Snuffbox Versus Wrist Radiocephalic Arteriovenous Fistulas: 10 Years Experience

Background The wrist radiocephalic arteriovenous fistula (RCAVF) is the initial suggested procedure for establishing hemodialysis vascular access (HVA) in the most distal site of the upper limb. The anatomical snuffbox arteriovenous fistula (SBAVF) is barely utilised, despite its remote location. In this study, we aimed to analyse and compare the results of SBAVF and RCAVF in terms of their maturity, patency, and failure rates. Methodology This descriptive, retrospective study compared outcomes between SBAVF and RCAVF in terms of maturation, patency, and failure. All patients with chronic kidney disease who attended and underwent either procedure at Betsi Cadwaladr University Health Board between 2013 and 2023 were studied. Results In a period of 10 years, 179 patients were included. Overall, 102 (57%) were male and 77 (43%) were female, with a male-to-female ratio of 1.3:1. Wrist radiocephalic fistula was the dominant type of surgery done in 76% (n = 136), while the snuffbox radiocephalic fistula was done in fewer than 24% (n = 43) of patients. Most patients underwent a successful arteriovenous (AV) fistula (n = 105, 58.7%), in contrast to 67 patients whose fistulas failed. There was a significant relationship between fistula failure and complications (p = 0.000). There was no significant effect of the fistula site, hypertension, diabetes, cardiac diseases, smoking, peripheral vascular disease, or central vein stenosis on the failure of the AV fistula (p = 0.127, 0.534, 0.510, 0.397, 0.017, 0.68, and 0.371, respectively). Conclusions The snuffbox AV fistula is a suitable and feasible first choice for patients on hemodynamic therapy.

Heterogeneous photocatalytic degradation of antiviral drug didanosine mediated by rose bengal and TiO2 nanoparticles

There is a great concern among the researcher to remove the problem of the persistent organic pollutants in wastewater. Pharmaceutical agrochemical and personal care products are generally considered Persistent organic pollutants. Therefore, it is a matter of concern to develop new techniques how to remove these pollutants safely at low cost. This study mainly focuses on the commonly used antiviral drug didanosine and one most commonly used dye rose bengal. In this study, an organic dye rose bengal and TiO2 nanoparticles have been used in combination with UV light to achieve the photodegradation of selected pharmaceutical products and the dye was also degraded by using TiO2 Nanoparticles. The formation of three oxidation products was detected by using a very popular separation technique thin layer and column chromatography. The isolated photoproduct was characterized by using advanced characterization techniques like FTIR (Fourier transform infrared spectroscopy), UV Spectroscopy, and Proton and 13C NMR (Nuclear Magnetic Resonance spectroscopy). The role of singlet oxygen as an active species in this reaction was confirmed by using D2O as a reaction medium. The role of singlet oxygen in this photochemical reaction was also established by the addition of sodium azide. The TiO2 nanophotocatalyst efficiently degrade the didanosine and rose bengal in the presence of the UV light. In the TiO2-induced photocatalytic degradation of didanosine and dyes, the hydroxyl and superoxide radical anion play a prominent role. The finding of this manuscript is very useful to develop an efficient low-cost method for the treatment of wastewater contaminated by antiviral drugs, similar pharmaceutical products and dyes. This study was also very helpful to establish a plausible mechanism behind the phototoxicity of the didanosine.

Indications and Outcome of Carotid Endarterectomy (CEA): A Single Centre Experience

Background Stroke is a prevalent ailment that impacts a substantial number of individuals globally, resulting in both physical impairment and mortality. One of its major causes is carotid artery stenosis. The symptoms and degree of stenosis are key indications for carotid endarterectomy (CEA). In this study, we highlight the indications and outcomes of carotid endarterectomy in our center. Methods This is a descriptive, retrospective, observational study. Data of patients who underwent CEA at Glan Clwyd Hospital from January 2018 to January 2023 was retrieved. The study sample consisted of patients diagnosed with symptomatic carotid artery stenosis who had CEA at Glan Clwyd Hospital. The data was analyzed using statistical software SPSS (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). Results A total of 150 patients were enrolled in the study. A majority of the patients were male, accounting for 69.3% (n = 104), and had a mean age of 71.1 ± 9.9 standard deviation. A majority of the patients were smokers (48.7%) and had additional medical conditions, including hypertension (34%), ischemic heart disease (17.3%), chronic obstructive pulmonary disease (73.3%), and diabetes (46.7%). Nevertheless, the remaining comorbidities were less common. The outcome of the CEA among the patients was cardiac event 3.3% (n = 5); transient ischemic attack (TIA) 3.3% (n = 5); stroke 0.6% (n = 1); hemorrhage 2.6% (n = 4); surgical site infection 2% (n = 3); perioperative mortality 1.3% (n = 2); and cranial nerve injury 1.3% (n = 2). However, no complications were reported in most of the patients, 85.6% (n = 128). Conclusion An endarterectomy is quite advantageous for treating symptomatic stenosis. The findings can be applied to patients who are physically suitable for surgery. The efficacy of endarterectomy is contingent upon not only the severity of carotid stenosis but also various other parameters, such as the time elapsed between the presenting event and the surgical intervention, as well as the patient's overall medical condition. However, the CEA is the gold standard in surgical management for symptomatic carotid disease.

Algal organic matter induced photodegradation of tinidazole

Antibiotic pollution has become one of the most emerging problems of the modern era. Tinidazole (TDZ) is one the most important nitroimidazole derivative drugs whose use has tremendously increased in the last few years. The proposed research work provides a good alternative cost-effective method for wastewater treatment. In the present investigation, algae were used as a photosensitizer in the treatment of the wastewater that was contaminated with antibiotic residue. The proposed research also provides the probable mechanism involved in the photodegradation of tinidazole. The different factors like concentration and pH of the test solution which play a key role in the photodegradation of drug molecules are also discussed in the present investigation. The result of this study established that the maximum degradation of drug molecules was observed at the algal concentration of 1.6 × 108 Cell/L and approximately 58% of drug molecules were degraded. This study also established that in an acidic medium ie at pH 5 the degradation occurs more efficiently. Results of the current study indicated that the use of algae-induced photodegradation of drug residue became one of the most promising routes for wastewater treatment. The results of the present study provide a new way to treat wastewater contaminated with antibiotics residue.

THE COVID-19 PANDEMIC LOCKDOWN'S IMPACT ON ROUTINE CHILDHOOD VACCINATION

The COVID-19 pandemic limits worldwide healthcare access, particularly mandated childhood vaccines. The frequency and mean of purposefully delayed immunizations in infants aged ≤1 year throughout the COVID-19 pandemic in Nineveh, Iraq, were studied. A retrospective observational study of vaccination data in Nineveh, Iraq, was conducted throughout the pre-pandemic period in 2019, the pandemic period in 2020, and comparable months in 2021-2022. The study covered every vaccination administered at ages neonate, 2, 4, 6, 9, and 12 months. The total number of visits mean for the period (Mar-May) 2020 (comprehensive lockdown period) decreased (-18.5%) against (March-May) 2019, and around 2726 children per day were missing immunization. All scheduled vaccines for children aged ≤12 months showed a decrease. The lowest monthly vaccination coverage rate was in March 2020 (61.0%), with the vaccine coverage rate of IPV (70.25%) being the lowest one, then the BCG vaccine at 70.39%, the Pentavalent vaccine at 70.98%, the HBV vaccine at 74.33%, OPV vaccine 79.3%, Measles vaccine (79.45%), and for MMR vaccine 87.34%. The COVID-19 pandemic's significant effects on childhood immunization, recovered in the months that followed but did not reach that before the pandemic in 2019. Intentional vaccination disruption exposes young infants to avoidable infectious illnesses, emphasizing the importance of personalized interventions to improve immunization visits as well as secure the delivery of services.

Harmonization service and global library of models to support country-driven global information on salt-affected soils

Global distribution of salt-affected soils (SAS) has remained at about 1 billion hectares in the literature over the years despite changes in climate, sea levels, and land use patterns which influence the distribution. Lack of periodic update of input soil data, data gaps, and inconsistency are part of the reasons for constant SAS distribution in the literature. This paper proposes harmonization as a suitable alternative for managing inconsistent data and minimizing data gaps. It developed a new harmonization service for supporting country-driven global SAS information update. The service contains a global library of harmonization models for harmonizing inconsistent soil data. It also contains models for identifying gaps in SAS database and for showing global distribution where harmonization of available data is needed. The service can be used by countries to develop national SAS information and update global SAS distribution. Its data availability index is useful in identifying countries without SAS data in the global database, which is a convenient way to identify countries to mobilize when updating global SAS information. Its application in 27 countries showed that the countries have more SAS data than they currently share with the global databases and that most of their data require SAS harmonization.

Automatic Diabetic Foot Ulcer Recognition Using Multi-Level Thermographic Image Data

Lower extremity diabetic foot ulcers (DFUs) are a severe consequence of diabetes mellitus (DM). It has been estimated that people with diabetes have a 15% to 25% lifetime risk of acquiring DFUs which leads to the risk of lower limb amputations up to 85% due to poor diagnosis and treatment. Diabetic foot develops planter ulcers where thermography is used to detect the changes in the planter temperature. In this study, publicly available thermographic image data including both control group and diabetic group patients are used. Thermograms at image level as well as patch level are utilized for DFU detection. For DFU recognition, several machine-learning-based classification approaches are employed with hand-crafted features. Moreover, a couple of convolutional neural network models including ResNet50 and DenseNet121 are evaluated for DFU recognition. Finally, a CNN-based custom-developed model is proposed for the recognition task. The results are produced using image-level data, patch-level data, and image-patch combination data. The proposed CNN-based model outperformed the utilized models as well as the state-of-the-art models in terms of the AUC and accuracy. Moreover, the recognition accuracy for both the machine-learning and deep-learning approaches was higher for the image-level thermogram data in comparison to the patch-level or combination of image-patch thermograms.

Environmental factors and its influence on human health in BRICS: implications for human development

BRICS economies are facing severe environmental issues that exert a detrimental impact on human health. The analysis intends to examine the impact of CO₂ emissions, environmental policy stringency, and environmental innovations on health outcomes for the BRICS economies. The long-run results of the ARDL-PMG infer that CO₂ has a significant negative in the life expectancy model while it has a significant positive in the death rate model. These findings imply that the rise in CO₂ emissions reduces life expectancy and increases the death rate in BRICS economies. On the other side, the estimates of environmental innovation and environmental policy stringency are positively significant in the life expectancy model; however, in the death rate model, the estimate of environmental innovation is insignificant, and environmental policy stringency is negatively significant in the death rate model. In a nutshell, the findings imply that CO₂ emissions exacerbate health problems, environmental innovations, and environmental policy stringency, improving the health status of the people. Our findings suggest that the BRICS economies should revisit their environmental policies for the betterment of human health.

The psychological burden of disease among patients undergoing cervical spine surgery: Are we underestimating our patients' inherent disability?

BACKGROUND

Studies have utilized psychological questionnaires to identify the psychological distress among certain surgical populations.

RESEARCH QUESTION

Is there an additional psychological burden among patients undergoing surgical treatment for their symptomatic degenerative cervical disease?

MATERIALS AND METHODS

Patients>18 years of age with symptomatic, degenerative cervical spine disease were included and prospectively enrolled. Correlations and multivariable logistic regression analysis assessed the relationship between these mental health components (PCS, FABQ) and the severity of disability described by the NDI, EQ-5D, and mJOA score. Patient distress scores were compared to previously published benchmarks for other diagnoses.

RESULTS

47 patients were enrolled (age: 56.0 years,BMI: 29.7kg/m²). Increasing neck disability and decreasing EQ-5D were correlated with greater PCS and FABQ(all P<0.001). Patients with severe psychological distress at baseline were more likely to report severe neck disability, while physician-reported mJOA had weaker associations. Compared to historical controls of lumbar patients, patients in our study had greater levels of psychological distress, as measured by FABQ (40.0 vs. 17.6; P<0.001) and PCS (27.4 vs. 19.3;P<0.001).

DISCUSSION AND CONCLUSION

Degenerative cervical spine patients seeking surgery were found to have a significant level of psychological distress, with a large portion reporting severe fear avoidance beliefs and catastrophizing pain at baseline. Strong correlation was seen between patient-reported functional metrics, but less so with physician-reported signs and symptoms. Additionally, this population demonstrated higher psychological burden in certain respects than previously identified benchmarks of patients with other disorders. Preoperative treatment to help mitigate this distress, impact postoperative outcomes, and should be further investigated.

LEVEL OF EVIDENCE

Level III.

Morphological and Ecological Correlates of Anuran Tadpoles in Scrub and Subtropical Pine Forests

We recorded tadpoles of eight anuran species from subtropical scrub and pine forests (District Rawalpindi and Islamabad Capital Territory, Pakistan). These include Duttaphrynus melanostictus, Duttaphrynus stomaticus, Microhyla nilphamariensis, Euphlyctis spp., Minervarya spp., Allopaa hazarensis, Nanorana vicina, and Hoplobatrachus tigerinus. Our results showed that the forest type featuring scrub vegetation, low elevation and warmer climate (day air temperature 30°C, day water temperature 28°C) had more species richness (six of the eight recorded species) while the subtropical pine forest featuring relatively low air (16°C) and water (14°C) temperatures and higher elevation had relatively higher anuran endemism. The Indus Valley Toad is an abundant species throughout scrub forest. Changes in climate resulting in increased temperatures in pine forests could negatively impact endemic species by encouraging the spread of species adapted for warmer temperatures.

Coated Controlled-Release Fertilizers: Potential Solution for Sustainable Agriculture

The use of fertilizer in the agricultural field is essential for plant growth but an excess amount of pure chemical contents in fertilizers becomes harmful to every living being. To reduce this chemical exposure, the use of materials coated with Controlled Release Fertilizers (CRFs) are being used. The coating of materials outside the fertilizer does not allow the chemicals to spread completely within one application of fertilizer but its spread can be extended as will be done in 2-3 applications of fertilizer. The features of the undercoating material are thus vital to attain this delayed or slow release of the nutrients present in the fertilizer. The longevity of CRFs depends upon the width of the material coating surrounding the fertilizer, temperature, and moisture. The review focuses on the consequences of conventional fertilizers, the need to control the release of fertilizers and types of coatings used, and their application in sustainable agriculture.

Enhanced sentiment analysis regarding COVID-19 news from global channels

For a healthy society to exist, it is crucial for the media to focus on disease-related issues so that more people are widely aware of them and reduce health risks. Recently, deep neural networks have become a popular tool for textual sentiment analysis, which can provide valuable insights and real-time monitoring and analysis regarding health issues. In this paper, as part of an effort to develop an effective model that can elicit public sentiment on COVID-19 news, we propose a novel approach Cov-Att-BiLSTM for sentiment analysis of COVID-19 news headlines using deep neural networks. We integrate attention mechanisms, embedding techniques, and semantic level data labeling into the prediction process to enhance the accuracy. To evaluate the proposed approach, we compared it to several deep and machine learning classifiers using various metrics of categorization efficiency and prediction quality, and the experimental results demonstrate its superiority with 0.931 testing accuracy. Furthermore, 73,138 pandemic-related tweets posted on six global channels were analyzed by the proposed approach, which accurately reflects global coverage of COVID-19 news and vaccination.

Antiglycation potential of plant based TiO2 nanoparticle in D-ribose glycated BSA in vitro

Biosynthetic procedure is one of the best alternatives, inexpensive and ecologically sound for the synthesis of titanium dioxide (TiO₂ ) nanoparticles using a methanolic extract of medicinal plant. The main prospect of this study was to investigate the antiglycation activity of the TiO₂ nanoparticles (TNP) prepared by ethanolic leaf extract of the Coleus scutellarioides. In this study, biosynthesized TNP characterized with UV-Visible spectroscopy, X-ray diffraction, Fourier transform infrared spectroscopy and scanning electron microscope. These TNP were further investigated with respect to their antiglycation property and it was checked in the mixture of d-ribose glycated bovine serum albumin (BSA) by measuring ketoamine, carbonyl content, Advanced glycation end products (AGEs) and aggregation of protein instigated by glycation process. The inhibitory effect of TNP to restore the structure of BSA in presence of d-ribose were also characterize by biophysical techniques mentioned above. Therefore, the findings of this study suggest repurposing of TNP for its antiglycation property that could be helpful in prevention of glycation instigated AGEs formation and structural loss of proteins.

PATENCY RATE OF BRACHIOCEPHALIC VS RADIOCEPHALIC AVF IN CHRONIC KIDNEY DISEASE PATIENTS IN POPULATION OF D.I.KHAN DIVISION, PAKISTAN

Background: All patients with chronic renal failure need vascular access for hemodialysis that is possible with CVP line but it can be retained for only 02-03weeks due to infection. The most suitable and effective vascular access on long term basis is the creation of arteriovenous fistula (AVF). The objective of this study was to compare the patency rate of Radiocephalic vs Brachiocephalic AVFs in population of D.I.Khan division, Pakistan. Materials & Methods: This randomized controlled trail was conducted in the surgical unit at District Headquarter Teaching Hospital D.I.Khan, Pakistan from January 2017 to January 2020. Two hundred and sixty six patients were randomly allocated by toss method into two groups, one for Brachiocephalic AVF (BCAVF) and second for Radiocephalic AVF (RCAVF). Sex & patency rates were our nominal while age grouping was our ordinal variable. The data for the sample was described by count & percentages & was analyzed for the population as confidence interval at 80% confidence level. McNemar chi-square test was used to test hypothesis to compare the patency rate of Brachiocephalic AVF vs. Radiocephalic AVF at alpha 0.05 with Yates continuity correction using online statistical calculator. Results: The patency was present in 129 (97%, 80% CI 94.45-98.39%) cases & absent in 4 (3%, 80% CI 1.61-5.55%) cases in Brachiocephalic AVF group while it was present in 107 (80.5%, 80% CI 76.04-84.86%) cases & absent in 26 (19.5%, 80% CI 15.52-24.32%) cases in Radiocephalic AVF group. McNemar chi-square test showed p-value of <.0001 (less than alpha). So, the null hypothesis was rejected, showing significant difference between two groups. Conclusion: Brachiocephalic AVF creation is more ideal in terms of patency and maturation as compare to Radiocephalic AVF because of increased vessel diameter and increased arterial pressure at proximal site below elbow joint.

Hearing improvement among children with cholesteatoma who underwent canal wall up and canal wall down surgical management

Objectives:

The most frequently used surgical methods for treating cholesteatoma include canal wall up and canal wall down procedures. The objective of the study was to compare the hearing improvement among children with cholesteatoma who underwent canal wall up and canal wall down surgical management.

Methods:

The cross-sectional analytical study design was used. The study was conducted at the ENT Department of Nishtar Medical University & Hospital Multan from 15^th June to 15^th Nov 2020.. Forty six patients with cholesteatoma were enrolled in the study after taking informed consent. Inclusion and exclusion criteria were followed. The participants were categorized into two groups. Group-A was treated with canal wall-up surgery while Group-B was treated with canal wall down Mastoidectomy. A 12-month post-operative follow-up and the audiometry assessment were compared with pre-surgical values. Additionally, a COMOT-15 survey was administered to analyze self-perceived hearing functions. The Chi-square test was used for comparative analysis of the surgical outcome and hearing improvement among the two groups. P-value (p value<0.05) was considered statistically significant.

Results:

Forty six patients were included in the study with 23 participants in each group. Among 46, 26 were male and 20 were female. The pre and post-operative mean Pure-tone average values were significantly different in (Group-A) who underwent canal wall up Mastoidectomy (p<0.05) than in Group-B, who underwent canal wall down Mastoidectomy. Similarly, hearing sub-section responses of the COMOT-15 survey favored the Canal wall technique. However, the survey showed no significant differences in the mental health status of the two groups (p<0.05).

Conclusion:

Our data collected after a one-year follow-up of patients suggests canal wall up as a preferred technique for hearing improvement than canal wall down technique.

Disease Progression Detection via Deep Sequence Learning of Successive Radiographic Scans

The highly rapid spread of the current pandemic has quickly overwhelmed hospitals all over the world and motivated extensive research to address a wide range of emerging problems. The unforeseen influx of COVID-19 patients to hospitals has made it inevitable to deploy a rapid and accurate triage system, monitor progression, and predict patients at higher risk of deterioration in order to make informed decisions regarding hospital resource management. Disease detection in radiographic scans, severity estimation, and progression and prognosis prediction have been extensively studied with the help of end-to-end methods based on deep learning. The majority of recent works have utilized a single scan to determine severity or predict progression of the disease. In this paper, we present a method based on deep sequence learning to predict improvement or deterioration in successive chest X-ray scans and build a mathematical model to determine individual patient disease progression profile using successive scans. A deep convolutional neural network pretrained on a diverse lung disease dataset was used as a feature extractor to generate the sequences. We devised three strategies for sequence modeling in order to obtain both fine-grained and coarse-grained features and construct sequences of different lengths. We also devised a strategy to quantify positive or negative change in successive scans, which was then combined with age-related risk factors to construct disease progression profile for COVID-19 patients. The age-related risk factors allowed us to model rapid deterioration and slower recovery in older patients. Experiments conducted on two large datasets showed that the proposed method could accurately predict disease progression. With the best feature extractor, the proposed method was able to achieve AUC of 0.98 with the features obtained from radiographs. Furthermore, the proposed patient profiling method accurately estimated the health profile of patients.

DHĀK BUTEA MONOSPERMA-A REVIEW ON ETHNOBOTANICAL AND UNANI PROSPECT AS WELL AS PHYTOCHEMICAL AND PHARMACOLOGICAL PROPERTIES

A large fraction of the world population, especially in the developing and underdeveloped countries depends mainly on the traditional system of medicine. India is well recognized for their traditional systems of medicine such as Unani, Ayurveda and Siddha that prevailed here from centuries and these are important components of the health care system. Unani Medicine is worldwide well ancient traditional system of medicine. There are over 25,000 herbal products documented in the traditional medical literature. In India more than 43% of the total flowering plants are reported to be of medicinal importance. The drugs in Unani system of medicine are derived from three sources i.e. plant, animal and mineral but mainly from herbs. Dhāk (Butea monosperma) one of the important medicinal plants in Unani medical system is used for therapeutic purpose. Many Unani scholars mentioned this drug in their treatises. Also, there exists a vast knowledge in the form of non codified or oral tradition for therapeutic uses of Butea monosperma. Different parts of the plant including bark, root, gum, leaves, flowers and seeds show pharmacological activities due to presence of Phytoconstituents like, Butrin, alkaloids, monospermoside, glucosides, triterpenes and various elements. In this paper, the botanical description of the drug is provided along with the pharmacological actions, therapeutic uses, dose and uses mentioned in Unani classical literature with ethno-botanical uses as well as phytochemical and pharmacological studies on this important plant

POST-OPERATIVE ORAL ANTIBIOTICS IN REDUCING FREQUENCY OF SURGICAL SITE INFECTION FOLLOWING NON-PERFORATED APPENDECTOMY IN POPULATION OF SOUTH WAZIRISTAN AGENCY, PAKISTAN

Background: Acute appendicitis is most frequent cause of acute abdomen in younger population, and surgical site infection (SSI) is commonest complication of appendectomy. The objective of this trial was to compare the efficacy of post-operative oral antibiotics versus placebo in reducing the frequency of surgical site infection (SSI) following appendectomy for non-perforated appendicitis in population of South Waziristan Agency, Pakistan.Materials Methods: The randomized placebo trial was conducted at Agency Headquarter Hospital, Wana, South Waziristan, Pakistan from October 1, 2016 to November 18, 2018. One hundred fifty (150) patients were randomly allocated into two groups, 75 in experimental group, to whom antibiotics were given and 75 in placebo group, to whom antibiotics were not given. Age groups and presence of SSI were two variables, being on nominal scale, were described by count and percentage with CI at 80%CL. McNemar chi-square test was applied to test the hypothesis to see the significance of difference between the experimental and placebo groups in terms of frequency of SSI at alpha .05.Results: SSI was present in nine (12%, 80%CI 7.19-16.80%) out of 75 cases in experimental group and in 12 (16%, 80%CI 10.57-21.42%) out of 75 cases in placebo group. McNemar chi-square test showed no significant difference between the experimental and placebo groups in terms of frequency of SSI (p=.2482).Conclusion: The results are comparable for post-operative oral antibiotics versus placebo in reducing the frequency of surgical site infection (SSI) following appendectomy for non-perforated appendicitis in population of South Waziristan Agency, Pakistan.

Mathematical analysis for the effect of voluntary vaccination on the propagation of Corona virus pandemic

In this manuscript, a new nonlinear model for the rapidly spreading Corona virus disease (COVID-19) is developed. We incorporate an additional class of vaccinated humans which ascertains the impact of vaccination strategy for susceptible humans. A complete mathematical analysis of this model is conducted to predict the dynamics of Corona virus in the population. The analysis proves the effectiveness of vaccination strategy employed and helps public health services to control or to reduce the burden of corona virus pandemic. We first prove the existence and uniqueness and then boundedness and positivity of solutions. Threshold parameter for the vaccination model is computed analytically. Stability of the proposed model at fixed points is investigated analytically with the help of threshold parameter to examine epidemiological relevance of the pandemic. We apply LaSalle's invariance principle from the theory of Lyapunov function to prove the global stability of both the equilibria. Two well known numerical techniques namely Runge-Kutta method of order 4 (RK4), and the Non-Standard Finite Difference (NSFD) method are employed to solve the system of ODE's and to validate our obtained theoretical results. For different coverage levels of voluntary vaccination, we explored a complete quantitative analysis of the model. To draw our conclusions, the effect of proposed vaccination on threshold parameter is studied numerically. It is claimed that Corona virus disease could be eradicated faster if a human community selfishly adopts mandatory vaccination measures at various coverage levels with proper awareness. Finally, we have executed the joint variability of all classes to understand the effect of vaccination strategy on a disease dynamics.

Prevalence of cestodes infection among school children of urban parts of Lower Dir district, Pakistan

Tapeworms of zoonotic importance have been described as a leading public health problem. Current research was aim to assess the prevalence of tapeworms among 5-12years school children residing in district Lower Dir, Pakistan from January 2019-December 2019. The wet mount preparation in saline/iodine/methods were used for stool examination. Data was analyzed using appropriate descriptive, static methods. Of the 400 children studied 71.7% were infected with one or more species of intestinal parasites. Single infection of cestode species was found in 69 individuals with 17.2% prevalence and multiple parasitic infections were identified in 19.7% (n=79/400) individuals. The multiple infection were comprised as 10% (n=40) double, 6.75% (n=27) triple and 3% (n=12) quadruple. A total of 9 species of helminths and one species of protozoan infection. Among the helminths Ascaris lumbricoides was the most prevalent 33.1% (n=95), Taenia saginata 22.6% (n=65), hookworm 19.8% (n=57), Hymenolepis nana 18.8% (n=54), Enterobius vermicularis and Hymenolepis diminuta 1.39% (n=4each), Trichuris trichura 1.04% (n=3), Toxocara spp 0.69% (n=2) and Schistosoma japonicum 0.34% (n=1) were reported. One protozoan species was Cryptosporidium spp 0.69% (n=2) in current study. In case of A.lumbricoides, hookworm, E.vermicularis, T.trichura, T.saginata, H.nana and H.diminuta the male children of below 8 years of age were highly infected. Other infections are reported in the same prevalence with slight difference if any. We conclude that there is a need for mass scale campaigns to create awareness regarding health and hygiene in children and the need for development of effective poverty control programs because deworming alone is not adequate to control parasitic infections.

Influence of raw milk quality attributes on its pricing in Pakistan

In developing countries, milk quality characteristics are not maintained by the milk producers and the middlemen. This study initially estimates the influence of various milk quality attributes on its price and then estimate the effect of socio-demographic characteristics on the marginal price of the milk components. Data collected from milk consumers through personal interview method, and milk sample took from the same consumers are used to estimate a two-stage hedonic model. In the first stage, prices were estimated for milk components and in the second stage, implicit price of each component was used as the dependent variable. The first stage results show that fat, solids-not-fat, total plate counts, color, and pleasant aroma have a significant impact on the milk price. The second stage results indicate that fat and solids-not-fat values are a function of the sociodemographic characteristics of consumers. To maintain milk quality attributes, we recommend the establishment of chilling centers for maintenance of quality, checkpoints and mobile laboratories for testing quality, provision of basic testing equipment at subsidized rates, hygiene awareness program for stakeholders in value chain, health risk awareness for consumers consuming raw milk and its products, and introduction and popularization of enzyme-based lactoperoxidase preservation technology.

TREATMENT OF CHRONIC APICAL PERIODONTITIS: IN A SINGLE OR MULTIPLE VISITS? (REVIEW)

The article describes the effectiveness of the treatment of chronic apical periodontitis in one visit compared to multiple visits. A systematic review of the literature was conducted analyzing articles published on PubMed, Google scholar, ResearchGate and ScienceDirect between 2011 and 2021, treatment effectiveness was the selected outcome variable. A total of 21 articles were selected, 9 of which were selected for detailed review. Chief question in this article was: which treatment approach is more effective? Cleaning, Shaping, disinfecting and obturating in one visit? Or multiple (two) visit protocol? Chronic Apical Periodontitis is treatable in one visit, if done properly. Chronic Apical Periodontitis is treatable in one visit, if done properly, with proper shaping, disinfection, and proper hermetic obturation of the root canal. Bioceramic sealers showed the highest success rate out of all sealers used, the usage of 3-5.25% sodium hydrochloride and 17% ethylenediaminetetraacetic acid showed favorable results, although photodynamic therapy and ultrasonic activated irrigation showed outstanding results.

Topics, Sentiments, and Emotions Triggered by COVID-19-Related Tweets from IRAN and Turkey Official News Agencies

There is no doubt that the COVID-19 epidemic posed the most significant challenge to all governments globally since January 2020. People have to readapt after the epidemic to daily life with the absence of an effective vaccine for a long time. The epidemic has led to society division and uncertainty. With such issues, governments have to take efficient procedures to fight the epidemic. In this paper, we analyze and discuss two official news agencies' tweets of Iran and Turkey by using sentiment- and semantic analysis-based unsupervised learning approaches. The main topics, sentiments, and emotions that accompanied the agencies' tweets are identified and compared. The results are analyzed from the perspective of psychology, sociology, and communication.

Outcome after acute und subacute TEVAR in uncomplicated type B aortic dissection

Objective

In the past years, a paradigm shift from best medical therapy to early thoracic endovascular aortic repair (TEVAR) has been observed in the treatment of uncomplicated type B aortic dissection (uTBAD). We aimed to analyze outcomes after TEVAR in the acute and subacute phase of uTBAD, focusing on aortic remodeling.

Methods

Retrospective analysis of consecutive patients who underwent TEVAR for acute or subacute uTBAD in two tertiary referral centers from 2008 – 2017. Two assessors per center reviewed computed tomography scans of each patient at presentation, at one year and at the last follow-up using post-processing software.

Results

Forty-nine patients were treated with TEVAR for uTBAD. The indication for TEVAR was the presence of multiple morphologic predictors of adverse aortic outcome. The most common predictors were a false lumen diameter of &gt; = 22mm in 76% of patients, a primary entry tear of &gt; = 10mm in 69% and a total aortic diameter of &gt; = 40mm in 67%. There were no in-hospital deaths and no deaths at 1 year. The median follow-up was 40.6 months. Three-year cumulative survival was 94 % (46/49). Fourteen secondary interventions were performed in 10 patients (20 %) after a median of 4.2 months. TEVAR lead to remodeling of the descending thoracic aorta with a median reduction of the total aortic diameter of 4.5 mm within one year and stable diameters after three years. The median maximum false lumen diameter diminished from 26 mm to 15 mm in one year (at 3 years: 14.8 mm).

Conclusion

In this cohort of selected patients with uTBAD and multiple morphologic predictors of worse aortic outcome, elective acute or subacute TEVAR was associated with a low mortality and positive aortic remodeling in the mid-term follow-up.

Socio demographic and lifestyle factors of metabolic syndrome among adult rural indigenous Malaysian population from Perak State, Malaysia

Metabolic syndrome (MetS) is defined as a cluster of known disorders that increase the risk for morbidity and mortality from cardiovascular diseases (CVD) and type 2 diabetes mellitus. This cross sectional study was carried out to estimate the prevalence of MetS using Adult Treatment Panel 3 (ATP 3) classification and socio-demographic and lifestyle factors contributing to metabolic syndrome among rural indigenous Malaysian population from Perak state, Malaysia which included 148 rural Malay and 145 Orang Asli(OA) individuals. This community based cross-sectional study revealed that the prevalence of MetS was significantly higher among Malays (27.7%) as compared to Orang Aslis (13.8%). Overall Prevalence of Metabolic syndrome in the rural indigenous Malaysian population was 20.8%. Prevalence of abdominal obesity and high blood pressure were significantly higher among Malays as compared to OA population. Metabolic syndrome was significantly higher among those above 45 years of age group in overall rural indigenous Malaysian population and among OA. The prevalence of MetS was significantly higher among those who were obese and overweight and among Malays who were regularly taking snacks between meals. There was no significant association between other dietary risk factors, smoking, alcohol use or physical activity with metabolic syndrome.

Selectivity of SO2 and H2S removal by ethanol-treated calcined eggshell at low temperature

Eggshell is a food waste produced worldwide in substantial amount with very limited recycling activity. In this study, the potential of ethanol-treated calcined eggshell was tested as sorbent for SO₂ and H₂S. Three variables were selected in the preparation of sorbents via response surface methodology (RSM), i.e., concentration of ethanol in water (50%, 70%, 90%), reaction temperature (20 °C, 40 °C, 60 °C), and contact time (30, 60, 90 min). Central composite design (CCD) was used to develop a quadratic model to correlate the operating variables with the adsorption capacity. Analysis of variance (ANOVA) was performed to identify the significant factors of the experimental design. It was found that the reaction temperature during the sorbent preparation was the most significant factor. The optimum preparation conditions using RSM were found at 20 °C of reaction temperature with 76.37% of ethanol concentration for 67 min of reaction time. The maximum adsorption capacity for the optimized sorbent was found to be 27.75 mg/g and 9.55 mg/g for SO₂ and H₂S, respectively. The prepared sorbent was more selective towards SO₂ compared with H₂S. Moreover, the presence of 40% of relative humidity in the inlet gas further enhanced the adsorption capacity of both gases. The ethanol-treated calcined eggshell was further substantiated by FESEM, BET, FTIR, XRD, and XRF. Results showed potential usage of eggshell as a sorbent for SO₂ and H₂S gases.

[Reversible cerebral vasoconstriction syndrome causing acute-onset headache]

Reversible cerebral vasoconstriction syndrome is caused by narrowing of cerebral arteries. The cardinal symptom is relapsing acute-onset headache also known as thunderclap headache, which may be accompanied by neurologic deficits. This is a case report of a 61-year-old woman with CT angiography-verified reversible cerebral vasoconstriction syndrome. We discuss the diagnostic work-up, i.e. lumbar puncture including test for xanthochromia and important brain imaging, differential diagnoses and treatment of the most important causes of thunderclap headache.

A quercetin based fluorescent chemical sensor for ultra-sensitive determination and speciation of tungsten species in water

The current study explores the use of quercetin for developing a highly selective spectrofluorimetric methodology for trace determination, speciation and thermodynamic characterization of tungstate (WO₄^2-) species in water. The study relies on the principle of chelate formation between WO₄^2- and quercetin with subsequent increase in the emission intensity. The developed method could be applied successfully in a wide linear range (1.0-400.0 μg L^-1) with a detection limit of 0.28 μg L^-1 and quantification limit of 0.92 μg L^-1 at λ_ex/em = 400/492 nm. The developed method was successfully applied in real tap and waste water samples. The suitability of the proposed method was further validated by inductively coupled plasma-optical emission spectrometry (ICP-OES) in terms of student's t and F tests at 95% confidence. Characterization (NMR, FTIR and electronic spectra), stoichiometry, stability constant, fluorescence mechanism and thermodynamic parameters (ΔH, ΔS, and ΔG) of the produced complex species were evaluated and properly assigned. The fluorescence quenching mechanism of tungstate quercetin complex by Triton X-100 was also evaluated for computing Stern-Volmer quenching constant and approximating quenching sphere. The method showed a clear significance over most of the reported methods for tungsten in literature in terms of good accuracy, robustness, ruggedness, short analytical time and cost-effectiveness.

Protocol of early lumen apposing metal stent removal for pseudocysts and walled off necrosis avoids bleeding complications

Background: EUS-guided drainage of pancreatic fluid collections (PFCs; pancreatic pseudocyst (PPC) or walled-off necrosis (WON)) using lumen apposing metal stents (LAMSs) is now standard of care. We adopted a protocol of early LAMS removal and prospectively followed patients to determine if this protocol avoids bleeding complications.Methods: Prospective, consecutive case series of all patients with PPC and WON who underwent drainage with LAMS at a tertiary care referral center from July 2016 to November 2018. LAMS was removed within 4 weeks for PPC and within 6 weeks for WON. Patients with residual necrosis after 6 weeks underwent removal of initial LAMS and replacement with new LAMS every 6 weeks until resolution. Patients were followed within protocol while monitoring for bleeding complications and clinical success. We also performed a literature review to determine rates of LAMS related bleeding at various timepoints.Results: Forty patients (PPC n = 19, WON n = 21) underwent drainage with LAMS. Median time for LAMS removal was 21.0 days for PPC and 33.5 days for WON. Technical success and clinical success were achieved in 40/40 patients with zero cases of delayed bleeding. A literature review of 21 studies and 1378 patients showed 52/1378 (3.8%) bleeding events with 24/52 (46.2%) events occurring within 1 week of LAMS placement.Conclusions: An early removal LAMS protocol for PFC is highly efficacious and prevents delayed bleeding. Based on analysis of published cases, half of LAMS related bleeding occurs within the first week suggesting procedural factors rather than stent dwell time impact risk of bleeding.

158 Optimal time of AI and changes in vaginal mucus characteristics relative to the onset of standing oestrus in Beetal goats

The aim of this study was to determine the optimum time of AI and its relationship with vaginal mucus characteristics relative to the onset of standing oestrus in Beetal goats. For this purpose, goats (n=257) were synchronised for oestrus by administering two doses of prostaglandin F2α (0.075mg intramuscularly, d+ cloprostenol, Dalmazin) 11 days apart during the breeding season (September-December, 2016-2018). The onset of standing oestrus was determined using apronised bucks. Intracervical inseminations were performed at 0 (n=28), 12 (n=84), 24 (n=101), and 36h (n=44) after the onset of standing oestrus using chilled semen (diluted in skim milk at 200×106 spermatozoa per 0.5-mL dose). Color (transparent=1, turbid=2, cheesy/whitish=3), consistency (thin=1, thick=2), and volume (excess=1, scant=2) of the vaginal mucus in goats were observed at the time of inseminations and graded to determine the cumulative mucus score. Resistive index of vaginal mucus (R-value) was monitored at the time of AI using a Draminski heat detector. The intervals to the onset of oestrus among different months of synchronisation, cumulative mucus score, and vaginal electrical resistance at different times of AI were compared using one-way analysis of variance. Pregnancy rates at different times of AI were compared using chi-square analysis, and the Pearson coefficient of correlation was used to correlate mucus color, consistency, and volume with the cumulative mucus score. Following the second prostaglandin F2α administration, the interval to the onset of standing oestrus was longer (P&lt;0.05) in goats synchronised in December than in those synchronised from September to November. The pregnancy rate was lower (P&lt;0.05) in goats inseminated at 0h (28.6%) compared with those inseminated at 12 (58.3%), 24 (56.4%), and 36h (54.5%). However, the pregnancy rates were similar in goats inseminated at 12, 24, and 36h (P&gt;0.05). Odds for pregnancy rate at 12h were 3.5, 1.08, and 1.16 times higher than those at 0, 24, and 36h, respectively. Relative to the time of AI, the cumulative mucus scores varied (P&lt;0.05), and changes in mucus colour and consistency were more highly correlated (r=0.832 and 0.793, respectively; P&lt;0.05) with cumulative mucus score than the mucus volume (r=0.588). Relative to the onset of standing oestrus, the R-value of the mucus was lower at 12h than at 0 and 36h (P&lt;0.05); however, there was no change in R-value of the mucus at 12 and 24h. In conclusion, the optimum time to inseminate Beetal does using chilled semen is 12h following the onset of oestrus, whereas cumulative mucus score and R-value can be used as alternatives if the time of the onset of oestrus is not known.

Optimization of activated palm oil sludge biochar preparation for sulphur dioxide adsorption

Palm oil sludge (POS) is an organic waste generated from the palm oil industry. POS causes environmental pollution if it is improperly disposed. In this study, the potential of activated POS biochar, as an adsorbent for the removal of SO₂ gas was tested. POS biochar was physically activated using CO₂ gas. The effects of activation preparation variables i.e. activation temperature (300-700 °C), activation time (30-150 min) and CO₂ flow rate (100-500 ml/min) were investigated using design expert version 8.0.7.1 software. Central Composite Design (CCD) was used to develop a quadratic model to correlate the operating variables with the activated biochar adsorption capacity. Analysis of variance (ANOVA) was performed to identify the significant factors on the experimental design response. The optimum preparation conditions of activated POS biochar were found to be at activation temperature of 442 °C, activation time of 63 min and CO₂ flow rate of 397 ml/min. The maximum adsorption capacity at the optimum conditions was recorded as 16.65 mg/g. The adsorption capacity increased significantly after the activation process. Characteristics of the activated POS biochar proposed that SO₂ was physically adsorbed. Furthermore, it was found that the adsorption capacity can be further enhanced by increasing the reaction temperature to 100 °C or with 15% of relative humidity in the inlet gas. The prepared adsorbents can be regenerated by thermal treatment.

Foeniculum vulgare (Fennel) promotes functional recovery and ameliorates oxidative stress following a lesion to the sciatic nerve in mouse model

Peripheral nerve injury is one of the major health concerns of the present era which can lead to the long-lasting disability and even demise. Currently, no effective and side effect free remedy exists and exploration of effective therapeutic strategies to regain functional outcome is a need of hour. In the present study, we used BALB/c mice (N = 14 age, 10-12 weeks & weight 32-34 g) that were divided into two groups: Normal chow (n = 7) and Fennel chow (n = 7) group. Here, we have explored the role of crude Foeniculum vulgare mill seeds in promoting functional recovery following a mechanical insult to the sciatic nerve by an oral administration of a crude dose of 500 mg/kg BW. The recovery of both sensory and motor functions was significantly (p > .05) accelerated in the treatment group, assessed by behavioral analyses alongside total antioxidant capacity increase. Conclusively, F. vulgare can be a potential therapeutic candidate for accelerating functional recovery after peripheral nerve injury. PRACTICAL APPLICATIONS: The outcomes of study have vital practical application both for scientists and consumers. The therapeutic role of phytochemicals on functional recovery has not been explored yet. This study will help figure out plant based regimen as booster for brain health and intervention against traumatic nerve injuries. Moreover, it may also attract the food and pharmaceutical industries to formulate cost effective therapeutic products. Likewise, it can prove instrumental for scientists for advance research on this aspect with more mechanistic targets.

Woodhouse-Sakati syndrome in a family is associated with a homozygous start loss mutation in the DCAF17 gene

BACKGROUND

Woodhouse-Sakati syndrome (WSS) is a rare neuroendocrine and ectodermal disorder inherited in an autosomal recessive pattern. The syndrome presents prominent clinical features, including alopecia, neuroendocrine defects, neurological findings and progressive hearing loss. The condition results from mutations in the DCAF17 gene.

AIMS

To search for the underlying genetic defect in a Pakistani family with WSS phenotypes.

METHODOLOGY

Whole exome sequencing was used to search for the disease-causing variant.

RESULTS

Analysis of the exome data revealed a start loss sequence variant (c.1A>G, p.M1?) in DCAF17.

CONCLUSION

This variant is predicted to abolish translation of the DCAF17 polypeptide. To our knowledge, this is the first start loss variant identified in the DCAF17.