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Several theoretical models explain the influence of identity factors on pro-environmental action; however, an integrative explanation of these factors is required, especially in nonactivist samples. This study aims to determine the mediating effects of social identity, group-based anger, and group efficacy on the relationship between shared reality and pro-environmental action. We use a correlational survey method on 258 and 305 students in Studies 1 and 2, respectively. The full structural equation model found that the model well fits both studies. Consistently in the two studies, shared reality positively predicts social identity, group-based anger, and group efficacy. We found that these factors mediate the relationship between shared reality and pro-environmental action. These findings conclude that ordinary people sharing the same environmental reality catalyze the formation of identity, emotion, and efficacy factors.

Background and purpose: In this study, the effects of a mixture of deoxypodophyllotoxin/DPT and Juniperus communis L. on apoptosis and cellular inhibition were evaluated. Also, their cytotoxicity effects on prostate cancer cells (PC3 and DU145) and normal cells (HGFs), their anti-inflammatory effects, oxidation properties, and their effects on the expression of androgen receptors (AR) and clusterin (CLU) receptors were evaluated. Materials and methods: In this experimental study, the cells were cultured in DMEM f12 medium containing L-glutamine, penicillin, streptomycin, and 10% FBS. Morphological changes induced by reverse microscope were investigated 24, 48, 72, and 96 hrs after adding pure DPT and juniper extract at 10, 100, 500, 1000 μg/ml. Survival rate was assessed by MTT assay in all three cell lines. The rate of apoptosis in all cell lines was assessed by flow cytometric analysis. The expression levels of AR and CLU genes were evaluated by Real-Time PCR. Results: The 10, 100, 500, 1000 μg/ml of DPT and 500 and 1000 oncentrations of extract after 24 hours caused morphological changes in PC3 and DU145 cells and these changes intensified after 48, 72, and 96 hr. The MTT test showed significant decrease in PC3 and DU145 cell survival levels at 100, 500, and 1000 μg/ml (P

Aim: Juglone with naphthoquinone structure has medicinal properties and its anticarcinogenic and antioxidant effects have been proven. In this research, the cytotoxic and apoptosis effects of juglone and Pterocarya fraxinifolia (PF) methanolic extract on human prostate cancer cells were studied. Materials and Methods: The PC3 and DU145 human cancer cells and normal cells of primary prostate epithelial cells (ATCC PCS-440-010) were treated with juglone and PF extract at the concentrations of 10, 50, 100, 500, and 1000 μg/mL for 24, 48, 72, and 96h. The morphological changes were examined by reversed microscope. The survival percentage of cell lines was evaluated by MTT (3,4,5-dimethylthiazole-2-yl-2,5-diphenyltetrazolium bromide) test. The rate of apoptosis and expression of AR and CLU genes were examined by flow cytometry and real-time polymerase chain reaction. Results: All concentrations after 24h caused morphological changes in PC3 and DU145 cells, and these changes were intensified after 48, 72, and 96h. Also, concentrations of 100 and 500 μg/mL caused morphological changes in normal cells. The results of MTT test showed a significant decrease in PC3 and DU145 cell survival rate at 50, 100, and 500 μg/mL concentrations (P < 0.05). Juglone at 10 μg/mL concentration induced apoptosis in cancer cell lines. Conclusion: Juglone and PF could decrease the growth of cancer cell lines through the mitochondrial pathway. So PF could be considered as a potential candidate for therapeutic herbal medicine in treating cancers.

Background: This study aimed to determine the role of core self-evaluation and job autonomy on nurseschr('39') job performance in Sanandaj public hospitals. Materials and Methods: This study was a descriptive and correlational one. The study population consisted of the nurses who work in Sanandaj city public hospitals, selected 213 people using stratified random sampling in 2016. In order to data gathering, Paterson job performance scale (1990), Judje et al. core self-evaluation scale (2003) and Gunster job autonomy (1989) were used. Pearson correlation coefficient, regression analysis and multivariate variance analysis (MANOVA) were performed to data analysis. Results: Study results revealed that mean score and SD of core self-evaluation, job autonomy and job performance were 43.84 ± 5.52, 42.65 ± 10.26 and 52.81 ± 5.85 respectively. So that, mean of core self-evaluation and job performance were desirable and job autonomy was at the intermediate level. Also, there was a significant association between core self-evaluation and nurseschr('39') performance which this variable was able to predict 15% of job performance variance. While, there was no significant association between job autonomy and nurseschr('39') job performance. Also, the study results revealed that there was a significant difference between core self-evaluation and job performance among male and female nurses. Conclusion: Based on study results, core self-evaluation has a significant association with job performance which can predict it among nurses.

Introduction: Acute kidney injury (AKI) is associated with adverse outcomes, including death and dialysis. The goal of this study was to identify prognostic biomarkers of AKI that could be used across multiple phenotypes of AKI and across different species., Methods: Liquid chromatography/tandem mass spectrometry analysis of urine samples from three species (human, rat, and mouse) and four etiologies of AKI identified five potential biomarkers, of which two were validated, complement C3 and vitamin D-binding protein, in a cohort of 157 patients that developed AKI following cardiothoracic surgery. We studied the relationship between the biomarker's concentration in the urine and the development of a composite primary endpoint (stage 3 AKI within 10 days or death within 30 days)., Results: Of the 153 patients who developed AKI following cardiovascular surgery, 17 met the combined primary outcome. The median concentration of urine complement C3 adjusted to urine creatinine had the best predictive value and was significantly higher in the primary outcome group than in the controls. Similarly, the median concentration of vitamin D-binding protein was higher in the primary outcome group., Conclusions: The studies provide proof in principle that cross-species discovery analyses could be a valuable tool for identifying novel prognostic biomarkers in AKI. Urine complement C3 and vitamin D-binding protein could be promising early predictors of adverse outcomes in patients who develop AKI after cardiac surgery., (© 2024 S. Karger AG, Basel.)

Objective: The goal of this study is to investigate the potential association between gestational anemia and antenatal depression in pregnant women., Methods: It is a case-control study consisting of 684 pregnant women under 18 years recruited in different tertiary care hospitals, in Lahore, between June 2023 and December 2023. Utilizing an online questionnaire, data collection encompassed demographics, dietary habits, and the Edinburgh Postnatal Depression Scale (EPDS). Pregnant women with antenatal hemoglobin (Hb) levels above and below 11.0 g/dL were categorized as a nonanemic and anemic group. Statistical analysis involved Chi-square tests to explore the relationships between gestational parameters and maternal factors., Findings: The depression scores of anemic and nonanemic pregnant women compare two groups of pregnant women based on their Hb levels: those with Hb <110 g/l during pregnancy (anemic) and those with Hb ≥110 g/l (nonanemic). The anemic group had higher depression scores than the nonanemic group, both for those with EPDS <12 points and those with EPDS ≥12 points. However, P = 0.077 indicates that this difference was not statistically significant at a typical alpha level of 0.05., Conclusion: No significant association was found between gestational anemia and antenatal depression in pregnant women. These findings prompt further research to unravel the intricacies of the association between gestational anemia and depression. The outcomes thus urge the researchers and health-care professionals to consider the diverse factors that may contribute to mental health outcomes during pregnancy and refine strategies for maternal care., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Research in Pharmacy Practice.)

Indoor air pollution arising from burning of biomass fuels poses a significant threat to child health in rural areas of Pakistan. This cross-sectional study aimed to assess health implications associated with indoor air pollution resulting from biomass burning among children under 12 years of age in rural Punjab. A questionnaire-based survey was conducted in six randomly selected rural districts of Punjab, characterized by their primary reliance on biomass fuels. The findings revealed that several characteristics, such as monthly household income, number of living rooms, secondary use of solid fuels, kitchen type, type of cooking stove, and presence of child in the kitchen with their mother, exhibited significant associations ( p  < 0.05) with negative health impacts among children. Reported health effects among the children included coughing (18.7%), watery eyes (17.7%), eye irritation (12.3%), runny nose (11.8%), breathing difficulties (8.5%), phlegm (38%), headache (25%), nausea (20.1%), dizziness (6.7%), asthma (6.4%), tuberculosis (1.8%), and pneumonia (1.5%).

Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Background: Dry eye disease (DED) is a common tear film disorder caused by decreased tear production or increased tear evaporation. The increased use of computers in the workplace has brought about the development of ocular health concerns, including dry eye disease. Therefore, this study was designed to determine the prevalence of DED associated with computer work and recommend preventing or reducing its development. This study investigated the prevalence of DED among IT students in Dera Ghazi Khan., Methods: A cross-sectional descriptive study was conducted among 327 undergraduate students of the IT department in the district of Dera Ghazi khan over 5 months from September 2021 to January 2022. DED was assessed subjectively with Ocular Surface Disease Index. Data were analysed using SPSS version 21. The quantitative analysis was presented as mean and standard deviation, and qualitative variables were introduced in frequency and percentages. The chi-square test (Fisher's exact test) was used to study the significance of associations between dependent and independent variables., Results: The mean age of the participants was 20.25 ± 1.305 years (range 17-25). The prevalence of DED among computer programmers was 47.7%. This study showed that gender (p = 0.31), contact lens usage (p = 0.64), and duration of time spent on computer display units (p = 0.47) were not significant determinants of DED among computer programmers., Conclusion: DED is prevalent among IT students, along with different symptoms. However, further studies are required to adequately measure the prevalence of DED during longer exposure time to computer screens and explore environmental risk factors., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Educating health professionals on patient safety can potentially reduce healthcare-associated harm. Patient safety courses have been incorporated into medical and nursing curricula in many high-income countries and their impact has been demonstrated in the literature through objective assessments. This study aimed to explore student perceptions about a patient safety course to assess its influence on aspiring health professionals at a personal level as well as to explore differences in areas of focus between medical and nursing students., Methods: A dedicated patient safety course was introduced for year III medical and year II and IV nursing students at the Aga Khan University (2021-2022). As part of a post-course assessment, 577 participating students (184 medical and 393 nursing) wrote reflections on the course, detailing its influence on them. These free-text responses were thematically analyzed using NVivo., Results: The findings revealed five major themes: acquired skills (clinical, interpersonal), understanding of medical errors (increased awareness, prevention and reduction, responding to errors), personal experiences with patient safety issues, impact of course (changed perceptions, professional integrity, need for similar sessions, importance of the topic) and course feedback (format, preparation for clinical years, suggestions). Students reported a lack of baseline awareness regarding the frequency and consequences of medical errors. After the course, medical students reported a perceptional shift in favor of systems thinking regarding error causality, and nursing students focused on human factors and error prevention. The interactive course format involving scenario-based learning was deemed beneficial in terms of increasing awareness, imparting relevant clinical and interpersonal skills, and changing perspectives on patient safety., Conclusions: Student perspectives illustrate the benefits of an early introduction of dedicated courses in imparting patient safety education to aspiring health professionals. Students reported a lack of baseline awareness of essential patient safety concepts, highlighting gaps in the existing curricula. This study can help provide an impetus for incorporating patient safety as a core component in medical and nursing curricula nationally and across the region. Additionally, patient safety courses can be tailored to emphasize areas identified as gaps among each professional group, and interprofessional education can be employed for shared learning. The authors further recommend conducting longitudinal studies to assess the long-term impact of such courses., (© 2024. The Author(s).)

Background: The high prevalence of adverse events (AEs) globally in health care delivery has led to the establishment of many guidelines to enhance patient safety. However, patient safety is a relatively nascent concept in low- and middle-income countries (LMICs) where health systems are already overburdened and underresourced. This is why it is imperative to study the nuances of patient safety from a local perspective to advocate for the judicious use of scarce public health resources., Objective: This study aims to assess the status of patient safety in a health care system within a low-resource setting, using a multipronged, multimethod approach of standardized methodologies adapted to the local setting., Methods: We propose purposive sampling to include a representative mix of public and private, rural and urban, and tertiary and secondary care hospitals, preferably those ascribed to the same hospital quality standards. Six different approaches will be considered at these hospitals including (1) focus group discussions on the status quo of patient safety, (2) Hospital Survey on Patient Safety Culture, (3) Hospital Consumer Assessment of Healthcare Providers and Systems, (4) estimation of incidence of AEs identified by patients, (5) estimation of incidence of AEs via medical record review, and (6) assessment against the World Health Organization's Patient Safety Friendly Hospital Framework via thorough reviews of existing hospital protocols and in-person surveys of the facility., Results: The abovementioned studies collectively are expected to yield significant quantifiable information on patient safety conditions in a wide range of hospitals operating within LMICs., Conclusions: A multidimensional approach is imperative to holistically assess the patient safety situation, especially in LMICs. Our low-budget, non-resource-intensive research proposal can serve as a benchmark to conduct similar studies in other health care settings within LMICs., International Registered Report Identifier (irrid): PRR1-10.2196/50532., (©Ghazal Haque, Fozia Asif, Fasih Ali Ahmed, Farwa Ayub, Sabih ul Hassan Syed, Nousheen Akber Pradhan, Malika Hameed, Muhammad Muneeb Ullah Siddiqui, Shafaq Mahmood, Tahani Zaidi, Sameen Siddiqi, Asad Latif. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 27.03.2024.)

Foot-and-mouth disease virus (FMDV) cripples livestock by imparting devastating effects to economy. A good vaccine is the key to stopping it, but due to instability of 146S of FMDV, it is becoming difficult. This is bad because only 146S can fight against disease and its dissociation ultimately leads to decreased potency of vaccine. This study aimed to preserve the integrity of 146S in vaccine using different inactivators and preservatives. Foot-and-mouth Disease virus type 'O' was propagated on baby hamster kidney 21 cell lines and inactivated using formalin or binary ethylenimine (BEI). Size exclusion high performance liquid chromatography analysis revealed minimal 146S loss after double inactivation with formalin and BEI. This inactivated virus was further formulated into oil-based vaccine with sodium thiomersal or chloroform as a preservative. Our findings demonstrated that chloroform outperformed thiomersal in maintaining shelf life of vaccine. This claims that the combined approach of double inactivation with formalin and BEI followed by chloroform as preservative offered a promising strategy for developing efficacious FMDV., Competing Interests: The author declares that they have no known competing financial interests or personal relationship that could have appeared to influence the work reported in this paper. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (© 2024 Urmia University. All rights reserved.)

Introduction: Adverse events are a major cause of patient harm in the hospitalised setting. Low-income and middle-income countries account for a disproportionate share of the global burden of adverse events. However, patient safety research is still centred around high-income countries and high-resource health systems. The methods and data produced from these efforts are ill-suited to low-income and middle-income systems due to the social and technical differences between these settings. We aim to use our pilot-tested, locally developed methodology to estimate the frequency and characteristics of adverse events in hospitalised patients in a lower-middle-income country to inform patient safety policies and initiatives., Methods and Analysis: This multi-centre study will employ a two-step chart review methodology to identify adverse events in a representative sample of patients admitted at five hospitals between 1 January 2019 and 31 December 2019. The first step will include assessing patient files against a list of triggers to detect adverse events and the second step will involve an in-depth review of the events to capture pertinent characteristics. The triggers have been adapted from validated tools used in other studies. The reviewing team will be trained on the use of research tools and operational definitions to ensure that data are collected uniformly. The main outcome of interest is the rate at which adverse events occur in hospitalised patients. Further analysis will look to identify and quantify associations between the main outcome of interest and a variety of variables such as patient age and gender using tests of independence and regression techniques., Ethics and Dissemination: This study protocol has been approved by the Ethics Review Committee at Aga Khan University (Reference number: 2023-6324-24566). The findings of this study will be published in a peer-reviewed journal and disseminated to the public through national and international conferences, workshops, websites and social media., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: High-Affinity Potassium ions represent one of the most important and large group of potassium transporters. Although HAK genes have been studied in a variety of plant species, yet, remain unexplored in common bean., Results: In the current study, 20 HAK genes were identified in common bean genome. Super-family "K&#95;trans" domain was found in all PvHAK genes. Signals for localization of PvHAK proteins were detected in cell membrane. Fifty three HAKs genes, across diverse plant species, were divided into 5 groups based on sequential homology. Twelve pairs of orthologs genes were found in various plant species. PvHAKs genes were distributed unequally on 7 chromosomes with maximum number (7) mapped on chromosome 2 while only 1 PvHAK found on each chromosome 1, 4, and 6. Tandem gene duplication was witnessed in 2 paralog pairs while 1 pair exhibited segmental gene duplication. Five groups were made in PvHAK gene family based on Phylogeny. Maximum PvHAKs (10) were detected in Group-V while group-II composed of only 1 PvHAK gene. Variation was witnessed in number and size of motifs, and structure of PvHAKs associated with different groups. Light and hormone responsive elements contributed 57 and 24% share, respectively, to cis regulatory elements. qRT-PCR based results revealed significant increase in expression of all 4 PvHAK genes under low-potassium stress., Conclusion: The current study provides valuable information for further functional characterization and uncovering the molecular mechanism associated with Potassium transportation in plants., (© 2023. The Author(s).)

Background: Training nursing students on quality and patient safety (PS) is crucial to ensuring safe healthcare practices given the key role nurses play on the healthcare team. The aim of this study was to evaluate the impact of quality and PS course on the knowledge, and system thinking of students at different stages of the undergraduate nursing course., Methods: A 4.5-day quality improvement and PS course was conducted at the Aga Khan University School of Nursing and Midwifery for 146 second- and 139 fourth-year students. Students' knowledge, self-assessment of knowledge and skills, and system thinking were assessed using pretest and posttest., Results: Of the total of 20 points, the course significantly improved students' knowledge by a mean of 4.91 points for second-year students (95% confidence interval [CI], 4.32-5.51) and 3.46 points for fourth-year students (95% CI, 2.90-4.02) between pretest and posttest. For systems thinking, the Systems Thinking Scale scores increased by 0.41 points (95% CI, 0.29-0.52) for second-year students and 0.33 points (95% CI, 0.22-0.44) for fourth-year students out of the total of 5 points. The self-assessment scores significantly increased on postcourse assessment for second (P < 0.05) and fourth-year students (P < 0.001). Positive experience reported by students in the narrative reflections complemented these results., Conclusions: There was a significant increase in nursing students' knowledge, self-efficacy, and system thinking after participating in this short PS course. Replication at a national level may improve safety knowledge and skills among nursing students with subsequent gains in the safety of healthcare delivery in Pakistan., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

To determine how often care is limited at the end of life and the factors that are associated with this decision, we reviewed the medical records of all patients that passed away in the intensive care units (ICU) of Aga Khan University. We found that a majority of patients had Do-Not-Resuscitate orders in place at the time of death. Our analysis yielded 6 variables that were associated with the decision to limit care. These are patient age, sex, duration of mechanical ventilation, Glasgow Coma Scale (GCS) ≤8 at any point during ICU stay, GCS ≤8 in the first 24 hours following ICU admission, and mean arterial pressure <65 mm of Hg while on vasopressors in the first 24 hours following ICU admission. These variables require further study and should be carefully considered during end of life discussions to allow for optimal management at the end of life., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Toxoplasmosis is a well-known zoonotic disease caused by Toxoplasma gondii . The main causes of the disease range from eating undercooked or contaminated meat and shellfish to cleaning litter trays into which cats that excreted toxoplasma via faeces. This pathogen can live for a very long time, possibly a lifetime, within the bodies of humans and other animals., Aims and Objectives: This study aimed to predict and analyse candidate immunogenic epitopes for vaccine development by evaluating the physio-chemical properties, multiple sequence alignment, secondary and tertiary structures, phosphorylation sites, transmembrane domains, and signal peptides, of T. gondii rhoptry proteins ROP7, ROP21, and ROP22 using bioinformatics tools., Methods: To find immunogenic epitopes of rhoptry proteins, numerous bioinformatics web servers were used containing multiple sequence alignment, physiochemical properties, antigenicity and allergenicity, post-translational modification sites (PTMs), signal peptides, transmembrane domains, secondary and tertiary structures, and screening of predicted epitopes. We evaluated immunogenic linear B-cell epitopes as candidate proteins for vaccine development., Results: Nine epitopes were identified for each protein, and analysis of immunogenicity, revealed three candidate epitopes for ROP7, one for ROP21, and four for ROP22. Among all candidate epitopes, ROP22 contained the most immunogenic epitopes with immunogenicity score of 0.50575., Conclusion: We acquired detailed information on predicted immunogenic epitopes using in-silico methods. The results provide a foundation for further experimental analysis of toxoplasmosis, and potential vaccine development., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (© 2023 Published by Elsevier Ltd.)

Background: Breast cancer has a high incidence rate, emphasizing the necessity of enhanced information on health-related quality of life (HrQOL) in this population of patients. The aim of this study was to identify the factors influencing the QOL experienced by patients in Pakistan., Methods: A cross-sectional study was conducted on women with breast cancer, and four instruments were used on a random sample of 130 Pakistani women: FACIT-B Version 4 questionnaire,WHO causality assessment scale, Naranjo's algorithm, and a demographic/clinical characteristics section. Data analysis included descriptive analysis, independent sample t-test, and analysis of variance (ANOVA) test., Results: The patients' mean age was 49.10 (standard deviation (SD) 10.89); 98.5% were married. The mean score was 18.34 for physical wellbeing (SD 5.92; interquartile range (IQR) 11), 16.33 for social/family wellbeing (SD 6.3; IQR 11.25), 13.6 for emotional wellbeing (SD 3.55; IQR 6), 17.13 for functional wellbeing (SD 3.73; IQR 6), and 24.86 for breast cancer subscale (SD 3.64; IQR 4). The study found that the age, entitlement, recurrence, marital status, salary, number of doses, duration of cancer treatment, and chemotherapy sessions were significantly related to QOL terms in the assessment of the FACIT-B scale. The WHO causality evaluation scale determined that 78.1% of the responses were "probable" and 20.1% were "possible". According to Naranjo's algorithm assessment scale, 80% of adverse drug reactions (ADRs) were "probable", whereas 18.4% were declared "possible". Chemotherapy-induced anemia was the most often reported ADR in 64.6% of patients, followed by chemotherapy-induced nausea and vomiting (61.5%)., Conclusion: Healthcare practitioners must acknowledge and take into account the significance of QOL in addition to therapy for breast cancer patients in order to enhance their health. The findings of this study will aid in filling gaps in current unknown knowledge and identifying sites where patients require additional assistance. Because cancer and chemotherapy clearly have a negative impact on individuals' QOL, oncologists must concentrate on strategies that help cancer patients during their sickness and treatment while also enhancing self-care and QOL. Those with cancer will benefit from emotional wellbeing and adaptation to their disease., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ayub, Khan, Baig, Amin and Tahir.)

Objective: To compare the knowledge of antibiotic resistance between medical and nonmedical university students of Lahore. Methodology . An observational cross-sectional survey-based study was conducted among students of Lahore, Pakistan, from November 12, 2021, to December 13, 2021. The convenience sampling method was used to select students. Descriptive analysis and chi-square test were performed using Statistical Package for Social Sciences version 25.0., Results: 52.9% medical and 42.25% nonmedical students knew about antibiotics. 24.1% medical and 18.3% nonmedical students do not take antibiotics without a prescription. 40.6% medical and only 19.3% nonmedical students knew about the course of antibiotics. Medical students let the minor ailments recover naturally compared to nonmedical students who visit the doctor more often. Both groups complete the course of antibiotics without a significant difference. 49% medical and 27.9% nonmedical students knew that bacteria can develop resistance against antibiotics. Most nonmedical students responded that antibiotics can work even after resistance. Medical students have better knowledge about the relationship of resistance with overuse and misuse., Conclusion: The knowledge of antibiotics and compliance to therapy of the nonmedical students were less than those of the medical students. Medical students were aware of the pattern of taking antibiotics because of their educational background. There is a dire need for awareness regarding antibiotic use in this group to conserve treatment options for future use., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this article., (Copyright © 2023 Fiza Ayub et al.)

The year 2022 has served as a recall for the impact that climate change has in the South Asian region, which is one of the most vulnerable regions to climate shock. With a paucity of climate-based and geospatial observational studies in South Asia, this paper (i) links power sectors and carbon dioxide emissions, (ii) maps nitrogen dioxide density across three countries (Pakistan, India, and Bangladesh), (iii) understands electricity generation trends and projects weather changes through 2100. We monitored data monitored between 1995 and 2021. The following databases were used: the International Energy Agency, the World Bank, the UN Food and Agricultural Organization. Raw data was obtained for climate indicators, which were entered into Microsoft Excel. Geospatial trends were generated in the ArcGIS geostatistical tool by adopting the ordinary kriging method to interpolate and create continuous surfaces depicting the concentration of nitrogen dioxide in the three countries. We found increased usage of coal and fossil fuels in three countries (Pakistan, India, and Bangladesh). Both were significant contributors to carbon dioxide emissions. The geographic localities in South Asia were densely clouded with nitrogen dioxide as reported with the tropospheric column mapping. There are expected to be increased days with a heat index >35 °C, and consecutive dry days from 2020 and 2100. We also found increased chances of flooding in certain regions across the three countries. This study monitored climate change indicators and projects between 1995 and 2100. Lastly, we make recommendations to improve the relationship of the environment and living beings.

Among heavy metals, cadmium (Cd) is one of the toxic metals, which significantly reduce the growth of plants even at a low concentration. Cd interacts with various plant mechanisms at the physiological and antioxidant levels, resulting in decreased plant growth. This research was conducted to exploit the potential of synergistic application of zinc oxide nanoparticles (ZnO NPs) and Moringa oleifera leaf extract in mitigation of Cd stress in linseed ( Linum usitatissimum L.) plants. The main aim of this study was to exploit the role of M. oleifera leaf extract and ZnO NPs on Cd-exposed linseed plants. Cd concentrations in the root and shoot of linseed plants decreased after administration of MZnO NPs. Growth parameters of plants, antioxidant system, and physiochemical parameters decreased as the external Cd level increased. The administration of MZnO NPs to the Cd-stressed linseed plant resulted in a significant increase in growth and antioxidant enzymes. Furthermore, the antioxidative enzymes superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and ascorbate peroxidase (APX) exhibited a considerable increase in the activity when MZnO NPs were applied to Cd-stressed seedlings. The introduction of MZnO NPs lowered the levels of malondialdehyde (MDA) and hydrogen peroxide (H 2 O 2 ) in the linseed plant grown in Cd-toxic conditions. The NPs decreased electrolyte leakage (EL) in Cd-stressed linseed leaves and roots. It was concluded that synergistic application of ZnO NPs and M. oleifera leaf extract alleviated Cd stress in linseed plants through enhanced activity of antioxidant enzymes. It is proposed that role of MZnO NPs may be evaluated for mitigation of numerous abiotic stresses., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ramzan, Ayub, Shah, Naz, Shah, Malik, Sardar, Telesiński, Kalaji, Dessoky and Elgawad.)

Background Chronic liver disease (CLD) is one of the most significant causes of morbidity and mortality among the pediatric age group. The identification of the etiology of the disease is of utmost importance for the effective management of the disease. Objective To determine the various causes of CLD in pediatric patients attending a large public sector pediatric hospital. Patients and methods A prospective cross-sectional study was conducted at the National Institute of Child Health, Karachi, Pakistan from August 1, 2021, to February 28, 2022. All patients below 16 years of age of either gender with more than three months of symptoms duration on admission were enrolled. The diagnosis was labeled after the standard reference ranges for the pediatric age group. Results Of 136 patients, the mean age was 4.42 ± 3.92 years. More than half of the patients were males (76, 55.9%). Hepatitis B (31, 22.8%), idiopathic (23, 16.9%), glycogen storage disorder (GSD) (21, 15.4%), and Wilson disease (14, 10.3%) were the most common cause of CLD. A significant association of hepatitis was observed with age (p-value < 0.001), residence (p-value = 0.048), symptomatic (p-value < 0.001), total bilirubin level (p-value = 0.003), direct bilirubin level (p-value = 0.002), and albumin level (p-value = 0.003). Whereas a significant association of GSD was observed with age (p-value = 0.001), residence (p-value < 0.001), and serum glutamic pyruvic transaminase (SGPT) level (p-value = 0.033). Conclusion In our cohort, hepatitis B, idiopathic, GSD, and Wilson disease were the most common causes of CLD in pediatric patients. Moreover, age, residence, symptomatic, total bilirubin level, direct bilirubin level, SGPT, and albumin level were the important predictor variables., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sardar et al.)

The new coronavirus disease 2019 (COVID-19) was declared a global pandemic in early 2020. The ongoing COVID-19 pandemic has affected morbidity and mortality tremendously. Even though multiple drugs are being used throughout the world since the advent of COVID-19, only limited treatment options are available for COVID-19. Therefore, drugs targeting various pathologic aspects of the disease are being explored. Multiple studies have been published to demonstrate their clinical efficacy until now. Based on the current evidence to date, we summarized the mechanism, roles, and side effects of all existing treatment options to target this potentially fatal virus., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Wasey Ali Yadullahi Mir et al.)

Background: Pfizer-BioNTech vaccine was the first of all coronavirus disease (COVID) vaccines to be used in Saudi Arabia. There have been over 17 million doses already administered to the general public in order to successfully reach herd immunity., Objective: The study aimed to explore the side effects of the Pfizer-BioNTech vaccine., Materials and Methods: This is a cross-sectional study comprising a sample of 386 participating adults of different age groups and genders. A validated modified questionnaire was distributed as a Google form to residents of the kingdom via social networking sites from February to March 2021. The questionnaire included questions regarding participants' socio-demographic details, vaccination details, and symptom analyses items., Results: The most common to least reported symptoms were local pain (79.3%), fatigue (42%), muscle pain (39.1%), local swelling (27.7%), joint pain (23.1%), headache (21.8%), fever (21.0%), chills (15.5%), local redness (14.8%), nausea (7.3%), with no reports of anaphylaxis, facial paralysis or syncope. There were more side effects after the second dose than the first (p<0.001). Significant predictors of a higher number of side effects after both doses of the vaccine were the female gender ((p<0.001)) and the presence of allergies (p=0.044)., Conclusion: Pfizer/BioNTech vaccination was quite safe with no reported anaphylaxis or serious events. The most common reported side effects were local pain and fatigue. Symptoms began within 24 hours and were mild to moderate in nature with a regressive course, especially after analgesics. More side effects were experienced after the second dose than the first. The significant predictors of side effects were the female gender and a history of allergies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Mohammed et al.)

Drug-induced immune thrombocytopaenia (DITP) is a type of thrombocytopaenia caused by medications. It is one of the common causes of unexplained thrombocytopaenia. It is caused by the formation of autoantibodies against a particular drug and is commonly observed with medications like heparin and beta-lactam antibiotics. One of the rare causes of DITP is eptifibatide, a widely used antiplatelet agent for pretreatment in cardiac catheterisation. These patients can be asymptomatic or develop complications like skin bruising, epistaxis and even intracranial haemorrhage. We present a case of a 64-year-old man who developed eptifibatide-induced profound thrombocytopaenia leading to extensive skin bruising. He was treated with platelet transfusions followed by prompt improvement in platelet count., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Oleanolic acid (OA) is a hydroxyl pentacyclic triterpene acid (HTAs) used in various ailments. Inflammatory diseases may be profoundly influenced by iron (Fe) and zinc (Zn) status. We studied the anti-asthmatic effects of two metal complexes (Fe and Zn) of OA in the ovalbumin (OVA)-induced rat model. Delayed type hypersensitivity (DTH) was measured. Total and differential leucocyte count was done in blood as well as bronchoalveolar lavage fluid (BALF). The mRNA expression levels of pro-inflammatory cytokines were measured in lung tissue by reverse transcription polymerase chain reaction. The levels of cyclooxygenase-2 (COX-2), immunoglobulin E (IgE) and 5-lipoxygenase (5-LOX) were estimated by enzyme linked immunosorbent assay. Splenocyte proliferation was performed through BrdU uptake method and nitric oxide levels were measured by colorimetric assay kit. The acute toxicity study was also done for the complexes. The asthmatic group developed allergic airway inflammation shown by increased DTH and inflammatory markers in blood and BALF. OA + Fe and OA + Zn displayed significant decrease in DTH, NO, expression of IL-4, 5, 13, 17, toll-like receptor-2, nuclear factor-kappa B and tumor necrosis factor-α; serum IgE, COX-2, and 5-LOX. The metal complexes also attenuated OVA-stimulated splenocyte proliferation. While no hepatotoxic or nephrotoxic potential was shown by OA + Fe and OA + Zn. Our findings indicate that both OA + Fe and OA + Zn possess significant anti-asthmatic effect which may be ascribed to its immunomodulatory and anti-inflammatory features.

Disorders of sex development (DSD) are defined as discrepancy between chromosomal, gonadal and anatomic sex. The basic principles for the management of DSD include a multidisciplinary approach for gender assignment. Clinical assessment includes a detailed history and examination of external genitalia. Most of the disorders with symmetrical gonades indicate hormonal cause while asymmetrical gonades are found in chromosomal DSDs. Karyotyping will indicate a 46XX DSD, 46 XY DSD or mosicism. Internal anatomy is defined by ultrasonography, genitoscopy and laparoscopy. Human chorionic gonadotrophins (hCG) stimulation test is carried out in under-virilised males to see the function of Leydig cells in testes. The Most common cause of 46XX DSD is congenital adrenal hyperplasia (CAH). The decision of gender assignment surgery is to be taken in a multidisciplinary environment and with informed consent of the parents. Most of 46 XX CAH patients, even if markedly virilised, and 46 XY complete androgen insensitivity syndrome are raised as females. Similarly, most of 5-α reductase deficiency and 17-β hydroxysteroid dehydrogenase deficiency patients are assigned to the male gender. The decision in cases of mixed gondal dysgenesis and ovotesticular DSD is based on the development of external and internal genitalia. Patients with androgen biosynthetic defects, partial androgen insensitivity syndrome are usually assigned to the male gender.

Oxidative stress plays an important role in wound healing but data relating oxidative stress to fracture healing are scarce. Nuclear factor erythroid 2-related factor 2 (Nrf2) is the major transcription factor that controls the cellular defence essential to combat oxidative stress by regulating the expression of antioxidative enzymes. This study examined the impact of Nrf2 on fracture healing using a standard closed femoral shaft fracture model in wild-type (WT) and Nrf2-knockout (Nrf2-KO)-mice. Healing was evaluated by histology, real-time RT-PCR, µCT and biomechanical measurements. We showed that Nrf2 expression is activated during fracture healing. Bone healing and remodelling were retarded in the Nrf2-KO compared to the WT-mice. Nrf2-KO-mice developed significantly less callus tissue compared to WT-mice. In addition, biomechanical testing demonstrated lower strength against shear stress in the Nrf2-KO-group compared to WT. The expression of vascular endothelial growth factor (VEGF) and osteocalcin is reduced during fracture healing in Nrf2-KO-mice. Taken together, our results demonstrate that Nrf2 deficiency in mice results in impaired fracture healing suggesting that Nrf2 plays an essential role in bone regeneration. Pharmacological activation of Nrf2 may have therapeutic potential for the enhancement of fracture healing.

The free-living, bacterial-feeding nematode Panagrolaimus sp. (strain NFS 24-5) has potential for use as live food for marine shrimp and fish larvae. Mass production in liquid culture is a prerequisite for its commercial exploitation. Panagrolaimus sp. was propagated in monoxenic liquid culture on Escherichia coli and parameters, like nematode density, population dynamics and biomass were recorded and compared with life history table data. A mean maximum nematode density of 174,278 mL(-1) and a maximum of 251,000 mL(-1) were recorded on day 17 after inoculation. Highest average biomass was 40 g L(-1) at day 13. The comparison with life history table data indicated that the hypothetical potential of liquid culture is much higher than documented during this investigation. Nematode development is delayed in liquid culture and egg production per female is more than five times lower than reported from life history trait analysis. The latter assessed a nematode generation time of 7.1 days, whereas the process time at maximum nematode density in liquid culture was 16 days indicating that a reduction of the process time can be achieved by further investigating the influence of nematode inoculum density on population development. The results challenge future research to reduce process time and variability and improve population dynamics also during scale-up of the liquid culture process.

Study of dental root surfaces prompted the authors to add to the routine odontogram 28 more maxillary surfaces and 22 mandibular surfaces, this making a total of 210 diagnostic signs. Employment of amplified panoramic roentgenography permitted the authors to detect specific features of the dental cavity, root canals, periodontal fissure structure, the presence of caries and its complications, inflammatory and systemic involvement, injury to the jaws and teeth. Visual examination of dental status and application of panoramic roentgenography will help improve forensic medical personal identification.