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BACKGROUND: Enterococcal bacteremia has become prevalent in the recent decade, especially in hospitalized patients. Moreover, the rise in resistance patterns against antibiotic drugs regarding enterococci infection, such as cephalosporins, ampicillin and vancomycin, is prevailing. The major driving force behind this is the incongruous use of antibiotics with a minor contribution from environmental stressors which calls for vigilant and prudent administration of evidence-based antibiotics. METHODS: A retrospective study was conducted from January 1 2017 until December 31 2021, at the tertiary care center, Dr Ziauddin Hospital in Karachi, Pakistan. RESULTS: Our research revealed ampicillin resistance in 87 (63.5%), with an estimated 25 (18.8%) mortality. Male gender 19 (76%) and vancomycin resistance 13 (52%) were associated with increased mortality. Furthermore, appropriate antibiotic therapy reduced the risk of death compared with inappropriate and excessive use of antibiotics 10 (40%) vs. 15 (60%) vs. 20 (80%) respectively. Targeted therapy with amoxicillin/clavulanic acid was associated with lower mortality 1 (4%) and higher discharge rates 34 (32.1%). On Kaplan-Meier survival, targeted therapy with amoxicillin/clavulanic acid was associated with shorter hospital stays and prolonged survival. UTI was found as the most common source of enterococcal bacteremia 57 (41.6%), followed by respiratory 21 (15.3%) and intra-abdominal 13 (9.5%). In 26 (19%) patients, no identifiable source of infection was found. CONCLUSION: Vancomycin resistance and male gender were found independent risk factors for mortality. The use of inappropriate antibiotics significantly increases mortality in these patients. The appropriate antibiotic therapy reduces the risk of death. Furthermore, overuse of antibiotics didn't reduce mortality; instead increased the financial burden and chances of developing multi-drug resistant strains of other organisms by increasing hospital stays of patients.
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Antibacterianos , Bacteriemia , Pessoal de Saúde , Gestão de Antimicrobianos , Humanos , Bacteriemia/tratamento farmacológico , Bacteriemia/mortalidade , Antibacterianos/uso terapêutico , Enterococos Resistentes à Vancomicina , Estudos Retrospectivos , Enterococcus/efeitos dos fármacos , Paquistão/epidemiologia , Padrões de Prática MédicaRESUMO
Through the transition of novel ideas, products, technologies, and business models, info-globalization facilitates the flow and expansion of cross-border information and resources. In the meantime, this stimulates the potential of informational globalization and the internet for environmental and other technological advancements, and assists to the realization of cleaner and greener production and consumption. However, prior studies have completely disregarded this facet of globalization. Thus, this novel study evaluates the role of technological innovation (TIN) and information globalization (ING) in predicting ecological footprints (EFP) and carbon emissions (CO2) in the world's top ten greenest economies. Besides, this study also unveils the moderating role of TIN and ING for environmental sustainability. The novel research employs non-parametric causality-in-quantiles approaches on quarterly data from 1994Q1 to 2019Q4 in order to quantify for causality-in-mean and causality-in-variance, since there may be no causation at first moment, but higher-order interdependencies may exist. The findings revealed that TIN and ING possess significant predictive potential for both ecological footprint and carbon emissions, indicating asymmetric predictability over environmental sustainability. Moreover, TIN and ING asserted a significant interaction role when it comes to predicting pollution levels in chosen countries. Overall, it is essential to note that natural resource conservation and pollution mitigation via green and technical innovation become a dilemma since pollution has no boundaries and will always stoke fires beyond them. The provision of financial and R&D assistance, as well as the use of mass and social media to raise awareness not only in their own regions but also in neighboring countries, might contribute to the achievement of SDG 13 and Cope26's ambition of cutting pollution by 2030.
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Invenções , Desenvolvimento Sustentável , Humanos , Carbono , Dióxido de Carbono , Desenvolvimento Econômico , Internacionalidade , Energia RenovávelRESUMO
Ride-sharing services are a sustainable form of the transportation system that needs to be popularized among students by examining the crucial factors that determine the students' behavior to use the innovative service. Therefore, this paper attempts to explore students' behavior regarding the use of ride-sharing services by extending the "Technology Acceptance Model." The expanded model includes the current TAM structures and integrates contextual stimuli that may or may not affect the ride-sharing service's behavior. Moreover, the study focuses on determining the moderating role of perceived risk between the proposed relationships. The paper uses PLS-SEM to analyze the research model and determine the results of the hypotheses. The findings of this research are useful for ride-sharing service providers and policymakers who can promote the services among students by reducing the perceived risks and promoting the environmental benefits of ride-sharing. Furthermore, the limitations of this paper pose future research directions.
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BACKGROUND: Globally, occupational stress is a common finding among dentists. The present study aimed to assess prevalence of perceived stress among practicing dentists of Karachi, Pakistan, and assess the perceived stress levels according to the professional standing among dental surgeons. METHODS: A cross-sectional survey was conducted using a convenience sampling technique in which 200 dentists from Karachi were recruited. A self-constructed questionnaire was used to collect data, including demographic and professional backgrounds. Stress level assessment was performed using the perceived stress scale (PSS). RESULTS: The response rate was 78.5%. In general, a moderate stress level (mean PSS = 18.35 ± 5.417) appeared in the sample size of 157 dentists, and the prevalence of perceived stress was 86%. The level of perceived stress was significantly lower in groups including 40 years old and above (mean diff; p = - 0.197), Rupees 1 lac (100,000) and more of monthly income (mean diff; p = 0.029), 11 and more years of experience (mean diff; p = 0.001) and Assistant Professor/Associate Professor/Professor (mean diff; p = 0.035). CONCLUSION: All groups representing the senior status of dentists have appeared with lower stress than groups representing the junior status of dentists. Exploratory studies are required to discover an effective coping strategy to deal with occupational stress among the junior dentists of Karachi.
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Estresse Ocupacional , Cirurgiões , Adulto , Estudos Transversais , Odontólogos , Humanos , Inquéritos e QuestionáriosRESUMO
This research examines the impact of the COVID-19 on cryptocurrencies' connectedness by employing two techniques: TVP-VAR-based connectedness and causality in the quantiles. First, the TVP-VAR-based connectedness unveils that cryptocurrencies act as a net receiver and transmitter of shocks, with Bitcoin, Ethereum are the highest transmitters among others. Moreover, the causality-in-quantile test shows that COVID-19 significantly causes spillover connectedness among cryptocurrencies, mainly at the quantiles ranging from 0.1 to 0.8, while an insignificant causal relationship is found in few cases. The study has implications for investors and policymakers.
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All over the world, humankind and nature are paying off economic development's opportunity cost through accelerated environmental degradation. Renewable energy is the best option to control and minimize environmental degradation for sustainable development. This study's primary motive is to examine the nonlinear relationship between renewable energy consumption, natural resource rent, and ecological footprint in the context of the world's top 15 renewable energy consumption economies to achieve sustainable development. Panel time-series data from 1996 to 2018 is focused on concluding the study. Panel Smooth Transition Model is used to explore the nonlinear relationship and transition between the low and high regimes because of the nonlinear behavior. The study's results suggest a negative association between renewable energy consumption and ecological footprint and a positive relationship between natural resource rent and ecological footprint in both low and high regimes in the case of these 15 economies. It is highly recommended that the nations must shift their energy consumption policies towards renewable energy sources by investing in renewable energy technology and research for a more sustainable development.
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Dióxido de Carbono , Desenvolvimento Econômico , Recursos Naturais , Energia RenovávelRESUMO
BACKGROUND: There is limited data on Pakistani dental students perceived competence in managing orofacial pain (OFP). This study aims to evaluate dental students self-perceived competence regarding the management of orofacial pain. METHODS: This cross-sectional study was conducted in Karachi at randomly selected two public and four private dental schools. This survey was conducted online from November 2020 to December 2020 in six dental schools. A questionnaire link was sent to the 475 students. A chi-square test and independent-sample t-test were conducted to assess the frequency distribution and compare mean scores of knowledge, diagnosis, and management parameters. RESULTS: Of the 475 students, 280 students filled the online survey leaving a response rate of 59%. A significant number of fourth-year students, 65 (51%, p = 0.005), feels knowledgeable regarding neuropathic pain compared to third-year students. The majority of the fourth-year students, 100 (78%, p = 0.010), feel comfortable managing intraoral pain. Almost all the students reported thinking that they need more knowledge related to five types of OFP. The fourth-year students had high mean scores related to knowledge, comfort in diagnosing and managing OFP categories. CONCLUSION: This study found that dental students perceived competence regarding orofacial pain management varies in relation to specific categories, being lowest for psychogenic pain.
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Estudantes de Odontologia , Transtornos da Articulação Temporomandibular , Competência Clínica , Estudos Transversais , Educação em Odontologia , Dor Facial/terapia , Humanos , Inquéritos e QuestionáriosRESUMO
The naturopathic treatment of obesity is a matter of keen interest to develop efficient natural pharmacological routes for disease management with low or negligible toxicity and side effects. For this purpose, optimized ultrasonicated hydroethanolic extracts of Taraxacum officinale were evaluated for antiobesity attributes. The 2,2-diphenyl-1-picrylhydrazyl method was adopted to evaluate antioxidant potential. Porcine pancreatic lipase inhibitory assay was conducted to assess the in vitro antiobesity property. Ultra-high performance chromatography equipped with a mass spectrometer was utilized to profile the secondary metabolites in the most potent extract. The 60% ethanolic extract exhibited highest extract yield (25.05 ± 0.07%), total phenolic contents (123.42 ± 0.007 mg GAE/g DE), total flavonoid contents (55.81 ± 0.004 RE/g DE), DPPH-radical-scavenging activity (IC50 = 81.05 ± 0.96 µg/mL) and pancreatic lipase inhibitory properties (IC50 = 146.49 ± 4.24 µg/mL). The targeted metabolite fingerprinting highlighted the presence of high-value secondary metabolites. Molecular-binding energies computed by docking tool revealed the possible contribution towards pancreatic lipase inhibitory properties of secondary metabolites including myricetin, isomangiferin, icariside B4, kaempferol and luteolin derivatives when compared to the standard drug orlistat. In vivo investigations revealed a positive impact on the lipid profile and obesity biomarkers of obese mice. The study presents Taraxacum officinale as a potent source of functional bioactive ingredients to impart new insights into the existing pool of knowledge of naturopathic approaches towards obesity management.
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Fármacos Antiobesidade/farmacologia , Metabolômica , Simulação de Acoplamento Molecular , Obesidade/tratamento farmacológico , Extratos Vegetais/farmacologia , Taraxacum/química , Animais , Fármacos Antiobesidade/metabolismo , Fármacos Antiobesidade/uso terapêutico , Peso Corporal/efeitos dos fármacos , Cromatografia Líquida de Alta Pressão , Etanol/química , Lipase/antagonistas & inibidores , Lipase/química , Lipase/metabolismo , Camundongos , Obesidade/metabolismo , Pâncreas/enzimologia , Extratos Vegetais/metabolismo , Extratos Vegetais/uso terapêutico , Conformação Proteica , Espectrometria de Massas em TandemRESUMO
Microglia transform from homeostatic to disease-associated-microglia (DAM) profiles in neurodegeneration. Within DAM, we recently identified distinct pro-inflammatory and anti-inflammatory sub-profiles although transcriptional regulators of homeostatic and distinct DAM profiles remain unclear. Informed by these studies, we nominated CEBPα, IRF1, and LXRß as likely regulators of homeostatic, pro-inflammatory and anti-inflammatory DAM states and performed in-vitro siRNA studies in primary microglia to identify roles of each transcriptional factor (TF) in regulating microglial activation, using an integrated transcriptomics, bioinformatics and experimental validation approach. Efficient (>70%) silencing of TFs in microglia revealed reciprocal regulation between each TF specifically following pro-inflammatory activation. Neuroinflammatory transcriptomic profiling of microglia coupled with qPCR validation revealed distinct gene clusters with unique patterns of regulation by each TF, which were independent of LPS stimulation. While all three TFs (especially IRF1 and LXRß) positively regulated core DAM genes (Apoe, Axl, Clec7a, Tyrobp, and Trem2) as well as homeostatic and pro-inflammatory DAM genes, LPS, and IFNγ increased pro-inflammatory DAM but suppressed homeostatic and anti-inflammatory DAM gene expression via an Erk1/2-dependent signaling pathway. IRF1 and LXRß silencing suppressed microglial phagocytic activity for polystyrene microspheres as well as fAß42 while IRF1 silencing strongly suppressed production of pro-inflammatory cytokines in response to LPS. Our studies reveal complex transcriptional regulation of homeostatic and DAM profiles whereby IRF1, LXRß, and CEBPα positively regulate both pro- and anti-inflammatory DAM genes while activating stimuli independently augment pro-inflammatory DAM responses and suppress homeostatic and anti-inflammatory responses via Erk signaling. This framework can guide development of therapeutic immuno-modulatory strategies for neurodegeneration.
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Proteínas Estimuladoras de Ligação a CCAAT/metabolismo , Homeostase/fisiologia , Inflamação/metabolismo , Fator Regulador 1 de Interferon/metabolismo , Receptores X do Fígado/metabolismo , Microglia/metabolismo , Doença de Alzheimer/metabolismo , Animais , Encéfalo/metabolismo , Células Cultivadas , Regulação da Expressão Gênica , Camundongos Endogâmicos C57BL , Cultura Primária de Células , Transcrição GênicaRESUMO
BACKGROUND: Microglia and CNS-infiltrating monocytes/macrophages (CNS-MPs) perform pro-inflammatory and protective anti-inflammatory functions following ischemic stroke. Selective inhibition of pro-inflammatory responses can be achieved by Kv1.3 channel blockade, resulting in a lower infarct size in the transient middle cerebral artery occlusion (tMCAO) model. Whether beneficial effects of Kv1.3 blockers are mediated by targeting microglia or CNS-infiltrating monocytes/macrophages remains unclear. METHODS: In the 30-min tMCAO mouse model, we profiled functional cell-surface Kv1.3 channels and phagocytic properties of acutely isolated CNS-MPs at various timepoints post-reperfusion. Kv1.3 channels were flow cytometrically detected using fluorescein-conjugated Kv1.3-binding peptide ShK-F6CA as well as by immunohistochemistry. Quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) was performed to measure Kv1.3 (Kcna3) and Kir2.1 (Kcnj2) gene expression. Phagocytosis of 1-µm microspheres by acutely isolated CNS-MPs was measured by flow cytometry. RESULTS: In flow cytometric assays, Kv1.3 channel expression by CD11b+ CNS-MPs was increased between 24 and 72 h post-tMCAO and decreased by 7 days post-tMCAO. Increased Kv1.3 expression was restricted to CD11b+CD45lowLy6clow (microglia) and CD11b+CD45highLy6Clow CNS-MPs but not CD11b+CD45highLy6chigh inflammatory monocytes/macrophages. In immunohistochemical studies, Kv1.3 protein expression was increased in Iba1+ microglia at 24-48 h post-tMCAO. No change in Kv1.3 mRNA in CNS-MPs was observed following tMCAO. CONCLUSIONS: We conclude that resident microglia and a subset of CD45highLy6clow CNS-MPs are the likely cellular targets of Kv1.3 blockers and the delayed phase of neuroinflammation is the optimal therapeutic window for Kv1.3 blockade in ischemic stroke.
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Isquemia Encefálica/metabolismo , Encéfalo/metabolismo , Canal de Potássio Kv1.3/biossíntese , Fagócitos/metabolismo , Acidente Vascular Cerebral/metabolismo , Animais , Encéfalo/patologia , Isquemia Encefálica/genética , Isquemia Encefálica/patologia , Expressão Gênica , Canal de Potássio Kv1.3/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fagócitos/patologia , Acidente Vascular Cerebral/genética , Acidente Vascular Cerebral/patologia , Fatores de TempoRESUMO
The leaves of Cycas revoluta were explored for their antioxidant, α-glucosidase and α-amylase inhibitory properties to develop safe and diet based therapeutic treatment of diabetes. In optimized fractionation, 60% ethanol provided the highest extract yield of 19.35±0.05a%, TPC 95.70±1.60a mg GAE/g and TFC 55 .60 ± 1.20a mg Rutin/g extract. The antioxidant and anti α-glucosidase activities of 60% ethanolic extracts were also promising and statistically significant as compared with remaining plant extracts. Ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-Q-TOF-MS/MS) analysis of the leaf extract revealed the presence of three apigenin derivatives, kaempferol derivative, hexadecenoic acid and citric acid. The binding energy values of molecular docking studies supported the synergistic behavior of leaf extract to inhibit α-glucosidase activity. The leaves of Cycas revoluta were proved to be apigenin rich natural pool of metabolites of antidiabetic importance to improvise food functionalities.
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Antioxidantes/farmacologia , Cycas/metabolismo , Inibidores de Glicosídeo Hidrolases/farmacologia , Extratos Vegetais/farmacologia , Folhas de Planta/metabolismo , Antioxidantes/química , Apigenina/análise , Cromatografia Líquida de Alta Pressão , Cycas/química , Avaliação Pré-Clínica de Medicamentos , Etanol , Inibidores de Glicosídeo Hidrolases/química , Simulação de Acoplamento Molecular , Extratos Vegetais/química , Plantas Medicinais/química , Plantas Medicinais/metabolismo , Espectrometria de Massas em Tandem , alfa-Amilases/antagonistas & inibidoresRESUMO
Current work was performed to evaluate antioxidant activity, α-glucosidase inhibition, phytochemical profiling and in vivo hypoglycemic activity of freeze dried, ultrasonicated Hyophorbe indica leaf extracts. The highest total phenolic contents of 208.77±2.11 mg GAE/g DE and total flavonoid contents of 173.90±2.30 mg Rutin/g DE were obtained in 60% ethanol extract. The 60% ethanol extract exhibited maximum DPPH radical scavenging with IC50 value of 35.35±0.189µg/mL and total antioxidant power of 330.26±3.13 (ASE/g PE), respectively. The highest α-glucosidase inhibition (IC50 36.52 ± 0.08µg/mL) was also observed for 60% ethanol extract. The 60% ethanol extract at dose of 450 mg/kg body weight reduced blood glucose level of alloxan induced diabetic mice by 51.41% which was quite comparable with metformin (56.67%). Twelve compounds namely citric acid, procyanidin B3, epicatechin, procyanidin B2, catechin, catechin derivative, procyanidin B1, apigenin-c-hexocide-c-hexocide, kaempferol, kaempferol derivative, quinic acid derivative and gallic acid have been identified by using UHPLC-Q-TOF-MS/MS in 60% ethanol extract.
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Antioxidantes/metabolismo , Arecaceae , Diabetes Mellitus Experimental/tratamento farmacológico , Hipoglicemiantes/metabolismo , Metaboloma/fisiologia , Extratos Vegetais/metabolismo , Animais , Antioxidantes/isolamento & purificação , Antioxidantes/uso terapêutico , Diabetes Mellitus Experimental/sangue , Hipoglicemiantes/isolamento & purificação , Hipoglicemiantes/uso terapêutico , Camundongos , Extratos Vegetais/isolamento & purificação , Extratos Vegetais/uso terapêutico , Folhas de Planta/metabolismoRESUMO
Synthetic drugs have widely been helpful in management of diabetes mellitus type 2. However, side effects associated with synthetic drugs serve as an impetus to explore plants as alternate mode of treatment. The hydroethanolic leaf extracts of Conocarpus erectus were evaluated for phenolic contents, flavonoid distribution, antioxidant activity and antidiabetic potential. The maximum extract yield, total phenolic and flavonoid contents were exposed by 60% ethanolic extract. The Antioxidant and anti α-glucosidase tendency of 60% ethanolic extract was the most promising and complemented by in-vivo antihyperglycemic impact on mice. The findings were substantial regarding suppression of blood glucose levels in alloxan induced diabetic mice establishing the Conocarpus erectus as proficient pool of nutraceuticals for diabetes mellitus type 2 management.
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Combretaceae/química , Diabetes Mellitus Experimental/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Fitoterapia/métodos , Animais , Antioxidantes/farmacologia , Glicemia/efeitos dos fármacos , Diabetes Mellitus Experimental/induzido quimicamente , Flavonoides/análise , Inibidores de Glicosídeo Hidrolases/farmacologia , Masculino , Camundongos , Fenóis/análise , Extratos Vegetais/química , Extratos Vegetais/uso terapêutico , Folhas de Planta/químicaRESUMO
BACKGROUND: Kv1.3 potassium channels regulate microglial functions and are overexpressed in neuroinflammatory diseases. Kv1.3 blockade may selectively inhibit pro-inflammatory microglia in neurological diseases but the molecular and cellular mechanisms regulated by Kv1.3 channels are poorly defined. METHODS: We performed immunoblotting and flow cytometry to confirm Kv1.3 channel upregulation in lipopolysaccharide (LPS)-activated BV2 microglia and in brain mononuclear phagocytes freshly isolated from LPS-treated mice. Quantitative proteomics was performed on BV2 microglia treated with control, LPS, ShK-223 (highly selective Kv1.3 blocker), and LPS+ShK-223. Gene ontology (GO) analyses of Kv1.3-dependent LPS-regulated proteins were performed, and the most representative proteins and GO terms were validated. Effects of Kv1.3-blockade on LPS-activated BV2 microglia were studied in migration, focal adhesion formation, reactive oxygen species production, and phagocytosis assays. In vivo validation of protein changes and predicted molecular pathways were performed in a model of systemic LPS-induced neuroinflammation, employing antigen presentation and T cell proliferation assays. Informed by pathway analyses of proteomic data, additional mechanistic experiments were performed to identify early Kv1.3-dependent signaling and transcriptional events. RESULTS: LPS-upregulated cell surface Kv1.3 channels in BV2 microglia and in microglia and CNS-infiltrating macrophages isolated from LPS-treated mice. Of 144 proteins differentially regulated by LPS (of 3141 proteins), 21 proteins showed rectification by ShK-223. Enriched cellular processes included MHCI-mediated antigen presentation (TAP1, EHD1), cell motility, and focal adhesion formation. In vitro, ShK-223 decreased LPS-induced focal adhesion formation, reversed LPS-induced inhibition of migration, and inhibited LPS-induced upregulation of EHD1, a protein involved in MHCI trafficking. In vivo, intra-peritoneal ShK-223 inhibited LPS-induced MHCI expression by CD11b+CD45low microglia without affecting MHCI expression or trafficking of CD11b+CD45high macrophages. ShK-223 inhibited LPS-induced MHCI-restricted antigen presentation to ovalbumin-specific CD8+ T cells both in vitro and in vivo. Kv1.3 co-localized with the LPS receptor complex and regulated LPS-induced early serine (S727) STAT1 phosphorylation. CONCLUSIONS: We have unraveled novel molecular and functional roles for Kv1.3 channels in pro-inflammatory microglial activation, including a Kv1.3 channel-regulated pathway that facilitates MHCI expression and MHCI-dependent antigen presentation by microglia to CD8+ T cells. We also provide evidence for neuro-immunomodulation by systemically administered ShK peptides. Our results further strengthen the therapeutic candidacy of microglial Kv1.3 channels in neurologic diseases.
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Canal de Potássio Kv1.3/biossíntese , Lipopolissacarídeos/farmacologia , Microglia/efeitos dos fármacos , Microglia/metabolismo , Proteômica/métodos , Animais , Linhagem Celular , Células Cultivadas , Relação Dose-Resposta a Droga , Feminino , Canal de Potássio Kv1.3/imunologia , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Macrófagos/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Microglia/imunologiaRESUMO
BACKGROUND AND PURPOSE: The purpose of this study is to evaluate the frequency and clinical utility of repeat cerebrovascular imaging with computed tomography angiography (CTA) of the head after contrast-enhanced magnetic resonance angiography (CE-MRA) of the head in acute stroke patients. MATERIALS AND METHODS: All stroke patients admitted to 2 academic medical centers from January 1, 2012 through December 31, 2014 were identified as part of prospective radiology database if they underwent CE-MRA of the head followed by subsequent CTA of the head within 7 days. Two vascular neurologists blinded to CTA results retrospectively reviewed medical records including documented indications for imaging studies and clinical changes in patients to determine necessity of CTA. RESULTS: Of 1355 acute stroke patients who underwent CE-MRA of the head, 195 (14%) patients underwent subsequent CTA of the head within 7 days, including 33 patients with nondiagnostic CE-MRA because of motion artifact. Of the remaining 162 (12%) patients, 69 (43%) were considered to have an unnecessary CTA of the head. Multivariable logistic regression analysis identified (1) absence of new neurologic examination changes [OR 7.29; 95% CI 1.92-27.63] and (2) same documented indication for both studies [OR 6.47; 95% CI 3.04-13.78] as significant predictors of an unnecessary CTA. Changes in clinical management after CTA were significantly more common in necessary CTAs compared with studies determined to be unnecessary (42% versus 7%, P < .0001). CONCLUSION: The utility of repeat cerebrovascular imaging with CTA of the head following a diagnostic CE-MRA is low when there is no change in neurologic examination or when ordered for the same indication.
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Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Hospitalização , Angiografia por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico por imagem , Procedimentos Desnecessários , Adulto , Idoso , Distribuição de Qui-Quadrado , Meios de Contraste/administração & dosagem , Bases de Dados Factuais , Feminino , Georgia , Hospitais Universitários , Humanos , Pacientes Internados , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia , Fatores de TempoRESUMO
This case presents a somewhat unique and different phenotype of hereditary spastic paraplegia from previously reported kinase D-interacting substrate of 220 kDa (KIDINS220) gene mutation-related disease. We report a unique putative causative heterozygous mutation in KIDINS220 in a pure hereditary spastic paraplegia (HSP) patient expanding the HSP group further. We also deliberate on how our case was different from prior KIDINS220-related pathologies including spastic paraplegia, intellectual disability, nystagmus, and obesity (SINO) syndrome, and the observation of KIDINS220 and aquaporin-4 (AQP4) downregulation in the ventricular ependymal lining of idiopathic normal pressure hydrocephalus (iNPH) patients. These findings warrant further investigations of the biology of KIDINS220. With the advent of new gene editing technologies like Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/CRISPR-associated protein 9 (Cas9), variants such as ours provide an opportunity for targeted precision medicine.
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This study analyzes the causal connection between financial inclusion and carbon emission in selected South Asian countries through a quantile technique-based linear Granger and non-parametric causality test. The analysis of the study covers quarterly data from 1980 Q1 to 2019 Q4. However, the linear Granger causality assessment outcome does not indicate any causal relationship between financial inclusion and carbon emission. In contrast, results from non-parametric assessment reveal a non-linear connection between the variables. The non-parametric test results of the South Asian countries exhibit that financial inclusion leads to carbon emission, which instigates the deterioration of the environment, except for Bhutan. Subsequently, creating awareness by promoting renewable energy resources is essential while investing in fuel-efficient technology to reduce the dependence on fossil fuels. The results of this study provide significant information to the governments and policymakers in emerging countries to improve financial literacy among people to reduce the risk of global warming by encouraging investment in energy-efficient resources.
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Dióxido de Carbono , Desenvolvimento Econômico , Humanos , Ásia Meridional , Dióxido de Carbono/análise , Energia Renovável , CarbonoRESUMO
This study examines long-term connection and short-term dynamics concerning ecological footprint and six independent variables, named fossil fuel consumption, energy consumption, financial depth, trade, GDP, and ICT for Pakistan's duration from 1960 to 2019. The "QARDL-quantile autoregressive distributed lag" technique is used for time series and panel estimation. The QARDL model exhibits the connection between variables over the quantiles range, reflecting varying stages of Pakistan's ecological footprint. The results exhibit noticeable quantile-varying co-integration connection among ecological footprint and six independent variables. The results accentuate the significant influence of energy consumption, strong financial position, economic growth, and ICT technologies on ecological well-being, which assists in understanding short and long-term impact on the environment in Pakistan.
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Dióxido de Carbono , Desenvolvimento Econômico , Dióxido de Carbono/análise , Combustíveis Fósseis , Paquistão , TecnologiaRESUMO
Global warming is a life-threatening risk to mankind and its survival; to combat this risk, the considerable contribution of renewable energy cannot be overlooked for sustainable growth globally. The aim of this paper is to scrutinize the threshold level and asymmetric connection among renewable energy consumption, foreign direct investment, financial inclusion, and agricultural productivity in dissimilar regimes of the different income levels of 123 countries from 1995 to 2019 by applying an advance technique PSTR (panel smooth transition regression) model. The PSTR model results imply that the connection between renewable energy consumption and agricultural productivity at all the estimates is non-linear. Moreover, in all countries, there is a positive and significant connection among renewable energy consumption, foreign direct investment, financial inclusion, and agricultural productivity in both low and high regimes, except the carbon emission, which has a negative and significant impact on agricultural productivity. Based on the results of this study, the recommendations are as follows: (i) to increase renewable energy consumption, efficient-energy resources should be used by farmers for the agricultural process; (ii) the dependence on non-renewable energy resources should be minimized and shifted towards natural and renewable resources.
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Dióxido de Carbono , Desenvolvimento Econômico , Energia Renovável , Internacionalidade , Investimentos em Saúde , AgriculturaRESUMO
According to the United Nations Agenda, the 2023 sustainable environment is necessary to secure this planet's future; public-private partnerships investment in energy is crucial to sustainable development. The research examines the quantile association between public-private partnership ventures in energy and environmental degradation in ten developing nations, and data is used from January 1998-December 2016. The advanced econometrics quantile-on-quantile regression approach is used to control the issues of heterogeneity and asymmetric relationship. According to the quantile-on-quantile approach, there is a strong positive association between public-private partnerships in energy and environmental degradation in Argentina, Brazil, Bangladesh, and India. But the negative relationship is observed on different quantiles of China, Malaysia, Mexico, Peru, Thailand, and the Philippines. The findings suggest that the world needs to act as a single community and divert its resources toward renewable energy sources to control climate change; also, to accomplish the UN 15-year road map of Agenda 2023 with 17-SDGs; out of these 17 sustainable goals, SDG-7 is related to affordable and clean energy, SDG-11 is about sustainable cities and communities, and SDG-13 focuses on climate action for sustainable development.