An autonomous mixed data oversampling method for AIOT-based churn recognition and personalized recommendations using behavioral segmentation.

The telecom sector is currently undergoing a digital transformation by integrating artificial intelligence (AI) and Internet of Things (IoT) technologies. Customer retention in this context relies on the application of autonomous AI methods for analyzing IoT device data patterns in relation to the offered service packages. One significant challenge in existing studies is treating churn recognition and customer segmentation as separate tasks, which diminishes overall system accuracy. This study introduces an innovative approach by leveraging a unified customer analytics platform that treats churn recognition and segmentation as a bi-level optimization problem. The proposed framework includes an Auto Machine Learning (AutoML) oversampling method, effectively handling three mixed datasets of customer churn features while addressing imbalanced-class distribution issues. To enhance performance, the study utilizes the strength of oversampling methods like synthetic minority oversampling technique for nominal and continuous features (SMOTE-NC) and synthetic minority oversampling with encoded nominal and continuous features (SMOTE-ENC). Performance evaluation, using 10-fold cross-validation, measures accuracy and F1-score. Simulation results demonstrate that the proposed strategy, particularly Random Forest (RF) with SMOTE-NC, outperforms standard methods with SMOTE. It achieves accuracy rates of 79.24%, 94.54%, and 69.57%, and F1-scores of 65.25%, 81.87%, and 45.62% for the IBM, Kaggle Telco and Cell2Cell datasets, respectively. The proposed method autonomously determines the number and density of clusters. Factor analysis employing Bayesian logistic regression identifies influential factors for accurate customer segmentation. Furthermore, the study segments consumers behaviorally and generates targeted recommendations for personalized service packages, benefiting decision-makers.

Binding selectivity analysis of AURKs inhibitors through molecular dynamics simulation studies.

Aurora kinases (AURKs) have been identified as promising biological targets for the treatment of cancer. In this study, molecular dynamics simulations were employed to investigate the binding selectivity of three inhibitors (HPM, MPY, and VX6) towards AURKA and AURKB by predicting their binding free energies. The results show that the inhibitors HPM, MPY, and VX6 have more favorable interactions with AURKB as compared to AURKA. The binding energy decomposition analysis revealed that four common residue pairs (L139, L83), (V147, V91), (L210, L154), and (L263, L207) showed significant binding energies with HPM, MPY, and VX6, hence responsible for the binding selectivity of AURKA and AURKB to the inhibitors. The MD trajectory analysis also revealed that the inhibitors affect the dynamic flexibility of protein structure, which is also responsible for the partial selectivity of HPM, MPY, and VX6 towards AURKA and AURKB. As expected, this study provides useful insights for the design of potential inhibitors with high selectivity for AURKA and AURKB.

Advancements in Diagnostic and Therapeutic Interventions of Non-alcoholic Fatty Liver Disease: A Literature Review.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common diseases of the liver globally. Non-alcoholic steatohepatitis (NASH) has a complicated pathophysiology which includes lipid buildup, oxidative stress, endoplasmic reticulum stress, and lipotoxicity. Recently, there has been tremendous improvement in understanding of NASH pathogenesis due to advancements in the scientific field. It is being investigated how non-invasive circulating and imaging biomarkers can help in NAFLD and NASH diagnosis and monitoring the progress. Multiple medications are now undergoing clinical trials for the treatment of NASH, and lifestyle changes have been acknowledged as one of the main treatment methods. The purpose of this review article is to discuss the incidence of NAFLD globally, management issues with NASH, and its relation to the metabolic syndrome. It explains pathophysiology as well as therapeutic strategies using natural items, dietary changes, and pharmaceutical treatments. While emphasizing the necessity for surrogate endpoints to facilitate medication development for NASH, the study also considers the potential of non-invasive imaging biomarkers including magnetic resonance imaging (MRI) and magnetic resonance elastography (MRE).

Point prevalence probing of antimicrobial prescription patterns from a developing country.

BACKGROUND: Irrational use of antibiotics intensifies resistance and jeopardizes advances made in modern medicine. We aimed to conduct a baseline gap analysis survey on antibiotic prescription practices across Pakistan. RESEARCH DESIGN AND METHODS: This multi-centered cross-sectional survey was conducted at six public sector tertiary care hospitals from February 2021 to March 2021. Data related to various variables including hospital infrastructure, policies and practices, monitoring and feedback, and epidemiological, clinical, and antibiotic prescription for surveyed patients was collected using World Health Organization (WHO) Point Prevalence Survey (PPS) methodology. RESULTS: In a survey of 837 inpatients, 78.5% were prescribed antibiotics. Most commonly prescribed antimicrobial was ceftriaxone (21.7%), followed by metronidazole (17.3%), cefoperazone-sulbactam (8.4%), amoxicillin-clavulanate (6.3%), and piperacillin/tazobactam (5.9%). Surgical prophylaxis (36.7%) and community-acquired infections (24.7%) were the main reasons for antibiotic prescriptions. Single antibiotics were given to 46.7% of patients, 39.9% received a combination of two antibiotics, and 12.5% were prescribed three or more antibiotics. Among six hospitals surveyed, two had drug and therapeutic committees, three had infection prevention and control committees, and one had an antibiotic formulary. CONCLUSION: Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasize the importance of expanding antimicrobial stewardship programs among hospitals. Mentoring clinical teams could help rationalize antimicrobial use.

Mesalamine - A Revered Drug for Inflammatory Bowel Disease With Detrimental Effects on the Lung and Heart.

To keep inflammatory bowel disease (IBD) in remission, mesalamine is frequently utilized. It primarily targets the inflammatory response and lowers prostaglandin and leukotriene synthesis. It can be applied topically, orally, or as a suppository. It is typically well tolerated, but occasionally it can cause serious side effects, leading to a variety of medical problems. We describe two cases of severe mesalamine-induced toxicity, one of which manifested as cardiomyopathy and the other as pneumonitis. However, early detection and treatment of the side effects can be lifesaving.

Exploring the Impact of the Gut Microbiome on Obesity and Weight Loss: A Review Article.

The global obesity pandemic has prompted efforts to search for novel intervention options, including maximizing the health benefits of certain gut microbes and their metabolic byproducts. Our increased understanding of gut microbiota can potentially lead to revolutionary advancements in weight management and general well-being. We studied the association between gut microbiota and obesity, as well as the possible benefits of probiotics, prebiotics, and synbiotics in the prevention and management of obesity in this review. We observed a relationship between the metabolism of nutrients, energy consumption, and gut flora. Numerous mechanisms, including the synthesis of short-chain fatty acids, hormone stimulation, and persistent low-grade inflammation, have been postulated to explain the role of gut bacteria in the etiology of obesity. It has been discovered that the diversity and composition of the intestinal microbiome vary in response to various forms of obesity therapy, which raises concerns about the potential impact of these changes on weight loss. According to research, probiotics, prebiotics, and synbiotics may alter the release of hormones, neurotransmitters, and inflammatory factors, thereby diminishing the stimuli of food consumption that lead to weight gain. More clinical research is required to determine the optimal probiotic, prebiotic, and synbiotic supplementation dosages, formulations, and regimens for long-term weight management and to determine how different gastrointestinal microbiome bacterial species may influence weight gain.

Effects of diverse irrigation with wastewater in soil and plants: assessing the risk of metal to the animal food chain.

In District Jhang, farmers use municipal wastewater to irrigate fodder crops as an alternative source to the deficient availability of fresh water. Therefore, the present study selected the three irrigation sources in District Jhang (canal water, ground water and municipal wastewater) to study the iron (Fe) concentration in the soil, fodder crops and ultimately their transfer into the animal body. Analysed Fe concentration varied as 16.40-27.53 mg/kg in soil samples, 19.72-30.34 mg/kg in fodder crops and 2.49-5.11 mg/kg in animals. Analysed Fe concentration in soil was higher on the wastewater irrigation site while canal water-irrigated fodder crop Zea mays exhibit the higher Fe concentration. In animal samples, higher Fe concentration was observed in the cow blood (4.09 mg/l), cow hairs (3.39 mg/kg) and cow faeces (5.11 mg/kg). Results of pollution load index (0.288-0.484 mg/kg) and enrichment factor (0.112-0.197 mg/kg) indicated that Fe concentration was minimally dispersed and enriched in these sites. Health risk and daily intake values were observed between the 0.029-0.059 and 0.042-0.084 mg/kg/day. Bio-concentration factor (0.834-1.47 mg/kg) for Fe which was greater than 1 explains that Fe contamination was transferred from the soil to fodder tissues and may raise health issues in the grazing animals if they are continuously exposed to these contaminated forages. Wastewater irrigation in study area has increased the Fe content in soil-plant environment that is a risking factor for animal and human health. Hence, this study recommended that wastewater should be treated prior to their irrigation on agricultural lands.

Appraising growth, daily intake, health risk index, and pollution load of Zn in wheat (Triticum aestivum L.) grown in soil differentially spiked with zinc.

Zinc (Zn) is a vital nutrient element required for plants normal growth and development. It performs imperative functions in numerous metabolic pathways in the plants. However, potentially noxious levels of Zn in terrestrial environment can lead to inhibited photosynthesis, growth, respiratory rate and imbalanced mineral nutrition. In micronutrient malnutrition, Zn deficiency is a global human health problem owing to the human dependence on cereals grains especially wheat-based diet. Therefore, this study investigated the Zn uptake efficacy in Triticum aestivum that is grown under two different doses (100 g/kg or 200 g/kg) of various soil amendments in both pot and field experimentation. Results of this study revealed that mean Zn concentration in different wheat varieties and treatments were varied from 1.53 to 6.03 mg/kg, 11.27 to 40.65 mg/kg, 11.28 to 39.93 mg/kg, and 11.32 to 37.70 mg/kg in amended soil, root, shoot, and grains, respectively. All observed Zn values in soil and wheat parts were lower than the FAO/WHO standards. Zinc values observed for pollution load index (0.034-0.134 mg/kg), daily intake (0.00492-0.01533 mg/kg), and health risk (0.0164-0.0570 mg/kg) index were lower than 1 except bio-concentration factor. Bio-concentration factor (5.076-10.165 mg/kg) revealed that DHARABI-11 variety showed maximum Zn uptake efficacy in farmyard manure treatment. The daily intake and health risk index values also showed that Zn level in grains is safe for inhabitants consumption. Overall, study recommended that these organic amendments are a good source of fertilizers, essentially required for the sustainable management of soil and increases the Zn accumulation in wheat grains which can ultimately reduce the Zn malnutrition in human food chain.

Bioaccumulation and transfer of zinc in soil plant and animal system: a health risk assessment for the grazing animals.

Heavy metals pollution has thorough worldwide apprehensions due to the instantaneous growth of industries. Farming regions are irrigated mainly with wastewater which contains both municipal and industrial emancipations. Keeping in view the above scenario, a study was designed in which three sites irrigated with ground, canal, and municipal wastewater in the District Jhang were selected to determine the zinc accumulation and its transfer in the soil, plant, and animal food chain. Zinc concentration was ranged as 18.85-35.59mg/kg in the soil, 26.42-42.67 mg/kg in the forage, and 0.982-2.85mg/kg in the animal samples. Investigated zinc concentration in soil and forages was found to be within the recommended WHO/FAO limits, but blood samples exceed the standards of NRC (2007). The maximum level of pollution load index (0.427-0.805mg/kg) and enrichment factor (0.373-0.894 mg/kg) for zinc was noticed upon wastewater irrigation. Daily intake (0.039 to 0.082 mg/kg/day) and health risk index (0.130 to 0.275 mg/kg/day) of zinc metal was higher in the buffaloes that feed on wastewater-irrigated forages. Bio-concentration factor (0.840 to 2.01mg/kg) for soil-forage was >1 which represents that these plants accumulated the zinc concentration into their tissues and raised health issues in grazing animals on consumption of wastewater-contaminated forages. As animal-derived products are part of human food, then zinc toxicity prevailed in livestock tissues ultimately affects the human food chain. Overall, findings of this study concluded that animal herds should be monitored periodically to devise preventive measures regarding the toxic level of heavy metals availability to livestock.

Ecological risk assessment of heavy metal chromium in a contaminated pastureland area in the Central Punjab, Pakistan: soils vs plants vs ruminants.

Grazing animals act as a bioindicator to study the heavy metal status in the pasture lands because excessive amount of toxic metals in the animal diet either disturb their normal activity or deposit the contaminants into their tissues. The aim of this study was to appraise the chromium status in soil and pasture crops with respect to the nutritional requirement of grazing animals. Three different sites were selected to collect soil, forages, and animal samples from District Jhang. All the samples were processed through atomic absorption spectrophotometer to analyze the chromium concentration in them. Chromium concentration was varied as 0.703-4.20 mg/kg in soil, 0.45-2.85 mg/kg in forages, and 0.588-2.37 mg/kg in all collected animal samples. Both the soil and forage samples displayed the maximum chromium concentration in the Capparis decidua, whereas animal samples revealed maximum concentration in animal blood. Results of pollution load index (0.078 to 0.463 mg/kg) exhibited that all the sample values are less than unity while enrichment factor (1.57-8.25mg/kg) showed that significant level of chromium is enriched in these sites. The maximum value of daily intake (0.0007-0.0055mg/kg/day) and health risk index (0.0004-0.00370055mg/kg/day) was observed in the buffalo that feed on the Capparis decidua. Bio-concentration factor (0.398-2.09mg/kg) value was the maximum in the Medicago sativa. It is concluded that all the animal samples showed chromium concentration beyond their standards. Thus, proper measures should be taken to reduce the metal contamination in these areas that ultimately lessen the availability of toxic metals to grazing animals.

Evaluation of potential ecological risk and prediction of zinc accumulation and its transfer in soil plants and ruminants: public health implications.

Present work evaluated the zinc (Zn) concentration in soil, forage, blood plasma, hair, and feces samples of cows, buffaloes, and sheep taken from Mianwali, Punjab, Pakistan. The concentration of Zn was found in the ranged of 21.82-35.09mg/kg, 32.59-42.17mg/kg, 0.927-2.48mg/l, 1.03-2.84mg/kg, and 0.923-1.98mg/kg in soil, forage, blood plasma, hair, and feces samples, respectively. The Zn concentration in soil, forage, blood, hair, and feces was safer compared to standard limits. Statistical analysis described that values for BCF, PLI, EF, DIM, and HRI ranged 1.03-1.57mg/kg, 0.486-0.782mg/kg, 0.457-0.696mg/kg, 0.048-0.08mg/kg, and 0.160-0.272mg/kg, respectively. It can be concluded from the present work that Zn concentration was safe in soil, forages, and animal samples. BCF was noticed as greater than 1 while PLI, EF, DIM, and HRI were found less than 1, so regular heavy metal analysis was required to appraise the contamination level in environment.

Comparison between qualitative and quantitative measurement of strength deficit in shoulder flexors of young females: A cross- sectional study.

OBJECTIVE: To determine the accuracy of manual muscle testing as a diagnostic tool to detect strength deficit across grades 5 and 4 in shoulder flexors at different percentage deficits of dynamometric strength. METHODS: The cross-sectional study was conducted at the University of South Asia, Lahore, in collaboration with the Association of Fatima Jinnah Old Graduates, Lahore, Pakistan, from May to June 2019. It included young healthy females aged 18-39 years without any ailment of upper extremity or generalised health problem. The strength of shoulder flexors was measured through manual muscle testing and hand-held dynamometer. Data was analysed using SPSS 25. RESULTS: There were 300 women with a mean age of 23.11±4.71 years. The majority 124(41.3%) were aged 20-24 years. The strength of the dominant shoulder flexors of 194(64.7%) participants and the strength of non-dominant shoulder flexors of 206(68.7%) was in grade 4. The overall diagnostic accuracy of manual muscle testing at 10% dynamometric measures was 68.67% (95% confidence interval: 63.21-73.65%) in non-dominant shoulder flexors, and 61.67% (95% confidence interval: 56.05-66.99%) in dominant shoulder flexors. The positive predictive value and specificity of manual muscle testing was better at 10% strength deficit in comparison with dynamometric measures, whereas negative predictive value and sensitivity was better at 20% strength deficit. CONCLUSIONS: The subjective area of grades 4 and 5 showed better, though not ideal, diagnostic worth at 10% deficit of dynamometric measures in shoulder flexors.

Assessing the Clinical Learning Environment in an Institution in the United Arab Emirates: The Resident Perspective.

BACKGROUND: A new accreditation model in the United States has increased focus on the clinical learning environment (CLE). There is limited research on trainee perceptions of the CLE in international settings. OBJECTIVE: We surveyed residents to obtain their perspective on the CLE at 1 sponsoring institution in the United Arab Emirates (UAE). METHODS: We surveyed residents at Tawam Hospital, UAE, a sponsoring institution with 142 trainees, on their perspectives in the 6 focal areas of the US Clinical Learning Environment Review (CLER) to gather baseline information. We administered a 26-item questionnaire to residents through an audience response system in November 2018. RESULTS: Of 100 residents in postgraduate year 2 and above, 72 (72%) responded. The perspective of the majority of respondents was favorable in the areas of reporting patient safety incidents, engaging in quality improvement activities, using a standardized form for care transition, and using professional guidelines for electronic health record documentation. In contrast, only half of the respondents perceived there is honesty in the reporting of duty hours, and only 36% felt the organization supported fatigue management. Other areas for improvement included residents' understanding of the concept of health disparities and activities to address health disparities. CONCLUSIONS: Our findings suggest that in key focal areas related to patient safety, health care quality, care transitions, and professionalism, UAE residents have similar perceptions of their CLE as US trainees. Opportunities for improvement include duty hour reporting, fatigue mitigation, and addressing health disparities.

Effect of calcium hypochlorite and chloramine on blood biochemistry and sodium pentobarbital induced sleeping time in mice.

Disinfectants are chemical agents used to eradicate, deactivate or kill microorganisms. Chemical disinfectants especially chlorine compound are extensively used for water sanitization. Among these calcium hypochlorite and chloramines are commonly used now a day. Large number of chemical compounds, drugs and endogenous substances are metabolized by hepatic enzymes known as cytochrome P450 enzyme system. Many chemicals are capable of enzyme induction. Enzyme induction may change the metabolism of other drugs and endogenous substances which may alter the plasma concentration of these chemicals. To evaluate the enzyme inducing ability of calcium hypochlorite and chloramine, sleeping time induced by sodium pentobarbital was noted in mice. Normal saline was taken as negative control. Rifampicin, chloramphenicol and grapefruit juice were taken as positive control group. On completion of dosing after 4 weeks, alteration in sleep induction and recovery times was noted and compared. Histological evaluation of liver was observed. A significant decrease in sleeping time was observed in calcium hypochlorite and chloramine treated groups. Both calcium hypochlorite and chloramine caused a significant change in liver enzymes and in the values of complete blood count. In histological evaluation both caused fat deposition in the hepatocytes. It was concluded from the study that both calcium hypochlorite and chloramine were hepatic microsomal enzyme inducer.

Imipenem Resistant Pseudomonas aeruginosa: The fall of the final quarterback.

OBJECTIVE: To isolate, determine the frequency, and study the demographic trends of MBL positive Pseudomonas aeruginosa from imipenem resistant isolates collected from clinical samples in a tertiary care hospital of Pakistan. METHODS: In this cross sectional study a total of 230 strains of Pseudomonas were isolated from various clinical specimens on the basis of culture and biochemical tests. Imipenem resistant isolates were selected by Kirby Bauer Diffusion technique, followed by screening for MBL production by Imipenem EDTA Combined Disk Test. Demographic details of each patient were recorded on a separate questionnaire. Chi-Square goodness-of-fit test was computed to review the isolation of MBL positive isolates (P-value ≤ 0.05) in different specimen. RESULTS: Out of 230 strains of P. aeruginosa 49.5% were imipenem resistant; MBL production was confirmed in 64.9% of the resistant isolates. Resistance to polymyxin B (12.5%) was notable. Majority of the MBL positive strains were isolated from patients aged between 20-39 years (45.9%) and the predominant source was pus (43.24%) which was found to be statistically significant (P-value=0.04). Outpatient departments (24.3%) and burn unit (21.6%) were the major places for resistant isolates. CONCLUSION: MBL production is one of the major causes of IRPA. Increasing resistance to polymyxin B is grave. Due to acquisition of MBL strains MDR P. aeruginosa has become endemic in tertiary setups.

A multicentre randomised controlled trial of a carer supervised culturally adapted CBT (CaCBT) based self-help for depression in Pakistan.

BACKGROUND: Cognitive Behaviour Therapy (CBT) based self-help has been found to be effective for treating depression and anxiety. There is some evidence to suggest that CBT needs to be culturally adapted for it to be effective in non-Western cultures. CBT is not widely used in low and middle income countries and there is a need to test its effectiveness in different settings and formats, including self-help. METHODS: We describe a RCT of a Culturally adapted CBT (CaCBT) based self-help manual in Pakistan. The trial was conducted in psychiatry departments in three cities. Assessments were carried out at baseline and at 12 weeks, using Hospital Anxiety and Depression Scale, Bradford somatic Inventory and brief disability Questionnaire. RESULTS: At the end of the trial CaCBT based self-help was found to be effective against care as usual in reducing the symptoms of depression and anxiety, as well as somatic symptoms and disability. LIMITATIONS: This study was conducted only in secondary care and required either patient or a carer to be able to read and write. CONCLUSIONS: This is the first study outside West of a CBT based self-help intervention for depression. This study highlights the importance of using cost effective interventions in developing world in low intensity formats. Future studies should focus on trying these resources in different settings, like primary care, and with the use of audio/video or multimedia resources to improve compliance in patients with lower literacy.

Efficacy of vancomycin versus linezolid against coagulase-negative staphylococci in various clinical specimens.

BACKGROUND: Worldwide increase in antibiotic resistance has become one of the major problems. Optimal and rationale use of antibiotic is important to prevent resistance against most of the bacteria including Coagulase-negative Staphylococci (CoNS), which has now been recognized as an important pathogen for nosocomial infections. This study was carried out to determine efficacy of vancomycin and linezolid against CoNS in various clinical specimens. METHODS: A total of 2989 specimens of blood, pus and wound swab were collected from wards, casualty, intensive care units (ICU) and out-patient department (O.P.D), out of these, Staphylococci were isolated in 1017 specimens, of which 381 were identified as CoNS. Culture, gram stain, catalase, coagulase test and antimicrobial susceptibility pattern were done on these specimens according to clinical manual of microbiology. A total of thirteen most commonly used antibiotics were used in this study. Susceptibility testing was done by Kirby Bauer disc diffusion technique. RESULTS: Antimicrobial resistance of these isolates were Amoxicillin (74.8%), Amoxicillin+clavulanate (32.8%), Ciprofloxacin (35.2%), Ofloxacin (33.6%), Ceftriaxone (30.4%), Erythromycin (58.3%), Clindamycin (16.3%), Kanamycin (52.2%) Fusidic acid (41.7%), Doxycycline (24.7%), Vancomycin (2.6%) and Linezolid (0.8%) respectively. Isolates obtained from blood were 45.9%. CONCLUSION: Vancomycin showed resistance against CoNS which is a real threat for currently applied therapy against methicilin resistant CoNS. However, linezolid efficacy is higher than vancomycin against CoNS in our study, which suggests that this drug may be considered superior to vancomycin for the treatment of infections associated with CoNS.

Assessment of patient satisfaction with mental health services in a tertiary care setting.

BACKGROUND: Patients' opinion regarding services has acquired great importance. Patient satisfaction is playing an increasingly important role in quality of care reforms and health-care delivery. The study aimed to measure patient satisfaction in a tertiary care hospital in order to know the patients' perspectives and expectations of the services and make appropriate improvements accordingly. METHODS: This was a cross-sectional study conducted at the Out-patient and Inpatient Departments of the Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, for a period of 8 months from October 2008 till June 2009. Sample size was 246 patients; which included 123 participants from Out-patient and In-patient departments each. Patients aged 18 and above, of both genders, who gave informed written consent, were consecutively recruited for the study. Learning disabled patients, frankly psychotic and those with severe cognitive impairment and severe co-morbid physical illnesses were excluded. Performa was filled in by the participants for their demographic details. The Client Satisfaction Questionnaire-8 was then orally administered in the native language (Urdu/Punjabi) to assess the degree of patient satisfaction. RESULTS: Among the participants, 72% were mostly satisfied, 18.7% mildly satisfied and 9.3% dissatisfied with the psychiatric care. Age was significantly associated with satisfaction however no such associations could be found for gender and economic status. CONCLUSION: Majority of the patients were satisfied with the psychiatric services. The younger people were more satisfied. Gender and economic status had no influence on patient satisfaction.