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Introduction: Acute encephalitis syndrome (AES) is one of the important causes of mortality among children in India. Active management of the cases, followed by addressing the cause of AES, is the key strategy for preventing mortality. Lack of laboratory facility and difficulty of sampling blood and cerebrospinal fluid (CSF) for assessing causes is one of the important barriers to early initiation of treatment. The main objective of the study is to validate the Scrub Typhus Encephalitis Assessment Tool (SEAT) for the management of AES. Methods: The study is a continuation of a study conducted in a tertiary care hospital in Eastern Uttar Pradesh. A machine learning (LightGBM) model was built to predict the probability of scrub typhus diagnosis among patients with acute encephalitis. Three models were built: one with sociodemographic characters, the second with Model 1 variables and blood parameters, and the third with Model 2 variables and CSF parameters. Results: The sensitivity of diagnosing the scrub typhus case was 71%, 77.5%, and 83% in Model 1, Model 2, and Model 3, respectively, and specificity was 61.5%, 75.5%, and 76.3%, respectively, in the models. In Model 1 fever duration, in Models 2 and 3, neutrophil/lymphocyte ratio was the most important predictor for differentiating the scrub and nonscrub cases. Conclusion: With the available sensitivity and specificity of the tool, the SEAT can be a valuable tool for the prediction of scrub typhus as a cause of AES cases in remote areas.

We conducted a systematic review of analytical epidemiological studies to assess the association between ChAdOx1-S vaccination and thromboembolic, thrombocytopenic, and hemorrhagic events. We searched Medline, Embase, Google Scholar, WHO-COVID-19 database, and medRxiv for studies evaluating the association between ChAdOx1-S and vascular events. Primary outcomes of interest were cerebral venous sinus thrombosis, peripheral venous thrombosis (PVT), and thrombocytopenia. Two independent reviewers screened for eligible studies, extracted data, and assessed the risk of bias. The DerSimonian-Laird random effects model was used to pool the incidence rate ratios (IRRs) separately for the first and second doses. Heterogeneity was assessed using I2 statistics. Twenty studies were included, of which 11 were self-controlled case series, and nine were cohort studies (254 million participants). Pooling of 17 studies showed a higher risk of cerebrovascular thrombosis (IRR = 3.5, 95% CI = 2.2–5.4, I2 = 79%), PVT (IRR = 2.0, 95% CI = 1.1–3.5, I2 = 95%) and thrombocytopenia (IRR = 1.6, 95% CI = 1.4–1.9, I2 = 93%) among those who received ChAdOx1-S vaccination as compared to controls. No increased risk was seen after the second dose or for secondary outcomes. There is moderate-to-high certainty of the evidence for the increased risk of cerebral venous sinus thrombosis, PVT, and thrombocytopenia following the first dose of the ChAdOx1-S vaccine. Systematic Review Registration: PROSPERO CRD42022372768.

The potential for influenza viruses to cause public health emergencies is great. The World Health Organisation (WHO) in 2005 concluded that the world was unprepared to respond to an influenza pandemic. Available surveillance guidelines for pandemic influenza lack the specificity that would enable many countries to establish operational surveillance plans. A well-designed epidemiological and virological surveillance is required to strengthen a country’s capacity for seasonal, novel, and pandemic influenza detection and prevention. Here, we describe the protocol to establish a novel mechanism for influenza and SARS-CoV-2 surveillance in the four identified districts of Tamil Nadu, India. This project will be carried out as an implementation research. Each district will identify one medical college and two primary health centres (PHCs) as sentinel sites for collecting severe acute respiratory infections (SARI) and influenza like illness (ILI) related information, respectively. For virological testing, 15 ILI and 10 SARI cases will be sampled and tested for influenza A, influenza B, and SARS-CoV-2 every week. Situation analysis using the WHO situation analysis tool will be done to identify the gaps and needs in the existing surveillance systems. Training for staff involved in disease surveillance will be given periodically. To enhance the reporting of ILI/SARI for sentinel surveillance, trained project staff will collect information from all ILI/SARI patients attending the sentinel sites using pre-tested tools. Using time, place, and person analysis, alerts for abnormal increases in cases will be generated and communicated to health authorities to initiate response activities. Advanced epidemiological analysis will be used to model influenza trends over time. Integrating virological and epidemiological surveillance data with advanced analysis and timely communication can enhance local preparedness for public health emergencies. Good quality surveillance data will facilitate an understanding outbreak severity and disease seasonality. Real-time data will help provide early warning signals for prevention and control of influenza and COVID-19 outbreaks. The implementation strategies found to be effective in this project can be scaled up to other parts of the country for replication and integration.

BACKGROUND: Although unintentional childhood injuries are a major cause of morbidity, there is a dearth of literature on the issue in Saudi Arabia. The aim of this study was to assess the prevalence of unintentional childhood injuries in Saudi children, safety of their home environment, and the parents' attitude toward home safety measures. MATERIALS AND METHODS: A cross-sectional survey was conducted in a consecutive sample of parents accompanying children aged ≤12 years to the pediatric outpatient clinics of a tertiary care hospital in Riyadh, Saudi Arabia. A validated self-administered questionnaire was used for data collection. Data was analysed using SPSS; Chi-square test and t-test were used to identify variables associated with injury in the preceding 12 months. Logistic regression analysis performed to identify the significant variables associated with injury after contolling for other variables. RESULTS: A total of 283 participants were enrolled. The prevalence of unintentional childhood injuries was 24.7% in the past 12 months. The majority of these injuries occurred at home (74.3%). Accidental falls were the most reported (62.9%) cause of injury followed by burns (22.9%). Being a male child, attending a nursery or kindergarten, and having parents who kept hazardous objects within the reach of children were found to be significantly associated with higher odds of injury. CONCLUSION: The prevalence of unintentional childhood injuries was high in the study population. Significant gaps were found between parents' reported knowledge and practice. Focused educational programs to improve home safety will be valuable in reducing this burden.

BACKGROUND: Patients' perception of their physician's empathy influences their compliance with treatment and the resulting quality of life. We aimed to measure the patient-rated empathy of physicians and to determine patient-level factors associated with it. MATERIALS AND METHODS: This hospital-based cross-sectional study enrolled adult (≥18 years) patients attending the outpatient clinics of the departments of family medicine, internal medicine, and surgery. We measured patients' rating of their physician's empathy using the Jefferson Scale of Patient's Perception of Physician Empathy questionnaire. Data were analyzed using SPSS v 23.0; categorical variables were presented as frequencies and percentages, and all quantitative variables were presented as mean and SD. Associations were explored by Chi-square test and Student's t-test. Regression analysis was performed to identify factors significantly associated with the empathy score; P< 0.05 was considered statistically significant. RESULTS: Of a total of 390 patients with a mean (standard deviation [SD]) age of 40.5 (13.6) years, 189 (48.5%) were male. The mean (SD) total patient-rated physician empathy score was 26.6 (6.0). Multilevel linear regression modeling revealed that having a health professional in the family, suffering from an acute illness (as compared to chronic illness), consulting a physician recommended by relatives/friends, trusting the physicians' expertise, shorter (

Summary: Background: India has 18% of the global population and an increasing burden of chronic respiratory diseases. However, a systematic understanding of the distribution of chronic respiratory diseases and their trends over time is not readily available for all of the states of India. Our aim was to report the trends in the burden of chronic respiratory diseases and the heterogeneity in their distribution in all states of India between 1990 and 2016. Methods: Using all accessible data from multiple sources, we estimated the prevalence of major chronic respiratory diseases and the deaths and disability-adjusted life-years (DALYs) caused by them for every state of India from 1990 to 2016 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016. We assessed heterogeneity in the burden of chronic obstructive pulmonary disease (COPD) and asthma across the states of India. The states were categorised into four groups based on their epidemiological transition level (ETL). ETL was defined as the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We also assessed the contribution of risk factors to DALYs due to COPD. We compared the burden of chronic respiratory diseases in India against the global average in GBD 2016. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings: The contribution of chronic respiratory diseases to the total DALYs in India increased from 4·5% (95% UI 4·0–4·9) in 1990 to 6·4% (5·8–7·0) in 2016. Of the total global DALYs due to chronic respiratory diseases in 2016, 32·0% occurred in India. COPD and asthma were responsible for 75·6% and 20·0% of the chronic respiratory disease DALYs, respectively, in India in 2016. The number of cases of COPD in India increased from 28·1 million (27·0–29·2) in 1990 to 55·3 million (53·1–57·6) in 2016, an increase in prevalence from 3·3% (3·1–3·4) to 4·2% (4·0–4·4). The age-standardised COPD prevalence and DALY rates in 2016 were highest in the less developed low ETL state group. There were 37·9 million (35·7–40·2) cases of asthma in India in 2016, with similar prevalence in the four ETL state groups, but the highest DALY rate was in the low ETL state group. The highest DALY rates for both COPD and asthma in 2016 were in the low ETL states of Rajasthan and Uttar Pradesh. The DALYs per case of COPD and asthma were 1·7 and 2·4 times higher in India than the global average in 2016, respectively; most states had higher rates compared with other locations worldwide at similar levels of Socio-demographic Index. Of the DALYs due to COPD in India in 2016, 53·7% (43·1–65·0) were attributable to air pollution, 25·4% (19·5–31·7) to tobacco use, and 16·5% (14·1–19·2) to occupational risks, making these the leading risk factors for COPD. Interpretation: India has a disproportionately high burden of chronic respiratory diseases. The increasing contribution of these diseases to the overall disease burden across India and the high rate of health loss from them, especially in the less developed low ETL states, highlights the need for focused policy interventions to address this significant cause of disease burden in India. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Summary: Background: The burden of cardiovascular diseases is increasing in India, but a systematic understanding of its distribution and time trends across all the states is not readily available. In this report, we present a detailed analysis of how the patterns of cardiovascular diseases and major risk factors have changed across the states of India between 1990 and 2016. Methods: We analysed the prevalence and disability-adjusted life-years (DALYs) due to cardiovascular diseases and the major component causes in the states of India from 1990 to 2016, using all accessible data sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016. We placed states into four groups based on epidemiological transition level (ETL), defined using the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed heterogeneity in the burden of major cardiovascular diseases across the states of India, and the contribution of risk factors to cardiovascular diseases. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings: Overall, cardiovascular diseases contributed 28·1% (95% UI 26·5–29·1) of the total deaths and 14·1% (12·9–15·3) of the total DALYs in India in 2016, compared with 15·2% (13·7–16·2) and 6·9% (6·3–7·4), respectively, in 1990. In 2016, there was a nine times difference between states in the DALY rate for ischaemic heart disease, a six times difference for stroke, and a four times difference for rheumatic heart disease. 23·8 million (95% UI 22·6–25·0) prevalent cases of ischaemic heart disease were estimated in India in 2016, and 6·5 million (6·3–6·8) prevalent cases of stroke, a 2·3 times increase in both disorders from 1990. The age-standardised prevalence of both ischaemic heart disease and stroke increased in all ETL state groups between 1990 and 2016, whereas that of rheumatic heart disease decreased; the increase for ischaemic heart disease was highest in the low ETL state group. 53·4% (95% UI 52·6–54·6) of crude deaths due to cardiovascular diseases in India in 2016 were among people younger than 70 years, with a higher proportion in the low ETL state group. The leading overlapping risk factors for cardiovascular diseases in 2016 included dietary risks (56·4% [95% CI 48·5–63·9] of cardiovascular disease DALYs), high systolic blood pressure (54·6% [49·0–59·8]), air pollution (31·1% [29·0–33·4]), high total cholesterol (29·4% [24·3–34·8]), tobacco use (18·9% [16·6–21·3]), high fasting plasma glucose (16·7% [11·4–23·5]), and high body-mass index (14·7% [8·3–22·0]). The prevalence of high systolic blood pressure, high total cholesterol, and high fasting plasma glucose increased generally across all ETL state groups from 1990 to 2016, but this increase was variable across the states; the prevalence of smoking decreased during this period in all ETL state groups. Interpretation: The burden from the leading cardiovascular diseases in India—ischaemic heart disease and stroke—varies widely between the states. Their increasing prevalence and that of several major risk factors in every part of India, especially the highest increase in the prevalence of ischaemic heart disease in the less developed low ETL states, indicates the need for urgent policy and health system response appropriate for the situation in each state. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Parkinson disease patients develop clinically significant cognitive impairment at variable times over their disease course, which is often preceded by milder deficits in memory, visuo-spatial, and executive domains. The significance of amyloid-β accumulation to these problems is unclear. We hypothesized that amyloid-β PET imaging by 18F-florbetapir, a radiotracer that detects fibrillar amyloid-β plaque deposits, would identify subjects with global cognitive impairment or poor performance in individual cognitive domains in non-demented Parkinson disease patients. We assessed 61 non-demented Parkinson disease patients with detailed cognitive assessments and 18F-florbetapir PET brain imaging. Scans were interpreted qualitatively (positive or negative) by two independent nuclear medicine physicians blinded to clinical data, and quantitatively by a novel volume-weighted method. The presence of mild cognitive impairment was determined through an expert consensus process using Level 1 criteria from the Movement Disorder Society. Nineteen participants (31.2%) were diagnosed with mild cognitive impairment and the remainder had normal cognition. Qualitative 18F-florbetapir PET imaging was positive in 15 participants (24.6%). Increasing age and presence of an APOE ε4 allele were associated with higher composite 18F-florbetapir binding. In multivariable models, an abnormal 18F-florbetapir scan by expert rating was not associated with a diagnosis of mild cognitive impairment. However, 18F-florbetapir retention values in the posterior cingulate gyrus inversely correlated with verbal memory performance. Retention values in the frontal cortex, precuneus, and anterior cingulate gyrus retention values inversely correlated with naming performance. Regional cortical amyloid-β amyloid, as measured by 18F-florbetapir PET, may be a biomarker of specific cognitive deficits in non-demented Parkinson disease patients.

Let f be analytic in open unit disc E = { z : | z | < 1 } with f ( 0 ) = 0 and f ′ ( 0 ) = 1 . The q-derivative of f is defined by: D q f ( z ) = f ( z ) − f ( q z ) ( 1 − q ) z , q ∈ ( 0 , 1 ) , z ∈ B − { 0 } , where B is a q-geometric subset of C . Using operator D q , q-analogue class k − U M q ( α , β ) , k-uniformly Mocanu functions are defined as: For k = 0 and q → 1 − , k − reduces to M ( α ) of Mocanu functions. Subordination is used to investigate many important properties of these functions. Several interesting results are derived as special cases.

We conducted a systematic review of analytical epidemiological studies to assess the association between ChAdOx1-S vaccination and thromboembolic, thrombocytopenic, and hemorrhagic events. We searched Medline, Embase, Google Scholar, WHO-COVID-19 database, and medRxiv for studies evaluating the association between ChAdOx1-S and vascular events. Primary outcomes of interest were cerebral venous sinus thrombosis, peripheral venous thrombosis (PVT), and thrombocytopenia. Two independent reviewers screened for eligible studies, extracted data, and assessed the risk of bias. The DerSimonian-Laird random effects model was used to pool the incidence rate ratios (IRRs) separately for the first and second doses. Heterogeneity was assessed using I2 statistics. Twenty studies were included, of which 11 were self-controlled case series, and nine were cohort studies (254 million participants). Pooling of 17 studies showed a higher risk of cerebrovascular thrombosis (IRR = 3.5, 95% CI = 2.2-5.4, I² = 79%), PVT (IRR = 2.0, 95% CI = 1.1-3.5, I² = 95%) and thrombocytopenia (IRR = 1.6, 95% CI = 1.4-1.9, I² = 93%) among those who received ChAdOx1-S vaccination as compared to controls. No increased risk was seen after the second dose or for secondary outcomes. There is moderate-to-high certainty of the evidence for the increased risk of cerebral venous sinus thrombosis, PVT, and thrombocytopenia following the first dose of the ChAdOx1-S vaccine. Systematic Review Registration: PROSPERO CRD42022372768. [ABSTRACT FROM AUTHOR]

Transfemoral Trans-catheter Aortic Valve Replacement (TF-TAVR) is a safe alternative to surgical aortic valve replacement (SAVR). Protamine is used to reverse heparin and reduce post-TAVR bleeding, but concerns about risks like valve thrombosis and stroke remain. This systematic review and meta-analysis, following PRISMA guidelines, found no statistically significant difference in major bleeding complications between the protamine and control groups [(3.0 % vs. 14.4 %); RR: 0.56; P = 0.16]. No differences were noted in life-threatening bleeding, blood transfusions, 30-day mortality, or stroke. Protamine appears safe post-TAVR without increasing stroke risk, but its effectiveness in reducing bleeding needs further investigation through a multicentric randomized study.

Current studies based on the determination of physicochemical properties and mineral content of natural honey samples collected from 14 districts (Barkhan, Chagi, Dera Bugti, Duki, Kachhi, Kharan, Qilla Abdullah, Kohlu, Lasbella, Lorali, Mach, Masky, Sibi and Zhob) of Balochistan, Pakistan. Among physicochemical properties the observed moisture (12.5-7.68%), Ash content (0.50-0.003%), pH (5.49-3.34), total acidity (65-17 meq/kg), Electrical conductivity (0.791-0.150 mS/cm) and colour (ranges dark amber to white). These values indicated that all collected samples meet well with national and international standards. For mineral content Atomic Absorption spectrophotometer is used to detect level of certain metals (Cd, Pb, Cr, Mn, Fe, Cu, Zn, Na, K, Ca, Mg) to detect the pollutions in the districts where sampling was done. However, the honey samples collected from Barkhan districts display best results among all. Principle component analysis (PCA) was applied to differentiate honey samples on the basis of on elemental composition. The results revealed that four groups were formed in which honey samples show correlation with elements. [ABSTRACT FROM AUTHOR]

This research presents a comprehensive investigation to enhance understanding of subsurface structural complexities within the Upper Cretaceous Pab Sandstone reservoir level in a gas-producing field within the Kirthar Fold Belt of the Southern Indus Basin, Pakistan. The seismic interpretation for accurate structural delineation and characterization of intricate fault systems is often challenging in Fold and Thrust Belt settings. The 3D structural maps of Upper Cretaceous Pab Sandstone at the reservoir level and the application of the ant-tracking attribute for fault extraction improve the structural understanding of the gas-producing field in the Kirthar Fold Belt in the Southern Indus Basin, Pakistan. Attribute-assisted 3D seismic interpretation has revealed several subsurface structure elements, including a large thrusted anticline extended towards the north-south, the pattern of north-south oblique ramp thrusts on the southeastern flank, and a combination of easterly vergent thrusts with a counter-back thrust creating a local pop-up structure in the area. A 3D structural model at the reservoir level was generated using horizon and fault framework volume-based modeling approach, serving as a structural model for Pab sandstone. The structural smoothing, variance and ant-tracking attribute were applied iteratively to get the best results and correlated with manual interpretation. 3D seismic interpretation and application of ant-tracking for fault extraction identifies discrete structural styles and revealed that all thrusting occurred due to compressional tectonics of the Plio-Pleistocene period. The apparent different styles result from the reactivation of earlier extensional fault systems and probably during phased periods of compression. The resulting 3D reservoir model can be used as an input to populate petrophysical properties and results can be extended for future field development plans. Integration of well and 3D seismic data interpretation and the application of automatic fault extraction techniques are highly recommended in structurally complex areas and have an equal implication for worldwide basins with similar conditions for reliable structural interpretation in Fold and Thrust Belts with structural complexity.

Aims: To assess the frontal QRS- T angle (f QRS- T angle) in patients with left bundle branch pacing (LBBP) as compared to right ventricular mid septal pacing (RVSP) implanted for symptomatic high degree atrioventricular (AV) block and to compare with control subjects with normal ventricular conduction (CSNVC) Methods: A total of one-fifty subjects were chosen (50 patients with LBBP, 50 patients with RVSP and 50 CSNVC). The indication for pacemaker implantation was symptomatic high degree AV block. Baseline clinical and electrocardiogram (ECG) parameters like QRS duration (QRSD), QRS axis and f QRS-T angle and Ejection Fraction (EF) were assessed. f QRS-T angle was measured as the difference between the computerised mean frontal QRS and T wave axes in the limb leads. If the difference between the QRS axis and T-wave axis exceeds 180°, then the resultant QRS-T angle would be calculated as 360° minus the absolute angle to obtain a value between 0° and 180°. Baseline, immediate post procedural and 6 month follow up (f/u) ECGs and EF were chosen for the analysis. Results: Patients who underwent LBBP had significantly shorter paced QRSD than patients who had undergone RVSP (112 ± 12 ms vs 146 ± 13 ms; 95 % confidence interval (CI): 43, −31; p

This study investigates the impact of lotus seed powder and chocolate addition on the frozen yogurt formulated with goat milk. It’s hypothesized that it would be a low-fat, high-protein, mineral-rich, healthy alternative to market-available dairy frozen desserts. Four different treatments T1 (7% cocoa powder (CP), milk 90%, lotus seed powder (LSP) 3%), T2 (5% CP, 90% milk, 5% LSP) and T3 (3% CP, 90% milk, 7% LSP) were created using lotus seed and cocoa powder, while T0 (100% pure goat milk) was used as the control. The product underwent a comprehensive evaluation, including a thorough assessment of its physicochemical, phytochemical, mineral, and sensory profiles. Prepared yogurt showed an increase in lotus seed powder i.e. 3, 5, and 7% showed reduction in moisture 31.3, 31.5 and 33.7%, respectively. pH ranged from a minimum of 4.41 in T0 to 5.72 in T2. The phytochemical analysis revealed the mean value of TPC, TFC and DPPH of the product in the range of 41.3–87.6 mg/GAE g, 118–147 mg/GAE g, 86–95 µg/mL. The mineral contents ranged 1405–1430 mg/g for Ca, and 149–165 mg/g for Mg. Sensory evaluation of the product revealed that T2 received the highest score for flavor, texture, color, and overall acceptance of the prepared product. Thus, the addition of lotus seed and cocoa powder to goat milk frozen yogurt demonstrated great sensory and nutritional advantages, making it optional for creating a fresh dairy product with high added values.

Food safety assurance systems are growing increasingly strict in both industrialized and developing nations as a result of increased, both real and perceived food safety concerns. This is happening as a result of developments in both public (such as direct regulation and product liability) and private (such as self and third-party certification) quality control systems. This study assessed the microbial safety, heavy metals contamination, and sensorial characteristics of beef seekh kababs made by local and branded restaurants in Faisalabad. A total of 24 samples were collected from four regions (R1 Lyallpur town, R2 Madina town, R3 Jinnah town, and R4 Iqbal town) of Faisalabad, and analyzed. Physicochemical parameters including moisture, fat, pH, ash, proteins and color (L*, b* and a*), microbiological parameters such as total plate count (TPC), total Coliform count (TCC), E. coli O157:H7, and heavy metals (Cd, Fe, Pb, and Zn) content were determined. Moreover, the lab supervisor and 18 food technology students, who had prior tasting experience, conducted sensory tests on the samples. They evaluated the samples right after they reached the laboratory, before any other analyses. Results showed that the R2 (Local) sample had the significantly (p