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Abstract Adoption of a health information system is always a challenge for hospitals. It is because most of the medical staff do not have enough skills to use the new technology and due to the sensitivity of medical data. These factors pose a challenge for the successful adoption of health information system in hospitals. The aim of this research is to find out the factors which influence the adoption of information systems in hospitals. The study investigated the impact of the Financial status of the Hospital; Perceived Usefulness and Perceived Ease of Use on the adoption of health information systems through a questionnaire survey. Data was collected from 602 healthcare workers from 20 hospitals through close-ended questionnaire in Pakistan, where the adoption of health information systems is very slow. PLS-SEM was used for the analysis. The findings show that the Financial status of the Hospital; Perceived Usefulness and Perceived Ease of Use have positive and significant role in the adoption of Health Information Systems. The finding also shows that hospital size moderates the relationship of Perceived ease of use and the adoption of health information systems and interestingly it does not moderate the relationship among perceived usefulness and financial strength toward the adoption of health information systems. The study concludes that perceived ease of use, perceived usefulness and financial strength are the main factors, necessary for the adoption of health information systems. The findings of the study have useful implications for policy makers, medical professionals to successfully adopt health information systems in hospitals. It also provides new avenues for researchers to explore other factors and test this framework in other countries.

Accurate evapotranspiration (ET) estimation is crucial for sustainable water management in the diverse and water-scarce Mediterranean region. This study compares three prominent models (Simulator of Terrestrial Ecohydrological Processes and Systems (STEPS), Soil-Canopy-Observation of Photosynthesis and Energy fluxes (SCOPE), and Two-Source Energy Balance (TSEB)) with established global datasets (Moderate Resolution Imaging Spectroradiometer 8-day global terrestrial product (MOD16A2), Global Land Evaporation Amsterdam Model (GLEAM), and TerraClimate) at multiple spatial and temporal scales and validates model outcomes with eddy covariance based ground measurements. Insufficient ground-based observations limit comprehensive model validation in the eastern Mediterranean part (Turkey and Balkans). The results reveal significant discrepancies among models and datasets, highlighting the challenges of capturing ET variability in this complex region. Differences are attributed to variations in ecosystem type, energy balance calculations, and water availability constraints. Ground validation shows that STEPS performs well in some French and Italian forests and crops sites but struggles with seasonal ET patterns in some locations. SCOPE mostly overestimates ET due to detailed radiation flux calculations and lacks accurate water limitation representation. TSEB faces challenges in capturing ET variations across different ecosystems at a coarser 10 km resolution. No single model and global dataset accurately represent ET across the entire region. Model performance varies by region and ecosystem. As GLEAM and TSEB excel in semi-arid Savannahs, STEPS and SCOPE are better in grasslands, croplands, and forests in few locations (5 out of 18 sites) which indicates these models need calibration for other locations and ecosystem types. Thus, a region-specific model calibration and validation, sensitive to extremely humid and arid conditions can improve ET estimation across the diverse Mediterranean region.

MicroRNAs (miRNAs) are small non-coding molecules that play a pivotal part in brain development and the processes of establishment and maintenance of dendrites and neurite outgrowth by modulating gene expression. Dysregulation of miRNAs has been linked with neurological disorders. Exogenous miRNAs are unstable in the plasma due to degradation by nucleases; hence, choosing a harmless and effective delivery mode is crucial in the quest for miRNA-based therapeutics to treat neurological disorders. This review aims to shed light on the emerging role of nanotechnology-based approaches using miRNAs to treat neurodegenerative disorders. Nanotechnology encompasses a broad spectrum of applications, one of which is its role in developing nanoscale drug delivery systems. Nanotechnology-based drug delivery systems have attracted the attention of researchers due to the superiority of this mode over conventional treatment systems in terms of their favorable attributes such as bio-compatibility, bio-degradability, extremely small size, and the ability to cross the blood-brain barrier. This review explores nanotechnology-based approaches using miRNAs highlighting the use of viral vectors as well as non-viral vectors (such as exosomes, liposome nanoparticles, gold and magnetic nanoparticles, dendrimer-based nanoparticles, polymeric nanoparticles) to treat neurodegenerative disorders.

Leukemoid Reaction (LR) signifies leukocytosis characterized by mature neutrophils. The incidence of LR is about 1 % among hospitalized patients. Mucormycosis is a rare, aggressive, fatal fungal infection that afflicts immune-compromised patients. This study discusses the case of concomitant leukemoid reaction and mucormycosis in a patient with severe COVID-19 infection.

Background: Effective contraceptive methods are necessary to control the exploding population of India for its socioeconomic development. Postpartum intra uterine contraceptive device (PPIUCD) has a huge potential as an effective contraceptive method. The increased institutional deliveries provide women an easy access to immediate PPIUCD services. Aim: To study acceptability rate of postpartum intrauterine contraceptive device among women attending government general hospital, Guntur. Materials and methods: This was a prospective observational study conducted in the department of Obstetrics and Gynaecology, Government General Hospital, Guntur, for a period of 6 months between 1st October 2020 to 31st March 2021. Subjects were antenatal women more than 34 weeks gestational age and women in their immediate postpartum period. 300 subjects were counseled regarding PPIUCD. Using validated questionnaire including age, education, parity, awareness of PPIUCD, willingness or refusal and reasons for willingness or refusal of PPIUCD were collected and data recorded. Acceptability was defined as the number of women who agreed and got PPIUCD inserted. Results: Out of 300 subjects counseled only 96 accepted PPIUCD insertion. Acceptability rate was found to be 32%. Acceptance was more in booked subjects (44.44%) and in subjects with prior knowledge of PPIUCD (80%). Husband’s refusal was the reason for refusal in 54.9%. Conclusion: Acceptability of PPIUCD was very poor in spite of PPIUCD being safe, effective and long acting with very few side effects. Proper counseling and awareness programs can increase acceptability of PPIUCD.

Background. The treatment of peripheral diabetic neuropathy is difficult to treat considering the pain is severe, long-lasting and does not respond to analgesics. Gabapentin has been recommended as the first line treatment for DPN but owing to cognitive dysfunction and other side effects the drug is discontinued. Recent studies suggest that oxcarbazepine; an antiepileptic drug has good-efficacy in management of DPN. This prospective, observational and comparative study was done to compare gabapentin and oxcarbazepine monotherapy in patient of DPN. Objectives. We assessed the efficacy of Oxcarbazepine monotherapy in terms of pain score, sleep score and quality of life and compared with gabapentin monotherapy. Methods. 100 patients with DPN or examinations suggesting DPN were divided into 2 groups to receive gabapentin 300- 1200 mg/day or Oxcarbazepine 300-600mg/day. Assessment of pain scores, sleep score and quality of life were done at different duration during the course of therapy. Results. Out of total subject selected, the maximum (46%) subjects were between age group 60-90 years and the least effected were (24%) between age group 50-59 years. Male were more prevalent with 57% when compared to females with 43%. Improvement in Sleep was seen on using Group II with p value (0.0005). However, the correlation of Pain and Quality of life with the treatment shows p –value 0.24, 0.31 and 0.27 respectively showing non-significance. Conclusion. The sleep improved statistically correlated in patients with DPN, but not with quality of life and pain as the calculated p value was (p= 0.24, 0.31 and 0.27) respectively. Findings of this study suggest that oxcarbazepine can be used as an alternative treatment owing to its similar analgesic efficacy and improvement in sleep.

Aims: In a cross-sectional study we aimed to assess the correlation between ultrasound transient elastography (TE), serum ferritin (SF), liver iron content (LIC) by magnetic resonance imaging (MRI) T2* along with the fibrosis-4 (FIB-4) score as a screening tool to detect significant liver fibrosis among chronically transfusion-dependent beta-thalassemia (TDT) patients. Methods: The study was conducted at a tertiary health center treating TDT patients. Transient elastography was performed within 3 months of Liver MRI T2* examinations at the radiology department. T-test for independent data or Mann-Whitney U test was used to analyze differences between groups and Spearman correlation with linear regression analysis were used to evaluate the correlation between TE liver stiffness measurements and Liver MRI T2* values along with SF levels. Results: In this study on 91 patients, the median age (IQR) of the subjects was 33 (9) years and body mass index was 23.8 (6.1) kg/m2. Median (IQR) TE by fibroscan, MRI T2*(3T), Liver iron concentration (LIC) by MRI Liver T2* and SF levels were 6.38 (2.6) kPa, 32.4 (18) milliseconds, 7(9) g/dry wt., and 1881 (2969) ng/mL, respectively. TE measurements correlated with LIC g/dry wt. (rS =0.39, p=0.0001) and with SF level (rS =0.43, P=0.001) but not with MRI T2* values (rS =-0.24; P=0.98). Conclusion: We observed that in transfusion dependent β thalassemia major patients there was a significant correlation with the TE measured by ultrasound transient elastography, and LIC by MRI as well as SF levels but not with the fibrosis-4 (FIB-4) score. Key Words: Serum ferritin; Fibrosis-4; Transfusion-dependent beta-thalassemia; Transient elastography; Magnetic resonance imaging

Pompe disease is a rare genetic neuromuscular disorder caused by acid α-glucosidase (GAA) deficiency resulting in lysosomal glycogen accumulation and progressive myopathy. Enzyme replacement therapy, the current standard of care, penetrates poorly into the skeletal muscles and the peripheral and central nervous system (CNS), risks recombinant enzyme immunogenicity, and requires high doses and frequent infusions. Lentiviral vector-mediated hematopoietic stem and progenitor cell (HSPC) gene therapy was investigated in a Pompe mouse model using a clinically relevant promoter driving nine engineered GAA coding sequences incorporating distinct peptide tags and codon optimizations. Vectors solely including glycosylation-independent lysosomal targeting tags enhanced secretion and improved reduction of glycogen, myofiber, and CNS vacuolation in key tissues, although GAA enzyme activity and protein was consistently lower compared with native GAA. Genetically modified microglial cells in brains were detected at low levels but provided robust phenotypic correction. Furthermore, an amino acid substitution introduced in the tag reduced insulin receptor-mediated signaling with no evidence of an effect on blood glucose levels in Pompe mice. This study demonstrated the therapeutic potential of lentiviral HSPC gene therapy exploiting optimized GAA tagged coding sequences to reverse Pompe disease pathology in a preclinical mouse model, providing promising vector candidates for further investigation.

The development of tooth is a highly complex procedure and mastered by specific genetic programs. Genetic alterations, environmental factors, and developmental timing can disturb the execution of these programs, and result in various dental anomalies like hypodontia/oligodontia, and supernumerary teeth, which are commonly seen in our clinical practice. Advances in molecular research enabled the identification of various genes involved in the pathogenesis of dental anomalies. In the near future, it will help provide a more accurate diagnosis and biological-based treatment for these anomalies. In this article, we present the molecular phenomenon of tooth development and the genetics of various dental anomalies.

Background. Though vaccines have been reported as highly efficacious in preventing severe COVID-19 disease, there is emerging data of severe infections, albeit a small number, in vaccinated individuals. We have conducted a retrospective observational study to assess the clinical characteristics, immunological response, and disease outcomes among the vaccinated and unvaccinated patients admitted to the ICU with severe COVID-19 disease. Methods. Study Design and Participants. We conducted a retrospective observational study in COVID ICU of a tertiary care hospital. Data were collected from the month of 1 April 2021 to 31 November 2021. All adult patients admitted to the ICU having severe COVID-19 disease were included in the study. Data were collected from the medical records database which included demographics, a clinical course in the ICU, laboratory and radiological parameters, and disease outcomes. In a subset of patients, cell-mediated immunity and S1S2-neutralising antibody assessment was done. Results. A total of 419 patients with severe COVID-19 were included in the study. Of the 419 patients, 90 (21.5%) were vaccinated, and 329 (78.5%) were unvaccinated. There was a significantly higher mortality in unvaccinated severe COVID 19 patients as compared to vaccinated severe COVID patients (46.2% vs 34.4%; P

Accurate evapotranspiration (ET) estimation is crucial for sustainable water management in the diverse and water-scarce Mediterranean region. This study compares three prominent models (Simulator of Terrestrial Ecohydrological Processes and Systems (STEPS), Soil-Canopy-Observation of Photosynthesis and Energy fluxes (SCOPE), and Two-Source Energy Balance (TSEB)) with established global datasets (Moderate Resolution Imaging Spectroradiometer 8-day global terrestrial product (MOD16A2), Global Land Evaporation Amsterdam Model (GLEAM), and TerraClimate) at multiple spatial and temporal scales and validates model outcomes with eddy covariance based ground measurements. Insufficient ground-based observations limit comprehensive model validation in the eastern Mediterranean part (Turkey and Balkans). The results reveal significant discrepancies among models and datasets, highlighting the challenges of capturing ET variability in this complex region. Differences are attributed to variations in ecosystem type, energy balance calculations, and water availability constraints. Ground validation shows that STEPS performs well in some French and Italian forests and crops sites but struggles with seasonal ET patterns in some locations. SCOPE mostly overestimates ET due to detailed radiation flux calculations and lacks accurate water limitation representation. TSEB faces challenges in capturing ET variations across different ecosystems at a coarser 10 km resolution. No single model and global dataset accurately represent ET across the entire region. Model performance varies by region and ecosystem. As GLEAM and TSEB excel in semi-arid Savannahs, STEPS and SCOPE are better in grasslands, croplands, and forests in few locations (5 out of 18 sites) which indicates these models need calibration for other locations and ecosystem types. Thus, a region-specific model calibration and validation, sensitive to extremely humid and arid conditions can improve ET estimation across the diverse Mediterranean region. [ABSTRACT FROM AUTHOR]

Chronic stable angina pectoris is the primary indication for ranolazine (RZ), an anti-anginal drug. The drug has an anti-ischemic action that is unaffected by either blood pressure or heart rate. Due to the first-pass effect, the drug has a reduced bioavailability of 35 to 50%. The study emphasized developing a novel transdermal drug delivery system of nanostructured lipid carriers (NLCs) for delivering RZ. Many pharmaceutical companies employ lipid nanoparticles as biocompatible carriers for medicinal, cosmetic, and biochemical uses. These carriers are appropriate for many applications, such as topical, transdermal, parenteral, pulmonary, and oral administration, because of the large variety of lipids and surfactants that are readily available for manufacturing. RZ NLCs were made using high-pressure homogenization. Statistical analysis was utilized to find the best formula by varying the concentrations of Precirol ATO 5 (X1), oleic acid (X2), and Tween 80 (X3). Variables such as entrapment effectiveness (EE) (Y1), particle size (Y2), polydispersity index (PDI) (Y3), and zeta potential (Y4) were tested. A variety of tests were performed on the new formulation to ascertain how well it would be absorbed in the body. These tests included in vivo absorption studies, skin permeability assessments, in vitro drug release assessments, and physicochemical analyses. The particle size of RZ-NLCs was shown to be very small (118.4 ± 5.94 nm), with improved EE (88.39 ± 3.1%) and low ZP and PDI (−41.91 ± 0.38 and 0.118 ± 0.028). SEM and TEM analysis confirmed the structure of the NLCs and showed a smooth, spherical surface. Improved RZ-NLCs were used to create NLC gel, which was then tested for elasticity both physically and rheologically. The formulation’s elasticity was investigated. Optimized RZ-NLCs and NLCG were found to have transdermal fluxes of 48.369 g/cm2/h and 38.383 g/cm2/h, respectively. These results showed that the transdermal delivery of RZ distribution through NLC’s transdermal gel had more significant potential. According to in vivo experiments, the drug’s bioavailability in Wistar rats increased when it was delivered through NLCs. The findings demonstrated that NLCs loaded with RZ successfully transported the RZ to the designated site with no interruptions and that a quadratic connection existed between the independent and dependent variables.