The influence of pharmacist-led collaborative care on clinical outcomes in type 2 diabetes mellitus: a multicenter randomized control trial.

Background: Health care providers are mandated to deliver specialized care for the treatment and control of type 2 diabetes mellitus. In Malaysia, Diabetes Medication Therapy Adherence Clinics (DMTAC) in tertiary hospitals have designated pharmacists to administer these services. Objective: To assess the effects of pharmacist-led interventions within DMTAC on the outcomes of patients with type 2 diabetes mellitus in two distinct hospitals in Kedah, Malaysia. Methods: Patients with type 2 diabetes were randomly selected from the two hospitals included in this study. The study population was divided into two equal groups. The control group consisted of 200 patients receiving routine care from the hospitals. On the other hand, the intervention group included those patients with type 2 diabetes (200), who received separate counseling sessions from pharmacists in the DMTAC departments along with the usual treatment. The study lasted 1 year, during which both study groups participated in two distinct visits. Results: Parametric data were analyzed by a paired t-test and one-way ANOVA, while non-parametric data were analyzed by a Chi-squared test using SPSS v24. A p < 0.05 was considered statistically significant. The study presented the results of a greater reduction in HBA1c levels in the intervention group compared to the control group, i.e., 3.59 and 2.17% (p < 0.001). Moreover, the Systolic and Diastolic values of BP were also significantly reduced in the intervention group, i.e., 9.29 mmHg/7.58 mmHg (p < 0.005). Furthermore, cholesterol levels were significantly improved in patients in the intervention group, i.e., 0.87 mmol/L (p < 0.001). Conclusion: Based on the findings of the current study it has been proven that the involvement of pharmacists leads to improved control of diabetes mellitus. Therefore, it is recommended that the government initiate DMTAC services in both private and government hospitals and clinics throughout Malaysia. Furthermore, future studies should assess the impact of pharmacist interventions on other chronic conditions, including but not limited to asthma, arthritis, cancer, Alzheimer's disease, and dementia.

Radiotherapy to the neck after neck dissection for head and neck squamous cell carcinoma from an unknown primary: A narrative review.

PURPOSE: To conduct a comprehensive narrative review of the evidence for radiotherapy target volumes to the neck, after neck dissection, for head and neck squamous cell carcinoma from an unknown primary (HNSCCUP). Inclusion or exclusion of mucosal irradiation is not the focus of interest for this review article. MATERIALS AND METHODS: Literature (PubMed-Medline, EMBASE database and Cochrane library) was searched using the relevant keywords. The search results were limited to the studies published in year 2000 or after. RESULTS: Eight studies met the inclusion criteria. All studies were retrospective in nature. The incidence of contralateral recurrence rates in the untreated neck when the involved neck only is treated remains very low (0%-10%). Survival has improved over the past two decades, most likely due to improved diagnostic techniques and the increase in incidence of HPV-related disease. CONCLUSION: Given the rarity of disease, level one evidence from randomised controlled trials is lacking. Available data are retrospective but support unilateral post-operative radiotherapy as a treatment option in selected cases.

Ecotoxicity of the fluoroquinolone antibiotic delafloxacin to the water flea Simocephalus vetulus and its offspring under the influence of calcium modulation.

Delafloxacin (DFX), one of the latest additions to the fluoroquinolone antibiotics, is gaining heightened recognition in human therapy due to its potential antibacterial efficacy in a wide range of applications. Concerns have arisen regarding its presence in the environment and its potential interactions with multivalent metals, such as calcium (Ca). The present study investigated the trans- and multigenerational effects of environmentally projected concentrations of DFX (100-400 µg DFX L-1) on individual- and population-level responses of parental S. vetulus (F0) and its descendants (F1) under normal (26 mg L-1) and high (78 mg L-1) Ca conditions. Exposure of the F0 generation to DFX under the normal Ca condition resulted in reduced juvenile body length (JBL), increased age-specific survival rate (lx), indicating prolonged developmental time, reduced age-specific fecundity rate (mx), and decreased population growth rate (rm). Under the high Ca condition, JBL, mx, and rm were adversely affected. Transgenerational effects of DFX existed, as F1 individuals exhibited persistent suppressions in at least one endpoint under both Ca conditions even after being transferred to a clear medium. Continuous exposure of the F1 generation to DFX had negative impacts on JBL, mx, and rm under the normal Ca condition, and on JBL and rm under the high Ca condition. However, cumulative effects were not observed, suggesting the potential development of tolerance to DFX in the F1 organisms. These findings suggest that DFX is a harmful compound for the non-target model organism S. vetulus and reveal a potential antagonism between DFX and Ca. Nevertheless, the interaction between other (fluoro)quinolones and Ca remains unclear, necessitating further research to establish this phenomenon more comprehensively, including understanding the interaction mechanism in ecotoxicological contexts.

Metastatic spinal cord compression: the Spinal Instability Neoplastic Score and early surgical intervention.

OBJECTIVES: To evaluate the value of Spinal Instability Neoplastic Score (SINS) in patients with spine metastasis who subsequently developed or did not develop metastatic spinal cord compression (MSCC). METHODS: In this single institutional retrospective descriptive observational study, of 589 patients with MSCC who were referred for radiotherapy, 34 patients (with 41 compression sites) met the inclusion criteria: availability of diagnostic MRI spine pre-development of MSCC (MRI-1) and at the time of MSCC development (MRI-2) (CordGroup).For comparison, NoCordGroup consisted of 152 patients (160 sites) treated with radiotherapy to spinal metastases. SINS was compared between the two groups. RESULTS: In CordGroup, the median interval between MRI-1 and MRI-2 was 11 weeks. The median SINS was 8 (range: 4-14) and 9 (range: 7-14) on MRI-1 and MRI-2, respectively. In NoCordGroup, the median SINS was 6 (range: 4-10). CONCLUSIONS: Our study showed a trend in difference in SINS value between the two groups. This difference should be a subject of future prospective research in this patient population with poor survival.

Advancements in Retinoblastoma Treatment: Unraveling the Potential of Intravitreal Chemotherapy.

Retinoblastoma necessitates urgent attention due to its potential fatality if untreated. Multiple treatment options are available and should be employed according to size, location, and the extent of dissemination. This review emphasizes the need for increased awareness, advanced diagnostic tools, and innovative treatment approaches, especially intravitreal chemotherapy (IVitC) to address the diverse manifestations and aggressive nature of retinoblastoma. Timely diagnosis and commitment to treatment are pivotal, as delays and reluctance to undergo enucleation contribute to unfavorable outcomes. The evolving treatment landscape, spanning from traditional interventions to modern targeted therapies such as intravitreal melphalan, holds promise for improved outcomes. While the intravitreal approach presents challenges, ongoing research aims to establish its definitive role in retinoblastoma treatment. In the treatment of retinoblastoma, IVitC raises considerations about side effects. The risk of tumor spread beyond the eye is rare, emphasising the potential of IVitC in carefully selected cases. Intravitreal injections exhibit fewer local adverse effects compared to intra-arterial chemotherapy, with careful measures reducing significant ocular complications. The evaluation of ocular toxicity, particularly with melphalan, underscores the importance of a nuanced approach to achieve the right balance between therapeutic efficacy and ocular safety. This comprehensive analysis of studies on IVitC and its ocular and systemic complications provides valuable insights for enhanced patient care. The review concludes with a focus on balancing safety and efficacy in local chemotherapeutic drugs, highlighting the need for thoughtful measures and continued research to optimise treatment modalities globally.

Beliefs, awareness, use, and factors associated with herbal supplements usage among patients with chronic diseases-A cross-sectional insight from Alkharj, Saudi Arabia.

BACKGROUND: Herbal supplements (HSs) are used to treat a variety of diseases and ailments. Individuals with chronic diseases are at a higher risk of having adverse events and drug interactions from the use of HSs. AIM: This study determined the beliefs, awareness, use, and factors associated with HSs usage among patients with chronic diseases in Alkharj, Saudi Arabia. METHOD: A cross-sectional study was conducted among patients with chronic diseases between February and June 2019. Face-to-face interviews were conducted at various out-patient clinics in different hospitals. Patients diagnosed with chronic diseases were included in the study. Data were analyzed by descriptive, comparative, and inferential statistics using SAS ver. 9.4. RESULTS: The study participants were consisted of 533 patients, with mean age 53.6 ±12.9 years. The most prevalent chronic diseases were diabetes mellitus (67.7%), followed by hypertension (54.8%), and hyperlipidemia (53.8%). Among the studied participants, 336 (63%) had used at least one HS, whereby the most commonly used HSs were ginger (74.7%), mint (72%), and cumin (66.7%). Almost 78% of HSs users did not consult any healthcare provider about their use. HSs use varied significantly between female and male participants (p<0.05), whereby 61.5% of female participants used HSs in comparison to the male participants (38.5%). Gender (AOR 0.328; 95% CI 0.139-0.772; p = 0.0107), number of chronic diseases (AOR 1.585; 95% CI 1.084-2.318; p = 0.0312), and hyperlipidemia (AOR 2.818; 95% CI 1.507-5.269; p = 0.0.0012) were the pure factors of HSs use among the studied patients. CONCLUSION: The results of this study showed that HSs usage was high among patients with chronic diseases in Saudi Arabia. Concurrent usage of HSs with drugs should be well-discussed with healthcare providers to avoid potential adverse events or drug interactions especially among patients with chronic diseases.

An adaptive ensemble deep learning framework for reliable detection of pandemic patients.

Nurses, often considered the backbone of global health services, are disproportionately vulnerable to COVID-19 due to their front-line roles. They conduct essential patient tests, including blood pressure, temperature, and complete blood counts. The pandemic-induced loss of nursing staff has resulted in critical shortages. To address this, robotic solutions offer promising avenues. To solve this problem, we developed an ensemble deep learning (DL) model that uses seven different models to detect patients. Detected images are then used as input for the soft robot, which performs basic assessment tests. In this study, we introduce a deep learning-based approach for nursing soft robots, and propose a novel deep learning model named Deep Ensemble of Adaptive Architectures. Our method is twofold: firstly, an ensemble deep learning technique detects COVID-19 patients; secondly, a soft robot performs basic assessment tests on the identified patients. We evaluate the performance of various deep learning-based object detectors for patient detection, examining implementations of You Only Look Once (YOLO), Single Shot MultiBox Detector (SSD), Region-Based Convolutional Neural Network (RCNN), and Region-Based Fully Convolutional Network (R-FCN) on a proprietary dataset comprising 32,668 hospital surveillance images. Our results indicate that while YOLO and VGG facilitate rapid detection, Faster-RCNN (Inception ResNet-v2) and our proposed Ensemble-DL achieve the highest accuracy. Ensemble-DL offers accurate results in a reasonable timeframe, making it apt for patient detection on embedded platforms. Through real-world experiments, our method outperforms baseline approaches (including Faster-RCNN, R-FCN variants, CNN+LSTM, etc.) in terms of both precision and recall. Achieving an impressive accuracy of 98.32%, our deep learning-based model for nursing soft robots presents a significant advancement in the identification and assessment of COVID-19 patients, ultimately enhancing healthcare efficiency and patient care.

New species and new records of genus Buellia (lichenized Ascomycota, Caliciaceae) from Pakistan using electron microscopy and DNA barcoding techniques.

Three new species Buellia darelensis, B. densitheca, B. kashmirensis and two new records B. elegans and B. taishanensis are added to the lichen biota of Pakistan. Buellia darelensis and B. kashmirensis share the same habitats found on the rock while B. densitheca colonized on bark of Pinus hardwoods in the Himalayan forest, Pakistan. Morphological, chemical, and phylogenetic analyses were carried out to elucidate the placement of these species and to support the delimitation of the new taxa. Detailed descriptions and figures for the species are given, and a key to all known buellioid species from Pakistan is provided. RESEARCH HIGHLIGHTS: During recent explorations of lichens from different regions of Pakistan, we observed specimens that could not be readily assigned to any known species. A phylogenetic analysis of the internal transcribed spacer nrDNA region confirms their position within the genus Buellia, and morphological data showed distinctiveness of three species from other known species of the genus. We therefore describe these specimens as new species to science, and two species are as new records for the country. Pakistan exhibits a large altitudinal variation, with climatic conditions and a diverse vegetation that supports a diverse and conspicuous lichen biota. The nature reserves have abundant biological resources, and it is expected that more new species of lichen may be discovered in the future.

Transcriptomic analysis reveals the beneficial effects of salt priming on enhancing defense responses in upland cotton under successive salt stress.

Priming-mediated stress tolerance in plants stimulates defense mechanisms and enables plants to cope with future stresses. Seed priming has been proven effective for tolerance against abiotic stresses; however, underlying genetic mechanisms are still unknown. We aimed to assess upland cotton genotypes and their transcriptional behaviors under salt priming and successive induced salt stress. We pre-selected 16 genotypes based on previous studies and performed morpho-physiological characterization, from which we selected three genotypes, representing different tolerance levels, for transcriptomic analysis. We subjected these genotypes to four different treatments: salt priming (P0), salt priming with salinity dose at 3-true-leaf stage (PD), salinity dose at 3-true-leaf stage without salt priming (0D), and control (CK). Although the three genotypes displayed distinct expression patterns, we identified common differentially expressed genes (DEGs) under PD enriched in pathways related to transferase activity, terpene synthase activity, lipid biosynthesis, and regulation of acquired resistance, indicating the beneficial role of salt priming in enhancing salt stress resistance. Moreover, the number of unique DEGs associated with G. hirsutum purpurascens was significantly higher compared to other genotypes. Coexpression network analysis identified 16 hub genes involved in cell wall biogenesis, glucan metabolic processes, and ribosomal RNA binding. Functional characterization of XTH6 (XYLOGLUCAN ENDOTRANSGLUCOSYLASE/HYDROLASE) using virus-induced gene silencing revealed that suppressing its expression improves plant growth under salt stress. Overall, findings provide insights into the regulation of candidate genes in response to salt stress and the beneficial effects of salt priming on enhancing defense responses in upland cotton.

Tackling antimicrobial resistance in primary care facilities across Pakistan: Current challenges and implications for the future.

Antibiotics are gradually becoming less effective against bacteria worldwide, and this issue is of particular concern in economically-developing nations like Pakistan. We undertook a scoping review in order to review the literature on antimicrobial use, prescribing, dispensing and the challenges associated with antimicrobial resistance in primary care (PC) settings in Pakistan. Furthermore, this review aims to identify potential solutions to promote appropriate use of antimicrobials in Pakistan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist, a comprehensive scoping review was conducted to review the literature of antimicrobials used, prescribed and dispensed in PC settings in Pakistan. Google Scholar and Pub-Med were searched for the period 2000-2023. Papers were analyzed on the basis of eligibility i.e., included antimicrobial use, prescribing and dispensing practices by general population at homes, by prescribers in outpatient departments of hospitals and by pharmacists/dispensers in community pharmacies, respectively. Two researchers analyzed the articles thoroughly and disagreements were resolved through discussion with a third reviewer. Both quantitative and qualitative research studies were eligible for inclusion. Additionally, the selected papers were grouped into different themes. We identified 4070 papers out of which 46 studies satisfied our eligibility criteria. The findings revealed limited understanding of antimicrobial resistance (AMR) by physicians and community pharmacists along with inappropriate practices in prescribing and dispensing antibiotics. Moreover, a notable prevalence of self-medication with antibiotics was observed among the general population, underscoring a lack of awareness and knowledge concerning proper antibiotic usage. Given the clinical and public health implications of AMR, Pakistan must prioritize its policies in PC settings. Healthcare professionals (HCPs) need to reduce inappropriate antibiotic prescribing and dispensing, improve their understanding of the AWaRe (access, watch and reserve antibiotics) classification and guidance, monitor current usage and resistance trends, as well as implement antimicrobial stewardship (ASP) activities starting in targeted locations.

Point Prevalence Survey of Antimicrobial Use and Resistance during the COVID-19 Era among Hospitals in Saudi Arabia and the Implications.

The inappropriate prescribing of antimicrobials increases antimicrobial resistance (AMR), which poses an appreciable threat to public health, increasing morbidity and mortality. Inappropriate antimicrobial prescribing includes their prescribing in patients hospitalized with COVID-19, despite limited evidence of bacterial infections or coinfections. Knowledge of current antimicrobial utilization in Saudi Arabia is currently limited. Consequently, the objective of this study was to document current antimicrobial prescribing patterns among Saudi hospitals during the COVID-19 pandemic. This study included patients with or without COVID-19 who were admitted to five hospitals in Makkah, Saudi Arabia. Data were gathered using the Global PPS methodology and analyzed using descriptive statistics. Out of 897 hospitalized patients, 518 were treated with antibiotics (57.7%), with an average of 1.9 antibiotics per patient. There were 174 culture reports collected, representing 36.5% of all cases. The most common indication for antibiotics use was community-acquired infections, accounting for 61.4% of all cases. 'Watch' antibiotics were the most commonly prescribed antibiotics, with the cephalosporins and carbapenems representing 38.7% of all antibiotics prescribed, followed by the penicillins (23.2%). Notably, Piperacillin/Tazobactam and Azithromycin were prescribed at relatively higher rates for COVID-19 patients. These findings highlight the need for continuous efforts to optimize the rational use of antibiotics through instigating appropriate antimicrobial stewardship programs in hospitals and, as a result, reduce AMR in the country.

Toxicological effects of copper on bioaccumulation and mRNA expression of antioxidant, immune, and apoptosis-related genes in Chinese striped-necked turtle (Mauremys sinensis).

Heavy metals are among the most ubiquitous environmental pollutants of recent decades. Copper is commonly used to control algal blooms or macrophyte and waste infestations, its ambient concentration has increased significantly, indicating possible environmental risk. To investigate the effects of copper exposure on bioaccumulation, antioxidant defense, immune response, and apoptosis in the Chinese Striped-necked Turtle Mauremys sinensis, three experimental groups, control (0.0 mg/L), Cu2 (2 mg/L) and Cu4 (4 mg/L) were designed, and sampled at 14 and 28 days. Results showed that copper accumulates in different organs depending on the concentration and exposure time, Liver > Kidney > Gut > Heart > Brain > Muscle and the time order was 28 days > 14 days. The liver enzymes AST, ALT, and ALP decreased when the turtles were exposed to copper stress, while the contents of bilirubin TBIL, DBIL, IBIL, and LDH showed a significant upward trend. Similarly, the mRNA expression level of acetylcholinesterase AChE in the brain was significantly downregulated upon copper exposure. An upward trend was noticed in the liver Metallothionein MT mRNA expression levels compared to the control group. The mRNA expression levels of antioxidant enzymes CAT, SOD, MnSOD, and GSH-PX1 in the liver increased initially and then significantly decreased. Furthermore, the relative mRNA expression levels of inflammatory cytokines IL-1ß, IL-8, TNF-α, and IFN-γ involved in inflammatory response significantly upregulated. Copper significantly increased the hepatic mRNA transcription of heat shock proteins HSP70 and HSP90 at different exposure durations. In addition, the relative mRNA levels of caspase3, caspase8, and caspase9 related to the caspase-dependent apoptotic pathway significantly increased under copper stress. These results explain that copper toxicity causes bioaccumulation, promotes oxidative stress, obstructs immunity, and induces inflammation and apoptosis by altering their gene expression levels in M. sinensis.

Vaccine Hesitancy of COVID-19 among Parents for Their Children in Middle Eastern Countries-A Systematic Review.

The current systematic review presents COVID-19 vaccine hesitancy among parents for their children in Middle Eastern countries. Moreover, the vaccine acceptance rate of parents from the Middle East and the factors effecting the acceptance rate were reviewed and summarized. For this systematic review, basic electronic academic databases (Scopus, Science Direct, ProQuest, Web of Science and PubMed) were used for the search, along with a manual search on Google Scholar. This systematic review was conducted by following the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)" guidelines. Moreover, utilizing the framework of the PECO-S (Population Exposure Comparison Outcome Study design), various observational studies were recruited for this review. Out of 2123 studies, 25 studies meeting the inclusion criteria were included in the current review. All of the included studies were about parental vaccine hesitancy for COVID-19 in Middle Eastern countries and published during 2020-2022. Overall, 25 research papers comprising 10 different Middle Eastern countries with 33,558 parents were included. The average age of parents was 39.13 (range: 18-70) years, while the mean age of children was 7.95 (range: 0-18) years. The overall hesitancy rate was 44.2% with a SD of ± 19.7. The included studies presented enhanced COVID-19 vaccine hesitancy among parents in Middle Eastern countries. The lower vaccine acceptance rate among parents was mainly because of a fear of the potential side effects. Furthermore, the lack of information regarding vaccine safety and efficacy, the fear of unreported side effects and concerns about the authenticity of vaccine development and preparation were the predictors of parental COVID-19 vaccine hesitancy among Middle Eastern countries.

Parents' Concerns, Behavior, Perception, and Hesitancy Regarding COVID-19 Vaccinations for Children in Central Saudi Arabia.

In Saudi Arabia, the Ministry of Health (MoH) has implemented strict rules to ensure COVID-19 vaccination uptake by the general public. However, there is hesitancy about COVID-19 vaccination among parents for their children worldwide. We aimed to determine the concerns, behaviors, perceptions, and hesitancy of COVID-19 vaccination among parents for their children in Saudi Arabia. Parents of children aged 5-11 years were included in this cross-sectional study. A total of 1507 responses were obtained using the convenience sampling technique. The data were analyzed using SPSS version 25.0 by applying descriptive and inferential statistics. Of the parents who responded, 74.5% believed that the COVID-19 vaccination could affect the genes of children, and 72.8% believed that the COVID-19 vaccination could have a greater number of positive impacts on the overall health of children. In total, 87% of the parents were satisfied with the vaccination services and effective policies of the MoH, Saudi Arabia. This study concluded that there is a greater need to increase public awareness regarding the beneficial impact of COVID-19 vaccination on the overall health of children. Effective awareness campaigns are also required to provide empirical information to the public that COVID-19 vaccination for children is safe and effective.

Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic.

Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj.

Surface water quality, public health, and ecological risks in Bangladesh-a systematic review and meta-analysis over the last two decades.

Water quality has recently emerged as one of the utmost severe ecological problems being faced by the developing countries all over the world, and Bangladesh is no exception. Both surface and groundwater sources contain different contaminants, which lead to numerous deaths due to water-borne diseases, particularly among children. This study presents one of the most comprehensive reviews on the current status of water quality in Bangladesh with a special emphasis on both conventional pollutants and emerging contaminants. Data show that urban rivers in Bangladesh are in a critical condition, especially Korotoa, Teesta, Rupsha, Pashur, and Padma. The Buriganga River and few locations in the Turag, Balu, Sitalakhya, and Karnaphuli rivers have dissolvable oxygen (DO) levels of almost zero. Many waterways contain traces of NO3, NO2, and PO4-3 pollutants. The majority of the rivers in Bangladesh also have Zn, Cu, Fe, Pb, Cd, Ni, Mn, As, and Cr concentrations that exceed the WHO permissible limits for safe drinking water, while their metal concentrations exceed the safety threshold for irrigation. Mercury poses the greatest hazard with 90.91% of the samples falling into the highest risk category. Mercury is followed by zinc 57.53% and copper 29.16% in terms of the dangers they pose to public health and the ecosystem. Results show that a considerable percentage of the population is at risk, being exposed to contaminated water. Despite hundreds of cryptosporidiosis cases reported, fecal contamination, i.e., Cryptosporidium, is totally ignored and need serious considerations to be regularly monitored in source water.

The chemoprotective potentials of alpha-lipoic acid against cisplatin-induced ototoxicity: A systematic review.

PURPOSE: Ototoxicity is one of the major adverse effects of cisplatin therapy which restrict its clinical application. Alpha-lipoic acid administration may mitigate cisplatin-induced ototoxicity. In the present study, we reviewed the protective potentials of alpha-lipoic acid against the cisplatin-mediated ototoxic adverse effects. METHODS: Based on the PRISMA guideline, we performed a systematic search for the identification of all relevant studies in various electronic databases up to June 2022. According to the inclusion and exclusion criteria, the obtained articles (n=59) were screened and 13 eligible articles were finally included in the present study. RESULTS: The findings of in-vitro experiments showed that cisplatin treatment significantly reduced the auditory cell viability in comparison with the control group; nevertheless, the alpha-lipoic acid co-administration protected the cells against the reduction of cell viability induced by cisplatin treatment. Moreover, the in-vivo results of the auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE) tests revealed a decrease in DPOAE and an increase in ABR threshold of cisplatin-injected animals; however, it was shown that alpha-lipoic acid co-treatment had an opposite pattern on the evaluated parameters. Other findings demonstrated that cisplatin treatment could significantly induce the biochemical and histopathological alterations in inner ear cells/tissue; in contrast, alpha-lipoic acid co-treatment ameliorated the cisplatin-mediated biochemical and histological changes. CONCLUSION: The findings of audiometry, biochemical parameters, and histological evaluation showed that alpha-lipoic acid co-administration alleviates the cisplatin-induced ototoxicity. The protective role of alpha-lipoic acid against the cisplatin-induced ototoxicity can be due to different mechanisms of anti-oxidant, anti-apoptotic, anti-inflammatory activities, and regulation of cell cycle progression.

Seasonal spermatogenesis in the red-eared slider (Trachemys scripta elegans): The roles of GnRH, actin cytoskeleton, and MAPK.

Reproduction is the key to the ecological invasion of alien species. As an invasive species, the characteristic and regularity of red-eared slider (Trachemys scripta elegans) spermatogenesis is an index for evaluating reproduction and ecological adaptation. Here, we investigated the characteristics of spermatogenesis i.e., the gonadosomatic index (GSI), plasma reproductive hormone levels, and the histological structure of testes by HE and TUNEL staining, and then RNA-Seq in T. s. elegans. The histomorphological evidence confirmed that seasonal spermatogenesis in T. s. elegans has four successive phases: quiescence (December-May of the following year), early-stage (June-July), mid-stage (August-September), and late-stage (October-November). In contrast to 17ß-estradiol, testosterone levels were higher during quiescence (breeding season) compared to mid-stage (non-breeding season). Based on RNA-seq transcriptional analysis, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were used to analyze the testis in the quiescent and mid-stage. Our study found that circannual spermatogenesis is regulated by interactive networks including gonadotropin-releasing hormone (GnRH) secretion, regulation of actin cytoskeleton, and MAPK signaling pathways. Moreover, the number of genes associated with proliferation and differentiation (srf, nr4a1), cell cycle (ppard, ccnb2), and apoptosis (xiap) were up-regulated in the mid-stage. With the maximum energy saving, this seasonal pattern of T. s. elegans determines optimal reproductive success and thus adapts better to the environment. These results provide the basis for the invasion mechanism of T. s. elegans and lay the foundation for deeper insight into the molecular mechanism of seasonal spermatogenesis in reptiles.

Knowledge, attitude, and perceptions about polycystic ovarian syndrome, and its determinants among Pakistani undergraduate students.

OBJECTIVE: The aim of the study was to evaluate knowledge, attitude, perception, and assess the determinants of polycystic ovarian syndrome (PCOS) among undergraduate students. METHODS: A cross-sectional study was conducted among female undergraduate students in Pakistan using a survey. The questionnaire was formulated in English language by a review of literature and expert consensus. The sampling approach was convenient, and survey was available as electronic as well as hardcopy. Data were analyzed using IBM SPSS v23. Descriptive statistics namely mean ([Formula: see text]), standard deviation (SD), or median ([Formula: see text]) and interquartile range (IQR) were used dependent upon data distribution. In addition, range (R) was also utilized to express the results. The logistic and linear regression analyses were also conducted. Study received ethical clearance from ethics committees. RESULTS: A total of 646 responses were analyzed. The average PCOS knowledge score was 11.58 ± 4.99 (overall), 12.02 ± 4.73 (medical students), 9.36 ± 5.65 (non-medical students) (α = 0.861). 68.6% participants did not feel embarrassed while discussing PCOS in the society, but 67.3% never discussed it with a doctor. Lack of self-knowledge (31.6%) and shyness/reluctance (21.4%) were identified as barriers by most students. Further, obesity, irregular menstrual periods, family history, hirsutism and contraceptive use were observed to be determinants for having PCOS (AOR > 2, p<0.05). The disease knowledge score was higher for participants studying in medical college (ß = 0.184), having menstrual periods < 5 days (ß = 0.125), and with a family history (ß = 0.121) (p<0.05). CONCLUSION: The disease knowledge among undergraduates was inadequate. However, there is greater acknowledgement of PCOS as a problem for Pakistani women and barriers have been identified in the study. Conducting awareness campaigns within academic institutions which include promoting disease education, arranging talks, distributing merchandise with disease awareness signage, would greatly help in raising awareness of the disease and lowering stigma and hesitancy.