Celiac Disease and Intussusception: A Common Association in Children.

OBJECTIVES: In young childhood, intestinal intussusception (IS) is the most common cause of small bowel obstruction. A lead point such as Meckel diverticulum, polyps, tumors, enlarged lymph nodes, cystic fibrosis, and Schoenlein-Henoch purpura are recognized causes. Association between celiac disease (CD) and IS has been well recognized in adults but rarely in children. Data on causes and outcome of intussusception among Saudi children are lacking in the literature. Our objectives were to characterize the pattern of IS among Saudi children and investigate the frequency, clinical presentation, and outcome of intussusception among children with CD. METHODS: We searched the hospital's picture archiving and communications system for abdominal imaging studies (ultrasound, magnetic resonance imaging, computed tomography scan, and barium contrast studies), performed between 2008 and 2019, using "intussusception" as a search key word. The hospital medical records of the identified cases of intussusception (aged 0-14 years) were then retrospectively reviewed to collect demographic, clinical, laboratory and imaging findings, management, and outcome. RESULTS: During the study period, 57 cases were identified as confirmed IS (31 boys, median age 1.95 years, range 0.33-11 years). Abdominal ultrasound was the diagnostic imaging study in 93%. An underlying cause (secondary IS) could be identified in 19 (33.3%) cases: CD in 6, malignancy and Henoch-Schoenlein purpura, 5 each, and Meckel diverticulum in 3; the remaining 38 (66.6%) cases of IS were idiopathic (primary IS). The presence of hypoalbuminemia and abdominal distension were significantly associated with secondary IS as compared with primary IS (P < 0.001, P = 0.006, respectively). All of the 6 cases of IS associated with CD resolved spontaneously, but 3 were recurrent. CONCLUSIONS: Secondary causes contributed to a large proportion of IS in our study cohort (33%) as compared with 5% to 10% in the literature. Celiac disease is an underrecognized cause of IS among children. A child with IS and hypoalbuminemia, anemia, or chronic diarrhea needs to be investigated for CD to avoid unnecessary surgery.

Synthesis, spectral characterization and antimicrobial studies of novel series of allylidene based multifaceted chalcones analogues.

Following the Claisen Schmidt condensation a series of chalcone, their allylidene derivatives and metallic complexes were produced and subsequently screened for antibacterial assay. The precursors were simple acetophenone and different substituted aryl benzaldehydes; which were made to react in basic ethanolic conditions. The structure of synthesized targets was established by IR, 1H-NMR and EIMS data. The antibacterial statistics showed that most of the bacterial strains particularly S. typhi and E. coli were potently inhibited by majority of the compounds like 3c, 5c, 7a & 7c. This structure activity relationship studies showed that these molecules possessed p-methoxy substituents in their framework and found active in rupturing the cell wall. These molecules might serve as potential drug candidates for future drug discovery and design. The presented manuscript highlights the pharmacological diversity of chalcones holding allylidene moiety and Zn+2 complexes.

Catalyzing sustainable development: Exploring the interplay between access to clean water, sanitation, renewable energy and electricity services in shaping China's energy, economic growth, and environmental landscape.

The Sustainable Development Goals (SDGs) reflect the shift in global economic conversation toward inclusive growth. The growth can promote inclusivity and widespread sharing of its advancements by concentrating on four key dimensions. (a) Equality of opportunity, (b) sharing prosperity, (3) environmental sustainability/climate adaptation, and (4) macroeconomic stability. We used the Kao cointegration test to study how certain variables are connected over a long period. The relationship between CO2 and GDP per capita, renewable energy and tourism, improved water and sanitation, and access to power all have a positive feedback effect on each other. Based on FMOLS's findings, a 1 % increase in Inclusive growth leads to a 0.342 % (Model 1) and 0.258 % (Model 3) increase in CO2 emissions. An increase of 1 percent in energy consumption per person resulted in a rise of 1.343 % in CO2 emissions in Case 1, 0.524 % in Case 2, and 0.618 % in Case 3. Increasing the tourism sector's proportion of total exports by just one percent will reduce CO2 emissions by 0.221 % (case 1) and 0.234 % (case 3). Based on CCR findings, a 1 % improvement in inclusive growth leads to a 0.403.

Geospatial quality assessment of locally available ice for heavy metals and metalloids and their potential risks for human health in Karachi, Pakistan.

Extreme hot conditions during summers, high poverty rate and continuous electricity load shedding affect commercial manufacturing and sale of ice in many countries. The vendors prepared ice using untreated piped water, tanker water and ground water. These waters may contain hazardous pollutants and ice made from them will pose a potential human health risk. Thus, it is important to regularly monitor the chemical composition of water sources and the quality of the manufactured ice. A contemporary examination was carried out to evaluate the physico-chemical properties and heavy metals and metalloids in the ice sold in all the districts of Karachi, Pakistan. This pioneering study was an innovative effort to assess the ice quality in relation to potential pollutant hazards to human health; with concomitant geospatial information. The geospatial distribution of ice quality and major constituents were among the measured parameters; carefully associated with further geospatial information, determined using GIS (Geographic Information Systems) and PCA (Principal Component Analysis) techniques. Interestingly, the physico-chemical analyses revealed that the ice quality was marginally adequate and the total mean metal-metalloid contents were in the sequence of Pb > Ni > Zn > Fe > Cr > As. The concentrations of these metals were above the upper allowable limits with reference to the recommended WHO guidelines. We observed that 57.1% and 35.7% ice samples had good physico-chemical properties assessed using the Ice Quality Index (IQI). Conversely, the IQI for metals showed that the ice was unsafe for human consumption. In terms of health risk assessment, the overall mean CDI (Chronic Daily Intake) and HQ (Hazard Quotient) values were in the order of Pb () > Ni (3.2) > Zn (2.3) > Fe (2.1) > Cr (1.6) > As (0.5) and Pb (7.4) > As (1.7) > Cr (0.5) > Ni (0.4 > Zn (0.008) > Fe (0.003), respectively. This study highlighted that routine monitoring of the water supplies available for making ice is required to protect public health.

Impact of geographical, meteorological, demographic, and economic indicators on the trend of COVID-19: A global evidence from 202 affected countries.

Research problem: Public health and the economy face immense problems because of pathogens in history globally. The outbreak of novel SARS-CoV-2 emerged in the form of coronavirus (COVID-19), which affected global health and the economy in almost all countries of the world. Study design: The objective of this research is to examine the trend of COVID-19, deaths, and transmission rates in 202 affected countries. The virus-affected countries were grouped according to their continent, meteorological indicators, demography, and income. This is quantitative research in which we have applied the Poisson regression method to assess how temperature, precipitation, population density, and income level impact COVID-19 cases and fatalities. This has been done by using a semi-parametric and additive polynomial model. Findings: The trend analysis depicts that COVID-19 cases per million were comparatively higher for two groups of countries i.e., (a) average temperature below 7.5 °C and (b) average temperature between 7.5 °C and 15 °C, up to the 729th day of the outbreak. However, COVID-19 cases per million were comparatively low in the countries having an average temperature between 22.5 °C and 30 °C. The day-wise trend was comparatively higher for the countries having average precipitation between (a) 1 mm and 750 mm and (b) 750 mm and 1500 mm up to the 729th day of the outbreak. The day-wise trend was comparatively higher for the countries having more than 1000 people per sq. km. Discussing the COVID-19 cases per million, the day-wise trend was higher for the HICs, followed by UMICs, LMICs, and LIC. Conclusion: The study highlights the need for targeted interventions and responses based on the specific circumstances and factors affecting each country, including their geographical location, temperature, precipitation levels, population density, and per capita income.

Estimation of economic, environmental, and social efficiency for sustainable development in G-8 and SAARC countries: a data envelopment analysis.

In the recent era, economic growth is not enough to represent sustainable development. Sustainable development has three dimensions (i.e., economic, social, and environment). This study estimated the economic, social, and environmental efficiency using data from 2000 to 2021. Input-oriented data envelopment analysis shows strong heterogeneity across developed (G-8) and developing countries (SAARC). There is a potential to increase economic and environmental efficiency in the G-8 and SAARC countries. The average economic efficiencies are 0.682 and 0.414, which implies the possibility of the same output (GDP/capita) by using 31.8% and 58.6% fewer inputs in G-8 and SAARC countries, respectively. The social efficiency score is more than 0.980 in both panels. The average environmental efficiencies are 0.712 and 0.724, which implies that selected countries can obtain the same output (CO2 emission reduction) by using 28.8% and 27.6% fewer inputs in G-8 and SAARC countries, respectively. The top three economically efficient countries are (a) the USA, the UK, and Japan in the G-8 panel and (b) Maldives, Sri Lanka, and Pakistan in the SAARC panel. The top three environmentally efficient countries are (a) France, the UK, and Italy in the G-8 panel and (b) Afghanistan, Nepal, and Bangladesh in the SAARC panel. It is recommended to adopt suitable policies to reduce emission, minimize waste, efficient utilization of resources, increase forest cover, and incentive for clean technologies. It is suggested to promote renewable energy through the provision of micro-credit to the poor, subsidizing renewable energy technologies, implementation of stringent environmental policies, and increasing awareness. It is essential to invest in eco-friendly and innovative technologies; thus, the government should encourage green practices in production. Human development is recommended to increase the living standard and healthy life. The government should invest in the health system and conduct seminars on general health awareness. Investment in basic infrastructure (drinking water, sanitation, and clean fuel) is essential to increase the living standard. The G-8 countries should provide financial and technological help to the SAARC countries.

Exploring the Students' Perceived Effectiveness of Online Education during the COVID-19 Pandemic: Empirical Analysis Using Structural Equation Modeling (SEM).

The world faced COVID-19, which was a threat to public health and disturbed the educational system and economic stability. Educational institutes were closed for a longer period, and students faced difficulty to complete their syllabus. The government adopted a policy of "suspending classes without stopping learning" to continue education activities. However, student satisfaction with online education is a growing concern. Satisfaction of students is an important indicator of academic quality. Therefore, this study attempts to investigate the influencing factors behind learning satisfaction using information from 335 students from various institutes in Pakistan. This research examined the impact of computer and internet knowledge, instructor and course material, and Learning Management Systems (LMS) on learning satisfaction. The path coefficients were obtained via Partial Least Square-Structural Equation Modeling (PLS-SEM). The LMS is a tool that facilitates the learning process with the provision of all types of educational material. The path coefficient was more in the case of LMS (0.489), which indicates its positive and significant role to attain learning satisfaction. The instructor and course material ordered second (0.261), which shows that the quality of an instructor and course material also plays a positive role to attain learning satisfaction. The computer and internet are essential ingredients of online education, showing a significant and positive path coefficient (0.123), implying that computer and internet knowledge could enhance learning satisfaction. The universities should develop their LMS to implement online education with quality course materials. It is also vital that the instructor should be up to date with modern learning techniques while ensuring internet connectivity, especially in rural areas. The government should provide an internet connection to students at discounted rates.

Celiac Disease With Autoimmune Hemolytic Anemia and Autoimmune Hepatitis in a Young Child: Case Report and Literature Review.

Celiac disease (CD) is a chronic autoimmune condition with intestinal and extra-intestinal features. Extra intestinal features including hematological, neurological, and endocrine symptoms are seen more frequently in elder children. A 4 years 7 months old male child presented in clinic with history of abdominal pain and diarrhea on and off for 1 year. On examination, he was hemodynamically stable, pale, and malnourished with distended abdomen. He was investigated for CD, Anti TTG IgA <0.1 (positive >10), Anti TTG IgG 13 (positive >10). To confirm celiac disease, Esophagogastroduodenoscopy (EGD) was done which was consistent with diagnosis of Celiac disease (MARSH Type 3a). Gluten free diet was advised. Later, after 12 days he again presented with jaundice, fever, anorexia, and dark colored urine and irritability. He was admitted for fulminant hepatic failure, his workup revealed direct hyperbilirubenemia, ANA +ve, and hyper IgG. Liver biopsy confirmed autoimmune hepatitis. Further workup for anemia showed reticulocyte count 7.1, LDH 423, direct and indirect coombs test was positive confirming autoimmune hemolytic anemia. Child responded well to Azathioprine and prednisolone with clinical improvement. We report a rare presentation of celiac disease with polyautoimmunity in a young child. Case reports of autoimmune hepatitis with CD patients have been reported in adult patients. Association of celiac disease with autoimmune hemolytic anemia and autoimmune hepatitis is a distinct and rare condition.

Hunting the Best Opportunity Through the Arrow of General Decision-Making Styles: Unfolding the Role of Social Capital and Entrepreneurial Intention.

This research aims to identify the investor's decision-making styles and their impact on entrepreneurial opportunities through the mediation role of entrepreneurial intention and moderation effect of social capital in the healthcare sector of Pakistan. This study applied a structural equation modeling (SEM) to test the hypotheses on a sample of 400 healthcare investors. Our findings reveal that the conditional indirect relationship of entrepreneurial intention through social capital was significant on opportunity creation and an insignificant influence on opportunity discovery from decision-making styles. This study provides implications for policymakers to enhance entrepreneurial opportunity creation by providing robust social environment investors and encouraging them to create business ventures in the healthcare sector.

4-Bromo-1-nitro-benzene.

The non-H atoms of the title mol-ecule, C(6)H(4)BrNO(2), are essentially coplanar with an r.m.s. deviation of 0.040 Å. In the crystal, π-π stacking occurs between parallel benzene rings of adjacent mol-ecules with centroid-centroid distances of 3.643 (3) and 3.741 (3) Å. Weak inter-molecular C-H⋯O hydrogen bonding and short Br⋯O contacts [3.227 (4) 3.401 (4) Å] are also observed in the crystal structure. The crystal studied was a non-morohedral twin with a 26.1 (6)% minor component.

Bis[5-chloro-2-(prop-2-yn-1-yl-oxy)phen-yl]methane.

The mol-ecule of the title compound, C(19)H(14)Cl(2)O(2), has two benzene rings connected to a methyl-ene C atom, and the rings are aligned at 66.3 (1)°. Inter-molecular C-H⋯π and π-π stacking inter-actions are observed in the crystal structure, the centroid-centroid distances between parallel benzene rings being 3.7529 (12) and 3.6201 (12) Å, respectively.

2,3-Dimeth-oxy-benzaldehyde azine.

There are one-and-a-half independent mol-ecules in the asymmetric unit of the title compound, C(18)H(20)N(2)O(4). One mol-ecule is centrosymmetric with the mid-point of the N-N bond located on a center of inversion. In the other, which lies on a general position, the benzene rings are aligned at 21.6 (1)°. Weak inter-molecular C-H⋯O hydrogen bonding is present in the crystal strcture.

Di-tert-Butyl 2,2'-[2,2'-methyl-enebis(naphthalene-2,1-diyldi-oxy)]diacetate.

In the title compound, C(33)H(36)O(6), two naphthalene ring systems are connected through a methyl-ene linkage [C-C-C = 114.9 (2)°]; the ring systems are aligned at an angle of 76.5 (1)°. Of the two -O-CH(2)-C(=O)-C(CH(3))(3) substituents, one adopts an extended conformation whereas the other is U-shaped. In the crystal, mol-ecules are linked via weak C-H⋯O hydrogen bonding, forming supra-molecular chains running along the c axis.

tert-Butyl 2-(4-nitro-phen-oxy)acetate.

In the title mol-ecule, C(12)H(15)NO(5), the nitro-phen-oxy portion is approximately planar (r.m.s. deviation = 0.034 Å) and makes an angle of 84.8 (1)° with respect to the -CH(2)-C(=O)-O-C fragment. In the crystal, π-π stacking is observed between nearly parallel benzene rings of adjacent mol-ecules, the centroid-centroid distance being 3.6806 (10) Å. Weak inter-molecular C-H⋯O hydrogen bonding is present in the crystal structure.

Role of knowledge, behavior, norms, and e-guidelines in controlling the spread of COVID-19: evidence from Pakistan.

The COVID-19 pandemic is straining public health systems and the global economy, triggering unprecedented measures by governments around the globe. The adoption of a preventive measure is required to control the spread. This research explores the impact of influencing factors like COVID-19 knowledge, behavioral control, moral and subject norms, preventive e-guidelines by the government, and environmental factors on the intention to prevent COVID-19 and risk aversion. A cross-sectional study was performed of 310 respondents about different COVID-19 related influencing factors in Pakistan. The partial least square-structural equation modeling was applied to estimate the path coefficient. Moral and subject norms (0.359) had a comparatively higher path coefficient. Other influencing factors/drivers were preventive e-guideline by the government (0.215) followed by COVID-19 knowledge (0.197), and behavioral control (0.121). The intention to prevent COVID-19 showed a positive and significant impact (0.705) on risk aversion. The indirect analysis also confirmed that the positive influence of moral and subject norms, COVID-19 knowledge, preventive e-guideline by the government, and behavioral control on risk aversion. However, the path coefficient of environmental factors was negative but insignificant, which implies than environmental factors do not influence the intention to prevent COVID-19. It is suggested to provide clear guidelines using print, social, electronic media. It is also suggested to provide e-guidelines in local languages. The COVID-19 knowledge about its transmission, symptoms, and precautions is also useful. It is suggested to include the causes, symptoms, and precaution of viral diseases in the educational syllabus. The government should ensure the availability of preventive medical items like surgical masks and sanitizers to meet the demand of the public.

Giardiasis: An Overlooked Cause of Recurrent Abdominal Pain.

Recurrent abdominal pain is defined as at least three episodes of abdominal pain, lasting for three months or more and affecting the daily activities of an individual. Giardiasis is one of the causes of recurrent abdominal pain but is often overlooked. We report the case of an 11-year-old girl who presented with complaints of severe abdominal pain and two episodes of fresh blood in stool in one day. She had recurrent episodes of abdominal pain, occasional bloating, and diarrhea over the past two years. Workup for differentials like appendicitis and ovarian torsion was done. She was initially treated for an ovarian cyst with oral contraceptives, but her symptoms showed no improvement. Therefore, a laparoscopic ovarian cystectomy and appendectomy were attempted. Despite surgical intervention, the abdominal pain failed to resolve. A duodenal biopsy was performed, which showed vegetative growths of Giardia lamblia (G. lamblia). This report highlights the unusual presentation of giardiasis as an acute abdomen, making it a diagnostic challenge.

Neuroblastoma: A Case of Massive Hepatomegaly.

Neuroblastoma is the most common embryonal tumor of childhood and has a variable presentation. Stage 4S neuroblastoma, described as a localized primary tumor in an infant with metastasis to skin, liver, or bone marrow, is an exception to the poor prognosis seen in widespread metastasis of neuroblastoma. Survival in infants with this stage of the disease is over 90%. Stage 4S with massive liver involvement, however, confers a poor prognosis. We need more research on the optimum treatment modality for patients with Stage 4S disease and massive hepatomegaly to improve patient outcomes.

Association between meteorological indicators and COVID-19 pandemic in Pakistan.

This study was designed to investigate the impact of meteorological indicators (temperature, rainfall, and humidity) on total COVID-19 cases in Pakistan, its provinces, and administrative units from March 10, 2020, to August 25, 2020. The correlation analysis showed that COVID-19 cases and temperature showed a positive correlation. It implies that the increase in COVID-19 cases was reported due to an increase in the temperature in Pakistan, its provinces, and administrative units. The generalized Poisson regression showed that the rise in the expected log count of COVID-19 cases was 0.024 times for a 1 °C rise in the average temperature in Pakistan. Second, the correlation between rainfall and COVID-19 cases was negative in Pakistan. However, the regression coefficient between the expected log count of COVID-19 cases and rainfall was insignificant in Pakistan. Third, the correlation between humidity and the total COVID-19 cases was negative, which implies that the increase in humidity is beneficial to stop the transmission of COVID-19 in Pakistan, its provinces, and administrative units. The reduction in the expected log count of COVID-19 cases was 0.008 times for a 1% increase in the humidity per day in Pakistan. However, humidity and COVID-19 cases were positively correlated in Sindh province. It is required to create awareness among the general population, and the government should include the causes, symptoms, and precautions in the educational syllabus. Moreover, people should adopt the habit of hand wash, social distancing, personal hygiene, mask-wearing, and the use of hand sanitizers to control the COVID-19.

4,4'-(Propane-1,3-diyldi-oxy)dibenz-aldehyde.

The title compound, C(17)H(16)O(4), is a dialdehyde in which two formyl-phen-oxy units are linked by a -CH(2)CH(2)CH(2)- chain; the mol-ecule is V-shaped with the middle methyl-ene C atom as the apex. The two benzene rings are aligned at 77.4 (1)°. In the crystal, mol-ecules are linked into centrosymmetric dimers by pairs of non-classical C-H⋯O hydrogen bonds.

Di-tert-butyl 2,2'-[(biphenyl-4,4'-diyl)-dioxy]diacetate.

The complete molecule of the title compound, C(24)H(30)O(6), is generated by a crystallographic inversion centre. In the unique part of the mol-ecule, the four-atom -O-CH(2)-C(= O)-O- chain between the benzene ring and the tert-butyl group assumes a zigzag conformation [O-C-C-O torsion angle = -162.3 (1)°].