Assessment of Cognitive Flexibility in Jordanian Diabetic Patients by Wisconsin Card Sorting and Trail Making Tests: Implications with Demographic, Anthropometric and Therapeutic Variables.

Purpose: Cognitive flexibility is a mental ability that aids in smoothly alternating between them tasks in the brain. Diabetes Mellitus (DM) is a, common disorder that has been associated with impairments in cognitive functions. This research is a retrospective case-control study aimed at establishing a clear relationship between cognitive flexibility and diabetes among Jordanians, considering demographic, anthropometric, and therapeutic variables. Patients and Methods: The Wisconsin Card Sorting Test (WCST)-64 item and the Trail Making Test (TMT) assessed cognitive flexibility in 268 people with diabetes and healthy control. Demographic, therapeutic data were collected. We also measured waist-to-hip ratio (WHR) and body mass index (BMI). As the variables were non-normally distributed, non-parametric statistical tests were used to examine differences (Kruskal-Wallis) and correlation (Spearman) between variables. Results: The patient group did worse on the WCST In contrast to the control group, patients exhibited more significant delays for both Part A and Part B of the TMT (p<0.05). Males had higher WCST conceptual level responses than females. In addition, participants with professional jobs showed less delay in TMT Part A (p<0.05). Age was positively correlated with WCST's total errors and TMT's Parts A and B (p<0.05). BMI was negatively correlated with the WCST's conceptual level of responses and positively correlated with TMT's Part B (p<0.05). In addition, urea and albumin levels were positively correlated with TMT's Part A (p<0.05). Furthermore, creatinine was positively correlated with WCST's total errors and TMT's Part A (p<0.05). Conclusion: Some measures of cognitive flexibility are associated with DM status in the studied sample of Jordanians and other variables (educational levels, occupation, lifestyle, average duration of illness, and age).

Phytochemicals, Antioxidant, and Antidiabetic Effects of Ranunculus hirtellus Aerial Parts and Roots: Methanol and Aqueous Extracts.

Ranunculus hirtellus, also known as crowfoot (buttercup), has a rich tradition of use in various biological contexts. While antibacterial studies on extracts from this plant have been conducted, the phytochemical composition, antioxidant properties, and antidiabetic effects remain unexplored. In this study, the phytochemical, antioxidant, and antidiabetic effects of its methanol and aqueous extracts were investigated. Our approach involved gas chromatography-mass spectrometry (GC/MS), alongside quantitative and qualitative methods, for phytochemical profiles. Additionally, concerning biological activities, the antioxidant effect was assessed through 2, 2-diphenyl-pieryl hydrazyl (DPPH) and 2, 2'-azino-bis (3-ethylbenzothiazoline-6-sulfonate) (ABTS) assays, while the antidiabetic effect was examined through the α-amylase inhibitory assay. The chloroform, ethyl acetate, and n-hexane extracts of R. hirtellus revealed the presence of 14 distinct compounds. In the methanol extract, sterols, quinones, glycosides, lactones, lignin, and flavonoids were identified. The aqueous extract contained sterols, alkaloids, glycosides, triterpenes, terpenoids, quinones, leucoanthocyanins, and lactones. The total flavonoid content (TFC), total phenolic content (TPC), total tannin content (TTC), and reducing sugar content (RDC) were determined in plant extracts, and a linear relationship was found between these parameters. Additionally, the TTC, TPC, and TFC values for both extracts hovered around 0.3786, 0.0476, and 0.1864 µg/mL, respectively, across all plant concentrations, while RDC ranged from 0.9336 to 1.0119 µg/mL in all four extracts. In vitro assays demonstrated dose-dependent antidiabetic activity in both methanolic and aqueous extracts by inhibiting α-amylase. Furthermore, the antioxidant activity observed in the DPPH assay was greater in the aqueous extract compared with the methanolic extract. In addition, the ethyl acetate extract exhibited the highest inhibition among chloroform and n-hexane in the ABTS assay. The results suggest that R. hirtellus can be a potential source of natural antioxidants and antidiabetic agents, and further studies are warranted to investigate the underlying mechanisms of its therapeutic effects.

Delayed symptomatic TFV in neonatal posthemorrhagic hydrocephalus-pathophysiology and therapeutic strategy: A case report and review of the literature.

INTRODUCTION: Trapped fourth ventricle (TFV), which is a rare neurosurgical condition with multifactorial etiology, requires a prompt diagnosis and appropriate therapeutic method selection. We report a case of post-hemorrhagic hydrocephalus and TFV incited/worsened by prematurity, sepsis, acute respiratory distress syndrome (ARDS), mechanical ventilation, and concomitant fourth ventricle outlets stenosis; which displayed a delayed onset. This article addresses the proposed pathophysiology and the clinical importance of appropriate therapeutic strategies with a mini-review of the literature. CASE PRESENTATION: We encountered a case involving a premature Asian male newborn with sepsis and posthemorrhagic hydrocephalus who required ventriculoperitoneal shunt surgery. However, after three years, the baby was diagnosed with a trapped fourth ventricle and subsequently underwent retrograde endoscopic surgery with stent insertion. DISCUSSION: TFV is traditionally known as a complication of lateral ventricle shunting. However, in rare cases such as our neonate patient, it develops as a consequence of multiple pathophysiological processes including ventricular system inflammation along with associated anatomic and physiologic alterations, which necessitates prompt diagnosis and a case-specific therapeutic strategy. CONCLUSION: Understanding the multifactorial pathophysiological mechanisms leading to the development of TFV is crucial. The presence of comorbidities such as prematurity, neonatal sepsis, and ARDS increased the risk of intraventricular hemorrhage and subsequent inflammation and further exacerbated obstructions in cerebrospinal fluid pathways. When posthemorrhagic TFV is accompanied by collapsed lateral ventricles, the optimal treatment approach is retrograde endoscopic fenestration with stent insertion. This treatment option has proven effective in alleviating the condition and restoring proper cerebrospinal fluid flow.

Investigation of hybrid ultrasonic machining process of Nomex honeycomb composite using a toothed disc cutter.

Nomex honeycomb composite (NHC) has been increasingly used in the automotive, aerospace and defence applications due to its excellent thermal and mechanical properties. Its complex cellular hexagonal thin-walled configuration along with heterogeneous, soft and brittle nature pose substantial processing defects such as burr formation, tearing of walls, surface roughness, dimensional inaccuracy and low machining quality during conventional machining (CM). These surface defects have a substantial influence on the operating life and functional performance of its sandwiched structural members. Hybrid ultrasonic vibration assisted machining (HUSVAM) technology has been introduced to overcome such limitations. For an in depth research on HUSVAM of NHC using ultrasonic toothed disc cutter (UTDC), three dimensional finite element model was developed and experimental validation was carried out. The numerical simulation and experimental results were found to be in good agreement with one another. The influence of various machining parameters including the ultrasonic tool vibration amplitude (UTVA), feed rate (FR), depth of cut (DoC) and spindle angular speed (SAS) on NHC cutting forces, chip formation and surface quality was investigated using both HUSVAM and CM techniques. Furthermore, stresses, deformation and forces near tool-workpiece interaction along with the surface topography and morphologies were also analysed and compared for various operating conditions. A reduction in the cutting forces was found with the increase of SAS and UTVA (up to 65.47 % and 65.74 %, respectively). Although, the cutting forces were observed to increase by increasing the DoC and FR (up to 159.45 % and 126.33 %, respectively). DoC has a greater impact on the cutting forces among all machining parameters according to 4 levels, 4 factors (L16) orthogonal experiments based on Taguchi method. The results show that the chip formation and machining quality of NHC core can be improved with HUSVAM technique using UTDC. HUSVAM also reduced the cutting forces (up to 73 %) compared to CM. The ultrasonic toothed disc cutter generated large number of burr with very short length, no tearing defects and no uncut fibers as observed from scanning electron microscopy of NHC hexagonal cell structure, walls and triple points. A burr formation of less than 10 % was realized during HUSVAM of NHC cores for Fx≤3N, while it was found up to 20 % if Fx>3N, compared to at least 40 % during CM. The finite element model developed can be used to investigate the influence of HUSVAM on modern difficult to machine materials for enhanced surface quality.

Ethnomedicinal Plants and Herbal Preparations Used by Rural Communities in Tehsil Hajira (Poonch District of Azad Kashmir, Pakistan).

The present study emphasizes the importance of documenting ethnomedicinal plants and herbal practices of the local rural communities of Tehsil Hajira (Pakistan). The aim was to document, explore and quantify the traditional ethnomedicinal knowledge. Ethnobotanical data were collected using semi-structured questionnaires and analyzed using various quantitative indices. The results showed that 144 medicinal plant species from 70 families and 128 genera play an important role in herbal preparations. The most common type of preparation was powder (19.0%), followed by paste (16.7%), aqueous extract (15.7%), decoction (14.7%) and juice (11.0%). Fragaria nubicola (0.94) and Viola canescens (0.93) had the highest relative frequency of mention (RFC), while Berberis lycium (1.22) and Fragaria nubicola (1.18) had the highest use value (UV). Geranium wallichianum (85.5), Ligustrum lucidum (83) and Indigofera heterantha (71.5) were the most important species in the study area with the highest relative importance (RI) value. The diseases treated were categorized into 17 classes, with diseases of the digestive system and liver having the highest Informant Consensus Factor (ICF) value, followed by diseases of the oropharynx and musculoskeletal system. Important plants mentioned for the treatment of various diseases of the gastrointestinal tract are Zanthoxylum alatum, Berberis lycium, Mentha longifolia, Punica granatum, Rubus ellipticus and Viola canescens. New applications of rarely documented plants from this area are: Oxalis corniculata paste of the whole plant to treat vitiligo, Carthamus tinctorius flowers to treat chicken pox, Dioscorea deltoidea tuber powder to treat productive cough, Inula cappa root decoction to treat miscarriage, Habenaria digitata tuber juice for the treatment of fever, Viola canescens leaves and flowers for the treatment of sore throat and Achillea millefolium root and leaf juice for the treatment of pneumonia. These plants may contain interesting biochemical compounds and should be subjected to further pharmacological studies to develop new drugs. Traditional medicinal knowledge in the area under study is mainly limited to the elderly, traditional healers and midwives. Therefore, resource conservation strategies and future pharmacological studies are strongly recommended.

A huge benign gastric schwannomas presented with upper and lower gastrointestinal bleeding: a case report and literature review.

Gastric schwannomas (GS) are rare mesenchymal tumors from Schwann cells in the gastrointestinal (GI) tract, representing 2-6% of such tumors. We report a 52-year-old woman who experienced abdominal pain, hematemesis, and melena, initially suspected of having a GI stromal tumor through ultrasound and computed tomography abdomen. Despite no active bleeding found during an upper endoscopy, she underwent a successful open subtotal gastrectomy, with histopathology confirming GS. The diagnosis of GS, which may mimic other GI conditions, relies heavily on imaging and histopathological analysis due to its nonspecific symptomatology, including the potential for both upper and lower GI bleeding. This case underscores the diagnostic challenges of GS and highlights surgical resection as the preferred treatment, generally leading to a favorable prognosis.

Comprehensive Therapeutic Approaches to Tuberculous Meningitis: Pharmacokinetics, Combined Dosing, and Advanced Intrathecal Therapies.

Tuberculous meningitis (TBM) presents a critical neurologic emergency characterized by high mortality and morbidity rates, necessitating immediate therapeutic intervention, often ahead of definitive microbiological and molecular diagnoses. The primary hurdle in effective TBM treatment is the blood-brain barrier (BBB), which significantly restricts the delivery of anti-tuberculous medications to the central nervous system (CNS), leading to subtherapeutic drug levels and poor treatment outcomes. The standard regimen for initial TBM treatment frequently falls short, followed by adverse side effects, vasculitis, and hydrocephalus, driving the condition toward a refractory state. To overcome this obstacle, intrathecal (IT) sustained release of anti-TB medication emerges as a promising approach. This method enables a steady, uninterrupted, and prolonged release of medication directly into the cerebrospinal fluid (CSF), thus preventing systemic side effects by limiting drug exposure to the rest of the body. Our review diligently investigates the existing literature and treatment methodologies, aiming to highlight their shortcomings. As part of our enhanced strategy for sustained IT anti-TB delivery, we particularly seek to explore the utilization of nanoparticle-infused hydrogels containing isoniazid (INH) and rifampicin (RIF), alongside osmotic pump usage, as innovative treatments for TBM. This comprehensive review delineates an optimized framework for the management of TBM, including an integrated approach that combines pharmacokinetic insights, concomitant drug administration strategies, and the latest advancements in IT and intraventricular (IVT) therapy for CNS infections. By proposing a multifaceted treatment strategy, this analysis aims to enhance the clinical outcomes for TBM patients, highlighting the critical role of targeted drug delivery in overcoming the formidable challenges presented by the blood-brain barrier and the complex pathophysiology of TBM.

Pharmacokinetic Interpretation of Applying Local Drug Delivery System for the Treatment of Deep Surgical Site Infection in the Spine.

Surgical site infections (SSIs) after spinal surgery present significant challenges, including poor antibiotic penetration and biofilm formation on implants, leading to frequent treatment failures. Polymethylmethacrylate (PMMA) is widely used for localized drug delivery in bone infections, yet quantifying individual drug release kinetics is often impractical. This retrospective study analyzed 23 cases of deep SSIs (DSSIs) following spinal surgery treated with antibiotic-loaded PMMA. A mathematical model estimated personalized drug release kinetics from PMMA, considering disease types, pathogens, and various antibiotics. The study found that vancomycin (VAN), ceftriaxone (CRO), and ceftazidime (CAZ) reached peak concentrations of 15.43%, 15.42%, and 15.41%, respectively, within the first two days, which was followed by a lag phase (4.91-4.92%) on days 2-3. On days 5-7, concentrations stabilized, with CRO at 3.22% and CAZ/VAN between 3.63% and 3.65%, averaging 75.4 µg/cm2. Key factors influencing release kinetics include solubility, diffusivity, porosity, tortuosity, and bead diameter. Notably, a patient with a low glomerular filtration rate (ASA IV) was successfully treated with a shortened 9-day intravenous VAN regimen, avoiding systemic complications. This study affirms the effectiveness of local drug delivery systems (DDS) in treating DSSIs and underscores the value of mathematical modeling in determining drug release kinetics. Further research is essential to optimize release rates and durations and to mitigate risks of burst release and tissue toxicity.

Analysis of the relationship among land surface temperature (LST), land use land cover (LULC), and normalized difference vegetation index (NDVI) with topographic elements in the lower Himalayan region.

Land Surface Temperature (LST) affects exchange of energy between earth surface and atmosphere which is important for studying environmental changes. However, research on the relationship between LST, Land Use Land Cover (LULC), and Normalized Difference Vegetation Index (NDVI) with topographic elements in the lower Himalayan region has not been done. Therefore, the present study explored the relationship between LST and NDVI, and LULC types with topographic elements in the lower Himalayan region of Pakistan. The study area was divided into North-South, West-East, North-West to South-East and North-East to South-East directions using ArcMap 3D analysis. The current study used Landsat 8 (OLI/TIRS) data from May 2021 for LULC and LST analysis in the study area. The LST data was obtained from the thermal band of Landsat 8 (TIRS), while the LULC of the study areas was classified using the Maximum Likelihood Classification (MLC) method utilizing Landsat 8 (OLI) data. TIRS collects data for two narrow spectral bands (B10 and B11) with spectral wavelength of 10.6 µm-12.51 µm in the thermal region formerly covered by one wide spectral band (B6) on Landsat 4-7. With 12-bit data products, TIRS data is available in radiometric, geometric, and terrain-corrected file format. The effect of elevation on LST was assessed using LST and elevation data obtained from the USGS website. The LST across LULC types with sunny and shady slopes was analyzed to assess the influence of slope directions. The relationship of LST with elevation and NDVI was examined using correlation analysis. The results indicated that LST decreased from North-South and South-East, while increasing from North-East and South-West directions. The correlation coefficient between LST and elevation was negative, with an R-value of -0.51. The NDVI findings with elevation showed that NDVI increases with an increase in elevation. Zonal analysis of LST for different LULC types showed that built-up and bare soil had the highest mean LST, which was 35.76 °C and 28.08 °C, respectively, followed by agriculture, vegetation, and water bodies. The mean LST difference between sunny and shady slopes was 1.02 °C. The correlation between NDVI and LST was negative for all LULC types except the water body. This study findings can be used to ensure sustainable urban development and minimize urban heat island effects by providing effective guidelines for urban planners, policymakers, and respective authorities in the Lower Himalayan region. The current thermal remote sensing findings can be used to model energy fluxes and surface processes in the study area.

Edible wild plant species used by different linguistic groups of Kohistan Upper Khyber Pakhtunkhwa (KP), Pakistan.

BACKGROUND: The mountainous territory of Kohistan shelters diverse food plant species and is considered one of the important hotspots of local plant knowledge. In the era of globalization and food commodification, wild food plants (WFPs) play an important role in supporting local food systems and related local knowledge is one of the important pillars of food sustainability across the region. Since the area is populated by different cultural groups and each culture has retained particular knowledge on the local plant species, therefore, to make a cross-culturally comparison, the study was planned to record and compare the local plants knowledge among three linguistic groups viz Gujjar, Kohistani and Shina in order to not only protect the local knowledge but to determine the food cultural adaptations among these groups looking through the lens of their food ethnobotanies. METHODS: Field ethnobotanical survey was carried out in 2020-2021 to gather the data on wild food plants. We used semi-structured interviews. Use reports were counted, and the results were visualized through Venn diagrams. RESULTS: In total, 64 plant species belonging to 45 botanical families were documented. Among these Ajuga integrifolia, Barbarea verna, Clematis grata, Impatiens edgeworthii, Ranunculus laetus (vegetables), Parrotiopsis jacquemontiana (fruit), Indigofera tinctoria (flower), Juniperus excelsa, Primula elliptica, P. macrophylla (flavoring agent), Leontopodium himalayanum (Chewing gum), and Juniperus excelsa (snuff) were reported for the first time. The highest use reports (≥ 90) were recorded for Mentha longifolia, Amaranthus hybridus, Quercus semecarpifolia, Solanum miniatum, Oxalis corniculata, Ficus palmata, and Urtica dioica. Maximum number of wild food plant species (WFPs) were reported by Kohistani, followed by Shinaki and Gujjari linguistic groups. The percentage overlap of traditional knowledge on WFPs was highest among Kohistani and Shinaki (56.0%), followed by Shinaki and Gujjars (17.0%), and Kohistani and Gujjars (15.0%). Kohistani and Shinaki groups exhibited maximum homogeneity in traditional knowledge. However, Gujjars had more knowledge on WFPs compared to Kohistani and Shinaki. In addition, some dairy products viz. Bhorus, Bagora, Bak, Cholam, Kacha, Gurloo and Poyeen were reported also reported that are consumed orally and used in traditional cuisines. CONCLUSIONS: The study indicates that Kohistan is one of the important spots of biocultural diversity and could be recognized as biocultural refugia. WFPs have been an integral part of the traditional food systems among the studied groups, particularly the Gujjars have reported more distinct plant uses which could be referred to their distinctive ecological experiences among others. However, social change is one of the challenges that might lead to the erosion of local plant knowledge. Moreover, intercultural negotiations among the studied groups are also a matter of concern which could homogenize the local knowledge among them. Therefore, we suggest solid policy measures to protect the local knowledge and celebrate diversity across this mountain territory.

A Rare Occurrence of Primarily Extranodal Spinal Epidural Lymphoma With Spinal Cord Compression and Invasion to the Thoracic Cavity.

A 41-year-old man suffered from progressive radiculomyelopathy caused by spinal epidural mass primarily encasing the spinal cord at the cervicothoracic vertebrae that extended into the thoracic cavity through the neural foramen. An urgent decompressive laminectomy and epidural tumor resection were performed to prevent neurological deterioration and effective spinal cord decompression. The histopathologic diagnosis was diffuse large B-cell lymphoma. As first-line treatment for stage II extranodal lymphoma, he received 6 cycles of R-CHOP (rituximab/cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisone) chemotherapy. Consequently, follow-up positron-emission tomography CT and MR images demonstrated a complete metabolic response (Deauville score 1). This rare occurrence of primarily extranodal spinal epidural lymphoma with limited disease will be presented in a literature review.

Analysis Of Caesarean Sections Rates Using Robson's Ten Group Classification System, Unit B Mchc, Ath Abbottabad.

BACKGROUND: There is growing international concern about the increased rate of caesarean sections (CS), Caesarean procedures performed in the absence of a clinical justification do not reduce maternal or infant death rates if carried out at a rate higher than 10%-15% Achieving reductions in maternal and infant morbidity and mortality are, among others, the objectives promoted by the World Health Organization (WHO) for 2030. The analysis of unjustified C/S rate is done by Using Robson's Ten Group Classification system. METHODS: Cross-sectional study by using Robson's Ten Group classification, in Unit B MCHC, ATH Abbottabad during 6 months, from 1st August 2021-31st January 2022. RESULTS: Total Patients Delivered during this duration of study were 777, among which 352 were delivered by C/S were 352. Analysis by Robson ten-group classification system showed C/S Rate as: Group 1:16.81%, Group 2: 78.95%, group 3:1.56%, group 4:77.14%, group 5:89.22%, group 6: 83.33, Group 7:67.86, Group 8:40, group 9:100%, Group 10:46.97. The total Caesarean section rate was 45.3%. CONCLUSIONS: By RTGCS analysis, C/S rates Group 5, 4 and 2 are major contributions in overall C/S rates in studied clinical setup. Group 1 and 10 are also contributing. Overall C/S rates can be decreased by working on them.

Early Liver Transplant In Patients With Liver Cirrhosis Recovered From COVID-19 Infection.

OBJECTIVES: Coronavirus disease 2019 has resulted in significant morbidities and mortalities in nearly all parts ofthe world. There remain major concerns about management, timing, and safety of liver transplant in patients who have recovered from COVID-19. We aimed to study the clinical course and outcomes of patients with liver cirrhosis who recovered from COVID-19 and underwent liver transplant from deceased donors. MATERIALS AND METHODS: A retrospective study was conducted on liver transplant recipients who underwent liver transplant from April 1, 2020, to January 30, 2021. We evaluated all recipients of liver transplantfrom deceased donors during this period in the COVID-19 pandemic. RESULTS: There were 14 patients with decompensated liver cirrhosis who had recovered from COVID-19 as documented by reverse transcription-polymerase chain reaction test for SARS-CoV-2. Mean duration from COVID-19 to transplant surgery was 56.14 ± 29.96 days. Mortality occurred in 3 patients, and of whom 2 had been hospitalized and received medications for COVID-19 before transplant. Five patients had positive reverse transcription-polymerase chain reaction results for SARS-CoV-2 after liver transplant. CONCLUSIONS: This is a large reported series of patients with liver cirrhosis who have received liver transplant after recovery from COVID-19. We provided evidence that liver transplant from deceased donors should be considered in patients recovered from COVID-19, especially in those with deterioration of clinical status.

Prevalence and Antibiotic Susceptibility of the Common Bacterial Uropathogen Among UTI Patients in French Medical Institute for Children.

Background: Urinary tract infections (UTIs) are the most prevalent infections, with a variety of etiologic agents, a high number of occurrences, relapses, and complications; also, antibiotic resistance of the pathogenic bacterium is a hugely significant challenge for physicians. Objective: The goal of this research was to identify the common bacterial uropathogens as well as their susceptibility to commonly used antibiotics. Materials and Methods: During the first six months of 2018, a descriptive cross-sectional study was conducted on urine samples of 1780 patients at FMIC based on culture. Bacterial typing was performed using cystine lactose electrolyte deficient agar and blood agar, and Kirby-Bauer disc diffusion was employed to assess the sensitivity of the bacteria to various antibiotics. Results: Among 1780 patients in 341 (19.15%) samples, uropathogens were isolated. E. coli (63.9%), Enterococcus (11.1%), Serratia species (10.8%), Staphylococcus species (8.2%), Klebsiella (2.9%), Proteus species (1.8%), and Pseudomonas aeruginosa (1.2%) were the most common bacterial uropathogens. More than two-thirds of patients were female (69.6%), with the remaining 30.4% male. Ampicillin, amoxicillin, and erythromycin were the antibiotics with the highest resistance rates in bacterial uropathogens, at 92.6%, 82.9%, and 82.1%, respectively. Furthermore, ceftriaxone, ceftazidime, cefixime, and sulfamethoxazole were antibiotics with resistance rates exceeding 70%. The antibiotics pristinamycin and ticarcillin were the most sensitive, with a TRR of zero. Ertapenem, imipenem, amikacin, tazobactam, fosfomycin, vancomycin, and nitrofurantoin were the antibiotics with the lowest resistance rates (less than 10%). Conclusion: E. coli was the most common bacterial uropathogen isolated in this study, followed by Enterococcus species. Our findings suggest that physicians, particularly in FMIC, consider E. coli, Enterococcus, Serratia and Staphylococcus as the most common bacteria, and use pristinamycin, ticarcillin, ertapenem, imipenem, amikacin, tazobactam, fosfomycin, vancomycin, and nitrofurantoin as sensitive antibiotics in empirical UTI treatment.

Broadband Circular Polarised Printed Antennas for Indoor Wireless Communication Systems: A Comprehensive Review.

With the rapid changes in wireless communication systems, indoor wireless communication (IWC) technology has undergone tremendous development. Antennas are crucial components of IWC systems that transmit and receive signals within indoor environments. Thus, the development of indoor technology is highly dependent on the development of indoor antennas. However, indoor environments with limited space require the fewest indoor antenna units and the smallest indoor antenna sizes possible. Hence, indoor antennas with compact size and broad applications have become widely preferred. In an IWC system, circularly polarised (CP) antennas are generally important, especially in dense indoor environments, because compared with linearly polarised (LP) antennas, CP antennas reduce polarisation mismatch and multipath losses. This paper combs through the existing studies related to three-dimensional (3D) geometry (nonplanar) or waveguide indoor antennas and the two common approaches to two-dimensional (2D) geometry (planar) indoor antennas, namely, broadband CP printed monopole antennas (BCPPMAs) and broadband CP printed slot antennas (BCPPSAs). The advantages, disadvantages and limitations of previous works are highlighted as well. These research works are summarised, compared and analysed to understand the recent specifications of BCPPMAs and BCPPSAs to generate the most appropriate design structure suitable for current IWC systems.

Modelling of Land Use/Cover and LST Variations by Using GIS and Remote Sensing: A Case Study of the Northern Pakhtunkhwa Mountainous Region, Pakistan.

Alteration in Land Use/Cover (LULC) considered a major challenge over the recent decades, as it plays an important role in diminishing biodiversity, altering the macro and microclimate. Therefore, the current study was designed to examine the past 30 years (1987−2017) changes in LULC and Land Surface Temperature (LST) and also simulated for next 30 years (2047). The LULC maps were developed based on maximum probability classification while the LST was retrieved from Landsat thermal bands and Radiative Transfer Equation (RTE) method for the respective years. Different approaches were used, such as Weighted Evidence (WE), Cellular Automata (CA) and regression prediction model for the year 2047. Resultantly, the LULC classification showed increasing trend in built-up and bare soil classes (13 km2 and 89 km2), and the decreasing trend in vegetation class (−144 km2) in the study area. In the next 30 years, the built-up and bare soil classes would further rise with same speed (25 km2 and 36.53 km2), and the vegetation class would further decline (−147 km2) until 2047. Similarly for LST, the temperature range for higher classes (27 -< 30 °C) increased by about 140 km2 during 1987−2017, which would further enlarge (409 km2) until 2047. The lower LST range (15 °C to <21 °C) showed a decreasing trend (−54.94 km2) and would further decline to (−20 km2) until 2047 if it remained at the same speed. Prospective findings will be helpful for land use planners, climatologists and other scientists in reducing the increasing LST associated with LULC changes.

Asthma Outcome Measures Before and After the COVID-19 Outbreak Among the Pediatric Population in a Community Hospital.

Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a global health threat that has affected patient care enormously. Moderate to severe asthma was listed as a risk factor for severe SARS-CoV-2 disease by the Centers for Disease Control. Little is known about the impact of the pandemic on asthma control in children, particularly African American children. Objective The present study sought to determine how changes during the coronavirus disease 2019 (COVID-19) pandemic affected asthma metrics in a majority African American pediatric population at a pediatric pulmonology clinic in a community hospital in New York. Methods This is a retrospective, pre-post, comparative cross-sectional study that included children three to 18 years of age with a known diagnosis of asthma followed in a pulmonary clinic. Data were gathered from electronic medical records. Subjects were selected if they presented to a pulmonology clinic within a certain time window both before and after the outbreak of the COVID-19 pandemic. Outcome variables included asthma medication statistics and healthcare utilization statistics. Results Inclusion criteria were met by 104 pediatric patients. The majority were African American. Emergency department visits, primary physician visits, and hospitalizations significantly decreased in the post-COVID study group compared to the pre-COVID control group. Conclusion Among a majority African American pediatric population, there were significant improvements in asthma outcomes after COVID-19 societal changes when compared to before COVID-19 based on outcome variables.

Equiosmolar hypertonic saline and mannitol for brain relaxation in patients undergoing supratentorial tumor surgery: A systematic review and meta-analysis.

Background: Hypertonic saline (HS) and mannitol are hyperosmolar agents that are usually used to reduce intracranial pressure (ICP) and provide a satisfactory brain relaxation. The aim of the study was to perform a systematic review and meta-analysis to compare the efficacy of HS and mannitol on brain relaxation intraoperatively in patient undergoing craniotomies for supra-tentorial brain tumors. Methods: A systematic review and meta-analysis of randomized control trials. We included randomized control trials that compared equiosmolar HS and mannitol in supratentorial tumors craniotomies and reported at least one of the following outcomes: degree of brain relaxation, ICP, central venous pressure, mean arterial pressure, perioperative fluid input, urine output, Na+ levels, and K+ levels. We searched Medline, Cochrane Central Register of Controlled Trials, and Embase using MESH terms and keywords. The bibliographic references of included studies and trial registries were also searched. Results: Seven articles were included. The degree brain of relaxation was comparable across the two groups with slight tendency toward HS (RR = 1.13, 95% CI 0.99-1.29; P = 0.08). Mannitol was associated with significantly higher urine output (standardized mean difference [SMD] = -1.33, 95% CI -1.56--1.10; P < 0.001). Na+ levels were higher in HS group (SMD = 1.47, 95% CI 0.86-2.09; P < 0.001). Mannitol was associated with non-significant decrease in CVP and increase fluid input (SMD = 0.42, 95% CI 0.00-0.85 and SMD = -0.18, 95% CI -0.37-0.02, respectively). Conclusion: Both HS and mannitol are associated with satisfactory brain relaxation with a non-statistically significant tendency for HS to achieve better relaxation scores with mannitol resulting in higher urine output while HS with higher Na+ levels.