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Saira Mauland Mansoor,1,2 Toril Rabben,1 Jonny Hisdal,1,2 Jørgen Joakim Jørgensen1– 3 1Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway; 2Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; 3Department of Traumatology, Oslo University Hospital, Oslo, NorwayCorrespondence: Saira Mauland Mansoor, Oslo Universitetssykehus, Ullevål, Karavdelingen, Postboks 4959 Nydalen, Oslo, 0424, Norway, Tel +47 92 82 92 78, Email saira.m.mansoor@gmail.comObjective: Since 2011, the Department of Vascular Surgery at Oslo University Hospital has offered screening for abdominal aortic aneurysm (AAA) to 65-year-old men living in Oslo, Norway. The aim of this study was to evaluate the effect of the screening project on AAA-related mortality and rupture and repair rates in the screened population.Methods: This cohort study included men that participated in AAA screening at the Department of Vascular Surgery at Oslo University Hospital in the period May 2011 to September 2019. All men with screen-detected AAA (aortic diameter ≥ 30 mm) and subaneurysmal aortic dilatation (aortic diameter 25– 29 mm) were included. A stratified (1:1 with the subaneurysm group), randomized selection of men with normal aortic diameter (< 25 mm) upon screening was also included. The follow-up data on events (ruptures, repairs, and deaths) after screening were collected retrospectively from patient electronic medical records at Oslo University Hospital, the National Population Register and the Norwegian Cause of Death Registry (CoDR).Results: In total, 2048 men were included, with a median follow-up time of 7.1 years (IQR 3.8). Among men with screen-detected AAA, 0.6% died of AAA-related causes (0.9 AAA-related deaths per 1000 person-years). The rupture rate was 0.3% among men with screen-detected AAA or subaneurysmal aortic dilatation, giving an incidence of 0.5 ruptures per 1000 person-years. The overall repair rate in the AAA group was 20.6% (36.1 repairs per 1000 person-years) and 0.6% (0.9 repairs per 1000 person-years) in the subaneurysm group.Conclusion: In a population screened for AAA, the incidence of rupture and the AAA-related mortality was very low. Almost one-fifth of the participants with screen-detected AAA underwent elective repair, representing a group that might have presented with rupture if untreated. These results indicate that screening is valuable in preventing AAA rupture and AAA-related mortality.Keywords: rupture rate, repair rate, subaneurysmal aortic dilatation, AAA-related mortality

Toril Rabben,1 Saira Mauland Mansoor,1 Dag Bay,2 Jon Otto Sundhagen,1 Cecilia Guevara,1 Jorgen Joakim Jorgensen1,3,4 1Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway; 2Department of Radiology and Interventional Radiology, Oslo University Hospital, Oslo, Norway; 3Department of Traumatology, Oslo University Hospital, Oslo, Norway; 4Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, NorwayCorrespondence: Toril RabbenDepartment of Vascular Surgery, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo, 0424, NorwayTel +47 97190981Email torabb@ous-hf.noPurpose: To investigate the prevalence of and risk factors for abdominal aortic aneurysm (AAA) in 65-year-old men in Oslo, Norway.Materials and Methods: From May 2011, until September 2019, the annual population of 65-year-old men living in Oslo were invited to an ultrasonographic screening of the abdominal aorta. Candidates received a one-time invitation by mail, including a questionnaire on possible risk factors and comorbidities. Abdominal aortic outer-to-outer diameter and ankle-brachial index were measured by the screening team. Participants were allocated into three groups: non-, sub- and aneurysmal aorta. Written information on recommended follow-up regime was given to participants with an aortic diameter ≥ 25 mm. Univariate and multivariate analyses of potential risk factors were performed, in addition to descriptive analyses and significance testing.Results: In total, 19,328 were invited, 13,215 men were screened, of which 12,822 accepted inclusion in the study. Aortic diameter was registered for 12,810 participants and 330 men had aortic diameter ≥ 30 mm, giving a prevalence of AAA of 2.6% (95% confidence interval (CI) 2.31– 2.86). We identified 4 independent risk factors for AAA: smoking (OR = 3.64, 95% CI 2.90– 4.58), hypertension (OR = 1.87, 95% CI 1.49– 2.35), BMI > 30 (OR = 1.02, 95% CI 1.00– 1.03), and diabetes mellitus (OR = 0.52, 95% CI 0.35– 0.79), the latter showing an inverse association with AAA growth. A subgroup of 862 men with aortic diameters 25– 29 mm had a significantly higher prevalence of BMI > 25, smoking and family history of AAA, compared to participants with aortic diameter < 25 mm.Conclusion: Among the participants in this study, the prevalence of abdominal aortic aneurysms was 2.6%. Participants with AAA more frequently reported cardiovascular risk factors, and less frequently diabetes mellitus.Keywords: prevalence, sub-aneurysmal aorta, ultrasonography, men, smoking, diabetes

Eyob Alemayehu Gebreyohannes,1 Akshaya Srikanth Bhagavathula,1,2 Tadesse Melaku Abegaz,1 Tamrat Befekadu Abebe,1 Sewunet Admasu Belachew,1 Henok Getachew Tegegn,1 Sarab M Mansoor3 1Department of Clinical Pharmacy, School of Pharmacy, University of Gondar-College of Medicine and Health Sciences, Gondar, Ethiopia; 2Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates; 3School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia Purpose: In health communication, pictogram has a comprehensive place to aid attention, memory recall, and promote adherence. This study was conducted to assess whether pictorial intervention would help to identify and improve adverse drug reactions (ADRs) reporting in an antiretroviral therapy (ART) clinic in Northwest Ethiopia.Patients and methods: A cross-sectional study on ART-naïve HIV-positive patients was conducted from July 2015 to January 2016. The patients were randomly categorized into two groups. Group A was subjected to receive pictorial medication information and a pictogram-enhanced tool to identify and report ADRs, while group B did not receive any pictogram-enhanced tool.Results: A total of 207 ART-naïve HIV-positive patients who were registered for the ART treatment attending Gondar University Hospital ART clinic were included. Bivariate analysis showed that sociodemographic characteristics, such as age, sex, education, employment, and marital status were the main predictors of identifying and reporting ADRs. Males were twice more likely to identify ADRs than females. Univariate analysis revealed that patients assigned to group A showed a significant association with the ability to identify ART medications using pictograms. Patients assigned to group A were more likely to identify lamivudine (OR [95% CI] =7.536 [4.042–14.021], P≤0.001), tenofovir (OR [95% CI] =6.250 [2.855–13.682], P≤0.001), nevirapine (OR [95% CI] =5.320 [1.954–14.484], P=0.001), efavirenz (OR [95% CI] =3.929 [1.876–8.228], P≤0.001), and zidovudine (OR [95% CI] =3.570 [1.602–7.960], P=0.002) using pictograms. Patients in group A were 4.3 times more likely to identify diarrhea as an ADR using pictogram compared with group B.Conclusion: The use of pictorial representation resulted in only slight improvement in identification and reporting of ADRs among naïve HIV-positive patients with limited literacy in Northwest Ethiopia. This representation of ADRs merits further investigation with regard to ADR identification and promoting patients’ safety, particularly for HIV-positive patients with limited educational levels. Keywords: HIV, AIDS, ADR, pictogram, Gondar, Ethiopia, HAART

This study was conducted to achieve an understanding of the potential applications of Kinesio Taping® (KT) in the craniomaxillofacial region. A comprehensive search of pertinent literature was performed through PubMed, Medline, Google Scholar, ProQuest, and ScienceDirect. The focused question that was addressed was, "What are the potential applications of KT in the craniomaxillofacial region?". The preliminary search identified 52 studies. Once duplicates were removed, the remaining 43 titles/abstracts were screened, where 9 studies were excluded and the remaining 34 were assessed. Three additional studies were obtained through reference review of the retrieved articles. KT is being used for the management of various conditions, including temporomandibular joint disorders, side effects associated with maxillofacial surgeries, various neurological conditions, etc. KT has not been proven as a reliable independent treatment option; however, it is considered to be useful as a complementary option to improve treatment outcomes for various conditions.

This work examines the (2+1)-dimensional Boiti-Leon-Pempinelli model, which finds its use in hydrodynamics. This model explains how water waves vary over time in hydrodynamics. We provide new explicit solutions to the generalized (2+1)-dimensional Boiti-Leon-Pempinelli equation by applying the Sardar sub-equation technique. This method is shown to be a reliable and practical tool for solving nonlinear wave equations. Furthermore, different types of solitary wave solutions are constructed: w-shaped, breather waved, chirped, dark, bright, kink, unique, periodic, and more. The results obtained with the variable coefficient Boiti-Leon-Pempinelli equation are stable and different from previous methods. As compared to their constant-coefficient counterparts, the variable-coefficient models are more general here. In the current work, the problem is solved using the Sardar Sub-problem Technique to produce distinct soliton solutions with parameters. Plotting these graphs of the solutions will help you better comprehend the model. The outcomes demonstrate how well the method works to solve nonlinear partial differential equations, which are common in mathematical physics.With the help of this method, we may examine a variety of solutions from significant physical perspectives., (© 2024. The Author(s).)

Context: Novel optoelectronic and thermoelectric properties with broad compositional range, non-toxic nature and structural stability make halide-based double perovskites fascinating for flexible optoelectronic devices. In this work, the structural electronic, optical and transport properties of Rb 2 TlSbX 6 (X = Cl, Br, I) were studied using density functional theory for optoelectronic devices. The elastic analysis demonstrates ductile nature, mechanical stability, anisotropic behaviour and feasibility for flexible optoelectronic devices. The band structure study using Tran-Blaha-modified Becke-Johnson (TB-mBJ) potential shows that all studied materials have direct bandgap. In addition, the bandgap of Rb 2 TlSbCl 6 is more appropriate for optoelectronic devices. The small loss and maximum absorption in visible regions make these materials prime candidates for optoelectronic devices. The transport features indicate that all the studied double perovskites reflect p-type semiconducting behaviour as highlighted by positive Seebeck coefficient values. Furthermore, the high power factor values of Rb 2 TlSbX 6 (X = Cl, Br, I) double perovskites make them suitable for thermoelectric device applications at high temperatures. Based on electronic optical and thermoelectric properties Rb 2 TlSbCl 6 is the best candidate for flexible optoelectronic devices., Methods: In this paper, structural optimization of Rb 2 TlSbX 6 (X = Cl, Br, I) double perovskites was conducted utilizing the Wien2k software based on first principle calculations with Perdew-Burke-Ernzerhof's generalized-gradient approximation (PBE-sol approximation). The TB-mBJ potential was employed to compute the accurate band gap of studied materials. The thermoelectric properties are evaluated with BoltzTraP code, showing a predominance of P-type charge carriers in all studied perovskites. This methodological strategy verifies the material's remarkable stability and optical properties and offers a solid framework for examining its potential in optoelectronic devices., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and objectives Cervical cancer remains a significant global health issue, particularly in low- and middle-income countries. While high-income countries have seen reduced incidence and mortality rates due to effective screening and HPV vaccination programs, these rates are still high in areas with limited healthcare infrastructure. In the United Arab Emirates (UAE), recent efforts are improving public health initiatives and awareness. This retrospective cohort study evaluates clinical outcomes and treatment efficacy in cervical cancer patients at a tertiary cancer center in Al Ain, Abu Dhabi. It analyzes treatment regimens, their effectiveness, and factors affecting survival, disease progression, and treatment completion. Methods and material The study included 275 cervical cancer patients treated between January 2008 and December 2021. Data were extracted from medical records, including demographic information, clinical characteristics, and treatment details. Statistical analyses, including Kaplan-Meier survival curves and Cramér's V correlation matrix, were used to evaluate survival outcomes and the relationships between various categorical variables. Results The mean age of patients was 48.88 years, with the majority being non-nationals, 221 (80.37%). Histopathologically, there were 234 (85.18%) cases of squamous cell carcinoma (SCC) and 33 (11.85%) cases of adenocarcinomas. The International Federation of Gynecology and Obstetrics (FIGO) staging indicated that 137 (49.80%) patients were in stage II and 60 (21.81%) were in stage III. Pelvic lymph node involvement was observed in 139 (50.54%) patients. The treatment modalities included surgery in 39 (14.18%) patients, 3D conformal radiotherapy (3D-CRT) in 247 (89.81%) patients, intensity-modulated radiation therapy (IMRT) in 11 (4.00%) patients, brachytherapy in 213 (77.45%) patients, and chemotherapy in 248 (90.18%) patients. The survival analysis showed no significant differences in survival among different treatment groups, as indicated by the Log-rank test (p = 0.4060). Conclusion The study highlights the demographic and clinical characteristics of cervical cancer patients in the UAE, emphasizing the prevalence of advanced-stage diagnoses and high-grade tumors. Despite significant efforts to improve screening and treatment, cervical cancer remains a concern in the UAE. The findings underscore the need for enhanced early detection and comprehensive treatment strategies. Addressing the study's limitations, such as the retrospective design and the absence of human papillomavirus (HPV) data, could further refine cervical cancer management and improve patient outcomes in future research., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Tawam Human Research Ethics Committee (T-HREC) issued approval MF2058-2021-794. 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, Balaraj et al.)

Background: Cubic perovskite titanium stannous oxide (TiSnO3) is a promising material for various applications due to its functional properties. However, understanding how these properties change under external stress is crucial for its development and optimization., Method: This study employed density functional theory calculations to investigate the structural, electronic, optical, thermal, and mechanical properties of TiSnO3 under varying degrees of external static isotropic stress (0-120 GPa)., Results: The study reveals a significant decrease in the bandgap of TiSnO3 with increasing stress due to lattice modifications and the formation of delocalized electrons. Partial density of states analysis indicates that Sn and O states play a key role in shaping the electronic band structure. TiSnO3 exhibits increased light absorption with stress, accompanied by a blue shift in absorption peaks, whereas, both polarizability and refractive index decrease with increasing stress. Mechanically, all elastic moduli (bulk, shear, and Young's) show an increase under stress, signifying a stiffening response of the material under stress. Similarly, the Pugh ratio suggests a transition from ductile to brittle behaviour at elevated stress levels. Phonon dispersion calculations indicate the instability of the cubic phase at 0 K. However, a phonon gap emerges at 30 GPa and widens with increasing stress. X-ray diffraction further supports these findings by demonstrating a shift in diffraction peaks towards higher angles with increasing stress, consistent with the applied stress., Conclusion: In conclusion, this computational study offers a thorough understanding of how external stress influences the properties of TiSnO3, providing valuable insights for potential applications in various fields., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Abdominal aortic aneurysm (AAA) screening has been offered to 65-year-old men living in Oslo, Norway, since May 2011. A significant number of AAA-related deaths occurred in individuals who are not eligible for screening. The primary aim of this study was to describe the group of patients admitted to Oslo University Hospital with a ruptured AAA after the implementation of the local AAA screening project. The following parameters were investigated: AAA detection before rupture, surveillance status, eligibility for screening, and comorbidities. We also sought to compare outcomes (repair rates and 30-day mortality) between patients with and without an incidentally detected AAA prior to rupture., Methods: This cohort study included patients admitted acutely to Oslo University Hospital due to a symptomatic or ruptured AAA in the period January 2011 to December 2022. Data on demographics, prior AAA detection, surveillance status, treatment, and mortality were collected retrospectively through electronic medical records., Results: We identified 200 patients with a symptomatic or ruptured AAA, among which 79 (40%) had an AAA detected before rupture-one (1%) through screening and 78 (39%) incidentally. Up to 30% of the incidentally detected AAAs were not under any surveillance. Six patients were found eligible for screening: one had attended, three were non-attenders, and two had not been invited. Patients with an incidentally detected AAA before rupture had a more advanced age and a significantly higher degree of comorbidities than patients without a previously detected AAA, and the repair rates in these groups were 56% and 84%, respectively (P < 0.001). Adjusted for comorbidities and risk factors, the odds ratio for repair among patients with incidentally detected AAA was 0.56 (P = 0.292). The 30-day mortality was not significantly different between the two groups (P = 0.097)., Conclusions: Most patients with a ruptured AAA were not eligible for screening, but 39% of the patients had an incidentally detected AAA prior to rupture. Standardized reporting and follow-up of incidentally detected AAAs is thus identified as an additional measure to organized screening in the effort to reduce AAA-related mortality., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

In the current study, the fish farm model perturbed with time white noise is numerically examined. This model contains fish and mussel populations with external food supplied. The main aim of this work is to develop time-efficient numerical schemes for such models that preserve the dynamical properties. The stochastic backward Euler (SBE) and stochastic Implicit finite difference (SIFD) schemes are designed for the computational results. In the mean square sense, both schemes are consistent with the underlying model and schemes are von Neumann stable. The underlying model has various equilibria points and all these points are successfully gained by the SIFD scheme. The SIFD scheme showed positive and convergent behavior for the given values of the parameter. As the underlying model is a population model and its solution can attain minimum value zero, so a solution that can attain value less than zero is not biologically possible. So, the numerical solution obtained by the stochastic backward Euler is negative and divergent solution and it is not a biological phenomenon that is useless in such dynamical systems. The graphical behaviors of the system show that external nutrient supply is the important factor that controls the dynamics of the given model. The three-dimensional results are drawn for the various choices of the parameters., (© 2024. The Author(s).)

Objectives: The aim of the study is to evaluate muscles with more prominent needle electromyographic findings to optimize needle electromyography screening of isolated C6 radiculopathy in patients with C6 root lesions., Design: This prospective clinical study was performed on 39 patients with isolated and unilateral cervical radiculopathy selected from all referrals of 1733 patients to the electrodiagnosis unit of the physical medicine and rehabilitation department of a tertiary medical center (from April 2021 to December 2021). The presence of fibrillation potentials, positive sharp waves, and/or neurogenic motor action potentials that occurred in isolation or combination with selected muscles was considered an abnormal finding., Results: Of 1733 referrals, 39 patients (18 males [46.1%] and 21 females [53.8%]), with a mean age of 49.7 ± 9.6 yrs, were found eligible. According to needle electromyography findings, the most involved muscles in C6 root lesion were pronator teres (100%), followed by extensor carpi radialis longus (94.8%), flexor carpi radialis (89.7%), brachioradialis (82%), infraspinatus (82%), supraspinatus (79.4%), deltoid (74.3%), biceps brachii (64.1%), extensor digitorum communis (33.3%), and triceps brachii (15.3%) muscles., Conclusions: The pronator teres is the most involved muscle of patients diagnosed with C6 radiculopathy. It might be considered the key muscle for screening and accurate diagnosis of C6 root involvement., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Continuous and excessive secretion of pro-inflammatory and anti-inflammatory chemicals and cytokines may further deteriorate inflammation. Anti-inflammatory drugs play an imperative role in inhibiting the evolution of inflammatory diseases. As per the Unani doctrine, a holistic treatment approach is used to treat illnesses. Therefore, drugs having different actions are used to achieve the synergic effect. Three drugs (Cinnamomum zeylanicum, Alpinia galanga, and Withania somnifera), which are frequently used in Unani medicine for joint disorders were selected to evaluate the anti-inflammatory activity of the extract derived from them., Methods: We used RAW 264.7 macrophage cells to see the expression of inflammatory markers IL-1β, IL-6, and TNF-α. Cytotoxic activity was assessed with MTT assay and Nitric Oxide (NO) was evaluated using Griess reagent. Further, anti-inflammatory activity was evaluated in Wistar Albino rats using carrageenan-induced paw oedema and immunohistochemistry assays for Cyclooxygenase-2 (COX-2). All the data were analyzed using ANOVA and Dunnett t test for multiple comparisons., Results: This extract did not show any cytotoxic effect and the gene expression was significantly reduced for IL-1β, IL-6, and TNF-α in a dose-dependent manner. Further, NO production was also significantly reduced in the test groups. Immunohistochemistry revealed that the test groups had less inflammation as compared to the control group., Conclusion: It may be inferred that the ethanolic extract of the three herbs has strong anti-inflammatory activity in the tested inflammatory models and the extract is safe as it did not show any cytotoxic effects in both in vitro and in vivo conditions.

The human body is affected by ultraviolet radiation because it can penetrate and harm bodily cells. Although skin cancer and early aging are consequences of prolonged exposure to ultraviolet (UV) rays, sun rays signify immediate excessive exposure. In this context, some structural, optical, electrical, and mechanical properties of the beryllium-based cubic fluoro-perovskite RBeF 3 (R[bond, double bond]K and Li) compounds are examined through the use of density functional theory (DFT) within generalized gradient approximation (GGA) using the Perdew-Burke-Ernzerhof (PBE) approximations (GGA-PBE). The compounds KBeF 3 and LiBeF 3 have space group 221-pm3m, and their lattice constants and volumes are (3.765, 3.566) Å and (53.380, 45.379) Å 3 , respectively, based on their structural properties. Computed results indicate that the compounds' bandgaps are 7.35 eV and 7.12 eV, respectively, with an indirect nature for KBeF 3 and LiBeF 3 . The properties of the band structure indicate that both compounds are insulators. The bonding properties of these compounds, RBeF 3 , are a combination of covalent and ionic. Optical properties of the compounds are examined which reflect the light-matter interaction like reflectivity, conductivity, and absorption. These materials were likely very hard but brittle, based on a higher bulk modulus B from elastic features, the B/G ratio, Pugh's ratio, and Vickers hardness. The compound RBeF 3 , as determined by the findings, is used as a UV protection and reflection layer for car and room windows., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background This study delves into the demographics and clinical characteristics of oral cavity tumors in the context of the United Arab Emirates. It further investigates the efficacy of four different treatment modalities in impacting patient survival rates. It aims to understand if any treatments significantly improve survival compared to others. Methodology To assess the survival outcomes across the different treatment groups, the study employed the log-rank test, a non-parametric statistical test widely used in survival analysis. The sample consisted of patients from the electronic medical records assigned to one of the following four treatment groups: radiotherapy only (RT), radiotherapy with surgery and chemotherapy (RT+S+C), radiotherapy with surgery (RT+S), and, finally, radiotherapy with chemotherapy including immunotherapy (RT+C). Data collection involved tracking survival times from the initiation of treatment until the last follow-up period or the occurrence of an event (e.g., death). The statistical analysis was conducted using the chi-squared statistic to determine the distribution of survival times across the groups, providing a quantitative measure of the difference between the observed and expected survival. The Kaplan-Meier curve was plotted for the cohort divided into four groups. Results The log-rank test yielded a p-value of 0.321019, suggesting no statistically significant difference in survival among the treatment groups at the 5% significance level. The chi-squared statistic was 3.498018, within the 95% acceptance region, further corroborating the null hypothesis of no significant survival difference across the groups. Despite this, an observed medium effect size of 0.59 indicates a moderate difference in survival between the groups. Conclusions The findings illustrate that while there is no statistically significant difference in survival rates among the four treatment groups, the medium effect size observed suggests a moderate difference in survival. This emphasizes the need to consider the statistical significance and effect size in clinical research, as they provide different insights into treatment efficacy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, AlNeyadi et al.)

Introduction Artificial intelligence (AI) is transforming healthcare, particularly in radiation oncology. AI-based contouring tools like Limbus are designed to delineate Organs at Risk (OAR) and Target Volumes quickly. This study evaluates the accuracy and efficiency of AI contouring compared to human radiation oncologists and the ability of professionals to differentiate between AI-generated and human-generated contours. Methods At a recent AI conference in Abu Dhabi, a blind comparative analysis was performed to assess AI's performance in radiation oncology. Participants included four human radiation oncologists and the Limbus® AI software. They contoured specific regions from CT scans of a breast cancer patient. The audience, consisting of healthcare professionals and AI experts, was challenged to identify the AI-generated contours. The exercise was repeated twice to observe any learning effects. Time taken for contouring and audience identification accuracy were recorded. Results Initially, only 28% of the audience correctly identified the AI contours, which slightly increased to 31% in the second attempt. This indicated a difficulty in distinguishing between AI and human expertise. The AI completed contouring in up to 60 seconds, significantly faster than the human average of 8 minutes. Discussion The results indicate that AI can perform radiation contouring comparably to human oncologists but much faster. The challenge faced by professionals in identifying AI versus human contours highlights AI's advanced capabilities in medical tasks. Conclusion AI shows promise in enhancing radiation oncology workflow by reducing contouring time without quality compromise. Further research is needed to confirm AI contouring's clinical efficacy and its integration into routine practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Shanbhag et al.)

In June 2022, Pakistan witnessed catastrophic floods, affecting millions of people. The ensuing epidemics of cholera, cryptosporidiosis, rotavirus infections, generalized diarrhoea, typhoid and paratyphoid fevers, as well as the frequency of vector-borne diseases including malaria and dengue fever, are studied in this investigation. It also explores the latest outbreak of poliomyelitis and the frequency of respiratory diseases such COVID-19, diphtheria, and tuberculosis, as well as how floods have contributed to skin and eye problems. The report also describes the obstacles governments must overcome in order to manage these health emergencies and offers possible solutions for reducing the effects of ongoing and anticipated epidemics. This flood emphasizes the pressing need for international action and acts as an alarming indicator of the significant impact of climate change. It emphasizes how crucial it is to have effective flood response and preparation strategies in developing nations that are vulnerable to natural disasters., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective This study aims to thoroughly assess the radiation dose distribution to critical organs in patients with nasopharyngeal carcinoma, focusing on the correlation between the radiation dosages for the various organs at risk (OARs) in nasopharyngeal cancer patients. Methods We meticulously analysed a dataset comprising 38 nasopharyngeal carcinoma patients, focusing on radiation dosages measured in Gray (Gy) and volumetric data in cubic centimetres (cc) of critical organs, including the lens, brainstem, spinal cord, optic nerve, optic chiasm, and cochlea. A detailed exploratory data analysis approach encompassed univariate, bivariate, and multivariate techniques. Results Our analysis revealed several key findings. The mean and median values across various dose measurements were closely aligned, indicating symmetrical distributions with minimal skewness. The histograms further corroborated this, showing evenly distributed dose values across different anatomical regions. The correlation matrix highlighted varying degrees of interrelationships between the doses, with some showing strong correlations while others exhibited minimal or no correlation. The 3D scatter plot provided a view of the multi-dimensional dose relationships, with a specific focus on the spinal cord, lens, and brainstem doses. The bivariate scatter plots revealed symmetrical distributions between the right and left lens doses and more complex relationships involving the brainstem and spinal cord, illustrating the intricacies of dose distribution in radiation therapy. Conclusion Our findings reveal distinct radiation exposure patterns to OARs of nasopharyngeal carcinoma. This research emphasises the need for tailored radiation therapy planning to achieve optimal clinical outcomes while safeguarding vital organs., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bin Sumaida et al.)

In this study, the Lengyel-Epstein system is under investigation analytically. This is the reaction-diffusion system leading to the concentration of the inhibitor chlorite and the activator iodide, respectively. These concentrations of the inhibitor chlorite and the activator iodide are shown in the form of wave solutions. This is a reaction†"diffusion model which considered for the first time analytically to explore the different abundant families of solitary wave structures. These exact solitary wave solutions are obtained by applying the generalized Riccati equation mapping method. The single and combined wave solutions are observed in shock, complex solitary-shock, shock singular, and periodic-singular forms. The rational solutions also emerged during the derivation. In the Lengyel-Epstein system, solitary waves can propagate at various rates. The harmony of the system's diffusive and reactive effects frequently governs the speed of a single wave. Solitary waves can move at a variety of speeds depending on the factors and reaction kinetics. To show their physical behavior, the 3D and their corresponding contour plots are drawn for the different values of constants., (© 2023. The Author(s).)

Background Endometrial carcinoma (EC) remains a pressing global health issue, with a discernible upsurge in incidence, especially in developed countries. Notably, the United Arab Emirates (UAE) has witnessed a surge in EC cases, demanding an in-depth, region-specific exploration into the disease's clinical, treatment, and prognostic facets against the backdrop of its unique socio-genetic and environmental contours. Aim This study aimed to profess a comprehensive understanding of EC by examining clinical parameters, treatment modalities, and prognostic outcomes in the UAE context, thereby seeking to delineate potential correlations between varied therapeutic combinations, patient demographics, and tumor characteristics in affecting prognostic outcomes. Materials and methods A retrospective cohort study involving 93 patients diagnosed with EC from January 2011 to March 2023 at a leading oncology center in the UAE was conducted. Data, including demographic information, clinical presentation, treatment modalities, and prognostic outcomes, were meticulously extracted and analyzed. The R software (version 4.2.2) facilitated exhaustive statistical analyses, involving descriptive statistics, correlation analyses with the polycor package, and survival analyses utilizing the Kaplan-Meier method and Cox regression analysis via the survival and survminer packages, respectively. Results Although the correlation matrix revealed a noticeable relationship between "Family history" and "Age," most parameters displayed independence, offering a robust platform for ensuing multivariate analyses. Kaplan-Meier survival curves, stratified by therapeutic modalities, exhibited no statistically significant survival differences across therapeutic cohorts (p-values: 0.44, 0.86, and 0.83). Conversely, the composite Cox regression model underscored "non-national" demographic, Diabetes Mellitus II, and stromal invasion as pivotal prognostic factors, indicating the multifactorial nature of survival in EC patients and emphasizing demographic and tumor characteristics over therapeutic modalities as influential prognostic determinants. Conclusion In conclusion, while therapy types were not directly correlated with survival, demographic and tumor traits prominently impacted prognostic outcomes, advocating for an intricate, multidimensional approach to managing EC in the UAE. This study hopes to sow seeds for subsequent research, shaping clinically and culturally apt practices and policies in the region's healthcare landscape., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Balaraj et al.)

Background: Pediatric neurorehabilitation has recently employed virtual reality (VR) technologies as a platform to design and implement novel modalities., Aims: To evaluate the feasibility of a multi-component VR-based program on motor skills and functional postural control for children with hemiplegic cerebral palsy (HCP)., Methods: A single-case-experimental design was conducted on eight children with HCP (12.33 ± 4.71 years and GMFCS= II, I). The VR-based program consisted of 3 sessions per week for four weeks. Timed Up and Go (TUG) test, Functional Reach Test (FRT), Pediatric Balance Scale (PBS), Activities Scale for Kids (ASK), ABILHAND-Kids, and Box and Block Test (BBT) were used to evaluate functional changes., Outcomes and Results: Statistical analysis showed that improvements in functional postural control were significant on at least one balance measure for seven out of eight participants during the intervention phase. For all participants, a significant increase was observed in the BBT scores. Before-after intervention analysis revealed statistically significant improvements in PBS ( z  = -2.52, p  ≤ 0.01), ABILHAND-Kids ( z  = -2.25, p  ≤ 0.01), and ASK ( z  = -2.38, p  ≤ 0.01)., Conclusions and Implications: This study provided early evidence of the effectiveness of the multi-component VR-based program in children with HCP. However, future studies with randomized controlled trial design are needed to evaluate the long-term effects and compare them with conventional rehabilitation practice., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

The etiology of polyneuropathies varies in the pediatric population, where hereditary or metabolic disorders are far more common than in adults. However, treatable polyneuropathies, also prevalent in these settings, are those to prioritize. Moreover, diagnosing subacute and chronic symptoms in children can be challenging compared to adults. Therefore, selecting the best and most relevant laboratory investigations and paraclinical studies is critical. This taskcan be relatively challenging in countries with limited resources or insurance coverage. This study describe the various types of polyneuropathies found in children and their characteristics and suggest an algorithm for using the best laboratory tests in the context of the Iranian healthcare system., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors.)

It has been reported that death related to cardiovascular disease has increased up to 12.5% just in the past decade alone with various factors playing a role. In 2015 alone, it has been estimated that there were 422.7 million cases of CVD with 17.9 million deaths. Various therapies have been discovered to control and treat CVDs and their complications including reperfusion therapies and pharmacological approaches but many patients still progress to heart failure. Due to these proven adverse effects of existing therapies, various novel therapeutic techniques have emerged in the near past. Nano formulation is one of them. It is a practical therapeutic strategy to minimize pharmacological therapy's side effects and nontargeted distribution. Nanomaterials are suitable for treating CVDs due to their small size, which enables them to reach more sites of the heart and arteries. The biological safety, bioavailability, and solubility of the drugs have been increased due to the encapsulation of natural products and their derivatives of drugs., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

The 1,3,4-oxadiazole derivatives Ox-6a-f have been synthesized by incorporating flurbiprofen moiety with the aim to explore the potential of target molecules to decrease the oxidative stress. The title compounds Ox-6a-f were prepared by simple reactions in which a flurbiprofen -COOH group was esterified with methanol in an acid-catalyzed medium, which was then reacted with hydrazine to afford the corresponding hydrazide. The acid hydrazide was then cyclized into 1,3,4-oxadiazole-2-thiol by reacting with CS 2 in the presence of KOH. The title compounds Ox-6a-f were synthesized by the reaction of an -SH group with various alkyl/aryl chlorides, which involves an S -alkylation reaction. The structures of the synthesized Ox-6a-f derivatives were ascertained by spectroscopic data. The in silico molecular docking was performed against target proteins cyclooxygenase-2 COX-2 (PDBID 5KIR) and cyclooxygenase-1 COX-1 (PDBID 6Y3C) to determine the binding affinity of the synthesized compounds with these structures. It has been inferred that most of the synthesized compounds bind well with an active binding site of 5KIR compared to 6Y3C, and especially compound Ox-6f showed excellent binding affinity (7.70 kcal/mol) among all synthesized compounds Ox-6a-f . The molecular dynamic (MD) simulation has also been performed to check the stability of docking complexes of ligands with COX-2 by determining their root mean square deviation and root mean square fluctuation. Little fluctuation was observed in case of Ox-6f, which forms the most stable complex with COX-2. The comprehensive antioxidant potential of the synthesized compounds has been evaluated by determining their free radical scavenging activity, including DPPH, OH, nitric oxide (NO), and iron chelation assay. The derivative Ox-6f showed promising results with 80.23% radical scavenging potential at a dose of 100 µg/mL while ascorbic acid exhibited 87.72% inhibition at the same dose. The anti-inflammatory activity of the final products has also been performed, and inflammatory markers were assayed, such as a thiobarbituric acid-reducing substance, nitric oxide, interleukin-6 (IL-6), and COX-2. The derivatives Ox-6d and Ox-6f displayed higher anti-inflammatory activity, exhibiting 70.56% and 74.16% activity, respectively. The results were compared with standard ibuprofen, which showed 84.31% activity at the same dose, 200 µg/mL. The anti-inflammatory potential has been performed by following the carrageen-induced hind paw edema model, and results showed that derivative Ox-6f exhibited 79.83% reduction in edema volume compared to standard ibuprofen, which reduced 84.31% edema volume. As dry lab and wet lab results confirm each other, it has been deduced that derivative Ox-6f may serve as the lead structure to design potent compounds to address oxidative stress.

Speech emotion recognition (SER) is a challenging task in human-computer interaction (HCI) systems. One of the key challenges in speech emotion recognition is to extract the emotional features effectively from a speech utterance. Despite the promising results of recent studies, they generally do not leverage advanced fusion algorithms for the generation of effective representations of emotional features in speech utterances. To address this problem, we describe the fusion of spatial and temporal feature representations of speech emotion by parallelizing convolutional neural networks (CNNs) and a Transformer encoder for SER. We stack two parallel CNNs for spatial feature representation in parallel to a Transformer encoder for temporal feature representation, thereby simultaneously expanding the filter depth and reducing the feature map with an expressive hierarchical feature representation at a lower computational cost. We use the RAVDESS dataset to recognize eight different speech emotions. We augment and intensify the variations in the dataset to minimize model overfitting. Additive White Gaussian Noise (AWGN) is used to augment the RAVDESS dataset. With the spatial and sequential feature representations of CNNs and the Transformer, the SER model achieves 82.31% accuracy for eight emotions on a hold-out dataset. In addition, the SER system is evaluated with the IEMOCAP dataset and achieves 79.42% recognition accuracy for five emotions. Experimental results on the RAVDESS and IEMOCAP datasets show the success of the presented SER system and demonstrate an absolute performance improvement over the state-of-the-art (SOTA) models.

Introduction: Considering disagreements on the normal range of median nerve cross-sectional area (MNCSA) and insufficient data in the Iranian population, this study aimed to measure normal MNCSA., Methods: In this cross-sectional study, bilateral upper limbs of 99 subjects were assessed by sonography, and MNCSA was measured at three levels: forearm, carpal tunnel inlet (CTI), and carpal tunnel outlet (CTO). The association between MNCSA and demographic factors was assessed., Results: Mean MNCSA was 6.33 mm 2 at the forearm, 9.41 mm 2 at CTI, and 10.67 mm 2 at CTO. MNCSA was significantly higher in males (6.78 vs. 5.94 mm 2 at the forearm, 9.98 vs. 8.92 mm 2 at CTI, and 11.24 vs. 10.84 mm 2 at CTO in males and females, respectively) and taller (>170 cm) subjects in all three levels (6.69 vs. 6.03 mm 2 at the forearm, 9.80 vs. 9.02 mm 2 at CTI, and 11.27 vs. 10.12 mm 2 at CTO in taller and shorter subjects, respectively). MNCSA was not significantly associated with wrist ratio (WR) or body mass index (BMI)., Conclusion: The normal MNCSA range in the Iranian population is 6.31 mm 2 (forearm) to 10.74 mm 2 (CTO). MNCSA is significantly higher in males and taller subjects but is not associated with BMI and WR., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Here, we outline the synthesis of a few 2-methoxy-6-((4-(6-morpholinopyrimidin-4-yl)piperazin-1-yl)(phenyl)methyl)phenol derivatives and assess their anti-inflammatory activity in macrophage cells that have been stimulated by LPS. Among these newly synthesized morpholinopyrimidine derivatives, 2-methoxy-6-((4-methoxyphenyl)(4-(6-morpholinopyrimidin-4-yl)piperazin-1-yl)methyl)phenol (V4) and 2-((4-fluorophenyl)(4-(6-morpholinopyrimidin-4-yl)piperazin-1-yl)methyl)-6-methoxyphenol (V8) are two of the most active compounds which can inhibit the production of NO at non-cytotoxic concentrations. Our findings also showed that compounds V4 and V8 dramatically reduced iNOS and cyclooxygenase mRNA expression (COX-2) in LPS-stimulated RAW 264.7 macrophage cells; western blot analysis showed that the test compounds decreased the amount of iNOS and COX-2 protein expression, hence inhibiting the inflammatory response. We find through molecular docking studies that the chemicals had a strong affinity for the iNOS and COX-2 active sites and formed hydrophobic interactions with them. Therefore, use of these compounds could be suggested as a novel therapeutic strategy for inflammation-associated disorders., Competing Interests: The authors declare that they have no known competing financial interests., (This journal is © The Royal Society of Chemistry.)

The permittivity of a material is an important parameter to characterize the degree of polarization of a material and identify components and impurities. This paper presents a non-invasive measurement technique to characterize materials in terms of their permittivity based on a modified metamaterial unit-cell sensor. The sensor consists of a complementary split-ring resonator (C-SRR), but its fringe electric field is contained with a conductive shield to intensify the normal component of the electric field. It is shown that by tightly electromagnetically coupling opposite sides of the unit-cell sensor to the input/output microstrip feedlines, two distinct resonant modes are excited. Perturbation of the fundamental mode is exploited here for determining the permittivity of materials. The sensitivity of the modified metamaterial unit-cell sensor is enhanced four-fold by using it to construct a tri-composite split-ring resonator (TC-SRR). The measured results confirm that the proposed technique provides an accurate and inexpensive solution to determine the permittivity of materials., Competing Interests: The authors declare no conflict of interest.

This study aimed to evaluate the efficacy of Duloxetine on electrodiagnostic findings of Paclitaxel-induced peripheral neuropathy in patients with breast cancer. This randomized, double-blind clinical trial was conducted on 40 patients with breast cancer who received Paclitaxel as their first chemotherapy session. All the patients were randomly allocated into two groups, intervention (20 subjects) and placebo (20 subjects). The intervention group received 30 mg duloxetine/day in the first week, followed by 60 mg (twice daily) until 8 weeks. The patient neurotoxicity questionnaire (PNQ) was used to evaluate the severity of neuropathy. Nerve conduction study was also performed. The evaluations were performed at the baseline and 8 weeks after the treatment. Out of 20 subjects in the placebo group, 10 (50%) patients had neurotoxicity (two milds, three moderate, four severe, and one incapacitated), according to PNQ. However, in the duloxetine group, two patients had mild neurotoxicity ( P = 0.03). Significant differences between groups related to the mean of Median Sensory Latency ( P <0.001), Median Motor Latency ( P < 0.001), and Median Motor velocity ( P = 0.001) were reported. However, the relative risk of polyneuropathy between the two groups (relative risk: 1) was not significant. Regarding the results, duloxetine could be an effective treatment for preventing paclitaxel-induced peripheral neuropathy in patients with breast cancer, and an electrodiagnostic study confirmed this effect., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Lumbosacral canal stenosis is known as the most common cause of back surgery with several complications. Selecting a minimally invasive treatment with high efficacy in such patients is necessary. This study was designed to evaluate the effectiveness of ozone therapy in combination with caudal epidural steroid in patients with lumbar spinal stenosis., Methods: A double-blind randomized clinical trial was conducted on 50 patients with lumbar spinal stenosis allocated into two study groups. Under ultrasound guidance, the first group received 80 mg of triamcinolone hexavalent with 4 mL of Marcaine 0.5% and 6 mL of distilled water to the caudal epidural space. The second group received an injection similar to the first group, combined with 10 mL of ozone (O2-O3) gas at a concentration of 10 µg/cc. The patients were followed at baseline, one, and six months after injection with clinical outcomes measures using Visual Analog Scale (VAS), Walking Distance (WD) and Oswestry Disability Index (ODI)., Results: The mean age of subjects, 30 males (60%) and 20 females (40%), was reported as 64.51 ± 7.19 years old. Reduction of pain intensity based on VAS score was statistically significant in both groups at follow-up periods (P < 0.001). The VAS changes in the first month and sixth months showed no significant difference between the two groups (P = 0.28 and P = 0.33, respectively). The improvement in disability index (ODI) in both types of treatment during follow-up was significant (P < 0.0001), and there was no difference between the two treatment groups in one month and six months (P = 0.48 and P = 0.88, respectively). As for walking distance, the improvement process with both types of treatment during follow-up periods was significant (P < 0.001). However, after one and six months of treatment, the rate of improvement in patients' walking distance in the caudal epidural steroid injection plus ozone group was significantly higher than in the epidural steroid group (p = 0.026 and p = 0.017, respectively)., Conclusions: In this study, the results of VAS and ODI outcomes showed that caudal epidural steroid injection combined with ozone has no advantage over caudal epidural steroid injection alone. Interestingly, our results demonstrated that the group receiving caudal epidural steroid injection plus ozone scored significantly higher on the walking distance index than the group receiving caudal epidural steroid alone., Trial Registration: IRCT IRCT20090704002117N2 (registration date: 07/08/2019)., (© 2023. The Author(s).)

Alzheimer's disease (AD) is a neurodegenerative disorder that affects 35 million people worldwide. However, no potential therapeutics currently are available for AD because of the multiple factors involved in it, such as regulatory factors with their candidate genes, factors associated with the expression levels of its corresponding genes, and many others. To date, 29 novel loci from GWAS have been reported for AD by the Psychiatric Genomics Consortium (PGC2). Nevertheless, the main challenge of the post-GWAS era, namely to detect significant variants of the target disease, has not been conducted for AD. N6-methyladenosine (m6a) is reported as the most prevalent mRNA modification that exists in eukaryotes and that influences mRNA nuclear export, translation, splicing, and the stability of mRNA. Furthermore, studies have also reported m6a's association with neurogenesis and brain development. We carried out an integrative genomic analysis of AD variants from GWAS and m6a-SNPs from m6AVAR to identify the effects of m6a-SNPs on AD and identified the significant variants using the statistically significance value ( p -value <0.05). The cis-regularity variants with their corresponding genes and their influence on gene expression in the gene expression profiles of AD patients were determined, and showed 1458 potential m6a-SNPs (based on p -value <0.05) associated with AD. eQTL analysis showed that 258 m6a-SNPs had cis-eQTL signals that overlapped with six significant differentially expressed genes based on p -value <0.05 in two datasets of AD gene expression profiles. A follow-up study to elucidate the impact of our identified m6a-SNPs in the experimental study would validate our findings for AD, which would contribute to the etiology of AD., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

The new coronavirus SARS-COV-2, which emerged in late 2019 from Wuhan city of China was regarded as causing agent of the COVID-19 pandemic. The primary protease which is also known by various synonymous i.e., main protease, 3-Chymotrypsin-like protease (3CL PRO ) has a vital role in the replication of the virus, which can be used as a potential drug target. The current study aimed to identify novel phytochemical therapeutics for 3CL PRO by machine learning-based virtual screening. A total of 4,000 phytochemicals were collected from deep literature surveys and various other sources. The 2D structures of these phytochemicals were retrieved from the PubChem database, and with the use of a molecular operating environment, 2D descriptors were calculated. Machine learning-based virtual screening was performed to predict the active phytochemicals against the SARS-CoV-2 3CL PRO . Random forest achieved 98% accuracy on the train and test set among the different machine learning algorithms. Random forest model was used to screen 4,000 phytochemicals which leads to the identification of 26 inhibitors against the 3CL PRO . These hits were then docked into the active site of 3CL PRO . Based on docking scores and protein-ligand interactions, MD simulations have been performed using 100 ns for the top 5 novel inhibitors, ivermectin, and the APO state of 3CL PRO . The post-dynamic analysis i.e,. Root means square deviation (RMSD), Root mean square fluctuation analysis (RMSF), and MM-GBSA analysis reveal that our newly identified phytochemicals form significant interactions in the binding pocket of 3CL PRO and form stable complexes, indicating that these phytochemicals could be used as potential antagonists for SARS-COV-2., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Samad, Ajmal, Mahmood, Khurshid, Li, Jan, Rehman, He, Abdalla, Umair, Hu and Wadood.)

Background: The incidence of heat emergencies, including heat stroke and heat exhaustion, have increased recently due to climate change. This has affected global health and has become an issue of consideration for human health and well-being. Due to overlapping clinical manifestations with other diseases, and most of these emergencies occurring in an elderly patient, patients with a comorbid condition, or patients on poly medicine, diagnosing and managing them in the emergency department can be challenging. This study assessed whether an educational training on heat emergencies, defined as heat intervention in our study, could improve the diagnosis and management practices of ED healthcare providers in the ED setting., Methods: A quasi-experimental study was conducted in the EDs of four hospitals in Karachi, Pakistan. Eight thousand two hundred three (8203) patients were enrolled at the ED triage based on symptoms of heat emergencies. The pre-intervention data were collected from May to July 2017, while the post-intervention data were collected from May to July 2018. The HEAT intervention, consisting of educational activities targeted toward ED healthcare providers, was implemented in April 2018. The outcomes assessed were improved recognition-measured by increased frequency of diagnosing heat emergencies and improved management-measured by increased temperature monitoring, external cooling measures, and intravenous fluids in the post-intervention period compared to pre-intervention., Results: Four thousand one hundred eighty-two patients were enrolled in the pre-intervention period and 4022 in the post-intervention period, with at least one symptom falling under the criteria for diagnosis of a heat emergency. The diagnosis rate improved from 3% (n = 125/4181) to 7.5% (n = 7.5/4022) (p-value < 0.001), temperature monitoring improved from 0.9% (n = 41/4181) to 13% (n = 496/4022) (p-value < 0.001) and external cooling measure (water sponging) improved from 1.3% (n = 89/4181) to 3.4% (n = 210/4022) (p-value < 0.001) after the administration of the HEAT intervention., Conclusion: The HEAT intervention in our study improved ED healthcare providers' approach towards diagnosis and management practices of patients presenting with health emergencies (heat stroke or heat exhaustion) in the ED setting. The findings support the case of training ED healthcare providers to address emerging health issues due to rising temperatures/ climate change using standardized treatment algorithms., (© 2023. The Author(s).)

Purpose: To evaluate the cost-effectiveness of Platelet Rich Plasma (PRP), Plasma Rich in Growth Factors (PRGF), Hyaluronic Acid (HA) and ozone as effective treatment approaches in knee osteoarthritis management from Iran Health care perspective., Methods: A decision tree model was conducted to assess the cost-effectiveness of four common intra-articular treatment approaches in patients with mild and moderate knee osteoarthritis. The data on clinical effectiveness was obtained from a randomized controlled trial (RCT) conducted in Iran and used to estimate utility values. The direct medical costs were estimated according to tariffs for public medical centers and hospitals, approved by the Iran Ministry of Health and Medical Education in 2021. The incremental cost-effectiveness ratio (ICER) and the net monetary benefit (NMB) were used to evaluate the cost-utility analysis. Deterministic and probabilistic sensitivity analyses are performed to investigate the robustness of the results and account for the different sources of uncertainty., Results: In this study, HA intra-articular injection-related costs ($581.67/patient) were defined as the highest cost, followed by PRGF ($328.10/patient), PRP (318.58/patient), and Ozone (103.20/patient). According to the utility value, PRP and PRGF (0.68) have the same and the most utility among Intra-articular injections in knee osteoarthritis management. However, the PRP injection method was identified as the most cost-effective intervention due to its high NMB and ICER estimates. Based on the Monte Carlo Simulation, PR intervention, compared to other ones, was introduced as the dominant strategy regarding knee OA management, with a WTP of $10,000 for 100% of cases., Conclusion: The study result demonstrated that intra-articular injection of PRP, compare to other injections, is a cost-effective treatment option for patients with mild and moderate knee osteoarthritis. In addition, intra-articular injection of PRP was identified as the best injection, with the highest level of net monetary benefit, for knee OA management., (© 2023. The Author(s).)

Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclosed no relevant interests.

Diabetes is a chronic disease that leads to abnormal carbohydrate digestion and hyperglycemia. The long-term use of marketed drugs results in secondary infections and side effects that demand safe and natural substitutes for synthetic drugs. The objective of this study is to evaluate the antidiabetic potential of compounds from the leaves of Tradescantia pallida . Thirteen phenolic compounds were identified from the ethyl acetate fraction of leaves of Tradescantia pallida using liquid chromatography-mass spectrometry. The compounds were then studied for the type of interactions between polyphenols and human α-glucosidase protein using molecular docking analysis. Prime Molecular Mechanics/Generalized Born Surface Area (MM-GBSA) calculations were performed to measure the binding free energies responsible for the formation of ligand-protein complexes. The compounds were further investigated for the thermodynamic constraints under a specified biological environment using molecular dynamic simulations. The flexibility of the ligand-protein systems was verified by Root Mean Square Deviation (RMSD), Root Mean Square Fluctuation (RMSF) and molecular interactions. The results authenticated the antidiabetic potential of polyphenols identified from the leaves of Tradescantia pallida . Our investigations could be helpful in the design of safe antidiabetic agents, but further in vitro and in vivo investigations are required.

Circulating cell-free mitochondrial DNA (cf-mtDNA) has been found in the plasma of severely ill COVID-19 patients and is now known as a strong predictor of mortality. However, the underlying mechanism of mtDNA release is unexplored. Here, we show a novel mechanism of SARS-CoV-2-mediated pro-inflammatory/pro-apoptotic mtDNA release and a rational therapeutic stem cell-based approach to mitigate these effects. We systematically screened the effects of 29 SARS-CoV-2 proteins on mitochondrial damage and cell death and found that NSP4 and ORF9b caused extensive mitochondrial structural changes, outer membrane macropore formation, and the release of inner membrane vesicles loaded with mtDNA. The macropore-forming ability of NSP4 was mediated through its interaction with BCL2 antagonist/killer (BAK), whereas ORF9b was found to inhibit the anti-apoptotic member of the BCL2 family protein myeloid cell leukemia-1 (MCL1) and induce inner membrane vesicle formation containing mtDNA. Knockdown of BAK and/or overexpression of MCL1 significantly reversed SARS-CoV-2-mediated mitochondrial damage. Therapeutically, we engineered human mesenchymal stem cells (MSCs) with a simultaneous knockdown of BAK and overexpression of MCL1 (MSCshBAK+MCL1) and named these cells IMAT-MSCs (intercellular mitochondrial transfer-assisted therapeutic MSCs). Upon co-culture with SARS-CoV-2-infected or NSP4/ORF9b-transduced airway epithelial cells, IMAT-MSCs displayed functional intercellular mitochondrial transfer (IMT) via tunneling nanotubes (TNTs). The mitochondrial donation by IMAT-MSCs attenuated the pro-inflammatory and pro-apoptotic mtDNA release from co-cultured epithelial cells. Our findings thus provide a new mechanistic basis for SARS-CoV-2-induced cell death and a novel therapeutic approach to engineering MSCs for the treatment of COVID-19.

Background: Although posterior procedures are used for most cases of basilar invagination, transoral decompression is an important tool in complex deformities with severe degeneration and neural compression., Methods: Consecutive patients who underwent transoral odontoidectomy for basilar invagination and atlantoaxial dislocation at the neurosurgical unit of Lady Reading Hospital Peshawar between June 2016 and January 2022 were retrospectively included. Preoperative and postoperative neurological, clinical, and radiological parameters were recorded and compared., Results: Of the 33 patients included in this study, 22 were men and 11 were women. The mean age was 23.4 years ±8.4 years (mean ± standard deviation). The most common presenting symptoms were gait abnormalities and neck pain. A total of 28 patients were treated for the first time, while 5 patients had prior posterior fusion. The mean distance of the tip of the dens above the chamberlain line was 8.9 ± 4.2 mm, while the mean anterior atlantodental interval was 6.5 ± 2.1 mm. Seven patients had an anomalous course of vertebral artery on at least one side. A total of 28 patients improved significantly, while 5 patients did not improve at the follow-up. The mean follow-up was 8.5 months ±6.3 (mean ± standard deviation). The mean Nurick and Modified Japanese Orthopedic Association scores improved postoperatively (P < 0.05). Three patients underwent reoperation including one with vertebral artery injury. Three patients underwent tracheostomy., Conclusions: With proper patient selection, transoral odontoidectomy can be safely performed in a limited-resource setting., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Sutures play a pivotal role in promoting healing in any surgical procedure. However, the versatile nature of the oral environment entails additional properties in the suture materials to assure uneventful healing. A surgeon needs to understand these delicate intricacies in the immediate postoperative phase and needs some kind of algorithm in the selection of sutures that suits the different surgical scenarios. Therefore, a study was designed to observe the effect of four different types of mouthwash, viz. Avohex, Aloedent, Parodontax and Betadine, on the mechanical properties of Vicryl (polyglactin 910), PTFE (polytetrafluoroethylene), Prolene (polypropylene) and Mersilk., Methods: A total of 288 suture samples were divided in four equal groups (72 = each group) and used for the experiments. Tensile load, tensile strength as well as percentage elongation of the suture materials were evaluated in the various stated media at 3rd, 7th, 10th and 14th days, which were compared with the controls. The results were analyzed statistically and inferences were drawn., Results: Mersilk in (Avohex, Parodontax and Betadine) solutions showed a statistically significant decrease in tensile load over time. All the sutures had the highest tensile strength in Parodontax and had the lowest in Betadine solution. Vicryl and PTFE presented significant percentage elongation over time as compared to Prolene and Mersilk., Conclusion: The author has given certain recommendations but also states that there is no standard rule for the use of a particular suture material in all clinical situations. However, the selection of the suture material should be based on the type of surgery and preferences of the surgeon.

Introduction: The coronavirus disease 2019 (COVID-19) is associated with a variety of physical and emotional disorders, and subsequently lower Quality of Life (QOL). This study aimed to investigate the effect of a 2-week exercise-based pulmonary rehabilitation on clinical characteristics and QOL of severe COVID-19 patients after discharge from intensive care unit (ICU)., Methods: In this quasi-experimental study, eligible severe COVID-19 cases, who had survived and were discharged from ICU were selected using convenience sampling method. O 2 saturation (SpO2), pulse rate, dyspnea, and QOL were evaluated and compared before and after two weeks of exercise-based pulmonary rehabilitation (PR)., Results: 35 cases with the mean age of 57.86 ± 11.73 (18-75) years were studied (51.4% female). The mean SpO2 increased from 90.41 ± 3.97 to 95.11 ± 1.96% after two weeks of pulmonary rehabilitation (p<0.0001). In addition, the mean pulse rate (98.97±16.23 to 88.91±14.03 pulse/minute; p<0.001) and the mean dyspnea severity (5.6±1.97 to 3.45±1.97; p<0.0001) decreased after two weeks of intervention. Besides, the mean total QOL and its dimensions, including general health (p<0.0001), physical status (p<0.0001), emotional status (p = 0.036), and social function (p<0.0001) of patients, had significantly increased after intervention., Conclusion: Based on the findings of this study, it seems that two-week exercise-based pulmonary rehabilitation could be effective in increasing the SpO2, decreasing dyspnea and pulse rate, and improving the QOL of patients with severe COVID-19 after discharge from ICU., Competing Interests: There is no conflict of interest

Globally, millions of people suffer from various substance use disorders (SUD), including mono-and polydrug use of opioids and methamphetamine. Brain regions such as the cingulate cortex, infralimbic cortex, dorsal striatum, nucleus accumbens, basolateral and central amygdala have been shown to play important roles in addiction-related behavioral changes. Clinical and pre-clinical studies have characterized these brain regions and their corresponding neurochemical changes in numerous phases of drug dependence such as acute drug use, intoxication, craving, withdrawal, and relapse. At present, many studies have reported the individual effects of opioids and methamphetamine. However, little is known about their combined effects. Co-use of these drugs produces effects greater than either drug alone, where one decreases the side effects of the other, and the combination produces a prolonged intoxication period or a more desirable intoxication effect. An increasing number of studies have associated polydrug abuse with poorer treatment outcomes, drug-related deaths, and more severe psychopathologies. To date, the pharmacological treatment efficacy for polydrug abuse is vague, and still at the experimental stage. This present review discusses the human and animal behavioral, neuroanatomical, and neurochemical changes underlying both morphine and methamphetamine dependence separately, as well as its combination. This narrative review also delineates the recent advances in the pharmacotherapy of mono- and poly drug-use of opioids and methamphetamine at clinical and preclinical stages., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hazani, Naina Mohamed, Muzaimi, Mohamed, Yahaya, Teoh, Pakri Mohamed, Mohamad Isa, Abdulrahman, Ramadah, Kamaluddin and Kumar.)

Background: Politico-economic sanctions over the recent years have led to significant challenges in the pharmaceutical supply chain (PSC) in Iran. Given the importance of the chain's resilience for the health system and its impact on accessibility, equity, and public health, this study was conducted to determine the major challenges facing pharmaceutical procurement in Iran after the imposition of these sanctions., Methods: This study was a qualitative research with a content analysis approach conducted in 2019. Eighteen policymakers and administrative managers in food and drug administration of two Iranian Medical Universities and Iran's Ministry of Health were included in the present study via snowball sampling and semi-structured interview. The data were analyzed using the framework analysis of MAX QDA10., Results: Five main themes and 15 sub-themes were identified, which addressed pharmaceutical supply chain challenges under politico-economic sanctions. These included the challenges in financing, purchasing, importing, and manufacturing domestic products in addition to storing and distributing medicines, along with challenges facing the general public, particularly patients., Conclusion: The results revealed that pharmaceuticals are not immune to politico-economic sanctions, although they are not directly subjected to them. Sanctions, similar to any economic crisis, can affect public health and limit their access to healthcare. Identifying supply chain challenges and planning to address them could help policymakers find solutions to enhance PSC resilience in the future., (Copyright: © Iranian Journal of Medical Sciences.)

Background: Clinical Practice Guidelines (CPGs) can be adapted to local conditions to prevent any resources from being wasted. Adaptation of CPGs implies a systematic view of developed guidelines through maintaining evidence-based principles in order to find the ones most relevant with patients' conditions and its integration with the cultural and regional requirements of the target population and health system facilities. The main purpose of the study was to describe, interpret and compare different frameworks for adaptation of clinical guidelines and proposing a comprehensive framework for Iran. Methods: This study was based on a review and comparative analysis of adaptation frameworks of CPGs. Initially, all adaptation frameworks were collected by systematic search in the literature. We searched the following electronic databases: PubMed, Scopus, Trip Database, Science Direct, and Google Scholar. Then, based on the stages of the comparative study, frameworks were described, interpreted, juxtaposed, and compared. Finally, a comprehensive framework for the adaptation of clinical guidelines was proposed by consulting a panel of experts. Results: Our literature search resulted in 26 frameworks, of which 18 were potentially relevant. Based on inclusion/exclusion criteria, nine frameworks were included in the study and have been described, interpreted, and compared. The proposed comprehensive framework for the adaptation of clinical guidelines consists of ten main steps. Conclusion: The proposed comprehensive framework is an appropriate tool for the adaptation of clinical guidelines in Iran that can be used in other countries. However, further validation of the framework requires case studies and expert consultation to determine its application to the adaptation of clinical guidelines., (© 2022 Iran University of Medical Sciences.)

Background: Internal herniation through the foramen of Winslow is a rare cause of bowel obstruction. The presented case illustrates this condition and considerations made regarding treatment., Case Presentation: An elderly woman was admitted to the hospital with sudden onset of epigastric pain and vomiting. Blood tests were normal except for a lactate value of 2.5 mmol/L (normal value < 1.8). Computer tomography showed internal herniation of the caecum through the foramen of Winslow. Initial treatment with intravenous fluids, a nasogastric tube and fasting did not resolve the bowel obstruction. The herniated caecum was laparoscopically reduced, and there were no signs of intestinal ischaemia., Interpretation: Internal herniation through the foramen of Winslow is rare. There are no evidence-based guidelines on treatment, or on prophylactic measures to prevent recurrence. Both laparoscopic and open surgical approaches have been reported, with or without closure of the foramen. There is little documentation on recurrence rates.

Sepsis is a clinical syndrome with high mortality and morbidity rates. In sepsis, the abrupt release of cytokines by the innate immune system may cause multiorgan failure, leading to septic shock and associated complications. In the presence of a number of systemic disorders, such as sepsis, infections, diabetes, and systemic lupus erythematosus (SLE), cardiorenal syndrome (CRS) type 5 is defined by concomitant cardiac and renal dysfunctions Thus, our study suggests that certain mRNAs and unexplored pathways may pave a way to unravel critical therapeutic targets in three debilitating and interrelated illnesses, namely, sepsis, SLE, and CRS. Sepsis, SLE, and CRS are closely interrelated complex diseases likely sharing an overlapping pathogenesis caused by erroneous gene network activities. We sought to identify the shared gene networks and the key genes for sepsis, SLE, and CRS by completing an integrative analysis. Initially, 868 DEGs were identified in 16 GSE datasets. Based on degree centrality, 27 hub genes were revealed. The gProfiler webtool was used to perform functional annotations and enriched molecular pathway analyses. Finally, core hub genes ( EGR1, MMP9 , and CD44 ) were validated using RT-PCR analysis. Our comprehensive multiplex network approach to hub gene discovery is effective, as evidenced by the findings. This work provides a novel research path for a new research direction in multi-omics biological data analysis.

Driven by the need to biosynthesize alternate biomedical agents to prevent and treat infection, silver nanoparticles have surfaced as a promising avenue. Cyanobacteria-derived nanomaterial synthesis is of substantive interest as it offers an eco-friendly, cost-effective, sustainable, and biocompatible route for further development. In the present study optimal conditions for synthesis of silver nanoparticles (AgNPs) were 1 : 9 v/v [cell extract: AgNO 3 (1 mM)], pH 7.4, and 30 °C reaction temperatures. Synthesis of nanoparticles was monitored by UV-vis spectrophotometry and the maximum absorbance was observed at a wavelength of 420 nm. SEM with EDX analysis confirmed 96.85% silver by weight which revealed the purity of AgNPs. TEM & XRD analysis exhibited a particle size of ∼12 nm with crystalline nature. FTIR analysis confirmed the presence of possible biomolecules involved in the synthesis and stabilization of AgNPs. Decapping of AgNPs followed by SDS-PAGE, LCMS and MALDI TOF analysis elucidates the proteinaceous nature of the capping and stabilizing agent. Cyanobacterial-derived capped AgNPs showed more cytotoxicicity towards a non-small cell lung cancer (A549) cell line, free radical scavenger and an antimicrobial than de-capped AgNPs. In addition they showed significant synergistic characteristics with antibiotics and fungicides. The test revealed that the capped AgNPs were biocompatible with good anti-inflammatory properties. The blend of antimicrobial and biocompatible properties, coupled with their intrinsic "green" and facile synthesis, made these biogenic nanoparticles particularly attractive for future applications in nanomedicine., Competing Interests: There are no conflicts of interest to declare., (This journal is © The Royal Society of Chemistry.)

Aim: Autologous conditioned serum has been studied as a treatment option in musculoskeletal disorders and resulted in varying outcomes. This study aims to pool the current data on this matter., Materials & Methods: Major databases were searched for the topics, and after screening the results, the final 21 papers (level of evidence I or II) were included., Results & Conclusion: This study showed a major focus of the literature on the effectiveness of autologous conditioned serum in osteoarthritis, in which there is much high-quality evidence suggesting its safety and efficacy. Also, some of the available experiments are assessing its application in tendinopathies and radiculopathies which, despite positive results, recommend further evaluations on this topic., Competing Interests: Financial & competing interests disclosure This study was funded by the Clinical Research Development Center, Shahid Modarres Educational hospital (School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript., (© 2022 The Authors.)