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Early diagnosis of pulmonary artery hypertension (PAH) is diagnostically challenging given the extent of pulmonary vascular remodeling required to bring about clinical signs and symptoms. Exercise testing can be invaluable in this setting, as stressing the cardiopulmonary system may unmask early disease. This report describes a young patient with a positive family history of PAH in whom contemporaneous invasive cardiopulmonary exercise testing and surgical lung biopsy reveal the novel association between exercise pulmonary hypertension (ePH) and early histological changes of PAH. Exercise PH currently carries no pathological correlates which means the hemodynamic effects of early pulmonary vascular remodeling remain unknown. Following the recent proceedings from the World Symposium in Pulmonary Hypertension 2018, which broaden the hemodynamic definition of PAH, this report suggests an important association between ePH and early pulmonary vascular remodeling supporting a role for exercise hemodynamic evaluation in patients at increased familial risk of PAH.

This study presents a new efficient alternative procedure for the assessment of the well-stirred (ws) condition of a mode-stirred reverberation chamber (RC) using newly developed coupling transfer gain functions. Coupling transfer voltage and current gain functions of the RC environment are developed from the ABCD parameters of the measured two-port S parameters in an RC. The proposed procedure involves the determination of the frequency corresponding to the well-stirred operation ( f wso ) of RC through the assessment of RC EM-field distribution and checking of theindependent samples requirements for a particular stirred environment. The estimated f wso of the RC using proposed method provides a faster way for the determination of the over-modded condition of RC when the placement of the two-antennas in imperative in RC. The minimization of antenna loading facotr results in more accurate esitmation of fwso using proposed procedure than only transfer characteristics. [ABSTRACT FROM AUTHOR]

Phosphorus (P) availability is the major constrain in obtaining optimum crop yield in calcareous soils due to its precipitation as dicalcium and octacalcium phosphate by reacting with Ca+2 and Mg+2. Therefore, we explored the role of phosphate solubilizing bacteria (without and with PSB @ 2 kg ha−1) in optimizing maize yield and P availability from soluble and insoluble P sources applied @ of 100 kg P2O5 into calcareous soil. PSB inoculation significantly improved maize plant height (5.6%), 1,000 grain weight (11%), dry matter (7.5%), stover (10.8%) and grain yield (6.8%), plant P concentration (10.1%) and uptake (18.6%), extractable P (3.1%), agronomic (48%) and uptake (53%) P use efficiency over uninoculated plots. Phosphorus application significantly improved maize yield, soil health and agronomic P use efficiency (4.84 times over control); however, its impact was more pronounced when applied as 50% P each from farmyard manure (FYM) and single super phosphate (SSP). On the basis of overall performance, the sources were ranked as 50% FYM + 50% SSP >50% rock phosphate (RP) + 50% SSP > 100% SSP > 75% FYM + 25% SSP > 75% RP +25% SSP > 100% FYM > 100 RP > control. Interactively, a significant and maximum increased over absolute control in most of the soil and plant tested characteristics were observed when 100 kg P2O5 ha−1 was supplemented 50% each as FYM and SSP along with PSB inoculation which was followed by 50% P each as FYM and SSP demonstrating that PSB were effective in enhancing RP solubilization under calcareous soil. Maximum value cost ratio of 3.1 was observed for 50% P each as FYM and SSP + PSB which was similar to 100% P as FYM + PSB and 75% FYM+ 25% SSP + PSB. Therefore, in calcareous soil P shall be amended 50% each as organic and mineral sources with PSB for its efficient utilization and obtaining optimum yield of maize.

OBJECTIVE: To determine the changes in glaucoma prescriptions during a single visit in real-world situation at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. METHODS: This cross-sectional descriptive study was conducted at Glaucoma Department of Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan from September 1st, 2015 to February 29th, 2016 after the ethical approval. Of total 876 consecutive participants, 868 were included in the study. Complete ocular examination was carried out for each subject including intraocular pressure (IOP) by Goldmann, visual field and nerve fiber analysis if it was scheduled. Ocular and systemic co-morbidities as well as ocular surgeries were also noted. Number of topical medications including anti-glaucoma and other drugs were recorded before and after their visit. The changes in anti-glaucoma medications were then categorized as unchanged, changed, added or deleted. The results were analyzed via SPSS version-24. RESULTS: A total 1600 eyes of 868 patients were included in this study. Out of 868 patients, 507 (58.41%) were males and 291 (33.52%) were in 61-70 years age group. Majority of patients (n=680/868: 78.34%) had open-angle glaucoma. Out of 1600 eyes studied, 574 (35.87%) had moderate and 556 (34.75%) had severe stage of glaucomatous optic neuropathy. During single visit, glaucoma-related prescriptions were unchanged, changed, added and deleted in 618/868 (71.20%), 84/868 (9.68%), 95/868 (10.94%) & 71/868 (8.18%) patients respectively. In our study, 911/1600 (56.94%) eyes achieved target IOP ≤14 mmHg. CONCLUSION: In real-world situation, most of our glaucoma patients were stable and required no changes to their prescriptions in single visit.

Melatonin is a pleiotropic signaling molecule that reduces the adverse effects of abiotic stresses, and enhances the growth and physiological function of many plant species. Several recent studies have demonstrated the pivotal role of melatonin in plant functions, specifically its regulation of crop growth and yield. However, a comprehensive understanding of melatonin, which regulates crop growth and yield under abiotic stress conditions, is not yet available. This review focuses on the progress of research on the biosynthesis, distribution, and metabolism of melatonin, and its multiple complex functions in plants and its role in the mechanisms of metabolism regulation in plants grown under abiotic stresses. In this review, we focused on the pivotal role of melatonin in the enhancement of plant growth and regulation of crop yield, and elucidated its interactions with nitric oxide (NO) and auxin (IAA, indole-3-acetic acid) when plants are grown under various abiotic stresses. The present review revealed that the endogenousapplication of melatonin to plants, and its interactions with NO and IAA, enhanced plant growth and yield under various abiotic stresses. The interaction of melatonin with NO regulated plant morphophysiological and biochemical activities, mediated by the G protein-coupled receptor and synthesis genes. The interaction of melatonin with IAA enhanced plant growth and physiological function by increasing the levels of IAA, synthesis, and polar transport. Our aim was to provide a comprehensive review of the performance of melatonin under various abiotic stresses, and, therefore, further explicate the mechanisms that plant hormones use to regulate plant growth and yield under abiotic stresses.

OBJECTIVES: To determine the frequency of anastomotic leak in primary closure patients presenting with enteric perforation. METHODOLOGY: Through a Descriptive case series Study Design, 253 patients with the perforated ilium and subjected to primary closure were included and followed up post-operatively to determine the anastomosis leak. RESULTS: The mean age of our sample was 42.2 years with a standard deviation of 8.6 years. Out of 253 patients, 70.8% were males, and 29.2% females were. The mean BMI of the study sample was 24.6 + 2.2kg/m2. 61.3% of patients belonged to urban settings, 41.1% were from lower socioeconomic class, and 36.4% had a middle school level education. On follow up, the anastomotic leak was recorded in 18.2% of patients. CONCLUSION: Ileal perforation subjected to primary defect closure is the most performed surgery for treatment, with a significant number of patients developing the anastomosis leak. The frequency of anastomosis leaks is high, and other treatment strategies must be researched to reduce the burden of these complications.

OBJECTIVES: To compare the effect of intravitreal-bevacizumab (IVB) and intravitreal-triamcinolone (IVT) with IVB alone on visual acuity (VA) and central foveal thickness (CFT) in patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO). METHODS: This quasi-experimental study was conducted from June 2018 to December 2018 on patients with ME secondary to CRVO, admitted at Hayatabad Medical Complex, Peshawar, Pakistan. Out of thirty patients included in this study, fifteen were included in Group-A (received combination therapy IVT and IVB) and 15 in Group-B (received IVB alone). The subjects were followed up at 3rd and 6th month post-treatment and changes in VA (logMAR) and CFT were recorded at each visit. The comparative analyses of variables were carried out with-in the groups and between the groups. RESULTS: Mean age of patients was 60.93±4.38 years (group-A) and 60.73±3.67 years (group-B). Mean VA at baseline & 6th month was 0.87±0.09 & 0.32±0.06 in group-A as compared to 0.88±0.10 to 0.44±0.06 LogMAR units in group-B respectively (p

Objective: To determine the frequency of active and latent pulmonary tuberculosis in apparently healthy young patients having subtle nonspecific x-ray chest abnormalities picked up during medical fitness for foreign assignment. Study Design: Cross-sectional study. Place and Duration of Study: Pulmonology department, Pak Emirates Military Hospital Rawalpindi, from Mar 2018 to Sep 2018. Methodology: A total of 85 healthy young patients having subtle nonspecific x-ray chest findings and no previous history of tuberculosis treatment or exposure were selected. All these patients underwent qualitative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and Mantoux testing followed by high-resolution computed tomography (HRCT) chest. An induration >10mm was considered positive test. An erythrocyte sedimentation rate greater than 20mm fall after one hour was considered abnormal. Lastly bronchoscopy with endobronchial washings was carried out in all study participants and samples sent for MTB Gene X-pert, Acid-Fast Bacillus (AFB) stain and Mycobacterial Tuberculosis culture and sensitivity. Results: Mean age of the participants was 35.81 with SD ± 4.5 (age range 27-54). Most common finding reported on chest x-ray was apical pleural thickening which was observed in 44.7% (38 cases). The most common high-resolution computed tomography scan chest finding was also apical pleural thickening reported in 75.3% (64) of the participants. Microbiological evidence of tuberculosis was found in 9.4% (8/85 cases). Only 5 had abnormal erythrocyte sedimentation rate but none of them were found were positive for tuberculosis. Mantoux was positive in 23 of participants and 17 were labelled to be suffering from latent tuberculosis infection (LTBI)..........

Summary: Background: We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods: Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings: Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation: This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding: The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations: For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.

To determine association of clinico-radiological factors and radiological activity with diagnostic yield in sputum-smear negative tuberculosis (TB). Prospective observational study in Military Hospital Rawalpindi from July to December 2018. Adult patients having no contraindications to bronchoscopy were included. HIV positive patients and those on anti-tuberculosis therapy for more than one week were excluded. High-Resolution Computed tomography (HRCT) findings were classified based on active and inactive tuberculosis features. Washings were sent for Acid-Fast Bacillus (AFB) smear, GeneXpert assay and cultures. Out of 215 patients, 42.3% (91) were diagnosed with microbiological or histological evidence of TB. On univariate analysis, cavitation (p-value

Glaucoma is the leading cause of permanent and irreversible blindness. It has been estimated that in 2040, 111.8 million of the world’s population will be affected by glaucoma.1 The term "steroid responder" refers to those who have increased intraocular pressure (IOP) after taking steroids. Although the prevalence of steroid-induced glaucoma (SIG) is unclear, it is believed that among the general population, roughly 33% have moderate, while 4-6% have a high response of IOP elevation in response to steroids.2 SIG in youngsters is becoming a major public health concern.3 According to a study of pediatric glaucoma patients, SIG is responsible for 24 percent of all pediatric glaucoma cases.4 It accounts for 5.86 percent of all glaucoma patients in our country, which is a significant percentage.5 SIG causes irreversible blindness, which has far-reaching consequences for an individual's quality of life, family, and the healthcare system. Since Pakistan's healthcare system is not as advanced as that of other developed nations, preventing this disease is an alternate and effective strategy to reduce SIG-related blindness. Pediatric SIG prevention would not only save our health and human resources, but it will also enable patients to participate in the country's growth in their own right. To prevent SIG-related blindness, there are a few actions that can be taken. • Role of Ophthalmologist: If an ophthalmologist prescribes a topical steroid for an ocular problem, it is his or her responsibility to assess intraocular pressure (IOP), and perform a dilated fundus examination at 4–6 weeks.3 If the patient sees another ophthalmologist for a follow-up visit, the attending ophthalmologist should examine the patient's IOP and optic discs. • Role of Allied Health Personnel (AHP): Allied healthcare professionals, such as physician assistants, and nurse practitioners, frequently prescribe steroids. Raised IOP is one of these medications' most harmful adverse effects. As a result, it's crucial that the healthcare team keep track of the patient's eye. When a patient visits an AHP, the AHP should measure IOP which can be done with a non-contact tonometer (NCT) or a Goldmann applanation tonometer. If the IOP rises, the AHP should refer the patient to a glaucoma specialist or ophthalmologist for further management.6 • Role of the Pharmacist: Self-medication is on rise in Pakistan with a frequency of 80.9-92.1% among the medical students.7 Steroids should not be provided without a proper prescription, and they should only be given for the duration of the treatment. Steroid supply without a prescription is a major issue in our system, and the government should take proper measures to combat it. • Role of Physician: The unjustified and irrational use of steroids, particularly by general physicians in underdeveloped nations needs attention.3 If someone needs steroids for a non-ocular problem then the treating physician must involve an ophthalmologist in the patient care. Alternatively, the physician should use steroid-sparing agents in patients who are at high risk of developing glaucoma e.g. family history of glaucoma, high myopia, younger age, diabetes mellitus, or connective tissue disorders. • Patient Education: The patient should be informed about the risks of glaucoma caused by steroids. Patients who self-medicate with steroids are showing a lack of understanding of the illness.3 This behavior ought to be avoided. They should be discouraged from using steroids for longer than the doctor recommends. They should be warned that self-medication can lead to SIG-related blindness that is irreversible. In conclusion, if these preventive measures are not implemented promptly, we will see an increase in SIG-related blindness soon. Not only will our healthcare system be overburdened, but our country's economic growth would be slowed as well. The government bears primary responsibility for public health and for enacting measures that will boost the nation's productivity. To raise public awareness, the government and health authorities should bring this public health concern up at every opportunity, including through seminars, walks, talk shows, and newspaper advertisements. If they don’t act to prevent SIG-related blindness then who will?

Objective: To study the patterns of resistance to anti tuberculosis drugs in patients of drug resistant pulmonary tuberculosis. Study Design: Cross sectional analytical study. Place and Duration of Study: Department of Pulmonology, PEMH Rawalpindi from Jul 2016 to Dec 2017. Methodology: Four hundred and eighty eight (n=488) adult patients with suspected pulmonary tuberculosis based on clinical history or Chest X-ray findings suggestive of pulmonary TB were included in the study after full informed consent and using consecutive sampling. Patients were evaluated with examination of sputum or/and endobronchial washings for AFB smear, MTB GeneXpert/RIF assay and Culture for mycobacterium tuberculosis with drug susceptibility testing for first and second line anti TB drugs. Patients with resistance to any anti TB drug were classified as drug resistant tuberculosis cases and pattern of drug resistance documented. Results: Overall 74 patients were found to have drug resistant tuberculosis. Treatment naïve patients made up 48.6% of the drug resistant cases while 51.4% of the patients of drug resistant cases were previously treated cases. Among the drug resistant TB patients, 29 Patients (39.2% of the DR TB cases) were found to have MDR TB while 28 patients (37.8%) were found to have mono resistance tuberculosis. Resistance to INH was the commonest being present in 57 (77% of DR TB cases) patients which included 25 patients with mono INH resistance (89.3% of mono drug resistant cases). Fourteen patients (18.9% of DR TB) were found to have rifampicin resistance (RR-TB) on GeneXpert/RIF assay alone. Fluoroquinolone resistance was present in 22 patients (29.7% of the DR TB cases) while resistance to second line injectables was detected in three patients (4.1% of DR TB cases) including two patients diagnosed a XDR TB. Conclusion: Drug resistant pulmonary tuberculosis was frequent in previously treated as well as new patients of pulmonary tuberculosis. Drug susceptibility testing including molecular methods for detection of resistance to first line and second line drugs are essential for optimum management of these cases.

Objective: To determine diagnostic accuracy of GeneXpert Assay and compare it with smear microscopy for AFB in terms of sensitivity, specificity on bronchial washings/bronchoalveolar lavage samples in sputum smear negative suspected tuberculosis. Study Design: A prospective cross sectional analytical study. Place and Duration of Study: Pulmonology Department, Pak Emirates Military Hospital Rawalpindi, from Jul to Dec 2018. Materials and Methods: Patients older than 12 years with suspected sputum negative tuberculosis were included in the study. Bronchoscopy findings were noted, bronchoalveolar lavage fluid/bronchial washings were taken. Samples were sent for AFB smear; GeneXpert Assay and Cultures. Data was analyzed in SPSS version 23. Results: A total of 224 patients were included in the study. 151 (67.4%) were males and 73 (32.6%) females. Mean age was 48.25 ± SD 18.21. Flexible bronchoscopy was diagnostic for tuberculosis in overall 42.4% (95/224) cases. Smear microscopy for AFB was positive in 53 (23.7%) cases, GeneXpert in 82 (36.6%) cases, culture in 66 (29%) cases while 6 cases (2.7%) showed rifampicin resistance on GeneXpert RIF resistance assay. Sensitivity, specificity, PPV and NPV of smear microscopy were 69.6%, 95.5%, 86.7%, 88.3% respectively whereas for GeneXpert they were 86.36%, 84.1%, 69.5%. 93.66% respectively; when compared to culture considered as gold standard. GeneXpert assay activity had statistically significant (p-value

BackgroundCytokine release syndrome (CRS) plays a pivotal role in the pathophysiology and progression of Coronavirus disease-2019 (COVID-19). Therapeutic plasma exchange (TPE) by removing the pathogenic cytokines is hypothesized to dampen CRS.ObjectiveTo evaluate the outcomes of the patients with COVID-19 having CRS being treated with TPE compared to controls on the standard of care.MethodologyRetrospective propensity score-matched analysis in a single centre from 1st April to 31st July 2020. We retrospectively analyzed data of 280 hospitalized patients developing CRS initially. PSM was used to minimize bias from non-randomized treatment assignment. Using PSM 1:1, 90 patients were selected and assigned to 2 equal groups. Forced matching was done for disease severity, routine standard care and advanced supportive care. Many other Co-variates were matched. Primary outcome was 28 days overall survival. Secondary outcomes were duration of hospitalization, CRS resolution time and timing of viral clearance on Polymerase chain reaction testing.ResultsAfter PS-matching, the selected cohort had a median age of 60 years (range 32-73 in TPE, 37-75 in controls), p = 0.325 and all were males. Median symptoms duration was 7 days (range 3-22 days' TPE and 3-20 days controls), p = 0.266. Disease severity in both groups was 6 (6.6%) moderate, 40 (44.4%) severe and 44 (49%) critical. Overall, 28-day survival was significantly superior in the TPE group (91.1%), 95% CI 78.33-97.76; as compared to PS-matched controls (61.5%), 95% CI 51.29-78.76 (log rank 0.002), pConclusionAn earlier use of TPE was associated with improved overall survival, early CRS resolution and time to discharge compared to SOC for COVID-19 triggered CRS in this selected cohort of PS-matched male patients from one major hospital in Pakistan.

Objective To study the frequency of venous thromboembolism in hospitalised patients with COVID-19 and correlation with the D-dimers and thromboprophylaxis.Design Cross-sectional descriptive study.Place and duration of study Queen Elizabeth Hospital, 20 April 2020–13 May 2020.Patients and methods One hundred and seven (n=107) patients of PCR-confirmed COVID-19 pneumonia admitted to Queen Elizabeth Hospital, Birmingham, between 20 April 2020 and 13 May 2020 were included in the study using consecutive sampling. Data were collected using the Excel audit tool and included age, gender, weight, estimated eGFR, D-dimer values on admission, intensive care unit admission, presence of respiratory failure, imaging results for evaluation of venous thromboembolism (VTE) and anticoagulation received on admission. The data were entered in the SPSS (V.17) and were analysed. Data were summarised as means±SD, number or percentage as appropriate. A p value of less than 0.05 was considered significant.Results The frequency of VTE was found to be 11.2% in patients hospitalised with COVID-19 pneumonia. The mean D-dimers were 3322.24 ng/mL±9603 ng/mL with the values significantly higher for patients with VTE and those requiring intensive care unit admission. All of the seven patients (100%) with D-dimers value above 2000 ng/mL who underwent imaging were found to have VTE.Conclusion VTE is frequent in patients with COVID-19 pneumonia despite anticoagulation. A higher D-dimers value correlates well with the risk of VTE in these patients and further evaluation of such patients for VTE is necessary especially with D-dimers values above 2000 ng/mL.

Kenaf (Hibiscus cannabinus L.) is a fibrous crop, grown in tropical climate having huge biomass and can be a good candidate for the phytoremediation of different heavy metals. Consequently, the present study was conducted to explore morpho-physiological traits, photosynthetic pigments, gaseous exchange attributes, antioxidative response and phytoextraction of copper (Cu) in H. cannabinus grown under different levels of Cu i.e. 0 (control), 60, 120 and 180 µmol L−1 in Hoagland nutrient solution (pH 6.2). The results from the present study revealed that Cu toxicity reduced plant height, plant diameter, plant fresh weight, plant dry weight, photosynthetic pigments and gaseous exchange attributes compared to control. Moreover, excess Cu in the nutrient solution ameliorates contents of malondialdehyde (MDA), hydrogen peroxide (H2O2) and electrolyte leakage (EL) which showed that Cu induced oxidative damage in the roots and leaves of H. cannabinus. The oxidative stress which was induced by a high concentration of Cu in the nutrient solution is overcome by enzymatic activities of antioxidants which increased with the increase in Cu concentration, i.e. 60 and 120 µmol L−1, while the addition of Cu (180 µmol L−1) caused a reduction in the activities of superoxidase dismutase (SOD), peroxidase (POD), catalase (CAT) and ascorbate peroxidase (APX) in the roots and leaves of H. cannabinus. The results also demonstrated that an increase in Cu concentration in the nutrient solution causes an increase in Cu accumulation through roots, leaves and stems of H. cannabinus, although the highest Cu concentration was accumulated in roots while only a little transported to the above ground parts (leaves and stems) of the plants. All the values of bioaccumulation factor (BAF) and translocation factor (TF) were less than 1, which also indicated that a small quantity of Cu concentration is transported to the aboveground part of the plants. These findings suggested that phytotoxicity of Cu affected plant growth and biomass and increased ROS production while accumulation of Cu in different parts of plant proved that H. cannabinus is an ideal specie for phytoremediation of Cu when grown under Cu contaminated sites.

Topical timolol eyedrops are frequently used as medical treatment of glaucoma. They decrease the production of aqueous humor by blocking the beta adrenergic receptors of ciliary body. Although systemic absorption of eyedrops is negligible, still it can cause some serious side effects like bradycardia, heart block, bronchospasm, confusion and hypotension. We present a case who developed nightmares with use of topical beta-blockers. He was a chronic case of primary open angle glaucoma whose target intraocular pressure (IOP) couldn’t be achieved with latanoprost alone, the first line drug, so we put him on topical timolol twice daily dosage to further decrease the IOP. On his follow-up visit he complained about bad dreams since starting timolol eye drops. This case report will add to the list of already known other side effects of timolol usage in glaucoma patients.

Combined application of nitrogen (N), phosphorus (P), and potassium (K) is a valuable practice to improve the growth and physiological activities of cotton, especially during a boll setting. The main purpose of this research was to investigate the effects of the different combined ratios of nitrogen (N), phosphorus (P), and K (potassium) on morpho-physiological activities of Bacillus thuringiensis (Bt) cotton genotypes Siza 1 and Sikang 1 during the cotton boll development stage. A two-year (2016−2017) field experiment was performed in which the total amount of combined N, P, and K were applied at different levels, B1 = 150 N, 0 P2O5, and 0 K2O kg ha−1 (control), B2 = 150 N, 45 P2O5, and 90 K2O kg ha−1, B3 = 150 N, 90 P2O5, and 135 K2O kg ha−1, and B4 = 150 N, 135 P2O5, and 180 K2O kg ha−1. Results revealed that combined application of N, P, and K significantly increased boll length by 5.8% and 2.3%, fresh boll weight by 12.2% and 16.4%, dry lint weight by 15.2% and 1.7%, number of seeds boll−1 by 15.2% and 2.5% as well as dry boll shell weight by 11.0% and 4.9% as compared with the treatment without P and K (1:0:0) across two growing seasons. Furthermore, superoxide dismutase activity was improved by 2.3% and 15.6% and soluble protein by 5.1% and 14.1% as compared with the control, respectively. Our study indicated that combined application of N, P, and K at appropriate ratios enhanced morpho-physiological activities (boll length, boll width, boll weight, protein content, sugar content, and superoxide dismutase) of cotton during boll development and generally the ratio of 150:135:180 considerably performed best amongst all treatments during two growing seasons in this study.

Presents an abstract for the article "Fast-Track Referral for Colorectal Cancer: 3-Year Results," by R. English, J. Yousaf, J. Sheffield, S. T. Gore, P. Ewings, C. Royle, and R. H. Kennedy.

Retinopathy is a group of retinal disabilities that causes severe visual impairments or complete blindness. Due to the capability of optical coherence tomography to reveal early retinal abnormalities, many researchers have utilized it to develop autonomous retinal screening systems. However, to the best of our knowledge, most of these systems rely only on mathematical features, which might not be helpful to clinicians since they do not encompass the clinical manifestations of screening the underlying diseases. Such clinical manifestations are critically important to be considered within the autonomous screening systems to match the grading of ophthalmologists within the clinical settings. To overcome these limitations, we present a novel framework that exploits the fusion of vision language correlation between the retinal imagery and the set of clinical prompts to recognize the different types of retinal disabilities. The proposed framework is rigorously tested on six public datasets, where, across each dataset, the proposed framework outperformed state-of-the-art methods in various metrics. Moreover, the clinical significance of the proposed framework is also tested under strict blind testing experiments, where the proposed system achieved a statistically significant correlation coefficient of 0.9185 and 0.9529 with the two expert clinicians. These blind test experiments highlight the potential of the proposed framework to be deployed in the real world for accurate screening of retinal diseases.

Background and Objective: This paper proposes a fully automated and unsupervised stochastic segmentation approach using two-level joint Markov-Gibbs Random Field (MGRF) to detect the vascular system from retinal Optical Coherence Tomography Angiography (OCTA) images, which is a critical step in developing Computer-Aided Diagnosis (CAD) systems for detecting retinal diseases., Methods: Using a new probabilistic model based on a Linear Combination of Discrete Gaussian (LCDG), the first level models the appearance of OCTA images and their spatially smoothed images. The parameters of the LCDG model are estimated using a modified Expectation Maximization (EM) algorithm. The second level models the maps of OCTA images, including the vascular system and other retina tissues, using MGRF with analytically estimated parameters from the input images. The proposed segmentation approach employs modified self-organizing maps as a MAP-based optimizer maximizing the joint likelihood and handles the Joint MGRF model in a new, unsupervised way. This approach deviates from traditional stochastic optimization approaches and leverages non-linear optimization to achieve more accurate segmentation results., Results: The proposed segmentation framework is evaluated quantitatively on a dataset of 204 subjects. Achieving 0.92 ± 0.03 Dice similarity coefficient, 0.69 ± 0.25 95-percentile bidirectional Hausdorff distance, and 0.93 ± 0.03 accuracy, confirms the superior performance of the proposed approach., Conclusions: The conclusions drawn from the study highlight the superior performance of the proposed unsupervised and fully automated segmentation approach in detecting the vascular system from OCTA images. This approach not only deviates from traditional methods but also achieves more accurate segmentation results, demonstrating its potential in aiding the development of CAD systems for detecting retinal diseases., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This study presents a comprehensive genomic exploration, biochemical characterization, and the identification of antibiotic resistance and specialty genes of Pediococcus acidilactici BCB1H strain. The functional characterization, genetic makeup, biological activities, and other considerable parameters have been investigated in this study with a prime focus on antibiotic resistance and specialty gene profiles. The results of this study revealed the unique susceptibility patterns for antibiotic resistance and specialty genes. BCB1H had good in vitro probiotic properties, which survived well in simulated artificial gastrointestinal fluid, and exhibited acid and bile salt resistance. BCB1H didn't produce hemolysis and had certain antibiotic sensitivity, making it a relatively safe LAB strain. Simultaneously, it had good self-coagulation characteristics and antioxidant activity. The EPS produced by BCB1H also had certain antioxidant activity and hypoglycemic function. Moreover, the genome with a 42.4 % GC content and a size of roughly 1.92 million base pairs was analyzed in the genomic investigations. The genome annotation identified 192 subsystems and 1,895 genes, offering light on the metabolic pathways and functional categories found in BCB1H. The identification of specialty genes linked to the metabolism of carbohydrates, stress response, pathogenicity, and amino acids highlighted the strain's versatility and possible uses. This study establishes the groundwork for future investigations by highlighting the significance of using multiple strains to investigate genetic diversity and experimental validation of predicted genes. The results provide a roadmap for utilizing P. acidilactici BCB1H's genetic traits for industrial and medical applications, opening the door to real-world uses in industries including food technology and medicine., (© 2024 the author(s), published by De Gruyter, Berlin/Boston.)

As the population of Somaliland continues to grow rapidly, the demand for electricity is anticipated to rise exponentially over the next few decades. The provision of reliable and cost-effective electricity service is at the core of the economic and social development of Somaliland. Wind energy might offer a sustainable solution to the exceptionally high electricity prices. In this study, a techno-economic assessment of the wind energy potential in some parts of the western region of Somaliland is performed. Measured data of wind speed and wind direction for three sites around the capital city of Hargeisa are utilized to characterize the resource using Weibull distribution functions. Technical and economic performances of several commercial wind turbines are examined. Out of the three sites, Xumba Weyne stands out as the most favorable site for wind energy harnessing with average annual power and energy densities at 80 m hub height of 317 kW/m 2 and 2782 kWh/m 2 , respectively. Wind turbines installed in Xumba Weyne yielded the lowest levelized cost of electricity (LCOE) of not more than 0.07 $/kWh, shortest payback times (i.e., less than 7.2 years) with minimum return on investment (ROI) of approximately 150%., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Montmorillonite clay and agar are naturally occurring materials of significant importance in designing biocompatible materials tailored for applications in biotechnology and medicine. The introduction of magnetic properties has the potential to significantly boost their characteristics and expand their applications. In this study, we have successfully synthesized highly intercalated magnetic composites, incorporating magnetic iron oxide nanoparticles (MNPs), montmorillonite clay (MMT), and agar (AG), through a thermo-physicomechanical method. Three samples of MMT-AG with 2, 1.5, and 0.5% MNPs and three sample composites of MNPs-AG with 2, 1, and 0.5% MMT clay are prepared. The synthesized composites were characterized by SEM, XRD, TGA, DTA, and FTIR. SEM analysis revealed a uniform dispersion of MNPs and MMT in the composite. The XRD pattern confirmed the presence of MNPs in the composite site. The TGA and DTA results demonstrated improved thermal stability due to the MNP incorporation. FTIR spectra showed all of the constituents of agar, MNPs, and MMT clay. The swelling ratio was observed to range from 835% to 1739%. The swelling study indicated an increased hydrophobicity with the addition of MNPs to the composite. Antibacterial activities revealed a significant inhibition of Escherichia coli ( E. coli ) growth by ranging from 10 to 19 nm in the composite. The composite also exhibited a considerable antioxidant action, with IC50 values of 7.96, 46.55, and 57.58 μg/mL, and electrical properties just like conductors., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Ethmoidal dural arteriovenous fistulas are a rare entity accounting for 10 % of all dAVFs. 3-6 Haemorrhage occurs in up to 91 % of cases, which is a particularly high risk and warrants therapeutic intervention. 8-9 Endovascular treatment for these fistulas using the conventional detachable microcatheter technique is associated with certain limitations and risks; 8.3 % rate of incomplete obliteration and an 8.3 % rate of complications. Complications include reflux of liquid embolic agent, posterior ischaemic optic neuropathy, acute visual loss, and small subdural haematoma secondary to a micro-perforation. 8,10-12 We present our recent experience with the Scepter Mini Balloon Microcatheter for the endovascular treatment of ethmoidal dural arteriovenous fistulas in 3 patients, involving bilateral simultaneous inflation of the balloon. It demonstrates a novel application of this technology with good outcomes. It supports the use of this microcatheter in treating ethmoidal dural arteriovenous fistulas endovascularly, either as a first-line option or as an adjunct to surgery., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Breast cancer stands out as the most frequently identified malignancy, ranking as the fifth leading cause of global cancer-related deaths. The American College of Radiology (ACR) introduced the Breast Imaging Reporting and Data System (BI-RADS) as a standard terminology facilitating communication between radiologists and clinicians; however, an update is now imperative to encompass the latest imaging modalities developed subsequent to the 5th edition of BI-RADS. Within this review article, we provide a concise history of BI-RADS, delve into advanced mammography techniques, ultrasonography (US), magnetic resonance imaging (MRI), PET/CT images, and microwave breast imaging, and subsequently furnish comprehensive, updated insights into Molecular Breast Imaging (MBI), diagnostic imaging biomarkers, and the assessment of treatment responses. This endeavor aims to enhance radiologists' proficiency in catering to the personalized needs of breast cancer patients. Lastly, we explore the augmented benefits of artificial intelligence (AI), machine learning (ML), and deep learning (DL) applications in segmenting, detecting, and diagnosing breast cancer, as well as the early prediction of the response of tumors to neoadjuvant chemotherapy (NAC). By assimilating state-of-the-art computer algorithms capable of deciphering intricate imaging data and aiding radiologists in rendering precise and effective diagnoses, AI has profoundly revolutionized the landscape of breast cancer radiology. Its vast potential holds the promise of bolstering radiologists' capabilities and ameliorating patient outcomes in the realm of breast cancer management.

Autism spectrum disorder (ASD) is a wide range of diseases characterized by difficulties with social skills, repetitive activities, speech, and nonverbal communication. The Centers for Disease Control (CDC) estimates that 1 in 44 American children currently suffer from ASD. The current gold standard for ASD diagnosis is based on behavior observational tests by clinicians, which suffer from being subjective and time-consuming and afford only late detection (a child must have a mental age of at least two to apply for an observation report). Alternatively, brain imaging-more specifically, magnetic resonance imaging (MRI)-has proven its ability to assist in fast, objective, and early ASD diagnosis and detection. With the recent advances in artificial intelligence (AI) and machine learning (ML) techniques, sufficient tools have been developed for both automated ASD diagnosis and early detection. More recently, the development of deep learning (DL), a young subfield of AI based on artificial neural networks (ANNs), has successfully enabled the processing of brain MRI data with improved ASD diagnostic abilities. This survey focuses on the role of AI in autism diagnostics and detection based on two basic MRI modalities: diffusion tensor imaging (DTI) and functional MRI (fMRI). In addition, the survey outlines the basic findings of DTI and fMRI in autism. Furthermore, recent techniques for ASD detection using DTI and fMRI are summarized and discussed. Finally, emerging tendencies are described. The results of this study show how useful AI is for early, subjective ASD detection and diagnosis. More AI solutions that have the potential to be used in healthcare settings will be introduced in the future.

This study aimed to evaluate 2D magnetic flux leakage (MFL) signals (B x , B y ) in D19-size reinforcing steel with several defect conditions. The magnetic flux leakage data were collected from the defected and new specimens using an economically designed test setup incorporating permanent magnets. A two-dimensional finite element model was numerically simulated using COMSOL Multiphysics to validate the experimental tests. Based on the MFL signals (B x , B y ), this study also intended to improve the ability to analyze defect features such as width, depth, and area. Both the numerical and experimental results indicated a high cross-correlation with a median coefficient of 0.920 and a mean coefficient of 0.860. Using signal information to evaluate defect width, the x-component (B x ) bandwidth was found to increase with increasing defect width and the y-component (B y ) amplitude rise with increasing depth. In this two-dimensional MFL signal study, both parameters of the two-dimensional defects (width and depth) affected each other and could not be evaluated individually. The defect area was estimated from the overall variation in the signal amplitude of the magnetic flux leakage signals with the x-component (B x ). The defect areas showed a higher regression coefficient (R 2 = 0.9079) for the x-component (B x ) amplitude from the 3-axis sensor signal. It was determined that defect features are positively correlated with sensor signals.

Globally, renal cancer (RC) is the 10th most common cancer among men and women. The new era of artificial intelligence (AI) and radiomics have allowed the development of AI-based computer-aided diagnostic/prediction (AI-based CAD/CAP) systems, which have shown promise for the diagnosis of RC (i.e., subtyping, grading, and staging) and prediction of clinical outcomes at an early stage. This will absolutely help reduce diagnosis time, enhance diagnostic abilities, reduce invasiveness, and provide guidance for appropriate management procedures to avoid the burden of unresponsive treatment plans. This survey mainly has three primary aims. The first aim is to highlight the most recent technical diagnostic studies developed in the last decade, with their findings and limitations, that have taken the advantages of AI and radiomic markers derived from either computed tomography (CT) or magnetic resonance (MR) images to develop AI-based CAD systems for accurate diagnosis of renal tumors at an early stage. The second aim is to highlight the few studies that have utilized AI and radiomic markers, with their findings and limitations, to predict patients' clinical outcome/treatment response, including possible recurrence after treatment, overall survival, and progression-free survival in patients with renal tumors. The promising findings of the aforementioned studies motivated us to highlight the optimal AI-based radiomic makers that are correlated with the diagnosis of renal tumors and prediction/assessment of patients' clinical outcomes. Finally, we conclude with a discussion and possible future avenues for improving diagnostic and treatment prediction performance.

Introduction: Few studies have evaluated meningioma patients' longer-term health-related quality of life (HRQoL) following diagnosis and treatment, particularly in those with incidental, actively monitored tumours., Methods: A single-center, cross-sectional study was completed. Adult patients with surgically managed or actively monitored meningioma with more than five years of follow-up were included. The patient-reported outcome measures RAND SF-36, EORTC QLQ-C30 and QLQ-BN20 were used to evaluate HRQoL. HRQoL scores were compared to normative population data. Outcome determinants were evaluated using multivariate linear regression analysis., Results: 243 patient responses were analyzed, and the mean time from diagnosis was 9.8 years (range 5.0-40.3 years). Clinically relevant, statistically significant HRQoL impairments were identified across several SF-36 and QLQ-C30 domains. Increasing education level (β = 2.9, 95% CI 0.9 to 4.9), P = .004), employment (β = 7.7, 95% CI 2.2 to 13.1, P = .006) and absence of postoperative complications (β=-6.7, 95% CI -13.2 to (-)0.3, P = .041) were associated with a better QLQ-C30 summary score. Other tumour and treatment variables were not., Conclusion: This study highlights the longer-term disease burden of patients with meningioma nearly one decade after diagnosis or surgery. Patients with actively monitored meningioma have similar HRQoL to operated meningioma patients. Healthcare professionals should be mindful of HRQoL impairments and direct patients to sources of support as needed., (© 2022. The Author(s).)