A 33-year-old young male patient with a history of uncontrolled hypertension was referred to my clinic due to a 2-week fever, generalized body aches, shortness of breath, and easy fatigue. Clinical examination showed a toxic dyspneic patient, but conscious and well-oriented. His blood pressure was 170/100 mm Hg, pulse 90 beat/min, respiratory rate 15/min, and the temperature was 38.6°C. Cardiac examination showed a harsh systolic murmur at the mitral area radiating to the axilla. Abdomen examination revealed moderate splenomegaly and mild hepatomegaly. The rest of the examination was unremarkable.

Karishma

The soil samples were collected from Melia dubia plantations in two different locations in Tamil Nadu. A total of twenty five actinomycetes isolates were isolated and they were screened for melanin pigment production using different culture media. Only two isolates were able to produce melanin pigment under in vitro study and one isolate showed positive reaction to L-tyrosine substrate. Based on morphological and bio-chemical characters the isolate was identified as Streptomyces sp. The DNA of the isolate was isolated and its 16S rDNA gene was amplified and sequenced. The phylogenetic analysis of Streptomyces puniciscabiei was carried out.

Dr. saranya devi k

Background: Water distribution systems within healthcare facilities are complex ecosystems that can harbor opportunistic pathogens, posing a significant risk to patient safety. Ensuring the microbiological quality of water requires rigorous monitoring and a deep understanding of the entire system, from source to point-of-use. This study undertakes a comprehensive statistical analysis of microbiological data from a healthcare facility’s water treatment and distribution network to identify contamination hotspots, evaluate the efficacy of critical treatment barriers, and map potential contamination pathways. Methods: This retrospective case study analyzed heterotrophic plate count (HPC) data collected from 29 distinct sampling points throughout a healthcare facility’s water system. The points represented various stages, including municipal source water, intermediate treatment steps (softening, ultrafiltration, reverse osmosis), storage tanks, and multiple points-of-use. Non-parametric statistical methods were employed due to the non-normal distribution of microbial data. A Kruskal-Wallis test with Dunn's post-hoc analysis was used to compare microbial loads across all sampling points. A focused Mann-Whitney U test was performed to assess the performance of the ultrafiltration (UF) unit. Results: The analysis revealed significant variability in microbiological quality throughout the system (Kruskal-Wallis, p<0.0001). One point-of-use and a pre-UF exhibited high median microbial counts and extreme variability, indicating chronic contamination and potential biofilm proliferation. Critically, the ultrafiltration unit failed to demonstrate a statistically significant reduction in microbial load between the pre-filter. Conclusion: The data reveals variability in microbiological levels across the water system, suggesting that the ultrafiltration barrier's performance is a significant factor influencing downstream water quality. The data points to systemic issues, likely involving widespread biofilm, that compromise water quality at the points-of-use.

Mostafa eissa

Current research investigates the nuanced impact of the COVID-19 pandemic on consumption patterns in rural Maharashtra, India. Our research has two main goals. First, we want to understand how factors like age, gender, job, education, and family size have affected how people in rural Maharashtra spent money during the pandemic. Second, we want to find out which of these factors had the biggest impact on spending in different parts of the state. Since rural areas have their own unique economic situations, we know it's important to look at how the pandemic affected these communities specifically. We're using math and tables to analyze the information and provide a detailed look at how the pandemic immediately changed spending habits and what it might mean for the future in rural households. This research is not only timely but also essential for informing policy decisions aimed at supporting rural communities in the aftermath of the pandemic. By unraveling the intricate dynamics of consumption in rural Maharashtra, we contribute to a deeper understanding of the economic challenges faced by these communities and provide insights that can guide targeted interventions to foster resilience and recovery.

Nandini jagannarayan

The increasing prevalence of Artificial Intelligence (AI) in creating content signifies a notable change in the digital communication landscape. While the broader effects on widespread media platforms have been extensively discussed, the specific consequences within specialized online communities remain less explored. These communities, frequently founded and established on shared interests, mutual confidence, and perceived genuineness, are particularly susceptible to alterations in the origin and trustworthiness of content. This paper challenges three questions: (1) How AI content affects credibility perceptions, (2) Verification methods used by communities, (3) Consequences for trust dynamics. A hypothetical framework would be used to investigate the potential impact of AI-produced content on the dynamics of trust and credibility within these focused digital environments. By drawing upon existing academic work in media studies, the behavior of online communities, and the concept of source credibility, a theoretical model and outline a potential research strategy were encouraged to examine how the presence, identification, and interpretation of content authored by AI might modify member interactions, processes for verifying information, and the overall unity of the community. The hypothetical outcome suggests that the subtle integration of AI content could diminish perceived authenticity, complicate established indicators of trust, and potentially lead to the fragmentation or decline of communities that depend on authentic human connection and collective expertise. The article concludes by considering the ramifications for those who manage communities, design platforms, and participate as members, stressing the importance of greater openness and digital literacy in navigating the evolving digital media landscape.

Mostafa eissa

Bhaishajya kalpana is an art and science of preparing and dispencing medicine. Guggulu is a Niryasa (oily latex) achieved from small tree called Indian bedellium. Botanical name is commiphora mukul. Guggulu is an amorphous, translucent, solid adhesive, oleo-gum resin is produced by the process of gummosis from its plant. Many other Ayurvedic classics have mentioned various formulations of Guggulu for the treatment of various ailments. Bhashajya ratnawali followed various kalpana use for formuations. Guggulu kalpana is secondary formulations of bhaishajya kalpana. . Guggulu is one among the best binding agents and its used as single or compound drug in the form of pills, Formulations which contains Guggulu as main ingredient, they can be called as Guggulu kalpana. Here in Bhaishajya Ratnawali, Guggulu is used in yoga for both purposes, as a base and as well as medicament also.In bhaishajya Ratnavali Guggulu when modified into different formulations. It can also be used in many diseases along with different combinations of drugs with their anupana, Guggulu kalpana beneficial in treating many diseases. The Guggulu Kalpana is indicated in almost all the strotovikaras and also a number of research works have been proved the wide range of action of Guggulu .

Suri abhiram

The aim of this study is to identify the move from cultural to creative cultural tourism as new model for meeting tourists' demands for creative experiences. Hence, traditional cultural tourism must reinvent itself as creative tourism for those creative tourists seeking more interactive experiences. This new trend in creative cultural tourism has emerged from the changes in the production of cultural tourist commodities, the skilled tourist activities, and new consumption patterns. Moreover, creative cultural tourism can solve those problems experienced by traditional cultural tourists. A literature review confirmed that a move to creative cultural tourism, or intangible heritage (i.e., linguistic diversity or gastronomy), from tangible cultural attractions (i.e., museums, monuments, and so forth) increases the attractiveness of tourism destinations. In addition, this study explains the transformation from traditional cultural to creative cultural tourism.

Mukhles m. al-ababneh

In the modern world, Tuberculosis (TB) is regarded as a serious health issue with a high rate of mortality. TB can be cured completely by early diagnosis. For achieving this, one tool utilized is CXR (Chest X-rays) which is used to screen active TB. An enhanced deep learning (DL) model is implemented for automatic Tuberculosis detection. This work undergoes the phases like preprocessing, segmentation, feature extraction, and optimized classification. Initially, the CXR image is preprocessed and segmented using AFCM (Adaptive Fuzzy C means) clustering. Then, feature extraction and several features are extracted. Finally, these features are given to the DL classifier Deep Belief Network (DBN). To improve the classification accuracy and to optimize the DBN, a metaheuristic optimization Adaptive Monarch butterfly optimization (AMBO) algorithm is used. Here, the Deep Belief Network with Adaptive Monarch butterfly optimization (DBN-AMBO) is used for enhancing the accuracy, reducing the error function, and optimizing weighting parameters. The overall implementation is carried out on the Python platform. The overall performance evaluations of the DBN-AMBO were carried out on MC and SC datasets and compared over the other approaches on the basis of certain metrics.

Dr h shaheen

Recent reports showed an association between bariatric surgery and the development of acute pancreatitis. This report presents a case of acute pancreatitis following a laparoscopic sleeve gastrectomy (LSG) in a 24-year-old Indian female patient, who presented to the Emergency Department at Hamad General Hospital, Qatar, with severe epigastric pain and persistent vomiting 13 days after LSG. She was diagnosed with acute pancreatitis based on a high level of lipase greater than three times the upper limit of normal, and a computed tomography scan of the abdomen, which was consistent with acute pancreatitis. The patient was treated conservatively with a significant improvement in her symptoms and laboratory tests throughout her admission and consequently was discharged.

Karishma

Background: Prescribing patterns in systemic hypertension vary from place to place. Studies have shown that cost could be one of the factors responsible for non-adherence to treatment among hypertensive patients. Nigerian pharmacoeconomics studies have not provided a general guide on cost-effective prescribing for hypertensive patients in the country. The aim of the study was to examine the prescribing patterns, do cost effectiveness and cost minimisation analyses of the commonly prescribed antihypertensives, and determine if cost is a major reason many of the hypertensive patients of the District Hospital are usually lost to follow up. Methods: 5267 adult (≥18 years) non-antenatal patients’ cards of 2016 were reviewed for hypertension. Examination of the prescriptions, cost-effectiveness and cost-minimisation analyses of the commonly prescribed antihypertensives were done. Results: 12.6% of the patients were hypertensive. 73% of these hypertensive patients were treated pharmacologically. 40.8% adhered to treatment. 73% of the adherent ones responded to treatment. Amlodipine was the most expensive prescribed antihypertensive (N22). Amiloride-hydrochlorothiazide with the largest cost effectiveness ratio (CER) (9) was the most cost effective of all the combinations. Lisinopril- hydrochlorothiazide (N17) was preferable to the triple combination of lisinopril-amlodipine-hydrochlorothiazide (N39), and amlodipine-hydrochlorothiazide (N32) in cost minimisation. Conclusions: Cost of drugs probably had played a significant role in non-adherence to treatment among hypertensive patients in the District Hospital in 2016, since moduretic with the largest CER (9) and nifedipine with the greatest BP reduction when combined with hydrochlorothiazide (56/22 mm Hg) were rarely prescribed.

Emmanuel umegbolu

Les études sur la langue française la présente souvent dans des situations où elle est en contact avec les langues africaines. Elle co-apparait avec les langues africaines dans les discours romanesques. Cette co-apparition n’est pas sans conséquences pour les deux langues en contact. Certains linguistes, surtout les sociolinguistes et les didacticiens, parlent d’insécurité linguistique. Ils la lient à toutes les situations linguistiques où deux langues entrent en contact. Ngamassu (2007, p.94) dit dans ce sens que « toute situation de contact des langues est source d’insécurité linguistique, car aucun locuteur/scripteur ne peut maîtriser toutes les variétés ou niveaux d’une langue ». Cette affirmation restreint l’insécurité au locuteur ou au scripteur. Les linguistes ignorent souvent l’impact négatif du contact des langues et s’intéressent à ses conséquences positives. Cet article a porté sur les manifestations de l’insécurité linguistique dans la prose romanesque de Kourouma et Badaman. Il a permis de voir que l’usage des langues maternelles dans le français constituait une menace de disparition et d’abâtardissement de la langue française.

Assanvo

The study aims to explore the possible morphological features of calcium hydrogen phosphate dihydrate (brushite) crystals on a glass slide. The study was conducted on a glass slide under a microscope to observe the growth patterns. As a result, needle, platy, star shape, and tetragonal bipyramidal crystals were observed. Different patterns of platy crystals, like plates with spatial branches and radiating assemblages of platy crystals, were also found.

Dr. salman ahmed

The blunted nose cone with and without a sharp aerospike and an aerodisk of various diameters and lengths are investigated numerically in detail in the current study at a hypersonic Mach number of 10. The aerodisk diameter is described as d/D ratios such as 0.2, 0.4 and 0.6, and the length of the aerospike is represented as the L/D ratio of 1, 1.5 and 2. The main objective of the research is to examine the aerodynamic properties of blunt noses with and without aerodisks and aerospikes, as well as the influence of shock production over the model. The design of blunted nose cones with aerodisk was made up using CATIA and numerical investigation was performed on the ANSYS Fluent. The turbulence model of SST k-omega was considered for study. The current study revealed that shock patterns drastically varied nearer to the nose cone model at L/D ratio 2 and variation of drag reduction occurred due to the increase in d/D ratio and aerospike and also flow pattern over the model was clearly investigated.

Boopathy govindarajan

Justificativa e objetivo: O uso inadequado da estatística básica é o maior responsável peloerro de interpretac ̧ão dos artigos científicos. O objetivo deste artigo de revisão foi rever algunstópicos básicos de estatística para alertar autores e leitores sobre a importância do relatoadequado da estatística básica.

Kamal singh

Background: Pregnancy-related hormonal changes increase the risk of gingival inflammation and bleeding. Poor oral hygiene and dietary habits, such as frequent intake of sugary foods, may worsen this risk. Understanding the relationship between diet, oral hygiene, and gingival health in pregnant women is essential for improving prenatal care. This study aimed to assess dietary patterns, oral hygiene practices, and self-reported gingival bleeding among pregnant women attending the Mother and Child Hospital, Ondo, Nigeria. Methods: A descriptive cross-sectional study was conducted over four months among 216 pregnant women at the Mother & Child Clinic, University of Medical Sciences Teaching Hospital, Ondo, Southwest Nigeria. A structured, self-administered questionnaire collected data on sociodemographic characteristics, oral hygiene habits, perceived oral health conditions, and dietary patterns. Clinical oral examinations were conducted using the Oral Hygiene Index. Data were analyzed using SPSS version 25, with p < 0.05 considered significant. Results: Most participants (79.2%) were in their second or third trimester. Although 83.3% used toothbrushes and 52.3% brushed twice daily, 39.8% had poor oral hygiene, and 33.3% reported gingival bleeding. Despite 76.4% awareness of dental services, 53.2% had never visited a dentist. Most participants frequently consumed fruits (88.9%), vegetables (84.8%), and animal proteins (84.7%), while 43.0% consumed sugary drinks regularly. No significant association was found between dietary habits and gingival bleeding. Conclusion: The study revealed a clear awareness–behavior gap: good knowledge of oral health did not translate into optimal hygiene practices or dental visits. Poor oral hygiene remained common, and gingival bleeding was prevalent. Although most participants had healthy diets, sugary drink intake was still high. Diet alone was not protective against gingival bleeding. Promoting effective oral hygiene and integrating dental care into prenatal programs is recommended.

Karishma

Pedagogical leadership has become an emerging and essential debate in the field of educational administration and leadership. This was a result of the shift from the hierarchical type in the past to a more inclusive, collaborative, and participative leadership. Previous studies indicate the furtherance of the inquiry into pedagogical leadership since it is a work in progress. For this reason, a systematic literature review mapped the literature relevant to pedagogical leadership. The review drew the lines between the empirical and theoretical-conceptual contributions, including the methodologies considered in both contributions. The results have implications for a more robust theoretical-empirical model or framework of pedagogical leadership applicable to specific levels of education, especially higher education contexts. The study also implies applying pedagogical leadership in the team, at departmental and organizational levels. Results imply promoting the culture of pedagogical leadership.

Manuel caingcoy

Background: Emerging data found that Type 2 diabetes mellitus (T2DM) is associated with Vitamin D deficiency at various frequencies. This study aims to estimate the prevalence of Vitamin D deficiency in T2DM patients in Qatar and the correlation between Vitamin D deficiency and other variables such as dyslipidemia, glycemic control, and microalbuminuria. Methods: This retrospective cross-sectional analytical study was conducted in the medical outpatient clinic at Hamad General Hospital. The study involved adult patients (≥18 years) with T2DM. The study covered patients admitted between January 1, 2018, and July 31, 2018. Ethical approval was obtained from the Medical Research Committee. Results: We recruited 400 subjects with T2DM. Their mean age was 58.97±10.32 years, and the majority were women (52.0%) and Arabs (69.5%). The mean duration of Type 2 diabetes diagnosis was 14.94±8.99 years. The prevalence of Vitamin D deficiency was 29.5%. A comparison between Vitamin D deficiency and non-vitamin D deficiency groups showed a statistically significant difference in terms of fasting blood (FB) sugar (p<0.001), random blood (RB) sugar (p<0.001), hemoglobin A1c (HBA1c) (p<0.001), total cholesterol (P = 0.001), low-density lipoprotein cholesterol (LDL [C]) (p=0.004), high-density lipoprotein cholesterol (HDL [C]) (p<0.001), triglyceride (p<0.001), and urinary albumin excretion rate (UAER) (p=0.007). Data analysis showed that a significant negative correlation was found between Vitamin D level and FB sugar (r=−0.208, p<0.001), RB sugar (r=−0.20, p<0.001), HBA1c (r=−0.260, p<0.001), total cholesterol (r=−0.218, p<0.001), LDL (C) (r=−0.176, p=0.004), triglyceride (r=−0.342, p<0.001), and UAER (r=−0.184, p=0.007). Conclusion: Our study showed a significant correlation between Vitamin D deficiency and the poor control of T2DM, dyslipidemia, and microalbuminuria. The results emphasize the importance of monitoring Vitamin D status in high-risk populations.

Karishma

The growing study of foreign policy change offers various explanations of change and continuity in foreign policy. By focusing on the actors of foreign policy decision-making, past scholarship has mainly concentrated on the role of institutional and noninstitutional factors in foreign policy change. However, decentralized decision-making is more relevant to democratic regimes than authoritarian regimes. Despite the abundance of case studies on foreign policy making in nondemocracies, advancements in the conceptual understanding of foreign policy change in authoritarian regimes are still needed. Addressing Uzbekistan’s foreign policy, this article proposes an advanced framework to explain why and how foreign policy change takes place under authoritarian leaders. A leader’s perception of the external environment is argued to be a decisive factor inducing authoritarian leaders to (re)consider their regime survival strategy. Concern with regime survival, in turn, shapes foreign policy goals which are manifested in distinctive foreign policy behavior of a leader. Ultimately, the behavior of a leader translates into certain foreign policy outcomes.

Feruza madaminova

The study aimed to determine the effectiveness of gamifying instruction in the English language proficiency of Grade 8 Filipino ESL students in one University in Bicol, Philippines, that offers Junior High School. The quasi-experimental single pretest-posttest design was used in the study. The researcher-made test which underwent series of validation was given before and after the intervention period to determine the level of English proficiency and level of effectiveness of the games. Statistical treatment was done employing frequency count, T-test and Analysis of Variance (ANOVA). The findings revealed that there was significant difference between the pretest and posttest of the respondents using gamification. Thus, it can be inferred that the games helped in improving the level of English proficiency of the Grade 8 students. The statistical test results disclosed further that the effectiveness of the three games introduced to the students were significantly high. With these findings, it was recommended that language teachers should use gamification as supplementary instructional material in improving the English proficiency of the students.

Darrel ocampo

The drug-drug interactions (DDIs) are actions or events that occur when two or more drugs administered together, may cause a clinical significance or not. There are certain factors that may affect the severity of DDIs such as age, gender, number of drugs prescribed, and physician specialists. This study aims to answer: Is there DDI in Libyan community pharmacies? In addition, to explore the factors that might be affecting DDI. Drug Interactions Checkers are used. 200 prescriptions were collected randomly from two different areas ( high and low income),100 from each one and were used to investigate the DDIs by using two different sources (Drugs.com and BNF platforms), bearing in mind, age, gender, prescribers’ specialty, and drug number (prescription size). A personal interview questionnaire with pharmacists for investigate a source of DDI knowledge was considered. The correlation test was used to analysis the findings. The randomly selected sample has 316 drug combinations. The study has revealed a minimum of three drugs (46.0%). In general, Drugs.com was the richer source of DDI than BNF (66.5% and 34.5%, respectively). It is found that 66.5% (67.0% of this is moderate DDI) of these combinations have DDI by Drugs.com. A significant correlation between DDI and gender (male > female, p = 0.035) was found. In a state of residential areas, the results are similar in both selected pharmacies. Most moderate DDIs (21.0% and 15.0%) are prescribed by orthopedics and psychiatrists, respectively. The observational interview questionnaire indicated that 100% of the participating pharmacists had no source of knowledge regarding DDI, 100% of 200 prescriptions had no chick it regarding DDI and 100% of found DDI is released to use by community pharmacies to patients. More than half of the prescribed drug combinations have DDIs (classified as moderate DDIs), and all of them are released for use by pharmacists.

Mediterranean journal of pharmacy and pharmaceutical sciences