Periodontitis, Dental Procedures, and Young-Onset Cryptogenic Stroke

Periodontitis is associated with an increased risk of ischemic stroke, and the risk may be particularly high among young people with unexplained stroke etiology. Thus, we investigated in a case-control study whether periodontitis or recent invasive dental treatments are associated with young-onset cryptogenic ischemic stroke (CIS). We enrolled participants from a multicenter case-control SECRETO study including adults aged 18 to 49 y presenting with an imaging-positive first-ever CIS and stroke-free age- and sex-matched controls. Thorough clinical and radiographic oral examination was performed. Furthermore, we measured serum lipopolysaccharide (LPS) and lipotechoic acid (LTA) levels. Multivariate conditional regression models were adjusted for stroke risk factors, regular dentist visits, and patent foramen ovale (PFO) status. We enrolled 146 case-control pairs (median age 41.9 y; 58.2% males). Periodontitis was diagnosed in 27.5% of CIS patients and 20.1% of controls (P < 0.001). In the fully adjusted models, CIS was associated with high periodontal inflammation burden (odds ratio [OR], 95% confidence interval) with an OR of 10.48 (3.18-34.5) and severe periodontitis with an OR of 7.48 (1.24-44.9). Stroke severity increased with the severity of periodontitis, having an OR of 6.43 (1.87-23.0) in stage III to IV, grade C. Invasive dental treatments performed within 3 mo prestroke were associated with CIS, with an OR of 2.54 (1.01-6.39). Association between CIS and invasive dental treatments was especially strong among those with PFO showing an OR of 6.26 (1.72-40.2). LPS/LTA did not differ between CIS patients and controls but displayed an increasing trend with periodontitis severity. Periodontitis and recent invasive dental procedures were associated with CIS after controlling for multiple confounders. However, the role of bacteremia as a mediator of this risk was not confirmed.

The local medicinal plant knowledge in Kashmir Western Himalaya: a way to foster ecological transition via community-centred health seeking strategies

BACKGROUND

The mountainous region of Kashmir is a biodiversity hotspot, with diverse local communities and a rich cultural history linked to nature. Mountain ecosystems are highly vulnerable to climate change. This study emphasises the need to record the indigenous ethnoecological knowledge of wild plants used for the treatment of various ailments at higher elevations in remote areas where globalisation poses a threat to this traditional knowledge.

METHODS

The field survey was carried out in 2020-2022, to collect data on wild medicinal plants. Informants were selected randomly to collect indigenous medicinal knowledge using semi-structured interviews and group discussions. Various quantitative indices were employed to evaluate ethnomedicinal data.

RESULTS

A total of 110 medicinal plants belonging to 49 families were recorded in the study area. These medicinal plants are extensively used by local communities for the treatment of 20 major disease categories. Asteraceae was the dominant family contributing (9.09%) to medicinal plants, followed by Polygonaceae (8.18%), Apiaceae (7.27%), Lamiaceae (5.45%), and Ranunculaceae (5.45%). We observed 166 remedies were used for the treatment of various diseases in humans, and 9 remedies were used for animals. The most frequently used medicinal remedy was tea or decoction (30.91%). Among the medicinal plants, herbs (85.5%) were most frequently used by the local populations of Kashmir, whereas leaves (10.26%) were used for the treatment of various ailments. Out of 110 species, 31 were endemic, 15 of which are endemic to the Kashmir region and 16 to the Western Himalaya. The highest RFC value was reported for Allium humile (0.77), the highest UV value for Fritillaria cirrhosa (1.33), and the highest ICF value for gastro-intestinal/digestive disorders (0.85).

CONCLUSIONS

Local communities still rely on wild medicinal plants for primary healthcare. These communities retained valuable indigenous knowledge, which needs to be preserved for the conservation and sustainable utilisation of natural resources. Further field exploration is required to fully explore indigenous knowledge in the mountainous regions of Kashmir, and this knowledge has the potential to support the ongoing ecological transition.

Optimizing Sugarcane Growth, Yield, and Quality in Different Ecological Zones and Irrigation Sources Amidst Environmental Stressors

The imbalanced use of fertilizers and irrigation water, particularly supplied from groundwater, has adversely affected crop yield and harvest quality in sugarcane (Saccharum officinarum L.). In this experiment, we evaluated the impact of potassium (K) and micronutrients [viz. Zinc (Zn), Iron (Fe), and Boron (B)] application and irrigation water from two sources, viz. canal, and tube well water on sugarcane growth, yield, and cane quality under field trails. Water samples from Mardan (canal water) and Rahim Yar Khan (tube well water) were analyzed for chemical and nutritional attributes. The results revealed that tube well water's electrical conductivity (EC) was three-fold that of canal water. Based on the EC and total dissolved salts (TDS), 83.33% of the samples were suitable for irrigation, while the sodium adsorption ratio (SAR) indicated only a 4.76% fit and a 35.71% marginal fit compared with canal water. Furthermore, the application of K along with B, Fe, and Zn had led to a significant increase in cane height (12.8%, 9.8%, and 10.6%), cane girth (15.8%, 15.6%, and 11.6%), cane yield (13.7%, 12.3%, and 11.5%), brix contents (14%, 12.2%, and 13%), polarity (15.4%, 1.4%, and 14%), and sugar recovery (7.3%, 5.9%, and 6%) in the tube well irrigation system. For the canal water system, B, Fe, and Zn increased cane height by 15.3%, 13.42%, and 11.6%, cane girth by 13.9%, 9.9%, and 6.5%, cane yield by 42.9%, 43.5%, and 42%, brix content by 10.9%, 7.7%, and 8%, polarity by 33.4%, 28%, and 30%, and sugar recovery by 4.0%, 3.9%, and 2.0%, respectively, compared with sole NPK application. In conclusion, the utilization of tube well water in combination with canal water has shown better results in terms of yield and quality compared with the sole application of canal water. In addition, the combined application of K and B significantly improved sugarcane yields compared with Zn and Fe, even with marginally suitable irrigation water.

Management of Primary Pterygium with Intralesional Bevacizumab (AVASTIN) Injection

Objective: To determine the management of primary Pterygium with intralesional Bevacizumab (AVASTIN) Injection. Study Design: Quasi-Experimental Study Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Oct 2019 to Mar 2020. Methodology: Sixty patients of Primary Pterygium with Grades 1, 2, and 3 were included. Pre-Intralesional injection evaluation includes the Ocular surface disease Index (OSDI), grading of Pterygium and ophthalmic examination, refraction,slit lamp bimicroscopy, fundoscopy, tonometry, and corneal topography. After four weeks of intralesional injection,reassessment was done. Results: A total of 60 participants with the mean age of the participants was 44.06±14.83 years were included in the study. In 26(43.3%) patients, grittiness, epiphora, redness, and photophobia were reported, and 16(26.6%) patients reported blurring of vision that improved in 100% of patients after intralesional injections. There was statistical significance (p-value ≤0.05) in means of K1, Sim K astigmatism, Surface asymmetry index, Surface Regularity Index, Grade of Pterygium, and Ocular surface disease index before and after the intralesional injection of Bevacizumab. However, no significant difference was recorded in Uncorrected Visual Acuity, Best Corrected Visual Acuity, and K2 parameters in pre and post-injection states (p-value ≥0.05).Only 7(11.6%) patients reported subconjunctival haemorrhage after the procedure. Conclusions: Treatment of Primary Pterygium with intralesional Bevacizumab injection successfully improves symptoms,Ocular Surface Disease Index, and reduces corneal astigmatism with minimum complications.

Monitoring of Insecticides resistance against cotton Jassid (Amrasca biguttutla biguttutla) under laboratory conditions

Development of insecticides resistance mainly hinge with managements techniques for the control of Jassid, Amrasca biguttutla biguttutla. Five insecticides were applied against field collected and laboratory rared jassid populations during the years of 2017 to 2019 to profile their resistance level against field population of jassid through leaf dip method. Very low resistance level was found in jassid against confidor whereas high level of resistance was observed by pyriproxyfen against other test insecticides. Gradual resistance was observed against diafenthiuron. It is concluded that for the management of Jassid repetition of same insecticide should be avoided. The use of confidor may be reduced to overcome resistance against Jassid.

159 Antibiotic Omissions: A Missed Dose Means A Missed Chance to Save A Life! Is E-Prescribing the Answer?

Omissions and delay in antimicrobial therapy are common in acute hospitals with an untowrds impact on patient outcomes resulting in harm and prolong stay. We carried out a Quality Improvement Project (QIP) assessing 2 interventions in PDSA cycles to improve situation. This QIP was done in 3 stages and involved about 80 patients over 7 months. We collected data regarding antibiotic omissions on 3 random separate days which gave baseline omission rate. This was 8.5% and quite higher than the national average (5.3%). The reason for the omissions was not documented on the drug kardexes on most occasions. Initial intervention included staff education, verbally and through posters. Post intervention data was collected again on 3 separate days. This showed improvement and the omission rate fell from 8.5% to 5.6%. The percentage of omissions with no code written reduced from 56.25% to 18.18%. The second intervention included participation in EPMA (Electronic prescribing and medicines administration) pilot on the ward. Post EPMA, the omission rate reduced to 4.59%. All omissions had now a code written. The phenomenon of Antibiotic Omissions is an open challenge and its consequences are serious. We can conclude from our study that educational measures though effective are likely to be short-lived.Therefore, it can be asserted that Electronic prescribing is appropriate solution for antibiotic omissions and it also opens up new horizons for patient safety.

Prospect of microbial food borne diseases in Pakistan: a review

Nowadays food borne illness is most common in people due to their epidemic nature. These diseases affect the human digestive system through bacteria, viruses and parasites. The agents of illness are transmitted in our body through various types of food items, water and uncooked. Pathogens show drastic changes in immunosuppressant people. This review gives general insights to harmful microbial life. Pakistan is a developed country and because of its improper food management, a lot of gastrointestinal problems are noted in many patients. Bacteria are most common agents to spread diarrhoea, villi infection, constipation and dysenteric disease in human and induce the rejection of organ transplant. Enhancement of their lifestyle, properly cooked food should be used and to overcome the outbreak of the diseases.

Enterolith causing bladder outlet obstruction in patient with imperforate anus. A rare case presentation

Imperforate anus is a rare anomaly associated with defects commonly referred to as vertebral defects, anal atresia, cardiac defects, tracheo-oesophageal fistula, renal anomalies and limb abnormalities (VACTERL). With modern surgical procedures the overall outcome is excellent. Permanent colostomy which is required in some cases of this disease can result in some rare complications such as enteroliths formation, as illustrated in the case we are presenting here related to a 28-year-old male who reported at urology emergency with features of urinary and acute large bowel obstruction. On investigation he was found to have two enteroliths in his distal loop of sigmoid colostomy. The more distal of the two enteroliths caused urinary retention and hence acute renal failure, and the proximal one caused large bowel obstruction by compressing the proximal loop of colostomy. This case demonstrates that the blind distal sigmoid colostomy loop can grow enteroliths secondary to stasis of its own contents over a long period.

Postcystic development of Blastocystis hominis

A concentrated suspension of Blastocystis hominis cysts was inoculated into Jones' medium and removed after 24 h for study of their development at the ultrastructural level. The parasite divides in the cyst, and up to three daughter cells can be seen. During this process the cyst wall dissolves, leaving behind thin membranous remnants. Excystation occurs mostly by the emergence of the daughter cells through an aperture in the outer fibrillar coat. Before excystation the vacuolar and the granular stages form and the daughter cells develop their own fibrillar layer.

Folate-responsive neuropathy: report of 10 cases

Ten patients with severe neurological disease that was clinically indistinguishable from subacute combined degeneration of the spinal cord were found to have normal serum vitamin B12 levels. All were folate deficient. Specific folate treatment led to significant reversal of the neuropathy. These findings indicate the need to review orthodox concepts of the role of folic acid in maintaining the integrity of the nervous system.