Particulate pollution in urban residential built environments during winter and summer seasons in Lahore, Pakistan

Indoor air pollution in urban residential areas of developing countries is of growing public health concern. The seasonal variation in mass concentration of PM1, PM2.5 and PM10was investigated in a residential built environment in Lahore, Pakistan by two DustTrak aerosol monitor (model 8520, TSI Inc.) during the winter and summer season. The measurements were carried out in the kitchen and living room simultaneously.The 24-hr meanconcentrationsfor PM1, PM2.5 and PM10in the kitchen and living room during the winter season were 157μg/m3 (±54), 733 μg/m3(±243), 409 μg/m3(±177) and 135μg/m3 (±39), 240 μg/m3 (±87), 300 μg/m3 (±115), respectively.During the summer the 24-hr mass concentration, for the same size fraction, in the kitchen and living room fell to 37μg/m3 (±4), 74μg/m3 (±11), 100 μg/m3 (±22) and31μg/m3 (±4), 71 μg/m3 (±19), 190 μg/m3 (±21), respectively. Apart from a higher concentration in winter than summer, a vast variation in 24hr and hourly mean concentration was also observed in the latter than in the former.Moreover background concentrations (hourly minimum) were also higher in winter than summer. These clearly highlight the impact of ventilation on indoor particulate matter as the sampling spaces (kitchen and living room) were more ventilated in summer than winter. The higher concentrationof the coarse size fraction in the living room than in the kitchen during summer time also shows the contribution from outdoor sources. These findings highlightthe impact of location, use and management of a residential built environment on exposure to indoor air pollutants

Application of general multilevel factorial design with formulation of fast disintegrating tablets containing croscaremellose sodium and Disintequick MCC-25

Despite the popularity of orally fast disintegrating tablets (FDTs), their formulation can sometimes be challenging, producing tablets with either poor mechanical properties or high disintegration times. The aim of this research was to enhance the properties of FDTs produced by direct compression to have both sufficient hardness to withstand manual handling, and rapid disintegration time. General multilevel factorial design was applied to optimise and evaluate main and interaction effects of independent variables (i) disintegrant concentration, (ii) % filler (Disintequick MCC-25) to mannitol on the responses hardness, tensile strength and disintegration time. In this experiment mannitol was used as a diluent, Disintequick MCC-25 (to best of our knowledge there is no publication available yet for its use with FDTs) was termed in this study as a filler and croscaremellose sodium was used as the superdisintegrant. Seven formulations were prepared following a progressive two-stage approach. Each stage involved the change in the ratio of excipients (Mannitol:Filler) (1:0), (1:0.25), (1:0.50), (1:1), (0.50:1), (0.25:1), (0:1) w/w and concentration of superdisintegrant (1%, 3%, 5%, 7%, 10% w/w). All FDTs were tested for different parameters such as diameter, hardness, tensile strength, thickness, friability and disintegration time. The results of multiple linear regression analysis show a good degree of correlation between experimental (R2:0.84, 0.94, 0.91) and predicted response (R2:0.83, 0.96, 0.95) for hardness, tensile strength and disintegration time respectively. The optimum formulations (regarding disintegration time with acceptable hardness and friability properties) consisted of: (i) 5% w/w disintegrant and 20% w/w filler to mannitol, showing a disintegration time of 30 s, a hardness of 66.6 N (6.8 kg/cm2) and friability of 2.2%; (ii) 7% or 10% w/w disintegrant with 33.33% w/w filler to mannitol, showing disintegration time of 84 s (for 7% disintegrant) and 107 s (for 10% disintegrant), hardness of 73.86 N (for 7% disintegrant) and 72.68 N (for 10% disintegrant) and friability of 1.44 (for 7% disintegrant) and 1.15% (for 10% disintegrant)

Neurodevelopment assessment of small for gestational age children in a community-based cohort from Pakistan

Background: Children born small for gestational age (SGA) may experience more long-term neurodevelopmental issues than those born appropriate for gestational age (AGA). This study aimed to assess differences in the neurodevelopment of children born SGA or AGA within a periurban community in Pakistan.Methods: This was a prospective cohort study in which study participants were followed from the pilot Doppler cohort study conducted in 2018. This pilot study aimed to develop a pregnancy risk stratification model using machine learning on fetal Dopplers. This project identified 119 newborns who were born SGA (2.4±0.4 kg) based on International Fetal and Newborn Growth Consortium standards. We assessed 180 children (90 SGA and 90 AGA) between 2 and 4 years of age (76% of follow-up rate) using the Malawi Developmental Assessment Tool (MDAT).Findings: Multivariable linear regression analysis comparing the absolute scores of MDAT showed significantly lower fine motor scores (β: -0.98; 95% CI -1.90 to -0.06) among SGAs, whereas comparing the z-scores using multivariable logistic regression, SGA children had three times higher odds of overall z-scores ≤-2 (OR: 3.78; 95% CI 1.20 to 11.89) as compared with AGA children.Interpretation: SGA exposure is associated with poor performance on overall MDAT, mainly due to changes in the fine motor domain in young children. The scores on the other domains (gross motor, language and social) were also lower among SGAs; however, none of these reached statistical significance. There is a need to design follow-up studies to assess the impact of SGA on child\u27s neurodevelopmental trajectory and school performance

THE USE OF TITANIUM MESH IN GUIDED BONE REGENERATION

A number of strategies are already recommended for the bone regeneration in clientele with atrophic ridges. Presently, GBR symbolizes the paragon, as well as it provides acquiring adequate bone quantities for just about any proper implant-prosthetic rehabilitation. The basic object of this study is to execute a specialized investigation about the Titanium Meshes utilization in in GBR, as well as relating to the function we inclined fifty-three patients of Ameen Medical and Dental Centre Karachi., in an effort to examine the stability in the treatment, the regrowth acquired, along with some outages. Moreover, we intend to examine the achievements and also rate of survival belonging to the implanted augmentations as mentioned above fifty-three patients. The basic concern of the patients is perpendicular or even crosswise re-formation with all the alveolar ridge operating the grids of titanium, in affiliation or perhaps not through biomaterials, prior to concurrently with the placement of implant. This analysis contains comprehensive fifty-three patients, males were thirty-four and females were nineteen. Titanium grids in collaboration through autogenous bone had been applied as part of two instances, five in combination through a combination of autogenous bone and bone replacements. As a whole rate of success and survival of implants have been 98.3% and 85.25%, respectively. As per conclusion the study reveals exactly how the utilization of Titanium Mesh exemplified a foreseeable technique towards the reclamation of complicated atrophic places. Keywords: Bone augmentation, Bone resorption, Dental implants, Guided bone regeneration, Titanium mesh

RELATIONSHIP OF LEARNED HELPLESSNESS AND SOCIAL INTEGRATION WITH PSYCHOLOGICAL DISTRESS IN MEDICAL STUDENTS

OBJECTIVE: To explore the relationship of learned helplessness with psychological distress and relationship of social integration with psychological distress in medical students. METHODS: This quantitative correlational survey research was conducted from September 2019 till January 2020, on 315 medical students, aging between 18-24 years, recruited from private and public medical colleges from Karachi, Pakistan. Data was collected through purposive sampling technique from students of all five medical years. To measure the variables, Learned Helplessness Scale, Social Inclusion Scale and Depression, Anxiety and Stress Scale were used. The institutes were visited as a part of survey-based methodology for this research. RESULTS: Out of 315 medical students, 223 (70.8%) were females and 92 (29.2%) were males. Mean age of students was 21.33±2.19 years and mean time spent by participants in university was 7.49±2.06 hours. Majority (n=272/315; 86.3%) were single. About 41.6% (n=131/315) completed three years of medical education. Majority (n=250/ 315; 79.4%) lived with their parents and 303 (96%) student’s parents could afford their medical education. Twenty-seven (8.6%) students consulted psychiatrist/psychologist at least once and 33 (10.5%) students had family history of psychological illness. Thirty-six (11.4%) students had other health-related problems. Outcomes depicts a weak positive correlation between learned helplessness and psychological distress (r= 0.218, p<0.01) and a weak negative correlation between social integration and psychological distress (r = -0.272, p<0.01). CONCLUSION: Medical students who had more robust social networks had a reduced chance of psychological distress than their counterparts who had weaker ties

Does academic assessment system type affect levels of academic stress in medical students? A cross-sectional study from Pakistan

Introduction Stress among medical students induced by academic pressures is on the rise among the student population in Pakistan and other parts of the world. Our study examined the relationship between two different systems employed to assess academic performance and the levels of stress among students at two different medical schools in Karachi, Pakistan. Methods A sample consisting of 387 medical students enrolled in pre-clinical years was taken from two universities, one employing the semester examination system with grade point average (GPA) scores (a tiered system) and the other employing an annual examination system with only pass/fail grading. A pre-designed, self-administered questionnaire was distributed. Test anxiety levels were assessed by The Westside Test Anxiety Scale (WTAS). Overall stress was evaluated using the Perceived Stress Scale (PSS). Results There were 82 males and 301 females while four did not respond to the gender question. The mean age of the entire cohort was 19.7±1.0 years. A total of 98 participants were from the pass/fail assessment system while 289 were from the GPA system. There was a higher proportion of females in the GPA system (85% vs. 59%; p \u3c 0.01). Students in the pass/fail assessment system had a lower score on the WTAS (2.4±0.8 vs. 2.8±0.7; p=0.01) and the PSS (17.0±6.7 vs. 20.3±6.8; p \u3c 0.01), indicating lower levels of test anxiety and overall stress than in students enrolled in the GPA assessment system. More students in the pass/fail system were satisfied with their performance than those in the GPA system. Conclusion Based on the present study, we suggest governing bodies to revise and employ a uniform assessment system for all the medical colleges to improve student academic performance and at the same time reduce stress levels. Our results indicate that the pass/fail assessment system accomplishes these objectives

COVID-19 vaccine-associated myocarditis: Analysis of the suspected cases reported to the EudraVigilance and a systematic review of the published literature

BACKGROUND: Myocarditis secondary to Coronavirus Disease 2019 (COVID-19) vaccination has been reported in the literature. OBJECTIVE: This study aimed to characterize the reported cases of myocarditis after COVID-19 vaccination based on age, gender, doses, and vaccine type from published literature and the EudraVigilance database. METHODS: We performed an analysis in the EudraVigilance database (until December 18, 2021) and a systematic review of published literature for reported cases of suspected myocarditis and pericarditis (until 30th June 2022) after the COVID-19 vaccination. RESULTS: EudraVigilance database analysis revealed 16,514 reported cases of myocarditis or pericarditis due to the vaccination with COVID-19 vaccines. The cases of myo- or pericarditis were reported predominantly in the age group of 18-64 (n = 12,214), and in males with a male-to-female (M: F) ratio of 1.7:1. The mortality among myocarditis patients was low, with 128 deaths (2 cases per 10.000.000 administered doses) being reported. For the systematic review, 72 studies with 1026 cases of myocarditis due to the vaccination with COVID-19 vaccines were included. The analysis of published cases has revealed that the male gender was primarily affected with myocarditis post-COVID-vaccination. The median (IQR) age of the myocarditis cases was 24.6 [19.5-34.6] years, according to the systematic review of the literature. Myocarditis cases were most frequently published after the vaccination with m-RNA vaccines and after the second vaccination dose. The overall mortality of published cases was low (n = 5). CONCLUSION: Myocarditis is a rare serious adverse event associated with a COVID-19 vaccination. With early recognition and management, the prognosis of COVID-19 vaccine-induced myocarditis is favorable

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Intelligent Predictive Solution Dynamics for Dahl Hysteresis Model of Piezoelectric Actuator

Piezoelectric actuated models are promising high-performance precision positioning devices used for broad applications in the field of precision machines and nano/micro manufacturing. Piezoelectric actuators involve a nonlinear complex hysteresis that may cause degradation in performance. These hysteresis effects of piezoelectric actuators are mathematically represented as a second-order system using the Dahl hysteresis model. In this paper, artificial intelligence-based neurocomputing feedforward and backpropagation networks of the Levenberg&ndash;Marquardt method (LMM-NNs) and Bayesian Regularization method (BRM-NNs) are exploited to examine the numerical behavior of the Dahl hysteresis model representing a piezoelectric actuator, and the Adams numerical scheme is used to create datasets for various cases. The generated datasets were used as input target values to the neural network to obtain approximated solutions and optimize the values by using backpropagation neural networks of LMM-NNs and BRM-NNs. The performance analysis of LMM-NNs and BRM-NNs of the Dahl hysteresis model of the piezoelectric actuator is validated through convergence curves and accuracy measures via mean squared error and regression analysis

Intelligent Predictive Solution Dynamics for Dahl Hysteresis Model of Piezoelectric Actuator

Piezoelectric actuated models are promising high-performance precision positioning devices used for broad applications in the field of precision machines and nano/micro manufacturing. Piezoelectric actuators involve a nonlinear complex hysteresis that may cause degradation in performance. These hysteresis effects of piezoelectric actuators are mathematically represented as a second-order system using the Dahl hysteresis model. In this paper, artificial intelligence-based neurocomputing feedforward and backpropagation networks of the Levenberg–Marquardt method (LMM-NNs) and Bayesian Regularization method (BRM-NNs) are exploited to examine the numerical behavior of the Dahl hysteresis model representing a piezoelectric actuator, and the Adams numerical scheme is used to create datasets for various cases. The generated datasets were used as input target values to the neural network to obtain approximated solutions and optimize the values by using backpropagation neural networks of LMM-NNs and BRM-NNs. The performance analysis of LMM-NNs and BRM-NNs of the Dahl hysteresis model of the piezoelectric actuator is validated through convergence curves and accuracy measures via mean squared error and regression analysis