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BackgroundCoronavirus disease 2019 (COVID-19) caused by the coronavirus SARS-CoV-2, has emerged as a rapidly spreading contagious disease across the globe. Recent studies showed that people with diabetes mellitus, severe obesity, and cardiovascular disease are at higher risk of mortality from COVID-19. It has been suggested that the increased risk is due to the chronic inflammatory state associated with type 2 diabetes. This study aimed to evaluate the efficacy of pioglitazone, a strong insulin sensitizer with anti-inflammatory properties, in improving the clinical outcomes of patients with type 2 diabetes admitted with moderate–severe COVID-19.MethodWe enrolled 350 patients with type 2 diabetes who were admitted to hospitals in Qatar and Kuwait with COVID-19. Patients were randomized to receive, in a double-blind fashion, pioglitazone (n = 189) or a matching placebo (n = 161) for 28 days. The study had two primary outcomes: (1) the incidence of a composite outcome composed of (a) the requirement for mechanical ventilation, (b) death, and (c) myocardial damage; and (2) an increase in C-reactive protein (CRP) levels.ResultsThe first primary outcome occurred in 28 participants (8%), and the secondary outcome occurred in 17. Treatment with pioglitazone showed a significant reduction in interleukin (IL)-3 levels compared with placebo treatment (mean (SD) 2.73 (± 2.14) [95% CI: 0.02, 1.1], p = 0.043 vs. 2.28 (± 1.67) [95% CI: − 0.23, 0.86], p = 0.3, respectively), with no effect seen in the levels of other inflammatory markers. Even though not significant, a few of the patients on pioglitazone exhibited serum troponin levels > 3 times higher than the normal range seen in patients on placebo. On the other hand, more patients on pioglitazone were admitted to the ICU than those with placebo, and no significant difference in the CRP reduction was observed between the two groups.ConclusionThe results of the present study demonstrate that pioglitazone treatment did not independently provide any additional clinical benefit to patients with type 2 diabetes admitted with a COVID-19 infection.Clinical trial registrationhttps://clinicaltrials.gov, identifier NCT04604223.

Microplastics (MPs) are small plastic particles less than 5 mm in size, which have become a common environmental contaminant, spreading across terrestrial and aquatic ecosystems. Concerns have been raised about the impact of microplastics on animal health and nutrition due to their accumulation and potential transfer through the food chain. This review aims to summarize current knowledge about microplastics in animal nutrition, with a focus on their occurrence, sources, routes of exposure, and potential effects on animal physiology and metabolism. Animals can consume microplastics through a variety of routes, including direct consumption of contaminated food, uptake from contaminated water, and ingestion of organisms that have already consumed microplastics. MPs have been found in a variety of animal species, including fish, birds, mammals, and invertebrates, highlighting the possibility of widespread exposure and bioaccumulation. MPs can interact with the gastrointestinal tract after being ingested, potentially influencing nutrient absorption, gut microbiota composition, and overall digestive efficiency. MPs may also act as carriers for other chemical pollutants, potentially increasing their bioavailability and toxic effects on animals. While some studies indicate that microplastics may cause adverse effects in animals such as inflammation, oxidative stress, and disruption of endocrine functions, the overall health effects and long-term consequences of microplastic (MP) exposure in animal nutrition remain unknown. Furthermore, the review discusses the potential consequences of microplastics in animal-derived food products, considering the human health risks associated with their consumption.

Extracellular vesicles (EVs) have emerged as key intercellular communication and pathogenesis mediators. Parasitic organisms’ helminths, cause widespread infections with significant health impacts worldwide. Recent research has shed light on the role of EVs in the lifecycle, immune evasion, and disease progression of these parasitic organisms. These tiny membrane-bound organelles including microvesicles and exosomes, facilitate the transfer of proteins, lipids, mRNAs, and microRNAs between cells. EVs have been isolated from various bodily fluids, offering a potential diagnostic and therapeutic avenue for combating infectious agents. According to recent research, EVs from helminths hold great promise in the diagnosis of parasitic infections due to their specificity, early detection capabilities, accessibility, and the potential for staging and monitoring infections, promote intercellular communication, and are a viable therapeutic tool for the treatment of infectious agents. Exploring host-parasite interactions has identified promising new targets for diagnostic, therapy, and vaccine development against helminths. This literature review delves into EVS’s origin, nature, biogenesis, and composition in these parasitic organisms. It also highlights the proteins and miRNAs involved in EV release, providing a comprehensive summary of the latest findings on the significance of EVs in the biology of helminths, promising targets for therapeutic and diagnostic biomarkers.

Nanotechnology has emerged as a promising solution for tackling antibiotic resistance in monogastric animals, providing innovative methods to enhance animal health and well-being. This review explores the novel use of nanotechnology-based nanomaterials as substitutes for antibiotics in monogastric animals. With growing global concerns about antibiotic resistance and the need for sustainable practices in animal husbandry, nanotechnology offers a compelling avenue to address these challenges. The objectives of this review are to find out the potential of nanomaterials in improving animal health while reducing reliance on conventional antibiotics. We examine various forms of nanomaterials and their roles in promoting gut health and also emphasize fresh perspectives brought by integrating nanotechnology into animal healthcare. Additionally, we delve into the mechanisms underlying the antibacterial properties of nanomaterials and their effectiveness in combating microbial resistance. By shedding light on the transformative role of nanotechnology in animal production systems. This review contributes to our understanding of how nanotechnology can provide safer and more sustainable alternatives to antibiotics.

Prion diseases are a type of neurodegenerative disorder caused by the transmission of specific pathogens containing prion proteins. Due to the unique structural characteristics of Prion proteins (PrP), which differ from other types of proteins, the extended incubation period observed in the transmission of specific Prions can be attributed to these differences, at least in part. Prions are found in several other mammals and animals. Prions are unique among false protein folding abnormalities because these are infections and contain various strains of contagious agents associated with a unique in vivo phenotype. They can be acquired either by inheritance or sporadically. There are two types: classical and typical BSP. The objective of this study was to observe the Bhagnari cattle breed of Balochistan, Pakistan, and compare the PrP gene sequence of the Bhagnari with other reported sequences from Pakistan and other parts of the world. This research collected 40 Bhagnari cattle blood samples from Tali, Bhag Nari, and Sibi district areas. DNA extraction of each sample was performed by inorganic method, and then DNA amplification and sequencing of PRNP Gene was performed. The results of this research work showed different polymorphic variations (SNPs) in 16 samples. In this study, while mutations causing prion diseases in cattle were detected in Italian and German breeds, none were identified in the PRNP gene of the cattle population investigated, despite its association with neurological disorders.

The current COVID-19 pandemic is caused by the novel SARS-CoV-2 coronavirus strain. Although SARS-CoV-2 infection can affect everyone, the kind and degree of infection and sickness vary widely between individuals and populations. It has been crucial since reported disease loads and case fatality rates vary greatly among countries. However, there are still uncertainties about the severity of the illness in certain people and, in other cases, the aetiology of a more severe illness. Various chronic conditions, such as diabetes, cardiovascular diseases, respiratory ailments, and immunodeficiency disorders, have been identified as significant risk factors for COVID-19. These comorbidities not only increase the susceptibility to contracting the virus but also exacerbate the severity of symptoms and the likelihood of adverse outcomes, including hospitalization, intensive care unit admission, and mortality. The objective of this article is to point out the proliferation of COVID-19 in relation to different diseases affecting the clinical outcome of COVID-19. The study included 1500 patients with various diseases such as HCV, HBV, kidney disease, heart disease, asthma, T.B., arthritis, smokers, and vaccinated or unvaccinated. Results showed that 22% of diabetic patients, 40% of heart patients, 40% of asthma patients, 26% of kidney patients, 25% of T.B patients, and 41% of smokers had high corona positive. Coronavirus positivity was found in 34% of vaccinated patients and 72% of non-vaccinated patients, with an overall calculated p-value of 0.0001 by ANOVA statistical analysis. The overall outcome of the results showed that the severity of Corona disease increased in relation to different diseases.

This study has been carried out to investigate the adverse effects of climate change on agriculture and its awareness among various stakeholders. This study aims to determine adverse effects and how the agriculture department of Naushahro Feroze District contributes to creating awareness among the stakeholders about the adverse effects of climate change on agriculture. This study uses a purposeful sample of 4 to 5 High-Rank officers and specialists of the Agriculture department were selected to collect the data. The qualitative Method was adopted using Interviews via Semi-structured open-ended questionnaires. The results show that bodies, Organizations, and Institutions working to mitigate losses are not properly aware of the recommendations by International Bodies. Moreover, there is no proper system for creating awareness.

Small extracellular vesicles called exosomes are produced by cells and contain a range of biomolecules, including proteins, lipids, and nucleic acids. Exosomes have been implicated in the development and spread of cancer, and recent studies have shown that their contents may be exploited as biomarkers for early detection and ongoing surveillance of the disease. In this review article, we summarize the current knowledge on exosomes as biomarkers of cancer. We discuss the various methods used for exosome isolation and characterization, as well as the different types of biomolecules found within exosomes that are relevant for cancer diagnosis and prognosis. We also highlight recent studies that have demonstrated the utility of exosomal biomarkers in different types of cancer, such as lung cancer, breast cancer, and pancreatic cancer. Overall, exosomes show great promise as noninvasive biomarkers for cancer detection and monitoring. Exosomes have the ability to transform cancer diagnostic and therapeutic paradigms, providing promise for more efficient and individualized. This review seeks to serve as an inspiration for new ideas and research in the never-ending fight against cancer. Moreover, further studies are needed to validate their clinical utility and establish standardized protocols for their isolation and analysis. With continued research and development, exosomal biomarkers have the potential to revolutionize cancer diagnosis and treatment.

The major intent of this research is to inspect the impact of work-life conflict, job stress and work overload of dual-career life partners on job contentment and how perceived organizational support moderates their relationship. We collected data from 170 employees of different organizations and companies in the capital city Islamabad and Rawalpindi. Moderation regression inspection was used to get results from the data and close-ended and adopted questionnaires were used in order to collect data. Analysis findings described that work overload, job stress and work-life conflict have a negative impact on job satisfaction in dual-profession couples. And if the organization provides support, then these problems may reduce. This study helps and guides managers, policymakers and market leaders in order to develop a flexible and supportive organizational culture to boost their workers’ job contentment. The data we collected for this study was mainly from two cities in Pakistan, Islamabad and Rawalpindi. So we are not able to generalize this study to the whole country. Other researchers and investigators may target other problems of dual-career professionals and they can target other cities’ populations.

Abstract Background Nonalcoholic fatty liver disease (NAFLD) showed significant association with PNPLA3 rs738409 polymorphism in unrelated individuals. However, it is still unknown whether the relationship of NAFLD with PNPLA3 variant exists or not among subjects with type 2 diabetes mellitus (T2DM). Therefore, the study aimed to evaluate sociodemographic and genetic determinants of NAFLD in type 2 diabetics. Methods The cross-sectional analytical study was conducted at the Department of Molecular Biology, Virtual University of Pakistan, Lahore, Pakistan, during 2019–2020. A total of 153 known cases of T2DM were enrolled using convenience sampling. After excluding patients (n = 24) with HCV, alcoholism, or missing information, data from 129 eligible diabetics with and without NAFLD were analyzed using SPSS. Odds ratios using crosstabs and adjusted odds ratios using binary and multinomial logistic regression were calculated to measure the risk of NAFLD. Results Adults 18–35 years were 7.0%, 36–55 years were 64.3%, ≥ 56 years were 28.7%, and females were 66.7%. A total of 41.1% of patients had obesity, 52.7% had NAFLD, and 29.05% carried mutant G allele of rs738409 polymorphism. Among overall diabetics, NAFLD showed association with female (OR = 2.998, p = 0.007), illiterate (OR = 3.067, p = 0.005), and obese (OR = 2.211, p = 0.046) but not with PNPLA3 genotype under any model (all p = > 0.05). Among obese diabetics, NAFLD showed association with female (AOR = 4.010, p = 0.029), illiterate (AOR = 3.506, p = 0.037), GG + CG/CC (AOR = 3.303, p = 0.033), and GG/CG + CC (AOR = 4.547, p = 0.034) using binary regression and with female (AOR = 3.411, p = 0.051), illiterate (AOR = 3.323, p = 0.048), GG + CG/CC (AOR = 3.270, p = 0.029), and GG/CG + CC (AOR = 4.534, p = 0.024) using multinomial regression. Conclusions NAFLD and obesity were the most common comorbid diseases of T2DM. Gender female, being illiterate, and PNPLA3 rs738409 polymorphism were significant risk factors of NAFLD among obese diabetic patients.

BACKGROUND & OBJECTIVE: Pleural tuberculosis is a common type of extrapulmonary tuberculosis and remains a common problem for pulmonologists. Early detection of tuberculosis is a global priority for TB control. Gene Xpert is a real-time PCR, which can reveal Mycobacterium tuberculosis within 2 hours. This study will bridge the gap and help the pulmonologist for deciding on the use of Gene Xpert as diagnostic tool for pleural tuberculosis. Our objective is to find the frequency of positive Gene Xpert among patients of pleural tuberculosis presenting to tertiary care hospital. METHODOLOGY: A Cross-sectional study was conducted in the Department of Pulmonology, Aziz Fatima Hospital, Faisalabad from 26 February 2022 to 25 March 2022. Total 187 patients ages between 15-80 years having pleural tuberculosis diagnosed during last 6 months were included in the study. Patients already taking anti-tuberculosis therapy were excluded. Pleural fluid was processed in Aziz Fatima Hospital, Faisalabad laboratory for Gene Xpert immediately. Reports were collected next day and noted in the proforma. Positive Gene Xpert as per operational definition. Data was stratified for variables like age, gender, comorbidities (like diabetes mellitus, HIV and smoking status). Chi-square test was applied taking p-value ≤ 0.05 as significant. RESULTS: Out of 187 patients, mean age was 43.71±14.93 years. 95(50.8%) patients were male and 92(49.2%) patients were females. Positive Gene Xpert was found in 49(26.2%) patients. Positive Gene Xpert is more common in patients of HIV positive 27 (38.6%) than the 22 (18.8%) patients of HIV negative shows significant association (p-value = 0.001). Out of 72 diabetic patients, 23(31.9%) patients had positive Gene Xpert and out of 115 non-diabetic patients, 26(22.6%) patients had positive Gene Xpert with p-value = 0.158. Out of 82 smoker patients, 27(32.9%) patients had positive Gene Xpert and out of 105 non-smoker patients, 22(21%) patients had positive Gene Xpert with p-value=0.065. Out of 57 HIV positive patients, 27(47.4%) patients had positive Gene Xpert and out of 130 HIV negative patients, 22(16.9%) patients had positive Gene Xpert with p-value =0.001. CONCLUSION: Gene Xpert can be used as a reliable investigation for detection of pleural tuberculosis and timely initiation of treatment.

Abstract Background Perinatal loss is a traumatic and complex experience that contributes to negative maternal psychological states and adverse outcomes impacting fetal development, maternal-fetal/infant bonding, marital/partner relationships, and child cognitive, emotional, and behavioral development. These outcomes present preventable disease burden and financial liability to individuals, families, and the healthcare system. Psychological interventions have the potential to improve outcomes for women and their families after perinatal loss. A few studies have explored the effectiveness of individual psychotherapeutic interventions in reducing maternal psychological distress after perinatal loss; however, a systematic review to compare these interventions has not been conducted. The primary objective of this systematic review is to determine the effectiveness of psychotherapeutic intervention on psychological distress and perception, coping, and adjustment in women who have experienced perinatal loss. The secondary objective of this review is to examine the content and delivery methods of effective psychotherapeutic interventions. Methods We endeavor to search electronic databases (PsycINFO, MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, CINAHL, Social Work Abstracts, Family and Society Studies Worldwide, Family Studies Abstracts, Academic Search Premier), gray literature databases (Proquest Dissertation and Theses Global, Web of Science Conference Proceedings Citation Index, OAIster, Open-Grey, Canadian Electronic Library, Canadian Research Index), and relevant organizational websites and conduct forward and backward citation searches of included studies. Inclusion criteria will consider studies that (1) are randomized controlled trials (RCTs), quasi-experimental (e.g., before-after design), and observational (prospective cohort); (2) include women affected by perinatal loss accessing psychotherapeutic intervention or support; and (3) evaluate a mental health or related outcome. Two authors will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using an appropriate tool. The primary outcome(s) will be measurements on the severity of depressive, anxiety, grief, and post-traumatic stress symptoms. Secondary outcomes will include measurements on difficulties in perception, coping, social, or dyadic adjustment. Conducting a narrative synthesis will identify relationships within study findings, and if appropriate, a random effects meta-analysis will be performed. Discussion This systematic review will summarize the effectiveness of psychological interventions, including their content and delivery method, in reducing psychological distress and improving outcomes for women affected by perinatal loss. The evidence generated from this review can inform researchers and policymakers in expanding on related research and developing customized interventions or programs. Systematic review registration PROSPERO CRD42019126456 .

Arthritis is a chronic inflammatory disease that causes severe joint pain. Interleukin 17F (IL17F) is considered as a candidate gene functionally; it mediates pro-inflammatory responses, depending on the type and site of inflammation. The present study examined the polymorphism of IL17F (rs763780 and rs2397084) among the families affected by arthritis. Demographic data and blood samples were collected from the families with at least one affected offspring with arthritis. Analysis of the IL17F gene polymorphism was performed by the digestion of DNA with NlaIII and AvaII. The results showed that IL17F rs763780 (AA, AG and GG genotypes) and rs2397084 (AA, AG and GG genotypes) were associated with arthritis (OA & RA). It was evaluated that about 65 and 21 percent of the individuals mutated with homozygous mutation for wild type allele A, heterozygous mutation A/G against selected SNPs respectively. But homozygous polymorphic allele for allele G was only found against rs2397084. Mutation in rs2397084 resulted to change Lysine into Arginine, whereas mutation in rs763780 changed Histidine into Arginine. Maternal history was found as a stronger factor in transferring arthritis. The results of this study revealed an association of arthritis with IL17F among Pakistani population.

Amongst the benign cardiac tumors atrial Myxomas are commonest. Tricuspid valve attachment is an uncommon site for cardiac Myxoma. We present a case of an 18 years old girl who presented to us with history of shortness of breath, abdominal distension, leg swelling, palpitations and dizziness for two months. On Echocardiography there was a large pedunculated mass attached to tricuspid valve. She underwent surgical excision of the mass. Biopsy confirmed the Myxoma. In conclusion, Myxoma originating from tricuspid valve are rare tumours which can cause tricuspid valve obstruction and right heart failure symptoms due to their location. In these cases shortness of breath, embolisation and symptoms of venous congestion are commonly observed. Key Words: Case report, Myxoma, right heart, cardiac CT, tricuspid valve. Continuous...

Abstract Background Psychological distress, defined as depression, anxiety and perceived stress, during pregnancy is common, with 15–25% of women experiencing clinically significant levels of such distress. Despite the far-reaching impact of prenatal psychological distress on mothers and their children, and that women are receptive to screening, few providers routinely screen for prenatal psychological distress and less than one in five women will receive the mental health care that they require. There is a lack of certainty regarding the most effective treatments for prenatal psychological distress. No online interpersonal psychotherapy (IPT) trials have been conducted that focus on improving psychological distress in prenatal women. The purpose of this pilot randomized controlled trial is to evaluate the perspectives of pregnant women on the feasibility and acceptability of online IPT (e-IPT) delivered during pregnancy. Methods A pilot randomized controlled trial design with repeated measures will evaluate the feasibility and acceptability of e-IPT for pregnant women compared to routine prenatal care. Qualitative interviews with 15–30 individuals in the intervention group will provide further data on the feasibility and acceptability of the intervention. Assessment of feasibility will include the ease of accessing and completing the intervention. Women will also be asked about what barriers there were to starting and completing the e-IPT. Assessment of acceptability will inquire about the perception of women regarding the intervention and its various features. A sample size of 160 consenting pregnant women aged 18 years and older will be enrolled and randomized into the experimental (e-IPT) or control (routine care) condition. The secondary outcome measures include: depression, anxiety and stress symptoms; self-efficacy; self-mastery; self-esteem; relationship quality (spouse, immediate family members); coping; and resilience. All participants will complete the aforementioned measures at baseline during pregnancy (T1), 3 months postrandomization (T2), at 8 months of pregnancy (T3), and 3 months postpartum (T4). Discussion The results of this pilot randomized controlled trial will provide data on the feasibility and acceptability of the intervention and identify necessary adaptations. This study will allow for optimization of full trial processes and inform the evaluation strategy, including sample size calculations for the full randomized controlled trial. Trial registration ClinicalTrials.gov, NCT01901796. Registered on 18 December 2014.

Abstract Background Interpersonal psychotherapy (IPT) is an intervention that has established efficacy in the prevention and treatment of depressive disorders. Previous systematic reviews have not evaluated the effectiveness of IPT on symptoms of stress, anxiety, depression, quality of life, relationship satisfaction/quality, social supports, and an improved psychological sense of well-being. There is limited data regarding factors that moderate and mediate the effectiveness of IPT including the timing of the intervention or the mode of delivery of IPT intervention. The objective of this systematic review and meta-analysis is to evaluate the effectiveness, feasibility, and acceptability of IPT interventions to treat perinatal psychological distress and to summarize the evidence on predictors, mediators, and moderators of IPT. Methods We will include peer-reviewed studies that recruited perinatal women. The search strategy will involve the following databases: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (Ovid), CINAHL with Full Text (EBSCO), Social Work Abstracts (EBSCO), SocINDEX with Full Text (EBSCO), Academic Search Complete (EBSCO), Family & Society Studies Worldwide (EBSCO), Family Studies Abstracts (EBSCO), and Scopus. Study inclusion criteria include (1) randomized controlled trials, quasi-experimental studies, and pre-post studies that evaluated the effectiveness of IPT; (2) qualitative studies that evaluated feasibility and acceptability of IPT; (3) study sample included and analyzed perinatal women; and (4) publication language was English. Using pilot-tested screening and data extraction forms, two reviewers will independently review studies in three steps: (1) abstract/title screening, (2) full-text screening of potentially accepted studies, and (3) data extraction of accepted studies. Disagreements will be resolved by a third reviewer. Studies will be aggregated for meta-synthesis and meta-analysis should the data allow for this. Two independent reviewers will grade methodological quality. Discussion Findings from this review will inform future development and implementation of IPT intervention research for perinatal women. Identifying key factors of successful IPT interventions will inform intervention design and adaptation of IPT interventions to increase the likelihood that perinatal women will engage in and benefit from IPT interventions. This review will also identify key considerations for increasing the effectiveness of IPT interventions during the perinatal period. Systematic review registration PROSPERO CRD42019114292

BACKGROUND: Hepatitis B is an important public health problem for Pakistan. Being asymptomatic in many of the carriers, it needs screening to assess disease burden. Screening blood donors will not only help point out the subliminally diseased individuals but will also offer a boost to treatment rates and preclude the dreaded complications in the affected population. AIM: The aim of this study is to estimate disease burden and depict current trend of Hepatitis B in healthy blood donors by assessing its prevalence at one of the largest hospitals of Pakistan over a 2-year interval. This will serve to offer a direction to health policymakers to channel their resources in an attempt to accelerate diagnostic, preventive, and therapeutic measures against the disease. METHODOLOGY: It is a retrospective single-center cross-sectional study. We screened 76,530 healthy blood donors for hepatitis B virus (HBV) visiting Mayo Hospital, Lahore, Pakistan during 2016 and 2017 with rapid test kits which used lateral flow immunoassay based on the principle of double antibody sandwich technique. RESULTS: Out of 76,530 donors in 2016 and 2017, we detected 1262 donors (1.65%) positive for hepatitis B viral serology. CONCLUSION: We found a positivity rate of 1.65% of hepatitis B in healthy blood donors during 2 years. Although in comparison to 2016, the positivity rate has somewhat declined in 2017, but it remains worrisome. Our findings endorse the need for policy making to sustain and amplify the current HBV screening and treatment strategies and enhance public awareness.

This paper presents the performance comparison of a dual-band conventional antenna with a split-ring resonator (SRR)- and electromagnetic bandgap (EBG)-based dual-band design operating at 2.4 GHz and 5.4 GHz. The compactness and dual-frequency operation in the legacy Wi-Fi range of this design make it highly favorable for wearable sensor network-based Internet of Things (IoT) applications. Considering the current need for wearable antennas, wash cotton (with a relative permittivity of 1.51) is used as a substrate material for both conventional and metamaterial-based antennas. The radiation characteristics of the conventional antenna are compared with the EBG and SRR ground planes-based antennas in terms of return loss, gain, and efficiency. It is found that the SRR-based antenna is more efficient in terms of gain and surface wave suppression as well as more compact in comparison with its two counterparts. The compared results are found to be based on two distinct frequency ranges, namely, 2.4 GHz and 5.4 GHz. The suggested SRR-based antenna exhibits improved performance at 5.4 GHz, with gains of 7.39 dbi, bandwidths of 374 MHz, total efficiencies of 64.7%, and HPBWs of 43.2 degrees. The measurements made in bent condition are 6.22 db, 313 MHz, 52.45%, and 22.3 degrees, respectively. The three considered antennas (conventional, EBG-based, and SRR-based) are designed with a compact size to be well-suited for biomedical sensors, and specific absorption rate (SAR) analysis is performed to ensure user safety. In addition, the performance of the proposed antenna under bending conditions is also considered to present a realistic approach for a practical antenna design.

Background: As mental healthcare expands to web-apps, smartphones, and other technologies, it is important to understand the psychological profiles of women who self-select to participate in perinatal mental health digital platform randomized control trials. There are concerns that those seeking internet-based mental health treatments may not be representative of the general perinatal populations seeking face-to-face treatments resulting in a lack of generalizability. The aim of this study is to describe the demographic and psychological profiles of prenatal women seeking treatment over the internet for mental health concerns as compared to the general perinatal population seeking mental health treatments. Methods: This was a descriptive study involving pregnant women across Alberta, Canada, aged 18–47 years old. Profiles were collected through self-report baseline demographics and mental health information using the Edinburgh Postnatal Depression Scale (EPDS), Antenatal Risk Questionnaire (ANRQ), Depression Anxiety Stress Scale (DASS-21)- Anxiety and Stress Subscales, and Maclean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Results: A total of 887 women completed self-reported baseline demographic data and 590 women completed baseline mental health data. Mean age of women was 31.3 years with a mean pregnancy gestational age of 15.3 weeks). A history of depression was reported by 36.3%, a history of anxiety was reported by 20.8% of women, and a history of abuse and emotional abuse was reported in 27.7% and 23.5% of women. At baseline, 57.6% of women had clinically significant mental health risk scores, 24.3% of women had probable minor depression, and mild to moderate levels of anxiety were reported in 23.2% of women. Borderline personality disorder was reported by 12.5% of women. Conclusions: Overall, this sample of pregnant women has prevalence rates of depression, anxiety, and stress that are comparable to those rates found in pregnant women in the general population. This suggests that there is broad utility for and consumer interest in internet-based mental health treatments.

Purpose: Puffery advertising is defined as advertising or promotional material that makes broad exaggerated or boastful statements which may mislead the consumers in developing their opinion or making purchase decisions. This study was conducted to explore the practice of puffery advertising in media industry of Pakistan and analyze the professionals’ perceptions about how it may influence the advertising industry. Design/Methodology/Approach: This study was conducted by getting the empirical data from major Pakistani advertising agencies. Both qualitative and quantitative research methods were used in this study. Amalgamation of different qualitative and quantitative techniques was ensured. Maximum quality of data was ensured by using both techniques. Findings: The study has been successful in digging out the possible issues and solutions related to puffery advertisements in the Pakistani advertising industry. Implications/Originality/Value: The results implicate that professionals are aware of this phenomenon, however, novice firms are involved in puffery advertisements. More awareness and responsible behaviors related to puffery in advertisements needs to be acculturated among professionals in advertising industry in Pakistan. The study has discussed the role of media regulating agency to take necessary measures to overcome such practice.

The study aims to examine the relationship between Core self-evaluation on employee’s outcomes (Work engagement, Work Success and Intention to leave) with moderation role of mentorship. The study investigates the relationship in Pakistani environment, particularly the employees in public sector universities of twin cities (Rawalpindi & Islamabad) of Pakistan. Data was collected through the questionnaire distributed among the 440 employees of different universities in capital city (Rawalpindi and Islamabad) of Pakistan. The responses obtained, their assessment done, passed through the statistical programs by using SPSS (23 version) to obtain the findings. Descriptive statistical methods (e.g. frequency, average, standard deviation) have been utilized during the appraisal of the data. The consequences explored that CSA is intensely linked to employee’s outcomes, the current research also empirically investigated that mentorship has moderating effect in the relationship between CSA and employee’s outcomes. This research is amongst those rare studies conducted in Pakistani environment that have inspected effect of CSA on employee’s outcome and also inspected the moderating effect of mentorship between the relationship of core self-evaluation and employee’s outcomes.

Abstract Background Childhood obesity has become a global epidemic irrespective of the socioeconomic status of a country or nation. Obesity increases the risk of various diseases in children, for example asthma, sleep apnea, bone and joint problems, type-2 diabetes, and heart problems. The existing literature informs us of the many factors associated with childhood obesity. Among these factors, maternal mental health has been found to be a strong predictor. Maternal mental health programs were implemented to address the issue of childhood obesity but with little or no improvement. It suggests systematically reviewing the literature to assess the contents of these programs and carrying out meta-analysis for the overall effect of these interventions. Methods The studies included in this review will be experimental designs such as randomized controlled trials (RCTs) which provide information on interventions to improve maternal mental health and its effects on childhood obesity. We plan to search MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, ERIC, CINAHL, ProQuest Dissertations and Theses Global, Scopus, and Web of Science with no restrictions as to language. Reference lists of the selected articles will also be searched for additional articles. The Cochrane EPOC Risk of Bias Tool will be used to assess the quality of studies. If the studies lend themselves to a statistical analysis, we will also carry out a meta-analysis. Discussion This review will help determine the effect of maternal health improvement programs on childhood obesity. These findings, in turn, will guide the research community on the development of related programs in the future. Systematic review registration PROSPERO: CRD42017072737.

Abstract Background The remarkable diversity and mobility of Newcastle disease viruses (NDV) includes virulent viruses of genotype VI. These viruses are often referred to as pigeon paramyxoviruses 1 because they are normally isolated and cause clinical disease in birds from the Columbidae family. Genotype VI viruses occasionally infect, and may also cause clinical disease in poultry. Thus, the evolution, current spread and detection of these viruses are relevant to avian health. Results Here, we describe the isolation and genomic characterization of six Egyptian (2015), four Pakistani (2015), and two Ukrainian (2007, 2013) recent pigeon-derived NDV isolates of sub-genotype VIg. These viruses are closely related to isolates from Kazakhstan, Nigeria and Russia. In addition, eight genetically related NDV isolates from Pakistan (2014–2016) that define a new sub-genotype (VIm) are described. All of these viruses, and the ancestral Bulgarian (n = 2) and South Korean (n = 2) viruses described here, have predicted virulent cleavage sites of the fusion protein, and those selected for further characterization have intracerebral pathogenicity index assay values characteristic of NDV of genotype VI (1.31 to 1.48). A validated matrix gene real-time RT-PCR (rRT-PCR) NDV test detect all tested isolates. However, the validated rRT-PCR test that is normally used to identify the virulent fusion gene fails to detect the Egyptian and Ukrainian viruses due to mismatches in primers and probe. A new rapid rRT-PCR test to determine the presence of virulent cleavage sites for viruses from sub-genotypes VIg was developed and evaluated on these and other viruses. Conclusions We describe the almost simultaneous circulation and continuous evolution of genotype VI Newcastle disease viruses in distant locations, suggesting epidemiological connections among three continents. As pigeons are not migratory, this study suggests the need to understand the possible role of human activity in the dispersal of these viruses. Complete genomic characterization identified previously unrecognized genetic diversity that contributes to diagnostic failure and will facilitate future evolutionary studies. These results highlight the importance of conducting active surveillance on pigeons worldwide and the need to update existent rapid diagnostic protocols to detect emerging viral variants and help manage the disease in affected regions.

Abstract Background Next-generation sequencing (NGS) allows ultra-deep sequencing of nucleic acids. The use of sequence-independent amplification of viral nucleic acids without utilization of target-specific primers provides advantages over traditional sequencing methods and allows detection of unsuspected variants and co-infecting agents. However, NGS is not widely used for small RNA viruses because of incorrectly perceived cost estimates and inefficient utilization of freely available bioinformatics tools. Methods In this study, we have utilized NGS-based random sequencing of total RNA combined with barcode multiplexing of libraries to quickly, effectively and simultaneously characterize the genomic sequences of multiple avian paramyxoviruses. Thirty libraries were prepared from diagnostic samples amplified in allantoic fluids and their total RNAs were sequenced in a single flow cell on an Illumina MiSeq instrument. After digital normalization, data were assembled using the MIRA assembler within a customized workflow on the Galaxy platform. Results Twenty-eight avian paramyxovirus 1 (APMV-1), one APMV-13, four avian influenza and two infectious bronchitis virus complete or nearly complete genome sequences were obtained from the single run. The 29 avian paramyxovirus genomes displayed 99.6% mean coverage based on bases with Phred quality scores of 30 or more. The lower and upper quartiles of sample median depth per position for those 29 samples were 2984 and 6894, respectively, indicating coverage across samples sufficient for deep variant analysis. Sample processing and library preparation took approximately 25–30 h, the sequencing run took 39 h, and processing through the Galaxy workflow took approximately 2–3 h. The cost of all steps, excluding labor, was estimated to be 106 USD per sample. Conclusions This work describes an efficient multiplexing NGS approach, a detailed analysis workflow, and customized tools for the characterization of the genomes of RNA viruses. The combination of multiplexing NGS technology with the Galaxy workflow platform resulted in a fast, user-friendly, and cost-efficient protocol for the simultaneous characterization of multiple full-length viral genomes. Twenty-nine full-length or near-full-length APMV genomes with a high median depth were successfully sequenced out of 30 samples. The applied de novo assembly approach also allowed identification of mixed viral populations in some of the samples.

Exposure to a natural disaster in childhood can have serious, long-lasting consequences, impacting physical and mental health, development, and learning. Although many children experience negative effects after a disaster, the majority do not, and what differentiates these groups is not well understood. Some of the factors that influence disaster-related outcomes in the midst of adversity include parents’ mental health, the home environment, and socioeconomic status. Furthermore, genetics has also a role to play in how children respond to stressors. We had the opportunity to conduct a natural experiment of disaster recovery following the Alberta 2013 Flood. This paper presents the detailed protocol on prediction of resilience in Albertan families, and validation with cortisol data. In addition, data collection procedures, developing resiliency screening tools, candidate gene identification, genotyping, DNA methylation, and genomic analyses are described to achieve the research objectives. This study produced new knowledge by using pre- and post-disaster information on children’s health and development, including children’s genetics and responses to stress. This information has been identified as important to governments and other organizations invested in early child development. Our comprehensive research plan generates evidence that can be mobilized population-based approaches to improve child and family resiliency.

Understanding the proteolytic processing of polyprotein mediated by NS2B-NS3 protease contributes to the exploration of the mechanisms underlying infection of Japanese encephalitis virus (JEV), a zoonotic flavivirus. In this study, eukaryotic and prokaryotic cell models were employed to identify the cleavage sites mediated by viral NS2B-NS3 protease in JEV polyprotein. Artificial green fluorescent protein (GFP) substrates that contained the predicted cleavage site sequences of JEV polyprotein were expressed in swine testicle (ST) cells in the presence and absence of JEV infection, or co-expressed in E. coli with the recombinant NS2B-NS3 protease that was generated by fusing the N-terminal protease domain of NS3 to the central hydrophilic domain of NS2B. The cleavage of GFP substrates was examined by western blot. Among twelve artificial GFP substrates containing the cleavage site sequences predictively processed by host cell and/or NS2B-NS3 proteases, all sites were found to be cleaved by host cell proteases with different efficiencies. The sites at internal C, NS2A/NS2B, NS2B/NS3 and NS3/NS4A junctions, but not the sites at internal NS3, internal NS4A and NS4B/NS5 junctions were identified to be cleaved by JEV NS2B-NS3 protease. These data provide insight into the proteolytic processing of polyprotein, which is useful for understanding JEV replication and pathogenesis.

Most evidence of the association between maternal depression and children's development is limited by being cross-sectional. To date, few studies have modelled trajectories of maternal depressive symptoms from pregnancy through the early postpartum years and examined their association with social emotional and behavior functioning in preschool children. The objectives of this study were to: 1) identify distinct groups of women defined by their trajectories of depressive symptoms across four time points from mid-pregnancy to one year postpartum; and 2) examine the associations between these trajectories and child internalizing and externalizing behaviors.We analyzed data from the All Our Families (AOF) study, a large, population based pregnancy cohort of mother-child dyads in Alberta, Canada. The AOF study is an ongoing pregnancy cohort study designed to investigate relationships between the prenatal and early life period and outcomes for children and mothers. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Children's behavioral functioning at age 3 was assessed using the Behavior Scales developed for the Canadian National Longitudinal Survey of Children and Youth. Longitudinal latent class analysis was conducted to identify trajectories of women's depressive symptoms across four time points from pregnancy to 1 year postpartum. We used multivariable logistic regression to assess the relationship between trajectories of maternal depressive symptoms and children's behavior, while adjusting for other significant maternal, child and psychosocial factors.1983 participants met eligibility criteria. We identified four distinct trajectories of maternal depressive symptoms: low level (64.7%); early postpartum (10.9%); subclinical (18.8%); and persistent high (5.6%). In multivariable models, the proportion of children with elevated behavior symptoms was highest for children whose mothers had persistent high depressive symptoms, followed by mothers with moderate symptoms (early postpartum and subclinical trajectories) and lowest for minimal symptoms. After accounting for demographic, child and psychosocial factors, the relationships between depression trajectories and child hyperactivity/inattention, physical aggression (subclinical trajectory only) and separation anxiety symptoms remained significant.These findings suggest both externalizing and internalizing children's behaviors are associated with prolonged maternal depressive symptoms. There is a good case for the need to move beyond overly simplistic clinical cutoff approaches of depressed/not depressed in screening for perinatal depression. Women with elevated depressive symptoms at clinical and subclinical levels need to be identified, provided with evidence-based treatment, and monitored with repeat screening to improve maternal mental health outcomes and reduce the risk of associated negative outcomes on children's early social-emotional and behavior development.

This research paper attempts to evaluate the consumer rights and their violation by electronic media through advertisement. This is misguiding the consumer to buy harmful and unnecessary products. This research also aims at interpolating and ascertaining the onus of responsibility of a responsible media with regards to advertising. In the recent past the principle of "Caveat Emptor" which meant "Buyers beware" governed the relationship between a seller and buyer. In the era of open markets the buyer and seller came face to face, seller exhibited his goods, and buyer thoroughly examined them and then purchased them. The assumption would be consumer would use all his care and skill while entering into a transaction. The buyer to examine the goods beforehand and most of the transactions are now concluded by correspondence. Discussion on consumer's rights and their violation by media through advertisements is suggestive that consumers today enjoy a good amount of legal protection. But, even today, a large number of us remain exploited.

Boerhavia procumbens is a medicinal herb used in the treatment of various ailments including asthma, cough and jaundice. The concentration of calcium (280.7 ± 0.0 mg/100 g, 102.3 ± 0.0 mg/100 g), potassium (240.4 ± 0.0 mg/100 g, 92.1 ± 0.0 mg/100 g), aspartic acid (30.9 ± 0.0 g/100 g, 26.1 ± 0.0 g/100 g), glutamicacid (25.2 ± 0.0 g/100 g, 17.7 ± 0.0 g/100 g) and alanine were the abundant in the stem and root than leaf while carbohydrate (79.9 ± 0.0%) was found higher in the leaf of B. procumbens. The leaf and root extracts revealed the presence of alkaloids, flavonoids, tannins and phenol. Leaf extract was found to be more active against S. aureus (11.5 ± 0.3 mm), C. michiganensis (12.1 ± 0.2 mm) and F. oxysporum (23.6 ± 0.2 mm) than the root extract of B. procumbens. It is concluded that stem and root of B. procumbens contain essential nutrients and the antimicrobial study encourages the use of leaf extract for the treatment of most common microbial diseases. Video Clip of Methodology: 4 min 54 sec Full Screen Alternate

Background. The vitamin D receptor (VDR) gene regulates insulin secretion from the pancreas and acts as a mediator of the immune response through vitamin D. Polymorphism in VDR causes alterations in the functioning of vitamin D, leading to type 1 diabetes (T1D) predisposition. The aim of the present study was to determine VDR gene polymorphism in association with T1D in Pakistanis. Methods. The association was evaluated by selecting rs2228570 (FokΙ), rs7975232 (ApaΙ), and rs731236 (TaqΙ) polymorphic sites in 102 patients and 100 controls. Genotypes were identified by DNA sequencing and PCR-RFLP. Results. The allelic and genotypic frequencies of FokΙ and ApaI were significantly associated with T1D (p0.05). CCGC, CCGG, CCTC, and CCTG haplotypes were significantly associated with disease development (p

Avian orthoavulavirus 13 (AOAV-13), also named avian paramyxovirus 13 (APMV-13), has been found sporadically in wild birds around the world ever since the discovery of AOAV-13 (AOAV-13/wild goose/Shimane/67/2000) in a wild goose from Japan in 2000. However, there are no reports of AOAV-13 in China. In the present study, a novel AOAV-13 virus (AOAV-13/wild goose/China/Hubei/V93-1/2015), isolated from a wild migratory waterfowl in a wetland of Hubei province of China, during active surveillance from 2013 to 2018, was biologically and genetically characterized. Phylogenetic analyses demonstrated a very close genetic relationship among all AOAV-13 strains, as revealed by very few genetic variations. Moreover, pathogenicity tests indicated that the V93-1 strain is a low virulent virus for chickens. However, the genome of the V93-1 virus was found to be 16,158 nucleotides (nt) in length, which is 12 nt or 162 nt longer than the other AOAV-13 strains that have been reported to date. The length difference of 12 nt in strain V93-1 is due to the existence of three repeats of the conserved sequence, “AAAAAT”, in the 5′-end trailer of the genome. Moreover, the HN gene of the V93-1 virus is 2070 nt in size, encoding 610 aa, which is the same size as the AOAV-13 strain from Japan, whereas that of two strains from Ukraine and Kazakhstan are 2080 nt in length, encoding 579 aa. We describe a novel AOAV-13 in migratory waterfowl in China, which suggests that diversified trailer region sequences and HN gene lengths exist within serotype AOAV-13, and highlight the need for its constant surveillance in poultry from live animal markets, and especially migratory birds.

According to the World Health Organization (WHO), more than 300 million individuals around the world are infected each year with some type of sexually transmitted infection (STI).1 Although these estimates are more than a decade old, they continue to provide an order of magnitude on the burden of this type of disease. Further analysis of these estimates suggests that most of this burden is felt by low and middle income countries especially in sub Saharan Africa, south and south-east Asia, Latin America and the Caribbean. Due to the high cost of laboratory tests recommended for the diagnosis of STIs, at times it becomes difficult in low-income countries that these tests be carried out for all persons presenting as suspected cases or potential carriers. To address this issue, WHO developed guidelines for the syndromic management of STIs especially when the main symptoms are pain on urination, urethral discharge and ulcers or sores.2 Since the application of WHO guidelines commenced in early 2000s, the outcome of their application has differed among countries, some studies supporting the role of guidelines in the effective treatment of the patients while others reporting findings which do not lend support for these guidelines.3-9 Relatively more studies suggested poor performance of syndromic management in correctly identifying patients with disease5-7, 9 Some studies showed high sensitivity with an increased number of false positives resulting in over diagnosis;3,4 another study with effective syndromic treatment was still unable to identify asymptomatic cases or carriers.8 Both types of findings, over diagnosis or missing a case, have significant implications at patient level as well as family or societal level depending upon the norms and culture of the country or region. Over-diagnosis results in over-treatment and unnecessary use of antibiotics, which have been found to be an important cause of drug resistance resulting in no cure or partial cure with conversion to carrier state. Apart from drug resistance, inappropriate use or over treatment of antibiotics also poses an economic burden on already compromised health systems in these countries. Wrong labeling of individuals with a diagnosis of STI may create inter-spousal mistrust at family level for the source of infection especially when the partner considers himself or herself as free of disease. This may also result in stigmatization at societal level especially in sub-urban and rural areas where information sharing by interpersonal communication is commonly practised. The fear of diagnosis or stigmatization especially after recurrent infections may urge some individuals to self-medicate with antibiotics; this is not an unusual phenomenon in low-income countries where little or no distinction is made between the prescriptions versus over-the-counter medications, and may be another cause of drug resistance in such settings.

BACKGROUND: As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH) services in two areas with different levels of service in Punjab, Pakistan. METHODS: A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA). Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. RESULTS: The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. CONCLUSIONS: Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an interim measure of a national and global challenge that remains a work in progress.

Objective: Microcephaly, in the form of congenital autosomal recessive disorder (MCPH), is characterized by the reduced occipital frontal head circumference >3 standard deviation of otherwise normal population of matching age and sex. The disease is primarily associated with mild to severe mental retardation. Earlier studies have unravelled that among Pakistan population, mutations in ASPM gene is strongly associated in MCPH. Experimental Methods: cDNA gene and protein sequences of ASPM gene were retrieved from NCBI database and subjected to the non-redundant BLAST. Consensus phylogenetic tree was developed after multiple sequence alignment and bootstrapping of the protein sequences of ASPM gene from different mammals using Neighbour Joining method, selecting non mammals as an out group. Comparisons of the gene synteny and exon and intron patterns of ASPM gene were also undertaken to investigate chromosomal changes during the course of human evolution. Different statistical evolutionary models namely, Results: Phylogenetic tree based on ASPM gene clearly segregated all non mammalian members as an out group. Mammalian in group holds the established evolutionary lineage, based on morpho-genetic attributes of mammalian evolution, segregating monotremes at the beginning followed by the members of rodentia and finally radiation of the primates including humans. Orientation of the ASPM gene remains conserved between human and chimpanzee, however, it was found reversed along with the flanking genes, a zinc finger binding domain 41 and coagulation factor XIII, which suggest relatively recent event of gene inversion.

Background: Coronavirus disease 2019 (COVID-19) caused by the coronavirus SARS-CoV-2, has emerged as a rapidly spreading contagious disease across the globe. Recent studies showed that people with diabetes mellitus, severe obesity, and cardiovascular disease are at higher risk of mortality from COVID-19. It has been suggested that the increased risk is due to the chronic inflammatory state associated with type 2 diabetes. This study aimed to evaluate the efficacy of pioglitazone, a strong insulin sensitizer with anti-inflammatory properties, in improving the clinical outcomes of patients with type 2 diabetes admitted with moderate-severe COVID-19. Method: We enrolled 350 patients with type 2 diabetes who were admitted to hospitals in Qatar and Kuwait with COVID-19. Patients were randomized to receive, in a double-blind fashion, pioglitazone (n = 189) or a matching placebo (n = 161) for 28 days. The study had two primary outcomes: (1) the incidence of a composite outcome composed of (a) the requirement for mechanical ventilation, (b) death, and (c) myocardial damage; and (2) an increase in Creactive protein (CRP) levels. Results: The first primary outcome occurred in 28 participants (8%), and the secondary outcome occurred in 17. Treatment with pioglitazone showed a significant reduction in interleukin (IL)-3 levels compared with placebo treatment (mean (SD) 2.73 (± 2.14) [95% CI: 0.02, 1.1], p = 0.043 vs. 2.28 (± 1.67) [95% CI: - 0.23, 0.86], p = 0.3, respectively), with no effect seen in the levels of other inflammatory markers. Even though not significant, a few of the patients on pioglitazone exhibited serum troponin levels > 3 times higher than the normal range seen in patients on placebo. On the other hand, more patients on pioglitazone were admitted to the ICU than those with placebo, and no significant difference in the CRP reduction was observed between the two groups. Conclusion: The results of the present study demonstrate that pioglitazone treatment did not independently provide any additional clinical benefit to patients with type 2 diabetes admitted with a COVID-19 infection. [ABSTRACT FROM AUTHOR]