Correction: Clinical outcomes in a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: A cohort analysis using routine data

[This corrects the article DOI: 10.1371/journal.pmed.1003279.].

Inhibitory effect of thymoquinone from Nigella sativa against SARS-CoV-2 main protease. An in-silico study

Abstract Nigella sativa is known for the safety profile, containing a wealth of useful antiviral compounds. The main protease (Mpro, 3CLpro) of severe acute respiratory syndrome 2 (SARS-CoV-2) is being considered as one of the most attractive viral target, processing the polyproteins during viral pathogenesis and replication. In the current investigation we analyzed the potency of active component, thymoquinone (TQ) of Nigella sativa against SARS-CoV-2 Mpro. The structures of TQ and Mpro was retrieved from PubChem (CID10281) and Protein Data Bank (PDB ID 6MO3) respectively. The Mpro and TQ were docked and the complex was subjected to molecular dynamic (MD) simulations for a period 50ns. Protein folding effect was analyzed using radius of gyration (Rg) while stability and flexibility was measured, using root means square deviations (RMSD) and root means square fluctuation (RMSF) respectively. The simulation results shows that TQ is exhibiting good binding activity against SARS-CoV-2 Mpro, interacting many residues, present in the active site (His41, Cys145) and also the Glu166, facilitating the pocket shape. Further, experimental approaches are needed to validate the role of TQ against virus infection. The TQ is interfering with pocket maintaining residues as well as active site of virus Mpro which may be used as a potential inhibitor against SARS-CoV-2 for better management of COVID-19.

Left bundle branch area pacing vs biventricular pacing for cardiac resynchronization: A systematic review and meta-analysis

Background

Left bundle branch area pacing (LBBAP) may offer greater physiological benefits than traditional biventricular pacing (BiVP). However, there are limited data comparing the efficacy of LBBAP vs BiVP in patients with systolic heart failure (HF).

Objective

The purpose of this meta-analysis was to compare the feasibility and electromechanical and clinical outcomes of both LBBAP and BiVP.

Methods

We conducted a systematic review of studies retrieved from various databases including PubMed, Embase, Google Scholar, Scopus, and Cochrane Central Register of Control Trials (CENTRAL) published up to May 22, 2023. The risk ratio (RR) and standardized mean difference (SMD) with corresponding 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively.

Results

We included 12 studies with a total of 3004 patients (LBBAP = 1242, BiVP = 1762). Pooled results showed that LBBAP resulted in a significant increase in left ventricular ejection fraction (SMD 0.40, 95% CI 0.25, 0.54, P < .00001), echocardiographic response (RR 1.19, 95% CI 1.10 to 1.29, P < .0001), improvement in New York Heart Association functional class (SMD -0.44, 95% CI -0.65 to -0.23, P < .0001), QRS duration reduction (SMD -0.90, 95% CI -1.14 to -0.66, P < .00001), left ventricular end-diastolic diameter reduction (SMD -0.31, 95% CI -0.57 to -0.05, P = .02), fewer HF hospitalizations (RR 0.72, 95% CI 0.62, 0.85, P < .0001), and improved survival (RR 0.73, 95% CI 0.58, 0.92, P = .007). In addition, LBBAP was associated with shorter fluoroscopy time (SMD -0.94, 95% CI -1.42 to -0.47, P < .0001) and lower pacing threshold at implantation (SMD -1.03, 95% CI -1.32 to -0.74, P < .00001) and at 6 months (SMD -1.44, 95% CI -2.11 to -0.77, P < .0001) as compared with BiVP.

Conclusion

Compared with BiVP, LBBAP was associated with better electromechanical and clinical outcomes, including left ventricular ejection fraction, QRS duration, echocardiographic response, New York Heart Association functional class, HF hospitalization, and all-cause mortality in patients with systolic HF.

Phenobarbital and Alcohol Withdrawal Syndrome: A Systematic Review and Meta-Analysis

Alcohol withdrawal syndrome (AWS) is a complication frequently encountered among patients who are chronic alcohol abusers. It is considered to have a significant impact on the United States healthcare system. It not only has a toll on the healthcare spending but also contributes to significant morbidity and mortality. Benzodiazepines are considered first line in the treatment of AWS. Since patients with alcohol use disorder have downregulated gamma aminobutyric acid (GABA) receptors, this often leads to benzodiazepine resistance. Phenobarbital is also used in the management of alcohol withdrawal syndrome. Here we present a systematic review and meta-analysis of the efficacy and safety of the drug. We conducted an electronic database search for relevant studies published between the inception of the project and November 20, 2022, in three databases, including Medline/PubMed, Embase, and Cochrane Library. Our study included all original studies with prime focus on the baseline characteristics of patients admitted to the intensive care unit (ICU) for alcohol withdrawal syndrome and management/monitoring protocol implemented for its treatment. The primary outcomes that were the focus of our study consisted of changes in the length of hospital stay, length of ICU stay, and changes in scoring systems (for alcohol withdrawal assessment and monitoring) following the implementation of phenobarbital. The secondary outcomes included complications such as intubation and mortality. Based on our analysis, the mean difference in hospital stay was statistically significant at -2.6 (95% CI, -4.48, -0.72, P=0.007) for phenobarbital compared to the benzodiazepine group. We were unable to comment on the heterogeneity in our meta-analysis due to the standard deviation not being reported in one study. There was no statistically significant difference regarding the length of stay in the intensive care unit compared to the control/comparative arm, with a mean difference of -1.17 (95% CI, -1.17, 0.09, P=0.07), with considerable heterogeneity (I²=77%, P=0.002). Our meta-analysis also investigated the risk of intubation between the phenobarbital and the control/comparative group. There was statistically significant difference in the incidence of intubation, relative risk (RR) 0.52 (95% CI, 0.25, 1.08, P=0.08), with considerable heterogeneity (I²=80%, P=0.0001). Our study concludes that phenobarbital is an effective tool in the management of AWS in an ICU setting. However, various studies have reported contradictory results, and vital information appears to be lacking. Moreover, there is a lack of uniformity in terms of phenobarbital dosing. Drug administration should be adapted according to the severity of the symptoms. Further studies need to be conducted discussing the safety profile and adverse effects of the drug when it comes to the management of alcohol withdrawal syndrome.

An analytical study on the identification of N-linked glycosylation sites using machine learning model

N-linked is the most common type of glycosylation which plays a significant role in identifying various diseases such as type I diabetes and cancer and helps in drug development. Most of the proteins cannot perform their biological and psychological functionalities without undergoing such modification. Therefore, it is essential to identify such sites by computational techniques because of experimental limitations. This study aims to analyze and synthesize the progress to discover N-linked places using machine learning methods. It also explores the performance of currently available tools to predict such sites. Almost seventy research articles published in recognized journals of the N-linked glycosylation field have shortlisted after the rigorous filtering process. The findings of the studies have been reported based on multiple aspects: publication channel, feature set construction method, training algorithm, and performance evaluation. Moreover, a literature survey has developed a taxonomy of N-linked sequence identification. Our study focuses on the performance evaluation criteria, and the importance of N-linked glycosylation motivates us to discover resources that use computational methods instead of the experimental method due to its limitations.

Effect of Ranque-Hilsch Vortex Tube Cooling to Enhance the Surface-Topography and Tool-Wear in Sustainable Turning of Al-5.6Zn-2.5Mg-1.6Cu-0.23Cr-T6 Aerospace Alloy

The aerospace metal cutting industry's search for environmentally friendly practices that do not compromise machining performance is well known. One of the major objectives is the reduction in use of cutting fluids, which play a major role in containing the harsh effects of severe heat generated during machining. Machining performance and product quality can be improved by controlling heat during machining. The purpose of this study was to determine the effectiveness of various environmentally friendly metalworking fluid (MF) strategies for the sustainable turning of aerospace aluminum alloy (Al-5.6Zn-2.5Mg-1.6Cu-0.23Cr-T6) for automotive, marine, and aerospace industrial applications. The SEM images were analyzed for worn tool surfaces and machined surfaces. Under dry conditions, heat does not dissipate well, and will enter the workpiece due to the absence of coolant. This causes extreme damage beneath a turned workpiece. Thus, at 10 µm, a drop in microhardness of approximately 20% can be observed. A similar observation was made in a Ranque-Hilsch vortex tube (RHVT) and in compressed air; however, the drop in hardness was relatively low compared to dry conditions. This evaluation of microhardness indicated a heat-based attention in the turned workpiece, and thus, the heat-based effect was found to be lowest in RHVT and compressed air compared to dry conditions. Results showed that RHVT reduces temperature up to 10%, surface roughness 13%, and tool wear 20% compared to dry turning. Overall, RHVT was identified as more effective environmentally friendly cooling strategy than dry and compressed air for the turning of aluminum alloy 7075-T6.

Bilateral Primary Adrenal B-Cell Lymphoma Diagnosed by Workup for Primary Adrenal Deficiency

Primary adrenal lymphoma (PAL) often occurs bilaterally and is a rare malignancy of old age. Workup for primary adrenal insufficiency often unmasks this underlying grave pathology. In this article, we present a case of a 73-yearold patient who presented with features of primary adrenal insufficiency and renal colic. Diagnostic abdominal imaging revealed bilateral suprarenal masses as the cause of adrenal gland destruction and the patient's symptoms. FDG PET-CT scan and histopathology confirmed the diagnosis of mature bilateral B-cell primary adrenal lymphomas. Though the patient showed an excellent initial response to the first four chemotherapy cycles, a relapse resulted in metastatic disease. This article highlights the PAL's disease course, imaging features, and management dilemma due to Chemotherapy's side effects and a higher recurrence rate. Keywords: Primary adrenal lymphoma, Primary adrenal insufficiency, R-CHOP, Role of imaging.

Sore Throat: Can It Be Primary Laryngeal Small Cell Carcinoma?

Small cell carcinoma of the larynx is a rare form of neuroendocrine carcinoma. Clinical and radiological properties are similar to other laryngeal cancers, prompting histopathology examination. Symptoms include sore throat, dysphagia, odynophagia, and weight loss. Multiple management options have been demonstrated in the literature. However, combined radiation and chemotherapy have proven to improve survival. Unfortunately, the prognosis for this cancer is dismal, as survival from diagnosis rarely exceeds two years. In this article, we present a 64-year-old female patient who presented with a sore throat and was diagnosed with primary small cell cancer of the larynx. Despite the relapse after the initial four cycles of chemotherapy with carboplatin and etoposide, our patient responded well to nivolumab and ipilimumab and is still in remission on a six-month follow-up.

Cefepime: a novel cause of thrombocytopaenia

Thrombocytopaenia is a commonly encountered finding in hospitalised patients. Many antibiotics, especially beta-lactams, are well known to cause thrombocytopaenia by an immune-mediated mechanism. We present a 55-year-old woman who was admitted to the hospital with a complicated urinary tract infection resulting in right-sided pyonephrosis and pararenal abscess. She was observed to develop thrombocytopaenia after initiation of cefepime therapy. Following an extensive work-up for her new-onset thrombocytopaenia, she was diagnosed as a case of a drug (cefepime)-induced thrombocytopaenia. Her platelet count recovered back to normal levels after cessation of cefepime therapy. Based on our PubMed search, there are only a few cases of cefepime-induced thrombocytopaenia published in the literature. This paper illustrates that physicians should include cefepime among the possible aetiologies of thrombocytopaenia. Additionally, this article outlines the currently available approaches to the diagnosis and management of drug-induced thrombocytopaenia.

Theoretical investigation of the optoelectronic response of highly correlated Cu3P photocatalyst

Photocatalytic materials attract immense scientific interest due to their possible applications in energy harvesting. These applications are strongly dependent on the material's band gap and efficient visible light absorption, which ultimately relies on the underlying electronic structure of the material. In this work, we have theoretically studied the electronic and optical response of a Cu₃P semiconductor. We have used Density Functional Theory (DFT), and the Many-Body Perturbation Theory (MBPT) based Bethe–Salpeter Equation (BSE). Cu₃P has intriguing band gap nature, as DFT predicts a semi-metallic state which was corrected by employing the Hubbard potentials. Only astronomically large values of Hubbard potentials reproduced the semiconducting state of Cu₃P. The optical response of the material is computed within a Random Phase Approximation (RPA) and using the BSE on top of DFT+U wavefunctions and on the ground state computed with the PBE0 functional. The BSE captures the excitonic physics, and the optical absorption obtained from it was red-shifted compared to the RPA, which shows the significance of electron–hole interactions in Cu₃P. The comparison of the BSE with experiments suggests that BSE@PBE0 reproduces the optical absorption much more closely to the experimental data.

The optical absorption from BSE@PBE0 is in better agreement with the experiment than BSE@DFT+U. The electron–hole interaction and strong correlation between electrons play a vital role in the optoelectronic response of Cu₃P.

Molecular docking, dynamics, and quantum chemical study of vanillylacetone and beta-hydroxy ketone derivatives against Mpro of SARS-CoV-2

This study is carried out to find novel active drug candidates which can effectively bind to key residues of main protease (Mpro) of SARS-CoV-2. We performed molecular docking of fifty-seven (57) ligands from two classes: vanillylacetone and its derivatives and beta-hydroxy ketone derivatives against Mpro of SARS-CoV-2. We also docked three antiviral drugs as reference/benchmark drugs including remdesivir (RDV), chloroquine (CQ), and hydroxychloroquine (HCQ) against Mpro for comparison of inhibition tendencies of selected ligands. Binding energies of our reference drugs are as: CQ = -5.1 kcal mol-1 (with predicted inhibition constant (Ki pred) = 177 μmol), HCQ = -5.7 kcal mol-1 (Ki pred = 64.07 μmol) and RDV -6.3 kcal mol-1 (Ki pred = 13.95 μmol). We got remarkable results for our docked ligands as 79% of total ligands indicated binding energies better than CQ, 39 % better than both HCQ and CQ, and 19 % better than all reference drugs. More interestingly interaction analysis of eight best-docked ligands showed that they interacted with desired key residues of Mpro. We further selected the four best-docked ligands L1 = -6.6 kcal mol-1 (Ki pred =13.95 μmol), L6 = -7.0 kcal mol-1 (Ki pred = 7.08 μmol), L34 = -6.0 kcal mol-1 (Ki pred = 38.54 μmol), and L50 = -6.6 kcal mol-1 (Ki pred =13.95 umol) for further analysis by quantum chemical study, molecular dynamic (MD) simulations and ADMET analysis. We have also carried out MD-simulations of six more docked ligand L2, L14, L20, L36, L46 and L48 some of which were showing weak binding affinities and some average binding affinities to check their simulation behavior. Their RMSD, RMSF and binding free energy results were also quite satisfying. We believe the current investigation will evoke the scientific community and highlights the potential of selected compounds for potential use as antiviral compounds against Mpro of SARS-CoV-2.

Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO): A Case Report

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) is an uncommon adulthood disorder that presents as focal swellings and pain accompanied by abnormal changes in bone and surrounding soft tissues. X-rays of the involved region are usually insignificant; however, CT and MRI show excellent visualization of the affected structures. Typical radiological images show cortical thickening leading to decreased marrow cavity, bony erosion, and ligament ossifications. Other associated findings are synovitis and joint effusions. It is usually diagnosed on the basis of clinical as well as radiological findings. The treatment initially relies on non-steroidal anti-inflammatory drugs (NSAIDs). Patients showing poor response are started on corticosteroids and disease-modifying antirheumatic drugs (DMARDs). We report two patients who presented with joint swellings. Their workup unmasked the underlying SAPHO, which was managed well with NSAIDs.

Hypertriglyceridemia-Induced Pancreatitis Complicated by Diabetic Ketoacidosis

Acute pancreatitis is a potentially fatal clinical entity having multiple underlying triggers. Though the incidence of hypertriglyceridemia-induced pancreatitis is low; however, patients with such risk factors develop severe disease. We present a case of a 47-year-old male who came to our facility with complaints of epigastric pain. Physical examination and laboratory workup unmasked the presence of pancreatitis alongside concurrent diabetic ketoacidosis (DKA). This presentation is unique, and to our knowledge, only a few cases have been reported in the literature. Furthermore, the co-existence of pancreatitis and DKA can overlap the clinical picture of each other, which might lead to unwanted complications if not diagnosed timely.

Chronic Recurrent Multifocal Osteomyelitis and Its Management

Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory disorder of bones first reported by Giedion et al. in 1972. It is a disease of childhood, comparable to SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) in adults. CRMO presents with pain and swelling overlying the involved bones. Inflammatory markers are usually raised and X-rays usually show sclerotic lesions. MRI demonstrates the extent of the lesions accurately and associated soft tissue changes. Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are the mainstays of the management. We report three patients who presented with bone pains. Extensive workup and radiological modalities along with clinical findings supported the diagnosis of CRMO. This article highlights important clinical presentations, radiological findings, and various management options.

Multiple Pilomatricoma in a Middle-Aged Woman

Pilomatricomas are rare skin tumors related to hair follicles. They typically present in children, and the most common locations are head and neck. Pilomatricomas are usually painless; however, they can cause cosmetic problems. Treatment is decided on an individual basis and involves local excision. However, caution should be taken if the lesion is malignant, as resection with safe margins (0.5-1.0 cm) is determinant of the overall outcome. Radiotherapy is indicated in cases of residual tumor tissue or recurrence. The role of chemotherapy in pilomatricomas is still undetermined. We report a 55-year-old female with multiple lumps on her shoulder and back. The sonographic features of these lesions were typically consistent with pilomatricomas. The patient decided to opt for excision due to cosmetic reasons and the histopathology features were suggestive of pilomatricoma.

Longitudinal stability of molecular alterations and drug response profiles in tumor spheroid cell lines enables reproducible analyses

The utility of patient-derived tumor cell lines as experimental models for glioblastoma has been challenged by limited representation of the in vivo tumor biology and low clinical translatability. Here, we report on longitudinal epigenetic and transcriptional profiling of seven glioblastoma spheroid cell line models cultured over an extended period. Molecular profiles were associated with drug response data obtained for 231 clinically used drugs. We show that the glioblastoma spheroid models remained molecularly stable and displayed reproducible drug responses over prolonged culture times of 30 in vitro passages. Integration of gene expression and drug response data identified predictive gene signatures linked to sensitivity to specific drugs, indicating the potential of gene expression-based prediction of glioblastoma therapy response. Our data thus empowers glioblastoma spheroid disease modeling as a useful preclinical assay that may uncover novel therapeutic vulnerabilities and associated molecular alterations.

Giant vesical calculus associated with migrant IUCD: a case report

Background

Intrauterine copper devices are a popular type of contraceptives, being in use for a long time. Migration of IUCD into the bladder is one of the many side effects of this contraceptive measure. Though a rare phenomenon, IUCD acting as a foreign body can cause stone formation in the bladder.

Case presentation

We present a 42-year-old female patient who presented with increased urinary frequency, dysuria, and suprapubic pain. Examination showed mild tenderness in the suprapubic region. On X-ray pelvis, she was found to have a giant stone covering IUCD in the bladder. She ultimately underwent cystolithotomy, and her IUCD with stone was removed. Consequently, she was discharged on the 4th postoperative day with a satisfactory condition.

Conclusion

Vesical calculus can form following migration of IUCD in the bladder. This article highlights the importance of careful insertion and follow-up investigation of IUCD. Radiological modalities like X-rays pelvis provide excellent visualization of the IUCD and can be used to confirm the accurate location of the contraceptive device.

First-principles study on the electronic and optical properties of Bi2WO6

Photocatalytic materials attract continued scientific interest due to their possible application in energy harvesting. These applications critically rely on efficient photon absorption and exciton physics, which are governed by the underlying electronic structure. We report the electronic properties and optical response of the Bi₂WO₆ bulk photocatalyst using first-principle methods. The density functional theory DFT-computed electronic band gap is corrected by including Hubbard potentials for W-5d and O-2p orbitals, and one of the most advanced methods, Quasi-Particle (QP) GW at different levels, with semi-core states of Bi (5s and 5p) and W (4f), carefully taken into account in GW calculations. The perplexing nature of band character of Bi₂WO₆ is examined, and it comes out to be direct at PBE level without SOC. However, it shows indirect nature at GW level or when Spin–Orbit Coupling (SOC) is turned on even at PBE level. The optical response of the material system is computed within independent-particle approximation (IPA), taking into account local field effects and employing the time-dependent DFT (TDDFT) method. Bethe–Salpeter equation (BSE) is used to capture the excitonic effect, and the results of these approximations are compared with the experimental data. Our first-principle calculations results indicate that electron–hole interaction significantly modifies optical absorption of Bi₂WO₆, thereby verifying the reported experimental observations.

The nature of the band gap obtained from SOC and QP corrections changes to indirect. The semi-core states of Bi have been proved to be crucial in the GW calculations. Optical absorption from BSE, including SOC best matches the experimental data.

A threefold approach including quantum chemical, molecular docking and molecular dynamic studies to explore the natural compounds from Centaurea jacea as the potential inhibitors for COVID-19

In the current report, we studied the possible inhibitors of COVID-19 from bioactive constituents of Centaurea jacea using a threefold approach consisting of quantum chemical, molecular docking and molecular dynamic techniques. Centaurea jacea is a perennial herb often used in folk medicines of dermatological complaints and fever. Moreover, anticancer, antioxidant, antibacterial and antiviral properties of its bioactive compounds are also reported. The Mpro (Main proteases) was docked with different compounds of Centaurea jacea through molecular docking. All the studied compounds including apigenin, axillarin, Centaureidin, Cirsiliol, Eupatorin and Isokaempferide, show suitable binding affinities to the binding site of SARS-CoV-2 main protease with their binding energies -6.7 kcal/mol, -7.4 kcal/mol, -7.0 kcal/mol, -5.8 kcal/mol, -6.2 kcal/mol and -6.8 kcal/mol, respectively. Among all studied compounds, axillarin was found to have maximum inhibitor efficiency followed by Centaureidin, Isokaempferide, Apigenin, Eupatorin and Cirsiliol. Our results suggested that axillarin binds with the most crucial catalytic residues CYS145 and HIS41 of the Mpro, moreover axillarin shows 5 hydrogen bond interactions and 5 hydrophobic interactions with various residues of Mpro. Furthermore, the molecular dynamic calculations over 60 ns (6×106 femtosecond) time scale also shown significant insights into the binding effects of axillarin with Mpro of SARS-CoV-2 by imitating protein like aqueous environment. From molecular dynamic calculations, the RMSD and RMSF computations indicate the stability and dynamics of the best docked complex in aqueous environment. The ADME properties and toxicity prediction analysis of axillarin also recommended it as safe drug candidate. Further, in vivo and in vitro investigations are essential to ensure the anti SARS-CoV-2 activity of all bioactive compounds particularly axillarin to encourage preventive use of Centaurea jacea against COVID-19 infections.

Payment for ecosystem services (PES): a holistic tool for sustainable forest management-a case study from Pakistan

Economic valuation of ecosystem services is a new concept in forest management. Economic valuation provides basis for payment for ecosystem services (PES). Therefore, objective of this study was to evaluate eco-tourism and carbon stock services of the Maindam valley, District Swat, Pakistan. For the carbon stock calculation, a sample size of 155 plots of 0.1 hectare (Ha) was taken using preliminary survey at 95% confidence interval and 10% allowable error. The data for tourism services was collected from owners of all the hotels, 100 tourists and key informants of the area at 10% sampling intensity on pretested questionnaire for twenty years period (1997-2017). Results showed that Miandam valley has carbon stock worth US$ 16,306,000 while the value of eco-tourism was US$ 1,578,458 on annual basis. The results also showed that trend of tourism has drastically declined after the 9/11 incident for foreigners and locals and the situation was further deteriorated during the era of Talibanization or militancy from 2008-2011. This study recommends implementation of PES strategy at the rate of 5%, thus a total of US$ 78,922 can be earned from eco-tourism and carbon crediting in the study area annually, which could play important role in sustainable forest management.

Coexistence of diabetic ketoacidosis and thyrotoxicosis: a jeopardy of two endocrine emergencies

Simultaneous occurrences of diabetic ketoacidosis (DKA) and thyroid storm have long been known, but only a few cases have been reported to date. Both these endocrine emergencies demand timely diagnosis and management to prevent adverse outcomes. Due to the similarities in their clinical presentation, DKA can mask the diagnosis of thyroid storm and vice versa. This case report describes a patient with Graves' disease who presented to the emergency department with nausea, vomiting and abdominal pain. He was found to have severe DKA without an explicit history of diabetes mellitus. Further evaluation revealed that the patient also had a concomitant thyroid storm that was the likely cause of his DKA. Early recognition and appropriate management of both conditions resulted in a favourable outcome. This paper emphasises that a simultaneous thyroid storm diagnosis should be considered in patients with DKA, especially those with a known history of thyroid disorders.

MTT Heterogeneity in Perfusion CT Imaging as a Predictor of Outcome after Aneurysmal SAH

BACKGROUND AND PURPOSE

Impairment of tissue oxygenation caused by inhomogeneous microscopic blood flow distribution, the so-called capillary transit time heterogeneity, is thought to contribute to delayed cerebral ischemia after aneurysmal SAH but has so far not been systematically evaluated in patients. We hypothesized that heterogeneity of the MTT, derived from CTP parameters, would give insight into the clinical course of patients with aneurysmal SAH and may identify patients at risk of poor outcome.

MATERIALS AND METHODS

We retrospectively analyzed the heterogeneity of the MTT using the coefficient of variation in CTP scans from 132 patients. A multivariable logistic regression model was used to model the dichotomized mRS outcome. Linear regression was used to eliminate variables with high linear dependence. T tests were used to compare the means of 2 groups. Furthermore, the time of the maximum coefficient of variation for MTT after bleeding was evaluated for correlation with the mRS after 6 months.

RESULTS

On average, each patient underwent 5.3 CTP scans during his or her stay. Patients with high coefficient of variation for MTT presented more often with higher modified Fisher (P = .011) and World Federation of Neurosurgical Societies grades (P = .014). A high coefficient of variation for MTT at days 3-21 after aneurysmal SAH correlated significantly with a worse mRS score after 6 months (P = .016). We found no correlation between the time of the maximum coefficient of variation for MTT after bleeding and the patients' outcomes after 6 months (P = .203).

CONCLUSIONS

Heterogeneity of MTT in CTP after aneurysmal SAH correlates with the patients' outcomes. Because the findings are in line with the pathophysiologic concept of the capillary transit time heterogeneity, future studies should seek to verify the coefficient of variation for MTT as a potential imaging biomarker for outcome.

Bioaccumulation of heavy metals in the tissues of Schizothorax plagiostomus at River Swat

Snow trout (Schizothorax plagiostomus) is an economically important freshwater fish, mostly found in northern areas of water reservoirs of Pakistan. The current study was conducted in River Swat to analyze the bioaccumulation of heavy metals (Pb, Cr, Ni, and Zn) in tissues of Schizothorax plagiostomus. Tissues were extracted and dissolved in perchloric acid (HClO4) and nitric acid (HNO3) along with hotplate. The heavy metals, zinc (Zn), lead (Pb), chromium (Cr), and Nickel (Ni) were determined using Perkin Elmer 2380 atomic absorption spectrophotometer. Results shows great variation in the content of the metal related to tissue type and sampling sites. A high concentration of bioaccumulation was reported at Charbagh, whereas lowest at Odigram: Charbagh>Landakai>Odigram. In the same way, Cr was the most accumulated heavy metal followed by lead, nickel, and Zinc.

Effect of different protein based feed on the growth of mahseer

For the proper growth of fish, it is necessary to feed the fish with a proper and balanced diet. A study was conducted to find out the effect of different protein-based diets on fingerlings of Tor putitora (mahseer). A feed with dietary protein levels of 35%, 40%, 45%, and 50% were prepared. The effect of different protein-based feed on weight gain, standard growth rate (SGR), food conversion ratio (FCR), percent weight gain, food conversion efficiency (FCE), and protein efficiency ratio (PER) was studied. An increase was observed in the growth rate with an increase in protein concentration up to 45%. The fingerlings fed a 45% protein diet shown the highest growth, followed by 50%, 40%, and 35%. The SGR value was greatest for 45% protein diet (8.56) followed by 50% and 40%, while the least values were observed for 35% protein feed (1.57). The same trend was observed for FCE. The highest PER values was observed in fishes fed 45% protein-based feed (0.65) followed by 50% (0.56), 40% (0.38) and35% (0.17). The food conversion ratio was lowest for 45% protein diet (3.41), while the greatest for 35% protein feed (16.85). It was concluded that a 45% protein-based diet was the best feed formulation for higher production of Tor putitora. However, research on the same percentage of protein diet is recommended for yearlings.

First-principles study of the electronic structures and optical and photocatalytic performances of van der Waals heterostructures of SiS, P and SiC monolayers

Designing van der Waals (vdW) heterostructures of two-dimensional materials is an efficient way to realize amazing properties as well as open up opportunities for applications in solar energy conversion, nanoelectronic and optoelectronic devices. The electronic structures and optical and photocatalytic properties of SiS, P and SiC van der Waals (vdW) heterostructures are investigated by (hybrid) first-principles calculations. Both binding energy and thermal stability spectra calculations confirm the stability of these heterostructures. Similar to the corresponding parent monolayers, SiS–P (SiS–SiC) vdW heterostructures are found to be indirect type-II bandgap semiconductors. Furthermore, absorption spectra are calculated to understand the optical behavior of these systems, where the lowest energy transitions lie in the visible region. The valence and conduction band edges straddle the standard redox potentials of SiS, P and SiC vdW heterostructures, making them promising candidates for water splitting in acidic solution.

The electronic structures and optical and photocatalytic properties of SiS, P and SiC van der Waals (vdW) heterostructures are investigated by (hybrid) first-principles calculations.

Stacking effects in van der Waals heterostructures of blueP and Janus XYO (X = Ti, Zr, Hf: Y = S, Se) monolayers

Using first-principles calculations, the geometry, electronic structure, optical and photocatalytic performance of blueP and XYO (X = Ti, Zr, Hf; Y = S, Se) monolayers and their corresponding van der Waal heterostructures in three possible stacking patterns, are investigated. BlueP and XYO (X = Ti, Zr, Hf; Y = S, Se) monolayers are indirect bandgap semiconductors. A tensile strain of 8(10)% leads to TiSeO(ZrSeO) monolayers transitioning to a direct bandgap of 1.30(1.61) eV. The calculated binding energy and AIMD simulation show that unstrained(strained) blueP and XYO (X = Ti, Zr, Hf; Y = S, Se) monolayers and their heterostructures are thermodynamically stable. Similar to the corresponding monolayers, blueP-XYO (X = Ti, Zr, Hf: Y = S, Se) vdW heterostructures in three possible stacking patterns are indirect bandgap semiconductors with staggered band alignment, except blueP-TiSeO vdW heterostructure, which signifies straddling band alignment. Absorption spectra show that optical transitions are dominated by excitons for blueP and XYO (X = Ti, Zr, Hf; Y = S, Se) monolayers and the corresponding vdW heterostructures. Both E VB and E CB in TiSO, ZrSO, ZrSeO and HfSO monolayers achieve energetically favorable positions, and therefore, are suitable for water splitting at pH = 0, while TiSeO and HfSeO monolayers showed good response for reduction and fail to oxidise water. All studied vdW heterostructures also show good response to any produced O2, while specific stacking reduces H+ to H2.

Paraganglioma of Urinary Bladder in a Pediatric Patient

Paragangliomas arise from neural cells and are found in different anatomical locations in the body. Paragangliomas in the adrenal glands are called pheochromocytoma, while the others are known as extra-adrenal paragangliomas. They are usually benign and are extremely rare in children. We present a case of a 13-year-old female patient who presented with complaints of hematuria for one year and left lower lumbar pain. Imaging investigations depicted a urinary bladder mass that was causing a mass effect at the left ureteric opening and backpressure changes in the left kidney. The patient underwent transurethral resection of bladder mass, and the histopathology confirmed the presence of paraganglioma. Though the paragangliomas of the urinary bladder are extremely rare in the pediatric age group, we suggest keeping paragangliomas on differentials when investigating a patient with bladder mass.

Co2YZ (Y= Cr, Nb, Ta, V and Z= Al, Ga) Heusler alloys under the effect of pressure and strain

Full Heuslers alloys are a fascinating class of materials leading to many technological applications. These have been studied widely under ambient conditions. However, less attention been paid to study them under the effect of compression and strain. Here in this work Co₂YZ (Y= Cr, Nb, Ta, V and Z = Al, Ga) Heusler alloys have been studied comprehensively under pressure variations. Calculated lattice constants are in reasonable agreement with the available data. It is determined that lattice constant deceases with the increase in tensile stress and increases by increasing pressure in reverse direction. Band profiles reveals the half metallic nature of the studied compounds. The bond length decreases while band gap increases in compressive strain. The compounds are found to be reflective in visible region, as characteristics of the metals. The magnetic moments reveal the half-mettalic ferromagnetic nature of the compounds.

Clinical outcomes in a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: A cohort analysis using routine data

BACKGROUND

Little is known about the content or quality of non-communicable disease (NCD) care in humanitarian settings. Since 2014, Médecins Sans Frontières (MSF) has provided primary-level NCD services in Irbid, Jordan, targeting Syrian refugees and vulnerable Jordanians who struggle to access NCD care through the overburdened national health system. This retrospective cohort study explored programme and patient-level patterns in achievement of blood pressure and glycaemic control, patterns in treatment interruption, and the factors associated with these patterns.

METHODS AND FINDINGS

The MSF multidisciplinary, primary-level NCD programme provided facility-based care for cardiovascular disease, diabetes, and chronic respiratory disease using context-adapted guidelines and generic medications. Generalist physicians managed patients with the support of family medicine specialists, nurses, health educators, pharmacists, and psychosocial and home care teams. Among the 5,045 patients enrolled between December 2014 and December 2017, 4,044 eligible adult patients were included in our analysis, of whom 72% (2,913) had hypertension and 63% (2,546) had type II diabetes. Using visits as the unit of analysis, we plotted the following on a monthly basis: mean blood pressure among hypertensive patients, mean fasting blood glucose and HbA1c among type II diabetic patients, the proportion of each group achieving control, mean days of delayed appointment attendance, and the proportion of patients experiencing a treatment interruption. Results are presented from programmatic and patient perspectives (using months since programme initiation and months since cohort entry/diagnosis, respectively). General linear mixed models explored factors associated with clinical control and with treatment interruption. Mean age was 58.5 years, and 60.1% (2,432) were women. Within the programme's first 6 months, mean systolic blood pressure decreased by 12.4 mm Hg from 143.9 mm Hg (95% CI 140.9 to 146.9) to 131.5 mm Hg (95% CI 130.2 to 132.9) among hypertensive patients, while fasting glucose improved by 1.12 mmol/l, from 10.75 mmol/l (95% CI 10.04 to 11.47) to 9.63 mmol/l (95% CI 9.22 to 10.04), among type II diabetic patients. The probability of achieving treatment target in a visit was 63%-75% by end of 2017, improving with programme maturation but with notable seasonable variation. The probability of experiencing a treatment interruption declined as the programme matured and with patients' length of time in the programme. Routine operational data proved useful in evaluating a humanitarian programme in a real-world setting, but were somewhat limited in terms of data quality and completeness. We used intermediate clinical outcomes proven to be strongly associated with hard clinical outcomes (such as death), since we had neither the data nor statistical power to measure hard outcomes.

CONCLUSIONS

Good treatment outcomes and reasonable rates of treatment interruption were achieved in a multidisciplinary, primary-level NCD programme in Jordan. Our approach to using continuous programmatic data may be a feasible way for humanitarian organisations to account for the complex and dynamic nature of interventions in unstable humanitarian settings when undertaking routine monitoring and evaluation. We suggest that frequency of patient contact could be reduced without negatively impacting patient outcomes and that season should be taken into account in analysing programme performance.

Cellulose extraction from methyltrioctylammonium chloride pretreated sugarcane bagasse and its application

Cellulose, the most abundant feedstock of chemicals and energy is extracted from various agro-industrial wastes, such as sugarcane bagasse (SB). Pretreatment of SB with ionic liquids improves extraction of cellulose, yet the use of ionic liquid is hindered by its high cost. In this study, cellulose was extracted from SB pretreated with methyltrioctylammonium chloride under relatively mild conditions. The extracted cellulose from pretreated SB (PTB) and untreated SB (UTB) was characterized by scanning electron microscopy and FTIR. Fermentation of cellulose extracted from PTB by a thermophilic bacterium, Bacillus aestuarii UE25, yielded 245.16% higher titers of cellulase than cellulose extracted from UTB. The recyclability of the IL was assessed to make the pretreatment process cost effective and was monitored through TLC and FTIR. The results of this research demonstrated the potential of ionic liquid pretreated SB for cellulose extraction and for its subsequent utilization in thermostable cellulase production.

Tracking the Influence of Thermal Expansion and Oxygen Vacancies on the Thermal Stability of Ni-Rich Layered Cathode Materials

The ever-growing demand for high-energy lithium-ion batteries in portable electronics and electric vehicles has triggered intensive research efforts over the past decade. An efficient strategy to boost the energy and power density of lithium-ion batteries is to increase the Ni content in the cathode materials. However, a higher Ni content in the cathode materials gives rise to safety issues. Herein, thermal expansion and oxygen vacancies are proposed as new critical factors that affect the thermal stability of charged Ni-rich cathode materials based on a systematic synchrotron-based X-ray study of Li0.33Ni0.5+ x Co0.2Mn0.3- x O2 (x = 0, 0.1, 0.2) cathode materials during a heating process. Charged cathode materials with higher Ni contents show larger thermal expansion, which accelerates transition metal migration to the Li layers. Oxygen vacancies are formed and accumulate mainly around Ni ions until the layered-to-spinel phase transition begins. The oxygen vacancies also facilitate transition metal migration to the Li layers. Thermal expansion and the presence of oxygen vacancies decrease the energy barrier for cation migration and facilitate the phase transitions in charged cathode materials during the heating process. These results provide valuable guidance for developing new cathode materials with improved safety characteristics.

Utilization of methyltrioctylammonium chloride as new ionic liquid in pretreatment of sugarcane bagasse for production of cellulase by novel thermophilic bacteria

Fermentation of carbohydrates present in lignocellulosic (LC) biomass is facilitated by lignin removal, which is usually achieved by adopting various pretreatment methods to provide the enzymes proper access to their respective substrates. Pretreatment using ionic liquid (IL) is relatively recent advancement and considered as mild and green process. ILs can dissolve extensive quantities of biomass and depolymerize the cellulose. In this context, an abundantly available LC biomass, sugarcane bagasse (SB), was pretreated using alkali or with an IL, methyltrioctylammonium chloride, and was used for cellulase production from thermophilic bacteria. In all, 26 indigenously isolated thermophilic bacterial strains were quantitatively screened for cellulase production. 16S rDNA sequences of the promising isolates UE10 and UE27 revealed relatedness with Brevibacillus borstelensis, while the strain UE1 belonged to Aneurinibacillus thermoaerophilus. Cellulase production was compared by utilizing alkali pretreated and IL pretreated SB and the later was found more appropriate. UE1, UE10 and UE27 yielded 22.2, 22.18 and 33.3 IU mL^-1 of endoglucanase, respectively, by fermenting IL pretreated SB. The changes in SB structure after pretreatment were evaluated by scanning electron microscopy. This study demonstrated the potential of novel thermophilic bacterial strains to utilize IL pretreated SB for production of industrially important enzyme, cellulase.

A multiscale investigation elucidating the structural complexities and electrochemical properties of layered-layered composite cathode materials synthesized at low temperatures

Layered-layered composite (xLi₂MnO₃·(1 -x) LiMO₂, M = Mn, Ni, Co, and Fe) cathode materials have attracted much attention as cathodes for high energy density lithium ion batteries. However, these materials are structurally unstable resulting from complicated phase transformation mechanisms during cycling. Additionally, the complex structural characteristics and structural stability of these materials largely depend on their preparation methods. Studying the correlation between multiscale structural properties and preparation methods is important in the development of layered-layered composite cathode materials. In this work, 0.5Li₂MnO₃·0.5LiCoO₂ composite materials were prepared with different heating and cooling rates with a maximum temperature of 600 °C. The structural properties of the 0.5Li₂MnO₃·0.5LiMO₂ composite materials were investigated using combined in situ X-ray absorption spectroscopy (XAS), in situ X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), and high resolution transmission electron microscopy (HRTEM) techniques. Heating and cooling rates have no significant effect on either the crystal or local atomic structures of the prepared samples. However, the microstructure was critically important for its impact on electrochemical properties.

Hierarchical N-doping germanium/carbon nanofibers as anode for high-performance lithium-ion and sodium-ion batteries

Germanium (Ge) has gained a great deal of attention as an anode material for sodium ion batteries (SIBs) and lithium ion batteries (LIBs) for its high theoretical capacity and ion diffusivity. Unfortunately, Ge particle pulverization triggered by huge volume expansion during the alloying and dealloying processes can cause rapid capacity fade. Herein we report a facile method for the preparation of ultrafine Ge nanoparticles embedded in hierarchical N-doped multichannel carbon fibers (denoted as Ge-NMCFs) by electrospinning. The hierarchical carbon matrix not only provides sufficient internal void space to accommodate the large volume expansion of Ge nanoparticles, but also provides numerous open channels for the easy access of electrolyte and Na/Li ions. As half-cell tests revealed, the composite provides discharge capacity of 303 mA h g^-1 (1st cycle) and 160 mA h g^-1 (700th cycle) for SIBs, 1146.7 mA h g^-1 (1st cycle) and 600 mA h g^-1 (500th cycle) for LIBs at a current density of 500 mA g^-1 (all the presented capacity based on the total weight of Ge/C composites). Density functional theory calculation suggests that N-doped in carbon can enhance the Na/Li ion storage and improve the electrochemical performance. This demonstration is an important step towards the development of SIBs and LIBs with much higher specific energy capacity and longer cycle stability.