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Abstract The emergence of critical-priority E. coli, carrying a wide array of resistance and virulence factors through food sources, poses a significant challenge to public health. This study aimed to investigate the potential role of oysters sold in Egypt as a source for E. coli, identify their resistance and virulence-associated gene profiles, and assess associated zoonotic risks. A total of 33 pooled fresh oyster samples were obtained from various retail fish markets in Egypt and examined bacteriologically for the presence of E. coli. Antimicrobial resistance was performed by the disk-diffusion method, and the multiple antibiotic resistance index (MAR) was calculated. All isolates were screened for extended-spectrum beta-lactamase (ESBL) (bla TEM, bla SHV, bla CTX−M, and bla OXA−1), plasmid-mediated AmpC bla CMY−2, and carbapenemases (bla KPC, bla NDM, bla VIM, and bla OXA−48) genes by Polymerase chain reaction. Moreover, the presence of virulence-encoding genes was investigated. The virulent MDR strains were clustered using R with the pheatmap package. The prevalence of E. coli was 72.7% (24 out of 33), with 66.7% of the isolates classified as multi-drug resistant, and 75% exhibited MAR values exceeding the 0.2 threshold. Different antimicrobial sensitivity phenotypes and genotype profiles were identified in E. coli isolates. The most prevalent gene detected among all isolates was bla TEM (22/24, 91.7%). Notably, all non-ESBL producers were positive for bla CMY2. Carbapenem-resistant and carbapenem-intermediate strains were carbapenemase producers, with the predominance of the bla KPC gene (11/24, 45.8%). Remarkably, twelve out of sixteen virulence genes were identified, with papC (21/24, 87.5%) and sfa (16/24, 66.7%) genes being the most prevalent. Most isolates carry virulence genes primarily associated with extra-intestinal pathogenic E. coli (ExPEC) (87.5%) and enteropathogenic (EPEC) (70.8%) pathotypes. Four E. coli isolates exhibit cluster patterns. This study provides the first insight into the emergence of virulent MDR E. coli among oysters in Egypt. It underscores the potential role of oysters as a source for disseminating these strains within aquatic ecosystems, presenting a possible threat to public health.

Abstract This work investigates the efficiency of green-synthesized WO3 nanoflakes for the removal of methylene blue dye. The synthesis of WO3 nanoflakes using Hyphaene thebaica fruit extract results in a material with a specific surface area of 13 m2/g and an average pore size of 19.3 nm. A combined theoretical and experimental study exhibits a complete understanding of the MB adsorption mechanism onto WO3 nanoflakes. Adsorption studies revealed a maximum methylene blue adsorption capacity of 78.14 mg/g. The pseudo-second-order model was the best to describe the adsorption kinetics with a correlation coefficient (R2) of 0.99, suggesting chemisorption. The intra-particle diffusion study supported a two-stage process involving surface adsorption and intra-particle diffusion. Molecular dynamic simulations confirmes the electrostatic attraction mechanism between MB and the (002) WO3 surface, with the most favorable adsorption energy calculated as -0.68 eV. The electrokinetic study confirmed that the WO3 nanoflakes have a strongly negative zeta potential of -31.5 mV and a uniform particle size of around 510 nm. The analysis of adsorption isotherms exhibits a complex adsorption mechanism between WO3 and MB, involving both electrostatic attraction and physical adsorption. The WO3 nanoflakes maintained 90% of their adsorption efficiency after five cycles, according to the reusability tests.

Purpose: Infertility is a global health issue and nutrition plays a significant role in fertility outcomes. We aimed to investigate the cross-sectional and prospective associations of glycemic index (GI) and glycemic load (GL) with semen quality parameters in a cohort of healthy young men. Materials and Methods: The study included 106 men aged 18–35 years from the FERTINUTS trial. Dietary intake was estimated through 3-day dietary records and several semen parameters were assessed. Multivariable linear regression analysis with the Least Absolute Shrinkage and Selection Operator (LASSO) approach was employed. Results: The cross-sectional analysis revealed positive associations between GI and GL and total sperm count, sperm concentration, and total motility. In the prospective analysis, baseline GI was associated with increases in pH, vitality, immotile sperm or abnormal midpiece and decreases in total sperm count and motility. Conversely, GL was positively associated with changes in vitality and total sperm count. Conclusions: While these findings suggest that GI may have adverse effects on several sperm quality parameters, the results were not consistently observed in the cross-sectional analysis. However, GL was consistently associated with better sperm quality in both analyses. The impact of carbohydrate quality and quantity on fertility remains uncertain and larger prospective studies are needed.

Abstract Incremental extreme learning machines (I-ELMs) can automatically determine the structure of neural networks and achieve high learning speeds. However, during the process of adding hidden nodes, unnecessary hidden nodes that have little relevance to the target may be added. Several studies have proposed methods to overcome this problem by measuring the relevance between hidden nodes and outputs and adding or removing hidden nodes accordingly. Random hidden nodes have the advantage of creating diverse patterns, but they encounter a problem in which hidden nodes that generate patterns with little or no relevance to the target can be added, thereby increasing the number of hidden nodes. Unlike in existing I-ELMs, which use random hidden nodes, we propose a compact I-ELM algorithm that initially adds linear regression nodes and subsequently applies a method to ensure that the hidden nodes have patterns differing from the existing ones. Based on benchmark data, we confirmed that the proposed method constructs a compact neural network structure with fewer hidden nodes compared to the existing I-ELM systems.

Abstract Background Attention-deficit/hyperactivity disorder (ADHD) affects approximately 5% of children globally, with symptoms often persisting into adulthood. While pharmacological interventions are commonly employed for management, understanding the optimal dosing for efficacy and tolerability remains crucial. This study aims to conduct a dose–response network meta-analysis to estimate the efficacy of pharmacological treatments across different doses, aiming to inform clinical decision-making and improve treatment outcomes. Methods This updated systematic review will include randomized controlled trials evaluating ADHD medication efficacy in children, adolescents, and adults. An updated search from a 2018 NMA will be conducted across multiple electronic databases with no language restrictions, using specific eligibility criteria focused on randomized controlled trials. The primary outcome will assess the severity of ADHD core symptoms, while secondary outcomes will consider treatment tolerability. A dose–response Bayesian hierarchical model will be used to estimate dose–response curves for each medication, identifying optimal dosing strategies. Discussion With this dose–response network meta-analysis, we aim to better understand the dose–response relationship of pharmacological treatment in ADHD, which could help clinician to the identification of optimal doses. Systematic review registration OSF https://doi.org/10.17605/OSF.IO/3MY4A .

Abstract One of the most important environmental challenges that needs to be resolved is the industrial discharge of synthetic dyes. Graphitic carbon nitride (g-C3N4), Titanium dioxide (TiO2) and flower-like copper oxide (CuO)/copper cobaltite (CuCo2O4) nanocomposites were synthesized in order to synthesis an effective visible light driven photocatalyst that could degrade Rhodamin B (Rh.B) dye under simulated solar light irradiation. The SEM and TEM results verifies that the flower-like CuO/CuCo2O4 (CCO) structure and g-C3N4/TiO2 (g-CN/TO) generated a smart hybrid structure with superior g-CN distribution. According to the photocatalytic studies, g- C3N4/TiO2/CuO/CuCo2O4 (g-CN/TO/CCO) shows good photodegradation of Rh.B dye (99.9%) in minmal times (1 h) in CCO: g-CN/TO (2:1) ratio by Z-Scheme mechanism. The enhanced visible light absorption and effective electron-hole pair separation provided by the synergistic dispersion of CuO/CuCo2O4 and g-C3N4 can be attributed to the improved photocatalytic performances. These novel insights into g-CN/TO/CCO based photocatalysts are useful for treating industrial effluent.

Abstract For a sustainable ecology, slaughterhouse sludge must be managed effectively in preview of the parasitic or coliforms’ spill over to the community. In order to determine the effectiveness of a customized biological decomposer solution in lowering the parasitic eggs and coliform bacteria, three composting units (Unit 1, Unit 2, and Unit 3) were treated with its different amounts. Over a period of 60 days, pH, temperature, humidity, number of the parasitic eggs per gram (EPG) of faecal material, viability of eggs, and coliform counts were evaluated. By the fifth day of the composting process, pH had significantly (P 45 °C), which persisted for 20 days for Unit 3 and 15 days for Units 1 and 2. Humidity levels initially increased significantly (P 0.05) 12.5% decline in EPG in Unit 2 and Unit 3 was recorded. After that, a significant (P

Abstract Background Health professions education, encompassing training programs for medicine and surgery, nursing, midwifery, medical laboratory sciences,, and public health, along with their regulations, are pivotal to achieving universal health coverage and Sustainable Development Goals, contributing significantly to health outcomes and public trust in the healthcare workforce. However, low- and middle-income countries, especially in sub-Saharan Africa, face challenges, such as inadequate resources, outdated curricula, and weak governance. Somalia in particular grapples with a fragmented health system and a critical shortage of skilled health professionals, exacerbated by decades of civil war and political instability. Methods This study employed a mixed-method approach that incorporated both qualitative and quantitative data collection and analysis. A comprehensive literature review was conducted along with semi-structured interviews with 44 key informants, including representatives from professional health schools and officials from the Ministry of Health. Additionally, five focus group discussions were held with young professionals and an online survey was administered to students enrolled in professional health courses. The data analysis employed descriptive for quantitative data, and thematic analysis for qualitative data, guided by the human resources for health (HRH) maturity model framework. Results This study identified 112 health professions schools across Somalia, with a significant concentration in urban areas, particularly in Benadir. The health workforce analysis revealed a pronounced urban-rural disparity and a density of health professionals below the WHO’s recommended threshold. The focus group discussions and surveys highlighted the employment challenges faced by young physicians and students’ perceptions of their training and future employment opportunities. Conclusion The proliferation of health professions schools without adequate quality control, the critical shortage and maldistribution of skilled health professionals, and the absence of a comprehensive regulatory framework are significant challenges facing Somalia’s healthcare system. The establishment of the National Health Professionals’ Council (NHPC) Act in 2020 marks a step towards addressing these issues. This study emphasizes the need for accreditation of health professions schools, capacity building of HRH teams, and collaboration among stakeholders to improve healthcare workforce development and regulation. Addressing urban-rural disparities and combating professional misconduct are also crucial for achieving universal health coverage and improving health outcomes in Somalia.

Abstract This study proposes a new deep-learning approach incorporating a superfluity mechanism to categorize knee X-ray images into osteoporosis, osteopenia, and normal classes. The superfluity mechanism suggests the use of two distinct types of blocks. The rationale is that, unlike a conventional serially stacked layer, the superfluity concept involves concatenating multiple layers, enabling features to flow into two branches rather than a single branch. Two knee datasets have been utilized for training, validating, and testing the proposed model. We use transfer learning with two pre-trained models, AlexNet and ResNet50, comparing the results with those of the proposed model. The results indicate that the performance of the pre-trained models, namely AlexNet and ResNet50, was inferior to that of the proposed Superfluity DL architecture. The Superfluity DL model demonstrated the highest accuracy (85.42% for dataset1 and 79.39% for dataset2) among all the pre-trained models.

Abstract This study introduces a novel approach for analyzing photovoltaic (PV) systems that employ block lookup tables for speedy and efficient simulation. It introduces an innovative method for tracking the Global Maximum Power Point (GMPP) by utilizing Zebra Optimization Algorithm (ZOA). The suggested method was carefully evaluated under difficult Partial Shading Conditions (PSCs) and Dynamic Shading Conditions (DSCs) to determine its global and local search capability. ZOA’s performance was examined in four scenarios and compared to four existing MPPT algorithms: Grey Wolf Optimization (GWO), Particle Swarm Optimization (PSO), Flower Pollination Algorithm (FPA), and Whale Optimization Algorithm (WOA). ZOA surpassed its competitors with an average tracking time of 0.875 s and a tracking efficiency of 99.95% in PSCs. In comparison, ZOA increased tracking efficiency by up to 2%, increased resilience under varied circumstances, and produced a faster convergence speed—approaching the maximum Power Point 10–15% faster than the other algorithms. Furthermore, ZOA significantly decreased operating point variations. The algorithm’s overall performance was tested using an experimental setup with a DSPACE board and a PV emulator. These findings demonstrate that ZOA is a highly efficient and dependable MPPT solution for PV systems, especially in severe PSCs.

Abstract Chromosomal instability (CIN) is a pivotal factor in gliomas, contributing to their complexity, progression, and therapeutic challenges. CIN, characterized by frequent genomic alterations during mitosis, leads to genetic abnormalities and impacts cellular functions. This instability results from various factors, including replication errors and toxic compounds. While CIN’s role is well documented in cancers like ovarian cancer, its implications for gliomas are increasingly recognized. CIN influences glioma progression by affecting key oncological pathways, such as tumor suppressor genes (e.g., TP53), oncogenes (e.g., EGFR), and DNA repair mechanisms. It drives tumor evolution, promotes inflammatory signaling, and affects immune interactions, potentially leading to poor clinical outcomes and treatment resistance. This review examines CIN’s impact on gliomas through a narrative approach, analyzing data from PubMed/Medline, EMBASE, the Cochrane Library, and Scopus. It highlights CIN’s role across glioma subtypes, from adult glioblastomas and astrocytomas to pediatric oligodendrogliomas and astrocytomas. Key findings include CIN’s effect on tumor heterogeneity and its potential as a biomarker for early detection and monitoring. Emerging therapies targeting CIN, such as those modulating tumor mutation burden and DNA damage response pathways, show promise but face challenges. The review underscores the need for integrated therapeutic strategies and improved bioinformatics tools like CINdex to advance understanding and treatment of gliomas. Future research should focus on combining CIN-targeted therapies with immune modulation and personalized medicine to enhance patient outcomes.

Abstract The rapid evolution of power electronics has triggered an intensified focus on thermal management within electronics circuits, stemming from the critical necessity to mitigate thermal-related failure rates. Thermal management in power electronics circuits relies heavily on efficient heat transfer to prevent overheating of components and ensure their reliable operation, optimal performance, and safety. To facilitate the effective heat transfer, a thermal interface material (TIM) is utilized between switching components such as MOSFETs and heat sinks to improve surface contact, which increases heat transfer. In this research work, a novel thermal interface material (TIM) based on Tungsten-Gallium is introduced and evaluated to enhance thermal properties such as thermal conductivity and viscosity of Gallium-based TIM material with the addition of Tungsten microparticles. The study involves the examination of three distinct TIM samples with varying Tungsten content. Their surface morphology, composition, and topography were analyzed through techniques such as Scanning Electron Microscopy (SEM) and Atomic Force Microscopy (AFM) within the context of a DC-DC boost converter. The results indicate that the addition of Tungsten significantly enhances TIM’s viscosity and fluidity, even at high temperatures reaching up to 308 °C, which is crucial for power electronics circuits. In addition, thermal constant analyzer, and DC-DC converter circuit such as boost converter circuit were utilized for thermal and electrical characterization, respectively. These characterization results demonstrate that 10%/wt. addition of Tungsten can increase the thermal conductivity of Gallium from 13.1 to 22.82 W/m.K at room temperature, which represents an overall 74.2% increase in thermal conductivity. Furthermore, when the proposed TIM sample 2 was used in a boost converter circuit, the switching frequency of MOSFET IRF3808 was increased up to 20 kHz while the conduction losses were also lowest compared to other TIM samples.

Abstract Background Pinworm, Enterobius vermicularis, is a common parasitic illness, particularly among children in Palestine. On rare occasions, it can cause serious consequences such as acute appendicitis, which can still present a challenging diagnosis especially in children. Case presentation This report describes two cases (a 9 year old male and a 11 year old female, both Palestinian children from Hebron district) of acute appendicitis referred to Queen Alia Hebron Governmental Hospital in Palestine. The clinical examination revealed a lower abdominal pain, and they were diagnosed with appendicitis. The pathological examination after appendectomy showed the presence of eggs and pinworms. Anthelminthic medication was provided, and they were followed up for 6 weeks after the operation without any incidents. Conclusion These cases highlight the importance of considering Enterobius vermicularis infestation in children with abdominal pain, as the parasites can mimic appendicitis. Prompt recognition and cautious laparoscopic appendectomy are crucial to prevent unnecessary surgery and peritoneal contamination, with the infestation being easily treatable with anthelmintic medication.

Aim: This meta-analysis investigates the association between testosterone replacement therapy [TRT] and carotid artery atherosclerosis. Methods: 3 databases were searched for studies up to June 2023 per the PRISMA guidelines. The eligibility criteria comprised RCTs and observational studies involving hypogonadal males receiving exogenous testosterone, in which CIMT was assessed. CAA was the primary outcome, whereas secondary outcomes included HDL, LDL, CRP, total cholesterol and total testosterone. The statistical analysis was performed using Review Manager. Results: Statistical analysis revealed no association between TRT and assessed outcomes. There was a significant increase in total testosterone levels, depicting indirect anti-atherosclerotic effects of TRT. Conclusion: Meta-analysis shows no relation between TRT and CIMT or other markers, allowing its safe usage for hypogonadal males.

Aim: The study aimed to explore the incidence of cancer as an adverse event to SGLT2 inhibitors (SGLT2i) use in Type 2 diabetes.Materials & methods: The study followed PRISMA guidelines to pool RCTs conforming the inclusion criteria. Random effects model was used to pool risk ratios.Results & conclusion: After reviewing 19 studies, the analysis suggested a possible increased risk of reproductive, breast, thyroid, hematologic/lymphatic, urinary, skin and skeletal cancers with SGLT2i use. Conversely, lower incidences of respiratory and cardiovascular cancers were noted. However, these associations lacked statistical significance. Caution is advised in using SGLT2i due to potential cancer risks, especially in diabetic patients prone to cancer. More RCTs are essential due to limited research in this area.

Abstract Measurement of cellular resting membrane potential (RMP) is important in understanding ion channels and their role in regulation of cell function across a wide range of cell types. However, methods available for the measurement of RMP (including patch clamp, microelectrodes, and potential-sensitive fluorophores) are expensive, slow, open to operator bias, and often result in cell destruction. We present non-contact, label-free membrane potential estimation which uses dielectrophoresis to determine the cytoplasm conductivity slope as a function of medium conductivity. By comparing this to patch clamp data available in the literature, we have demonstratet the accuracy of this approach using seven different cell types, including primary suspension cells (red blood cells, platelets), cultured suspension cells (THP-1), primary adherent cells (chondrocytes, human umbilical mesenchymal stem cells), and adherent (HeLa) and suspension (Jurkat) cancer cell lines. Analysis of the effect of ion channel inhibitors suggests the effects of pharmaceutical agents (TEA on HeLa; DMSO and neuraminidase on red blood cells) can also be measured. Comparison with published values of membrane potential suggest that the differences between our estimates and values recorded by patch clamp are accurate to within published margins of error. The method is low-cost, non-destructive, operator-independent and label-free, and has previously been shown to allow cells to be recovered after measurement.

Abstract Carbapenem-resistant Acinetobacter baumannii (CRAB) is a major human pathogen and a research priority for developing new antimicrobial agents. CRAB is a causative agent of a variety of infections in different body sites. One of the manifestations is catheter-associated urinary tract infection, which exposes the bacteria to the host’s urine, creating a particular environment. Exposure of two CRAB clinical isolates, AB5075 and AMA40, to human urine (HU) resulted in the differential expression levels of 264 and 455 genes, respectively, of which 112 were common to both strains. Genes within this group play roles in metabolic pathways such as phenylacetic acid (PAA) catabolism, the Hut system, the tricarboxylic acid (TCA) cycle, and other processes like quorum sensing and biofilm formation. These results indicate that the presence of HU induces numerous adaptive changes in gene expression of the infecting bacteria. These changes presumably help bacteria establish and thrive in the hostile conditions in the urinary tract. These analyses advance our understanding of CRAB’s metabolic adaptations to human fluids, as well as expand knowledge on bacterial responses to distinct human fluids containing different concentrations of human serum albumin (HSA).

Abstract Background Cerebellar abscesses are rare, life-threatening infections often originating from bacterial sources, while metastatic brain lesions from lung adenocarcinoma are relatively common. However, the coexistence of a cerebellar abscess secondary to metastatic lung adenocarcinoma is exceedingly rare and presents unique diagnostic and management challenges. Case Presentation We report a case of a 35 year-old Pakistani female patient with persistent headaches, nausea, and vertigo, who was found to have a large cerebellar mass with features suggestive of metastatic lung adenocarcinoma. Further investigation revealed a concomitant cerebellar abscess. Surgical excision and broad-spectrum antibiotics were initiated, resulting in a favorable outcome. Conclusion This case showcases the rarity and complexity of cerebellar abscesses due to metastatic lung adenocarcinoma. Timely intervention, including surgery and targeted therapy, is crucial for successful management. Further research is needed to enhance treatment strategies.

Abstract Background Academic achievement is essential for all students seeking a successful career. Studying habits and routines is crucial in achieving such an ultimate goal. Objectives This study investigates the association between study habits, personal factors, and academic achievement, aiming to identify factors that distinguish academically successful medical students. Methods A cross-sectional study was conducted at the College of Medicine, King Saud University, Riyadh, Saudi Arabia. The participants consisted of 1st through 5th-year medical students, with a sample size of 336. The research team collected study data using an electronic questionnaire containing three sections: socio-demographic data, personal characteristics, and study habits. Results The study results indicated a statistically significant association between self-fulfillment as a motivation toward studying and academic achievement (p = 0.04). The results also showed a statistically significant correlation between recalling recently memorized information and academic achievement (p = 0.05). Furthermore, a statistically significant association between preferring the information to be presented in a graphical form rather than a written one and academic achievement was also found (p = 0.03). Students who were satisfied with their academic performance had 1.6 times greater chances of having a high-grade point average (OR = 1.6, p = 0.08). Conclusion The results of this study support the available literature, indicating a correlation between study habits and high academic performance. Further multicenter studies are warranted to differentiate between high-achieving students and their peers using qualitative, semi-structured interviews. Educating the students about healthy study habits and enhancing their learning skills would also be of value.

Abstract Magnesium oxide nanoparticles (MgO NPs) represent an interesting inorganic material widely utilized across various fields including sensing, antimicrobial applications, optical coatings, water purification, fuel additives, absorbents, and catalysis, owing to their exceptional broad energy band gap, surface affinity, and strong chemical and thermal durability. In this investigation, MgO NPs were successfully synthesized through a green approach employing fruit extract from the gingerbread tree (Hyphaene thebaica). Analysis via scanning electron microscopy (SEM) and transmission electron microscopy (TEM) confirmed their agglomerated quasi-spherical shape with a size range of 20–60 nm. The X-ray diffraction (XRD) pattern exhibited prominent peaks at planes (200) and (220), indicating the high crystallinity of MgO NPs with a crystallite size of 32.6 ± 5 nm while Energy-dispersive X-ray spectroscopy (EDS) analysis highlighted the composition comprises 40.47% Magnesium and 48.64% Oxygen by weight. Fourier transform infrared spectroscopy (FT-IR) revealed characteristic Mg-O bonds through peaks at 560 cm−1 and 866 cm−1, while Raman spectroscopy affirmed the cubic structure of MgO. Subsequently, the photocatalytic performance of MgO NPs under visible light irradiation was evaluated. Remarkably, the addition of 1 g/L of MgO nano-catalyst resulted in a degradation efficiency of 98% after 110 min on methylene blue dye, showcasing the high catalytic activity of MgO NPs. This remarkable photocatalytic efficiency emphasizes the potential of MgO NPs in environmental remediation.

Abstract Guillain–Barré syndrome (GBS) is an acute autoimmune polyneuropathy with substantial geographic variations in demography, antecedent events, clinical manifestations, electrophysiological sub-types, diagnostic findings, treatment modalities, and prognostic indicators. However, there is limited contemporary data on GBS patient profiles and prognostic factors from low-resource settings like Ethiopia. The objective of this study is to investigate the clinical profile, factors associated with mortality, and hospital outcomes among GBS patients admitted to Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. A retrospective cross-sectional study was conducted among 60 GBS patients admitted to TASH from January 2018 to December 2022. Data on demographics, clinical features, treatments, complications, and outcomes were extracted from medical records. Bivariate and multivariate logistic regression analyses identified factors associated with mortality and poor hospital outcomes. The cohort had a mean age of 28.5 years, with 76.7% aged 14–34 years. Males comprised 61.7% of cases. Ascending paralysis (76.7%) was the predominant presentation. Absent or reduced reflexes were seen in 91.7% of patients. The most common antecedent event was gastroenteritis (26.7%), followed by upper respiratory tract infection (URTI) (15%) and vaccination (11.7%). The mean interval from symptom onset to hospital presentation was 8.77 days, and the peak symptom severity was 4.47 days. The axonal variant (75.5%) was the most common subtype, followed by the demyelinating variant (24.5%). Intravenous immunoglobulin was administered to 41.7% of patients. Respiratory failure requiring invasive mechanical ventilator (MV) support occurred in 26.7% of cases. The mortality rate was 10%, with mechanical ventilation being the only factor significantly associated with mortality (95% CI 2.067–184.858; P 3 (AOR 0.106, 95% CI 0.024–0.467) were factors significantly associated with poor hospital outcomes. GBS in this cohort primarily affected individuals of young age, commonly preceded by gastroenteritis and characterized by a high frequency of the axonal variant. Mechanical ventilation was found to be significantly linked to mortality. Alongside mechanical ventilation requirements, severe disability upon presentation emerged as a crucial determinant of poor outcomes upon discharge, underscoring the importance of early identification of high-risk patients and prompt interventions.

Abstract The therapeutic potential of insect-derived bioactive molecules as anti-SARS-CoV-2 agents has shown promising results. Hymenopteran venoms, notably from Apis mellifera (honeybee) and Vespa orientalis (oriental wasp), were examined for the first time in an in vitro setting for their potential anti-COVID-19 activity. This assessment utilized an immunodiagnostic system to detect the SARS-CoV-2 nucleocapsid antigen titer reduction. Further analyses, including cytotoxicity assays, plaque reduction assays, and in silico docking-based screening, were performed to evaluate the efficacy of the most potent venom. Results indicated that bee and wasp venoms contain bioactive molecules with potential therapeutic effects against SARS-CoV-2.Nevertheless, the wasp venom exhibited superior efficacy compared to bee venom, achieving a 90% maximal (EC90) concentration effect of antigen depletion at 0.184 mg/mL, in contrast to 2.23 mg/mL for bee venom. The cytotoxicity of the wasp venom was assessed on Vero E6 cells 48 h post-treatment using the MTT assay. The CC 50 of the cell growth was 0.16617 mg/mL for Vero E6 cells. The plaque reduction assay of wasp venom revealed 50% inhibition (IC50) at a 0.208 mg/mL concentration. The viral count at 50% inhibition was 2.5 × 104 PFU/mL compared to the initial viral count of 5 × 104 PFU/mL. In silico data for the wasp venom revealed a strong attraction to binding sites on the ACE2 protein, indicating ideal interactions. This substantiates the potential of wasp venom as a promising viral inhibitor against SARS-CoV-2, suggesting its consideration as a prospective natural preventive and curative antiviral drug. In conclusion, hymenopteran venoms, particularly wasp venom, hold promise as a source of potential therapeutic biomolecules against SARS-CoV-2. More research and clinical trials are needed to evaluate these results and investigate their potential for translation into innovative antiviral therapies.

Abstract This study proposes an innovative geometry of a microstrip sensor for high-resolution microwave imaging (MWI). The main intended application of the sensor is early detection of breast, lung, and brain cancer. The proposed design consists of a microstrip patch antenna fed by a coplanar waveguide with a metamaterial (MTM) layer-based lens implemented on the back side, and an artificial magnetic conductor (AMC) realized on as a separate layer. The analysis of the AMC’s permeability and permittivity demonstrate that the structure exhibits negative epsilon (ENG) qualities near the antenna resonance point. In addition, reflectivity, transmittance, and absorption are also studied. The sensor prototype has been manufactures using the FR4 laminate. Excellent electrical and field characteristics of the structure are confirmed through experimental validation. At the resonance frequency of 4.56 GHz, the realized gain reaches 8.5 dBi, with 3.8 dBi gain enhancement contributed by the AMC. The suitability of the presented sensor for detecting brain tumors, lung cancer, and breast cancer has been corroborated through extensive simulation-based experiments performed using the MWI system model, which employs four copies of the proposed sensor, as well as the breast, lung, and brain phantoms. As demonstrated, the directional radiation pattern and enhanced gain of the sensor enable precise tumor size discrimination. The proposed sensor offers competitive performance in comparison the state-of-the-art sensors described in the recent literature, especially with respect to as gain, pattern directivity, and impedance matching, all being critical for MWI.

Abstract This study focused on detecting the reflections of healing and change in cortex activation in full-face transplantation and lesions patients on EEG activity. Face transplant patients have facial lesions before transplantation and, to identify pre-face transplant patients' brain activity in the absence of pre-transplant recordings, we used data obtained from pre-transplant facial lesion patients. Ten healthy, four facial lesion and three full-face transplant patients participated in this study. EEG data recorded for four different sensory stimuli (brush from the right face, right hand, left face, and left-hand regions) were analyzed using wavelet packet transform method. EEG waves were analyzed for standard bands. Our findings indicate significant change in the 2–4 Hz frequency range which may be a result of ongoing or previous cortical reorganization for face lesion and transplant patients. Alterations of the delta wave seen in patients with facial lesion and face transplant can also be explained by the intense central plasticity. Our findings show that the delta band differences might be used as a marker in the evaluation of post-transplant cortical plasticity in the future.

Abstract Background Understanding the root canal morphology is essential for the success of root canal treatment. Therefore, this study aimed to evaluate and analyze the root canal configuration of maxillary premolars using Cone Beam Computed Tomography in the Pakistani subpopulation. Method This cross-sectional study utilized CBCT scans from two distinct centres: Aga Khan University in Karachi and Jinnah MRI and Body Scans in Lahore. The CBCT images were visualized using GALAXIS version 1.9 (SICAT GmbH and Co. KG, Bonn, Germany), integrated within the Sirona Dental System (D-64625 Bensheim, Germany). The scanning parameters were standardized at 85 kV, 7 mA, with a 15-s exposure time and a voxel size of 0.16 mm. A total of 707 CBCT scans were collected, encompassing 2180 maxillary premolars. Root canal configurations were classified based on (Ahmed et al. Int Endod J. 2017;50(8):761–70). Statistical analyses were performed using SPSS version 26, employing the Chi-square test with a significance level set at p

Abstract Cerium oxide nanoparticles possess unique properties that make them promising candidates in various fields, including cancer treatment. Among the proposed synthesis methods for CNPs, biosynthesis using natural extracts, offers an eco-friendly and convenient approach for producing CNPs, particularly for biomedical applications. In this study, a novel method of biosynthesis using the aqueous extract of Eucalyptus camaldulensis leaves was used to synthesize CNPs. Scanning electron microscopy and Transmission electron microscopy (TEM) techniques revealed that the synthesized CNPs exhibit a flower-like morphology. The particle size of CNPs obtained using Powder X-ray diffraction peaks and TEM as 13.43 and 39.25 nm. Energy-dispersive X-ray spectroscopy and Fourier transform infrared spectroscopy confirmed the effect of biomolecules during the synthesis process and the formation of CNPs. The cytotoxicity of biosynthesized samples was evaluated using the MTT method demonstrating the potential of these samples to inhibit MCF-7 cancerous cells. The viability of the MCF-7 cell line conducted by live/dead imaging assay confirmed the MTT cytotoxicity method and indicated their potential to inhibit cancerous cells. Furthermore, the successful uptake of CNPs by MCF-7 cancer cells, as demonstrated by confocal microscopy, provides evidence that the intracellular pathway contributes to the anticancer activity of the CNPs. In general, results indicate that the biosynthesized CNPs exhibit significant cytotoxicity against the MCF-7 cancerous cell line, attributed to their high surface area.

Abstract Green synthesis aligns with the global demand for eco-friendly and sustainable technologies, reducing the dependency on harmful chemicals and high-energy processes typically used in conventional synthesis techniques. This study highlights a novel green synthesis route for nickel cobaltite nanoparticles (NiCO2O4 NPs) utilizing Hyphaene thebaica extract as a natural reducing and stabilizing agent. The synthesized NiCO2O4 NPs, with sizes ranging from 20 to 30 nm, exhibited uniform diamond-like structures as confirmed by SEM and TEM imaging. XRD analysis verified the polycrystalline nature of these nanoparticles, while EDS measurements confirmed the elemental composition of Ni and Co. The presence of functional groups was subsequently verified through FT-IR analysis, and Raman spectroscopy further confirmed phase formation. Electrochemical evaluations revealed significant pseudocapacitive behavior, showing a specific capacitance of 519 F/g, demonstrating their potential for high-performance supercapacitors. To further assess the applicability of the synthesized NiCO2O4 NPs, their photocatalytic activity against methylene blue (MB) dye was investigated, resulting in a 99% degradation rate. This impressive photocatalytic efficiency highlights their potential application in environmental remediation. Overall, this work underscores the significant potential of green synthesis methods in producing high-performance nanomaterials while simultaneously reducing environmental impact and promoting sustainable development.

Blood transfusion, a vital medical intervention, is susceptible to errors in the laboratory phase, which can lead to severe consequences. This systematic review explores the literature on laboratory errors in blood transfusion, highlighting the impact of these errors on patient safety and outcomes. It also presents strategies for error prevention and management. The review underscores the potential for improvement in blood transfusion services through ongoing quality improvement efforts, a responsibility for all of us. After a comprehensive search and analysis of relevant literature published from 2014 to 2024 under PARSMA2020 guidelines, nine articles met the inclusion criteria, revealing a range of errors across different stages of the transfusion process. Preanalytical errors were found to be the most common. Procedural deviations, insufficient collaboration, and work fatigue among medical staff were identified as the causes of these errors. The review suggests that implementing educational and contentious training programs for medical staff, along with highly accountable policies, could significantly reduce these errors, thereby reducing total mortality and morbidity rates.

Abstract The study examines the using of Aboodh residual power series method and the Aboodh transform iteration method (ATIM) to analyze modified Korteweg-de Vries equation (mKdV) beside coupled Burger’s equations in the framework of the Caputo operator. These sets of equations represent the non-linear wave description for various physical systems. Through APM and ATIM, the solution for the coupled Burger’s equations and the mKdV equation get accurate dynamics information that will reveal the nature of their interactions. Using mathematically proven techniques and computational simulations, the developed methods’ efficiency and reliability are illustrated in the complex behaviors of these nonlinear wave equations, so that we can gain deeper insights into their complex dynamics. The research is aimed at an increase of the knowledge about the fractional calculus utilization for nonlinear wave motion and it also provides analytical tools for an analysis of wave acting in different scientific and engineering areas.

Abstract Recently, hydrogen-based distributed generators (DG) have gained significant attention for modern energy generation systems. These modem DGs are typically outfitted with power electronics converters, resulting in harmonic pollution. Furthermore, increasing the growth of modern nonlinear loads may result in exceeding the harmonic beyond the permitted level. This research proposes a framework for optimal incorporation of inverter-based distributed generation (a fuel cell connected to an AC distribution system) for minimizing power losses, enhancing the voltage profile, and limiting both total and individual harmonic distortion according to the IEEE-519 standard. In addition, for accounting system sustainability, the proposed framework considers load variation and the expected rise in demand. Therefore, the suggested framework comprises three stages, which include fundamental and harmonic power flow analysis. The first stage identifies the optimal size and location of the DG in relation to the base load operating condition. While, with the optimal DG of the first stage, the amount of harmonic pollution may violate the limits during a high level of nonlinear load penetration, as a result, the second stage resizes the DG, considering the connection bus of the first stage, to mitigate the harmonics and optimize the system at a higher level of nonlinear load penetration. Both the first and second stages are performed off-line, while the third stage optimizes the system operation during run time according to loading conditions, harmonic pollution, and the available DG capacity of the previous stages. DG’s harmonic spectrum is represented according to recently issued IEEE 1547-2018 for permissible DG’s current distortion limits. The suggested approach is applied and evaluated using an IEEE 33-bus distribution system for various combinations of linear and nonlinear loads. For run-time operation throughout the day, the presented framework reduces the energy losses from 5.281 to 2.452 MWh/day (about 53.57% energy savings). This saving is associated with voltage profile enhancement without violating the permissible standard levels of harmonics and other system constraints.

Abstract Cryotherapy is widely utilized in medicine, particularly for pain management. This randomized clinical trial aimed to assess the effect of intraoral cold pack application (cryotherapy) on postoperative pain (POP) and the level of Substance P (SP) in patients with symptomatic apical periodontitis (SAP). Enrolled patients were randomly assigned to either cryotherapy or control group. After adequate anesthesia, access cavity, and biomechanical preparation of the root canal system were completed, the first apical fluid (AF) sample (S1) was obtained. A custom-made intraoral ice-gel pack was applied for 30 min in the cryotherapy group, while no intervention was performed in the control group. The second AF sample (S2) was collected 30 min later in both groups. Patients were asked to complete the Visual Analogue Scale (VAS) questionnaire to assess their POP. Quantification of SP in AF samples was performed using the enzyme-linked immunosorbent assay (ELISA) test. Data were analyzed statistically, revealing a significant reduction in POP and SP levels in the cryotherapy group compared to the control group (P ≤ 0.05). Furthermore, a moderate positive correlation was observed between SP levels and POP (P ≤ 0.05). In conclusion, intraoral cryotherapy represents a simple and cost-effective option for controlling POP and reducing inflammation levels in patients with SAP.

Abstract Multiple Sclerosis (MS) is a complex autoimmune disorder that significantly impacts the central nervous system, leading to a range of complications. While intracranial haemorrhage (ICH) is a rare but highly morbid complication, more common CNS complications include progressive multifocal leukoencephalopathy (PML) and other CNS infections. This severe form of stroke, known for its high morbidity and mortality rates, presents a critical challenge in the management of MS. The use of disease-modifying drugs (DMDs) in treating MS introduces a nuanced aspect to patient care, with certain medications like Dimethyl Fumarate and Fingolimod showing potential in reducing the risk of ICH, while others such as Alemtuzumab and Mitoxantrone are associated with an increased risk. Understanding the intricate relationship between these DMDs, the pathophysiological mechanisms of ICH, and the individualised aspects of each patient's condition is paramount. Factors such as genetic predispositions, existing comorbidities, and lifestyle choices play a crucial role in tailoring treatment approaches, emphasising the importance of a personalised, vigilant therapeutic strategy. The necessity for ongoing and detailed research cannot be overstated. It is crucial to explore the long-term effects of DMDs on ICH occurrence and prognosis in MS patients, aiming to refine clinical practices and promote patient-centric, informed therapeutic decisions. This approach ensures that the management of MS is not only comprehensive but also adaptable to the evolving understanding of the disease and its treatments.

Abstract Accurate screening of COVID-19 infection status for symptomatic patients is a critical public health task. Although molecular and antigen tests now exist for COVID-19, in resource-limited settings, screening tests are often not available. Furthermore, during the early stages of the pandemic tests were not available in any capacity. We utilized an automated machine learning (ML) approach to train and evaluate thousands of models on a clinical dataset consisting of commonly available clinical and laboratory data, along with cytokine profiles for patients (n = 150). These models were then further tested for generalizability on an out-of-sample secondary dataset (n = 120). We were able to develop a ML model for rapid and reliable screening of patients as COVID-19 positive or negative using three approaches: commonly available clinical and laboratory data, a cytokine profile, and a combination of the common data and cytokine profile. Of the tens of thousands of models automatically tested for the three approaches, all three approaches demonstrated > 92% sensitivity and > 88 specificity while our highest performing model achieved 95.6% sensitivity and 98.1% specificity. These models represent a potential effective deployable solution for COVID-19 status classification for symptomatic patients in resource-limited settings and provide proof-of-concept for rapid development of screening tools for novel emerging infectious diseases.

Abstract Globally one-third of global population are victims of anemia, significantly impacting maternal and infant health and linked to poor cognition, productivity, and mortality risks. We used randomly selected 4040 lactating mothers’ record from nationally representative survey. Descriptive statistics were weighted, and the standard hemoglobin cutoff point (below 12 g/dl) was used. Bivariable and multivariable multilevel binary logistic regression model considering the individual and community-level factors associated with anemia was employed. Crude and adjusted odds ratios with a 95% confidence interval were reported. In Ethiopia, 32.3% (95% CI 30.9–33.7%) of lactating women were anemic, with 23.4% having mild, 7.3% moderate, and 1.2% severe anemia. Pastoral regions (Afar, Somalia, and Oromia region) had higher burden of anemia than the others. The advanced age of the mother above 45 years (AOR = 1.43 (1.11–1.82), unemployment (AOR = 1.19; 95% CI 1.08–1.32), household wealth index (AOR = 0.56; 95% CI 0.50–0.63), extended family size (AOR = 1.20; 95% CI 1.04–1.46), and not using family planning (AOR = 1.70; 95% CI 1.49–1.93) were significant factors associated with anemia. Anemia is a moderate public health problem and associated with location and other factors to be addressed via effective interventions.

OBJECTIVE: To investigate the expression of epidermal growth factor receptor (EGFR) in surface epithelial ovarian cancers (EOCs) among the local population, considering its potential role as a therapeutic target in ovarian cancer treatment. METHODS: This cross-sectional study was conducted at Ayub Medical College, Abbottabad, and Khyber Medical University Peshawar, Pakistan, from July 1st to December 31st, 2022. Data from 73 patients diagnosed with EOC were collected using consecutive sampling. Inclusion criteria required histopathological confirmation of EOC and sufficient biopsy specimens for immune-histochemical (IHC) analysis. Patients who declined participation or lacked adequate biopsy samples for IHC were excluded. Biopsy samples were histologically confirmed for EOC, and IHC staining was performed to detect EGFR-1 protein, validated with positive and negative controls. RESULTS: The mean age of the participants was 53.42±9.99 years, with serous type lesions being the most prevalent (n=40, 54.8%). EGFR expression varied, with 46.6% showing moderate positivity, 27.4% and 19.2% cases demonstrating weak and strong positivity respectively. Significant differences in EGFR positivity were noted between lesion types (p=0.002) and among patients with positive vs. negative family histories (p=0.001). No significant associations were found with parity or socioeconomic status. ANOVA analysis revealed no significant differences in age, age at menarche, or age at menopause based on EGFR positivity levels (p > 0.05). CONCLUSIONS: A moderate to high intensity level of EGFR expression in cases of serous cyst adenocarcinomas and patients with family history of reproductive system malignancy suggest its potential as a therapeutic target for ovarian cancer treatment in such patients.

Background: The COVID-19 pandemic has caused an excess burden of disease in disabled and vulnerable populations. These populations may face an increased risk of contracting COVID-19, greater demand for services and social support, and reduced access to treatment. Despite various national and international efforts towards disability rights and inclusion, substantial gaps exist between disability rights legislation and its implementation. Aims: To assess the inclusion of people with disability and other vulnerable groups in policy and planning documents related to the COVID-19 pandemic response in sub-Sahara Africa. Methods: We conducted content analysis using the EquiFrame policy analysis tool and assessed commitment to 12 vulnerable groups and 21 core human rights in policy and planning documents related to the COVID-19 pandemic. We included documents on general pandemic response, stakeholder engagement, risk communication, and the COVID-19 vaccine from five sub-Saharan African countries, including Nigeria, South Africa, Ethiopia, Kenya, and Zambia. Results: The study highlights the varying degrees to which countries integrate disability, vulnerable groups, and other core human rights concepts into their COVID-19 health policies and planning documents. Only Kenya mentioned disability in their pandemic response plan. However, all countries have explicitly mentioned disability in their stakeholder engagement plans. Except for Kenya, all countries have included disability in their risk communication plans. Notably, South Africa and Zambia demonstrated extensive disability inclusion in their stakeholder engagement and vaccine plan. Thus, these countries have the potential for comprehensive and inclusive health policymaking. In contrast, Nigeria and Ethiopia lag, therefore highlighting areas of improvement across all policy domains. Conclusion: The findings emphasize the critical importance of not only mentioning disability and other vulnerable groups, but also ensuring the depth and quality of this inclusion. While there are positive strides in certain areas, there remains a consistent need for deeper and broader inclusion across all policy domains. Received: 10 September 2024 | Reviewed: 16 October 2024 | Revised: 03 November 2024 | Accepted: 05 November 2024.

BackgroundAn estimated 6.7 million persons are living with dementia in the United States, a number expected to double by 2060. Persons experiencing moderate to severe dementia are 4 to 5 times more likely to fall than those without dementia, due to agitation and unsteady gait. Socially assistive robots fail to address the changing emotional states associated with agitation, and it is unclear how emotional states change, how they impact agitation and gait over time, and how social robots can best respond by showing empathy. ObjectiveThis study aims to design and validate a foundational model of emotional intelligence for empathetic patient-robot interaction that mitigates agitation among those at the highest risk: persons experiencing moderate to severe dementia. MethodsA design science approach will be adopted to (1) collect and store granular, personal, and chronological data using Personicle (an open-source software platform developed to automatically collect data from phones and other devices), incorporating real-time visual, audio, and physiological sensing technologies in a simulation laboratory and at board and care facilities; (2) develop statistical models to understand and forecast the emotional state, agitation level, and gait pattern of persons experiencing moderate to severe dementia in real time using machine learning and artificial intelligence and Personicle; (3) design and test an empathy-focused conversation model, focused on storytelling; and (4) test and evaluate this model for a care companion robot (CCR) in the community. ResultsThe study was funded in October 2023. For aim 1, architecture development for Personicle data collection began with a search for existing open-source data in January 2024. A community advisory board was formed and met in December 2023 to provide feedback on the use of CCRs and provide personal stories. Full institutional review board approval was received in March 2024 to place cameras and CCRs at the sites. In March 2024, atomic marker development was begun. For aim 2, after a review of open-source data on patients with dementia, the development of an emotional classifier was begun. Data labeling was started in April 2024 and completed in June 2024 with ongoing validation. Moreover, the team established a baseline multimodal model trained and validated on healthy-person data sets, using transformer architecture in a semisupervised manner, and later retrained on the labeled data set of patients experiencing moderate to severe dementia. In April 2024, empathy alignment of large language models was initiated using prompt engineering and reinforcement learning. ConclusionsThis innovative caregiving approach is designed to recognize the signs of agitation and, upon recognition, intervene with empathetic verbal communication. This proposal has the potential to have a significant impact on an emerging field of computational dementia science by reducing unnecessary agitation and falls of persons experiencing moderate to severe dementia, while reducing caregiver burden. International Registered Report Identifier (IRRID)PRR1-10.2196/55761

Nanotechnology is an exciting area with great potential for use in biotechnology due to the far-reaching effects of nanoscale materials and their size-dependent characteristics. Silver and other metal nanoparticles have attracted a lot of attention lately because of the exceptional optical, electrical, and antimicrobial characteristics they possess. Silver nanoparticles (AgNPs) stand out due to their cost-effectiveness and abundant presence in the earth’s crust, making them a compelling subject for further exploration. The vital efficacy of silver nanoparticles in addressing environmental concerns is emphasized in this thorough overview that dives into their significance in environmental remediation. Leveraging the distinctive properties of AgNPs, such as their antibacterial and catalytic characteristics, innovative solutions for efficient treatment of pollutants are being developed. The review critically examines the transformative potential of silver nanoparticles, exploring their various applications and promising achievements in enhancing environmental remediation techniques. As environmental defenders, this study advocates for intensified investigation and application of silver nanoparticles. Furthermore, this review aims to assist future investigators in developing more cost-effective and efficient innovations involving AgNPs carrying nanoprobes. These nanoprobes have the potential to detect numerous groups of contaminants simultaneously, with a low limit of detection (LOD) and reliable reproducibility. The goal is to utilize these innovations for environmental remediation purposes.

Abstract Introduction The prevalence of abdominal injuries in war and conflict zones, particularly in low‐ and middle‐income countries (LMICs), presents a significant healthcare challenge. These injuries, often resulting from explosive devices, firearms, and shrapnel, lead to high morbidity and mortality rates due to delayed diagnoses, inadequate medical infrastructure, and limited access to specialised care. This review aims to summarise the literature on conflict‐related abdominal injuries in LMICs, highlighting the impact of such trauma on healthcare systems and patient outcomes, and suggesting strategies for improvement. Methods A comprehensive narrative review was conducted, focusing on studies from contemporary and historical conflict‐ridden nations. Databases such as PubMed, EMBASE, Google Scholar, the Cochrane Library, and Scopus were searched using specific keywords. Inclusion criteria encompassed various study designs and both paediatric and adult populations, with studies providing raw data prioritised. Exclusions included non‐English articles, non‐peer‐reviewed studies, and those not reporting outcomes or involving high‐income countries. Results The review identified significant challenges in managing war‐related abdominal trauma in LMICs, including a shortage of healthcare personnel and infrastructure, socio‐political barriers, and research gaps. Clinical implications of such injuries include elevated mortality rates, with surgical and nonsurgical management outcomes varying significantly. Positive advancements in diagnostics and surgical techniques have improved survival rates, yet the need for further infrastructural and workforce enhancements remains critical. Conclusion Abdominal trauma in conflict‐affected LMICs necessitates focused efforts to improve healthcare delivery, including targeted funding for infrastructure and equipment, development of training programs for trauma specialists, and increased humanitarian aid. Bridging research gaps and fostering collaborative efforts are essential for advancing the management of abdominal trauma and enhancing patient outcomes in these challenging environments.

Abstract Background and Aims Myocardial infarction (MI) is a major cause of mortality worldwide, irrespective of its presentation as non‐ST‐segment elevation MI (NSTEMI) or ST‐segment elevation MI (STEMI). The objective of this study was to assess national results of management and clinical outcome of acute MI patients in Kosovo. Methods This cross‐sectional descriptive study, conducted at the Clinic of Cardiology of the University Clinical Center of Kosovo, in Prishtina, included all patients hospitalized with acute MI over a period of 7 years (2014‐2020). The primary outcome of the study was in‐hospital mortality. Results Among 7353 admitted patients with acute MI (mean age 63 ± 12 years, 29% female) and according to the final diagnosis, 4436 (59.4%) patients had STEMI, and 2987 (40.6%) NSTEMI. More patients with STEMI received primary percutaneous intervention (PPCI) than those with NSTEMI (50% vs. 41%, p

The aim of this study was to investigate the effects of acute anaerobic exercise on serum levels of adipokines Zinc-α2-glycoprotein (ZAG), apelin, and lipasin. Eighteen male athletes who actively played soccer and trained at least four days a week, with a mean age of 19.11 ± 2.59 years, body weight of 70.61 ± 8.17 kg, height of 176.0 ± 7.71 cm, sport age of 7.22 ± 2.60 years and BMI of 22.76 ± 1.68 kg/m2 participated in the study. Athletes were subjected to the Running-Based Anaerobic Sprint Test (RAST) for anaerobic performance. Blood samples were collected from the athletes 4 times (at rest, 10 minutes, 60 minutes, and 24 hours after exercise). The results of the study showed that acute anaerobic exercise significantly increased ZAG levels (p 0.05). In conclusion, the findings of this study indicate that acute anaerobic exercise is associated with an increase in ZAG levels, but not apelin or lipasin levels. The observations suggest that ZAG may have a specific response to anaerobic exercise, which provides valuable insight into its potential impact on energy metabolism.

Key Clinical Message Primary signet‐ring cell carcinoma of the anal canal and rectum is an extremely rare and aggressive malignancy. The present case underscores the importance of considering primary signet‐ring cell carcinoma in differential diagnoses for young patients with chronic anorectal symptoms. It highlights the need for a multidisciplinary treatment approach (including surgery, chemotherapy, and radiotherapy) and comprehensive follow‐up for managing this challenging condition and improving long‐term patient outcomes. Abstract Primary signet‐ring cell carcinoma of the anal canal and rectum is an exceedingly rare subtype of colorectal adenocarcinoma, often originating as an extension of rectal adenocarcinoma. This malignancy constitutes a small fraction of colorectal cancers and is scarcely reported in medical literature. We present the case of an 18‐year‐old male with a three‐year history of progressively worsening hematochezia, anorectal pain, and defecation‐associated prolapse. Initial conservative treatments failed, leading to further investigations that revealed a palpable, nodular anorectal mass. Imaging studies (including CT and MRI), and biopsy confirmed poorly differentiated adenocarcinoma with signet‐ring cell morphology. The tumor exhibited extensive lymphovascular invasion and involved perirectal lymph nodes, and was staged as pT3, N2a. Immunohistochemical staining was positive for CK 7, CK 20, and SATB2, supporting the primary anorectal origin. The treatment regimen included initial diversion colostomies for symptom relief, followed by neoadjuvant chemotherapy with a modified 5‐fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) regimen and concurrent chemoradiation with Xeloda. The patient subsequently underwent an abdominoperineal resection (APR), which confirmed the diagnosis and achieved curative resection. Postoperative complications included transient ileus and wound infection, which were managed with supportive care. This case underscores the diagnostic and therapeutic challenges posed by primary signet‐ring cell carcinoma of the anorectal region, highlighting the need for a high index of suspicion and comprehensive diagnostic workup in atypical presentations. The multimodal treatment approach, incorporating surgery, chemotherapy, and radiotherapy, was crucial in managing this locally advanced tumor. The rarity and aggressiveness of this carcinoma necessitate a tailored treatment strategy to improve patient outcomes. Long‐term follow‐up, including regular imaging and surveillance, is vital for monitoring disease recurrence and evaluating treatment effectiveness.

Dear Editor, An electronic cigarette or electronic nicotine delivery system is a tobacco-free device powered by a battery. It usually contains a solution of nicotine, flavorings, and various chemicals, some of which may carry potential risks...

Background It is unclear whether different exercise programs lead to an increase in the concentration of plasma Pentraxin3 (PTX3), an anti-inflammatory protein. This study aimed to investigate the effects of aerobic exercise (AE) and high-intensity interval training (HIIT) on plasma PTX3 levels in overweight and obese women. Method A total of 45 sedentary women aged between 32.26 ± 6.30 voluntarily participated in the study. The control group (CG, n = 15) was selected among normal-weight women. Women in the group of participants who partook in exercise consisted of overweight and obese women according to a random method, including the AE group (n = 15) and the HIIT group (n = 15). The AE session conducted was 50 min in duration and consisted of warm-up exercises (5 min), and primary exercises (40 min, basic aerobic-step exercises). HIIT consists of warm-up exercises (5 min), primary exercises (work intervals: 6−10 × 1 min (80–90% HRmax), rest intervals: 1 min (walk, 50% HRmax), 21–29 min running. The exercises were applied for three sessions/week for 12 weeks. Fasting blood samples were taken from all participants before and after exercise and their body composition was measured. Results As a result of two different 12-week exercises, serum PTX3 levels increased significantly by 47.53% in the AE group and 50.21% in the HIIT group (p .05). Also, no significant differences were found between the two types of exercises in terms of parameters. A significant negative correlation in the total sample was found between PTX3 with BMI, fat mass, LDL-C, and hsCRP. Conclusion The percentage change in PTX3 values was not different between exercise types, whereas PTX3 was increased with exercise, regardless of the type of exercise. It can be said that both aerobic and HIIT increase PTX3, VO2max levels and improve lipid metabolism in overweight and obese women.

Hypomelanosis of Ito (HI) though said to be the thirdmost common neurocutaneus disorder, is rarely reported in paediatric practice in Africa. A high index of suspicion must be maintained in children with cutaneous lesions as a seizure may be the first symptom that may bring the child to attention. A case of HI in a neonate is hereby reported to sensitize clinicians about this relatively uncommon disorder

Background: Neither radiological phenotypic characteristics nor reconstruction CT scan has been used to study the early anatomical disruption of the cranial bone in children with the so-called idiopathic type of West syndrome. Material and Methods: The basic diagnostic measures and the classical antiepileptic treatments were applied to these children in accordance with the conventional protocol of investigations and treatment for children with West syndrome. Boys from three unrelated families were given the diagnosis of the idiopathic type of West syndrome, aged 7, 10 and 12 years old. Parents underwent extensive clinical examinations. Three parents (age range of 28–41 year) were included in this study. All children showed a history of intellectual disabilities, cryptogenic epileptic spasms and fragmented hypsarrhythmia. These children and their parents were referred to our orthopedic departments because of variable skeletal deformities. Variable forms of skeletal deformities were the motive for the families to seek orthopedic advice. A constellation of flat foot, torticollis and early-onset osteoarthritis were observed by the family doctor. Apparently, and from the first clinical session in our practice, we felt that all these children are manifesting variable forms of abnormal craniofacial contour. Thereby, we immediately performed detailed cranial radiological phenotypic characterization of every affected child, as well as the siblings and parents, and all were enrolled in this study. All affected children underwent whole-exome sequence analysis. Results: The craniofacial phenotype of all children revealed apparent developmental anatomical disruption of the cranial bones. Palpation of the skull bones showed unusual palpable bony ridges along different sutural locations. A 7-year-old child showed abnormal bulging over the sagittal suture, associated with bilateral bony ridges over the squamosal sutures. AP skull radiograph of a 7-year-old boy with West syndrome showed facial asymmetry with early closure of the metopic suture, and other sutures seemed ill-defined. A 3D reconstruction CT scan of the skull showed early closure of the metopic suture. Another 3D reconstruction CT scan of the skull while the patient was in flexion showed early closure of the squamosal sutures, pressing the brain contents upward, causing the development of a prominent bulge at the top of the mid-sagittal suture. A reformatted 3D reconstruction CT scan confirmed the bilateral closure of the squamosal suture. Examination of the parents revealed a similar skull radiographic abnormality in his mother. A 3D reformatted frontal cranial CT of a 35-year-old mother showed early closure of the metopic and sagittal sutures, causing a mid-sagittal bony bulge. A 10-year-old boy showed an extremely narrow frontal area, facial asymmetry and a well palpable ridge over the lambdoid sutures. A 3D axial reconstruction CT scan of a 10-year-old boy with West syndrome illustrated the asymmetry of the posterior cranial bones along the lambdoid sutures. Interestingly, his 28-year-old mother has been a client at the department of spine surgery since she was 14 years old. A 3D reconstruction CT scan of the mother showed a noticeable bony ridge extending from the metopic suture upwards to involve the sagittal suture (red arrow heads). The black arrow shows a well demarcated bony ridge over the squamosal suture. A 3D reconstruction CT scan of the skull and spine showed the thick bony ridge of the metopic and the anterior sagittal as well as bilateral involvement of the squamosal, causing apparent anterior narrowing of the craniofacial contour. Note the lumbar scoliosis. A 12-year-old boy showed brachycephaly. A lateral skull radiograph of a 12-year-old boy with West syndrome showed premature sutural fusion, begetting an abnormal growth pattern, resulting in cranial deformity. The nature of the deformity depends on which sutures are involved, the time of onset and the sequence in which individual sutures fuse. In this child, brachycephalic secondary to craniosynostosis, which occurred because of bilateral early ossification of the coronal sutures, led to bi-coronal craniosynostosis. Thickened frontal bones and an ossified interclinoid ligament of the sella turcica were encountered. The lateral skull radiograph of a 38-year-old mother with a history of poor schooling achievements showed a very similar cranial contour of brachycephaly, thickening of the frontal bones and massive ossification of the clinoid ligament of the sella turcica. Maternal history revealed a history of multiple spontaneous miscarriages in the first trimester of more than five times. Investigating his parents revealed a brachycephalic mother with borderline intelligence. We affirm that the pattern of inheritance in the three boys was compatible with the X-linked recessive pattern of inheritance. Whole-exome sequencing showed non-definite phenotype/genotype correlation. Conclusions: The aim of this study was sixfold: firstly, to refute the common usage of the term idiopathic; secondly, we feel that it could be possible that West syndrome is a symptom complex rather than a separate diagnostic entity; thirdly, to further detect the genetic carrier, we explored the connection between the cranial bones in children with West syndrome with what has been clinically observed in their parents; fourthly, the early life anatomical disruptions of the cranial bones among these children seem to be heterogeneous; fifthly, it shows that the progressive deceleration in the development of this group of children is highly connected to the progressive closure of the cranial sutures; sixthly, we affirm that our findings are novel.

Abstract Doxorubicin (DOX) is a highly effective, commonly prescribed, potent anti-neoplastic drug that damages the testicular tissues and leads to infertility. Apigetrin (APG) is an important flavonoid that shows diverse biological activities. The present research was designed to evaluate the alleviative role of APG against DOX-induced testicular damages in rats. Forty-eight adult male albino rats were randomly distributed into 4 groups, control, DOX administered (3 mgkg−1), DOX + APG co-administered (3 mgkg−1 of DOX; 15 mgkg−1 of APG), and APG administered group (15 mgkg−1). Results of the current study indicated that DOX treatment significantly reduced the activities of superoxide dismutase (SOD), glutathione reductase (GSR), catalase (CAT) and glutathione peroxidase (GPx), while increasing the levels of malondialdehyde (MDA) and reactive oxygen species (ROS). DOX treatment also reduced the sperm count, viability, and motility. Moreover, DOX significantly increased the sperm morphological anomalies and reduced the levels of plasma testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The administration of DOX significantly increased the expressions of Bax and Caspase-3, as well as the levels of inflammatory markers. Additionally, DOX treatment significantly downregulated the expressions of steroidogenic enzymes (StAR, 3β-HSD and 17β-HSD) and Bcl-2. Furthermore, DOX administration provoked significant histopathological abnormalities in the testicular tissues. However, APG supplementation significantly reversed all the testicular damages due to its androgenic, anti-apoptotic, anti-oxidant and anti-inflammatory nature. Therefore, it is concluded that APG may prove a promising therapeutic agent to treat DOX-induced testicular damages.

Abstract Head and neck cancer treatments, such as radiotherapy, chemotherapy, and surgery, have diverse effects on patients, leading to dysphagia as a significant post-treatment issue. This study aims to evaluate the effectiveness of the Arabic version of the EAT-10 screening instrument (A-EAT-10) using Fiber-Optic Endoscopic Evaluation of Swallowing (FEES) as an imperfect gold standard. Additionally, we seek to establish a correlation between A-EAT-10 and PEG tube insertion in head and neck cancer (HNC) patients. Our sample comprised 130 head and neck cancer patients with varying cancer types at King Hussein Cancer Center (KHCC). We followed these patients throughout their distinct treatment plans up to one month after their final treatment session. During follow-up visits, we administered the A-Eat-10 instrument to monitor dysphagia. FEES were conducted at the initial and concluding visits to compare results with A-EAT-10 scores. The results in our tests, assuming independence or dependence, demonstrated excellent agreement. A-EAT-10 exhibited outstanding predictive capabilities with an AUC ranging from 93 to 97%. A-EAT-10 tended to slightly overestimate dysphagia at later treatment stages by approximately 20% compared to FEES, with an RR of 1.2 (95% CI 0.91, 1.56, p-value = 0.21), indicating statistical insignificance. In conclusion, A-EAT-10 is an excellent option for dysphagia evaluation, offering non-invasive, straightforward, and cost-effective advantages compared to FEES. Its utility extends to predicting the need for PEG tube insertion at initial patient visits, making it a valuable tool for informed treatment decisions. Notably, A-EAT-10 demonstrates a diminishing correlation with FEES over time.

Abstract In Proton Exchange Membrane Fuel Cells (PEMFCs), the presence of residual water within the Gas Diffusion Layer (GDL) poses challenges during cold starts and accelerates degradation. A computational model based on the Lattice Boltzmann Method (LBM) was developed to consider the capillary pressure inside the PEMFC and to analyze the exact geometries of the GDLs, which were obtained using the Computed Tomography scan. The novelty of this study is to suggest a methodology to compare the quantitative water removal performance of the GDLs without long-term experimental testing. Two different samples of GDLs were considered, pristine and aged. The results of quantitative measurements revealed the amount of water columns (breakthroughs) inside each sample. Considering the volume of 12,250,000 µm3 for each sample, the pristine and the aged samples are prone to have 774,200 µm3 (6.32%) and 1,239,700 µm3 (10.12%) as water columns in their porous domain. Micro-structural properties such as connectivity, mean diameter, effective diffusivity, etc. were also compared to observe the impacts of aging on the properties of the GDL.