Optimizing immunization services: A Data Envelopment Analysis (DEA) of child immunization facilities in Pakistan

INTRODUCTION

Child immunization, though cost-beneficial, experiences varying costs influenced by individual facility-level factors. A real-time solution is to optimize resources and enhance vaccination services through proper method to measure immunization facility efficiency using existing data. Additionally, examine the impact of COVID-19 on facility efficiency, with the primary goal of comprehensively assessing child immunization facility efficiency in Pakistan.

METHODS

Utilizing survey data collected in four rounds from May 2018 to December 2020, the research focuses on doses administered and stock records for the preceding six months in each phase. In the initial stage, Data Envelopment Analysis (DEA) is utilized to compute facility efficiency, employing two models with varied outputs while maintaining consistent inputs. Model 1 assesses doses administered, encompassing three outputs (pentavalent vaccine 1, 2, and 3). Meanwhile, Model 2, focuses on stock used featuring a single output (total doses used). The inputs considered in both models include stock availability, staff members, cold chain equipment, vaccine carriers, and vaccine sessions. The second stage involves the application of two competing regression specifications (Tobit and Simar-Wilson) to explore the impact of the COVID-19 pandemic and external factors on the efficiency of these facilities.

RESULTS

In 12 districts across Punjab and Sindh, we assess 466 facilities in Model 1 and 455 in Model 2. Model 1 shows 59% efficiency, and Model 2 shows 70%, indicating excess stock. Stock of vaccines need to be reduced by from 36% to 43%. In the stage, COVID-19 period reduced efficiency in Model 1 by 10%, however, insignificant in Model 2.

CONCLUSIONS

The proposed methodology, utilizing DEA, emerges as a valuable tool for immunization facilities seeking to improve resource utilization and overall efficiency. Model 1, focusing on doses administered indicates facilities low efficiency at average 59% and proves more pertinent for efficiency analysis as it directly correlates with the number of children vaccinated. The prevalent issue of overstocking across all facilities significantly impacts efficiency. This study underscores the critical importance of optimizing resources through the redistribution of excess stock with low efficiency.

Multidrug resistance among uropathogenic clonal group A E. Coli isolates from Pakistani women with uncomplicated urinary tract infections

OBJECTIVE

Multi-drug resistance (MDR) has notably increased in community acquired uropathogens causing urinary tract infections (UTIs), predominantly Escherichia coli. Uropathogenic E. coli causes 80% of uncomplicated community acquired UTIs, particularly in pre-menopausal women. Considering this high prevalence and the potential to spread antimicrobial resistant genes, the current study was conducted to investigate the presence of clinically important strains of E. coli in Pakistani women having uncomplicated cystitis and pyelonephritis. Women belonging to low-income groups were exclusively included in the study. Seventy-four isolates from urine samples were processed, phylotyped, and screened for the presence of two Single Nucleotide Polymorphisms (SNPs) particularly associated with a clinically important clonal group A of E. coli (CgA) followed by antibiotic susceptibility testing and genome sequence analysis.

RESULTS

Phylogroup B2 was most prevalent in patients and 44% of isolates were positive for the presence of CgA specific SNPs in Fumarate hydratase and DNA gyrase subunit B genes. Antibiotic susceptibility testing showed widespread resistance to trimethoprim-sulfamethoxazole and extended-spectrum beta-lactamase production. The infection analysis revealed the phylogroup B2 to be more pathogenic as compared to the other groups. The genome sequence of E. coli strain U17 revealed genes encoding virulence, multidrug resistance, and host colonization mechanisms.

CONCLUSIONS

Our research findings not only validate the significant occurrence of multidrug-resistant clonal group A E. coli (CgA) in premenopausal Pakistani women suffering from cystitis and pyelonephritis but also reveal the presence of genes associated withvirulence, and drug efflux pumps. The detection of highly pathogenic, antimicrobial-resistant phylogroup B2 and CgA E. coli strains is likely to help in understanding the epidemiology of the pathogen and may ultimately help to reduce the impact of these strains on human health. Furthermore, the findings of this study will particularly help to reduce the prevalence of uncomplicated UTIs and the cost associated with their treatment in women belonging to low-income groups.

An ensemble machine learning approach for the detection of unannounced meals to enhance postprandial glucose control

BACKGROUND

Hybrid automated insulin delivery systems enhance postprandial glucose control in type 1 diabetes, however, meal announcements are burdensome. To overcome this, we propose a machine learning-based automated meal detection approach; METHODS:: A heterogeneous ensemble method combining an artificial neural network, random forest, and logistic regression was employed. Trained and tested on data from two in-silico cohorts comprising 20 and 47 patients. It accounted for various meal sizes (moderate to high) and glucose appearance rates (slow and rapid absorbing). To produce an optimal prediction model, three ensemble configurations were used: logical AND, majority voting, and logical OR. In addition to the in-silico data, the proposed meal detector was also trained and tested using the OhioT1DM dataset. Finally, the meal detector is combined with a bolus insulin compensation scheme; RESULTS:: The ensemble majority voting obtained the best meal detector results for both the in-silico and OhioT1DM cohorts with a sensitivity of 77%, 94%, 61%, precision of 96%, 89%, 72%, F1-score of 85%, 91%, 66%, and with false positives per day values of 0.05, 0.19, 0.17, respectively. Automatic meal detection with insulin compensation has been performed in open-loop insulin therapy using the AND ensemble, chosen for its lower false positive rate. Time-in-range has significantly increased 10.48% and 16.03%, time above range was reduced by 5.16% and 11.85%, with a minimal time below range increase of 0.35% and 2.69% for both in-silico cohorts, respectively, compared to the results without a meal detector; CONCLUSION:: To increase the overall accuracy and robustness of the predictions, this ensemble methodology aims to take advantage of each base model's strengths. All of the results point to the potential application of the proposed meal detector as a separate module for the detection of meals in automated insulin delivery systems to achieve improved glycemic control.

Synthesis, biochemical and computational evaluations of novel bis-acylhydrazones of 2,2'-(1,1'-biphenyl)-4,4'-diylbis(oxy))di(acetohydrazide) as dual cholinesterase inhibitors

A series of twenty-seven bis(acylhydrazones) were successfully synthesized with high yields through a multistep process, which entailed the esterification of hydroxyl groups, hydrazination with an excess of hydrazine hydrate, and subsequent reactions with various carbonyl moieties (aldehydes). In the final stage of synthesis, different chemical species including aromatic, heterocyclic, and aliphatic compounds were integrated into the framework. The resulting compounds were characterized using several spectroscopic techniques (1H NMR, 13C NMR, and mass spectrometry). Their anticholinesterase activities were assessed in vitro by examining their interactions with two cholinesterase enzymes: acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). Among the synthesized hits, compounds 3, 5, 6, 9-12, and 14 exhibited good to moderate inhibition of AChE. Specifically, 10 (IC50 = 26.3 ± 0.4 μM) and 11 (IC50 = 28.4 ± 0.5 μM) showed good inhibitory activity against AChE, while 9, 12, 3, and 6 exhibited significant inhibition potential against AChE with IC50 values ranging from 35.2 ± 1.1 μM to 64.4 ± 0.3 μM. On the other hand, 5 (IC50 = 22.0 ± 1.1 μM) and 27 (IC50 = 31.3 ± 1.3 μM) displayed significant, and 19 (IC50 = 92.6 ± 0.4 μM) showed moderate inhibitory potential for BChE. Notably, 5 and 27 exhibited dual inhibition of AChE and BChE, with greater potency than the standard drug galantamine. The binding patterns of these molecules within the binding cavities of AChE and BChE were anticipated by molecular docking which showed good correlation with our in vitro findings. Further structural optimization of these molecules may yield more potent AChE and BChE inhibitors.

Medical brain drain: A critical challenge to Pakistan's healthcare sector

Madam, Medical brain drain describes a condition where highly skilled healthcare workers leave their country of origin to work overseas in search of better working conditions, higher pay, or more opportunities for career advancement leading to deprivation of medical professionals and a loss of expertise and talent (1). Unfortunately, the exodus of skilled individuals from Pakistan is jeopardises country's intellectual assets and demands immediate attention. Skilled healthcare workers shortage is worsening in Pakistan due to the high number of talented professionals migrating for better career opportunities in the foreign land. According to the Bureau of Emigration and Overseas Employment in 2022 alone, approximately 765,000 Pakistanis, including 2,500 physicians, left the country, highlighting the severity of the situation (2) The medical profession is highly regarded in Pakistan and attracts a significant number of people. Despite this, Pakistan is among the 57 countries that lack sufficient human health resources to fulfil its healthcare requirements and objectives. The country is confronted with a considerable discrepancy in the ratio of doctors to patients which stands at 1:1300, significantly below the ratio of 1:1000 recommended by the World Health Organization (WHO) (3) The degradation of the healthcare system, shortage of residency positions and lower salaries during a period of high inflation, coupled with cultural biases and undervaluation of professions like nursing have led to a shortage of healthcare staff. Moreover, societal expectations for women to prioritize their domestic duties contribute to the disproportionate number of female doctors leaving the medical field. This further burdens the healthcare system by increasing the workload for the remaining healthcare professionals (4) Brain drain hampers economic growth and innovation by robbing the nation of its skilled professionals and their expertise. This issue can be addressed by adopting a comprehensive approach such.  Improving the healthcare infrastructure and working conditions, increasing residency positions and salaries and providing better job opportunities could help retain competent doctors. Encouraging research on brain drain can aid policymakers in developing tailored policies based on the country's needs. These measures can help Pakistan build a robust healthcare system and provide quality medical services to its people.

Paraganglioma at the cerebellopontine angle: A case report and review of literature

Paragangliomas (PGLs) are rare neuroendocrine tumors. Sometimes, these tumors secrete excessive catecholamines, which results in the manifestations of various signs and symptoms, usually with a triad of hypertension, tachycardia, and headache. We report the case of a 42-year-old woman presenting with uncontrolled hypertension, right facial palsy, vomiting, and disturbed gait. Diagnosis for PGL was confirmed on postoperative histological examination of the excised mass and correlated with preoperative clinical and radiological findings. Tumor excision was done via a suboccipital craniotomy approach. Our case presents the typically severe features of a jugulotympanic PGL, but most importantly, it highlights the necessity of biochemical diagnosing, thorough probing of the causes of hypertension, and a multi-disciplinary approach in dealing with these tumors. Moreover, the case emphasizes necessitating the use of preoperative embolization in vascular tumors of the head and neck to avoid a hemorrhagic crisis during surgery. Unfortunately, due to a lack of adequate hospital funds, the surgeon had to proceed without preoperative embolization. Despite such a risk, the excision was a success.

Thermal stratification and mixing processes response to meteorological factors in a monomictic reservoir

Formation and extinction of thermal stratifications impact the reservoir ecosystems and have been closely influenced by meteorological and hydrological factors. However, quantifying the relative importance of these crucial environmental factors and mechanisms in reservoir regions characterized by various depths remain comparatively uninvestigated. Tianbao Reservoir is a typical monomictic warm and drinking water source reservoir in Southwest China. This study supplemented field observations with a three-dimensional numerical simulation model to quantitatively analyze mixing and turnover events. Air temperature and wind were two important meteorological factors resulting in hydrodynamics during stratification and mixing processes. Air temperature led to variations in stratification strength and wind-induced fluctuations of thermocline depth. A 10% rise in air temperature increased stratification strength by 18%, and a 3 m/s rise in wind speed induced the deepening of the thermocline by 2.09 m. Two hydrodynamics involved penetrative convection caused by temperature plummets and wind-induced mixing during winter turnover events were identified. Penetrative convection was the main driving force, and wind shear mixed the upper 21% of the mixed layer, which was contributed by convection. Response of water temperature to air temperature in shallow regions was faster (58 d), and the mixing depth caused by the wind was smaller than that in deep regions. Research on physical processes during stratification and mixing processes can provide support for further study on water quality deterioration distributions.

Chitosan nanoparticles loaded with Foeniculum vulgare extract regulate retrieval of sensory and motor functions in mice

In this study, chitosan nanoparticles (CSNPs) encapsulating Foeniculum vulgare (FV) seed extract (SE) were prepared for the controlled delivery of bioactive phytoconstituents. The prepared CSNPs encapsulating FVSE as sustain-releasing nanoconjugate (CSNPs-FVSE) was used as a potent source of functional metabolites including kaempferol and quercetin for accelerated reclamation of sensory and motor functions following peripheral nerve injury (PNI). The nanoconjugate exhibited in vitro a biphasic diffusion-controlled sustained release of quercetin and kaempferol ensuring prolonged therapeutic effects. The CSNPs-FVSE was administered through gavaging to albino mice daily at a dose rate of 25 mg/kg body weight from the day of induced PNI till the end of the experiment. The conjugate-treatment induced a significant acceleration in the regain of motor functioning, evaluated from the sciatic function index (SFI) and muscle grip strength studies. Further, the hotplate test confirmed a significantly faster recuperation of sensory functions in conjugate-treated group compared to control. An array of underlying biochemical pathways regulates the regeneration under well-optimized glucose and oxidant levels. Therefore, oxidant status (TOS), blood glycemic level and total antioxidant capacity (TAC) were evaluated in the conjugate-treated group and compared with the controls. The treated subjects exhibited controlled oxidative stress and regulated blood sugars compared to the non-treated control. Thus, the nanoconjugate enriched with polyphenolics significantly accelerated the regeneration and recovery of functions after nerve lesions. The biocompatible nanocarriers encapsulating the nontoxic natural bioactive constitutents have great medicinal and economic value.

Uropathogenic bacteria and deductive genomics towards antimicrobial resistance, virulence, and potential drug targets

Urinary tract infections (UTIs) are among the most prevalent bacterial infections affecting people in inpatient and outpatient settings. The current study aimed to sequence the genome of uropathogenic Escherichia coli strain CUI-B1 resourced from a woman having uncomplicated cystitis and pyelonephritis. Followed by deductive genomics towards potential drug targets using E. coli strain CUI-B1, strain O25b: H4-ST131, Proteus mirabilis strain HI4320, Klebsiella pneumoniae strain 1721, and Staphylococcus saprophyticus strain ATCC 15305 uropathogenic strains. Comparative genome analysis revealed that genes related to the survival of E. coli, P. mirabilis, K. pneumoniae, and S. saprophyticus, such as genes of metal-requiring proteins, defense-associated genes, and genes associated with general physiology, were found to be highly conserved in the genomes including strain CUI-B1. However, the genes responsible for virulence and drug resistance, mainly those that are involved in bacterial secretion, fimbriae, adherence, and colonization, were found in various genomic regions and varied from one species to another or within the same species. Based on the genome sequence, virulence, and antimicrobial-resistant gene dataset, the subtractive proteomics approach revealed 22 proteins mapped to the pathogen's unique pathways and among them, entB, clbH, chuV, and ybtS were supposed to be potential drug targets and the single drug could be utilized for all above-mentioned strains. These results may provide the foundation for the optimal target for future discovery of drugs for E. coli-, P. mirabilis-, K. pneumoniae-, and S. saprophyticus-based infections and could be investigated further to employ in personalized drug development.

Changes in immunoglobulin levels during clozapine treatment in schizophrenia

BACKGROUND AND HYPOTHESIS

Use of clozapine in treatment-resistant schizophrenia is often limited due to risk of adverse effects. Cross-sectional associations between clozapine treatment and low immunoglobulin levels have been reported, however prospective studies are required to establish temporal relationships. We tested the hypothesis that reductions in immunoglobulin levels would occur over the first 6 months following initiation of clozapine treatment. Relationships between immunoglobulin levels and symptom severity over the course of clozapine treatment were also explored.

DESIGN

This prospective observational study measured immunoglobulin (Ig) levels (A, M and G) in 56 patients with treatment-resistant schizophrenia at 6-, 12- and 24-weeks following initiation with clozapine. Clinical symptoms were also measured at 12 weeks using the positive and negative syndrome scale (PANSS).

RESULTS

IgA, IgG and IgM all decreased during clozapine treatment. For IgA and IgG the reduction was significant at 24 weeks (IgA: β = -32.66, 95% CI = -62.38, -2.93, p = 0.03; IgG: β = -63.96, 95% CI = -118.00, -9.31, p = 0.02). For IgM the reduction was significant at 12 and 24 weeks (12 weeks: β = -23.48, 95% CI = -39.56, -7.42, p = 0.004; 24 weeks: β = -33.12, 95 %CI = -50.30, -15.94, p = <0.001). Reductions in IgA and IgG during clozapine treatment were correlated with reductions in PANSS-total over 12 weeks (n = 32, IgA r = 0.59, p = 0.005; IgG r = 0.48, p = 0.03).

CONCLUSIONS

The observed reductions in immunoglobulin levels over six months of clozapine treatment add further evidence linking clozapine to secondary antibody deficiency. Associations between Ig reduction and symptom improvement may however indicate that immune mechanisms contribute to both desirable and undesirable effects of clozapine.

Infantile Monosialoganglioside2 (GM2) Gangliosidosis With Concurrent Bronchopneumonia: An Extraordinary Case of Tay-Sachs Disease

Tay-Sachs disease (TSD) is a rare, fatal neurodegenerative disorder characterized by the deficiency of the enzyme hexosaminidase-A (Hex A), which results in the accumulation of monosialoganglioside2 (GM2) ganglioside within nerve cells, predominantly affecting individuals of Ashkenazi Jewish descent. We report a remarkable case of a three-year-old South Asian male with infantile GM2 gangliosidosis, compounded by bronchopneumonia, a rarely documented complication in Tay-Sachs patients. The patient presented with recurrent seizures, fever, cough, and developmental delay. Confirmation of the diagnosis was obtained through reduced Hex A enzyme activity, corroborated by imaging and blood and urine analyses. Family history was significant for consanguinity and similar sibling fatalities. Despite the progressive nature of the disease, symptomatic management, including antiepileptic drugs, antibiotic therapy, and supportive care, led to an improvement in clinical condition, though ongoing monitoring remains essential. In this case, the coexistence of bronchopneumonia with Tay-Sachs disease is unusual, reflecting the necessity for this case report. The patient's response highlights the potential for symptomatic management, the importance of genetic counseling, and the imperative for research into gene and enzyme replacement therapies. The uniqueness of this case provides novel insights into the disease's spectrum, enhancing awareness, encouraging early diagnosis, and refining care strategies for Tay-Sachs disease, aligning with the broader goals of improving patient outcomes and advancing medical research.

Transforming Bariatric Surgery Outcomes: The Pivotal Role of Enhanced Recovery After Surgery (ERAS) Protocols in Patient-Centered Care

Bariatric surgery is a critical strategy in managing morbid obesity. Enhanced recovery after surgery (ERAS) protocols have revolutionized perioperative care in this field. This systematic review aims to synthesize current evidence on the impact of ERAS protocols on patient-centered outcomes in bariatric surgery. A comprehensive search across multiple databases was conducted, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies involving adult patients undergoing bariatric surgery and focusing on the implementation and outcomes of ERAS protocols were included. Data extraction and analysis emphasized patient recovery, well-being, and satisfaction. Eleven studies met the inclusion criteria. The review revealed that ERAS protocols are associated with reduced postoperative recovery times, decreased hospital stays, and enhanced patient satisfaction. Notably, ERAS protocols effectively reduced complications and optimized resource utilization in bariatric surgery. Comparative insights from non-bariatric surgeries highlighted the versatility and adaptability of ERAS protocols across different surgical disciplines. ERAS protocols significantly improve patient-centered outcomes in bariatric surgery. Their adoption facilitates a patient-focused approach, accelerating recovery and enhancing overall patient well-being. The findings advocate for the broader implementation of ERAS protocols in surgical care, emphasizing the need for continuous refinement to meet evolving healthcare demands. This review supports the paradigm shift toward integrating ERAS protocols in bariatric surgery and potentially other surgical fields.

EFFECT OF RELIGIOUS FASTING ON THE SERUM LEVEL OF PRE-HAPTOGLOBIN-2 AND SOME OTHER BIOCHEMICALS

During the month of Ramadan, which falls on the ninth month of the Hijri Calendar, Muslims are obligated to observe religious fasting. The goal of the study was to examine the impact of fasting on various blood parameters, specifically zinc, magnesium, pre-haptoglobin-2, serum copper, total cholesterol, and HDL-cholesterol levels. In a study, a group of volunteers consisting of 20 men and 10 women agreed to partake in the fast, abstaining from food and drink for approximately 14-15 hours each day. The researchers collected two blood samples from each participant, one before the start of Ramadan fasting and another after 29 days of fasting, serum was separated and analysed for specified parameters. Serum zinc levels showed a significant (p<0.05) decrease after fasting. On the other hand, serum magnesium levels exhibited a significant (p<0.05) increase, Regarding pre-haptoglobin-2, there was a small, insignificant increase observed after 29 days of fasting. However, the study did not identify any significant changes in serum copper, total cholesterol, or HDL-cholesterol levels. Based on these findings, the study concludes that Ramadan fasting may necessitate zinc supplementation or an increase in the consumption of zinc-rich foods. Furthermore, it suggests a decrease in the intake of high-fat foods. These recommendations aim to counteract the observed decrease in serum zinc levels during fasting.

Isolation, identification, and characterization of resistant bacteria to antibiotics from pharmaceutical effluent and study of their antibiotic resistance

Pharmaceutical effluents primarily enter aquatic environments through the discharge of treated and untreated wastewater from various sources, including hospitals, pharmaceutical manufacturing facilities, and households. Microbes sourced from pharmaceutical effluents such as Pseudomonas spp. pose a significant public health concern because of their high levels of resistance to multiple drugs and extreme multidrug resistance. Therefore, the present study was conducted for the isolation, identification, and molecular characterization of selected isolates from pharmaceutical effluents and also determined their antibiotic sensitivity patterns. From June 2016 to March 2017, a study was conducted on four well-known pharmaceutical companies specializing in antibiotic production in Dhaka and Gazipur. Four wastewater samples were collected from various origins and then brought to the Bacteriology laboratory for microbiological examination. Twelve pure isolates were obtained and characterized through cultural and biochemical tests while molecular identification of Pseudomonas spp. was performed using the 16S rRNA gene sequence. Twelve commercially available antibiotics were used for antibiotic sensitivity tests using Kirby-Bauer disk diffusion methods. We isolated the most predominant isolates, Pseudomonas aeruginosa (41.67%), followed by Bacillus spp. (33.33%) and Staphylococcus spp. (25%) respectively. Among 12 antibiotics, ciprofloxacin is 100% sensitive against P. aeruginosa, while the remaining 11 antibiotics are 100% resistant. Bacillus spp. showed 100% resistance to all antibiotics while 50% sensitive to vancomycin and 100% to chloramphenicol, respectively. Staphylococcus spp. was 100% resistant to all antibiotics. Our research suggested that P. aeruginosa is the reservoir of antibiotic resistance genes and spreads disease to humans from the environment. The findings of this study, i.e., the isolation, identification, and characterization of antibiotic-resistant bacteria from pharmaceutical effluent have highlighted, comprehended, and mitigated the dissemination of antibiotic resistance and opportunistic bacteria.

Exploring the typology of decision-makers, institutions, and incentives that shape health decisions in Pakistan and insulate decision makers from citizens feedback

Introduction

In developing countries such as Pakistan, program and policies underperform in providing public good as weak institutions lead to decisions that are unresponsive to citizens and are driven by personal motivations of the incumbents. We describe the decision-making processes in the health sector through the framework of "Public Choice" theory which posits how individual motives shape institutional performance and direction.

Methods

We conducted 84 qualitative interviews with five types of stakeholders: politicians, senior and mid-level bureaucrats, donors, public health experts and media personnel spanning 2 periods over a decade. The initial interviews were conducted during 2013-2015 period and a case study on decision-making during the COVID-19 response was added in 2020-2022 period.

Findings

Most new ideas originate from top political leadership, guided by personal agendas or political expediency. Senior bureaucrats implement politicians' agenda and mid-level officials maintain the status quo and follow established "authority." Since officials' performance, promotions, transfers, and the rare dismissals are based on tenure deviations rather than work performance, individuals and institutions are reluctant to take initiative without "consensus" among their colleagues often leading to inaction or delays that obviate initiative and reform. The public sector lacks institutional memory, formal information gathering, and citizen engagement, impacting public goods, health services, and policies. Media and donor personnel are important influencers. However, media mostly report only "hot issues" in health, with short publication and reader attention cycles. Donor personnel are the most likely to follow evidence for decision making, albeit while following their institutional priorities determined centrally. The COVID-19 response is presented as a contrast from usual practices, where evidence was used to guide decisions, as the pandemic was perceived as a national threat by the highest leadership.

Conclusion

Absence of citizen feedback and formal systems for evidence gathering and processing leads to decisions that neglect the needs of those they serve, prioritizing personal or political gains and perpetuating the status quo. However, the COVID-19 pandemic emphasized the importance of evidence-based decision-making and offers valuable lessons for reforming decision-making processes.

Characterization for optimizing the integrated management of solid waste for energy recovery and circular economy

Municipal solid waste (MSW) management poses a significant environmental challenge in municipalities across developing nations worldwide. Our studies were focused on characterizing the waste and analyzing the chemical properties of mixed waste fractions to assess their potential for waste-to-energy conversion. The objective of our study was to scrutinize the existing state of the MSW management system and gauge its waste generation rates. Specific ASTM methods were employed to carry out both physical and chemical characterizations. The outcomes reveal that the city generates a daily volume of 1155 tons of domestic solid waste (DSW), translating to a generation rate of 0.51 kg-1 capita-1 day-1. When analyzed by source, organic matter emerged as the predominant constituent, accounting for 73.74% of the waste, followed by combustible content waste at 15.17%. The moisture content of MSW ranged between 26 and 58% throughout the seasons, while volatile solids varied from 22.35 to 99.74%. Among the components screened, carbon and oxygen stood out as the dominant elements. The calorific values encompassed a broad range, ranging from 14.87 MJ kg-1 for leather waste to a substantial 25,629.27 MJ kg-1 for organic waste. To alleviate the escalating burden of increasing solid waste generation, alternative treatment approaches were recommended. These include composting, biomethane plants, the establishment of recycling facilities, and the enhancement of existing landfill sites to scientifically designed landfills. In summary, the findings from this study provide valuable insights for regulatory bodies and municipal authorities. These insights can guide the formulation of policies concerning waste sampling, characterization, segregation, and the implementation of education and awareness campaigns.

Computational exploration of novel ROCK2 inhibitors for cardiovascular disease management; insights from high-throughput virtual screening, molecular docking, DFT and MD simulation

Cardiovascular disorders are the world's major cause of death nowadays. To treat cardiovascular diseases especially coronary artery diseases and hypertension, researchers found potential ROCK2 (Rho-associated coiled-coil-containing protein kinase 2) target due to its substantial role in NO-cGMP and RhoA/ROCK pathway. Available drugs for ROCK2 are less effective and some of them depict side effects. Therefore, a set of novel compounds were screened that can potentially inhibit the activity of ROCK2 and help to treat cardiovascular diseases by employing In-silico techniques. In this study, we undertook ligand based virtual screening of 50 million compound's library, to that purpose shape and features (contain functional groups) based pharmacophore query was modelled and validated by Area Under Curve graph (AUC). 2000 best hits were screened for Lipinski's rule of 5 compliance. Subsequently, these selected compounds were docked into the binding site of ROCK2 to gain insights into the interactions between hit compounds and the target protein. Based on binding affinity and RMSD scores, a final cohort of 15 compounds were chosen which were further refined by pharmacokinetics, ADMET and bioactivity scores. 2 potential hits were screened using density functional theory, revealing remarkable biological and chemical activity. Potential inhibitors (F847-0007 and 9543495) underwent rigorous examination through MD Simulations and MMGBSA analysis, elucidating their stability and strong binding affinities. Results of current study unveil the potential of identified novel hits as promising lead compounds for ROCK2 associated with cardiovascular diseases. These findings will further investigate via In-vitro and In-vivo studies to develop novel druglike molecules against ROCK2.

An efficient synthesis and characterization of La@MOF-808: A promising strategy for effective arsenic ion removal from water

Addressing serious waterborne arsenic issues, for the first time, lanthanum-doped MOF-808 (La@MOF-808) has been developed to remove total arsenic (Total As) and arsenite [As(III)] from water. This study involves the solvothermal synthesis of La@MOF-808, its characterization via FTIR, XRD, TGA, and SEM, in which distinct physicochemical attributes were identified, and the adsorption capacity of arsenic ions. The saturated adsorption capacity of La@MOF-808 for Total As and As(III) reached 282.9 mg g-1 and 283.5 mg g-1, as compared to 229.7 mg g-1 and 239.1 mg g-1 for pristine MOF-808, respectively. XRD and ATR-FTIR analyses underscored the central roles of electrostatic interactions and hydroxyl groups in the pollutant adsorption process. The impact of temperature, concentration, pH, and exposure duration times on adsorption performance was thoroughly investigated. The Langmuir model showed the maximum adsorption capacities (qmax) of La@MOF-808 was 307.7 mg g-1 for Total As and 325.7 mg g-1 for As(III), surpassing those of MOF-808 adsorbent, which suggests that monolayer adsorption occurred. Optimal adsorption was observed in a pH range of 2.0-7.0, and thermodynamic studies classified the process as spontaneous and endothermic. The adsorbent retains high capacity across repeated cycles, outperforming many standard adsorbents. Lanthanum doping markedly enhances MOF-808's arsenic removal, underscoring its potential for water treatment.

Identification, Genome Sequencing, and Characterizations of Helicobacter pylori Sourced from Pakistan

The stomach's colonization by Helicobacter pylori (H. pylori) results in gastritis, ulcers, and stomach cancer. Frequently, pain is treated with medication, but resistant H. pylori infections are not. Therefore, it is important to find pharmacological targets and improved treatments for resistant H. pylori strains. The aim of the current study was sampling, identification, drug susceptibility testing following genome sequencing and comparative genome-wide analysis of selected H. pylori strains from Pakistan with three representative strains for virulence and drug-resistant characteristics. Based on culture, biochemistry, and molecular biology, 84 strains of H. pylori were identified, which made up 47% of the enrolled cases. Among all H. pylori strains, the highest resistance was reported for metronidazole with 82 H. pylori strains (98%), followed by clarithromycin with 62 resistant strains (74%). Among metronidazole-resistant strains, 38 strains (46%) were also resistant to clarithromycin, contributing 61% of clarithromycin resistant cases. Two strains, HPA1 and HPA2, isolated from 'gastritis' and 'gastric ulcer' patients, respectively, were further processed for WGS. The draft genome sequences of H. pylori strains HPA1 and HPA2 encode 1.66 Mbp and 1.67 Mbp genome size, 24 and 4 contiguous DNA sequences, and 1650 and 1625 coding sequences, respectively. Both the genomes showed greater than 90% similarity with the reference strain H. pylori ATCC 43504/PMSS1. The antibiotic-resistant genes were identified among all the strains with overall similarity above 95%, with minor differences in the sequence similarity. Using the virulent gene data obtained from the Virulence Factor Database, 75 to 85 virulent genes were identified in the five genome assemblies with various key genes such as cytolethal distending toxin (cdt), type IV secretion system, cag PAI, plasticity region, cell-motility- and flagellar-associated genes, neutrophil-activating protein (HP-NAP), T4SS effector cytotoxin-associated gene A (cagA), and urease-associated genes ureA and ureB, etc. Sequence similarity between the virulence factors found in this study and reference genes was at least 90%. In summary, the results of our study showed the relationship between clinical results and specific H. pylori strains' (HPA1 and HPA2) genetics such as antibiotic resistance and specific virulence factors. These findings provide valued understanding of the epidemiology of H. pylori-associated diseases. Moreover, identification and genomics analysis have provided insights into the epidemiology, genetic diversity, pathogenicity, and potential drug resistance genes of H. pylori strains, offering a foundation for developing more targeted and effective medical interventions, including anti-virulent medications.

Sustainable appraisal of lac (Kerria Lacca) based anthraquinone natural dye for chemical and bio-mordanted viscose and silk dyeing

The coloring behavior of laccaic acid, a natural red dye derived from lac insects, has been investigated in this work for the dyeing of silk and viscose fabrics while being heated in MW radiation. The extract was made in an aqueous and acidic media and then used to color fabrics under microwave treatment for up to 10 min. For developing new shades, eco-friendly green bio-mordants and, in comparison, chemical mordants were employed at given conditions. The obtained results revealed that the aqueous extract after 4 min of radiation exposure produced a high color strength (K/S  =  17.132) onto silk and the aqueous extract after 6 min of radiation exposure produced better color strength (K/S  =  6.542) onto viscose at selected conditions. The fastness ratings evaluation as per ISO standards demonstrates that bio-anchors have provided good ratings under selected irradiation and dyeing conditions. It is concluded that this environmentally friendly technique has improved the natural coloration process of fabrics as well as addition of green mordants has furnished colorfast shades using lac-derived natural anthraquinone dye.

An Automated Brain Metastasis Detection and Segmentation System from MRI with a Large Multi-Institutional Dataset

PURPOSE/OBJECTIVE(S)

Developments of automated systems for brain metastasis (BM) detection and segmentation from MRI for assisting early detection and stereotactic radiosurgery (SRS) have been reported but most based upon relatively small datasets from single institutes. This work aims to develop and evaluate a system using a large multi-institutional dataset, and to improve both identification of small/subtle BMs and segmentation accuracy of large BMs.

MATERIALS/METHODS

A 3D U-Net system was trained and evaluated to detect and segment intraparenchymal BMs with a size > 2mm using 1856 MRI volumes from 1791 patients treated with SRS from seven institutions (1539 volumes for training, 183 for validation, and 134 for testing). All patients had 3D post-Gd T1w MRI scans pre-SRS. Gross tumor volumes (GTVs) of BMs for SRS were curated by each institute first. Then, additional efforts were spent to create GTVs for the untreated and/or uncontoured BMs, including central reviews by two radiologists, to improve accuracy of ground truth. The training dataset was augmented with synthetic BMs of 3773 MRIs using a 3D generative pipeline. Our system consists of two U-Nets with one using small 3D patches dedicated for detecting small BMs and another using large 3D patches for segmenting large BMs, and a random-forest based fusion module for combining the two network outputs. The first U-Net was trained with 3D patches containing at least one BM < 0.1 cm3. For detection performance, we measured BM-level sensitivity and case-level false-positive (FP) rate. For segmentation performance, we measured BM-level Dice similarity coefficient (DSC) and 95-percentile Hausdorff distance (HD95). We also stratified performances based upon BM sizes.

RESULTS

For 739 BMs in the 134 testing cases, the overall lesion-level sensitivity was 0.870 with an average case-level FP of 1.34±1.92 (95% CI: 1.02-1.67). The sensitivity was >0.969 for the BMs >0.1 cm3, but dropped to 0.755 for the BMs < 0.1 cm3 (Table 1). The average DSC and HD95 for all detected BMs were 0.786 and 1.35mm. The worse performance for BMs > 20 cm3 was caused by a case with 83 cm3 GTV and artifacts in the MRI volume.

CONCLUSION

We achieved excellent detection sensitivity and segmentation accuracy for BMs > 0.1 cm3, and promising performance for small BMs (<0.1cm3) with a controlled FP rate using a large multi-institutional dataset. Clinical utility for assisting early detection and SRS planning will be investigated. Table 1: Per-lesion detection and segmentation performance stratified by individual BM size. N is the number of BMs in each category.

Ugi efficient synthesis of novel N-alkylated lipopeptides, antimicrobial properties and computational studies in Staphylococcus aureus via MurD antibacterial target

Lipopeptides are medicinally essential building blocks with strong hemolytic, antifungal and antibiotic potential. In the present research article, we are presenting our findings regarding the synthesis of N-alkylated lipopeptides via Ugi four-component approach, their antimicrobial potential against pathogenic (Gram-positive and Gram-negative) bacteria, as well as computational studies to investigate the compounds binding affinity and dynamic behavior with MurD antibacterial target. Molecular docking demonstrated the compounds have good binding ability with MurD enzyme. The FT94, FT95 and FT97 compounds revealed binding affinity scores of -8.585 kcal mol- 1, -7.660 kcal mol- 1 and -7.351 kcal mol- 1, respectively. Furthermore, dynamics analysis pointed the systems high structure dynamics. The docking and simulation results were validated by binding free energies, demonstrating solid intermolecular interactions and in the assay in vitro, the Minimal Inhibitory Concentration (MIC) of FT97 to Staphylococcus aureus (S. aureus) was 62.5 μg/mL. In conclusion, a moderate inhibitory response of peptoid FT97 was observed against the Gram-positive bacteria, S. aureus and B. cereus.

Polymorphs of Substituted p-Toluenesulfonanilide: Synthesis, Single-Crystal Analysis, Hirshfeld Surface Exploration, and Theoretical Investigation

Polymorphism is an exciting feature of chemical systems where a compound can exist in different crystal forms. The present investigation is focused on the two polymorphic forms, triclinic (MSBT) and monoclinic (MSBM), of ethyl 3-iodo-4-((4-methylphenyl)sulfonamido)benzoate prepared from ethyl 4-amino-3-iodobenzoate. The prepared polymorphs were unambiguously confirmed by single-crystal X-ray diffraction (SC-XRD) analysis. According to the SC-XRD results, the molecular configurations of both structures are stabilized by intramolecular N-H···I and C-H···O bonding. The crystal packing of MSBT is different as compared to the crystal packing of MSBM because MSBT is crystallized in the triclinic crystal system with the space group P1̅, whereas MSBM is crystallized in the monoclinic crystal system with the space group P21/c. The molecules of MSBT are interlinked in the form of dimers through N-H···O bonding to form R22(8) loops, while the MSBM molecules are connected with each other in the form of an infinite chain through C-H···O bonding. The crystal packing of both compounds is further stabilized by off-set π···π stacking interactions between phenyl rings, which is found stronger in MSBM as compared to in MSBT. Moreover, Hirshfeld surface exploration of the polymorphs was carried out, and the results were compared with the closely related literature structure. Accordingly, the supramolecular assembly of these polymorphs is mainly stabilized by noncovalent interactions or intermolecular interactions. Furthermore, a density functional theory (DFT) study was also carried out, which provided good support for the SC-XRD and Hirshfeld studies, suggesting the formation of both intramolecular and intermolecular interactions for both compounds.

Equity, Diversity and Inclusion (EDI) in Organ Transplantation: An ESOT Survey About EDI Within ESOT as an Organization and its Educational Activities, and Transplantation Research and Science

The European Society of Organ Transplantation (ESOT) strives to promote equity, diversity, and inclusion (EDI) across all its activities. We surveyed the transplant community's experiences and perspectives regarding EDI within ESOT as an organization and its educational activities, and research in general. A total of 299 respondents completed the questionnaire. About half agreed that ESOT's Executive Committee, Council, and Sections/Committees are diverse and inclusive (51%) and that ESOT promotes EDI in its live and digital educational activities (54%). Forty percent of respondents agreed that scientific and clinical trials in the field of transplantation are diverse and inclusive. Despite the wide distribution of the survey, most of the respondents self-identified as White and were either physician or surgeon. However, the results contribute a unique insight into the experiences and perspectives of the transplantation community regarding EDI. Whilst ESOT is committed to the principles of EDI, perceptions and the high number of proposals show the apparent need to prioritize efforts to embed EDI across ESOT and transplantation science. These data should constitute a starting point for change and provide guidance for future efforts to promote EDI within the transplantation community.

New supramolecules of bis(acylhydrazones)-linked bisphenol sulfide for Alzheimer's: targeting cholinesterases by in vitro and in silico approaches

In current research, two functional components, i.e., hydrazone and bisphenol sulfide were combined to get useful supramolecules in medicinal chemistry. Herein 25 new 4,4'-thiodiphenol bis-acylhydrazones were synthesized in good to excellent yields. Initially ethyl-2-chloroacetate was reacted with 4,4'-thiodiphenol, which was further reacted with excess hydrazine hydrate to produce 2,2'-((thiobis(4,1-phenylene))bis(oxy))di(acetohydrazide), which was then combined with various aromatic and aliphatic aldehydes to get the desired products (hydrazones, 4a-4y). The synthesized supramolecules were characterized by contemporary spectroscopic techniques such as 1H NMR, 13C NMR, and mass spectroscopy. The synthetic compound's cholinesterase blocking activity was tested against acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) enzymes where compounds 4n, and 4h showed excellent inhibitory potential for AChE, while 4b, and 4h, demonstrated most potent inhibition of BChE. The starting compound (SM3) and compounds 4h and SM3 depicted excellent dual inhibitory capabilities for both enzymes. The chemical basis of anticholinesterase activity was investigated using a structure-based molecular docking approach. The biological significance and the ease of synthesis of this class of compounds should be considered in therapeutic development for Alzheimer's disease treatments.

Iron-modified biochar improves plant physiology, soil nutritional status and mitigates Pb and Cd-hazard in wheat (Triticum aestivum L.)

Environmental quality and food safety is threatened by contamination of lead (Pb) and cadmium (Cd) heavy metals in agricultural soils. Therefore, it is necessary to develop effective techniques for remediation of such soils. In this study, we prepared iron-modified biochar (Fe-BC) which combines the unique characteristics of pristine biochar (BC) and iron. The current study investigated the effect of pristine and iron modified biochar (Fe-BC) on the nutritional values of soil and on the reduction of Pb and Cd toxicity in wheat plants (Triticum aestivum L.). The findings of present study exhibited that 2% Fe-BC treatments significantly increased the dry weights of roots, shoots, husk and grains by 148.2, 53.2, 64.2 and 148%, respectively compared to control plants. The 2% Fe-BC treatment also enhanced photosynthesis rate, transpiration rate, stomatal conductance, intercellular CO2, chlorophyll a and b contents, by 43.2, 88.4, 24.9, 32.5, 21.4, and 26.7%, respectively. Moreover, 2% Fe-BC treatment suppressed the oxidative stress in wheat plants by increasing superoxide dismutase (SOD) and catalase (CAT) by 62.4 and 69.2%, respectively. The results showed that 2% Fe-BC treatment significantly lowered Cd levels in wheat roots, shoots, husk, and grains by 23.7, 44.5, 33.2, and 76.3%. Whereas, Pb concentrations in wheat roots, shoots, husk, and grains decreased by 46.4, 49.4, 53.6, and 68.3%, respectively. Post-harvest soil analysis showed that soil treatment with 2% Fe-BC increased soil urease, CAT and acid phosphatase enzyme activities by 48.4, 74.4 and 117.3%, respectively. Similarly, 2% Fe-BC treatment significantly improved nutrients availability in the soil as the available N, P, K, and Fe contents increased by 22, 25, 7.3, and 13.3%, respectively. Fe-BC is a viable solution for the remediation of hazardous Cd and Pb contaminated soils, and improvement of soil fertility status.

Anar Phali (Opuntia ficus) juice extract as a novel pollution-free source of natural betalain dye for wool yarn

Green products such as plant pigments in all filed are gaining fame globally due to their excellent ayurvedic and biological characteristics. In this study, microwave rays have been employed for the isolation of colorants from Anar Phali while bio-mordant have been included to get color-fast shades. The colorant was isolated in an acidic medium before and after microwave rays for 2 min. For getting darker shades with different tints, sustainable chemical and plant-based extracts as bio-mordant have been employed before and after bio coloration of wool yarn at given conditions. CIE Lab system computed in Colori-spectrophotometer (CS-410) was used to observe the change in color depth and tonal variation of dyed fabrics, and ISO standard methods have been employed to rate the colorfastness to light, washing, and rubbing at grey scale. It is concluded that microwave rays have an excellent sustainable efficacy to isolate colorant from Anar Phali powder for wool dyeing, whereas the addition of bio-mordants has made the process more sustainable and eco-friendly.

Navigating Glioblastoma Diagnosis and Care: Transformative Pathway of Artificial Intelligence in Integrative Oncology

Glioblastoma multiforme (GBM), an aggressive brain tumor with high recurrence rates and limited survival, presents a pressing need for accurate and timely diagnosis. The interpretation of MRI can be complex and subjective. Artificial Intelligence (AI) has emerged as a promising solution, leveraging its potential to revolutionize diagnostic imaging. Radiomics treats images as numerical data and extracts intricate features from images, including subtle patterns that elude human observation. By integrating radiomics with genetics through radiogenomics, AI aids in tumor classification, identifying specific mutations and genetic traits. Furthermore, AI's impact extends to treatment planning. GBM's heterogeneity and infiltrative growth complicate delineation for treatment purposes. AI-driven segmentation techniques provide accurate 2D and 3D delineations, optimizing surgical and radiotherapeutic planning. Predictive features like angiogenesis and tumor volumes enable AI models to anticipate postop complications and survival rates. It can also aid in distinguishing posttreatment radiation effects from tumor recurrence. Despite these merits, concerns linger. The quality of medical data, transparency of AI techniques, and ethical considerations require thorough addressing. Collaborative efforts between neurosurgeons, data scientists, ethicists, and regulatory bodies are imperative for AI's ethical development and implementation. Transparent communication and patient consent are vital, fostering trust and understanding in AI-augmented medical care. In conclusion, AI holds immense promise in diagnosing and managing aggressive brain tumors like GBM. Its ability to analyze complex radiological data, integrate genetics, and aid in treatment planning underscores its potential to transform patient care. However, carefully considering ethical, technical, and regulatory aspects is crucial for realizing AI's full potential in oncology.

Preparation, Crystal Structure, Supramolecular Assembly, and DFT Studies of Two Organic Salts Bearing Pyridine and Pyrimidine

The effective preparation of two new pyrimidine- and pyridine-based organic crystalline salts with substituted acidic moieties (i.e., (Z)-4-(naphthalen-2-ylamino)-4-oxobut-2-enoic acid (DCNO) and 2-hydroxy-3,5-dinitrobenzoic acid (PCNP)) using methanol as a solvent has been reported. These molecular salts have ionic interactions that are responsible for their structural stabilization in their solid-state assemblies. The crystal structures of DCNO and PCNP were determined by the single-crystal X-ray diffraction (SCXRD) technique. The SCXRD study inferred that cations and anions are strongly packed due to N-H···O, N-H···N, and C-H···O noncovalent interactions in DCNO, whereas in PCNP, N-H···N noncovalent interactions are absent. The noncovalent interactions in both organic crystalline salts were comprehensively investigated by Hirshfeld surface analysis. Further, a detailed density functional theory (DFT) study of both compounds was performed. The optimized structures of both compounds supported the existence of the H-bonding and weak dispersion interactions in the synthesized organic crystalline salt structures. Both compounds were shown to have large and noticeably different HOMO/LUMO energy gaps. The atomic charge analysis results supported the SCXRD and HSA results, showing the formation of intermolecular noncovalent interactions in both organic crystalline salts. The results of the natural bond orbital (NBO) analysis confirmed the existence of (relatively weak) noncovalent interactions between the cation and anion moieties of their organic crystalline salts. The global reactivity parameters (GRPs) analysis showed that both organic crystalline salts' compounds should be quite thermodynamically stable and that DCNO should be less reactive than PCNP. For both compounds, the molecular electrostatic potential (MEP) analysis results support the existence of intermolecular electrostatic interactions in their organic crystalline salts.

Morphometric analysis and roosting ecology of bat species Pteropus Medius in Mansehra, Khyber Pakhtunkhwa, Pakistan

Morphometric measurement and roosting ecology of Pteropus medius were aimed to find out in Mansehra district of KP, Pakistan. Total 3149 numbers of bats were found in eight biological spots visited; Baffa Doraha, Darband, Dadar, Jallu, Hazara University, Garhi Habibullah Chattar Plain and Jabori, in total 299 numbers of different species of trees including; Morus alba, Pinus raxburghi, Eucalyptus camaldulensis, Morus nigra, Grevillea robusta, Brousonetia papyrifera, Platanus orientalis, Ailanthus altissima, Hevea brasiliensis and Populus nigra. Morphometric features were measured and found vary according to sex of the bats. The average wing span, wing`s length from tip of wing to neck, from thumb to tip of wing and the body`s length from head and claws were recorded to be 102.98 cm, 49.07cm, 28.7 cm and 22.78 cm respectively in males while 93.67 cm, 44.83cm, 24.78cm and 22.78 cm respectively in female bats. Mean circumference of the body including wings and without wing were measured as 22.78 cm and 17.29 cm in males and that of female were 20.07 cm and 16.9 cm. Average length of thumb 3.64 cm, ear`s length 3.1 cm, snout 5.62cm, eye length were 1.07 cm for both sexes and length between the feet in extended position were16.3 cm. Generally different measurement of males bodies were found to be greater than female such as mean body surface area, mass, volume and pressure were found to be 2691.79 cm2, 855.7gm,1236.4 ml and 295.77 dyne/ c m 3 for male and 2576.46 cm2, 852.71gm,1207 ml and 290.2 dyne/ c m 3 respectively for female. While weight and density for both males and females bats were same with mean of 8.59 newton and 0.701 g/m3. Findings of current reports can add valued information in literature about bats, which can be used for species identification and conservation.

Potential anticancer and antioxidant lauric acid-based hydrazone synthesis and computational study toward the electronic properties

The modification of natural products is one of the key areas of synthetic organic chemistry for obtaining valuable chemical building blocks that have medicinal significance. In this study, lauric acid-based hydrazones, namely (E)-N'-(2-nitrobenzylidene)dodecanehydrazide (NBDH), (E)-N'-(naphthalen-1-ylmethylene)dodecanehydrazide (NMDH), and (E)-N'-(4-fluorobenzylidene)dodecanehydrazide (FBDH), were synthesized and characterized using spectroscopic techniques. The newly synthesized lauric acid-based hydrazones were screened for their anticancer and antioxidant potential. The antioxidants showed their activity by inhibiting the oxidative chain reactions that produce reactive oxygen species. The antioxidant activity showed that NBDH exhibited the maximum DPPH inhibitory activity when compared with that of NMDH and FBDH, whereas the anticancer activity showed that FBDH exhibited maximum percent viability when compared to that of NBDH and NMDH. The reactivity and biological needs of the synthesized compounds NBDH, NMDH, and FBDH were met by performing geometrical, FT-IR vibrational, UV-visible, global reactivity parameters (GRP), MEP, FMO, NBO, ELF, LOL, and nonlinear optical (NLO) analysis at the DFT/B3LYP/6-311+G(d,p) level. NBO analysis confirmed the existence of extended conjugation and intramolecular charge transfer among NBDH, NMDH, and FBDH, which have the lowest gap in π → π*, which are in line with the FMO results where successful charge transfer occurred from the highest occupied molecular orbital (HOMO) to the lowest unoccupied molecular orbital (LUMO). GRP analysis confirmed the potential of NBDH, NMDH, and FBDH for biological, electronic, and NLO applications. It is clear from the comparative analysis of the urea molecule that NBDH, NMDH, and FBDH all comprise fine NLO properties.

Plant-Derived Smoke Mitigates the Inhibitory Effects of the Auxin Inhibitor 2,3,5-Triiodo Benzoic Acid (TIBA) by Enhancing Root Architecture and Biochemical Parameters in Maize

The present study was designed to investigate and compare the effects of plant-derived smoke (PDS) and auxin (IAA and IBA) on maize growth under the application of 2,3,5-triiodo benzoic acid (TIBA). For this purpose, indole-3-acetic acid (IAA) and indole-3-butyric acid (IBA), each at a concentration of 10 ppm, along with PDS at a ratio of 1:500 (v/v) were used alone and in combination with 10 ppm of TIBA. The results indicate that the germination percentage (%) of maize seeds was enhanced under IAA, IBA and PDS treatment. However, IAA and IBA resulted in reduced germination when applied in combination with TIBA. Importantly, the germination percentage (%) was improved by PDS under TIBA treatment. The analysis of seedling height, length of leaves, and number of primary, seminal and secondary/lateral roots showed improvement under individual treatments of IAA and IBA, PDS and PDS + TIBA treatment, while these values were reduced under IAA + TIBA and IBA + TIBA application. Chlorophyll content, total soluble sugars and antioxidative enzymatic activity including POD and SOD increased in seedlings treated with PDS alone or both PDS and TIBA, while in seedlings treated with IAA and TIBA or IBA and TIBA, their levels were decreased. APX and CAT responded in the opposite way-under IAA, IBA and PDS treatment, their levels were found to be lower than the control (simple water treatment), while TIBA treatment with either IAA, IBA or PDS enhanced their levels as compared to the control. These results reveal that PDS has the potential to alleviate the inhibitory effects of TIBA. This study highlights the role of PDS in preventing TIBA from blocking the auxin entry sites.

Candida pneumonia in young and immunocompetent lady: A case report and literature review

Background

Candida is a frequent respiratory tract colonizer. True candida pneumonia is rare and seen with predominance in immunosuppressed patients. Our aim is to document a previously unreported case of Candida pneumonia in a young and immunocompetent patient, highlighting, an unusual pathological manifestation of this infection in immunocompetent individuals.

Case summary

We report a previously healthy young lady who remained symptomatic with fever, cough and shortness of breath for three weeks duration despite treatment with extensive antibiotics regimen for community acquired pneumonia. She was eventually treated as a probable, rare case of candida pneumonia. The patient demonstrated a dramatic response to single antifungal treatment both clinically and biochemically within the first 24hrs of treatment. Candida albican was isolated on repetitive cultures form the sputum and bronchoalevolar lavage samples. The patient had negative blood cultures. Her HRCT scan revealed bilateral basal air space opacities with peri bronchovascular distribution and centrilobular nodules with branching pattern suggestive of tree in bud predominantly in lower lobes. Her endobronchial biopsies was mostly unremarkable apart from rare non-necrotizing granuloma.

Conclusion

Candida can rarely cause clinically significant pneumonia in immunocompetent patients and should be considered in the differential diagnosis of granulomatous lung disease.

Physical, Psychological and Social Impact of COVID-19 Pandemic on Healthcare Workers at a COVID Designated Bangladeshi Public Hospital

The world has been devastated facing the outbreak of a novel infectious disease known as Corona virus disease (COVID-19). This has been declared as a pandemic by the World Health Organization. The frontline health care workers, who are directly involved in the diagnosis, treatment and care of patients with COVID-19, are taking significant personal risks on their own health and those of their family members. Objectives of the study include establishing the physical, psychological and social impact experience by the healthcare workers serving in public hospitals of Bangladesh. This prospective cross-sectional observational study was carried out at Kuwait Bangladesh Friendship Government Hospital, the first Covid-19 designated hospital of Bangladesh between the 1st June and the 31st August, 2020. A total of 294 doctors, nurses, ward boys and ailed healthcare workers were included in this study via purposive sampling. The study found statistically significant (p value 0.024) difference of medical co-morbidities between Covid-19 positive and Covid-19 negative groups of health care professionals. Significant association was found between duration of work and presence during aerosol generating procedure with COVID infectivity of the study subjects. 72.8% respondents experienced public fear of contracting the virus from them and 69.0% noticed negative attitude of the society towards them. Eighty five percent (85.0%) did not get any community support during this pandemic crisis. The health care professionals engaged in COVID-19 treatment have been taking significant personal risk on their life in terms of physical, psychological and social perspective. Providing safeguard to the health care workers are integral components of public health measures for addressing the COVID-19 pandemic. Special interventions to promote their physical wellbeing and arrangement of adequate psychological training need to be immediately implemented to cope up this critical situation.

Aerobic Bacterial Contamination In Platelet Concentrates At The Regional Blood Centre, Peshawar

BACKGROUND

Platelet concentrates play a crucial role in transfusion medicine, aiding in the management of various medical conditions, including haemorrhage, thrombocytopenia, and platelet dysfunction. However, their storage conditions at 22° C present an optimal environment for bacterial growth, making them susceptible to contamination. Of particular concern is the transmission of microorganisms from the skin flora during the phlebotomy process, which can lead to the transfusion of contaminated platelet concentrates. Such contamination poses significant risks to patients, potentially resulting in morbidity and mortality. Determining the frequency and identifying causative organisms of bacterial contamination in platelet concentrates.

METHODS

It was a descriptive cross-sectional study conducted at the Institute of Pathology and Diagnostic Medicine, Khyber Medical University, and the Regional Blood Center in Peshawar from May to October 2021, spanning a duration of six months. The study included 500 participants aged between 18 and 50 years (mean: 28.13±7.67 years. A simple convenient sampling technique was employed. Blood products underwent screening for Hepatitis B, Hepatitis C, HIV, Syphilis, and Malaria. Leaked units were excluded from the study. Platelets were prepared using a Cryofuge and subsequently subjected to culture media.

RESULTS

The mean age of the participants included in the study was 28.13±7.67 years, with an age range of 18 to 50 years. Out of the total sample size of 500, there were 483 (96.6%) male participants and 17 (3.4%) female participants. Among the collected samples, bacterial growth was observed in only 11 (2.2%) platelet concentrates. The isolated organisms were Staphylococcus epidermidis, found in 7 (1.4%) platelet concentrates, and Staphylococcus aureus, found in 4 (0.8%) platelet concentrates.

CONCLUSIONS

Bacterial contamination of platelet bags is higher compared to developed countries. Therefore, implementing quality control procedures is necessary to reduce the risk of bacterial contamination in platelet concentrates. Additionally, employing enhanced skin disinfection techniques at the phlebotomy site can significantly minimize bacterial contamination.

Identification and genome-wide analysis provide insights into the genetic diversity and biotechnological potentials of novel cold-adapted Acinetobacter strain

Extreme cold environments, such as polar regions or high-altitude mountains, are known for their challenging conditions including low temperatures, high salinity, and limited nutrient availability. Microbes that thrive in these environments have evolved specialized strategies to survive and function under such harsh conditions. The study aims to identify, sequence the genome, perform genome assembly, and conduct a comparative genome-wide analysis of Acinetobacter sp. strain P1, which was isolated from the Batura glacier regions of Pakistan. A basic local alignment search tool of NCBI using 16 s RNA gene sequence confirmed the strain Acinetobacter following phylogenetic analysis revealed that strain P1 clustered with Acinetobacter sp. strain AcBz01. The high-throughput Genome sequencing was done by the NovaSeq 6000 sequencing system following de novo genome assembly reported 23 contigs, a genome size of 3,732,502 bp containing approximately 3489 genes and 63 RNAs (60 tRNA, 3 rRNA). The comparative genome analysis revealed that Acinetobacter sp. strain P1 exhibited the highest homology with the Acinetobacter baumannii ATCC 17978 genome and encompassed 1668 indispensable genes, 1280 conserved genes 1821 specific genes suggesting high genomic plasticity and evolutionary diversity. The genes with functional assignments include exopolysaccharide phosphotransferase enzyme, cold-shock proteins, T6SS, membrane modifications, antibiotic resistance, and set of genes related to a wide range of metabolic characteristics such as exopolysaccharides were also present. Moreover, the structural prediction analysis of EPS proteins reveals that structural flexibility allows for conformational modifications during catalysis, which boosts or increases the catalytic effectiveness at lower temperatures. Overall, the identification of Acinetobacter, a cold-adapted bacterium, offers promising applications in bioremediation, enzyme production, food preservation, pharmaceutical development, and astrobiology. Further research and exploration of these microorganisms can unlock their full biotechnological potential and contribute to various industries and scientific endeavors.

Transplacental Transfer of SARS-CoV-2 Receptor-Binding Domain IgG Antibodies from Mothers to Neonates in a Cohort of Pakistani Unvaccinated Mothers

The presence of COVID-19 antibodies in the maternal circulation is assumed to be protective for newborns against SARS-CoV-2 infection. We investigated whether maternal COVID-19 antibodies crossed the transplacental barrier and whether there was any difference in the hematological parameters of neonates born to mothers who recovered from COVID-19 during pregnancy. The cross-sectional study was conducted at the Saidu Group of Teaching Hospitals, located in Swat, Khyber Pakhtunkhwa. After obtaining written informed consent, 115 healthy, unvaccinated mother-neonate dyads were included. A clinical history of COVID-19-like illness, laboratory-confirmed diagnosis, and contact history were obtained. Serum samples from mothers and neonates were tested for SARS-CoV-2 anti-receptor-binding domain (anti-RBD) IgG antibodies. Hematological parameters were assessed with complete blood counts (CBC) and peripheral blood smear examinations. The study population consisted of 115 mothers, with a mean age of 29.44 ± 5.75 years, and most women (68/115 (59.1%)) were between 26 and 35 years of age. Of these mothers, 88/115 (76.5 percent) tested positive for SARS-CoV-2 anti-RBD IgG antibodies, as did 83/115 (72.2 percent) neonatal cord blood samples. The mean levels of SARS-CoV-2 IgG antibodies in maternal and neonatal blood were 19.86 ± 13.82 (IU/mL) and 16.16 ± 12.90 (IU/mL), respectively, indicating that maternal antibodies efficiently crossed the transplacental barrier with an antibody transfer ratio of 0.83. The study found no significant difference in complete blood count (CBC) parameters between seropositive and seronegative mothers, nor between neonates born to seropositive and seronegative mothers.

Healthcare in Pakistan: Navigating Challenges and Building a Brighter Future

A healthcare system is one of the most essential pillars of any country. The primary role of a healthcare system is to ensure that all people get the best available health facilities in a timely, acceptable, affordable, and accessible manner. However, for a healthcare system to function as such, it requires proper infrastructure and financial support. To a large extent, the healthcare system in Pakistan is facing several challenges. There is a massive shortage of hospitals, doctors, nurses, and paramedical staff. Most life-saving medications are too expensive for people to afford. Now and then, there is a shortage of medicines in the market. Above all, there exists a lack of trust in the healthcare system, which gives way to the ever-increasing quackery in the country. Two parallel systems exist in the healthcare system of Pakistan. One consists of public hospitals, and the other consists of private hospitals. The former is short even of basic healthcare facilities, and the latter is too costly for the people of Pakistan to afford. Solutions to the stumbling and compromised healthcare system of Pakistan are adequate financial support and infrastructure development. Stakeholders need to invest in the healthcare system; otherwise, the healthcare system in Pakistan will continue fighting for its survival rather than improving and competing with the healthcare systems of other nations in the region.

Is there an ideal method of reconstruction for proximal humerus osteosarcoma? A review of different reconstruction techniques

Osteosarcoma is the commonest primary bone malignancy occurring in patients aged <20, and humerus is the third most common site affected by it. In the past, ablative surgery with poor functional outcomes was the only option, but due to advances in chemotherapy, medical imaging and surgical techniques, patient survivorship and the rate of limb salvage surgery has increased significantly. Over the decades many treatment options have been proposed for the reconstruction of the defect following extirpation of the tumour in the proximal humerus, with every procedure having its merits and demerits. However, there is no agreement on the preferred treatment even in similar age groups, and the best way to reconstruct the proximal humerus remains debatable because the restoration of the function of the shoulder girdle remains primarily dependant on the extent of muscle-loss during tumour resection, available surgical expertise and financial constraints in different health systems. The current narrative review was planned to discuss the various reconstruction techniques with their advantages and disadvantages, and a present general review of the relevant literature.

Diverse Repertoire and Relationship of Exopolysaccharide Genes in Cold-Adapted Acinetobacter sp. CUI-P1 Revealed by Comparative Genome Analysis

This study focused on the exploration of microbial communities inhabiting extreme cold environments, such as the Passu and Pisan glaciers of Pakistan, and their potential utilization in industrial applications. Among the 25 initially screened strains, five were found to be suitable candidates for exopolysaccharide (EPS) production, with strain CUI-P1 displaying the highest yield of 7230.5 mg/L compared to the other four strains. The purified EPS from CUI-P1 was tested for its ability to protect probiotic bacteria and E. coli expressing green fluorescence protein (HriGFP) against extreme cold temperatures, and it exhibited excellent cryoprotectant and emulsification activity, highlighting its potential use in the biotechnological industry. Furthermore, the genome of Acinetobacter sp., CUI-P1 comprised 199 contigs, with a genome size of 10,493,143bp and a G + C content of 42%, and showed 98.197% nucleotide identity to the type genome of Acinetobacter baumannii ATCC 17978. These findings offer promising avenues for the application of EPS as a cryoprotectant, an essential tool in modern biotechnology.

Nanosuspension of Foeniculum Vulgare Promotes Accelerated Sensory and Motor Function Recovery after Sciatic Nerve Injury

The seed extract of Foeniculum vulgare (FV) was used for the preparation of a nanosuspension (NS) with an enhanced bioavailability of phytoconstituents. Subsequently, it was employed as a potent source of polyphenols, such as quercetin and kaempferol, to accelerate the regeneration and recovery of motor and sensory function in injured nerves. The NS was administered through daily gauging as NS1 (0.5 mg/mL) and NS2 (15 mg/mL), at a dose rate of 2 g/kg body weight until the end of the study. The NS-mediated retrieval of motor functions was studied by evaluating muscle grip strength and the sciatic functional index. The recovery of sensory functions was assessed by the hotplate test. Several well-integrated biochemical pathways mediate the recovery of function and the regeneration of nerves under controlled blood glucose and oxidative stress. Consequently, the NS-treated groups were screened for blood glucose, total antioxidant capacity (TAC), and total oxidant status (TOS) compared to the control. The NS administration showed a significant potential to enhance the recuperation of motor and sensory functions. Moreover, the oxidative stress was kept under check as a result of NS treatments to facilitate neuronal generation. Thus, the nanoformulation of FV with polyphenolic contents accelerated the reclamation of motor and sensory function after nerve lesion.

Marine life as a source for breast cancer treatment: A comprehensive review

Breast cancer, one of the most significant tumors among all cancer cells, still has deficiencies for effective treatment. Moreover, substitute treatments employing natural products as bioactive metabolites has been seriously considered. The source of bioactive metabolites are not only the most numerous but also represent the richest source. A unique source is from the oceans or marine species which demonstrated intriguing chemical and biological diversity which represents an astonishing reserve for discovering novel anticancer drugs. Notably, marine sponges produce the largest amount of diverse bioactive peptides, alkaloids, terpenoids, polyketides along with many secondary metabolites whose potential is mostly therapeutic. In this review, our main focus is on the marine derived secondary metabolites which demonstrated cytotoxic effects towards numerous breast cancer cells and have been isolated from the marine sources such as marine sponges, cyanobacteria, fungi, algae, tunicates, actinomycetes, ascidians, and other sources of marine organisms.

Fabrication and employment of cobalt-doped yttrium iron garnets for the electrochemical analysis of anti-diabetic, metformin in serum of type 2 diabetes mellitus patients

Metformin (MET) is an anti-diabetic drug employed as the first-line therapy for patients of type II diabetes mellitus (T2DM). Overdosage of drugs leads to severe outcomes, and its monitoring in biofluids is vital. The present study develops cobalt-doped yttrium iron garnets and employs them as an electroactive material immobilized on a glassy carbon electrode (GCE) for the sensitive and selective detection of metformin via electroanalytical techniques. The fabrication procedure via the sol-gel method is facile and gives a good yield of nanoparticles. They are characterized by FTIR, UV, SEM, EDX, and XRD. Pristine yttrium iron garnet particles are also synthesized for comparison, where the electrochemical behaviors of varying electrodes are analyzed via cyclic voltammetry (CV). The activity of metformin at varying concentrations and pH is investigated via differential pulse voltammetry (DPV), and the sensor generates excellent results for metformin detection. Under optimum conditions and at a working potential of 0.85 V (vs. Ag/AgCl/3.0 M KCl), the linear range and limit of detection (LOD) obtained through the calibration curve are estimated as 0-60 μM and 0.04 μM, respectively. The fabricated sensor is selective for metformin and depicts a blind response toward interfering species. The optimized system is applied to directly measure MET in buffers and serum samples of T2DM patients.

Amide Functionalized Mesoporous MOF LOCOM-1 as a Stable Highly Active Basic Catalyst for Knoevenagel Condensation Reaction

Acyl-amide is extensively used as functional group and is a superior contender for the design of MOFs with the guest accessible functional organic sites. A novel acyl-amide-containing tetracarboxylate ligand, bis(3,5-dicarboxy-pheny1)terephthalamide, has been successfully synthesized. The H₄L linker has some fascinating attributes as follows: (i) four carboxylate moieties as the coordination sites confirm affluent coordination approaches to figure a diversity of structure; (ii) two acyl-amide groups as the guest interaction sites can engender guest molecules integrated into the MOF networks through H-bonding interfaces and have a possibility to act as functional organic sites for the condensation reaction. A mesoporous MOF ([Cu₂(L)(H₂O)₃]·4DMF·6H₂O) has been prepared in order to produce the amide FOS within the MOF, which will work as guest accessible sites. The prepared MOF was characterized by CHN analysis, PXRD, FTIR spectroscopy, and SEM analysis. The MOF showed superior catalytic activity for Knoevenagel condensation. The catalytic system endures a broad variety of the functional groups and presents high to modest yields of aldehydes containing electron withdrawing groups (4-chloro, 4-fluoro, 4-nitro), offering a yield > 98 in less reaction time as compared to aldehydes with electron donationg groups (4-methyl). The amide decorated MOF (LOCOM-1-) as a heterogeneous catalyst can be simply recovered by centrifugation and recycled again without a flagrant loss of its catalytic efficiency.

An assessment of the efficacy of biochar and zero-valent iron nanoparticles in reducing lead toxicity in wheat (Triticum aestivum L.)

Soil heavy metal contamination is increasing rapidly due to increased anthropogenic activities. Lead (Pb) is a well-known human carcinogen causing toxic effects on humans and the environment. Its accumulation in food crops is a serious hazard to food security. Developing environment-friendly and cost-efficient techniques is necessary for Pb immobilization in the soil. A pot experiment was executed to determine the role of biochar (BC), zero-valent iron nanoparticles (n-ZVI), and zero-valent iron nanoparticles biochar composite (n-ZVI-BC) in controlling the Pb mobility and bioaccumulation in wheat (Triticum aestivum L.). The results showed that BC and n-ZVI significantly enhanced the wheat growth by increasing their photosynthetic and enzymatic activities. Among all the applied treatments, the maximum significant (p ≤ 0.05) improvement in wheat biomass was with the n-ZVI-BC application (T3). Compared to the control, the biomass of wheat roots, shoots & grains increased by 92.5, 58.8, and 49.1%, respectively. Moreover, the soil addition of T3 amendment minimized the Pb distribution in wheat roots, shoots, and grains by 33.8, 26.8, and 16.2%, respectively. The outcomes of this experiment showed that in comparison to control treatment plants, soil amendment with n-ZVI-BC (T3) increased the catalase (CAT), superoxide dismutase (SOD) activity by 49.8 and 31.1%, respectively, ultimately declining electrolyte leakage (EL), malondialdehyde (MDA) and hydrogen peroxide (H₂O₂) content in wheat by 38.7, 33.3, and 38%respectively. In addition, applied amendments declined the Pb mobility in the soil by increasing the residual Pb fractions. Soil amendment with n-ZVI-BC also increased the soil catalase (CAT), urease (UR), and acid phosphatase (ACP) activities by 68, 59, and 74%, respectively. Our research results provided valuable insight for the remediation of Pb toxicity in wheat. Hence, we can infer from our findings that n-ZVI-BC can be considered a propitious, environment friendly and affordable technique for mitigating Pb toxicity in wheat crop and reclamation of Pb polluted soils.