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Delirium is a common, often preventable fluctuating state of cognition associated with increased morbidity and mortality. This report describes the implementation of an interprofessional consultative Delirium Team formed to improve the prevention, detection, and management of delirium in a community hospital. Team members consulted refered inpatients with delirium to establish a care plan and provide recommendations for pharmacological and non-pharmacological management. The team also offered delirium-related education to unit staff, patients, and caregivers. Consultations were initially completed by the team Nurse Practitioner or Occupational Therapist, and complex patients were discussed with the team Geriatrician and Psychiatrist at rounds to optimize specialist input. Of the 160 patients managed by the team over the 8-month study period, two-thirds of referred patients did not require specialist consultation for their delirium management. Strategies most often recommended by experts for managing delirium were related to medical management, social/cognitive engagement, and functional mobility. Two-thirds of all recommendations made by the team were implemented. Barriers and facilitators to implementation and improving unit staff adherence are further described. The consultative Delirium Team is a promising model that should be further explored for managing an aging population in a capacity-limited medical system.

Intravascular diffuse large B-cell lymphoma is an exceedingly rare subtype of B-cell lymphomas. This cancer is often associated with poor prognosis and can be lethal if left untreated. Intravascular diffuse large B-cell lymphoma is divided into three variants: the ‘classical variant’, the hemophagocytic syndrome-associated variant or ‘Asian variant’, and the ‘cutaneous variant’, according to the clinical presentation and affected organs. We present a unique case of ‘classic variant’ intravascular diffuse large B-cell lymphoma with cutaneous findings, peripheral nervous system involvement and acquired ichthyosis in a patient of Asian descent. This case highlights the importance of a prompt dermatology consultation in the diagnosis of intravascular diffuse large B-cell lymphoma. As bone marrow biopsy is often negative, clinicians must recognize the cutaneous findings and acknowledge that skin biopsy can be an essential tool to establish the diagnosis rapidly. Additional finding making this case unique is the concurrent presence of acquired ichthyosis, which has only been previously reported in one case of intravascular diffuse large B-cell lymphoma.

This article contains results of the existence of fuzzy fixed points of fuzzy mappings that satisfy certain contraction conditions using the platform of partial b-metric spaces. Some non-trivial examples are provided to authenticate the main results. The constructed results in this work will likely stimulate new research directions in fuzzy fixed-point theory and related hybrid models. Eventually, some fixed-point results on multivalued mappings are established. These theorems provide an excellent application of main theorems on fuzzy mappings. The results of this article are extensions of many already existing results in the literature.

Introduction Sustainable livelihood approach is one of the new approaches in sustainable rural development that has been considered to reduce poverty and rural development. This approach focuses on the diversity and increase of various rural activities and emphasizes the diversity and increase of various rural activities. Sustaining the sustainable livelihood of the villagers in today's world is one of the priorities that should use the various assets (natural, human, financial, physical and social) of the villagers to improve and enhance their livelihood. The general purpose of this study is to evaluate the living conditions of rural communities in Darrehshahr city using SLF approach and CIPP model. Took. The total size of the statistical population was 16.140 households and the sample size was determined using Cochran's formula of 380 people.To analyze the data, descriptive and inferential statistical methods were used using SPSS software. The obtained results show that there is a significant difference between the studied villages in terms of livelihood assets. Friedman test also shows that the share of natural assets is higher in the studied villages and the share of human, social, natural, physical and financial assets is 3.39, 3.30, 3.59, 1.33, 3.39, respectively. Data and Method The present research is non-experimental in terms of application type, non-experimental in terms of data collection and survey type. The statistical population of the study includes 16140 rural households living in Darhshahr city, which has a population of about 58429. The sample size was obtained based on Cochran's formula of 380 households. The data collection tool in this study is a structured and researcher-made questionnaire. SPSS software was used to analyze the data. The collection tools in this research include library and field methods. The validity of the questionnaire was confirmed using a panel of experts, and for the reliability of Cronbach's alpha used, its total value (0.73) was obtained. The independent variables of this research include five variables (human, physical, social, natural and financial) and the dependent variable is sustainable livelihood. The following hypotheses have been used in this study. Results and Discussion The results show that among 380 respondents, 60.86% were men and 90.12% were women, of which 2.14% were literate, 17.4% were middle school students, 9.33% were diploma students, and 6.6% were graduates. , 14.2% were associates and 6.6% were bachelors and above. Also, 3.70% were self-employed, 3.19% were government employees, 8.5% were retired, 1.8% were unemployed and 9.2% were students. Conclusion Regarding physical capital, the findings showed that the situation of marketing of agricultural products and products and the infrastructure of agricultural activities is very weak, while the main livelihood of the villages under study is provided by agriculture. . Regarding the natural factors, the findings showed that the recent droughts have had the greatest impact on the living conditions of the studied villages, which is consistent with the results of Bazrafshan et al. 1397 and Darban Astana et al., 1397. Regarding financial factors, the findings showed that fluctuations related to agricultural products have a great impact on people's lives. Also, the findings showed that investment to create employment by the government and the willingness of the private sector to invest in the villages studied is very low It is very high, which is consistent with the results of research by Weiss et al., 2017 . Regarding humanities, the findings showed that the level of access to educational services on livelihood and employment issues, unemployment rate at different ages and the status of courses and educational programs related to livelihood is very low. Which is in accordance with the results of Jamehpour and Ahmadi research, 2011. Also, the spirit of cooperation and cooperation and family relations among the residents of the studied villages is high in terms of livelihood activities, which is consistent with the results of Bazrafshan et al. 1397. Regarding social factors, the findings showed that the tendency of villagers to urban life and the departure of labor and youth migration to urban areas is very high, which contradicts the results of research by Jomehpour and Ahmadi, 2011. Also, the level of use of media and social networks is very low.

Abstract Background The Global Initiative for Asthma has only recently added tiotropium bromide as adjunct controller therapy in severe asthma (Step 4 or 5) in adults (2015) and children (2019). Although not yet approved for pediatric use by Health Canada, it has been occasionally offered by asthma specialists as a therapeutic trial in children with troublesome asthma or treatment for adverse effects. The objective of this study was to describe the indications and real-life clinical experience in initiating tiotropium in children with asthma. Methods We designed a retrospective mixed-method case series study of children aged 1–17 years who initiated tiotropium in our tertiary-care centre between 2013 and 2020. Clinical information was extracted from electronic medical records and tiotropium dispensing, from drug claims. Parents/children and physicians independently completed a questionnaire about treatment goals, perceived efficacy, safety, satisfaction, and lessons learned. Results The 34 (11 females; 23 males) children had a median (range) age of 9.1 (1.4–17.8) years. Children were primarily on Step 4 (85%) or 5 (6%) prior to tiotropium initiation, yet most (84%) did not increase their treatment step after tiotropium initiation. The physicians’ treatment goals were to improve asthma control, alleviate adverse effects of current therapy, and/or improve lung function. The most improved symptoms were coughing/moist cough, difficulty breathing, whistling breath, and bronchial secretions/mucus. Although most parents and physicians reported a significant benefit with tiotropium bromide, physicians particularly remarked, as their “lesson learned’, on the improvement in chronic symptoms in asthmatic children, particularly those with prominent moist cough and in lung function, in those with seemingly none (or incompletely) reversible obstruction as well as the ability to decrease the ICS and/or LABA dose to lessen adverse effects. A few physicians raised caution on the risk of lower adherence with an additional inhaler. Conclusion In children with severe asthma on Step 4 or 5, tiotropium bromide was primarily used as substitute, rather than additional, adjunct therapy to improve asthma control, alleviate adverse effects, and/or to improve lung function. The latter two indications, combined with its perceived effectiveness in children with prominent moist cough, also suggest additional indications of tiotropium to be formally explored.

Objective: To examine the clinical severity and magnitude of COVID-19 patients after the second dose of the COVID-19 vaccine. Study Design: Cross-sectional study. Place and Duration of Study: Tertiary Care Hospital, Islamabad Pakistan, from Feb to Jun 2021. Methodology: The individuals who had two doses of the vaccine (dead inactivated- Vero Cell) and got COVID-19 at least two weeks after vaccination were included in the study. These patients were divided into Mild, Moderate and Severe categories based on their symptoms and Investigations. Results: Out of 5000 individuals vaccinated, 225(4.5%) got infected with COVID-19 later. Among these 225, 172(76.4%) had mild symptoms and recovered, with only 1(0.4%) death was reported. Conclusion: COVID-19 vaccination does not infer 100% immunity, but if someone gets infected with COVID after vaccination,there are remarkable chances of recovery.

The alfalfa plant, after harvesting, was washed, dried, and grinded to get fine powder used in water treatment. We used the alfalfa plant with ethanol to make the alcoholic extract characterized by using (GC-Mass, FTIR, and UV) spectroscopy to determine active compounds. Alcoholic extract was used to prepare zinc nanoparticles. We characterized Zinc nanoparticles using (FTIR, UV, SEM, EDX Zeta potential, XRD, AFM). Zinc nanoparticle with Alfalfa extract and alfalfa powder were used in the treatment of water polluted with inorganic elements such as Cr, Mn, Fe, Cu, Cd, Ag by (Batch processing). The batch process with using alfalfa powder gets treated with Pb (51.45%), which is the highest percentage of treatment. Mn (13.18%), which is the lowest percentage of treatment. The batch process with using Zinc nanoparticles gets the result treated with Pb(98.822%), which is the highest percentage of treatment, and Mn (10.31%), which is the lowest percentage of treatment. When comparing alfalfa powder and zinc nanoparticle, it has been found that the treatment with zinc nanoparticle is more efficient in the removal of inorganic pollutants.

Introduction: Since the 1960s, lasers have been used in dentistry, and their clinical uses have been evaluated. Many dental procedures involve lasers, which are noted for their simplicity, efficiency, comfort, and superiority over older methods. Lasers have been employed in various therapy approaches, from identifying small caries to planning and treating more severe lesions or cancers. Methodology: To conduct a comprehensive search for our systematic review, we employed three search engines: PubMed, Cochrane, and Google Scholar. Following combinations; Lasers [general dentistry], Laser [soft tissue], and Laser [hard tissue], published in the last five years. After applying inclusion-exclusion criteria, 46 original articles were studied in detail. Objective: The systematic review aimed to study the long-term outcomes of lasers on soft and hard tissues in dentistry. Result: Tooth decay, gum disease, biopsy or lesion removal, teeth whitening, and other procedures are performed using lasers. Lasers are frequently utilized because they cause less pain, require less anesthesia and avoid anxiety in patients who are afraid of dental drills and instruments. Conclusion: Laser technology in clinical dentistry practice is currently at an advanced stage of development and has a bright future. With the expanding use of lasers on both hard and soft tissue in clinical dentistry, treatment planning and prognosis have significantly improved.

Fluorine is characterized by high electronegativity and small atomic size, which provide this molecule with the unique property of augmenting the potency, selectivity, metabolic stability, and pharmacokinetics of drugs. Fluorine (F) substitution has been extensively explored in drug research as a means of improving biological activity and enhancing chemical or metabolic stability. Selective F substitution onto a therapeutic or diagnostic drug candidate can enhance several pharmacokinetic and physicochemical properties such as metabolic stability and membrane permeation. The increased binding ability of fluorinated drug target proteins has also been reported in some cases. An emerging line of research on F substitution has been addressed by using 18F as a radiolabel tracer atom in the extremely sensitive methodology of positron emission tomography (PET) imaging. This review aims to report on the fluorinated drugs approved by the US Food and Drug Administration (FDA) from 2016 to 2022. It cites selected examples from a variety of therapeutic and diagnostic drugs. FDA-approved drugs in this period have a variety of heterocyclic cores, including pyrrole, pyrazole, imidazole, triazole, pyridine, pyridone, pyridazine, pyrazine, pyrimidine, triazine, purine, indole, benzimidazole, isoquinoline, and quinoline appended with either F-18 or F-19. Some fluorinated oligonucleotides were also authorized by the FDA between 2019 and 2022.

Background: Lung cancer is one of the most fatal cancers worldwide, and malignant tumors are characterized by the growth of abnormal cells in the tissues of lungs. Usually, symptoms of lung cancer do not appear until it is already at an advanced stage. The proper segmentation of cancerous lesions in CT images is the primary method of detection towards achieving a completely automated diagnostic system. Method: In this work, we developed an improved hybrid neural network via the fusion of two architectures, MobileNetV2 and UNET, for the semantic segmentation of malignant lung tumors from CT images. The transfer learning technique was employed and the pre-trained MobileNetV2 was utilized as an encoder of a conventional UNET model for feature extraction. The proposed network is an efficient segmentation approach that performs lightweight filtering to reduce computation and pointwise convolution for building more features. Skip connections were established with the Relu activation function for improving model convergence to connect the encoder layers of MobileNetv2 to decoder layers in UNET that allow the concatenation of feature maps with different resolutions from the encoder to decoder. Furthermore, the model was trained and fine-tuned on the training dataset acquired from the Medical Segmentation Decathlon (MSD) 2018 Challenge. Results: The proposed network was tested and evaluated on 25% of the dataset obtained from the MSD, and it achieved a dice score of 0.8793, recall of 0.8602 and precision of 0.93. It is pertinent to mention that our technique outperforms the current available networks, which have several phases of training and testing.

The skin is an organ involved in several biological processes essential to the proper functioning of the organism. One of these essential biological functions of the skin is its barrier function, mediated notably by the lipids of the stratum corneum, and which prevents both penetration from external aggression, and transepidermal water loss. Bioactive lipid mediators derived from polyunsaturated fatty acids (PUFAs) constitute a complex bioactive lipid network greatly involved in skin homeostasis. Bioactive lipid mediators derived from n-3 and n-6 PUFAs have well-documented anti- and pro-inflammatory properties and are recognized as playing numerous and complex roles in the behavior of diverse skin diseases, including psoriasis. Psoriasis is an inflammatory autoimmune disease with many comorbidities and is associated with enhanced levels of pro-inflammatory lipid mediators. Studies have shown that a high intake of n-3 PUFAs can influence the development and progression of psoriasis, mainly by reducing the severity and frequency of psoriatic plaques. Herein, we provide an overview of the differential effects of n-3 and n-6 PUFA lipid mediators, including prostanoids, hydroxy-fatty acids, leukotrienes, specialized pro-resolving mediators, N-acylethanolamines, monoacylglycerols and endocannabinoids. This review summarizes current findings on lipid mediators playing a role in the skin and their potential as therapeutic targets for psoriatic patients.

Cotton leaf curl virus (CLCuV) causes devastating losses to fiber production in Central Asia. Viral spread across Asia in the last decade is causing concern that the virus will spread further before resistant varieties can be bred. Current development depends on screening each generation under disease pressure in a country where the disease is endemic. We utilized quantitative trait loci (QTL) mapping in four crosses with different sources of resistance to identify single nucleotide polymorphism (SNP) markers associated with the resistance trait to allow development of varieties without the need for field screening every generation. To assist in the analysis of multiple populations, a new publicly available R/Shiny App was developed to streamline genetic mapping using SNP arrays and to also provide an easy method to convert and deposit genetic data into the CottonGen database. Results identified several QTL from each cross, indicating possible multiple modes of resistance. Multiple sources of resistance would provide several genetic routes to combat the virus as it evolves over time. Kompetitive allele specific PCR (KASP) markers were developed and validated for a subset of QTL, which can be used in further development of CLCuV-resistant cotton lines.

Carbapenem resistance has become major concern in healthcare settings globally; therefore, its monitoring is crucial for intervention efforts to halt resistance spread. During May 2019–April 2022, 2170 clinical strains were characterized for antimicrobial susceptibility, resistance genes, replicon and sequence types. Overall, 42.1% isolates were carbapenem-resistant, and significantly associated with Klebsiella pneumoniae (K. pneumoniae) (p = 0.008) and Proteus species (p = 0.043). Carbapenemases were detected in 82.2% of isolates, with blaNDM-1 (41.1%) associated with the ICU (p < 0.001), cardiology (p = 0.042), pediatric medicine (p = 0.013) and wound samples (p = 0.041); blaOXA-48 (32.6%) was associated with the ICU (p < 0.001), cardiology (p = 0.008), pediatric medicine (p < 0.001), general surgery (p = 0.001), general medicine (p = 0.005) and nephrology (p = 0.020); blaKPC-2 (5.5%) was associated with general surgery (p = 0.029); blaNDM-1/blaOXA-48 (11.4%) was associated with general surgery (p < 0.001), and wound (p = 0.002), urine (p = 0.003) and blood (p = 0.012) samples; blaOXA-48/blaVIM (3.1%) was associated with nephrology (p < 0.001) and urine samples (p < 0.001). Other detected carbapenemases were blaVIM (3.0%), blaIMP (2.7%), blaOXA-48/blaIMP (0.1%) and blaVIM/blaIMP (0.3%). Sequence type (ST)147 (39.7%) represented the most common sequence type identified among K. pneumoniae, along with ST11 (23.0%), ST14 (15.4%), ST258 (10.9%) and ST340 (9.6%) while ST405 comprised 34.5% of Escherichia coli (E. coli) isolates followed by ST131 (21.2%), ST101 (19.7%), ST10 (16.0%) and ST69 (7.4%). Plasmid replicon types IncFII, IncA/C, IncN, IncL/M, IncFIIA and IncFIIK were observed. This is first report describing the carbapenem-resistance burden and emergence of blaKPC-2-ST147, blaNDM-1-ST340 and blaNDM-1-ST14 in K. pneumoniae isolates and blaNDM-1-ST69 and blaNDM-1/blaOXA-48-ST69 in E. coli isolates coharboring extended-spectrum beta-lactamases (ESBLs) from Pakistan.

The pace of daily life and its requirements are getting higher and are led by technology with its direct effects on the health of the individual. There is no doubt that its benefits are endless but its negative effects on the health of the user have become clear, to reduce the negative energy accompanying it to the lowest level by facing another positive energy that is superior to restore the balance first, and overcome it to be the dominant feature of space, the house is the most important place where individuals spend most of their time, which imposes on the designer not be specialized not only to the forms and relations but beyond to form the modern house itself with power to reset the balance of life in general. The house based on Islamic foundations is featured with great energy that has been reflected as positive energy on the residents which is necessitated studying to use in the formation of modern houses with energy. The problem of research was (a knowledge gap about the energy sources in the house according to the Islamic perspective and employment it in the contemporary house). The research aims to study the house in accordance with the Islamic perspective and its relation to energy and determine the elements of its composition and organization through a theoretical framework for the process of energy composition of the Islamic house and the revealing what is verified in contemporary production, the study concluded to depending on forming the house with energy since the beginning of the design process as one of the constants and at different horizontal and vertical levels of housing units because of their effectiveness in promoting the positive energy of the resident.

IntroductionSince its approval for adults with moderate-to-severe atopic dermatitis (AD) in 2017, dupilumab has been incorporated into clinical practice guidelines (CPGs). However, recommendations differ internationally, and the quality assessment of their development is unclear.ObjectiveWe aimed to systematically review and appraise the quality of CPGs for adult AD reported since 2017 and map the recommendations for dupilumab initiation relative to conventional systemic therapy (CST).Materials and MethodsA literature search was conducted in June 2020 in MEDLINE, EMBASE, SCOPUS, and CINAHL. Twelve CPGs were retrieved. Methodological quality was assessed using the validated Appraisal of Guidelines for Research & Evaluation II tool (AGREE-II). Recommendations were extracted and compared.ResultsAGREE-II median scores per domain of the CPGs were (%, r = range): scope/purpose, 78% (50–96); stakeholder involvement, 54% (28–85); rigor of development, 39% (21–63); clarity of presentation, 85% (69–100); applicability, 27% (6–51); and editorial independence, 76% (42–100). Neither met the threshold of 70% quality criteria for rigor of development nor the applicability domains. Three CPGs met the criteria for recommendation without modification. CPGs' approach to dupilumab initiation was as follows: second line, preferred over CST and nbUVB (n = 1/12 CPG); second line, equivalent to CST or nbUVB (n = 3/12 CPGs); third line, after nbUVB or CST (n = 5/12 CPGs); and fourth line after nbUVB and CST (n = 2/12). No consensus was reached for n = 1/12 CPG.Conclusion and RelevanceDupilumab is now incorporated into CPGs for adult AD. These CPGs exhibited good quality in scope/purpose, clarity, and editorial independence domains. However, none met AGREE-II criteria for methodological rigor/applicability. Gaps were found in mechanisms for updates, facilitators/barriers, resource implications, and stakeholder involvement. Only n = 3/12 CPGs met quality criteria for recommendation without modifications. Of these, two favored a conservative sequential approach for the initiation of dupilumab relative to CST, while one did not reach consensus. Our findings highlight divergent recommendations AD treatment, underlining a need to incorporate quality criteria into future guideline development.

Current lifestyle, eating habits, stress, environmental factors and intensive use of synthetic chemicals in food processing and agriculture have radically increased the progression of several human diseases. Globally, researchers have been looking for natural therapeutic substances that can be used to treat or delay the onset of these lifestyle-related disorders. Numerous types of medicinal plants have shown the potential to be frequently used in the therapeutics due to the presence of several bioactive compounds. Among these, fenugreek is an important herb which has been recognized as an imperative medicinal plant by various scientists around the world. This herb has been widely reported as beneficial against numerous diseases such as cancer, hypercholesterolemia, diabetes and inflammation. Due to its medicinal value, the extracts/powders from different parts of fenugreek have been effectively utilized in food and pharmaceutical industries. Accordingly, the present review is an attempt to highlight the important nutritional benefits and curative applications of fenugreek as an effectual therapeutic agent against different diseases.

Madam, allogeneic hematopoietic stem cell transplant (HSCT) remains a life altering cure to exceptionally challenging diseases ranging from hematologic malignancies to primary immunodeficiencies and blood cancers. One of its adversities includes graft versus host disease (GVHD), a lethal immunologically mediated condition wherein the donor's T-cells attack the host's tissues. The presentation can be classified as acute or chronic. Acute GVHD is divided into four grades. Despite current prophylaxis, including a combination of calcineurin inhibitor with either methotrexate or sirolimus, the incidence of grade-II or higher GVHD is between 30% to 80%, with grade-IV GVHD approaching mortality rates up to 90%.1 A recent phase II trial by Farag et al. addresses the issue by introducing a novel combination of sitagliptin – a specific DPP-4 inhibitor used to manage type 2 diabetes in adults – along with tacrolimus and sirolimus for prevention of GVHD.2 Using the new blend, an overall marked reduction in the risks of grade-II to IV (5%) and grade-III to IV (3%) acute GVHD was shown, compared to previous studies using only sirolimus and tacrolimus.3 Moreover, no adverse effects were associated with the drug during the period of study. Advancements in the field of HSCTs are particularly crucial in developing countries such as Pakistan. The high prevalence of consanguineous marriages and insufficient genetic counselling make the country especially vulnerable to diseases like thalassemia, bone marrow failure syndromes and immunodeficiency states. Up to 9000 children require transplantation each year due to the high prevalence of beta- thalassemia major.4 The situation is further complicated by limited resources and few stem cell transplant centres, which are limited to major cities. Although HSCT efficiently treats numerous life-threatening conditions, only 719 patients underwent HSCT till mid-2017 cumulatively in Pakistan.4 In accordance with the aforementioned factors, the number of transplants performed heavily outnumbers their demand, making it essential to tackle a complication as deadly as acute GVHD. In a 2005 study conducted in Rawalpindi by Hashmi et al., the overall incidence of acute GVHD grade-II to IV after standard immunosuppressive therapy was 44.2%.5 While the results were comparable to other studies, the high f morbidity and mortality rates necessitates alternate treatment courses. Sitagliptin, a locally manufactured, cost-effective drug, will be an appropriate choice of medication in Pakistan where average income amounts to a meagre US$1000 per year.4 However, randomized trials are needed to further investigate its role in the prevention of acute GVHD. Continue....

Maternal mortality is a serious health concern, with casualties amounting to 295,000 in 2017.[1] As of present, about 25% of all maternal deaths fall under a condition known as postpartum haemorrhage (PPH), which is defined as abnormal bleeding of more than 500 – ml post child birth; 80% of all PPH cases are attributed to an atonic uterus. Consequently, a stepwise progression is observed to achieve haemostasis, starting from compression therapy to uterotonics like oxytocin followed by uterine balloon tamponade and even surgical intervention as the last line of treatment.[2] In their study, Dalton et al. introduce The Jada System, a novel intrauterine vacuum induced haemorrhage control device and evaluate its safety and effectiveness. [3] This novel innovation uses low- level intrauterine vacuum to assist physiological forces, collapse the uterine cavity and occlude blood vessels to control excessive bleeding. Moreover, the study showcased successful definitive treatment in 94% of the patients within an average of 3 minutes, minimal low-grade adversities, 98% investigators deeming it easy to use and majority recommending it for future treatment.[3] The Jada System’s rapid and early use renders it an exceptional treatment to PPH in comparison with alternatives like balloon tamponade that can only be used after a significant blood loss. Furthermore, with a success rate of 87%, the balloon tamponade can take up to 24 hours to control bleeding and carries numerous risks like rupture of the overfilled balloon, infections, cervical tears and vaginal lacerations. [4] While tackling maternal mortality with the help of The Jada System, it is imperative to recognize that 94% of all maternal deaths occur in low and lower middle-income countries, therefore coherent and competent approaches to maternal health care must be introduced to developing countries around the world.[1] Pakistan is one such low-middle income country that reported a Maternal Mortality Rate (MMR) of 140 per 100000 deaths in 2017.[1] Additionally, in a 2002 study, Jafarey outlined lack of management, scarcity of medications, services, skills and blood banks to accommodate excessive blood loss as the major causes of continued maternal deaths due to PPH (52.9%) in the country.[5] Considering The Jada System's high success rate in managing PPH, low - middle income countries like Pakistan can invest in the local production of this device in a cost- efficient manner. Such an incentive can prove to be a feasible and swift solution to obstetric emergencies in the region.

Abstract Dog Rose shrub is one of the valuable medicinal plants that, due to the richness of useful compounds in the fruits, has the potential to be used as dietary supplements. The aim of this study was to investigate some morphological and phytochemical traits of 20 Dog Rose genotypes collected from natural habitats of the northwest and west of Iran. Trunk diameter, trunk cross-sectional area, plant height, canopy width, tree size, and volume index were recorded before harvesting. The leaf length, leaf width, leaf fresh weight, fruit length and width, fruit tail length, fruit fresh weight, number of seeds per fruit, fruit flavor, fruit texture, fruit appearance and attractiveness, total phenol, total flavonoids, and antioxidant capacity were measured. The results of the analysis of variance showed that there was a significant difference at the 1% probability level among the samples collected from different locations for all traits. The poor correlation between traits resulted in the first two components of principal component analysis justifying a lower percentage of variation in the data. Cluster analysis using Euclidean Squared Distance and Ward Method showed that the studied genotypes were divided into four groups with different characteristics. The sample of Showt city, which was placed alone in the fourth group and also had the lowest elevation, had the highest value for most of the traits and could be considered in breeding programs.

Staphylococcus aureus (S. aureus) is a major causative agent of mastitis and is resistant to many antibiotics. Thus, there is a need to characterize the genetic determinants of S. aureus erythromycin resistance, such as ermA, ermB and ermC. The current study aimed to determine the phenotypic and genotypic erythromycin resistance profile and relatedness of S. aureus recovered from bovine mastitis and humans in close contact. A total of 14 mastitis-infected buffalo milk samples and 16 samples from their respective milkers were collected from different farms of Lahore, Pakistan. The antibiotic resistance profile was determined through the disk diffusion test. The overall prevalence of S. aureus in mastitis-affected buffaloes was found to be 75%, of which 52.1% were resistant to erythromycin and 42.8% to clindamycin. S. aureus isolates recovered from milker nasal samples showed 56.25% resistance to erythromycin and 44% resistance to clindamycin. Genotypic antibiotic resistance profiles were determined from 14 milk samples through PCR. Overall, eight (52.1%), three (21.4%) and five (35.7%) S. aureus isolates were positive for the ermA, ermB and ermC genes, respectively. Moreover, 16 milker nasal S. aureus isolates were also tested for the presence of ermA, ermB and ermC genes. The ermA, ermB and ermC genes were observed in nine(56.7%), five (31.3%) and seven (43.7%) isolates, respectively. A significant association was shown between phenotypic and genotypic erythromycin resistance. The results indicate both that there are sufficient genetic similarities, and the actual transmission of erythromycin resistance genes between these two hosts of S. aureus.

The emergence of carbapenem-resistant Escherichia coli (E. coli) is considered an important threat to public health resulting in resistance accumulation due to antibiotics misuse and selection pressure. This warrants periodic efforts to investigate and develop strategies for infection control. A total of 184 carbapenem-resistant clinical strains of E. coli were characterized for resistance pattern, resistance genes, plasmids, sequence types and in vitro efficacy of silver nanoparticles (AgNPs). Carbapenem resistance was prevalent in E. coli isolated from female patients (64.7%), urine samples (40.8%) and surgical wards (32.1%). Polymyxin-B showed higher susceptibility. ESBLs and carbapenemases were produced in 179 and 119 isolates, respectively. Carbapenemase-encoding genes were observed among 104 strains with blaNDM-1 (45.1%), blaOXA-48 (27%), blaNDM-7 (3.8%), blaNDM-1/blaOXA-48 (15.4%), blaNDM-7/blaOXA-48 (2.9%), blaOXA-48/blaVIM (3.8%) and blaNDM-1/blaVIM (2%). ESBL resistance genes were detected in 147 isolates, namely blaSHV (24.9%), blaCTX-M (17.7%), blaTEM (4.8%), blaSHV/blaCTX-M (29.2%), blaSHV/blaTEM (15%) and blaCTX-M/blaTEM (8.8%). ST405 (44.4%) and ST131 (29.2%) were more frequent sequence types with ST101 (9.7%), ST10 (9.7%) and ST648 (7%). The replicon types IncFII, IncFIIK, IncA/C, IncN and IncL/M were detected. The combination of MEM/AgNPs remained effective against carbapenemase-positive E. coli. We reported genetically diverse E. coli strains coharboring carbapenemases/ESBLs from Pakistan. Moreover, this study highlights the enhanced antibacterial activity of MEM/AgNPs and may be used to manage bacterial infections.

As a prevalent progressive neurodegenerative disorder, Parkinson’s disease (PD) is characterized by the neuropathological hallmark of the loss of nigrostriatal dopaminergic (DAergic) innervation and the appearance of Lewy bodies with aggregated α-synuclein. Although several familial forms of PD have been reported to be associated with several gene variants, most cases in nature are sporadic, triggered by a complex interplay of genetic and environmental risk factors. Numerous epidemiological studies during the past two decades have shown positive associations between PD and several environmental factors, including exposure to neurotoxic pesticides/herbicides and heavy metals as well as traumatic brain injury. Other environmental factors that have been implicated as potential risk factors for PD include industrial chemicals, wood pulp mills, farming, well-water consumption, and rural residence. In this review, we summarize the environmental toxicology of PD with the focus on the elaboration of chemical toxicity and the underlying pathogenic mechanisms associated with exposure to several neurotoxic chemicals, specifically 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), rotenone, paraquat (PQ), dichloro-diphenyl-trichloroethane (DDT), dieldrin, manganese (Mn), and vanadium (V). Our overview of the current findings from cellular, animal, and human studies of PD provides information for possible intervention strategies aimed at halting the initiation and exacerbation of environmentally linked PD.

The p-Laplace equation is a nonlinear generalization of the Laplace equation. This generalization is often used as a model problem for special types of nonlinearities. The p-Laplace equation can be seen as a bridge between very general nonlinear equations and the linear Laplace equation. The aim of this paper is to solve the p-Laplace equation for 1 < p < 2 and to find strong solutions. The idea is to apply a hypercomplex integral operator and spatial function theoretic methods to transform the p-Laplace equation into the p-Dirac equation. This equation will be solved iteratively by using a fixed-point theorem. Applying operator-theoretical methods for the p-Dirac equation and p-Laplace equation, the existence and uniqueness of solutions in certain Sobolev spaces will be proved. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]