Search

Abstract Allergic rhinitis is an inflammatory disorder affecting nasal mucosa in response to allergen exposure and is commonly assessed and managed in family medicine. In this article, we review new international guidelines on the diagnosis and management of allergic rhinitis and generate evidence‐informed recommendations for family medicine doctors.

Abstract In the rapidly growing Internet of Things (IoT) landscape, federated learning (FL) plays a crucial role in enhancing the performance of heterogeneous edge computing environments due to its scalability, robustness, and low energy consumption. However, one of the major challenges in such environments is the efficient selection of edge nodes and the optimization of resource allocation, especially in dynamic and resource-constrained settings. To address this, we propose a novel architecture called Multi-Edge Clustered and Edge AI Heterogeneous Federated Learning (MEC-AI HetFL), which leverages multi-edge clustering and AI-driven node communication. This architecture enables edge AI nodes to collaborate, dynamically selecting significant nodes and optimizing global learning tasks with low complexity. Compared to existing solutions like EdgeFed, FedSA, FedMP, and H-DDPG, MEC-AI HetFL improves resource allocation, quality score, and learning accuracy, offering up to 5 times better performance in heterogeneous and distributed environments. The solution is validated through simulations and network traffic tests, demonstrating its ability to address the key challenges in IoT edge computing deployments.

Abstract ENPP1 (ectonucleotide pyrophosphatase/phosphodiesterase 1) plays a critical role by converting extracellular ATP to AMP, generating extracellular PPi, a potential inhibitor of calcification. Pathogenic variants in the ENPP1 cause generalized arterial calcification of infancy (GACI [OMIM 208000]). GACI, is an ultra-rare disease characterized by early-onset calcification of large and medium-sized arteries, leading to severe cardiovascular complications such as heart failure, pulmonary stenosis (PS), hypertension, and more. In this study, we report a novel homozygous splice-site pathogenic variant in ENPP1 (NM_006208, c.2230 + 5G > A; p.Asp701Asnfs*2) residing in C-terminal nuclease-like domain (NLD) of ENPP1 protein in a Pakistani family diagnosed with severe valvular PS and mild right ventricular hypertrophy (RVH). cDNA assays confirmed the skipping of exon 21, and the splice product underwent nonsense-mediated decay. Functional studies on fibroblasts from the patient demonstrated increased calcification and decreased enzymatic activity of ENPP1, recapitulating the hallmarks of GACI. By combining genetic analysis with the in vitro study, we substantiate that ENPP1:c.2230 + 5G > A variant is pathogenic, underscoring its role in the development of GACI.

Background: Esophageal cancer (EC) remains a significant health challenge in South Asia, with poor prognosis despite advancements in diagnostics and treatment. Identifying and validating prognostic factors is essential for improving patient outcomes. Methods: A prospective study was conducted with 146 biopsy-confirmed EC patients at the Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan. Clinical and laboratory data were collected and analyzed using descriptive statistics, receiver operating characteristic (ROC) analysis, and the Chi-square test. Survival outcomes were assessed using Kaplan–Meier curves, log-rank tests, and Cox proportional hazard models for univariate and multivariate regression analyses, with statistical significance set at p ≤ 0.05. Results: Bivariate analysis showed significant associations of the neutrophil lymphocyte ratio (NLR) (p = 0.017), C-reactive protein to albumin ratio (CAR) (p = 0.033), red cell distribution width to platelet ratio (RPR) (p = 0.020), and systemic immune-Inflammation index (SII) (p = 0.009) with patient survival. Univariate analysis identified tumor length >10 cm (p = 0.016), T4 stage (p = 0.015), metastasis (p < 0.001), surgery not performed (p < 0.001), and SII (p = 0.022) as significant factors for survival, with higher SII linked to poorer overall survival (p = 0.020). Interestingly, in the multivariate model, only metastasis (p < 0.001) and surgery not performed (p = 0.011) remained significant. Conclusions: Immuno-inflammatory markers may be less pertinent prognostic factors for EC in the South Asian population.

OBJECTIVE: To identify outcomes of wound healing after using Plasma rich platelet therapy METHODOLOGY: A prospective cross-sectional study was conducted at ISRA University Hospital, Hyderabad, from July to December 2022, with a sample size of 50 and a non-probability sampling technique. Both genders aged 45 to 75 years, Diabetes mellitus type II, Chronic or Non-healing wounds/ulcers for 3 to 6 months, and Wound size 2cm to 6cm were included. Participants who were not willing to study, Patients on steroid and Anticoagulant therapy and Immunosuppressive drugs, Pregnant females, those with Cardiovascular Disorders, and Associated Lymphoedema were excluded. Data was analyzed by SPSS version 21. RESULTS: Fifty patients were enrolled after matching the inclusion and exclusion criteria. The age range was 40 years to 70 years. Thirty-one were males, and 19 were females. Co-morbid conditions included were diabetes mellitus type II and hypertension. The most common cause of lower limb ulcers was diabetic foot, and the most common site was the dorsum of the foot. 52% of patients had

Internships are widely recognized within higher education as a useful work-based learning (WBL) approach to enhance student employability. However, there remains a need to understand whether internships provide a developmental experience that includes higher-level (soft) skills such as self-responsibility, flexibility and innovation. Our study inductively analyses 154 undergraduate student-interns' reflective diaries over a 3-year period to explore the relationship between internship experience and the development of higher-level skills, or protean "meta-competencies." In the research, we find the interns' developed three meta-competencies that can broadly be categorized as "self-regulation," "self-awareness" and "self-direction." Our findings also highlight the role of socio-political dynamics of internship work in shaping students' experiences as an indicator of the changing world of work. The study has implications for higher education institutions (HEIs) and host organisations in adopting a WBL approach that supports interns with reflexive engagement with situated organizational practices and accessing (in)formal learning opportunities in the workplace. Our research, therefore, offers insights into a learner-centred WBL approach that contributes towards a more holistic internship/WBL experience that facilitates student interns in developing protean meta-competencies and graduate employability.