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Right ventricular function has prognostic significance in patients with pulmonary hypertension. We evaluated whether cardiac magnetic resonance-derived strain and strain rate parameters could reliably reflect right ventricular systolic and diastolic function in precapillary pulmonary hypertension. End-systolic elastance and the time constant of right ventricular relaxation tau, both derived from invasive high-fidelity micromanometer catheter measurements, were used as gold standards for assessing systolic and diastolic right ventricular function, respectively. Nineteen consecutive precapillary pulmonary hypertension patients underwent cardiac magnetic resonance and right heart catheterization prospectively. Cardiac magnetic resonance data were compared with those of 19 control subjects. In pulmonary hypertension patients, associations between strain- and strain rate-related parameters and invasive hemodynamic parameters were evaluated. Longitudinal peak systolic strain, strain rate, and early diastolic strain rate were lower in PAH patients than in controls; peak atrial-diastolic strain rate was higher in pulmonary hypertension patients. Similarly, circumferential peak systolic strain rate was lower and peak atrial-diastolic strain rate was higher in pulmonary hypertension. In pulmonary hypertension, no correlations existed between cardiac magnetic resonance-derived and hemodynamically derived measures of systolic right ventricular function. Regarding diastolic parameters, tau was significantly correlated with peak longitudinal atrial-diastolic strain rate ( r = −0.61), deceleration time ( r = 0.75), longitudinal systolic to diastolic time ratio ( r = 0.59), early diastolic strain rate ( r = −0.5), circumferential peak atrial-diastolic strain rate ( r = −0.52), and deceleration time ( r = 0.62). Strain analysis of the right ventricular diastolic phase is a reliable non-invasive method for detecting right ventricular diastolic dysfunction in PAH.

Objectives: To identify the percentage of ovarian cancers with positive peritoneal cytology and to correlate the positive cytology with the prognostic factors. Methods: This retrospective, cross-sectional study, evaluated the data of surgical specimens of malignant ovarian tumors, received in the Department of Pathology, Dow University of Health Sciences over a period of three years. The peritoneal cytology was correlated with these prognostic parameters: the size of the tumor, stage, capsular invasion, omental, and lymph node metastasis. Results: Eighty malignant ovarian tumors were diagnosed. Serous carcinoma was the most common ovarian tumor, diagnosed in 24 (30.0%) cases, followed by endometrioid carcinoma in 17 (21.25%) and Granulosa cell tumor in 11 (13.75%) cases. The mean age of the patients was 41.91 years (range 7-71 years). The mean size of the tumors was 10.03 cm (SD 5.62 cm). The ovarian capsular invasion was present in 27 (33.75%) tumors. Peritoneal cytology was positive in 10/24 cases, with a detection rate of 41.66%. Omentum was involved in 12/34 (35.29%) cases. Lymph node dissection was performed in three cases, two were reported as positive for metastasis. Peritoneal cytology significantly correlated with the tumor size (p=0.045), and with ovarian capsular invasion (p=0.054) and omental metastasis (p=0.052). Most of the tumors were staged as FIGO stage IA. Conclusion: Peritoneal cytology correlates with the tumor size, stage, and omental metastasis of the malignant ovarian tumors. It should be routinely performed at the time of surgery for the optimal staging of the patients. doi: https://doi.org/10.12669/pjms.38.1.4393 How to cite this:Gulzar R, Shahid R, Mumtaz S, Hassan JA. Significance of peritoneal washing cytology in the accurate staging of malignant ovarian tumors. Pak J Med Sci. 2022;38(1):128-132. doi: https://doi.org/10.12669/pjms.38.1.4393 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

We review the literature on organizational ambidexterity using the hybrid review approach, which integrates bibliometric analysis with a framework-based review. We provide directions for future studies by identifying key gaps in the existing literature. The bibliometric analysis provides the trends and progress of the research field through citation analysis, analysis of keyword co-occurrence, and other bibliometric indicators such as most influential journals, countries, and authors. The TCCM (Theories, Contexts, Characteristics, and Methodology) framework helps us to identify the widely used theories, constructs, and methods in ambidexterity research and provides new avenues for future research by analyzing the most used theories, methods, constructs, and research contexts. We suggest that future researchers should explore the behavioral components of firms’ environment as an antecedent factor and there should be more emphasis on summarization of the divergent views pertaining to ambidexterity enablers. In addition to identifying the key research themes and knowledge structure of organizational ambidexterity, this review would help to create a value to the ambidexterity literature in terms of quantification and consolidation of research evolution. This is the first comprehensive literature review using hybrid approach (bibliometric review with TCCM framework) in the field of organizational ambidexterity research.

Introduction. In recent years, there has been evidence not only of the widespread prevalence of the obstructive sleep apnea (OSA) in the population, but also of the progression of the disease in the dynamic follow-up of patients. The purpose of this review article is to analyze the current state of etiopathogenesis, clinics of obstructive sleep apnea and to identify more promising treatment approaches and risk factors for its development. Materials and methods. The analysis of publications was performed for the period 2016-2021 on the basis of data from Elibrary, the Federal Electronic Medical Library of the Ministry of Health of the Russian Federation, the bibliographic database of medical publications MEDLINE, created by the US National Library of Medicine. Sixty-one sources were selected for the review. Results and discussion. Obstructive sleep apnea is widely represented in the group of sleep disorders and is correlated with a number of clinical conditions: cardiovascular diseases (acute cerebrovascular disease, resistant arterial hypertension, coronary heart disease, heart rhythm disorder), endocrine system (diabetes mellitus, hypothyroidism, metabolic syndrome, obesity), ophthalmological pathology (neurooptikopathies), sudden death, etc. Severe daytime sleepiness due to OSA is not only a medical but also a social problem due to increased injury rates, accidents at work and on the road, and decreased labor productivity. Conclusion. The introduction of a comprehensive interdisciplinary approach to diagnostic standards will improve the detection and treatment of obstructive sleep apnea and improve the quality of life of patients. Change of lifestyle and use of PAP-therapy in patients with OSA is currently the most adequate direction in the treatment of this pathology. High prevalence, serious consequences for the nation's health and economy dictate the need for further study of markers of this disease for early prediction and primary prevention of cardiovascular diseases and diseases associated with obstructive sleep apnea.

Introduction: Atlanto-occipitalization(AOZ) is one of the congenital anomalies related to craniovertebral synostosis. The clear understanding of its anatomical features and cranial foraminal variants plays a critical role in finding the possible coping mechanism with its pathogenesis such as segmental instability or neurologic deficits. Objective: This study aimed to investigate the incidence of occipitalization of Atlas and related variant foramina, as the baseline awareness of these conditions among the Nepalese population is yet to be documented. Methodology: A retrospective study was performed for the total 86 dry skulls available in the department of Anatomy in Katmandu University of Medical Sciences, Institute of Medical Science, and B.P. Koirala Institute of Health Sciences. The skulls were examined thoroughly to evidence the occurrence of cranio-vertebral variations. Result: Out of 86 human adult skulls, 2 cases (2.32 %) were found with partial AOZ presenting posterior spina bifida close to the midline. Sphenoidal emissary foramen (SEF) was also observed in 17 skulls (19.76 %), an additional foramen lying anteromedial to the foramen ovale. Moreover, one of the skulls (1.16 %) was found with the presence of pterygospinous bar creating an additional foramen ‘foramen of Civinini’ in the lateral pterygoid plate of the sphenoid bone. Conclusion: The incidence of AOZ and pterygospinous bar seems to be quite low as compared to the cases of SEF. However, the knowledge of such variations and the presence of additional foramina carry great significance for orthopedists and neurosurgeons to have prognostic implications and an accurate surgical approach.

This paper presents a convolution neural network (CNN)-based direction of arrival (DOA) estimation method for radio frequency (RF) signals acquired by a nonuniform linear antenna array (NULA) in unmanned aerial vehicle (UAV) localization systems. The proposed deep CNN, namely RFDOA-Net, is designed with three primary processing modules, such as collective feature extraction, multi-scaling feature processing, and complexity-accuracy trade-off, to learn the multi-scale intrinsic characteristics for multi-class angle classification. In several specific modules, the regular convolutional and grouped convolutional layers are leveraged with different filter sizes to enrich diversified features and reduce network complexity besides adopting residual connection to prevent vanishing gradient. For performance evaluation, we generate a synthetic signal dataset for DOA estimation under the multipath propagation channel with the presence of additive noise, propagation attenuation and delay. In simulations, the effectiveness of RFDOA-Net is investigated comprehensively with various processing modules and antenna configurations. Compared with several state-of-the-art deep learning-based models, RFDOA-Net shows the superiority in terms of accuracy with over 94% accuracy at 5 dB signal-to-noise ratio (SNR) with cost-efficiency.

Background: Anovulation is the commonest cause of female infertility and polycystic ovarian syndrome (PCOS) is the most frequently seen cause of anovulation among infertile females. Letrozole and Clomiphene Citrate are two common drugs for PCOS. But controversial data was noticed regarding their effectiveness. Aim: To compare effectiveness of Letrozole versus Clomiphene Citrate to evaluate the ovulation induction in patients with polycystic ovarian syndrome Methods: After fulfilling the selection criteria, total 360 females were enrolled according to calculated sample size and were randomly divided into two equal groups. One is treated with letrozole and other is clomiphene citrate. Successful ovulation was noted on follow up. Data was collected in proforma and later on analyzed in SPSS version 23. Results: The mean age of patients in letrozole group was 26.61± 4.81 years and in clomiphene citrate was it 27.89±4.24 years. Successful ovulation induction was noted in 172 with letrozole and 150 with clomiphene citrate i. e p-value=0.001. Conclusion: Letrozole has significantly better efficacy for successful ovulation than Clomiphene Citrate for PCOS. Keywords: Ovulation, Clomiphene citrate, Letrozole, polycystic ovarian syndrome

Hepatitis B virus (HBV) is a highly prevalent infection worldwide. It primarily infects liver and presents with features of chronic liver disease. Rarely, it presents with extra-hepatic manifestations. Kidney involvement in HBV infection is not uncommon. However, presentation with rapidly progressive glomerulonephritis is distinctly rare. A 40-year-old man with undiscovered HBV infection presented with fever-triggered body swelling for one month. Serum creatinine was 2.3 mg/dl on admission, which increased during hospitalization to 4.5 mg/dl. Renal biopsy demonstrated crescentic membranoproliferative glomerulonephritis, immune complex-mediated. Clinical, laboratory and imaging studies revealed mild chronic liver damage. Complete renal, hepatic and virological remission was achieved with steroids, plasmapheresis and antiviral therapy. This case emphasizes on early diagnosis and institution of multimodal therapy for better outcomes.

Background and Aim: Postpartum intrauterine device (PPIUD) is a reversible, long-term and effective technique of contraception. The intrauterine device (IUD) is inserted within 48 hours of delivery. The immediate insertion of an intrauterine device causes certain complications. The present study aimed to assess the prevalence of complications after Interval Postpartum Intrauterine Device Insertion. Materials and Methods: This cross-sectional study was carried out on 147 women who underwent postpartum IUD (PPIUD) insertions during from January 2021 to June 2021 at Gynecology department, Mufti Mehmood Memorial Teaching Hospital (MMMTH), Dera Ismail Khan and Muhammad Teaching Hospital Peshawar. All the women who delivered and showed willingness for PPIUCD insertion were enrolled and continuously follow-up for 4 to 6 weeks after delivery. Demographic, obstetric, and clinical parameters were recorded on pre-designed medical proforma. PPIUCD insertion after 6 weeks of delivery were followed-up for the evaluation of complications. Uterine infection, medical removal of IUD, IUD expulsion, perforation, and method discontinuation were the outcome variables. SPSS version 20 was used for data analysis. Results: Of the total deliveries, 147 women inserted the postpartum intrauterine contraceptive device (PPIUCD). Of the total, about 122 (83%) women returned for follow-up after 6 weeks. All the women underwent transvaginal insertion of intrauterine contraceptive devices. The PPIUCD insertion related complications with prevalence were uterine infection 26 (21.3%), overall method suspension 17 (13.9%), perforation 20 (16.4%), interceptive uterine device expulsions 25 (20.5%), and intrauterine device removal 32 (26.2%). The severe uterine infection was in 2 (1.7%) cases who were hospitalized. Conclusion: The postpartum intrauterine device cumulative expulsion rate was higher among women compared to the expulsion rate of insertions. The longer duration of bloody lochia flow and delivery intrauterine device insertions were the key risk factors for expulsion of PPIUCD. Women can safely utilize intrauterine contraceptive devices with low complications beyond four week. Keywords: Postpartum intrauterine device; Complications; Intrauterine device expulsion

The aim of the study. To study the peculiarities of responding to stress, the stress resistance and adaptation of older men and women with chronic brain ischemia, as well as the stressboard effect of Mexidol.Material and methods. 124 patients aged 60–74 years old are surveyed: 72 men and 52 women (average age, respectively, 65.3 ± 0.4 and 64.7 ± 0.7 years) with Chronic Brain Ischemia I–II stage against the background of arterial hypertension and its combinations with atherosclerosis of cerebral vessels. The level of psychosocial stress was determined on the Holmes-Ray scale. Features of the response of patients to stress was studied using the methodology Scale of Psychological Stress PSM-25 and S. Rogenzweig. Stress resistance was investigated using S. Kuhlen's stress resistance self-resistant test and Villianson. The level of anxiety was determined using a scale of Ch.D. Spilberger and Yu.L. Khanin, depressed – backup questionnaire. The type of adaptation reactions was studied in the leukocyte blood formula on the percentage ratio of lymphocytes and segmented neutrophils, taking into account the representation of other formed elements.Results. The level of stress in older women with Chronic Brain Ischemia was higher than in men. The predominance of the intrinsic orientation of the reaction to stress and resolving the type of response to men, and the extrapunitive or self-defense type among women, which may indicate the largerness of the latter. The level of stress resistance was lower in women than in men, which correlated with higher indicators of situational anxiety. Adverse adaptation reactions were more often registered in women than in men. The course of treatment with Mexidol of elderly patients with chemical leads to a decrease in the severity of subjective and objective symptoms, alarming disorders, increases the stress resistance and adaptive capabilities of the body, which is confrmed by an increase in the number of persons with favorable adaptation reactions. The high effciency and safety of sequential therapy with Mexidol (injections, then the tableted form of Mexidol Forte 250) is shown.

OBJECTIVES The study explored the perceptions of adult smokers with cardiovascular and respiratory diseases regarding cigarette smoking cessation. We also explored factors that may hinder or facilitate smoking cessation process. DESIGN Qualitative descriptive exploratory design SAMPLE: Purposive sample of 13 adult smokers with cardiovascular or respiratory diseases visiting outpatient cardiac and respiratory clinics at a private tertiary care hospital MEASUREMENTS: In-depth, face-to-face, and semi-structured interviews were conducted. The interviews were digitally recorded and transcribed verbatim followed by a six steps process of manual thematic analysis of data. RESULTS Meaningful statements were assigned codes and grouped into categories. Categories were clustered under three themes representing individual factors, socio-cultural factors, and institutional factors. CONCLUSIONS Smoking cessation is influenced by personal, cultural, as well as social aspects. Institutionally, there is a need to recognize that smoking is a learned behavior; hence, prohibiting public smoking will potentially contribute to non-smoking behaviors. Although the nature of misconceptions varies, this is imperative to ensure consistency in messaging, programming, and supports led by healthcare professionals.

With the sudden onset of the COVID-19 pandemic and disruption of the education systems worldwide, private universities in Bangladesh transitioned to online classes to ensure continuity of education. Therefore, it was important to investigate the private university teachers' and students' perceptions regarding various dimensions of accessing online instruction and coping strategies used by teachers. A mixed-methods approach was used to collect data from 208 teachers and 674 students through questionnaires and focus group discussions. The findings indicate that teachers and students encountered several barriers, including unstable internet connection, costly internet packages, minimal support for teachers, issues with online assessment, and an unsuitable home environment. To combat existing problems related to assessment and to increase interaction in the classroom, teachers used a small range of coping strategies. Measures are suggested to ensure access to stable internet connectivity, financial support to students and teacher training on online pedagogy and assessment. © 2021 European Knowledge Development (EUROKD). All Rights Reserved.

Background: Persons with bipolar disorder (BD) have a higher cardiovascular mortality compared to the general population, partially explained by the increased burden of cardiovascular risk factors. Research regarding outcomes following acute coronary syndrome (ACS) in this population remains scarce. Design: This Danish register-based study included patients diagnosed with BD and ACS in the period between January 1st, 1995, to December 31st, 2013. Study participants were matched 1:2 to patients without BD on sex, date of birth, time of ACS diagnosis and comorbidities. The primary outcome of interest was major adverse cardiovascular events (MACE) a composite of all-cause mortality, reinfarction or stroke. MACE and its individual components were compared between patients with and without BD. Results: 796 patients with BD were compared to 1592 patients without BD, both groups had a mean age of first ACS of 66.5 years. MACE was 38% increased (HR 1.38 95% CI 1.25–1.54), all-cause mortality was 71% increased (HR 1.71 95% CI 1.52–1.92), stroke was 94% increased (HR 1.94 95% CI 1.56–2.41) and reinfarction rates were 17% lower (HR 0.83 95% CI 0.69–1.00) in the BD population compared to the population without BD. We also found higher prevalences of heart failure (9.1% vs. 6.5%), valve disease (5.3% vs. 3.5%), anemia (8.7% vs. 5.8%), chronic obstructive pulmonary disease (13.4% vs. 9.3%) and stroke (11.8% vs. 7.8%) in the population with BD at baseline, all p-values

Background. Type 2 diabetes mellitus, obstructive sleep apnea, osteoarthritis and certain types of cancer are known to correlate with obesity. The mechanisms underlying the link between metabolic disorders and cancer remain obscure, yet assuming a potentially important role of reduced insulin sensitivity, altered glucose metabolism in tumor cells (the so-called Warburg effect), changes in the spectrum of secreted adipokines or interaction with their cognitive receptors as well as changes in steroid sex hormone production.Material and methods. A search for articles published in peer-reviewed journals indexed in pubmed, Wos, scopus and Rsci was carried out. More than 150 articles devoted to the study of the relationship between metabolic disorders and tumor progression were analyzed, of which 69 were included in this review.Results. The main strategy of anticancer therapy is to suppress the proliferation of tumor cells and metastasis. However, one should take into consideration a significant role of additional factors that can enhance side effects of anticancer therapy, ensure the resistance of tumor cells to chemotherapy or change cancer cell metabolic profile. New data recently emerging in the literature indicate an important function of proteins such as t-cadherin and urokinase receptor (upar) and their possible involvement in the regulation of tumor cell metabolism, in particular, sensitivity to insulin and adipose tissue hormones. The review encompasses recent data on the involvement of t-cadherin and upar in the regulation of metabolism and proposes a model explaining the relationship between these proteins and metabolic disorders associated with the processes of carcinogenesis and chemoresistance of cancer cells.Conclusion. Understanding of the factors and mechanisms that support obesity and metabolic disorders is relevant both for the development of cancer preventive measures and optimization of therapeutic strategies for combating cancer.

Agro-industry generates large amount of waste with diverse characteristics. The accumulation of agricultural waste is in the excess of 2 billion tons worldwide. This makes it imperative to investigate how agro-industrial waste utilization can be advanced to the next phase to maximise benefits from the sector. Improper management of these wastes leaves undesirable footprints in environment as well as on the economic health of many nations. In this direction, development of proper clean and green waste management approaches is the need of the hour, firstly, efficient conversion of wastes to value added products, by-products within affordable treatment costs and secondly, impact assessment on soil quality and productivity. This review fills the existing research gap on how agro-based waste can be productively harnessed. The review comprehends elaborately the industrial innovations and technology for recovery of agro-industrial wastes, which has triggered high resource efficiency, sustainable production and safe disposal.

Diabetic eye disease (DED) is a cluster of eye problem that affects diabetic patients. Identifying DED is a crucial activity in retinal fundus images because early diagnosis and treatment can eventually minimize the risk of visual impairment. The retinal fundus image plays a significant role in early DED classification and identification. An accurate diagnostic model’s development using a retinal fundus image depends highly on image quality and quantity. This paper presents a methodical study on the significance of image processing for DED classification. The proposed automated classification framework for DED was achieved in several steps: image quality enhancement, image segmentation (region of interest), image augmentation (geometric transformation), and classification. The optimal results were obtained using traditional image processing methods with a new build convolution neural network (CNN) architecture. The new built CNN combined with the traditional image processing approach presented the best performance with accuracy for DED classification problems. The results of the experiments conducted showed adequate accuracy, specificity, and sensitivity.

Many years after the discovery of X-ray's and gamma rays. They have been used empirically in medicine, later on realized that this approach was dangerous mainly in radiotherapy and up to some extent in diagnostic radiology. Thus Means of measuring x-ray/γ-rays had to be found in terms of unit of x-rays quantity dened and accepted. The magnitude of the biological effect desirable in case therapy and undesirable in case of diagnosis. It depends upon how much radiation energy is absorbed by irradiated material. X-ray dosimetry is the measurement of energy absorbed in any material particularly in different tissues of the body.

Diagnosis of congenital heart disease (CHD) which is a structural abnormality of the heart or intra thoracic great vessels in the earliest possible time is very important. Identifying the various modes of presentation, early referral and appropriate intervention can save lives and reduce risk of complications. The objectives of this study were to determine the clinical profile, complication and immediate outcome of children with congenital heart disease in first year of life. This cross-sectional observational study was conducted from October 2011 to March 2012 among 50 children from zero to one year of age who was diagnosed as CHD by echocardiography admitted in Department of Paediatrics of ShaheedSuhrawardy Medical College, Dhaka and Department of Paediatric Cardiology of National Institute of Cardiovascular Diseases, Dhaka, Bangladesh. Among 50 infants acyanotic CHD was detected in 70% and cyanotic in 30% infants. Major structural defects were venticularseptal defect 34%, patent ductusarteriosus 30%, tetralogy of fallot’s 14%, transposition of great arteries 12%, atrial septal defect 6%. Presenting features were cough 82%, dyspnea 80%, poor weight gain 70%, feeding difficulty 68% and fever 58%. Frequently observed complications were failure to thrive, pulmonary hypertension and heart failure. Among the outcome of CHD 8% cases closed spontaneously, case fatality rate was 8% and the rest were advised accordingly for surgery, intervention and medical management among which 14% had device closure within the study period. High index of suspicion, early diagnosis, close monitoring and timely intervention can reduce complication of CHD. Bangladesh Med J. 2020 Sept; 49(3) : 17-21

In response to a published national payer survey indicating striking needs for multistakeholder initiatives to increase biosimilar adoption, a focus workgroup meeting joining payers and providers was conducted in December 2019 in Boston, MA. Before the focus group meeting, a survey was sent to health care providers to collect perceptions about barriers to biosimilar adoption and gather input on best potential strategies for addressing these barriers. The focus group panel consisted of 5 managed care pharmacists and 3 physician experts in rheumatology, dermatology, and gastroenterology, representing large managed care organizations and health care systems in the Boston area. A clinical moderator facilitated discussions between the payers and providers regarding challenges to biosimilar adoption and potential collaborative strategies to overcome these barriers. The focus group participants identified hurdles to biosimilar adoption in 3 major areas: (1) the lack of confidence in biosimilar interchangeability and a need for education about biosimilars, (2) the lack of financial incentives to switch to biosimilars from the reference biologic product, and (3) administrative burdens that impair the prescription of biologics. Learning from their mutual experiences, the focus group participants formulated action plans to address these barriers. The top strategies recommended by the participants included advancing biosimilar education, facilitating administrative processes related to biosimilar prescriptions, and increasing provider reimbursement while reducing cost sharing to patients receiving biosimilars.

Background Maintenance hemodialysis (MHD) patients face disadvantages with higher risk of acquiring SARS‐CoV‐2 infection, atypical manifestations, and associated multiple comorbidities. We describe patients' outcomes with symptomatic COVID‐19 on MHD in a large cohort of patients from India. Methods Data were collected prospectively from hemodialysis units in 11 public and private hospitals between March 15, 2020, and July 31, 2020. The survival determinants were analyzed using stepwise backward elimination cox‐regression analysis. Results Of the 263 total patients (mean age 51.76 ± 13.63 years and males 173) on MHD with symptomatic COVID‐19, 35 (13.3%) died. Those who died were older (p = 0.01), had higher frequency of diabetic kidney disease (p = 0.001), comorbidities (p = 0.04), and severe COVID‐19 (p = 0.001). Mortality was higher among patients on twice‐weekly MHD than thrice‐weekly (p = 0.001) and dialysis through central venous catheter (CVC) as compared to arteriovenous fistula (p = 0.001). On multivariate analysis, CVC use (HR 2.53, 95% CI 1.26–5.07, p = 0.009), disease severity (HR = 3.54, 95% CI 1.52–8.26, p = 0.003), and noninvasive ventilatory support (HR 0.59, 95% CI 0.25–0.99, p = 0.049) had significant effect on mortality. Conclusion The adjusted mortality risk of COVID‐19 in MHD patients is high in patients associated with severe COVID‐19 and patients having CVC as vascular access.

Neurocognitive compromise, neuropsychiatric symptoms and psychopathology are all evident in the acute stages of autoimmune encephalitides. These factors considerably affect functional independence after discharge. Drawing on psychometric assessments and qualitative descriptions, this review explores the nature, extent and diagnosis of cognitive disorder in autoimmune encephalitides. Potential pathophysiological and neuroanatomical architecture related to neurocognitive compromise in the acute and chronic stages of this illness is examined. In regard to outcomes, the review highlights clinicodemographic factors currently known to be associated with poorer cognitive outcome. Finally, the review delves into neuropsychiatric symptomology and psychological concerns that should be considered at diagnosis and during follow up of these patients.

INTRODUCTION Exclusive breastfeeding (EBF) practices during first six months of life are the most cost-effective intervention for reducing infant and child morbidity and mortality. However, adherence to EBF practices in developing countries remains unsatisfactory, where maternal employment has been identified as one of the influencing factor. The study aims to identify and compare EBF practices and its factors influencing among employed and unemployed mothers. MATERIALAND METHODS An institutional based comparative cross-sectional study was conducted among 362 mothers of infants visiting the immunization clinic of Universal College of Medical Sciences, Bhairahawa, Nepal, from December 2020 to March 2021 following ethical clearance (UCMS/IRC/114/20) and verbal consent from participants. Descriptive statistics was used to compare EBF practices and multivariate logistic regression to identify independent predictors of EBF. RESULTS Total 362 (181 employed and 181 unemployed) mothers were interviewed. Prevalence of EBF was 13.8% and 81.2% among employed and unemployed mothers respectively. Further EBF practice had significant association with working status of mothers (AOR= 15.44, 95% CI 6.76-35.25) and monthly family income (AOR=3.31, 95% CI 1.24-8.84). Among employed, EBF practice had significant association with carry infant to work place (AOR= 12.36, 95% CI 4.35-49.87) whereas type of delivery (AOR= 3.88, 95% CI 1.69-8.90) was significantly associated among unemployed mothers. CONCLUSION EBF practices among employed mothers were less than that of unemployed mothers. Provisions to provide additional supports, either by revising the period of maternity leave or adopting different alternatives to prolong the period of EBF may be beneficial for employed mothers and their children.

Injudicious consumption of antibiotics in the past few decades has arisen the problem of resistance in pathogenic organisms against most antibiotics and antimicrobial agents. Scenarios of treatment failure are becoming more common in hospitals. This situation demands the frequent need for new antimicrobial compounds which may have other mechanisms of action from those which are in current use. Limonene can be utilized as one of the solutions to the problem of antimicrobial resistance. Limonene is a naturally occurring monoterpene with a lemon-like odor, which mainly present in the peels of citrus plants like lemon, orange, grapefruit, etc. The study aimed to enlighten the antimicrobial properties of limonene as per previous literature. Advantageous contributions have been made by various research groups in the study of the antimicrobial properties of limonene. Previous studies have shown that limonene not only inhibits disease-causing pathogenic microbes, however, it also protects various food products from potential contaminants. This review article contains information about the effectiveness of limonene as an antimicrobial agent. Apart from antimicrobial property, some other uses of limonene are also discussed such as its role as fragrance and flavor additive, as in the formation of nonalcoholic beverages, as solvent and cleaner in the petroleum industry, and as a pesticide. Antibacterial, antifungal, antiviral, and anti-biofilm properties of limonene may help it to be used in the future as a potential antimicrobial agent with minimal adverse effects. Some of the recent studies also showed the action of limonene against COVID-19 (Corona virus). However, additional studies are requisite to scrutinize the possible mechanism of antimicrobial action of limonene. [ABSTRACT FROM AUTHOR] Copyright of Journal of Pure & Applied Microbiology is the property of Dr. M. N. Khan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pincus is credited for evolution of porcelain veneers. He attached the thin labial porcelain veneers temporarily with denture adhesive powders to improve dental esthetic appearance. Improvement of patient’s lost natural dental esthetics have become important goal of discipline of dentistry and credited for wide ranging applications from improving common man’s appearance to filmstars. Esthetic problems may be result of interplay of complex factors like color, shape, and structural and position abnormalities of anterior teeth. Laminate veneers are used for purpose of improving esthetic deficiencies and discolorations as well as existing abnormalities. Successful application of porcelain veneers depends on multiple factors such as the clinical and laboratory steps involved, along with the understanding of the scientific background of procedure. Conservative and esthetic approaches, such as direct and indirect laminate veneer restorations are most preferred way chosen by dentist across world to improve compromised esthetics of human beings. Technological advancements such as intraoral scanner for impression making have significantly improved the success of prosthesis. Keywords: Esthetic deficiencies, Indirect restoration, Smile analysis, laminate, Intraoral scanner.

Introduction. The paper focuses on the challenging issue of treatment of newborns with gastroschisis (GS) and a high level of intraabdominal hypertension in case of severe viscero-abdominal disproportion. The aim of the paper is to present the current state of the problem at the regional level based on our own clinical experience in observation and treatment of newborns with GS. Material and methods. The study is based on the analysis of examination and treatment of 29 newbornswith GS. The distribution of boys and girls was nearly the same: 16 (55.17%) boys and 13 (44.83%) girls. The number of premature babies was 23 (79.31%). The complex of diagnostic procedures included clinical laboratory examination, radiologic investigation (using contrast agents when required), ultrasound investigation and Doppler sonography, intraabdominal pressure measurement, histologic study of surgical specimens.Results. Prenatal information on the congenital anterior abdominal wall defect was obtained with the help of prenatal ultrasound. In most cases, fetal GS is diagnosed before 20 weeks of pregnancy. Prenatal ultrasound was performed in 13 (44.83%) pregnant women out of the researched group. Two false test results were obtained.Radiologic investigation of a child with GS is necessary to detect intestinal obstruction, necrosis or bowel perforation. Among patients under our study, two cases of ileal atresia were registered. The analysis of intraabdominal pressure indices in patients with GS showed a high level of intraabdominal hypertension in approximately 70% of cases. It proves that patients with GS have a high level of surgical and anesthetic risk. The main therapy measures include the following steps: appropriate preoperative preparation, anesthetic management, and the choice of appropriate perioperative techniques taking into account the level of intraabdominal hypertension and viscero-abdominal disproportion.Depending on the child's condition, type of GS and level of intraabdominal hypertension, there were twosurgical options:1. Primary radical surgery.2. Staged surgical treatment.Analyzing the results of the study, it may be noted that 8 newborns in total died after the surgery, which is 27.59%(it used to be 56-60% till 2005). The main causes of death were respiratory failure, neonatal sepsis and unfavorable premorbid conditions (very low gestational age, severe comorbidity, multiple congenital malformations).Conclusions. 1. Successful treatment of newborns with GS depends on the early diagnosis of the pathology, which must be prenatal, and elimination of contradictions in treatment tactics. 2. Before suturing the abdominal wall defect in newborns with GS, it is necessary to measure intraabdominal pressure, since intraabdominal hypertension leads to a significant deterioration in the mechanical properties of the lungs, hemodynamic abnormalities,oliguria, intestinal ischemia, decrease in organ perfusion, which must be taken into account when carrying out preoperative preparation and aesthetic management. 3. The level of intraabdominal hypertension in patients with GS,which is high in 68.96% of cases, must be an indication for choosing the method of surgical correction of the defect i.e.the refusal of radical plasty of the abdominal wall and the resort to staged intervention or other surgical techniquesthat involve an increase in the abdominal cavity volume. 4. The reduction in mortality in newborns with GS to 27.59%is possible due to the introduction of etiopathogenetic approaches to early diagnosis, preoperative management, anesthetic management and surgical correction of this pathology into the practice of neonatal surgery.

PurposeIn this paper, using the antecedents, decisions and outcomes (ADO) framework, the factors/key performance indicators (KPIs) most relevant for creating or building a learning organization (LO) are identified. This study aims to contribute to the field of knowledge management (KM) in terms of introducing KPIs to foster a business organization with a continuous learning process, mechanisms of knowledge creation and memorization.Design/methodology/approachIn total, 57 papers were selected for this systematic literature review (SLR) from Web of Science and Scopus covering the period 1985–2019.FindingsThe 12 most relevant KPIs are identified based on the literature survey conducted in the field of LO.Research limitations/implicationsThe managerial implications of this review paper will be an added advantage to the modern business organization worldwide that have adopted KM practices to foster knowledge management with information technology (IT) infrastructure. As IT infrastructure focuses on knowledge acquisition, dissemination and storage but the KPIs revealed through this review will help in transforming stored information as learning for the organization to improve its overall performance.Originality/valueThis review synthesizes prior studies and provides directions for future research.

Aim: To compare the frequency of infection and expulsion following insertion of IUCD immediate post casarean to that of interval insertion in parturient undergoing elective caesarean section Method: This Randomized controlled trial was conducted from 21 February to 20th August 2010. Results: It was observed that in immediate post cesarean group(Group A) expulsion rate was 8.1% and infection rate 7.2% where as in interval insertion group(Group B) expulsion rate was 10.9%and infection rate was 9.0%. The difference of expulsion rate was statistically significant in two groups (p value 0.491) i.e expulsion rate was proven to be significantly higher in interval insertion group than immediate trans cesarean insertion group. The difference of infection rate was not statistically significant between two groups (p value 0.623) although infection rate was found to be higher in interval insertion group but not clinically significant difference was found. Conclusion: Null hypothesis was rejected for expulsion rate of IUCD and a statistically significant increased expulsion rate was found in interval insertion group as compared to immediate post cesarean insertion group. Null hypothesis was accepted for infection rate after IUCD placement in two groups as no statistically significant increased infection rate was found between immediate post cesarean and interval insertion groups Keywords: Expulsion rate, infection rate,immediate post cesarean insertion,interval insertion.

The present study focuses on the use of Motivational Synergy as means to ameliorate the comprehension of ESL Learners at various campuses of the University of Education. The study is correlational. The survey method was adopted to carry out the research. A convenient purposive sampling technique was used to collect the sample which is comprised of 100 public sector university students including 33% males and 67% females studying in the M.A. English program. This study focused on reading comprehension and listening comprehension. The results show that bottom-up training had a negative impact on comprehension. In contrast, top-down training positively affected fluency but had no impact on comprehension. Further, the results do suggest that fast-paced reading may potentially lead to improved comprehension. These findings have implications for the type of language instruction used in classrooms and, therefore, for teachers of adult ESL learners.

Climate change is widely recognized as one of the most pressing issues confronting humanity today. It is considered to be a direct threat to our food production system including rice. Climate change affects rice production in various ways. The variability in temperature and precipitation increases, predictability of seasonal weather patterns reduces and the frequency and intensity of extreme weather events such as droughts, floods and cyclones increases. In India, the effect of natural disasters on agriculture, including disasters caused by climate change has been gradually growing. It is believed that during the mid and end century India's future rice production is projected to reduced by 2.5 to 5% from the current level. As there is less scope for rice area to grow in the future, any growth in rice production will have to come only from productivity gains. Since climate change is a continuous process, the rice production system requires specific adaptation strategies to prevent rice yield losses and its variability. Therefore, it's critical to understand how climate change affects rice crop and to follow better production practises including crop establishment methods, water management, weed management, nutrient management and microbial resources utilization that make cropping systems more resilient to extreme weather events. The spread of climate resilient production technologies would benefit rice production systems' resilience.

Among the various fused heterocyclic rings, benzothiazole and its analogs have been explored broadly in search of newer therapeutic medicinal agents. The benzothiazole scaffold has been associated with huge biological potential like anticancer, antidiabetic, anti-inflammatory, antitubercular, antiviral, anti-convulsant etc. The occurrence of benzothiazole core in various compounds proves its value in the sphere of pharmaceutical chemistry. The connected research and developments in benzothiazole based chemistry become an active topic for medicinal scientists. A large number of benzothiazole and its heterocyclic derivatives are available in the market and used for the treatment as clinical drugs have been extensively used in practice to treat diverse types of ailments with high therapeutic potential. This review presents the latest therapeutic developments of benzothiazole containing compounds in the medicinal chemistry.

The energy sector of Pakistan has undergone several changes over the previous several years, due to the ever-increasing energy consumption. The objective of this study is to determine the extent to which the consumption of energy sources can be attributed to Pakistan’s institutional quality, based on the perception of positive impact of institutional quality on facilitation of public goods. In this context, the demand functions of energy sources (electricity, natural gas and petroleum products) for four main economic sectors(i.e., residential, industry, commercial and agricultural sectors), have been examined by employing bound testing to cointegration (ARDL approach), over a period of 35 years (1984-2019). The analysis reveals that institutional quality has significant positive impact on energy consumption. The results of the study provide implications for energy sector reforms by illustrating the importance of institution-building policy efforts.

Objectives: To determine the knowledge of MBBS students of a public sector medical university regarding hand hygiene and to assess the practical implication of their knowledge regarding hand hygiene during the clinical postings. Study Design and Setting: A cross sectional study was conducted in Sindh Medical College, Jinnah Sindh Medical University (SMC-JSMU) Karachi, from July to November 2018. Methodology: A total of 316 M.B.B.S students from first year to final year were included in the study. Students were equally divided into preclinical and clinical groups. Hence, the knowledge of preclinical and clinical students were compared in the present study. Age range of participants was 18 to 24 years and both male and female participants were involved. Data was analyzed by SPSS 22.0. P value < 0.05 was considered as statistically significant. Results: Approximately 249 (78.8%) students agreed that hands of health care workers are a source of nosocomial infections. Nearly 293 (92.7%) students admitted that hand decontamination and gloving is necessary before bedside procedures. Only 61 (38.6%) students performed it routinely. Chief restricting factor in performance of hand hygiene was inadequate supply of hand hygiene resources as reported by 122 (77.2%) students. Conclusions: Majority of medical students in both preclinical and clinical groups were well aware of HH practices and its significant role in infection control. However, only a limited number of students routinely performed HH. The difference between knowledge and practice of students was mainly due to the inadequate facilities of hand washing in public sector hospitals

Iridocorneal endothelial syndrome has three clinical entities- Chandler’s syndrome, progressive iris atrophy and Cogan Reese syndrome. A 40 year old female presented to the department of Ophthalmology with a chief complaint of unusually looking left eye for many years. Ocular examination revealed left eye visual acuity 6/6, Several iris stretch holes at 9 to 12 o’clock, with marked iris thinning. Pupil had polycoria and corectopia. Fundus examination revealed normal disc with 0.5cup disk ratio, IOP -24mm Hg. OCT RNLF and visual fields were normal. RE was completely within normal limits. Patient was started on eye drop Timolol 0.5%, 1 drop BD in left eye. On follow up the IOP was under control (18 mm Hg). Since patient had predominant progressive changes in the iris and specific unilateral clinical features, it was diagnosed as essential iris atrophy with early secondary glaucomatous features. Keywords: Progressive iris, Secondary glaucoma.

Background and aim Excess adiposity is associated with an increased risk of diabetes. Amongst the various measures of adiposity, the most appropriate one to predict the risk of diabetes remains debatable. Therefore, the aim of this study was to compare the ability of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) in predicting type 2 diabetes mellitus (DM) among Pakistani adults. Subjects and methods This was the sub-analysis of a large population based Second National Diabetes Survey of Pakistan (NDSP) 2016–2017. With this survey, 10834 individuals were recruited and 4788 individuals fulfilled the inclusion criteria for this sub-analysis (subjects with missing anthropometric details were excluded). Participants were categorized into two groups; subjects with type 2 DM and subjects without DM. Data of participants was collected via pre-designed detailed questionnaire. Clinical and anthropometric measurements were measured using standardized techniques. Results Out of 4788 individuals, 3085(64.4%) were non-DM subjects and 1703(35.6%) were type 2 DM subjects with mean age of 39.78 ± 13.79 and 50.38 ± 11.33 years, respectively. Logistic regression analysis revealed a significant association of WC with type 2 diabetes after adjustment for possible confounders. Area under the curve (AUC) of WC was found higher than AUC of BMI and WHR. Conclusion The findings from second NDSP (2016–2017) demonstrated that WC is a better marker than WHR and BMI in predicting type 2 DM for Pakistani population.

As a rule, coronavirus infections are mild in healthy adults and do not require special approaches to treatment. However, highly pathogenic strains, particularly the recently isolated SARS-CoV2, which causes COVID-19 infection, in about 15% of cases lead to severe complications, including acute respiratory distress syndrome, which causes high patient mortality. In addition, a common complication of COVID-19 is the development of pulmonary fibrosis. Why is the novel coronavirus so pathogenic? What new treatments can be proposed to speed up the recovery and subsequent rehabilitation of the organism? In 2020, over 34 000 scientific articles were published on the structure, distribution, pathogenesis, and possible approaches to the treatment of infection caused by the novel SARS-CoV2 coronavirus. However, there are still no definitive answers to these questions, while the number of the diseased is increasing daily. One of the comprehensive approaches to the treatment of the consequences of the infection is the use of multipotent human mesenchymal stromal cells and products of their secretion (secretome). Acting at several stages of the development of the infection, the components of the secretome can suppress the interaction of the virus with endothelial cells, regulate inflammation, and stimulate lung tissue regeneration, preventing the development of fibrosis. The results of basic and clinical research on this topic are summarized, including our own experimental data, indicating that cell therapy approaches can be successfully applied to treat patients with COVID-19.

Objective: The main purpose of this study is to evaluate the hepatoprotective effects of propolis in hepatocytes injury caused by ATT due to isoniazid and rifampicin. Methods: Healthy albino rats of with average weight of 200-250g were under this study. These rats dividing into main four groups, A group is taken a control group and then further into the group B, group C, and group D as group for experiments. The control group had 15 rats with measured weight, they were given distilled water. Group B had 15 rats, they were given with standard dose of rifampicin and isoniazid. Group c had 15 rats, they were also given with standard dose of rifampicin and isoniazid. Group D had 15 rats, they were given with standard dose of rifampicin and isoniazid and also extract of the propolis we prepared. Results: Serum ALT in the experimental group B with group C, group D were also found to be of statistically significant with p-value < 0.001. ALT serum level observed high in group B. Multiple comparison between groups revealed that group B with a significantly increase in the serum enzyme AST level in comparison to group A, group C and group D with p-value

The Danish-German Jerash Northwest Quarter Project revealed a robust and striking pattern of the extreme dominance (>99%) of locally produced ceramics over six centuries and across different depositional contexts (in total over half a million pottery sherds). The archaeology of Jerash points towards an exceptional degree of self-sufficiency in craft products: why? The project team implemented a full quantification approach during excavation, manually and digitally recording and counting all pottery and other classes of artefacts. This enabled a full analysis of trends in production and use of ceramics throughout the archaeologically documented history of Jerash and revealed the unexpected pattern of the extreme dominance of local pottery. Archaeologists formulated a set of hypotheses to explain this pattern, and we developed an agent-based model of simple customer preference driving product distribution to evaluate several explanatory factors and their potential interactions. Our simulation results reveal that preference for locally produced ceramics at Jerash might be a plausible theory, but only if its intrinsic value was considered rather high in comparison to other goods, or if it was preferred by a majority of the population, and there was a tendency to follow this majority preference (or a combination of these factors). Here, we present a complete research pipeline of a full quantification of ceramics, analysis and modelling applicable at any archaeological site. We argue that transparent methods are necessary at all stages of an archaeological project: not only for data collection, management and analysis but also in theory development and testing. By focusing on a common archaeological material and by leveraging a range of widely available computational tools, we are able to better understand local and intra-regional distribution patterns of craft products in Jerash and in the ancient eastern Mediterranean.

Alzheimer’s disease affects daily routine due to loss of memory and decline in cognition. In vitro data showed acetylcholine esterase inhibition activity of Malva neglecta but no in vivo evidence is available. The current study aims to investigate the anti-Alzheimer’s activity of Malva neglecta methanolic extract in the AlCl3-induced Alzheimer disease rats’ model. Thirty Wistar rats were divided into six groups and respective doses were given orally for 21 days. Behavioural observations were recorded and biochemical analysis was performed on brain homogenate. Improvement in memory and cognition was noted in treated rats as compared to disease control. A dose-dependent decrease (0.530 ± 0.009 at 200 mg/kg, 0.212 ± 0.007 at 400 mg/kg, 0.173 ± 0.005 at 600 mg/kg) in AChE activity was noted in the treatment groups with reference to disease control value (1.572 ± 0.013). This decrease in AChE activity is linked with an increase in acetylcholine in the brain which plays a key role in retaining memory. Oxidative stress biomarkers; GSH (66.77 ± 0.01 at 600 mg/kg), SOD (26.60 ± 0.10 at 600 mg/kg), CAT (21.46 ± 0.01 at 600 mg/kg) levels were increased with a decrease in MDA (103.33 ±0.49 at 600 mg/kg) level in a dose-dependently manner in the treatment groups as compared to disease control respective values. It is concluded that Malva neglecta could ameliorate Alzheimer’s symptoms possibly by decreasing AChE activity and oxidative stress.

The Human epidermal growth factor receptor 2 positive (HER2+) breast cancer (BC) is a more aggressive tumor with 5 years median survival rates after metastasis. Despite successful treatment, unfortunately, the majority of affected patients die. Defects in cell cycle and transcription regulation phases which are governed by cyclin-dependent kinases (CDKs) are the hallmark of many cancers that underpinning the progression of the disease. Therefore, the current study looked at the alteration of six CDKs mRNA expression levels in pre- and postmenopausal lung metastasis BC groups; the majority were HER2+. Two hundred pre-and postmenopausal lung metastasis breast cancer and healthy control blood samples were taken for RNA isolation. Quantitative PCR was done for CDKs mRNA expressions. We observed overexpression of CDK11, CDK12, CDK17, CDK18, and CDK19 in both pre- and postmenopausal groups. However, CDK20 showed progressive downregulation from early to advanced stages in both groups of patients. Collectively, this data revealed that CDKs overexpression levels may predict BC disease progression and provide further rationale for novel anticancer strategies for HER2+ BC cancers.

We report here, case series of patients with acute kidney injury (AKI) developing in associationwith hemolytic uremic syndrome (HUS). Different causes of HUS and outcome of patients in this group of patients is aimed to be reported. Patients and Methods: subjects for the study reported here comprised of a cohort of 105 patients admitted with the diagnosis of AKI due to HUS. AKI was defined according to RIFLE criteria and HUS on basis of hematological, biochemical and/or histological features. All patients had normal size kidneys on ultrasonography and no previous co- morbidity. Results: One hundred and five patients with AKI due to HUS were brought to this institute from January 2000 - July 2019; among these 76 were females, mean age of these patients was 27.83±10.50 years. Causes of HUS were febrile illness, with or without diarrhea, diarrhea alone, pregnancy related complications and one each from snake bite, HCV infection / IFN therapy and use of combination of drugs. In pregnancy related HUS one patient had HUS during pregnancy while rest were during postpartum. Renal replacement was required in 95.23 % patients. Complete renal recovery was observed in 22 patients, while 15 died during acute phase of illness. CKD-V developed in 24 patients, 41 patients lost long term follow up, but were dialysis free till last follow up. Treatment with plasmapheresis revealed significantly better renal recovery (p value 0.026) in this group of patients. Conclusion: HUS can be severe life threatening disease; AKI with background of HUS may remain irreversible in many of these patients. Plasmapheresis should be offered to patients with established diagnosis of HUS.

The Covid-19 pandemic forced providers to alter their delivery of care to special populations, including older adults with cognitive impairment. The Montefiore–Einstein Center for the Aging Brain, a specialty multidisciplinary center for the evaluation and management of patients with neurodegenerative disorders, developed a coordinated approach (Coordinated Care At Risk/Remote Elderly program [CCARRE]) to reach our diverse population during the initial Covid-19 crisis in New York City, USA. In the tele-evaluation of the first 85 patients seen with CCARRE, we recognized unique factors that could improve patient care, lessen burden and optimize access to community resources. Lessons learned from the experience are shared.