Differential responses to UCP1 ablation in classical brown versus beige fat, despite a parallel increase in sympathetic innervation.

In the cold, the absence of the mitochondrial uncoupling protein 1 (UCP1) results in hyper-recruitment of beige fat, but classical brown fat becomes atrophied. Here we examine possible mechanisms underlying this phenomenon. We confirm that in brown fat from UCP1-knockout (UCP1-KO) mice acclimated to the cold, the levels of mitochondrial respiratory chain proteins were diminished; however, in beige fat, the mitochondria seemed to be unaffected. The macrophages that accumulated massively not only in brown fat but also in beige fat of the UCP1-KO mice acclimated to cold did not express tyrosine hydroxylase, the norepinephrine transporter (NET) and monoamine oxidase-A (MAO-A). Consequently, they could not influence the tissues through the synthesis or degradation of norepinephrine. Unexpectedly, in the cold, both brown and beige adipocytes from UCP1-KO mice acquired an ability to express MAO-A. Adipose tissue norepinephrine was exclusively of sympathetic origin, and sympathetic innervation significantly increased in both tissues of UCP1-KO mice. Importantly, the magnitude of sympathetic innervation and the expression levels of genes induced by adrenergic stimulation were much higher in brown fat. Therefore, we conclude that no qualitative differences in innervation or macrophage character could explain the contrasting reactions of brown versus beige adipose tissues to UCP1-ablation. Instead, these contrasting responses may be explained by quantitative differences in sympathetic innervation: the beige adipose depot from the UCP1-KO mice responded to cold acclimation in a canonical manner and displayed enhanced recruitment, while the atrophy of brown fat lacking UCP1 may be seen as a consequence of supraphysiological adrenergic stimulation in this tissue.

Analysis of Transgenic Cotton Plants Containing Universal Stress Protein (GaUSP-1, GaUSP-2) and Zinc Finger Transcriptional Factor (GaZnF) Genes under Drought Stress.

Water is the most limiting factor for plant growth and crop productivity. Drought stress adversely affects crop yield throughout the world. Up to 50% of crop yield in Pakistan is severely affected by the shortage of water. Cotton is an important cash crop for Pakistan known as "white gold." It accounts for 8.2% of the value added in agriculture and about 3.2% of GDP. Besides, being the world's fourth-largest cotton producer, our yield per acre ranks 13th in the world. If we look at the Pakistan scenario, water deficiency is one of the major yield-limiting factors. Limitations related to conventional breeding and the advancements in plant genomics and biotechnology applications have opened new horizons to plant improvements. Therefore, in the current study, we carry out a comparative analysis to evaluate the morphological, physiological biochemical and molecular parameters in transgenic plants containing GaUSP-1, GaUSP-2 and GaZinc Finger genes under different drought stress conditions. Data showed that transgenic plants showed more tolerance as compared to non-transgenic plants. Transgenic and non-transgenic assist us in our better understanding of the drought-responsive mechanism and its effect on different plant growth traits, so, in this way, we would be able to explore drought tolerance mechanism and this will open the doors for the identification of drought-related genes.

Effect of exercise on fatigue and depression in breastcancer women undergoing chemotherapy: a systematic review and meta-analysis.

This meta-analysis examined the effectiveness of exercise interventions in reducing fatigue and depression among women undergoing chemotherapy for breast cancer. The study followed PRISMA guidelines and analysed seven randomized controlled trials between 2016 and 2022. The results showed that exercise can substantially reduce fatigue levels (MD: -0.40, CI: -0.66, -0.14, P: 0.003), a common side effect of chemotherapy. Although depression did not significantly change (MD: -0.39, CI: -0.98, 0.20, P: 0.19), this study highlights the positive impact of exercise on mental health outcomes. The control group also experienced decreased quality of life (MD: 0.18, CI: 0.01-0.35, P: 0.03), emphasizing the importance of incorporating exercise interventions to improve overall well-being during breast cancer treatment. In addition to primary outcomes, the study revealed that exercise positively affected secondary aspects such as cognitive fatigue, social function, physical function, constipation, and dyspnoea.

Effect of Sodium-Glucose Cotransporter 2 Inhibitors on the 24-Hour Ambulatory Blood Pressure in Patients With Type 2 Diabetes Mellitus and Hypertension: An Updated Meta-Analysis.

OBJECTIVE: Sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially developed for type 2 diabetes mellitus (DM) treatment, have shown potential benefits beyond glycemic control, including a positive impact on the blood pressure (BP). This meta-analysis aimed to evaluate their effects on patients with type 2 DM and hypertension. METHODS: We searched the PubMed, Google Scholar, and Cochrane databases for relevant randomized controlled trials published until May 31, 2023. Ten randomized controlled trials involving participants with confirmed type 2 DM were selected. The intervention group received SGLT2i, whereas the control group received a placebo or standard care. The primary outcomes were the 24-hour ambulatory systolic BP (SBP) and diastolic BP (DBP). RESULTS: The results showed a significant reduction in the 24-hour ambulatory SBP (weighted mean difference, -5.08 mm Hg; 95% confidence interval, -7.02 to -3.14; P <.00001) and DBP (weighted mean difference, -2.73 mm Hg; 95% confidence interval, -4.25 to -1.20; P =.0005) with the use of SGLT2i compared with that using the placebo. However, a high-heterogeneity level was observed in both analyses (SBP, I2 = 83%; DBP, I2 = 91%). Sensitivity analysis excluding specific studies reduced heterogeneity while maintaining statistically significant and clinically relevant reductions in the BP. CONCLUSION: In conclusion, this meta-analysis proves that SGLT2i significantly reduce the 24-hour ambulatory BP. SGLT2i may be considered an effective treatment option for lowering the BP in addition to standard care in patients with hypertension and type 2 DM.

Expanding boundaries: The synergy of creative writing and reflective learning in medicine.

This paper explores the role of reflective practice in the medical field and investigates the factors that influence reflective writing. While reflective practice is widely acknowledged as crucial in medical education, there is a need to expand its conceptual boundaries and move beyond mere pedagogical exercises. The paper argues for the inclusion of creative writing, specifically poetry, as a form of reflective practice that allows medical students to effectively process their emotions and develop a more compassionate approach to patient care. By engaging in poetic expression, students can navigate ethical dilemmas, reflect on personal challenges, and cultivate empathy and appreciation for diverse perspectives.

An Unusual Case of Takotsubo Cardiomyopathy with Cardiac Arrest: The Importance of Clinical Context in Implanted Cardioverter Defibrillator Candidacy.

Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, is characterized by acute heart failure, reversible left ventricular dysfunction, and other complications such as life-threatening arrhythmias. The management of TTS is challenging due to its unpredictable clinical course and the lack of evidence-based treatment recommendations. In this case report, we present a 71-year-old female who developed TTS with ventricular tachycardia (VT) cardiac arrest following septic shock and an exploratory laparotomy for appendicitis. Despite the presence of VT cardiac arrest and a left ventricular ejection fraction of 30-35%, an implanted cardioverter-defibrillator (ICD) was not indicated due to the rapid and satisfactory recovery of the patient's ventricular function. This case highlights the importance of considering the clinical context and the transient nature of TTS in the decision-making process for ICD candidacy.

Comparative taxonomical, biological and pharmacological potential of healthy and geminivirus infected leaves of Hibiscus rosa-sinensis L.: First report.

In the present research project, the first report on comparative analysis of the taxonomical, biological and pharmacological potential of healthy and geminivirus infected Hibiscus rosa sinensis (L.) leaves of the family Malvaceae was done by using different micro and macroscopic techniques. First of all, leaves were characterized for Cotton leaf curl Multan virus (CLCuMuV) and its associated betasatellite (Cotton leaf curl Multan Betasatellite; CLCuMB). Different morphological parameters like shape and size of stem, leaves, seeds and roots, presence and absence of ligule, distance between nodes and internodes and type of inflorescence etc. were analyzed. CLCuMuV infected H. rosa-sinensis revealed systematic symptoms of infection like chlorosis of leaves, stunted growth, decrease in size of roots, shoots and distortion etc. Anatomical investigation was performed under light ad scanning electron microscope. Different anatomical features like length and shape of guard cells, subsidiary cells, presence or absence of stomata, secretory ducts and trichomes were examined. In both plant samples anomocytic types of stomata and elongated, non-glandular and pointed tip trichomes were present, but the size (especially length and width) of trichomes and other cells like epidermal, subsidiary, and guard cells were highest in virus infected plants likened to healthy one. In the antibacterial activity, the maximum antibacterial potentail was seen in methanolic extract of K. pneumonea while antifungal activity was shown by methanolic extract of A. solani. Plants interact with different biological entities according to environmental conditions continuously and evolved. These types of interactions induce changes positively and negatively on plant metabolism and metabolites production. Many plant viruses also attacked various host plants consequently alter their secondary metabolism. To overcome such virus infected plants produces many important and different types of secondary plant metabolites as a defense response. Subsequent analysis of this n-hexane plant extract using Gas chromatography mass spectroscopy technique revealed that Hibiscus eluted contained 10 main compounds in Healthy sample and 13 compounds in infected one. Presence of essential secondary metabolites were also analyzed by FTIR analysis. The present study provides a comprehensive and novel review on taxonomy (morphology, anatomy) and antimicrobial potential of both healthy and geminivirus infected H. rosa-sinensis.

Caduceus vs. Rod of Asclepius: A Serpentine Dilemma in Medical Iconography.

This scholarly inquiry delves into the historical significance of two enduring medical symbols: the Rod of Asclepius and the Caduceus. Tracing their origins back to ancient Greek mythology, we uncover their distinct identities and profound meanings as symbols of healing, unity among medical practitioners, and ethical responsibilities. Beyond aesthetics, these emblems serve as powerful educational tools, fostering universal understanding and connecting modern medicine to its historical heritage. Consequently, embracing their true essence can inspire genuine dedication to the noble mission of caring for others.

Effect of whey protein isolate addition on set-type camel milk yogurt: Rheological properties and biological activities of the bioaccessible fraction.

The manufacture of camel milk (CM) yogurt has been associated with several challenges, such as the weak structure and watery texture, thereby decreasing its acceptability. Therefore, this study aimed to investigate the effect of whey protein isolate (WPI) addition on the health-promoting benefits, texture profile, and rheological properties of CM yogurt after 1 and 15 d of storage. Yogurt was prepared from CM supplemented with 0, 3, and 5% of WPI and compared with bovine milk yogurt. The results show that the water holding capacity was affected by WPI addition representing 31.3%, 56.8%, 64.7%, and 45.1% for yogurt from CM containing 0, 3 or 5% WPI, and bovine milk yogurt, respectively, after 15 d. The addition of WPI increased yogurt hardness, adhesiveness, and decreased the resilience. CM yogurt without WPI showed lower apparent viscosity, storage modulus, and loss modulus values compared with other samples. The supplementation of CM with WPI improved the rheological properties of the obtained yogurt. Furthermore, the antioxidant activities of yogurt before and after in vitro digestion varied among yogurt treatments, which significantly increased after digestion except the superoxide anion scavenging and lipid oxidation inhibition. After in vitro digestion at d 1, the superoxide anion scavenging of the 4 yogurt treatments respectively decreased from 83.7%, 83.0%, 79.1%, and 87.4% to 36.7%, 38.3%, 44.6%, and 41.3%. The inhibition of α-amylase and α-glucosidase, angiotensin-converting enzyme inhibition, cholesterol removal, and degree of hydrolysis exhibited different values before and after in vitro digestion.

Comprehensive Review of Hypertensive Disorders Related to Pregnancy.

Hypertensive disorder of pregnancy is a common complication during pregnancy that affects approximately 10% of pregnancies and is responsible for nearly 14% of maternal deaths worldwide. It affects the mother and the fetus simultaneously, sometimes putting the health of the mother and the fetus at odds with each other. It may present with only hypertension and proteinuria or with life-threatening complications in the mother such as eclampsia; stroke; acute pulmonary edema; acute renal failure; disseminated intravascular coagulation; placental abruption; hemolysis, elevated liver enzymes, and low platelet syndrome; pregnancy loss; and fetal growth restriction and prematurity resulting from the frequent need of delivering preterm in the fetus. In this review, we aimed to describe hypertensive disorders of pregnancy, mainly preeclampsia and chronic hypertension in pregnancy, by discussing the pathophysiology, the central role of abnormal placentation, the release of antiangiogenic factors in the circulation and immunological factors, the clinical outcome in the mother and the fetus, and the diagnostic criteria and principles of management of both the conditions. We also discuss possible screening methods and prevention of preeclampsia using low-dose aspirin and eclampsia prophylaxis.

Investigating the Properties and Characterization of a Hybrid 3D Printed Antimicrobial Composite Material Using FFF Process: Innovative and Swift.

Novel strategies and materials have gained the attention of researchers due to the current pandemic, the global market high competition, and the resistance of pathogens against conventional materials. There is a dire need to develop cost-effective, environmentally friendly, and biodegradable materials to fight against bacteria using novel approaches and composites. Fused filament fabrication (FFF), also known as fused deposition modeling (FDM), is the most effective and novel fabrication method to develop these composites due to its various advantages. Compared to metallic particles alone, composites of different metallic particles have shown excellent antimicrobial properties against common Gram-positive and Gram-negative bacteria. This study investigates the antimicrobial properties of two sets of hybrid composite materials, i.e., Cu-PLA-SS and Cu-PLA-Al, are made using copper-enriched polylactide composite, one-time printed side by-side with stainless steel/PLA composite, and second-time with aluminum/PLA composite respectively. These materials have 90 wt.% of copper, 85 wt.% of SS 17-4, 65 wt.% of Al with a density of 4.7 g/cc, 3.0 g/cc, and 1.54 g/cc, respectively, and were fabricated side by side using the fused filament fabrication (FFF) printing technique. The prepared materials were tested against Gram-positive and Gram-negative bacteria such as Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa (P. aeruginosa), Salmonella Poona (S. Poona), and Enterococci during different time intervals (5 min, 10 min, 20 min, 1 h, 8 h, and 24 h). The results revealed that both samples showed excellent antimicrobial efficiency, and 99% reduction was observed after 10 min. Hence, three-dimensional (3D) printed polymeric composites enriched with metallic particles can be utilized for biomedical, food packaging, and tissue engineering applications. These composite materials can also provide sustainable solutions in public places and hospitals where the chances of touching surfaces are higher.

Ring of Hope: A Novice's Experience in a Cancer Centre.

The ringing of a bell has become an honored and cherished tradition in the realm of cancer survivorship care. As a medical student, I was initially unaware of this practice, but I have since gained a profound appreciation for its deep significance and emotional potency. Through the act of ringing the bell, patients who have successfully completed their cancer treatment are able to mark the end of a gruelling journey, while also heralding the start of a new and hopeful chapter in their lives.

Pilot Study Evaluating Cross-Disciplinary Educational Material to Improve Patients' Knowledge of Palliative Radiation Therapy.

Palliative radiation therapy (PRT) is underutilized, partially due to misconceptions about its risks, benefits, and indications. The objective of this pilot study was to determine if patients with metastatic cancer would gain knowledge from educational material describing PRT and perceive it as useful in their care. A one-page handout conveying information about the purpose, logistics, benefits, risks, and common indications for PRT was offered to patients undergoing treatment for incurable, metastatic solid tumors in one palliative care clinic and four medical oncology clinics. Participants read the handout, then completed a questionnaire assessing its perceived value. Seventy patients participated between June and December 2021. Sixty-five patients (93%) felt they learned from the handout (40% learned "lots"), and 69 (99%) felt the information was useful (53% "very useful"). Twenty-one patients (30%) were previously unaware that PRT can relieve symptoms, 55 (79%) were unaware that PRT can be delivered in five treatments or less, and 43 (61%) were unaware that PRT usually has few side effects. Sixteen patients (23%) felt they currently had symptoms not being treated well enough, and 34 (49%) felt they had symptoms that radiation might help with. Afterwards, most patients felt more comfortable bringing symptoms to a medical oncologist's (n = 57, 78%) or radiation oncologist's (n = 51, 70%) attention. Patient-directed educational material about PRT, provided outside of a radiation oncology department, was perceived by patients as improving their knowledge and adding value in their care, independent of prior exposure to a radiation oncologist.

Stem cells in degenerative lumbar spine disease: a review and focus on utility in Low- and Middle-Income Countries.

Stem cell therapy is a common adjunct in regenerative medicine and has recently seen greater adoption in spinal surgery. Arthrodesis is typically achieved with iliac-crest bone grafts with several adverse events, leading to the development of alternative biomaterials. One such biomaterial is stem cells, which may be equal in terms of effectiveness but with significantly fewer complications. Low- and Middle-Income Countries (LMICs) have seen slow adoption of stem cell therapy due to resource constraints but may benefit the most from these techniques. We conducted a comprehensive review of literature in the PUBMED, Scopus, and Cochrane Library databases on the use of stem cells and stem cell-based biomaterials in spinal surgery. Our review showed promising results, from a variety of methods including augmentation of existing scaffold with mesenchymal stem cells or concentrated bone marrow aspirate. With minimal complications, stem cell augmentation can be a good alternative to existing biomaterial use for spinal fusion and repair.

Frequency of human papilloma virus (HPV) vaccination among female health care providers and reasons for non-immunization at a public sector hospital.

OBJECTIVE: To assess the knowledge and attitude of female healthcare providers about human papilloma virus and its vaccination, to determine the frequency of respondents vaccinated against the virus, and to evaluate the reasons for non-immunisation. METHODS: The cross-sectional study was conducted at the Jinnah Hospital, Lahore, Pakistan, from January 7 to February 20, 2022, and comprised female health care providers aged 20-60 years. Data was collected using a self-assessing questionnaire. Data was analysed using SPSS 22. RESULTS: Of the 250 individuals approached, 210(84%) took part in the study. The mean age was 28.9+/-7.99 years. Most of the subjects were house officers, medical officers or senior registrars 138(65.7%), and 126(60%) were unmarried. Overall, 170(81%) respondents knew about human papilloma virus and 174(82.9%) were aware of its link with cervical cancer. Even though 128(61%) respondents knew that the virus can be prevented by vaccine, 14(6.7%) were actually vaccinated. The vaccinated individuals had better knowledge about HPV, its spread, complications, its association with cervical cancer, prevention by vaccination and availability of vaccine compared to the non-vaccinated (p =0.05). CONCLUSIONS: The trend of human papilloma virus vaccination among female health professionals was found to be low, and lack of awareness and counselling was the leading cause.

Faculty Willingness For Continuing Online Teaching-Post COVID-19 Pandemic In Pakistan.

Objectives: To determine faculty willingness for continuing online education after coronavirus disease-2019 in Pakistan, and to correlate it with perceived gain in experience in online teaching during the pandemic. METHODS: The cross-sectional study was conducted at Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan, from January to July 2021, and comprised medical faculty with teaching experience of at least 2 years. Data was collected using an online questionnaire though Google Forms. Multiple regression analysis was done to determine faculty willingness with perceived experience levels in online education. Data was analysed using SPSS 25. RESULTS: Of the 100 subjects approached, 68(68%) responded; 51(75%) females and 17(25%) males. Of the total, 30(44.1%) participants were aged 33-40 years, 25(37%) were from Basic Sciences, 27(39.7%) from Clinical Sciences, 16(23.5%) from Allied Health Sciences, and 39(57.4%) had teaching experience <5 years.. Overall, 39 (57.4%) participants were willing to continue online education post-pandemic, 20(29.4%) agreed partially and 9 (13.2%) did not agree. A positive linear relationship was found between willingness to continue online education and increase in perceived experience level in teaching online (p=0.021). CONCLUSIONS: There was a significant difference between perceived experience level in online teaching before and after the coronavirus disease-2019 pandemic. Those with increase in perceived experience level were willing to continue online education.

Right Atrial and Endocardial Lead Mass Secondary to Anterior Mediastinal Mass Encasing Left Subclavian Vein.

INTRODUCTION: Multimodality cardiac imaging is a valuable tool for the noninvasive evaluation of right atrial masses (tumor, vegetation, or thrombus). CASE PRESENTATION: We report a case of right atrial mass that was discovered on a transthoracic echocardiogram ordered for pacemaker-pocket erythema in a 101-year-old man with heart failure/reduced left-ventricular ejection fraction and a dual-chamber pacemaker. Transthoracic and transesophageal echocardiogram showed a large hypoechoic mobile RA mass extending from the superior vena cava, with pacemaker device lead attachment. Infective endocarditis was excluded (no symptoms of systemic infection; negative blood cultures). CT angiography of the chest revealed an anterior mediastinal mass, highly suspicious for malignancy, encasing the left subclavian vein. The patient chose not to pursue invasive assessment of the mediastinal mass. Role of anticoagulation is unclear. CONCLUSION: Computed tomography complemented echocardiographic assessment and management of a right atrial mobile echo density due to a large anterior mediastinal mass.

Transient Complete Atrioventricular Block Associated With Herbal Supplement Use.

INTRODUCTION: Increasing and easy availability of so-called natural/herbal supplements pose the unique challenge of identifying associated side effects, including arrhythmias in otherwise-healthy individuals. CASE PRESENTATION: A 25-year-old female patient presented to the emergency department with fatigue and lightheadedness. The electrocardiogram showed complete AV block with a junctional escape rhythm at 55 beats per minute with QT prolongation (542ms). One week ago, she started to use a herbal medication (Muscle Eze Advanced) for muscle cramps after workouts. Extensive cardiac testing, including complete blood count, complete metabolic panel, TSH, transthoracic echocardiography, urine drug analysis, Lyme antibody were negative. Normal sinus rhythm was restored spontaneously within 1 day of discontinuing the herbal medication. PR and corrected QT intervals returned to baseline over the next two weeks. CONCLUSION: Muscle Eze Advanced consists of seven ingredients, including Melissa officinalis and Valeriana officinalis that have negative chronotropic, negative dromotrophic and QT prolonging effects. Recognizing the association between certain over-the-counter supplements and brady-arrhythmias may circumvent need for permanent pacemakers - an important consideration especially in the young.

Promoting continence in older people.

The prevalence of urinary incontinence (UI) is strongly associated with increasing age. Twenty five percent of women over 80 years of age have clinically significant symptoms in population surveys, but prevalence is as high as 70% in older hospital in-patients and residents of care homes with nursing. UI substantially affects quality of life and well-being, and generates significant economic burden for health and social care. Sadly, UI is considered as taboo by society, leading to isolation, depression and reluctance to seek help. As with all aspects of care of older people, a multi-modal approach to assessment and management is needed. Key to effective management of incontinence is recognition. As a minimum, clinicians should actively ask patients about continence, especially in older adults living with frailty. Careful evaluation and establishment of any underpinning diagnosis and aetiological factors requires comprehensive, multimodal, usually multidisciplinary, assessment. A lack of awareness of the problem and what can be done about it exists in both laypeople and clinicians, this needs correcting. An interdisciplinary approach to research and management must be the way into the future.

Facile Pressure-Sensitive Capacitive Touch Keypad for a Green Intelligent Human-Machine Interface.

There is a great demand for human-machine interfaces (HMIs) in emerging electronics applications. However, commercially available plastic-based HMIs are primarily rigid, application-specific, and hard to recycle and dispose of due to their non-biodegradability. This results in electronic and plastic waste, potentially damaging the environment by ending up in landfills and water resources. This work presents a green, capacitive pressure-sensitive (CPS), touch sensor-based keypad as a disposable, wireless, and intelligent HMI to mitigate these problems. The CPS touch keypads were fabricated through a facile green fabrication process by direct writing of graphite-on-paper, using readily available materials such as paper and pencils, etc. The interdigitated capacitive (IDC) touch sensors were optimized by analyzing the number of electrode fingers, dimensions, and spacing between the electrode fingers. The CPS touch keypad was customized to wirelessly control a robotic arm's movements based on the touch input. A low-pressure touch allows slow-speed robotic arm movement for precision movements, and a high-pressure touch allows high-speed robotic arm movement to cover the large movements quickly. The green CPS touch keypad, as a disposable wireless HMI, has the potential to enforce a circular economy by mitigating electronic and plastic waste, which supports the vision of a sustainable and green world.