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Nephrotic syndrome progresses with various metabolic disturbances, such as proteinuria over 3.5 grams in 24 hours, hypoalbuminemia, and hypercoagulability. Patients usually complain about diffuse edema throughout the body, which is secondary to hypoalbuminemia. It has many primary and secondary causes. Patients may require a renal biopsy to confirm the diagnosis. Besides, many secondary causes of nephrotic syndrome should be examined and excluded. Although many vaccines were developed due to the COVID-19, many side effects are still reported because of the Pfizer-BioNTech COVID-19 vaccine (COVID-19 mRNA and BNT162b2), which is widely used in Turkey. This study examines a case of nephrotic syndrome with acute renal injury after Pfizer-BioNTech vaccine.

Objectives: To determine the correlation of subclinical hypothyroidism (SCH) with polycystic ovarian syndrome (PCOS) and to assess its impact on the clinical, biochemical and hormonal features in polycystic ovarian syndrome. Background: PCOS is one of the most common endocrinopathies seen in women of the reproductive age group with a prevalence ranging from [Formula: see text] to [Formula: see text] globally (Joshi et al., 2014) and [Formula: see text] to [Formula: see text] (Malik et al., 2014) in the Indian population. Thyroid disorders are quite commonly seen in PCOS patients, SCH are seen in up to [Formula: see text] of this population (de Medeiros et al., 2018). Its association with PCOS has been insufficiently explored and therefore this study was designed to better understand the correlation. Methodology: This was a cross-sectional study conducted from November 2019 to 2021 in the Department of Obstetrics and Gynecology of Jawaharlal Nehru Medical College and Hospital, Aligarh, India, on 150 PCOS women in the age bracket of 18–35 years. They were divided in two groups: one with normal thyroid levels and the other with SCH. Measurement of clinical, anthropometrical, biochemical and hormonal profile was made in both groups and comparison was made using appropriately matched tests of significance and coefficient of correlations. Results: Notable findings included a positive and statistically significant correlation between SCH and menstrual cycle irregularities ([Formula: see text], [Formula: see text]), infertility ([Formula: see text], [Formula: see text]), body mass index ([Formula: see text], [Formula: see text]), waist to hip ratio ([Formula: see text], [Formula: see text]), testosterone([Formula: see text], [Formula: see text]), total cholesterol ([Formula: see text], [Formula: see text]), triglyceride values ([Formula: see text], [Formula: see text]), fasting insulin ([Formula: see text], [Formula: see text]) and HOMA-IR ([Formula: see text], [Formula: see text]). A positive but statistically insignificant correlation was found with hirsutism ([Formula: see text], [Formula: see text]), luteinizing hormone ([Formula: see text], [Formula: see text]), follicle-stimulating hormone ([Formula: see text], [Formula: see text]), prolactin levels ([Formula: see text], [Formula: see text]), high-density lipoprotein ([Formula: see text], [Formula: see text]), low-density lipoprotein ([Formula: see text], [Formula: see text]) and fasting blood sugar values ([Formula: see text], [Formula: see text]). No statistical significance with systolic blood pressure ([Formula: see text], [Formula: see text]) and diastolic blood pressure ([Formula: see text], [Formula: see text]) was found. Conclusion: The study showed a significant correlation between SCH and multiple variables in PCOS and thereby necessitating thyroid screen in PCOS population.

C. camphora is a renowned traditional Unani medicinal herb and belongs to the family Lauraceae. It has therapeutic applications in various ailments and prophylactic properties to prevent flu-like epidemic symptoms and COVID-19. This comprehensive appraisal is to familiarize the reader with the traditional, broad applications of camphor both in Unani and modern medicine and its effects on bioactive molecules. Electronic databases such as Web of Science, PubMed, Google Scholar, Scopus, and Research Gate were searched for bioactive molecules, and preclinical/clinical research and including 59 research and review papers up to 2022 were retrieved. Additionally, 21 classical Unani and English herbal pharmacopeia books with ethnomedicinal properties and therapeutic applications were explored. Oxidative stress significantly impacts aging, obesity, diabetes mellitus, depression, and neurodegenerative diseases. The polyphenolic bioactive compounds such as linalool, borneol, and nerolidol of C. camphora have antioxidant activity and have the potential to remove free radicals. Its other major bioactive molecules are camphor, cineole, limelol, safrole, limonene, alpha-pinene, and cineole with anti-inflammatory, antibacterial, anxiolytic, analgesic, immunomodulatory, antihyperlipidemic, and many other pharmacological properties have been established in vitro or in vivo preclinical research. Natural bioactive molecules and their mechanisms of action and applications in diseases have been highlighted, with future prospects, gaps, and priorities that need to be addressed.

Background: Standardization of a single potent Unani drug Saad Kufi is a must for maintaining and assessing the quality and safety as to attain the desired therapeutic effect. This will help prepare the ideal monograph which will serve in establishing its authenticity, quality, safety and reproducibility. Aim: The study aims to prepare the ideal monograph of the Saad Kufi (Cyperus scariosus R.Br)which is an important cardiovascular drug. Methodology: Physicochemical and preliminary phytochemical analyses were carried out according to the guidelines given by WHO. Result: Saad Kufi powder was coarse, brown incolor, Agreeable smell, and Tasteless. Total ash, acid insoluble ash, water-soluble ash, loss in weight on drying, pH (1% and 10% solution) were found to be16.3±0.07, 8.616±0.20, 3.1±0.30, 8.5±0.173, 5.76±0.08 and 5.23±0.08 respectively. The crude fibre content was 46.43±0.19 The Phytochemical screening revealed the presence ofalkaloids, carbohydrates, proteins, phenols, sterols, glycosides, Cardiac glycosides, flavonoids, sterols/ terpenes and volatile oil. TLC studies of various extracts of drugs obtained in different solvent system have been conducted and Rf values of various spots in different solvent systems have been noted in day light, UV light and after treatment with iodine vapours. The Rf values in the given solvent are used to characterize the drugs identity and purity. Conclusion: The above findings could be considered for laying down pharmacopoeial standards. No data exhibits in this regard to compare with, thus our findings may be considered as standard for future references. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 858-864

Various biomarkers and clinical variables are used to determine the probability risk, diagnosis, and the prognosis of acute ischemic stroke, but effective markers are still warranted.We aimed to determine the effectiveness of Hs-cTnI levels to predict the prognosis of AIS.This study was planned as a retrospective observational study. Patients with available data and over 18 years old were included in the study. Diffusion magnetic resonance images were evaluated by a senior radiologist and the infarct size was calculated.We included 110 (54.2%) males and 93 (45.8%) females; a total of 203 patients with a mean age of 68.9 were included in the present study. Patients were divided into two groups according to the cut-off level of Hs-troponin-I (group I: lower than 8.5 mg/dL; group 2: higher than 8.5 mg/dL). These two groups were compared for mortality and infarct volume. Infarct volume and the mortality ratio of the group 2 was significantly higher [p = 0.041, U = 4294.5, LV = 6.5 (IQR = 1.8-25.4)].Hs-troponin I may be an effective biomarker in predicting the prognosis of patients with acute ischemic stroke. Multicenter comprehensive prospective studies are warranted to obtain stronger results.

Although the bioactive peptides associated with the apelinergic system are known to be associated with heart failure and ischemic heart disease, there are no data on their association with acromegaly.We aimed to investigate the change in serum Elabela levels, a novel peptide of the apelinergic system, in patients with acromegaly.Our study included 30 treatment naive patients who were recently diagnosed with acromegaly, and 50 age-and-sex-matched healthy controls. In addition to routine history, physical examination and laboratory examinations, serum Elabela level was measured. Participants were divided into two groups as individuals with and without acromegaly and compared to each other.Diastolic blood pressure (DBP) and systolic blood pressure (SBP) were found to be higher in patients with acromegaly. Serum glucose, Hs-CRP, NT-proBNP, insulin-like growth factor-1, growth hormone and serum Elabela levels were higher in patients with acromegaly (p 0.05 for each). Left ventricular ejection fraction (LV-EF) was found to be lower in patients with acromegaly than the patients in healthy control group (p 0.05). In multivariate analysis; age, systolic blood pressure, NT-proBNP, Insulin-like growth factor 1 and growth hormone levels were found to be very closely and positively related to serum Elabela level (p 0.05 for each).Serum Elabela level can be used as an early and objective indicator of early cardiovascular involvement in patients with acromegaly. Further research is needed to clarify the role of serum Elabela levels on cardiovascular system in acromegaly patients.

Tokyo guidelines (TG13/18) are used for the severity assessment of acute cholangitis (AC). Lactate is a clinical marker of tissue hypoxia and disease severity, independent from blood pressure.The aim of this study is to investigate the relationship between blood lactate level and TG13/18 criteria in patients diagnosed with AC.One hundred fifteen patients with AC were included in this retrospective study. Demographic characteristics of the patients and laboratory data were scanned from their hospital medical records. According to TG13/18 guidelines, the patients were divided into 3 groups as mild (grade 1), moderate (grade 2), and severe (grade 3) AC.Sixty three (54.7%) of the patients were grade 1, 37 (32.1%) were grade 2, and 15 (13.0%) were grade 3. It was found that blood lactate level increased significantly from grade 1 to grade 3 (p 0.001). In logistic regression analysis, white blood cell (WBC) count, total bilirubin and blood lactate levels independently determined the patients to be grade 2 or 3 AC. When the blood lactate cut-off value was taken as 16.5 mg/dL, we diagnosed grade 2 or 3 AC with a sensitivity of 78.8% and a specificity of 75.7%. From among lactate, WBC, and C reactive protein, lactate showed the highest value regarding the area under the curve, which is an index for predicting grade III upon ROC analysis.The blood lactate level is associated with the severity of AC. In addition to TG13/18 guidelines, blood lactate level can be a useful biomarker in the severity grading of AC.

One of the most important steps for preventing deaths due to snake bites is to administer snake antivenom to the eligible patients in a swift manner. In our study, we aimed to investigate whether procalcitonin is useful for predicting the clinical severity and the necessity of antivenom therapy at the early stages in patients presenting with snake bite. A total of 78 patients over the age of 18 who applied to the emergency department within the first 24 hours were included in this retrospective cross-sectional study. Age and sex of patients, severity of snake bites, total antivenom vials administered, observation periods and outcomes were recorded. Patients were graded according to their clinical severity after the snake bite. Procalcitonin, complete blood count and biochemical parameters of the patients were recorded. According to their clinical severity, the patients' grades were as follows: 21 (26.9%) patients were grade 0; 21 patients (26.9%) were grade 1; 16 patients (20.5%) were grade 2; and 20 patients (25.6%) were grade 3. Snake antivenom was administered to 57 (73.1%) patients. There was a statistically significant difference between procalcitonin levels of patients in respect to their grade (P0.001). Sensitivity and specificity of procalcitonin levels of 13.45 and above were 100% and 100% respectively, both for the need of antivenom administration and for the blister formation in the patients. According to our study, we believe that elevated procalcitonin levels should alert the clinicians for possible blister formation, higher clinical severity, and increased requirement for antivenom administration.

Climate change seriously impacts global agriculture, with rising temperatures directly affecting the yield. Vegetables are an essential part of daily human consumption and thus have importance among all agricultural crops. The human population is increasing daily, so there is a need for alternative ways which can be helpful in maximizing the harvestable yield of vegetables. The increase in temperature directly affects the plants’ biochemical and molecular processes; having a significant impact on quality and yield. Breeding for climate-resilient crops with good yields takes a long time and lots of breeding efforts. However, with the advent of new omics technologies, such as genomics, transcriptomics, proteomics, and metabolomics, the efficiency and efficacy of unearthing information on pathways associated with high-temperature stress resilience has improved in many of the vegetable crops. Besides omics, the use of genomics-assisted breeding and new breeding approaches such as gene editing and speed breeding allow creation of modern vegetable cultivars that are more resilient to high temperatures. Collectively, these approaches will shorten the time to create and release novel vegetable varieties to meet growing demands for productivity and quality. This review discusses the effects of heat stress on vegetables and highlights recent research with a focus on how omics and genome editing can produce temperature-resilient vegetables more efficiently and faster.

IntroductionT cells are crucial for pathogenesis as well as control for tuberculosis (TB). Although much is known about the signaling pathways which are required for the activation of T cells during acute infection but the way these cells respond during persistent of infection still remained elusive. Therefore, it is rationale to understand T cell activation during tuberculous pleural effusion (TPE), which is similar to bacterial persistency system.MethodsHerein, we will employ T cell receptor (TCR) based approaches for studying events of T cell activation pathways in cells of blood and pleural fluid among patients with TPE. We performed spectrofluorimetric analysis to study effect of M. tuberculosis antigens, ESAT-6 and Ag85A stimulation on intracellular calcium levels, Phosphorylation levels of ZAP-70 (Zeta-chain-associated protein kinase 70), PKC-θ (Protein kinase C theta), Erk1/2 (Extracellular signal-regulated kinase 1 and 2) and p-38 two important members of MAPKs (Mitogen activated Protein kinases) in CD3 and CD28 induced cells of blood and pleural fluid of same patients with TPE by western blotting. Patients with non-TPE were also included as matching disease controls in this study.ResultsWe observed significantly higher intracellular calcium levels, Phosphorylation levels of ZAP-70, Erk1/2 and p-38 in CD3 and CD28 induced cells of pleural fluid as compared to the blood cells of same patients with TPE. Alteration in the activation of these events has also been noted after stimulation of ESAT-6 and Ag85A.DiscussionPresent study demonstrated up-regulated activation of TCR mediated T cell signaling events at local disease site (Pleural fluid) as compared to the blood sample of TB pleurisy patients which could be involved in T-cell dysfunctioning during the progression of the disease and also could be responsible for Th 1 dominance at local disease site in patients with TPE.

Background: Glioblastoma Multiforme (GBM) is a deadly tumor with poor prognosis. Resistance to apoptosis considered as an important factor in treatment failure. Therefore, identification of new compounds that facilitates apoptosis is crucial. Natural Anti-inflammatory compounds have emerged as potential anti-cancer agents and should be explored for their apoptotic activity against GBM. Therefore, the present study aims to evaluate growth inhibitory and apoptotic activity of a natural anti-inflammatory compound “Opuntiol” against GBM cell line U87. Methods: MTT assay was performed to determine the effect of Temozolomide and Opuntiol on growth inhibition of U87 cell. While, TUNEL assay was used to assess their apoptotic activity. To further assess apoptosis, nuclear condensation and nuclear area factor (NAF) was evaluated through DAPI staining. Whereas, active caspase-3 protein expression determined using immunocytochemistry. Results: Significant growth inhibition was observed in U87 cells treated with Temozolomide (IC50 380 µM) and Opuntiol (IC50 357 µM). Temozolomide (p

This study conducted an in-depth analysis combining computational and experimental verifications of the deleterious missense mutations associated with the SLC29A4 protein. The functional annotation of the non-synonymous single nucleotide polymorphism (nsSNPs), followed by structure-function analysis, revealed 13 single nucleotide polymorphisms (SNP) as the most damaging. Among these, six mutants P429T/S, L144S, M108V, N86H, and V79E, were predicted as structurally and functionally damaging by protein stability analysis. Also, these variants are located at evolutionary conserved regions, either buried, contributing to the structural damage, or exposed, causing functional changes in the protein. These mutants were further taken for molecular docking studies. When verified via experimental analysis, the SNPs M108V (rs149798710), N86H (rs151039853), and V79E (rs17854505) showed an association with type 2 diabetes mellitus (T2DM). Minor allele frequency for rs149798710 (A G) was 0.23 in controls, 0.29 in metformin responders, 0.37 in metformin non-responder, for rs151039853 (A C) was 0.21 in controls, 0.28 in metformin responders, 0.36 in metformin non-responder and for rs17854505 (T A) was 0.20 in controls, 0.25 in metformin responders, 0.37 in metformin non-responder. Hence, this study concludes that SLC29A4 M108V (rs149798710), N86H (rs151039853), and V79E (rs17854505) polymorphisms were associated with the increased risk of T2DM as well as with the increased risk towards the failure of metformin therapeutic response in T2DM patients of Pakistan. Communicated by Ramaswamy H. Sarma.

SUMMARY OBJECTIVE: This study aimed to evaluate the SARS-CoV-2 immunoglobulin G (IgG) levels after 6 months of polymerase chain reaction (PCR) negative but assumed to be COVID-19 positive cases to investigate the relationship between IgG levels and thoracic computed tomography (CT) findings. METHODS: This was a single-center study that included patients whose PCR test results were negative at least three times using nasopharyngeal swabs but had clinical findings of COVID-19 and thoracic CT findings compatible with viral pneumonia. Six months after discharge, the IgG antibodies were analyzed. The cutoff value for negative and positive serology was defined as

Cardiovascular disease (CVD) is a significant noncommunicable disease associated with high long-term mortality. In addition to more effective secondary therapies, the primary prevention of CVD has developed markedly in the past several years. This study aims to investigate the evidence and impact of reducing the threshold for primary CVD risk management to 10% over 10 years with "statin" therapy. To conduct research a systematic review utilizing 5 electronic database searches was completed for studies, analyzing the clinical effect of reducing the threshold of CVD risk to 10% over 10 years for primary prevention with statin therapy. The study included six (6) trials. Statin therapy was allocated to 31,018 participants. The mean age was 61 years and the mean follow-up was 4.6 years. The mean relative reduction in total cholesterol was 19% (from an average of), low-density lipoprotein cholesterol was 28.3% (from mmol/L to mmol/L) and triglycerides were 14.8% (from mmol/L to mmol/L). High-density lipoprotein cholesterol was observed to increase by a mean of 3.3% (from mmol/L to mmol/L). When examining all-cause mortality, statin therapy was associated with a 12% relative risk reduction compared with control, where overall rates were reduced from 1.4% to 1. % There is a 30% risk reduction in general major coronary events (from to %). There is a 19% risk reduction in general major cerebrovascular events with the statin group. While there is undoubtedly statistical evidence that supports the observation of the effectiveness of statin therapy for primary prevention, there is a risk that many hundreds of patients need to be treated to avoid a single adverse clinical outcome.

Reduction in isometric strength of the scapulohumeral muscles is a commonly seen impairment in overhead athletes afflicted with shoulder impingement syndrome (SIS). The purpose of this study was to compare the effects of two different treatment programs: progressive resistance exercises plus manual therapy (PRE plus MT) and motor control exercises (MCE), on isometric strength of upper trapezius (UT), middle trapezius (MTr), lower trapezius (LT), serratus anterior (SA), supraspinatus (Supr.), anterior deltoid (A.D), and latissimus dorsi (LD). 80 male university-level overhead athletes clinically diagnosed with SIS were randomly allocated into either of the two groups: PRE plus MT and MCE group. Athletes in the PRE plus MT group underwent graduated exercises with resistance elastic band, stretching exercises, and mobilization of the thoracic and shoulder joints. MCE group was submitted to motor control exercises in varied planar positions. Athletes in both groups underwent management 3 times a week for 8 weeks. Isometric strength of UT, MTr, LT, Supr, A.D, SA, and LD was measured at three-time points: baseline, 4th week, and 8th week. Relative to baseline, both interventions were found to be effective in increasing and optimizing the isometric strength of muscles ( p < 0.05 ) except for supraspinatus in the MCE group ( p > 0.05 ). However, athletes in PRE plus MT group presented a more pronounced increase in isometric strength than those in the MCE group. Between groups analysis found the largest isometric strength improvement in PRE plus MT group for A.D, followed by Supr. and UT muscles ( p < 0.05 ; effect size: 0.39 to 0.40). The study concluded that compared to MCE, PRE plus MT provides greater improvement in the isometric strength of scapulohumeral muscles.

Purpose: To throw light on some unethical Human resource policies followed by companies and suggest ways to overcome them. Approach: This is a theoretical paper designed to provide conceptual clarity on the subject. An exploratory study aims to enhance recognition and understanding of some policies and practices causing discomfort to employees. Findings: Several policies reported to be unethical by employees worldwide have been described in detail. Practical implications: This paper will offer insights to HR professionals encouraging them to realize and change some policies and practices that have become a part of their organizations. It also will encourage people from other fields to learn how they can flag unethical practices in their organizations.

Since most infectious diseases can develop into sepsis, it is still a major medical problem. Some in-vivo studies showed promising properties of fluoxetine in the treatment of infections. This study aims the antimicrobial effect of fluoxetine on the inflammatory process used in the treatment of sepsis-modeled rats. Besides, to investigate the efficacy of fluoxetine on modifying the antibiotic effect of imipenem in the inflammatory response. An experimental sepsis model was divided into negative control, positive control, fluoxetine 5 mg/kg, imipenem 60 mg/kg, and combined (fluoxetine; imipenem). Procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), lactate, myeloperoxidase activity (MPO), the inflammation markers interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), tumor necrosis factor-alfa (TNF-alpha), and monocyte chemoattractant protein-1 (MCP-1) levels were measured by enzyme-linked immunosorbent assay method. Oxidative stress markers, total oxidant status (TOS), total antioxidant status (TAS), total thiol (TT), and native thiol (NT) were measured using photometric methods. Oxidative stress index (OSI) was calculated according to TAS and TOS levels. The statistical analysis was performed by Statistical Package for Social Sciences version 22.0. After treatment with fluoxetine, imipenem, and combined groups, IL-1 beta, IL-6, TNF-alpha, MPO activity, MCP-1, hs-CRP, PCT, lactate, and the oxidative stress markers OSI, and disulfide levels were decreased (p < 0.05). The TT, NT, and TAS levels significantly statistically increased (p < 0.05). This research demonstrates that fluoxetine has effects as anti-inflammatory and antioxidant, and the combined treatment with antibioticum imipenem indicates positive synergistic effects in the experimental sepsis model. Bezmialem Vakif University

The baseline composition of T cells directly impacts later response to a pathogen, but the complexity of precursor states remains poorly defined. Here we examined the baseline state of SARS-CoV-2 specific T cells in unexposed individuals. SARS-CoV-2 specific CD4+T cells were identified in pre-pandemic blood samples by class II peptide-MHC tetramer staining and enrichment. Our data revealed a substantial number of SARS-CoV-2 specific T cells that expressed memory phenotype markers, including memory cells with gut homing receptors. T cell clones generated from tetramer-labeled cells cross-reacted with bacterial peptides and responded to stool lysates in a MHC-dependent manner. Integrated phenotypic analyses revealed additional precursor diversity that included T cells with distinct polarized states and trafficking potential to other barrier tissues. Our findings illustrate a complex pre-existing memory pool poised for immunologic challenges and implicate non-infectious stimuli from commensal colonization as a factor that shapes pre-existing immunity.One Sentence SummaryPre-existing immunity to SARS-CoV-2 contains a complex pool of precursor lymphocytes that include differentiated cells with broad tissue tropism and the potential to cross-react with commensal antigens.

Background:Reactive aldehydes are involved in diseases associated with oxidative stress, including diabetes. Human salivary aldehyde dehydrogenase (hsALDH) presumably protects us from many toxic ingredient/contaminant aldehydes present in food.Objective:This study aimed to probe the activity of hsALDH in patients with diabetes and than to correlate it with various oxidative stress markers in the saliva.Methods:The saliva samples were collected from total 161 diabetic patients from Rajiv Gandhi Centre for Diabetes, Jawaharlal Nehru Medical College (JNMC), AMU, Aligarh, (India). HsALDH activity and markers of oxidative stress [8-hydroxydeoxyguanosine (8-OHDG), malondialdehyde (MDA) and advanced glycation end products (AGEs)] were measured in the saliva samples.Results:Patients with early stage of diabetes had higher activity of hsALDH when compared with the control group. As the history of diabetes increases, the activity of the enzyme decreases and also higher oxidative stress markers (8-OHDG, MDA and AGEs) are detected in the saliva samples. Negative significant correlation between hsALDH activity and oxidative stress markers were observed (p Conclusion:The activity of hsALDH increases in early stages of diabetes most probably to counter the increased oxidative stress associated with diabetes. However, in later stages of diabetes, the activity of the enzyme decreases, possibly due to its inactivation resulting from glycation.

Electrocardiography (ECG) is a well-known noninvasive technique in medical science that provides information about the heart’s rhythm and current conditions. Automatic ECG arrhythmia diagnosis relieves doctors’ workload and improves diagnosis effectiveness and efficiency. This study proposes an automatic end-to-end 2D CNN (two-dimensional convolution neural networks) deep learning method with an effective DenseNet model for addressing arrhythmias recognition. To begin, the proposed model is trained and evaluated on the 97720 and 141404 beat images extracted from the Massachusetts Institute of Technology-Beth Israel Hospital (MIT-BIH) arrhythmia and St. Petersburg Institute of Cardiological Technics (INCART) datasets (both are imbalanced class datasets) using a stratified 5-fold evaluation strategy. The data is classified into four groups: N (normal), V (ventricular ectopic), S (supraventricular ectopic), and F (fusion), based on the Association for the Advancement of Medical Instrumentation® (AAMI). The experimental results show that the proposed model outperforms state-of-the-art models for recognizing arrhythmias, with the accuracy of 99.80% and 99.63%, precision of 98.34% and 98.94%, and F1-score of 98.91% and 98.91% on the MIT-BIH arrhythmia and INCART datasets, respectively. Using a transfer learning mechanism, the proposed model is also evaluated with only five individuals of supraventricular MIT-BIH arrhythmia and five individuals of European ST-T datasets (both of which are also class imbalanced) and achieved satisfactory results. So, the proposed model is more generalized and could be a prosperous solution for arrhythmias recognition from class imbalance datasets in real-life applications.

The key feature that distinguishes mild cognitive impairment (MCI) from dementia is the absence of significant functional decline because of cognitive impairment. In Parkinson's disease patients (PD) with MCI (PD-MCI), the effect of cognitive impairment on complex instrumental daily activities, such as medication management, is not well established.26 patients with PD-MCI (diagnosed to Level 2 Movement Disorders Society diagnostic criteria) and 32 idiopathic PD patients without cognitive impairment participated in the study. A detailed neuropsychological testing battery (including tests for attention and working memory, executive functions, language, visuospatial functions, episodic memory) and various prospective memory tasks were applied to the patients. Medication taking behaviors were evaluated using two different methods based on the performance (medication management ability assessment) and self-reporting (adherence scale).The PD-MCI group obtained significantly lower scores in medication management assessment and made more mistakes on following prescription instructions (e.g., they took more or less tablets and did not use medications as instructed with regard to meal times). Cognitive areas predicting success in medication management performance were language, event-based prospective memory and visuospatial functions. There was no significant difference between the two groups' self-reporting of adherence.Mild cognitive impairment in patients with PD adversely affects medication management. Diagnosing MCI in PD is important to ensure that the appropriate measures can be taken to provide support and improve the medication management process. Adherence assessments based on self-reporting may not provide reliable and sensitive information in patients with PD-MCI.

PurposeThere is a compelling need for developing constructs in management science rather than adapting the constructs that have been developed in other domains. Having emerged in the 1950s, quality of work-life (QWL) measures have proved to be ineffective due to the lack of conceptual clarity and theoretical support. The article analyses the QWL measures highlights their coherence and verifies them for being used in specific contexts.Design/methodology/approachThe study includes three stages to develop a QWL Measurement Scale. Fourteen questions were developed based on QWL concepts. They were validated using exploratory factor analysis (EFA) which split the dimensions into five factors. A survey was conducted on 375 medical residents. Finally, confirmatory factor analysis (CFA), convergence and validity were tested along the five dimensions.FindingsResults extend the QWL concept and provide theoretical support for the same. Five dimensions were developed to measure QWL namely: pay and benefits, supervision, intra-group relations, working conditions and training.Practical implicationsThe study may offer an overview of evaluation strategies to researchers and organizations that aim to improve employee QWL while they enhance its effectiveness through reliable instruments.Originality/valueThe scale developed in this study contributes to the body of QWL literature in the healthcare arena. It may be beneficial to carry out further research in this domain.

INTRODUCTION Fine needle aspiration cytology (FNAC), along with thyroid ultrasound, is an important tool in evaluation of thyroid nodules that helps in further management of these patients in making a decision of surgical intervention vs follow-up. The Bethesda System for Reporting Thyroid Cytopathology category III of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) has risk of malignancy (ROM) ranging from 5% to 15%. The aim of the present study was to describe the frequency of AUS/FLUS in thyroid gland FNACs and the surgical outcomes of these cases. METHODS The integrated laboratory management system retrieved the thyroid FNACs from 2010 to 2018 and subsequent surgical pathology specimens. For the AUS/FLUS cases, data regarding patient demographics, cytology and histological diagnoses were recorded. The results were tabulated as the overall frequency of AUS/FLUS in thyroid FNACs, cytohistological correlation (benign and malignant) and ROM. RESULTS Over a period of 9 years, 256 (10.9%) cases out of 2342 thyroid FNACs were reported as AUS/FLUS at our institution. Mean age was 43.5 years. The majority (70.3%) of patients were female. Seventy-two of 104 resection specimens (69.2%) were reported as benign and 32 cases (30.7%) had malignant diagnosis. Upper-bound ROM was 30.7% (32 cases with malignant diagnosis out of 104 resection specimens). Lower-bound ROM was calculated as 12.5% (32 cases with malignant diagnosis out of 256 total AUS diagnosis). CONCLUSION The AUS/FLUS category of thyroid cytology and associated ROM remain an evolving area. Individual institutions should monitor the frequency and include ROM in the dashboard indicators to remain within the recommended range.

Purpose To evaluate the changes in intraocular pressure (IOP), central corneal thickness (CCT), axial length, and ocular surface in patients with end-stage renal failure after single-session hemodialysis treatment and to examine the correlation of these findings with systemic hemodynamic parameters. Patients and Methods A total of 112 eyes of 112 patients enrolled in a hemodialysis treatment program for three times a week (approximately four hours per session) for at least three months in our hospital between December 2019 and March 2020 were included in the study. Approximately 30 minutes before and after hemodialysis, the best-corrected visual acuity measurement, slit-lamp examination, IOP measurement, and dilated fundus examination with the Goldmann applanation tonometer were performed in all patients. The axial length measurement was undertaken by ultrasonic biometry, and the CCT measurement by ultrasonic pachymetry. The ocular surface evaluation was performed based on the tear breakup time (BUT), basal secretion time (BST) and keratoepitheliopathy score. Blood pressure, serum osmolarity, and body weight were measured before and after hemodialysis. Results The mean IOP decreased from 12.2 ± 3.5 to 10.8 ± 2.2 mmHg, and the mean decrease was 1.4 ± 2 mmHg, indicating statistical significance (p

Ebstein anomaly can be managed by single ventricular, bi-ventricular and one and a half ventricular repairs. We present midterm results of Comprehensive Tricuspid Valve repair (CTVR) with bi-directional cavo-pulmonary shunt (BCPS). In this prospective observational study (Jan2012–July2018), 69 patients underwent surgery for Ebstein anomaly. In Group I (n = 48; 69.6%), all patients got CTVR and a BCPS (one and a half ventricle repair). Group II (n = 15; 21.8%) consisted of a similar repair without BCPS (bi-ventricle repair). All patients were echocardiographed at six monthly intervals. Median age of the cohort was 17 years (range 1–68). 12 (17.4%) patients were Carpentier type B, 51 (73.9%) were type C and 6 (8.7%) were type D. There were two early mortalities (2.89%). At a mean follow up of 3.2 ± 1.2 years, there were no late deaths and one delayed repair-failure in each group. Group I had significantly lower mean TR grade (1.2 ± 0.4vs1.6 ± 0.5, p = 0.03) as compared to Group II without a significant difference in the mean gradients (1.5 ± 0.5vs1.6 ± 0.6, p = 0.4). Mean indexed TAPSE (15.0 ± 6.7vs.16.6 ± 5.6 mm/m2, p = 0.21), NYHA class (1.2 ± 0.4vs1.3 ± 0.4) and six-minute walk distance (506 vs 507 m, p = 0.7) was similar in both groups. One and a half ventricle repair of Ebstein anomaly gives a more functionally competent, non-stenotic and durable tricuspid valve as compared to a two-ventricle repair. BCPS doesn’t result in facial swelling or AV malformations. Preload reduction by BCPS may allow the myopathic ventricle to remodel.

This study aims to understand the main issues in design education and discuss solutions. We conducted two workshops on the state of implementation of design in the Singaporean education system at the Design Education Summit, a conference for educators. We found that the main issues were the inclusion of design education within curriculum and change of stakeholder mindsets. Several solutions were discussed, such as ways to introduce design as part of the organization culture. We summarize results into action items and recommendations.

Background In the emerging field of nanotechnology, copper oxide (CuO) nanomaterials are considered to be one of the most important transition metal oxides owing to its fascinating properties. Its synthesis from green chemistry principles is gaining importance as next-generation antibiotics due to its simplicity, eco-friendliness, and cost-effectiveness. In the present study, CuO nanorods (CuO NRs) were synthesized from the aqueous fruit extract of Momordica charantia and characterized using different analytical techniques. Further, the biomedical therapeutic potential was evaluated against multi-drug resistant microbial strains. Materials and Methods To synthesize CuO NRs, 0.1M of CuSO4.5H2O solution was added to aqueous extract of Momordica charantia in a 1:3 (v/v) ratio (pH=11) and heated at 50°C followed by washing and drying. The synthesized CuO NRs were subjected to characterization using different analytical techniques such as UV visible spectroscopy, zeta sizer equipped with zeta potential, Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM) equipped with energy-dispersive X-ray spectroscopy (EDS) and transmission electron microscopy (TEM). Further, the application as a biomedical therapeutic potential was evaluated in vitro using well diffusion method against eleven multidrug-resistant clinical bacterial strains, a fungus- Trichophyton rubrum and in ovo against the R2B virus using haemagglutination (HA) test. Results Characterization was preliminarily done by the spectral study that confirms the absorbance band at 245nm. FTIR analysis at 628 cm-1 peak identified copper oxide vibration. SEM analysis revealed agglomerated particle clusters. However, with TEM clear nanorods of average diameter of 61.48 ± 2 nm were observed. EDAX confirmed CuO formation while XRD showed a typical monoclinic structure with 6 nm crystallite size. Biological screening of CuO NRs showed significant results against both in vitro and in ovo methods. Significant inhibitory activity (p

The apelinergic system plays an important role in the modulation of the cardiovascular system via the apelin peptide and the apelin receptor (APJ receptor). Apelin and elabela, also known toddler, are peptide ligands for the apelin receptor. These two peptides show similar biological actions, such as vasodilatation, increased myocardial contractility, angiogenesis, and energy metabolism. However, the serum levels of elabela in patients with hyperthyroidism are not well known. The aim of this study was to investigate the changes in serum elabela levels in patients with hyperthyroidism and its association with hypertension. This cross-sectional study included 74 patients with newly diagnosed hyperthyroidism due to Graves' disease and 20 healthy individuals. Serum elabela levels were measured by enzyme-linked immunosorbent assay. The patients were divided into two groups: hyperthyroid patients without hypertension (n = 51) and those with hypertension (n = 23). Basal heart rate, serum glucose and high-sensitive C reactive protein were significantly higher in hyperthyroid patients with and those without hypertension than in healthy controls (p < 0.05 for each). Serum elabela levels were significantly elevated in hyperthyroid patients compared with healthy controls, with higher serum elabela levels found in hyperthyroid patients with hypertension than those without hypertension. Linear regression analysis showed that serum elabela levels were correlated with systolic blood pressure (p < 0.001). In conclusion, serum elabela levels were significantly increased in patients with hyperthyroidism, especially in hyperthyroid patients with hypertension. Elevation in serum elabela levels may contribute to alleviation of cardiovascular complications of hyperthyroidism and hypertension.

In certain pathologies, mitral valve repair is complicated by a paucity of tissue caused by fibrosis or destruction. Utilization of autologous pericardium for leaflet augmentation may be the only option to repair these valves. We present the midterm results of mitral valve leaflet augmentation with glutaraldehyde-fixed autologous pericardium. One hundred thirty consecutive patients undergoing mitral valve repair with glutaraldehyde-fixed pericardial augmentation of leaflets were followed up clinically and by echocardiography at 6-month intervals. Mean age was 24.8 years (range 2-64). The etiology was rheumatic in 75.3%, indeterminate in 8.4%, and other in 16.1%. Out of the rheumatics, 57.1%, 24.4%, and 18.3% had combined mitral stenosis and mitral regurgitation, isolated mitral regurgitation, and mitral stenosis, respectively. About 21.5% had a recent history of rheumatic activity. Eight were operated emergently for intractable heart failure. Majority of the patients required repair of multiple components of the mitral valve apparatus. Leaflet peeling was done in 52.3%. Pericardial patch augmentation of anterior mitral leaflet, posterior mitral leaflet, or both were carried out in 61.5%, 34.6%, and 3.8% patients respectively. Sixty percent got chordal procedures, while 92.3% got annuloplasty. There were no deaths during the mean follow-up period of 28 months. Ninety-three percent of our patients were in New York Heart Association class I and II on follow-up. There were 11 repair failures. Seven patients underwent a reoperation, while 4 patients are being managed conservatively (reoperation rate 5.38%). Augmentation of mitral valve leaflets with autologous pericardium allows many significantly fibrosed and destroyed valves to be reliably repaired with good midterm durability and hemodynamics.

A 28-year-old woman with a history of systemic lupus erythematosus on hydroxychloroquine and steroid therapy presented with fever, dysentery, and thrombocytopenia. Marrow aspirate revealed yeast forms of histoplasmosis. She was treated with liposomal amphotericin B followed by itraconazole with resolution of symptoms and marrow recovery.

Current evidence does not allow a consensus on the management of moderate chronic ischemic mitral regurgitation (CIMR). We compared moderate CIMR patients undergoing off-pump CABG (OPCABG) alone and CABG + MV repair for early mortality, major adverse systemic events (MASE) and mid-term functional outcomes.210 patients with moderate CIMR who underwent off-pump coronary artery bypass grafting (OPCABG) Group I (n = 106) or CABG + mitral valve repair (MV rep) Group II (n = 104) were followed prospectively. For comparison, patients were further sub-divided based on the product of regurgitant fraction and ejection fraction "RFEF"(Good/Bad) and MR jet direction (Central/Eccentric). The primary end point of the study was mortality and secondary end points were MASE, percentage improvements in indexed left ventricle end-systolic volume (LVESVI %), MR grade and functional outcomes of the patients.In-hospital and overall mortality was significantly lower in Group I (1.89% vs. 13.46%, p 0.001 and 5.66% vs. 15.38%; p = 0.024 respectively). Group II had significantly higher MASE, ventilation time, mean ICU and hospital stay. At 36 months, LVESVI% (17.56% ± 9.12% vs. 18.81% ± 7.48%; p = 0.279), MR grade improvement (80.18% vs. 83.50%; p = 0.544), NYHA class and MLHF scores were also similar in both groups. On subgroup analysis, Good RFEF with Central jet subgroup had comparable improvement in LVESVI% and MR grade with either procedure, while Bad Eccentric subgroup showed a significantly higher improvement in LVESVI% and MR grade with CABG + MV repair.OPCABG is associated with significantly reduced mortality and MASE with comparable improvement in LVEDVI% and MR grade. CABG + MV Rep results in significant improvement in LVEDVI% and MR grade in patients with bad eccentric MR. The recommended procedures in the "Good Central" and "Bad Eccentric" subsets are CABG and CABG + Mvrepair, respectively.

Grain size is an essential factor of grain quality and yield in rice. The genetic studies have substantially contributed to enhancing yield and maintaining a good quality of rice. The two major genes GS3 (a negative regulator of grain length) and GW2 (a negative regulator of grain width) with functional mutation play a significant role in controlling the grain size of rice. METHODS AND RESULTS: In the study, 17 different widely grown Pakistani landraces of various genetic and geographic backgrounds were evaluated for grain phenotypic traits (1000-grain weight, length, width, and thickness) and also screened for genotypic mutation in GS3 and GW2 genes. Phenotypic data revealed the range for grain weight from 16.86 g (Lateefy) to 26.91 g (PS2), grain length ranged from 7.27 mm (JP-5) to 12.18 mm (PS2), grain width ranged from 2.01 mm (Lateefy) to 3.51 mm (JP5), and grain thickness ranged from 1.79 mm to 2.19. Correlation revealed a negative and significant correlation between grain width and length. There was no significant correlation between grain length and 1000-grain weight and grain width. LSD test displayed that the means of three variables grain length, grain width, and 1000-grain weight were statistically different from one another except grain width and grain breadth. Fifteen accessions carried the domesticated allele of GS3 while JP5 and Fakhr-e-Malakand carried the dominant allele. Similarly, fifteen accessions carried the dominant allele of GW2 while JP-5 and Fakhr-e-Malakand carried the mutant allele.The study shows that the mutant alleles of both genes are of significance to pyramid them in any breeding program. However, just incorporating favorable alleles is not the sole solution for improving the grain size. Therefore, further elucidation of GS3 and GW2 genes regulatory network, their interaction, trade-off, and pathways will better coordinate their marker-assisted selection in the future breeding program. Additionally, the study concluded that the selection of grain size was not dependent on 1000-grain weight in the selected germplasm.

We are facing a high risk of exposure to emerging contaminants and increasing environmental pollution with the concomitant growth of industries. Persistence of these pollutants is a major concern to the ecosystem. Laccases, also known as "green catalysts" are multi-copper oxidases which offers an eco-friendly solution for the degradation of these hazardous pollutants to less or non-toxic compounds. Although various other biological methods exist for the treatment of pollutants, the fact that laccases catalyze the oxidation of broad range of substrates in the presence of molecular oxygen without any additional cofactor and releases water as the by-product makes them exceptional. They have a good possibility of utilization in various industries, especially for the purpose of bioremediation. Besides this, they have also been used in medical/health care, food industry, bio-bleaching, wine stabilization, organic synthesis and biosensors. This review covers the catalytic behaviour of laccases, their immobilization strategies, potential applications in bioremediation of recalcitrant environmental pollutants and their engineering. It provides a comprehensive summary of most factors to consider while working with laccases in an industrial setting. It compares the benefits and drawbacks of the current techniques. Immobilization and mediators, two of the most significant aspects in working with laccases, have been meticulously discussed.

To assess the utility of comprehensive sonographic examination including scrotal sonography, Testicular Doppler and Transrectal Ultrasound (TRUS) to evaluate the male reproductive system and differentiate between obstructive (OG) and non-obstructive (NOG) causes of azoospermia.30 infertile men with azoospermia and 30 control subjects with normospermia underwent sonographic evaluation. FNAC/biopsy findings were used for assigning a final diagnosis of obstructive or non-obstructive azoospermia. Qualitative and quantitative imaging parameters were retrospectively compared between the groups using Chi-square/Fisher's exact test and unpaired t-test, respectively. P 0.05 was considered significant.Ectasia of rete testis/epididymal tubules, altered epididymal echogenicity, dilated terminal vas deferens were significantly more common in OG while inhomogeneous testicular echo-texture and reduced testicular vascularity were more common in NOG (P 0.05). Testicular volume and epididymal head size were significantly higher in OG than in NOG and controls (18.2 ml/10 mm Vs 8.2 ml/7.2 mm and 13.4 ml/8.8 mm respectively; P 0.05); while Resistive Index (RI) of intra-testicular vessels was higher in NOG as compared to OG and controls (0.65 vs 0.54 and 0.52 respectively; P 0.05). On ROC curve analysis, cut-off values of testicular volume (AUC: 0.939; P 0.001), epididymal head size (AUC: 0.772; P = 0.001) and testicular RI (AUC: 0.761; P = 0.001) to differentiate between the groups were 12.1 ml (sensitivity-94.4%; specificity-83.3%), 9 mm (sensitivity-66.7%; specificity-71%) and 0.62 (sensitivity-62%; specificity-100%) respectively.Comprehensive sonographic evaluation can be used to differentiate obstructive from non-obstructive infertility and should be routinely incorporated in the diagnostic workup of infertile men with azoospermia.

To improve future agricultural production, major technological advances are required to increase crop production and yield. Targeting the coding region of genes via the Clustered Regularly Interspaced Short Palindromic Repeats/CRISPR-associated Protein (CRISPR/Cas) system has been well established and has enabled the rapid generation of transgene-free plants, which can lead to crop improvement. The emergence of the CRISPR/Cas system has also enabled scientists to achieve cis-regulatory element (CRE) editing and, consequently, engineering endogenous critical CREs to modulate the expression of target genes. Recent genome-wide association studies have identified the domestication of natural CRE variants to regulate complex agronomic quantitative traits and have allowed for their engineering via the CRISPR/Cas system. Although engineering plant CREs can be advantageous to drive gene expression, there are still many limitations to its practical application. Here, we review the current progress in CRE editing and propose future strategies to effectively target CREs for transcriptional regulation for crop improvement.