerated depreciation of environmentally friendly enterprises. The most important recommendations include: 1.Issuing an environmental accounting standard and an environmental tax standard through a proposed accounting framework to activate the role of environmental taxes in achieving sustainable development. 2.Take advantage of foreign tax systems by passing an environmental tax law that complies with the environmental tax standard through which the application of the role of environmental taxes in achieving sustainable development is implemented. 3.The imperative to link taxes to licenses and renew annually with the tax return is also linked to the national number of the fund and in the case of serious environmental risk the establishment is closed immediately, and the financier is prohibited from engaging in any commercial, industrial, agricultural or other activity that arises either the financier or any of his relatives up to the fourth degree to prevent manipulation of the loopholes of the law.

Objectives: To evaluate the available evidence of natural honey and its effect on improving lipid profiles among the adult population. Methods: The following databases were searched in May 2020 for randomized controlled trials (RCTs) and crossover studies without any restrictions in language, publication year, or status: CENTRAL, Embase Elsevier, ClinicalTrials.gov, MEDLINE, the WHO International Clinical Trials Registry Platform, and Google Scholar. We included all RCTs and crossover studies that studied the effect of natural honey on improving lipid levels in individuals at any age, for any dose and duration. Trials investigated the intake of honey alone or honey dissolved in water. The comparison groups were no intervention or placebo. Two independent reviewers screened and evaluated the included trials. The third reviewer was involved in resolving any disagreement. Our aim was to evaluate the evidence available regarding the effect of natural honey in improving lipid profile. Results: Seven trials with 370 participants fitted the inclusion criteria. Pooled analysis showed, honey was found to reduce total cholesterol levels with statistical significance (mean difference [MD]: -14.97 mg/dl, 95% CI: 19.61 to -10.32). Honey was associated with a statistically significant increase in high-density lipoprotein (HDL) levels (MD: 1.78 mg/dl, 95% CI: 0.68 to 2.88). There was a statistically significant LDL reduction level (MD: 18.99 mg/dl, 95% CI: -22.79 to -15.20). Finally, honey was found to lower triglyceride levels significantly (MD: 9.68 mg/dl, 95% CI: -15.56 to -3.80). Conclusions: Total cholesterol was significantly reduced with the use of natural honey intake, as well as low-density lipoprotein (LDL), and triglycerides. High-density lipoprotein showed significant increment. Small quantity of honey can be recommended for patients with dyslipidemia. The impact on clinical outcomes such as cardiovascular mortality and morbidity needs to be evaluated in large studies. PROSPERO REG. NO. CRD: 42020130741

Carbamazepine (CBZ) is a widely used antiepileptic drug to control grand mal epilepsy, as well as for the treatment of peripheral neuralgia. According to the biopharmaceutical classification system (BCS), CBZ is considered a class II drug. CBZ is characterized by a slow and irregular gastrointestinal absorption, with irregular oral bioavailability; due to its low water solubility. Therefore, the release of the drug from the dosage form (tablets in this study) and the subsequent step of dissolution represent the most important parameters that decide whether a sufficient plasma concentration will be achieved or not. In the current study, the FTIR study for the pure API, CBZ, and the different commercially available brands of CBZ conventional tablets, available in the Iraqi drug market (Mosul city as an example), were examined. Subsequently, various quality control parameters such as the weight variation, content uniformity, friability, and hardness of the conventional CBZ tablets were conducted. Moreover, the disintegration and the dissolution tests of the different brands of CBZ available in the Iraqi drug market were performed. Keywords: Antiepileptic Drug, Bioequivalence; Epilepsy; Generic; Brand vs generic; IVIVC; QC

Rationale: Patients with malignant/paramalignant pleural effusions (MPE/PMPEs) may have tunneled pleural catheter (TPC) management withheld due to infection concerns from immunosuppression associated with antineoplastic therapy. Objective: To determine the rate of infections related to TPC use and to determine the relationship to antineoplastic therapy, immune system competency and overall survival (OS)? Methods: We performed an international, multi-institutional study of MPE/PMPE patients undergoing TPC management from 2008-2016. Patients were stratified by whether or not they underwent antineoplastic therapy and/or were immunocompromised or not. Cumulative incidence functions and multivariable competing risk regression analyses were performed to identify independent predictors of TPC-related infection. Kaplan-Meier method and multivariable Cox proportional-hazards modeling were performed to examine for independent effects on OS. Results: A total of 1,408 TPCs were placed in 1,318 patients. Patients had a high frequency of overlap between antineoplastic therapy and an immunocompromised state (75-83%). No difference in the overall (6-7%), deep pleural (3-5%) or superficial (3-4%) TPC-related infection rates between subsets of patients stratified by antineoplastic therapy or immune status was observed. The median time to infection was 41 (interquartile range: 19-87) days following TPC insertion. Multivariable competing risk analyses demonstrated longer TPC duration was associated with a higher risk of TPC-related infection [subdistribution hazard ratio (95% CI): 1.03 (1.00-1.06), p=0.028]. Cox proportional-hazards analysis showed antineoplastic therapy was associated with better OS [hazard ratio (95% CI): 0.84 (0.73-0.97), p=0.015]. Conclusion: The risk of TPC-related infection does not appear to be increased by antineoplastic therapy use or an immunocompromised state. The overall rates of infection are low and comparable to immunocompetent patients with no relevant antineoplastic therapy. These results support TPC palliation for MPE/PMPE regardless of plans for antineoplastic therapy.

OBJECTIVE To compare the effectiveness and safety of repeat misoprostol versus expectant management in women with first-trimester incomplete miscarriage who have been initially treated with misoprostol. METHODS The study was an open-labeled randomized controlled trial including women with an incomplete first-trimester miscarriage after administration of misoprostol. The participants were randomly assigned to vaginal misoprostol or expectant management using a computer-generated table of random numbers. The primary outcome was the number of women with a complete miscarriage at 1 week. RESULTS Eighty-eight women (44 women in each group) were analyzed. The rate of complete miscarriage at 1 week was significantly higher in the misoprostol group than the expectant management group-29 (69.0%) versus 7 (16.7%) (P

Spring discharge from the Masingini catchment plays a crucial role in the Zanzibar Municipality water supply scheme. However, there has been remarkable attenuation in spring discharge over the years due to a change in rainfall patterns. The study's objective was to assess the effect of rainfall variability on Mtoni and Bububu springs discharge in the Masingini catchment. It analyzed rainfall variability on the Masingini catchment between 1992 and 2018 to assess spring discharge at least ten years before and after the water policy. The monthly rainfall data was collected from Tanzania Meteorological Agency in the Zanzibar office. The spring discharge data was collected from Zanzibar Water Authority and supplemented by field measurements of monthly groundwater levels for wet and dry seasons from fifteen boreholes. The data analysis was carried out using the M-K test. The results revealed a non-significant downward trend in seasonal rainfall over rainfall stations due to the decline of seasonal rainfall over the years. Annual rainfall showed a significant decreasing trend for Kizimbani Agromet station (p < 0.05). On the other hand, the groundwater level dropped by an average of 5±2.6m between the long rainy and dry seasons. The maximum and minimum spring discharges coincide with wet and dry seasons, respectively. There was a significant decreasing trend in annual spring discharge at α = 0.05 and α = 0.01 for Mtoni and Bububu spring discharge, respectively. The M-K revealed a significantly positive correlation of annual spring discharge and rainfall, τ = 0.333 and τ = 0.453 for Mtoni and Bububu spring, respectively, implying that discharge increases as rainfall increases. The average daily discharge of Mtoni and Bububu spring declined by 23.9% and 18.9%, respectively, before and after water policy. The study concluded that rainfall variability was the primary hydroclimate factor for declining spring discharge on the catchment.

Computer-Aided Detection (CAD) systems are one of the most effected tools nowadays in aiding physicians in the detection of liver tumors at early stage. In this paper, the CADe system will be built which has the ability to detect the abnormal tumor inside the liver. In order to create that system, different types of classifiers must be implemented. In our CADe system, a support vector machine (SVM) and K-Nearest Neighbor (KNN) will be used as classifiers. A total number of 120 images including the normal and abnormal cases were collected. Initially, the features will be extracted from database images in order to distinguish between the classes of those liver tumors. Then, by using SVM and KNN the images will be classified into two classes normal and abnormal cases. The paper reveals that SVM and KNN, which demonstrated 100 percent precision, 100 percent sensitivity, and 100 percent specificity, were the best classifiers.

Objectives: IFN gamma-release assays (IGRAs) used for diagnosis of Mycobacterium (M.) tuberculosis infection have limited sensitivity. Alternative cytokines and M. tuberculosis latency-associated antigens may improve immune-based tests.Methods: Multiplex cytokine analyses was done in culture supernatants after 6-day in vitro restimulation with M. tuberculosis IGRA and latency-associated antigens (i.e. Rv2628, Rv1733) in tuberculosis patients (n = 22) and asymptomatic contacts (AC)s (n = 20) from Ghana.Results: Four cytokines (i.e. IFN gamma, IP-10, IL-22 and IL-6) were significantly increased after IGRA-antigen specific restimulation. IFN gamma, IP-10, and IL-22 correlated positively and showed no differences between the study groups whereas IGRA-antigen induced IL-6 was significantly higher in tuberculosis patients. Using adjusted IGRA criteria, IL-6 showed the highest sensitivity for detection of tuberculosis patients (91%) and ACs (85%) as compared to IFN gamma, IP-10, and IL-22. Rv2628 and Rv1733 restimulation induced significantly higher IFN gamma, IP-10, and IL-22 concentrations in ACs. Combined antigen/cytokine analyses identified study group specific patterns and a combination of Rv2628/Rv1733 induced IFN gamma with IGRA-antigen induced IL-6 was optimal for classification of tuberculosis patients and ACs (AUC: 0.92, p

Summary Background Improving hypertension control is an important global health priority, yet, to our knowledge, there is no direct evidence on the relationship between blood pressure and mortality in sub-Saharan Africa. We aimed to investigate the relationship between systolic blood pressure and mortality in South Africa and to assess the comparative effectiveness of different systolic blood pressure targets for clinical care and population-wide hypertension management efforts. Methods In this country-wide, population-based cohort study, we used longitudinal data on adults aged 30 years and older from five waves (2008, 2010–11, 2012, 2014–15, and 2017) of the South African National Income Dynamics Study. We estimated the relationship between systolic blood pressure and 6-year all-cause mortality and compared the mortality reductions associated with lowering systolic blood pressure to different targets (120 mm Hg, 130 mm Hg, 140 mm Hg, 150 mm Hg). We also estimated the mean blood pressure reduction required to achieve each target, the share of the population in need of management, and the number needed to treat (NNT) to avert one death under different hypothetical population-wide scale-up scenarios. Findings Of the 8338 age-eligible respondents in the 2010–11 survey, 4993 had all required data and were included in our study. We found a weak, non-linear relationship between systolic blood pressure and 6-year mortality, with larger incremental mortality benefits at higher systolic blood pressure values: reducing systolic blood pressure from 160 mm Hg to 150 mm Hg was associated with a relative risk of mortality of 0·95 (95% CI 0·90 to 0·99; p=0·033), reducing systolic blood pressure from 150 mm Hg to 140 mm Hg had a relative risk of 0·96 (0·91 to 1·01; p=0·12), with no evidence of incremental benefits of reducing systolic blood pressure below 140 mm Hg. At the population level, reducing systolic blood pressure to 150 mm Hg among all those with a starting systolic blood pressure of more than 150 mm Hg was associated with the lowest NNT (n=50), 3·3 deaths averted (95% CI −0·6 to 0·3) per 1000 population, blood pressure management for 16% (95% CI 15·2 to 17·3) of individuals, and a −2·7 mm Hg mean change in systolic blood pressure required to achieve the 150 mm Hg scale-up target (−3·0 to −2·5; p Interpretation The relationship between systolic blood pressure and mortality is weaker in South Africa than in high-income and many low-income and middle-income countries. As such, we do not find compelling evidence in support of targets below 140 mm Hg and find that scaling up management based on a 150 mm Hg target is more efficient in terms of the NNT compared with strategies to reduce systolic blood pressure to lower values. Funding None

Fibers Reinforced Polymer (FRP) bars are being increasingly used recently as a replacement of conventional steel reinforcement in structures subjected to harsh environmental conditions due to their non-corrodible characteristics. However, little attention has been given to deep beams reinforced with longitudinal FRP bars and without web reinforcement. Usually, the Strut and Tie Model (STM) approach is used for the design and analysis of deep beams reinforced with steel reinforcement as recommended by many codes of practice; however, it is not clear whether those models are applicable to deep beams reinforced with FRP bars. Therefore, this study investigates the accuracy of the STMs adopted by ACI 318-14, Eurocode 2 and CSA S806-12 codes to assess the strength of deep beams reinforced with longitudinal FRP bars. For this purpose, a total of 52 FRP reinforced deep beams was collected from previous experimental investigations, and their failure loads were predicted using the aforementioned STMs, and compared with the actual failure load obtained from experiments. In general, the results have shown that both ACI 318-14 and Eurocode 2 STMs can result in unsafe design, since they overestimate the shear strength of FRP reinforced deep beams considerably. While the STM proposed by CSA S806-12 can result in uneconomic design, since it underestimates the shear strength considerably. In order to determine the appropriate efficiency factor to be used for the concrete strut, a regression analysis was conducted using the data base. Based on which, a new efficiency factor was proposed and incorporated into the Strut and Tie Model. The new STM was then tasted using the database, and it proven to be much more accurate than the other STMs.

Asthma is a common condition among young children, especially between 4 and 11 years of age. Early diagnosis of asthma and compliance with medications can reduce the incidence of complications and adverse medication events. However, this is mainly dependent on the awareness of parents about the disease and its treatment. This review aimed to assess parents' awareness and attitudes toward asthma during the last decade. The literature was searched through Medline, Ovid, Embase, and PubMed database from 2010 to October 2020. After the inclusion of only original studies and exclusion of review articles, 11 articles were taken under consideration. Eight articles were defined as eligible, covering a total of 3,701 parents of children who had asthma, and were from different countries. Awareness and practices of parents toward their children's asthma care measures should be improved in order to reduce the prevalence of uncontrolled asthma among children.

Background:The objective of this prospective randomized study was to study the effect of the residual gastric antrum size on the outcome of laparoscopic sleeve gastrectomy and to evaluate the effect of antral resection on weight reduction and complications after LSG.Patients and Methods: Sixty patients underwent LSG as a primary bariatric procedure from November 2016 to March 2019 were randomized into two groups depending on the distance from the pylorus at which gastric division begins. In group (A), the distance was 2 cm from the pylorus, whereas the distance was 6 cm in group (B). The follow-up period was at least 6 months. Baseline and 3 and 6 month outcomes were analyzed including assessments of the percent excess weight lost (% EWL), reduction in BMI, morbidity, mortality, reoperations, quality of life, and co-morbidities.Result(s): Sixty patients included in this study, whose mean pre-operative age was (32.48± 7.92) years, three (5%) patients were males and 57(95%) patients were females with a mean pre-operative BMI was (53.45 ± 8.00) Kg/m2. In group A, the mean % EWL was (33.1 ± 7.15) and (51.37 ± 8.57) at 3 and 6 months respectively. In group B the mean % EWL was (29.29 ± 6.1) and (46.44 ± 9.85) at 3 and 6 months respectively. Patients with the first staple line started 2 cm from the pylorus had better weight loss than those started 6 cm from the pylorus after 3 and 6 months, but this difference statistically insignificant.Conclusion(s): LSG with 2 cm or 6 cm first staple firing from the pylorus produces significant weight loss after surgery. The 2 procedures are equally effective regarding %EWL, morbidity, quality of life, and improvement of co-morbiditieswith insignificant superiorities of 6 cm group.

Background: Stroke is known to be the second leading cause of death and persistent disability worldwide, with 5.5 million deaths each year. Public knowledge regarding risk factors, signs and symptoms and the prevention of stroke is an important factor in reducing the incidence of stroke. Objective: This study aimed to determine the level of awareness regarding stroke in Riyadh, Saudi Arabia. Methods: This study recruited 150 participants from primary health care (PHC) centres, based on the methodology of a similar cross-sectional study conducted in Riyadh. The study group included adult male and female PHC visitors and excluded visitors with mental illness and medical personnel. Systematic random sampling was used to select participants. Data were collected using a self-administered questionnaire and analysed using SPSS. Microsoft Excel was used to generate tables and charts. Consent was obtained before data collection, with emphasis on each participant's right to withdraw from the study at any time. Result: A total of 150 respondents were included in this study. We found that the majority of the participants had a high level of awareness regarding the risk factors of stroke (n = 115, 76.66%). More than half of the participants (n = 95, 63.3%) had a moderate level of awareness of the signs and symptoms of stroke. The study also revealed that there was no statistically significant relationship between education level and level of awareness regarding risk factors of stroke (p = 0.334). Conclusion: This study found that the majority of participants had a high level of awareness regarding stroke. Regarding the education level of the participants, we found that the majority of participants with primary school-level education had a high level of awareness regarding stroke risk factors. Furthermore, we found that the level of awareness about prevention of stroke was moderate among participants. Thus, further studies should explore how to improve levels of awareness regarding the prevention of stroke.

Snakebite being medical emergency and known cause for increased mortality needs assessment and treatment on high-priority bases, even in patients of snakebite who appear fine initially. The current retrospective study presents the snake bites in Saudi Arabia from 2015 to 2018 reported by General Administration of Statistics and Information, Ministry of Health, Kingdom of Saudi Arabia. The data presented in the current study, was extracted, analyzed, and reported after getting ethical approval from institutional committee. Totally, 14,679 cases of snakebites were reported during the four-year study period, with a higher prevalence in males (80%) in their productive age. Most patients were within the age group between 25 and 44 followed by 44 to 64 years. The majority of snakebite affected inhabitants were reported from farms of the rural areas, commonly during night hours of spring and summer seasons when snakes are very active. Only 36 (0.24%) patients out of 14,679 were reported dead and 14,643 (99.63%) were discharged after the treatment. Awareness among the general public should be encouraged and early diagnosis and usage of proper snake antivenoms could be life-saving. The delay in appropriate treatment can lead to significant morbidity and mortality.

Drilling operations consist of breaking the rock to deepen a wellbore for oil or gas extraction. A drilling fluid, circulating from the surface through the drill pipe and from the annulus to the surface, is used to remove rock cuttings and maintain hydrostatic pressure. Drilling fluid lost circulation incidents (LCIs) are major sources of non-productive time (NPT) in drilling operations. These incidents occur due to preexisting natural fractures (vugs, caverns, etc.) and/or drilling-induced hydraulic fractures. The initiation of an LCI could lead to other hazardous drilling phenomena, such as formation influx or kick/blowout, stuck pipe incidents, among others. LCIs are typically monitored at the rig site by observing drilling fluid levels in the fluid tanks. This manual process incurs missing the occurrence or late detection of LCIs. Machine learning (ML) and deep learning (DL) classification algorithms are powerful in processing time-series data and achieving early detection of such temporal phenomena. In this study, we performed a large-scale analysis of the surface drilling and rheology data obtained from historical wells with LCIs. This analysis includes primary and secondary preprocessing steps including, aggressive sampling, feature engineering, and window normalization to derive generalizable DL models for real-time operations. Focal loss was utilized to account for data class imbalance and train robust and generalizable models. The results obtained from different ML/DL algorithms showed that one-dimensional convolutional neural network models resulted in the best performance with state-of-the-art precision, recall, and F1 scores of 87.34%, 73.40%, and 79.77%, respectively, on unseen test drilling data.

Background. Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia. Aim. To determine the current standard of ICU PT practice, attitude, and barriers. Methods. A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU. Results. The response rate was 28.1% (124/442). Frequent cases referred to the PTs were traumatic paraplegia (n = 111, 89%) and stroke (n = 102, 82.3%) as compared to congestive heart failure (n = 20, 16.1%) and pulmonary infections (n = 7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (n = 102, 82.2%) and positioning (n = 73, 58.8%), whereas functional electrical stimulation (n = 12, 9.6%) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (n = 89, 71.7%) followed by inadequate training (n = 53, 42.7%), and the least quoted barrier was a communication gap between the critical care team members (n = 8, 6.4%). Conclusion. PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.

Surgery is regarded by many as the go-to treatment option for severe obesity; yet how physically altering the gastrointestinal tract produces such striking results on body weight and overall metabolic health is poorly understood. In a recent issue of Cell Reports Ye et al. (2020) compare mouse models of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the two most commonly performed weight loss surgeries in the clinic today, to show that the former reconfiguring procedure selectively increases resting metabolic rate through splanchnic nerve-mediated browning of mesenteric white fat. More significantly, they demonstrate that this effect for RYGB is required for the maintained negative energy balance and improved glycemic control that it confers.

Correction: Chemical Senses, Volume 46, 2021, bjab050, https://doi.org/10.1093/chemse/bjab050 Published: 08 December 2021 Recent anecdotal and scientific reports have provided evidence of a link between COVID-19 and chemosensory impairments, such as anosmia. However, these reports have downplayed or failed to distinguish potential effects on taste, ignored chemesthesis, and generally lacked quantitative measurements. Here, we report the development, implementation, and initial results of a multilingual, international questionnaire to assess self-reported quantity and quality of perception in 3 distinct chemosensory modalities (smell, taste, and chemesthesis) before and during COVID-19. In the first 11 days after questionnaire launch, 4039 participants (2913 women, 1118 men, and 8 others, aged 19-79) reported a COVID-19 diagnosis either via laboratory tests or clinical assessment. Importantly, smell, taste, and chemesthetic function were each significantly reduced compared to their status before the disease. Difference scores (maximum possible change +/- 100) revealed a mean reduction of smell (-79.7 +/- 28.7, mean +/- standard deviation), taste (-69.0 +/- 32.6), and chemesthetic (-37.3 +/- 36.2) function during COVID-19. Qualitative changes in olfactory ability (parosmia and phantosmia) were relatively rare and correlated with smell loss. Importantly, perceived nasal obstruction did not account for smell loss. Furthermore, chemosensory impairments were similar between participants in the laboratory test and clinical assessment groups. These results show that COVID-19-associated chemosensory impairment is not limited to smell but also affects taste and chemesthesis.The multimodal impact of COVID-19 and the lack of perceived nasal obstruction suggest that severe acute respiratory syndrome coronavirus strain 2 (SARS-CoV-2) infection may disrupt sensory-neural mechanisms.

In this paper, a reconfigurable multi-mode Class-AB/F power amplifier (PA) is proposed for 0.1–4.2 GHz multistandard applications. The PA operates in linear mode (class-AB) for variable-envelope modulated signals and switching mode (class-F) for constant-envelope modulated signals. The proposed linear mode PA design is suitable for multi-band LTE, IOT, WSN and multi-standard RF transmitter, while switching mode PA design can be used in multi-band IOT-LPWA and BLE (Bluetooth Low Energy) RF transmitter. The proposed PA has a reconfigurable off-chip inter-stage and output matching networks over the specified frequency band, while the input stage is Complementary Current-Reuse common-gate with active shunt feedback configuration to achieve Ultra-Wideband (UWB) input matching. The proposed multi-mode PA is designed using a 130 nm CMOS process. Class-AB PA has a saturated output power of 23.5 dBm ± 1 dB over 0.1–4.2 GHz, a power-added efficiency (PAE) of 41%, a third-order intercept point (OIP3) of 17 dBm, and adjacent channel power ratio (ACPR) of − 29.3 dBc for LTE 15 MHz channel bandwidth. The maximum PAE of 62.1% under the class-F operation is achieved at output power of 24.5 dBm. The PA occupies 0.64 mm2 of chip area, while the estimated off-chip area is 13.3 mm2. The proposed PA consumes 164 mW, and 16 mW in class-AB and class-F, respectively.

Background Lifestyle change interventions (LCI) for prevention of type 2 diabetes are covered by Medicare, but rarely by US Medicaid programs that constitute the largest public payer system in the USA. We estimate the long-term health and economic implications of implementing LCIs in state Medicaid programs. Methods We compared LCIs modeled after the intervention of the Diabetes Prevention Program versus routine care advice using a decision analytic simulation model and best available data from representative surveys, cohort studies, Medicaid claims data, and the published literature. Target population were non-disability-based adult Medicaid beneficiaries aged 19–64 years at high risk for type 2 diabetes (BMI ≥25 kg/m2 and HbA1c ≥ 5.7% or fasting plasma glucose ≥ 110 mg/dl) from eight study states (Alabama, California, Connecticut, Florida, Iowa, Illinois, New York, Oklahoma) that represent around 50% of the US Medicaid population. Incremental cost-effectiveness ratios (ICERs) measured in cost per quality-adjusted life years (QALYs) gained, and population cost and health impact were modeled from a healthcare system perspective and a narrow Medicaid perspective. Results In the eight selected study states, 1.9 million or 18% of non-disability-based adult Medicaid beneficiaries would belong to the eligible high-risk target population – 66% of them Hispanics or non-Hispanic black. In the base-case analysis, the aggregated 5- and 10-year ICERs are US$226 k/QALY and US$34 k/QALY; over 25 years, the intervention dominates routine care. The 5-, 10-, and 25-year probabilities that the ICERs are below US$50 k (US$100 k)/QALY are 6% (15%), 59% (82%) and 96% (100%). From a healthcare system perspective, initial program investments of US$800 per person would be offset after 13 years and translate to US$548 of savings after 25 years. With a 20% LCI uptake in eligible beneficiaries, this would translate to upfront costs of US$300 million, prevent 260 thousand years of diabetes and save US$205 million over a 25-year time horizon. Cost savings from a narrow Medicaid perspective would be much smaller. Minorities and low-income groups would over-proportionally benefit from LCIs in Medicaid, but the impact on population health and health equity would be marginal. Conclusions In the long-term, investments in LCIs for Medicaid beneficiaries are likely to improve health and to decrease healthcare expenditures. However, population health and health equity impact would be low and healthcare expenditure savings from a narrow Medicaid perspective would be much smaller than from a healthcare system perspective. Electronic supplementary material The online version of this article (10.1007/s40258-020-00565-w) contains supplementary material, which is available to authorized users.

Purpose To describe 12-month intraocular pressure (IOP) and medication use outcomes following excisional goniotomy (EG) as a stand-alone procedure in eyes with medically uncontrolled glaucoma. Methods This was a retrospective analysis of data from surgeons at 8 centers (6 US, 2 Mexico). Eyes with glaucoma undergoing standalone EG with a specialized instrument (Kahook Dual Blade, New World Medical, Rancho Cucamonga, CA) for IOP reduction and followed for 12 months postoperatively were included. Data were collected preoperatively, intraoperatively, and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. The primary outcome was reduction from baseline in IOP, and key secondary outcomes included IOP-lowering medication reduction as well as adverse events. Results A total of 42 eyes were analyzed, of which 36 (85.7%) had mild to severe primary open-angle glaucoma (POAG). Mean (standard error) IOP at baseline was 21.6 (0.8) mmHg, and mean number of medications used at baseline was 2.6 (0.2). At 3, 6, and 12 months postoperatively, mean IOP reductions from baseline were 4.6 mmHg (22.3%), 5.6 mmHg (27.7%), and 3.9 mmHg (19.3%) (p≤0.001 at each time point). At the same time points, mean medications reductions of 0.7 (25.8%), 0.9 (32.6%), and 0.3 (12.5%) medications were seen (p

Background: The etiology of lichen planus is predominantly autoimmune, with various associations. A variable association of oral lichen planus with hepatitis- C infection has been reported extensively in the literature. The same association has not been studied in this geographical region. The present study was undertaken to evaluate the association of all clinical types of lichen planus with hepatitis-C virus infection in subjects hailing from this region. Objectives: To evaluate the association of lichen planus with hepatitis-C infection. Settings and design: The study was conducted in a tertiary care hospital. This was an observational, case control study. Materials and Methods: The study comprised of 100 cases and an equal number of age and sex matched healthy controls. The serum of both the groups was subjected to 4th generation HCV tridot test to detect anti HCV antibodies. Statistical analysis: The data was subjected to descriptive and inferential statistical analysis using mean, percentage, frequency and Chi square test. Results: The seropositivity of HCV antibody could not be demonstrated in any of the cases or control subjects. Conclusion : The association of lichen planus with hepatitis C virus infection could not be demonstrated in our study. Keywords: Lichen planus- A case control study on association of lichen planus with hepaitits C virus infection.

Background Post-operative pain is a common concern following elective foot and ankle surgery. NSAIDs used for pain relief have led to bone-healing complications in animal models and in vitro studies. This retrospective study examined the rate of bone-healing complications in post-surgical patients using NSAIDs. Methods Participants underwent elective foot surgeries between January 2016 and May 2018. Radiographs were used to identify bony nonunion at osteotomy sites 12 weeks post-surgery. Results Two-hundred thirty-two patients were evaluated; 59 (25.43%) were prescribed ibuprofen, 62 (27%) ketorolac, 15 (6.47%) acetaminophen, and 92 (40%) hydrocodone-acetaminophen. Two-hundred and twelve (91.38%) patients exhibited radiographic evidence of osseous union at 12 weeks and 20 (8.62%) had radiographic evidence of non-union of the osteotomy sites. There was no significant relationship between NSAID use and osseous non-union (p Conclusions Short-term use of oral ibuprofen and ketorolac in the post-operative period was not associated with bony non-union.

Background Sometimes it becomes a dilemma to repair a failed circumcised distal penile hypospadias with partial or complete wound dehiscence. In many of these cases, redo operations need a graft or a flap. The aim of this study is to evaluate the double-folded meatal-based flap in redo circumcised hypospadias with shallow urethral plate and a small glans penis. Results From September 2015 to August 2018, we prospectively studied the double-folded meatal-based flap in 56 failed circumcised distal hypospadias without penile curvature with shallow urethral plate and a small glans penis. Distally folded Mathieu flap was done. Forty-seven cases only had completed the study. We had 19 patients with distal penile hypospadias, 19 with sub-coronal hypospadias, and 9 with coronal hypospadias. Median operative time was 50 (range 40–80 min). The median length of the double-folded flap was 14 (range 10–18 mm). The median follow-up was 12 (range 1–33 months). The success of the operation means that there is an absence of any complications. Our success rate was 73%. We had 8 patients with meatal retraction, one fistula, and one patient with wound disruption. Only 3 patients (6.4%) needed re-operation: one case with meatal retraction, another with fistula, and a third with complete wound disruption. Conclusion Distally folded meatal-based flap is an additional option in redo circumcised hypospadias with shallow urethral plate, small glans penis, and pliable anterior penile skin with a considerable high percent of meatal recession.

The majority of congenital and adult cardiac surgery is performed through a median sternotomy. For surgeons, this incision provides excellent exposure; however, for patients, a median sternotomy confers a poorer cosmetic outcome and the possibility of postoperative respiratory dysfunction, chronic pain, and deep sternal wound infections. Despite the advances in adult cardiac surgery, the use of minimally invasive techniques in pediatric patients is largely limited to small case series and less complex repairs. In this article, we review the risks, benefits, and limitations of the minimally invasive congenital cardiac approaches being performed today. The interest in these approaches continues to grow as more data supporting reduced morbidity, decreased length of stay, and faster recovery are published. In the future, as the technology and surgical familiarity improve, these alternative approaches will become more common, and may someday become the standard of care.

India is home to nearly 200 million undernourished people, yet little is known about the characteristics of those experiencing food insecurity, especially among urban households. The objectives of this study were: (1) to report the prevalence of food insecurity in two large, population-based representative samples in urban India, (2) to describe socio-economic correlates of food insecurity in this context, and (3) to compare the dietary intake of adults living in food insecure households to that of adults living in food secure households. Data are from 4334 households participating in an ongoing population-based cohort study of a representative sample of Delhi and Chennai, India. The most recent wave of data (2017-2018) were analysed. Food insecurity was measured using the 9-item Household Food Insecurity Access Scale (HFIAS) and dietary intake using a 33-item semi-quantitative food frequency questionnaire. The overall prevalence of food insecurity was 8.5% (95% confidence interval [CI], 6.8-10.2); 15.2% (95% CI 12.0-18.4) of the poorest households (lowest wealth index tertile) were food insecure compared to 1.7% (95% CI 1.0-2.3) of the wealthiest households (highest wealth index tertile). Participants experiencing food insecurity were significantly younger and more likely to be from Delhi compared to Chennai. After adjustment for socio-economic factors (city, age, sex, education, wealth index, fuel used for cooking, and source of drinking water), participants experiencing food insecurity had significantly higher meat, poultry, roots and tubers (potato), and sugar sweetened beverage intakes, and lower vegetables, fruit, dairy, and nut intakes. Food insecurity is highly prevalent among the poorest households in urban India and is associated with intake of a number of unhealthy dietary items.

Background Susceptibility to metabolic diseases may be influenced by mitochondrial genetic variability among people living with human immunodeficiency virus (HIV; PLWH), but remains unexplored in populations with African ancestry. We investigated the association between mitochondrial DNA (mtDNA) haplogroups and the homeostatic model assessments of β-cell function (HOMA-B) and insulin resistance (HOMA-IR), as well as incident diabetes mellitus (DM), among Black women living with or at risk for HIV. Methods Women without DM who had fasting glucose (FG) and insulin (FI) data for ≥2 visits were included. Haplogroups were inferred from genotyping data using HaploGrep. HOMA-B and HOMA-IR were calculated using FG and FI data. Incident DM was defined by a combination of FG ≥ 126 mg/dL, the use of DM medication, a DM diagnosis, or hemoglobin A1c ≥ 6.5%. We compared HOMA-B, HOMA-IR, and incident DM by haplogroups and assessed the associations between HOMA-B and HOMA-IR and DM by haplogroup. Results Of 1288 women (933 living with HIV and 355 living without HIV), PLWH had higher initial HOMA-B and HOMA-IR than people living without HIV. PLWH with haplogroup L2 had a slower decline in HOMA-B per year (Pinteraction = .02) and a lower risk of incident DM (hazard ratio [HR], 0.51; 95% confidence interval [CI], .32–.82) than PLWH with other haplogroups after adjustments for age, body mass index, combination antiretroviral therapy use, CD4 cell counts, and HIV RNA. The impact of HOMA-IR on incident DM was less significant in those with haplogroup L2, compared to non-L2 (HR, 1.28 [95% CI, .70–2.38] vs 4.13 [95% CI, 3.28–5.22], respectively; Pinteraction < .01), among PLWH. Conclusions Mitochondrial genetic variation is associated with β-cell functions and incident DM in non-Hispanic, Black women with HIV and alters the relationship between insulin resistance and DM.

Considerable evidence supports transradial angiography and intervention in patients with acute coronary syndrome, with an emphasis on decreasing major bleeding and access site vascular complications. Patients undergoing invasive treatment are at greatest risk of bleeding and have the most to gain. The radial advantage has consistently been shown to translate into reduced mortality in pooled data analyses. The benefits of transradial access have been demonstrated across the acute coronary syndrome spectrum and in both sexes. A radial-first strategy should be the default approach and continuous efforts should be made to increase operator expertise of transradial access in these patients.