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Andrea Georgiou, Reshma Ramesh, Peter Schofield, Patrick White, Timothy H Harries School of Population Health & Environmental Sciences, King’s College London, London, UKCorrespondence: Timothy H Harries, King’s College London, Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, 3rd Floor Addison House, Guys Campus, London, SE1 1UL, UK, Tel +44 20 7836 5454, Email timothy.harries@kcl.ac.ukBackground: Inhaled corticosteroid (ICS) therapy has been demonstrated to reduce the risk of COPD exacerbations. It should only be prescribed to COPD patients who are not adequately controlled by dual long-acting bronchodilator therapy and who have ≥ 2 exacerbations per year and a blood eosinophil count ≥ 300cells/μL. ICS therapy is widely prescribed outside guidelines to COPD patients, making ICS withdrawal an important consideration. This systematic review aims to provide an up-to-date analysis of the effect of ICS withdrawal on exacerbation frequency, change in lung function (FEV1) and to determine the proportion of COPD patients who resume ICS therapy following withdrawal.Methods: Randomised controlled trials (RCTs) and observational studies which compared ICS withdrawal with ICS continuation treatment were included. Cochrane Central, Web of Science, CINHAL, Embase and OVID Medline were searched. Risk of bias was assessed using the Cochrane RoB2 tool and the Newcastle-Ottawa Scale. Quality assessment of RCTs was conducted using GRADE. Meta-analysis of post-hoc analyses of RCTs of ICS withdrawal, stratified by blood eosinophil count (BEC), was undertaken.Results: Ten RCTs (6642 patients randomised) and 6 observational studies (160,029 patients) were included in the results. When ICS was withdrawn and long-acting bronchodilator therapy was maintained, there was no consistent difference in exacerbation frequency or lung function change between the ICS withdrawal and continuation trial arms. The evidence for these effects was of moderate quality. There was insufficient evidence to draw a firm conclusion on the proportion of patients who resumed ICS therapy following withdrawal (estimated range 12– 93% of the participants).Discussion: Withdrawal of ICS therapy from patients with COPD is safe and feasible but should be accompanied by maintenance of bronchodilation therapy for optimal outcomes.Keywords: COPD, inhaled corticosteroid, drug withdrawal, exacerbations, randomised controlled trials, observational studies

Studies of rainfall variation generally focus on large areas. For example, in India, the area average monsoon rainfall series of the whole country or meteorological subdivisions are used. This would be of no use for local agriculture, particularly in places where rainfall is very high or very low, especially for crops like small cardamom and vanilla which are very sensitive to soil moisture and atmospheric air relative humidity. With this view, we present the data and analysis of the long term rainfall variations in semi arid as well as tropical humid environments in cardamom hill slopes in south-WesternGhats in India. In our analysis, the semi-arid cardamom hill slopes showed decreasing trend in rainfall over the recent past three decades ranging from 2.7 to 3.4 mm/yr with R2 values ranging from 0.42 to 0.85 (P= 0.05). Year-to-year variation in rainfall was considerable. No alternating pattern of increase and decrease in rainfall was seen in decads, epochal trends as accounted by ISM for the rest of the country were absent. If the present trend continues, agricultural production in this semi-arid, poor rain fed system will suffer, unless conservation and mitigation efforts are undertaken. In case of windward side humid tropics, the year- to- year variations in the monthly rainfall values were very large. For example, January and February rainfall values changed by a factor as high as two or more from one year to another. The lowest rainfall during a period was reported in 1987 which was one of the intense El-Nino years. There was a strong association of El-Nino phenomenon with below average rainfall (67% of the El-Nino years), indicating a good ENSO relationship. In case of La-Nina years, fifty per cent of the years had enjoyed excess rainfall. However, the impact of El-Nino phenomenon was not severe during the first pentad of this century (2000-2005) in this mountain range. This indicates that the relationship seems to have weakened. The coefficient of variation of rainfall for the entire data series ranged from 9 to 27%. The decadal averages for the first three decades (1896-1925) and the last three decades (1976-2005) studied, reported less than the annual mean (5000 mm) for the whole period (1896-2005). Only during the middle period (1926-1975) the decadal average rainfall exceeded the series annual mean.

Roshni Ramesh,* Anoop Sasi,* Shahana C Mohamed, Sonia P Joseph Department of Periodontology, Government Dental College, Thiruvananthapuram, Kerala, India*These authors contributed equally to this workCorrespondence: Roshni Ramesh, Department of Periodontology, Government Dental College, Thiruvananthapuram, Kerala, India, Email roshniarun73@gmail.comPurpose: Compression necrosis refers to bone tissue damage that can occur when excessive pressure or force is applied to surrounding bone during implant placement. This pressure can compromise blood supply to the bone, leading to necrosis. Compression necrosis is a concern, because it can affect the stability and long-term success of dental implant.Patients and Methods: This case report highlights a case of early bone loss and implant failure possibly due to compression necrosis. Clinical data, photographs, radiographs, blood examination report and histology were presented to document the early failure of an implant placed in the mandibular left posterior region of a 33-year-old female patient.Results: Radiograph taken six weeks after implant placement showed severe angular defect. Therefore, the implant was surgically removed. Histological examination of the area showed bony trabeculae with an absence of osteoblastic riming, suggestive of necrotic bone.Conclusion: Using excessive torque values when placing implants in dense bones can increase the risk of implant failure due to bone over compression. Dental professionals must follow the manufacturer’s instructions and employ quality surgical techniques during implant placement into dense cortical bone to minimise risks.Keywords: bone loss, dental implants, implant failure, necrosis

Salinity represents an ever-challenging problem of agriculture in arid and semi-arid regions. This problem is considered a key limiting factor of agricultural production in the countries of Southwest Asia. In recent years, the use of alternative methods of chemical fertilizers has emerged as a promising approach to mitigate the negative effects of salinity on crop yield. In this research, the effect of Micrococcus yunnanensis and indole-3-acetic (IAA) acid on the growth and chemical composition of Vetiver grass (Vetiveria zizanioides) under salt stress has been investigated. Based on the results, application of IAA, M. yunnanensis and their interaction significantly increased the average plant growth, fresh and dry weight of aerial parts and root dry weight. Considering chemical properties of the plant, interaction between IAA and M. yunnanensis significantly increased shoot phosphorus, potassium and sodium absorption. Proline content, catalase, superoxide dismutase and peroxidase activity were significantly influenced by application of IAA, M. yunnanensis and their interaction. Follow-up experiments after vetiver harvest showed that IAA and M. yunnanensis treatments improved soil microbial biomass and respiration. In total, plant biomass improved by 34% and the activities of catalase, superoxide dismutase and peroxidase enzymes decreased by −20.61, −4.70 and −8.00%, respectively, which shows that the stress pressure on the plant has decreased. This study reinforces the previous literature on the positive effects of biological treatments to improve plant performance by providing new evidence of the positive effects of IAA and M. yunnanensis on mitigating the negative effects of salinity.

Quinoa (Chenopodium quinoa Willd.) has gained worldwide recognition for its nutritional values, adaptability to diverse environments, and genetic diversity. This review explores the current understanding of quinoa tolerance to environmental stress, focusing on drought, salinity, heat, heavy metals, and UV-B radiation. Although drought and salinity have been extensively studied, other stress factors remain underexplored. The ever-increasing incidence of abiotic stress, exacerbated by unpredictable weather patterns and climate change, underscores the importance of understanding quinoa’s responses to these challenges. Global gene banks safeguard quinoa’s genetic diversity, supporting breeding efforts to develop stress-tolerant varieties. Recent advances in genomics and molecular tools offer promising opportunities to improve stress tolerance and increase the yield potential of quinoa. Transcriptomic studies have shed light on the responses of quinoa to drought and salinity, yet further studies are needed to elucidate its resilience to other abiotic stresses. Quinoa’s ability to thrive on poor soils and limited water resources makes it a sustainable option for land restoration and food security enterprises. In conclusion, quinoa is a versatile and robust crop with the potential to address food security challenges under environmental constraints.

Arabic handwriting recognition and conversion are crucial for financial operations, particularly for processing handwritten amounts on cheques and financial documents. Compared to other languages, research in this area is relatively limited, especially concerning Arabic. This study introduces an innovative AI-driven method for simultaneously recognizing and converting Arabic handwritten legal amounts into numerical courtesy forms. The framework consists of four key stages. First, a new dataset of Arabic legal amounts in handwritten form (“.png” image format) is collected and labeled by natives. Second, a YOLO-based AI detector extracts individual legal amount words from the entire input sentence images. Third, a robust hybrid classification model is developed, sequentially combining ensemble Convolutional Neural Networks (CNNs) with a Vision Transformer (ViT) to improve the prediction accuracy of single Arabic words. Finally, a novel conversion algorithm transforms the predicted Arabic legal amounts into digital courtesy forms. The framework’s performance is fine-tuned and assessed using 5-fold cross-validation tests on the proposed novel dataset, achieving a word level detection accuracy of 98.6% and a recognition accuracy of 99.02% at the classification stage. The conversion process yields an overall accuracy of 90%, with an inference time of 4.5 s per sentence image. These results demonstrate promising potential for practical implementation in diverse Arabic financial systems.

This review focuses on the pivotal role microscopy has played in diagnosing the type(s) of microbial attacks present in waterlogged ancient wooden objects, and to understand the nature and extent of deterioration of such objects. The microscopic journey began with the application of light microscopy (LM) to examine the deterioration of waterlogged woods, notably foundation piles supporting historic buildings, progressing into the use of high-resolution imaging tools (SEM and TEM) and techniques. Although bacteria were implicated in the deterioration of foundation piles, confirmation that bacteria can indeed degrade wood in its native state came when decaying wood from natural environments was examined using electron microscopy, particularly TEM, which enabled bacterial association with cell wall regions undergoing degradation to be clearly resolved. The information base has been a catalyst, stimulating numerous studies in the past three decades or so to understand the nature of microbial degradation of waterlogged archaeological wood more precisely, combining LM, SEM, and TEM with high-resolution chemical analytical methods, including chemical microscopy. The emerging information is aiding targeted developments towards a more effective conservation of ancient wooden objects as they begin to be uncovered from burial and waterlogging environments.