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Achieving an optimal concrete mix design is critical for mechanical performance and sustainability, particularly by incorporating supplementary cementitious materials to promote eco-friendly concrete. This study introduces an intelligent concrete mix design method that optimizes performance and integrates machine learning and multi-criteria decision-making techniques. In the initial phase, three machine learning models—Decision Tree, Random Forest, and Multi-layer Perceptron—were developed and trained on a dataset of 1030 records to predict sustainable concrete's compressive strength accurately. Among these models, the Random Forest model demonstrated the highest accuracy, exceeding 90 % in testing, affirming its superior predictive capability for concrete strength compared to other models reported in the literature. In Tthe optimization phase, multi-objective optimization was involved. Thus, compressive strength was optimized alongside sustainability criteria, including CO₂ emissions and cost-effectiveness. This optimization was processed by Pareto analysis and the Technique for Order of Preference by Similarity to the Ideal Solution (TOPSIS) to identify the most effective mix design, which was achieved with a binary combination of supplementary cementitious materials. This combination was identified as the top-ranked mix regarding sustainability and performance metrics. For the validation in practical cases involving commercial buildings, it has acheived 27 % cost reduction and 63 % decrease in CO₂ emissions compared to conventional concrete mixing. This intelligent mix design approach significantly advances sustainable concrete development in reducing environmental impact as well as promoting cost-effective.

Modular construction is an emerging technique being adopted with varying levels of modularization. Assessing its sustainability performance during the planning phase is essential for deciding between precast elements and traditional cast-in-situ methods. To address this, this study developed a comprehensive sustainability assessment framework that integrates economic, environmental, and social indicators. A total of 26 indicators were extracted from the literature and prioritized by 55 experts. Thus, ten indicators were designated critical and quantified for the case of a three-story building using three slab alternatives: cast-in-situ (CIS), I-girder (PIS), and hollow core (PHS). BIM analyses and qualitative data for the ten sustainability criteria were configured into a decision matrix through a multicriteria decision-making approach, i.e., TOPSIS. Simulations were conducted on the matrix by varying the weights of sustainability domains (0.33 – 0.80) to prioritize the best alternative. The BIM analyses revealed significant advantages of PIS, including a 33% and 31% reduction in material and labor costs, respectively, compared to the CIS. Furthermore, precast elements show a 60% reduction in carbon emissions, a 95% decrease in wastage, and an additional benefit of 90% less air pollution. The TOPSIS simulations concluded the PIS system as the most sustainable alternative with the highest relative closeness coefficients (RCC) in all domains and weight cases. The PIS performed best in the environmental with RCCs of 0.83 – 0.97, then in the economic with 0.83 – 0.86, and with 0.69 – 0.83 in the social domain.

Cementless binders are made possible by the invention of geopolymers, which utilize alkaline activators to activate alumina-silicate materials. Alkaline activators, however, are corrosive and hazardous. Its minimal usage combined with advanced technology can make it sustainable. Therefore, this work was designed to develop alkali-activated binders (AABs) through mechano-chemical activation. Initially, three types of fly ashes (FAs) were activated, and their performance was evaluated using the strength activity index. The best-performing FA was used in the second group of experiments. Slag was coupled with FA, and dune sand (DS) was coupled in the third group. The physico-mechanical performance of each group was evaluated and the geopolymerization mechanism was assessed through FTIR analysis. By using DS, it was observed that the compressive strength has been significantly enhanced with an increase of 100 % compared to the FA-based binder, while the bulk density of both cases is almost the same (i.e., 1,650 kg/m3). Based on the multi-criteria analysis for three scenarios, it is revealed that the key performances of the high strength and durability, the lightweight and insulation, and the strength requirement are optimized by alkali-activated binders of FA + DS, FA-3, and FA + GGBS (Slag), respectively.

Safety management is important throughout the world specifically on building projects, which are prone to accidents due to their unique operations, dynamic and ever-changing nature. In every country, contractors implement safety management systems (SMSs) to avoid accidents and comply with applicable laws, regulations and to provide safe work environments for their workers. Nonetheless, accidents still happen on many building projects in the country. The objective of this work is to measure safety management as perceived on building projects by employing a proactive approach in the Kingdom of Saudi Arabia to improve site safety. A survey instrument is utilized to gather data from building projects. Another questionnaire is used to conduct interviews with the key managers on the same projects. Analysis of the questionnaire survey is performed after entering the data into SPSS software by applying factor analysis and multiple linear regression. Factor analysis extracted two significant factors, including “management commitment, employee involvement, and safety training”—factor 1, and “project safety plan, safety committee, and safe use of equipment”—factor 2, which proactively measure the implementation of safety management on the building projects. The safety model obtained by multiple regression analysis identifies two significant contributors to the performance of the SMS. Analysis of the interviews complemented and validated the results of the questionnaire survey. The findings provide in-depth understanding of proactively measuring safety management on building projects for the construction industry practitioners to make project sites safer.

Abstract In oceans, fish usually live in an environment that is best suited for their growth. When these fish are introduced into man-made environment, e.g. in mariculture and aquaculture set-ups, the physical parameters might stray from their ideal values, resulting in improper growth and undesired outcomes. Hence, to prevent these undesirable outcomes, continuous monitoring of the physical parameters of the water such as pH, temperature and dissolved oxygen is required. In this work, we present a system called H2O sense, which continuously monitors the physical parameters of the water in tanks and alerts the user in case the values deviate from ideal. We use only low-power, low-cost hardware and open-source development tools, which makes the system easily applicable to various settings. The deployment of our system in the Maritime Laboratory of the University of Namibia shows its efficacy. Furthermore, we evaluate in detail the performance of our system and discuss its applicability in similar challenged environments.

Background: Ophthalmology consultation on inpatients is often important to optimise eye care and provide information for referring teams. Inpatient consultation may constitute a not-insignificant workload however. This study reports on the nature and necessity of ophthalmology inpatient consults in a large Irish hospital., Methods: Retrospective analysis of all consecutive ophthalmology inpatient consultations over a 12-month period., Results: In total, 359 consult requests were received primarily from adult medicine (57.9%), surgery (22%) and paediatric teams (18.4%). The most common reasons for referral were loss of vision (23.7%); visual field testing (15%); diplopia or abnormal eye movements (11.4%); and screening for ocular features of systemic disease (10.6%). Presumptive diagnoses by referring teams were correct in 29.5% of cases. The majority had normal eye examinations (53.2%) or non-sight-threatening features (16.8%), while a minority had acute eye pathology (30%). Most patients (80.4%) required no intervention. A minority required medical (12.5%), orthoptic (4.6%) or surgical (2.4%) intervention. The majority of patients (81%) were fit for transfer to the eye clinic and did not require bedside examination., Conclusions: Our study found a high proportion of ophthalmology inpatient consultations had normal eye exams and required no intervention. The quality of referrals was variable suggesting that clearer guidelines and more ophthalmology education is needed for referring teams., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Background Incidental upper gastrointestinal wall thickness (GIWT) is a nonspecific finding often observed on computed tomography (CT) scans performed to investigate patients admitted with various symptoms both gastrointestinal (GI) and non-GI. Its clinical significance is uncertain, and patients often undergo endoscopic evaluation under an urgent cancer pathway to exclude malignancy. We aimed to conduct this study to determine how well the CT findings correlated endoscopically.  Methods  A retrospective data collection was performed for patients who were referred to the endoscopy department between July 2021 and July 2024 for evaluation of GIWT over a period of four years. We analyzed age, gender, reason for initial CT, endoscopic findings, histology findings, and evidence of cancer. Results Our final cohort included 50 patients who underwent endoscopic and subsequent histological examination following abnormal CT findings. The mean age of the included cohort was 71. Thirty-one were males and 19 patients were females. Ninety percent had esophageal wall thickness while 10% had gastric wall thickness. Twenty-six percent of patients had red flag symptoms such as weight loss and iron deficiency anemia as an indication for undergoing CT scans. About 8% of the patients were confirmed to have malignancy on endoscopy of which 6% had red flag symptoms such as weight loss and iron deficiency anemia. Seventy-eight percent of the cohort had gastroscopy within two to four weeks, 10% in four to 12 weeks and 12% after 12 weeks. Conclusion Our results illustrate that a majority of people with incidental GIWT had benign pathologies whereas a small number of patients had malignancy. It is worth noting that malignancy was more common among patients who had red flag symptoms, and therefore urgent endoscopy assessment under the urgent cancer pathway is recommended in these patients. On the contrary, the risk is noted to be low in patients with no red flag symptoms, therefore we recommend assessing such patients individually for the need for endoscopic evaluation based on detailed history and examination. We think further multicenter large studies are required in this area of research and develop standard protocols in relation to investigating incidental upper GIWT with endoscopy., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Idrees et al.)

Hereditary hemochromatosis (HH) is an inherited disorder, characterized by abnormal iron metabolism, resulting in systemic iron overload. The iron deposits in multiple organs including the liver, pancreas, heart, pituitary gland, joint, and skin and causes tissue damages leading to clinical manifestations. On the contrary, celiac disease (CD) is an autoimmune disorder associated with genetic and environmental triggers and frequently associated with iron deficiency. Additionally, pregnancy results in a physiological state of increased iron requirement due to volume expansion and fetus growth and development. We present an interesting case of a young female patient with concomitant CD and HH, who developed iron depletion following venesection which was further complicated by pregnancy and the postpartum period. This case highlights the rare co-existence of CD and HH, underscoring the diagnostic and therapeutic challenges in managing these concurrent conditions. Furthermore, it emphasizes the importance of patient education, clinical management, appropriate follow-up, and close monitoring of patients by multidisciplinary teams to establish the correct balance of body iron storage in order to prevent potential complications in a female patient of child-bearing age., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Idrees et al.)

Dysphagia, or difficulty swallowing, can result from esophageal motility disorders and is often linked to hypocalcemia. Calcium is essential for the proper function of pharyngeal and esophageal muscles, and low calcium levels can impair swallowing. Additionally, certain diuretics may worsen this by increasing calcium and magnesium loss, complicating the management of hypocalcemia. In this case, an 82-year-old male presented with a sudden onset of dysphagia, which had worsened over one week. He was intolerant to both solids and liquids and had a complex medical history, including non-erosive gastritis and previous benign adenoma surgery. Magnetic resonance imaging (MRI) of the brain ruled out acute stroke. On admission, he had severe hypocalcemia (serum calcium level of 1.19 mmol/L) and hypomagnesemia (serum magnesium level of 0.17 mmol/L). A mildly elevated parathyroid hormone (PTH) level of 7.5 pmol/L suggested a compensatory response. Despite intravenous (IV) calcium administration, his calcium levels showed only slight improvement. Hypomagnesemia contributed to resistance to calcium therapy, necessitating IV magnesium. His use of furosemide at a dose of 40 mg per day, a diuretic that increases renal calcium excretion, likely exacerbated both conditions. After two days of IV calcium and magnesium, his serum calcium normalized to 1.96 mmol/L, and magnesium improved to 0.84 mmol/L. Post-treatment, he showed marked improvement in dysphagia, regaining the ability to swallow both solids and liquids. The endoscopic examination of the upper gastrointestinal (GI) tract shows normal findings. The gastroesophageal junction and esophagus have healthy mucosa with no visible abnormalities such as lesions, strictures, or inflammation. The stomach appears normal, with smooth, intact mucosa and well-formed gastric folds. Some food debris is present but does not indicate any pathology. The resolution of symptoms with electrolyte correction confirmed that hypocalcemia was the primary cause of his dysphagia, which was challenging to manage due to hypomagnesemia. This case emphasizes the importance of considering electrolyte imbalances, particularly hypocalcemia, as potential reversible causes of severe dysphagia. The patient's improvement in swallowing function with calcium correction supports the hypothesis that these electrolyte disturbances significantly contributed to his symptoms. This case highlights the crucial role of calcium in esophageal motility and emphasizes the need to evaluate and correct electrolyte imbalances in acute dysphagia. This case also highlights the role of magnesium in overcoming resistance to calcium supplementation in cases of severe hypocalcemia. Further research could improve the understanding and management of similar cases., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Akhtar et al.)

Background: Retinal tears occur as a result of traction at sites of retinal and vitreous adhesion-this allows retrohyaloid fluid into the subretinal space. Prompt management is required to prevent progression to rhegmatogenous retinal detachment (RRD)., Aims: To identify the post-procedural outcomes following treatment of retinal tears with laser retinopexy in an emergency setting., Methods: Retrospective review of all patients who underwent emergency slit-lamp laser retinopexy between January and December 2021 in Cork University Hospital, an Irish tertiary referral centre., Results: A total of 87 patients were identified-mean age of 60 ± 12 years and 54% female. Follow-up ranged from 1 week to 11 months. Pre-disposing risk factors were identified-myopia (37%), recent trauma (2%), and RRD family history (5%). All patients had slit-lamp mounted laser-retinopexy performed in the eye-casualty. 63 patients (72%) had a superior break, 66 patients (76%) had a horse-shoe retinal tear, and 21 patients (24%) had a retinal hole. Associated findings included lattice degeneration (26%), sub-retinal fluid (55%), and vitreous haemorrhage (33%). Fourteen patients (16%) required multiple slit-lamp laser retinopexies while 18 patients (21%) required intervention by a vitreo-retinal surgeon including indirect-laser retinopexy (3%), cryotherapy (11%), and pars-plana vitrectomy (6%). At the most recent follow-up, all the patients had anatomically attached retinas., Conclusion: A notable proportion of patients (21%) undergoing emergency laser retinopexy required further intervention. Patients with anteriorly located retinal tears would benefit from an early discussion with a vitreo-retinal surgeon. Departmental training in laser retinopexy and retinal tear management is recommended as part of ongoing quality improvement., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Introduction: Organ donation is the act of removing an organ or tissue from a donor and transplanting the said organ/tissue to a recipient. Despite being the only definitive treatment for end-organ failure, there is a lot of hesitation surrounding the practice of organ donation. Even among medical students, who are more aware of the benefits of organ donation than the general public, this reluctance is widespread.Therefore, we conducted this research to determine the basis of this skepticism, so that the root causes can be identified and eradicated. Our research sought to ascertain the overall attitudes of Rawalpindi Medical University, Pakistan's students towards organ donation, the associated factors that influenced this attitude (religious devotion, gender, age, year of study) and the reasons for the hesitance., Methods: A cross-sectional study targeting the students of first to final year MBBS was conducted at Rawalpindi Medical University, Pakistan in the year 2022. The sample size was calculated using OpenEpi software, and came out to be 292. The students enrolled at Rawalpindi Medical University during the year 2021-2022 were made a part of the study. A self-structured questionnaire that was developed after substantial research was used to collect the data using a non-random convenience sample technique. Chi Square test was used to determine significance after data analysis using SPSS-22., Results: A total of 290 students participated in the study, 58 from each year. All of the participants were Muslim. A very strong correlation was found between high devoutness and willingness towards organ donation (p = 7.4252E-13). Only 9/290 (3%) of people in Pakistan have joined The Transplantation Society of Pakistan; the main cause of this low ratio is that very few people were aware that such a group even existed (according to 62% of the responders). The mistrust of doctors and the belief that appropriate efforts would not be done to resuscitate patients who have signed up for organ donation is a significant factor in the anxiety surrounding organ donation., Conclusions: There are several reasons why people are reluctant to donate their organs, including a lack of understanding of religious perspectives on the subject, mistrust of medical professionals and medical administration, and general public ignorance. We can make a significant progress toward closing the gap between the demand for and supply of organ donations if these problems are remedied. The most effective strategy to stop organ trafficking is through organ donation. Through seminars, conversations, and workshops, we need to raise awareness about organ donation., Competing Interests: The authors report no conflicts of interest., (© 2022 The Author(s).)

Introduction: Neonatal mortality remains a significant challenge not only to the world,but especially to a developing country like Pakistan. It can be majorly attributed to the sub-par healthcare, insufficient and under-recognised community health workers, and the lack of knowledge of proper newborn care on the part of the parents. This study targets the level of knowledge of the mothers and the services provided by community health care workers as the main factors determining neonatal care., Methods: A cross-sectional study was conducted in the OBS (obstetrics) wards of Hospitals affiliated with Rawalpindi Medical University from January 2022 to June 2022. The sample size was 138. Data was collected by one-on-one interviews, using a standardized USAID Community Health Worker Assessment and Improvement Matrix questionnaire. Data analysis was done using SPSS v28. Chi-square test was applied to check for significance., Results: Out of the total 138 participants, 47.8% (n = 66/138) were between the ages of 21-25. Results showed that women between the ages of 21-25 (P = 0.000058) and women who had their first child between the ages of 23-27 had good knowledge about neonatal care. 45% (n = 62/138) of the participants had poor knowledge of neonatal care, whereas 55% (n = 76/138) had good knowledge (P = 0.000002). As for the role of community health workers, only 20-30% of the participants were being provided with their services; hence their performance was not found to be adequate., Conclusions: The world of medicine is moving rapidly toward a new framework of the health systems in which the real foundation will be based on what actually takes place in the community, therefore, community health workers can play an important role in improving maternal and neonatal care. Family-centered care, appropriate age of first conception and motherhood, and proper guidance to first-time parents can ensure significant improvement in neonatal care in the future., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 The Authors.)

Obesity is a recently defined illness whose diagnosis and treatment continue to be stigmatized. Currently, due to lifestyle changes brought on by technological advancements and the wide availability and affordability of high-calorie foods, millions of people around the world suffer from obesity and/or its sequelae. Finding adequate prevention and treatment options would therefore lead to massive improvements in the duration and quality of life of affected individuals. In this review, we searched the PubMed database for studies exploring the safety and efficacy of the five medications currently approved by the FDA for the treatment of obesity. We included only studies pertaining to adult patients that have been published between 2012 and 2022. We found evidence that all the drugs analyzed such as orlistat, phentermine/topiramate, naltrexone/bupropion, liraglutide, and semaglutide appear to be effective in inducing weight loss, with the suggestion that semaglutide may have superior efficacy. However, a massive obstacle in developing treatment guidelines remains the lack of prolonged studies monitoring the long-term safety and efficacy of obesity medications. Nevertheless, in patients at risk of complications from obesity, the benefits of losing fat mass may outweigh the potential side effects associated with these medications and clinicians should prescribe whichever of the FDA-approved pharmacotherapy they deem most appropriate for the patient's specific set of circumstances., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Idrees et al.)

The Industrial Internet of Things (IIoT) refers to the use of smart sensors, actuators, fast communication protocols, and efficient cybersecurity mechanisms to improve industrial processes and applications. In large industrial networks, smart devices generate large amounts of data, and thus IIoT frameworks require intelligent, robust techniques for big data analysis. Artificial intelligence (AI) and deep learning (DL) techniques produce promising results in IIoT networks due to their intelligent learning and processing capabilities. This survey article assesses the potential of DL in IIoT applications and presents a brief architecture of IIoT with key enabling technologies. Several well-known DL algorithms are then discussed along with their theoretical backgrounds and several software and hardware frameworks for DL implementations. Potential deployments of DL techniques in IIoT applications are briefly discussed. Finally, this survey highlights significant challenges and future directions for future research endeavors.

Background:  In adults, lymph nodes are not normally palpable. A number of patients with asymptomatic lymphadenopathy never visit physicians for the condition, and thus, this important sign is often missed by the medical practitioner if it is not the presenting complaint. The incidence of lymphadenopathy is suggested to be increasing. While lymphadenopathy is benign and self-limiting in most patients, the underlying disease may range from treatable infectious etiology to malignant neoplasms. In most cases clinical examination and history guide towards the cause of lymphadenopathy. In recent years, fine needle aspiration cytology (FNAC) has become an easy clinical tool (with or without the assistance of CT, MRI, and ultrasound) for the diagnosis of the underlying cause of lymphadenopathy., Aims and Objectives:  To find out the cytomorphological pattern in superficial lymphadenopathy with the help of FNAC., Materials and Methods:  This descriptive cross-sectional study was conducted at HBS General Hospital, Islamabad from January 2017 to June 2019. Patients presenting with superficial lymphadenopathy were included in the study. FNAC was performed by the pathologist, histopathological reports were examined and analyzed using Statistical Package for the Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY).  Results: Six hundred and thirty-two patients underwent FNAC. Tuberculous lymphadenitis was the most common diagnosis (56.1%) followed by reactive hyperplasia (28.29%). The sample showed metastatic malignancy 3.36% and lymphoma 2.05%. Cervical lymphadenopathy was the most common site for TB (49.36%). Metastatic cancer observed in cervical lymph nodes was 3.16% and lymphoma was 1.74%., Conclusion:  FNAC is recognized as a simple and safe diagnostic technique that can diagnose cases of superficial and deep lymphadenopathy easily. The most common cause of superficial lymphadenopathy in our study was tuberculosis with cervical lymph nodes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Islam Sheikh et al.)

Background/aims: To describe the epidemiology, outcomes, and prognostic factors of intraocular foreign body (IOFB) injuries at a tertiary ophthalmic referral centre in Cork University Hospital, Ireland., Methods: A retrospective review of 23 eyes with IOFB that presented to Cork University Hospital (CUH) from January 2009 to December 2019 was performed. The mechanism and characteristics of IOFB injury were all noted. This data was collated and analysed to ascertain the epidemiology of IOFB injury in CUH and to describe the prognostic factors affecting visual outcome following IOFB injury., Results: There was a 100% male prevalence. The mean age was 37.4 years. The majority of IOFBs were metal in nature and were acquired by hammering, often while working and frequently in the absence of personal protective equipment (PPE). The route of entry for the IOFB was via the cornea in 70% of cases. Fifty-two percent of cases were clinically detectable and 43% of cases were only identifiable on CT (computed tomography) imaging. Eighty-seven percent of cases underwent surgery on the same day as presentation. There was no incidence (0%) of endophthalmitis. Seventeen percent of cases developed post-operative retinal detachment (RD). The mean pre-operative VA was 0.79 LogMAR (6/38 Snellen equivalent-SE) compared to a mean VA of 0.58 LogMAR (6/24 SE) following surgery., Conclusions: This review provides important epidemiological data for IOFB injuries in Ireland. It also adds some useful information to the literature in relation to prognostic factors and lens status post IOFB injury., (© 2020. Royal Academy of Medicine in Ireland.)

Background: Coronavirus disease 2019 (COVID-19) has left a significant impact on the world's health, economic and political systems; as of November 20, 2020, more than 57 million people have been infected worldwide, with over 1.3 million deaths. While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life., Aim: To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence, highlight gaps in knowledge, and elucidate further meta-analyses and umbrella reviews that are yet to be performed., Methods: We explored studies based on systematic reviews and meta-analyses with the key-terms, including severe acute respiratory syndrome (SARS), SARS virus, coronavirus disease, COVID-19, and SARS coronavirus-2. The included studies were extracted from Embase, Medline, and Cochrane databases. The publication timeframe of included studies ranged between January 01, 2020, to October 30, 2020. Studies that were published in languages other than English were not considered for this systematic review. The finalized full-text articles are freely accessible in the public domain., Results: Searching Embase, Medline, and Cochrane databases resulted in 1906, 669, and 19 results, respectively, that comprised 2594 studies. 515 duplicates were subsequently removed, leaving 2079 studies. The inclusion criteria were systematic reviews or meta-analyses. 860 results were excluded for being a review article, scope review, rapid review, panel review, or guideline that produced a total of 1219 studies. After screening articles were categorized, the included articles were put into main groups of clinical presentation, epidemiology, screening and diagnosis, severity assessment, special populations, and treatment. Subsequently, there was a second subclassification into the following groups: gastrointestinal, cardiovascular, neurological, stroke, thrombosis, anosmia and dysgeusia, ocular manifestations, nephrology, cutaneous manifestations, D-dimer, lymphocyte, anticoagulation, antivirals, convalescent plasma, immunosuppressants, corticosteroids, hydroxychloroquine, renin-angiotensin-aldosterone system, technology, diabetes mellitus, obesity, pregnancy, children, mental health , smoking, cancer, and transplant., Conclusion: Among the included articles, it is clear that further research is needed regarding treatment options and vaccines. With more studies, data will be less heterogeneous, and statistical analysis can be better applied to provide more robust clinical evidence. This study was not designed to give recommendations regarding the management of COVID-19., Competing Interests: Conflict-of-interest statement: All authors confirm the absence of personal and financial interests impacting the outcomes of this research study., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

Competing Interests: Competing interests: None declared.

With the swift growth in commerce and transportation in the modern civilization, much attention has been paid to air quality monitoring, however existing monitoring systems are unable to provide sufficient spatial and temporal resolutions of the data with cost efficient and real time solutions. In this paper we have investigated the issues, infrastructure, computational complexity, and procedures of designing and implementing real-time air quality monitoring systems. To daze the defects of the existing monitoring systems and to decrease the overall cost, this paper devised a novel approach to implement the air quality monitoring system, employing the edge-computing based Internet-of-Things (IoT). In the proposed method, sensors gather the air quality data in real time and transmit it to the edge computing device that performs necessary processing and analysis. The complete infrastructure & prototype for evaluation is developed over the Arduino board and IBM Watson IoT platform. Our model is structured in such a way that it reduces the computational burden over sensing nodes (reduced to 70%) that is battery powered and balanced it with edge computing device that has its local data base and can be powered up directly as it is deployed indoor. Algorithms were employed to avoid temporary errors in low cost sensor, and to manage cross sensitivity problems. Automatic calibration is set up to ensure the accuracy of the sensors reporting, hence achieving data accuracy around 75⁻80% under different circumstances. In addition, a data transmission strategy is applied to minimize the redundant network traffic and power consumption. Our model acquires a power consumption reduction up to 23% with a significant low cost. Experimental evaluations were performed under different scenarios to validate the system's effectiveness.

Diabetes, and associated diabetic neuropathic pain, impact negatively on cognitive function. However, the underlying mechanisms remain poorly understood. This study investigated neuropathic pain-related behaviour and cognitive function in the rat streptozotocin (STZ) model of diabetes, and assessed cannabinoid1 (CB1) receptor functionality in discrete brain regions. Male Lister-Hooded rats received STZ (60 mg/kgs.c.) or vehicle. Sensory responses were assessed in von Frey and Hargreaves tests. Cognitive, motor and sensorimotor functions were assessed using novel object recognition and Morris water maze tasks. CB1 receptor functionality was assessed by [(35)S]GTPγS (guanosine 5'-O-[gamma-thio]triphosphate) autoradiography. STZ treatment was associated with mechanical allodynia and thermal hypoalgesia. Novel object recognition was unaltered in diabetic rats. STZ treatment was associated with impaired performance in the Morris water maze acquisition phase, but there were no differences in memory retrieval in the probe trial. Stimulus-response learning in the water maze cued trial was also disrupted in STZ-treated rats, possibly indicating sensorimotor deficits. CB1 receptor agonist-stimulated [(35)S]GTPγS binding was attenuated in the substantia nigra of STZ-treated rats but unaltered in the hippocampus. In conclusion, STZ treatment as a model of diabetic neuropathy was associated with specific functional deficits in the Morris water maze, effects which may be related to altered CB1 receptor functionality in the substantia nigra., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Proximal humeral fractures account for 4-5% of all fractures. Most fractures are minimally displaced and can be managed non-operatively in adults. Displaced and unstable fractures are difficult to manage and should be treated to achieve painless shoulder and full function. Our aim was to evaluate the functional outcome of proximal humerus fractures (Neers classification 2 part, 3 part and 4 part) treated with PHILOS (Proximal humeral internal locking system)., Methods: We retrospectively reviewed 22 patients who had proximal humerus fractures treated with PHILOS plate from Jan 2012 to June 2013 conducted at Orthopaedic Department Liaquat National Hospital. Clinical outcome was measured using DASH (disability of arm, shoulder and hand) Score System. Radiological union was assessed by serial X rays., Results: Two patients were lost to follow up. Mean age was 40 years (20-70). Mean follow up was 6 months. 4 patients had two-part fracture, 10 patients had three-part and 6 patients had four-part fracture. Radiological union was achieved in average 8.31 weeks (±1.37SD). Average DASH score in young patients was 15.14 (±1.91SD) and in elderly was 31.66 (±4.08SD). One case of implant failure was noted. Better results in younger patients were achieved as compared to elderly proved by DASH score., Conclusions: Increase in number of fracture parts and delay in treatment did not affect the outcome. Our study concluded that this implant provides stable fixation in younger patients with good quality bone sufficient to allow mobilization.

Background: Despite the common occurrence of ankle sprains, no treatment is considered to be the gold standard for the management of such sprains. We assessed functional treatment versus plaster of Paris (POP) for the treatment of lateral ankle sprains, with pain and function employed as the outcome measures., Materials and Methods: 126 Patients were eligible for inclusion. They were assigned to either the functional treatment Tubigrip (TG) group or the POP group after applying block randomization. Characteristics such as age, dominant ankle, and gender were assessed at baseline. Pain and functional assessments were done using the visual analog scale (VAS) and the Karlsson score (KS) at baseline (at the start of the study) and during the 2nd and 6th weeks, respectively. Data on other subjective parameters, such as the number of painkillers used, the number of days taken off work, and the number of sleepless nights, were requested from the patients at the end of the study. SPSS version 16 was used for analysis, and p < 0.05 was taken to indicate significance., Results: 60 Patients completed the trial in each group. The mean ages were 28.77 ± 6.72 in the TG group and 29.83 ± 6.30 in the POP group (p = 0.034). There was a slight female predominance. Right and left ankles were equally involved in the TG group, while left ankles were mainly involved in the POP group. Mean differences in VAS and KS between the two groups were statistically significant at the end of the study. The mean number of painkillers used by the patients in the TG group was higher than the number used in the POP group (p < 0.001). The mean number of days taken off work was 4.18 ± 1.73 days in the TG group, and 6.25 ± 2.73 days in the POP group (p < 0.001). The mean number of sleepless nights was higher in the POP group., Conclusion: The results of our study indicate that functional treatment provides better functional support and pain reduction than a below-knee POP cast., Level of Evidence: Level I.

Objective: To assess microbiological isolates from diabetic foot ulcers presented at a tertiary care teaching hospital., Methods: The prospective observational study was conducted at department of Orthopaedics, Liaquat National Hospital Karachi, from January 2009 to October 2011, and comprised patients with diabetic foot ulcers (Wagner grading 1-4). Grade 0 and 5 were excluded. Wound swabs or tissue biopsies were taken before the induction of antibiotic prophylaxis according to the standard aseptic protocols. SPSS 16 was used for statistical analysis., Results: Of the 250 patients in the study, 151(60.4%) were male with an overall mean age of the subjects of 46±8.1 years. Mean duration of diabetes was 14±6.7 years. Based on Wagner's grading, 90(36%) patients had grade 1, 58(23.2%) grade 2, 97(38.8%) grade 3, and 5(2%) grade 4. The most common isolates were polymicrobial in 90(36%) patients and pseudomonas aeruginosa in 87(34.8%). Resistance antibiogram for pseudomonas aeruginosa showed sensitivity against Imipenem, Aztreonam, Ceftazidime, Ciprofloxacin and Gentamicin., Conclusions: The isolation of pseudomonas aeruginosa gives an idea about the recent microbial spectra from our region and should prompt the need for multi-centre studies from South Asia to devise treatment guidelines for this part of the world.

Purpose: To report a rare case of isolated bilateral simultaneous superior ophthalmic vein occlusions secondary to antiphospholipid syndrome., Case Report: We report the case of a 77-year-old female who presented with a one week history of right relative proptosis, conjunctival injection and optic disc swelling. Magnetic resonance imaging revealed bilateral orbital masses which were diagnosed as superior ophthalmic vein occlusion. The patient was anticoagulated and the lesions resolved completely. System cardiovascular and haematological work-up revealed the patient was suffering from anti-phospholipid syndrome., Conclusion: Although superior ophthalmic vein occlusion is rare, it is an important differential as orbital biopsy is to be avoided. This is only the second reported case secondary to antiphospholipid syndrome and the first such case with bilateral occlusions.

Purpose: Stuve-Wiedemann syndrome is a rare condition consisting of bone dysplasia, hypotony, and dysautonomia with ocular and neuropathic features. We present the ocular findings and visual outcome in 4 patients (2 siblings, 1 related cousin, and 1 unrelated patient) with this syndrome., Methods: A retrospective case series review. Clinical notes of 4 patients with Stuve-Wiedemann syndrome were reviewed for findings of systemic features, ocular examination, visual acuity, and ocular procedures., Results: The median age at presentation was 16 months (range, 14-72 months). All 4 cases consisted of bilateral plaque-like corneal scarring with reduced corneal sensation. Treatment comprised topical lubrication, punctal plugs, lateral tarsorrhaphies, surgical optical iridectomies when required, and aggressive visual rehabilitation with frequent refraction and occlusion therapy if necessary. Mean best-corrected visual acuity (BCVA) in the eye with best vision was 0.86 logarithm of the minimum angle of resolution (logMAR) (range, 0.72-1.1 logMAR) at presentation and 0.43 logMAR (range, 0.25-0.56 logMAR) at the last follow-up. The BCVA in the eye with worst vision was 0.98 logMAR (range, 0.72-1.3 logMAR) at presentation and 0.68 logMAR (range, 0.47-1.0 logMAR) at the last follow-up. The median follow-up was 3.2 years (range, 1.1-5.8 years)., Conclusions: All of our patients showed improved BCVA with the treatment regimen prescribed. Given these children's debilitating orthopedic problems, visual function is important and has hitherto been reported as being poor.

Objective: To study the prevalence of anxiety and depression symptoms in patients with dengue and to examine their correlation with symptom severity., Methods: In this cross sectional study, 531 consecutive patients who met the World Health Organization criteria for dengue fever admitted to Mayo Hospital, Lahore between September and November 2011 were administered the Hospital Anxiety and Depression Scale (HADS). In addition to the HADS, the severity of their symptoms, like headache, myalgias/arthralgias, fever, and retro/periorbital pain, was assessed on a 3-point scale (mild, moderate, and severe)., Results: About 60% of the patients in our study met the criteria for anxiety and 62.2% of the patients met criteria for depression. Severity of fever, headache, myalgias and arthralgias, and retro/periorbital pain was positively correlated with both anxiety (Correlation coefficients: 0.148, 0.247, 0.184, 0.184 respectively and P < 0.01 for all) and depression scores (Correlation coefficients: 0.098, 0.154, 0.131, 0.125 respectively and P value < 0.01 for all). The strongest correlation was found between severity of headache and scores for both anxiety and depression. Both mean anxiety and depression scores were significantly higher in patients with platelet count below median (30,000/mm3) than in patients with platelet count above median (9.1 +/- 4.7 vs 8.2 +/- 4.7, P < 0.03, and 9.5 +/- 4.5 vs 8.5 +/- 4.5, P < 0.01, respectively)., Conclusion: A majority of patients with dengue have anxiety and depression symptoms. Psychiatric evaluation should be done in all Dengue patients so timely treatment can be initiated.

A 59-year-old man presented with endophthalmitis, following a perforating eye injury from pulling out a wire that was embedded in the ground. On presentation, his vision was perception of light (PL). Tetanus toxoid was given, and he was commenced on ciprofloxacin. A primary repair was performed. Conjunctival swabs, discharge from wound site and anterior chamber aspirate were sent for culture. The eye was tense and the anterior chamber was full of a gelatinous brown substance which precluded performance of vitrectomy. Intravitreal vancomycin and ceftazidime was given. Hourly topical fortified vancomycin and ceftazidime was given. Postoperatively, the patient's vision remained PL with no evidence of improvement. On day 2, Clostridium perfringens was cultured. The patient was commenced on intravenous benzylpenicillin and clindamycin. Intravitreal clindamycin and vancomycin was administered. The patient was NPL on day 3. There was no evidence of response to treatment and an evisceration was performed on day 6.

Objectives: The goal of this study was to identify factors associated with lower platelet inhibition (PI) with clopidogrel in subjects with cardiovascular disease (CVD)., Background: A heterogeneous platelet reactivity response to clopidogrel exists, and the clinical or biochemical predictors of suboptimal PI with clopidogrel remain unclear., Methods: This study prospectively enrolled subjects with CVD requiring treatment with clopidogrel (75 mg daily for > or =7 days or 600-mg bolus > or =24 h before recruitment). A bedside rapid platelet function assay (VerifyNow, Acccumetrics, San Diego, California) to measure maximal and clopidogrel-mediated platelet reactivity was utilized, and factors associated with lower PI were identified., Results: A heterogeneous, normally distributed PI (mean 40.8 +/- 26.2%) response to clopidogrel was observed in 157 subjects (age 67.2 +/- 12.2 years; 59.9% men). Multiple variable analysis of clinical and biochemical factors known to affect platelet reactivity revealed lower PI in patients with an elevated plasma fibrinogen level (> or =375 mg/dl), diabetes mellitus, and increased body mass index (BMI) (> or =25 kg/m(2)). On testing for interaction, elevated fibrinogen level was associated with diabetic status, resulting in lower PI in diabetic patients (23.9 +/- 3.9% vs. 45.1 +/- 4.5%, p < 0.001), but not nondiabetic patients (44.7 +/- 4.4% vs. 46.3 +/- 4.8%, p = 0.244). Increased BMI remained independently associated with lower PI after clopidogrel therapy regardless of diabetic status or fibrinogen level (36.8 +/- 9.0% vs. 49.0 +/- 7.0%, p < 0.001)., Conclusions: Elevated plasma fibrinogen (> or =375 mg/dl) in the presence of diabetes mellitus and increased BMI (> or =25 kg/m(2)) are associated with lower PI with clopidogrel in patients with CVD.

Purpose: To evaluate the incidence of ocular injuries and clinical ocular signs in patients with orbitozygomatic fractures of varying severity, presenting to a regional oral and maxillofacial surgery service., Patients and Methods: This is a retrospective study of patients presenting to Limerick Regional Hospital (Limerick, Ireland) with orbitozygomatic fractures from January 1998 to December 2004. Patients with panfacial fractures and those with isolated zygomatic arch fractures were excluded. All patients were examined by the ophthalmology service preoperatively and reviewed postoperatively as indicated. The study population was divided into 3 subgroups based on the extent of the bony injury (confirmed by clinical, plain radiographic, and CT examination) as follows: group 1: "simple" noncomminuted orbitozygomatic complex fractures; group 2: comminuted orbitozygomatic complex fractures; group 3: "pure" orbital blowout fractures. Patient demographics, fracture etiology, and ocular findings were recorded., Results: The study population included 148 patients (130 males, 18 females). All fractures were unilateral. Ocular findings were present in 29 (20%) patients, consisting of 8 of 85 patients (9%) in group 1; 15 of 53 patients (28%) in group 2; and in 6 of 10 patients (60%) in group 3., Conclusions: Clinical ocular findings and injuries are a relatively common complication of orbitozygomatic fractures, occurring in 29 (20%) patients in this study. These injuries occur more often in patients with orbital blowout fractures compared with comminuted orbitozygomatic complex fractures or simple orbitozygomatic complex fractures. Ophthalmology consultation is recommended for all patients presenting with orbitozygomatic fractures, and is essential for patients with orbital blowout fractures, based on the high incidence of clinical ocular findings and injuries in this subgroup of patients.