Association of Gestational Iron-deficiency Anemia with Antenatal Depression among Pregnant Women: A Case-control Study from Tertiary Care Hospitals, Lahore.

Objective: The goal of this study is to investigate the potential association between gestational anemia and antenatal depression in pregnant women. Methods: It is a case-control study consisting of 684 pregnant women under 18 years recruited in different tertiary care hospitals, in Lahore, between June 2023 and December 2023. Utilizing an online questionnaire, data collection encompassed demographics, dietary habits, and the Edinburgh Postnatal Depression Scale (EPDS). Pregnant women with antenatal hemoglobin (Hb) levels above and below 11.0 g/dL were categorized as a nonanemic and anemic group. Statistical analysis involved Chi-square tests to explore the relationships between gestational parameters and maternal factors. Findings: The depression scores of anemic and nonanemic pregnant women compare two groups of pregnant women based on their Hb levels: those with Hb <110 g/l during pregnancy (anemic) and those with Hb ≥110 g/l (nonanemic). The anemic group had higher depression scores than the nonanemic group, both for those with EPDS <12 points and those with EPDS ≥12 points. However, P = 0.077 indicates that this difference was not statistically significant at a typical alpha level of 0.05. Conclusion: No significant association was found between gestational anemia and antenatal depression in pregnant women. These findings prompt further research to unravel the intricacies of the association between gestational anemia and depression. The outcomes thus urge the researchers and health-care professionals to consider the diverse factors that may contribute to mental health outcomes during pregnancy and refine strategies for maternal care.

Granulomatosis With Polyangiitis Mimicking Infective Endocarditis: A Case Report.

Granulomatosis with polyangiitis is a rare systemic disease that causes necrotizing granulomatous inflammation of small- and medium-sized blood vessels. We present the case of a 46-year-old male with medical history significant for chronic sinusitis, prior history of drug abuse, and a recent tooth infection. He was suspected to have infective endocarditis, but further workup revealed diagnostic findings of granulomatosis with polyangiitis. We discuss how the signs and symptoms of granulomatosis with polyangiitis can overlap with infective endocarditis, a pathophysiologically distinct condition with a strikingly similar presentation.

Multifaceted roles of zinc nanoparticles in alleviating heavy metal toxicity in plants: a comprehensive review and future perspectives.

Heavy metal (HM) toxicity is a serious concern across the globe owing to their harmful impacts on plants, animals, and humans. Zinc oxide nanoparticles (ZnO-NPs) have gained appreciable attention in mitigating the adverse effects of abiotic stresses. The exogenous application of ZnO-NPs induces tolerance against HMs by improving plant physiological, metabolic, and molecular responses. They also interact with potential osmolytes and phyto-hormones to regulate the plant performance under HM stress. Moreover, ZnO-NPs also work synergistically with microbes and gene expression which helps to withstand HM toxicity. Additionally, ZnO-NPs also restrict the uptake and accumulation of HMs in plants which improves the plant performance. This review highlights the promising role of ZnO-NPs in mitigating the adverse impacts of HMs in plants. In this review, we explained the different mechanisms mediated by ZnO-NPs to counter the toxic effects of HMs. We also discussed the interactions of ZnO-NPs with osmolytes, phytohormones, and microbes in mitigating the toxic effects of HMs in plants. This review will help to learn more about the role of ZnO-NPs to mitigate HM toxicity in plants. Therefore, it will provide new insights to ensure sustainable and safer production with ZnO-NPs in HM-polluted soils.

Pharmacological and economical aspects of important species of Cordyceps sensu lato: A review.

Cordyceps is a well-known endo-parasitic fungus commonly used in traditional Chinese medicine for a long time. The demand for Cordyceps is increasing daily because it is commonly used as a nutritional food, medicine, and supplement owing to its natural source. It is very attractive in almost all countries with no side effects. Most Cordyceps species have been studied in China, Bhutan, India, Japan, South Korea, and Nepal. We have discussed the important contents of Cordyceps, dietary source and nutritional value of Cordyceps, multiple pharmacological properties of four important Cordyceps species, Ophiocordyceps sinensis, Cordyceps militaris, Cordyceps cicadae, and Cordyceps tenuipes, along with the economic status of Cordyceps and its benefits in terms of medicine, supplements, and the cosmetics industry. Owing to the high demand and several benefits of Cordyceps, it offers mysterious economic improvements in developed and underdeveloped countries. Therefore, more attention is required to save the endangered species of Cordyceps to fulfil the medicinal and nutritional demands worldwide.

A homozygous missense variant in YTHDC2 induces azoospermia in two siblings.

Male infertility is a complex multifactorial reproductive disorder with highly heterogeneous phenotypic presentations. Azoospermia is a medically non-manageable cause of male infertility affecting ∼1% of men. Precise etiology of azoospermia is not known in approximately three-fourth of the cases. To explore the genetic basis of azoospermia, we performed whole exome sequencing in two non-obstructive azoospermia affected siblings from a consanguineous Pakistani family. Bioinformatic filtering and segregation analysis of whole exome sequencing data resulted in the identification of a rare homozygous missense variant (c.962G>C, p. Arg321Thr) in YTHDC2, segregating with disease in the family. Structural analysis of the missense variant identified in our study and two previously reported functionally characterized missense changes (p. Glu332Gln and p. His327Arg) in mice showed that all these three variants may affect Mg2+ binding ability and helicase activity of YTHDC2. Collectively, our genetic analyses and experimental observations revealed that missense variant of YTHDC2 can induce azoospermia in humans. These findings indicate the important role of YTHDC2 deficiency for azoospermia and will provide important guidance for genetic counseling of male infertility.

An Unusual Case of Syphilis With Pulmonary Involvement.

Syphilis can affect multiple organs in the secondary or tertiary stages of the disease. Recent reports have suggested an increase in the incidence of the disease. Involvement of the lung has been rarely described in syphilis. In this report, we discuss the case of a 26-year-old female with past medical history significant for HIV who presented to the hospital with complaints of shortness of breath and underwent thoracentesis; she was found to have syphilis with pulmonary involvement.

SRPK3 Is Essential for Cognitive and Ocular Development in Humans and Zebrafish, Explaining X-Linked Intellectual Disability.

OBJECTIVE: Intellectual disability is often the outcome of neurodevelopmental disorders and is characterized by significant impairments in intellectual and adaptive functioning. X-linked intellectual disability (XLID) is a subset of these disorders caused by genetic defects on the X chromosome, affecting about 2 out of 1,000 males. In syndromic form, it leads to a broad range of cognitive, behavioral, ocular, and physical disabilities. METHODS: Employing exome or genome sequencing, here we identified 4 missense variants (c.475C > G; p.H159D, c.1373C > A; p.T458N, and c.1585G > A; p.E529K, c.953C > T; p.S318L) and a putative truncating variant (c.1413_1414del; p.Y471*) in the SRPK3 gene in 9 XLID patients from 5 unrelated families. To validate SRPK3 as a novel XLID gene, we established a knockout (KO) model of the SRPK3 orthologue in zebrafish. RESULTS: The 8 patients ascertained postnatally shared common clinical features including intellectual disability, agenesis of the corpus callosum, abnormal eye movement, and ataxia. A ninth case, ascertained prenatally, had a complex structural brain phenotype. Together, these data indicate a pathological role of SRPK3 in neurodevelopmental disorders. In post-fertilization day 5 larvae (free swimming stage), KO zebrafish exhibited severe deficits in eye movement and swim bladder inflation, mimicking uncontrolled ocular movement and physical clumsiness observed in human patients. In adult KO zebrafish, cerebellar agenesis and behavioral abnormalities were observed, recapitulating human phenotypes of cerebellar atrophy and intellectual disability. INTERPRETATION: Overall, these results suggest a crucial role of SRPK3 in the pathogenesis of syndromic X-linked intellectual disability and provide new insights into brain development, cognitive and ocular dysfunction in both humans and zebrafish. ANN NEUROL 2024;96:914-931.

Exploring the 3E, hydrogen, and ammonia creation potentials of a concentrated solar power (CSP) plant using an air-cooled condenser.

The need to move to more sustainable energy generation has become a major concern among world leaders due to the debilitating effect of greenhouse gases on the environment. Africa has the greatest potential to transition to more sustainable energy sources due to its enormous renewable energy resource potential, particularly solar. This study thus assessed the potential of generating power using a concentrated solar tower power plant (CSTP) at three different locations in Algeria. The study evaluated the system's technical, environmental, economic, and employment creation potential and analyzed the hydrogen and ammonia creation potential using the electricity produced by the CSTP system. Naama, Laghouat, and Ghardaia recorded annual energies of 507 GWh, 502 GWh, and 547 GWh, with capacity factors of 57.6%, 57.6%, and 62%, respectively. A real levelized cost of energy ranging between 7.72 and 8.47 cent$/kWh was obtained. A total of 8530 tons of nitrogen and 1844 tons of hydrogen will be theoretically needed to produce ammonia (fertilizer) for 500,000 hectares of arable land for agricultural activities. In addition, using hydrogen from the CSTP system to produce the estimated ammonia will save 6124.56 tons of CO2 emissions from polluting the environment annually. The creation of thousands of direct and indirect jobs will significantly benefit Algerians. The study concluded with some policy recommendations based on its findings.

Modeling different infectious phases of hepatitis B with generalized saturated incidence: An analysis and control.

Hepatitis B is one of the global health issues caused by the hepatitis B virus (HBV), producing 1.1 million deaths yearly. The acute and chronic phases of HBV are significant because worldwide, approximately 250 million people are infected by chronic hepatitis B. The chronic stage is a long-term, persistent infection that can cause liver damage and increase the risk of liver cancer. In the case of multiple phases of infection, a generalized saturated incidence rate model is more reasonable than a simply saturated incidence because it captures the complex dynamics of the different infection phases. In contrast, a simple saturated incidence rate model assumes a fixed shape for the incidence rate curve, which may not accurately reflect the dynamics of multiple infection phases. Considering HBV and its various phases, we constructed a model to present the dynamics and control strategies using the generalized saturated incidence. First, we proved that the model is well-posed. We then found the reproduction quantity and model equilibria to discuss the time dynamics of the model and investigate the conditions for stabilities. We also examined a control mechanism by introducing various controls to the model with the aim to increase the population of those recovered and minimize the infected people. We performed numerical experiments to check the biological significance and control implementation.

Application of Zinc Oxide Nanoparticles to Mitigate Cadmium Toxicity: Mechanisms and Future Prospects.

Cadmium (Cd), as the most prevalent heavy metal contaminant poses serious risks to plants, humans, and the environment. The ubiquity of this toxic metal is continuously increasing due to the rapid discharge of industrial and mining effluents and the excessive use of chemical fertilizers. Nanoparticles (NPs) have emerged as a novel strategy to alleviate Cd toxicity. Zinc oxide nanoparticles (ZnO-NPs) have become the most important NPs used to mitigate the toxicity of abiotic stresses and improve crop productivity. The plants quickly absorb Cd, which subsequently disrupts plant physiological and biochemical processes and increases the production of reactive oxygen species (ROS), which causes the oxidation of cellular structures and significant growth losses. Besides this, Cd toxicity also disrupts leaf osmotic pressure, nutrient uptake, membrane stability, chlorophyll synthesis, and enzyme activities, leading to a serious reduction in growth and biomass productivity. Though plants possess an excellent defense mechanism to counteract Cd toxicity, this is not enough to counter higher concentrations of Cd toxicity. Applying Zn-NPs has proven to have significant potential in mitigating the toxic effects of Cd. ZnO-NPs improve chlorophyll synthesis, photosynthetic efficiency, membrane stability, nutrient uptake, and gene expression, which can help to counter toxic effects of Cd stress. Additionally, ZnO-NPs also help to reduce Cd absorption and accumulation in plants, and the complex relationship between ZnO-NPs, osmolytes, hormones, and secondary metabolites plays an important role in Cd tolerance. Thus, this review concentrates on exploring the diverse mechanisms by which ZnO nanoparticles can alleviate Cd toxicity in plants. In the end, this review has identified various research gaps that need addressing to ensure the promising future of ZnO-NPs in mitigating Cd toxicity. The findings of this review contribute to gaining a deeper understanding of the role of ZnO-NPs in combating Cd toxicity to promote safer and sustainable crop production by remediating Cd-polluted soils. This also allows for the development of eco-friendly approaches to remediate Cd-polluted soils to improve soil fertility and environmental quality.

High Velocity Passive Stretching Mimics Eccentric Exercise in Cerebral Palsy and May Be Used to Increase Spastic Muscle Fascicle Length.

Muscle fascicles are shorter and stiffer than normal in spastic Cerebral Palsy (CP). Increasing fascicle length (FL) has been attempted in CP, the outcomes of which have been unsatisfactory. In healthy muscles, FL can be increased using eccentric exercise at high velocities (ECC). Three conditions are possibly met during such ECC: muscle micro-damage, positive fascicle strain, and momentary muscle deactivation during lengthening. Participants with and without CP underwent a single bout of passive stretching at (appropriately) high velocities using isokinetic dynamometry, during which we examined muscle and fascicle behaviour. Vastus lateralis (VL) FL change was measured using ultrasonography and showed positive fascicle strain. Measures of muscle creatine kinase were used to establish whether micro-damage occurred in response to stretching, but the results did not confirm damage in either group. Vastus medialis (VM) and biceps femoris muscle activity were measured using electromyography in those with CP. Results supported momentary spastic muscle deactivation during lengthening: all participants experienced at least one epoch (60 ms) of increased activation followed by activation inhibition/deactivation of the VM during knee flexion. We argue that high-velocity passive stretching in CP provides a movement context which mimics ECC and could be used to increase spastic FL with training.

Exome sequencing in four families with neurodevelopmental disorders: genotype-phenotype correlation and identification of novel disease-causing variants in VPS13B and RELN.

Neurodevelopmental disorders (NDDs) are a clinically and genetically heterogeneous group of early-onset pediatric disorders that affect the structure and/or function of the central or peripheral nervous system. Achieving a precise molecular diagnosis for NDDs may be challenging due to the diverse genetic underpinnings and clinical variability. In the current study, we investigated the underlying genetic cause(s) of NDDs in four unrelated Pakistani families. Using exome sequencing (ES) as a diagnostic approach, we identified disease-causing variants in established NDD-associated genes in all families, including one hitherto unreported variant in RELN and three recurrent variants in VPS13B, DEGS1, and SPG11. Overall, our study highlights the potential of ES as a tool for clinical diagnosis.

Review of the marine energy environment-a combination of traditional, bibliometric and PESTEL analysis.

Marine renewable energy is regarded as a nascent renewable energy resource that is less utilized due to a number of challenges in the sector. This paper focused on using both traditional and bibliometric analysis approaches to review the marine energy industry. It also assessed the various opportunities and challenges in the sector beyond technological challenges using PESTEL analysis. The results from the study identified the availability of renewable energy targets, international and national greenhouse gas (GHG) emissions reduction targets, job creation, skill transfer from offshore industries, renewable support, and low GHG emissions as the major opportunities for the sector. The challenges in the sector include the lack of commonality in device designs, high initial capital costs, lack of appropriate legal and regulatory frameworks, lack of funding, fragmentations in regulatory institutions, bad macro-economic indicators in some countries, environmental challenges, the survivability of the various technologies in the harsh oceanic environment, and strong competition from other renewable energy sources. The outcome of the bibliometric analysis spanning from 2013 to 2023 shows that tidal power is the focus of research in the field, and most studies are either focused on ways to improve its efficiency in terms of technology or on the identification of resource potentials for the siting of the various marine renewable power systems. Recommendations such as strong cooperation between the government and private sector, increased public education, collaboration with existing players in the marine sector, and increased research and development, among others, were proposed for the development of the sector.

Streptomyces enissocaesilis L-82 has broad-spectrum antibacterial activity and promotes growth for Carassius auratus.

Aeromonas is the main pathogen causing bacterial diseases in fish. The disadvantages of chemical drugs to control fish diseases have been highlighted, and it is urgent to find an eco-friendly control method. In this study, an actinomycete strain with antibacterial activity against fish pathogenic bacteria was screened from soil samples. Combined with morphological characteristics, physiological and biochemical characteristics, and gyrB gene and whole genome comparison analysis, it was identified as a new strain of Streptomyces enissocaesilis, named Streptomyces enissocaesilis L-82. The strain has broad-spectrum antibacterial activity against fish pathogens. A substance with a mass-to-charge ratio of 227.20 [M + H] + was isolated and purified by high-performance liquid chromatography and mass spectrometry. It was presumed to be a derivative of 5-dimethylallylindole-3-acetonitrile. The strain is safe and non-toxic to crucian carp, and can stably colonize crucian carp and inhibit the proliferation of A. hydrophila. After feeding the feed containing 1 × 108 CFU/mL strain concentration, the weight growth rate and specific growth rate of crucian carp increased, the activity of ACP and SOD in serum increased, and the survival rate of crucian carp increased after challenge. Genome-wide analysis showed that the strain had strong ability to metabolize and tolerate extreme environments. And has a strong potential for disease resistance. Therefore, the strain is expected to be developed as a feed additive for fish farming. KEY POINTS: • The new Streptomyces enissocaesilis L-82 has a broad spectrum and stable antibacterial activity and meets the safety standards of feed additives. • Strain L-82 can colonize crucian carp, improve the growth, antioxidant, and immune performance of the host, and improve the survival rate after being infected with A. hydrophila. • Genome-wide analysis suggests that the strain has great disease resistance potential and is expected to be developed as a feed additive for fish culture.

Healthcare professionals' understanding and perception of drug-related issues linked to off-label pharmacological medications used for COVID-19.

BACKGROUND: To evaluate the opinions of healthcare workers regarding drug therapy problems linked to anti-infective medicines used for the treatment of COVID-19 infection in Pakistan. RESEARCH METHODOLOGY: This cross-sectional study was conducted from January to October 2022 using a self-administered questionnaire developed by the authors, having three sections: demographics, knowledge, and perception. The study was validated by research experts and pilot-tested on 30 subjects. The study included medical doctors, nurses, pharmacists from Punjab's government and private medical institutes. RESULTS: In this study, 382 of 400 participants replied. The mean knowledge score was 9.52 (SD 2.97), showing that participants had adequate knowledge of COVID-19 pharmacological interventions. The knowledge scores were significantly higher of those who treated COVID-19 patients and were from Lahore. Many doctors considered that elderly patients and those with blood disorders were at greater risk of experiencing drug-related problems. Most pharmacists support electronic prescription systems. Many doctors thought the lack of unified treatment guidelines, multiple prescribers, and self-medication were key obstacles in managing COVID-19 patients. CONCLUSION: Most respondents had adequate knowledge. Older patients with comorbidities are at risk of adverse effects. Self-medication, polypharmacy, and multiple prescriptions can lead to misdiagnosis and complications. Electric prescriptions, team effort, and training programs can decrease these issues.

Prior Use of Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers and Clinical Outcomes of Sepsis and Septic Shock: A Systematic Review and Meta-analysis.

ABSTRACT: Sepsis and septic shock are life-threatening conditions that are associated with high mortality and considerable health care costs. The association between prior angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs) use and outcomes after sepsis is elusive. The aim of this study was to evaluate the role of the prior use of ACEi or ARBs and outcomes after sepsis and septic shock. A relevant literature review was performed in 4 databases from inception until July 2022. Independent reviewers first screened the title, abstract, and full text, and then, data extraction and analysis were performed. One post hoc analysis of a trial and 6 retrospective cohort studies were included in this review. There were 22% lower odds of in-hospital/30-day mortality among patients who have used ACEi/ARBs in the past [23.83% vs. 37.20%; odds ratio (OR), 0.78, 95% confidence interval (CI), 0.64-0.96], and reduced 90-day mortality (OR, 0.80, 95% CI, 0.69-0.92). ACEi/ARBs users were found to have 31% lesser odds of developing acute kidney injury as compared with nonusers (OR, 0.69, 95% CI, 0.63-0.76). There was no significant difference in the length of hospital stay (MD 1.26, 95% CI, ‒7.89 to 10.42), need for renal replacement therapy (OR, 0.71, 95% CI, 0.13-3.92), mechanical ventilation (OR, 1.10, 95% CI, 0.88-1.37) or use of vasopressors (OR, 1.21, 95% CI, 0.91-1.61). Based on this analysis, prior use of ACEi/ARBs lowers the risk of mortality and adverse renal events in patients with sepsis and septic shock.

An epidemiological model for analysing pandemic trends of novel coronavirus transmission with optimal control.

Symptomatic and asymptomatic individuals play a significant role in the transmission dynamics of novel Coronaviruses. By considering the dynamical behaviour of symptomatic and asymptomatic individuals, this study examines the temporal dynamics and optimal control of Coronavirus disease propagation using an epidemiological model. Biologically and mathematically, the well-posed epidemic problem is examined, as well as the threshold quantity with parameter sensitivity. Model parameters are quantified and their relative impact on the disease is evaluated. Additionally, the steady states are investigated to determine the model's stability and bifurcation. Using the dynamics and parameters sensitivity, we then introduce optimal control strategies for the elimination of the disease. Using real disease data, numerical simulations and model validation are performed to support theoretical findings and show the effects of control strategies.

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

INTRODUCTION: Fluoroquinolones (FQs) is a distinct class of antibiotics which are prescribed and used quite frequently worldwide, despite the box warnings (BW) issued by Food and Drug Administration (FDA). Literature has shown in spite of BWs related to FQs there is minimal impact on health care professionals (HCPs) prescribing habits, potentially attributing towards limited and insufficient awareness. In Pakistan, FQs are mostly prescribed antibiotics for microbial treatments, therefore the purpose of this study was to determine the level of knowledge about the safety profile, use, and BW of FQs among HCPs working in Pakistan. METHODS: A cross-sectional study was undertaken among the HCPs of Khyber Pakhtunkhwa province of Pakistan from October 2022 to December 2022. A validated questionnaire was used to assess the knowledge of HCPs regarding FQs, its safety profile and BW. A random convenient sample technique was used while recruiting HCPs in this study. As the HCPs comprised physicians, dentists, pharmacist and nurses, all were approached in person and the study objective was fully elaborated and explained to them. The statistic test like: one-way ANOVA, independent-t test, multivariate logistic regression were used keeping the p-value < 0.05 as statistically significant. RESULTS: A total of n = 250 HCPs were approached, of which n = 186 HCPs completed the questionnaire with a response rate of 74.4%. FQs prescribing pattern was only assessed among the prescribers, i.e., physicians and dentists (39/186). The mean knowledge score for indications was 5.29 ± 3.05, while for the adverse effects was 7.70 ± 2.61. The highest score for knowledge for indications and adverse effect score was achieved by physicians followed by dentist. The mean knowledge score for the BW was 3.46 ± 2.93 and among the HCPs for the BW of FQs, 20.4% of the HCPs had appropriate knowledge score (score ≥ 50%). The knowledge score was significantly higher in males (p = 0.039), dentists (p = 0.001), HCPs having master/specialization level of education (p = 0.003), HCPs working in government sector hospitals (p = 0.010) and secondary care hospitals (p = 0.001) while the multivariate logistic regression analysis showed that HCPs working in primary care hospital (OR: 6.2) and secondary care hospital (OR: 20.3) were associated with the tendency to achieve 50% or above knowledge score. CONCLUSION:  Findings of this study reveals the unsatisfactory knowledge of HCPs regarding the safety profile, use, and BW of FQs putting patients at heightened risks of FQs associated AEs. Therefore, it is crucial to implement a national antimicrobial stewardship program, seminars and lectures aimed at continuously updating the knowledge of HCPs, regardless of their specialties, and effectively restrict the misuse of antimicrobial and disseminate FDA BWs in clinical practice.