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INTRODUCTION: Pakistan has significantly strengthened its capacity for active case finding (ACF) for tuberculosis (TB) that is being implemented at scale in the country. However, yields of ACF have been lower than expected, raising concerns on its effectiveness in the programmatic setting. Distribution of TB in communities is likely to be spatially heterogeneous and targeting of ACF in areas with higher TB prevalence may help improve yields. The primary aim of SPOT-TB is to investigate whether a policy change to use a geographically targeted approach towards ACF supported by an artificial intelligence (AI) software, MATCH-AI, can improve yields in Pakistan. METHODS AND ANALYSIS: SPOT-TB will use a pragmatic, stepped wedge cluster randomised design. A total of 30 mobile X-ray units and their field teams will be randomised to receive the intervention. Site selection for ACF in the intervention areas will be guided primarily through the use of MATCH-AI software that models subdistrict TB prevalence and identifies potential disease hotspots. Control areas will use existing approaches towards site selection that are based on staff knowledge, experience and analysis of historical data. The primary outcome measure is the difference in bacteriologically confirmed incident TB detected in the intervention relative to control areas. All remaining ACF-related procedures and algorithms will remain unaffected by this trial. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Health Services Academy, Islamabad, Pakistan (7-82/IERC-HSA/2022-52) and from the Common Management Unit for TB, HIV and Malaria, Ministry of Health Services, Regulation and Coordination, Islamabad, Pakistan (26-IRB-CMU-2023). Findings from this study will be disseminated through publications in peer-reviewed journals and stakeholder meetings in Pakistan with the implementing partners and public-sector officials. Findings will also be presented at local and international medical and public health conferences. TRIAL REGISTRATION NUMBER: NCT06017843.
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Inteligencia Artificial , Tuberculosis , Humanos , Pakistán/epidemiología , Tuberculosis/epidemiología , Programas Informáticos , Prevalencia , Ensayos Clínicos Pragmáticos como Asunto , Tamizaje Masivo/métodos , Tuberculosis Pulmonar/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto/métodosRESUMEN
One of the most important areas of nanotechnology is the use of nanoparticles (NPs) for a variety of environmental and biological applications, with silver nanoparticles (Ag-NPs) gaining a lot attention due to their distinct properties. The current study deals with the synthesis of Ag-NPs from Dicliptera bupleuroides Nees leaf extract and to determine their antioxidant, antimicrobial potential and effects on wheat seed germination and growth. UV-Visible spectrum revealed a prominent absorption peak at 442 nm, elucidating the conformation of the Ag-NPs synthesis. Scanning electron microscopy (SEM) showed distinctive triangular, pyramidal, and irregular shape. X-ray diffraction (XRD) demonstrated their crystalline nature, with average crystallite size of the Ag-NPs measured at 20.52 nm. Fourier-transform infrared spectroscopy (FT-IR) further confirmed the presence of functional groups such as Phenols (O-H stretch), transition metal carbonyls N-H, ≡C-H, C ≡ N, C ≡ C, C-Cl, C-Br and O-H bonds on the surface Ag-NPs. The antibacterial activity of the Ag-NPs was most pronounced against Bacillus subtilis, with a zone of inhibition (ZOI) measuring 11 mm ± 0.57 at a concentration of 1000 µg/mL (45% inhibition). Likewise, Ag-NPs exhibited highest antioxidant potential (73.2%) at 100 µg/mL compared with standard (ascorbic acid) which showed (76%) at the same concentration. Furthermore, the effect of D. bupleuroides mediated Ag-NPs on wheat seeds growth and germination was recorded maximum at high concentrations (200-300 ppm). In conclusion, D. bupleuroides mediated Ag-NPs showed safe, cost effective and environmentally friendly synthesis which can be used as an antibacterial and antioxidant agent as well as for enhancing the growth and seed germination of crop seeds globally. RESEARCH HIGHLIGHTS: Nanotechnology is the study of nanoparticles for biological and environmental applications. Ag-NPs among other NPs have received broad attention because of their unique properties. D. bupleuroides Ag-NPs: 45% antibacterial, 73.2% antioxidant, enhance wheat germination. D. bupleuroides-mediated Ag-NPs are both cost-effective and environmentally beneficial.
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Bacillus genera, especially among rhizobacteria, are known for their ability to promote plant growth and their effectiveness in alleviating several stress conditions. This study aimed to utilize indigenous Bacillus cereus PM38 to degrade four organophosphate pesticides (OPs) such as chlorpyrifos (CP), profenofos (PF), monocrotophos (MCP), and dimethoate (DMT) to mitigate the adverse effects of these pesticides on cotton crop growth. Strain PM38 exhibited distinct characteristics that set it apart from other Bacillus species. These include the production of extracellular enzymes, hydrogen cyanide, exopolysaccharides, Indol-3-acetic acid (166.8 µg/mL), siderophores (47.3 µg/mL), 1-aminocyclopropane-1-carboxylate deaminase activity (32.4 µg/mL), and phosphorus solubilization (162.9 µg/mL), all observed at higher concentrations. This strain has also shown tolerance to salinity (1200 mM), drought (20% PEG-6000), and copper and cadmium (1200 mg/L). The amplification of multi-stress-responsive genes, such as acdS, ituC, czcD, nifH, sfp, and pqqE, further confirmed the plant growth regulation and abiotic stress tolerance capability in strain PM38. Following the high-performance liquid chromatography (HPLC) analysis, the results showed striking compatibility with the first kinetic model. Strain PM38 efficiently degraded CP (98.4%), PF (99.7%), MCP (100%), and DMT (95.5%) at a concentration of 300 ppm over 48 h at 35 °C under optimum pH conditions, showing high coefficients of determination (R2) of 0.974, 0.967, 0.992, and 0.972, respectively. The Fourier transform infrared spectroscopy (FTIR) analysis and the presence of opd, mpd, and opdA genes in the strain PM38 further supported the potential to degrade OPs. In addition, inoculating cotton seedlings with PM38 improved root length under stressful conditions. Inoculation of strain PM38 reduces stress by minimizing proline, thiobarbituric acid-reactive compounds, and electrolyte leakage. The strain PM38 has the potential to be a good multi-stress-tolerant option for a biological pest control agent capable of improving global food security and managing contaminated sites.
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Bacillus cereus , Cloropirifos , Monocrotofos , Cloropirifos/metabolismo , Cloropirifos/toxicidad , Bacillus cereus/metabolismo , Monocrotofos/toxicidad , Dimetoato/toxicidad , Gossypium , Biodegradación Ambiental , Organotiofosfatos , Rizosfera , FosforamidasRESUMEN
Three Cd2+ resistant bacterium's minimal inhibition concentrations were assessed and their percentages of Cd2+ accumulation were determined by measurements using an atomic absorption spectrophotometer (AAS). The results revealed that two isolates Bacillus paramycoides (PM51) and Bacillus tequilensis (PM52), identified by 16S rDNA gene sequencing, showed a higher percentage of Cd2+ accumulation i.e., 83.78% and 81.79%, respectively. Moreover, both novel strains can tolerate Cd2+ levels up to 2000 mg/L isolated from district Chakwal. Amplification of the czcD, nifH, and acdS genes was also performed. Batch bio-sorption studies revealed that at pH 7.0, 1 g/L of biomass, and an initial 150 mg/L Cd2+ concentration were the ideal bio-sorption conditions for Bacillus paramycoides (PM51) and Bacillus tequilensis (PM52). The experimental data were fit to Langmuir isotherm measurements and Freundlich isotherm model R2 values of 0.999 for each of these strains. Bio sorption processes showed pseudo-second-order kinetics. The intra-diffusion model showed Xi values for Bacillus paramycoides (PM51) and Bacillus tequilensis (PM52) of 2.26 and 2.23, respectively. Different surface ligands, was investigated through Fourier-transformation infrared spectroscopy (FTIR). The scanning electron microscope SEM images revealed that after Cd2+ adsorption, the cells of both strains became thick, adherent, and deformed. Additionally, both enhanced Linum usitatissimum plant seed germination under varied concentrations of Cd2+ (0 mg/L, 250 mg/L,350 mg/L, and 500 mg/L). Current findings suggest that the selected strains can be used as a sustainable part of bioremediation techniques.
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Bacillus , Cadmio , Bacillus/metabolismo , Bacillus/genética , Cadmio/metabolismo , Plantones/metabolismo , Plantones/efectos de los fármacos , Plantones/microbiología , Biodegradación Ambiental , AdsorciónRESUMEN
INTRODUCTION/AIMS: Electrodiagnostic examinations, such as nerve conduction studies (NCS) and needle electromyography (EMG), are perceived as painful by children and their parents/guardians. Methods to reduce peri-procedural pain improve compliance and have neurocognitive and neuropsychiatric benefits. This study aimed to assess the efficacy of combined oral and topical analgesics (COTA), oral analgesics (OA), and placebo in reducing pain during NCS/EMG in children. METHODS: We performed a double-blind, randomized, placebo-controlled trial on children presenting to our neurophysiology lab. Patients were stratified into two age groups (6M-6Y and 7Y-18Y) and randomized into three arms: COTA, OA, and placebo. Pain scores post-NCS/EMG were assessed using the Modified Behavioral Pain Scale (MBPS) and Faces Pain Scale-Revised (FPS-R). RESULTS: One hundred thirteen participants were enrolled. A comparison of participants from both age groups combined revealed no significant differences in guardian FPS-R scores across all arms for NCS and EMG. A significant difference in the distribution of post-NCS FPS-R score severities in children aged 7Y-18Y was noted between OA and placebo (p = .007). EMG was more painful than NCS across all arms (p < .05). In children aged 6M-6Y undergoing at least 10 muscle samplings during EMG, those receiving COTA had significantly lower pain scores (p = .014). DISCUSSION: This study reveals the complexity of pediatric pain perception during NCS/EMG and highlights that other methods to reduce experienced pain are required. Our findings suggest that procedural characteristics, such as number of muscles sampled, may influence the effectiveness of analgesia and serve as a foundation for future research aimed at optimizing pain management strategies.
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Administración Tópica , Electromiografía , Dimensión del Dolor , Humanos , Niño , Masculino , Femenino , Adolescente , Método Doble Ciego , Administración Oral , Preescolar , Dimensión del Dolor/métodos , Analgésicos/administración & dosificación , Analgesia/métodos , Electrodiagnóstico/métodos , Conducción Nerviosa/efectos de los fármacos , Conducción Nerviosa/fisiología , Dolor/tratamiento farmacológico , Dolor/diagnósticoRESUMEN
Skeletal dysplasias (SKDs) are a heterogeneous group of more than 750 genetic disorders characterized by abnormal development, growth, and maintenance of bones or cartilage in the human skeleton. SKDs are often caused by variants in early patterning genes and in many cases part of multiple malformation syndromes and occur in combination with non-skeletal phenotypes. The aim of this study was to investigate the underlying genetic cause of congenital SKDs in highly consanguineous Pakistani families, as well as in sporadic and familial SKD cases from India using multigene panel sequencing analysis. Therefore, we performed panel sequencing of 386 bone-related genes in 7 highly consanguineous families from Pakistan and 27 cases from India affected with SKDs. In the highly consanguineous families, we were able to identify the underlying genetic cause in five out of seven families, resulting in a diagnostic yield of 71%. Whereas, in the sporadic and familial SKD cases, we identified 12 causative variants, corresponding to a diagnostic yield of 44%. The genetic heterogeneity in our cohorts was very high and we were able to detect various types of variants, including missense, nonsense, and frameshift variants, across multiple genes known to cause different types of SKDs. In conclusion, panel sequencing proved to be a highly effective way to decipher the genetic basis of SKDs in highly consanguineous families as well as sporadic and or familial cases from South Asia. Furthermore, our findings expand the allelic spectrum of skeletal dysplasias.
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Consanguinidad , Linaje , Humanos , Masculino , Femenino , Pakistán/epidemiología , India/epidemiología , Osteocondrodisplasias/genética , Osteocondrodisplasias/diagnóstico , Osteocondrodisplasias/patología , Fenotipo , Niño , Mutación , Enfermedades del Desarrollo Óseo/genética , Predisposición Genética a la Enfermedad , Preescolar , Secuenciación de Nucleótidos de Alto Rendimiento , Heterogeneidad GenéticaRESUMEN
The present research investigates the effectiveness of nano-emulsified coatings (C-1, C-2, and C-3) in preserving the kiwifruit at a temperature of 10 ± 2 °C with 90-95 % relative humidity (RH) for 30 days. The nano-emulsions were prepared from varied carboxymethyl cellulose (CMC) concentrations with different combinations of essential oils such as thyme, clove, and cardamom. Dynamic light scattering investigation with Zeta Sizer revealed that C-1, C-2, and C-3 nano-emulsions have nano sizes of 81.3 ± 2.3, 115.3 ± 4.2, and 63.2 ± 3.2 nm, respectively. The scanning electron microscopy images showed that the nanoemulsion of C-1 had homogenous spherical globules, C-2 had voids, and C-3 showed a non-porous structure with uniform dispersion. The X-ray diffraction analysis indicated that C-1, C-2, and C-3 nano-emulsion exhibited distinct crystallinity and peaks. The nano-emulsion C-1 had reduced crystallinity, while C-2 had lower intensity peaks, and C-3 had increased crystallinity. The results documented that compared to control kiwifruit samples, the samples coated with C-3 nano-emulsion have decreased weight loss, decay incidence, soluble solids, maturity index activity, ethylene production, total bacterial count, and increased titratable acid, and firmness attributes. The results of current research are promising and would be applicable in utilization in industrial applications.
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Películas Comestibles , Aceites Volátiles , Conservación de Alimentos/métodos , Carboximetilcelulosa de Sodio/química , Temperatura , Emulsiones/químicaRESUMEN
The binding mode of antineoplastic antimetabolite, floxuridine (FUDR), with human serum albumin (HSA), the leading carrier in blood circulation, was ascertained using multi-spectroscopic, microscopic, and computational techniques. A static fluorescence quenching was established due to decreased Ksv values with rising temperatures, suggesting FUDR-HSA complexation. UV-vis absorption spectral results also supported this conclusion. The binding constant, Ka values, were found within 9.7-7.9 × 103 M-1 at 290, 300, and 310 K, demonstrating a moderate binding affinity for the FUDR-HSA system. Thermodynamic data (ΔS = +46.35 J.mol-1.K-1 and ΔH = -8.77 kJ.mol-1) predicted the nature of stabilizing forces (hydrogen-bonds, hydrophobic, and van der Waals interactions) for the FUDR-HSA complex. Circular dichroism spectra displayed a minor disruption in the protein's 2° and 3° structures. At the same time, atomic force microscopy images proved variations in the FUDR-HSA surface morphology, confirming its complex formation. The protein's microenvironment around Trp/Tyr residues was also modified, as judged by 3-D fluorescence spectra. FUDR-bound HSA showed better resistance against thermal stress. As disclosed from ligand displacement studies, the FUDR binding site was placed in subdomain IIA (Site I). Further, the molecular docking analysis corroborated the competing displacement studies. Molecular dynamics evaluations revealed that the complex achieved equilibrium during simulations, confirming the FUDR-HSA complex's stability.
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Floxuridina , Albúmina Sérica Humana , Humanos , Albúmina Sérica Humana/química , Floxuridina/metabolismo , Simulación del Acoplamiento Molecular , Unión Proteica , Espectrometría de Fluorescencia , Sitios de Unión , Dicroismo Circular , TermodinámicaRESUMEN
Pyelonephritis is a prevalent diagnosis of emergency department visits. It commonly presents as flank pain and costovertebral tenderness with urinary symptoms. However, some cases occur without typical symptoms. Our study highlights the dubious presentation of pyelonephritis with lower urinary tract symptoms (LUTS) only. This study was conducted at a tertiary care hospital, where charts and files were reviewed from January 11, 2018 to February 28, 2019 for all the patients with a diagnosis of acute pyelonephritis from medical records. In our study, 521 patients were included and 492 (94%) of the participants were suffering from pyelonephritis. Approximately 22.8% of the patients showed the absence of both flank pain and costovertebral tenderness but were diagnosed with pyelonephritis based on computed tomography (CT) and magnetic resonance imaging (MRI). Moreover, 27% of the patients reported upper urinary tract symptoms only and were diagnosed by CT or MRI findings. Out of that only 24% and 16% of the patients reported flank pain and costovertebral tenderness, respectively. Insignificant associations with pyelonephritis were found for age, gender and other comorbidities. Our study showed a significant number of patients with pyelonephritis without any upper urinary tract symptoms. Patients with LUTS should be evaluated further by imaging if they belong to the high-risk population.
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Síntomas del Sistema Urinario Inferior , Pielonefritis , Humanos , Dolor en el Flanco/complicaciones , Pielonefritis/diagnóstico , Pielonefritis/diagnóstico por imagen , Síntomas del Sistema Urinario Inferior/diagnóstico , Síntomas del Sistema Urinario Inferior/epidemiología , Síntomas del Sistema Urinario Inferior/etiología , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
5-Fluorouracil (5-FU) is one of the most potent drugs against solid tumors. However, its parenteral administration is associated with systemic toxicity, while its topical application has limited percutaneous absorption. To overcome these limitations, the current study undertakes the formulation of 5-FU as niosomal vesicles that were coated with hyaluronic acid to improve its targeting efficiency for cancer cells. The niosomes were prepared by the thin-film hydration method using cholesterol as physiological lipid and nonionic surfactants (Tween 80 and Span 80) in the ratio of 1:1. The niosomal vesicles were characterized for their size, size distribution, viscosity, surface tension, density, and drug entrapment efficiency. The vesicles were within the particle size range of 337-478 nm with relatively homogeneous particle size distribution (PDI ≤ 0.5). The ζ-potential and drug entrapment efficiency of coated formulations (F2 and F4) were comparatively higher than corresponding noncoated formulations (F1 and F3). The release behavior of 5-FU from niosomal vesicles using a dialysis membrane depicts that initial burst drug release was higher for F1 and F3 due to their smaller particle size in comparison to their coated counterparts. However, the release was more controlled for F4 due to the larger particle size, higher viscosity, and entrapped fraction of the formulation. The permeation of the drug through the rat's skin was comparatively higher in the case of noncoated formulations than their coated counterparts (p ≤ 0.05). This could be attributed to their small particle size and lower surface tension. In the case of coated formulations, the hydrophilic hyaluronic acid hinders the permeation of the drug through the lipid bilayer membrane of the skin. The retention of the drug in the skin was found to be in the range of 20-40%, which is sufficient to achieve optimum drug concentration in the tumorous tissue. Overall, the study successfully designed novel niosomal carrier systems for improved 5-FU delivery after topical application.
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The coronavirus disease-2019 (COVID-19) infection has taken the world by storm within a few months. Evidence has suggested that patients with electrolyte imbalances at baseline may have a longer duration of hospital stay. We aimed to determine the factors associated with hyponatremia on admission in COVID-19 patients and its impact on the length of stay. We conducted a retrospective study including 521 patients who tested positive for COVID-19 and had their electrolytes checked on admission from June 2020 to October 2020. Patients with sodium <135 mmol/l were included in the hyponatremic group and were compared against normonatremic patients. The severity of COVID-19 was found to be more prevalent in the case group as compared to control (38.3% vs 29.2%; 21.1% vs 17.7%). Hyponatremic patients stayed more than 5 days in hospital (56.3% vs 46.5%), and stayed longer in special care (23.4% vs 20.0%) as compared to controls. Hyponatremic patients as compared to control were more likely to have diabetes (47.9% vs 30.0%), hypertension (49.0% vs 38.5%), ischemic heart disease (20.7% vs 15.4%), chronic liver disease (2.7% vs 1.2%), and chronic kidney disease (9.6% vs 3.8%). Upon matching on the age, the adjusted odds of hyponatremia in COVID-19-positive patients were 1.9 times among diabetic patients. Moreover, COVID-19-positive patients suffering from CKD had a higher risk of developing hyponatremia (ORâ =â 2.3, 95% CI: 1.1-5.6). The risk of hyponatremia among COVID-19-positive patients is statistically higher in patients with 1 comorbidity (ORâ =â 1.9, 95%CI: 1.3-3.4). Hyponatremia on admission can be used to forecast the length of hospital stay and the severity of illness in COVID-19 patients.
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COVID-19 , Hiponatremia , Humanos , Hiponatremia/etiología , Estudios Retrospectivos , Tiempo de Internación , Centros de Atención Terciaria , COVID-19/complicaciones , COVID-19/epidemiología , Gravedad del PacienteRESUMEN
Recently, the trend of circular economy innovation (CEI) drive SMEs to initiate more sustainable practices to attain market competitiveness but rare attention has been paid in emerging economies. Hence, this study plans to explore the impacts of CEI on the triple bottom lines (TBL) efficiencies in the light of market competitiveness among the production SMEs in emerging economies. The study complied data by using a survey-based technique in Pakistan, Malaysia, and China. With a sample of 306 for each segment, data were evaluated with PLS-SEM to clarify results. The findings reveal that CEI has positive significant effects on the market competitiveness and TBL efficiencies among the production SMEs in emerging economies. The findings also clarify that market competitiveness mediates the relationship between CEI and the TBL efficiencies. The findings elaborate the theoretical foundations for environmental-based production SMEs to formulate more sustainable strategies in the light of CEI to gain market competitiveness. It also clarifies the understandings of policy makers and environmental regulators by providing a novel precursor to frame the environment-based TBL guidelines for SMEs. It adds to the UN sustainability agenda by elevating the role of CEI as a novel domain among emerging economies grounded on the resource-based view theory.
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Encuestas y Cuestionarios , China , Malasia , PakistánRESUMEN
The coloring behavior of laccaic acid, a natural red dye derived from lac insects, has been investigated in this work for the dyeing of silk and viscose fabrics while being heated in MW radiation. The extract was made in an aqueous and acidic media and then used to color fabrics under microwave treatment for up to 10â min. For developing new shades, eco-friendly green bio-mordants and, in comparison, chemical mordants were employed at given conditions. The obtained results revealed that the aqueous extract after 4â min of radiation exposure produced a high color strength (K/S = 17.132) onto silk and the aqueous extract after 6â min of radiation exposure produced better color strength (K/S = 6.542) onto viscose at selected conditions. The fastness ratings evaluation as per ISO standards demonstrates that bio-anchors have provided good ratings under selected irradiation and dyeing conditions. It is concluded that this environmentally friendly technique has improved the natural coloration process of fabrics as well as addition of green mordants has furnished colorfast shades using lac-derived natural anthraquinone dye.
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Colorantes , Seda , Textiles , AntraquinonasRESUMEN
A hydrothermal technique was employed to synthesize Ni/Mg/Al ternary L.D.H.s modified with montmorillonite (NMA-MMT-LDHs). Many characterization methods, including X-ray diffraction (XRD), scanning electron microscopy (S.E.M.), Fourier transform infrared (FTIR), and Brunauer, Emmett, and Teller (B.E.T.), were used to assess the physiochemical properties of the produced analytes. Congo red and methylene blue were utilized as model dyes to treat textile waste with the synthesized analytes. The batch adsorption model was utilized to conduct the adsorption experiments under varying contact time, adsorbent dosage, and solution pH conditions. A pseudo-second-order kinetics and the Langmuir adsorption model control the adsorption process. The maximum monolayer adsorption capacities of C.R. and M.B. were determined to be 344 and 200 mg/g, respectively. As the quantity of dosage increased from the 0.01-0.04 g, the percent removal efficiency (%) increased from 75 to 87 % for S2-LDH, 84-88 % for S2-MMT, 86-93 % for S3-MMT, and 95-97% for S4-MMT for C.R. dye and 82-85 % for S2-LDH, 83-89 % for S2-MMT, 83-91 % for S3-MMT, and 84-92 % for S4-MMT for M.B. dye. The removal percentage of C.R. dye for adsorbents S2-LDH, S2-MMT, S3-MMT, and S4-MMT were 75 %, 84 %, 86 %, and 95 %, respectively and 82 %, 83 %, 83 %, and 85 %, respectively for the M.B. dye removal. The presence of MMT significantly increases the affinity of Ni/Mg/Al-LDHs (NMA-LDHs), and the designed production technique can be used to produce a variety of compositionally distinct adsorbent materials.
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RATIONALE: Dengue fever is a widespread mosquito-borne viral disease, most prevalent in the tropical and subtropical areas of the world. There has been a significant rise in the incidence and number of outbreaks of dengue in recent years, which has made it a matter of global concern. It may be associated with a number of renal complications, ranging from hematuria, proteinuria, glomerulonephritis, and acute tubular necrosis. However, renal cortical necrosis (RCN) is a rare renal complication of this disease. PATIENTS CONCERNS: We report the case of a young gentleman who presented with fever, vomiting, and anuria. On workup, he was found to be having complicated Dengue fever with RCN resulting in acute renal failure. DIAGNOSIS: To the best of our knowledge, RCN is not a reported renal complication of dengue fever. INTERVENTIONS AND OUTCOMES: Our report highlights the importance of early consideration of renal cortical necrosis in patients with dengue fever and persistent anuria. LESSON: This would allow for better disease prognostication while enabling physicians to develop more effective treatment strategies.
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Anuria , Dengue , Necrosis de la Corteza Renal , Masculino , Humanos , Necrosis de la Corteza Renal/etiología , Anuria/complicaciones , Resultado del Tratamiento , Hematuria , Dengue/complicaciones , Dengue/diagnósticoRESUMEN
EDSS1, a syndrome characterized by ectodermal dysplasia-syndactyly, is inherited in an autosomal recessive manner due to mutations in the NECTIN4/PVRL4 gene. Clinical manifestations of the syndrome include defective nail plate, sparse to absent scalp and body hair, spaced teeth with enamel hypoplasia, and bilateral cutaneous syndactyly in the fingers and toes. Here, we report a consanguineous family of Kashmiri origin presenting features of EDSS1. Using whole exome sequencing, we found a recurrent nonsense mutation (NM_030916: c.181C > T, p.(Gln61 ∗)) in the NECTIN4 gene. The variant segregated perfectly with the disorder within the family. The candidate variant was absent in 50 in-house exomes pertaining to other disorders from the same population. In addition to the previously reported clinical phenotype, an upper lip cleft was found in one of the affected members as a novel phenotype that is not reported by previous studies in EDSS1 patients. Therefore, the study presented here, which was conducted on the Kashmiri population, is the first to document a NECTIN4 mutation associated with the upper lip cleft as a novel phenotype. This finding broadens the molecular and phenotypic spectrum of EDSS1.
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Labio Leporino , Displasia Ectodérmica , Anomalías Maxilomandibulares , Nectinas , Sindactilia , Humanos , Alopecia/complicaciones , Moléculas de Adhesión Celular/genética , Labio Leporino/genética , Labio Leporino/complicaciones , Codón sin Sentido/genética , Consanguinidad , Displasia Ectodérmica/genética , Displasia Ectodérmica/complicaciones , Anomalías Maxilomandibulares/complicaciones , Mutación , Nectinas/genética , Linaje , Fenotipo , Sindactilia/genética , Sindactilia/complicaciones , SíndromeRESUMEN
Employees' green creativity is the basic input to organizational innovation capabilities, the prime focus of practitioners to stay competitive, and a mean to solve the society's sustainable issues in dynamic markets. Hence, this study aims to evaluate the nexus between authentic leadership, psychological environment, and employees' green creativity based on the theoretical lenses of social identity and social exchange theories that have rare application in these domains. Data were collected through questionnaires from 367 operational staff members of different technical training centers of renewable energy projects in Rawalpindi and Islamabad regions at Pakistan. The findings reveal that authentic leadership is a significant precursor of employee's green creativity and self-efficacy. In addition, self-efficacy mediates while the environment of trust and safety has non-mediating role in the relationship between authentic leadership and employee's green creativity. This work brings attention to the initiatives in technical training centers for renewable energy projects and contributes to the field of employees' green creativity in the context of authentic leadership and psychological environment based on the philosophy of social identity and social exchange theories.
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Creatividad , Liderazgo , Humanos , Encuestas y Cuestionarios , PakistánRESUMEN
A basic urea technique was successfully used to synthesize Mg/Al-Layered double hydroxides (Mg/Al LDHs), which were then calcined at 400 °C to form Mg/Al-Layered double oxides (Mg/Al LDOs). To reconstruct LDHs, Mg/Al LDOs were fabricated with different feeding ratios of Ni by the co-precipitation method. After synthesis, the Ni/Mg/Al-layered double hydroxides (NMA-LDHs) with 20% and 30% Ni (S1 and S2) were roasted at 400 °C and transformed into corresponding Ni/Mg/Al-layered double oxides (NMA-LDOs) (S1a and S2b, respectively). The physiochemical properties of synthesized samples were also evaluated by various characterization techniques, such as X-ray diffraction (XRD), Scanning electron microscopy (SEM), Energy dispersive X-ray spectroscopy (EDS), Fourier transform infrared (FTIR), and Brunauer, Emmett, and Teller (BET). The adsorption behavior of methyl orange (MO) onto the synthesized samples was evaluated in batch adsorption mode under varying conditions of contact time, adsorbent quantity, and solution pH. As the dosage amount increased from 0.01-0.04 g, the removal percentage of MO dye also increased from 83% to 90% for S1, 84% to 92% for S1a, 77% to 87% for S2, and 93% to 98% for S2b, respectively. For all of the samples, the adsorption kinetics were well described by the pseudo-second-order kinetic model. The equilibrium adsorption data were well fitted to both Langmuir and Freundlich models for methyl orange (MO). Finally, three adsorption-desorption cycles show that NMA-LDHs and NMA-LDOs have greater adsorption and reusability performance for MO dye, signifying that the design and fabrication strategy can facilitate the application of the natural hydrotalcite material in water remediation.
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The coronavirus disease 2019 (Covid-19) has created emerging mental health challenges around the world. Like other countries, Pakistan is also confronted with covid-19 calamities. The aim of the study is to examine the impacts of workplace measures (WM) on the job performance (JP) and covid-19 fears (CF) along with the moderating role of academic competence (AC) based on the organizational support theory (OST) and job demand and resources (JDR) theory. A quantitative approach was applied to collect data from 333 banking employees in Gujranwala (Pakistan), and the hypothesis were tested via structural equation modeling using SPSS and AMOS. The study findings indicate that workplace measures significantly affect covid-19 fears except for individual preventive measures (IPM). Similarly, workplace measures significantly impact on job performance apart from information about the pandemic (IAP). Moreover, academic competence insignificantly moderates between workplace measures and covid-19 fears, but a significant moderation is found between information about pandemic (IAP) and covid-19 fears. Meanwhile, academic competence significantly moderates between workplace measures and job performance instead of a relationship between information about pandemic and job performance. However, this study was limited only to the banking sector of Pakistan. So, it will open the doors for future researchers to investigate other cultural contexts and sectors. This research gives a holistic understanding of workplace measures and contributes to the body of knowledge by enlightening the moderating role of academic competence in the banking sector of Pakistan. These useful insights would enable practitioners and policy makers to develop more efficient strategies and workplace measures to enhance job performance and reduce the fears of covid-19 among employees.
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BACKGROUND: Iron deficiency anemia is a common public health issue among women of reproductive age (WRA) because it can result in adverse maternal and birth outcomes. Although studies are undertaken to assess iron efficacy, some gaps and limitations in the existing literature need to be addressed. To fill the gaps, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the role of iron in reducing anemia among WRA in low-middle-income countries (LMICs). METHODS: A comprehensive search strategy was used to search Medline through PubMed, Embase, and Science Direct for RCTs published between 2000 and 2020. The primary outcome was the mean change in hemoglobin level. We used standardized mean differences and their respective 95% CI to estimate the pooled effect. We used I2 statistics and Egger's test to assess heterogeneity and publication bias, respectively. This review was carried out in accordance with revised guidelines based on the Preferred Reporting Items for Systematic Review and Meta-analysis. RESULTS: The findings showed that iron therapy improved hemoglobin and ferritin levels, though the results varied across studies. An overall pooled effect estimate for the role of iron therapy in improving the hemoglobin levels among WRA was -0.71 (95% CI: -1.27 to -0.14) (p = 0.008). Likewise, the overall pooled effect estimate for the role of iron therapy in improving the ferritin levels among WRA was -0.76 (95% CI: -1.56 to 0.04) (p = 0.04). The heterogeneity (I2) across included studies was found to be statistically significant for studies assessing hemoglobin (Q = 746.93, I2 = 97.59%, p = 0.000) and ferritin level (Q = 659.95, I2 = 97.88%, p = 0.000). CONCLUSION: Iron therapy in any form may reduce anemia's burden and improve hemoglobin and ferritin levels, indicating improvement in iron-deficiency anemia. More evidence is required, however, to assess the morbidity associated with iron consumption, such as side effects, work performance, economic outcomes, mental health, and adherence to the intervention, with a particular focus on married but non-pregnant women planning a pregnancy in the near future. TRIAL REGISTRATION: Registered with PROSPERO and ID is CRD42020185033.