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The current study centred on assessing the effect of various lifestyle factors (diet, physical activity [PA] level, sleep pattern, and stress level) on women's fertility. This hospitalbased comparative study was conducted at the Avicenna Medical College and Hospital, Lahore, Pakistan, with 104 females (aged 18-40 years) as participants. Half the participants had a history of infertility and 51.8% had a BMI >25. About 43% and 85% reported intake of "junk food" and "fruit and vegetable (F&V)", respectively, twice a week. DASS-21 scale endorsed "moderate-to-high-stress" in 58% of the participants. Further, moderate and intense PAable was documented in 30% and 20% of the participants. About 37% reported sleeping for ≤5 hours/day. Fertility was significantly but inversely correlated with F&V intake, stress level, and BMI. Less sleep and a sedentary lifestyle had a significantly detrimental impact on fertility. Women's fertility was positively impacted by F&V intake, moderate PA, and adequate sleep but negatively impacted by obesity and mental stress.

Background: Among people with COPD, smartphone and wearable technology may provide an effective method to improve care at home by supporting, encouraging, and sustaining self-management. The current study was conducted to determine if patients with COPD will use a dedicated smartphone and smartwatch app to help manage their COPD and to determine the effects on their self-management., Methods: We developed a COPD self-management application for smartphones and smartwatches. Participants were provided with the app on a smartphone and a smartwatch, as well as a cellular data plan and followed for 6 months. We measured usage of the different smartphone app functions. For the primary outcome, we examined the change in self-management from baseline to the end of follow up. Secondary outcomes include changes in self-efficacy, quality of life, and COPD disease control., Results: Thirty-four patients were enrolled and followed. Mean age was 69.8 years, and half of the participants were women. The most used functions were recording steps through the smartwatch, entering a daily symptom questionnaire, checking oxygen saturation, and performing breathing exercises. There was no significant difference in the primary outcome of change in self-management after use of the app or in overall total scores of health-related quality of life, disease control or self-efficacy., Conclusion: We found older patients with COPD would engage with a COPD smartphone and smartwatch application, but this did not result in improved self-management. More research is needed to determine if a smartphone and smartwatch application can improve self-management in people with COPD., Trial Registration: ClinicalTrials.Gov NCT03857061, First Posted February 27, 2019., (© 2024. The Author(s).)

Barley (Hordeum vulgare ) is the world's fourth most important cereal crop, and is particularly well adapted to harsh environments. However, lodging is a major productivity constraint causing 13-65% yield losses. Gibberellic acid (GA) homeostatic genes such as HvGA20ox, HvGA3ox and HvGA2ox are responsible for changes in plant phenotype for height and internodal length that contribute towards lodging resistance. This study explored the expression of different HvGAox transcripts in two contrasting barley genotypes (5-GSBON-18, lodging resistant; and 5-GSBON-70, lodging sensitive), which were sown both under controlled (hydroponic, completely randomised factorial design) and field conditions (split-plot, completely randomised block design) with two irrigation treatments (normal with three irrigation events; and water deficit with one irrigation event). In the hydroponic experiment, expression analysis was performed on seedlings at 0, ¾, 1½, 3 and 6h after application of treatment. In the field experiment, leaf, shoot nodes and internodes were sampled. Downregulation of HvGA20ox.1 transcript and 2-fold upregulation of HvGA2ox.2 transcript were observed in 5-GSBON-18 under water deficit conditions. This genotype also showed a significant reduction in plant height (18-20%), lodging (<10%), and increased grain yield (15-18%) under stress. Utilisation of these transcripts in barley breeding has the potential to reduce plant height, lodging and increased grain yield.

The present study was designed to explore the potential of fenugreek and flaxseed polysaccharide-based edible coatings to enhance the postharvest storage life of apple fruit. The experimental plan involved the preparation of five different coating formulations, which were subsequently applied to the fruit. The coated fruit was then stored at a temperature of 25 ± 2°C for a duration of 35 days. The effects of these coatings on physicochemical and biochemical attributes (weight loss, firmness, acidity, pH, sugar content, antioxidant activity, microbial growth, and sensory properties) of coated and uncoated samples were evaluated at regular intervals: 0, 7, 14, 21, 28, and 35 days of storage. The experimental results revealed a significant difference ( p  ≤ .05) in the physicochemical parameters of uncoated and coated apple at different storage times. The coated apple fruits showed significantly ( p  ≤ .05) lower weight loss, pH, total sugars, total soluble solids, and maximum retention of ascorbic acid, firmness, acidity, and antioxidant contents, leading to enhanced organoleptic properties. The application of edible coatings extended the shelf-life of the apples by inhibiting microbiological spoilage without substantial impact on sensory and nutritional properties. Based on these results, it is concluded that the edible coating formulation labeled T 1 (containing 2.5 g fenugreek polysaccharide and 1.5 g flax polysaccharide) effectively preserved the valuable physicochemical and organoleptic characteristics of the apple fruit throughout the storage period., Competing Interests: Authors have no conflict of interest to declare., (© 2023 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Large amounts of waste, including dead birds, manure, and poultry litter, are produced by the poultry industry. Poultry waste should be disposed of properly to avoid major pollution and health risks. Composting litter and dead birds could be an option to recycle the waste and use in poultry feed. A study was conducted to investigate the effects of feeding composted poultry waste on the organoleptic qualities and compositional profile of the meat of broiler chickens. A total of 300 day-old broiler chicks (500-Cobb) were randomly allocated to five treatment groups replicated six times with 10 birds each, under a completely randomized design (CRD). Five iso-caloric and iso-nitrogenous diets including composted poultry byproducts at concentrations of 0, 2.5, 5, 7.5, and 10% were fed ad libitum to the birds from day 0 to day 35. The sensory grading and meat composition profile of 500 Cobb broiler chickens were tested at 35 days of age. The findings showed that there were no variations in the sensory profiles of the meat from birds given various diets (P>0.05). Although the results were somewhat lower for the chicks fed compost-containing diets than for the control group, this difference was deemed to be insignificant (P>0.05). Similarly, there were no variations in the compositional profile values of the meat between meat from birds fed various diets (P>0.05). These findings imply that broiler chickens may be raised on diets containing up to 10% poultry byproduct compost without any negative impacts on the meat's sensory quality or composition. Additionally, using compost into broiler diets may help to lower the cost of feed.

The poultry industry generates a lot of waste, including dead birds, manure, and poultry litter. Poultry waste should never be disposed of improperly because it can seriously harm the environment. The waste can be recycled as a feedstock for use in poultry feed by composting the litter and deceased birds. The compositional profile and organoleptic properties of the meat of growing Japanese quail were examined over the course of a 4-week trial to ascertain the effect of adding compost to the diet. In a completely randomized design (CRD), 1200 newly hatched quail chicks (Coturnix coturnix japonica) were divided into five treatment groups (diets with 0, 2.5, 5, 7.5, and 10% compost), each consisting of 40 birds with six replicates. The addition of compost to the diet had no noticeable effects on the organoleptic qualities of appearance, color, aroma, taste, texture, juiciness, tenderness, and acceptability (P>0.05). The compositional profile characteristics for chicks given compost at any level compared to chicks fed the control diet showed no differences (P>0.05). These findings suggest that the sensory characteristics and compositional profile of growing meat quails can be maintained when fed diets including up to 10% compost.

In this experimental study, hydroxyapatite (HAp), as a valuable calcium source, was extracted from discarded goat bone; raw and nano-biogenic powders were prepared through calcination and ultra-sonication. Resultant powders were characterized by using various spectroscopy techniques. As per the findings of atomic absorption spectroscopy, raw and nano-biogenic powders depicted 1439.7 ± 0.12 and 3194.8 ± 0.07 ppm calcium content, respectively. The range of particle size of nano-biogenic and raw powders was 47-139 and 183 nm, respectively. X-ray diffraction (XRD) confirmed crystalline behavior whereas laser-induced breakdown spectroscopy (LIBS)-derived Ca/P-ratio endorsed excellence in nano-biogenic 1.76 against 1.63 in raw powder. In vitro bioavailability of calcium in raw and nano-biogenic powder was ∼36% and ∼39%, respectively. Next, the powders were further used to develop calcium-fortified mango mousse with varied formulations. A maximum overrun of 23.31% was found in the case of "Raw-A," whereas a maximum viscosity of 8489.98 mPa s was found in the case of "Nano-A." Sensory data of mango mousse were obtained by fuzzy logic method, and PCA ranked the Nano-B and Nano-A samples the best in terms of overall acceptability. Meanwhile, the consumer responses toward product likeness and/or dislikeness were recorded by the hedonic scale that endorsed Nano-A and Nano-B formulations as the most preferred samples. PRACTICAL APPLICATION: The revolution in the eating habits of consumers from traditional foods to fast food imposes the development of new products having good nutritional values. Different waste biogenic food sources can provide an acceptable powdered form of ingredients for the development of novel food products. In this regard, the development of novel food products using calcium supplements has gained space in the food industry., (© 2023 Institute of Food Technologists.)

The occlusal surface of a tooth is affected by the development of biofilm in pits and fissures as bacteria and food particles accumulate in its complex structure. In this study, miswak fibers containing cellulose and antimicrobial extract were incorporated in commercial pit and fissure sealants. The miswak powder was characterized by different analytical techniques. The powder was mixed in different ratios (0-5%) into a pit and fissure sealant to result in five sealants (Groups 0-5), and their mechanical properties i.e. flexural strength, compressive strength, and Vickers hardness were evaluated. The sealants were also evaluated against streptococcus mutans oral pathogenic bacteria. SEM analysis confirmed irregular shape and micron-size particles of miswak powder. The infrared spectral analysis and X-ray differential peaks showed characteristic peaks related to miswak fibers. The particle appearance increased in prepared pits and fissure sealants with higher loading of miswak powder in SEM analysis. The flexural strength, compressive strength, and Vickers hardness values were obtained in the range of 148-221 (±16.6: p -value < 0.001) MPa, 43.1-50.3 MPa (±1.7: p- value <0.001), and 15.2-21.26 VHN (±0.56: p -value <0.001) for control and prepared sealant specimens respectively. In the antibacterial study, the zone of inhibitions increased with increased content of miswak from 15.6 ± 0.45 mm (Group 1) to 20.3 ± 0.32 mm (Group 5). The MIC was calculated to be 0.039%. The prepared experimental sealant had acceptable mechanical and good antibacterial properties therefore it could be recommended as an efficient pit and fissure sealant., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

This study aims to evaluate the effect of ionic liquids and their structure on the mechanical (tensile bond strength (TBS) and Shore A hardness), mass change, and antifungal properties of soft denture lining material. Butyl pyridinium chloride (BPCL) and octyl pyridinium chloride (OPCL) were synthesized, characterized, and mixed in concentrations ranging from 0.65-10% w/w with a soft denture liner (Molloplast-B) and were divided into seven groups (C, BPCL1-3, and OPCL1-3). The TBS of bar-shaped specimens was calculated on a Universal Testing Machine. For Shore A hardness, disc-shaped specimens were analyzed using a durometer. The mass change (%) of specimens was calculated by the weight loss method. The antifungal potential of ionic liquids and test specimens was measured using agar well and disc diffusion methods ( p ≤ 0.05). The alamarBlue assay was performed to assess the biocompatibility of the samples. The mean TBS values of Molloplast-B samples were significantly lower ( p ≤ 0.05) for all groups except for OPCL1. Compared with the control, the mean shore A hardness values were significantly higher ( p ≤ 0.05) for samples in groups BPCL 2 and 3. After 6 weeks, the OPCL samples showed a significantly lower ( p ≤ 0.05) mass change as compared to the control. Agar well diffusion methods demonstrated a maximum zone of inhibition for 2.5% OPCL (20.5 ± 0.05 mm) after 24 h. Disc diffusion methods showed no zones of inhibition. The biocompatibility of the ionic liquid-modified sample was comparable to that of the control. The addition of ionic liquids in Molloplast-B improved the liner's surface texture, increased its hardness, and decreased its % mass change and tensile strength. Ionic liquids exhibited potent antifungal activity., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Przhevalskiana silenus (warble fly) grubs cause myiasis in goats, in mountainous and semi-mountainous areas and different regions in Pakistan, and cause substantial losses to livestock. The palpation method for detecting warble flies generally neglects the infestation intensity; therefore, the development of a reliable and efficient diagnostic technique is extremely necessary. This study compared three indirect enzyme-linked immunosorbent assay (ELISA) methods for detecting anti- P. silenus antibodies using the hypodermin C (HyC) purified from Hypoderma spp. Larvae collected in cattle (local isolate, Microbiology Laboratory, PMAS-Arid Agriculture University, Rawalpindi), the crude antigen from the first instar stage of P. silenus , and a commercial Bovine Hypodermosis Antibody ELISA kit (IDEXX Laboratory), for accurately estimating the seroprevalence of goat warble fly infestation (GWFI) in the Pothwar plateau, Punjab, Pakistan. The ELISA with the crude antigen of P. silenus proved very sensitive and specific, 91% and 93%, respectively. The optical density exhibited a monthly variation, and the antibody titer began increasing from June, continually increased from July to December, and gradually decreased thereafter until March. The study confirmed the endemic status of GWFI in the Pothwar region and identified that ELISA based on the crude antigen of P. silenus was a more sensitive and specific immunodiagnostic method for determining seroprevalence, and could be employed for initiating nationwide eradication campaigns.

Potato crop, currently, is the staple food crop of about 1.3 billion global population. Potato is attaining even more admiration globally day by day owing to its public acceptability. However, potato sustainable production is distinctly challenged by multiple factors like diseases, pests and climate change etc. Among diseases, common scab is one of the prime threats to potato crop due to its soil-borne nature and versatility in phytotoxins' secretion. Common scab is caused multiple number of phytopathogenic streptomyces strains. Despite extensive research programs, researchers are still unable to identify a significant solution to this threat that is proliferating exceptional rate across the globe. To develop feasible remedies, adequate information regarding host-pathogen interaction should be available. This review possesses insights on existing pathogenic species, the evolution of novel pathogenic streptomyces spp. and phytotoxins produced by the pathogenic strains. Furthermore, which type of physiological, biochemical and genetic activities occur during pathogen's infestation of the host are also canvassed., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: There are not enough reliable studies available in physiotherapy to determine the effects of spinal manipulative therapy added to exercise on thoracic spinal pain and quality of life., Objective: To investigate the effects of spinal manipulation on pain and quality of life in subjects with thoracic spinal pain. Study Design . It was an open-label "randomized controlled trial." Study Settings . Department of Physiotherapy, Services Hospital, Lahore, Pakistan. Participants . There were one hundred subjects with an age group between 18 and 60 years fulfilling the inclusion criteria. These subjects were divided equally into two groups; an experimental and a control group., Methods: In the experimental group ( n = 50), thoracic spinal manipulation was applied along with thoracic muscle strengthening exercises. In the control group ( n = 50) thoracic muscle exercises alone were given. Pain was measured by visual analogue scale (VAS) and quality of life with SF-36. Measurements were taken at baseline, immediately after session, after 8th session, and later as follow-ups at 12 weeks. Repeated measure ANOVA and independent sample T -test were used for within and between-group comparisons., Results: Mean age of subjects in control group was 38.56 ± 12.44 and in experimental group was 36.02 ± 11.32. Both groups demonstrated significant improvement in VAS score, and all domains of SF 36 but between-group comparison showed greater improvement in VAS of the experimental group compared to the baseline ( P < 0.05), but between-group comparison of 8th session to follow-up has shown that effects of exercise persist while health-related quality of life in spinal manipulation group was significantly reduced after discontinuation of treatment. After the 8th session, spinal manipulation group showed notable results in terms of pain (mean diff 1.14 (0.62, 1.65) 95% CI and all aspects of SF 36 ( P value <0.05). However, after week 12 of follow-up, no significant difference ( P value >0.05) was observed among the study groups for pain and quality of life., Conclusion: Spinal manipulation added to thoracic exercise was more effective than thoracic exercise alone for improving pain and quality of life at the end of 8th session of care. However, the inclusion of spinal manipulation was not found effective at the 12-week follow-up. This trial is registered with IRCT20190327043125N1., Competing Interests: There is no conflict of interest., (Copyright © 2023 Muhammad Sharif Waqas et al.)

Objectives: To observe the effects of dietary counselling on weight management after liposuction., Methods: The case-control study was conducted at the La Chirurgie Cosmetic Surgery Centre and Hair Transplant Institute, F-8/3, Islamabad, Pakistan, from January to July 2018, and comprised adults (100) of either gender undergoing liposuction and/or abdominoplasty who were followed for three months in the postoperative period. The subjects were divided into dietary-counselled group A, which received diet plans, and control group B, which followed up without any dietary advice. Lipid profile was done at baseline and three months post-liposuction. Data was analysed using SPSS 20., Results: Of the 100 subjects enrolled, 83(83%) completed the study; 43(51.8%) in group A and 40(48.2%) in group B. Overall, there were 19(22.9%) males, 64(77.1%) females, and 55(66.3%) were aged <40 years, while 28(33.7%) were aged ≥40 years. Intra-group improvement was significant for total cholesterol, low-density lipoprotein, and triglycerides for both the groups (p<0.05). The change for very low-density lipoprotein in group B was not significant (p>0.05). Change in high-density lipoprotein was for the better in group A, while it decreased in group B and the change in both cases was significant (p<0.05). Inter-group differences were not significant (p>0.05) except for total cholesterol (p<0.05)., Conclusions: Liposuction alone resulted in the improvement of lipid profile, while dietary intervention resulted in better values with respect to very low-density lipoprotein and high-density lipoprotein.

A wide range of novelties and significant developments in the field of veterinary science to treat helminth parasites by using natural plant products have been assessed in recent years. To the best of our knowledge, to date, there has not been such a comprehensive review of 19 years of articles on the anthelmintic potential of plants against various types of helminths in different parts of the world. Therefore, the present study reviews the available information on a large number of medicinal plants and their pharmacological effects, which may facilitate the development of an effective management strategy against helminth parasites. An electronic search in four major databases (PubMed, Scopus, Web of Science, and Google Scholar) was performed for articles published between January 2003 and April 2022. Information about plant species, local name, family, distribution, plant tissue used, and target parasite species was tabulated. All relevant studies meeting the inclusion criteria were assessed, and 118 research articles were included. In total, 259 plant species were reviewed as a potential source of anthelmintic drugs. These plants can be used as a source of natural drugs to treat helminth infections in animals, and their use would potentially reduce economic losses and improve livestock production.

Objective: The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, cervical range of motion, and disability., Methods: It was a randomized clinical trial; data was collected from Mayo Hospital, Lahore. Eighty-eight patients fulfilling the sample selection criteria were randomly assigned into group 1 (neural mobilization) and group 2 (conventional treatment). Pain intensity was measured on a numeric pain rating scale, range of motion with an inclinometer, and functional status with neck disability index (NDI). Data were analyzed using SPSS, repeated measure ANOVA for cervical ranges and the Friedman test for NPRS and NDI were used for within-group analysis. Independent samples t-test for cervical ranges and Mann-Whitney U test for NPRS and NDI were used for between-group comparisons., Results: There was a significant improvement in pain, disability, and cervical range of motion after the treatment in both groups compared to the pre-treatment status (p < 0.001), and when both groups were compared neural mobilization was more effective than conventional treatment in reducing pain and neck disability (p < 0.001), but there was no significant difference present in the mean score of cervical range of motion between both groups. (p>0.05)., Conclusions: The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patients with cervical radiculopathy, however, neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy., Trial Registration: RCT20190325043109N1., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Rafiq et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Produced water (PW) generated from the petroleum industry, during the extraction of oil and gas, has harmful impacts on human health and aquatic life, due to its complex nature. Therefore, it is necessary to treat it before discharging it into the environment in order to avoid serious environmental concerns. In this research, oil adsorption from PW was investigated using clay-alginate beads loaded with ionic liquids (ILs), as the adsorbent material. The effects of several process parameters, such as the initial concentration of oil, contact time, pH, and temperature on the removal efficiency of the beads, were analyzed and optimized. Different characterization methods, such as the Fourier transform infrared spectrophotometer (FTIR), scanning electron microscopy (SEM), energy dispersive X-ray (EDX), and thermal gravimetric analysis (TGA), were used to investigate the surface morphology, the chemical bond structure and functional group, and the thermal stability of the ILs-based beads. The results revealed that the clay-alginate-ILs beads indicated a removal efficiency of 71.8% at the optimum conditions (600 ppm initial oil concentration, 70 min contact time, 10 pH, and at room temperature) with an adsorption capacity of 431 mg/g. The FTIR analysis confirmed the successful chemical bond interaction of the oil with the beads. The SEM analysis verified that the beads have a porous and rough surface, which is appropriate for the adsorption of oil onto the bead's surface. The TGA analysis provides the thermal degradation profile for the clay-alginate-ILs. The beads used in the adsorption process were regenerated and used for up to four cycles.

Purpose: Cervical radiculopathy is disorder of cervical spinal nerve root affecting large number of population. Previously many studies are conducted to design suitable protocol for management of this disorder, but they lack in quality. The purpose of this study was to compare the effects of neural mobilization and cervical isometrics on health-related quality of life and deep flexors endurance in cervical radiculopathy., Methods: A double-blinded randomized clinical trial was conducted at Mayo Hospital, Lahore, Pakistan. Eighty-eight patients within the age range of 35-50 years were included in the study after taking their consent. In the experimental group ( n = 44), median nerve mobilization was applied along with cervical isometric exercises. The control group ( n = 44) performed cervical isometric exercises alone. Muscle endurance was measured by craniocervical flexion test and quality of life on 36 items short form health survey SF-36 scale. Measurements were taken at baseline, at 2 nd week, and at 4 th week. For missing data, intention-to-treat analysis was used., Results: Within-group comparison with Friedman test showed a significant difference between pre, mid, and posttreatment scores on craniocervical flexion test and in all domains of SF 36 in both groups. While between-group comparison with Mann-Whitney U test showed all variables were similar at baseline but after 4 weeks there was a statistically significant improvement in craniocervical flexion test scores and all domains of SF 36 in the experimental group. But domain of pain showed mean rank of 49.43 after 4 weeks in the experimental group and 39.57 in the control group with p = 0.065 and d = 0.579, while for all the other 7 domains values were p < .05 and d > 0.25., Conclusion: Neural mobilization combined with cervical isometrics shows significant effects in improving quality of life and deep flexors endurance in patients with cervical radiculopathy than cervical isometrics alone., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Shazia Rafiq et al.)

Background: Eventually Oral submucous fibrosis causes pronounced stiffness and failure to open the mouth. Objectives are to determine compare the efficacy of intralesional steroids alone and combination of steroids with hyaluronidase on mouth opening in oral submucous fibrosis., Methods: It was a prospective comparative cohort study. Total of 74 patients both male and female having history of pan chewing and limited mouth opening and burning sensations were included in the study. Informed consent was taken and divided into two groups. Patients of group 1 were managed with mixture of betamethasone 1 ml and hyaluronidase 1500 IU and patients of group 2 were treated with only steroid injection of betamethasone 1 ml given intralesional, both injections were given intralesional, by multiple puncture technique and once a week and continued for twelve weeks (3 months). And data compiled and analyzed in SPSS-20., Results: The mean age of group 1 was 40.027±6.97 years, and mean age of Group 2 was 37.351±5.48 years. In both groups, the greatest number of cases aged from 31-59 years. Compared to females in both groups, the majority of patients were males. In 32 (86.4)% patients of group 1 showed efficacy compared with 18[43.2] patients in group 2 [p-0.000]., Conclusion: In this study Intralesional steroids with hyaluronidase injections are more efficient for opening the mouth in patients with oral sub-mucus fibrosis.

S-Adenosyl methionine (SAM), a universal methyl group donor, plays a vital role in biosynthesis and acts as an inhibitor to many enzymes. Due to protein interaction-dependent biological role, SAM has become a favorite target in various therapeutical and clinical studies such as treating cancer, Alzheimer's, epilepsy, and neurological disorders. Therefore, the identification of the SAM interacting proteins and their interaction sites is a biologically significant problem. However, wet-lab techniques, though accurate, to identify SAM interactions and interaction sites are tedious and costly. Therefore, efficient and accurate computational methods for this purpose are vital to the design and assist such wet-lab experiments. In this study, we present machine learning-based models to predict SAM interacting proteins and their interaction sites by using only primary structures of proteins. Here we modeled SAM interaction prediction through whole protein sequence features along with different classifiers. Whereas, we modeled SAM interaction site prediction through overlapping sequence windows and ranking with multiple instance learning that allows handling imprecisely annotated SAM interaction sites. Through a series of simulation studies along with biological significant evaluation, we showed that our proposed models give a state-of-the-art performance for both SAM interaction and interaction site prediction. Through data mining in this study, we have also identified various characteristics of amino acid sub-sequences and their relative position to effectively locate interaction sites in a SAM interacting protein. Python code for training and evaluating our proposed models together with a webserver implementation as SIP (Sam Interaction Predictor) is available at the URL: https://sites.google.com/view/wajidarshad/software., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Personalized hydration level monitoring play vital role in sports, health, wellbeing and safety of a person while performing particular set of activities. Clinical staff must be mindful of numerous physiological symptoms that identify the optimum hydration specific to the person, event and environment. Hence, it becomes extremely critical to monitor the hydration levels in a human body to avoid potential complications and fatalities. Hydration tracking solutions available in the literature are either inefficient and invasive or require clinical trials. An efficient hydration monitoring system is very required, which can regularly track the hydration level, non-invasively. To this aim, this paper proposes a machine learning (ML) and deep learning (DL) enabled hydration tracking system, which can accurately estimate the hydration level in human skin using galvanic skin response (GSR) of human body. For this study, data is collected, in three different hydration states, namely hydrated, mild dehydration (8 hours of dehydration) and extreme mild dehydration (16 hours of dehydration), and three different body postures, such as sitting, standing and walking. Eight different ML algorithms and four different DL algorithms are trained on the collected GSR data. Their accuracies are compared and a hybrid (ML+DL) model is proposed to increase the estimation accuracy. It can be reported that hybrid Bi-LSTM algorithm can achieve an accuracy of 97.83%., (© 2022. The Author(s).)

Acrylic resins-based artificial teeth are frequently used for the fabrication of dentures has and contribute a very strong share in the global market. However, the scientific literature reporting the comparative analysis data of various artificial teeth is scarce. Focusing on that, the present study investigated various types of commercially available artificial teeth, composed of polymethyl methacrylate (PMMA). Artificial teeth are characterized for chemical analysis, morphological features, thermal analysis, and mechanical properties (surface hardness, compressive strength). Different types of artificial teeth showed distinct mechanical (compression strength, Vickers hardness) and thermal properties (thermal gravimetric analysis) which may be attributed to the difference in the content of PMMA and type and quantity of different fillers in their composition. Thermogravimetric analysis (TGA) results exhibited that vinyl end groups of PMMA degraded above 200 °C, whereas 340-400 °C maximum degradation temperature was measured by differential thermal analysis (DTA) for all samples. Crisma brand showed the highest compressive strength and young modulus (88.6 MPa and 1654 MPa) while the lowest value of Vickers hardness was demonstrated by Pigeon and Vital brands. Scanning electron microscope (SEM) photographs showed that Crisma, Pigeon, and Vital exhibited characteristics of a brittle fracture; however, Artis and Well bite brands contained elongated voids on their surfaces. According to the mechanical analysis and SEM data, Well bite teeth showed a significantly higher mechanical strength compared to other groups. However, no considerable difference was observed in Vickers hardness of all groups. Graphical abstract., (© 2022. The Author(s).)

Background: COVID-19 has posed unique challenges for adolescents in different dimensions of their life including education, home and social life, mental and physical health. Whether the impact is positive or negative, its significance on the overall shaping of adolescents' lives cannot be overlooked. The aim of the present study was to explore impacts of the pandemic on the adolescents' everyday lives in Pakistan., Methods: Following ethical approval, this cross-sectional study was conducted through September to December, 2020 via an online survey on 842 adolescents with the mean age of 17.14 ± SD 1.48. Socio-demographic data and Epidemic Pandemic Impact Inventory-Adolescent Adaptation (EPII-A) was used to assess the multi-dimensional effects of the pandemic., Results: Among the 842 participants, 84% were girls. Education emerged as the most negatively affected Pandemic domain (41.6-64.3%). Most of the adolescents (62.0-65.8%) had reported changes in responsibilities at home including increased time spent in helping family members. Besides, increase in workload of participants and their parents was prominent (41.8% & 47.6%). Social activities were mostly halted for approximately half (41-51%) of the participants. Increased screen time, decreased physical activity and sedentary lifestyle were reported by 52.7%, 46.3% and 40.7% respectively. 22.2-62.4% of the adolescents had a direct experience with quarantine, while 15.7% experienced death of a close friend or relative. Positive changes in their lives were endorsed by 30.5-62.4% respondents. Being male and older adolescents had significant association with negative impact across most domains (p<0.05)., Conclusions: Results have shown that COVID-19 exert significant multidimensional impacts on the physical, psycho-social, and home related domains of adolescents that are certainly more than what the previous researches has suggested., Competing Interests: The authors have declared that no competing interests exist.

Though emergence of multi-drug resistant bacteria in the environment is a demonstrated worldwide phenomenon, limited research is reported about the prevalence of resistant bacteria in fecal ecology of neonatal calf diarrhea (NCD) animals in Pakistan. The present study aimed to identify and assess the prevalence of bacterial pathogens and their resistance potential in the fecal ecology of NCD diseased animals of Pakistan. The presence of antibiotic resistance genes (bla TEM , bla NDM-1 , bla CTX-M , qnrS) was also investigated. A total of 51 bacterial isolates were recovered from feces of young diarrheic animals (n = 11), collected from 7 cities of Pakistan and identified on the basis of 16S rRNA gene sequence and phylogenetic analysis. Selected isolates were subjected to antimicrobial susceptibility by disc diffusion method while polymerase chain reaction (PCR) was used to characterize the bla TEM , bla NDM-1 , bla CTX-M , qnrS and mcr-1 antibiotic resistance genes. Based on the 16S rRNA gene sequences (Accession numbers: LC488898 to LC488948), all isolates were identified that belonged to seventeen genera with the highest prevalence rate for phylum Proteobacteria and genus Bacillus (23%). Antibiotic susceptibility explained the prevalence of resistance in isolates ciprofloxacin (100%), ampicillin (100%), sulfamethoxazole-trimethoprim (85%), tetracycline (75%), amoxicillin (55%), ofloxacin (50%), ceftazidime (45%), amoxicillin/clavulanic acid (45%), levofloxacin (30%), cefpodoxime (25%), cefotaxime (25%), cefotaxime/clavulanic acid (20%), and imipenem (10%). MICs demonstrated that almost 90% isolates were multi-drug resistant (against at least three antibiotics), specially against ciprofloxacin, and tetracycline with the highest resistance levels for Shigella sp. (NCCP-421) (MIC-CIP up to 75 μg mL -1 ) and Escherichia sp. (NCCP-432) (MIC-TET up to 250 μg mL -1 ). PCR-assisted detection of antibiotic resistance genes showed that 54% isolates were positive for bla TEM gene, 7% isolates were positive for bla CTX-M gene, 23% isolates were positive for each of qnrS and mcr-1 genes, 23% isolates were co-positive in combinations of qnrS and mcr-1 genes and bla TEM and mcr-1 genes, whereas none of the isolate showed presence of bla NDM-1 gene., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of human mortality worldwide. Traditionally, estimating COPD severity has been done in controlled clinical conditions using cough sounds, respiration, and heart rate variability, with the latter reporting insights on the autonomic dysfunction caused by the disease. Advancements in remote monitoring and wearable device technologies, in turn, have allowed for remote COPD monitoring in daily life conditions. In this study, we explore the potential for predicting COPD severity and exacerbation using a low-cost wearable device that measures heart rate and activity data. We collected smartwatch sensor data from 35 COPD patients over a period of three months. Our evaluation shows that future trajectory of the disease can be predicted using only the first few days of continuous unobtrusive wearable data collected from COPD patients. Using features extracted from wearable device an Isolation Forest was able to predict exacerbation with an area under curve (AUC) 0.69 thus showing improvement over a random choice classifier.

As early intervention is highly effective for young children with autism spectrum disorder (ASD), it is imperative to make accurate diagnosis as early as possible. ASD has often been associated with atypical visual attention and eye gaze data can be collected at a very early age. An automatic screening tool based on eye gaze data that could identify ASD risk offers the opportunity for intervention before the full set of symptoms is present. In this paper, we propose two machine learning methods, synthetic saccade approach and image based approach, to automatically classify ASD given children's eye gaze data collected from free-viewing tasks of natural images. The first approach uses a generative model of synthetic saccade patterns to represent the baseline scan-path from a typical non-ASD individual and combines it with the real scan-path as well as other auxiliary data as inputs to a deep learning classifier. The second approach adopts a more holistic image-based approach by feeding the input image and a sequence of fixation maps into a convolutional or recurrent neural network. Using a publicly-accessible collection of children's gaze data, our experiments indicate that the ASD prediction accuracy reaches 67.23% accuracy on the validation dataset and 62.13% accuracy on the test dataset., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Background: Plant cell walls are the main physical barrier encountered by pathogens colonizing plant tissues. Alteration of cell wall integrity (CWI) can activate specific defenses by impairing proteins involved in cell wall biosynthesis, degradation and remodeling, or cell wall damage due to biotic or abiotic stress. Polygalacturonase (PG) depolymerize pectin by hydrolysis, thereby altering pectin composition and structures and activating cell wall defense. Although many studies of CWI have been reported, the mechanism of how PGs regulate cell wall immune response is not well understood., Results: Necrosis appeared in leaf tips at the tillering stage, finally resulting in 3-5 cm of dark brown necrotic tissue. ltn-212 showed obvious cell death and accumulation of H 2 O 2 in leaf tips. The defense responses were activated in ltn-212 to resist bacterial blight pathogen of rice. Map based cloning revealed that a single base substitution (G-A) in the first intron caused incorrect splicing of OsPG1, resulting in a necrotic phenotype. OsPG1 is constitutively expressed in all organs, and the wild-type phenotype was restored in complementation individuals and knockout of wild-type lines resulted in necrosis as in ltn-212. Transmission electron microscopy showed that thicknesses of cell walls were significantly reduced and cell size and shape were significantly diminished in ltn-212., Conclusion: These results demonstrate that OsPG1 encodes a PG in response to the leaf tip necrosis phenotype of ltn-212. Loss-of-function mutation of ltn-212 destroyed CWI, resulting in spontaneous cell death and an auto-activated defense response including reactive oxygen species (ROS) burst and pathogenesis-related (PR) gene expression, as well as enhanced resistance to Xanthomonas oryzae pv. oryzae (Xoo). These findings promote our understanding of the CWI mediated defense response.

Early diagnosis of Autism Spectrum Disorder (ASD) is crucial for best outcomes to interventions. In this paper, we present a machine learning (ML) approach to ASD diagnosis based on identifying specific behaviors from videos of infants of ages 6 through 36 months. The behaviors of interest include directed gaze towards faces or objects of interest, positive affect, and vocalization. The dataset consists of 2000 videos of 3-minute duration with these behaviors manually coded by expert raters. Moreover, the dataset has statistical features including duration and frequency of the above mentioned behaviors in the video collection as well as independent ASD diagnosis by clinicians. We tackle the ML problem in a two-stage approach. Firstly, we develop deep learning models for automatic identification of clinically relevant behaviors exhibited by infants in a one-on-one interaction setting with parents or expert clinicians. We report baseline results of behavior classification using two methods: (1) image based model (2) facial behavior features based model. We achieve 70% accuracy for smile, 68% accuracy for look face, 67% for look object and 53% accuracy for vocalization. Secondly, we focus on ASD diagnosis prediction by applying a feature selection process to identify the most significant statistical behavioral features and a over and under sampling process to mitigate the class imbalance, followed by developing a baseline ML classifier to achieve an accuracy of 82% for ASD diagnosis.

This study was conducted to investigate the physicochemical, phytochemical, in vitro antidiabetic and anticancer potential of Olea ferruginea R bark. After extraction using Soxhlet, in vitro antidiabetic and cytotoxic activity on human hepatocellular carcinoma (HepG2) cells was assessed by nonenzymatic glycosylation of hemoglobin assay, alpha-amylase inhibition assay, glucose uptake by yeast cells, and 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide assay, respectively, and gene expression via real-time polymerase chain reaction. Primary and secondary metabolites were present in the extractants; polyphenols (35.61 ± 0.03) and flavonoids (64.33 ± 0.35 ) in the chloroform; and polysaccharides in the ethanol (268.75 ± 0.34), and glycosaponins (78.01 ± 0.07) in the methanol. The chloroform extract exhibited maximum antidiabetic potential, showing inhibition of nonenzymatic glycosylation of hemoglobin (65%), and alpha-amylase inhibition (32%) with maximum percent glucose uptake by the ethanol extract (78%). Only the ethanol extract had dose-dependent cytotoxic potential against the HepG2 cells. After 24-h exposure to the ethanol-extract, the expression of protein kinase B (Akt) remained unchanged, while the expression of B-cell lymphoma 2 (BCL2) and BCL2 associated X (BAX) changed significantly. After 48-h exposure, the expression of Akt decreased significantly, while that of BCL2 and BAX increased significantly. Olea ferruginea R bark possessed in vitro antidiabetic potential and anticancer/cytotoxic effects, attributable to the decline in the prosurvival signals of the Akt signaling pathway., Competing Interests: CONFLICT OF INTEREST: none declared, (Copyright © 2021 The Author(s).)

Background: Punjab is the most populous province of Pakistan, with only 12 countries in the world succeeding it in terms of population., Aims: This review article has the objective of providing novel statistics regarding available cancer therapeutics in Punjab across four different sectors-including government, semi-private, trust and private sectors., Methods and Results: Keywords such as "cancer treatment," "facilities," "Pakistan," were used to search Pubmed Database. 36 results were generated: after sifting based on a personal reference list as well as for relevance, 16 articles were finally reviewed. Novel statistics regarding current state of access to cancer facilities were drawn from personal references as well as from studies conducted in other LMICs. There is a gross deficit of oncological services in Punjab, with the ratio of medical oncologists to population being 0.027 per 100, 000, and every oncologist checking 1300-1500 patients annually. Only 21.4% of the population has access to radiotherapy facilities. Major problems include lack of healthcare professional awareness; poor infrastructure including drug access, radiotherapy, and cancer pain management facilities; lack of planning; and lack of educational and research programs., Conclusions: Improving education & training, developing infrastructure based on public-private-partnership models, building cancer registries and organizing national cancer screening programs, as well as encouraging basic health education and research in oncology, are measures that can ensure Punjab's healthcare delivery system becomes capable of handling increasing incident burden of cancer., (© 2020 Wiley Periodicals LLC.)

Seamless sharing between imaging facilities of medical images obtained on the same patient is crucial in providing accurate and efficient care to patients. However, the terminology used to describe semantically similar examinations can vary widely between facilities. Current practice is manual table-based mapping to a standard terminology, which has substantial potential for mislabelled and missing examinations. In this work, we establish several baseline methods for automating the mapping of radiology imaging procedure descriptions to a SNOMED CT based standard terminology. Our best performing baseline, consisting of a bag of words representation and shallow neural network, achieved 96.3% accuracy. In addition, we explore an unsupervised clustering method that explores relevancy matching without the need for an intervening standard. Lastly, we make the procedure name dataset used in this work available to encourage extension of this application., (©2020 AMIA - All rights reserved.)

Signs of autism spectrum disorder (ASD) emerge in the first year of life in many children, but diagnosis is typically made much later, at an average age of 4 years in the United States. Early intervention is highly effective for young children with ASD, but is typically reserved for children with a formal diagnosis, making accurate identification as early as possible imperative. A screening tool that could identify ASD risk during infancy offers the opportunity for intervention before the full set of symptoms is present. In this paper, we propose two machine learning methods, synthetic saccade approach and image based approach, to automatically classify ASD given the scanpath data from children on free viewing of natural images. The first approach uses a generative model of synthetic saccade patterns to represent the baseline scan-path from a typical non-ASD individual and combines it with the input scanpath as well as other auxiliary data as inputs to a deep learning classifier. The second approach adopts a more holistic image based approach by feeding the input image and a sequence of fixation maps into a state-of-the-art convolutional neural network. Our experiments indicate that we can get 65.41% accuracy on the validation dataset.

Gram-negative infections are a rising concern faced by the medical community. Approximately 30% of nosocomial bloodstream infections in intensive care units in the United States are caused by these gram-negative species. Emergence of multidrug-resistant organisms further complicate this issue. In this article, we report a case of an 84-year-old Caucasian male who was diagnosed with Shewanella pneumonia treated with cefepime with minimal to no improvement in his symptoms. To the best of our knowledge, this is the third reported case of Shewanella putrefaciens nosocomial pneumonia and first case of bacteremia secondary to pneumonia by Shewanella putrefaciens ., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Honey clasps several medicinal and health effects as a natural food supplement. It has been established as a potential therapeutic antioxidant agent for various biodiverse ailments. Data report that it exhibits strong wound healing, antibacterial, anti-inflammatory, antifungal, antiviral, and antidiabetic effects. It also retains immunomodulatory, estrogenic regulatory, antimutagenic, anticancer, and numerous other vigor effects. Data also show that honey, as a conventional therapy, might be a novel antioxidant to abate many of the diseases directly or indirectly associated with oxidative stress. In this review, these wholesome effects have been thoroughly reviewed to underscore the mode of action of honey exploring various possible mechanisms. Evidence-based research intends that honey acts through a modulatory road of multiple signaling pathways and molecular targets. This road contemplates through various pathways such as induction of caspases in apoptosis; stimulation of TNF- α , IL-1 β , IFN- γ , IFNGR1, and p53; inhibition of cell proliferation and cell cycle arrest; inhibition of lipoprotein oxidation, IL-1, IL-10, COX-2, and LOXs; and modulation of other diverse targets. The review highlights the research done as well as the apertures to be investigated. The literature suggests that honey administered alone or as adjuvant therapy might be a potential natural antioxidant medicinal agent warranting further experimental and clinical research.

Purpose: This study developed light cured dental composites with added monocalcium phosphate monohydrate (MCPM), tristrontium phosphate (TSrP) and antimicrobial polylysine (PLS). The aim was to produce composites that have enhanced water sorption induced expansion, can promote apatite precipitation and release polylysine., Materials and Methods: Experimental composite formulations consisted of light activated dimethacrylate monomers combined with 80 wt% powder. The powder phase contained a dental glass with and without PLS (2.5 wt%) and/or reactive phosphate fillers (15 wt% TSrP and 10 wt% MCPM). The commercial composite, Z250, was used as a control. Monomer conversion and calculated polymerization shrinkage were assessed using FTIR. Subsequent mass or volume changes in water versus simulated body fluid (SBF) were quantified using gravimetric studies. These were used, along with Raman and SEM, to assess apatite precipitation on the composite surface. PLS release was determined using UV spectroscopy. Furthermore, biaxial flexural strengths after 24 hours of SBF immersion were obtained., Results: Monomer conversion of the composites decreased upon the addition of phosphate fillers (from 76 to 64%) but was always higher than that of Z250 (54%). Phosphate addition increased water sorption induced expansion from 2 to 4% helping to balance the calculated polymerization shrinkage of ~ 3.4%. Phosphate addition promoted apatite precipitation from SBF. Polylysine increased the apatite layer thickness from ~ 10 to 20 μm after 4 weeks. The novel composites showed a burst release of PLS (3.7%) followed by diffusion-controlled release irrespective of phosphate addition. PLS and phosphates decreased strength from 154 MPa on average by 17% and 18%, respectively. All formulations, however, had greater strength than the ISO 4049 requirement of > 80 MPa., Conclusion: The addition of MCPM with TSrP promoted hygroscopic expansion, and apatite formation. These properties are expected to help compensate polymerization shrinkage and help remineralize demineralized dentin. Polylysine can be released from the composites at early time. This may kill residual bacteria., Competing Interests: The work is covered by the following licensed patent families: Formulations and composites with reactive fillers (US8252851 B2, EP2066703B1, US20100069469, WO2008037991A1), and Formulations and materials with cationic polymers (PCT/GB2014/052349, WO2015015212 A1, EP3027164A1, US20160184190). This may be considered a conflict of interest as in the future the corresponding author (Anne Young) may receive royalties when a commercial product is produced. This author currently has funding from NIHR and is working with Schottlander Dental Company to optimize a similar product to those in the publication. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Studies on polymorphism of estrogen receptor (ESR) alpha and beta genes have been mostly implicated in infertility, but the results have been controversial due to lack of comprehensive data. The present study focused on association of ESR genes with both male and female infertility. In ESRα, PvuII (rs2234693) and XbaI (rs9340799) were studied while in ESRβ gene, risk of infertility was determined for silent G/A RsaI (rs1256049) polymorphism. Total 124 subjects (74 cases and 50 controls) were part of this study having primary infertility. Restriction fragment length polymorphism (RFLP) was performed with PvuII, XbaI and RsaI to determine polymorphism. Correlation between age and follicle stimulating hormone (FSH) of cases and controls was determined and no association was found between infertility and FSH hormone. Heterozygous AG genotype of XbaI polymorphism (P= 2.505e-06) and heterozygous TC genotype (P= 0.00003) in PvuII polymorphism were strongly associated with risk of infertility. In ESRβ gene, there was lack of polymorphism for RsaI in our population as all subjects were homozygous (GG). Haplotype frequencies showed that XbaI and PvuII polymorphisms are in strong linkage disequilibrium. This study shows that in our population XbaI and PvuII polymorphisms of ESRα are associated with risk of infertility.

Osteopetrosis is a hereditary disorder of bone characterized by sclerosis of bone and decreased marrow spaces. Due to depressed marrow function, this disorder can cause anemia, hepatosplenomegaly, recurrent infections and osteomyelitis of jaw. Excessive bone deposition in skull base leads to narrowing of foramina and cranial nerve compression. Bone marrow transplantation is the only curative treatment. Other treatments, like interferon gamma, corticosteroids, parathormone and erythropoietin are also used for management. Transfusion of blood, debridement of wound and antibiotics is used to manage complications. Due to its rarity, it is always difficult to diagnose osteopetrosis. Proper diagnosis and treatment decreases the long-term sequelae of the disease.

Novel, quinolone-fluoroquinolone conjugates 10a-f, 11a-f, 13a-f and 14a-f with amino acid linkers were synthesized in good yields utilizing benzotriazole chemistry. Antibacterial bioassay showed the synthesized bis-conjugates exhibit anti-bacterial properties comparable with the parent drugs., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Primary healthcare (PHC) workers often work alone or in isolation. Healthcare managerial supervision is recommended to help assure quality; but this requires skilled supervisors and takes time and resources. It is therefore important to assess to what extent supervision is beneficial and the ways in which it can be implemented., Objectives: To review the effects of managerial supervision of health workers to improve the quality of PHC (such as adherence to guidance or coverage of services) in low- and middle-income countries., Search Strategy: We searched The Cochrane Central Register of Controlled Trials (CENTRAL) 2011, Issue 1, part of The Cochrane Library. www.thecochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 10 March 2011); MEDLINE, Ovid 1950 to March Week 1 2011 (searched 08 March 2011); EMBASE, Ovid 1980 to 2011 Week 12 (searched 08 March 2011); CINAHL, Ebsco 1981 - present (searched 10 March 2011); LILACS, VHL (searched 10 March 2011)., Selection Criteria: Randomised controlled trials, controlled before-and-after studies, and interrupted time series studies, conducted in PHC in low- and middle-income countries. Supervision includes site visits from a central level of the health system, plus at least one supervisory activity. We excluded studies aimed solely at improving the clinical skills of PHC workers., Data Collection and Analysis: We extracted data using a predefined form and assessed for risk of bias using the EPOC risk of bias criteria. Data are presented in a narrative way without pooling the effects on the outcomes as studies and outcomes were diverse., Main Results: Nine studies met the inclusion criteria: three compared supervision with no supervision, five compared enhanced supervision with routine supervision, and one study compared less intensive supervision with routine supervision. Most outcomes were scores relating to providers' practice, knowledge and provider or user satisfaction. The majority of the outcomes were measured within nine months after the interventions were introduced. In two studies comparing supervision with no supervision, small benefits on provider practice and knowledge were found. For methods of enhancing supervision, we identified five studies, and two studies of frequent supportive supervision demonstrated small benefits on workers performance. The one study examining the impact of less intensive supervision found no evidence that reducing the frequency of visits had any effect on the utilisation of services. The GRADE evidence quality for all comparisons and outcomes was "low" or "very low"., Authors' Conclusions: It is uncertain whether supervision has a substantive, positive effect on the quality of primary health care in low- and middle-income countries. The long term effectiveness of supervision is unknown.

Distraction osteogenesis (DO) is a surgical process in which two bony segments are gradually separated so new soft tissue and bone will form between them by applying tension through a fixation device. There are three phases to this process: latency phase, distraction phase, and consolidation phase. The technique was originally applied to long bones but in recent years the method has been adapted for use in maxillofacial surgery. Distraction osteogenesis is a new variation of more traditional; orthognathic surgical procedures which can be applied for the correction of dento-facial deformities and syndromes of the jaws, treating upper airway obstruction in paediatric patients with mandibualr retrognathia, due to tongue collapse and physical obstruction in the hypopharangeal region. It is an effective and powerful reconstructive surgical technique, which can be performed safely without the need of bone graft or blood transfusion. We present treatment of a child with severe facial asymmetry after unilateral TMJ ankylosis corrected bydistraction osteogenesis.