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Background: Patients with partial thickness rotator cuff tears (PTRCTs) often present with concurrent pathology of the long head of the biceps tendon (LHBT). To address both conditions simultaneously, long head of the biceps (LHB) tenotomy or tenodesis can be performed at the time of arthroscopic rotator cuff repair (RCR). This study aims to compare postoperative shoulder active range of motion (AROM) and complications following transtendinous RCR with concurrent LHB tenodesis or tenotomy. Methods: A total of 90 patients with PTRCTs met inclusion criteria for this study. Patients who underwent tear-completion-and-repair, revision surgery, or open repair of the LHB tendon were excluded. Patients were stratified into tenotomy, arthroscopic suprapectoral tenodesis, or no biceps operation cohorts and were propensity matched 1:1:1 on age, sex, body mass index, and smoking status. Primary outcome measures included AROM in forward flexion, abduction, external rotation, and internal rotation at 6 weeks, 3 months, and 6 months postoperatively. The development of severe stiffness and rates of rotator cuff retear at final follow-up were recorded as secondary outcomes. Results: When comparing the tenotomy and tenodesis cohorts, tenotomy patients were found to have increased AROM at 3 months in forward flexion (153.2° vs. 130.1°, P = .004), abduction (138.6° vs. 114.2°, P = .019), and external rotation (60.4° vs. 43.8°, P = .014), with differences in forward flexion remaining significant at 6 months (162.4° vs. 149.4°, P = .009). There were no significant differences in interval rates of recovery in any plane between cohorts. Additionally, there were no significant differences in rates of symptomatic retears between groups (P = .458). Rates of severe postoperative stiffness approached but did not achieve statistical significance between tenotomy (4.2%) and tenodesis (29.2%) cohorts (P = .066). Smoking status was a significant predictor of severe stiffness (odds ratio, 13.69; P = .010). Conclusion: Despite significant differences in absolute AROM between cohorts, the decision to perform tenotomy or tenodesis was not found to differentially affect rates of AROM recovery for patients undergoing arthroscopic transtendinous RCR for PTRCT. Notably, however, transient stiffness complications were more commonly observed in smokers, and data trends suggested an increased risk of stiffness for patients undergoing LHB tenodesis. Overall, postoperative stiffness is likely multifactorial and attributable to both patient- and procedure-specific factors, and LHB tenotomy may be more appropriate for patients with risk factors for developing stiffness postoperatively.

Background: While studies have assessed comparative rates of restoration of shoulder function and alleviation of symptoms, comparative systemic postoperative complication rates between biceps tenotomy and tenodesis have yet to be assessed. The purpose of the present study was to use a national administrative database to perform a comprehensive investigation into 30-day complication rates after biceps tenotomy versus tenodesis, thus providing valuable insights for informed decision-making by clinicians and patients regarding the optimal surgical approach for pathologies of the long head of the biceps tendon. Methods: The National Surgical Quality Improvement Program database was queried to analyze postoperative complication rates and metrics associated with biceps tenotomy and tenodesis. Patient data spanning from 2012 to 2021 was extracted, with relevant variables assessed to identify and compare these two surgical approaches. Adjusted and unadjusted analyses were utilized to analyze patient demographics, comorbidities, operative times, lengths of stay, readmissions, adverse events, and yearly surgical volume, along with trends in usage, across cohorts. Results: Of 11,527 total patients, 264 (2.29%), 6826 (59.22%), and 4437 (38.49%) underwent tenotomy, tenodesis with open repair, and tenodesis with arthroscopic repair, respectively. Tenotomy operative times ([mean ± SD]: 66.25 ± 44.76 minutes) were shorter than those for open tenodesis (78.83 ± 41.82) and arthroscopic tenodesis (75.98 ± 40.16). Conversely, tenotomy patients had longer hospital days (0.88 ± 4.86 days) relative to open tenodesis (.08 ± 1.55) and arthroscopic tenodesis (.12 ± 2.70). Multivariable logistic regression controlling for demographics and comorbidities demonstrated that patients undergoing tenodesis were less likely to be readmitted (adjusted odds ratio [AOR]: 0.42, 95% confidence interval [CI]: 0.17-0.98, P = .050) or sustain serious adverse events (AOR: 0.27, 95% CI: 0.13-0.57, P

Geogrid is a geosynthetic material commonly used for soil stability purposes in road embankments and reinforced earth walls due to its tensile reinforcing capability. Recent research has shown the efficiency of Geogrid as an internal reinforced concrete column confinement that increases significantly the ductility, but slightly decreases the axial compressive strength of the column. The study reported in this paper investigated the feasibility of using geogrids as external column confinement. It was important to compare external geogrid confinement with internal geogrid confinement on one hand and with bitumen coated E-glass textile sheets on the other. A total of 22 small-scale reinforced concrete (RC) column specimens were tested under uniaxial compression. Each specimen had a 240 mm diameter, 500 mm length, and was reinforced with four 10 mm longitudinal bars confined with three 6 mm ties spaced at 200 mm. The test variables were the confinement material (Geogrid, or Bitumen coated E-glass textile), type of geogrid (uniaxial or biaxial), number of confinement layers (one or two), and confinement location (internal or external). Assessment of the variables was done by analyzing the axial load-displacement behavior, the modes of failure, and the structural ductility measured by fracture energy and energy dissipation. Available analytical models for FRP confined specimens were modified to be applicable to the tested geogrid and bitumen textile confined specimens. A performance-to-cost analysis was also conducted. Results showed that external confinement of reinforced concrete columns using geogrid significantly enhanced the strength, ductility, and energy capacity of the tested specimens.

Abstract Background Abnormal fetal growth pattern during pregnancy including excessive fetal size and intrauterine growth restrictions are the major determinants for perinatal outcomes and postnatal growth. Ultrasonography is a useful tool in monitoring fetal growth for appropriate care and interventions. However, there are few longitudinal studies using serial ultrasonography in low and middle-income countries. Moreover, the reference charts used for fetal growth monitoring in low-income countries comes from high income countries with distinct population features. Therefore, the purpose of this study was to evaluate the intrauterine growth pattern of the fetus using serial ultrasonography. Methods We conducted a prospective community-based cohort study from March 2018 to December 2019. Pregnant women with gestational age of 24 weeks or below living in the Butajira HDSS were enrolled. We followed the pregnant women until delivery. Serial ultrasound measurements were taken, and fetal weight was estimated using the Hadlock algorithm based on biparietal diameter, head circumference, abdominal circumference, and femur length. The z-scores and percentiles of biometric measurements were calculated and compared to the INTERGROWTH-21st International Standards for Fetal Growth. Results We reviewed a total of 2055 ultrasound scans and 746 women who fulfill the inclusion criteria were involved”. We found similar distribution patterns of biometric measurements and estimated fetal weight compared to the previous study done in Ethiopia, the WHO and INTERGROWTH-21st references. In our study, the 5th,50th and 95th percentiles of estimated fetal weight distribution have a similar pattern to the WHO and INTERGROWTH-21st charts. The 50th and 95th percentile had also a similar distribution pattern with the previous study conducted in Ethiopia. We found that 10% of the fetus were small for gestational age (below the 10th percentile) based on the Z-score of estimated fetal weight. Conclusion Our study evaluated the fetal growth patterns in rural community of Ethiopia using serial ultrasound biometric measurements. We found similar IUG patterns to the WHO and INTERGROWTH-21st reference standards as well as the previous study conducted in Ethiopia.

Kashif Asghar,1 Shaarif Bashir,2 Iftikhar Ali Rana,2 Muhammad Abu Bakar,3 Asim Farooq,1 Muhammad Hassan,1 Zukhruf Asif,1 Mahnoor Afzal,1 Iqra Masood,4 Muhammad Ishaq,2 Muhammad Tahseen,2 Sundus Bilal,5 Shafqat Mehmood,5 Nosheen Kanwal,6 Islah Ud Din,6 Asif Loya2 1Department of Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan; 2Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan; 3Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan; 4Department of Clinical Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan; 5Department of Internal Medicine (Gastroenterology), Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan; 6Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, PakistanCorrespondence: Kashif Asghar, Department of Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7-A Block R-3, Johar Town, Lahore, Punjab, 54000, Pakistan, Tel +92-42-35905000, Fax +92-42-35945206, Email kashifasghar@skm.org.pkBackground/Aim: Hepatocellular carcinoma (HCC) is one of the most common forms of liver cancer that is modulated by the immune system. Programmed cell death ligand-1 (PD-L1) has emerged as a novel therapeutic target in various cancers. Indoleamine 2,3-dioxygenase (IDO) is an immunosuppressive enzyme that is associated with poor prognoses in various cancer types. The aim of this study was to investigate the PD-L1 expression, and clinicopathological features of non-HCV and non-HBV-associated HCC patients, including IDO expression.Patients and Methods: In this study, immunohistochemical analysis was performed to analyze the expression of PD-L1 and IDO. Formalin-fixed paraffin-embedded HCC tumor tissues (n=50) were obtained from the pathology department, at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan between 2005 and 2022. All the patients were HBV and HCV negative. Furthermore, it was a rare group of patients with no previous history of any viral hepatitis. In addition, for categorical and continuous variables chi-square or Fisher exact test and Mann–Whitney U-test was performed.Results: Of 50 tissue specimens, PD-L1+ was observed in 21 [high: 12 (24%), low: 9 (18%)] and PD-L1- was observed in 29 HCC patients. IDO+ was observed in all 50 specimens [high: 42 (84%), low: 8 (16%)]. Additionally, both PD-L1 and IDO had high expression in 11 (22%) patients. While both PD-L1 and IDO had low expression in 2 (4%) patients. Furthermore, in IDO+/PD-L1- group, 20 (69%) out of 29 patients died while in the IDO+/PD-L1+ group, 9 (43%) out of 21 patients died.Conclusion: Evaluation of IDO and PD-L1 expression may add therapeutic advantage in non-HCV and non-HBV-associated HCC patients that overexpress IDO. Further validation in a larger cohort is warranted.Keywords: programmed cell death ligand-1, indoleamine 2, 3-dioxygenase, non-HCV HCC, non-HBV HCC, immune checkpoint molecules

Sobia Bilal,1 Snigdha Misra,2 Sumaira Hussain,3 Seok Shin Tan,2,4 Ekta Priya5 1Division of Prevention and Public Health Sciences, Pediatric Dentistry, College of Dentistry, University of Illinois Chicago, Chicago, IL, USA; 2Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia; 3Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia; 4Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia; 5MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, ScotlandCorrespondence: Snigdha Misra, Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia, Tel +603-2731 7608 ; +6016-617 9247, Fax +603-8656 7229, Email snigdha_misra@imu.edu.myAbstract: An inter-professional project with a collaborative endeavor between the programs of Dentistry, Nutrition and Medicine was carried out with the aim to emphasise oral health maintenance, making the right nutritional choices and effective hand washing among pre-school children. The purpose of this paper is to share a detailed description of the design, development process, implementation, and planned evaluation of an interprofessional school-based health promotion intervention model “Do Right, Be Bright”. This model is part of a quasi-experimental study, targeting pre-school children as the “Targets of Change” through the empowerment of school teachers as the “Agents of Change”. The program design was based on Bartholomew’s Intervention Mapping Approach, which proposes a direction for developing a theory-based health promotion intervention and on the most extensively applied theories of health behavior, the Health Belief Model. Therefore, based on a thorough literature review and needs assessment, three key areas of needs were identified for the targeted preschool children: oral hygiene, hand hygiene and nutrition. The efficacy of this model will be pilot tested in a preschool in Kuala Lumpur Malaysia.Keywords: oral hygiene, hand hygiene, nutrition, interprofessional education, health-promoting schools

One of the most important factors limiting the development of industrial processes is the consumption of large amounts of clean water and the generation of large amounts of wastewater. Pigments are available in a wide range of colors, consisting of small molecules practically insoluble in the medium and known to be unique compounds for many industries. They are widely used in dyestuff, cosmetics, food products, pharmaceuticals, manufacturing processes, etc. This study focuses on the removal of pigments and other components from wastewater discharged from pigment plants. The separation process was carried out in two stages: the first was to use prepared activated carbon as an adsorbent to separate the pigment, and then the separation process by electrodialysis to remove other components such as salts, acids, and others. This study considers prepared activated carbon (AC) as an effective separating adsorbent. The preparation process mainly included two-stage pyrolysis and activation using potassium hydroxide (KOH) and sodium hydroxide (NaOH).

Objective: Novel coronavirus disease 2019 is known to have poor impacts on health with health systems facing serious challenges. Limited information is available on health issues for patients who have recovered from the disease. Our study aims to investigate the extent of sleep disorders in patients who have recovered from the coronavirus disease. Material and Methods: A casecontrol study with 256 patients who had recovered from coronavirus disease 2019 was carried out, with 491 patients enrolled as the control. All participants were 18 years or older, and sleep quality was assessed using the Pittsburgh sleep quality index. Furthermore, sleep latency and hours needed for sleep were calculated. Chi-square and t-test statistical methods were used to analyze the variables. Results: A total of 215 (84%) recovered patients were associated with poor sleep quality, with 384 patients (78%) in the control group. The PSQI values for recovered and control groups were 8.77±3.7591 and 8.139±3.068, respectively, with a significant p-value of 0.014. Average hours needed for sleep were 6.899±3.7869 and 6.44±1.477 for recovered and control patients, respectively, with a significant p-value of 0.01. The difference in sleep latency was non-significant (p=0.374), with 29.01±39.3702 and 33.520±38.208 minutes for recovered and control patients, respectively. Conclusion: Sleep disorders were more prevalent among patients who had recovered from COVID-19 than the control group.

Incorporation of momentum gradients produced due to inertial motion of the lid along with the presence of temperature differences in the configuration make the physical problem more significant. The joint variation of momentum and thermal diffusion in diversified natural liquids is recognized as mixed convection. Valuable attention has been received by such a phenomenon in different areas of science and technology such as in wind current --based solar receivers, electronic instruments, control of emergency shutdown in reactors, thermal exchangers, oceanic currents, control of atmospheric pollution, and so on. So, the main focus is to contemplate hydrothermal characteristics of a power-law fluid contained in a square cavity with themovement of the upper lid and being thermally adiabatic. The other extremities are considered to be at rest, and the base wall is prescribed with uniform/nonuniform temperature distributions. The governing formulation of the problem is handled by executing a finite element approach. Hybrid meshing is performed for domain discretization, and weak variational formulation is utilized for formulation discretization. Second-degree polynomials are employed as the interpolation function, providing information about velocity and temperature distributions at boundary and intermediate nodes. The system of finalized non-linear equations is resolved by using the Paradiso software. The results for velocity and temperature distributions are attained comparatively for uniformly and non-uniformly heated profiles. The kinetic energy and average Nusselt number are also computed against flow concerning variables. From the attained graphical and tabular data, it is deduced that by increasing the Reynolds number, inertial forces dominate over buoyancy forces and the effect of lid movement is prominent on flow characteristics. It is also inferred that for the shear thickening case and for all values of the Reynolds number, the average Nusselt number shows a constant behavior. [ABSTRACT FROM AUTHOR]

Introduction: Anomalous Coronary arteries is a well-known congenital entity with variable effects. The majority of such patients are asymptomatic but some can have adverse effects like ischemia and arrhythmia. Its association with Sudden Cardiac Death in young is established. Objective: To determine the frequency of ACA on MDCT in patients referred for coronary artery disease assessment and to determine the origin, course, and morphological variable of SCD of ACA on MDCT. Materials and Methods: The study was done in the Department of Cardiovascular Imaging at the Punjab Institute of Cardiology. A retrospective data of patients undergoing CTA for CAD between a period of Jan 2009 and Dec 2017 were analyzed for the presence of Anomalous Coronary Artery (ACA). All patients having anomalous origin from opposite coronary cusp and its course were included. The patients with myocardial bridging and coronary artery fistula were excluded. Results: Total patients analyzed with MDCT for CAD and graft assessment between Jan 2009 and December 2017 were 8028. Fifty-three patients were excluded because of poor image quality. Among these ACA were found in 166 (2.08%). Gender distributions were 126 (75.9%) males and 40 (24.09%) females, the mean age in years was 49.31 ± 13.23. The most common ACA was Right coronary artery 83 followed by Left Circumflex 44 (26.50%), Left Anterior Descending Artery 22 (13.25%), and Left Main Stem 17 (10.24%) respectively. Fifty-three (31.92%) patients had previously unknown ACA and were found to have ACA on MDCT and 82 (49.39%) patients were referred following ICA for the confirmation of ACA. The Inter-arterial course was predominant in RCA and Left Coronary Artery 97% and 77% respectively. A retro artic course was predominant (100%) in LCx. Seven patients had associated cyanotic heart disease with ACA. Two patients(one LAD and one RCA) had origin from the Main Pulmonary artery. Conclusion: MDCT is the imaging modality of choice for the evaluation of ACA. It can identify the origin of ACA from opposite coronary cusp and defines the malignant course of ACA for the potential risk of sudden cardiac death.