Evaluation of healthcare professionals' understanding of fluoroquinolones' safety profile, usage, and boxed warnings in Pakistan

INTRODUCTION

Fluoroquinolones (FQs) is a distinct class of antibiotics which are prescribed and used quite frequently worldwide, despite the box warnings (BW) issued by Food and Drug Administration (FDA). Literature has shown in spite of BWs related to FQs there is minimal impact on health care professionals (HCPs) prescribing habits, potentially attributing towards limited and insufficient awareness. In Pakistan, FQs are mostly prescribed antibiotics for microbial treatments, therefore the purpose of this study was to determine the level of knowledge about the safety profile, use, and BW of FQs among HCPs working in Pakistan.

METHODS

A cross-sectional study was undertaken among the HCPs of Khyber Pakhtunkhwa province of Pakistan from October 2022 to December 2022. A validated questionnaire was used to assess the knowledge of HCPs regarding FQs, its safety profile and BW. A random convenient sample technique was used while recruiting HCPs in this study. As the HCPs comprised physicians, dentists, pharmacist and nurses, all were approached in person and the study objective was fully elaborated and explained to them. The statistic test like: one-way ANOVA, independent-t test, multivariate logistic regression were used keeping the p-value < 0.05 as statistically significant.

RESULTS

A total of n = 250 HCPs were approached, of which n = 186 HCPs completed the questionnaire with a response rate of 74.4%. FQs prescribing pattern was only assessed among the prescribers, i.e., physicians and dentists (39/186). The mean knowledge score for indications was 5.29 ± 3.05, while for the adverse effects was 7.70 ± 2.61. The highest score for knowledge for indications and adverse effect score was achieved by physicians followed by dentist. The mean knowledge score for the BW was 3.46 ± 2.93 and among the HCPs for the BW of FQs, 20.4% of the HCPs had appropriate knowledge score (score ≥ 50%). The knowledge score was significantly higher in males (p = 0.039), dentists (p = 0.001), HCPs having master/specialization level of education (p = 0.003), HCPs working in government sector hospitals (p = 0.010) and secondary care hospitals (p = 0.001) while the multivariate logistic regression analysis showed that HCPs working in primary care hospital (OR: 6.2) and secondary care hospital (OR: 20.3) were associated with the tendency to achieve 50% or above knowledge score.

CONCLUSION

 Findings of this study reveals the unsatisfactory knowledge of HCPs regarding the safety profile, use, and BW of FQs putting patients at heightened risks of FQs associated AEs. Therefore, it is crucial to implement a national antimicrobial stewardship program, seminars and lectures aimed at continuously updating the knowledge of HCPs, regardless of their specialties, and effectively restrict the misuse of antimicrobial and disseminate FDA BWs in clinical practice.

Bladder cancer patient and provider perspectives on smoking cessation

BACKGROUND

Smoking is the most common risk factor for bladder cancer and is associated with adverse clinical and cancer-related outcomes. Increasing understanding of the patient and provider perspectives on smoking cessation may provide insight into improving smoking cessation rates among bladder cancer survivors. We sought to inform strategies for providers promoting cessation efforts and help patients quit smoking.

METHODS

Using a modified Delphi process with multidisciplinary input from bladder cancer providers, researchers, and a patient advocate, 2 surveys were created for bladder cancer patients and providers. Surveys included multiple-choice questions and free answers. The survey was administered electronically and queried participants' perspectives on barriers and facilitators associated with smoking cessation. Survey responses were anonymous, and participants were provided with a $20 Amazon gift card for participating. Patients were approached through the previously established Bladder Cancer Advocacy Network (BCAN) Patient Survey Network, an online bladder cancer patient and caregiver community. Providers were recruited from the Society of Urologic Oncology (SUO) and the Large Urology Group Practice Association (LUGPA).

RESULTS

From May to June 2021, 308 patients and 103 providers completed their respective surveys. Among patients who quit smoking, most (64%) preferred no pharmacologic intervention ("cold turkey") followed by nicotine replacement therapy (28%). Repeated efforts at cessation commonly occurred, and 67% reported making more than one attempt at quitting prior to eventual smoking cessation. Approximately 1 in 10 patients were unaware of the association between bladder cancer and smoking. Among providers, 75% felt that barriers to provide cessation include a lack of clinical time, adequate training, and reimbursement concerns. However, 79% of providers endorsed a willingness to receive continuing education on smoking cessation.

CONCLUSIONS

Bladder cancer patients utilize a variety of cessation strategies with "cold turkey" being the most used method, and many patients make multiple attempts at smoking cessation. Providers confront multiple barriers to conducting smoking cessation, including inadequate time and training in cessation methods; however, most would be willing to receive additional education. These results inform future interventions tailored to bladder cancer clinicians to better support provider efforts to provide smoking cessation counseling.

Microsponge-derived mini tablets loaded with immunosuppressive agents: Pharmacokinetic investigation in human volunteers, cell viability and IVIVC correlation

Sirolimus, a potent immunosuppressant, has been demonstrated to have remarkable activity in inhibiting allograft rejection in transplantation. The objective of the study was to fabricate microsponge mini tablets with enhanced solubility and bioavailability. β-Cyclodextrin and NEOCEL C91 were selected to prepare the microsponges (SLM-M) to improve the stability and solubility of sirolimus. The current study involved the quasi emulsion-solvent diffusion technique to design sirolimus-loaded microsponges that were further compressed into mini tablets 4 mm in diameter. Solid-state characterization, dissolution at different pH values, stability, and pharmacokinetic profiles with IVIVC data were analyzed in humans. Fourier transform infrared (FTIR) spectroscopy, differential scanning calorimetry (DSC), and X-ray diffraction (XRD) were used to characterize the formulations, and high-performance liquid chromatography (HPLC) was used to assess the drug stability of the compressed microsponge minitablets. The API changed from the crystalline state to an amorphous state, as shown by XRD and DSC. The compressed mini tablets showed a 4-fold enhancement in the drug dissolution profile. A toxicology investigation suggested that mini tablets were safe. In humans, the bioavailability of sirolimus compressed mini tablets from SLM-M was significantly improved. The results suggest that mini tablets prepared with β-cyclodextrin and NEOCEL C91 by a quasi emulsion-solvent diffusion process might be an alternative way to improve the bioavailability of sirolimus. In addition, the manufacturing process is easily scalable for the commercialization of drugs to market.

Optical soliton solutions of the coupled Radhakrishnan-Kundu-Lakshmanan equation by using the extended direct algebraic approach

The analytical soliton solutions place a lot of value on birefringent fibres. The major goal of this study is to generate novel forms of soliton solutions for the Radhakrishnan-Kundu-Lakshmanan equation, which depicts unstable optical solitons that arise from optical propagations using birefringent fibres. The (presumably new) extended direct algebraic (EDA) technique is used here to extract a large number of solutions for RKLE. It gives soliton solutions up to thirty-seven, which essentially correspond to all soliton families. This method's ability to determine many sorts of solutions through a single process is one of its key advantages. Additionally, it is simple to infer that the technique employed in this study is really straightforward yet one of the quite effective approaches to solving nonlinear partial differential equations so, this novel extended direct algebraic (EDA) technique may be regarded as a comprehensive procedure. The resulting solutions are found to be hyperbolic, periodic, trigonometric, bright and dark, combined bright-dark, and W-shaped soliton, and these solutions are visually represented by means of 2D, 3D, and density plots. The present study can be extended to investigate several other nonlinear systems to understand the physical insights of the optical propagations through birefringent fibre.

Current Trends In Complete Denture Education In Undergraduate Dental Colleges Of Pakistan

Objective

To determine the current trends in complete denture education in undergraduate dental colleges.

METHODS

The survey-based study was conducted in April and May 2020 at undergraduate dental colleges of Pakistan, and comprised heads of the Prosthodontics Department at all dental colleges across Pakistan having at least one batch of final year dental students. Data was collected using an online predesigned questionnaire that explored theoretical and practical teaching patterns of complete denture prosthodontics in the undergraduate years, and the materials and practices of students when constructing complete dentures in the clinics. The participants were given the option of choosing more than one option where needed. Data was analysed using SPSS 23.

RESULTS

Of the 49 subjects approached, 40(81.6%) returned the forms duly filled; 11(27.5%) from public-sector institutions and 29(72.5%) from the private sector. There were 26(65%) institutions which required that their undergraduate students fabricate 2-4 conventional complete dentures. In all 40(100%) colleges, faculty gave live clinical demonstrations before students fabricated conventional complete dentures in the outpatient departments. Teaching strategy included small group discussions in 25(62.5%) institutions. Green stick 40(100%), zinc oxide eugenol 40(100%) and impression compound 39(97.2%) were the materials of choice for various steps of impression making. In all the 40(100%) institutions, students fabricated conventional complete dentures during their prosthodontics rotation. Immediate, copy and overdentures were constructed by students in 8(20%), 3(7.5%) and 8(20%) institutions, respectively.

Conclusion

Majority of the dental schools used similar impression materials and techniques for fabricating conventional complete dentures. Didactic teaching of conventional and unconventional complete dentures was being carried out at a huge majority of the dental institutions studied.

Selenium-Priming mediated growth and yield improvement of turnip under saline conditions

Salt toxicity is one of the foremost environmental stresses that declines nutrient uptake, photosynthetic activity and growth of plants resulting in a decrease in crop yield and quality. Seed priming has become an emergent strategy to alleviate abiotic stress and improve plant growth. During the current study, turnip seed priming with sodium selenite (Na2SeO3) was investigated for its ability to mitigate salt stress. Turnip (Brassica rapa L. var. Purple Top White Globe) seeds primed with 75, 100, and 125 μML-1 of Se were subjected to 200 mM salt stress under field conditions. Findings of the current field research demonstrated that salt toxicity declined seed germination, chlorophyll content, and gas exchange characteristics of B. rapa seedling. Whereas, Se-primed seeds showed higher germination rate and plant growth which may be attributed to the decreased level of hydrogen peroxide (H2O2) and malondialdehyde (MDA) decreased synthesis of proline (36%) and besides increased total chlorophyll (46%) in applied turnip plants. Higher expression levels of genes encoding antioxidative activities (CAT, POD, SO,D and APX) mitigated oxidative stress induced by the salt toxicity. Additionally, Se treatment decreased Na+ content and enhanced K+ content resulting in elevated K+/Na+ ratio in the treated plants. The in-silico assessment revealed the interactive superiority of Se with antioxidant enzymes including CAT, POD, SOD, and APX as compared to sodium chloride (NaCl). Computational study of enzymes-Se and enzymes-NaCl molecules also revealed the stress ameliorative potential of Se through the presence of more Ramachandran-favored regions (94%) and higher docking affinities of Se (-6.3). The in-silico studies through molecular docking of Na2SeO3, NaCl, and ROS synthesizing enzymes (receptors) including cytochrome P450 (CYP), lipoxygenase (LOX), and xanthine oxidase (XO), also confirmed the salt stress ameliorative potential of Se in B. rapa. The increased Ca, P, Mg, and Zn nutrients uptake nutrients uptake in 100 μML-1 Se primed seedlings helped to adjust the stomatal conductivity (35%) intercellular CO2 concentration (32%), and photosynthetic activity (41%) resulting in enhancement of the yield attributes. More number of seeds per plant (6%), increased turnip weight (115 gm) root length (17.24 cm), root diameter (12 cm) as well as turnip yield increased by (9%tons ha-1) were recorded for 100 μML-1 Se treatment under salinity stress. Findings of the current research judiciously advocate the potential of Se seed priming for salt stress alleviation and growth improvement in B. rapa.

Antimicrobial efficacy of Mentha piperata-derived biogenic zinc oxide nanoparticles against UTI-resistant pathogens

Misuse of antibiotics leads to the worldwide spread of antibiotic resistance, which motivates scientists to create new antibiotics. The recurring UTI due to antibiotics-resistant microorganism's challenges scientists globally. The biogenic nanoparticles have the potential to meet the escalating requirements of novel antimicrobial agents. The green synthesis of nanoparticles (NPs) gained more attention due to their reliable applications against resistant microbes. The current study evaluates the biogenic ZnO NPs of Mentha piperata extract against resistant pathogens of urinary tract infections by agar well diffusion assay. The biogenic ZnO NPs revealed comparatively maximum inhibition in comparison to synthetic antibiotics against two bacterial strains (Proteus mirabilis, Pseudomonas aeruginosa) and a fungal strain (Candida albicans).The synthesized biogenic ZnO NPs alone revealed maximum activities than the combination of plant extract (PE) and ZnO NPs, and PE alone. The physiochemical features of ZnO NPs characterized through UV-Vis spectroscopy, FTIR, XRD, SEM, and EDX. The UV-Vis spectroscopy revealed 281.85 nm wavelengths; the XRD pattern revealed the crystalline structure of ZnO NPs. The FTIR analysis revealed the presence of carboxylic and nitro groups, which could be attributed to plant extract. SEM analysis revealed spherical hollow symmetry due to electrostatic forces. The analysis via EDX confirmed the presence of Zn and oxygen in the sample. The physiochemical features of synthesized ZnO NPs provide pivotal information such as quality and effectiveness. The current study revealed excellent dose-dependent antimicrobial activity against the pathogenic isolates from UTI-resistant patients. The higher concentration of ZnONPs interacts with the cell membrane which triggers oxidative burst. They may bind with the enzymes and proteins and brings epigenetic alteration which leads to membrane disruption or cell death.

An efficient spline technique for solving time-fractional integro-differential equations

Spline curves are very prominent in the mathematics due to their simple construction, accuracy of assessment and ability to approximate complicated structures into interactive curved designs. A spline is a smooth piece-wise polynomial function. The primary goal of this study is to use extended cubic B-spline (ExCuBS) functions with a new second order derivative approximation to obtain the numerical solution of the weakly singular kernel (SK) non-linear fractional partial integro-differential equation (FPIDE). The spatial and temporal fractional derivatives are discretized by ExCuBS and the Caputo finite difference scheme, respectively. The present study found that it is stable and convergent. The validity of the current approach is examined on a few test problems, and the obtained outcomes are compared with those that have previously been reported in the literature.

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

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

Developing Nanosuspension Loaded with Azelastine for Potential Nasal Drug Delivery: Determination of Proinflammatory Interleukin IL-4 mRNA Expression and Industrial Scale-Up Strategy

In order to increase bioavailability and intranasal absorbance, the current work set out to create azelastine nasal spray based on nanosuspension. Chondroitin was utilized as a polymer to prepare azelastine nanosuspension through the precipitation procedure. A size of 500 nm and a polydispersity index of 0.276 with a negative potential (-20 mV) were achieved. X-ray diffraction, scanning electron microscopy, Fourier transform infrared spectroscopy, thermal analysis including differential scanning calorimetry and thermogravimetric analysis, in vitro release, and diffusion studies were used to characterize the optimized nanosuspension. MTT assay was used to assess the viability of the cells, and hemolysis assay was used to assess the blood compatibility. Using RNA extraction and reverse transcription polymerase chain reaction, the levels of the anti-inflammatory cytokine IL-4, which is most closely related to cytokines in allergic rhinitis, were measured in mouse lungs. The drug dissolution and diffusion study indicated 2.0-fold increase compared to pure reference sample. Therefore, the azelastine nanosuspension could be suggested as a practical and simple nanosystem for intranasal delivery with improved permeability and bioavailability. The outcome obtained in this study indicated that azelastine nanosuspension has great potential to treat allergic rhinitis as intranasal treatment.

The burden of pre-admission pain, depression, and caregiving on palliative care needs for seriously ill trauma patients

INTRODUCTION

Increasing numbers of individuals admitted to hospitals for trauma are older adults, many of whom also have underlying serious illnesses. Older adults with serious illness benefit from palliative care, but the palliative care needs of seriously ill older adults with trauma have not been elucidated. We hypothesize that older adults with serious illness have a high prevalence of pain, depression, and unpaid caregiving hours before trauma admission.

METHODS

Using Health and Retirement Study data (2008-2018) linked to Medicare claims, we identified patients 66 years or older who met an established definition of serious illness in surgery and were admitted with trauma. Descriptive analyses were performed for baseline patient characteristics, pre-admission pain (dichotomized as none/mild vs. moderate/severe), depression (dichotomized as no, Center for Epidemiologic Studies Depression scale [CES-D] < 3 vs. yes, CES-D ≥ 3), and unpaid caregiving hours (dichotomized as low (<30 h/month), high (≥30 h/month)).

RESULTS

We identified 1741 patients, 67.4% were female and 86.8% White. Mean age was 83 (SD 7.5), and 60.3% had ≥4 comorbidities. The majority (62.9%) were admitted due to falls, 33.5% had isolated hip fracture. The prevalence of baseline moderate/severe pain and depression were 38.1% and 42.6%, respectively. Among the cohort, 42.2% had unpaid caregiving, of those 27.7% had ≥30 h/week of unpaid caregiving hours.

CONCLUSIONS

Prior to trauma admission, older adults with serious illness have a high prevalence of pain, depression, and unpaid caregiving hours. These findings may inform targeted palliative care interventions to reduce symptom burden and post-discharge healthcare utilization.

Prevalence of unpaid caregiving, pain, and depression in older seriously ill patients undergoing elective surgery

INTRODUCTION

Serious illness is a life-limiting condition negatively impacting daily function, quality of life, or excessively straining caregivers. Over 1 million older seriously ill adults undergo major surgery annually, and national guidelines recommend that palliative care be available to all seriously ill patients. However, the palliative care needs of elective surgical patients are incompletely described. Understanding baseline caregiving needs and symptom burden among seriously ill older surgical patients could inform interventions to improve outcomes.

METHODS

Using Health and Retirement Study data (2008-2018) linked to Medicare claims, we identified patients ≥66 years who met an established serious illness definition from administrative data and underwent major elective surgery using Agency for Healthcare Research and Quality (AHRQ) criteria. Descriptive analyses were performed for preoperative patient characteristics, including: unpaid caregiving (no or yes); pain (none/mild or moderate/severe); and depression (no, CES-D < 3, or yes, CES-D ≥ 3). Multivariable regression was performed to examine the association between unpaid caregiving, pain, depression, and in-hospital outcomes, including hospital days (days admitted between discharge date and one-year post-discharge), in-hospital complications (no or yes), and discharge destination (home or non-home).

RESULTS

Of the 1343 patients, 55.0% were female and 81.6% were non-Hispanic White. Mean age was 78.0 (SD 6.8); 86.9% had ≥2 comorbidities. Before admission, 27.3% of patients received unpaid caregiving. Pre-admission pain and depression were 42.6% and 32.8%, respectively. Baseline depression was significantly associated with non-home discharge (OR 1.6, 95% CI 1.2-2.1, p = 0.003), while baseline pain and unpaid caregiving needs were not associated with in-hospital or post-acute outcomes in multivariable analysis.

CONCLUSIONS

Prior to elective surgery, older adults with serious illnesses have high unpaid caregiving needs and a prevalence of pain and depression. Baseline depression alone was associated with discharge destinations. These findings highlight opportunities for targeted palliative care interventions throughout the surgical encounter.

Determination of α1-acid glycoprotein (AGP) concentration by HPLC in patients following local infiltration analgesia for primary total hip arthroplasty and its relation to ropivacaine (total and unbound)

Introduction: This study was performed to determine the levels of α1-acid glycoprotein (AGP) in old-age patients undergoing total hip arthroplasty. AGP is considered an acute phase protein produced during the acute phase reaction in the body to various stimuli; their proper monitoring is thus important. Methods: In order to study how AGP concentrations in old age patients change in response to surgical stress (total hip arthroplasty), a high-performance liquid chromatography assay was performed to measure AGP levels. AGP was isolated from the plasma by adding perchloric acid and was analyzed using PLRP-S 4000°A column. The mobile phase consisted of 1 mL TFA/L of water (Solvent A pH 2) and 1 mL TFA/L of acetonitrile (Solvent B). The gradient used was as follows: 0 min 18% B and 82% A, 15 min 60% B and 40% A, and 17 min 60% B and 40% A followed by column re-equilibration for 7 min before the next injection. AGP peak was obtained between 8.8 and 8.9 min. The method was fully optimised according to established guidelines. Results: The data obtained were analyzed on ChromQuest software. AGP concentrations were determined in all samples, including baseline and samples taken at different timed intervals. The peak for AGP was obtained between 8.8 and 8.9 min for both standard AGP and patient plasma. The graphs indicate that AGP concentration in almost all patient samples increased considerably, especially after 4 h and 24 h-for example, initial concentration in patient 1 was 10.36 mg/100 mL but, after 24 h, increased to 23.50 mg/100 mL. There was thus almost a 13 mg/100 mL increase in 24 h, which is confirmed by AGP concentration increasing after various conditions, including surgery. The increased plasma protein binding was comparatively associated with the unchanged free fraction of the drug. Conclusion: This surgically induced increase in AGP concentration resulted in increased plasma protein binding of the drug (ropivacaine), which in turn kept the free portion of ropivacaine stable during the postoperative period.

Comparative Evaluation of Condylar Guidance Angles Measured Using Arcon and Non-Arcon Articulators and Panoramic Radiographs-A Systematic Review and Meta-Analysis

The condylar guidance value (CGV) measurement constitutes an important part of a holistic prosthodontic treatment plan, with horizontal CGVs (HCGVs) and lateral CGVs (LCGVs) being two of the most prominently recognized. This systematic review aimed at evaluating the efficacy of two different types of CGV measurement protocols-articulators (both arcon and non-arcon) and panoramic radiographs. Additionally, it attempts to determine which of the mentioned methods performs better across several parameters. Several important web databases were searched using search terms derived from medical subject headings (MeSH), using keywords linked to "Arcon articulator", "Condylar guidance angle", "non-arcon articulator", "Panoramic x-ray" and "Radiographic examination", which constituted the first step in the study selection strategy. After completion, the search strategy which initially turned up to 831 papers, eventually ended up with 13 studies. The review and subsequent meta-analysis revealed that panoramic radiographs had noticeably greater efficacy in terms of the CGVs as compared to the articulators in the majority of the studies. Within the articulators, the arcon types recorded slightly higher CGVs than the non-arcon variety owing to the precision of jaw movement simulation in the former. However, further studies are required to validate these findings and establish more precise guidelines for the use of CGV measurement protocols in prosthodontic practice.

Patient Perspectives and Side-Effects Experience on Chemotherapy of Non-Small Cell Lung Cancer: A Qualitative Study

Purpose

This study aimed to explore patients' experiences of palliative chemotherapy for non-small cell lung cancer (NSCLC), how patients adapt to their new and challenging life after chemotherapy, their beliefs, and their quality of life.

Patients and Methods

The study used an exploratory descriptive qualitative approach that was designed to explore the experiences and side effects of NSCLC patients on chemotherapy in Pakistan. The study was designed to obtain a deeper understanding of 22 NSCLC patients' experiences, using a face-to-face approach and interviews were conducted. Patients who have completed chemotherapy agreed to participate in semi-structured interviews.

Results

The data were arranged into five themes: hospital facilities and environment, patient's beliefs in alternative treatments, presenting a positive/negative face, life is for living, and health insurance coverage. The major complaints related to bad experiences of chemotherapy-induced side effects, but these patients still managed to complete the full course of their respective chemotherapy. Additionally, the current study revealed the real experience of patients with NSCLC which had been less studied. The patient's experience was summarized into four themes and several subthemes.

Conclusion

This study aid healthcare providers when deciding on treatment options that will improve shared decision-making between clinicians and treatment outcomes.

Estimation of dihydroartemisinin in human plasma using a highly sensitive LTQ Orbitrap mass spectrometer with Xcalibur software

Background: Artemether (ARM), the O-methyl ether prodrug of dihydroartemisinin (DHA), is considered a first-line antimalarial agent. Artemether is extensively metabolized in vivo to its active metabolite DHA, and therefore its determination offers considerable difficulties. In the present study, DHA identification and estimation were accurately performed by the mass spectrometric analysis, using a high-resolution liquid chromatography/electrospray ionization-mass spectrometry (LC/ESI-MS) LTQ Orbitrap hybrid mass spectrometer. Methods: The plasma samples were taken from healthy volunteers, and the spiked plasma was extracted by adding 1 mL of a mixture of dichloromethane and tert.-methyl butyl ether (8:2 v/v) to 0.5 mL of plasma. The internal standard solution (artemisinin 500 ng/mL) was added to the plasma samples. After vertexing and centrifugation, the organic layer was separated and transferred into another tube and dried under nitrogen. The residue was reconstituted in 100 μL of acetonitrile and was injected onto the LC-MS system for analysis. Measurement of standards and samples was carried out isocratically on a Surveyor HPLC system combined with an LTQ Orbitrap mass spectrometer using an ACE 5 C18-PFP column. Mobile phase A consisted of 0.1% v/v formic acid in water, Mobile phase B consisted of acetonitrile only, and isocratic elution was carried out with A:B 20:80, v/v. The flow rate was 500 μL/min. The ESI interface was operated in a positive ion mode with a spray voltage of 4.5 kV. Results: Artemether is not a very biologically stable compound and is immediately metabolized to its active metabolite dihydroartemisinin, so no clear peak was observed for artemether. Both artemether and DHA after ionization undergo neutral losses of methanol and water, respectively, in the source of the mass spectrometer. The ions observed were (MH-H₂O) m/z 267.15 for DHA and (MH-m/z 283.15 for internal standard artemisinin. The method was validated according to international guidelines. Discussion: The validated method was applied successfully for the determination and quantification of DHA in plasma samples. This method works well for the extraction of drugs, and the Orbitrap system with the help of Xcalibur software accurately and precisely determines the concentration of DHA in spiked as well as volunteer's plasma.

Hybrid Deep Learning and Discrete Wavelet Transform-Based ECG Biometric Recognition for Arrhythmic Patients and Healthy Controls

The intrinsic and liveness detection behavior of electrocardiogram (ECG) signals has made it an emerging biometric modality for the researcher with several applications including forensic, surveillance and security. The main challenge is the low recognition performance with datasets of large populations, including healthy and heart-disease patients, with a short interval of an ECG signal. This research proposes a novel method with the feature-level fusion of the discrete wavelet transform and a one-dimensional convolutional recurrent neural network (1D-CRNN). ECG signals were preprocessed by removing high-frequency powerline interference, followed by a low-pass filter with a cutoff frequency of 1.5 Hz for physiological noises and by baseline drift removal. The preprocessed signal is segmented with PQRST peaks, while the segmented signals are passed through Coiflets' 5 Discrete Wavelet Transform for conventional feature extraction. The 1D-CRNN with two long short-term memory (LSTM) layers followed by three 1D convolutional layers was applied for deep learning-based feature extraction. These combinations of features result in biometric recognition accuracies of 80.64%, 98.81% and 99.62% for the ECG-ID, MIT-BIH and NSR-DB datasets, respectively. At the same time, 98.24% is achieved when combining all of these datasets. This research also compares conventional feature extraction, deep learning-based feature extraction and a combination of these for performance enhancement, compared to transfer learning approaches such as VGG-19, ResNet-152 and Inception-v3 with a small segment of ECG data.

Charge Transport Enhancement in BiVO4 Photoanode for Efficient Solar Water Oxidation

Photoelectrochemical (PEC) water splitting in a pH-neutral electrolyte has attracted more and more attention in the field of sustainable energy. Bismuth vanadate (BiVO₄) is a highly promising photoanode material for PEC water splitting. Additionally, cobaltous phosphate (CoPi) is a material that can be synthesized from Earth's rich materials and operates stably in pH-neutral conditions. Herein, we propose a strategy to enhance the charge transport ability and improve PEC performance by electrodepositing the in situ synthesis of a CoPi layer on the BiVO₄. With the CoPi co-catalyst, the water oxidation reaction can be accelerated and charge recombination centers are effectively passivated on BiVO₄. The BiVO₄/CoPi photoanode shows a significantly enhanced photocurrent density (J_ph) and applied bias photon-to-current efficiency (ABPE), which are 1.8 and 3.2 times higher than those of a single BiVO₄ layer, respectively. Finally, the FTO/BiVO₄/CoPi photoanode displays a photocurrent density of 1.39 mA cm^-2 at 1.23 V_RHE, an onset potential (V_on) of 0.30 V_RHE, and an ABPE of 0.45%, paving a potential path for future hydrogen evolution by solar-driven water splitting.

Exome sequencing identifies a novel pathogenic variant in RAB3GAP1 causing Warburg Micro syndrome in a Pakistani family

BACKGROUND

Warburg Micro (WARBM) syndrome is a rare heterogeneous recessive genetic disorder characterized by ocular, neurological, and endocrine problems. To date, disease-causing variants in four genes have been identified to cause this syndrome; of these, RAB3GAP1 variants are the most frequent. Very little is known about WARBM syndrome in rural populations.

OBJECTIVES

This study aims to investigate the genetics underpinnings of WARBM syndrome in a Pashtun family with two patients from Pakistan. The patients presented with spastic diplegia, severe intellectual disability, microphthalmia, microcornea, congenital cataracts, optic atrophy, and hypogonadism.

METHODS

Magnetic resonance imaging (MRI) analysis revealed pronounced cerebral atrophy including corpus callosum hypoplasia and polymicrogyria. Exome sequencing and subsequent filtering identified a novel homozygous missense variant NM_001172435: c.2891A>G, p.Gln964Arg in the RAB3GAP1 gene. The variant was validated, and its segregation confirmed, by Sanger sequencing.

RESULTS

Multiple prediction tools assess this variant to be damaging, and structural analysis of the protein shows that the mutant amino acid residue affects polar contact with the neighboring atoms. It is extremely rare and is absent in all the public databases. Taken together, these observations suggest that this variant underlies Micro syndrome in our family and is extremely important for management and family planning.

CONCLUSIONS

Identification of this extremely rare variant extends the mutations spectrum of Micro syndrome. Screening more families, especially in underrepresented populations, will help unveil the mutation spectrum underlying this syndrome.

A Comparative Study of Plastic and Conserving Surgery in Surgical Treatment for Breast Cancer

Objective: Tumor surgeons now pay special attention to the alteration in breast form following breast-conserving surgery. Safety of breast-conserving margins and postoperative breast appearance are typically challenging in conventional breast-conserving surgery due to the effect of variables such as big breast tumors or unusual placements. It's important to remember that postoperative breast deformity is a real possibility. Breast-conserving tumor plastic surgery combines tumor excision with plastic surgery, allowing for a more thorough removal of the tumor. It provides a more humane treatment option for the majority of patients by ensuring the safety of surgical margins, considering the aesthetic effects, increasing the breast-conserving opportunities for patients with tumors in special parts, and expanding the indications for breast-conserving surgery. It also greatly improves the postoperative quality of life and mental state. In this article, we deeply examine the current state of knowledge concerning the effectiveness, safety, and appropriate patient population for breast-conserving surgery in the context of tumor plastic surgery.

Tellurium Doping Inducing Defect Passivation for Highly Effective Antimony Selenide Thin Film Solar Cell

Antimony selenide (Sb₂Se₃) is emerging as a promising photovoltaic material owing to its excellent photoelectric property. However, the low carrier transport efficiency, and detrimental surface oxidation of the Sb₂Se₃ thin film greatly influenced the further improvement of the device efficiency. In this study, the introduction of tellurium (Te) can induce the benign growth orientation and the desirable Sb/Se atomic ratio in the Te-Sb₂Se₃ thin film. Under various characterizations, it found that the Te-doping tended to form Sb₂Te₃-doped Sb₂Se₃, instead of alloy-type Sb₂(Se,Te)₃. After Te doping, the mitigation of surface oxidation has been confirmed by the Raman spectra. High-quality Te-Sb₂Se₃ thin films with preferred [hk1] orientation, large grain size, and low defect density can be successfully prepared. Consequently, a 7.61% efficiency Sb₂Se₃ solar cell has been achieved with a V_OC of 474 mV, a J_SC of 25.88 mA/cm², and an FF of 64.09%. This work can provide an effective strategy for optimizing the physical properties of the Sb₂Se₃ absorber, and therefore the further efficiency improvement of the Sb₂Se₃ solar cells.

A very rare case of diphallia with anorectal malformation

INTRODUCTION AND IMPORTANCE

Diphallia is extremely rare urological anomaly with reported incidence of 1 in 5-6 million live births. It can present as complete or incomplete diphallia. In most of the cases it is associated with complex urological, gastrointestinal or anorectal malformations.

CASE PRESENTATION

We report here case of a newborn who was presented to us at 1st day of life with diphallia and anorectal malformation. He had true diphallia with two separate uretheral orifices. Both phalluses were uncircumcised, phallus 1 was 2.5 cm in length while phallus 2 was 1.5 cm. Both phalluses had normal shaped glans with uretheral opening located at the normal place He had a single scrotum with two midline raphe and well-formed rouge. He was passing urine from both orifices. His ultrasonography of urological system showed two ureters and a single hemi bladder. He was admitted and operated upon and a sigmoid divided colostomy was constructed. Per-operatively congenital pouch colon (type 4) was identified. His post-operative recovery was uneventful. The patient was discharged on second post-operative day and called for follow up.

CLINICAL DISCUSSION

Diphallia is a rare congenital anomaly, which means two structurally and anatomically separate phalluses. Complete Duplication in Diphallia presents the kind of Diphallia in which both the phalluses have two corpus cavernosum and only one corpus spongiosum. As diphallia presents with a spectrum of diseases; therefore, it requires a multidisciplinary approach. A case of Diphallia may well present with complex urogenital, gastrointestinal or anorectal malformations. As in our case the patient had Diphallia with anorectal malformation. Hence he was operated upon and a sigmoid colostomy was constructed.

CONCLUSION

Diphallia is a very rare congenital anomaly which can occur in association with anorectal malformations. Management of such cases should be individualized depending upon the spectrum of disease.

Transformation of a copper-based metal-organic polyhedron into a mixed linker MOF for CO2 capture

A new mixed linker metal-organic framework (MOF) has been synthesized from a copper-based metal-organic polyhedron (MOP-1) and 2,2'-bipyridine (2,2'-bipy). The CuMOF-Bipy with a formula of [Cu₂(2,2'-bpy)₂(m-BDC)₂]_n is comprised of a binuclear Cu(II) node coordinated to 2,2'-bipy, and isophthalic acid (m-BDC), which bridges to neighboring nodes. The crystal structure of CuMOF-Bipy consists of a stacked two-dimensional framework with the sql topology. CuMOF-Bipy was characterized by single-crystal X-ray diffraction (SC-XRD), X-ray photoelectron spectroscopy (XPS), thermogravimetric analysis (TGA), and CO₂ sorption. CuMOF-Bipy was shown to have one-dimensional sinusoidal channels that allow diffusion of CO₂ but not N₂.

Synthesis of Fluoro-Bridged Ho3+ and Gd3+ 1,3,5-Tris(4-carboxyphenyl)benzene Metal-Organic Frameworks from Perfluoroalkyl Substances

A new fluoro-bridged rare-earth (RE) metal-organic framework consisting of 15-connected nonanuclear and 9-connected trinuclear clusters {[RE₉-(μ₃-F)₁₄(H₂O)₆][RE₃(μ₃-F)(H₂O)₃](HCO₂)₃-(BTB)₆}·(solvent)x 2 (RE = Ho³⁺ and Gd³⁺) was synthesized through the transformation of a dimeric complex formulated as bis(2,2'-bipyridine)tetrakis(μ-2-fluorobenzoato-O,O')-bis(2-fluorobenzoato)diRE(III) 1 with the bridging linker 1,3,5-tris(4-carboxyphenyl)benzene (H₃BTB). The rare-earth metal ions Ho³⁺ and Gd³⁺ were also found to remove fluorine from other organo-fluorine compounds such as perfluorohexanoic acid (PFHxA) and perfluorooctanoic acid (PFOA), resulting in the new fluoro-bridged RE-MOFs.