Tannin in Ruminant Nutrition: Review.

Tannins are polyphenols characterized by different molecular weights that plants are able to synthetize during their secondary metabolism. Macromolecules (proteins, structural carbohydrates and starch) can link tannins and their digestion can decrease. Tannins can be classified into two groups: hydrolysable tannins and condensed tannins. Tannins are polyphenols, which can directly or indirectly affect intake and digestion. Their ability to bind molecules and form complexes depends on the structure of polyphenols and on the macromolecule involved. Tannins have long been known to be an "anti-nutritional agent" in monogastric and poultry animals. Using good tannins' proper application protocols helped the researchers observe positive effects on the intestinal microbial ecosystem, gut health, and animal production. Plant tannins are used as an alternative to in-feed antibiotics, and many factors have been described by researchers which contribute to the variability in their efficiencies. The objective of this study was to review the literature about tannins, their effects and use in ruminant nutrition.

Community-Based Assessment of Knowledge, Attitude, Practices and Risk Factors Regarding COVID-19 Among Pakistanis Residents During a Recent Outbreak: A Cross-Sectional Survey.

Exceptional precautionary measures have been adopted to stop the transmission and control of COVID-19 through the world and Pakistan is facing lockdown in this scenario. Public loyalty to precautionary measures is affected by their knowledge, attitude, risk factors and practices (KAP) towards COVID-19. The present study was conducted among the Pakistani residents to observe the knowledge, attitude, practices and risk factors towards COVID-19 outbreak in Pakistan. A questionnaire was designed, and a cross-sectional survey was conducted among participants of the study area. Participants were asked the questions regarding knowledge, attitude, practices and risk factors towards COVID-19. Data were analyzed by SPSS and t/F test and correlation was applied among the knowledge, attitude, risk factors and practices. A total of 1060 questionnaires were received. 1004 were included while 56 were excluded. The highest representation was from Punjab province (65.6%), female (63%) and age group of 21-30 years (62.1%). Most participants were single (85%), Muslim (99.4%), Urdu speaking (45.6%) and were graduates (51.5%). Most of the participants were students (52.9%) and were from economically middle-class families (40.8%). The knowledge was positively correlated with attitude and practices whereas negatively correlated with risk factors (P < 0.05). The attitude was negatively correlated with risk factor and positively correlated with practices. The risk factors and practices were positively correlated with each other. Health education program to improve the COVID-19 knowledge, attitude, practices and risk factors should be initiated to combat current health challenge.

Comparison between primary closure with Limberg Flap versus open procedure in treatment of pilonidal sinus, in terms of frequency of post-operative wound infection.

OBJECTIVE: Pilonidal sinus is a disorder of the sacrococcygeal region affecting younger individuals with a higher hair and weight distribution. Treatment involves the use of various surgical modalities, most of which are associated with a high rate of complications. Open procedure (OP) and Limberg Flap (LF) are two commonly performed surgical procedures for the correction of pilonidal sinus disease in our setup. The objective of our study was to compare the treatment of pilonidal sinus disease by primary closure with Limberg Flap verses Open procedure in terms of frequency of postoperative wound infection. METHODS: The study is a randomized clinical trial (RCT) conducted at the department of surgery, military hospital, Rawalpindi, Pakistan. It was carried out over a period of 8 months from 16 February, 2015 to 16 September, 2015. Using consecutive non-probability sampling, a total of 60 patients were selected, 30 of whom underwent Limberg Flap procedure and the remaining 30 underwent open procedure. Postoperatively, observations for wound infection on date of discharge and then again on the various follow-up visits over the next 3 weeks. The data collected was then compared by applying the chi-square test, with p-value less than 0.05 considered statistically significant. RESULTS: Our results showed that both primary closure with Limberg flap, and open procedure are comparable options in terms of wound infection. There was no statistical significance in the incidence of post operative infections, between the two surgeries. CONCLUSION: In terms of wound infection, both procedures are satisfactory surgical procedures for Pilonidal sinus disease.

Comparing the effectiveness of topical dexamethasone emollient, lidocaine gel, and glycerin emollient on the endotracheal tube for postoperative hoarseness of voice, sore throat, and laryngospasm.

During general anesthesia, inserting a relatively stiff endotracheal tube using a metallic laryngoscope through the soft tissues of the pharynx and larynx, along with applying a pressured cuff, can result in varying degrees of tissue trauma and adverse outcomes. Anesthesiologists commonly encounter post-operative issues such as hoarseness, sore throat, and laryngospasm. This study aimed to compare the effectiveness of topical applications of dexamethasone emollient, lidocaine gel, and glycerin emollient in reducing these complications. One hundred patients were randomly assigned to four groups of 25 patients each: the control group (Group C), lidocaine gel group (Group L), glycerin emollient group (Group G), and dexamethasone emollient group (Group D). The assigned medication was topically applied to the endotracheal tube, and patients were monitored for postoperative laryngospasm, hoarseness, and sore throat within the first 24 hours. No statistically significant differences were found among the four groups in terms of demographic characteristics, postoperative sore throat, hoarseness, or laryngospasm (p>0.05). Lidocaine gel was an effective drug that can be used to attenuate the incidence rate of post-operative sore throat.

Pulmonary abnormality screening on chest x-rays from different machine specifications: a generalized AI-based image manipulation pipeline.

BACKGROUND: Chest x-ray is commonly used for pulmonary abnormality screening. However, since the image characteristics of x-rays highly depend on the machine specifications, an artificial intelligence (AI) model developed for specific equipment usually fails when clinically applied to various machines. To overcome this problem, we propose an image manipulation pipeline. METHODS: A total of 15,010 chest x-rays from systems with different generators/detectors were retrospectively collected from five institutions from May 2020 to February 2021. We developed an AI model to classify pulmonary abnormalities using x-rays from a single system. Then, we externally tested its performance on chest x-rays from various machine specifications. We compared the area under the receiver operating characteristics curve (AUC) of AI models developed using conventional image processing pipelines (histogram equalization [HE], contrast-limited histogram equalization [CLAHE], and unsharp masking [UM] with common data augmentations) with that of the proposed manipulation pipeline (XM-pipeline). RESULTS: The XM-pipeline model showed the highest performance for all the datasets of different machine specifications, such as chest x-rays acquired from a computed radiography system (n = 356, AUC 0.944 for XM-pipeline versus 0.917 for HE, 0.705 for CLAHE, 0.544 for UM, p [Formula: see text] 0.001, for all) and from a mobile x-ray generator (n = 204, AUC 0.949 for XM-pipeline versus 0.933 for HE, p = 0.042, 0.932 for CLAHE (p = 0.009), 0.925 for UM (p = 0.001). CONCLUSIONS: Applying the XM-pipeline to AI training increased the diagnostic performance of the AI model on the chest x-rays of different machine configurations. RELEVANCE STATEMENT: The proposed training pipeline would successfully promote a wide application of the AI model for abnormality screening when chest x-rays are acquired using various x-ray machines. KEY POINTS: • AI models developed using x-rays of a specific machine suffer from generalization. • We proposed a new image processing pipeline to address the generalization problem. • AI models were tested using multicenter external x-ray datasets of various machines. • AI with our pipeline achieved the highest diagnostic performance than conventional methods.

Short-term neurochemical effects of transcutaneous trigeminal nerve stimulation using 7T magnetic resonance spectroscopy.

BACKGROUND AND PURPOSE: The purpose was to explore the effects of transcutaneous trigeminal nerve stimulation (TNS) on neurochemical concentrations (brainstem, anterior cingulate cortex [ACC], dorsolateral prefrontal cortex [DLPFC], ventromedial prefrontal cortex [VMPFC], and the posterior cingulate cortex [PCC]) using ultrahigh-field magnetic resonance spectroscopy. METHODS: This double-blinded study tested 32 healthy males (age: 25.4 ± 7.3 years) on two separate occasions where participants received either a 20-minute TNS or sham session. Participants were scanned at baseline and twice post-TNS/sham administration. RESULTS: There were no group differences in concentration changes of glutamate, gamma-aminobutyric acid, glutamine, myoinositol (mI), total N-acetylaspartate, total creatine (tCr), and total choline between the baseline scan and the first post-TNS/sham scan and between the first and second post-TNS/sham scan in the brainstem, ACC, DLPFC, VMPFC, and PCC. Between the baseline scan and the second post-TNS/sham scan, changes in tCr (mean difference = 0.280 mM [0.075 to 0.485], p = .026) and mI (mean difference = 0.662 mM [0.203 to 1.122], p = .026) in the DLPFC differed between groups. Post hoc analyses indicated that there was a decrease in tCr (mean change = -0.201 mM [-0.335 to -0.067], p = .003) and no change in mI (mean change = -0.327 mM [-0.737 to 0.083], p = .118) in the TNS group; conversely, there was no change in tCr (mean change = -0.100 mM [-0.074 to 0.274], p = .259) and an increase in mI (mean change = 0.347 mM [0.106 to 0.588], p = .005) in the sham group. CONCLUSION: These data demonstrate that a single session of unilateral TNS slightly decreased tCr concentrations in the DLPFC region.

Severe hypoglycemia secondary to methimazole-induced insulin autoimmune syndrome in a 16 year old African-American male.

Insulin autoimmune syndrome (IAS) or Hirata's disease is a rare disorder characterized by hypoglycemia secondary to insulin autoantibodies (IAb). Over 200 patients have been described from Japan with significantly less numbers being reported from outside the Orient. IAS is more common in patients older than 40 yr of age with reports in the pediatric age group being notably rarer. Exposure to sulfhydryl group containing medications is implicated in the pathogenesis of this syndrome. In this report, we describe a case of IAS in an African-American adolescent. A 16-yr-old healthy African-American male was diagnosed with Graves' disease and started on Methimazole. Four weeks later, he was found unconscious and hypoglycemic (blood sugar 1.5 mmol/L). Evaluation was negative for insulinoma. Insulin antibodies were positive. Oral glucose tolerance test revealed elevated free insulin concentrations with disproportionately elevated total insulin levels. The patient was started on prednisone, diazoxide, and propranolol for management of IAS and hyperthyroidism. Thyroid radio-ablation was subsequently undertaken. The doses of prednisone and diazoxide were tapered and these medications discontinued after 9 months. The insulin antibody levels decreased gradually and became undetectable in 6 months with resolution of the hypoglycemia.

Assessing the role of urban green spaces for human well-being: a systematic review.

Human has been evolving in a natural environment over a long time; thus, he is habitual to adapt it. Green spaces are obligatory landscapes in an urban structure that provide a natural environment and accelerate other life events. In contrast, unplanned urbanization, and conversion from green to grey structures have damaged natural environmental resources. Studies through different angles have highlighted the importance of urban green spaces for human well-being but now need to identify their role according to the potential. The demands of urban green spaces may differ with the change of population size, types of grey structure, urban expansion, the altitude of the place, and geographical location. Therefore, this systematic review aims to analyse the significance of urban green spaces for human well-being. The study opted for a systematic process during the selection and organization of studies for this review. After analysing, 46 studies were finalized with the consensus of three review authors. Accordingly, literature was analysed under the central theme of "Urban Green Spaces for Human Well-being." Human Well-being was assessed under six sub-themes; physical, psychological, mental, social, subjective, and environmental well-being. The review concluded that urban green spaces are the primary pillar for a sustainable urban place and human well-being due to highly positive and positive correlations. Moreover, the study did not find any demarcation line between green spaces and grey structures according to any specific need. Therefore, the study suggested that the role of urban green spaces for human well-being should be analysed according to their potential and required optimal ratio under different communities' urban specific environments and social behaviour.

Transfer Learning-Based Model for Diabetic Retinopathy Diagnosis Using Retinal Images.

Diabetic retinopathy (DR) is a visual obstacle caused by diabetic disease, which forms because of long-standing diabetes mellitus, which damages the retinal blood vessels. This disease is considered one of the principal causes of sightlessness and accounts for more than 158 million cases all over the world. Since early detection and classification could diminish the visual impairment, it is significant to develop an automated DR diagnosis method. Although deep learning models provide automatic feature extraction and classification, training such models from scratch requires a larger annotated dataset. The availability of annotated training datasets is considered a core issue for implementing deep learning in the classification of medical images. The models based on transfer learning are widely adopted by the researchers to overcome annotated data insufficiency problems and computational overhead. In the proposed study, features are extracted from fundus images using the pre-trained network VGGNet and combined with the concept of transfer learning to improve classification performance. To deal with data insufficiency and unbalancing problems, we employed various data augmentation operations differently on each grade of DR. The results of the experiment indicate that the proposed framework (which is evaluated on the benchmark dataset) outperformed advanced methods in terms of accurateness. Our technique, in combination with handcrafted features, could be used to improve classification accuracy.

Prevalence of Fascioliasis in Livestock and Humans in Pakistan: A Systematic Review and Meta-Analysis.

Fascioliasis is a parasitic infection that affects both livestock and humans. Understanding the distribution of Fasciola spp. can help the development of preventive measures to control fascioliasis. This systematic review and meta-analysis aimed to estimate the status of fascioliasis among livestock and humans in Pakistan between 2000 and 2020. Based on the selection criteria, 25 articles were selected from Google Scholar, PubMed, and Scopus. This review included 76,099 animals, including 13,738 that were positive for fascioliasis. The overall prevalence was 18.1%; it was 0.3% in humans and 20.1% in livestock. Among animal hosts, the prevalence was highest in sheep (53.5%), followed by the goats (44.9%), cows (21.3%), buffaloes (16.8%), cattle (12.7%), and humans (0.3%). Sindh had the highest prevalence at 42.7%, followed by Baluchistan (25.2%), Punjab (17.7%), Khyber Pakhtunkhwa (10.7%), and Islamabad capital territory (1.5%). In the Punjab province, sheep had the highest prevalence (65.7%); in Khyber Pakhtunkhwa, it was buffalo (15.9%); and in Baluchistan, it was cows (28.5%). The prevalence of Fasciola spp. was higher in Sindh and Baluchistan than in the other provinces. The presented results are essential for developing preventive approaches for the management of human health and minimizing economic loss in the livestock industry in Pakistan. Preventive-curative treatments two times a year followed by a prophylactic treatment at the end of the dry season are crucial throughout the areas of Pakistan that serve as hotspots for infection by Fasciola sp. For humans, regular, prioritized surveys must be performed for high-risk populations so that the real situation can be assessed and addressed in a timely manner.

My tummy hurts - a case report of abdominal pain and macrocytic anemia caused by hypothyroidism.

A 6-year-old female presented with chronic intermittent abdominal pain for 1 year. She underwent extensive investigation, imaging and invasive procedures with multiple emergency room visits. It caused a significant distress to the patient and the family with multiple missing days at school in addition to financial burden and emotional stress the child endured. When clinical picture was combined with laboratory finding of macrocytic anemia, a diagnosis of hypothyroidism was made. Although chronic abdominal pain in pediatric population is usually due to functional causes such as irritable bowel syndrome, abdominal migraine and functional abdominal pain. Hypothyroidism can have unusual presentation including abdominal pain. The literature on abdominal pain as the main presentation of thyroid disorder is limited. Pediatricians should exclude hypothyroidism in a patient who presents with chronic abdominal pain. Contrast to its treatment, clinical presentation of hypothyroidism can be diverse and challenging, leading to a delay in diagnosis and causing significant morbidity. LEARNING POINTS: Hypothyroidism can have a wide range of clinical presentations that are often nonspecific, which can cause difficulty in diagnosis.In pediatric patients presenting with chronic abdominal pain as only symptom, hypothyroidism should be considered by the pediatricians and ruled out.In pediatric population, treatment of hypothyroidism varies depending on patients' weight and age.Delay in diagnosis of hypothyroidism can cause significant morbidity and distress in pediatrics population.