A Dual Diagnostic Dilemma: Viral Encephalitis and Cerebral Venous Thrombosis.

Herpes encephalitis is caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). One of the infrequent complications of herpes encephalitis is cerebral venous thrombosis (CVT) because of the inflammation in the brain parenchyma. We report a unique and challenging case of a 14-year-old female patient presenting with confusion, headache, and fever. On examination, there was no neck rigidity and a negative Kernig's sign with no focal neurological deficits. Systemic examination was done to rule out other systems as a cause for her symptoms, and she was empirically treated as a case of encephalitis. An initial computed tomography (CT) scan of the brain without contrast was normal except for a subtle hypoattenuating area involving the right thalamus. Cerebrospinal fluid (CSF) analysis revealed viral infection while we awaited the results of CSF polymerase chain reaction (PCR) and culture analysis for specific microorganisms. Her Glasgow Coma Scale (GCS) deteriorated following an episode of generalized tonic-clonic seizure, and she was subsequently catheterized and an enteral feeding tube (nasogastric tube) was passed. CSF PCR detected HSV-1. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of the brain with contrast revealed encephalitis with superior sagittal sinus, transverse sinus, straight sinus, and vein of Galen thrombosis yielding a diagnosis of HSV encephalitis with concurrent cerebral venous thrombosis. Hence, this required a very specialized and cautious approach to her treatment. She was started on intravenous acyclovir and subcutaneous enoxaparin, and she recovered over the next few days. She did, however, develop acyclovir-induced renal toxicity in the absence of another offending agent, and the dose of the acyclovir was adjusted accordingly. A diagnosis of CVT, although rarely described, should be systematically suspected in patients with HSV encephalitis presenting with sudden deterioration or unexpected neurological findings in the early phase of treatment or inadequate response to treatment for better management and outcomes.

Synthesis and Characterization of Highly Fluorinated Hydrophobic Rare-Earth Metal-Organic Frameworks (MOFs).

Tuning a material's hydrophobicity is desirable in several industrial applications, such as hydrocarbon storage, separation, selective CO2 capture, oil spill cleanup, and water purification. The introduction of fluorine into rare-earth (RE) metal-organic frameworks (MOFs) can make them hydrophobic. In this work, the linker bis(trifluoromethyl)terephthalic acid (TTA) was used to make highly fluorinated MOFs. The reaction of the TTA and RE3+ (RE: Y, Gd, or Eu) ions resulted in the primitive cubic structure (pcu) exhibiting RE dimer nodes (RE-TTA-pcu). The crystal structure of the RE-TTA-pcu was obtained. The use of the 2-fluorobenzoic acid in the synthesis resulted in fluorinated hexaclusters in the face-centered cubic (fcu) framework (RE-TTA-fcu), analogous to the UiO-66 MOF. The RE-TTA-fcu has fluorine on the linker as well as in the cluster. The MOFs were characterized by powder X-ray diffraction, X-ray photoelectron spectroscopy, thermogravimetric analysis, and contact angle measurements.

Evaluating the Impact of Pre-Configured Uplink Resources in Narrowband IoT.

Deploying Cellular Internet of Things (CIoT) devices in urban and remote areas faces significant energy efficiency challenges. This is especially true for Narrowband IoT (NB-IoT) devices, which are expected to function on a single charge for up to 10 years while transmitting small amounts of data daily. The 3rd Generation Partnership Project (3GPP) has introduced energy-saving mechanisms in Releases 13 to 16, including Early Data Transmission (EDT) and Preconfigured Uplink Resources (PURs). These mechanisms extend battery life and reduce latency by enabling data transmission without an active Radio Resource Control (RRC) connection or Random Access Procedure (RAP). This paper examines these mechanisms using the LENA-NB simulator in the ns-3 environment, which is a comprehensive framework for studying various aspects of NB-IoT. The LENA-NB has been extended with PURs, and our analysis shows that PURs significantly enhance battery life and latency efficiency, particularly in high-density environments. Compared to the default RAP method, PURs reduce energy consumption by more than 2.5 times and increases battery life by 1.6 times. Additionally, PURs achieve latency reductions of 2.5-3.5 times. The improvements with PURs are most notable for packets up to 125 bytes. Our findings highlight PURs' potential to enable more efficient and effective CIoT deployments across various scenarios. This study represents a detailed analysis of latency and energy consumption in a simulated environment, advancing the understanding of PURs' benefits.

Examining the interplay of dust and defects: A comprehensive experimental analysis on the performance of photovoltaic modules.

The performance of photovoltaic (PV) modules is greatly impacted by dust accumulation and defects appearing in photovoltaic (PV) modules. Existing studies primarily focus on the effect of dust on general photovoltaic performance, neglecting the interactions with pre-existing defects such as snail trails. These defects are known to degrade the efficiency of PV modules. However, their interaction with environmental factors like dust accumulation has not been extensively analyzed. This research comprehensively analyzes the impact of dust accumulation on the performance of PV modules affected by snail trails. Using an experimental setup under outdoor conditions, the study incorporates thermal imaging, current-voltage characteristic curve tracing (IV curve tracing), electroluminescence (EL) imaging, and chemical analysis of the accumulated dust, to evaluate the electrical and thermal parameters affecting PV module performance. The study focuses on three types of modules, clean serves as a reference module (PV-R), normal unclean (PV-N), and snail trail-affected unclean PV module (PV-S). Compared to the PV-R module, the study meticulously quantifies the effect of accumulated dust on key performance indicators such as output power, V, and I. The PV-N module exhibits reductions of 17.7 % in current, 3.91 % in voltage, and 18.15 % in power output. The PV-S module experienced a decrease of 7.4 % in current, 7.55 % in voltage, and 14.87 % in power output under the dust deposition density of 6.984 g/m^2 having a mean particle size of 2.2279 µm. The dust deposition reduced the transmittance of glass, which indicates a potentially adverse impact on the PV module's efficiency. The findings highlighted in the current work provide a significant understanding of the detrimental impacts of dust accumulation on defected photo voltaic modules, highlighting the need for regular maintenance and cleaning to ensure optimal performance.

Insight Into Systemic Lupus Erythematosus: Unveiling Central Retinal Artery Occlusion as an Initial Indicator.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with diverse clinical manifestations. Among these, ocular complications are notably prevalent, affecting up to one-third of patients. One rare but serious ocular complication of SLE is central retinal artery occlusion (CRAO), which can result in significant vision loss. We report a case of a young woman with sudden, painless vision loss in her right eye over two days. Fundoscopy confirmed CRAO, with no light perception in the affected eye and normal vision in the left eye. Physical examination revealed symptoms suggestive of a connective tissue disorder, including malar rash and Raynaud's phenomenon. Laboratory tests confirmed SLE. Despite treatment with methylprednisolone, hydroxychloroquine, aspirin, and nifedipine, the patient's vision did not improve. CRAO in SLE indicates severe retinal vasculopathy and has a poor prognosis. This case highlights the importance of considering SLE in patients with sudden vision loss and systemic symptoms, emphasizing early diagnosis and comprehensive management to prevent severe complications.

Systematic Analysis of the BrHAT Gene Family and Physiological Characteristics of Brassica rapa L. Treated with Histone Acetylase and Deacetylase Inhibitors under Low Temperature.

Brassica rapa L. is an important overwintering oilseed crop in Northwest China. Histone acetyltransferases (HATs) play an important role in epigenetic regulation, as well as the regulation of plant growth, development, and responses to abiotic stresses. To clarify the role of histone acetylation in the low-temperature response of B. rapa L., we identified 29 HAT genes in B. rapa L. using bioinformatics tools. We also conducted a comprehensive analysis of the physicochemical properties, gene structure, chromosomal localization, conserved structural domains and motifs, cis-acting regulatory elements, and evolutionary relationships of these genes. Using transcriptome data, we analyzed the expression patterns of BrHAT family members and predicted interactions between proteins; the results indicated that BrHATs play an important role in the low-temperature response of B. rapa L. HAT inhibitor (curcumin; CUR) and histone deacetylase inhibitor (Trichostatin A; TSA) were applied to four B. rapa L. varieties varying in cold resistance under the same low-temperature conditions, and changes in the physiological indexes of these four varieties were analyzed. The inhibitor treatment attenuated the effect of low temperature on seed germination, and curcumin treatment was most effective, indicating that the germination period was primarily regulated by histone acetylase. Both inhibitor treatments increased the activity of protective enzymes and the content of osmoregulatory substances in plants, suggesting that histone acetylation and deacetylation play a significant role in the response of B. rapa L. to low-temperature stress. The qRT-PCR analyses showed that the expression patterns of BrHATs were altered under different inhibitor treatments and low-temperature stress; meanwhile, we found three significantly differentially expressed genes. In sum, the process of histone acetylation is involved in the cold response and the BrHATs gene plays a role in the cold stress response.

Melatonin Enhances Heat Tolerance via Increasing Antioxidant Enzyme Activities and Osmotic Regulatory Substances by Upregulating zmeno1 Expression in Maize (Zea mays L.).

Heat stress severely affects the yield and quality of maize. Melatonin (N-acetyl-5-methoxy-tryptamin, MT) plays an important role in various types of stress resistance in plants, including heat tolerance. Enolase (ENO, 2-phospho-D-glycerate hydrolyase) contributes to plant growth, development, and stress response. As of now, the molecular mechanisms by which MT and ENO1 affect heat tolerance are unknown. In our research, we have revealed that heat stress (H) and heat stress + MT (MH) treatment upregulate ZmENO1 expression levels by 15 and 20 times, respectively. ZmENO1 overexpression and mutant maize lines were created by transgenic and genome editing. These results illustrate that heat stress has a significant impact on the growth of maize at the seedling stage. However, ZmENO1-OE lines showed a lower degree of susceptibility to heat stress, whereas the mutant exhibited the most severe effects. Under heat stress, exogenous application of MT improves heat resistance in maize. The ZmENO1-OE lines exhibited the best growth and highest survival rate, while the zmeno1 mutants showed the least desirable results. Following treatment with H and MH, the level of MT in ZmENO1-OE lines exhibited the greatest increase and reached the maximum value, whereas the level of MT in the zmeno1 mutant was the lowest. Heat stress decreased the maize's relative water content and fresh weight, although ZmENO1-OE lines had the highest and zmeno1 mutants had the lowest. Heat stress led to an increase in the levels of MDA, hydrogen peroxide, and superoxide in all plants. Additionally, the ionic permeability and osmotic potential of the plants were significantly increased. However, the levels of MT were decreased in all plants, with the greatest decrease observed in the ZmENO1-OE lines. Interestingly, the zmeno1 mutant plants had the highest expression levels of MT. Heat stress-induced upregulation of ZmSOD, ZmPOD, ZmAPX, ZmCAT, ZmP5CS, and ZmProDH in all plants. However, the ZmENO1-OE lines exhibited the greatest increase in expression levels, while the zmeno1 mutants showed the lowest increase following MT spraying. The patterns of SOD, POD, APX, and CAT enzyme activity, as well as proline and soluble protein content, aligned with the variations in the expression levels of these genes. Our findings indicate that MT can upregulate the expression of the ZmENO1 gene. Upregulating the ZmENO1 gene resulted in elevated expression levels of ZmSOD, ZmPOD, ZmAPX, ZmCAT, ZmP5CS, and ZmProDH. This led to increased activity of antioxidant enzymes and higher levels of osmoregulatory substances. Consequently, it mitigated the cell membrane damage caused by heat stress and ultimately improved the heat resistance of maize. The results of this study provide genetic resources for molecular design breeding and lay a solid foundation for further exploring the molecular mechanism of MT regulation of heat stress tolerance in maize.

Integrated miRNA and mRNA Transcriptome Analysis Reveals Regulatory Mechanisms in the Response of Winter Brassica rapa to Drought Stress.

Drought is a major abiotic stress factor that reduces agricultural productivity. Understanding the molecular regulatory network of drought response in winter rape is of great significance for molecular Brassica rapa. In order to comprehensively analyze the network expression of DEGs and DEMIs in winter rape under drought stress, in this study we used Longyou 7 as the experimental material to identify DEGs and DEMIs related to drought stress by transcriptome and miRNA sequencing. A total of 14-15 key differential mRNA genes related to drought stress and biological stress were screened out under different treatments in the three groups. and 32 differential miRNAs were identified through targeted regulatory relationships, and the mRNA expression of 20 target genes was negatively regulated by the targeting regulatory relationship. It is mainly enriched in starch and sucrose metabolism, carbon metabolism and other pathways. Among them, gra-MIR8731-p3_2ss13GA18GA regulated the expression of multiple mRNAs in the three treatments. miRNA is mainly involved in the drought resistance of Chinese cabbage winter rape by regulating the expression of target genes, such as starch and sucrose metabolism, amino acid biosynthesis, and carbon metabolism. These miRNAs and their target genes play an indispensable role in winter rapeseed drought stress tolerance regulation.

Orange peel-mediated synthesis of silver nanoparticles with antioxidant and antitumor activities.

Orange (Citrus sinensis L.) is a common fruit crop widely distributed worldwide with the peel of its fruits representing about 50% of fruit mass. In the current study, orange peel was employed to mediate the synthesis of silver nanoparticles (AgNPs) in a low-cost green approach. Aqueous extracts of suitably-processed peel were prepared using different extraction methods; and their phytochemical profile was identified. Based on phytochemical screening, amount of main phytochemicals, free radical-scavenging ability, reducing power and antioxidant activity, the peel extract prepared by boiling seemed to be the most promising. Thus, major compounds of this extract were identified by gas chromatography-mass spectrometry. Potency of the peel extract to mediate the synthesis of AgNPs was then monitored by visual observation, UV-visible spectroscopy, energy dispersive X-ray analysis, transmission electron microscopy and zetametry. Color change of the reaction mixture to brown and absorption peak at 450 nm indicated AgNPs formation. Characterization of AgNPs revealed spherical shape, size of 30-40 nm, zeta potential of -18.2 mV and yield conversion of 82%. The as-synthesized AgNPs had antioxidant capacity (free radical-scavenging ability, reducing power and antioxidant activity) lower than that of the orange peel extract. However, these biogenic AgNPs had antitumor activity (IC50 of 16 ppm against HCT-116 and 1.6 ppm against HepG2 cell lines) much higher than the peel extract that was completely non-toxic to the considered cell lines.

Intrathecal Dexmedetomidine as an Adjuvant to Low Dose Hyperbaric 0.5% Bupivacaine on Haemodynamic Parameters in Patients Undergoing Transurethral Resection of Prostate.

OBJECTIVE: To determine the role of dexmedetomidine in potentiating the local anaesthetic efficacy of a low dose of bupivacaine when used as an adjuvant. STUDY DESIGN: A prospective, double-blind, randomised study. Place and Duration of the Study: Department of Anaesthesia, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from July 2021 to February 2022. METHODOLOGY: One hundred and eight patients of ASA physical class I-III undergoing transurethral resection of the prostate (TURP) under sub-arachnoid block (SAB) were enroled and distributed into two equal groups. Group BUPIPURE (BP) was given 7.5 mg of pure 0.5% hyperbaric bupivacain whereas group BUPIDEX (BD) was given 6 mg of 0.5% hyperbaric bupivacain with 3 µg dexmedetomidine intrathecally. The effects in Both groups were compared using chi-square and unpaired t-tests. A significance level of p <0.05 was used to evaluate the statistical significance. RESULTS: Both groups demonstrated a steady decrease in mean heart rate (mean HR 98.9-62.7 per minute as compared to 79.1-59.4 per minute in groups BP and BD, respectively), however, no patient reached to HR <50/min. Group BP had a higher HR variability than group BD. The two groups' median peak sensory levels were similar. However, a statistically significant difference was revealed in the time taken for 2-segment regression (87.5 ± 11.3 min vs. 115.5 ± 6.2 min p <0.001 in BP and BD), as well as the time to reach T10 sensory level (13.56 ± 2.5 min vs. 10.9 ± 3.0 min p <0.001). CONCLUSION: In patients having TURP, intrathecal dexmedetomidine combined with low-dose bupivacaine results in a quicker start, extended sensory and motor block, and a decreased need for rescue analgesics. KEY WORDS: Adjuvants, Dexmedetomidine, Spinal anaesthesia, Transurethral Resection of Prostate.

Dexmedetomidine versus Ketofol for Moderate Sedation in Endoscopic Retrograde Cholangiopancreatography.

OBJECTIVE: To compare the efficacy of dexmedetomidine versus ketofol for moderate sedation in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). STUDY DESIGN: Randomised controlled trial. Place and Duration of the Study: Department of Anaesthesia, SICU and Pain Management, Sindh Institute of Urology and Transplantation, Karachi, Paksitan, from December 2021 to June 2022. METHODOLOGY: Sixty-two patients aged 20-60 years of any gender scheduled for elective ERCP were included. Patients were randomly divided into Dexmedetomidine group (2ml ampule of 100ug/ml diluted in 18ml of normal saline) and Ketofol group (2ml ketamine and 10ml of propofol 1% diluted in 8ml of normal saline) for sedation. The mean difference in time to achieve Ramsay Sedation Scale (RSS) score of 4 and Modified Aldrete's Score (MAS) of 9 were noted as outcomes in each group. In addition, complications during the procedure and recovery were also noted. RESULTS: The mean age was 39.15 ± 9.82 years. There were 33 (53.2%) males and 29 (46.8%) females. The mean time to achieve RSS 4 was significantly lower in patients who were treated with Dexmedetomidine as compared to Ketofol, i.e., 11.84 ± 1.77 minutes vs. 13.10 ± 1.64 minutes respectively (p-value 0.005, 95% CI -2.12 to -0.39). Similarly, the mean time to achieve MAS score 9 was significantly lower in patients who were treated with Dexmedetomidine as compared to Ketofol, i.e., 11.19 ± 1.72 minutes vs. 12.23 ± 1.84 minutes, respectively (p-value 0.026, 95% CI -1.94 to -0.13). CONCLUSION: Dexmedetomidine proved to be more effective than Ketofol for sedation in ERCP, achieving faster sedation and quicker recovery. KEY WORDS: Dexmedetomidine, Ketofol, Sedation, Endoscopic Retrograde Cholangiopancreatography.

Pyrolysed maize feedstock utilization in combination with Trichoderma viride against Macrophomina phaseolina.

Maize cultivation is under the growing threat of charcoal rot (Macrophomina phaseolina). Chemical control of diseases imparts serious health hazards to humans and the ecosystem. Biochar as an alternative disease management approach has been under consideration of the researchers for some time now. The biochar utilized in this study was derived from maize stalks and cobs. Crystallographic structure, inorganic minerals content and size of maize biochar were analyzed by powder X-ray diffractometer, while scanning electron microscopy revealed rough, irregular, tubular structure of the biochar surface. EDX spectra revealed that the maize biochar composition was dominated by 'C' followed by 'O'. The current study was designed to determine the synergistic effect of maize biochar (MB), and biocontrol agent (BCA) Trichoderma viride as soil amendments on the suppression of M. phaseolina. In vitro bioassays were conducted to check the efficiency of antagonistic effect of Trichoderma spp., in combination with maize biochar. On the basis of maximum mycelial growth inhibition T. viride was selected for a glasshouse experiment. Maize plants were grown in pots containing a mixture of soil with MB at application at the rate of 3 and 6% (v/v) separately, associated with or without T. viride. Treatments amended with 3% MB inoculated with M. phaseolina significantly reduced the percentage disease severity index by 40%. While in the presence of T. viride, 3% MB showed maximum disease suppression and a minimum percentage severity index i.e. 60 and 20%, respectively. Highest nitrogen contents were 18.4 g kg-1 observed in treatment 6% MB, while highest phosphorus and potassium contents were 3.11 and 15.2 g kg-1, respectively in the treatment with 3% MB. Conclusively, the effect of variable concentrations of maize biochar and T. viride as soil amendment was evident on the development of charcoal rot, growth and physiology of maize plants. According to the available literature, our report is the first on the implementation of biochar in synergism with T. viride to suppress the charcoal rot in maize.

Evaluating iodine deficiency and goiter in hilly areas of District Poonch Azad Jammu Kashmir.

Background & Objectives: Iodine deficiency is considered as a global challenge, even after decades of efforts to solve the issue. Our objective was to assess the iodine deficiency status and associated prevalence of goiter in population groups (school-age children and women) from rural areas of District Poonch, and to assess the determinants of iodine deficiency in the area. Methods: Cross-sectional study was conducted in District Poonch Azad Jammu and Kashmir from 25 April 2022 to 30 June 2023. A total of 150 goiter patients from different villages of the District Poonch was included. Their urinary iodine concentration and goiter prevalence was assessed. Using palpation techniques, a trained and experienced public health officer assessed the presence of goiters based on WHO/ UNICEF/ICCIDD criteria. Descriptive statistics were computed for continuous variables and presented in frequency and percentage, based on the distributional characteristics of the data. chi-square was used to check association between socio-demographic factors and goiter. It was a HEC Project No.: 20-16988/NRPU/R&D/HEC/2021. Results: Iodine status and associated goiter prevalence was high and 59.3% of them were severely iodine deficient. Within the district, the highest severe iodine deficiency was observed in 81.1% goiter patients of the Rawalakot subdivision, Hajira and Abbaspur subdivisions. Regarding goiter status 40% of the patients were classified with palpable-visible goiter and 56% were characterized with visible but nodular goiter. Conclusion: Study showed that there was a severe iodine deficiency and associated goiter prevalence in the area. Policymakers should take actions for future to overcome iodine deficiency in future.

The Impact of Surgeon Volume on Unicompartmental Knee Arthroplasty Survivorship: A Michigan Arthroplasty Registry Collaborative Quality Initiative Database Analysis.

BACKGROUND: The utilization of unicompartmental knee arthroplasty (UKA) has remained low when compared to total knee arthroplasty (TKA), possibly due to higher rates of revision and reoperation. This study aimed to quantify surgeon UKA case-volumes and measure the effect of surgeon volume on early revision. We hypothesized that surgeons who have high case volumes would have lower revision rates compared to medium- and low-volume surgeons. METHODS: Primary UKAs were performed between February 2012 and November 2021, and associated revisions were identified utilizing the Michigan Arthroplasty Registry Collaborative Quality Initiative. Surgeon information, including total cases and annual UKA volume, was collected. Case volume per year was stratified as High (≥ 35 cases per year), Medium (15 to 34 cases per year), and low (< 15 cases per year). RESULTS: There were a total of 15,542 UKAs performed. Of these, 701 (4.5%) were revised, and 412 (58.8%) revisions occurred within 2 years. Of the 287 surgeons who performed an UKA in the registry, 237 (82.6%) were low-volume surgeons, 36 (12.5%) were medium-volume, and 14 (4.9%) were high-volume. High-volume surgeons were more likely to operate on older patients (P < 0.01), Medicare patients (P < 0.01), and patients who had American Society of Anesthesiologists scores of III and IV (P < 0.01). High-volume surgeons had significantly lower 5-year revision rates compared to medium and low-volume surgeons (high: 4.3% (95% confidence interval: 3.7 to 4.9), medium: 5.2% (4.4 to 6.1), low: 7.2% (6.4 to 8.0); P < 0.001). In comparison, the 5-year revision rate for TKA in Michigan was 3.0% (95% confidence interval: 2.9 to 3.1). CONCLUSIONS: When UKAs were performed by high-volume surgeons in the state of Michigan, there was better survivorship when compared to low-and medium-volume surgeons. High-volume surgeons were more likely to perform UKA on older patients, Medicare patients, and patients who had American Society of Anesthesiologists scores of III and IV. The revision rate for the high-volume surgeons still exceeded the 5-year revision rate for TKA in Michigan.

In-silico optimization of resveratrol interaction with nano-borophene: A DFT-guided study of supramolecular artistry.

In this study, the potential of borophene (BOR) as a drug delivery system for resveratrol (RVT) was explored to evaluate its efficacy in cancer treatment. The excited, electronic, and geometric states of RVT, BOR, and the borophene-adsorbed resveratrol complex (BOR@RVT) were calculated to assess BOR's suitability as a drug carrier. Noncovalent interaction (NCI) plots indicated a weak force of attraction between BOR and RVT, which facilitates the offloading of RVT at the target site. Frontier molecular orbital (FMO) analysis showed that during electron excitation from Highest Occupied Molecular Orbital (HOMO) to Lowest Unoccupied Molecular Orbital (LUMO), charge transfer occurs from RVT to BOR. This was further confirmed by charge decomposition analysis (CDA). Calculations for the excited state of BOR@RVT revealed a red shift in the maximum absorption wavelength (λmax), indicating a photoinduced electron transfer (PET) process across various excited states. PET analysis demonstrated fluorescence quenching due to this interaction. Our findings suggest that BOR holds significant potential as a drug delivery vehicle for cancer treatment, offering a promising platform for the development of advanced drug delivery systems.

Improvement in Inhaler Techniques After Training and Counseling in Patients With Chronic Obstructive Pulmonary Disease or Asthma.

Background Chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma significantly impair quality of life and impose a substantial burden on healthcare systems. Proper inhalation technique is important for effective management of these diseases, yet remains poorly performed by many patients. This study evaluated the impact of structured counseling and training sessions on inhaler use among patients with COPD and asthma, aiming to enhance technique correctness and disease control. Methodology This cross-sectional study analyzed 150 patients with asthma and COPD who fulfilled the inclusion criteria for inhalation techniques. Patients were counseled regarding the proper seven-step inhalation technique for each inhaler type [metered-dose inhaler (MDI), MDI with spacer, and dry powder inhaler (DPI)] through practical demonstration at baseline visits. Correct use of inhalers was assessed by a predefined checklist for each inhaler device at the baseline visit and after three months. The correctness of the inhalation technique was evaluated by scoring each of the seven steps. The disease control assessment was done using the COPD assessment test (CAT) and asthma control test (ACT) at the baseline visit and after three months. Results In this study of 150 patients, there were 97 (64.7%) males and 53 (35.3%) females. In total, 67 (44.7%) were diagnosed with asthma and 83 (55.3%) with COPD. The mean age was 45.33 ± 12.62 years. Post-counseling improvements in inhaler technique were marked, with MDI users enhancing their technique score from an average of 4.4 to 6.1, MDI with spacer from 4.56 to 6.26, and DPI from 4.92 to 6.24 (p < 0.001 for all). Disease control also showed significant gains; CAT scores decreased for MDI users from 23.4 to 20.5, MDI with spacer from 23.92 to 20.96, and DPI from 24.89 to 21.96. Concurrently, ACT scores increased for MDI users from 16.4 to 18.0 (p = 0.002), MDI with spacer from 17.29 to 19.04, and DPI from 16.42 to 18.37 (p < 0.001 for both), reflecting substantive advances in managing COPD and asthma symptoms. Furthermore, patients with primary education exhibited a significant boost in technique mastery post-counseling (p < 0.001), underscoring the potential of well-crafted counseling to transcend educational barriers in promoting effective inhaler use. Conclusions Post-counseling, inhaler technique improved significantly across all types, with MDI with spacer users demonstrating the most progress. Technique scores increased notably (p < 0.001), and disease control scores for COPD and asthma, measured by CAT and ACT, also showed significant improvements (p < 0.001). Remarkably, primary education level participants exhibited substantial technique gains post-intervention, emphasizing the effectiveness of counseling irrespective of initial educational status in enhancing inhaler use and disease management.

ChatGPT-4 Generates More Accurate and Complete Responses to Common Patient Questions About Anterior Cruciate Ligament Reconstruction Than Google's Search Engine.

Purpose: To replicate a patient's internet search to evaluate ChatGPT's appropriateness in answering common patient questions about anterior cruciate ligament reconstruction compared with a Google web search. Methods: A Google web search was performed by searching the term "anterior cruciate ligament reconstruction." The top 20 frequently asked questions and responses were recorded. The prompt "What are the 20 most popular patient questions related to 'anterior cruciate ligament reconstruction?'" was input into ChatGPT and questions and responses were recorded. Questions were classified based on the Rothwell system and responses assessed via Flesch-Kincaid Grade Level, correctness, and completeness were for both Google web search and ChatGPT. Results: Three of 20 (15%) questions were similar between Google web search and ChatGPT. The most common question types among the Google web search were value (8/20, 40%), fact (7/20, 35%), and policy (5/20, 25%). The most common question types amongst the ChatGPT search were fact (12/20, 60%), policy (6/20, 30%), and value (2/20, 10%). Mean Flesch-Kincaid Grade Level for Google web search responses was significantly lower (11.8 ± 3.8 vs 14.3 ± 2.2; P = .003) than for ChatGPT responses. The mean correctness for Google web search question answers was 1.47 ± 0.5, and mean completeness was 1.36 ± 0.5. Mean correctness for ChatGPT answers was 1.8 ± 0.4 and mean completeness was 1.9 ± 0.3, which were both significantly greater than Google web search answers (P = .03 and P = .0003). Conclusions: ChatGPT-4 generated more accurate and complete responses to common patient questions about anterior cruciate ligament reconstruction than Google's search engine. Clinical Relevance: The use of artificial intelligence such as ChatGPT is expanding. It is important to understand the quality of information as well as how the results of ChatGPT queries compare with those from Google web searches.

Facilitators and barriers in acceptance of telemedicine among healthcare providers in Pakistan: A cross-sectional survey.

Objectives: This study aimed to assess healthcare professionals' awareness and acceptance of telemedicine residing in Pakistan. Materials and Methods: A cross-sectional study was conducted across Pakistan from November 2021 to March 2022. Data entry was done through a self-administered questionnaire. In this survey, the non-probability purposive sampling method was adopted. Medical doctors from all specialties that fall into the age category of 20-60 years were included in this study. Statistical Package for Social Sciences (SPSS) version 22.0 was used for univariate data analysis. Results: Among the 860 healthcare professionals who received the survey, 198 responded (23.0% response rate). The mean ± SD age of the participants was 31.16 ± 8.56. The results were found to be statistically significant for knowledge about telemedicine among healthcare professionals workplace, that is, healthcare professionals working in the private sector indicated a high level of awareness regarding telemedicine as compared to those in the public sector (p = 0.03). A significant difference (p-value ⩽ 0.05) in knowledge was seen among doctors working in the public sector and those working in a private setup. Results indicate significant positive associations between telemedicine utilization and perceived benefits over disadvantages (ß = 1.03, p = 0.017), reliance among healthcare professionals (ß = 1.22, p = 0.008), and enhancement in healthcare quality (ß = 1.42, p = 0.001). Moreover, familiarity with telemedicine correlates strongly with its usage (ß = 2.56, p < 0.000). Conclusion: Overall, healthcare professionals exhibited satisfactory knowledge regarding telemedicine and showed an accepting attitude toward telemedicine. Our study recommends enhancing the importance of Telemedicine training at the Healthcare professionals' level to produce quality service delivery in healthcare organizations.

Facilitators and barriers in acceptance of telemedicine among healthcare providers in Pakistan: A Cross-sectional survey: The aim of this study, was to evaluate healthcare professionals' knowledge and acceptance of telemedicine in Karachi, Pakistan. A cross-sectional survey was carried out between November 2021 and March 2022, and 198 out of 860 healthcare professionals responded (representing a 23.0% response rate). The participants' average age was 31.16 years. The results showed that healthcare professionals in the public and private sectors differed significantly in their awareness of telemedicine, with the former group having higher awareness levels. Most of the medical professionals showed adequate understanding and acceptance of telemedicine. However, in order to improve service delivery in healthcare organizations, the study emphasizes the necessity for improved telemedicine awareness and training among healthcare providers, especially in the public sector. The findings highlighted how crucial it is to integrate telemedicine within medical education.

Experimental development of lightweight manipulators with improved design cycle time that leverages off-the-shelf robotic arm components.

The growing market for lightweight robots inspires new use-cases, such as collaborative manipulators for human-centered automation. However, widespread adoption faces obstacles due to high R&D costs and longer design cycles, although rapid advances in mechatronic engineering have effectively narrowed the design space to affordable robot components, turning the development of lightweight robots into a component selection and integration challenge. Recognizing this transformation, we demonstrate a practical framework for designing lightweight industrial manipulators using a case-study of indigenously developed 5 Degrees-of-Freedom (DOF) cobot prototype. Our framework incorporates off-the-shelf sensors, actuators, gears, and links for Design for Manufacturing and Assembly (DFMA), along with complete virtual prototyping. The design cycle time is reduced by approximately 40% at the cost of cobot real-time performance deviating within 2.5% of the target metric. Our physical prototype, having repeatability of 0.05mm calculated as per the procedure defined in ISO 9283:1998, validates the cost-effective nature of the framework for creating lightweight manipulators, benefiting robotic startups, R&D organizations, and educational institutes without access to expensive in-house fabrication setups.

Carbon taxation on high utility transport fuels: An implementation of enviro-economic analysis for the sustainable environment".

The humongous increase in carbon emissions in the past few decades presents an environmental challenge to the scientific community. The current study proposes a method of taxation on high-carbon emission fuels. For this purpose, a comparative enviro-economic analysis is carried out on the three most commonly used fuels (gasoline, Liquefied Petroleum Gas (LPG), and Compressed Natural Gas (CNG)). The speed of the test engine varied from 1800 to 4200 Revolution per Minute (RPM) in increments of 400 RPM. Performance parameters (Brake Power (BP), Brake Thermal Efficiency (BTHE), and Brake Specific Fuel Consumption (BSFC)) were measured using a hydro dynamometer. Emission analysis, including Carbon Dioxide (CO2), Carbon Monoxide (CO), Unburned Hydrocarbons (HC), and Nitrogen Oxide (NOx), was conducted using the TESTO 350 analyzer. The application of Weibull distribution with a 95 % confidence interval, on emission data, explained the adequacy of the data. Among test fuels, CNG emerged as an environment-friendly fuel with an emission reduction of 16, 42, and 43 percent for CO2, CO, and HC in comparison to gasoline. Also, BTHE and BSFC of CNG were better than other alternatives. Moreover, the carbon penalty for CNG fuel showed a price reduction of 32 and 20.8 percent in comparison to gasoline and LPG respectively. The study provides a novel approach to assess the environmental impact of fuels by economic analysis based on emitted carbon quantity. In addition, this very idea is novel in promoting the Sustainable Development Goals (SDG) of the United Nations (UN) through carbon taxation.