Eco-friendly synthesis of mesoporous bioactive glass ceramics and functionalization for drug delivery and hard tissue engineering applications

Hard tissue regenerative mesoporous bioactive glass (MBG) has traditionally been synthesized using costly and toxic alkoxysilane agents and harsh conditions. In this study, MBG was synthesized using the cheaper reagent SiO2by using a co-precipitation approach. The surface properties of MBG ceramic were tailored by functionalizing with amino and carboxylic groups, aiming to develop an efficient drug delivery system for treating bone infections occurring during or after reconstruction surgeries. The amino groups were introduced through a salinization reaction, while the carboxylate groups were added via a chain elongation reaction. The MBG, MBG-NH2, and MBG-NH-COOH were analyzed by using various techniques: x-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), Brunauer-Emmett-Teller (BET), scanning electron microscopy and energy-dispersive x-ray spectroscopy. The XRD results confirmed the successful preparation of MBG, and the FTIR results indicated successful functionalization. BET analysis revealed that the prepared samples were mesoporous, and functionalization tuned their surface area and surface properties. Cefixime, an antibiotic, was loaded onto MBG, MBG-NH2, and MBG-NH-COOH to test their drug-carrying capacity. Comparatively, MBG-NH-COOH showed good drug loading and sustained release behavior. The release of the drug followed the Fickian diffusion mechanism. All prepared samples displayed favorable biocompatibility at higher concentration in the Alamar blue assay with MC3T3 cells and exhibited the good potential for hard tissue regeneration, as carbonated hydroxyapatite formed on their surfaces in simulated body fluid.

Adsorption of trace heavy metals through organic compounds enriched biochar using isotherm adsorption and kinetic models

Trace heavy metals such as copper and nickel, when exceeds a certain level, cause detrimental effects on the ecosystem. The current study examined the potential of organic compounds enriched rice husk biochar (OCEB's) to remove the trace heavy metals from an aqueous solution in four steps. In 1st step, biochar' physical and chemical properties were analyzed through scanning electron microscope (SEM) and Fourier transforms infrared spectroscopy (FTIR). In the 2nd step, two biochar vis-a-vis glycine, alanine enriched biochar (GBC, ABC) was selected based on their adsorption capacity of four different metals Cr, Cu, Ni and Pb (chromium, copper, nickel, and lead). These two adsorbents (GBC, ABC) were further used to evaluate the best interaction of biochar for metal immobilization based on varying concentrations and times. Langmuir isotherm model suggested that the adsorption of Ni and Cu on the adsorbent surface supported the monolayer sorption. The qmax value of GBC for Cu removal increased by 90% compared to SBC (Simple rice husk biochar). The interaction of Cu and Ni with GBC and ABC was chemical, and 10 different time intervals were studied using pseud first and second-order kinetics models. The current study has supported the pseudo second-order kinetic model, which exhibited that the sorption of Ni and Cu occurred due to the chemical processes. The % removal efficiency with GBC was enhanced by 21% and 30% for Cu and Ni, respectively compared to the SBC. It was also noticed that GBC was 21% more efficient for % removal efficiency than the CBC. The study's findings supported that organic compound enriched rice husk biochar (GBC and ABC) is better than SBC for immobilizing the trace heavy metals from an aqueous solution.

The association between climatic factors and waterborne infectious outbreaks with a focus on vulnerability in Pakistan: integrative review

Climate change affects the spread of waterborne infectious diseases, yet research on vulnerability to outbreaks remains limited. This integrative review examines how climate variables (temperature and precipitation) relate to human vulnerability factors in Pakistan. By 2060, mean temperatures are projected to rise from 21.68°C (2021) to 30°C, with relatively stable precipitation. The epidemiological investigation in Pakistan identified Diarrhea (119,000 cases/year), Malaria (2.6 million cases/year), and Hepatitis (A and E) as the most prevalent infections. This research highlighted vulnerability factors, including poverty (52% of the population), illiteracy (59% of the population), limited healthcare accessibility (55% of the population), malnutrition (38% of the population), dietary challenges (48% of the population), as well as exposure to water pollution (80% of the population) and air pollution (55% of the population). The findings suggest that the coordinated strategies are vital across health, environmental, meteorological, and social sectors, considering climatic variability patterns and population vulnerability determinants.

Fabrication of green composite hand knitted silk mesh reinforced with silk hydrogel

Soft tissue defects like hernia and post-surgical fistula formation can be resolved with modern biomaterials in the form of meshes without post-operative complications. In the present study hand knitted silk meshes were surface coated with regenerated silk fibroin hydrogel and pure natural extracts. Two phytochemicals (Licorice extract (LE) and Bearberry extract (BE)) and the two honeybee products (royal jelly (RJ) and honey (HE)) were incorporated separately to induce antibacterial, anti-inflammatory, and wound healing ability to the silk hydrogel coated knitted silk meshes. Meshes were dip coated with a blend of 4 % silk hydrogel (w/v) and 5 % extracts. Dried modified meshes were characterized using SEM, DMA, GC-MS and FTIR. Antimicrobial testing, in-vitro cytotoxicity, in-vitro wound healing and Q-RT-PCR were also performed. SEM analysis concluded that presence of coating reduced the pore size up to 47.7 % whereas, fiber diameter was increased up to 17.9 % as compared to the control. The presence of coating on the mesh improved the mechanical strength/Young's modulus by 1602.8 %, UTS by 451.7 % and reduced the % strain by 51.12 %. Sustained release of extracts from MHRJ (62.9 % up to 72 h) confirmed that it can induce antibacterial activity against surgical infections. Cytocompatibility testing and gene expression results suggest that out of four variables MHRJ presented best cell viability, % wound closure and expression of wound healing marker genes. In-vivo analyses in rat hernia model were carried out using only MHRJ variant, which also confirmed the non- toxic nature and wound healing characteristics of the modified mesh. The improved cell proliferation and activated wound healing in vitro and in vivo suggested that MHRJ could be a valuable candidate to promote cell infiltration and activate soft tissue and hernia repair as a biomedical implant.

Does the ultrasound imaging predict lower limb tendinopathy in athletes: a systematic review

BACKGROUND

To conduct a systematic review looking into the possibility of US imaging to anticipate and identify future patellar or Achilles tendinopathy symptoms.

METHODS

The studies that were taken into consideration for this review were prospective studies that employed baseline US imaging of the patellar OR Achilles tendons in asymptomatic patients and follow-up measures of pain and/or function. Two impartial reviewers evaluated the study's quality using the Critical Appraisal Skills Programme instrument.

RESULTS

Participants in the included studies in this review came from various sports. The systematic review revealed a link between baseline tendon abnormalities in the US and a higher chance of developing both patellar and Achilles tendinopathy as well as their future occurrence. Nine of the included studies examined the patellar tendon alone, eight the patellar and Achilles tendon together, and four the Achilles tendon exclusively. For both tendons, US administration is done in a largely consistent manner. The tendon abnormalities of tendon thickness, hypoechogenicity and vascularity at baseline were associated with an increased risk of both Achilles and patellar tendinopathy.

CONCLUSIONS

This systematic review shows that abnormal tendon structures seen by US in asymptomatic persons can predict the development of tendinopathy.

Spatio-temporal analysis of land use land cover change and its impact on land surface temperature of Sialkot City, Pakistan

The dynamic interplay between urbanization and its impacts on climate is a subject of recent concern, particularly in rapidly urbanizing cities of Pakistan. This research investigated the spatio-temporal effects of urban growth in terms of Land Use Land Cover changes on the thermal environment (Land Surface Temperature) of the Sialkot city, Pakistan using satellite data spanning four distinct time periods (1989, 2000, 2009 and 2020) and predicted changes for year 2030 by employing Cellular Automata Markov Chain Model. Satellite imagery (Landsat 5, 7 and 8) was processed, and maximum likelihood supervised classification was done to generate LULC maps for each of the aforementioned years. In addition to LULC classification, thermal bands of satellite data (for summer and winter) were processed to compute Land Surface Temperature (LST) of the city. The prediction of LULC changes and LST was done for year 2030 using Cellular Automata Markov Chain Model. The accuracy of classified and prediction maps was checked using Kappa Index. The LULC analysis revealed 4.14% increase in the built-up area and 3.43% decrease in vegetation cover of the city during 1989 to 2020. Both land covers are expected to change in the future (year 2030) by + 1.31% (built-up) and - 1.1% (vegetation). Furthermore, a declining trend in the barren land and water bodies was also observed over time. These LULC changes were found affecting the LST of study area. The transformation of vegetation cover into built-up area resulted in an increase in LST over time. A notable rise of 4.5 °C (summer) and 5.7 °C (winter) in the mean LST of Sialkot was observed during 1989 to 2020 and further increases are anticipated in year 2030. This study calls for attention of the policy makers to reduce human impact on the local climate of the city. The study will also help city developers in analyzing the urban population growth trend, finding suitable location to built new infrastructure by governmental authorities and how the rising temperature can affect energy demand and agriculture production of the city in future.

Phyto- and bio-management of metal(loid)-contaminated soil by inoculating resistant bacteria: evaluating tolerance of treated rice plant and soil with its efficiency

Anthropogenic activities are increasing the amount of heavy metals and metalloids in the environment on a global scale, harming all living things and necessitating the employment of bioremediation procedures. Metal-resistant bacteria were used to clean polluted soil and promote plant growth; this approach has gained attention in recent years for bioremediation of heavy metal-contaminated systems. We studied the effects of chromium and lithium in Oryza sativa under controlled conditions. In the present study, lithium concentration was applied 50 ppm to 200 ppm according to the dose tolerance level, while the concentration of chromium was 10 ppm throughout the experimental setup due to its concentration observed up to 10 ppm in the targeted soil, which is present in Kasur area Punjab, Pakistan, for rice crop production in future perspective. The results reflect that plants with high lithium concentration have shown decreased plant growth and development, but due to bacterial presence, they thrived until harvesting stage. Due to increase in stress concentration up to 200 ppm, decline in plant growth was observed, but after bacterial inoculation, better growth was seen (chlorophyll content increased to 40, and panicle numbers were more than 13). Our findings reveal that lithium and chromium have a direct negative impact on Oryza sativa, which can be minimized by utilizing halophilic microbes (Klebsiella pneumonia and Enterobacter cloacae) through soil-plant system.

Investigating the role of bulking agents in compost maturity

Kitchen waste is increasing globally, similarly in Pakistan bulk of municipal solid waste comprises of kitchen waste specifically, tea waste. Composting of kitchen waste is one of the promising ways to convert waste into useful product, resulting into zero waste. This study is aimed to convert waste (kitchen waste) in to a resource (compost) using bulking agents (tea waste and biochar) for reducing maturity time. Secondly, compost application on Solanum lycopersicum (tomato) was also tested. Four compost treatments were designed under aerobic composting conditions for 30 days. Tea waste and biochar have accelerated the maturity rate and produced a nutrient rich compost. Final compost had Electrical Conductivity of 2mS/cm, Carbon Nitrogen ration of 15, 54% of organic matter, 15% of moisture content, 48% of cellulose content, and 28% of Lignin content. With the use of Co-compost the Solanum lycopersicum showed 133% germination index, 100% germination, 235% Munoo-Liisa Vitality Index and 1238% seed vigor index. Co-compost also improved the soil total nitrogen by 1.4%, total phosphorous by 2%, total potassium by 2.1% and bulk density by 2.6 gcm-3. This study successfully used tea waste and biochar as bulking agents to reduce maturation time to 30 days. Tea waste and biochar enhanced the organic matter degradation, lignocellulose degradation, water holding capacity, porosity, seed's vigor, germination index. This research can be helpful in developing home composting and home gardening to combat solid waste management and food security issue in developing countries.

Silk Meshes Coated with Chitosan-Bioactive Phytochemicals Activate Wound Healing Genes In Vitro

Meshes from natural silk are hand knitted and surface functionalized to facilitate hernia repair and other load bearing, tissue applications. Purified organic silk is - hand knitted and then coated with chitosan (CH)/bacterial cellulose (BC) blend polymer using four phytochemicals such as pomegranate (PG) peel, Nigella sativa (NS) seed, Licorice root (LE), and Bearberry leaf extracts (BE) separately. Characterizations using GCMS analysis shows the presence of bioactive chemicals in the extracts. Scanning electron microcopy (SEM) shows that the surface is coated with the composite polymer t. Fourier transform infrared spectroscopy (FTIR) shows significant elements found in CH, BC, and phytochemicals in plant extracts with no chemical changes. Tensile strength of the coated meshes is higher to support tissue as implants. The release kinetics suggest sustained release of phytochemical extracts. In vitro studies confirmed the noncytotoxic, biocompatible, wound healing potential of the meshes. Furthermore, gene expression analysis of 3-wound healing genes shows marked increase in the in vitro cell cultures due to the presence of extracts. These results suggest that the composite meshes can efficiently support hernia closure while facilitating wound/tissue healing and combating bacterial infections. Therefore, these meshes can be good candidates for fistula and cleft palate repair.

Effect of Ionic Liquids on Mechanical, Physical, and Antifungal Properties and Biocompatibility of a Soft Denture Lining Material

This study aims to evaluate the effect of ionic liquids and their structure on the mechanical (tensile bond strength (TBS) and Shore A hardness), mass change, and antifungal properties of soft denture lining material. Butyl pyridinium chloride (BPCL) and octyl pyridinium chloride (OPCL) were synthesized, characterized, and mixed in concentrations ranging from 0.65-10% w/w with a soft denture liner (Molloplast-B) and were divided into seven groups (C, BPCL1-3, and OPCL1-3). The TBS of bar-shaped specimens was calculated on a Universal Testing Machine. For Shore A hardness, disc-shaped specimens were analyzed using a durometer. The mass change (%) of specimens was calculated by the weight loss method. The antifungal potential of ionic liquids and test specimens was measured using agar well and disc diffusion methods (p ≤ 0.05). The alamarBlue assay was performed to assess the biocompatibility of the samples. The mean TBS values of Molloplast-B samples were significantly lower (p ≤ 0.05) for all groups except for OPCL1. Compared with the control, the mean shore A hardness values were significantly higher (p ≤ 0.05) for samples in groups BPCL 2 and 3. After 6 weeks, the OPCL samples showed a significantly lower (p ≤ 0.05) mass change as compared to the control. Agar well diffusion methods demonstrated a maximum zone of inhibition for 2.5% OPCL (20.5 ± 0.05 mm) after 24 h. Disc diffusion methods showed no zones of inhibition. The biocompatibility of the ionic liquid-modified sample was comparable to that of the control. The addition of ionic liquids in Molloplast-B improved the liner's surface texture, increased its hardness, and decreased its % mass change and tensile strength. Ionic liquids exhibited potent antifungal activity.

Effects of conventional physical therapy with and without proprioceptive neuromuscular facilitation on balance, gait, and function in patients with Parkinson's disease

The study was conducted at University of Lahore Teaching Hospital and Sir Ganga Ram Hospital, Lahore, using non-probability convenience sampling. Thirty-eight patients of Parkinson's disease were allocated by randomisation into two groups. PNF Group (group A) performed proprioceptive neuromuscular facilitation incorporated with conservative treatment, while for the conventional therapy group (group B) only conservative treatment was followed. Berg Balance Scale, Freezing of Gait questionnaire, and Functional Independence measure were used as outcome measuring tool. Berg balance scale values were significantly improved in group A at 12th week as compared to group B. Freezing of gait and functional independence was more significantly reduced in group A at sixth and 12th week as compared to group B. Hence, it is concluded that Proprioceptive neuromuscular facilitation combined with routine treatment regime improves balance, gait, and function of Parkinson's patients more effectively as compared with routine treatment protocol only.

Effectiveness of ultrasound guided dry needling in management of jumper's knee: a randomized controlled trial

Jumper's knee is highly prevalent condition in athletes. Very limited evidence is available on clinical effects of tendon dry needling. Therefore, the objective of this study is to compare the effects of ultrasound-guided dry needling (UG-DN) combined with conventional physical therapy and conventional physical therapy alone in patients with jumper's knee. A total of 96 patients with pre-diagnosed jumper's knee were randomly assigned to experimental group (UG-DN + CPT) and conventional group (CPT alone) with 48 participants each. Pain intensity and functional disability were recorded using visual Analogue Scale (VAS), Victorian Institute of Sports Assessment-Patellar Tendinopathy (VISA-P) questionnaire, Lysholm Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS) respectively at baseline, at 1st, 2nd, and 4th week. Whereas ultrasonographic features of patellar tendon were measured through musculoskeletal ultrasound (MSKUS) at baseline and 4th week. Total 8 sessions of treatment were provided. Mann Whitney U test and Friedman test were used to compute between and within group differences respectively. P value was significant at 0.05. Results showed that patients in both groups had improvement in signs of jumper's knee but the improvement in UG-DN + CPT group was more significant (p ≤ 0.05). Significant difference was seen after 4 weeks of intervention in UG-DN + CPT group in VAS (Median ± I.Q.R = 3 ± 1, p = 0.000), VISA-P (Median ± I.Q.R = 83.5 ± 7, p = 0.000), KOOS (Median ± I.Q.R = 83.5 ± 8, p = 0.000), , Lysholm (Median ± I.Q.R = 84 ± 5, p = 0.000) than CPT group VAS (Median ± I.Q.R = 1.5 ± 1, p = 0.000), VISA-P (Median ± I.Q.R = 92 ± 2, p = 0.000), KOOS (Median ± I.Q.R = 92 ± 3, p = 0.000), Lysholm (Median ± I.Q.R = 92 ± 4, p = 0.000) and ultrasonographic features of jumper's knee were more significant in experimental group(p-value ≤ 0.05). The Ultrasound guided dry needling with conventional physical therapy of patellar tendon had been found an effective treatment for jumper's knee and helps in reducing pain intensity, improving function and ultrasonographic features in patients with jumper's knee. UG-DN + CPT group showed more significant results as compared to CPT.Trial registration: (IRCT20210409050913N1). Dated: 17.04.2021.

Techno-economic and environmental sustainability analysis of filament-winding versus pultrusion based glass-fiber composite technologies

In the era of sustainable development, glass-fiber reinforced polymer (GFRP) composites have made their way into modern engineering, construction, and building sectors due to their exponential characteristics. While considering the rapid growth and development in this sector, this research has assessed the relative environmental and techno-economic sustainability of two sorts of GFRP composite technologies: (a) filament winding and (b) pultrusion to effectively appraise their application, merits, and demerits. This study will help low-middle-income countries like Pakistan toward cleaner production, environmental management, and sustainable industrial development. The techno-economic sustainability is determined by using life cycle costing and techno-economic indicators, i.e., benefit-cost (B/C) ratio, net present value (NVP), internal rate of return (IRR), and payback period. The B/C ratio depicts the relationship between the relative cost and benefits of a technology, and NVP expresses the calculated present value of the future payback stream of a technological investment, while the IRR is an effective techno-economic indicators which can predict the efficacy of an investment, and the payback period is the time forecast for a technology to recover its investments. These techno-economic analytics showed that the net life-cycle cost performance, B/C ratio, and IRR are 5%, 7%, and 15% higher respectively for filament winding-based GFRP technology than the pultrusion-based manufacturing technology, whereas overall net life cycle benefits are about 80% greater for filament winding. Similarly, the payback time is shorter for filament winding compared to pultrusion. The environmental sustainability is determined, by employing a relative life cycle analysis (LCA) for both technologies. The system boundary for the study is "gate to gate," i.e., manufacturing phase, where these technologies are assessed for their environmental externalities. The functional unit of "1 kg finished product," i.e., manufactured by pultrusion and filament winding technology, and eight life cycle impact assessment (LCIA) categories; climate change potential (CCP), terrestrial eco-toxicity potential (TETP), ozone depletion potential (ODP), fossil resource depletion potential (FDP), acidification potential (AP), eutrophication potential (EP), particulate matter (PM) formation, and water consumption potential (WCP) have been selected. The significant ecological impact scores are determined in the categories of CCP (kg CO₂ eq.) as 10.8E + 00 and 5.01E + 00 and ETP (kg. 2,4-D eq.) as 1.26E-02 and 9.47E-03 and FDP (kg Oil eq.) as 3.96E + 00 and 2.59E + 00 for filament winding and pultrusion-based GFRP technologies, respectively. These LCIA results depicted that the ecological performance of filament winding technology is specifically better than pultrusion technology in the categories of EP, PM, and WCP, while, for all other life cycle impact categories, the pultrusion technology has depicted significantly lower impact potential and is environmentally more sustainable. The outcomes of this research will be greatly assistive for researchers, developers, manufacturers, and policymakers to effectively appraise the externalities and selection of a more sustainable GFRP technology.

Association of human cohorts exposed to blood and urinary biomarkers of PAHs with adult asthma in a South Asian metropolitan city

Semi-volatile organic compounds (SVOCs) are a major global problem that causes the greatest impact on urban settings and have been linked to bronchial asthma in both children and adults in Pakistan. The association between exposure of polycyclic aromatic hydrocarbons (PAHs) and asthma in the adult population is less clear. The current study aimed to assess the clinico-chemical parameters and blood levels of naphthalene phenanthrene, pyrene, and 1,2-benzanthracene and urinary levels of 1-OH pyrene and 1-OH phenanthrene as well as asthma-related biomarkers immunoglobulin E (IgE), resistin, and superoxide dismutase (SOD) of oxidative stress and other hematologic parameters in adults and their relationship with bronchial asthma. The GC/MS analysis showed higher mean concentrations of blood PAHs in asthma respondents (4.48 ± 1.34, 3.46 ± 1.04, 0.10 ± 0.03, and 0.29 ± 0.09) (ng/mL) as compared to controls (3.07 ± 0.92, 1.71 ± 0.51, 0.06 ± 0.02, and 0.11 ± 0.03) (ng/mL), with p = .006, p = .001, p = .050, and p = .001. Similarly, urinary levels of 1-OHpyr and 1-OHphe were significantly increased in adults with bronchial asthma (0.54 ± 0.16; 0.13 ± 0.04) (μmol/mol-Cr) than in controls (0.30 ± 0.09; 0.05 ± 0.02) (μmol/mol-Cr), with p = .002 and p = .0001, respectively, with a significant positive correlation to asthma severity. The asthma-related biomarkers IgE, resistin, and SOD were significantly higher (p 0.0001, 0.0001, and 0.0001) in people with asthma than in control persons. The findings showed that higher blood and urine PAHs levels were linked to higher asthma risk in adults and significant interaction with participants who smoked, had allergies, had a family history of asthma, and were exposed to dust. The current study's findings will be useful to local regulatory agencies in Lahore in terms of managing exposure and advocating efforts to minimize PAH pollution and manage health.

Human health risk estimation of antibiotics transferred from wastewater and soil to crops

Antibiotics enter into agricultural land, via manure application or wastewater irrigation. The practices of using untreated wastewater in the agricultural system help in the bioaccumulation of antibiotics in vegetables and other crops. Exposure to the bioaccumulated antibiotics poses serious health risks to ecosystem and human. In this study, the prevalence of two fluoroquinolones (levofloxacin and ciprofloxacin), their bioaccumulation in five crops (Daucus carota L., Pisum sativum L., Raphanus raphanistrum L., Lactuca sativa L., Spinacia oleracea L.), and associated human health risks were investigated. Lettuce showed highest bioaccumulation of levofloxacin (LEV) (12.66 μg kg-1) and carrot showed high bioaccumulation of ciprofloxacin (CIP) (13.01 μg kg-1). In roots, bioconcentration factor (BCFroot) was observed to be relatively high in radish (LEV 0.24-0.43, CIP 0.32-0.49) and observed to be lower in spinach (LEV 0.05-0.13, CIP 0.12-0.19). The translocation factor (TF) for LEV and CIP was generally >1 for all five crops under all treatment. The final transfer and distribution of LEV and CIP in the edible parts of the crops were as follows: leaves > shoots > roots for both antibiotics. Risk quotient of both LEV and CIP in current study is found to be in between 0.018 and 0.557 and shows a medium risk (0.1 to 1) to human health due the discharge of untreated wastewater into the fields. However, our study reports that both antibiotics do accumulate in the edible plant parts; therefore, it poses potential risks to human health.

Role of ambient air pollution in asthma spread among various population groups of Lahore City: a case study

Air pollution levels rise as a result of industrial and vehicular emissions, epidemiological issues such as asthma become more prevalent in Lahore, Punjab, Pakistan and cause adverse public health effects. Many studies explored the association between air pollutants and frequency of asthma hospital visits, although their effects are unclear. This study examined the link between air pollution, asthma, and socioeconomic and demographic factors. A questionnaire survey was administered among four age groups (15-25, 25-45, 45-60, and over 60 years old) in public and private hospitals of Lahore city. Daily average concentrations of five air pollutants including carbon monoxide (CO), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ozone (O₃), and particulate matter (PM_2.5 and PM₁₀) were recorded at ten fixed air monitoring sites in Lahore city. There were favorable connections between outpatient department (OPD) asthma visits (64%) and levels of outdoor air quality during winter season throughout the study period. The correlation between 1, 29, and 370 asthma patients and average daily air pollution levels found that the condition was more prevalent in females (53%) than males (47%). There was a significant correlation between PM₁₀ exposure and asthma OPD visits in the city (p 0.001), as well as the elevated PM₁₀ levels were substantially linked with OPD asthma visits over the winter season in the city. The hazard index (HI) for all adult population was estimated 0.001132. The study's findings indicate that exposure to ambient air pollution is a significant predictor of asthma hospital visits, particularly among the elderly. Strategies can be developed by policymakers in response to the worrying situation of allergic disease asthma in industrial cities due to air pollution.

Efficacy of ultrasound guided dry needling as an adjunct to conventional physical therapy for patients with jumper’s knee: A randomized controlled trial

Background

Jumper’s knee is a degenerative condition among athletes, and it has been treated with conventional physical therapy (CPT). Ultrasound guided dry needling (USG-DN) is a relatively new technique to explore clinical outcomes in patients with tendinopathy.

Methods

This parallel group, single-blinded randomized controlled trial was carried out involving 94 athletes with clinically diagnosed jumper’s knee, divided into an intervention group (USG-DN + CPT, n = 47) and a control group (CPT, n = 47). Participants received a 4-week programme; the intervention group received ultrasound guided patellar tendon dry needling (DN) in conjunction with CPT. The control group received only CPT. The visual analog scale (VAS), Victorian institute of sports assessment-Patellar tendinopathy (VISA-P) questionnaire, Lysholm scale, Knee injury and osteoarthritis outcome score (KOOS) and ultrasonographic features of patellar tendinopathy were evaluated at baseline,1 week, 2 weeks, and 4 weeks. The data were analyzed through SPSS-26.

Results

The study found statistically significant differences (P < 0.05) regarding VAS, Lysholm, VISA-P, and KOOS scales at baseline, 1st, 2nd, and 4th week post-intervention. Within-group differences also showed statistically significant results after the intervention. There were significant results observed in ultrasonographic outcomes between both groups at 1 month post-intervention (all P < 0.05).

Conclusion

The results of the current study suggest, ultrasound guided DN of patellar tendon in combination with CPT reduced pain, improved function, and showed a tendency to decrease tendon thickness in patients with patellar tendinopathy.

Clinical Trial Registration Number

(IRCT20210409050913N1). Dated: 17.04.2021. https://www.irct.ir/user/trial/55607/view.

Clinical application of low-level laser therapy (Photo-biomodulation therapy) in the management of breast cancer-related lymphedema: a systematic review

Background

Breast cancer-related lymphedema (BCRL) is a frequent issue that arises after mastectomy surgery in women and compromises physical and mental function. Previously published studies have shown positive effects with the use of Low-level laser therapy in another term Photo-biomodulation therapy (PBM). This research investigated the efficacy of clinical use of LLLT (PBM) in the treatment of metastatic breast cancer-related lymphedema.

Methods

PubMed, PEDro, Medline, and the Cochrane Library were searched for LLLT clinical trials published before October 2021. The methodological quality of randomized trials and the effectiveness of Laser Therapy for BCRL were evaluated. The primary objectives were arm circumference or arm volume, whereas the secondary goals were to assess shoulder mobility and pain severity.

Results

Eight clinical trials were analyzed in total. Typically, the included RCTs had good research quality. At four weeks, there was a considerable reduction in arm circumference/volume, and this continued with long-term follow-up. However, no statistically significant change in shoulder mobility or pain severity was seen between the laser and placebo groups at 0-, 1-, 2-, and 3-month short-term follow-up.

Conclusions

The findings of this comprehensive study demonstrated that LLLT (PBM) was successful in diminishing arm circumference and volume than improving shoulder mobility and pain. Data indicates that laser therapy (PBM) may be a beneficial treatment option for females with PML. Because of the scarcity of evidence, there is a strong need for well-conducted and longer-duration trials in this field.

Trial registration

Details of the protocol for this systematic review were registered on PROSPERO and can be accessed at www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42022315076.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-10021-8.

966 IMPROVING COMMUNICATION WITH RELATIVES IN THE COVID ERA - DEVELOPMENT OF A NEW SERVICE STANDARD

Background

Quality improvement project undertaken by the Ageing and Complex Medicine team to improve the quality and quantity of communication with patients’ relatives.

Introduction

Visitation restrictions at RAEI since the onset of the COVID pandemic have created barriers to effective communication between patients’ relatives and the medical team. Patients’ relatives were frequently receiving poorly structured information, incorrect information, or even no information. This problem was hospital wide and likely to have affected other trusts. It particularly affected elderly care wards, where the cohort of patients were often less able provide their relatives with updates themselves. We therefore agreed a service standard whereby the medical team would provide a medical update via phone to the patients’ next of kin within 24 hours of admission followed by twice weekly updates by any member of the wider MDT. Our aim was to improve the quality and quantity of communication with the patients’ relatives.

Method

So far 6 data capture cycles have seen us implement change in various ways such as utilisation of a white board to highlight when updates are due, a staff feedback survey to highlight barriers to providing the service and a relative feedback survey to evaluate their experience.

Results

Compared to baseline data we have seen an improvement in the quantity of relative updates with most cycles.

Conclusion

We have improved the quantity of relative updates and embedded it as established culture on Astley ward. Barriers to success include staffing levels, time burden, and low confidence levels amongst junior doctors. Cycle 7 will see implementation of a teaching session for new junior doctor cohorts to improve their confidence. I would like to share our learning and success with the wider hospital and see implementation of the service standard across all wards within the trust.

Analysis of environmental sustainability of e-waste in developing countries - a case study from Pakistan

The electronic waste generation rate is increasing drastically at a rate of 3 to 5% per year in developing countries. The aim of this study is to analyze the environmental sustainability and economic benefits of such e-waste management in the developing economies like Pakistan. The life cycle assessment (LCA) method has been employed for streamlined impact analysis of the end-of-life processing of e-waste focusing mainly on laptop computers and liquid crystal display (LCD) desktop computers in Pakistan. The method of cumulative exergy extraction from the natural environment (CEENE) has also been deployed for the relative assessment of resources' consumption of e-waste recycling versus landfilling scenario. The determined impact scores are 1.79E + 03 kg CO₂ eq., 7.19E-07 kg CFC-11 eq., 1.02E + 03 kg 1,4-DCB, 7.13E + 01 kg 1,4-DCB, and 3.41E-03 kg Cu eq. in climate change potential, stratospheric ozone depletion, ecotoxicity potential, human noncarcinogenic potential, and mineral resource depletion impact categories, respectively. The results of CEENE analysis reveal that approximately 80% of the impact on natural resources is reduced by the efficient recycling of e-waste. The comparative assessment of respective scores for current and target material weight recovery (MWR) indicators represented that by increasing the MWR indicator by 33.8% for laptop computers and by 27.2% for LCD computers, the country will achieve an annual economic benefit of US $191.56 million. This is greatly significant for a transitional shift towards e-waste revalorization while realizing the objectives of sustainable resource consumption. Innovative improvement measures ensuring economically feasible, energy-efficient, and environment friendly waste collection, treatment, and recycling practices present an invaluable opportunity for developing countries.

The Pivotal Role of Major Chromosomes of Sub-Genomes A and D in Fiber Quality Traits of Cotton

Lack of precise information about the candidate genes involved in a complex quantitative trait is a major obstacle in the cotton fiber quality improvement, and thus, overall genetic gain in conventional phenotypic selection is low. Recent molecular interventions and advancements in genome sequencing have led to the development of high-throughput molecular markers, quantitative trait locus (QTL) fine mapping, and single nucleotide polymorphisms (SNPs). These advanced tools have resolved the existing bottlenecks in trait-specific breeding. This review demonstrates the significance of chromosomes 3, 7, 9, 11, and 12 of sub-genomes A and D carrying candidate genes for fiber quality. However, chromosome 7 carrying SNPs for stable and potent QTLs related to fiber quality provides great insights for fiber quality-targeted research. This information can be validated by marker-assisted selection (MAS) and transgene in Arabidopsis and subsequently in cotton.

Genome-wide characterization and expression analysis of Erf gene family in cotton

BACKGROUND

AP2/ERF transcription factors are important in a variety of biological activities, including plant growth, development, and responses to biotic and abiotic stressors. However, little study has been done on cotton's AP2/ERF genes, although cotton is an essential fibre crop. We were able to examine the tissue and expression patterns of AP2/ERF genes in cotton on a genome-wide basis because of the recently published whole genome sequence of cotton. Genome-wide analysis of ERF gene family within two diploid species (G. arboreum & G. raimondii) and two tetraploid species (G. barbadense, G. hirsutum) was performed.

RESULTS

A total of 118, 120, 213, 220 genes containing the sequence of single AP2 domain were identified in G. arboreum, G. raimondii, G. barbadense and G. hirsutum respectively. The identified genes were unevenly distributed across 13/26 chromosomes of A and D genomes of cotton. Synteny and collinearity analysis revealed that segmental duplications may have played crucial roles in the expansion of the cotton ERF gene family, as well as tandem duplications played a minor role. Cis-acting elements of the promoter sites of Ghi-ERFs genes predict the involvement in multiple hormone responses and abiotic stresses. Transcriptome and qRT-PCR analysis revealed that Ghi-ERF-2D.6, Ghi-ERF-12D.13, Ghi-ERF-6D.1, Ghi-ERF-7A.6 and Ghi-ERF-11D.5 are candidate genes against salinity tolerance in upland cotton.

CONCLUSION

Overwhelmingly, the present study paves the way to better understand the evolution of cotton ERF genes and lays a foundation for future investigation of ERF genes in improving salinity stress tolerance in cotton.

Source identification and risk assessment of polycyclic aromatic hydrocarbons (PAHs) in air and dust samples of Lahore City

During two consecutive summer and winter seasons in Lahore, the health risk of air and dust-borne polycyclic aromatic hydrocarbons (PAHs) was evaluated. Gas chromatography/mass spectrometry (GS/MS) was used to determine air and dust samples from various functional areas across the city. The mean ∑₁₆PAHs were higher in air 1035.8 ± 310.7 (pg m^-3) and dust 963.4 ± 289.0 (ng g^-1 d.w.) during winter seasons as compared to summer seasons in air 1010.9 ± 303.3 (pg m^-3) and dust matrices 945.2 ± 283.6 (ng g^-1 d.w.), respectively. PAHs ring profile recognized 3 and 4 rings PAHs as most dominant in air and dust samples. Estimated results of incremental lifetime cancer risk (ILCR) highlighted high carcinogenic risk among the residents of Lahore via ingestion and dermal contact on exposure to atmospheric PAHs. The total ILCR values in air among children (summer: 9.61E - 02, winter: 2.09E - 02) and adults (summer: 1.45E - 01, winter: 3.14E - 02) and in dust, children (summer: 9.16E - 03, winter: 8.80E - 03) and adults (summer: 1.38E - 02, winter: 1.33E - 02) during the study period. The isomeric ratios in the study area revealed mixed PAH sources, including vehicular emission, petroleum, diesel and biomass combustion. As a result, it is advised that atmospheric PAHs should be monitored throughout the year and the ecologically friendly fuels be used to prevent PAHs pollution and health concerns in the city. The findings of this study are beneficial to the local regulating bodies in terms of controlling the exposure and promoting steps to reduce PAHs pollution and manage health in Lahore.

Period of Purple Crying Program for the Prevention of Abusive Head Trauma/Shaken Baby Syndrome

The Period of PURPLE Crying Program is an educational program delivered to parents of newborn children that aims to reduce the incidence of abusive head trauma/shaken baby syndrome1. The program was developed by a research-based, non-profit organisation and has already been implemented in many countries around the world. It educates parents on what to expect during the first few months of their newborn infant's life, allowing parents to become more informed and better prepared to care for their child. The recent surge in the number of cases of abusive head trauma in children during the COVID-19 pandemic has highlighted the need for greater resources being made available to parents. The Period of PURPLE Crying Program is one such resource that could be implemented in Ireland.

Assessment of organochlorine pesticides and health risk in tobacco farming associated with River Barandu of Pakistan

Diffuse pesticide pollution through tobacco fields is a serious threat to both natural integrities and living beings because tobacco is known as a pesticide-intensive crop. Upsurge in the knowledge of detrimental impacts caused by organochlorine pesticides (OCPs) has made them a burning issue particularly in developing countries. Pakistan is a country famous for its agro-based economy and simultaneously is the second most significant pesticide consumer in South Asian countries. The studied area is tobacco hub of the country. Thus, the present work is aimed to investigate the contamination profile that highlights the ecological and health risk posed by OCPs in River Barandu, located in the proximity of tobacco farming region. ΣOCP levels in sediments ranged between 32.918 and 98.810 ng/g and in water between 0.340 and 0.935 μg/L. Hexachlorocyclohexanes (HCHs) and heptachlor were the most prevailing pesticides in both matrices of the river. Isomeric composition of DDTs and HCHs highlighted that the β-HCH and p,p'-DDT were dominant isomers in water, while α-HCH and p,p'-DDT in sediment compartment. Enantiomeric compositions of HCH and DDT indicate both recent and historic uses of these compounds in the area. Indirect contamination through nearby tobacco clusters has been depicted through spatial analysis. Ecological risk assessment based upon the risk quotient (RQ) method revealed that α-endosulfan, dieldrin, heptachlor, and ∑HCHs represent a very high level of ecological risks. The OCPs' lifetime carcinogenic and non-carcinogenic health risks associated with dermal exposure to river's water were considered nominal for surrounding populations. However, detailed ecological and health risk studies are recommended considering the bio-accumulating nature of these contaminants in the food chain.

Translation, cross-cultural adaptation and psychometric properties of the Urdu version of knee injury and osteoarthritis outcome score questionnaire for Pakistani population

Background

Knee injury and osteoarthritis outcome score questionnaire is a widely used tool for measuring short and long-term patient-relevant outcomes following knee injury. KOOS is neither translated nor examined for psychometric properties before. Therefore, the aim of this study was to translate, culturally adapt and check the psychometric properties of the KOOS in Urdu.

Methodology

The translation and cultural adaptation was performed according to pre-defined guidelines. A total of 117 participants (54 males and 63 females) were recruited. The study had two steps: 1) Translation and cultural adaptation 2) Reliability and validity testing. The reliability (test-retest and internal consistency at (95% confidence interval) as well as the validity (Convergent validity) of final Urdu version of KOOS was tested.

Results

For all five domains, the KOOS Urdu version (KOOS-U) has demonstrated high test-retest reliability ICC = 0.90–0.96(CI = 95%). For all domains, the internal consistency was determined to be excellent (α = 0.82–0.96). There were no floor or ceiling impacts noted. Convergent validity was found to be good, as measured by Pearson’s correlation coefficient. The findings revealed a strong negative association between the KOOS-U (QOL and pain) and the NPRS. And there was a low to high positive correlation between five KOOS-U domains and all SF-12 domains, i.e., there was a significant positive correlation between the pain domains of both KOOS and SF-12 with the r = 0.87(p < 0.05).

Conclusion

The Urdu version of KOOS is a valid, reliable, and responsive instrument to assess functional disability of patients with Knee Osteoarthritis with excellent psychometric properties.

Fabrication and performance evaluation of polymeric membrane using blood compatible hydroxyapatite for artificial kidney application

In the current study, a phase inversion scheme was employed to fabricate hydroxyapatite (HA)/polysulfone (PSF)-based asymmetric membranes using a film applicator with water as a solvent and nonsolvent exchanging medium. Fourier Transform Infrared (FTIR) and X-ray diffraction (XRD) spectroscopic studies were conducted to confirm the bonding chemistry and purity of filler. The inherent thick nature of PSF generated sponge-like shape while the instantaneous demixing process produced finger-like pore networks in HA/PSF-based asymmetric membranes as exhibited by scanning electron microscope (SEM) micrographs. The FTIR spectra confirmed noncovalent weak attractions toward the polymer surface. The leaching ratio was evaluated to observe the dispersion behavior of HA filler in membrane composition. Hydrophilicity, pore profile, pure water permeation (PWP) flux, and molecular weight cutoff (MWCO) values of all formulated membranes were also calculated. Antifouling results revealed that HA modified PSF membranes exhibited 43% less adhesion of bovine serum albumin (BSA) together with >86% recovery of flux. Membrane composition showed 74% total resistance, out of which 60% was reversible resistance. Biocompatibility evaluation revealed that the modified membranes exhibited prothrombin time (PT), and thrombin time (TT) comparable with typical blood plasma, whereas proliferation of living cells over membrane surface proved its nontoxic behavior toward biomedical application. The urea and creatinine showed effective adsorption aptitude toward HA loaded PSF membranes.

308 A Qualitative Study Evaluating the Uses, Benefits and Barriers of Tele-Consultations in The Pre-Operative Pathway for Elective Orthopaedic Surgery at A Major London Teaching Hospital

Introduction

Digital healthcare technology is becoming a prodigious tool in healthcare management, supporting efforts for effective demand management and personalised, user-centred care. One example is tele-consultations, clinical consultations conducted remotely using technology such as telephones or videos. However, there is slow adoption of such technology and lack of literature supporting its use, particularly within the pre-operative surgical pathway, where communication, patient education and planning is vital to post-surgical outcomes. This study aimed to evaluate the uses, benefits and barriers of tele-consultations in the pre-operative pathway for elective hip and knee arthroplasty, at Imperial College Healthcare NHS Trust, from the perspective of key clinical stakeholders.

Method

16 Semi Structured Interviews were conducted with Healthcare professionals (HCPs) along the preoperative pathway before conducting a thematic analysis.

Ethical approval was received from Imperial College Research Ethics Committee on 05/02/2019.

Results

HCPs suggested use-cases for tele-consultation use in pre-assessment consultations with lower risk patients, information delivery, physiotherapy, and occupational therapy pre-assessment. Benefits cited were reduced overall costs and time, increased workflow efficiency with barriers noted as accessibility challenges, lack of holistic examination of patient and digital illiteracy.

Conclusions

Future studies should be conducted in other NHS trusts to identify greater uses within the entire surgical pathway.

Socio-economic and environmental impacts of COVID-19 pandemic in Pakistan-an integrated analysis

The COVID-19 pandemic has affected about 210 countries with more than 67 million confirmed cases and over 1.5 million deaths across the globe including Pakistan. Considering the population density, health care capacity, existing poverty and environmental factors with more than 420,000 infected people and about 8300 plus mortalities, community transmission of the coronavirus happened rapidly in Pakistan. This paper analyses the short- and long-term effects of COVID-19 peak on the socio-economic and environmental aspects of Pakistan. According to the estimates, an economic loss of about 10%, i.e. 1.1 trillion PKR, will be observed in the FY 2021. Certain pandemic impediment measures like lockdowns, social distancing and travel restrictions taken by the Government have been thoroughly analysed to determine how they impacted the livelihoods of nearly 7.15 million workers. Consequently, a rise of 33.7% of poverty level is projected. While many negative impacts on primary, secondary and tertiary sectors of the economy such as agriculture, education and health care are observed, a drastic improvement in air quality index of urban centres of the country has been recorded amid lockdowns. With current economic crisis, fragile health care system and critical health literacy, a well-managed and coordinated action plan is required from all segments of the society led by the public authorities. Thorough assessment of COVID-19 scenario, management and control measures presented in this study can be assistive for the provision of policy guidelines to governments and think tanks of countries with similar socio-economic and cultural structure.

Effect of industrial wastewater on wheat germination, growth, yield, nutrients and bioaccumulation of lead

Due to fresh water scarcity, farmers are using polluted water for irrigation. This research was conducted to study the bioaccumulation of Pb in wheat (Cv. Shafaq-2006). The experiment was comprised of seven treatments of lead i.e. 0–1,000 mg Pb/kg. The results revealed that lead severely reduces germination (− 30%), seedling fresh weight (− 74%), seedling dry weight (− 77%), vigor index (− 89%), tolerance index (− 84%), plant height (− 33%), number of leaves (− 41%), root fresh weight (− 50%), shoot fresh weight (− 62%), root dry weight (− 63%), shoot dry weight (− 71%), and root length (− 45%). The physiological parameters also respond negatively like stomatal conductance (− 82%), transpiration rate (− 72%) and photosynthetic rate (− 74%). Similarly, biochemical parameters also showed negative impacts, like carotenoids (− 41), total chlorophyll (− 43), chlorophyll a (− 42) and chlorophyll b (− 53). Yield parameters like the number of seed/plant, seed weight/plant, 1,000 seed weight and harvest index were reduced by 90%, 88%, 44% and 61%, respectively in T₆. In addition, protein contents (− 81%), phosphorous (− 60%) and potassium (− 55%) were highly effected in the highest lead concentration (T₆). Lead accumulation was extremely higher in seeds (119%) as compared to control plants. Lead bio-accumulation above threshold concentrations in crop parts is a serious human health concern.

Synthesis and characterization of cellulose/hydroxyapatite based dental restorative composites

The aim of this study was an in-situ synthesis of hydroxyapatite (HA) on cellulose fibers to be used as a new reinforcing agent for dental restorations. The microwave irradiation method was used for synthesis and the materials were characterized with analytical techniques. The prepared dental resin composites were mechanically tested by a universal testing machine and electrodynamic fatigue testing system. FTIR, XRD, SEM/EDS analysis confirmed the successful synthesis of HA on cellulose fibers. The Alamar blue biocompatibility assay showed more than 90% cell viability for the prepared cellulose/HA. The mechanical properties of resin composites improved with cellulose content from 30 wt.% to 50 wt.% in the polymer matrix. Substantially, increasing the cellulose/HA content from 40% to 50% improved the mechanical properties. The results suggested that HA could be successfully synthesized on cellulose fibers using microwave irradiation and contributed to improving the mechanical properties of dental resin composites.

59 A Qualitative Study Evaluating Patient Education in the Pre-Operative Pathway for Elective Hip and Knee Arthroplasty at A Major London Teaching Hospital

Introduction

Rising demands for hip and knee arthroplasty have been met with incremental advancements in both implant design and surgical technique. Despite these advancements in the intraoperative setting, the preoperative pathway has remained largely unchanged. The resulting ineffective demand management and improper patient optimisation through education and engagement, has contributed to long waiting times and increasing surgical cancellations. This has in turn lead to both patient distress and the disruption of clinical workflow.

Aims

This study aimed to investigate the effectiveness of patient education in the pre-operative pathway for elective hip and knee arthroplasty, at Imperial College Healthcare NHS Trust, from the perspective of key clinical stakeholders.

Methods

16 Semi Structured Interviews were conducted with Healthcare professionals (HCPs) along the preoperative pathway. These included GPs, Orthopaedic Surgeons, Nurses, Anaesthetists, Orthogeriatricians, Occupational Therapists and Physiotherapists. Interviews were recorded, transcribed and thematically analysed. Sampling continued until information redundancy was reached.

Results

HCPs stressed that patient education lacked engagement & effectiveness. Whilst joint school (an MDT run seminar) is in place for patients before surgery, it was resource intensive meaning sessions were infrequent and often overcrowded.

Furthermore, not all patients were invited/attended joint school as a result of problems with scheduling and transport. Of those whom did, information retention was identified as a problem, highlighted by patients not bringing in medication, and failing to follow fasting instructions, leading to cancellations on the day of surgery. A significant proportion of elderly patients also needed additional and continued support in understanding and interpreting information, a key issue that was not addressed by traditional joint school.

Conclusions

This study has provided a more in-depth analysis of patient education in the pre-operative pathway revealing inadequate tailoring, and delivery of education material particularly for the older patient. Both timing, content and frequency of patient education could be improved in order to improve quality of care and reduce cancellations in turn improving the management of demand for orthopaedic services. Future studies may want to evaluate the use of digital technology in this area of the pathway in efforts to overcome these issues.

Piloting restoration initiatives in subtropical scrub forest: specifying areas asserting adaptive management

Subtropical scrub forests in Pakistan have diminished by about 75% over the last hundred years, mainly due to indiscriminate exploitation and invasion by exotics species. Lack of initiatives, awareness, and research in utilizing the techniques used for accelerating natural forest succession is resulting in further degradation of the remaining forests. To promote active restoration with local communities and governmental authorities, a restoration scheme was piloted between 2010 and 2016 to examine enrichment population effects. Over 4,000 saplings of two woody climax species, Acacia modesta and Olea ferruginea, raised from seeds of local provenance, were planted in three subjectively selected trial plots representing various stages of degradation, covering a total area of about 4 ha. The results showed an overall 46% survival rate, accompanied by natural regeneration. Comparative analyses of the trial plots have shown variations which were strongly site specific, in addition, it also helped in gauging compliance of the site coordinators in implementing restoration measures as an effective management tool. This study provided an opportunity to appreciate the differences in terms of interventions used for implementing ecological restoration across landscape in the degraded scrub forests.

Vulnerability, well-being, and livelihood adaptation under changing environmental conditions: a case from mountainous region of Pakistan

Climatic changes pose serious risks to the rural community's livelihoods of many developing countries whereas people in mountainous regions are exposed to multiple hazards with limited livelihood resources and heavy dependence on natural resources. The objective of the current study is to assess the livelihood practices and adaptive capacity of a mountainous region of Pakistan, the Balakot, where people are highly vulnerable to climatic changes. The study uses a triangulation method to explore various issues and options of climate change risks sand adaptation and impact of well-being on resilience capacity and livelihood strategies. For this purpose, ten focus group discussions (FGDs) with carefully selected key informants and structured interviews with randomly selected 200 local households are conducted to evaluate different hazards and their associated livelihood effects. It is observed that the changing climate has significantly influenced livelihoods of the local community in the recent past through resource degradation, gradual unavailability of sufficient basic services (quantity and quality of drinking water, crop food diversity, fuel wood, and non-timber forest products), low agricultural productivity, and social inequity viz. income distribution, health, education, and food storage. Such a brunt is felt disproportionately more by poor households due to their low adaptive capacity to climate change with constrained livelihood resources. The study emphasizes the need for targeted efforts to move from coping strategies to adaptations among people considering their social inequalities. Timely information sharing, livelihood diversification and preservation of livelihood resources such as crop and forest production, livestock grazing, creating awareness on the pace, and pattern of climate change in the region and subsequent role of adaptation options are major interventions that should be emphasized by the public bodies.

Developing a synthetic composite membrane for cleft palate repair

An oronasal fistula is a passage between the oral and nasal cavity. Currently, surgical procedures use mucosal flaps or collagen grafts to make a barrier between oral and nasal cavities. Our aim was to develop a cell-free synthetic repair material for closure of nasal fistulas. We surface functionalized electrospun polyurethane (PU) and poly-L-lactic acid (PLLA) and composite polymer (PU-PLLA) membranes with acrylic acid through plasma polymerization. Membranes were treated in a layer-by-layer approach to develop highly charged electrostatic layer that could bind heparin as a pro-angiogenic glycosaminoglycan. The properties were evaluated through physical, chemical, and mechanical characterization techniques. Cytotoxicity was tested with MC3T3 pre-osteoblast cell lines for 3, 7, and 14 days, and vasculogenesis was assessed by implantation into the chorio-allantoic membrane in chick embryos for 7 days. In vivo biocompatibility was assessed by subcutaneous implantation in rats for 1, 3, and 6 weeks. The membranes consisted of random fibers of PLLA-PU with fiber diameters of 0.47 and 0.12 μm, respectively. Significantly higher cell proliferation and migration of MC3T3 cells at 3, 7, and 14 days were shown on plasma-coated membranes compared with uncoated membranes. Further, it was found that plasma-coated membranes were more angiogenic than controls. In vivo implantation of membranes in rats did not reveal any gross toxicity to the materials, and wound healing was comparable with the native tissue repair (sham group). We therefore present a plasma-functionalized electrospun composite polymer membrane for use in the treatment of fistulas. These membranes are flexible, non-cytotoxic, and angiogenic, and we hope it should lead to permanent closure of oronasal fistula.

Incidence and management of cleft lip and palate in Pakistan

OBJECTIVE

To compare the occurrence, distribution and management of clefts of lip and palate in local patients with the available data from India and China.

METHODS

The retrospective study was conducted at the Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan, and comprised data related to a three-month period from January to March 2015 at two medical centres in Lahore. Data from Pakistani centres was analysed based on province, gender, age and clefts of lip and palate conditions and Spearman's correlation matrix.

RESULTS

Of the 1574 cases, 1061(67.4%) were from Punjab, 361(23%) Khyber Pakhtunkhwa, 85(5%) Sindh and 67(4.2%) were from Azad Jammu and Kashmir. The incidence of clefts of lip and palate was higher in males than females. There was higher awareness of the need for timely management in new borns with clefts of lip and palate. Some patients seeking secondary treatment were also being surgically corrected. There is no national registry of children born with cleft defect, making it difficult to assess the full scale of the problem..

CONCLUSIONS

Based on available data, it is likely that there are many adults who have not been treated when younger..