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Abstract Background Differentiation between isolated hypogonadotropic hypogonadism (IHH) and constitutional delay in puberty (CDP) throughout adolescence can be challenging for doctors. This study examines the withdrawal effects of short-term, low-dose testosterone treatment (testosterone priming) on the ability of dynamic testing to distinguish between CDP and IHH based on activation of the hypothalamo-pituitary–testicular axis. Methods A case–control study included 20 boys with delayed puberty (group A) and 20 patients with IHH (group B). Both groups underwent Triptorelin and human chorionic gonadotropin (hCG) stimulation tests before and 2 months after testosterone injections (100 mg) intramuscularly every 4 weekly for 3 months. Results The triptorelin-stimulated 4-h LH with a cutoff of 2.4 IU/L and the hCG-stimulated testosterone with a cutoff of 1.160 ng/mL had sensitivities of 65% each, and specificities of 90% and 95%, respectively, to diagnose CDP. After testosterone withdrawal, the cut-off values for 4-h LH were 8.850 IU/L and 3.190 ng/mL for hCG-stimulated testosterone. Basal inhibin B > 88.25 pg/ml was found to be a differentiating factor in diagnosing CDP after testosterone withdrawal. Conclusions following the withdrawal of testosterone therapy, Inhibin B levels or 4-h stimulated LH are the most effective discriminant assays to distinguish CDP from IHH.

Abstract Little is known about how the epigenomic states change during development and evolution in a 3D genome context. Here we use Drosophila pseudoobscura with complex turnover of sex chromosomes as a model to address this, by collecting massive epigenomic and Hi-C data from five developmental stages and three adult tissues. We reveal that over 60% of the genes and transposable elements (TE) exhibit at least one developmental transition of chromatin state. Transitions on specific but not housekeeping enhancers are associated with specific chromatin loops and topologically associated domain borders (TABs). While evolutionarily young TEs are generally silenced, old TEs more often have been domesticated as interacting TABs or specific enhancers. But on the recently evolved X chromosome, young TEs are instead often active and recruited as TABs, due to acquisition of dosage compensation. Overall we characterize how Drosophila epigenomic landscapes change during development and in response to chromosome evolution, and highlight the important roles of TEs in genome organization and regulation.

Abstract Introduction Nirmatrelvir/ritonavir (NMV/r) is approved in the United States (US) and more than 70 other countries for the treatment of mild to moderate COVID-19 in nonhospitalized adults at high risk for severe disease. Because ritonavir inhibits several drug metabolizing enzymes, potential drug–drug interactions (DDIs) between ritonavir and concomitant medications are an important consideration for prescribers. Here, we conducted a real-world analysis of data from Pfizer’s global safety database regarding adverse events (AEs) reported during use of NMV/r concomitantly with potentially interacting drugs. Methods Data were extracted regarding DDI cases occurring from the start of NMV/r authorization through October 31, 2023. Results regarding concomitant treatment, specific AEs, and clinical outcomes are summarized. Overall NMV/r exposure was estimated based on packs of medication dispensed and was used to calculate reporting rates. Results Among 19,617,670 patients exposed globally to NMV/r, 966 cases of potential DDIs were reported. Of these, 594 occurred in the US against an estimated US exposure of 14,646,990 patients, representing a reporting rate of 0.004%. Globally and in the United States, 66.8% and 77.3% of cases, respectively, were nonserious. Simvastatin and tacrolimus were the most frequently reported drugs associated with potential DDIs, and the most frequently reported AE regarding a specific event or symptom was dysgeusia (altered sense of taste), an AE known to be associated with NMV/r. Conclusions Low reporting rates of DDIs support the potential for NMV/r treatment to be safely managed with careful use of available drug interaction resources to aid in risk mitigation.

BACKGROUND: Maximum oxygen consumption (VO2max), an essential indicator of integrated function of the cardiovascular, respiratory, and muscular systems, is an excellent predictor of all-cause morbidity and mortality. Direct measurement is a sophisticated procedure which for some individuals is difficult to perform. The use of international formulae leads to overestimation or underestimation of values. Therefore, the present study aimed to generate a best-fit VO2max prediction formula for young Saudi females. MATERIALS AND METHODS: One hundred and two randomly selected young healthy Saudi females (19–25 years) with normal body mass index (18.5–24.99 kg m−2) and sedentary lifestyle underwent maximum cardiopulmonary exercise testing on cycle ergometer when using breath-by-breath analyzing system. Hemodynamic and ventilatory parameters were assessed before and during the maximum exercise. Significantly correlated exercise and nonexercise parameters enterd in multiple linear regression analysis to find the best-fit model, and used to generate a VO2max prediction formula. RESULTS: The mean measured VO2max was 1449.1 ± 233.92 ml min−1. The VO2max prediction formula was 1304.193 ± 17.902 × body weight + 43.857 × time until exhaustion − 6.83 × maximum heart rate. The mean calculated VO2max was 1449.14 ± 143.97 ml min−1. No statistically significant difference was observed between the measured and calculated VO2max. The Bland–Altman test for the limit of agreement was performed and showed good agreement between the two values with a minute proportional bias. The standard error of the estimate was 156.34, which is approximately 10.6% of the mean measured VO2max. Reliability analysis yielded a Cronbach’s alpha of 0.709. CONCLUSION: This study presents a reliable and valid VO2max prediction formula for young Saudi females. This nationally generated formula is far more representative of the VO2max value than international formulae. We recommend the implementation of this formula and an investigation of its validity in other Saudi population groups.

Abstract Background Adolescence is commonly perceived as a distinct and typically healthy stage of life. However, in regions with a high prevalence of HIV, like Ethiopia, numerous adolescents are contracting the virus. Upon testing and diagnosis, they encounter care-related issues, particularly barriers and facilitators of the healthcare transition from adolescent to adult clinics. Hence, the study aimed to investigate the barriers and facilitators influencing the transition of adolescents living with HIV (ALWHs) in the resource-limited settings of Southern Ethiopia. Methods The research employed a phenomenological study design with a qualitative methodology. Purposive sampling was used to gather data through in-depth interviews (IDIs) and focus group discussions (FDGs) involving ALWHs and their parents. The data analysis followed Van Manen’s principles. Results Following Van Manen’s guidelines, the data analysis revealed a conceptual framework with two major themes: “Barriers” and “Facilitators”. The theme barrier was derived from three sub-themes including behavioral barriers, social barriers, and system barriers in the transition. The theme facilitator was derived from four sub-themes including self-acceptance as an adult, a desire to experience new things, a supportive family, and friendly healthcare services. The study identified three levels of factors influencing the transition into adult clinics: individual, family/peer, and healthcare-related factors. The barriers to transition included lack of knowledge, being in a romantic relationship, psychosocial struggles, perceiving us as immature, stigma, negative peer pressure, lack of timely disclosure, absence of transition guidelines, disrespectful treatment, and absence of separate clinics. On the other hand, facilitators such as self-acceptance as an adult, desire for new experiences, family support, informed support and promising outcomes, flexible appointment scheduling, and psycho-social support groups were found to improve the transition process and enhance the overall well-being of adolescents living with HIV. Conclusion The study highlights the complex transition process for ALWHs into adult healthcare. Barriers such as lack of knowledge, stigma, and disrespectful treatment pose challenges during this critical period. Conversely, facilitators like self-acceptance, family support, and youth-friendly healthcare services can enhance the transition experience and well-being of ALWHs. Collaborative efforts among ALWHs, families, and healthcare providers are crucial for successful transitions and improved health outcomes. Separated clinics catering to the unique needs of ALWHs are recommended to address privacy concerns.

Abstract Background Human immunodeficiency virus (HIV), a viral infection impacting CD4 cells, requires an understanding of factors influencing CD4 cell counts to reduce acquired immunodeficiency syndrome(AIDS)-related morbidity and mortality. Despite its importance, no studies have examined predictors of CD4 cell count progression post-transition to adult-oriented HIV care in Ethiopia. This study aimed to identify predictors affecting CD4 cell count trends among adolescents and young adults transitioning to adult-oriented HIV care. Therefore, this study aimed to identify the predictors that affect the trends of CD4 cell count over time among adolescents and young adults who transitioned to adult-oriented HIV care. Methods A retrospective cohort study was conducted among 206 adolescents and young adults who transitioned to adult-oriented HIV care and had at least two CD4 cell counts in eight selected health facilities in Southern Ethiopia. These facilities were chosen due to their high volume of people living with HIV. A multivariable linear mixed effect model was fitted to identify the predictors of CD4 cell count progression through time. Multi-collinearity between variables was checked using the variance inflation factor. Model comparisons were done using Akaike and Bayesian information criteria. Regression coefficients with 95% confidence intervals (CI) and P-value ≤ 0.05 were used to measure the strength of association and significance level. Results The average CD4 cell count was raised by 6.7 cells/mm3 every six months among the study participants. Transitioning at the age of 18 or older (β = 204.71; 95% CI = 81.86347, 327.5574; P

Tadalafil (TDA) is a class II drug of the biopharmaceuticals classification system (BCS), with limited aqueous solubility and high permeability. This study aims to improve the bioavailability of poorly soluble tadalafil by developing intranasal nanocrystals (NCs) of TDA. TDA NCs that were stabilised by polyvinyl alcohol (PVA) had the lowest size and the best solubility. F11 had a 196 nm in size with PDI and zeta potential of 0.21 and -11.20, respectively, which shows 5.5 and 1.6-fold higher in solubility (9.37 ± 0.36 μg/mL) and dissolution (50.11 ± 1.69%) than pure tadalafil, respectively. An in vivo animal study demonstrated that the maximum plasma concentration (Cmax) and total area under the curve (AUC0∞) achieved in the TDA NCs group were 352.77 ± 35.17 ng/mL and 3377 ± 558 ng.h/mL, respectively, and were significantly higher than the pure TDA group after intranasal administration. In conclusion, TDA NCs were successfully prepared by the sonoprecipitation technique, with significant enhancement in in vitro and in vivo properties. Therefore, intranasal administration of TDA nanocrystals was a good model for the treatment of erectile dysfunction.

Abstract Objectives To determine predictors of successful ictal single photon emission computed tomography (SPECT) injections during Epilepsy Monitoring Unit (EMU) admissions for patients undergoing presurgical evaluation for drug‐resistant focal epilepsy. Methods In this retrospective study, consecutive EMU admissions were analyzed at a single center between 2019 and 2021. All seizures that occurred during the admission were reviewed. “Injectable seizures” occurred during hours when the radiotracer was available. EMU‐level data were analyzed to identify factors predictive of an EMU admission with a successful SPECT injection (successful admission). Seizure‐level data were analyzed to identify factors predictive of an injectable seizure receiving a SPECT injection during the ictal phase (successful injection). A multivariate generalized linear model was used to identify predictive variables. Results 125 EMU admissions involving 103 patients (median 37 years, IQR 27.0–45.5) were analyzed. 38.8% of seizures that were eligible for SPECT (n = 134) were successfully injected; this represented 17.4% of all seizures (n = 298) that occurred during admission. Unsuccessful admissions were most commonly due to a lack of seizures during EMU‐SPECT (19.3%) or no injectable seizures (62.3%). Successful EMU‐SPECT was associated with baseline seizure frequency >1 per week (95% CI 2.1–3.0, P 1 per week, a PET hypometabolic focus, and a patient's ability to indicate seizure onset were identified as predictors of success. These findings may assist EMUs in optimizing their SPECT protocols, patient selection, and resource allocation.

Abstract Cyanobacteria, being a prominent category of phototrophic organism, exhibit substantial potential as a valuable source of bioactive compounds and phytonutrients, including liposomes, amino derivatives, proteins, and carotenoids. In this investigation, a polyphasic approach was employed to isolate and characterize a newly discovered cyanobacterial strain from a rice field in the Garh Moor district of Jhang. Desertifilum sp. TN-15, a unique and less explored cyanobacterial strain, holds significant promise as a novel candidate for the synthesis of nanoparticles. This noticeable research gap underscores the novelty and untapped potential of Desertifilum sp. TN-15 in the field of nanomedicine. The characterization of the biogenically synthesized ZnO–NPs involved the application of diverse analytical techniques. Ultraviolet–visible spectroscopy revealed a surface plasmon resonance peak at 298 nm. Fourier transform infrared spectral analysis was utilized to confirm the involvement of biomolecules in the biogenic synthesis and stability. Scanning electron microscopy was employed to probe the surface morphology of the biogenic ZnO–NPs unveiling their size of 94.80 nm and star-shaped. Furthermore, X-ray diffraction analysis substantiated the crystalline nature of ZnO–NPs, with a crystalline size measuring 46 nm. To assess the physical stability of ZnO–NPs, zeta potential and dynamic light scattering measurements were conducted, yielding values of + 31.6 mV, and 94.80 nm, respectively, indicative of favorable stability. The antibacterial capabilities of Desertifilum sp. TN-15 are attributed to its abundance of bioactive components, including proteins, liposomes, amino derivatives, and carotenoids. Through the synthesis of zinc oxide nanoparticles (ZnO–NPs) with this strain, we have effectively used these chemicals to generate nanoparticles that exhibit noteworthy antibacterial activity against Staphylococcus aureus (MIC: 30.05 ± 0.003 µg/ml). Additionally, the ZnO–NPs displayed potent antifungal activity and antioxidant properties, as well as significant antihemolytic effects on red blood cells (IC50: 4.8 µg/ml). Cytotoxicity assessment using brine shrimps revealed an IC50 value of 3.1 µg/ml. The multifaceted actions of the biogenically synthesized ZnO–NPs underscore their potential applications in pharmacological and therapeutic fields. This study proposes a novel method for ZnO–NPs production utilizing the recently identified cyanobacterial strain Desertifilum sp. TN-15, highlighting the growing significance of biological systems in the environmentally friendly fabrication of metallic oxide nanomaterials.

Developing novel antibiotics, traditional pharmaceuticals, and chemically altered drugs addresses medical concerns and underscores the need for sustained and productive implementation of metallic nanotechnology across various domains. Nanoparticles (NPs) present a range of advantages over bulk particles due to their targeting capabilities, wound repair characteristics, capacity for biocomposite preparation, and potential as a gene and drug delivery system. Silver nanoparticles (AgNPs) have garnered significant interest among researchers as a result of their exceptional conductivity, chemical stability, catalytic behavior, and antimicrobial properties compared with other metal NPs. This study aims to provide a basic understanding of AgNPs and their functions in biomedical research.

To reduce the addition of chemical fertilizer to agricultural soils, this research has been conducted to assess the impact of three types pre-decomposed organic manures (chicken, sheep, and alfalfa green manure) on productivity of wheat plant (Triticum aestivum L.). after composting process of selected manures, the pot experiment was conducted to study the effect of inoculated and decomposed manures at three rates (0.5%,1%,2% w/w) on wheat growth. Essential growth parameters such as number of seeds and spikes, weight and protein of seeds, length of shoot and root, Concentration of N, P and K in wheat plant under the effect of local manures were studied. The results shows that chicken manure at rate of 2% had greatest result in weight and number (25.96g ,683.33) of seeds also protein percent (16.72) compare to other treatments, while sheep manure at rate of 2% recorded high result in number of spikes parameter. Number, weight of seeds and root length gets low result (101.00cm ,3.84cm ,25.73cm) with adding 0.5% alfalfa green manure. Also, Number of spikes, seed protein and shoot length gets low result (2.93 ,12.69 ,81.40) with 0.5%sheep manure. The growth parameter of length of shoot and root reveled maximum (101.06cm, 50.06cm) with chicken manure2% and minimum (81.40cm, 25.73cm) with sheep manure0.5% and alfalfa green manure0.5% respectively. Macro nutrients of N and K gets high value (3.89%, 2.90%) in chicken treatments2% respectively and P gets high amount (0.90%) in alfalfa green manure2%. Lowest result of N, P and K (2.24%, 0.14%, 2.23%) recorded at 0.5% rate in alfalfa green manure and chicken manure respectively. The study tells that decomposed chicken manure2% generally have great effect on growth and yield of wheat plant compare to other manures and rates.

OBJECTIVE: To find out the association of primary ovarian carcinomas (POC) and metastatic gastrointestinal carcinoma (MGC) by utilizing a panel of antibodies including Cytokeratin (CK) 7, CK20, Caudal-type Homeobox Transcription Factor-2 (CDX2), and SATB2 with their clinicopathological parameters. METHODS: This prospective cross-sectional study was conducted from Mar, 2023 to Dec 2023 at Dow University of Health Sciences, Karachi, Pakistan. Biopsy tissue specimens from female patients over the 40 years, diagnosed with primary and metastatic ovarian carcinomas (MOC), were included. Immunohistochemistry, employing a three-tier scoring system, assessed CK7, CK20, CDX2, and SATB2 expressions. Statistical analysis was performed, utilized SPSS version 26.0 by employing Chi-Square test. RESULTS: Over a 9-month period, 100 biopsied tissue samples were collected from patients aged 42-71 years (mean age 53.24 ± 8.03 years). Among these, 79 were POC (51% serous carcinoma, 9% mucinous carcinoma, 18% endometrioid carcinoma, and 1% clear cell carcinoma), and 21 were MGC. CK7 showed diffuse staining predominantly in POC and was absent in MGC (p < 0.001). CK20 exhibited significant focal and diffuse staining in MGC and was largely absent in POC (p = 0.005). CDX2 was significantly absent in POC and showed diffuse and focal staining in MGC (p < 0.001). SATB2 was absent in POC and displayed focal or diffuse staining in MGC (p < 0.001). CONCLUSION: The inclusion of SATB2 in immunohistochemical panels, alongside CK7, CK20, and CDX2, improves the accuracy of diagnosing primary and metastatic ovarian carcinomas. This approach provides support in the distinction between ovarian and gastrointestinal tumors.

Purpose: The purpose of this study was to document secondary polycythemia (SP)-associated retinal changes and the favorable role of phlebotomy in the treatment of SP-induced retinal complications. Design: This was a retrospective, observational, noncomparative case series. Participants: A total of 8 eyes of 4 male patients with an age range of 28–78 years were studied. MATERIALS AND METHODS: A total of 04 consecutive patients were received over a year on an outpatient basis at a single tertiary care center, with only vision-related complaints. After documentation of ocular findings, all the patients were subjected to meticulous clinical and laboratory evaluation to determine the cause of ocular conditions. Patients were subjected to the treatment for underlying pathological conditions based on the outcomes of their clinical and laboratory evaluation. Main Outcome Measures: Determination of Janus kinase 2 (JAK2) mutation-negative SP as a cause of associated retinal complications and favorable role of phlebotomy as a treatment measure. Results: All the patients were adult, nonsmoker, and nonalcoholic males. A total of 05 eyes were diagnosed with proliferative vitreoretinopathy while 2 eyes had retinal venous occlusion. One eye was normal. Except SP, no other cause for retinal lesions could be ascertained in all patients. Three patients underwent phlebotomy as decided by the hematologists. Each patient was followed monthly for 6 months. All the patients showed resolution of retinal lesions at the end of follow-up. Conclusion: Nonpolycythemia vera (PV) erythrocytosis or unmutated JAK2 SP is still a very poorly studied entity. Almost no information is available regarding ocular involvement and its treatment in SP. Our observations suggest that SP may run a chronic course causing serious retinal damage such as other myeloproliferative disorders or PV and that phlebotomy has an important role in the management of such cases.

Background: Serum vitamin B12 plays a crucial role in cellular growth, DNA synthesis, and maintaining a healthy nervous system. Its deficiency can lead to various health issues, including cardiovascular problems. The reference range for vitamin B12 varies between populations due to cultural, genetic, and dietary differences. Methods: A cross-sectional study was conducted on 127 healthy An-Najah National University students aged between 18 and 25. Blood samples were collected, and a questionnaire assessed factors affecting vitamin B12 levels. Serum vitamin B12 levels were measured using ACCUBIND ELIZA microwells. Results: The study found a reference range for serum vitamin B12 of 136–640 pg/mL (5th to 95th percentile) among the studied population, which differed from the manufacturer’s claimed range of 200–835 pg/mL. Gender did not significantly affect the reference intervals. Conclusion: The study highlights the importance of establishing local reference values for laboratory tests like vitamin B12 due to variations in demographics. Further research in different Palestinian regions and age groups with larger sample sizes is recommended to refine these reference values.

Abstract Background Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic. Methods This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants’ response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates. Results A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017). Conclusions This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study’s findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics. Trial registration Clinicaltrials.gov, NCT04352634.

Abstract Objective Individuals who serve as peer mentors within Canadian spinal cord injury (SCI) community service organizations are reporting compassion fatigue from their roles. One psychological resource that has the potential to reduce compassion fatigue and promote overall mental health among peer mentors is self-compassion. However, there is limited knowledge of any self-compassion programs that have been tailored to address the needs of these individuals. To address this limitation, this paper outlines a protocol to examine the feasibility, acceptability, implementation, and effectiveness of a tailored self-compassion program to reduce compassion fatigue and enhance compassion satisfaction, self-compassion, and mental health among peer mentors within Canadian SCI community service organizations. Design The 6-week online program will be tested among 20 individuals (five separate groups of four) who serve as peer mentors within two Canadian SCI community service organizations. Method Feasibility and implementation data will be collected throughout the duration of the program and post program while acceptability data will be collected post program. To evaluate the effectiveness of the program, we will follow a single-group quasi-experimental design with surveys (pre/post/follow-up) and semi-structured interviews (post/follow-up). Results Results from this study are intended to inform the design of a self-compassion program for peer mentors within Canadian SCI community service organizations who experience compassion fatigue and reduced mental health. Conclusion Providing evidence for the effectiveness of this program could prove useful for Canadian SCI community service organizations who wish to better support and retain their peer mentors and thus improve the quality of support they provide to mentees.

This study investigates the impact of foreign direct investment (FDI) on bank stability in the Gulf Cooperation Council (GCC) region, differentiating between Islamic and conventional banks. The results reveal a negative relationship between FDI and bank stability, and Islamic banks can mitigate this impact, enhancing overall stability. Notably, during recent crises (the global financial crisis (GFC) and the COVID-19 pandemic (COVID-19)), FDI's effect on bank stability intensified, and the GFC had a stronger influence than COVID-19. Islamic banks were more resilient to FDI during these crises, highlighting their pivotal role in strengthening the banking system across the member countries in the GCC. The study offers critical insights for regulators, policy makers, and risk managers, advising cautious supervision over FDI in order to preserve monetary and financial stability.

Paratesticular inflammatory pseudotumor is a rare entity that poses significant challenges in diagnosis and treatment due to its clinical and radiological appearance, which can mimic malignancy. We report the case of a 52-year-old male who presented with a painful mass in the left testicle. A few weeks later, the patient developed backache and leg stiffness. A left radical orchiectomy was performed, and postoperative biopsy results were obtained. Histopathological examination is crucial for definitive diagnosis, and early recognition along with appropriate surgical intervention is essential for effectively managing these benign tumors. This case contributes to the expanding literature on the unique disease entity.

ABSTRACTWater scarcity is growing quickly, especially in the arid and semi-arid regions along with the growing population. So, using treated wastewater in agricultural irrigation presents a sustainable approach, enhancing soil quality, increasing organic carbon levels, and improving crop productivity are achieved through this approach, concurrently reducing the need for chemical fertilizers. Yet, escalating industrial effluent discharge raises concerns regarding trace metals in wastewater and associated health risks. Our study in the Tenth of Ramadan City focused on employing secondary treated mixed industrial and municipal wastewater for olives, mandarins, and guavas. Sampling wastewater, soil, and plant parts, we analyzed their properties and trace element concentrations, employing Visual MINTEQ for geochemical speciation. Adhering to the international guidelines, the wastewater exhibited acceptable pH and alkalinity but showed concerning trace element levels for irrigation. Differences in soil composition and trace element concentrations suggest potential contamination in soils irrigated with wastewater, raising concerns about health risks associated with elevated metal levels in plants. Variations in trace element concentrations in guavas, olives, and mandarins’ leaves and fruits were observed, with efficient translocation in olives, while mandarin and guava displayed reduced efficiency. Bioaccumulation Factor trends indicated species-specific metal uptake differences. Waste “Minimization Prioritization Tool categorized” trace element levels as of low concern. Daily Intake of Trace Metals and Health Risk Index highlighted the need for health risk assessment, especially for elevated Ni in mandarins and guavas. Regression findings emphasized soil factors influencing metal uptake in plants, highlighting the need for vigilant soil management to curb trace element contamination in agriculture, ensuring both food safety and environmental health. Therefore, water reuse adds contributes to sustainable development, which is three dimensions; Economic, Social and Environmental. It improves economics to utilize water that would be otherwise wasted, and by making water more productive. It improves the social dimension by addressing water scarcity and satisfying the increasing water demand for sustainable livelihoods. It also improves the environment by increasing wastewater treatment levels and reducing pollution.

Introduction Widespread use of effective and safe vaccines is the most promising method to contain the COVID-19 pandemic. This study aimed to assess the acceptance level of COVID-19 vaccination among the general population in six Middle East countries (Egypt, Jordan, Palestine, Tunisia, Sudan, and Yemen) as well as to assess factors associated with acceptance or refusal of vaccination.Methods A cross-sectional multinational study was conducted during the period from May 20 to August 8 2021. A web-based, self-administered, Google form Arabic questionnaire was used after a pilot study using 30 participants.Results The COVID-19 vaccine acceptance rate was 62.9%. The highest rate was reported among Tunisians (70%), while the lowest rate was detected among Egyptians (54.4%) and Yemenis (49%). Fear of side effects of vaccination was the main barrier to vaccination (53.1%). Meanwhile, nearly three-fifths (57.7%) of the respondents reported that vaccination would reduce the risk of infection. Logistic regression analysis stated that age >40 years, having children, being Health-Care Workers (HCWs), had higher education and higher income levels, and administering influenza vaccination were significant predictors of vaccine acceptance, as well as Jordanians, Palestinians, and Sudanese had higher probabilities of vaccine acceptance than Egyptians and Yemenis.Conclusions The acceptance rate was moderate. Fear of vaccine side effects and lack of receiving appropriate information were reported as barriers to vaccination. It is important to improve vaccine acceptance and reduce the barriers to COVID-19 vaccination.

Abstract Background The incidence of breast cancer in Pakistan has been rising with approximately one third of these patients requiring mastectomy. Among breast reconstruction treatment options, the use of Acellular Dermal Matrix (ADM) for pre-pectoral breast implant surgery has proven effective with improved cosmetic outcome. However, due to high cost it cannot be regularly implemented in a developing country like Pakistan. An alternative to ADM, Polyglactin 910 (Vicryl™, Ethicon) mesh has been introduced in pre-pectoral breast reconstructive surgery which has shown to be almost 10 times lower in cost. We set out to determine the frequency of early postoperative complications when using Polyglactin 910 mesh for pre-pectoral implant-based breast reconstruction surgery. Methods A single centre, retrospective, chart review was conducted, and a total 28 women were included in the study. Thirty-two pre-pectoral implant-based mastectomies with Polyglactin 910 mesh were performed. Early post-operative outcomes (within 12 months of procedure) including duration of antibiotic use, post-operative infection, implant displacement, flap necrosis, seroma formation, wound dehiscence, hematoma formation, capsular contracture and reconstruction failure, were recorded. Results Only 4 (12.5%) women experienced early post-operative morbidity. One patient developed a wound dehiscence, which eventually led to reconstruction failure and removal of the implant. Another patient had seroma formation and flap necrosis. None of the patients developed postoperative implant displacement, hematoma formation or capsular contracture in the early post-operative period. Conclusion This study reveals that early post-operative outcomes with Polyglactin 910 mesh in breast reconstructive surgery are few, thus making it a cost effective, reliable, and safe treatment option, especially in developing countries like Pakistan.

Abstract This article demonstrates a mathematical model and theoretical analysis of the Micropolar fluid in the reverse roll coating process. It is important because micropolar fluids account for the microstructure and microrotation of particles within the fluid. These characteristics are significant for accurately describing the behavior of complex fluids such as polymer solutions, biological fluids, and colloidal suspensions. First, we modeled the flow equations using basic laws of fluid dynamics. The flow equations are made modified using low Reynolds number theory. The simplified equations are solved analytically. The exact expression for velocity and pressure gradient are obtained, while pressure is calculated numerically using Simpson Rule. Graphical depictions are carried out to comprehend the impact of the newly emerged physical constraints. The influence of micropolar and microrotation parameters on the velocity, pressure and pressure gradient are elaborated with the help of different graphs.

Abstract Therapeutics that interfere with the damage/pathogen-associated molecular patterns (DAMPs/PAMPs) have evolved as promising candidates for hepatic inflammation like that occurring in non-alcoholic fatty liver disease (NAFLD). In the current study, we examined the therapeutic impact of the phosphodiesterase-1 inhibitor vinpocetine (Vinpo), alone or when combined with Lactobacillus, on hepatic abnormalities caused by a 13-week high-fat diet (HFD) and diabetes in rats. The results show that Vinpo (10 and 20 mg/kg/day) dose-dependently curbed HFD-induced elevation of liver injury parameters in serum (ALT, AST) and tissue histopathology. These effects were concordant with Vinpo’s potential to ameliorate HFD-induced fibrosis (Histological fibrosis score, hydroxyproline, TGF-β1) and oxidative stress (MDA, NOx) alongside restoring the antioxidant-related parameters (GSH, SOD, Nrf-2, HO-1) in the liver. Mechanistically, Vinpo attenuated the hepatocellular release of DAMPs like high mobility group box (HMGB)1 alongside lowering the overactivation of the pattern recognition receptors including, toll-like receptor (TLR)4 and receptor for advanced glycation end-products (RAGE). Consequently, there was less activation of the transcription factor nuclear factor-kappa B that lowered production of the proinflammatory cytokines TNF-α and IL-6 in Vinpo-treated HFD/diabetes rats. Compared to Vinpo treatment alone, Lactobacillus probiotics as adjunctive therapy with Vinpo significantly improved the disease-associated inflammation and oxidative stress injury, as well as the insulin resistance and lipid profile abnormalities via enhancing the restoration of the symbiotic microbiota. In conclusion, combining Vinpo and Lactobacillus probiotics may be a successful approach for limiting NAFLD in humans.

Background:Diabetic foot ulcers (DFUs) are severe complications of diabetes, leading to osteomyelitis, gangrene, and limb amputation. These outcomes increase mortality risk and bacterial resistance in surviving patients. The selection of the most effective antibiotics for DFUs remains a growing challenge. Objectives:The study aimed to identify risk factors, bacterial pathogens, and drug resistance in DFU patients, and explore the correlation between interleukin-6 (IL-6), vascular endothelial growth factor (VEGF) levels, and DFUs. Materials and Methods:Sixty isolates of bacteria were isolated aerobically from 100 samples of DFU (30 isolates from Pseudomonas aeruginosa and 30 isolates from Staphylococcus aureus). All isolates were identified by biochemical tests, then confirmation diagnosis was done by using VITEK-2. Determination multiple drug resistance isolates by susceptibility tests, then estimation of the activity of silver nanoparticles (AgNPs) as antibacterial with different concentrations were done. VEGF and IL-6 levels were determined by using Enzyme-linked immunosorbent assay (ELISA) technique. Results:The study revealed that many bacteria-resistant antibiotics, but AgNPs significantly inhibit multi-drug resistant bacteria, suggesting their potential as an alternative treatment. VEGF and IL-6 levels were significantly higher (P-value < 0.001) in DFU patients, with IL-6 negatively correlating with VEGF. Conclusion:Diabetic foot infections, caused by various bacteria, require understanding of antibiotic sensitivity for effective treatment. AgNPs showed strong antimicrobial effects against common bacteria, suggesting potential as an alternative treatment. The study also found elevated VEGF and IL-6 levels in DFU patients, with IL-6 potentially inhibiting VEGF, thus impairing healing.

Abstract Background The increased socioeconomic inequality in catastrophic health expenditure (CHE) disproportionately affects disadvantaged populations, subjecting them to financial hardships, limiting their access to healthcare, and exacerbating their vulnerability to morbidity. Objectives This study examines changes in socioeconomic inequality related to CHE and analyzes the contributing factors responsible for these changes in Pakistan between 2010-11 and 2018-19. Methods This paper extracted the data on out-of-pocket health expenditures from the National Health Accounts for 2009-10 and 2017-18. Sociodemographic information was gathered from the Household Integrated Economic Surveys of 2010-11 and 2018-19. CHE was calculated using budget share and the ability-to-pay approaches. To assess socioeconomic inequality in CHE in 2010-11 and 2018-19, both generalized and standard concentration indices were used, and Wagstaff inequality decomposition analysis was employed to explore the causes of socioeconomic inequality in each year. Further, an Oaxaca-type decomposition was applied to assess changes in socioeconomic inequality in CHE over time. Results The concentration index reveals that socioeconomic inequality in CHE decreased in 2018-19 compared to 2010-11 in Pakistan. Despite the reduction in inequality, CHE was concentrated among the poor in Pakistan in 2010-11 and 2018-19. The inequality decomposition analysis revealed that wealth status was the main cause of inequality in CHE over time. The upper wealth quantiles indicated a positive contribution, whereas lower quantiles showed a negative contribution to inequality in CHE. Furthermore, urban residence contributed to pro-rich inequality, whereas employed household heads, private healthcare provider, and inpatient healthcare utilization contributed to pro-poor inequality. A noticeable decline in socioeconomic inequality in CHE was observed between 2010 and 2018. However, inequality remained predominantly concentrated among the lower socio-economic strata. Conclusion These results underscore the need to improve the outreach of subsidized healthcare and expand social safety nets.

Abstract Background There is a dearth of research examining the couple characteristics in determining contractive utilization behavior in developing countries. This study fills the gap by analyzing the roles of women’s intra-household bargaining power and spousal age differentials in predicting contraceptive utilization behavior in Pakistani women. Methods A sample of 13,331, excluding pregnant and sexually inactive married women aged 15–49, was extracted from the Pakistan Demographic and Health Survey 2017–18. The dataset is cross-sectional. Exploratory analysis was used to examine the pattern of contraceptive knowledge, types of contraceptive utilization, and intention to use contraceptives among women. Furthermore, binary regressions were employed to examine the association of women's intrahousehold bargaining power and spousal age difference with contraceptive utilization without and after accounting for all potential covariates. Results Only 33% of women use contraceptives, while 30% express an intention to use contraceptives in the future. Almost all women (98%) knew about modern contraceptives. Compared to same-age couples, higher odds of current contraceptive use are observed among women whose husbands are at least 20 years older than them or whose husbands are young to them. The odds of the intention to use contraceptives tend to increase with the increase in spousal age difference. Women’s intra-household bargaining is a significant predictor of current contraceptive utilization and intention to use contraceptives. Conclusion Findings underscore the importance of considering the couple’s characteristics in reproductive healthcare programming and policies. Recommendation Greater women's intra-household bargaining power and smaller spousal age differences are associated with higher contraceptive usage. Empowering women and promoting their decision-making authority within households can enhance reproductive health outcomes.

Purpose/Objectives: This article introduces the Key Electronic Assessment Platform (KEAP), an electronic-based assessment platform created in-house at the College of Dentistry (COD), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. It highlights the platform’s integral value and demand within the educational system. Methods: The article introduces the KEAP system design and architecture, describes its features, tests, and implementation in addition to its maintenance and security. It also presents the outcomes of KEAP utilization and the level of users’ satisfaction. Results: The KEAP item bank has been expanded by more than 26,500 questions over the last four academic years and 1,255 exams have been administered. KEAP provides a highly secure structured framework for assessment planning, conduction, and evaluation. More than 90% of students and faculty are satisfied or very satisfied with their experience using the KEAP system indicating that it is well accepted by the end users. Conclusions: The development of KEAP is based on contextual factors in COD, KSAU-HS with the aim of creating a process for assessment that is valid, efficient, standardized, and highly secure. KEAP’s design and successful implementation can provide a successful example of implementing electronic-based assessment in higher education.

Objective: To determine the common anatomical variants of maxillary sinus and nasal cavity on cone beam computed tomography. Study Design: Retrospective cross-sectional study. Place and Duration of Study: This study was carried out at Anatomy and Radiology Department of Liaquat National Hospital & Medical College, Karachi, from 11 Nov 2022 till 22 Nov 2023. Materials and Methods: Cone-Beam Computed Tomography (CBCT) scans of 353 adults were evaluated retrospectively, who had scan for sinusitis for anatomical variations of maxillary sinus and nasal anatomy were included in study. Data analysis was done by SPSS v27. Results: There were 52% male and 48% female patients, with the majority (43.5%) being in the 26–35 age range. During the course of our investigation, we discovered that 27.8% of patients had a right deviated nasal septum with chonca bullosa, 25.5% had a left deviated nasal septum, and 19.9% had a nasal septal spine. In contrast, 56.3% of patients had hyper pneumatize maxillary sinuses, and 29.3% had hypoplasia of the maxillary sinuses. Anatomical variations in the nasal cavity were significantly associated with age (p = 0.001) and gender (p = 0.002). Conclusion: Based on our findings, although there was no significant association detected between the anatomical variations in the maxillary sinus and age (p = 0.641). The anatomical variation from the study's results of the nasal cavity is a deviated nasal septum on the right side, followed by a deviated nasal septum on the left, and that the most common variation in the maxillary sinus is hyper pneumatize maxillary sinus, which was followed by hypoplasia.

This investigation aims to explore previous research on the implementation of feature selection in intrusion detection. Feature selection has demonstrated its ability to enhance or sustain comparable classification accuracy levels for intrusion detection systems, while simultaneously improving classification efficiency. The evaluation includes an assessment of filter-based, wrapper-based, and hybrid feature selection techniques. Given that Big Data challenges can affect intrusion detection, feature selection’s classification efficiency can aid in lowering computing requirements. Older KDD intrusion detection datasets have received considerable attention in previous feature selection research. Consequently, researchers need more high-quality datasets that are available to the general public.

Abstract Antibiotic resistance among bacteria is recognized as the primary factor contributing to the failure of treatment. In this research, our objective was to examine the prevalence of antibiotic resistance in H. pylori bacteria in Palestine. We enlisted 91 individuals suffering from dyspepsia, comprising 49 females and 42 males. These participants underwent esophagogastroduodenoscopy procedures with gastric biopsies. These biopsies were subsequently subjected to microbiological assessments and tested for their susceptibility to various antimicrobial drugs. Among the 91 patients, 38 (41.7%) exhibited the presence of H. pylori. Notably, Ciprofloxacin displayed the highest efficacy against H. pylori, followed by Levofloxacin, Moxifloxacin, and Amoxicillin, with resistance rates of 0%, 0%, 2.6%, and 18.4%, respectively. On the contrary, Metronidazole and Clarithromycin demonstrated the lowest effectiveness, with resistance percentages of 100% and 47.4%, respectively. The outcomes of this investigation emphasize that H. pylori strains within the Palestinian patient group exhibit substantial resistance to conventional first-line antibiotics like clarithromycin and metronidazole. However, alternative agents such as fluoroquinolones and amoxicillin remain efficacious choices. Consequently, we recommend favoring quinolone-based treatment regimens for H. pylori infections and adopting a more judicious approach to antibiotic usage among the Palestinian population.

Abstract In this study, the complete plastome sequence of Nigella sativa (black seed), was analyzed for the first time. The plastome spans approximately 154,120 bp, comprising four sections: the Large Single-Copy (LSC) (85,538 bp), the Small Single-Copy (SSC) (17,984 bp), and two Inverted Repeat (IR) regions (25,299 bp). A comparative study of N. sativa’s plastome with ten other species from various genera in the Ranunculaceae family reveals substantial structural variations. The contraction of the inverted repeat region in N. sativa influences the boundaries of single-copy regions, resulting in a shorter plastome size than other species. When comparing the plastome of N. sativa with those of its related species, significant divergence is observed, particularly except for N. damascena. Among these, the plastome of A. glaucifolium displays the highest average pairwise sequence divergence (0.2851) with N. sativa, followed by A. raddeana (0.2290) and A. coerulea (0.1222). Furthermore, the study identified 12 distinct hotspot regions characterized by elevated Pi values (> 0.1). These regions include trnH-GUG-psbA, matK-trnQ-UUG, psbK-trnR-UCU, atpF-atpI, rpoB-psbD, ycf3-ndhJ, ndhC-cemA, petA-psaJ, trnN-GUU-ndhF, trnV-GAC-rps12, ycf2-trnI-CAU, and ndhA-ycf1. Approximately, 24 tandem and 48 palindromic and forward repeats were detected in N. sativa plastome. The analysis revealed 32 microsatellites with the majority being mononucleotide repeats. In the N. sativa plastome, phenylalanine had the highest number of codons (1982 codons), while alanine was the least common amino acid with 260 codons. A phylogenetic tree, constructed using protein-coding genes, revealed a distinct monophyletic clade comprising N. sativa and N. damascene, closely aligned with the Cimicifugeae tribe and exhibiting robust support. This plastome provides valuable genetic information for precise species identification, phylogenetic resolution, and evolutionary studies of N. sativa.

Abstract Ionic liquids (ILs) are highly effective for capturing carbon dioxide (CO2). The prediction of CO2 solubility in ILs is crucial for optimizing CO2 capture processes. This study investigates the use of deep learning models for CO2 solubility prediction in ILs with a comprehensive dataset of 10,116 CO2 solubility data in 164 kinds of ILs under different temperature and pressure conditions. Deep neural network models, including Artificial Neural Network (ANN) and Long Short-Term Memory (LSTM), were developed to predict CO2 solubility in ILs. The ANN and LSTM models demonstrated robust test accuracy in predicting CO2 solubility, with coefficient of determination (R2) values of 0.986 and 0.985, respectively. Both model's computational efficiency and cost were investigated, and the ANN model achieved reliable accuracy with a significantly lower computational time (approximately 30 times faster) than the LSTM model. A global sensitivity analysis (GSA) was performed to assess the influence of process parameters and associated functional groups on CO2 solubility. The sensitivity analysis results provided insights into the relative importance of input attributes on output variables (CO2 solubility) in ILs. The findings highlight the significant potential of deep learning models for streamlining the screening process of ILs for CO2 capture applications.

Abstract Background One of the most prevalent health problems affecting children worldwide is untreated caries in primary teeth. Agents to arrest caries are used to manage untreated decay in children in disadvantaged communities. Nano Silver Fluoride (NSF) overcomes the staining problems of Silver Diamine Fluoride (SDF). This study compared the clinical cariostatic effect of NSF to 38% SDF for arresting caries lesions. Methods The study included 360 children younger than 4 years, with at least one active lesion, ICDAS score ≥ 3, recruited from nurseries in a rural area in Alexandria, Egypt, in 2022. They were randomly assigned to receive a single application of NSF at baseline, or two applications of SDF at baseline and after 6 months. The arrest of active carious lesions was assessed after 6 and 12 months using ICDAS criteria, and parents’ satisfaction with child appearance was also assessed. Chi-Square test was used to compare the groups and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest at lesion level and binary logistic regression was used to assess the effect at patient level. Results 1853 active lesions were included in children whose mean (SD) age was 42.3 (8.2) months. The arrest rate was significantly higher in the NSF than the SDF group at lesion level (78.4% and 65.0% at 6 months and 71.3% and 56.3% at 12 months, p

Abstract The intended research aims to explore the convection phenomena of a hybrid nanofluid composed of gold and silver nanoparticles. This research is novel and significant because there is a lack of existing studies on the flow behavior of hybrid nanoparticles with important physical properties of blood base fluids, especially in the case of sidewall ruptured dilated arteries. The implementation of combined nanoparticles rather than unadulterated nanoparticles is one of the most crucial elements in boosting the thermal conduction of fluids. The research methodology encompasses the utilization of advanced bio-fluid dynamics software for simulating the flow of the nanofluid. The physical context elucidates the governing equations of momentum, mass, momentum, and energy in terms of partial differential equations. The results are displayed in both tabular and graphical forms to demonstrate the numerical and graphical solutions. The effect of physical parameters on velocity distribution is illustrated through graphs. Furthermore, the study’s findings are unique and original, and these computational discoveries have not been published by any researcher before. The finding implies that utilizing hybrid nanoparticles as drug carriers holds great promise in mitigating the effects of blood flow, potentially enhancing drug delivery, and minimizing its impact on the body.

Writing proficiency, especially at the B2 level in English as a Foreign Language (EFL), poses challenges for learners, necessitating mastery of various competencies, including linguistic accuracy and content organization. This study investigates the effectiveness of integrating "training pills" into the Flipped Classroom model to enhance B2-level writing skills. The research adopts a quasi-experimental design conducted over two academic years (2020-2022) in Seville, Spain. The sample consists of 120 high school students, with the experimental group using training pills (short audiovisual lessons), while the control group follows traditional instruction. Pre- and post-tests measured the improvement in writing skills, supplemented by questionnaires assessing satisfaction and engagement. Quantitative data analysis revealed that the experimental group improved by 34.4%, significantly outperforming the control group (11.8%). Qualitative feedback highlighted the accessibility and engagement benefits of the training pills, particularly their role in improving students' organizational and communicative success in writing. The study concludes that training pills, when integrated into a Flipped Classroom model, effectively enhance B2 writing acquisition by providing flexible and self-paced learning opportunities. These findings have significant implications for technology-enhanced learning and offer practical insights for educators seeking to optimize writing instruction for EFL learners.

BackgroundFindings from Kronos Early Estrogen Prevention Study (KEEPS)-Cog trial suggested no cognitive benefit or harm after 48 months of menopausal hormone therapy (mHT) initiated within 3 years of final menstrual period. To clarify the long-term effects of mHT initiated in early postmenopause, the observational KEEPS Continuation Study reevaluated cognition, mood, and neuroimaging effects in participants enrolled in the KEEPS-Cog and its parent study the KEEPS approximately 10 years after trial completion. We hypothesized that women randomized to transdermal estradiol (tE2) during early postmenopause would show cognitive benefits, while oral conjugated equine estrogens (oCEE) would show no effect, compared to placebo over the 10 years following randomization in the KEEPS trial.Methods and findingsThe KEEPS-Cog (2005-2008) was an ancillary study to the KEEPS (NCT00154180), in which participants were randomized into 3 groups: oCEE (Premarin, 0.45 mg/d), tE2 (Climara, 50 μg/d) both with micronized progesterone (Prometrium, 200 mg/d for 12 d/mo) or placebo pills and patch for 48 months. KEEPS Continuation (2017-2022), an observational, longitudinal cohort study of KEEPS clinical trial, involved recontacting KEEPS participants approximately 10 years after the completion of the 4-year clinical trial to attend in-person research visits. Seven of the original 9 sites participated in the KEEPS Continuation, resulting in 622 women of original 727 being invited to return for a visit, with 299 enrolling across the 7 sites. KEEPS Continuation participants repeated the original KEEPS-Cog test battery which was analyzed using 4 cognitive factor scores and a global cognitive score. Cognitive data from both KEEPS and KEEPS Continuation were available for 275 participants. Latent growth models (LGMs) assessed whether baseline cognition and cognitive changes during KEEPS predicted cognitive performance at follow-up, and whether mHT randomization modified these relationships, adjusting for covariates. Similar health characteristics were observed at KEEPS randomization for KEEPS Continuation participants and nonparticipants (i.e., women not returning for the KEEPS Continuation). The LGM revealed significant associations between intercepts and slopes for cognitive performance across almost all domains, indicating that cognitive factor scores changed over time. Tests assessing the effects of mHT allocation on cognitive slopes during the KEEPS and across all years of follow-up including the KEEPS Continuation visit were all statistically nonsignificant. The KEEPS Continuation study found no long-term cognitive effects of mHT, with baseline cognition and changes during KEEPS being the strongest predictors of later performance. Cross-sectional comparisons confirmed that participants assigned to mHT in KEEPS (oCEE and tE2 groups) performed similarly on cognitive measures to those randomized to placebo, approximately 10 years after completion of the randomized treatments. These findings suggest that mHT poses no long-term cognitive harm; conversely, it provides no cognitive benefit or protective effects against cognitive decline.ConclusionsIn these KEEPS Continuation analyses, there were no long-term cognitive effects of short-term exposure to mHT started in early menopause versus placebo. These data provide reassurance about the long-term neurocognitive safety of mHT for symptom management in healthy, recently postmenopausal women, while also suggesting that mHT does not improve or preserve cognitive function in this population.

Consumers are increasingly seeking nutritionally enhanced products, unique flavours and packaging, and ethically sourced ingredients. Significant technological advancements and investments in product innovation by manufacturers are driving the overall market growth for plant-based protein alternatives. In Europe, this growth is largely due to the rising adoption of veganism and the flexitarian trend. During vegetable processing, certain activities generate large amounts of by-products, many of which are discarded by manufacturers. These legumes and their by-products contain substantial amounts of protein. Manufacturers using legumes and their by-products-based proteins in food formulations must comply with European Union (EU) regulations and standards to obtain market approval. For this study, the regulatory framework and novel food dossier application process were sourced from the official EU website (Europa), while relevant standards were obtained from the International Organisation for Standardisation (ISO) and European Committee for Standardisation (CEN)-European Committee for Electrotechnical Standardisation (CENELEC) website. This review provides an overview of protein extraction from legumes and their by-products, followed by an analysis of the legal requirements for processing, production, and commercialisation of these extracted proteins in food formulations. It addresses standardisation and relevant standards in areas such as characterisation and safety. Furthermore, the novel food dossier application process and the EU requirements for legume proteins, if considered novel in the EU, are discussed. This review aims to serve as a guide for manufacturers already using, or considering the use of, legume proteins in food formulations within the EU, providing essential insights for gaining market acceptance and regulatory approval for these ingredients, whether existing or novel. Further research is needed to explore the incorporation of proteins extracted from legume by-products into food formulations.

Background: Accurate differentiation between fibroadenomas and phyllodes tumours (PTs) is challenging due to overlapping morphological features. CD10, an immunohistochemistry (IHC) marker, has shown promise in distinguishing these breast lesions. This study aimed to evaluate CD10 expression patterns in fibroepithelial lesions (FELs) of the breast. Methodology: This cross-sectional study was conducted in the Histopathology Department, at Dow University of Health Sciences over 1 year (01st Jan 2023 to 15th Dec 2023). Through the purposive sampling technique, the female patients having FELs were diagnosed by Consultant Pathologists as fibroadenomas or PT and were included in the study by employing specific histological parameters on H & E slides. Immunohistochemistry with CD10 antibody was conducted on a total of 120 samples with an equal split of fibroadenomas, benign PT, borderline PT, and malignant PT (30 cases each), assessing stromal cell staining and categorizing expression as negative (30% positivity). Data was statistically analyzed by using SPSS version 26 including reporting mean ± S.D for continuous data and utilizing the Chi-square test to assess associations, with significance set at p

Background: Globally, millions of circumcisions are performed annually by both medical and non-medical providers, with minor and major adverse outcomes. Short-term outcomes are well documented but there are limited reports of long-term, group-based assessments after Plastibell circumcision of infants. Through this study, we aim to assess the rate and types of late complications in the group of boys circumcised as part of Safe Circumcision Program (SCP) in Karachi, Pakistan, to document the safety of our technique and approach in the long-term. Methods: This cross-sectional study was conducted on male infants circumcised via Plastibell technique as part of the SCP from June 2016 to May 2021. A sample size of 602 was calculated using OpenEpi. After obtaining consent, telephone interviews of parents/guardians were conducted by health workers using a structured questionnaire. All complications reported by parents and identified by health workers were documented, and the babies were then referred to a pediatric surgeon for review. Results: Parents of 46 (7.5%) children reported a total of 81 concerns. After health worker assessment, 20 babies were referred to a specialist for in-person review and complications were documented in four (adhesion, inclusion cyst, skin bridge and meatal stenosis); thus, a late complication rate of 0.7% was recorded. Conclusion: The long-term complication rate for Plastibell circumcisions performed by trained providers is less than 1% with all reported complications minor and amenable to surgical correction.

In this study, the stir casting technique (SCT) was applied to form aluminium (Al) nanocomposites with various weight percentages of nanotitanium dioxide powder (TiO2). The structural, mechanical, and corrosion properties of nanocomposites were investigated. The microstructure was taken by scanning electron microscopy (SEM), while the crystal structure of the specimens was obtained using X-ray diffraction (XRD). In addition, nanocomposites were immersed in 0.5 M HCl solution for potentiodynamic and corrosion rate measurements. The results showed that the best specimen is 0.03%, as it increased by 23% for hardness, but the tensile strength increased to 52%. Whereas, SEM images of the specimens reinforced with nanoparticles showed a clear homogeneity and diffusion of nanoparticles in the matrix. So, the addition of TiO2 nanoparticles to aluminium metal improved the hardness and tensile strength of the nanocomposites appreciably. The corrosion results showed that nanocomposite materials have higher corrosion resistance than Al7075-based composite materials.

This narrative review explores the burgeoning field of Artificial Intelligence (AI)-driven Breast Cancer (BC) survival prediction, emphasizing the transformative impact on patient care. From machine learning to deep neural networks, diverse models demonstrate the potential to refine prognosis accuracy and tailor treatment strategies. The literature underscores the need for clinician integration and addresses challenges of model generalizability and ethical considerations. Crucially, AI’s promise extends to Low- and Middle-Income Countries (LMICs), presenting an opportunity to bridge healthcare disparities. Collaborative efforts in research, technology transfer, and education are essential to empower healthcare professionals in LMICs. As we navigate this frontier, AI emerges not only as a technological advancement but as a guiding light toward personalized, accessible BC care, marking a significant stride in the global fight against this formidable disease.

Abstract Objective To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone. Data source Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023. Study Selection Randomized clinical trials and observational studies with the outcomes of interest were included. Data collect We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy. Data synthesis Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42). Conclusion Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure. PROSPERO CRD42023449655

Objective:. To assess the accuracy, quality, and readability of patient-focused breast cancer websites using expert evaluation and validated tools. Background:. Ensuring access to accurate, high-quality, and readable online health information supports informed decision-making and health equity but has not been recently evaluated. Methods:. A qualitative analysis on 50 websites was conducted; the first 10 eligible websites for the following search terms were included: “breast cancer,” “breast surgery,” “breast reconstructive surgery,” “breast chemotherapy,” and “breast radiation therapy.” Websites were required to be in English and not intended for healthcare professionals. Accuracy was evaluated by 5 breast cancer specialists. Quality was evaluated through the DISCERN questionnaire. Readability was measured using 9 standardized tests. Mean readability was compared with the American Medical Association and National Institutes of Health 6th grade recommendation. Results:. Nonprofit hospital websites had the highest accuracy (mean = 4.06, SD = 0.42); however, no statistical differences were observed in accuracy by website affiliation (P = 0.08). The overall mean quality score was 50.8 (“fair”/“good” quality) with no significant differences among website affiliations (P = 0.10). Mean readability was at the 10th grade reading level, the lowest being for commercial websites with a mean 9th grade reading level (SD = 2.38). All websites exceeded the American Medical Association- and National Institutes of Health-recommended reading level by 4.4 levels (P < 0.001). Websites with higher accuracy tended to have lower readability levels, whereas those with lower accuracy had higher readability levels. Conclusion:. As breast cancer treatment has become increasingly complex, improving online quality and readability while maintaining high accuracy is essential to promote health equity and empower patients to make informed decisions about their care.

The aim of our study was to determine whether high flow oxygen therapy reduced the rate of endotracheal intubation and improve pulmonary outcome score. A total of 300 consecutive patients were enrolled in the study. The etiologies of acute respiratory failure were classified into trauma, lung diseases, fluid overload states and undifferentiated. Patients were randomized by block randomization method into two groups. First group received HFNC while the second received conventional oxygen therapy. Patients in both the groups were escalated to either NIV or invasive mechanical ventilator support if there were any signs of respiratory distress noted. Pulmonary outcome scoring done at 2 hours was designed to see if there was any improvement in patient’s condition in both the groups. SPSS (version 21.0, Illinois, Chicago) was used for the statistical analysis. The partial pressures of oxygen improved significantly in the HFNC group as compared to the COT group irrespective of the etiology. The partial pressures of CO2 on ABG were similar in both the groups until 12 hrs. However, pCO2 was earlier reduced in the HFNC group as compared to the COT group. Steady decrease in serum lactate levels were observed in HFNC group. The base deficit was corrected between 6-12 hours in patients of HFNC group which could not be seen in patients of COT group. There was a statistically significant difference noted at 12 and 24 hours between the two groups. The mean length of stay in HFNC group was around 4 days which was less compared to the length of hospital stay in COT which was an average of 7 days. The mortality in HFNC group was 4% and in COT group was 7.33% in our study. The study demonstrated that the use of HFNC in ED patients presenting with AHRF was associated with a greater reduction in need for escalation of ventilation requirements and improves pulmonary outcomes compared with standard oxygen therapy.

Objective: The present study was aimed to investigate students’ perspective on the virtual teaching and learning of human anatomy during COVID-19 pandemic. Study type,settings & duration: Thiswas a cross-sectional study and was conducted by the Department of Anatomy, Liaquat National Hospital and Medical College, Karachi from August toSeptember 2021. Methodology: A self-designed questionnaire was prepared and distributed among the studentsof 1st and 2nd year MBBS, who were exposed to the online teaching methodology during lock down imposed by government. This questionnaire was composed of demographic details of participants, their reflection on virtual learning and problems faced during the online sessions. The data was later translated on excel and SPSS 23 was used to analyze the results. Results: The findings of the present study revealed majority of the participants (47.8%) were laptop users for seeking the virtual classes. They do not find this learning experience as effective as face-to-face classes and expressed that neither theoretical nor practical aspects of anatomy could be learnt effectively online. They listed technical issues like slow internet speed and connectivity errors as barriers during the course of study. However, the respondents (3.33±0.94 & 3.01±1.07) found that the sessions were well-organized, they saved students time and continued the process of learning despite of the strict COVID-19 restrictions. Conclusion: Virtual teachings continued the learning process during the pandemic but they cannot be a replacement of real class-room experience. The traditional anatomy teaching remains the most preferred and effective teaching modality among students.

The Performance Measurement Systems (PMSs) have been gaining an increased interest from both academics and businesses since almost the beginning of 1990, and many frameworks and approaches have been developed and introduced since then. The literature on PMSs is very extensive, however, there is limited number of studies regarding the pitfalls that could cause the failure of these systems, as well as the barriers that could block their implementation. Moreover, only a few studies discuss the reasons behind the unsuccessful PMSs based on actual experiences. The aim of this paper is to address some of the reasons that could affect the successful implementation of PMSs based on examining the available literature regarding this topic. The lack of understanding, the poor design and implementation of metrics, the required resources, as well as the fear of adopting new systems and technologies were of the most discussed reasons behind PMSs failure.

The aim of this paper is to examine the relationship between financial decision-making ability and financial choices, and also to check the mediating role of time perspective in this relationship. Financial decision-making ability is composed of two factors: financial behavior (FB) and financial literacy (FL). Whereas, three financial choices are used, which are: investment, savings, and consumption. Using structural equation modeling (SEM), the sample of 380 participants was used to analyze the results. The findings indicate that both financial literacy and financial behavior significantly increase the investment and choices of individuals, while financial behavior also increase consumption. In addition, study found that different factors of time perspective also mediate the relationship between financial decision-making ability and financial choices. The paper concludes with significant policy implications.