Evaluation of mRNA-1273 Vaccine in Children 6 Months to 5 Years of Age.

BACKGROUND: The safety, reactogenicity, immunogenicity, and efficacy of the mRNA-1273 coronavirus disease 2019 (Covid-19) vaccine in young children are unknown. METHODS: Part 1 of this ongoing phase 2-3 trial was open label for dose selection; part 2 was an observer-blinded, placebo-controlled evaluation of the selected dose. In part 2, we randomly assigned young children (6 months to 5 years of age) in a 3:1 ratio to receive two 25-µg injections of mRNA-1273 or placebo, administered 28 days apart. The primary objectives were to evaluate the safety and reactogenicity of the vaccine and to determine whether the immune response in these children was noninferior to that in young adults (18 to 25 years of age) in a related phase 3 trial. Secondary objectives were to determine the incidences of Covid-19 and severe acute respiratory syndrome coronavirus 2 infection after administration of mRNA-1273 or placebo. RESULTS: On the basis of safety and immunogenicity results in part 1 of the trial, the 25-µg dose was evaluated in part 2. In part 2, 3040 children 2 to 5 years of age and 1762 children 6 to 23 months of age were randomly assigned to receive two 25-µg injections of mRNA-1273; 1008 children 2 to 5 years of age and 593 children 6 to 23 months of age were randomly assigned to receive placebo. The median duration of follow-up after the second injection was 71 days in the 2-to-5-year-old cohort and 68 days in the 6-to-23-month-old cohort. Adverse events were mainly low-grade and transient, and no new safety concerns were identified. At day 57, neutralizing antibody geometric mean concentrations were 1410 (95% confidence interval [CI], 1272 to 1563) among 2-to-5-year-olds and 1781 (95% CI, 1616 to 1962) among 6-to-23-month-olds, as compared with 1391 (95% CI, 1263 to 1531) among young adults, who had received 100-µg injections of mRNA-1273, findings that met the noninferiority criteria for immune responses for both age cohorts. The estimated vaccine efficacy against Covid-19 was 36.8% (95% CI, 12.5 to 54.0) among 2-to-5-year-olds and 50.6% (95% CI, 21.4 to 68.6) among 6-to-23-month-olds, at a time when B.1.1.529 (omicron) was the predominant circulating variant. CONCLUSIONS: Two 25-µg doses of the mRNA-1273 vaccine were found to be safe in children 6 months to 5 years of age and elicited immune responses that were noninferior to those in young adults. (Funded by the Biomedical Advanced Research and Development Authority and National Institute of Allergy and Infectious Diseases; KidCOVE ClinicalTrials.gov number, NCT04796896.).

Evaluation of mRNA-1273 SARS-CoV-2 Vaccine in Adolescents.

BACKGROUND: The incidence of coronavirus disease 2019 (Covid-19) among adolescents between 12 and 17 years of age was approximately 900 per 100,000 population from April 1 through June 11, 2021. The safety, immunogenicity, and efficacy of the mRNA-1273 vaccine in adolescents are unknown. METHODS: In this ongoing phase 2-3, placebo-controlled trial, we randomly assigned healthy adolescents (12 to 17 years of age) in a 2:1 ratio to receive two injections of the mRNA-1273 vaccine (100 µg in each) or placebo, administered 28 days apart. The primary objectives were evaluation of the safety of mRNA-1273 in adolescents and the noninferiority of the immune response in adolescents as compared with that in young adults (18 to 25 years of age) in a phase 3 trial. Secondary objectives included the efficacy of mRNA-1273 in preventing Covid-19 or asymptomatic severe acute respiratory syndrome coronavirus 2 infection. RESULTS: A total of 3732 participants were randomly assigned to receive mRNA-1273 (2489 participants) or placebo (1243 participants). In the mRNA-1273 group, the most common solicited adverse reactions after the first or second injections were injection-site pain (in 93.1% and 92.4%, respectively), headache (in 44.6% and 70.2%, respectively), and fatigue (in 47.9% and 67.8%, respectively); in the placebo group, the most common solicited adverse reactions after the first or second injections were injection-site pain (in 34.8% or 30.3%, respectively), headache (in 38.5% and 30.2%, respectively), and fatigue (in 36.6% and 28.9%, respectively). No serious adverse events related to mRNA-1273 or placebo were noted. The geometric mean titer ratio of pseudovirus neutralizing antibody titers in adolescents relative to young adults was 1.08 (95% confidence interval [CI], 0.94 to 1.24), and the absolute difference in serologic response was 0.2 percentage points (95% CI, -1.8 to 2.4), which met the noninferiority criterion. No cases of Covid-19 with an onset of 14 days after the second injection were reported in the mRNA-1273 group, and four cases occurred in the placebo group. CONCLUSIONS: The mRNA-1273 vaccine had an acceptable safety profile in adolescents. The immune response was similar to that in young adults, and the vaccine was efficacious in preventing Covid-19. (Funded by Moderna and the Biomedical Advanced Research and Development Authority; Teen COVE ClinicalTrials.gov number, NCT04649151.).

A review on endophytic fungi: a potent reservoir of bioactive metabolites with special emphasis on blight disease management.

Phytopathogenic microorganisms have caused blight diseases that present significant challenges to global agriculture. These diseases result in substantial crop losses and have a significant economic impact. Due to the limitations of conventional chemical treatments in effectively and sustainably managing these diseases, there is an increasing interest in exploring alternative and environmentally friendly approaches for disease control. Using endophytic fungi as biocontrol agents has become a promising strategy in recent years. Endophytic fungi live inside plant tissues, forming mutually beneficial relationships, and have been discovered to produce a wide range of bioactive metabolites. These metabolites demonstrate significant potential for fighting blight diseases and provide a plentiful source of new biopesticides. In this review, we delve into the potential of endophytic fungi as a means of biocontrol against blight diseases. We specifically highlight their significance as a source of biologically active compounds. The review explores different mechanisms used by endophytic fungi to suppress phytopathogens. These mechanisms include competing for nutrients, producing antifungal compounds, and triggering plant defense responses. Furthermore, this review discusses the challenges of using endophytic fungi as biocontrol agents in commercial applications. It emphasizes the importance of conducting thorough research to enhance their effectiveness and stability in real-world environments. Therefore, bioactive metabolites from endophytic fungi have considerable potential for sustainable and eco-friendly blight disease control. Additional research on endophytes and their metabolites will promote biotechnology solutions.

Decoding LY6G6D in colorectal cancer: Unraveling biomarker potential and therapeutic insights.

Colorectal cancer (CRC) poses a significant global health challenge with high morbidity and mortality rates. This study investigates the role of LY6G6D, a member of the LY6/uPAR superfamily, in CRC. Employing a bioinformatic approach, we analyzed LY6G6D expression across different cancer types, compared it with known oncogenes in CRC, explored the involved genomic alterations, and assessed associated clinicopathological characteristics. LY6G6D exhibited aberrant expression, particularly elevated in CRC adenocarcinoma and highly specific to tumor tissues when compared with other oncogenes, despite its comparatively low frequency of genomic alteration. Subsequently, tumor immune infiltration analysis revealed distinct associations, primarily indicating a negative correlation, suggesting immune down-regulation. Survival analysis in context of LY6G6D was conducted with Kaplan-Meier (KM) curves, indicating a 10% risk of disease recurrence in the case of elevated expression. Additionally, we constructed a 3D protein model of LY6G6D through ab-inito approach. The protein model was validated, followed by conservation analysis and active site identification. Active site identification of LY6G6D's final predicted model revealed some similar sites that were estimated to be conserved. Target-guided drug molecules were collected and molecular docking was executed, proposing Cardigin (Digitoxin) and Manzamine A as potential therapeutic candidates. In conclusion, LY6G6D emerges as a significant biomarker for diagnostic and therapeutic applications in CRC, highlighting its multifaceted role in tumorigenesis. The proposed drugs present avenues for further investigations.

Antibiotic Stewardship: A Handshaking Strategy Among Physicians and Pharmacists to Improve therapeutic Outcomes in Hematology-Oncology.

Background: Infections are highly susceptible in patients with hematological malignancies due to immune suppression, immunosuppressive therapies and disease progression. Rational use of antibiotics following Antimicrobial Stewardship (AMS) guidelines in early detection and response to infection is significant to improve patient care. Objectives: The present study was conducted to determine the impact of clinical pharmacists' interventions (PIs) on antibiotics usage in hematology-oncology set up in Karachi, Pakistan. Methodology: An observational prospective study was conducted for a period of 4 months in a well-known 75-bed teaching hospital, specializing in bone marrow transplantation in Karachi, Pakistan without a structured Antimicrobial stewardship programs (ASPs). The information was gathered from patient medical histories, laboratory, and microbiological records. Results: A total of 876 PIs (1 to 5 per patient) were implemented. Dose modifications or interval changes accounted for the major interventions (n = 190, 21.6%). The majority of all recommendations were related to antipseudomonal ß-lactams, aminoglycosides, sulfamethoxazole-trimethoprim and vancomycin. Overall, 94.3% (n = 876) of the 928 PIs were accepted. Conclusion: The PIs and the high physician acceptance rate may be useful for improving the safe use of antibiotics, lowering their toxicity, lowering the need for special-vigilance medications and potentially improving patient care.

Associations of Immunogenicity and Reactogenicity After Severe Acute Respiratory Syndrome Coronavirus 2 mRNA-1273 Vaccine in the COVE and TeenCOVE Trials.

BACKGROUND: The reactogenicity and immunogenicity of coronavirus disease 2019 (COVID-19) vaccines are well studied. Little is known regarding the relationship between immunogenicity and reactogenicity of COVID-19 vaccines. METHODS: This study assessed the association between immunogenicity and reactogenicity after 2 mRNA-1273 (100 µg) injections in 1671 total adolescent and adult participants (≥12 years) from the primary immunogenicity sets of the blinded periods of the Coronavirus Efficacy (COVE) and TeenCOVE trials. Associations between immunogenicity through day 57 and solicited adverse reactions (ARs) after the first and second injections of mRNA-1273 were evaluated among participants with and without solicited ARs using linear mixed-effects models. RESULTS: mRNA-1273 reactogenicity in this combined analysis set was similar to that reported for these trials. The vaccine elicited high neutralizing antibody (nAb) geometric mean titers (GMTs) in evaluable participants. GMTs at day 57 were significantly higher in participants who experienced solicited systemic ARs after the second injection (1227.2 [1164.4-1293.5]) than those who did not (980.1 [886.8-1083.2], P = .001) and were associated with fever, chills, headache, fatigue, myalgia, and arthralgia. Significant associations with local ARs were not found. CONCLUSIONS: These data show an association of systemic ARs with increased nAb titers following a second mRNA-1273 injection. While these data indicate systemic ARs are associated with increased antibody titers, high nAb titers were observed in participants after both injections, consistent with the immunogenicity and efficacy in these trials. These results add to the body of evidence regarding the relationship of immunogenicity and reactogenicity and can contribute toward the design of future mRNA vaccines.

A Critical Cybersecurity Analysis and Future Research Directions for the Internet of Things: A Comprehensive Review.

The emergence of the Internet of Things (IoT) technology has brought about tremendous possibilities, but at the same time, it has opened up new vulnerabilities and attack vectors that could compromise the confidentiality, integrity, and availability of connected systems. Developing a secure IoT ecosystem is a daunting challenge that requires a systematic and holistic approach to identify and mitigate potential security threats. Cybersecurity research considerations play a critical role in this regard, as they provide the foundation for designing and implementing security measures that can address emerging risks. To achieve a secure IoT ecosystem, scientists and engineers must first define rigorous security specifications that serve as the foundation for developing secure devices, chipsets, and networks. Developing such specifications requires an interdisciplinary approach that involves multiple stakeholders, including cybersecurity experts, network architects, system designers, and domain experts. The primary challenge in IoT security is ensuring the system can defend against both known and unknown attacks. To date, the IoT research community has identified several key security concerns related to the architecture of IoT systems. These concerns include issues related to connectivity, communication, and management protocols. This research paper provides an all-inclusive and lucid review of the current state of anomalies and security concepts related to the IoT. We classify and analyze prevalent security distresses regarding IoT's layered architecture, including connectivity, communication, and management protocols. We establish the foundation of IoT security by examining the current attacks, threats, and cutting-edge solutions. Furthermore, we set security goals that will serve as the benchmark for assessing whether a solution satisfies the specific IoT use cases.

A misdiagnosis of choledochal cyst type IB and recommendation to use gold-standard imaging techniques: A case report.

A choledochal cyst (CC) is a rare congenital dilation of the biliary ductal system that can cause troublesome complications when left untreated. CC in children classically manifests as a rare triad of the right upper quadrant mass, jaundice, and abdominal pain. Here, we report the case of an eight-year-old boy seen in Paediatric Unit I of Dr Ruth K. M. Pfau Civil Hospital Karachi, Pakistan, on October 9, 2019, who was initially misdiagnosed for liver abscess due to the non-specific symptoms and managed appropriately with antibiotics, which failed to improve the symptoms. Moreover, a hydatid cyst was considered based on ultrasonography (USG) which was later ruled out by the negative serology. A definitive diagnosis of CC was established on magnetic resonance cholangiopancreatography (MRCP). In resource-limited countries, USG is always the first line screening tool for biliary duct abnormalities which in some cases is comprehensibly enough for the diagnosis of a rare entity like CC, thus requiring a highly specific imaging test like MRCP to be performed to devise an effective treatment and surgical plan.

Chest X ray and cough sample based deep learning framework for accurate diagnosis of COVID-19.

All witnessed the terrible effects of the COVID-19 pandemic on the health and work lives of the population across the world. It is hard to diagnose all infected people in real time since the conventional medical diagnosis of COVID-19 patients takes a couple of days for accurate diagnosis results. In this paper, a novel learning framework is proposed for the early diagnosis of COVID-19 patients using hybrid deep fusion learning models. The proposed framework performs early classification of patients based on collected samples of chest X-ray images and Coswara cough (sound) samples of possibly infected people. The captured cough samples are pre-processed using speech signal processing techniques and Mel frequency cepstral coefficient features are extracted using deep convolutional neural networks. Finally, the proposed system fuses extracted features to provide 98.70% and 82.7% based on Chest-X ray images and cough (audio) samples for early diagnosis using the weighted sum-rule fusion method.

Incorporating a clinical oncology pharmacist into an ambulatory care pharmacy in pediatric hematology-oncology and transplant clinic: Assessment and significance.

BACKGROUND: Beta thalassemia patients, post-bone marrow transplant, and leukemia patients require long term therapy with an intense care follow-up especially for pediatric hematology-oncology origin. Emergence of side effects and noncompliance to therapy lead to reduced efficacy of medicines resulting in relapse of diseases. There is an increasing fact to support the incorporation of a pharmacist into clinical team due to their distinctive skills. Clinical oncology pharmacist with experience and specialized training in hematological cancers and bone marrow transplantation (BMT) patient care has in-depth knowledge and skills of chemotherapy regimens including drug information, monitoring parameters of cancer treatment, dose adjustment, drug-drug interactions, adverse effects, and patient counseling skills. AIM AND OBJECTIVES: The main objective of our study was to assess the significance of incorporation of clinical oncology pharmacist in ambulatory care in pediatric hematology-oncology and transplant clinic. MATERIAL AND METHOD: This study was conducted at National Institute of Blood Diseases and Bone Marrow Transplantation hospital with duration of five months from 17 March 2019 to 16 July 2019. In this study the clinical oncology pharmacist was made available at ambulatory clinic of hematology-oncology and transplantation. The activities performed by a clinical oncology pharmacist were observed by resident BMT clinical pharmacist during the visits of patients and their families in a clinic. The BMT pharmacist is a clinical oncology pharmacist with experience and specialized training in hematological cancers and BMT patient care. Only pediatrics patients with beta thalassemia major and those who were on chemotherapy treatment and post-transplant patient were included in this study. RESULTS: During the five months' tenure, there were 1820 pediatric patients' visits in total. The clinical oncology pharmacist performed 980 direct patient interviews and documented 1665 pharmacist interventions. The majority of the documented clinical oncology pharmacist interventions were review of medication histories (n: 404, 24%) and "deferiprone" dose adjustments (n:400, 24%). Genomic profiling interventions were also among the commonly reported activities by the clinical oncology pharmacist. For beta thalassemia patients undergoing hydroxyurea therapy, the genomic profiling was performed to assess whether the hydroxyurea treatment is clinically effective or not (n:396, 23%). CONCLUSION: The involvement of clinical oncology pharmacist into a specialized outpatient clinic of hematology-oncology and transplant clinic plays an integral role in minimizing the adverse effect and reduction in readmission into the hospital. This is new expansion of pharmacist's role especially in underdeveloped country, considering the relevant clinical participation of clinical oncology pharmacist into specialized clinic revealing through optimized therapy and future prospect of clinical oncology pharmacist in pediatric hematology.

Optimization of chitosan for microencapsulation of flaxseed oil through spray drying.

The study is aimed to characterize the wall material chitosan in combination with maltodextrin for microencapsulation of flaxseed oil to enhance the delivery of polyunsaturated fatty acids in functional foods. Four formulations of water-based oil emulsions containing flaxseed oil were prepared, homogenized, and analyzed in terms of stability and viscosity. Resulting emulsions were spray dried and further evaluated physicochemically. Results revealed that total moisture content of spray dried microcapsules was in range of 3.1 ± 0.01-3.32 ± 0.04, while highest microencapsulation efficiency found for spray dried powder was 88.8 ± 1.45. Peroxide and anisidine value revealed high oxidative stability of dried powders during storage at room temperature as compared to bulk FO. Among the four formulations, formulation 3 was found to be highly efficient with high encapsulation efficiency and lower PV (3.93 ± 0.13) and AV (2.93 ± 0.21) value. Fatty acid profile was stable after 30 days and slight change observed in composition. Formulations with different concentration of chitosan has significant (p <0.05) impact on emulsion properties and oxidative stability values. It is concluded that spray dried flaxseed oil microcapsules prepared using chitosan as coating material enhance the stability and delivery of omega-3 fatty acids.

Sodium arsenate induced genotoxicity, morphometric and morphological changes in mice embryo and protective role of Moringa oleifera extracts.

The present study was carried out to find the comparative ameliorative role of Moringa oleifera leaf and flower extracts against sodium arsenate induced genotoxic, morphometric and morphological changes in mice embryo. Seven to eight week old pregnant females (N=44) with body weight of 20-25g at gestation day zero were divided randomly in groups (A, B, C, D, E, F, G, H, I, J and K). Group A was of control while all others were experimental groups and administered with selected doses of sodium arsenate as toxicant (6mg/kg B.W and 12mg/kg/B.W) and Moringa oleifera leaf and flower extracts as antidote (150mg/kg and 300mg/kg B.W). Significant (p<0.05) amelioration at dose 300mg/kg of Moringa oleifera leaf extract was observed against sodium arsenate induced morphological abnormalities like micromelia, excencephally, cryptothalmia, anopthalmia, laproschisis and morphometric changes like fetus weight, head circumference, crown rump and snout length were observed. Significant protection of DNA was showed in Moringa oleifera leaf extract treated groups (27.50±2.51) as compared to sodium arsenate (66.25±2.75). So concluded that sodium arsenate induced teratogenicity can be decreased using Moringa extract especially of Moringa oleifera leaf extract as it contains bioactive compounds like phenolics.

Edge Computing to Secure IoT Data Ownership and Trade with the Ethereum Blockchain.

With an increasing penetration of ubiquitous connectivity, the amount of data describing the actions of end-users has been increasing dramatically, both within the domain of the Internet of Things (IoT) and other smart devices. This has led to more awareness of users in terms of protecting personal data. Within the IoT, there is a growing number of peer-to-peer (P2P) transactions, increasing the exposure to security vulnerabilities, and the risk of cyberattacks. Blockchain technology has been explored as middleware in P2P transactions, but existing solutions have mainly focused on providing a safe environment for data trade without considering potential changes in interaction topologies. we present EdgeBoT, a proof-of-concept smart contracts based platform for the IoT built on top of the ethereum blockchain. With the Blockchain of Things (BoT) at the edge of the network, EdgeBoT enables a wider variety of interaction topologies between nodes in the network and external services while guaranteeing ownership of data and end users' privacy. in EdgeBoT, edge devices trade their data directly with third parties and without the need of intermediaries. This opens the door to new interaction modalities, in which data producers at the edge grant access to batches of their data to different third parties. Leveraging the immutability properties of blockchains, together with the distributed nature of smart contracts, data owners can audit and are aware of all transactions that have occurred with their data. we report initial results demonstrating the potential of EdgeBoT within the IoT. we show that integrating our solutions on top of existing IoT systems has a relatively small footprint in terms of computational resource usage, but a significant impact on the protection of data ownership and management of data trade.

Awareness About Ebola Virus Disease Among the Health Care Professionals in Karachi, Pakistan.

Background: Ebola virus disease is an acute and life-threatening illness, which, if untreated, is fatal. It was first discovered in 1976, which aware the world with sporadic outbreaks of Ebola in some parts of Africa. According to Centers for Disease Control and Prevention (CDC), the natural reservoir for Ebola virus remains unknown; however, it is yet to be affirmed that the natural habitat is animal-borne where bats are most likely to carry over this virus. Therefore, the aim of this study was to estimate awareness of health care professionals as they serve as the integral part of our health care system. Methods: A cross-sectional survey was conducted among 149 health care workers (HCWs) in Civil Hospital of Karachi from June 2015 to August 2015. The study participants were randomly selected individuals who were students of and/or were working in the university's affiliated tertiary care hospital in Karachi, Pakistan. Results: Baseline characteristics of the study participants are shown in Table 1. Median age of the participants is 21 (range: 17-24) years. Female preponderance was found to be higher (104; 69.8%) as compared with the males (45; 30.2%). Discipline of majority of the study participants was medical technology (80; 53.7%), followed by nurses (38; 25.5%) and doctors (31; 20.8%). Majority of the study respondents were undergraduate medical students (60; 75%) as compared with medical technologist and the nurses (17; 24.6%) with a P value < .001 as shown in Figure 1. The mean for correct responses was 8.43 ± 4.08 (range: 3-17). Appropriate knowledge was observed in 84 (56.4%) responders and inappropriate knowledge was observed in 65 (43.6%) of the study respondents. Conclusion: Our study concludes that there is an unsatisfactory knowledge about Ebola virus disease among health care professionals. Moreover, public health authorities should signify the importance of prevention against Ebola virus disease not only among the health care professionals but also into the communities through mass media and awareness campaigns which can thus halt the panic and incidence of Ebola virus outbreaks in coming decades.

Ameliorative effects of Moringa oleifera leaf and flower extracts on sodium arsenate induced oxidative stress and histopathological changes in mice embryo.

The study is aimed to investigate the protective role of Moringa oleifera extracts against sodium arsenate induced embryo toxicity in albino mice. Forty four pregnant mice were divided into 11groups (A-K). Group A was control while B and C were sodium arsenate treated groups with dose, A (0.00), B (6.00, 0.00), C (12.00, 0.00). Group D to G were of sodium arsenate+Moringa oleifera flower extract treated groups with doses D (6.00, 150.00), E (6.00, 300.00), F (12.00, 150.00), G (12.00, 300.00) and groups H to K were sodium arsenate+Moringa oleifera leaf extract treated groups H (6.00, 150.00), I (6.00, 300.00), J (12.00, 150.00) and K (12.00, 300.00) mg/kg B.W. Moringa oleifera leaf extract treated groups showed significant (p<0.05) amelioration against sodium arsenate induced histopathological changes as malformed heart, spina bifida, enlarged ventricles, poorly developed kidneys, anopthalmia and cavitation in brain. Significant (p<0.05) increased in malondialdehyde 36±0.81 and decreased glutathione 8.25±0.95 values in sodium arsenate treated groups were observed as compared to control 22.5±0.57 and 19±0.81.Whereas Moringa oleifera leaf extract at dose of 300mg/kg B.W normalizesd the malondialdehyde 23±0.81 and glutathione 17.75±3.20 values. So concluded that Moringa oleifera leaf extract has ameliorative effects against sodium arsenate induced embryotoxicity.

A Fractal-Based Authentication Technique Using Sierpinski Triangles in Smart Devices.

The prevalence of smart devices in our day-to-day activities increases the potential threat to our secret information. To counter these threats like unauthorized access and misuse of phones, only authorized users should be able to access the device. Authentication mechanism provide a secure way to safeguard the physical resources as well the information that is processed. Text-based passwords are the most common technique used for the authentication of devices, however, they are vulnerable to a certain type of attacks such as brute force, smudge and shoulder surfing attacks. Graphical Passwords (GPs) were introduced as an alternative for the conventional text-based authentication to overcome the potential threats. GPs use pictures and have been implemented in smart devices and workstations. Psychological studies reveal that humans can recognize images much easier and quicker than numeric and alphanumeric passwords, which become the basis for creating GPs. In this paper a novel Fractal-Based Authentication Technique (FBAT) has been proposed by implementing a Sierpinski triangle. In the FBAT scheme, the probability of password guessing is low making system resilient against abovementioned threats. Increasing fractal level makes the system stronger and provides security against attacks like shoulder surfing.

Progression of a Buschke-Lowenstein tumor into invasive squamous cell carcinoma.

Buschke-Lowenstein tumors primarily are slow-growing giant condylomata accuminata of the anogenital region. They are locally destructive with a low rate of metastasis. Sexually transmitted oncogenic human papillomavirus type 6 and 11 are the greatest risk factors for Buschke-Lowenstein tumors or verrucous carcinomas, a type of squamous cell cancer. Grossly, the tumor appears as a large fungating, erythematous, cauliflower-like mass. Radical surgical excision of the tumor is the treatment of choice and close follow-up for recurrence is essential. The use of radiation or chemotherapy as adjunct treatments is controversial. This case report describes a patient with this rare condition.

Drug Compliance and Its Associated Factors Among Hypertensive Patients in Pakistan: A Cross-sectional Study.

The drug compliance and its associated factors were investigated among hypertensive patients attending the outpatient department of National Institute of Cardiovascular Disease (NICVD), Karachi, from September 2014 to March 2015. Data were collected retrospectively from 300 hypertensive patients taken treatment for >1 year. Half of the patients (51%) were >55 years of age with the predominance of males (52.70%). Most respondents (47%) had had ischemic heart disease (IHD), 30% had diabetes, 47% had both IHD and diabetes, while only a small number of subjects (18%) reporting no comorbidity. Most respondents (82%) reported that they took medicine regularly. Drug compliance was found significantly higher in males (55.70%) as compared with females (44.30%) (P = .025). Similarly, drug compliance was found significantly higher in patients who monitored their blood pressure (BP) regularly (59.30%) as compared with the patients who did not monitor their BP regularly (40.70%) (P = .001). Most respondents (46.30%) with hypertension (HTN) duration ≤5 years had significantly higher drug compliance as compared with the patients with HTN duration of 6 to 10 years and ≥11 years, that is, 33.30% and 20.30%, respectively (P = .018). In conclusion, the rate of drug adherence is not up to the mark in hypertensive patients, with high compliance reported in only half of the respondents.

Detection of the Incidence of HBV, HCV Infection and Febrile Neutropenia Associated With CHOP With or Without Rituximab in Diffuse Large B-Cell Lymphoma-Treated Patients.

Background: Reactivation of hepatitis B virus (HBV) and hepatitis C virus (HCV) and febrile neutropenia (FN) are common in diffuse large B-cell lymphoma (DLBCL) patients undergoing cyclophosphamide, hydroxyrubicin, Oncovin, and prednisolone (CHOP) or cyclophosphamide, hydroxyrubicin, Oncovin, prednisolone - rituximab containing (R-CHOP) chemotherapy. This ultimately leads to delaying the therapy, increasing hospital stay, and raising the pharmacoeconomic burden on patients. Aim and Objective: The aim of this study was to determine the incidence of HBV and HCV infection and febrile neutropenia in DLBCL patients treated with R-CHOP and CHOP. Methodology: This was an institutional approved study in which patient records from a private hospital, specialized in hematology and oncology (Karachi, Pakistan), were reviewed retrospectively from 2014 to 2016. Patients aged above 18 years with known diagnosis of DLBCL who underwent CHOP-21 or R-CHOP-21 chemotherapy regimen were included. Baseline blood chemistry and liver function tests along with the data regarding HBV (hepatitis B surface antigen [HBsAg], hepatitis B surface antibody [anti-HBs]), HCV (antibody anti-HCV), and febrile neutropenia were collected from patient records. Results: In total, 35 cases of DLBCL were treated during a 3-year period (ie, from 2014 to 2016), of which 16 were on CHOP-21 regimen whereas 19 were treated with R-CHOP-21. Of the 19 patients who underwent R-CHOP chemotherapy, only 2 (10%) patients were HBsAg reactive. Before commencing the second cycle, 2 (10%) patients reported to hospital with fever and had hematological (low neutrophil count) and microbiological (Escherichia coli) proven febrile neutropenia. The incidence of HBV infection post treatment was lower in group treated with CHOP (1 patient showed HBsAg reactivity).