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Background: The incidence of urinary tract infections associated with Candida is increasing in Yemeni public hospitals., Objectives: The primary objective of this research was to isolate specific Candida species responsible for catheter-associated urinary tract infections (UTIs) and to examine the antifungal sensitivity of these Candida isolates., Patients and Methods: A total of 200 samples were collected from patients with catheters admitted to multiple hospitals of Thamar city (Yemen). There were 50 positive samples with Candida out of 200 samples. We conducted the primary identification process using the established protocols. Before isolation and identification, all yeast isolates underwent sub-culturing on Sabouraud dextrose agar. We employed the standard microbiological procedures such as Gram staining, colonial morphology analysis, lactophenol cotton blue assay, germ tube formation assessment, colony staining on chrom agar Candida medium, and incubation at 37 °C for 48 h. The assessment of cultures was conducted by evaluating their predominant species. All Candida isolates were tested for antifungal susceptibility using the disk diffusion technique, as indicated by the Clinical and Laboratory Standards Institute (CLSI) M44-A document recommendations., Results: In this study, the prevalence of Candida species obtained from catheter-associated UTIs was shown to be the highest among individuals aged 51-60 years (28.0%) and the lowest was among those aged 10-20 years (8.0%). Males exhibit higher rates than females, with males accounting for 56.0 and females for 44.0%, respectively. The predominant strain from catheters linked to urinary tract infections was Candida albicans. The Candida isolates had the highest susceptibility to itraconazole, with fluconazole and nystatin at sensitivity rates of 64, 60, and 50%, respectively. Amphotericin B and ketoconazole exhibited the most elevated concentrations. The p value of duration of catheterization < 5 was significant (p = 0.01), as well as significant in anti-fungal susceptibility testing of itraconazole, ketoconazole, and nystatin which are (p = 0.03), (p = 0.04), and (p = 0.03) respectively., Conclusion: Urinary tract infection due to candiduria was more common in patients with indwelling urinary catheter. The catheter-associated urinary tract infection caused by Candida species occurred mainly in old male patients. Candia albicans was the predominant Candida species isolated from urinary tract infection associated with urinary catheter at Thamar city hospitals. This study determined that diabetes and antibiotic use are significant predisposing factors associated with isolation of Candida in specimens submitted by patients at Thamar city hospitals., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objectives: The present study aimed to calculate the estimated size and confidence interval for the effects of adding visual aid to counselling on anxiety, stress and fear of patients undergoing upper gastrointestinal endoscopy. The secondary aim was to calculate confidence interval for endoscopy-related variables that predict which patients are likely to benefit from visual aids., Method: In a randomized, single-blind, two arm, parallel group, superiority trial, 232 consecutive patients who were scheduled to undergo either gastroscopy or colonoscopy were randomly divided into two intervention groups; counselling with video of endoscopic procedure and counselling with no-video ( n  = 116 in each group). Primary outcome was anxiety and secondary outcomes were stress and fear., Results: One-way ANCOVA showed that there was significant between group differences of anxiety, stress and fear after controlling for the effect of covariates. Planned contrasts revealed that counselling along with visual aid of endoscopy procedure significantly decreased anxiety [Mean difference at post; -4.26 (-4.47, -4.05), p < .001, partial η 2 = 0.88], stress [-5.35 (-5.63, -5.07), p  < .001, partial η 2 = 0.86] and fear [-2.82 (-2.97, -2.67), p < .001, partial η 2 = 0.86] compared to counselling alone. Linear regression showed that gender, nature of complaints and concern over seniority of endoscopist were significant negative predictors, however, satisfaction on briefing of endoscopy procedure was significant positive predictor of outcome variables in visual aid condition., Conclusion: The increase in anxiety, acute stress and fear related to endoscopic procedures can be alleviated with psychological counselling coupled with visual aids before the procedure. Visual aid could lead to supplementary benefits in reducing anxiety scores., Trial Registration: ClinicalTrial.gov Number: NCT05241158. Registered 16/11/2022; https://clinicaltrials.gov/ct2/show/NCT05241158KEY MESSAGESCounselling along with visual aid of endoscopy procedure significantly decreased anxiety, stress and fear as compared to counselling alone.Male patients were less stressed after visual aid intervention as compared to female patients. Patients who had chronic GI symptoms were less stressed after visual aid intervention as compared to those who had acute GI symptoms. Patients who had concern over seniority of endoscopist were less stressed after visual aid intervention as compared to those who had no concerns over seniority.Satisfaction on briefing of endoscopy procedure was significant positive predictor of stress and fear.

In an effort to develop a long-lasting gas sensor, this article presents titanium nitride (TiN) as a potential substitute sensitive material in conjunction with (copper(II) benzene-1,3,5-tricarboxylate) Cu-BTC-derived CuO. The work focused on the gas-sensing characteristics of TiN/CuO nanoparticles in detecting H 2 S gas at various temperatures and concentrations. XRD, XPS, and SEM were utilized to analyze the composites with varied Cu molar ratios. The responses of TiN/CuO-2 nanoparticles to 50 and 100 ppm H 2 S gas at 50 °C and 250 °C are 34.8 and 60.0, respectively. The related sensor had high selectivity and stability towards H 2 S, and the response of TiN/CuO-2 is still 2.5-5 ppm H 2 S. The gas-sensing properties as well as the mechanism are fully explained in this study. TiN/CuO might be a choice for the detection of H 2 S gas, opening up new avenues for applications in industries, medical facilities, and homes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Nano materials have found developing interest in biogenic approaches in the present times. In this study, metal oxide nanoparticles (NPs) such as cobalt oxide (Co 3 O 4 ), copper oxide (CuO), nickel oxide (NiO) and zinc oxide (ZnO), were synthesized using a convenient and rapid method. The structural features of synthesized metal oxide NPs were studied using various microscopic and spectroscopic techniques like SEM, TEM, XRD, FTIR and EDX. The characterization results confirmed that the prepared NPs possess highly pure, unique and crystalline geometry with size ranging between 10 and 20 nm. The synthesized nanoparticles were successfully employed for pharmacological applications. Enzyme inhibition potential of NPs was evaluated against the urease and tyrosinase enzymes. The percent inhibition for the urease enzyme was observed as 80 to 90% by using Co 3 O 4 , CuO, NiO and ZnO NPs while ZnO NPs were found to have best anti-urease and anti-tyrosinase activities. Moreover, effective inhibition was observed in the case of ZnO NPs at IC 50 values of 0.0833 and 0.1732 for urease and tyrosinase enzymes which were comparable to reference drugs thiourea and kojic acid. The lower the IC 50 value, higher the free radical scavenging power. Antioxidant activity by DPPH free radical scavenging method was found moderately high for the synthesized metal oxide NPs while best results were obtained for Co 3 O 4 and ZnO NPs as compared to the standard ascorbic acid. Antimicrobial potential was also evaluated via the disc diffusion and well diffusion methods. CuO NPs show a better zone of inhibition at 20 and 27 mm by using both methods. This study proves that the novel metal oxide NPs can compete with the standard materials used in the pharmacological studies nowadays., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: Improving handwashing with soap (HWWS) among children in humanitarian emergencies has the potential to reduce the transmission of several important infectious diseases. However, there is limited evidence on which approaches are effective in increasing HWWS among children in humanitarian settings. One recent innovation - the "Surprise Soap" intervention - was shown to be successful in a small-scale efficacy trial in a humanitarian setting in Iraq. This intervention includes soap with embedded toys delivered through a short household session comprising a glitter game, instruction of how and when to wash hands, and HWWS practice. Whilst promising, this approach has not been evaluated at programmatic scale in a complex humanitarian setting., Methods: We conducted a cluster-randomised controlled equivalence trial of the Surprise Soap intervention in IDP camps in Kahda district, Somalia. Proportionate stratified random sampling was employed to recruit 200 households, with at least one child aged 5-12, across the camps. Eligible households were randomly allocated to receive the Surprise Soap intervention (n = 100) or an active comparator handwashing intervention in which plain soap was delivered in a short household session comprising standard health-based messaging and instruction of how and when to wash hands (n = 100). The primary outcome was the proportion of pre-specified occasions when HWWS was practiced by children aged 5-12 years, measured at baseline, 4-weeks, 12 weeks, and 16 weeks post invention delivery., Results: HWWS increased in both groups (by 48 percentage points in the intervention group and 51 percentage points in the control group, at the 4-week follow up), however, there was no evidence of a difference in HWWS between the groups at the 4-week (adjusted RR (aRR) = 1.0, 95% CI 0.9-1.1), 12-week (aRR = 1.1, 95% CI 0.9-1.3), or 16-week (aRR = 1.0, 95% CI 0.9-1.2) follow-up., Conclusions: In this complex humanitarian setting, where soap availability and past exposure to handwashing promotion was low, it appears that well-designed, household-level targeted handwashing interventions that include soap provision can increase child HWWS and potentially reduce disease risk, but the Surprise Soap intervention offers no marginal benefit over a standard intervention that would justify the additional costs., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2023 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Background: There are limited randomized controlled trials with long-term outcomes comparing autologous chondrocyte implantation (ACI) versus alternative forms of surgical cartilage management within the knee., Purpose: To determine at 5 years after surgery whether ACI was superior to alternative forms of cartilage management in patients after a failed previous treatment for chondral or osteochondral defects in the knee., Study Design: Randomized controlled trial; Level of evidence, 1., Methods: In total, 390 participants were randomly assigned to receive either ACI or alternative management. Patients aged 18 to 55 years with one or two symptomatic cartilage defects who had failed 1 previous therapeutic surgical procedure in excess of 6 months prior were included. Dual primary outcome measures were used: (1) patient-completed Lysholm knee score and (2) time from surgery to cessation of treatment benefit. Secondary outcome measures included International Knee Documentation Committee and Cincinnati Knee Rating System scores, as well as number of serious adverse events. Analysis was performed on an intention-to-treat basis., Results: Lysholm scores were improved by 1 year in both groups (15.4 points [95% CI, 11.9 to 18.8] and 15.2 points [95% CI, 11.6 to 18.9]) for ACI and alternative, with this improvement sustained over the duration of the trial. However, no evidence of a difference was found between the groups at 5 years (2.9 points; 95% CI, -1.8 to 7.5; P = .46). Approximately half of the participants (55%; 95% CI, 47% to 64% with ACI) were still experiencing benefit at 5 years, with time to cessation of treatment benefit similar in both groups (hazard ratio, 0.97; 95% CI, 0.72 to 1.32; P > .99). There was a differential effect on Lysholm scores in patients without previous marrow stimulation compared with those with marrow stimulation ( P = .03; 6.4 points in favor of ACI; 95% CI, -0.4 to 13.1). More participants experienced a serious adverse event with ACI ( P = .02)., Conclusion: Over 5 years, there was no evidence of a difference in Lysholm scores between ACI and alternative management in patients who had previously failed treatment. Previous marrow stimulation had a detrimental effect on the outcome of ACI., Registration: International Standard Randomised Controlled Trial Number: 48911177.

Background Foreign body ingestion is a prevalent issue among children and presents considerable morbidity and mortality rates. Due to children's increased accessibility to electronic toys and equipment, foreign body ingestion has become a common reason for presenting to pediatric emergency departments worldwide. In this context, this research aims to determine the prevalence of foreign body ingestion among children in AlAhsa, Saudi Arabia. Methodology This observational retrospective descriptive study was conducted at Maternity and Children Hospital, AlAhsa, Saudi Arabia, from 2017 to 2021. The study included children (less than 14 years old) who presented to the emergency department with a history of foreign body ingestion. The biographical data, clinical presentation, type of foreign body, and X-ray findings were documented. Results A total of 91 cases of foreign body ingestion or aspiration in children under 14 years of age were included. Approximately half of the patients were under the age of three, and 62.2% of them were male, while 37.8% were female. The clinical presentation revealed that only 24% were symptomatic. Coins were the most commonly ingested foreign bodies (28.9%), followed by metallic objects (20%), and batteries were the least frequently ingested foreign bodies, recorded in eight cases. Conclusion Early detection and treatment of foreign body ingestion is crucial to prevent consequences. In this study, the most frequent foreign bodies detected were coins among children up to three years old. Raising parents' awareness about the prevention of foreign body ingestion is an important step toward reducing its incidence., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Al Ghadeer et al.)

Segmentation of patient-specific anatomical models is one of the first steps in Electrocardiographic imaging (ECGI). However, the effect of segmentation variability on ECGI remains unexplored. In this study, we assess the effect of heart segmentation variability on ECG simulation. We generated a statistical shape model from segmentations of the same patient and generated 262 cardiac geometries to run in an ECG forward computation of body surface potentials (BSPs) using an equivalent dipole layer cardiac source model and 5 ventricular stimulation protocols. Variability between simulated BSPs for all models and protocols was assessed using Pearson's correlation coefficient (CC). Compared to the BSPs of the mean cardiac shape model, the lowest variability (average CC = 0.98 ± 0.03) was found for apical pacing whereas the highest variability (average CC = 0.90 ± 0.23) was found for right ventricular free wall pacing. Furthermore, low amplitude BSPs show a larger variation in QRS morphology compared to high amplitude signals. The results indicate that the uncertainty in cardiac shape has a significant impact on ECGI.

Electrocardiographic Imaging (ECGI) is a promising tool to non-invasively map the electrical activity of the heart using body surface potentials (BSPs) and the patient specific anatomical data. One of the first steps of ECGI is the segmentation of the heart and torso geometries. In the clinical practice, the segmentation procedure is not fully-automated yet and is in consequence operator-dependent. We expect that the inter-operator variation in cardiac segmentation would influence the ECGI solution. This effect remains however non quantified. In the present work, we study the effect of segmentation variability on the ECGI estimation of the cardiac activity with 262 shape models generated from fifteen different segmentations. Therefore, we designed two test cases: with and without shape model uncertainty. Moreover, we used four cases for ectopic ventricular excitation and compared the ECGI results in terms of reconstructed activation times and excitation origins. The preliminary results indicate that a small variation of the activation maps can be observed with a model uncertainty but no significant effect on the source localization is observed.

The present study aimed to find out differences in health risk factors of COVID-19 among doctors, nurses and psychologists by determining the relationship of cognitive appraisal, coping styles, stress and fear among health professionals. Cross-sectional research design was used. Sample comprised of 3 groups; doctors, nurses and psychologists ( n  = 145 in each group) working in tertiary care hospitals. Stress appraisal measure, Brief COPE inventory, Perceived stress scale and Fear contracting COVID-19 questionnaire were used to assess cognitive appraisal, coping, stress and fear respectively. Results showed that nurses had high uncontrollable, stressfulness and primary appraisal, used more avoidant emotional and problem focused coping, were more stressed and fearful as compared to doctors and psychologists. Psychologists had a high appraisal of control-self and control-others as compared to doctors and nurses and were more fearful than doctors. Doctors and psychologists used more coping of humor as compared to nurses. Moreover, primary appraisal and avoidant emotional coping positively predicted stress whereas control-self appraisal negatively predicted stress among health professionals. Uncontrollable and stressfulness appraisal positively correlated with fear. This study will direct the administrative authorities to take effective measures to improve psychological wellbeing and to deal with fear and stress of health professionals.

The present study aimed to examine the relationship and prediction of cognitive appraisal and coping with Stress and Fear contracting COVID-19 among the working population of Pakistan. Cross-sectional research design was employed. The data was collected from 980 participants of almost 39 different professions using the purposive sampling technique. Stress Appraisal Measure (Peacock et al., in Stress Med 6:227-236, 1990, http://www.drpaulwong.com/wp-content/uploads/2018/03/Stress-Appraisal-Measure-SAM-Peacock-Wong-1990-Paper.pdf). Brief COPE Inventory (Caver, in Int J Behav Med 4:92-100, 1997), and Perceived Stress Scale (Cohen et al., in J Health Soc Behav 24:385-396, 1983) were used to measure cognitive appraisal, coping, and stress, respectively. Fear was measured by using Fear contracting COVID-19 questionnaire (Ali et al., in J Pakistan Soc Int Med 2(2):140-144, 2021). Age, education, and previously attended stress management training were significantly positively correlated with stress and fear. Females were more stressed and fearful than males. Average time spent on social media was significantly positively correlated with stress. Participants, who were employed, had family members of the older age group above 50 years and had family members with the history of biological diseases were more fearful. Results of hierarchical multiple regression analyses showed that threat, centrality, stressfulness appraisal, and avoidant emotional coping significantly positively predicted stress, whereas control-self appraisal and active emotional coping significantly negatively predicted stress. Moreover, threat, challenge, centrality, stressfulness appraisal, and problem-focused coping significantly positively predicted fear contracting COVID-19, whereas control-self appraisal and active emotional coping significantly negatively predicted fear contracting COVID-19 after controlling for covariates. This study will address the administrative authorities and government institutions to provide first-aid mental health services for emergencies, epidemics, or pandemics in the future., Competing Interests: Conflict of interestThe author declare that they have no conflict of interests., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)

This research looked at the effects of COVID-19 on a number of the world's most important stock exchanges, as well as the empirical relation between the COVID-19 wave and stock market volatility. In order to plan proper portfolio diversification in international financial markets, researchers must examine COVID-19 anxiety in relation to stock market volatility. The stock market volatility connected with the COVID-19 pandemic was measured using AR(1)-GARCH(1,1). COVID-19 fear, according to our research, is the ultimate driver of public attention and stock market volatility. The findings show that throughout the pandemic, stock market performance and GDP growth both declined significantly due to average increases. Furthermore, a 1% increase in COVID-19 causes a 0.8% and 0.56% decline in stock return and GDP, respectively. The stock market, on the other hand, showed a slight movement in GDP growth. Furthermore, the COVID-19 pandemic reported cases index, death index, and global panic index all influenced public perceptions of purchasing and selling. As a result, rather than investing in stocks, it is recommended that you invest in gold. The research also makes policy recommendations for important stakeholders. We look to examine how stock returns respond dynamically to unanticipated changes in the COVID-19 scenarios, as well as the uncertainty that comes with a pandemic. Using daily data from Canada and the USA, we conclude that a spike in COVID-19 instances has a negative impact on the stock market in general. Furthermore, in both the increase and decline scenarios in Canada, the stock return reactions are asymmetric. The disparity is due to the unfavorable impact of the pandemic's unpredictability. We also discovered that uncertainty had a negative impact on the US stock market. The magnitude, however, is insignificant., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The optoelectronic properties of functional π-conjugated organic materials are affected by their ability to self-assemble within thin films of devices. There are limited reports that demonstrate the positive impact of self-assembly on the photovoltaic performance of organic solar cells. Here, we demonstrate that hydrogen-bonded supramolecular arrays of a cyanopyridone-based oligothiophene donor, CP6, show notable improvement in photovoltaic performance upon self-assembly into a nanofibrous network. The honeycomb-like blend network exhibited higher hole mobility, leading to efficient charge generation and transport. The photovoltaic performance of CP6 was superior to that of two structural analogues, CP5 and CP1, and was attributed to the enhanced capability of CP6 to self-assemble into a film morphology favorable for BHJ devices. The BHJ devices comprising CP6 and the conventional fullerene acceptor (PC 71 BM) exhibited an efficiency of 7.26%, which is greater than that of CP5 (5.19%) and CP1 (3.11%) and is among the best-performing, cyanopyridone-based oligothiophene donors described to date.

Objectives: The present study aimed to compare the stress experience of employees facing to differentiated types of lockdown situations: total vs. partial. It also aimed to identify the cognitive appraisal, coping, stress, and fear of contracting COVID-19 associated with lock down situations among employees., Method: A cross-sectional research design was employed. The sample comprises two groups (n = 490 in each group), complete lockdown (people working from home) and partial lockdown (people going to workplace), and was drawn from Pakistan using purposive sampling technique. Stress Appraisal Measure, Brief COPE Inventory, Perceived Stress Scale, and Fear of Contracting COVID-19 Questionnaire were used to measure cognitive appraisal, coping, stress, and fear, respectively., Results: Independent sample t-test showed that the threat and uncontrollable appraisal was high in people going to workplace as compared to people working from home. Results of binary logistic regression showed that people going to workplace were more likely to cope with COVID-19 situation through seeking instrumental support, behavior disengagement, acceptance, and religion as compared to people working from home. Moreover, people working from home were 0.84 times more likely to cope through emotional support than people going to workplace. Fear was found to be 1.1 times more likely associated with people going to workplace than people working from home., Conclusion: This study would help administrative authorities and government institutions in designing mental health services for working population. It would help the emergency departments in devising first aid management plan to deal with the psychological needs of the workers under pandemic/lockdown situations.

Export marketing strategy has become an exciting research topic in strategic management literature because of its momentous role in sustainable competitive advantage and performance of firms. However, it is not yet recognized what factors enable top management team in adaptation of the export marketing strategy. This research aims to unleash how the intangible skills; creativity, business experience and intellectual capital facilitate marketing managers in adaptation of the expert marketing strategy (product, price, promotion and distribution) that can spur sustainable competitive performance. We collected data from 293 SMEs and used structural equation modeling for testing the hypotheses. The results indicate that the intangible skills; creativity, experience and intellectual capital do not directly contribute to sustainable competitive performance. However, creativity has a significant influence on product, price, promotion and distribution strategy, experience has a significant influence on product, price and promotion strategy and intellectual capital is only a significant predictor of product strategy. In the dimensions of export marketing strategy, product, price and distribution significantly while promotion does not significantly contribute to sustainable competitive performance. Moreover, export marketing strategy adaptation fully mediates the relationship between creativity and sustainable competitive performance as well as between experience and sustainable competitive performance while it does not mediate the path between intellectual capital and sustainable competitive performance. The findings recommend SMEs to emphasize highly skilled marketing staff who have competencies (experience, creative and intellectual) in order to build an effective export marketing strategy-resulting sustainable competitive performance. Further implications are discussed., Competing Interests: NO authors have competing interests.

Antimicrobial resistance is one of the biggest worldwide challenging problems that associates with high morbidity and mortality rates. The resistance of bacteria to various antibiotic classes results in difficulties in the treatment of infectious diseases caused by those bacteria. This paper highlights and provides a critical overview of observational and experimental studies investigating the presence of antibiotic resistant bacteria in different environments in Middle East countries and the mechanisms by which bacteria acquire and spread resistance. The data of this research considered the published papers within the last ten years (2010-2020) and was carried out using PubMed. A total of 66 articles were selected in this review. This review covered studies done on antibiotic resistant bacteria found in a wide range of environments including foods, animals, groundwater, aquatic environments as well as industrial and hospital wastewater. They acquire and achieve their resistance through several mechanisms such as antibiotic resistant genes, efflux pumps and enzymatic reactions. However, the dissemination and spread of antibiotic resistant bacteria is affected by several factors like anthropogenic, domestic, inappropriate use of antibiotics and the expulsion of wastewater containing antibiotic residues to the environments. Therefore, it is important to increase the awareness regarding these activities and their effect on the environment and eventually on health., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The amount of waste activated sludge (WAS) has grown dramatically in China. WAS is considered as a problematic and hazardous waste, which should be disposed in a safe and sustainable manner. In order to recycle WAS to an anaerobic granular sludge (AnGS) process for anaerobic digestion, Fe powder and steel slags (rusty and clean slags) were used to enhance the granulation process. The results demonstrated that both rusty and clean slags encouraged the development of granular sludge. Adding 10 g/L clean slags could increase AnGS granulation rate by 37%. In the presence of clean slags, extracellular polymeric substances (EPS) concentration in granules increased noticeably to 715 mg/g mixed liquor suspended solids (MLSS). High throughput sequencing analysis exhibited more diversity and higher abundance of functional microbial communities in the batch bottle with 10 g/L clean slags. This study suggested that adding clean slags at 10 g/L dosage was a sustainable and effective method for the sludge granulation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Firms need sufficient resources (tangible and intangible) and capabilities to build unique products due to customers' demands and choices, market competition and globalization. Despite sufficient resources, many firms cannot build new products according to the customers' preferences and market trends due to lack of marketing capabilities, lack of skilled marketing staff and lack of experienced managers. However, studies have not yet examined what types of intangible skills of marketing managers are prominent for building new products. This study examines the importance of the intangible skills; intellectual captial, financial literacy and business experience in new product development that results in sustainable competitive performance. We used a mixed-method approach; questionnaire (283) and interviews (16) for data collection and then applied structural equation modelling for testing the hypotheses. The results revealed that all the three intangible skills; intellectual captial, financial literacy and business experience significant influence new product development and sustainable competitive performance. However, considering the relative importance, financial literacy and intellectual capital are the most significant predictors of sustainable competitive performance and new product development respectively. Moreover, new product development fully mediates the path between intellectual capital and sustainable competitive performance while it partially mediates the link between financial literacy, business experience and sustainable competitive performance. Considering the importance of tangible resources, our study scrutinized that financial resources have a significant influence on new product development and sustainable competitive performance while technological resources do not play a significant role. This research recommends firms to emphasize on the improvement of intangible skills of the managers in order to build new products that result in sustainable competitive position. This study also recommends marketing managers to improve their financial skills and experience by participating in various seminars and workshops that can spur their new idea generation and new product development capabilities., Competing Interests: The authors have declared that no competing interests exist.

This work reports synthesis, thin film characterizations, and study of an organic semiconductor 2-aminoanthraquinone (AAq) for humidity and temperature sensing applications. The morphological and phase studies of AAq thin films are carried out by scanning electron microscope (SEM), atomic force microscope (AFM), and X-ray diffraction (XRD) analysis. To study the sensing properties of AAq, a surface type Au/AAq/Au sensor is fabricated by thermally depositing a 60 nm layer of AAq at a pressure of ~10 -5 mbar on a pre-patterned gold (Au) electrodes with inter-electrode gap of 45 µm. To measure sensing capability of the Au/AAq/Au device, the variations in its capacitance and resistance are studied as a function of humidity and temperature. The Au/AAq/Au device measures and exhibits a linear change in capacitance and resistance when relative humidity (%RH) and temperature are varied. The AAq is a hydrophobic material which makes it one of the best candidates to be used as an active material in humidity sensors; on the other hand, its high melting point (575 K) is another appealing property that enables it for its potential applications in temperature sensors.

In the Kingdom of Bahrain a high percentage of extra-intestinal infectious diseases are reported as urinary tract infections UTIs. These UTIs are repeatedly diagnosed as multidrug resistant isolates. In a recent investigation, a novel DNA segment was identified in a UTI cefotaxime resistant Escherichia coli isolate. The DNA sequence was associated to pathogenicity island III 536 locus. The current work is investigating/elucidating the genomic context of the newly identified locus in the UTI isolate using Single Genome Specific Primer-PCR (SGSP-PCR) approach. The isolate was characterized and redefined as strain EC1091 (genotype: bla TEM , bla CTX-M , gyrB, chuA, yjaA, TSpE4.C2) and its novel genomic contents were found to acquire antibiotic resistance genes: bla CTX-M and aac (3). The bla CTX-M was found to be a new beta-lactamase allele with no significant BLASTN results in the National Center for Biotechnology Information (NCBI), but a protein PSI-BLAST against non-redundant database revealed a remote similarity to CTX-M proteins., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Anaerobic digestion (AD) reactors often encounter low pH inhibition during startup and high organic loading periods. The use of a large amount of NaOH in order to raise and buffer the low pH, is reported to be inhibitory to methanogens. In order to address this problem, we acclimatized aceticlastic methanogens to low pH. Methanogens were successfully acclimatized to initial low pH down to 3.5 in a lengthy, five months, acclimatization period. The aceticlastic methanogen, Methanothrix soehngenii which was 96.3% of the total methanogenic population at pH 4.5 and 86.75% at pH 3.5, demonstrated that they were the most tolerant aceticlastic methanogens to low pH. After acclimatization, methane yield at pH 4.5 was comparable to neutral pH. Methanosaeta maintained its dominance over Methanosarcina at an elevated level of acetate (66 mM), and a negative correlation was observed between them. There was a positive correlation between the CH 4 content and pH., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction One of the common causes of chronic sinusitis is a fungal infection, and there are various types of fungal rhinosinusitis (FRS). Missed diagnosis of occasional granulomatous invasion of fungal sinusitis can lead to involvement in the central nervous system. The aim of this study is to determine the frequency of granulomatous invasive fungal sinusitis (GIFS) in patients with clinical suspicion of chronic FRS. Methods We conducted a descriptive cross-sectional study in the Department of Ear, Nose and Throat (ENT), Nishtar Hospital, Multan from January 1, 2017 to July 1, 2018. Eighty-one patients with chronic FRS participated in the study. After informed consent, nasal tissue was biopsied for granulomatous fungal invasion. Results The frequency of GIFS was 29.6% (n=24) in this study. The significant risk factors included duration of chronic FRS for more than 12 weeks, history of diabetes mellitus, and living status as rural. Conclusion GIFS is a common complication in patients with clinical suspicion of chronic FRS. Nasal biopsy should be a common practice among patients of chronic FRS who have a long duration of disease and a history of diabetes mellitus., Competing Interests: The authors have declared that no competing interests exist.

Salmonellosis is one of the major public health concerns in Bahrain as it has increased rapidly during the past few years. This study aims to determine the prevalence of salmonellosis in children and the possible risk factors such as age, geographical area, nationality, gender, unsafe drinking water, infant born weight and gastrointestinal disease. The cases of salmonellosis in children reported by the Ministry of Health of Bahrain ranged from 21 to 26 per 100,000 population during the period 2012-2016. Salmonellosis cases were geographically concentrated in the capital and northern regions. Statistical analysis showed a significant difference in the number of salmonellosis cases between Bahrainis and non-Bahrainis based on region, and gender ( p < 0.001). In the Bahraini cohort, there was an association between the increase of cases and the number of gastrointestinal disease-related deaths ( p < 0.05). In addition, unsafe water (over the level of 2.14%) and low-birth weight (<3.100 g) were associated, but not statistically significant ( p = 0.086 and p = 0.126, respectively) with the increase of salmonellosis cases. Despite the decline in the number of cases, the results of this study contribute to the understanding of the epidemiology of Salmonella in humans and this, in turn, will help develop and implement preventative measures., Competing Interests: The authors declare no conflict of interest.

In this cross-sectional study, 76 consecutive children with autism spectrum disorder (ASD) were studied for the clinical and demographic parameters at Autism Resource Centre in Pakistan. The median age at first consultation was 30 months, 36 months at diagnosis, and 42 months at referral to a specialised centre. Clinical psychologists, therapists and paediatricians were the most frequently involved people in diagnosis. There was an average delay of one year between the first consultation and referral to the specialised centre. The male to female ratio was 4.4:1. Consanguinity was observed in 33 (43.4%) children. Three children had another affected sibling. Half of the children were from the affluent class, while two-thirds of the parents were professionals having good education. The severity of ASD showed that 13 (17%) children had borderline features, 50 (66%) had mild to moderate ASD, while 13 (17%) had severe ASD.

By using panel data over the 1980-2017 period and two alternative indicators of environmental pollution (carbon dioxide (CO 2 ) and sulfur dioxide (SO 2 ) emissions), this paper investigates the validity of the environmental Kuznets curve (EKC) hypothesis in the Gulf Cooperation Council (GCC) region. Using three alternative econometric estimation techniques, we find strong evidence of a long-run inverted U-shaped relationship between real GDP per capita and both environmental indicators in the GCC region. Country-level short-run analysis indicates that the EKC hypothesis holds for Bahrain, Kuwait, Qatar, Saudi Arabia, and the United Arab Emirates (UAE) when CO 2 emissions are used as a measure of environmental pollution. However, when SO 2 emissions are used as a measure of environmental pollution, the EKC hypothesis holds for Oman, Qatar, Saudi Arabia, and the UAE. The results of a recently developed panel causality test reveal one-way causality from real GDP per capita to CO 2 emissions and from real GDP per capita to SO 2 emissions.

Background: There is an increase in the number of Enterobacteriaceae with Extended-spectrum beta-lactamase (ESBL) type of antibiotic resistance in the Kingdom of Bahrain. However, the virulence determinants of the clinical isolates have not been previously assessed. The current study investigates the distribution of different virulence factors and the phylogenetic groups of antibiotic resistant Escherichia coli isolates in extraintestinal infections., Results: All isolates tested were CTX-M producers. Most of the isolates were positive for bla TEM ; while 47% were positive for bla SHV . Certain virulence markers (PAI I CFT073 , PAI II CFT073 and PAI IV 536 ) were associated with the CTX-M-15 type., Conclusions: The current study investigated the prevalence of the ESBLs and virulence markers among different extraintestinal pathogenic E. coli. The findings of the study concur with previous investigations in regards to the presence of certain virulence determinants (PAI I CFT073 , PAI II CFT073 and PAI IV 536 ); found in multi-drug resistant clones such as ST131. A novel DNA fragment (597 bases) was identified, and the full sequence of the site is being investigated to retrieve the mosaic structure of the island., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To measure awareness about adverse drug reaction (ADRs) reporting among doctors, pharmacists and nurses and to determine reasons of ADRs under-reporting in Pakistan., Methods: In present study, a self-administered questionnaire was used to measure the awareness level about ADRs reporting among health care professionals (HCPs) of Pakistan. This was a cross sectional study., Results: Out of the respondents 51 % were physicians, 29.7 % pharmacists and 19.3 % were nurses. 65.5 % of HCP population observed ADRs, out of which only 57.4 % reported these in their respective hospitals. About 77.3 % of population understood the importance of reporting ADRs while 67.3 % of population agrees that pharmacists are chief personnel for the development of system. 71.8 % of HCPs agrees that ADRs are not reported because Community pharmacy lacks legally qualified pharmacists. Only 14.3 % of HCPs population knows that there is any ADR reporting organization in Pakistan., Conclusion: The study recommends the need of such reporting system and more than half of the studied population agreed that pharmacists are required in developing such system.

Ellis-van Creveld syndrome (EVC) is a rare developmental disorder characterized by short limbs, short ribs, postaxial polydactyly, dysplastic nails, teeth, oral and cardiac abnormalities. It is caused by biallelic mutations in the EVC or EVC2 gene, separated by 2.6 kb of genomic sequence on chromosome 4p16. In the present study, we have investigated two consanguineous families of Pakistani origin, segregating EVC in autosomal recessive manner. Linkage in the families was established to chromosome 4p16. Subsequently, sequence analysis identified a novel nonsense mutation (p.Trp234*) in exon 8 of the EVC2 gene and 15 bp duplication in exon 14 of the EVC gene in the two families. This further expands the mutations in the EVC or EVC2 genes resulting in the EVC syndrome.

Objective: To evaluate the perception of medical students regarding tutorial and case-based learning formats., Methods: The within stage mixed model research was conducted at the Army Medical College, National University of Sciences and Technology, Islamabad, Pakistan, from April 2012 to March 2013, and comprised medical students of 4th year. Data-collection tool was a self-developed questionnaire, and it was statistically analysed using SPSS 16., Results: Of the 144 students, 86(60%) were males. The overall age range was 21.5-23.4 years. Case-based learning method had significantly higher scores compared to tutorial method for learning process (p<0.001), for behavioural influence of facilitators (p<0.001), for group dynamics (p<0.001), and for learning environment (p<0.001). For open-ended questions regarding like or dislike of the two methods, majority named some faculty members as their role models and appreciated their support in better and in-depth learning through case-based learning format., Conclusions: Case-based learning format was significantly more appreciated and favoured as a learning strategy by students.

Objective: To compare PCR (Polymerase Chain Reaction) with blood culture, typhi-dot and Widal test for the diagnosis of typhoid in patients taking antibiotics., Study Design: Cross-sectional, comparative study., Place and Duration of Study: National University of Sciences and Technology, Islamabad, Pakistan, from April 2013 to August 2014., Methodology: One hundred and five patients were included in the study. Blood was collected and inoculated into tryptone soya broth for culture. Any growth obtained was identified by API 20 E and confirmed by Salmonella anti-sera. Typhi-dot and Widal test were also done on all the samples. DNA extraction was done and PCR was carried out., Results: Among the 105 patients, 79 (75.2%) were males and 26 (24.8%) were females, with mean age of 20.64 ±14 years. Typhi-dot was positive in 58 (55.2%) and negative in 47 (44.8%) patients. Blood widal test was positive in 27 (25.7%) and negative in 78 (74.3%) patients. Salmonella Typhi was positive on blood culture in only one (1%) patient. PCR for Salmonella Typhi was positive in 102 (97.1%) and negative in 3 (2.9%) patients. Positive cases detected by PCR were significantly higher as compared to Typhi-dot (p < 0.001), blood Widal test (p < 0.001) and blood culture (p < 0.001)., Conclusion: Positivity rate of PCR was significantly higher as compared to blood culture, Typhi-dot or Widal test for diagnosing typhoid in patients who were already taking antibiotics.

Objective: To evaluate patterns of external injury resulting from bomb blasts in Karachi, and compare the injury profile resulting from explosions in open versus semi-confined blast environments., Methods: The retrospective, cross-sectional study was conducted in Karachi and comprised relevant data from January 2000 to October 2007. Casualty medical records and medico-legal certificates of the victims presented to three large public-sector hospitals were evaluated using a self-designed proforma. SPSS 17 was used for statistical analysis., Results: Of the 1146 victims, data of 481(42%) represented the final study sample. Of these, 306(63.6%) were injured in open spaces and 175(36.4%) in semi-confined spaces. Of the 896 recorded injuries, lacerations were encountered as external injury in 427(47.7%) cases, followed by penetrating wounds in 137(15.3%). Lower and upper extremities were injured in 348(38.8%) and 170(19%) victims respectively. Open and semi-confined blast environments produced specific injury pattern and profile (p<0.001)., Conclusions: External injuries sustained during bomb blast attacks in Karachi demonstrated specific injury patterns and profiles. Further studies are required to account for internal injuries and classification of injuries based on standardised scoring systems.

Methylmalonic Acidemia (MMA) is an inborn error of metabolism that results in accumulation of methylmalonic acid in blood and increased excretion in urine. The effects of MMA vary from mild to life threatening and it usually presents in early infancy. Affected infants can have vomiting, dehydration, hypotonia, developmental delay and failure to thrive. The emergency treatment of the newborn with MMA mainly comprises rehydration and promotion of anabolism, followed by long-term dietary management by both the restriction of precursor amino acids using a low protein diet and avoidance of prolonged fasting. Prognosis depends on the type of MMA and whether the condition is well controlled in general and during episodes of metabolic decompensation. We report here the presentation and management of a 2-year boy with MMA who failed to achieve expected milestones for age. To the best of our knowledge, only one case of MMA has been reported from Pakistan.

Objective: To characterise sleep quality and assess degree of daytime sleepiness among medical students of Karachi., Methods: The cross-sectional study was conducted between August and December 2013 and subjects were recruited from five haphazardly selected medical colleges in Karachi. A convenience sample of medical students underwent two validated self-administered questionnaires i.e. Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. SPSS 17 was used for statistical analysis., Results: Of the 650 students approached, 504(77.5%) subjects completely filled out the questionnaires. Of them, 300(59.5%) were females and 204(40.5%) were males. Overall mean age was 20±1.4 years. Of them, 199(39.5%) were classified as "Poor Sleepers". Poor sleep quality was associated with female gender (p <0.05), excessive daytime sleepiness (p <0.05), total hours slept (p <0.001) and sleep disturbances (p <0.001). Bed-timing analysis showed 365(72%) students went to bed after midnight., Conclusions: Sleep quality among Pakistani medical students was significantly poor. Efforts must be directed towards proper sleep hygiene education.

The synergy of computational and physical network components leading to the Internet of Things, Data and Services has been made feasible by the use of Cyber Physical Systems (CPSs). CPS engineering promises to impact system condition monitoring for a diverse range of fields from healthcare, manufacturing, and transportation to aerospace and warfare. CPS for environment monitoring applications completely transforms human-to-human, human-to-machine and machine-to-machine interactions with the use of Internet Cloud. A recent trend is to gain assistance from mergers between virtual networking and physical actuation to reliably perform all conventional and complex sensing and communication tasks. Oil and gas pipeline monitoring provides a novel example of the benefits of CPS, providing a reliable remote monitoring platform to leverage environment, strategic and economic benefits. In this paper, we evaluate the applications and technical requirements for seamlessly integrating CPS with sensor network plane from a reliability perspective and review the strategies for communicating information between remote monitoring sites and the widely deployed sensor nodes. Related challenges and issues in network architecture design and relevant protocols are also provided with classification. This is supported by a case study on implementing reliable monitoring of oil and gas pipeline installations. Network parameters like node-discovery, node-mobility, data security, link connectivity, data aggregation, information knowledge discovery and quality of service provisioning have been reviewed.

Complete duplication of genitourinary system, colon and vertebral column is a very rare and complex congenital condition termed as "caudal duplication syndrome" with variable presentations. This term is often quoted as a type of incomplete separation of mono-ovular twins or conjoined twinning. It is associated with other congenital malformations of the genitourinary, gastrointestinal and other organ systems. The hereby reported case, a 3-month-old male infant had presented with the classical form of the disease i.e., duplication of the gastrointestinal, genitourinary system and vertebral column with anterior abdominal wall hernia and a large lipomeningocele.

Takayasu arteritis is a systemic vasulitis of large vessels that mainly involves the aorta and its branches. It normally presents in third decade of life and has rarely been reported in children under 10 years of age. We report here a case of Takayasu arteritis in a 5 years old girl who presented with headache, generalized body swelling, severe hypertension, proteinuria and minimal functioning kidneys. Conventional angiography demonstrated narrowing of descending aorta, right subclavian artery and right common iliac artery. She responded steroids, diuretics, antiplatelets and digoxin and discharged home on maintenance therapy.

Objectives: To investigate whether certain DR alleles might also contribute to the genetic susceptibility among Coeliac disease patients in Pakistan., Methods: The case-control study was conducted at the Military Hospital, Rawalpindi, from October 2011 to January 2012, and analysed 25 children diagnosed to have coeliac disease as per the criteria set by the European Society of Paediatric Gastroenterology and Nutrition, which included histopathological alterations in duodenal biopsies, clinical response to gluten withdrawal, and presence of anti-endomyseal antibodies. Patients were compared with a group of 150 healthy subjects. Dioxyribonucleic acid was extracted from peripheral blood collected in ethylenediaminetetraacetic acid.K3. Human leukocyte antigen DRB1 typing was carried out on allele level (DRB1*01--DRB1*16) using sequence specific primers. Human leukocyte antigen type was determined by agarose gel electrophoresis and results were recorded. Phenotype frequency of various alleles among the patient group and the control group was calculated by direct counting, and significance of their association was determined by Fisher Exact Test., Results: A total of 11 (44%) female paediatric coeliac patients in age range 1-9 (mean 7.2 +/- 4.8 years) and 14 (56%) male paediatric patients in the age range 6-14 (mean 8.6 +/- 5.1 years) were genotyped for HLA-DRB1 loci. A statistically significant positive association of the disease with HLA-DRB1*03 (n = 23; 92% versus n=31; 21% in controls, p < 0.01) was observed., Conclusion: HLA-DRB1*03 is associated with increased risk of developing coeliac disease.

Respiratory diseases are the most frequent chronic illnesses in babies and children. Although a vigorous innate immune system is critical for maintaining lung health, a balanced response is essential to minimize damaging inflammation. We investigated the functional and clinical impact of human genetic variants in the promoter of NFKBIA, which encodes IκBα, the major negative regulator of NF-κB. In this study, we quantified the functional impact of NFKBIA promoter polymorphisms (rs3138053, rs2233406, and rs2233409) on promoter-driven protein expression, allele-specific and total NFKBIA mRNA expression, IκBα protein expression, and TLR responsiveness; mapped innate immune regulatory networks active during respiratory syncytial virus infection, asthma, and bronchopulmonary dysplasia; and genotyped and analyzed independent cohorts of children with respiratory syncytial virus infection, asthma, and bronchopulmonary dysplasia. Genetic variants in the promoter of NFKBIA influenced NFKBIA gene expression, IκBα protein expression, and TLR-mediated inflammatory responses. Using a systems biology approach, we demonstrated that NFKBIA/IκBα is a central hub in transcriptional responses of prevalent childhood lung diseases, including respiratory syncytial virus infection, asthma, and bronchopulmonary dysplasia. Finally, by examining independent pediatric lung disease cohorts, we established that this immunologically relevant genetic variation in the promoter of NFKBIA is associated with differential susceptibility to severe bronchiolitis following infection with respiratory syncytial virus, airway hyperresponsiveness, and severe bronchopulmonary dysplasia. These data highlight the importance of negative innate immune regulators, such as NFKBIA, in pediatric lung disease and begin to unravel common aspects in the genetic predisposition to bronchopulmonary dysplasia, bronchiolitis, and childhood asthma.

Purpose: Posterior cruciate ligament (PCL) injury has a reported incidence of 3-20 %. PCL reconstruction is aimed at reducing onset of premature articular degeneration and improving function. Numerous operative techniques have been described with varying degrees of result consistency., Methods: We evaluated 15 patients treated for isolated primary posterior cruciate ligament injury with a mean follow-up of 4.1 years (range one to nine). Post-reconstruction clinical assessment included the Lysholm and Tegner knee scoring scale, international knee documentation committee (IKDC) ligament evaluation, and KT2000 arthrometer assessment., Results: On the Lysholm knee score 11 patients (73 %) had excellent results, three patients (20 %) had good results and one patient (7 %) had a poor result. On the Tegner activity score the majority of patients scored 7-8 with a return to high level sports. At the final follow-up, the post-reconstruction IKDC score was normal or nearly normal (A and B) in 14 (93 %) patients, and abnormal (C) in one (7 %) patient. According to KT-2000 arthrometer measurements at final follow-up review, 11 patients (73 %) were rated as normal (A, 0-2 mm), and four patients (27 %) as nearly normal (B, 3-5 mm). These results were independent of age, mechanism of injury, time elapsed to surgical reconstruction, and length of follow-up., Conclusions: Despite being a technically demanding procedure, the outcomes reported in this study show that single bundle transtibial arthroscopic PCL repair using four strands hamstring autograft provides satisfactory and consistent functional outcomes.

Objectives: NGAL (Neutrophil Gelatinase-Associated Lipocalin) has emerged as a new biomarker for the identification of acute kidney injury. Reliable clinical evaluations require a simple, robust test method for NGAL, and knowledge of specimen handling and specimen stability characteristics. We evaluated the performance of a new urine NGAL assay on the ARCHITECT analyzer., Methods: Assay performance characteristics were evaluated using standard protocols. Urine specimen storage requirements were determined and biological variability was assessed in a self-declared apparently healthy population., Results: Assay performance data showed good precision, sensitivity and lot-to-lot reproducibility. There was good short term 2-8 degrees C sample stability, however, long term storage samples must be kept at -70 degrees C or colder. The largest variance component in a biological variance study was within-day., Conclusions: The ARCHITECT NGAL assay proved to be a precise and reproducible assay for the determination of urine NGAL., (Copyright 2009 The Canadian Society of Clinical Chemists. All rights reserved.)

Aplasia cutis congenita is a rare skin condition characterized by the absence of localized or widespread areas of skin at birth. We are reporting a variant aplasia cutis congenita, which involved over 90% of the body surface area, which occurred in a baby born to a mother with pemphigus vulgaris who was on oral prednisolone and azathioprine. A case of extensive aplasia cutis congenita was seen and oral intake of azathioprine by the mother during pregnancy was suspected as an etiologic factor. The parents of the patient did not consent for biopsy or autopsy so the histopathological picture was not available and hence involvement of other systems could not be ascertained. Due, to financial constraints some of the investigations which might have helped in assigning the patient to a particular category of aplasia cutis such as karyotyping and CT scan brain could not be carried out.

Purpose: The recovery of gastrointestinal function following surgery for congenital intestinal atresias can be prolonged and may increase morbidity and hospital stay. This study was conducted to investigate the prokinetic effect of erythromycin in neonates undergoing surgery for small bowel atresias., Methods: A randomized-controlled trial was conducted at the Departments of Paediatrics and Paediatric Surgery, Military Hospital, Rawalpindi, Pakistan, from January to December 2007 to study the prokinetic effect of erythromycin (3 mg/kg per dose 4 times daily). Thirty consecutive neonates undergoing primary anastomosis for congenital small bowel atresias were randomly divided into two groups: group I (erythromycin) and group II (control). The groups were similar in terms of gestational age, sex, mode of delivery, birth weight and types of atresias. Postoperative recovery of intestinal functions was measured as time taken to achieve full enteral feed (150 ml/kg per 24 h), duration of total parenteral nutrition (TPN) and hospital stay., Results: Neonates receiving oral erythromycin achieved full enteral feeding early (13.07 vs. 16.13 days) required TPN for shorter duration (10.53 vs. 13.73 days) and their hospital stay was less (16.2 vs. 18.0 days) as compared to the neonates in the control group who did not receive any erythromycin. The differences were statistically significant., Conclusion: The administration of oral erythromycin following primary anastomosis for small intestinal atresias results in early recovery of intestinal function, fewer days on TPN and a trend for shorter hospital stay.

Chronic granulomatous disease (CGD) is an X-linked/ autosomal recessive primary immunodeficiency disorder characterized by recurrent infections. The diagnosis is primarily based on simple Nitrobluctetrazolium dye reduction test. We describe here an unusual case of an 8 year old girl, as the disease is X-linked in most of the cases.

Background and Objectives: The authors have previously shown that urine neutrophil gelatinase-associated lipocalin (NGAL), measured by a research ELISA, is an early predictive biomarker of acute kidney injury (AKI) after cardiopulmonary bypass (CPB). In this study, whether an NGAL immunoassay developed for a standardized clinical platform (ARCHITECT analyzer, Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, IL) can predict AKI after CPB was tested., Design, Setting, Participants, & Measurements: In a pilot study with 136 urine samples (NGAL range, 0.3 to 815 ng/ml) and 6 calibration standards (NGAL range, 0 to 1000 ng/ml), NGAL measurements by research ELISA and by the ARCHITECT assay were highly correlated (r = 0.99). In a subsequent study, 196 children undergoing CPB were prospectively enrolled and serial urine NGAL measurements obtained by ARCHITECT assay. The primary outcome was AKI, defined as a > or = 50% increase in serum creatinine., Results: AKI developed in 99 patients (51%), but the diagnosis using serum creatinine was delayed by 2 to 3 d after CPB. In contrast, mean urine NGAL levels increased 15-fold within 2 h and by 25-fold at 4 and 6 h after CPB. For the 2-h urine NGAL measurement, the area under the curve was 0.95, sensitivity was 0.82, and the specificity was 0.90 for prediction of AKI using a cutoff value of 100 ng/ml. The 2-h urine NGAL levels correlated with severity and duration of AKI, length of stay, dialysis requirement, and death., Conclusions: Accurate measurements of urine NGAL are obtained using the ARCHITECT platform. Urine NGAL is an early predictive biomarker of AKI severity after CPB.