With the increasing pace in the industrial sector, the need for a smart environment is also increasing and the production of industrial products in terms of quality always matters. There is a strong ...burden on the industrial environment to continue to reduce impulsive downtime, concert deprivation, and safety risks, which needs an efficient solution to detect and improve potential obligations as soon as possible. The systems working in industrial environments for generating industrial products are very fast and generate products rapidly, sometimes leading to faulty products. Therefore, this problem needs to be solved efficiently. Considering this problem in terms of faulty small-object detection, this study proposed an improved faster regional convolutional neural network-based model to detect the faults in the product images. We introduced a novel data-augmentation method along with a bi-cubic interpolation-based feature amplification method. A center loss is also introduced in the loss function to decrease the inter-class similarity issue. The experimental results show that the proposed improved model achieved better classification accuracy for detecting our small faulty objects. The proposed model performs better than the state-of-the-art methods.
Malnutrition a health disorders arising due to over or low use of minerals, vitamins and nutritional substances required for proper functioning of body tissues and organs. Zinc (Zn) is the most ...important mineral required for the normal metabolism of plants and humans. Zinc-deficiency is one of the major cause of malnutrition globally. Maize is highly susceptible to Zn-deficiency and inflicts Zn-deficiency to humans and other animals being nourished on it. This study evaluated the effect of zinc-lysine chelate alone (0.1, 0.5, 1.0 and 1.5%) as seed priming and in combination with Zn-solubilizing bacteria (PMEL-1, PMEL-48, PMEL-57and PMEL-71)) on grain biofortification of autumn maize. The Zn accumulation in different parts (roots, stem, leaves, grains and cob pith) was quantified. Results indicated that Zn contents were 18.5% higher in the seeds primed with 1.5% solution of Zn-lysine chelate and inoculation of ZSB strains compared to control treatments. Seed priming with 1.5% Zn-lysine chelate in combination with ZSB inoculation significantly improved cob diameter and cob length by 16.75% and 42% during 2016 and by 11.36% and 34.35% during 2017. The increase in 100 grains weight over control was 18.4% and 15.27% for 2016 and 2017, respectively. The Zn contents were increased by 15.3%, 15.6%, 49.1%, and 33.0% in grain, cob-pith, stemand roots, respectively compared from control. Thus, the combined application of 1.5% Zn-lysine chelates along with ZSB inoculation could be used for combating malnutrition.
In the current study, unexplored type IV halogen⋯halogen interaction was thoroughly elucidated, for the first time, and compared to the well-established types I−III interactions by means of the ...second-order Møller−Plesset (MP2) method. For this aim, the halobenzene⋯halobenzene homodimers (where halogen = Cl, Br, and I) were designed into four different types, parodying the considered interactions. From the energetic perspective, the preference of scouted homodimers was ascribed to type II interactions (i.e., highest binding energy), whereas the lowest binding energies were discerned in type III interactions. Generally, binding energies of the studied interactions were observed to decline with the decrease in the σ-hole size in the order, C6H5I⋯IC6H5 > C6H5Br⋯BrC6H5 > C6H5Cl⋯ClC6H5 homodimers and the reverse was noticed in the case of type IV interactions. Such peculiar observations were relevant to the ample contributions of negative-belt⋯negative-belt interactions within the C6H5Cl⋯ClC6H5 homodimer. Further, type IV torsional trans → cis interconversion of C6H5X⋯XC6H5 homodimers was investigated to quantify the π⋯π contributions into the total binding energies. Evidently, the energetic features illustrated the amelioration of the considered homodimers (i.e., more negative binding energy) along the prolonged scope of torsional trans → cis interconversion. In turn, these findings outlined the efficiency of the cis configuration over the trans analog. Generally, symmetry-adapted perturbation theory-based energy decomposition analysis (SAPT-EDA) demonstrated the predominance of all the scouted homodimers by the dispersion forces. The obtained results would be beneficial for the omnipresent studies relevant to the applications of halogen bonds in the fields of materials science and crystal engineering.
Objective: To identify factors causing diagnostic and therapeutic delay in patients with rheumatoid arthritis, and to evaluate relationship of diagnostic and therapeutic delay with disease outcome.
...Methods: This cross-sectional study was conducted in Rheumatology Department, Fatima Memorial Hospital, Lahore, Pakistan, from May 2018 to July 2018. In this study 102 patients fulfilling ACR/EULAR criteria 2010 were enrolled. Lag times were calculated in months: lag-1 (delay in initial medical consultation); lag-2 (delay in consulting rheumatologists); lag-3 (diagnostic delay); lag-4 (therapeutic delay). Disease activity and functional outcome were measured by DAS28, HAQ-DI respectively. Association of lag-3 and lag-4 with HAQ-DI and DAS28 was calculated by Pearson correlation.
Results: Median (IQR) disease duration of study group was 6(2-10) years. Initial consultations were with; orthopedic surgeon 40(39.2%), general practitioner 27(26.5%), rheumatologist 13(12.7%), medical specialists 14(13.7%). Median (IQR) lag times in months: lag-1 (delayed initial consultation): 2(0-5), lag-2 (delay in consulting rheumatologist): 30(7.7-72), lag-3 (diagnostic delay): 12(3-48), lag-4 (therapeutic delay):18(5.7-72). Factors attributed to lag-3 (diagnostic delay) and lag-4 (therapeutic delay) (p<0.05): older Age (r= 0.2), education level (r= - 0.2), initial consultation (non-rheumatologist) (r=0.2), lag-2(r=0.8), >three doctors visited before diagnosis(r=0.6). Positive anti-CCP antibodies(r=0.2) and lag-1 (delayed initial consultation) (r=1) were associated with lag-3 (diagnostic delay) only; no association was found with positive RA factor. Significant correlation (p=<0.05) of lag-3 (diagnostic delay) was found with both DAS28(r=0.2) & HAQ-DI(r=0.2). Similarly lag-4 (therapeutic delay) also correlated with both & DAS28(r=0.2) & HAQ-DI(r=0.3) (p=<0.05).
Conclusion: Diagnostic and therapeutic delay were associated with older age, lower education and delayed consultation with rheumatologist but not with positive RA factor. Positive anti-CCP antibodies were associated with diagnostic delay only. Diagnostic and therapeutic delay led to high disease activity and poor functional outcome in RA patients.
doi: https://doi.org/10.12669/pjms.37.4.3471
How to cite this:Naeem F, Khan SEA, Saeed MA, Farman S. Diagnostic and therapeutic delay in Rheumatoid Arthritis patients: Impact on disease outcome. Pak J Med Sci. 2021;37(4):1001-1007. doi: https://doi.org/10.12669/pjms.37.4.3471
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.
ABSTRACT Objective: To determine the short-term efficacy and safety of Secukinumab in Pakistani patients with ankylosing spondylitis and psoriatic arthritis in regular clinical practice. Study ...Design: Case series. Place and Duration of Study: Department of Rheumatology, National Hospital and Medical Centre, Lahore Pakistan from Aug 2019 to Feb 2021. Methodology: Patients diagnosed with ankylosing spondylitis according to assessment of spondyloarthritis International Society criteria and psoriatic arthritis according to classification criteria for psoriatic arthritis (CASPAR), who were started on Secukinumab, were enrolled. Disease activity scores and adverse events were recorded in the 12th and 24th weeks. The primary outcomes were remission and low disease activity, and the secondary outcomes were the recording of Adverse events on each visit. Results: There were 42 patients registered. The mean duration of disease was 11.86±7.31 years for AS and 9.19±4.87 years for PsA patients. At 24 weeks of follow-up, 10% of patients discontinued treatment, 73.7% of AS patients, and 94.7% of PsA patients achieved complete remission or low disease activity. No significant AEs were noted at 24 weeks, except for upper respiratory tract infections. One patient developed a lower respiratory tract infection after 24 weeks of treatment, and one died during treatment (possible myocardial infarction). Conclusion: Secukinumab was effective and safe in patients with Ankylosing Spondylitis and Psoriatic Arthritis in this study, despite advanced disease with long disease duration.
Indian siris, Albizia lebbeck (L.) Benth. (Fabaceae: Mimosoideae) has significant importance to human beings for its multipurpose use. Insects play a crucial role in the pollination biology of ...flowering plants. In the current study, we studied the pollination biology of A. lebbeck with special reference to insect floral visitors. The effectiveness of floral visitors was investigated in term of visitation frequency, visitation rate and pollen load during 2012 and 2013. In the second experiment, effect of pollinators on yield of A. lebbeck was studied in open and cage pollination experiments. Floral visitor fauna of A. lebbeck included eight-bees, two wasps, two flies, and two butterflies species. Among them, Apis dorsata, Apis florea, Amegilla cingulata, and Nomia oxybeloides had maximum abundance ranging from 349–492, 339–428, 291–342 and 235–255 numbers of individuals, respectively during two flowering seasons. A. dorsata had the highest visitation frequency (6.44 ± 0.49–8.78 ± 0.48 visits/flower/5min) followed by Amegilla cingulata (6.03 ± 0.43–7.99 ± 0.33 visits/flower/5min) and A. florea (3.61 ± 0.31–4.44 ± 0.18 visits/flower/5min). A. dorsata, N. oxybeloides, and Amegilla cingulata had the highest visitation rates (18.904 ± 1.53–11.43 ± 1.17 flower visited/min) and pollen load (15333 ± 336.22–19243 ± 648.45 pollen grains). The open pollinated flowers had significantly higher capsule weight (4.97 ± 0.21 g), seed weight (1.04 ± 0.05 g), seed numbers per pod (9.80 ± 0.34) and seed germination percentage (84.0 ± 1.78%) as compared to caged flowers. The results suggested bees especially A. dorsata, N. oxybeloides and Amegilla cingulata could be effective pollinators of A. lebbeck.
Aims
To determine the prevalence of inflammatory back pain (IBP) and radiographic axial spondyloarthritis (SpA) in a semi‐urban community of Lahore, Pakistan.
Methods
This cross‐sectional household ...survey was designed as per the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) model. In Phase 1, the subjects were interviewed for musculoskeletal (MSK) pain in the last 7 days by clinical assistants. In Phase 2, physiotherapists identified subjects with spinal/back pain and interviewed for Assessment in Spondyloarthritis International Working Group (ASAS) criteria for IBP. In Phase 3 subjects having IBP or chronic back pain (CBP) with an age at onset ≤45 years, were assessed and further investigated.
Results
A total of 4922 subjects with a mean age of 35.3 ± 14.5 years, including 2770 (56%) women were surveyed in Phase 1. MSK pain in last 7 days was reported by 1407 (28.6%) of whom 1034 (21%) had spinal pain. The ASAS criteria for IBP were met in 329 (6.7%, 95% CI 6.0‐7.0). In Phase 3, 222 with IBP and 83 having CBP with age at onset ≤45 years were evaluated. Out of this total of 305, 144 (2.9%) were confirmed to have IBP by rheumatologists as per at least 1 of the 3 criteria. ASAS criteria were met in 107 (2.2%, 95% CI 1.8‐2.6). ASAS criteria for radiographic axial SpA were met in 47 (1%, 95% CI 0.7‐1.3) of the surveyed population.
Conclusion
Inflammatory back pain was reported in 6.7% by physiotherapists, confirmed in 3% by rheumatologists. The prevalence of radiographic axial SpA was 1%.
In this work, three new bis-Schiff bases, namely 1,1'-(2,2'-dibromo-1,1'-biphenyl-4,4'-diyl)bis(
-phenylmethanimine) (BNSB01), 1,1'-(2,2'-dibromo-1,1'-biphenyl-4,4'-diyl)bis(
...-(4-bromophenyl)methanimine) (BNSB02) and 4,4'-(((2,2'-dibromo-1,1'-biphenyl-4,4'-diyl)bis(methanylylidene))bis(azanylylidene))diphenol (BNSB03), were synthesized. These Schiff bases were evaluated for their corrosion inhibition ability on mild steel specimens in 0.5 M HCl by using electrochemical and weight loss techniques. The inhibition performance was found to increase with an increase in the inhibitor concentration and decrease with an increase in temperature. The results revealed that the synthesized compounds followed the Langmuir isotherm model and were efficient mixed-type inhibitors. The electrochemical impedance studies also indicated that with a rise in the concentration of inhibitors, the charge transfer resistance increased. The surface morphology of the inhibited and uninhibited specimens was examined using scanning electron microscopy (SEM). The efficiency of the compounds was in the order BNSB02 > BNSB03 > BNSB01. All the results obtained were in good correlation with each other.
This study investigated pollinator assemblage diversity and richness in four forested ecosystems of southern Punjab, Pakistan, with different landscape types. Pirowal is situated in the plains of ...irrigated Punjab, Lal Suhanra is part of a sandy desert ecosystem, Ghazi Ghat is part of the Indus River delta, and Fort Munro is located in dry hilly mountains. A yearlong survey of pollinator populations was carried out in these four forested ecosystems from January to December of 2010. Fortnightly hand netting was performed for collecting flower-visiting insects whereas, pan traps of three colors (white, blue, and yellow) were deployed for collecting the data. A total of 8,812 individuals from two orders (Lepidoptera and Diptera) were observed, including 22 families and 154 species. Bees were the most abundant, with 4,502 individuals, and the most species-rich taxa, with 70 species in five families, followed by flies having 2,509 individuals and 51species in 10 families. Wasps were the least abundant with 1,801 individuals and 33 species in seven families. The assemblage structure of pollinator communities as visualized through rank abundance curves showed that there were many species with low abundance and only a few species with a much higher abundance. The most abundant species among the bees, in order, were Nomia sp.3, Megachile bicolor, and Colletes sp.3; among flies, Syrphus sp.2, Calliphoridae sp.1, and Empididae sp.4; and among wasps, Tiphiidae sp.1, Myzininae sp.2, and Scelionidae sp.1.
Objective: To determine the real-world efficacy and safety of subcutaneous Tocilizumab in patients with rheumatoid arthritis.
Study Design: Case series.
Place and Duration of Study: Department of ...Rheumatology, National Hospital and Medical Centre, Lahore Pakistan, from Aug 2019 to Dec 2020.
Methodology: In this study, 33 patients receiving subcutaneous Tocilizumab 162 mg every two weeks as monotherapy or with conventional synthetic disease modifying anti-rheumatic drugs were followed per standard study protocol. Increasing or decreasing the dosing interval was allowed according to disease activity at the discretion of the treating rheumatologist. The primary outcome was patients achieving Low Disease Activity as per Clinical Disease Activity Index (>2.8-10.0) and Disease Activity Score-28(>2.6-3.2). The secondary outcome was a clinically meaningful improvement in Disease Activity Score -28 (reduction of ≥1.2 units in Disease Activity Score-28 score). Adverse events were recorded at each follow-up visit.
Results: Of the 33 patients, 25(75.8%) were biologics-naive, 9(27.2%) patients achieved the target of Low Disease Activity as per Clinical Disease Activity Index (2.9-10.0) and 8(24.2%) patients achieved Low Disease Activity as per Disease Activity Score-28(2.7-3.2). At six months, the proportion of patients achieving clinically meaningful improvement (decrease ≥1.2) in Disease Activity Score -28 was 13(54.2%). Overall, 14(42.4%) patients developed adverse events and 3(9.1%) patients discontinued Tocilizumab owing to adverse events.
Conclusion: Tocilizumab has been seen to be an effective biologic in only one-third of patients, and it was tolerated in twothirds of the patients.Keywords: Conventional synthetic disease modifying anti-rheumatic drugs, Efficacy, Rheumatoid arthritis, Safety, Subcutaneous tocilizumab.
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