Effectiveness of Oral Azithromycin in Treating Enteric Fever: A Hospital-Based Study on Pediatric Patients.

Introduction Enteric fever is prevalent in underdeveloped and developing countries. It is caused by Salmonella Typhi, which has developed resistance over the years to commonly used antimicrobials. Meropenem is an effective treatment for all complicated and uncomplicated extensively drug-resistant (XDR) bacteria, but it is administered intravenously, three times daily, by infusion, and it is quite expensive for the patient. Oral azithromycin is shown by some authors to be effective in extensively drug-resistant enteric fever. Material and methods This retrospective cross-sectional study was conducted in the outpatient department of Lady Reading Hospital Medical Teaching Institution, Peshawar. The duration of the study was one year. Data was collected after approval from the hospital's Ethical and Research Committee. All pediatric patients meeting the inclusion criteria for extensively drug-resistant enteric fever were included. Data on patient demographics, blood culture and laboratory results, treatment given, and effectiveness were documented in a specialized proforma. Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY, US) was used for data analysis. Results Out of the total 106 patients, 72 (67.9%) were male and 34 (32.1%) were female. The mean age was 7.51 ± 2.75 years, with a range of 1 to 15 years. Among them, 66 (62.3%) had anemia (hemoglobin less than 11 grams per deciliter for under 5 years and 11.5 for 5-15 years old children), with a mean hemoglobin level of 10.6 ± 1.53 grams per deciliter (g/dl), ranging from 7.2 to 13.8 g/dl. Thrombocytopenia was found in 14 (13%) patients. The mean platelet count was 317 x 103 ± 164 cells per microliter, with a range of 61 x 103 to 834 x 103 cells per liter. The mean total leukocyte count was 9.71x 103 ± 4.321 cells per microliter, with a range of 2.01 x 103 to 30.40 x103 cells per microliter. However, leucopenia was seen in only 5 (4.7%) patients. In 98.1% of cases, azithromycin was found to be effective in treating enteric fever caused by extensively drug-resistant Salmonella. Conclusion Azithromycin is effective in treating extensively drug-resistant enteric fever. It can be confidently used in patients with no or mild complications with extensively drug-resistant enteric fever. Good compliance and complete dosage should be followed to avoid resistance to this drug. Blood cultures should always be sent when prescribing antibiotics, especially when suspecting enteric fever.

Effects of betaine supplementation on dry matter intake, milk characteristics, plasma non-esterified fatty acids, and ß-hydroxybutyric acid in dairy cattle: a meta-analysis.

Betaine supplementation in dairy cattle has gained attention due to its potential benefits to production and health as a methyl donor, which can play a crucial role in the metabolism of dairy cows. The objective of the current meta-analysis was to quantify the effects of betaine supplementation on milk production, composition, ß-hydroxybutyric acid (BHBA), and non-esterified fatty acids (NEFA). A systematic literature search was carried out, all relevant studies were retrieved, and the meta-analysis was carried out. The mean difference (MD) for dry matter intake (DMI) using the random-effects model was 0.499 kg/d (P < 0.0001). The subgroup analysis indicated that supplementing betaine in heat-stressed cows increased DMI by 0.584 kg/d (P < 0.001), while in cows not exposed to heat stress, DMI was increased by 0.381 kg/d (P = 0.007). The energy-corrected milk (ECM) increased by 1.36 kg/d (P < 0.0001). The milk fat yield was significantly increased in betaine-supplemented cows (MD = 0.040 kg/d, 95% CI = 0.015 to 0.065). The milk protein yield (kg/d) (MD = 0.014, P = 0.138) was increased (MD = 0.035, P = 0.0005) by betaine supplementation. The lactose yield (kg/d) was also significantly higher (MD = 0.055, P = 0.020) in betaine-supplemented cows. The standardized mean difference (SMD) for NEFA (SMD = - 0.447, 95% CI = - 1.029 to 0.135, P = 0.114) and BHBA (SMD = - 0.130, 95% CI = - 0.491 to 0.234). In conclusion, the findings from this meta-analysis suggest that betaine supplementation positively influences DMI, ECM, milk fat yield, milk lactose yield, and milk protein yield. Subgroup analysis further indicated that the positive effects on DMI are greater in heat-stressed cows compared to those not exposed to heat stress. The analysis did not find significant effects on the levels of NEFA or BHBA, suggesting that betaine supplementation may not directly influence these metabolic parameters.

The aim of this meta-analysis was to examine the effects of dietary betaine supplementation on dairy cows' dry matter intake, milk production, milk composition, non-esterified fatty acids, and ß-hydroxybutyric acid. The results indicated that the supplementation of betaine increased dry matter intake (+0.584 kg/d/cow), energy-corrected milk (+1.36 kg/d), milk fat yield (+ 0.040 kg/d), milk protein yield (+ 0.014 kg/d), and lactose yield (+ 0.055 kg/d). ß-Hydroxybutyric acid and plasma non-esterified fatty acids were not influenced by betaine supplementation in dairy cattle.

Using decapsulated local brine shrimp cysts on feeding common carp larvae in hatcheries.

The current study aims at using non-hatchable artemia eggs of local origin and making use of these eggs by decapsulating and presenting them as food for the larvae of the Cyprinus carpio as a source of animal protein with high nutritional value instead of throwing them away. The results showed that the second parameter (A2) was highly significant at the level (P≤0.05) in the growth rates of the larvae that were fed on decapsulated artemia eggs alone, and it was better than the two control parameters (A1), in which the larvae were fed with feed designated for Cyprinus carpio fish. It also outperformed the third parameter (A3), in which the feed was mixed with artemia eggs with 50% decapsulation, which also outperformed the control parameter with high significance at the same level (P≤0.05).

Phytochemical Analysis of Centaurea calcitrapa L. Aerial Flowering Parts Serial Solvent Extracts and Its Antibacterial and Antioxidant Activities.

To evaluate the phytochemical composition, antibacterial, and antioxidant activity of successive extracts of Centaurea calcitrapa L. (C. calcitrapa) aerial flowering parts, they were assessed in vitro. Using a spectrophotometer, the sample absorbance at 517 nm was used to quantify the scavenging activity. The negative control was DPPH. In the current study, the diffusion using agar wells technique was adapted to measure antimicrobial activity. Phytochemical analysis was performed using the recommended standard procedures. The methanol extract of C. calcitrapa exhibited high levels of total phenolic acids expressed as gallic acid (GA), measured as (97.25 ± 0.73 mg GAE/g) content compared to the chloroform, acetyl acetate, and aqueous extracts (27.42 ± 0.29, 64.25 ± 0.96, and 17.25 ± 0.73 mg GAE/g), respectively. Additionally, the methanol extract had a higher total tannin (27.52 ± 0.53 mg TAE/g) content compared to the chloroform, ethyl acetate, and aqueous extracts (12.02 ± 0.55, 26.01 ± 0.81, and 7.35 ± 0.56 mg TAE/g), respectively, while the aqueous extract contains a lower percentage of flavonoids (141.10 ± 1.31 mg RTE/g) compared to the higher content achieved by the methanol extract (425.93 ± 1.27 mg RTE/g). The hydroxyl groups of the flavonoid and the phenolic compounds found in C. calcitrapa are essentially scavenging free radicals. Radical scavenging activity was highest in the methanol extract (IC50 = 2.82 µg/mL), aqueous extract (IC50 = 8.03 µg/mL), ethyl acetate extract (IC50 = 4.79 µg/mL), and chloroform extract (IC50 = 6.33 µg/mL), as compared to the standard scavenging activity (IC50 = 2.52 µg/mL). The antibacterial properties of C. calcitrapa against Gram-negative bacterial strains Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, and Acinetobacter baumanii, in addition to Gram-positive strains Staphylococcus haemolyticus, Enterococcus faecalis, and Staphylococcus aureus, revealed inhibition zone diameter. The findings of this investigation establish that the aerial flowering parts of C. calcitrapa have substantial antibacterial action against human infections, and the plant can serve as a significant antioxidant that can be employed to prevent and treat severe degenerative diseases brought on by oxidative stress. qPCR showed that C. calcitrapa extracts elevate both SOD1 and SOD2 (cellular oxidation markers) with remarkable folds (1.8-fold for SOD1 and SOD2) with ethyl acetate plant extract against ascorbic acid as a control. This result reflects that C. calcitrapa extracts have remarkable antioxidant activity.

Engaging Mood Brain Circuits with Psilocybin (EMBRACE): a study protocol for a randomized, placebo-controlled and delayed-start, neuroimaging trial in depression.

BACKGROUND: Major depressive disorder (MDD) is a leading cause of disability worldwide across domains of health and cognition, affecting overall quality of life. Approximately one third of individuals with depression do not fully respond to treatments (e.g., conventional antidepressants, psychotherapy) and alternative strategies are needed. Recent early phase trials suggest psilocybin may be a safe and efficacious intervention with rapid-acting antidepressant properties. Psilocybin is thought to exert therapeutic benefits by altering brain network connectivity and inducing neuroplastic changes that endure for weeks post-treatment. Although early clinical results are encouraging, psilocybin's acute neurobiological effects on neuroplasticity have not been fully investigated. We aim to examine for the first time how psilocybin acutely (intraday) and subacutely (weeks) alters functional brain networks implicated in depression. METHODS: Fifty participants diagnosed with MDD or persistent depressive disorder (PDD) will be recruited from a tertiary mood disorders clinic and undergo 1:1 randomization into either an experimental or control arm. Participants will be given either 25 mg psilocybin or 25 mg microcrystalline cellulose (MCC) placebo for the first treatment. Three weeks later, those in the control arm will transition to receiving 25 mg psilocybin. We will investigate whether treatments are associated with changes in arterial spin labelling and blood oxygenation level-dependent contrast neuroimaging assessments at acute and subacute timepoints. Primary outcomes include testing whether psilocybin demonstrates acute changes in (1) cerebral blood flow and (2) functional brain activity in networks associated with mood regulation and depression when compared to placebo, along with changes in MADRS score over time compared to placebo. Secondary outcomes include changes across complementary clinical psychiatric, cognitive, and functional scales from baseline to final follow-up. Serum peripheral neurotrophic and inflammatory biomarkers will be collected at baseline and follow-up to examine relationships with clinical response, and neuroimaging measures. DISCUSSION: This study will investigate the acute and additive subacute neuroplastic effects of psilocybin on brain networks affected by depression using advanced serial neuroimaging methods. Results will improve our understanding of psilocybin's antidepressant mechanisms versus placebo response and whether biological measures of brain function can provide early predictors of treatment response. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06072898. Registered on 6 October 2023.

Molecular epidemiology of recurrent zoonotic transmission of mpox virus in West Africa.

Nigeria and Cameroon reported their first mpox cases in over three decades in 2017 and 2018 respectively. The outbreak in Nigeria is recognised as an ongoing human epidemic. However, owing to sparse surveillance and genomic data, it is not known whether the increase in cases in Cameroon is driven by zoonotic or sustained human transmission. Notably, the frequency of zoonotic transmission remains unknown in both Cameroon and Nigeria. To address these uncertainties, we investigated the zoonotic transmission dynamics of the mpox virus (MPXV) in Cameroon and Nigeria, with a particular focus on the border regions. We show that in these regions mpox cases are still driven by zoonotic transmission of a newly identified Clade IIb.1. We identify two distinct zoonotic lineages that circulate across the Nigeria-Cameroon border, with evidence of recent and historic cross border dissemination. Our findings support that the complex cross-border forest ecosystems likely hosts shared animal populations that drive cross-border viral spread, which is likely where extant Clade IIb originated. We identify that the closest zoonotic outgroup to the human epidemic circulated in southern Nigeria in October 2013. We also show that the zoonotic precursor lineage circulated in an animal population in southern Nigeria for more than 45 years. This supports findings that southern Nigeria was the origin of the human epidemic. Our study highlights the ongoing MPXV zoonotic transmission in Cameroon and Nigeria, underscoring the continuous risk of MPXV (re)emergence.

Genomic epidemiology uncovers the timing and origin of the emergence of mpox in humans.

Five years before the 2022-2023 global mpox outbreak Nigeria reported its first cases in nearly 40 years, with the ongoing epidemic since driven by sustained human-to-human transmission. However, limited genomic data has left questions about the timing and origin of the mpox virus' (MPXV) emergence. Here we generated 112 MPXV genomes from Nigeria from 2021-2023. We identify the closest zoonotic outgroup to the human epidemic in southern Nigeria, and estimate that the lineage transmitting from human-to-human emerged around July 2014, circulating cryptically until detected in September 2017. The epidemic originated in Southern Nigeria, particularly Rivers State, which also acted as a persistent and dominant source of viral dissemination to other states. We show that APOBEC3 activity increased MPXV's evolutionary rate twenty-fold during human-to-human transmission. We also show how Delphy, a tool for near-real-time Bayesian phylogenetics, can aid rapid outbreak analytics. Our study sheds light on MPXV's establishment in West Africa before the 2022-2023 global outbreak and highlights the need for improved pathogen surveillance and response.

Spinal cord metrics derived from diffusion MRI: improvement in prognostication in cervical spondylotic myelopathy compared with conventional MRI.

OBJECTIVE: A major shortcoming in optimizing care for patients with cervical spondylotic myelopathy (CSM) is the lack of robust quantitative imaging tools offered by conventional MRI. Advanced MRI modalities, such as diffusion MRI (dMRI), including diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI), may help address this limitation by providing granular evaluations of spinal cord microstructure. METHODS: Forty-seven patients with CSM underwent comprehensive clinical assessments and dMRI, followed by DTI and DBSI modeling. Conventional MRI metrics included 10 total qualitative and quantitative assessments of spinal cord compression in both the sagittal and axial planes. The dMRI metrics included 12 unique measures including anisotropic tensors, reflecting axonal diffusion, and isotropic tensors, describing extraaxonal diffusion. The primary outcome was the modified Japanese Orthopaedic Association (mJOA) score measured at 2 years postoperatively. Extreme gradient boosting-supervised classification algorithms were used to classify patients into disease groups and to prognosticate surgical outcomes at 2-year follow-up. RESULTS: Forty-seven patients with CSM, including 24 (51%) with a mild mJOA score, 12 (26%) with a moderate mJOA score, and 11 (23%) with a severe mJOA score, as well as 21 control subjects were included. In the classification task, the traditional MRI metrics correctly assigned patients to healthy control versus mild CSM versus moderate/severe CSM cohorts, with an accuracy of 0.647 (95% CI 0.64-0.65). In comparison, the DTI model performed with an accuracy of 0.52 (95% CI 0.51-0.52) and the DBSI model's accuracy was 0.81 (95% CI 0.808-0.814). In the prognostication task, the traditional MRI metrics correctly predicted patients with CSM who improved at 2-year follow-up on the basis of change in mJOA, with an accuracy of 0.58 (95% CI 0.57-0.58). In comparison, the DTI model performed with an accuracy of 0.62 (95% CI 0.61-0.62) and the DBSI model had an accuracy of 0.72 (95% CI 0.718-0.73). CONCLUSIONS: Conventional MRI is a powerful tool to assess structural abnormality in CSM but is inherently limited in its ability to characterize spinal cord tissue injury. The results of this study demonstrate that advanced imaging techniques, namely DBSI-derived metrics from dMRI, provide granular assessments of spinal cord microstructure that can offer better diagnostic and prognostic utility.

Initial Experience With Robotic Liver Resection in the United States.

BACKGROUND: This study's aim was to show the feasibility and safety of robotic liver resection (RLR) even without extensive experience in major laparoscopic liver resection (LLR). METHODS: A single center, retrospective analysis was performed for consecutive liver resections for solid liver tumors from 2014 to 2022. RESULTS: The analysis included 226 liver resections, comprising 127 (56.2%) open surgeries, 28 (12.4%) LLR, and 71 (31.4%) RLR. The rate of RLR increased and that of LLR decreased over time. In a comparison between propensity score matching-selected open liver resection and RLR (41:41), RLR had significantly less blood loss (384 ± 413 vs 649 ± 646 mL, P = .030) and shorter hospital stay (4.4 ± 3.0 vs 6.4 ± 3.7 days, P = .010), as well as comparable operative time (289 ± 123 vs 290 ± 132 mins, P = .954). A comparison between LLR and RLR showed comparable perioperative outcomes, even with more surgeries with higher difficulty score included in RLR (5.2 ± 2.7 vs 4.3 ± 2.5, P = .147). The analysis of the learning curve in RLR demonstrated that blood loss, conversion rate, and complication rate consistently improved over time, with the case number required to achieve the learning curve appearing to be 60 cases. CONCLUSIONS: The findings suggest that RLR is a feasible, safe, and acceptable platform for liver resection, and that the safe implementation and dissemination of RLR can be achieved without solid experience of LLR.

Analysis of attitudes and practices toward gastroesophageal reflux disease among the general population of Pakistan.

Aim: Gastro-esophageal reflux disease (GERD) is a growing health concern. Methods: In this cross-sectional study, participants' knowledge, attitude and practice toward GERD were assessed using a questionnaire. Results: In our study of 411 participants, 92.5% knew about GERD. Correctly identified risk factors were smoking (62.3%), fatty food (84.2%), spicy food (91.2%) and meal timing (80.8%). Identified symptoms were burning sensation (92.2%) and regurgitation (81.0%). 43.6% of participants were unaware of GERD's complications. Only 46.2% would seek medical advice for feeling full after eating, but 85% would for severe symptoms. 88.7 and 86.8% of participants showed willingness to amend diet and lifestyle. Conclusion: General population has knowledge regarding GERD and its risk factors but poor attitude and practices toward the condition.

What is this summary about?: This summary presents the findings of a survey conducted to gauge people's understanding, attitudes and behaviors concerning gastroesophageal reflux disease (GERD). GERD is a condition involving the movement of stomach contents back into the esophagus or mouth, which can lead to the development of symptoms or complications. Common risk factors associated with the emergence of GERD symptoms, such as heartburn and the regurgitation of stomach contents into the oropharynx, include smoking, consumption of fatty and spicy foods and meal timing. While people are aware of these risk factors and the signs of GERD, many do not take proactive steps to seek medical assistance or make lifestyle changes. The goal of this study is to assess people's knowledge, attitudes and practices regarding GERD. What were the results & what do they mean?: In Pakistan, most people have good knowledge of GERD, but there's still a knowledge gap with important public health implications. Greater awareness and education are needed to improve GERD management and health outcomes for those affected. Who is this article for?: The authors of the original article developed this summary to help patients, caregivers, patient advocates, healthcare professionals, policymakers and insurance providers to understand the results of their study.

Diagnostic Accuracy of Non-invasive Tests Versus Arthroscopy in Anterior Cruciate Ligament (ACL) Injuries.

BACKGROUND: The knee joint assessment to detect anterior cruciate ligament (ACL) injury after trauma involves clinical examination and radiography. The gold standard method is doing arthroscopy. We did this study seeking to evaluate the effectiveness of other non-invasive diagnostic methods, including the Anterior Drawer test, Lachman test and magnetic resonance imaging (MRI) in detecting ACL tears after trauma, compared to the reference standard method (the arthroscopy). METHODOLOGY: This descriptive cross-sectional study was conducted in the Orthopaedic Department of the Khyber Teaching Hospital, Peshawar, for six months. A total of 86 participants with knee injuries fulfilling the inclusion criteria were recruited for the study. Mechanism of injury, side of injury and body weight were recorded. The Anterior Drawer test and Lachman test for ACL injury were performed by orthopaedic surgeons with at least five years of post-fellowship experience in orthopaedic surgery. Sensitivities, specificities and accuracy of the clinical tests and MRI were calculated. RESULTS: The statistical analysis revealed that the mean age of participants was 35.73 (SD 12.7) years, with a range from 18 to 55 years. Among the participants, 67 (77.91%) were male and 19 (22.09%) were female. The side of injury was predominantly right in 50 (58.14%) and left in 36 (41.86%) participants. Road traffic accidents (RTAs) were the leading cause of knee injury, accounting for 63.95% (55) of cases, followed by sports injuries at 23.26% (20). Regarding diagnostic accuracy, MRI showed a sensitivity of 98.57%, specificity of 87.50% and diagnostic accuracy of 96.51% in detecting ACL tears. The Lachman test demonstrated a sensitivity of 90%, specificity of 87.5% and diagnostic accuracy of 89.53% compared to arthroscopy. Similarly, the anterior Drawer test exhibited a sensitivity of 88.57%, specificity of 87.50% and diagnostic accuracy of 88.37% against the gold standard of arthroscopy. These findings underscore the effectiveness of these diagnostic modalities in identifying ACL injuries. CONCLUSIONS: All three tests (MRI, Lachman test and anterior Drawer test) can be used for the diagnosis of anterior cruciate ligament injury with optimal results.

Diffusion MRI Metrics Characterize Postoperative Clinical Outcomes After Surgery for Cervical Spondylotic Myelopathy.

BACKGROUND AND OBJECTIVES: Advanced diffusion-weighted MRI (DWI) modeling, such as diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI), may help guide rehabilitation strategies after surgical decompression for cervical spondylotic myelopathy (CSM). Currently, however, postoperative DWI is difficult to interpret, owing to signal distortions from spinal instrumentation. Therefore, we examined the relationship between postoperative DTI/DBSI-extracted from the rostral C3 spinal level-and clinical outcome measures at 2-year follow-up after decompressive surgery for CSM. METHODS: Fifty patients with CSM underwent complete clinical and DWI evaluation-followed by DTI/DBSI analysis-at baseline and 2-year follow-up. Clinical outcomes included the modified Japanese Orthopedic Association score and comprehensive patient-reported outcomes. DTI metrics included apparent diffusion coefficient, fractional anisotropy, axial diffusivity, and radial diffusivity. DBSI metrics evaluated white matter tracts through fractional anisotropy, fiber fraction, axial diffusivity, and radial diffusivity as well as extra-axonal pathology through restricted and nonrestricted fraction. Cross-sectional Spearman's correlations were used to compare postoperative DTI/DBSI metrics with clinical outcomes. RESULTS: Twenty-seven patients with CSM, including 15, 7, and 5 with mild, moderate, and severe disease, respectively, possessed complete baseline and postoperative DWI scans. At 2-year follow-up, there were 10 significant correlations among postoperative DBSI metrics and postoperative clinical outcomes compared with 3 among postoperative DTI metrics. Of the 13 significant correlations, 7 involved the neck disability index (NDI). The strongest relationships were between DBSI axial diffusivity and NDI (r = 0.60, P < .001), DBSI fiber fraction and NDI (rs = -0.58, P < .001), and DBSI restricted fraction and NDI (rs = 0.56, P < .001). The weakest correlation was between DTI apparent diffusion coefficient and NDI (r = 0.35, P = .02). CONCLUSION: Quantitative measures of spinal cord microstructure after surgery correlate with postoperative neurofunctional status, quality of life, and pain/disability at 2 years after decompressive surgery for CSM. In particular, DBSI metrics may serve as meaningful biomarkers for postoperative disease severity for patients with CSM.

Disseminated Sarcocystis miescheriana infection in a finisher pig in Grenada.

Sarcocystis miescheriana infection is an important cause of carcass condemnation during meat inspection. The infection can cause morbidity and mortality in domestic pigs. In this study, an 8-month-old finisher pig was presented to a local abattoir for slaughter. Multiple white nodular lesions affecting the meat were observed, resulting in the condemnation of the carcass. Consequently, half of the carcass was submitted to the necropsy diagnostic laboratory in the School of Veterinary Medicine for further evaluation. Grossly, all superficial and deep muscle groups had severe multifocal macrocysts (3 mm × 2 mm × 1 mm) on the surface and extending deep into the skeletal musculature. Histopathology revealed moderate multifocal granulomatous and eosinophilic myositis with intralesional degenerated and intact parasites. Sample genomic DNA sequence analysis of the 18S RNA gene showed 100% identity to S. miescheriana in the GenBank. This is the first report of S. miescheriana in Grenada, West Indies.

Comparative and Predictive Significance of Serum Leptin Levels in Non-alcoholic Fatty Liver Disease.

Background Non-alcoholic fatty liver disease (NAFLD) has emerged as the single most common chronic non-viral liver disease. The burden of the disease on healthcare-providing services has increased tremendously. Although a liver biopsy is the most authentic laboratory investigation for scoring the disease progression, it is an invasive technique. Researchers are vigorously working to find alternate markers for the scoring purpose. Despite the importance and association of leptin with metabolic syndrome and its related disorders, there have been relatively fewer studies on serum leptin and its association with NAFLD. Objective This study aimed to investigate variations in serum leptin levels between subjects with and without fibrosis in NAFLD and to assess the predictive value of serum leptin levels in NAFLD subjects. Materials and methods The study comprised 130 NAFLD subjects from two tertiary care hospitals in Lahore along with 86 healthy controls that were age, gender, and BMI matched with the subjects. Based on the NAFLD fibrosis score (NFS), the subjects were divided into two sub-groups, subjects with simple steatosis and those with fibrosis. Fasting serum leptin, glucose, and insulin levels were measured using enzyme-linked immunosorbent assay (ELISA). The Kruskal-Wallis test was applied to find differences between the three groups and Fisher's exact test for categorical comparison. To assess the predictive value of serum leptin for steatosis and fibrosis in NAFLD subjects, receiver operation characteristic (ROC) curve analysis was implemented. Results The difference in serum leptin level was statistically highly significant (p-value <0.001), with leptin levels of 10 (17.1) ng/mL among controls, 20.5 (21) ng/mL in simple steatosis, and 21 (28.6) ng/mL in fibrosis. The area under the ROC curve was 0.67 and 0.52 for steatosis and fibrosis, respectively. The cut-off value of 12.2 ng/mL showed 70% sensitivity and 50% specificity for steatosis, while at a threshold of 18 ng/mL, leptin demonstrated 40% sensitivity and specificity for fibrosis. Conclusion In conclusion, this study found that serum leptin levels are higher in NAFLD subjects compared to healthy controls, and it is a good independent predictor for the detection of liver steatosis.

Group decision-making algorithm with sine trigonometric r,s,t-spherical fuzzy aggregation operators and their application.

r, s, t-spherical fuzzy (r, s, t-SPF) sets provide a robust framework for managing uncertainties in decision-making, surpassing other fuzzy sets in their ability to accommodate diverse uncertainties through the incorporation of flexible parameters r, s, and t. Considering these characteristics, this article explores sine trigonometric laws to enhance the applicability and theoretical foundation for r, s, t-SPF setting. Following these laws, several aggregation operators (AOs) are designed for aggregation of the r, s, t-SPF data. Meanwhile, the desired characteristics and relationships of these operators are studied under sine trigonometric functions. Furthermore, we build a group decision-making algorithm for addressing multiple attribute group decision-making (MAGDM) problems using the developed AOs. To exemplify the applicability of the proposed algorithm, we address a practical example regarding laptop selection. Finally, parameter analysis and a comprehensive comparison with existing operators are conducted to uncover the superiority and validity of the presented AOs.

q-Rung orthopair fuzzy 2-tuple linguistic WASPAS algorithm for patients' prioritization based on prioritized Maclaurin symmetric mean aggregation operators.

Due to the fuzziness of the medical field, q-rung orthopair fuzzy 2-tuple linguistic (q-RF2L) set is the privileged way to aid medical professionals in conveying their assessments in the patient prioritization problem. The theme of the present study is to put forward a novel approach centered around the merging of prioritized averaging (PA) and the Maclaurin symmetric mean (MSM) operator within q-RF2L context. According to the prioritization of the professionals and the correlation among the defined criteria, we apply both PA and MSM to assess priority degrees and relationships, respectively. Keeping the pluses of the PA and MSM operators in mind, we introduce two aggregation operators (AOs), namely q-RF2L prioritized Maclaurin symmetric mean and q-RF2L prioritized dual Maclaurin symmetric mean operators. Meanwhile, some essential features and remarks of the proposed AOs are discussed at length. Based on the formulated AOs, we extend the weighted aggregated sum product assessment methodology to cope with q-RF2L decision-making problems. Ultimately, to illustrate the practicality and effectiveness of the stated methodology, a real-world example of patients' prioritization problem is addressed, and an in-depth analysis with prevailing methods is performed.

Subcutaneous Emphysema Complicating the Convalescent Stage of Measles in a Malnourished Indigent Child: A Case Report From North-Western Nigeria.

Measles is a highly infectious, vaccine-preventable viral disease that runs a devastating course in developing countries due to its association with malnutrition and poor immunization coverage. Subcutaneous emphysema (SE) is a rare complication of measles that can be challenging to manage and may portend poor outcomes if untreated. We present a case of a two-year-old unimmunized rural dweller who presented with facial, neck, and chest swellings three days after being managed for measles exanthem from a referral hospital. Clinical findings were consistent with massive SE comorbid with malnutrition complicating the convalescent stage of measles. The child failed to improve with conservative management but responded to closed thoracostomy tube drainage (CTTD) through an underwater seal bottle with intermittent negative pressure wound therapy (NPWT). The child spent 47 days in the hospital during which the social welfare unit of the hospital supported the treatment. SE is a rare complication of measles infection that can be challenging to manage, especially when comorbid with malnutrition in an indigent child. The application of a multidisciplinary team approach and the use of CTTD with NPWT may shorten the duration of hospital stay for the patient.

An integrated group decision-making method under q-rung orthopair fuzzy 2-tuple linguistic context with partial weight information.

Considering the advantages of q-rung orthopair fuzzy 2-tuple linguistic set (q-RFLS), which includes both linguistic and numeric data to describe evaluations, this article aims to design a new decision-making methodology by integrating Vlsekriterijumska Optimizacija I Kompromisno Resenje (VIKOR) and qualitative flexible (QUALIFLEX) methods based on the revised aggregation operators to solve multiple criteria group decision making (MCGDM). To accomplish this, we first revise the extant operational laws of q-RFLSs to make up for their shortcomings. Based on novel operational laws, we develop q-rung orthopair fuzzy 2-tuple linguistic (q-RFL) weighted averaging and geometric operators and provide the corresponding results. Next, we develop a maximization deviation model to determine the criterion weights in the decision-making procedure, which accounts for partial weight unknown information. Then, the VIKOR and QUALIFLEX methodologies are combined, which can assess the concordance index of each ranking combination using group utility and individual maximum regret value of alternative and acquire the ranking result based on each permutation's general concordance index values. Consequently, a case study is conducted to select the best bike-sharing recycling supplier utilizing the suggested VIKOR-QUALIFLEX MCGDM method, demonstrating the method's applicability and availability. Finally, through sensitivity and comparative analysis, the validity and superiority of the proposed method are demonstrated.

Dietary supplement for mood symptoms in early postpartum: a double-blind randomized placebo controlled trial.

Background: Postpartum blues (PPB) is a frequent syndrome of sad mood, crying spells, anxiety, restlessness, reduced appetite, and irritability, typically peaking day 5 postpartum. When severe, it greatly increases risk for later postpartum depression. This trial compared a dietary supplement to placebo on PPB severity. The supplement was designed to counter downstream effects of elevated monoamine oxidase A level, implicated in causing PPB. Methods: Participants recruited by advertisement from the Toronto region completed procedures at CAMH, Canada and/or participants' homes. Oral supplement or identical appearing relatively inert placebo were administered in randomised, double-blind fashion. Supplement was blueberry juice and extract given four times between nighttime day 3 and morning day 5 postpartum; tryptophan 2 g nighttime day 4 postpartum, and tyrosine 10 g morning day 5 postpartum. On day 5, depressed mood induction procedure (MIP) and postpartum blues were assessed. All data is presented (NCT03296956 closed, clinicaltrials.gov). Findings: Between January 2019 and December 2022, participants took supplement (n = 51) or placebo (n = 52). There was no significant effect on primary outcome MIP on visual analogue scale for depressed mood (mean difference = -0.39 mm, 95% CI: -6.42 to 5.65 mm). Stein Maternity Blues scores, exploratory PPB measure, was lower in the active group (effect size 0.62; median, interquartile range (IQR): active 2.00 (IQR 1, 4); placebo 4.00 (IQR 1.5, 6); regression with general linear model, supplement effect, ß coefficient = -1.50 (95%: CI -2.60, -0.40), p = 0.008; effect of CES-D crying category before supplement, p = 0.03-0.00000023). Twenty-six and 40 different adverse events occurred within 25% and 42% of supplement and placebo cases respectively (Chi-Square, p = 0.06). Interpretation: The primary outcome was negative for effect on depressed mood induction, however the supplement moderately reduced PPB. Funding: CAMH/Exeltis.

Not missing at random: Missing data are associated with clinical status and trajectories in an electronic monitoring longitudinal study of bipolar disorder.

There is limited information on the association between participants' clinical status or trajectories and missing data in electronic monitoring studies of bipolar disorder (BD). We collected self-ratings scales and sensor data in 145 adults with BD. Using a new metric, Missing Data Ratio (MDR), we assessed missing self-rating data and sensor data monitoring activity and sleep. Missing data were lowest for participants in the midst of a depressive episode, intermediate for participants with subsyndromal symptoms, and highest for participants who were euthymic. Over a mean ± SD follow-up of 246 ± 181 days, missing data remained unchanged for participants whose clinical status did not change throughout the study (i.e., those who entered the study in a depressive episode and did not improve, or those who entered the study euthymic and remained euthymic). Conversely, when participants' clinical status changed during the study (e.g., those who entered the study euthymic and experienced the occurrence of a depressive episode), missing data for self-rating scales increased, but not for sensor data. Overall missing data were associated with participants' clinical status and its changes, suggesting that these are not missing at random.