Influence of Confining Element Stiffness on the In-Plane Seismic Performance of Confined Masonry Walls.

Confined masonry (CM) construction is being increasingly adopted for its cost-effectiveness and simplicity, particularly in seismic zones. Despite its known benefits, limited research exists on how the stiffness of confining elements influences the in-plane behavior of CM. This study conducted a comprehensive parametric analysis using experimentally validated numerical models of single-wythe, squat CM wall panels under quasi-static reverse cyclic loading. Various cross-sections and reinforcement ratios were examined to assess the impact of the confining element stiffness on the deformation response, the cracking mechanism, and the hysteretic behavior. The key findings included the observation of symmetrical hysteresis in experimental CM panels under cyclic loading, with a peak lateral strength of 114.3 kN and 108.5 kN in push-and-pull load cycles against 1.7% and 1.3% drift indexes, respectively. A finite element (FE) model was developed based on a simplified micro-modeling approach, demonstrating a maximum discrepancy of 2.6% in the peak lateral load strength and 5.4% in the initial stiffness compared to the experimental results. The parametric study revealed significant improvements in the initial stiffness and seismic strength with increased depth and reinforcement in the confining elements. For instance, a 35% increase in the lateral strength was observed when the depth of the confining columns was augmented from 150 mm to 300 mm. Similarly, increasing the steel reinforcement percentage from 0.17% to 0.78% resulted in a 16.5% enhancement in the seismic strength. These findings highlight the critical role of the stiffness of confining elements in enhancing the seismic performance of CM walls. This study provides valuable design insights for optimizing CM construction in seismic-prone areas, particularly regarding the effects of confining element dimensions and reinforcement ratios on the structural resilience.

Global Analysis of RTS, S/AS01 Malaria Vaccine Acceptance Rates and Influencing Factors: A Systematic Review.

Malaria remains a significant global health challenge, with Plasmodium parasites transmitted by Anopheles mosquitoes causing substantial morbidity and mortality. Despite historical efforts, malaria continues to affect millions worldwide, particularly in tropical regions. This systematic review aimed to assess the acceptability of the RTS, S/AS01 malaria vaccine among diverse populations. A comprehensive search strategy was employed across databases such as Cochrane Library, Embase, Google Scholar, and Medline. Studies were included based on specific criteria, including observational and cross-sectional designs involving adults. Data extraction and analysis were conducted meticulously, encompassing key variables related to vaccine acceptance rates and influencing factors. Analysis of 18 studies involving 18,561 participants revealed an overall malaria vaccine acceptance rate of 87.51%, ranging from 32.26% to 99.30%. Significant variations were observed based on demographics, with Ghana and Nigeria reporting high acceptance rates. Factors influencing acceptance included knowledge levels, past vaccination experiences, community preferences, and engagement in malaria prevention behaviors. Concerns about adverse reactions and regional disparities were noted as potential barriers to acceptance. This review highlights the importance of understanding public perceptions and concerns regarding malaria vaccines to enhance vaccine coverage and uptake. Tailored communication strategies, advocacy efforts, and targeted education interventions are crucial for addressing misconceptions and increasing vaccine acceptance. Policy recommendations should consider demographic and regional factors to ensure effective implementation of malaria vaccination programs, ultimately contributing to global malaria prevention efforts and public health initiatives.

Geraniol mitigates anxiety-like behaviors in rats by reducing oxidative stress, repairing impaired hippocampal neurotransmission, and normalizing brain cortical-EEG wave patterns after a single electric foot-shock exposure.

Anxiety-like conditions can interfere with daily activities as the adaptive mechanism fails to cope with stress. These conditions are often linked with increased oxidative stress, and abrupt neurotransmission and electroencephalography (EEG) wave pattern. Geraniol, a monoterpenoid, has antioxidant and anti-inflammatory activities, as well as brain-calming effects. Therefore, in this study, geraniol was tested for the potential anxiolytic effects in a rat model of anxiety. The rats were exposed to an electric foot shock (1 mA for 1 s) to develop anxiety-like symptoms. Treatment was carried out using geraniol (10 and 30 mg/kg) and the standard diazepam drug. The behavior of the rats was analyzed using the open field test, light-dark test, and social interaction test. Afterward, the rats were decapitated to collect samples for neurochemical and biochemical analyses. The cortical-EEG wave pattern was also obtained. The study revealed that the electric foot shock induced anxiety-like symptoms, increased oxidative stress, and altered hippocampal neurotransmitter levels. The power of low-beta and high-beta was amplified with the increased coupling of delta-beta waves in anxiety group. However, the treatment with geraniol and diazepam normalized cortical-EEG wave pattern and hippocampal serotonin and catecholamines profile which was also reflected by reduced anxious behavior and normalized antioxidant levels. The study reports an anxiolytic potential of geraniol, which can be further explored in future.

Rice myo-inositol-3-phosphate synthase 2 (RINO2) alleviates heat injury-induced impairment in pollen germination and tube growth by modulating Ca2+ signaling and actin filament cytoskeleton.

Low phytic acid (lpa) crop is considered as an effective strategy to improve crop nutritional quality, but a substantial decrease in phytic acid (PA) usually has negative effect on agronomic performance and its response to environment adversities. Myo-inositol-3-phosphate synthase (MIPS) is the rate-limiting enzyme in PA biosynthesis pathway, and regarded as the prime target for engineering lpa crop. In this paper, the rice MIPS gene (RINO2) knockout mutants and its wild type were performed to investigate the genotype-dependent alteration in the heat injury-induced spikelet fertility and its underlying mechanism for rice plants being imposed to heat stress at anthesis. Results indicated that RINO2 knockout significantly enhanced the susceptibility of rice spikelet fertility to heat injury, due to the severely exacerbated obstacles in pollen germination and pollen tube growth in pistil for RINO2 knockout under high temperature (HT) at anthesis. The loss of RINO2 function caused a marked reduction in inositol and phosphatidylinositol derivative concentrations in the HT-stressed pollen grains, which resulted in the strikingly lower content of phosphatidylinositol 4,5-diphosphate (PI (4,5) P2) in germinating pollen grain and pollen tube. The insufficient supply of PI (4,5) P2 in the HT-stressed pollen grains disrupted normal Ca2+ gradient in the apical region of pollen tubes and actin filament cytoskeleton in growing pollen tubes. The severely repressed biosynthesis of PI (4,5) P2 was among the regulatory switch steps leading to the impaired pollen germination and deformed pollen tube growth for the HT-stressed pollens of RINO2 knockout mutants.

How abiotic stresses trigger sugar signaling to modulate leaf senescence?

Plants have evolved the adaptive capacity to mitigate the negative effect of external adversities at chemical, molecular, cellular, and physiological levels. This capacity is conferred by triggering the coordinated action of internal regulatory factors, in which sugars play an essential role in the regulating chloroplast degradation and leaf senescence under various stresses. In this review, we summarize the recent findings on the senescent-associated changes in carbohydrate metabolism and its relation to chlorophyl degradation, oxidative damage, photosynthesis inhibition, programmed cell death (PCD), and sink-source relation as affected by abiotic stresses. The action of sugar signaling in regulating the initiation and progression of leaf senescence under abiotic stresses involves interactions with various plant hormones, reactive oxygen species (ROS) burst, and protein kinases. This discussion aims to elucidate the complex regulatory network and molecular mechanisms that underline sugar-induced leaf senescence in response to various abiotic stresses. The imperative role of sugar signaling in regulating plant stress responses potentially enables the production of crop plants with modified sugar metabolism. This, in turn, may facilitate the engineering of plants with improved stress responses, optimal life span and higher yield achievement.

Association of Hypomagnesemia With Diabetic Complications.

OBJECTIVE: The study aimed to study the association of hypomagnesemia with diabetic complications in type 2 diabetics. MATERIALS AND METHOD: This cross-sectional study, conducted at a Ghurki Trust Teaching Hospital, spanned from January to June 2023 and included 100 randomly selected diabetic patients aged 30-70. With institutional board approval and informed consent, the study focused on assessing hypomagnesemia, using a standard level of below 1.6 mg/dL, ensuring participant confidentiality and privacy. Data collected through physical assessments were analyzed using IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States), including descriptive statistics, analysis of variance (ANOVA), and paired t-test. RESULTS: A total of 100 diabetic admitted patients were randomly selected for the study ages from 30 to 70 years irrespective of their gender. The mean age of the participants was 53.86±9.74 years. The mean HbA1c of the participants was 8.7±2.32. Forty-eight percent of them had HbA1c less than 8, while 52% had greater than 8 HbA1c. The mean HbA1c in the hypomagnesemia group was 10.8±1.98, while in the normomagnesemia group, it was 8.9±2.2. There were 58.97% of foot ulcers in Group 1, while in Group 2, there were 31.14%. Around 38.46% and 14.75% had neuropathy in Groups 1 and 2, respectively. Nephropathy in Group 1 was 28.20%, while in Group 2, it was 11.47%. Around 69.23% of Group 1 had retinopathy and 37.70% had retinopathy in Group 2. Hypertension was 23.07% in Group 1 and 37.70% in Group 2; moreover, 7.69% and 8.19% had coronary diseases in Groups 1 and 2 accordingly. CONCLUSION:  The current study concluded that hypomagnesemia was found to have an association with diabetic complications like neuropathy, nephropathy, foot ulcers, and poor glycemic control as evidenced by HbA1c.

Rice ins(3)P synthase1 (RINO1) participates in embryonic development by regulating inositol-associated changes in auxin synthesis and its distribution.

The breeding of low phytic acid (LPA) crops is widely considered an effective strategy to improve crop nutrition, but the LPA crops usually have inferior seed germination performance. To clarify the reason for the suboptimal seed performance of LPA rice, this study investigated the impact of reduced seed phytic acid (InsP6) content in rice ins(3)P synthase1 (EC 5.5.1.4, RINO1), one of the key targets for engineering LPA rice, knockouton cellular differentiation in seed embryos and its relation to myo-inositol metabolism and auxin signalling during embryogenesis. The results indicated that the homozygotes of RINO1 knockout could initiate differentiation at the early stage of embryogenesis but failed to form normal differentiation of plumule and radicle primordia. The loss of RINO1 function disrupted vesicle trafficking and auxin signalling due to the significantly lowered phosphatidylinositides (PIs) concentration in seed embryos, thereby leading to the defects of seed embryos without the recognizable differentiation of shoot apex meristem (SAM) and radicle apex meristem (RAM) for the homozygotes of RINO1 knockout. The abnormal embryo phenotype of RINO1 homozygotes was partially rescued by exogenous spraying of inositol and indole-3-acetic acid (IAA) in rice panicle. Thus, RINO1 is crucial for both seed InsP6 biosynthesis and embryonic development. The lower phosphatidylinositol (4,5)-bisphosphate (PI (4,5) P2) concentration and the disorder auxin distribution induced by insufficient inositol supply in seed embryos were among the regulatory switch steps leading to aberrant embryogenesis and failure of seed germination in RINO1 knockout.

Integration of capacitive deionization and forward osmosis for high water recovery and ultrapure water production: concept, modelling and performance analysis.

Forward Osmosis (FO), a membrane desalination technology and Capacitive Deionization (CDI), an electrically operated desalination technology, are numerically integrated utilizing four different configurations for the high-water recovery rate and ultrapure water production from brackish water resource. To minimize the wastewater rejection, the CDI desorption stream is continuously fed to the FO unit, efficiently recovering the remaining freshwater. To produce ultrapure water, freshwater stream obtained from FO is provided to the CDI cell, which adsorbs the remaining dissolved solute particles. These two configurations serve the purpose of both industrial as well as domestic water supply requirements. Continuing this concept, the formation of the other two configurations allows us to obtain fresh water and ultrapure water simultaneously and up to a 90% freshwater recovery rate for the areas with inadequate supply. The performance parameters to assess the integration are the Water Recovery Rate (WRR) and Specific Energy Consumption (SEC). The first configuration (CDI-FO), proposed for a high freshwater recovery rate, resulted in 79.33% WRR with an SEC of 0.689kWh/m3. While, for the second configuration (FO-CDI), 34.25% water was recovered as 2.87 ppm ultrapure water along with 34.25% freshwater. The third proposed configuration (CDI-FO-CDI) had a WRR of 79.33%, 14.67% of which was recovered as ultrapure water of concentration 2.86 ppm. The fourth configuration (CDI-FO-FO) developed for high water recovery, removed the maximum of water from the feed stream with a WRR of 91.33% and remained energy-efficient, consuming an SEC of 0.908kWh/m3.

Concrete incorporating supplementary cementitious materials: Temporal evolution of compressive strength and environmental life cycle assessment.

The use of Supplementary Cementitious Materials (SCMs) or industrial wastes as a partial replacement for cement in the production of concrete is an urgent need in the construction industry due to cement's growing environmental challenges and rising cost. In respect of this, we conducted research work on proportioning binary concrete mixes. Fly ash (FA) replaced 10 %, 20 %, and 30 % of the cement, while silica fume (SF) replaced 5 %, 10 %, and 15 % of the cement. A control concrete mix was also developed with 100 % cement and no SCM. The results showed no increase in compressive strength for FA concrete compared to control at the early age of 3-28 days, but a maximum increase in compressive strength of 4 % was discovered at a later age of 56 days for concrete with 20 % FA. For 5 % SF concrete, a considerable strength increase of 15 % was seen at the early age of 3 days. Like with FA concrete, 2 % improvement in strength was recorded at the later age of 56 days for 10 % SF concrete. This study further focused on the concrete's temporal evolution of compressive strength by developing a strength evolution model (SEM) using nonlinear regression analysis at a 95 % confidence level. Pearson correlation coefficient was used to determine the correlation between the model values and the experimental results. For comparison, the fib Model Code 2010 was applied to the experimental data, and a good agreement was observed among the proposed model, the fib Model values, and the experimental results. The proposed model can be expanded to address further regression-related problems. Finally, environmental life cycle assessment revealed that utilizing 10 %, 20 %, and 30 % of FA lowered Global Warming Potential (GWP) by 9 %, 19 %, and 29 %, respectively. Likewise, using 5 %, 10 %, and 15 % of SF reduced the GWP by 5 %, 9 %, and 14 %.

Antibiotic resistance: a global crisis, problems and solutions.

Healthy state is priority in today's world which can be achieved using effective medicines. But due to overuse and misuse of antibiotics, a menace of resistance has increased in pathogenic microbes. World Health Organization (WHO) has announced ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) as the top priority pathogens as these have developed resistance against certain antibiotics. To combat such a global issue, it is utmost important to identify novel therapeutic strategies/agents as an alternate to such antibiotics. To name certain antibiotic adjuvants including: inhibitors of beta-lactamase, efflux pumps and permeabilizers for outer membrane can potentially solve the antibiotic resistance problems. In this regard, inhibitors of lytic domain of lytic transglycosylases provide a novel way to not only act as an alternate to antibiotics but also capable of restoring the efficiency of previously resistant antibiotics. Further, use of bacteriophages is another promising strategy to deal with antibiotic resistant pathogens. Taking in consideration the alternatives of antibiotics, a green synthesis nanoparticle-based therapy exemplifies a good option to combat microbial resistance. As horizontal gene transfer (HGT) in bacteria facilitates the evolution of new resistance strains, therefore identifying the mechanism of resistance and development of inhibitors against it can be a novel approach to combat such problems. In our perspective, host-directed therapy (HDT) represents another promising strategy in combating antimicrobial resistance (AMR). This approach involves targeting specific factors within host cells that pathogens rely on for their survival, either through replication or persistence. As many new drugs are under clinical trials it is advisable that more clinical data and antimicrobial stewardship programs should be conducted to fully assess the clinical efficacy and safety of new therapeutic agents.

Intelligent prediction modeling for flexural capacity of FRP-strengthened reinforced concrete beams using machine learning algorithms.

Fiber-reinforced polymers (FRP) are widely utilized to improve the efficiency and durability of concrete structures, either through external bonding or internal reinforcement. However, the response of FRP-strengthened reinforced concrete (RC) members, both in field applications and experimental settings, often deviates from the estimation based on existing code provisions. This discrepancy can be attributed to the limitations of code provisions in fully capturing the nature of FRP-strengthened RC members. Accordingly, machine learning methods, including gene expression programming (GEP) and multi-expression programming (MEP), were utilized in this study to predict the flexural capacity of the FRP-strengthened RC beam. To develop data-driven estimation models, an extensive collection of experimental data on FRP-strengthened RC beams was compiled from the experimental studies. For the assessment of the accuracy of developed models, various statistical indicators were utilized. The machine learning (ML) based models were compared with empirical and conventional linear regression models to substantiate their superiority, providing evidence of enhanced performance. The GEP model demonstrated outstanding predictive performance with a correlation coefficient (R) of 0.98 for both the training and validation phases, accompanied by minimal mean absolute errors (MAE) of 4.08 and 5.39, respectively. In contrast, the MEP model achieved a slightly lower accuracy, with an R of 0.96 in both the training and validation phases. Moreover, the ML-based models exhibited notably superior performances compared to the empirical models. Hence, the ML-based models presented in this study demonstrated promising prospects for practical implementation in engineering applications. Moreover, the SHapley Additive exPlanation (SHAP) method was used to interpret the feature's importance and influence on the flexural capacity. It was observed that beam width, section effective depth, and the tensile longitudinal bars reinforcement ratio significantly contribute to the prediction of the flexural capacity of the FRP-strengthened reinforced concrete beam.

Sensitive and specific CRISPR-Cas12a assisted nanopore with RPA for Monkeypox detection.

Monkeypox virus (MPXV) poses a global health emergency, necessitating rapid, simple, and accurate detection to manage its spread effectively. The Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) technique has emerged as a promising next-generation molecular diagnostic approach. Here, we developed a highly sensitive and specific CRISPR-Cas12a assisted nanopore (SCAN) with isothermal recombinase polymerase amplification (RPA) for MPXV detection. The RPA-SCAN method offers a sensitivity unachievable with unamplified SCAN while also addressing the obstacles of PCR-SCAN for point-of-care applications. We demonstrated that size-counting of single molecules enables analysis of reaction-time dependent distribution of the cleaved reporter. Our MPXV-specific RPA assay achieved a limit of detection (LoD) of 19 copies in a 50 µL reaction system. By integrating 2 µL of RPA amplifications into a 20 µL CRISPR reaction, we attained an overall LoD of 16 copies/µL (26.56 aM) of MPXV at a 95% confidence level using the SCAN sensor. We also verified the specificity of RPA-SCAN in distinguishing MPXV from cowpox virus with 100% accuracy. These findings suggest that the isothermal RPA-SCAN device is well-suited for highly sensitive and specific Monkeypox detection. Given its electronic nature and miniaturization potential, the RPA-SCAN system paves the way for diagnosing a wide array of other infectious pathogens at the point of care.

Cellular signaling in the hypoxic cancer microenvironment: Implications for drug resistance and therapeutic targeting.

The rewiring of cellular metabolism is a defining characteristic of cancer, as tumor cells adapt to acquire essential nutrients from a nutrient-poor environment to sustain their viability and biomass. While hypoxia has been identified as a major factor depriving cancer cells of nutrients, recent studies have revealed that cancer cells distant from supporting blood vessels also face nutrient limitations. To overcome this challenge, hypoxic cancer cells, which heavily rely on glucose as an energy source, employ alternative pathways such as glycogen metabolism and reductive carboxylation of glutamine to meet their energy requirements for survival. Our preliminary studies, alongside others in the field, have shown that under glucose-deficient conditions, hypoxic cells can utilize mannose and maltose as alternative energy sources. This review aims to comprehensively examine the hypoxic cancer microenvironment, its association with drug resistance, and potential therapeutic strategies for targeting this unique niche. Furthermore, we will critically evaluate the current literature on hypoxic cancer microenvironments and explore state-of-the-art techniques used to analyze alternate carbohydrates, specifically mannose and maltose, in complex biological fluids. We will also propose the most effective analytical methods for quantifying mannose and maltose in such biological samples. By gaining a deeper understanding of the hypoxic cancer cell microenvironment and its role in drug resistance, novel therapeutic approaches can be developed to exploit this knowledge.

Disruptions of sugar utilization and carbohydrate metabolism in rice developing anthers aggravated heat stress-induced pollen abortion.

High temperature (HT) stress at reproductive stage is one of most important environment negatively affecting spikelet fertility and rice yield. In this study, the effect of HT exposure on the sugar composition and carbohydrate metabolism in developing anthers and its relation to floret fertility and pollen viability were investigated by different temperature regimes under well-controlled climatic condition. Result showed that HT exposure during microspore development significantly reduced the starch deposition in developing anther and evidently disrupted the spatial distribution of sugar and starch concentrations in different compartments of rice anther, with the higher ratio of sucrose to hexose concentrations in HT-stressed anthers relative to the control ones. Under HT exposure, the amount of starch deposition in the fraction of sporophytic tissues dropped evidently, while the concentrations of sucrose and starch in anther wall tissue enhanced significantly, suggesting that HT exposure impaired the translocation of sucrose from the anther wall tissue to the sporophytic tissues inside rice anther. Furthermore, we presented possible contribution of various genes and key enzymes involving in sugar conversion and carbohydrate metabolism in developing anther to the formation of HT-induced pollen abortion by disrupting the sugar utilization in HT-stressed anther. HT exposure suppressed the activities of cell wall and vacuolar invertase, hexokinase, and ADP-glucose pyrophosphorylase in developing anther, while it was opposite for the effect of HT exposure on sucrose synthase and fructokinase. HT-induced suppression of OsCWIN3 in the anther walls might be strongly responsible for the HT-induced impairments of sugar utilization in HT-stressed anthers.

Involvement of plant signaling network and cell metabolic homeostasis in nitrogen deficiency-induced early leaf senescence.

Nitrogen (N) is a basic building block that plays an essential role in the maintenance of normal plant growth and its metabolic functions through complex regulatory networks. Such the N metabolic network comprises a series of transcription factors (TFs), with the coordinated actions of phytohormone and sugar signaling to sustain cell homeostasis. The fluctuating N concentration in plant tissues alters the sensitivity of several signaling pathways to stressful environments and regulates the senescent-associated changes in cellular structure and metabolic process. Here, we review recent advances in the interaction between N assimilation and carbon metabolism in response to N deficiency and its regulation to the nutrient remobilization from source to sink during leaf senescence. The regulatory networks of N and sugar signaling for N deficiency-induced leaf senescence is further discussed to explain the effects of N deficiency on chloroplast disassembly, reactive oxygen species (ROS) burst, asparagine metabolism, sugar transport, autophagy process, Ca2+ signaling, circadian clock response, brassinazole-resistant 1 (BZRI), and other stress cell signaling. A comprehensive understanding for the metabolic mechanism and regulatory network underlying N deficiency-induced leaf senescence may provide a theoretical guide to optimize the source-sink relationship during grain filling for the achievement of high yield by a selection of crop cultivars with the properly prolonged lifespan of functional leaves and/or by appropriate agronomic managements.

Early Diagnosis of Autism Spectrum Disorder: A Review and Analysis of the Risks and Benefits.

Autism spectrum disorder (ASD) is a neurodevelopmental condition made up of enduring challenges in social communication and interaction and the presence of repetitive and restricted behavior patterns. Early diagnosis of autism is crucial for timely intervention and improved long-term outcomes. This review aims to explore some of its signs and symptoms, look into some diagnostic tools, and analyze the benefits and risks associated with an early diagnosis of autism. The symptoms of ASD vary from child to child, some of which are: avoidance of eye contact, lack of response to names, excessive fear, and lack of interactive and pretend play. Early identification of these symptoms by caregivers and healthcare providers facilitates the need for diagnosis and appropriate interventions. Some screening and diagnostic tools that have been found to help make the diagnosis are the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), the Social Communication Questionnaire (SCQ), the Parents' Evaluation of Developmental Status (PEDS), and the Childhood Autism Rating Scale (CARS), amongst others. The benefits of early diagnosis include the opportunity for early intervention, which has been shown to enhance developmental outcomes and improve adaptive skills. Early identification allows for the implementation of specialized interventions tailored to the specific needs of individuals with autism, targeting social communication, language development, and behavioral challenges. Furthermore, early diagnosis enables families to access appropriate support services, educational resources, and community programs, facilitating better coping mechanisms, reducing parental stress, and increasing adult independence. However, early diagnosis of autism also entails certain risks. One significant concern is the potential for labeling and stigmatization, which can impact the child's self-esteem and social interactions. There is a risk of overdiagnosis or misdiagnosis, leading to unnecessary interventions and treatments. Additionally, the diagnostic process can be lengthy, complex, and emotionally challenging for families, requiring comprehensive assessments by multidisciplinary teams. This review highlights the importance of a balanced approach when considering the benefits and risks of early diagnosis. Early identification allows for timely interventions that significantly improve developmental outcomes and quality of life for individuals with autism. To mitigate the risks, it is crucial to ensure accurate and reliable diagnostic procedures, support families throughout the process, and promote societal awareness and acceptance. We also highlighted some future directions in the management of autism, including the use of biomarkers and the use of artificial intelligence and learning for diagnosing ASD.

An Unusual Case of Sublingual Epidermoid Cyst Mimicking Plunging Ranula.

Epidermoid cyst in the oral cavity is uncommon. It is even more rare to see an epidermoid cyst in the sublingual region. We report the case of a 30-year-old male presenting with a swelling in the floor of the mouth extending into the submental and submandibular regions. The midline swelling was painless, soft, and dome-shaped. CT scan contrast revealed the site and extent of swelling. The complete surgical excision of the lesion was performed via a transcervical approach. Histopathology revealed cystic fibrocollagenous tissue covered by squamous epithelium containing some keratin flakes.

Pyoderma Gangrenosum Precipitated by Breast Engorgement Following Lactation Discontinuation: A Rare Case Report.

Pyoderma gangrenosum (PG) is an inflammatory disease characterized by recurrent painful ulcers, eventually leading to cribriform scars. PG is mostly a diagnosis of exclusion with neutrophilic skin infiltration. We present a case of a 35-year-old female patient whose first presentation of PG occurred in the first trimester of pregnancy, which recurred after discontinuation of breastfeeding. The patient also had a history of taking prolonged IM and IV analgesics for her chronic migraines. The patient was initially treated with steroids and necessary wound care, during which symptoms remained controlled. However, a year later, the patient presented with an acute flare-up of the disease in her postpartum period, mainly involving her breasts bilaterally. Extensive wound debridement was performed due to the severity of her necrotic ulcers and failure to respond to conservative management, which was followed by partial thickness skin grafting.

A Comparative Study of the Efficacy and Safety of Oral Misoprostol, Intravenous Oxytocin, and Intravaginal Dinoprostone for Labor Induction in Pakistani Women.

INTRODUCTION: A frequent medical procedure to accelerate labor is the induction of labor. There are different methods of labor induction, including the use of medications such as misoprostol, oxytocin, and dinoprostone. OBJECTIVE: This research compared the effectiveness and safety of oral misoprostol, intravenous oxytocin, and intravaginal dinoprostone for labor induction in Pakistani women. METHODOLOGY: A study was conducted in the Department of Obstetrics and Gynaecology, Hayatabad Medical Complex-Medical Teaching Institute (MTI) and Lady Reading Hospital-MTI, Peshawar, Pakistan, over two years. It included 378 women between 38 and 42 gestational weeks, divided into three groups of 126 women each. The oral misoprostol group was given a maximum of six doses of a 25 µg oral misoprostol solution (oral misoprostol tablet of 200 µg dissolved in 200 ml) at intervals of two hours. The drip rate for the intravenous oxytocin group ranged from 6 mIU/minute to 37 mIU/minute. The intravaginal dinoprostone group received a controlled-release vaginal insert containing 10mg of intravaginal dinoprostone, which was left in place for 12 hours. RESULTS: More women in the oral misoprostol group (n=94; 74.6%) had successful inductions when compared to the intravaginal dinoprostone (n=83; 65.9%) and intravenous oxytocin (n = 77; 64.71%) groups. Oral misoprostol had the greatest proportion of normal vaginal deliveries (n=62; 65.95%), followed by intravaginal dinoprostone (n=47; 56.63%), and intravenous oxytocin had the lowest rate (n=33; 42.85%). Cesarean section rates were greatest in the intravenous oxytocin group (n=31; 40.26%), followed by the intravaginal dinoprostone group (n=29; 34.94%), and lowest in the oral misoprostol group (n=24; 25.53%). CONCLUSION: Oral misoprostol induces labor in women safely and effectively, resulting in the lowest percentage of cesarean deliveries and the highest percentage of normal vaginal deliveries, respectively. Intravaginal dinoprostone showed the lowest rate of side effects, followed by oral misoprostol while intravenous oxytocin had the highest rate of side effects.