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Reyaz Hassan Mir,1 Goutami Godavari,2 Nasir Ali Siddiqui,3 Bilal Ahmad,4 Ramzi A Mothana,3 Riaz Ullah,3 Omer M Almarfadi,3 Sanjay M Jachak,2 Mubashir Hussain Masoodi1 1Pharmaceutical Chemistry Division, Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, India; 2Department of Natural Products, National Institute of Pharmaceutical Education and Research (NIPER), Sahibzada Ajit Singh Nagar, India; 3Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia; 4Department of Molecular Science and Technology, Ajou University, Suwon, South KoreaCorrespondence: Mubashir Hussain MasoodiPharmaceutical Chemistry Division, Department of Pharmaceutical Sciences, University of Kashmir, Hazratbal, Srinagar, Kashmir, 190006, IndiaTel +919419076525Email mubashir@kashmiruniversity.ac.inIntroduction: Oleanolic acid, a pentacyclic triterpenic acid, is widely distributed in medicinal plants and is the most commonly studied triterpene for various biological activities, including anti-allergic, anti-cancer, and anti-inflammatory.Methods: The present study was carried out to synthesize arylidene derivatives of oleanolic acid at the C-2 position by Claisen Schmidt condensation to develop more effective anti-inflammatory agents. The derivatives were screened for anti-inflammatory activity by scrutinizing NO production inhibition in RAW 264.7 cells induced by LPS and their cytotoxicity. The potential candidates were further screened for inhibition of LPS-induced interleukin (IL-6) and tumour necrosis factor-alpha (TNF-α) production in RAW 264.7 cells.Results: The results of in vitro studies revealed that derivatives 3d, 3e, 3L, and 3o are comparable to that of the oleanolic acid on the inhibition of TNF-α and IL-6 release. However, derivative 3L was identified as the most potent inhibitor of IL-6 (77.2%) and TNF-α (75.4%) when compared to parent compound, and compounds 3a (77.18%), 3d (71.5%), and 3e (68.8%) showed potent inhibition of NO than oleanolic acid (65.22%) at 10μM. Besides, from docking score and Cyscore analysis analogs (3e, 3L, 3n) showed greater affinity towards TNF-α and IL-1β than dexamethasone.Conclusion: Herein, we report a series of 15 new arylidene derivatives of oleanolic acid by Claisen Schmidt condensation reaction. All the compounds synthesized were screened for their anti-inflammatory activity against NO, TNF-α and IL-6. From the data, it was evident that most of the compounds exhibited better anti-inflammatory activity.Keywords: LPS, natural products, IL-1β, IL-6, inflammation, RAW 264.7 cells

Sana Samreen,1 Nasir A Siddiqui,2 Syed Wajid,3 Ramzi A Mothana,2 Omer M Almarfadi2 1Department of Pharmacy, College of Pharmacy, Aurobindo College of Pharmaceutical Sciences, Warangal, India; 2Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 3Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Syed Wajid Tel +966-11-4677256Fax +966-11-4677245Email wali@ksu.edu.saPurpose: Dietary supplements (DSs) are popular in many countries, and their use among individuals is increasing worldwide. Therefore, this study aimed to assess the prevalence and use of DSs among pharmacy students in King Saud University College of Pharmacy, Riyadh, Saudi Arabia.Methods: This study used a cross-sectional design targeting male senior pharmacy students in their fourth and fifth years of Bachelor and Doctor of Pharmacy courses. The data were collected between August and October 2019 using paper-based questionnaires.Results: A total of 46.8% of the students used DSs. Of all students surveyed, 19% used branded supplements whereas 9.7% used generic or local supplements and 12.3% used both generic and branded supplements. Furthermore, 8.2% students suffered from side effects, including 5.6% who suffered from nausea, vomiting, and diarrhea and 2.6% who suffered from headache, confusion, and disorientation. Approximately 24.6% of students used fiber DSs whereas 19% and 16.4% used DSs for protein and glucosamine/omega 3 fatty acids, respectively.Conclusion: The study findings indicated that the prevalence of DS use is increasing. However, approximately half of the respondents encourage the use of DSs only with a doctor’s recommendation. Educating about the safe use of DSs is warranted.Keywords: dietary supplements, performance boosters, pharmacy students, minerals, vitamins, Saudi university

Abstract Introduction Visceral leishmaniasis, a tropical infectious disease, is a major public health problem in India. Tuberous sclerosis, a congenital neuro-ectodermosis, is an uncommon disease which requires life long treatment. Case presentation A 15-year-old Indian patient, presented to the outpatient department of our institute with a high-grade fever for two months, splenomegaly and a history of generalized tonic-clonic convulsions since childhood. The clinical and laboratory findings suggested visceral leishmaniasis with tuberous sclerosis. The patient was treated with miltefosine and antiepileptics. Conclusion The patient responded well and in a follow up six months after presentation, she was found free of visceral leishmaniasis and seizures. Diagnosis and treatment of this rare combination of diseases is difficult.

Dodonaea viscosa (Sapindaceae) was collected from Riyadh, Saudi Arabia. For the simultaneous measurement of quercetin and kaempferol, a validated high-performance thin-layer chromatography (HPTLC) approach was devised in D. viscosa leaf extract. The antioxidant activity was evaluated using diphenyl 1-picrylhydrazyl (DPPH) and 2,2′-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) assays. Moreover, the cytotoxic effect was tested against three cancer cell lines A549, HepG2, and MDA-MB-231. The potential anti-inflammatory properties of different fractions of D. viscosa were also evaluated using lipopolysaccharide (LPS)-induced THP-1 macrophages cells. The test samples include a crude extract of leaves and its solvent-soluble fractions of D. viscosa. The results showed that the crude extract and its fractions exhibited various significant biological activities, the fraction of chloroform demonstrated the highest free radical scavenging activity with IC50 values: 172.2 and 257.7 µg/mL for both DPPH and ABTS tests. Additionally, the chloroform fraction had the greatest cytotoxic activity against MDA-MB-231 (IC50 values: 24.6 ± 0.4 µg/mL). Moreover, the chloroform fraction exhibited the highest downregulation of the LPS-induced expression of TNF-α and IL-6. Quercetin and kaempferol were estimated concurrently in leaves crude extract using a validated technique on an HPTLC plate (10 cm2 × 10 cm2) with a combination of toluene–ethyl acetate–formic acid (5:4:0.2; v/v/v) as the mobile phase and a λ max of 254 nm. The amount of quercetin and kaempferol was found to be 31.8 and 15.01 mg/g of dried leaf extract, respectively. The presence of high levels of quercetin and kaempferol in D. viscosa leaves extract could explain its remarkable antioxidant, cytotoxic, and anti-inflammatory effects. The devolved HPTLC method can be used for routine analysis and standardization of D. viscosa crude plant material, extracts, and/or finished products using quercetin and kaempferol as appropriate markers.

Agriculture plays a key role in deciding the economy of the country and agricultural marketing has become the potential driver of the agricultural sector. Green revolution and succeeding technologies made our farmers to succeed in the production front, but lagging appreciably in terms of price realization owing to their inability to stop post-harvest losses and inaccessibility to efficient and scientific marketing system. Post-harvest management includes storage, packaging, coating, disease management, extended shelf life, maintaining food quality. Foods and other products can be preserved by storage at low temperature, which retards the activities of microorganisms and preserve perishable foods in their natural state. Preservation depends on the storage time required whether short or long-term short and the type of product. A cold storage unit works on two principles: Vapour absorption system (VAS), and Vapour compression system (VCS). Although VAS is a bit costlier, but economical in operation. Food irradiation is another recent food preservation technology to address some of post-harvest losses. Food is exposed to ionizing radiation (i.e. radiowaves, microwaves, UV rays, X-rays, gamma rays etc.). Food irradiation can be applied to specific purposes as quarantine treatment of fruits and vegetables and as a method to ensure hygienic quality of foods. Food processing techniques like grading, sorting and packaging, etc add value and enhances shelf life of food. Agricultural productivity augmentation needs a concurrent development of post-harvest support mechanism and efficient and organized marketing system, which would ensure maximum price rrealization to the farmers.

Guaianolide is a type of naturally occurring sesquiterpene lactone compounds that have attracted attention due to their diverse biological properties. In this work, a guaiane-type sesquiterpene lactone identified as deoxycynaropicrin (compound 1) was isolated and reported for the first time from the leaves of Centaurothamnus maximus with two known flavonoid derivatives namely luteolin 6-O-methyl ether (compound 2) and quercetin 3-methyl ether 5-O-glucopyranoside (compound 3). The cytotoxic activity of all the three compounds was evaluated against the THP-1 human leukemia cell lines. Moreover, flow cytometry was employed to explore the cell cycle arrest and apoptosis induction for the active compound. We found that compound 1 (deoxycynaropicrin) exerted the highest cytotoxicity while compounds 2 and 3 showed no activity. Cell cycle analysis showed that compound 1 arrested the cells’ population at the G2/M phase. Furthermore, THP-1 cells treated with compound 1 exhibited a marked increase in the apoptotic cells compared to the control. Overall, this study showed that deoxycynaropicrin induces cytotoxicity against human leukemia cell lines and provided an important insight into its potential therapeutic effects against leukemia cells.

Advances in surgical techniques and greater understanding of the anatomy of the hip now permit minimally invasive hip replacement. Benefits include shorter hospitalization and faster rehabilitation. [ABSTRACT FROM AUTHOR]

The asymmetric unit of the title compound (systematic name: 2-benzoyl-4-chloroaniline), C13H10ClNO, contains four independent molecules with similar dihedral angles between the benzene rings [ranging from 53.7 (2) to 59.8 (2)°]. In the crystal, the molecules are linked by N—H...O hydrogen bonds into a three-dimensional supramolecular architecture.

The Unani eye drop is an ophthalmic formulation prepared for its beneficial effects in the inflammatory and allergic conditions of the eyes. In the present study, the Unani eye drop formulation was prepared and investigated for its anti-inflammatory and antihistaminic activity, using in vivo and in vitro experimental models respectively. The Unani eye drop formulation exhibited significant anti-inflammatory activity in turpentine liniment-induced ocular inflammation in rabbits. The preparation also showed antihistaminic activity in isolated guinea-pig ileum. The anti-inflammatory and antihistaminic activity of eye drop may be due to presence of active ingredients in the formulation. Although there are many drugs in Unani repository which are mentioned in classical books or used in Unani clinical practice effectively in treatment of eye diseases by various Unani physicians. Inspite of the availability of vast literature, there is a dearth of commercial Unani ocular preparations. So, keeping this in mind, the eye drop formulation was prepared and its anti-inflammatory and antihistaminic activity was carried out in animal models. Thus, in view of the importance of alternative anti-inflammatory and anti- allergic drugs, it becomes imperative to bring these indigenous drugs to the front foot and evaluate their activities.

3-Arylidene-5-(4-methylphenyl)-2(3H)-furanones 2a-m were prepared from 3-(4-methyl-benzoyl)propanoic acid 1 and several aromatic aldehydes. Some of the selected furanones were reacted with ammonia gas and benzylamine to give corresponding 3-arylidene-1,3-dihydro-5-(4-methylphenyl)-2H-pyrrol- 2-ones 3a-h and 3-arylidene-1-benzyl-1,3-dihydro-5-(4-methylphenyl)-2H- -pyrrol-2-ones 4a-f, respectively, which were characterized on the basis of IR, 1H-NMR, mass spectral data and elemental analysis results. These compounds were tested for their anti-inflammatory and antibacterial activities. The compounds, which showed significant anti-inflammatory activity, were further screened for their analgesic and ulcerogenic activities. Three new compounds (2e, 2h and 4d), out of twenty-seven showed very good anti-inflammatory activity in the carrageenan induced rat paw edema test, with significant analgesic activity in the acetic acid induced writhing test together with negligible ulcerogenic action. The antibacterial activity is expressed as the corresponding MIC values.

Abstract Background Alzheimer's disease (AD) is common among older adults and leads to significant disability. Volatile anesthetic gases administered during general anesthesia (GA) have been hypothesized to be a risk factor for the development of AD. The objective of this study is to systematically review the association between exposure to GA and risk of AD. Methods We searched electronic databases including MEDLINE, Embase, and Google scholar for observational studies examining the association between exposure to GA and risk of AD. We examined study quality using a modified version of the Newcastle-Ottawa risk of bias assessment for observational studies. We used standard meta-analytic techniques to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup and sensitivity analyses were undertaken to evaluate the robustness of the findings. Results A total of 15 case-control studies were included in the review. No cohort studies were identified that met inclusion criteria. There was variation in the methodological quality of included studies. There was no significant association between any exposure to GA and risk of AD (pooled OR: 1.05; 95% CI: 0.93 - 1.19, Z = 0.80, p = 0.43). There was also no significant association between GA and risk of AD in several subgroup and sensitivity analyses. Conclusions A history of exposure to GA is not associated with an increased risk of AD although there are few high-quality studies in this area. Prospective cohort studies with long-term follow-up or randomized controlled trials are required to further understand the association between GA and AD.

Abstract Background Gallbladder carcinoma (GC) is a relatively rare malignancy worldwide but is the second commonest gastrointestinal cancer in Pakistani women. Gallstones have a positive association with GC but other factors also influence in causation. Methods This is a retrospective case control study over a period of 19 years. The cases (Group A) were patients with histopathological proven carcinoma gallbladder (N = 60) and controls were patients with cholelithiasis but no carcinoma gallbladder on histopathology (N = 120). Multivariate regression analysis was done to calculate the odds ratio, 95% confidence interval and P-Value. A positive relationship was found between size of stone > 1 cm, solitary stone, age > 55 years and multi-parity in women. Results There were 60 patients in Group A and 120 patients in Group B. mean age of diagnosis in Group A patients was 57 ± 2.4 years while mean age of diagnosis in Group B patients was 48 ± 1.35 years. Sixty seven percent of cancer group patients were female as compared to 78% females in non-cancer group. In Group A, 69% of female patients were multiparous (parity of more than 5) while 43% of group B patients were multiparous. For body mass index (BMI), both groups were not very different in our study population i.e. around 78% patients in each group has BMI of more than 23 Kg/m2. In Group A, 37% (n = 22) have solitary stones as compared to 15% (n = 18) in group B. similarly Group A patients has larger stone size as compared to Group B i.e.59% (n = 36) patients in Group A have stones of more than 1 cm when compared to 35% (n = 41) patients in Group B. After using multivariate regression analysis, age more than 55 years (OR - 7.27, p value- < 0.001), solitary stone (OR - 3.33, p value - 0.002) and stone of more than 1 cm (OR - 2.73, p value - 0.004) were found to be independent risk factors for development of gallbladder cancer. Conclusion Most of the patients (78%) with GC were female, and the statistically significant risk factors were older age, solitary stones and stones size more than one centimeter. A case can be made for prophylactic cholecystectomy in such a high risk group. However a population based study is required to calculate the true incidence of GC in Karachi and a prospective multi center study is needed to produce strong evidence for screening and prophylactic cholecystectomy. Trial Registration As this was a retrospective review of medical records, as per institution policy, its gives waiver from any registration (ethical/trial).

Abstract Background The chemokine and chemokine receptor families play critical roles in both the healthy and diseased organism mediating the migration of cells. The chemokine system is complex in that multiple chemokines can bind to one chemokine receptor and vice versa. Although chemokine receptors have been well characterised in humans, the chemokine receptor repertoire of cattle is not well characterised and many sequences are yet to be experimentally validated. Results We have identified and sequenced bovine homologs to all identified functional human chemokine receptors. The bovine chemokine receptors show high levels of similarity to their human counterparts and similar genome arrangements. We have also characterised an additional bovine chemokine receptor, not present in the available genome sequence of humans or the more closely related pigs or horses. This receptor shows the highest level of similarity to CCR1 but shows significant differences in regions of the protein that are likely to be involved in ligand binding and signalling. We have also examined the mRNA abundance levels of all identified bovine chemokine receptors in mononuclear phagocytic cells. Considerable differences were observed in the mRNA abundance levels of the receptors, and interestingly the identified novel chemokine receptor showed differing levels of mRNA abundance to its closest homolog CCR1. The chemokine receptor repertoire was shown to differ between monocytes, macrophages and dendritic cells. This may reflect the differing roles of these cells in the immune response and may have functional consequences for the trafficking of these cells in vivo. Conclusions In summary, we have provided the first characterisation of the complete bovine chemokine receptor gene repertoire including a gene that is potentially unique to cattle. Further study of this receptor and its ligands may reveal a specific role of this receptor in cattle. The availability of the bovine chemokine receptor sequences will allow further characterisation of the function of these genes and will confer wide-reaching benefits to the study of this important aspect of the bovine immune response.

Establishing a potential site characterization for carbon dioxide (CO 2 ) storage in geological formations anticipates the appropriate reservoir properties, such as porosity, permeability, and so forth. Well logs and seismic data were utilized to determine key reservoir properties, including volume of shale, porosity, permeability, and water saturation. These properties were cross validated with core data sets to ensure accuracy. To enhance permeability estimation, sophisticated machine learning (ML) methods were employed, categorizing permeability into five classes ranging from extremely good (0) to very low (4). Two ML models, Naïve Bayes (NB) and multilayer perceptron (MLP), were applied to predict permeability. The MLP model outperformed the NB model, achieving 99% training accuracy and 93% testing accuracy, compared to 78 and 73%, respectively, for the NB model. The resulting comprehensive permeability model revealed the distribution across three stratigraphic layers: the B100 zone exhibited extremely low permeability, suitable as a caprock, while the D35-1 and D35-2 zones demonstrated excellent permeability, indicating potential as CO 2 storage reservoirs. The "X" field reservoir, located at depths exceeding 1300 m, meets the depth requirements (1000-1500 m) for CO 2 storage. Our integrated approach, combining empirical and ML-based calculations with core data and well logs, proved effective in characterizing the reservoir. The lithological model defined nonreservoir sections between the clay and silt lines, identifying important caprocks and interbedded shale/clay intervals. Seismic profiling confirmed the B100 zone as a continuous caprock overlying the D group reservoir zone, crucial for preventing upward CO 2 migration. This comprehensive analysis supports the potential of the "X" field in the Malay Basin as a viable site for CO 2 storage, contributing to the ongoing efforts in carbon capture and storage research., Competing Interests: The authors declare no competing financial interest., (© 2025 The Authors. Published by American Chemical Society.)

Japanese encephalitis (JE) is the leading cause of acute encephalitis syndromes (AES). Although Bihar has comprehensive data on JE, it ranks third behind Uttar Pradesh and Assam in terms of reported cases. We wanted to determine the incidence of JE cases in Bihar and the endemic districts. In Patna, Muzaffarpur and Gaya, Bihar, this study revealed that JEV is one of the major causes of AES and its epidemiology. We analyzed blood and CSF samples from AES patients delivered to a viral diagnostic laboratory between January 2018 and December 2022 for IgM antibodies against JEV using the enzyme immunoassay recommended by NIV, Pune, India. We detected JEV IgM in 193 (8.79 %) of 2195 individuals. Patient demographics included age, gender and place of residence. Most patients were 6-10 years old and had the disease in June. We need to increase awareness initiatives and cross-sector prevention despite the decline in case fatality rate., Competing Interests: Declaration of competing interest There is no conflict of interest among all the authors of the research work entitled “Prevalence of Japanese Encephalitis infection in Children below 15 years’ age, Bihar” in your esteemed journal., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The Constructing an efficient and low-cost oxygen evolution reaction (OER) electrocatalyst is critical for improving the performance of electrolysis in alkaline water. In this study, a self-supported electrocatalyst of flower-like cobalt phosphide and tungsten oxide (Co 2 P/WO 3-x /CC) was prepared on carbon cloth (CC) surface by hydrothermal reaction with solution immersion etching and phosphorization annealing under H 2 /Ar atmosphere. This strategy can generate oxygen vacancies (O V ), improving the speed of charge transfer between cobalt phosphide (Co 2 P) and tungsten oxide (WO 3-x ) components. The catalyst greatly increases the electrochemical active surface area, which is beneficial for efficient oxygen evolution. Electrochemical testing studies show that in 1.0 M KOH solution, Co 2 P-WO 3-x /CC catalyst exhibits good OER activity, with a low overpotential of 254 mV at 10 mA cm -2 , a small Tafel slope of 58.32 mV dec -1 . The synergistic effect of oxygen vacancies and Co 2 P with WO 3-x can regulate electronic structures, expose more active sites, and cooperatively enhancing the OER activity. This study provides a workable strategy for preparing efficient non-noble metal OER electrocatalysts on engineered interfaces and O V ., (© 2024 Wiley-VCH GmbH.)

Minimally invasive surgery (MIS) continues to develop as a viable alternative to traditional open surgery for various foot and ankle pathologies. The neuropathic foot is one area where MIS can be very beneficial to surgeons and their patients. Improving wound healing and decreasing the surgical footprint and thus reducing complications associated with soft tissue in this population is advantageous. Further research is necessary; however, the early successful outcomes in neuroarthropathy reconstruction via MIS are encouraging., Competing Interests: Disclosure S. Mateen and M. Greenblatt have no financial disclosures or conflicts of interest. N.A. Siddiqui is a consultant for Arthrex. The following organizations supported the institution of M. Greenblatt, S. Mateen, and N.A. Siddiqui: DePuy Synthes, United States, NuVasive Specialized Orthopedics, United States, Orthofix, United States, OrthoPediatrics, Paragon 28, Pega Medical, Smith & Nephew, United Kingdom, Stryker, United States, Turner Imaging Systems, and WishBone Medical., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study aimed to evaluate the accuracy and reproducibility of information provided by ChatGPT, in response to frequently asked questions about radiofrequency ablation (RFA) for varicose veins., Methods: This cross-sectional study was conducted at The Aga Khan University Hospital, Karachi, Pakistan. A set of 18 frequently asked questions regarding RFA for varicose veins were compiled from credible online sources and presented to ChatGPT twice, separately, using the new chat option. Twelve experienced vascular surgeons (with >2 years of experience and ≥20 RFA procedures performed annually) independently evaluated the accuracy of the responses using a 4-point Likert scale and assessed their reproducibility., Results: Most evaluators were males (n = 10/12 [83.3%]) with an average of 12.3 ± 6.2 years of experience as a vascular surgeon. Six evaluators (50%) were from the UK followed by three from Saudi Arabia (25.0%), two from Pakistan (16.7%), and one from the United States (8.3%). Among the 216 accuracy grades, most of the evaluators graded the responses as comprehensive (n = 87/216 [40.3%]) or accurate but insufficient (n = 70/216 [32.4%]), whereas only 17.1% (n = 37/216) were graded as a mixture of both accurate and inaccurate information and 10.8% (n = 22/216) as entirely inaccurate. Overall, 89.8% of the responses (n = 194/216) were deemed reproducible. Of the total responses, 70.4% (n = 152/216) were classified as good quality and reproducible. The remaining responses were poor quality with 19.4% reproducible (n = 42/216) and 10.2% nonreproducible (n = 22/216). There was nonsignificant inter-rater disagreement among the vascular surgeons for overall responses (Fleiss' kappa, -0.028; P = .131)., Conclusions: ChatGPT provided generally accurate and reproducible information on RFA for varicose veins; however, variability in response quality and limited inter-rater reliability highlight the need for further improvements. Although it has the potential to enhance patient education and support healthcare decision-making, improvements in its training, validation, transparency, and mechanisms to address inaccurate or incomplete information are essential., Competing Interests: Disclosures None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

This study aims to explore the perspectives of medical students on the newly introduced Surgical Sub-internship (SI) rotation in year 5 Surgical Clerkship. This cross-sectional study was conducted at The Aga Khan University Hospital, Karachi, Pakistan from September 2022 to September 2023. A self-designed 5-point Likert scale-based evaluation form was created to explore students' perspectives regarding their one-week Surgical SI rotation. We included students from the class of 2022 and 2023 who completed the surgical SI rotation. A total of 121 medical students from the class of 2022 ( n =73,60%) and 2023 ( n =48, 40%) participated in the study with a female-to-male ratio of 53 (44%):68 (56%). Students expressed positive attitudes toward the SI rotation, with 92 (76%) agreeing on the accessibility of medical staff/chief residents, 89 (74%) indicating clarity in goals, 86 (71%) understanding practical issues in clinical settings, 83 (69%) recognizing good learning opportunities for practicing essential skills, and 81 (67%) reporting good opportunities to observe and perform procedures. However, 53 (44%) found the rotation duration inadequate for achieving the desired objectives. Written feedback as narrative comments were also received. The commonly identified areas of improvement included effective communication of rotation objectives, a conducive learning environment, patient volume, standardized teaching, operating room exposure, student assignment to interns, resident involvement in teaching, and awareness of the stakeholders. Medical students provided positive perceptions regarding the surgical SI rotation. However, the identified areas of improvement should be integrated to enhance its overall effectiveness., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

The medicinal and commercial value of pomegranate peel is attributed to its rich content of phenolic compounds, yet little is known about their concentrations and biological activity across different ripening stages. Pomegranate peels at different growth stages 1-3 (40, 80, and 120 days after fruit appearance respectively) were collected, dried, and macerated with 90% methanol. Stage 2 and stage 3 extract showed significant antimicrobial activity against S. aureus , and L. monocytogenes . Further, stage 2 extract showed highest efficacy against lung, breast, and liver cancer cells with IC 50 values of 19.76 ± 1.3, 24.28 ± 6.99, and 16.04 ± 2.78 µg/mL, respectively. Molecular docking, and simulation further confirmed the antimicrobial and cytotoxic activity of the most prominent stage 2 phytoconstituent (γ-Sitosterol). The study indicates that stage 2 pomegranate peel extract has potential as a safe and natural antimicrobial and cytotoxic agent. However, additional in vitro and in vivo testing is needed to validate these results.

Hydrogen, known for its high energy density and environmental benefits, serves as a prime substitute for fossil fuels. Nonetheless, the hydrogen evolution reaction (HER), essential in electrolysis, encounters challenges with slow kinetics and significant overpotential, which elevate costs and reduce efficiency. Thus, developing efficient electrocatalysts to reduce HER overpotential is vital to enhance hydrogen production efficiency and minimize energy consumption. Adjusting the electronic structure of transition metal oxides via elemental doping is a potent strategy to improve the effectiveness of electrocatalysts for hydrogen evolution. In this work, we synthesized a set of niobium-doped tungsten oxides (Nb x -W 18 O 49 ) under anoxic conditions using a straightforward "one-pot" solvothermal approach. After doping Nb, the oxygen vacancy content inside W 18 O 49 was increased, which induced a synergistic effect with the active sites of tungsten. In acidic environments, the hydrogen evolution activity of the Nb 0.6 -W 18 O 49 electrocatalyst is second only by 20 wt % Pt/C. It attains a current density of -10 mA cm -2 at an overpotential of 102 mV. By comparison with W 18 O 49 , Nb 0.4 -W 18 O 49 and Nb 0.5 -W 18 O 49 , Nb 0.6 -W 18 O 49 demonstrates a reduced charge transfer resistance, which significantly enhances its conductivity and the speed of electron movement across interfaces. Coupled with this feature are notably faster HER kinetics. Additionally, it exhibits excellent stability, meaning it maintains its performance and structural integrity over prolonged periods and under various operational conditions. This article provides a new perspective for discovering inexpensive and efficient hydrogen evolution electrocatalyst materials., (© 2024 Wiley-VCH GmbH.)

Swelling of shale in clastic reservoirs poses a significant challenge, causing instability in wellbores. Utilizing water-based drilling mud with shale inhibitors is preferable for environmental reasons over oil-based mud. Ionic liquids (ILs) have garnered interest as shale inhibitors due to their customizable properties and strong electrostatic features. However, widely used imidazolium-based ILs in drilling fluids are found to be toxic, non-biodegradable, and expensive. Deep Eutectic Solvents (DES), considered a more economical and less toxic alternative to ILs, still fall short in terms of environmental sustainability. The latest advancement in this field introduces Natural Deep Eutectic Solvents (NADES), renowned for their genuine eco-friendliness. This study explores NADES formulated with citric acid (as a Hydrogen Bond Acceptor) and glycerine (as a Hydrogen Bond Donor) as additives in drilling fluids. The NADES based drilling mud was prepared according to API 13B-1 standards and their efficacy was compared with KCl, imidazolium based ionic liquid, and Choline Chloride: Urea-DES based mud. A thorough physicochemical characterization of the in-house prepared NADES is detailed. The research evaluates rheological, filtration and shale inhibition properties of the mud, demonstrating that NADES enhanced the yield point to plastic viscosity ratio (YP/PV), reduced mudcake thickness by 26%, and decreased filtrate volume by 30.1% at a 3% concentration. Notably, NADES achieved an impressive 49.14% inhibition of swelling and improved shale recovery by 86.36%. These outcomes are attributed to NADES' ability to modify surface activity, zeta potential, and clay layer spacing which are discussed to understand the underlying mechanism. This sustainable drilling fluid promises to reshape the drilling industry by offering a non-toxic, cost-effective, and highly efficient alternative to conventional shale inhibitors, paving the way for environmentally conscious drilling practices., (© 2024. The Author(s).)

An assessment of the treatment outcomes of single-dose liposomal amphotericin B, implemented in 2010, had not been conducted until this study. This prospective cross-sectional study encompassed 527 cases, comprising 470 (89%) cases of visceral leishmaniasis (VL) and 57 (11%) cases of post-kala-azar dermal leishmaniasis (PKDL). The male proportion was higher (55% for VL), and the mean (±SD) age was 39.2 (±33.9) years. Among VL cases (426) treated with single-dose liposomal amphotericin B, 402 cases were cured at the 6-month follow-up, resulting in a cure rate of 95%, whereas fewer than 1% (0.9%) experienced unsuccessful outcomes and 4.1% faced relapse. A statistically highly significant difference in treatment outcomes (successful versus unsuccessful) was observed between males and females (P = 0.0005). Males had higher odds of successful outcomes compared with females, with an odds ratio of 5.03 (95% CI: 1.84-13.74). Those aged ≤23 years had higher odds of successful outcomes than unsuccessful outcomes, with an odds ratio of 6.82 (95% CI: 2.29-20.33). Patients with PKDL had a mean (±SD) age of 28.5 (±10.6) years, with 63% being male. Among the 57 PKDL cases, 21 (37%) had been treated with single-dose liposomal amphotericin B, whereas others had received alternative drugs. The median duration of PKDL development for single-dose liposomal amphotericin B was significantly shorter (14.5 months), with a statistically significant difference (P <0.001) compared with other drugs. The current treatment strategy necessitates continuous close monitoring and reviews to ensure consistent and improved outcomes.

Objectives: Simulation is used across surgical specialties for skill enhancement. The choice and assessment method of a simulator varies across literature. In the age of endovascular approach, trainees have limited exposure to open lower limb bypass procedures which needs attention. This review aims to assess the utility of simulation training in lower limb bypass surgery using Kirkpatrick's model., Methods: Using PRISMA statement, we included all the studies done on simulators in lower limb bypass surgical procedures for this systematic review. The primary outcome was to assess the effectiveness of different types of simulation used for lower limb bypass surgery using the Kirkpatrick's model for training evaluation., Results: An initial search identified 295 articles out of which 7 articles were found to be eligible for this systematic review. A variety of simulators were used including cadavers and synthetic models. Most studies ( n =5) found the use of simulation as an effective tool in achieving technical competence. All the five studies we found at level 2 on Kirpatrick's model evaluation., Conclusion: Most of the existing studies are at level 2 of Kirkpatrick's model which reflects learning changes in trainees after simulation. Feedback mechanism needs to be evolved where the improvement after simulation training can be gauged by its replication in clinical practice and improved patient care practices corresponding to the highest level of Kirkpatrick's model., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Rheumatoid arthritis, a chronic autoimmune disorder affecting millions worldwide each year, poses a significant threat due to its potential for progressive joint damage and debilitating pain if left untreated. Topical anti-inflammatory and analgesic treatments offer localized relief with reduced systemic side effects compared to conventional oral therapies, making them a promising option for managing rheumatoid arthritis. Therefore, the current study endeavored to formulate a microemulsion gel formulation loaded with diclofenac and curcumin for topical administration in the management of rheumatoid arthritis, utilizing Tea tree oil. The ratio of surfactant and cosurfactant was 4:1, assessed by pseudoternary phase diagram on the basis of the maximum emulsification region. The microemulsion underwent optimization using a Central Composite Rotatable Design (CCRD) with constraints of minimum particle size, polydispersity index, and maximum transmittance. The Curcufenac-T microemulsion had a particle size, polydispersity index (PDI), and transmittance of 151.82 ± 15.9 nm, 0.287 ± 0.021, and -5.78 ± 0.26 mV, respectively. DSC analyses confirmed the stability and compatibility of diclofenac and curcumin within the formulation. The microemulsion was changed into gel form by incorporating 1% carbopol-934. Skin permeation analysis revealed that the percentage of diclofenac permeated at 0.5 h from Curcufenac-T microemugel and the conventional gel was 12.1% and 3.9%, respectively, while at 12 h, the rates were 82.6% and 34.2%, respectively. In vitro permeability demonstrated significant potential for the effective delivery of diclofenac and curcumin to targeted sites, compared to conventional gel. Therefore, it was deduced that the Tea tree oil integrated diclofenac and curcumin microemulsion gel could enhance the effectiveness of diclofenac and serve as a promising vehicle for rheumatoid arthritis treatment.

The Baraichari Shale Formation, which is equivalent to the Boka Bil Formation, is well exposed within the Neogene sequence of the Sitapahar Anticline in the Chittagong-Tripura Fold Belt, Bengal Basin, Bangladesh. Regardless of its importance in hydrocarbon accumulation, a comprehensive facies analysis is essential to understand and explain the heterogeneity within different depositional architectural elements. The purpose of this work is to delineate the lithofacies characteristics, depositional environment heterogeneities and propose a generic depositional model for the Middle to Late Miocene shallow marine sediments of the formation. The sedimentary facies were investigated at three outcrops along the Kaptai-Chandraghona road cut sections of the Sitapahar anticline. The formation is composed of dark to bluish-gray shale, silty shale, yellowish brown siltstone, and gray to yellowish brown fine-to medium-grained sandstone. Eight distinct sedimentary facies have been identified and were categorized into three facies associations: subtidal or estuarine, mixed flats with tidal creeks, and tidal mud flats. The subtidal facies, predominant in the middle member, consists of fine to medium-grained ripple cross-stratified sandstone-siltstone, herringbone cross-stratified sandstone, and trough cross-stratified sandstone, indicating sub-tidal channel deposition. Mixed flats with tidal creeks exhibit heterolithic facies, suggesting energy level changes in intertidal to sub-tidal zones influenced by tidal currents. Tidal mud flats are predominantly laminated shale/mudstone and lenticular laminated sandstone-siltstone, reflecting deposition during tide transitions in the intertidal zone. Fining upward cycles within the formation indicate progressive progradation or changes in inner tidal flats conditions during regressive periods. These depositional settings serve as analogs for equivalent subsurface reservoirs and contribute to the construction of reservoir models with greater accuracy., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Numair Ahmed Siddiqui reports financial support was provided by 10.13039/501100016152YUTP. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

With growing environmental concerns, the removal of toxic industrial dyes from wastewater has become a critical global issue. In this study, TiO 2 -CuSe composites were synthesized using a cost-effective and simple chemical method to determine the optimal concentration of CuSe for the efficient degradation of methylene blue (MB) under visible light. The TiO 2 samples exhibited a mix of rutile and anatase phases, while CuSe formed in a hexagonal phase. Both TiO 2 and CuSe were observed to have agglomerated particles with indistinct boundaries. The optical bandgap shifted towards the visible region from 3.25 eV (pure TiO 2 ) to 2.91 eV with increasing the amount of CuSe in the composites. The photocatalytic activity of TiO 2 , CuSe, and TiO 2 -CuSe composites was evaluated by monitoring MB degradation, with the composites outperforming the individual components under visible light. Notably, the TiO 2 -20% CuSe composite (AK-4) demonstrated superior efficiency, removing 98% of MB in just 70 minutes. The photocatalysts also exhibited enhanced antibacterial properties, effectively reducing E. coli colonies from 1.71 × 10 12 CFU mL -1 (pure TiO 2 ) to 1 × 10 10 CFU mL -1 for the AK-4 composite. This study suggests that visible light-activated TiO 2 -CuSe composites could be effective for both water purification and bacterial infection control., Competing Interests: The authors declare no conflicts of interest., (This journal is © The Royal Society of Chemistry.)

This systematic review and meta-analysis aimed to assess the association of neutrophil-to-lymphocyte ratio (NLR) with an elevated risk of vascular access failure in end-stage renal disease (ESRD) patients undergoing hemodialysis. A comprehensive database search of MEDLINE (via PubMed), Scopus, and Cochrane Central was performed. Studies reporting the values of NLR in both functional and non-functional AVF groups in ESRD patients were selected. Quality assessment was performed using the Modified Newcastle-Ottawa scale for observational studies. Meta-analysis was performed using an inverse variance random effects model. Seven observational studies met the inclusion criteria, including 1313 participants with 554 cases and 759 controls. Pooled results showed significantly high NLR levels in patients with non-functional arteriovenous fistula (AVF) compared to functional AVF (SMD = 1.19, 95% CI = 0.74-1.65, p  < 0.001). Subgroup analysis confirmed the consistency of the association between NLR and AVF failure across study design (SMD = 1.76, 95% CI = 0.78-2.73, p =  0.0004 in prospective vs SMD = 0.87, 95% CI = 0.42-1.32, p =  0.0001 in retrospective studies), etiology (SMD = 1.63, 95% CI = 0.75-2.52, p =  0.0003 in stenosis or thrombosis; and SMD = 0.80, 95% CI = 0.27-1.34, p  = 0.003 in failure to mature of AVF), and NLR measurement timing (SMD = 0.98, 95% CI = 0.42-1.54, p =  0.0006 in preoperative vs SMD = 1.58, 95% CI = 0.47-2.69, p =  0.005 in postoperative NLR). The pooled odds ratio revealed high NLR values as a significant predictor of AVF failure in ESRD patients (OR = 3.91, 95% CI = 1.91-7.98, p  = 0.0002). The pooled sensitivity and specificity were 89.72% (95% CI = 77.51%-95.67%) and 72.95% (95% CI = 63.82%-80.47%), respectively. The high NLR is a useful and predictive marker for AVF failure in hemodialysis patients. Future studies should prioritize larger cohort studies to validate and reinforce these observations., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Miltefosine stands as the sole oral medication approved for the treatment of leishmaniasis. The appearance of severe ophthalmic toxicities induced by miltefosine in the context of leishmaniasis treatment is a matter of significant concern. The main objective of this study is to present a comprehensive summary of the ophthalmic adverse effects associated with miltefosine when used in the treatment of leishmaniasis., Methods: A systematic search was performed on PubMed, ScienceDirect, Embase, Scopus, and Google Scholar, covering articles from inception up to June 2023, without language restrictions, to identify relevant studies documenting ocular toxicity following miltefosine treatment for leishmaniasis., Results: A total of eight studies involving 31 leishmaniasis patients who developed ocular toxicities while undergoing miltefosine treatment were included in the analysis. These studies were conducted in various regions, with five originating from India, two from Bangladesh, and one from Nepal. Patients presented a spectrum of ophthalmic complications, including uveitis, keratitis, scleritis, and Mooren's ulcer. Commonly reported symptoms included pain, redness, excessive tearing, partial vision impairment, permanent blindness, light sensitivity, and the appearance of white spots on the eye. On average, patients received miltefosine treatment for a duration of 47 days before experiencing the onset of ocular problems. It is important to note that the risk of ocular toxicities increases with prolonged use of miltefosine., Conclusions: Therefore, to mitigate the potential for irreversible damage to the eyes, it is imperative that all individuals undergoing miltefosine therapy undergo regular eye examinations.

Post-kala-azar dermal leishmaniasis (PKDL) is a neglected skin disease that has tremendous epidemiological significance as a reservoir of Leishmania parasites. Relapse, drug resistance, non-compliance to prolonged treatment, poor health-seeking behaviour, along with limited therapeutic options pose a significant impact on the management of PKDL. In this study, we aimed to review the efficacy, safety and tolerability data of combination therapies for PKDL in the published literature. We have also described patients' compliance with treatment and associated co-infections in PKDL. A comprehensive literature search was conducted in PubMed, Scopus and Google Scholar to identify the relevant articles. A total of nine studies were eligible for inclusion in this review. Drug combinations used in India were miltefosine-liposomal amphotericin-B, miltefosine-paromomycin, miltefosine-amphotericin-B, sodium stibogluconate (SSG)-immunotherapy and SSG-rifampicin. However, in Sudan, except one, all studies have used SSG-based combinations viz. SSG-rifampicin, SSG-paromomycin and SSG-immunotherapy. The efficacy and safety of miltefosine in combination with liposomal amphotericin-B as well as conventional amphotericin-B were found to be excellent in a limited number of patients. These combinations are said to have better patient compliance and shorter treatment duration. Another combination of miltefosine and paromomycin was found to be satisfactory with a final cure rate of 83.3%. SSG in combination with paromomycin had a good clinical outcome among severe PKDL patients in Sudan, though pain at the injection site was experienced by all patients. There is a lack of data on combination therapies for PKDL through large-scale randomised controlled trials (RCTs). Therefore, multicentric randomized controlled trials with a sufficiently large sample size are urgently needed to verify the efficacy, safety, and other advantages of combination therapies for PKDL. With the availability of liposomal amphotericin-B, miltefosine and immunotherapy, clinical management of PKDL appears promising., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Dermatology.)

Background and Purpose: SGLT2 inhibitors are class of drugs that are used in adults with type 2 diabetes through a novel mechanism of action by reducing renal tubular glucose reabsorption, leading to a reduction in blood glucose without stimulating insulin release. In this systematic review, we report the effects of treatment with SGLT2 inhibitors on urinary tract infection (UTI) and genitourinary infection (GUI)., Method: The study integrated data from landmark trials of SGLT2 inhibitors (CANVAS, CREDENCE, DECLARE-TIMI 58, and EMPA-REG) to interpret the association of SGLT2 inhibitors with genital infection (GI) and UTI. We reported the review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome was a composite of participants reporting UTI and GUI prescribed on SGLT2 inhibitors., Results: The analysis of four studies involving 38,723 participants revealed incidences of both UTIs and GUI. In the SGLT2 inhibitor group, comprising 21,266 participants, 222 (1.04%) experienced UTIs, and 477 (2.24%) reported GUI. In contrast, among the placebo group consisting of 17,457 participants, 201 (1.15%) reported UTIs, and 70 (0.40%) reported genital infections. These findings underscore the elevated risk associated with SGLT2 inhibitor use, particularly regarding GUI, necessitating careful consideration in clinical practice and patient management strategies., Conclusion: The incidence of UTIs and particularly more pronounced GUI associated with SGLT2 inhibitors highlights the importance of careful risk assessment and monitoring in clinical decision-making, underscoring the need for patient management strategies., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Objective: To determine the frequency and pattern of different aetiologies of leg pain among patients visiting vascular surgery clinics., Study Design: Cross-sectional study. Place and Duration of the Study: Vascular Surgery Clinics of the Aga Khan University Hospital, Karachi, Pakistan, between February 2021 and June 2023., Methodology: This study examined patients presenting with leg pain for the first time at vascular surgery clinics. The socio-demographic and clinical data including the clinical symptoms, physical examination findings, and management of leg pain were noted using a specially designed proforma., Results: In a total of 142 patients (200 limbs), 82 (57.7%) were females and 60 (42.3%) were males, with a mean age of 46.8 ± 15.1 years. The patients' mean body mass index (BMI) was 30.2 ± 7.9 kg/m2. Ninety-one (64.1%) patients had a predominantly standing job compared to 51 (35.9%) patients who had a predominantly sitting job. The most common aetiology of leg pain was chronic venous insufficiency (CVI), diagnosed in 107 (53.5%) patients, followed by neurogenic pain [41 (20.5%)], musculoskeletal pain including knee osteoarthritis [30 (15.0%)], and arterial insufficiency [22 (11.0%)].  Conclusion: CVI followed by neuropathic pain was the leading cause of leg pain in vascular surgery clinics at a tertiary care hospital., Key Words: Chronic venous insufficiency, Arterial insufficiency, Vascular surgery, Leg pain, Musculoskeletal pain, Neuralgia.

In this case report, we highlight a rare case of palindromic rheumatism (PR) presenting as polymyalgia rheumatica (PMR). Many challenges and complexities are associated with diagnosing and treating PR. Literature reviews showed only a few case reports of this unique presentation. PR has a distinct presentation that often goes unnoticed and is misinterpreted by medical professionals. A more thorough clinical approach is required to identify and treat this condition. We hope sharing such uncommon cases will help the medical community better understand PR and develop improved diagnostic and therapeutic options. This case also demonstrates the need for further research to better understand the pathogenesis of this uncommon condition., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Farooq et al.)

Background: Post-kala-azar dermal leishmaniasis (PKDL) is a dermatosis which can occur after successful treatment of visceral leishmaniasis (VL) and is a public health problem in VL endemic areas. We conducted a systematic scoping review to assess the characteristics of published PKDL clinical studies, understand the scope of research and explore the feasibility and value of developing a PKDL individual patient data (IPD) platform., Methods: A systematic review of published literature was conducted to identify PKDL clinical studies by searching the following databases: PubMed, Scopus, Ovid Embase, Web of Science Core Collection, WHO Global Index Medicus, PASCAL, Clinicaltrials.gov, Ovid Global Health, Cochrane Database and CENTRAL, and the WHO International Clinical Trials Registry Platform. Only prospective studies in humans with PKDL diagnosis, treatment, and follow-up measurements between January 1973 and March 2023 were included. Extracted data includes variables on patient characteristics, treatment regimens, diagnostic methods, geographical locations, efficacy endpoints, adverse events and statistical methodology., Results: A total of 3,418 records were screened, of which 56 unique studies (n = 2,486 patients) were included in this review. Out of the 56 studies, 36 (64.3%) were from India (1983-2022), 12 (21.4%) from Sudan (1992-2021), 6 (10.7%) were from Bangladesh (1991-2019), and 2 (3.6%) from Nepal (2001-2007). Five (8.9%) studies were published between 1981-1990 (n = 193 patients), 10 (17.9%) between 1991-2000 (n = 230 patients), 10 (17.9%) between 2001-2010 (n = 198 patients), and 31 (55.4%) from 2011 onwards (n = 1,865 patients). Eight (14.3%) were randomised clinical trials, and 48 (85.7%) were non-randomised studies. The median post-treatment follow-up duration was 365 days (range: 90-540 days) in 8 RCTs and 360 days (range: 28-2,373 days) in 48 non-randomised studies. Disease diagnosis was based on clinical criterion in 3 (5.4%) studies, a mixture of clinical and parasitological methods in 47 (83.9%) and was unclear in 6 (10.7%) studies. Major drugs used for treatment were miltefosine (n = 636 patients), liposomal amphotericin B (L-AmB) (n = 508 patients), and antinomy regimens (n = 454 patients). Ten other drug regimens were tested in 270 patients with less than 60 patients per regimen., Conclusions: Our review identified studies with very limited sample size for the three major drugs (miltefosine, L-AmB, and pentavalent antimony), while the number of patients combined across studies suggest that the IPD platform would be valuable. With the support of relevant stakeholders, the global PKDL community and sufficient financing, a PKDL IPD platform can be realised. This will allow for exploration of different aspects of treatment safety and efficacy, which can potentially guide future healthcare decisions and clinical practices., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Singh-Phulgenda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study focuses on the current applications, potential, and challenges to Artificial Intelligence (AI) integration in vascular surgery with specific emphasis on its relevance in Pakistan. Despite the benefits of AI in vascular surgery, there is a substantial gap in its adoption in Pakistan compared to global standards. In our context with limited resources and a scarcity of vascular surgeons, AI can serve as a promising solution. It can enhance healthcare accessibility, improve diagnostic accuracy, and alleviate the workload on vascular surgeons. However, hurdles including the absence of a comprehensive vascular surgery database, a shortage of AI experts, and potential algorithmic biases pose significant challenges to AI implementation. Despite these obstacles, the study underscores the imperative for continued research, collaborative efforts, and investments to unlock the full potential of AI and elevate vascular healthcare standards in Pakistan.

Objective: To develop and content validate a questionnaire to assess the financial and functional impact of major lower limb amputation in patients with diabetes-related foot disease., Design: Prospective observational study., Setting: This study was conducted at a tertiary care centre in Pakistan., Participants: We conducted a thorough literature review and a group interview with 10 participants, resulting in domain identification and item generation. The group included seven patients with diabetes-related foot disease who underwent major lower limb amputation and three caregivers. Subsequently, a focused group discussion was held to assess overlap and duplication among the items, and two rounds of content validation were carried out by five content and five lay experts in both English and Urdu. Question items with a Content Validity Index (CVI) score of >0.79 were retained, items with a CVI score between 0.70 and 0.79 were revised and items with a CVI score of <0.70 were excluded., Results: The initial literature review and group interview resulted in 61 items in the financial and functional domains. After the focused group discussion, the questionnaire was reduced to 37 items. Following two rounds of content validation, the English questionnaire achieved the Scale-Content Validity Index/Average (S-CVI/Ave) of 0.92 and 0.89 on relevance and clarity, respectively. Similarly, the Urdu questionnaire achieved the S-CVI-Ave of 0.92 and 0.95, respectively., Conclusion: A 37-item multidimensional questionnaire was developed and rigorously content-validated to assess the financial and functional impact of major lower limb amputation in patients with diabetes-related foot disease. The questionnaire used in this study has shown robust content validity specifically for our population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The early to middle Permian Dohol Formation is characterized by a significant presence of shale deposits. While these shales exhibit a low potential to generate hydrocarbons, there is a need to ascertain the possible reasons for the low hydrocarbon generation potential. Also, there are several unidentified properties and attributes associated with these shales in terms of their inorganic geochemical characteristics and their mineralogy. This study is focused on using XRF, ICPMS, and SEM with EDX to determine the mineralogical and geochemical characteristics of these shales and use these data to discuss their provenance history and tectonic setting and interpret the paleoclimatic and paleoweathering conditions. The inorganic geochemical analysis shows that the shales from the Dohol Formation are from a felsic igneous source. The shales were also identified to be from a passive margin based on the bivariate plot of SiO 2 vs log (K 2 O/Na 2 O) and several multidimensional diagram plots. The CIA and CIW data, as well as the A-CN-K plot, all point to a significant degree of chemical weathering, ranging from mild to intense. The Sr/Cu ratio and C-value, combined with various other geochemical proxies, indicate that the shales were formed in warm-humid climatic conditions. The SEM analysis shows that the samples are mainly composed of kaolinite and illite, and this result was supported by the EDX elemental composition. The high terrigenous influx of sediments, the oxic to sub-oxic conditions in which the sediments were deposited, and finally low marine productivity were found to be the reasons for the low TOC in the shales from the Dohol Formation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)