Cadmium (Cd) influences calcium (Ca) levels in the skeleton of a freshwater fish Channa gachua

Abstract Environmental contamination with heavy metals is a threat to the organisms due to their toxicity, persistence and bioaccumulation in food chains. The study was aimed to assess cadmium (Cd) effect on calcium (Ca) level in bones of a freshwater fish Channa gachua. 42 fish individuals were kept into six (6) aquaria; labelled aq.0, 1, 2, 3,4 and 5 in the laboratory for treatment. Aq.0 was control group and aq.1, 2,3,4,5 were experimental with treatment solution of Cd 0, 0.1ppm, 0.5ppm, 1ppm, 2.5ppm and 5ppm respectively for three months. After exposure, bones tissue were examined for Cd accumulation and Ca concentration. Highest accumulation of Cd were recorded in aq.5 mean 46.86 ± 0.46 mgkg-1 .and lowest in the control group with mean 0.61 ± 0.06 mgkg-1. The order of Cd bioaccumulation in bones were aq.5 > aq.4 >aq.3 > aq.2 > aq.1 > aq.0. Highest concentration of Ca were noted in aq.0 (Control group) mean 7888.06 ± 4827.22 mgkg-1 and lowest were 1132.36 ± 203.73 mgkg-1 in aq.5 (at 5.0 ppm). Generally a pattern of decreasing Ca level were observed with each rise of Cd bioaccumulation aq.0 > aq.1 > aq.2 > aq.3 > aq.4 > aq.5. Current study indicated that Cd accumulation have substantial effect on Ca level in bones and hence on skeleton system. Strict rules must be implemented by government to control metals pollution and exploitations of biota.

Effects of replacement of dietary fish oil with plant oil on growth performance and fatty acid composition of spinefoot rabbitfish, Siganus rivulatus

Abstract A 95-day feeding study was carried out to evaluate the impact of complete replacement of fish oil by plant oils in the growth performance, feed consumption fatty acid and body composition of juvenile rabbitfish, Siganus rivulatus. There were four treatments i.e., A (fish oil diet), (linseed oil diet), C (soybean meal oil diet) and D (sunflower oil diet). The experimental trial was conducted in twelve 1.5-m3 fiber glass tanks (n=3). Spinefoot rabbitfish juveniles had an average initial weight of 0.948 g ± 0.124 g and they were stocked at 50 fish per tank. Fish fed diet A showed significantly better growth rate, final body weight, and total body weight than fish fed on the other diets. Moreover, the best FCR was observed for diet A followed by diet C and diets B and D had the worst FCR. Fish body composition for crude protein, dry matter, ashes and gross energy at the end of the trial had not differed between the treatments. The highest polyunsaturated fatty acids (PUFA) was found in fish fed diet A followed in decreasing order by diets D, B, and C. Fish oil is a better dietary lipid source for Spinefoot rabbitfish juveniles, Siganus rivulatus, than plant oils. Among plant oils, soybean oil was better than linseed oil and sunflower oil as the main dietary fat source.

Size at sexual maturity estimation for 36 species captured by bottom and mid-water trawls from the marine habitat of Balochistan and Sindh in the Arabian Sea, Pakistan, using maximum length (Lmax) and logistic (L50) models

Abstract The aim of this study was to estimate the size at first sexual maturity (Lm) for 36 species belonging to 24 families from the marine habitat of Balochistan and Sindh in Arabian Sea, Pakistan through maximum length based an empirical and logistic model using commercial catch during June 2020 to May 2021. Individual total length (TL) was noted up to 0.1 cm using measuring broad. The Lm was calculated using two formulae; (i) log (Lm) = - 0.1246 + 0.9924 * log (Lmax) for Elasmobranchs and (ii) log (Lm) = -0.1189 + 0.9157* log (Lmax) for ray-finned fishes. The minimum Lm was recorded as 10.27 cm TL for Caranx malabaricus and 108.38 cm TL for Isurus oxyrinchus, respectively. Around Lm with 58.33% species were ranges from 19.00 cm to 25.00 cm TL. This study was estimated 16 newly Lm which is globally absent and rest 20 Lm are absent in the Arabian Sea (Pakistan coastal habitats). Therefore, the results will be helpful for the sustainable management and conservation of these marine fishes through the establishment of mesh size of trawl nets based on the size at sexual maturity (Lm).

Partial bicorporeal uterus with unexpected cervical findings and a longitudinal obstructing vaginal septum - a case report

Mullerian duct anomalies are prevalent in 4-7% of the female population and come in many different shapes and forms. A lot of effort has already gone into trying to classify these anomalies, and some are still found that do not match any of the subcategories. We report a 49-year-old patient, presenting with abdominal pressure and recent onset of abnormal vaginal bleeding. A laparoscopic hysterectomy was performed, which revealed a U3a-C(?)-V2 mullerian anomaly with three cervical ostia. The origin of the third ostium remains unclear. Early and correct diagnosis of Mullerian anomalies is of the utmost importance to provide individually tailored care and to avoid unnecessary surgeries.

Case Report: A Case of Post-Transplant Chagas Reactivation after Negative Trypanosoma cruzi Testing

Patients with Chagas cardiomyopathy carry a significant risk of reactivation after heart transplantation. Reactivation of Chagas disease can lead to graft failure or systemic complications such as fulminant central nervous system disease and sepsis. As such, careful screening for Chagas seropositivity prior to transplant is crucial to preventing negative outcomes in the post-transplant setting. One challenge in screening these patients is the variety of laboratory tests available and their differing sensitivities and specificities. In this case report, we present a patient who tested positive by a commercial Trypanosoma cruzi antibody assay and later tested negative by CDC confirmatory serological analysis. After the patient underwent orthotopic heart transplant, he underwent protocol-based polymerase chain reaction surveillance for reactivation as a result of persistent concerns for T. cruzi infection. It was discovered shortly thereafter that the patient had reactivation of Chagas disease, confirming that he did have Chagas cardiomyopathy prior to transplantation, despite negative confirmatory testing. This case illustrates the complexities of serological diagnosis of Chagas disease and the importance of additional testing for T. cruzi when the post-test probability remains high even with a commercial, negative serologic test.

Work stress among physicians, dubai health authority, in the year 2018-2019

Background: Work stress is a significant problem that affects physicians. Multiple sources can contribute to this problem. High-stress rates among physicians can manifest in various expressions, including cognitive, behavioral, and somatic expressions. Work performance and quality of medical care administered to patients can be undermined by over-stressed physicians. The study aimed to assess the prevalence of stress among physicians working in governmental health facilities in Dubai (2018-2019) and their relationship with socio-demographic and job factors.  Methods: It is a cross-sectional study. This study population includes all physicians practicing in Dubai Health Authority hospitals and primary health care centers in the Year 2018-2019. Target Number is 1337 taken from the registry of Dubai health authority administration, but only 668 questionnaires were included with a RR of 49.9%. The data tool used in this study is a modified self-administered questionnaire from both validated health and safety executive (Barbaranelli et al., 2018) occupational stress and stress questionnaire by International Stress Management Association UK 2013. It consists of 22 items which were divided into demographic, stress indicators, factors, and other domains. They were distributed as hard copies by hand.  Findings: The study concluded that 40.2% were more likely to experience stress, while 59.8% were most prone to stress. Furthermore, the study showed a strong association with different factors such as the role of managers, shift duty, and multi-task work.  Conclusion: Work stress is a prevalent problem among physicians working at Dubai health authority. The stress is associated with factors: such as multi-task work, shift hours’ duties, time pressure, and the role of line manager. Implications for Occupational Health Nursing Practice or Implications for Occupational Health Practice: Healthier working environment will promote the well-being of its staff and ensure the proper delivery of care to the community.

Pulse oximetry: why oxygen saturation is still not a part of standard pediatric guidelines in low-and-middle-income countries (LMICs)

BACKGROUND

With the high frequency of acute respiratory infections in children worldwide, particularly so in low-resource countries, the development of effective diagnostic support is crucial. While pulse oximetry has been found to be an acceptable method of hypoxemia detection, improving clinical decision making and efficient referral, many healthcare set ups in low- and middle-income countries have not been able to implement pulse oximetry into their practice.

MAIN BODY

A review of past pulse oximetry implementation attempts in low- and middle-income countries proposes the barriers and potential solutions for complete integration in the healthcare systems. The addition of pulse oximetry into WHO health guidelines would prove to improve detection of respiratory distress and ensuing therapeutic measures. Incorporation is limited by the cost and unavailability of pulse oximeters, and subsequent oxygen accessibility. This restriction is compounded by the lack of trained personnel, and healthcare provider misconceptions. These hurdles can be combated by focus on low-cost devices, and cooperation at national levels for development in healthcare infrastructure, resource transport, and oxygen delivery systems.

CONCLUSION

The implementation of pulse oximetry shows promise to improve child morbidity and mortality from pneumonia in low- and middle-income countries. Steady measures taken to improve access to pulse oximeters and oxygen supplies, along with enhanced medical provider training are encouraging steps to thorough pulse oximetry integration.

Trends in outcomes, complications and readmission rates in patients undergoing transcatheter aortic valve implantation: a nationwide analysis from 2012 to 2019

Background

Transcatheter aortic valve implantation (TAVI) has evolved over the years from a procedure requiring surgical vascular access and general anesthesia, to one that can be completed entirely percutaneously with conscious sedation. Advancement in procedural techniques and operator experience has resulted in better outcomes for patients undergoing TAVI.

Purpose

The purpose of our study was to analyze the trends over the years in outcomes, complications and unplanned readmission rate in patients undergoing TAVI.

Methods

The United States Nationwide Readmission Database for the years 2012 to 2019 was queried to identify all adult patients who underwent elective TAVI. The primary outcome of the study was inpatient mortality during TAVI hospitalization. Secondary outcomes included periprocedural complications (like acute kidney injury, bleeding requiring transfusion, need for permanent pacemaker implantation, stroke), length of stay, hospitalization cost, and unplanned 30-day readmission rate. Appropriate International Classification of Diseases (ICD-9 and ICD-10) codes were used to identify comorbidities and complications.

Results

A total of 283,409 patients who underwent TAVI were included in the study. The baseline characteristics of these patients are shown in picture 1. The inpatient mortality during TAVI admission declined steadily and significantly from 5.3% in the year 2012 to 0.0% in the year 2019 (p value for trend <0.001). There was a significant reduction in peri-TAVI occurrence of acute kidney injury (from 18.1% in 2012 to 8.7% in 2019), bleeding requiring transfusion (from 28.0% in 2012 to 4.3% in 2019), and stroke (from 1.8% in 2012 to 0.1% in 2019) (p value for trend <0.001 for all). Periprocedural conduction abnormalities requiring permanent pacemaker implantation increased from 7.4% in 2012 to 12.1% in 2015, before coming down to 8.9% in 2019 (p value for trend <0.001). The mean length of hospital stay and inflation-adjusted costs during admission for TAVI decreased from 9.6 days and $64,695 in the year 2012, to 3.6 days and $49,710 in the year 2019, respectively (p value for both <0.001). The unplanned 30-day all-cause readmission rate after TAVI also reduced steadily and significantly from 18.2% in 2012 to 11.5% in 2019 (p value <0.001).

Conclusion

Over the years, there has been a significant reduction in inpatient mortality, periprocedural complications (such as acute kidney injury, need for blood transfusion, stroke), length of hospital stay, and inflation-adjusted hospital costs in patients undergoing transcatheter aortic valve implantation. Furthermore, there has been a significant decline in the 30-day unplanned readmission rate after transcatheter aortic valve implantation.

Funding Acknowledgement

Type of funding sources: None.

Same-day discharge following transcatheter aortic valve replacement: a propensity-matched analysis from national readmission database

Background

The length of hospital stay following transcatheter aortic valve replacement (TAVR) has decreased in recent years, and next-day discharge strategy is being increasingly adopted in some centers. Whether it is safe to further expedite discharge post-TAVR in selected patients by allowing discharge on the same day as the procedure remains unknown. In addition to potentially decreasing hospitalization costs, it could also limit the inpatient footprint and strain on healthcare resources.

Purpose

The purpose of our study was to compare the 30-day readmission rate in patients receiving TAVR who were discharged the same day (same-day discharge or SDD group) with those who were discharged on a different day (different-day discharge or DDD group). Additionally, we aimed to identify risk factors for readmission after TAVR.

Methods

We used the United States Nationwide Readmission Database to identify all adults who underwent elective TAVR in the years 2015–2019. The primary outcome of this study was all-cause 30-day readmission rate. The secondary outcomes were total hospital costs for the index admission, and risk factors for 30-day readmission. Propensity score matching was conducted to compare the SDD and DDD groups. Independent risk factors of 30-day readmission were identified using multivariate Cox proportional hazards regression analysis of the unmatched cohort.

Results

Of the 196,618 patients who received TAVR (mean age 79.5±8.4 years, 45.0% females), 245 (0.12%) patients were discharged on the same day they received TAVR (SDD group), and the remaining 196,373 were discharged on a different day (DDD group). In the DDD group, the median length of hospital stay was 2 days (interquartile range 1–4 days). A 1:3 propensity score analysis generated a matched cohort including 245 and 889 patients in the SDD and DDD groups, respectively. The 30-day readmission rate was similar between the SDD and DDD groups (11.0% versus 10.8%, hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.59–1.71, p=0.989). Hospitalization costs were significantly lower in the SDD group than the DDD group ($37,811±18,029 versus $49,130±27,007, p<0.001) (see Picture 1). Age, female gender, history of diabetes, chronic kidney disease, chronic pulmonary disease, oxygen use, prior stroke, peripheral vascular disease, anemia, liver disease, and cancer were found to be independent risk factors for 30-day readmission after TAVR (see Picture 2).

Conclusion

In this large nationwide database analysis, patients receiving uncomplicated TAVR who were discharged on the same day as the procedure had a similar all-cause 30-day readmission rate and significantly lower hospital costs compared to those discharged on a different day. These results indicate that same-day discharge after TAVR may be a safe and feasible option in carefully selected patients.

Funding Acknowledgement

Type of funding sources: None.

Comparison between 2 futility scores in comatosed survivors of out of hospital cardiac arrest in a large tertiary centre in the United Kingdom: MIRACLE2 vs NULL-PLEASE

Background

The management of patients presenting with an out of hospital cardiac arrest (OHCA) is resource intensive, and mortality remains very high. Several scoring systems have been developed to predict mortality and adverse neurological outcomes, and thus aid decision making for patients arriving to heart attack centres. Two of the most commonly used scoring systems are NULL-PLEASE (1) and MIRACLE2 (2).

Purpose

The MIRCALE2 score predicts poor neurological outcome at 6 months, as measured by Cerebral Performance Category (CPC). The NULL-PLEASE score predicts in-hospital morality. We aimed to compare both scores in predicting their primary end-points in a large tertiary centre in the UK.

Method and results

This was a retrospective analysis of 435 patient who were admitted with OHCA via the primary PCI pathway to a large tertiary cardiac centre between January 2016 and September 2020. Only comatosed OHCA survivors requiring pre-hospital ventilatory support were included. 319 patients were eligible 238 patients had complete set of data and were included in the final analysis.

The association of the primary outcome was examined using logistic regression analysis. The predictive ability of the scores for the primary endpoint was tested using AUC analysis.

In-hospital mortality was 45% (108 patients), with 53% having good neurological outcome at 6 months (CPC <3). The median MIRACLE2 score for our cohort was 5 (total score 10). The median neurological outcome measured by CPC was 2. The median NULL-PLEASE score was 2 (total 14). A ROC curve for both scores was plotted, with area under the curve at 0.73 for the MIRACLE2, and 0. 0.81 for NULL-PLEASE (figure 1 and 2). Our final analysis demonstrated a MIRACLE2 score of 5 or more had sensitivity of 67% to predict poor neurological outcome (CPC 3–5). The NULL-PLEASE, score of >3 had 74% sensitivity to predict in hospital mortality.

Conclusion

To our knowledge, this is the first study to compare the MIRCLE2 and NULL-PLEASE scoring systems. Both scores did not perform as expected in our large retrospective analysis. The NULL-PLEASE was more sensitive in predicting in-hospital mortality, although MIRACLE 2 score was easier to use as it had less variables to collect.

Funding Acknowledgement

Type of funding sources: None.

Myers-Briggs Type Indicator Personality Types of Female Intern Doctors and Their Specialty Preference

The Myers-Briggs Type Indicator (MBTI) personality types were established in 1940s. Career planning of doctors were found related to the MBTI personality. There are 16 subtypes of MBTI based on 4 dichotomies. Relationship between MBTI and career choice has been changed gradually in last few decades. Extroverted doctors are supposed to select surgery and introverted are prone to choose medicine according to MBTI study. This was a cross-sectional study on the female interns of Sylhet Women's Medical College Hospital, Bangladesh from September 2021 to November 2021, to evaluate their MBTI personality type and the career planning of these individual subtypes. Commonest subtypes of participants ISTP (Introverted, Sensing, Thinking, Perceiving) (14.13%) and ESTP (Extraverted, Observant, Thinking and Prospecting) (14.13%). Other common MBTI personality subtypes were ISTJ (Introversion, Sensing, Thinking and Judgment) (9.78%), ISFP (Introverted, Sensing, Feeling, Perceiving) (8.69%), ESFJ (Extraverted, Sensing, Feeling and Judging) (6.52%), ENTP (Extraverted, Intuitive, Thinking and Perceiving) (5.43%), INFJ (Introverted, Intuitive, Feeling and Judging) (5.43%), INTJ (Introverted, Intuitive, Thinking and Judging) (5.43%) and ISFJ (Introverted, Sensing, Feeling and Judging) (5.43%). Introverted (57.7%) participants were more than extroverted (42.3%) participants. Percentage of general surgery and OBG were higher in the extroverted group and the percentage of medicine was more in the introverted group but the differences were not statistically significant (p>0.05). The career planning of ENFJ, ENFP, ESTP and ISTJ subtypes of participants of this study had similarity of those of MBTI database.

When coronary imaging and physiology are discordant, how best to manage coronary lesions? An appraisal of the clinical evidence

BACKGROUND

Discordant physiology and anatomy may occur when nonsevere angiographic stenosis has positive physiology as well as the opposite situation.

AIM

To underline the reasons behind the discrepancy in physiology and anatomy and to summarize the information that coronary imaging may add to physiology.

METHODS

A review of the published literature on physiology and intravascular imaging assessment of intermediate lesions was carried out.

RESULTS

The limitations of angiography, the possibility of an underlying diffuse disease, the presence of a "grey zone" in both techniques, the amount of myocardial mass that subtends the stenosis, and plaque vulnerability may play a role in such discrepancy. Intracoronary imaging has a poor diagnostic accuracy compared to physiology. However, it may add information about plaque vulnerability that might be useful in deciding whether to treat or not a certain lesion.

CONCLUSIONS

Coronary revascularization is recommended for patients with ischemia based on physiology. Intracoronary imaging adds information on plaque vulnerability and can help on the decision whether to revascularize or not a lesion.

Development of Kaya Slice (coconut jam slice): evaluation of physicochemical, sensory evaluation and macronutrients composition when cooperated with gelatin

Kaya Slice is a nutritious traditional breakfast-on-the-go that was innovated from the traditional kaya. In this study, the traditional kaya was transformed into square shape gelatin to make it a more convenient and ready-to-eat breakfast. A total of six formulations were developed by using commercial and fresh coconut milk together with different percentages of gelatin (2%, 4%, and 6%). This insight was investigated by sensory evaluation using a 9-point hedonic and scoring test in descriptive data set. The best formulation obtained from the evaluation of 35 panellists was then characterized in terms of physicochemical properties (Texture Profile Analysis (firmness), Brix, Protein, Fat, Fiber, and Calories). From the descriptive data, all formulations were accepted by the panellist. Nevertheless, ANOVA analysis indicated that C2 (commercial coconut milk + 4% of gelatin) is the best formulation. In macronutrient analysis, Kaya Slice was found to have good dietary fibre content (0.11 g/100 g), high-fat content (0.49 g/100 g), protein content (0.32 g/100 g) compare to the commercial kaya (0.00 g/100 g), (1.00 g/100 g), and (0.00 g/100 g) respectively. Low-calorie content in Kaya Slice with 45 % of °Brix value is the minimal degree of Brix and the texture was softer (hardness) (significantly different (p<0.05)) to commercially processed cheese slice as standard. Overall, Kaya Slice has a great potential in becoming new emergent of traditional nutritious breakfast on the go.

Green synthesis of gold nanaoparticles using Delphinium Chitralense tuber extracts, their characterization and enzyme inhibitory potential

Green synthesis has been introduced as an alternative to chemical synthesis due to the serious consequences. Metal nanoparticles synthesized through green approach have different pharmaceutical, medical and agricultural applications. The present study followed a green and simple route for the preparation of potentially bioactive gold nanoparticles (Au NPs). Au NPs were prepared via green synthesis approach using crude basic alkaloidal portion of the tuber of Delphinium chitralense. The green synthesized Au NPs were characterized by transmission electron microscopy (TEM), scanning electron microscopy (SEM), X-ray diffraction (XRD) fourier transform infrared (FTIR), and UV-Visible spectrophotometer. Morphological analysis shows that Au NPs have cubic geometry with different sizes. UV-Vis spectroscopic analysis confirmed the synthesis of Au NPs while XRD proved their pure crystalline phase. The Au NPs showed promising dose dependent inhibition of both AChE and BChE as compared to the crude as well as standard drug.

Cryoballoon Ablation for Persistent Atrial Fibrillation in a Patient with a Left Pneumonectomy

Pulmonary vein (PV) isolation (PVI) is the most important component of catheter ablation of atrial fibrillation (AF) and can be achieved by radiofrequency or cryoballoon ablation (CBA). The CBA system has shown excellent efficacy and safety in a number of clinical trials and is independent of the PV anatomy. However, pneumonectomy can significantly alter the anatomy posing a challenge to CBA. Few cases of PVI accomplished by CBA have been described in patients with lobectomy, but none in the pneumonectomy population. We describe a case of successful CBA for paroxysmal AF in a patient with a left total pneumonectomy.

Ventricular Fibrillation Cardiopulmonary Arrest Following Micra™ Leadless Pacemaker Implantation

Leadless cardiac pacemakers such as the Micra™ transcatheter leadless pacing system (Medtronic, Minneapolis, MN, USA) are an alternative to traditional transvenous pacemakers. Implantation of leadless pacemakers, albeit safe, may be associated with complications, including cardiac tamponade; high capture thresholds; and, rarely, ventricular arrhythmias. We report a case of ventricular fibrillation arrest following the implantation of a Micra™ leadless pacemaker.

2 μm passively mode-locked thulium-doped fiber lasers with Ta2AlC-deposited tapered and side-polished fibers

In this work, mode-locked thulium-doped fiber lasers operating in the 2 µm wavelength region were demonstrated using tantalum aluminum carbide (Ta2AlC)-based saturable absorbers (SAs) utilizing the evanescent wave interaction. The Ta2AlC MAX Phase was prepared by dissolving the Ta2AlC powder in isopropyl alcohol and then deposited onto three different evanescent field-based devices, which were the tapered fiber, side-polished fiber, and arc-shaped fiber. Flame-brushing and wheel-polishing techniques were used to fabricate the tapered and arc-shaped fibers, respectively, while the side-polished fiber was purchased commercially. All three SA devices generated stable mode-locked pulses at center wavelengths of 1937, 1931, and 1929 nm for the tapered, side-polished, and arc-shaped fibers. The frequency of the mode-locked pulses was 10.73 MHz for the tapered fiber, 9.58 MHz for the side-polished fiber, and 10.16 MHz for the arc-shaped fiber. The measured pulse widths were 1.678, 1.734, and 1.817 ps for each of the three SA devices. The long-term stability of the mode-locked lasers was tested for each configuration over a 2-h duration. The lasers also showed little to no fluctuations in the center wavelengths and the peak optical intensities, demonstrating a reliable, ultrafast laser system.

Larvicidal efficacy of temephos impregnated onto kenaf cellulose nanofibre to control Aedes aegypti (Diptera: Culicidae) larvae

Larviciding is an effective control method in managing mosquito-borne diseases. However, most of the current larvicide formulations have raised environmental concerns due to the presence of non-biodegradable inert or carrier materials. Therefore, the utilisation of biodegradable natural cellulosic fibres has created much attention. This study aims to evaluate the application of biodegradable kenaf cellulose nanofibre (KCNF) in larvicide formulation where the larvicide, namely temephos, is impregnated onto the fibre matrix (KCNF+T). The bioefficacy of the formulation was evaluated against Aedes aegypti ( A. aegypti) mosquito larvae. The presence of the temephos on the KCNF was evaluated through micro- morphological analysis using a field emission scanning electron microscope (FESEM) and a transmission electron microscope (TEM), while the quantity of temephos impregnated, released, and retained on the fibres upon dispersion in water were determined using high performance liquid chromatography (HPLC). It was observed that 97% of the temephos (0.1 mg) were impregnated on the KCNF. Upon dispersion in water, 53% of the temephos were released from the KCNF+T and the retention of temephos on the KCNF+T gradually decreased to 30%, 17%, and 7% on the first, third, and fifth month, respectively. Exposure of the A. aegypti larvae to the KCNF+T at concentrations ranging between 0.006 to 0.01 mg/L was effective in killing A. aegypti larvae at 17-25 folds as compared to using the temephos without KCNF. Microscopic examination revealed the accumulation of the KCNF on the larval appendages. In conclusion, this study demonstrated that the utilisation of KCNF in pesticide formulation is an effective way of delivering the temephos to control A. aegypti mosquito larva.

Women's mobility and transport in the peripheries of three African cities: Reflecting on early impacts of COVID-19

This paper reflects on the mobility experiences of women in African cities in COVID-19, based on research conducted both prior to and following entry into the COVID-19 'moment'. It draws on material collected during an ongoing action research study aimed at addressing the everyday transport and mobility challenges faced by young women living in poor peripheral communities of three African cities - Abuja, Cape Town and Tunis. The project has the specific objective of supporting young women's improved access to employment opportunities through trialling various mobility/transport-related skills interventions (based on prior in-depth analysis of mobility constraints). With the onset of COVID-19 some readjustments to the research focus and planned interventions became necessary. The research teams, together with an NGO partner, are now working to chart how young women's everyday experiences of mobility and transport - both as transport users and as transport sector workers - are changing as processes of lockdown and their relaxation evolve. The paper covers the period from early 2019 through to March 2021, and offers reflections regarding 'lived experiences' of mobility practice pre-pandemic, during the pandemic, and the potential longer-term mobility-related impacts for women resident in low-income neighbourhoods in a post-COVID-19 era. This leads to consideration of key policy lessons. There is potential for prioritisation of Non-Motorised Transport interventions towards a green restart that would benefit women (for instance through promoting women's cycling), and for growing women's participation as transport operators, even perhaps the usage of drones to aid women's safer pedestrian travel. But such interventions will require far greater representation of women in COVID-19 and wider transport decision-making entities than has hitherto been the case.

Detection of subclinical rheumatic heart disease in children using a deep learning algorithm on digital stethoscope: a study protocol

INTRODUCTION

Rheumatic heart diseases (RHDs) contribute significant morbidity and mortality globally. To reduce the burden of RHD, timely initiation of secondary prophylaxis is important. The objectives of this study are to determine the frequency of subclinical RHD and to train a deep learning (DL) algorithm using waveform data from the digital auscultatory stethoscope (DAS) in predicting subclinical RHD.

METHODS AND ANALYSIS

We aim to recruit 1700 children from a group of schools serving the underprivileged over a 12-month period in Karachi (Pakistan). All consenting students within the age of 5-15 years with no underlying congenital heart disease will be eligible for the study. We will gather information regarding sociodemographics, anthropometric data, history of symptoms or diagnosis of rheumatic fever, phonocardiogram (PCG) and electrocardiography (ECG) data obtained from DAS. Handheld echocardiogram will be performed on each study participant to assess the presence of a mitral regurgitation (MR) jet (>1.5 cm), or the presence of aortic regurgitation (AR) in any view. If any of these findings are present, a confirmatory standard echocardiogram using the World Heart Federation (WHF) will be performed to confirm the diagnosis of subclinical RHD. The auscultatory data from digital stethoscope will be used to train the deep neural network for the automatic identification of patients with subclinical RHD. The proposed neural network will be trained in a supervised manner using labels from standard echocardiogram of the participants. Once trained, the neural network will be able to automatically classify the DAS data in one of the three major categories-patient with definite RHD, patient with borderline RHD and normal subject. The significance of the results will be confirmed by standard statistical methods for hypothesis testing.

ETHICS AND DISSEMINATION

Ethics approval has been taken from the Aga Khan University, Pakistan. Findings will be disseminated through scientific publications and to collaborators.

ARTICLE FOCUS

This study focuses on determining the frequency of subclinical RHD in school-going children in Karachi, Pakistan and developing a DL algorithm to screen for this condition using a digital stethoscope.

Prevalence of active HCV infection and genotypic distribution among the general population of district Mardan, Pakistan

Hepatitis C virus (HCV) is the serious global public health burden of liver disease. Approximately 170 million people in the world are infected with (HCV). In Pakistan, where the disease has high occurrence rate. The present study envisages an up-to-date prevalence of HCV and genotypic distribution in the general population of Mardan District, Khyber Pakhtunkhwa (KP), Pakistan. The blood samples from 6,538 individuals including 3,263 males and 3,275 females were analyzed for hepatitis C surface antigen by Immuno-chromatographic test (ICT), Enzyme-linked immunosorbent assay (ELISA), and reverse transcription-polymerase chain reaction (PCR). It was found that 396 (12.13%) out of 3263 individuals contained antibodies in their blood against HCV, while among the different age groups, the highest incidences of HCV antibodies were found in the 31-40 age group (11.01%). The ICT positive samples were further screened by nested PCR to determine the existence of active HCV-RNA. It was identified that 7.11% (3263) of the total population (6538) tested was positive, among which the 461 (14.07%) females possessed antibodies in their blood against HCV. Our data showed total HCV infection in the investigated population was 5.78%. Higher percentage of HCV prevalence was detected in males than females in the age group 31-40 and 41-50. To compare the prevalence of HCV genotypes age-wise in male and female genotype 3a was found most prevalent genotype followed by 1a, 2a and 3b, respectively.

Passively mode locked thulium and thulium/holmium doped fiber lasers using MXene Nb2C coated microfiber

As a result of the emergence of two-dimensional (2D) materials for various opto-electronics applications, a new class of materials named MXenes have been attracting interests due to their outstanding nonlinear properties. In this work, an MXene niobium carbide (Nb2C) was proposed and demonstrated as a saturable absorber to induce mode-locking in thulium- and thulium/holmium-doped fiber lasers. The Nb2C solution was first prepared using the liquid exfoliation technique, and then deposited onto a microfiber for integration into the laser cavity. Stable mode-locking operation was observed in both laser cavities, where the center wavelengths of the laser were recorded at 1944 nm for the TDFL and 1950 nm for the THDFL. The generated pulses in the TDFL and THDFL had repetition rates of 9.35 and 11.76 MHz respectively, while their corresponding pulse widths were 1.67 and 1.34 ps. Both of the lasers were highly stable, having SNR values of more than 52 dB and showed no major fluctuations when tested for their long-term stabilities. The results demonstrate an excellent performance of the Nb2C as a saturable absorber, offering opportunities to further explore MXenes for future photonics devices.

Assessing atrial fibrillation ablation priority during COVID-19 -does use of patient questionnaires help in stratification above physician assessment?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Catheter ablation for atrial fibrillation (AF) is largely offered for symptomatic relief. The ORBIT registry has shown that patients with a higher EHRA class and lower quality of life (QoL) scores (AFEQT score <65.7) are more likely to suffer emergency hospital admissions. To help prevent unplanned AF admissions and to best utilise the reduced capacity for elective work during the COVID-19 pandemic, it has become even more important to prioritise the most symptomatic AF patients for ablation. Purpose: To evaluate the accuracy of a subjective symptom-based clinician prioritisation schema compared to objective patient-completed quality of life (QoL) scores. Methods: In July 2020, all elective cases awaiting AF ablation at our institution were categorised by their cardiologist as either category 1 (C1-urgent), category 2 (C2–priority, procedure to be done during the ongoing COVID-19 pandemic) or category 3 (C3–routine, procedure may be delayed until post pandemic). This categorisation was based on review of clinic letters where EHRA AF symptom class or PROMS are not routinely recorded.  All patients in C2 and C3 were then posted an AF specific (AFEQT) and a generic (EQ5D) QoL questionnaire to complete. Physicians were blinded to patient responses on the QoL questionnaires. Results: Details of physician prioritisation and completed questionnaires were available for 85 patients (62 ± 10 years, PAF in 61%, males 66%). The 18 patients that had been categorised in C2 (priority) group were found to have a significantly lower AFEQT score (30.4, IQR 17.2-51.9) compared to the 67 patients classed in C3 (routine) group (56.5, IQR 32.1-74.1; p < 0.01)(Figure 1a). EQ5D scores also tended to be lower in the C2 patients (0.7, IQR 0.4-0.8) compared to C3 (0.8, IQR 0.6-0.9; p = 0.056) (Figure 1c). 16 (89%) patients in C2 had significant AF-related impact on QoL (as defined as AFEQT score <65.7) compared to 42 (63%) of patients in C3.  However, there was significant overlap between groups (Figure 1b). 4 patients in C3 had unplanned AF related hospital admissions while awaiting ablation, as compared to none in C2. The median AFEQT score of these 4 patients was 23.3, indicating that they were highly symptomatic despite being classified in C3 by their cardiologist. Conclusion : Physician assessments are moderately accurate in prioritising patients awaiting AF ablation. The addition of formal patient-completed QoL assessment such as with AFEQT, helps to identify the most symptomatic patients at risk of emergency hospital admission, and physicians should consider using these as part of routine assessment, especially during the COVID pandemic.

1.3 µm dissipative soliton resonance generation in Bismuth doped fiber laser

In this work, a Figure-9 (F9) bismuth-doped fiber laser (BiDFL) operating in the dissipative soliton resonance (DSR) regime is presented. The 1338 nm laser used a BiDF as the active gain medium, while a nonlinear amplifying loop mirror (NALM) in an F9 configuration was employed to obtain high energy mode-locked pulses. The wave breaking-free rectangular pulse widened significantly in the time domain with the increase of the pump power while maintaining an almost constant peak power of 0.6 W. At the maximum pump power, the mode-locked laser delivered a rectangular-shaped pulse with a duration of 48 ns, repetition rate of 362 kHz and a radio-frequency signal-to-noise ratio of more than 60 dB. The maximum output power was recorded at around 11 mW with a corresponding pulse energy of 30 nJ. This is, to the best of the author's knowledge, the highest mode-locked pulse energy obtained at 1.3 μm as well as the demonstration of an NALM BiDFL in a F9 configuration.

Enhanced Biosynthesis Synthesis of Copper Oxide Nanoparticles (CuO-NPs) for their Antifungal Activity Toxicity against Major Phyto-Pathogens of Apple Orchards

PURPOSE

The present study made an attempt to develop copper nanoparticles (Cu-NP) with antifungal property using green synthesis method. Copper oxide nanoparticles (CuO-NPs) botanically synthesized using Neem leaf extract (Azadirachta indica A. Juss) were characterized by using different techniques like; UV-visible spectrophotometry, FTIR, XRD, SEM and TEM.

METHODS

Materials were chosen the disease free and fresh Azadirachta indica A. Juss were collected and identified at Center of Biodiversity and Taxonomy. The plant samples were vigorously washed with distilled water then shade dried followed by sterilization with 0.1% mercuric chloride for 20 s and again it was washed with distilled water. 15 g powder form of plant material was added to 200 ml double distilled, CO₂ free and deionized water and kept in shaker at 80°C and 1500 rpm for six hours. After agitation, the extract was separated by regular centrifugation at 10,000 rpm followed by filtration by using whatmann filter paper. The final volume of 100 ml of supernatant was collected as pure extract and stored in cool place for further use.

RESULTS

The final results confirm a significant inhibition of CuO-NPs for the test fungi. Additionally, CuO-NPs demonstrated an enhanced effect when combined with Neem leaf extract. A total of 20-30% improvement in activity was noticed after combination, which correlates with commonly used synthetic fungicides. The toxicity results reveal that A. indica extract and their combined fractions with CuO-NP were less toxic to the test seeds of experimental plant while as bulk Cu followed by biosynthesized CuO-NPs influenced the germination rate as compared to control pots.

CONCLUSIONS

The study drops a concern of research and offers a promising route of developing Copper based green fungicides that can help to combat with modern issues of synthetic fungicides. An average size of 80 ± 15 nm monoclinic cupric oxide (CuO) and cubic cuprous oxides (Cu₂O) nanocrystals that existed in mixed form were successfully developed.

Mediastinal tissue friability-An unreported complication from Mycobacterium chimaera infection post-cardiac surgery

Mycobacterium chimaera can cause disseminated infection following cardiac surgery with cardiopulmonary bypass and contaminated heater-cooler devices. We discuss a 41-year-old man with a disseminated M. chimaera infection following surgery for a type A aortic dissection. His presentation included cachexia and dorsalgia with a work-up revealing vertebral osteomyelitis with an epidural abscess, bone marrow, and pulmonary infiltration, and fluid collection around his aortic graft. He received 1 month of antibiotics before the explantation of infected foreign material, mediastinal debridement, and aortic reconstruction. Complications included septic shock, respiratory and renal failure, mediastinitis, and four distal aortic anastomotic dehiscences from friable tissue and persistent infection.

Generation of Q-switched Pulses in Thulium-doped and Thulium/Holmium-co-doped Fiber Lasers using MAX phase (Ti3AlC2)

A MAX phase Ti3AlC2 thin film is demonstrated as a saturable absorber (SA) to induce Q-switching in the 2.0 μm region. The Ti3AlC2 thin film is sandwiched between two fiber ferrules and integrated into thulium doped fiber laser (TDFL) and thulium-holmium doped fiber laser (THDFL) cavities. Stable Q-switched pulses are observed at 1980.79 nm and 1959.3 nm in the TDFL and THDFL cavities respectively, with repetition rates of 32.57 kHz and 21.94 kHz and corresponding pulse widths of 2.72 μs and 3.9 μs for both cavities. The performance of the Ti3AlC2 based SA for Q-switching operation indicates the high potential of other MAX phase materials to serve as SAs in future photonics systems.

Wide multiwavelength Brillouin-Raman fiber laser assisted by an arc-shaped fiber attenuator

A wide bandwidth, single-spacing half-open-cavity multiwavelength Brillouin-Raman fiber laser (MWBRFL) is demonstrated. The laser cavity contains a fiber loop mirror (FLM) with an arc-shaped optical fiber attenuator that is used to control the mirror reflectivity, thereby suppressing gain competition from longitudinal cavity modes. A tuning range of 45 nm with 632 lines at Raman and 1525 nm Brillouin pump powers of 1.2 W and 12 dBm can be achieved using the 10 dB arc-shaped optical fiber attenuator in the cavity. This is in comparison to 433 Stokes lines obtained over a 31 nm tuning range for the half-open MWBRFL cavity without any feedback power optimization. The MWBRFL has low power fluctuations of less than 0.1 dB over a 1 h test period. The inclusion of the arc-shaped optical fiber attenuator in the MWBRFL provides substantial control over the reflectivity of the FLM as well as improving the laser's tuning range to generate a high number of Brillouin Stokes signals.

A triangulation for passive design strategies in public hospital

This study touches on passive design elements used at the preparatory design stage of public hospital in Malaysia. Passive design is an aspect of sustainable architecture that needs to be understood and adopted in an environmentally sensitive architectural design. The most common problem is that the designers do not have proper guidelines for passive design to help them in designing a public hospital. Currently there is no comprehensive guidelines on passive design or sustainable architecture that may help designers. This consequently affects the increase of energy usage in hospitals. The intent of this study is to furnish evidence that the initial process of systematic design and guidance is essential in planning for a sustainable public hospital environment. In this study, the researcher uses a mixed method to obtain outcome for guideline. Through this method, a combination of qualitative and quantitative metadata to foster effective interventions to improve the quality of environmental friendly hospital design. The conclusions obtained from this study are to assist in the process of more efficient public hospital design. In addition to making these passive design guidelines as helpful in providing explanations and working to ensure that the guideline produced has credibility and meet the criteria.

Mechanically exfoliated In2Se3 as a saturable absorber for mode-locking a thulium-doped fluoride fiber laser operating in S-band

The rise of 2D materials since the discovery of graphene has been exponential. Their mechanical, electrical and optical properties are exceptional, similar to their 3D counterparts. In this paper, an α-In₂Se₃ crystal is mechanically exfoliated and transferred directly onto a fiber ferrule to serve as a saturable absorber (SA). A thulium-doped fluoride fiber is used as a gain medium to generate mode-locked pulses together with the In₂Se₃-based SA. The SA has a modulation depth of 14.6% and a saturation intensity of 0.4  kW/cm². The passively generated mode-locked pulses have a repetition rate of 6.93 MHz and a pulse width of 5.79 ps. The mode-locked pulses also have a signal-to-noise ratio of 65.4 dB and a time-bandwidth product of 0.36. The pulse energy and peak power are 0.179 nJ and 27.2 W, respectively.

Effects of dietary supplementation with enzymatically treated Artemisia annua on growth performance, intestinal morphology, digestive enzyme activities, immunity, and antioxidant capacity of heat-stressed broilers

The gastrointestinal tract is considered as one of the main target organs affected by heat stress. Phytogenic feed additives containing phenolics and flavonoids can improve the resistance of broilers to heat stress. This study was conducted to investigate the effects of dietary supplementation with enzymatically treated Artemisia annua (EA) on growth performance, intestinal morphology, digestive enzyme activities, immunity and antioxidant capacity of broilers challenged with heat stress. One hundred and forty-four 21-day-old male Arbor Acres broilers were randomly distributed into 3 treatments: 1) non-challenged control (CON); 2) heat-stress-challenged control (HS); and 3) heat-stress-challenged group + 1 g EA/kg diet (HS-EA). From 22 to 41 d, broilers in the CON group were housed at 22 ± 1°C, the HS and HS-EA groups, in which broilers were raised at 34 ± 1°C for 8 h (0900-1700 h) and the temperature for the rest time was the same as that of the CON group. The EA supplementation alleviated the compromised body weight gain and intestinal morphology impairment caused by heat stress challenge (P < 0.05). The EA attenuated heat-stress-induced decreased intestinal lipase, trypsin and total superoxide dismutase activities, and reduced intestinal secretory immunoglobulin A (SIgA) and IgG concentrations (P < 0.05). The EA inclusion prevented the elevation of intestinal malondialdehyde content and reduction of intestinal glutathione concentration induced by heat stress challenge (P < 0.05). The intestinal mRNA abundances of nuclear factor erythroid 2-related factor 2, heme oxygenase 1, glutathione peroxidase, gamma-glutamyl cysteine ligase larger catalytic subunit and gamma-glutamyl cysteine ligase smaller modulator subunit in heat-stressed broilers were increased in response to dietary EA treatment (P < 0.05). In conclusion, dietary supplementation of 1 g/kg EA could alleviate heat-stress-induced compromised growth performance and intestinal damage of broilers.

Investigation of Potential Grounding Compound for Portable Applications

<span>This paper applies to the electrical engineering world by making earthing system portable in providing low and acceptable resistance path. The system is develop in a small scale portable earthing system against the massiveness of Earth and becomes leverage if soil at the place is not suitable for plant grounding system. Hence, this paper presents findings on the research of new grounding medium material that will be housed in a small scale enclosure which behaves like native earth related earthing system by using kaolin and bauxite. The data obtained from lightning flashover testing, morphological and chemical composition of material analysis indicated that bauxite is more useful for portable grounding system application much better than kaolin in term of zero reference point function. The portable earthing system can be apply to air aviation systems , railway systems and military sectors particularly for electronic equipment zero referencing.</span>