Prevalence of concomitant rheumatologic diseases and autoantibody specificities among racial and ethnic groups in SLE patients.

Objective: Leveraging the Manhattan Lupus Surveillance Program (MLSP), a population-based registry of cases of systemic lupus erythematosus (SLE) and related diseases, we investigated the proportion of SLE with concomitant rheumatic diseases, including Sjögren's disease (SjD), antiphospholipid syndrome (APLS), and fibromyalgia (FM), as well as the prevalence of autoantibodies in SLE by sex and race/ethnicity. Methods: Prevalent SLE cases fulfilled one of three sets of classification criteria. Additional rheumatic diseases were defined using modified criteria based on data available in the MLSP: SjD (anti-SSA/Ro positive and evidence of keratoconjunctivitis sicca and/or xerostomia), APLS (antiphospholipid antibody positive and evidence of a blood clot), and FM (diagnosis in the chart). Results: 1,342 patients fulfilled SLE classification criteria. Of these, SjD was identified in 147 (11.0%, 95% CI 9.2-12.7%) patients with women and non-Latino Asian patients being the most highly represented. APLS was diagnosed in 119 (8.9%, 95% CI 7.3-10.5%) patients with the highest frequency in Latino patients. FM was present in 120 (8.9%, 95% CI 7.3-10.5) patients with non-Latino White and Latino patients having the highest frequency. Anti-dsDNA antibodies were most prevalent in non-Latino Asian, Black, and Latino patients while anti-Sm antibodies showed the highest proportion in non-Latino Black and Asian patients. Anti-SSA/Ro and anti-SSB/La antibodies were most prevalent in non-Latino Asian patients and least prevalent in non-Latino White patients. Men were more likely to be anti-Sm positive. Conclusion: Data from the MLSP revealed differences among patients classified as SLE in the prevalence of concomitant rheumatic diseases and autoantibody profiles by sex and race/ethnicity underscoring comorbidities associated with SLE.

Assessing the Feasibility of a Multifaceted Intervention Package for Improving Respiratory Health of Textile Workers: Findings From the MultiTex Pilot Study in Karachi, Pakistan.

We piloted the development and implementation of a multifaceted intervention package for improving respiratory health among textile workers using a pre-post design at six mills in Karachi. The intervention, implemented following a baseline survey (n = 498), included health and safety training of workers and managers, promotion of cotton dust control measures, and the provision of facemasks. Follow-up surveys were conducted at 1, 6, and 12 months post-intervention. Knowledge, attitude, and practice (KAP) scores and respiratory symptoms were assessed through a questionnaire and spirometry was conducted. The intervention was provided to 230 workers and led to an improvement in KAP scores that was more likely among workers with a higher educational status, spinners, smokers, those with a permanent employment status, working in morning shifts, and with ⩾5 years of textile experience. We found the intervention acceptable and feasible in these textile mills henceforth, trials are required to determine its effectiveness.

Circular economy and its implementation in cement industry: A case point in Pakistan.

The cement industry contributes substantially to world emissions. Sustainable and circular practices are adopted globally to mitigate such emissions. Developing countries like Pakistan lack adaptation to circular and sustainable practices. The study proposes an alternative mix of coal and crop residues that can be used for cement production. The study aims to find the best mixtures of coal with crop residue for combustion purposes in cement industries. The Life Cycle Assessment (LCA) and Life Cycle Cost Analysis (LCCA) are implemented for the environmental and economic viability of the proposed material mixtures. Moreover, the study seeks to explore risks associated with the implementation of circular practices in the cement industry of a developing country. The study adopts Modified Safety Improvement Risk Assessment (SIRA) for assessing the risks. The results suggest that the partial replacement of coal with bagasse is the most viable mixture with lower environmental emissions and is economically feasible among other alternate mixtures. In terms of risk assessment, there is a lack of governmental support for adopting circular economy (CE) practices and profit uncertainties of these CE practices.

Neuroprotective effects of vitamin B1 on memory impairment and suppression of pro-inflammatory cytokines in traumatic brain injury.

Traumatic Brain Injury (TBI) remains one of the prevailing disorders that affect millions of people around the globe. There is a cascade of secondary attributes attached to TBI including excitotoxicity, axonal degeneration, neuroinflammation, oxidative stress, and apoptosis. Neuroinflammation is caused due to the activation of microglia along with pro-inflammatory cytokines. The activation of microglia triggers TNF-α which sequentially results in the triggering and upregulation of NF-kB. The aim of the current research was to investigate vitamin B1's potential as neuroprotective agent against TBI-induced neuroinflammation arbitrated memory impairment together with pre- and post-synaptic dysfunction in an adult albino male mice model. TBI was induced using the weight-drop method which caused the microglial activation resulting in neuroinflammation along with synaptic dysfunction leading to the memory impairment of the adult mice. Vitamin B1 was administered for seven days via the intraperitoneal pathway. To analyze the memory impairment and efficacy of vitamin B1, Morris water maze and Y-maze tests were performed. The escape latency time and short-term memories of the experimental mice treated with vitamin B1 were significantly different from the reference mice. The western blot results showed that vitamin B1 has reduced neuroinflammation by downregulating proinflammatory cytokines (NFκ-B, TNF- α). Vitamin B1 also proved its worthiness as a convincing neuroprotective agent by reducing memory dysfunction and recovering the activities of pre- and post-synapse via upregulation of synaptophysin and Postsynaptic density protein 95 (PSD-95).

Solar PV power plant site selection using a GIS-based non-linear multi-criteria optimization technique.

The ongoing rise in energy consumption imposed serious environmental challenges by using fossil fuels. The use of renewable energy sources is being increasingly explored as a potential answer for achieving sustainable energy production and minimizing adverse environmental effects. In the modern day, photovoltaic (PV) systems are viewed as a possible replacement for fossil fuels as a clean energy source. The installation of solar PV power plants requires vast land and huge investment. Therefore, it is necessary to select a suitable site to achieve maximum efficiency and low cost. A feasible location of photovoltaic (PV) system must consider certain criteria including land restrictions, access to roads, and transmission lines. This study analyzed ten factors grouped into four categories: geographic, technical, economic, and flood susceptibility criterion. The data of each factor is extracted from various governments, United Nation (UN), and non-government organizational bodies. Weights were assigned to ten factors by using a non-linear multi-criteria optimization technique called full consistency method (FUCOM). A geographic information system (GIS) software, ESRI ArcGIS pro, performs the weighted overlay analysis of the ten factors with weighted importance calculated by the above technique. A suitability map is created showing that a total of 2.02% of the country's area is suitable for PV power plants, which are further divided into five suitability classes. The results highlight the distribution of suitable sites for the construction of solar PV power plant throughout the country. A sensitivity analysis is performed to highlight the impact of the factor on the final suitability map. These findings can promote the future widespread development and application of solar energy resources.

Effect Of Cotton Dust Exposure On Respiratory Health Outcomes Among Textile Workers.

BACKGROUND: Cotton dust is generated during various textile manufacturing processes. Only a few studies from Pakistan assessed cotton dust exposure and explored the relationship of duration of work in the textile industry with respiratory health outcomes. We aimed to assess cotton dust exposure and its association with lung function and respiratory symptoms among textile workers in Pakistan. METHODS: We report findings from the baseline survey of the larger study, MultiTex, among 498 adult male textile workers from six mills conducted between October 2015-March 2016 in Karachi, Pakistan. Data collection included the use of standardized questionnaires; spirometry, and area dust measurements through UCB-PATS. Multivariable logistic and linear regression models were developed to assess the association of risk factors with respiratory symptoms and illnesses. RESULTS: We found the mean age of workers to be 32.5 (±10) years; around 25% were illiterate. The prevalence of COPD, asthma, and byssinosis was 10%, 17%, and 2%, respectively. The median cotton dust exposure was 0.33 mg/m3 (IQR: 0.12-0.76). Increased duration of work among non-smokers was associated with a decline in lung function, FVC (-245 ml; 95% CI: -385.71, -104.89) and FEV1 (-200 ml; 95% CI: -328.71, -841.1). Workers with certain job titles (machine operators, helpers, and jobbers), those with greater duration of work, and higher dust exposure, were more likely to report respiratory symptoms and illnesses. CONCLUSIONS: We report a high prevalence of asthma and COPD and a low prevalence of byssinosis. Cotton dust exposure and duration of employment were associated with respiratory health outcomes. Our findings highlight the need for preventive interventions in the textile industry in Pakistan.

Risk assessment of circular economy practices in construction industry of Pakistan.

The construction industry (CI) is responsible for consuming 3 billion tons of natural raw materials annually. Also, as per the survey by World Resources Institute, the CI accounts for 40 % of the total waste generated globally. The solution to this inefficient resource usage and adverse effects on the ecosystem is implementing Circular Economy (CE) practices in CI. However, the concept of circular construction is in developmental stages. Therefore, it is more prone to damaging risks than traditional construction. The primary aim of this study is to identify and assess the risk related to implementing CE practices in developing country construction sector. To achieve this aim, 25 risks were shortlisted from the literature review and evaluated upon the probability, detection, and severity risk criteria. This study proposed a novel hybrid fuzzy Multi-Criteria Decision Making (MCDM) approach to analyze the shortlisted risks. Fuzzy Step Wise Assessment Ratio Analysis (FSWARA) is employed to gauge the risk criterion weightage. Moreover, Fuzzy VIKOR (FVIKOR) is used to determine the risks' ranking as per the weightage of the risk criterion. The analyses ranked "lack of political support and incentives for circular construction", "difficulty in selection of circular construction experts", "profit uncertainty", and "circular material quality" as the most critical risks. Therefore, it is recommended for legislative authority to devise a framework that promotes and provides support to circular construction. Moreover, this study fills the literature gap by assessing the risks of CE practices in the CI of Pakistan.

Population-based prevalence and incidence estimates of mixed connective tissue disease from the Manhattan Lupus Surveillance Program.

OBJECTIVE: Epidemiological data for MCTD are limited. Leveraging data from the Manhattan Lupus Surveillance Program (MLSP), a racially/ethnically diverse population-based registry of cases with SLE and related diseases including MCTD, we provide estimates of the prevalence and incidence of MCTD. METHODS: MLSP cases were identified from rheumatologists, hospitals and population databases using a variety of International Classification of Diseases, Ninth Revision codes. MCTD was defined as one of the following: fulfilment of our modified Alarcon-Segovia and Kahn criteria, which required a positive RNP antibody and the presence of synovitis, myositis and RP; a diagnosis of MCTD and no other diagnosis of another CTD; and a diagnosis of MCTD regardless of another CTD diagnosis. RESULTS: Overall, 258 (7.7%) cases met a definition of MCTD. Using our modified Alarcon-Segovia and Kahn criteria for MCTD, the age-adjusted prevalence was 1.28 (95% CI 0.72, 2.09) per 100 000. Using our definition of a diagnosis of MCTD and no other diagnosis of another CTD yielded an age-adjusted prevalence and incidence of MCTD of 2.98 (95% CI 2.10, 4.11) per 100 000 and 0.39 (95% CI 0.22, 0.64) per 100 000, respectively. The age-adjusted prevalence and incidence were highest using a diagnosis of MCTD regardless of other CTD diagnoses and were 16.22 (95% CI 14.00, 18.43) per 100 000 and 1.90 (95% CI 1.49, 2.39) per 100 000, respectively. CONCLUSIONS: The MLSP provided estimates for the prevalence and incidence of MCTD in a diverse population. The variation in estimates using different case definitions is reflective of the challenge of defining MCTD in epidemiologic studies.

Evaluation of potential bacterial protease inhibitor properties of selected hydroxyquinoline derivatives: an in silico docking and molecular dynamics simulation approach.

Antimicrobial drug resistance (AMR) is a severe global threat to public health. The increasing emergence of drug-resistant bacteria requires the discovery of novel antibacterial agents. Quinoline derivatives have previously been reported to exhibit antimalarial, antiviral, antitumor, antiulcer, antioxidant and, most interestingly, antibacterial properties. In this study, we evaluated the binding affinity of three newly designed hydroxyquinolines derived from sulfanilamide (1), 4-amino benzoic acid (2) and sulfanilic acid (3) towards five bacterial protein targets (PDB ID: 1JIJ, 3VOB, 1ZI0, 6F86, 4CJN). The three derivatives were designed considering the amino acid residues identified at the active site of each protein involved in the binding of each co-crystallized ligand and drug-likeness properties. The ligands displayed binding energy values with the target proteins ranging from -2.17 to -8.45 kcal/mol. Compounds (1) and (3) showed the best binding scores towards 1ZI0/3VOB and 1JIJ/4CJN, respectively, which may serve as new antibiotic scaffolds. Our in silico results suggest that sulfanilamide (1) or sulfanilic acid (3) hydroxyquinoline derivatives have the potential to be developed as bacterial inhibitors, particularly MRSA inhibitors. But before that, it must go through the proper preclinical and clinical trials for further scientific validation. Further experimental studies are warranted to explore the antibacterial potential of these compounds through preclinical and clinical studies.Communicated by Ramaswamy H. Sarma.

Evaluation of the EULAR/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus in a Population-Based Registry.

OBJECTIVE: Using the Manhattan Lupus Surveillance Program, a multiracial/ethnic population-based registry, we aimed to compare 3 commonly used classification criteria for systemic lupus erythematosus (SLE) to identify unique cases and determine the incidence and prevalence of SLE using the EULAR/American College of Rheumatology (ACR) criteria. METHODS: SLE cases were defined as fulfilling the 1997 ACR, the Systemic Lupus International Collaborating Clinics (SLICC), or the EULAR/ACR classification criteria. We quantified the number of cases uniquely associated with each and the number fulfilling all 3 criteria. Prevalence and incidence using the EULAR/ACR classification criteria and associated 95% confidence intervals (95% CIs) were calculated. RESULTS: A total of 1,497 cases fulfilled at least 1 of the 3 classification criteria, with 1,008 (67.3%) meeting all 3 classifications, 138 (9.2%) fulfilling only the SLICC criteria, 35 (2.3%) fulfilling only the 1997 ACR criteria, and 34 (2.3%) uniquely fulfilling the EULAR/ACR criteria. Patients solely satisfying the EULAR/ACR criteria had <4 manifestations. The majority classified only by the 1997 ACR criteria did not meet any of the defined immunologic criteria. Patients fulfilling only the SLICC criteria did so based on the presence of features unique to this system. Using the EULAR/ACR classification criteria, age-adjusted overall prevalence and incidence rates of SLE in Manhattan were 59.6 (95% CI 55.9-63.4) and 4.9 (95% CI 4.3-5.5) per 100,000 population, with age-adjusted prevalence and incidence rates highest among non-Hispanic Black female patients. CONCLUSION: Applying the 3 commonly used classification criteria to a population-based registry identified patients with SLE fulfilling only 1 validated definition. The most recently developed EULAR/ACR classification criteria revealed prevalence and incidence estimates similar to those previously established for the ACR and SLICC classification schemes.

Evaluation of critical risk factors in the implementation of modular construction.

Modular construction is considered as a preferred construction method over conventional construction due to a number of benefits including reduction in project completion time, improved environmental performance, better quality, enhanced workers' safety and flexibility. However, successful implementation of modular construction is hindered by various risk factors and uncertainties. Therefore, it is imperative to perform a comprehensive risk assessment of critical risk factors that pose a negative impact on the implementation of modular construction. Moreover, there is also a relatively less rate of modular construction adoption in developing countries, highlighting the need to focus more on underdeveloped regions. This study aims to propose a risk assessment framework for identification, evaluation and prioritization of critical risk factors affecting the implementation of modular construction in Pakistan. 20 risk factors were identified from previous literature which were then evaluated to shortlist the most significant risks using Fuzzy Delphi. The most significant risk factors were then prioritized using a novel Full-Consistency Method (FUCOM). The results specified 'Inadequate skills and experience in modular construction', 'Inadequate capacity of modular manufacturers' and 'Inability to make changes in design during the construction stage' as top three critical risks in the implementation of modular construction. This is the first study to propose a risk assessment framework for modular construction in Pakistan. The results of the study are useful to provide insights to construction industry practitioners in highlighting and eliminating risks involved in modular construction planning and execution.

Implementation of the circular supply chain management in the pharmaceutical industry.

The ever-increasing levels of pollution and waste creation have subjected industries around the world to incorporate the concept of circular economy (CE) in their supply chains. The amalgamation of the CE approach along with supply chain management is called circular supply chain management (CSCM). Among other industries, the pharmaceutical industry is also involved in damaging the ecosystem. Hence, an effective framework for the adoption of CSCM in a particular industry is very essential. Therefore, this paper aims to devise a model that will help the pharmaceutical industries to adopt CSCM in their organizations. For this purpose, the study in the first phase identifies ten barriers that are working as an impediment in the adoption of the CSCM approach. To counter those barriers, the study in the second phase identifies a set of twelve enablers. To analyse the barriers and enablers, the study uses a new hybrid methodology. For allocating weights and prioritizing the barriers, the fuzzy multi-criteria decision-making (MCDM) technique, i.e. fuzzy full consistency method (F-FUCOM) is used, whereas the total quality management tool, i.e. fuzzy quality function deployment (FQFD) is used to rank the enablers. The results from F-FUCOM suggest "lack of financial resources and funding", "market challenges", and "lack of coordination and collaboration among the entire supply chain network" to be the top-most barriers, respectively, whereas the results achieved from the FQFD suggest "industrial symbiosis", "Reverse Logistic (RL) infrastructure", and "block chain technology" to be the top-ranked enablers, respectively. The provision of a facilitating framework for the adoption of CSCM in the pharmaceutical industry and the newly developed hybrid methodology are both novelties of this study.

Insights into the structure and drug design of benzimidazole derivatives targeting the epidermal growth factor receptor (EGFR).

Tyrosine kinase overexpression could result in an unfavourable consequence of cancer progression in the body. A number of kinase inhibitor drugs targeting various cancer-related protein kinases have been developed and proven successful in clinical therapy. Benzimidazole is one of the most studied scaffolds in the search for effective anticancer drugs. The association of various functional groups and the structural design of the compounds may influence the binding towards the receptor. Despite numerous publications on the design, synthesis and biological assays of benzimidazole derivatives, their inhibitory activities against epidermal growth factor receptor (EGFR), a receptor tyrosine kinase (RTK), have not been specifically analysed. This review covers recent research reports on the anticancer activity of benzimidazole derivatives focusing on EGFR expression cell lines, based on their structure-activity relationship study. We believe it would aid researchers to envision the challenges and explore benzimidazole's potentials as tyrosine kinase inhibitors.

Adoption of circular economy for food waste management in the context of a developing country.

Food wastage is a global concern with high economic, social and environmental impacts. Pakistan, a developing country, is also significantly affected by the adverse impacts of food wastage. For overcoming this problem, the transition from a Linear to a Circular Economy (CE) for the management of food wastage can serve as a viable strategy. However, there are barriers of political, technical and cultural nature, which are impediments in the path of this transition. This study aims to identify and prioritize these barriers in order of their significance. This research study evaluated and ranked these barriers using a Fuzzy Multi-Criteria Decision Making (MCDM) technique, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). A total of 15 barriers were analyzed, and the 'complicated intrinsic nature of CE', 'misleading information about shelf-life leading to waste rather than distribution', 'the poor economic viability of start-ups with CE model', 'corporate and organizational hesitance to change/innovate' and 'technological backwardness of farmers/growers on the agricultural production side' were ranked as the most significant hurdles. The novelty of this study lies in its application. This study is unique as it has focused on developing countries and proposed policy recommendations for the transition towards a CE. In light of the above-mentioned results, this study provides policy recommendations for public and private sector policymakers that would facilitate the food industry in shifting towards the CE model.

A facilitating framework for a developing country to adopt smart waste management in the context of circular economy.

To achieve higher standards of sustainability, the waste management sector now requires the incorporation of circular economy (CE) principles. However, an easy transition toward the particular goal would require the use of smart waste technologies. To achieve the aforementioned goal, this study aims to provide a facilitating framework for the adoption of smart waste management in the context of CE for Pakistan. To help Pakistan transition toward the new paradigm, a total of 16 critical facilitators are evaluated based on five distinctive criteria using a novel fuzzy hybrid multi-criteria decision-making (MCDM) approach. The hybrid MCDM approach includes fuzzy Stepwise Weight Assessment Ratio Analysis (SWARA) for allocating weights to the determined criteria; whereas, the fuzzy VIsekriterijumsko kompromisno rangiranje (VIKOR) approach is used to rank the critical facilitators adopted from the secondary literature. The fuzzy approach in both cases is to deal with any kind of uncertainty during the data collection process. Based on the achieved results, the study suggests that before the application of smart waste technologies in the country, Pakistan should first focus on devising regulations that effectively address the mismanagement of waste produced in the country. Also, the industries in the country need to become more responsible and should adopt environmental management systems that foster waste minimization. Lastly, the country in the third phase should focus on the wide application of digitalization both in the streams of ICT and IoT, for collecting, sharing, and receiving waste data. The study further provides policy recommendations to the respective stakeholders that will help the country achieve zero-waste CE.

Isolation, Characterization and Neuroprotective Activity of Folecitin: An In Vivo Study.

Neurodegenerative diseases (NDs) extend the global health burden. Consumption of alcohol as well as maternal exposure to ethanol can damage several neuronal functions and cause cognition and behavioral abnormalities. Ethanol induces oxidative stress that is linked to the development of NDs. Treatment options for NDs are yet scarce, and natural product-based treatments could facilitate ND management since plants possess plenty of bioactive metabolites, including flavonoids, which typically demonstrate antioxidant and anti-inflammatory properties. Hypericum oblongifolium is an important traditional medicinal plant used for hepatitis, gastric ulcer, external wounds, and other gastrointestinal disorders. However, it also possesses multiple bioactive compounds and antioxidant properties, but the evaluation of isolated pure compounds for neuroprotective efficacy has not been done yet. Therefore, in the current study, we aim to isolate and characterize the bioactive flavonoid folecitin and evaluate its neuroprotective activity against ethanol-induced oxidative-stress-mediated neurodegeneration in the hippocampus of postnatal day 7 (PND-7) rat pups. A single dose of ethanol (5 g/kg body weight) was intraperitoneally administered after the birth of rat pups on PND-7. This caused oxidative stress accompanied by the activation of phosphorylated-c-Jun N-terminal kinase (p-JNK), nod-like receptor family pyrin domain containing 3 (NLRP3), apoptosis-associated speck-like protein (ASC), and cysteine-aspartic acid protease-1 (caspase-1) proteins to form a complex called the NLRP3-inflammasome, which converts pro-interleukin 1 beta (IL-1B) to activate IL-1B and induce widespread neuroinflammation and neurodegeneration. In contrast, co-administration of folecitin (30 mg/kg body weight) reduced ethanol-induced oxidative stress, inhibited p-JNK, and deactivated the NLRP3-inflammasome complex. Furthermore, folecitin administration reduced neuroinflammatory and neurodegenerative protein markers, including decreased caspase-3, BCL-2-associated X protein (BAX), B cell CLL/lymphoma 2 (BCL-2), and poly (ADP-ribose) polymerase-1 (PARP-1) expression in the immature rat brain. These findings conclude that folecitin is a flavone compound, and it might be a novel, natural and safe agent to curb oxidative stress and its downstream harmful effects, including inflammasome activation, neuroinflammation, and neurodegeneration. Further evaluation in a dose-dependent manner would be worth it in order to find a suitable dose regimen for NDs.

What Has Dual Energy CT Taught Us About Gout?

PURPOSE OF THE REVIEW: Dual energy computed tomography (DECT) scan has emerged as a useful diagnostic tool in the diagnosis of gout over recent years. Here, we review the role of DECT in the context of typical and atypical gout, including its role in identifying extra-articular monosodium urate (MSU) deposition. RECENT FINDINGS: DECT has been found to be more accurate than ultrasound in detecting extra-articular MSU deposition in soft tissue. It has the ability to identify axial MSU deposition in gout patients with non-specific back pain. For individuals with no other clear etiology, this potentially implicates MSU as the cause of the pain. DECT also has the ability to detect vascular MSU deposition. This correlates with high coronary calcium scores and elevated Framingham cardiovascular risk. DECT continues to aid our understanding of articular and extra-articular MSU deposition, including the role of vascular MSU deposition on cardiovascular health. Not only does it allow quantification of urate burden but it can also potentially avoid invasive diagnostic procedures. The limitations and advantages of DECT are further explored in this article.

The risk and severity of stroke in patients with atrial fibrillation and gout: A National Representative Database study.

BACKGROUND: It has been shown that gout is associated with left atrium remodeling and a pro-inflammatory state leading to the development of atrial fibrillation (AF). There is limited evidence whether gout increases the risk of stroke in patients with AF. We assessed the incidence of gout and the risk of stroke in patients with AF. METHODS: This is a retrospective cohort study using the 2016 US National Inpatient Sample (NIS) based on ICD-10 codes. The outcomes of the study were the risk and severity of new stroke in patients with pre-existing AF and gout. RESULTS: In 2016, we identified 3 844 057 patients admitted to the hospitals in NIS with history of AF, of which 240 875 had history of gout. Patients with AF and gout have higher risk of new stroke (OR 2.07 [1.97-2.19], P < .001), and this risk remains significantly elevated after adjusting for CHADS2VASC score variables, chronic kidney disease, dyslipidemia, obesity, and race (OR 1.10 [1.01-1.11], P = .041). However, presence of gout in patients with AF was not associated with all-cause in-hospital mortality, need for mechanical ventilation, percutaneous gastrostomy tube insertion, or discharge to skilled nursing facility. CONCLUSION: Subjects with AF and gout compared to AF alone had an increased risk of new stroke, but presence of gout was not associated with stroke severity. There is a potential role of gout as a risk factor or a risk marker for stroke in subjects with AF.

Sustainable production of diapers and their potential outputs for the Pakistani market in the circular economy perspective.

One of the challenging issues of any country's agenda today is the management of solid waste in the circular economy and eco-efficiency perspective. In this context, there has been much debate about the disposal of diapers, but the current research lacks data for developing countries. Furthermore, the research lacks quantification of data, in terms of output products generated through sustainable waste management practices particularly for diapers. Thus, this research aims to develop a quantitative study based on Life Cycle Assessment (LCA) and Life Cycle Costing Analysis (LCCA) which help to evaluate the overall eco-efficiency of various disposal methods by taking into account their net input and resultant monetary value, in the context of Pakistan. To cover limitations of LCA approach, results have been compared along with the expert's opinion using the well-known multi-criteria method Fuzzy logic and Technique for Order of preference by similarity to ideal solution (TOPSIS) technique. Human health and environment have been used as end-point indicators. The main research result points out that incorporating small scale incineration plants along with recycling using Thermal Pyrolysis Hydrolysis (TPH) plants can help to sustainably dispose-off diapers. The results also indicate the importance for policy makers and industrial sector to find solutions to facilitate implementation of circular economy principles for diapers. In fact, the recycling of diapers using waste-to-energy technologies is a significantly eco-efficient alternative for the Pakistani market, which can be pivotal for Sustainable development and initiation of a circular economy model.