Background: Many of the tropical diseases are neglected by the researchers and medicinal companies due to lack of profit and other interests. The Drugs for Neglected Diseases initiative (DNDi) is established to overcome the problems associated with these neglected diseases. According to a report published by the WHO, leprosy (Hansen's disease) is also a neglected infectious disease. Methods: A negligible amount of advancements has been made in last few decades which includes the tools of diagnosis, causes, treatment, and genetic studies of the bacterium (Mycobacterium leprae) that causes leprosy. The diagnosis of leprosy at earlier stages is important for its effective treatment. Recent studies on vitamin D and its receptors make leprosy diagnosis easier at earlier stages. Skin biopsies and qPCR are the other tools to identify the disease at its initial stages. Results: Until now a specific drug for the treatment of leprosy is not available, therefore, Multi-Drug Therapy (MDT) is used, which is hazardous to health. Besides Mycobacterium leprae, recently a new bacterium Mycobacterium lepromatosis was also identified as a cause of leprosy. During the last few years the genetic studies of Mycobacterium leprae, the role of vitamin D and vitamin D receptors (VDR), and the skin biopsies made the treatment and diagnosis of leprosy easier at early stages. The studies of micro RNAs (miRNAs) made it easy to differentiate leprosy from other diseases especially from tuberculosis. Conclusion: Leprosy can be distinguished from sarcoidosis by quantitative study of reticulin fibers present in skin. The treatment used until now for leprosy is multi-drug treatment. The complete genome identification of Mycobacterium leprae makes the research easy to develop target specified drugs for leprosy. Rifampicin, identified as a potent drug, along with other drugs in uniform multi-drug treatment, has a significant effect when given to leprosy patients at initial stages. These are effective treatments but a specific drug for leprosy is still needed to be identified. The current review highlights the use of modern methods for the identification of leprosy at its earlier stages and the effective use of drugs alone as well as in combination.
This article deals with the study of disturbance that travels through the transversely isotropic medium in the form of waves. The particles of the considered medium have an additional property of small-scale internal rotation along with macroscopic translational deformation. This extra translational freedom causes the medium to be micropolar in nature. Along with this, the medium is incompressible, and the dispersion relation of waves propagating through the medium is obtained under specific plan-strain conditions. From the dispersion relation, we can conclude that because of incompressibility, three transverse waves propagate through the medium. The velocity profile, attenuation coefficient, and specific heat loss for these waves are discussed for a particular medium. Later, the special normalized local sensitivity analysis (NLSA) technique is used to depict the effects of parameters on the outcomes of the mathematical model. The obtained results are represented graphically for a particular medium. The proposed model is used to model the mechanical behavior of complex materials with microstructural heterogeneity, such as composites and biological tissues.
Platypnea-orthodeoxia is an uncommon syndrome characterized by dyspnea and hypoxemia in upright position that improves with recumbent position. It can occur due to intracardiac shunts, pulmonary arteriovenous shunts and ventilation perfusion mismatch. We present a unique and rare cause of platypnea-orthodeoxia syndrome. CASE PRESENTATION: A 68 years old man with history of coronary artery disease and COPD presented with acute onset chest pain and associated difficulty breathing. Patient did have several months' history of exertional dyspnea which did not improve with rest this time. On presentation, patient was noted to be hypoxic with oxygen saturation of 88% and ABG showed PH 7.41, PaO2 47 mmHg and PaCO2 22.4 mmHg. Oxygen saturation improved to 94% with 3L of supplemental oxygen. EKG and troponin were unremarkable. CT PE was unremarkable for pulmonary embolism as well. IV heparin drip was started for suspected unstable angina and patient underwent cardiac catheterization that revealed non-obstructive coronary artery disease. Echocardiography showed ejection fraction of 55-60% with mild mitral and tricuspid regurgitationDuring the course of hospitalization, patient was noted to have intermittent positional hypoxemia. He had normal resting saturation on 2 L of oxygen which dropped to 88% sitting upright and dropped to 84% on 2 L of oxygen upon raising both arms. Platypnea-orthodeoxia syndrome was strongly suspected with possible intra-cardiac or intrapulmonary shunt. Meanwhile, CT chest was unremarkable for interstitial lung disease. Right heart catheterization revealed normal right atrial RA (68.9%) and pulmonary arterial PA (68.3%) saturation at rest but reduced RA (42.5%) and PA (43.2%) saturation with sitting up. Echocardiography with bubble study showed right-to-left shunting and trans-esophageal echocardiography revealed a small 0.5 cm atrial septal defect (ASD) with bidirectional shunting. Patient was diagnosed with Platypnea-orthodeoxia syndrome secondary to ASD. He was discharged home on supplemental oxygen and outpatient follow-up for ASD closure.
Increased transparency encourages management to perform efficiently which leads to increase profitability of Firm. Firms in Pakistan are exposed to political risk but they are adopting strategies for the risk management and performing well. The objective of this study is to examine the relationship between firm level transparency and firm value of non-financial firms in Pakistan. Sixty registered firms in KSE 100 Index of Pakistan were considered for analysis for the period 2014-2018. The researchers had developed an index for measuring the firm’s transparency (disclosure). Regression analysis technique was used to find important relationships between the variables. The results showed higher firm level transparency leads to accelerate firm financial value. The results provide singifcnat information about the issues under study. On the other hand higher level of transparency on firm level decreases firm value in Pakistani market. While inverse relationship was thus found amid political risk, transparency and firm financial value. This study had unveiled fact that mostly Pakistani firms are undervalued, riskier and slow growing which disclose more to combat with negative assessments in market from participants.
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