The impact of biochar addition on morpho-physiological characteristics, yield and water use efficiency of tomato plants under drought and salinity stress.

The use of saline water under drought conditions is critical for sustainable agricultural development in arid regions. Biochar is used as a soil amendment to enhance soil properties such as water-holding capacity and the source of nutrition elements of plants. Thus, the research was carried out to assess the impact of biochar treatment on the morphological and physiological characteristics and production of Solanum lycopersicum in greenhouses exposed to drought and saline stresses. The study was structured as a three-factorial in split-split-plot design. There were 16 treatments across three variables: (i) water quality, with freshwater and saline water, with electrical conductivities of 0.9 and 2.4 dS m- 1, respectively; (ii) irrigation level, with 40%, 60%, 80%, and 100% of total evapotranspiration (ETC); (iii) and biochar application, with the addition of biochar at a 3% dosage by (w/w) (BC3%), and a control (BC0%). The findings demonstrated that salt and water deficiency hurt physiological, morphological, and yield characteristics. Conversely, the biochar addition enhanced all characteristics. Growth-related parameters, such as plant height, stem diameter, leaf area, and dry and wet weight, and leaf gas exchange attributes, such rate of transpiration and photosynthesis, conductivity, as well as leaf relative water content were decreased by drought and salt stresses, especially when the irrigation was 60% ETc or 40% ETc. The biochar addition resulted in a substantial enhancement in vegetative growth-related parameters, physiological characteristics, efficiency of water use, yield, as well as reduced proline levels. Tomato yield enhanced by 4%, 16%, 8%, and 3% when irrigation with freshwater at different levels of water deficit (100% ETc, 80% ETc, 60% ETc, and 40% ETc) than control (BC0%). Overall, the use of biochar (3%) combined with freshwater shows the potential to enhance morpho-physiological characteristics, support the development of tomato plants, and improve yield with higher WUE in semi-arid and arid areas.

Arrhythmogenic right ventricular cardiomyopathy: Unveiling clinical presentations, CMR insights and prognosis in a single-center retrospective study.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a hereditary condition with a prevalence ranging from 1 in 2000 to 1 in 5000 individuals. ARVC is a significant contributor to sudden cardiac death, particularly in young individuals and athletes, and remains challenging to diagnose definitively. We conducted a single-center retrospective study to evaluate the presentations, electrocardiogram findings, and imaging characteristics of ARVC patients evaluated at our center between 2021 and 2023. Notably, our study is the second investigation of ARVC conducted in Pakistan. We report divergent symptom prevalence as compared to the current literature and have incorporated the Task Force Criteria. Despite limited access to cardiac magnetic resonance (CMR) facilities worldwide, our findings underscore the critical role ofCMR in ARVC diagnosis. Our cohort had a mortality rate of 17 % highlighting the importance of early detection and the need for improved diagnostic facilities for ARVC in the region.

Efficacy and Safety of Radiation Segmentectomy with 90Y Resin Microspheres for Hepatocellular Carcinoma.

Background Limited data are available on radiation segmentectomy (RS) for treatment of hepatocellular carcinoma (HCC) using yttrium 90 (90Y) resin microsphere doses determined by using a single-compartment medical internal radiation dosimetry (MIRD) model. Purpose To evaluate the efficacy and safety of RS treatment of HCC with 90Y resin microspheres using a single-compartment MIRD model and correlate posttreatment dose with outcomes. Materials and Methods This retrospective single-center study included adult patients with HCC who underwent RS with 90Y resin microspheres between July 2014 and December 2022. Posttreatment PET/CT and dosimetry were performed. Adverse events were assessed using the Common Terminology Criteria for Adverse Events, version 5.0. Per-lesion and overall response rates (ie, complete response [CR], objective response, disease control, and duration of response) were assessed at imaging using the Modified Response Evaluation Criteria in Solid Tumors, and overall survival (OS) was assessed using Kaplan-Meier analysis. Results Among 67 patients (median age, 69 years [IQR, 63-78 years]; 54 male patients) with HCC, median tumor absorbed dose was 232 Gy (IQR, 163-405 Gy). At 3 months, per-lesion and overall (per-patient) CR was achieved in 47 (70%) and 41 (61%) of 67 patients, respectively. At 6 months (n = 46), per-lesion rates of objective response and disease control were both 94%, and per-patient rates were both 78%. A total of 88% (95% CI: 79 99) and 72% (95% CI: 58, 90) of patients had a per-lesion and overall duration of response of 1 year or greater. At 1 month, a grade 3 clinical adverse event (abdominal pain) occurred in one of 67 (1.5%) patients. Median posttreatment OS was 26 months (95% CI: 20, not reached). Disease progression at 2 years was lower in the group that received 300 Gy or more than in the group that received less than 300 Gy (17% vs 61%; P = .047), with no local progression in the former group through the end of follow-up. Conclusion Among patients with HCC who underwent RS with 90Y resin microspheres, 88% and 72% achieved a per-lesion and overall duration of response of 1 year or greater, respectively, with one grade 3 adverse event. In patients whose tumors received 300 Gy or more according to posttreatment dosimetry, a disease progression benefit was noted. © RSNA, 2024 Supplemental material is available for this article.

Exploring Nanomaterials for Hydrogen Storage: Advances, Challenges, and Perspectives.

Hydrogen energy heralded for its environmentally friendly, renewable, efficient, and cost-effective attributes, stands poised as the primary alternative to fossil fuels in the future. Despite its great potential, the low volumetric density presents a formidable challenge in hydrogen storage. Addressing this challenge necessitates exploring effective storage techniques for a sustainable hydrogen economy. Solid-state hydrogen storage in nanomaterials (physically or chemically) holds promise for achieving large-scale hydrogen storage applications. Such approaches offer benefits, including safety, compactness, lightness, reversibility, and efficient generation of pure hydrogen fuel under mild conditions. This article presents solid-state nanomaterials, specifically nanoporous carbons (activated carbon, carbon fibers), metal-organic frameworks, covalently connected frameworks, nanoporous organic polymers, and nanoscale metal hydrides. Furthermore, new developments in hydrogen fuel cell technology for stationary and mobile applications have been demonstrated. The review outlines significant advancements thus far, identifies key barriers to practical implementation, and presents a perspective for future sustainable energy research. It concludes with recommendations to enhance hydrogen storage performance for cost-effective and long-lasting utilization.

Mechanical and Durability Characterization of Hybrid Recycled Aggregate Concrete.

The recycling of construction and demolition waste (CDW) for the extraction of recycled concrete aggregates (RCAs) to be used to produce recycled aggregate concrete (RAC) is widely acknowledged internationally. However, CDW not only contains concrete debris but may also contain burnt clay bricks. The recycling of such CDW without the segregation of different components would result in recycled aggregates having different proportions of concrete and brick aggregates. The utilization of these aggregates in concrete requires a detailed investigation of their mechanical and durability properties. In this regard, the present study focused on investigating the mechanical and durability properties of hybrid recycled aggregate concrete (HRAC) made by the 100% replacing of natural aggregates with recycled brick (RBAs) and RCA in hybrid form. The partial replacement of cement with fly ash was also considered to reduce the corban footprint of concrete. An extensive experimental program was designed and carried out in two phases. In the first phase, a total of 48 concrete mixes containing coarse RBA and RCA in mono and hybrid forms were prepared and tested for their compressive strength. The test results indicated that the compressive strength of HRAC is greatly affected by the proportion of coarse RBA and RCA. In the second phase, based on the results of the first phase, eight concrete mixes with the most critical proportions of RBA and RCA in hybrid form were selected to evaluate their mechanical and durability performance. In addition, four mixes with natural aggregates were also prepared for comparison purposes. To evaluate the mechanical properties of the concrete mixes, compressive strength and modulus of rupture (MOR) tests were performed, while for the evaluation of durability properties, water absorption and behavior after exposure to aggressive conditions of acidic and brine solutions were studied. The results revealed that a 20% replacement of cement with fly ash resulted in acceptable mechanical and durability properties of HRAC intended to be used for making concrete bricks or pavers.

Phase formation and dielectric properties of MgFe2O4 nanoparticles synthesized by hydrothermal technique.

In the recent development of energy storage devices, the scientific study has demonstrated a significant interest in the applications of the magnesium iron oxide (MgFe2O4) nanoparticles. In this work, we present synthesized novel MgFe2O4 nanoparticles at different molarities (0.1-0.5 M), via hydrothermal technique. An X-ray Diffractometer was used to study the phase analysis of the prepared samples at different molarities. A pure cubic phase of the MgFe2O4 is observed at molar concentrations of 0.3 M and 0.4 M. However, the mixed phases consisting of (MgFe2O4 + Î³-Fe2O3) were also observed at 0.1 M, 0.2 M, and 0.5 M. The pure cubic MgFe2O4 nanoparticles depict the large value of crystallite size, 19.5 nm, and the lowest dislocation density and strain. The vibrating Sample Magnetometer shows the ferromagnetic nature of the pure MgFe2O4 with a high saturation magnetization. The value of saturation magnetization surged from 36.88 emu/g to 55.2 emu/g at 0.4 M concentration. The dielectric response of the materials as a function of applied frequency was studied thoroughly by using an Impedance Analyzer. The highest value of dielectric constant and low tangent loss was also reported at 0.4 M. Cole-Cole plots are the affirmation of the contribution of both grains and grain boundaries in the charge mechanism. These distinctive features make the synthesized material an excellent choice for future spintronics and energy storage devices.

Effects of prilled fat supplementation in diets with varying protein levels on production performance of early lactating Nili Ravi Buffaloes.

Objective: The objective of the current study was to find out the independent and interactive effects of prilled fat supplementation with protein on the production performance of early lactating Nili Ravi buffaloes. Methods: Sixteen early lactating buffaloes (36.75 ± 5.79 d in milk; mean ± SE) received 4 treatments in 4 × 4 Latin-square design according to 2 × 2 factorial arrangements. The dietary treatments were:1) LPLF = low protein low fat, 2) LPHF = low protein high fat, 3) HPLF = high protein low fat, and 4) HPHF = high protein high fat. The dietary treatments contained 2 protein (8.7 and 11.7% CP, crude protein) and fat levels (2.6 and 4.6% EE, ether extract) on a dry matter basis. Results: The yields of milk and fat increased with increasing protein and fat independently (p≤0.05). Energy-, protein-, and fat-corrected milk yields also increased with increasing protein and fat independently (p≤0.05). Increasing dietary protein increased the protein yield by 3.75% and lactose yield by 3.15% and increasing dietary fat supplies increased the fat contents by 3.93% (p≤0.05). Milk yield and fat-corrected milk to dry matter intake ratios were increased at high protein and high fat levels (p≤0.05). Milk nitrogen efficiency was unaffected by dietary fat (p>0.10), whereas it decreased with increasing protein supplies (p≤0.05). Plasma urea nitrogen and cholesterol were increased by increasing protein and fat levels, respectively (p≤0.05). The values of predicted methane production reduced with increasing dietary protein and fat. Conclusion: It is concluded that prilled fat and protein supplies increased milk and fat yield along with increased ratios of milk yield and fat-corrected milk yields to dry matter intake. However, no interaction was observed between prilled fat and protein supplementation for production parameters, body weight, BCS and blood metabolites. Predicted methane production decreased with increasing protein and fat levels.

Digital eye strain and its associated factors among radiology physicians in Pakistan: a cross-sectional survey using logistic regression analysis.

Background and aims: Increased use of digital devices in the modern era has led to the development of digital eye strain (DES) or computer vision syndrome in their users. This can result in the development of various ocular and visual symptoms among them. In this study, the authors aimed to view the prevalence of digital eye strain among radiology physicians in Pakistan and their associated risk factors. Materials and methods: A cross-sectional study was conducted to evaluate occupational DES among radiology physicians in Pakistan. The data collection was done using the convenience sampling technique, and the data were analyzed using IBM SPSS for Windows, Version 25.0. Results: Out of the 247 respondents, 33.6% were males and 66.4% were females. 41.7% of them were between 30 and 40 years of age and 51.8% of them were radiology residents. 52.2% of the participants had a refractive error and were using a corrective lens. The majority of the radiologists in our study (84.2%) preferred picture archiving and communication system (PACS) over films and 82.2% of them reported having breaks of less than 15 min. Major symptoms reported by the participants were tired or heavy eyes (69.6%) and headache (69.3%). The proportion of developing DES was higher in females [P=0.001, adjusted odds ratio (aOR)=2.94], radiology residents (P=0.031, aOR=3.29), and working hours of more than 4 h per day (P<0.001, aOR=0.04). Conclusion: With recent advances in the field of radiology in Pakistan, the frequency of developing DES among radiologists is increasing. Being a female, having long working hours, and having noticeable flickers on the digital screens were among the significant factors in developing DES among radiologists.

The 3-component mixture of power distributions under Bayesian paradigm with application of life span of fatigue fracture.

Mixture distributions are naturally extra attractive to model the heterogeneous environment of processes in reliability analysis than simple probability models. This focus of the study is to develop and Bayesian inference on the 3-component mixture of power distributions. Under symmetric and asymmetric loss functions, the Bayes estimators and posterior risk using priors are derived. The presentation of Bayes estimators for various sample sizes and test termination time (a fact of time after that test is terminated) is examined in this article. To assess the performance of Bayes estimators in terms of posterior risks, a Monte Carlo simulation along with real data study is presented.

Assessment of the Implementation of Pakistan's National Action Plan on Antimicrobial Resistance in the Agriculture and Food Sectors.

The agriculture and food (agrifood) sectors play key roles in the emergence, spread, and containment of antimicrobial resistance (AMR). Pakistan's first National Action Plan (NAP) on AMR was developed to guide One Health interventions to combat AMR through 2017-2022. To improve subsequent iterations, we assessed the implementation of Pakistan's NAP in the agrifood sectors (NAPag) in October 2022, using the Progressive Management Pathway on AMR tool developed by the Food and Agriculture Organization of the United Nations (FAO). The assessment tool addressed four crucial focus areas of the NAPag: governance, awareness, evidence, and practices. Each focus area contains multiple topics, which involve four sequential stages of activities to progressively achieve systematic management of AMR risk in the agrifood sectors. High-level representatives of the NAPag stakeholders provided information for the assessment through pre-event documentary review and workshop discussions. The assessment results showed that Pakistan's NAPag had an overall moderate coverage (59%) of the anticipated activities. Gaps were particularly notable in strengthening governance, good practices, and interventions in non-livestock sectors. Furthermore, only 12% of the evaluated activities were fully executed and documented, consistently remaining at the planning and piloting stages in the livestock sector across all the examined topics. Insufficient attention to non-livestock sectors, inadequate regulation and enforcement capacity, and resource constraints have hindered scalable and sustainable interventions under the current plan. This assessment provides valuable insights to strengthen the inclusiveness and contribution of the agrifood sectors in the next NAP iteration. In the short-to-medium term, strategic prioritization is necessary to optimize the use of limited resources and target the most critical gaps, such as improving awareness among key stakeholders and fortifying regulations for prudent antimicrobial use. In the long term, integration of AMR into the country's broader health, development, and agricultural transformation agendas will be needed to generate sustainable benefits.

Situation analysis of the quality of primary health care services in Pakistan.

Background: Primary health care services to promote the mental and physical health of communities include preventive, promotive, curative, general hygiene, and nutritional elements. Aim: To assess the quality of service delivery at primary healthcare settings in Punjab, Pakistan. Methods: Quantitative surveys were conducted at 106 health facilities: 92 basic health units (BHUs) and 14 rural health centres (RHCs) across Punjab in 2020. Data from the survey were supplemented with information from observations by the researchers and all data were analysed using SPSS version 25. Findings: All the 7 district health authorities surveyed had monthly targets for number of normal deliveries and the outpatient department. Systems for safe transportation and storage of medicines were deficient except in 2 districts. Anti-venom and anti-rabies vaccines were either limited or not available at most of the health units visited. Some 14% of clinical equipment examined at the BHUs and RHCs were non-functional, and no BHU had ultrasonic machines to improve the quality of antenatal care. Sterilization of surgical instruments was unsatisfactory at most health units. Several key positions at BHU and RHC were vacant. Most health units did not have fence and their main buildings were in poor condition. Conclusions: Several gaps were identified at the primary healthcare level in Punjab that need to be addressed to improve the quality of service delivery.

The palmitoylation of gasdermin D directs its membrane translocation and pore formation during pyroptosis.

Plasma membrane perforation elicited by caspase cleavage of the gasdermin D (GSDMD) N-terminal domain (GSDMD-NT) triggers pyroptosis. The mechanisms underlying GSDMD membrane translocation and pore formation are not fully understood. Here, using a proteomic approach, we identified fatty acid synthase (FASN) as a GSDMD-binding partner. S-palmitoylation of GSDMD at Cys191/Cys192 (human/mouse), catalyzed by palmitoyl acyltransferases ZDHHC5 and ZDHHC9 and facilitated by reactive oxygen species (ROS), directly mediated membrane translocation of GSDMD-NT but not full-length GSDMD (GSDMD-FL). Palmitoylation of GSDMD-FL could be induced before inflammasome activation by stimuli such as lipopolysaccharide (LPS), consequently serving as an essential molecular event in macrophage priming. Inhibition of GSDMD palmitoylation suppressed macrophage pyroptosis and IL-1ß release, mitigated organ damage, and enhanced the survival of septic mice. Thus, GSDMD-NT palmitoylation is a key regulatory mechanism controlling GSDMD membrane localization and activation, which may offer an additional target for modulating immune activity in infectious and inflammatory diseases.

Genomic regions and biological pathways associated with sex-limited reproductive traits in bovine species.

Many animal species exhibit sex-limited traits, where certain phenotypes are exclusively expressed in one sex. Yet, the genomic regions that contribute to these sex-limited traits in males and females remain a subject of debate. Reproductive traits are ideal phenotypes to study sexual differences since they are mostly expressed in a sex-limited way. Therefore, this study aims to use local correlation analyses to identify genomic regions and biological pathways significantly associated with male and female sex-limited traits in two distinct cattle breeds (Brahman (BB) and Tropical Composite (TC)). We used the Correlation Scan method to perform local correlation analysis on 42 trait pairs consisting of six female and seven male reproductive traits recorded on ~1000 animals for each sex in each breed. To pinpoint a specific region associated these sex-limited reproductive traits, we investigated the genomic region(s) consistently identified as significant across the 42 trait pairs in each breed. The genes found in the identified regions were subjected to Quantitative Trait Loci (QTL) colocalization, QTL enrichment analyses, and functional analyses to gain biological insight into sexual differences. We found that the genomic regions associated with the sex-limited reproductive phenotypes are widely distributed across all the chromosomes. However, no single region across the genome was associated all the 42 reproductive trait pairs in the two breeds. Nevertheless, we found a region on the X-chromosome to be most significant for 80-90% (BB; 33 and TC; 38) of the total 42 trait pairs. A considerable number of the genes in this region were regulatory genes. By considering only genomic regions that were significant for at least 50% of the 42 trait pairs, we observed more regions spread across the autosomes and the X-chromosome. All genomic regions identified were highly enriched for trait-specific QTL linked to sex-limited traits (percentage normal sperm, metabolic weight, average daily gain, carcass weight, age at puberty, etc.). The gene list created from these identified regions were enriched for biological pathways that contribute to the observed differences between sexes. Our results demonstrate that genomic regions associated with male and female sex-limited reproductive traits are distributed across the genome. Yet, chromosome X seems to exert a relatively larger effect on the phenotypic variation observed between the sexes.

Alkali Polymer Flooding of a Romanian Field Containing Viscous Reactive Oil.

The study demonstrates the significant enhancement in oil production from a Romanian oil field using alkali-polymer (AP) flooding for reactive viscous oil. We conducted comprehensive interfacial tension (IFT) measurements across various alkali and AP concentrations, along with phase behavior assessments. Micromodel flooding experiments were used to examine pore-scale effects and select appropriate chemical concentrations. We tested displacement efficiency at the core level and experimented with different sequences and concentrations of alkali and polymers to minimize costs while maximizing the additional recovery of reactive viscous oil. The IFT analysis revealed that saponification at the oil-alkali interface significantly lowers IFT, but IFT gradually increases as soap diffuses away from the interface. Micromodels indicated that polymer or alkali injection alone achieve only minimal incremental recovery beyond waterflooding. However, AP flooding significantly enhanced incremental oil recovery by efficiently moving the mobilized oil with the viscous fluid and increasing exposure of more oil to the alkali solution. Coreflood experiments corroborated these findings. We also explored how divalent cations influence polymer concentration selection, finding that softening the injection brine significantly increased the viscosity of the AP slug.

A DFT investigation on structural, electronic, magnetic, optical, elastic and hydrogen storage properties of Ru-based hydride-perovskites XRuH3 (X = Cr, V, Ni).

The present investigation delves into various physical properties exhibited by CrRuH3, VRuH3 and NiRuH3. Notably adopting a stable cubic configuration, both compounds manifest a distinct metallic demeanor characterized by an absolute absence of band gap. In-depth analysis through Total Density of States (TDOS) and Partial Density of States (PDOS) justify this metallic conduct by distinctly showcasing peak conductivity at the Fermi level. The materials' magnetic behavior reveals an antiferromagnetic disposition for CrRuH3 and NiRuH3, while their intrinsic attributes emerge as anisotropic and rigid. Applying Poisson's ratio (ν) and the B/G ratio, all investigated compounds show ductility, but the CrRuH3 is superior among them. The heightened values of Young's modulus, Bulk modulus, and mean shear modulus observed in CrRuH3 underscore its enhanced rigidity as compared to VRuH3 and NiRuH3. Within the optical realm, CrRuH3 displays notable optical conductivity and absorption, particularly within the lower energy spectrum. Remarkably, at 0 eV, CrRuH3 showcases elevated reflectivity and refractive index as compared to the other investigated materials. On the hydrogen storage front, XRuH3 (X = Cr, V, Ni) exhibit promising potential, yet CrRuH3 emerges as the more favorable candidate for hydrogen storage applications.

Surface modification strategies for improved hemocompatibility of polymeric materials: a comprehensive review.

Polymeric biomaterials are a widely used class of materials due to their versatile properties. However, as with all other types of materials used for biomaterials, polymers also have to interact with blood. When blood comes into contact with any foreign body, it initiates a cascade which leads to platelet activation and blood coagulation. The implant surface also has to encounter a thromboinflammatory response which makes the implant integrity vulnerable, this leads to blood coagulation on the implant and obstructs it from performing its function. Hence, the surface plays a pivotal role in the design and application of biomaterials. In particular, the surface properties of biomaterials are responsible for biocompatibility with biological systems and hemocompatibility. This review provides a report on recent advances in the field of surface modification approaches for improved hemocompatibility. We focus on the surface properties of polysaccharides, proteins, and synthetic polymers. The blood coagulation cascade has been discussed and blood - material surface interactions have also been explained. The interactions of blood proteins and cells with polymeric material surfaces have been discussed. Moreover, the benefits as well as drawbacks of blood coagulation on the implant surface for wound healing purposes have also been studied. Surface modifications implemented by other researchers to enhance as well as prevent blood coagulation have also been analyzed.

Recent Trends and Advances in Additive-Mediated Composting Technology for Agricultural Waste Resources: A Comprehensive Review.

Agriculture waste has increased annually due to the global food demand and intensive animal production. Preventing environmental degradation requires fast and effective agricultural waste treatment. Aerobic digestion or composting uses agricultural wastes to create a stabilized and sterilized organic fertilizer and reduces chemical fertilizer input. Indeed, conventional composting technology requires a large surface area, a long fermentation period, significant malodorous emissions, inferior product quality, and little demand for poor end results. Conventional composting loses a lot of organic nitrogen and carbon. Thus, this comprehensive research examined sustainable and adaptable methods for improving agricultural waste composting efficiency. This review summarizes composting processes and examines how compost additives affect organic solid waste composting and product quality. Our findings indicate that additives have an impact on the composting process by influencing variables including temperature, pH, and moisture. Compost additive amendment could dramatically reduce gas emissions and mineral ion mobility. Composting additives can (1) improve the physicochemical composition of the compost mixture, (2) accelerate organic material disintegration and increase microbial activity, (3) reduce greenhouse gas (GHG) and ammonia (NH3) emissions to reduce nitrogen (N) losses, and (4) retain compost nutrients to increase soil nutrient content, maturity, and phytotoxicity. This essay concluded with a brief summary of compost maturity, which is essential before using it as an organic fertilizer. This work will add to agricultural waste composting technology literature. To increase the sustainability of agricultural waste resource utilization, composting strategies must be locally optimized and involve the created amendments in a circular economy.

Safety and efficacy of extended thrombophilia screening directed venous thromboembolic events (VTE) prophylaxis in live liver donors: do we really need extended thrombophilia screening routinely?

Background and aims: The study aimed to determine the prevalence of hereditary thrombophilia, and stratify its severity among live liver donors in Pakistan. Also, the authors evaluated the safety and efficacy of thrombophilia profile testing directed venous thromboembolic events (VTE) prophylaxis while balancing bleeding risk and the need for routine thrombophilia testing before live liver donation among living donor candidates. Materials and methods: Protein S (PS), protein C (PC), anti-thrombin (AT) III, and anti-phospholipid antibody panel (APLA) levels were measured in 567 potential donor candidates. Donors were divided into normal, borderline and high-risk groups based on Caprini score. The safety endpoints were VTE occurrence, bleeding complications or mortality. Results: Among 567 donors, 21 (3.7%) were deficient in protein C, and 14 (2.5%) were deficient in anti-thrombin-III. IgM and IgG. Anti-phospholipids antibodies were positive in 2/567 (0.4%) and 2/567 (0.4%), respectively. IgM and IgG lupus anticoagulant antibodies were positive in 3/567 (0.5%) and 3/567 (0.5%), respectively. VTE events, bleeding complications and postoperative living donors liver transplantation-related complications were comparable among the three donor groups (P>0.05). One donor in the normal donor group developed pulmonary embolism, but none of the donors in either borderline or high-risk group developed VTE. The mean length of ICU and total hospital stay were comparable. No donor mortality was observed in all donor groups. Conclusions: Due to thrombophilia testing directed VTE prophylaxis, VTE events were comparable in normal, borderline and high-risk thrombophilia donor groups, but more evaluations are required to determine the lower safe levels for various thrombophilia parameters including PC, PS and AT-III before surgery among living donor candidates.

Perceptions of telemedicine among healthcare professionals in rural tertiary care hospitals of rural Sindh, Pakistan: a qualitative study.

Background: Telemedicine has proven to be a boon in the field of medical sciences, as it provides a platform for all health-care personnel to assist patients remotely through digital technology advancements. It brings hope to the lower middle-income regions of the world. Thus, the study was conducted to explore the perceptions regarding telemedicine among healthcare professionals (HCP) in rural Sindh, Pakistan. Methodology: Overall, 19 in-depth interviews were conducted and this comprised of HCP working in the Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences (PAQSJIMS) and Peoples University of Medical and Health Sciences for Women (PUMHSW) being involved in providing online consultations and practicing telemedicine. The interviews were conducted and audio recorded in Sindhi and Urdu and were later transcribed in to English, coded for themes and sub-themes, and were analyzed using content analysis. Results: The opportunities perceived with the use of telemedicine services were reducing nosocomial infections, facilitating the healthcare in remote areas, handling telemedicine tools, application of telemedicine services on the ground and reducing stress. However, inadequate awareness regarding telemedicine, difficulty in physical examination, the need for training, lack of compliance, and concerns regarding accuracy in diagnosis and treatment were identified as the perceived barriers to the use of telemedicine services. Conclusion: HCP had perception toward telemedicine as have numerous opportunities favoring implementation as well as various barriers are needed to overcome to promote the usage of telemedicine. Increased awareness, training programs, and technological advancements are key to overcome these challenges.