Evaluation of non-invasive diagnostic tools for diarrhea: a systematic review of point-of-care tests and biomarkers.

Background: Diarrhea is a prevalent condition affecting millions worldwide. However, current standard diagnostic methods have many drawbacks. This review examines various non-invasive point-of-care (POC) tests and biomarkers aiding rapid diagnosis of diarrhea from different causes. Methods: PubMed, PubMed Central, ScienceDirect, Cochrane Library, and Google Scholar were searched from 2013 to present for relevant literature. Two reviewers independently assessed included studies' quality using the Critical Appraisal Skills Programme (CASP) checklist. Results: The search yielded 1453 studies, of which 39 were included after screening and applying eligibility criteria. Polymerase chain reaction (PCR) was the POC test in 25 studies, providing consistent sensitivity and specificity. For biomarkers, C-reactive protein (CRP), fecal calprotectin, and procalcitonin offered high sensitivity and specificity for conditions like acute pediatric diarrhea, microscopic colitis, and inflammatory diarrhea, respectively. Conclusion: PCR proved the ideal POC test for rapid diarrhea diagnosis, while the procalcitonin biomarker helps differentiate inflammatory from non-inflammatory diarrhea. Other reviewed tools also demonstrated promising diagnostic performance, though improvements in sensitivity, specificity, and usability are still needed.

Volatile-mediated oviposition preference for healthy over root-infested plants by the European corn borer.

The selection of oviposition sites by female moths is crucial in shaping their progeny performance and survival, and consequently in determining insect fitness. Selecting suitable plants that promote the performance of the progeny is referred to as the Preference-Performance hypothesis (or 'mother-knows-best'). While root infestation generally reduces the performance of leaf herbivores, little is known about its impact on female oviposition. We investigated whether maize root infestation by the Western corn rootworm (WCR) affects the oviposition preference and larval performance of the European corn borer (ECB). ECB females used leaf volatiles to select healthy plants over WCR-infested plants. Undecane, a compound absent from the volatile bouquet of healthy plants, was the sole compound to be upregulated upon root infestation and acted as a repellent for first oviposition. ECB larvae yet performed better on plants infested below-ground than on healthy plants, suggesting an example of 'bad motherhood'. The increased ECB performance on WCR-infested plants was mirrored by an increased leaf consumption, and no changes in the plant primary or secondary metabolism were detected. Understanding plant-mediated interactions between above- and below-ground herbivores may help to predict oviposition decisions, and ultimately, to manage pest outbreaks in the field.

Intriguing insight into unanswered questions about Mpox: exploring health policy implications and considerations.

The 2022 multi-country Monkeypox (Mpox) outbreak has added concerns to scientific research. However, unanswered questions about the disease remain. These unanswered questions lie in different aspects, such as transmission, the affected community, clinical presentations, infection and prevention control and treatment and vaccination. It is imperative to address these issues to stop the spread and transmission of disease. We documented unanswered questions with Mpox and offered suggestions that could help put health policy into practice. One of those questions is why gay, bisexual or other men who have sex with men (gbMSM) are the most affected community, underscoring the importance of prioritizing this community regarding treatment, vaccination and post-exposure prophylaxis. In addition, destigmatizing gbMSM and implementing community-based gbMSM consultation and action alongside ethical surveillance can facilitate other preventive measures such as ring vaccination to curb disease transmission and track vaccine efficacy. Relevant to that, vaccine and drug side effects have implied the questionability of their use and stimulated the importance of health policy development regarding expanded access and off-label use, expressing the need for safe drug and vaccine development manufacturing. The possibility of reverse zoonotic has also been raised, thus indicating the requirement to screen not only humans, but also their related animals to understand the real magnitude of reverse zoonosis and its potential risks. Implementing infection prevention and control measures to stop the virus circulation at the human-animal interface that includes One Health approach is essential.

A machine learning based depression screening framework using temporal domain features of the electroencephalography signals.

Depression is a serious mental health disorder affecting millions of individuals worldwide. Timely and precise recognition of depression is vital for appropriate mediation and effective treatment. Electroencephalography (EEG) has surfaced as a promising tool for inspecting the neural correlates of depression and therefore, has the potential to contribute to the diagnosis of depression effectively. This study presents an EEG-based mental depressive disorder detection mechanism using a publicly available EEG dataset called Multi-modal Open Dataset for Mental-disorder Analysis (MODMA). This study uses EEG data acquired from 55 participants using 3 electrodes in the resting-state condition. Twelve temporal domain features are extracted from the EEG data by creating a non-overlapping window of 10 seconds, which is presented to a novel feature selection mechanism. The feature selection algorithm selects the optimum chunk of attributes with the highest discriminative power to classify the mental depressive disorders patients and healthy controls. The selected EEG attributes are classified using three different classification algorithms i.e., Best- First (BF) Tree, k-nearest neighbor (KNN), and AdaBoost. The highest classification accuracy of 96.36% is achieved using BF-Tree using a feature vector length of 12. The proposed mental depressive classification scheme outperforms the existing state-of-the-art depression classification schemes in terms of the number of electrodes used for EEG recording, feature vector length, and the achieved classification accuracy. The proposed framework could be used in psychiatric settings, providing valuable support to psychiatrists.

Ethnobotany for food security and ecological transition: wild food plant gathering and consumption among four cultural groups in Kurram District, NW Pakistan.

BACKGROUND: In traditional food systems, especially those of rural populations around the world, wild food plants remain crucial. These resources need to be urgently documented to lay the foundations for sustainable livelihoods and food security. METHODS: In the present field study, we gathered information about wild food plants and mushrooms consumed by four ethnic groups (Turis, Khushis, Hazaras, and Christians) living in Kurram District, NW Pakistan, by conducting semi-structured interviews and holding group discussions. RESULTS: A total of 57 wild edible plants and mushrooms were reported, with the documented taxa belonging to 50 genera and 34 families. Turis reported the highest number of wild food plants (41), followed by Hazaras (37), Khushis (35), and then Christians, who reported only 11 plants. The most dominant families were Rosaceae, followed by Polygonaceae, Brassicaceae, Fabaceae, Lamiaceae, Moraceae, and Plantaginaceae. The comparative analysis we conducted with the pre-existing Pakistani ethnobotanical studies revealed that 23 wild edible plants have not been previously reported as food items in the area under study, which included Fragaria nubicola, Lepidium draba, Pinus wallichiana, Podophyllum emodi, Prunus jacquemontii, Sambucus nigra, Sideroxylon mascatense, and Thymus linearis. Four wild edible mushrooms are also reported for the area for the first time: Calvatia gigantea, Morchella esculenta, Pisolithus albus, and Tulostoma squamosum. The cross-cultural analysis of wild edible plants and their uses revealed remarkable similarity between Khushis and Hazaras. The overlapping pattern of wild edible plant use among these two groups, as well as Turis, confirms the existence of cross-cultural interactions among these communities, which have shared the same environmental and socio-cultural space for several decades. Food heritage and some unique dishes are linked to wild edible plants in the area, such as Zamda, prepared by Turis, and Saba, famous among Khushis and Hazaras. CONCLUSION: This study suggests that some wild edible plants could be cultivated to protect a few threatened species from overexploitation, while the overall wild food plant heritage should be promoted and revitalized; for example, within educational platforms aimed at improving the wellbeing of local communities and the global ecological transition we must deal with.

Quality of Neonatal Care: A Health Facility Assessment in Balochistan Province, Pakistan.

Introduction Balochistan is the largest of Pakistan's four provinces, yet it is also the poorest and most impoverished, particularly in terms of neonatal healthcare. In order to build and tailor strategies to improve neonatal outcomes, it is necessary to identify barriers and facilitators for interventions. Therefore, we conducted this study to provide an overview of neonatal healthcare quality and assess the structural capacity for the improvement and further development of neonatal healthcare facilities in Balochistan. Methods A descriptive, observational, cross-sectional study was conducted in Balochistan, a province of Pakistan. The survey was designed to assess the level of staffing and facilities in the neonatal health care units. Data were gathered through trained staff either by in-person visits to the facility or via telephone. Results A total of 177 facilities were assessed in 25 districts of Balochistan. A majority (88.7%) of the facilities were from the public sector. Birth and neonatal care services were provided at only 63 (36%) of the assessed facilities and only three had newborn intensive care units (NICUs) with a 1:5 staff: patient ratio. Unfortunately, all NICUs lacked the basic advanced facilities. None of the hospitals had an infection control policy or staff nor any training program for doctors. Conclusion In conclusion, healthcare facilities to manage neonatal patients requiring hospital care are extremely limited in Balochistan and the ones that are available have very limited resources. To improve the healthcare system in Balochistan, all stakeholders should be involved in the planning, decision-making, and implementation of healthcare programs at all levels to ensure sustainability and efficiency.

Quantifying Temperature and Osmotic Stress Impact on Seed Germination Rate and Seedling Growth of Eruca sativa Mill. via Hydrothermal Time Model.

Germination models are quite helpful in predicting emergence times, dormancy periods, and their applications in crop management. This study investigated the germination behaviors of Eruca sativa Mill. in response to fluctuations in temperatures (Ts) and water potentials (ψs). Germination percentage (GP) increased 95% with rising temperature within the range of 20-30 °C, and decreased 25% at 5 °C. Moreover, each ψ and T resulted in a decrease in GP as ψ decreased. Further, we noted that the θT1 value was substantially high at 30 °C and in (0 MPa), whereas the θT2 value was maximum at 10 °C (-0.02 MPa) and it decreased with decreasing Ψ. The maximum hydrothermal time constant (θHTT) and hydrotime (θH) values were obtained at 10 and 30 °C, respectively. In addition, a linear increase in the GR(g) pattern was observed at Tb and a decrease below the To. The calculated cardinal Ts was 5 °C for the base T, and 30 °C for both the optimum and ceiling T. The germination characteristics were higher at 30 °C having (0 MPa). Therefore, using cardinal temperatures, germination results, and the hydrothermal time model (HTT) could reveal the independent and interactive impacts of both T and the Ψ on the response of seed germination subjected to diverse environmental conditions.

Accuracy of Spontaneous Breathing Trial Using ET-CPAP in Predicting Successful Extubation of Neonates.

OBJECTIVE: Extubation failure is common in mechanically ventilated neonates. Finding objective criteria for predicting successful extubation may help to reduce the incidence of failure and the length of mechanical ventilation (MV). We conducted this study to determine the accuracy of the spontaneous breathing trial (SBT) and lung function measurements in predicting successful extubation in neonates. METHODOLOGY: This cross-sectional validation study was conducted at a tertiary care neonatal intensive care unit (NICU) over 12 months from December 2019 to December 2020. Neonates intubated for >24 hours and considered ready for extubation were enrolled in the study. Neonates who met defined eligibility criteria underwent a three minutes SBT using endotracheal continuous positive airway pressure (ET-CPAP) before extubation. The primary clinical team was blinded to the results, and all neonates were extubated after SBT. Extubation was considered successful if patients remained extubated for 48 hours. RESULTS: Among the 107 infants, 77.5% (n=83) of infants passed the SBT. Of these, 78 were successfully extubated, giving the positive predictive value of 93.97%. The overall extubation success rate was 90% (n=96). The sensitivity and specificity of SBT were 81.2% and 54.5%, respectively. VE (ET-CPAP) and VE-ventilator at a cutoff of ≥238 ml and ≥143.7 ml have an area under the curve (AUC) of 0.77 and 0.75 respectively to predict successful extubation (p-value 0.003, 0.008 respectively). CONCLUSION: SBT predicts extubation success with pronounced accuracy. Therefore, we propose SBT as a valuable and crucial step that guides clinicians' decision-making regarding extubation preparedness or impending failure in neonates.

A Case of Early Diagnosis of Turner Syndrome in a Neonate.

Turner syndrome (TS), or Bonnevie-Ullrich syndrome, also known as congenital ovarian hypoplasia syndrome, is the most common sex chromosome abnormality in females in approximately 1 in 2000 live birth. It occurs when the X chromosome is partially or completely missing in females caused by monosomy or structural abnormalities of the X chromosome. It is mainly diagnosed in late childhood or adolescent age and rarely identified during the neonatal period. It is characterized by short stature, webbed neck, lymphedema of extremities, widely spaced-out nipples, and cubital valgus. Early diagnosis of TS allows for appropriate and timely initiation of therapy with comprehensive care. We report a case of a neonate presented with the complaint of edema of feet since birth and syndromic features. TS was diagnosed by the chromosomal analysis, which demonstrated a gene karyotype of 46.X,i(X)(q10){20}.

Risk Perception and Willingness to Work Among Doctors and Medical Students of Karachi, Pakistan During the COVID-19 Pandemic: A Web-Based Cross-Sectional Survey.

PURPOSE: During the timeline of twenty years, several epidemics and pandemics have occurred. Yet, a consistent feature of these public health crises is the surge in the demand for healthcare services exceeds the availability. MATERIALS AND METHODS: A cross-sectional web-based survey was conducted in the month of June and July 2020 in Karachi, Pakistan. The study participants included doctors and medical students residing in Karachi. RESULTS: Out of 187 doctors, 74.3% were working during the COVID-19 pandemic, of which 58.3% were willing to work. Out of 200 medical students, 93.5% were not volunteering during the COVID-19 pandemic, of which 46% were willing to volunteer. Doctors strongly agreed that they would be willing to work during the COVID-19 pandemic if they were healthy and able to do so (57.2%), if they were provided personal protective equipment (PPE) (51.3%), and if they were guaranteed coverage of treatment cost if they get infected while working (57.8%). Medical students strongly agreed that they would be willing to volunteer during the COVID-19 pandemic if they were provided PPE (49.0%), and if their parents were supportive of their decision to volunteer (44.5%). Most doctors (54.5%) felt that they were extremely likely to get infected while working during the COVID-19 pandemic and 59.4% felt that in turn, they were extremely likely to infect their families as well. Most medical students (40.5%) felt that they were somewhat likely to get infected while volunteering during the COVID-19 pandemic and 55.5% felt that in turn, they were extremely likely to infect their family as well. In the event of infection with COVID-19, 51.3% doctors and 42.0% medical students felt that they would recover without hospitalization. CONCLUSION: Since future pandemics are likely, we encourage health-care policymakers to utilize the findings of this study to create a sustainable pandemic response.

Overcoming Tribal Boundaries: The Biocultural Heritage of Foraging and Cooking Wild Vegetables among Four Pathan Groups in the Gadoon Valley, NW Pakistan.

The foraging and consumption of wild food plants is a long-standing tradition in many parts of the world and their importance in promoting food security has become more widely debated in recent years. The current study aimed to document, analyze, and interpret the traditional knowledge of non-cultivated vegetables among four Pathan tribes (Alisher Khel, Hadarzai, Haji Khel, and Umarzai) living in the Gadoon Valley, Swabi District, Khyber Pakhtunkhwa, NW Pakistan, and to evaluate how these practices vary among the considered tribal communities. A total of 104 informants were interviewed via a semi-structured, open-ended questionnaire and group discussions. The field survey was conducted from October 2018 to November 2020. Information about local names, growth habit, used plant parts, food/cooking details, medicinal perceptions, availability season, and market prices were collected. The field survey recorded 51 non-cultivated vegetables belonging to 24 botanical families, for which the frequently used plant parts included young leaves, stems, and flowers. The greatest number of use reports was recorded for Colocasia and the highest cultural index value was recorded for Rumex dentatus; the dominant botanical families were Asteraceae and Fabaceae (six species each). Seven species were found to be sold at local and regional markets. Cross-cultural analysis among the four considered tribes showed that the largest number of species was reported by members of the Hadarzai and Umarzai tribes, although most of the quoted wild vegetables were homogenously gathered among all considered communities, with some more idiosyncratic plant uses among the Umarzai group, who have likely been less affected by the erosion of traditional knowledge or possibly have had less access to traded cultivated vegetables. The novelty of the data was assessed by comparing it with the previously published wild food ethnobotanical literature of Pakistan, which showed fifteen new wild vegetables not yet reported in the NW of the country. The recorded food biocultural heritage should be seriously considered in future local development projects aimed at fostering environmental sustainability and food security.

Quantitative Ethnobotanical Study of Indigenous Knowledge on Medicinal Plants Used by the Tribal Communities of Gokand Valley, District Buner, Khyber Pakhtunkhwa, Pakistan.

The current study on the traditional use of medicinal plants was carried out from February 2018 to March 2020, in Gokand Valley, District Buner, Pakistan. The goal was to collect, interpret, and evaluate data on the application of medicinal plants. Along with comprehensive notes on individual plants species, we calculated Use Value (UV), Relative Frequency of Citation (RFC), Use Report (UR), Fidelity Level (FL), Informant Consensus Factor (FCI), as well as Family Importance Value (FIV). During the current study, a total of 109 species belonging to 64 families were reported to be used in the treatment of various ailments. It included three families (four species) of Pteridophytes, 58 families (99 species) of angiosperm, one family (three species) of Gymnosperms, and two families (three species) of fungi. The article highlights the significance of domestic consumption of plant resources to treat human ailments. The UV varied from 0.2 (Acorus calamus L.) to 0.89 (Acacia modesta Wall.). The RFC ranged from 0.059 (Acorus calamus L. and Convolvulus arvensis L.) to 0.285 (Acacia modesta Wall.). The species with 100% FL were Acacia modesta Wall. and the fungus Morchella esculenta Fr., while the FCI was documented from 0 to 0.45 for gastro-intestinal disorders. The conservation ranks of the medicinal plant species revealed that 28 plant species were vulnerable, followed by rare (25 spp.), infrequent (17 spp.), dominant (16 spp.), and 10 species endangered. The traditional use of plants needs conservation strategies and further investigation for better utilization of natural resources.

Awake Proning: A Necessary Evil During the COVID-19 Pandemic.

The spread of COVID-19 has been exponential throughout the globe. Though only a small percentage of infected individuals reach the critical stage of the disease, i.e., acute respiratory distress syndrome (ARDS), this percentage represents a significant number of patients that can overwhelm the healthcare system. Patients presenting with ARDS need mechanical ventilation, as their lungs are unable to oxygenate blood on their own due to fluid accumulation. One way to manage this excess pressure of fluid build-up around the lung tissues is to relieve the dorsal alveoli by prompting the patient to lie face down on the stomach; this is called awake proning. It is a procedure that is directed towards the recruitment of lung parenchyma when infected with pneumonia or when the condition has worsened into ARDS. This helps in relieving the pressure from the dorsal lung surface that has markedly higher perfusion than the ventral surface. Awake proning delays the use of mechanical ventilation and facilitates the patients with severe ARDS or severe pneumonia in maintaining the supply of oxygen to the body tissues. Since medical institutes are overburdened and limited ventilators are available, awake proning can reduce not only the burden on hospitals but also decrease the need for ventilators.

Strategies for Rational Use of Personal Protective Equipment (PPE) Among Healthcare Providers During the COVID-19 Crisis.

As the coronavirus 2019 (COVID-19) began spreading globally with no clear treatment in sight, prevention became a major part of controlling the disease and its effects. COVID-19 spreads from the aerosols of an infected individual whether they are showing any symptoms or not. Therefore, it becomes nearly impossible to point exactly where the patient is. This is where personal protective equipment (PPE) comes in. These are masks, respirators, gloves, and in hospitals where the contact with the infected and confirmed patient is direct, also gowns or body covers. The PPEs play a major role in the prevention and control of the COVID-19. The PPE is able to prevent any invasion of the virus particles into the system of an individual which is why it is an essential item to have for healthcare workers. Due to the high demand for PPEs all around the world, it is important to optimize the use of protective gear and ration the supplies so that the demand are met. However, there are guidelines recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to maintain the supply in the wake of this increased demand of PPE, how the manufacturers should track their supplies, and how the recipients should manage them. Various strategies can be used to increase the re-use of PPEs during the COVID-19 pandemic that has modified the donning and doffing procedure.