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This study explored the effect of Morus nigra fruit extract (MFE) on microanatomical and physiological parameters of cryopreserved bovine sperms. Three ejaculates were collected on weekly basis, from five fertile bulls. Each semen sample was mixed with dilution medium (DM) (1:2 v/v), centrifuged (32 g) for 10 minutes to pore away the upper-half of the mixture. The remaining material was then extended (1:4 ratios) with standard cryopreservation extender (SCE). Three aliquots (0.3 mL) from this extended sample were further extended with 0.7 mL pure SCE (control group), 0.7 mL SCE containing 3% MFE (MFE-3 group) and 0.7 mL SCE containing 6% MFE (MFE-6 group) respectively to attain final dilutions (25 times dilution of fresh semen ejaculate, containing approximately 1836.5 ± 85.23 million sperms per mL). From each final dilution (0.1 mL) sample was directly analyzed for semen quality parameters (SQPs) and rest of the material was placed in liquid nitrogen for 24 hrs for post thaw study of the SQPs and in-vitro fertilizability. Results revealed substantial improvement in sperm membrane integrity, motility, and fertilizability in MFE-3 and MFE-6 against SCE group. Likewise, significantly high mean percent number of progressively motile sperms and sperms showing 20 µ/sec or above velocity both before and after cryopreservation, were observed in MFE-6 and MFE-3 groups as compared to SCE. These findings show protective effects of MFE for bovine spermatozoa against cryoinjuries and the post thawed oxidative stress. [ABSTRACT FROM AUTHOR]

Carbon tetrachloride (CCl4) is used extensively for the production of chlorofluorocarbon refrigerants, foam-blowing agents, paints, plastics and as a solvent in metal cleaning and in fumigants. The present research reports the hepato-regenerative potentials of Basella alba, Grewia asiatica, Solanum nigrum, and Ficus carica fruit pulp extracts (FPEs) against CCl4 induced hepatic anomalies in mice. Sixty male albino mice were divided into six groups as: (1) Control (Ct), (2) CCl4 (C), (3) CCl4 + Basella alba (CB), (4) CCl4 + Grewia asiatica (CG), (5) CCl4 + Solanum nigrum (CS), and (6) CCl4 + Ficus carica (CF). Except for the Ct group, CCl4 (0.1 mL of 0.2 mL kg–1) was given to the relevant FPE group of animals for the next 5 consecutive days, while the animals in the Ct and CCl4 groups received water instead of FPE. Liver and blood samples were obtained from each animal on day 7 for biochemical and histological investigations. The CCl4 exposure led to various histometric and histological alterations (peri-central debris and hepatic cords distortions) that were recovered in CB and CG groups. Large number of regenerative cells (progenitor oval stem cells (POSC) and cholangiocytes/bilary epithelial cells (BEC) that move towards damage area and establish the aggregations as well as leads to hepatic regeneration) were evident in histological sections of CB and CG groups. The micrometric data indicates abundance of oval stem cells; nascent hepatocytes and number of mononucleated hepatocytes also substantially support the histological findings. The serum biochemical markers (bilirubin, serum glutamic-pyruvic transaminase (SGPT), serum glutamic-oxaloacetic transaminase (SGOT), alkaline phosphatase, total proteins, albumins, globulins and albumin/globulins (A/G) ratios) remained in line with the histological and micrometric findings. The wholesome picture of the differential ability of the rescuing and regenerative potentials of these medicinal fruits indicates best capabilities to be residing in CB and CG that must in turn be attributable to the precious blend of phyto-medicinal components of their fruits. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) caused several impacts. Focusing on 360 participants (178 males, 182 females), this study explored the association between COVID-19 related distress, risk perception, stigma, and vaccine hesitancy and acceptance in the general population. Measures used included the Hospital Anxiety and Depression Scale (HADS) and COVID Stress Scale (CSS) to evaluate anxiety, depression, and COVID-19 related distress, the COVID-19 Risk Perception Scale and COVID-19 Stigma Discrimination Scale to assess risk perception and stigma, and the Oxford COVID-19 Vaccine Hesitancy Scale and Vaccine Acceptance Instrument to measure vaccine hesitancy and acceptance. The findings revealed that 66.9% of participants exhibited vaccine hesitancy, and stress and risk perception were significant predictors of both vaccine hesitancy and acceptance, even after controlling for demographic factors. This study highlights the importance of understanding the factors mentioned above that will contribute to vaccine hesitancy and acceptance, which will contribute to promoting vaccine acceptance.

Manganese is essential for adequate feto-maternal health; however, an inverted U-shaped relation has been found between maternal manganese status and pregnancy complications. This systematic review summarizes the effect of maternal manganese exposure and perinatal health. We adopted a systematic approach to retrieve the recent literature. After applying the inclusion/exclusion criterion, a total of 20 studies were included in this review. Results found a non-significant relationship between maternal manganese exposure and risk of gestational diabetes mellitus (GDM), while only three studies reported the association between higher manganese levels and risk of preterm birth. Also, inconsistent results were found regarding higher manganese status and risk of low birth weight. This review reported no association between higher maternal manganese status andrisk of GDM. Nevertheless, the paucity of literature related to small for gestational age and pre-eclampsia prohibits a conclusion. Further studies are required for evaluation of environmental manganese exposure and maternal manganese status.

Background: Heavy metals like lead (Pb) have been used by humans for a very long time, but throughout the industrial revolution, their use expanded, increasing exposure to the metal. Lead, however, has no biological purpose in the human body and is hazardous when it gets into soft tissues and organs. Lead is still used in a variety of industries, including battery manufacturing and car maintenance, despite efforts to limit its usage., Objective: This study investigates the teratogenic and morphometric effects of lead on chick embryos and the potential ameliorative effects of vitamin B6., Methods: Two hundred fertilized eggs from the golden black chicken were divided into four groups: control, lead acetate, vitamin B6, and lead + vitamin B6., Results: On the 14th day, embryos were analyzed. Significant reductions in body weight and size were observed in the lead-exposed group (33.93 ± 1.27 g) compared to the control (41.12 ± 0.97 g). Pronounced deformities included rudimentary beaks, protruding eyes, tridactyl limbs, hydrocephaly, and neck deformities. Appendicular deformities like phocomelia, amelia, and abnormal phalanges growth were also noted. Vitamin B6 demonstrated therapeutic benefits, significantly improving mean embryo weight in the Lead + Vitamin B6 group (42.37 ± 0.99 g). The lead-exposed group showed a reduction in maxilla length (3.61 ± 1.30 mm) compared to the Lead + Vitamin B6 group (7.57 ± 0.79 mm). This group also showed reduced severity of muscular dystrophy and bone thinning, with signs of recovery in beak and bone sizes., Conclusions: The study highlights vitamin B6's beneficial impact in mitigating lead's toxic effects on chick embryonic development., (© 2024 Wiley Periodicals LLC.)

RCI2/PMP3s are involved in biotic and abiotic stresses and have an influence on the regulation of many genes. RCI2/PMP3 genes, which particularly encode small membrane proteins of the PMP3 family, are involved in abiotic stress responses in plants. In this work, in silico studies were used to investigate RCI2's potential function in stress tolerance and organogenesis. We conducted an extensive study of the RCI2 gene family and revealed 36 RCI2 genes from cotton species that were distributed over 36 chromosomes of the cotton genome. Functional and phylogenetic examination of the RCI2/PMP3 gene family has been studied in Arabidopsis, but in cotton, the RCI2/PMP3 genes have not yet been studied. Phylogenetic and sequencing studies revealed that cotton RCI2s are conserved, with most of them categorized into six distinct clades. A chromosome distribution and localization study indicated that cotton RCI2 genes were distributed unevenly on 36 chromosomes with segmental duplications, suggesting that the cotton RCI2 family is evolutionarily conserved. Many cis-elements related to stress responsiveness, development, and hormone responsiveness were detected in the promoter regions of the cotton RCI2. Moreover, the 36 cotton RCI2s revealed tissue-specific expression patterns in the development of cotton performed by transcriptome analysis. Gene structure analysis indicated that nearly all RCI2 genes have two exons and one intron. All of the cotton RCI2 genes were highly sensitive to drought, abscisic acid, salt, and cold treatments, demonstrating that they may be employed as genetic objects to produce stress-resistant plants., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interests. Ethical Approval: This article does not contain any studies with human participants or animals performed by any of the authors. Consent to Participate: Not applicable. Consent for Publication: Not applicable., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Radio frequency interference disrupts services offered by Global Navigation Satellite Systems (GNSS). Spoofing is the transmission of structured interference signals intended to deceive GNSS location and timing services. The identification of spoofing is vital, especially for safety-of-life aviation services, since the receiver is unaware of counterfeit signals. Although numerous spoofing detection and mitigation techniques have been developed, spoofing attacks are becoming more sophisticated, limiting most of these methods. This study explores the application of machine learning techniques for discerning authentic signals from counterfeit ones. The investigation particularly focuses on the secure code estimation and replay (SCER) spoofing attack, one of the most challenging type of spoofing attacks, ds8 scenario of the Texas Spoofing Test Battery (TEXBAT) dataset. The proposed framework uses tracking data from delay lock loop correlators as intrinsic features to train four distinct machine learning (ML) models: logistic regression, support vector machines (SVM) classifier, K-nearest neighbors (KNN), and decision tree. The models are trained employing a random six-fold cross-validation methodology. It can be observed that both logistic regression and SVM can detect spoofing with a mean F1-score of 94%. However, logistic regression provides 165dB gain in terms of time efficiency as compared to SVM and 3 better than decision tree-based classifier. These performance metrics as well as receiver operating characteristic curve analysis make logistic regression the desirable approach for identifying SCER structured interference., Competing Interests: The authors declare there are no competing interests., (©2024 Nabi et al.)

Background Pancytopenia is defined as a decrease in all three hematologic cell lines. The condition is not a disease in itself but a common pathway caused by various etiologies that can be infectious, autoimmune, genetic, nutritional, and/or malignant. Determining the cause of pancytopenia is a challenge and is key in determining the proper treatment regimen and estimating prognosis. Objective The aim of this study was to evaluate the etiological spectrum of pancytopenia in patients who underwent bone marrow biopsy at a tertiary care hospital. Methodology This study was conducted at the Internal Medicine and Gastroenterology Departments of Lady Reading Hospital, Peshawar, Pakistan, from January 1, 2023, to December 31, 2023. A total of 120 patients with pancytopenia aged 12 to 60 years who underwent bone marrow biopsy were enrolled. Data on age, gender, clinical presentations, and bone marrow biopsy findings were observed. Results The mean age was 34.97 years. Males were more frequently affected, 74 (61.7%), than females, 46 (38.3%). Pallor, 86 (71.7%), and weakness, 66 (55.0%), were the most frequent presentations of pancytopenia. The etiological spectrum showed that megaloblastic anemia was present in 48 (40%) of the cases, followed by infection-related changes in 20 (16.7%) and aplastic anemia in 20 (16.7%). Conclusion Megaloblastic anemia emerged as the leading cause of pancytopenia in our study, followed by aplastic anemia and infection-related changes., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board Medical Teaching Institute - Lady Reading Hospital Peshawar issued approval 280/LRH/MTI dated 15/12/2023. Approval has been granted to Dr Inayatullah, assistant professor, medicine, for the study titled "Etiological Spectrum of Bone Marrow Biopsy In Patients With Pancytopenia". Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ullah et al.)

Abstract: Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by renal phosphate wasting and impaired bone mineralization secondary to secretion of fibroblast growth factor 23 (FGF23) from mesenchymal tumors (phosphaturic mesenchymal tumors, PMTs). PMTs have wide anatomical distribution but typically affect extremities and craniofacial bones. Diagnosis of TIO/PMT is often delayed, and a high index of suspicion is essential in patients with unexplained fractures, but many physicians lack familiarity with TIO/PMT and simply attribute fractures to the more common diagnosis of osteoporosis. We present 5 cases of TIO, with 4 having long histories of multiple insufficiency fractures prior to recognition of TIO and localization of a PMT. Four patients were treated surgically, while 1 preferred medical management. Two patients had lesions localized to the skull base, both of which showed marked hypervascularity on arterial spin label perfusion imaging. Thus, arterial spin label may not only help to localize these tumors, but may also be a helpful supplemental imaging finding in supporting this diagnosis. PMT should be considered in the differential diagnosis for hypervascular skull base masses, especially if the patient has any history of insufficiency fracture or imaging evidence of osteopenia, as early diagnosis of TIO can help prevent disabling complications., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Cardiovascular diseases (CVDs) are the major cause of mortality worldwide, emphasizing the critical need for timely and accurate diagnosis. Artificial intelligence (AI) and machine learning (ML) have become revolutionary tools in the healthcare system with significant potential for cardiovascular diagnosis and imaging. AI and ML techniques, including supervised and unsupervised learning, logistic regression, deep learning models, neural networks, and convolutional neural networks (CNNs), have significantly advanced cardiovascular imaging. Applications in echocardiography include left and right ventricular segmentation, ejection fraction measurement, and wall motion analysis. AI and ML hold substantial promise for revolutionizing cardiovascular imaging, demonstrating improvements in diagnostic accuracy and efficiency. This narrative review aims to explore the current applications, advantages, challenges, and future pathways of AI and ML in cardiovascular imaging, highlighting their impact on different imaging modalities and their integration into clinical practice., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Cerdas et al.)

Objective: Exercise improves postprandial glycaemia and insulin sensitivity in individuals with prediabetes, but the optimal intensity for this metabolic regulation remains unclear. The current study aims to explore the impact of various exercise intensities on metabolic markers in prediabetic individuals to identify the optimal intensity for improving these indicators., Methods: In this crossover study, 25 prediabetic individuals participated in exercise sessions at 50 %, 60 %, 70 %, and 80 % intensities of their predicted maximum heart rate using a treadmill. Each session lasted for 30 min, including a 5-min warm-up and a 5-min cool-down period. Blood samples were collected at four distinct time points: during fasting, immediately before exercise, and 30 and 60 min post-exercise. These samples were analyzed for glucose, insulin, and C-peptide levels. The effects of exercise intensity on these parameters were evaluated using repeated measures ANOVA, with post hoc tests conducted to determine specific differences between the intensities., Results: The participants had an average age of 34.88 years, a mean height of 170 cm, and a BMI of 30.34 kg/m². A significant reduction in insulin and glucose levels post-exercise was observed at 70 % intensity (p ≤ 0.001). Despite high fasting blood glucose levels (110-115 mg/dL), significant reductions were noted at 30 and 60 min post-exercise (p ≤ 0.001). Insulin levels approached near baseline at 70 % intensity, from fasting (26.74 ± 20.83) to 60 min post-exercise (28.47 ± 20.79), indicating a positive response at this intensity. C-peptide levels also showed significant changes, with the 70 % intensity exercise bringing them closest to fasting levels by 60 min post-exercise., Conclusion: This study highlights the importance of exercise intensities in enhancing metabolic parameters in prediabetic individuals. Specifically, 70 % of the predicted maximum heart rate was beneficial, optimizing insulin sensitivity and potentially reducing the risk of progressing from prediabetes to diabetes., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Authors.)

Background: Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo., Methods: This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. We included iPCAo patients treated with either EVT or MM. The primary outcome was the modified Rankin Scale (mRS) at 90 days, with secondary outcomes including functional independence, mortality, and safety profiles such as hemorrhagic complications., Results: A total of 177 patients were analyzed (88 MM and 89 EVT). EVT showed a statistically significant improvement in 90-day mRS scores (OR = 0.55, 95% CI = 0.30-1.00, p  = 0.048), functional independence (OR = 2.52, 95% CI = 1.02-6.20, p  = 0.045), and a reduction in 90-day mortality (OR = 0.12, 95% CI = 0.03-0.54, p  = 0.006) compared to MM. Hemorrhagic complications were not significantly different between the groups., Conclusion: EVT for iPCAo is associated with better neurological outcomes and lower mortality compared to MM, without an increased risk of hemorrhagic complications. Nevertheless, these results should be interpreted with caution due to the study's observational design. The findings are hypothesis-generating and highlight the need for future randomized controlled trials to confirm these observations and establish definitive treatment guidelines for this patient population., Competing Interests: Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Regenhardt serves on a DSMB for a trial sponsored by Rapid Medical, serves as site PI for studies sponsored by Penumbra and Microvention, and receives stroke research grant funding from the National Institutes of Health, Society of Vascular and Interventional Neurology, and Heitman Stroke Foundation. Dr. Guenego reports consultancy for Rapid Medical and Phenox, not directly related to the present work. Dr. Clarençon reports conflicts of interest with Medtronic, Balt Extrusion (consultant), ClinSearch (core lab), Penumbra, Stryker (payment for reading), and Artedrone (Board); all not directly related to the present work. Dr. Henninger received support from W81XWH-19-PRARP-RPA form the CDMRP/DoD, NS131756 and U24NS113844 from the NINDS, and NR020231 from the NINR and received compensation from Myrobalan, Inc. and General Dynamics during the conduct of this study unrelated to this work. Dr. Liebeskind is consultant as Imaging Core Lab to Cerenovus, Genentech, Medtronic, Stryker, Rapid Medical. Dr. Yeo reports Advisory work for AstraZeneca, Substantial support from NMRC Singapore and is a medical advisor for See-mode, Cortiro, and Sunbird Bio, with equity in Ceroflo. All unrelated to the present work. Dr. Griessenauer reports a proctoring agreement with Medtronic and research funding by Penumbra. Dr. Marnat reports conflicts of interest with Microvention Europe, Stryker Neurovascular, Balt (consulting), Medtronic, Johnson & Johnson, and Phenox (paid lectures), all not directly related to the present work. Dr. Puri is a consultant for Medtronic Neurovascular, Stryker NeurovascularBalt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc, and Arsenal Medical, he received research grants from NIH, Microvention, Cerenovus, Medtronic Neurovascular, and Stryker Neurovascular, and holds stocks in InNeuroCo, Agile, Perfuze, Galaxy, and NTI. Dr. Tjoumakaris is a consultant for Medtronic and Microvention (funds paid to institution, not personally). Dr. Jabbour is a consultant for Medtronic, Microvention, and Cerus.

Vaccination provides great protection against several infections, including coronavirus disease 2019 (COVID-19). However, the endeavor faces multiple context-specific problems that affect its uptake, leading to vaccine hesitancy. Vaccine hesitancy is a focal barrier to the success of COVID-19 vaccination programs. This umbrella review aimed to present a summary of global data regarding vaccine hesitancy and acceptance rates among medical students, health professionals, and health care workers. In this regard, two databases, PubMed and Scopus, were selected for data retrieval and analysis. A search term and an inclusion/exclusion criterion were applied to summarize the findings of existing systematic reviews. A pooled prevalence of vaccine acceptance and hesitancy with 95% confidence interval (CI) was taken as a prerequisite for this review. The results found a high percentage of COVID-19 vaccination ranging from 13.1% (95% CI, 6.9%-20.9%) to 46% (95% CI, 0.38%-0.54%), while the percentage of acceptance varied from 46% (95% CI, 37%-54%) to 83.0% (95% CI, 71%-96%) among medical students, health professionals, and health care workers. This umbrella review found a high percentage of COVID-19 vaccine hesitancy among medical students, health professionals, and health care workers. Further studies analyzing the determinants of vaccine hesitancy are important predictors for successful vaccination programs at the global level., Competing Interests: No potential conflict of interest relevant to this article was reported., (© Korean Vaccine Society.)

Background & Aims: There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process., Methods: A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management. A total of 34 experts participated in the 2 rounds of the Delphi process, with quantitative and qualitative data analyzed for each round to achieve consensus., Results: A total of 23 statements achieved a high degree of consensus. Overall, the expert panel agreed on the following: (1) same-day discharge after POEM can be considered in select patients; (2) a single dose of prophylactic antibiotics may be as effective as a short course; (3) a modified diet can be advanced as tolerated; and (4) all patients should be followed in clinic and undergo objective testing for surveillance and management of reflux. Consensus could not be achieved on the indication of post-POEM esophagram to evaluate for leak., Conclusions: The results of this Delphi process established expert agreement on several important issues and provides practical guidance on key aspects in the care of patients following POEM., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Journal selection is very important for any researcher in every field. Publication in a reputable journal not only has a higher reach among a greater number of people but also sets a benchmark for significance and quality. This primer aims to guide researchers in the field of cardiothoracic research, including medicine, surgery, and imaging, to assist in journal selection for their respective articles. Journal selection depends on a variety of factors, such as impact factors, publication charges, review processes, article types that a journal accepts, and indexing. This primer highlights all these factors in detail that are essential for the selection of a suitable journal. The article emphasizes the importance of these factors in making a reasoned decision about journal selection. This article also focuses on different types of publication models and their implications, including hybrid open access, gold open access, and diamond open access. In conclusion, this primer aims to provide insights to researchers in the fields of cardiothoracic surgery, medicine, and imaging about the publication landscapes and guide them to strategically plan their submissions., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Grewal et al.)

Heavy metal ions pose significant risks to human health, pelagic, and several other life forms due to perniciousness, tendency to accumulate, and resistance to biodegradation. Waste bio-materials extend a budding alternative as low-cost adsorbent to address the removal of noxious pollutants from wastewater on account of being cost-effective and exhibiting exceptional adsorption capacities. The current exploration was accomplished to gauge the performance of raw and modified human hair concerning lead scavenging in a down-flow fixed bed column. The appraisal of column performance under varying operational parameters encompassing bed height (15-45 cm), influent metal ion concentration (60-140 mg L -1 ), and a solution flow rate (20-40 mL min -1 ) was performed by breakthrough curve analysis. The consequences acquired were evaluated using the Yoon Nelson, Thomas, Adam-Bohart, and Bed Depth Service Time (BDST) model. Among these employed models, Bed Depth Service Time (BDST) and Thomas models exhibited the highest R-squared value compared to the Yoon Nelson and Adam-Bohart's model for most cases. In addition, the optimization of lead adsorption was followed using the Box-Behnken design of response surface methodology (RSM). The optimal conditions (desirability-1.00) for achieving a goal of maximum percent removal of lead ions were marked to be a bed height of 42.79 cm, solution flow rate of 20.92 mL min -1, and an initial metal concentration of 139.51 mg L -1 . Under these optimized conditions, the percent amputation of lead in a fixed bed was observed to be 82.31 %, while the results of the experiment performed approximately under these optimized conditions revealed a percent removal of 85.05 %, reflecting a reasonable conformity with values acquired through Box-Behnken design., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: The benefits of dietary macronutrients for weight management depend on the integrity of gut hormones. The role of food temperature in the release of satiety hormones and satiety needs elucidation. We aimed to determine the impact of different food temperatures with varying macronutrient compositions on satiety-related gut hormones glucagon-like peptide-1 (GLP-1) and cholecystokinin (CCK) and find the correlation of satiety hormones with appetite scores and remainder-day food (energy) intake., Materials and Methods: Thirteen healthy participants (eight males and five females) aged 25-35 years with body mass index 18.5-24.9 kg/m 2 with no medical illnesses or eating disorders consumed three compositions of meals (high carbohydrate, high fat, and high protein meals) each at three temperatures (cold, warm, and hot) in a randomized, double-blinded, controlled crossover design. Plasma concentrations of peptide hormones were determined at 0, 30, and 240 minutes by enzyme-linked immunosorbent assay, and 24-hours food recall was used for remainder-day food intake (remainder energy). Data were analyzed using SPSS version 27.0. The change in plasma levels of gut hormones with time was assessed using Friedman test; Kruskal-Wallis test was employed to compare GLP-1 and CCK hormonal levels across nine meals., Results: A comparison of the three meals at the three temperatures (total of nine groups), showed that the GLP-1 and CCK plasma concentrations were significantly different ( P < 0.001). GLP-1 and CCK responses increased more after hot meals than cold meals. Overall, high-fat meals had more effective gut hormone secretions. The area under the curve was increased for GLP-1 in high-fat meals and for CCK in hot meals. The peptide hormones (GLP-1 and CCK) were positively correlated with satiety scores and inversely with remainder food intake., Conclusion: The temperature of food was found to be an effective stimulus for the regulation of CCK and GLP-1 secretion. Hot food temperature increased satiety hormones (CCK and GLP-1), independent of food macronutrient composition., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family and Community Medicine.)

Mastitis is considered one of the most widespread infectious disease of cattle and buffaloes, affecting dairy herds. The current study aimed to characterize the Staphylococcus aureus isolates recovered from subclinical mastitis animals in Pothohar region of the country. A total of 278 milk samples from 17 different dairy farms around two districts of the Pothohar region, Islamabad and Rawalpindi, were collected and screened for sub clinical mastitis using California Mastitis Test. Positive milk samples were processed for isolation of Staphylococcus aureus using mannitol salt agar. The recovered isolates were analyzed for their antimicrobial susceptibility and virulence genes using disc diffusion and PCR respectively. 62.2% samples were positive for subclinical mastitis and in total 70 Staphylococcus aureus isolates were recovered. 21% of these isolates were determined to be methicillin resistant, carrying the mecA gene. S. aureus isolates recovered during the study were resistant to all first line therapeutic antibiotics and in total 52% isolates were multidrug resistant. SCCmec typing revealed MRSA SCCmec types IV and V, indicating potential community-acquired MRSA (CA-MRSA) transmission. Virulence profiling revealed high prevalence of key genes associated with adhesion, toxin production, and immune evasion, such as hla, hlb, clfA, clfB and cap5. Furthermore, the Panton-Valentine leukocidin (PVL) toxin, that is often associated with recurrent skin and soft tissue infections, was present in 5.7% of isolates. In conclusion, the increased prevalence of MRSA in bovine mastitis is highlighted by this study, which also reveals a variety of virulence factors in S. aureus and emphasizes the significance of appropriate antibiotic therapy in combating this economically burdensome disease., (© 2024. The Author(s).)

Background:  Liver cirrhosis is the replacement of normal liver parenchyma by fibrous tissue and nodularity. Cirrhosis liver has a negative effect on the body's ability to regulate blood glucose levels because the liver cannot release the amount of glucose it would ultimately cirrhotic patients are at risk of hypoglycemia., Objective:  To determine the frequency of hypoglycemia in cirrhotic patients just before endoscopy after being nil per mouth (NPO) for 6 hours., Methodology:  This cross-sectional study was done at the Department of Gastroenterology Lady Reading Hospital, Peshawar from 1st April 2023 to 30th September 2023. Patients aged > 20 years of both genders, having Child-Pugh class C cirrhosis, and undergoing upper gastrointestinal (GI) endoscopy were enrolled in the study while patients with a history of diabetes using oral or parenteral hypoglycemic medications, patients taking steroids, patients with hepatocellular carcinoma and patients with hepatic encephalopathy were excluded. Diagnosis of liver cirrhosis was based on clinical examination, serum albumin level, and prothrombin time followed by characteristic findings on ultrasound. Serum glucose level was determined in the blood sample of the patient from the hospital laboratory.  Results: One hundred and ninety-six patients were enrolled including 130 (67.4%) males and 66 (32.6%) females. Age of the patients ranged from 20 to 60 years. The mean age of the participants was 46.68±10.239 years. Hypoglycemia was found in 48% of patients with liver cirrhosis. A significant association of hypoglycemia was found with disease duration and Child-Pugh class., Conclusion:  Hypoglycemia is a frequent finding in patients with liver cirrhosis and needs urgent management to prevent complications. Prolonged illness and patients with Child-Pugh class C cirrhosis are more likely to have hypoglycemia., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board Lady Reading Hospital Peshawar issued approval 1033/LRH dated 01/06/2023. It is certified that approval is hereby granted to Dr. Dilaram Khan, assistant professor Gastroenterology, to conduct study on “Frequency of hypoglycemia in cirrhotic patients before endoscopy”. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khan et al.)

This review aims to explore the potential of artificial intelligence (AI) in coronary CT angiography (CCTA), a key tool for diagnosing coronary artery disease (CAD). Because CAD is still a major cause of death worldwide, effective and accurate diagnostic methods are required to identify and manage the condition. CCTA certainly is a noninvasive alternative for diagnosing CAD, but it requires a large amount of data as input. We intend to discuss the idea of incorporating AI into CCTA, which enhances its diagnostic accuracy and operational efficiency. Using such AI technologies as machine learning (ML) and deep learning (DL) tools, CCTA images are automated to perfection and the analysis is significantly refined. It enables the characterization of a plaque, assesses the severity of the stenosis, and makes more accurate risk stratifications than traditional methods, with pinpoint accuracy. Automating routine tasks through AI-driven CCTA will reduce the radiologists' workload considerably, which is a standard benefit of such technologies. More importantly, it would enable radiologists to allocate more time and expertise to complex cases, thereby improving overall patient care. However, the field of AI in CCTA is not without its challenges, which include data protection, algorithm transparency, as well as criteria for standardization encoding. Despite such obstacles, it appears that the integration of AI technology into CCTA in the future holds great promise for keeping CAD itself in check, thereby aiding the fight against this disease and begetting better clinical outcomes and more optimized modes of healthcare. Future research on AI algorithms for CCTA, making ethical use of AI, and thereby overcoming the technical and clinical barriers to widespread adoption of this new tool, will hopefully pave the way for profound AI-driven transformations in healthcare., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Thribhuvan Reddy et al.)

Background and Aims: Opioid-induced esophageal dysfunction (OIED) often presents as spastic esophageal disorders (SEDs) and esophagogastric junction outflow obstruction (EGJOO). The aim of this study was to evaluate and compare clinical outcomes of peroral endoscopic myotomy (POEM) for SEDs and EGJOO among opioid users and nonusers., Methods: This propensity score (PS) matching study included consecutive opioid users and nonusers who underwent POEM for SEDs and EGJOO between January 2018 and September 2022. The following covariates were used for the PS calculation: age, sex, duration of symptoms, Eckardt score, type of motility disorder, and length of myotomy during POEM. Clinical response was defined as a post-POEM Eckardt score ≤3., Results: A total of 277 consecutive patients underwent POEM during the study period. PS matching resulted in the selection of 64 pairs of patients strictly matched 1:1 (n = 128) with no statistically significant differences in demographic, baseline, or procedural characteristics or in the parameters considered for the PS between the 2 groups. Clinical response to POEM was significantly lower among opioid users (51 of 64 [79.7%]) versus nonusers (60 of 64 [93.8%]) (P = .03) at a median follow-up of 18 months. Among opioid users, higher opioid dose (>60 morphine milligram equivalents per day) was associated with a higher likelihood of failure to respond to POEM (odds ratio, 4.59; 95% confidence interval, 1.31-3.98; P = .02)., Conclusions: Clinical response to POEM for SEDs and EGJOO is significantly lower among opioid users versus nonusers. There was a dose-relationship between opioids and response to POEM, with higher daily opioid usage associated with a higher likelihood of treatment failure., Competing Interests: Disclosure The following authors disclosed financial relationships: D. Yang: consultant for Olympus, Fujifilm, Apollo Endosurgery, Medtronic, and Microtech; and research support from Microtech and 3D-Matrix. M.K. Hasan: consultant for Boston Scientific and Olympus. P. V. Draganov: consultant for Olympus, Boston Scientific, Fujifilm, Cook Medical, and Medtronic. N. Sharma: consultant for Boston Scientific, Medtronic, Steris, and Olympus. J. H. Hwang: consultant for Boston Scientific, Olympus, Medtronic, Fujifilm, and Microtech. A. Sethi: consultant for Boston Scientific, Interscope, Medtronic, and Olympus; and research support from Boston Scientific and Fujifilm. P. Benias: consultant for Boston Scientific, Apollo Endosurgery, and Fujifilm. P. Kedia: consultant for Boston Scientific, Olympus, and Medtronic. S. Jawaid: consultant for Lumendi, Creo Medical, and ConMed. M. B. Ujiki: member of the advisory board for Boston Scientific and Apollo Endosurgery; and speaker for Gore and Medtronic. R. Kim: consultant for Medtronic, Cook Medical, and Apollo Endosurgery. M. Othman: consultant for Olympus, Boston Scientific, Creo Medical, Apollo Endosurgery, Lumendi, AbbVie, and Nestle; and research support from Boston Scientific, ConMed, Lucid Diagnostic, AbbVie, and Nestle. All other authors disclosed no financial relationships., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Menstruation is part of women's normal life, which requires basic hygienic practices. Managing hygiene can be affected by several factors and situations such as natural disasters. Focusing on 'super flooding' in Pakistan's Sindh Province, we pay attention to how this 'natural disaster' has affected hygienic practices of menstrual cycle of women. The study meticulously examines the dynamics of menstrual hygiene management, encompassing the nuanced encounters with feelings of shame and embarrassment among girls and women situated in flood camps, schools, and community shelters. It also intends to highlight women's challenge and embarrassment to participate in the distribution process of essential resources such as pads. The insights garnered from this study hold potential relevance for various stakeholders, including policymakers, healthcare practitioners, and researchers, offering a nuanced comprehension of the intersection of menstrual hygiene, climate change, and well-being of women.

The aim of the present study was the validation of the already reported Bos taurus SNPs in the Sahiwal breed. A total of nine SNPs of the casein gene were studied. Out of nine, seven Bos taurus SNPs of casein protein genes were found to be significantly associated with milk productivity traits. The genomic DNA was extracted from the mammary alveolar endothelial cells of a flock of 80 purebred Sahiwal lactating dams available at Khizrabad Farm near Sargodha. New allele-specific primers were designed from the NCBI annotated sequence database of Bos taurus to obtain 100 nt-long PCR products. Each dam was tested separately for all the SNPs investigated. Animals with genotype GG for the SNPs rs43703010, rs10500451, and 110323127, respectively, exhibited high milk yield. Similarly, animals with genotype AA for the SNPs rs11079521, rs43703016, and rs43703017 showed high milk yield consistently. For the SNP rs43703015, animals with genotype CC showed high milk productivity. These above-mentioned SNPs have previously been reported to significantly up-regulate casein protein contents in Bos taurus . Our results indicated SNPs that significantly affect the milk protein contents may also significantly increase per capita milk yield. These finding suggest that the above-mentioned reported SNPs can also be used as genetic markers of milk productivity in Sahiwal cattle.

Background and study aims Alterations to interstitial cells of Cajal (ICC) and collagen fibrosis have been implicated in the pathogenesis of gastroparesis. We aimed to evaluate the feasibility and safety of pyloric muscle sampling during gastric peroral endoscopic myotomy (G-POEM) and the association between pyloric ICC density and degree of fibrosis with clinical outcomes. Patients and methods This was a single-center prospective study of gastroparetic patients who underwent G-POEM and intraprocedural pyloric muscle biopsies between January 2022 and April 2023. ICC count was estimated using CD117 stain and trichome for collagen fibrosis. Clinical response to G-POEM was defined as an improvement of ≥ 1 point on the Gastroparesis Cardinal Symptom Index. Results Fifty-six patients (median age 60 years, 71.4% women) underwent G-POEM (100% technical success; 71.4% clinical response). ICC depletion (< 10/high-power field) and fibrosis were encountered in 70.4% and 75% of the cases, respectively. There was no difference in mean ICC count between G-POEM responders vs. non-responders (7±3.6 vs. 7.7±3.3; P = 0.9). There was no association between ICC density or degree of fibrosis with the etiology of gastroparesis, duration of symptoms, gastric emptying rate, or pyloric impedance planimetry. Patients who did not respond to G-POEM had a significantly higher degree of moderate/severe fibrosis when compared with those who responded (81.3% vs. 25%; P = 0.0002). Conclusions Pyloric muscle biopsies during G-POEM was feasible and safe. ICC depletion and pyloric muscle fibrosis are common in gastroparetic patients. The degree of fibrosis may be related to pyloric dysfunction and clinical response to G-POEM. Additional studies are needed to confirm these results., Competing Interests: Conflict of Interest Dr. Yang is a consultant for Olympus, Fujifilm, Boston Scientific, Medtronic, 3D-Matrix, Microtech, and Neptune Medical. Dr. Yang receives research grants from Microtech and 3D-Matrix. MK Hasan is a consultant for Boston Scientific, Olympus, and Microtech. Dr. Cosgrove is a consultant for Boston Scientific and Olympus. Dr. Arain is a consultant for Boston Scientific, Olympus and Cook Medical. All other authors have no disclosures., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

This study aimed to explore polymorphisms in the promoter region of the caprine BMPR1B (Bone morphogenetic protein receptor 1 beta) gene and its association with body measurement and litter size traits in Damani does. A total of 53 blood samples were collected to analyze the association between the BMPR1B gene polymorphism and 11 phenotypic traits in Damani female goats. The results revealed that three novel SNPs were identified in the promoter region of the caprine BMPR1B gene, including g.67 A > C (SNP1), g.170 G > A(SNP2), and g.501A > T (SNP3), among which the SNP1 and SNP2 were significantly (p < 0.05) associated with litter size and body measurement traits in Damani goats. In SNP1 the AC genotype could be used as a marker for litter size, and the CC genotype for body weight in Damani goats. In SNP2, the genotype GG was significantly (p < 0.05) associated with ear and head length. Therefore, we can conclude from the present study, that genetic variants AC and CC of the caprine BMPR1B gene could be used as genetic markers for economic traits through marker-assisted selection for the breed improvement program of the Damani goat., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Objectives: To evaluate the implementation of frailty screening in people living with HIV (PLWH) in a large urban cohort of patients in Brighton, UK., Methods: Focus group discussions with HIV professionals and PLWH interviews helped inform the design and implementation of the frailty screening pathway in the clinic. Data were collected from PLWH aged over 60 years attending their HIV annual health check from July 2021 to January 2023 (n = 590), who were screened for frailty by nurses using the FRAIL scale. We assessed the proportions of PLWH who screened as frail, prefrail or robust and compared patient characteristics across groups. All PLWH identified as frail were offered a comprehensive geriatric assessment delivered by a combined HIV geriatric clinic, and uptake was recorded., Results: A total of 456/590 (77.3%) PLWH aged over 60 years were screened for frailty. Median age and time since HIV diagnosis (range) for those screened were 66 (60-99) years and 21 (0-32) years, respectively. In total, 56 (12.1%) of those screened were identified as frail, 118 (25.9%) as prefrail and 282 (61.8%) as robust. A total of 10/56 (18%) people identified as frail declined an appointment in the geriatric clinic. Compared with non-frail individuals, frail PLWH had been living with HIV for longer and had a greater number of comorbidities and comedications but were not chronologically older., Conclusions: Implementing frailty screening in PLWH over 60 years old is feasible in a large cohort of PLWH, as recommended by the European AIDS Clinical Society. More research is needed to determine if frailty screening can improve clinical outcomes of older PLWH and the use of the comprehensive geriatric assessment within HIV services., (© 2023 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)

The toxic effects of heavy metals are drastic, including accumulation. Fish species are important bio-indicators of heavy metal pollution in aquatic bodies. The current study aimed to assess the seasonal variation of heavy metals in the vital organs of mostly consumed fishes in River Jhelum, Pakistan. Samples of fish, including Wallago attu (Malhi), Rita rita (Khagga), and Mystus seenghala (Singhari), were collected from four different sites, i.e., Khushab, Muhammad Wala (M. Wala), 8.R.D and Rasool barrage during summer and winter seasons. Heavy metals such as iron (Fe), lead (Pb), chromium (Cr), cobalt (Co) and Cadmium (Cd) were estimated through acid digestion and spectrometric analysis. Results showed a significantly higher (P < 0.05) amount of these metals in the liver, followed by the kidneys of fish species. There were seasonal variations in the absorption of these metals as well. Cr (11.71) and Fe (58.66) were detected in higher amounts in Khagga which showed the greatest affinity for certain metals in some cases. In contrast, Singhari showed the greatest affinity to other metals in other cases. Comparative analysis revealed that there was a highly significant (P < 0.05) difference for the accumulation of almost all metals in both seasons and summer had the highest concentration of Cd, Pb, Co, Cr and Fe as compared to winter in all four sampling stations in the case of kidney and liver of all the three fishes. Elevated levels of heavy metals were detected in the summer due to increased temperature. Heavy metals found in the River Jhelum may demonstrate that metals can significantly affect the fish species., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Accurate breast cancer (BC) diagnosis is a difficult task that is critical for the proper treatment of BC in IoMT (Internet of Medical Things) healthcare systems. This paper proposes a convolutional neural network (CNN)-based diagnosis method for detecting early-stage breast cancer. In developing the proposed method, we incorporated the CNN model for the invasive ductal carcinoma (IDC) classification using breast histology image data. We have incorporated transfer learning (TL) and data augmentation (DA) mechanisms to improve the CNN model's predictive outcomes. For the fine-tuning process, the CNN model was trained with breast histology image data. Furthermore, the held-out cross-validation method for best model selection and hyper-parameter tuning was incorporated. In addition, various performance evaluation metrics for model performance assessment were computed. The experimental results confirmed that the proposed model outperformed the baseline models across all evaluation metrics, achieving 99.04% accuracy. We recommend the proposed method for early recognition of BC in IoMT healthcare systems due to its high performance.

Pelvic inflammatory disease (PID) is one of the major public health concerns accounting for 30% of infertility and 50% of ectopic pregnancy cases due to severe inflammation and fibrosis. Punicalagin® are known to exhibit potent anti-inflammatory activity. The aim of this study was to demonstrate the anti-inflammatory and antioxidant effects of Punicalagin®, against pelvic inflammatory disease in rats. Female Sprague Dawley rats ( n  = 24) were divided into 6 groups ( n  = 4) as control, PID, prophylactic (low dose and high dose) and therapeutic group (low dose and high dose). PID model was constructed by implanting the rat cervix with mixed microbe ( Escherichia Coli and Staphylococcus Aureus ) solution. Prophylactic group was gavaged with 3 mg/kg (low dose) and 6 mg/kg (high dose) Punicalagin® daily starting one day before PID induction and therapeutic group was gavaged with 3 mg/kg (low dose) and 6 mg/kg (high dose) Punicalagin® daily starting 1 day after confirmation of PID model. Rats were sacrificed at the end of experiment and samples from upper genital tract were collected for ELISA, antioxidant assay and histopathological examination. According to results, obvious signs of inflammation and oxidative stress including infiltration of neutrophils and significantly raised levels of cytokines, and oxidative stress markers were observed in PID group when compared to control group. Punicalagin® significantly decreased the levels of IL-1β, catalase and lipid peroxidation in both prophylactic and therapeutic groups when compared to PID group. Punicalagin® also decreased the infiltration of leucocytes in uterus of prophylactic and therapeutic group when compared to PID group, as determined by histological examination. On basis of these results, we concluded that Punicalagin® showed anti-inflammatory and antioxidant potential in rat model of pelvic inflammatory disease and could be used as possible therapeutic agent in treatment of PID.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive intervention that has established itself as the gold standard therapeutic option for various pancreaticobiliary conditions. Deep cannulation of the common bile duct (CBD) is essential in ERCP. However, cannulation is not possible in approximately 20% of the cases with the usual techniques even when performed by highly trained professionals or at major healthcare institutions. In case of failure on the first attempt, alternative choices include redoing the procedure (on the second attempt) or moving on to more proficient endoscopic methods such as endoscopic ultrasound (EUS) or radiology-aided techniques (rendezvous procedures), totally percutaneous approaches, or surgical treatments., Objective: To analyze the effectiveness of the second attempt ERCP 24 hours (second day) after primary failure., Methodology: This analytical study was conducted to check the outcomes of second attempt ERCP in patients with prior failed cannulation, from June 20, 2023, to November 20, 2023, at the Department of Gastroenterology, Lady Reading Hospital, Peshawar. Patients of either sex, aged >16 years with failed biliary cannulation, and who were otherwise clinically stable were included in the study. Patients with surgically modified anatomy, an unidentified main duodenal papilla, or a history of sphincterotomy at another setup were excluded. Outcomes were assessed in terms of gaining deep biliary access (cannulation) using a therapeutic duodenoscope and endoscopy system supported by a fluoroscope while using a wire-guided sphincterotome. Factors linked to second ERCP cannulation success or failure were analyzed using SPSS version 24., Results: Ninety-four patients were enrolled including 61 (64.9%) males and 33 (35.10%) females. The mean age of the participants was 39.01±14.831 years. The most common indication for the intervention was CBD stones, which were present in 70 (74.5%) patients. Successful cannulation on the second attempt was achieved in 72 (76.6%) patients. Experienced endoscopists achieved a greater proportion of successful cannulation (86.8%) compared to 33.3% by endoscopists with lower experience (p-value: <0.001). Logistic regression analysis was conducted to predict the outcomes (cannulation), which revealed an odds ratio for endoscopist experience of 33.604 (95% confidence interval: 6.948-162.52)., Conclusion: A second ERCP attempt 24 hours after the primary failed attempt appears to be the best course of action for the majority of clinically stable patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Khan et al.)

This study aimed to evaluate the impact of Basella rubra fruit extract ( BR -FE) on cryopreserved ram sperm's motility, velocity, and membrane integrity. Thirty ejaculates collected from 3 fertile rams (10 from each) were diluted with semen dilution extender (SDE) in a ratio (1:2) and centrifuged to remove 50% supernatant. The remaining sample was mixed with semen cryopreservation extender (SCE) in 1:4 ratio. Then 1.2 mL of SCE diluted sample was divided in four aliquots (0.3 mL each) that were further extended with [(1) control group (0.7 mL of SCE), (2) BR -FE-0.6% group (0.7 mL of SCE supplemented with 0.6% BR -FE), (3) BR -FE-0.8% group (0.7 mL of SCE supplemented with 0.8% BR -FE), and (4) BR -FE-1.6% group (0.7 mL SCE supplemented with 1.6% BR -FE)]. All extended samples were cooled gradually from 25°C to 4°C in half an hour. The 0.1 mL sample from all aliquots was analyzed for precryopreservation sperm parameters and the remaining sample was loaded in 0.5 mL plastic semen straws, cooled gradually to -20°C, and then dipped in liquid nitrogen. After 24 hours of cryopreservation, the straws were thawed for postcryopreservation sperm evaluations. The results (analysis of variance based) showed significantly enhanced percentage of post-thaw sperm membrane integrity, progressive motility, and velocity in BR -FE-0.6% group at both pre- and postcryopreservation stages as compared with all other groups. However, analysis of covariance revealed concentration-dependent cryoprotective effect of BR -FE with maximum percentage of sperm membrane integrity in the 1.6% group. According to these results, BR -FE supplementation adds enormous sperm protective potential to ram sperm cryopreservation medium.

Background: Fecal immunochemical test (FIT) is a yearly alternative colorectal screening modality for average risk individuals unwilling or unable to undergo invasive colorectal cancer (CRC) screening due to cost and accessibility. This study aimed to determine whether FIT should be interpreted within the context of patient demographics and medical history., Methods: Patients >50 years old who had a FIT followed by colonoscopy within 1 year were analyzed based on age, race, BMI, social and medical comorbidities. False positive (FP) and false negative (FN) FIT results within each patient demographic and medical history variable were determined by comparing with the gold standard of colonoscopy using χ 2 analysis., Results: One thousand twenty-five patients were reviewed. 21.8% of FIT results were positive. Factors which differed in positive FIT rates were age (P=0.003), smoking (P<0.001), alcohol (P=0.001), and hypertension (P<0.001). The difference in rates of FP and FN FIT outcomes among each variable underwent further subanalysis. The FP was 66.8% and the FN rate was 12.8%. Higher FN outcomes were noted in those above 70, males and smokers, though the result was only statistically significant for males (P=0.009). Females were observed to have higher FP rates (P=0.019)., Conclusions: Females had higher FP FIT rates compared to males, indicating that sex may influence FIT outcomes and should be accounted for when interpreting FIT results. This information can be utilized to identify populations at higher risk of FP or FN FIT results to target CRC screening. Additionally, recalculating the FP and FN rates for each variable may help determine new FIT targets.

Background: Cultural sensitivity (CS) training is vital to pediatric emergency medicine (PEM) curricula. This study aimed to explore CS in Yale PEM fellows and emergency medicine (EM) residents at Indus Hospital and Health Network (IHHN) in Pakistan through distance simulation activities., Methods: This mixed-methods analysis of an educational intervention was conducted at Yale University in collaboration with IHHN. We approached seven U.S. PEM fellows and 22 Pakistani EM residents. We performed a baseline CS assessment using the Clinical Cultural Competency Questionnaire (CCCQ). Afterward, the U.S. PEM fellows facilitated the Pakistani EM residents through six distance simulation sessions. Qualitative data were collected through online focus groups. The CCCQ was analyzed using descriptive statistics, and content analysis was used to analyze the data from the focus groups., Results: Seven U.S. PEM fellows and 18 of 22 Pakistani EM residents responded to the CCCQ at the beginning of the module. The mean (±SD) CCCQ domain scores for the U.S. PEM fellows versus the Pakistani EM residents were 2.56 (±0.37) versus 2.87 (±0.72) for knowledge, 3.02 (±0.41) versus 3.33 (±0.71) for skill, 2.86 (±0.32) versus 3.17 (±0.73) for encounter/situation, and 3.80 (±0.30) versus 3.47 (±0.47) for attitude (each out of 5 points). Our qualitative data analysis showed that intercultural interactions were valuable. There is a common language of medicine among the U.S. PEM fellows and Pakistani EM residents. The data also highlighted a power distance between the facilitators and learners, as the United States was seen as the standard of "how to practice PEM." The challenges identified were time differences, cultural practices such as prayer times, the internet, and technology. The use of local language during debriefing was perceived to enhance engagement., Conclusion: The distance simulation involving U.S. PEM fellows and Pakistani EM residents was an effective approach in assessing various aspects of intercultural education, such as language barriers, technical challenges, and religious considerations., Competing Interests: The authors have no conflicts of interest to disclose., (© 2023 Society for Academic Emergency Medicine.)

Background: Hypertension is highly prevalent and uncontrolled among hemodialysis patients. In Pakistan published data does not provide enough information about the management and factors associated with uncontrolled hypertension in hemodialysis patients., Objective: This study was conducted to evaluate the factors influencing the pharmacotherapeutic management and control of hypertension in hemodialysis patients., Methods: A prospective follow-up study was conducted on hemodialysis patients who were enrolled at study sites between 1 June 2020 and 31 December 2020. The predialysis blood pressure (BP) readings were recorded as mean SBP and DBP at baseline and for each of 6 months. Multivariate analyses were applied to analyze the factors associated with uncontrolled hypertension in hemodialysis patients., Results: The average predialysis BP (SBP and DBP) of study participants at baseline visit was 158.41 and 87.22 mmHg respectively. After 6 months the study participants have 150.27 mmHg and 80.03 mmHg average predialysis SBP and DBP respectively. Only 28.1% of hemodialysis patients were on target BP after 6 months. Results of multivariate analysis have shown that the use of beta-blockers and calcium channel blockers (CCBs) were significantly associated with hypertension control at baseline [odds ratio (OR) = 1.432, P value = 0.034] (OR = 1.499, P value = 0.045) and at after 6 months (OR = 2.824, P value = 0.015) (OR = 1.883, P value = 0.032)., Conclusion: This study revealed that among the antihypertensive drugs, CCBs and beta-blockers provided better management in controlling hypertension among hemodialysis patients., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

There are several conditions where the function of the aortic valve can be compromised in the pediatric population. The aortic valve is composed of three leaflets which are thin and mobile and are attached to the aortic sinuses. Each leaflet is made up of connective tissue, forming a highly ordered network of extracellular matrix components. Together, this enables the aortic valve to open and close more than 100,000 times throughout the day. However, there are conditions where the structure of the aortic valve can be compromised resulting in its function being affected. Conditions such as congenital valvular aortic stenosis and abnormal valve morphology including bicuspid valves often necessitate intervention to improve symptoms and quality of life in children. Other conditions which result in requiring surgical intervention include infective endocarditis and trauma. In this article, we present the common forms of aortic valve disease in the pediatric population and the clinical presentation and pathophysiology of these. We also discuss the range of management options including medical management and percutaneous intervention. Surgical interventions such as Aortic annular enlargement techniques, the Ross procedure and the Ozaki procedure will also be discussed. The effectiveness, complications and long-term outcomes associated with these methods will be explored.

Objectives: This study aimed to compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado scoring to accurately identify acute appendicitis., Material and Methods: A cross-sectional prospective study was carried out in the department of surgery. Patients were enrolled and scored using RIPASA and Alvarado scoring systems. Appendectomy was done, and the specimen was sent for histopathology examination, which was used as the gold standard for diagnosis. Among 400 recruits, 11 patients were lost to follow-up, giving us a sample size of 389 patients. The cut-off value for RIPASA and Alvarado scores was 7.5 and 7.0, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in diagnosing acute appendicitis of both scores were analyzed using SPSS., Results: Among 389 patients, 256 (66%) were males, and 277 (71%) were under the age of 40 years. RIPASA was more than 7.5 in 345 cases, while Alvarado was more than 7.0 in 261 patients. RIPASA score had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 95.8%, 87.9%, 98.9%, and 65.9%, respectively. In contrast, the ALVARADO score was 71.1% sensitive and 75.8% specific. RIPASA had a diagnostic accuracy of 95.12%, while Alvarado was only 71.46% accurate in diagnosing acute appendicitis., Conclusion: Compared to the Alvarado scoring system, RIPASA is a better tool in terms of accuracy, sensitivity, and specificity for diagnosing acute appendicitis., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (Copyright © 2023, Turkish Surgical Society.)

Cytokines play an important role in SARS-CoV-2 infection progression and severity. A number of inflammatory cytokines have been directly associated with disease severity including IL-6 (interleukin-6), IL-10, TNF-α (tumor necrosis factor alpha), IFN-γ (interferon-gamma). Here, in this study, the aim was to better understand the interplay between host immune response mediated by cytokines and severity of SARS-CoV-2 infection by assessing cytokine expression. Therefore, we measured expression levels of a total of 12 genes (IFNA-1, IFN-γ, IL-1α, IL-1β, IL-4, IL-6, IL-7, IL-10, IL-11, IL-13, IL-15, and IL-27) encoding inflammatory, anti-inflammatory and regulatory cytokines using QRT-PCR in hospitalized patients with severe infection compared to mildly infected. IFN-γ was identified as a potent marker of disease severity as indicated previously. Moreover, levels of IL-7 were also found to be partially reduced in patients compared to the healthy controls and linked negatively to disease severity. Identification of these cytokines may be helpful in not only understanding disease pathogenesis but also in better management of the patients after covid infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Mansoor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: The developmental abnormalities of the in-ovo exposure of Fluoride ions (F-ions) and Bifenthrin (BF) on the embryonic chick eye were investigated., Materials and Methods: 165 fresh fertilized eggs of zero day and 40-50 g weight were divided into three groups (55 eggs each) on the basis of inter-vitelline treatment of eggs on zero day of study: 1) Control group (CG); 0.1 ml of 5 % DMSO aqueous solution 2),3) Fluoride group (FG), and Bifenthrin group (BFG); 0.01 mg/kg F-ions (from NaF) and 0.01 mg/kg BF in 0.1 ml of 5 % DMSO aqueous solution respectively. After incubation for 14 days at 37 ± 0.5 °C embryos were externalized. Eyes of each embryo were removed for micro-anatomical, micrometric and histopathological studies., Results: The histological sections have shown denser and enlarged marginal mitotic region of the developing eye lenses in FG and BFG. In vertical sections of the eye lenses the nuclei of the crystalline cells in FG and BFG show a highly depressed bow shaped arrangement. Moreover, the nuclei of the core crystalline cells of the lens were apparently smaller in FG and BFG than CG. Out of the six anatomical layers of the retina the nuclear and the plexiform layers were highly enlarged in FG and BFG, similarly the three corneal cell layers (endothelial, parenchymal and epithelial) were enlarged in FG and BFG than CG. The morphometric, histometric and micrometric estimations also show significant variations in FG and BFG than CG., Conclusion: The results indicate subtle developmental anomalies of the eyes attributable to the F-ions and BF exposure indicating their developmental neuro-optic disruption potentials. Results further revealed higher toxicity of BF as compared to F-ions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Cardiac disorders are a leading cause of global casualties, emphasizing the need for the initial diagnosis and prevention of cardiovascular diseases (CVDs). Electrocardiogram (ECG) procedures are highly recommended as they provide crucial cardiology information. Telemedicine offers an opportunity to provide low-cost tools and widespread availability for CVD management. In this research, we proposed an IoT-based monitoring and detection system for cardiac patients, employing a two-stage approach. In the initial stage, we used a routing protocol that combines routing by energy and link quality (REL) with dynamic source routing (DSR) to efficiently collect data on an IoT healthcare platform. The second stage involves the classification of ECG images using hybrid-based deep features. Our classification system utilizes the "ECG Images dataset of Cardiac Patients", comprising 12-lead ECG images with four distinct categories: abnormal heartbeat, myocardial infarction (MI), previous history of MI, and normal ECG. For feature extraction, we employed a lightweight CNN, which automatically extracts relevant ECG features. These features were further optimized through an attention module, which is the method's main focus. The model achieved a remarkable accuracy of 98.39%. Our findings suggest that this system can effectively aid in the identification of cardiac disorders. The proposed approach combines IoT, deep learning, and efficient routing protocols, showcasing its potential for improving CVD diagnosis and management.

Endothelial dysfunction (ED) is a significant risk factor of blood vessel related diseases of diabetes and this study evaluate the effect of adding Momordica charantia (Mc) to glibenclamide (GLB) on ED markers in diabetic rats. Streptozotocin (STZ-40mg/kg b. w.) induced diabetic rats were randomly put into 3 groups with 10 rats/group; diabetic control [DC] group, glibenclamide treated group (GLB -2.5mg/kg) and GLB-Mc treated group (2.5mg/kg + 400mg/kg). Serum glucose was measured weekly for eight weeks whereas insulin, sVCAM-1, vWF-Ag and interleukin-6 [IL-6] were measured at week 0 and week 8. Luciferase assay was performed to determine luminescence. At week 8, GLB and GLB-Mc groups revealed improvements in blood glucose and insulin concentrations (P≤0.05) when compared to corresponding baseline values with GLB-Mc group showing slightly greater improvements. GLB-M c group also revealed improvement (P≤0.05) in vWF-Ag, sVCAM-1 and IL-6 concentrations but was non-significant in GLB group when compared to corresponding baseline values. Comparison between GLB and GLB-Mc group showed significantly high concentration of sVCAM-1 in GLB group (P≤0.05) due to its minimal effect on TGR5 activation. We conclude that adding M. charantia to GLB may be a useful choice for modulating diabetes induced ED due to its stimulatory effect on TGR5 receptors.