The Cost-Effectiveness of Early Invasive Procedures for Acute Coronary Syndrome in Low-Income Regions: A Prospective Cohort Study in Pakistan.

Background Acute coronary syndrome (ACS) is a significant cause of mortality and morbidity globally, necessitating effective intervention strategies. Early invasive procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are often recommended for high-risk patients. However, their cost-effectiveness in low-income regions remains uncertain, particularly in Pakistan, where healthcare resources are limited. Objective This study aims to evaluate the cost-effectiveness of early invasive procedures compared to standard care for ACS in low-income regions of Pakistan. Methods We conducted a prospective cohort study from January 1, 2021, to January 31, 2021, at four major hospitals in Pakistan: Army Cardiac Center Combined Military Hospital (CMH) Lahore, National Institute of Cardiovascular Diseases in Karachi, Lady Reading Hospital in Peshawar, and Mardan Medical Complex. The participants included 436 patients diagnosed with ACS aged 18 years or older and presenting within 24 hours of symptom onset. The patients were divided into two groups: the early invasive procedure group (n = 218) and the standard care group (n = 218). The primary outcome was the 30-day mortality rate. Secondary outcomes included recurrent myocardial infarctions, hospital readmissions, healthcare costs, and procedural complications. Data were analyzed using SPSS version 25.0 (IBM SPSS Statistics, Armonk, NY), employing descriptive statistics, chi-square tests, independent t-tests, and Kaplan-Meier survival analysis. Results The early invasive procedure group showed a mortality rate of 18 (8%) compared to 33 (15%) in the standard care group, demonstrating a significant reduction in mortality (p = 0.01). Additionally, the average healthcare cost was significantly lower in the early invasive group, with mean costs of Pakistani rupee (PKR) 187,200 (US dollar {USD} 1,200) compared to PKR 280,800 (USD 1,800) in the standard care group (p < 0.01). Recurrent myocardial infarctions occurred in 11 (5%) of the early invasive group versus 26 (12%) in the standard care group (p < 0.05). Hospital readmission rates were lower in the early invasive group, 22 (10%) compared to 39 (18%) in the standard care group (p < 0.05). Healthcare costs were significantly lower in the early invasive group, with mean costs of PKR 187,200 (USD 1,200) compared to PKR 280,800 (USD 1,800) in the standard care group (p < 0.01). Conclusion Early invasive procedures for ACS significantly improve survival rates, reduce complications, and lower healthcare costs in low-income regions of Pakistan. These findings suggest that such strategies should be considered in resource-limited settings to optimize patient outcomes and healthcare resource utilization.

Enviro-economic and optimal hybrid energy system: Photovoltaic-biogas-hydro-battery system in rural areas of Pakistan.

To satisfy the electricity needs of a village in Tangi, northwest Pakistan, the present research can design and evaluate the environmental and economical aspects of an optimal hybrid photovoltaic-biogas-hydropower-battery energy sustainable system (PV-BG-HP-BESS). This framework integrates various renewable energy sources, delivering a modern, efficient approach to sustainable energy solutions. The HOMER Pro software is utilized to optimize the most economical and effective hybrid energy system. The results showed that the proposed hybrid system comprising 91.4 kWp PV modules, 19.6 kW hydropower, a 50 kW biogas generator (BG), 36 batteries, and a 60.6 kW converter was the most economical choice. This system, which used the cyclic charging (CC) method, had a cost of energy (COE) of 0.0728 $/kWh and a total net present cost (NPC) of $152,242. The suggested hybrid energy system for rural areas of Pakistan includes photovoltaic (PV), biogas (BG), hydro, and battery components to provide a dependable and sustainable power supply. This system minimizes the need for expensive fossil fuels while simultaneously minimizing environmental impact by lowering pollutants and greenhouse gas emissions. The system's annual electricity production is 294,782 kWh, with PV leads at 59.4%, BG at 6.02%, and hydro at 34.6%, ensuring uninterrupted power generation even in remote areas. The unmet load, extra electricity, and capacity shortage illustrate the reliability of the system and make it possible to address rural electrification challenges while supporting sustainable development and economic growth. Moreover, the outcomes of the proposed hybrid system dominate the previous studies in multiple objectives, including cost and sensitivity analysis, when compared.

Ethnic Disparities in Access to Mental Health Services for Black and Asian Migrants in Major Resettlement Countries.

Ethnic inequalities in high-income countries result in higher risk of mental illness and lower access to healthcare services for migrant populations than the majority White populations. This literature review examined evidence of the responsible barriers. A systematic search of six databases (Psychology and Behavioral Sciences Collection; eBook Collection [EBSCOhost]; CINAHL; GreenFILE; Library, Information Science & Technology Abstracts; and MEDLINE) was done using search terms. Eighteen recent, locally accessible studies conducted in six major resettlement countries were selected following PRISMA guidelines and the extracted evidence was analysed descriptively and thematically. Three main themes of ethnic mental health differentials of Black and Asian migrants were identified: access to services (13 studies), risk of mental illness (7 studies), and experience of care services (7 studies). Their access disparities revealed migrants suffer inequalities in service utilisation (5 studies) and greater obstacles to receiving care (8 studies). Their higher risk of mental illness was related to over-diagnosis of psychosis (2 studies), higher prevalence (4 studies), and exposure to predisposing factors (3 studies). Migrants experienced poorer quality and outcomes of care (3 studies), and use of restraint (2 studies) and seclusion (1 study) and expressed fear and mistrust of services (2 studies). The common ethnic barriers in service delivery were language and cultural difficulties, systemic discrimination and marginalisation, and social stigmatisation. It is proposed that systemic racism as well as communication and cultural difficulties are the core determinants of migrants' ethnic disparities of accessing mental health services in these major host countries.

Corrigendum: The outbreak of seasonal goat's brucellosis in the Swat ecosystem of Khyber Pakhtunkhwa.

No abstract available.

Developing a web-based app for non-mental health nurses to assess the mental health needs and risks of children and young people.

There is high demand for specialist mental health services for children and young people in the UK. Non-mental health nurses are well-placed to assess the mental health needs and risks of children and young people to maximise opportunities for early intervention and relieve the pressure on child and adolescent mental health services. This article provides an overview of a service development project to develop a web-based application (app) to support non-mental health nurses when assessing the mental health needs and risks of children and young people. The article describes the development, testing and evaluation process, which involved consultation with children and young people as well as interviews, focus groups and an online survey with a range of professionals working with children and young people. Overall, the findings suggest that the app is appropriate for use by non-mental health nurses in terms of quality, functionality and acceptability.

Comparative analysis of foliar epidermal anatomical traits and their taxonomic relevance in Lilium pumilum, L. brownii, and L. davidi.

The anatomical traits of plant species are essential for taxonomic analyses and evolutionary evaluations. Clarifying the anatomical characteristics of the foliar epidermis in three distinct Lilium species L. pumilum Delile, L. brownii F.E.Br. ex Miellez and L. davidii Duch. ex Elwes were studied in this article. The objective is to assess the taxonomic relevance of these characteristics and their potential as indicators of species divergence within the genus Lilium. Plant samples were gathered in Gansu, China, from numerous populations of each species that represented a range of climatic and ecological factors. A microscopic analysis employing thin slices and peel mounts was done to assess the stomatal density and dimensions. Significant interpopulation differences in stomatal features were found in the results, offering potential opportunities for taxonomic discrimination. The species differ in qualitative and quantitative characters to differentiate the three species. The links between the observed anatomical characteristics and species classification within the Lilium genus were clarified for the three studied species. In the end, this research advances knowledge of Lilium taxonomy, aids in conservation efforts, and deepens awareness of the general patterns of plant variety. RESEARCH HIGHLIGHTS: Epidermal Traits Aid Taxonomy: Cell shape, arrangement, and structures aid Lilium Identification. Cuticle Reveals Taxonomic Clues: Thickness, composition, and structure inform classification. Micromorphology for Species ID: Cell shape, wax, and striations differentiate Lilium species.

Immunoinformatic based designing of potential immunogenic novel mRNA and peptide-based prophylactic vaccines against H5N1 and H7N9 avian influenza viruses.

Influenza viruses are the most common cause of serious respiratory illnesses worldwide and are responsible for a significant number of annual fatalities. Therefore, it is crucial to look for new immunogenic sites that might trigger an effective immune response. In the present study, bioinformatics tools were used to design mRNA and multiepitope-based vaccines against H5N1 and H7N9 subtypes of avian influenza viruses. Several Immunoinformatic tools were employed to extrapolate T and B lymphocyte epitopes of HA and NA proteins of both subtypes. The molecular docking approach was used to dock the selected HTL and CTL epitopes with the corresponding MHC molecules. Eight (8) CTL, four (4) HTL, and Six (6) linear B cell epitopes were chosen for the structural arrangement of mRNA and of peptide-based prophylactic vaccine designs. Different physicochemical characteristics of the selected epitopes fitted with suitable linkers were analyzed. High antigenic, non-toxic, and non-allergenic features of the designed vaccines were noted at a neutral physiological pH. Codon optimization tool was used to check the GC content and CAI value of constructed MEVC-Flu vaccine, which were recorded to be 50.42% and 0.97 respectively. the GC content and CAI value verify the stable expression of vaccine in pET28a + vector. In-silico immunological simulation the MEVC-Flu vaccine construct revealed a high level of immune responses. The molecular dynamics simulation and docking results confirmed the stable interaction of TLR-8 and MEVC-Flu vaccine. Based on these parameters, vaccine constructs can be regarded as an optimistic choice against H5N1 and H7N9 strains of the influenza virus. Further experimental testing of these prophylactic vaccine designs against pathogenic avian influenza strains may clarify their safety and efficacy.Communicated by Ramaswamy H. Sarma.

The outbreak of migratory goat's brucellosis in the Swat ecosystem of Khyber Pakhtunkhwa.

Brucellosis is a major threat to public health especially in developing countries including Pakistan. This study reveals the characterisation of Brucella species affecting humans and goats in the Swat region of Khyber Pakhtunkhwa, Pakistan. Blood samples were collected from shepherds and goats and analysed by Rose Bengal precipitation test (RBPT), standard plate agglutination test (SPAT), polymerase chain reaction (PCR) and Sanger sequencing of 16S rRNA gene. The findings of the study indicated 24% (36/150) and 11.3% (17/150) positivity for Brucella abortus and Brucella melitensis, respectively, in human samples. In samples of goats, 26.66% (40/150) were positive for B. abortus and 16.66% (25/150) samples were positive B. melitensis by SPAT. The species-specific PCR confirmed B. abortus in 24% (36/150) of human samples and 26.66% (17/150) of goat samples by targeting the IS711 locus. The remaining seropositive samples were confirmed as B. melitensis using IS711 M species-specific primer. The sequences of the amplified fragments of the 16S rRNA gene were blasted, and phylogenetic analysis revealed that Brucella species circulating in the Swat district were closely related to B. melitensis and B. abortus reported from India, China, Philippines, and the United States (US) showing the existence of the possible epidemiological linkage among the Brucella species. This study concluded that there was a higher prevalence of B. abortus (26.6%) in humans and goats compared to B. melitensis (16.6%). These results revealed that the Brucella species were circulating in both humans and goats in the study areas. The findings of the study concluded that B. abortus and B. melitensis were circulating in goats and shepherds with a higher prevalence of B. abortus than B. melitensis. Furthermore, the Brucella species identified in Swat were phylogenetically related to the Brucella species reported from India, China, Philippines and the US.Contribution: The proposed study covers the scope of the journal. The species of the genus Brucella affect both animals and shepherds. This study investigates the seroprevalence of brucellosis in shepherds and goats in different geographical areas in the Swat district. The phylogenetic analysis of the Brucella spp. identified in Swat showed close relationships to the Brucella species reported in India, China, Philippines and the US, which shows the possible epidemiological linkages between the Brucella spp.

Therapeutic potential of natural products and antibiotics against bovine mastitis pathogen of cows and buffaloes.

The present study aims to evaluate the prevalence and antimicrobial sensitivity of Staphylococcus aureus associated with bovine mastitis to selected antibiotics and plant extracts. In the current study, 140 milk samples were collected from cows and buffaloes. Among the 140 samples, 93 samples were positive for sub-clinical mastitis based on the California Mastitis Test (CMT). Out of the total positive samples, 45 were confirmed for S. aureus on a Mannitol salt agar media. The antimicrobial susceptibility test revealed that 44.82% of the isolates were resistant to cefoxitin (oxacillin) confirming methicillin-resistant S. aureus (MRSA) with a higher percentage (51.61%) in the buffalo than in the cow samples. Furthermore, the PCR assay confirmed the presence of the mecA gene in all the MRSA isolates. Among the seven tested antibiotics, sulfamethoxazole + trimethoprim showed high efficacy (71.1%) against methicillin-susceptible S. aureus isolates (MSSA). Oxytetracycline and sulfamethoxazole + trimethoprim showed 20% efficacy against MRSA followed by enrofloxacin (10%). On the other hand, the tested samples from Pistacia chinensis revealed that the ethyl acetate extract of bark showed a maximum zone of inhibition of 21.3 mm against MSSA and MRSA isolates at 3 000 µg/disc. Moreover, the methanol extract of Cotoneaster microphyllus formed a 12.3 mm and 9.1 mm zone of inhibition against the MSSA and MRSA isolates, respectively.

AI-Enabled Traffic Control Prioritization in Software-Defined IoT Networks for Smart Agriculture.

Smart agricultural systems have received a great deal of interest in recent years because of their potential for improving the efficiency and productivity of farming practices. These systems gather and analyze environmental data such as temperature, soil moisture, humidity, etc., using sensor networks and Internet of Things (IoT) devices. This information can then be utilized to improve crop growth, identify plant illnesses, and minimize water usage. However, dealing with data complexity and dynamism can be difficult when using traditional processing methods. As a solution to this, we offer a novel framework that combines Machine Learning (ML) with a Reinforcement Learning (RL) algorithm to optimize traffic routing inside Software-Defined Networks (SDN) through traffic classifications. ML models such as Logistic Regression (LR), Random Forest (RF), k-nearest Neighbours (KNN), Support Vector Machines (SVM), Naive Bayes (NB), and Decision Trees (DT) are used to categorize data traffic into emergency, normal, and on-demand. The basic version of RL, i.e., the Q-learning (QL) algorithm, is utilized alongside the SDN paradigm to optimize routing based on traffic classes. It is worth mentioning that RF and DT outperform the other ML models in terms of accuracy. Our results illustrate the importance of the suggested technique in optimizing traffic routing in SDN environments. Integrating ML-based data classification with the QL method improves resource allocation, reduces latency, and improves the delivery of emergency traffic. The versatility of SDN facilitates the adaption of routing algorithms depending on real-time changes in network circumstances and traffic characteristics.

Structural insights into the effect of mutations in the spike protein of SARS-CoV-2 on the binding with human furin protein.

The SARS COV-2 and its variants are spreading around the world at an alarming speed, due to its higher transmissibility and the conformational changes caused by mutations. The resulting COVID-19 pandemic has imposed severe health consequences on human health. Several countries of the world including Pakistan have studied its genome extensively and provided productive findings. In the current study, the mCSM, DynaMut2, and I-Mutant servers were used to analyze the effect of identified mutations on the structural stability of spike protein however, the molecular docking and simulations approaches were used to evaluate the dynamics of the bonding network between the wild-type and mutant spike proteins with furin. We addressed the mutational modifications that have occurred in the spike protein of SARS-COV-2 that were found in 215 Pakistani's isolates of COVID-19 patients to study the influence of mutations on the stability of the protein and its interaction with the host cell. We found 7 single amino acid substitute mutations in various domains that reside in spike protein. The H49Y, N74K, G181V, and G446V were found in the S1 domain while the D614A, V622F, and Q677H mutations were found in the central helices of the spike protein. Based on the observation, G181V, G446V, D614A, and V622F mutants were found highly destabilizing and responsible for structural perturbation. Protein-protein docking and molecular simulation analysis with that of furin have predicted that all the mutants enhanced the binding efficiency however, the V622F mutant has greatly altered the binding capacity which is further verified by the KD value (7.1 E-14) and therefore may enhance the spike protein cleavage by Furin and increase the rate of infectivity by SARS-CoV-2. On the other hand, the total binding energy for each complex was calculated which revealed -50.57 kcal/mol for the wild type, for G181V -52.69 kcal/mol, for G446V -56.44 kcal/mol, for D614A -59.78 kcal/mol while for V622F the TBE was calculated to be -85.84 kcal/mol. Overall, the current finding shows that these mutations have increased the binding of Furin for spike protein and shows that D614A and V622F have significant effects on the binding and infectivity.

Embracing green banking as a mean of expressing green behavior in a developing economy: exploring the mediating role of green culture.

According to a plethora of research and publications, the volume and amount of pollution are largely attributable to human-made emissions. Even during the recently ended Covid-19 outbreak, there was a notable decrease in global pollution, particularly in Pakistan's heavily populated cities. Due to the current situation, it is strategically important to safeguard the environment, and there are many criteria and predictors that should be used to encourage green behavior. This study examines green banking as a means of demonstrating ecologically responsible conduct in a developing nation. A survey questionnaire was used to collect information from 280 respondents via human contact and an internet platform. Software called SmartPLS3.0 was used to analyze the structural relationships between the study's variables. The results show that customers' adoption of green banking practices is statistically significantly influenced by their level of environmental consciousness and attitude. Similarly, green culture exhibits a substantial mediating influence between the independent variables and green behavior as well as a positive significant effect on green behavior. However, it is established that the consumer's apparent behavioral control is negligible. Particularly, the cognitive connection between behavior and culture is weak and insufficient to forecast behavior. For policymakers, especially those working in the field of green education, this study has many real-world applications.

Long-Term Clinical Outcome of Tacrolimus Skin Ointment (0.03%) for the Treatment of Vernal Keratoconjunctivitis: A Quasi-Experimental Study.

Background Vernal keratoconjunctivitis (VKC) is an allergic conjunctival inflammation with severe ocular complications if left untreated. The current management regimen is plagued with adverse effects, long-term problems, and clinical relapses. Tacrolimus offers an alternative treatment option, and long-term studies are needed to determine its efficacy. Methods A two-year follow-up based study was conducted on moderate to severe VKC patients, who were prescribed tacrolimus skin ointment. The 5-5-5 exacerbation scale was used for the monitoring and grading severity of the disease. Analysis of variance (ANOVA) and intergroup comparisons were conducted on exacerbation scale scores among follow-ups. Results A significant reduction was observed in the total score of severity from baseline (203.17±102.05) to three months' follow-up (69.94±70.54), and it kept reducing for 18 months post therapy. Similar results with statistically significant reduction were observed for all grades of the scale. The relapse rate was 5.71% within a month after therapy cessation, and none of the other patients showed relapse afterward. No significant ocular and systemic complications were observed during the study. Conclusion Tacrolimus is effective in the long-term management of VKC without the complications of conventional steroid-based therapy.

Impact of COVID-19 on the wellbeing of micro and small entrepreneurs of rural Pakistan.

According to the constitution of Pakistan, the state is responsible for the provision of necessities of life to its citizens whenever their livelihood is permanently or temporarily threatened. COVID-19 and its associated lockdowns were a series of events where amenities of life around the world were seriously endangered. Especially, hard hit were the small- and medium-sized entrepreneurs (SMEs) of rural Pakistan. To quantitatively assess the social and economic impact of COVID-19, we interviewed the local microenterprise owners in rural Pakistan from January to February 2021 and then June 2021. Mean comparison tests were estimated for pre- and post-COVID-19 periods. Results reveal that the COVID-19 pandemic has significantly and negatively affected wellbeing of micro and small entrepreneurs in the regions as the income of most of the sampled entrepreneurs significantly decreased during the pandemic. Disaggregated consumption analysis however revealed that nominal consumption of food, clothing, energy, health, and education all increased, except for communication, during the pandemic. Furthermore, the regression analysis revealed that changes in income, occupation, borrowing during COVID-19, and family type of the respondents were significant factors in mitigating the effects of COVID-19. Based on the findings, policy recommendations are also spelled out in the last section.

Awareness Level of Business Students regarding Drinking Water Safety and Associated Adulteration Accidents: A Multinomial Logistic Regression Approach.

The industrialization of metropolis urban areas with dry and steppe climates raise substantial environmental contamination, particularly in the water domain. This research investigated the awareness levels of business students toward drinking water quality and safety. We further explored the knowledge of the business students regarding drinking water issues and remedies. Eighty-four percent of respondents were happy with the quality of their drinking water, according to the findings. Approximately 66% of respondents paid special or rather high attention to drinking water quality and contamination incidents, particularly regarding possible harm to the human body and health, impact scope, and accident reasons. Few respondents reported to the health department or phoned the water safety department; 47.5% of respondents resolved drinking water issues independently. Age and education level did not play a significant role in the degree of public satisfaction with water quality or the public's perception of water pollution incidents; however, business students in Samundri were more satisfied with their drinking water quality, and residents of Faisalabad Sadar were more aware of drinking water contamination incidents than residents in areas without such a network. Respondents with higher levels of education were more aware of water quality and pollution incidents than those with lower levels of education. The steppe climate, diverse human activities, and industrialization led to water pollution. The current research findings may provide fundamental data for efficient water management in the most populated and industrialized regions.

Ultrasound-assisted deep eutectic solvent-based liquid-liquid microextraction for simultaneous determination of Ni (II) and Zn (II) in food samples.

A new approach was developed for the simultaneous pre-concentration and determination of Ni (II) and Zn (II) in food samples. This method is based on ultrasound-assisted liquid-liquid micro extraction using hydrophobic deep eutectic solvent (DES) and 1,10-phenanthroline as chelating agent. The effect of several parameters, such as pH, selection and volume of DES, amount of chelating agent, time of sonication and centrifugation, was studied. Under optimized conditions, the developed procedure offered exceptional sensitivity and linearity. The limit of detection was approximately 0.029 µg/Kg and 1.5 µg/Kg for Ni (II) and Zn (II), respectively. The proposed method was applied for the pre-concentration and determination of Ni (II) and Zn (II) in hydrogenated edible oils, fishes, and milk samples. The results of this study were compared with reported methods in the literature revealing its advantages.

Do Chief Executives Matter in Corporate Financial and Social Responsibility Performance Nexus? A dynamic Model Analysis of Chinese Firms.

This study examined the relationship between Corporate Financial Performance (CFP) and Corporate Social Responsibility Performance (CSRP). Furthermore, it explored the effectiveness of chief executive characteristics as a moderator in the CFP-CSRP nexus. We employed a dynamic sysGMM regression model on 2,439 firm-year observations of Chinese firms. The results reveal that CFP (market-based) has a significant positive impact on CSRP. However, CFP (historical) is significantly negatively related to CSRP. Furthermore, the study found that CEO turnover and CEO duality negatively moderate the CFP-CSRP relationship, while CEO as CFO positively moderates this relationship. The findings have substantial implications for all stakeholders, including investors, CEOs, corporate regulators, and policymakers.

Computational modelling of potentially emerging SARS-CoV-2 spike protein RBDs mutations with higher binding affinity towards ACE2: A structural modelling study.

The spike protein of SARS-CoV-2 and the host ACE2 receptor plays a vital role in the entry to the cell. Among which the hotspot residue 501 is continuously subjected to positive selection pressure and induces unusual virulence. Keeping in view the importance of the hot spot residue 501, we predicted the potentially emerging structural variants of 501 residue. We analyzed the binding pattern of wild type and mutants (Spike RBD) to the ACE2 receptor by deciphering variations in the amino acids' interaction networks by graph kernels along with evolutionary, network metrics, and energetic information. Our analysis revealed that N501I, N501T, and N501V increase the binding affinity and alter the intra and inter-residue bonding networks. The N501T has shown strong positive selection and fitness in other animals. Docking results and repeated simulations (three times) confirmed the structural stability and tighter binding of these three variants, correlated with the previous results following the global stability trend. Consequently, we reported three variants N501I, N501T, and N501V could worsen the situation further if they emerged. The relations between the viral fitness and binding affinity is a complicated game thus the emergence of high affinity mutations in the SARS-CoV-2 RBD brings up the question of whether or not positive selection favours these mutations or not?

Using implementation intentions to prevent relapse after remission from psychological treatment for depression: The SMArT intervention.

OBJECTIVE: To provide evidence of the effectiveness of a brief relapse prevention intervention using implementation intentions (Self-Management after Therapy, SMArT), following remission from depression and to identify effective relapse prevention strategies. METHOD: The SMArT intervention was provided to 107 patients who were recovered after psychological therapy for depression. Relapse events were calculated as reliable and clinically significant increases in PHQ-scores. Sixteen patients receiving the intervention and eight practitioners providing it were interviewed. Framework Analysis identified seven themes which highlighted effective relapse prevention strategies and effective implementation of the SMArT intervention. RESULTS: Relapse rates at the final SMArT session (four months after the end of acute stage therapy) were 11%. Seven themes were identified that supported effective self-management: (1) Relationship with the practitioner-feeling supported; (2) Support networks; (3) Setting goals, implementing plans and routine; (4) Changing views of recovery; (5) The SMArT sessions-mode, content, timing, duration; (6) Suitability for the person; and (7) Suitability for the service. CONCLUSION: The study provides some support for the effectiveness of the SMArT intervention, although a randomized controlled trial is required; and identifies important relapse prevention strategies.

Peripheral Neuropathy in Beta-Thalassemia: Corneal Confocal Microscopy-Based Study.

Background Peripheral neuropathy is a controversial but serious complication of beta-thalassemia (ß-Th). Although few studies have reported no relationship between neuropathy and thalassemia, many have linked it with increasing age, iron overload, and iron chelator toxicity. This study aims to investigate the presence of neuropathy in ß-Th using corneal nerve fibers. Methodology A cross-sectional study was conducted using corneal confocal microscopy on individuals with intermediate and major ß-Th who were compared to healthy individuals. The main outcome variables were corneal main nerve and branch nerve densities which were calculated using Image J software. The comparison between groups was done using the independent-samples F-test and Bonferroni post-hoc analysis. Results There was reduced corneal main nerve and branch nerve density in ß-Th intermediate and major patients compared to the control group, and the results were statistically significant (p-value <0.05). However, a significant correlation was not observed between serum ferritin levels and corneal nerve parameters. Conclusions The reduction in corneal nerve parameters in ß-Th patients compared to healthy controls can be an indication of peripheral neuropathy in ß-Th. Further work is needed to confirm these findings.