Triglyceride-glucose index: A surrogate marker of homeostasis model assessment of insulin resistance to predict diabetic nephropathy.

Objectives: To determine the association of triglyceride-glucose index with homeostasis model assessment of insulin resistance in type 2 diabetes mellitus patients, and to determine the association of triglyceride-glucose index with urinary albumin-to-creatinine ratio for predicting diabetic nephropathy. METHODS: The observational, cross-sectional study was conducted from September 2021 to September 2022 at the Department of Chemical Pathology, Pakistan Railway Hospital, Rawalpindi, Pakistan and comprised recently-diagnosed type 2 diabetes mellitus patients. Recorded data included age, gender, vitals, diabetes duration, body mass index and other pertinent demographic and clinical information. Measurements included spot urine albumin-to-creatinine ratio, triglycerideglucose index, homeostasis model assesment of insulin resistance as well as fasting serum insulin, fasting plasma glucose, glycosylated haemoglobin, triglycerides, total cholesterol and serum creatinine. On the basis of triglyceride-glucose index scores, the participants were divided into 4 quartiles; Q1=4.5-5, Q2=5.1-5.5, Q3=5.6-6, and Q4=>6. Data was analysed using SPSS 26. RESULTS: Of the 218 patients, 141(64.7%) were females and 77(35.3%) were males. The overall mean age was 49.22±11.46 years. There were 102(46.8%) overweight patients, 33(15.1%) obese and 82(37.2%) had normal weight. There were 58(26.6%) patients in Q1, 86(39.4%) in Q2, 46(21.1%) in Q3 and 28(12.8%) in Q4. Those in Q4 showed elevated fasting plasma glucose, glycated haemoglobin, triglycerides, total cholesterol, low-density lipoprotein cholesterol, homeostasis model assessment of insulin resistance and urine albumin-to-creatinine ratio (p<0.05), as well as low values for high-density lipoprotein cholesterol and estimated glomerular filtration rate(p<0.05). Fasting serum insulin was negatively linked to glycated haemoglobin (r=-0.12, p=0.07). Triglyceride-glucose index (r=0.76, p<0.001), homeostasis model assessment of insulin resistance (r=0.48, p<0.001), and urine albumin-to-creatinine ratio (r=0.10,p=0.05) positively correlated with glycated haemoglobin. Fasting serum insulin (r=-0.13, p=0.05), negatively correlated with triglyceride-glucose index, while homeostasis model assessment of insulin resistance (r= 0.32, p<0.001) and urine albumin-to-creatinine ratio (r=0.28, p=0.05) had a positive correlation. The estimated glomerular filtration rate was significantly positively linked with fasting serum insulin (r=0.05, p=0.05), and correlated significantly negatively with triglyceride-glucose index (r=-0.35, p=0.01), homeostasis model assessment of insulin resistance (r=-0.01, p=0.86) and urine albumin-to-creatinine ratio (r=-0.02, p=0.8). CONCLUSIONS: The triglyceride-glucose index showed a strong association with homeostasis model assessment of insulin resistance, and surpassed it in terms of predicting diabetic nephropathy in type 2 diabetes mellitus patients.

Prevalence of lymphedema among Anderson-Fabry disease patients: A report from the Fabry registry.

BACKGROUND: Anderson-Fabry disease (AFD) is a rare X-linked lysosomal storage disease due to a genetic variation in the α-galactosidase A (GLA) gene. As a result, the activity of the α-galactosidase A (AGAL-A) enzyme is reduced or absent, which causes sphingolipid deposition within different body parts. AFD typically manifests with cardiovascular, renal, cerebrovascular, and dermatologic involvement. Lymphedema is caused by sphingolipid deposition within lymphatics. Lymphedema can cause intolerable pain and limit daily activities. Very limited data exist on lymphedema in AFD patients. METHODS: Using data from the Fabry Registry (NCT00196742) with 7671 patients included (44% males and 56% females), we analyzed the prevalence of lymphedema among AFD patients who were ever assessed for lymphedema and studied the age of first reported lymphedema. Additionally, we assessed whether patients received AFD-specific treatment at some point during their clinical course. The data was stratified by gender and phenotype. RESULTS: Our study showed that lymphedema occurred in 16.5% of the Fabry Registry patients who were ever assessed for lymphedema (n = 5487). Male patients when compared to female patient have higher prevalence (21.7% vs 12.7%) and experienced lymphedema at a younger age (median age at first reported lymphedema of 43.7 vs 51.7 years). When compared to other phenotypes, classic phenotype has the highest prevalence of lymphedema with the earliest reported lymphedema. Among those who reported lymphedema, 84.5% received AFD-specific treatment during their clinical course. CONCLUSIONS: Lymphedema is a common manifestation of AFD in both genders, with a tendency to present later in female patients. Recognition of lymphedema can offer an important opportunity for intervention and potential impact on associated morbidity. Additional future studies are needed to characterize the clinical implications of lymphedema in AFD patients and identify additional treatment options for this growing population.

Exploring the Impact of Social Media Sites on Compulsive Shopping Behavior: The Mediating Role of Materialism.

Purpose: This study aims to examine the influence of social media sites and television advertisements on compulsive shopping behavior, and whether this influence is mediated by materialism in the university students of Saudi Arabia. Methods: Data was collected from 487 students at Saudi universities. AMOS and Structural equation modeling (SEM) were utilized to examine the data. The research supports the Hypothesis that adolescents who are more materialistic are more prone than less materialistic adolescents to engage in compulsive shopping behavior. Results: The findings were consistent with other research, suggesting that the same remains true in the culture of Saudi Arabia. The research's findings show that television advertisements and the use of social media sites positively related to compulsive shopping behavior among university students, and materialism mediated the relationship between television advertisements and social media sites. Conclusion: The research emphasizes the significance of comprehending the materialistic attitude and consumption choices of adolescents and offers crucial information for scholars, decision-makers, and management of top companies.

Exploring sustainable healthcare: Innovations in health economics, social policy, and management.

The healthcare sector faces several challenges, such as rising costs, rising demand, and the need for sustainability. A new area of healthcare has emerged due to these problems, focusing on long-term improvements in management, social policy, and health economics. This research explores the cutting edge of healthcare, concentrating on long-term advancements in management, social policy, and health economics. To better understand the problems affecting the healthcare sector and to pinpoint the areas where sustainable solutions are most required, a survey of 2000 healthcare professionals and policymakers was performed. The data were analyzed using structural equation modeling (SEM), and a thorough sustainable healthcare model was created. According to the survey's findings, the healthcare sector now faces three significant challenges: growing prices, increased demand, and the need for sustainability. According to the respondents, the three main areas where sustainable innovations are most required are management, social policy, and health economics. These conclusions were supported by the (SEM) analysis, which also showed that sustainable practices in these fields significantly impact the sustainability of the healthcare system. These findings lead this research to conclude that to guarantee the accessibility and affordability of healthcare for everyone, a move towards sustainable practices in health economics, social policy, and management is needed. Cooperation between healthcare providers, policymakers, and other stakeholders is required to create creative solutions that support sustainability in the healthcare sector. This study offers a thorough framework for sustainable healthcare that may act as a guide for further research and the formulation of new regulations.

Pretreatment identification of 90-day readmission among heart failure patients receiving aquapheresis treatment.

BACKGROUND: The use of traditional models to predict heart failure (HF) has limitations in preventing HF hospitalizations. Artificial intelligence (AI) and machine learning (ML) in cardiovascular medicine only have limited data published regarding HF populations, with none assessing the favorability of decongestive therapy aquapheresis (AQ). AI and ML can be leveraged to design non-traditional models to identify those who are at high risk of HF readmissions. OBJECTIVES: This study aimed to develop a model for pretreatment identification of risk for 90-day HF events among HF patients who have undergone AQ. METHODS: Using data from the AVOID-HF (Aquapheresis versus Intravenous Diuretics and Hospitalization for Heart Failure) trial, we designed a ML-based predictive model that can be used before initiating AQ to anticipate who will respond well to AQ and who will be at high risk of future HF events. RESULTS: Using ML we identified the top ten predictors for 90-day HF events. Interestingly, the variable for 'intimate relationships with loved ones' strongly predicted response to therapy. This ML-model was more successful in predicting the outcome in HF patients who were treated with AQ. In the original AVOID-HF trial, the overall 90-day HF event rate in the AQ arm was 32%. Our proposed predictive model was accurate in anticipating 90-day HF events with better statistical accuracy (area under curve 0.88, sensitivity 80%, specificity 75%, negative predictive value 90%, and positive predictive value 57%). CONCLUSIONS: ML can help identify HF patients who will respond to AQ therapy. Our model can identify super-respondents to AQ therapy and predict 90-day HF events better than currently existing traditional models. CONDENSED ABSTRACT: Utilizing data from the AVOID-HF trial, we designed a ML-predictive model that can be used before initiating AQ to anticipate who will respond well to AQ and who will be at high risk of future HF events. Using ML, we identified the top 10 predictors for 90-day HF events. Our model can identify super-respondents to ultrafiltration therapy and predict 90-day HF events better than currently existing traditional models.

A Clinical Study of Intraoperative Perfusion Chemotherapy in Gastric Cancer: A Prospective Cohort Study.

INTRODUCTION: Gastric cancer (GC) is the third largest cause of cancer-related death worldwide, with major geographic disparities in incidence and outcomes. Sociodemographic indicators, food habits, and genetic predispositions all add to the load. Despite advances in systemic treatments, peritoneal metastasis remains a concern, with intraperitoneal chemotherapy (IPC) emerging as a promising treatment option. METHODS: A prospective cohort research was done, with 30 GC patients receiving cytoreductive surgery (CRS) followed by lobaplatin-based intraoperative chemotherapy. The study evaluated postoperative complications, survival rates, and disease recurrence using Statistical Package for the Social Sciences (SPSS) version 25.0 (IBM SPSS Statistics, Armonk, NY) for data analysis. The purpose of this study is to assess the effectiveness, safety, and dependability of lobaplatin as an intraoperative chemotherapeutic agent in patients having gastric cancer surgery, with a particular emphasis on those patients who do not have distant metastases. RESULTS: The study population had a balanced gender distribution, with an average age of 44.83 years. Most patients had advanced-stage cancer (T3 and T4), and lobaplatin treatment resulted in a low frequency of serious postoperative sequelae. Preliminary studies suggest that lobaplatin is a safe and potentially effective IPC drug for GC, with few side effects and adequate survival rates. CONCLUSION: Lobaplatin shows promise as an intraoperative chemotherapeutic treatment for gastric cancer, necessitating more research in bigger, randomized controlled studies to determine its efficacy and safety profile. The study emphasizes the need for novel treatment strategies to enhance the prognosis of GC patients, particularly those with peritoneal involvement.

A Clinical Study of Intraoperative Perfusion Chemotherapy With Raltitrexed in Colon Cancer: A Prospective Cohort Study.

INTRODUCTION: Colorectal cancer (CRC) ranks as the second leading cause of cancer-related mortality among women and the third leading cause of cancer-associated mortality among men. Treatment of colon cancer is very crucial for a patient's survival. In this study, we assessed the reliability, efficacy, and safety of raltitrexed in intraoperative intraperitoneal chemotherapy for colon cancer. METHODOLOGY: A total of 57 patients with clinical stages II and III of colon cancer were included in the study. R0 resection surgery + hyperthermic intraperitoneal chemotherapy (HIPEC) procedure was done with raltitrexed. It was given in a dose of 3 mg/m2 in a 0.9% NS injection in a volume of 500 milliliters. Postoperative complications were observed. RESULT: The most common postoperative complication was nausea/vomiting, which was seen in 21 out of 57 patients (37%). The second most common complication was fever (18/57). None of the patients died or developed renal toxicity, hepatic toxicity, and intestinal obstruction. CONCLUSION: Raltitrexed is a reliable, efficient, and safe drug and can be used in intraoperative intraperitoneal chemotherapy of colon cancer.

Examining the Impact of Pro-Environmental Factors on Sustainable Consumption Behavior and Pollution Control.

Saudi Arabia is one of the most oil-rich countries in the world, and oil production is the country's primary source of income. The aspects of greenhouse gas emissions and the harm they cause to the environment and residents have been overlooked because of the continuous emphasis on economic growth and a high reliance on oil resources. Consequently, environmental issues have become challenging for residents and questionable for industries. Despite various environmental awareness and pollution control studies around the world, Saudi Arabia's pollution rate appears to be increasing. This study attempted to understand the impact of pro-environmental factors on pollution control and sustainable gasoline consumption in order to fill a research gap in the literature. Environmental awareness, self-efficacy and self-identity, ecological attitude, contextual factors, and social norms were considered as factors to investigate local residents' sustainable consumption and pollution control behaviors. Primary data were collected from 416 local residents and analyzed using multiple regression. The results demonstrate the positive significant impact of pro-environmental variables on sustainable consumption and efforts toward pollution control. This study further presents practical implications for the Saudi government and environmentalists.

Examining the informal urban growth trends in a Port city.

Rapid urban developmental growth is a heated debate worldwide due to environmental challenges. This research has examined the spatiotemporal trend of informal built-up growth in Karachi city. Using a geo-information system, the past twenty years (2000-2020) trends of informal built-up growth are examined. For attaining the research objectives, geo-referenced high-resolution maps and satellite images are used for accuracy based spatial data. Karachi is divided into five different land use and land cover (LULC): formal built-up, informal built-up, vacant, water bodies, and green spaces. Spatial data of informal built-up growth change of five different years, 2000, 2005, 2010, 2015, and 2020 are generated through acquired maps digitization using ArcMap. Subsequently, the gains and transfers of Karachi's informal built-up growth based on five years 2000-2005, 2005-2010, 2010-2015, and 2015-2020 are analyzed using the Land Change Modeler (LCM) in IDRISI software. Also, land use land cover changes (LULCC) are predicted for the next 40 years (2020-2060) using the integrated Cellular Automata Markov (CA-Markov) simulation model in IDRISI. The results revealed that Karachi's built-up is expanding rapidly. Land conversion into the informal built-up area is alarming, as it has changed from 144.31 km2 to 217.19 km2 with 72.88 km2 in the past twenty years (2000-2020) and has occupied green and agricultural land. Most informal built-up areas have transitioned from vacant (71.01 km2) land use land cover (LULC). The informal built-up area could expand from 217.19 km2 to 317.63 km2, with about 100.44 km2 up to 2060. The planned and unplanned development will be towards the city's East (E) direction and will convert and ruin agriculture and vacant land. The present study provides suggestions to urban planners, administrative authorities, and policymakers to control informal growth and achieve sustainable development goals in developing countries.

The Mediating Role of Customer Satisfaction between Antecedent Factors and Brand Loyalty for the Shopee Application.

Lately, smartphones have had a significant impact on how individuals act, mainly when they shop. In Malaysia, Shopee is the online shopping website that has garnered the most traffic from e-commerce sites. Shopee Express recognizes the importance of customer happiness and brand loyalty in measuring consumer purchasing behavior for long-term performance. Some prior studies have had mixed results on the factors that influence online shopping apps' brand loyalty with the interactive effect of other variables. To contribute to resolving these varied views, this study proposes that customer satisfaction mediates the antecedent factors that influence students' loyalty to the Shopee app. As a cross-sectional online survey, we obtained data from 298 university students using the Shopee application. Partial least squares structural equation modeling (PLS-SEM) was used to analyze data, whereby the results confirmed a significant effect of the accuracy of delivery on brand loyalty and customer satisfaction, the price of delivery and customer satisfaction, and information quality on brand loyalty and customer satisfaction. Furthermore, easy payment also significantly affected brand loyalty and customer satisfaction, and customer satisfaction mediates delivery accuracy and brand loyalty, the price of delivery, information quality, and the brand loyalty link of students to the Shopee application. This study's novelty is uncovering the intervening role of customer satisfaction in the antecedent factors of brand loyalty of the Shopee app. This study further contributes by providing helpful information to the stream of online logistic firms like Shopee to meet client needs and by providing valuable insights for scholars.

Frequency of Acquired Renal Cystic Disease in Patients on Long-Term Hemodialysis and Associated Renal Cell Carcinoma.

Background Acquired cystic renal disease is one of the complications of end-stage renal disease (ESRD) patients on dialysis. We aimed to define the prevalence of acquired cystic renal disease in a dialysis center in a tertiary care setup in Pakistan. Materials and methods We conducted a cross-sectional study of 246 patients with ESRD from October 1, 2017, to March 30, 2018. We collected patient demographic data, comorbidities, duration (years), frequency (sessions/week), length of each dialysis session (hours), ultrasound findings, cystic renal disease occurrence, and associated complications for analysis. Results Our patient population consisted of 115 women (46.7%) and 131 men (53.3%) and had a mean age of 55.9 ± 15.1 years. Thirty-seven patients were on dialysis for one year, 78 (31.7%) for two years, and 131 (53.3%) for three or more years, as its more common with increasing duration. The mean dialysis duration was 2.3 ± 0.7 years. Of 246 patients, 49 (19.9%) had acquired cystic renal disease. Conclusions Given improved health care facilities, an increasing number of patients have a good survival on dialysis and develop long-term complications associated with end-stage renal disease, such as acquired cystic renal disease. Because the acquired renal cystic disease is associated with renal cell carcinoma, physicians should evaluate dialysis patients for renal cell carcinoma, especially after three to five years of dialysis.

Severe pneumocystis jiroveci pneumonia in a patient on temozolomide therapy: A case report and review of literature.

A 66 year old man was diagnosed with CNS diffuse large B-cell lymphoma, and underwent treatment with Temozolomide, Dexamethasone, Rituximab, and radiation therapy, and prolonged steroid taper with Dexamethasone. Approximately one month after this, he presented with severe acute hypoxemic respiratory failure, and was admitted to the Medical Intensive Care Unit. Imaging showed diffuse ground glass opacities. Patient underwent diagnostic bronchoalveolar lavage which was positive for Pneumocystis jiroveci. He did not respond well to appropriate therapy and was transitioned to comfort care per his family's wishes, and expired. Pneumocystis jiroveci should always be included in the differential diagnosis of pneumonia in patients treated with Temozolomide, especially when this agent is used in combination with long term, high dose corticosteroids and radiation therapy.

Lemmel's Syndrome: A Rare Cause of Obstructive Jaundice Secondary to Periampullary Diverticulum.

In 1934 Lemmel was the first to report the presence of juxtapapillary diverticula and hepatocholangiopancreatic disease, excluding cholelithiasis. Obstructive jaundice caused by periampullary duodenal diverticulum (PAD) in absence of choledocholithiasis or tumor is known as Lemmel syndrome. A patient with an extraluminal duodenal diverticulum presenting with obstructive jaundice and pancreatitis is presented in this case. Although initially managed conservatively, the patient had recurrence of symptoms after 2 months but then had successful surgical resection of the duodenal diverticulum. LEARNING POINTS: Lemmel's syndrome should be considered in patients with pancreaticobiliary disease in the absence of tumors, stricture, or cholelithiasis.Non-invasive imaging studies should be considered first but endoscopic retrograde cholangiopancreatography (ERCP) remains the diagnostic method of choice.Surgical resection (diverticulectomy), endoscopic sphincterotomy, and papillary balloon dilatation are treatment options when conservative management fails.

Deceased-donor organ transplantation: knowledge and attitudes among health care professionals managing critically ill patients in Karachi.

OBJECTIVES: Adequate knowledge and positive attitudes of health care professionals regarding deceased-donor organ transplants lead to higher donation consent rates. This study assessed the knowledge and attitudes of health care professionals toward this issue in the light of recent organ transplant legislation in Pakistan. MATERIALS AND METHODS: Health care professionals in critical care areas of 2 hospitals in Karachi were selected (n=243) and asked to complete a questionnaire regarding their knowledge and attitudes toward deceased-donor organ transplants. RESULTS: In all, 58.8% of the participants were physicians and 41.2% were nurses; 91.4% correctly identified brain death; 51.5% expressed support for deceased-donor organ transplants; 56.8% had concerns of religious rulings against deceased organ donation; 67.5% felt that a government body could not run such a system fairly; 56.4% of the respondents would consider receiving a deceased-donor organ if needed, but only 35.3% would donate after their own death. Only 42.7% and 37% were willing to approach patients and families for consent for a deceased-donor organ transplant, respectively. Most of those unwilling felt that the patient could refuse, become upset and aggressive, and lose trust in the health care professionals. CONCLUSIONS: Before implementing a deceased-donor organ transplant system in hospitals, health care professionals should attend a training program regarding their concerns. This would increase motivation when approaching patients/patients' families for consent, thus increasing deceased-donor consent rates.