Challenges in the management of idiopathic pulmonary fibrosis from a low- and middle-income country.

Idiopathic pulmonary fibrosis (IPF) is the most common progressive form of interstitial lung disease (ILD) that leads to gradual deterioration of lung function and ultimately death. Data from low- and middle-income countries (LMIC) on IPF is scarce. In this communication, we report the challenges encountered in managing IPF from Pakistan's largest tertiary care centre. A total of 108 patients with IPF were evaluated at the Aga Khan University Hospital in Karachi, Pakistan from January 2017 to March 2020. A significant concern was that most patients with IPF presented late during their disease. A bigger challenge encountered in clinical practice was the cost and nonavailability of antifibrotic therapy in the country until mid-2020. Successfully addressing these limitations, it is anticipated that better care will be available for the patients suffering from IPF in this part of the world.

Assessment of textile effluent treatment by immobilized Trametes pubescens MB 89 for plant growth promotion.

Industrialization and the ever-increasing world population have diminished high-quality water resources for sustainable agriculture. It is imperative to effectively treat industrial effluent to render the treated water available for crop cultivation. This study aimed to assess the effectiveness of textile effluent treated with Trametes pubescens MB 89 in supporting maize cultivation. The fungal treatment reduced the amounts of Co, Pb and As in the textile effluent. The biological oxygen demand, total dissolved solids and total suspended solids were within the permissible limits in the treated effluent. The data indicated that the irrigation of maize with fungal-treated textile effluent improved the growth parameters of the plant including root, shoot length, leaf area and chlorophyll content. Moreover, better antioxidant activity, total phenol content and protein content in roots, stems and leaves of maize plants were obtained. Photosynthetic parameters (potential quantum yield, electron transport rate and fluorescence yield of non-photochemical losses other than heat) were also improved in the plants irrigated with treated effluent as compared to the control groups. In conclusion, the treatment of textile effluent with the immobilized T. pubescens presents a sustainable solution to minimize chemical pollution and effectively utilize water resources.

Gender inequalities across ethnicities in primary care cancer referrals: scoping review protocol.

BACKGROUND: Early cancer diagnosis is associated with improved mortality and morbidity; however, studies indicate that women and individuals from ethnic minorities experience longer times to diagnosis and worse prognosis compared to their counterparts for various cancers. In countries with a gatekeeper healthcare system, such as UK, most suspected cancer referrals are initiated in primary care. AIM: To understand the extent of evidence available on the relationship between primary care cancer referral pathways and cancer outcomes in relation to gender across different ethnic groups. This will identify research gaps and enable development of strategies to ease potential inequalities in cancer diagnosis. DESIGN & SETTING: A scoping review based on the Joanna Briggs Institute methodology. PRISMA-ScR will be used. METHOD: Electronic databases and private collections of the team members will be searched for studies. Two independent reviewers will carry out the study selection and data extraction. Based on participants, concept and context framework, this review will consider studies after year 2000 that explored the relationship between gender, across various ethnic groups, and cancer outcomes following primary care cancer referral in countries with gatekeeper healthcare systems (UK, New Zealand, Sweden, Australia, Canada, Denmark, Ireland and Norway). Results will be presented as a narrative analysis. CONCLUSION: The results are expected to provide an overview of the discrepancies in primary care cancer referrals based on gender across ethnic groups, which will be crucial to define an appropriate range of strategies to ease any inequalities in primary healthcare cancer diagnosis. OPEN SCIENCE FRAMEWORK PROTOCOL REGISTRATION: https://osf.io/jvtxb.

Kidney function assessment in the geriatric population.

PURPOSE OF REVIEW: Kidney function declines with normal aging. But it also declines with the progression of some diseases. This review calls for a more nuanced interpretation of kidney function in the geriatric population, who may have frailty and comorbidities. RECENT FINDINGS: GFR declines with healthy aging kidneys. Aging kidney changes include decreased cortical volume, senescent global glomerulosclerosis, and reduced nephron numbers. Yet normal aging is not associated with increased glomerular volume or single-nephron GFR. The prevalence of GFR less than 60 ml/min/1.73 m 2 in the geriatric population is high. However, the decline in GFR with normal aging may not reflect true CKD without albuminuria. Although the risk of ESKD and mortality increases in all age groups when eGFR less than 45 ml/min/m 2 , there is no significant increased relative risk of ESKD and mortality in the geriatric population when eGFR 45-59 ml/min/m 2 in the absence of albuminuria. Innovative approaches are needed to better estimate GFR and define CKD in the geriatric population. SUMMARY: The expected GFR decline in the geriatric population is consistent with normal aging kidney changes. To avoid CKD overdiagnosis and unnecessary referrals to nephrology for possible CKD, age-adapted definitions of CKD in the absence of albuminuria are needed.

Disparities in patient-resident physician communication and counseling: A multi-perspective exploratory qualitative study.

Effective communication between physicians and patients plays an integral role in clinical care. Gaps in a physician's ability to ensure effective communication, especially with patients from diverse backgrounds, are known causes of medical errors. This study explores the potential biases and disparities in patient-resident communication, which may influence a patient's quality of care. This exploratory qualitative study was conducted at the largest academic medical center in Pakistan. Purposive sampling was used to approach participants from surgery, medicine, obstetrics and gynecology, pediatrics and family medicine. Faculty, fellows and residents working in these departments and medical students in their fourth and fifth years of undergraduate education with prior experience of at least one month in these specialties during their clinical rotations were included. Focus group discussions (FGDs) lasting 45-60 minutes were conducted with each cohort of healthcare professionals separately, using a semi-structured interview guide. Sixty participants (19 males and 41 females, mean age: 32.9, SD: 10.9) took part in the study. Thematic analysis revealed five major themes. Four themes focused on residents' biases and patient disparities hindering patient-resident communication: (1) patient-resident gender discordance (2) ethnicity and language barriers, (3) differing social class of the patient, and (4) challenging patient-resident interactions (patients resistant to treatment, exceedingly inquisitive and those with multiple attendants, etc.). The fifth theme identified the need for a communication skills curriculum in postgraduate medical education. Opposite gender and discordant socioeconomic/cultural backgrounds of patients pose a challenge to effective patient-physician communication. Self-identification and awareness of residents' biases when interacting with patients can ensure their active elimination and improve their communication skills. Integrating these components in a standardized curriculum within postgraduate programs can enable resident-physicians to provide the same level of care and communicate more efficiently with patients of all backgrounds.

Does green innovation promote environmental efficiency from a global perspective? A hybrid approach (fuzzy DEA-SEM-ANN).

Green innovation is crucial for reducing carbon dioxide (CO2) emissions and promoting environmental efficiency worldwide. However, there is a lack of scholarly research investigating the relationship between environmentally friendly innovations and improved environmental performance. To fill this knowledge gap, a comprehensive study was conducted using data from 64 countries spanning 2010 to 2018. The study employed a hybrid approach, combining fuzzy DEA, structural equation modeling (SEM), and artificial neural networks (ANN) to analyze the nexus between green innovation and environmental efficiency. The SEM analysis revealed that green innovation, green trade, green employment, and green investment significantly impact environmental efficiency. The ANN model achieves a perfect prediction rate for environmental efficiency and green growth, emphasizing the importance of incorporating various sources of green innovation to achieve long-term environmental goals. The study's findings have significant implications for policymakers and governments, highlighting the value of environmentally friendly technologies and the need to allocate resources toward their development. Regional collaboration and integrating green innovation throughout the development process are essential for achieving environmental efficiency. By embracing green innovation, nations can capitalize on its potential benefits while mitigating pollution and promoting sustainable development. Overall, this research serves as a cornerstone for decision-makers, providing insights into the importance of green innovation and guiding efforts to foster environmentally conscious technologies globally.

National cervical cancer burden estimation through systematic review and analysis of publicly available data in Pakistan.

BACKGROUND: Cervical cancer is a major cause of cancer-related deaths among women worldwide. Paucity of data on cervical cancer burden in countries like Pakistan hamper requisite resource allocation. OBJECTIVE: To estimate the burden of cervical cancer in Pakistan using available data sources. METHODS: We performed a systematic review to identify relevant data on Pakistan between 1995 to 2022. Study data identified through the systematic review that provided enough information to allow age specific incidence rates and age standardized incidence rates (ASIR) calculations for cervical cancer were merged. Population at risk estimates were derived and adjusted for important variables in the care-seeking pathway. The calculated ASIRs were applied to 2020 population estimates to estimate the number of cervical cancer cases in Pakistan. RESULTS: A total of 13 studies reported ASIRs for cervical cancer for Pakistan. Among the studies selected, the Karachi Cancer Registry reported the highest disease burden estimates for all reported time periods: 1995-1997 ASIR = 6.81, 1998-2002 ASIR = 7.47, and 2017-2019 ASIR = 6.02 per 100,000 women. Using data from Karachi, Punjab and Pakistan Atomic Energy Cancer Registries from 2015-2019, we derived an unadjusted ASIR for cervical cancer of 4.16 per 100,000 women (95% UI 3.28, 5.28). Varying model assumptions produced adjusted ASIRs ranging from 5.2 to 8.4 per 100,000 women. We derived an adjusted ASIR of 7.60, (95% UI 5.98, 10.01) and estimated 6166 (95% UI 4833, 8305) new cases of cervical cancer per year. CONCLUSION: The estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.

Assessment of the appropriateness of antibiotic prescribing in an acute UK hospital using a national audit tool: a single centre retrospective survey.

INTRODUCTION: Antibiotic use drives antibiotic resistance. The UK antimicrobial resistance (AMR) strategy aims to reduce antibiotic use. We aimed to quantify excess antibiotic use in a district general hospital in south-west England. METHODS: Medical patients discharged in August 2020 who had received antibiotics were included. An audit tool of antibiotic prescribing appropriateness was used to collect relevant clinical information regarding each patient case. The appropriateness of antibiotic use was then determined by two infection specialists and excess days of therapy (DOTs) calculated. RESULTS: 647 patients were discharged in August 2020. Of the 1658 antibiotic DOTs for the 184 patients reviewed, 403 (24%) were excess DOTs. The excess antibiotic DOTs were prescribed in 92 patients (50%); 112/403 (27.8%) excess DOTs originated at the initiation of antibiotic therapy (time point A); 184/403 (45.7%) of excess DOTs occurred at the antibiotic review pre-72 hours (time point B); and 107/403 (26.6%) of excess DOTs were due to protracted antibiotic courses (time point C). CONCLUSION: 24% of antibiotic DOTs were deemed unnecessary. The greatest opportunity to reduce antibiotic use safely was the pre-72 hours antibiotic review, which may provide a target for reducing excess antimicrobial therapy in line with the national AMR strategy.

Water quality and health risk assessment of trace elements in surface water at Punjnad Headworks, Punjab, Pakistan.

Pollution of the aquatic ecosystem due to different trace elements has become a global concern which has raised health-related issues for both aquatic and human life. Industrial and agricultural water run-off drained into the rivers and deposit trace elements in water, sediments and planktons. This study was designed to calculate the burden of trace elements such as aluminium (Al), arsenic (As), barium (Ba), and lead (Pb) in the river water of Punjnad Headworks, Bahawalpur, Punjab, Pakistan. Samples were collected from surface water, bed sediments and planktons during autumn, winter and spring seasons (September 2018 to May 2019). The results showed that the concentration of Pb was highest in surface water (453.87 mg L-1), while that of Al was highest in sediments (370.24 µg g-1) and plankton (315.05 µg g-1). A significant difference was found in metal concentrations among surface water, bed sediments and plankton at different sampling stations during various seasons. Importantly, the Exping (0.71, 1.23-3, 0.34, 0.02 for Pb, As, Al, and Ba, respectively) and Expderm (7.09-8, 1.2310, 3.42-8, and 2.48-9 for Pb, As, Al, and Ba, respectively) for trace elements were below 1.0 suggesting non-significant adverse effects of trace elements on human health. This study provided better understanding of various pollutants and their concentrations in water sources at the studied location.

Environmental impacts of hazardous waste, and management strategies to reconcile circular economy and eco-sustainability.

The rise in living standards and the continuous development in the global economy led to the depletion of resources and increased waste generation per capita. This waste might posture a significant threat to human health or the environmental matrices (water, air, soil) when inadequately treated, transported, stored, or managed/disposed of. Therefore, effective waste management in an economically viable and environmentally friendly way has become meaningful. Prominent technology is the need of the day for circular economy and sustainable development to reduce the speed of depletion in resources and produce an alternative means for the future demands in the different sectors of science and technology. In order to meet the potential requirements for energy production or producing secondary raw material, solid waste may be the prime source. The activities of living organisms convert waste products in one form or another in which electronic waste (e-waste) is a modern-day problem that is growing by leaps and bounds. The disposal protocols of the e-waste management need to be given proper attention to avoid its hazardous impacts. The e-waste is obtained from any equipment or devices that run by electricity or batteries like laptops, palmtops, computers, televisions, mobile phones, digital video discs (DVD), and many more. E-waste is one of the rapidly growing causes of world pollution today. Plenty of research is available in the scientific literature, which shows different approaches being set up and followed to manage and dispose of waste products. These strategies to manage waste products designed by the states all over the globe revolves around minimal production, authentic techniques for the management of waste produced, reuse and recycling, etc. The virtual survey of the available literature on waste management shows that it lacks specificity regarding the management of waste products parallel to ecological sustainability. The presented review covers the sources, potential environmental impacts, and highlights the importance of waste management strategies to provide the latest and updated knowledge. The review also put forward the countermeasures that need to be taken on national and International levels addressing the sensitive issue of waste management.

Revisiting the costs and utilization of family planning services in the public sector in Pakistan.

OBJECTIVE: We revisited the costs of Family Planning per woman served per year in the public sector using data from the Pakistan Demographic and Health Survey 2017-18. These costs were estimated previously in 2006-07. The public sector (Population Welfare Department and the Department of Health) accounts for around 35% of all family planning services provided each year. We looked at utilization patterns of public sector family planning services and estimated its costs of FP per woman served per year and cost per Couple Years of Protection (CYP). METHODS: Pakistan Demographic and Health Survey 2017-18 was used to estimate the number of users of public sector services and their usage patterns. These were depicted using simple tables and with binary logistic regression analysis. National Health Accounts 2012-16 were used to estimate government allocations for family planning. Costs of FP were estimated by simply dividing the allocation by the two public sector departments - Population Welfare (PWD) and Health (DoH) - with the number of users they serve each year. Costs were also depicted per CYP generated. RESULTS: Both the public and private sectors provide family planning services. The PWD serves an estimated 724,320 clients annually compared to 915,817 by DoH. Together these amount to around 5% of all MWRA, a proportion that remains unchanged over past decade. Due to their very different method mix PWD serves 2,344,411 CYP while DoH serves 988,603. DoH delivers most of its services in the form of condoms and pills which LHWs can carry. The PWD, having increased its range of products as compared to a decade ago, provides condoms, pills, IUDs and tubal ligations. Users of the public sector tend to belong to urban areas (AOR 1.2, range 1.2-1.2), are poor (AOR 2.7, range 2.7-2.7), and tend to have more children (AOR 1.1, range: 1.1-1.1). The exception is that DoH's lady health workers serve a large portion of rural population. Costs of FP per woman per year for PWD are USD 28 and for DOH are USD 14, costs per CYP are calculated are USD 9 and 13 respectively. CONCLUSIONS: The public sector fills an important niche by serving a poorer population and through rural household outreach. While costs have decreased since 2007, they remain higher than regional averages and suggest significant inefficiencies as both fixed facilities and lady health workers are considerably underutilized.

Using crowdsourcing to estimate populations in communities: Providing a key measurement for coverage assessment of community programmes.

INTRODUCTION: Crowdsourcing pools together dispersed information that is considered public knowledge in an area, to form realistic estimates about the area, or to identify new ideas. The technique can be extremely helpful to develop estimates of public health indicators such as catchment area populations or healthcare providers; however, such uses must be scientifically validated. METHODS: We divided the community into 1040 discrete segments of similar lengths of streets (called spots) and then randomly selected 605 of these spots for crowdsourcing. Local respondents were asked to estimate the maximum and the minimum population residing in those spots. Five informants were interviewed per spot. Median values for the maximum and minimum were averaged to arrive at an estimate for the spot's population. Estimates for all spots were added together to arrive at the population of the community. One hundred spots from the 597 crowdsourced spots were revisited to conduct a household census as a "gold standard". RESULTS: Spots where both crowdsourcing and census estimates were computed had a crowdsource population estimate of 19,255 versus a census estimate of 18,119 - a variation of 5.9% (p: <0.001). However, within spot variation was a mean of 25%. CONCLUSIONS: Crowdsourcing communities for public knowledge information can yield more accurate information about public health indicators such as populations. In turn these estimates can help to better understand public health programme coverage. Other applications to consider may be missed children for immunization or schooling, deaths or births in communities or to identify total formal or informal healthcare providers in a community.

Echocardiographic assessment before and after Percutaneous Transvenous Mitral Commissurotomy in patients with Rheumatic Mitral Stenosis.

OBJECTIVES: To determine the changes produced in mitral valve morphology after Percutaneous Trans-Venous Mitral Commissurotomy. METHODS: Patients with mitral stenosis who underwent PTMC at the cardiology department of Lady Reading Hospital, Peshawar, Pakistan, from 2006-2016 were included in this study. All the data were manually obtained from the electronic medical record (M.F.E.). Wilkin's echocardiographic scoring system was used to assess the severity of mitral valve thickness, leaflet mobility, valvular calcification, and Subvalvular disease. The student t-test was used for mean comparison. P-value < 0.05 was considered significant. RESULTS: Of the total 229 patients, males were 96(41.9%), and females were 133(58.1%). The mean [SD] age of the patients was 25 ± 11years. The total Wilkin score was 7 ±1.5. 151(65.9%) were in New York Heart Association (NYHA) functional class III, and 78(34.1%) were in NYHA class IV. There was no immediate change after PTMC in systolic myocardial velocities (SV) measured at the lateral tricuspid annulus. The 2D mitral valve area increased from 0.98±0.94 cm2 to 1.78 ± 0.44 cm2 (P=0.001). Left Atrium diameter was 5.16±0.75 mm prior to PTMC, significantly decreased to 4.7± 0.7 mm (p=0.005) after PTMC. Ejection fraction (Left Ventricular Ejection Fraction) changed from 60.45± 8.25 mm Hg to 62.76±10 mm Hg (p=0.001). Mean Right Ventricular Ejection Fraction (RVEF) of patients before PTMC was 48.7 ± 4.7%, did not change significantly immediately after PTMC. CONCLUSION: PTMC is associated with significant changes in mitral valve morphology in terms of splitting of the fused mitral commissures, increased MVA, improved leaflet excursion, and splitting of the subvalvular structures.

Differences in Baseline Characteristics and White Blood Cell Ratios Between Racial Groups in Patients with Pancreatic Adenocarcinoma.

PURPOSE: Pancreatic adenocarcinoma remains a malignancy with poor prognosis. Black patients experience poorer overall survival compared with other races. Recent studies have elucidated certain prognostic factors at the time of diagnosis of pancreatic cancer which have largely not been studied for differences between racial groups. We present a study examining differences in blood levels between Black and non-Black patients and their effects on overall survival. METHODS: This is a retrospective cohort study. One hundred sixty-three patients were confirmed to carry a tissue diagnosis of pancreatic adenocarcinoma and included in analysis; 27 of the patients were self-identified as "Black"; 136 were analyzed together as "Non-Black" with the majority identifying as "White". Various blood markers were drawn at the time of diagnosis. Kaplan-Meier and multivariable Cox regression models were used to examine differences in these factors between Black and non-Black patients, as well as their effect on overall survival. RESULTS: Black patients were younger at diagnosis (p = 0.001) and were more likely to experience significant weight loss leading up to diagnosis (p = 0.009); Black patients also had a lower neutrophil-to-lymphocyte ratio (NLR) (p = 0.001) and higher lymphocyte-to-monocyte ratio (LMR) (p = 0.001) at diagnosis. In multivariable analysis, an NLR > 3.5 had a significantly negative impact on overall survival (p = 0.002), as did the presence of metastatic disease (p < 0.001). CONCLUSION: Black patients demonstrated a "favorable" white blood cell profile (higher LMR, lower NLR) compared with non-Black patients. This may suggest that the immune response in pancreatic adenocarcinoma is not what is driving disparately poor outcomes in Black patients. Further study is warranted to ascertain the role of immune response in pancreatic adenocarcinoma, the prognostic use of these measurements at diagnosis, and possible other factors, such as genetics, which may better explain poorer outcomes in Black patients.

Removal of azo dye from aqueous solution by a low-cost activated carbon prepared from coal: adsorption kinetics, isotherms study, and DFT simulation.

The high-risk organic pollutants produced by industries are of growing concern. The highly porous coal-based activated carbon (AC) having a specific surface area of 3452.8 m2/g is used for the adsorption of azo dye from synthetic solution. The sorbent is characterized through BET, SEM, TEM, XRD, FT-IR, TGA, and zeta potential. The sorbent exhibits - 18.7 mV surface charge, which is high enough for making suspension. The maximum dye uptake of 333 mg/g is observed in sorbent under acidic medium. The thermodynamics parameters like ∆G, ∆H, and ΔS were found to be - 12.40 kJ mol-1, 39.66 kJ mol-1, and 174.55 J mol-1 K-1 at 293 K, respectively, revealing that the adsorption mechanism is spontaneous, endothermic, and feasible. The experimental data follows the Langmuir and D-R models. The adsorption follows pseudo 2nd-order kinetics. DFT investigation shows that the dye sorption onto AC in configuration No. 4 (CFG-4) is more effective, as this configuration has high ∆H (enthalpy change) and adsorption energy (Eads). This is confirmed by Mullikan atomic charge transfer phenomenon.

Clinical and Biochemical Assessment of Liver Function Test and Its Correlation with Serum Ferritin Levels in Transfusion-dependent Thalassemia Patients.

Aims The aim of our study was to correlate liver function tests with serum ferritin levels in multi-transfused thalassemia patients. Methods  This was a descriptive cross-sectional study conducted in the department of hematology, Khyber Medical University, from January 2018 to December 2018. Thalassemia patients of either sex dependent on transfusion ≥ 1 year and having a confirmatory report of the disease were included in our study. The nonprobability convenience sampling technique was used. The Pearson correlation coefficient was applied to observe the correlation between serum ferritin level and liver function tests. A p-value of ≤0.05 was considered statistically significant. SPSS version 23 (SPSS Inc., Chicago, Illinois) was used for data analysis. Results A total of 138 subjects of age range 2-23 years, with a mean age of 12.08 ± 6.02 years, were included in our study. The mean serum ferritin of patients in our study was 3278.64 ng/ml with the lowest of 285.2 ng/mL and the highest of 10940.2 ng/ml. With the increase in serum ferritin levels, a rapid increase in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) levels was seen. When serum ferritin levels were correlated with total bilirubin level, the bilirubin level remains static with a further increase in serum ferritin levels. Conclusion It was deduced that iron deposition is the ultimate reason for increased liver enzymes. There was a positive correlation between serum ferritin and ALT, AST, and ALP while a weak connection was found between serum ferritin and bilirubin levels.

Prevalence and management of diabetic neuropathy in secondary care in Qatar.

AIMS: Diabetic neuropathy (DN) is a "Cinderella" complication, particularly in the Middle East. A high prevalence of undiagnosed DN and those at risk of diabetic foot ulceration (DFU) is a major concern. We have determined the prevalence of DN and its risk factors, DFU, and those at risk of DFU in patients with type 2 diabetes mellitus (T2DM) in secondary care in Qatar. MATERIALS AND METHODS: Adults with T2DM were randomly selected from the two National Diabetes Centers in Qatar. DN was defined by the presence of neuropathic symptoms and a vibration perception threshold (VPT) ≥ 15 V. Participants with a VPT ≥ 25 V were categorized as high risk for DFU. Painful DN was defined by a DN4 score ≥4. Logistic regression analysis was used to identify predictors of DN. RESULTS: In 1082 adults with T2DM (age 54 ± 11 years, duration of diabetes 10.0 ± 7.7 years, 60.6% males), the prevalence of DN was 23.0% (95% CI, 20.5%-25.5%) of whom 33.7% (95% CI, 27.9%-39.6%) were at high risk of DFU, and 6.3% had DFU; 82.0% of the patients with DN were previously undiagnosed. The prevalence of DN increased with age and duration of diabetes and was associated with poor glycaemic control (HbA1c ≥ 9%) AOR = 2.1 (95% CI, 1.3-3.2), hyperlipidaemia AOR = 2.7 (95% CI, 1.5-5.0), and hypertension AOR = 2.0 (95% CI, 1.2-3.4). CONCLUSIONS: Despite DN affecting 23% of adults with T2DM, 82% had not been previously diagnosed with one-third at high risk for DFU. This argues for annual screening and identification of patients with DN. Furthermore, we identify hyperglycaemia, hyperlipidaemia, and hypertension as predictors of DN.

Optimal control analysis of Ebola disease with control strategies of quarantine and vaccination.

BACKGROUND: The 2014 Ebola epidemic is the largest in history, affecting multiple countries in West Africa. Some isolated cases were also observed in other regions of the world. METHOD: In this paper, we introduce a deterministic SEIR type model with additional hospitalization, quarantine and vaccination components in order to understand the disease dynamics. Optimal control strategies, both in the case of hospitalization (with and without quarantine) and vaccination are used to predict the possible future outcome in terms of resource utilization for disease control and the effectiveness of vaccination on sick populations. Further, with the help of uncertainty and sensitivity analysis we also have identified the most sensitive parameters which effectively contribute to change the disease dynamics. We have performed mathematical analysis with numerical simulations and optimal control strategies on Ebola virus models. RESULTS: We used dynamical system tools with numerical simulations and optimal control strategies on our Ebola virus models. The original model, which allowed transmission of Ebola virus via human contact, was extended to include imperfect vaccination and quarantine. After the qualitative analysis of all three forms of Ebola model, numerical techniques, using MATLAB as a platform, were formulated and analyzed in detail. Our simulation results support the claims made in the qualitative section. CONCLUSION: Our model incorporates an important component of individuals with high risk level with exposure to disease, such as front line health care workers, family members of EVD patients and Individuals involved in burial of deceased EVD patients, rather than the general population in the affected areas. Our analysis suggests that in order for R 0 (i.e., the basic reproduction number) to be less than one, which is the basic requirement for the disease elimination, the transmission rate of isolated individuals should be less than one-fourth of that for non-isolated ones. Our analysis also predicts, we need high levels of medication and hospitalization at the beginning of an epidemic. Further, optimal control analysis of the model suggests the control strategies that may be adopted by public health authorities in order to reduce the impact of epidemics like Ebola.

Assessment of Antiviral Properties of Peramivir against H7N9 Avian Influenza Virus in an Experimental Mouse Model.

The H7N9 influenza virus causes a severe form of disease in humans. Neuraminidase inhibitors, including oral oseltamivir and injectable peramivir, are the first choices of antiviral treatment for such cases; however, the clinical efficacy of these drugs is questionable. Animal experimental models are essential for understanding the viral replication kinetics under the selective pressure of antiviral agents. This study demonstrates the antiviral activity of peramivir in a mouse model of H7N9 avian influenza virus infection. The data show that repeated administration of peramivir at 30 mg/kg of body weight successfully eradicated the virus from the respiratory tract and extrapulmonary tissues during the acute response, prevented clinical signs of the disease, including neuropathy, and eventually protected mice against lethal H7N9 influenza virus infection. Early treatment with peramivir was found to be associated with better disease outcomes.

Assessment of algorithms for mitosis detection in breast cancer histopathology images.

The proliferative activity of breast tumors, which is routinely estimated by counting of mitotic figures in hematoxylin and eosin stained histology sections, is considered to be one of the most important prognostic markers. However, mitosis counting is laborious, subjective and may suffer from low inter-observer agreement. With the wider acceptance of whole slide images in pathology labs, automatic image analysis has been proposed as a potential solution for these issues. In this paper, the results from the Assessment of Mitosis Detection Algorithms 2013 (AMIDA13) challenge are described. The challenge was based on a data set consisting of 12 training and 11 testing subjects, with more than one thousand annotated mitotic figures by multiple observers. Short descriptions and results from the evaluation of eleven methods are presented. The top performing method has an error rate that is comparable to the inter-observer agreement among pathologists.