Comprehensive Quality Analysis of Conventional and Novel Biomarkers in Diagnosing and Predicting Prognosis of Coronary Artery Disease, Acute Coronary Syndrome, and Heart Failure, a Comprehensive Literature Review.

Coronary artery disease (CAD), acute coronary syndrome (ACS), and heart failure (HF) are major global health issues with high morbidity and mortality rates. Biomarkers like cardiac troponins (cTn) and natriuretic peptides (NPs) are crucial tools in cardiology, but numerous new biomarkers have emerged, proving increasingly valuable in CAD/ACS. These biomarkers are classified based on their mechanisms, such as fibrosis, metabolism, inflammation, and congestion. The integration of established and emerging biomarkers into clinical practice is an ongoing process, and recognizing their strengths and limitations is crucial for their accurate interpretation, incorporation into clinical settings, and improved management of CVD patients. We explored established biomarkers like cTn, NPs, and CRP, alongside newer biomarkers such as Apo-A1, IL-17E, IgA, Gal-3, sST2, GDF-15, MPO, H-FABP, Lp-PLA2, and ncRNAs; provided evidence of their utility in CAD/ACS diagnosis and prognosis; and empowered clinicians to confidently integrate these biomarkers into clinical practice based on solid evidence.

Failure in HiRes Ultra Series Recall Devices Does Not Necessarily Lead to Decrement in Performance.

OBJECTIVE: To understand the impact on speech perception for patients experiencing Advanced Bionics V1 series Ultra and Ultra 3D cochlear implant failure. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary academic center. PATIENTS: Adult patients implanted with V1 series devices. INTERVENTIONS: Device integrity and speech perception testing. MAIN OUTCOME MEASURES: consonant-nucleus-consonant and AzBio in quiet speech recognition scores. RESULTS: At our institution, 116 V1 series cochlear implants were placed in 114 patients. Thirteen devices in prelingual patients were excluded, leaving 103 (89%) for final analysis. Forty-eight (46.6%) devices were considered as failed using the company provided EFI analysis tool. There were 36 (65.5%) of the remaining 55 devices that consistently tested within normal range; the remainder lost to follow-up with unknown status. Among the 48 device failures, 29 were revised and 19 patients were not revised. Among those not revised, 11 self-opted for observation (57.9%). Observed patients, despite impedance changes meeting failure criteria, had no subjective or objective changes in speech perception. Sentence testing scores for failure patients who elected observation (82.9 ± 11.4%) were significantly higher at failure compared with those opting for revision (55 ± 22.8%, p = 0.006). For those undergoing revision surgery, significant improvement in post-activation scores was noted as compared with time of failure with a mean improvement of 12.9% (p = 0.002, n = 24) for consonant-nucleus-consonant word scores and 17.2% (p = 0.001, n = 19) for AzBio in quiet scores. CONCLUSIONS: Proactive monitoring using EFI identifies a higher rate of Ultra Series V1 device failure than previously reported. However, about 20% of these patients may not have subjective change in hearing or objective decline in test scores and could be observed. Should performance worsen, reimplantation provides significant improvement in speech recognition.

In-depth analysis of ambient air pollution changes due to the COVID-19 pandemic in the Asian Monsoon region.

The COVID-19 pandemic has given a chance for researchers and policymakers all over the world to study the impact of lockdowns on air quality in each country. This review aims to investigate the impact of the restriction of activities during the lockdowns in the Asian Monsoon region on the main criteria air pollutants. The various types of lockdowns implemented in each country were based on the severity of the COVID-19 pandemic. The concentrations of major air pollutants, especially particulate matter (PM) and nitrogen dioxide (NO2), reduced significantly in all countries, especially in South Asia (India and Bangladesh), during periods of full lockdown. There were also indications of a significant reduction of sulfur dioxide (SO2) and carbon monoxide (CO). At the same time, there were indications of increasing trends in surface ozone (O3), presumably due to nonlinear chemistry associated with the reduction of oxides of nitrogens (NOX). The reduction in the concentration of air pollutants can also be seen in satellite images. The results of aerosol optical depth (AOD) values followed the PM concentrations in many cities. A significant reduction of NO2 was recorded by satellite images in almost all cities in the Asian Monsoon region. The major reductions in air pollutants were associated with reductions in mobility. Pakistan, Bangladesh, Myanmar, Vietnam, and Taiwan had comparatively positive gross domestic product growth indices in comparison to other Asian Monsoon nations during the COVID-19 pandemic. A positive outcome suggests that the economy of these nations, particularly in terms of industrial activity, persisted during the COVID-19 pandemic. Overall, the lockdowns implemented during COVID-19 suggest that air quality in the Asian Monsoon region can be improved by the reduction of emissions, especially those due to mobility as an indicator of traffic in major cities.

In-depth characterization of particulate matter in a highly polluted urban environment at the foothills of Himalaya-Karakorum Region.

In recent years, the rising levels of atmospheric particulate matter (PM) have an impact on the earth's system, leading to undesirable consequences on various aspects like human health, visibility, and climate. The present work is carried out over an insufficiently studied but polluted urban area of Peshawar, which lies at the foothills of the famous Himalaya and Karakorum area, Northern Pakistan. The particulate matter with an aerodynamic diameter of less than 10 µm, i.e., PM10 are collected and analyzed for mineralogical, morphological, and chemical properties. Diverse techniques were used to examine the PM10 samples, for instance, Fourier transform infrared spectroscopy, x-ray diffraction, and scanning electron microscopy along with energy-dispersive x-ray spectroscopy, proton-induced x-ray emission, and an OC/EC carbon analyzer. The 24 h average PM10 mass concentration along with standard deviation was investigated to be 586.83 ± 217.70 µg/m3, which was around 13 times greater than the permissible limit of the world health organization (45 µg/m3) and 4 times the Pakistan national environmental quality standards for ambient PM10 (150 µg/m3). Minerals such as crystalline silicate, carbonate, asbestiform minerals, sulfate, and clay minerals were found using FTIR and XRD investigations. Microscopic examination revealed particles of various shapes, including angular, flaky, rod-like, crystalline, irregular, rounded, porous, chain, spherical, and agglomeration structures. This proved that the particles had geogenic, anthropogenic, and biological origins. The average value of organic carbon, elemental carbon, and total carbon is found to be 91.56 ± 43.17, 6.72 ± 1.99, and 102.41 ± 44.90 µg/m3, respectively. Water-soluble ions K+ and OC show a substantial association (R = 0.71). Prominent sources identified using Principle component analysis (PCA) are anthropogenic, crustal, industrial, and electronic combustion. This research paper identified the potential sources of PM10, which are vital for preparing an air quality management plan in the urban environment of Peshawar.

Toxicological profile and potential health concerns through metals and trace elements exposure in brick kiln workers from Lahore, Pakistan.

This study examined levels of lead (Pb), cadmium (Cd), chromium (Cr), copper (Cu), mercury (Hg), and arsenic (As) in blood, hair, and nails of 18 brick kiln workers from three brick kiln units located around a metropolitan city, Lahore, Pakistan. All the trace elements except Hg and As were detected in the studied matrices of Brick kiln workers. In general, brick kiln workers reflect the highest concentration of Pb, followed by Cd, Cr, and Cu. Of the pollutants analyzed, Pb has the highest mean (min-max) concentrations at 0.35 (0.09-0.65) in blood (µg/mL), 0.34 (0.14-0.71) in hairs (µg/g), and 0.44 (0.32-0.59) in nails (µg/g) of brick kiln workers. Following Pb, the trend was Cd 0.17 (0.10-0.24), Cu 0.11(0.03-0.27), and Cr 0.07 (0.04-0.08) in blood (µg/mL), followed by Cr 0.11(0.05-0.20), Cd 0.09 (0.03-0.13), and Cu 0.08 (0.04-0.16) in hairs (µg/g) and Cu 0.16 (0.05-0.36), Cd 0.13 (0.11-0.17), and Cr 0.10 (0.05-0.14) in nails (µg/g) respectively. Relatively higher concentrations of metals and other trace elements in blood depicts recent dietary exposure. The difference of trace elements except Pb was non-significant (P > 0.05) among studied matrices of workers as well as between Zigzag and traditional exhaust-based brick kilns. The concentrations of Pb, Cd and Cr in blood of brick kilns workers are higher than the values reported to cause health problems in human populations. It is concluded that chronic exposure to metals and other trace elements may pose some serious health risks to brick kiln workers which needs to be addressed immediately to avoid future worst-case scenarios.

Therapeutic drug monitoring of vancomycin in surgical patients using a validated HPLC method.

BACKGROUND: Vancomycin is being used for the treatment of a variety of infections caused by methicillin resistant Staphylococcus aureus and methicillin susceptible Staphylococcus aureus. Therapeutic drug monitoring (TDM) is highly recommended for ensuring the safe and effective therapy with vancomycin. A reliable and cost-effective bioanalytical method is required for TDM as well as pharmacokinetic studies of vancomycin. MATERIALS AND METHODS: A selective, sensitive, and cost effective HPLC method was developed and validated for quantification of vancomycin concentrations in human plasma. The mobile phase was a mixture of buffer (50 mM ammonium dihydrogen phosphate, pH 2.4) and acetonitrile 88 : 12 v/v. The separation was carried on C18 column (125 × 4.6 mm, particle size 5 µm) with isocratic flow rate of 0.370 mL/min at room temperature with UV detection at 215 nm. The method was validated for sensitivity, accuracy, and precision as well as stability of vancomycin in human plasma by following European Medicine Agency (EMA) guideline. Therapeutic drug monitoring of vancomycin was performed by quantifying the trough concentrations of vancomycin in 65 human plasma samples after administration of therapeutically relevant dose. RESULTS: The developed method was sensitive enough to quantify vancomycin concentrations as low as 0.25 mg/L in human plasma. Moreover, the method was proved accurate and precise in terms of quantifying the unknown concentration of vancomycin. The evaluation of short-term, long-term, and freeze-thaw stability proved the stability of vancomycin in human plasma. The TDM of vancomycin by using this method showed that 39 (60%) samples were within the target trough concentration range (TTCR), i.e. 10 - 20 mg/L, while 23 samples (35.4%) were below the TTCR, and 3 samples (4.6%) were above this range. CONCLUSION: The developed method is sensitive and cost effective for quantification of vancomycin in human plasma. The results of sample analysis shows that the developed method can be used reliably for TDM of vancomycin.

Evaluating the Aphrodisiac Potential of Mirabilis jalapa L. Root Extract: Phytochemical Profiling and In Silico, In Vitro, and In Vivo Assessments in Normal Male Rats.

The traditional use of Mirabilis jalapa L. roots to enhance male sexual performance prompted us to assess the in silico, in vitro, and in vivo aphrodisiac activities of its hydroethanolic extract using normal male rats. Spectroscopic characterization indicated the presence of ß-D-glucopyranoside, methyl-1,9-benzyl-2,6-dichloro-9H-purine, and Bis-(2-ethylhexyl)-phthalate; these compounds have a significant inhibitory effect on the phosphodiesterase-5 (PDE-5) enzyme in silico evaluation and minerals (including zinc, cadmium, and magnesium). Other phytochemical analyses revealed the presence of phenolic compounds and flavonoids. These phytochemicals and minerals may contribute to the aphrodisiac activities of the extract. Additionally, the in vivo study revealed that the administration of M. jalapa root extract (300 mg/kg) significantly enhanced (p < 0.01, p < 0.03) mount, intromission, and ejaculation frequencies while significantly (p < 0.05) decreasing the mount and intromission latencies, as well as the post-ejaculatory interval time, in comparison with the standard drugs sildenafil and ginseng, resulting in enhanced erection and sexual performance in the rats. Furthermore, the extract significantly (p < 0.05) increased penile reflexes and also elevated the levels of testosterone and luteinizing hormones. Extract (300 mg/kg) significantly (p < 0.05) inhibited the PDE-5 enzyme in an in vitro study. Concludingly, the comprehensive findings of this study suggest that a standardized herbal extract derived from M. jalapa roots alleviates erectile dysfunction and premature ejaculation in male rats. M. jalapa root extract proved to be an alternative treatment for erectile dysfunction and premature ejaculation.

A Systematic Review and Meta-Analysis of Independent Predictors for Acute Respiratory Distress Syndrome in Patients Presenting With Sepsis.

The current meta-analysis was conducted to determine the predictors of acute respiratory distress syndrome (ARDS) in patients with sepsis. The present meta-analysis was conducted in accordance with the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. We conducted a systematic search using the PubMed, Cochrane Library, and EMBASE databases for studies published between 1 January 2000 and 28 February 2023 that assessed the predictors of ARDS in patients with sepsis. We used key terms such as "predictors," "acute respiratory distress syndrome," and "sepsis" to search for relevant articles. Our search was limited to human studies published in English. A total of six studies were included in this meta-analysis. Of the six studies, four were retrospective and two were prospective. The pooled incidence of ARDS was 11.27%. We identified six factors with a consistent and statistically significant association with ARDS, including sequential organ failure assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, pulmonary sepsis, smoking, pancreatitis, and C-reactive protein. Age, diabetes, and chronic obstructive pulmonary disease (COPD) were not found to be significantly associated with ARDS in this patient population. It is important for healthcare providers to consider these predictors when assessing patients with sepsis and septic shock to identify those at high risk for developing ARDS and implement appropriate preventive measures.

Libman-Sacks Endocarditis With Triple Valvular Involvement.

Systemic lupus erythematosus (SLE) is a systemic inflammatory autoimmune disease with a broad spectrum of clinical manifestations. Libman-Sacks endocarditis (LSE) is due to sterile vegetations that arise in association with SLE. Nonbacterial thrombotic endocarditis, also known as marantic endocarditis, Libman-Sacks endocarditis, and verrucous endocarditis, is linked to a number of illnesses, the most prevalent of which is advanced cancer. Most often, the surfaces of mitral and aortic valves are involved. However, the involvement of the tricuspid valve is possible and is rarely described in the literature. We present a case of a 25-year-old female who presented with LSE, lupus nephritis, and pulmonary involvement secondary to SLE. On detailed exploration, she was found to have SLE with lupus nephritis and pulmonary hypertension secondary to valvular involvement. Through this case, we would like to elaborate on the course of SLE with triple valvular involvement.

A Brief Review of Transparent Conducting Oxides (TCO): The Influence of Different Deposition Techniques on the Efficiency of Solar Cells.

Global-warming-induced climate changes and socioeconomic issues increasingly stimulate reviews of renewable energy. Among energy-generation devices, solar cells are often considered as renewable sources of energy. Lately, transparent conducting oxides (TCOs) are playing a significant role as back/front contact electrodes in silicon heterojunction solar cells (SHJ SCs). In particular, the optimized Sn-doped In2O3 (ITO) has served as a capable TCO material to improve the efficiency of SHJ SCs, due to excellent physicochemical properties such as high transmittance, electrical conductivity, mobility, bandgap, and a low refractive index. The doped-ITO thin films had promising characteristics and helped in promoting the efficiency of SHJ SCs. Further, SHJ technology, together with an interdigitated back contact structure, achieved an outstanding efficiency of 26.7%. The present article discusses the deposition of TCO films by various techniques, parameters affecting TCO properties, characteristics of doped and undoped TCO materials, and their influence on SHJ SC efficiency, based on a review of ongoing research and development activities.

Exploring the nexus between land use land cover (LULC) changes and population growth in a planned city of islamabad and unplanned city of Rawalpindi, Pakistan.

For the last three decades, Islamabad - a planned city, and Rawalpindi - an unplanned city, have experienced massive land use and land cover changes. The main objective of this study was a comparative assessment and quantification of LULC changes in relation to population growth and urbanization from 1990 to 2021 with the help of satellite imagery and population data in planned and unplanned cities. For classification four land-use land cover classes: built-up, vegetation, bare land, and water were selected. Maximum likelihood algorithm and confusion matrix were employed for classification and accuracy assessment. Results revealed that built-up increased from 5.7% (52 km2) to 25.7% (233 km2) and 3.7% (60 km2) to 14.1% (228 km2) from 1990 to 2021 for Islamabad and Rawalpindi, respectively. Wherein the bare land decreased from 42.2% (382 km2) to 18.1% (164 km2) in Islamabad and 65.5% (1058 km2) to 32.1% (518 km2) in Rawalpindi. Vegetation showed an increment of 4.7% for Islamabad and 24.5% for Rawalpindi. Surface water bodies decreased in both study areas. Population growth showed a strong positive correlation with the built-up class and a strong negative correlation with the bare land class for both cities. The outcomes of this study may be helpful in policymaking for better planning and management of land use land cover and urban sprawl in the context of sustainable development goals.

Antibiotics induced changes in nitrogen metabolism and antioxidative enzymes in mung bean (Vigna radiata).

Excessive use and release of antibiotics into the soil environment in the developing world have resulted in altered soil processes affecting terrestrial organisms and posing a serious threat to crop growth and productivity. The present study investigated the influence of exogenously applied oxytetracycline (OXY) and levofloxacin (LEV) on plant physiological responses, key enzymes involved in nitrogen metabolism (e.g., nitrate reductase, glutamine synthetase), nitrogen contents and oxidative stress response of mung bean (Vigna radiata). Plants were irrigated weekly with antibiotics containing water for exposing the plants to different concentrations i.e., 1, 10, 20, 50, and 100 mg L-1. Results showed a significant decrease in nitrate reductase activity in both antibiotic treatments and their mixtures and increased antioxidant enzymatic activities in plants. At lower concentrations of antibiotics (≤20 mg L-1), 53.9 % to 78.4 % increase in nitrogen content was observed in levofloxacin and mixtures compared to the control, resulting in an increase in the overall plant biomass. Higher antibiotic (≥50 mg L-1) concentration showed 58 % decrease in plant biomass content and an overall decrease in plant nitrogen content upon exposure to the mixtures. This was further complemented by 22 % to 42 % increase in glutamine synthetase activity observed in the plants treated with levofloxacin and mixtures. The application of low doses of antibiotics throughout the experiments resulted in lower toxicity symptoms in the plants. However, significantly higher malondialdehyde (MDA) concentrations at higher doses (20 mg L-1 and above) than the control showed that plants' tolerance against oxidative stress was conceded with increasing antibiotic concentrations. The toxicity trend was: levofloxacin > mixture > oxytetracycline.

Hydrological and ecological impacts of run off river scheme; a case study of Ghazi Barotha hydropower project on Indus River, Pakistan.

Run off river schemes are getting widespread importance as they are considered environmentally safe. However, number of studies and the consequent information regarding impacts of run off river schemes is very limited worldwide. Present study attempted to analyze impacts of Ghazi Barotha Hydropower Plant, which is a run off river scheme situated in Khyber Pakhtunkhwa province of Pakistan. This study attempted to analyze impacts of this run off river scheme on hydrological and ecological conditions of downstream areas. Data on river discharge, groundwater levels, agriculture area, vegetation and bare soil was utilized for this study. All data sets between the year 1990 till 2020 were analyzed. Hydrological impacts were analyzed through secondary data analysis, whereas ecological impacts were studied through remote sensing technique. Statistical methods were applied to further draw conclusions between hydrological and ecological interrelationships. Results showed that after functioning of Ghazi Barotha, there was 47% and 91% reduction of river discharge, in summer and winter seasons respectively. Groundwater level dropped by 50%. Agriculture area reduced by 1.69% and 9.11% during summer and winter respectively, whereas land under bare soil increased. River water diversion was considered to be responsible for groundwater reduction, as strong correlation was found between both. Agriculture land recovery, in post Ghazi Barotha period, was premised at intense groundwater mining, as groundwater level and agriculture area were significantly related (p < 0.05). Governments' groundwater development schemes, and a shift into motorized groundwater mining were major factors behind further groundwater exploitation in study area. This study came to the conclusion that Ghazi Barotha Hydropower Plant had impacted flow regime of Indus River, as well as groundwater levels and land use of downstream area along the river. These effects were triggered by inappropriate compensatory measures and uncontrolled water resource exploitation.

Observed and predicted precipitation variability across Pakistan with special focus on winter and pre-monsoon precipitation.

This study utilises ground, satellite and model data to investigate the observed and future precipitation changes in Pakistan. Pakistan Meteorological Department's (PMD) monthly precipitation data set along with the Tropical Rainfall Measuring Mission (TRMM) monthly dataset TRMM_3B43 (0.25° × 0.25° resolution) and European Centre for Medium-Range Weather Forecasts's (ECMWF) monthly reanalysis product ERA5 have been used to evaluate rainfall trends over the climatic zones of Pakistan through Mann-Kendall test, Sen's slope estimator and innovative trend analysis for the time period 1978-2018. Community Climate System Model (CCSM4) projections have been employed to explore the projected changes in precipitation until 2099. Furthermore, TRMM and CCSM4 projections have been correlated and validated using root mean square error (RMSE) and mean bias error (MBE). There is a good correlation between TRMM and PMD ground observation at all stations of the country for all seasons, with correlation coefficient values ranging from 0.89 (November) to 0.97 (July and August). However, ERA5 monthly precipitation tends to overestimate rainfall in the winter months. The study shows a decreasing trend in winter precipitation in all zones of the country with a significant decrease over western mountains, i.e. zone C of the country. During 2008-2018, a sharp decrease in winter precipitation is observed as compared to the baseline value of 1978-2007 in all climatic zones. Rainy days have also shown a decrease in winter and pre-monsoon seasons. There seems to be a shift in precipitation from winter towards pre-monsoon season as pre-monsoon precipitation in the last 11 years increased in all zones except for zone C. Coherently, there is a decrease in an area affected by winter precipitation and an increase in area for pre-monsoon precipitation. Future precipitation estimates from the CCSM4 model for RCP 4.5 and RCP 8.5 overestimate precipitation in most parts of the country for the first 9 observed years (2010-2018) and predict a rise in precipitation by 2099 which is more pronounced in the northern and western Pakistan while a decrease is predicted for the plains of the country, which might have negative consequences for agriculture.

Comparative pharmacokinetics of valproic acid among Pakistani and South Korean patients: A population pharmacokinetic study.

PURPOSE: The pharmacokinetics of valproic acid have been evaluated in a variety of populations however, the comparison in two different populations was yet to be reported. This study is aimed to compare the pharmacokinetics of valproic acid in Pakistani and South Korean patients. METHOD: The therapeutic drug monitoring (TDM) data of valproic acid from 92 Pakistani patients with 218 samples was combined with the data of 99 South Korean patients with 335 samples in order to form a pooled dataset of 191 patients with 553 samples. Population pharmacokinetic model was developed on NONMEM® software by using first order conditional estimation method for estimation of pharmacokinetic parameters. The influence of different covariates including ethnicity was evaluated the stepwise covariate modelling. The final model was evaluated for predictive performance and robustness by using goodness of fit plots and bootstrap analysis respectively. RESULTS: The data was better described by one compartment model with first order elimination. The value for clearance (CL) of valproic in pooled data was 0.931 L/h with 43.4% interindividual variability (IIV) while volume of distribution (Vd) was 16.6 L with 22.3% IIV. In covariate analysis, ethnicity and body weight were significant covariates for CL while body weight was also significant for Vd. CONCLUSION: A significant difference in CL of valproic acid among Pakistani and South Korean patients was observed. The model can be used for the dose tailoring of valproic acid based on ethnicity and body weight of Pakistani and South Korean patients.

Perceptions of oncology as a career choice among the early career doctors in Pakistan.

BACKGROUND: Lack of oncologists is a growing global concern. With the rise in cancer burden across the world, the supply-demand mismatch of the oncology workforce is projected to increase. Furthermore, oncology is a low-ranked field of choice among medical students, and without understanding the perceptions and concerns of early-career doctors regarding oncology, any investments made in cancer care will be futile. This study aims to determine the opinions of young doctors and the factors most affecting their preferences in order to devise focused strategies to attract more doctors into oncology. METHODS: A cross-sectional study was conducted on 300 early-career doctors across various public and private hospitals in Pakistan, from March to November 2019. A close-ended, self-administered questionnaire was used to assess their opinions in terms of the workplace environment, scope, and the emotional and financial aspects of oncology. Data was analyzed using SPSS version 23 and the influence (positive or negative) of the perceptions on the choice of oncology as a career was determined by binary logistic regression analysis. RESULTS: Almost three-quarters of the participants did not want a career in oncology. The top positive perceptions about oncology in descending order were: progressive field, gender-neutral, stable working hours, financially healthy, and work-family balance. Top negative perceptions were: lack of oncologic facilities in hospitals, radiation exposure, need for private practice, poor patient prognosis, high patient load, and depressing environment. Participants who attended private medical school (p < 0.10), planned to live abroad (p < 0.10), had an oncologist (p < 0.05), cancer survivor or death due to cancer in the family (p < 0.05), were more likely to adopt oncology as a career. Those who believed that poor patient prognosis can have an impact on career choice were less likely to prefer oncology (p < 0.05). CONCLUSION: Despite the rising cancer burden, early career doctors are reluctant to join oncology. Curricular, infrastructural and policy changes are needed at the level of medical school, oncology training and practice to recruit more young doctors and minimize the existing paucity of the oncologic workforce.

Dose Tailoring of Vancomycin Through Population Pharmacokinetic Modeling Among Surgical Patients in Pakistan.

Background: Vancomycin is a narrow therapeutic agent, and it is necessary to optimize the dose to achieve safe therapeutic outcomes. The purpose of this study was to identify the significant covariates for vancomycin clearance and to optimize the dose among surgical patients in Pakistan. Methods: Plasma concentration data of 176 samples collected from 58 surgical patients treated with vancomycin were used in this study. A population pharmacokinetic model was developed on NONMEM® using plasma concentration-time data. The effect of all available covariates was evaluated on the pharmacokinetic parameters of vancomycin by stepwise covariate modeling. The final model was evaluated using bootstrap, goodness-of-fit plots, and visual predictive checks. Results: The pharmacokinetics of vancomycin followed a one-compartment model with first-order elimination. The vancomycin clearance (CL) and volume of distribution (Vd) were 2.45 L/h and 22.6 l, respectively. Vancomycin CL was influenced by creatinine clearance (CRCL) and body weight of the patients; however, no covariate was significant for its effect on the volume of distribution. Dose tailoring was performed by simulating dosage regimens at a steady state based on the CRCL of the patients. The tailored doses were 400, 600, 800, and 1,000 mg for patients with a CRCL of 20, 60, 100, and 140 ml/min, respectively. Conclusion: Vancomycin CL is influenced by CRCL and body weight of the patient. This model can be helpful for the dose tailoring of vancomycin based on renal status in Pakistani patients.

Cost-efficient service selection and execution and blockchain-enabled serverless network for internet of medical things.

These days, healthcare applications on the Internet of Medical Things (IoMT) network have been growing to deal with different diseases via different sensors. These healthcare sensors are connecting to the various healthcare fog servers. The hospitals are geographically distributed and offer different services to the patients from any ubiquitous network. However, due to the full offloading of data to the insecure servers, two main challenges exist in the IoMT network. (i) Data security of workflows healthcare applications between different fog healthcare nodes. (ii) The cost-efficient and QoS efficient scheduling of healthcare applications in the IoMT system. This paper devises the Cost-Efficient Service Selection and Execution and Blockchain-Enabled Serverless Network for Internet of Medical Things system. The goal is to choose cost-efficient services and schedule all tasks based on their QoS and minimum execution cost. Simulation results show that the proposed outperform all existing schemes regarding data security, validation by 10%, and cost of application execution by 33% in IoMT.

Emerging challenges of air pollution and particulate matter in China, India, and Pakistan and mitigating solutions.

This study examines point and non-point sources of air pollution and particulate matter and their associated socioeconomic and health impacts in South Asian countries, primarily India, China, and Pakistan. The legislative frameworks, policy gaps, and targeted solutions are also scrutinized. The major cities in these countries have surpassed the permissible limits defined by WHO for sulfur dioxide, carbon monoxide, particulate matter, and nitrogen dioxide. As a result, they are facing widespread health problems, disabilities, and causalities at extreme events. Populations in these countries are comparatively more prone to air pollution effects because they spend more time in the open air, increasing their likelihood of exposure to air pollutants. The elevated level of air pollutants and their long-term exposure increases the susceptibility to several chronic/acute diseases, i.e., obstructive pulmonary diseases, acute respiratory distress, chronic bronchitis, and emphysema. More in-depth spatial-temporal air pollution monitoring studies in China, India, and Pakistan are recommended. The study findings suggest that policymakers at the local, national, and regional levels should devise targeted policies by considering all the relevant parameters, including the country's economic status, local meteorological conditions, industrial interests, public lifestyle, and national literacy rate. This approach will also help design and implement more efficient policies which are less likely to fail when brought into practice.