Search Results (255)

High-quality end-of-life care (EoLC) is a critical yet often underemphasised component of oncology care. Several shortcomings in the delivery of EoLC for oncology patients in our centre during the COVID-19 pandemic were identified in our initial 2021 audit. In 2022, we introduced a care of dying patients proforma, an EoLC quality checklist, targeted education and training for staff, and an expanded end-of-life (EoL) committee. This re-audit aimed to review how these changes impacted on the care received by patients in a tertiary cancer centre. A second retrospective re-audit of patients who died between 11 July 2022 and 30 April 2023 was performed to assess quality of EoLC using the Oxford Quality indicators. A total of 72 deaths occurred over the audit period. Quality of EoLC improved significantly when compared to the initial audit (χ² (3, n = 138) = 9.75, p = 0.021). Exploration of patients’ wishes was documented in 48.8% and referral to pastoral care was documented in 68.3%, from 24.2% and 10.6%, respectively. The proportion of patients receiving poor EoLC reduced from 21.2% to 8.3%. Our study demonstrates the benefits of simple interventions, the importance of re-audit, and the role of ongoing interdisciplinary commitment to improving EoLC for our patients. Full article

Red sandstones of the Cambrian age are globally distributed and represent an important sedimentation phase during this critical time interval. Their sedimentology and geochemistry can provide key information about the sedimentation style, paleoclimatic conditions, and weathering trends during the Cambrian. In the Salt Range of Pakistan, the Khewra Sandstone constitutes the Lower Cambrian strata and consists of red–maroon sandstones with minor siltstone and shale in the basal part. Cross-bedding, graded bedding, ripple marks, parallel laminations, load casts, ball and pillows, desiccation cracks, and bioturbation are the common sedimentary features of the formation. The sandstones are fine to medium to coarse-grained with subangular to subrounded morphology and display an overall coarsening upward trend. Petrographic analysis indicates that the sandstones are sub-arkose and sub-lithic arenites, and dolomite and calcite are common cementing materials. X-ray Diffraction (XRD) analysis indicates that the main minerals in the formation are quartz, feldspars, kaolinite, illite, mica, hematite, dolomite, and calcite. Geochemical analysis indicates that SiO₂ is the major component at a range of 53.3 to 88% (averaging 70.4%), Al₂O₃ ranges from 3.1 to 19.2% (averaging 9.2%), CaO ranges from 0.4 to 25.3% (averaging 7.4%), K₂O ranges from 1.2 to 7.4% (averaging 4.8%), MgO ranges from 0.2 to 7.4% (averaging 3.5%), and Na₂O ranges from 0.1 to 0.9% (averaging 0.4%), respectively. The results of the combined proxies indicate that the sedimentation occurred in fluvial–deltaic settings under overall arid to semi-arid paleoclimatic conditions with poor to moderate chemical weathering. The Khewra Sandstone represents the red Cambrian sandstones on the NW Indian Plate margin of Gondwana and can be correlated with contemporaneous red sandstones in the USA, Europe, Africa, Iran, and Turkey (Türkiye). Full article

The 26th annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Saskatoon, Saskatchewan, on 17–18 October 2024. The WCGCCC is an interactive multidisciplinary conference that was attended by healthcare professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with hepatocellular and biliary tract cancers. Specialists from the fields of medical and radiation oncology, interventional radiology, pathology and laboratory medicine, and general and hepatobiliary surgery participated in presentations and discussions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of hepatocellular and biliary tract cancers. Full article

Primary dysmenorrhea (PD) is characterized by lower abdominal spasms and painful cramps during menstruation in females with a normal pelvic anatomy. Cymbopogon citratus (DC.) Stapf, commonly known as lemongrass, is consumed in the form of herbal tea around the world. It has been traditionally used for menstrual disorders in several communities. This study aims to evaluate the traditional use of C. citratus for its efficacy in alleviating the symptoms of PD. C. citratus extract (CcE) was chemically characterized using HPLC and GCMS, which indicated the presence of several phenolic compounds and long-chain fatty acids. The anti-inflammatory activity of CcE was assessed by COX-I, COX-II, and 5-LOX enzyme inhibition with IC₅₀ values of 143.7, 91.7, and 61.5 µg/mL, respectively, and showed good total antioxidant capacity and free radical scavenging activity. PD was induced in female Wistar rats by administering estradiol valerate followed by oxytocin to induce PD symptoms. CcE efficacy was assessed at 30, 100, and 300 mg/kg concentrations and compared with ibuprofen. CcE 300 mg/kg reduced abdominal contortions and inflammation in the rat uterus. The inflammatory (COX-II, TNFα and IL-10) and oxidative stress (TAC, TOS, MDA and SOD) markers in uterine tissue homogenate were also improved. An in vivo analgesic assessment through hot-plate, tail-flick, and acetic acid-induced writhing assays showed good analgesic activity by CcE, while ex vivo experiments described tocolytic effects in rat uterine muscles. CcE alleviates PD by its antioxidant, anti-inflammatory, analgesic, and tocolytic effects. Full article

The Lahore–Islamabad Motorway (M-2) is a critical transportation corridor in Pakistan, where contamination in roadside dust by potentially toxic elements (PTEs) presents potential environmental and health concerns. This study evaluates the concentration, spatial distribution, and ecological risks of PTEs (Mn, Ni, Cr, Cu, Pb, Zn, Cd, Ag, Fe) in road dust along the M-2. PTE concentrations were determined using standard protocols and by analysis using an atomic absorption spectrometer. The findings indicate substantial variability in metal concentrations, with Fe (CV% = 9.35%) and Pb (CV% = 7.06%) displaying the highest consistency, whereas Ni exhibited the greatest fluctuation (CV% = 168.80%). Contamination factor analysis revealed low to moderate contamination for Ni and Fe, while Zn contamination was significant in 60% of samples. Cr and Cd exhibited persistently high contamination, and Pb was uniformly elevated across all locations. Ecological risk assessment categorized Ni, Zn, and Cu as low-risk elements, while Pb posed a substantial risk. Cd concentrations indicated high to extreme ecological hazards, emphasizing the necessity for urgent mitigation measures. Factor analysis suggested an interaction of various sources, including industrial, vehicular emissions, and construction materials. Strengthened pollution control strategies and systematic monitoring are essential for mitigating contamination and ensuring environmental sustainability along the motorway. Full article

Under the 1960 Indus Water Treaty, Pakistan owned the Western rivers (Indus, Jhelum, and Chenab) and India the Eastern rivers (Ravi, Suleimanki, and Beas). Pakistan’s per capita water availability will reduce from 5260 m³ to less than 1000 m³ by 2025, causing water stress. The Indus Basin’s water availability was examined at inflow and outflow gauges between 1991 and 2015. The Indus Basin inflow and outflow gauges indicated exceptionally low and high flows before, during, and after floods. Lower flow values vary greatly for the Indus, Chenab, and Jhelum rivers. During Rabi and Kharif, the Indus and Chenab rivers behaved differently. Lower flows (Q90 to Q99) in Western Rivers are more periodic than higher flows (Q90 to Q99) and medium flows (Q90 to Q99). The outflow gauge Kotri reported 35% exceedance with zero flows during pre-flood and post-flood seasons and 50% during flood season, indicating seasonal concerns. Outflow and inflow both fell, particularly after the year 2000, according to data collected over a longer period (1976–2015). Low storage and regulating upstream capacity caused the Indus Basin outflow to reach 28 MAF (million acre feet) between 1976 and 2015, which is 70% more than the permitted 8.6 MAF downstream Kotri gauge. For 65 percent of the year, the Indus Basin does not release any water downstream of Kotri. As a result, the ecosystem relies on an annual influx of at least 123 MAF to sustain itself, and an outflow of 8.6 MAF from the Indus Basin necessitates an inflow of 113.51 MAF. At high-flow seasons, the Indus Basin experiences devastating floods, yet it dries out at a frightening rate before and after floods. The preservation of ecosystems and riparian zones downstream depends on the large environmental flows in eastern rivers. This is achievable only by fully implementing IWT and improving water management practices at western rivers. Full article

Historical landrace collections, such as the Watkins Wheat Collection, harbor immense genetic diversity that holds the potential to transform our understanding of crop resilience and adaptation. This study employs a novel integrative phenotyping approach to dissect regional adaptation and nitrogen stress resilience in Watkins wheat landraces under contrasting nitrogen regimes. By leveraging a multidimensional framework, including stress indices, geographic analyses, and multivariate clustering, this work identifies 48 landraces with contrasting responses to nitrogen limitation. High-performing genotypes, such as WATDE0013 and WATDE0020, exhibited superior biomass partitioning under stress, reflecting historical adaptation to low-input agroecosystems spanning Europe, Asia, and North Africa. These findings emphasize the value of phenotypic plasticity in nitrogen use efficiency (NUE) improvement. In contrast, low-performing accessions, such as WATDE1055, highlighted vulnerabilities to nitrogen limitation, illustrating the importance of comprehensive phenotypic screening for gene-bank prioritization. Regional adaptation patterns, elucidated through geographic analyses, uncovered stress-resilient genotypes clustered in historically marginal agricultural regions, revealing adaptive traits shaped by environmental selection pressures. Principal component analysis (PCA) and hierarchical clustering delineated five distinct phenotypic groups, enhancing our understanding of evolutionary trajectories within this collection. This integrative approach transcends traditional phenotyping methods by linking phenotype, genotype, and geographic context to uncover nuanced adaptive traits. By bridging gene bank conservation with a systems-level understanding of crop evolution, this study provides actionable insights and a robust framework for breeding climate-resilient wheat varieties. These findings underscore the critical role of preserving genetic diversity in landraces to address global challenges in nitrogen stress and climate resilience. Full article

Pesticides are considered a major factor in the decline of bee populations. Flupyradifurone, a novel insecticide, is believed to be relatively ‘bee-safe’. This study aims to evaluate the acute and chronic toxicity of flupyradifurone and assess its risks to both commercial bumblebee Bombus terrestris and the Asian native species B. lantschouensis. Oral toxicity tests demonstrated species-specific sensitivity, with B. lantschouensis exhibiting 5.4-fold higher acute toxicity (72-h LD₅₀: 5.1 μg/bee vs. 28 μg/bee) and 3-fold lower chronic toxicity (No Observed Adverse Effect Concentration, NOAEC: 20 μg/mL vs. 60 μg/mL) compared to B. terrestris. Risk assessments indicated low Hazard Quotients (HQ) of 4 for B. terrestris and 20 for B. lantschouensis. However, the Exposure Toxicity Ratio (ETR) values from both screening and first-tier assessments exceeded the trigger levels, necessitating further testing. This study provides crucial data on the acute and chronic toxic effects of flupyradifurone and highlights the need for more comprehensive insecticide risk assessments, particularly for non-Apis pollinators, to better protect these vital species. Full article

Background and Objective: A lifestyle-associated disease, diabetes mellitus, mandates compliance with established policies by physicians and patients to achieve optimal glycemic control. Collaborative care from health care providers and patients is essential for effective management, which slows disease progression, improves quality of life, and reduces medication costs. This study assessed the effectiveness of pharmacist-led educational initiatives provided to patients on clinical outcomes and direct treatment costs for those with diabetes in two public hospitals in Malaysia. Methods: Four hundred type 2 diabetes patients included in this study were randomly allocated to two corresponding groups. The control group, consisting of 200 patients (100 from each hospital), received standard treatment using the Malaysian Clinical Practice Guideline 2015, while the intervention group, also comprising 200 patients (100 from each hospital), received pharmacist-led care through Diabetic Medication Therapy Adherence Clinics (DMTACs), including pharmacist-provided education, alongside conventional treatment. The patients were equally selected from both hospitals based on the sample size calculation. The pharmacists provided educational interventions emphasizing dietary adjustments, lifestyle modifications, the significance of physical activity, and appropriate medication storage. Among these, 143 control patients and 156 intervention patients completed this one-year study, which comprised an initial and two follow-up visits. Clinical outcomes and treatment expenses were evaluated, and a data analysis was performed utilizing version 24 SPSS. Descriptive statistics were presented as the mean ± standard deviation, including normality assessed using the skewness, kurtosis, and Kolmogorov–Smirnov test. Independent t-tests were applied for hypothesis testing when the data showed normal distribution. Paired t-tests were used for cost assessments. Results: After the research, the group receiving intervention had a much higher decrease in HbA1c levels relative to the control group (3.59% versus 2.17%; p < 0.001). The intervention group had considerable decreases in systolic blood pressure (9.29 mmHg) and similarly in diastolic blood pressure (7.58 mmHg; with p < 0.005). Additionally, the levels of cholesterol in the intervention group improved significantly (0.13 mmol/L; p < 0.001). Moreover, treatment expenses for the pharmacist-led intervention group showed a substantial reduction (p < 0.001). By the second follow-up, the additional cost per patient since baseline was MYR 236.07 (Malaysian Ringgit), approximately 53.45 USD, in the control group, compared to only MYR 47.33 per patient, approximately 10.72 USD, in the intervention group with pharmacist involvement. Only medication costs were considered, and all unnecessary medications were discontinued as patient clinical outcomes improved sufficiently with pharmacist intervention, allowing for management through lifestyle changes alone. Counseling costs were not included since the pharmacists providing education were already employed in these hospitals, and no additional pharmacists were appointed for this purpose. Conclusion: Pharmacist-led interventions led to a significant improvement in HbA1c levels. While medication expenses increased in both groups from the initial follow-up, the control group exhibited a significantly greater increase in costs and HbA1c levels than the intervention group. Full article

The aaccurate prediction of enzymes with environment detoxification functions is crucial, not only to achieve a better understanding of bioremediation strategies, but also to alleviate environmental pollution. In the present study, a novel machine learning model was introduced which classifies enzymes by their toxin degradation ability. In this model, two different sets of data were used which include enzymes that can catalyze the toxin degradation as a positive dataset and non-toxin-degrading enzymes as a negative dataset. Further, a comparison of multiple classifiers was performed to find the best model and a Random Forest (RF) classifier was selected due to its strong performance. To enhance the accuracy, we combined RF with a Deep Neural Network (DNN), forming an ensemble model which effectively integrated both techniques. This combination achieved 95% precision, surpassing individual models. Our ensemble model not only ensures high prediction accuracy but also reliably differentiates toxin-degrading enzymes from non-degrading ones. This study highlights the power of combining classical machine learning with deep learning to advance prediction. Our model represents a significant step in enzyme classification and serves as a valuable resource for environmental biotechnology, food nutrition, and health applications. Full article

Climate change has led to global biodiversity loss, severely impacting all species, including essential pollinators like bees, which are highly sensitive to environmental changes. Like other bee species, A. dorsata is also not immune to climate change. This study evaluated the habitat suitability of A. dorsata under climate change in Pakistan by utilizing two years of occurrence and distribution data to develop a Maximum Entropy (MaxEnt) model for forecasting current and future habitat distribution. Future habitat projections for 2050 and 2070 were based on two shared socioeconomic pathways (SSP245 and SSP585) using the CNRM-CM6-1 and EPI-ESM1-2-HR-1 global circulation models. Eight bioclimatic variables (Bio1, Bio4, Bio5, Bio8, Bio10, Bio12, Bio18, and Bio19) were selected for modeling, and among the selected variables, the mean temperature of the wettest quarter (Bio8) and precipitation of the warmest quarter (Bio18) showed major contributions to the model building and strongest influence on habitat of A. dorsata. The model estimated 23% of our study area as a suitable habitat for A. dorsata under current climatic conditions, comprising 150,975 km² of moderately suitable and 49,792 km² of highly suitable regions. For future climatic scenarios, our model projected significant habitat loss for A. dorsata with a shrinkage and shift towards northern, higher-altitude regions, particularly in Khyber Pakhtunkhwa and the Himalayan foothills. Habitat projections under the extreme climatic scenario (SSP585) are particularly alarming, indicating a substantial loss of the suitable habitat for the A. dorsata of 40% under CNRM-CM6-1 and 79% for EPI-ESM1-2-HR-1 for the 2070 time period. This study emphasizes the critical need for conservation efforts to protect A. dorsata and highlights the species’ role in pollination and supporting the apiculture industry in Pakistan. Full article

Background and Objective: Irrational use and overuse of antibiotics is considered a major cause of antimicrobial resistance (AMR) among patients admitted to hospitals, especially in intensive care units (ICUs). ICUs are the most critical wards in healthcare settings, where the use of antibiotics is much higher compared to other wards. Therefore, the appropriate administration and monitoring of antibiotic usage in these units is a matter of concern. Materials and Methods: This retrospective study evaluated the types, utilization patterns, sensitivity, and resistance of various antibiotics used among patients admitted to the ICUs of different hospitals after the third wave of the coronavirus disease in 2019 (COVID-19) in Pakistan. Results: It was observed that more than 40% of the patients were given two antibiotics and 54.3% were given at least one antibiotic each day. A total of 768 antibiotics from different groups, based on the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classification, were prescribed to 313 patients admitted to ICUs between April and August 2021. Among the types of antibiotics, amoxicillin/clavulanic acid was the most frequently used antibiotic (75 prescriptions). It was also observed that the majority of the bacterial isolates were more sensitive to carbapenems than the other antibiotics. The current study showed that antibiotic usage according to the AWaRe classifications was 31.8% in the Access category, 59.5% in the Watch category, and 8.7% in the Reserve category in ICUs of the studied hospitals after the third wave of COVID-19. Conclusions: The findings of the study also highlight the importance and continuous need for the implementation of antibiotic stewardship programs to optimize the appropriate utilization of antibiotics in the ICUs of the studied hospitals. Full article

Background and Objectives: The average age of presentation of coronary artery disease (CAD) is one decade younger in the Saudi population relative to other patients worldwide. It is imperative to investigate the prevalence of premature coronary artery disease (PCAD) risk factors in Saudi Arabia’s younger population in order to prevent the incidence of cardiovascular diseases in the future. Thus, the present study aimed to evaluate the severity and identify the risk factors associated with PCAD in patients under the age of 50 at King Saud University Medical City (KSUMC), Saudi Arabia. Methods: This observational retrospective study was conducted between June 2022 and June 2023 at King Saud University Medical City, Riyadh, Saudi Arabia. A total of 718 participants were included in the study. The patients, confirmed by electrocardiographic and/or angiographic findings of coronary artery disease, were divided into three age groups: group 1 (<40 years), group 2 (40–45 years), and group 3 (45–50 years). The severity of vessel occlusions was evaluated using the Gensini scoring system. Electrocardiographic findings, sociodemographic variables, and risk factors were also taken into consideration. Results: The mean age of patients in group 1 was 35.2 ± 4.5 years, in group 2 was 43.0 ± 1.3 years, and in group 3 was 48.4 ± 1.4 years. Patients in group 2 had a significantly higher BMI (31.3 ± 10.5) compared to patients in group 3 (29.4 ± 5.3; p = 0.015). Nearly 55% of patients under 40 years had 2 or 3 vessel occlusions according to the vessel score. The percentage of patients with inferior ST elevation was significantly higher in group 1 (<40 years, 11.2%) compared to groups 2 (40–45 years, 10.1%) and 3 (45–50 years, 6.0%; p = 0.001). Non-specific ST-T changes were more common in group 1 (31.4%) and group 2 (32.0%) compared to group 3 (28.4%). Although not statistically significant, left main artery occlusion tended to be higher in group 3 (8.6%) compared to groups 1 (4.6%) and 2 (4.5%; p = 0.229). Hyperlipidemia levels were significantly higher in patients with a Gensini score > 39 compared to those with a Gensini score < 39 (47.9% vs. 37.5%, respectively; p = 0.05). The prevalence of smoking was about 54% in group 1, followed by type 2 diabetes mellitus, dyslipidemia, and hypertension (37%, 36%, and 33%, respectively). Conclusions: This study suggested that PCAD Saudi patients below 40 years of age had a higher percentage of inferior ST elevation compared to older patients, while non-specific ST-T changes were significantly higher in older patients. Astonishingly, more than 50% of patients in all groups had two or three vessel occlusions. There was a high prevalence of modifiable risk factors, such as smoking, in younger patients, whereas hyperlipidemia was a risk factor for PCAD in all age groups. In addition, hyperlipidemia was highly correlated with severe vessel occlusion according to the Gensini score. Therefore, early preventive measures should be taken into consideration to reduce the future burden of cardiovascular complications in this population. Full article

Mango (Mangifera Indica L.), a key horticultural crop, particularly in Pakistan, has been primarily studied locally using low- to medium-resolution satellite imagery, usually focusing on a particular phenological stage. The large canopy size, complex tree structure, and unique phenology of mango trees further accentuate intrinsic challenges posed by low-spatiotemporal-resolution data. The absence of mango-specific vegetation indices compounds the problem of accurate health classification and yield estimation at the tree level. To overcome these issues, this study utilizes high-resolution multi-spectral UAV imagery collected from two mango orchards in Multan, Pakistan, throughout the annual phenological cycle. It introduces MangiSpectra, an integrated two-staged framework based on Long Short-Term Memory (LSTM) networks. In the first stage, nine conventional and three mango-specific vegetation indices derived from UAV imagery were processed through fine-tuned LSTM networks to classify the health of individual mango trees. In the second stage, associated data such as the trees’ age, variety, canopy volume, height, and weather data were combined with predicted health classes for yield estimation through a decision tree algorithm. Three mango-specific indices, namely the Mango Tree Yellowness Index (MTYI), Weighted Yellowness Index (WYI), and Normalized Automatic Flowering Detection Index (NAFDI), were developed to measure the degree of canopy covered by flowers to enhance the robustness of the framework. In addition, a Cumulative Health Index (CHI) derived from imagery analysis after every flight is also proposed for proactive orchard management. MangiSpectra outperformed the comparative benchmarks of AdaBoost and Random Forest in health classification by achieving 93% accuracy and AUC scores of 0.85, 0.96, and 0.92 for the healthy, moderate and weak classes, respectively. Yield estimation accuracy was reasonable with $R^2=0.21$, and $\mathrm{RMSE}=50.18$. Results underscore MangiSpectra’s potential as a scalable precision agriculture tool for sustainable mango orchard management, which can be improved further by fine-tuning algorithms using ground-based spectrometry, IoT-based orchard monitoring systems, computer vision-based counting of fruit on control trees, and smartphone-based data collection and insight dissemination applications. Full article