Atypical Presentations of Respiratory Syncytial Virus Infection : Case series

The respiratory syncytial virus (RSV) usually causes a lower respiratory tract infection in affected patients. RSV has also been infrequently linked to extrapulmonary diseases in children. We report four children who had unusually severe clinical manifestations of RSV infections requiring critical care admission. These patients presented to the Royal Hospital, Muscat, Oman, in December 2013 with acute necrotising encephalopathy (ANE), acute fulminant hepatic failure with encephalopathy, pneumatoceles and croup. A unique presentation of ANE has not previously been reported in association with an RSV infection. All patients had a positive outcome and recovered fully with supportive management

Characterisation and cytotoxicity assessment of UV absorbers-intercalated zinc/aluminium-layered double hydroxides on dermal fibroblast cells

Zn/Al-layered double hydroxide (LDH) was used as a host to intercalate various organic ultraviolet (UV) radiation absorbers. The intercalation compounds were prepared via the co-precipitation method. Powder X-ray diffraction (PXRD) confirmed the successful intercalation of anions into the interlayer regions of the LDH nanocomposites. As a result of intercalation, the resulting nanocomposites loaded with UV-ray absorbers, cinnamic acid (CA), benzophenone 4 (B4) and Eusolex®232 (EUS)—exhibited basal spacings of 17.9 Å, 21.3 Å and 21.0 Å, respectively. Photochemical analysis revealed an increase in the UV-ray absorption capability of UV absorber/LDH nanocomposites compared to pure UV-ray absorbers. The retention ability of the organic moieties in the LDH host was tested in a skin pH simulation and was found to demonstrate low release over an extended period of time. Cytotoxicity findings indicated that none of the nanocomposites exhibit significant cytotoxicity towards human dermal fibroblast (HDF) cells up to the test concentration of 25 μg/mL

Epidemiology of Diabetes Mellitus in Oman : Results from two decades of research

Objectives: This study aimed to describe the epidemiology of diabetes mellitus over the past two decades in Oman, particularly in terms of its prevalence and incidence. In addition, the study sought to estimate the future incidence of diabetes in Oman. Methods: Three national and three regional surveys conducted between 1991 and 2010 were analysed to obtain the age-adjusted prevalence and undiagnosed proportion of type 2 diabetes mellitus (T2DM) among Omani subjects aged ≥20 years. Diabetes mellitus registers and published studies were used to determine incidence rates of both type 1 diabetes mellitus (T1DM) and T2DM in Oman. Linear regression was used to determine trends and projections for diabetes in 2050. Results: The age-adjusted prevalence of T2DM in Oman varied from 10.4% to 21.1%, while the highest prevalence of impaired fasting glucose was found in males (35.1%). In comparison to men, higher incidence rates of T2DM were found in women (2.7 cases compared to 2.3 cases per 1,000 person-years, respectively). No significant trends were observed for the prevalence or incidence of T2DM in both genders. Undiagnosed T2DM was more common in men (range: 33–68%) than women (range: 27–53%). The results of this study show that by 2050, there will be an estimated 350,000 people with T2DM living in Oman (a 174% increase compared to estimates for 2015). Conclusion: Health authorities need to prioritise diabetes prevention and control in order to prevent or delay long-term complications and avert a potential epidemic of diabetes in Oman

Emergence of resistance to fluoroquinolones and third-generation cephalosporins in Salmonella Typhi in Lahore, Pakistan

Extensively drug-resistant (XDR) Salmonella Typhi has been reported in Sindh province of Pakistan since 2016. The potential for further spread is of serious concern as remaining treatment options are severely limited. We report the phenotypic and genotypic characterization of 27 XDR S. Typhi isolated from patients attending Jinnah Hospital, Lahore, Pakistan. Isolates were identified by biochemical profiling; antimicrobial susceptibility was determined by a modified Kirby-Bauer method. These findings were confirmed using Illumina whole genome nucleotide sequence data. All sequences were compared to the outbreak strain from Southern Pakistan and typed using the S. Typhi genotyping scheme. All isolates were confirmed by a sequence analysis to harbor an IncY plasmid and the CTX-M-15 ceftriaxone resistance determinant. All isolates were of the same genotypic background as the outbreak strain from Sindh province. We report the first emergence of XDR S. Typhi in Punjab province of Pakistan confirmed by whole genome sequencing

Synthesis of (cinnamate-zinc layered hydroxide) intercalation compound for sunscreen application

Background: Zinc layered hydroxide (ZLH) intercalated with cinnamate, an anionic form of cinnamic acid (CA), an efficient UVA and UVB absorber, have been synthesized by direct method using zinc oxide (ZnO) and cinnamic acid as the precursor. Results: The resulting obtained intercalation compound, ZCA, showed a basal spacing of 23.9 Å as a result of cinnamate intercalated in a bilayer arrangement between the interlayer spaces of ZLH with estimated percentage loading of cinnamate of about 40.4 % w/w. The UV–vis absorption spectrum of the intercalation compound showed excellent UVA and UVB absorption ability. Retention of cinnamate in ZLH interlayers was tested against media usually came across with sunscreen usage to show low release over an extended period of time. MTT assay of the intercalation compound on human dermal fibroblast (HDF) cells showed cytotoxicity of ZCA to be concentration dependent and is overall less toxic than its precursor, ZnO. Conclusions: (Cinnamate-zinc layered hydroxide) intercalation compound is suitable to be used as a safe and effective sunscreen with long UV protection effect

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Synthesis of zinc-layered hydroxide and zinc-aluminium-layered double hydroxide as host of ultraviolet ray absorbing molecules for sunscreen application

New sunscreen formulation was formulated with the intercalation of organic ultraviolet (UV)-ray absorbing molecules into two layered materials; namely zinc layered hydroxide (ZLH) and Zn/Al layered double hydroxide (LDH). Intercalation in inorganic matrix was attempted with the intention of maintaining UV absorption properties of the otherwise photodegradable organic molecules. Furthermore, ZLH and LDH as host carriers provide a barrier between skin and chemical compounds and consequently prevent the phototoxic and photoallergic reactions. ZLH intercalated with cinnamate (CA) was successfully synthesized using direct reaction of zinc oxide (ZnO) and cinnamic acid. The intercalated compound, ZCA, has a basal spacing of 23.9 Å, with the estimated percentage loading of CA around 40.4 w/w %. The intercalation of benzophenone 9 (B9) into Zn/Al LDH was carried out by two different routes; co-precipitation and ion exchange method. Powder x-ray diffraction (PXRD) patterns of the co-precipitated product (ZB9C) and ion exchanged product (ZB9I) showed basal spacing of 15.9 Å and 16.6 Å, respectively. The percentage loading of B9 anions is 46.6 w/w % for ZB9C and 43.9 w/w % for ZB9I. The intercalation of CA, benzophenone 4 (B4) and eusolex® 232 (EUS) into Zn/Al LDH was also successfully performed via co-precipitation method with the expansion of basal spacing from 8.8 Å in Zn/Al LDH to 17.9 Å, 21.3 Å and 21.0 Å, respectively. Percentages loading of CA, B4 and EUS anions in Zn/Al LDH host are 35.8 w/w %, 41.9 w/w % and 41.7 w/w %, respectively. Co-precipitation of equimolar concentration of B4 and EUS with Zn/Al LDH host showed an intercalation selectivity that is preferential to EUS. It was also shown that the selectivity ratio of intercalated anions was altered by varying molar ratio of guests during the synthesis. Dual-guest nanocomposite synthesized with B4:EUS molar ratio 3:1 (ZEB (3:1)) showed an intercalation percentage of 20.5 w/w % for B4 and 17.9 w/w % for EUS. The selectivity ratio of B4:EUS could be rephrased as 53:47. ZEB (3:1) nanocomposite was monitored using PXRD and showed a basal spacing of 21.8 Å, which is slightly larger than single intercalation product of B4 and EUS in Zn/Al LDH. The solid-state absorbance spectra of UV absorbent-intercalated compounds showed broadened UV absorptivity range compared to pure UV absorbent due to the spatial confinement and host-guest interactions. Retention study of sunscreen molecules in ZLH and LDH was conducted with various release media; namely deionized water, pH 5.5 phosphate buffer (skin pH simulation) and 0.5 mol/L NaCl solution (artificial sea water), to observe nanocomposites performance in close to actual application. Anion release patterns in release media showed a slowed and restricted deintercalation from inorganic host. The cytotoxicity study of intercalation compounds on human dermal fibroblast (HDF) cells was investigated using Methylthiazol Tetrazolium (MTT) assay. In general, 24 h exposure with nanocomposites did not produce any significant cytotoxicity up to maximum concentration of 25 μg/mL. In brief, the UV absorbent/layered material system show great promise as a safe and efficient sunscreen formulation with prolonged UV protection effect

A New Framework for Fraud Detection in Bitcoin Transactions Through Ensemble Stacking Model in Smart Cities

Bitcoin has a reputation of being used for unlawful activities, such as money laundering, dark web transactions, and payments for ransomware in the context of smart cities. Blockchain technology prevents illegal transactions, but cannot detect these transactions. Anomaly detection is a fundamental technique for recognizing potential fraud. The heuristic and signature-based approaches were the foundation of earlier detection techniques, but tragically, these methods were insufficient to explore the entire complexity of anomaly detection. Machine Learning (ML) is a promising approach to anomaly detection, as it can be trained on large datasets of known malware samples to identify patterns and features of the transactions. Researchers are focusing on determining an efficient fraud and security threat detection model that overcomes the drawbacks of the existing methods. Therefore, ensemble learning can be applied to anomaly detection in Bitcoin by combining multiple ML classifiers. In the proposed model, the ADASYN-TL (Adaptive Synthetic &#x002B; Tomek Link) balancing technique is used for data balancing. Random search, grid search and Bayesian optimization are used for hyperparameter tuning. The hyperparameters have a great impact on the performance of the model. For classification, we used the stacking model by combining Decision Tree, Naive Bayes, K-Nearest Neighbors, and Random Forest. We used SHapley Additive exPlanation (SHAP) to interpret the predictions of the stacking model. The model also explores the performance of different classifiers using accuracy, F1-score, Area Under Curve-Receiver Operating Characteristic (AUC-ROC), precision, recall, False Positive Rate (FPR) and execution time, and ultimately selects the ideal model. The proposed model contributes to the development of effective fraud detection models that address the limitations of the existing algorithms. Our stacking model, which combines the prediction of multiple classifiers, achieved the highest F1-score of 97&#x0025;, precision of 96&#x0025;, recall of 98&#x0025;, accuracy of 97&#x0025;, AUC-ROC of 99&#x0025; and FPR of 3&#x0025;

Efficient Deep Learning Models for Predicting Super-Utilizers in Smart Hospitals

In healthcare, a huge amount is paid to meet the requirements of High-Need High-Cost (HNHC) patients, also known as super-utilizers. The major aim of the proposed study is to predict HNHC patients. This paper proposes hybrid Deep Learning (DL) models that identify HNHC patients, and help the management to manage their resources and budgets accordingly. We use the strategy of the Interquartile Range (IQR) that specifies the range of HNHC. The dataset used in this work has a lot of inconsistencies that are tackled by different techniques. Using three DL models, Gated Recurrent Unit (GRU), Fully Convolutional Network (FCN) and Vanilla Recurrent Neural Network (VRNN), we proposed 2 hybrid DL models, FCN-VRNN and GRU-FCN, for the prediction of HNHC patients. The performance of these models is evaluated based on different performance metrics, Mean Squared Error (MSE), Root Mean Squared Error (RMSE), Mean Absolute Percentage Error (MAPE), Mean Absolute Error (MAE), R-Squared ( $R^{2}$ ) and execution time. The results depict that the proposed hybrid models show more competitive and outperforming results than the individual models. Proposed hybrid system model 1 FCN-VRNN achieves MSE of 0.4&#x0025;, RMSE of 7&#x0025;, MAPE of 29.8&#x0025;, MAE of 3&#x0025;, and $R^{2}$ of 99.4&#x0025;. Proposed hybrid system model 2 GRU-FCN achieves MSE of 0.4&#x0025;, RMSE of 6.5&#x0025;, MAPE of 23.55&#x0025;, MAE of 2.5&#x0025;, and $R^{2}$ of 99.5&#x0025;

Enhanced anti-inflammatory potential of cinnamate-zinc layered hydroxide in lipopolysaccharide-stimulated RAW 264.7 macrophages

Background: Cinnamic acid (CA) is a phytochemical originally derived from Cinnamomum cassia, a plant with numerous pharmacological properties. The intercalation of CA with a nanocarrier, zinc layered hydroxide, produces cinnamate-zinc layered hydroxide (ZCA), which has been previously characterized. Intercalation is expected to improve the solubility and cell specificity of CA. The nanocarrier will also protect CA from degradation and sustain its release. The aim of this study was to assess the effect of intercalation on the anti-inflammatory capacity of CA. Methods: In this study, the anti-inflammatory activity of ZCA was investigated and compared with that of nonintercalated CA. Evaluations were based on the capacity of ZCA and CA to modulate the release of nitric oxide, prostaglandin E2, interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), IL-1β, and IL-10 in lipopolysaccharide-induced RAW 264.7 cells. Additionally, the expression of proinflammatory enzymes, ie, cyclooxygenase-2, inducible nitric oxide synthase, and nuclear factor kappa B (NF-κB), were examined. Results: Although both ZCA and CA downregulated nitric oxide, prostaglandin E2, tumor necrosis factor alpha, IL-1β, and IL-6, ZCA clearly displayed better activity. Similarly, expression of cyclooxygenase-2 and inducible nitric oxide synthase were inhibited in samples treated with ZCA and CA. The two compounds effectively inactivated the transcription factor NF-κB, but the anti-inflammatory cytokine, IL-10, was significantly upregulated by ZCA only. Conclusion: The present findings suggest that ZCA possesses better anti-inflammatory potential than CA, while zinc layered hydroxide had little or no effect, and these results were comparable with the positive control