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Abstract This study aims to assess the efficacy of machine learning models in predicting solute concentration (C) distribution in a membrane separation process, using the input parameters which are spatial coordinates. Computational fluid dynamics (CFD) was employed with machine learning for simulation of process. The models evaluated include Kernel Ridge Regression (KRR), Radius nearest neighbor regression (RNN), K-nearest neighbors (KNN), LASSO, and Multi-Layer Perceptron (MLP). Additionally, Harris Hawks Optimization (HHO) was utilized to fine-tune the hyperparameters of these models. Leading the way is the MLP model, which achieves a remarkable test R2 value of 0.98637 together with very low RMSE and MAE values. Strongness and generalization capacity are shown by its consistent performance on test and training datasets. To conclude, the effectiveness of using machine learning regression methods more especially, KRR, KNN, RNN, LASSO, and MLP in estimating concentration from spatial coordinates was demonstrated in this work. For separation science via membranes where predictive modeling of spatial data is essential, the results offer important new perspectives by developing hybrid model.

Objectives: The objective is to compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and ultrasound-guided (US-guided) shock wave lithotripsy (SWL) for the treatment of radiolucent lower pole calculi of 1–2 cm. Materials and Methods: This prospective randomized study was performed at our tertiary care urology institute of Benha University Hospitals; cases were randomized either to undergo RIRS (Group A) or US-guided SWL with a triple focus system (Group B). The safety and effectiveness of both therapies were compared using new criteria for stone-free rate (SFR): Grade A (absolutely stone free), Grade B (≤2 mm fragments), and Grade C (>2 mm up to 4 mm fragments), fluoroscopy time, operative time, auxiliary procedures, retreatment, and complications. Results: Out of 100 patients, 92 were eligible for this study. RIRS had a higher SFR of 88.9% compared to SWL, 72.3% (P = 0.045). Furthermore, stone-free classification significantly differed between the studied groups (P < 0.001), with Grade A being significantly higher in Group A. Conversely, Grades B and C were lower in Group A. On the other hand, operative and fluoroscopy times were significantly reduced with SWL (P = 0.004 and < 0.001, respectively). While complications did not significantly differ between the two groups (P = 0.340), a significant distinction was observed in terms of the Clavien–Dindo classification. Conclusions: RIRS is an effective and safe option for treating radiolucent lower calyceal stones of ≤2 cm, with a greater SFR and lower need for auxiliary operations. However, Sono SWL is a cost-effective alternative that can achieve a comparable success rate after retreatment sessions.

Background: Evaluating ulnar variance (UV) and triangular fibrocartilage complex (TFCC) is crucial since they might have dual effects on the wrist structure and function. This study aims to assess some anthropometric measurements of the wrists of the Saudi population using MRI. Materials and methods: A cross-sectional retrospective study was conducted on 64 wrist normal MR images. Sociodemographic characteristics were retrieved and kept confidential. Image analysis was performed on Digital Imaging and Communications in Medicine files. UV and TFCC thickness and angle were measured in the same slice. Statistical analysis was conducted, and a significance

This study proposes a hierarchical automated methodology for detecting brain tumors in Magnetic Resonance Imaging (MRI), focusing on preprocessing images to improve quality and eliminate artifacts or noise. A modified Extreme Learning Machine is then used to diagnose brain tumors that are integrated with the Modified Sailfish optimizer to enhance its performance. The Modified Sailfish optimizer is a metaheuristic algorithm known for efficiently navigating optimization landscapes and enhancing convergence speed. Experiments were conducted using the “Whole Brain Atlas (WBA)” database, which contains annotated MRI images. The results showed superior efficiency in accurately detecting brain tumors from MRI images, demonstrating the potential of the method in enhancing accuracy and efficiency. The proposed method utilizes hierarchical methodology, preprocessing techniques, and optimization of the Extreme Learning Machine with the Modified Sailfish optimizer to improve accuracy rates and decrease the time needed for brain tumor diagnosis. The proposed method outperformed other methods in terms of accuracy, recall, specificity, precision, and F1 score in medical imaging diagnosis. It achieved the highest accuracy at 93.95 %, with End/End and CNN attaining high values of 89.24 % and 93.17 %, respectively. The method also achieved a perfect score of 100 % in recall, 91.38 % in specificity, and 75.64 % in F1 score. However, it is crucial to consider factors like computational complexity, dataset characteristics, and generalizability before evaluating the effectiveness of the method in medical imaging diagnosis. This approach has the potential to make substantial contributions to medical imaging and aid healthcare professionals in making prompt and precise treatment decisions for brain tumors.

Metal Matrix Composite (MCC) reveals considerably better properties, such as low density, high tensile strength, hardness, and good resistance to wear compared with every alloy or other metal. The current study concentrated upon the assessment of the properties of aluminum matrix composites (AMCs) synthesis with the Al-7075 as a matrix and the MSGNPs that sieved to (35 nm) at different weight fractions percentages as reinforcements using stir-casting method and compared with Al7075/B4C-WC nanocomposites. These experiments aim to select the appropriate type and percentage of reinforcement particles for producing Al-7075 composites with the best mechanical properties. The mechanical properties, as well as the metallurgical features for analyzing the microstructure and the distribution of (MSGNP, SiC-WC) into the composite alloy specimens, have been studied utilizing the mechanical tests and the Optical Microscopy (OM), Scanning Electron Microscope (SEM), Energy Dispersive Spectroscopy (EDS), and X-Ray Diffraction (XRD) SEM pictures. By reviewing the mechanical test results, they manifested that the value of the composite's ultimate strength was enhanced with the additive concentration of nanoglass. The maximum tensile strength was obtained for the sample comprising 4% MSGNP—the composite with 6 wt.% B4C and WC have the highest hardness value, which means the increase of the added composite material beyond 10% will decrease the hardness. The X-ray diffraction (XRD) examination results illustrate the various phases of the two-theta value-generated diffraction patterns for the Al-7075/MSGNP and Al-7075/B4C-WC workpieces materials. These examinations show that the matrix of Al and the clear glass are the two major composite constituents and contain B4C, WC, and aluminum matrix, which are consistent with what was shown by the optical microstructure of the composite. The Al-7075 microstructure analysis also demonstrated a virtuous metallic bonding between the particles of Al and the uniformly dispersed and transparent glass particles at the optimal addition of 8wt%. Such enhancement was ascribed to the reinforcement's sufficiency and the uniform dispersion of MSGNP. Therefore, the addition of 8 wt.% was chosen in the present work.

Anemia is a severe health issue that affects around one-third of the global population. Therefore, the present study aims to conduct a bibliometric analysis to investigate the research trends regarding advancements on iron formulations in treating iron deficiency anemia via oral or parenteral route. This study adopts thematic and bibliometric methods on existing research on novel iron formulations. It also provides perspective into the existing understanding on treatment strategies for iron deficiency anemia. This study is conducted on 543 papers on various ferrous and ferric formulations used in the treatment of iron deficiency anemia. The study period is from 1977 to 2022, and the papers are identified from the Scopus database. The bibliometric analysis was carried out using the R tool's Bibliometrix package. The study discusses performance analysis, including annual publications, geographic analysis, relevant affiliations, journal analysis, and citation analysis. In addition, the conceptual structure, including the co-occurrence network, thematic map, thematic evolution, intellectual structure highlighting co-citation analysis, and social structure depicting the collaboration network and collaboration world map, are presented. The results showed increased research on formulation strategies for the treatment of iron deficiency anemia from 2010 onwards. The top 5 contributing countries are the USA, Italy, India, Germany, and the UK, and peer-reviewed journals from the area of nutrition. The most trending areas of study are iron deficiency anemia in pregnancy, chronic kidney diseases, inflammatory bowel diseases, and various intravenous formulations used in its treatment. The authors from Europe collaborate the most with authors from other countries. The study concludes that a safer and more effective iron formulation is needed to reduce the prevalence of anemia. The findings of the study are helpful in advancing research on innovative formulations for treating iron deficiency anemia. The insights from the study are helpful to policymakers in designing specific health policies and investing more in research and development of novel formulations for the treatment of iron deficiency anemia.

A 316L stainless steel (SS) alloy was developed with 1, 3, and 5 vol% titanium (Ti) reinforcement using the powder injection molding route, representing a low-cost option for biomedical implants. The investigation encompassed 1300 °C, 1350 °C, and 1380 °C sintering temperatures to ascertain the optimal physical and mechanical properties. Both sintering temperature and Ti influenced sintered density, and Ti mitigated the deleterious effects of residual carbon. At higher sintering temperatures, carbon and silicon tended to migrate and accumulate at the brink of Ti, leading to the formation of intermetallic compounds and increased brittleness. Dispersed Ti particles within the 316L matrix acted as nucleation sites and enhanced solid solubility with improved density. An astounding 96.11 % sintered density was achieved at 3 vol% Ti sample sintered at 1380 °C. During the tensile test, 5 vol% Ti at 1380 °C exhibited a low modulus of 58.9 GPa, which is highly desirable for orthopedic implant application. The XRD, SEM, tensile test, and nano-indentation results collectively provide evidence of beta-titanium formation during the sintering process. Conversely, the sample incorporating 3 vol% titanium, sintered at 1380 °C, demonstrated a balanced performance, showcasing 432.94 ± 12.8 MPa ultimate tensile strength, 3.06 ± 0.17 % elongation, 74.2 GPa modulus, and 322 MPa and 423 MPa 0.2 % offset flexural and compressive yield strengths, respectively. Notably, an improvised wear resistance test underscored its aptitude for sliding wear resistance, solidifying its potential as a promising candidate for biomedical implants.

Benefits achieved by the biodegradable magnesium (Mg) and zinc (Zn) implants could be suppressed due to the invasion of infectious microbial, common bacteria, and fungi. Postoperative medications and the antibacterial properties of pure Mg and Zn are insufficient against biofilm and antibiotic-resistant bacteria, bringing osteomyelitis, necrosis, and even death. This study evaluates the antibacterial performance of biodegradable Mg and Zn alloys of different reinforcements, including silver (Ag), copper (Cu), lithium (Li), and gallium (Ga). Copper ions (Cu2+) can eradicate biofilms and antibiotic-resistant bacteria by extracting electrons from the cellular structure. Silver ion (Ag+) kills bacteria by creating bonds with the thiol group. Gallium ion (Ga3+) inhibits ferric ion (Fe3+) absorption, leading to nutrient deficiency and bacterial death. Nanoparticles and reactive oxygen species (ROS) can penetrate bacteria cell walls directly, develop bonds with receptors, and damage nucleotides. Antibacterial action depends on the alkali nature of metal ions and their degradation rate, which often causes cytotoxicity in living cells. Therefore, this review emphasizes the insight into degradation rate, antibacterial mechanism, and their consequent cytotoxicity and observes the correlation between antibacterial performance and oxidation number of metal ions.

Autoimmune hepatitis (AIH) is a common and debilitating pathology that has acute, subacute, and chronic presentation, requiring prompt diagnosis and early intervention. Several serologic markers are found to be associated with the pathogenesis and progression of autoimmune hepatitis, most notably antinuclear antibodies and anti-smooth muscle antibodies [Front Immunol. 2018;9:609]. In addition, AIH is also characterized by the elevation of gamma globulin levels, mainly immunoglobulin G (IgG) [World J Gastroenterol. 2015;21(1):60–83]. Although the literature has well established the presence of increased IgG levels in AIH, few studies have evaluated the subtypes of IgG and their differential levels associated with AIH. Here, we present a rare case of AIH that lacks the common serologic markers but instead reveals an elevation in IgG1 level. Our patient was subsequently placed on corticosteroids, and her symptoms quickly resolved. We intend to introduce this case to the medical community in the hope of aiding in the proper diagnosis and timely intervention of subsequent cases with similar presentations.

Maesa indica Roxb. Sweet is a shrub known for its richness in secondary metabolites. A callus culture protocol was established to enhance its chemical profile. Sixteen elicitation culture treatments were evaluated, and we confirmed that the treatment of 200 mg/L polyethylene glycol (4000) coupled with exposure to 30 W UV irradiation for 60 min (PEG4) resulted in the highest total phenolic and total flavonoid contents, which were 4.1 and 4.9 times those of the plant ethanolic extract and 4.9 and 4.8 times those of a control sample, respectively. The phenolic compounds in the different treatments were identified qualitatively and quantitatively using the LC-ESI-MS/MS-MRM technique. Molecular docking studies of the phenolic compounds were conducted using MOE software and revealed that rutin showed the highest binding affinity toward the anti-cancer target (p38α MAPK). The cytotoxicity of the ME and PEG 4 treatment was tested against colon, breast, prostate, lung, and liver cell lines using an MTT assay. The highest cytotoxic effect of PEG4 was against prostate cancer with an IC50 value of 25.5 µg/mL. Hence, this study showed enhanced secondary metabolite accumulation and identified the phenolic compounds in the 16 treatments. The cytotoxicity assay highlighted the possible cytotoxic effect of the PEG4 treatment, and we recommend further investigations into its activity.

Background & Objectives: Methotrexate (MTX) is commonly used to manage psoriasis. The drug has erratic absorption characteristics and shows several complications. The present study uses different experimental models to evaluate the solid-lipid nanoparticles of MTX (SLN-MTX) for the anti-psoriatic effect. Methods: A prepared SLN-MTX formulation was used and its permeability studies were conducted on Wistar rat abdominal skin. The organ-level distribution of the drug in the formulation was tested in mice and the in-vitro anti-psoriatic activity was determined in CL-177; XB-2 keratinocytes cell lines. The efficacy of SLN-MTX formulation was compared with standard MTX and marketed MTX preparations. The results are analyzed statistically using the student’s t-test. Results: The data suggested that MTX from the formulation was slowly released and completely (80.36%) permeated through the skin. The flux and permeation data were found to be maximum for SLN-MTX compared to marketed and standard preparations. MTX in the formulation was found to be distributed more in the liver (67.5%) and kidney (2.34%). Further, SLN-MTX formulation showed dose-dependent inhibition on the growth of keratinocytes, and the cytotoxic concentration (CTC50) was found to be the least (518 mcg/ml). Interpretation & Conclusion: The findings suggested that MTX in solid-lipid nanoparticles could be a promising formulation for the management of psoriasis since the drug was slowly released, progressively inhibited the growth of keratinocytes, and distributed mostly in organs meant for elimination. More studies in this direction might establish the precise safety and efficacy of SLN-MTX formulation in psoriasis.

Simultaneous estimation of folic acid and methotrexate in bulk and tablet dosage form by RP-HPLC-PDA was conducted via Box‒Behnken design application. Three-factor numerical values were finalized from the graphical and numerical optimization with built-in ANOVA in BBD. Sharp and symmetric peaks were observed at 4.138 and 6.929 min for folic acid and methotrexate, respectively. The mobile phase composition was methanol and 0.1% formic acid in water with a ratio of 31:69 and a flow rate of 1.1 ml/min. Both drugs were detected at a wavelength of 291 nm. The developed method was validated according to ICH guidelines. The results of the validation parameters were within acceptable limits. Stress stability studies have been performed under acidic, alkali, oxidation, neutral and photolytic conditions. Three different brand-marketed tablets were assessed with the developed method (MGXT, FOLTNAX and TRUXOFOL). In the tablet formulations, chromatogram percentages of folic acid and methotrexate were calculated at 99.13% and 99.50 in MGXT, 99.17% and 99.47 in FOLTNAX, and 99.91 and 100.05 in TRUXOFOL.

Background/Aim: Bystander cardiopulmonary resuscitation (CPR) during out of-hospital cardiac arrest increases both survival rates and neurological recovery, but in Pakistan, an alarmingly low 2.3 % of these individuals receive bystander CPR. This study was designed to identify the reasons that affect the perception and willingness of the public toward bystander CPR training and performance in Lahore, Pakistan. Methods: A CPR master trainer from the USA visited various organisations from 1 December 2022 to 31 January 2023, to conduct training sessions. Before and after the training, a questionnaire was distributed among respondents to fill in. The subjects were asked to answer questions about their perception and willingness to perform bystander CPR. Results: Out of 401 participants, 240 completed the survey, with a response rate of 59.85 %. The majority of them were males [146 (60.8 %)], 215 (89.6 %) were below the age of 40, 107 (44.6 %) were graduated, 182 (75.8 %) never participated in any CPR training, mainly due to their ignorance towards the importance of bystander CPR (52.8 %) and 152 (63.3 %) were eager to participate in the CPR training course. Furthermore, the leading problem in providing bystander CPR was lack of technique or fear of possible harm that can be proved fatal (48.8 %), followed by concerns related to involvement in any legal procedure (10.0 %). Conclusions: Bystander CPR is still uncommon in Pakistan. Participants were reluctant to perform bystander CPR because of various concerns and fears. Lack of proper skill and causing additional harm were the main reasons associated with this. Hence, while improving CPR training and public education, these findings must be considered.

Kenaf mat/epoxy composite possesses low mechanical properties. The investigation examined the hybridization impact on the mechanical performance of kenaf mat/carbon/epoxy and kenaf mat/glass/epoxy hybrid composites. Pure and hybrid composites were fabricated using the vacuum-assisted resin infusion method. Density, tensile, flexural, interlaminar shear, and fracture toughness (Mode II) properties were tested according to the ASTM standards. The results showed that density increased around 10% for kenaf mat/carbon/epoxy hybrid and 29% for kenaf mat/glass/epoxy hybrid compared to pure kenaf mat/epoxy composites. Kenaf mat/carbon/epoxy hybrid composites displayed approximately 529%, 497%, 512%, 1055%, 272%, and 443% improvement in the tensile strength, tensile modulus, flexural strength, flexural modulus, interlaminar shear strength (ILSS), and fracture toughness, respectively, compared to the pure kenaf mat/epoxy composite. Kenaf mat/glass/epoxy hybrid composites displayed approximately 467%, 275%, 405%, 413%, 232%, and 366% improvement in the tensile strength, tensile modulus, flexural strength, flexural modulus, ILSS, and fracture toughness, respectively, compared to the pure kenaf mat/epoxy composite. Although the carbon fiber volume fraction was the lowest (17.23%) in hybrid kenaf mat/carbon/epoxy composites compared to glass fiber (24.83%) in hybrid kenaf mat/glass/epoxy composites, the tensile, flexural, and interlaminar shear performance was higher in hybrid kenaf mat/carbon/epoxy composites than hybrid kenaf mat/glass/epoxy composites.

Flax is the strongest natural fiber used as reinforcement for polymer-based composites due to its ecological properties, low specific gravity, renewability, biodegradability, recyclability besides its high mechanical properties. However, thermal properties of flax fibers depend on its chemical composition and structure, so it should be carefully controlled during the production process of composites, which affect the final product performance. A review of flax fiber-reinforced thermoset composites (FRTCs) and their hybrids is presented in the article, mainly focus on thermal performance, water absorption, and durability of the composites. The effects of filler materials hybridization and fiber’s chemical modification on the properties and performance of the FRTCs are also covered. Finally, key industrial applications and future possible research work based on the current understanding of FRTCs, and their hybrids also are addressed.

The increasing consumption of unregulated herbal and dietary supplements has presented clinicians with new challenges in assessing and managing acute liver injury. Patients may present in various ways ranging from asymptomatic transaminitis to acute liver failure. Several natural products have been found to mitigate drug-induced liver injury, which has led to the creation of numerous registries to outline all its aspects further. We describe the case of a 36-year-old female who developed a clinically significant acute liver injury with a cholestatic pattern due to an over-the-counter herbal liver detox tea. This is the first case reported of a hepatotoxic effect from any of these compounds or ingredients in the detox tea: burdock root, stinging nettle leaf, cleavers herb, dandelion root, lemon peel, and lemon myrtle leaf (Backhousia citriodora). Idiosyncratic drug-induced liver injury (DILI) remains poorly understood; however, recognizing potential toxins is imperative to understanding toxicogenomics and identifying those at risk.

Flax is a natural fiber that possesses excellent specific properties, low density, safe to handle, eco-friendly, and easily available. These make it exceedingly popular and a potential candidate to replace synthetic reinforcements in polymer composite applications. The thermoset polymer is used for structural application due to its excellent mechanical and interface bonding properties compared to the thermoplastic polymer. Flax-based thermoset polymer composites are becoming popular among researchers for advanced industrial applications. This article is intended to offer a review of the main results presented in the literature on flax fiber-based polymer composites, focusing the attention on the fiber structure, chemical arrangement, physical and mechanical properties. Then, the mechanical performance of pure and hybrid flax fiber reinforced epoxy or polyester composites is comprehensively analyzed.

Ex vivo expanded decidua-basalis(DB)-derived mesenchymal stem cells (MSCs) obtained from single donors have demonstrated therapeutic benefits in in vitro and in vivo studies. In this report, the intravenous and subcutaneous administration of DB-MSCs obtained from five healthy donors was assessed considering clinical grade proliferation, accessibility, and toxic effects in Wistar albino rats. The ability of the obtained DB-MSCs for differentiating, as well as their expression of several cell surface markers and immunomodulatory activities, were all assessed. Clinical standard proliferated cells were administered to animals intravenously and subcutaneously in a series of preclinical models in order to assess their in vivo toxicity, general safety, and tumorigenic possibilities. We established that DB cells exhibit structural and functional traits with MSCs. At various doses supplied intravenously or subcutaneously, the research showed no fatality, abnormal response to therapy, or substantial pathological modifications in the rats. Furthermore, there was no indication of prenatal damage in the same animal species when the rats were repeatedly treated with DBMSCs. Thus, DBMSCs were demonstrated to be non-toxic, non-teratogenic, and non-tumorigenic. To determine whether they can be administrated to human patients without risk, more investigation is recommended.

Maesa indica (Roxb.) Sweet is one of the well-known traditionally-used Indian plants. This plant is rich in secondary metabolites like phenolic acids, flavonoids, alkaloids, glycosides, saponins, and carbohydrates. It contains numerous therapeutically active compounds like palmitic acid, chrysophanol, glyceryl palmitate, stigmasterol, β-sitosterol, dodecane, maesaquinone, quercetin 3-rhaminoside, rutin, chlorogenic acid, catechin, quercetin, nitrendipine, 2,3-dihydroxypropyl octadeca-9,12-dienoate, kiritiquinon, and β-thujone. The Maesa indica plant has been reported to have many biological properties including antidiabetic, anticancer, anti-angiogenic, anti-leishmanial, antioxidant, radical scavenging, antibacterial, antiviral, and anti-coronavirus effects. One purpose of the current study was to investigate the leaves’ metabolome via Triple-Time-of-Flight-Liquid-Chromatography-Mass Spectrometry (T-TOF LC/MS/MS) to identify the chemical constituents of the Maesa indica ethanolic extract (ME). Another purpose of this study was to explore the protective effect of ME against potassium dichromate (PD)-induced pulmonary damage in rats. Rats were assigned randomly into four experimental groups. Two different doses of the plant extract, (25 and 50 mg/kg), were administered orally for seven consecutive days before PD instillation injection. Results of our study revealed that ME enhanced cellular redox status as it decreased lipid peroxidation marker, MDA and elevated reduced glutathione (GSH). In addition, ME upregulated the cytoprotective signaling pathway PI3K/AKT. Moreover, ME administration ameliorated histopathological anomalies induced by PD. Several identified metabolites, such as chlorogenic acid, quercetin, apigenin, kaempferol, luteolin, and rutin, had previously indicated lung-protective effects, possibly through an antioxidant effect and inhibition of oxidative stress and inflammatory mediators. In conclusion, our results indicated that ME possesses lung-protective effects, which may be the result of its antioxidant and anti-inflammatory properties.

OBJECTIVE: functional outcome of improvement after decompression for dorsal spine tuberculosis in terms of frankle grading. METHODOLOGY: This prospective study was conducted after ethical approval at neurosurgical ward mmc/mti through non-probability sampling. Clinical and radiological examined patients with carriers of dorsal spine tuberculosis were enrolled in study. After surgery they were followed for three months and improvement were measured comparing pre and post op Frankle grading. RESULTS: Total of 38 patients underwent surgical procedure decompression ± fusion through postero-lat approach (costotransversectomy) in which 42% were male and 58% were female. Mean age was 34±5. Distribution for age group was 18-30(08), 31-40(13), and 51-60 (06). Level of disease D4-D8 were 17(44.8%), D9-D12 were 21(55.2%). CONCLUSION: decompression and stabilization in spine tuberculosis is safe, effective and results in good outcome clinically. The advantages of surgery include through debridement, decompression and achievement of spinal stabilization. KEY WORDS: Dorsal spine tuberculosis, corpectomy with fusion, laminectomy, outcome measures

يهدف البحث إلى بيان مدى دور القيادة الاستراتيجية كمتغير مستقل في تحقيق الرشاقة التنظيمية كمتغير تابع. ذلك من أجل التوصل إلى أفضل السبل لتحقيق جوانب الرشاقة التنظيمية في كافة مفاصل ديوان محافظة الانبار، إذ تم اعتماد المنهج التحليلي الوصفي من أجل انجاز البحث الحالي، إذ تم الاختبار لعدد من الفرضيات الرئيسة والفرعية فيما يتعلق علاقات التأثير والارتباط، إذ تم التوصل إلى إجابات عن الأسئلة المتعلقة بمشكلة البحث، حيث تم اختيار عينة عمدية قصدية تمثلت بـ (60) شخصاً من القيادات العليا واصحاب القرار في ديوان محافظة الانبار، إذ تم الاعتماد على الاستبانة كأداة رئيسية في جمع المعلومات، وقد تم تحليل ومعالجة البيانات وفق برنامج (SPSS) الاحصائي، كما تم استخدام الوسائل المتمثلة بالانحراف المعياري والوسط الحسابي الموزون والأهمية النسبية ومعامل الارتباط لسبيرمان، أبرز الاستنتاجات التي توصل اليها الباحث هو حصول بعد اتخاذ القرار على الترتيب الأول من بين الأبعاد التي قيس بها (الرشاقة التنظيمية) ويدل ذلك على الاهتمام الواضح في صياغة اتخاذ القرارات وفق مبدأ المشاورة وعدم التفرد في اتخاذها , أما أبرز التوصيات هو زيادة الاهتمام برأس المال البشري من خلال اقامة الندوات والعمل على زيادة الالفة والتعاون بين أفرادها وزيادة مهاراتهم الابداعية والمعرفية.

Objective: To determine the frequency and antimicrobial susceptibility pattern of pathogens responsible for superadded bacterial infection in COVID-19 patients and correlate the association of these infections with serological markers. Study Design: Cross-sectional study. Place and Duration of study: Department of Pathology, Combined Military Hospital, Multan Pakistan, from Jan to Dec 2021. Methodology: A total of 290 patients having positive RT-PCR for SARS CoV-2 were included. All samples were processed per Clinical Laboratory Standard Institute (CLSI) protocols. API 20E and API 20NE were used for the identification of Gramnegative rods. Antimicrobial susceptibility testing was performed by the modified Kirby Bauer disc diffusion method.Serological markers, including C-reactive protein (CRP), total leucocyte count (TLC) and serum Ferritin, were determined and compared for significance in positive and negative culture cases. Results: A total of 75 patients had positive bacterial cultures. Among these, 42(56%) were blood culture, 26(35 %) were respiratory culture and 7(9%) were urine culture. Commonly isolated organisms were Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa, i.e., 23(31%), 20(27%), 13(17%), and 12(16%) respectively. CRP, TLC and S. ferritin were markedly raised in superadded bacterial infection compared to patients with COVID-19 infection only. Conclusion: The frequency of superadded bacterial infections in COVID-19 patients is high. The pathogens isolated in these cases were multidrug-resistant, reflecting mostly hospital-acquired flora. The association of serological markers in depicting superadded infection is statistically significant and may be used to screen for superadded bacterial infection in COVID-19 patients.

Objective: To determine the diagnostic accuracy of Colistin agar for detection of Colistin resistance in clinical isolates of MultiDrug Resistant Gram-Negative Bacilli. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Feb to Aug 2019. Methodology: A total of 100 Multi-Drug Resistant Gram-Negative Bacilli in clinical isolates were included. Isolates were identified using Gram stain, Catalase, Oxidase, API 20E, and API 20NE. After approval from the institutional ethical review committee, Colistin susceptibility was determined simultaneously by Colistin agar and Broth Micro Dilution Minimum Inhibitory Concentration method as per CLSI. For susceptibility criteria, EUCAST guidelines were followed. Results were validated with the gold standard test, i.e., Broth Micro Dilution. Results: Out of 100 Multi-Drug Resistant clinical isolates, the distribution was K. pneumoniae n=60, E.coli n=16, A. baumannii n=11, C. freundii n=8, and E. cloacae n=5. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of Colistin agar for detection of Colistin resistance, keeping Broth Micro Dilution Minimum Inhibitory Concentration method as the gold standard was 96.67%, 97.14%, 93.55%, 98.55%, and 97%, respectively. Conclusion: Colistin agar has excellent diagnostic accuracy for the detection of colistin resistance with standardized inoculum density. Due to its ease of use, cost-effectiveness, and accurate results, it can be used in lab setups deficient in manpower and advanced equipment for Broth Micro Dilution or genetic sequencing.

Background: Range of techniques have been described in traditional prosthodontics to establish Vertical dimension of occlusion (VDO). Experienced clinicians agree that there is no one single method, which is universally accepted record VDO precisely and consistently. Many facial and body landmarks have been proposed in the literature correlating to the VDO. Presence of so many methods to determine VDO further leads to confusion in the minds of clinicians. There is always a need for a research to both substantiate the findings in the literature and check reliability of such correlations in local population. Such correlation between the anthropological measurements and VDO would give clinician an evidence based approach to establish VDO during prosthetic rehabilitation. Hence this study was planned to check reliability of various anthropometric measurements in measuring VDO in a cross section of Saudi population. Material and method: Total of 500 subjects selected for the study following an inclusion and exclusion criteria. Anthropological readings such as Index finger, Little finger, Thumb finger, Distance between Inner canthus of left eye to outer canthus of right eye and Outer canthus of the right eye to corner of mouth (rima oris) were recorded using digital Vernier caliper. The data were analyzed statistically. Results: Strong positive correlation was observed between VDO and anthropological landmarks selected in the study. Pearson’s correlation test showed VDO in males has strong coefficient correlation with Index finger (r = 0.7341) and in females strong coefficient correlation with Little finger. (r = 0.5827). Conclusion: In Saudi Males, VDO could be correlated to the index finger measurements followed by Thumb finger. In Saudi females subjects, VDO correlated with little finger measurements followed by outer canthus of the eye to corner of the mouth reading. It is always appropriate to use one or more methods to approximate the measurements of VDO initially and then use the other methods to test the appropriateness of the dimensions initially established.

Objective: To determine the diagnostic accuracy of PANBIO COVID-19 rapid antigen method in nasopharyngeal swab, for screening of COVID-19 infection in emergency cases. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Multan, from Jan to Mar 2021. Methodology: After taking approval from institutional ethical review committee, total 1539 patients were included in this study according to sample size. With informed consent, nasopharyngeal swab specimens were taken for PANBIO COVID-19 rapid antigen method from each patient presenting as emergency medical/surgical case to Combined Military Hospital Multan as well as for Polymerase Chain Reaction for SARS CoV-2 RNA. PANBIO COVID-19 rapid antigen method and polymerase chain reaction for SARS CoV-2 RNA were performed simultaneously on swabs. Polymerase chain reaction for SARS CoV-2 RNA was considered to be the gold standard for comparison with the PANBIO COVID-19 rapid antigen method. Results: A total of 21 patients had SARS CoV-2 RNA detected by polymerase chain reaction indicating COVID-19 infection. Out of polymerase chain reaction positive patients, PANBIO™ COVID-19 Ag test was able to detect 19 cases. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy was calculated and found to be 90.47%, 100%, 100%, 99.8% and 99.8% respectively. Conclusion: PANBIO™ COVID-19 rapid antigen method was found to have excellent diagnostic accuracy in detection of COVID-19 infection. It can provide as a good alternate test for screening of masses with a short turn around time of only 15 minutes.

Monkeypox is a viral illness endemic to African countries. 20 May 2022, W.H.O alarmed all countries on the outbreak of the monkeypox virus1. Symptoms include headache fever swollen lymph nodes lethargy and the development of rash. Two types of clades (strains) are found that is central and West African clades. A central clade is more infectious than a western clade. A western clade is self-limiting within 2-3 weeks with a case fatality rate of 1% while the central clade is a 10% fatality rate. Monkeypox virus causes monkeypox a zoonotic disease which belongs to the poxviridae family2 which is closely related to the smallpox virus. Indicated from historical data smallpox vaccination with vaccinia virus (orthopoxviral) was 85% protective against monkey pox3. Danish laboratory in 1958 discover the virus in monkeys from where its name monkey pox originates4. The first case was discovered in a 9-month baby for the first time in Congo in 19705. A previous systematic review of the summer of 2018 described the epidemiological outbreak of the monkeypox virus6. United Kingdom’s first case was presented on 16 May 24, 2022, after laboratory confirmation7. The incubation period of monkeypox ranges from 6-13 days with possible extension to 5-21 days. The illness consistently ends by 2-4 weeks. Smallpox vaccines provide adequate protection against the monkeypox virus. World health organization suggests that health workers who are treating or exposed to monkeypox patients or their laboratory samples be immunized against smallpox. Effective laboratory investigation is a significant measure for identification and management. PCR on multiple lesions from various sites can be utilized to diagnose the potential condition. It should be sent to the government public lab and the control & command center must be notified. Refrigerated (2-8c) samples should be sent within 5 days of collection. Sample of swab should be of nylon, polyester, or Dacron swab with plastic, wood, or thin aluminum shaft. International support for increased surveillance and detection is important for monkeypox cases for understanding the changing epidemiology of the resurging disease. In the current environment of pandemic threats, the public health importance should not be underestimated. Outside of African countries appearances of cases highlights the risk of geographical spread. Discontinuation of the smallpox vaccine has created a landscape for monkeypox. Government guidelines for emergency diseases should be used with proper notification of case reports to the directorate. Personal protection equipment with equipped labs should be provided. All children less than 12 should be vaccinated with smallpox vaccines. A combination of standard, contact, droplet and airborne precaution should be used. Place the patient in a single room with a portable HEPA filter or airborne infection isolation room. Staff from equipped laboratories should obtain samples from suspected/confirmed monkeypox virus infection. Appropriate personal protective equipment (PPE) should be provided and disposed of properly before leaving the room. Monitoring and tracing contact must be maintained and recorded. World health organization effective hand hygiene five moments should be performed by healthcare workers frequently. Use guidelines for correct containment and disposal of contaminated waste. Be care full always with the soiled laundry to avoid contact with lesion material and used PPE materials. Ensure procedures are in place for cleaning and disinfecting environmental surfaces in patient care zones. Always use the government of Pakistan’s national health guidelines for emergencies.

OBJECTIVES The aim of this study was to assess pregnancy induce diabetes and hypertension in medical doctors. METHODOLOGY This case-control study was conducted after approval by the ethics committee. A total of 72 physicians who were pregnant and diagnosed with pregnancies causing hypertension or diabetes participated in the study. Daily details of hourly blood glucose levels were recorded at the beginning and end of the day. Use SPSS version 24.0 to analyze the results. RESULTS Out of the 33 patients, 23 remained hypertensive at the end of the day, while 10 had normal hypertension at the beginning of the day. Hypotension appeared from the 39th day of which 24 of her ended high, 15 were normal and 10 were diet controlled. The maximum number of pregnancies was 40 in high-care controls and 32 in low-care controls. Out of 30(16) had high FBS at the beginning of the day and 17 of the 42 who had the highest at the end of the day had low FBS. The highest score of 17(42) was presented at the beginning of the day with low FBS and 17 at end of the day with a high ratio and high count of 42. CONCLUSION Health care is important for all patients, whether they are health workers or not. Daily Record helps patients and providers understand patient disease management and take appropriate action.

OBJECTIVES The aim was to find the difference between government and private hospitals at the Mardan secondary level for sehat sahulat card effect on patients for their selection of hospital, dates, and time issues for elective and emergency cases with department facilities. METHODOLOGY This quantitative cross-sectional study was conducted to see the difference between the government and private hospitals for sehat the sahulat program effect on patients. Patients care is important on both sides but to find out the difference where more work should be done to achieve universal global health under the Khyber Pakhtunkhwa government for the benefit of their people’s health. RESULTS Total patients 10112 visited District Head Quarter (DHQ) hospital from February 2021 to February 2022 while 5672 were in a private hospital in which the ratio for gynaecology was 19 % (854 pts. DHQ) and 31% (1652) private hospital. Medical admissions were 2224 (50%) for a government hospital and none for private while surgical admissions were 1379 (31%) for government and 2665 (50%) for private hospitals. The significant ratio for chi-sq was P

Objective: Diabetes mellitus is a metabolic syndrome that alters the composition of carbohydrates, proteins and fat content in the body due to decreased insulin secretion. This disrupts the insulin-signaling cascade, resulting in failure in the targeted tissues, such as insulin-stimulated glucose absorption muscle and fat. Natural products such as plants, which are rich in nutrient, offer a wide range of treatments for a number of diseases and infections including diabetes mellitus. Hence, this study investigates the anti-hyperglycemic efficacy of the methanolic leaves extract of Jatropha gossypifolia in experimental diabetic rats. Methods: Phytochemical constitution of J. gossypifolia showed tannin content to be significantly increased in methanolic extract and HPLC analysis also revealed phenolic derivative tannic acid to be main constitution. An intraperitoneal administration of 110 mg/kg body weight (b.w) nicotinamide and 45 mg/kg b.w. streptozotocin was provided to male Wistar albino rats, thus inducing diabetic. Diabetic induced rats treated with methanolic leaves extract of J. gossypifolia at the concentration between 100 and 50 mg/kg for 35 days. Periodic blood glucose level and body weight were measured. Methanolic extract influence was evaluated with q-PCR and western blot analysis on the cellular targets of insulin signaling cascades. Results: The results showed the decrease in blood glucose levels and increased serum insulin level in treated groups was significant (P

Plant secondary metabolites are key components for new, safe and effective drugs. Ethanolic extract of Maesa indica Roxb. Sweet (ME) aerial parts were used for biosynthesis of sustainable green zinc oxide nanoparticles (ZnO NPs) with an average particle size 6.80 ± 1.47 nm and zeta potential −19.7 mV. Both transmission electron microscopy and X-ray diffraction assay confirmed the hexagonal shape of ZnO NPs. Phenolic ingredients in ME were identified using LC-ESI-MS/MS-MRM revealing the identification of chlorogenic acid, gallic acid, caffeic acid, rutin, coumaric acid, vanillin, naringenin, quercetin, ellagic acid, 3.4-dihydroxybenzoic acid, methyl gallate, kaempferol, ferulic acid, syringic acid, and luteolin. The major compound was chlorogenic acid at concentration of 1803.84 μg/g. The antiviral activity of ME, ZnO NPs, and combination of ME with ZnO NPs against coronavirus 229E were investigated. ZnO NPs had superior antiviral effect against coronavirus 229E than ME while their combination showed the highest anti-coronavirus 229E effect, with 50% inhibition concentration (IC50) of 5.23 ± 0.18 µg/mL and 50% cytotoxic concentration (CC50) of 138.49 ± 0.26 µg/mL while the selectivity index (SI) was 26.47. The current study highlighted the possible novel anti-coronavirus 229E activity of green ZnO NPs synthesized from Maesa indica. More studies are needed to further investigate this antiviral activity to be utilized in future biomedical and environmental applications.

Mechanistic target of rapamycin (mTOR) is a protein kinase that regulates cellular growth, development, survival, and metabolism through integration of diverse extracellular and intracellular stimuli. Additionally, mTOR is involved in interplay of signalling pathways that regulate apoptosis and autophagy. In cells, mTOR is assembled into two complexes, mTORC1 and mTORC2. While mTORC1 is regulated by energy consumption, protein intake, mechanical stimuli, and growth factors, mTORC2 is regulated by insulin-like growth factor-1 receptor (IGF-1R), and epidermal growth factor receptor (EGFR). mTOR signalling pathways are considered the hallmark in cancer due to their dysregulation in approximately 70% of cancers. Through downstream regulators, ribosomal protein S6 kinase β-1 (S6K1) and eukaryotic translation initiation factor 4E binding protein 1 (4E-BP1), mTORC1 influences various anabolic and catabolic processes in the cell. In recent years, several mTOR inhibitors have been developed with the aim of treating different cancers. In this review, we will explore the current developments in the mTOR signalling pathway and its importance for being targeted by various inhibitors in anti-cancer therapeutics.

Diabetes mellitus is a major challenge for global health, and Bougainvillea spectabilis Willd. (B. spectabilis) is a widely used herbal remedy with diverse cultivars traditionally used for diabetes treatment. However, the comparative efficacy of these cultivars remains ambiguous. This study aimed to evaluate the D-pinitol content and DPPH radical-scavenging activity of methanolic leaves extracts of five B. spectabilis cultivars. Furthermore, the effects of these cultivars on various parameters, including blood glucose levels, oxidative stress markers, inflammatory cytokines, lipid profiles, liver enzymes, renal function markers, and histopathological changes, were assessed in STZ-induced diabetic rats after one month of oral daily treatment. All tested cultivars demonstrated significant improvements in the measured parameters, albeit to varying extents. Notably, the LOE cultivar, distinguished by its orange bracts, exhibited the highest efficacy, surpassing the effectiveness of glibenclamide, an antidiabetic medication, and displayed the highest concentration of D-pinitol. These findings underscore the importance of carefully selecting the appropriate B. spectabilis cultivar to maximize the antidiabetic efficacy, with a particular emphasis on the correlation between antidiabetic activity and D-pinitol concentrations.

Objective: To find out the underlying causes of chronic diarrhea in soldiers and how it differs from general population. Study Design: Prospective comparative study. Place and Duration of Study: Combined Military Hospital (CMH) Multan and Pak Emeritus Military Hospital (PEMH) Rawalpindi, from Dec 2017 to Jan 2020. Methodology: All soldiers in active service, having diarrhea more than 4 weeks in study and non-soldiers of the same age were included in the control group. There were inquired in details about the diarrhea symptoms and investigations carried out accordingly to find out the underlying cause. The two groups were compared to find out any differences. The data were analyzed by SPSS version 22. Results: Seventy one in study and 50 patients in control had their mean ages of 34.61 ± 8.35 and 32.42 ± 10.28 years. Mean duration of symptoms were 18 and 15 months in study and control groups respectively. Irritable Bowel Syndrome (IBS) was more common in both groups i.e. 14 (20%) and 20 (40%) in study and control groups respectively but frequency was more in second one. Seropositive celiac disease 13 (18.5%), seronegative villous atrophy 10 (14%) in study and Inflammatory Bowel Disease IBD 6 (12%) in control group were second most common conditions. Conclusions: Irritable bowel syndrome is common in this age group. Celiac and seronegative villous atrophy is second common conditions in the study group.

Infectious diseases caused by viruses and bacteria are a major public health concern worldwide, with the emergence of antibiotic resistance, biofilm-forming bacteria, viral epidemics, and the lack of effective antibacterial and antiviral agents exacerbating the problem. In an effort to search for new antimicrobial agents, this study aimed to screen antibacterial and antiviral activity of the total methanol extract and its various fractions of Pulicaria crispa (P. crispa) aerial parts. The P. crispa hexane fraction (HF) was found to have the strongest antibacterial effect against both Gram-positive and Gram-negative bacteria, including biofilm producers. The HF fraction reduced the expression levels of penicillin binding protein (PBP2A) and DNA gyrase B enzymes in Staphylococcus aureus and Pseudomonas aeruginosa, respectively. Additionally, the HF fraction displayed the most potent antiviral activity, especially against influenza A virus, affecting different stages of the virus lifecycle. Gas chromatography/mass spectrometry (GC/MS) analysis of the HF fraction identified 27 compounds, mainly belonging to the sterol class, with β-sitosterol, phytol, stigmasterol, and lupeol as the most abundant compounds. The in silico study revealed that these compounds were active against influenza A nucleoprotein and polymerase, PBP2A, and DNA gyrase B. Overall, this study provides valuable insights into the chemical composition and mechanism of action of the P. crispa HF fraction, which may lead to the development of more effective treatments for bacterial and viral infections.

Intrusion detection systems (IDS) play a crucial role in securing networks and identifying malicious activity. This is a critical problem in cyber security. In recent years, metaheuristic optimization algorithms and deep learning techniques have been applied to IDS to improve their accuracy and efficiency. Generally, optimization algorithms can be used to boost the performance of IDS models. Deep learning methods, such as convolutional neural networks, have also been used to improve the ability of IDS to detect and classify intrusions. In this paper, we propose a new IDS model based on the combination of deep learning and optimization methods. First, a feature extraction method based on CNNs is developed. Then, a new feature selection method is used based on a modified version of Growth Optimizer (GO), called MGO. We use the Whale Optimization Algorithm (WOA) to boost the search process of the GO. Extensive evaluation and comparisons have been conducted to assess the quality of the suggested method using public datasets of cloud and Internet of Things (IoT) environments. The applied techniques have shown promising results in identifying previously unknown attacks with high accuracy rates. The MGO performed better than several previous methods in all experimental comparisons.

Abstract Prostate cancer (PC) is the most prevalent type of cancer in men worldwide. In Saudi Arabia, the rate of PC is increasing annually. The sex steroid hormones androgens and their receptors have critical roles in PC development and progression. Additionally, apoptosis-related proteins such as heat-shock proteins are vital molecules in PC development. Steroid hormone-deprivation therapies remain the essential treatment for patients with metastatic PCs; however, acquired resistance to hormone deprivation and the transition to PC androgen independence is a major health obstacle. In this review, we aim to detail the roles of androgens, androgen receptors and sex steroid hormones in inducing apoptosis in PC.

OBJECTIVES: To determine outcome of fistula in ano after incision drainage of acute peri anal abscess. METHODOLOGY: This descriptive case series study was conducted after approval of the Ethical committee. A total of 154 patients were observed for a six-month duration. Pre-design proforma was used to collect data. An inclusive criterion was age between 18-50 years of both genders with acute perianal abscess with low-level fistula (submucosal and mucocutaneous) and high-level fistula (ischiorectal and pelvirectal). Exclusive criterion was observed in all admitted patients who include secondary abscess formation for example diabetes mellitus, tuberculosis, and carcinoma with any previous history of fistula in ano. The result was analyzed through the SPSS-24 version. RESULTS: Ratio 35 (22.72%) was obtained for age group 18-30, 49 (31.81%) for age group 31-40 and 70 (45.44%) were in age group 41-50. The mean age was 38.25 years with SD ±9.70. The ratio of Males 143 (92.85%) leads high to females 11 (7.15%). The fistula was found in 64 (41.55%) patients postoperative after incision drainage for perianal abscess. Among 64 patients, 54 (37.01%) were male and 7 (4.54%) females. 90 (58.44%) patients had no fistula postoperatively. Low-level 45 (29.22%) and 19 (12.33%) high-level fistula was found in patients. Among the low-level ratio, 40 were male and 5 were female. Similarly, in high-level fistula 17 were male and 2 were female. CONCLUSION: Fistula is more common in males than females. Low lying fistula leads the chart more than a high lying fistula. The incidence of anal fistula in our observed patient’s abscess was 41.55%.

Multi-morbidity is the presence of two or more long-term health conditions, including defined physical or mental health conditions, such as diabetes or schizophrenia. One of the regular and critical health cases is an elderly person with a multi-morbid health condition and special complications who lives alone. These patients are typically not familiar with advanced Information and Communications Technology (ICT), but they are comfortable using smart devices such as wearable watches and mobile phones. The use of ICT improves medical quality, promotes patient security and data security, lowers operational and administrative costs, and gives the people in charge to make informed decisions. Additionally, the use of ICT in healthcare practices greatly reduces human errors, enhances clinical outcomes, ramps up care coordination, boosts practice efficiencies, and helps in collecting data over time. The proposed research concept provides a natural technique to implement preventive health care innovative solutions since several health sensors are embedded in devices that autonomously monitor the patients' health conditions in real-time. This enhances the elder's limited ability to predict and respond to critical health situations. Autonomous monitoring can alert doctors and patients themselves of unexpected health conditions. Real-time monitoring, modeling, and predicting health conditions can trigger swift responses by doctors and health officials in case of emergencies. This study will use data science to stimulate discoveries and breakthroughs in the United Arab Emirates (UAE) and India, which will then be reproduced in other world areas to create major gains in health for people, communities, and populations.

This study was conducted to compare the response rate of Quetiapine and Haloperidol in patients with acute manic episodes. A total of 120 patients with acute episode of mania with baseline Young Mania Rating Scale (YMRS) of more than 20 were included and randomly allocated to either Quetiapine (Group A) or Haloperidol (Group B). Each patient was assessed at baseline. YMRS was administered at the start and at follow-up visit after six weeks. Comparison of response rate (>50% reduction in YMRS) was not statistically significant between the two groups (70% vs. 71.7%; p=0.410) after six weeks in acute manic episode. Quetiapine and Haloperidol emerged as equally effective pharmacological strategies for the treatment of bipolar mania. Quetiapine may be used as an alternative to conventional antipsychotics; Haloperidol can be used as replacement of Quetiapine as well, as it is of low cost. Key Words: Acute manic episode; Quetiapine; Haloperidol

Detection of mitotic tumor cells per tissue area is one of the critical markers of breast cancer prognosis. The aim of this paper is to develop a method for the automatic detection of mitotic figures from breast cancer histological slides using a partially supervised deep learning framework. Unlike the previous literature, which has focused on solving the problem of mitosis detection in the weakly annotated datasets using centroid pixel labels (weak labels) only without taking advantage of the available pixel-level labels (strong labels) of other datasets, in this paper, we design a novel partially supervised framework based on two parallel deep fully convolutional networks. One of them is trained using weak labels and the other is trained using strong labels, together with a weight transfer function. In the detection phase, we fuse the segmentation maps produced by the two networks to obtain the final mitosis detections. Our system exploits the available large sets of mitosis detection samples with mitosis centroid annotation, such as the 2014 ICPR dataset and the AMIDA13 dataset, and only a small set of samples with the annotation of all mitosis pixels, such as the 2012 ICPR dataset, to perform a more accurate mitosis detection on weakly labeled data. This enables us to outperform all previous mitosis detection systems by achieving F-scores of 0.575 and 0.698 on the 2014 ICPR dataset and the AMIDA13 dataset respectively.

Vehicles authentication, the integrity of messages exchanged, and privacy-preserving are essential features in vehicular ad hoc network (VANETs) security. Most of the previously proposed VANETs security solutions do not sufficiently satisfy the security and efficiency requirements. Besides, most of those solutions are heavily dependent on the system key and long-term sensitive data stored in an ideal tamper-proof device, which may not be practical or ideal for resource-constrained onboard units (OBUs), especially in the case of an unexpected cloning or physical attack. Therefore, a robust authentication solution should consider those security issues and the nature of resource-constrained nodes. To satisfy all these requirements, we propose a lightweight multi-factor authentication and privacy-preserving security solution for VANETs. It employs a combination of physically unclonable functions (PUF) and one-time dynamic pseudo-identities as authentication factors. Furthermore, it eliminates the heavy dependency on the system key by decentralising the wide precinct of the certificate authority (CA) into regional domains and achieves robust control of domains keys. A detailed analysis demonstrates that our scheme efficiently meets the VANETs security requirements, and offers more suitable communication and computation costs and features than existing schemes.

OBJECTIVES: To determine the frequency of complications following cataract surgery in diabetic patients admitted in the ophthalmology unit. METHODOLOGY: A prospective descriptive interventional case series study was conducted after approval of the ethical committee, from June 2017-June 2020 at the Ophthalmology department MTI-MMC. A total of 129 patients from either gender were enrolled in study. All the study patients went through detailed history and complete ocular examination. After necessary investigations, surgical procedure was carried out. Results were analyzed through the SPSS-24 version. RESULTS: Out of the total 129 eyes of the diabetic patients, fifty-nine (45.7%) were males and seventy (54.3%) were females with a ratio of 1:1.2. Uveitis leads the chart in complications found in twenty (15.50%) eyes while PODR being the least common found in only ten (7.75%) eyes. Worse visual acuity was observed in fourteen (10.85%) eyes. Striate keratopathy and posterior capsule opacification were found in sixteen (12.40%) and fifteen (11.62%) eyes respectively. Among the patients, 15.7% were having more than one complication during follow-up visits and eighty-eight (68.2%) eyes were found to have none complication. The age group 51-60 years observed frequent complications as compared to other groups. Similarly female gender (38.57%) has frequent complications as compared to males (2.7%). CONCLUSION: The study concludes Uveitis as the most common complication observed in 15.50% 0f the eyes while worse visual acuity (10.85%) and progression of diabetic retinopathy (7.75%) being the least common. Striate keratopathy was found in 12.40% while posterior capsule opacification in 11.62% of the eyes.

Protein loss enteropathy (PLE) is a complex disease process that can result in potentially fatal protein losses. Gastrointestinal protein losses usually arise from damage to the gastrointestinal mucosa or from lymphatic obstruction. The goal of management is to identify and treat the underlying causes and maintain normal serum protein levels. Here, we present a patient with diarrhea and generalized edema, with decreased serum albumin and gamma-globulin levels, concerning for protein loss enteropathy. He was ultimately found to be positive for HIV infection, and his stool alpha-1 antitrypsin levels were diagnostic of protein loss enteropathy. His endoscopic and histologic evaluation revealed gastric Epstein–Barr virus-encoded small RNA- (EBER-) positive lymphoma. Though gastrointestinal lymphomas are known to cause PLE, this will be the first documented case of EBER-positive gastric lymphoma presenting with PLE. We hope to bring awareness to this unique presentation to aid in expedient diagnosis and treatment to avoid delays in treatment and potentially fatal outcomes.

(1) Background: estragole is a monoterpene found in the essential oils of several aromatic plants, which can be used for several pharmacological activities. The aim of this study was to evaluate the antinociceptive effect of estragole (Es) and its β-cyclodextrins inclusion complex (Es/β-CD). (2) Methods: the effects of Es and Es/β-CD on the central nervous system (CNS) were evaluated through open field and rota-rod assays, and the antinociceptive effect in formalin models, abdominal writhing induced by acetic acid, hot plate, tail flick test and plantar mechanical hyperalgesia. (3) Results: Es and Es/β-CD showed no alterations on the CNS evaluated parameters and the results suggested there was an antinociceptive action in the formalin, abdominal writhing, hot plate, tail flick tests and plantar mechanical hyperalgesia, proposing the involvement of the nitric oxide, glutamatergic signaling pathways, cyclic guanosine monophosphate and vanilloid pathways. (4) Conclusion: the results suggest that Es and Es/β-CD have a promising antinociceptive potential as a possible alternative for the pharmacological treatment of pain, also showing that the encapsulation of Es in β-cyclodextrins probably improves its pharmacological properties, since the complexation process involves much lower amounts of the compound, contributing to better bioavailability and a lower probability of adverse effect development.

Oral cancer has a high mortality rate, which is mostly determined by the stage of the disease at the time of admission. Around half of all patients with oral cancer report with advanced illness. Hitherto, chemotherapy is preferred to treat oral cancer, but the emergence of resistance to anti-cancer drugs is likely to occur after a sequence of treatments. Curcumin is renowned for its anticancer potential but its marred water solubility and poor bioavailability limit its use in treating multidrug-resistant cancers. As part of this investigation, we prepared and characterized Curcumin nanomicelles (CUR-NMs) using DSPE-PEG-2000 and evaluated the anticancer properties of cisplatin-resistant cancer cell lines. The prepared CUR-NMs were sphere-shaped and unilamellar in structure, with a size of 32.60 ± 4.2 nm. CUR-NMs exhibited high entrapment efficiency (82.2%), entrapment content (147.96 µg/mL), and a mean zeta potential of −17.5ζ which is considered moderately stable. The cellular uptake and cytotoxicity studies revealed that CUR-NMs had significantly higher cytotoxicity and cellular uptake in cisplatin drug-resistant oral cancer cell lines and parental oral cancer cells compared to plain curcumin (CUR). The DAPI and FACS analysis corroborated a high percentage of apoptotic cells with CUR-NMs (31.14%) compared to neat CUR (19.72%) treatment. Conclusively, CUR-NMs can potentially be used as an alternative carrier system to improve the therapeutic effects of curcumin in the treatment of cisplatin-resistant human oral cancer.

OBJECTIVES: To determine the visual outcome of ocular trauma in patients admitted in the ophthalmology unit. METHODOLOGY: This descriptive cross sectional study was conducted after approval of ethical committee, from June 2017 till June 2019 at Ophthalmology Department, Medical Teaching Institution, Mardan Medical Complex, Mardan (MTI-MMC). A total of 501 patients of either gender having ocular trauma were enrolled in study. Following informed written consent, detailed history, ocular examination and investigations the surgical procedure was carried out. A pre-designed proforma was used to record the outcome along with demographics and type of trauma, which was analyzed using SPSS V-24.0. RESULTS: In a total of 501 patients the mean age of sample was 30.5±2.2. Among 501, males were 408 (81.44%) and female were 93 (18.56%) with ratio of 9:1. Ocular trauma was more common in age of

يهدف البحث تعرف فاعلية التعلم التفارغي في تنمية التفكير الاستدلالي لطالبات الصف الخامس الأدبي، لما له من أثر أي التعلم التفارغي في جعل الطالبات قادرات على الاستقراء والاستنتاج والتحليل والتفسير عند دراسة مادة قواعد اللغة العربية، مما يذلل من صعوبة المادة، وذلك من خلال تطبيق الخطوات الخمس للتعلم التفارغي بدءً من مرحلة المشكلة، ثم مرحلة المراجع، وبعدها العمليات العقلية، فالشبكة الدلالية، وآخراً الدلالات.

Background Globally, iron-deficiency anemia (IDA) remains a major health obstacle. This health condition has been identified in 47% of pre-school students (aged 0 to 5 years), 42% of pregnant females, and 30% of non-pregnant females (aged 15 to 50 years) worldwide according to the WHO. Environmental and genetic factors play a crucial role in the development of IDA; genetic testing has revealed the association of a number of polymorphisms with iron status and serum ferritin. Aim The current study aims to reveal the association of TMPRSS6 rs141312 and BMP2 rs235756 with the iron status of females in Saudi Arabia. Methods A cohort of 108 female university students aged 18–25 years was randomly selected to participate: 50 healthy and 58 classified as iron deficient. A 3–5 mL sample of blood was collected from each one and analyzed based on hematological and biochemical iron status followed by genotyping by PCR. Results The genotype distribution of TMPRSS6 rs141312 was 8% (TT), 88% (TC) and 4% (CC) in the healthy group compared with 3.45% (TT), 89.66% (TC) and 6.89% (CC) in the iron-deficient group (P = 0.492), an insignificant difference in the allelic distribution. The genotype distribution of BMP2 rs235756 was 8% (TT), 90% (TC) and 2% (CC) in the healthy group compared with 3.45% (TT), 82.76% (TC) and 13.79% (CC) in iron-deficient group (P = 0.050) and was significantly associated with decreased ferritin status (P = 0.050). In addition, TMPRSS6 rs141312 is significantly (PConclusion Our finding potentially helps in the early prediction of iron deficiency in females through the genetic testing.