Intermittent fasting regimens for metabolic dysfunction-associated steatotic liver disease: a systematic review and network meta-analysis of randomized controlled trials.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent metabolic disorder characterized by excessive hepatic fat accumulation. Intermittent fasting (IF) has emerged as a potential therapeutic strategy with the ability to induce weight loss, improve insulin sensitivity and reduce hepatic steatosis. We aim to compare the efficacy of different IF regimens for MASLD management. A systematic review and network meta-analysis of randomized controlled trials investigating different IF regimens for MASLD. PubMed , EMBASE , WOS , SCOPUS and Cochrane Central Register of Controlled Trials were searched until 10 April 2023. Analysis was performed using R software with the meta and netmeta packages. Mean difference (MD) was used to pool continuous outcomes with 95% confidence intervals (CIs). Our meta-analysis was registered in PROSPERO (CRD42023418467). Our meta-analysis included eight randomized controlled trials with a total of 635 participants. The 5 : 2 diet significantly improved liver stiffness (MD, -0.32; 95% CI, -0.55 to -0.09; P  < 0.01). Time-restricted feeding significantly improved liver steatosis (controlled attenuation parameter score) (MD, -39.83; 95% CI, -64.78 to -14.87; P  < 0.01). No significant changes were observed in asparate aminotransferase, gamma-glutamyl transpeptidase, low-density lipoproteins cholesterol, total cholesterol, triglyceride levels, basal metabolic index, blood pressure, Homeostatic Model Assessment of Insulin Resistance, fasting blood sugar, lean body mass or waist circumference across all IF regimens. However, alternate-day fasting showed positive results in anthropometric measures, including significant improvements in lean body mass, waist circumference, fat mass and weight reduction ( P  < 0.05). IF regimens showed various positive effects on clinical outcomes in MASLD patients; however, these effects were not consistent. Therefore, a patient-tailored IF regimen should be considered.

Perioperative balanced crystalloids versus normal saline during kidney transplantation: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: In kidney transplant (KT) surgery, the perioperative administration of intravenous (IV) fluids plays a crucial role, with potential effects on graft function. Our meta-analysis aims to assess the post-KT outcomes of perioperative balanced crystalloids (BC) versus normal saline (NS). METHODS: We conducted a comprehensive search across five databases to identify relevant randomized controlled trials (RCTs). The search results were imported into Covidence for article eligibility screening, and all relevant outcome data were synthesized using risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CIs) in meta-analysis models within RevMan 5.4. PROSPERO ID: CRD42023448457. RESULTS: Pooled data from 15 RCTs with 2,008 participants showed that the rate of delayed graft function (DGF) was significantly lower with BC (RR: 0.78, 95% CI [0.68, 0.91], P = 0.0009). Also, BC was associated with significantly higher post-op blood pH (MD: 0.05, 95% CI [0.03, 0.07], P < 0.01), lower serum chloride (MD: - 7.31, 95% CI [- 10.58, - 3.77], P < 0.01), and sodium (MD: - 1.94, 95% CI [- 3.32, - 0.55], P = 0.006) as compared to NS. However, serum potassium, serum creatinine, and urine output at POD 1 to 7 did not differ between the two groups. CONCLUSION: BC significantly reduced the incidence of DGF, resulting in more stable post-operative acid-base parameters, and lower chloride levels compared to NS. Hence, substituting NS with BC offers a strategy to protect grafts from acidotic and hyperchloremic insults, optimizing KT outcomes.

Efficacy of sexual intercosurse in the spontaneous passage of distal or intramural ureteral stones: a randomsized controlled trial.

Background: The role of sexual intercourse as an alternative treatment approach for ureteral stones (UTSs) is a recent area of investigation with only small sample-sized studies. This study aims to evaluate the role of sexual intercourse in the spontaneous passage of distal or intramural UTSs via a larger sample size. Materials and methods: The study population included cases that had either a distal ureteric or an intramural radiopaque stone. The patients were divided into two groups; group A was instructed to engage in sexual intercourse two to three times per week while also receiving symptomatic treatment for 4 weeks. Group B received symptomatic treatment alone and was instructed to abstain from sexual intercourse or masturbation for the same period. Results: A total of 160 male patients were enrolled in this study. The ages of the patients ranged from 21 to 58 years. The rate of stone expulsion after 2 weeks was 68.18% in group A and 53% in group B (P=0.053). The expulsion rate after 4 weeks was 80% in group A and 68.4% in group B (P=0.072). The mean expulsion time was 13.9±5.4 days for the experimental group and 15.2±6.7 days for the control group (P=0.179). The experimental group required fewer analgesic injections in comparison to the control group (P<0.05). Conclusion: While the role of sexual intercourse in facilitating the passage of distal or intramural UTSs cannot be fully established, it may aid to some extent. However, it should not be relied upon as a standalone treatment modality.

Detection of offensive terms in resource-poor language using machine learning algorithms.

The use of offensive terms in user-generated content on different social media platforms is one of the major concerns for these platforms. The offensive terms have a negative impact on individuals, which may lead towards the degradation of societal and civilized manners. The immense amount of content generated at a higher speed makes it humanly impossible to categorise and detect offensive terms. Besides, it is an open challenge for natural language processing (NLP) to detect such terminologies automatically. Substantial efforts are made for high-resource languages such as English. However, it becomes more challenging when dealing with resource-poor languages such as Urdu. Because of the lack of standard datasets and pre-processing tools for automatic offensive terms detection. This paper introduces a combinatorial pre-processing approach in developing a classification model for cross-platform (Twitter and YouTube) use. The approach uses datasets from two different platforms (Twitter and YouTube) the training and testing the model, which is trained to apply decision tree, random forest and naive Bayes algorithms. The proposed combinatorial pre-processing approach is applied to check how machine learning models behave with different combinations of standard pre-processing techniques for low-resource language in the cross-platform setting. The experimental results represent the effectiveness of the machine learning model over different subsets of traditional pre-processing approaches in building a classification model for automatic offensive terms detection for a low resource language, i.e., Urdu, in the cross-platform scenario. In the experiments, when dataset D1 is used for training and D2 is applied for testing, the pre-processing approach named Stopword removal produced better results with an accuracy of 83.27%. Whilst, in this case, when dataset D2 is used for training and D1 is applied for testing, stopword removal and punctuation removal were observed as a better preprocessing approach with an accuracy of 74.54%. The combinatorial approach proposed in this paper outperformed the benchmark for the considered datasets using classical as well as ensemble machine learning with an accuracy of 82.9% and 97.2% for dataset D1 and D2, respectively.

Early detection of student degree-level academic performance using educational data mining.

Higher educational institutes generate massive amounts of student data. This data needs to be explored in depth to better understand various facets of student learning behavior. The educational data mining approach has given provisions to extract useful and non-trivial knowledge from large collections of student data. Using the educational data mining method of classification, this research analyzes data of 291 university students in an attempt to predict student performance at the end of a 4-year degree program. A student segmentation framework has also been proposed to identify students at various levels of academic performance. Coupled with the prediction model, the proposed segmentation framework provides a useful mechanism for devising pedagogical policies to increase the quality of education by mitigating academic failure and encouraging higher performance. The experimental results indicate the effectiveness of the proposed framework and the applicability of classifying students into multiple performance levels using a small subset of courses being taught in the initial two years of the 4-year degree program.

The sclerosing Sertoli cell tumor of the testis is an extremely rare entity.

We present the case of a 31-year-old single male patient, who was admitted through emergency unit with painless hard nodule of his left testis of 6 months' duration. Ultrasound scan of the scrotum showed a fairly well-defined hypo echoic area in the left testicular parenchyma in its middle part, measuring approximately 10 × 9 mm in size. We performed left inguinal radical orchidectomy. Histopathology examination of the left testis revealed sclerosing Sertoli cell tumor (SSCT) of the testis. This is a very rare testicular tumor with very few published case reports. Systemic examination was performed to exclude systemic metastasis. SSCT is characterized by the presence and aggregates of tubules of Sertoli cells, separated by a sclerotic intercellular matrix formed by fibrotic connective tissue.

Molecular Genetics and the Role of Molecularly Targeted Agents in Metastatic Colorectal Carcinoma.

BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of mortality and morbidity in the world. It is the third most common malignancy and fourth leading cancer-related deaths worldwide. In the USA, CRC is the third most commonly diagnosed cancer in both men and women. It is caused by genetic components and potential environmental factors such as consumption of processed meat, red meat, animal fats, low fiber intake, and obesity. Despite the utilization of effective screening modalities and guidelines in the USA, a significant number of patients are diagnosed with advanced, metastatic disease at the time of presentation to the physician. Recent advances in the understanding of molecular medicine with subsequent development and incorporation of newer therapeutic agents into current chemotherapeutic regimens have improved outcomes; however, the management of metastatic CRC remains challenging, particularly for the treating oncologists. METHODS: We conducted a literature search on CRC mainly related to molecular genetics, targeted biologic agents, and published clinical trials. We also searched and reviewed ongoing clinical trials from Clinicaltrials.gov. RESULTS AND CONCLUSIONS: Alterations in several oncogenes are associated with CRC, among those RAS, BRAF, and HER2 are of current clinical importance. Chemotherapy drugs, along with vascular endothelial growth factor or epidermal growth factor receptor monoclonal antibodies, are proven to be efficient with manageable toxicity profiles in metastatic CRC. Additional researches on Her-2-directed therapy, BRAF-targeted agents, immunotherapeutic, and newer molecularly targeted agents are needed for further improvement in outcome.

Cardiac changes in moderately malnourished children and their correlations with anthropometric and electrolyte changes.

OBJECTIVE: To evaluate electrocardiographic and echocardiographic changes in moderately malnourished children and to correlate them with both anthropometric and electrolyte changes. PATIENTS AND METHOD: Sixty moderately malnourished children were taken as patient group, and 60 healthy children of matched age and sex were taken as control group. Weight, height, body mass index (BMI), serum albumin, and electrolytes were measured for all children. Electrocardiographic evaluation for calculated QT (QTc) and QT dispersion (QTd) was performed. Left ventricular (LV) function was also evaluated using conventional echocardiography, tissue Doppler, and strain methods. Left ventricular mass index (LVMI) was also calculated. RESULTS: Weight, BMI, serum levels of albumin, total calcium, and ionized calcium were significantly lower, while QTc and QTd were significantly prolonged in malnourished children (P = .001 for all). There was significant reduction in LV fraction shortening (FS), LV E'/A', LV strain (S), LV myocardial performance index (MPI), LV global systolic strain (GLSS), and LVMI (P = .001 for all) in malnourished children. There was significant correlation between BMI and all cardiac variables. Moreover, there was significant positive correlation between serum albumin level and LV E'/A' (P = .02), LV GLSS (P = .03), and LVMI (P = .03).Total and ionized calcium level were significantly correlated with QTc, QTd, and LVMI (P < .05 for all). BMI was the most powerful predictor of these electrocardiographic and echocardiographic changes. CONCLUSION: Cardiac changes were present in moderately malnourished children as documented by electrocardiographic and echocardiographic changes, and these changes are in strong association with BMI and for a lesser extent with electrolyte changes especially serum calcium.

A heartrending burden of gynaecological cancers in advance stage at nuclear institute of medicine and radiotherapy Jamshoro Sindh.

OBJECTIVES: In Pakistan gynaecological cancers are among the leading causes of women's morbidity and mortality posing huge financial burden on families, communities and state. Due to lack of national cancer registry exact facts and figures are unknown therefore this study was planned to find out prevalence, age, site and stage of presentation of gynaecological cancers at Nuclear Institute of Medicine and Radiotherapy (NIMRA), Jamshoro. METHODS: A retrospective, cross sectional study was conducted from 1(st) January 2011 to 31(st) December 2011 at NIMRA Jamshoro. All cases of genital tract cancers were evaluated, required data was entered on predesigned performa and results were analyzed manually. RESULTS: Out of 2401 total registered cancer cases, 231 (9.6%) patients were suffering from gynaecological cancer making it third most common cancer. Ovary was commonest site followed by cervix and uterus. More than 60% cases presented in advanced stage, mostly during 4(th) and 5(th) decade of life. CONCLUSION: Gynecological cancer was among top three cancers at one of the busiest public sector cancer institute in Sindh province and significant number presented in advance stage making treatment difficult and expensive. There is urgent need for development and implementation of an effective health policy regarding cancer prevention and treatment.

Assessment of the Heavy Metals in Al Asfar Lake, Al-Hassa, Saudi Arabia.

Al Asfar Lake is a shallow wetland and habitat for wildlife and birds in a desert environment. The water of this lake is originated from the drainage water collected by earthen drainage network and discharged into the lake. The purpose of this study was to assess physico- chemical characteristics and some of heavy metals in Al Asfar lake water. The studied parameters are iron, manganese, copper, zinc, cadmium, chromium, lead, pH, electrical conductivity, and nitrate. Forty-five surface water samples were collected in March 2013. The results revealed that the pH ranged from 7.33 to 8.67, electrical conductivity ranged from 8.28 to 11.34 dS/m, and NO(3)(-) ranged from 0.84 to 2.29 mg/L. In addition, heavy metals concentrations in water were found in the following order: Fe > Mn > Cu > Zn > Cd > Cr = Pb. The mean concentrations of heavy metals in surface water of Al Asfar lake ranged from 0.027 to 0.159 ppm, 0.007 to 0.142 ppm, 0.005 to 0.017 ppm, 0.005 to 0.066 ppm, 0.001 to 0.033 ppm, 0 ppm, and 0 ppm for iron, manganese, copper, zinc, cadmium, chromium, and lead, respectively. Moreover, pH, NO(3)(-), Fe, Mn, and Zn concentrations in the surface water of Al Asfar Lake were found to be within the international permissible limits. On the other hand, Cu and Cd concentrations exceeded the international permissible limits. The high level of some parameters of the measured heavy metals could be attributed to the contamination of Al Asfar Lake with discharge water enriched with chemical fertilizers in addition to domestic and industrial effluents.

Power doppler ultrasonography guided and random prostate biopsy in prostate cancer diagnosis - a comparative study.

OBJECTIVE: To compare the diagnostic accuracy of power Doppler-guided targeted prostate biopsy and random sextant biopsy in the diagnosis of prostate cancer. METHODS: The prospective study was carried out at the Allama Iqbal Medical College and Jinnah Hospital, Lahore, Pakistan, from January to December, 2012, and comprised clinically suspected cases of carcinoma prostate. Power Doppler-guided biopsies using automatic biopsy gun were obtained from the suspected targeted site. One to three cores per suspected site were obtained. Subsequently random sextant biopsies were performed in the same sitting. Six cores were obtained from 6 random sites using the same gun. Biopsies from both sources were processed for routine haematoxylin and eosin stainstained sections for histopathological examination. RESULTS: Of the 50 patients in the study, 30(60%) were diagnosed with power Doppler-guided biopsy as malignant, whereas random sextant biopsy could pick up 22(44%) cases. For benign prostatic hyperplasia, random sextant biopsy labelled 28(56%)as benign, whereas only 20 (40%) were labelled as benign with power Doppler-guided biopsy. Discrepancy in the results between the two procedures was observed in 14(28%) cases, and of them, 1 1(22%) were labelled as malignant on power Doppler-guided biopsy while histopathology of sextant biopsies labelled these as benign.The sextant biopsies rendered a specificity, sensitivity, negative predictive value, positive predictive value and diagnostic accuracy of 60.71%, 86.36%, 85%, 63.33% and 72% respectively. CONCLUSION: Random sextant biopsy in combination with power Doppler-guided targeted biopsy increases the rate of detection of prostate cancer whereas both procedures in isolation have low sensitivity and specificity for cancer detection.

Dose measurement of cobalt-60 radiotherapy beams in treatment fields.

BACKGROUND: Radiation-therapy is a complex process with multiple steps, each of which has an impact on the quality of treatment. Accurate dosimetry is a critical step during the radiotherapy of cancer patients.The aim of the present study was to measure and evaluate the doses of two cobalt- 60 (60Co) teletherapy units GWXJ80 of NPIC China and Theratron 780 of AECL Canada at various points within fields for different field sizes. METHODS: This cross-sectional descriptive study was done to measure the 60Co doses in the treatment fields.The dose measurements were done in air and 30x30x30 cm3 Phantom at 80 cm SSD by using calibrated NE 2570 Farmer Electrometer & NE 2571 Farmer Ionization Chamber and percentage of doses were calculated. RESULTS: The results showed that 60% central area of all fields ranging from 100-98.79% and 100-96.12% for GWXJ80 in the air and phantom, whereas for Theratron 780, they were ranging from 100-98.50% and 100-96.45% in air and phantom respectively. The percentages of doses at the edges for GWXJ80 and Theratron 780 in the air were 75.39-38.66% & 85.65-46.47% respectively and they were 82.22-40.39% & 49.05-24.55% respectively in phantom. CONCLUSIONS: The doses within 60% central area of fields in air were higher than phantom for both teletherapy units. The doses at field edges in air were lower in GWXJ80 than Theratron 780 whereas in phantom they were vice versa. But all were in the acceptable range as recommended by International Commission on Radiation Units and Measurements.

Multiple myeloma in younger age.

A Multiple Myeloma (MM) is rare in younger age group. We report MM in a 30-year-old female, who presented with multiple lytic areas upon skeletal survey, but with negative Bence Jones protein. Bone marrow biopsy confirmed it to be a case of multiple myeloma. Patient was put on chemotherapy and radiography to which she responded and now is ambulatory.

Hydrochemical processes and metal composition of Ain Umm-Sabah natural spring in Al-Hassa Oasis Eastern Province, Saudi Arabia.

This study was carried out to determine the hydro-chemical processes and the metal concentration of spring water to evaluate its suitability for irrigation and other purposes. A total of 10 water samples were collected from Ain Umm Sabah at different times and from different locations from the spring basin. EC (dS m(-1)), pH, temperature, total cations (Na, Ca, Mg, K) and anions [Cl, CO3, HCO3, SO4, NO3, Fluoride (F)] were determined. Some trace and heavy metals (Al, As, Ba, B, Br, Mo, Ni, Si, Cd, Cu, V, Fe, I, Pb, Mn, Zn, Sr, Se, Sb, La and Se were determined. The Spring water is classified as C4S2 (high salinity with medium sodicity problem water). Chloride (Cl) and nitrate (NO3) concentrations were higher than the permissible limits according to World Health Organization Standards. The Ain Umm Sabah water is Na-Cl dominant water and can create soil sodicity problems and cause Na and Cl ion toxicity to plants if used for irrigation of sensitive crops. The spring water is under-saturated (negative SI) with respect to calcite, dolomite, gypsum, anhydrite, halite, fluorite and aragonite and oversaturated (positive SI) with respect to goethite, siderite and hematite minerals. The concentration of all the estimated trace metals was within the permissible limits for its use as drinking water and other purposes according to WHO. Since the spring water contains high concentration of NO3, hence can not be used for drinking purposes without prior treatment. The study findings suggest careful use and pumping of water from the spring. Further studies are required on regular basis to monitor the depletion in the spring water level and the temporal change in water salinity.

Role of hysterosalpingoscintigraphy in the workup of infertility.

OBJECTIVE: To assess the role of hysterosalpingoscintigraphy (HSSG) in the evaluation of fallopian tube patency and function and compare the results with hysterosalpingography (HSG) and laparoscopy (LS). DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The study was conducted at Multan Institute of Nuclear Medicine and Radiotherapy (MINAR), Multan from August 2004 to February 2005. PATIENTS AND METHODS: HSSG was performed after instillation of 4mCi (148 MBq) 99mTechnetium-macroaggregated albumin (99mTc-MAA) in posterior vaginal fornix in 65 patients. Serial static images were acquired in supine position at 1 hour, 2 hours, 3 hours and, if needed, at 24 hours. The results were compared to the findings on LS and HSG. RESULTS: Out of 65 patients, 37 (56.9%) patients had bilateral blocked tubes, 17 (26.1%) patients had bilateral patent tubes, 6 (9.2%) patients had blocked left tube and 5 (7.1%) patients had blocked right tube. The calculated sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and accuracy for HSSG were 90%, 83%, 90% and 90% respectively. The agreement between HSSG and LS was found in 32 out of 35 patients and agreement between HSG and HSSG was found in 24 out of 30 patients. CONCLUSION: This simple procedure can delineate tubal physiology; in selected cases it can replace HSG and in others augment the information gathered by HSG. HSSG should be part of the infertility workup algorithm.

Cervical osteophytes: a cause of potentially life-threatening laryngeal spasms. Case report.

This 80-year-old woman presented with acute breathing difficulty during neck flexion when cyanosis also developed. The only potential causes were detected on cervical magnetic resonance imaging: two large anterior cervical osteophytes compressing the retropharyngeal space. Excision of these osteophytes resulted in resolution of the symptoms.