Adherence to growth hormone therapy in children with growth hormone deficiency: Experience at a public sector tertiary care hospital

Objective: To determine the adherence rate of recombinant human Growth Hormone therapy (rhGH) in children suffering from growth hormone deficiency and parent’s perspectives regarding reasons for non-compliance. Materials and Methods: This study was conducted at District Headquarters Hospital, Rawalpindi from January 2020 to June 2021. All children already diagnosed with Growth hormone deficiency were included in the study. Children with less than one-year duration of treatment were excluded. Demographic details were recorded on a predesigned proforma. Adherence to treatment was assessed using a combination of methods based on previous studies. The proportion of days covered >80% was taken as good adherence. Data was entered and analyzed in SPSS 25. Qualitative variables such as gender, socioeconomic status, source of growth hormone injections, and adherence were presented as frequency and percentages. Self-reported reasons for non-adherence were presented as frequency and percentage. Results: A total of 38 patients meeting the inclusion criteria were included in the study. Both genders were equal in number. The mean age at diagnosis was 8.2 ± 3.6 years. Socioeconomic status was the middle (upper or lower) in 55% of the cases while 45% belonged to the lower socioeconomic group. Adherence was good in 44% of the patients while suboptimal in 56%. The cost of treatment was the main reason for non-adherence in all the cases. Conclusion: Non-adherence to rhGH therapy is common in our setup. Clinicians should be aware of different factors affecting adherence and all efforts should be made to ensure good adherence so that optimal targets may be achieved. Keywords: Adherence, Growth hormone therapy, socioeconomic statu

A comparison of Male and Female Medical Student's Motivation towards Career Choice

Objective: To compare motivation to become a doctor in both genders Study Design: Observational cross-sectional study Place and Duration of Study:  Rawalpindi Medical University in March 2019. Materials and Methods: First and second-year M.B.B.S students were included in the study. Age, year of study, and gender were recorded.  The questionnaire included 18 questions assessing six motivational dimensions: status and security; nature of the occupation; career opportunities; patient care and working with people; use of personal skills; and interest in science. Responses were recorded as ‘agree’ or ‘disagree’ for each question and results were analyzed using SPSS v19. Results: Out of 350 medical students, 247 (70.6%) were female and 103 (29.4%) were male. Most frequent motivational factors for females were “Opportunity to care for/ help people” (n=240; 97.1%) followed by “responsible job” (n=220; 89%) and “use of mental skills” (n=217; 87.8%). Male students were motivated mostly by “use of mental skills” (n=90; 87.3%) followed by “provides secure career” (n=87; 84.4%) and “challenging field” (n=83; 80.5%). In our study, (n=61; 25%) of females responded in agreement that boosts in marriage perspective was an underlying motivational factor for their choice of studying medicine while (n=41; 40%) males agreed to it. There was a significant difference between both genders with a p-value of 0.005.  Conclusions: We infer that female medical students have more humanitarian grounds for choosing the medical profession and are more motivated than their male counterparts

Effects of different acetylsalicylic acid doses on body organs, histopathology, and serum biochemical parameters in broiler birds

A indústria avícola é afetada por diversas doenças ou estresses. Particularmente devido às aves serem antipiréticas. O ácido acetilsalicílico (AAS) é largamente utilizado com diferentes objetivos que incluem o controle do estresse calórico, bem como a atividade respiratória e digestiva. O propósito deste estudo foi a avaliação dos efeitos benéficos e tóxicos do emprego de diferentes dosagens do AAS em frangos de corte. As variáveis analisadas foram: exame físico, parâmetros bioquímicos, bem como as alterações histopatológicas em seções de tecidos colhidas das aves em um ensaio experimental. O estudo foi conduzido em 60 frangos de corte com um dia de idade adquiridos em um mercado local de Faisalabad que foram recriados nos primeiros 14 dias em idênticas condições. Então no 15º dia as aves foram distribuídas randomicamente em quatro grupos identificados pelos números 1 a 4, com 15 aves em cada grupo. O grupo 4 foi mantido como grupo controle e os grupos 1, 2 e 3 foram tratados com AAS, respectivamente, nas doses de 300, 600 e 1200 mg/L de água de bebida, durante 21 dias. Foram realizadas três amostragens nos dias 21, 28 e 35 pós-tratamento. O peso vivo corpóreo e da carcaça foi registrado em cada amostragem. Em todos os órgãos viscerais foi analisada a presença de alterações patológicas. As amostras de soro sanguíneo foram colhidas para a avaliação bioquímica. O exame histopatológico de todos os órgãos viscerais foi realizado para a observação de alterações microscópicas. A partir da segunda amostragem foi observado um aumento significante (p<0,05) no peso corpóreo na dosagem de 300mg/L. Um significante aumento no peso relativo dos órgãos foi registrado na dosagem de 1200 mg/L. Os grupos tratados com dosagens de 600 e 1200 mg/L de AAS, apresentaram aumento significante dos níveis de AST, ALT e de creatinina quando comparados ao grupo controle. O grupo tratado com 1200 mg/L de AAS apresentou um aumento significante (P,0,05) de uréia, proteína sérica total e de albumina em todas as amostragens. No grupo de alta dosagem foram observados alterações histopatológicas constituídas por aumento dos hepatócitos, aumento dos espaços sinusoidais no fígado, congestão e anormalidades nos espaços glomerulares nos rins, congestão e ruptura alveolar nos pulmões, degeneração das vilosidades e celular nos intestinos A conclusão obtida foi que em frangos de corte uma baixa dosagem do AAS pode ser utilizada por um período de longa duração, apresentando um efeito promotor do crescimento, contudo as doses elevadas determinam toxicidade hepática e renal.The poultry industry suffers from various diseases or stresses. In poultry, apart from being antipyretic, acetylsalicylic acid (ASA) is widely used to cope with different issues including heat stress, and respiratory and digestive orders. This study evaluated the beneficial and toxic effects of ASA at different dose levels in broiler birds. To evaluate these toxic and beneficial effects it is necessary to examine the physical and serum biochemical parameters as well as the histopathological changes with tissue sections taken from broiler birds under experimental trial. This study was conducted on 60 one-day-old broiler chicks purchased from a local market in Faisalabad. Chicks were reared for the first 14 days under similar conditions. On the 15th day, birds were randomly divided into 4 groups (1-4) with 15 birds in each group. Group 4 was kept as control, while groups 1, 2, and 3 were treated with ASA at the dose of 300, 600, and 1200 mg/L of drinking water for 21 days. There were 3 samplings performed at 21, 28, and 35 days post-treatment. The live body weight and carcass weight were noted on each sampling. All the visceral organs were recorded for gross pathological changes. The serum samples were collected for biochemical evaluation. Histopathology of all the visceral organs was performed to observe the microscopic changes. A significant (P<0.05) increase in live body weight at a 300mg/L dose was noted after the first 2 samplings. A significant (P<0.05) increase in the relative organ weight was recorded at 1200 mg/L. The groups treated with ASA 600 and 1200 mg/L showed increased (P<0.05) AST, ALT, and creatinine levels from that of the control group. The group treated with 1200 mg/L of ASA showed increased (P<0.05) urea, serum total protein, and albumin level in all the samplings. Histopathological changes revealed swollen hepatocytes, increased sinusoidal spaces in the liver, congestion and abnormal glomerular spaces in the kidney, congestion and alveolar disruption in the lungs, and generation of villi and cellular degeneration in the intestine in a high-dose group. The study concluded that ASA at a low dose can be used for a long time in broilers and has a growth promontory role, while high-level doses cause hepatorenal toxicity

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Introduction of CdO nanoparticles into graphene and graphene oxide nanosheets for increasing adsorption capacity of Cr from wastewater collected from petroleum refinery

Graphene and graphene oxide nanocomposites are promising and fascinating types of nanocomposites because of their fast kinetics, unique affinity for heavy metals, and greater specific area. Initially, in this study, a green, cost-effective and facile method was utilized to prepare G, GO, CdO, G-CdO, and CdO-GO nanocomposites by Azadirachta indica and then analyzed using UV–vis spectroscopy, Fourier-transform spectroscopy, Raman, X-ray diffraction and scanning electron microscope. The synthesized nanocomposites were explored for chromium elimination from wastewater collected from a petroleum refinery. CdO-GO, G-CdO nanocomposites showed remarkable adsorption capability of 699 and 430 mg g−1 which was higher than G (80 mg g−1), GO (65 mg g−1), and CdO (400 mg g−1). Based on the R2 (correlation coefficient) values, the kinetic statistics of Cr (VI) onto the G, GO, CdO, G-CdO, and CdO-GO were effectively obeyed by pseudo-second-order than by all other models. The R2 values for the five nano-bioadsorbents were extraordinarily high (R2 greater than 0.990) which ensured the chemisorption. This study ensured that the adsorptive removal rate of Cr (VI) is still greater than 85 % after repeated five cycles, suggesting that the produced nanomaterials are adsorbents with strong recyclability

AI-Driven Approaches to Cybersecurity: The Impact of Machine and Deep Learning

Computer Security is constantly evolving and dynamic; today, applying Artificial Intelligence techniques becomes indispensable in treating and detecting threats to which organizations are exposed. Developing information and communications technologies requires cybersecurity mechanisms that guarantee confidentiality, integrity, availability of information, and the development of skills to detect and control new threats on time