bluuebunny/crossref_metadata_2025 huggingface dataset:
Helicopter emergency medical services demonstrate reduced time to emergency anaesthesia in an undifferentiated trauma population: a retrospective observational analysis across three major trauma networks
Authors: Heritage Daniel , Griggs Joanne , Barrett Jack , Clarke Scott , Carroll Rory , Lyon Richard , Bootland Duncan
Published: December 2024

Background

Early rapid sequence induction of anaesthesia (RSI) and tracheal intubation for patients with airway or ventilatory compromise following major trauma is recommended, with guidance suggesting a 45-min timeframe. Whilst on-scene RSI is recommended, the potential time benefit offered by Helicopter Emergency Medical Services (HEMS) has not been studied. We compared the time from 999/112 emergency call to delivery of RSI between patients intubated either in the Emergency Department or pre-hospital by HEMS.

Methods

A retrospective observational cohort study of major trauma patients in South-East England who received a pre-hospital RSI (PHRSI) or Emergency Department RSI (EDRSI) between 2 January 2018 and 24 September 2019. Data were extracted from the UK Trauma Audit and Research Network database. The primary outcome was the time from emergency call to delivery of RSI. Secondary outcomes included mortality at 30-days or hospital discharge, time from arrival of service at hospital or scene to RSI, time from emergency call to Computerised Tomography scan, and conveyance interval. Linear regression was used to model time to RSI in both groups.

Results

Of 378 eligible patients, 209 patients met inclusion criteria. 103 received a PHRSI and 106 received an EDRSI. Most patients were male (n = 171, 82%) and the median age was 48 years (IQR 28–65). 94% sustained a blunt injury mechanism and head was the most injured body region for both cohorts (n = 134, 64%). 63% (n = 67) of patients receiving a PHRSI were conveyed by helicopter. PHRSI was delivered significantly earlier with a median of 64 [IQR 51–75] minutes (95% CI, 60–68) compared with EDRSI with a median of 84 [IQR 68–113] minutes (95% CI, 76–94), p < 0.001).

Conclusion

Major trauma patients who had a pre-hospital RSI received this time-critical intervention sooner after their injury than those who received an emergency anaesthetic after conveyance to a specialist hospital. Patient outcome benefit of HEMS delivered early RSI should be explored.
The Rhipicephalus sanguineus group: updated list of species, geographical distribution, and vector competence
Authors: Dantas-Torres Filipe , de Sousa-Paula Lucas C. , Otranto Domenico
Published: December 2024

The Rhipicephalus sanguineus group is an assembly of species morphologically and phylogenetically related to Rhipicephalus sanguineus sensu stricto. The taxonomy and systematics of this species group have remained obscure for a long time, but extensive research conducted during the past two decades has closed many knowledge gaps. These research advancements culminated in the redescription of R. sanguineus sensu stricto, with subsequent revalidation of former synonyms (Rhipicephalus linnaei, Rhipicephalus rutilus, and Rhipicephalus secundus) and even the description of new species (Rhipicephalus afranicus and Rhipicephalus hibericus). With a much clearer picture of the taxonomy of these species, we present an updated list of species belonging to the R. sanguineus group, along with a review of their geographic distribution and vector role for various pathogens of animals and humans. We also identify knowledge gaps to be bridged in future studies.

Graphical abstract
The evolution of cephalic fins in manta rays and their relatives: functional evidence for initiation of domain splitting and modulation of the Wnt signaling pathway in the pectoral fin AER of the little skate
Authors: McFarland Emily P. , Crow Karen D.
Published: December 2024

Background

Batoids possess a unique body plan associated with a benthic lifestyle that includes dorsoventral compression and anteriorly expanded pectoral fins that fuse to the rostrum. The family Myliobatidae, including manta rays and their relatives, exhibit further modifications associated with invasion of the pelagic environment, and the evolution of underwater flight. Notably, the pectoral fins are split into two domains with independent functions that are optimized for feeding and oscillatory locomotion. Paired fin outgrowth is maintained during development by Wnt3, while domain splitting is accomplished by expression of the Wnt antagonist Dkk1, which is differentially expressed in the developing anterior pectoral fins of myliobatids, where cephalic fins separate from pectoral fins. We examine the evolution of this unique feature in the cownose ray (Rhinoptera bonasus), a member of the genus that is sister to Mobula.

Results

Here, we provide functional evidence that DKK1 is sufficient to initiate pectoral fin domain splitting. Agarose beads soaked in DKK1 protein were implanted in the pectoral fins of little skate (Leucoraja erinacea) embryos resulting in AER interruption. This disruption arrests fin ray outgrowth, resembling the myliobatid phenotype. In addition, fins that received DKK1 beads exhibit interruption of Axin2 expression, a downstream target of β-catenin-dependent Wnt signaling and a known AER marker. We demonstrate that Msx1 and Lhx2 are also associated with fin expansion at the AER. These results provide functional evidence for the underlying genetic pathway associated with the evolution of a novel paired fin/limb modification in manta rays and their relatives. We introduce the gas/brake pedal model for paired fin remodeling at the AER, which may have been co-opted from domain splitting in pelvic fins of cartilaginous fishes 370 million years earlier.

Conclusions

The pectoral fins of manta rays and their relatives represent a dramatic remodel of the ancestral batoid body plan. The premiere feature of this remodel is the cephalic fins, which evolved via domain splitting of the anterior pectoral fins through inhibition of fin ray outgrowth. Here, we functionally validate the role of Dkk1 in the evolution of this phenotype. We find that introduction of ectopic DKK1 is sufficient to recapitulate the myliobatid pectoral fin phenotype in an outgroup lacking cephalic fins via AER interruption and fin ray truncation. Additional gene expression data obtained via in situ hybridization suggests that cephalic fin development may have evolved as a co-option of the pathway specifying claspers as modifications to the pelvic fins, the only other known example of domain splitting in vertebrate appendages.
Hybrid Service Delivery for voluntary, community and social enterprise organisations working with adults with learning disabilities and/or autism: a realist review protocol
Authors: Varley Danielle , Southby Kris , Trigwell Joanne , Brown Sally SJ , Lines Nicola , Hearn Amy , Bagnall Anne-Marie
Published: December 2024

Background

Delivery of health and care services using a combination of remote and/or in-person channels and digital and/or traditional tools (Hybrid Service Delivery, HSD) is increasingly seen as a way of improving quality and affordability, improving access, personalisation and sustainability, and reducing inequalities. Across the voluntary, community and social enterprise sector (VCSE), using a combination of remote and/or in-person channels and digital and/or traditional tools (HSD) has enabled the essential provision of services for people who have learning disabilities and/or autistic (LDA). However, it is unclear how different tools and channels have been used, what worked well or not well, for whom, and in what circumstances. The aim of this realist review is to explore how VCSE organisations can effectively use digital technologies alongside or instead of in-person activity to provide social care services to adults with learning disabilities and/or autism.

This review protocol is presented in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P).

Methods

We will conduct a participatory realist review. Following realist review methodology, and involving people with LDA and organisations who deliver services to them, we will define the scope of the review/theory development, search for and appraise evidence, extract and synthesise findings, and develop the narrative. Using a developed strategy, electronic databases (Academic Search Complete, CINAHL, MEDLINE, PsycInfo, SCOPUS, Social Science Citation Index and Social Policy and Practice) will be searched. A data extraction table will be used to assist in sifting, sorting and organising relevant information from identified studies. For each proposition statement, relevant data from the identified literature will be synthesised and compared with the proposed theory to develop an understanding of how, why and when hybrid delivery works in different settings with different populations.

Discussion

This review aims to collate and synthesise evidence relating to hybrid service delivery in VCSE organisations to provide social care services to LDA adults. By conducting a participatory realist review, we anticipate that the findings will lead to a greater understanding of contextual factors and therefore more relevant recommendations.

Systematic review registration

PROSPERO CRD42024457161.
Prediction and parametric assessment of soil one-dimensional vertical free swelling potential using ensemble machine learning models
Authors: Habib Maan , Habib Ahed , Alibrahim Bashar
Published: December 2024

Investigating soil swelling potential is indeed a critical research area in geotechnical engineering, given its significant influence on the stability and longevity of civil structures. This study aims to predict and assess the one-dimensional vertical free swelling potential of soils using ensemble machine learning models. Within the study context, a large dataset encompassing a wide array of soil parameters from 210 soil samples, including moisture content, unit weight, plasticity, and clay content, will be used. These parameters are critical in understanding the swelling behavior of soils under varying environmental and load conditions. The novel approach of this research lies in the application of ensemble machine learning techniques, which offer a robust framework to analyze complex, nonlinear relationships within soil properties. Another key aspect of this research is the parametric assessment, where the influence of individual soil properties on swelling potential is investigated using feature importance and partial dependence analyses. These analyses provide valuable insights into the relative importance of different soil parameters on soil behavior. The outcomes of this study contribute to soil mechanics and machine learning applications in geotechnical engineering and offer practical implications for engineers and practitioners. Besides, the predictive models developed in this study aid in more informed decision-making in the design and construction of civil structures, particularly in swelling-prone areas.
Intraplate seismic mechanisms in the Zhangjiakou-Bohai Seismic Belt: insights from magnetotelluric data
Authors: Zhang Yuyang , Jin Sheng , Ye Gaofeng , Zhang Haijiang , Wei Wenbo , Dong Hao , Gao Ji
Published: December 2024

The Zhangjiakou-Bohai Seismic Belt (ZBSB) is a crucial intraplate seismic belt in Eastern China, covering densely populated and economically developed regions with significant seismic hazards. A refined model is essential to investigate the intraplate seismic mechanism here. We obtained the three-dimensional resistivity model based on magnetotelluric array data covering the central segment of the ZBSB. The model shows a thick high-resistivity body within the Sanhe-Pinggu seismogenic zone and a widespread low-resistivity anomaly in the mid-lower crust east of the Xiadian fault. Moreover, the Tangshan seismogenic zone exhibits a highly resistive layer in the mid-upper crust and a high-conductivity anomaly from the lower crust to the upper mantle west of the Tangshan fault. The ZBSB is primarily affected by mantle thermal material migration from the west and mantle material upwelling in the central segment of the ZBSB. In the central-western sections, the horizontal eastward push, caused by the migration of mantle thermal material from the west, accumulates stress within the rigid blocks in the Sanhe-Pinggu seismogenic zone, leading to strike-slip and rupture along the Xiadian fault. The ductile mid-lower crust on the east side of the Xiadian fault unloads stress from the rigid body, hindering eastward stress transmission. In the central-eastern segments, seismic events are mainly triggered by mantle-derived material upwelling. The NE horizontal stress exerted on the rigid body of the Tangshan seismogenic zone, resulting in strike-slip and rupture along the brittle Tangshan fault, leading to earthquakes.

Graphical Abstract
Framework and overview of the Pediatric Spinal Muscular Atrophy Registry Program of Iran
Authors: Babaee Marzieh , Vahidi Ara Sara , Vahidi Hossein , Jafari Narjes , Zeinali Vahide , Farahbakhsh Nazanin , Sadr Saeed , Khanbabaee Ghamartaj , Tabatabaii Seyed Ahmad , Ahamdabadi Farzad , Miryounesi Mohammad , Hashemi Nazari Seyed Saeed , Rayegani Seyed Mansoor , Taghdiri Mohammad Mahdi , Karimzadeh Parvaneh , Nasehi Mohammad Mehdi , Boland Nazar Najmeh Sadat
Published: December 2024

Background

The Pediatric Spinal Muscular Atrophy Registry Program of Iran (PSMAIR) was established as part of the global TREAT-NMD network, which collects data from spinal muscular atrophy (SMA) patients under 18 years of age in Iran. The registry employs a web-based data entry system to collect detailed longitudinal demographic, geographic, clinical, genetic, and treatment outcome data of Iranian children who suffer from SMA.

Results

From October 2021 to September 2022, 59 SMA patients were enrolled; 52.5% were female, 47.5% were male, and the average age was 4.98 ± 4.08 years. The majority of registered patients were diagnosed with SMA Type I (47%), followed by Type II (29%) and Type III (24%). Overall, about 19% of the registered patients died; all of them were Type I patients. In the registry, 44% of patients had been hospitalized previously. Usage rates for wheelchairs or other mobility assistive devices, occurrence of scoliosis, tube feeding, and mechanical ventilation among these patients were 15%, 15%, 19%, and 20%, respectively. The data reveal a gradient of severity across SMA types, with earlier symptom onset, lower CMAP amplitude, and lower ACTIVLIM scores associated with more severe SMA (type I), and increments observed moving towards milder forms (type III). The data reveal that symptom onset age, CMAP amplitude, and ACTIVLIM scores progressively increase from SMA type I to SMA type III. The CHOP-INTEND questionnaire's average score was notably higher in children with SMA type II compared to those with type I, while the HFMSE questionnaire scores were notably increased in type III compared to type II patients. A significant correlation between the SMN2 copy number and the SMA phenotype was observed in the population. The geographic distribution of the enrolled patients covers 15 and 18 (out of the 31) provinces of Iran for place of birth and current place of residence, respectively. For patients residing outside Tehran city (where the registry’s referral center is located), the average distance to the registry’s referral center was roughly 463 km.

Conclusions

The PSMAIR offers an important step toward understanding the characteristics of Iranian pediatric SMA patients. The outcome of PSMAIR facilitates data-driven planning and decision-making for Iranian pediatric SMA patients and can help in the advancement of SMA care standards, management, and therapies.
Lung transplantation for diffuse pulmonary arteriovenous malformations associated with juvenile polyposis–hereditary hemorrhagic telangiectasia overlap syndrome: a case report
Authors: Ryo Taiki , Nakajima Daisuke , Kimura Satoshi , Date Hiroshi
Published: December 2024

Background

Lung transplantation is a viable lifesaving option for patients with diffuse pulmonary arteriovenous malformations (AVMs). We present a case of diffuse pulmonary AVMs associated with juvenile polyposis and hereditary hemorrhagic telangiectasia (JP-HHT) that was successfully managed by lung transplantation.

Case presentation

A 19-year-old woman developed severe hypoxemia due to pulmonary AVMs diagnosed at 4 years of age. She also had epistaxis, hemangioma of the tongue, and numerous polyps in the gastrointestinal tract, leading to the JP-HHT diagnosis. Although she had undergone transcatheter embolization for pulmonary AVMs four times, all lesions became recanalized, and her hypoxemia never improved. She also had hepatic AVMs that did not result in portal hypertension or required any interventions. She underwent bilateral lung transplantation from a brain-dead donor at 3 years after registration. Given that she had severe hypoxemia caused by intrapulmonary shunting, venoarterial extracorporeal membrane oxygenation (V-A ECMO) support was initiated from the femoral vessels under local anesthesia. Then, she was anesthetized and intubated. Peripheral V-A ECMO was switched to central cardiopulmonary bypass during the transplant procedure to prevent persistent hypoxia of the upper body and thromboembolic event due to severe polycythemia. The total graft ischemic time was > 11 h, which resulted in ischemia–reperfusion injury immediately after transplantation. Furthermore, the patient’s postoperative course was complicated by acute cellular rejection and right heart failure due to hepatic AVM progression. She was finally discharged home without oxygen therapy on postoperative day 68. At 1-year post-transplantation, she is currently enjoying college life. However, she still has to undergo periodic endoscopic examinations to monitor her numerous polyps, which are known to carry a risk of cancer development.

Conclusions

Lung transplantation can be a viable treatment option for diffuse pulmonary AVMs in patients with JP-HHT. However, meticulous perioperative management is mandatory to prevent the development of multiple organ disorders.
Peripheral Heart Action Training for Fitness and Health
Authors: Mang Zachary A. , Kravitz Len
Published: December 2024

Apply It!

• Training programs that combine aerobic exercise and resistance exercise have more profound health benefits than either modality alone.

• Hybrid training programs, such as circuit weight training, combine aerobic and resistance exercise in time-efficient sessions.

• Peripheral heart action training is a simple application of circuit weight training that may improve aerobic fitness, body composition, blood pressure, heart rate variability, and muscular strength.
A Non-Invasive Window into Cellular Health
Authors: Lafontant Kworweinski , Sterner Danielle A. , Fukuda David H. , Stout Jeffrey R.
Published: December 2024

Apply It!

From this article, the reader should:

• Gain a better understanding of what phase angle and impedance ratio are.

• Be able to track their clients' changes in cellular health from exercise training.

• Become familiar with best practices for using bioelectrical impedance analysis (BIA).
All Exercise Should be Gender Inclusive
Authors: Adams Melanie
Published: December 2024

Apply It!

• Practice using nonbinary language; “folks” instead of “guys” and introducing yourself using your pronouns.

• Instead of giving fitness test results from male and female norms, use the raw scores, loads, and reps to show progress.

• Focus on individualized function over body image. Do not “gender” movements, activities, or equipment. For example, call barbells by their weights rather “women's” or “men's” (33/45 lb).

• Ask what the client needs to feel safe and be willing to try it.
A TSC2 recurrent variant c.5126C>T in a Han-Chinese family with tuberous sclerosis complex
Authors: Deng Xinyue , Wu Shan , Deng Hao , Yuan Lamei
Published: December 2024

Objective: To identify the disease-causing variant in a family with tuberous sclerosis complex (TSC).
Methods: This study including a Han-Chinese pedigree recruited from the Third Xiangya Hospital, Central South University, Changsha, Hunan, China was conducted between February, 2019 and January, 2023. Detailed clinical examinations were performed on the proband and other family members of a Han-Chinese family with TSC. Whole exome sequencing of the proband and Sanger sequencing of all family members were performed, followed by variant pathogenicity prediction and conservation analysis. SWISS-MODEL and PyMOL software were used for protein modelling and creating the three-dimensional structure model illustration of the critical GTPase-activating protein (GAP) domain. The variant was classified following the American College of Medical Genetics and Genomics (ACMG) standards and guidelines.
Results: The female proband exhibited typical features of TSC, including hypomelanotic macules, angiofibromas, shagreen patches, seizures, brain lesions, cognitive impairment, renal abnormalities, and cardiovascular abnormalities. A recurrent c.5126C>T variant in the TSC complex subunit 2 gene (TSC2) was identified as the genetic cause of TSC in this family, classified as “pathogenic” according to ACMG standards and guidelines. The c.5126C>T variant leads to an amino acid change from proline to leucine at position 1709 (p.P1709L) in the functional GAP domain of tuberin protein, which may impair tumor growth inhibition of the hamartin-tuberin complex.
Conclusion: This study reported a Han-Chinese TSC patient with a recurrent variant TSC2 c.5126C>T (p.P1709L). These findings broaden the phenotypic spectrum of TSC caused by this variant and may contribute to improving TSC genetic diagnoses as well as understanding of its mechanisms.
doi: https://doi.org/10.12669/pjms.41.1.10153
How to cite this: Deng X, Wu S, Deng H, Yuan L. A TSC2 recurrent variant c.5126C>T in a Han-Chinese family with tuberous sclerosis complex. Pak J Med Sci. 2025;41(1):263-268. doi: https://doi.org/10.12669/pjms.41.1.10153
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Randomized controlled trial on the treatment of Hypoferritinemia without Anemia: Comparing oral and intravenous iron supplementation among reproductive age women in Pakistan
Authors: Akram Shehla , Akhtar Abdul Majeed , Zakar Rubeena
Published: December 2024

Background & Objectives: Hypoferritinemia without anemia (HWA) is an under-recognized public health concern. Early identification and targeted treatment of HWA can prevent unnecessary medication use and potential drug abuse. This study aims to establish clearer guidelines for recognizing and managing HWA, improving patient’s outcome. The study objectives will be to compare the treatment efficacy of oral and IV iron on patients with HWA and to check the severity of clinical indicators of HWA post treatment among reproductive age women.
Methods: We will choose a multicenter, multi-arm randomized controlled trial with a parallel assignment interventional model. About three hundred participants (n=300) aged 18-45 with hypoferritinemia without anemia and no comorbidities will be recruited. Participants will be randomized into three groups of one hundred each: Group-A will receive oral iron supplements (Iron III Hydroxide Polymaltose Complex, 100 mg elemental iron) one tablet per day for three months; Group-B will receive intravenous iron (Ferric carboxymaltose, one dose per month for three months); Group-C will receive no treatment. All groups will be followed for four months.
Conclusion: The primary outcome will be the change in serum ferritin levels among groups at four months post-intervention. Secondary outcomes will include changes in clinical symptoms post-intervention. Data will be analyzed by using independent t-tests for between-group ferritin levels, paired t-tests for within-group comparisons, Wilcoxon Rank and Friedman tests for clinical symptoms, and ANOVA for comparisons across multiple groups.
doi: https://doi.org/10.12669/pjms.41.1.11083
How to cite this: Akram S, Akhtar AM, Zakar R. Randomized controlled trial on the treatment of Hypoferritinemia without Anemia: Comparing oral and intravenous iron supplementation among reproductive age women in Pakistan. Pak J Med Sci. 2025;41(1):286-294.  doi: https://doi.org/10.12669/pjms.41.1.11083
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Effect of Centratherum anthelminticum seeds on Glycated hemoglobin, Cardiovascular disease risks and dyslipidemia in Type-2 diabetic patients in Karachi: A non-blind randomized controlled trial
Authors: Hina Akram Mudassir  , Syed Muhammed Talha Arshad  , Munazzah Naheed  , Sadia Anwer
Published: December 2024

Objective: To explore the effect of Centratherum antheminticum seeds powder {CapCASP 500 mg} capsule in diabetes Type-2 (T2DM) patients in Karachi.
Methods: A randomized selection of 40 T2DM patients from Sindh Government Hospital New Karachi with their consents was done for a non-blinded controlled trial from October to December 2019 and divided into PGroup (Positive Control, metformin 500 mg) & TGroup (Test, CapCASP + was also included, using the same dosage of CapCASP on twenty healthy volunteers. The data were analyzed using an online graph pad student’s t-test and a one-way ANOVA (SPSS version 24) metformin 500mg each). Both groups had (n = 20). CGroup (healthy control), was also included with twenty healthy volunteers with same dose of CapCASP. The biochemical tests (lipid profile, HbA1c, fasting blood glucose) of both groups were done in biochemistry lab Federal Urdu University of Arts, Science & Technology and results were analyzed by one-way ANOVA (SPSS version 24) and online graph pad student´s t-test.
Results: CASP showed potent (in-vitro) anti-diabetic activity (72.81%) than standard acarbose (standard drug). Most of in-vivo parameters in TGroup showed significant improvements. Body weight (p<0.01) & (p<0.05), HbA1c & fasting blood glucose (p<0.0001), coronary risk index (CRI), atherogenic index (A Indx) (p<0.05, p<0.0001) & atherogenic dyslipidemia ratio (A-DLR) (p<0.0001 & p<0.01) were reduced after six and twelve weeks. Reduction in serum cholesterol and triglycerides (p< 0.05 & p< 0.01) after six as well as (p< 0.01) after twelve weeks. Very low density lipoprotein reduced after both (p< 0.05) six and (p< 0.0001) twelve weeks. High density lipoprotein increased (p< 0.01) & low density lipoprotein decreased (p< 0.05) after twelve weeks.
Conclusion: When given standard care to T2D patients, the CASP intervention demonstrated both anti-diabetic and anti-lipidemic effects.
doi: https://doi.org/10.12669/pjms.41.1.8496
How to cite this: Mudassir HA, Arshad SMT, Naheed M, Anwer S. Effect of Centratherum anthelminticum seeds on Glycated hemoglobin, Cardiovascular disease risks and dyslipidemia in Type-2 diabetic patients in Karachi: A non-blind randomized controlled trial. Pak J Med Sci. 2025;41(1):257-262. doi: https://doi.org/10.12669/pjms.41.1.8496
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The burden of cutaneous fungal infections in a tertiary care hospital in Pakistan
Authors: Najam us Saher  , Saadia Tabassum  , Sajid Madiha , Khabir Yumna , Faheem Aisha
Published: December 2024

Objective: In Pakistan, the real extent of fungal infection is unknown. Our objective was to estimate the burden of major fungal diseases here to emphasize their public health importance.
Methods: In this retrospective study, the medical records (January 2019 - December 2019) of 863 patients diagnosed with superficial fungal infection (SFI) were reviewed at the dermatology department of Aga Khan University Hospital (AKUH) Karachi. Stata 17.0 was used to analyze the data. Chi-squared test or Fisher’s exact test was used to evaluate association between variables. Descriptive analyses include means, frequencies, standard deviations, and percentage tests whereas Poisson regression with robust standard error was used to examine the association of age, gender, diabetes, and type of SFI with recurrence of SFI.
Results: In this study, the most common SFI was tinea cruris (234/863, 27.1%) in men (n=62, 21.7%) and females (n=172, 29.8%) followed by pityriasis versicolor (n=77, 26.9%) in males and tinea corporis (n=115, 19.9%) in females. Tinea cruris recurrence rates were similar between males and females (34/234, 14.5%).
Conclusion: These findings show that fungal infections are a public health problem in Pakistan and that additional research is needed to assess their frequency in the general population. Clinicians must be taught and made aware of these infections to enhance diagnosis and treatment.
doi: https://doi.org/10.12669/pjms.41.1.9061
How to cite this: Najam-us-Saher, Tabassum S, Sajid M, Khabir Y, Faheem A. The burden of cutaneous fungal infections in a tertiary care hospital in Pakistan. Pak J Med Sci. 2025;41(1):269-274. doi: https://doi.org/10.12669/pjms.41.1.9061
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Research on grading detection methods for diabetic retinopathy based on deep learning
Authors: Zhang Jing , Juan Chen
Published: December 2024

Objective: To design a deep learning-based model for early screening of diabetic retinopathy, predict the condition, and provide interpretable justifications.
Methods: The experiment’s model structure is designed based on the Vision Transformer architecture which was initiated in March 2023 and the first version was produced in July 2023 at Affiliated Hospital of Hangzhou Normal University. We use the publicly available EyePACS dataset as input to train the model. Using the trained model, we predict whether a given patient’s fundus images indicate diabetic retinopathy and provide the relevant affected areas as the basis for the judgement.
Results: The model was validated using two subsets of the IDRiD dataset. Our model not only achieved good results in terms of detection accuracy, reaching around 0.88, but also performed comparably to similar models annotated for affected areas in predicting the affected regions.
Conclusion: Utilizing image-level annotations, we implemented a method for detecting diabetic retinopathy through deep learning and provided interpretable justifications to assist clinicians in diagnosis.
doi: https://doi.org/10.12669/pjms.41.1.9171
How to cite this: Zhang J, Chen J. Research on grading detection methods for diabetic retinopathy based on deep learning. Pak J Med Sci. 2025;41(1):225-229. doi: https://doi.org/10.12669/pjms.41.1.9171
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Influence of early rehabilitation nursing on postoperative rehabilitation of patients with hallux valgus based on information-motivation-behavior skills model
Authors: Yu Shuting , Yang Yiqin , Su Hui , Zhou Ling , Zhou Jin
Published: December 2024

Objective: To probe the influence of early rehabilitation nursing on postoperative rehabilitation of patients with hallux valgus on the basis of information-motivation-behavior skills (IMB) model.
Methods: Convenience sampling was adopted, and 80 patients with hallux valgus admitted to the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University from July 2020 to July 2022 were randomly separated into control group (CG) and observation group (OG) with 40 patients in each group according to the time of admission. Patients in the CG received routine nursing and rehabilitation guidance and follow-up. Patients in the OG were given rehabilitation guidance and follow-up based on IMB model. The American Orthopaedic Foot and Ankle Association Scoring System (AOFAS) scores, Self-efficacy for Rehabilitation Out-come Scale (SER) scores, The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores, quality of Life scores, incidence of complications as well as nursing satisfaction in both groups were compared.
Results: After receiving usual nursing and rehabilitation guidance in each group, AOFAS scores, SER scores, quality of life scores and nursing satisfaction in the OG were elevated compared to the CG (P<0.05), SAS and SDS scores, and the incidence of complications in the OG were lessened compared to the CG (P<0.05).
Conclusion: To sum up, Early rehabilitation nursing based on IMB model could promote the postoperative recovery of limb function after hallux valgus, reduce bad emotions, decrease the occurrence of complications, promote self-efficacy, and promote the quality of life of patients, which is valuable for promotion.
doi: https://doi.org/10.12669/pjms.41.1.9791
How to cite this: Yu S, Yang Y, Su H, Zhou L, Zhou J. Influence of early rehabilitation nursing on postoperative rehabilitation of patients with hallux valgus based on information-motivation-behavior skills model. Pak J Med Sci. 2025;41(1):235-241.  doi: https://doi.org/10.12669/pjms.41.1.9791
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Tadeusz Smoleński (1884–1909): A Pioneer of Polish Egyptology
Authors: Popielska-Grzybowska Joanna , Zinkow Leszek
Published: December 2024

The Polish scholar Tadeusz Smoleński is worthy of remembrance by the international scientific community, particularly in light of the commemorated in 2024 140th anniversary of his birth. Pursuing his studies at the Jagiellonian University in Kraków, Smoleński developed an interest in Egyptology while convalescing in Egypt. This interest led him to become one of the pioneers of Egyptian archaeology in East Central Europe. In Cairo he undertook rigorous studies under the tutelage of the renowned French Egyptologist Gaston Maspero, rapidly attaining remarkable outcomes and formulating a future academic career. He translated ancient Egyptian texts, published scientific articles and prepared a doctoral dissertation while initiating excavation work assigned to him as a citizen of the Austro-Hungarian Empire. Moreover, he demonstrated an interest in the ethnography of the region as well as contemporary political events in the Middle East. However, he suffered a sudden relapse of his illness, necessitating his return to Kraków, where he died at the young age of 25.
Osiąganie dobrostanu w cyfrowym świecie w kontekście potrzeb dzieci i młodzieży – indywidualne i społeczne wymiary zjawiska
Authors: Pulak Irena
Published: December 2024

Celem artykułu jest ukazanie wielowymiarowości dobrostanu cyfrowego, w ujęciu zarówno indywidualnym, jak i społecznym, w tym opisanie komponentów, które składają się na ogólną jakość życia w przestrzeni cyfrowej z punktu widzenia młodego użytkownika mediów cyfrowych, ze szczególnym uwzględnieniem sfery informacyjnej i komunikacyjnej. W tekście przedstawione zostały zagadnienia związane z różnorodnością podejść i perspektyw w wymiarze teoretycznym i praktycznym. Szerzej opisano również zdolności i warunki, które są współcześnie wymagane, aby móc osiągnąć równowagę w korzystaniu z nowych technologii, sprawnie i bezpiecznie poruszać się w środowisku mediów cyfrowych, unikając potencjalnych zagrożeń oraz by wykorzystać tkwiący w nich potencjał.
Omówiono również wspomagającą rolę rodziców i nauczycieli w procesie osiągania przez młode pokolenie dobrostanu w świecie mediów cyfrowych. Zaprezentowano i przeanalizowano wyniki prowadzonych na przestrzeni ostatnich lat badań, które ukazują poziom zanurzenia dzieci i młodzieży w przestrzeni cyfrowej oraz towarzyszące temu nowe zjawiska. Wskazano także na aktualne trendy i przemiany w sposobach korzystania z mediów, które mają wpływ na ogólny dobrostan jednostki.
Layout Optimization for a Large-Scale Grid-Connected Solar Power Plant
Authors: Wang Chong , Wu Qinghua , Pan Kai , Shen Zuo-Jun Max
Published: December 2024

A solar power plant provides green electricity to the public via a power grid. As governments worldwide have pledged to reduce carbon emissions and achieve carbon neutrality, large-scale grid-connected solar power plants are booming. Developing such a plant requires significant investment, a large proportion of which covers construction costs. Such costs, together with the energy yield, critically depend on the plant’s layout. The layout planning of a solar power plant involves a series of complex optimization problems such as district partitioning, photovoltaic (PV) component location, and cable routing problems in a solar power plant. These problems have received limited attention in the literature and are highly challenging because they involve large-scale instances, complex design principles, and complicated physical constraints. Motivated by our collaborative projects with an electrical engineering company in China, this paper specifically focuses on the integrated location and routing (ILR) problem, which involves locating service ways, inverters, combiner boxes, and routing cables to connect them. We develop exact algorithms to effectively solve the ILR problem via a decomposition framework (leading to a variant of Benders decomposition (BD)), which is proven to produce an optimal solution. We also develop an exact branch-and-cut scheme to solve each subproblem in the decomposition framework by incorporating cutting planes and separation algorithms. Our solution approach is evaluated on 50 real-world data instances via extensive numerical experiments. Compared with the manual method based on greedy heuristics used in practice, our approach reduces the total cost by approximately 20%. Our decomposition method also achieves an average gap of 0.02% between the obtained lower and upper bounds, significantly smaller than the 16.08% gap achieved with the traditional BD.

History: Accepted by Alice E. Smith and David Alderson, Area Editors for Network Optimization: Algorithms & Applications.

Funding: This work was partially supported by the Research Grants Council of Hong Kong [Grant 15501221], the National Natural Science Foundation Program of China [Grants 72122006, 72471100, and 72131008], Huazhong University of Science and Technology Double First-Class Funds for Humanities and Social Sciences (Digital Intelligence Decision Optimization Innovation Team), the Interdisciplinary Research Program of HUST [Grant 5003300129], and the Fundamental Research Funds for the Central Universities [Grant 2023WKFZZX101].

Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information ( https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2023.0223 ) as well as from the IJOC GitHub software repository ( https://github.com/INFORMSJoC/2023.0223 ). The complete IJOC Software and Data Repository is available at https://informsjoc.github.io/ .
Fears over hidden impact Budget will have on children's provision
Authors: Simpson Fiona
Published: December 2024

Education experts and children's services leaders warn Rachel Reeves’s first Budget could have hidden consequences for local authority finances after Chancellor sticks with pledge to tax private schools
Probation hub points to improved support
Authors: Simpson Fiona
Published: December 2024

Two-year evaluation of young adult probation hub pilot highlights desire for specialist support tailored to neurodivergent needs
Amerdeep Somal
Authors: Simpson Fiona
Published: December 2024

Fiona Simpson talks to the local government and social care ombudsman
CHILDREN’S MENTAL HEALTH
Authors: Hayes Derren
Published: December 2024

The rise in the number of children with mental health conditions has prompted policymakers and practitioners to develop services to support young people earlier to prevent problems escalating
Adoption contact
Authors: Poore Jane , Harris Alexandra Conroy
Published: December 2024

CoramBAAF's Jane Poore, adoption consultant, and Alexandra Conroy Harris, legal consultant, outline latest legal cases on how practitioners manage post adoption contact with birth families
Coaches make school transition less daunting
Authors: Crown Hannah
Published: December 2024

Sports mentoring helps pupils who contend with a range of issues transition from primary to secondary school, improving both wellbeing and behaviour
Labour embarks on overhaul of the children's social care system
Authors: Hayes Derren
Published: December 2024

The government's new policy paper sets out measures to rebalance children's social care towards early help through boosting family support, curtailing profiteering and creating new provision that better meets needs
Feeding the future
Authors: Brackley Dayna
Published: December 2024

Dayna Brackley discusses research exploring the barriers that settings face to providing nutritious, locally sourced food
Evaluation of Sepsis Severity Using Combined High-Density Lipoprotein and Red Cell Distribution Width Indicators
Authors: Gao Yan , Chen Yao , Gao Li
Published: December 2024

Aims/Background Sepsis is a life-threatening condition resulting from dysregulated immune responses to infection, leading to organ dysfunction. High-density lipoprotein (HDL) and red cell distribution width (RDW) have shown significant correlations with sepsis severity, yet the combined prognostic value of HDL and RDW in evaluating sepsis severity and outcomes remains unclear. This study examines the relationship between HDL and RDW levels and sepsis severity, as well as evaluates the combined utility of these markers in predicting disease severity and patient outcomes.

Methods This retrospective study included 103 patients diagnosed with sepsis. Clinical data, including HDL and RDW levels, were collected for analysis. Patients were divided into shock and non-shock groups based on the presence of septic shock and into survival and death groups based on 30-day in-hospital mortality. Multivariate logistic regression was used to identify factors influencing sepsis severity and prognosis, while the predictive value of HDL in combination with RDW was evaluated using receiver operating characteristic (ROC) curve analysis.

Results Multivariate analysis identified sequential organ failure assessment (SOFA) score (OR = 6.566), interleukin-6 (IL-6) (OR = 2.568), HDL (OR = 0.864), and RDW (OR = 4.052) as independent predictors of sepsis severity (p < 0.05 for all). ROC analysis demonstrated that HDL combined with RDW yielded the highest diagnostic accuracy for sepsis severity, with an area under curve (AUC) of 0.962, sensitivity of 97.56%, and specificity of 91.94%. Additionally, SOFA score (OR = 2.354), interleukin-6 (IL-6) (OR = 1.446), HDL (OR = 0.870), and RDW (OR = 3.502) were independent prognostic indicators (p < 0.05 for all). ROC analysis for prognosis showed that HDL combined with RDW had the highest predictive efficacy for the prognosis of sepsis, with an AUC of 0.922, sensitivity of 79.31%, and specificity of 93.24%.

Conclusion The combination of HDL and RDW is a robust indicator for the evaluation of sepsis severity and is a valuable prognostic tool for assessing 30-day mortality risk in sepsis patients.
Correlation between Serum Biomarkers and Disease Progression of Chronic Kidney Disease
Authors: Xu Junyue , Jia Xingwang , Zhang Xueguang , Jiao Xiaocui , Zhang Shana , Zhao Yahong , Wu Xiaohong , Li Yi , Liu Xuetong , Yu Qian
Published: December 2024

Aims/Background The present study aimed to assess the capability of biomarkers, including inflammatory indicators, anaemic markers, lipid markers, and renal function indices, to differentiate between different stages of chronic kidney disease (CKD). Expected to provide a new strategy for monitoring the development of CKD and stratified treatment management, providing valuable insights for future biomarker studies to explore early detection of CKD.

Methods The changes in inflammatory markers (interferon gamma [IFN-γ], interleukin [IL]-17A, IL-10, IL-6, IL-4, IL-2, IL-1 and white blood cells [WBC]), lipid markers (high-density lipoprotein cholesterol [HDL-c], low-density lipoprotein cholesterol [LDL-c], and triglyceride [TG]), indicators of kidney injury (serum creatinine [Scr] and blood urea nitrogen [BUN]) in 451 patients with different stages of CKD were examined. Furthermore, these markers were compared between 299 anemic patients and 53 non-anemic patients. Univariate and multivariate regression analyses were employed to analyze the association between these biomarkers and estimated glomerular filtration rate (eGFR). To identify risk factors associated with the development of CKD, we utilized principal component analysis to evaluate their utility as potential diagnostic and prognostic markers for the disease.

Results Significant differences were found in IL-6, BUN, and hemoglobin (Hb) levels across CKD stages 2 to 5. Anaemic individuals had elevated levels of IL-6, Scr, and BUN compared to non-anaemic individuals. In addition, the multivariate linear regression analysis revealed that IL-1 (p = 0.022), IL-6 (p = 0.022), Hb (p < 0.001), and BUN (p < 0.001) were statistically significant predictors of eGFR. Furthermore, it was discovered that the blood levels of IL-6 (p = 0.012), BUN (p < 0.001), and Hb (p < 0.001) were risk factors associated with the stages of CKD.

Conclusion Serum levels of IL-6, BUN and Hb have been associated with the progression of CKD. Using a combination of serum biomarkers is a potential strategy for tracking the development of CKD, facilitating stratified management and early intervention.
The Place for Space
Authors: Williamson Jonny
Published: December 2024

Decades of experience in aerospace engineering, manufacturing and research has proven to be the perfect launchpad for the South West’s journey into space.
US Approval for Robotic Surgical Tool Developed with UK Company
Authors: Ford Jason
Published: December 2024

TMINI Miniature Robotic System can be marketed following development work with Sagentia Innovation
Louis Blériot: Aircraft Manufacturer and Pilot of The Pioneer Era of Aviation
Authors: Smith Nick
Published: December 2024

As the first to fly a heavier-than-air aircraft across the English Channel, Louis Blériot is among the greats of aviation. He was also a brilliant inventor, engineer and entrepreneur
PESQUISAR COM PÉS PLANTADOS NA TERRA: POR UM REFLORESTAMENTO ACADÊMICO
Authors: Andrade Lorena Santos , De Vasconcelos Michele de Freitas Faria , Domingas Romanzini Lazzarotto Gislei
Published: December 2024

A que(m) servem (nossos) saberes? É possível produzir conhecimento acadêmico que faça frente ao projeto neoliberal (re)colonizatório, civilizatório euro-hegemônico? Como resistir à (nossa) branquitude? Na peleja com essas perguntas, o artigo alinhava uma cantoria entre memórias e narrativas que transversalizam universidade, colonialidade, branquitude e monocultura do pensamento. De um assombro devastador, recobra-se forças pelo acompanhar a decomposição de folhas e galhos no rio da memória, a potência heterogenética de microrganismos em articulação, a recomposição de raízes e ramificações de uma gramática onírica de um Pindorama que insiste em brotar no cimento desses tempos.