Effect of Coca-Cola on the Dissolution of Persimmon-Related Phytobezoar in a Tertiary Care Hospital

Introduction Bezoars, masses of indigestible foreign bodies formed in the gastrointestinal tract, pose challenges in their management. Phytobezoars are particularly problematic due to their difficult diagnosis and resilience towards treatment. Recently, Coca-Cola has emerged as a potential solution due to its acidic composition and mucolytic properties. However, existing evidence is limited, highlighting the need for comprehensive studies. This research explores the efficacy of Coca-Cola in dissolving persimmon-related phytobezoars, aiming to contribute valuable insights to non-invasive treatment options. Material and methods Conducted as a descriptive case series, this study employed gastric cola lavage using non-probability purposive sampling. Patients aged 18-70 with persimmon-related phytobezoars were included. Two nasogastric tubes were inserted for cola lavage over 12 hours, utilizing three liters of cola until the disappearance of symptoms. When the bezoar disappeared, it was considered as complete success to the treatment. Results Out of 31 patients, 45.2% were male and 54.8% were female, with a mean age of 56.77 ± 9.01 years. Efficacy was noted in 54.8% of cases. Age less than 50 and no history of diabetes mellitus were associated with higher chances of treatment success (p-value ≤0.05). Conclusion Ingestion of Coca-Cola was highly effective, safe, and reliable for the dissolution of persimmon-related phytobezoars, as the frequency of efficacy was high in our study. Coca-Cola ingestion is a non-invasive and cost-effective mode of phytobezoar dissolution that should be taken as a first-line initial treatment option to attain desired outcomes.

Surgical Strategies for Ingrown Toenails: A Comprehensive Review of Techniques, Outcomes, and Advancements

Ingrown toenail (IGTN), known as onychocryptosis or unguis incarnatus, is a painful condition affecting the big toe, with symptoms including pain, inflammation, and infection. This review explores surgical options for IGTN, categorized into altering the nail plate or diminishing periungual tissues. Conservative treatments alleviate early-stage symptoms, while surgical interventions are reserved for severe cases. Various surgical techniques are discussed, such as the Winograd technique, Vandenbos procedure, chemical matricectomy, radiofrequency ablation, bipolar diathermy, carbon dioxide laser ablation, Zadik's procedure, Howard-Dubois procedure, Super U procedure, Noël's procedure, knot technique, and toenail paronychium flap. The choice of procedure depends on the severity and recurrence of IGTN.

Evaluating the symmetric and asymmetric effectiveness of low carbon energy consumption for ecological footprint in China: the role of environment-related technological innovation

The objective of this study is to scrutinize the impact of low carbon energy consumption, environmental-related technological innovation, urbanization, economic growth, and trade on China's ecological footprint from 1980 to 2021. To investigate the nature of the long-term connections between the variables, we employ the symmetric and asymmetric autoregressive distributed lag (ARDL) technique to explore the long- and short-run elasticities of coefficients. The results of ARDL and NARDL verified the environmental Kuznets curve (EKC) hypothesis in the long run in the presence of low carbon energy consumption. Moreover, the findings show that the positive part of low carbon energy consumption is negatively connected with the ecological footprint. Alternatively, the positive part of low carbon energy consumption is positively linked with the ecological footprint. The outcome highlights that environment-related technological innovation reduces the level of ecological footprint. Similarly, urbanization has a detrimental effect on the ecological footprint. Based on the estimated findings, it is suggested that China's economy should place a greater emphasis on increasing its level of investment in the low carbon energy sector and adopting severe environmental legislation to protect the economy from environmental burden.

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

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

Optimized Extraction of Polyphenols from Unconventional Edible Plants: LC-MS/MS Profiling of Polyphenols, Biological Functions, Molecular Docking, and Pharmacokinetics Study

Plant bioactive phenolic metabolites have recently attracted the attention of researchers due to their numerous health advantages. Therefore, this study aimed to investigate with advanced techniques the bioactive metabolites and antioxidant and antidiabetic capacity of four unconventional edible plant leaves: lemongrass (Cymbopogon citratus (DC.) Stapf), chicory (Cichorium intybus L.), moringa (Moringa oleifera Lam.), and ryegrass (Lolium perenne L.). The extraction process was optimized using different solvents. These plants' phenolic composition, identification, and characterization have been determined herein using LCESI-QTOF-MS/MS. This research identified 85 phenolic compounds, including 24 phenolic acids, 31 flavonoids, 7 stilbenes and lignans, and 17 other metabolites. Moreover, the study determined that moringa has the highest total phenolic content (TPC; 18.5 ± 1.01 mg GAE/g), whereas ryegrass has the lowest (3.54 ± 0.08 mg GAE/g) among the selected plants. It seems that, compared to other plants, moringa was found to have the highest antioxidant potential and antidiabetic potential. In addition, twenty-two phenolic compounds were quantified in these chosen edible plants. Rosmarinic acid, chlorogenic acid, chicoric acid, ferulic acid, protocatechuic acid, and caffeic acid were the most abundant phenolic acids. In silico molecular docking was also conducted to investigate the structure-function relationship of phenolic compounds to inhibit the alpha-glucosidase. Finally, the simulated pharmacokinetic characteristics of the most common substances were also predicted. In short, this investigation opens the way for further study into these plants' pharmaceutical and dietary potential.

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

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

The mechanical effect of geometric design of attachments in invisible orthodontics

INTRODUCTION

In invisible orthodontics, attachments are used with aligners to better control tooth movement. However, to what extent the geometry of the attachment can affect the biomechanical properties of the aligner is unknown. This study aimed to determine the biomechanical effect of attachment geometry on orthodontic force and moment using 3-dimensional finite element analysis.

METHODS

A 3-dimensional model of mandibular teeth, periodontal ligaments, and the bone complex was employed. Rectangular attachments with systematic size variations were applied to the model with corresponding aligners. Fifteen pairs were created to move the lateral incisor, canine, first premolar, and second molar mesially for 0.15 mm, respectively. The resulting orthodontic forces and moments were analyzed to compare the effect of attachment size.

RESULTS

Expansion in the attachment size showed a continuous increase in force and moment. Considering the attachment size, the moment increased more than the force, resulting in a slightly higher moment-to-force ratio. Expanding the length, width, or thickness of the rectangular attachment by 0.50 mm increases the force and moment up to 23 cN and 244 cN-mm, respectively. The force direction was closer to the desired movement direction with larger attachment sizes.

CONCLUSIONS

Based on the experimental results, the constructed model successfully simulates the effect of the size of attachments. The larger the size of the attachment, the greater the force and moment, and the better the force direction. The appropriate force and moment for a particular clinical patient can be obtained by choosing the right attachment size.

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

BACKGROUND

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

RESEARCH QUESTION

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

MATERIALS AND METHODS

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

RESULTS

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

DISCUSSION AND CONCLUSION

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

LEVEL OF EVIDENCE

Level III.

Efficacy of heterologous boosting against SARS-CoV-2 using a recombinant interferon-armed fusion protein vaccine (V-01): a randomized, double-blind and placebo-controlled phase III trial

Waning of neutralizing titres along with decline of protection efficacy after the second dose of COVID-19 vaccines was observed, including China-made inactivated vaccines. Efficacy of a heterologous boosting using one dose of a recombinant SARS-CoV-2 fusion protein vaccine (V-01) in inactivated vaccine-primed population was studied, aimed to restore the immunity. A randomized, double-blind and placebo-controlled phase III trial was conducted in healthy people aged 18 years or older in Pakistan and Malaysia. Each eligible participant received one dose of the V-01 vaccine developed by Livzon Mabpharm Inc. or placebo within the 3-6 months after the two-dose primary regimen, and was monitored for safety and efficacy. The primary endpoint was protection against confirmed symptomatic SARS-CoV-2 infection. A total of 10,218 participants were randomly assigned to receive a vaccine or placebo. Virus-neutralizing antibodies were assessed in 419 participants. A dramatic increase (11.3-fold; 128.3–1452.8) of neutralizing titres was measured in the V-01 group at 14 days after the booster. Over two months of surveillance, vaccine efficacy was 47.8% (95%CI: 22.6–64.7) according to the intention-to-treat principle. The most common adverse events were transient, mild-to-moderate pain at the injection site, fever, headache, and fatigue. Serious adverse events occurred almost equally in V-01 (0.12%) and placebo (0.16%) groups. The heterologous boosting with the V-01 vaccine was safe and efficacious, which could elicit robust humoral immunity under the epidemic of the Omicron variant.

Trial registration:ClinicalTrials.gov identifier: NCT05096832.

On implementation of a semi-analytic strategy to develop an analytical solution of a steady-state isothermal tube drawing model

In this paper, we consider an isothermal glass tube drawing model consisting of three coupled nonlinear partial differential equations. The steady-state solution of this model is required in order to investigate its stability. With the given initial and boundary conditions, it is not possible to determine an analytical solution of this model. The difficulty lies in determining the constants of integrations while solving the second order ordinary differential equation analytically appearing in the steady-state model. To overcome this difficulty, we present a numerical based approach for the first time to develop an analytical solution of the steady-state isothermal tube drawing model. We use a numerical technique called shooting method to convert the boundary value problem into a set of initial value problems. Once the model has been converted into a system of differential equations with initial values, an integrating technique is implemented to develop the analytical solution. The computed analytical solution is then compared with the numerical solution to better understand the accuracy of obtained solution with necessary discussions.

Role of interatrial conduction in atrial fibrillation. Mechanistic insights from renewal theory-based fibrillatory dynamic analysis

Background

Interatrial conduction has been postulated to play an important role in atrial fibrillation (AF). The pathways involved in interatrial conduction during AF remain incompletely defined.

Objective

We recently showed physiological assessment of fibrillatory dynamics could be performed using renewal theory, which determines rates of phase singularity formation (λ_f) and destruction (λ_d). Using the renewal approach, we aimed to understand the role of the interatrial septum and other electrically coupled regions during AF.

Method

RENEWAL-AF is a prospective multicenter observational study recruiting AF ablation patients (ACTRN 12619001172190). We studied unipolar electrograms obtained from 16 biatrial locations prior to ablation using a 16-electrode Advisor HD Grid catheter. Renewal rate constants λ_f and λ_d were calculated, and the relationships between these rate constants in regions of interatrial connectivity were examined.

Results

Forty-one AF patients (28.5% female) were recruited. A positive linear correlation was observed between λ_f and λ_d (1) across the interatrial septum (λ_f r² = 0.5, P < .001, λ_d r² = 0.45, P < .001), (2) in regions connected by the Bachmann bundle (right atrial appendage–left atrial appendage λ_f r² = 0.29, P = .001; λ_d r² = 0.2, P = .008), and (3) across the inferior interatrial routes (cavotricuspid isthmus–left atrial septum λ_f r² = 0.67, P < .001; λ_d r² = 0.55, P < .001). Persistent AF status and left atrial volume were found to be important effect modifiers of the degree of interatrial renewal rate statistical correlation.

Conclusion

Our findings support the role of interseptal statistically determined electrical disrelation in sustaining AF. Additionally, renewal theory identified preferential conduction through specific interatrial pathways during fibrillation. These findings may be of importance in identifying clinically significant targets for ablation in AF patients.

Asymmetric effects of premature deagriculturalization on economic growth and CO2 emissions: fresh evidence from Pakistan

This paper examines the relationship between deagriculturalization, economic growth, and CO₂ emissions in Pakistan from the period 1975 to 2018 by employing a nonlinear autoregressive distributed lag (NARDL) model and Granger causality approach. The asymmetric ARDL findings show that there is a significant negative relationship between agriculturalization and economic growth, while deagriculturalization does not induce economic growth in the long run in Pakistan. Moreover, agriculturalization and deagriculturalization have a negative significant effect on Pakistan's carbon emissions in the long run. This study concludes that the asymmetric results deviate from symmetric results in Pakistan. The asymmetric causality test shows unidirectional asymmetric causality running from agriculturalization, deagriculturalization, and CO₂ emissions. Moreover, agriculturalization and deagriculturalization do not Granger cause economic growth in Pakistan. Based on the results, the study stressed to formulate such policies which support economic growth and lower carbon emissions through reforming agriculture sector practices. These outcomes are very useful for Pakistan to formulate relevant policies.

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

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

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

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

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

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

Demographic variation and risk factors regarding breast cancer among females in Southern Punjab, Pakistan

OBJECTIVE

To explore epidemiology, clinical profiles and contribution of reproductive and non-reproductive risk factors in breast cancer development.

METHODS

The case-control study was conducted from October 2017 to March 2018 at Quaid-i-Azam University, Islamabad, Pakistan, and comprised breast cancer patients and age-matched controls recruited from the Bahawalpur Institute of Nuclear Medicine and Oncology, and the Bahawal Victoria Hospital, Bahawalpur. Socio-demographic data, family history of cancer, reproductive health and lifestyle factors were recorded using a structured questionnaire. Data was analysed using SPSS 21 and Stata/IC 14.1.

RESULTS

Of the 326 women, 163(50%) each were cases and controls. The mean age for both the groups was identical at 46.04±10.62 years. Positive family history and hypertension were significantly linked to increased breast cancer risk (p<0.05), while intense physical activity, increased anthropometric measurements and breastfeeding per child in months were inversely associated with the risk (p<0.05).

CONCLUSIONS

Established risk factors for breast cancer were reaffirmed.

The trade-off between economic growth and environmental quality: does economic freedom asymmetric matter for Pakistan?

This empirical study investigates the dynamic effects of economic freedom on economic growth and air quality for Pakistan over the period 1990-2019. The ARDL results suggest that economic freedom and other variables do not have any visible impact on economic growth and pollution in the short-run. However, in the long-run, economic freedom significantly mitigates air pollution whereas inflation instability increases emissions. The NARDL results show that a partial sum of positive change in economic freedom is negatively linked with economic growth in the short term but has positive effect in the long term. However, the negative change in economic freedom has negative but insignificant impact on growth confirming asymmetric effects. The results for the pollution model show that a partial sum of positive change in economic freedom has positive impact on emissions both in the short and long-runs, whereas a negative change has no significant effect in the short-run and has negative impact in the long-run. Thus, economic freedom supports economic activities that, in turn, escalate emissions in the atmosphere.

Green logistics, economic growth, and environmental quality: evidence from one belt and road initiative economies

The significance of global green logistics in improving green economic activities is a critically considered and debatable research topic in the context of economic growth and environment. This study aims to analyze the growth and environmental effects of green logistics performance for One Belt and Road Initiative (OBRI) countries over the period 2007-2019. The study used panel data two-stage least squares (2SLS) and generalized method of moments (GMM) estimators with robust inferences. The findings have revealed that green logistics performance improves the economic growth in OBRI, Europe, and MENA economies. While green logistics performance enhances the environmental pollution in OBRI, Central Asia, and MENA economies, it significantly improves the environmental quality in Europe and East and Southeast Asia regions. The control variables have also importance in economic growth and environment in policy implication in OBRI and five sub-regions of OBRI economies. Based on these findings, we can conduct some robust green logistics policies in OBRI.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Physical infrastructure, energy consumption, economic growth, and environmental pollution in Pakistan: an asymmetry analysis

This study explores the symmetric and asymmetric effects of physical infrastructure on energy consumption, economic growth, and air pollution of Pakistan over the period 1990-2019. The ARDL results for the energy consumption model suggest that aircraft carriers (ACC) and road infrastructure foster energy consumption in the short term. For the growth model, the impact of trade is negative and significant in both short run and long run. The results for environmental pollution model suggest that information communication technology (ICT) is positively associated with CO2 emissions, whereas trade is negatively associated with emissions in the short and long run. The road has a positive impact on CO2 emissions while ACC has a negative impact in the long run. The nonlinear ARDL results reveal that negative component of ICT negatively influences energy consumption, while positive component has insignificant impact. Similarly, ACC, road, and trade also exhibit asymmetric effects. ICT has a significantly negative impact on economic growth. Finally, the positive shock to road has a significantly positive impact on pollution but the negative shock has no impact. Additionally, the coefficient of ACC and trade also infer asymmetries in pollution model. The results offer important policy implications for achieving high growth and better environmental quality in Pakistan.

Prospective cross-sectional study using Poisson renewal theory to study phase singularity formation and destruction rates in atrial fibrillation (RENEWAL-AF): Study design

BACKGROUND

Unstable functional reentrant circuits known as rotors have been consistently observed in atrial fibrillation and are mechanistically believed critical to the maintenance of the arrhythmia. Recently, using a Poisson renewal theory-based quantitative framework, we have demonstrated that rotor formation (λf) and destruction rates (λd) can be measured using in vivo electrophysiologic data. However, the association of λf and λd with clinical, electrical, and structural markers of atrial fibrillation phenotype is unknown.

METHODS

RENEWAL-AF is a multicenter prospective cross-sectional study recruiting adult patients with paroxysmal or persistent atrial fibrillation undergoing clinically indicated catheter ablation. Patients will undergo intraprocedural electrophysiologic atrial fibrillation mapping, with λf and λd to be determined from 2-minute unipolar electrogram recordings acquired before ablation. The primary objective will be to determine the association of λf and λd as markers of fibrillatory dynamics with clinical, electrical, and structural markers of atrial fibrillation clinical phenotype, measured by preablation transthoracic echocardiogram and cardiac magnetic resonance imaging. An exploratory objective is the noninvasive assessment of λf and λd using surface ECG characteristics via a machine learning approach.

RESULTS

Not applicable.

CONCLUSION

This pilot study will provide insight into the correlation between λf/λd with clinical, electrophysiological, and structural markers of atrial fibrillation phenotype and provide a foundation for the development of noninvasive assessment of λf/λd using surface ECG characteristics will help expand the use of λf/λd in clinical practice.

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

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

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

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

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

BACKGROUND

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

AIMS

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

METHODOLOGY

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

RESULTS

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

CONCLUSION

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

121 Ovulatory response to gonadotropin-releasing hormone relative to day and diameter of dominant follicle during the first follicular wave in Beetal goats

In Beetal goats under subtropical conditions, ovulatory response of first-wave dominant follicle based on diameter and day of oestrous cycle is unknown to date. The objective of this study was to evaluate the ovulatory response to gonadotropin-releasing hormone (GnRH) relative to day and diameter of dominant follicle during the first follicular wave in Beetal goats. Fifty goats were synchronized using a single dose of prostaglandin F2α (75 µg; D+ cloprostenol, Fatro, Italy), and scanned every 6 hours for ovulation using a 7.5-MHz trans-rectal transducer (Honda HS: 1500, Japan). Following ovulation (Day 0), goats (n=40; 10/day) were given GnRH (25µg lecirelin, Fatro, Italy) on Days 2, 4, 6, and 8 of oestrous cycle. Follicular dynamics was monitored daily from D 0 until GnRH, and every 4 hours after GnRH until ovulation. Ovulation frequency relative to day and dominant follicular diameter was analysed by binary logistic regression, whereas diameter of dominant follicle at time of GnRH, ovulation time, time of wave emergence and growth rate of dominant follicle following GnRH were analysed by one-way ANOVA and independent sample t-test (SPSS 20, IBM Corp., Armonk, NY, USA). Eighty percent of the goats ovulated within 74.7±1.3h after prostaglandin F2α. Overall, 37% (14/38) of the goats ovulated following GnRH within 12.0±1.5h. Ovulations (%) following GnRH were higher (P=0.03) on Day 4 than 2 (60 v. 10%; i.e. 14 times higher than Day 2) and decreased gradually from Day 4 to 8 (P&gt;0.05). Similarly, ovulations following GnRH were higher (P=0.00) in first-wave dominant follicles having diameter 6.1-7.0mm than those having less than 6.1mm (88v. 23%; i.e. 24 times higher than &lt;6.1mm). Ovulations (%) decreased as the diameter of dominant follicle increased from 6.1-7.0mm (P&gt;0.05). Diameters of ovulatory follicles at time of GnRH between Day 2, 4, 6, and 8 were not different (P&gt;0.05). Regardless of day of GnRH treatment, diameter of ovulatory v. anovulatory follicles differed (6.44±0.03v. 5.1±0.4 mm; P=0.00). Overall, growth rate of dominant follicles following GnRH was 0.2±0.11mm and did not differ between ovulatory and anovulatory goats (0.29±0.13v. 0.13±0.15 mm; P&gt;0.05). Interval to the emergence of a new wave following GnRH was prolonged for Day 4 compared to Day 2, 6, and 8 (i.e. 22v. 8, 11, and 12 h; respectively, P&lt;0.05). In conclusion, GnRH treatment at Day 4 resulted in maximum ovulations as the first-wave dominant follicle reached a size of 6.1 to 7.0 mm.

122 Effect of gonadotropin-releasing hormone plus 7-day progesterone (CIDR) with or without eCG on follicular dynamics, estrus response, and pregnancy rate in anestrous Beetal goats during nonbreeding season under subtropical conditions

Oestrus induction is a challenging task during the nonbreeding season in goats. Therefore, our objective was to evaluate the efficacy of gonadotropin-releasing hormone (GnRH) plus a 7-day CIDR-based protocol with or without eCG for the induction of oestrus and fertility in acyclic Beetal goats during the nonbreeding season under subtropical conditions. Based on the absence of corpus luteum via ultrasonography, goats (n=56; mean weight=32.8±0.5 kg; body condition scre=2.5±0.1) were inserted with a CIDR (300mg progesterone) along with GnRH (Day 0), and randomly treated either with eCG (400 IU; n=35) or without eCG (control; n=21) on Day 7. The CIDR was removed on Day 7 and all does were administered single dose of prostaglandin F2α (75µg cloprostenol; Fatro, Italy). Following CIDR insertion, ovarian follicular dynamics was monitored daily through a 7.5-MHz transrectal transducer (Honda HS 1500, Japan) until ovulation in a subset of eCG (n=11) and control goats (n=10). Oestrus was detected at every 12h after CIDR removal with aproned bucks and does were bred naturally. Pregnancy was detected 25 days after breeding by transrectal ultrasound. Data were analysed by t-test, ANOVA, and Chi-squared test using SPSS (version 20.0, SPSS Inc., Chicago, IL, USA). Oestrus occurred more often following CIDR removal in eCG v. control goats (94v. 57%; P&lt;0.05). Similarly, onset of oestrus was earlier (36.0±2.1v. 54.2±4.7 h; P&lt;0.05) and the duration of oestrus was longer in eCG v. control goats (i.e. 30.2±1.3v. 22.1±2.3 h; P&lt;0.05). However, diameter of preovulatory follicles and interval to ovulation after CIDR removal were similar between eCG and control goats (P&gt;0.05). In contrast, growth rate of preovulatory follicle after CIDR removal until ovulation in eCG goats was greater, and ovulation rate was higher than control goats (0.7±0.1v. 0.3±0.1 mm/day; 2.2±0.2v. 1.4±0.2, respectively; P&lt;0.05). In eCG goats, the dominant follicle grew rapidly between Days 8 to 9 (P&lt;0.05), whereas within control goats the dominant follicle grew at consistent rate (P&gt;0.05). After CIDR removal, percentage of ovulating goats in eCG was higher as compared to the control group (100v. 44%; P&lt;0.05). Within control goats, size of the dominant follicle in ovulatory goats was greater at the time of CIDR removal than anovulatory goats (5.7±0.3v. 5.0±0.15 mm; P&lt;0.05), whereas wave emergence tended to be earlier after CIDR insertion in anovulatory goats (4.2±1v. 2.6±0.4 days; P=0.09). Pregnancy rate 25 days postbreeding did not differ between eCG and control goats [i.e. 49% (16/33) v. 25% (3/12); odds ratio 2.9/1; P&gt;0.05]. In conclusion, the eCG protocol resulted in higher oestrus response, ovulation rate, and 3 times higher pregnancy rate in anestrous goats during the nonbreeding season.

118 A retrospective analysis of follicular dynamics, LH, estradiol-17β, and progesterone in prostaglandin F2α-induced estrus of Beetal goats

The objective of the study was to reveal the factors associated with variable interval to ovulation following a single dose of prostaglandin F2α (PGF2) in Beetal goats. In experiment 1, the extent of ovulation time was demonstrated after synchronizing Beetal goats (n=38) by using a single injection of PGF2 based on corpus luteum detection by B-mode transrectal ultrasonography. Ovulations were detected every 6h from PGF2 until ovulation. To explore the changes in follicular dynamics, endocrine profiles and behavioural events due to the variation in the interval to ovulation, another set of goats (n=13; experiment 2) were synchronized by a single dose of PGF2 given at random days of the luteal phase. Follicular dynamics were monitored every 12h from PGF2 until ovulation and oestrus was detected by apronized bucks every 6h from PGF2 treatment. Blood sampling (3mL) for oestradiol-17β and progesterone was done every 12h from PGF2 until ovulation and every 2h for LH assay by radioimmunoassay. Data were analysed by Student’s t-test, general linear models, and Pearson coefficient correlation (SPSS, version 20.0, SPSS Inc., Chicago, IL, USA). Results revealed that ovulation time varied from 60 to 96h after PGF2, and 57% of ovulations occurred by 72h after PGF2 (experiment 1). Based on this observation, goats (n=13) in second experiment were retrospectively divided into early and late ovulators (i.e. 72 and 84h following PGF2, respectively). Onset of oestrus, peak oestradiol-17β concentration, and LH surge after PGF2 were first observed in early than late ovulators (P&lt;0.05). The goats having greater follicle diameter and smaller corpus luteum diameter at the time of PGF2 ovulated earlier than late ovulators (5.4±0.2v. 4.3±0.2mm and 10±0.6v. 11.8±0.3mm, respectively; P&lt;0.05). Likewise, plasma progesterone concentration tended to be lower (P=0.087) in early than late ovulators. However, interval from onset of oestrus to peak LH and ovulation, duration of standing oestrus, interval from LH peak to ovulation, diameter and growth rate of preovulatory follicles, and number of ovulations were similar (P&gt;0.05) between early and late ovulators. In conclusion, the size of dominant follicle and corpus luteum at the time of PGF2 determines the interval to ovulation following a single dose of PGF2 during the luteal phase.

Community-based integrated approach to changing women's family planning behaviour in Pakistan, 2014-2016

Setting: Karachi, Pakistan. Objective: To assess the effectiveness of a community-based integrated approach in changing women's behaviour regarding contraceptive use. Design: The Sukh Initiative is a multipronged approach with door-to-door services using community health workers to provide quality family planning/reproductive health services at both public and private facilities and a 24/7 family planning helpline service that provides youth skill-based education. Methods: Retrospective pre- and post-intervention data using samples of 5140 and 3810 women, respectively. Results: The contraceptive prevalence rate increased by 10.7%, from 42.3% at baseline to 53.0% mid-intervention, with an increase in use of modern contraceptive methods of 9.2%. A significant association was found between door-to-door counselling and the use of contraceptive methods (OR 3.4, 95%CL 2.9-4.1) and access to public and private facilities for modern contraceptives (OR 2.4, 95%CL 2.0-3.0). However, support group meetings and 24/7 helpline use did not show any association with use of contraceptive method. Conclusion: The study helped to increase access to and choice of family planning services through a community-based approach that successfully reduced unmet needs and improved continuity in contraceptive use.

Homozygous XYLT2 variants as a cause of spondyloocular syndrome

Spondyloocular syndrome (SOS) is a rare autosomal recessive, skeletal disorder. Two recent studies have shown that it is the result of biallelic sequence variants in the XYLT2 gene with pleiotropic effects in multiple organs, including retina, heart muscle, inner ear, cartilage, and bone. The XYLT2 gene encodes xylosyltransferase 2, which catalyzes the transfer of xylose (monosaccharide) to the core protein of proteoglycans (PGs) leading to initiating the process of PG assembly. SOS was originally characterized in 2 families A and B of Iraqi and Turkish origin, respectively. Using DNA from affected members of the same 2 families, we performed whole exome sequencing, which revealed 2 novel homozygous missense variants (c.1159C > T, p.Arg387Trp) and (c.2548G > C, p.Asp850His). Our findings extend the body of evidence that SOS is caused by homozygous variants in the XYLT2 gene. In addition, this report has extended the phenotypic description of SOS by adding follow-up data from 5 affected individuals in one of the two families, presented here.