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OBJECTIVE: To compare the frequency of vitamin D levels between cirrhotic and non-cirrhotic liver disease patients. METHODOLOGY: This retrospective comparative cross-sectional study compressed 296 diagnosed chronic liver disease patients who visited the Department of Gastroenterology at the Aga Khan University Hospital in Karachi, fulfilling the study inclusion criteria. Demographic and clinical characteristics such as age, sex, disease duration, etiology and severity of all patients were obtained. Cirrhotic status and vitamin D levels were noted. Data was analyzed on Statistical Package for Social Sciences (SPSS), Version 22. RESULTS: The mean age was 41.48+/-9.88 years, and the mean vitamin D level in chronic liver disease patients was 14.61+/-8.37 (ng/ml). In cirrhosis and non-cirrhosis patients, mean vitamin D levels were (12.97 vs 16.08; P: 0.001), respectively. Significantly reduced levels were observed in Cirrhotic patients. In cirrhotic patients, vitamin D deficiency was more prevalent than the non-cirrhotic group (80.7% vs 66%; P: 0.004); overall, 73% of chronic liver disease patients were diagnosed as vitamin D deficient. CONCLUSION: In chronic liver disease patients, liver cirrhosis increases the likelihood of vitamin D deficiency. Factors like young age, male sex, and etiology (hepatitis C virus) strongly correlate with vitamin D deficiency. Furthermore, patients with advanced liver disease are more prone to be vitamin D deficient.

AbstractStaphylococcus pseudintermedius is a significant bacterial pathogen that frequently colonizes different body sites and mucous membranes of pets. The objectives of the cross-sectional study were to estimate the prevalence, antimicrobial resistance pattern, and detection of diverse resistance as well as virulence genes of S. pseudintermedius in cats. A standard bacteriological method, species-specific gene and different antimicrobial resistance as well as virulence genes were confirmed by PCR assay. A total of 233 swab samples were collected from different body sites of 102 cats, among them 146 swabs from 73 healthy cats, and 87 from 29 diseased cats. Overall, prevalence of S. pseudintermedius in cats was 12.01%, while dermatitis and otitis affected cats were 26.08% and 33.33%, respectively. The highest antimicrobial resistance was observed against penicillin (96.42%) followed by streptomycin (85.71%) and erythromycin (78.57%). Moreover, 89.28% of S. pseudintermedius isolates exhibit multi-drug resistance (MDR) (≥ 3 classes’ antimicrobial resistant). In addition, 17.86% isolates harbored the mecA gene; thus, were classified as methicillin-resistant S. pseudintermedius (MRSP). Furthermore, the erythromycin resistance genes ermA and ermB were harbored by 25% and 10.71% of isolates, while 42.86% and 17.86% of isolates carried tetK and tetL (tetracycline resistance) genes, respectively. In virulence profiling, 32.14% (sea) and 10.71% (seb) of isolates were found positive for enterotoxin genes, whereas, the toxic shock syndrome toxin-1 (tst-1) gene and the Panton-Valentine leukocidin gene (pvl) were detected in 25% and 14.29% of isolates, respectively. To our knowledge, this is the first report of cats in Bangladesh for MDR S. pseudintermedius, MRSP, and their virulence profiling.

An effective government agropolicy should be balanced: To reduce the state budget pressure, it is important to reduce public spending and encourage farmers to use agricultural loans. Reducing public spending should not lead to a shortage in the agricultural market. The paper aims to substantiate the directions of government agropolicy transformation based on the optimal ratio of public expenditures and loans in the agrosector and the dependence of agroproduction dynamics on state financing. The research base is data from 10 countries with different income levels (World Bank), presented in FAOSTAT for 2004–2021. For each country, the optimal (determined by the structural modeling method) and actual proportions between state financing and lending in the agrosector are compared, adjusted for the agroproduction index. The modeling showed that the share of public funds should increase in Germany, Israel, Italy, and the UK and decrease in Azerbaijan and Georgia; the current proportion is optimal in the USA, Russia, Turkey, and Ukraine. Based on a panel regression model with fixed effects, the influence of the actual level of state agrofinancing on the FAO Production Indices of the main types of agroproducts was determined. It is the largest for crops, meat, and milk (a decrease in state funding by USD 1 million threatens to reduce the respective indices by 4.5, 3.47, and 3.79 points), medium for cereals and sugar crops (according to points 2.69 and 2.11), and the smallest for livestock and non-food products (by 1.53 and 0.001 points, respectively).

Objective: Pharmacogenomics plays an important role in drug metabolism. A stable anticoagulation is important for primary and secondary prevention of cardioembolic stroke and cerebral venous sinus thrombosis (CVST). We report the role of cytochrome P450 (CYP2C9*2/*3) and vitamin K epoxide reductase subunit 1 (VKORC1) genotypes and acquired causes in maintaining stability of anticoagulation following acenocoumarin in cardioembolic stroke and CVST. Methods: The study comprised 157 individuals with cardioembolic stroke and CVST who were on acenocoumarin. Their comorbidities, comedication, and dietary habits were noted. Prothrombin time and international normalized ratio (INR) were measured during follow-up, and the coagulation status was categorized as stable (>50% occasions in therapeutic range) and unstable (>50% below and above therapeutic range). Genotyping of VKORC1, CYP2C9*2, and CYP2C9*3 was done by polymerase chain reaction-restriction fragment length polymorphism. Bleeding and embolic complications were noted. The predictors of unstable INR were evaluated using multivariate analysis. Results: INR was stable in 47.8% and unstable in 52.2% of patients. Patients with mutant genotypes required low dose of acenocoumarin. The predictors of unstable INR were metallic valve (odds ratio [OR] 4.07, 95% confidence interval [CI] 1.23–13.49, P = 0.02), use of digoxin (OR 0.031, 95% CI 0.13–0.74, P = 0.09), proton pump inhibitor (OR 0.23, 95% CI 0.06–0.91, P = 0.037), sodium valproate (OR 0.22, 95% CI 0.05–0.85, P = 0.029), and CYP2C9*2 genotype (OR 5.57, 95% CI 1.19–26.06, P = 0.02). Conclusions: Variant genotypes of VKORC1, CYP2C9*2, and CYP2C9*3 required lower dose of acenocoumarin, and CYP2C9*2 was associated with unstable INR. Comedication is a modifiable risk factor that needs attention.

The purpose of this study is to investigate the potential anticarcinogenic effects of three phytochemicals, namely Alpha-pinene (AP), Gamma-terpinene (GT), and P-cymene (PC), on melanoma cells (A2058 cell line). Additionally, the study aims to explore the synergistic activities of these phytochemicals with Dacarbazine, a chemotherapy drug. To understand the molecular mechanism involved in apoptosis induction in the A-2058 cell line, it was used AO/EB staining for apoptosis detection and cell cycle analysis, monitored through flow cytometry. It also determined the mRNA expression levels of different apoptosis-regulatory genes, including p53, Bax, NF-kB, Bcl-2, Bcl-xl, and caspase-3. The antitumor activities of these phytochemicals and their combinations were investigated in a subcutaneous mouse tumor model. The tumor diameter was 21.4 ± 1.1 mm in the Dacarbazine treatment group and 42.4 ± 3.1 mm in the control group. The antitumoral activities of AP and PC in the tumor model were similar to those of Dacarbazine. On the other hand, GT exhibited remarkable antitumoral activity, with a 1.75-fold reduction in tumor diameter compared to the Dacarbazine group. When different combinations of phytochemicals and Dacarbazine were used, the GT plus Dacarbazine treatment group was found to have a 3.5-fold reduction in tumor diameter compared to the Dacarbazine group. The tumor diameters in the Dacarbazine, AP plus GT, GT plus Dacarbazine, and AP plus Dacarbazine treatment groups were 21.4 ± 1.1, 7.6 ± 2.2, 8.6 ± 0.5, and 6.2 ± 1.9 mm, respectively.

The aim of our study was to determine whether high flow oxygen therapy reduced the rate of endotracheal intubation and improve pulmonary outcome score. A total of 300 consecutive patients were enrolled in the study. The etiologies of acute respiratory failure were classified into trauma, lung diseases, fluid overload states and undifferentiated. Patients were randomized by block randomization method into two groups. First group received HFNC while the second received conventional oxygen therapy. Patients in both the groups were escalated to either NIV or invasive mechanical ventilator support if there were any signs of respiratory distress noted. Pulmonary outcome scoring done at 2 hours was designed to see if there was any improvement in patient’s condition in both the groups. SPSS (version 21.0, Illinois, Chicago) was used for the statistical analysis. The partial pressures of oxygen improved significantly in the HFNC group as compared to the COT group irrespective of the etiology. The partial pressures of CO2 on ABG were similar in both the groups until 12 hrs. However, pCO2 was earlier reduced in the HFNC group as compared to the COT group. Steady decrease in serum lactate levels were observed in HFNC group. The base deficit was corrected between 6-12 hours in patients of HFNC group which could not be seen in patients of COT group. There was a statistically significant difference noted at 12 and 24 hours between the two groups. The mean length of stay in HFNC group was around 4 days which was less compared to the length of hospital stay in COT which was an average of 7 days. The mortality in HFNC group was 4% and in COT group was 7.33% in our study. The study demonstrated that the use of HFNC in ED patients presenting with AHRF was associated with a greater reduction in need for escalation of ventilation requirements and improves pulmonary outcomes compared with standard oxygen therapy.

This study investigates the correlation between carbon dioxide (CO2) emissions, renewable energy consumption (REC), and the consumer price index (CPI) in Azerbaijan between 1995 and 2019. The research employs measurements of CO2 emissions in kilotons, renewable energy consumption as a proportion of total energy consumption, and the consumer price index using real values as of 2010. Various analytical techniques such as Johansen, DOLS, FMOLS, and CCR were applied to analyze the time series data. Additionally, the Granger causality test was employed to establish the causal relationship between the variables. The findings of the empirical analysis indicate that a 1% increase in CPI is associated with an average CO2 increase of 0.14%, whereas a 1% increase in REC is linked to an average CO2 decrease of 0.06%. The research suggests that improving state policies to promote alternative energy sources for energy consumption in Azerbaijan is necessary. Keywords: Consumer price index, Renewable energy, CO2 emissions, Environmental Kuznets curve, Cointegration. RESUMEN Este estudio investiga la correlación entre las emisiones de dióxido de carbono (CO2), el consumo de energía renovable (REC) y el índice de precios al consumidor (IPC) en Azerbaiyán entre 1995 y 2019. La investigación emplea mediciones de las emisiones de CO2 en kilotones, el consumo de energía renovable como proporción del consumo total de energía y el índice de precios al consumidor utilizando valores reales a partir de 2010. Se aplicaron diversas técnicas analíticas como Johansen, DOLS, FMOLS y CCR para analizar los datos de series de tiempo. Además, se empleó la prueba de causalidad de Granger para establecer la relación causal entre las variables. Los hallazgos del análisis empírico indican que un aumento del 1% en el IPC está asociado con un aumento promedio de CO2 del 0,14%, mientras que un aumento del 1% en REC está relacionado con una disminución promedio de CO2 del 0,06%. La investigación sugiere que es necesario mejorar las políticas estatales para promover fuentes de energía alternativas para el consumo de energía en Azerbaiyán. Palabras clave: Índice de precios al consumo, Energías renovables, Emisiones de CO2, Curva de Kuznets ambiental, Cointegración.

High resolution (HR) images consist of higher quality and more detail information in comparison to low-resolution images. But obtaining HR images entails higher costs and requires a larger workforce. The solution is using super-resolution (SR) images. Single image SR is the process of creating HR images from a single low-resolution image. Obtaining SR images from low-resolution images is a well-known problem in the domains of computer vision and image processing. Advancement in technology has given rise to many SR algorithms. The perceptual quality assessment of super-resolved images can be used to benchmark the techniques employed for image SR. In this work, a cascaded network-blind super-resolution image quality assessment (CN-BSRIQA) methodology is proposed. The proposed approach works under the cascaded architecture where a convolutional neural network (CNN) is cascaded with a deep belief network (DBN). CNN is employed as a shallow network in the proposed methodology to extract low-level information after partitioning the input image into patches. To assess the visual quality of the SR images, the features retrieved from CNN are incorporated into a DBN. Three databases are used to evaluate the performance of proposed CN-BSRIQA i.e., SR Quality Database (SRQD), SR Image Quality Database (SRID), and visual quality evaluation for super-resolved images (QADS). When compared to other state-of-the-art methodologies for assessing the visual quality of SR images, CN-BSRIQA outperforms them. For the perceptual quality assessment of SR images, the experimental results reveal that CNN-based techniques outperform techniques based on hand-crafted features. Furthermore, the shallow CNN proposed in the CN-BSRIQA can extract features that are content-independent i.e., they show better performance over cross-database evaluation in comparison to existing state-of-the-art techniques.

The Sub-tropical forests of Pinus roxburghii (chir pine) provide various ecosystem services and act as watershed for low lying regions. However, this species is prone to human induced fire primarily due to local communities' dependence for various resources exacerbated by the current dry conditions. The impact of fire across various vegetation layers and developmental stages has not been thoroughly studied. Bearing to this, the present study was conducted using composite burn index to assess the severity on various layers of vegetation and their long-term impact through a chronological approach. The impact of fire on 40 representative circular plots with a radius of 30 m, categorized into five forest strata: large and intermediate trees, seedlings/saplings, pole stage, shrubs, and soil were investigated and compared across four different time interval: unburnt (B0), burnt two years ago (B2), burnt five years ago (B5), and burnt 15 years ago (B15). The results were statistically proved using Kruskal–Wallis followed by Dunn's Post Hoc and Friedman test with the Holm correction in R Language. The study revealed significant variations in the average burn severity for each treatment, with shrubs having the highest average score of burn severity (average = 1.4) and soil showing the lowest (average = 0.408). The results of the Friedman test indicated non-uniform distribution of burn severity across different ecological treatments. This study is contributing significant insights into the effects of forest fires and their severity on different vegetation layers, which can be instrumental in devising and executing successful restoration strategies.

Background:Pancreatic cancer is a leading cause of cancer-related mortality worldwide with increasing global incidence. We previously reported the anticancer effect of Rhus coriaria ethanolic extract (RCE) in triple negative breast and colon cancer cells. Herein, we investigated the anticancer effect of RCE on human pancreatic cancer cells.Methods: Cell viability was measured using Cell Titer-Glo and staining of viable and dead cells based on differential permeability to two DNA binding dyes. Cell cycle distribution and annexin V staining was carried out in Muse cell analyzer. Protein level was determined by Western blot. Tumor growth was assessed by in ovo chick embryo chorioallantoic membrane assay.Results: We found that RCE significantly inhibited the viability and colony growth of pancreatic cancer cells (Panc-1, Mia-PaCa-2, S2-013, AsPC-1). The antiproliferative effects of RCE in pancreatic cancer cells (Panc-1 and Mia-PaCa-2) were mediated through induction of G1 cell cycle arrest, Beclin-1-independent autophagy, and apoptosis. RCE activated both the extrinsic and intrinsic pathways of apoptosis and regulated the Bax/Bcl-2 apoptotic switch. Mechanistically, we found that RCE inhibited the AKT/mTOR pathway, downstream of which, inactivation of the cell cycle regulator p70S6K and downregulation of the antiapoptotic protein survivin was observed. Additionally, we found that RCE-induced autophagy preceded apoptosis. Further, we confirmed the anticancer effect of RCE in a chick embryo xenograft model and found that RCE inhibited the growth of pancreatic cancer xenografts without affecting embryo survival.Conclusion: Collectively, our findings demonstrate that Rhus coriaria exerts potent anti-pancreatic cancer activity though cell cycle impairment, autophagy, and apoptosis, and is hence a promising source of anticancer phytochemicals.

Aims This audit assesses the adherence to and effectiveness of rapid tranquilization protocols in a tertiary care psychiatric facility in Pakistan, particularly focusing on the use of intramuscular (IM) haloperidol and promethazine. The evaluation also includes an analysis of how these practices align with the prescribed guidelines for managing psychiatric emergencies. Methods A comprehensive retrospective analysis of patient records from January to December 2023 was conducted. The focus was on assessing the sequence of interventions (de-escalation techniques, oral medication, IM administration), medication choices, adherence to protocol steps, and documentation of patient monitoring post-administration. Descriptive and inferential statistical methods were applied to analyze the data. Results Among 482 patient records: The primary diagnoses included schizophrenia (44%), bipolar disorder (29%), and severe depression with psychotic features (27%). IM haloperidol and promethazine were predominantly used, with 68% of cases bypassing oral medication or de-escalation attempts. Only 60% of cases showed adherence to the recommended protocol steps, including assessment for medical causes and optimization of regular prescriptions. In 12% of cases, a second injection was necessary, with the interval between injections undocumented in 15% of these cases. Vital monitoring post-administration was not recorded in 30% of cases. Medication unavailability was an issue in 8% of aggressive cases. Protocol deviations included the omission of recommended pre-treatments, such as ECG for haloperidol and the lack of alternative options like buccal midazolam or inhaled loxapine. Conclusion The audit reveals significant deviations from established guidelines in the rapid tranquilization process. The frequent omission of non-invasive interventions and the lack of consistent monitoring and documentation practices highlight areas needing immediate improvement. Training in de-escalation techniques, adherence to step-wise intervention protocols, and ensuring the availability of a range of medications are crucial. This study underscores the importance of aligning psychiatric emergency practices with established guidelines to ensure patient safety and effective treatment outcomes.

Aims This project evaluated the accuracy and evolution of psychiatric diagnoses in patients admitted through the Outpatient Department (OPD) and Emergency Room (ER) at Benazir Bhutto Hospital. It aimed to understand the factors contributing to diagnostic changes, especially the impact of comorbid conditions and interdisciplinary discussions. Methods Over an eight-month period, this study reviewed 200 patient records from the psychiatric department. It compared initial psychiatric diagnoses from OPD and ER admissions with final diagnoses at discharge. The evaluation examined the influence of ward round discussions, serial mental state examinations, and newly identified comorbid medical conditions, such as thyroid disorders and neurological issues, on diagnostic changes. Results Analysis showed that 38.2% of ER admissions had a revised diagnosis by discharge, compared with 22.5% from OPD. Initial diagnoses primarily included major depressive disorder (30.1%) and bipolar disorder (27.2%). By discharge, increases were observed in personality disorders (up by 18.3%) and substance use disorders (up by 14.7%). Comorbid medical conditions were newly diagnosed in 26.8% of patients. Factors influencing diagnostic changes included ward round discussions (57.3%), serial mental state examinations (40.2%), lab findings (33.5%), and medical/interdisciplinary consultations (29.6%). Conclusion The service evaluation at Benazir Bhutto Hospital reveals significant diagnostic evolution in psychiatric care, more pronounced in ER admissions. The identification of additional disorders and comorbid medical conditions highlights the necessity for comprehensive, ongoing psychiatric assessment. Lab findings and interdisciplinary consultations played a crucial role in refining diagnoses, suggesting the importance of an integrated care approach. Recommendations include improving initial diagnostic processes in ER settings and strengthening interdisciplinary communication to enhance accuracy in psychiatric diagnosis and patient treatment outcomes.

Objective: To evaluate Antithrombin III and Factor V Leiden mutation in stroke among young patients and its association with various socio-demographic aspects. Study Design: Cross-sectional study. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Dec 2020. Methodology: A total of 103 individuals, aged 18-65 years, with acute ischemic stroke were included. The diagnosis was confirmed using computed tomography/Magnetic Resonance Imaging Brain scan. Plasma AT III activity and Factor V Leiden mutation were analyzed using standard techniques. Various socio demographic features like age, gender, body mass index, smoking, deployment at High altitude (>10,000 feet), family history of stroke and hyperlipidemia were recorded and statistically analyzed. Results: Only two (1.9%) patients had AT III deficiency while one (0.9%) patient showed Factor V Leiden mutation. All patients were male. Working at high altitude, family history of stroke and tobacco smoking were related with the presence of low AT III levels (p-value

Municipal solid waste management is a major concern in developing economies, requiring collective international efforts to achieve carbon neutrality by diverting waste from disposal facilities. This study aims to highlight the importance of the waste sector as it has the potential to significantly contribute to climate change and its toxicity impact on the local ecosystem. Out of the total municipal solid waste generated, only 78 % is collected, either open dumped or thrown in sanitary landfills. The waste sector's ecological impact value is calculated for the Earth's regions, and it is very high at >50 % in Africa, Asia, Latin America and the Caribbean. This sectoral impact value is mainly responsible for greenhouse gas emissions and degradation of the local ecosystem health. Current business‒as‒usual practices attribute 3.42 % of global emissions to the waste sector. Various scenarios are developed based on waste diversion and related emissions modelling, and it is found that scenarios 3 and 4 will support the policymakers of the regions in attaining zero carbon footprints in the waste sector. Our findings conclude that cost-effective nature-based solutions will help low‒income countries reduce emissions from disposal sites and significantly improve the local ecosystem's health. Developed economies have established robust waste‒handling policies and implementation frameworks, and there is a need for collaboration and knowledge sharing with developing economies at the regional level to sustain the sector globally.

In Rhabdomyolysis, muscle releases its contents into blood that can cause Acute Kidney Injury. We reported a very rare case of rhabdomyolysis after Diclofenac intramuscular injection with super added gluteal abscess formation, eventually led to acute kidney injury.