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Background: During preclinical training, dental students take radiographs of acrylic (plastic) blocks containing extracted patient teeth. With the digitisation of medical records, a central archiving system was created to store and retrieve all x-ray images, regardless of whether they were images of teeth on acrylic blocks, or those from patients. In the early stage of the digitisation process, and due to the immaturity of the data management system, numerous images were mixed up and stored in random locations within a unified archiving system, including patient record files. Filtering out and expunging the undesired training images is imperative as manual searching for such images is problematic. Hence the aim of this stidy was to differentiate intraoral images from artificial images on acrylic blocks. Methods: An artificial intelligence (AI) solution to automatically differentiate between intraoral radiographs taken of patients and those taken of acrylic blocks was utilised in this study. The concept of transfer learning was applied to a dataset provided by a Dental Hospital. Results: An accuracy score, F1 score, and a recall score of 98.8%, 99.2%, and 100%, respectively, were achieved using a VGG16 pre-trained model. These results were more sensitive compared to those obtained initally using a baseline model with 96.5%, 97.5%, and 98.9% accuracy score, F1 score, and a recall score respectively. Conclusions: The proposed system using transfer learning was able to accurately identify “fake” radiographs images and distinguish them from the real intraoral images.

Abstract Background Obsidio conformable embolic (OCE, Boston Scientific, MA) is a novel, radiopaque and conformable embolic. The purpose of this report is to describe its use for treatment of acute intra-abdominal hemorrhages. Methods and results Three patients presented with acute hemorrhage and were treated with OCE, including post-paracentesis hemorrhage, penetrating trauma to the liver, and blunt trauma in the spleen. All cases were performed under moderate sedation, with hemostasis achieved by end of procedure using less than 1 vial of OCE (0.2-0.4 ml). No severe adverse events occurred. None required repeated treatment. Short conclusion OCE is a safe and effective embolic agent for treatment of intra-abdominal or visceral hemorrhage. Future studies with larger sample sizes and longer follow-up are warranted.

Abstract Background Truth-telling in health care is about providing patients with accurate information about their diagnoses and prognoses to enable them to make decisions that can benefit their overall health. Physicians worldwide, especially in the United Kingdom (U.K.) and the United States (U.S.), openly share such medical information. Bangladesh, however, is a Muslim-majority society with different social norms than Western societies. Therefore, we examined whether Muslim culture supports truth disclosure for patients, particularly how and to what extent medical information about life-threatening diseases is provided to patients in Bangladesh. Methods This was a phenomenological qualitative study. We conducted thirty in-depth interviews with clinicians, nurses, patients and their relatives at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. We also used observations to explore interactions between patients, families and healthcare professionals regarding their involvement in medical decisions and truth disclosure issues. NVivo software was used to identify common themes, and a thematic analysis method was utilised to analyse the datasets. Results This study identified three recurring themes relevant to the ethics and practice of truth disclosure: best interest rather than autonomy, the ambivalent value of deception and who understands what. The participants revealed that physicians often withhold fatal medical prognoses from terminally ill patients to ensure the best healthcare outcomes. The results indicate that deception towards patients is commonly accepted as a means of reducing burden and providing comfort. The participants opined that true medical information should be withheld from some patients, assuming that such disclosures may create a severe burden on them. Whether or to what extent medical information is disclosed primarily depends on a family’s wishes and preferences. Conclusions While truth disclosure to patients is considered an ethical norm in many cultures, such as in the U.K. and the U.S., the practice of concealing or partially revealing severe medical prognoses to patients is an actual medical practice in Bangladeshi society. This study emphasises the importance of recognising a patient’s active involvement and respecting the cultural values that shape family involvement in medical decision-making. These findings may have significant policy and practical implications for promoting patient autonomy within Bangladeshi family dynamics and religious-based cultural values.

The development and assessment of pharmaceutical dosage forms make considerable use of gamma-scintigraphy. Gamma scintigraphy is an imaging technique that is integrated with CT to assess and evaluate the targeting of drugs to various delivery sites, the impact of treatment, and the severity of the disease. A small number of radioisotopes were tagged with the delivery system and emitted radiation can be visualized by the gamma camera which forms a 2-D image displaying the tissue-specific distribution of radioactivity. The isotopes that are used widely include Technetium-99 m (99Tc), Iodine (131I), Fluorodeoxyglucose (18F-FDG), Fluoromisonidazole (18F-FMISO) and Gallium (Ga67), Indium (111In). This review mainly covers different applications of gamma scintigraphy for the assessment of drug targeting via different routes to different organs and their visualization by gamma scintigraphy. The review mainly focuses assessment of drug targeting in the tumor tissue, thyroid gland, brain, pulmonary pathway, skin deposition, detection of renal impairment as well as cardiac diseases, drug release from formulations, drug deposition in arthritis, drug retention in the scalp, and behavior of formulation when administered via intra-vaginal route. Various pre-clinical and clinical studies were included in the review that demonstrates the importance and future of gamma scintigraphy in sensing drug delivery.

Background: The coronary arteries, being the major vascular channels, are known to affect the complete circulatory system and hemodynamics of the body. However, as a matter of fact, the coronary arteries are known to have many anatomical and developmental variations along all the morphological aspects, which include location of orifices, various routes that the artery and its tributaries follow, and of course, the pattern of branching of the main artery. The developmental anomalies in the arterial structures result in abnormalities of arterial blood flow, hypoxia, and other conditions which may lead to atherosclerosis of the coronary artery. To the best of our knowledge, the current systematic review and meta-analysis aim to assess the association between variations in the branching pattern of the coronary artery. Moreover, we propose future studies to assess the association and preventive strategies for clinicians and various health-care workers. Methodology: We performed an electronic search of PubMed, MEDLINE, Cochrane Central Register, EMBASE, Science Citation Index, Web of Science, and Database of Abstracts of Reviews of Effects, and various clinical tribulation registries till 2022. Two independent reviewers extracted the data, and the present meta-analysis was performed with the help of RevMan version 5.4. For the present meta-analysis, we used 10-year database from 2012 to 2022. Results: Appropriate data were fetched from studies that were included for the meta-analysis, and the data were presented in tables for evaluation and drawing of accurate results. A total of 904 articles were found after searching all of the major medical databases. Thirteen more sources of reference were included in the search. After primary screening, full text articles of around 148 were analyzed, and among them, 114 were excluded because those articles were in the category of #case series, reports, or #letters to the editors, #animal studies or #irrelevant documents, reporting duplicate documents, or broadcasting a certain variant as opposed to occurrence. After the complete screening and analysis of the data were done, the final number of articles that were included in the meta-analysis was 29 (n = 29). Conclusion: The present meta-analysis is an attempt to review and analyze the recent literature published on the variation in anatomy and developmental abnormalities of the coronary arteries in the differing population across the geography of the globe. The structural aspects of the coronary arteries, and not just the lifestyle issues, are the ones which are associated with coronary artery disease (CAD), a major cause of mortality in the population. However, the anatomical factors are not attending limelight as other obesity- or age-related issues for the same. Hence, the present review aimed to deliver a thorough understanding of the most predominant branching pattern of the coronary artery seen among Asian population. This study will be beneficial to cardiologists and radiologists when performing various treatments such as coronary angiograms, coronary angioplasty, bypass grafting, and other medical procedures and can also lead to prevention of the CAD.

The rapid increase in plastic usage today poses a significant threat to our environment and the planet. It contributes to global warming and negatively impacts biodiversity. Most plastic ends up in landfills, where it can take up to 1000 years to decompose. Shockingly, only 9% of the plastic produced annually is recycled, while an astounding 2 million plastic bags are used every minute worldwide. This paper highlights the primary goal of plastic recycling, with a particular focus on using plastic to manufacture roof tiles. The motivation behind this approach is that everyone deserves a decent roof over their heads. To achieve this, a well-balanced mixture of waste polypropylene (PP), quartz sand, and fly ash minerals was utilized in producing plastic roof tiles. The research employed a hot press process to prepare samples of all composite materials, and no cracks or fractures were observed on the surface of these samples. The results of this innovative process exceed the standards set for most building materials in terms of both mechanical and thermal properties, demonstrating a compressive strength of 99.8 MPa, a flexural strength of 35.6 MPa, and an impact energy absorption of 7.93 KJ/m2. Importantly, all samples exhibited zero percent water absorption, making these roof tiles ideal for insulation purposes. Additionally, the resulting roof tiles are lightweight and cost-effective compared to conventional options.

Total knee arthroplasty (TKA) is a common surgery for osteoarthritis, with increasing prevalence expected in the near future. This systematic review and meta‐analysis compared the effectiveness of computerized TKA versus traditional TKA, focusing on postoperative outcomes measured by the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the Knee Society score (KSS). A search on PubMed and Cochrane databases on November 14, 2023 for retrospective randomized controlled trials (RCTs) yielded data on WOMAC and KSS. The search strategy was predefined, and methodological quality of studies was critically appraised. Two researchers extracted data. Unpaired t‐testing assessed the mean monthly changes in KSS and WOMAC for computer‐aided versus traditional TKA. Review Manager 5.3 was used for data synthesis and analysis. Out of 729 records, five RCTs enrolling 339 patients were eligible and analyzed using a random effects meta‐analysis. The mean monthly ΔKSS score differed significantly between the traditional and computerized groups (11.47 ± 8.76 vs. 9.26 ± 6.05, respectively; p

Kuwaiti maritime proverbs are often misinterpreted by non-native speakers due to cultural references and metaphors. This study aimed to analyse these proverbs from a semantic, rather than a folkloristic, perspective. It is the first to examine and conceptualise Kuwaiti maritime proverbs using the Natural Semantic Metalanguage (NSM) system of componential semantics, as outlined in the works of Wierzbicka and Goddard. Five maritime proverbs were analysed using simple words to express more complex meanings, with explanations built using the five-part semantic template for English and Malay proverbs proposed by Goddard (2009, 2014). A communicative translation strategy was used to translate the proverbs into English. Data for analysis were collected from three specialised dictionaries on Kuwaiti proverbs and six related to Kuwaiti maritime history and culture. The analysis revealed common themes, such as the importance of cooperation, resilience, and the unpredictability of the sea. For example, the Kuwaiti proverb ‘Two captains sank the ship’ underscores the dangers of having multiple leaders in a single endeavour, which can yield counterproductive outcomes due to a lack of coordination and singular vision. NSM helped clarify such cultural nuances, reducing misunderstanding by explicating meanings. This study contributes to a deeper understanding of Kuwaiti maritime proverbs and their cultural significance, offering a valuable tool for cross-cultural communication. The findings also highlight the challenges in pairing proverbs from different languages, posing issues in both dictionaries and second-language learning environments.

Aims Uremic patients require dialysis to replace the declined kidney function, and arteriovenous fistula (AVF) is a commonly used dialysis access route. Our study aimed to explore vascular endothelial cells cadherin (VE-cadherin) and Delta-like ligand 4 (DLL4) expression in uremic patients undergoing primary AVF surgery and their correlation with AVF maturation. Methods We conducted a prospective study that included n = 55 voluntary uremic patients receiving their initial AVF procedure for renal replacement therapy, subjects were divided into a mature group and a failure group based on whether the AVF matured within 3 months post-operatively. We analyzed the association of VE-cadherin and DLL4 with AVF maturation by examining their expression levels in serum and the endothelium of cephalic veins. Results Pre-operative serum VE-cadherin, in the mature group measured 125.07 (106.77–167.65) ng/L, and DLL4 was 92.78 (83.83–106.72) pg/mL, while the failure group had VE-cadherin at 95.40 (79.03–107.16) ng/L (P = 0.001), and DLL4 at 60.42 (43.98–80.15) pg/mL with a statistical significant; (P = 0.002), binary logistic regression analysis indicated a significant association between cephalic vein diameter, VE-cadherin, DLL4 levels, and AVF immaturity (P = 0.024, P = 0.014 respectively). Immunohistochemical staining showed slightly higher VE-cadherin levels in the mature group than in the failure group (P = 0.366). DLL4 was primarily located in the cell membrane and cytoplasm, concentrated in the inner membrane, with significantly higher levels in the mature group compared to the failure group (P = 0.027). Conclusion The failure group exhibited lower levels of VE-cadherin and DLL4 in serum and vascular tissue, these results suggest that VE-cadherin and DLL4 might play pivotal regulatory roles in the onset and the progression of fistula immaturity, potentially serving as promising targets for future interventions.

Historical data on monuments offers valuable insights into that period's past sculpture, architecture, and preferences. Realising the importance of historical data and the scarcity of data on historical places, this study presents a dataset collected from Panam City. Panam City, established in the late 1300s century, was the capital of the fifteenth-century Bengal ruler Isa Khan. The city was once an important trading and political centre and is now considered a world heritage site by the United Nations Educational Scientific and Cultural Organisation (UNESCO). Panam City is located in Sonargaon, Dhaka, Bangladesh. The aim of data collection is to capture past architectural design, materials used for the building, and the current state of the walls and structures of Panam City. This dataset can benefit researchers, architects, archaeologists, and cultural organisations. Historians and architects can gain insights into the wall's construction methods and materials, informing future restoration efforts. Historic datasets can create exciting AR/VR experiences by digitizing and 3D modelling historical artefacts and environments, integrating them into AR/VR platforms using game engines and development tools, and enhancing the user experience with interactive storytelling and educational content. Tourism boards and cultural heritage organisations can leverage this resource to develop engaging experiences that highlight the rich history and significance of Panama City. By making this data accessible, this study contributes to understanding and appreciating Panam City's historical significance while promoting innovative approaches to heritage preservation in the digital age. This dataset contains 2292 images of degraded wall classes such as Artistic, Corroded Brick, Corroded Plaster, Fungus, and Living Plant.

Abstract The widespread administration of COVID-19 vaccines has prompted a need to understand their safety profile. This investigation focuses on the safety of inactivated and mRNA-based COVID-19 vaccines, particularly concerning potential cardiovascular and haematological adverse events. A retrospective cohort study was conducted for 1.3 million individuals residing in Abu Dhabi, United Arab Emirates, who received 1.8 million doses of the inactivated BBIBP CorV (by SinoPharm) and mRNA-based BNT162b2 (Pfizer-BioNTech) vaccines between June 1, 2021, and June 30, 2022. The study’s primary outcome was to assess the occurrence of selected cardiovascular and haematological events leading to hospitalization or emergency room visits within 21 days post-vaccination. Results showed no significant increase in the incidence rates of these events compared to the subsequent 22 to 42 days following vaccination. Analysis revealed no elevated risk for adverse outcomes following first (IRR 1·03; 95% CI 0·82-1·31), second (IRR 0·92; 95% CI 0·72-1·16) and third (IRR 0·82; 95% CI 0·66-1·00) doses of either vaccine. This study found no substantial link between receiving either mRNA and inactivated COVID-19 vaccines and a higher likelihood of cardiovascular or haematological events within 21 days after vaccination.

Najmaddin A H Hatem,1 Mohammed A Kubas,2,3 Seena A Yousuf,4 Abdunaser Rassam,5 Mohamed Izham Mohamed Ibrahim6 1Department of Clinical Pharmacy, College of Clinical Pharmacy, Hodeidah University, Al-Hudaydah, Yemen; 2Clinical Pharmacy Department, School of Pharmacy & Medical Sciences (SPMS), Lebanese International University, Sana’a, Yemen; 3Clinical Pharmacy Department, University of Science and Technology (UST) Hospital, Sana’a, Yemen; 4Social Medicine and Public Health Department, Faculty of Medicine and Health Sciences, Aden University, Aden, Yemen; 5Clinical Pharmacy Department, The 48 Hospital, Sana’a, Yemen; 6Department of Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, QU Health, Doha, QatarCorrespondence: Najmaddin A H Hatem, Department of Clinical Pharmacy, College of Clinical Pharmacy, Hodeidah University, P.O. 3114, Al-Hudaydah, Yemen, Tel +967 775040472, Email clin.pharm.najmaddin@gmail.com; najmaddin@hoduniv.net.yeBackground: Clinical pharmacy services (CPSs) are still in their infancy in Yemen. Furthermore, pharmacists are not members of a multidisciplinary healthcare team, so their responsibilities are limited to drug dispensing and marketing. This study examines physicians’ attitudes and perceived obstacles regarding the inclusion of clinical pharmacists in hospital medical wards.Methods: A descriptive observational study was carried out using a validated, self-administered bilingual questionnaire. The study’s questionnaire was conducted among physicians in three leading hospitals. Those hospitals were at the forefront of establishing clinical pharmacy units and embracing clinical pharmacy services. Data were analyzed using descriptive statistics.Results: Sixty-five responses were included. Our data results indicated that physicians believed the most important contributions for clinical pharmacists to improve patient care were “attending medical rounds”, followed by “order review”. About 75% of physicians showed positive attitudes toward the clinical pharmacist role. However, more than 70% of physicians believed that clinical pharmacists should leave patient care to other healthcare professionals and focus on drug products. Not enough clinical pharmacist staff working in the health center was considered the top perceived barrier (83.1%), followed by “clinical pharmacist responsibilities were not clearly defined” and “clinical pharmacist recommendations are not properly documented”.Conclusion: Strategies to expand clinical pharmacy services in Yemen should focus on several key areas. Protocols must be established to clearly outline the collaboration between clinical pharmacists and physicians. Additionally, fostering inter-professional relationships is crucial to overcoming resistance and increasing awareness and understanding of CPS adoption among healthcare team members.Keywords: clinical pharmacist, clinical pharmacy services, attitudes, physicians, collaboration, Yemen

Background/Aims Roxadustat, an oral medication for treating renal anemia, is a hypoxia-inducible factor prolyl hydroxylase inhibitor used for regulating iron metabolism and promoting erythropoiesis. To investigate the efficacy and safety of roxadustat in patients undergoing peritoneal dialysis (PD) with erythropoietin hyporesponsiveness. Methods Single-center, retrospective study, 81 PD patients (with erythropoietin hyporesponsiveness) were divided into the roxadustat group (n = 61) and erythropoiesis-stimulating agents (ESAs) group (n = 20). Hemoglobin (Hb), total cholesterol, intact parathyroid hormone (iPTH), brain natriuretic peptide (BNP), related indicators of cardiac function and high-sensitivity C-reactive protein (hs-CRP) were collected. Additionally, adverse events were also recorded. The follow-up period was 16 weeks. Results The two groups exhibited similar baseline demographic and clinical characteristics. At baseline, the roxadustat group had a mean Hb level of 89.8 ± 18.9 g/L, while the ESAs group had a mean Hb level of 95.2 ± 16.0 g/L. By week 16, the Hb levels had increased to 118 ± 19.8 g/L (p < 0.05) in the roxadustat group and 101 ± 19.3 g/L (p > 0.05) in the ESAs group. The efficacy of roxadustat in improving anemia was not influenced by baseline levels of hs-CRP and iPTH. Cholesterol was decreased in the roxadustat group without statin use. An increase in left ventricular ejection fraction and stabilization of BNP were observed in the roxadustat group. Conclusions For PD patients with erythropoietin hyporesponsiveness, roxadustat can significantly improve renal anemia. The efficacy of roxadustat in improving renal anemia was not affected by baseline levels of hs-CRP0 and iPTH.

Kousalya Prabahar,1 Manar Saleem Alhawiti,2 Asmaa Mokhtar Yosef,2 Raghad Saleh Alqarni,2 Fai Yahya Sayd,2 Mohammed Omar Alsharif,3 Vikashini Subramani,4 Hanan Alshareef,1 Ahmed ME Hamdan,1 Saleh Alqifari,1 Ghadi Saleh Alqarni,5 Sumayah Mokhtar Yousuf6 1Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia; 2Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia; 3Director of Pharmaceutical Care Administration, Ministry of Health, Tabuk, Saudi Arabia; 4Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Nilgiris, TN, India; 5Pharmacist and Store Manager, Alnahdi Company, Tabuk, Saudi Arabia; 6Pharmacist, Prince Sultan Military Medical City, Riyadh, Saudi ArabiaCorrespondence: Kousalya Prabahar, Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, 71491, Saudi Arabia, Email kgopal@ut.edu.saPurpose: Older persons are frequently prescribed several medications; therefore, inappropriate medication prescriptions are common. Prescribing potentially inappropriate medications (PIMs) poses a serious risk and hence, we aimed to assess the PIMs in older patients in Tabuk, using the 2023 Beers criteria.Patients and Methods: A retrospective cross-sectional study was carried out, including older persons ≥ 65 years of age admitted in two government hospitals from June 2022 to May 2023, and prescribed with five or more medications. PIMs were assessed using the 2023 Beers criteria. Descriptive analysis was performed for the categorical and continuous variables. Logistic regression was used to assess the influence of age, gender, number of medications and comorbidities on PIMs using SPSS version 27.Results: The study included 420 patients. The mean age of the participants was 75.52 ± 8.70 years (range, 65– 105 years). There was a slightly higher proportion of females (52%). The prevalence of PIMs was 81.43%, where 35.41% were prescribed one PIM, 26.48% were prescribed two PIMs, and 17.32% were prescribed three PIMs. The proportion of medications considered potentially inappropriate among older patients was 70.11%, and proton pump inhibitors were the most commonly prescribed medication (52.99%). The proportion of medications to be used with caution was 19.55%, with diuretics being the most frequently administered medication (91.43%). Gender and comorbidity did not influence PIMs, but age and number of medications significantly influenced the likelihood of PIMs.Conclusion: PIMs are prevalent among older people and are significantly associated with age and multiple medications. Caution should be exercised while prescribing medications to older persons. Frequent audits should be performed to assess PIMs, and clinicians should be informed of the same to avoid serious outcomes associated with PIMs. Interventions designed to reduce PIM need to be initiated.Keywords: older persons, inappropriate medication, American Geriatrics Society, prescription

Background: Antimicrobial resistance is associated with increasing mortality rates and the emergence of multidrug-resistant (MDR) organisms. There is scarcity of data on the short-term impact of Antimicrobial Stewardship Programs (ASP) on antibiotic usage, clinical outcome and MDR organisms’ pattern following the COVID-19 pandemic. This study evaluated the short-term effects of ASP on antibiotic usage, clinical outcomes and MDR organisms’ pattern in the post COVID-19 era. Methods: Conducted at a tertiary academic health center, this observational study involved adult patients (≥18 years) in the general medical unit, treated with oral or intravenous antibiotics from May 1, 2021, to April 30, 2022. The applied ASP strategy was a prospective audit and feedback where a weekly meeting was held to discuss the antimicrobial therapy of admitted patient, after which recommendations were made regarding antimicrobial use. Results: The study included 301 patients with 166 (55.1%) pre-ASP and 135 (44.9%) post-ASP. The median (IQR) age was 69 (55−77) years with 56.1% were female. Antibiotic usage dropped by 25.2% post-ASP. The length of hospital stay (LOS) was longer post-ASP (7 days vs. 7.9 days, p = 0.001), with MDR infections being a significant predictor (OR: 0.486, p

Dima Tareq Al Absi,1 Khadija Yousuf,2 Kholoud Aljaberi,2 Rahma AlBreiki,2 Mecit Can Emre Simsekler,1 Mohammed Atif Omar,1 Sanjay Ayathan,2 Tahir Mehmood,2 Siddiq Anwar,2,3 Deanne T Kashiwagi2 1Department of Management Science and Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; 2Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates; 3College of Medicine and Health Science of Medicine, Khalifa University of Science and Technology, Abu Dhabi, United Arab EmiratesCorrespondence: Siddiq Anwar, Department of Medicine, Sheikh Shakhbout Medical City, P.O. Box 11001, Abu Dhabi, United Arab Emirates, Tel +971 2 314 2760, Fax +971 2 314 4446, Email sanwar@ssmc.aeBackground: Research has increasingly become important to career progression and a compulsory component in most medical programs. While medical trainees are consistently urged to undertake research endeavors, they frequently encounter obstacles at both personal and organizational levels that impede the pursuit of high-quality research. This study aims to identify the barriers and recommend successful interventions to increase research productivity amongst medical trainees.Methods: A descriptive cross-sectional survey was carried out among interns, residents, and fellows within a single hospital located in the emirate of Abu Dhabi, UAE. The survey included inquiries regarding perceived obstacles hindering engagement in research activities, factors driving motivation for research involvement, and the assessment of how research participation relates to their job in terms of relevance.Results: Fifty-seven medical trainees participated in the survey, reflecting a response rate of 53%. The survey highlighted common obstacles, notably including time constraints, insufficient statistical and methodology training, the weight of other educational commitments, as well as inadequate incentives and rewards. While a majority of participants expressed interest in engaging in research activities, the consensus was that more incentives and increased funding opportunities would significantly encourage their involvement.Conclusion: Implementing successful interventions such as allocating dedicated time for research, facilitating access to research mentors, and organizing training sessions have the potential to be effective strategies in fostering a thriving research culture and subsequently elevating research productivity of medical trainees.Keywords: medical research, residents, medical trainees, medical training, future of work, medical education

In Bangladesh, sweet orange cultivation has been popular among fruit growers as the fruit is in demand. However, the disease of sweet oranges decreases fruit production. Research suggests that computer-aided disease diagnosis and machine learning (IML) models can improve fruit production by detecting and classifying diseases. In this line, a dataset of sweet oranges is required to diagnose the disease. Moreover, like many other fruits, sweet orange disease may vary from country to country. Therefore, in Bangladesh, a sweet orange dataset is required. Lastly, since different ML algorithms require datasets in various formats, only a few existing datasets fulfil the necessity. To fulfil the limitations, a sweet orange dataset in Bangladesh is collected. The dataset was collected in August and comprises high-quality images documenting multiple disease conditions, including Citrus Canker, Citrus Greening, Citrus Mealybugs, Die Back, Foliage Damage, Spiny Whitefly, Powdery Mildew, Shot Hole, Yellow Dragon, Yellow Leaves, and Healthy Leaf. These images provide an opportunity to apply machine learning and computer vision techniques to detect and classify diseases. This dataset aims to help researchers advance agri engineering through ML. Other sweet orange growing countries with having similar environments may find helpful information. Lastly, such experiments using our dataset will assist farmers in taking preventive measures and minimising economic losses.

Vision Transformer (ViT) has recently attracted significant attention for its performance in image classification. However, studies have yet to explore its potential in detecting and classifying plant leaf disease. Most existing research on diseased plant leaf detection has focused on non-transformer convolutional neural networks (CNN). Moreover, the studies that applied ViT narrowly experimented using hyperparameters such as image size, patch size, learning rate, attention head, epoch, and batch size. However, these hyperparameters significantly contribute to the model performance. Recognising the gap, this study applied ViT to Java Plum disease detection using optimised hyperparameters. To harness the performance of ViT, this study presents an experiment on Java Plum leaf disease detection. Java Plum leaf diseases significantly threaten agricultural productivity by negatively impacting yield and quality. Timely detection and diagnosis are essential for successful crop management. The primary dataset collected in Bangladesh includes six classes, ‘Bacterial Spot’, ‘Brown Blight’, ‘Powdery Mildew’, and ‘Sooty Mold’, ‘healthy’, and ‘dry’. This experiment contributes to a thorough understanding of Java Plum leaf diseases. Following rigorous testing and refinement, our model demonstrated a significant accuracy rate of 97.51%. This achievement demonstrates the possibilities of using deep-learning tools in agriculture and inspires further research and application in this field. Our research offers a foundational model to ensure crop quality by precise detection, instilling confidence in the global Java Plum market.

The COVID-19 pandemic spread across the world in several days. This disease has badly affected corporations, industries, and educational institutions worldwide. The education sector suffered several crises, around 77 million students were affected and absent from class during the pandemic. Using remote learning during the pandemic was beneficial, but it was difficult to find comfort and dependability. The present study examines the challenges faced by Pakistani students and teachers in remote learning, academic performance, and satisfaction levels of students and teachers who have participated in remote learning during the COVID-19 pandemic. Based on the respondents’ comments, analyzed the demographic data and remote learning data using statistical calculations in the R language, and displayed the results in graphs. It used machine-learning models to calculate sentiment analysis results using the R language. According to the calculation results, the proposed study performs well using a support vector machine (SVM) and neural network (NNET), which give an accuracy of 83.5, while the accuracy of the k-nearest neighbor (KNN) is 69.9. The proposed study formulates suggestions for future work that are useful for improving the outcomes of remote learning.

Introduction: A tumor refers to an abnormal mass of cells in the body, which can be either benign or malignant. Among cancers, breast cancer is the most frequently diagnosed in females, followed by lung cancer and prostate cancer. Sarcomas, comprising over 70 different subtypes, represent approximately 1% of all cancers. Case presentation: A 21-year-old from Borama, Somaliland/Somalia, presented with a 5-day fever, along with other symptoms. Past surgical history revealed a thyroid lesion diagnosed as round cell sarcoma. Imaging showed thyroid carcinoma with metastases. Discussion: The rising cancer incidence in sub-Saharan Africa is attributed to factors like increased life expectancy and lifestyle changes. Challenges in rare cancer cases include late-stage diagnosis and limited treatment options. Efforts to persuade the patient for treatment are ongoing. Conclusion: Improvements in healthcare infrastructure, access to imaging, and pathology services, along with cultural sensitivity, are crucial in managing rare cancers like round cell sarcoma in sub-Saharan Africa. Resumen: Introducción: Un tumor se refiere a una masa anormal de células en el cuerpo, que puede ser benigna o maligna. Entre los cánceres, el cáncer de mama es el más frecuentemente diagnosticado en mujeres, seguido por el cáncer de pulmón y el cáncer de próstata. Los sarcomas, que comprenden más de 70 subtipos diferentes, representan aproximadamente el 1% de todos los cánceres. Presentación del caso: Joven de 21 años de Borama, Somalilandia/Somalia, que presentó fiebre de cinco días, junto con otros síntomas. Los antecedentes quirúrgicos revelaron una lesión tiroidea diagnosticada como sarcoma de células redondas. Las imágenes mostraron carcinoma tiroideo con metástasis. Discusión: El aumento de la incidencia de cáncer en el África subsahariana se atribuye a factores como el aumento de la esperanza de vida y los cambios en el estilo de vida. Los desafíos en los casos raros de cáncer incluyen el diagnóstico en etapa tardía y las opciones de tratamiento limitadas. Los esfuerzos para persuadir al paciente para que reciba tratamiento están en curso. Conclusión: Las mejoras en la infraestructura sanitaria, el acceso a los servicios de diagnóstico por imágenes y patología, junto con la sensibilidad cultural, son cruciales en el tratamiento de cánceres raros como el sarcoma de células redondas en el África subsahariana.

IntroductionThis study was undertaken to investigate whether sustained rather than a single measure of corneal nerve loss was associated with the onset of diabetic peripheral neuropathy (DPN) and the progression of neuropathic symptoms and deficits in individuals with type 2 diabetes (T2D).MethodsParticipants underwent clinical, metabolic testing and assessment of neuropathic symptoms, vibration perception threshold (VPT), sudomotor function, and corneal confocal microscopy (CCM) at baseline, 1, 2, and 4–7 years. Sustained corneal nerve loss was defined as abnormal corneal nerve fiber density (CNFD,

Abstract Purpose This study investigated the levels of salivary proinflammatory cytokines in the saliva of patients living with type II diabetes mellitus (DM) compared to those in healthy individuals three times: before tooth extraction and at 2 hours and 2 days after tooth extraction. Methods The study included 27 participants. Among them, 20 (n = 20; 74%) had type II DM, and seven (n = 7; 26%) were healthy control subjects. Saliva samples were collected at three time intervals: before tooth extraction and 2 hours and 2 days after tooth extraction. The salivary biomarkers were investigated using a Luminex multiplex assay. These salivary biomarkers included tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), interleukin 1-beta (IL-1β), and interferon-gamma (IFN-γ). Results At baseline, patients with type II DM had significantly lower levels of IL-1β (P = 0.016). Moreover, 2 hours after extraction, patients with type II DM had significantly lower levels of IL-1β and TNF-α than did healthy control subjects (P = 0.046 and P = 0.020, respectively). In addition, 2 days after tooth extraction, the DM group had significantly greater IL-6 levels (P = 0.010) than the control group. Conclusions In patients with type II DM, salivary proinflammatory biomarker levels are generally comparable or lower than those in healthy control subjects. Proinflammatory cytokines manifest differently in patients with type II DM after tooth extraction than in normal healthy individuals. There is generally a delayed early response of salivary proinflammatory markers in patients living with type II DM who undergo tooth extraction.

Cardiovascular diseases are the leading cause of mortality and morbidity globally. Clinicians must know cutaneous signs of cardiovascular disease, including petechiae, macules, purpura, lentigines, and rashes. Although cutaneous manifestations of diseases like infectious endocarditis and acute rheumatic fever are well established, there is an indispensable need to evaluate other important cardiovascular diseases accompanied by cutaneous signs. Moreover, discussing the latest management strategies in this regard is equally imperative. This review discusses distinctive skin findings that help narrow the diagnosis of cardiovascular diseases and recommendations on appropriate treatment.

IntroductionThe Eastern Mediterranean Regional Office (EMRO) region accounts for almost 8% of all global Mycobacterium tuberculosis (TB) cases, with TB incidence rates ranging from 1 per 100,000 per year in the United Arab Emirates (UAE) to 204 per 100,000 in Djibouti. The national surveillance data from the Middle East and North Africa (MENA) region on the epidemiology and antimicrobial resistance trends of TB, including MDR-TB remains scarce.MethodsA retrospective 12-year analysis of N = 8,086 non-duplicate diagnostic Mycobacterium tuberculosis complex (MTB complex) isolates from the UAE was conducted. Data were generated through routine patient care during the 2010–2021 years, collected by trained personnel and reported by participating surveillance sites to the UAE National Antimicrobial Resistance (AMR) Surveillance program. Data analysis was conducted with WHONET, a windows-based microbiology laboratory database management software developed by the World Health Organization Collaborating Center for Surveillance of Antimicrobial Resistance, Boston, United States (https://whonet.org/).ResultsA total of 8,086 MTB-complex isolates were analyzed. MTB-complex was primarily isolated from respiratory samples (sputum 80.1%, broncho-alveolar lavage 4.6%, pleural fluid 4.1%). Inpatients accounted for 63.2%, including 1.3% from ICU. Nationality was known for 84.3% of patients, including 3.8% Emiratis. Of UAE non-nationals, 80.5% were from 110 countries, most of which were Asian countries. India accounted for 20.8%, Pakistan 13.6%, Philippines 12.7%, and Bangladesh 7.8%. Rifampicin-resistant MTB-complex isolates (RR-TB) were found in 2.8% of the isolates, resistance to isoniazid, streptomycin, pyrazinamide, and ethambutol, was 8.9, 6.9, 3.4 and 0.4%, respectively. A slightly increasing trend of resistance among MTB-complex was observed for rifampicin from 2.5% (2010) to 2.8% (2021).ConclusionInfections due to MTB-complex are relatively uncommon in the United Arab Emirates compared to other countries in the MENA region. Most TB patients in the UAE are of Asian origin, mainly from countries with a high prevalence of TB. Resistance to first line anti-tuberculous drugs is generally low, however increasing trends for MDR-TB mainly rifampicin linked resistance is a major concern. MDR-TB was not associated with a higher mortality, admission to ICU, or increased length of hospitalization as compared to non-MDR-TB.

Calcium pyrophosphate deposition (CPPD) is a condition where calcium pyrophosphate crystals cause arthritis. Its occurrence in the temporomandibular joint (TMJ) is sparingly reported in the literature. Non-surgical treatment modalities consist of non-steroidal anti-inflammatory drugs, colchicine, and intra-articular cortisone injection. In the TMJ, previous reports have described resection of affected joint with reconstruction. We present a case of an extensive CPPD lesion affecting the left TMJ requiring surgical resection and reconstruction with a custom made TMJ prosthesis alongside with a review of the existing literature.

Objective: Dengue fever, Malaria and Enteric fever are common pediatric acute febrile illnesses, pre- senting with overlapping clinical manifestations. The hematological parameters of these disease may give a clue to the specific diagnosis before definitive investigations are available. We designed this study to determine the hematological predictors of dengue fever, malaria and enteric fever in pediatric inpatient population. Methods: We collected data for this observational study from May to October 2022 from Pediatrics De- partment, Dr. RKMP Civil Hospital Karachi. We reviewed the medical records of patients 1 month to 12 years of age admitted with definitive diagnosis of dengue, malaria and/or enteric fever. We re- corded the demographic and clinical variables and hematologic parameters of Complete Blood Count and calculated the P value and sensitivity / specificity of each parameter in SPSS 22.0, for differentiating the three diseases. Results: A total of 205 patients were included in the study, out of which 82 (40%) had malaria, 71 (34.6%) had dengue and 52 (25.4%) had enteric fever. Male gender was predominant in 73.6%. Patients with dengue fever mostly had normal hemoglobin (>11gm/dl) with a higher hematocrit, lymphopenia (

Background: The variety of innovations to traditional centre-based pulmonary rehabilitation (CBPR), including different modes of delivery and adjuncts, are likely to lead to differential responses in physical activity, sedentary behaviour and sleep. Objectives: To examine the relative effectiveness of different pulmonary rehabilitation-based interventions on physical activity, sedentary behaviour and sleep. Methods: Randomised trials in chronic respiratory disease involving pulmonary rehabilitation-based interventions were systematically searched for. Network meta-analyses compared interventions for changes in physical activity, sedentary behaviour and sleep in COPD. Results: 46 studies were included, and analyses were performed on most common outcomes: steps per day (k=24), time spent in moderate-to-vigorous physical activity (MVPA; k=12) and sedentary time (k=8). There were insufficient data on sleep outcomes (k=3). CBPR resulted in greater steps per day and MVPA and reduced sedentary time compared to usual care. CBPR+physical activity promotion resulted in greater increases in steps per day compared to both usual care and CBPR, with greater increases in MVPA and reductions in sedentary time compared to usual care, but not CBPR. Home-based pulmonary rehabilitation resulted in greater increases in steps per day and decreases in sedentary time compared to usual care. Compared to usual care, CBPR+physical activity promotion was the only intervention where the lower 95% confidence interval for steps per day surpassed the minimal important difference. No pulmonary rehabilitation-related intervention resulted in greater increases in MVPA or reductions in sedentary time compared to CBPR. Conclusion: The addition of physical activity promotion to pulmonary rehabilitation improves volume of physical activity, but not intensity, compared to CBPR. High risk of bias and low certainty of evidence suggests that these results should be viewed with caution.

OBJECTIVE: To determine the clinical spectrum of metabolic storage disorders presenting to a public sector tertiary care hospital in Karachi, Pakistan. METHODOLOGY: This retrospective, cross-sectional study was conducted at the Department of Pediatrics, Dr. Ruth K.M Pfau Civil Hospital Karachi, in 2021. We reviewed the medical records of patients from January 2015 to December 2020. We included all pediatric patients admitted with suspicion of metabolic storage disorders based on two or more: visceromegaly, developmental delay, regression of milestones, fits without fever, family history of similar illness, and family history of expiry of children due to unknown reasons. Patients of malaria, enteric fever, epilepsy and cerebral palsy were excluded. We noted the demographic and clinical variables and applied descriptive statistics using SPSS version 22. RESULTS: Out of n=140 suspected children, n=40 (28.5%) patients were diagnosed with metabolic storage disorder. Among these, 26 (65%) were Lysosomal, and 14 (35%) were Glycogen storage disorders (LSDs and GSDs). The most common clinical feature of LSDs was faltering growth in 23 (88.4%), while for GSDs, it was abdominal distention and hepatomegaly in 100% of patients. Mucopolysaccharidoses were the most common type of LSD identified in 9 (34.6%). Interestingly, family history of similar illness was not a standard feature (19.2% for LSDs and 7% for GSDs). CONCLUSION: Metabolic storage disorders are an emerging concern to pediatric health in our population. Physicians need to keep a high index of suspicion for patients with faltering growth and visceromegaly, with or without a significant family history.

Objective: To assess the accuracy of pediatric risk of mortality score in predicting mortality risk among children admitted in the pediatric intensive care unit. Methods: It is a descriptive cohort study conducted at PICU. It was conducted over six months from December 2022 to June 2022. All patients admitted in PICU with critical illness having age 1 month to 12 years of either gender was consecutively enrolled. Patients were classified in 3 groups accord ing to the PRISM scores 1-10 (low risk), 11-20 (moderate risk), and 21-30 (high risk) was also done. The accuracy of PRISM III score was defined based on the presence of moderate or high risk of mortality at the time of hospitalization in the PICU among patients who died within 14 days. Data was analyzed on SPSS version 24. Results: Of 135 patients, the mean age of the patients was 2.65 ±2.14 years. There were 90 (66.6%) with d”3 years of age while 45 (33.3%) with >3 years of age. Low PRISM risk score was observed in 65 (48.1%), moderate in 64 (47.4%), and high in 6 (4%) patients. Mortality was observed in 28 (20.7%) patients. The sensitivity of the PRISM score is found to be 94.8%, the specificity is 62.8%, and positive predictive value of 33.9%, negative predictive value was 95.9%. The accuracy of the PRISM score is found to be 65.57%. Conclusion: PRISM III is a reliable score in predicting mortality risk among children admitted to the Pediatric intensive care unit.

This study aimed to investigate the potential protective effects of diminazene, an activator of angiotensin II converting enzyme (ACE2), on kidney function and structure in rats with acute kidney injury (AKI) induced by the anticancer drug doxorubicin (DOX). The impact of diminazene was compared to that of two other drugs: the ACE inhibitor lisinopril and the angiotensin II type 1 (AT1) receptor blocker valsartan. Rats were subjected to a single intraperitoneal injection of DOX (13.5 mg/kg) on the 5th day, either alone or in combination with diminazene (15 mg/kg/day), lisinopril (10 mg/kg/day), or valsartan (30 mg/kg/day) for 8 consecutive days. Various markers related to kidney function, oxidative stress, and inflammation were measured in plasma and urine. Additionally, kidney tissues were assessed histopathologically. DOX-induced nephrotoxicity was confirmed by elevated levels of plasma urea, creatinine, and neutrophil gelatinase-associated lipocalin (NGAL). DOX also led to increased urinary N-acetyl-β-D-glucosaminidase (NAG) activity and decreased creatinine clearance, albumin levels, and osmolality. Moreover, DOX caused a reduction in renal oxidative stress markers, including superoxide dismutase (SOD), glutathione reductase (GR), and catalase activities, while increasing malondialdehyde (MDA) levels. It also raised plasma inflammatory markers, tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β). Concurrently administering diminazene significantly mitigated these DOX-induced changes, including histopathological alterations like renal tubule necrosis, tubular casts, shrunken glomeruli, and increased renal fibrosis. Similar protective effects were observed with lisinopril and valsartan. These protective effects, at least in part, appear to result from the anti-inflammatory and antioxidant properties of these drugs. In summary, this study suggests that the administration of diminazene, lisinopril, or valsartan had comparable effects in ameliorating the biochemical and histopathological aspects of DOX-induced acute kidney injury in rats.

Chemical excipients used in topical formulations may be toxic to living skin cells. Here, we compared the in vitro toxicity of some common solubilizing excipients against human melanoma cells, human keratinocytes (HaCaT) and primary skin fibroblasts (FB) as examples of cancerous, immortalized and primary human skin cells, often used as experimental models representative of in vivo conditions. Two distinct endpoint assays (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and crystal violet (CV)) were used. The mechanism of cell death after excipient exposure was assessed through Reactive Oxygen Species (ROS) production, cell membrane integrity and cell cycle progression. Results showed that the surfactants, Labrasol®, Labrafil® and Transcutol®, were less toxic than Triton X-100 (a model irritant) in all cell types whereas the oil, Labrafac®, was non-toxic. The human melanoma WM164 cell line showed the greatest sensitivity toward cytotoxicity after chemical exposure, while the other cell lines were more resistant. The relative excipient cytotoxicity responses observed in the MTT and CV assays were comparable and similar trends were seen in their estimated 50 % inhibitory concentration (IC50) values. DNA fragmentation by flow cytometry after exposing the cells to IC50 concentrations of the excipients showed negligible apoptotic populations. ROS production was increased in all cell types after toxic exposure; however, ROS elevation did not lead to apoptosis. The toxicity profiles of each excipient are not only relevant to their use in formulating safe topical products but also in the potential synergistic efficacy in the topical treatment of melanoma.

This paper introduces a new derivation of the radix-22 fast algorithm for the forward odd new Mersenne number transform (ONMNT) and the inverse odd new Mersenne number transform (IONMNT). This involves introducing new equations and functions in finite fields, bringing particular challenges unlike those in other fields. The radix-22 algorithm combines the benefits of the reduced number of operations of the radix-4 algorithm and the simple butterfly structure of the radix-2 algorithm, making it suitable for various applications such as lightweight ciphers, authenticated encryption, hash functions, signal processing, and convolution calculations. The multidimensional linear index mapping technique is the conventional method used to derive the radix-22 algorithm. However, this method does not provide clear insights into the underlying structure and flexibility of the radix-22 approach. This paper addresses this limitation and proposes a derivation based on bit-unscrambling techniques, which reverse the ordering of the output sequence, resulting in efficient calculations with fewer operations. Butterfly and signal flow diagrams are also presented to illustrate the structure of the fast algorithm for both ONMNT and IONMNT. The proposed method should pave the way for efficient and flexible implementation of ONMNT and IONMNT in applications such as lightweight ciphers and signal processing. The algorithm has been implemented in C and is validated with an example.

Abstract Skin cancer is a global threat to the healthcare system and is estimated to incline tremendously in the next 20 years, if not diagnosed at an early stage. Even though it is curable at an early stage, novel drug identification, clinical success, and drug resistance is another major challenge. To bridge the gap and bring effective treatment, it is important to understand the etiology of skin carcinoma, the mechanism of cell proliferation, factors affecting cell growth, and the mechanism of drug resistance. The current article focusses on understanding the structural diversity of skin cancers, treatments available till date including phytocompounds, chemotherapy, radiotherapy, photothermal therapy, surgery, combination therapy, molecular targets associated with cancer growth and metastasis, and special emphasis on nanotechnology-based approaches for downregulating the deleterious disease. A detailed analysis with respect to types of nanoparticles and their scope in overcoming multidrug resistance as well as associated clinical trials has been discussed. Graphical Abstract

Today, around the world, there is huge demand for natural materials that are biodegradable and possess suitable properties. Natural fibers reveal distinct aspects like the combination of good mechanical and thermal properties that allow these types of materials to be used for different applications. However, fibers alone cannot meet the required expectations; design modifications and a wide variety of combinations must be synthesized and evaluated. It is of great importance to research and develop materials that are bio-degradable and widely available. The combination of PLA+, a bio-based polymer, with natural fillers like sawdust and soybean oil offers a novel way to create sustainable composites. It reduces the reliance on petrochemical-based plastics while enhancing the material’s properties using renewable resources. This study explores the creation of continuous hexagonal-shaped 3D-printed PLA+ samples and the application of post-print fillers, specifically sawdust and soybean oil. PLA+ is recognized for its eco-friendliness and low carbon footprint, and incorporating a hexagonal pattern into the 3D-printed PLA+ enhances its structural strength while maintaining its density. The addition of fillers is crucial for reducing shrinkage and improving binding capabilities, addressing some of PLA+’s inherent challenges and enhancing its load-bearing capacity and performance at elevated temperatures. Additionally, this study examines the impact of varying filler percentages and pattern orientations on the mechanical properties of the samples, which were printed with an infill design.

In this paper, we introduce and thoroughly examine new generalized ψ-conformable fractional integral and derivative operators associated with the auxiliary function ψ(t). We rigorously analyze and confirm the essential properties of these operators, including their semigroup behavior, linearity, boundedness, and specific symmetry characteristics, particularly their invariance under time reversal. These operators not only encompass the well-established Riemann–Liouville and Hadamard operators but also extend their applicability. Our primary focus is on addressing complex fractional boundary value problems, specifically second-order nonlinear implicit ψ-conformable fractional integro-differential equations with nonlocal fractional integral boundary conditions within Banach algebra. We assess the effectiveness of these operators in solving such problems and investigate the existence, uniqueness, and Ulam–Hyers stability of their solutions. A numerical example is presented to demonstrate the theoretical advancements and practical implications of our approach. Through this work, we aim to contribute to the development of fractional calculus methodologies and their applications.

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the white matter. The pathophysiology is thought to be immune-mediated as in most cases the condition follows an infection or triggering incident. More recent literature has demonstrated that there may be a link between autoimmune conditions and ADEM. Here we present a case of ADEM in a middle-aged woman with systemic lupus erythematosus that recovered well after treatment with corticosteroids and rituximab.

Atopic dermatitis (AD) is the most common chronic skin disease, significantly impacting patients’ quality of life. One of the most effective management approaches for AD involves addressing the defective skin barrier by urging AD patients to regularly use suitable moisturizers. Therapeutic moisturizers designed for AD are precisely formulated with ingredients targeting critical and often early symptoms of AD (e.g., itch, inflammation, damaged skin barrier). Dermo-cosmetic products, which are rich in moisturizing and emollient agents contributing to recovery as well as strengthening the skin barrier, have proven to be excellent adjuncts in AD treatment. There are various galenic forms of dermo-cosmetics, such as lotions, gels, creams, foams, and sprays, requiring a rationale in choosing ingredients for the product formulation and development. In addition, the role of moisturizer and emollient therapy to address skin dryness linked to dermatological conditions is hugely dependent on varying chemistry and morphology in the deeper regions of the skin. There are also limits to the efficacy of treatments, corticosteroid side effects, and product sensory appeal, which may decrease patient acceptance and compliance. The objective of this review is thus to offer a comprehensive overview of the critical aspects involved in the development of cosmetic vehicles, as well as a detailed examination of the primary ingredients used in formulations for AD.

Reducing low-density lipoprotein cholesterol levels lowers the risk of atherosclerotic cardiovascular disease. With the current and future portfolios of emerging lipid-lowering therapies included in various national and international guidelines, the objectives of this study were (i) to investigate the perceptions of UK prescribers’, including doctors, pharmacists, and nurses, on current lipid management for cardiovascular diseases and prescriptions of novel lipid-lowering therapies, and (ii) to explore the challenges and facilitating factors of prescribing novel lipid-lowering therapies through qualitative interviews. Qualitative semi-structured interviews with twelve medical and non-medical prescribers were conducted, around 20–30 min in length. The interviews were audio-recorded and transcribed on an online platform. A thematic analysis was deployed. Four major themes emerged from the analysis: (1) prescribing barriers; (2) prescribing enablers; (3) inter-profession variability; and (4) health literacy. These themes highlighted the contrast between the need for optimal shared decision making and the various constraints in practice. Participants expressed their inexperience with novel lipid-lowering therapies and acknowledged the requirement and importance of these agents for primary cardiovascular disease prevention. Participants recognised confidence and competence as key drivers for prescribing therapies and welcomed further education and training to enhance their skillset. Patients’ misconceptions towards current lipid-lowering therapies contributed to their refusal of newer agents, highlighting a requirement to improve patient education. Targeting communities through awareness campaigns was identified as a viable solution.

ObjectivesPatients with atrial fibrillation (AF) have lower left atrial (LA) strain, which is a predictor for LA function. Here, we evaluated the prognostic value of LA strain to predict the rhythm outcome in patients with persistent AF undergoing LA cryoablation concomitant to minimally invasive mitral valve repair.MethodsBetween 01/2016 and 12/2020, 72 patients with persistent AF underwent LA cryoablation during minimally invasive mitral valve surgery. All patients received a complete LA lesion set and left atrial appendage (LAA) closure with a clip. All patients received preoperative transthoracic echocardiography (TTE) with LA and left ventricular strain measurements. Preoperative LA and LV strain analysis was correlated with postoperative rhythm outcome.ResultsThe mean age of the patients was 66.9 ± 7.2 years, of whom 42 (58%) were male patients. No major ablation-related complications occurred in any of the patients. Successful LAA closure was confirmed by intraoperative echocardiography in all patients. The 1-year survival rate was 97%. Freedom from AF at 12 months was 72% and 68% off antiarrhythmic drugs. Preoperative LA strain values were statistically significantly higher in patients with freedom from AF at 12 months of follow-up (12.7% ± 6.9% vs. 4.9% ± 4.1%, p = 0.006). Preoperative LV strain value was not associated with postoperative rhythm outcome. In multivariate logistic regression analysis, LA strain (p

Background Transthyretin cardiac amyloidosis (ATTR‐CA) is a progressive and ultimately fatal cardiomyopathy. Biomarkers reflecting multiorgan dysfunction are of increasing importance in patients with heart failure; however, their significance in ATTR‐CA remains largely unknown. The aims of this study were to characterize the multifaceted nature of ATTR‐CA using blood biomarkers and assess the association between blood biomarkers and prognosis. Methods and Results This is a retrospective cohort study of 2566 consecutive patients diagnosed with ATTR‐CA between 2007 and 2023. Anemia (39%), high urea (52%), hyperbilirubinemia (18%), increased alkaline phosphatase (16%), increased CRP (C‐reactive protein; 27%), and increased troponin (98.2%) were common findings in the overall population, whereas hyponatremia (6%) and hypoalbuminemia (2%) were less common. These abnormalities were most common in patients with p.(V142I) hereditary ATTR‐CA, and became more prevalent as the severity of cardiac disease increased. Multivariable Cox regression analysis demonstrated that anemia (hazard ratio [HR], 1.19 [95% CI, 1.04–1.37]; P=0.01), high urea (HR, 1.23 [95% CI, 1.04–1.45]; P=0.01), hyperbilirubinemia (HR, 1.32 [95% CI, 1.13–1.57; P=0.001), increased alkaline phosphatase (HR, 1.20 [95% CI, 1.01–1.42; P=0.04), hyponatremia (HR, 1.65 [95% CI, 1.28–2.11]; P56 ng/L (HR, 1.72 [95% CI, 1.46–2.03]; P

Objective: To evaluate the gingival phenotypes of healthy young adult Pakistanis attending a dental institution. Methods: A cross-sectional study of gingival phenotype, probing depth (PD), papilla height (PH), gingival width (GW), gingival thickness (GT), crown width (CW) and crown length (CL) of maxillary central incisors was conducted in 510 healthy, Pakistani young adults, aged 20–35 years, attending a regional dental hospital in Pakistan. The K-means clustering technique was employed to delineate clusters based on the characteristics of the periodontal phenotypes. The resultant data was compared with the available international findings. Results: Three quarters (76 %) of the 510 patients examined exhibited a thick gingival phenotype, and the remainder a thin phenotype. The K-means clustering deployed the individual into three different clusters 1, 2 and 3, with varying ratios of PD, GW, CW/CL, with significant variations across the three clusters (p

IntroductionAcinetobacter spp., in particular A. baumannii, are opportunistic pathogens linked to nosocomial pneumonia (particularly ventilator-associated pneumonia), central-line catheter-associated blood stream infections, meningitis, urinary tract infections, surgical-site infections, and other types of wound infections. A. baumannii is able to acquire or upregulate various resistance determinants, making it frequently multidrug-resistant, and contributing to increased mortality and morbidity. Data on the epidemiology, levels, and trends of antimicrobial resistance of Acinetobacter spp. in clinical settings is scarce in the Gulf Cooperation Council (GCC) and Middle East and North Africa (MENA) regions.MethodsA retrospective 12-year analysis of 17,564 non-duplicate diagnostic Acinetobacter spp. isolates from the United Arab Emirates (UAE) was conducted. Data was generated at 317 surveillance sites by routine patient care during 2010–2021, collected by trained personnel and reported by participating surveillance sites to the UAE National AMR Surveillance program. Data analysis was conducted with WHONET.1ResultsSpecies belonging to the A. calcoaceticus-baumannii complex were mostly reported (86.7%). They were most commonly isolated from urine (32.9%), sputum (29.0%), and soft tissue (25.1%). Resistance trends to antibiotics from different classes during the surveillance period showed a decreasing trend. Specifically, there was a significant decrease in resistance to imipenem, meropenem, and amikacin. Resistance was lowest among Acinetobacter species to both colistin and tigecycline. The percentages of multidrug-resistant (MDR) and possibly extensively drug-resistant (XDR) isolates was reduced by almost half between the beginning of the study in 2010 and its culmination in 2021. Carbapenem-resistant Acinetobacter spp. (CRAB) was associated with a higher mortality (RR: 5.7), a higher admission to ICU (RR 3.3), and an increased length of stay (LOS; 13 excess inpatient days per CRAB case), as compared to Carbapenem-susceptible Acinetobacter spp.ConclusionCarbapenem-resistant Acinetobacter spp. are associated with poorer clinical outcomes, and higher associated costs, as compared to carbapenem-susceptible Acinetobacter spp. A decreasing trend of MDR Acinetobacter spp., as well as resistance to all antibiotic classes under surveillance was observed during 2010 to 2021. Further studies are needed to explore the reasons and underlying factors leading to this remarkable decrease of resistance over time.

Objective: The study is aimed to understand the antibacterial sensitivity of native and Indian varieties of garlic (Allium sativum) and ginger (Zingiber officinale) crude extracts against multi¬drug-resistant (MDR) poultry pathogen (Escherichia coli and Salmonella sp.). Materials and Methods: Thin layer chromatography (TLC) is used to identify the target spices' bioactive antibacterial compounds. MDR E. coli and Salmonella sp. were isolated from poultry. The TLC-Bioautography technique was applied to explore the antibacterial potentiality of garlic and ginger. Results: Inhibitory activities of garlic were Zone of inhibition (ZI) = 14.03 ± 0.15 mm and 19.70 ± 0.36 mm, Minimum inhibitory concentration (MIC): 0.625 and 0.325 mg/ml, and ginger were ZI = 14.63 ± 0.30 mm and 11.56 ± 0.51mm, MIC: 9.0 mg/ml against E. coli and Salmonella sp., respec¬tively. Two bands of garlic (Rf value = 0.31 and 0.50) and one band of ginger (Rf value = 0.71) showed inhibitory potential in TLC-Bioautography against both MDR isolates. Conclusion: Garlic and ginger were effective against MDR E. coli and Salmonella sp. These spices could be a suitable alternative during the antibiotic void. [J Adv Vet Anim Res 2023; 10(2.000): 151-156]

Abstract Introduction The phospholipase A2 group VI gene (PLA2G6) encodes an enzyme that catalyzes the hydrolytic release of fatty acids from phospholipids. Four neurological disorders with infantile, juvenile, or early adult‐onset are associated with PLA2G6 genetic alterations, namely infantile neuroaxonal dystrophy (INAD), atypical neuroaxonal dystrophy (ANAD), dystonia‐parkinsonism (DP), and autosomal recessive early‐onset parkinsonism (AREP). Few studies in Africa reported PLA2G6‐associated disorders and none with parkinsonism of late adult onset. Material and Methods The patients were clinically assessed following UK Brain Bank diagnostic criteria and International Parkinson and Movement Disorder Society's Unified Parkinson's Disease Rating Scale (MDS‐UPDRS). Brain MRI without contrast was performed. Genetic testing was done using a custom‐made Twist panel, screening 34 known genes, 27 risk factors, and 8 candidate genes associated with parkinsonism. Filtered variants were PCR‐amplified and validated using Sanger sequencing and also tested in additional family members to study their segregation. Result Two siblings born to consanguineous parents developed parkinsonism at the age of 58 and 60 years, respectively. MRI showed an enlarged right hippocampus in patient 2, but no overt abnormalities indicative of INAD or iron deposits. We found two heterozygous variants in PLA2G6, an in‐frame deletion NM_003560:c.2070_2072del (p.Val691del) and a missense variant NM_003560:c.956C>T (p.Thr319Met). Both variants were classified as pathogenic. Conclusion This is the first case in which PLA2G6 is associated with late‐onset parkinsonism. Functional analysis is needed to confirm the dual effect of both variants on the structure and function of iPLA2β.

Abstract Background Cardiovascular diseases are responsible for a significant proportion of mortalities worldwide. Elderly patients are the most affected by cardiovascular diseases, and because of factors such as polypharmacy, multimorbidity, and age-related changes in drug availability and metabolism, they are highly susceptible to the occurrence of drug–drug interactions. Drug–drug interactions are among the many drug-related problems leading to negative outcomes among inpatients and outpatients. Thus, it is important to investigate the prevalence, involved drugs, and factors related to potential drug–drug interactions (pDDIs) to properly optimize pharmacotherapy regimens for these patients. Objective We aimed to determine the prevalence of pDDIs, drugs most frequently implicated, and significant predictors associated with these interactions among hospitalized patients in the Cardiology Unit at Sultan Qaboos University Hospital in Muscat, Oman. Methods This retrospective cross-sectional study included 215 patients. Micromedex Drug-Reax® was used to identify pDDIs. Data extracted from patients’ medical records were collected and analyzed. Univariable and multivariable linear regression was applied to determine the predictors associated with the observed pDDIs. Results A total of 2057 pDDIs were identified, with a median of nine (5–12) pDDIs per patient. Patients with at least one pDDI accounted for 97.2% of all the included patients. The majority of pDDIs were of major severity (52.6%), fair level of documentation (45.5%), and pharmacodynamic basis (55.9%). Potential drug–drug interactions between atorvastatin and clopidogrel were the most frequently observed (9%). Of all the detected pDDIs, around 79.6% of them included at least one antiplatelet drug. Having diabetes mellitus as a comorbidity (B = 2.564, p < 0.001) and the number of drugs taken during the hospitalization period (B = 0.562, p < 0.001) were factors positively associated with the frequency of pDDIs. Conclusions Potential drug–drug interactions were highly prevalent among hospitalized cardiac patients at Sultan Qaboos University Hospital, Muscat, Oman. Patients having diabetes as a comorbidity and with a high number of administered drugs were at a higher risk of an increased number of pDDIs.