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Objective: To assess gender bias, discrimination and bullying at medical schools, and to explore the phenomenon of 'doctor brides'., Methods: The multicentre survey was conducted at 14 medical education institutions across Pakistan from September 2020 to April 2021, and comprised medical students of either gender at both public-sector and private-sector institutions. The survey questions explored beliefs, experiences and knowledge related to common stereotypes and social issues in medical education, including female role models, work-life balance, gender roles, lack of support from family and faculty, and bullying. Association between gender with survey variables was explored. Data was analysed using SPSS 26. Thematic analysis was used to exploring knowledge around 'doctor-brides'., Results: Of the 377 subjects, 245(65%) were females. The overall mean age was 21.4±1.8 years. There were 211(53.8%) subjects aged 21-23 years, and 368(97.6%) were Muslims. Significantly more women than men were of the opinion that men are encouraged and are more likely to assume leadership roles (p=0.002). More women than males agreed that household chores and work had an impact on speciality choice (p<0.001). Most sexual assault victims were women (p<0.0001), but men generally faced more bullying and hostile behaviour (p=0.014). With regard to women being forced to quit medicine after marriage/childbirth by their in-laws/husbands or change their careers from clinical medicine to preclinical teaching, 99(26.25%) subjects knew first-hand of such cases, while 238(63.12%) had no such experience to share., Conclusions: Gender bias, discriminatory behaviour and bullying were found to be widely prevalent in medical schools across Pakistan. The general perception of 'doctor brides' needs to be revisited.

Abstract The recent rise of artificial intelligence represents a revolutionary way of improving current medical practices, including cardiovascular (CV) assessment scores. Retinal vascular alterations may reflect systemic processes such as the presence of CV risk factors. The value of swept-source retinal optical coherence tomography–angiography (SS OCT-A) imaging is significantly enhanced by image analysis tools that provide rapid and accurate quantification of vascular features. We report on the interest of using machine-learning (ML) and deep-learning (DL) models for CV assessment from SS OCT-A microvasculature imaging. We assessed the accuracy of ML and DL algorithms in predicting the CHA2DS2-VASc neurocardiovascular score based on SS OCT-A retinal images of patients from the open-source RASTA dataset. The ML and DL models were trained on data from 491 patients. The ML models tested here achieved good performance with area under the curve (AUC) values ranging from 0.71 to 0.96. According to a classification into two neurocardiovascular risk groups, the EfficientNetV2-B3, a well suited DL model for retinal OCT-A images, predicted risk correctly in 68% of cases, with a mean absolute error (MAE) of approximately 0.697. Our models enable a confident prediction of the CHA2DS2-VASc score from SS OCT-A imaging, which could be a useful tool contributing to the assessment of neurocardiovascular profiles in the future.

Abstract Improving rice threshing unit performance and structure significantly enhances the thresher’s overall efficiency by raising its productivity while lowering costs and power consumption. This study evaluated and optimized longitudinal axial flow threshing device performance using two threshers’ structures, namely conical thresher and drum thresher, under different rotating speeds of 1100, 1300, and 1500 rpm and feeding rates of 0.8, 1.1, and 1.4 kg/s. The studied parameters were evaluated regarding thresher throughput, efficiency, seed damage, and specific energy, and it was figured that the experimental parameters greatly affected the whole performance of the threshing unit. The drum thresher increased the threshing throughput from 2304 to 2448 kg/h and maximized the efficiency from 98.6 to 99.07% at 1500 rpm rotation speed and 1.8 kg/s feeding rate. Moreover, it reduced the specific energy from 3.37 to 3.15 kW.h/ton for the experimental variables 1100 rpm speed and 1.4 kg/s feeding. The lowest damage rate of 0.24% was recorded using the drum thresher at a feeding rate of 0.8 kg/s and 1100 rotating speed. These results highlight the distinct effect of the new thresher structure and operating parameters on the rice threshing device’s overall effectiveness for medium-sized combine harvesters.

Abstract Essential oils of basil herbs such as nyazbo or sweet basil (Ocimum basilicum), holy basil or tulsi (O. tenuiflorum), and African or clove basil (O. gratissimum) have traditionally been used for their therapeutic potential. These medicinal herbs are being cultivated and consumed globally, and the increasing demand for antimicrobial and antifungal natural products has led to the assessment of the potential of essential oils of medicinal plants to inhibit mycelial growth rather than synthetic fungicides. Thus, the present study explored natural alternatives to inhibit mycelial growth (Aspergilus flavus) and aflatoxin production. Linalool (25.40%), methyl chavicol (37.63%), and eugenol (39.52%) were identified as chief compounds in the EOs of O. basilicum, O. tenuiflorum, and O. gratissimum respectively. Ocimum tenuiflorum EO demonstrated the highest inhibitory activity at 0.75 µL mL− 1 against Aspergillus flavus and totally inhibited the synthesis of aflatoxin B1 (AFB1). The AFB2 production was completely inhibited at 0.25 µL mL− 1 by O. tenuiflorum EO, while O. basilicum and O. gratissimum EOs showed inhibition against AFB2 at 0.50 µL mL− 1, and 1.0 µL mL− 1, respectively. The present study suggests that EOs of basil herbs could be a potential natural alternative of synthetic fungicides to inhibit the fungal growth and aflatoxin production.

Abstract Sulfonamide derivatives are a significant class of medicinal compounds. Gold nanoparticles (AuNPs) offer precise cancer treatment through targeted delivery, boasting high drug-loading capacity and low toxicity. This study aimed to develop and evaluate 99mTc-labeled benzenesulfonamide derivative-entrapped gold citrate nanoparticles as a tumor-targeting agent. A novel benzenesulfonamide derivative bearing a pyridine moiety was synthesized. Compound 3 (4-((3-cyano-4-(2,4-dichlorophenyl)-6-phenylpyridin-2-yl)amino)-N-(diaminomethylene)benzenesulfonamide) exhibited remarkable anti-cancer activity against MCF-7 cells. The chemical reduction method was employed to create compound 3-citrate-AuNPs. A comprehensive examination of the synthesized nano-platform was conducted, including zeta potential, size analysis, radiochemical yield, and in-vivo biodistribution in tumor-bearing mice. The nano-platform was successfully produced with good stability, optimal particle size (9 nm diameter for AuNPs), and high radiochemical purity for [99mTc]Tc-compound 3 (88.31 ± 2.14%). In-vivo investigations revealed that intravenously administered [99mTc]Tc-compound 3-citrate-AuNPs accumulated in tumors with a high target-to-non-target ratio. The findings validate the efficacy of the novel [99mTc]Tc-compound 3-citrate-AuNPs platform as a tumor-targeting agent.

Background: Understanding the basics of embryologic development and the structure of the gallbladder can help identify and detect various abnormalities. This study aims to identify anatomical variations and congenital anomalies of the gallbladder in Sudanese patients observed during laparoscopic cholecystectomy. Methods and Results: A retrospective study included 345 patients diagnosed with cholelithiasis who underwent laparoscopic cholecystectomy. The study patients’ ages ranged from 14 to 71, with a mean age of 45.59±13.29 years. Of 345 cases of cholelithiasis, 83.2% were females, and 16.8% were males, with a female-to-male ratio of 4.95:1. Preoperative ultrasound examination revealed chronic cholecystitis in 99.7% of patients. Among the operated patients, the majority (99.13%) underwent laparoscopic cholecystectomy and 0.87% open cholecystectomy. A normal anatomy of the biliary system was found in 82.9% of all patients who underwent laparoscopic cholecystectomy. Among 59 patients with anomalies of the biliary system, gallbladder anomalies were detected in 19(32.2%) cases and included buried gallbladder (11.9%), floating gallbladder (1.7%), double gallbladder (3.4%), bilobed gallbladder (8.5%), and diverticulum of the gallbladder (6.8%). Conclusion: During laparoscopic cholecystectomy, surgeons must identify anomalies to prevent unintended intraoperative injury and bleeding, thereby improving postoperative outcomes.

The study was to isolate and characterize fructophilic lactic acid bacteria (FLAB) species from the honey bee gut. Based on the results of this study, it was found that the FLAB species obtained from honey were gram-positive and catalase-negative, and this identification was confirmed through 16S rRNA gene sequencing.

An uncommon and severe form of human malignancy is called NUT midline carcinoma (NMC). The mediastinum or midline of the upper aerodigestive tract contains the majority of NMCs. A chromosomal rearrangement affecting the NUT gene, which produces oncoproteins regarded as a major pathogenic driver of cellular transformation, is the genetic cause of NMC. When a commercial antibody against NUT is available, NMC can be diagnosed, and the diagnosis is confirmed by positive nuclear immunohistochemistry staining. There is no standard treatment for NMC to date. There may be a multimodal approach for NMC such as chemotherapy, surgical intervention, and radiotherapy adopted currently in clinical practice. Despite aggressive radiation therapy and chemotherapy, the typical survival is less than 1 year. The majority of cases with NMC die due to local complications of the tumor or complications due to treatment. Here, we are presenting a case of NMC in young adults with isolated involvement of the anterior skull base with bony erosion and intracranial extension.

In order to address many issues, such as the inconsistent and unreliable seeding process in traditional mechanical garlic seed metering systems (SMS), as well as the lack of ability to monitor the effectiveness of the seeding, a highly accurate electric-driven metering system (EDMS) was developed and created specifically for garlic seed planters. This study provided a description of the overall structure and functioning principle, as well as an analysis of the mechanism for smooth transit and delivery. A combination of an infrared (IR) sensor, Arduino Mega board, stepper motor, speed sensor, and a Wi-Fi module was employed to operate the EDMS, as well as monitor and count the quantity of garlic seeds during the planting process and determine the qualified rate (QR) and missing rate (MR). A monitoring system of the planting quality of garlic seeds was created based on the IoT concept. Then, the performance of the EDMS was validated in a laboratory setting utilizing a bench test at six operating velocities of 10, 20, 30, 40, 50, and 60 rpm of the EDMS. The obtained results showed that the correlation coefficient between the actual and detected garlic seed using the garlic seed monitoring and counting system (GSMCS) was 0.9723. Additionally, the EDMS observed a maximum QR of 96.23% at an operating velocity of 20 rpm, with a standard division and standard error of 1.61030 and 0.72015, respectively. Additionally, the EDMS minimized the MR up to 3.77% at the same operating velocity, with standard division and standard error of 1.65325 and 0.73936, respectively. Furthermore, the results indicated a progressive increase in the QR and MQ standard errors as the EDMS's operating velocity increased. Additionally, the sensor's monitoring accuracy gradually declined with an increase in the operating speed of the EDMS. Finally, this study introduced a novel EDMS to garlic seed planters that was not used before. The developed EDMS and GSMCS are technical manuals for developing and designing monitoring systems capable of precisely measuring and identifying the rates of qualifying and missing garlic seed measurements.

[This corrects the article DOI: 10.1371/journal.pone.0294064.].

Abstract Brain metastasis in gastric cancer (GC) patients is a rare phenomenon that is associated with adverse clinical outcomes and poor survival rates. We conducted a retrospective cohort study to investigate the incidence, risk factors and prognostic factors of brain metastasis in GC patients. Data on sociodemographic and tumor characteristics of GC patients from 2010 to 2019 was extracted from the Surveillance, Epidemiology and End-Results (SEER) database. Descriptive statistics, multivariable logistic and Cox regression were applied on SPSS. Kaplan–Meier-Survival curves and ROC curves were constructed. A total of 59,231 GC patients, aged 66.65 ± 13.410 years were included. Brain metastasis was reported in 368 (0.62%) patients. On logistic regression, the risk of brain metastasis was significantly greater in males, patients aged

Background: Nevoid Basal Cell Carcinoma Syndrome (NBCCS) is an autosomal dominant syndrome that has various expressions in each patient. Generally; NBCCS is followed by multiple nevoid basal cell carcinoma of the skin, orbital anomalies, skeletal anomalies, central nervous system anomalies and multiple odontogenic keratocysts (OK). NBCCS is usually diagnosed between the ages of 5–30 years, with multiple basal cell carcinomas of the skin and OKs in the jaws as the initial findings. The purpose of this paper is to describe and compare the radiographic findings of the OKs in NBCCS patients in the literature with additional cases. Materials and Methods: In this study, we evaluated the OKs of the patients with NBCCS in PubMed Database with 5 additional cases from our database. A total of 305 articles were found and the articles in English with full-text access were evaluated. Results: Despite all limitations for a fair discussion; we would like to state that among 59 cases that specified whether a 3D or 2D imaging modality was used, 29 cases were only interpreted with 2D data which should be avoided in OK evaluation. Discussion: According to the World Health Organization’s Classification of Head and Neck Tumours Book which was published in 2017, OKs in NBCCS has a higher chance to have small satellite cystic lesions which increase their recurrence possibility post-operatively, thus, a thorough clinical and 3D radiographic evaluation should be performed both to NBCCS patients and non-syndromic OK patients to avoid any recurrence. Conclusion: High recurrence rates of OKs should be reminded all the time. Radiographic examinations with 3D imaging modalities should be done in patients with NBCCS in order to provide a concise diagnosis and optimum treatment.

Introduction: Breast cancer is the most common malignancy diagnosed in women, and despite advancements in diagnosis and treatment, it still leads to significant morbidity and mortality. Distinguishing between benign and malignant breast disease is clinically challenging, and there is currently no serum biomarker available for early breast cancer detection. As part of the preoperative work-up for breast lesions, a Complete Blood Count (CBC) analysis is typically performed. Aim: This study aimed to evaluate the utility of CBC parameters in diagnosing malignant breast lesions and to analyse the diagnostic role of haematological parameters within benign and malignant breast lesions, as well as different histological breast cancer stages. Materials and Methods: This retrospective observational study was conducted for one year, from January to December 2021, at the Department of Pathology of PSG Institute of Medical Sciences and Research in Coimbatore, Tamil Nadu, India. The study included 60 female patients with both benign and malignant breast lesions. Histopathological examination confirmed the diagnoses of these lesions. CBC parameters, including haemoglobin, Total White Cell Count (TWBC), neutrophil count, lymphocyte count, monocyte count, platelet count, and Mean Platelet Volume (MPV), were collected from a total of 120 cases. Additionally, the Neutrophil-Lymphocyte Ratio (NLR), MonocyteLymphocyte Ratio (MLR), and Platelet-Lymphocyte Ratio (PLR) were calculated from the obtained CBC parameters for all cases. The values were expressed as mean and standard deviation, and an independent t-test was used to compare the two groups. A p-value less than 0.05 was considered significant. Results: Malignant breast lesions showed a significant increase in neutrophils (64.1±8.4%) and a significant decrease in lymphocytes (25.9±8%) and MPV (7.6±0.76 pg) compared to benign breast cases. The calculated ratios, such as NLR (2.9±1.7), MLR (0.32±0.2), and PLR (14.4±8), were also found to be increased in malignant cases. However, there were no significant variations in CBC parameters across the various stages of breast malignancy. Conclusion: Among the CBC parameters evaluated, neutrophil count, lymphocyte count, MPV, NLR, MLR, and PLR were significantly altered in breast malignancy compared to benign breast masses. Measuring CBC parameters and their derived ratios are fast, simple, inexpensive, and readily available method that can assist physicians in predicting breast malignancy.

[This corrects the article DOI: 10.1371/journal.pone.0275781.].

The plant Cissus tuberosa Moc is abundant in phenolics, has been documented to have neuroprotective properties. The study seeks to determine the neuroprotective effects of C. tuberosa ethanolic extract (CTE) against Parkinson's disease by evaluating its impact on motor dysfunction, cognitive deficits, neuroinflammation, and neurodegeneration in paraquat-induced Parkinson's disease models. The research hypothesizes that CTE can modulate key biomarkers involved in Parkinson's pathology, including α-synuclein, interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α), assessed through qRT-PCR, as well as interleukin-6 (IL-6) and TNF-α, evaluated through ELISA. Parkinson disease was induced by using paraquat intraperitoneally. The study was designed by considering various groups with their respective treatments, control group treated normally, disease control receiving paraquat (1 mg/kg, i.p.), standard treated grabbed with (levodopa+carbidopa), and three treatment groups received plant extract (150, 300, 600 mg/kg) respectively for 21 days study period. Both behavioral, and biochemical analysis were performed. HPLC analysis revealed the presence of several phenolic compounds. CTE significantly improved motor function and cognitive performance in rats, showing a dose-dependent reduction in paraquat-induced neurotoxicity (150 < 300 < 600 mg/kg, P

Abstract Malignant pleural effusions (MPE) complicate malignancies and portend worse outcomes. MPE is comprised of various components, including immune cells, cancer cells, and cell-free DNA/RNA. There have been investigations into using these components to diagnose and prognosticate MPE. We hypothesize that the microbiome of MPE is unique and may be associated with diagnosis and prognosis. We compared the microbiota of MPE against microbiota of pleural effusions from non-malignant and paramalignant states. We collected a total of 165 pleural fluid samples from 165 subjects; Benign (n = 16), Paramalignant (n = 21), MPE-Lung (n = 57), MPE-Other (n = 22), and Mesothelioma (n = 49). We performed high throughput 16S rRNA gene sequencing on pleural fluid samples and controls. We showed that there are compositional differences among pleural effusions related to non-malignant, paramalignant, and malignant disease. Furthermore, we showed differential enrichment of bacterial taxa within MPE depending on the site of primary malignancy. Pleural fluid of MPE-Lung and Mesothelioma were associated with enrichment with oral and gut bacteria that are commonly thought to be commensals, including Rickettsiella, Ruminococcus, Enterococcus, and Lactobacillales. Mortality in MPE-Lung is associated with enrichment in Methylobacterium, Blattabacterium, and Deinococcus. These observations lay the groundwork for future studies that explore host-microbiome interactions and their influence on carcinogenesis.

Abstract The aim of the study was to assess the predictive value of interim FDG-PET/CT (iPET) in patients with Hodgkin’s lymphoma (HL) treated with Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy. A total of 245 consecutive patients with de novo HL between 12/2013 and 12/2017 were evaluated retrospectively. All patients were treated with upfront ABVD, performed PET/CT scans at baseline, after 2 cycles (interim PET, iPET2) or 4 cycles (iPET4) and at the end of therapy, and followed up for at least 6 months after therapy. The response status on iPET was defined according to the standard five-point Deauville scores (DS) as follows: complete metabolic response (CMR, DS 1–3) and non-complete metabolic response (nCMR) (DS 4 and 5). End-of-treatment (EoT) response was assessed by FDG-PET/CT and if needed biopsy confirmation of PET-positive findings. The association between iPET and EoT response was investigated using logistic regression analysis. Survival analysis was performed using the Cox regression hazard model and Kaplan–Meier methods. Sixty-nine patients underwent iPET-2 and 176 iPET-4. No association was found between the timing of iPET and iPET response status (P-value = 0.71). Two hundred and one patients (82%) had iPET-CMR and 44 (18%) iPET -nCMR. iPET was strongly associated with EoT response status: 194/201 (96 .5%) of iPET-CMR had a complete response at the EoT while only 21/44 (47.7%) of patients with iPET-nCMR presented a complete response at EoT (P-value

Abstract Since it is requested that the smashed straw should not be scattered onto the stubble in the first season harvest, a smashing and scattering device matched with the first season harvester of ratoon rice was designed in this paper to smash and scatter the straw into the rolling area. The main structural parameters affecting the straw scattering performance were determined by theoretical analysis of the deflecting performance of the straw deflector. EDEM software was used to simulate and analyze the straw scattering situation under the action of the deflector. Taking the qualified rate of straw scattering as the performance index, the optimal parameter combination of the straw deflector was determined by L27 (313) orthogonal test, and the operating performance of the device was verified by bench test and field comparison test. The test results show that: The optimal parameter combination was 45° between the straw deflector and the vertical direction, 200 mm height difference between straw deflector and outlet, 0° inclination angle of inner deflector and 35° inclination angle of outer deflector. The qualified rate of straw scattering was 72.2% in the corresponding simulation test, 93.6% in the bench test and 95.2% in the field test, which could meet the demand of first season harvest of ratoon rice.

Objectives To evaluate mediating factors for the effect of therapeutic exercise on pain and physical function in people with knee/hip osteoarthritis (OA).Methods For Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA), individual participant data (IPD) were sought from all published randomised controlled trials (RCTs) comparing therapeutic exercise to non-exercise controls in people with knee/hip OA. Using the Counterfactual framework, the effect of the exercise intervention and the percentage mediated through each potential mediator (muscle strength, proprioception and range of motion (ROM)) for knee OA and muscle strength for hip OA were determined.Results Data from 12 of 31 RCTs of STEER OA (1407 participants) were available. Within the IPD data sets, there were generally statistically significant effects from therapeutic exercise for pain and physical function in comparison to non-exercise controls. Of all potential mediators, only the change in knee extension strength was statistically and significantly associated with the change in pain in knee OA (β −0.03 (95% CI −0.05 to −0.01), 2.3% mediated) and with physical function in knee OA (β −0.02 (95% CI −0.04 to −0.00), 2.0% mediated) and hip OA (β −0.03 (95% CI −0.07 to −0.00), no mediation).Conclusions This first IPD mediation analysis of this scale revealed that in people with knee OA, knee extension strength only mediated ±2% of the effect of therapeutic exercise on pain and physical function. ROM and proprioception did not mediate changes in outcomes, nor did knee extension strength in people with hip OA. As 98% of the effectiveness of therapeutic exercise compared with non-exercise controls remains unexplained, more needs to be done to understand the underlying mechanisms of actions.

Abstract While many studies suggested the isolated effects of plyometric and whole-body vibration exercises on physical performance variables, only few studies have compared the acute effects of plyometric and whole-body vibration on the occurrence of post-activation potentiation and the resultant improvements in performance. Therefore, we aimed to compare the acute effects of plyometric exercises and whole-body vibration training on physical performance in collegiate basketball players. Twenty-four collegiate male basketball players (age 20.8 ± 2.02 years, height 1.79 ± 0.7 m, and weight 71.2 ± 7.6 kg) participated in this randomized crossover study. Subjects were received both plyometric and whole-body vibration exercises after a 48-h washed-out period. Countermovement Jump height, sprint, and agility time were measured at baseline, 4- and 12-min post-plyometric, and whole-body vibration exercises. The result suggests a positive effect of both the plyometric and whole-body vibration exercises on countermovement jump and agility time (p = 0.001). While the countermovement jump height and agility were higher in the plyometric group (mean difference 1.60 cm and 0.16 s, respectively), the sprint performance was higher in the whole-body vibration group. However, these differences were statistically non-significant between the two groups (p > 0.05). This study suggests that both plyometric and whole-body vibration exercises may improve post-activation potentiation, which leads to better physical performance. Trial registration CTRI/2019/05/019059. Registered with the Clinical trials registry, India on 10/05/2019. http://ctri.nic.in/Clinicaltrials/advsearch.php .

Background: The purpose of this study was to assess the vitamin D supplementation intake status among children from different nationalities in the UAE, to determine vitamin D intake practices through diet and lifestyle, and the barriers that parents in the UAE face with providing vitamin D supplementation to their children. Methods: A cross-sectional observational questionnaire-based survey study design was used.. The study was conducted in the U.A.E and the study participants were parents of children from ages 4-15 years. The questionnaire used in this study was both self-administered and interviewer-administered while inquiring the questions from the parents. A convenience sampling technique was used to collect the data. The response rate of participants was expected to be 63%, the margin of error was 5% and the level of confidence was 95%. Results: A total of 248 participants (203 mothers, 39 fathers and 6 caregivers) completed the study. Participants reported that the supplements used the most by children were vitamin D supplements (21.85%), followed by multivitamins (21.8%) and calcium supplements (5.6%) and 27.8% of participants in this study reported to no supplementation at all. The rate of vitamin D supplementation among children was higher in those families with higher income levels, parents/caregivers who were more educated, those families who attained health insurance. However, there was no statistical significance between these correlations. Conclusion: The study concluded that challenges like the educational and financial background of parents, family-income level, and health insurance status could help aid in addressing the overall burden of vitamin D deficiency among young children in the UAE. Pediatricians and health care professionals could use our study and use it as an aid to provide screening on lifestyle, sun light exposure, and dietary modifications and also educate parents why and how vitamin D is crucial for their children.

Background: Lack of knowledge among parents can result in inappropriate administration practices. After analyzing different studies among children, there was no data on challenges and barriers in the administration of medicines among children in this region because of the diverse environmental issues and challenges in the UAE. The objective of this study was to determine the reported administration practices of parents and challenges and barriers in the administration of medicines among children in UAE. Methods: A questionnaire-based survey was conducted. A convenience sampling technique was used to collect the data. An online Raosoft® sample size calculator was applied (n = 248). The inclusion criteria were parents who had a child under 10 years of age and gave consent to participate in this study. Children with vision problems, cognitive/physical disabilities, and caregivers other than parents were excluded from this study. Results: The study reported response rate of 73.2%. The mean ± S.D age of the parents in years was 35.5 ± 7.8, and the mean ± S.D of children aged years was 2.60 ± 1.54. 26.2% of parents reported treatment failure due to oral medicine administration. A total of 22.2% of parents reported that they gave medicines in doses higher than prescribed by the doctor to treat their children more quickly. Similarly, a total of 64.5% of the parents reported self-medication without consultation from a healthcare provider. Conclusions: The study concluded that there were inappropriate medicine administration practices among parents. Parents reported administration of higher doses to treat their children quickly.

Abstract The aim of this study was to create a surgical guide platform that maintains its integrity while the surgeon performs an intestinal anastomosis or another similar procedure, which then breaks apart and is eliminated from the body in a controlled manner. The device contains mixed polymeric structures that give it a controlled rate of disassembly that could meet the requirements of a specific surgical purpose. The intraluminal anastomotic guide was manufactured as a hollow cylinder composed of layers of porous polyurethane/PCL with polyvinylpyrrolidone as the binding agent similar to a “brick–mortar” architecture. This combination of polymeric structures is a promising manufacturing method from which a variety of tunable devices can be fabricated for specific medical procedures and site-specific indications. The guide was designed to rapidly disassemble within the intestinal lumen after use, reliably degrading while maintaining sufficient mechanical rigidity and stability to support manipulation during complex surgical procedures. The nature of the device’s disassembly makes it suitable for use in hollow structures that discharge their contents, resulting in their elimination from the body. A swine model of intestinal anastomosis was utilized to validate the use and function of the device.

Abstract The threshing unit is the main working unit of the combine harvester and plays an essential role in rice threshing efficiency, seed loss, and damage. Every thresher has its limitation for feeding, and when the feeding quantity exceeds the maximum rated amount, the thresher gets blocked, resulting in higher losses, low threshing efficiency, more power consumption, and combine overloading shutting down. This study constructed a longitudinal axial flow rice threshing platform, and a stress monitoring system for the threshing drum top cover was designed using force sensing resistors. The sensors were installed on the thresher top cover inner surface to detect the impact and extrusion forces caused by the threshing process and detect the feeding rate when it exceeds the suitable feeding. Three feeding rates (0.8, 1.1, and 1.4 kg/s) and three thresher speeds (1100, 1300, and 1500 rpm) were tested. The time of the testing process was calculated using high-speed photography. The obtained results revealed that the force signals collected by thin-film sensors significantly correlated with thresher rotating speed and feeding rate. The thresher top cover’s average stress, average strain, and average total deformation were simulated using ANSYS finite element analysis. This study provides a new method for threshing drum real-time feeding quantity monitoring and early warning of thresher blockage.

Objective: To study the response of irritable bowel syndrome patients presenting with diarrhea and abdominal pain to the treatment with Rifaximin. Study Design: Observational descriptive study. Place and Duration of Study: Study was carried out from 1st February 2019 to 1st December 2019 at Gastroenterology department of Combined Military Hospital Rawalakot. Materials and Methods: Total of 113 patients were consecutively chosen from the Gastroenterology Outpatient Department, Sheikh Khalifa Bin Zayed Al Nahyan Hospital/ AK Combined Military Hospital Rawalakot. Irritable bowel syndrome, diarrhea was diagnosed using Rome III criteria. All participants received 550 mg Rifaximin in two divided doses for a period of fourteen days and were observed for six weeks. The assessed symptoms were diarrhea and abdominal pain, which were recorded at baseline and then at 6 week follow up. Descriptive statistics were done to look for the response of patients’ clinical symptoms to Rifaximin. Results: Mean age of the participants was 26.96 years. Out of 113 subjects, 45% were male (51/113) and 55% (62/113) females. Rifaximin was found to be effective in relieving symptoms in 99(87.6%) cases while it did not relieve symptoms in 14 (12.4%) cases. Only 14(12.4%) patients developed headache as a side effect, while the rest 99(87.6%) tolerated it well. Conclusion: Rifaximin is a useful, effective and a safe drug for the treatment of irritable bowel syndrome patients suffering from diarrhea and abdominal pain.

The establishment of grid-connected prosumer communities to bridge the demand-supply gap in developing nations, especially in rural areas will assist to minimize the use of carbon enriched fossil fuels and the resulting economic pressure. In the promoted study, an economic and ecosystem-friendly hybrid energy model is proposed for grid-connected prosumer community of 147 houses in district Kotli, AJK. The grid search algorithm-based HOMER software is used to simulate and analyze the load demand and biomass sources-based onsite collected data through a survey for an optimal proposed design. The research objectives are to minimize the net present cost (USD) of design, the per unit cost of energy (USD/kWh), and the carbon emissions (kgs/year). A sensitivity analysis based on photovoltaic module lifetime is also performed. The simulations show that the per unit cost of energy is reduced from 0.1 USD/kWh to 0.001 USD/kWh for the annual energy demand (kWh/year) of the community. The number of carbon emissions is also minimized from 122056 kgs/year to 1628 kgs/year through the proposed optimal energy model.

IntroductionRohingya- the Forcibly Displaced Myanmar Nationals (FDMN)- are largely characterized by a high total fertility rate (TFR) and a low contraceptive prevalence rate. This study aimed to explore the reasons behind their high fertility behavior by utilizing the Theory of Planned Behavior.Data and methodWe adopted a cross-sectional qualitative research approach. Fifteen semi-structured, face-to-face in-depth interviews were conducted with the Rohingya husbands, wives, and community leaders (Majhi and Imam/Khatib) living in Camps 1 and 2 of Ukhiya Refugee Camp, Cox's Bazar, Bangladesh. We analyzed the qualitative data using the thematic analysis approach.ResultsThe Muslim-majority FDMN predominantly constructed the fertility outcome as the will and order of Allah. On the one hand, the Rohingya parents highlighted various religious, political, economic, and social advantages of having more children, especially sons. On the other hand, beliefs about religious restriction, fear of side effects, and community pressure against contraception sustained the reality of the low contraceptive prevalence rate in the community. Alarmingly, the Rohingya religious leaders and mass people were found highly politically motivated to continue the practice of high fertility with a view to 'expanding the Rohingya community' or 'to increase Muslim soldiers', so that they may fight back and take control of their ancestors' place in Myanmar in the future. Furthermore, these pronatalist attitudes and beliefs translated into high TFR through various high-fertility-supportive social norms and practices widely prevalent in the Rohingya community. These include child marriage, gendered division of labor, women's subordinate nature, the Purdah system, and joint-family members' support during childbirth and rearing.ConclusionReligion, ethnic identity, and the unique political context and experiences of the Rohingya people jointly explain their high fertility behavior. This study warrants the urgency of initiating social and behavior change communication programs to change the religiopolitically-motivated high-fertility notions that prevailed in the Rohingya community.

Objective: To find out the effectiveness of short message service (SMS) on glycaemic control among patients with diabetes at a tertiary care hospital in Rawalpindi. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Endocrinology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2020. Methodology: A total of 218 patients with diabetes were included in the study. Patients were randomized into two groups by lottery method. Group-A received a tailored SMS package daily for six months along with printed dietary instructions, while Group-B was given only printed dietary instructions. After six months, HbA1c levels and other sociodemographic factors were compared among the two Groups A and B. Results: In Group-A (SMS-Group) mean HbA1c levels reduced from 9.3±2.0 to 7.0±0.4 compared to Group-B (non-SMSGroup) with mean HbA1c levels from 9.7±1.8 to 8.8 ±1.4. Before SMS intervention, all variables, including HbA1c levels between the two groups, were insignificant. However, the use of structured SMS-based intervention in Group-A showed a statistically significant reduction in HbA1c levels compared to Group-B (p-value

The objective of this article is to review the role of the dentist in the early diagnosis of pediatric obstructive sleep apnea (OSA) and to provide an in-depth review of the best evidence-based practices available to treat and/or to refer these patients for intervention. Material and methods: A narrative review was performed using indexed data bases (PubMed, Medline, EMBASE, OVID, Scopus and Cochrane) up to year 2020, and approximately 1000 articles were reviewed. The articles included were those with the best information provided. Results: Detailed review of the literature suggests that the role of the dentist has been redefined owing to their expertise in the orofacial region. Every patient consulting a dental practice is not merely a dental patient; he/she also requires a comprehensive medical review. The role of the dentist is pivotal in pediatric patients once diagnosed with OSA; as the patients grow, growth modification can be achieved, and future management will be easier. Initiating dental treatments during growth can benefit patients two-fold, saving them from malocclusion, and intervening in orofacial structural growth can help to avoid cumbersome treatments, such as CPAP and various surgeries. Proper diagnosis and management of systemic illnesses can prevent compromised quality of life, delays in treatment, morbidity and, in some cases, mortality.

Abstract Among bacterial species implicated in hospital-acquired infections are the emerging Pan-Drug Resistant (PDR) and Extensively Drug-Resistant (XDR) Acinetobacter (A.) baumannii strains as they are difficult to eradicate. From 1600 clinical specimens, only 100 A. baumannii isolates could be recovered. A high prevalence of ≥ 78% resistant isolates was recorded for the recovered isolates against a total of 19 tested antimicrobial agents. These isolates could be divided into 12 profiles according to the number of antimicrobial agents to which they were resistant. The isolates were assorted as XDR (68; 68%), Multi-Drug Resistant (MDR: 30; 30%), and PDR (2; 2%). Genotypically, the isolates showed three major clusters with similarities ranging from 10.5 to 97.8% as revealed by ERIC-PCR technique. As a resistance mechanism to fluoroquinolones (FQs), target site mutation analyses in gyrA and parC genes amplified from twelve selected A. baumannii isolates and subjected to sequencing showed 12 profiles. The selected isolates included two CIP-susceptible ones, these showed the wild-type profile of being have no mutations. For the ten selected CIP-resistant isolates, 9 of them (9/10; 90%) had 1 gyrA/1 parC mutations (Ser 81 → Leu mutation for gyrA gene and Ser 84 → Leu mutation for parC gene). The remaining CIP-resistant isolate (1/10; 10%) had 0 gyrA/1 parC mutation (Ser 84 → Leu mutation for parC gene). Detection of plasmid-associated resistance genes revealed that the 86 ciprofloxacin-resistant isolates carry qnrA (66.27%; 57/86), qnrS (70.93%; 61/86), aac (6')-Ib-cr (52.32%; 45/86), oqxA (73.25%; 63/86) and oqxB (39.53%; 34/86), while qepA and qnrB were undetected in these isolates. Different isolates were selected from profiles 1, 2, and 3 and qnrS, acc(6,)-ib-cr, oqxA, and oqxB genes harbored by these isolates were amplified and sequenced. The BLAST results revealed that the oqxA and oqxB sequences were not identified previously in A. baumannii but they were identified in Klebsiella aerogenes strain NCTC9793 and Klebsiella pneumoniae, respectively. On the other hand, the sequence of qnrS, and acc(6,)-ib-cr showed homology to those of A. baumannii. MDR, XDR, and PDR A. baumannii isolates are becoming prevalent in certain hospitals. Chromosomal mutations in the sequences of GyrA and ParC encoding genes and acquisition of PAFQR encoding genes (up to five genes per isolate) are demonstrated to be resistance mechanisms exhibited by fluoroquinolones resistant A. baumannii isolates. It is advisable to monitor the antimicrobial resistance profiles of pathogens causing nosocomial infections and properly apply and update antibiotic stewardship in hospitals and outpatients to control infectious diseases and prevent development of the microbial resistance to antimicrobial agents.

The objective of this meta-analysis study was to evaluate the comparative efficacy of empagliflozin (25 mg) with placebo in the treatment and management of type 1 diabetes mellitus. This study is a meta-analysis, so an ethical statement is not required. Different databases and individual journal websites like SCOPUS, Science direct, Cochrane review library etc. were used. The articles were evaluated based on the search and eligibility criteria. A total of five RCTs were incorporated in this meta-analysis. These studies contained a total of 1058 patients, including 526 patients with placebo (or control-treated patients), and 532 patients with empagliflozin (25 mg) treated combination. The mean follow-up time ranged from 7 days to 6 months. Overall, mean reduction in placebo was -0.50% and empa-treated was -0.85%, while the pooled WMD was 3.82 995% CI 1.20 – 5.88, p=0.0001). Regarding urinary glucose excretion, that the pooled WMD was 6.67 (95% CI 4.87-10.14, p=0.001) indicated a significant increase in empa-arm compared to placebo. No heterogeneity was found (I2 – 15.03%). This meta-analysis underlined the therapeutic benefit of empagliflozin as an adjunctive therapy for patients with type 1 diabetes.

Abstract This study examined the associations between vitamin E, oxidative stress markers, total homocysteine levels, and physical activity or cognitive capacity in older adults. One hundred and six older adults (62 men, 44 women) within the age range of 56–81 years participated. The Global Physical Activity Questionnaire and the Loewenstein Occupational Therapy Cognitive Assessment were used to assess physical activity and cognitive function, respectively. Vitamin E (e.g., α-tocopherol and γ-tocopherol), oxidative stress markers (e.g., total antioxidant capacity and nitric oxide), and total homocysteine were estimated. There were significant associations between physical activity (high versus moderate versus poor) and all biomarkers (all p = 0.000, and p = 0.010 for γ-tocopherol). While total homocysteine and total antioxidant capacity were significantly associated with cognitive capacity (p = 0.000), vitamin E levels (e.g., α-tocopherol and γ-tocopherol) and nitric oxide (p = 0.354, 0.103 and 0.060, respectively) were not related to cognitive capacity in older adults. This study concludes that physical activity was associated with Vitamin E, oxidative stress markers, total homocysteine, and cognitive capacity in older adults. Although cognitive capacity was associated with total homocysteine and total antioxidant capacity, it was unrelated to vitamin E levels and nitric oxide in older adults.

Abstract Acinetobacter baumannii (A. baumannii), an opportunistic, gram-negative pathogen, has evoked the interest of the medical community throughout the world because of its ability to cause nosocomial infections, majorly infecting those in intensive care units. It has also drawn the attention of researchers due to its evolving immune evasion strategies and increased drug resistance. The emergence of multi-drug-resistant-strains has urged the need to explore novel therapeutic options as an alternative to antibiotics. Due to the upsurge in antibiotic resistance mechanisms exhibited by A. baumannii, the current therapeutic strategies are rendered less effective. The aim of this study is to explore novel therapeutic alternatives against A. baumannii to control the ailed infection. In this study, a computational framework is employed involving, pan genomics, subtractive proteomics and reverse vaccinology strategies to identify core promiscuous vaccine candidates. Two chimeric vaccine constructs having B-cell derived T-cell epitopes from prioritized vaccine candidates; APN, AdeK and AdeI have been designed and checked for their possible interactions with host BCR, TLRs and HLA Class I and II Superfamily alleles. These vaccine candidates can be experimentally validated and thus contribute to vaccine development against A. baumannii infections.

Abstract COVID-19 may manifest as mild, moderate or severe disease with each grade of severity having its own features and post-viral implications. With the rising burden of the pandemic, it is vital to identify not only active disease but any post-recovery complications as well. This study was conducted with the aim of identifying the presence of post-viral symptomatology in patients recovered from mild COVID-19 disease. Presence or absence of 11 post-viral symptoms was recorded and we found that 8 of the 11 studied symptoms were notably more prevalent amongst the female sample population. Our results validate the presence of prolonged symptoms months after recovery from mild COVID-19 disease, particularly in association with the female gender. Hence, proving the post-COVID syndrome is a recognizable diagnosis in the bigger context of the post-viral fatigue syndrome.

Abstract Optimally preserved urinary exfoliated renal proximal tubule cells were assessed by multispectral imaging of cell autofluorescence. We demonstrated different multispectral autofluorescence signals in such cells extracted from the urine of patients with healthy or diseased kidneys. Using up to 10 features, we were able to differentiate cells from individuals with heathy kidneys and impaired renal function (indicated by estimated glomerular filtration rate (eGFR) values) with the receiver operating characteristic area under the curve (AUC) of 0.99. Using the same method, we were also able to discriminate such urine cells from patients with and without renal fibrosis on biopsy, where significant differences in multispectral autofluorescence signals (AUC = 0.90) were demonstrated between healthy and diseased patients (p

Abstract Background Public trust is central to the collection of genomic and health data and the sustainability of genomic research. To merit trust, those involved in collecting and sharing data need to demonstrate they are trustworthy. However, it is unclear what measures are most likely to demonstrate this. Methods We analyse the ‘Your DNA, Your Say’ online survey of public perspectives on genomic data sharing including responses from 36,268 individuals across 22 low-, middle- and high-income countries, gathered in 15 languages. We examine how participants perceived the relative value of measures to demonstrate the trustworthiness of those using donated DNA and/or medical information. We examine between-country variation and present a consolidated ranking of measures. Results Providing transparent information about who will benefit from data access was the most important measure to increase trust, endorsed by more than 50% of participants across 20 of 22 countries. It was followed by the option to withdraw data and transparency about who is using data and why. Variation was found for the importance of measures, notably information about sanctions for misuse of data—endorsed by 5% in India but almost 60% in Japan. A clustering analysis suggests alignment between some countries in the assessment of specific measures, such as the UK and Canada, Spain and Mexico and Portugal and Brazil. China and Russia are less closely aligned with other countries in terms of the value of the measures presented. Conclusions Our findings highlight the importance of transparency about data use and about the goals and potential benefits associated with data sharing, including to whom such benefits accrue. They show that members of the public value knowing what benefits accrue from the use of data. The study highlights the importance of locally sensitive measures to increase trust as genomic data sharing continues globally.

Objective: To determine the impact of physician led life style modifications (diet and daily step count by using pedometer) on glycemic control of type II diabetic patients Study Design: Quasi experimental study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, Aug 2018 to Feb 2019. Methodology: The sample population comprised of 200 diabetic patients reporting for the routine follow-up at a tertiary care hospital in Rawalpindi. Patients were divided into two groups by random method. Group A had the patients with continuation of the routine anti-diabetic medication while group received the physician led life style modifications in addition to the routine anti diabetic medication. Values of HBA1c among the groups were compared three months after the start of study. Results: Mean age of the patients was 42.19 ± 6.175 years. Mean duration of DM in the study participants was 4.52 ± 4.166 years. Out of 115 patients were male while 85 were female. HBA1c in the intervention group was 7.96% ± 0.39 while in the control group was 7.04% ± 0.81. Difference between the two groups was statistically significant (p-value

Objective: To assess the frequency, variants, clinical profile and outcome of patients admitted with the diagnosis of GuillianBarre Syndrome at neurology unit of a tertiary care teaching hospital of Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Neurology department, Pak Emirates Military Hospital Rawalpindi, from Jan to Dec 2018. Methodology: This study was conducted on 42 patients of Guillian-Barre Syndrome admitted in hospital. Demographic profile included age, gender, and the symptoms with which the patient presented. Medical and neurological complications were also documented among the target population. Outcomes included recovery, shifting to intensive care unit and death. Results: Out of 42 patients included in the final analysis 25 were male and 17 were female. Most of the patients presented with lower limb weakness followed by numbness. Acute inflammatory demyelinating polyneuropathy was the commonest while cranial nerve variant was least reported. Motor deficit were the commonest complication faced by the patients followed by respiratory involvement. Out of 42 patients, 34 (80.9%) recovered, 4 (9.5%) were shifted to the intensive care unit and 4 (9.5%) died. Conclusion: This study gives an insight into the pattern of a fairly common neurological illness which if diagnosed and managed in time has a good outcome in our set up. Management of critically ill Guillian-Barre Syndrome patients involves a multidisciplinary team with a need of intensive care unit during the course of management. Variety of types and presentations should be part of training of neurology doctors as well as internal medicine doctors.

Background and objective: One of the important health problems in Duhok city, Iraqi Kurdistan Region, is sickle cell disease. Blood transfusion remains a significant therapeutic intervention in patients with sickle cell disease that reduces complications related to vaso-occlusions. This study aimed to assess compliance to guidelines for the use of blood transfusionsin Duhok, Kurdistan, Iraq. Methods: This is a cross-sectional study that included 135 patients with sickle cell disease registered at Jeen center of pediatric hematological diseases in Duhok, Kurdistan, Iraq. Between April 1st and July 31st, 2019, 205 medical visits of sickle cell disease were registered. Every patient was evaluated to record the clinical setting and explanations behind visiting and indications for transfusion. Results: Of 135 patients,65.9% had sickle cell anemia (HbSS disease), 33.3% had sickle beta thalassemia, and one patient (0.7%) had Sickle/D disease. A total of 205 medical visits of sickle cell disease were registered with 84 blood transfusion decisions. The most common indicated guideline reasons for transfusion were symptomatic anemia and acute hemolytic crisis with a drop of hemoglobin >2 g/dl below steady state hemoglobin and severe painful crisis only accounted for 38.1%. Conclusion: In this study of patients with sickle cell disease, most blood transfusions were not indicated according to the transfusion guidelines (British Committee for Standards in Haematology – BCSH, 2017).

Abstract Antibiotic overuse is a major factor for causing antibiotic resistance globally. However, only few studies reported the implementation and evaluation of antimicrobial stewardship programs in Gulf Cooperation Council. This study was conducted within 8-months periods to evaluate the effect of the newly implemented antibiotic stewardship program on improving the prescribing practice of surgical antibiotic prophylaxis in a secondary care hospital in the United Arab Emirates by releasing local hospital guidelines. The data of 493 in patients were documented in the predesigned patient profile form and the prescribing practice of surgical antibiotic prophylaxis for clean and clean-contaminant surgical procedures was compared and analyzed two months’ prior (period A) and post (period B) the implementation of antibiotic stewardship program. The 347 patient’s data (PD) were analyzed during period A and 146 PD during period B. The prescription of piperacillin/tazobactam was decreased from 2.4% from all surgical prophylaxis antibiotic orders in period A to 0% in period B. The appropriateness of the antibiotic therapy was found to differ non significantly for the selection of prophylactic antibiotic (p = 0.552) and for the timing of first dose administration (p = 0.061) between A and B periods. The total compliance was decreased non significantly (P = 0.08) from 45.3 to 40.2%. Overall, the guidelines have improved the prescribing practice of antibiotics prior to surgery. However, further improvement can be achieved by initiating educational intervention via cyclic auditing strategy.

Background and objective: Vitamin D deficiency appears to be related to the development of diabetes mellitus type 2 and metabolic syndrome. This study aimed to assess the association between the level of 25-hydroxy vitamin D{25(OH)D3 and the glycemic control in patients with type 2 diabetes. Methods: This case-control study involved 240 participants divided into two groups, 119 patients with type 2 diabetic mellitus and 120 healthy individuals as a control group. The study was conducted in Layla Qassim Diabetic Center in Erbil from March 2018 to March 2019. The data were collected from all the cases, including history and physical examination, using a specially designed questionnaire. From all cases, blood was taken, and samples were sent to the laboratory for serum vitamin D3 level estimation. Results: From the total of 240 participants, the mean age of cases was 54.04 ± 10.56 years and of controls was 53.12 ± 9.84 years. The mean serum vitamin D3 level of the cases was 9.21 ± 5.69ng/ml, and it was non-significantly (P = 0.3) higher than the control (8.61±4.57)ng/ml. Both groups were within the vitamin D deficient range. Vitamin D level was non-significantly deficient in 84 (70.6%) of diabetic patients compared to 89(73.6%) of control. There was a non-significant difference in vitamin D level in poorly controlled diabetic patients compared to well-controlled diabetic patients (P = 0.584). Conclusion: No significant association was detected between vitamin D level and glycemic control.

The effective segmentation of lesion(s) from dermoscopic skin images assists the Computer-Aided Diagnosis (CAD) systems in improving the diagnosing rate of skin cancer. The results of the existing skin lesion segmentation techniques are not up to the mark for dermoscopic images with artifacts like varying size corner borders with color similar to lesion(s) and/or hairs having low contrast with surrounding background. To improve the results of the existing skin lesion segmentation techniques for such kinds of dermoscopic images, an effective skin lesion segmentation method is proposed in this research work. The proposed method searches for the presence of corner borders in the given dermoscopc image and removes them if found otherwise it starts searching for the presence of hairs on it and eliminate them if present. Next, it enhances the resultant image using state-of-the-art image enhancement method and segments lesion from it using machine learning technique namely, GrabCut method. The proposed method was tested on PH2 and ISIC 2018 datasets containing 200 images each and its accuracy was measured with two evaluation metrics, i.e., Jaccard index, and Dice index. The evaluation results show that our proposed skin lesion segmentation method obtained Jaccard Index of 0.77, 0.80 and Dice index of 0.87, 0.82 values on PH2, and ISIC2018 datasets, respectively, which are better than state-of-the-art skin lesion segmentation techniques.

ObjectiveThe aim of this study was to compare the clinical outcomes associated with different combinations of oral diabetic drugs among patients with type 2 diabetes mellitus.MethodA prospective multicenter longitudinal, noninterventional observation study design was applied. At baseline (0 month), clinical parameters including glucose profile, renal function, lipid profile and risk assessment for cardiovascular risks were calculated. Mean Weighted difference (MWD) with heterogeneity and effect z was calculated to determine the risk reduction at the end of the study.ResultsA total of 1,657 were enrolled to different cohorts with response rate of 75.5%. The distribution of patients was based on prescribed drug. A total of 513 (30.9%) in G1 (metformin alone), 217 (13.09%) in G2 (metformin with Glimepiride), 231 (12.85%) in G3 (Metformin with Gliclazide), 384 (23.17%) in G4 (metformin with Sitagliptin) and 312 (18.89%) in G5 (Metformin with Saxagliptin). There was no significant different in all clinical and social variables at baseline. The Intergroup analysis showed significant differences with all the primary outcome variables except BMI (p = 0.217) and eGFR (p = 0.782) among patients using sulphonylurea (SU) combination (G2 & G3). Findings also showed significant high frequency of emergency visit and hospitalization in G1 (78.16% & 30.8%) as compared to SU (70.1% & 28.3%, p = 0.001) and DPP-4 (56.6% & 20.4%, p = 0.001). The overall reported effect was z = 2.58, p = 0.001 for ASCVD risk reduction assessment.ConclusionThe study concluded that significant effect of Dipeptidyl peptidase-4 inhibitor on reduction of hospitalization, lipid profile and also ASCVD risk score of type-II diabetes mellitus patients regardless of clinical comorbidities. Also, sulfonylurea combinations have showed significant reduction in LDL and triglycerides values.

BackgroundT2D is an increasingly common disease that is associated with worse outcomes in patients with heart failure. Despite this, no contemporary study has assessed its impact on heart transplantation outcomes. This paper examines the demographics and outcomes of patients with type 2 diabetes (T2D) undergoing heart transplantation.MethodsUsing the United Network for Organ Sharing (UNOS) database, patients listed for transplant were separated into cohorts based on history of T2D. Demographics and comorbidities were compared, and cox regressions were used to examine outcomes.ResultsBetween January 1st, 2011 and June 12th, 2020, we identified 9,086 patients with T2D and 23,676 without T2D listed for transplant. The proportion of patients with T2D increased from 25.2% to 27.9% between 2011 and 2020. Patients with T2D were older, more likely to be male, less likely to be White, and more likely to pay with public insurance (pConclusionsOver the last ten years, the proportion of heart transplant recipients with T2D has increased. These patients are more likely to be from traditionally underserved populations. Patients with T2D have a lower likelihood of transplantation and a higher likelihood of post-transplant mortality. After the allocation system change, likelihood of transplantation has improved for patients with T2D.

Neurobehavioral impairment associated with COVID-19 infection has been recently documented in the literature. COVID-19 infection has also been associated with an increased risk for developing psychiatric symptoms, including rare reports on psychosis. We report a case of a 46-year-old male with no significant medical, family, and psychiatric history admitted to the hospital with COVID-19-related psychosis. Possible contributory factors for his condition are discussed, including the relationship between infections and the brain circuitry, inadvertent iatrogenic effects of pharmaceuticals used to manage COVID-19, as well as diathesis-stress associated with the tribulation of the prevailing pandemic.

Background: Occupational contact with dust particles is a well-known phenomenon, particularly in developing countries of the world. Crystalline silica present in marble dust is the main etiology of a rising prevalence of obstructive lung diseases in marble stone workers, who are in direct contact with marble dust in the surrounding environment during their regular work. The purpose of this study was to compare the pulmonary function parameters of workers in marble workshops and age matched healthy individuals in the Lahore District of Pakistan. Methods: The study included 164 male individuals, 82 individuals working in marble workshops and 82 healthy individuals from the same community. Data were collected through in-person interviews using a structured questionnaire after obtaining written consent. A Spiro Lab spirometry for pulmonary function tests was used to identify any change in the lung function parameters. FVC% (forced vital capacity), FEV 1 (forced expiratory volume in first second) and FEV1 / FVC ratio were evaluated. Results: Mean age in the exposed group (marble workers) and non-exposed group (healthy individuals) were 29.92 ± 6.19 and 30.58 ± 6.37 years, respectively. The mean years of work experience of the exposed group was 11.92 ± 5.67 years. A statistically insignificant difference was observed between marble exposed workers & healthy individuals from the demographic variables. Lung function parameters in marble workers exhibited a highly significant (P < 0.001) decrease in FVC%, FEV1 & FEV1 / FVC ratio when compared to healthy individuals. Seventy-one percent of marble workers had abnormal pulmonary parameters whereas 34% of workers had restrictive pulmonary impairment. Marble workers who had worked for more than 15 years had a highly significant risk of developing abnormal pulmonary function (P < 0.001). Conclusion: Continuous exposure to marble dust deteriorates the lung function of marble workers.

Objective: To determine the immunohistochemical (IHC) expression of transducer like enhancer of split 1 (TLE-1) in diagnosed cases of synovial sarcoma (SS). Study Design: Cross sectional study. Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan, from Jan 2017 to Jun 2018. Methodology: In our study, 60 cases of SS diagnosed on hematoxylin & eosin (H&E) morphology, IHC expression of CD99 and epithelial membrane antigen (EMA) were retrieved from archive of Histopathology department AFIP Rawalpindi. Patient’s age, gender, tumor site and histologic type were noted. IHC for TLE-1 was applied and results were recorded. Data was analyzed using SPSS version 22. Results: A total of 60 cases were included in which 33 were males and 27 were females. The male to female ratio was 1.2:1. Mean age of the study patients was 36.6 ± 15 years. SS was found be more common in soft tissues of limbs/ extremities around tendons sheaths (76%); other sites being lungs, head & neck and retroperitoneum. Out of 60 cases of SS, 42 (70%) cases were monophasic, while 15 (25%) and 3 (5%) cases were biphasic and poorly differentiated SS, respectively. A total of 90% samples (n=54) showed immunoreactivity for TLE-1 (p=0.023) out of which 61% samples (n=33) had diffuse (2+) nuclear staining while 21 (39%) showed weak to moderate nuclear staining for TLE-1. However, 6 (10%) cases did not show nuclear staining for TLE-1. Conclusion: TLE-1 was found to be a novel marker which was extremely helpful in diagnosis of SS, especially in cases where diagnostic challenge arises when other spindle cell neoplasms are considered in the differential diagnosis and in laboratory set ups where advanced facilities of molecular testing by fluorescent in situ hybridization (FISH) is not available.

Background: Head and neck cancer (HNC) is one of the most common cancers in Pakistan. Disease free survival in HNC remains poor due to inefficient loco-regional disease control. The aim of the present study was to assess the response rate and toxicity of concomitant vinorelbine and External radiation therapy (ERT) in advanced Head and Neck cancer in local Pakistani population. The study as per Good Clinical Practice (GCP) guidelines was conducted at the oncology department of Nishat hospital Multan from 2015 to 2017. Methodology: An observational, prospective study with enrollment of 50 patients of advanced head and neck cancer was followed to analyze the outcome for radiosensitization. Primary tumor sites were tongue in 15 (30%) patients; lower lip in 6 (12%); buccal cavity in 5 (10%); cheek in 5 (10%); tonsil in 4 (8%); larynx in 6 (12%); hypopharynx in 5 (10%); and parotid in 4 (8%) patients. Initial clinical stage was: IV in 23 (46%) patients and III in 27 (54%) patients. Vinorelbine (VNB) was given at dose of 10 mg i.v. infusion weekly with ERT (3D conformal radiation plan). Response rate was evaluated after at least 8 doses. Response evaluation criteria in Solid Tumors (RECIST) was used to assess complete response (CR) and partial response (PR); progressive disease (PD) and stable disease (SD). Toxicity was assessed using common toxicity criteria version 3.0 (CTCV3.0). Results: 44 out of 50 patients were evaluable for response rate and toxicity. Immediate response was 90% CR. After 24 months of followup CR, PR, SD, and PD were seen in 26 (59%), 6 (13%), 7 (15%) and 6 (13%) patients respectively. Grade III mucositis and dysphagia were observed in 19 (43%) and 8 (18%) patients respectively, grade III skin rash in 14 (30%) patients, grade-II peripheral neuropathy was seen in 3 (6%) patients. Conclusion: The study showed that vinorelbine as a radiosensitizer in advanced HNC is a feasible option with acceptable toxicities. A large study is required to define its definite role.