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Objective: The diagnosis and treatment of breast cancer is associated with significant distress that has huge impact on survivors’ quality of life. The objective of this study is to assess the effectiveness of an integrated intervention “Moving on After Breast Cancer (ABC) Plus culturally adapted Cognitive Behavior Therapy” (Moving on ABC Plus). Method: This is a randomized controlled trial that aims to recruit 354 breast cancer survivors from the inpatient and outpatient oncology departments in public and private hospitals in Karachi, Hyderabad, Lahore, Multan, and Rawalpindi in Pakistan. Patients scoring 10 or above on either the Patient Health Questionnaire—9 and/or the Generalized Anxiety Disorder scale (GAD-7) will be recruited. Baseline assessments will include Functional Assessment of Cancer Therapy—Breast; EuroQol-5D; Multidimensional Scale for Perceived Social Support; Intrusive Thoughts Scale; and Rosenberg Self-Esteem Scale. Participants randomized into intervention arm, Moving on ABC Plus, will receive 12 individual therapy sessions over 4 months. Follow-up will be completed at 4- and 6-month post-randomization, using all baseline instruments along with the Client Satisfaction Questionnaire (CSQ-8). We will also explore the participants’, their family members’, and the therapists’ experiences of the trial and intervention. Results: We will be assessing the effectiveness of intervention in reducing depression and anxiety in breast cancer survivors as a primary outcome of the trial. The secondary outcomes will include effectiveness of intervention in terms of reduction in intrusive thoughts and improvement in health-related quality of life, self-esteem, and perceived social support. Conclusion: The results of the study will inform the design of a future larger randomized control trial with long-term follow-up.

Although ongoing control strategies are attempting to minimize certain metabolic disorders such as hyperketonemia, factors such as genetics, management, environment, and geography still present a potential challenge to the achievement of the desired results. In light of this, this study was conducted (i) to determine the prevalence of subclinical and clinical ketosis based on the concentration of ketone bodies (BHB) using ELISA Kit, and (ii) to examine a number of epidemiological risk factors related to the conditions. From October, 2020 to the January, 2021. A 80 blood samples were collected in a cross-sectional survey in different areas of Mosul. Data included age, management systems, parity, and origin. At the cut-off point ≥1.2-≤ 1.4 mmol / L, the prevalence of subclinical ketosis was 27.5% and for clinical ketosis it was 5%. Results revealed that the animals aged > 3 years were more at risk for subclinical ketosis compared to animals aged ≤ 3 years RR = 2.6471. Multiparous animals were more at risk compared to the primiparous (two or less births) RR = 2.0652. No significant difference between the animals’ origins RR = 0.6863. Indoor and outdoor system animals were more at risk for subclinical ketosis compared to the indoor system only RR = 2.1389. In conclusion, hyperketonemia is prevalent in Mosul. Certain risk factors should be taking into account when planning control programs. Attention should be paid to diagnosis, management, and control of this disease during the risk stage to avert economic loss to the dairy farmers.

Drug delivery via aerosolization for localized and systemic effect is a non-invasive approach to achieving pulmonary targeting. The aim of this study was to prepare spray-dried proliposome (SDP) powder formulations to produce carrier particles for superior aerosolization performance, assessed via a next generation impactor (NGI) in combination with a dry powder inhaler. SDP powder formulations (F1-F10) were prepared using a spray dryer, employing five different types of lactose carriers (Lactose monohydrate (LMH), lactose microfine (LMF), lactose 003, lactose 220 and lactose 300) and two different dispersion media. The first dispersion medium was comprised of water and ethanol (50:50% v/v ratio), and the second dispersion medium comprised wholly of ethanol (100%). In the first dispersion medium, the lipid phase (consisting of Soya phosphatidylcholine (SPC as phospholipid) and Beclomethasone dipropionate (BDP; model drug) were dissolved in ethanol and the lactose carrier in water, followed by spray drying. Whereas in second dispersion medium, the lipid phase and lactose carrier were dispersed in ethanol only, post spray drying. SDP powder formulations (F1-F5) possessed significantly smaller particles (2.89 ± 1.24-4.48 ± 1.20 μm), when compared to SDP F6-F10 formulations (10.63 ± 3.71-19.27 ± 4.98 μm), irrespective of lactose carrier type via SEM (scanning electron microscopy). Crystallinity of the F6-F10 and amorphicity of F1-F15 formulations were confirmed by XRD (X-ray diffraction). Differences in size and crystallinity were further reflected in production yield, where significantly higher production yield was obtained for F1-F5 (74.87 ± 4.28-87.32 ± 2.42%) then F6-F10 formulations (40.08 ± 5.714-54.98 ± 5.82%), irrespective of carrier type. Negligible differences were noted in terms of entrapment efficiency, when comparing F1-F5 SDP formulations (94.67 ± 8.41-96.35 ± 7.93) to F6-F10 formulations (78.16 ± 9.35-82.95 ± 9.62). Moreover, formulations F1-F5 demonstrated significantly higher fine particle fraction (FPF), fine particle dose (FPD) and respirable fraction (RF) (on average of 30.35%, 890.12 μg and 85.90%) when compared to counterpart SDP powder formulations (F6-F10). This study has demonstrated that when a combination of water and ethanol was employed as dispersion medium (formulations F1-F5), superior formulation properties for pulmonary drug delivery were observed, irrespective of carrier type employed.

This paper is an analytical comparative morphological study of class changing of some of derivational affixes in Standard English and Central Kurdish from the standpoints of Generative Morphology. For the analysis, this work relies heavily on the identification of various class changing affixes between the two languages under study. The main goal is to identify the points of similarity and difference of class changing affixes that change the grammatical categories and the lexical meaning of the existing lexemes. The findings show that English and Kurdish are similar in the formation of nominal and adjectival affixes where certain lexemes can change the lexical categories and the meaning of the newly derived words. In English, in the formation of verbal affixes, a ‘noun’ and an ‘adjective’ can be converted into a ‘verb’ by adding certain prefixes and suffixes. While in Kurdish, no new lexemes can be formed from the root of the verb since the internal structure of the verbs in Kurdish works differently compared to English. In Kurdish, the suffix -a is attached to some cardinal numerals to derive a new noun, whereas in English, no newly derived nouns can be formed by numerals. English and Kurdish are different in the formation of new adverbial affixes. In English, certain adjectives and nouns can derive certain types of adverbs while in Kurdish these lexical categories are unable to derive adverbs by attaching certain derivational affixes.

Toll-like receptors (TLRs) are key players in the pathogenesis of inflammatory conditions including coronary arterial disease (CAD). They are expressed by a variety of immune cells where they recognize pathogen-associated molecular patterns (PAMPs). TLRs recruit adaptor molecules, including myeloid differentiation primary response protein (MYD88) and TIRF-related adaptor protein (TRAM), to mediate activation of MAPKs and NF-kappa B pathways. They are associated with the development of CAD through various mechanisms. TLR4 is expressed in lipid-rich and atherosclerotic plaques. In TLR2−/− and TLR4−/− mice, atherosclerosis-associated inflammation was diminished. Moreover, TLR2 and TLR4 may induce expression of Wnt5a in advanced staged atheromatous plaque leading to activation of the inflammatory processes. TLR9 is activated by CpG motifs in nucleic acids and have been implicated in macrophage activation and the uptake of oxLDL from the circulation. Furthermore, TLR9 also stimulates interferon-α (INF-α) secretion and increases cytotoxic activity of CD4+ T-cells towards coronary artery tunica media smooth muscle cells. This review outlines the pathophysiological role of TLR2, TLR4, and TLR9 in atherosclerosis, focusing on evidence from animal models of the disease.

Aims and method We aimed to examine the burden of mental disorders in Pakistan over the past three decades. We used the crude data of disability-adjusted life-years (DALYs) obtained from the Global Burden of Disease Study database (1990–2019) to represent burden. Data were retrieved on 26 January 2021. Data for adults of reproductive age (aged 15–49 years) were analysed to discuss and interpret the disease burden. An analysis was conducted on total DALYs separately for the genders for ten mental disorders reported in Pakistan. Results DALYs increased drastically with the onset of reproductive age. Depressive disorder was the most reported mental disorder, contributing 3.13% (95% CI 2.25–4.24) of total DALYs, and varied significantly between genders: females 3.89% (95% CI 2.73–5.29) versus males 2.37% (95% CI 1.62–3.25). Clinical implications A nationwide high-quality epidemiological surveillance system should be implemented to monitor mental disorders and offer culturally appropriate preventive services.

Background In settings with high burden of extrapulmonary tuberculosis, the use of various diagnostic modalities can result in superior and quick diagnosis leading to prompt initiation of treatment. Objective This study assessed the diagnostic performance of the fine-needle aspiration cytology (FNAC), Ziehl–Neelsen (ZN) stain, fluorescence microscopy (FM) and cartridge-based nucleic acid amplification test (CBNAAT) in patients with suspected tuberculous lymphadenitis (TBLN). Methods This cross-sectional studyodes, who underwent FNAC. The FNAC samples were subjected to cytomorphological examinati involved 255 patients clinically suspected of TBLN with palpable lymph non, ZN stain, FM and CBNAAT. The diagnostic performance of each modality was compared with CBNAAT, and combined performance was determined. The diagnostic performance of CBNAAT was determined by comparing it with composite reference standard. Results Of 255 patients, 148 (58.04%) showed features of TBLN on FNAC. The presence of epithelioid cell granulomas with caseous necrosis (67.57%) was the predominant cytomorphological pattern. On ZN stain, FM and CBNAAT, 31 (20.95%), 63 (42.57%) and 100 (67.57%) patients were found to be positive for TBLN, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of CBNAAT was 58.59%, 91.83%, 92% and 58.06%, respectively. Finally, the combination of ZN stain, FM and CBNAAT led to the detection of 88.51% patients with TBLN. Conclusion Combined use of ZN stain, FM and CBNAAT leads to superior and swift diagnosis of patients with clinically suspected TBLN.

Cerclage wiring may be used to optimize the stability of intramedullary nail or plate fixations in comminuted proximal femoral fractures, periprosthetic fractures, and other selected cases. In this article, we presented a novel case of iatrogenic sciatic nerve entrapment from cerclage wiring used to supplement intramedullary nail fixation. We also illustrate and highlight the role of ultrasound in assessing the sciatic nerve to make a timely diagnosis.

The recent utilization of transferosomes (a type of vesicular drug-carrier system) has shown promising results in enhancing the transport of drugs through the skin when administered topically. Phospholipids and surface active agents constitute the primary components of these entities. Surface active agents play a crucial role in enhancing the permeability and flexibility of lipid bilayers. The present research critically examines previous studies to gain insights into the influence of surface active agents on the characteristics and performance of transferosomes. Specifically, it focuses on the effects of these agents on transferosome size, entrapment efficiency (EE), zeta potential, stability, and transdermal flux. The type of surface active agent generally exerts a notable influence on the size of vesicles, encapsulation efficiency (EE), and zeta potential. This phenomenon could potentially be attributed to variations in the hydrophilic-lipophilic balance (HLB), the hydrophilicity of the surface active agent, and the length of the carbon chain. Therefore, it is imperative to investigate the influence of surface active agent properties in the development of transferosomes. The evaluation of the cytocompatibility of surface active compounds was also incorporated into the study.

ABSTRACT Objective: To assess the oral health status of elderly people living in Karachi based old home. Methodology: Study setting: Different old homes in Karachi. Study Type: descriptive cross sectional, Duration: 2-3 months. Older adults aged 65 and above who are mentally stable and have given consent were included. Ninety-six old subjects were included via purposive sampling. Data was collected via a self-constructed Proforma with WHO Oral examination form. Data was entered and analyzed via SPSS 23.0. Expected outcomes include higher Decayed Missing Filled Teeth (DMFT) scores, as well as a higher rate of periodontal disease resulting in higher rate of tooth loss. Results: A total of Fifty-nine males and 37 females were included in the study.70.8% had Bleeding on probing (BOP). Sixty two percent had pocketing of 4-5 mm. 66.6% had a greater decayed component, and eighty five percent had missing teeth. T test results showed that the Decayed component was significantly associated with gender (p 0.01) and age (p 0.01). The Missing component was significantly associated with age only (p 0.00). The Decayed Missing Filled Teeth DMFT index was significantly associated with gender (p 0.00), systemic disease (p 0.04) and age (p 0.02). The Community Probing Index CPI was found significant with gender (0.01) and age (p 0.05). ANOVA test showed that Decayed, Missing component and DMFT were significantly associated with marital status only (p 0.001, p 0.09 and 0.00 respectively). Conclusion: Oral health status worsens with age as shown by the current study. Old home people are more vulnerable to debilitating condition and hence need more care.

Background A widely accepted set of imaging criteria or classification has not yet been adopted to evaluate response to treatment by percutaneous sclerotherapy for aneurysmal bone cyst (ABC). In this article, we described and illustrated the Royal Orthopaedic Hospital (ROH) scoring system which is a new, reproducible, and objective tool to evaluate the radiological response. We also reported our institutional experience in the efficacy of computed tomography (CT)-guided sclerotherapy for treating such lesions.

Hybrid composite sandwich structures, known for remarkable energy absorption, rigidity, and strength, are emerging as a preferred choice for fortifying structures against a diverse range of firearms and artillery. Despite their higher density, these panels demonstrate commendable qualities, making them optimal for armored vehicles and body armor. Numerous structural options compete for recognition as effective ballistic shields in today's context. In this study, three sample configurations were rigorously tested for ballistic impact using a 7.62×39 mm bullet. The first sample (S1) comprised silicon carbide ceramic tiles (SiC), Kevlar fiber, and carbon fiber in the face sheet, with an unfilled aluminum honeycomb core and a carbon fiber rear sheet. Subsequent samples, S2 and S3, maintained the S1 composition but varied in the core. S2 had a honeycomb core injected with polyurethane foam, while S3 utilized a silicone rubber-filled honeycomb core. Ballistic tests revealed a notable difference: S1 and S2 failed to prevent bullet penetration, whereas S3 successfully met this crucial objective. After penetration, the bullets' velocities were S1 -45.9 m/s, S2-22.9 m/s, and S3 -0m/s. Remarkably, S3 exhibited an optimal 0mm back face signature (BFS) and a penetration depth (DOP) of 13.74 mm, well within limits. Cumulative energy absorption (EA) was as follows: S1-2577.23 J, S2-2583.57 J, and S3-2617.92 J. The armors demonstrated specific energy absorptions (SEA) of 2386.33, 2389.97, and 2015.32 J/kg, respectively. Their areal densities were 48, 48.1, and 57 kg/m2, respectively. The ballistic limit velocities (BLV), derived from initial (IV) and residual velocities (RV), measured 802.68, 803.673, and 804 m/s for S1, S2, and S3.

Gender and social dimensions of access to and use of water resources are often overlooked in policy and programming despite their importance in shaping water security. This study examines factors affecting water security in urban Pakistan through a gender lens. We surveyed 560 men and women in two towns in Islamabad and Rawalpindi facing water and sanitation challenges. Through a binary logit model and marginal effects analysis, we analyzed the relationship between water security and multiple variables, including gender, education, age, employment status, payment for water, urban wealth quintile, drinking water source, individual water concern level, water satisfaction, and water quality perception. While more than 50 percent of both genders experience water insecurity, the prevalence of water insecurity is notably higher among women. Men in the surveyed population had higher levels of employment, wealth, and education levels compared to women. The regression analysis across both genders reveals that paying for drinking water negatively and significantly impacts water security, while concern about future water issues, satisfaction with drinking water, and water quality significantly and positively impact water security levels. For women specifically, access to improved drinking water sources, higher education levels, and employment significantly improve their water security level, underscoring the importance of promoting women's education and economic empowerment. For men, age and wealth levels emerged as significant factors impacting their water security, with older men more vulnerable to water insecurity than younger men and women. These findings underscore the complex interplay of individual, social, and structural dynamics shaping water security experiences, emphasizing the need for gender-responsive and intersectional approaches to water interventions in urban Pakistan and beyond. Equitable water policies and programs necessitate the collection of more disaggregated data. This study marks the first application of the Individual Water Insecurity Experiences (IWISE) Scale used in Pakistan's urban context, with recommendations for its broader implementation to improve decision-making that can lead to sustainable water solutions across diverse gender and social groups.