Hematological profile and gametocyte carriage in malaria patients from southern Pakistan

Background: Malarial infection is a major cause of concern, both worldwide and in Pakistan. Gametocytes are the sexual forms of the parasite that are essential for transmission. They fuse inside the mosquito to develop sporozoites. Gametocytes of the plasmodium parasites, which cause the infection, differentiate into male and female gametocytes. These gametocytes constitute the sexual stage of the malaria parasite and are essential in transmission of the disease from human to vector Anopheles. Gametocytes are affected by factors such as host immunity, drug treatment, reticulocytemia, anemia, low levels of asexual parasitemia and stress to the parasite. The aim of this study was to observe the hematological parameters, age and gametocyte carriage in an area of seasonal malaria transmission.Methods: The study was conducted at Aga Khan University Hospital (AKUH) Laboratory over the period of one year and 294 patients with uncomplicated malaria were recruited. Patients infected with Plasmodium falciparum (P. falciparum) or Plasmodium vivax (P. vivax) malaria and no co-morbidities were included in the study.Results: Gametocytemia was highest during the period of July to November, with P. vivax, 267 (90.8%), predominating compared to P. falciparum, 27 (9.2%). P. vivax gametocytes were observed from May to October and P. falciparum gametocytes were observed from July to December. Low hemoglobin in females and low platelet levels were observed. The mean platelet count was significantly lower in cases of P. vivax having gametocytes compared to P. falciparum with gametocytes. Higher parasitic index was associated with lower platelet count. The most significantly altered parameters were hemoglobin, hematocrit, white blood cell (WBC), and platelet count. Hemoglobin and platelets were significantly lower during the malaria season in study participants, both male and female.Conclusion: In conclusion, infection with P. falciparum and P. vivax modulates significant changes in hematological parameters in populations living in malaria endemic regions. In the malaria season males were more frequently affected by malaria with thrombocytopenia. Gametocyte carriage remains unaffected by seasonal changes thus ensuring parasite transmission during the dry season

Role of deep brain stimulation (DBS) in addiction disorders

Background: Addiction disorders pose significant challenges to public health, necessitating innovative treatments. This assesses deep brain stimulation (DBS) as a potential intervention for addiction disorders. Methods: A literature review was carried out with a focus on the role of DBS in addiction disorders and its future implications in neurosurgical research. Results: The online literature shows that DBS precisely modulates certain brain regions to restore addiction-related neural circuits and promote behavioral control. Conclusion: Preclinical evidence demonstrates DBS’s potential to rebalance neural circuits associated with addiction, and early clinical trials provide encouraging outcomes in enhancing addiction-related outcomes. Ethical considerations, long-term safety, and personalized patient selection require further investigation

Intelligent Systems Research in the Construction Industry

YesWith the increasing complexity of problems in the construction industry, researchers are investigating computationally rigorous intelligent systems with the aim of seeking intelligent solutions. The purpose of this paper is therefore to analyse the research published on ‘intelligent systems in the construction industry’ over the past two decades. This is achieved to observe and understand the historical trends and current patterns in the use of different types of intelligent systems and to exhibit potential directions of further research. Thus, to trace the applications of intelligent systems to research in the construction industry, a profiling approach is employed to analyse 514 publications extracted from the Scopus database. The prime value and uniqueness of this paper lies in analysing and compiling the existing published material by examining variables (such as yearly publications, geographic location of each publication, etc.). This has been achieved by synthesising existing publications using 14 keywords2 ‘Intelligent Systems’, ‘Artificial Intelligence’, ‘Expert Systems’, ‘Fuzzy Systems’, ‘Genetic Algorithms’, ‘Knowledge-Based Systems’, ‘Neural Networks’, ‘Context Aware Applications’, ‘Embedded Systems’, ‘Human–Machine Interface’, ‘Sensing and Multiple Sensor Fusion’, ‘Ubiquitous and Physical Computing’, ‘Case-based Reasoning’ and ‘Construction Industry’. The prime contributions of this research are identified by associating (a) yearly publication and geographic location, (b) yearly publication and the type of intelligent systems employed/discussed, (c) geographic location and the type of research methods employed, and (d) geographic location and the types of intelligent systems employed. These contributions provide a comparison between the two decades and offer insights into the trends in using different intelligent systems types in the construction industry. The analysis presented in this paper has identified intelligent systems studies that have contributed to the development and accumulation of intellectual wealth to the intelligent systems area in the construction industry. This research has implications for researchers, journal editors, practitioners, universities and research institutions. Moreover, it is likely to form the basis and motivation for profiling other database resources and specific types of intelligent systems journals in this area

Dexmedetomidine sedation in ICU

Dexmedetomidine (DEX), a highly selective α2-adrenergic receptor agonist, is the newest agent introduced for sedation in intensive care unit (ICU). The sedation strategy for critically ill patients has stressed light sedation with daily awakening and assessment for neurologic, cognitive, and respiratory functions, since Society of Critical Care Medicine (SCCM) guidelines were presented in 2002. The traditional GABAergic agents, including benzodiazepines and propofol, have some limitations for safe sedatives in this setting, due to an unfavorable pharmacokinetic profile and to detrimental adverse effects (such as lorazepam associated propylene glycol intoxication and propofol infusion syndrome). DEX produces it's sedative, analgesic and cardiovascular effects through α2 receptors on the locus ceruleus (LC). Activities of LC, the tuberomammillary nucleus (TMN) are depressed and activity of the ventrolateral preoptic nucleus (VLPO) is increased during DEX sedation, which is similar in features to normal non-REM (NREM) sleep. At the same time, perifornical orexinergic activity is maintained, which might be associated with attention. This mechanism of action produces a normal sleep-like, cooperative sedation. The characteristic feature of sedation, together with a concomitant opioid sparing effect, may decrease the length of time spent on a ventilator, length of stay in ICU, and prevalence and duration of delirium, as the evidence shown from several comparative studies. In addition, DEX has an excellent safety profile. In conclusion, DEX is considered as a promising agent optimized for sedation in ICU

SpHincterotomy for Acute Recurrent Pancreatitis Randomized Trial: Rationale, Methodology, and Potential Implications

Objectives: In patients with acute recurrent pancreatitis (ARP), pancreas divisum, and no other etiologic factors, endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (miES) is often performed to enlarge the minor papillary orifice, based on limited data. The aims of this study are to describe the rationale and methodology of a sham-controlled clinical trial designed to test the hypothesis that miES reduces the risk of acute pancreatitis. Methods: The SpHincterotomy for Acute Recurrent Pancreatitis (SHARP) trial is a multicenter, international, sham-controlled, randomized trial comparing endoscopic ultrasound + ERCP with miES vs. endoscopic ultrasound + sham for the management of ARP. A total of 234 consented patients having two or more discrete episodes of acute pancreatitis, pancreas divisum confirmed by magnetic resonance cholangiopancreatography, and no other clear etiology for acute pancreatitis will be randomized. Both cohorts will be followed for a minimum of 6 months and maximum of 48 months. Results: The trial is powered to detect a 33% risk reduction of acute pancreatitis frequency. Conclusions: The SHARP trial will determine whether ERCP with miES benefits patients with idiopathic ARP and pancreas divisum. Trial planning has informed the importance of blinded outcome assessors and long-term follow-up

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Deep eutectic solvent based ultrasonic assisted liquid phase microextraction for the FAAS determination of cobalt

A novel deep eutectic solvent based ultrasound-assisted liquid phase microextraction (DES-UALPME) has introduced for preconcentration of cobalt. Deep eutectic solvents (DESs) are studied as a green and eco-friendly solvents. In this method, 1-nitroso-2-naphthol was used as ligand. Cobalt concentration in DES rich phase was measured by a microsample injection system coupled with flame atomic absorption spectrometer (MS-FAAS). Under optimum conditions, LOD, LOQ preconcentration factor (PF) and % RSD were determined as 1.10 mu g L-1, 3.60 mu g L-1,15 and 7.1% respectively. The accuracy of the developed method was evaluated by the analysis of a pharmaceutical supplement and tea samples. Recoveries of certified reference materials and spiked samples were obtained in the range of 97-105%. Finally, the performance characteristics of the proposed method were compared with other liquid phase microextraction procedures. (C) 2016 Elsevier B.V. All rights reserved

Nanomaterials-based solid phase extraction and solid phase microextraction for heavy metals food toxicity

In the last few years, nanomaterials are widely used sorbents for the extraction of heavy metals in food samples. The nanomaterials have a larger surface area and show high selectivity, fast adsorption capability, and high efficiency for food contaminants (heavy metals). Carbon nanomaterials (CNMs), magnetic nanoparticles (MNPs), nano-imprinted polymers (NIPs), nano-based metal-organic frameworks (N-MOFs), and silica nanoparticles (SiNPs) are most prominent nanomaterials used in the preconcentration and determination of heavy metals. The most popular sorbent-based techniques for the extraction of heavy metals are solid phase extraction (SPE) and solid phase microextraction (SPME). The use of these nanomaterial sorbents increases the extraction efficiency of both techniques. This review summarizes the nanomaterial sorbents (published 2015 to May-2020) used in solid phase extraction (SPE) and solid phase microextraction (SPME) for heavy metals extraction in food

Dispersive solid phase microextraction (DSP-μE) by using nanodiamond@Bi2MoO6 composite for the separation-preconcentration of Pb(II) in food and water samples

A nanodiamond@Bi2MoO6 nanocomposite was synthesized using a hydrothermal procedure. The nanodiamond@Bi2MoO6 was characterized using various techniques like BET, FT-IR, FESEM, EDX, and XRD. It was used as an adsorbent for dispersive solid phase microextraction (DSP-μE) of Pb(II) at ultra-trace levels prior to its flame atomic absorption spectrometric detection. The analytical parameters such as pH values, adsorbent dose, eluent concentration, eluent volume, eluent time, and sample volume on the quantitative recoveries of lead(II) on nanodiamond@Bi2MoO6 were optimized. Additionally, matrix effects were investigated. The LOD, LOQ, and PF were calculated as 1.75 μg L-1, 5.85 μg L-1 and 16.7, respectively. The validation of the DSP-μE procedure was checked by using certificated reference material (CRM) Wheat Gluten RM8418 and BCR Estuarine water 505 for satisfactory with 98.5 to 102.4 % recovery results. The new DSP-μE procedure was applied to be successful for Pb determination in instant noodles and water samples. The concentration of Pb(II) in instant noodles samples ranged between 23 and 194 µg kg−1. In water samples, Pb(II) concentration was observed in the range of 7.95–8.05 and 123.3–142.7 µg/L, tap water, and industrial water respectively. The estimated daily intake of total Pb(II) in the food (noodles/serving i.e., noodles, seasoning spices, water) was come out as 4.27– 16.12 µg kg−1 day−1 and compared with PTDI level