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Muhammad M Hammami,1,2 Safa Hammami,1 Hala A Amer,1 Nesrine A Khodr1 1Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia Background: Understanding culture-and sex-related end-of-life preferences is essential to provide quality end-of-life care. We have previously explored end-of-life choices in Saudi males and found important culture-related differences and that Q-methodology is useful in identifying intraculture, opinion-based groups. Here, we explore Saudi females’ end-of-life choices.Methods: A volunteer sample of 68 females rank-ordered 47 opinion statements on end-of-life issues into a nine-category symmetrical distribution. The ranking scores of the statements were analyzed by averaging analysis and Q-methodology.Results: The mean age of the females in the sample was 30.3 years (range, 19–55 years). Among them, 51% reported average religiosity, 78% reported very good health, 79% reported very good life quality, and 100% reported high-school education or more. The extreme five overall priorities were to be able to say the statement of faith, be at peace with God, die without having the body exposed, maintain dignity, and resolve all conflicts. The extreme five overall dis-priorities were to die in the hospital, die well dressed, be informed about impending death by family/friends rather than doctor, die at peak of life, and not know if one has a fatal illness. Q-methodology identified five opinion-based groups with qualitatively different characteristics: “physical and emotional privacy concerned, family caring” (younger, lower religiosity), “whole person” (higher religiosity), “pain and informational privacy concerned” (lower life quality), “decisional privacy concerned” (older, higher life quality), and “life quantity concerned, family dependent” (high life quality, low life satisfaction). Out of the extreme 14 priorities/dis-priorities for each group, 21%–50% were not represented among the extreme 20 priorities/dis-priorities for the entire sample.Conclusion: Consistent with the previously reported findings in Saudi males, transcendence and dying in the hospital were the extreme end-of-life priority and dis-priority, respectively, in Saudi females. Body modesty was a major overall concern; however, concerns about pain, various types of privacy, and life quantity were variably emphasized by the five opinion-based groups but masked by averaging analysis. Keywords: end-of-life priorities, end-of-life dis-priorities, Q-methodology, score-averaging, Muslims, Saudi females

Abstract The shisham tree (Dalbergia sissoo) is a keystone hardwood species of South Asia, highly valued in economic value in forestry, agroforestry, and landscape horticulture due to its durable, fragrant, and decay-resistant wood. However, shisham's health on both public and private lands is seriously compromised by recurrent outbreaks of dieback disease. Shisham has a history of severe dieback over the last century throughout its natural and introduced range. Since 1918, mortality associated with shisham dieback has been studied to determine its spread and underlying causes. Like most pathosystems, shisham dieback involves complex interactions among multiple biotic and abiotic factors, with certain site- and stand-level factors exacerbating disease severity across various regions and times. Recent outbreaks of shisham dieback in Pakistan have been linked to Ceratocystis dalbergicans. Previously, Fusarium was linked to wilt/dieback disease in Shisham. This disease has been differentiated from often-confusing Fusarium wilt/dieback on the same plant and explains dieback, a separate disease of shisham. Currently, published guidelines for managing Ceratocystis infections in shisham are limited. While researchers have explored potential management strategies, including identifying host resistance genes and chemical control methods, achieving sustainable disease control will require long-term, dedicated efforts due to the extended lifespan of shisham trees. This review provides a historical and updated perspective on the investigation and establishment of the pathogenic basis of shisham dieback, focusing on the role of Ceratocystis species. This work aims to clarify existing knowledge gaps, resolve controversies surrounding disease causation, and inform future research to enhance shisham conservation efforts.

This paper introduces the concept of set-valued almost $ \Upsilon $-contractions in $ \mathcal{F} $-metric spaces, aiming to obtain the best proximity point results for set-valued mappings. The newly proposed idea of set-valued almost $ \Upsilon $-contractions includes various contractive conditions like set-valued almost contractions, set-valued $ \Upsilon $-contractions, and traditional $ \Upsilon $-contractions. Consequently, the results presented here extend and unify numerous established works in this domain. To illustrate the practical significance of the theoretical findings, a specific example is provided.

Abstract Background Recent reports have revealed that nephropathy leading to kidney injury (KI) is a prevalent complication of COVID-19 and is linked to high mortality and morbidity in diabetes mellitus type II (DM-T-II) patients. This systematic literature review and meta-analysis aimed to critically analyze existing studies and evidence on the impact of COVID-19 on nephropathy and kidney injury in diabetes mellitus type II (DM-T-II) patients. Method A systematic search was conducted in the Web of Science (WoS), PubMed and Cochrane databases for relevant studies published between March 2020 and July 2023. To ensure the integrity of the systematic literature review and meta-analysis, observational studies that specifically reported post-COVID-19 kidney injury in DM-T2 patients were included, whereas we did not include articles in the press, meta-analyses, case reports, case series, Diabetes Type-I articles or non-English papers. The primary outcome was kidney injury in patients with type II diabetes after contracting COVID-19. The protocol for this study was published on PROSPERO (registration number CRD42023413887). Results Initially, 6,339 articles were included in the search, from which only 6 observational studies were selected by following the 2020 PRISMA statement. The quality of the evidence was assessed by a tool provided by the National Institutes of Health (observational studies). The total number of participants included in the studies was 14,723. Our systematic literature review and meta-analysis provide compelling evidence that kidney injury is a prevalent complication of COVID-19 infection in the type II diabetes population, with a pooled odds ratio of 2.27 (95% CI: 2.05–2.51; p

This retrospective observational study was conducted in Libya to examine the frequency and determinants of drug-drug interactions (DDIs) among hospitalised haemodialysis inpatients between January 2018 and June 2020. The study highlighted a notable prevalence of DDIs among HD patients, with a prevalence rate of 71.1%. Regarding the identification of DDI predictors and their correlations with extended hospital stays and polypharmacy, regression analysis was conducted to identify predictors and outcomes. The study found that DDIs were associated with prolonged hospital stays and were independently linked to polypharmacy in HD patients. Furthermore, a significant clinical impact of DDIs on HD patients was observed, particularly in relation to in-hospital mortality.

Greywater can be reused after treatment. Several techniques for treating greywater can be adopted. However, the selection of the optimal technique is a difficult action. Therefore, this study adopted an experimental approach to compare two different techniques to determine the optimal one. Two systems were designed and constructed to study the optimal technique for greywater pretreatment. The first system consists of a 5000L anaerobic fiberglass tank of 2.5m depth whereas the other system consists of 5 separated cylindrical tanks; each tank of 1000L fiberglass. The pH, biological oxygen demand (BOD5), total suspended solids (TSS), Total N, Total P, chemical oxygen demand (COD), total organic Carbon (TOC), SO4, Alkaline, Na+1, Ca+2, K+1, and water temperature for raw greywater and effluent from each tank were continuously measured for ten months. According to performance data, ineffective anaerobic bacteria weaken wastewater in septic tanks by roughly 30–40% while extremely effective aerobic bacteria do the same in protonated tanks by more than 93%. Compared to anaerobic bacteria, aerobic bacteria enhance the quality of greywater that exits a septic tank. The present study exposed the nitrification of waste through aerobic treatment of greywater using ozone and air (1:1 volume %) to reduce odor, COD, TSS, and BOD5 and remove nitrogen.

The purpose of this study is to examine the relationship between consumer ethnocentrism (CE), perceived interactivity (PI), perceived value (PV), attitude, subjective norm (SN), perceived behavioral control (PBC), and intention to adopt energy-saving vehicles (EVs) in virtual brand communities among Chinese consumers. A total of 411 completed questionnaires were collected through purposive sampling to empirically test the proposed hypotheses using SPSS and AMOS-SEM. The results suggest that in the backdrop of China EVs market, CE and PI positively influence PV respectively, where CE positively influences intention and PI positively influences attitude simultaneously in virtual brand communities. PV further positively influences consumer attitude in such brand communities. Furthermore, attitude, SN, and PBC positively influence intention to purchase EVs, while SN directly influences PBC. In addition, PBC and attitude fully mediate the relationship between SN and intention. This study provides a more comprehensive explanation on the purchase of EVs among Chinese consumers in the virtual brand communities circumstance, by utilizing the theory of planned behavior in green marketing literature. Findings of this study would greatly benefit EVs business operators and other key stakeholders in the emerging markets.

AbstractThe contemporary business landscape is witnessing a paradigm shift towards environmental sustainability, prompting organizations to adopt green practices. Among these, Green Employee Empowerment (GEE) and Green Training (GT) have emerged as pivotal strategies. This study aims to explore the interplay between GEE, GT, Job Satisfaction, Pro-environmental Behavior (PEB), and Environmental Performance (EP) within hotel organizations. Using a cross-sectional design, a questionnaire survey was administered to 400 full-time employees. The data were analyzed using Partial Least Square- Structural equation modelling (PLS-SEM) v4 techniques. The study’s findings highlight the substantial impact of GEE and GT on both PEB and Job Satisfaction among employees in hotel organizations. Interestingly, the results reveal that GEE significantly influences Environmental Performance (EP), underscoring its role in driving positive outcomes in terms of sustainability practices within hotels. However, the surprising finding is that GT, despite its emphasis on environmental training, has an insignificant impact on EP. This unexpected result warrants further exploration and underscores the need for a nuanced understanding of the effectiveness of different green initiatives in influencing the overall environmental performance. As hotels worldwide grapple with the imperative to adopt sustainable business practices, this study provides valuable insights and a roadmap for hotel organizations seeking to navigate the complex landscape of environmental responsibility and social accountability. The findings provide practical guidance for luxury hotels striving to strike a balance between economic success and environmental stewardship, fostering a holistic approach to sustainability in the hotel industry.

Background Over the last few decades, the pharmacy profession has witnessed a substantial evolution accompanied by the developing role of community pharmacists (CPs). Evidence indicates that extending the role of CPs contributes to fostering public health outcomes. However, in many countries, their role is still underused. To extend the role of CPs in Oman, it is crucial to understand their perception and determine the influences.Aim This study determines the willingness of CPs in Oman to extend their role and assess their perception towards barriers.Method A cross-sectional study was conducted across Oman using an online self-administered survey targeting CPs working in the private sector.Result Generally, respondents welcomed broadening their professional role. However, among the top perceived barriers were shortage of staff, insufficient training, lack of interconnection between CPs and physicians, and regulation constraints. Different socio-demographic characteristics of respondents showed a noticeable impact on their responses.Conclusion CPs welcomed extending their role. However, several obstacles were raised that need to be tackled to enable CPs to advance their role.

PurposeThe development of brain metastases (BM) can significantly increase the psycho-oncological burden in cancer patients, requiring timely intervention. In addition, this aspect may negatively affect the course of the disease and treatment outcome. However, screening for psycho-oncological burden is often overlooked in clinical routine. Therefore, we analyzed the extent of psycho-oncological distress in a patient population with BM receiving neurosurgical resection and identified clinical characteristics associated with a high need for psycho-oncological intervention.MethodsWe prospectively screened 353 patients (169 female, 184 male, mean age 61.9 years) scheduled for microsurgical resection of one or more BM. Psycho-oncological screening was performed on the day of admission using the Hornheider screening instrument (HSI) and the distress thermometer (DT). Screening results were correlated with demographic and clinical data.ResultsMost patients (73.1%) completed the screening questionnaire. Patients who failed to complete the questionnaire presented more frequently with metachronous BM (74.7% vs. 25.3%, p=0.009), were significantly older (p=0.0018), and had a significantly lower KPS score (p=0.0002). Based on the threshold values of the questionnaires, 59.3% of the patients showed a significant psycho-oncological burden requiring immediate intervention. Univariate analysis demonstrated that synchronous BM (p=0.034), tumors in eloquent areas (p=0.001), lower KPS (p=0.031), female gender (p=0.009), and presurgical aphasia (p=0.042) were significantly associated with high psycho-oncological burden. Multivariate analysis showed synchronous BM (p=0.045), female gender (p=0.005), and lower KPS (p=0.028) as independent factors associated with high psycho-oncological burden.ConclusionThe majority of patients with BM have a high psycho-oncological burden. Female gender, synchronous BM, and lower KPS are independently associated with a need for psycho-oncological intervention.

Background: Nephrolithiasis is the formation of hard, crystalline mineral that originates in the kidney which may descends in the urinary tract. Objective: Objective of this study is to describe the management of left ureteric calculus in hospital setting. Setting: Department of Urology in Amina Hospital Cantt, Sialkot, Pakistan. Method: In this case study, referred patient of 50 years old male is suffering from nephrolithiasis having hematuria along with hypertension. Main outcome measure: Lumbar pain and burning micturation of patient was relieved after the use of diclofenac sodium and citrosoda respectively. Also, the stone removal was done by tamsulosin. Result: Flank pain was treated by pharmacological therapy as well as by dietary modifications to improve hydration by increasing water intake which finally stabilizes the patient. Conclusion: Tamsulosin and ciprofloxacin along with citro-soda is an effective therapy for treating left lumbar pain radiating to groin area due to nephrolithiasis.

Abstract Background Dengue Viral Infection (DVI) has become endemic in Pakistan since the first major outbreak in Karachi in 1996. Despite aggressive measures taken by relevant authorities, Pakistan has been dealing with a worsening dengue crisis for the past two decades. DHF is severe form of dengue infection which is linked with significant morbidity and mortality. Early identification of severe dengue infections can reduce the morbidity and mortality. In this context we planned current study in which we find out the different factors related with DHF as well as clinical laboratory features of DHF and compare them to DF so that patients can be best evaluated for DHF and managed accordingly at admission. Methods Retrospective study conducted over a period of 6 years (2013–2018) in two tertiary care hospitals in Pakistan. Data were collected by using a pre-structured data collection form. Data were statistically analyzed to determine the clinical and laboratory characteristics of DVI and risk factors of dengue hemorrhagic fever (DHF). Results A total 512 dengue cases (34.05 ± 15.08 years; Male 69.53%) were reviewed. Most common clinical manifestations of DVI were fever (99.60%), headache (89.1%), chills (86.5%), rigors (86.5%), myalgia (72.3%). Less common clinical manifestations were vomiting (52.5%), arthralgia (50.2%) and skin rashes (47.5%). Furthermore, nasal bleeding (44.1%), gum bleeding (32.6%), pleural effusion (13.9%) and hematuria (13.1%) were more profound clinical presentations among DHF patients. Mortality rate was 1.5% in this study. Logistic regression analysis indicated that delayed hospitalization (OR: 2.30) and diabetes mellitus (OR:2.71), shortness of breath (OR:2.21), association with risk groups i.e., living near stagnant water, travelling to endemic areas, living in endemic regions (OR:1.95), and presence of warning signs (OR:2.18) were identified as risk factors of DHF. Statistically we found that there is strong association of diabetes mellitus (DM) with DHF while the patient suffering from DM individually had higher odds (2.71) of developing DHF than patients without disease. Conclusions The current study demonstrated that the clinical and laboratory profiles of DF and DHF are significantly distinct. Significant predictors of DHF were advanced age, diabetes mellitus, ascites, pleural effusion, thick gallbladder and delayed hospitalization. The identification of these factors at early stage provides opportunities for the clinicians to identify high risk patients and to reduce dengue-related morbidity and mortality.

SUMMARY: Bacterial chondronecrosis with osteomyelitis (BCO) lameness has been a major concern in the broiler industry, causing financial losses and animal welfare issues. BCO lameness is caused by a bacterial infection in leg bones. Pathogens enter the bloodstream via respiratory and intestinal epithelial translocation and infect the tibia and femoral heads of the birds. Supplementation of 1,25(OH)2D3 is crucial in regulating calcium and phosphorus homeostasis, immune system, and bone metabolism. 1,25(OH)2D3 glycosides derived from Solanum glaucophyllum (G-1,25(OH)2D3) were hypothesized to mitigate BCO lameness in broilers. In this study, G-1,25(OH)2D3 alone or in combination with phytogenic antioxidants were tested for their impacts on cumulative BCO lameness in the broiler population. BCO seeder group and the negative control had developed 78,0% and 73.5% cumulative lameness (P = 0.64), respectively. Supplementation of 1 µg/kg of G-1,25(OH)2D3 was more effective in reducing the cumulative lameness than 10 µg/kg of G-1,25(OH)2D3 (P < 0.05). There were no significant differences between 1 µg/kg of G-1,25(OH)2D3 alone or in combination with 500 mg/kg of a mixture of Curcuma longa plus Trachyspermum ammi (PH1), 750 mg/kg of a mixture of Solanum xanthacarpum plus Piper longum (PH2), or 500 mg/kg thyme oil. Therefore, 1 µg/kg of G-1,25(OH)2D3 provided better protection against BCO lameness compared to 10 µg/kg of G-1,25(OH)2D3. Additionally, the combination with phytogenic antioxidants did not result in any further reduction of cumulative BCO lameness compared to the use of G-1,25(OH)2D3 alone.

Background: Despite the introduction of bedaquiline (Bdq) containing all-oral regimens for treating patients with rifampicin resistant/multidrug resistant tuberculosis (MDR/RR-TB) in 2019, data on its effectiveness in Pakistan, which has the fifth highest MDR-TB burden, is lacking. This study evaluates treatment outcomes and identifies factors associated with unsuccessful outcomes among MDR/RR-TB patients treated with an all-oral longer treatment regimen (LTR). Methods: This retrospective record review included all microbiologically confirmed pulmonary MDR/RR-TB patients treated with an all-oral LTR between August 2019 and February 2021 across nine PMDT centres in Pakistan. Sociodemographic and clinical data were retrieved from the Electronic Nominal Recording and Reporting System. Treatment outcomes, defined by WHO criteria, were analysed using SPSS and multivariate binary logistic regression to identify factors associated with unsuccessful outcomes. A p-value 5 drugs (OR:3.12, 95 %CI:1.36–11.64, p = 0.013) were significantly associated with death and treatment failure. Whereas, lung cavitation had statistically significant association with LTFU (OR:2.66, 95 %CI:1.10–7.32, p = 0.045). Conclusion: Treatment success rate (70.3 %) in this study fell below the WHO recommended target success rate (>90 %). Enhanced clinical management, coupled with special attention to patients exhibiting identified risk factors could improve treatment outcomes.

The consumption value seems to be insufficient to explain consumers' domestic electric vehicle purchase behaviour, especially in a highly competitive global environment. This study aims to investigate how consumer ethnocentrism and perceived interactivity influence consumption value and pro-environmental value, subsequently affecting attitude and intention. A total of 353 valid questionnaires were collected through convenience sampling in Xuzhou, China, and the partial least square (PLS) path modelling approach was performed to test the hypotheses. The results show that consumer ethnocentrism and perceived interactivity positively influence function value, emotional value, and social value; perceived interactivity also positively influences altruistic value, biospheric value, and collectivistic value. Function value, social value, and collectivistic value positively influence attitude; however, emotional value, altruistic value and biospheric value did not find a correlation with attitude. Furthermore, attitude positively influences intention to adopt domestic electric vehicles. Finally, the theoretical and practical implications, as well as limitations were discussed accordingly.

Background: Despite advances in asthma treatments, severe asthma exacerbation (SAE) remains a life-threatening condition in adults, and there is a lack of data derived from adult patients admitted to intensive care units (ICUs) for SAE. The current study investigated changes in adult patient characteristics, management, and outcomes of SAE over a 20-year period in 40 ICUs in the greater Paris area. Methods: In this retrospective observational study, admissions to 40 ICUs in the greater Paris area for SAE from January 1, 1997, to December 31, 2016 were analyzed. The primary outcome was the proportion of ICU admissions for SAE during 5-year periods. Secondary outcomes were ICU and hospital mortality, and the use of mechanical ventilation and catecholamine. Multivariate analysis was performed to assess factors associated with ICU mortality. Results: A total of 7049 admissions for SAE were recorded. For each 5-year period, the proportion decreased over time, with SAE accounting for 2.84% of total ICU admissions (n=2841) between 1997 and 2001, 1.76% (n=1717) between 2002 and 2006, 1.05% (n=965) between 2007 and 2011, and 1.05% (n=1526) between 2012 and 2016. The median age was 46 years (interquartile range [IQR]: 32–59 years), 55.41% were female, the median Simplified Acute Physiology Score II was 20 (IQR: 13–28), and 19.76% had mechanical ventilation. The use of mechanical ventilation remained infrequent throughout the 20-year period, whereas the use of catecholamine decreased. ICU and hospital mortality rates decreased. Factors associated with ICU mortality were renal replacement therapy, catecholamine, cardiac arrest, pneumothorax, acute respiratory distress syndrome, sepsis, and invasive mechanical ventilation (IMV). Non-survivors were older, had more severe symptoms, and were more likely to have received IMV. Conclusion: ICU admission for SAE remains uncommon, and the proportion of cases decreased over time. Despite a slight increase in symptom severity during a 20-year period, ICU and hospital mortality decreased. Patients requiring IMV had a higher mortality rate.

This literature review critically examines the historical, current, and prospective dimensions of sternal wound reconstruction in the specific context of deep sternal wound infection (DSWI), aiming to enhance patient outcomes and optimise surgical techniques. Preventive measures, including prophylactic antibiotic administration and surgical site preparation, are crucial in reducing the incidence of DSWI. Effective management necessitates a multidisciplinary approach encompassing surgical debridement, drainage, and sternum repair utilising diverse procedures in conjunction with antibiotic therapy. Traditional approaches to managing DSWI involved closed irrigation and drainage techniques. While these methods exhibited certain advantages, they also exhibited limitations and varying degrees of success. The current care paradigms emphasise prophylactic antibiotic administration and surgical interventions like closed suction and irrigation, vacuum-assisted closure, and flap reconstruction. Future advancements in surgical techniques and technology hold promise for further enhancing sternal wound reconstruction. This review separates and emphasises the distinct roles of prophylaxis, antibiotic treatment, and reconstructive techniques, each relevant specifically to DSWI management. Collaborative efforts between cardiac and plastic surgeons, supported by ongoing research and innovation, are indispensable to advance sternal wound restoration and achieve superior outcomes in terms of patient welfare, morbidity and mortality reduction, and surgical efficacy.

Background: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. Method: The subjects of this analysis were 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD). Propensity score matching was performed by estimating a propensity score from being treated with the Bentall or the David procedure using multilevel mixed-effects logistics, considering the cluster effect of the participating hospitals. Results: A Bentall procedure was performed in 862 patients, while a David operation was performed in 139 patients. The proportion of aortic root replacement, as well as the different techniques of aortic root replacement, varied significantly between the participating hospitals (p < 0.001). After propensity score matching, we obtained two groups of 115 patients each, and no statistical differences were reported in terms of postoperative outcomes, except for the rate of dialysis, which was higher in the patients requiring a Bentall procedure (17.4% vs. 7.0%, p-value 0.016). In the unmatched cohorts, the David procedure was associated with a lower 10-year mortality rate compared to the Bentall procedure (30.1% vs. 45.6%, p-value 0.004), but no difference was observed after matching (30.0% vs. 43.9%, p-value 0.082). After 10 years, no differences were observed in terms of proximal aortic reoperation (3.9% vs. 4.1%, p-value 0.954), even after propensity score matching (2.8% vs. 1.8%, p-value 0.994). Conclusions: The David and Bentall procedures are durable treatment methods for TAAD. When feasible, it is advisable that the David procedure is performed for acute TAAD by surgeons with experience with this demanding surgical technique.

SUMMARY: Spirulina platensis is an emerging poultry diet source due to its essential nutrition and bioactive ingredients. Spirulina microalgae confers beneficial effects on broiler's growth performance, immune response, and antioxidant activity. We investigated the effect of Spirulina platensis on BCO lameness, one of the most driving factors for economic and animal well-being concerns in the poultry industry. Additionally, supplementation of Availa ZMC containing organic trace minerals – zinc, manganese, and copper – was shown to alleviate lameness by 20 to 25%. We hypothesized that pairing microalgae and organic trace minerals might confer a synergistic effect in reducing BCO. A 2 × 2 factorial study, with microalgae (5% Spirulina platensis and 5% Spirulina platensis plus 0.15% Availa ZMC) and without microalgae (0.15% Availa ZMC and a negative control diet), plus one BCO source group were applied to 1,320 one-day-old chicks with 5 replicates of 60 chicks per treatment for lameness assessment. No significant difference in lameness was observed between the negative control and BCO source group (60.0% vs. 54.5%, P = 0.56). Compared to the negative control, Availa ZMC significantly reduced lameness by 51.2% (60.0% vs. 29.3%, P < 0.001), while microalgae slightly increased lameness by 6.3% (60.0% vs. 63.8%, P = 0.1). Availa ZMC plus microalgae alleviated lameness by 16.7% (50.0% vs. 60.0%, P = 0.005) compared to the negative control, which was statistically lower than microalgae alone and higher than Availa ZMC alone. These findings suggested the inclusion of 5% Spirulina platensis did not reduce BCO lameness, while Availa ZMC significantly alleviated lameness. When combined, there was no significant interaction between Availa ZMC and microalgae in mitigating broiler lameness.

The coronavirus disease (COVID-19) pandemic affects the healthcare system worldwide and challenges many governments and institutions. Antimicrobial stewardship program advocating the wise use of antimicrobial agents. Its metrics include antimicrobial use measures, process, and outcome performance indications. We will conduct a retrospective observational study with the main hypothesis that the COVID-19 pandemic does not affect the antimicrobial stewardship program and its metrics. We will compare antimicrobial stewardship metrics (process, outcome, utilization) and antibiotic resistance two years before (2018–2019) (Group A) & two years with the COVID-19 pandemic (2020–2021) (Group B). The study will be conducted in Saqr Hospital, a secondary care hospital in the emirate of Ras Al Khaimah in the United Arab Emirates. Data will be analyzed using SPSS version 22. Numerical data will be presented as mean (SD) or median (IQR). Chi-square or Fisher's exact test will be used to analyze categorical data. The t-test or Mann–Whitney U test will be used to compare the difference of numerical variables. p < 0.05 will be considered statistically significant. Multivariate logistic regression will be used to investigate the relation between different variables with (1) cost and (2) antibiotic resistance.

Herein, short review paper investigated the rapidly progress in fluorescent biosensors field and their significant influences on analytical chemistry applications. An electrical signal can be produced from a biological reaction using an integrated receptor-transducer device called a biosensor. Because there are so many uses for biosensors in the medical field, including medication delivery, environmental monitoring, water and food quality monitoring, and illness detection, biosensor design and development have become a top priority for scientists and researchers in the last ten years. In the beginning, we started to explain the basic principles of fluorescence. Then, we moved to discuss about the current advancements, creative sensor designs, and the fusion of materials science and nanotechnology. The paper highlighted the sensitivity of fluorescent biosensors by addressing a wide range of applications, including biological research, environmental monitoring, and medical diagnostics. This review paper censoriously assessed the present difficulties, such as interference and constrained dynamic range, and provided explanations into ongoing research. Advanced material and nanotechnology integration is emerging as a force that improves biosensor performance and broadens their uses. This study also discussed the future possible breakthroughs in biosensor technology and its broad use in a variety of scientific and societal fields.

ABSTRACT: Bacterial chondronecrosis with osteomyelitis (BCO) lameness is the most critical animal health and welfare issue facing the broiler industry worldwide. It is estimated that 1 to 2% of bird condemnation at marketing age is caused by BCO lameness, resulting in tens of millions of dollars in annual losses. Fast-growing broilers are prone to mechanical stress that triggers bacterial translocation across epithelial barriers into the bloodstream, followed by bacterial colonization in the growth plate of long bones, and eventually, bone necrosis and lameness. Mycotoxins (MTX) are secondary metabolites produced naturally by microfungi, of which deoxynivalenol (DON), fumonisin (FUM), and zearalenone are the most prevalent in corn and soybean-meal-based diets. The presence of these mycotoxins in feed has been proven to reduce the barrier strength of the intestinal tracts and trigger immunosuppressive effects. In this study, we investigated the effects of the DON and FUM-contaminated feeds on the incidence of BCO lameness in broilers reared in both wire- and litter-floors. 720 one-day-old broiler chicks were assigned to the 2 × 2 factorial design: 2 MTX diets containing DON and FUM on wire flooring (MTX-W) and litter flooring (MTX-L), and 2 diets without MTX contamination on control wire flooring (CW) and control litter flooring (CL). Throughout the trial, the cumulative incidence of lameness per treatment was assessed by necropsying the lame birds. Birds in the MTX-W group had a higher incidence of lameness compared to those in CW (73.3% vs. 62.0%) (P < 0.05), and birds in the MTX-L group had a higher incidence of lameness compared to birds in CL (54.0% vs. 34.0%) (P < 0.05). MTX elicited net increases in BCO to a greater degree on litter (+20%) than on wire flooring (+12%). The increased incidence of BCO lameness in the MTX-W coincided with increased intestinal permeability supporting a correlation between intestinal barrier integrity and BCO lameness. To conclude, DON and FUM are predisposing factors for increasing BCO. However, no significant interaction exists between the diet and floor types in inducing lameness in broilers.

Background: Mitral regurgitation (MR) is the most common valvular disease worldwide. MR has been managed surgically, with either a mitral valve replacement or repair. Percutaneous transcatheter mitral valve repair (TMVr) with MitraClip® insertion has gained wide popularity and success over medical and surgical therapy for MR. Some patients with acute MR or decompensated heart failure could benefit from urgent TMVr. This meta-analysis aims to compare clinical outcomes of urgent versus elective TMVr. Methods: We performed a study-level meta-analysis to compare the clinical outcomes of urgent versus elective TMVr using the MitraClip system. The primary endpoint outcome was all-cause mortality. Additional outcomes included procedural success, postoperative acute kidney injury (AKI), stroke, and length of in-hospital stay. Results: Overall, 30-day mortality was significantly higher in the urgent group (odds ratio [OR]: 2.74; 95% confidence interval [CI] [2.17, 3.48]; P < 0.00001; I2 =0%). However, subgroup analysis of matched cohorts showed no significant difference between both groups (OR: 1.80; 95% CI [0.94, 3.46]; P = 0.08; I2 =0%). One-year mortality was similar between both groups (and: 1.67; 95% CI [0.96, 2.90]; P = 0.07; I2 =0%). Procedural success was similar between both groups (89.4% vs. 89.8%; P = 0.43). Postoperative AKI was significantly higher in the urgent group (OR: 4.12; 95% CI [2.87, 5.91]; P < 0.00001; I2 =0%). Conclusion: Urgent TMVr should be indicated in select populations as it is considered therapeutic with acceptable outcomes therein.

The major objectives of this research article are to introduce the notion of ($ \alpha, \psi $)-contraction in the context of $ \mathfrak{F} $-bipolar metric space and establish fixed point theorems. In this way, coupled fixed point results are obtained by applying the leading theorems. Some non-trivial examples are also furnished to show the validity of established results. As applications of the main result, we investigate the solution of an integral equation and a homotopy problem.

Broiler chicken lameness caused by bacterial chondronecrosis with osteomyelitis (BCO) is presently amongst the most important economic and animal welfare issues faced by the poultry industry, and the estimated economic loss is around USD 150 million. BCO lameness is associated with multiple opportunistic bacterial pathogens inhabiting the respiratory and gastrointestinal tracts. In cases of immune deficiency resulting from stress, injury, or inflammation of the tissue, opportunistic pathogens, mainly Staphylococcus spp., can infiltrate the respiratory or gastrointestinal mucosa and migrate through the bloodstream to eventually colonize the growth plates of long bones, causing necrosis that leads to lameness. This is the first report of developing a Staphylococcus vaccine against BCO lameness disease in broiler chickens. Electron beam (eBeam) technology causes irreparable DNA damage, preventing bacterial multiplication, while keeping the epitopes of the cell membrane intact, helping the immune system generate a more effective response. Our results show a 50% reduction of lameness incidence in the eBeam-vaccinated chicken group compared to the control. Additionally, the eBeam-vaccinated chickens present higher titer of anti-Staphylococcus IgA, signifying the development of an efficient and more specific humoral immune response. Our data establish the eBeam-killed Staphylococcus vaccine as an effective approach to reducing the incidence of lameness in broiler chickens.

Bacterial chondronecrosis with osteomyelitis (BCO) lameness is a major welfare issue for broiler production worldwide affecting approximately 1.5% of broilers over 42 days old. Excessive body weight gain causes mechanical stress on long bones, leading to micro-fractures. This condition induces a bacterial infection of fractures, resulting in bone necrosis and eventual BCO lameness. Increasing gut integrity and supporting Calcium metabolism contribute to the optimal bone structure and subsequently reduce BCO lameness. Probiotics thus provide an excellent strategy for alleviating BCO due to the improvement of intestinal integrity and barrier function. Accordingly, the present study investigated the lameness reduction through the feed supplementation of a selected probiotic. Broiler chickens were assigned to three treatments, including a control litter group (FL), a PoultryStar®Bro probiotic fed group (BRO), and a control wire-flooring group (CW) designed to induce BCO lameness. The probiotic significantly decreased lameness by 46% compared to the control group (p < 0.05). The most predominant bacteria identified from the BCO lesions were Staphylococcus cohnii and Staphylococcus lentus. Moreover, significant increments of tight junction gene expression in jejunum and ileum, plus numerical improvements of body weight gain (BW; +360 g) and feed conversion ratio (FCR; −12 pts) were observed in BRO-supplemented birds.

Introduction Lung transplantation (LTx) aims at improving survival and quality of life for patients with end-stage lung diseases. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used as intraoperative support for LTx, despite no precise guidelines for its initiation. We aim to evaluate two strategies of VA-ECMO initiation in the perioperative period in patients with obstructive or restrictive lung disease requiring bilateral LTx. In the control ‘on-demand’ arm, high haemodynamic and respiratory needs will dictate VA-ECMO initiation; in the experimental ‘systematic’ arm, VA-ECMO will be pre-emptively initiated. We hypothesise a ‘systematic’ strategy will increase the number of ventilatory-free days at day 28.Methods and analysis We designed a multicentre randomised controlled trial in parallel groups. Adult patients with obstructive or restrictive lung disease requiring bilateral LTx, without a formal indication for pre-emptive VA-ECMO before LTx, will be included. Patients with preoperative pulmonary hypertension with haemodynamic collapse, ECMO as a bridge to transplantation, severe hypoxaemia or hypercarbia will be secondarily excluded. In the systematic group, VA-ECMO will be systematically implanted before the first pulmonary artery cross-clamp. In the on-demand group, VA-ECMO will be implanted intraoperatively if haemodynamic or respiratory indices meet preplanned criteria. Non-inclusion, secondary exclusion and VA-ECMO initiation criteria were validated by a Delphi process among investigators. Postoperative weaning of ECMO and mechanical ventilation will be managed according to best practice guidelines. The number of ventilator-free days at 28 days (primary endpoint) will be compared between the two groups in the intention-to-treat population. Secondary endpoints encompass organ failure occurrence, day 28, day 90 and year 1 vital status, and adverse events.Ethics and dissemination The sponsor is the Assistance Publique–Hôpitaux de Paris. The ECMOToP protocol version 2.1 was approved by Comité de Protection des Personnes Ile de France VIII. Results will be published in international peer-reviewed medical journals.Trial registration number NCT05664204.

BackgroundAcute ischemic stroke (AIS) remains a substantial global health challenge, contributing to increased morbidity, disability, and mortality. This study aimed at investigating the predictive value of the neutrophil percentage to albumin ratio (NPAR) in determining intensive care unit (ICU) admission among AIS patients.MethodsA retrospective observational study was conducted, involving AIS cases admitted to a tertiary hospital in Jordan between 2015 and 2020. Lab data were collected upon admission, and the primary outcome was ICU admission during hospitalization. Descriptive and inferential analyses were performed using SPSS version 29.ResultsIn this study involving 364 AIS patients, a subset of 77 (21.2%) required admission to the ICU during their hospital stay, most frequently within the first week of admission. Univariable analysis revealed significantly higher NPAR levels in ICU-admitted ischemic stroke patients compared to those who were not admitted (23.3 vs. 15.7, p

BackgroundHealth care providers are mandated to deliver specialized care for the treatment and control of type 2 diabetes mellitus. In Malaysia, Diabetes Medication Therapy Adherence Clinics (DMTAC) in tertiary hospitals have designated pharmacists to administer these services.ObjectiveTo assess the effects of pharmacist-led interventions within DMTAC on the outcomes of patients with type 2 diabetes mellitus in two distinct hospitals in Kedah, Malaysia.MethodsPatients with type 2 diabetes were randomly selected from the two hospitals included in this study. The study population was divided into two equal groups. The control group consisted of 200 patients receiving routine care from the hospitals. On the other hand, the intervention group included those patients with type 2 diabetes (200), who received separate counseling sessions from pharmacists in the DMTAC departments along with the usual treatment. The study lasted 1 year, during which both study groups participated in two distinct visits.ResultsParametric data were analyzed by a paired t-test and one-way ANOVA, while non-parametric data were analyzed by a Chi-squared test using SPSS v24. A p

Abstract Background Excessive use of mobile phones leading to development of symptoms suggestive of dependence syndrome with teenagers are far more likely to become dependent on mobile phones as compared to adults. COVID-19 pandemic has had an impact on the mental health of several groups in society, especially university students. This study aimed to explore the prevalence of mobile phone dependence among university students and its associated factors. Methods Between September 2021 and January 2022, a cross-sectional study was conducted at universities in Jordan, Lebanon, Egypt, Bahrain, and Saudi Arabia utilizing an online and paper-based self-administered questionnaire. We employed a previously developed questionnaire by Aggarwal et al. Results A total of 5,720 university students were involved in this study (Egypt = 2813, Saudi Arabia = 1509, Jordan = 766, Lebanon = 432, and Bahrain = 200). The mean estimated daily time spent on using mobile phone was 186.4 (94.4) minutes. The highest mobile dependence score was observed for the university students from Egypt and the lowest mobile dependence score was observed for the university students from Lebanon. The most common dependence criteria across the study sample was impaired control (55.6%) and the least common one was harmful use (25.1%). Females and those reported having anxiety problem or using a treatment for anxiety were at higher risk of developing mobile phone dependence by 15% and 75%, respectively. Conclusion Mobile phone dependence is common among university students in Arab countries in the Middle East region. Future studies exploring useful interventions to decrease mobile phone dependence are warranted.

Abstract Background Acute and chronic pancreatitis constitute a continuum of inflammatory disease of the pancreas with an increasing incidence in most high-income countries. A subset of patients with a history of pancreatitis suffer from recurrence of acute pancreatitis attacks, which accelerate disease progression towards end-stage chronic pancreatitis with loss of exocrine and endocrine function. There is currently no available prophylactic treatment for recurrent acute pancreatitis apart from removing risk factors, which is not always possible. Pain is the primary symptom of acute pancreatitis, which induces the endogenous release of opioids. This may further be potentiated by opioid administration for pain management. Increased exposure to opioids leads to potentially harmful effects on the gastrointestinal tract, including, e.g. increased sphincter tones and decreased fluid secretion, which may impair pancreatic ductal clearance and elevate the risk for new pancreatitis attacks and accelerate disease progression. Peripherally acting µ-opioid receptor antagonists (PAMORAs) have been developed to counteract the adverse effects of opioids on the gastrointestinal tract. We hypothesize that the PAMORA naldemedine will reduce the risk of new pancreatitis attacks in patients with recurrent acute pancreatitis and hence decelerate disease progression. Methods The study is a double-blind, randomized controlled trial with allocation of patients to either 0.2 mg naldemedine daily or matching placebo for 12 months. A total of 120 outpatients will be enrolled from five specialist centres in Denmark and Sweden. The main inclusion criteria is a history of recurrent acute pancreatitis (minimum of two confirmed pancreatitis attacks). The primary endpoint is time to acute pancreatitis recurrence after randomization. Secondary outcomes include changes in quality of life, gastrointestinal symptom scores, new-onset diabetes, exocrine pancreatic insufficiency, disease severity, health care utilization, adherence to treatment, and frequency of adverse events. Exploratory outcomes are included for mechanistic linkage and include the progression of chronic pancreatitis-related findings on magnetic resonance imaging (MRI) and changes in circulating blood markers of inflammation and fibrosis. Discussion This study investigates if naldemedine can change the natural course of pancreatitis in patients with recurrent acute pancreatitis and improve patient outcomes. Trial registration EudraCT no. 2021–000069-34. ClinicalTrials.gov NCT04966559. Registered on July 8, 2021.

This paper introduces the concept of proximal (α,F)-contractions in F-metric spaces. We establish novel results concerning the existence and uniqueness of best proximity points for such mappings. The validity of our findings is corroborated through a non-trivial example. Furthermore, we demonstrate the applicability of these results by proving the existence of solutions for Volterra integral equations related to population growth models. This approach not only extends best proximity theory, but also paves the way for further research in applied mathematics and beyond.

We sequenced and assembled genomes for 17 isolates of Staphylococcus cohnii isolated from osteomyelitis lesions in young broilers from two separate experiments where we induced lameness using a hybrid wire-litter flooring system. Whole genome comparisons using three different methods support a close relationship of genomes from both S. cohnii and Staphylococcus urealyticus. The data support three different lineages, which we designated as Lineage 1, Lineage 2, and Lineage 3, uniting these two species within an evolving complex. We present evidence for horizontal transfer between lineages of genomic regions from 50–440 kbp. The transfer of a 186 kbp region from Lineage 1 to Lineage 2 appears to have generated Lineage 3. Human-associated isolates appear to be limited to Lineages 2 and 3 but Lineage 2 appears to contain a higher number of human pathogenic isolates. The chicken isolates from our lameness trials included genomically diverse isolates from both Lineage 1 and 2, and isolates from both lineages were obtained from osteomyelitis lesions of individual birds. Our results expand the diversity of Staphylococci associated with osteomyelitis in poultry and suggest a high diversity in the microbiome of day-old chicks. Our data also support a reevaluation and unification of the taxonomic classifications of S. cohnii and S. urealyticus.

We study the split fixed point problem with multiple output sets in nonlinear spaces, particularly in CAT(0) spaces. We modify the existing self-adaptive algorithm for solving the split common fixed point problem with multiple output sets in the settings of generalized structures. We also present the consequences of our main theorem in terms of the split feasibility problem and the split common fixed point problem.

Background: Limited information exists regarding the pathophysiological interactions between osteoporosis and chronic obstructive pulmonary disease (COPD). Objective: To study the association of Osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-Β ligand (RANKL) in male COPD patients. Methods: An observational clinical study was conducted at Penang General Hospital in Malaysia. Participants were divided into three groups: COPD patients with osteoporosis, COPD patients without osteoporosis, and healthy participants of the same age groups. Serum OPG (sOPG) and RANKL (sRANKL) levels were investigated. Results: The mean age of COPD patients was 64.10 ± 10.04 years. COPD patients had lower body mass index (23.22 ± 6.43) than healthy participants (27.32 ± 6.80). The T-score was significantly lower among COPD patients than healthy participants (p = 0.018). The sOPG concentration among healthy participants was significantly higher (361.90 ± 29.10 pg/mL, p < 0.001) than in the other groups, while the sRANKL concentration was not significantly different. The serum OPG/RANKL concentration was markedly higher in the control group than in the COPD patient group (p < 0.05). The COPD patients with osteoporosis had significantly lower pulmonary parameters (forced expiratory volume in the first [FEV]1% and FEV1/[forced vital capacity] (FVC), p < 0.01) and more dyspnea (modified medical research council = 2.60 ± 0.78 versus 1.90 ± 0.70, p < 0.01) than did the patients without osteoporosis. Furthermore, patients with severe COPD had a 3 times greater risk of developing osteoporosis (OR = 2.997 [95% CI = 2.181, 4.118], p < 0.001), while spirometric parameters had a significant inverse relationship with osteoporosis (FEV1% OR = 0.970, [95% CI = 0.954, 0.986], p = 0.001; FEV1/FVC OR = 0.984, (95% CI = 0.970, 0.999], p = 0.035). Conclusion: The study concluded that COPD patients had lower sOPG levels, leading to decreased OPG/RANKL ratio and faster bone resorption. Low bone mineral density was associated with more severe COPD.

This paper aims to introduce a novel variation of almost Hardy–Rogers ψ,ϕ-type multivalued contraction and ϑ-type contraction mappings. The main focus is on proving new fixed point (FP) results in M℘-metric space (M℘-MS). Additionally, several consequences are derived from our main findings. To elucidate the recency of our outcomes, various examples are provided. Finally, we utilize the obtained results to scrutinize the existence of solutions for nonlinear fourth-order differential equations (NFODEs).

الهدف: دراسة عوامل الخطورة لدى مرضى الخثار الوريدي العميق الحاد في الطرفين السفليين، وتحديد نسبة كل منها، إضافة لتحديد حالات الخثار البدئي غير المحرض والتي لم يتبين وجود أي عامل مؤهب فيها. طرائق الدراسة والمرضى: تم إجراء دراسة رصدية مقطعية تضمنت مرضى الخثار الوريدي العميق الحاد في الطرفين السفليين، والذين تم قبولهم في شعبة جراحة الأوعية الدموية- مستشفى تشرين الجامعي خلال الفترة بين 1-1-2022 و 31-12-2022.تم أخذ قصة مرضية مفصلة لجميع المرضى مع فحص سريري كامل، وإجراء إيكو دوبلر للطرفين السفليين، إضافة لتقييم مخبري وشعاعي يتضمن إيكو بطن و/أو صورة صدر عند الضرورة. تم اعتماد تشخيص الخثار الوريدي العميق الحاد بناء على الفحص وموجودات الإيكو دوبلر، حيث تضمنت المعايير التشخيصية:تغير في صدوية اللمعة، عدم قابلية الوريد للانخماص بالضغط وغياب الجريان العفوي أو المحرض. لم يتم الاعتماد على التصوير الوريدي الظليل أو الطبقي المحوري الوريدي في أي من الحالات المشخصة، وعلى ذلك تمت دراسة البيانات. الـنـتـائـج: شملت عينة البحث 46 مريضاً وبلغت نسبة الذكور 56.5% والإناث 43.5% مع متوسط عمر بلغ56.7 ±14.9 سنة. توزعت عينة الدراسة على جميع الفئات العمرية وبلغت أعلى نسبة 54.3% ضمن الفئة 51-70 سنة. وفقاً للموقع التشريحي: توضع الخثار لدى 52.2% في الطرف السفلي الأيسر، 39.1% في الأيمن و8.7% في كلا الطرفين. لوحظ وجود عامل مؤهب في دراستنا لدى 25 مريضاً وبنسبة بلغت 54.34%، في حين لم يتبين وجود أي عامل خطورة محدد لدى 45.6% من المرضى. أشيع عوامل الخطورة في دراستنا تمثلت بما يلي: التدخين 37% ،وجود خباثة 15.2% (أشيعها ورم المثانة 6.5% يليه ورم الكولون والمبيض)، قصة عمل جراحي حديث 15% (أشيعها التداخلات على البطن 6.5% يليها الجراحات النسائية والبولية) ، البدانة و سوابق خثار وريدي 6.5%، دوالي الطرفين السفليين وقصة استلقاء مديد 4.3%. لم يتبين في دراستنا وجود قصة عائلية صريحة لدى أي من مرضى الدراسة. الخلاصة:بلغت نسبة المرضى الذين لديهم عوامل خطورة لتطور خثار وريدي 54.3%، وأشيع العوامل المؤهبة لديهم تمثلت بـ : الجراحة الحديثة، الخباثة، التدخين وزيادة الوزن

Jleli and Samet introduced the notion of F-metric space as a generalization of traditional metric space and proved Banach contraction principle in the setting of these generalized metric spaces. The aim of this article is to utilize F-metric space and establish some common α-fuzzy fixed point theorems for rational (β-ϕ)-contractive conditions. Our results extend, generalize and unify some well-known results in the literature. As application of our main result, we discuss the solution of fuzzy integrodifferential equations in the setting of a generalized Hukuhara derivative.

ABSTRACT Background and Objective: A global increase in the prevalence of diabetes mellitus (DM) is associated with increased morbidity and mortality. Oxidative stress is a fundamental component in the pathogenesis of DM Ajwa dates are known to have a high antioxidant content, especially in their seeds. Hence this study was designed to determine the preventive effects of Ajwa date fruit on alloxan-induced diabetes in an experimental rat model. Methods: This experimental study was conducted at the Post Graduate Medical Institute, Lahore, Pakistan. A total of forty Sprague-Dawley rats were divided into five groups with eight animals in each. Rats in group A were normal control, whereas rats in group B were induced with intraperitoneal alloxan (160 mg/kg body weight) to develop diabetes. Groups C, D, and E rats were fed on a diet supplemented with Ajwa flesh, seed, and whole Ajwa respectively for 1 week. Blood and urine glucose levels were measured on days 0, 7 (pre-alloxan) and 11, 14, 19 (post-alloxan). Serum insulin, homeostatic model assessment (HOMA) for β-cell function (HOMA-β), and insulin resistance (HOMA[1]IR) were estimated terminally. Results: Diabetes was induced successfully in animals of all experimental groups except the normal control group. Rats of the Ajwa-seed group (D) showed relative resistance to diabetes induction with three non-diabetic rats on day 19. In group E, rats had lower blood sugar levels than rats in group C (p = 0.010). Serum insulin, HOMA-β and HOMA-IR, revealed partial beta cells restoration in the experimental animals of groups D and C. Insulin resistance was significantly higher, despite the highest insulin level (3.77 µIU/ml; p value Conclusion: Ajwa date seed powder appears to provide relative protection against the development of diabetes in rats induced by alloxan.

In this research article, we give the notion of graphic F-contraction in the setting of F-metric space and establish some fixed point results. We also supply some examples to demonstrate the brilliance of the established results. We also establish some fixed point results for orbitally continuous and orbitally G -continuous graphic F-contractions as applications of our main results. Also, we discuss the existence and the uniqueness of solutions of functional equations involving in dynamic programming.

The purpose of this article is to establish common fixed point results on complex valued extended b-metric spaces for the mappings satisfying rational expressions on a closed ball. Our investigations generalize some well-known results of literature. Furthermore, we supply a significant example to show the authenticity of established results. As application, we solve Urysohn integral equations by our main results.

In this research paper, we presented a four-dimensional mathematical system modeling the anaerobic mineralization of phenol in a two-step microbial food-web. The inflowing concentrations of the hydrogen and the phenol are considered in our model. We considered the case of general class of nonlinear growth kinetics, instead of Monod kinetics. Due to some conservative relations, the proposed model was reduced to a two-dimensional system. The stability of the steady states was carried out. Based on the species growth rates and the three main operating parameters of the model, represented by the dilution rate and input concentrations of the phenol and the hydrogen, we showed that the system can have up to four steady states. We gave the necessary and sufficient conditions ensuring the existence and the stability for each feasible equilibrium state. We showed that in specific cases, the positive steady state exists and is stable. We gave numerical simulations validating the obtained results.

Background: Tuberculosis (TB) mainly affects the lungs (pulmonary TB) and also can impact other parts of the body (extrapulmonary TB). Objectives: The main purpose of this study was to experience the prevalence of tuberculosis and the treatment outcome rate in Babylon, Iraq. Materials and Methods: A cohort retrospective study was carried out at the health center for asthma and allergies from January 2016 to March 2021 in the Babylon Province, Iraq. This study sighted on the characteristics of TB patients; age, sex, site of tuberculosis, and treatment outcome. Results: There were 1774 cases of TB registered in the medical records of the health center in Babylon, Iraq. As a result, we found that female patients represented 53.4% of patients, as compared with male patients who constituted 46.6% of patients. The age group between 61 years old and older recorded the highest percentage (n = 359; 20.2%) and the less percentage of those who are

Abstract Background Poor-grade aneurysmal subarachnoid hemorrhage (SAH) is associated with poor neurological outcome and high mortality. A major factor influencing morbidity and mortality is brain swelling in the acute phase. Decompressive craniectomy (DC) is currently used as an option in order to reduce intractably elevated intracranial pressure (ICP). However, execution and optimal timing of DC remain unclear. Methods PICASSO resembles a multicentric, prospective, 1:1 randomized standard treatment-controlled trial which analyzes whether primary DC (pDC) performed within 24 h combined with the best medical treatment in patients with poor-grade SAH reduces mortality and severe disability in comparison to best medical treatment alone and secondary craniectomy as ultima ratio therapy for elevated ICP. Consecutive patients presenting with poor-grade SAH, defined as grade 4–5 according to the World Federation of Neurosurgical Societies (WFNS), will be screened for eligibility. Two hundred sixteen patients will be randomized to receive either pDC additional to best medical treatment or best medical treatment alone. The primary outcome is the clinical outcome according to the modified Rankin Scale (mRS) at 12 months, which is dichotomized to favorable (mRS 0–4) and unfavorable (mRS 5–6). Secondary outcomes include morbidity and mortality, time to death, length of intensive care unit (ICU) stay and hospital stay, quality of life, rate of secondary DC due to intractably elevated ICP, effect of size of DC on outcome, use of duraplasty, and complications of DC. Discussion This multicenter trial aims to generate the first confirmatory data in a controlled randomized fashion that pDC improves the outcome in a clinically relevant endpoint in poor-grade SAH patients. Trial registration DRKS DRKS00017650. Registered on 09 June 2019.

Chronic pancreatitis (CP) is the end-stage of continuous inflammation and fibrosis in the pancreas evolving from acute- to recurrent acute-, early, and, finally, end-stage CP. Currently, prevention is the only way to reduce disease burden. In this setting, early detection is of great importance. Due to the anatomy and risks associated with direct sampling from pancreatic tissue, most of our information on the human pancreas arises from circulating biomarkers thought to be involved in pancreatic pathophysiology or injury. The present review provides the status of circulating biomarkers involved in the development of and progression to CP.

Irrigation scheduling techniques is one of the suggested solutions for water scarcity problem. The study aims to show the possibility of using practical and applicable irrigation scheduling program which was designed by Water Resources Department at the University of Baghdad by using Spreadsheet Formulas for Microsoft Excel program, version 2007, with some modification to generalize it and made it applicable to various climatic zone and different soil types, as a salvation for the shortage of irrigation water inside the irrigation projects. Irrigation projects which incidence of Tigris River basin will be taken as an applicable example. This program was based on water budgeting and programmed depending on scientific concepts which facilitate irrigation structures operation and ease the use by farmers. By using the abilities of this program, the monthly and annually water requirements and drainage water were estimated. Finally a comparison is made between the calculated discharges with the designers suggested ones. This comparisons showed that the use of this type of irrigation scheduling (i.e. predicted irrigation scheduling) with itsapplicable constrains require high attention when choosing the cropping pattern for each climate zone. Also it found that this irrigation program is a useful tool for saving water if cropping pattern has been chosen carefully.

Loading rHuEPO-alpha drug on the surface of magnesium oxide nanoparticles further improves the effect of the drug as a treatment for anemia. After preparation of magnesium oxide nanoparticles by precipitation method, it was diagnosed by X-ray diffraction and Transmission Electron Microscopy. the loaded was diagnosed by Docking program, UV-Visible and Transmission Electron Microscopy. The study of LD50 was for thirty male mice. Magnesium Oxide nanoparticles had an average crystallite size of 8.42 nm. oral LD50 test was 896 mg/kg. Docking results presented a high energy binding with force linkage due to the link of the oxygen atom of MgO NPs with three hydrogen bonds of amino acids in the rHuEPO-alpha structure. The UV-Visible result was certain that all rHuEPO-alpha drug was loaded on the surface of MgO NPs. TEM shows that the average particle size was 9.94 nm after loaded of the rHuEPO-alpha drug on MgO NPs while was 9 nm before the loaded. Magnesium oxide nanoparticles may exhibit an effect on increasing the efficacy of rHuEPO-alpha after the loaded, leading to elevated hemoglobin and reduced anemia disease.

This study investigated how the Coronavirus Disease 2019 (COVID-19) pandemic has affected the rate of healthcare-associated infections (HAIs). PubMed, Scopus and Google Scholar were searched to identify potentially eligible studies published from December 2019 to September 2022. A random effect model was used to determine the changes in the rate of HAIs during the pandemic. Thirty-seven studies, mostly from the United States (n = 13), were included. Fifteen studies described how the pandemic affected the rate of CLABSIs and CAUTIs, and eight of them showed a significant increase in CLABSIs. The risk of CLABSIs and CDIs was 27% (pooled odds ratio [OR]: 0.73; confidence interval [CI]: 0.61–0.89; p < 0.001) and 20% (pooled OR: 1.20; CI: 1.10–1.31; p < 0.001) higher during the pandemic compared to before the COVID-19 pandemic period, respectively. However, the overall risk of HAIs was unaffected by the pandemic (pooled OR: 1.00; 95 CI: 0.80–1.24; p = 0.990). Furthermore, there were no significant changes in the risk of CAUTIs (pooled OR: 1.01; 95 CI: 0.88–1.16; p = 0.890), and SSIs (pooled OR: 1.27; CI: 0.91–1.76; p = 0.16) between the two periods. The COVID-19 pandemic had no effect on the overall risk of HAIs among hospitalized patients, but an increased risk of CLABSIs and CDI were observed during the pandemic. Therefore, more stringent infection control and prevention measures and prudent interventions to promote the rational use of antibiotics are warranted across all healthcare facilities to reduce the burden of HAIs.

Bitter gourd (Momordica charantia L.) belongs to family Cucurbitaceae, and is a popular vegetable crop in the tropical and sub-tropical countries. It is an annually grown herbaceous vine that requires warm climate for growth. The leaves, stem and roots of bitter gourd contains a lot of bio-active components having nutritional and medicinal importance. Alternaria leaf blight (Alternaria cucumerina Ellis & Everh.) is a fungus which causes leaf blight on bitter gourd and leads to significant crop damage. The present study investigated the efficacy of five different fungicides against Alternaria leaf blight (ALB) of bitter gourd under in vivo and in vitro conditions. The single hyphal tip method was used to isolate and purify the fungal pathogen from the ALB infected leaves of bitter gourd. Five commercially available fungicides (1. Melody duo 66.8% WP, 2. Polyram DF 70%, 3. Score 250 EC, 4. Tilt 250 EC, 5. Flumax 60% EC) were evaluated at concentrations of 50 ppm and 100 ppm for effective ALB diseased control. Among tested fungicides, maximum inhibition (90 %) of fungal growth was given by Melody duo @ 100 ppm concentration followed by Polyram (81 %), Score (77 %) and Tilt (70 %), whereas Flumax resulted in minimum (45 %) fungal inhibition under in vivo. Melody duo revealed minimum disease incidence (15.67 %) compared to disease incidence recorded in polyram (17.83 %), Score (20.50 %) and Tilt (22.33 %) treated crop. Flumax was not tested in vitro because it gave minimum disease control in in vitro experiments. The control plants showed high disease incidence (56%).