Publications by authors named "Muhammad Afzal"

617 Publications

Clinical Practice Guidelines For The Management Of Colorectal Cancer, A Consensus Statement By The Society Of Surgeons® And Surgical Oncology Society Of Pakistan®.

J Pak Med Assoc 2021 Sep;71(Suppl 6)(10):S1-S7

Professor of Surgery, University of Lahore Medical College, President SOS PK.

A joint effort by the Society of Surgeons Pakistan and Society of Surgical Oncology Pakistan, these guidelines provide a framework for the practicing surgeons involved in care and management of patients with colorectal cancer. The guidelines take into account the issues related to our local circumstances and provide a minimum standard of care that must be given to these patients. The Guideline Committee had members from all disciplines, including surgery, surgical oncology, medical oncology and radiation oncology. The guidelines have attempted to simplify things to understand and follow for the practicing surgeons. With these guidelines we wish to eliminate disparities in treatment among institutions and prevent any under treatment of patients.
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September 2021

Clinical Concept Extraction with Lexical Semantics to Support Automatic Annotation.

Int J Environ Res Public Health 2021 Oct 9;18(20). Epub 2021 Oct 9.

Department of Computer Science and Engineering, Global Campus, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin-si 17104, Korea.

Extracting clinical concepts, such as problems, diagnosis, and treatment, from unstructured clinical narrative documents enables data-driven approaches such as machine and deep learning to support advanced applications such as clinical decision-support systems, the assessment of disease progression, and the intelligent analysis of treatment efficacy. Various tools such as cTAKES, Sophia, MetaMap, and other rules-based approaches and algorithms have been used for automatic concept extraction. Recently, machine- and deep-learning approaches have been used to extract, classify, and accurately annotate terms and phrases. However, the requirement of an annotated dataset, which is labor-intensive, impedes the success of data-driven approaches. A rule-based mechanism could support the process of annotation, but existing rule-based approaches fail to adequately capture contextual, syntactic, and semantic patterns. This study intends to introduce a comprehensive rule-based system that automatically extracts clinical concepts from unstructured narratives with higher accuracy and transparency. The proposed system is a pipelined approach, capable of recognizing clinical concepts of three types, problem, treatment, and test, in the dataset collected from a published repository as a part of the I2b2 challenge 2010. The system's performance is compared with that of three existing systems: Quick UMLS, BIO-CRF, and the Rules (i2b2) model. Compared to the baseline systems, the average F1-score of 72.94% was found to be 13% better than Quick UMLS, 3% better than BIO CRF, and 30.1% better than the Rules (i2b2) model. Individually, the system performance was noticeably higher for problem-related concepts, with an F1-score of 80.45%, followed by treatment-related concepts and test-related concepts, with F1-scores of 76.06% and 55.3%, respectively. The proposed methodology significantly improves the performance of concept extraction from unstructured clinical narratives by exploiting the linguistic and lexical semantic features. The approach can ease the automatic annotation process of clinical data, which ultimately improves the performance of supervised data-driven applications trained with these data.
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http://dx.doi.org/10.3390/ijerph182010564DOI Listing
October 2021

CasTabDetectoRS: Cascade Network for Table Detection in Document Images with Recursive Feature Pyramid and Switchable Atrous Convolution.

J Imaging 2021 Oct 16;7(10). Epub 2021 Oct 16.

Department of Computer Science, Technical University of Kaiserslautern, 67663 Kaiserslautern, Germany.

Table detection is a preliminary step in extracting reliable information from tables in scanned document images. We present CasTabDetectoRS, a novel end-to-end trainable table detection framework that operates on Cascade Mask R-CNN, including Recursive Feature Pyramid network and Switchable Atrous Convolution in the existing backbone architecture. By utilizing a comparativelyightweight backbone of ResNet-50, this paper demonstrates that superior results are attainable without relying on pre- and post-processing methods, heavier backbone networks (ResNet-101, ResNeXt-152), and memory-intensive deformable convolutions. We evaluate the proposed approach on five different publicly available table detection datasets. Our CasTabDetectoRS outperforms the previous state-of-the-art results on four datasets (ICDAR-19, TableBank, UNLV, and Marmot) and accomplishes comparable results on ICDAR-17 POD. Upon comparing with previous state-of-the-art results, we obtain a significant relative error reduction of 56.36%, 20%, 4.5%, and 3.5% on the datasets of ICDAR-19, TableBank, UNLV, and Marmot, respectively. Furthermore, this paper sets a new benchmark by performing exhaustive cross-datasets evaluations to exhibit the generalization capabilities of the proposed method.
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http://dx.doi.org/10.3390/jimaging7100214DOI Listing
October 2021

Comparative Study on Overground Gait of Stroke Survivors with a Conventional Cane and a Haptic Cane.

IEEE Trans Neural Syst Rehabil Eng 2021 Oct 19;PP. Epub 2021 Oct 19.

The conventional cane (single cane) is widely used to promote gait ability of stroke survivors as it provides postural stability by extending the base of support. However, its use can reduce muscle activity in the user's paretic side and cause upper limb neuropathies due to the intermittent and excessive loading of the upper limb. The provision of low magnitude support and speed regulation may result in collective improvement of gait parameters such as symmetry, balance and muscle activation. In this paper, we developed a robotic Haptic Cane (HC) that is composed of a tilted structure with motorized wheels and sensors to allow continuous haptic contact with the ground while moving at a regulated speed, and carried out gait experiments to compare the HC with an Instrumented conventional Cane (IC). The results show that use of the HC involved more continuous ground support force of a comparatively lesser magnitude than the IC, and resulted in greater improvements in the swing symmetry ratio and significant improvements in the step length symmetry ratio. Percentage of Non-Paretic Activity (%NPA) of paretic muscles (vastus medialis obliquus (VMO), semitendinosus (SMT), tibialis anterior (TBA) and gastrocnemius medialis (GCM)) in swing phase was significantly improved by the use of either device at fast speed. However, the use of HC improved %NPA of paretic VMO and SMT more than the use of IC at both preferred and fast speeds. It also significantly improved %NPA of paretic GCM in stance phase. Furthermore, comfortable speed with the HC was higher than with the IC and exhibited better RMS of anteroposterior (AP) tilt. Thus, the developed device with a simple and intuitive mechanism can provide efficient assistance for overground gait of stroke patients with a high possibility of widespread use.
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http://dx.doi.org/10.1109/TNSRE.2021.3121412DOI Listing
October 2021

Fustin Ameliorates Elevated Levels of Leptin, Adiponectin, Serum TNF-α, and Intracellular Oxidative Free Radicals in High-Fat Diet and Streptozotocin-Induced Diabetic Rats.

ACS Omega 2021 Oct 28;6(40):26098-26107. Epub 2021 Sep 28.

Department of Biochemistry, Faculty of Science, King Abdulaziz University Jeddah 21589 Saudi Arabia.

Fustin is a prominent ingredient of Stokes (Anacardiaceae) and has a wide range of pharmacological and clinical effects. The present study attempted to evaluate the antidiabetic potential of fustin in streptozotocin- and high-fat diet-induced diabetes in rats. The efficacy of fustin 50 mg/kg and 100 mg/kg/day p.o. was studied in 60% of total calories from fat as a high-fat diet along with single-dose administration streptozotocin (50 mg/kg, i.p.) experimentally induced diabetes in rats for 42 days. The mean body weight; blood glucose; and biochemical parameters such as lipid profile, total protein (TP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), insulin, leptin levels, adiponectin levels, glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT) activity in serum were measured. The rats' weight was maintained in the fustin groups compared to the diabetic control group. Diabetes caused a significant increase in serum levels in blood glucose, lipid profile, MDA, TNF-α, ALT, and AST parameters and a decrease in serum insulin, adiponectin, leptin, GSH, SOD, and CAT compared to healthy rats. The treatment regimen with fustin (50 and 100 mg/kg) significantly restored all serum parameters in test groups. The present study found clinical evidence for the first time regarding the significant antidiabetic property of fustin, which could be a worthwhile candidate for the treatment of diabetes.
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http://dx.doi.org/10.1021/acsomega.1c03068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515611PMC
October 2021

Cardiac radioablation in the treatment of ventricular tachycardia.

Clin Transl Radiat Oncol 2021 Nov 12;31:71-79. Epub 2021 Feb 12.

Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA.

Cardiac radioablation with SBRT is a very promising non-invasive modality for the treatment of refractory VT and potentially other cardiac arrhythmias. Initial reports indicate that it is relatively safe and associated with excellent responses, particularly in reduction of ICD-related events, need for anti-arrhythmic medications, and resulting in significantly improved quality of life for patients. Establishment of objective criteria for candidates for cardiac radioablation will accelerate the adoption of this important radiation therapy modality in the treatment of refractory VT and other cardiac arrhythmias in the coming years. In addition, in order to develop more prospective safety and efficacy data, treatment of patients should ideally be performed in the context of clinical trials or prospective registries at, or in collaboration with, experienced centers. Taken together, the future of cardiac radioablation is rich and worthy of further investigation to become a standard treatment in the armamentarium against refractory VT.
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http://dx.doi.org/10.1016/j.ctro.2021.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8498093PMC
November 2021

A computer aided drug discovery based discovery of lead-like compounds against KDM5A for cancers using pharmacophore modeling and high-throughput virtual screening.

Proteins 2021 Oct 12. Epub 2021 Oct 12.

School of Biochemistry and Biotechnology, University of the Punjab, Lahore, Punjab, Pakistan.

KDM5A over-expression mediates cancer cell proliferation and promotes resistance toward chemotherapy through epigenetic modifications. As its complete mechanism of action is still unknown, there is no KDM5A specific drug available at clinical level. In the current study, lead compounds for KDM5A were determined through pharmacophore modeling and high-throughput virtual screening from Asinex libraries containing 0.5 million compounds. These virtual hits were further evaluated and filtered for ADMET properties. Finally, 726 compounds were used for docking analysis against KDM5A. On the basis of docking score, 10 top-ranked compounds were selected and further evaluated for non-central nervous system (CNS) and CNS drug-like properties. Among these compounds, N-{[(7-Methyl-4-oxo-1,2,3,4-tetrahydrocyclopenta [c] chromen-9-yl) oxy]acetyl}-l-phenylalanine (G-score: -11.363 kcal/mol) was estimated to exhibit non-CNS properties while 2-(3,4-Dimethoxy-phenyl)-7-methoxy-chromen-4-one (G-score: -7.977 kcal/mol) was evaluated as CNS compound. Docked complexes of both compounds were finally selected for molecular dynamic simulation to examine the stability. This study concluded that both these compounds can serve as lead compounds in the quest of finding therapeutic agents against KDM5A associated cancers.
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http://dx.doi.org/10.1002/prot.26262DOI Listing
October 2021

Community health workers at the dawn of a new era: 2. Planning, coordination, and partnerships.

Health Res Policy Syst 2021 Oct 12;19(Suppl 3):103. Epub 2021 Oct 12.

Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Background: Community health workers (CHWs) play a critical role in grassroots healthcare and are essential for achieving the health-related Sustainable Development Goals. While there is a critical shortage of essential health workers in low- and middle-income countries, WHO and international partners have reached a consensus on the need to expand and strengthen CHW programmes as a key element in achieving Universal Health Coverage (UHC). The COVID-19 pandemic has further revealed that emerging health challenges require quick local responses such as those utilizing CHWs. This is the second paper of our 11-paper supplement, "Community health workers at the dawn of a new era". Our objective here is to highlight questions, challenges, and strategies for stakeholders to consider while planning the introduction, expansion, or strengthening of a large-scale CHW programme and the complex array of coordination and partnerships that need to be considered.

Methods: The authors draw on the outcomes of discussions during key consultations with various government leaders and experts from across policy, implementation, research, and development organizations in which the authors have engaged in the past decade. These include global consultations on CHWs and global forums on human resources for health (HRH) conferences between 2010 and 2014 (Montreux, Bangkok, Recife, Washington DC). They also build on the authors' direct involvement with the Global Health Workforce Alliance.

Results: Weak health systems, poor planning, lack of coordination, and failed partnerships have produced lacklustre CHW programmes in countries. This paper highlights the three issues that are generally agreed as being critical to the long-term effectiveness of national CHW programmes-planning, coordination, and partnerships. Mechanisms are available in many countries such as the UHC2030 (formerly International Health Partnership), country coordinating mechanisms (CCMs), and those focusing on the health workforce such as the national Human Resources for Health Observatory and the Country Coordination and Facilitation (CCF) initiatives introduced by the Global Health Workforce Alliance.

Conclusion: It is imperative to integrate CHW initiatives into formal health systems. Multidimensional interventions and multisectoral partnerships are required to holistically address the challenges at national and local levels, thereby ensuring synergy among the actions of partners and stakeholders. In order to establish robust and institutionalized processes, coordination is required to provide a workable platform and conducive environment, engaging all partners and stakeholders to yield tangible results.
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http://dx.doi.org/10.1186/s12961-021-00753-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8506104PMC
October 2021

War-torn Afghanistan - potential risk to the polio eradication efforts: A call for global concern!

J Infect 2021 Oct 7. Epub 2021 Oct 7.

Department of Life Sciences, School of Science, University of Management and Technology (UMT), Lahore, Pakistan. Electronic address:

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http://dx.doi.org/10.1016/j.jinf.2021.10.004DOI Listing
October 2021

Biochar and slow-releasing nitrogen fertilizers improved growth, nitrogen use, yield, and fiber quality of cotton under arid climatic conditions.

Environ Sci Pollut Res Int 2021 Oct 1. Epub 2021 Oct 1.

Department of Agronomy, Muhammad Nawaz Shareef University of Agriculture, Multan, Pakistan.

The efficiency of nitrogenous fertilizers in South Asia is on a declining trajectory due to increased losses. Biochar (BC) and slow-releasing nitrogen fertilizers (SRNF) have been found to improve nitrogen use efficiency (NUE) in certain cases. However, field-scale studies to explore the potential of BC and SRNF in south Asian arid climate are lacking. Here we conducted a field experiment in the arid environment to demonstrate the response of BC and SRNF on cotton growth and yield quality. The treatments were comprised of two factors, (A) nitrogen sources, (i) simple urea, (ii)neem-coated urea, (iii)sulfur-coated urea, (iv) bacterial coated urea, and cotton stalks biochar impregnated with simple urea, and (B) nitrogen application rates, N=160 kg ha, N = 120 kg ha, and N = 80 kg ha. Different SRNF differentially affected cotton growth, morphological and physiological attributes, and seed cotton yield (SCY). The bacterial coated urea at the highest rate of N application (160 kg ha) resulted in a higher net leaf photosynthetic rate (32.8 μmol m s), leaf transpiration rate (8.10 mmol s), and stomatal conductance (0.502 mol m s), while leaf area index (LAI), crop growth rate (CGR), and seed cotton yield (4513 kg ha) were increased by bacterial coated urea at 120 kg ha than simple urea. However, low rate N application (80 kg ha) of bacterial coated urea showed higher nitrogen use efficiency (39.6 kg SCY kg N). The fiber quality (fiber length, fiber strength, ginning outturn, fiber index, and seed index) was also increased with the high N application rates than N2 and N3 application. To summarize, the bacterial coated urea with recommended N (160 kg ha) and 75% of recommended N application (120 kg ha) may be recommended for farmers in the arid climatic conditions of Punjab to enhance the seed cotton yield, thereby reducing nitrogen losses.
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http://dx.doi.org/10.1007/s11356-021-16576-6DOI Listing
October 2021

Usefulness of convalescent plasma transfusion for the treatment of severely ill COVID-19 patients in Pakistan.

BMC Infect Dis 2021 Sep 27;21(1):1014. Epub 2021 Sep 27.

National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan.

Background: Convalescent plasma(CP) was utilized as potential therapy during COVID-19 pandemic in Pakistan. The study aimed at appraisal of CP transfusion safety and usefulness in COVID pneumonia.

Methods: Single arm, MEURI study design of non-randomized open label trial was conducted in five centers. Patients werecategorized as moderately severe, severe, and critical. The primary endpoint was a) improvement in clinical status and change in category of disease severity; secondary endpoint was b) CP ability to halt disease progression to invasive ventilation. CP transfused to hospitalized patients. Statistical tests including median (interquartile ranges), Mann-Whitney U test, Fisher's exact test using SPSS ver. 23, ANOVA and Chi-square test were applied for the analysis of results parameters before and after CP treatment. SOFA score was applied for multiorgan failure in severe and critical cases.

Results: A total of 50 adult patients; median age 58.5 years (range: 29-92 years) received CP with infusion titers; median 1:320 U/mL (Interquartile range 1:80-1:320) between April 4 to May 5, 2020. The median time from onset of symptoms to enrollment in trial was 3 to 7 days with shortness of breath and lung infiltration as severity criterion. In 35 (70%) recipients, oxygen saturation improved from 80 to 95% within 72h, with resolution of lung infiltrates. Primary endpoint was achieved in 44 (88%) recipients whereas secondary endpoint was achieved in 42 (84%). No patient experienced severe adverse events. A high SOFA score (> 7) correlated with deaths in severe and critical patients. Eight (16%) patients expired due to comorbidities; cardiac arrest in 2 (4%), multiorgan failure secondary to cytokine storm in 5 (10%) and ventilator associated complications in 1 (2%).

Conclusion: CP transfusion can be used as a safe and useful treatment in moderately severe and severe patients.

Trial Registration: The trial registration number is NCT04352751  ( https://www.irct.ir/search/result?query=IRCT20200414047072N1 ). Trial Registration date is 28th April 2020.
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http://dx.doi.org/10.1186/s12879-021-06451-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475331PMC
September 2021

Nanoparticles encapsulation of Phoenix dactylifera (date palm) mucilage for colonic drug delivery.

Int J Biol Macromol 2021 Sep 25;191:861-871. Epub 2021 Sep 25.

Hill Fruit Research Station, Sunny Bank, Murree, Pakistan.

Compressed tablet formation from granular drug require binder with Cohesiveness property. Plants mucilage as pharmaceutical excipients are available. In this study, biocompatible date palm mucilage was encapsulated with silver nano particles for sustained drug release to provoke an immune response. Nano formulated mucilage was characterized by UV/VIS, FTIR, XRD, SEM/EDX spectrophotometry. UV/VIS spectra revealed an intense surface plasmon resonance peak at 406 nm for spherical mono dispersed silver nano formulated mucilage resulted from efficient reduction of silver ions to AgNPs. Zeta sizer disclosed the emergence of single peak at 139.7 nm with 100% intensity. Crude mucilage exhibited number of peaks in the region of 4000-500 cm by FT-IR spectroscopy whereas purified as well as nano formulated samples showed somewhat different pattern of peaks in addition to peaks of crude sample. XRD spectra of crude mucilage revealed somewhat regular pattern while purified and modified mucilage displayed irregular structure. In SEM analysis, crude mucilage was appeared as granular that turned into porous network with entangled tiny silver nano spheres. A controlled release of drug levofloxacin hemihydrate was evaluated using crude/ nano formulated mucilage as excipient. Nano formulated mucilage delayed the onset exposure of drug in gastric medium giving recommendations as value added bio binder for drug to the target organ.
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http://dx.doi.org/10.1016/j.ijbiomac.2021.09.126DOI Listing
September 2021

A homozygous ROR2 variant in a family with atypical Robinow syndrome and tetramelic transverse deficiency of autopods.

Am J Med Genet A 2021 Sep 27. Epub 2021 Sep 27.

Department of Molecular Biology and Genetics, MOBGAM, Istanbul Technical University, Istanbul, Turkey.

We present five members of a consanguineous Pakistani kinship with the most severe familial tetramelic transverse autopod deficiency reported to date and additionally having some of the common autosomal recessive Robinow syndrome-1 (RRS1) features including short stature, short neck, severe vertebral anomalies of kyphoscoliosis, hemivertebrae, fusion of thoracic vertebrae, broad forehead, and dental crowding. We mapped the locus of this atypical RRS and detected homozygous 8-nucleotide deletion c.1353_1360del (p.(Met452Alafs*4)) in ROR2, the gene responsible for RRS1. We did not find any other variant shared by all affected individuals that could possibly act as a modifier of limb defect. Autopods are affected in RRS1, but severe autopod deficiency is not a characteristic feature. Over 30 biallelic variants dispersed throughout the gene are known in ROR2-related RS, with no genotype-phenotype correlation for specific RRS1 features. Considering together with the sporadic case homozygous for variant p.(Arg442*) and the case homozygous for p.(Arg441Thrfs*16) in a family where heterozygous members have brachydactyly type B1, we propose that homozygous truncating variants that originate at residues 441-452 can cause severe autopod reduction anomalies, suggesting some genotype-phenotype correlation for this particular phenotype.
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http://dx.doi.org/10.1002/ajmg.a.62514DOI Listing
September 2021

A 10 J shock impedance in sinus rhythm correlates with a 65 J defibrillation impedance during subcutaneous defibrillator implantation using an intermuscular technique.

J Cardiovasc Electrophysiol 2021 Sep 23. Epub 2021 Sep 23.

Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

Introduction: Defibrillation testing (DT) is recommended during the subcutaneous defibrillator (S-ICD) placement. We sought to compare 10 J shock impedance in sinus rhythm (SR) with 65 J defibrillation impedance and evaluate device position on a postimplant chest X-ray (CXR) using an intermuscular (IM) technique.

Methods: Consecutive S-ICD implantations between 12/2019 and 12/2020 at The Ohio State University were reviewed. All implantations were performed using a two-incision IM technique. Standard DT with 65 J shock and 10 J shock in SR were performed unless contraindicated. The PRAETORIAN score was calculated based on CXR.

Results: A total of 37 patients (age: 47.2 ± 15.8 years old, male: n = 26 [70.3%], body mass index: 30.1 ± 6.7 kg/m ) underwent IM S-ICD implantation, and of those, 27 (73%) underwent both 65 J shock and 10 J shock in SR. The coefficient of determination (R ) between 10 J shock impedance and 65 J shock impedance was 0.84. The mean of an impedance difference was 1.6 ± 4.8 Ω (minimum - 11 and maximum 8). Postimplant CXR was available for 33 out of 37 patients (89.2%). The PRAETORIAN score was less than 90 in all patients and the mean score was 32.7 ± 8.8.

Conclusion: We demonstrated that 10 J shock impedance in SR correlated well with 65 J defibrillation impedance during IM S-ICD implantation. An IM implantation technique provides excellent generator location on postimplant CXR. The IM technique combined with 10 J shock in SR may be sufficient to predict and ensure the defibrillation efficacy of the S-ICD.
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http://dx.doi.org/10.1111/jce.15249DOI Listing
September 2021

Assessment of morphological and molecular variability of some Solanum melongena L. cultivars and wild Solanum incanum L. in Saudi Arabia.

Biol Futur 2021 Jun 1;72(2):187-199. Epub 2021 Jan 1.

Plant Production Department, College of Food and Agriculture Sciences, King Saud University, P.O. Box 2460, Riyadh, 11451, Saudi Arabia.

The genus Solanum exhibits a wide range of variability in morphology, flavor, and tolerance to biotic and abiotic stresses. Phenotypic and genetic variability using ISSR and RAPD markers of Solanum incanum distributed in Al-Baha province of the Kingdom of Saudi Arabia is assessed. Thirty samples are representing three different locations: Baljershy, Aqeeq, and Tohama, besides twenty-five samples representing five different commercial cultivars tested. Growth type, the number of leaves per plant, fruit size (phenotypic traits), crude protein, carbohydrates, digestive organic matter, and Mg, Ca, P were the principal contributors in the PCA. Molecular analysis showed that 114 ISSR and 80 RAPD alleles with a 100% polymorphism were recorded. The polymorphism information content (PIC) values ranged from 0.84 to 0.91 for ISSR and from 0.59 to 0.89 for RAPD data. Similarity values ranged from 0.16 to 1.00, with an average of 0.47 for ISSR and from 0.01 to 0.97, with an average of 0.36 for RAPD. It resulted in a positive and significant correlation between morphological, molecular, nutritional, and chemical analysis of fruits using Mantel analysis. UPGMA and PCA for morphological traits and molecular data discriminated commercial cultivars and wild relatives. Solanum incanum was more diverse than commercial varieties. This study revealed a wide genetic diversity among and within collected eggplant accessions and may use in breeding programs of eggplants. There is a need to increase the present eggplant collection to widen the genetic diversity of cultivated eggplant varieties in Saudi Arabia.
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http://dx.doi.org/10.1007/s42977-020-00052-2DOI Listing
June 2021

Flood hazards and livelihood vulnerability of flood-prone farm-dependent Bait households in Punjab, Pakistan.

Environ Sci Pollut Res Int 2021 Sep 18. Epub 2021 Sep 18.

Department of Economics, Preston University, Islamabad, Pakistan.

Pakistan is one of the most climate change- and natural disaster-affected country of the world where livelihood and lives of inhabitants are often affected due to these disasters. In the scenario of various disasters and risks, flood disasters are the most recurrent hazards that cause Bait households' livelihood to be more vulnerable. Hence, this research work has focused to investigate livelihood vulnerability of flood-prone Bait households in southern Punjab of Pakistan. This study used multistage sampling technique for collection of the cross-sectional data of 398 flood disasters vulnerable Bait household's respondents from three high-risk flood-prone districts Muzaffargarh, Rajanpur, and Rahim Yar Khan. Face-to-face interview procedure and well-developed pre-tested questionnaire were used for data collection in this research work. This study applied vulnerability framework of LVI-IPCC and LVI in the direction of comparing the level of vulnerabilities in preferred three Bait district households. Empirical estimates of LVI major components and framework of IPCC vulnerability have indicated Bait households of Muzaffargarh more vulnerable owing to higher exposure and sensitivity and lower adaptive capacity than other districts. In contrast to other districts, Muzaffargarh households have investigated more vulnerable to flood disasters more particularly in LVI sub-components such as health (0.460), water (0.360), and food (0.515) access. These research findings will be helpful to policymakers to work out and put into practice effectual programs and strategies such as constructing more water reserves, developing overhead infrastructure, easy access of institutional loans, and generating off-farm income sources. These local-based feasible measures will be helpful for native inhabitants to reduce frequency of floods in the direction of lessened vulnerability and increased resilience via recovering generally the livelihood of vulnerable Bait households in Punjab Pakistan and particularly the district Muzaffargarh.
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http://dx.doi.org/10.1007/s11356-021-16443-4DOI Listing
September 2021

Predicting COVID-19 incidence in war-torn Afghanistan: A timely response is required!

J Infect 2021 Sep 16. Epub 2021 Sep 16.

Department of Life Sciences, School of Science, University of Management and Technology (UMT), Lahore 54700, Pakistan. Electronic address:

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http://dx.doi.org/10.1016/j.jinf.2021.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443316PMC
September 2021

Exploring the prophylactic role of soy isoflavones against polycystic ovarian syndrome.

Food Sci Nutr 2021 Sep 9;9(9):4738-4744. Epub 2021 Jul 9.

Department of Food Science Faculty of Life Sciences Government College University Faisalabad Pakistan.

Soy isoflavones (SI) have strong estrogenic effect in tissues by binding to estrogen receptors and might be beneficial for women with polycystic ovarian syndrome (PCOS) by reduction in testosterone, cholesterol, insulin, weight gain, inflammatory markers, and oxidative stress. The study was planned to examine the effect of various levels of SI on nutrient intake, digestibility, lipid profile, insulin, and reproductive hormones of estradiol valerate (4 mg/rat/IM) PCOS induced rat models. Thirty-six Wistar 45 days old rats weighing 95 ± 5 g were divided into 4 groups, each having 9 rats: C (control: without SF), SF10 (SF 0.10 g/kg BW), SF15 (SF 0.15 g/kg BW), and SF20 (SF 0.20 g/kg BW). SF was given through the oral gavage. Food and water were offered ad libitum, and intake was recorded daily. During last week of trial, collected feces by total collection method and blood samples were used to calculate nutrient digestibility and biochemical analysis, respectively. Estrogen, progesterone, and prolactin were ( < .05) high in rats fed SF diet that was 4% and 30% increase from C, respectively. Insulin, testosterone, FSH, and LH were lowest in rats fed diet SF20. Significant ( < .05) reduction in cholesterol was observed in rats fed SF15 and SF20 as compared to C. Serum HDL was improved ( < .05) in all SIF, SIF and SIF in comparison with PC. Serum LDL was significantly reduced to 68.89 ± 4.36 (mg/dl) in SIF and to 108.20 ± 4.14 (mg/dl) in SIF whereas insignificant reduction was observed in SIF as compared to PC. Highly significant reduction was noted in triglycerides level in SIF however, significant reduction was observed in both SIF and SIF as compared to PC after 3 months of treatment with soy isoflavones.
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http://dx.doi.org/10.1002/fsn3.2322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8441391PMC
September 2021

Does denosumab offer survival benefits? -Our experience with denosumab in metastatic non-small cell lung cancer patients treated with immune-checkpoint inhibitors.

J Thorac Dis 2021 Aug;13(8):4668-4677

Department of Hematology-Oncology, Norris Cotton Cancer Center, One Medical Center Dr., Lebanon, NH, USA.

Background: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of non-small-cell lung cancer (NSCLC). Denosumab is a humanized monoclonal antibody to RANK ligand used to prevent skeletal-related events of bone metastases in solid tumors. We are reporting the clinical outcomes in our NSCLC patients who received RANKL inhibitor in combination with ICIs.

Methods: This observational study used retrospective data from a tertiary cancer center from 2015-2020. Stage IV non-small cell lung cancer patients who received denosumab within 30 days of ICIs (pembrolizumab, nivolumab, atezolizumab, ipilimumab) were included. Kaplan-Meier curves were obtained for survival analysis.

Results: We identified 69 patients and all had skeletal metastases, and 37.7% had brain metastases. Median OS was 6.3 months and median PFS was 2.8 months, with overall response rate (ORR) of 18.8% and disease control rate (DCR) of 40.6%. Median OS in patients with concomitant denosumab and ICIs more than 3 months was 11.5 months, comparing to 3.6 months in patients with <3 months of concomitant therapy (P=0.0005). OS and PFS did not differ with respect to brain metastases or number of skeletal metastases. However, the duration of ICIs and denosumab overlap was associated with improved OS and PFS. Among the 18.8% of patients who achieved complete response (CR) and partial response (PR), six-month survival rate was 100% and one-year survival rate was 69.2%. Most of the patients tolerated denosumab well, and hypocalcemia was the most commonly reported side effect.

Conclusions: Patients receiving combination therapy did not perform poorly comparing to published studies despite of poor prognostic features such as brain metastases and numerous skeletal metastases. Although we did notice potential benefit of the longer duration of concomitant use of ICI and denosumab, future prospective clinical trials are needed to evaluate the synergistic effect of RANKL inhibitors/ICI and if duration of RANKL inhibitors matters.
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http://dx.doi.org/10.21037/jtd-21-150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411139PMC
August 2021

Glutamate dehydrogenase (GdhA) of is required for high temperature adaptation.

Infect Immun 2021 Sep 7:IAI0040021. Epub 2021 Sep 7.

Department of Respiratory Sciences, University of Leicester, Leicester, UK.

During its progression from the nasopharynx to other sterile and non-sterile niches of its human host, must cope with changes in temperature. We hypothesised that the temperature adaptation is an important facet of pneumococcal survival in the host. Here, we evaluated the effect of temperature on pneumococcus and studied the role of glutamate dehydrogenase (GdhA) in thermal adaptation associated with virulence and survival. Microarray analysis revealed a significant transcriptional response to changes in temperature, affecting the expression of 252 genes in total at 34°C and 40°C relative to at 37°C. One of the differentially regulated genes was which is upregulated at 40°C and downregulated at 34°C relative to 37°C. Deletion of attenuated the growth, cell size, biofilm formation, pH survival, and biosynthesis of proteins associated with virulence in a temperature-dependent manner. Moreover, deletion of stimulated formate production irrespective of temperature fluctuation. Finally, Δ grown at 40°C was less virulent compare to other temperatures or than the wild type at the same temperature in a infection model, suggesting that GdhA is required for pneumococcal virulence at elevated temperature.
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http://dx.doi.org/10.1128/IAI.00400-21DOI Listing
September 2021

Temporal Changes and Clinical Implications of Delayed Peridevice Leak Following Left Atrial Appendage Closure.

JACC Clin Electrophysiol 2021 Aug 17. Epub 2021 Aug 17.

Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address:

Objective: The aim of this study was to assess temporal changes and clinical implications of peridevice leak (PDL) after left atrial appendage closure.

Background: Endocardial left atrial appendage closure devices are alternatives to long-term oral anticoagulation (OAC) for patients with atrial fibrillation. PDL > 5 mm may prohibit discontinuation of OAC.

Methods: Patients included in the study had: 1) successful Watchman device implantation without immediate PDL; 2) new PDL identified at 45 to 90 days using transesophageal echocardiography; 3) eligibility for OAC; and 4) 1 follow-up transesophageal echocardiographic study for PDL surveillance. Relevant clinical and imaging data were collected by chart review. The combined primary outcome included failure to stop OAC after 45 to 90 days, transient ischemic attack or stroke, device-related thrombi, and need for PDL closure.

Results: Relevant data were reviewed for 1,039 successful Watchman device implantations. One hundred eight patients (10.5%) met the inclusion criteria. The average PDL at 45 to 90 days was 3.2 ± 1.6 mm. On the basis of a median PDL of 3 mm, patients were separated into ≤3 mm (n = 73) and >3 mm (n = 35) groups. In the ≤3 mm group, PDL regressed significantly (2.2 ± 0.8 mm vs 1.6 ± 1.4 mm; P = 0.002) after 275 ± 125 days. In the >3 mm group, there was no significant change in PDL (4.9 ± 1.4 mm vs 4.0 ± 3.0 mm; P = 0.12) after 208 ± 137 days. The primary outcome occurred more frequently (69% vs 34%; P = 0.002) in the >3 mm group. The incidence of transient ischemic attack or stroke in patients with PDL was significantly higher compared with patients without PDL, irrespective of PDL size.

Conclusions: New PDL detected by transesophageal echocardiography at 45 to 90 days occurred in a significant percentage of patients and was associated with worse clinical outcomes. PDL ≤ 3 mm tended to regress over time.
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http://dx.doi.org/10.1016/j.jacep.2021.06.018DOI Listing
August 2021

Constructed wetlands as a sustainable technology for wastewater treatment with emphasis on chromium-rich tannery wastewater.

J Hazard Mater 2021 Aug 16;422:126926. Epub 2021 Aug 16.

UNESCO Chair on Groundwater Arsenic within the 2030 Agenda for Sustainable Development, University of Southern Queensland, West Street, Toowoomba 4350, Queensland, Australia.

Water scarcity is a major threat to agriculture and humans due to over abstraction of groundwater, rapid urbanization and improper use in industrial processes. Industrial consumption of water is lower than the abstraction rate, which ultimately produces large amounts of wastewater such as from tannery industry containing high concentration of chromium (Cr). Chromium-contaminated tannery industry wastewater is used for irrigation of food crops, resulting in food safety and public health issues globally. In contrast to conventional treatment technologies, constructed wetlands (CWs) are considered as an eco-friendly technique to treat various types of wastewaters, although their application and potential have not been discussed and elaborated for Cr treatment of tannery wastewater. This review briefly describes Cr occurrence, distribution and speciation in aquatic ecosystems. The significance of wetland plant species, microorganisms, various bedding media and adsorbents have been discussed with a particular emphasis on the removal and detoxification of Cr in CWs. Also, the efficiency of various types of CWs is elaborated for advancing our understanding on Cr removal efficiency and Cr partitioning in various compartments of the CWs. The review covers important aspects to use CWs for treatment of Cr-rich tannery wastewater that are key to meet UN's Sustainable Development Goals.
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http://dx.doi.org/10.1016/j.jhazmat.2021.126926DOI Listing
August 2021

Ipilimumab and nivolumab induced immune-related adverse events in metastatic mucosal melanoma.

BMJ Case Rep 2021 Aug 20;14(8). Epub 2021 Aug 20.

Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

Mucosal melanoma is a rare subtype of melanoma and represents a unique diagnosis and treatment challenge. Immune-checkpoint inhibitors (ICIs) have revolutionised metastatic melanoma treatment, and one of the leading regimens is the combination of ipilimumab (anti-cytotoxic T lymphocyte-associated antigen 4: CTLA4) and nivolumab (anti-programmed cell death protein 1: PD1). We report a case of a patient with metastatic mucosal melanoma treated with ipilimumab and nivolumab who developed multiple immune-related adverse events (irAEs) including uveitis, type I diabetes complicated by diabetic ketoacidosis, destructive thyroiditis, hepatitis and vitiligo. Endocrinopathies including type 1 diabetes and hypothyroidism were treated with insulin and levothyroxine. Hepatitis was responsive to steroids. She had sustained complete response 12 months after discontinuation of the combination therapy. With the wide usage of ICIs in multiple types of malignancies, it is important for general practioners to recognise common and serious irAEs due to ICIs.
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http://dx.doi.org/10.1136/bcr-2021-243713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381294PMC
August 2021

Efficacy of pedagogical framework in neonatal resuscitation skill learning in a resource-limited setting: a randomized controlled trial.

BMC Med Educ 2021 Aug 18;21(1):436. Epub 2021 Aug 18.

Department of Zoology, The Government College University, Lahore, Pakistan.

Background: The educational efficacy in neonatal resuscitation relies on the subject and teaching strategies. Therefore, it is imperative to test diverse educational methods if they are more instructive to engage students in active learning and practicing knowledge. Hence, the present study aims to investigate the efficacy of a pedagogical framework in neonatal resuscitation skill learning among nursing students in a resource-limited setting.

Methods: A single-blind randomized controlled trial was conducted between October 2020 to March 2021. Sixty nursing students in the 3rd and 4th year of professional training were randomly allocated to the pedagogy and the traditional group. The pedagogy group learned via 6-step LSPPDM (Learn, See, Practice, Prove, Do, Maintain) pedagogy including lectures, video, clinical observation, skill sessions under supervision, and self-directed practice. The traditional group learned through 2-step (Learn, Practice) method that included lectures and skill sessions under supervision. The outcomes measured included technical and non-technical skills in neonatal resuscitation. The technical skill deals with steps such as stimulation, ventilation, oxygenation, intubation, chest compression, medications, and reporting. Non-technical skills refer to teamwork skills that focus on the interaction between leader and helper. Both skills were measured through previously published validated tools two times before and after the intervention by blinded assessors in a simulated delivery room.

Results: Overall, the skill was significantly improved in both groups after intervention. Yet, the results showed that the mean difference of technical skill score in the pedagogy group (24.3 ± 3.5) was significantly higher (p <  0.001) compared to the traditional group (16.2 ± 2.4). Likewise, the mean difference of non-technical skill score in the pedagogy (36.9 ± 1.9) was highly significant (p <  0.001) compared to the traditional group (31.2 ± 1.7).

Conclusions: The LSPPDM pedagogy was found more effective in enhancing technical and non-technical skills in neonatal resuscitation compared to the traditional method. The results of this study support the efficacy of the 6-step LSPPDM pedagogy in the education of nursing students regarding neonatal resuscitation in a resource-limited setting.

Trial Registration: Prospectively registered at ClinicalTrials.gov ( NCT04748341 ).
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http://dx.doi.org/10.1186/s12909-021-02846-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8371841PMC
August 2021

A rare case of extensively drug-resistant  typhi meningitis in a 9-year old: a case report.

Future Microbiol 2021 Sep 17;16:931-933. Epub 2021 Aug 17.

Department of Medical Lab Technology, National Skills University, Islamabad, Pakistan.

Meningitis caused by typhi is rare and is generally seen in infants. We report a case of a 9-year-old boy with extensively drug-resistant typhi meningitis. The patient was diagnosed using a culture sensitivity test and successfully treated with meropenem. Culture sensitivity may be included in routine testing for the diagnosis of  typhi especially in developing countries due to high burden of disease and emergence of drug resistance.
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http://dx.doi.org/10.2217/fmb-2020-0257DOI Listing
September 2021

Survey and Performance Analysis of Deep Learning Based Object Detection in Challenging Environments.

Sensors (Basel) 2021 Jul 28;21(15). Epub 2021 Jul 28.

Department of Computer Science, Technical University of Kaiserslautern, 67663 Kaiserslautern, Germany.

Recent progress in deep learning has led to accurate and efficient generic object detection networks. Training of highly reliable models depends on large datasets with highly textured and rich images. However, in real-world scenarios, the performance of the generic object detection system decreases when (i) occlusions hide the objects, (ii) objects are present in low-light images, or (iii) they are merged with background information. In this paper, we refer to all these situations as challenging environments. With the recent rapid development in generic object detection algorithms, notable progress has been observed in the field of deep learning-based object detection in challenging environments. However, there is no consolidated reference to cover the state of the art in this domain. To the best of our knowledge, this paper presents the first comprehensive overview, covering recent approaches that have tackled the problem of object detection in challenging environments. Furthermore, we present a quantitative and qualitative performance analysis of these approaches and discuss the currently available challenging datasets. Moreover, this paper investigates the performance of current state-of-the-art generic object detection algorithms by benchmarking results on the three well-known challenging datasets. Finally, we highlight several current shortcomings and outline future directions.
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http://dx.doi.org/10.3390/s21155116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8348086PMC
July 2021

Acute Pancreatitis-Induced Euglycemic Diabetic Ketoacidosis.

Cureus 2021 Jun 26;13(6):e15949. Epub 2021 Jun 26.

Endocrinology, Diabetes, and Metabolism, Saint Joseph's Regional Medical Center, Paterson, USA.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of medications utilized for the treatment of diabetes mellitus by mechanisms promoting incretin release and insulin production. Although poorly understood, cases of acute pancreatitis have been observed in patients taking GLP-1 RAs. Sodium-glucose co-transporter-2 inhibitors (SGLT-2is) are another class of diabetic medications inhibiting renal glucose reabsorption which have been associated with rare cases of euglycemic ketoacidosis. Acute pancreatitis itself has been an observable cause of diabetic ketoacidosis, although typically in a hyperglycemia state. In this case report, we present a patient on SGLT-2is and GLP-1 RAs who developed acute pancreatitis, which may have precipitated euglycemic diabetic ketoacidosis (eu-DKA).
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http://dx.doi.org/10.7759/cureus.15949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8312994PMC
June 2021

Emerging polio hotspots in Pakistan: Challenges and the way forward.

J Infect 2021 10 26;83(4):496-522. Epub 2021 Jul 26.

Department of Life Sciences, School of Science, University of Management and Technology (UMT), Lahore 54700, Pakistan. Electronic address:

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http://dx.doi.org/10.1016/j.jinf.2021.07.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453661PMC
October 2021

A dielectric free near field phase transforming structure for wideband gain enhancement of antennas.

Sci Rep 2021 Jul 28;11(1):14613. Epub 2021 Jul 28.

School of Electrical and Data Engineering, University of Technology Sydney (UTS), Sydney, NSW, 2007, Australia.

The gain of some aperture antennas can be significantly increased by making the antenna near-field phase distribution more uniform, using a phase-transformation structure. A novel dielectric-free phase transforming structure (DF-PTS) is presented in this paper for this purpose, and its ability to correct the aperture phase distribution of a resonant cavity antenna (RCA) over a much wider bandwidth is demonstrated. As opposed to printed multilayered metasurfaces, all the cells in crucial locations of the DF-PTS have a phase response that tracks the phase error of the RCA over a large bandwidth, and in addition have wideband transmission characteristics, resulting in a wideband antenna system. The new DF-PTS, made of three thin metal sheets each containing modified-eight-arm-asterisk-shaped slots, is significantly stronger than the previous DF-PTS, which requires thin and long metal interconnects between metal patches. The third advantage of the new DF-PTS is, all phase transformation cells in it are highly transparent, each with a transmission magnitude greater than - 1 dB at the design frequency, ensuring excellent phase correction with minimal effect on aperture amplitude distribution. With the DF-PTS, RCA gain increases to 20.1 dBi, which is significantly greater than its 10.7 dBi gain without the DF-PTS. The measured 10-dB return loss bandwidth and the 3-dB gain bandwidth of the RCA with DF-PTS are 46% and 12%, respectively.
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http://dx.doi.org/10.1038/s41598-021-93975-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319319PMC
July 2021
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