Synthesis and Characterization of a Titanium-Based Functionally Graded Material-Structured Biocomposite using Powder Metallurgy.

This investigation aims at synthesizing and characterizing a biocomposite of hydroxyapatite (HA) and titanium (Ti) as a functionally graded material (FGM) via an economical powder metallurgy route. Ti particles were produced through drilling and chipping, followed by compaction and sintering. Ti foams, so obtained, were then infused with varying volume fractions of HA. The pure Ti foam control sample and the FGM composite samples were then subjected to various characterizations to validate their biocompatibility, structural strength, and integrity. The interface development between the load-bearing Ti implant and living tissue was resolved through an FGM structure, where the base of the implant consisted of load-bearing Ti and the outer periphery changed to HA gradually. HA/Ti specimens of different volume fractions were tested for density measurements, microstructure, hardness, and bioactivity. The bioactive behavior was investigated using the potentiodynamic polarization technique to measure the corrosion rate of the pure Ti foam (0/100 HA/Ti) and the FGM composite (10/90 HA/Ti) samples in a simulated body fluid (SBF). The results showed that the hardness of FGM composites, despite being less than that of 0/100 HA/Ti, was still within safe limits. The corrosion rate, however, was found to be decreased by a significant value of almost 40% for the 10/90 HA/Ti FGM composite sample compared to the pure Ti foam control sample. It was concluded that the optimum composition 10/90 HA/Ti sample offers improved corrosion resistance while maintaining a sufficient allowable hardness level.

The association of antibiotic exposure with new-onset inflammatory bowel disease: A systematic review and meta-analysis.

INTRODUCTION: The role of antibiotics in the development of inflammatory bowel disease (IBD) remains controversial, primarily due to conflicting data from individual studies. We conduct a systematic review and meta-analysis to study the effect of antibiotic exposure on IBD development. METHODOLOGY: The MEDLINE and Cochrane CENTRAL databases were queried from their inception to April 2021 for published articles studying the association between antibiotic exposure and new-onset IBD. Our analysis was stratified by timing of antibiotic exposure - exposure in childhood and any lifetime exposure. Adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) from each study were pooled using a random-effects model. RESULTS: 10 case-control studies and 2 cohort studies (N = 29,880 IBD patients and N = 715,548 controls) were included. Patients with Crohn's Disease (CD), compared with controls, were associated significantly with antibiotic exposure in childhood and any lifetime exposure to antibiotics (OR 1.52 [1.23-1.87]; p<0.00001). Patients with Ulcerative Colitis (UC), compared with controls, reported non-significant association with antibiotic exposure in childhood and any lifetime exposure. (OR 1.11 [0.93-1.33]; p = 0.25) CONCLUSION: This meta-analysis suggests that exposure to antibiotics significantly increases the odds of developing CD and IBD. These findings re-emphasize the importance of cautious and judicious use of antibiotics.

Therapeutic Plasma exchange therapy in Burns.

Severe burn injury affects the body in many devastating ways, the most severe being systemic inflammatory response syndrome. This results in a myriad of effects like increasing capillary permeability, thereby fluid loss. It also causes a surge in inflammatory mediators like interleukin (IL)-6, which further increases the capillary leak and fluid loss. This results in refractory hypotension in patients despite adequate fluid resuscitation. Plasma exchange has been used in the management of a number of illnesses with a significant inflammatory component, and, therefore can be considered to have a role in burn injury. In our article, we would like to share our experience of using therapeutic plasma exchange therapy in burn patient.

Effect of Multiple Thermal Cycles on the Microstructure and Mechanical Properties of AISI 1045 Weldments.

AISI 1045 medium carbon steel sheets having 10 mm thickness were subjected to the shielded metal arc welding process with three, five, and seven passes. The variations in the microstructure due to multiple thermal cycles in the heat-affected zone (HAZ), base metal (BM), and fusion zone (FZ) have been investigated and correlated with measured mechanical properties. Upon comparing fracture mechanics and mechanical properties with microstructural observations, it is elucidated that samples become ductile by increasing the number of thermal cycles which can be attributed to the transformations in the ferrite morphology in the HAZ. Based on mechanical, microstructural, and fracture analysis, it is concluded that post-weld heat treatment can be avoided if the number of passes during welding is increased.

Synthesis of Geopolymer from a Novel Aluminosilicate-Based Natural Soil Precursor Using Electric Oven Curing for Improved Mechanical Strength.

Natural soil (NS)-based geopolymers (GPs) have shown promise as environmentally friendly construction materials. The production of ordinary Portland cement is known to release significant amounts of greenhouse gas (CO2) into the atmosphere. The main objective of this work is to synthesize a geopolymer (GP) from an uncommon aluminosilicate-based NS and a sodium silicate (SS) activating solution that would not only minimize the emission of harmful gases, but also offer improved mechanical strength. Samples of different compositions were produced by varying the wt.% of NS from 50% to 80% and adding a balancing amount of SS solution. The drying and curing of the samples were carried out in an electric oven at specific temperatures. The degree of geopolymerization in the samples was measured by Fourier transform infrared spectroscopy, and microstructural analysis was performed using a scanning electron microscope. Mechanical tests were conducted to evaluate the range of compressive strength values of the prepared GP samples. A minimum compressive strength of 10.93 MPa at a maximum porosity of 37.56% was observed in a sample with an NS to SS ratio of 1:1; while a ratio of 3:1 led to the maximum compressive strength of 26.39 MPa and the minimum porosity of 24.60%. The maximum strength (26.39 MPa) was found to be more than the reported strength values for similar systems. Moreover, an improvement in strength by a factor of three has been observed relative to previously developed NS-based GPs. It may be inferred from the findings that for the given NS, with almost 90% aluminosilicate content, the extent of geopolymerization increases significantly with its increasing proportions, yielding better mechanical strength.

Understanding community resistance to sexuality education and exploring prospective implementation strategies in Pakistan: A content and network analysis of qualitative data.

Providing comprehensive sexuality education (CSE) in schools is a work in progress in many countries throughout the world. In some countries, the journey is just beginning; in others, investments in this field have been made for many years. It is and has been difficult in Pakistan to implement and promote reproductive health, women's empowerment, and CSE. In Pakistan, previous implementation efforts revealed the critical role of community influencers in propagating misleading information about the initiatives, inciting organized community resistance, and provoking backlash. This paper looked at several aspects of community resistance, as well as approaches for overcoming the resistance for increasing community engagement in the implementation of CSE in Islamabad, Pakistan. To analyze community perceptions of CSE implementation in Islamabad, the community readiness assessment (CRA) questionnaire was adapted. Questions and prompts for discussion included leadership, current initiatives, community knowledge, resource availability, community support, and implementation strategies. A total of 35 in-depth interviews were conducted. Data was analyzed and interpreted using qualitative content analysis to explore community perspectives that contribute to resistance around CSE, as well as implementation options. Using inter-code relationship data, network analysis was conducted to provide a graphical representation of the analyzed qualitative data. The study reveals community resistance to CSE being implemented in schools. Misconceptions, a lack of awareness, a lack of priority, and the lack of dedicated resources are just a few of the primary implementation challenges to consider when implementing CSE in practice. Network analysis identified, based on modularity class, five distinct clusters of highly connected nodes/codes: non-governmental organizations (NGOs), misconceptions, resources and policy, strategies and community support, and personal social and health education (PSHE) and current efforts. In conservative environments and when confronted with resistance, innovative marketing and rebranding are critical for priority setting and community engagement, especially when developing curriculum and implementing CSE. Some of the suggested strategies for implementation include community sensitization through strategic awareness campaigns, involving already established infrastructure and NGOs, endorsement by all major stakeholders, particularly decision-makers, and the use of creative digital platforms for better dissemination.

Effect of Ultrasonic Surface Mechanical Attrition Treatment-Induced Nanograins on the Mechanical Properties and Biocompatibility of Pure Titanium.

Commercially pure titanium (Ti) is widely used in bio-implants due to its high corrosion resistance. However, Ti exhibits marginally low mechanical and tribological properties, which limit its applications in some orthopedic implants. In this work, the Ti samples were subjected to ultrasonic surface mechanical attrition treatment (SMAT) for various durations to improve their surface properties such as hardness, strength and surface energy. SMAT-induced grain refinement was analyzed using optical, scanning electron and atomic force microscopy techniques. A Vickers hardness test was performed to determine the through-thickness hardness. Mechanical testing was carried out to measure the yield strength, ultimate tensile strength and ductility of the specimens. Corrosion tests were performed on a Gamry Potentiostat. The surface energy of SMAT-modified samples was calculated using the Owens-Wendt method. It was observed that SMAT reduced the average grain size from 50 µm to as low as 100 nm. The grain refinement and the corresponding grain boundary density led to a significant improvement in mechanical properties and biocompatibility in terms of increased hardness, yield and tensile strengths, surface energy, corrosion rate and hydrophilicity.

Effect of novel glucose lowering agents on non-alcoholic fatty liver disease: A systematic review and meta-analysis.

BACKGROUND: The efficacy of novel glucose-lowering drugs in treating non-alcoholic fatty liver disease (NAFLD) in patients with and without type-2 diabetic patients (T2DM) remains unclear. AIM: To conduct a meta-analysis to evaluate the efficacy of 3 novel glucose-lowering drug classes, namely glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose co-transporter 2 (SGLT2) inhibitors, and dipeptidyl-peptidase-4 (DPP4) inhibitors on hepatic parameters: Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Gamma-Glutamyl Transferase (GGT), Bilirubin, and FIB-4 (Fibrosis). METHODS: MEDLINE was searched from inception through October 2021 for randomized placebo or active glucose-lowering drug-controlled trials. A random-effects model was used to pool the results. A p-value of less than or equal to 0.05 was considered significant. Results were presented as weighted mean differences (WMD) and corresponding 95% confidence intervals (CIs). RESULTS: Our pooled analysis consisted of 40 studies. A significant reduction was seen in AST with SGLT2 inhibitors (WMD = -2.31 IU/L, 95%CI: -3.16 to -1.47 IU/L, P < 0.00001) and GLP-1RA (WMD = -3.29 IU/L, 95%CI: -5.98 to -0.61 IU/L, P = 0.02). Similarly, significant reduction was seen in ALT with SGLT2 inhibitors (WMD = -5.93 IU/L, 95%CI: -7.70 to -4.16 IU/L, P < 0.00001) and GLP-1RAs (WMD = -9.92 IU/L, 95%CI: -19.89 to 0.05 IU/L, P = 0.05). In contrast, DPP-4 inhibitors showed no significant reduction in AST (WMD = -3.20 IU/L, 95%CI: -11.13 to 4.73 IU/L, P = 0.43) or ALT (WMD = -4.81 IU/L, 95%CI: -15.83 to 6.21 IU/L, P = 0.39). A significant reduction in GGT was seen with SGLT2 inhibitors (WMD = -6.49 IU/L, 95%CI: -11.09 to -1.89 IU/L, P = 0.006) and GLP-1RAs (WMD = -12.38 IU/L, 95%CI: -15.69 to -9.07 IU/L, P < 0.00001). However, significant results were not observed with DPP-4 inhibitors (WMD = -0.92 IU/L, 95%CI: -5.80 to 3.96 IU/L, P = 0.71). There was a statistically significant reduction in FIB-4 index with SGLT2 inhibitors (WMD = -0.21, 95%CI: -0.40 to -0.03, P = 0.02) and GLP-1 RA (WMD = -0.15, 95%CI: -0.29 to 0.00, P = 0.05). Lastly, SGLT2 inhibitors led to a significant change in bilirubin levels (WMD = 2.03, 95%CI: 0.76 to 3.30, P = 0.002) while the change in bilirubin was not significant with GLP-1 agonists (WMD = -0.21, 95%CI: -1.09 to 0.66, P = 0.63) and DPP-4 inhibitors (WMD = 0.14, 95%CI: -1.55 to 1.83, P = 0.87). CONCLUSION: SGLT2 inhibitors and GLP-1 agonists have a beneficial effect on hepatic parameters in patients with NAFLD. However, further research is needed to evaluate the effect of DPP-4 inhibitors on hepatic function properly.

Evaluating data-driven methods for short-term forecasts of cumulative SARS-CoV2 cases.

BACKGROUND: The WHO announced the epidemic of SARS-CoV2 as a public health emergency of international concern on 30th January 2020. To date, it has spread to more than 200 countries and has been declared a global pandemic. For appropriate preparedness, containment, and mitigation response, the stakeholders and policymakers require prior guidance on the propagation of SARS-CoV2. METHODOLOGY: This study aims to provide such guidance by forecasting the cumulative COVID-19 cases up to 4 weeks ahead for 187 countries, using four data-driven methodologies; autoregressive integrated moving average (ARIMA), exponential smoothing model (ETS), and random walk forecasts (RWF) with and without drift. For these forecasts, we evaluate the accuracy and systematic errors using the Mean Absolute Percentage Error (MAPE) and Mean Absolute Error (MAE), respectively. FINDINGS: The results show that the ARIMA and ETS methods outperform the other two forecasting methods. Additionally, using these forecasts, we generate heat maps to provide a pictorial representation of the countries at risk of having an increase in the cases in the coming 4 weeks of February 2021. CONCLUSION: Due to limited data availability during the ongoing pandemic, less data-hungry short-term forecasting models, like ARIMA and ETS, can help in anticipating the future outbreaks of SARS-CoV2.

A Cross-Sectional Community Readiness Assessment for Implementing School-Based Comprehensive Sexuality Education in Islamabad, Pakistan.

Evidence indicates that school-based sexuality education empowers children and adolescents with the skills, values, and attitudes that will enable them to appreciate their health and well-being, nourish respectful social and sexual relationships, understand their rights, and to make informed choices. Owing to organized community resistance and prevalent misconceptions, promoting sexual and reproductive health has been challenging, especially in conservative settings like Pakistan. This study aimed at systematically exploring communities' perceptions regarding implementing school-based comprehensive sexuality education by conducting a cross-sectional community readiness assessment in Islamabad, Pakistan. A total of 35 semi-structured interviews were conducted with community key informants. Following the guidelines of the community readiness handbook, the interviews were transcribed and scored by two independent raters. The results indicate that, overall, the Islamabad community is at stage two of community readiness, the denial/resistance stage. Individual dimension scores indicate that knowledge of efforts, resources for efforts, knowledge about the issue, and leadership dimensions are at the denial/resistance stage. Only community climate was rated at stage three of community readiness, the vague awareness stage. This indicates that, for promoting sexuality education in the Pakistani context, it is essential to tackle resistance by sensitizing the community and the stakeholders through awareness campaigns.

A Cross-Sectional Survey to Assess Biorisk Management System in Research and Diagnostic Laboratories in Khyber Pakhtunkhwa, Pakistan.

Financial, cultural, and managerial hurdles have made biosafety and biosecurity measures difficult in resource-constrained countries like Pakistan. Because of increasing awareness of biorisk management, diagnostic and research laboratories have made major advances in biosafety and biosecurity in the recent decade. As a result, identifying and addressing gaps in biorisk management has never been more critical. The purpose of this study was to assess the current situation of personal protective equipment (PPE), biosafety behavior, waste management, biosafety and biosecurity measures, training and safety, and health services in diagnostic and research laboratories across Pakistan's Khyber Pakhtunkhwa (KP) province. We adapted the WHO Laboratory Assessment tool (2012) and CWA 15793 (Biorisk management guidelines) for conducting a cross-sectional survey, which was distributed among various laboratories in KP. The survey included 30 laboratories, including 11 diagnostic and 19 research laboratories. In comparison to diagnostic laboratories, biorisk management practices in research laboratories were better in terms of PPE, biosafety behavior, waste management, biosafety measures, biosecurity measures, trainings, and safety and health services. KP laboratories' biorisk management practices have improved over time, according to our findings. However, we were able to identify inadequacies that would require considerable improvements to the current setups based on the WHO and CWA 15793 recommendations. Organizations can tailor their biosafety measures and training to address identified gaps using the presented KP snapshot.

Key indicators for appraising adolescent sexual and reproductive health in South Asia: international expert consensus exercise using the Delphi technique.

BACKGROUND: There is a need for an accurate assessment of the patterns and determinants of sexual and reproductive health in South Asia owing to high fertility rates and high incidence of unplanned pregnancy among adolescents. Health indicator sets, with a wide range of health dimensions, also support in formulating evidence-based policies. For attaining this, indicators should be developed and prioritized based on consensus and relevance. OBJECTIVE: This study aimed to develop a comprehensive list of adolescent sexual and reproductive health (ASRH) key indicators for South Asia through systematic participatory expert consultation exercise using the Delphi technique. METHODS: Experts were invited to two rounds of an indicator rating exercise and a third round to discuss the results in a broader regional perspective. A list of nine indicator categories, including 41 adolescent health indicators, was rated by the expert panel. Prioritization was based on mean Likert scores while consensus was established using Kendall's W. RESULTS: 24, 16 and six experts participated in the first, second and third round, respectively. Out of the nine indicator categories, demographics, reproductive health, violence, and nutrition were ranked high in relevance by the expert panel. Experts had a strong consensus on the relevance of parental control and connection, and behavioral indicators while there was moderate consensus on the relevance of nutrition, infectious disease, and mortality indicators. CONCLUSION: As far as we know, this is the first study that employs the Delphi technique for prioritizing ASRH indicators for South Asia. Engaging a diverse group of experts, using an online platform, we developed a comprehensive list of key indicators for appraising ASRH relevant to South Asia based on expert panel consensus and recommendations. Our results also highlight that there is a need for developing a region-specific prioritized list of indicators which might assist in identifying regional health needs.

Effects of temperature on baseline susceptibility and stability of insecticide resistance against Plutella xylostella (Lepidoptera: Plutellidae) in the absence of selection pressure.

Plutella xylostella L. (Lepidoptera: Plutellidae) is an important pest causing significant losses to vegetables worldwide. Insecticides resistance in P. xylostella is a serious issue for scientists since last 30 years. However, deltamethrin and Bt Cry1Ac are commonly used insecticides against P. xylostella but studies involving development of resistance in P. xylostella against these two insecticides at different temperatures are lacking. The current study was aimed to find out the toxicity of deltamethrin and Bt Cry1Ac, and resistance development in P. xylostella. Results showed that the positive correlation between the temperature and toxicities of deltamethrin and Bt Cry1Ac. The results indicated -0.051, -0.049, -0.047, and -0.046 folds of deltamethrin resistance at 15 °C, 20 °C, 25 °C, and 30 °C temperatures, respectively from 1st to 12th generations. The toxicity of Bt Cry1Ac after 24 h was 2.2 and 4.8 folds on 1st generation at 20 °C and 25 °C temperatures, respectively compared to the toxicity recorded at 15 °C (non-overlapping of 95% confidence limits). Based on the results of this study, it is concluded that the temperature has a positive correlation with the toxicity of deltamethrin and Bt Cry1Ac against the larvae of P. xylostella. This study suggests that deltamethrin and Bt Cry1Ac can be included in the management program of P. xylostella on many vegetable crops. The baseline susceptibility data might be helpful to understand the resistance mechanisms in P. xylostella.

Artemisinin: A Promising Adjunct for Cancer Therapy.

Artemisinin is a herb derived from Artemesia annua (also known as sweet wormwood) and is known for its use as effective antimalarial pharmacotherapy. Recent studies have shown that artemisinin has anti-angiogenic and growth inhibition effects, as well as an apoptotic ability secondary to its inherent endo-peroxidase activity.

Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK.

BACKGROUND: People of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT) consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI) to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK. METHODS: We conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs) likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index). In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering the BCI, respectively. Quit success was assessed at 6 months by saliva/urine cotinine. RESULTS: The BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients' motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at 6 months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content - maximum score achievable 44; and between 1.4 and 14 for the quality of interaction - maximum score achievable was 14. Interviews with advisors highlighted the need for additional training on BCTs, integrating nicotine replacement and reducing duration of the pre-quit session. Clients were receptive to health messages but most reported SLT reduction rather than complete cessation. CONCLUSION: We developed a theory-based BCI that was also acceptable and feasible to deliver with moderate fidelity scores. It now needs to be evaluated in an effectiveness trial.