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Pakistan is currently facing the largest outbreak of ceftriaxone-resistant Salmonella enterica serotype Typhi described to date. Here we aimed to report the outbreak investigation done in Hyderabad, Pakistan, and identify disease risk factors. We did an age-matched case-control (1:4) study, in which cases of ceftriaxone-resistant S Typhi were identified from active sentinal sites (three hospitals in Hyderabad, Pakistan), community, and laboratory-based surveillance. Ceftriaxone-resistant S Typhi infection (ie, resistance to ampicillin, chloramphenicol, co-trimoxazole, fluoroquinole, and ceftriaxone) was confirmed using blood culture. Healthy participants (controls) were enrolled for the first 200 people (cases) with ceftriaxone-resistant S Typhi. A structured questionnaire was administered to identify exposures 4 weeks before the illness (cases) or enrolment (controls). Cases were included if written informed consent was provided. Four controls were selected from the same community as the corresponding case, matched on age, being healthy at the time of enrolment, and with no febrile illness in the 4 weeks before enrolment. Samples of drinking water from households and community water sources (ie, hand pumps or taps in common areas outside households) were collected for testing. Conditional logistic regression analysis was used to assess the risk factors for ceftriaxone-resistant S Typhi outbreak in Hyderabad. Between Nov 30, 2016, and Dec 30, 2017, 486 people with ceftriaxone-resistant S Typhi were identified from Hyderabad. Of the 486 cases, 296 (61%) were male and 447 (92%) were aged 15 years or younger. Several factors were significantly associated with acquisition of ceftriaxone-resistant S Typhi, including male sex (adjusted odds ratio [aOR] 1·53, 95% CI 1·06–2·21), eating outside of the house (aOR 1·48, 1·01–2·19), exposure to a patient with S Typhi infection (aOR 3·81, 2·21–6·83), and a history of antimicrobial use (aOR 4·25, 2·53–7·13). Nine (69%) of 13 water samples taken from the households of people with ceftriaxone-resistant S Typhi infection were positive for Escherichia coli, indicating faecal contamination. S Typhi DNA was detected in 12 (22%) of 55 water samples from community water sources. Geospatial mapping showed clustering of cases around sewerage lines. Hyderabad faces the largest reported outbreak of ceftriaxone-resistant S Typhi. The outbreak is suspected to be attributed to the contaminated drinking water, especially the mixing of sewage with drinking water. The risk of ceftriaxone-resistant S Typhi infection is increased among children aged 15 years and younger, male individuals, and those eating outside the house. Vaccination and chlorination of water are recommended for the containment of the outbreak. None.

Advancements in neuromorphic computing have given an impetus to the development of systems with adaptive behavior, dynamic responses, and energy efficiency characteristics. Although charge-based or emerging memory technologies such as memristors have been developed to emulate synaptic plasticity, replicating the key functionality of neurons—integrating diverse presynaptic inputs to fire electrical impulses—has remained challenging. In this study, we developed reconfigurable metal-oxide-semiconductor capacitors (MOSCaps) based on hafnium diselenide (HfSe 2 ). The proposed devices exhibit (1) optoelectronic synaptic features and perform separate stimulus-associated learning, indicating considerable adaptive neuron emulation, (2) dual light-enabled charge-trapping and memcapacitive behavior within the same MOSCap device, whose threshold voltage and capacitance vary based on the light intensity across the visible spectrum, (3) memcapacitor volatility tuning based on the biasing conditions, enabling the transition from volatile light sensing to non-volatile optical data retention. The reconfigurability and multifunctionality of MOSCap were used to integrate the device into a leaky integrate-and-fire neuron model within a spiking neural network to dynamically adjust firing patterns based on light stimuli and detect exoplanets through variations in light intensity. Reconfigurable MOS memory enables light-controlled synaptic functions. Integrated into LIF neurons, the device demonstrates potential for dynamic firing patterns in response to light stimuli, promising applications in exoplanet detection.

Background: Medicinal plants continue to offer a promising source of novel bioactive compounds for cancer therapy due to their affordability, biocompatibility, and low toxicity. Rhus punjabensis Stewart, an ethnomedicinal species from the family Anacardiaceae, has long been used in the traditional medicine of northern Pakistan to treat inflammatory, hepatic, and infectious diseases. However, its phytochemical composition and anticancer potential remain largely unexplored. Methods: This study employed a bioactivity-guided isolation strategy to identify and characterize anticancer constituents from R. punjabensis leaves. The plant material was sequentially fractionated using solvents of increasing polarity, followed by purification via column chromatography. Each fraction and purified compound was evaluated using antioxidant (DPPH, total antioxidant capacity, and total reducing power) and cytotoxic assays, including brine shrimp lethality, Sulfo-rhodamine B (SRB) against five human cancer cell lines, protein kinase inhibition, and NF-κB chemo-preventive assays. Results: Comparative analysis of spectral data (UV, 1D/2D NMR, and ESI-MS) led to the identification of three triterpenoid compounds—Lupeol, Cycloartenol, and β-sitosterol—reported for the first time from R. punjabensis. Among them, Lupeol displayed the most potent cytotoxicity against DU-145 prostate (IC50 = 11.2 ± 1.2 μg/mL) and HL-60 leukemia (IC50 = 15.2 ± 1.1 μg/mL) cell lines and showed significant NF-κB inhibitory activity (IC50 = 19.4 ± 1.1 μg/mL), indicating its chemo-preventive potential. Cycloartenoland β-sitosterol exhibited moderate antioxidant and antimicrobial activities. Conclusion: The findings validate the ethnopharmacological use of R. punjabensis and confirm it as a new source of triterpenoids with notable anticancer activity. This study provides the first comprehensive account of its bioactive metabolites, reinforcing the significance of bioactivity-directed isolation as a powerful approach for discovering natural anticancer agents. Further in vivo and mechanistic evaluations are warranted to establish their therapeutic efficacy and safety profiles.

Antimicrobial resistance (AMR) is one of the most significant global health threats of the 21st century, endangering healthcare systems worldwide as a silent pandemic. Despite the globally recognized role of pharmacists as antimicrobial stewards, their involvement remains limited in antimicrobial stewardship (AMS) endeavors in Pakistan. By utilizing the Straussian grounded theory methodology, this study aimed to develop a pharmacist-centered novel AMS approach for healthcare in Pakistan in order to enhance the engagement of pharmacists in AMS and reduce the burden of AMR in Pakistan. Through 13 semi-structured in-depth interviews with pharmacists and AMS experts, this study explored the facilitators and obstacles faced by pharmacists in Pakistan pertaining to their participation in AMS. The findings highlighted the underutilization of pharmacists in AMS owing to persistent policy, institutional, and resource-level barriers. Several facilitators were also identified, including institutional ownership and pharmacist-prescriber-patient (3P) communication. The evidence generated informed the development of the pharmacist-centered novel AMS approach, which recommends extending AMS policy support to pharmacists, improving One Health interdisciplinary collaborations, promoting pharmacist-led behavior change campaigns, granting prescribing rights to pharmacists for minor ailments, and advancing AMS trainings and education. Formally integrating pharmacists into AMS efforts is the need of the hour to contain the consequences of AMR in Pakistan.

In April 2019, an HIV screening camp for all ages was established in response to a report of an unusually large number of paediatric HIV diagnoses in Larkana, Pakistan. We aimed to understand the clinical profile of the children who registered for HIV care. In this cross-sectional study, we review the outbreak response from the government, academia, and UN agencies in Larkana, Sindh, Pakistan. We report age-stratified and sex-stratified HIV prevalence estimated among individuals screened. For children who registered for HIV care, clinical history of previous injections and blood transfusions, HIV disease stage, hepatitis B and hepatitis C status, and CD4 count was abstracted from clinical records from Sindh AIDS Control Program HIV Clinic (Shaikh Zayed Childrens Hospital, Larkana, Pakistan) and analysed using percentages, χ2 tests, and weight-for-age Z scores. We also analysed data for parents who were tested for HIV. Between April 24, and July 15, 2019, 31 239 individuals underwent HIV testing, of whom 930 (3%) tested positive for HIV. Of these, 763 (82%) were younger than 16 years and 604 (79%) of these were aged 5 years and below. Estimated HIV prevalence was 3% overall; 7% (283 of 3803) in children aged 0–2 years, 6% (321 of 5412) in children aged 3–5 years, and 1% (148 of 11 251) in adults aged 16–49 years. Of the 591 children who registered for HIV care, 478 (81%) were 5 years or younger, 379 (64%) were boys, and 315 (53%) of 590 had a weight-for-age Z score of −3·2. Prevalence of hepatitis B surface antigen was 8% (48 of 574) and hepatitis C antibody positivity was 3% (15 of 574). Of children whose mothers tested for HIV, only 39 (11%) of 371 had HIV-positive mothers. Most children (404 [89%] of 453) reported multiple previous injections and 40 (9%) of 453 reported blood transfusions. This HIV outbreak is unprecedented among children in Pakistan: a 54% increase in paediatric HIV diagnoses over the past 13 years. The outbreak was heavily skewed towards young children younger than 5 years, with a predominance of boys. Epidemiological and molecular studies are needed to understand the full extent of the outbreak and its drivers to guide HIV control strategies. None.

The Internet of Things (IoT) is a transformative technology that is reshaping industries and daily life, leading us towards a connected future that is full of possibilities and innovations. In this paper, we present a robust framework for the application of Internet of Things (IoT) technology in the agricultural sector in Bangladesh. The framework encompasses the integration of IoT, data mining techniques, and cloud monitoring systems to enhance productivity, improve water management, and provide real-time crop forecasting. We conducted rigorous experimentation on the framework. We achieve an accuracy of 87.38% for the proposed model in predicting data harvest. Our findings highlight the effectiveness and transparency of the framework, underscoring the significant potential of the IoT in transforming agriculture and empowering farmers with data-driven decision-making capabilities. The proposed framework might be very impactful in real-life agriculture, especially for monsoon agriculture-based countries like Bangladesh.

Purpose This study aimed to clarify the size and morphology of the mandible, and to identify the location of the mandibular canal for the planning of the dental implantation. Methods CT data of 79 Japanese patients (52 male and 27 female) were analyzed. Results The means of the height and width ranged from 27.6 to 31.0 mm and from 10.5 to 15.8 mm, respectively. The height in male subjects was significantly greater than that in female subjects, and the width in male subjects was slightly but not significantly greater than that in female subjects. The morphology of the mandible was classified into three types. Type C (round) (59–61%) was the most common in the posterior region, followed by type A (lingual concavity) (36–39%), whereas type B (buccal concavity) (58–74%) and type C (17–36%) were the most common types in the anterior region. The distance from the mandibular canal to the alveolar crest, ranged from 15.3 to 17.4 mm. The anterior loop, was observed on 55% of all sides. Conclusions The size and morphology of the mandible and the location of the mandibular canal were determined clearly using cross-sectional CT images.

Background The co-occurrence of diabetes mellitus and breast cancer poses a significant global health challenge. Most research has focused on Western populations, with genetics, lifestyle, and environmental differences limiting generalizability to Pakistanis. This study aimed to fill this gap by investigating the diabetes-breast cancer association among Pakistani adults. Methods A cross-sectional study was conducted from October 2023 to January 2024 at Pinum Cancer Hospital, Faisalabad. 400 participants were categorized as normal, diabetic, cancerous, and diabetic cancerous. Data were analyzed using SPSS with descriptive statistics and inferential tests at p  < 0.05 significance. Results Among 9,725 patients, 1.03% had concurrent diabetes and breast cancer. Females showed higher risk with a strong gender association ( P  < 0.0001) across groups. Significant associations were found for body weight ( P  < 0.009), BMI ( P  < 0.014), and fat distribution ( P  < 0.0001). Dietary factors such as fried fish ( P  < 0.001), red meat ( P  < 0.0001), processed food ( P  < 0.0001), and kitchen practices like overcooked oil ( P  < 0.003) were significant. Lifestyle factors including physical activity ( P  < 0.0001) and stress ( P  < 0.0001), environmental factors such as x-rays, and chemical exposure ( P  < 0.013) and female-specific factors like postmenopausal status ( P  < 0.0001) and contraceptive use ( p  < 0.032), and makeup ( P  < 0.0001) also showed significant association. Conclusion Diabetes and breast cancer are strongly associated in Pakistani adults, influenced by clinical, dietary, lifestyle, and environmental factors. Personalized prevention and management strategies are crucial to improve treatment outcomes.

Groundwater is a crucial natural resource that varies in quality and quantity across Bangladesh. Increased population and urbanization place enormous demands on groundwater supplies, reducing both their quality and quantity. This research aimed to delineate the groundwater potential zone in the Gazipur district, Bangladesh, by integrating eleven thematic layers. Data and information were gathered from Landsat 8, the digital elevation model, the google earth engine, and several ancillary sources. A multi-criterion decision-making (MCDM) based analytical hierarchy process (AHP) was used in a GIS platform to estimate the groundwater potential index. The potential index values were finally classified into five sub-groups: very low, low, moderate, high, and very high to generate a groundwater water potential zone (GWPZ) map. The results show that groundwater potential in about 0.002% (0.026 km2) of the area is very low, 3.83% (63.18 km2) of the area is low, 56.2% (927.05 km2) of the area is medium, 39.25% (647.46 km2) of the area is high, and the rest 0.72% (11.82 km2) of the area is very high. The validation of GWPZ maps based on the groundwater level data at 20 observation wells showed an overall accuracy of 80%. In addition, the ROC curve showed 84% accuracy of GWPZ maps when validated with water inventory points across the study region. Overall, this study presents an easy and practical approach for identifying groundwater potential zones, which may help improve planning and sustainable groundwater resource management.

Enteric fever is caused by Salmonella enterica serovars Typhi (S. Typhi) and Paratyphi A, B, and C. It continues to be a significant cause of morbidity and mortality worldwide. In highly endemic areas, children are disproportionately affected, and antimicrobial resistance reduces therapeutic options. It is estimated that 2-5% of enteric fever patients develop chronic asymptomatic infection. These carriers may act as reservoirs of infection; therefore, the prospective identification and treatment of carriers are critical for long-term disease control. We aimed to find the frequency of Salmonella Typhi carriers in patients undergoing cholecystectomy. We also compared the detection limit of culturing versus qPCR in detecting S. Typhi, performed a geospatial analysis of the carriers identified using this study, and evaluated the accuracy of anti-Vi and anti-YncE in identifying chronic typhoid carriage. We performed a cross-sectional study in two centers in Pakistan. Gallbladder specimens were subjected to quantitative PCR (qPCR) and serum samples were analyzed for IgG against YncE and Vi by ELISA. We also mapped the residential location of those with a positive qPCR result. Out of 988 participants, 3.4% had qPCR-positive gallbladder samples (23 S. Typhi and 11 S. Paratyphi). Gallstones were more likely to be qPCR positive than bile and gallbladder tissue. Anti-Vi and YncE were significantly correlated (r = 0.78 p<0.0001) and elevated among carriers as compared to qPCR negative controls, except for anti-Vi response in Paratyphi A. But the discriminatory values of these antigens in identifying carriers from qPCR negative controls were low. The high prevalence of typhoid carriers observed in this study suggests that further studies are required to gain information that will help in controlling future typhoid outbreaks in a superior manner than they are currently being managed.