Pulmonary tuberculosis masquerading as a mass cancer lesion: A rare case report and review of literature.

Key Clinical Message: Despite being generally treatable and preventative, pulmonary tuberculosis (PTB) is one of the most common infectious agents that cause death. Misdiagnosis of TB frequently leads to unwarranted diagnostic procedures and postpones the start of treatment. Abstract: Pulmonary tuberculosis (PTB) can present with various unusual radiological and clinical characteristics. Misdiagnosis of TB frequently leads to unwarranted diagnostic procedures and postpones the start of treatment. Here, we describe a 50-year-old man who presented with a cancerous-type lesion on radiological findings and atypical symptoms that led to an initial diagnosis of lung cancer. However, histopathology and biopsy of the lung lesion revealed chronic granulomatous inflammation with caseous necrosis, confirming PTB as the true cause, with no further indications of malignancy.

LASU: An efficient and stable phthalocyanine dye with tolerable safety profile for self-disinfecting anti-COVID textiles activated by ambient light.

BACKGROUND: Recent COVID crisis has demonstrated that modern society urgently needs an accessible protection against mass infections, especially viruses, as the new strains are appearing at an ever-increasing pace and cause severe harm to the population and the world economy. METHODS: We have developed an efficient phthalocyanine photosensitizer LASU, that is suitable for dyeing textiles and allows to prepare reusable self-disinfecting fabrics with strong antiviral properties. The safety profile of LASU was evaluated in accredited laboratories by several in vitro assays according to the OECD-guidelines. RESULTS: The textiles impregnated with LASU phthalocyanine showed a significant antiviral photodynamic effect even under moderate indoor and outdoor light. The dye did not show any genotoxic potential in human lymphocyte micronucleus assay. It showed a possible indication for eye irritation in human EpiOcular™ model and was phototoxic when tested in mouse BALB/c 3T3 cell test in the presence and absence of UVA-irradiation. CONCLUSION: Novel phthalocyanine-dyed textiles are suitable for general use as self-disinfecting antiviral barriers and materials in hospitals, households, and public places. The safety profile of LASU is the phototoxic effect which is related to LASU´s mode of action.

Cost volume profit analysis for full paying patient services in Malaysia: A study protocol.

Dual practice within public hospitals, characterised by the concurrent provision of public and private healthcare services within public hospitals, has become a widespread phenomenon. With the participation of selected public hospitals, dual practice within public hospitals, also known as Full Paying Patient services, was an initiative the Ministry of Health Malaysia took in 2007 to retain senior specialist physicians in Malaysia. The revenue generated from the Full Paying Patient services aims to provide an avenue for public sector specialists to supplement their incomes while alleviating the Government's burden of subsidising healthcare for financially capable individuals. However, the effectiveness of Full Paying Patient services in recouping service delivery costs and yielding a profit is still uncertain after 16 years of implementation. This study is designed to evaluate the impact of Full Paying Patient inpatient services volume, revenue, and cost on profit versus loss at selected hospitals from 2017 to 2020. From the perspective of healthcare providers, we plan to perform a cost volume profit analysis. This analysis enables us to determine the break-even point, at which total revenues match total costs, along with no-loss and no-profit thresholds for Full Paying Patient services. This study has the potential to provide insights into how variations in service volume, cost, and pricing impact healthcare providers' profitability. It also offers critical financial information regarding the volume of services required to reach the break-even point. A comprehensive understanding of service volume, cost and pricing is imperative for making informed decisions to fulfil the objectives and ensure the sustainability of the FPP services.

The role of government policy, social infrastructure and Fengshui in intending to buy tourism real estate.

People typically purchase residential properties for two reasons: to live in or invest. However, both purposes necessitate careful consideration before deciding because high financial costs are involved, and housing loans are typically considered necessary for this purpose. Customers' demands are constantly changing, becoming more complicated with higher requirements. The focus of this research is on tourism real estate selection. This market in Vietnam is still new and emerging and has encountered numerous issues regarding government policy, finance, and land authorization for constructing, owning, and managing. Because the form of tourism real estate is still new, customers are hesitant about investing in or buying these properties. Hence, to compete in the current fiercely real estate industry, real estate firms must understand their customers' expectations by frequently involving customer research in the company's strategy. However, there is still a lack of research on the connection between these factors and individual expectations in the well-known philosophy of the Theory of Planned Behavior (TPB), leading to behavioral intentions. Therefore, to fulfill the gap in the previous literature, this paper aims to investigate the connection between these factors with core variables of TPB, hence, addressing the current problems in the real estate industry. 471 valid respondents in Vietnam were collected for data analysis through two survey approaches. PLS-SEM was used to test hypotheses due to the relationship complication in the conceptual models. The results show that government policy influences attitudes and perceived behavioral control, whereas social infrastructure affects social norms and perceived behavioral control. Moreover, Fengshui ambient condition also positively influences all three core factors: attitudes, social norms, and perceived behavioral control. Finally, these factors impact on intention to buy tourism real estate. Through results, this paper has developed a purchase intention model through social aspects of the tourism real estate industry. In addition, this paper demonstrates the connection between social factors and individuals' expectations for a purchase intention, providing the importance of the government's role, architecture style, and social infrastructure in the marketing literature of the real estate industry. As a result, managers and governments need to take advantage of new releases of government regulations in time to enhance customers' positive attitudes toward purchasing tourism real estate. Moreover, social infrastructure and Fengshui conditions are crucial to establishing social norms and perceived control, aiming to leverage the intention to purchase tourism real estate. Thereby, recommendations of marketing strategies based on these findings were suggested to attain the optimal result for sales. Finally, this research also includes some limitations. Hence, suggestions for further research were also provided, such as possible moderation, possible mediating effects, or control of data bias.

Specialists' Dual Practice within Public Hospital Setting: Evidence from Malaysia.

In line with the commitment of the Malaysian government and Ministry of Health to prevent the brain drain of specialists from public hospitals, they have been permitted to perform dual practice within the public hospital setting (DPH) since 2007. DPH allowed them to hold jobs in both public and private practices within the same public hospitals that they are affiliated to, permitting these specialists to treat public and private patients. Nevertheless, the information regarding DPH in Southeast Asia region is still limited. This narrative review provides insight into the implementation of DPH in Malaysia. It highlights that DPH has been well-governed and regulated by the MOH while serving as a means to retain specialists in the public healthcare system by providing them with opportunities to obtain additional income. Such a policy has also reduced the financial burden of the government in subsidizing healthcare. However, as in other countries with similar policies, multiple challenges have arisen from the implementation of DPH in Malaysia despite its positive achievements and potentials. This paper concludes that proactive governance, monitoring, and regulation are key to ensure the success of DPH.

Towards low-energy-light-driven bistable photoswitches: ortho-fluoroaminoazobenzenes.

Thermally stable photoswitches that are driven with low-energy light are rare, yet crucial for extending the applicability of photoresponsive molecules and materials towards, e.g., living systems. Combined ortho-fluorination and -amination couples high visible light absorptivity of o-aminoazobenzenes with the extraordinary bistability of o-fluoroazobenzenes. Herein, we report a library of easily accessible o-aminofluoroazobenzenes and establish structure-property relationships regarding spectral qualities, visible light isomerization efficiency and thermal stability of the cis-isomer with respect to the degree of o-substitution and choice of amino substituent. We rationalize the experimental results with quantum chemical calculations, revealing the nature of low-lying excited states and providing insight into thermal isomerization. The synthesized azobenzenes absorb at up to 600 nm and their thermal cis-lifetimes range from milliseconds to months. The most unique example can be driven from trans to cis with any wavelength from UV up to 595 nm, while still exhibiting a thermal cis-lifetime of 81 days.

Inpatient Case-mix Cost Vs Average Cost for Health Care Services in King Fahd Central Hospital, Saudi Arabia: A Comparative Study.

Health care systems aim to deliver high-quality medical care while considering efficient resource usage and cost-effective forms of interventions. Such purposes require scientific tools or mechanisms which aid in cost assessment before the efforts of cost reduction are considered. Diagnosis-related groups based costing methodology (Case-mix) is considered one of the preferred costing approaches in the health care sector. King Fahd Central hospital Jazan, the only tertiary hospital in the Jazan region, was selected for case-mix system-based patient-level costing of health services. The study's objective was to estimate the cost per Diagnosis-Related Group (DRG) per inpatient admission and compare it with the already established average cost of health care services for inpatients. We applied a cross-sectional retrospective approach to categorize the inpatients based on their diagnosis and procedures and then estimate the actual cost of health care services provided to inpatients during 2018 and compared it with the average cost of the health services. There was a considerable difference between DRG-based costing (SAR 269,663,897) and average costing (SAR 247,035,938). The Diagnosis Related Group costing was found to be more reliable and representative of the services provided to the patients and is recommended to be used for reimbursement purposes.

Expanding excitation wavelengths for azobenzene photoswitching into the near-infrared range via endothermic triplet energy transfer.

Developing azobenzene photoswitches capable of selective and efficient photoisomerization by long-wavelength excitation is an enduring challenge. Herein, rapid isomerization from the Z- to E-state of two ortho-functionalized bistable azobenzenes with near-unity photoconversion efficiency was driven by triplet energy transfer upon red and near-infrared (up to 770 nm) excitation of porphyrin photosensitizers in catalytic micromolar concentrations. We show that the process of triplet-sensitized isomerization is efficient even when the sensitizer triplet energy is substantially lower (>200 meV) than that of the azobenzene used. This makes the approach applicable for a wide variety of sensitizer-azobenzene combinations and enables the expansion of excitation wavelengths into the near-infrared spectral range. Therefore, indirect excitation via endothermic triplet energy transfer provides efficient and precise means for photoswitching upon 770 nm near-infared light illumination with no chemical modification of the azobenzene chromophore, a desirable feature in photocontrollable biomaterials.

Moving towards sustainability: how do natural resources, financial development, and economic growth interact with the ecological footprint in Malaysia? A dynamic ARDL approach.

Without enhancing the quality of the environment, the goals of sustainable development remain unachievable. In order to minimize the damage to the planet, sustainable practices need to be considered. This study is conducted to identify some of the drivers behind the increasing sustainability issues and tried to investigate the impact of natural resources, financial development, and economic growth on the ecological footprint in Malaysia from the year 1980-2019 by utilizing the dynamic simulated autoregressive distribution lag approach. It was identified that financial development, economic growth, and natural resources are the determinants behind the upsurge of the ecological footprint as all three show a positive and significant effect on ecological footprint. However, in the long run, the presence of the Environmental Kuznets Curve hypothesis was also validated in Malaysia. Therefore, it is recommended to increase awareness among the public regarding the adoption of sustainable practices in everyday life and to use green technologies that offer maximum efficiency and minimum damage to the environment in commercial and domestic activities. Finally, based on the research results, a comprehensive policy framework was proposed which could allow the Malaysian economy to attain the objectives of Sustainable Development Goals (SDGs) 7, 8, and 13.

Development of unit cost for the health services offered at King FAHD Central hospital Jazan, Saudi Arabia.

BACKGROUND: Efficiency remains one of the most important drivers of decision making in health care system. Fund allocators need to receive structured information about the cost healthcare services from hospitals for better decisions related to resource allocation and budgeting. The objective of the study was to estimate the unit cost for health services offered to inpatients in King Fahd Central hospital (KFCH) Jazan during the financial year 2018. METHODS: We applied a retrospective approach using a top-down costing method to estimate the cost of health care services. Clinical and Administrative departments divided into cost centres, and the unit cost was calculated by dividing the total cost of final care cost centres into the total number of patients discharged in one year. The average cost of inpatient services was calculated based on the average cost of each ward and the number of patients treated. RESULTS: The average cost per patient stayed in KFCH was SAR 19,034, with the highest cost of SAR 108,561 for patients in the Orthopedic ward. The average cost of the patient in the Surgery ward, Plastic surgery, Neurosurgery, Medical ward, Pediatric ward and Gynecology ward was SAR 33,033, SAR 29,425, SAR 23,444, SAR 20,450, SAR 9579 and SAR 8636 respectively. CONCLUSION: This study provides necessary information about the cost of health care services in a tertiary care setting. This information can be used as a primary tool and reference for further studies in other regions of the country. Hence, this data can help to provide a better understanding of tertiary hospital costing in the region to achieve the privatization objective.

An Index Case of Diffuse Alveolar Hemorrhage Secondary to Chikungunya.

Chikungunya virus (CHIKV) is an alphavirus transmitted by mosquitoes, mostly by Aedes aegypti and Aedes albopictus. It is starting to become a very common entity in Pakistan, with a wide range of clinical manifestations. Here we report a case of a young male with CHIKV who presented with a clinical manifestation of diffuse alveolar hemorrhage which has not been observed so far in a patient suffering from this illness.

Light-fuelled freestyle self-oscillators.

Self-oscillation is a phenomenon where an object sustains periodic motion upon non-periodic stimulus. It occurs commonly in nature, a few examples being heartbeat, sea waves and fluttering of leaves. Stimuli-responsive materials allow creating synthetic self-oscillators fuelled by different forms of energy, e.g. heat, light and chemicals, showing great potential for applications in power generation, autonomous mass transport, and self-propelled micro-robotics. However, most of the self-oscillators are based on bending deformation, thereby limiting their possibilities of being implemented in practical applications. Here, we report light-fuelled self-oscillators based on liquid crystal network actuators that can exhibit three basic oscillation modes: bending, twisting and contraction-expansion. We show that a time delay in material response dictates the self-oscillation dynamics, and realize a freestyle self-oscillator that combines numerous oscillation modes simultaneously by adjusting the excitation beam position. The results provide new insights into understanding of self-oscillation phenomenon and offer new designs for future self-propelling micro-robots.

Two-Year Changes in Neighborhood Juvenile Arrests After Implementation of a Park-Based Afterschool Mental Health Promotion Program in Miami-Dade County, Florida, 2015-2017.

Objectives. To examine the association of Fit2Lead, an afterschool park-based youth mental health promotion program, and neighborhood juvenile arrests (2015-2017) in Miami-Dade County, Florida. Methods. We tracked juvenile (ages 12-17 years) arrest rates over 2 years of program implementation across zip codes matched by (1) park and (2) baseline sociodemographics and youth arrests. Fit2Lead mental and physical health, meditation, resilience, and life skills activities were offered in 12 high-need areas for youths (n = 501) aged 12 to 17 years. We tested the association of Fit2Lead implementation (binary variable) and change in juvenile arrest rates by zip code, adjusting for area-level gender, age, race/ethnicity, single-parent households, and poverty. Results. Fit2Lead was offered in areas composed of 48% male youths, 60% Hispanics, 29% non-Hispanic Blacks, 33% single-parent households, and 33% of residents living in poverty. After covariate adjustment, zip codes with Fit2Lead implementation showed a significant mean reduction (P < .001) in youth arrests per 10 000 youths aged 12 to 17 years per year compared with zip codes without program implementation (b = -6.9; 95% confidence interval = -9.21, -4.65). Conclusions. Park-based programs may have the potential to promote mental health and resilience, and also to prevent violence among at-risk youths.

Using misoprostol to treat postpartum hemorrhage in home deliveries attended by traditional birth attendants.

OBJECTIVE: To explore the clinical and programmatic feasibility of using 800 µg of sublingual misoprostol to prevent and treat postpartum hemorrhage (PPH) during home delivery. METHODS: The present double-blind randomized controlled trial included women who underwent home deliveries in Chitral district, Khyber Pakhtunkhwa province, Pakistan, after presenting at healthcare facilities during the third trimester of pregnancy between May 28, 2012, and November 27, 2014. Participants were randomized in a 1:1 ratio to receive either 800 µg of misoprostol or placebo sublingually if PPH was diagnosed, having previously received a prophylactic oral dose of 600 µg misoprostol. The primary outcome, hemoglobin decrease of 20 g/L or greater from pre- to post-delivery assessment, was compared on a modified intention-to-treat basis. RESULTS: There were 49 patients allocated to receive misoprostol and 38 allocated to receive placebo; the incidence of a 20 g/L decrease in hemoglobin was similar between the groups (20/43 [47%] vs 19/33 [58%], respectively; P=0.335). CONCLUSION: There was no significant difference in clinical outcomes between the two trial arms. ClinicalTrials.gov:NCT01485562.

Natural experiment examining the longitudinal association between change in residential segregation and youth cardiovascular health across race/ethnicity and gender in the USA.

BACKGROUND: Identifying how racial/ethnic residential segregation and mobility may impact health can guide innovative strategies for reducing youth disparities. METHODS: This natural experiment examined the association between change in residential segregation and cardiovascular health outcomes across race/ethnicity and gender for youth (n=2250, mean age 9.1 years, 54% male; 51% Hispanic, 49% non-Hispanic black (NHB); 49% high area poverty) attending a multisite park-based afterschool fitness programme in Florida, USA. Two-level generalised linear mixed models with random intercepts for park effects were fit to test the change in segregation-cardiovascular health association over two school years. RESULTS: After covariate adjustment (individual-level gender, race/ethnicity, age, time and park-area poverty), greater improvements in cardiovascular health including body mass index percentile, sum of skinfold thicknesses, systolic/diastolic blood pressure percentiles and 400 m run time were found for youth who attended the program in a less segregated area compared with their home area (p<0.05 for all outcomes). NHB girls showed the greatest cardiovascular health improvements. Specifically, compared with the reference group (no change in segregation), skinfold thicknesses and systolic blood pressure percentiles decreased 17% (incidence rate ratio (IRR) 95% CI 0.81 to 0.86) and 16% (IRR 95% CI 0.82 to 0.87), respectively, versus 1% increase for both outcomes (IRR 95% CI 0.98 to 1.05) and (IRR 95% CI 0.98 to 1.05), respectively, for movement to less versus more segregated areas. CONCLUSION: In light of a continually expanding youth obesity epidemic, the global effort to reduce health inequities may be supported through Parks and Recreation Departments given potential to expand geographic mobility for low resource subgroups.

Thermal Isomerization of Hydroxyazobenzenes as a Platform for Vapor Sensing.

Photoisomerization of azobenzene derivatives is a versatile tool for devising light-responsive materials for a broad range of applications in photonics, robotics, microfabrication, and biomaterials science. Some applications rely on fast isomerization kinetics, while for others, bistable azobenzenes are preferred. However, solid-state materials where the isomerization kinetics depends on the environmental conditions have been largely overlooked. Herein, an approach to utilize the environmental sensitivity of isomerization kinetics is developed. It is demonstrated that thin polymer films containing hydroxyazobenzenes offer a conceptually novel platform for sensing hydrogen-bonding vapors in the environment. The concept is based on accelerating the thermal cis-trans isomerization rate through hydrogen-bond-catalyzed changes in the thermal isomerization pathway, which allows for devising a relative humidity sensor with high sensitivity and quick response to relative humidity changes. The approach is also applicable for detecting other hydrogen-bonding vapors such as methanol and ethanol. Employing isomerization kinetics of azobenzenes for vapor sensing opens new intriguing possibilities for using azobenzene molecules in the future.

Impact of change in neighborhood racial/ethnic segregation on cardiovascular health in minority youth attending a park-based afterschool program.

Research on the mechanistic factors associating racial/ethnic residential segregation with health is needed to identify effective points of intervention to ultimately reduce health disparities in youth. We examined the association of changes in racial/ethnic segregation and cardiovascular health outcomes including body mass index percentile, sum of skinfold thicknesses, systolic and diastolic blood pressure percentile, and 400 m run time in non-Hispanic Black (NHB) and Hispanic youth (n = 2,250, mean age 9.1 years, 54% male; 51% Hispanic, 49% NHB; 49% high area poverty; 25% obese) attending Fit2Play™, a multisite park-based afterschool program in Miami, Florida, USA. A series of crude and adjusted two-level longitudinal generalized linear mixed models with random intercepts for park effects were fit to assess the association of change in segregation between home and program/park site and cardiovascular health outcomes for youth who participated for up to two school years in Fit2Play™. After adjusting for individual-level factors (sex, age, time, and park-area poverty) models showed significantly greater improvements in cardiovascular health if youth attended Fit2Play™ in an area less segregated than their home area (p < 0.05 for all outcomes) except 400 m run time and diastolic blood pressure percentile in Hispanics (p<.001 and p = 0.11, respectively). Area poverty was not found to confound or significantly modify this association. These findings have implications for youth programming focused on reducing health disparities and improving cardiovascular outcomes in NHB and Hispanic youth, particularly in light of a continually expanding obesity epidemic in these groups. Parks and Recreation Departments have potential to expand geographic mobility for minorities, therein supporting the national effort to reduce health inequalities.

Economic burden of managing Type 2 diabetes mellitus: Analysis from a Teaching Hospital in Malaysia.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic disease that consumes a large amount of health-care resources. It is essential to estimate the cost of managing T2DM to the society, especially in developing countries. Economic studies of T2DM as a primary diagnosis would assist efficient health-care resource allocation for disease management. OBJECTIVE: This study aims to measure the economic burden of T2DM as the primary diagnosis for hospitalization from provider's perspective. METHODS: A retrospective prevalence-based costing study was conducted in a teaching hospital. Financial administrative data and inpatient medical records of patients with primary diagnosis (International Classification Disease-10 coding) E11 in the year 2013 were included in costing analysis. Average cost per episode of care and average cost per outpatient visit were calculated using gross direct costing allocation approach. RESULTS: Total admissions for T2DM as primary diagnosis in 2013 were 217 with total outpatient visits of 3214. Average cost per episode of care was RM 901.51 (US$ 286.20) and the average cost per outpatient visit was RM 641.02 (US$ 203.50) from provider's perspective. The annual economic burden of T2DM for hospitalized patients was RM 195,627.67 (US$ 62,104) and RM 2,061,520.32 (US$ 654,450) for those being treated in the outpatient setting. CONCLUSIONS: Economic burden to provide T2DM care was higher in the outpatient setting due to the higher utilization of the health-care service in this setting. Thus, more focus toward improving T2DM outpatient service could mitigate further increase in health-care cost from this chronic disease.

Pseudosymmetric random matrices: Semi-Poisson and sub-Wigner statistics.

Real nonsymmetric matrices may have either real or complex conjugate eigenvalues. These matrices can be seen to be pseudosymmetric as ηMη^{-1}=M^{t}, where the metric η could be secular (a constant matrix) or depending upon the matrix elements of M. Here we construct ensembles of a large number N of pseudosymmetric n×n (n large) matrices using N[n(n+1)/2≤N≤n^{2}] independent and identically distributed random numbers as their elements. Based on our numerical calculations, we conjecture that for these ensembles the nearest level spacing distributions [NLSDs, p(s)] are sub-Wigner as p_{abc}(s)=ase^{-bs^{c}}(0