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The use of neurophysiological measurements to advance the design, development, use, acceptance, influence and adaptivity of information systems is receiving increasing attention. Within the field of education, neurophysiological measurements have commonly been used to capture a learner's psychological constructs such as cognitive load, attention and emotion, which play an important role in student learning. This paper systematically examines the literature on the use of neurophysiological measurements in higher education. In particular, using a well-established Systematic Literature Review (SLR) method, we identified 83 papers reporting empirical evidence about the outcome of employing neurophysiological measurements within educational technologies in higher education. The findings of the SLR are divided into three main themes discussing the employed measurements, experimental settings and constructs and outcomes. Our findings identify that (1) electroencephalography and facial expression recognition are the dominantly employed types of measurement, (2) the majority of the experiments used a pre-experimental design, (3) attention and emotion are the two foremost cognitive and non-cognitive constructs under investigation, while less emphasis is paid to meta-cognitive constructs and (4) the reported results mostly focus on monitoring learners' states, which are not always the same as the intended purpose, such as developing an adaptive system. On a broader term, the review of the literature provides evidence of the effective use of neurophysiological measurements by educational technologies to enhance learning; however, a number of challenges and concerns related to the accuracy and validity of the captured construct, the intrusiveness of the employed instruments as well as ethical and privacy considerations have surfaced, that need to be addressed before such technologies can be employed and adopted at scale.

Abstract Background Orbital apex syndrome is a symptom complex of visual loss and ophthalmoplegia resulting from a disease involving the orbital apex. It can be caused by inflammation, infection, and malignancies. Mucormycosis is an infection caused by filamentous saprophytes of the order Mucorales. It is ubiquitous, and the infection can occur from ingesting contaminated food, inhaling spores, or injecting the disrupted skin or wounds. It is mainly a disease of the immunocompromised, affecting patients with poorly controlled diabetes, organ transplant recipients, and patients with hematological malignancies. We present the case of a man with orbital apex syndrome resulting from rapidly spreading rhino-ocular cerebral mucormycosis, who had a poor outcome despite an aggressive combined medical and surgical treatment. This is an unusual cause of orbital apex syndrome. Case presentation A 46-year-old Bangladeshi man presented to the emergency department with a history of toothache and pain in the left eye. On examination, the patient had a left-sided periorbital edema, ptosis, and proptosis. He had complete ophthalmoplegia and absent direct pupillary response in the left eye. Magnetic resonance imaging of the brain and orbit showed bilateral ethmoidal, left frontal, maxillary, and sphenoidal sinusitis with left orbital cellulitis. His left orbit was surgically decompressed and histology confirmed mucormycosis. Despite aggressive treatment, the patient had only a partial improvement in his symptoms. Conclusions Mucormycosis is a rare disease that can easily be misdiagnosed, leading to delayed treatment and disease dissemination. Clinicians must be suspicious of mucormycosis in patients presenting with multiple cranial nerve palsy.

Abstract This paper proposes a new optimization technique to make an integration between the Optimal Reactive Power Dispatch (ORPD) problem and Electric Vehicles (EV). Here, a modified metaheuristic algorithm, called the Promoted Osprey Optimizer (POO) is used for this purpose. Inspired by the hunting behavior of ospreys, a predatory bird species, the POO algorithm employs various strategies like diving, soaring, and gliding to effectively explore the search space and avoid local optima. To evaluate its performance, the POO-based model has been applied to the IEEE 118-bus and IEEE 57-bus systems, considering different scenarios of EV penetration. The experimental findings demonstrate that the POO algorithm can effectively optimize the reactive power dispatch problem with EV integration, achieving significant reductions in active power losses and voltage deviations toward several existing metaheuristic optimization techniques in different terms. The POO algorithm demonstrates a significant reduction in power loss, achieving up to 22.2% and 16.2% in the 57-bus and 118-bus systems, respectively. This improvement is accompanied by reductions in voltage deviation of up to 20.6% and 15.7%. In the 57-bus system, power loss is reduced from 2.35 MW to 1.93 MW, while voltage deviation decreases from 0.034 p.u. to 0.027 p.u. For the 118-bus system, power loss is lowered from 4.21 MW to 3.53 MW, and voltage deviation is reduced from 0.051 p.u. to 0.043 p.u. Furthermore, the POO algorithm surpasses other optimization methods in minimizing voltage deviation, achieving reductions of up to 0.056 p.u. in the 57-bus system and up to 0.163 p.u. in the 118-bus system. Consequently, the POO algorithm holds great potential as a valuable tool for power system operators and planners to optimize reactive power dispatch and enhance power system performance with EV integration.

Abstract Wheat (Triticum aestivum L.) is a staple crop of immense economic importance, especially in the agronomic context of Dera Ismail Khan, Khyber Pakhtunkhwa (KPK), Pakistan. Understanding the effects of various agronomic practices, such as priming techniques, sowing methods, and seed rates, on wheat yield and growth is crucial for optimizing production and ensuring regional food security. To study the effects of priming and sowing techniques in combination with seed rates on short (Israr Shaheed) and long (Gomal) duration, three experiments were conducted at the agronomic research site of Gomal University, Dera Ismail Khan, Pakistan, wheat varieties. In the first experiment, various priming techniques were used. Among different techniques used Farmyard manure priming produced the tallest plants at 111.3 and 125.3 cm, the maximum number of tillers (335.7 and 345.0 m-2), longest spikes (8.6 and 7.6 cm), maximum spikelets (27.2 and 31.0 spike-1), maximum number of grains (45.5 and 48.7 spike-1), maximum grain yield (4.4 and 4.6 t ha-1) and maximum harvest index (38.7 and 41.5%) respectively for Israr Shaheed and Gomal. Conversely, compost manure produced heavier grains than other interactions (49.2 and 42.3 g) while sodium chloride showed the maximum biological yield (12.4 and 11.8 t ha-1) for Israr Shaheed and Gomal correspondingly. In 2nd experiment, different sowing methods were tested on two wheat varieties Israr Shaheed and Gomal. Dry sowing followed by flooding produced tallest plants measuring (105.5 and 101.7 cm), maximum number of tillers (398.2 and 406.7 m-2), longest spikes (8.3 and 7.2 cm), maximum spikelets (29.8 and 35.5 spike-1), maximum number of grains (54.3 and 51.6 spike-1) and maximum grain yield (4.3 and 4.6 t ha-1) respectively for Israr Shaheed and Gomal. Israr Shaheed and Gomal showed maximum 1000-grain weights (45.3 and 45.0 g) in sprouted seeding in flooded fields respectively. The highest biological yield (13.6 t ha-1) was in dry seed in the flooded field while the maximum harvest index (33.5 and 33.9%) was recorded in soaked seed followed by flooding for Israr Shaheed and Gomal. In the last experiment, different seed rates were studied. The results showed that plants grown with seed rate 150 kg ha-1 showed the tallest plants at 111.0 and 111.7 cm, maximum number of tillers (411.6 and 408.2 m-2), longest spikes (7.8 and 7.7 cm), maximum spikelets (34.3 and 34.3 spike-1), maximum number of grains (50.8 and 47.2 spike-1), maximum grain yield (4.6 and 4.5 t ha-1) and maximum harvest index (38.4 and 36.7%) respectively for Israr Shaheed and Gomal. The maximum number of 1000-grains weight (g) was found on 200 and 250 kg ha-1 for Israr Shaheed and Goma-8, respectively giving 45.2 g while biological yield was the highest in 175 kg ha-1 respectively. Conclusively, the results indicated that yield and yield attributes in wheat were enhanced up to 150 kg ha-1 seed rate when interacted with farmyard manure priming along with dry sowing of seed followed by flooding. Future research should explore the integration of advanced irrigation techniques and nutrient management practices to further enhance wheat productivity in the Dera Ismail Khan region.

Background Preanalytical phase of laboratory testing is defined as that which includes clinician’s request for examination, patient preparation, sample collection, and transportation of specimen to the laboratory. Any errors occurring during this phase are referred to as preanalytical errors (PAEs). Objective The objective is to study the effect of training on improvement in the PAEs in venous blood sampling at a tertiary care center. Materials and Methods An observational prospective study was carried out in two phases of 6 months each in the outpatient department collection center, Gandhi Hospital, Secunderabad. First, venous blood samples collected were observed for the following errors: (1) incorrect volume of specimen, (2) hemolyzed samples, (3) clotted samples, (4) wrong vacutainer used, and (5) samples without requisition forms. The evaluation for performance based on quality indicators given by the International Federation of Clinical Chemistry Laboratory Medicine working group on Laboratory Errors and Patient Safety was done. Later, training classes were conducted on the correct phlebotomy techniques for the staff, and then venous blood samples were observed again for any errors. Results Of 43,286 samples collected in the first 6 months, 2208 (5.1%) were found to have errors. The most common cause for rejection was hemolysis followed next by samples collected in inappropriate tubes. Following the training session, a total of 41,064 samples were observed in the next phase. Of these, only 4.6% were found to have errors. Conclusion After training the laboratory technicians on the correct techniques of sample collection, there was a significant reduction in the percentage of errors. Therefore, it is important to give continuous training and education to reduce the frequency of errors and improve the quality of lab testing.

Background:Tea and coffee have been consumed since decade ago and became a significant part of social life and cultural traditions. Objective:The study aims to evaluate the effects of coffee and black tea extract on some blood factors in adult albino rats. Materials and Methods:Eighteen adult male albino rats, classified into three groups of six: group 1 (control) received orally drinking water only, group 2 (tea) received orally extract tea, group 3 (coffee) treated orally with coffee. Coffee and tea extracts were prepared daily at a dose of 30 g/L and provided at all times to the rats for 30 day as drinking water. Iron and ferritin levels, cholesterol concentration of low-density lipoprotein (LDL) and high-density lipoprotein (HDL), superoxide dismutase (SOD), glutathione peroxidase (GPx) activities as well as the levels of tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were compared among these groups. Results:This study inferred, there was a significant decrease the amount of iron in the blood as well as the ferritin. Also consumption of coffee or tea lowers LDL cholesterol and HDL cholesterol and enhanced antioxidant activity by SOD and GPx enzymes more than control group. Furthermore, increased these levels in proinflammatory cytokines (IL-6 and TNF-α) in treated rats with tea and coffee extract more than their levels in the control group. Conclusion:The extracts of tea and coffee lowered the iron and ferritin concentration, have remarkable antioxidant activity, and increased the levels in proinflammatory cytokines (IL-6 and TNF-α) in the rat blood.

Background: Chronic kidney disease (CKD) is becoming an increasing public health problem. A study that reviewed patients receiving treatment in hemodialysis centers reported 79.2% of patients from Jigawa State to be managed for CKD. This study aimed to find the factors associated with CKD among adults from high-burden kidney disease areas of Jigawa State. MATERIALS AND METHODS: A cross-sectional descriptive study design that utilized mixed methods (quantitative and qualitative) of data collection (sequential explanatory) was used to study eligible respondents from the four local government areas (LGAs) reported to have a high burden of kidney disease. The modified WHO STEPS questionnaire, key informant interview, and in-depth interview guides were employed to collect information from the eligible selected community members. Multistage and purposive sampling techniques were used, and data were analyzed using IBM SPSS version 22.0 with a statistical significance set at P ≤ 0.05. Thematic analysis was used to analyze the qualitative interviews. Results: The age of the respondents ranged from 18 to 102 years, with a median of 45 (interquartile range = 30–80) years. The period prevalence over the past five years (2018–2023) of having kidney disease in the family was 67 (18.6%), while the point prevalence (currently having a patient with kidney disease) was 51 (14.1%). In terms of the distribution of cases by LGAs, Jahun reported more cases, 33.3% in the family within the last five years, followed by Hadejia 18.7%. In the same vein, respondents from Jahun 28.9% and Hadejia 16.5% reported more current cases of kidney disease in the family. The prevalence of ever had patient with chronic kidney disease in the family was significantly higher among those with systolic hypertension (BP) ≥140 mmHg (29.3%, P < 0.001). Elevated systolic BP was significantly associated with currently having a kidney disease patient (23.3%, P = 0.001). The interviews revealed late presentation and noncompliance to medications among those with risk factors as the perceived facilitators of kidney disease. Conclusions: The prevalence of kidney disease was alarming in the high-burden kidney disease areas. The government should develop a sustainable model for mass community screening of risk factors and community-based health insurance to effectively manage all identified cases.

Objective: The objective of this study was to identify the factors associated with the outcome of the 2023 diphtheria outbreak in Jigawa State, Nigeria. Methods: A descriptive cross-sectional study was conducted amongst all line-listed diphtheria cases reported from Jigawa State, Nigeria, using the 2023 Integrated Disease and Surveillance Response line list of cases that met the World Health Organization case definition of diphtheria. A total of 245 line-listed cases from January 2023 to December 2023 met the criteria for inclusion in the study. Data were analysed using IBM SPSS version 22.0 with a P value set at ≤5%. Binary logistic regression was used to identify the independent predictors of the outcome of the 2023 outbreak. Results: The maximum age of the line-listed cases was 39 years, and the minimum was 1 year with a median of 8 (interquartile range = 5–8) years. More than two-thirds (68.2%) of the cases were ≥5 years of age. More than one-third of the cases (39.6%) were from the northeast senatorial zone of the state. Out of the total 245 cases, 14 died of the disease representing a case fatality rate of 6%, and an attack rate of 3.4 per 100,000 populations. The majority of the cases (95.5%) had fever, cough (81.2%), pharyngitis (86.9%), tonsillitis (96.7%) and laryngitis (82.0%). More diphtheria-related mortalities were recorded amongst cases

Background: Pre-diabetes is an important risk factor for the development of type 2 diabetes and is common in Nigeria. Effective intervention can reverse the underlying pathogenesis of insulin resistance in pre-diabetes. This study aimed to determine and compare the impact of moderate exercise and metformin interventions on insulin resistance among participants with pre-diabetes. Materials and Methods: Using a randomised placebo-controlled design, 54 Nigerians with pre-diabetes were selected using simple random sampling. They were offered metformin, moderate exercise or placebo treatment and followed up for 12 weeks. Insulin resistance was assessed before and after the interventions and the outcome was compared. Results: Forty-nine participants with pre-diabetes completed the study. Participants in both the exercise and metformin groups had significantly decreased insulin resistance compared to placebo after 12 weeks of intervention. However, there was a decrease in insulin resistance by 77.3% (homeostasis model assessment-insulin resistance [HOMA-IR]) and an increase in insulin sensitivity by 81.2% (quantitative insulin sensitivity check index [QUICKI]) in the exercise group. In comparison, participants in the metformin group had a decrease in insulin resistance by 66.3% (HOMA-IR) and an increase in insulin sensitivity by 76.2% (QUICKI). Conclusion: Amongst Nigerians with pre-diabetes, both moderate exercise and metformin have significantly higher efficacy than placebo in improving insulin resistance. However, moderate exercise improved insulin resistance more than the metformin intervention. Participants in this study need to be followed up for a longer period to assess the long-term effects of these interventions.

Abstract The demand for sustainable development goals and the absence of systematic development and organised exploration for gold has prompted this study to integrate magnetic and radiometric datasets with lithology to evaluate the gold mineralisation potential in the Ilesha schist belt. This study considers 3168.72 km2 of the Ilesha schist belt in southwestern Nigeria, a frontier belt for gold deposits. The high-resolution airborne magnetic and radiometric datasets were processed using enhancement techniques, including the analytical signal, lineament density, and K/Th ratio. CET grid analysis, Euler deconvolution, and analytical signal depth estimation methods were used to aid the interpretation. The spatial integration and interpolation were performed using the Analytical Hierarchy Process (AHP) and weighted overlay analytical tools within the ArcGIS environment. The dominant structural controls for potential mineralisation are ENE–WSW and ESE–WNW trends. The depth of the magnetic sources revealed by the analytical signal ranged from 63.17 to 629.47 m, while depths ranging from 47.32 to 457.22 m were obtained from Euler deconvolution. The delineated highly magnetic edge sources, dense lineaments, radiometrically highlighted alteration zones, and lithological hosts for gold mineralisation were integrated to establish the gold mineralisation potential map. The AHP deductions reveal that 10.52% of the study site is within the high mineralisation potential class, a remarkable 60.39% falls within the moderate class, a significant portion (28.86%) falls within the poor class, and 0.23% is considered unfavourable. The result was optimised by validation using known mines, with 94% (i.e., 15 out of 16 mining sites) plotting within the high mineralisation potential class. This assessment provides invaluable insight for stakeholders and policymakers to embark on gold exploration and exploitation and promote sustainable mineral development.

In order to improve the sensitivity of the newly established methodology, a thorough examination was carried out on the essential parameter. A rapid and highly responsive technique has been developed for the detection of loratadine. This method involves the generation of pale white species through the reaction between sodium nitroprusside and loratadine. The transducer's energy response was evaluated using the NAG-4SX3-3D analyzer. The linear range for measuring loratadine is 0.01-10 mM (millimolary). For concentrations of 4 and 10 mM. The RSD (relative standard deviation) for six trials was significantly lower than 0.14 percent. The measurement of loratadine has a limit of detection (LOD) of 261.890 ng/sample for (n=13). The calibration graph shows a progressive dilution across the lowest concentration linear dynamic range, with a correlation coefficient (r) of 0.9984. The percentage linearity (R2 %) is 99.68. The proposed approach was evaluated in comparison to the previous technique, which involved UV-spectrophotometric analysis at a wavelength of 275 nm. Based on the findings, it can be inferred that the technique exhibits enhanced sensitivity and surpasses the classic reference method's 10 mm irradiation, owing to its utilization of specific chemicals. Based on the aforementioned information, it is determined that the developed methodology is the most appropriate for analyzing loratadine in pharmaceutical samples when compared to the reference techniques.

Background & Aims: The article aims to evaluate trends in occupational radiation exposure for employees in different departments at the Center for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan. Materials & Methods: This retrospective study examination of 9780 film dosimeter dose data was carried out from 2019 to 2023. The quantities analyzed were the highest and minimum annual effective doses, distribution of workers, and their average yearly effective doses in different effective dose intervals. The annual collective effective dose and average effective dosage were also included. Results: Yearly average effective doses in Radiotherapy, Nuclear Medicine, Medical Physics, and Diagnostic Radiology range from 0.5 to 3.00 mSv. Records show that 90% of workers fall within 1-3.00 mSv, with 10% between 0.5 mSv and the minimum detectable level. Minimum and maximum yearly individual doses in Radiotherapy and Nuclear Medicine are 0.10 mSv and 2.3 mSv. Average doses for the fields range from 1.01 to 1.14 mSv. Conclusion: Employees received doses that were lower than the yearly maximum, showing successful radiation shielding. The findings imply that safety measures are followed in the researched departments, which is important for clinical practice. This research improves our understanding of occupational radiation exposure, notably at CENAR, and promotes radiation safety in medical settings.

Abstract Recent studies indicate that Glypican 1 (GPC-1) is aberrantly expressed and plays a key role in certain cancers, but little is known in the hepatocellular carcinoma. Raw data from TCGA, GTEx and TIMER databases were utilized to comprehensively analyze GPC-1 expression landscape in pan-cancer, and the biological function of GPC-1 was investigated in liver cancer cells. The results revealed that GPC-1 is highly expressed in HCC, negatively correlated with survival, and also positively correlated with immune infiltration and clinical stage. Furthermore, GPC-1 promoted cell proliferation and inhibited apoptosis in the HCC cell lines. WGCNA analysis and HCCDB database revealed that Akt acted as a key molecule related to GPC-1, influencing biological functions and regulating cell malignant behaviors via the AKT signaling pathway. In conclusion, our findings provide a relatively comprehensive understanding of the oncogenic role of GPC-1 in HCC, implying that GPC-1 could serve as an innovative therapeutic target.

Background: Care of the children with mental health disorders is fraught with challenges particularly in developing countries and, where the family is the major source of care. Consequently assessing the impact of these disorders on the family is relevant to providing these children with optimal care. Objective: To assess the impact of childhood mental health disorders on family function and parental burden. Method: A monogamous family that had 3 children diagnosed as having childhood onset schizophrenia using the International Classification of Disease version 10(ICD 10) Classification was studied. Family function was assessed using the Family APGAR Score and the Zarit Burden Interview (ZBI) Score used in assessing parental burden. Results: The Family APGAR Scores were low (highly dysfunctional family) and the ZBI Scores high (highly burdened) in the family. Areas of serious dysfunction in the family were in adaptation, partnership and growth. In the ZBI Scores feelings about quality and cost of care offered, stress and other negative attributes associated with providing care, inability to meet other parental obligations and uncertainty about the future, were the major contributors to the highly burdensome outcome. Conclusion: The study highlights significant family burden and dysfunction in a family who had three children with schizophrenia. It underscored the need for provision of more comprehensive health and social support services to children with mental health disorders and their families.

Background. Alzheimer's disease is a neurodegenerative disorder that worsens over time as more brain regions are affected and symptoms increase. It usually starts slowly and advances permanently. Ranolazine is a piperazine derivative used as a second-line treatment for people with chronic aortic stenosis who are unresponsive to other medications and have steady or ineffectively-managed angina pectoris. This study is intended to look into the possible neuroprotective effects of ranolazine scopolamine-induced Alzheimer's illness-like features in a mouse model. Methods. This is a randomized controlled animal study that has been carried out in Department of Pharmacology from College of Medicine of Al-Nahrain University. Mice were separated into five groups equally (each group with 10); a control group, and an induction group (mice were administered scopolamine 1 mg per kg intraperitoneally every 24 hr for seven days to induce features similar to Alzheimer's disease). The mice in the remaining three treatment groups were given tested medications prophylactically for 14 days, then the induction was carried out with scopolamine 1 mg/kg i.p. once daily while the tested medication dosages were continued for an additional 7 days; these treatment groups included: donepezil group (5 mg/Kg/d), ranolazine group (40 mg/Kg/d), and combination groups - donepezil (5 mg/Kg/d) with ranolazine (40 mg/Kg/d); all were administrated i.p. once daily. Behavioral parameters including the Y maze test and novel object recognition test were assessed for inflammatory cytokines and oxidative stress parameters. Result. Ranolazine exhibits significant improvement in behavior and memory, oxidative stress parameter level, as well as inflammatory cytokines. When the scopolamine induction group was compared to the control group, the spontaneous alteration considerably decreased (p ≤0.001). However, compared to the induction group, all three donepezil, ranolazine, and combination (donepezil + ranolazine) groups had a highly significant increase in the spontaneous alteration and when compared with the control group, there were no statistically significant changes (p >0.05). In comparison with a control group, the scopolamine (induction group) revealed a highly significant reduction (p ≤0.001) in the recognition index. In contrast to the induction group, all three donepezil, ranolazine, and combination (donepezil + ranolazine) groups demonstrated a highly statistically significant improvement in the recognition index. When compared with the control group, there were no statistically significant changes (p >0.05). Conclusion. The current investigation demonstrated ranolazine's neuroprotective action against scopolamine-induced AD-like characteristics in mouse models. The present work has demonstrated the considerable antioxidant and anti-inflammatory benefits of ranolazine, which may account for these positive results.

Objectives. Alzheimer's disease is the most prevalent neurodegenerative disease and accounts for approximately 70% of all dementia cases worldwide. Levosimendan is a positive inotropic agent with well-documented pleiotropic properties, including anti-inflammatory and antioxidant effects. The current research evaluated the possible effect of levosimendan alone or in combination with donepezil against scopolamine-induced mice models of Alzheimer’s disease. Material and methods. Mice were divided into five groups: the control group, the induction group (scopolamine 1 mg/ kg/i.p once daily for 7 days), other groups that received the tested drugs prophylactically for 2 weeks and then induced with scopolamine together with the same doses of the tested drug for one week. These treatment groups included the levosimendan group (200 μg/ kg i.p. once weekly for 3 weeks), the donepezil group (5 mg/kg i.p once daily for 3 weeks), and the fifth group received a combination of levosimendan (200 μg/ kg i.p. once weekly) and donepezil (5mg/kg i.p once daily). Cognitive performance was assessed by conducting behavioral tests (a novel objective recognition test and Y Maze test), and the levels of biological markers of oxidative stress (SOD and MDA), inflammatory cytokines (TNFα, IL1β and IL-6) and AChE in the brain tissue homogenate were measured utilizing available ELISA kits. Results. Levosimendan preserved the spatial memory and recognition function and significantly reduced: ACHE level, IL6, IL-1β, TNF-α, and MDA levels, and significantly increased SOD level in mice brain tissue homogenate as compared to the induction group. And the combination of levosimendan with donepezil resulted in non-significant improvement as compared to each drug alone specifically in ACHE level reduction and oxidative stress markers. Conclusions. The current study showed that levosimendan produced a neuroprotective effect against the scopolamineinduced mice models of AD. This effect may be in part attributed to the antioxidant and anti-inflammatory properties of levosimendan.

Background: Dysglycaemia and diabetes mellitus (DM) are important and preventable risk factors associated with kidney diseases, cardiovascular complications, and mortality worldwide. Aim: This study aimed to identify the prevalence and factors associated with dysglycaemia and diabetes among adults in high-burden kidney disease areas of Jigawa State, Northwest Nigeria. Methods: A cross-sectional survey of representative sample of 361 adults, aged ≥18 years, was conducted in four local government areas (LGAs) of Jigawa State, considered to have a high burden of kidney disease requiring hemodialysis. Data were collected using a modified World Health Organization STEPS questionnaire using a multistage sampling technique and were analyzed using IBM SPSS Statistics for Windows, version 22.0, with statistical significance set at P ≤ 0.05. Results: The minimum age of the respondents was 18 and the maximum was 102 with a median of 45 (interquartile range = 30–80) years. The majority of the respondents 89.5% were >24 years of age. The prevalence of dysglycemia and DM in the high-burden LGAs was 10.5% and 3.6%, respectively. Dutse LGA had the highest prevalence of dysglycemia 16.7%, followed by Hadejia LGA with a prevalence of 12.2%. On the other hand, Hadejia LGA had the highest prevalence of DM 7.7%, followed by Jahun LGA with a prevalence of 3.3%. Age ≥40 years, family histories of diabetes, being overweight, alcohol ingestion, and previous blood sugar tests were identified as factors associated with DM. The odds of developing diabetes were significantly higher among those with a reported history of alcohol consumption, family history of diabetes, and overweight. Conclusion: Dysglycaemia and diabetes are significant public health problems, and many people who have the conditions are unaware they have them. Family history of diabetes, alcohol ingestion, and overweight are important risk factors. The government and all the relevant stakeholders should prioritize community screening and other relevant interventions for early detection and timely management of cases.

Abstract Tuberculosis (TB), caused by Mycobacterium tuberculosis, ranks among the top causes of global human mortality, as reported by the World Health Organization’s 2022 TB report. The prevalence of M. tuberculosis strains that are multiple and extensive-drug resistant represents a significant barrier to TB eradication. Fortunately, having many completely sequenced M. tuberculosis genomes available has made it possible to investigate the species pangenome, conduct a pan-phylogenetic investigation, and find potential new drug targets. The 442 complete genome dataset was used to estimate the pangenome of M. tuberculosis. This study involved phylogenomic classification and in-depth analyses. Sequential filters were applied to the conserved core genome containing 2754 proteins. These filters assessed non-human homology, virulence, essentiality, physiochemical properties, and pathway analysis. Through these intensive filtering approaches, promising broad-spectrum therapeutic targets were identified. These targets were docked with FDA-approved compounds readily available on the ZINC database. Selected highly ranked ligands with inhibitory potential include dihydroergotamine and abiraterone acetate. The effectiveness of the ligands has been supported by molecular dynamics simulation of the ligand–protein complexes, instilling optimism that the identified lead compounds may serve as a robust basis for the development of safe and efficient drugs for TB treatment, subject to further lead optimization and subsequent experimental validation.

Background & Aims: The collimator angle significantly impacts radiation leakage between the multi-leaf collimator (MLCs) leaves. This study aims to examine dose-volume evaluation in planning target volume (PTV) and organs at risk (OARs) for Head & Neck patients undergoing volumetric-modulated arc therapy (VMAT) with 2.5 arcs and varying collimator angles. Materials & Methods: In this experimental study, five patients with nasopharyngeal cancer were selected for treatment with the VMAT method. CT images were prepared using a CT simulator and transferred to the treatment planning system. For optimizing VMAT plans, volume and dose constraints were applied to OARs and PTVs by the algorithm. Then, the doses were calculated using the AAA algorithm. Results: Although no significant differences were observed in DVH curves across different collimator angles, other parameters exhibited variations. Notably, in Head & Neck cancer patients, optimal values for dose conformity, homogeneity, MUs, and gradient index were found at collimator angles of 20° and 30°. Additionally, OAR sparing was favorable at these angles. Based on target coverage, homogeneity, and MUs, the collimator angles were optimized for VMAT planning. Conclusion: Our findings offer valuable guidance to clinical medical physicists in making informed decisions regarding collimator angles. The dosimetric analysis underscores the importance of selecting the optimal collimator angle for accurate PTV coverage.

Abstract Objective Pregnancy is a complex phenomenon accompanied by biological, physiological and psychosocial changes for a mother. It is also regarded as a stressful life event where a woman’s role, identity and interpersonal relationships are restructured. The present study from Pakistan explores the association of sleep quality and poor sleeping habits with prenatal stress using Pittsburgh Sleep quality Index. Results There were a total of 516 women (mean age = 29.82 years), with more than half reporting poor sleep quality. Ethnically, a majority (395, 76.6%) were natives of the Punjab province while rest were non-natives. A high percentage of respondents reported poor subjective sleep quality (22.1%), sleep latency (44.1%), habitual sleep efficiency (27.5%), sleep disturbance (30.1%), use of medications (7.1%) and daytime dysfunction (29.5%). According to logistic regression analysis, respondents with poor sleep quality were 2.24 (95% CI = 1.55–3.22, P

Background: In modern healthcare, decision-making processes are becoming increasingly data-driven, aiming to optimize patient care and resource allocation. Coronary artery bypass grafting (CABG) is a critical procedure for high-risk patients, and the use of intra-aortic balloon pump (IABP) assistance can significantly impact patient outcomes. Objective: To identify preoperative factors that predict the need for IABP assistance in high-risk CABG patients and to develop a predictive model that can enhance clinical decision-making. Subjects and Methods: The study involved fifty high-risk coronary artery bypass graft patients, with 24 cases necessitating intra-aortic balloon pump assistance and the rest not requiring it. Seven preoperative variables, including age, weight, ejection fraction, number of grafts, creatinine level, diabetic status, and blood pressure, were considered as potential predictors. SPSS was adopted to conduct a multi-variable regression analysis and derive the mathematical equations for the predictive model. A graphical user interface (GUI) was developed to utilize these equations for predicting the need for IABP support. Results: The findings revealed a strong correlation among several preoperative factors and the likelihood of requiring IABP assistance. By employing the predictions from the model to guide preoperative intra-aortic balloon insertion, the potential for optimizing hemodynamic support during surgery was maximized. Conclusions: This research emphasizes the importance of enhancing risk assessment techniques to empower medical specialists to tailor treatment plans to each patient's specific needs. Early identification of individuals at risk of requiring IABP can significantly enhance surgical outcomes and patient safety. Incorporating the predictive model into clinical practice allows for more individualized and effective care during high-risk CABG surgeries. This modern strategy has the potential to revolutionize cardiac outcomes, improve patient results, and extend the use of intra-aortic balloon support.

Abstract The relationship between ammonia and liver-related complications (LRCs) in acute-on-chronic liver failure (ACLF) patients is not clearly established. This study aimed to evaluate the association between ammonia levels and LRCs in patients with ACLF. The study also evaluated the ability of ammonia in predicting mortality and progression of LRCs. The study prospectively recruited ACLF patients based on the APASL definition from the ACLF Research Consortium (AARC) from 2009 to 2019. LRCs were a composite endpoint of bacterial infection, overt hepatic encephalopathy (HE), and ascites. A total of 3871 cases were screened. Of these, 701 ACLF patients were enrolled. Patients with LRCs had significantly higher ammonia levels than those without. Ammonia was significantly higher in patients with overt HE and ascites, but not in those with bacterial infection. Multivariate analysis found that ammonia was associated with LRCs. Additionally, baseline arterial ammonia was an independent predictor of 30-day mortality, but it was not associated with the development of new LRCs within 30 days. In summary, baseline arterial ammonia levels are associated with 30-day mortality and LRCs, mainly overt HE and ascites in ACLF patients.

Abstract The current study involves a synthesis of a composite of nickel oxide nanoparticles (NiONPs) with a chromium dopant to yield (Cr/NiONPs). Synthesis of nickel oxide was performed by the co-precipitation method. The synthesis of the composite was conducted by the impregnation method. FTIR, EDX, SEM, and XRD were used to characterize the synthesized materials. The synthesised materials’ point zero charges (PZC) were performed using the potentiometric titration method. The obtained results show that the PZC for neat nickel oxide was around 5, and it was around 8 for Cr/NiONPs. The adsorption action of the prepared materials was examined by applying them to remove Reactive Red 2 (RR2) and Crystal Violate (CV) dyes from solutions. The outcomes demonstrated that Cr/NiONPs were stronger in the removal of dyes than NiONPs. Cr/NiONPs achieved 99.9% removal of dyes after 1 h. Adsorption isotherms involving Freundlich and Langmuir adsorption isotherms were also conducted, and the outcomes indicated that the most accurate representation of the adsorption data was offered by Langmuir adsorption isotherms. Additionally, it was discovered that the adsorption characteristics of the NiONPs and Cr/NiONPs correspond well with the pseudo-second-order kinetic model. Each of the NiONPs and Cr/NiONPs was reused five times, and the results display that the effectiveness of the removal of RR2 dye slightly declined with the increase in reuse cycles; it lost only 5% of its original efficiency after the 5 cycles. Generally, Cr/NiONPs showed better reusability than NiONPs under the same conditions.

Abstract Patients receiving Medicaid often experience social risk factors for poor health and limited access to primary care, leading to high utilization of emergency departments and hospitals (acute care) for non-emergent conditions. As programs proactively outreach Medicaid patients to offer primary care, they rely on risk models historically limited by poor-quality data. Following initiatives to improve data quality and collect data on social risk, we tested alternative widely-debated strategies to improve Medicaid risk models. Among a sample of 10 million patients receiving Medicaid from 26 states and Washington DC, the best-performing model tripled the probability of prospectively identifying at-risk patients versus a standard model (sensitivity 11.3% [95% CI 10.5, 12.1%] vs 3.4% [95% CI 3.0, 4.0%]), without increasing “false positives” that reduce efficiency of outreach (specificity 99.8% [95% CI 99.6, 99.9%] vs 99.5% [95% CI 99.4, 99.7%]), and with a ~ tenfold improved coefficient of determination when predicting costs (R2: 0.195–0.412 among population subgroups vs 0.022–0.050). Our best-performing model also reversed the lower sensitivity of risk prediction for Black versus White patients, a bias present in the standard cost-based model. Our results demonstrate a modeling approach to substantially improve risk prediction performance and equity for patients receiving Medicaid.

Objective: To determine the frequency of conversion of laparoscopic cholecystectomy to open cholecystectomy using proposed intra-operative scoring system and to check the validity of the scoring system. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted in the Department of Surgery, Federal Government. Polyclinic Hospital (FGPC) Islamabad from 1 February 2019 to 31 July, 2019. Materials and Methods: This study enrolled 197 patients of either gender with age ranging between 20-60 years planned for laparoscopic cholecystectomy (LC). All the recruits were assessed intraoperatively using proposed objective intraoperative scoring-system for difficult LC. The conversion rate of LC to open cholecystectomy was recorded in correlation with demographic data and co-morbidities. Data was entered and analyzed using SPSS version 25.0. Results: Out of 197 enrolled patients, 64% were females. The mean age of study population was 42.7 ± 12.1 years. Forty six percent (46%) patients had co-morbidities with fifty-nine (n=59) being diagnosed as hypertensive and thirty-two (n=32) as diabetic. A total of 8.1% (n=16/197) patients underwent conversion to open cholecystectomy. The overall mean objective intra-operative score was 3.6 ± 1.73; which was significantly higher in patients who underwent conversion to open cholecystectomy compared to those who did not undergo conversion (7.19 ± 0.83 vs 3.28 ± 1.39; p-value = 0.001). Conversion rate was significantly more in the patients who were above 40 years, hypertensive, and diabetic. (p

Background/Objectives: Inflammation and analgesia are two prominent symptoms and often lead to chronic medical conditions. To control inflammation and analgesia, many marketed drugs are in practice but the majority of them have severe side effects. Methods: This study involved the synthesis of a pivalate-based Michael product and evaluated it for in vitro COX-1, COX-2, and 5-LOX inhibitory potentials using specific assays. Molecular docking studies were also assessed. Based on the in vitro results, the compound was also subjected to in vivo anti-inflammatory and antinociceptive studies. Results: The pivalate-based Michael product (MAK01) was synthesized by an organocatalytic asymmetric Michael addition of ethyl isobutyrate to N-phenylmaleimide with an isolated yield of 96%. The structure of the compound was confirmed through 1H and 13C NMR analyses. The observed IC50 values for COX-1, COX-2, and 5-LOX were 314, 130, and 105 μg/mL, respectively. The molecular docking studies on the synthesized compound showed binding interactions with the minimized pockets of the respective enzymes. In a carrageenan model, a percent reduction in edema when administered at 10 mg/kg (a reduction of 33.3 ± 0.77% at the second hour), 20 mg/kg (a reduction of 34.7 ± 0.74% at the second hour), and 30 mg/kg (a reduction of 40.58% ± 0.84% after the fifth hour) was observed. The compound showed a significant response at concentrations of 50, 100, and 150 mg/kg with latency times of 10.32 ± 0.82, 12.16 ± 0.51, and 12.93 ± 0.45 s, respectively. Conclusion: In this study, we synthesized a pivalate-based Michael product for the first time. Moreover, based on its rationality and potency, it was found to be an effective future medicine for the management of analgesia and inflammation.

This case report discusses the diagnostic challenge of congenital lobar emphysema (CLE) in a three-month old infant with severe respiratory distress. The infant was initially misdiagnosed and managed as a case of pneumothorax. This case highlights the importance of CT scans as a diagnostic tool for early diagnosis and lifesaving management of CLE. It also signifies the need for adequate funds and infrastructure in the health care system especially in rural areas of developing countries like Pakistan. Keywords: Congenital lobar emphysema, respiratory distress, CT scan.

Key Clinical Message Button battery ingestion has been a common condition encountered by otorhinolaryngologists. Impaction in the esophagus can lead to serious and fatal complications such as tracheoesophageal fistula. Management involves a multidisciplinary team and varies from supportive therapy to surgical intervention. Abstract Ingestion of button batteries has been seen with increasing frequency over the past decade. In several small numbers of reported cases, their impaction in the esophagus has led to severe, sometimes fatal, complications. The management of these cases has varied from expectant, supportive therapy to early surgical intervention. We report a case of button battery ingestion that was diagnosed late and resulted in a complication of tracheoesophageal fistula with migration to the thorax which was managed by open surgery.

Objective: To determine the severity and outcome of acute hepatitis in dengue patients. Study Design: Comparative cross-sectional study. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2022 to Oct 2023. Methodology: The study included 215 confirmed cases of dengue infection. Data included demographic details day of illness, clinical findings, laboratory parameters, duration of hospital stay, and mortality at the 20th day. Patients experiencing dengue complications such as bleeding and shock were monitored. We divided patients into two groups based on ALT levels: mild to moderate hepatitis with ALT levels up to 299 IU/L and severe hepatitis with ALT levels greater than 300 IU/. Results: A total of 215 patients with dengue fever were included in this study, out of which 184(83% were male) and 31(14% were female). Out of the total sample size, 181(86%) of patients had dengue fever, 75(33%) had dengue hemorrhagic fever, and 13(6%) had dengue shock syndrome. The study showed statistically significant differences in terms of bleeding in patients with mild/moderate hepatitis (median=109.50) and severe hepatitis (median=55.92), Z=2.52, p=0.012, r=0.174. Conclusion: This study concluded that severe hepatitis in dengue patients was associated with higher rates of dengue hemorrhagic fever and dengue shock syndrome. Severe hepatitis was also associated with decreased levels of platelets and higher rates of dengue complications like ascites and pleural effusion. It was also associated with a longer hospital stay.

Objective: To determine the diagnostic accuracy of Doppler assessment of hepatic venous waveforms for predicting large esophageal varices in patients with cirrhosis, keeping esophagogastroduodenoscopy as a gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology & Imaging, Rawalpindi Pakistan, from Jan 2021 to Jan 2022. Methodology: According to the Child-Pugh classification, 157 cases of liver cirrhosis were included in this study. With a convex probe operating at 3.5 to 5 MHz, a Doppler ultrasound was executed. If quiet breathing wasn't an option, the spectral waveform was captured at the end of the inhalation phase while holding your breath. This was roughly 3–6 cm from where it connects to the inferior vena cava. All patients underwent an esophagogastroduodenoscopy. Results: In Doppler USG-positive patients, 84 (true positive) developed significant esophageal varices on endoscopy, while 4 (false positive) did not. Among 69 individuals with negative Doppler USG results, six (false negative) had significant esophageal varices on endoscopy, whereas 63 (true negative) did not (p=0.0001). We found that the overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of Doppler evaluation of hepatic venous waveforms were 93.33%, 94.0%, 95.45%, 91.30%, and 93.6% for finding large esophageal varices in cirrhotic patients using esophagogastroduodenoscopy as the gold standard. Conclusion: This study proved that using Doppler to look at hepatic vein waveforms is a very sensitive and accurate noninvasive way to tell if someone with cirrhosis will get big esophageal varices.

Introduction While research into adolescent mental health has developed a considerable understanding of environmental and psychosocial risk factors, equivalent biological evidence is lacking and is not representative of economic, social and ethnic diversity in the adolescent population. It is important to understand the possible barriers and facilitators to conduct this research. This will then allow us to improve our understanding of how biology interacts with environmental and psychosocial risk factors during adolescence. The objective of this scoping review is to identify and understand the needs, barriers and facilitators related to the collection of biological data in adolescent mental health research.Methods and analysis Reviewers will conduct a systematic search of PubMed, Medline, Scopus, Cochrane, ERIC, EMBASE, ProQuest, EBSCO Global Health electronic databases, relevant publications and reference lists to identify studies published in the English language at any time. This scoping review will identify published studies exploring mental health/psychopathology outcomes, with biological measures, in participants between the ages of 11 and 18 and examine the reported methodology used for data collection. Data will be summarised in tabular form with narrative synthesis and will use the methodology of Levac et al, supplemented by subsequent recommendations from the Joanna Briggs Institute Scoping Review Methodology.Ethics and dissemination Ethical approval is not required for this scoping review. The scoping review will be conducted with input from patient and public involvement, specifically including young people involved in our study (‘Co-producing a framework of guiding principles for Engaging representative and diverse cohorts of young peopLE in Biological ReseArch in menTal hEalth’—www.celebrateproject.co.uk) Youth Expert Working Group. Dissemination will include publication in peer-reviewed journals, academic presentations and on the project website.

Purpose To evaluate the Visual Outcome in Diabetic Retinopathy with Macular Oedema after Combined Therapy with Intravitreal Avastin (Bevacizumab) and Retinal Photocoagulation. Material and Methods The study included a total of 142 eyes in 142 patients with diabetic macular oedema. All eyes were treated with intravitreal bevacizumab followed by laser photocoagulation .Visual outcome was measured in terms of changes in visual acuity (logMAR) at I month and 3 months after treatment and central macular thickness using spectral domain Ocular Coherence Tomography (OCT) at 3 months after treatment. Results Visual acuity improved from the mean best corrected visual a cuity (BCVA) log (MAR) of 0.9678 ± 0.2306 at baseline to 0.8928 ± 0.2516 at first visit and then 0.7831 ± 0.2866 at final visit in all 142 patients. OCT determined central macular thickness changed from a mean value of 624 ± 151 microns at first visit to 478 ± 141 microns at final visit in all studied subject. Conclusion Combined therapy with intravitreal bevacizumab and laser photocoagulation has a role in stabilizing the retinal anatomy and reducing retinal edema both in NPDR (Non proliferative diabetic retinopathy) and PDR (Proliferative diabetic retinopathy) with macular oedema. The decrease in the central macular thickness is also associated with a significant improvement in BCVA.

Objective: To determine the correlation of renal ultrasonographic parameters with serum creatinine levels in patients with chronic kidney disease. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Sep 2020 to April 2021. Methodology: One hundred thirteen patients with chronic kidney disease (Stages 1 to 4) were enrolled in a cross-sectional study. Detailed history and examination were carried out. Serum creatinine levels were carried out, and findings were noted. All patients underwent renal ultrasonography evaluation, kidney parameters were assessed, findings were noted, and statistical analysis was performed. Results: The mean age of the patients was 42.96±12.71 years, the duration of Chronic kidney disease was 30.38±14.59 months, the length of the kidneys was 7.15±1.84 cm, the volume of the kidneys was 59.4±12.7 ml, the thickness of the renal cortex was 3.78±1.41 cm, thickness of renal parenchyma was 8.33±1.71 mm and serum creatinine levels were 5.36±2.63. Renal ultrasound parameters negatively correlated {for length of kidneys r=-0.187 (p=0.047), for volume r=-0.133 (p=0.161), for cortical thickness r=-0.285 (p=0.002) and parenchymal thickness r=-0.083 (0.382)} with serum creatinine level and only cortical thickness and length of kidneys had significant correlation with it. Conclusion: Ultrasound assessment is an easy and reliable tool. Measurement of cortical thickness and length of kidneys must be routinely incorporated in the ultrasonographical assessment of patients with Chronic kidney disease.

Objective: To compare the effectiveness of Methotrexate (MTX) versus Cyclosporine (CyA) in the patients of moderate to severe atopic dermatitis (AD) Study Design: Systematic review and Meta-analysis. Methodology: After formulating our research team and PICO question rationally, a search strategy and literature search were carried out as per Cochrane guidelines. Full-text articles were retrieved after title and abstract screening per our inclusion criteria. The whole search process was documented in the form of a PRISMA flow chart. Team members made and filed data extraction sheets, and qualitative data synthesis was performed. Afterwards, a meta-analysis was carried out, involving a total of 03 randomized controlled trials. Revman was used to process the continuous and dichotomous data collected for our outcomes. RoB 2 was used to assess the risk of bias in the included studies. Grade pro-GDT was used to summarize the findings in the table. Results: Pooled results from 3 RCTs showed that CyA in a 2.5mg/kg dose is better than MTX @0.4 mg/kg/week at 12 weeks in AD. At follow-up, MTX maintains better disease control, i.e., until 24 weeks post-treatment. MTX has a better safety profile than CyA. Conclusion: MTX and CyA are both effective drugs for moderate to severe AD, but they have their pros and cons.

Abstract Background and Aims Antibiotic resistance (ABR) is a global public health emergency which has seen an uptick in low‐ to middle‐income countries in recent times due to a plethora of aggravating factors and has led to a whole host of setting‐specific pathogens registering high rates of resistance, causing outbreaks with graver mortality and morbidity. This review analyzes available literature to determine the causes and effects of ABR and recommend solutions to the problem in a Pakistani setting. Methods Sources for this narrative review were identified via electronic databases using keyword search methods. The information was retrieved using databases such as PubMed and Science Direct. Additionally, websites such as CDC and World Health Organization were used to attain pertinent information. All the sources were selected as per their relevance and appropriateness toward the purpose of this review. Results This review details the causes by dividing them into three primary strata, namely (1) under‐regulation, (2) over‐prescription and self‐medication, and (3) lack of medical stewardship. This is made much graver when the COVID‐19 pandemic and the subsequent erratic treatment response is considered, with the pandemic augmenting already high levels of consumption. These factors have led a cascade of effects including, but not limited to, a considerable increase in ABR in pathogens to first‐line drugs Conclusion ABR is a serious and growing issue which will result in undesirable personal, local, and national consequences if unchecked. Mitigation and reversal of this trend is necessary by developing existing programs and investing in novel therapies and pharmaceutical research and strengthening regulatory policies and mechanisms.

OBJECTIVE: To determine the knowledge and barriers to contact lens usage among spectacle wearers. METHODS: This cross-sectional study was conducted from November 2020 to January 2021 on the spectacle wearers visiting Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. Data were obtained from all the respondents of either gender, aged between 18 and 50 years, using a structured questionnaire after obtaining informed consent. RESULTS: Out of 362 study respondents, 184 (50.8%) were females, 248 (68.5%) hailed from urban areas, 92 (25%) were graduates. Mean age of participants was 35.94 ± 10.56 years. Majority (n=170; 47.0%) had Myopia, followed by Astigmatism (n=56; 15.5%). A majority (n=284; 78.5%) expressed satisfaction with their spectacles. Overall, 246 (68%) individuals were aware of contact lenses, and 184 (50.8%) participants were knowledgeable about the dual usage of contact lenses for both cosmetic and correction purposes. Females (63.6%) had more knowledge about contact lenses than males (53.9%). Barriers to contact lens wear reported were lack of interest (14.5%), lack of knowledge (13.5%), difficulty in insertion and removal (12.7%), and fear of side effects (9.5%). The younger adults and those from urban areas were more likely to know about contact lenses. A significant association was seen among barriers and demographics of respondents (p-value 0.012). CONCLUSION: Despite having good knowledge of contact lenses, people were not interested in using them as an alternative vision correction tool. Educating people about contact lenses and conducting experimental trials for visual performance on potential candidates may help overcome the barriers to wearing contact lenses.

OBJECTIVE: To derive an equation for accurate estimation of low-density lipoprotein cholesterol (LDL-C) in the Pakistani population. METHODS: A modified equation was derived on the dataset (n = 59,148) from the Pakistani population, comprising directly measured LDL-C (dLDL-C) and other lipids using a regression model. The equation was validated on an internal (n = 29,633) and external dataset (n = 385,434), and the results were compared with the standard equations being used in the Pakistani population: Friedewald and Teerakanchana equation. The concordance between the dLDL-C and calculated LDL-C (cLDL-C) was determined by median difference (MD) and the agreement between dLDL-C and cLDL-C was analyzed by Bland Altman graphics. RESULTS: The modified equation (M.Eq) displayed best correlation (r = 0.974) and MD of -0.07 mmol/L on the derivation dataset. Similarly, the equation provided the best correlation and least MD on the internal (r = 0.970, MD = -0.13) and external validation datasets (r = 0.953, MD = -0.02). The Bland-Altman plot for the modified equation displayed the least bias in the derivation (-0.0012 mmol/L), internal validation (-0.13 mmol/L), and external validation (-0.02 mmol/L). CONCLUSION: The modified equation can be utilized for clinical settings in Pakistan that do not facilitate direct measurements of LDL-C.

The prevalence of glomerulonephritis (GN), especially membranous GN (MGN), changes from time to time. This change may be due to genetic predisposition, environmental factors race, age, and indications for a renal biopsy. This study was conducted to evaluate the distribution and changing patterns of GN by further assessing the prevalence of MGN. A 1000, 123 biopsies were performed from January 2012 to October 2019 in Hospital Serdang and Hospital Kuala Lumpur. Electron microscopy, immunohistochemistry, and clinical presentations were used to differentiate primary and secondary MGN, from which 611 and 457 primary and secondary subjects were diagnosed with primary and secondary GN, respectively. Primary MGN accounts for 13% of all the primary GN, while lupus nephritis (LN) accounts for 44.2% of all secondary GN followed by diabetes mellitus (25.6%). The proportions of primary and secondary MGN were 64.8% and 35.2%, respectively, with a male-to-female ratio of 1:1.1 in favor of females. The renal biopsy obtained from the registry of two prominent hospitals in Malaysia provided valuable prevalence and demonstrated changes in the prevalence of GN in Malaysia. Notwithstanding, immunoglobulin A nephropathy and LN remain the most common causes of primary and secondary GN in Malaysia.

Background. Tympanoplasty type 1 is a reconstruction of tympanic membrane perforation with an examination of the middle ear to ensure normality. Aim. Assess the effect of the age of the patient, site, and size of tympanic membrane perforation on hearing gain and graft uptake in patients with chronic otitis media. Patients and method. Thirty patients with type 1 tympanoplasty aged between 10 years and 50 years. Patients had been submitted for audiological tests and examination pre-operatively and at 1, 3 and 6-month intervals postoperatively. Results. Improvement was 57% in 10-25 years, 59% in 25-40 years, and 56% in 40-50 years. While graft uptake was 90% in the three groups. Hearing improvement in anterior perforation was (60%), ost. perforation (41.5%), inferior perforation (43%). While the take rate is 100% in the post, perforation, 80% in anterior perforation and 83.3% in inferior perforation, hearing gain was 40% in large perforation, 66% in medium size and 77% in small size. While the take rate in small perforation was 100%, in medium perforation 90% and large perforation 80%. About 70% of patients had closure of the air-bone gap to within 15 dB and 83 % to within 20 dB. Conclusion. Age had no impact on hearing gain and graft uptake. Size of perforation affects hearing gain and graft uptake where they are better in small and medium size perforation than large perforation. The site of perforation affects hearing gain and graft uptake where hearing gain was better in anterior perforation, while graft up was better in posterior perforation.

Abstract Cryptosporidium is one of the most important protozoan parasitic pathogens, and it is a common cause of diarrhoea in humans, domestic animals, and wild vertebrates and has serious public health threats. A cross-sectional study was designed to determine the prevalence of Cryptosporidium oocysts in raw-eaten vegetables in Maiduguri Metropolitan Council (MMC) and Jere Local Government Areas (LGAs). A total of 400 samples were collected from four (4) different locations, namely Tashan Bama, Gomboru, and Monday Markets (n = 100), while fifty (n = 50) each from 202-Vegetable-Vendors and Unimaid Commercials. A total of 16 visits were conducted in all the sampling areas (twenty-five samples per visit). The Cryptosporidium oocysts were detected using the Modified Ziehl–Neelsen Staining Technique. The locations, sources, and types of raw-eaten vegetables were also assessed. The oocysts were confirmed (100×) as bright pink spherules. Data generated were analyzed using IBM-SPSS V23.0, and p ≤ 0.05 was considered significant. Out of the total samples (n = 400) analyzed, cabbage appeared to have the highest number of 10 (12.5%) of Cryptosporidium oocysts detected, while Tomato and garden egg had 9 (11.3%) and 1 (1.2%), respectively. There was a statistically significant association (χ2 = 12.5, P = 0.014) between the presence of Cryptosporidium oocysts in raw-eaten vegetables and vegetable types. Among the sources of the vegetables sampled, Alau had the highest number of Cryptosporidium oocysts, 15 (12.5%), followed by Kilari-Abdullahi and Zabarmari sources with 4 (10.0%) and 4 (5.0%), respectively. However, Jetete appeared to have the least number 2 (2.5%) of oocysts, and there was a statistically significant association (χ2= 10.4, P = 0.034) between the presence of Cryptosporidium oocysts and the sources of vegetables and fruits. The study concludes that the raw-eaten vegetables sampled from Maiduguri Metropolis were contaminated with Cryptosporidium oocysts. The study recommends that all raw-eaten vegetables should be from cleaned sources and washed before consumption. Consumers should be enlightened on the hygienic measures in the food chain in line with the Hazard Analysis and Critical Control Points (HACCP) principles.

Background and objective: Chronic lymphocytic leukemia (CLL) is a clonal, mature B-cell neoplasm, its clinical features, cell morphology, and immunophenotyping are used to establish the diagnosis. Immunophenotyping by flow cytometry is the most accurate procedure for diagnosing CLL, there is no single marker exclusively expressed in CLL, however, a complex of immunophenotypic markers that incorporates several B-cell markers and assists in differentiating CLL from other mature B-cell neoplasms, the expression of these immunophenotypic markers is considered in the specific CLL scoring system (Moreue scoring system).this study aimed to assess the clinico – hematological features and immunophenotypic characteristics of CLL patients and to assess the role of immunophenotyping in the differential diagnosis of CLL. Methods: an observational prospective and retrospective study was carried out at Nanakaly hospital for blood diseases and oncology in Erbil city, Iraq. That was conducted on 100 patients newly diagnosed with mature B cell neoplasm which included 68 cases of CLL and 32 cases with other mature B cell neoplasm (MBN), usinga convenience sampling method. The study period was from the1st of September 2021 to the end of April 2022. An interview questionnaire was used to collect the study data from the patients. Results: The mean of age ± standard deviation of the CLL patients (58.85 ± 10.69) years and (66.2%) was male, The most frequent clinical presentations for CLL cases were fatigue (50%), lymphadenopathy (41.2%), and splenomegaly (41.2%), (50%) of CLL patients had anemia, thrombocytopenia was seen in (32.4%) and leukocytosis was seen (98.5%), all patients had lymphocytosis and (97%) had an absolute B lymphocyte count of more than 5 x109 /L. all the studied CLL patients expressed both CD45 and CD19 markers, the expression of the immunophenotypic markers was as following: CD5 (98.5%), CD23 (97.1%) and CD200 (97.1%), Half of the patients (50%) showed expression of monoclonal lambda light chain, sIgM (4.4%), CD20 (88.2%) and CD43 (54.4%) and CD38 (26.5%). The expression of the following marker had a significant role in the differentiation between CLL and other MBN: CD5, CD23, CD79b, FMC7, sIgM, CD200, and CD43. Conclusion: Our results have shown that the clinical presentations and hematological profile of Iraqi CLL patients were not significantly different from that of previous local and global studies, the distinct immunophenotyping, as well as it has been found that immunophenotyping is a promising method for supporting the clinical and morphological characterization of CLL.

Abstract Glycolate oxidase (GLO) is an FMN-containing enzyme localized in peroxisomes and performs in various molecular and biochemical mechanisms. It is a key player in plant glycolate and glyoxylate accumulation pathways. The role of GLO in disease and stress resistance is well-documented in various plant species. Although studies have been conducted regarding the role of GLO genes from spinach on a microbial level, the direct response of GLO genes to various stresses in short-season and leafy plants like lettuce has not been published yet. The genome of Lactuca sativa cultivar ‘Salinas’ (v8) was used to identify GLO gene members in lettuce by performing various computational analysis. Dual synteny, protein–protein interactions, and targeted miRNA analyses were conducted to understand the function of GLO genes. The identified GLO genes showed further clustering into two groups i.e., glycolate oxidase (GOX) and hydroxyacid oxidase (HAOX). Genes were observed to be distributed unevenly on three chromosomes, and syntenic analysis revealed that segmental duplication was prevalent. Thus, it might be the main reason for GLO gene diversity in lettuce. Almost all LsGLO genes showed syntenic blocks in respective plant genomes under study. Protein–protein interactions of LsGLO genes revealed various functional enrichments, mainly photorespiration, and lactate oxidation, and among biological processes oxidative photosynthetic carbon pathway was highly significant. Results of in-depth analyses disclosed the interaction of GLO genes with other members of the glycolate pathway and the activity of GLO genes in various organs and developmental stages in lettuce. The extensive genome evaluation of GLO gene family in garden lettuce is believed to be a reference for cloning and studying functional analyses of GLO genes and characterizing other members of glycolate/glyoxylate biosynthesis pathway in various plant species.

Despite improvements in the design of mechanical prosthetic heart valves and regular use of anticoagulation, prosthetic heart valve thrombosis remain the most dreadful complication associated with high mortality. Surgical thrombectomy or valvereplacement is used as a conventional therapy. Medical thrombolysis, on the other hand, is a therapy choice. Present case is of a 26-year old female with Ebstein's irregularity who effectively endured tricuspid prosthetic valve thrombolysis usingintravenous Streptokinase (SK). The outcome of our patient supports that SK can be an adequate therapeutic option for thrombolysis of tricuspid Prosthetic Valve Thrombosis (PVT) in children and adolescents.

Introduction: Anderson-Hynes (AH) dismembered pyeloplasty is the standard procedure performed for the management of Pelviureteric Junction Obstruction (PUJO). Ultrasonography (USG) and diuretic renography are of great importance for the diagnosis and follow-up of PUJO. Aim: To evaluate the morphological and functional outcomes of open dismembered pyeloplasty in children with unilateral PUJO and to find the correlation between functional and morphological outcomes. Materials and Methods: A retrospective observational study was conducted, assessing the clinical charts of 200 children under 10 years of age with congenital PUJO who underwent open AH dismembered pyeloplasty in the Department of Paediatric Surgery at a teritary teaching Institute, Government medical college, Thiruvananthapuram, Kerala, India from from June 2015 to June 2020. The preoperative radiological assessment included renal USG and diuretic renography for all patients. Morphological and functional surgical outcomes were measured one year after surgery. The morphologic parameters analysed were the Anteroposterior Diameter (APD) of the pelvis and Parenchymal Thickness (PT). The functional outcome was assessed by improvements in Glomerular Filtration Rate (GFR), Split Renal Function (SRF), and drainage curve. Success was defined as improvement in function and morphology in followup USG and renogram after one year of surgery. Paired t-test was applied for statistical analysis using Statistical Package for the Social Sciences (SPSS) software version 23.0. Results: Among the total 200 patients,180 (90%) cases demonstrated improved renal function after pyeloplasty. Among the total 200 cases, males were 120 (60%) and females were 80 (40%). Morphologic outcome improved in 188 out of 200 (94%) cases. The overall outcome was good in 168 out of 200 (84%) patients. The results showed a moderate negative correlation for APD with respect to SRF (r=-0.677, p-value=0.01) and GFR (r=- 0.430, p-value=0.01), whereas a moderate positive correlation was observed between SRF and GFR (r=0.423, p-value=0.01). Conclusion: AH dismembered pyeloplasty is an effective treatment for PUJO in children, not only relieving obstruction but also improving renal function. The present study recommends considering both morphologic and functional parameters to assess the success of the surgery.

Background and objective: Worldwide immunophenotyping by flow cytometry (FCM) in acute leukemia (AL) is the golden step in the diagnosis. It’s very common for acute leukemias to aberrantly express antigens or cluster of differentiation (CD) markers which are usually expressed in other lineages of the disease hence this study aimed at determining the prevalence of aberrancy in AL and to find out the frequency of each aberrant CD marker and their association with the clinic-hematological profile of the cases. Methods: Following history and clinical examination of enrolled patients, blood and/or bone marrow aspirate was drawn for morphological examination and immunophenotyping by FCM from 86 newly diagnosed acute leukemia cases then multiple steps procedure was applied followed by interpretation of the results. Results: The prevalence of aberrant phenotype was 46.5%. The proportional frequency of aberrant phenotype in acute myeloid leukemia (AML) was 41%, in B-acute lymphoblastic leukemia (B-ALL) was 48.8% and in T-acute lymphoblastic leukemia (T-ALL) was 66.6%. The commonest aberrant CD markers in AML were CD22 and CD2, in B-ALL were CD66c and CD13 while in T-ALL were CD13 and CD33. The aberrant phenotype harbored lower white blood cell (WBC) count and blast percentage in PB, also splenomegaly was more frequent in lymphoid positive (Ly+) AML and myeloid positive (My+) T-ALL while in B-ALL, splenomegaly was more frequent in myeloid negative (My-) B-ALL. Conclusion: Aberrant phenotype prevalence in our study sample was comparable to other studies, considerable frequency of aberrant markers is present in cases of AL and some variations exist regarding the clinical and hematological profile of the aberrant group.

Objective: Black cumin (Nigella sativa L.) seeds and its crude extract or essential oils have been widely used traditionally for nutritional and medicinal applications in Asian countries. Its effects on diabetics with high fat diet consumption have not been adequately studied. This study was undertaken to study its effects on body weight, abdominal girth, lipid profile and plasma glucose levels in diabetic high fat diet fed rats. Materials and Methods : Streptozotocin induced male Wistar rats were fed high fat diet [5130 kcal] for 4 weeks after which they were given vehicle, Nigella sativa ethanolic extract (300mg/kg), Nigella sativa ethanolic extract (600 mg) or metformin (100 mg). Lipid profile, blood glucose, body weight & abdominal girth were measured. Results: Nigella sativa ethanolic extract (600 mg) caused significant reduction in blood glucose, total cholesterol, triglycerides, VLDL and non HDL cholesterol comparable to metformin. Conclusion : Nigella sativa shows anti-hyperglycemic effects and improvement in lipid profile in diabetic high fat diet fed rats which is comparable to metformin. Further studies are required to advocate its use in patients with diabetes and dyslipidemias. Keywords: Nigella sativa, diabetes mellitus, antihyperlipidemic, antihyperglycemic, high fat

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the coronavirus disease 2019 pandemic (COVID-19) has put millions of people at risk in an increasing number of countries, suggesting a serious threat to global public health. The first identification in late 2019, the strain has undergone several changes that have resulted in several genetically different variations that are cause for concern. By comprising the Delta, Gamma, Beta, and Alpha variations, each of which has shown evidence of increased virulence, transmissibility, or capacity for immune evasion as compared to ancestral strains. Their advancement over ancestral strains in transmission was discovered by genomic surveillance, highlighting the vital necessity for monitoring the evolution of SARS-CoV-2. Remdesivir and other treatments showed promising results in reducing the duration of the disease; however, the development of antivirals to prevent the emergence of new variations is still an important goal. The vaccine also provides hope, although its effectiveness against new genotypes needs to be evaluated. Pakistan is also facing the implications of COVID-19. The months-long closing of colleges and universities affected education as well. As SARS-CoV-2 continues to evolve, creating efficient antiviral therapies and guaranteeing vaccination accessibility continue to be critical concerns.

Background The COVID-19 pandemic had an enormous impact on people’s quality of life worldwide. Appropriate use of facemasks is an important checkpoint in containing the spread of infection, which was believed to provide the desired level of protection and preserve the community. Given the relative novelty of facemask use in the general population, it is imperative to prioritize the promotion of appropriate facemask utilization and identify factors that may contribute to poor adherence. Aim This study assessed the factors that determined facemask use among the public. Methods A cross-sectional questionnaire-based study was conducted among the residents of the Kingdom of Saudi Arabia between November 2020 and January 2021. The current study explored the factors such as demographic characteristics influencing the knowledge and practice of proper use of facemasks. The study included a total of 198 participants. The results were derived through binomial logistic regression analysis to determine the relationship between the demographic characteristics and responses. Results The key findings of the study which are crucial in developing targeted intervention strategies to enhance the responsible use and disposal of facemasks are gender, income and employment. A significant difference was found between male and female participants regarding a positive approach to using facemasks, such as washing their hands (P = 0.042). In addition, homemakers differed significantly from students, regarding the correct usage of facemasks (P = 0.026). The study participants were aware that hand hygiene is essential when putting on and removing facemasks. Despite wearing facemasks properly, adult participants possessed less knowledge about the hazards of reusing facemasks and appropriate disposal (OR = 0.202, 95% CI [0.032–1.298]). Conclusion The present research identified gender, income, and employment as the primary attributes that play a pivotal role in the formulation of focused intervention tactics aimed at improving the cautious use and appropriate disposal of facemasks. It is essential to implement nationwide awareness activities, such as information campaigns, to enhance knowledge. Health authorities should establish a functional infrastructure for the collection and disposal of used facemasks by the general public, starting with the dissemination of knowledge. Moreover, the results of the present study have significant implications for health preventive programs aimed at preparing for future pandemics, since they highlight the specific demographic groups that should be prioritized in the development of such policies. Furthermore, it is advisable to integrate these interventional initiatives with national health polices to promote preparedness for handling future pandemics.

Deep learning and artificial intelligence offer promising tools for improving the accuracy and efficiency of diagnosing various lung conditions using portable chest x-rays (CXRs). This study explores this potential by leveraging a large dataset containing over 6,000 CXR images from publicly available sources. These images encompass COVID-19 cases, normal cases, and patients with viral or bacterial pneumonia. The research proposes a novel approach called "Enhancing COVID Prediction with ESN-MDFS" that utilizes a combination of an Extreme Smart Network (ESN) and a Mean Dropout Feature Selection Technique (MDFS). This study aimed to enhance multi-class lung condition detection in portable chest X-rays by combining static texture features with dynamic deep learning features extracted from a pre-trained VGG-16 model. To optimize performance, preprocessing, data imbalance, and hyperparameter tuning were meticulously addressed. The proposed ESN-MDFS model achieved a peak accuracy of 96.18% with an AUC of 1.00 in a six-fold cross-validation. Our findings demonstrate the model's superior ability to differentiate between COVID-19, bacterial pneumonia, viral pneumonia, and normal conditions, promising significant advancements in diagnostic accuracy and efficiency.

This paper presents the design and analysis of a metamaterial-based compact dual-band antenna for WBAN applications. The antenna is designed and fabricated on a 0.254 mm thick semi-flexible substrate, RT/Duroid® 5880, with a relative permittivity of 2.2 and a loss tangent of 0.0009. The total dimensions of the antenna are 0.26λo×0.19λo×0.002λo, where λo corresponds to the free space wavelength at 2.45 GHz. To enhance overall performance and isolate the antenna from adverse effects of the human body, it is backed by a 2×2 artificial magnetic conductor (AMC) plane. The total volume of the AMC integrated design is 0.55λo×0.55λo×0.002λo. The paper investigates the antenna's performance both with and without AMC integration, considering on- and off-body states, as well as various bending conditions in both E and H-planes. Results indicate that the AMC-integrated antenna gives improved measured gains of 6.61 dBi and 8.02 dBi, with bandwidths of 10.12% and 7.43% at 2.45 GHz and 5.80 GHz, respectively. Furthermore, the AMC integrated antenna reduces the specific absorption rate (SAR) to (>96%) and (>93%) at 2.45 GHz and 5.80 GHz, meeting FCC requirements for low SAR at both frequencies when placed in proximity to the human body. CST Microwave Studio (MWS) and Ansys High-Frequency Structure Simulation (HFSS), both full-wave simulation tools, are utilized to evaluate the antenna's performance and to characterize the AMC unit cell. The simulated and tested results are in mutual agreement. Due to its low profile, high gain, adequate bandwidth, low SAR values, and compact size, the AMC integrated antenna is considered suitable for WBAN applications.