Effect of Terminal Hydroxy Groups on the Structural Properties of Acyl Thioureas.

The 1-acyl thiourea family [R1C(O)NHC(S)NR2R3] exhibits the flexibility to incorporate a wide variety of substituents into their structure. The structural attributes of these compounds are intricately tied to the type and extent of substitution. In the case of 3-mono-substituted thioureas (R2=H), the conformational behavior is predominantly shaped by the presence of an intramolecular N-H ⋅ ⋅ ⋅ O=C hydrogen bond. This study delves into the structural consequences stemming from the inclusion of substituents possessing hydrogen-donor capabilities within four novel 1-acyl-3-mono-substituted thiourea derivatives. A comprehensive suite of analytical techniques, encompassing FTIR, Raman spectroscopy, multinuclear (1H and 13C) NMR spectroscopy, single-crystal X-ray diffraction, and supported by computational methods, notably NBO (Natural Bond Orbital) population analysis, Hirshfeld analysis, and QTAIM (Quantum Theory of Atoms in Molecules), was harnessed to scrutinize and characterize these compounds. In the crystalline state, these compounds exhibit an intricate interplay of intermolecular interactions, prominently featuring an expansive network of hydrogen bonds between the hydroxy (-OH) groups and the carbonyl and thiocarbonyl bonds within the 1-acyl thiourea fragment. Notably, the topological analysis underscores significant distinctions in the properties of the acyl thiourea fragment and the intramolecular >C=O ⋅ ⋅ ⋅ H-N bond when transitioning from the isolated molecule to the crystalline environment.

Unveiling diagnostic prowess: a comparative study of exercise treadmill test and CT coronary in coronary artery disease detection in Pakistan (2021-2023).

Coronary Artery Disease (CAD) is a global health concern, with diagnostic modalities and risk factors that exhibit regional variations. This study, conducted at the Islamabad Diagnostic Center, Pakistan, aimed to provide a comprehensive assessment of CAD prevalence, severity, and associated risk factors, while also evaluating the diagnostic accuracy of Computed Tomography Coronary Test (CTT) and Exercise Treadmill Test (ETT) in a cohort of 2909 patients. Among the patients assessed via CT Coronary scans, CAD was universally observed, presenting with varying degrees of severity. Our findings indicated that 24.5% of patients had mild CAD, 28.6% exhibited mild to moderate CAD, 16.3% were diagnosed with moderate CAD, 18.4% demonstrated moderate to severe CAD, and 20.4% displayed severe CAD. This spectrum underscores the diverse nature of CAD within the study population. In addition to CTT, we conducted a detailed evaluation of ETT results in 49 patients. These results revealed that 55.1% of patients tested positive for ischemia during the exercise test, emphasizing the prevalence of cardiac stress and underlying CAD. Conversely, 32.7% of patients exhibited negative ETT results, indicating favorable cardiac tolerance during physical activity. A subset of patients yielded non-diagnostic or inconclusive results, necessitating further clinical assessment. Disease history analysis showed a dichotomy within the cohort, with 20.4% having a known medical history and 79.6% possessing an unknown disease history, highlighting the importance of comprehensive medical records in clinical practice. Hypertension, a critical cardiovascular risk factor, was identified in 87.8% of patients, underscoring its significance. Smoking history displayed notable variation, with 69.4% categorized as smokers, 14.3% as ex-smokers, and 10.2% as non-smokers. Lipid profile analysis indicated that 69.4% of patients had abnormal lipid levels. To assess the diagnostic accuracy of CTT and ETT, we calculated Positive Predictive Values (PPV) and Negative Predictive Values (NPV). CTT exhibited a PPV of approximately 5.99% and an NPV of approximately 4.40%, whereas ETT displayed a higher PPV of around 26.44% and a substantially higher NPV of about 49.24%. This study offers valuable insights into CAD prevalence, severity, and associated risk factors in a Pakistani cohort, emphasizing the importance of holistic risk assessment and tailored interventions in clinical practice. Our findings also highlight the diagnostic utility of ETT in CAD assessment.

Evaluating the Safety of Retrograde Intrarenal Surgery (RIRS): Intra- and Early Postoperative Complications in Patients Enrolled in the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR)

ABSTRACT Purpose To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. Methods We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Results Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Conclusions Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology.

SARS-CoV-2 clearance in term of Cycle Threshold (Ct) during first two waves of COVID-19 in Pakistan: a phenomenon of delayed viral clearance post-corticosteroid treatment.

SARS-CoV-2 is recently emerged virus, which caused millions of deaths, all over the world. To tackle COVID-19 pandemic, there is an utmost need for in-depth analysis of viral replication. We aimed to examine viral load in SARS-CoV-2 patients during first two waves of COVID-19 in Pakistan. 225,615 suspected subjects from 75 different regions of Pakistan were selected in the study. SARS-CoV-2 RNAs were detected via real time PCR. During first wave (period of June-July, 2020) of COVID-19 the prevalence of SARS-CoV-2 was 20.38%. However, during second wave (period of November-December, 2020) of COVID-19, the rate of prevalence was 9.41%. During first wave of COVID-19 96.31% of participants remained PCR positive for 14 to 21 days, 3.39% of subjects showed positive results for 22 to 35 days, while delayed Ct values were observed among 0.26% of participants for 36 to 49 days. However, during second wave of COVID-19 89.31% of the subjects exhibited symptoms and showed real-time PCR positive results for 14 to 21 days, 9.42% showed positive results for 22 to 35 days, while significantly delayed Ct value results were observed among 1.026% of participants for 36 to 63 days (3.95 times higher than first wave). In contrast to first wave of COVID-19, the factors that were different in second wave were neither viral (different strains) nor host (same population). But treatment factors changed significantly. As during second wave besides azithromycin, corticosteroid dexamethasone consumption was increased consequently causing delayed Ct value negativity. This suggests that corticosteroid treatment might be linked with delayed Ct value or viral clearance. This study is crucial for re-considering effective therapeutic options against COVID-19.

Investigation of environmental ethics, spiritual health, and its relationship with environmental protection behaviors in nursing students.

Objective: To investigate the relationship between environmental ethics, spiritual health, and environmental behavior among nursing students. Methods: In this cross-sectional study, 200 iranian students from the Chabahar Nursing School were selected using a simple random sampling method. The data collection tool included a questionnaire on demographic information, knowledge, attitudes and behaviors towards the environment, environmental ethics, and spiritual health. Partial least squares structural equation modeling (PLS-SEM) was utilized to evaluate the conceptual framework in this study. Results: The mean score for environmental ethics among nursing students was 65.73±10.61 out of 100. Most of the students (47%) had desirable environmental ethics. The knowledge structure (ß=0.46) predicted attitude. The attitude structure also predicted environmental behavior (ß=0.28) and spiritual health (ß=0.31). Ultimately, the results showed that spiritual health and environmental ethics predict environmental behavior directly and indirectly (p<0.001). Conclusion: Spiritual health and environmental ethics were strong predictors of environmental behavior. Therefore, it is necessary to take into account not only students' spiritual health but also their ethical behaviors to promote environmental protection behaviors in the future.

Neurovascular crossing patterns between leash of Henry and deep branch of radial nerve: implications for neurointervention and diagnostic imaging.

OBJECTIVE: To detail the neurovascular crossing patterns between the leash of Henry (LoH) and the deep branch of the radial nerve (DBRN) in supination and pronation of the forearm, using imaging methods with anatomic correlation. MATERIALS AND METHODS: This cross-sectional study was performed ex vivo with HRUS and MRI with anatomic correlation on 6 samples and in vivo with HRUS with Doppler on 55 participants scanned bilaterally. The in vivo participants were enrolled over a 6-month period. The crossing patterns between the LoH and DBRN were assessed ex vivo and in vivo. Additional morphological features of the DBRN, LoH, and fat plane were assessed in vivo only. Biometric features of the participants were recorded. Statistical analyses were performed using Shapiro-Wilk, parametric and non-parametric tests. RESULTS: The most common neurovascular crossing pattern was the ascending branch of the radial recurrent artery (RRAab) crossing below (ex vivo: 83.3%, in vivo: 85.3%) and the muscular branch crossing above (ex vivo: 100%, in vivo: 63.2% %) the DBRN. Both the deep and superficial surfaces of the DBRN exhibited an intimate relationship with the vessels of the LoH. A positive correlation between vessel diameter and anthropometric factors was observed. In addition, the muscular branch exhibited a significantly smaller diameter than the RRAab. CONCLUSION: Our study detailed the relationship between the LoH and the DBRN and highlighted the high incidence of vessel crossing above the DBRN at the level of the muscular branch. Knowledge of neurovascular crossings is crucial for understanding neurovascular entrapment syndromes and planning interventional procedures to reduce vascular complications.

Association and correlation of patient symptom perception and asthma control - a rapid literature review.

BACKGROUND: Several studies suggest that patients often under-estimate their asthma symptoms and over-estimate their level of asthma control, potentially putting them at risk of undertreatment with inhaled corticosteroids. OBJECTIVE: To determine the association and correlation between patient symptom perception and asthma control. METHODS: A rapid literature review comprising searches in MEDLINE, Embase and Cochrane Library identified English language articles published between 2011-2021 that included a statistical measure of the association or correlation between perceptions of symptoms and asthma control in patients with asthma (adults and/or children). [PROSPERO CRD42021230152]. The Joanna Briggs Institute (JBI) instrument was used for study quality appraisal. RESULTS: Of 22 identified studies, nine presented association data and 13 reported correlation analyses. Eight of nine association studies showed a discordance between patients perceived symptoms and level of asthma control or lung function; among these, patients more frequently overestimated their asthma control than they underestimated their asthma control. Of 10 studies reporting correlation coefficients, all reported a statistically significant correlation between increased symptoms and worse asthma control; however, the strength of the correlation was shown to be only weak or moderate in most studies (coefficients numerically ranged from 0.12 to 0.74). CONCLUSION: Many patients with asthma tend to overestimate their level of asthma control. Although more frequent or worse symptoms were shown to be statistically significantly correlated with worsening asthma control, there was wide variation in correlation strengths, most showing weak or moderate correlations. Research to further understand the reasons for patient symptom misperceptions are warranted.

Analysis of perturbed Boussinesq equation via novel integrating schemes.

To analyze and study the behaviour of the shallow water waves, the perturbed Boussinesq equation has acquired fundamental importance. The principal objective of this paper is to manifest the exact traveling wave solution of the perturbed Boussinesq equation by two well known techniques named as, two variables [Formula: see text] expansion method and generalized projective Riccati equations method. A diverse array of soliton solutions, encompassing periodic, bright solitons, singular solitons and bright singular solitons are obtained by the applications of proposed techniques. The constraint conditions for newly constructed solutions are also specified. To enhance comprehension, the numerical illustrations of constructed solutions have been represented using surface plots, 2D plots and density plots. The results delineated in this paper transcend existing analysis, offering a novel, well-structured, and modern perspective. The solutions obtained not only enrich understanding of shallow water wave models but also exhibit efficacy in providing detailed descriptions of their dynamics.

PLA2-MjTX-II from Bothrops moojeni snake venom exhibits antimetastatic and antiangiogenic effects on human lung cancer cells.

Phospholipases A2 (PLA2s) from snake venom possess antitumor and antiangiogenic properties. In this study, we evaluated the antimetastatic and antiangiogenic effects of MjTX-II, a Lys49 PLA2 isolated from Bothrops moojeni venom, on lung cancer and endothelial cells. Using in vitro and ex vivo approaches, we demonstrated that MjTX-II reduced cell proliferation and inhibited fundamental processes for lung cancer cells (A549) growth and metastasis, such as adhesion, migration, invasion, and actin cytoskeleton decrease, without significantly interfering with non-tumorigenic lung cells (BEAS-2B). Furthermore, MjTX-II caused cell cycle alterations, increased reactive oxygen species production, modulated the expression of pro- and antiangiogenic genes, and decreased vascular endothelial growth factor (VEGF) expression in HUVECs. Finally, MjTX-II inhibited ex vivo angiogenesis processes in an aortic ring model. Therefore, we conclude that MjTX-II exhibits antimetastatic and antiangiogenic effects in vitro and ex vivo and represents a molecule that hold promise as a pharmacological model for antitumor therapy.

Targeting KRAS Oncogene for Patients With Colorectal Cancer: A New Step Toward Precision Medicine.

KRAS mutations are common driver oncogenes associated with the development of several solid tumors. KRAS oncogene has been considered a highly challenging target for drug development because of structural features, including the lack of deep groove on its catalytic unit. However, by leveraging cysteine residues, covalent KRAS inhibitors irreversibly trap KRAS G12C mutants in their inactive GDP-bound state. These agents have resulted in significant clinical responses among patients with KRAS G12C-mutant solid tumors, including patients with colorectal cancer (CRC). Other allele-specific inhibitors of KRAS oncogene and panKRAS and panRAS inhibitors are also currently being investigated in clinical trials. This review article overviews recent clinical progress on KRAS G12C targeting for the management of patients with KRAS G12C-mutant CRC and provides an update on other RAS targeting approaches. We also discuss the unique biological features of RAS-mutant CRC, which require the combination of KRAS inhibitors and anti-epidermal growth factor receptor therapy, and elaborate on resistance mechanisms and novel therapeutic avenues that may define future treatment paradigms of patients with RAS-mutant CRC.

The CNS relapse in T-cell lymphoma index predicts CNS relapse in patients with T- and NK-cell lymphomas.

ABSTRACT: Little is known about risk factors for central nervous system (CNS) relapse in mature T-cell and natural killer cell neoplasms (MTNKNs). We aimed to describe the clinical epidemiology of CNS relapse in patients with MTNKN and developed the CNS relapse In T-cell lymphoma Index (CITI) to predict patients at the highest risk of CNS relapse. We reviewed data from 135 patients with MTNKN and CNS relapse from 19 North American institutions. After exclusion of leukemic and most cutaneous forms of MTNKNs, patients were pooled with non-CNS relapse control patients from a single institution to create a CNS relapse-enriched training set. Using a complete case analysis (n = 182), including 91 with CNS relapse, we applied a least absolute shrinkage and selection operator Cox regression model to select weighted clinicopathologic variables for the CITI score, which we validated in an external cohort from the Swedish Lymphoma Registry (n = 566). CNS relapse was most frequently observed in patients with peripheral T-cell lymphoma, not otherwise specified (25%). Median time to CNS relapse and median overall survival after CNS relapse were 8.0 and 4.7 months, respectively. We calculated unique CITI risk scores for individual training set patients and stratified them into risk terciles. Validation set patients with low-risk (n = 158) and high-risk (n = 188) CITI scores had a 10-year cumulative risk of CNS relapse of 2.2% and 13.4%, respectively (hazard ratio, 5.24; 95% confidence interval, 1.50-18.26; P = .018). We developed an open-access web-based CITI calculator (https://redcap.link/citicalc) to provide an easy tool for clinical practice. The CITI score is a validated model to predict patients with MTNKN at the highest risk of developing CNS relapse.

Evaluating the Safety of Retrograde Intrarenal Surgery (RIRS): Intra- and Early Postoperative Complications in Patients Enrolled in the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR).

PURPOSE: To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. METHODS: We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. RESULTS: Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. CONCLUSIONS: Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology.

Deciphering epigenetic regulations in the inflammatory pathways of atopic dermatitis.

Atopic dermatitis, commonly referred to as atopic eczema, is a persistent inflammatory skin disorder that predominantly manifests in children but may endure into adulthood. Its clinical management poses challenges due to the absence of a definitive cure, and its prevalence varies across ethnicities, genders, and geographic locations. The epigenetic landscape of AD includes changes in DNA methylation, changes in histone acetylation and methylation, and regulation by non-coding RNAs. These changes affect inflammatory and immune mechanisms, and research has identified AD-specific variations in DNA methylation, particularly in the affected epidermis. Histone modifications, including acetylation, have been associated with the disruption of skin barrier function in AD, suggesting the potential therapeutic benefit of histone deacetylase inhibitors such as belinostat. Furthermore, non-coding RNAs, particularly microRNAs and long non-coding RNAs (lncRNAs), have been implicated in modulating various cellular processes central to AD pathogenesis. Therapeutic implications in AD include the potential use of DNA methylation inhibitors and histone deacetylase inhibitors to correct aberrant methylation patterns and modulate gene expression related to immune responses and skin barrier functions. Additionally, the emerging role of lncRNAs suggests the possibility of using small interfering RNAs or antisense oligonucleotides to inhibit lncRNAs and adjust their regulatory impact on gene expression. In conclusion, the importance of epigenetic elements in AD is becoming increasingly clear as studies highlight the contribution of DNA methylation, histone modifications and, control by non-coding RNAs to the onset and progression of the disease. Understanding these epigenetic changes provides valuable insights for developing targeted therapeutic strategies.

Health Care Utilization and Direct Costs Prior to Subspecialty Care in Children with Chronic Pain Compared with Other Chronic Childhood Diseases: A Cohort Study.

OBJECTIVES: To understand the burden associated with pediatric chronic pain (CP) on the health care system compared with other costly chronic diseases prior to subspecialty care. STUDY DESIGN: In this retrospective cohort study, we assessed all-cause health care utilization and direct health care costs associated with pediatric CP (n = 91) compared with juvenile arthritis (n = 135), inflammatory bowel disease (n = 90), type 1 diabetes (n = 475) or type 2 diabetes (n = 289), anxiety (n = 7193), and controls (n = 273) 2 and 5 years prior to patients entering subspecialty care in Manitoba, Canada. Linked data from physician encounters, emergency department visits, hospitalizations, and prescriptions were extracted from administrative databases. Differences in health care utilization and direct health care costs associated with CP vs the other conditions were tested using negative binomial and zero-inflated negative binomial regression models, respectively. RESULTS: After adjustment for age at diagnosis, sex, location of residence, and socioeconomic status, CP continued to be associated with the highest number of consulted physicians and subspecialists and the highest number of physician billings compared with all other conditions (P < .01, respectively). CP was significantly associated with higher physician costs than juvenile arthritis, inflammatory bowel disease, type 1 diabetes, type 2 diabetes, or controls (P < .01, respectively); anxiety was associated with the highest physician and prescription costs among all cohorts (P < .01, respectively). CONCLUSION: Compared with chronic inflammatory and endocrinologic conditions, pediatric CP and anxiety were associated with substantial burden on the health care system prior to subspecialty care, suggesting a need to assess gaps and resources in the management of CP and mental health conditions in the primary care setting.

Use of K-Y Jelly on Throat Packs for Postoperative Sore Throat after Nasal Surgery: A Randomized Controlled Trial.

Introduction Postoperative sore throat (POST) is a fairly common side effect of general anesthesia. The K-Y jelly is a well-known lubricant used in many medical procedures. Objective In this randomized study, we evaluated the use of throat packs soaked with K-Y jelly for POST outcomes in patients submitted to nasal surgery. Methods The present double-blinded, randomized, controlled study included 140 ASA I-II patients undergoing nasal surgery under general anesthesia. Patients received either or K-Y jelly or water-soaked X-ray detectable throat packs fully inserted into the mouth to occlude the oropharynx. Results Comparison between the studied groups regarding the severity of POST assessed by visual analog scale revealed significantly lower POST levels in the K-Y jelly group on recovery from anesthesia, and at 2, 4, and 6 hours postoperatively. Conclusions The use of K-Y jelly-soaked throat packs was associated with less severe POST after nasal surgery.

Investigation of environmental ethics, spiritual health, and its relationship with environmental protection behaviors in nursing students / Investigación sobre ética ambiental, salud espiritual y su relación con comportamientos de protección ambiental en estudiantes de enfermería / Pesquisa sobre ética ambiental, saúde espiritual e sua relação com comportamentos de proteção ambiental em estudantes de enfermagem

Objective.To investigate the relationship between environmental ethics, spiritual health, and environmental behavior among nursing students . Methods. In this cross-sectional study, 200 iranian students from the Chabahar Nursing School were selected using a simple random sampling method. The data collection tool included a questionnaire on demographic information, knowledge, attitudes and behaviors towards the environment, environmental ethics, and spiritual health. Partial least squares structural equation modeling (PLS-SEM) was utilized to evaluate the conceptual framework in this study. Results. The mean score for environmental ethics among nursing students was 65.73±10.61 out of 100. Most of the students (47%) had desirable environmental ethics. The knowledge structure (ß=0.46) predicted attitude. The attitude structure also predicted environmental behavior (ß=0.28) and spiritual health (ß=0.31). Ultimately, the results showed that spiritual health and environmental ethics predict environmental behavior directly and indirectly (p<0.001). Conclusion. Spiritual health and environmental ethics were strong predictors of environmental behavior. Therefore, it is necessary to take into account not only students' spiritual health but also their ethical behaviors to promote environmental protection behaviors in the future.

Objetivo. Investigar la relación entre la ética ambiental, la salud espiritual y el comportamiento ambiental entre los estudiantes de enfermería. Métodos. En este estudio transversal se seleccionaron 200 estudiantes iraníes de la Escuela de Enfermería de Chabahar mediante un método de muestreo aleatorio simple. La herramienta de recogida de datos incluía un cuestionario sobre información demográfica, conocimientos, actitudes y comportamientos hacia el medio ambiente, ética medioambiental y salud espiritual. Se utilizó el modelo de ecuaciones estructurales por mínimos cuadrados parciales (PLS-SEM) para evaluar el marco conceptual de este estudio. Resultados. La puntuación media en ética medioambiental entre los estudiantes de enfermería fue de 65.73±10.61 sobre 100. El 47% de los estudiantes tenían una ética medioambiental deseable. La estructura de conocimientos (0.46) predijo la actitud. La estructura de la actitud también predijo el comportamiento medioambiental (0.28) y la salud espiritual (0.31). En última instancia, los resultados mostraron que la salud espiritual y la ética medioambiental predicen el comportamiento medioambiental directa e indirectamente (p<0.001). Conclusión. La salud espiritual y la ética medioambiental fueron fuertes predictores del comportamiento medioambiental. Por lo tanto, es necesario tener en cuenta no sólo la salud espiritual de los estudiantes, sino también sus comportamientos éticos para promover conductas de protección del medio ambiente en el futuro.

Objetivo. Investigar a relação entre ética ambiental, saúde espiritual e comportamento ambiental entre estudantes de enfermagem. Métodos. Neste estudo transversal, 200 estudantes da Escola de Enfermagem de Chabahar (Irã) foram selecionados usando um método de amostragem aleatória simples. A ferramenta de coleta de dados incluiu um questionário sobre informações demográficas, conhecimento, atitudes e comportamentos em relação ao meio ambiente, ética ambiental e saúde espiritual. A modelagem de equações estruturais por mínimos quadrados parciais (PLS-SEM) foi usada para avaliar a estrutura conceitual deste estudo. Resultados. A pontuação média sobre ética ambiental entre os estudantes de enfermagem foi de 65.73±10.61 de um total de 100. 47% dos estudantes tinham uma ética ambiental desejável. A estrutura de conhecimento (0.46) previu a atitude. A estrutura da atitude também previu o comportamento ambiental (0.28) e a saúde espiritual (0.31). Por fim, os resultados mostraram que a saúde espiritual e a ética ambiental previram o comportamento ambiental direta e indiretamente (p<0.001). Conclusão. A saúde espiritual e a ética ambiental foram fortes preditores do comportamento ambiental. Portanto, é necessário considerar não apenas a saúde espiritual dos alunos, mas também seus comportamentos éticos, a fim de promover comportamentos de proteção ambiental no futuro.

Analytical assessment of clinical sensitivity and specificities of pharmaceutical rapid SARS-CoV-2 detection nasopharyngeal swab testing kits in Pakistan.

Despite of the global unity against COVID-19 pandemic, the threat of SARS-CoV-2 variants on the lives of human being is still not over. SARS-CoV-2 pandemic has urged the need of rapid viral detection at earliest. To cope with gradually expanding scenario of SARS-CoV-2, accurate diagnosis is extremely crucial factor which should be noticed by international health organizations. Limited research followed by sporadic marketing of SARS-CoV-2 rapid pharmaceutical detection kits raises critical questions against quality assurance and quality control measures. Herein we aimed to interrogate effectivity and specificity analysis of SARS-CoV-2 pharmaceutical rapid detection kits (nasopharyngeal swab based) using conventional gold standard triple target real-time polymerase chain reaction (USFDA approved). A cross-sectional study was conducted over 1500 suspected SARS-CoV-2 patients. 100 real time-PCR confirmed patients were evaluated for pharmaceutical RDT kits based upon nasopharyngeal swab based kits. The SARS-CoV-2 nasopharyngeal swab based rapid diagnostic kit (NSP RDTs) analysis showed 78% reactivity. Among real time PCR confirmed negative subjects, 49.3% represented false positivity. The positive predictive analysis revealed 67.82%, while negative predictive values were 64.40%. The NSP RDTs showed limited sensitivities and specificities as compared to gold standard real time PCR. Valid and authentic detection of SARS-CoV-2 is deemed necessary for accurate COVID-19 surveillance across the globe. Current study highlights the potential consequences of inadequate detection of SARS-CoV-2 and emerging novel mutants, compromising vaccine preventable diseases. Current study emphasizes need to wake higher authorities including strategic organizations for designing adequate measures to prevent future SARS-CoV-2 epidemics.

The Role of Snake Venom Disintegrins in Angiogenesis.

Angiogenesis, the formation of new blood vessels, plays a critical role in various physiological and pathological conditions. Snake venom disintegrins (SVDs) have been identified as significant regulators of this process. In this review, we explore the dual roles of SVD in angiogenesis, both as antiangiogenic agents by inhibiting integrin binding and interfering with vascular endothelial growth factors and as proangiogenic agents by enhancing integrin binding, stimulating cell migration and proliferation, and inducing neoangiogenesis. Studies in vitro and in animal models have demonstrated these effects and offer significant therapeutic opportunities. The potential applications of SVD in diseases related to angiogenesis, such as cancer, ocular diseases, tissue regeneration, wound healing, and cardiovascular diseases, are also discussed. Overall, SVDs are promising potential therapeutics, and further advances in this field could lead to innovative treatments for diseases related to angiogenesis.

Effect of composite radiopacity and margin location of the restoration on the diagnosis of secondary caries.

This research aimed to evaluate the effect of the radiopacity of a Bulk-Fill composite (X-TraFil, VOCO, Germany) and a Conventional composite (P60, 3M ESPE, USA) and assessment of the margin location in the enamel and dentin on the diagnosis of secondary caries. 76 intact premolars with MOD preparation were divided into two equal groups and filled with the conventional and bulk-fill composite. Four regions were considered to simulate carious lesions (two regions in enamel and two regions in dentin). In each group, half of the regions in the dentin and half in the enamel were randomly selected for secondary caries simulation and filled with a wax-plaster combination while the remaining regions stayed intact. Bitewing imaging was done using the PSP digital sensor. Five examiners reviewed the images, and lesions were recorded. Caries diagnosis indicators and paired-sample t-test were used for statistical analysis. The reproducibility and accuracy of the examiners' responses were evaluated using the kappa and agreement coefficient (α=0.05). The sensitivity, specificity, and accuracy of diagnosing secondary carious lesions in enamel were significantly better under conventional than bulk-fill composite. Similarly, the sensitivity and accuracy of diagnosing secondary caries in dentin were significantly higher under conventional composite than bulk-fill composite (p<0.05). No significant differences were found in the agreement and kappa coefficient between conventional and bulk-fill composites in the enamel and dentin (p>0.05). The diagnostic accuracy of carious lesions was higher under conventional composite than bulk-fill composite. However, the location of the secondary was ineffective in caries diagnosis.

Trastuzumab deruxtecan in human epidermal growth factor receptor 2-positive breast cancer brain metastases: a systematic review and meta-analysis.

BACKGROUND: Trastuzumab deruxtecan (T-DXd) has shown promising results in patients with breast cancer brain metastases (BCBMs). We conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of T-DXd in the human epidermal growth factor receptor 2 (HER2)-positive BCBM population. PATIENTS AND METHODS: We searched PubMed, Embase, and Cochrane Library databases as well as American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), and San Antonio Breast Cancer Symposium (SABCS) websites for clinical trials (CTs) and observational studies evaluating T-DXd in patients with HER2-positive BCBM. Heterogeneity was assessed with I2 statistics. Random effects models were used for all statistical analyses, which were carried out using R software (version 4.2.2). RESULTS: Ten studies were included, six CTs (n = 189) and four observational studies (n = 130), with a total of 319 patients. The median progression-free survival was 15 months [95% confidence interval (CI) 13.9-16.1 months]. The objective response rate (ORR) was 61% (95% CI 52% to 70%), and the intracranial (IC)-ORR was 61% (95% CI 54% to 69%). No significant differences in ORR and IC-ORR were observed between CTs and observational studies (P = 0.31 and 0.58, respectively). The clinical benefit rate (CBR) was 80% (95% CI 52% to 94%), and the IC-CBR was 70% (95% CI 54% to 82%). The ORR was 68% (95% CI 57% to 77%) in the subgroup of patients with stable BMs and 60% (95% CI 48%-72%) in patients with active BM, with no significant difference between groups (P = 0.35). CONCLUSIONS: Our systematic review and meta-analysis supports the IC activity of T-DXd in patients with stable BM and active BM. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) under the protocol number CRD42023422589.