Morphometric and molecular characterization of Channa marulius from Riverine system of Punjab, Pakistan.

OBJECTIVE: Channidae family, are major freshwater fish species amongst the local aquatic fauna of Pakistan, while, there is limited availability of local data on their molecular identification and phylogenetic analysis. METHODS: Channa species were collected from four different geographical sites in the tertiary of Punjab province on the Indus and Chenab rivers of Pakistan. Morphometric records and molecular techniques were used to determine the intraspecific variations among populations of Channa marulius. Mitochondrial DNA was extracted from the flesh of C. marulius, while, COI gene was used for molecular identification and variation levels were estimated by using Principal Component Analysis. RESULTS: Data recorded on the basis of morphometric parameters clearly divided the C. marulius of different locations into two distinct categories, which accounted for a cumulative variability of 97.6%. Non-significance (P < 0.05) among the C. marulius showed that it contains a unique control haplotype localized within the sub-population. The intra-species distance ranged from 0.000 to 0.001 for four different populations, in contrast, the sequences retrieved from the NCBI database exhibited a range span of 0.000-0.003, while, sequence diversity ranged from 0.000 to 0.006 for this intra-specific comparison. The cladogram was also constructed for C. marulius of different geographical locations for observation of phylogenetic relationship. The conclusion drawn from the phylogenetic analysis of C. marulius populations used in this study, contributes significantly to the understanding of genetic variations within populations of this species. The findings provide valuable insight to devise conservation strategies in fisheries management programs in Pakistan.

Quantitative analysis of solid dosage forms of Atenolol by Raman spectroscopy.

OBJECTIVE: To develop a Raman spectroscopy-based analytical model for quantification of solid dosage forms of active pharmaceutical ingredient (API) of Atenolol.Significance: For the quantitative analysis of pharmaceutical drugs, Raman Spectroscopy is a reliable and fast detection method. As part of this study, Raman Spectroscopy is explored for the quantitative analysis of different concentrations of Atenolol. METHODS: Various solid-dosage forms of Atenolol were prepared by mixing API with excipients to form different solid-dosage formulations of Atenolol. Multivariate data analysis techniques, such as Principal Component Analysis (PCA) and Partial least square regression (PLSR) were used for the qualitative and quantitative analysis, respectively. RESULTS: As the concentration of the drug increased in formulation, the peak intensities of the distinctive Raman spectral characteristics associated with the API (Atenolol) gradually increased. Raman spectral data sets were classified using PCA due to their distinctive spectral characteristics. Additionally, a prediction model was built using PLSR analysis to assess the quantitative relationship between various API (Atenolol) concentrations and spectral features. With a goodness of fit value of 0.99, the root mean square errors of calibration (RMSEC) and prediction (RMSEP) were determined to be 1.0036 and 2.83 mg, respectively. The API content in the blind/unknown Atenolol formulation was determined as well using the PLSR model. CONCLUSIONS: Based on these results, Raman spectroscopy may be used to quickly and accurately analyze pharmaceutical samples and for their quantitative determination.

Quantitative analysis of cephalexin in solid dosage form by Raman spectroscopy and chemometric tools.

OBJECTIVE: To use Raman Spectroscopy for qualitative and quantitative evaluation of pharmaceutical formulations of active pharmaceutical ingredient (API) of Cephalexin. SIGNIFICANCE: Raman Spectroscopy is a noninvasive, nondestructive, reliable and rapid detection technique used for various pharmaceutical drugs quantification. The present study explores the potential of Raman Spectroscopy for quantitative analysis of pharmaceutical drugs. METHOD: For qualitative and quantitative analysis of Cephalexin API, various standard samples containing less and more concentration of API than commercial tablet was prepared. To study spectral differences, the mean plot of all the samples was prepared. For qualitative analysis, Principal Component Analysis (PCA) and for quantitative analysis Partial Least Square Regression analysis (PLSR) was used. Both of these are Multivariate data analysis techniques and give reliable results as published in previous literature. RESULTS: PCA model distinguished all the Raman Spectral data related to the various Cephalexin solid dosage formulations whereas the PLSR model was used to calculate the concentration of different unknown formulations. For the PLSR model, RMSEC and RMSEP were determined to be 3.3953 and 3.8972, respectively. The prediction efficiency of this built PLSR model was found to be very good with a goodness of the model value (R2) of 0.98. The PLSR model also predicted the concentrations of Cephalexin formulations in the blind or unknown sample. CONCLUSION: These findings demonstrate that the Raman spectroscopy coupled to PLSR analysis could be regarded as a fast and effectively reliable tool for quantitative analysis of pharmaceutical drugs.

Distribution of dental practices in Jazan of Saudi Arabia: a GIS-based approach.

BACKGROUND: Jazan region in the Kingdom of Saudi Arabia (KSA) has been extensively studied regarding access to dental care services, but there is currently no specific study on the distribution of public (primary healthcare centres (PHCs) and hospitals) and private dental healthcare facilities in the area. This study aimed to evaluate the spatial distribution of public and private dental care facilities in the Jazan region in relation to the population distribution in each governorate of the region. METHODS: The most up-to-date, easily accessible, and anonymous data and information were used for this investigation. The Ministry of Health's (MOH) Statistical Yearbook 2020 and interactive map were used to identify the locations of healthcare facilities. These locations were plotted on a map using Google Maps, and the data was converted to longitude and latitude with 90% level building accuracy. QGIS's integrated database was used to develop buffer zones and perform attribute analysis. The data was then exported for analysis in Microsoft Excel, where healthcare facility-to-population ratios were determined. RESULTS: In Jazan region, consisting of 17 governorates and a population of 1,726,739, there were 275 public and private dental clinics, with a ratio of one dental clinic per 6,279 people in terms of general health services. Only 12.4% of these clinics were located beyond 20 km of the city centre, serving approximately 70% of the region's population. CONCLUSION: The uneven distribution of dental clinics in the Jazan region has hampered access to dental treatments and has led to a significant burden on dental health facilities, reducing the quality of care available in the region. Mapping the distribution of MOH, private, and other health facilities, as well as the burden of oral disease in the Jazan region, is necessary for further research.

An Intelligent Agent-Based Detection System for DDoS Attacks Using Automatic Feature Extraction and Selection.

Distributed Denial of Service (DDoS) attacks, advanced persistent threats, and malware actively compromise the availability and security of Internet services. Thus, this paper proposes an intelligent agent system for detecting DDoS attacks using automatic feature extraction and selection. We used dataset CICDDoS2019, a custom-generated dataset, in our experiment, and the system achieved a 99.7% improvement over state-of-the-art machine learning-based DDoS attack detection techniques. We also designed an agent-based mechanism that combines machine learning techniques and sequential feature selection in this system. The system learning phase selected the best features and reconstructed the DDoS detector agent when the system dynamically detected DDoS attack traffic. By utilizing the most recent CICDDoS2019 custom-generated dataset and automatic feature extraction and selection, our proposed method meets the current, most advanced detection accuracy while delivering faster processing than the current standard.

PTFE/EP Reinforced MOF/SiO2 Composite as a Superior Mechanically Robust Superhydrophobic Agent towards Corrosion Protection, Self-Cleaning and Anti-Icing.

Organic resin cross-linking ZIF-67/SiO2 superhydrophobic (SHPB) multilayer coating was successfully fabricated on metal substrate. The perfluoro-octyl-triethoxy silane (POTS) modified ZIF-67 and SiO2 coating was applied on primary coated polytetrafluoroethylene (PTFE) and epoxy resin (EP) via spray coating method. Here, we present that the robust superhydrophobicity can be realized by structuring surfaces at two different length scales, with a nanostructure design to provide water repellence and a microstructure design to provide durability. The as-fabricated multilayer coating displayed superior water-repellence (CA=167.4°), chemical robustness (pH=1-14) and mechanical durability undergoing 120th linear abrasion or 35th rotatory abrasion cycle. By applying different acidic and basic corrosive media and various weathering conditions, it can still maintain superior-hydrophobicity. To get a better insight of interaction between inhibitor molecules and metal surface, density functional theory (DFT) calculations were performed, showing lower energy gap and increased binding energy of ZPS/SiO2 /PTFE/EP (ZPS=ZIF-67+POTS) multilayer coating compared to the ZIF-67/SiO2 /PTFE/EP, thereby supporting the experimental findings. Additionally, such coatings may be useful for applications such as anti-corrosion, self-cleaning, and anti-icing multi-functionalities.

CAVVPM: Challenge-Based Authentication and Verification of Vehicle Platooning at Motorway.

As a result of vehicle platooning, advantages including decreased traffic congestion and improved fuel economy are expected. Vehicles in a platoon move in a single line, closely spaced, and at a constant speed. Vehicle-to-vehicle communications and sensor data help keep the platoon formation in place, and the CACC system is responsible for maintaining it. In reality, V2V transmissions are essential for reducing platooning distances while still ensuring their safety and security. It is far more difficult to confirm the veracity of a V2V message's content than it is to verify its integrity and source authentication. Only platoon members can send and receive V2V communications by implementing a practical access control mechanism. The goal is to link a prospective platoon member's digital identification to their actual location inside the unit. A physical challenge-response interaction is used in the CAVVPM process to verify that a prospective platoon member respects the rules. The applicant is asked to perform a series of random longitudinal movements, thus, the protocol's name. Remote attackers cannot join the platoon or send bogus CACC communications because CAVVPM blocks them. CAVVPM is more resistant to pre-recording assaults than previous work, and it can validate that the candidate is precisely behind the verifier in the same lane compared to previous studies.

Spatio-temporal assessment of land use land cover based on trajectories and cellular automata Markov modelling and its impact on land surface temperature of Lahore district Pakistan.

This research aims to assess the urban growth and impact on land surface temperature (LST) of Lahore, the second biggest city in Pakistan. In this research, various geographical information system (GIS) and remote sensing (RS) techniques (maximum likelihood classification (MLC)) LST, and different normalized satellite indices have been implemented to analyse the spatio-temporal trends of Lahore city; by using Landsat for 1990, 2004, and 2018. The development of integrated use of RS and GIS and combined cellular automata-Markov models has provided new means of assessing changes in land use and land cover and has enabled the projection of trajectories into the future. Results indicate that the built-up area and bare area increased from 15,541 (27%) to 23,024 km2 (40%) and 5756 km2 (10%) to 13,814 km2 (24%). Meanwhile, water area and vegetation were decreased from 2302 km2 (4%) to 1151 km2 (2%) and 33,961 km2 (59%) to 19,571 km2 (34%) respectively. Under this urbanization, the LST of the city was also got affected. In 1990, the mean LST of most of the area was between 14 and 28 ℃, which rose to 22-28 ℃ in 2004 and 34 to 36 ℃ in 2018. Because of the shift of vegetation and built-up land, the surface reflectance and roughness of each land use land cover (LULC) class are different. The analysis established a direct correlation between Normalized Difference Water Index (NDWI), Normalized Difference Vegetation Index (NDVI) with LST and an indirect correlation among Soil Adjusted Vegetation Index (SAVI), Normalized Difference Built-up Index (NDBI), and Built-up Index (BI) with LST. The results are important for the planning and development department since they may be used to guarantee the sustainable utilization of land resources for future urbanization expansion projects.

Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: A worldwide study.

BACKGROUND & AIMS: Corticosteroids are the only effective therapy for severe alcohol-associated hepatitis (AH), defined by a model for end-stage liver disease (MELD) score >20. However, there are patients who may be too sick to benefit from therapy. Herein, we aimed to identify the range of MELD scores within which steroids are effective for AH. METHODS: We performed a retrospective, international multicenter cohort study across 4 continents, including 3,380 adults with a clinical and/or histological diagnosis of AH. The main outcome was mortality at 30 days. We used a discrete-time survival analysis model, and MELD cut-offs were established using the transform-the-endpoints method. RESULTS: In our cohort, median age was 49 (40-56) years, 76.5% were male, and 79% had underlying cirrhosis. Median MELD at admission was 24 (19-29). Survival was 88% (87-89) at 30 days, 77% (76-78) at 90 days, and 72% (72-74) at 180 days. A total of 1,225 patients received corticosteroids. In an adjusted-survival-model, corticosteroid use decreased 30-day mortality by 41% (hazard ratio [HR] 0.59; 0.47-0.74; p <0.001). Steroids only improved survival in patients with MELD scores between 21 (HR 0.61; 0.39-0.95; p = 0.027) and 51 (HR 0.72; 0.52-0.99; p = 0.041). The maximum effect of corticosteroid treatment (21-30% survival benefit) was observed with MELD scores between 25 (HR 0.58; 0.42-0.77; p <0.001) and 39 (HR 0.57; 0.41-0.79; p <0.001). No corticosteroid benefit was seen in patients with MELD >51. The type of corticosteroids used (prednisone, prednisolone, or methylprednisolone) was not associated with survival benefit (p = 0.247). CONCLUSION: Corticosteroids improve 30-day survival only among patients with severe AH, especially with MELD scores between 25 and 39. LAY SUMMARY: Alcohol-associated hepatitis is a condition where the liver is severely inflamed as a result of excess alcohol use. It is associated with high mortality and it is not clear whether the most commonly used treatments (corticosteroids) are effective, particularly in patients with very severe liver disease. In this worldwide study, the use of corticosteroids was associated with increased 30-day, but not 90- or 180-day, survival. The maximal benefit was observed in patients with an MELD score (a marker of severity of liver disease; higher scores signify worse disease) between 25-39. However, this benefit was lost in patients with the most severe liver disease (MELD score higher than 51).

Comparative analysis of the mitochondrial proteins reveals complex structural and functional relationships in Fasciola species.

Mitochondria is a cellular source of energy, appears to play an essential role in dealing with cellular stress induced by environmental stimuli. The genetic diversity of mitochondrial genes involved in oxidative phosphorylation affecting the production of cellular energy and regional adaptation to various ecological (climatic) pressures affecting amino acid sequences (variants of protein). However, little is known about the combined effect of protein changes on cell-level metabolic alterations in simultaneous exposure to various environmental conditions, including mitochondrial dysfunction and oxidative stress induction. The present study was designed to address this issue by analyzing the mitochondrial proteins in Fasciola species including Cytochrome oxidase (COX1, COX2, COX3, and CYTB) and NADH dehydrogenase (ND1, ND2, ND3, ND4, ND5, and ND6). Mitochondrial proteins were used for detailed computational investigation, using available standard bioinformatics tools to exploit structural and functional relationships. These proteins in Fasciola hepatica, Fasciola gigentica, and Fasciola jacksoni were functionally annotated using public databases. The results showed that the protein of COX1 of F. hepatica, F. gigantica, and F. jacksoni consist of 510, 513, and 517 amino acids, respectively. The alignment of proteins showed that these proteins are conserved in the same regions at ten positions in COX and CYTB proteins while at twelve locations in NADH. Three-dimensional structure of COX, CYTB, and NADH proteins were compared and showed differences in additional conserved and binding sites in COX and CYTB proteins as compared to NADH in three species of Fasciola. These results based on the amino acid diversity pattern were used to identify sites in the enzyme and the variations in mitochondrial proteins among Fasciola species. Our study provides valuable information for future experimental studies, including identification of therapeutic, diagnostic, and immunoprophylactic interests with novel mitochondrial proteins.

Meta-Analysis of Randomized Controlled Trials Comparing the Efficacy of Radioactive Iodine Monotherapy versus Radioactive Iodine Therapy and Adjunctive Lithium for the Treatment of Hyperthyroidism.

Background: The objective of this article is to evaluate the outcomes in patients undergoing radioactive iodine (RAI) with adjunctive lithium (Li) therapy versus (vs.) RAI therapy alone for the treatment of hyperthyroidism.Methods: A systematic review of the literature was undertaken to analyze clinical trials comparing RAI with adjunctive Li therapy vs. RAI therapy alone for the treatment of hyperthyroidism.Results: Six randomized-controlled trials (RCT) involving 755 patients were analyzed. RAI with adjunctive Li was associated with a significantly higher cure rate for hyperthyroidism when compared to RAI alone. Furthermore, a significantly higher cure rate for hyperthyroidism at 12 months was achieved with RAI and adjunctive Li. Adjuvant Li with RAI for ≤ 7 days showed significantly higher cure rate compared to RAI alone, whereas > 7 days of adjuvant Li with RAI did not show any difference in cure rate compared to RAI alone. RAI with adjunctive Li was associated with a significantly higher cure rate for patients with Graves' disease compared to RAI alone. There was no significant difference between RAI with adjunctive Li and RAI alone for toxic nodular thyroid disorder (toxic nodule and toxic multinodular goiter) and thyroid volume >40 grams and ≤40 grams.Conclusions: RAI with adjunctive Li therapy demonstrated superiority over RAI therapy alone with regards to both curing hyperthyroidism and, reduced time till cure, with a limited side effect profile. A large multicenter RCT is required, and if this confirms the data from these smaller trials, then this could change current practice.

Estimation of salivary matrix metalloproteinases- 12 (MMP- 12) levels among patients presenting with oral submucous fibrosis and oral squamous cell carcinoma.

BACKGROUND: Oral squamous cell carcinoma is a global threat and accounts for approximately 90% of malignant oral lesions. The emergence of oral carcinoma is linked to precancerous lesions, which act as precursors of the disease. Matrix metalloproteinases appear to play a significant role in the pathogenesis of both precancerous conditions and oral malignancies due to their participation in remodeling of the extracellular matrix. METHODOLOGY: This is an analytical study conducted at Dow University of Health Sciences, Pakistan. Unstimulated saliva samples were collected from healthy, oral submucous fibrosis and oral squamous cell carcinoma patients. The level of MMP-12 was estimated using enzyme-linked immunosorbent assay. One-way Analysis of variance was run to determine if MMP-12 levels differ between the three groups, which was preceded by post hoc Tuckey test. MMP-12 cut off values were determined using Receiver operating characteristic curve. RESULTS: A significant difference in salivary MMP-12 expression was observed in OSF and OSCC (p < 0.001). The expression of salivary MMP-12 was higher in OSF and OSCC patients as compared to the healthy group (p < 0.001). The mean MMP-12 expression in OSCC appeared higher than in OSF cases (p < 0.05). MMP-12 value of [Formula: see text] 4.05 ng/ml and [Formula: see text] 4.20 ng/ml is predictive of OSF and OSCC respectively, with 100% sensitivity and specificity (p < 0.001). CONCLUSION: Increased expression of MMP-12 appears as the healthy patient advances to OSF and OSCC. The study results also demonstrate higher MMP-12 expression in OSCC patients as compared to OSF. Therefore, the estimation of salivary MMP-12 serves as a valuable non-invasive early diagnostic tool in diagnosing oral submucous fibrosis and oral squamous cell carcinoma.

Simplified Synthesis of Biomass-Derived Si/C Composites as Stable Anode Materials for Lithium-Ion Batteries.

Synthesis of silicon/carbon (Si/C) composites from biomass resources could enable the effective utilization of agricultural products in the battery industry with economical as well as environmental benefits. Herein, a simplified process was developed to synthesize Si/C from biomass, by using a low-cost agricultural byproduct "rice husk (RH)" as a model. This process includes the calcination of RH for SiO2 /C and the reduction of SiO2 /C by Al in molten salts at a moderate temperature. This process does not need the removal of carbon before thermal reduction of SiO2 , which is thought to be necessary to avoid the formation of SiC at elevated temperatures. Thus, carbon derived from biomass can be directly used for Si/C composites for anode materials. The resultant Si/C shows a high reversible capacity of 1309 mAh g-1 and long cycle life (300 cycles). This research advocates a new and simplified strategy for the synthesis of RH-based biomass-derived Si/C, which is beneficial for low-cost, environmentally friendly, and green energy storage applications.

Anti-insect activity of a partially purified protein derived from the entomopathogenic fungus Lecanicillium lecanii (Zimmermann) and its putative role in a tomato defense mechanism against green peach aphid.

Many biotrophic and necrotrophic fungi synthesize proteins that may elicit induced plant resistance against different herbivore pests. This in-vitro study elucidates the sub-lethal effect of a partially-purified protein derived from the entomopathogenic fungus Lecanicillium lecanii (Zimmerman) (Hypocreales: Clavicipitaceae) against green peach aphid Myzus persicae (Sulzer) (Hemiptera: Aphididae), an economically important pest of many solanaceous crops including tomato. Bioassays were conducted to determine the impact of different concentrations of protein (i.e. 0.018, 0.036 and 0.054 µM) on the survival and fecundity of M. persicae on tomato (Lycopersicon esculentum) plants. Moreover, the potential role of this exogenous protein in the plant defense mechanism was assessed by expression analyses of key genes associated with salicylic acid (SA) and jasmonic acid (JA) pathways using RT-qPCR. The results indicated a significant negative effect of all protein concentrations on the survivorship and fecundity of M. persicae. The highest concentration (0.054 µM) resulted in lowest survival (46%) of aphids at 7th day post-treatment, while two other concentrations (0.036 and 0.018 µM) resulted in 61 and 71% survival rate, respectively. Similarly, lowest and highest mean fecundity rates were recorded for the highest protein concentration and the control (1.5 and 2.4 nymphs day-1 female-1), respectively. Moreover, L. lecanii-derived protein strongly upregulated the SA associated genes PR1, BGL2 and PAL, and moderately upregulated the JA associated genes LOX, AOS and AOC in protein-treated tomato plants compared to the control plants. These findings demonstrate the systemic resistance induced in tomato plants against M. persicae by the exogenous application of partially-purified protein extracted from L. lecanii, suggesting its further purification and characterization as a novel biological pest management tool against aphids and other phloem-feeding insect pests.

Current trends and future perspectives for medical education in Colombia.

Colombia is the second largest country in South America. In this article, we provide an overview of medical education in Colombia, including a description of existing public and private medical schools and available undergraduate and postgraduate programs. Medical education in Colombia has evolved through time, following international trends. In addition to 61 undergraduate medical programs, there are 529 postgraduate clinical, 30 PhD, and 131 Master programs in health sciences in Colombia. We identify current challenges and highlight future perspectives for medical education in Colombia.

Pharmacological evaluation of Acacia modesta bark for antipyretic, anti-inflammatory, analgesic, antidepressant and anticoagulant activities in Sprague Dawley rats.

In this study the bark of Acacia modesta was evaluated for anti-inflammatory, antipyretic, analgesic, antidepressant and anticoagulant activity by carrageenan, hot plat, forced swim and capillary tube method respectively in rats. Highest anti-inflammatory activity was exhibited by chloroform (AMC) extract (74.96% inhibition) while other two active fractions being n-hexane (AMH) and ethyl acetate (AME) exhibited 71.26% and 52.87% inhibition of edema respectively. On the other hand, the aqueous (AMA) fraction showed most effective response with 67.06% analgesic activity. Additionally, the significant (p<0.05) post-treatment antipyretic effect was found by all fractions in time dependent manner. The current findings showed that AMC, AME and AMA had significant reduction in immobility time in the antidepressant test, while AMH showed mild antidepressant activity. In anticoagulant assay, the coagulation time of crude extract A. modesta and its all fractions were comparable to that of positive control aspirin (208s). Moreover, neither mortality nor lethality was observed in the tested animals. Overall, the plant extracts showed potent anti-inflammatory, antipyretic, analgesic, antidepressant and anticoagulant activities which concludes that the bark of A. modesta have significant therapeutic potential.

Metal-Organic Frameworks-Derived Mesoporous Si/SiOx @NC Nanospheres as a Long-Lifespan Anode Material for Lithium-Ion Batteries.

Silicon (Si)-based anode materials with suitable engineered nanostructures generally have improved lithium storage capabilities, which provide great promise for the electrochemical performance in lithium-ion batteries (LIBs). Herein, a metal-organic framework (MOF)-derived unique core-shell Si/SiOx @NC structure has been synthesized by a facile magnesio-thermic reduction, in which the Si and SiOx matrix were encapsulated by nitrogen (N)-doped carbon. Importantly, the well-designed nanostructure has enough space to accommodate the volume change during the lithiation/delithiation process. The conductive porous N-doped carbon was optimized through direct carbonization and reduction of SiO2 into Si/SiOx simultaneously. Benefiting from the core-shell structure, the synthesized product exhibited enhanced electrochemical performance as an anode material in LIBs. Particularly, the Si/SiOx @NC-650 anode showed the best reversible capacities up to 724 and 702 mAh g-1 even after 100 cycles. The excellent cycling stability of Si/SiOx @NC-650 may be attributed to the core-shell structure as well as the synergistic effect between the Si/SiOx and MOF-derived N-doped carbon.

Revised Marshall Score: A New Approach to Stratifying the Severity of Acute Pancreatitis.

BACKGROUND: Modified Marshall Score is one of the severity scores for acute pancreatitis (AP) and is included in the Revised Atlanta Classification, but given its utilization of a set serum creatinine level (sCr), it may misclassify stable patients with chronic kidney disease (CKD) to a more severe class just due to their elevated sCr. AIMS: Our study aims to evaluate the role of CKD in AP and the possibility of utilizing acute kidney injury (AKI) into developing a new scoring system. METHODS: We retrospectively reviewed the electronic medical records of three hundred consecutive patients who were diagnosed with AP during hospitalization. Multiple demographic variables and clinical course indices were collected. Univariate logistic regression was then applied to predict mortality and ICU admission. Finally, receiver operating curve was utilized to compare original versus New Revised Marshall Score. RESULTS: Two hundred and eight-four (284) patients had a definitive diagnosis of AP. When comparing patients who had AKI on admission to those without AKI, the AKI group showed statistically significant higher mortality rate (5.6% vs. 1.1%, p = 0.04). Finally, we substituted the renal part of Marshall Score with our AKIN and we plotted the New "Revised" Marshall Score, which showed a higher AUROC compared to the original modified version (C-statistics 0.93 vs. 0.89, p < 0.05). CONCLUSION: We found that AKI predicts mortality and outperforms the use of a fixed sCr value alone. The use of our New Revised Marshall Score can accurately classify AP severity, avoiding misclassification of AP severity and providing better patient care.

Recent developments in bioreactor scale production of bacterial polyhydroxyalkanoates.

Polyhydroxyalkanoates (PHAs) are biological plastics that are sustainable alternative to synthetic ones. Numerous microorganisms have been identified as PHAs producers. They store PHAs as cellular inclusions to use as an energy source backup. They can be produced in shake flasks and in bioreactors under defined fermentation and physiological culture conditions using suitable nutrients. Their production at bioreactor scale depends on various factors such as carbon source, nutrients supply, temperature, dissolved oxygen level, pH, and production modes. Once produced, PHAs find diverse applications in multiple fields of science and technology particularly in the medical sector. The present review covers some recent developments in sustainable bioreactor scale production of PHAs and identifies some areas in which future research in this field might be focused.

Psychotherapeutic interventions for chronic pain: Evidence, rationale, and advantages.

BACKGROUND: Long-term use of opioids to treat chronic pain incurs serious risks for the individual-including misuse, abuse, addiction, overdose and death-as well as creating economic, social, and cultural impacts on society as a whole. Chronic pain and substance use disorders are often co-morbid with other medical problems and at the present time, primary care clinicians serve most of this population. Primary care clinicians would benefit from having alternatives to opioids to employ in treating such patients. METHOD: We electronically searched different medical databases for studies evaluating the effect of nonpharmacological treatments for chronic pain. We describe alternative approaches for the treatment of chronic pain and cite studies that provide substantial evidence in favor of the use of these treatments. RESULTS: Cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based programs have well-documented effectiveness for the treatment of chronic nonmalignant pain. Integration of such behavioral health therapies into primary care settings may optimize health resources and improve treatment outcomes. CONCLUSION: Evidence-based psychotherapy for chronic pain has established efficacy and safety and improves quality of life and physical and emotional functioning. Such interventions may be used as an alternative or adjunct to pharmacological management. Chronic opioid use should be reserved for individuals undergoing active cancer treatment, palliative care, or end-of-life care.