The impact of diabetes mellitus on the emergence of multi-drug resistant tuberculosis and treatment failure in TB-diabetes comorbid patients: a systematic review and meta-analysis

BackgroundThe existence of Type 2 Diabetes Mellitus (DM) in tuberculosis (TB) patients is very dangerous for the health of patients. One of the major concerns is the emergence of MDR-TB in such patients. It is suspected that the development of MDR-TB further worsens the treatment outcomes of TB such as treatment failure and thus, causes disease progression.AimTo investigate the impact of DM on the Emergence of MDR-TB and Treatment Failure in TB-DM comorbid patients.MethodologyThe PubMed database was systematically searched until April 03, 2022 (date last searched). Thirty studies met the inclusion criteria and were included in this study after a proper selection process.ResultsTuberculosis-Diabetes Mellitus patients were at higher risk to develop MDR-TB as compared to TB-non-DM patients (HR 0.81, 95% CI: 0.60–0.96, p < 0.001). Heterogeneity observed among included studies was moderate (I2 = 38%). No significant change was observed in the results after sub-group analysis by study design (HR 0.81, 95% CI: 0.61–0.96, p < 0.000). In the case of treatment failure, TB-DM patients were at higher risk to experience treatment failure rates as compared to TB-non-DM patients (HR 0.46, 95% CI: 0.27–0.67, p < 0.001).ConclusionThe results showed that DM had a significant impact on the emergence of MDR-TB in TB-diabetes comorbid patients as compared to TB-non-DM patients. DM enhanced the risk of TB treatment failure rates in TB-diabetes patients as compared to TB-non-DM patients. Our study highlights the need for earlier screening of MDR-TB, thorough MDR-TB monitoring, and designing proper and effective treatment strategies to prevent disease progression

Time to endoscopy for acute upper gastrointestinal bleeding: results from a prospective multicentre trainee-led audit

Background: Endoscopy within 24 hours of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24h of admission).Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between Nov-Dec 2017. Analyses were performed to identify factorsassociated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups.Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2h (IQR 12.0- 35.7), comprising median admission to referral and referral to endoscopy times of 8.1h (IQR 3.7- 18.1) and 6.7h (IQR 3.0-23.1) respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0% - 87.5%, p=0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7am-7pm or via the Emergency Department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1d; p= 0.004), but not 30-day mortality (p=0.344).Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome

THE ADJUSTED MARKET POWER, COMPETITION, AND PERFORMANCE: ISLAMIC VS CONVENTIONAL BANKS

This study explores the relationship between competition and performance in a dual-banking setting. More specifically, we compare whether using the Traditional Lerner index (TLI) the efficiency-adjusted Lerner index (EALI) would yield different conclusions. We take data from 2008 to 2020 and take Malaysia as a case study. Considering the nature of the dataset and the variables within, we employ the system Generalized Method of Moments. Our findings reveal contradictory results when market power is measured differently. Based on the overall sample, the models using the adjusted market power is supportive of the ‘competition-stability view’ while the models with TLI report evidence in favor of the ‘competition-fragility view.’ The Islamic banks' results support the ‘competition-fragility view’ when competition is measured with the efficiency-adjusted Lerner index (EALI) and the ‘competition-stability view’ when measured with the TLI. These findings are robust to different econometric estimators and carry important policy implications

Application of Soft Semi-Open Sets to Soft Binary Topology

This paper introduces an application of soft semi-open setsin soft binary topology. An important outcome of this work is a formalframework for the study of information associated with ordered pairs ofsoft sets. Five main results concerning binary soft topological spaces aregiven in this pape

WLAN RSS-Based Fingerprinting for Indoor Localization: A Machine Learning Inspired Bag-of-Features Approach

Location-based services have permeated Smart academic institutions, enhancing the quality of higher education. Position information of people and objects can predict different potential requirements and provide relevant services to meet those needs. Indoor positioning system (IPS) research has attained robust location-based services in complex indoor structures. Unforeseeable propagation loss in complex indoor environments results in poor localization accuracy of the system. Various IPSs have been developed based on fingerprinting to precisely locate an object even in the presence of indoor artifacts such as multipath and unpredictable radio propagation losses. However, such methods are deleteriously affected by the vulnerability of fingerprint matching frameworks. In this paper, we propose a novel machine learning framework consisting of Bag-of-Features and followed by a k-nearest neighbor classifier to categorize the final features into their respective geographical coordinate data. BoF calculates the vocabulary set using k-mean clustering, where the frequency of the vocabulary in the raw fingerprint data represents the robust final features that improve localization accuracy. Experimental results from simulation-based indoor scenarios and real-time experiments demonstrate that the proposed framework outperforms previously developed models

Molecular docking unveils prospective inhibitors for the SARS-COV-2 main protease

The recent emergence of a novel coronavirus strain (SARS-CoV-2) has stimulated global efforts to identify potential drugs that target proteins expressed by this novel coronavirus. Among these, the main protease of SARS-CoV-2 (3CL-protease (3CLPro), also known as (MPro) is one of the best choices for the scientists to target. 3CLPro is involved in the processing of polyproteins into mature non-structural viral proteins. An X-ray crystallographic structure (PDB ID 6LU7) of this protein was obtained from the PDB database. ChemDiv libraries of ~80,000 antiviral and ~13,000 coronavirus-targeting molecules were screened against the 3D structure of 3CLPro of SARS-CoV-2. We have identified a panel of molecules that showed an activity and potentially block the active site of the SARS-CoV-2 main protease. These molecules can be investigated further to develop effective virus-inhibiting molecules to treat this highly distressing disease, causing extreme unrest across the globe

Irrigation Scheduling and Weed Management: A Sustainable Approach for Managing Broomrape and Other Weeds in Tomato Crop

Broomrape (Orobanche cernua L.) is an obligate root parasitic weed that significantly reduces the qualitative and yield attributes of tomatoes globally. The efficient management of broomrape is challenging because of its complicated parasitic nature. Field trials were conducted to assess the influence of various irrigation scheduling and weed control strategies on broomrape, weed presence, and tomato productivity. The experiment was conducted with a randomized complete block design (RCBD) with a split-plot arrangement and was replicated three times. Three irrigation intervals (3, 6, and 9 days) were assigned to the main block, while sub-blocks including treatments and year were taken as the source of variance (year × irrigation timing × treatments). The experiment comprised sixteen treatments, including transparent polythene, black polythene, weedy check (Control), sole weeding of broomrape only, weeding of all weeds, weeding except broomrape, humic acid 25 kg ha−1+ copper oxychloride in single and split doses, copper oxychloride (1.5 kg a.i ha−1 in single and split doses), ammonium sulphate 200 kg ha−1 in single and split doses, copper sulfate (2 kg ha−1 in single/split doses), and glyphosate 48 SL (1.5 kg a.i ha−1) and pendimethalin 33 EC (1.44 kg a.i ha−1). The results revealed that among the various irrigation intervals, the highest broomrape intensity (4.34 plant−1) was observed with a9-day irrigation interval. Similarly, the highest weed density (35 m−2) resulted in a3-day irrigation interval. Furthermore, irrigation at a 6-day interval increased the plant height by 11%, fruit yield tons ha−1 by 24.9 %, and produced the highest cost/benefit ratio (CBR) of (1:4). Black polythene, transparent polythene, and pendimethalin reduced the weed density by 92%, 89%, and 84%;weed dry biomass by 97%, 95%, and 91%; and broomrape intensity by 67%, 77%, and 28%. Conversely, the plant height increased by 24%, 23%, and 23.6%; and fruit yield by 286%, 270%, and 191%; and had the highest CBR of 1:5, 1:4, and 1:4, respectively, as compared to the weedy check. Consequently, an increase in irrigation frequency increases other weed densities and decreases the broomrape intensity plant−1 of tomato. Therefore, black polythene could be recommended in a severely broomrape-infested field. Moreover, irrigation at 6-day intervals combined with pendimethalin and ammonium sulfate fertilizers revealed the lowest incidence of broomrape and other weeds and produced an economic yield

Hospital preparedness for disaster and mass casualty management in Pakistan: A cross-sectional evaluation study

Background: World Health Organization has advocated preemptive readiness of health systems to manage disastrous events. Pakistan is known to be highly susceptible to disasters on the one hand and significantly lacking in coping ability on the other. Preparedness of health facilities in such locales is especially important, despite which there is little published evidence regarding hospitals’ response capacity in Pakistan.Methods: From 12 most disaster prone districts of the country, a purposive sample of 20 hospitals was assessed using 51 indicators, scored as fully (2), partially (1), or not prepared (0). Two domains, disaster preparedness and mass casualty management, and five subdomains, networking, planning, staff-readiness, materials, and safety, were evaluated. Proportions of maximum possible scores achieved by an entity were categorized as acceptable (≥66 percent), partial (35-65 percent), or inadequate (<35 percent).Results: Out of the 20 hospitals, 14 (70 percent) were secondary and 3 tertiary level facilities (30 percent). Overall, hospitals were partially prepared with a score of 54.0 percent, 95 percent confidence interval [52.3 percent, 54.7 percent]. Disaster preparedness, 55.2 percent [54.0, 57.0], was significantly better prepared than mass casualty management, 49.2 percent [46.8, 51.6], p < 0.001. Overall, facility safety was the least prepared among the subdomains, 38.3 percent [31.8, 44.8], while materials were the best, 75.9 percent [72.6, 79.3]. The least prepared subdomains were staff-readiness in Punjab, 52.1 percent [47.5, 56.8], and facility safety in KP, 29.2 percent [22.1, 36.4].Conclusions: Hospitals’ preparedness for disaster and mass casualty management is deficient in these most vulnerable districts of Pakistan. Improvement initiatives commensurate with locale vulnerabilities should be instituted

Clinical characteristics, mortality and associated risk factors in COVID-19 patients reported in ten major hospitals of Khyber Pakhtunkhwa, Pakistan

COVID-19 is an ongoing public health issue across the world. Several risk factors associated with mortality in COVID-19 have been reported. The present study aims to describe clinical and epidemiological characteristics and predictors of mortality in hospitalized patients from Khyber Pakhtunkhwa, a province in Pakistan with highest COVID-19 associated case fatality rate. This multicentre, retrospective study was conducted in hospitalized COVID-19 patients who died or discharged alive until 1st May 2020. Data about sociodemographic characteristics, clinical and laboratory findings, treatment and outcome were obtained from hospital records and compared between survivors and non-survivors. Statistical tests were applied to determine the risk factors associated with mortality in hospitalized patients. Of the total 179 patients from the 10 designated hospitals, 127 (70.9%) were discharged alive while 52 (29.1%) died in the hospital. Overall, 109 (60.9%) patients had an underlying comorbidity with hypertension being the commonest. Multivariate logistics regression analysis showed significantly higher odds of in-hospital death from COVID-19 in patients with multiple morbidities (OR 3.2, 95% CI 1.1, 9.1, p-value=0.03), length of hospital stay (OR 0.8, 95% CI 0.7, 0.9, p-value &lt;0.001), those presenting with dyspnoea (OR 4.0, 95% CI 1.1, 14.0, p-value=0.03) and oxygen saturation below 90 (OR 9.6, 95% CI: 3.1, 29.2, p-value &lt;0.001). Comorbidity, oxygen saturation and dyspnoea on arrival and length of stay in hospital (late admission) are associated with COVID-19 mortality. The demographic, clinical and lab characteristics could potentially help clinician and policy makers before potential second wave in the country