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Salima Qamar, Najma Shaheen, Sadia Shakoor, Joveria Farooqi, Kauser Jabeen, Rumina Hasan Clinical Microbiology, Department of Pathology And Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan Introduction: Management of infections with carbapenem-resistant Enterobacteriaceae (CRE) is challenging. In recent times, agents such as colistin and fosfomycin have been used in combination with other antibiotics to treat such infections. In this study, we aim to seek frequency of colistin and fosfomycin resistance in CRE from Pakistan.Methods: This study was conducted at clinical laboratories, Aga Khan University Hospital. In total, 251 CRE were included in the study. Colistin minimum inhibitory concentrations (MICs) were performed using broth microdilution (BMD) method and VITEK® 2 system, whereas fosfomycin susceptibility was performed using Kirby–Bauer method. MIC50 and MIC90 were calculated for colistin and agreement between VITEK and BMD was also calculated.Results: Out of 251 strains colistin MIC of ≥4 µg/mL was seen in 40 (15.9%). Of these strains 20 (50%) were Klebsiella pneumoniae. Colistin MIC50 and MIC90 were found to be 0.5 and 16 µg/mL, respectively. BMD and VITEK 2 showed 100% categorical agreement. Essential agreement was 88.5% with kappa score 0.733 indicating strong agreement between VITEK and BMD. 31 out of 251 (12.3%) CREs were resistant to fosfomycin.Conclusion: Study shows frequency of colistin and fosfomycin resistance to be 15.9% and 12.3%, respectively. In countries where rate of CREs is high, emerging resistance against these last resort antibiotics is alarming as it leaves clinicians with almost no options to manage such multidrug resistant and extensively drug resistant infections. Keywords: emerging drug resistance, colistin resistance, fosfomycin resistance, carbapenam resistant enterobacteriaceae, salvage antibiotics

Spall failure is of interest due to its prevalence in high strain rate problems in which the spallation is driven by the interaction of release waves. In this article, a porosity-based damage model that includes microinertial effects is used to examine spall failure. The model is successfully calibrated to plate impact-driven experiments and then used to evaluate experimental conditions producing more extreme strain rate conditions, such as those in laser-driven experiments. The incorporation of microinertia allows us to better understand the increase in apparent macroscopic spall strength seen at high strain rates. Correspondingly, we conclude that the incorporation of microinertial effects improves the model's predictive capabilities. Microinertial effects result in more severe local tensile stresses that affect the damage evolution, and microinertia can play a significant role in the approach to the material's ideal strength at extreme loading rates. A preliminary parametric study is also carried out to investigate the role of microstructural aspects such as nucleation volume fraction and initial pore radius. One counter-intuitive result from the microinertial effects is that, for a given nucleation site volume fraction, having larger initial pore nucleation sites can lead to an improved macroscopic spall strength. [ABSTRACT FROM AUTHOR]

Trypsin inhibitors are known to act against insect pests by inhibiting proteases of the digestive tract. In this study, we report structural and functional characterization of ∼ 19 kDa Albizia procera Kunitz-type trypsin inhibitor (ApKTI) protein with potential bio-insecticidal applications. Crystal structure of ApKTI protein has been refined to 1.42 Å and molecular structure (8HNR) showed highly beta sheeted conformation including 12 beta sheets, 15 loops and two small alpha helices. Docking between predicted model of Tribolium castaneum trypsin (TcPT) and 8HNR produced a stable complex (−11.3 kcal/mol) which reflects the inhibitory potential of ApKTI against insect gut trypsin. Significant mortality was observed in all life stages of T. castaneum including egg, larvae, pupae and adults with a 3.0 mg native ApKTI treatment in comparison to negative control. Although standard trypsin inhibitor (Glycine max trypsin inhibitors; GmKTI; 3.0 mg) produced maximum reduction against all above life stages; however, a non-significant mortality difference was observed in comparison to 3.0 mg native ApKTI. The study further explores the synthesis and characterization of Graphene (GNPs) and Zinc oxide (ZnONPs) nanoparticles, followed by the optimization of ApKTI and GmKTI loading on both nanoparticles to evaluate their enhanced insecticidal effectiveness. Encapsulated proteins showed significant mortality against T. castaneum across all concentrations, with GNPs proving more effective than ZnONPs. Additionally, encapsulated GmKTI produced significant mortality of eggs compared to loaded ApKTI treatments while other life stages were non-significantly affected by two proteins. This research highlights the importance of encapsulated ApKTI protein for eco-friendly pest management strategies.

Abstract The utilization of biochar’s as soil amendments for enhancing nutrient retention in subsoils present potential limitations. To address this issue, we conducted a greenhouse experiment to assess the effects of various biochar’s derived from animal manures (swine manure, poultry litter, cattle manure) and plant residues (rice straw, soybean straw, corn straw) when applied to surface of an acidic soil. Our study focused on wheat crops under a no-tillage system, with a subsequent evaluation of the residual impacts on soybeans. The experimental design involved the application of biochar’s at different rates i.e. 10 and 20 Mg ha−1, followed by the assessment of their influence on NPK levels, pH, and exchangeable Al in stratified soil layers (0–5, 5–10, 10–15, and 15–25 cm). Furthermore, we investigated the interplay between biochar doses and the application of nitrogen (N) in the top 5 cm of soil, specifically examining $${\text{NO}}_{{3}}^{ - }$$ NO 3 - , $${\text{NH}}_{{4}}^{ + }$$ NH 4 + , P and K levels. Our findings revealed that in the top 5 cm of soil, biochar doses and N application significantly affected $${\text{NO}}_{{3}}^{ - }$$ NO 3 - , $${\text{NH}}_{{4}}^{ + }$$ NH 4 + , P and K concentrations. However, in deeper soil layers, no significant differences were observed among biochar doses with or without N application. Interestingly, K levels were impacted throughout all soil depths, regardless of the presence or absence of N application. Moreover, biochar application up to a 5 cm depth induced favorable changes in soil pH and reduced exchangeable Al. In contrast, deeper layers experienced a decrease in soil pH and an increase in exchangeable Al following biochar treatment. In conclusion, our study demonstrates that biochar’s can effectively retain NPK nutrients, enhance soil pH, and decrease exchangeable Al, independent of the type and dosage of application under a no-tillage system. Nonetheless, the efficacy of biochar amendments may vary with soil depth and type of nutrient, warranting careful consideration for maximizing their benefits in sustainable agricultural practices.

Objective The prevalence of postnatal anxiety is high among women during the first year of childbirth globally. Rates are higher in low and middle-income countries (LMICs), that is, 24%. Existing literature on maternal mood and its impact on child development has largely focused on postnatal depression. Postnatal anxiety has been recognised to have significant independent effects similar to those of postnatal depression, including negative effects on various aspects of maternal well-being including quality of life, parent–child interaction and child development. The evidence exploring lived experiences of postnatal anxiety is limited from LMICs. This study explored the lived experiences of anxiety in postnatal mothers in Pakistan.Design A phenomenological approach was used for this qualitative study. The audio-recorded interviews were transcribed and analysed using the process of thematic analysis.Settings The study was conducted in two community settings in Karachi, Pakistan; the Bin Qasim and Gadap town.Participants Women who were 18 years of age or older, had a live childbirth within the previous 12 months and had a score of 10 or higher on the Generalised Anxiety Disorder-7.Results In-depth, one-to-one interviews were conducted with 10 participants. The qualitative data comprised of three themes. Theme one: Factors perceived to be associated with postnatal anxiety, Theme two: The perceived impact of postnatal anxiety and Theme three: Support needs. The first theme was further subdivided into two subthemes, that is, Mothers’ perception of navigating domestic responsibilities and sociocultural norms of motherhood and financial constraints.Conclusion Despite the high prevalence of postnatal anxiety in LMICs there is not any published evidence on exploring this phenomenon through in-depth research in Pakistan. Understanding the lived experiences will help health professionals to identify women at risk of developing postnatal anxiety and to develop effective culturally appropriate interventions for women with anxiety during this postnatal period.

Tribolium castaneum Herbst (Coleoptera: Tenebrionidae) is a significant and economically detrimental pest that infests stored grains, particularly wheat, which serves as a staple food for a substantial portion of the Asian population. Environmental and health hazards of available chemical control options coupled with development of resistance against them warrants discovery of more sustainable and environment friendly pest control materials. This study aimed to investigate the physical properties and insecticidal efficacy of zinc oxide nanoparticles (ZnO NPs), fabricated with Anagallis arvensis extracts, against T. castaneum. The synthesized ZnO NPs were characterized using various analytical techniques. The UV–Visible spectrograph exhibited a characteristic peak at 320 nm at room temperature, while Fourier Transform Infrared Spectroscopy (FTIR) was employed to determine the organic constituents in NPs. Following that, the Scanning Electron Microscopy - Energy Dispersive X-ray (SEM-EDX) analyses were conducted to assess the shape, size, and weight of the nanoparticles. Dynamic Light Scattering (DLS) analysis provided information on their surface charge and hydrodynamic diameter. The mortality bioassay demonstrated that ZnO NPs exhibited a significant toxic effect against T. castaneum (p

نُفذ البحث في مشتل كلية الهندسة الزراعية بجامعة تشرين- اللاذقية- سورية خلال الموسمين الزراعيين 2021 و2022 م ، وذلك بزراعة طرز وراثية من التبغ الشرقي هي (بريليب، بصما والتبغ البلدي)، وإجراء التهجين نصف التبادلي Half Diallel Cross بينها وفقاً للطريقة الثانية. في الموسم التالي تمَّ إجراء تقييم للأصناف الأبوية بالإضافة إلى الهجن الفردية الناتجة عن التهجينات المختلفة، وذلك في تجربة نُفذت وفق تصميم القطاعات العشوائية الكاملة (R.C.B.D) وبثلاثة مكررات للمعاملة الواحدة، بهدف دراسة علاقات الارتباط بين كلٍّ من: صفة غلة الأوراق الجافة، غلة الأوراق الخضراء، الوزن النوعي للأوراق، مساحة المسطح الورقي، نسبة التصافي، لتحديد الصفات التي يمكن اعتمادها كمعايير انتخاب لتحسين غلة النبات الجافة. أظهرت نتائج الارتباط المظهري أن أعلى ارتباط مرغوب وعالي المعنوية كان لصفة الغلة الجافة مع صفة الغلة الخضراء (r = 0.9)، وصفة الغلة الخضراء مع صفة الوزن النوعي للأوراق (r = 0.9)، يليه في المرتبة الثانية ارتباط مرغوب وعالي المعنوية لصفة الغلة الجافة وصفة نسبة التصافي (r = 0.89). وقد عزّزت قراءة معادلة خط الانحدار البسيط العلاقات الارتباطية بين الصفات المدروسة، وهذا يعني أن زيادة الغلة الخضراء بمقدار (1 كغ/ دونم) من المتوقع أن تعمل على زيادة الغلة الجافة بمقدار (0.31 كغ/ دونم)، وبنسبة مساهمة 81%، ومن المتوقع أيضاً أن زيادة نسبة التصافي بمقدار (1%) ستؤدي إلى زيادة الغلة الجافة بمقدار (8.72 كغ/ دونم)، وبنسبة مساهمة 80%.

The limitations in the available reinforcing methods have accompanied the increasing popularity of 3D Concrete Printing (3DCP). Incorporating steel fibers as reinforcement is a promising approach to overcome these limitations. However, the impact of the printing process on the alignment of these fibers is not well understood. Therefore, the objective of this research is to quantitatively analyze the distribution of steel fiber alignment in 3D printed concrete. To achieve this, digital image analysis was employed to assess the influence of nozzle diameter, print speed, and fiber content on fiber alignment in both mold-cast and 3D-printed samples. UHPC matrix without fiber addition and fiber reinforced UHPC composites with brass-coated steel fiber contents of 1.5% and 3% by volume fraction were printed. Furthermore, Material nozzles ranging from 10 mm to 40 mm in size were employed and printing speeds of 15, 25, 35, and 45 mm/s were adjusted. Subsequently, the study examined the implications of fiber alignment on the hardened performance of printed specimens and compared them with conventionally mold-cast samples. The findings of the study demonstrated that increasing the fiber content and using smaller diameter nozzles during the printing procedure led to significant improvements in fiber orientation along the printing direction. As a result, the mechanical performance of the printed samples showed a substantial enhancement compared to the specimens produced through mold casting, primarily due to the improved fiber alignment.

The CYP2C19 gene is frequently included in different pharmacogenomic panels tested in clinical practice, due to its involvement in the metabolism of a myriad of frequently prescribed medications. Accordingly, CYP2C19 genotyping can promote precise therapeutic decisions and avoid the occurrence of significant drug-drug-gene interactions in the clinical setting. A comprehensive examination of the role of the CYP2C19 gene in real-world medical settings is presented in this review. This review summarizes the most recent information on how genetic variants in CYP2C19 affect drug metabolism and therapeutic outcomes. It goes into the wide range of CYP2C19 phenotypes, with different degrees of metabolizing activity, and their implications for customized medication response through a review of the literature. The review also analyzes the clinical significance of CYP2C19 in several medical specialties, including cardiology, psychiatry, and gastro-enterology clinics, and illuminates how it affects pharmacological efficacy, safety, and adverse effects. Finally, CYP2C19-supported clinical decision-making is outlined, highlighting the possibility of improving therapeutic outcomes and achieving more affordable treatment options, a step towards optimizing healthcare provision through precision medicine.

IntroductionMidazolam, by either the oral or the nasal route, is safe and effective in reducing anxiety and improving behavior in children during dental procedures.AimTo compare both children's acceptance and parents’ satisfaction with midazolam premedication, when administered as an oral syrup or as a nasal spray and explore whether there were positive or negative changes in acceptance during consecutive dental treatment visits.MethodsRandomized controlled study among uncooperative 2–6-year-old children who needed at least two similar dental treatments. On each visit, the acceptability of the medication was assessed as good, fair, or poor. The duration of crying after medication administration was recorded. Additionally, parents were asked to rank their satisfaction with the mode of administration.ResultsThe study group included 60 children; 30 patients received midazolam orally and 30 nasally. Route of administration did not correlate with medication acceptance in the first (p = 0.11) and second visit (p = 0.61). However, in the oral group, medication acceptance of 73% of children deteriorated on the second visit, compared to 33% in the nasal group (p = 0.01). Parents of children in the oral group expressed less satisfaction with premedication administered on the second visit than did parents of children in the nasal group, p = 0.00. Poor medication acceptance at the first visit (p = 0.014) and oral route of administration (p = 0.014) were found to be predictors of poor medication acceptance at the second visit.ConclusionsAcceptance of premedication is expected to deteriorate after the first treatment visit, especially in the oral route of administration. Dentists should consider nasal spray administration for young pediatric patients who need more than one dental treatment. Parents should be prepared for possible resistance or refusal by children.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT02679781.

This paper investigates the seismic performance of prefabricated segmental bridge columns (PSBCs) with hybrid post-tensioned tendons and energy dissipation (ED) bars under cyclic loading. PSBCs with unbonded and hybrid bonded prestressed tendons and columns incorporating ED bars are designed to improve the lateral strength, energy dissipation, and limit the residual drift. The PSBCs under cyclic loading were investigated using the three-dimensional finite element (FE) modeling platform ABAQUS. The FE model was calibrated against experimental results, with an overall error of less than 10%. The seismic performance of the proposed PSBCs was evaluated based on critical parameters, including lateral strength, residual plastic displacement, and the energy dissipation capacity. The results show that bonding the tendons in the plastic hinge region as opposed to the overall bonding along the column leads to a better cyclic performance. The lateral strength, and recentering abilities are further improved by bonding tendons up to 2/3 of the length in the plastic hinge region, along with 100–300 mm in the footing. It was also found that selecting a longitudinal length of ED bars crossing multiple precast segmental joints and having a circumferential spread of 70–90% of core concrete results in a higher bearing capacity and energy dissipation compared to ED bars crossing the single joint.

الأهداف: يعد الابيضاض من الأمراض المتزايدة حول العالم، ونظراً إلى أن الخلايا الورمية تعتمد على تحلل السكر اللاهوائي لاستهلاك الطاقة الذي يؤدي إلى ارتفاع تراكيز LDH المصلية، مما دفعنا لدراسة الأهمية الإنذارية لهذا الأنزيم بهدف البحث عن واسم نوعي، سهل التحليل وقليل التكلفة. الطرق: اشتملت الدراسة على 105 مشارك: 75 مريضاً مشخصين حديثاً بابيضاض دم حاد (40 مريضاً مصاباً بابيضاض نقوي حاد و35 مريضاً مصاباً بابيضاض لمفاوي حاد)، و30 مشاركاً من الأشخاص الأصحاء ظاهرياً. تمت معايرة مستويات الـ LDH بتقنية المعايرة الطيفية الضوئية بواسطة جهاز Mindray. تم تقسيم عينات المرضى وفقاً لمستويات LDH المصل إلى ثلاث مجموعات: المجموعة A لديهم مستويات LDH أقل من ضعفي القيمة الطبيعية، المجموعة B لديهم مستويات LDH بين ضعفي إلى خمس أضعاف القيمة الطبيعية أما المجموعة C لديهم مستويات LDH أكبر من خمس أضعاف القيمة الطبيعية. النتائج: كانت معدلات البقيا الإجمالية والبقيا الخالية من النكس أعلى بشكل هام إحصائياً في المجموعة ذات مستويات LDH الأقل، حيث لوحظ فرقاً إحصائياً هاماً بين مجموعات المرضى الثلاث التي تم تقسيمها وفقاً لمستويات LDH، فكانت نسبة البقيا الإجمالية والبقيا الخالية من النكس (93.8% و68.6%) على التوالي في المجموعة A. الاستنتاجات: تعتبر مستويات LDH المصل قبل العلاج مشعراً تنبؤياً هاماً لدى مرضى الابيضاض، وتترافق المستويات العالية من الـ LDH مع إنذارية سيئة ومعدل بقيا منخفض، ويمكن الاعتماد عليه كفحص روتيني غير مكلف وسهل التحليل.

The aim of present study is to emphasize the phytochemical and biological studies of root extracts of Bryophyllum pinnatum, as little work was documented on the roots. Phytochemical analysis of powder and extracts were evaluated by the standard methods. UV/Visible scanning, FTIR and atomic absorption spectroscopy were also performed for the purposes of standardization. In vitro anti-inflammatory investigation was done by protein denaturation method and xanthine oxidase inhibition assay was performed to confirm anti-gout effect. Phytochemical analysis results revealed the presence of primary metabolites (%w/w); carbohydrates (48.54×0.6) > proteins (21.06×0.6) > lipids (1.32×0.001). Secondary metabolites (mg/g) were also isolated; methanol extract has higher concentrations of flavonoids (95.81×0.026) and glycosaponins (39.9×0.103) while in water extract polysaccharide (139.4 × 0.026) and polyphenols (114.93×0.0234) were found to be in maximum quantities as compared to the other extracts. UV/Visible and FTIR scanning results have shown the presence of various significant functional groups. In vitro anti-inflammatory evaluation showed that aqueous extract (87.46%) was found to be the most active with IC50 (570.24ug/ml) as compared to the reference drug diclofenac sodium. In vitro xanthine oxidase inhibition activity was performed and methanol extract (88.24%) found to be the most effective. The findings confirm the plant nutritional value and rationale behind its use in traditional medicine for the treatment of inflammation and gout. [ABSTRACT FROM AUTHOR]

Backgroup: the widespread COVID-19 infection worldwide has resulted in the inability of healthcare facilities to receive all infected patients; therefore, most are treated at home. In addition, factors such as high mortality, types and severity of symptoms, and the prevalence of unreliable information have prompted patients to resort to self-treatment. Objectives: To assess prevention, treatment, degree of symptoms, and sources of information among patients with COVID-19 in Arab countries Method: A cross-sectional study was conducted in seven Arab countries: Algeria, Egypt, Iraq, Lebanon, Libya, Tunisia, and the United Arab of Emirates. People who have recovered from COVID-19 completed the study questionnaire. Score of symptoms during and after COVID-19 infection has been calculated by giving the participants a list of 13 symptoms. Results: A total of 3519 participants completed the survey. Mostly females (68.3%), and aged between 18 and 40 years old (59.4%). Prophylaxis treatments, including vaccines and antibiotics, have been used in around 40% of the participants. The total average score of symptoms during the infection period was found 7.31 ± 3.66 out of 13. However, the symptoms score upon recovery was low (0.48 ± 1.11 score). The significant associations with increased incidence of symptoms during infection were reported with older people, married, divorced or widowed, people with chronic diseases, and obese. Moreover, significant associations with decreased symptoms were reported with those who worked in the health sector, non- or ex-smokers, and vaccinated people. Conclusion: The use of medication and other treatments to prevent infection with COVID-19 was common among the participants in the seven countries. Taking the vaccine was the only effect on the number of symptoms experienced by patients. Although nearly two years have passed since the onset of the disease, there is still a need to raise treatment awareness among patients at home.