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Diabetic Retinopathy (DR) poses a critical health concern, affecting millions of individuals globally, particularly in light of the increasing prevalence of diabetes. Early diagnosis and treatment can prevent vision loss in up to 95% of DR patients. However, the shortage of ophthalmologists, coupled with the limitations of traditional DR diagnostic methods, necessitates innovative solutions to provide timely and accessible DR screening and diagnosis, especially in underserved regions. In this study, we present a deep learning (DL) based framework for DR screening, with a specific focus on its suitability for resource-constrained edge devices. Our methodology is built upon addressing five key research questions to enhance the model's accuracy, ensure scalability, establish robustness, optimize computational complexity, and provide a thorough performance comparison with existing models. The developed framework attains a very high accuracy of 98.4%, accompanied by a sensitivity of 95.6% and a specificity of 98.6%. It not only exhibits efficient resource utilization, with a 40-fold improvement in the accuracy-to-size ratio, but also excels with minimal CPU and GPU inference times, and low memory requirements. Our proposed framework combines enhanced accuracy and faster inference times with a lean DL model. Its adaptability facilitates inferences on edge devices in remote areas, even when cloud connectivity is intermittent. Looking forward, our focus will be on enhancing model generalization through cross-validation and hybrid databases, integrating security through federated learning, and implementing adaptive learning to ensure the model's continued relevance in evolving healthcare scenarios. This work represents a significant contribution to the field of DR screening, providing an accessible and efficient solution for mass screening, particularly in regions with limited access to healthcare resources. [ABSTRACT FROM AUTHOR]

Specific language impairment (SLI) is a developmental disorder with substantial genetic contributions. A genome-wide linkage analysis and homozygosity mapping were performed in five consanguineous families from Pakistan. The highest LOD scores of 2.49 at 12p11.22-q11.21 in family PKSLI-31 and 1.92 at 6p in family PKSLI-20 were observed. Homozygosity mapping showed a loss of heterozygosity on 1q25.3-q32.2 and 2q36.3-q37.3 in PKSLI-20. A loss of heterozygosity mapped, in PKSLI-31 and PKSLI-34 flanks, NFXL1 and CNTNAP2, which are genes previously identified in SLI. Our findings report novel SLI loci and corroborate previously reported SLI loci, indicating the utility of a family-based approach. [ABSTRACT FROM AUTHOR]

Tin selenide (SnSe)-based solar cells are gaining significant interest from researchers due to their exceptional semiconductor properties. The primary aim of this study is to enhance the performance of the newly proposed Cu/FTO/CdS/SnSe/Sb2Se3/Au solar cell and to analyze the effects of the Sb2Se3 second absorber layer and CdS buffer layer on key performance metrics such as open circuit voltage (VOC), short circuit current density (JSC), fill factor (FF), and power conversion efficiency (PCE). SCAPS-1D simulation software was used for this investigation. Various factors were examined to improve performance, including the impacts of thickness variation, carrier concentration, bulk defect concentration in each layer, interface defects, operating temperature, and the placement of front and rear electrodes. The reference structure (Cu/FTO/CdS/SnSe/Au) showed a PCE of 26.15%, VOC of 0.79 V, JSC of 36.36 mA/cm2, and FF of 85.94%. By adding the Sb2Se3 layer as a second absorber in the proposed structure (Cu/FTO/CdS/SnSe/Sb2Se3/Au), the performance improved to a PCE of 28.18%, VOC of 0.84 V, JSC of 38.42 mA/cm2, and FF of 86.57%. This study offers valuable insights and a practical approach to developing economically viable SnSe-based thin-film solar cells. [ABSTRACT FROM AUTHOR]

Speech is the most common means of communication in humans. Any defect in accurate speech production ability results in the development of speech sound disorder (SSD), a condition that can significantly impair an individual's academic performance, social interactions, and relationships with peers and adults. This study investigated the genetic basis of SSD in three Pakistani families. We performed family-based genome-wide parametric linkage analysis and homozygosity mapping in three consanguineous families with SSD from the Punjab province of Pakistan. The Test for Assessment of Articulation and Phonology in Urdu (TAAPU) was used to analyze the speech articulation data and determine the Percentage Correct Consonants (PCC) score. The PCC score defined the affected and unaffected individuals in each family. Parametric linkage analysis revealed a linkage to chromosome 5 (5q21.3-5q23.1) with a significant logarithm of the odds (LOD) score of 3.13 in a Pakistani family with specific language impairment-97 (PKSLI-97) under an autosomal recessive mode of inheritance. The other two families showed a suggestive linkage at 6p22.1, 14q12, and 16q12.1 under the recessive mode of inheritance. Interestingly, homozygosity mapping showed a loss of heterozygosity in the linkage region at 5q15-5q23.1, shared among seven affected (mostly in the younger generation) and one unaffected individual of PKSLI-97. Our analysis identified the 6p22 locus previously implicated in dyslexia, childhood apraxia of speech (CAS), and language impairment, confirming the role of KIAA0319 and DCDC2 in this locus. These findings provide statistical evidence for the genomic regions associated with articulation disorder and offer future opportunities to further the role of genes in speech production. [ABSTRACT FROM AUTHOR]

Introduction: Early diagnosis of tuberculosis (TB) and universal access to drug-susceptibility testing (DST) are critical elements of the WHO End TB Strategy. Current rapid tests (e.g., Xpert® MTB/RIF and Ultra-assays) can detect rifampicin resistance-conferring mutations, but cannot detect resistance to Isoniazid and second-line anti-TB agents. Although Line Probe Assay is capable of detecting resistance to second-line anti-TB agents, it requires sophisticated laboratory infrastructure and advanced skills which are often not readily available in settings replete with TB. A rapid test capable of detecting Isoniazid and second-line anti-TB drug resistance is highly needed. Methods: We conducted a diagnostic accuracy study to evaluate a new automated Xpert MTB/XDR 10-colour assay for rapid detection of Isoniazid and second-line drugs, including ethionamide, fluoroquinolones, and injectable drugs (Amikacin, Kanamycin, and Capreomycin). Positive Xpert MTB/RIF respiratory specimens were prospectively collected through routine diagnosis and surveillance of drug resistance at the Central TB Reference Laboratory in Tanzania. Specimens were tested by both Xpert XDR assay and LPA against culture-based phenotypic DST as the reference standard. Findings: We analysed specimens from 151 TB patients with a mean age (SD) of 36.2 (12.7) years. The majority (n = 109, 72.2%) were males. The sensitivity for Xpert MTB/XDR was 93.5% (95% CI, 87.4–96.7); for Isoniazid, 96.6 (95% CI, 92.1–98.6); for Fluoroquinolone, 98.7% (95% Cl 94.8–99.7); for Amikacin, 96.6%; and (95% CI 92.1–98.6) for Ethionamide. Ethionamide had the lowest specificity of 50% and the highest was 100% for Fluoroquinolone. The diagnostic performance was generally comparable to that of LPA with slight variations between the two assays. The non-determinate rate (i.e., invalid M. tuberculosis complex detection) of Xpert MTB/XDR was 2·96%. Conclusion: The Xpert MTB/XDR demonstrated high sensitivity and specificity for detecting resistance to Isoniazid, Fluoroquinolones, and injectable agents. This assay can be used in clinical settings to facilitate rapid diagnosis of mono-isoniazid and extensively drug-resistant TB. [ABSTRACT FROM AUTHOR]

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Background: Eliminating hepatitis B virus (HBV) is a significant worldwide challenge requiring innovative approaches for vaccination, screening, disease management, and the prevention of related conditions. Programs that support patients in accessing needed clinical services can help optimize access to preventive services and treatment resources for hepatitis B. Methods: Here, we outline a coordinator-supported program (HBV Pathway) that connects patients infected with HBV to laboratory testing, imaging, and specialty care for treatment initiation and/or liver cancer surveillance (screening of high-risk patients for liver cancer). This study describes the HBV Pathway steps and reports sociodemographic factors of patients by initiation and completion. Results: Results showed a 72.5% completion rate (defined as completing all Pathway steps including the final specialty visit) among patients who initiated the Pathway. Differences in completion were observed by age, race, ethnicity, and service area, with higher rates for younger ages, Asian race, non-Hispanic ethnicity, and lower rates for patients within one service area. Of those who completed the specialty visit, 59.5% were referred for hepatocellular carcinoma surveillance. Conclusions: The HBV Pathway offers dual benefits– care coordination support for patients to promote Pathway completion and a standardized testing and referral program to reduce physician burden. This program provides an easy and reliable process for patients and physicians to obtain updated clinical information and initiate treatment and/or liver cancer screening if needed. [ABSTRACT FROM AUTHOR]

Pyrazinamide, an antituberculosis but documented toxic drug, is subjected to computational investigation along with the metal complexes via a DFT approach to predict the structure-activity and structure-toxicity relationship. 6-31G(d,p) basis set was used for Zn, Ni, Mn, Fe, and Co, while the SDD basis set was applied to Cu, Cr, Cd, and Hg. Several reactivity parameters and charge distribution were calculated and the reactivity profile was estimated. The complexes were found to be soft and polarizable which could be responsible for their binding with bacterial targets to inhibit their growth. In contrast, pyrazinamide which is found to be hard among all is susceptible to being toxic. Moreover, the electronegative nature of the complexes can endow them with a better antibacterial effect. Since metal complexes have been found to be less toxic and more biologically interactive by computational methods, they can be employed as potent drugs for the cure of tuberculosis. [ABSTRACT FROM AUTHOR]

The objective of this study is to develop an improved shoe insole that enhances heat and moisture transmission (thermo-physiological comfort) qualities, as well as its mechanical characteristics, through the utilization of weft knitting spacer fabric. Two samples were prepared. One sample was comprised of Tri-Blend knitted fabric layers, while the other sample was made using cotton knitted fabrics in both layers. These layers, in both samples, were connected by spacer yarns of monofilament nylon. Tri-blend fabric was made from Bamboo (80%), flax (15%), and polypropylene (5%). Monofilament nylon was used in spacer layer. Thermo-physiological comfort testing i.e., air permeability, moisture management and thermal resistance test were performed for all the samples. The investigation also established the correlation between the mechanical properties, such as puncture resistance and tactile comfort, of footwear materials and their interaction with the human body. The prepared samples of shoe insole were also compared with the commercially available insoles made from synthetic materials. The outcome of the study suggests that the natural fiber spacer fabric can be used as an alternative to rubber. In conclusion, the results of this study offer valuable insights for product developers seeking sustainable alternatives that can meet consumer demands for both wearability and comfort. [ABSTRACT FROM AUTHOR]

Objective: Anorexia nervosa (AN) is a serious eating disorder treated using psychological interventions, yet outcomes remain limited. Emotional difficulties are recognised as a treatment target. This research programme developed and evaluated feasibility of an emotion‐focused therapy for adults with AN. Methods: Phase One intervention development utilised 'intervention mapping'. Qualitative research drew on lived experience highlighting objectives for change. Empirical evidence was synthesised into hypotheses of core emotional difficulties and an associated model of change. Relevant psychotherapeutic theory‐based change methods were integrated to form the Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS) intervention, guidebook and clinician training package. Phase Two tested SPEAKS in a single‐arm, multisite feasibility trial across two specialist services, utilising prespecified progression criteria, and embedded process evaluation. Results: SPEAKS was 9–12 months (40 sessions) of weekly individual psychotherapy, drawing on a range of psychotherapeutic modalities, predominantly Emotion Focused Therapy and Schema Therapy. Forty‐six participants consented to feasibility trial participation; 42 entered the trial and 34 completed. Thirteen of 16 feasibility criteria were met at green level and three at amber, highlighting areas for improving model adherence. Conclusions: A randomised controlled trial is indicated. Therapist training and guidebook adjustments to improve model adherence are suggested. Highlights: Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex is an emotion‐focused intervention for adults with Anorexia nervosa following a proposed causal model of emotion change. Theory, tasks and techniques integrate Emotion Focused Therapy and Schema Therapy, alongside other modalities, to facilitate the proposed change processes.SPEAKS was developed using a clear 'intervention mapping' process, utilising mixed methods and seeking to engage and learn from those with lived experience.This feasibility trial suggests SPEAKS is an acceptable, engaging and clinically feasible intervention and progression to a larger randomised controlled trial is indicated. [ABSTRACT FROM AUTHOR]

Objective: Investigate the acceptability of Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS), a novel intervention for anorexia nervosa (AN), conducted as a feasibility trial to provide an initial test of the intervention. Methods: SPEAKS therapy lasting 9–12 months was provided to 34 people with AN or atypical AN by eight specialist eating disorder therapists trained in the model across two NHS Trusts in the UK (Kent and Sussex) during a feasibility trial. All participants were offered a post‐therapy interview; sixteen patients and six therapists agreed. All patient participants were adult females. Interviews were semi‐structured and asked questions around individuals' experience of SPEAKS, the acceptability of the intervention and of the research methods. Interviews were analyzed using thematic analysis. Results: Key areas explored in line with research questions led to 5 overarching themes and 14 subthemes: (1) shift in treatment focus and experience, (2) balancing resources and treatment outcomes, (3) navigating the online treatment environment, (4) therapist adaptation and professional development, and (5) research processes. Discussion: SPEAKS was found to be an acceptable intervention for treating AN from the perspective of patients and therapists. The findings provide strong support for delivery of a larger scale randomized control trial. Recommendations for future improvements, particularly pertaining to therapist understanding of the treatment model are detailed, alongside broader clinical implications. Public Significance: We aimed to evaluate the acceptability of a new anorexia nervosa treatment called SPEAKS. Interviews were conducted with patients and therapists involved in the pilot study and responses were analyzed. Results showed that both patients and therapists found SPEAKS to be an acceptable treatment for anorexia nervosa. The study suggests that SPEAKS meets the criteria for moving forward with a larger trial to assess its effectiveness. [ABSTRACT FROM AUTHOR]

The tourism sector has experienced expansion, diversification, and intensification of sustainable management as one of the largest and fastest growing economic sectors in the world because it is developed in an integrated manner based on contextual or conventional marketing and virtual marketing, called digital marketing at once. This Conference Paper analyzes and explains the importance of contextual marketing as the basis of the value creation process for the development of integrated tourism destinations. The data, information, and knowledge regarding the focus on the research locus in the Province of South Sulawesi Indonesia were obtained through observations of several leading tourism destinations along with the author’s experience of visiting tourist destinations in the country and abroad as benchmarking. In addition, interviews and focus group discussions were conducted with stakeholders on tourism destinations. Qualitative descriptive analysis was carried out following an interactive model which included data collection, data condensation, data presentation, and verification or concluding. The results of the study found that the development of integrated tourism destinations based on contextual marketing strategies is related to generic marketing functions that are applied to strengthen tourism functions as a leading sector of sustainable multi-dimensional development. The development is carried out contextually or conventionally and virtually or referred to as tourism marketing in the air while still revitalizing the content, context, and infrastructure of tourism marketing. The success of integrated tourism development in the eyes of the public can be seen from the existence of social learning and knowledge creation processes that form a harmonious partnership-collaborative relationship in a Hexa-helix pattern. The basic values and value orientation of integrated tourism destination development both contextually and virtually or digitally marketing can be achieved when togetherness has become a necessity that is practiced. The effectiveness of its implementation is carried out - at least - through the 7-C’s public relations communication (PRC) approach which consists of credibility, context, content, clarity, continuity and consistency, channels, and capability of the audience as the basis of digital marketing. [ABSTRACT FROM AUTHOR]

Background: Acute upper‑limb ischemia (AULI) is not always as limb‑threatening as those in the leg, so thrombo‑embolectomy is not always as necessary for limb salvage. Objective: To evaluate “the outcomes of limb and life at the end of one month, in patients with AULI” and to analyze the following factors: presentation from the time of the acute event, evaluation of limb at the time of presentation regarding its viability, and compare the outcomes in early presentation vs late presentation. Methodology: This was a retrospective study; hence, clinical profiles of all patients during the past seven years were reviewed for those presenting with AULI. Data on anticoagulation were collected, imaging and operative procedures were extracted. All statistical analyses were performed using SPSS 11.0 for Windows. Results: In our study, 25 (42.4%) patients were included due to native arterial thrombosis, 11 (18.6%) due to embolic disease, and the same percentage due to exposure to a high‑altitude area (HAA) (more than 9000 feet). 4 (6.8%) patients had thoracic outlet syndrome and cervical rib, and 5 (8.5%) had hypercoagulable disorder. Our study population was younger with a mean of 44.9 years with an SD of 13, and the majority were male (5 out of 59 were female). 16 were active smokers, and 2 were former smokers. The left upper limb incidence was 59% (n = 35), and the right upper limb was 41% (n = 24). In our study, the most common site was the brachial artery 53% (26 out of 49) and axillary artery 35% (17 out of 49) when iatrogenic, traumatic, and thoracic outlet syndromes are excluded. Out of the 59 patients, 39 patients had undergone color Doppler flow imaging of the affected limb and 30 patients had undergone CT angiography of the arch and the limb. Two patients presented with gangrene to the forearm, and 12 patients underwent Colour doppler flow imaging (CDFI) before they presented to our center. In our study, 37% of the patients presented within 48 hours of the onset of symptoms, out of which above‑elbow amputation was done in only 1 patient, that is, 4.5%, and 24% of the patients presented within an 8–14‑day period, among which one patient (11%) had undergone above‑elbow amputation and 22% of the patients presented after 14 days, in which there were 2 above‑elbow‑amputation patients (15%) with a statistically non‑significant P value of 0.5. A total of 45 patients were managed with anticoagulation. A detailed discussion on the treatment outcome of each case has been presented in the article. Conclusion: CT angiography, when available, is a well‑accepted first‑line investigation for AULI. When we compare AULI with lower‑limb ischemia, collateral circulation conservative management is also an option, provided that it is not associated with tissue loss. AULI like lower‑limb ischemia has better limb salvage when diagnosed and intervened early. [ABSTRACT FROM AUTHOR]

Compression sportswear is specialized clothing chiefly designed for the athletes muscle fatigue reduction. Compression stockings are widely used in sportswear to support muscles and control excessive body vibrations. Compression/interface pressure between the wearer and stocking's surface is considerable in compression sportswear efficacy. However, thermo-physiological comfort is also influential while preparing summer sportswear. The research investigates the effect of fibers type and the inlay yarns number of covering filaments on compression, air permeability, water vapor permeability, and thermal resistance of sportswear compression stockings. Three different fibers, sorbtek (channelized polyester), nylon 6, and micro Nylon (polyamide-6), have been used as main yarns. Also, three distinct levels of covering yarn number of filaments have been utilized. Data have been statistically analyzed using full factorial design of experiment and regression analysis to predict fiber type and the number of covering yarn filaments for achieving desired comfort properties without compromising compression characteristics. [ABSTRACT FROM AUTHOR]

The evolution of sports coach education programs on a global scale is a dynamic and ever-improving process. This study aimed to scrutinize the characteristics, overarching development trends, and structure and content of sports coach education programs. The research involved 46 experts, each with a minimum of 8 years of coaching experience across 12 diverse sports, who participated in a comprehensive survey. Information retrieval relied on specialized scientific databases, utilizing keywords such as "coaching," "sport coaches," "program," and "education program." A total of 4539 publications were identified, with 501 selected for inclusion in this research. The study's findings reveal discernible variations in the global practice of training sports coaches, encompassing differences in program structure, content, duration, and qualification evaluation criteria. Despite these differences, a common thread unites sports coaching education programs worldwide, reflecting shared features, structures, and content. The field has matured into a prestigious domain with recognized importance in the social, scientific, and academic spheres. These results offer valuable insights for the development and effective implementation of sports coach training programs, contributing to the ongoing refinement of coaching practices globally. [ABSTRACT FROM AUTHOR]

Antimony (Sb) chalcogenides, particularly antimony selenide (Sb2Se3), have gained attention as promising semiconductor materials in order to creat and advancement of competitive solar cells. These materials exhibit a range of desirable qualities, such as excellent absorption rate, ability to modify band gap, and plentiful in the crust of the earth. This article describes an antimony selenide (Sb2Se3) absorber based high-efficient thin film solar cell (TFSC) with copper oxide (Cu2O) as as back surface field (BSF) by dint of Al/ITO/TiO2/Sb2Se3/Cu2O/Ni heterostructure using SCAPS-1D Simulator. This research entails an in-depth assessment of various physical and electrical characteristics of every solar active semiconductorof TiO2,Sb2Se3, and Cu2O covering the thickness of each layer, concentration of carrier doping, defect density in the bulk and at the interface, carrier generation rate together with recombination. Initially, the variation in photovoltaic parameters of open circuit voltage (Voc), short-circuit current density (Jsc), fill factor (FF), power conversion efficiency (PCE), and quantum efficiency (QE) investigated without the BSF layer, followed by a comprehensive analysis on the role of Cu2O BSF layer for enhancing cell's performance explored systematically. The proposed heterostructure shows improved PCE of over 32% (which was 21% without BSF) with JSC of 37.492 mA/cm2, VOC of 1.024 V, and FF of 83.595%. Thus, the utilisation of a heterostructure comprising Sb2Se3 absorber and copper oxide Cu2O BSF layer demonstrates significant promise in the development and production the high-efficiency greenery thin-film solar cells (TFSCs). [ABSTRACT FROM AUTHOR]

Background: Renal resistive index is a recognised and early indicator of type II diabetes mellitus-related cardiovascular risk as well as diabetic nephropathy. Aim: To determine the relationship between resistive index and estimated glomerular filtration rate of subjects with diabetic nephropathy and to determine the frequency of occurrence of high resistive index in subjects with diabetic nephropathy. Material and methods: The present cross sectional study entitled to study the correlation of renal resistive index and estimated glomerular filtration rate in diabetic nephropathy was conducted on 50 patients of type 2 diabetes mellitus with the diabetic nephropathy with reduced renal function (stage G1-G5), attending outdoor department or admitted in Medicine Department of Guru Nanak Dev Hospital, attached to Government Medical College, Amritsar. Results: Out of 50 patients, females comprise 22 (44%) and males 28 (56%). The mean egfr in patients with RI <0.7 was 28.5 and in patients with >0.7 was 20.1. The difference was significant (P< 0.05). The mean RI in patients with CKD stage 2 was 0.65, in patients with stage 3was 0.69, in patients with stage 4 was 0.74 and in patients with stage 5 was 0.78. A significant difference was observed (P< 0.05). Conclusion: Renal RI could be a useful complementary test for the evaluation of functional alterations in renal hemodynamics in the early stages of diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Background: Acute limb ischemia (ALI) can be defined as sudden deterioration in limb perfusion, often producing new or worsening symptomatology and usually threatening limb viability. The incidence of ALI is approximately 1.5 cases per 10,000 persons per year. Objective: The main objective of the study is to assess the spectrum of ALI and effective management options in a tertiary care center. Methodology: This was a retrospective and prospective observational study. All patients admitted in tertiary care center with ALI were included in this study. The medical records of patients admitted since last three years were collected retrospectively and the data of patients with ALI getting admitted during next one year was collected simultaneously. Patients who were included prospectively were followed for at least one month. Results: In the study period, we received 136 patients with 138 ALI (ALI presenting with 14 days = 95, ACLI = 17, ALI with delayed presentation = 26). Average age of patients was 47.4 years. 21 to 40 years age group made the largest cohort of 56 patients. 10.79% of the lower limb ischemia were female (15 out of 136). Among these categories, the outcomes depend upon the time of presentation (earlier presentation has the better outcomes in terms of limb salvage). The delayed presentation of ALI has poorer outcome of amputation whereas mortality rates are higher in ALI presenting early. Patency in ALI is better due to embolus. Outcome of ALI due to embolus are best followed by acute thromboembolic occlusion without pre-existing CLI. The worst outcomes in amputation are for ACLI when they present late. Etiology wise Cardio embolic group comprised as the commonest cause; High Altitude Thrombosis also is very significant in our setting. Class II B ischemia which is most surgically amenable, and the amputation rate is 20%. Conclusion: In our study, outcome of various modalities of management of ALI has been evaluated. Our study provided data which could be accessed to define the outcome and most amenable to any useful intervention affecting outcome in patients of limb ischemia. Revascularization in ALI is aimed not only to prevent amputation but also to limit the level of amputation which is a forgotten aspect of salvage procedure in lower extremity. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical spectrum of MDR and XDR typhoid fever in different age groups of pediatric population as the disease is generally more common in children with higher rates of complications and mortality. Study Design: Prospective Cross-sectional study. Setting: Department of Pediatric, Government Teaching Hospital Shahdara, Lahore. Period: July 2020 to July 2021. Material & Methods: 211 patients with suspected/confirmed enteric fever between 6 months to 5 years were initially enrolled. Blood culture was performed in all cases. Only culture confirmed cases (143/211) were included. Data was entered and analyzed using SPSS version 23. Quantitative variables like age group, fever defervescence time and duration of hospital stay were calculated as mean and standard deviations while qualitative variables like gender, clinical symptoms and signs, types of typhoid and response to antibiotics were calculated as percentages. Chisquare test was used taking P value <0.05 as statistically significant. Results: Mean age of study population was 6.8 ± 3.1 years. Majority (44.1%) of patients belonged to age group >5-10 years and were males (54.5%). Anorexia, coated tongue and hepatomegaly was prevalent among all age groups. High grade fever, loose motions and splenomegaly were common in children <5 years as were anemia, leukocytosis and enteric hepatitis. Children >5-10 years of age had more frequency of abdominal pain (P value <0.03), toxic look (P value <0.04) and leucopenia. While vomiting and thrombocytopenia were common in children >10-15 years of age. MDR typhoid was common in young children (<5 years) while XDR typhoid was common in children of >5-15 years. All MDR patients responded to ceftriaxone while XDR patients responded to either monotherapy or a combination of drugs. Age and gender did not affect antibiotic resistance in both MDR and XDR typhoid (P value >0.05). Fever defervescence time (FDT) was 3-5 days in both MDR and XDR typhoid and it was not significantly different with either monotherapy or a combination of drugs (P value 0.40). Conclusion: There are age related differences in clinical spectrum and lab parameters of drug resistant typhoid fever (MDR & XDR). Resistance to antibiotics in both MDR and XDR typhoid was not significantly affected by age and gender. [ABSTRACT FROM AUTHOR]

Background: Several previous studies have suggested a positive association between Alopecia Areata and thyroid disorders. However, there is a paucity of such studies in our country. Our study aimed to know the frequency of thyroid dysfunction and thyroid autoimmunity in patients reporting to Dermatology Outdoors with Alopecia Areata (AA) and to compare it with normal controls. Methods: This was a Case-Control study conducted at the Dermatology outpatient of a tertiary care hospital in Pakistan. 102 patients with AA and 102 age and sex-matched controls were enrolled. The age of onset of the disease, the involved sites and the presence of other associated diseases were noted. Venous blood samples were taken from patients and controls for Thyroid function tests and Anti-Thyroid peroxidase antibodies (Anti-TPO Ab). The data was analyzed using Statistical Package for Social Sciences (SPSS) version 23. Results: The mean age of onset of the disease was 30.37±12.53. 91.2% of patients had the classic patch type of AA. The most commonly involved site was Scalp. Associated diseases were found in eight (7.8%) patients. Thyroid dysfunction was found in two patients and none of the Controls. Both the patients had Subclinical thyroid disease. The p-value was 0.157, which was not statistically significant. Thyroid autoimmunity (raised Anti-TPO Ab titre) was detected in five (4.90%) patients and none of the Controls. The p-value was 0.024, which was statistically significant. Conclusion: AA is significantly associated with Thyroid autoimmunity but there is no significant association between AA and clinical or subclinical thyroid disease. [ABSTRACT FROM AUTHOR]

Dental Cones are little pills that are used after tooth extraction to reduce bleeding and halt the formation of germs. They should be made to dissolve or erode during a 20-40-minute period in the presence of a modest volume of serum or fluid. To determine if the local administration into the periodontal pocket could help in boosting medication concentration and reducing systemic adverse effects. d-PTFE membranes, painkillers, mouthwash, sutures, and CT scanners are some of the techniques employed in dental extraction and biomaterial insertion procedures. For this study, 39 Articles in total were included and examined. By having antibacterial, anti-inflammatory, and antioxidant properties, local drug delivery methods can aid in the management of periodontitis. [ABSTRACT FROM AUTHOR]

Background: After an intensive care unit (ICU) admission, nearly 20% of survivors of chronic critical illness require admission to a long-term acute care hospital (LTACH) for continued subspecialty care. The effect of the burden of medical comorbidities on discharge disposition after LTACH admission remains unclear. Methods: A retrospective cohort study was performed involving patients with chronic critical illness who were discharged from the medical ICU and admitted to an LTACH between 2016 and 2018. The patients' Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Nutrition Risk in the Critically Ill (NUTRIC), and Charlson Comorbidity Index (CCI) scores at the time of LTACH admission were calculated from electronic medical records. The mean scores on each instrument were compared by discharge disposition. Results: A total of 156 patients were admitted to the LTACH from the medical ICU between 2016 and 2018. They had a mean (SD) age of 61.5 (13.3) years, a mean (SD) body mass index of 28.1 (8.3), a median (IQR) ICU stay of 16.3 (1-108) days, and a median (IQR) LTACH stay of 38.2 (1-227) days. Patients who were discharged home had lower mean (SD) APACHE II (14.6 [5.0] vs 18.2 [5.4], P =.01), SOFA (3.3 [2.1] vs 4.6 [2.1], P =.03), NUTRIC (3.3 [1.4] vs 4.6 [1.4], P =.001), and CCI (4.3 [2.5] vs 6.1 [2.8], P =.02) scores on admission to the LTACH than those who were not discharged home. Conclusion: Severity-of-illness scores on admission to an LTACH can be used to predict patients' likelihood of being discharged home. [ABSTRACT FROM AUTHOR]

The biological evaluation of coordination complexes is an active research area ascribed to structural modification and synergistic action due to metal ions. The mononuclear complexes of Zn(II) and Mn(II) piroxicam were evaluated for their encyclopedic biological activities, DFT, and docking exploration. Different antioxidant methods were used to assess their antioxidant potential. DNA cleavage and protein binding properties of the complexes were monitored through gel electrophoresis and UV‐visible spectrophotometry. The low IC50 value of both complexes implies more potency than the piroxicam. The percent cleavage and binding constant values indicated that the complexes bind with DNA and BSA more efficiently than the piroxicam. In SD rats, complexes were screened for analgesic, anti‐anxiety, anti‐inflammatory, and anti‐hyperglycemic effects. The complexes demonstrated statistically significant results for in‐vivo analysis. Photodegradation results of the metal complexes under UV lamp exhibited abrupt degradation than the piroxicam. Docking results also validate a better propensity of both complexes to bind with DNA and BSA. Hydrogen bonding and Van der Waals forces play a key role in stabilizing complexes in DNA and BSA binding pockets. These metal complexes have evident therapeutic potential more than piroxicam and could be promising drugs for relieving pain, anxiety, inflammation, and associated comorbidities with good pharmacodynamic properties. [ABSTRACT FROM AUTHOR]

Background: Autopsy or necropsy means postmortem examination of a dead body. In each and every case, the autopsy must be complete, all the body cavities should be opened, and every organ must be examined because evidence contributory to the cause of death may be found in more than one organ. Partial autopsies have no place in forensic pathologic practice. Aims and objectives: The aim of the study was to find out the profile of the autopsies reported, manner of death, whether accidental, suicidal or homicidal cause of death, whether natural or unnatural and time since death. The objective was to observe the overall pattern of the autopsy cases in this region of the state. Results: Majority of cases reported were in the age group of 40-49 years were 70 (22.2%) cases, followed by the age group of 30-39 years which had 68(21.6%) cases and 64(20.2%) cases in the age group of 20-29 years. 277(87.6%) were males followed by females 38(12.1%). Majority of the population belonged to the Sikh religion in 149 (47.2%) cases followed by Hindus. Majority of cases 84(26.6%) had time since death of 12 to 24 hours followed by 80(25.3%) having time since death of 3 to 5 days. Conclusion: Autopsy plays a pivotal role in assessing cause of death, time since death, mode, manner and mechanism of death, thus helps in dispensation of justice in medicolegal cases. Multi-disciplinary study would yield far reaching results and would be better informative. Number of unidentified cases can be reduced by introducing more personal identification parameters in police investigation. [ABSTRACT FROM AUTHOR]

The present study evaluates the impact of the COVID-19 lockdown on the water quality of a tropical lake (East Kolkata Wetland or EKW, India) along with seasonal change using Landsat 8 and 9 images of the Google Earth Engine (GEE) cloud computing platform. The research focuses on detecting, monitoring, and predicting water quality in the EKW region using eight parameters—normalized suspended material index (NSMI), suspended particular matter (SPM), total phosphorus (TP), electrical conductivity (EC), chlorophyll-α, floating algae index (FAI), turbidity, Secchi disk depth (SDD), and two water quality indices such as Carlson tropic state index (CTSI) and entropy‑weighted water quality index (EWQI). The results demonstrate that SPM, turbidity, EC, TP, and SDD improved while the FAI and chlorophyll-α increased during the lockdown period due to the stagnation of water as well as a reduction in industrial and anthropogenic pollution. Moreover, the prediction of EWQI using an artificial neural network indicates that the overall water quality will improve more if the lockdown period is sustained for another 3 years. The outcomes of the study will help the stakeholders develop effective regulations and strategies for the timely restoration of lake water quality. [ABSTRACT FROM AUTHOR]

Moringa oleifera is gaining popularity as multi-cut quality fodder in Pakistan because of its great nutritional value and biomass production. For successful quality biomass production, proper crop nutrition is vital especially during dry season. Therefore, the present study was conducted with the objective to explore the impact of variable doses of "nitrogen, phosphorus, and potassium (NPK)" fertilizer for maximum foliage production and improve the quality of moringa under field conditions. Three levels of NPK (No fertilizer, 25:25:50, and 50:50:100 kg ha−1) were applied in already established two years old moringa plants on 15 September 2016, at research area of University of Agriculture, Faisalabad-Pakistan. Dimension of each experimental unit was 3.5 × 5.5 m. After thirty days of fertilizer treatments, two cuttings were taken with the interval of 30 days. The experimental design was RCBD with factorial arrangements having three replications. Significant differences were observed in growth, biomass production, and quality of produce. The moringa plants treated with application of 50:50:100 kg NPK ha−1 produced maximum dry biomass with good quality (crude protein, fiber, fat, and ash%) during both cuttings. Nonetheless, first cutting produced more growth and biomass as compared to second cutting. While NPK supplementation increased 50% more biomass production and better quality compared to control in second cutting. Increased biomass production of moringa was associated with high chlorophyll contents, better antioxidant, and quality (crude protein, fiber, fat, and ash%) status with NPK supplementation. [ABSTRACT FROM AUTHOR]

Guillain‐Barre syndrome (GBS) is a rare autoimmune disease that often manifests as a post‐viral complication. However, its association with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is unclear. We present a rare case of GBS secondary to COVID‐19 infection complicated by rapidly progressive sensorimotor deterioration resistant to plasma exchange therapy. [ABSTRACT FROM AUTHOR]

This study aimed to find the association of receptive vocabulary in the development of speech and language among school-going children (4–13 years) with language disorders. On the basis of non-verbal receptive vocabulary and percentage correct consonants (PCC) scores, children from public schools in Punjab, Pakistan with speech and language issues were separated into three groups; Speech sound disordered (SSD, N = 15), Language Impaired (LI) comorbid with SSD (N = 42) and typically developed (TD, N = 15). Urdu version of Peabody picture vocabulary test, fourth edition (U-PPVT-4), Digit memory test (DMT), and Test for assessment of articulation and phonology in Urdu (TAAPU) were used to assess non-verbal receptive vocabulary, Short-term memory (STM), Working memory (WM), and SSD. Correlation and regression analyses were performed to find the association of receptive vocabulary with other measures used. Receptive vocabulary, STM, WM, omission, substitution, and PCC scores were significantly different (p < 0.01) when compared among LI+SSD, SSD, and TD groups. Regression analysis showed that receptive vocabulary was significantly associated with STM and WM in the LI+SSD group. A positive correlation was found between the U-PPVT-4 standard score with STM and WM for LI+SSD and SSD groups. Our findings in Urdu-speaking children suggested that STM and WM were less developed in children with speech and language impairments. Moreover, children with speech and language deficits not only had weaker receptive vocabulary but also attention should be given to improving STM and WM that contribute to LI. [ABSTRACT FROM AUTHOR]

In the present study, two new meloxicam complexes with Mg(II) and Sr(II) were synthesized and characterized by spectroscopic and analytical methods, that is, UV–vis, IR, 1H NMR, 13C NMR, powder XRD, SEM–EDX, and TG analysis. The biological evaluation was done by in vitro antioxidant, BSA‐binding, DNA cleavage activities, and in vivo anti‐inflammatory, analgesic, and anxiolytic methods. Furthermore, in silico docking was done with Keap1 receptor to visualize the anti‐inflammatory effect of complexes. The spectral characterization suggested that meloxicam coordinated with the metal ions by oxygen and nitrogen of amide group and thiazolyl ring (Oamide and Nthiazolyl), respectively. The SEM pictures depicted dissimilar morphologies, and the powder XRD patterns showed different crystallinities of complexes than meloxicam. TG analysis exhibited high thermal stabilities of complexes and Coats–Redfern method was employed to calculate the important thermodynamic parameters. The complexes showed effective biological activities and enhanced safety index (LD50 = 1000 mg kg−1). The Mg(II) complex revealed greatest inhibitory effects in carrageenan‐induced paw inflammation (92.85%) and in acetic acid‐induced writhing (71.05%). Furthermore, the complexes showed higher potential to bind with BSA and cleave the DNA as compared with the meloxicam. Moreover, molecular docking against Keap1 showed that Mg(II) complex inhibited Keap1 with highest docking score (6166 kcal mol−1), docking area (804.40) and ACE (−417.49 kJ mol−1) which explained its higher anti‐inflammatory effect. Mg(II) complex of meloxicam might be considered as a candidate anti‐inflammatory drug; however, more research is required to investigate their other biological potential. [ABSTRACT FROM AUTHOR]

Salt stress is a major problem at the global level and it is very important to utilize salt-affected soils using appropriate techniques. Growing halophytes on saline-sodic soil is a win-win strategy for getting economic crop production and conservation of soil resources. However, it is prerequisite to identify the cultivars which can be recommended for salt-affected soils considering physiological and biochemical responses under salt-stress. Therefore, sugar beet cultivars were characterized at seedling stage based on growth, physiological and biochemical parameters under different levels of salt stress. A hydroponic experiment was conducted using eight sugar beet cultivars (AMALDI, GELLERT, VANGELIS, VEDA, WYNNYK, SERENADA, CALIFORNIA and ALBINA VEREDUANA) and two salt stress levels (60 and 120 mM NaCl) in comparison with that of an untreated control. The plants were harvested ten days after giving salt stress. Cluster dendrogram and principal component analysis were the most appropriate methods for screening the suitable cultivar. Most of the sugar beet cultivars responded as resistant against salt stress, however, VEDA cultivar performed best against it. Thus, VEDA cultivar acquired highest position at 60 mM NaCl showing 6.4% plant biomass improvement as compared to control, while 2.1% reduction was recorded at 120 mM NaCl as compared to 60 mM NaCl. Additionally, this cultivar showed highest growth attributes, antioxidant activity with higher K+/Na+ ratio, hydrogen peroxide, phenolic and malondialdehyde content, indicating strong defense mechanism against salt induced oxidative and osmotic stress mainly owing to the best K+ and Na+ balance. It is concluded from this study that VEDA is the best salt-resistant cultivar with great potential to be grown on salt-affected soils and can be proceeded for field trials at various salt-stress levels. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Natural Fibers is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Runs of homozygosity (ROHs) analysis of controls provide a convenient resource to minimize the association of false positive results of disease-associated ROHs and genetic variants for simple and complex disorders in individuals from the same population. Evidence for the value of ROHs to speech or language-related traits is restricted due to the absence of population-matched behaviourally defined controls and limited family-based studies. This study aims to identify common ROHs in the Pakistani population, focussing on the total length and frequency of ROHs of variable sizes, shared ROHs, and their genomic distribution. We performed homozygosity analysis (in PLINK) of 86 individuals (39 males, 47 females) with no history of speech or language-related phenotypes (controls) who had been genotyped with the Illumina Infinium QC Array-24. ROHs of 1-<4 megabases (Mb) were frequent in unrelated individuals. We observed ROHs over 20 Mb among six individuals. Over 30 percent of the identified ROHs were shared among several individuals, indicating consanguinity's effect on the Pakistani population. Our findings serve as a foundation for family-based genetic studies of consanguineous families with speech or language-related disorders to ultimately narrow the homozygosity regions of interest to identify pathogenic variants. [ABSTRACT FROM AUTHOR]

Objective: Duplex ultrasound surveillance (DUS) is commonly used following infrainguinal vein bypass. The role of DUS following endovascular revascularisation is as yet unclear. This study focuses on the role of DUS in a contemporary group of patients undergoing infrainguinal bypass or stent insertion. Methods: All patients undergoing either an infrainguinal vein graft bypass or stent insertion into the femoro-popliteal segment (November 2014 - January 2017) were identified. Patients were followed up for 2 years. Data on entry into DUS, pre-operative characteristics, adjunctive pharmacotherapy and reintervention were collated. The primary outcomes were major lower limb amputation and mortality at 2 years post revascularisation. Results: One hundred and thirty-five patients underwent infrainguinal vein bypass and 100 patients underwent stent insertion. 107 patients in the bypass cohort and 58 patients in the stent cohort entered DUS. For the bypass cohort, entering DUS was associated with a lower mortality rate (P =.003) but was not associated with an improvement in amputation rates. The odds ratio of major amputation or mortality was greater in the no surveillance group (4.58, 95% CI: 1.855 – 11.364). In the stent cohort, DUS was not associated with a significant improvement in either major amputation or death (odds ratio 2.13 (95% CI 0.903 – 5.051; P =.081). Conclusion: DUS was associated with improved survival rates in patients undergoing lower limb bypass but had no benefit in those patients undergoing stent insertion. The role of DUS following stent insertion in the femoropopliteal segment needs to be better defined. [ABSTRACT FROM AUTHOR]

In this article, the authors have studied various robust features for acoustic modality based moving vehicle identification system. Due to non-stationary signal characteristics of the vehicle and its aerodynamics, the features become prominent parameters for vehicle identification in the outdoor environment. The proposed features are extracted from the experimentally generated dataset of moving vehicles. For computation of features, various feature extraction technique especially time domain, fast Fourier transform (FFT), short-time Fourier transform (STFT) and wavelets transform (WT) are applied on the vehicle's signal. The essential features from above mentioned techniques are determined by recursive feature elimination (RFE) method. Furthermore, these proposed features are examined by Pearson correlation coefficient as well as boxplot parameters. It is observed that the Pearson correlation coefficient values for FFT based features i.e., spectral flux, MFCC-5, MFCC-7 and MFCC-13 are 0.13, 0.018, − 0.0073 and − 0.006, respectively to discriminate among the feature set of bus and gypsy. The boxplot parameters of spectral flux and MFCCs shows that there is significant variation in the experimental datasets of bus, gypsy and background noise. The SVM classifier has achieved the higher identification accuracy, 90% and better performance measures on FFT based features as compared to other feature extraction techniques for vehicle identification in the outdoor environment. [ABSTRACT FROM AUTHOR]

Background: There is a clear link between skin disease and psychological factors and this relationship works both ways: skin diseases can cause psychological distress and psychological issues can worsen skin disease. There are a number of therapies that approach this problem from the psychological side and may be useful, especially as adjunctive therapies in select patients. Objective: The aim of this review was to determine the efficacy of various psychological therapies and mind–body techniques in the management of common dermatologic diseases in individuals of all ages. Methods: A systematic review of PubMed, Elsevier, and Wiley was performed for studies investigating psychological and mind–body interventions in the management of various skin diseases. Both physical and non-physical treatment outcomes were considered. Studies were evaluated for both risk of bias and overall quality of evidence. Results: A total of 40 articles studying unique sets of dermatological patients receiving psychological therapies or mind–body interventions were identified. Of the 40 included articles encompassing 3112 patients, 18 investigated these interventions in psoriasis management while 15 focused on atopic dermatitis. The remaining studies investigated vitiligo (2), pruritus (2), acne vulgaris (2), and acne excoriée (1). Conclusions: Based on the analysis of included studies and an assessment of their quality of evidence, the most promising interventions are cognitive behavioral therapy, mindfulness-based interventions, and habit reversal therapy. [ABSTRACT FROM AUTHOR]

Objective: To determine the levels and patterns of resistance to first- and second-line anti-tuberculosis (TB) drugs among new and previously treated sputum smear positive pulmonary TB (PTB) patients.Methods: We conducted a nationally representative cross-sectional facility-based survey in June 2017-July 2018 involving 45 clusters selected based on probability proportional to size. The survey aimed to determine the prevalence of anti-TB drug resistance and associated risk factors among smear positive PTB patients in Tanzania. Sputum samples were examined using smear microscopy, Xpert MTB/RIF, culture and drug susceptibility testing (DST). Logistic regression was used to account for missing data and sampling design effects on the estimates and their standard errors.Results: We enrolled 1557 TB patients, including 1408 (90.4%) newly diagnosed and 149 (9.6%) previously treated patients. The prevalence of multidrug-resistant TB (MDR-TB) was 0.85% [95% confidence interval (CI): 0.4-1.3] among new cases and 4.6% (95% CI: 1.1-8.2) among previously treated cases. The prevalence of Mycobacterium tuberculosis strains resistant to any of the four first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) was 1.7% among new TB patients and 6.5% among those previously treated. Drug resistance to all first-line drugs was similar (0.1%) in new and previously treated patients. None of the isolates displayed poly-resistance or extensively drug-resistant TB (XDR-TB). The only risk factor for MDR-TB was history of previous TB treatment (odds ratio = 5.7, 95% CI: 1.9-17.2).Conclusion: The burden of MDR-TB in the country was relatively low with no evidence of XDR-TB. Given the overall small number of MDR-TB cases in this survey, it will be beneficial focusing efforts on intensified case detection including universal DST. [ABSTRACT FROM AUTHOR]

Background: Third coronavirus disease 2019 (COVID-19) vaccine doses are broadly recommended, but immunogenicity data remain limited, particularly in older adults.Methods: We measured circulating antibodies against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein receptor-binding domain, ACE2 displacement, and virus neutralization against ancestral and omicron (BA.1) strains from prevaccine up to 1 month following the third dose, in 151 adults aged 24-98 years who received COVID-19 mRNA vaccines.Results: Following 2 vaccine doses, humoral immunity was weaker, less functional, and less durable in older adults, where a higher number of chronic health conditions was a key correlate of weaker responses and poorer durability. One month after the third dose, antibody concentrations and function exceeded post-second-dose levels, and responses in older adults were comparable in magnitude to those in younger adults at this time. Humoral responses against omicron were universally weaker than against the ancestral strain after both the second and third doses. Nevertheless, after 3 doses, anti-omicron responses in older adults reached equivalence to those in younger adults. One month after 3 vaccine doses, the number of chronic health conditions, but not age, was the strongest consistent correlate of weaker humoral responses.Conclusions: Results underscore the immune benefits of third COVID-19 vaccine doses, particularly in older adults. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Natural Fibers is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)