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Paula Furlan Bavia,1 Shehryar Khawaja,2,3 María F Hernández-Nuño de la Rosa,4 Lisa A Tseng,5 David Alexander Keith6 1Private Practice Boca Raton Prosthodontics (Practice Limited to Orofacial Pain), Boca Raton, FL, USA; 2Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan; 3Craniofacial Pain Center, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 4Department of Oral and Maxillofacial Surgery, Tufts University School of Dental Medicine, Boston, MA, USA; 5Pain Medicine, Kaiser Permanente, Redwood City, CA, USA; 6Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USACorrespondence: Paula Furlan Bavia, Email paulabavia@gmail.comPurpose: Sleep impairment is associated with many chronic pain disorders. While there is an association between chronic pain and sleep disturbances, little is known about the influence of pharmacotherapy for chronic pain conditions, particularly chronic opioid therapy, on sleep. This study aimed to 1) compare the sleep quality (SQ) in patients with two different pain conditions-chronic body pain and chronic orofacial pain; 2) assess the correlation of SQ and pain intensity; and 3) evaluate the association between pharmacotherapy and SQ.Patients and Methods: The Pittsburgh Sleep Quality Index (PSQI) was used to measure the SQ in subjects with 1) chronic body pain (n = 100) and 2) chronic orofacial pain (n = 100). The visual analogue scale was applied for pain intensity rating. All subjects were adults recruited at Massachusetts General Hospital, United States. The subjects’ demographic data, pain intensity, diagnosis and concurrent use of medications were extracted from their electronic medical records (EMR). Statistical analyses were performed using T-test and Pearson correlation coefficient.Results: Among 200 subjects (mean age 51.01 ± 15.52 years), 141 (70.5%) were females. PSQI and pain intensity were statistically significantly different between the two groups (p < 0.05 and p < 0.0001, respectively) and higher in subjects with chronic body pain. There was a positive correlation between PSQI and pain intensity (chronic orofacial pain r = 0.3535, p = 0.0004; chronic body pain: r = 0.2247, p < 0.026). PSQI was higher in chronic orofacial pain subjects utilizing opioids and benzodiazepines (PSQI = 15.25).Conclusion: Chronic pain impairs SQ, which is noticeably worse in subjects with body pain conditions. In addition, pain intensity was correlated with poorer SQ, which in turn was linked to the concomitant use of opioid and benzodiazepine therapy in chronic orofacial pain.Keywords: sleep quality, chronic pain, pain intensity, pharmacotherapy, opioids, benzodiazepines

Shehryar Khawaja,1– 3 Roxanne Bavarian,4 Summaiya Abdul Rehman,1 Haroon Hafeez1 1Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan; 2Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 3Department of Oral Diagnostic Sciences, University at Buffalo, School of Dental Medicine, Buffalo, NY, USA; 4Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA, USACorrespondence: Shehryar Khawaja, Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3 M.A. Johar Town, Lahore, 54782, Pakistan, Tel +92 42 3590 5000 Ext 4452, Email Khawajashehryar@gmail.comObjective: This study aimed to describe the clinical characteristics and prevalence of different painful phenotypes in head and neck cancer (HNC)-related pain.Materials and Methods: A cross-sectional study was conducted on 100 patients who presented with HNC-related pain. All patients underwent a comprehensive clinical assessment and were stratified in one or more painful phenotypes constructed based on the International Classification for Orofacial Pain, first edition, and International Classification for Headache Disorders, third edition.Results: Among the participants included, 68% were male, and the mean age of the cohort was 49.71 ± 14.14 years. The most prevalent cancer sites were the tongue (29%) and buccal mucosa (24%). The average pain intensity was 5.88 ± 2.53 on an 11-point numeric verbal pain rating scale, where 0 was indicative of “no pain” and 10 was suggestive of “worst pain imaginable”. However, the worst pain intensity over the last month was 8.95 ± 1.53. The average number of pain sites per patient was 6, and the most common pain descriptors were dull ache, burning, and sharpness. Myofascial pain, jaw bone pain, and burning pain disorder were the most common phenotypes, and on average, three different phenotypes co-existed.Conclusion: HNC-related pain has a varying and complex clinical profile, which may mirror the pain profiles of primary pain disorders, such as myofascial pain, jaw bone pain, or burning pain disorders, and often presents together as a cluster of phenotypes.Plain language summary: The clinical presentation of head and neck cancer (HNC)-related pain varies considerably. This study assessed 100 patients with HNC-related pain. It stratified their symptoms into one or more known painful disorders based on the International Classification for Orofacial Pain, first edition and International Classification for Headache Disorders, third edition. It was found that HNC-related most commonly resembled myofascial pain, jaw bone pain, and burning pain disorder. On average, features of three different types of painful disorders co-existed. These results help illustrate the uniqueness and difficulty associated with managing HNC-related pain.Keywords: head and neck cancer, pain, phenotypes, myofascial, neuralgia, neuropathic, trigeminal

Abstract Background The button mangrove (Conocarpus erectus L.) is regarded as a peripheral species within mangrove communities. This particular species has the ability to thrive in regions that are arid or semiarid, where there is limited availability of nutrients. This study provides evidence of the ecological dominance of Conocarpus erectus across various habitats, highlighting its adaptability and success throughout the country of Pakistan. We collected twelve populations from four distinct ecological regions, including artificial forest plantations, agricultural fields, roadsides, and wastelands, offering a comprehensive assessment of C. erectus adaptability across diverse environmental contexts. Results Forest plantation populations exhibited impressive shoot growth and moderate root lengths, with plants generally tall and well-weighted. Physiologically, they had moderate chlorophyll content and low carotenoid levels, with a balanced chlorophyll a/b ratio, indicating stable photosynthetic activity. Anatomically, these populations had thicker epidermal and cortical root layers but smaller vascular bundles and phloem regions. Stem and leaf structures were generally moderate in size, with thicker midribs and cortical layers in the leaves. Agricultural field populations showed robust shoot and root systems with balanced fresh and dry biomass. They exhibited high chlorophyll and carotenoid levels, indicating strong photosynthetic capacity. Root and stem anatomy revealed larger root areas, thicker cortex, and wide vascular bundles, reflecting enhanced structural development. Leaves from these populations had moderate midrib and cortical thickness, with larger stomatal areas, promoting efficient gas exchange. Roadside populations displayed deeper roots and reduced biomass production. These populations adapted to environmental stress through leaf expansion, with high leaf numbers and areas. Physiologically, populations had high chlorophyll content, with a high chlorophyll a/b ratio. Root and stem anatomy showed compact structures with smaller vascular bundles, indicating adaptation to harsher conditions. Leaf anatomy was moderate, with smaller vascular bundles and reduced water transport capacity. Wasteland populations exhibited poor growth and high shoot biomass despite small leaves. Physiologically, these populations had the highest total soluble protein and proline contents, reflecting stress adaptation. Anatomically, root and stem structures were variable, with some populations showing reduced cortical cell areas and smaller vascular bundles, indicating limited resource transport. Leaf structures had thicker lamina, thinner epidermal layers, and lower stomatal densities, reflecting adaptation to nutrient-poor soils. Conclusion This study reveals the adaptability and thriving potential of Conocarpus erectus across varied habitats, providing key insights into its resilience and survival strategies. Understanding these adaptive traits can support habitat restoration, conservation planning, and improve species management in diverse environmental conditions, especially in response to climate change and habitat degradation.

The transformation of business and the economy is a key business problem, and its importance was further heightened during the COVID-19 pandemic, with the increased pressure on enterprises. Hence, the digital readiness of their business will likely determine its future competitiveness in the field. Objectives: The paper addresses the issue of digital readiness for business, with the aim of examining similarities and differences in the digital readiness of European Union countries. The main focus is on identifying the changes during the first two years of the pandemic. Methods/Approach: We conducted a factor analysis and hierarchical cluster analysis based on selected indicators. The results revealed some significant differences. Results: While the countries that lead in digital readiness remained the same, there were relatively large differences in the classification of other EU countries. Some countries, such as Latvia or Slovenia, significantly improved in many aspects of digital readiness during the pandemic. On the other hand, Bulgaria and Romania are still included in the same cluster, representing an overall low digital readiness. Conclusion: Enterprises in more developed countries also have a higher level of digital readiness. Although COVID-19 had a positive impact on digital readiness in some less developed countries, the impact is only partial, indicating a need for stronger actions to bridge the digital divide at the EU level. These findings provide a hopeful outlook, suggesting that with the right actions, the digital divide in the EU can be effectively bridged.

Abstract Background Chromium (Cr) toxicity significantly threatens agricultural ecosystems worldwide, adversely affecting plant growth and development and reducing crop productivity. Trehalose, a non-reducing sugar has been identified as a mitigator of toxic effects induced by abiotic stressors such as drought, salinity, and heavy metals. The primary objective of this study was to investigate the influence of exogenously applied trehalose on maize plants exposed to Cr stress. Results Two maize varieties, FH-1046 and FH-1453, were subjected to two different Cr concentrations (0.3 mM, and 0.5 mM). The results revealed significant variations in growth and biochemical parameters for both maize varieties under Cr-induced stress conditions as compared to the control group. Foliar application of trehalose at a concentration of 30 mM was administered to both maize varieties, leading to a noteworthy reduction in the detrimental effects of Cr stress. Notably, the Cr (0.5 mM) stress more adversely affected the shoot length more than 0.3mM of Cr stress. Cr stress (0.5 mM) significantly reduced the shoot length by 12.4% in FH-1046 and 24.5% in FH-1453 while Trehalose increased shoot length by 30.19% and 4.75% in FH-1046 and FH-1453 respectively. Cr stress significantly constrained growth and biochemical processes, whereas trehalose notably improved plant growth by reducing Cr uptake and minimizing oxidative stress caused by Cr. This reduction in oxidative stress was evidenced by decreased production of proline, SOD, POD, MDA, H2O2, catalase, and APX. Trehalose also enhanced photosynthetic activities under Cr stress, as indicated by increased values of chlorophyll a, b, and carotenoids. Furthermore, the ameliorative potential of trehalose was demonstrated by increased contents of proteins and carbohydrates and a decrease in Cr uptake. Conclusions The study demonstrates that trehalose application substantially improved growth and enhanced photosynthetic activities in both maize varieties. Trehalose (30 mM) significantly increased the plant biomass, reduced ROS production and enhanced resilience to Cr stress even at 0.5 mM.

Abstract Background Cockroaches can pose a significant health risk in hospital environments because they may serve as reservoirs and vectors for nosocomial pathogens. Cockroaches harbor epidemiologically significant extended spectrum and metalo beta lactamase producing Gram negative bacterial pathogens, which complicate nosocomial infections. Objectives The main aim of this study is to determine aetiology and phenotypic extended spectrum and metalo beta lactamase producing Gram negative bacteria pathogens from cockroaches collected in hospitals. Methods A cross-sectional study was employed from February to May 2022 to determine the antibiotic resistance producing bacterial isolates from cockroaches by giving special emphasis to metalo beta lactamase and extended spectrum beta lactamase production from different wards of WSUCSH. Cockroaches were collected with hands wearing sterile gloves. External homogenate was prepared and incubated microbiologically by using different culture media and differentiated biochemically. Antimicrobial susceptibility testing was performed by disk diffusion method. ESBL production was conducted using double disc synergy method and double disk method was used to detect MBL enzyme detection. Descriptive statistics was used to determine prevalence and percentage. Result Out of 245 cockroaches, 108 Gram negative bacteria were isolated. K. pneumoniae 29(26.9%) was the most predominant bacteria and Enetrobacter spp. 8(7.4%), was the least. All, K. pneumoniae, P. mirabilis, and Enterobacter isolates were pan-resistant to Ampicillin. P.aeruginosa and P.mirabilis antibiotics showed ≥ 80% resistant for amoxicillin/clavulanic acid antibiotics. Cefotaxime, ceftazidime, ceftriaxone and imipenem showed relative efficacy compared with other antibiotics. Out of 78 amoxicillin-clavulanic acid resistant isolates, 42(34.7%) were ESBL producers. ESBL production is more depicted by P. aeruginosa, A. baumannii, K. pneumoniae and E. coli. The overall prevalence of MBL production is 29(23.1%). K. pneumoniae P. aeruginosa, E.coli, A. baumannii, Enterobacter spp and K.oxytoca revealed MBL production. Conclusion The overall prevalence of ESBL and MBL producing nosocomial agents from hospital cockroaches was 34.7% and 23.1% respectively. P.aeruginosa, A.baumannii, K.pneumoniae and E.coli showed pronounced ESBL production. All bacterial isolates except P. mirabilis and C. freundii showed MBL production. The needed to evaluate our antibiotic stewardship program and antibiotic resistance detection for treatment is mandatory. The impact of cockroach as a source of AMR should be sought.

Student engagement needs to be context-specific to embrace holistic learning for increasingly diverse students in higher education. This paper presented a case study on the context-specific adaptation of a student engagement measure for a private university in Bangladesh. The adaptation process involved steps such as benchmarking theoretically sound student engagement measures, drawing on the opinions of academic experts, and statistical model fit analysis. A 34-item adapted Measure of Student Engagement in Higher Education (MSEHE) was tested with 953 undergraduate and postgraduate students from two disciplines. This process expanded the original five-component student engagement measure with new insights such as students engaging with integration of ideas from real-life problems. The MSEHE had acceptable internal consistency (Cronbach’s standardised alpha = 0.61 to 0.91) and model fit (RMSEA = 0.048, CFI = 0.933, NNFI = 0.923). All domains of student engagement in the MSEHE were positively and significantly correlated. Hierarchical regression analysis confirmed that the three domains of the MSEHE (i.e. cognitive, affective, and social engagement with teachers) can also predict student satisfaction. A systematic process of context-specific adaptation is critical for a pragmatic student engagement measure capable of directing the university toward achieving long-term goals such as implementing outcome-based education and having employable graduates.

Plant growth regulators (PGR’s) are considered potential substances which lessen the abiotic stresses and help in delaying the pre-mature fruit drop (PFD). Therefore, a two-year (2021 and 2022) multi-locational study was designed to assess the effects of three different PGR’s (NAA, 2, 4-D, GA3) on PFD and postharvest quality of selected apple varieties (‘Kashmir Amri’, ‘Red Delicious’, ‘Star Crimson’) grown at three different locations (Bagh, Dheerkot, Rawalakot) of Azad Jammu and Kashmir (AJK). All PGR’s were applied through foliar spray using a low pressure hand sprayer before the flowering period at the same concentration (25 ppm), while apple trees without any treatment application served as control. Apple trees sprayed with 25 ppm GA3 showed 44.56% less PFD at Dheerkot location as compared to control. Moreover, 25 ppm GA3 treated fruits showed better fruit size, fruit weight, and overall yield as well. In terms of postharvest quality parameters, a significantly high amount of strife index (5.60%), titratable acidity (2.58%), total soluble solids (13.81%), crude fiber (1.44%), total ash content (0.51%), total phenolics (136.3 mg GAE/100g FW), total flavonoids (14.83 mg/100g FW) and antioxidant activity (97.0 µg/100g FW) was found in apple trees sprayed with 25 ppm GA3 as compared with other treatments. Among apple varieties, ‘Star Crimson’ while among locations, Dheerkot showed promising results. Thus, the overall results of this study revealed that PFD could be potentially minimized and postharvest quality could be enhanced with 25 ppm GA3 spray, while Dheerkot is the most suitable location for growing apples.

Abstract Background Early blight (EB) of Tomatoes, caused by Alternaria solani, is a serious fungal disease that adversely affects tomato production. Infection is characterized by dark lesions on leaves, stems, and fruits. Several agrochemicals can be used to control infection, these chemicals may disrupt environmental equilibrium. An alternative technology is needed to address this significant fungal threat. This study was designed to control the growth of EB in tomatoes caused by A. solani, using green-fabricated silver nanoparticles (Ag-NPs). Results Ag-NPs were synthesized through an environmentally friendly and cost-effective approach using leaf extract of Quercus incana Roxb. (Fagaceae). The physico-chemical characterization of the Ag-NPs was conducted through UV-visible spectroscopy, scanning electron microscopy, X-ray diffraction analysis, and Fourier transform infrared spectrometry. The Ag-NPs produced were round with a mean diameter of 27 nm. The antifungal activity of these Ag-NPs was assessed through in vitro Petri plate and in vitro leaflet assays against A. solani. The green fabricated Ag-NPs exhibited excellent antifungal activity in vitro at a concentration of 100 mg/l against A. solani, inhibiting growth by 98.27 ± 1.58% and 92.79 ± 1.33% during Petri plate and leaflet assays, respectively. Conclusion In conclusion, this study suggests the practical application of green-fabricated Ag-NPs from Q. incana leaf extract against A. solani to effectively control EB disease in tomatoes.

Background. Lower Respiratory Tract Infections (LRTI) impose a huge problem on society due to their tenacious and unescapable health problems, and they were the reasons for consultation and hospitalization. Patients with LRTI were present with a wide spectrum of diseases that range from life-threatening infections to minor self-limiting illnesses. Materials and methods. Sputum samples from 310 patients with complaints of lower respiratory tract infections were collected and analyzed. After microscopic analysis, 30 were excluded from the study. Of the 280 that were included in the study, 171 were males and 109 were females. The age group between 56 and 65 years comprised the highest number of patients in the study. Different antibiotics were used to check antibiotic sensitivity patterns against isolated Gram-positive and negative bacteria. Results. Of the 280 samples processed, 122 (43.5%) were culture-positive. Among the 122 bacterial isolates, the predominant organism was Klebsiella pneumoniae 55 (45%). The most common predisposing factor identified in 115 (37%) patients was smoking. Using the Double Disk Synergy Test, 11 (20%) out of a total of 55 K. pneumoniae isolates and 4 (30.7%) out of 13 Pseudomonas isolates showed Extended Spectrum Beta Lactamases (ESBL). The Klebsiella and Pseudomonas isolates showed resistance to 2nd and 3rd generation Cephalosporins. Conclusion. Because of different geographical regions and conditions, the etiology and the antibiotic sensitivity patterns of LRTI vary, so the etiology, predisposing factors, and the antibiotic sensitivity pattern of LRTI need to be updated regularly. The diagnostic facilities for early and rapid identification of LRTI also need to be improved.

While the occupation of a train driver can be likened to other transportation professions like truck or bus drivers, it is essential to note that there are distinct hazards exclusive to this role that have a notable impact on the mental and physical well-being of train drivers. The study aims to define personal characteristics, work organisation and work characteristics, professional development and work in general in connection with risk factors among employees who perform the work tasks of train drivers in railway transport.

The present study conceptualizes and simulates a methanol production process through the direct hydrogenation of captured CO2. CuO/ZnO/ZrO2 was employed as the catalyst and Aspen HYSYS was used for the process simulation. Configurational optimization of the process flowsheet was carried out using a step-by-step hierarchical approach. Many alternate flowsheets have resulted, and their capital investment, product cost, and profitability measures were calculated. The discrimination among the competing flowsheets was carried out based on net profit and percent return on investment. The retained flowsheet was further analyzed for optimizing the recycle ratio and evaluating the effect of the price of captured CO2, green H2, natural gas (fuel), and catalyst on the economic performance of the plant. The optimum value of the recycle ratio was computed to be 4.23. Additionally, it was found that the price of H2 is the most important parameter in defining the feasibility and profitability of the process. Mathematical correlations were also developed that relate the profitability and price of the above-mentioned feed materials.

Abstract Background Recently, researchers are focusing on creating new tools to combat the antibiotic resistant bacteria and malignancy issues, which pose significant threats to humanity. Biosynthesized silver nanoparticles (AgNPs) are thought to be a potential solution to these issues. The biosynthesis method, known for its environmentally friendly and cost-effective characteristics, can produce small-sized AgNPs with antimicrobial and anticancer properties. In this study, AgNPs were bio-fabricated from the distilled water and methanolic extracts of Viburnum grandiflorum leaves. Physio-chemical characterization of the bio-fabricated AgNPs was conducted using UV-visible spectroscopy, scanning electron microscopy, energy dispersive X-ray, and X-ray diffraction analysis. Results AgNPs produced from the methanol extract were smaller in size (12.28 nm) compared to those from the aqueous extract (17.77 nm). The bioengineered AgNPs exhibited a circular shape with a crystalline nature. These biosynthesized AgNPs demonstrated excellent bactericidal activity against both gram-negative (Pseudomonas aeruginosa) and gram-positive (Staphylococcus aureus) bacteria. Highest antibacterial activity was observed with the methanol extract against P. aeruginosa (14.66 ± 0.74 mm). AgNPs from the methanol extract also displayed the highest antioxidant activity, with an IC50 value of 188.00 ± 2.67 μg/mL against 2,2-diphenyl-1-picrylhydrazyl (DPPH). Furthermore, AgNPs exhibited notable cytotoxic activity against Rhabdomyosarcoma cell line (RD cell) of human muscle cancer cell. The IC50 values calculated from the MTT assay were 26.28 ± 1.58 and 21.49 ± 1.44 μg/mL for AgNPs synthesized from aqueous and methanol extracts, respectively. Conclusion The methanol extract of V. grandiflorum leaves demonstrates significant potential for synthesizing AgNPs with effective antibacterial, antioxidant, and anticancer actions, making them applicable in various biomedical applications.

Introduction: This investigation assessed the clinical characteristics of patients who received care through telemedicine and the clinical impact telemedicine service had on breast cancer patients in a low-income country. Materials and Methods: This natural experimental study assessed the impact of telemedicine service on cancer outcomes among breast cancer patients at Shaukat Khanum Memorial Trust (SKMT), Pakistan, between January 1st, 2018, to December 31st, 2022. The study group (hybrid group) consisted of patients that had both face-to-face and telemedicine appointments, and the control group (physical group) included patients with only face-to-face encounters. Results: A total of 3,205 patients were included in the analysis. Among those included in the analysis, 3,188 (99.5 %) were females, and the mean age of the cohort was 48.10 ± 11.94 years. Statistically significant differences were observed between the two groups in age, demographic distribution, disease stage, average number of emergency room visits, mean length of stay in the Intensive care unit, and the final patient status (alive at the end of observation period). However, the binary logistic regression model (forward-LR) suggested that the final patient outcome was related to disease relapse, COVID-19 infection, and age. Conclusion: Telemedicine clinics, when conducted in parallel with physical clinics (hybrid setup), are safe and have a clinical impact similar to having just physical encounters among breast cancer patients in a low-income country.

Abstract The removal of toxic dye pigments from the environment is of utmost importance since even trace amounts of these pollutants can lead to harmful impacts on ecosystems. Heterogeneous photocatalysis is a potential technique for eliminating microbiological, inorganic, and organic pollutants from wastewater. Here, we report the band gap alteration of ZnO by making its composites with CuSe to enhance photocatalytic activity. The purpose is to develop metal oxide nanocomposites (ZnO/CuSe) as an effective and efficient material for the photodegradation of methyl blue. The photocatalysts, ZnO nanorods, CuSe, and ZnO/CuSe nanocomposites of different weight ratios were synthesized by the simple and cost-effective technique of precipitation. UV–Vis spectra verified that the ZnO/CuSe photocatalyst improved absorption in the visible region. The optical bandgap of ZnO/CuSe nanocomposites reduced from 3.37 to 2.68 eV when CuSe concentration increased from 10 to 50%. ZnO/CuSe composites demonstrated better photocatalytic activity than ZnO when exposed to UV–visible light. The pure ZnO nanorods could absorb UV light and the nanocomposites could absorb visible light only; this was attributed to the transfer of excited high-energy electrons from ZnO to CuSe.