Prevalence of communicable, non-communicable diseases, disabilities and related risk factors in Khyber Pakhtunkhwa Pakistan:Findings from the Khyber Pakhtunkhwa Integrated Population and Health Survey (2016-17)

Introduction Pakistan is facing a triple burden of diseases: communicable diseases (CDs), non-communicable diseases (NCDs) and disabilities. There is limited evidence on the patterns of these diseases in Pakistan, specifically Khyber Pakhtunkhwa. Additionally there remains limited study on the impact of sex-, age and setting-stratified morbidities in Khyber Pakhtunkhwa. Objectives The objective of this study was to present the demographic characteristics and the burden of locally-specific CDs (hepatitis B and C, TB, AIDS), NCDs (diabetes, renal diseases, asthma, epilepsy, coronary heart diseases, cancer, hypertension, cholesterol, thalassemia), and disabilities (congenital, post-disease, post-injury, paralysis) stratified by sex, age and setting in the Khyber Pakhtunkhwa province of Pakistan. Material and methods The Khyber Pakhtunkhwa Integrated Population and Health Survey (KP-IPHS) was conducted in 2016–17 to gather comprehensive information about the demographic characteristics and locale-specific health-related issues of the people of Khyber Pakhtunkhwa, Pakistan. This cross-sectional survey was conducted in 24 districts across all 7 divisions of Khyber Pakhtunkhwa on population ageing ≥18 years. A total of 20704 respondents were taken from primary (n = 1061) and secondary sampling units (n = 15724), designed with considerations for urban/rural and socio-economic status. Each primary unit included 250–300 households. The sample selection utilised a multi-staged stratified systematic cluster sampling technique, involving the inclusion of every 16th household in rural areas and every 12th household in urban areas. Observations were recorded on demographics, quality of life, physical activity, BMI, disabilities, CDs and NCDs. Results Among all NCDs, hypertension has the highest prevalence (29.2%), showing a significant difference between females (32.7%) and males (25.0%). The proportion of males and females with diabetes is 7.4% and 5.2%, respectively, with a more substantial percentage (11.2%) observed in the ≥50 years’ age group compared to 2.5% in the 18–29 years’ age group and 5.0% in the 30–49 years’ age group. Among the included CDs, hepatitis B and C (0.5% and 0.8%, respectively) are most prevalent. Hepatitis B is more common in females (0.8%) and in rural settings (0.6%) compared to males (0.3%) and urban settings (0.2%), respectively. The prevalence of congenital disabilities is the highest of all disabilities, with a significantly high prevalence in females (5.3%) and rural settings (3.5%) compared to males (0.9%) and urban settings (0.6%) respectively. Furthermore, post-injury, post-disease disabilities, and paralysis significantly increase with age (P < 0.001). Conclusions Our findings show that the prevalence of CDs, NCDs and disabilities varies across sex, age and settings, with a notable prevalence in females and the old-age population (≥50 years). The results emphasise the necessity of public health efforts, such as screening, prevention, and treatment, to tackle the triple burden of CDs, NCDs, and disabilities in Khyber Pakhtunkhwa Pakistan

Decoding of Ankle Joint Movements in Stroke Patients Using Surface Electromyography

Stroke is a cerebrovascular disease (CVD), which results in hemiplegia, paralysis, or death. Conventionally, a stroke patient requires prolonged sessions with physical therapists for the recovery of motor function. Various home-based rehabilitative devices are also available for upper limbs and require minimal or no assistance from a physiotherapist. However, there is no clinically proven device available for functional recovery of a lower limb. In this study, we explored the potential use of surface electromyography (sEMG) as a controlling mechanism for the development of a home-based lower limb rehabilitative device for stroke patients. In this experiment, three channels of sEMG were used to record data from 11 stroke patients while performing ankle joint movements. The movements were then decoded from the sEMG data and their correlation with the level of motor impairment was investigated. The impairment level was quantified using the Fugl-Meyer Assessment (FMA) scale. During the analysis, Hudgins time-domain features were extracted and classified using linear discriminant analysis (LDA) and artificial neural network (ANN). On average, 63.86% ± 4.3% and 67.1% ± 7.9% of the movements were accurately classified in an offline analysis by LDA and ANN, respectively. We found that in both classifiers, some motions outperformed others (p &lt; 0.001 for LDA and p = 0.014 for ANN). The Spearman correlation (ρ) was calculated between the FMA scores and classification accuracies. The results indicate that there is a moderately positive correlation (ρ = 0.75 for LDA and ρ = 0.55 for ANN) between the two of them. The findings of this study suggest that a home-based EMG system can be developed to provide customized therapy for the improvement of functional lower limb motion in stroke patients

Areas of normal pulmonary parenchyma on HRCT exhibit increased FDG PET signal in IPF patients

Purpose: Patients with idiopathic pulmonary fibrosis (IPF) show increased PET signal at sites of morphological abnormality on high-resolution computed tomography (HRCT). The purpose of this investigation was to investigate the PET signal at sites of normal-appearing lung on HRCT in IPF. Methods: Consecutive IPF patients (22 men, 3 women) were prospectively recruited. The patients underwent 18F-FDG PET/HRCT. The pulmonary imaging findings in the IPF patients were compared to the findings in a control population. Pulmonary uptake of 18F-FDG (mean SUV) was quantified at sites of morphologically normal parenchyma on HRCT. SUVs were also corrected for tissue fraction (TF). The mean SUV in IPF patients was compared with that in 25 controls (patients with lymphoma in remission or suspected paraneoplastic syndrome with normal PET/CT appearances). Results: The pulmonary SUV (mean ± SD) uncorrected for TF in the controls was 0.48 ± 0.14 and 0.78 ± 0.24 taken from normal lung regions in IPF patients (p < 0.001). The TF-corrected mean SUV in the controls was 2.24 ± 0.29 and 3.24 ± 0.84 in IPF patients (p < 0.001). Conclusion: IPF patients have increased pulmonary uptake of 18F-FDG on PET in areas of lung with a normal morphological appearance on HRCT. This may have implications for determining disease mechanisms and treatment monitoring. © 2013 The Author(s)

Effect of glycemic control on tuberculosis treatment outcomes among patients with tuberculosis and diabetes mellitus:A systematic review and meta-analysis

Introduction: Tuberculosis (TB) and diabetes mellitus comorbidity can lead to poor TB treatment outcomes, particularly with uncontrolled blood glucose levels. Understanding the impact of glycemic control on TB treatment outcomes is essential. Objective: To synthesise evidence on the association between glycemic control and TB treatment outcomes in patients with TB and diabetes mellitus. Methodology: A systematic review was conducted using Medline, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Google Scholar for all types of studies published between 1975 and May 2024, including adult TB patients of >18 years of age, with or without diabetes mellitus for whom blood glucose testing along with TB treatment outcome comparison with glucose levels (low/high) was reported were considered for inclusion. A random-effects model was used for meta-analysis, heterogeneity was assessed using I-squared statistics, subgroup and sensitivity analysis was performed followed by publication bias assessment. Results: Of 576 identified studies, 12 met the inclusion criteria, analysing 2320 cases (1572 with uncontrolled high blood glucose [≥7% HbA1c] and 748 with controlled low blood glucose [<7% HbA1c]). Low certainty evidence shows that patients with uncontrolled high glucose had a 1.91 times higher risk of TB treatment failure (risk ratios [RR] = 1.91, 95% confidence interval [CI] 1.81–3.07, p = 0.008), and a 2.97 times higher risk of sputum positivity at 3 months (RR = 2.97, 95% CI 1.10–8.07, p = 0.03). Subgroup and sensitivity analyses showed significant improvement in pooled effects, lowering of heterogeneity and narrower CIs. For overall pooled effect, substantial heterogeneity was observed; therefore, the interpretation and generalisation of results should be done with caution. Conclusion: A low certainty evidence shows that uncontrolled high blood glycemic level significantly impacts TB treatment outcomes, increasing treatment failure and sputum positivity among TB patients with diabetes mellitus

Performance evaluation of phosphonium based deep eutectic solvents coated cerium oxide nanoparticles for CO2 capture

The critical challenge being faced by our current modern society on a global scale is to reduce the surging effects of climate change and global warming, being caused by anthropogenic emissions of CO2 in the environment. Present study reports the surface driven adsorption potential of deep eutectic solvents (DESs) surface functionalized cerium oxide nanoparticles (CeNPs) for low pressure CO2 separation. The phosphonium based DESs were prepared using tetra butyl phosphoniumbromide as hydrogen bond acceptor (HBA) and 6 acids as hydrogen bond donors (HBDs). The as-developed DESs were characterized and employed for the surface functionalization of CeNPs with their subsequent utilization in adsorption-based CO2 adsorption. The synthesis of as-prepared DESs was confirmed through FTIR measurements and absence of precipitates, revealed through visual observations. It was found that DES6 surface functionalized CeNPs demonstrated 27% higher adsorption performance for CO2 capturing. On the contrary, DES3 coated CeNPs exhibited the least adsorption progress for CO2 separation. The higher adsorption performance associated with DES6 coated CeNPs was due to enhanced surface affinity with CO2 molecules that must have facilitated the mass transport characteristics and resulted an enhancement in CO2 adsorption performance. Carboxylic groups could have generated an electric field inside the pores to attract more polarizable adsorbates including CO2, are responsible for the relatively high values of CO2 adsorption. The quadruple movement of the CO2 molecules with the electron-deficient and pluralizable nature led to the enhancement of the interactive forces between the CO2 molecules and the CeNPs decorated with the carboxylic group hydrogen bond donor rich DES. The current findings may disclose the new research horizons and theoretical guidance for reduction in the environmental effects associated with uncontrolled CO2 emission via employing DES surface coated potential CeNPs

Impact of ¹⁸F-fluciclovine PET/CT on salvage radiotherapy plans for men with recurrence of prostate cancer postradical prostatectomy

Objectives Imaging options to localize biochemical recurrence (BCR) of prostate cancer after radical prostatectomy (RP) are limited, especially at low prostate-specific antigen (PSA) levels. The FALCON study evaluated the impact of 18F-fluciclovine PET/CT on management plans for patients with BCR. Here, we evaluate salvage radiotherapy decisions in patients post-RP. Methods We conducted a subgroup analysis of post-RP patients enrolled in FALCON who had a prescan plan for salvage radiotherapy (± androgen-deprivation therapy). Patients’ treatment plans post-18F-fluciclovine PET/CT were compared with their prescan plans. Fisher exact test was used to determine the impact of PSA and Gleason sum on positivity and anatomical patterns of uptake. Results Sixty-five (63%) FALCON patients had undergone RP. Of these, 62 (median PSA, 0.32 ng/mL) had a prescan plan for salvage radiotherapy. Twenty-one (34%) had 18F-fluciclovine-avid lesions. Disease was confined to the prostate bed in 11 patients (52%) and to the pelvis in a further 5 (24%), while 5 (24%) had extrapelvic findings. Trends towards more disseminated disease with increasing PSA or Gleason sum were observed but did not reach statistical significance. Postscan, 25 (40%) patients had a management change; 17 (68%) were changed to the treatment modality (8 to systemic therapy, 8 to active surveillance, 1 other) and 8 (32%) were radiotherapy field modifications. Conclusions Incorporating 18F-fluciclovine PET/CT into treatment planning may help identify patients suitable for salvage radiotherapy, help augment planned radiotherapy to better target lesions and support the clinician to optimise patient management.</p

Effect of 18F-fluciclovine positron emission tomography on the management of patients with recurrence of prostate cancer: Results from the FALCON Trial

Purpose: Early and accurate localization of lesions in patients with biochemical recurrence (BCR) of prostate cancer may guide salvage therapy decisions. The present study, 18F-Fluciclovine PET/CT in biochemicAL reCurrence Of Prostate caNcer (FALCON; NCT02578940), aimed to evaluate the effect of 18F-fluciclovine on management of men with BCR of prostate cancer. Methods and Materials: Men with a first episode of BCR after curative-intent primary therapy were enrolled at 6 UK sites. Patients underwent 18F-fluciclovine positron emission tomography/computed tomography (PET/CT) according to standardized procedures. Clinicians documented management plans before and after scanning, recording changes to treatment modality as major and changes within a modality as other. The primary outcome measure was record of a revised management plan postscan. Secondary endpoints were evaluation of optimal prostate specific antigen (PSA) threshold for detection, salvage treatment outcome assessment based on 18F-fluciclovine-involvement, and safety. Results: 18F-Fluciclovine was well tolerated in the 104 scanned patients (median PSA = 0.79 ng/mL). Lesions were detected in 58 out of 104 (56%) patients. Detection was broadly proportional to PSA level; ≤1 ng/mL, 1 out of 3 of scans were positive, and 93% scans were positive at PSA &gt;2.0 ng/mL. Sixty-six (64%) patients had a postscan management change (80% after a positive result). Major changes (43 out of 66; 65%) were salvage or systemic therapy to watchful waiting (16 out of 66; 24%); salvage therapy to systemic therapy (16 out of 66; 24%); and alternative changes to treatment modality (11 out of 66, 17%). The remaining 23 out of 66 (35%) management changes were modifications of the prescan plan: most (22 out of 66; 33%) were adjustments to planned brachytherapy/radiation therapy to include a 18F-fluciclovine-guided boost. Where 18F-fluciclovine guided salvage therapy, the PSA response rate was higher than when 18F-fluciclovine was not involved (15 out of 17 [88%] vs 28 out of 39 [72%]). Conclusions: 18F-Fluciclovine PET/CT located recurrence in the majority of men with BCR, frequently resulting in major management plan changes. Incorporating 18F-fluciclovine PET/CT into treatment planning may optimize targeting of recurrence sites and avoid futile salvage therapy