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Molecular hybridization produced six new derivatives by combining isatin analogues with two fenamic acid derivatives. These compounds were characterized using FT-IR and 1H-NMR and tested for antimicrobial activity. Most of these compounds show potent activity compared to ciprofloxacin against gram-positive bacteria (Staphylococcus aureus, Streptococcus pneumoniae, and Bacillus subtilis) and gram-negative (Neisseria gonorrheae, Pseudomonas aeruginosa, and Escherichia coli). Additionally, they demonstrated a higher antifungal activity than fluconazole against Candida albicans. A molecular docking study was performed for all six hybrids with three proteins: E. coli DNA Gyrase B (PDB: 6H86), S. aureus (PDB: 2W9H), and CYP51 (PDB: 4WMZ). The results showed promising inhibition of the bacterial and fungal proteins. Furthermore, the ADME study predicted favorable drug-like properties for these compounds.

Abstract Nucleation and subsequent growth of new aerosol particles in the atmosphere is a major source of cloud condensation nuclei and persistent large uncertainty in climate models. Newly formed particles need to grow rapidly to avoid scavenging by pre-existing aerosols and become relevant for the climate and air quality. In the continental atmosphere, condensation of oxygenated organic molecules is often the dominant mechanism for rapid growth. However, the huge variety of different organics present in the continental boundary layer makes it challenging to predict nanoparticle growth rates from gas-phase measurements. Moreover, recent studies have shown that growth rates of nanoparticles derived from particle size distribution measurements show surprisingly little dependency on potentially condensable vapors observed in the gas phase. Here, we show that the observed nanoparticle growth rates in the sub-10 nm size range can be predicted in the boreal forest only for springtime conditions, even with state-of-the-art mass spectrometers and particle sizing instruments. We find that, especially under warmer conditions, observed growth is slower than predicted from gas-phase condensation. We show that only a combination of simple particle-phase reaction schemes, phase separation due to non-ideal solution behavior, or particle-phase diffusion limitations can explain the observed lower growth rates. Our analysis provides first insights as to why atmospheric nanoparticle growth rates above 10 nm h−1 are rarely observed. Ultimately, a reduction of experimental uncertainties and improved sub-10 nm particle hygroscopicity and chemical composition measurements are needed to further investigate the occurrence of such a growth rate-limiting process.

Obesity is a growing health concern in Indonesia, with its prevalence steadily increasing and contributing to a variety of non-communicable diseases such as diabetes and heart disease. One effective way to monitor and manage body weight is by regularly calculating the Body Mass Index (BMI). This study aims to develop a digital weighing scale prototype based on the Internet of Things (IoT), equipped with BMI calculation and real-time weight tracking features. The prototype utilizes load cell sensors, HX711, ESP8266, and an OLED display for measuring weight, which is then transmitted to a Flutter-based application (MyWeightApp) connected to Firebase for data storage and graphical visualization. The research adopts the waterfall model for system development, encompassing requirements analysis, planning, modeling, construction, and system handover. Hardware testing demonstrates an accuracy rate of 0.78% error, well below the 5% tolerance threshold. Software testing using black-box testing confirms that the application successfully tracks weight, calculates BMI, and provides effective weight progress graphs. The results of this study indicate that the IoT-based digital weighing scale prototype developed can serve as a practical solution for obesity prevention and health monitoring in Indonesia.

Abstract Objectives Predictions regarding the on-going burden of SARS-CoV-2, and vaccine recommendations, require an understanding of infection-associated immune protection. We assessed whether early COVID-19 provided protection against Omicron infection. Methods We enrolled a cohort of adults in Ontario, Canada, with COVID-19 prior to October 2020 (early infection, EI), and a matched cohort with COVID-19 testing and a negative PCR (non-EI). Participants completed baseline surveys then surveys every two weeks until January 2023. Multivariable Cox regression was used to assess factors associated with COVID-19 infection during the first 14 months of Omicron. Results Overall, 624 EI (70%) and 175 (77%) non-EI participants met criteria for analysis; 590 (95%) EI and 164 (94%) non-EI had received at least 2 COVID-19 vaccine doses prior to Omicron. Of 624 EI, 175 (28%) had one SARS-CoV-2 re-infection and 8 (1.3%) had two, compared to 84 (48%) non-EI participants with one, 5 (2.9%) with two and 1 (0.6%) with 3 infections (P

Abstract Background Assessment shapes educational activities and curriculum mapping, influences learning outcomes, and motivates students. In medical education, aligning assessment items with curricular goals ensures that learning outcomes are accurately measured. Our study aimed to evaluate the alignment of multiple-choice questions (MCQs) with curriculum objectives, identify any flaws in these items, and propose enhancements to improve assessment quality. Methodology A quantitative descriptive study was conducted at Islamic International Medical College, Riphah University, in 2023. Pre-hoc reports from mid-stake assessments across five academic years were analyzed, covering both preclinical and clinical years. A total of 2,400 multiple-choice questions (MCQs) were reviewed for the mid-stake exams against the institutional checklist in which flaws were categorized into three types: test wiseness, irrelevant difficulty, and miscellaneous flaws. Results The analysis revealed a significant misalignment between assessment items and curriculum objectives. Of the 2,400 MCQs reviewed across all five years, 561 flaws were identified: 125 test wiseness flaws, 198 irrelevant difficulty flaws, and and 238 miscellaneous flaws. The latter category was recognized as “alignment flaws” which was not previously documented.The documentation and rectification of these flaws, which included issues such as misaligned learning objectives, incorrect assessment strategies, and disconnects between scenarios and lead-ins, led to their inclusion in the institutional checklist, facilitating ongoing improvements in assessment quality. Conclusions Our study revealed significant gaps in the alignment of multiple-choice questions (MCQs) with curriculum objectives, emphasizing the need for a systematic approach to address these flaws. Document analysis identified misalignments between content objectives, cognitive processes, and assessment strategies, which compromise the quality of evaluations and can hinder the development of critical thinking and problem-solving skills. To address these issues, we propose integrating identified flaws into institutional guidelines and implementing an updated checklist for pre-hoc evaluation of assessment items, with a focus on curriculum alignment and cognitive levels.

Background: Central serous chorioretinopathy (CSCR) is a sporadic disorder of the outer blood-retinal barrier, characterized by a localized detachment of the sensory retina usually affecting one eye in young males. Usually, a self-limiting disease various treatments have been investigated in recent times. Aim: To evaluate the final visual outcome, recurrence rate, and possible complications in patients of CSCR treated with observation, oral acetazolamide, oral eplerenone, and double-frequency neodynium-doped yttrium aluminium garnet (ND-YAG) laser photocoagulation. Methods: A prospective interventional study was conducted on patients newly diagnosed with CSCR. The patients were divided into four groups namely: Group A on observation, Group B on oral acetazolamide Group C on oral eplerenone, and Group D on Double frequency Nd-YAG laser. The visual recovery, recurrence rate, and possible complications of these therapies were compared. Results: The study comprised of 76 patients. Group D patients showed the fastest improvement in visual acuity at 2 weeks. At 12 weeks, all groups had comparable improvement. Three patients in Group A, 1 each in Groups B and D, and 2 in Group C showed recurrence. Paresthesia, numbness, and gastric upset related to acetazolamide were noted in 5 patients of Group B. However, 16.7% of cases in Group A, 10.5% in Group B, 5.3% in Group C, and 5% in Group D showed leakage on Fundus fluorescent angiography after 12 weeks. Conclusion: In acute CSCR eplerenone seems to be efficient with the least side effects and early resolution. In chronic cases, Double frequency Nd-YAG laser seems to give better results. Early treatment should be given for better visual recovery of patients.

The aim of this study is to determine whether the use of plant extracts like Ecballium elaterium and Senna italica leaf aqueous extracts helps support the activity of meropenem and vancomycin antibiotics against Staphylococcus aureus and Staphylococcus epidermis bacteria. The minimum inhibitory concentration (MIC) and the fractional inhibitory concentration (FIC) were used to find out the antibacterial effect of E. elaterium and S. italica extracts in combination with meropenem and vancomycin antibiotics by employing microbroth dilution assay and checkerboard assay. According to the obtained results, all combinations showed a synergistic effect against S. aureus except vancomycin and S. italica combinations which exhibited an additive effect. Moreover, all combinations exhibited an additive effect against S. epidermis except vancomycin and E. elatenium, which showed a synergistic effect. In conclusion, E. elaterium and S. italica leaf aqueous extracts have great potential as sources of antibacterial compounds against microorganisms and they can be used to treat infectious diseases caused by antibiotic-resistant microorganisms.

The Internet of Things (IoT) revolutionizes precision healthcare by enhancing patient care and reducing costs. However, this technology poses challenges in securing Healthcare-IoT (H-IoT) devices, as low-latency packet transmission increases vulnerability to attacks (e.g., Distributed Denial of Service (DDoS)) in 5G networks. This research develops a monitoring frequency-based detection and dynamic threshold mitigation method using Temporal Convolutional Networks (TCNs) in 5G H-IoT environments. A monitoring frequency-based detection method calculates each H-IoT node’s message count over the past five seconds as a percentage of total traffic. A dynamic threshold strategy also provides adaptive security by averaging detected malicious behavior messages across all nodes to determine the base threshold. This approach enhances classification accuracy, effectively mitigates actual DDoS attack nodes, and blacklists malicious nodes without false positives in H-IoT environments. Moreover, this research creates DDoS attack models, monitoring parameters using two simulators (Cooja and ns-3) on H-IoT devices. Data is collected over the Message Queuing Telemetry Transport (MQTT) and User Datagram Protocol (UDP) in a realistic 5G-based H-IoT environment, creating two datasets with malicious and benign data. The proposed TCN-based DDoS prediction and mitigation method achieves 99.98% and 95% accuracy on the MQTT dataset. This model also attains a slightly higher prediction accuracy of 99.99% and mitigation of 80% on the UDP dataset. This research evaluates the proposed model against prior methods, including Bidirectional Long Short-Term Memory (BiLSTM) and Convolutional Neural Networks (CNNs), demonstrating improved accuracy. Thus, the proposed TCN model is a versatile and resilient security solution for H-IoT environments.

Abstract Background The principal objective of our study is to evaluate the characteristics of babies with type 1 ROP, screening practices and treatment trends in a tertiary care centre in Pakistan. Methods This prospective study at Mayo Hospital, Lahore (July 2022–July 2024), included 89 preterm infants with type 1 ROP, selected using non-probability sampling. Infants were categorized based on international (GA

Abstract Female sexual response has historically been understudied. Using the female sexual function index (FSFI-6), this study estimated female sexual response and its associations with sociodemographic characteristics, self-reported health conditions, and logging of sex events. Participants included a large and demographically diverse sample of 2392 users of the Flo Health mobile application (app) in the United States. Participants scored higher on FSFI-6, suggesting higher sexual function, if they were actively trying to conceive, met the criteria for obesity (body mass index (BMI) ≥ 30 kg/m2), or engaged in higher-than-average in-app sex event logging. Conversely, being underweight (BMI

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.

Background: Inositol was previously classified as a vitamin, but it is not one as it is produced by the body. It plays a role as a second messenger of insulin in several insulin-dependent processes, including polycystic ovarian syndrome (PCOS) and metabolic syndrome. Objective: This study aims to determine the impact of myo+ D-chiro inositol treatment on gut hormones insulin-like peptide 5 (ILP5) and phosphodiesterase 9 (PDE9) inhibitors, as well as determine if it improves the metabolic profile and the state of PCOS. Materials and Methods: The research conducted by the University of Baghdad’s College of Medicine was authorized by the ethics committee. In the study, 50 obese women without PCOS, and 50 obese women with PCOS were enrolled, and they were then treated with 2000 mg of myo-inositol (MI) and 50 mg of D-chiro inositol (DCI) in a 40:1 ratio for 3 months while having their vital signs and laboratory tests checked both before and after the treatment. We examined fasting glucose, insulin, ILP5, PDE9 inhibitor, free testosterone, dehydroepiandrosterone, the homeostatic model assessment index, and pretreatment and posttreatment. From February 2022 to the end of August 2022, participants in the study visited the Infertility Unit at the Higher Institute for Infertility Diagnosis and Assisted Reproductive Technologies at Al-Nahrain University in Baghdad, Baghdad, Iraq. Participants in this research completed questionnaires to indicate their consent for the study to record information on women. Results: The results revealed that after administering the treatment to polycystic ovary patients, a significant decrease in their weight and an improvement in insulin resistance markers were observed, as well as a decrease in the levels of ILP5 (171.53 ± 22.55 vs. 83.60 ± 18.94), and an increase in the levels of phosphodiesterase9 enzyme (7.17 ± 1.58 ng/mL vs. 8.16 ± 1.37 ng/mL). Conclusion: This study concludes that MI–DCI could be proposed as a potential therapeutic approach for the treatment of women with polycystic ovaries, showing a positive effect on correcting PCOS symptoms and infertility.

Abstract Noise pollution is defined as any disturbing or unwanted sound that disrupts or harms human health or wildlife. Noise pollution can have profound effects on both human health and the environment. For humans, exposure to excessive noise levels has been linked to a range of health issues, including hearing damage, stress, and sleep disturbances. Noise monitoring and mapping play a crucial role in understanding, managing, and mitigating the impacts of noise pollution on communities and the environment. Urban areas near borders are generally less studied due to restrictions. Therefore, a study has been conducted aiming the monitoring of noise level and looking into its propagation through 2D noise maps in the urban areas of Jammu and Kashmir lying near the Indian border. The monitoring results revealed that even boarder areas are exposed to high noise levels. Bhatindi in Jammu city recorded highest equivalent noise level, Leq of 91.2 dB(A) during evening. Nowshera is calmest among other study area with noise level, Leq of 80.1 dB(A). Further, 2D noise mapping showed some critical locations in study areas of Jammu and Kashmir that the noise propagates to the nearby residential and commercial areas which require immediate remedial measures. The findings not only contribute to the scientific understanding of noise patterns in border regions but also hold practical implications for urban planning, public health, and environmental conservation.

Abstract Background and aim The present survey aimed to explore northern Saudi medical students’ perceptions and sociodemographic influencing factors in choosing ophthalmology as a career specialty to determine if they are in alignment with the health sector transformation program of the Vision 2030 initiative. Methods This study was conducted among 384 medical students from two universities in northern Saudi Arabia (KSA). We used a standard and validated questionnaire to collect the required data. The perception aspect consisted of 20 questions divided into five subdomains: personal and lifestyle factors, residency program aspects, patients’ care, work culture, and financial factors. We used binomial logistic regression to find sociodemographic predictors for choosing ophthalmology as the first choice. Results The present study demonstrated that northern Saudi medical students preferred ophthalmology as the second most preferred specialty (11.2%). Among the motivational factors, the most frequently reported was the influence of faculty members from their college (74.2%), followed by financial aspects (74%) and family and friends (73.7%). The preference to choose ophthalmology was significantly higher among female gender (ref: male, AOR = 2.63, 95% CI = 1.39–4.88, p = 0.001) and students with a GPA of 4.6 and above (ref: GPA less than 3.5, AOR = 3.77, 95% CI = 2.99–5.36, p = 0.023). Conclusion Northern Saudi medical students’ preference for ophthalmology aligns with Vision 2030 goals. Therefore, it is essential to tailor strategies by policymakers to the medical students according to the identified sociodemographic influencing factors. Furthermore, we recommend prospective studies across all the regions of KSA to identify regional variations.

In the current study, wild land plant specimens were collected during the flowering and fruiting period of these plants in February, April, June, August, andOctober 2023 from the riparian area of the Dujail River, Salahaldin Province, north of Baghdad, Iraq. Identified and the results showed that the number of these species were: 104 species, belong to 29 plant families,Included 26 dicotyledon families with 76 genera and 96 species. The asteraceae family was the most diverse, with 30 species, followed by Brassicaceae with (12) species. Additionally, there were 13 families represented by only one species in Dujail Riverwhich included: Apocynaceae, Berberidaceae, Capparaceae, Caryophyllaceae, Convolvulaceae, Geraniaceae, Lythraceae, Malvaceae, Papaveraceae, Plumbaginaceae, Primulaceae, Rutaceae and Urticaceae. For the monocotyledonseven genera and eight species. The Poaceae family was the most diverse, with five genera and five species, followed by Cyperaceae which has one genus and two species.

Abstract Ensuring everyone enjoys healthy lifestyles and well-being at all ages, Progress has been made in increasing access to clean water and sanitation facilities and reducing the spread of epidemics and diseases. The synthesis of nano-particles (NPs) by using microalgae is a new nanobiotechnology due to the use of the biomolecular (corona) of microalgae as a capping and reducing agent for NP creation. This investigation explores the capacity of a distinct indigenous microalgal strain to synthesize silver nano-particles (AgNPs), as well as its effectiveness against multi-drug resistant (MDR) bacteria and its ability to degrade Azo dye (Methyl Red) in wastewater. An extract of Spirulina platensis was obtained from a local source to synthesize silver nano-particles (AgNPs). The synthesized AgNPs were subsequently subjected to characterization utilizing several analytical methods, namely UV-visible spectroscopy, scanning electron microscopy (SEM), X-ray diffraction, and Fourier transform infrared spectroscopy (FTIR analysis). Subsequently, the disc diffusion method assessed their anti-bacterial efficacy against multi-drug resistant (MDR) bacteria and their ability to degrade Azo dye (Methyl Red) in wastewater. The nano-particles produced through biological synthesis exhibited a prominent peak in the UV-visible spectrum at a wavelength of 430 nm. Furthermore, these nano-particles were determined to possess a crystalline nature, with an average size of 28.72 nm and a distinctive star-like shape. The synthesized silver nano-particles (AgNPs) exhibited a dose-dependent anti-bacterial effect against some clinical bacterial isolates as multi-drug resistant (MDR), including Gram− ve bacteria such as Pseudomonas aeruginosa and Escherichia coli, as well as Gram+ ve bacteria like Staphylococcus aureus and Streptococcus pneumoniae. The action can be ascribed to the unique biological and physicochemical features of AgNPs, which facilitate the disruption of bacterial cell membranes. The UV-visible analysis solution after the introduction of AgNPs indicated that the decrease in the absorbance peak of methyl red was attributed to the existence of silver nano-particles. Metal nano-particles can be synthesized using environmentally friendly processes and hold great potential for combating multi-drug resistant bacteria and degrading Azo dyes. Silver nano-particles (AgNPs) are synthesized with an extract derived from the algae Spirulina platensis, which is a sustainable and eco-friendly alternative.

Abstract In recent years, Lip-reading has emerged as a significant research challenge. The aim is to recognise speech by analysing Lip movements. The majority of Lip-reading technologies are based on cameras and wearable devices. However, these technologies have well-known occlusion and ambient lighting limitations, privacy concerns as well as wearable device discomfort for subjects and disturb their daily routines. Furthermore, in the era of coronavirus (COVID-19), where face masks are the norm, vision-based and wearable-based technologies for hearing aids are ineffective. To address the fundamental limitations of camera-based and wearable-based systems, this paper proposes a Radio Frequency Identification (RFID)-based smart mask for a Lip-reading framework capable of reading Lips under face masks, enabling effective speech recognition and fostering conversational accessibility for individuals with hearing impairment. The system uses RFID technology to make Radio Frequency (RF) sensing-based Lip-reading possible. A smart RFID face mask is used to collect a dataset containing three different classes of vowels (A, E, I, O, U), Consonants (F, G, M, S), and words (Fish, Goat, Meal, Moon, Snake). The collected data are fed into well-known machine-learning models for classification. A high classification accuracy is achieved by individual classes and combined datasets. On the RFID combined dataset, the Random Forest model achieves a high classification accuracy of 80%.

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.

Water 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.

Background: The postpartum period is critical for women and newborns. Many complications, such as deaths, are preventable by utilizing appropriate postpartum care. We aimed to assess healthcare professionals’ adherence to the World Health Organization’s (WHO) immediate postpartum care guidelines, investigating factors influencing their adoption at Jordanian hospitals. Materials and Methods: A methodological study design, developing, and testing the psychometric properties of the Immediate Postpartum Care Adherence Questionnaire (IPCAQ) was created based on the Theory of Planned Behavior, extensive literature review, and the WHO guidelines following a manual construct questionnaire, and using a deductive method. The IPCAQ was developed using four steps: domain identification, scale construction, judgmental evidence, and psychometric evaluation. Results: The final draft of IPCAQ consisted of four domains and 63 items deductively formulated from the theoretical constructs. The domains are attitudes, behavioral intention, subjective norms, and perceived behavioral control. They were subsumed by four subthemes, general caring assessment, counseling, subjective norms, and perceived behavioral control. The IPCA showed high content (0.94) and face validity indices (0.97), moderate content scale universal agreement (0.77), and excellent face agreement (0.81) for the 63 items. IPCAQ is a reliable instrument that measures adherence to immediate postpartum care guidelines. Conclusions: IPCAQ is reliable and valid in the current sample. The IPCAQ can be used to assess healthcare professionals’ adherence to immediate postpartum care guidelines, identify factors influencing the adoption of standardized care to overcome barriers to adherence, and facilitate high-quality care.

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 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 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.

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.

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 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

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.

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.

Large amounts of hazardous and synthetic dye are produced by the textile industry. Nevertheless, the literature still lacks an effective method for removing hazardous synthetic dye, specifically malachite green, from wastewater. To fill this gap, this study used a batch method to evaluate the adsorption of malachite green onto an adsorbent derived from walnut shells (ACWS). According to previous studies, zinc chloride is rarely used as a chemical agent for activating walnut shells. Moreover, very little carbon has been used to eliminate the dye. To identify the ideal conditions, this paper examined the effects of washing, carbonization temperature, contact duration, adsorbent dosage, and dye concentration on the adsorption capacity and removal percentage. The Freundlich and Langmuir models were used to analyze the experimental isotherm data. The equilibrium adsorption data fit the Langmuir equation more closely, as evidenced by a high correlation factor (R2 = 0.9970). The data also showed an acceptable fit with the Freundlich model, with the “n” constant ranging from 2 to 10. The parameter values for the aforementioned models were as follows: Qm = 588.23 mg/g, KL = 0.0602 L/mg, KF = 201, and 1/n = 0.1838. The adsorption process of malachite green onto ACWS was further investigated using both first- and second-pseudo-order models. The kinetics of adsorption, with a determination coefficient (R2) of 0.9943, closely followed a pseudo-second-order kinetic model. The rate constants were found to be 0.0274 min−1 for the pseudo-first-order and 0.0033 g/min·mg for the pseudo-second-order kinetics. The thermodynamic parameters were determined from the adsorption isotherms at various temperatures, yielding free energy ΔG° values ranging from −5.5241 to −9.27 kJ/mol, a positive enthalpy change ΔH° of 31.0538 kJ/mol, and an entropy change ΔS° of 124.84 J/mol·K. The positive ΔH° and negative ΔG° indicate that the overall adsorption of MG is endothermic and spontaneous.

Social media use has increased after the COVID-19, indicating several effects on users. Talking specifically about its effects on adolescents, several studies have witnessed its positive and negative consequences on young users. This research also aims to examine the positive effects of social media use on adolescents from a Media Mindfulness Perspective, including tolerance, community peace, and online ethical awareness. Theoretically supported by Social Learning Theory, the data were gathered using 379 structured questionnaires. Results indicated an overall positive influence of social media use on adolescents in UAE. It is found that social media use positively affects tolerance among adolescents, suggesting an improved tolerance among the relevant users. Also, the effect of social media uses on community peace remained positive, implying that digital platforms are constructive means of teaching peace and harmony. Finally, results also indicated the positive effects of social media use on online ethical awareness among adolescents in UAE. Overall, these results suggest a positive, constructive role of social media use in changing the behaviors of the young generation. Under the social learning theory, this study also suggested social media as a powerful tool for learning positive behaviors, further influencing and improving societal peace and harmony. Finally, the study’s significance and limitations are discussed.

Aims and Objectives: The current research’s target is to obtain the dissolution profile of various brands of Linezolid 600 mg tablets available in Karachi, Pakistan and the assay was also performed using both the UV Spectrophotometric Technique and High Performance Liquid Chromatographic Techniques. Methodology: Dissolution profile was conducted using 0.05M phosphate buffer (pH 6.8). UV spectrophotometry and HPLC techniques were employed for assay. The mobile phases used were Methanol: Buffer (55:45) for HPLC and Acetonitrile: Water (50:50) for UV. Results: The dissolution profiles showed that Brand C-1 had the fastest dissolution rate, achieving 100% dissolution within 20 minutes. The assay results showed that Brand C-1 had an HPLC assay value of 99.5% ± 0.84 and a UV assay value of 104.3% ± 0.14. Therefore, Brand C-1 can be considered as the best brand among the tested brands. Conclusion: HPLC is recommended as the best analytical method for the estimation of Linezolid due to its high precision and accuracy. However, the UV spectrophotometric method is rather quick and affordable. Complex procedures or treatments (often associated with the chromatographic approach) do not require it. This study fills a research vacuum by comparing the dissolution profile and assay of various brands of 600 mg Linezolid tablets that are available in Karachi, Pakistan. By using both UV Spectrophotometric and High Performance Liquid Chromatographic (HPLC) methodologies, the study specifically aims to close the gap in assessing the bioequivalence and quality consistency of various brands.

This paper introduces the Morphologically-Analyzed and Syntactically-Annotated Quran (MASAQ) dataset, a comprehensive resource designed to address the scarcity of annotated Quranic Arabic corpora and facilitate the development of advanced Natural Language Processing (NLP) models. The Quran, being a cornerstone of classical Arabic, presents unique challenges for NLP due to its sacred nature and complex linguistic features. MASAQ provides a detailed syntactic and morphological annotation of the entire Quranic text, utilizing a rigorously verified text from Tanzil.net. The dataset includes more than 131K morphological entries and 123K instances of syntactic functions, covering a wide range of grammatical roles and relationships. The annotation process involved a team of expert Arabic linguists who employed traditional i'rab methodologies to ensure high accuracy and consistency. The dataset is structured in multiple formats (tab-separated text file (tsv), SQLite3 database (.db), comma-separated file (csv), and JavaScript Object Notation (.JSON)) to cater to various research needs. MASAQ's unique features include a comprehensive tagset of 72 syntactic roles, detailed morphological analysis, and context-specific annotations. This dataset is particularly valuable for tasks such as dependency parsing, grammar checking, machine translation, and text summarization. The potential applications of MASAQ are vast, ranging from pedagogical uses in teaching Arabic grammar to developing sophisticated NLP tools. By providing a high-quality, syntactically annotated dataset, MASAQ aims to advance the field of Arabic NLP, enabling more accurate and more efficient language processing tools. The dataset is made available under the Creative Commons Attribution 3.0 License, which governs its use and distribution. It has been created in compliance with ethical guidelines and with respect for the integrity of the Quranic text.

IntroductionMalnutrition among children is one of the major health challenges in Pakistan. The National Nutritional Survey 2018 revealed that 44% of children are stunted. Different circumstances surrounding a child's birth can lead to inequality of opportunity in early childhood, with significant nutritional inequalities between rural and urban areas. This study aims to identify the drivers of inequality of opportunity in stunting among children under-five years of age in Pakistan.MethodsThis study used Pakistan Demographic and Health Survey, 2017-18 to identify the factors contributing to inequality of opportunity in child's stunting. The Dissimilarity index (D-index), along with Oaxaca decomposition, and Shapely decomposition were employed to measure and decompose inequality in opportunity in stunting. Regional variations in stunting among children under various circumstances were analyzed using Geographic Information System or GIS.ResultsThe burden of stunting is exceptionally high in Pakistan, with the prevalence in rural areas significantly exceeding that in urban areas from 1990 to 2018. Shapley decomposition of the contributors to inequality in opportunity indicates that maternal education accounted for 24% of total inequality among rural children and 44% among urban children. Water and sanitation contributed 22% to overall inequality in rural areas but only 2% in urban areas, highlighting the critical role of inadequate water and sanitation in rural settings. The wealth index was a predominant contributor to inequality both nationally and in urban areas. Southern regions exhibit a higher prevalence of stunting and a greater proportion of households lacking adequate water and sanitation. Additionally, the concentration of uneducated mothers and stunted children is notably high in Balochistan and Sindh.ConclusionsThe lack of maternal education, inadequate access to water and sanitation services, and lower socio-economic status are key factors contributing to inequality of opportunity in stunting among children under five in Pakistan. Understanding the critical role of these circumstances can help policymakers address the situation and implement concrete steps to enhance equal opportunities for child health.

Objective: Peer-assisted learning (PAL) is teaching by the learners to the learners, a teaching strategy globally integrated into curricula. One particular variant is same-year reciprocal PAL, in which peer tutors and tutees are from the same academic year and alternate teaching roles. However, few studies have examined this specific form of PAL, and both student and faculty perspectives on its efficacy remain largely unexplored. To address this gap, we conducted a qualitative study among fourth-year medical students during their Family Medicine clerkship. Methods: Employing content thematic analysis, we gathered data through in-depth interviews and focus group discussions involving both faculty members and students. Students received training to lead small group discussions, and their perceptions were subsequently collected. Coding of the transcripts was carried out by three researchers independently, with themes agreed upon mutually. COREQ guidelines were followed throughout the planning, implementation, and analysis of this study. Results: The finalized themes included "Enhancement of Teaching Skills," "Conducive Educational Environment," "Operational Issues," and "Recommendations for the Future". Conclusion: Our findings suggest that PAL promotes collaboration among students and enhances knowledge, confidence, time management, teamwork and reflecting skills besides many other. It serves as a valuable supplement to traditional teaching methods, although it cannot replace them entirely. Thorough planning prior to implementation is essential for achieving beneficial long-term outcomes for both students and faculty. Key words: peer groups, medical students, learning, clinical clerkship, teaching methods, undergraduate medical education.

Objective: To perform clinical and genetic investigations in two patients suffering from Artemis deficiency with total deficiency of T-B- lymphocytes. Methods: We enrolled a Pakistani family with one male patient suffering from Severe Combined Immune Deficiency (SCID). Immunological investigations including lymphocyte subset analysis, and serum immunoglobulin levels were performed. Genetic analysis was performed on patients and available parents. Polymerase Chain Reaction (PCR) based amplification and electrophoresis in patients, parents and control was performed. Results: A detailed clinical investigation revealed mild fever, lower respiratory tract infections, watery diarrhoea, and oral moniliasis from the age of one month. Lymphocyte subset analysis showed T-/B- and NK+ type SCID. Genetic analysis revealed two exon deletions in the Artemis encoding gene (DCLRE1C, OMIM 602450). Conclusion: This study reveals a novel mega deletion mutation in the gene DCLRE1C, (two exon deletions) confirmed through PCR-based electrophoresis. The mutation leads to Artemis deficiency T-/B-/NK+ type of SCID. Keywords: CNV repeats, SCID, Artemis deficiency, Lymphocyte subset analysis, Immunoglobulins.

The steroid hormone progesterone (P4) regulates multiple aspects of reproductive and metabolic physiology. Classical P4 signaling operates through nuclear receptors that regulate transcription. In addition, P4 signals through membrane P4 receptors (mPRs) in a rapid nongenomic modality. Despite the established physiological importance of P4 nongenomic signaling, the details of its signal transduction cascade remain elusive. Here, using Xenopus oocyte maturation as a well-established physiological readout of nongenomic P4 signaling, we identify the lipid hydrolase ABHD2 (α/β hydrolase domain-containing protein 2) as an essential mPRβ co-receptor to trigger meiosis. We show using functional assays coupled to unbiased and targeted cell-based lipidomics that ABHD2 possesses a phospholipase A2 (PLA2) activity that requires mPRβ. This PLA2 activity bifurcates P4 signaling by inducing clathrin-dependent endocytosis of mPRβ, resulting in the production of lipid messengers that are G-protein coupled receptor agonists. Therefore, P4 drives meiosis by inducing an ABHD2 PLA2 activity that requires both mPRβ and ABHD2 as obligate co-receptors.

Tetanus, although rare in vaccinated regions, remains common in developing countries. Cephalic tetanus, caused by Clostridium tetani, is a rare, potentially fatal neurological condition. The presenting symptoms include spasms, rigidity, and paralysis in the head and neck. This case report describes a 5-year-old girl with unilateral facial paralysis initially diagnosed as Bell's palsy. Subsequent development of trismus and dysphagia led to a revised diagnosis of cephalic tetanus. Peripheral facial palsy may be an early sign of cephalic tetanus and should be considered in patients with relevant exposure history. Our patient’s recent nasal foreign body removal raised suspicion of cephalic tetanus, confirmed through clinical findings. Treatment with tetanus immunoglobulin and antibiotics led to gradual improvement. This case emphasizes the importance of considering cephalic tetanus in the differential diagnosis of facial nerve palsy, especially if there is a history of foreign body exposure. Early recognition and treatment are essential for favorable outcomes.

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

The grand chess board of world geopolitics has effectively been dominated by the U.S since past many decades, however, economic rise of China and resultant maritime power contestation with US is rapidly changing the status-quo within Indo Pacific Region. The announcement of “Pivot to Asia” followed by “Asia Rebalance” strategies by US President Obama and labelling of Asia Pacific to a more focused “Indo-Pacific” by the President Trump clearly reflects U.S. strategic shift to the region. To counter U.S. presence in Southeast Asia and address strategic maritime vulnerability of her Sea Lines of Communications (particularly in South China Sea), China has embarked upon an ambitious military modernization plan coupled with initiation of mega economic projects in Asia. This research is focused on developing an understanding regarding the evolving and rapidly changing maritime power contestation milieu between US and China, studied through the Realist lens. It is an in-depth study of Chinese maritime vulnerability and adopted strategy to overcome it. The research employs theoretical lens of Offensive Realism for studying the U.S national strategy to retain stature of hegemon and Defensive Realist lens to study the adopted Chinese strategy to ensure her steady rise and safeguarding its strategic maritime vulnerabilities.

Synthetic antidiabetic drugs are often associated with various adverse side effects, including hypoglycemia, nausea, gastrointestinal disturbances, headaches, and even liver damage. In contrast, plant-derived natural antidiabetic bioactive compounds typically exhibit lower toxicity and fewer side effects and have been reported to aid effectively in diabetes management. These plant extracts regulate diabetes by restoring pancreatic function, enhancing insulin secretion, inhibiting intestinal glucose absorption, and facilitating insulin dependent metabolism. This study explored four extraction methods, including reflux distillation (RD), ultrasound assisted extraction (UAE), microwave assisted extraction (MAE), and enzyme assisted extraction (EAE) to optimize the yield of crude leaf extract and vasicine from Adhatoda zeylanica. RD produced the highest crude extract yield (98.29 g/kg of dried leaf), while MAE was the most effective for vasicine extraction, yielding 2.44 g vasicine per kg dried leaf. High Performance Liquid Chromatography (HPLC) with a diode array detector (DAD) was used to identify and quantify vasicine, a quinazoline alkaloid with known antidiabetic properties. The hypoglycemic effects of leaf extracts were evaluated in alloxan-induced diabetic mice, and the effect of A. zeylanica extract was compared to the extracts of Centella asiatica, Allamanda cathartica, and the standard drug metformin. At a dose of 400 mg/kg body weight (BW), methanolic leaf extracts of A. zeylanica, C. asiatica, and A. cathartica reduced blood glucose level by 78.95 %, 74.50 %, and 70.19 %, respectively, compared to the standard drug metformin, which reduced blood glucose levels by 85.84 %. A. zeylanica at 400 mg/kg BW dose and metformin demonstrated statistically similar and significant blood glucose level reduction (p 89 %), highlighting its potential as a safe and effective source of antidiabetic agent.

Introduction: Sentinel lymph node biopsy (SLNB) of the axilla is standard in breast cancer (BC) management; however, its role in prophylactic/contralateral prophylactic mastectomy (CPM) is still questioned. To avoid future consequences on surgical morbidity and socioeconomic aspects in low and middle-income countries (LMICs), we intend to determine the prevalence of occult breast cancer (OBC) among CPM cases. Objective: To determine the prevalence of OBC in patients undergoing prophylactic mastectomy (PM). Design: This is a retrospective cohort study. Materials and methods: This retrospective cohort study is conducted at a tertiary-care hospital from January 2017 to December 2022. All individuals with the positive genetic test for high-risk breast cancer (HRBC) genes who underwent PMs/CPM at our centre were included. We analysed data using SPSS version 23.0. Results: Twenty-six mutation-positive females underwent PM/CPM (16.1%). Two (7.69%) of 26 had later post-PM recurrence. Only 8 (30.76%) patients had SLNB and all were negative. No OBC was seen in PM/CPM specimens, whereas 3 (11.5%) had atypical ductal hyperplasia (ADH). Two of the ADH had BI-RADS-1, whereas 1 was BI-RADS-4 (33.3%) on the preoperative assessment. Results also showed that with an increase in the tumour grade of the diseased breast, the BI-RADS score of the asymptomatic breast was subsequently increased ( P = .029). Conclusion: Our study shows negative OBCs in PM/CPM cases with persistently negative SLNB results; however, ADH is identified in 11.5% of specimens. Our results suggest that SLNB can be safely omitted in patients undergoing CPM, but, preoperatively, patient and disease factors should be considered.

Background: Deep vein thrombosis (DVT) is a leading cause of death disability. DVT can be classified based on the location and extent of the clot into isolated distal DVT (iDDVT), isolated proximal DVT (iPDVT), or mixed DVT. The aim of this study is to explore the baseline characteristics and clinical outcomes of patients with different types of DVT. Methods: This was a retrospective study of patients who experienced their first DVT event and received an anticoagulant for management. The outcomes of this study include evaluating patients’ characteristics for patients with DVT and assessing the incidence of recurrent DVT, major bleeding (MB), VTE-related rehospitalization, and DVT-related inpatient mortality across different types of DVT. Results: A total of 493 patients were included in the study. Of those, 273 (55.4%) had iPDVT, 25 (5.1%) had iDDVT, and 195 (39.6%) had mixed DVT. The VTE etiology was similar across the groups except for the leg injury, which was significantly higher in patients with iDDVT (24%) compared to iPDVT (6.2%) and mixed DVT (5.6%) ( P = .002). At 12 months, a total of 49 patients (9.9%) had a recurrent DVT event; 25 (9.2%) in the iPDVT group, 3 (12.0%) in the iDDVT group, and 21 (10.8%) in the mixed DVT group ( P = .797). Rates of MB, re-hospitalization, and death from DVT were similar between the groups. Conclusion: Baseline characteristics were not significantly linked to the risk of developing a specific type of lower extremity DVT. Long-term outcomes were similar across all DVT types.

Background/Objective: 4H syndrome is a rare form of leukodystrophy characterized by hypomyelination, hypodontia, and hypogonadotropic hypogonadism. In 95% of cases, hypomyelination is present, but other clinical features, such as hypodontia and hypogonadotropic hypogonadism, are not always present and may not be necessary for diagnosis. Hypogonadotropic hypogonadism is the most common endocrine complication that can occur in 4H syndrome. Other endocrine abnormalities are short stature and growth hormone deficiency. Case Report: We present a 19-year-old female with 4H syndrome due to POLR3B gene mutations who presented with primary amenorrhea. She was referred to our endocrinology clinic by her primary care physician. She was diagnosed with 4H syndrome at age 15 by her pediatrician when she initially presented with primary amenorrhea, ataxia, and tremors and underwent karyotyping and confirmatory genetic tests. However, she received no endocrine care before coming to our clinic at 19. Neurologic exam revealed slight tremors in outstretched hands. A brain MRI study revealed no intracranial abnormalities. We subsequently placed her on Loestrin birth control, an estrogen/progestin combination contraceptive, and she begun having her menstrual periods. Discussion: The prevalence of POLR3-related leukodystrophy is currently unknown. It can appear during childhood or later in life. Early onset increases the risk of mortality in young adulthood. Endocrine care entails hormone replacement therapy and monitoring for dysfunction over time. Conclusion: Early diagnosis of hypogonadotropic hypogonadism in women, with or without other hormonal deficiencies caused by 4H syndrome, is crucial for effective treatment. Treatment should be multidisciplinary and aimed mainly at correcting low estrogen levels.

This paper studied the mechanical properties of carbon fiber-reinforced polylactic acid (CF-PLA) samples manufactured with three different 3D-printed patterns: gyroid, tri-hexagon, and triangular. Filler content was generated in the samples at infill ratios of 30%, 60%, and 90%. Conventional tensile, flexural, impact, and fatigue tests were conducted to investigate the mechanical properties. It was found that the gyroid infill pattern enhanced performance, exhibiting tensile strength and modulus of elasticity up to 63% and 13% greater, respectively, than the tri-hexagon pattern at a 90% infill ratio. The fatigue life improvement was 113% compared with the tri-hexagon pattern. The tensile strength and modulus of elasticity increased up to 35% and 40% after including carbon fibers. The increase in flexural modulus was 30% compared to the triangular pattern, whereas impact energy absorption reached the best result with the triangular pattern, up to 89% more than the gyroid pattern. These results elucidate the optimization of infill patterns and ratios together with carbon fiber reinforcement for the development of CF-PLA components as a high-performance 3D printing solution for a wide range of engineering applications.

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.

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.

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.