Expression analysis of ABCA1 in type 2 diabetic Pakistani patients with and without dyslipidemia and correlation with glycemic index and lipid profile

Diabetes Mellitus type II, earlier considered as an endocrinological disorder is now more regarded as an inflammatory disorder along with lipid aberrations. It demands for regular monitoring, healthy dietary habits and lifestyle modification. This study was focused on gene expression of ATP binding cassette protein 1 (ABCA1) in diabetic dyslipidemia patients in comparison with control groups of only diabetics and healthy individuals. Blood samples and data were collected from recruited 390 patients who were further divided into three groups (130 each). Glycemic index and lipid profile was assessed. Delta Delta Ct method was used that revealed downregulation of the studied gene more in diabetic dyslipidemia patients as compared to only diabetics and healthy controls. The Ct values of ABCA1 were associated with glycemic index and lipid profile using Pearson's correlation. A negative correlation with fasting blood sugar and a positive correlation with HbA1cwas observed in only diabetics group. While in diabetic dyslipidemia and normal healthy controls, a negative correlation was found with both. As far as the lipid profile is concerned a positive correlation was observed among only diabetics with whole lipid profile. In diabetics with dyslipidemia, a negative correlation with all parameters except the TAGs was observed. A positive correlation with all except HDL was observed in healthy controls. The Ct values and fold change were compared among diseased and healthy individuals by applying independent t test. The cycle threshold in only diabetics was p = 0.000018 and in diabetic dyslipdemia individuals was p = 0.00251 while fold change in only diabetics (p = 0.000230) and in diabetics with dyslipidemia (p = 0.001137) was observed to be as statistically significant.

Estimation of genetic components, heterosis and combining ability of elite Pakistani wheat varieties for yield attributing traits and stripe rust response

Wheat (Triticum aestivum L.) is a staple food and major source of dietary calories in Pakistan. Improving wheat varieties with higher grain yield and disease resistance is a prime objective. The knowledge of genetic behaviour of germplasm is key. To achieve this objective, elite wheat varieties were crossed in 4 by 3, line × tester design, and tested in 2019 in a triplicate yield trial to estimate genetic variance, general and specific combining ability, mid-parent heterosis and stripe rust (Puccinia striiformis L.). High grain 3358 kg·ha-1 was recorded in F1 hybrid (ZRG-79 × PAK-13). Analysis of variance (ANOVA) revealed significant genotypic variance in grain yield. Broad sense heritability (H2) was recorded in the range of 28 to 100 %. General combining ability (GCA) significant for grain yield in parents except FSD-08 and PS-05 was recorded, while specific combining ability (SCA) was recorded to be highly significant for grain yield only in two crosses (ZRG-79 × NR-09 and ZRG-79 × PAK-13). Mid-parent heterosis was estimated in the range of -28 to 62.6 %. Cross combinations ZRG-79 × PAK-13 depicted highly significant mid-parent heterosis (62.6 %). Highly significant correlation was observed among spike length, spikelets per spike, plant height and 1000-grain weight. Rust resistance index was recorded in the range of 0 to 8.5. These findings suggest exploitation of GCA for higher grain yield is important due to the presence of additive gene action and selection in the filial generations will be effective with improved rust resistance, while cross combinations ZRG-79 × PAK-13 high GCA are best suited for hybrid development.

Water Quality Index and Human Health Risk Assessment of Drinking Water in Selected Urban Areas of a Mega City

The present study was conducted to evaluate the quality of drinking water and assess the potential health hazards due to water contaminants in selected urban areas of Lahore, Pakistan. Water samples were collected from ten sites and analyzed for different physico-chemical parameters including turbidity, color, pH, total dissolved solids (TDS), nitrates, fluoride, residual chlorine, and total hardness. Additionally, heavy metal (arsenic) and microbial parameters (E. coli) were also determined in the water samples. Drinking water quality evaluation indices, including the water quality index (WQI) for physico-chemical and biological parameters and human health risk assessment (HHRA) for heavy metal were estimated using the analytical results of the target parameters. It was found in most of the areas that the levels of arsenic, fluoride, TDS, and residual chlorine were higher than those recommended by the National Environmental Quality Standard (NEQS) and World Health Organization (WHO) guidelines. In addition to the physico-chemical parameters, microbial content (E. coli) was also found in the drinking water samples of the selected areas. Statistical analysis of the results indicated that levels of target parameters in drinking water samples are significantly different between sampling sites. The WQI for all physico-chemical and microbial parameters indicated that drinking water in most of the areas was unfit and unsuitable (WQI > 100) for drinking purposes except for the water of Bhatti Gate and Chota Gaon Shahdara with a WQI of 87 and 91, respectively. Drinking water in these areas had a very poor WQI rating. According to HHRA, drinking water from the selected sites was found to be of high risk to children and adults. The carcinogenic risk of arsenic indicated that all samples were of high risk to both adults and children (4.60 and 4.37 × 10^-3, respectively). Regular monitoring of drinking water quality is essential, and proactive measures must be implemented to ensure the treatment and availability of safe drinking water in urban areas.

The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

BACKGROUND

The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.

METHODS

This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.

RESULTS

Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.

CONCLUSIONS

Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

Epileptiform activity predicts epileptogenesis in cerebral hemorrhage

This retrospective case-controlled study was performed to evaluate whether Epileptiform Activity, suspected clinical seizures, and/or 2HELPS2B/S after nontraumatic Intraparenchymal Hemorrhage or Subarachnoid Hemorrhage can predict Epilepsy. Hundred and thirty-two patients were included-29 (Epilepsy), 103 (Control Group). After matching, the average effect for all three risk factors was significant as follows: (1) Epileptiform Activity (p = 0.012, odds ratio 3.14), (2) suspected seizures (p = 0.021, odds ratio 3.78), and (3) 2HELPS2B/S score (p < 0.001, odds ratio 4.94). This study shows that Epileptiform Activity, suspected seizures, and particularly, the 2HELPS2B/S score in the acute phase are risk factors for the development of epilepsy after nontraumatic intraparenchymal and subarachnoid hemorrhage.

Glossopharyngeal Neuralgia Associated With Bradycardia and syncope—a Case Report

We describe a case of 76-year-old woman with glossopharyngeal neuralgia who developed bradycardia and syncope after decreased carbamazepine dosing due to worsening renal function. Telemetry and EKG showed bradycardia and sinus pauses associated with paroxysms of typical glossopharyngeal neuralgia pain. With the addition of gabapentin to carbamazepine, her glossopharyngeal neuralgia pain as well as bradycardia resolved. A pacemaker was placed to prevent bradycardia and syncope. Clinicians should be mindful of the association between glossopharyngeal neuralgia and bradycardia and cardiac syncope so appropriate treatment can be offered in a timely manner to prevent adverse outcomes associated with syncope and cardiac arrest.

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P &lt; 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P &lt; 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Variation in final sheet thickness in case of Sutterby fluid during the calendering process

This paper investigates the isothermal calendering process for Sutterby fluid model. Lubrication approximation theory (LAT) is used for the simplification of the governing equations. The perturbation technique is utilized to find the system solution. The zeroth-order and first-order solutions of velocity profile, sheet thickness, pressure gradient and pressure are obtained while numerical solution of other mechanical quantities is evaluated. The values of the parameters influencing the different flow and engineering parameters are obtained through graphs and in a tabular manner. It is observed that the material parameter mainly controls the sheet thickness, roll separating force, flow rate, power input, exiting sheet thickness, and pressure distribution. It is to be noted from the results that with the increase in the material parameter, the sheet thickness and power input increase while roll separating force decreases.

Ethnobotanical investigation of medicinal plants used in Lingchuan county, Shanxi, China

Abstract Medicinal plants are the primary sources of healthcare among the people of developing countries in villages and local towns. Documenting and reporting the traditional knowledge of medicinal plants may contribute to pharmaceutical research development. For this reason, we present our findings on ethnomedicinal plants from Lingchuan County, Shanxi, China, an unexplored area rich in medicinal plant resources. Information of ethnomedicinal plants were collected through questionnaire/semi-structured interviews from 180 informants, including traditional healers. Field surveys were conducted in 53 villages of Lingchuan County from 2017 to 2018. Informed consent was obtained from each participant before conducting the interview process. Quantitative analysis was performed for each recorded species, such as Relative Frequency Citation (RFC), Use Value (UV), and Factor of Informant Consensus (FIC). Diseases were categorized into twelve groups. A total 138 species of medicinal plants were recorded, belonging to 123 genera of 58 families. Asteraceae was the dominant plant family with 19 species, followed by Rosaceae and Fabaceae. Herbs were dominant among plant life-forms with 96 species, followed by shrubs and trees (15 species each). Roots were the most commonly used plant parts with 58 species, followed by whole plants and fruits (28 species each). Most plant species were reported non-toxic (84, 60%), followed by unknown toxicity (35, 25%), poisonous, and less toxic (19, 14%). Quantitative analysis revealed that Forsythia suspensa was with higher (0.33) RFC value, and Scutellaria baicalensis was recorded with a higher (0.91) UV. Treated diseases were categorized in 12 groups and evaluated by their FIC value, in which gynecological diseases have higher (0.93) FIC value followed by urinary system diseases. Most medicinal plants are used to clear away heat and relieve the surface. The present study revealed that local people of Lingchuan County confidently use ethnomedicinal plants for their healthcare needs. The higher indices value of a plant species resulted from quantitative analysis warrants further investigation, which may possess valuable phytochemical compounds that may result in new drugs for treating various human disorders.

Effect of cell density on the biological titer and yield of 146S fraction of foot-and-mouth disease virus O in cell suspension

Foot-and-mouth disease (FMD) is a highly infectious disease of cattle and other cloven-hoofed animals, causing huge economic losses annually worldwide. This disease is endemic in Pakistan where the serotypes of the foot-and-mouth disease virus (FMDV) are A, O and ASIA-1. At present, trivalent FMDV vaccines are being used to prevent FMD but the current production process is laborious and is unable to fulfill the needs of the meat and dairy industries. To meet the vaccine needs of Pakistan, the conventional method of using adherent cell lines to produce the vaccine could be replaced by suspension cell cultures which produce higher yields in less time and less volume. Therefore, the aim of this study was to investigate and optimize some of the factors that affect viable cell density and subsequent virus yield. The relationship between the yield of the 146S fraction and the TCID₅₀ of the virus preparations obtained was also evaluated as a mean to control and check the quality of the vaccine product. The results provided optimized conditions for vaccine production using cell suspensions and showed that there was a linear relationship between TCID₅₀ and 146S fraction yield. Either TCID₅₀ or the 146S fraction yield, or both could be used as parameters for quality monitoring during vaccine production. Using TCID₅₀ reduced the number of steps involved in virus production while measuring 146S fraction yield was useful for quality control. However, more studies are required to evaluate the relative effectiveness of vaccines produced by virus cultures using either TCID₅₀ or 146S fraction as quality monitoring tools.

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND

The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.

METHODS

Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups.

RESULTS

Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005).

CONCLUSION

Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.

Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study

BACKGROUND

No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer.

METHOD

This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%).

RESULTS

Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC.

CONCLUSION

Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.

Comparison of short-term outcomes from the International Oesophago-Gastric Anastomosis Audit (OGAA), the Esophagectomy Complications Consensus Group (ECCG), and the Dutch Upper Gastrointestinal Cancer Audit (DUCA)

BACKGROUND

The Esophagectomy Complications Consensus Group (ECCG) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA) have set standards in reporting outcomes after oesophagectomy. Reporting outcomes from selected high-volume centres or centralized national cancer programmes may not, however, be reflective of the true global prevalence of complications. This study aimed to compare complication rates after oesophagectomy from these existing sources with those of an unselected international cohort from the Oesophago-Gastric Anastomosis Audit (OGAA).

METHODS

The OGAA was a prospective multicentre cohort study coordinated by the West Midlands Research Collaborative, and included patients undergoing oesophagectomy for oesophageal cancer between April and December 2018, with 90 days of follow-up.

RESULTS

The OGAA study included 2247 oesophagectomies across 137 hospitals in 41 countries. Comparisons with the ECCG and DUCA found differences in baseline demographics between the three cohorts, including age, ASA grade, and rates of chronic pulmonary disease. The OGAA had the lowest rates of neoadjuvant treatment (OGAA 75.1 per cent, ECCG 78.9 per cent, DUCA 93.5 per cent; P < 0.001). DUCA exhibited the highest rates of minimally invasive surgery (OGAA 57.2 per cent, ECCG 47.9 per cent, DUCA 85.8 per cent; P < 0.001). Overall complication rates were similar in the three cohorts (OGAA 63.6 per cent, ECCG 59.0 per cent, DUCA 62.2 per cent), with no statistically significant difference in Clavien-Dindo grades (P = 0.752). However, a significant difference in 30-day mortality was observed, with DUCA reporting the lowest rate (OGAA 3.2 per cent, ECCG 2.4 per cent, DUCA 1.7 per cent; P = 0.013).

CONCLUSION

Despite differences in rates of co-morbidities, oncological treatment strategies, and access to minimal-access surgery, overall complication rates were similar in the three cohorts.

How Transformational Leadership Influences the Knowledge-Sharing Process

This study aims to investigate the mediating effects of both affect-based and cognition-based trust on the relationship between using a transformational leadership style and the effectiveness of followers' knowledge sharing processes (i.e., knowledge donating and knowledge collecting). Using data collected from 287 employees at 32 pharmaceutical companies in Pakistan, the structural equation modelling (SEM) technique was utilised to analyse the hypothesised relationships. The results showed that leaders with a transformational leadership style directly affect their followers' knowledge donating and knowledge collecting processes. In addition, affect-based trust was found to fully mediate the relationships between transformational leadership and followers' knowledge donating and knowledge collecting processes, while cognition-based trust produced insignificant mediation effects. From a social exchange perspective, these findings demonstrate the importance of focusing on building affect-based trust between leaders and followers in order to develop transformational leadership that could positively influence the knowledge sharing process.

An association between exposure to Middle East Respiratory Syndrome (MERS) and mortality rate of Coronavirus Disease 2019 (COVID-19)

OBJECTIVE

Our objective was to find an association between exposure of a population to Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and mortality rate due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) across different countries worldwide.

MATERIALS AND METHODS

To find the relationship between exposure to MERS-CoV and mortality rate due to SARS-CoV-2, we collected and analyzed data of three possible factors that may have resulted in an exposure of a population to MERS-CoV: (1) the number of Middle East Respiratory Syndrome (MERS) cases reported among 16 countries since 2012; (2) data of MERS-CoV seroprevalence in camels across 23 countries, as working with camels increase risk of exposure to MERS-CoV; (3) data of travel history of people from 51 countries to Saudi Arabia was collected on the assumption that travel to a country where MERS is endemic, such as, Saudi Arabia, could also lead to exposure to MERS-CoV.

RESULTS

We found a significantly lower number of Coronavirus disease 2019 (COVID-19) deaths per million (deaths/M) of a population in countries that are likely to be exposed to MERS-CoV than otherwise (t-stat=3.686, p<0.01). In addition, the number of COVID-19 deaths/M of a population was significantly lower in countries that reported a higher seroprevalence of MERS-CoV in camels than otherwise (t-stat=4.5077, p<0.01). Regression analysis showed that increased travelling history to Saudi Arabia is likely to be associated with a lower mortality rate due to COVID-19.

CONCLUSIONS

This study provides empirical evidence that a population that was at an increased risk of exposure to MERS-CoV had a significantly lower mortality rate due to SARS-CoV-2, which might be due to cross-protective immunity against SARS-CoV-2 in that population because of an earlier exposure to MERS-CoV.

Effect of Flavonoid-Coated Gold Nanoparticles on Bacterial Colonization in Mice Organs

Multidrug resistance (MDR) has been a potentiator for the exploration of antibiotics. Nano drug delivery systems have opened new avenues to overcome this challenge. Although antibacterial nanocarriers are extensively realized, their effect on the bacteria residing inside the tissues and their toxicity is rarely explored. This study investigated the effects of flavonoid coated gold nanoparticles (FAuNPs) on the colonization of Enterococcus faecalis in the mouse liver and kidneys. Flavonoids were extracted from the leaves of Berberis lycium Royle and used to stabilize gold following a green synthesis approach. FAuNPs were characterized by ultraviolet-visible (UV-Vis) spectroscopy, Fourier-transform infrared spectroscopy (FTIR), scanning transmission electron microscopy (STEM), X-ray powder diffraction (XRD), and energy-dispersive X-ray spectroscopy (EDS). FAuNPs showed significantly higher reduction in bacterial counts in in-vitro and in-vivo in mice organs as compared to the free flavonoids owing to their biocompatibility and effectiveness.

'We need to share our stories': the lives of Pakistanis with intellectual disability and their guardians

INTRODUCTION

The experiences of Pakistanis with intellectual disabilities (IDs) and their family members have been underexplored empirically.

METHOD

The present study sought to address this gap by understanding the lives of five Special Olympics Pakistan athletes and their guardians through PhotoVoice.

FINDINGS

Through thematic analysis, we present the primary theme concerning Pakistan's cultural context that provides an empirical exploration of cultural beliefs about intellectual disability, cultural expectations and support received by people with intellectual disabilities and their guardians.

DISCUSSION

We discuss implications for research and practice.

Sorption Studies of Chromate by Iron Oxide from Drinking Water

Chromium is well-thought-out heavy metal which is one of the enormously lethal due to its cancer-causing nature. In this study, iron oxide is used as adsorbent for chromate removal from aqueous solution as a function of pH, time, temperature, concentration of adsorbate and media dosage. The influence of pH on Cr (VI) sorption by iron oxide reveals that adsorption is significantly increased as pH is decreased from 8 to 2. The sorption rate is detected to be higher in the beginning and then it remains constant after 120 min of equilibrium time. The removal of Cr (VI) is found to be greater at higher temperature, which confirms the endothermic nature of Cr (VI) adsorption by iron oxide. Whereas, the kinetic investigations confirm that the chromate adsorption follows the pseudo second order with kinetic energy in the range of 8.4–83.7 kJ mol−1.

INTERNET USE BEHAVIOR: EMERGING STUDENT MENTAL HEALTH PROBLEM

Background: Internet addiction is emerging community mental health issue. Objective of study was to determine frequency of three types of internet use behaviors, modal reason of internet use and association of internet use behavior to different socio demographic variables. Material & Methods: This comparative cross-sectional study was conducted in Gomal Medical College from 1st September to 30th September 2018. A sample size of 100 students was chosen through non probability sampling technique. All students were given a questionnaire. Our sociodemographic variables were age, residence, gender, language and socioeconomic status. Research variables were frequency of different internet use behaviors and modal reason of internet use. SPSS version 19 was used for data analysis. Categorical variables were expressed as frequency and percentages and numerical variables expressed as mean and SD. Chi square test was done to see association of internet use behaviors with socio demographic variables. Results: in this study male and female were both equal in number with 50 each. Majority of them were below 25 yrs of age 99%, hosteler 74%, Pushto speaking 54% and from middle class 78%. Regarding internet use behavior 53% were normal user,45% were problematic user and 2 were addict. Chi square test did not show any significant difference between type of user and sociodemographic characteristics. Conclusion: In our study frequency of problematic user is high and internet use behavior is not significantly associated to different sociodemographic groups. Entertainment was the most frequent reason for using internet.

Leaf cell membrane stability-based mechanisms of zinc nutrition in mitigating salinity stress in rice

Excess salt affects about 955 million ha of arable land worldwide, and 49% of agricultural land is Zn-deficient. Soil salinity and zinc deficiency can intensify plant abiotic stress. The mechanisms by which Zn can mitigate salinity effects on plant functions are not well understood. We conducted an experiment to determine how Zn and salinity effects on rice plant retention of Zn, K⁺ and the salt ion Na⁺ affect chlorophyll formation, leaf cell membrane stability and grain yield. We examined the mechanisms of Zn nutrition in mitigating salinity stress by examining plant physiology and nutrition. We used native Zn-deficient soils (control), four salinity (EC) and Zn treatments - Zn 10 mg·kg^-1 (Zn₁₀ ), EC 5 dS·m^-1 (EC₅ ), Zn₁₀ +EC₅ and Zn₁₅ +EC₅ , a coarse rice (KS-282) and a fine rice (Basmati-515) in the study. Our results showed that Zn alone (Zn₁₀ ) significantly increased rice tolerance to salinity stress by promoting Zn/K⁺ retention, inhibiting plant Na⁺ uptake and enhancing leaf cell membrane stability and chlorophyll formation in both rice cultivars in native alkaline, Zn-deficient soils (P < 0.05). Further, under the salinity treatment (EC₅ ), Zn inputs (10-15 mg·kg^-1 ) could also significantly promote rice plant Zn/K⁺ retention and reduce plant Na⁺ uptake, and thus increased leaf cell membrane stability and grain yield. Coarse rice was more salinity-tolerant than fine rice, having significantly higher Zn/K⁺ nutrient retention. The mechanistic basis of Zn nutrition in mitigating salinity impacts was through promoting plant Zn/K⁺ uptake and inhibiting plant Na⁺ uptake, which could result in increased plant physiological vigour, leaf cell membrane stability and rice productivity.

Sequence analysis of hepatitis C virus nonstructural protein 3-4A serine protease and prediction of conserved B and T cell epitopes

The hepatitis C virus (HCV) is a global health issue. The nonstructural protein 3 (NS3)-4Agene of HCV is responsible for serine protease activity. The aim of the present study was to develop a global consensus sequence of HCV serine protease, analyze conserved residues, and predict highly conserved B- and T-cell binding epitopes in the NS3-4A protein. A total of 160 NS3-4A sequences from the six genotypes of HCV were refracted in the current study. The amino acid sequences were aligned to obtain a global consensus sequence. The location of possible B- and T-cell epitopes were predicted in the HCV NS3-4A consensus sequence by employing bioinformatics tools. Despite the high mutation rate of HCV, the functionally important residues are highly conserved. These include residues that form the catalytic triad (His57, Asp81 and Ser139), the S1 and S6 pocket, zinc-binding site (Cys97, Cys99, Cys145 and His149) and the substrate binding groove. The epitopes B1, B8 and B9 are predicted to be ideal candidates for B-cell-based vaccine and are >95% conserved across six major HCV genotypes. The major histocompatibility complex (MHC) class I epitopes, M4, M5, M7 and M10, and MHC class II epitopes, T5, T7 and T10 are ideal epitopes for vaccine development with high antigenicity scores and high conservancy across major HCV genotypes. The predicted B- and T-cell epitopes are ideal targets for vaccine development, and are capable of producing a strong immune response for all major genotypes of HCV.

Comparative sorption studies of chromate by nano-and-micro sized Fe2O3 particles

The comparative adsorption studies of Cr (VI) on nano and micro-powder Fe2O3 were investigated using kinetics and batch adsorption techniques. The uptake of chromate onto both the oxides of iron was observed to be dependent on the pH, contact time, temperature, media dosage and concentration of chromate anions. The values of sorption maxima were higher in the case of Fe2O3 nanopowder than the micro-powder which can be ascribed to the high surface area and point of zero charge (PZC) of the former oxide. The Dubinin-Radushkivech and Langmuir models were found well fitted for the description of the batch adsorption data. The FTIR studies confirmed that the hexavalent chromium was adsorbed onto both the iron oxides in the form of the Cr2O72−.

Brachial Artery Injury in a Child following Closed Elbow Dislocation: Case Report of a Rare Injury

Elbow dislocation, though a common orthopaedic emergency is rare with brachial artery injury and is even more uncommon in the paediatric age group. We present the case of a child who sustained trauma resulting in closed elbow dislocation with brachial artery injury. Elbow dislocation with brachial artery injury can present with palpable distal pulses and good capillary refill because of rich collaterals at the elbow. But this patient presented with signs of frank ischemia distally, and was managed with ipsilateral reverse cephalic vein graft. He had good volume pulses at one year follow-up. Patients with such presentation should have careful clinical and radiological assessment to exclude complicated elbow dislocation.

Cation-Exchange Properties of Aluminium(III) Phosphate

Potentiometric titrations of aluminium(III) phosphate have been performed in the presence of aqueous electrolyte solutions containing Cu2+, Zn2+, Ni2+ and K+ ions as a function of the concentration of the latter, the pH and the temperature. The sorption of Zn2+ ions has also been studied and the data for metal ion sorption shown to correlate with the Potentiometric titration data, indicating that the process responsible for metal ion uptake is ion exchange. The pKa value of the exchanger and its thermodynamic parameters have been evaluated.

Exchange of Some Divalent Metal Cations and Their Effect on the Dissociation of Iron(III) Phosphate

Potentiometric titrations of iron(III) phosphate have shown an apparently weak monobasic acid behaviour towards alkali, alkaline earth and divalent transition metal ions. The selectivity sequence and dissociation of the exchanger was found to increase in the order Cu2+ > Zn2+ > Ni2+ > Ca2+ > K+. The dissociation constants of iron(III) phosphate have been determined from Potentiometric titration data in the temperature range 303–323 K. In addition, the exchange of Cu2+, Zn2+ and Co2+ on iron(III) phosphate and the effect of these ions on dissociation were also studied as a function of concentration, temperature and solution pH value. The thermodynamic parameters ΔH0, ΔS0 and ΔG0 for the dissociation of iron(III) phosphate are also presented.

Temperature and pH Effect on the Sorption of Divalent Metal Ions by Silica Gel

The sorption of Zn2+, Ni2+ and Cd2+ ions by silica gel was studied as a function of ion concentration, pH and temperature. An increase in all three parameters led to an increase in the extent of sorption for all the metal cations studied. The selectivity of the solid was observed to be in the order Zn2+ > Ni2+ > Cd2+. Sorption of the metal cations was accompanied by the release of H+ ions into the bulk phase. On average two moles of H+ ions were released per mole of metal cation sorbed. The sorption data fitted the linear forms of both the Kurbatov and Langmuir adsorption equations. The values of the binding constants were used to estimate the apparent thermodynamic parameters, ΔH and ΔS, for the adsorption process. FT-IR spectroscopic studies also showed that the uptake of metal cations by the silica gel occurred via a cation-exchange process.

Sorption of Metal Ions on a Mixed Oxide [0.5 M SiO2:0.5 M Fe(OH)3]

The sorption of Zn2+, Ni2+, Cd2+, Ca2+ and Mg2+ ions on to a mixed oxide of iron and silicon was found to increase with increasing temperature, concentration and pH of the system. The selectivity of this mixed oxide was Cd2+ ≥ Zn2+ ≥ Ni2+ > Ca2+ > Mg2+, indicating that the mixed oxide was more selective as an exchanger towards Cd2+ ions relative to its components, SiO2 and Fe(OH)3. The sorption data fitted the linear forms of the Kurbatov and Langmuir adsorption equations. The sorption of metal cations was accompanied by the release of H+ ions to the bulk phase. On average 1 mol H+ was released for every cation sorbed. The values of the binding constants were used to estimate the apparent thermodynamic parameters, ΔH and ΔS. The phenomenon of enthalpy/entropy compensation showed that the adsorption of metal ions by the mixed oxide occurred typically through a cation-exchange mechanism.

Cation-Exchange Properties of CrPO4

Alkali metal ion exchange (Li+, Na+ and K+) on chromium phosphate (CrPO4) was studied potentiometrically as a function of temperature and metal ion concentration. The shift in the potentiometric titration curves corresponding to the exchange of alkali metal cations increased with increasing pH and concentration of the metal ions, while the opposite results were obtained by increasing the temperature of the system. The affinity of the exchanger for alkali metal ions was also found to be in the order Li+ > Na+ > K+. The data were employed to evaluate the apparent deprotonation constants of CrPO4 and the corresponding thermodynamic parameters ΔH0, ΔS0 and ΔG0.

PEG capped methotrexate silver nanoparticles for efficient anticancer activity and biocompatibility

BACKGROUND

Nanocarriers endow tremendous benefits to the drug delivery systems depending upon the specific properties of either component. These benefits include, increase in the drug blood retention time, reduced efflux, additional toxicity and targeted delivery. Methotrexate (MTX) is clinically used for cancer treatment. Higher dosage of MTX results in hepatic and renal toxicity. In this study methotrexate silver nanoparticles (Ag-MTX) coated with polyethylene glycol (PEG) are synthesized and characterized. Their anticancer activity and biocompatibility is also evaluated.

RESULTS

Ag-MTX nanoparticles are synthesized by chemical reduction method. They are characterized by Ultraviolet-Visible Spectroscopy and Fourier Transform Infrared Spectroscopy. Average size of PEG coated Ag-MTX nanoparticles (PEG-Ag-MTX nanoparticles) is 12nm. These particles exhibited improved anticancer activity against MCF-7 cell line. Hemolytic activity of these particles was significantly less than MTX.

CONCLUSION

PEG-Ag-MTX nanoparticles are potential nanocarrier of methotrexate which may offer MTX based cancer treatment with reduced side effects. In-vivo investigations should be carried out to explore them in detail.

Mixed-linker approach in designing porous zirconium-based metal–organic frameworks with high hydrogen storage capacity

New zirconium based metal–organic framework (UBMOF-31) synthesised using mixed-linker strategy showing permanent porosity, excellent hydrogen uptake, and high selectivity for adsorption of CO₂ over N₂.

Correlation of interleukin-4 levels with Plasmodium falciparum malaria parasitaemia in Sudanese children

OBJECTIVES

This study aimed to measure the level of interleukin-4 (IL-4) in the serum of children patients with falciparum malaria and to correlate the production of this cytokine with the severity of malaria parasitaemia.

METHODS

One hundred ten patients with malaria participated in this study (53 males and 57 females) and their results were compared with that of 60 healthy control subjects. Their ages ranged between 6 months and 15 years. For the detection of parasitaemia, a calibrated thick-smear technique was used with standard Giemsa staining. For designation of the relative parasite count, a simple code from one to four crosses is used according to the criteria mentioned by Gilles and Warrell. The blood samples were assessed for IL-4 using enzyme-linked immunosorbent assay (ELISA) technique.

RESULTS

Thirty-three malaria patients (30.27%) had one cross (+) parasitaemia, 13 patients (11.93%) had (++) parasitaemia, 24 patients (22.02%) had (+++) parasitaemia and 39 patients (35.78%) had (++++) parasitaemia. There was a significant difference (P<0.009) in the concentration of IL-4 between malaria patients (160.74±25.5 pg/ml) and control group (62.136±18.16 pg/ml). Uncomplicated malaria patients showed the highest record of IL-4 level followed by cerebral malaria (CM) group and then severe malaria anaemia group (SMA) (255.8±54.13, 102.7±34.88 and 90.95±20.90 pg/ml respectively, P>0.0001).

CONCLUSION

It was concluded that elevation of serum IL-4 in Sudanese children suffering from Plasmodium falciparum malaria is correlated with the severity of malaria hyperparasitaemia rather than with the severity of the disease.

Is home delivery really preferred? a mixed-methods national study in Pakistan

BACKGROUND

Pakistan has a high maternal mortality ratio and a low rate of skilled birth attendants (SBAs). To address these two important issues, the Pakistan Maternal Newborn and Child Health (MNCH) programme launched the community midwives (CMW) initiative in 2007. CMWs are supposed to conduct deliveries at community level outside health facilities. The purpose of the current study is to document perceptions about CMWs and preferences for birthing place.

METHODS

A mixed-methods study was conducted covering four provinces. For the quantitative survey, households were selected through a multistage sampling technique from rural districts. In 1,450 rural households, preferences of respondents about CMW-conducted deliveries were recorded. Qualitative data were obtained through focus group discussions (FGDs) and in-depth interviews (IDIs) with women, community elders, CMWs, and MNCH programme personnel in the same areas where the quantitative study was carried out. In both studies, preferences and the reasons behind particular respondent preferences were recorded. Frequencies of responses were analysed for the quantitative study. Narration and quotes from various types of participants were used to present findings from FGDs and IDIs.

RESULTS

In the quantitative study, 42% of respondents expressed a preference for birthing stations, i.e. a place where CMWs conduct deliveries; 22% preferred home deliveries. Birthing stations were favoured because of the availability of space and equipment and the proximity to women's homes. These findings were largely supported by the qualitative component, although a range of views about where a CMW should conduct deliveries were expressed.

CONCLUSION

Insights into where CMWs might provide delivery services were obtained through this study. Birthing stations may be an option as a preferred location for delivery care and should be considered as part of Pakistan's national CMW programme.

Review and follow-up of patients using a regional sperm cryopreservation service: ensuring that resources are targeted to those patients most in need

Are all patients undergoing chemotherapy for long-term sperm banking at risk of permanent sterility? Male fertility is generally lower in men with cancer and all patient groups are at risk of azoospermia. Careful management is required to ensure that samples are not stored for excessively long periods should they not be required. A retrospective analysis of 1688 patient records and prospective recall of patients for semen testing were performed. Pre-therapy fertility was compared with a group of pre-vasectomy patients as a comparator. Those who fail to bank spermatozoa, rates of disposal of samples and the utilization in assisted reproduction were also examined. Sperm quality was poorest in testicular cancer (TC) patients followed by those with Hodgkin's lymphoma (HL) prior to treatment. Post-therapy data were available in 376 patients (42%). Sperm number was lowest (and azoospermia highest at 77%) in patients with HL treated with regimens other than adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). Non-HL NHL and leukaemic patients had similarly high rates of azoospermia at 46 and 55%. HL patients treated with ABVD (11%) and TC patients (9.7%) had the lowest rates of azoospermia. Azoospermia was seen in every treatment group except for TC patients receiving carboplatin. Only 45 patients used their samples in ART (4.5%) in 10 years. Little is known about the fertility status of the patients not coming forward for follow-up testing, those conceiving naturally, those with no intention of conceiving and some which may have psychological reasons for not attending. In conclusion, virtually all patients undergoing chemotherapy are potentially at risk of temporary or permanent infertility. However, as uptake and utilization of stored material remain low, sperm banks should be carefully managed to ensure that resources are targeted to the patients most in need.

DNA barcoding for species identification in the Palmae family

DNA barcoding is a promising tool for species identification at the molecular level. The barcoding system is well established for species differentiation in animals, while it is less common in plants. We evaluated 2 barcoding regions, maturase K (matK) and ribulose bisphosphate carboxylase (rbcL), to compare species of Palmae according to amplification success, discrimination power, and inter- and intra-specific divergence. Both regions appear to have potential to discriminate most species of Palmae, but 2 species, Phoenix dactylifera and Phoenix sylvestris, did not show variation in the nucleotides of the barcode genes. P. sylvestris is said to be the sister species of P. dactilyfera according to its morphological and genetic proximity to the cultivated date palm. Thus, the status of these 2 species needs to be re-evaluated considering more genes as barcodes. Furthermore, rbcL has a higher discrimination power (90%) than matK (66.6%) and can thus be potentially used as a standard barcode to discriminate the species of Palmae.