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The idea of a crime-free society is a fable. In truth, it is not possible to imagine a society without against the law and crook hassle. The primary trouble of the concept of crime is social order. It is generally acknowledged that as a network member, guys 's pursuits are fine protected. Everybody in society has a few duties to his fellow residents, in addition to certain rights and benefits that he expects others to provide for him. The abovecited concept of mutual respect and self-assurance within the rights of others governs the conduct of society's contributors as an entire. Although most of the people of individuals adhere to the ‘‘live and allow live” philosophy, there are a choose range who, for whatever purpose, wreck from this widespread and interact with anti-social forces. This certainly locations a responsibility at the state to preserve society's normalcy. The nation, which administers it with the assist of the regulation, has the difficult duty of safeguarding lawabiding individuals and punishing lawbreakers. 'Regulation', according to Salmond, is a 'rule of motion' that governs human beings's conduct in society. Wrongful acts or crimes are defined as conducts which can be prohibited by the law in impact at the time and place, while lawful conducts are described as the ones which can be authorised via the regulation. Under the regulation of crime, the culprit who commits a crime is penalised for his moves.

Background: Hypoxic Ischemic Encephalopathy is a frequently encountered occurrence in a pediatric setting and more prevalent in the low middle income countries. Magnetic resonance imaging (MRI) is considered a reliable source of investigation. Our study determined the imaging findings and cause of Hypoxic ischemic encephalopathy in children referred for MR Imaging to our radiology department. Study design: A prospective cross-sectional study. Place and duration of study: Our prospective cross-sectional study was conducted at a pediatric tertiarycare hospital, of Karachi Pakistan from 1st November 2021 to 30th October 2022. Methods: Our study included children from newborns to 16 years of age who either had a history of fits, abnormal APGAR score, delayed cry or delayed milestones. The brain MRI was performed on 1.5 tesla scanner with a standard protocol and interpreted by Experienced Radiologists Findings were recorded on anExcel Sheet and data was analyzed on SPSS version 26. Our study included children from newborns to 16 years of age who were at risk of hypoxic insult and were born to mothers who had hypertension, diabetes milletus, history of maternal substance abuse and maternal history of fits history of fits and children who had a history of fits, abnormal APGAR score, delayed cry and/or delayed milestones. Children who were born via instrumental delivery were excluded from our study. Result: A total number of 187 patients were included in our study with 98 males and 89 females. The most common age group involved was from age >1 year to 5 years (50.3%). The most common presenting complaints included delayed milestones (63.6%) and fits (59.9%), delayed cry (52.4). On examination 42.2% had microcephaly. One-third of the patients had a positive maternal history for diabetes mellitus, hypertension and anemia. APGAR score was checked at 1 minute and 5 minute which showed the most common APGAR score of 3-6 which was seen in 81.8% of the patients. On MR Imaging 54.5% had periventricular leukomalacia, 35.3% had deep gray matter involvement, 3.7% had germinal matrix hemorrhage, and only 1.6% had watershed infarcts. A statically significant association was seen between gestation at birth and periventricular leukomalacia (P=

Background: Retinoblastoma is a rare tumor of eye in the pediatric population. It is seen in every 15000-18000 births with no gender or racial predilection. Retinoblastoma can have a variable presentation ranging from leukocoria to a mass in the eye. Aim: To provide physicians a snapshot of different modes of presentation. This study employs the data from computed tomography (CT) and magnetic resonance imaging (MRI) and analyzing it for frequency of different presentations from a radiological point of view. Methods: This was a retrospective cross-sectional study carried out at the National Institute of Child Health (NICH) which is the largest tertiary care pediatric center in Karachi, Pakistan. Records of children from 1 month to 16 years who were diagnosed with retinoblastoma between March 2021 to March 2022 were accessed from the database and assessed. The collected data was then analyzed on SPSS 26. Results: The most frequent presentation noted was leukocoria followed by vision loss, swelling, pain and redness. Calcification was the most frequently reported feature in CT scan whereas retroglobular involvement was mostly seen in MRI scans. Chi square showed a statistically significant correlation between age at presentation with presenting symptoms (p=0.04) and sellar involvement (p=0.00). Additionally, statically significant association was seen between family history and laterality in our study. Conclusion: MRI is the recommended modality due to its sensitivity and superior soft-tissue resolution. CT scan is superior to MRI in detecting calcifications. In developing countries due to a lack of proper facilities and awareness, there is a disparity in the prognosis and presentation of retinoblastoma. Bilateral tumors are most commonly heritable and patients presenting with tumors in both eyes are recommended a through genetic workup. Keywords: Retinoblastoma, ocular tumor, leukocoria, red eye, Magnetic resonance imaging, computed tomography

Pantothenate kinase-associated neurodegeneration (PKAN) is a rare autosomal recessive disorder characterized by progressive motor symptoms such as dystonia and spasticity. Classical PKAN is the most common subtype of neurodegeneration with brain iron accumulation (NBIA). There is no current established treatment for PKAN. Baclofen and botulinum toxin have been reported to improve motor symptoms and ease care in these patients. Deferiprone is a well-tolerated iron chelator and has been shown effective in reducing the brain iron accumulation. We report a seven-year-old boy who presented to our ward with spastic gait and extrapyramidal signs. Brain MRI was performed which showed features of neurodegeneration secondary to brain iron accumulation with specific appearance of eye-of-the-tiger sign. Genetic testing was positive for a homozygous mutation in PKAN2 and the diagnosis of early stage classical PKAN was made. The case report highlights the potent efficacy of baclofen, botulinum toxin, and deferiprone in slowing down the disease progression at an early stage and improving the severity of symptoms.

Pierson syndrome is caused by mutations in the laminin β2 gene causing absent β2 laminin, which is a normal component of the basement membranes of the mature glomerulus, structures in the anterior eye and neuromuscular junctions. The mutations manifest as congenital nephrotic syndrome and microcoria which are characteristic ocular features of this disease. These mutations may also result in neurological abnormalities such as hypotonia and psychomotor retardation. We report a two-month old boy who presented to the Pediatrics Department of Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan, in 2015, with the typical features of microcoria and congenital nephrotic syndrome. The hypocalcaemia, hypoproteinaemia and probable immunocompromised state consequent to nephrotic syndrome resulted in seizures, hypothyroidism and urosepsis. Despite being treated aggressively with high dose antibiotics, ionotropic support, angiotensin-converting enzyme inhibitors, thyroxine replacement and nutritional support, the infant died due to significant multiorgan disease including renal failure and septic shock. Keywords: Pierson Syndrome; Microcoria and Congenital Nephrotic Syndrome; Congenital Microcoria; Hypothyroidism; Septic Shock; Case Report; Pakistan.

Background: Henoch-Schönlein Purpura (HSP) is the most common vasculitis among children and adolescent characterized by skin, joints, renal and gastrointestinal involvement. There is different presenting feature of Henoch-Schönlein Purpura (HSP) and systemic involvement may vary at a certain age group. Methods: This was a ten-year retrospective cohort study done at a tertiary care hospital of Pakistan conducted from 2011–2020. Patients admitted with the diagnosis of Henoch-Schönlein Purpura (HSP) and in accordance with inclusion criteria were divided into groups based on their age, gastrointestinal symptoms and renal symptoms with the objective to compare the clinical features and investigations of Henoch-Schönlein Purpura (HSP) patients. Younger age group had patients age 7 years and less while the other group included patients who were older than 7 years. p-value

The resolution of Harten’s non-oscillatory explicit second-order accurate total variation diminishing scheme was relatively high for computations of nonlinear wave equations. However, this scheme shows false dissipation for sharp discontinuities, such as shocks and contacts, when applied to 1D Euler equation. The selection of the entropy fixing parameter, flux limiter, and appropriate eigenvector matrix is crucial to control the amount of such dissipation. This study focuses on the formulation of eigenvector matrix, which is used for the decoupling of a highly coupled nonlinear 1D Euler equation into a nonlinear wave equation. The selection of the eigenvector matrix is crucial to limit the unwanted false dissipation, which is inherent to the numerical schemes derived for nonlinear wave equations. A generalized form of the scaling factor for the eigenvector matrix is then derived, which is satisfied by the scaling factors used by Harten, Hofmann, and Yee. LAX, SOD, and inverse shock test cases of the shock tube problem are solved to examine and analyze the corresponding physical aspects. The findings show that multiplying the scaling factor by itself or by a constant does not affect the results. However, the variables inside the scaling factor, as well as powers of these variables play a vital role in controlling false dissipation. These scaling factors can effectively capture physics in one case, but might not exhibit satisfactory performance for other problems. In addition, Yee’s scaling factor can effectively capture shock and contact discontinuities, especially for the inverse shock test case.

Background: Dementia is the decline in cognitive function sufficient to impair one’s accustomed functioning. Countries with aging populations, such as Singapore, face rising rates of dementia. Dementia patients and their caregivers endure great financial and emotional stress. With the broad aim of minimizing these stresses, this study provides a cross-sectional view of the knowledge, attitudes, and perceptions (KAP) towards dementia in middle-aged Singaporean residents. Objective: We aim to examine 1) the associations between demographic correlates and KAP; and 2) the effect of dementia knowledge on attitudes and perceptions towards dementia. Methods: An online anonymous cross-sectional questionnaire was administered to Singaporeans and Permanent Residents aged 45 to 65 years old in English, Mandarin, and Malay. Knowledge was evaluated across three domains: symptoms, risk factors, and management. Total and domain scores were dichotomized as good or poor knowledge using median cut-offs. Attitudes/perceptions across six domains were evaluated on Likert scales, and responses to each question were dichotomized into positive or negative attitudes/perceptions. Results: From 1,733 responses, 1,209 valid complete responses were accepted (mean age±SD 54.8±5.12 years old, females = 69.6%). Lower socioeconomic status was associated with poorer knowledge and greater barriers to risk-mitigating lifestyle modifications. Lack of personal experience with dementia and poor knowledge were also associated with erroneous attitudes/perceptions. Conclusion: Socioeconomic status and personal experience affect KAP towards dementia. Policy and education campaigns to address KAP towards dementia should account for baseline differences across demographics, for greater improvements in dementia incidence and support.

Limited natural resources and a continuous increase in the demand for modern technological products, is creating a demand and supply gap for rare earth elements (REEs) and Sc. There is therefore a need to adopt the sustainable approach of the circular economy system (CE). In this review, we defined six steps required to close the loop and recover REEs, using a holistic approach. Recent statistics on REEs and Sc demand and the number of waste generations are reported and studies on more environmentally friendly, economic, and/or efficient recovery processes are summarized. Pilot-scale recovery facilities are described for several types of secondary sources. Finally, we identify obstacles to closing the REE loop in a circular economy and the reasons why secondary sources are not preferred over primary sources. Briefly, recovery from secondary sources should be environmentally and economically friendly and of an acceptable standard concerning final product quality. However, current technologies for recovery from for secondary sources are limiting and technology needs will vary depending on the source type. The quality/purity of the recovered metals should be proven so that they do not result in any adverse effects on the product quality, when they are being used as secondary raw material. In addition, for industrial-scale facilities, process improvements are required that consider environmental conditions.

Parked vehicles can create deadly environments for young children who are left unattended. This study was a descriptive analysis to describe circumstances leading to death in children left unattended in parked motor vehicles in India. Between 2011 and 2018, there were 16 incidents that resulted in 28 fatalities across India, mostly in the summer months. The majority of children (19/28) were aged 4–6 years, of whom 25 (89%) gained access to unattended vehicles and became accidentally locked in. Hyperthermia-related deaths are a poorly recognised type of vehicular injury in India; there has been no analysis to describe circumstances leading to such fatalities.

Background Pacifier use has been popular for ages. They are prevalent all over the world because of their various perceived benefits. On the other hand, there is a common belief that they do carry health risks as well. Due to these contradicting belief systems, the frequency of their use, and the factors that determine them, need to be thoroughly evaluated. Since Pakistan is a developing country with a low literacy rate, it can be implied that a vast majority of the country’s population may lack awareness regarding the advantages and disadvantages of pacifier use, making them incapable of weighing associated risks versus benefits. The data evaluating these factors in this region are however scarce in the published literature. We, therefore, aimed to highlight the frequency and predictors of pacifier use in the low socioeconomic group of Karachi, Pakistan. Materials and methods A descriptive, cross-sectional study was conducted on a sample of 300 mothers visiting a tertiary care hospital in Karachi, Pakistan. We included mothers who had at least one child under the age of two years, and whose child did not have any oro-nasal anomaly that could prevent them from sucking a pacifier. Data were collected using pre-tested questionnaires and analyzed using the Statistical Package for Social Sciences (SPSS version 23.0, IBM Corp., Armonk, NY, US). Frequencies were calculated and presented in the form of tables. The chi-square test was used to determine the significance of all categorical variables. A P-value of

Rare earth elements or REEs are a vital and irreplaceable part of our modern technological and digital industries. Among the REEs that are the most critical to be recovered are Ce, La, and particularly, Nd, and Y, due to high demand and at a potential future supply risk. Innovative techniques must be considered to recover REEs from secondary resources. In this study, REEs are extracted from iron mining sludge from Central Anatolia in Turkey. Two different acid solutions were compared, one with a higher acid content (120 ml HCl and 80 ml HNO3 per liter) and one with lower acid content (20 ml HNO3 per liter). Nanofiltration, as a process to concentrate the acidic leachate and increase the REE concentration, was carried out at pH levels of 1.5, 2.5, and 3.5 and under 12, 18, and 24 bar operating pressures. SLM studies had been carried out using a PVDF membrane with a pore diameter of 0.45 mu m, with three different carriers to separate the REEs from other major elements in the concentrated leachate. Through this analysis, the optimum operating conditions for nanofiltration are at pH 3.5 at 12 bar, using the leach with low acidity, achieving about 90% recovery efficiency of the REEs. SLM studies using 0.3M D2EHPA, with a 3-h reaction time, showed the highest mass flux values for the REEs. Nanofiltration and SLM represent novel methods of REE concentration and extraction from iron mining sludge.

Sentiment analysis is the task of automatic analysis of opinions and emotions of users towards an entity or some aspect of that entity. Political Sentiment Analysis of social media helps the political strategists to scrutinize the performance of a party or candidate and improvise their weaknesses far before the actual elections. During the time of elections, the social networks get flooded with blogs, chats, debates and discussions about the prospects of political parties and politicians. The amount of data generated is much large to study, analyze and draw inferences using the latest techniques. Twitter is one of the most popular social media platforms enables us to perform domain-specific data preparation. In this work, we chose to identify the inclination of political opinions present in Tweets by modelling it as a text classification problem using classical machine learning. The tweets related to the Delhi Elections in 2020 are extracted and employed for the task. Among the several algorithms, we observe that Support Vector Machines portrays the best performance.

Tumor-induced hypoglycemia is a serious disorder most commonly caused by insulinoma or non-islet cell tumor hypoglycemia (NICTH). The hypoglycemia can be severe and refractory to conventional therapy, leading to significant morbidity and mortality. The objective of this work is to describe a series of challenging cases in which refractory, tumor-induced hypoglycemia was shown to respond to the use of pasireotide, a second-generation somatostatin receptor ligand. We describe the clinical and biochemical features of 3 patients with tumor-induced hypoglycemia due to an occult insulinoma, malignant insulinoma, and non-islet cell tumor hypoglycemia. In these 3 individuals, the hypoglycemia remained refractory to guideline-recommended medical therapy, such as diazoxide, nonpasireotide somatostatin analogues, and glucocorticoids. Pasireotide was substituted to attenuate the refractory hypoglycemia for each patient. The addition of pasireotide led to prompt improvement in the frequency and severity of hypoglycemic episodes for each tumor-induced hypoglycemia patient. We demonstrate the successful treatment of 3 individuals with refractory, tumor-induced hypoglycemia with pasireotide. We offer the first reported use of pasireotide for the successful treatment of nonmalignant insulinoma and non-islet cell tumor hypoglycemia.

Background Fatalities in children left unattended in parked motor vehicles are being reported frequently in the last decade but little research has been done analysing the circumstances leading to such preventable deaths in India. Objectives To analyse circumstances leading to fatalities in children left unattended in parked motor vehicles in India. Methods This study was a descriptive analysis conducted on the basis of an Internet search of published news in major Indian newspapers/channels using different combination of keywords. We extracted data from the published news using a pre-determined tool. Results Between 2011 and 2020, there were 23 incidents that resulted in 40 fatalities across India mostly in summer months. Majority of children were 4–6 years of age (26/40). Ninety percent of children gained access to unattended vehicles for playing and getting locked accidentally (36/40) while remaining cases involved being forgotten (3/40) or intentionally left behind (1/40). Conclusion Majority of hyperthermia-related deaths occurred while children gained access to unattended vehicles for playing and getting locked accidentally.

Non islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome generally seen in tumors of mesenchymal and hepatic origin. This syndrome is characterized by life threatening hypoglycemia caused by over expression of high molecular weight insulin-like growth factor 2 (IGF 2). The main stay of treatment is surgical resection of the tumor with no clear medical management being reported as standard of care. We present the case of a 72 year old Cambodian man with no history of diabetes mellitus who presented to our institution with severe hypoglycemia complicated by a seizure and was found to have hepatocellular carcinoma (HCC). Hypoglycemia occurred during times of fasting. Laboratory evaluation revealed a serum glucose of 30mg/dl with insulin level of 2.2 mcIU/mL [2.6 - 24.9 mcIU/ml], C-Peptide of 0.17 ng/mL [0.80 - 3.85 ng/ml], BHB Hepatocellular carcinoma has been associated with NICTH in the literature. NICTH is characterized by an IGF2:IGF1 ratio >10 as there is no commercially available assay for big IGF II. Definitive treatment involves surgical resection or tumor debulking. Octreotide has antiangiogenic and antineoplastic properties and unfortunately, few studies have shown improved survival and quality of life in patients with advanced HCC. In the case of our patient, tumor was unresectable and NICTH improved with octreotide and prednisolone.

Bisphenol A an estrogen-mimic endocrine disrupting chemical, used to manufacture polycarbonate plastics and epoxy resins with toxic effects for male reproduction. Due to its toxicity, industries have started to replace it with other bisphenols. In this study, the toxicity of BPA analogues (BPB, BPF and BPS) was evaluated in a chronic study. We investigated whether the chronic exposure to low bisphenols doses affects spermatogenesis with outcomes on oxidative stress and male reproductive system. Male rats (22 day old) were exposed to water containing 0.1% ethanol for control or different concentrations of BPA and its analogues BPB, BPF and BPS (5, 25 and 50 μg/L) in drinking water for 48 weeks. Results of the present study showed a significant alteration in the gonadosomatic index (GSI) and relative reproductive organs weights. Oxidative stress in the testis was significantly elevated while sperm motility, Daily sperm production (DSP) and number of sperm in epididymis were reduced. Plasma testosterone, LH and FSH concentrations were reduced and estradiol levels were high in 50 μg/L exposed group. These results suggest that exposure to BPA and its analogues for chronic duration can induce structural changes in testicular tissue and endocrine alterations in the male reproductive system.

Aims and objectives The objective of the study is to assess the outcome of lengthy root canal sessions (more than 2 hours) on temporomandibular joint (TMJ) and its associated structures. Materials and methods Totally, 250 patients who had undergone root canal treatment that lasted for more than 2 hours were examined for the status of TMJ and masticatory muscles. The second part of the examination was performed after 1 week to check for any pain and tenderness. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Results Results showed that patients of older age suffered from more pain postoperatively. Similarly, women experienced more pain than males. Those patients who were treated for their posterior teeth complained of more pain than those treated for anterior teeth. Conclusion Prolonged root canal sessions result in longer and wider opening of mouth for longer period of time, thus causing harm to TMJ and associated masticatory structures and may give rise to sign and symptoms of temporomandibular disorder (TMD). Clinical significance It is prudent to break treatment sessions into shorter appointments and let patients relax during the treatment to prevent any extra stress on the TMJ and associated masticatory apparatus. How to cite this article Siddiqui TM, Wali A, Siddiqui F, Naireen D. Effect of Prolonged Endodontic Treatment on Temporomandibular Joint and Masticatory Muscles. World J Dent 2018;9(1):38-42.

Background: Spontaneous resolution of primary hyperparathyroidism (PHPT) is extremely rare, and has previously been reported exclusively in the setting of apoplexy (auto-infarction) of a large parathyroid adenoma outgrowing its blood supply. We report an unusual case of spontaneous PHPT resolution after Covid-19 infection. Clinical Case: A 38-year-old Hispanic woman was seen in clinic for evaluation of hypercalcemia first noted on routine bloodwork in 2018. She had a history of nephrolithiasis (1 episode) but no other symptom associated with hypercalcemia. She was not on medications associated with hypercalcemia, and had no family history of Ca disorder. Serum biochemistry was notable for hypercalcemia (Ca: 10.9, 10.5, and 10.8 mg/dL, nl 8.4–10.2), normal albumin and Cr, elevated PTH (106 and 70 pg/mL, nl 15–65), with low phosphate (2.3 mg/dL, nl 2.4–4.5) and 25-OH-Vit. D (14 ng/mL, nl 20–80). 24-hr urinary studies showed elevated urine Ca (285 and 375 mg/day, nl 100–250), with urine Cr of 1.3 and 1.5 g/day, respectively. Findings of hypercalcemia, hypercalciuria, and elevated serum PTH, led to the diagnosis of PHPT. Neck ultrasound and sestamibi scan of the parathyroids with SPECT-CT did not localize any abnormal parathyroid gland. A month after PHPT diagnosis, and prior to surgical evaluation, patient presented with a 9-day history of fever, cough, and shortness of breath. She tested positive for Covid-19 infection by SARS-CoV-2 PCR on nasal swab, and was quarantined at home with symptomatic treatment. No glucocorticoids were given. Serum Ca was normal (9.5 mg/dL) at the time of Covid-19 diagnosis. All Covid-19 symptoms subsided 14 days after onset. Repeat labs 1 and 3 months after Covid-19 infection showed persistently normal serum Ca (10.0 and 9.8 mg/dL), with low then normal PTH (13 and 43 pg/mL), compatible with spontaneous resolution of PHPT. Patient denied any neck discomfort before, during, or after Covid-19 infection. Spontaneous resolution of PHPT is rare and follows apoplexy of a large parathyroid adenoma. In our patient, imaging failed to localize a large parathyroid adenoma, making it less likely that resolution of her PHPT was caused by apoplexy. Resolution of PHPT temporally coincided with Covid-19 infection, although the link between the two conditions is unclear at this time. Hypothesized mechanisms include an imbalance in the normal PTH-Ca axis caused by SARS-CoV-2 mediated release of inflammatory cytokines (e.g. interferon, previously reported to lower serum calcium), or development of antibodies against the parathyroid or CaSR. RNA and protein expression of ACE2, the SARS-CoV-2 cell receptor gene, is not detected in normal parathyroid tissue. Conclusion: To our knowledge, this is the first reported case of spontaneous resolution of PHPT after Covid-19 infection. Further studies are needed to understand the frequency of this occurrence, and the underlying mechanism.

Though not a reliable indicator of malignancy, ultrasonic monitoring of nodule growth still has a role in the evaluation of nodules, e.g. indicating when a nodule may require biopsy or re-biopsy. Observer and technical limitations, however, limit the precision of ultrasonic determination of simple growth, vs. stability or shrinkage. Ultrasonic parameters used for this purpose all have their own limitations. Monitoring nodule growth by VOL frequently exhibits wide and conflicting swings in apparent size compared to the penultimate size, doubtlessly reflecting measurement limitations. As a growth parameter, LD typically exhibits a smoother time course but does not address growth in the other two dimensions. SUM3D includes changes in all dimensions but, like LD, is not a true measure of nodule mass or volume. This study was to determine the relative error of these three growth parameters and how it relates to their relative efficacy for nodular growth monitoring. The anterior-posterior (AP), left-right (LR) and superior-inferior (SI) dimensions of 34 benign nodules were determined ultrasonographically by four pairs of trained observers. One observer of a pair was regarded as a Time-1 observer and the other as a Time-2 observer, simulating the process for determining growth change over time. All observers measured the same image of each of the 34 nodules but were unaware of the measurements obtained by any other observer. For each image for each pair of observers, the dimensions were used to calculate the VOL, LD and SUM3D and the perceived changes thereof from Time-1 to Time-2. Since only one image for each nodule was distributed, differences between the Time-1 vs Time-2 measurements for each nodule could only reflect observer-based differences. “S”-curves plotting the nominal %-change in a parameter reported by the Time-2 observer compared to that reported by the Time-1 observer (x-axis) were rank-ordered from negative to positive changes (y-axis). The %-change in each parameter due to observer/technical error ranging from the highest over-estimate to the lowest were, in order from Top 10%, Middle 40%, and Bottom 10%, respectively: LD: 19-36%, -4 to 6%, -15 to -42%; SUM3D: 15 to 28%, -4 to 4%, -11 to -43%; VOL: 48 to 105%, -13 to 15%, -33 to -81%. The magnitude of %-change from Time-1 to Time-2 for the VOL parameter were 2 to 3 times greater than that of the LD or SUM3D parameters for the top 10% of values, the middle 40% of values, and the bottom 10% of values. These degrees of difference coincide with the wide variability seen in nodular growth curves [not illustrated here] when nodular VOL (y-axis) is plotted as a function of length of observation (x-axis). This study helps explain why monitoring nodular growth by LD or by the SUM3D usually provides a clearer, less fluctuant illustration of thyroid nodule growth over time than does VOL.

Explicit formulation of one-dimensional Euler equation with TVD scheme is bounded by the stability criterion $$\hbox {CFL}

This article proposes a discriminant function and an algorithm to analyze the data addressing the situation, where the data are positively skewed. The performance of the suggested algorithm based on the suggested discriminant function (LNDF) has been compared with the conventional linear discriminant function (LDF) and quadratic discriminant function (QDF) as well as with the nonparametric support vector machine (SVM) and the Random Forests (RFs) classifiers, using real and simulated datasets. A maximum reduction of approximately 81% in the error rates as compared to QDF for ten-variate data was noted. The overall results are indicative of better performance of the proposed discriminant function under certain circumstances.

Caffey disease is a rare and self-limiting condition characterised by cortical hyperostosis with inflammation of adjacent fascia and muscles. It usually presents in infancy and clinical features include hyperirritability, acute inflammation with swelling of overlying soft tissues and subperiosteal new bone formation. Awareness of the existence of this rare condition and its typical clinical and radiological profile will avoid unnecessary investigations and treatment and help the physician to explain its good prognosis to parents of affected children. We report a three-month-old male infant who presented to the Outpatient Paediatrics Department at Moti Lal Nehru Medical College, Allahabad, India, in 2018 with a right shoulder mass, decreased upper limb movements and irritability. The patient was treated with ibuprofen and paracetamol. Irritability and limitation of movement improved over a treatment period of two weeks.Keywords: Caffey Disease; Infant; Prostaglandin E1; Thrombocytosis; Case Report; India.

To determine the incidence of tumour lysis syndrome and to identify associated factors and mortality rate in paediatric haematological patients.The prospective study was conducted from April to September 2016 at Indus Children Cancer Hospital, Karachi, and collected data for all new paediatric oncology patients registered with diagnosis of haematological malignancies. Each patient was monitored for a period of three days before and seven days after the start of the treatment. SPSS 21 was used for data analysis.of the 232 patients, 86(37.1%) developed laboratory tumour lysis syndrome and 35(40.7%) of these patients developed the spontaneous variety. Overall, 24 (10.3%) patients progressed to clinical syndrome with 12(50%) of them developing spontaneous clinical syndrome. Mortality occurred in 17 (7.3%) patients.Despite preventive measures, tumour lysis syndrome remains an oncological emergency in children with haematological malignancies.

Bisphenol A (BPA) is used as the main component of many consumer products such as infant's feeding bottles, coatings of beverages, and food cans. BPA can migrate into the environment, and it has been detected in the saliva, blood, and food. BPA leakage from many consumer products resulted in a ban on its use in many countries where alternatives to BPA were introduced into the market. BPA alternatives such as bisphenol B (BPB), bisphenol F (BPF), and bisphenol S (BPS) have a similar chemical structure and binding ability for estrogen receptor (ER), which shows toxicological effects in animals. In the present study, comparative effects of exposure to BPA and its analogs BPB, BPF, and BPS on testosterone concentration in the rat testis were evaluated by in vitro and in vivo approaches in which oxidative stress markers and antioxidant enzyme activities in reproductive tissues were determined. In the in vivo study, male rats were exposed to different concentrations of BPA and its analogs BPB, BPF, and BPS (5, 25, and 50 mg/kg/day) for 28 days. In the in vitro exposure study, antioxidant enzyme activities and oxidative stress markers were induced in the testes, whereas testosterone production was reduced. In the in vivo exposure study, we observed that antioxidant enzyme activities and protein content were reduced, whereas reactive oxygen species and lipid profile were increased in the treated groups compared to the control group. The present comparative study on BPA and its analogs, namely, BPB, BPF, and BPS suggests the toxic effect of these chemicals on the testes and spermatogenesis, and we also observed that these chemicals induce oxidative stress in the reproductive tissues of male rats.

A mobile ad hoc network (MANET) is a collection of mobile nodes that are ceaselessly self-designing and work on foundation-less network. A mechanism for broadcasting is flooding where a request is retransmitted by a node at least once, but it is ineffectual in terms of bandwidth and energy. Energy management plays an important role in network. The proposed scheme uses two techniques: First technique is calculating queue length of every node to reduce normalized routing load. The second technique is selecting the route based on a threshold value to maintain efficient transmission to destination. The proposed protocol uses load energy metric algorithm which conserves the energy levels of nodes. The algorithm considers the queue length of every node. The work is implemented using ns2 simulator. The performance evaluation shows a reduction in routing overhead when compared to existing approach and AODV routing protocol.

Background Abandonment of treatment is one of the toughest challenges to deal with in pediatric oncology. It leads to unnecessary mortality and morbidity in patients from low- and middle-income countries. Procedure The objective of our retrospective study was to determine the prevalence and predictors for abandonment among children with cancer at our hospital in Karachi, Pakistan. We analyzed data on patients younger than 18 years, diagnosed with any malignancy between November 2014 and May 2016. Results From a total of 821 patients, one hundred and eighty-two (22.2%) patients abandoned treatment at various stages, 92 (11.2%) patients did not initiate treatment at all, and the remaining 90 (11.0%) left during treatment. The gender ratio at registration was skewed toward males but not statistically significant for abandonment. Of 295 registered females, 74 (25.1%) abandoned treatment compared to 108 (20.5%) abandonments among 526 males. In multivariable regression analysis, the type of malignancy, guardian's profession, and travelling from outside the city of Karachi (odds ratio [OR]: 1.48; 95% confidence interval [CI] 1.02–2.15; P = 0.039) correlated with increased abandonment. Treatment abandonment was higher among patients with brain tumors (45.7%) and solid tumors (30.8%) and among those whose guardians were associated with a rural profession (24.7%). Monthly income, age, and number of siblings had no impact on the decision to abandon treatment. Conclusion Despite the provision of free treatment, the prevalence of abandonment was high. More qualitative data need to be collected to identify and target groups of individuals who may be likely to abandon treatment, thus improving outcome of patients.

Using molecular dynamics (MD) simulations, the frictional properties of the interface between graphene nanoflake and single crystalline diamond substrate have been investigated. The equilibrium distance between the graphene nanoflake and the diamond substrate has been evaluated at different temperatures. This study considered the effects of temperature and relative sliding angle between graphene and diamond. The equilibrium distance between graphene and the diamond substrate was between 3.34 &Aring, at 0 K and 3.42 &Aring, at 600 K, and it was close to the interlayer distance of graphite which was 3.35 &Aring, The friction force between graphene nanoflakes and the diamond substrate exhibited periodic stick-slip motion which is similar to the friction force within a graphene&ndash, Au interface. The friction coefficient of the graphene&ndash, single crystalline diamond interface was between 0.0042 and 0.0244, depending on the sliding direction and the temperature. Generally, the friction coefficient was lowest when a graphene flake was sliding along its armchair direction and the highest when it was sliding along its zigzag direction. The friction coefficient increased by up to 20% when the temperature rose from 300 K to 600 K, hence a contribution from temperature cannot be neglected. The findings in this study validate the super-lubricity between graphene and diamond and will shed light on understanding the mechanical behavior of graphene nanodevices when using single crystalline diamond as the substrate.

In Sindh province, total 103 species of reptiles comprising of 42 Lizards, 45 Snakes, 14 Turtles, 1 species each of Tortoise, Crocodile and Gavial has been recorded. 13 key areas for the reptiles have been identified in Sindh along with three important sites viz. Karachi coast, Deh Akro Wildlife Sanctuary and Nara Wetland Complex. Some reptiles are under threat due to large scale exploitation for skin, medicinal use and as food item. Marine Turtles are threatened mainly due to habitat degradation. The common species include Indian Fringe-toad Lizard, Indian Sand Swimmer, Indian Garden Lizard, Sindh Sand Gecko, Desert Monitor and Saw-scaled Viper. Eight species are threatened and 16 species are of special conservation interest and need to be conserved.

To the Editor: We describe a case report of galactorrhea with prolactin level within normal limits in a healthy 16-year-old African American girl after administration of quetiapine. Prolactin is an endogenous hormone from the anterior pituitary gland that promotes lactation. Dopamine predominantly inhibits prolactin. Antipsychotic medications block the dopamine-2 (D2) receptor via the tuberoinfundibular dopamine pathway, which can result in hyperprolactinemia.1 Serotonin is an indirect modulator of prolactin secretion.2 Hyperprolactinemia can cause galactorrhea, gynecomastia, sexual dysfunction, menstrual irregularities, infertility, hirsutism, and acne in women due to hypoestrogenism; hypogonadism and impaired growth and sexual maturation in adolescents; and potential osteoporosis.3,4 Women have greater prolactin elevations from antipsychotics than do men.5,6 Children and adolescents may also have greater prolactin elevations in response to antipsychotics.7 Conventional antipsychotics, risperidone, zotepine, and amisulpride are known to elevate prolactin more than other atypical antipsychotic medications.4,8–10 The median time to onset of galactorrhea is 20 days (range, 7–75 days) after commencement of an antipsychotic medication.8 Compared to typical antipsychotics with tighter D2 receptor binding, most atypical antipsychotics are less likely to cause hyperprolactinemia and thus galactorrhea. Quetiapine is known to have overall weaker dopamine binding activity; positron emission tomography scans showed transiently high striatal D2 receptor occupancy. Quetiapine’s transient association with the D2 receptor is postulated to allow normal dopaminergic neurotransmission in the tuberoinfundibular pathway and thus avoid hyperprolactinemia. This may explain only a temporary elevation of prolactin levels. D2 receptor occupancy decreases to 0%–27% in 12 hours.11 Quetiapine is less likely to elevate serum prolactin levels than risperidone.10,12 Fluoxetine also has been described to cause hyperprolactinemia and galactorrhea, possibly by stimulating prolactin release from pituitary lactotrophs.13 Hyperprolactinemia and galactorrhea from selective serotonin reuptake inhibitor use tended to correlate with above average dosages.14 Our patient was taking fluoxetine at 15 mg daily. Oral fluoxetine at 60 mg daily for 6 days increased prolactin levels in various studies.14,15 Case report. Mary, a 16-year-old African American adolescent girl, presented to the adolescent inpatient unit in 2011 for a chief complaint of “hearing voices and seeing spirits that tell her to kill herself.” As a child, she had delays in meeting her milestones in walking, talking, and toileting. She denied any substance abuse history. Her urine drug screen was negative. Her medical history was unremarkable except for previous diagnosis of schizoaffective disorder. Mary started hearing voices at 12 years of age. Previously, the voices commanded her to hurt others. She was in the 11th grade and receiving special education for behavior issues when she lost her grandfather and started hearing voices again. This time, the voices consisted of the voice of her deceased grandfather, the voice of her aunt, and an unidentified male voice. The voices were instructing her to kill herself now. She had multiple attempts of suicide by cutting herself. Sometimes, she “blacked out” in severe distress from the voices. She reported memory lapses and recalls poor choices and actions made during such episodes. Her medications at admission included oral fluoxetine 10 mg daily and oral ziprasidone 60 mg twice daily. After reviewing her history, symptoms, and medication trials, we decided to treat her with oral fluoxetine 15 mg daily and oral quetiapine extended release (XR) 100 mg daily. Ziprasidone was discontinued because it was not effective. She reported bilateral mastalgia, breast enlargement, and “milk discharge” from her breasts 3 days after starting quetiapine. Galactorrhea was confirmed by physical examination. She denied having headaches and vision changes. Her serum prolactin level was 19.9 ng/mL (reference range is 3.4 to 24.1 ng/mL) 6 days after starting fluoxetine and quetiapine XR. Prolactin levels > 100 ng/mL are characteristic of tumors secreting prolactin.4 We checked her serum prolactin level on 2 different occasions; findings of both serum prolactin assays were not elevated beyond a normal reference range (reference range for a 13- to 15-year-old girl is < 60 ng/mL16). Both prolactin assays were obtained in a fasting state. Quetiapine XR was discontinued at this time. Her serum prolactin level was 19.2 ng/mL 7 days after stopping quetiapine XR. It can take 3 days to 3 weeks for serum prolactin levels to normalize after stopping antipsychotic medications.4 Mary stated that her menstrual cycle was regular over the last 3 months. She did endorse vaginal discharge. The pelvic examination showed pelvic tenderness. Urinalysis confirmed elevated white blood cells and nitrites. We tested her for gonorrhea and chlamydia, and the results were negative. We treated her with doxycycline and azithromycin. Her urine culture was positive for diphtheroid bacilli. Her urine pregnancy test was negative, and her serum beta human chorionic gonadotropin test was also negative. Her thyroid-stimulating hormone and free T4 levels were within normal limits. Euprolactinemic galactorrhea has been associated with thyroid abnormalities.17 Her blood urea and creatinine levels were within normal limits. Prolactin can be high in patients with chronic renal failure.18 Gonadotropin-associated protein and acetylcholine have been identified as prolactin-inhibiting factors in animals.19 A computed tomography scan of the head, performed after hospital discharge, showed no mass lesion in the brain. Mary exhibited hostile behavior and mood alterations with other females that were problematic. These behaviors can be a clinical manifestation of hyperprolactinemia,20 but our patient had prolactin levels within normal limits. Quetiapine was discontinued, and after 2 weeks her galactorrhea resolved. Prolactin levels can be high in patients with chronic renal failure.17 Her serum prolactin level was checked again 2 weeks after discontinuation of quetiapine, and it was still within the normal range. Drug-induced hyperprolactinemia is postulated to occur through various mechanisms. One mechanism decreases dopamine, another increases serotonin. Prolactin can be increased by various medications and mechanisms. Lithium acts on serotoninergic pathways to elevate prolactin. Estrogen potentiation of vasoactive intestinal peptide mediates hypothalamic synthesis of prolactin. Estrogen also has actions on the pituitary lactotroph cells to stimulate prolactin release. Opiates can inhibit dopamine synthesis and raise prolactin. H2 antagonists can inhibit dopamine release. Alprazolam raises prolactin levels through an unclear mechanism. Most psychotropic medications increase prolactin by inhibiting dopaminergic pathways.2,4 Thyrotropin-releasing hormone promotes prolactin release.21 There is a trend to apply atypical antipsychotics to treat a broad spectrum of psychiatric diseases. Quetiapine has a lower affinity for dopamine D2 receptors and appears to be selective for mesolimbic and mesocortical dopamine receptors, with relative sparing of the tuberoinfundibular system.22 Quetiapine has also been used to correct olanzapine-induced galactorrhea.23 However, there is a case report documenting dose-dependent quetiapine-induced galactorrhea.24 Female adolescents are more vulnerable to the side effect of galactorrhea caused by antipsychotic medications. In this case, typical and atypical antipsychotic medications most likely contributed to the galactorrhea, although fluoxetine may have contributed as well. Our patient had a serum prolactin level within normal limits despite the galactorrhea. Our patient was reluctant to reveal that she had galactorrhea; clinicians should screen female adolescents for galactorrhea when prescribing psychotropic medications and administer atypical antipsychotics cautiously.

To the Editor: The street drug “ecstasy” (3, 4-methylenedioxymethamphetamine [MDMA; also “X” or “E”]) is a synthetic amphetamine that has both stimulant and hallucinogenic properties.1 It is increasingly used as a recreational drug and has a strong association with the “rave” culture. Subjective effects of MDMA include elevated mood, increased self-confidence and sensory sensitivity, and a peaceful feeling coupled with insight, empathy, and closeness to persons.2 It has gained a deceptive reputation as a “safe” drug among its users. MDMA use has been associated with various medical complications such as renal and liver failure, rhabdomyolysis, disseminated intravascular coagulation, hepatitis, cerebral infarction, seizures, delirium, fulminant hyperthermia, intracranial bleed, cerebral edema, and coma.3–6 Adverse psychiatric symptomatology associated with MDMA includes panic attack, depression, suicidal ideation, flashbacks, rage reactions, psychosis, and severe paranoia.3 Persistent psychosis after even a single use has been reported.1,4,7 This case report describes persistent psychosis in a previously healthy adolescent girl after a single ingestion of MDMA Case report. In October 2010, Ms A, a 17-year-old African American girl without previous psychiatric or medical history, obtained MDMA from her friend and ingested the pill. She began experiencing auditory hallucinations and displaying disorganized speech and behavior shortly thereafter. She was taken to the University of South Alabama, Mobile, emergency department for evaluation and treatment of her behavior. In the emergency department, the consultation-liaison psychiatrist noticed that the patient was awake and alert, but could not engage in meaningful communication. Results of routine laboratory testing showed no alcohol or illicit drugs present. Physical examination findings were unremarkable. She was seen by the neurology service, where physicians believed that the patient had no obvious etiology for her current symptomatology. There was no family history of mood disorders or psychosis among first- or second-degree relatives. The patient was cleared medically in the emergency department and was then transferred to an acute care inpatient psychiatric unit affiliated with the University of South Alabama. In the psychiatric unit, she continued to demonstrate odd, bizarre behavior. She exhibited frequent episodes of crying and using profanity. She displayed sexually inappropriate behavior, eg, touching others sexually, dancing seductively, and assuming unusual postures by putting her hands underneath her pelvis while pushing the pelvis upwards. In addition, she attempted to eat food from another person's plate and multiple trash cans. Her speech was mostly nonsensical, and at times she claimed that she was pregnant and had an acquired immunodeficiency syndrome (AIDS) infection. She appeared to be responding strongly to internal stimuli. She gave the appearance of being paranoid, feeling scared, and being socially withdrawn. After a literature review, we decided to institute olanzapine orally disintegrating tablets 10 mg every 12 hours. Haloperidol 5 mg and lorazepam 1 mg were also employed on an as-needed basis and were administered frequently over several days. After 14 days of this medication regimen, normal behavior was noticed, but there were intervals during which she became agitated and confused. After that point, her family had decided to take her home against medical advice. She was sent to school for a day by family to resume a normal life (she is an honor roll student and had been accepted to college on a scholarship). According to the family, the school personnel advised her to go back home immediately because “she is not normal.” She was promptly rehospitalized in our care due to frequent agitation, confusion, leaving the house at night, and walking in traffic. In the unit, her assessment demonstrated her to be staring off blankly into space and making repetitive hand, eye, and head movements while screaming. She was placed on 1:1 observation due to her unpredictable behavior. Olanzapine was increased to 15 mg every 12 hours. Gradually, her behavior improved, such that she was no longer displaying stereotypic behavior. She was capable of having meaningful conversations. Furthermore, her reality testing improved. Upon discharge, she showed improvement of symptoms and organized thoughts. However, she continued to describe dysphoric mood. She recounted use of MDMA in October. Instantaneously she noticed she was not herself nor did she recall what happened immediately after taking MDMA. MDMA-induced psychotic disorder can be distinguished from schizophrenia by several characteristics associated with the former, including complete lack of prodromal symptoms (social withdrawal, anxiety, or lack of motivation), absence of sustained mood disturbance, and good premorbid functioning.1 The cause of MDMA-induced psychotic symptoms is not well understood.1 Evidence from animal and human studies suggests that MDMA reduces levels of brain serotonergic activity and depletes serotonin stores.8 MDMA acts by binding to presynaptic monoamine transporters, most strongly to the serotonin receptor transporter, causing rapid release and subsequent depletion of serotonin and dopamine from presynaptic terminals.6,9–11 Further damage is caused by the generation of free radicals that are taken by the serotonin nerve terminal, exhausting the antioxidant capacity of brain tissues.12 In laboratory animals, MDMA causes persistent damage to serotonergic neurons.6,9,12 It is thought that it causes similar damage to neurons in the human brain. MDMA does not have a potent direct agonist effect on dopamine receptors.1,2 MDMA may induce psychosis through dopaminergic or serotonergic pathways.13 Our patient did not have medical complications, as compared to a published case report.14 In our case, there was no laboratory toxicology evidence of MDMA exposure; however, routine toxicology screens do not screen for MDMA. Furthermore, presumptive diagnosis of MDMA use is often made without toxicologic evidence. In our patient, we were able to support MDMA use through patient interview and collateral from friends and family. The use of high-dose antipsychotic medication (haloperidol and olanzapine) and anticonvulsants (diazepam and carbamazepine) has been documented for the treatment of psychosis after MDMA use.1,5,6,15 The widespread use of MDMA and the potential adverse effects associated with it underlines the need for clinicians to inquire carefully about MDMA use and to include MDMA in toxicology screenings. MDMA use as a differential diagnosis in patients presenting with paranoid psychosis, affective disorders, or anxiety has become increasingly important. When MDMA exposure is suspected, there should be close collaboration between the psychiatrist and medical personnel, since MDMA use is associated with serious medical complications. Whether these complications are due to MDMA use directly or caused by unrelated adulterants added during manufacturing is an area of ongoing research. Further studies are required to clarify the etiology of persistent psychosis after MDMA use and to describe the treatment options.