Precision Agriculture: Computer Vision-Enabled Sugarcane Plant Counting in the Tillering Phase.

The world's most significant yield by production quantity is sugarcane. It is the primary source for sugar, ethanol, chipboards, paper, barrages, and confectionery. Many people are affiliated with sugarcane production and their products around the globe. The sugarcane industries make an agreement with farmers before the tillering phase of plants. Industries are keen on knowing the sugarcane field's pre-harvest estimation for planning their production and purchases. The proposed research contribution is twofold: by publishing our newly developed dataset, we also present a methodology to estimate the number of sugarcane plants in the tillering phase. The dataset has been obtained from sugarcane fields in the fall season. In this work, a modified architecture of Faster R-CNN with feature extraction using VGG-16 with Inception-v3 modules and sigmoid threshold function has been proposed for the detection and classification of sugarcane plants. Significantly promising results with 82.10% accuracy have been obtained with the proposed architecture, showing the viability of the developed methodology.

Brain natriuretic peptide in acute heart failure and its association with glomerular filtration rate: A systematic review and meta-analysis.

BACKGROUND: Acute heart failure (AHF) is one of the most common cardiovascular diseases. Early diagnosis and prognosis are essential, as they can eventually lead to a fatal condition. Recently, brain natriuretic peptide (BNP) has been recognized as one of the most popular biomarkers for AHF. Changes in glomerular filtration rate (GFR) are often observed in AHF. METHODS: We searched PubMed, Google Scholar, and ScienceDirect between March and June 2023. Original case control studies written in English that assessed levels oh BNP in AHF were included. Systematic reviews, letters to editor, correspondence, comprehensive reviews, and duplicated studies were excluded. Funnel plots were constructed to assess publication bias. RESULTS: A total of 9 studies were selected and we obtained the mean difference (MD) of BNP level to be 2.57 (95% CI: 1.35, 3.78), and GFR to be -15.52, (95% CI: -23.35, -7.70) in AHF patients. Sensitivity analyses supported the robustness of the outcome. CONCLUSION: Results indicated that BNP was a promising prognostic biomarker of AHF, whereas GFR was found to be negatively correlated with AHF.

Investigating the therapeutic potential of aqueous extraction of curry plant (Murraya koenigi) leaves supplementation for the regulation of blood glucose level in type 2 diabetes mellitus in female human subjects.

Type 2 diabetes mellitus is characterized by hyperglycemia and insulin resistance. It is spreading around the globe like a pandemic. Major factors behind the development of diabetes can be genetics, environmental factors, dietary choices and obesity. Many medicinal plants have anti-diabetic potential. This study has investigated the anti-diabetic effect of curry leaves extract. This study also investigated the chemical characterization of curry leaves. Phytochemicals including saponins, tannins, alkaloids, flavonoids, phenols and glycosides were also investigated. Encapsulated 5mg per kg of the body weight and 10mg per kg of the body weight were given to treatment groups I and II. Random blood sugar, fasting blood sugar and HbA1c of 45 diabetic female adults were measured on the 0-day and 45th days. All results were analyzed using the two-sample t-test in IBM SPSS Statistics 20. Curry leaves contained moisture (24.1±1.78)%, ash (17.82±2.13)%, nitrogen free extract (36.12±3.52)%, crude protein (8.32±0.83)%, crude fiber (6.98±2.31)% and crude fat (6.87±0.21)%. Mineral analysis showed that magnesium and calcium were major minerals present in curry leaves. Curry leaves extract contained saponins 2.71±0.23, flavonoids 7.84±0.42, tannins 0.91±0.09, glycosides 0.17±0.01, phenols 3.89±0.12, alkaloids 2.01±0.87. These phytochemicals were expressed in mg/100 g of the sample. Curry leaf extract showed a significant (p<0.05) reduction in fasting blood sugar, random blood sugar and glycated hemoglobin in both treatment groups.

Restless Leg Syndrome in Patients with Liver Cirrhosis! Its Frequency, Severity, and Correlation.

BACKGROUND: Restless leg syndrome (RLS) has been recognized as a typical additional manifestation among patients with cirrhosis of the liver. RLS prevalence in liver cirrhosis further worsens the quality of life, which has already been compromised with the disease-related complications of cirrhosis itself. AIMS: The study aimed to determine the frequency and severity of Restless Leg Syndrome (RLS) among patients with cirrhosis of the liver and to correlate its severity with the severity of cirrhosis. METHODS: This prospective cross-sectional study was carried out at Ruth K.M. Pfau Civil Hospital (Karachi, Pakistan) from December 2019 to February 2020. Three hundred and fifteen cirrhotic patients with any etiology were included in the study after informed written consent. Restless leg syndrome with its severity was determined in all cirrhotic patients. For continuous variables, means and medians with standard deviations were calculated, while percentages and proportions were used for discrete variables. Spearman correlation was used to find significance between RLS Severity Score (RSS) and Model of End-stage Liver Disease MELD Score. A p value of < 0.05 was considered significant for all analyses. RESULTS: The frequency of RLS among cirrhotic patients was 38.4%. More than half (54.5%) of the patients had severe RLS. Viral related hepatitis C and hepatitis B were the most common cause of cirrhosis of the liver (57.8% and 30.8%). A significant difference was found between as patients both with or without RLS in terms of age (p=0.003), gender (p=0.005), hemoglobin (p=0.00), and serum albumin (p=0.01). No significant association was found between RLS severity score and MELD Score (p=0.693). CONCLUSION: Prevalence of RLS is very high among cirrhotic patients, but no correlation was found between the severity of RLS and cirrhosis. Further studies should be carried out to assess the quality of life in cirrhotic patients having RLS.

Free flap reconstruction after lower limb trauma - outcome analysis using National Surgical Quality Improvement Programme (NSQIP) parameters.

OBJECTIVE: To assess the outcomes of free flap reconstructions performed for the management of lower limb trauma. METHODS: This retrospective study was conducted at Aga Khan University Hospital (AKUH), Karachi and included data from June 2017 to May 2019 of patients who underwent free flap reconstruction as part of management of lower limb trauma. RESULTS: The mean age of the 8 adult patients was 34±11 years. Also included were two paediatric patients aged 7 and 8 years. Nine of the total 10 patients were male. Road traffic accidents were the most common mechanism of injury, occurring in 5(50%), followed by blast injuries in 3(33%). The anterolateral thigh flap was the most common type of flap used for reconstruction, done in 8(80%) patients. Flap survival rate was 90% and full flap loss was seen in only 1(10%) patient. Re-exploration surgery was done in 5(50%) patients during the same hospital stay. The length of hospital stay varied greatly from 4 to 105 days depending on associated diagnoses and whether the free flap surgery was performed during an elective admission. One patient did not survive to discharge, and the cause of death was attributed to septic complications. Functional outcomes on follow-up could not be determined. CONCLUSIONS: Free flap reconstruction surgery is an effective solution for management of lower limb trauma and has a high flap survival rate. Further studies are needed to ascertain the functional outcomes of limb salvage after free flap surgery.

Lateral Arm Flap: Its Usage as Pedicle and Free Flap.

Introduction The lateral arm flap is an excellent flap for both local and microvascular reconstruction. For local reconstruction on the upper extremity or as a distant microvascular flap, its advantages include short operation time, thin pliable tissue, non-dominant vessel, and minimal donor site morbidity. Moreover, it fulfills the goal of optimal reconstruction of form, function, and aesthetics. The objective is to share our experience of using the lateral arm flap, both as a free flap and as a pedicled flap. Methods After taking exemption from the ethical review committee (ERC) of Aga Khan University Hospital, a retrospective data analysis of patients who had undergone lateral arm flap at the Plastic and Reconstructive Surgery department of the Aga Khan University Hospital was carried out from January 2012 to December 2019. The data examined included the patient's age, gender, diagnosis, location of the defect, size of the flap, and outcome of the flap at three weeks post-operation. For free flaps, data of the recipient artery used for anastomosis and the number of veins anastomosed were also included. Results Over a period of eight years, 33 lateral arm flaps were performed, including 23 free flaps and 10 pedicled flaps. The average size of the free flap was 12x6 cm and that of the pedicled flap was 8x5 cm. In the free-flap group, there was a failure in three flaps, two of which were due to arterial anastomosis in the zone of injury. There were no failures in the pedicled flap group. Conclusion The lateral arm flap is a reliable flap, with consistent anatomy, which can be used for coverage in different parts of the body.

Non-invasive assessment of large esophageal varices with liver cirrhosis ; a study conducted in Pakistan.

The assessment of non-invasive parameters for the prediction of large esophageal varices among patients with liver cirrhosisis is of utmost importance. In this study, non-invasive parameters for prediction of large esophageal varices were retrospectively evaluated. The presence of esophageal varices grade III and IV was classified as large esophageal varices positive while no varices or grade I and II were classified as large esophageal varices negative. There were 473 (90.09%) patients with ascites [mild 38 (8.03%), moderate 257 (54.33%) and severe 178 (37.63%)]. Frequency of esophageal varices was found to be higher (n=415, 79.04%). Whereas, large esophageal varices were found in 251 (47.81%) patients. The sensitivity, specificity, positive predicted value, negative predicted value and test accuracy of thrombocytopenia in predicting large esophageal varices were found to be 88.05%, 59.85%, 66.77%, 84.54% and 73.33% respectively. A significant association for large esophageal varices was observed for low platelet counts (AOR : 0.98, 95% CI : 0.97-0.99), high bilirubin level (AOR : 1.22, 95% CI : 1.07-1.39), ascites (AOR : 1.98, CI : 1.02-3.85) and Child score A (AOR : 0.26, 95% CI : 0.09-0.75) and Child Score B (AOR : 0.42, 95% CI : 0.28-0.61). In conclusion, low platelet count, high bilirubin level and ascites are found to be non-invasive predictive factor for large esophageal varices. J. Med. Invest. 66 : 248-251, August, 2019.

Synthesis and Characterization of pH-Sensitive Genipin Cross-Linked Chitosan/Eudragit® L100 Hydrogel for Metformin Release Study Using Response Surface Methodology.

BACKGROUND: In this study, central composite design was utilized for the optimization of genipin cross-linked chitosan/Eudragit®-L 100 interpenetrating hydrogel network films fabricated through solvent evaporation technique. METHODS: Hydrogel formulations were studied using response surface methodology; regression analysis and the surface plots were used to evaluate the effect of variables on T50% (the time for 50% of drug release) and dynamic swelling with optimum formulation selection. Initial burst release of drug was observed from the formulated hydrogels during the first 2 hours of dissolution at simulated gastric pH 1.2 and then slow release during the next 10 hours in the simulated intestinal fluid at pH 7.4. Different polymer ratios in formulation showed significant influence on T50% and dynamic swelling of hydrogel. The highest T50% was observed at 9.89 hour and dynamic swelling at 7.86 h. RESULT: It was observed that by changing the polymer ratio with cross-linker, release rate of metformin could be modified. Cross-linker also affects drug release rate, i.e. the release rate is decreased with the increase in its concentration. The physical state of hydrogel was investigated by scanning electron microscope. CONCLUSION: It indicated the uniform distribution of drug in hydrogel matrix system. Moreover, the presence of hydrogen and ionic bonds between polymers and crosslinking agent formed interpenetrating hydrogel network, likely responsible for increased value of T50%, as confirmed by FTIR. Acute oral toxicity study was performed to investigate the toxic effect of crosslinking agent and polymer used in formulations.

In vitro Evaluation of Genipin-crosslinked Na-alginate/Chitosan Hydrogel Films for Delivery of Metformin: Effect of Chitosan Molecular Weight.

OBJECTIVES: In this study, central composite factorial design was used for the preparation and optimization of chitosan/Na-alginate hydrogel films containing metformin via solvent evaporation technique. METHODS: Low and high molecular weight (MW) chitosan was used as a polymer in different concentrations while genipin was used as a crosslinking agent. Drug release studies were performed in simulated gastric and intestinal fluids at pH 1.2 and 7.4 of formulated hydrogels. RESULTS: For low MW chitosan hydrogel, the highest drug release at pH 1.2 was observed i.e., 9.82% for 2 hrs while at pH 7.4, 95.52% drug release was observed after 12 hrs. In case of high MW chitosan hydrogel 9.67% drug release at ph1.2 for 2 hrs and 90.63% drug release at pH 7.4 after 12 hrs was observed. The highest T50% of low MW and high MW chitosan hydrogel was observed as 22.72 and 33.34 hrs, respectively, while the highest dynamic swelling was observed as 8.21 and 7.9, respectively. CONCLUSION: It was found that by changing the ratios of polymers as well as crosslinking agent, the release rate of metformin can be modified. Low MW chitosan hydrogel showed an increased release rate than high MW chitosan hydrogel and by increasing the concentration of crosslinking agent, the release rate was found to be decreased and vice versa.

Fabrication and characterization of genipin cross-linked chitosan/gelatin hydrogel for pH-sensitive, oral delivery of metformin with an application of response surface methodology.

In this study, central composite design was utilized for the preparation and optimization of chitosan-gelatin hydrogel films containing metformin using different concentrations of genipin as crosslinking agent. Solvent evaporation technique was used to develop hydrogel films. The formulated hydrogels were subjected to study the drug release in the simulated gastric pH1.2 for 3h. Initial burst release was observed from hydrogel during the first 2h of dissolution in gastric simulated environment. Different polymer ratios in formulation showed significant influence on T50% and dynamic swelling of hydrogel. The highest T50% was observed at 40.23min and dynamic swelling at 9.1. It was observed that by changing the polymer ratio with cross-linker, release rate of metformin could be modified. Cross-linker also affects the release rate as its concentration increases, the release rate decreases. The physical state of hydrogel was investigated by scanning electron microscope. It indicated the uniform presence of drug crystals in hydrogel matrix system. Fourier transform infrared spectroscopy (FTIR) confirmed the presence of hydrogen and ionic bonds between polymers and crosslinking agent leaving the drug intact in the matrix system. Scanning electron microscopy (SEM) images confirmed the uniform drug distribution. As per conclusion, the immediate release, pH sensitive, hydrogel formulation with good safety profile can be successfully fabricated by using CHI and GLN polymers with varying concentration of crosslinking agent.

Finasteride Topical Delivery Systems for Androgenetic Alopecia.

Androgenetic alopecia, generally recognized as male pattern baldness, is a gradually developing medical and physiological change, which is manifested by continuous hair-loss from scalp. Finasteride (4-aza-3-oxosteroid) is a potent anti-baldness compound that selectively and competitively inhibits the 5α-reductase isoenzymes. Prolonged oral use of finasteride leads to the emergence of sexual disorders including decrease in libido, gynecomastia, erectile dysfunction, ejaculation disorder, orgasm disorders and mood disturbances. Since, hair follicles widely home in 5α-reductase, topical formulations of finasteride in comparison to its oral formulations are expected to potentially reduce its systemic adverse effects. The analysis of literature has revealed some delivery systems developed for the enhanced and localized penetration of finasteride into the skin. These finasteride delivery systems include polymersomes, vesicular nanocarriers, vesicular ethosomal carriers, liposomes and niosomes, liquid crystalline nanoparticles, topical solutions and gels. The aim of this review article is to briefly amass all literature on topical delivery of finasteride to elaborate best dosage form, i.e. formulation having maximum permeation rate. This study will serve as a future perspective regarding topical delivery of finasteride. The literature analysis has exhibited that most of the previous investigators have used propylene glycol in their finasteride-loaded topical formulations, while poloxamer P407, monoolein, transcutol P and choline was used in few formulations. Moreover, among all drug delivery systems, finasteride liposomal gel system consisting of 2% methyl cellulose and gel system containing poloxamer P407 exhibited the highest flux with a value of 28.4 ± 1.3 µg/cm2h and 23.1 ± 1.4 µg/cm2h, respectively. Several topical drug delivery techniques such as topical microneedles, aerosol foams, nanoemulsions, microsponges, and emulsifier free formulations, fullerenes, ointments, pastes, creams, gel and lotions are still to be worthy regarding finasteride topical delivery in future.

Novel sequence variants in the LIPH and LPAR6 genes underlies autosomal recessive woolly hair/hypotrichosis in consanguineous families.

Autosomal-recessive woolly hair/hypotrichosis (ARWH/H) is a rare genetic disorder of hair caused by variants in the LIPH and LPAR6 genes. The disease is characterized by congenital tightly curled hair leading to sparse hair later in life. In the present report genetic characterization of three consanguineous families of Pakistani origin, displaying clinical features of ARWH/H, was performed. Haplotype and DNA sequence analysis of the LIPH gene revealed a novel homozygous nonsense variant (c.688C > T; p.Gln230*) in family A. In two other families, B and C, sequence analysis of the LPAR6 gene revealed a novel homozygous frameshift variant (c.68_69dupGCAT; p.Phe24Hisfs*29) and a previously reported missense variant (c.188A > T; p.Asp63Val), respectively. Taken together, our findings will expand the spectrum of variants reported in the LIPH and LPAR6 genes.

Multiple Osteolytic Lesions Causing Hypercalcemia: A Rare Presentation of Acute Lymphoblastic Leukemia.

Acute lymphoblastic leukemia is characterized by unchecked proliferation of malignant lymphoblasts which replaces the normal bone marrow culminating in anemia due to red blood cells inadequacy as well as in easy bruising/bleeding secondary to insufficient platelets production. Even the white blood cells which are produced excessively are immature and abnormal. ALL is the most common hematological malignancy in children. Most commonly, patients present with lymphadenopathy, recurrent infections, bleeding, fatigue, and bone pains. Bone pains, often particularly involving long bones, occur in about 21-38% of cases and are due to overcrowding of bone marrow with malignant cells. Vast majority of children with ALL have thrombocytopenia and/or anemia with a normal or mildly elevated white blood cells count with the presence of lymphoblasts on peripheral smear. About 50% of children present with bleeding while about 75% of patients have platelet count 100,000/microL. Visceromegaly is not uncommon but osteolytic lesions and hypercalcemia are rather uncommon. We present a 22-year-old gentleman with generalized fatigue and bone pains without visceromegaly. There was severe hypercalcemia with normal parathyroid levels but multiple osteolytic lesions. Peripheral smear showed anemia without blasts, whereas a bone marrow biopsy revealed > 30% blasts with interspersed CD 10 positive cells.

Formulation and in vitro evaluation of carbopol 934-based modified clotrimazole gel for topical application.

The aim of present study was to enhance topical permeation of clotrimazole gel preparation by using various permeability enhancers such as coconut oil, pistachio oil and sodium lauryl sulphate (SLS). Clotrimazole gel preparations were prepared and optimized by using three factor, five level central composite design. A second-order polynomial equation was generated in order to estimate the effect of independent variables i.e. coconut oil (X1), pistachio oil (X2) and sodium lauryl sulphate (X3) at various dependent variables i.e. flux (Y1), lag time (Y2), diffusion coefficient (Y3), permeability coefficient (Y4), and input rate (Y5) of clotrimazole gel formulations. Ex vivo skin permeation study was performed through rat skin by using modified Franz diffusion cell system. Optimized formulation F8 exhibited highest flux 2.17 µg/cm2/min, permeability coefficient 0.0019 cm/min and input rate 1.543 µg/cm2/min, along with moderate lag time 77.27 min and diffusion coefficient 0.063 cm2/min, which is further supported by anti-fungal activity that exhibited more prominent zone of inhibition against Candida albicans, Aspergillus niger and Mucor. Thus, it can be concluded that permeation of clotrimazole gel was enhanced by various combination of coconut oil, pistachio oil and sodium lauryl sulphate but optimized formulation F8 containing 0.4 ml pistachio oil, 0.8 ml coconut oil and 0.04 g of SLS exhibited more pronounced and promising effect through rat skin.

Green synthesis of silver nanoparticles via plant extracts: beginning a new era in cancer theranostics.

With the development of the latest technologies, scientists are looking to design novel strategies for the treatment and diagnosis of cancer. Advances in medicinal plant research and nanotechnology have attracted many researchers to the green synthesis of metallic nanoparticles due to its several advantages over conventional synthesis (simple, fast, energy efficient, one pot processes, safer, economical and biocompatibility). Medicinally active plants have proven to be the best reservoirs of diverse phytochemicals for the synthesis of biogenic silver nanoparticles (AgNPs). In this review, we discuss mechanistic advances in the synthesis and optimization of AgNPs from plant extracts. Moreover, we have thoroughly discussed the recent developments and milestones achieved in the use of biogenic AgNPs as cancer theranostic agents and their proposed mechanism of action. Anticipating all of the challenges, we hope that biogenic AgNPs may become a potential cancer theranostic agent in the near future.

Pulmonary microlithiasis - A case report.

Pulmonary alveolar microlithiasis is a rare diffuse lung disease characterized by widespread sand-like intra-alveolar calcifications (calcospherites composed of calcium and phosphorus). Around 800 cases have been reported in the literature to date. We report here a case of a 35 years old female with prolonged h/o of exertional dyspnoea and mild cough. Clinical examination was mostly normal. Her Chest X-Ray revealed bilateral multiple nodular opacities (sand storm appearance). CT Scan chest showed diffuse micronodular calcifications with septal thickening, compatible with alveolar microlithiasis. Pulmonary function tests showed moderately restrictive lung disease. Bronchoscopic alveolar lavage revealed calcospherites in the alveloli and bronchi confirming the diagnosis of pulmonary alveolar microlithiasis.

Naja naja karachiensis envenomation: biochemical parameters for cardiac, liver, and renal damage along with their neutralization by medicinal plants.

Naja naja karachiensis envenomation was found to hit more drastically heart, liver, and kidneys. 400 µg/kg of venom-raised moderate serum levels of ALT (72 ± 4.70 U/L, 0.1 > P > 0.05), AST (157 ± 24.24 U/L, 0.1 > P > 0.05), urea (42 ± 3.08 mg/dL, 0.05 > P > 0.02), creatinine (1.74 ± 0.03 mg/dL, 0.01 > P > 0.001), CK-MB (21 ± 1.5 U/L, 0.05 > P > 0.02), and LDH (2064 ± 15.98 U/L, P < 0.001) were injected in experimental rabbits. However, lethality was enhanced with 800 µg/kg of venom in terms of significant release of ALT (86 ± 5.0 U/L, 0.05 > P > 0.02), AST (251 ± 18.2 U/L, 0.01 > P > 0.001), urea (57.6 ± 3.84 mg/dL, 0.02 > P > 0.01), creatinine (2.1 ± 0.10 mg/dL, 0.02 > P > 0.01), CK-MB (77 ± 11.22 U/L, 0.05 > P > 0.02), and LDH (2562 ± 25.14 U/L, P ≪ 0.001). Among twenty-eight tested medicinal plant extracts, only Stenolobium stans (L.) Seem was found the best antivenom (P > 0.5) compared to the efficacy of standard antidote (ALT = 52.5 ± 3.51 U/L, AST = 69.5 ± 18.55 U/L, urea = 31.5 ± 0.50 mg/dL, creatinine = 1.08 ± 0.02 mg/dL, CK-MB = 09 ± 0.85 U/L, and LDH = 763 ± 6.01 U/L). Other plant extracts were proved less beneficial and partly neutralized the toxicities posed by cobra venom. However, it is essential in future to isolate and characterize bioactive compound(s) from Stenolobium stans (L.) Seem extract to overcome the complications of snake bite.

The formulation of flurbiprofen loaded microspheres using hydroxypropylmethycellulose and ethylcellulose.

OBJECTIVES: The aim of the present work was to formulate flurbiprofen (FLB) loaded microspheres of hydroxypropylmethycellulose and ethylcellulose polymers to study the effect of different proportions of the polymer mixture on the release behavior of the drug. MATERIAL AND METHODS: A series of microspheres were prepared using tween-80 as a surfactant. The prepared microspheres were evaluated for entrapment efficiency (%) and percentage recovery. Drug release was performed in USP phosphate buffers of pH 1.2 and 6.8. Drug release data were plotted in various kinetic models, including zero-order, first-order, Higuchi and Korsmeyer-Peppas models to investigate the optimum composition suitable for sustained drug delivery. RESULTS: A significant difference in drug release kinetics was observed by varying the composition of hydroxypropylmethycellulose/ethylcellulose. As the ratio of EC/HPMC was increased, the release rate of flurbiprofen decreased. CONCLUSIONS: This study demonstrated the potential of polymer combinations in the formulation of microspheres for water-insoluble drugs utilizing HPMC and EC as release retardant materials, using a simple solvent evaporation microencapsulation technique. It was observed that various physico-chemical properties of the microspheres varied according to the change in polymer concentrations used in the formulations.