Oral health status, self-perceptions, and risk awareness among young adult users of electronic cigarettes in Pakistan.

INTRODUCTION: The use of electronic cigarettes (ECs) has surged globally, particularly among young individuals. This study aimed to assess the perceptions of vaping-related oral health risks, clinical oral health status, and self-perceived dental and periodontal conditions among young adult users of ECs in Pakistan. METHODS: A cross-sectional study was conducted from June 2023 to March 2024, recruiting 142 young users of ECs. Intraoral examinations assessed Decayed, Missing, and Filled Teeth (DMFT) index, Oral Hygiene Index Simplified (OHI-S), Gingival Bleeding Index (GBI), Plaque Index (PI), and dental stain. Data on sociodemographic characteristics, oral health behaviors, vaping habits, and perceptions of impact of vaping on oral health were gathered through a self-administered questionnaire. Associations between EC use and various oral health variables were analyzed using the chi-squared and Fisher's exact tests. RESULTS: Mean DMFT was 5.66 (SD=2.20). Poor oral hygiene (29.6%) and severe dental staining were prevalent. Most participants (76.1%) brushed once daily, while only 34.5% attended regular dental check-ups. Gingival bleeding and plaque accumulation were observed in 47.2% and 35.3% of participants. Around 66% reported daily EC use, with 80.3% initiating vaping before the age of 18 years. Most common reason for vaping was perception that ECs are safer than traditional smoking (31.7%). Participants' perceptions of vaping-related oral health risks were relatively low, with 45% associating vaping with tooth decay, 48% with gum disease, and 58.5% with tooth staining. Tooth brushing frequency, vaping frequency (per day), and time since vaping started, were significantly associated with oral clinical indicators (p<0.05). The education level was the only variable significantly associated with vaping-related risk perception (p<0.05). CONCLUSIONS: The study reveals that oral health awareness among young vapers is low, with many starting EC use at a young age and exhibiting poor oral health behaviors. Misconceptions about the safety of ECs compared to conventional cigarettes may contribute to increased vaping.

Postoperative dysgeusia following microsurgical resection for acoustic neuroma: a systematic review and meta-analysis.

OBJECTIVE: To determine the collated rate of postoperative dysgeusia after microsurgical intervention in acoustic neuroma patients. METHODS: The systematic review with meta-analysis was undertaken following PRISMA guidelines. A thorough search of PubMed/Medline, the Cochrane Database of Systematic Reviews, and Epistemonikos was undertaken for studies published up until May 16, 2024 reporting postoperative taste disturbance rates after microsurgical intervention for acoustic neuroma. The methodological quality of the included studies was assessed via the Methodological Index for Non-Randomized research (MINORS) tool. Using MedCalc (v. 20.215) software, the random-effects model was developed for proportional meta-analysis. RESULTS: Eight studies, encompassing 2,402 patients (mean age = 49.06 years; 48.54% female population), were included in the analysis. The overall pooled rate of postoperative dysgeusia following microsurgical management of acoustic neuroma was 23.7% (95% CI: 9.266-42.359, p < 0.0001). When stratified by surgical approach, the rate of postoperative dysgeusia for the retrosigmoid approach was 18.8% (95% CI: 2.821-44.461, p < 0.0001). Postoperative dysgeusia data stratified for other major microsurgical approaches (subtemporal and translabirynthine approaches) was not reported by any of the included studies. CONCLUSION: Our systematic review and meta-analysis calculated a collated rate of almost 25% and recognized postoperative dysgeusia as a common complication following microsurgical management of acoustic neuromas. These results highlight the significance of preoperative counselling and the development of strategies that minimize the likelihood of harm to the chorda tympani nerve during microsurgical intervention for acoustic neuroma.

Yao Syndrome: An Overview of Genotypic Associations, Clinical Manifestations, Diagnosis, and Treatment.

BACKGROUND: Yao syndrome (YAOS) is a rare systemic autoinflammatory disorder (AID) of the innate immune system. It was recently categorized as genetically transitional disease (GTD) and is associated with NOD2 variants located at multiple NOD2 gene loci. Unlike most other periodic fever syndromes, the estimated disease prevalence is 1-10/100,000 with a predominance for females and white adult population. In this review, we aimed to provide a detailed analysis of different aspects of this syndrome to help better understand the underlying pathogenesis and incorporate the current evidence-based medicine published to diagnose and manage these patients. SUMMARY: We conducted literature search on YAOS from 2011 to 2024 using PubMed, Embase, and Scopus databases. Thirty-two studies were included in our narrative review. A descriptive analysis was performed of both Yao and non-Yao authored records to embrace the syndrome reported from all investigators and assess differences and similarities. The most reported gene variant is the homozygous IVS8+158 followed by compound heterozygous IVS8+158 and R702W. Mean age of disease onset is between 36 and 42 years. The mean age of disease diagnosis is between 40 and 45 years with a variable disease duration. Fever is the most commonly reported symptom followed by musculoskeletal, gastrointestinal symptoms and dermatitis. On laboratory workup, patients have elevated levels of erythrocyte sedimentation rate, C-reactive protein, and serum ferritin with negative autoantibody workup. Arthritic symptoms in YAOS patients have a positive response to sulfasalazine and glucocorticoids, while nonsteroidal anti-inflammatory drugs and colchicine produce minimal response. Anti-IL1 and anti-IL6 agents (canakinumab, anakinra, and tocilizumab) are effective treatment modalities. KEY MESSAGES: The evolving concept and acceptance of GTD will hopefully further our understanding about this SAID and similar disorders. We suggest developing a registry of patients with YAOS to keep track of expanding data on this subject. It is important to understand various aspects of YAOS including genetic and environmental factors, differential diagnosis, clinical manifestations, laboratory findings, and treatment options available to diagnose and manage these patients appropriately and timely.

Current otolaryngologic applications of the novel self-assembling RADA-16 peptide matrix.

A novel bioresorbable agent on the market is PuraGel® (3-D Matrix, Tokyo, Japan), a RADA-16 product that acts as a synthetic hemostatic and space-filling gel that promotes wound healing and prevents adhesion formation. Given the reported benefits of accelerated wound healing and scar tissue prevention, there are multiple otolaryngologic applications where RADA-16 might improve outcomes. Our study highlights current utilization and associated post-operative complications with this product.

Atrial Myxoma: Presenting as a Large Splenic Infarction.

Cardiac myxomas are the most common benign primary heart tumors, with the majority occurring in the left atrium. Clinical manifestations are a result of constitutional, obstructive, and/or embolic events. Complications include myocardial infarction and stroke, as well as renal and limb ischemia. Our unusual case is a middle-aged female who presented with a one-week history of progressively worsening abdominal pain and was found to have a large splenic infarction on a CT scan. There was no personal or family history of autoimmune diseases or hypercoagulable states. The evaluation revealed a large left atrial myxoma confirmed on biopsy after surgical resection. Our patient's clinical presentation was relatively benign compared to the size of her mass. Although her myxoma was very large, morphologically solid, and attached to the interatrial septum, she did not have any evidence of congestive heart failure. The tumor's irregular surface and mobility likely led to splenic embolization. Hence, the differential diagnosis of splenic infarction should include left atrial myxoma.

Scalp metastasis from atypical meningioma: A case report and literature review.

Key Clinical Message: Scalp metastasis from atypical meningioma, though rare, underscores the importance of meticulous surgical techniques to prevent tumor cell implantation. Early detection and comprehensive management, including surgery and adjuvant therapy, are crucial for optimal outcomes. Abstract: Meningiomas are tumors of the meninges that originate in the arachnoid layer from arachnoid cap cells. Atypical meningiomas, classified as WHO grade 2 tumors, tend to metastasize and recur if not surgically managed properly. Scalp metastasis is a rare occurrence that presents as a subcutaneous elevation. A 33-year-old patient presented with a complaint of a constant, dull pressure headache persisting for the past 12 months, exacerbated by exertion, along with seizures and neuropsychiatric symptoms. The patient had no significant medical history but had undergone surgery 4 years ago for a WHO grade 2 meningioma. The current brain MRI revealed a dural tail sign, along with masses on both the left and right sides of the frontal lobe, extending to involve the skin on the forehead and scalp. The patient underwent surgical resection and adjuvant radiation therapy. At the 12-month follow-up, no neurological deterioration or tumor recurrence was observed. A literature review on scalp metastasis in patients with atypical meningioma was also conducted, including eight articles published up to September 2023. The mechanism of metastasis development appears to be consistent in all eight reported cases, involving the implantation of tumor cells during resection. Therefore, there is a critical need for meticulous intra- and post-operative surgical techniques to prevent such implantation.

Awareness regarding breast cancer amongst women in Pakistan: A systematic review and meta-analysis.

BACKGROUND: Breast cancer (BCa) is the most common cause of cancer death in Pakistan. In 2019, Pakistan saw the highest global BCa-associated death rate. But do Pakistani women know about the various aspects of BCa? And how prevalent are BCa screening methods amongst Pakistani females? These questions formed the basis for our study. METHODS: We conducted this review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. On September 1, 2023, we searched PubMed, Embase, Scopus, and Google Scholar, and performed a citation search to search for eligible studies published in 2010 or after, using the following terms: "breast cancer" and "Pakistan". Observational studies that evaluated BCa awareness and/or practice amongst Pakistani females who were not associated with medicine were eligible. We used the National Institutes of Health quality assessment tool to assess the risk of bias. We conducted a proportion meta-analysis to calculate pooled prevalences for variables. RESULTS: Responses from 9766 Pakistani women across 18 included studies showed alarmingly low levels of BCa knowledge: risk factors, 42.7% (95% CI: 34.1%-51.4%); symptoms, 41.8% (95% CI: 26.2%-57.5%); diagnostic modalities, 36.3% (95% CI: 23.1%-49.4%); treatments, 46.6% (95% CI: 13.5%-79.8%). Prevalence of breast self-examination (BSE) and ever having undergone a clinical breast exam (CBE) was 28.7% (95% CI: 17.9%-39.6%) and 15.3% (95 CI: 11.2%-19.4%), respectively. BCa knowledge was significantly associated with better educational status, age, and socioeconomic status. CONCLUSION: On average, only two in five Pakistani women are aware of one or more risk factors, symptoms, or diagnostic modalities. Approximately one in two women know about possible BCa treatment. Less than one in three women practice regular BSE, and less than one in five women have ever undergone a CBE.

The Effect of High Parity on the Occurrence of Anaemia in Pregnant Women.

OBJECTIVE: To compare high-para and low-para women with respect to haematological findings, determinants, and consequences secondary to anaemia. STUDY DESIGN: Descriptive cohort study. Place and Duration of the Study: Maternity and Child Hospital, Hail, Saudi Arabia and Specialist Care Hospital (private), Islamabad, Pakistan, from April 2022 to April 2023. METHODOLOGY: The study population comprised of pregnant women in the last trimester, with the exception of those women who had more than one fetus and history of haematological disease. Purposive non-probability sampling technique was adopted. Hospital data were retrieved retrospectively for the past obstetrical, contraception usage, and supplement history. Blood parameters, type of delivery, and maternofetal complications were noted down. For qualitative-variable and quantitative-variable comparisons, Chi-square test and t-test were applied, respectively. Significance level was kept at p ≤0.05. RESULTS: The frequency of severe anaemia in high-para was 52%. High parity and anaemia had a significant dose-response relationship (p <0.05). There was a significant difference (p <0.05) in blood parameters between high-para and low-para groups. Main determinants identified for anaemia were lack of intake of iron-rich food (36%) followed by inadequate intake of oral iron (25%). Preterm birth (68%) and post-partum haemorrhage (96%) were significantly associated (p <0.05) with high parity. There was a significantly high proportion (83%) of high-para women with more than 3 cesarean deliveries and admissions in ICU. CONCLUSION: High parity and anaemia had a significant dose-response relationship. High parity was the main determinant of maternal and fetal admissions in ICU. KEY WORDS: Parity, Comparison, Maternal anaemia, Haematological findings, Diet, Contraception, Cost-effective.

Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs.

Background: Increased HIV testing is essential to ending the HIV epidemic. People who inject drugs (PWID) are among the highest risk for HIV infection. Previous research at Tufts Medical Center identified low HIV testing rates in hospitalized PWID. Our research team aimed to identify and overcome barriers to inpatient HIV screening of PWID using implementation science methods. Methods: Stakeholders were engaged to gather perspectives on barriers and facilitators of HIV testing. A PWID care bundle was developed and implemented, which included (1) HIV screening; (2) hepatitis A, B, and C testing and vaccination; (3) medications for opioid use disorder; and (4) naloxone prescription. Strategies from all nine Expert Recommendations for Implementing Change (ERIC) clusters guided the implementation plan. Stakeholder feedback was gathered throughout implementation, and implementation outcomes of acceptability and feasibility were assessed. Results: PWID overall felt comfortable with HIV testing being offered while hospitalized. Clinicians cited that the main barriers to HIV testing were discomfort and confusion around consenting requirements. Many resident physicians surveyed reported that, at times, they forgot HIV testing for PWID. Overall, though, resident physicians felt that the PWID bundle was useful and did not distract from other patient care responsibilities. Conclusions: Engagement of key stakeholders to increase HIV testing in an inpatient setting led to the implementation of a PWID bundle, which was feasible and acceptable. Bundling evidence-informed care elements for inpatient PWID should be investigated further.

People who inject drugs (PWID) are at an increased risk of contracting HIV. HIV testing is a key strategy to stop the spread of HIV. Our study created a bundle of services and tests to offer to all PWID who were admitted to the hospital. The bundle included HIV testing; hepatitis A, B, and C testing and vaccination; medications for opioid use disorder; and prescription for Narcan, a medication that can reverse opioid overdose. We then asked doctors and patients how they felt about the bundle and any barriers and facilitators that they predicted for expanding HIV testing to PWID while admitted to the hospital. Patients were accepting of expanding HIV testing, and resident physicians felt it was important as well and was a manageable addition to their list of responsibilities. However, the most likely part of the bundle to be forgotten was HIV testing. This study lays the groundwork for bundling services for PWID while they are hospitalized. We also highlight areas for future exploration.

Why do women still give birth at home; perceptions of Pakistani women and decision-makers from marginalized communities.

In low- and middle-income countries (LMICs), maternal and newborn mortality is high due to the high prevalence of home births. Understanding the reasons behind this behavior is essential for improving maternal and newborn outcomes. Therefore, a qualitative exploratory study was conducted in a peri-urban community in Karachi, Pakistan to understand the perceptions of pregnant women who delivered at home despite receiving antenatal care and the perceptions of their decision-makers regarding this behavior. In-depth interviews were conducted with 15 randomly sampled women who chose to deliver at home after receiving antenatal care at a health facility, as well as 15 family members who were purposively identified as decision-makers by the women themselves. Thematic analysis was performed to explore the perceptions, myths, and cultural beliefs about homebirths as well as women's decision-making power related to childbirth. The three main themes identified showed that traditional beliefs and practices, poverty and gender inequality, and poor healthcare systems significantly influence the preference for childbirth. Traditional beliefs and practices, including religious and cultural beliefs, played a role in perceiving childbirth as a natural process best managed at home. The presence of traditional birth attendants who provide personalized care and emotional support further reinforced this preference. Gender inequalities, including limited access to mobile phones and women's caregiving roles, were identified as barriers to seeking formal healthcare at the time of delivery. Additionally, poor experiences with the formal healthcare system, such as the poor attitude of formal healthcare workers and fear of medical interventions, also contributed to the decision to deliver at home. The study highlighted the complex interplay between traditional/religious beliefs, gender inequalities, and healthcare experiences in shaping the decision to deliver at home despite receiving ANC services in marginalized settings. Addressing these factors is necessary for promoting facility-based delivery and improving maternal and neonatal outcomes in LMICs.

Tackling a Post-COVID-19 Cholecystectomy Waiting List: Are We Meeting the Challenge?

Background and Objectives: The COVID-19 pandemic has led to a tremendous backlog in elective surgical activity. Our hospital trust adopted an innovative approach to dealing with elective waiting times for cholecystectomy during the recovery phase from COVID-19. This study aimed to evaluate trends in overall cholecystectomy activity and the effect on waiting times. Materials and Methods: A prospective observational study was undertaken, investigating patients who received a cholecystectomy at a large United Kingdom hospital trust between February 2021 and February 2022. There were multiple phased strategies to tackle a 533-patient waiting list: private sector, multiple sites including emergency operating, mobile theatre, and seven-day working. The correlation of determination (R2) and Kruskal-Wallis analysis were used to evaluate trends in waiting times across the study period. Results: A total of 657 patients underwent a cholecystectomy. The median age was 49 years, 602 (91.6%) patients had an ASA of 1-2, and 494 (75.2%) were female. A total of 30 (4.6%) patients were listed due to gallstone pancreatitis, 380 (57.8%) for symptomatic cholelithiasis, and 228 (34.7%) for calculous cholecystitis. Median waiting times were reduced from 428 days (IQR 373-508) to 49 days (IQR 34-96), R2 = 0.654, p < 0.001. For pancreatitis specifically, waiting times had decreased from a median of 218 days (IQR 139-239) to 28 (IQR 24-40), R2 = 0.613, p < 0.001. Conclusions: This study demonstrates the methodology utilised to safely and effectively tackle the cholecystectomy waiting list locally. The approach utilised here has potential to be adapted to other units or similar operation types in order to reduce elective waiting times.

The Association between Grand Multiparity and Adverse Neonatal Outcomes: A Retrospective Cohort Study from Ha'il, Saudi Arabia.

Inconsistent evidence exists regarding the association of grand multiparity with adverse neonatal outcomes. This study aims to compare specific adverse outcomes in grand multiparas (those with five or more births at twenty or more weeks of gestation, regardless of fetal outcome) compared to those with lower parity (those with less than five births at twenty or more weeks of gestation, regardless of fetal outcome). A retrospective cohort study was undertaken at the Maternity and Children Hospital in Ha'il region, Saudi Arabia. After calculating the required sample size, data were collected from consenting participants with a viable singleton delivery. Socio-demographic variables, select maternal characteristics, and adverse neonatal outcomes (admission to the neonatal intensive care unit, low birth weight, prematurity, and APGAR score less than 7 in the first 5 min) were compared between grand multiparas and women with lower parity. Two hundred ninety-four participants were recruited (ninety-eight grand multiparas and one hundred ninety-six of lower parity). There was a statistically significant difference between the two groups in relation to age, level of education, body mass index, and the occurrence of gestational diabetes. Out of the studied adverse neonatal outcomes after the adjustment for maternal age between the two groups, no statistically significant difference in the adverse neonatal outcomes was found between the two groups. Grand multiparity does not incur an additional risk of adverse neonatal outcomes compared to women of lower parity. Furthermore, increasing maternal age and comorbid conditions might have a more detrimental effect on neonatal outcomes than grand multiparity per se.

High prevalence of food insecurity in peri-urban communities in Karachi, Pakistan: The flood aftermath.

BACKGROUND: Food insecurity (FI) is at a steep risk, especially in low middle-income countries. FI is further compounded in areas that experience environmental and economic instability, thus a reassessment in such critical times is required for burden estimation and to propose targeted interventions. AIMS: The objectives of this study were to assess the prevalence of, and sociodemographic factors associated with FI, as well as the coping strategies utilized in response to FI in peri-urban communities in Karachi, Pakistan. METHODS: We conducted a cross-sectional survey from November-December 2022 on 400 households in four peri-urban communities in Karachi, Pakistan. The Household Food Insecurity Access Scale (HFIAS) and reduced Coping Strategies Index (rCSI) questionnaire were used to assess FI. A Poisson regression was used to assess associations between sociodemographic factors and FI. RESULTS: The overall prevalence of FI was found to be 60.2% (n = 241) of which 33.8% (n = 135) were severely food insecure. Age, women's and breadwinners' education, women's occupation, and parity were significantly associated with FI. Participants reported relying on less expensive foods (44%) and borrowing food or help from others (35%) as the most common coping strategies overall in the FI households. CONCLUSION: With more than half the households facing FI and adopting severe measures to cope in these communities, it is pivotal to design and test interventions that can withstand economic and climate catastrophes and help ensure a safety need for food security for the most vulnerable.

Photosynthetic activity and metabolic profiling of bread wheat cultivars contrasting in drought tolerance.

The rapid increase in population growth under changing climatic conditions causes drought stress, threatening world food security. The identification of physiological and biochemical traits acting as yield-limiting factors in diverse germplasm is pre-requisite for genetic improvement under water-deficit conditions. The major aim of the present study was the identification of drought-tolerant wheat cultivars with a novel source of drought tolerance from local wheat germplasm. The study was conducted to screen 40 local wheat cultivars against drought stress at different growth stages. Barani-83, Blue Silver, Pak-81, and Pasban-90 containing shoot and root fresh weight >60% of control and shoot and root dry weight >80% and 70% of control, respectively, P (% of control >80 in shoot and >88 in root), K+ (>85% of control), and quantum yield of PSII > 90% of control under polyethylene glycol (PEG)-induced drought stress at seedling stage can be considered as tolerant, while more reduction in these parameters make FSD-08, Lasani-08, Punjab-96, and Sahar-06 as drought-sensitive cultivars. FSD-08 and Lasani-08 could not maintain growth and yield due to protoplasmic dehydration, decreased turgidity, cell enlargement, and cell division due to drought treatment at adult growth stage. Stability of leaf chlorophyll content (<20% decrease) reflects photosynthetic efficiency of tolerant cultivars, while ~30 µmol/g fwt concentration of proline, 100%-200% increase in free amino acids, and ~50% increase in accumulation of soluble sugars were associated with maintaining leaf water status by osmotic adjustment. Raw OJIP chlorophyll fluorescence curves revealed a decrease in fluorescence at O, J, I, and P steps in sensitive genotypes FSD-08 and Lasani-08, showing greater damage to photosynthetic machinery and greater decrease in JIP test parameters, performance index (PIABS), maximum quantum yield (Fv/Fm) associated with increase in Vj, absorption (ABS/RC), and dissipation per reaction center (DIo/RC) while a decrease in electron transport per reaction center (ETo/RC). During the present study, differential modifications in morpho-physiological, biochemical, and photosynthetic attributes that alleviate the damaging effects of drought stress in locally grown wheat cultivars were analyzed. Selected tolerant cultivars could be explored in various breeding programs to produce new wheat genotypes with adaptive traits to withstand water stress.

Role of Parity and Age in Cesarean Section Rate among Women: A Retrospective Cohort Study in Hail, Saudi Arabia.

In the context of the global increase in the rate of cesarean deliveries, with an associated higher morbidity and mortality, this study aimed to investigate the role of maternal age and parity in the cesarean section rate among women in the Hail Region of Saudi Arabia. This retrospective cohort study used data collected from the labor ward of the Maternity and Child Health Hospital, Hail, over a period of 8 months, forming a cohort of 500 women. Women were categorized into four different parity classes. The results revealed that there was no significant relationship between cesarean deliveries and maternal age (p-value, 0.07). There was no significant difference in the mode of delivery between the study's parity cohort group. A significant increase in cesarean deliveries was noticed among obese women with a BMI between 35-39.9 (52.14%). This increase was even greater among those with a BMI above 40 (63.83%). Fetal distress, malpresentation and abruptio placenta were the most significant indications for CS among all age groups (p-value 0.000, 0.021, and 0.048, respectively). Conclusions: The number of cesarean deliveries has no association with parity or age. However, there was a statistically significant association with BMI, a perineal tear after previous vaginal delivery, and a history of diabetes mellitus and gestational diabetes. The most reported reasons for CS were fetal distress, malpresentation, and abruptio placenta among all age groups.

Mixing tannery effluent had fertilizing effect on growth, nutrient accumulation, and photosynthetic capacity of some cucurbitaceous vegetables: A little help from foe.

Tannery effluent contains a number of organic and inorganic elements as pollutants which reduce plant growth. To overcome shortage of water, use of diluted industrial wastewater such as tannery effluent can be a viable strategy for improving crop growth and yield. A pot experiment was conducted to determine the effects of tannery effluent and its various dilutions on physiological and biochemical characteristics of five cucurbitaceous vegetables. Tannery effluent was applied 0, 25, 50, 75 and 100% to 3-week-old plants of five cucurbitaceous vegetables (Cucurbita maxima, Luffa cylindrica, Citrullus vulgaris, Cucumis melo, and Praecitrullus fistulosus) for 4 weeks. Tannery effluent reduced the growth of all five cucrbitaceous vegetables. Diluted tannery effluent (25%) improved the growth of Cucurbita maxima, Citrullus vulgaris, and Cucumis melo. Moderately diluted (50%) did not affect the growth of Citrullus vulgaris and Cucumis melo. Toxic effects of tannery effluent were associated with high accumulation of heavy metals Cr, Cd, Mn, and Fe in leaves and roots. High accumulation of heavy metals in leaves reduced the accumulation of nutrients in leaves (N, P, K) and reduced photosynthetic pigments and photosynthetic rate. Changes in photosynthetic rates of all vegetable species due to tannery effluent were not associated with stomatal limitations (stomatal conductance, transpiration rate, internal CO2). Toxic effects of tannery effluent on plants also include changes in N-metabolism (amino acid and protein). However, extent of these adverse effects of tannery effluent on vegetables was species specific. It is suggested that Cucurbita maxima can be grown by supplying 25% tannery effluent, whereas Citrullus vulgaris and Cucumis melo can be grown with moderately diluted (50%) tannery effluent.

Does percutaneous cholecystostomy timing in high anaesthetic-risk patients impact on outcome?

The optimal timing for percutaneous cholecystostomy (PCT) in patients with acute biliary sepsis, who are high-risk for cholecystectomy, requires further investigation. We aimed to study local factors influencing the timing to PCT placement, and investigate patient outcomes in early (≤ 48 h) vs. delayed PCT over a six-year period. A retrospective observational study investigating patients who required a PCT at a single hospital in the UK between January 2014 and December 2019. Placement of a PCT was at the discretion of the on-call surgical consultant according to their own personal experience and not based on a standard local protocol. Clinical outcomes, hospital statistics and details of any subsequent bridging surgery were analysed using multivariate logistic regression models adjusting for age, sex, Charlson Comorbidity Index (CCI) and American Society of Anaesthesiologists (ASA) grade. There were 72 patients with 35/72 (48.6%) classed as TG18 AC grade 3; 26/72 (36.1%) had an early PCT placed and 46/72 (63.9%) delayed. Median age was 76 (65-83) years, 52.8% were female, and 51.4% were classed ASA ≥ 3 with 94.0% scoring CCI > 2. Trial on antibiotic therapy was the primary reason for delayed PCT. In adjusted models, early PCT was associated with a shorter length in hospital stay (OR 3.02, p = 0.044), successful definitive treatment (OR 6.26, p = 0.009); and reduced likelihood for catheter dislodgment (OR 0.12, p = 0.004) with fewer patients bridging to later emergency open surgery (OR 0.19, p = 0.024). Clinical outcomes may be superior in urgent or early PCT for high anaesthetic-risk patients following acute biliary sepsis.

Diagnosis and Treatment of Liver Disease: Current Trends and Future Directions.

This narrative review delves into the intricate landscape of liver diseases, providing a comprehensive background of the diverse conditions that afflict this vital organ. Liver diseases, ranging from viral hepatitis and non-alcoholic fatty liver disease (NAFLD) to cirrhosis and hepatocellular carcinoma (HCC), pose significant global health challenges. Understanding these diseases' multifaceted origins and progression is pivotal for developing effective diagnostic and therapeutic strategies. The epidemiology and etiology of liver diseases emphasize the global impact of viral hepatitis, with hepatitis B and C as significant contributors. Concurrently, the rising prevalence of NAFLD, linked to lifestyle factors and metabolic syndrome, underscores the intricate relationship between modern living and liver health. Chronic liver diseases often evolve insidiously, progressing from inflammation to fibrosis and, ultimately, to cirrhosis - a stage characterized by irreversible scarring and compromised function. The heightened risk of HCC in advanced liver disease stages further underscores the urgency of effective diagnostic and therapeutic interventions. The evolving landscape of non-invasive diagnostic tools is explored for their role in enabling early detection and accurate staging of liver diseases. In the realm of treatment, there is a continuous transition toward personalized medicine, customized to suit the unique profiles of individual patients. This shift encompasses a broad spectrum, ranging from personalized pharmacological interventions to lifestyle modifications and surgical options. Delving into innovative therapies, such as gene editing and immunomodulation, offers a glimpse into the promising future directions that have the potential to redefine the landscape of liver disease diagnosis and treatment.

Novel Therapies in Diabetes: A Comprehensive Narrative Review of GLP-1 Receptor Agonists, SGLT2 Inhibitors, and Beyond.

Diabetes mellitus, a widespread metabolic illness with increasing global occurrence, continues to have a significant impact on public health. Diabetes is a condition marked by long-term high blood sugar levels. It is caused by a combination of genetic, environmental, and lifestyle factors, which lead to problems with insulin production and insulin resistance. This dysfunctional state disturbs the delicate balance of glucose regulation, promoting the emergence of problems in both large and small blood vessels that have a substantial impact on illness and death rates. Traditional therapy methods have traditionally given more importance to managing blood sugar levels by using insulin sensitizers, secretagogues, and other medications that lower glucose levels. Advancements in our understanding of the underlying mechanisms of diabetes have led to a significant change in approach, focusing on comprehensive therapies that target not only high blood sugar levels but also the accompanying dangers to the heart and kidneys. This study examines the evolving field of diabetes therapies, explicitly highlighting the significance of GLP-1 receptor agonists and SGLT2 inhibitors. These two types of drugs have become essential components in modern diabetes management. GLP-1 receptor agonists replicate the effects of natural glucagon-like peptide-1, leading to insulin production that is reliant on glucose levels, reducing the release of glucagon, and providing cardiovascular advantages that go beyond controlling blood sugar levels. SGLT2 inhibitors, however, act on the process of renal glucose reabsorption, leading to increased excretion of glucose in the urine and showing significant benefits for cardiovascular and renal protection. This extensive investigation seeks to contribute to the ongoing discourse on diabetes therapies by synthesizing existing research. This review aims to provide clinicians, researchers, and policymakers with a comprehensive understanding of the disease background and the specific pharmacological details of GLP-1 receptor agonists, SGLT2 inhibitors, and other related treatments. The goal is to assist them in developing more effective and personalized strategies to tackle the complex challenges presented by diabetes.

Comparison of Fetomaternal Complications in Women of High Parity with Women of Low Parity among Saudi Women.

High parity is associated with the risk of fetomaternal complications such as gestational diabetes mellitus, hypertensive disorders, maternal anemia, preterm labor, miscarriage, postpartum hemorrhage, and perinatal and preterm mortality. The objective of the study was to compare fetomaternal complications in women of high parity with women of low parity. This involved a cohort study on a sample size of 500 women who had singleton births. Data were collected from the Maternity and Child Hospital, Ha'il, Kingdom of Saudi Arabia. Participants were classified into two groups according to parity, i.e., women of low parity and women of high parity. Socio-demographic data and pregnancy complications, such as gestational diabetes, hypertension, preeclampsia, intrauterine growth restriction, etc., were retrieved from participants' files. Participants were followed in the postnatal ward until their discharge. The results revealed that women of high parity mostly (49%) were married before 20 years of age, less educated, obese, and were of un-booked cases. Premature babies and fetal mortality are significantly high (0.000) in this group. There is a significant difference between the two groups with respect to maternal anemia, gestational diabetes mellitus, joint pain, perineal tear, miscarriage, postpartum hemorrhage, preeclampsia, vaginal tear, and cesarean section. Determinants responsible for high parity should be identified via evidence-based medicine. Public health education programs targeting couples, weight control, nutrition, and contraception would be a cost-effective strategy for reducing the risk of possible fetomaternal complications.