Microlearning Environment of Orthodontic Postgraduate Training Programmes in Pakistan: A Multicentre Cross-Sectional Study

OBJECTIVE

To explore the perception of residents regarding the microlearning environment of orthodontic postgraduate training programmes across Pakistan.

STUDY DESIGN

Descriptive, cross-sectional, multicentre study. Place and Duration of the Study: Department of Orthodontics, Dental College, HITEC Institute of Medical Sciences, Taxila, from February to July 2022.

METHODOLOGY

This questionnaire-based study was conducted using a pre-validated HEMLEM tool for data collection. QuestionPro survey tool was utilised for data collection and SPSS version 23 was used for data analysis. Independent t-test and one-way ANOVA were performed for comparison of different subgroups.

RESULTS

A total of 204 residents participated in this study and collectively showed a mean score of 45.2. Male residents showed significantly higher level of satisfaction than females. Residents below the age of 25 years and those in the first year of training showed maximum level of satisfaction with their learning environments. In general, participants perceived the teaching quality and supervision as more satisfactory than the staff attitude and behaviour.

CONCLUSION

Overall, a higher HEMLEM score was recorded, which suggested that Pakistani orthodontic residents felt satisfied with their microlearning environment. Clinical supervisors, curriculum designers, and programme directors could use the findings of this study to further improve the learning environment of their training programmes.

KEY WORDS

Learning environment, Microlearning environment, Residents, Clinical training, Supervision, Staff support.

Microarray needles comprised of arginine-modified chitosan/PVA hydrogel for enhanced antibacterial and wound healing potential of curcumin

Wound healing is a multifaceted and complex process that includes inflammation, hemostasis, remodeling, and granulation. Failures in any link may cause the healing process to be delayed. As a result, wound healing has always been a main research focus across the entire medical field, posing significant challenges and financial burdens. Hence, the current investigation focused on the design and development of arginine-modified chitosan/PVA hydrogel-based microneedles (MNs) as a curcumin (CUR) delivery system for improved wound healing and antibacterial activity. The substrate possesses exceptional swelling capabilities that allow tissue fluid from the wound to be absorbed, speeding up wound closure. The antibacterial activity of MNs was investigated against S. aureus and E. coli. The results revealed that the developed CUR-loaded MNs had increased antioxidant activity and sustained drug release behavior. Furthermore, after being loaded in the developed MNs, it revealed improved antibacterial activity of CUR. Wound healing potential was assessed by histopathological analysis and wound closure%. The observed results suggest that the CUR-loaded MNs greatly improved wound healing potential via tissue regeneration and collagen deposition, demonstrating the potential of developed MNs patches to be used as an effective carrier for wound healing in healthcare settings.

Revolutionizing ocular cancer management: a narrative review on exploring the potential role of ChatGPT

This paper pioneers the exploration of ocular cancer, and its management with the help of Artificial Intelligence (AI) technology. Existing literature presents a significant increase in new eye cancer cases in 2023, experiencing a higher incidence rate. Extensive research was conducted using online databases such as PubMed, ACM Digital Library, ScienceDirect, and Springer. To conduct this review, Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines are used. Of the collected 62 studies, only 20 documents met the inclusion criteria. The review study identifies seven ocular cancer types. Important challenges associated with ocular cancer are highlighted, including limited awareness about eye cancer, restricted healthcare access, financial barriers, and insufficient infrastructure support. Financial barriers is one of the widely examined ocular cancer challenges in the literature. The potential role and limitations of ChatGPT are discussed, emphasizing its usefulness in providing general information to physicians, noting its inability to deliver up-to-date information. The paper concludes by presenting the potential future applications of ChatGPT to advance research on ocular cancer globally.

The Hyperledger fabric as a Blockchain framework preserves the security of electronic health records

The Hyperledger Fabric (HF) framework is widely studied for securing electronic health records (EHRs) in the healthcare sector. Despite the various cross-domain blockchain technology (BCT) applications, little is known about the role of the HF framework in healthcare. The purpose of the systematic literature review (SLR) is to review the existing literature on the HF framework and its applications in healthcare. This SLR includes literature published between January 2015 and March 2023 in the ACM digital library, IEEE Xplore, SCOPUS, Springer, PubMed, and Google Scholar databases. Following the inclusion and exclusion criteria, a total of 57 articles emerged as eligible for this SLR. The HF framework was found to be useful in securing health records coming from the Internet of Medical Things (IoMT) and many other devices. The main causes behind using the HF framework were identified as privacy and security, integrity, traceability, and availability of health records. Additionally, storage issues with transactional data over the blockchain are reduced by the use of the HF framework. This SLR also highlights potential future research trends to ensure the high-level security of health records.

Revolutionizing Chronic Obstructive Pulmonary Disease Care with the Open AI Application: ChatGPT

Chronic Obstructive Pulmonary Disease (COPD) is one of the major and leading threats to human being. To cope with this health challenge, several studies have been undertaken in the literature. However, COPD is not paid close attention to eliminate it entirely. The current study aims to examine the role of ChatGPT application to bring improvement in controlling and managing COPD in patients. ChatGPT is used to give prompt answers of text-based questions in a variety of fields. It has potential role in knowing the symptoms of COPD, and letting individuals to modify their life styles. ChatGPT suggests medications for COPD individuals based on the established medical guidelines. Compared to the literature, ChatGPT provides a comprehensive list of COPD test and evaluation methods. ChatGPT has the potential to help physicians to take decisions in diagnosing, treating, and managing COPD among individuals in its upcoming versions. More researches can be conducted to identify the limits of ChatGPT application in future works.

Synergist response of the Peach fruit fly, Bactrocera zonata (Saunders) to some ammonium based proteinaceous food bait attractants

BACKGROUND

Under the family Tephritidae, Bactrocera zonata (Saunders) is a serious pest, attacking fruits and vegetables causing large quantitative and qualitative damages throughout the world. Fruit flies require proteinaceous food for sexual maturation and egg development. Therefore, food bait attractants are frequently utilized for fruit fly detection, monitoring, mass trapping, and control. Using a Y-shape olfactometer (behavioral tests), we selected the best synthetic proteinaceous food bait attractants to volatiles identified by fruit fly antennae. The responses of B. zonata adults, male and female, to some ammonium compounds (ammonium acetate (AA), trimethylamine (TMA), and putrescine) that were mixed with certain food attractants were evaluated under laboratory conditions. Using flies ranging in age from 5 to 30 days, possible mixtures were discovered that might be useful in developing fruit fly attractants for both males and females. So, four base baits were developed by mixing protein hydrolysate with jaggery, papaya powder, kachri powder, potassium hydroxide (KOH), and guava pulp. Finally, thirty-two (32) synthetic blends were developed when the above four base baits were mixed with synthetic attractants.

RESULTS

The olfactometer bioassay indicated that protein hydrolysate and jaggery-based baits were effective in attracting both male and female flies throughout their adult lives when combined with AA + putrescine (Bait 6) and AA + TMA + putrescine (Bait 8). Similarly, protein hydrolysate + guava pulp-based baits combined with AA + putrescine (Bait 6) and AA + TMA + putrescine (Bait 8) was effective in attracting both male and female flies from 5 to 30 days of age. The pH of all 32 synthetic blends was measured and ranged from 4.77 to 11.35.

CONCLUSIONS

According to our observation, the variation in pH may be due to differences in chemical composition between the attractants and food constituents. The pH of protein bait attractants may be an important factor in the attraction efficiency of B. zonata males and females.

ChatGPT Applications and Challenges in Controlling Monkey Pox in Pakistan

Generative Pre-trained Transformer-based Chatbot (ChatGPT) is an emerging OpenAI application with its greater role in revolutionizing the world. ChatGPT can generate a massive amount of data by using the simple textual input. ChatGPT has its role in supporting the communities to make deciding role in healthcare sector. This paper aims to provide information about monkey pox (mpox) infection in Pakistan. Moreover, this paper analyzes the text-based information given by ChatGPT and narrates potential advantages and disadvantages about mpox infection. Spread of infection, symptoms and diagnose of mpox, control and management, and government responsibilities are major identified advantages. Findings of this paper also show some potential issues of ChatGPT AI application, which are as lack of latest data about mpox in Pakistan, reliability and performance issues, cost and resources for appropriate development and implementation of Open AI application in healthcare. Future works can be carried out to address these limitations in ChatGPT AI application.

Awareness and Practices towards Vaccinating Their Children against COVID-19: A Cross-Sectional Study among Pakistani Parents

There are typically lower COVID-19 vaccination rates among developing versus higher-income countries, which is exacerbated by greater vaccine hesitancy. However, despite the increasing evidence of safety, parents are still reluctant to vaccinate their children against COVID-19. This is a concern in countries experiencing successive waves, such as Pakistan. Consequently, the objective of this study was to gain better understanding and practice regarding parents vaccinating their children against COVID-19 in Pakistan. A cross-sectional study was conducted to measure parents' attitudes towards vaccinating their children. In total, 451 parents participated in the study, giving a response rate of 70.4%; 67.4% were female, 43.2% belonged to the 40-49 years age group, and 47.7% had three children, with 73% of parents fully immunized against COVID-19. We found that 84.7% of parents did not consider COVID-19 to be a very serious issue, and 53.9% considered that their children were not at high risk of COVID-19. Overall, only a quarter of the study participants had currently vaccinated their children and 11.8% were willing to vaccinate their children in the near future. Parents who had a better knowledge of COVID-19, secondary or higher education, children who had chronic illness, and those parents whose children had been infected with COVID-19 were more likely to have their children vaccinated. The most common reasons for vaccine hesitancy were "my child is not at high risk of COVID-19" (61%) and "I am afraid to put/inject a foreign object inside my child's body" (52.2%). Overall, vaccine acceptance was low among the parents of the children. Those parents with higher education, chronic illnesses, greater knowledge of COVID-19 and its vaccines, and those whose children had been infected with COVID-19 were significantly (p < 0.001) inclined towards vaccinating their children. Effective campaigns as well as awareness sessions are needed to address misinformation and reduce vaccine hesitancy.

Automation of structural health monitoring (SHM) system of a bridge using BIMification approach and BIM-based finite element model development

This research focuses on the automation of an existing structural health monitoring system of a bridge using the BIMification approach. This process starts with the Finite Element Analysis (FEA) of an existing bridge for the numerical calculations of static and dynamic parameters. The validation of the FE model and existing SHM system was carried out by the field load testing (Static and dynamic) of the bridge. Further, this study tries to fill the research gap in the area of automatic FE model generation by using a novel methodology that can generate a BIM-based FE model using Visual Programming Language (VPL) scripts. This script can be exported to any FE software to develop the geometry of the FE model. Moreover, the SHM devices are deployed to the Building Information modelling (BIM) model of the bridge to generate the BIM-based sensory model (as per the existing SHM system). In this way, the BIM model is used to manage and monitor the SHM system and control its sensory elements. These sensors are then linked with the self-generated (Internet of Things) IoT platform (coded in Arduino), developing a smart SHM system of the bridge. Resultantly, the system features visualisation and remote accessibility to bridge health monitoring data.

Evaluation of chemosterility effect of different insect growth regulators on Bactrocera zonata population

The indiscriminate application of synthetic pesticides on horticultural plants for the management of Bactrocera zonata has both economic and environmental implications due to the biomagnification of harmful residues in humans via the food chain. This necessitates the use of some eco-friendly control measures such as insect growth regulators (IGRs) as an alternative. A laboratory experiment was laid out to determine the potential chemosterilant effect of five IGRs including pyriproxyfen, novaluron, lufenuron, buprofezin, and flubendiamide at six different concentrations on B. zonata after treating adult diet. Using the oral bioassay, B. zonata were fed on IGRs impregnated diet (50-300 ppm/5 mL diet) which was replaced with the normal diet after 24 h of feeding. Ten pairs of B. zonata were placed in a separate plastic cage accommodating an ovipositor attractant guava for eggs collection and calculation. An analysis of the result revealed that fecundity and hatchability were higher at a low dose and vice versa. Lufenuron at 300 ppm/5 mL of diet significantly decreased the fecundity rate (31.1%) as compared to pyriproxyfen, novaluron, buprofezin and flubendiamide, which had 39.3%, 39.3%, 43.8%, and 47.5%, respectively. The lowest hatchability (19.9%) was noted in lufenuron treated diet followed by pyriproxyfen, novaluron, buprofezin, and flubendiamide, which had 22.1%, 25.0%, 30.9%, and 31.6%, respectively. Furthermore, in a population of crosses between the lufenuron treated male and female, a significant decrease in fecundity (45.5%) and hatchability (51.7%) was noted as compared to other IGRs. Overall, this study identified the chemosterilant potential of lufenuron on the population of B. zonata which can be integrated for its management strategy.

Enhancements in yield, agronomic, and zinc recovery efficiencies of rice-wheat system through bioactive zinc coated urea application in Aridisols

BACKGROUND

Zinc (Zn) deficiency and source-dependent Zn fertilization to achieve optimum Zn levels in rice and wheat grains remain global concern for human nutrition, especially in developing countries. To-date, little is known about the effectiveness of bioactive Zn-coated urea (BAZU) to enhance the concentration, uptake, and recovery of Zn in relation to agronomic efficiency in paddy and wheat grains.

RESULTS

Field experiments were carried out during 2020-21 on the rice-wheat system at Lahore, Faisalabad, Sahiwal, and Multan, Punjab, Pakistan using four treatments viz.T1 (Urea 46% N @ 185 kg ha-1 + zero Zn), T2 (Urea 46% N @ 185 kg ha-1 + ZnSO4 33% Zn @ 15 kg ha-1), T3 (BAZU 42% N @ 103 kg ha-1 + Urea 46% N @ 62 kg ha-1 + 1% bioactive Zn @ 1.03 kg ha-1) and T4 (BAZU 42% N @ 125 kg ha-1 + Urea 46% N @ 62 kg ha-1 + 1% bioactive Zn @ 1.25 kg ha-1) in quadruplicate under Randomized Complete Block Design. Paddy yield was increased by 13, 11, 12, and 11% whereas wheat grain yield was enhanced by 12, 11, 11, and 10% under T4 at Multan, Faisalabad, Sahiwal, and Lahore, respectively, compared to T1. Similarly, paddy Zn concentration was increased by 58, 67, 65 and 77% (32.4, 30.7, 31.1, and 34.1 mg kg-1) in rice whereas grain Zn concentration was increased by 90, 87, 96 and 97% (46.2, 43.9, 46.7 and 44.9 mg kg-1) in wheat by the application of BAZU (T4) at Multan, Faisalabad, Sahiwal, and Lahore, respectively, in comparison to T1. Zinc recovery was about 9-fold and 11-fold higher in paddy and wheat grains, respectively, under BAZU (T4) treatment relative to T2 while, the agronomic efficiency was enhanced up to 130% and 141% in rice and wheat respectively as compared to T2.

CONCLUSION

Thus, T4 application at the rate of 125 kg ha-1 could prove effective in enhancing the rice paddy and wheat grain yield along with their Zn biofortification (∼34 mg kg-1 and ∼47 mg kg-1, respectively) through increased agronomic and Zn recovery efficiencies, the underlying physiological and molecular mechanisms of which can be further explored in future.

Emerging technologies and their roles during the COVID-19 pandemic and safety challenges of frontline medical staff: a rapid review

Purpose

The coronavirus 2019 (COVID-19) pandemic has rapidly spread worldwide, with an ever-increasing number of confirmed positive cases and mortality rate. Moreover, frontline medical staff fighting with the COVID-19 infection have been infected and show psychological effects of the pandemic. This study presents an overview of the emerging literature on the safety challenges of frontline medical staff and how technology is being used to control the COVID-19 pandemic.

Methods

This study conducts a rapid review of available studies by following the “preferred reporting items for systematic reviews and meta-analyses” (PRISMA) guidelines. Sixty-three articles were selected for this rapid review paper from three popular digital data repositories.

Results

The majority of the studies chosen focused on the discussion of COVID-19 with regard to China, Singapore, Italy, and the USA. A previously proposed framework is used to synthesize the findings of this study. The results throw light on the several challenges faced by medical staff during the COVID-19 pandemic. Eleven major technologies have been identified in this paper.

Conclusion

This work concludes that technology helps in the prevention and detection of the COVID-19 infection, where it specifically helps in reducing the safety challenges of frontline medical staff and monitoring the COVID-19 patients.

Exploration of ethnomedicinal plants and their practices in human and livestock healthcare in Haripur District, Khyber Pakhtunkhwa, Pakistan

BACKGROUND

The utilization of plants and plant resources for various ethnobotanical purposes is a common practice in local towns and villages of developing countries, especially in regard to human and veterinary healthcare. For this reason, it is important to unveil and document ethnomedicinal plants and their traditional/folk usage for human and livestock healthcare from unexplored areas. Here we advance our findings on ethnomedicinal plants from Haripur District, Pakistan, not only for conservation purposes, but also for further pharmacological screenings and applied research.

METHODOLOGY

Information of ethnomedicinal plants was obtained using a carefully planned questionnaire and interviews from 80 local people and traditional healers (Hakims) in Haripur District, Pakistan, from 2015 to 2017. Informed consent was obtained from each participant before conducting the interview process. Quantitative ethnobotanical indices, such as relative frequency of citation (RFC), use value (UV) and Jaccard index (JI), were calculated for each recorded species. Correlation analysis between the RFC and UV was tested by Pearson's correlation, SPSS (ver. 16).

RESULTS

A total of 80 plant species (33 herbs, 24 trees, 21 shrubs and 2 climbers) belonging to 50 families were being used in the study area to treat livestock and human diseases. Lamiaceae was the most dominant family with 7 species (8.7%), followed by Fabaceae with 6 species (7.5%), and Moraceae with 5 species (6.2%). Local people used different methods of preparation for different plant parts; among them, decoction/tea (22 species) was the popular method, followed by powder/grained (20 species) and paste/poultice (14 species). It was observed that most of the species (~ 12 to 16 species) were utilized to treat human and livestock digestive system-related problems, respectively. The Jaccard index found that plant usage in two studies (District Abbottabad and Sulaiman Range) was more comparable. Local people mainly relied on folk medicines due to their rich accessibility, low cost and higher efficacy against diseases. Unfortunately, this important traditional knowledge is vanishing fast, and many medicinal plants are under severe threat. The most threats associated to species observed in the study area include Dehri, Garmthun, Baghpur, Najafpur and Pharala.

CONCLUSION

The study has indicated that local people have higher confidence in the usage of ethnomedicinal plants and are still using them for the treatment of various ailments. Comparative analysis with other studies may strongly reflected the novel use of these plants, which may be due to the deep-rooted and unique socio-cultural setup of the study area. However, awareness campaigns, conservation efforts and pharmacological and applied research are required for further exploration and may be a step in the right direction to unveil prospective pharmaceuticals.

Combined measures to control the COVID-19 pandemic in Wuhan, Hubei, China: A narrative review

Coronavirus disease 2019 (COVID-19) is an emerging disease caused by the coronavirus, SARS-CoV-2, which leads to severe respiratory infections in humans. COVID-19 was first reported in December 2019 in Wuhan city, a populated area of the Hubei province in China. As of now, Wuhan and other cities nearby have become safe places for locals. The rapid control of the spread of COVID-19 infection was made possible due to several interventions and measures that were undertaken in Wuhan. This narrative review study was designed to evaluate the emerging literature on the combined measures taken to control the COVID-19 pandemic in Wuhan city. Science Direct, Springer, Web of Science, and the PubMed data repositories were searched for studies published between December 1, 2019, and June 07, 2020. The referred "preferred reporting items for systematic reviews and meta-analyses" (PRISMA) protocol was used to conduct this narrative review. A total of 330 research studies were found as a result of the initial search based on exclusion and inclusion criteria, and 30 articles were chosen on final evaluation. It was discovered that the combined measures to control the spread of COVID-19 in Wuhan included cordon sanitaire, social distancing, universal symptom surveys, quarantine strategies, and transport restrictions. Based on the recommendations presented in this review study, existing policies with regard to combined measures and public health policies can be enforced by other countries to implement a rapid control procedure to control the spread of the COVID-19 pandemic.

Protection challenges of pregnant women against vertical transmission during COVID-19 epidemic: A narrative review

This paper presents a narrative review study of 5 popular data repositories focusing on challenges of pregnant women protection during the COVID-19 pandemic. The study concludes that the likelihood of a vertical transmission of COVID-19 infection from pregnant women to neonates was not observed. Nevertheless, it remains a serious risk for them during their earlier stage of pregnancy, thus, special attention from health professionals has been recommended.

Cervical cancer screening decentralized policy adaptation: an African rural-context-specific systematic literature review

Background: Worldwide, nearly 570,000 women are diagnosed with cervical cancer each year, with 85% of new cases in low- and middle-income countries. The African continent is home to 35 of 40 countries with the highest cervical cancer mortality rates. In 2014, a partnership involving a rural region of Senegal, West Africa, was facing cervical cancer screening service sustainability barriers and began adapting regional-level policy to address implementation challenges.

Objective: This manuscript reports the findings of a systematic literature review describing the implementation of decentralized cervical cancer prevention services in Africa, relevant in context to the Senegal partnership. We report barriers and policy-relevant recommendations through Levesque’s Patient-Centered Access to Healthcare Framework and discuss the impact of this information on the partnership’s approach to shaping Senegal’s regional cervical cancer screening policy.

Methods: The systematic review search strategy comprised two complementary sub-searches. We conducted an initial search identifying 4272 articles, then applied inclusion criteria, and ultimately 19 studies were included. Data abstraction focused on implementation barriers categorized with the Levesque framework and by policy relevance.

Results: Our findings identified specific demand-side (clients and community) and supply-side (health service-level) barriers to implementation of cervical cancer screening services. We identify the most commonly reported demand- and supply-side barriers and summarize salient policy recommendations discussed within the reviewed literature.

Conclusions: Overall, there is a paucity of published literature regarding barriers to and best practices in implementation of cervical cancer screening services in rural Africa. Many articles in this literature review did describe findings with notable policy implications. The Senegal partnership has consulted this literature when faced with various similar barriers and has developed two principal initiatives to address contextual challenges. Other initiatives implementing cervical cancer visual screening services in decentralized areas may find this contextual reporting of a literature review helpful as a construct for identifying evidence for the purpose of guiding ongoing health service policy adaptation.

Temporal Trends in the Prevalence of Diabetes Decompensation (Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State) Among Adult Patients Hospitalized with Diabetes Mellitus: A Nationwide Analysis Stratified by Age, Gender, and Race

Background

Disproportionate change in the burden of diabetes mellitus across various subgroups has been reported in the United States. However, changing landscape of the prevalence and mortality of decompensated diabetes (diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)) remains indistinct across various age, gender, and racial groups of hospitalized diabetics.

Methods

The National Inpatient Sample (NIS) datasets (2007-2014) were sought to assess the prevalence and temporal trends in decompensated diabetes stratified by age, gender, and race and related in-hospital outcomes among the adult patients hospitalized with diabetes using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Discharge weights were used to obtain national estimates.

Results

Of 56.7 million hospitalizations with diabetes, 0.5 (0.9%) million patients revealed decompensated diabetes from 2007 to 2014. The decompensated diabetics consisted of younger (~52 vs. 66 yrs), more often black (24.2% vs. 17.3%) and Hispanic (12.9% vs. 10.9%) patients as compared to those without decompensation (p<0.001). Younger diabetes patients demonstrated the highest prevalence of in-hospital decompensation (18-44 yrs; 3.7%) with a relative increase of 32.4% (from 3.4% to 4.5%) from 2007 to 2014 (p_trend<0.001). Older diabetics (≥65 years) with decompensation suffered the highest in-hospital mortality (12.8%). The overall rate of decompensation was similar (0.9%) among male and female diabetes patients. However, over a period of 8 years, the rates of decompensation rose to 1.1% (p_trend<0.001) in males and 1.2% (p_trend<0.001) in females, respectively. All-cause in-hospital mortality among females with decompensated diabetes declined from 6.6% in 2007 to 5.9% in 2014 (p_trend=0.019). However, there was no significant drop in in-hospital mortality among male diabetics with acute decompensation (6.7% in 2007 to 6.8% in 2014, p_trend=0.811). We observed significantly increasing trends in decompensated diabetes among all race groups between 2007 and 2014 (p_trend<0.001). The in-hospital mortality was highest among Asian or Pacific Islander (0.9%) diabetes patients with decompensation from 2007 to 2014. There was a declining trend in the inpatient mortality among Asian or Pacific Islander (p_trend=0.029) and Hispanic (p_trend<0.001) patients with decompensated diabetes, whereas other race groups did not observe any significant decline in mortality over the study period. Diabetes hospitalizations with decompensation demonstrated significantly higher in-hospital mortality (6.3% vs. 2.6%; p<0.001), average length of stay (7.7 vs. 5.4 days; p<0.001), hospital charges ($65,904 vs. $42,889, p<0.001), and more frequent transfers to short-term hospitals (3.9% vs. 2.9%; p<0.001) in comparison to those without decompensation. The rates of acute myocardial infarction (AMI) (10.4% vs. 4.8%; p<0.001), stroke (4.0% vs. 3.3%; p<0.001) and venous thromboembolism (3.5% vs. 2.6%; p<0.001) were substantially higher among diabetics with decompensation compared to those without.

Conclusions

There was an increasing trend in the prevalence of decompensated diabetes from 2007 to 2014, most remarkable among younger black male diabetics. The patients with decompensated diabetes suffered higher in-hospital mortality and rates of AMI, stroke and venous thromboembolism, there was no significant decline in the mortality between 2007 and 2014.

Bacterial impregnation of mineral fertilizers improves yield and nutrient use efficiency of wheat

BACKGROUND

The fertilizer use efficiency (FUE) of agricultural crops is generally low, which results in poor crop yields and low economic benefits to farmers. Among the various approaches used to enhance FUE, impregnation of mineral fertilizers with plant growth-promoting bacteria (PGPB) is attracting worldwide attention. The present study was aimed to improve growth, yield and nutrient use efficiency of wheat by bacterially impregnated mineral fertilizers.

RESULTS

Results of the pot study revealed that impregnation of diammonium phosphate (DAP) and urea with PGPB was helpful in enhancing the growth, yield, photosynthetic rate, nitrogen use efficiency (NUE) and phosphorus use efficiency (PUE) of wheat. However, the plants treated with F8 type DAP and urea, prepared by coating a slurry of PGPB (Bacillus sp. strain KAP6) and compost on DAP and urea granules at the rate of 2.0 g 100 g^-1 fertilizer, produced better results than other fertilizer treatments. In this treatment, growth parameters including plant height, root length, straw yield and root biomass significantly (P ≤ 0.05) increased from 58.8 to 70.0 cm, 41.2 to 50.0 cm, 19.6 to 24.2 g per pot and 1.8 to 2.2 g per pot, respectively. The same treatment improved grain yield of wheat by 20% compared to unimpregnated DAP and urea (F0). Likewise, the maximum increase in photosynthetic rate, grain NP content, grain NP uptake, NUE and PUE of wheat were also recorded with F8 treatment.

CONCLUSION

The results suggest that the application of bacterially impregnated DAP and urea is highly effective for improving growth, yield and FUE of wheat. © 2017 Society of Chemical Industry.

Posttraumatic stress disorder as a risk factor for obesity among male military veterans

OBJECTIVE

Obesity is a significant public health problem in the United States, particularly among military veterans with multiple risk factors. Heretofore, posttraumatic stress disorder (PTSD) has not clearly been identified as a risk factor for this condition.

METHOD

We accessed both a national and local database of PTSD veterans.

RESULTS

Body mass index (BMI) was greater (P < 0.0001) among male military veterans (n = 1819) with PTSD (29.28 +/- 6.09 kg/m(2)) than those veterans (n = 44 959) without PTSD (27.61 +/- 5.99 kg/m(2)) in a sample of randomly selected veterans from the national database. In the local database of male military veterans with PTSD, mean BMI was in the obese range (30.00 +/- 5.65) and did not vary by decade of life (P = 0.242).

CONCLUSION

Posttraumatic stress disorder may be a risk factor for overweight and obesity among male military veterans.

Association of educational attainment with HIV risk in African American active injection drug users

This study explored the association between educational attainment and HIV/AIDS risk among African American active injection drug users (IDUs) in Chicago, US. Using snowball sampling techniques, 813 African American active IDUs were recruited for semi-structured interviewing and HIV counseling, testing and partner notification. Logistic regression examined the relationship between level of education attained (three categories: less than high school; equivalent to high school; and greater than high school) and HIV risk behaviors (12 unsafe sex and drug-related practices) and HIV serostatus (positive or negative). Compared with the reference category (less than high school education), those with education equal to high school were less likely to share water, p = 0.044, OR = 0.70 (95%CI: 0.50-0.99). Compared with the reference category, those with education greater than high school were less likely to receive money for sex, p = 0.048, OR = 0.62 (95%CI: 0.38-0.99); share needles with person having HIV or AIDS, p = 0.015, OR = 0.58 (95%CI: 0.37-0.90); and test positive for HIV, p = 0.027, OR = 0.58 (95%CI: 0.36-0.94). The significant associations found between educational attainment and certain HIV risk behaviors and HIV serostatus have implications for tailoring HIV prevention efforts for less educated African American IDUs.

Influence of religiosity on HIV risk behaviors in active injection drug users

Previous studies have shown a positive relationship between religiosity and the practice or adoption of protective health behaviors, including reduction of illicit drug use among hard-core injecting drug users (IDUs). The purpose of this study was to examine the role of religiosity in predicting HIV high-risk drug and sexual practices among a sample of IDUs in Chicago, USA. We hypothesized that high religiosity would be associated with a lower likelihood of IDUs engaging in risky behaviors for HIV transmission. Snowball sampling techniques were used to recruit 1,095 active IDUs for HIV testing, counseling and partner notification. Data were analyzed from 880 subjects who self-identified with one of three religions, Christianity, Islam or Judaism. Logistic regression was used to examine the relationship between religiosity (based on self-reports of personal strength of religious belief: very strong; somewhat strong; not at all), independent of specific religion, and HIV risk behaviors (defined as 12 unsafe sex- and drug-related practices) as well as HIV serostatus. Contrary to our hypothesis, subjects with stronger religiosity were more likely to engage in four risk behaviors related to sharing injection paraphernalia. Compared to those who self-reported having no religiosity, subjects who stated that their lives were strongly influenced by religious beliefs were significantly more likely to share injection outfits, cookers, cotton and water. The association of certain HIV risk behaviors with higher religiosity has implications for HIV prevention and warrants further research to explore IDUs' interpretation of religious teachings and the role of religious education in HIV prevention programs.

Improvement in variability of the horizontal meridian of the primary visual area following high-resolution spatial normalization

We investigated the decrease in intersubject functional variability in the horizontal meridian (HM) of the primary visual area (V1) before and after individual anatomical variability was significantly reduced using a high-resolution spatial normalization (HRSN) method. The analyzed dataset consisted of 10 normal, right-handed volunteers who had undergone both an O-15 PET study, which localized retinotopic visual area (V1), and a high-resolution anatomical MRI. Individual occipital lobes were manually segmented from anatomical images and transformed into a common space using an in-house high-resolution regional spatial normalization method called OSN. Individual anatomical and functional variability was quantified before and after HRSN processing. The reduction of individual anatomical variability was judged by the reduction in gray matter (GM) mismatch and by the improvement in overlap frequency between individual calcarine sulci. The reduction in intersubject functional variability of HM was determined by measurements of the overlap frequency between individual HM areas and by improvement in intersubject Z-score maps. The HRSN processing significantly reduced the individual anatomical variability: GM mismatch was reduced by a factor of two and the mean calcarine sulcus overlap frequency was improved from 37 to 68%. The reduction in functional variability was more subtle. However, both HM mean overlap (increased from 18 to 28%) and the average Z-score (increased from 2.2 to 2.55) were significantly improved. Although, functional registration was significantly improved by matching sulci, there was still residual variability. This is believed to be the variability of individual areas within the calcarine sulcus, and cannot be resolved by sulcal match. Thus, the proposed methodology provides an efficient, unbiased, and automated way to study structure-functional relationship in human brain.

Management strategies for community acquired pneumonia

The past decade has witnessed dramatic changes in the etiology, diagnosis, and management of community acquired pneumonia (CAP). Due to the wide variation in practice patterns, physicians and professional societies have taken the lead in developing practice guidelines. To better understand the range of these multiple protocols, various stages of the disease and treatment are described and compared. Experts agree that CAP management should include: defining a correct diagnosis, identifying high risk populations in order to determine the severity of the disease, recommending appropriate treatment therapies, and obtaining positive and cost beneficial outcomes.

Evaluation of a new fluorescent dye method to measure urinary albumin in lieu of urinary total protein

Urinary total protein (UTP) determinations are notoriously inaccurate, poorly reproducible, and difficult to interpret in early renal disease, causing many investigators to measure urinary albumin instead. In this study, we compare a new nonimmunologic fluorescent dye (AB-dye) for measuring albumin with the more expensive and cumbersome radioimmunoassay. We tested 207 urine specimens from patients with variable protein concentrations and divided the results into five arbitrary ranges (0 to 20, 21 to 50, 51 to 100, 101 to 200, and 201 to 400) for chi-square analysis. There was a high degree of correlation between the two methods (chi-square = 260. 8 with 16 degrees of freedom; P < 0.001). The correlation was also high when analyzed by linear regression (R = 0.86; F < 0.01). Based on our comparison of total protein and albumin concentration in the same urine samples, we hypothesized that patients with mild proteinuria may not necessarily have microalbuminuria. Urine samples with UTP between 150 and 400 microg/mL were tested for albumin by the AB-dye. Of 41 samples in this range, 18 (44%) had normal albumin levels. We conclude that measuring urinary albumin with the AB-dye is comparable in performance to radioimmunoassay and could replace UTP determinations, especially for patients with borderline elevations of UTP, many of whom do not have microalbuminuria.

Suppression of hyperparathyroidism by calcitriol therapy

We reviewed the charts of 160 patients on hemodialysis and identified 33 with parathyroid hormone (PTH) > 800 pg/ml at any time during the last 3 years to confirm our impression that patients with PTH elevations for short durations of time require significantly smaller doses of calcitriol than those with prolonged PTH elevations. We divided the patients into two groups: 18 with PTH > 800 pg/ml on three or fewer occasions (Group 1, short-term hyperparathyroidism) and 15 with PTH > 800 pg/ml more than three times (Group 2, long-term hyperparathyroidism). Most patients received once weekly intravenous calcitriol, but if this failed to suppress PTH, the dose was increased gradually to three times a week, PTH was measured at mid-week, calcitriol was held if serum calcium rose to >11 mg/dl, and calcitriol was started again when calcium fell to <11 mg/dl. We found that the duration of dialysis was generally shorter in Group 1, as were maximal PTH levels. Calcitriol suppressed PTH levels to <200 pg/ml in both groups. However, the weekly dose of calcitriol needed to suppress PTH was significantly lower in Group 1 (5.4 +/- 1.2 microg in Group 1 and 11.4 +/- 1.8 microg in Group 2; p < 0.001). Further follow-up of seven patients for 1 more year showed continued suppression of PTH, and the dose of calcitriol required to maintain the suppression was lower than the initial dose. Thus patients with longer histories of dialysis and prolonged hyperparathyroidism required higher doses of calcitriol to suppress PTH to the same level as patients who were new on dialysis or with transient hyperparathyroidism. A protocol of three times weekly, high dose calcitriol with strict monitoring of serum calcium will avoid parathyroidectomy in most cases.

Dialysis-associated renal cystic disease resembling autosomal dominant polycystic kidney disease: a report of two cases

Acquired renal cystic disease is common in patients receiving dialysis. Characteristically, the kidneys are small or, less often, normal in size, and the cysts are usually less than 0.6 cm in diameter. We present here 2 patients who, after 5 and 7 years on hemodialysis, developed marked renal enlargement, with large cysts in the kidneys and, in 1 patient, in the liver as well; the appearance on ultrasonography and computed tomography was indistinguishable from autosomal dominant polycystic kidney disease. Before starting dialysis the first patient was a 19-year-old man who developed renal shutdown from crescentic glomerulonephritis, and the second patient was a 33-year-old man who developed end-stage renal failure from malignant hypertension. Neither patient had renal cysts at the onset of end-stage renal failure.