Diagnostic accuracy of low dose CT-Scan abdomen in patients with clinical features of acute appendicitis.

Background & Objective: Acute appendicitis is one of the commonest causes of acute abdominal pain presenting to emergency department (ED) and Computerized Tomography scan (CT) is considered gold standard for its diagnosis. Internationally Low Dose Computerized Tomography scan (LDCT) in emergency department is recommended as a beneficial tool to diagnose acute appendicitis with less exposure to radiation and reduction in the rate of negative laparotomy. Local trials are needed to determine the diagnostic accuracy of LDCT as the first line imaging test for acute appendicitis. Our objective was to determine the diagnostic accuracy of LDCT as the first line imaging test for acute appendicitis. Methods: An observational study was conducted over a sample of 147 patients presented with suspected acute appendicitis to the emergency department of Ziauddin University Hospital, Karachi from November 2018 till May 2019. Non-probability consecutive technique used. Aged ≥ 16 years presented in emergency department with the history (symptoms) and physical examination (Signs) suspecting acute appendicitis were included. Patients with contraindications to CT scan e.g. pregnant women. Patients with signs of Acute Peritonitis requiring immediate surgery. CT scan refused by the patient or patient's attendant were excluded. Histopathology was the gold standard in diagnosing acute appendicitis. The data was analyzed using open epi sample size calculator. Results: One hundred forty six patients had positive findings on LDCT for acute appendicitis (99.3%) whereas only one patient had negative findings (0.7%). The sensitivity and specificity of LDCT for the detection of acute appendicitis were estimated as 96.45% and 16.67% by taking histopathology as gold standard. Negative predictive value (NPV) and positive predictive value (PPV) were estimated as 16.67% and 96.45% respectively. The overall accuracy of LDCT was 93.88%. Conclusion: Our study showed that for diagnosing acute appendicitis, LDCT is harmless, fast and economical imaging modality and has diagnostic accuracy with decrease in radiation dose.

Additive-manufactured paper-PMMA hybrid microfluidic chip for simultaneous monitoring of creatinine and pH in artificial urine.

Nowadays, kidney dysfunction is a common health issue due to the modernized lifestyle. Even though medications are commercially available to treat kidney diseases, early diagnosis is crucial and challenging. Clinically, measuring urine creatinine and pH has gained significant interest as a way to diagnose kidney diseases early. In the present work, we attempted to develop a low-cost, robust, accurate and naked-eye colorimetric method to determine both creatinine levels and pH variations in artificial urine samples using a simple 3D-printed hybrid microfluidic device. Creatinine was detected by the incorporation of the traditional Jaffe test onto the hybrid paper-PMMA microfluidic device and pH (4-8) was measured by a simple anthocyanin test. Notably, the tests were established without employing any sophisticated or costly instrument clusters. The developed 3D-printed microfluidic probe showed a limit of detection (LOD) of 0.04 mM for creatinine over a concentration range of 1-10 mM, with a regression coefficient (R2) of 0.995 in laboratory conditions. Interestingly, the experimental data obtained with artificial urine exhibited a wide linear range from 0.1 mM to 5 mM under different pH values ranging from 4 to 8 in the presence of matrices commonly found in urine samples other than proteins, indicating the potential use of this method in pre-clinical analysis. Since the wide linear range of urine creatinine in artificial urine samples falls well below the clinically relevant concentrations in humans (0.07-0.27 mM), the developed lab-on-chip device is further suitable for clinical evaluation with proper ethical clearance. This 3D-printed hybrid microfluidic colorimetry-based creatinine detection and pH indicator platform can be beneficial in the healthcare sector due to the on-site testing capability, cost-effectiveness, ease of use, robustness, and instrument-free approach.

Dysregulation of Gamma Delta T-Cells, CD8+ T Cells, CD4+ T Cells, and Natural Killer Cells in Brain Pathology: Understanding HIV-Induced Impairment and Exploring Targeted GSH Therapy.

This review comprehensively explores the dysregulation of Gamma Delta T-cells, CD8+ T Cells, and Natural Killer T Cells in the context of Human Immunodeficiency Virus (HIV) infection and its implications for brain pathology. It encompasses an overview of the HIV disease process, immune cell dysregulation, association with neurological diseases, and the critical role of Glutathione (GSH) in T-cell function. The alterations in Gamma Delta T-cells during chronic infection, the intricate dynamics of Vδ1 and Vδ2 subsets, and the potential of Vγ9Vδ2 T cells in inhibiting HIV replication are discussed. Additionally, the review addresses the exhaustion, impaired cytotoxicity, and premature senescence of CD8+ T cells, as well as the dysregulation of Natural Killer Cells (NKCs) and their impact on overall immune system activity. Furthermore, it examines the role of Gamma Delta (γδ) T-cells in brain injuries, infections, and tumors and highlights the therapeutic implications of elevated GSH levels in promoting a T helper 1 (Th1) immune response. However, HIV-infected patients with decreased GSH exhibit a T helper 2 (Th2) bias, compromising protection against intracellular pathogens. Finally, the review discusses studies in murine models demonstrating the impact of GSH levels on immune responses and underscores the therapeutic potential of targeting GSH to enhance immunity in HIV patients. Overall, this review provides valuable insights into the complex interplay between immune dysregulation, GSH levels, and HIV-associated brain pathology, offering insights into potential therapeutic avenues for mitigating immune compromise and neurological impairments in HIV patients.

Improvement in variance estimation using transformed auxiliary variable under simple random sampling.

This paper offers a novel approach to formulate efficient ratio estimator of the population variance using a transformed auxiliary variable. The impact of transformation on auxiliary information has also been discussed. It is observed that incorporating a transformed auxiliary variable result in a high gain in efficiency. Theoretical properties of the newly developed estimators have been derived. The empirical and simulation studies show that the suggested estimators outperformed the existing estimators.

Metastasis of lung adenocarcinoma to the pituitary gland.

Pituitary metastasis (PM) is rare occurrence and accounts for <1% of all intracranial metastatic lesions. In this study, we highlight the importance of considering atypical sites for lung adenocarcinoma metastasis by presenting a case of a 54-year-old male who was diagnosed with PM 15 months after being diagnosed with stage IV lung adenocarcinoma with metastasis to the spine, pelvis, left frontal lobe, and right occipital lobe. He was on a prolonged course of chemotherapy during those 15 months and received palliative radiation for his brain metastasis with subsequent remission after 5 months following his initial diagnosis. The pituitary lesion was picked up as an incidental finding on a routine staging magnetic resonance imaging (MRI) 10 months after his brain metastasis remission. The patient successfully underwent trans-sphenoidal pituitary lesion resection. This case emphasizes the importance of routine surveillance and examination of atypical sites of metastasis even in patients undergoing a prolonged course of chemotherapy.

Spatial-dependent suppressive aftereffect produced by a sound in the rat's inferior colliculus is partially dependent on local inhibition.

In a natural acoustic environment, a preceding sound can suppress the perception of a succeeding sound which can lead to auditory phenomena such as forward masking and the precedence effect. The degree of suppression is dependent on the relationship between the sounds in sound quality, timing, and location. Correlates of such phenomena exist in sound-elicited activities of neurons in hearing-related brain structures. The present study recorded responses to pairs of leading-trailing sounds from ensembles of neurons in the rat's inferior colliculus. Results indicated that a leading sound produced a suppressive aftereffect on the response to a trailing sound when the two sounds were colocalized at the ear contralateral to the site of recording (i.e., the ear that drives excitatory inputs to the inferior colliculus). The degree of suppression was reduced when the time gap between the two sounds was increased or when the leading sound was relocated to an azimuth at or close to the ipsilateral ear. Local blockage of the type-A γ-aminobutyric acid receptor partially reduced the suppressive aftereffect when a leading sound was at the contralateral ear but not at the ipsilateral ear. Local blockage of the glycine receptor partially reduced the suppressive aftereffect regardless of the location of the leading sound. Results suggest that a sound-elicited suppressive aftereffect in the inferior colliculus is partly dependent on local interaction between excitatory and inhibitory inputs which likely involves those from brainstem structures such as the superior paraolivary nucleus. These results are important for understanding neural mechanisms underlying hearing in a multiple-sound environment.

Stemphylium lycopersici and Stemphylium solani improved antioxidant system of soybean under chromate stress.

Ecologists around the world are giving great attention to the metal pollution of agronomic soil. Recently, several techniques have been employed to remediate heavy metals, but the use of microorganisms is cheap, less time-consuming, and easily available. In the current study, the endophytic strains, Cp1 and Cp2 were isolated from sterilized 1-5 cm long root and leaf segments of Chlorophytum comosum using Hagem media. To get pure colonies, the strains were repeatedly cultured on potato dextrose agar (PDA) media. The strains Cp1 and CP2 were identified as Stemphylium lycopersici and Stemphylium solani based on ITS sequencing and neighbor joining (NJ) method. Both strains showed a growth-promoting potential in soybean seedlings exposed to chromate (Cr) stress. Moreover, S. lycopersici and S. solani improved the Indole-3-acetic acid (IAA), flavonoids, phenolics, protein, and proline contents, whereas, lowered Salicylic acid (SA) production in the seedlings. The selected endophytic fungal strains also promoted the antioxidant system of soybean seedlings through enhanced production of ascorbic acid oxidase (AAO), catalases (CAT), peroxidase, and free radical scavenging enzymes. Both strains bio-transformed the toxic Cr-VI to less toxic Cr-III in the cultural filtrate as well as host plants. In fact, efficient uptake of Cr and its conversion by the isolated endophytic fungal strains could be used as a viable tool to remediate Cr contamination in agricultural soils.

Endophytic Fusarium oxysporum GW controlling weed and an effective biostimulant for wheat growth.

Wheat crop has to compete with several weeds including Avena fatua, a noxious weed that alone is responsible for 30-70% losses in the yield annually. Because of the environmental concerns associated with conventional methods, researchers are on a continuous hunt to find clean alternatives in order to manage weeds. Fungi have shown promising weedicide potential in lab studies. The current study aimed to isolate endophytic fungi from wheat plants which can promote wheat growth and inhibit the growth of common weed, A. fatua. Of several isolates, GW (grayish white) was selected for its promising features, and the strain was identified as Fusarium oxisporum through ITS sequencing technique. This fungus released a number of compounds including Isovitexin, Calycosin, quercetagetin, and dihydroxy-dimethoxyisoflavone that inhibited the growth of A. fatua but did not influence the growth of wheat seedlings. Biomass of this fungus in the soil also reduced growth parameters of the weed and promoted the growth of wheat. For instance, the vigor index of A. fatua seedlings was reduced to only 6% of the control by this endophyte. In contrast, endophyte-associated wheat seedlings showed a higher vigor index than the control. Behind this differential response of the two plants were their contrasting physiological and biochemical status. Lower growth phenotypes of A. fatua seedlings had reduced levels of IAA, GAs, and SA and higher the levels of JA and ABA. Besides, their ROS scavenging ability was also compromised as evident from relatively lower activities of catalase, peroxidase, and ascorbic acid oxidase, as well as higher accumulation of ROS in their leaves. Wheat seedlings response to GW was opposite to the A. fatua. It may be concluded that F. oxysporum GW has the ability to differentially modulate physiology and biochemistry of the two hosts leading to contrasting phenotypic responses.

Use of diesel and emulsified diesel in CI engine: A comparative analysis of engine characteristics.

Despite a number of efforts to evaluate the utility of water-diesel emulsions (WED) in CI engine to improve its performance and reduce its emissions in search of alternative fuels to combat the higher prices and depleting resources of fossil fuels, no consistent results are available. Additionally, the noise emissions in the case of WED are not thoroughly discussed which motivated this research to analyze the performance and emission characteristics of WED. Brake thermal efficiency (BTE) and brake specific fuel consumption (BSFC) were calculated at 1600 rpm within 15%-75% of the load range. Similarly, the contents of NOx, CO, and HC, and level of noise and smoke were measured varying the percentage of water from 2% to 10% gradually for all values of loads. BTE in the case of water emulsified diesel was decreased gradually as the percentage of water increased accompanied by a gradual increase in BSFC. Thus, WED10 showed a maximum 13.08% lower value of BTE while BSFC was increased by 32.28%. However, NOx emissions (21.8%) and smoke (48%) were also reduced significantly in the case of WED10 along with an increase in the emissions of HC and CO and noise. The comparative analysis showed that the emulsified diesel can significantly reduce the emission of NOx and smoke, but it has a negative impact on the performance characteristics and HC, CO, and noise emissions which can be mitigated by trying more fuels variations such as biodiesel and using different water injection methods to decrease dependency on fossil fuels and improve the environmental impacts of CI engines.

A Gull Alpha Power Weibull distribution with applications to real and simulated data.

In this paper, we produced a new family of distribution called Gull Alpha Power Family of distributions (GAPF). A Special case of GAPF is derived by considering the Weibull distribution as a baseline distribution called Gull Alpha Power Weibull distribution (GAPW). The suitability of the proposed distribution derives from its ability to model both the monotonic and non-monotonic hazard rate functions which are a common practice in survival analysis and reliability engineering. Various statistical properties were derived in addition to their special cases. The unknown parameters of the model are estimated using the maximum likelihood method. Moreover, the usefulness of the proposed distribution is supported by using two real lifetime data sets as well as simulated data.

Lomax exponential distribution with an application to real-life data.

In this paper, a new modification of the Lomax distribution is considered named as Lomax exponential distribution (LE). The proposed distribution is quite flexible in modeling the lifetime data with both decreasing and increasing shapes (non-monotonic). We derive the explicit expressions for the incomplete moments, quantile function, the density function for the order statistics etc. The Renyi entropy for the proposed distribution is also obtained. Moreover, the paper discusses the estimates of the parameters by the usual maximum likelihood estimation method along with determining the information matrix. In addition, the potentiality of the proposed distribution is illustrated using two real data sets. To judge the performance of the model, the goodness of fit measures, AIC, CAIC, BIC, and HQIC are used. Form the results it is concluded that the proposed model performs better than the Lomax distribution, Weibull Lomax distribution, and exponential Lomax distribution.

Geographical origin of Chinese apples based on multiple element analysis.

BACKGROUND: Apples from different regions of China show different qualities and internal characteristics, and appeal to different customers. However, these aspects have not been studied in depth. We characterized the profiles of 14 elements in 317 apple samples collected from five regions of China. Principal component analysis (PCA), linear discriminant analysis (LDA), and back-propagation artificial neural networks analysis (BP-ANN) were used to build models for apple authentication. RESULTS: Fourteen elements were successfully identified in apple samples by performing graphite furnace atomic absorption spectrometry (GFAAS) and inductively coupled plasma atomic emission spectroscopy (ICP-AES) analyses. Comparative analysis showed significantly different element profiles in samples from different regions. The first five principal components obtained by PCA accounted for 71.8% of the total variance. The LDA obtained 70.0% classification rates. The BP-ANN obtained 82.7% classification rates. CONCLUSION: This study indicated the possibility that apples could be authenticated based on differences in their element profiles, and provided a basis for further geographical origin studies. © 2019 Society of Chemical Industry.

Unlicensed and off-label use of drugs in pediatric surgical units at tertiary care hospitals of Pakistan.

Background Unlicensed and off-label prescribing practice is global dilemma around the world. This pioneering study was designed to determine unlicensed and off-label use of drug in surgical wards of tertiary care hospitals of Pakistan. Objective To assess unlicensed and off-label use of drugs in pediatric surgical unit at three tertiary care hospitals in Peshawar, Pakistan. Setting Two government and one private tertiary care hospitals in Pakistan. Method Drug profiles of 895 patients from three different clinical settings were evaluated for unlicensed and off-label use of drugs using Micromedex DRUGDEX. Main outcome measure Characteristics of the unlicensed and off-label drug prescriptions. Result Total of 3168 prescribed drugs were analyzed in this study. Indication (38.7%) and dose (34.8%) were the most frequent off-label categories. In comparison with the corresponding reference categories, infants and children, male patients and having less than five prescribed drugs were significant predictors of unlicensed prescriptions. In comparison with the corresponding reference categories, significant predictors of off-label drug prescribing were children younger than two year, children between 2-12 years, patient staying at hospital less than 5 days and patients having less than five prescribed drugs. Conclusion The prevalence of unlicensed and off-label drug prescriptions are high at pediatric surgical ward of tertiary care hospitals. More awareness of the efficacy and safety of drugs are required in pediatrics. In addition, new formulations with advanced dosing for children are also required to minimize the risk of adverse outcomes.

Proton pump inhibitors use; beware of side-effects.

Proton pump inhibitors are most widely prescribed medicines all over the world. Since their introduction in pharmacy, life of millions of people has changed completely. Their ability to inhibit acid secretion in stomach has changed the natural history of many once-dreaded conditions like peptic ulcer and gastroesophageal reflux disease. Operation like gastrectomy and partial gastrectomy are carried out very rarely. These medicines are considered very cost-effective, have excellent safety profile, and provide prompt symptomatic relief. However, they are not without side effects, and several warnings have been issued by the Food and Drug Agency of the United States about the risk of hypomagnesaemia, possibility of increased fracture risk, and reduction in efficacy of clopidogrel by concomitant use of proton pump inhibitors. But despite all these warnings, their use is still on the rise. This Review was planned to highlight side effects and drug interactions so that a practising physician may keep the rare but potentially devastating effects in mind while prescribing the pumps.