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Introduction: Gendered differences in career paths of medical graduates persist globally. We aim to explore the impact of domestic tethers on the career paths of physicians by studying gendered differences in domestic burdens of physicians as well as differences in perceptions around the impact of domestic work on professional advancement., Methods: A web-based survey including 38 questions was sent to all 3866 physician alumni of the top academic medical school in Lebanon. Data was collected between November 2018 and January 2019, with up to three invite reminders. Overall, 382 were included in the final analysis, 124 women (32%), 258 men (68%)., Results: The study had a response rate of 10.4%. Findings show that a greater percentage of men were married and had children (77.5% vs 62.1%, p = 0.004, 77.9% vs 51.6%, <0.001, respectively). Majority of both women and men held full-time positions (82.1% and 87.1%), having children however reduced the odds significantly [OR = 0.2, 95% CI: (0.1-0.6), p = 0.01]for women, while only older age reduced it for men (OR = 0.1,95% CI: (0.04-0.2), p<0.001]. Among full-time physicians, men and women spent similar time on professional activities (60.2hrs/wk vs 58.3hrs/wk, p = 0.32). Women spent more time on parenting and household work (23.5hrs/wk vs 10.4hrs/wk, <0.001; 8.9hrs/wk vs 6.0hrs/wk, p = 0.001, respectively). Women physicians' spouses contributed to 14.5 hours/week of total time on domestic activities whereas men physicians' spouses spent two folds more time on domestic activities (35.0 hours/week, P<0.001). Of physicians with children, a higher percentage of women than men reported that children prevented their career advancement or their participation in development opportunities (43.8% vs 15.9%, p<0.001; 50.0% vs 19.4%, p<0.001, respectively). A greater percentage of women than men scaled back their career after first child (31.3% vs 3.5%, <0.001). Of married/partnered physicians, fewer women than men reported their career took priority over their partner's when conflicts arose, (52.0% vs 86.0%, p<0.001)., Conclusion: These findings highlight the heavier impact of domestic tethers on the career paths of women physicians than men physicians. Men are more likely than women to hold full-time positions in the early advancement defining phases of their careers. Full-time women shoulder more domestic work than men and experience more professional advancement concessions. Closing persistent gender gaps in medicine requires addressing inequities in domestic burdens through strategies that include mentorship on domestic tethers, support of on-site child-care and advocacy for parental leave policies that encourage shared care-work., Competing Interests: The authors have declared that no competing interests exist.

Abstract Intratumoral heterogeneity is an important clinical challenge because low burden clones expressing specific genetic alterations drive therapeutic resistance mechanisms. We have developed CAVE (cancer-associated variant enrichment), a gene-agnostic computational tool to identify specific enrichment of low-burden cancer driver variants in next-generation sequencing (NGS) data. For this study, CAVE was applied to TP53 in chronic lymphocytic leukemia (CLL) as a cancer model. Indeed, as TP53 mutations are part of treatment decision-making algorithms and low-burden variants are frequent, there is a need to distinguish true variants from background noise. Recommendations have been published for reliable calling of low-VAF variants of TP53 in CLL and the assessment of the background noise for each platform is essential for the quality of the testing. CAVE is able to detect specific enrichment of low-burden variants starting at variant allele frequencies (VAFs) as low as 0.3%. In silico TP53 dependent and independent analyses confirmed the true driver nature of all these variants. Orthogonal validation using either ddPCR or NGS analyses of follow-up samples confirmed variant identification. CAVE can be easily deployed in any cancer-related NGS workflow to detect the enrichment of low-burden variants of clinical interest.

Abstract The present study evaluated the use of green-synthesized selenium nanoparticles (SeNPs), using the microalgae Pediastrum boryanum as a diet additive in aquaculture to improve the growth performance, health, and immune response of Nile tilapia. Nile tilapia were fed different concentrations of green SeNPs (79.26 nm) as follows: 0, 0.75, and 1.5 mg/kg of SeNPs for 8 weeks. Following the trial, growth performance, biochemical indices, antioxidant and pro-inflammatory cytokine-related genes, and tissue histological examinations were performed. The study showed that SeNPs significantly improved (P 0.05). Serum malondialdehyde and superoxide dismutase levels were not significantly changed, while reduced glutathione and catalase were significantly enhanced (P

Abstract Background Acid sphingomyelinase deficiency (ASMD) or Niemann–Pick disease types A, A/B, and B is a progressive, life-limiting, autosomal recessive disorder caused by sphingomyelin phosphodiesterase 1 (SMPD1) gene mutations. There is a need to increase the understanding of morbidity and mortality across children to adults diagnosed with ASMD. Methods This observational retrospective survey analysed medical records of patients with ASMD with retrievable data from 27 hospitals in France, diagnosed/followed up between 1st January 1990 and 31st December 2020. Eligible records were abstracted to collect demographic, medical/developmental history, and mortality data. Survival outcomes were estimated from birth until death using Kaplan–Meier survival analyses; standardised mortality ratio (SMR) was also explored. Results A total of 118 medical records of patients with ASMD (type B [n = 94], type A [n = 15], and type A/B [n = 9]) were assessed. The majority of patients were males (63.6%); the median [range] age at diagnosis was 8.0 [1.0–18.0] months (type A), 1.0 [0–3] year (type A/B), and 5.5 [0–73] years (type B). Overall, 30 patients were deceased at the study completion date; the median [range] age at death for patients with ASMD type A (n = 14) was 1 [0–3.6] year, type A/B (n = 6) was 8.5 [3.0–30.9] years, and type B (n = 10) was 57.6 [3.4–74.1] years. The median [95% confidence interval (CI)] survival age from birth in patients with ASMD type A and type A/B was 2.0 [1.8–2.7] years and 11.4 [5.5–18.5] years, respectively. Survival analysis in ASMD type B was explored using SMR [95% CI] analysis (3.5 [1.6–5.9]), which showed that age-specific deaths in the ASMD type B population were 3.5 times more frequent than those in the general French population. The causes of death were mostly severe progressive neurodegeneration (type A: 16.7%), cancer (type B: 16.7%), or unspecified (across groups: 33.3%). Conclusions This study illustrated a substantial burden of illness with high mortality rates in patients with ASMD, including adults with ASMD type B, in France.

Abstract Bulk zinc oxide (ZnO-BPs) and its nanoparticles (ZnO-NPs) are frequently used in various products for humans. Helisoma duryi embryos can serve as effective model organisms for studying the toxicity of NPs. This study aimed to compare the teratogenic potency of ZnO-BPs and ZnO NPs in the embryonic stages of H. duryi to evaluate the utility of this snail as a bioindicator for ZnO-NPs in the aquatic environment. The mechanisms of teratogenesis were evaluated by determination of the LC50, studying the effect of sub-lethal concentrations of both ZnO forms on the embryos, and studying their enzyme activity, oxidative stress, and biochemical analysis. The SDS-PAGE electrophoresis was undertaken to assess the effect of ZnO-BPs and ZnO NPs on protein synthesis. The results revealed that the veliger stage of H. duryi is the specific stage for bulk and nano ZnO. ZnO-NPs proved to be more toxic to snails’ embryos than ZnO-BPs. Exposure to ZnO influences specific types of defects in development, which in the case of BPs are far less drastic than those caused by NPs. Thus, the toxicity of ZnO-NPs in embryonic development is due to their unique physicochemical properties. The observed malformations include mainly hydropic malformation, exogastrulation, monophthalmia, shell misshapen, and cell lyses. Almost all tested oxidative biomarkers significantly changed, revealing that ZnONPs display more oxidative stress than ZnO-BPs. Also, the low concentration of ZnO induces many disturbances in the organic substances of veliger larvae, such as a decrease in the total protein and total lipid levels and an increase in the glycogen level. The results indicated that ZnO-BPs increase the number of protein bands. Conversely, ZnO-NPs concealed one band from treated egg masses, which was found in the control group. Embryos of snail are an appropriate model to control freshwater snails. This study demonstrates that H. duryi embryos can serve as effective model organisms to study the toxicity of ZnO-NPs.

Background: Birth injuries to the brachial plexus are highly rare; however, they necessitate treatment and follow-up from infancy until skeletal maturity. Many complications may arise as a result of primary nerve surgery. Objectives: To study the long-term complications of nerve repair procedures in patients with obstetric brachial plexus palsy. Patients and methods: This was retrospective research that was performed on 8 cases having obstetric brachial plexus palsy and underwent nerve surgery procedure. The ages ranged from 3 to 20 months. The assessment of the surgical procedure outcomes involves post-operative evaluation of both short and long-term complication. Results: Our study showed that the most frequent long-term complications were decreased innervation (25%), followed by decreased strength and stamina and balanced discoordination (12.50%) while there were no complications encountered in 50% of cases. The short-term complications included wound infection, seroma and hematoma. Conclusion: The nerve surgery procedure is an efficient primary approach in the management of cases with brachial plexus injury. However, a long-term follow-up is usually associated with late squeal such as reduced innervation and decrease in the overall strength and stamina.

Abstract Background Acute hepatitis A infection is common among children in developing nations. The clinical presentation in children is usually asymptomatic and anicteric, and it is a self-limiting infection. Rarely, it can be associated with extrahepatic complications such as pleural effusion, acalculous cholecystitis, and ascites. Case presentation An 8-year-old middle eastern child presented with abdominal pain, jaundice in the sclera, yellowish color of urine, and poor appetite. In the last two days, abdominal distension developed. After conducting diagnostic investigations, the child was diagnosed with HAV hepatitis associated with bilateral pleural effusion, acalculous cholecystitis, and ascites. He was managed conservatively with vitamin K supplementation and supportive parenteral fluids. After 4 days, clinical improvement was observed. Conclusion Hepatitis A infections presented with extrahepatic manifestations like pleural effusion, acalculous cholecystitis, and ascites are very rare, especially in children. There have been some reports of these manifestations occurring in isolation, but for them to co-exist to our knowledge, this has only been reported in two cases in the literature, and this is the third case with all these three rare complications being presented simultaneously in a single child. Although HAV infection is an asymptomatic and self-limiting viral disease in childhood, it can manifest with rare extrahepatic complications, so pediatricians should be aware of this rare association to avoid unnecessary investigations.

Abstract This paper presents an innovative control scheme designed to significantly enhance the power factor of AC/DC boost rectifiers by integrating an adaptive neuro-fuzzy inference system (ANFIS) with predictive current control. The innovative control strategy addresses key challenges in power quality and energy efficiency, demonstrating exceptional performance under diverse operating conditions. Through rigorous simulation, the proposed system achieves precise input current shaping, resulting in a remarkably low total harmonic distortion (THD) of 3.5%, which is well below the IEEE-519 standard threshold of 5%. Moreover, the power factor reaches an outstanding 0.990, indicating highly efficient energy utilization and near-unity power factor operation. To validate the theoretical findings, a 500 W laboratory prototype was implemented using the dSPACE ds1104 digital controller. Steady-state analysis reveals sinusoidal input currents with minimal THD and a power factor approaching unity, thereby enhancing grid stability and energy efficiency. Transient response tests further demonstrate the system’s robustness against load and voltage fluctuations, maintaining output voltage stability within an 18 V overshoot and a 20 V undershoot during load changes, and achieving rapid response times as low as 0.2 s. Comparative evaluations against conventional methods underscore the superiority of the proposed control strategy in terms of both performance and implementation simplicity. By harnessing the strengths of ANFIS-based voltage regulation and predictive current control, this scheme offers a robust solution to power quality issues in AC/DC boost rectifiers, promising substantial energy savings and improved grid stability. The results affirm the potential of the proposed system to set new benchmarks in power factor correction technology.

The Internet of Medical Things (IoMT) has revolutionized healthcare with remote patient monitoring and real-time diagnosis, but securing patient data remains a critical challenge due to sophisticated cyber threats and the sensitivity of medical information. Traditional machine learning methods struggle to capture the complex patterns in IoMT data, and conventional intrusion detection systems often fail to identify unknown attacks, leading to high false positive rates and compromised patient data security. To address these issues, we propose RCLNet, an effective Anomaly-based Intrusion Detection System (A-IDS) for IoMT. RCLNet employs a multi-faceted approach, including Random Forest (RF) for feature selection, the integration of Convolutional Neural Networks (CNN) and Long Short-Term Memory (LSTM) models to enhance pattern recognition, and a Self-Adaptive Attention Layer Mechanism (SAALM) designed specifically for the unique challenges of IoMT. Additionally, RCLNet utilizes focal loss (FL) to manage imbalanced data distributions, a common challenge in IoMT datasets. Evaluation using the WUSTL-EHMS-2020 healthcare dataset demonstrates that RCLNet outperforms recent state-of-the-art methods, achieving a remarkable accuracy of 99.78%, highlighting its potential to significantly improve the security and confidentiality of patient data in IoMT healthcare systems.

Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with an array of intestinal injuries: erosions, ulcers, enteropathy, strictures and diaphragm disease. The diagnosis of diaphragm disease is challenging. Diaphragm disease can cause thin, concentric and stenosing strictures, which can induce intermittent or complete bowel obstruction. NSAID-induced lesions are reversible following discontinuation of the offending agent. Treatment of diaphragm disease can be conservative, endoscopic or surgical through stricturoplasty and/or segmental resection. We report a case of a 59-year-old female presenting with intermittent right lower quadrant pain diagnosed with diaphragm disease upon combined ileo-colonoscopy and histopathological analysis. Her diaphragm disease was successfully treated conservatively through drug cessation, avoiding more invasive procedures like endoscopic and surgical interventions.

Introduction: Congenital adrenal hyperplasia (CAH) is an autosomal-recessive condition primarily caused by 21- hydroxylase deficiency. It is the most common cause of ambiguous genitalia in infants and children. It can be a fatal condition if left untreated. Objectives: The study's objective was to estimate the levels of 17-hydroxyprogesterone, plasma direct renin, testosterone, and electrolytes in patients with CAH. Place and Duration of Study: This cross-sectional study was conducted at the University of Child Health Sciences, Lahore between March 2021 till April 2022. Material & Methods: This study included ninety CAH patients up to 14 years of age who underwent clinical and physical testing without gender restriction. Patients without confirmed CAH but with elevated levels of 17- hydroxyprogesterone were excluded. An ultrasound examination was done to confirm the presence of ambiguous genitalia. ELISA was used to estimate the values of 17-hydroxyprogesterone. Plasma direct renin and testosterone were measured by chemiluminescence immunoassay. The values of sodium, potassium and chloride were measured using an electrolyte analyzer. Data was analyzed using IBM SPSS version 26.0. Results: Of the total 90 patients, 46 (51.11%) were boys and 44 (48.88%) were girls. 55 (61.10%) CAH patients had high levels of 17-OHP. High testosterone and plasma direct renin levels were observed in 31 (34.40%), and 43 (47.80%) CAH patients respectively. Mostly, CAH patients had normal levels of sodium 70 (77.80%), potassium 54 (60.0%), and chloride 57 (63.30%). The difference in 17-OHP (ng/mL) levels was found to be statistically significant (p=0.002) in both genders. Conclusion: There is a significant association between elevated 17-OHP and CAH in the pediatric population, indicating that the 17-OHP can be used as a diagnostic tool for CAH patients.

Abstract Reinforcement of the Internet of Medical Things (IoMT) network security has become extremely significant as these networks enable both patients and healthcare providers to communicate with each other by exchanging medical signals, data, and vital reports in a safe way. To ensure the safe transmission of sensitive information, robust and secure access mechanisms are paramount. Vulnerabilities in these networks, particularly at the access points, could expose patients to significant risks. Among the possible security measures, biometric authentication is becoming a more feasible choice, with a focus on leveraging regularly-monitored biomedical signals like Electrocardiogram (ECG) signals due to their unique characteristics. A notable challenge within all biometric authentication systems is the risk of losing original biometric traits, if hackers successfully compromise the biometric template storage space. Current research endorses replacement of the original biometrics used in access control with cancellable templates. These are produced using encryption or non-invertible transformation, which improves security by enabling the biometric templates to be changed in case an unwanted access is detected. This study presents a comprehensive framework for ECG-based recognition with cancellable templates. This framework may be used for accessing IoMT networks. An innovative methodology is introduced through non-invertible modification of ECG signals using blind signal separation and lightweight encryption. The basic idea here depends on the assumption that if the ECG signal and an auxiliary audio signal for the same person are subjected to a separation algorithm, the algorithm will yield two uncorrelated components through the minimization of a correlation cost function. Hence, the obtained outputs from the separation algorithm will be distorted versions of the ECG as well as the audio signals. The distorted versions of the ECG signals can be treated with a lightweight encryption stage and used as cancellable templates. Security enhancement is achieved through the utilization of the lightweight encryption stage based on a user-specific pattern and XOR operation, thereby reducing the processing burden associated with conventional encryption methods. The proposed framework efficacy is demonstrated through its application on the ECG-ID and MIT-BIH datasets, yielding promising results. The experimental evaluation reveals an Equal Error Rate (EER) of 0.134 on the ECG-ID dataset and 0.4 on the MIT-BIH dataset, alongside an exceptionally large Area under the Receiver Operating Characteristic curve (AROC) of 99.96% for both datasets. These results underscore the framework potential in securing IoMT networks through cancellable biometrics, offering a hybrid security model that combines the strengths of non-invertible transformations and lightweight encryption.

Abstract MicroRNAs are small RNA molecules that have a significant role in translational repression and gene silencing through binding to downstream target mRNAs. MiR-762 can stimulate the proliferation and metastasis of various types of cancer. Hippo pathway is one of the pathways that regulate tissue development and carcinogenesis. Dysregulation of this pathway plays a vital role in the progression of cancer. This study aimed to evaluate the possible correlation between miR-762, the Hippo signaling pathway, TWIST1, and SMAD3 in patients with lung cancer, as well as patients with chronic inflammatory diseases. The relative expression of miR-762, MST1, LATS2, YAP, TWIST1, and SMAD3 was determined in 50 lung cancer patients, 30 patients with chronic inflammatory diseases, and 20 healthy volunteers by real-time PCR. The levels of YAP protein and neuron-specific enolase were estimated by ELISA and electrochemiluminescence immunoassay, respectively. Compared to the control group, miR-762, YAP, TWIST1, and SMAD3 expression were significantly upregulated in lung cancer patients and chronic inflammatory patients, except SMAD3 was significantly downregulated in chronic inflammatory patients. MST1, LATS2, and YAP protein were significantly downregulated in all patients. MiR-762 has a significant negative correlation with MST1, LATS2, and YAP protein in lung cancer patients and with MST1 and LATS2 in chronic inflammatory patients. MiR-762 may be involved in the induction of malignant behaviors in lung cancer through suppression of the Hippo pathway. MiR-762, MST1, LATS2, YAP mRNA and protein, TWIST1, and SMAD3 may be effective diagnostic biomarkers in both lung cancer patients and chronic inflammatory patients. High YAP, TWIST1, SMA3 expression, and NSE level are associated with a favorable prognosis for lung cancer.

Background: Risk factors for cardiovascular disease (CVD) are more common and frequently occur among PCOS women. The objective of this study was to evaluate atherogenic index of plasma (AIP) as a predictor of CVD and its association with hyperandrogenemia among PCOS women. Methods and Results: This hospital-based study, conducted in Khartoum (Sudan) from October 2020 to September 2021, used a case-control design. The patients (n=150) were women with diagnosed PCOS, according to Rotterdam criteria. The controls were 150 infertile women who did not have PCOS. An ELISA reader (ASYS Expert Plus Microplate, Austria) was used to quantify serum insulin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and anti-Mullerian hormone (AMH) by indirect methods and total testosterone (TT) by competitive method during the follicular phase of the menstrual cycle. Serum samples of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose (FPG) were assayed on the Cobas c311 system (Roche Diagnostics GmbH, Germany). The triglyceride–glucose index (TyGI) and TyGI-BMI, as a marker for insulin resistance (IR), were calculated. The logarithmically converted ratio of the molar concentrations of TG to HDL-C was used to determine the AIP. Low CVD risk was defined as < 0.1, medium risk as 0.1‒ 0.24 and high risk as >0.24. PCOS women had a significant increase in BMI, compared to non-PCOS (P0.1. PCOS women with hyperandrogenemia showed significantly increased AIP and decreased HDL-C. Additionally, about 73% of PCOS women with hyperandrogenemia had lower HDL-C, and 29.9% had a high risk of CVD (AIP>0.24). A Spearman correlation revealed that PCOS women’s TT correlates positively with TC, TG, TyGI, and AIP and inversely correlates with HDL-C. AIP positively correlates with TT, TC, TyGI, and TyGI-BMI index. Conclusion: Our data revealed a significant occurrence of hyperandrogenemia, dyslipidemia, AIP, and obesity, all of which are considered risk factors for CVD in PCOS women.

Objective To describe presenting diagnoses and rates and causes of death by age category and sex among children with acute illness brought to a district headquarter hospital in Pakistan.Design Prospective cohort study.Setting Sanghar district headquarter hospital, Sindh, Pakistan between December 2019 and April 2020 and August 2020 and December 2020.Participants 3850 children 0–14 years presenting with acute illness to the emergency and outpatient departments and 1286 children admitted to the inpatient department.Outcome measures The primary outcome was Global Burden of Disease diagnosis category. Secondary outcomes were 28-day mortality rate, cause of death and healthcare delays, defined as delay in care-seeking, delay in reaching the healthcare facility and delay in appropriate treatment.Results Communicable diseases were the most common presenting diagnoses among outpatients and among inpatients aged 1 month to 9 years. Non-communicable diseases and nutritional disorders were more common with increasing age. Few children presented with injuries. Newborn period (age

Summary: Background: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by a progressive loss of motor neurons. The limited efficacy of recent therapies in clinical development may be linked to lack of drug penetration to the affected motor neurons due to the blood-brain barrier (BBB) and blood-spinal cord barrier (BSCB). Methods: In this work, the safety and efficacy of repeated short transient opening of the BSCB by low intensity pulsed ultrasound (US, sonication) was studied in females of an ALS mouse model (B6.Cg-Tg(SOD1∗G93A)1Gur/J). The BSCB was disrupted using a 1 MHz ultrasound transducer coupled to the spinal cord, with and without injection of insulin-like growth factor 1 (IGF1), a neurotrophic factor that has previously shown efficacy in ALS models. Findings: Results in wild-type (WT) animals demonstrated that the BSCB can be safely disrupted and IGF1 concentrations significantly enhanced after a single session of transient BSCB disruption (176 ± 32 μg/g vs. 0.16 ± 0.008 μg/g, p

Despite their overlooked status, weeds are increasingly recognized for their therapeutic value, aligning with historical reliance on plants for medicine and nutrition. This study investigates the medicinal potential of native weed species in Bangladesh, specifically pigments, antioxidants, and free radical scavenging abilities. Twenty different medicinal weed species were collected from the vicinity of Khulna Agricultural University and processed in the Crop Botany Department Laboratory. Pigment levels were determined using spectrophotometer analysis, and phenolics, flavonoids, and DPPH were quantified accordingly. Chlorophyll levels in leaves ranged from 216.70 ± 9.41 to 371.14 ± 28.67 µg g−1 FW, and in stems from 51.98 ± 3.21 to 315.89 ± 17.19 µg g−1 FW. Flavonoid content also varied widely, from 1,624.62 ± 102.03 to 410.00 ± 115.58 mg CE 100 g−1 FW in leaves, and from 653.08 ± 32.42 to 80.00 ± 18.86 mg CE 100 g−1 FW in stems. In case of phenolics content Euphorbia hirta L. displaying the highest total phenolic content in leaves (1,722.33 ± 417.89 mg GAE 100 g−1 FW) and Ruellia tuberosa L. in stems (977.70 ± 145.58 mg GAE 100 g−1 FW). The lowest DPPH 2.505 ± 1.028 mg mL−1was found in Heliotropium indicum L. leaves. Hierarchical clustering links species with pigment, phenolic/flavonoid content, and antioxidant activity. PCA, involving 20 species and seven traits, explained 70.07% variability, with significant PC1 (14.82%) and PC2 (55.25%). Leaves were shown to be superior, and high-performing plants such as E. hirta and H. indicum stood out for their chemical composition and antioxidant activity. Thus, this research emphasizes the value of efficient selection while concentrating on the therapeutic potential of native weed species.

OBJECTIVE: To identify the pathogenic alleles in primary congenital glaucoma patients for early cure of the disease METHODOLOGY: A cross-sectional descriptive study was carried out after approval from the ethical committee of SIOVS from December 2022 to November 2023 at Sindh Institute of Ophthalmology & Visual Sciences, Hyderabad. The consanguineous pedigree consisting of more than one affected was included, and the pedigree consists only one affected or secondary cause of vision loss was excluded. After getting informed consent, ten cc blood samples from all available participants in the pedigree were drawn, and DNA was extracted. The ARMS Assay and Sanger sequencing methods were adapted to analyze the CYP1B1 gen. RESULTS: In the present study, one novel c.1187C>T, p.Pro396Leu and one reported c.1169G>A, p.Arg390His allele in CYP1B1 gene were found in two isolated pedigrees enrolled from Sindh Pakistan. ARMS Assay method and the Sanger sequencing method were adopted to detect pathogenic variants. Bioinformatics tools were used to analyze the pathogenesis of identified alleles and compare phenotype-genotype correlation. CONCLUSION: The findings of novel and frequently reported mutations have a significant role in advancing genetic testing protocols, enabling more accurate targeting of diagnoses and identified alleles that may be added to existing repositories of the genetic database

Abstract Background Sample self-collection for reproductive tract infection diagnosis has been found to offer greater convenience, privacy, autonomy, and expanded access to testing in non-pregnant adults. This review aimed to determine whether sample self-collection is as accurate as provider-collection for detection of group B streptococcus colonisation in pregnancy and whether a strategy of self-collection compared to provider-collection might improve maternal and neonatal health outcomes. Methods We searched CINAHL Plus, Medline, EMBASE, Maternity and Infant Care Database, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews in June 2022. Eligible studies compared self-collected and provider-collected samples taken from the same participants or participants randomised to either self-collection or provider-collection for reproductive tract infection testing using the same test and testing method in pregnant individuals. We included trials and observational studies. Reviewers assessed risk of bias using the QUADAS-2 checklist and independently extracted data. Sensitivity and specificity for group B streptococcus colonisation of self-collected compared to provider-collected samples were pooled using a bivariate, random-effects, meta-analytic model. This review was registered with PROSPERO (CRD42023396573). Results The search identified 5909 references, of which eleven diagnostic accuracy group B streptococcus studies were included (n = 3269 participants). No studies assessed the effects of self-collection in pregnancy on health outcomes. All studies had high or unclear risk of bias. Pooled sensitivities of self-collected samples for group B streptococcus detection were 82% (95% CI: 66–91%; I 2 = 68.85%) in four trials (n = 1226) and 91% (95% CI: 83–96%; I 2 = 37.38%) in seven non-randomised studies (n = 2043). Pooled specificities were 99% (95% CI: 98–99%; I 2 = 12.08%) and 97% (95% CI: 94–99%; I 2 = 72.50%), respectively. Conclusions Self-collected samples for group B streptococcus detection in pregnancy had high specificity compared to provider-collection, but lower sensitivity, particularly for included trials. Studies investigating the effect of self-collection on health outcomes, and further higher quality trials comparing accuracy of self-collection to provider-collection, are required.

Objective To develop an automatic gout register from electronic health records (EHRs) data.Methods We analysed the EHR of all patients >18 years old from a tertiary academic hospital (2013–2022) based on six criteria: International Classification of Diseases 10 gout diagnosis, urate-lowering therapy prescription, monosodium urate crystals in joint aspiration and gout-related terms in problem lists, clinical or imaging reports. We assessed the positive and negative predictive value (PPV and NPV) of the query by chart reviews.Results Of 2 110 902 outpatients and inpatients, 10 289 had at least one criterion for gout. The combination of joint aspiration OR diagnostic in the problem list OR≥2 other criteria created a register of 5138 patients, with a PPV of 92.4% (95% CI 88.5% to 95.0%) and an NPV of 94.3% (95% CI 91.9% to 96.0%). PPV and NPV were similar among outpatients and inpatients. Incidence was 2.9 per 1000 person-year and dropped by 30% from the COVID-19 pandemic onward. Patients with gout were on average 71.2 years old (SD 14.9), mainly male (76.5%), overweight (69.5%) and polymorbid (mean number of comorbidities of 3, IQR 1–5). More than half (57.4%) had received a urate-lowering treatment, 6.7% had a gout that led to a hospitalisation or ≥2 flares within a year and 32.9% received a rheumatology consultation.Conclusion An automatic EHR-based gout register is feasible, valid and could be used to evaluate and improve gout management. Interestingly, the register uncovered a marked underdiagnosis or under-reporting of gout since the COVID-19 pandemic.

BackgroundIn Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics. ObjectiveThe study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention. MethodsThe Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite). ResultsThe study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation. ConclusionsThis study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care. Trial RegistrationClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759 International Registered Report Identifier (IRRID)RR1-10.2196/47525

Abstract It has been previously shown that clinical cardiovascular manifestations can be caused by mild changes in thyroid function. However, the implication of angiotensinogen (Agt) and vascular smooth muscle cells (VSMCs) dysfunction in the pathophysiology of cardiovascular manifestations in hypothyroidism have not yet been investigated. We induced experimental hypothyroidism in Psammomys obesus by administering carbimazole for five months. At the end of the experiment, the animals were sacrificed and histopathological analysis was performed using Masson's trichrome staining of the aorta and thyroid gland. The expression of the Agt gene and the genes implicated in cholesterol metabolism regulation in the liver and VSMCs was determined by qRT-PCR. Histological observations revealed profound remodeling of the aorta structure in animals with hypothyroidism. In addition, Agt gene expression in the liver was significantly increased. In vitro study, showed that VSMCs from hypothyroid animals overexpressed 3-hydroxy-3-methylglutaryl coenzyme A reductase (Hmgcr) and Acyl CoA:cholesterol acyltransferase (Acat) 1, with failure to increase the efflux pathway genes (ATP-binding cassette subfamily G member (Abcg) 1 and 4). These results suggest that hypothyroidism leads to vascular alterations, including structural remodeling, VSMCs cholesterol metabolism dysfunction, and their switch to a synthetic phenotype, together with hepatic Agt gene overexpression.

Abstract Recent research has shed light on the culpability of LA (left atrial) abnormality, in the form of atrial cardiopathy, as an independent risk factor for the development of atrial fibrillation, LA thrombus and subsequent stroke. The aim of this study was to measure LA electromechanical dissociation (EMD), LA volumes, P-wave dispersion (PWD) and P-wave terminal force in V1 (PTFV1) as markers of atrial cardiopathy in patients with ESUS (embolic stroke of undetermined source), to determine whether atrial cardiopathy is an integral part in the causal pathway of ESUS. 28 patients presenting with ischemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study along with a control group of 28 age- and gender-matched apparently healthy individuals. On ECG, PWD and PTFV1 were measured. On echocardiography, LA EMD and LA volumes were recorded. Increased PWD (34.14 ± 9.89 ms vs. 27.32 ± 8.95 ms; p = 0.01), atrial EMD (73.32 ± 16.31 ms vs. 63.63 ± 13.59 ms; p = 0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p

Abstract Integrating nanoparticles in waste oil-derived biodiesel can revolutionize its performance in internal combustion engines, making it a promising fuel for the future. Nanoparticles act as combustion catalysts, enhancing combustion efficiency, reducing emissions, and improving fuel economy. This study employed a comprehensive approach, incorporating both quantitative and qualitative analyses, to investigate the influence of selected input parameters on the performance and exhaust characteristics of biodiesel engines. The focus of this study is on the potential of using oils extracted from food waste that ended up in landfills. The study's results are analysed and compared with models created using intelligent hybrid prediction approaches including adaptive neuro-fuzzy inference system, Response surface methodology-Genetic algorithm, and Non sorting genetic algorithm. The analysis takes into account engine load, blend percentage, nano-additive concentration, and injection pressure, and the desired responses are the thermal efficiency and specific energy consumption of the brakes, as well as the concentrations of carbon monoxide, unburned hydrocarbon, and oxides of nitrogen. Root-mean-square error and the coefficient of determination were used to assess the predictive power of the model. Comparatively to Artificial Intelligence and the Response Surface Methodology-Genetic Algorithm model, the results provided by NSGA-II are superior. This is because it achieved a pareto optimum front of 24.45 kW, 2.76, 159.54 ppm, 4.68 ppm, and 0.020243% for Brake Thermal Efficiency, Brake Specific Energy Consumption, Oxides of nitrogen, Unburnt Hydro Carbon, and Carbon monoxide. Combining the precision of ANFIS's prediction with the efficiency of NSGA-optimization II's gives a reliable and thorough evaluation of the engine's settings. The qualitative assessment considered practical aspects and engineering constraints, ensuring the feasibility of applying the parameters in real-world engine applications.

Abstract Access to dependable and environmentally friendly energy sources is critical to a country's economic growth and long-term development. As countries seek greener energy alternatives, the interaction of environmental elements, temperature, and sunlight becomes more critical in utilizing renewable energy sources such as wind and bioenergy. Solar power has received much attention due to extraordinary efficiency advances. under this context, the present work focus on solar radiation and chemical processes in the presence of modified ternary hybrid nanofluids (THNFs) circulating over an exponentially stretched surface in both aiding flow (A-F) and opposing flow (O-F) circumstances. The primary objective of this investigation is to dive into the complicated dynamics of these structures, which are distinguished by complex interactions involving radiation, chemical reactions, and the movement of fluids. We construct reduced ordinary differential equations from the governing equations using suitable similarity transformations, which allows for a more in-depth examination of the liquid's behavior. Numerical simulations using the Runge–Kutta Fehlberg (RKF) approach and shooting techniques are used to understand the underlying difficulties of these reduced equations. The results show that thermal radiation improves heat transmission substantially under O-F circumstances in contrast to A-F conditions. Furthermore, the reaction rate parameter has an exciting connection with concentration levels, with greater rates corresponding to lower concentrations. Furthermore, compared to the O-F scenario, the A-F scenario promotes higher heat transfer in the context of a modified nanofluid. Rising reaction rate and solid fraction volume enhanced mass transfer rate. The rate of thermal distribution in THNFs improves from 0.13 to 20.4% in A-F and 0.16 to 15.06% in O-F case when compared to HNFs. This study has real-world implications in several fields, including developing more efficient solar water heaters, solar thermal generating plants, and energy-saving air conditioners.

Suicide accounts for 33% of deaths of women during the postnatal period in many low- and middle-income countries (LMICs). Resilience refers to an ability to adapt and recover from adversity or misfortune. Resilience building against mental health challenges during pregnancy and the postnatal period is critical for women to raise their child efficiently and maintain a healthy life. The exploration of maternal resilience against mental health challenges including its developmental processes and the determinants of its successful or unsuccessful cultivation among mothers during pregnancy and childbirth is of paramount importance. Understanding why a subset of mothers effectively develops resilience while others significantly struggle is critical for devising targeted interventions and support mechanisms aimed at improving maternal well-being. This inquiry not only seeks to delineate the factors that contribute to or hinder the development of resilience but also aims to inform the creation of comprehensive support systems that can bolster maternal health outcomes. This paper endeavors to present a comprehensive analysis of maternal resilience, aiming to cultivate a nuanced and profound understanding of the concept within the framework of previous traumatic events and adverse pregnancy outcomes in LMICs. The eight-step method approach proposed by Walker and Avant was utilized for this concept analysis. Several defining attributes were identified in the analysis including social adaptation, support system, optimistic approach, and mindfulness. This analysis contributes to knowledge advancement regarding maternal resilience and provides nurses and other healthcare professionals with a clear understanding of the concept of maternal resilience to help promote resilience among mothers.

This study aimed to identify the impact of nutrition education on various health-related components of hemodialysis patients. A systematic review was conducted according to the PRISMA guidelines. Relevant literature published between 2013 and 2023 was identified across two databases (PubMed and Science Direct). The protocol was registered in PROSPERO (CRD42023460681). Two independent reviewers retrieved the data, and 41 studies were selected. Nine components related to the impact of nutrition education in hemodialysis patients were identified. Each component was clarified by mentioning each study and its results. This study enabled us to characterize the various components of the impact of nutritional education in hemodialysis patients, namely biological markers, quality of life, cost of care, adherence to dietary recommendations, knowledge, malnutrition inflammation, dietary intake, weight change, and behavior change. This systematic review enables healthcare providers to assess the impact of nutritional education on hemodialysis patients. Also, it gives professionals an exact idea of the impact of nutrition education on hemodialysis patients, with knowledge of new methods using behavior change theories and innovative technological tools.

Abstract Treatment with 5-fluorouracil (5-FU) based therapy is still used for colorectal cancer (CRC). Epigenetics has become a focus of study in cancer because of its reversibility besides its known regulatory functions. In this study, we will monitor the change in microRNAs (miRNAs) levels with 5-FU-based therapy at baseline and after 3 and 6 months of treatment to be correlated with their prognostic potential. The expression levels of 5 miRNAs, namely miRNA223-3p, miRNA20a-5p, miRNA17-5p, miRNA19a-3p, and miRNA7-5p, were measured in the peripheral blood of 77 CRC patients, along with the expression of 3 proteins PTEN, ERK, and EGFR. At baseline, CRC patients had significantly higher levels of circulating miRNAs than healthy controls. This level was reduced after 3 months of 5-FU-based therapy, then increased after 6 months significantly in responder patients compared to non-responders. MiRNA19a-3p showed that significant pattern of change in the subgroups of patients with high ERK, EGFR, and PTEN protein levels, and its 6 months level after 5-FU-based therapy showed significance for the hazard of increased risk of disease recurrence and progression.

Abstract Background Niemann-Pick disease type C (NP-C) is a rare neurovisceral lysosomal lipid storage disease characterized by progressive neurodegeneration and premature death. While miglustat can stabilize neurological manifestations in later onset forms of NP-C, its efficacy in the early-infantile neurological form has not been demonstrated. In this observational retrospective study, we compared long-term neurodevelopmental outcome and survival between an untreated and a treated group of early infantile NP-C patients. Methods Data available on all NP-C patients with early infantile neurological onset diagnosed in France between 1990 and 2013 were compiled. Patients with incomplete data or who had died from a systemic perinatal, rapidly fatal form were excluded. Results Ten patients were included in the treated group (year of birth: 2006–2012), and 16 patients in the untreated group [born 1987–2005 (n = 15), 2012 (n = 1)]. The median age at neurological onset was 9 months (5–18) in the treated group, and 12 months (3–18) in the untreated group (p = 0.22). Miglustat therapy was started at a median age of 24.5 months (9–29) and median duration was 30 months (11–56). Gastrointestinal adverse events were reported in 7/10 patients on miglustat. All patients developed loss of psychomotor acquisitions or additional neurological symptoms despite miglustat therapy. The ages of developmental milestones and neurological involvement did not significantly differ between the two groups. Four patients in the untreated group were lost to follow up. The 22 remaining patients had died by the end of the study and no patient survived beyond the age of 7.4 years. The median survival age was 4.42 years in the untreated group and 5.56 years in the treated group; the Kaplan–Meier survival curves were not significantly different (log-rank test: p = 0.11). Conclusions Miglustat allowed no significant long-term neurodevelopmental improvement nor significant increase of survival in patients with early infantile NP-C.

Abstract The current study describes a straightforward, biologically and environmentally friendly method for creating magnetic iron oxide (γ-Fe2O3) nanoparticles. We report here that the Bacillus subtilis SE05 strain, isolated from offshore formation water near Zaafarana, the Red Sea, Hurghada, Egypt, can produce highly magnetic iron oxide nanoparticles of the maghemite type (γ-Fe2O3). To the best of our knowledge, the ability of this bacterium to reduce Fe2O3 has yet to be demonstrated. As a result, this study reports on the fabrication of enzyme-NPs and the biological immobilization of α-amylase on a solid support. The identified strain was deposited in GenBank with accession number MT422787. The bacterial cells used for the synthesis of magnetic nanoparticles produced about 15.2 g of dry weight, which is considered a high quantity compared to the previous studies. The XRD pattern revealed the crystalline cubic spinel structure of γ-Fe2O3. TEM micrographs showed the spherically shaped IONPs had an average size of 7.68 nm. Further, the importance of protein-SPION interaction and the successful synthesis of stabilized SPIONs in the amylase enzyme hybrid system are also mentioned. The system showed the applicability of these nanomaterials in biofuel production, which demonstrated significant production (54%) compared to the free amylase enzyme (22%). Thus, it is predicted that these nanoparticles can be used in energy fields.

Transmission of dermatophytes, especially Trichophyton mentagrophytes genotype VII, during sexual intercourse has been recently reported. We report 13 such cases in France. All patients were male; 12 were men who have sex with men. Our findings suggest sexual transmission of this pathogen within a specific population, men who have sex with men.

Background: Saliva is a specimen that is easily collected by non-invasive means and does not require well-trained staff; it could be helpful in measuring inflammatory markers to determine COVID-19 severity. The aim of this study was to investigate saliva as an alternative specimen for measuring inflammatory markers IL-10, IL-4, and IL-1β among COVID-19 patients in relation to disease severity. Methods and Results: This cross-sectional study was conducted among COVID-19 patients in a fever clinic, isolated hotels, and hospitals providing care for positive COVID-19 patients and in public health centers for negative control patients in Jeddah, Saudi Arabia. A total of 151 subjects participated in this study, including 101 patients with COVID-19 and 50 healthy controls. Patients with COVID-19 were categorized according to the severity of their symptoms into mild (n=50) and severe cases (n=51). The salivary concentrations of IL-4, IL-10, and IL-1β were measured using sandwich MyBioSource ELISA Test Kits. The age of the study population ranged from 19 to 70 years old, with a mean age of 43.3±13.0 years. The distribution of the study population showed that more of the patients were men (65[64.4%]) than women (36[35.6%]) (P=0.004). The frequency of severe infection in men was higher than in women (35[68.6%] and 16[31.4%], respectively, P=0.008). The group of severe cases was significantly older than the group of mild cases (47.9±11.03 years and 38.64±13.82 years, respectively, P=0.0007). The volume of saliva was the smallest in severe COVID-19, compared to mild cases and controls (P=0.0000 in all cases). The salivary levels of IL-4, IL-10, and IL-1β were greater in the severe cases than in mild cases and controls (46.14±11.61 pg/mL, 12.86±1.99 pg/mL, and 27.45±11.47 pg/mL versus 19.31±5.72 pg/mL, 7.96±2.12 pg/mL, and 6.59±1.90 pg/mL, respectively; P=0.0000 in all cases). The salivary levels of IL-4 and IL-10 in mild cases were greater than in controls (19.31±5.72 pg/mL and 7.96±2.12 pg/mL versus 15.30±4.36 pg/mL and 6.02±0.89 pg/mL, respectively; P=0.0329 and P=0.000, respectively), but salivary IL-1β levels in mild cases did not differ from controls (6.59±1.90 pg/mL vs. 6.03±2.28 pg/mL, P=0.9129). Conclusion: Saliva could be used as an alternative sample in measuring IL-10, IL-4, and IL-1β with the suggestion of using IL-10 and IL-4 as markers for predicting disease severity.

Introduction The surveillance of hepatocellular carcinoma (HCC) using semi-annual liver ultrasound (US) is justified in patients with cirrhosis. In this context, US has a low sensitivity (3% per year) could increase the rates of patients with a tumour detected at an early stage accessible to curative-intent treatment, and demonstrate its cost-effectiveness in this population.Methods and analysis The FASTRAK trial is a multicentre, randomised controlled trial with two parallel arms, aiming for superiority and conducted on patients at high risk for HCC (yearly HCC incidence >3%). Randomisation will be conducted on an individual basis with a centralised approach and stratification by centre. After inclusion in the trial, each patient will be randomly assigned to the experimental group (semi-annual US and AMRI) or the control group (semi-annual US alone). The main objective is to assess the cost/quality-adjusted life year and cost/patient detected with a BCLC 0 HCC in both arms. A total of 944 patients will be recruited in 37 tertiary French centres during a 36-month period and will be followed-up during 36 months.Ethics and dissemination The FASTRAK trial received ethical approval on 4 April 2022. Results will be disseminated via publication in peer-reviewed journals as well as presentation at international conferences.Trial registration number Clinical trial number (ClinicaTrials.gov) NCT05095714.

Background. Najaf governorate was recorded as one of the most polluted Iraqi governorates with increased cancer, autoimmune, and abortion cases. Study Groups. A total of 88 adult volunteers from three test groups were divided based on their inhabitance in different geographical regions in Najaf governorate. Group 1 (G1; n, 29) inhabitants of Al-Ansar, Al-Abbaseyeh, and Al-Manathera districts, Group 2 (G2; n, 27) inhabitants of 22 different scattered districts of the governorate, Group 3 (G3; n, 32) inhabitants of Kufa city and center districts in the old Najaf city. According to previous authors' findings, all participants had uranium contamination in their urine and blood samples, and also, they had DNA damage according to the level of urinary 8-OHdG compound. The control group 4 (G4; n, 25) were adult healthy Iraqi volunteers who were residents of the Sulaimaniyah governorate, which has low-level uranium pollution. The present study aims to determine the effect of uranium pollution and DNA damage on the immune system function in terms of estimating the levels of serum interleukin (IL)-6, interferon-gamma (IFN-γ), and IL-1 beta (β). Method. Enzyme-linked immunosorbent assay (ELISA) (Sandwich method technique) was used for estimating the serum cytokines levels in test and control groups. Results. A significant elevation of cytokines levels was reported as compared with the control groups (p≤0.01). The level of IL-6 was 764.64 ± 24.12 pg/ml, 768.87 ± 19.64 pg/ml, and 735.62 ± 18.47 in G1, G2, and G3, respectively. The level of IFN-γ was 264.55 ± 19.17 pg/ml, 259 ± 18.76 pg/ml, and 261.20 ± 12.99 pg/ml for G1, G2, and G3, respectively. The level of IL-1β was 99.85 ± 10.81 pg/ml, 116.8 ± 10.71 pg/ml, and 83 ± 19.24 pg/ml in G1, G2, and G3, respectively. The levels of IL-6, IFN-γ, and IL-1β were 86.5 ± 22.9 pg/ml, 19.4 ± 2.8 pg/ml, and 16.1 ± 3.2 pg/ml in the sera of control (G4). The results showed significant statistical elevation with the corresponding p value cut-off p≤0.01 in IL-6, IFN-γ, and IL-1β in the sera of three test groups as compared with the results of the control group. Conclusion. The change in the proinflammatory cytokines (IL-6, IFN-γ, and IL-1β) levels indicates a persistent inflammatory response in the participants and may reflect immune system impairment as a consequence of exposure to long-term low-dose ionizing radiation.

ObjectivesControlling population expansion and reducing unintended pregnancies through the use of modern contraceptives is a cost-effective strategy. In recent years, the rate of modern contraceptive use in Bangladesh has been declining. So, this study aimed to investigate the associated factors of the deterioration in modern contraceptive usage.MethodsThis study used data from two successive Bangladesh Demographic and Health Surveys (2014 and 2017-18) and applied the Blinder-Oaxaca decomposition analysis to understand the drivers. A popular binary logistic regression model is fitted to determine the factors that influence the use of modern contraceptive methods over the years.ResultsThis study revealed that highly educated women were more likely to use modern contraception methods, and their use increased by 3 percent over the years. Factors such as women's working status, husband's education, number of living children, and fertility preference were found significantly associated with decreased usage of modern contraception methods over years. The result of the Blinder-Oaxaca (BO) decomposition analysis found a significant decrease between 2014 and 2018. Respondent's age, working status, husband's age, opinion on decision making, region, and media exposure were the most significant contributors to explaining the shift between 2014 and 2018. The two factors that contributed most to narrowing the difference between the two surveys were women's decision on own health (26%), and employment status (35%).ConclusionsThe factors that influence modern contraceptive prevalence are important to know for policy implication purposes in Bangladesh. The findings indicate the need for further improvement of factors for balancing the usage of modern contraception methods.

Recent advances in gene editing are enabling the engineering of cells with an unprecedented level of scale. To capitalize on this opportunity, new methods are needed to accelerate the different steps required to manufacture and handle engineered cells. Here, we describe the development of an integrated software and hardware platform to automate Fluorescence-Activated Cell Sorting (FACS), a central step for the selection of cells displaying desired molecular attributes. Sorting large numbers of samples is laborious, and, to date, no automated system exists to sequentially manage FACS samples, likely owing to the need to tailor sorting conditions ("gating") to each individual sample. Our platform is built around a commercial instrument and integrates the handling and transfer of samples to and from the instrument, autonomous control of the instrument's software, and the algorithmic generation of sorting gates, resulting in walkaway functionality. Automation eliminates operator errors, standardizes gating conditions by eliminating operator-to-operator variations, and reduces hands-on labor by 93%. Moreover, our strategy for automating the operation of a commercial instrument control software in the absence of an Application Program Interface (API) exemplifies a universal solution for other instruments that lack an API. Our software and hardware designs are fully open-source and include step-by-step build documentation to contribute to a growing open ecosystem of tools for high-throughput cell biology.

Liquid chromatography purification of multiple recombinant proteins, in parallel, could catalyze research and discovery if the processes are fast and approach the robustness of traditional, "one-protein-at-a-time" purification. Here, we report an automated, four channel chromatography platform that we have designed and validated for parallelized protein purification at milligram scales. The device can purify up to four proteins (each with its own single column), has inputs for up to eight buffers or solvents that can be directed to any of the four columns via a network of software-driven valves, and includes an automated fraction collector with ten positions for 1.5 or 5.0 mL collection tubes and four positions for 50 mL collection tubes for each column output. The control software can be accessed either via Python scripting, giving users full access to all steps of the purification process, or via a simple-to-navigate touch screen graphical user interface that does not require knowledge of the command line or any programming language. Using our instrument, we report milligram-scale, parallelized, single-column purification of a panel of mammalian cell expressed coronavirus (SARS-CoV-2, HCoV-229E, HCoV-OC43, HCoV-229E) trimeric Spike and monomeric Receptor Binding Domain (RBD) antigens, and monoclonal antibodies targeting SARS-CoV-2 Spike (S) and Influenza Hemagglutinin (HA). We include a detailed hardware build guide, and have made the controlling software open source, to allow others to build and customize their own protein purifier systems.

Abstract Inflammatory processes are increasingly attributed to macrophage polarization. Proinflammatory macrophages promote T helper (Th) 1 response, tissue repair, and Th2 responses. Detection of macrophages in tissue sections is facilitated by CD68. Our study is focused on the expression of CD68 and the estimation of proinflammatory cytokines in children’s patients with chronic tonsillitis secondary to vitamin D supplementation. This hospital-based Randomized prospective case–control study was conducted on 80 children with chronic tonsillitis associated with vitamin D deficiency where (40 received vitamin D 50,000 IU weekly for 3–6 months and 40 received 5 ml distilled water as placebo). The serum 25-hydroxyvitamin D [25(OH)D] was measured using an Enzyme-linked immunosorbent assay on all included children. Different histological and immunohistochemical studies for the detection of CD68 were done. There was a significantly lower serum level of 25(OH)D in the placebo group versus the vitamin D group (P

Abstract The world's population is projected to grow 32% in the coming years, and the number of Muslims is expected to grow by 70%—from 1.8 billion in 2015 to about 3 billion in 2060. Hijri is the Islamic calendar, also known as the lunar Hijri calendar, which consists of 12 lunar months, and it is tied to the Moon phases where a new crescent Moon marks the beginning of each month. Muslims use the Hijri calendar to determine important dates and religious events such as Ramadan, Haj, Muharram, etc. Till today, there is no consensus on deciding on the beginning of Ramadan month within the Muslim community. This is mainly due to the imprecise observations of the new crescent Moon in different locations. Artificial intelligence and its sub-field machine learning have shown great success in their application in several fields. In this paper, we propose the use of machine learning algorithms to help in determining the start of Ramadan month by predicting the visibility of the new crescent Moon. The results obtained from our experiments have shown very good accurate prediction and evaluation performance. The Random Forest and Support Vector Machine classifiers have provided promising results compared to other classifiers considered in this study in predicting the visibility of the new Moon.

Abstract Various biomaterials have been evaluated to enhance bone formation in critical-sized bone defects; however, the ideal scaffold is still missing. The objective of this study was to investigate the in vitro and in vivo regenerative capacity of graphitic carbon nitride (g-C3N4) and graphene oxide (GO) nanomaterials to stimulate critical-sized bone defect regeneration. The in vitro cytotoxicity and hemocompatibility of g-C3N4 and GO were evaluated, and their potential to induce the in vitro osteogenesis of human fetal osteoblast (hFOB) cells was assessed using qPCR. Then, bone defect in femoral condyles was created in rabbits and left empty as control or filled with either g-C3N4 or GO. The osteogenesis of the different implanted scaffolds was evaluated after 4, 8, and 12 weeks of surgery using X-ray, computed tomography (CT), macro/microscopic examinations, and qPCR analysis of osteocalcin (OC) and osteopontin (OP) expressions. Both materials displayed good cell viability and hemocompatibility with enhanced collagen type-I (Col-I), OC, and OP expressions of the hFOB cells. Compared to the control group, the bone healing process in g-C3N4 and GO groups was promoted in vivo. Moreover, complete healing of the bone defect was observed radiologically and grossly in g-C3N4 implanted group. Additionally, g-C3N4 implanted group showed higher percentages of osteoid tissue, mature collagen, biodegradation, and expressions of OC and OP. In conclusion, our results revealed that g-C3N4 and GO nanomaterials could induce osteogenesis in critical-sized bone defects.

Abstract Aloe vera has antimicrobial activity and enhances the osseointegration process, thus it may have the potential in treating periodontal defects. This study aimed to evaluate the effect of Aloe vera as an adjunction to Beta-tricalcium phosphate (β-TCP) bone graft in Grade II furcation defects. A randomized study was conducted on six healthy mongrel dogs' premolars. A total of twenty-four Grade II furcation critical-sized defects were surgically created after reflecting a full-thickness flap, twelve defects were filled with β-TCP while the other twelve defects were filled with Aloe vera mixed with β-TCP and both covered by collagen membrane. Animals were euthanized at the end of the fourth and eighth week and defects were analyzed histologically and histomorphometrically. Histologically, Aloe vera mixed with β-TCP resulted in more bone formation and new PDL fibers compared to β-TCP alone. After 2 and 4 weeks, the experimental group had significantly higher newly formed interradicular bone height (p

Abstract Background Porphyrias are a rare group of disease due to inherited defects of heme synthesis with important systemic manifestations and great burden of disease for patients and families due to the exceptional course of disease with disabling chronic symptoms interposed by life-threatening acute attacks. Unfortunately, the porphyrias are usually underrecognized reflecting a lack of medical and disease awareness as well as few studies about natural history in large cohorts of patients. The main aim of this article is present consistent data about natural history and burden of disease in a large Brazilian cohort. Methods We conducted a national cross-sectional registry with retrospective clinical data of Brazilian patients with porphyria collected with Brazilian patients Association with Porphyria in collaboration with a tertiary care center for rare diseases. Results A cohort of 172 patients was analyzed in which 148 (86%) patients had the diagnosis of acute hepatic porphyria [AHP] that needed a mean of 62.04 medical visits and 9.6 years to achieve a definitive diagnosis. About AHP cohort, the most common first clinical manifestation were abdominal pain in 77 (52%) patients and acute muscle weakness in 23 (15.5%) with 73 (49.3%) patients presenting only one attack during disease course and 37 (25%) exhibiting 4 or more attacks in the last year. Of note, 105 patients with AHP reported chronic manifestations and the scores for quality of life are lower when compared with general healthy population. Conclusions Brazilian patients with AHP had a higher prevalence of chronic disabling manifestations and a poor quality of life like other cohorts and a higher proportion of patients with recurrent attacks than previously reported.

Multiple myeloma is a common malignant bone-based disease. Pleural effusions reported in these patients remain rare. It is commonly due to congestive heart disease, pulmonary embolism, nephrotic syndrome or a second neoplasia. The true myelomatous pleural effusion resulting from a direct tumoral invasion of the pleural are extremely rare. We report here the case of a massive pleural effusion revealing multiple myeloma in a 71-year-old patient. The chest ultrasound showed a massive pleural effusion in the left side with a multinodular thickening of the pleura. The medical thoracoscopy showed a grape-cluster appearance. The diagnosis was made by pleural guided biopsy revealing abnormal plasma cells with an intense positive CD 138 (plasma cell marker) and MUM1 (multiple myeloma oncogene1) staining with a light kappa chain in the protein electrophoresis associated with a myeloma. Unfortunately, our patient died one month after the initial diagnosis. We present also a review of the recent literature in order to highlight the clinical presentations of the myelomatous pleural effusion, the diagnostic tools, the therapeutic strategies as well as the outcomes.

Objectives To estimate the economic costs, health-related quality-of-life outcomes and cost-effectiveness of subthreshold micropulse laser (SML) versus standard laser (SL) for the treatment of diabetic macular oedema (DMO) with central retinal thickness (CRT) of

Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare interstitial lung disease of unknown cause. It usually responds well to systemic corticosteroid therapy, but relapses are frequent. We describe two cases of 21- and 27-year-old patients, presenting with dyspnea. The diagnosis of steroid-relapsing and steroid-dependent ICEP was made respectively. Mepolizumab was prescribed to both patients. This treatment resulted in successful long-term disease management with much fewer side effects than a traditional corticosteroid therapy.

Abstract This study investigated the effect of the silver nanoparticles (AgNPs) and platelet-rich fibrin (PRF) in the healing of the severed superficial digital flexor tendon in donkeys (SDFT). Twenty-seven adult donkeys were used in the study. The animals were divided into three equal groups. The first group (control group) in which the severed SDFT was sutured without the addition of any adjuvant. In the second group, there was a suture of severed SDFT with the addition of 1 ml of 1 mM silver nanoparticles (AgNPs group). The third group was subjected to the cutting of SDFT and then the addition of PRF after its suture. Each group of animals was divided into three equal subgroups that were examined after 1, 2, and 3 months. Each group of animals was clinically evaluated by assessing lameness. Gross and microscopic examinations of the healed tendons were performed after 1, 2, and 3 months of surgery. In comparison to the control group, the lameness degree decreased in the PRF and AgNPs groups, particularly in the third month after surgery. Furthermore, the lameness decreased significantly after the 3rd month relative to the 1st-month lameness in the AgNPs group. Interestingly, it was found that the PRF and AgNPs enhanced cell alignment and collagen deposition at the site of tendon injury, particularly among third-month subgroups. Therefore, it could be concluded that the PRF and AgNPs are effective materials for enhancing SDFT healing in donkeys.

Introduction: Anal fissure (AF) is a common anorectal disease. Although several pharmacological treatments are available, many patients still require surgical interventions. In this study, we aimed to evaluate the efficacy of an ointment based on a multifunctional blend of herbal ingredients including hemp (ProctoFiz) for chronic AF. Methods: A single-arm, questionnaire-based prospective study was conducted in a large tertiary center to evaluate the outcomes of patients suffering from chronic AF treated with topical ProctoFiz. Results: Ninety-two patients were included in the study, 54 (58.7%) were females with a median age of 39 (range 17–78). 32 patients (34.7%) suffered from recurrent AF before enrolling in the study, and 5 patients (5.4%) underwent previous surgical interventions for AF. Three patients (3.2%) were lost to follow-up, leaving 89 patients for analysis. Eighty patients (89.9%) reported significant improvement of symptoms after 1 week using ProctoFiz, and 79 patients reported continued improvement after 1 month of treatment. The mean pain Visual Analog Score (VAS) declined by 6.6 points (8.9 vs. 2.3; 95% CI: 7.20 to −5.99, p < 0.0001) following 1 week of treatment, with continuous improvement to a mean of 0.64 after 1 month. Negative impact on quality of life significantly decreased from a mean of 8.8 to 0.38 following a month of treatment (p < 0.0001), with significant reduction in the number of patients suffering from bleeding following bowel movements (64.1–2.5%; p = 0.0001). Conclusion: Hemp-based topical treatment of AF is feasible and significantly improves AF-correlated symptoms.