Association between exposure to ambient air pollution, meteorological factors and atopic dermatitis consultations in Singapore-a stratified nationwide time-series analysis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting approximately 20% of children globally. While studies have been conducted elsewhere, air pollution and weather variability is not well studied in the tropics. This time-series study examines the association between air pollution and meteorological factors with the incidence of outpatient visits for AD obtained from the National Skin Centre (NSC) in Singapore. The total number of 1,440,844 consultation visits from the NSC from 2009 to 2019 was analysed. Using the distributed lag non-linear model and assuming a negative binomial distribution, the short-term temporal association between outpatient visits for AD and air quality and meteorological variability on a weekly time-scale were examined, while adjusting for long-term trends, seasonality and autocorrelation. The analysis was also stratified by gender and age to assess potential effect modification. The risk of AD consultation visits was 14% lower (RR10th percentile: 0.86, 95% CI 0.78-0.96) at the 10th percentile (11.9 µg/m3) of PM2.5 and 10% higher (RR90th percentile: 1.10, 95% CI 1.01-1.19) at the 90th percentile (24.4 µg/m3) compared to the median value (16.1 µg/m3). Similar results were observed for PM10 with lower risk at the 10th percentile and higher risk at the 90th percentile (RR10th percentile: 0.86, 95% CI 0.78-0.95, RR90th percentile: 1.10, 95% CI 1.01-1.19). For rainfall for values above the median, the risk of consultation visits was higher up to 7.4 mm in the PM2.5 model (RR74th percentile: 1.07, 95% CI 1.00-1.14) and up to 9 mm in the PM10 model (RR80th percentile: 1.12, 95% CI 1.00-1.25). This study found a close association between outpatient visits for AD with ambient particulate matter concentrations and rainfall. Seasonal variations in particulate matter and rainfall may be used to alert healthcare providers on the anticipated rise in AD cases and to time preventive measures to reduce the associated health burden.

The effect of oral anticoagulants on the incidence of dementia in patients with atrial fibrillation: A systematic review and meta-analysis.

Background: Dementia is a recognized complication of atrial fibrillation (AF). Oral anticoagulant (OAC) therapy can potentially be protective against this complication. Methods: A comprehensive search of MEDLINE and Embase for comparative observational studies reporting the efficacy of OAC therapy for the incidence of dementia in patients with AF was conducted from its inception until March 2023. Studies that had patients with prior use of OAC or with a previous history of dementia were excluded. Results: A total of 22 studies were included in this review involving 617,204 participants. The pooled analysis revealed that OAC therapy, including direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), was associated with a reduced incidence of dementia in AF patients. Specifically, compared to non-OAC treatment, OACs demonstrated a significant reduction in dementia incidence (HR 0.68, 95 % CI [0.58, 0.80], p < 0.00001), with similar findings observed for DOACs (HR 0.69, 95 % CI [0.51, 0.94], p = 0.02) and VKAs (HR 0.73, 95 % CI [0.56, 0.95], p = 0.02). The comparison of DOAC vs VKA revealed that DOACs are associated with reduced risk of dementia (HR 0.87, 95 % CI [0.79, 0.96], p = 0.004). Conclusion: Our SR and meta-analysis showed that the use of OAC therapy is associated with a reduced risk of dementia in individuals with AF. However, our results are limited by the potential influence of confounding bias and significant heterogeneity in the analyses.

Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo-Surgical Aortic Valve Replacement in Patients With Aortic Stenosis: A Systematic Review and Meta-analysis.

Aortic stenosis is a common and significant valve condition requiring bioprosthetic heart valves with transcatheter aortic valve replacement (TAVR) being strongly recommended for high-risk patients or patients over 75 years. This meta-analysis aimed to pool existing data on postprocedural clinical as well as echocardiographic outcomes comparing valve-in-valve (ViV)-TAVR to redo-surgical aortic valve replacement to assess the short-term and medium-term outcomes for both treatment methods. A systematic literature search on Cochrane Central, Scopus, and Medline (PubMed interface) electronic databases from inception to August 2023. We used odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Twenty-four studies (25,216 patients) were pooled with a mean follow-up of 16.4 months. The analysis revealed that ViV-TAVR group showed a significant reduction in 30-day mortality (OR 0.50, 95% confidence interval [CI] 0.43 to 0.58, p <0.00001), new-onset atrial fibrillation (OR 0.34, 95% CI 0.17 to 0.67, p = 0.002), major bleeding event (OR 0.28, 95% CI 0.17 to 0.45, p <0.00001) and lower rate of device success (OR 0.25, 95% CI 0.12 to 0.53, p = 0.0003). There were no significant differences between either group when assessing 1-year mortality, stroke, myocardial infarction, postoperative left ventricular ejection fraction, and effective orifice area. ViV-TAVR cohort showed a significantly increased incidence of paravalvular leaks, aortic regurgitation, and increased mean aortic valve gradient. ViV-TAVR is a viable short-term option for elderly patients with high co-morbidities and operative risks, reducing perioperative complications and improving 30-day mortality with no significant cardiovascular adverse events. However, both treatment methods present similar results on short-term to medium-term complications assessment.

Spontaneous Preterm Births in Malaysia: Are There Modifiable Antenatal Risk Factors?

Background Spontaneous preterm birth (SPB) is a global public health concern with devastating health effects on SPB survivors. This study aimed to determine modifiable antenatal risk factors associated with SPB among women attending government healthcare facilities in Malaysia. Methodology A retrospective record review of 49,416 national obstetrics registry data from 2015 was conducted and analyzed using binary logistic regression based on six antenatal factor divisions. Results Mothers with pre-existing diabetes had higher odds (adjusted odds ratio (aOR) = 3.09) of delivering prematurely than mothers without diabetes. Mothers with chronic hypertension with superimposed pre-eclampsia (aOR = 2.51) and gestational hypertension (aOR = 1.44) had higher odds of experiencing preterm birth than mothers with no hypertension. Underweight mothers had higher odds (aOR = 1.27) of delivering prematurely than mothers with an ideal body mass index (18.5 to <25.0 kg/m2). Mothers with moderate anemia (hemoglobin level: 7 to <9 g/dL) had higher odds (aOR = 1.18) of preterm birth than mothers with normal hemoglobin levels (≥11 g/dL). Conclusions Maternal biomarkers, such as glucose level, blood pressure, BMI, and hemoglobin level, play an important role in reducing the rate of SPB in Malaysia. This study recommends strengthening pre-pregnancy, antenatal, and postpartum care through multidisciplinary and multi-agency team collaboration, addressing both modifiable and non-modifiable risk factors and adopting a dual approach that combines preventive and curative care.

From Skin to Solution: Exploring Epicutaneous Immunotherapy for Peanut Allergy-A Systematic Review and Meta-Analysis.

Peanut allergy is a leading cause of severe food reactions. This meta-analysis evaluates the efficacy and safety of epicutaneous immunotherapy (EPIT) compared to placebo for peanut-allergic individuals. After prospectively registering on PROSPERO, we searched three databases (PubMed, Google Scholar, and Cochrane CENTRAL) and 2 trial registries till September 2023. Analysis was conducted via RevMan where data was computed using risk ratios (RR). The Cochrane Risk of Bias tool and GRADE criteria were used to appraise and evaluate the evidence. From 4927 records, six multicenter randomized placebo-controlled trials comprising 1453 participants were included. The 250 µg EPIT group had a significant increase in successful desensitization compared to placebo (RR: 2.13 (95% C.I: 1.72, 2.64), P < 0.01, I2 = 0%), while the 100 µg EPIT group did not (RR: 1.54 (95% C.I: 0.92, 2.58), P = 0.10, I2 = 0%) (moderate certainty evidence). Moreover, there was a significant increase in local (RR: 1.69 (95% C.I: 1.06, 2.68), P = 0.03, I2 = 89%) and systemic adverse events (RR: 1.75 (95% C.I: 1.14, 2.69), P = 0.01, I2 = 0%) with EPIT. Additionally, individuals administered EPIT have an increased probability of requiring rescue medications like epinephrine (RR: 1.91 (95% C.I: 1.12, 3.28), P = 0.02, I2 = 0%) and topical corticosteroids (RR: 1.49 (95% C.I: 1.29, 1.73), P < 0.01, I2 = 0%) to treat adverse events. The association of adverse events post-treatment including anaphylaxis (RR: 2.31 (95% C.I: 1.00, 5.33), P = 0.05, I2 = 36%), skin/subcutaneous disorders like erythema or vesicles (RR: 0.93 (95% C.I: 0.79, 1.08), P = 0.33, I2 = 0%), and respiratory disorders like dyspnea or wheezing (RR: 0.94 (95% C.I: 0.77, 1.15), P = 0.55, I2 = 0%) with EPIT is inconclusive. EPIT, although effective in desensitization, is linked to an increased risk of adverse events. PROSPERO registration: CRD42023466600.

Characterization and in-vitro plant-based control of hindgut bacteria isolated from Odontotermes obesus Rambur (Termitidae) and Heterotermes indicola Wasmann (Rhinotermitidae).

Termites cause a serious menace to wooden structures all over the world. They rely mostly on entozoic fauna residing in their hindgut for the digestion of cellulosic and hemicellulosic materials. One of the ways to control termites is through their gut symbionts. The present study was designed to characterize the hindgut bacteria isolated from Odontotermes obesus and Heterotermes indicola. Furthermore, the growth inhibitory effect of eight tropical plant extracts was investigated to find out potential control agents for these bacterial isolates. The characterization of bacteria was carried out based on their morphology, Gram staining, biochemical and amplification of 16SrRNA gene. Amplified products were sequenced to confirm their relationship with bacterial isolates from termites of other regions. The growth inhibitory effect of ethanolic leaf extracts of eight plants was evaluated in an invitro agar well diffusion method. Qualitative and quantitative phytochemical analysis of the most effective plant was carried out to learn about bioactive agents. The results confirmed the presence of five bacteria from each termite species. The Bacillus cereus, Escherichia coli, and Lysinibacillus fusiformis were common to both termites whereas Lysinibacillus xylanilyticus and Lysinibacillus macrolides were found in O. obesus only and H. indicola harbor Bacillus subtilis and Shigella sonnei in addition to common three ones. Among the plant extracts of Carica papaya, Eucalyptus camaldulensis, Osmium basilicum, Grevillea robusta, Eucalyptus globulus, Pongamia pinnata, Mentha longifolia, and Melia azedarach, the G. robusta > E. camaldulensis > O. basilicum were found to have growth inhibitory effects with increasing concentrations from 100 to 2000 µg/mL. The biodiversity of the bacterial fauna is important for the biological control of termites. Leaf extracts of these medicinal plants can be used to control termite infestation in an environment-friendly manner to save huge economic loss.

Phenolic compounds of Theobroma cacao L. show potential against dengue RdRp protease enzyme inhibition by In-silico docking, DFT study, MD simulation and MMGBSA calculation.

BACKGROUND: Currently, there is no antiviral medication for dengue, a potentially fatal tropical infectious illness spread by two mosquito species, Aedes aegypti and Aedes albopictus. The RdRp protease of dengue virus is a potential therapeutic target. This study focused on the in silico drug discovery of RdRp protease inhibitors. METHODS: To assess the potential inhibitory activity of 29 phenolic acids from Theobroma cacao L. against DENV3-NS5 RdRp, a range of computational methods were employed. These included docking, drug-likeness analysis, ADMET prediction, density functional theory (DFT) calculations, and molecular dynamics (MD) simulations. The aim of these studies was to confirm the stability of the ligand-protein complex and the binding pose identified during the docking experiment. RESULTS: Twenty-one compounds were found to have possible inhibitory activities against DENV according to the docking data, and they had a binding affinity of ≥-37.417 kcal/mol for DENV3- enzyme as compared to the reference compound panduratin A. Additionally, the drug-likeness investigation produced four hit compounds that were subjected to ADMET screening to obtain the lead compound, catechin. Based on ELUMO, EHOMO, and band energy gap, the DFT calculations showed strong electronegetivity, favouravle global softness and chemical reactivity with considerable intra-molecular charge transfer between electron-donor to electron-acceptor groups for catechin. The MD simulation result also demonstrated favourable RMSD, RMSF, SASA and H-bonds in at the binding pocket of DENV3-NS5 RdRp for catechin as compared to panduratin A. CONCLUSION: According to the present findings, catechin showed high binding affinity and sufficient drug-like properties with the appropriate ADMET profiles. Moreover, DFT and MD studies further supported the drug-like action of catechin as a potential therapeutic candidate. Therefore, further in vitro and in vivo research on cocoa and its phytochemical catechin should be taken into consideration to develop as a potential DENV inhibitor.

Unravelling the link between SARS-CoV-2 mutation frequencies, patient comorbidities, and structural dynamics.

Genomic surveillance is crucial for tracking emergence and spread of novel variants of pathogens, such as SARS-CoV-2, to inform public health interventions and to enforce control measures. However, in some settings especially in low- and middle- income counties, where sequencing platforms are limited, only certain patients get to be selected for sequencing surveillance. Here, we show that patients with multiple comorbidities potentially harbour SARS-CoV-2 with higher mutation rates and thus deserve more attention for genomic surveillance. The relationship between the patient comorbidities, and type of amino acid mutations was assessed. Correlation analysis showed that there was a significant tendency for mutations to occur within the ORF1a region for patients with higher number of comorbidities. Frequency analysis of the amino acid substitution within ORF1a showed that nsp3 P822L of the PLpro protease was one of the highest occurring mutations. Using molecular dynamics, we simulated that the P822L mutation in PLpro represents a system with lower Root Mean Square Deviation (RMSD) fluctuations, and consistent Radius of gyration (Rg), Solvent Accessible Surface Area (SASA) values-indicate a much stabler protein than the wildtype. The outcome of this study will help determine the relationship between the clinical status of a patient and the mutations of the infecting SARS-CoV-2 virus.

Use of thermal drone in detection and assessment of larval mass temperature in decomposed rabbit carcasses.

Manual ground searches and cadaver dogs are traditional methods for locating remains, but they can be time- and resource-intensive, resulting in the decomposition of bodies and delay in victim identification. Therefore, thermal imaging has been proposed as a potentially useful tool for detecting remains based on their temperature. This study investigated the potential of a novel search technique of thermal drones to detect surface remains through the detection of maggot mass temperatures. Two trials were carried out at Selangor, Malaysia, each utilizing 12 healthy male Oryctolagus cuniculus European white rabbits and DJI Matrice 300 RTK drone China, equipped with a thermal camera; Zenmuse H20T to record the thermal imaging footage of the carcasses at various heights (15, 30, 60-100 m) for 14 days for each trial. Our results demonstrated that the larval masses and corresponding heat emissions were at their largest during the active decay stage; therefore, all the carcasses were observable in thermal images on day 5 and remained until day 7. Statistical analyses showed that (1) no statistically significant differences in thermal images between clothed and unclothed subjects (p > 0.05); (2) 15 m above ground level was proven to be the optimal height, as it showed the greatest contrast between the carcass heat signature and the background (p < 0.005). Our data suggested the potential window of detection of thermal signatures was detectable up to 7 days post-deposition. This could be an important guideline for the search and recovery teams for operational implementation in this tropical region.

Evaluating sustainable municipal solid waste management scenarios: A multicriteria decision making approach.

Due to increasing urbanization and population growth, municipal solid waste management (MSWM) is a significant environmental concern in developing countries. Inadequate waste management systems lead to environmental pollution, health hazards, and economic losses. While considering the challenges and limitations, policymakers and authorities need to opt for such waste management scenarios that are environmentally friendly and resolve energy issues. Ten MSWM scenarios were developed and evaluated using seven different criteria. Four multi-criteria decision-making (MCDM) techniques, namely fuzzy logic, AHP, TOPSIS, and PROMETHEE II, were employed to rank the scenarios and identify the most appropriate option for solid waste management in Lahore. This study highlights that the optimal waste management approach comprises a composition of 54% anaerobic digestion, 37% gasification, and 9% landfill technologies. These percentages collectively represent the most suitable and effective strategies for the city's waste management needs. All the MCDM techniques consistently produce similar results. These scenarios have broader applicability across cities in Central Asia and beyond. The study's findings are aligned to promote sustainable and environmentally friendly MSWM practices. These findings endorse implementing strategies and measures aimed at fostering environmental sustainability and the responsible handling of waste, serving as a valuable reference for various regions.

Introduction of Aedes aegypti mosquitoes carrying wAlbB Wolbachia sharply decreases dengue incidence in disease hotspots.

Partial replacement of resident Aedes aegypti mosquitoes with introduced mosquitoes carrying certain strains of inherited Wolbachia symbionts can result in transmission blocking of dengue and other viruses of public health importance. Wolbachia strain wAlbB is an effective transmission blocker and stable at high temperatures, making it particularly suitable for hot tropical climates. Following trial field releases in Malaysia, releases using wAlbB Ae. aegypti have become operationalized by the Malaysian health authorities. We report here on an average reduction in dengue fever of 62.4% (confidence intervals 50-71%) in 20 releases sites when compared to 76 control sites in high-rise residential areas. Importantly the level of dengue reduction increased with Wolbachia frequency, with 75.8% reduction (61-87%) estimated at 100% Wolbachia frequency. These findings indicate large impacts of wAlbB Wolbachia invasions on dengue fever incidence in an operational setting, with incidence expected to further decrease as wider areas are invaded.

Development of low-cost and high-efficiency solar modules based on perovskite solar cells for large-scale applications.

Solar energy has emerged as a viable and competitive renewable resource due to its abundance and cost-effectiveness. To meet the global energy demands, there is a growing need for efficient devices with unique compositions. In this study, we designed and analyzed a perovskite solar cell (PSC) incorporating methylammonium tin iodide (CH3NH3SnI3) as the active optical absorber material, tin iodide (SnO2) as the electron transport layer (ETL), and copper thiocyanate (CuSCN) as the hole transport layer (HTL) using SCAPS-1D software for numerical investigations. Subsequently, the optimized outcomes were implemented in the PVSyst software package to derive the characteristics of a solar module based on the proposed novel solar cell composition. The objective of our research was to enhance the stability of solar cell for use in solar module. This was achieved by optimizing the thicknesses of the compositional layers which resulted in the enhancement of excess electron and hole mobilities and a reduction in defect densities, thereby leading to an improvement in the device performance. The optimization of excess electron and hole mobilities, as well as defect densities, was conducted to improve the device performance. SCAPS calculations indicated that the perovskite absorber layer (CH3NH3SnI3) may achieve the best possible performance with a maximum optimized thickness of 3.2 µm. The optimized thickness value for CuSCN-HTL and SnO2-ETL were found to be 0.07 µm and 0.05 µm respectively resulting in a maximum power conversion efficiency (PCE) of 23.57%. Variations in open circuit voltage (Voc), short circuit current (Jsc), fill factor (FF %), and quantum efficiency (QE) associated with the optimized thickness values of all layers in the ITO/SnO2/CH3NH3SnI3/CuSCN/Mo composition were critically analyzed. The use of these input parameters resulted in power creation of 557.4 W for a module consisting of 72 cells with an annual performance ratio of 80.3%. These recent investigations are expected to be effective in the design and fabrication of eco-friendly and high-performance solar cells in terms of efficiency.

Innovative technologies for removal of micro plastic: A review of recent advances.

Plastics are becoming a pervasive pollutant in every environmental matrix, particularly in the aquatic environment. Due to increased plastic usage and its impact on human and aquatic life, microplastic (MP) pollution has been studied extensively as a global issue. The production of MP has been linked to both consumer and commercial practices. There is a significant amount of MP's that must be removed by wastewater treatment plants before they can be bioaccumulated. Many researchers have recently become interested in the possibility of eliminating MPs in wastewater treatment plants (WWTP). Many studies have analyzed MP's environmental effects, including its emission sources, distribution, and impact on the surrounding environment. The effectiveness of their removal by various wastewater treatment technologies requires a critical review that accounts for all these methods. In this review, we have covered the most useful technologies for the removal of MP during WWTP. The findings of this review should help scientists and policymakers move forward with studies, prototypes, and proposals for significant remediation impact on water quality.

Comparison of postoperative hypersensitivity between Total-etch and Universal adhesive system: a randomized clinical trial.

The objective was to determine the postoperative hypersensitivity of two-step Total-etch as compared to one-step Universal adhesives followed by composite restorations on 100 patients by applying Total-etch on one tooth and Universal adhesive on another tooth. The bonds and teeth were randomly selected. Postoperative hypersensitivity was recorded by visual analog scale before, immediately after, and 24 h after the restoration using cold stimulus. The Mann-Whitney test was applied for statistical comparison of postoperative hypersensitivity between the two bonds as well as for any significant difference in genders with each bond. No significant difference was found between postoperative hypersensitivity of the two adhesives before (p-value = 0.57), immediately after (p-value = 0.604), and 24 h after (p-value = 0.728) the restoration. Males showed more hypersensitivity with Total-etch as compared to females before (p-value = 0.037), immediately after (p-value = 0.047), and 24 h after the restoration (p-value = 0.022). No significant difference was found between gender and Universal adhesive at all three stages (p-value > 0.05). The results suggest no significant difference in postoperative hypersensitivity between the two materials when good sample size and proper technique were observed along with the removal of bias like different patients having different pain perceptions and multiple operators having different operating skills. Males showed more hypersensitivity to Total-etch.Trial registration number: Australian New Zealand Clinical Trials. Registry number: ACTRN12622001213730. (Retrospectively registered: 09/09/2022).

Face-to-face and e-learning during the COVID-19 pandemic: A Pakistani dental undergraduates perspective.

BACKGROUND: Globally, educational institutes have been obliged to make a quick transition from traditional face-to-face teaching to e-learning during the coronavirus disease 2019 (COVID-19) pandemic, which has purportedly created various barriers to achieving desired learning outcomes. OBJECTIVE: The aim of our study was to assess the perceptions of undergraduate dental students regarding online and physical learning in Pakistan. METHODS: This cross-sectional study was conducted from January to March 2022. The study comprised dental students from 1st to 4th years who were above the age of 18 and of either gender. The Google Forms questionnaire was created to evaluate the quality and efficiency of online and physical learning among dentistry undergraduates. RESULTS: In a survey of 246 students, 70.3% strongly agreed that they would prefer face-to-face instruction over e-learning. There was a statistically significant difference in the improvement of students' technical skills (p = 0.01), accessibility to instructors (p = 0.01) and classmates (p = 0.02), value of technology (p = 0.03), improvement of oral communication skills (p = 0.01), promotion of hybrid model learning after the pandemic (p = 0.01), and utilization of tutorial services (p = 0.04) between different year of study. CONCLUSION: Pakistani dental students indicated satisfaction with numerous aspects of e-learning, such as technical skills, accessibility to instructors and classmates, the value of technology, improvement of oral communication skills, promotion of hybrid model learning, and utilization of tutorial services compared to face-to-face education concerning the year of study.

Development of Data-driven Machine Learning Models and their Potential Role in Predicting Dengue outbreak.

ABSTRACT: Dengue fever is one of the most widespread vector-borne viral infections in the world, resulting in increased socio-economic burdens. The WHO has reported that 2.5 billion people are infected with dengue fever across the world, resulting in high mortalities in tropical and subtropical regions. The current article endeavors to present an overview of predicting dengue outbreaks through data-based machine-learning models. This artificial intelligence model uses real-world data such as dengue surveillance, climatic variables, and epidemiological data and combines big data with machine learning algorithms to forecast dengue. Monitoring and predicting dengue incidences have been significantly enhanced through innovative approaches. This involves gathering data on various climatic factors, including temperature, rainfall, relative humidity, and wind speed, along with monthly records of dengue cases. The study functions as an efficient warning system, enabling the anticipation of dengue outbreaks. This early warning system not only alerts communities but also aids relevant authorities in implementing crucial preventive measures.

The effect of having a physician in the triage area on the rate of patients leaving without being seen: A quality improvement initiative at King Fahad Specialist hospital.

OBJECTIVES: To evaluate the effect of the presence of a physician in the triage area on the number of patients who leave without being seen (LWBS) and some of the factors affecting emergency department (ED) crowding. METHODS: This was a pre-post study carried out at King Fahad Specialist Hospital, Dammam, Saudi Arabia. The 3-month study, consisting of 7826 patients, was split into pre-physician and post-physician periods. Variables compared across these periods were the number of LWBS patients, length of hospital stay, time to physician, and time to disposition decision. Statistical analysis was carried out using R version 4.3.0. RESULTS: Our results showed that the presence of a triage physician significantly decreased the number of LWBS patients (p<0.001) and the time taken to encounter an ED physician (p<0.001). However, it did not have any significant impact on the length of hospital stay (p=0.5) or time to disposition decision (p=0.9). CONCLUSION: The appointment of a triage physician has streamlined patient flow and decreased LWBS rates in the ED, demonstrating the need for more thorough research in this area.

Management of Rectal Wall Abscess: A Rare Case Report.

A 34-year-old male presented with spontaneous rectal pain. He was diagnosed with a posterior rectal wall abscess 7 cm proximal to the anal verge that was confirmed on an MRI (magnetic resonance imaging) pelvis. This abscess was drained through a transrectal route. Rectal wall abscess is an exceedingly rare pathology compared to perianal abscess; therefore, this case highlights the key aspects of its management.

Role of diet and dietary habits in causing dental caries among adults reporting to a tertiary care hospital in Pakistan; a case-control study.

Objective: To determine the association of diet and dietary practices with dental caries among adults. Design: A case-control study. Setting: Operative Department, Rawal Institute of Health Sciences, Islamabad, Pakistan. Participants: 300 participants of both genders, aged 25-50 years. Interventions: A food frequency questionnaire and a patient proforma were used to determine the frequency and preferences of diet and dietary habits that may be associated with dental caries among adults, respectively. The diet and dietary habits of 150 adults with caries (cases) were compared with those of 150 adults without dental caries (control). An independent sample T-test was applied to determine the difference in mean age. Mann-Whitney and Chi-Square tests were applied to determine the significance of diet and dietary habits respectively. Multivariate logistic regression analysis determined the odd ratio change in significant variables. P-value ≤0.05 was considered significant. Results: Refined sugar (p-value = 0.69), fruit juices (p-value = 0.45), carbonated beverages (p-value = 0.91), duration of consumption of sugary food (p-value = 0.07), and frequency of brushing (p-value = 0.15) were not found to be significantly associated with dental caries in adults. The gender (p-value = 0.02), preferred time for eating sugary foods (p-value <0.001), smoking (p-value <0.001), and tea consumption (p-value = 0.02) were found to be significantly associated with dental caries. Conclusion: Adults who regularly consumed sugar as a snack other than regular mealtimes were more likely to be associated with dental caries. Men, smokers, and adults who frequently took shots of sugar with their tea were more likely to be associated with dental caries.

Soil erosion vulnerability and soil loss estimation for Siran River watershed, Pakistan: an integrated GIS and remote sensing approach.

Soil erosion is a problematic issue with detrimental effects on agriculture and water resources, particularly in countries like Pakistan that heavily rely on farming. The condition of major reservoirs, such as Tarbela, Mangla, and Warsak, is crucial for ensuring an adequate water supply for agriculture in Pakistan. The Kunhar and Siran rivers flow practically parallel, and the environment surrounding both rivers' basins is nearly identical. The Kunhar River is one of KP's dirtiest rivers that carries 0.1 million tons of suspended sediment to the Mangla reservoir. In contrast, the Siran River basin is largely unexplored. Therefore, this study focuses on the Siran River basin in the district of Manshera, Pakistan, aiming to assess annual soil loss and identify erosion-prone regions. Siran River average annual total soil loss million tons/year is 0.154. To achieve this, the researchers integrate Geographical Information System (GIS) and remote sensing (RS) data with the Revised Universal Soil Loss Equation (RUSLE) model. Five key variables, rainfall, land use land cover (LULC), slope, soil types, and crop management, were examined to estimate the soil loss. The findings indicate diverse soil loss causes, and the basin's northern parts experience significant soil erosion. The study estimated that annual soil loss from the Siran River basin is 0.154 million tons with an average rate of 0.871 tons per hectare per year. RUSLE model combined with GIS/RS is an efficient technique for calculating soil loss and identifying erosion-prone areas. Stakeholders such as policymakers, farmers, and conservationists can utilize this information to target efforts and reduce soil loss in specific areas. Overall, the study's results have the potential to advance initiatives aimed at safeguarding the Siran River watershed and its vital resources. Protecting soil resources and ensuring adequate water supplies are crucial for sustainable agriculture and economic development in Pakistan.