Photonic Pigments of Polystyrene-block-Polyvinylpyrrolidone Bottlebrush Block Copolymers via Sustainable Organized Spontaneous Emulsification

Prior studies on photonic pigments of amphiphilic bottlebrush block copolymers (BBCPs) through an organized spontaneous emulsification (OSE) mechanism have been limited to using polyethylene glycol (PEG) as the hydrophilic side chains and toluene as the organic phase. Herein, a family of polystyrene-block-polyvinylpyrrolidone (PS-b-PVP) BBCPs are synthesized with PVP as the hydrophilic block. Biocompatible and sustainable anisole is employed for dissolving the obtained BBCPs followed by emulsification of the solutions in water. Subsequent evaporation of oil-in-water emulsion droplets triggers the OSE mechanism, producing thermodynamically stable water-in-oil-in-water (w/o/w) multiple emulsions with uniform and closely packed internal droplet arrays through the assembly of the BBCPs at the w/o interface. Upon solidification, the homogeneous porous structures are formed within the photonic microparticles that exhibit visible structural colors. The pore diameter is widely tunable (150∼314 nm) by changing the degree of polymerization of BBCP (69∼110), resulting in tunable colors across the whole visible spectrum. This work demonstrates useful knowledge that OSE can be generally used in the fabrication of ordered porous materials with tunable internal functional groups, not only for photonic applications, but also offers a potential platform for catalysis, sensing, separation, encapsulation, etc.

Characterization of structural changes occurring in insulin at different time intervals at room temperature by surface-enhanced Raman spectroscopy

BACKGROUND

Insulin storage above the temperature recommended by food and drug administration (FDA) causes decrease in its functional efficacy due to degradation and aggregation of its protein based active pharmaceutical ingredient (API) that results poor glycemic control in diabetic patients. The aggregation of protein causes serious neurodegenerative diseases such as type-2 diabetes, Huntington disease, Parkinson's disease, and Alzheimer's disease. Surface-enhanced Raman spectroscopy (SERS) has been employed for the denaturation study of many proteins at the temperature above the recommendations of food and drug administration (FDA) (above 30 °C) which indicates potential of technique for such studies.

OBJECTIVE

SERS along with multivariate discriminating analysis techniques-based analysis of degradation of liquid pharmaceutical insulin protein after regular intervals of time at room temperature to analyze the structural changes in this protein during the storage of insulin pharmaceutical at room temperature.

METHODS

Silver nanoparticles (Ag-NPs) prepared by chemical reduction method are used as SERS active substrate for the surface enhancement of the insulin spectral signal. SERS spectral measurements of insulin were collected from eight different samples of insulin in the time range of 7 pm to 7 am first at fridge temperature (5 °C), second after half hour and next six with the time difference of 2 h each time at room temperature. The acquired SERS spectral data was preprocessed and analyzed. SERS structural transformations detection and discrimination potential in insulin was further confirmed by applying multivariate discriminating analysis techniques including principal component analysis (PCA) and Partial least square regression analysis (PLSR).

RESULTS

SERS significantly detects the structural changes produced in insulin even after 2 h of insulin placement at room temperature. PCA successfully differentiates the insulin spectral data obtained after regular intervals of time according to PC-1 (77 %) explained variance. Application of PLSR model provides quantitative confirmation of SERS efficiency, by providing insulin data regression coefficients plot, efficient prediction of time with calibration data set having 0.77 mean square absolute error of calibration (RMSAEC), validation data set with 0.80 mean square absolute error of prediction (RMSAEP) and 0.98 coefficient of determination (R2) for both calibration and validation data set.

CONCLUSION

SERS is proved as a highly sensitive and discriminating technique to detect and discriminate insulin structural changes after regular intervals of time at room temperature.

Tackling microplastics pollution in global environment through integration of applied technology, policy instruments, and legislation

Microplastic pollution is a serious environmental problem that affects both aquatic and terrestrial ecosystems. Small particles with size of less than 5 mm, known as microplastics (MPs), persist in the environment and pose serious threats to various species from micro-organisms to humans. However, terrestrial environment has received less attention than the aquatic environment, despite being a major source of MPs that eventually reaches water body. To reflect its novelty, this work aims at providing a comprehensive overview of the current state of MPs pollution in the global environment and various solutions to address MP pollution by integrating applied technology, policy instruments, and legislation. This review critically evaluates and compares the existing technologies for MPs detection, removal, and degradation, and a variety of policy instruments and legislation that can support the prevention and management of MPs pollution scientifically. Furthermore, this review identifies the gaps and challenges in addressing the complex and diverse nature of MPs and calls for joint actions and collaboration from stakeholders to contain MPs. As water pollution by MPs is complex, managing it effectively requires their responses through the utilization of technology, policy instruments, and legislation. It is evident from a literature survey of 228 published articles (1961-2023) that existing water technologies are promising to remove MPs pollution. Membrane bioreactors and ultrafiltration achieved 90% of MPs removal, while magnetic separation was effective at extracting 88% of target MPs from wastewater. In biological process, one kg of wax worms could consume about 80 g of plastic/day. This means that 100 kg of wax worms can eat about 8 kg of plastic daily, or about 2.9 tons of plastic annually. Overall, the integration of technology, policy instrument, and legislation is crucial to deal with the MPs issues.

The Effectiveness of Transcranial Magnetic Stimulation in Treating Apraxia

Apraxia can be detected when engaging in mental motor envisioning exercises. The nonverbal skills of manufacturing, representation, strategizing, arithmetic, visual sensitivity, and motor skills are all related to apraxia. Limb apraxia also negatively affects communication gestures and linguistic skills. The impairment of brain regions related to motion patterns is the primary cause of apraxia. People with apraxia may struggle to complete a variety of tasks because they are unable to focus on various movements. Apraxia can result from injury to the premotor cortex since it has a role in the left hemisphere-dependent selection of movements. Cognitive and complicated motor system deficits are hallmarks of the corticobasal syndrome. Apraxia of the limbs and visuospatial abnormalities are typical clinical types. TMS was used to study these problems; however, no research was done on the relationship between TMS parameters and clinical types. It is possible for changes in brain activity to last a long time when repetitive TMS (rTMS) is utilized. Electromyography shows that noninvasive TMS of the motor cortex causes target muscle spasms (MEP). The human motor cortex is a part of the cerebral cortex that is involved in the organization, management, and execution of voluntary movements. TMS and other neuroimaging techniques are frequently used to identify changes in this region. Cortical motor excitability varies among different diagnoses; therefore, it is important to determine the effectiveness of TMS. Therefore, this study aims to review the causes and neurophysiological simulation of apraxia along with the principles and effects of TMS on apraxia.

Bacillus thuringiensis CHGP12 uses a multifaceted approach for the suppression of Fusarium oxysporum f. sp. ciceris and to enhance the biomass of chickpea plants

BACKGROUND

Bacillus species synthesize antifungal lipopeptides (LPs) making them a sustainable and eco-friendly management option to combat Fusarium wilt of chickpea.

RESULTS

In this study, 18 endophytic Bacillus strains were assessed for their antifungal activity against Fusarium oxysporum f. sp. ciceris (FOC) associated with Fusarium wilt of chickpea. Among them, 13 strains produced significant inhibition zones in a direct antifungal assay while five strains failed to produce the inhibition of FOC. Bacillus thuringiensis CHGP12 exhibited the highest inhibition 3.45 cm of FOC. The LPs extracted from CHGP12 showed significant inhibition of the pathogen. Liquid chromatography-mass spectrometry (LC-MS) analysis confirmed that CHGP12 possessed the ability to produce fengycin, surfactin, iturin, bacillaene, bacillibactin, plantazolicin, and bacilysin. In an in vitro qualitative assay CHGP12 exhibited the ability to produce lipase, amylase, cellulase, protease, siderophores, and indole 3-acetic acid (IAA). IAA and gibberellic acid (GA) were quantified using ultra-performance liquid chromatography (UPLC) with 370 and 770 ng mL^-1 concentrations of IAA and GA respectively. Furthermore, the disease severity showed a 40% decrease over control in CHGP12 treated plants compared to the control in a glasshouse experiment. Moreover, CHGP12 also exhibited a significant increase in total biomass of the plants namely, root and shoot growth parameters, stomatal conductance, and photosynthesis rate.

CONCLUSION

In conclusion, our findings suggest that B. thuringiensis CHGP12 is a promising strain with high antagonistic and growth-promoting potential against Fusarium wilt of chickpea. © 2022 Society of Chemical Industry.

Surface-enhanced Raman spectroscopy for studying the interaction of N-propyl substituted imidazole compound with salmon sperm DNA

BACKGROUND

Surface Enhanced Raman Spectroscopy (SERS) is a very promising and fast technique for studying drugs and for detecting chemical nature of a molecule and DNA interaction. In the current study, SERS is employed to check the interaction of different concentrations of n-propyl imidazole derivative ligand with salmon sperm DNA using silver nanoparticles as SERS substrates.

OBJECTIVES

Multivariate data analysis technique like principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) are employed for the detailed analysis of the SERS spectral features associated with the mode of action of the imidazole derivative ligand with DNA.

METHODOLOGY

Silver nanoparticles were used as a SERS substrate in DNA-drug interaction. Five different concentrations of ligands were interacted with DNA and mix with Ag-NPs as substrate. The SERS spectra of were acquired for all seven samples and processed using MATLAB. Additionally, PCA and PLS-DA were used to assessed the ability SERS to differentiate interaction of DNA-drug.

RESULTS

Differentiating SERS features having changes in their peak position and intensities are observed including 629, 655, 791, 807, 859, 1337, 1377 and 1456 cm^-1. These SERS features reveal that binding of ligand with DNA is electrostatic in nature, and have specificity to major groove where it forms GC-CG interstrand cross-linking with the DNA double helix.

CONCLUSIONS

SERS give significant information regarding to Drug-DNA interaction mechanism, SERS spectra inferred the mode of action of anticancer compound that are imidazole in nature.

Recent advances in bioremediation of heavy metals and persistent organic pollutants: A review

Heavy metals and persistent organic pollutants are causing detrimental effects on the environment. The seepage of heavy metals through untreated industrial waste destroys the crops and lands. Moreover, incineration and combustion of several products are responsible for primary and secondary emissions of pollutants. This review has gathered the remediation strategies, current bioremediation technologies, and their primary use in both in situ and ex situ methods, followed by a detailed explanation for bioremediation over other techniques. However, an amalgam of bioremediation techniques and nanotechnology could be a breakthrough in cleaning the environment by degrading heavy metals and persistant organic pollutants.

Community- vs. hospital-based management of multidrug-resistant TB in Pakistan

BACKGROUND Multidrug-resistant TB (MDR-TB) treatment takes 18-24 months and is complex, costly and isolating. We provide trial evidence on the WHO Pakistan recommendation for community-based care rather than hospital-based care.METHODS Two-arm, parallel-group, superiority trial was conducted in three programmatic management of drug-resistant TB hospitals in Punjab and Sindh Provinces, Pakistan. We enrolled 425 patients with MDR-TB aged >15 years through block randomisation in community-based care (1-week hospitalisation) or hospital-based care (2 months hospitalisation). Primary outcome was treatment success.RESULTS Among 425 patients with MDR-TB, 217 were allocated to community-based care and 208 to hospital-based care. Baseline characteristics were similar between the community and hospitalised arms, as well as in selected sites. Treatment success was 74.2% (161/217) under community-based care and 67.8% (141/208) under hospital-based care, giving a covariate-adjusted risk difference (community vs. hospital model) of 0.06 (95% CI -0.02 to 0.15; P = 0.144).CONCLUSIONS We found no clear evidence that community-based care was more or less effective than hospital-based care model. Given the other substantial advantages of community-based care over hospital based (e.g., more patient-friendly and accessible, with lower treatment costs), this supports the adoption of the community-based care model, as recommended by the WHO.

De novo synthesis of photocatalytic bifunctional MIL-125(Ti)/gC3N4/RGO through sequential self-assembly and solvothermal route

In this study we have synthesized a heterostructured metal organic framework (MOF) consisting of self-assembled porous carbon nitride (gC₃N₄) and, reduced graphene oxide (RGO) with MIL-125(Ti) (CN-GO-MIL) through a simple synthesis route. As-synthesized CN-GO-MIL was characterized to determine its morphological, surface, structural, and optical properties. The synthesis produced a porous nanomaterial with efficient visible light capture and electron transport. CN-GO-MIL proved 2.23 and 1.23 times as effective as bare MIL-125(Ti) for Rhodamine B (RhB) degradation and chromium (Cr) reduction, respectively. We propose a governing photocatalytic degradation and reduction mechanism in which superoxide plays a major role in the photocatalytic degradation, followed by O₂¹, OH·, and holes, and identify methanol as a suitable hole scavenger for reduction of Cr. Moreover, Cr reduction can be best achieved at pH 2 in the presence of methanol. Performance of material in terms of apparent quantum yield (AQY), figure of merit (FOM), and catalyst surface efficiency (S.E), suggests 5% CN-GO-MIL is an efficient photocatalyst for degradation of RhB. Comparison of the AQY with previously reported MOF-based composites shows that the as synthesized 5% CN-GO-MIL can be regarded as one of best performing photocatalyst under visible light irradiation for abatement of organic and inorganic pollution.

Predisposition of Early Maladaptive Schemas and Postpartum Depression during COVID-19 Crisis: Mediation of Mindfulness

BACKGROUND

Past studies provide crucial evidence that pregnancy and childbirth increase the risk of emotional vulnerability and instability. Current research intends to explore the role of early maladaptive schemas and mindfulness as determinants of postpartum depression for expecting mothers during COVID-19 pandemic.

METHOD

The data was collected from 170 expecting mothers who conceived and gave birth during the COVID-19 pandemic. Edinburgh postnatal depression scale, the young schema questionnaire-SF 75 items, and the Kentucky inventory for mindfulness scale were administered.

RESULTS

Results discovered that mindfulness partially mediated the relationship between three kinds of early maladaptive schemas and postpartum depression.

CONCLUSION

Mindfulness-based control techniques can be considered to buffer the impact of the early maladaptive schemas on postpartum depression, for mothers who give birth during any challenging time.

CURATIVE BENEFIT OF SUBMUCOPERICHONDRIAL RESECTION OPERATION ON PULMONARY AR

Objective: We aimed at establishing a correlation between deviated nasal septum and pulmonary artery hypertension in patients reporting in Otorhinolaryngology (ENT) clinic at Combined Military Hospital Quetta, and evaluating the beneficial impact of sub mucoperichondrial resection (SMR) operation on right heart myocardial function, primarily related to Pulmonary Arterial Pressures of these patients of longstanding nasal septal deviation. Study Design: Descriptive; hospital-based cross-sectional survey. Place and Duration of Study: Departments of Otorhinolaryngology & Cardiology, Combined Military Hospital, Quetta, from Sep 2019 to Apr 2021. Methodology: Electrocardiographic and 2-Dimensional Echocardiographic parameters of 87 randomized patients suffering from symptomatic longstanding deviated nasal septum (DNS) who had consented to undergo sub mucoperichondrial resection (SMR) operation were compared and studied for any change in status of probability of pulmonary arterial hypertension before and two months after their surgery. Probability of pulmonary hypertension was estimated using probability criteria from updated European Society of Cardiology Pulmonary Hypertension Guidelines 2019. Patients were classified into low, intermediate and high probability depending upon the number of criteria fulfilled by echocardiographic parameters. Results: Two (2.3%) patients suffering from deviated nasal septum presented with p-pulmonale. Twelve (13.8%) reported with right bundle branch block, and 7 (8%) patients demonstrated right axis deviation on electrocardiography. Overall high probability to develop pulmonary hypertension was discovered in 2 (2.3%) patients. We observed a significant improvement in pulmonary artery pressures in patients suffering from long term upper airway obstruction, two months following sub mucoperichondrial resection operation, in terms of maximum velocity and peak tricuspid regurgitation, right ventricle/left..........

Effect of Agaricus blazei Murill on exploratory behavior of mice-model

Increased anxiety and depressive symptoms have reported to be its association with long term illness. Because of having unwanted effects of newly available drugs, patients administering anxiolytic drugs usually discontinue the treatment before they are completely recovered. Therefore, there is a serious need to develop new anxiolytic drugs. The anxiolytic effect of hydro-alcoholic extract of Agaricus blazei in animal models was assessed. 24 male mice (Mus musculus genus) were included in the study. Four groups were prepared and each group contained six animals. The groups were vehicle control, positive control (diazepam 1.0 mg/kg, i.p.) as well as two treatment groups receiving Agaricus blazei hydro-alcoholic extract at a dose of 136.50 mg/kg and 273.0 mg/kg orally. The Marble burying test, Nestlet shredding test and Light and Dark box test used to assess anxiolytic activity. Mice administered with diazepam 1.0 mg/kg, i.p. while hydro-alcoholic extract of AbM (136.50 and 273.0 mg/kg, respectively) was administered via oral route which exhibited marked reduction in number of marbles-burying as compared to vehicle control group. Mice administered with diazepam 1.0 mg/kg, i.p. and Oral administration of hydro-alcoholic extract of AbM (136.50 and 273.0 mg/kg, respectively) exhibited significant decrease in nestlet shredding in comparison to vehicle control group. The oral administration of hydro-alcoholic extract at a dose of 136.5mg/kg and 273mg/kg showed elevation in time spent in light box and was comparable to standard treated group while time spent by mice following oral administration of hydro-alcoholic extract of Agaricus blazei at a dose of 273.0 mg/kg also showed elevation and was found to be more near to standard treated group (diazepam 1 mg/kg, i.p.).

Effect of HCl treatment on physico-chemical properties and photocatalytic performance of Fe-TiO2 nanotubes for hexavalent chromium reduction and dye degradation under visible light

In this study, we prepared Fe₂O₃/TNT composite (Fe-TNT) foil by combining anodization with the hydrothermal method. Photocatalytic reaction was restricted by a cluster of iron particles accumulated on the foil surface and the photocatalytic reaction sites reduces. Herein, using XPS determined that these iron particles are composed of iron oxide. An acid treatment, hydrochloric acid (HCl) was used to successfully remove the surface accumulation of iron oxide particles on the photocatalyst. Using cleaned Fe-TNT foil, the photocatalytic activity of 5 mg/L Congo red (CR) and hexavalent chromium reduction was significantly increased under visible irradiation. In addition, the influence of different aspects such as pH, the concentration of Fe, and the effect of different acid treatment time was evaluated. Removing the surface accumulated iron oxide and adjusting the pH in acidic medium, 73% hexavalent chromium reduction achieved within 180 min. The reusability was also explored by monotonous CR degradation. The CR degradation using Fe_0.25-TNT was lessened from 78% in the first cycle to 71% in the 3rd cycle. It was also confirmed experimentally that photocatalytic activity improvement of HCl treated Fe-TNT was not due to alternation in nanotube structure.

Study of human knowledge and attitude toward urban birds in Faisalabad city, Pakistan

Birds are very valuable indicators of species richness and endemic patterns in a specified ecosystem, which eventually help the scientist to measure the environmental degradation. The aim of present study was to know human knowledge and attitude toward urban birds in Faisalabad city, Pakistan. The study conducted in four consecutive months: November 2019 to February 2020. Population of birds was noted from eight residential towns of Faisalabad city, data were collected through questionnaire. Faisalabad has a reasonably large population of birds and present data show that, there is a significant difference between favorite bird of residential areas and institutions. The pigeon received the most likeness in bird population among residential area residents, while the myna received the least. The most popular bird in Faisalabad institutions was the sparrow, while the least popular bird was the common myna. Bird adaptation percentage of residential areas and institutional areas of Faisalabad was the highest for parrot and sparrow respectively. People in residential areas and institutions, on the other hand, adapted least to common myna. It is concluded that people of the study area like birds and offered food and high population of birds are present in study area.

In Silico Mutagenesis-Based Remodelling of SARS-CoV-1 Peptide (ATLQAIAS) to Inhibit SARS-CoV-2: Structural-Dynamics and Free Energy Calculations

The prolific spread of COVID-19 caused by a novel coronavirus (SARS-CoV-2) from its epicenter in Wuhan, China, to every nook and cranny of the world after December 2019, jeopardize the prevailing health system in the world and has raised serious concerns about human safety. Multi-directional efforts are made to design small molecule inhibitors, and vaccines and many other therapeutic options are practiced, but their final therapeutic potential is still to be tested. Using the old drug or vaccine or peptides could aid this process to avoid such long experimental procedures. Hence, here, we have repurposed a small peptide (ATLQAIAS) from the previous study, which reported the inhibitory effects of this peptide. We used in silico mutagenesis approach to design more peptides from the native wild peptide, which revealed that substitutions (T2W, T2Y, L3R, and A5W) could increase the binding affinity of the peptide towards the 3CLpro. Furthermore, using MD simulation and free energy calculation confirmed its dynamics stability and stronger binding affinities. Per-residue energy decomposition analysis revealed that the specified substitution significantly increased the binding affinity at the residue level. Our wide-ranging analyses of binding affinities disclosed that our designed peptide owns the potential to hinder the SARS-CoV-2 and will reduce the progression of SARS-CoV-2-borne pneumonia. Our research strongly suggests the experimental and clinical validation of these peptides to curtail the recent corona outbreak.

Granulocyte to Lymphocyte Ratio among Different Categories of Neonatal Sepsis according to their Vitamin D Status

The objective of this study was to ascertain whether, among the cases of neonatal sepsis, there is any significant difference between GLR (Granulocyte to Lymphocyte ratio) of different groups of patients according to their vitamin D status. One hundred and nine neonates with odd admission number, admitted in NICU (Neonatal Intensive Care Unit) with clinical manifestations of neonatal sepsis during the study period from December 2017 to December 2018, were included in the study. Vitamin D deficiency was present in 83 (76.1%), normal vitamin D levels were present in 21 (19.3%), and hypervitaminosis D was detected in 5 (4.6%) patients. Kruskal-Wallis test showed that there was no significant difference between GLR of different group of patients, according to their vitamin D status. There was no significant difference between GLR of different groups, according to outcome. Key Words: Granulocyte to Lymphocyte Ratio, Vitamin D, Neonatal sepsis.

Experimental studies on water matrix and influence of textile effluents on photocatalytic degradation of organic wastewater using Fe-TiO2 nanotubes: Towards commercial application

The application of photocatalysis for the effective removal of textile dyes is dependent on various parameters related with both water quality and different chemicals discharge during the dying process. Because the oxidation rates of the particular mixtures mainly influenced by the elements of the water matrix. These elements comprised of organic, inorganic salts, heavy metals, and ions. The impact of water matrices (Tap water, DI water, seawater, surface water, and ultra-pure water) on the Congo red decolorization, total organic carbon, and chemical oxygen demand removal efficacy has been assessed using Fe-TiO₂ nanotubes as a photocatalyst. The photocatalytic degradation rate decreased in unclean water due to the interferences of dissolved organics and minerals. However, all the environmental water matrices depict the significant decrease in turbidity and conductivity after treating with photocatalytic process. The photoactivity and capacity for decantation are the two crucial elements that have an impact on the "practical efficiency" of photocatalysts. Moreover, the textile wastewater contains a large quantity of dyes mixed with number of detrimental chemicals and other effluents discharged into the water which consequently pollute ecosystem and cause serious risks to human health. For environmental applications, we investigated individually the impact of various harmful chemicals commonly discharged from each step of textile wet processing which can have inhibiting or promoting effect on the azo dye photocatalytic degradation.

Bioconjugate synthesis, phytochemical analysis, and optical activity of NiFe2O4 nanoparticles for the removal of ciprofloxacin and Congo red from water

In this paper, Jr.NiFe2O4 nanoparticles (NPs) were synthesized first time using the leaves extract of Juglans regia via a straightforward process. The physio and phytochemical analysis of plant confirm the presence of macromolecules which function as bio-reductant and stabilize the nanoparticles. The Jr.NiFe2O4 NPs were characterized by UV-visible, FTIR spectroscopy, PXRD pattern, SEM and TGA/DTA analysis. The nanoparticles proved to be optically active having a value of indirect bandgap of energy in the range of 1.53 eV. The Jr.NiFe2O4 NPs have the ability in scavenging 2,2-diphenyl-1-picrylhydrazyl hydrate (DPPH) free radicals and showed 58.01% ± 1.2% scavenging activity at 100 µg/mL concentrations. The photocatalytic degradation study of ciprofloxacin (CIP) and Congo red (CR) reveals that the highest degradation rate was acquired for CIP using pH = 3, at 254 nm, while 85% of removal rate was analysed for CR. The kinetic studies in case of CR removal followed pseudo-first-order model with thermodynamic parameters (∆G° = - 5.87 kJ mol-1 K, ΔH° = 1393.50 kJ mol-1 and ΔS° = 22.537 kJ mol-1 K) with error analysis. Overall, these data recommend an innovative inspiring application of a plant-mediated synthesis of Jr.NiFe2O4 NPs.

Antiemetic Effect of Fruit Extracts of Trapa bispinosa Roxb. in Chick Emesis Model

Background: Vomiting and nausea are common symptoms associated with many diseased conditions. They also occur as side effects due to intake of certain medications. Natural remedies are nowadays being considered as a better alternate compared to allopathic medicine. Aim: The current study was designed to evaluate the antiemetic effect of hexane and ethanolic extracts of Trapa bispinosa Roxb fruit. Methodology: The study was conducted on young chicks aged 6-7 days using Copper sulfate (50 mg/kg) for the induction of emesis using oral route. Antiemetic effect was determined by observing the reduction in the number of retches in different groups of chicks. Metoclopramide and Chlorpromazine (150 mg/kg) were used as standard antiemetic agents. Chicks were treated with both extracts (ethanolic and hexane) at the dose of 150 mg/kg. Results: Hexane extract was found to be most effective when compared with all the groups. The results showed that T.bispinos Roxb. hexane extract was able to effectively prevent the copper sulfate induced emesis in chicks. Phytochemical analysis was also performed and it was predicted that the antiemetic effect of hexane extract might be due to the presence of alkaloids and triterpenoids. Conclusion: The positive effects obtained from this study showed that natural remedy might also be used as an alternate to allopathic medicine for nausea and vomiting.

Role of Genetics, Genomics, and Breeding Approaches to Combat Stripe Rust of Wheat

Puccinia striiformis (Pst) is a devastating biotrophic fungal pathogen that causes wheat stripe rust. It usually loves cool and moist places and can cause 100% crop yield losses in a single field when ideal conditions for disease incidence prevails. Billions of dollars are lost due to fungicide application to reduce stripe rust damage worldwide. Pst is a macrocyclic, heteroecious fungus that requires primary (wheat or grasses) as well as secondary host (Berberis or Mahonia spp.) for completion of life cycle. In this review, we have summarized the knowledge about pathogen life cycle, genes responsible for stripe rust resistance, and susceptibility in wheat. In the end, we discussed the importance of conventional and modern breeding tools for the development of Pst-resistant wheat varieties. According to our findings, genetic engineering and genome editing are less explored tools for the development of Pst-resistant wheat varieties; hence, we highlighted the putative use of advanced genome-modifying tools, i.e., base editing and prime editing, for the development of Pst-resistant wheat.

Hemoglobin, Ferritin levels and RBC Indices among children entering school and study of their correlation with one another

OBJECTIVE

To study correlation of various complete blood count variables with one another and to ascertain the values of intercept and slope among those having strong correlation.

METHODS

The cross-sectional study was conducted in Marach 2017 in the Rabwah town of Punjab province in Pakistan, and comprised randomly selected one in four children studying under the Nazrat Taleem School System. Serum sample from each subject was used to analyse complete blood count on an automated analyser, and ferritin levels were checked by enzyme-linked immunosorbent assay. SPSS20 was used for data analysis.

RESULTS

There were 299 children with a median age of 67 months. Mean haemoglobin level was 12.09±0.82gm/dl. There was a very strong positive correlation between haemoglobin and haematocrit; mean corpuscular volume; and red cell distribution width; mean corpuscular volume and mean corpuscular haemoglobin; red cell distribution width and mean corpuscular haemoglobin (p<0.001).Moderate positive correlation was found between haemoglobin and red blood cell count; haematocrit and red blood cell count; mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration (p<0.05). Moderate negative correlation was present between red blood cell count and mean corpuscular volume; red blood cell count and red cell distribution width; red blood cell count and mean corpuscular haemoglobin (p<0.05).

CONCLUSIONS

There were strong to moderate correlation between various complete blood count variables in the studied population. Ferritin level was the only variable which did not have any correlation with any of the other variables.

Identification of Novel Phyto-chemicals from Ocimum basilicum for the Treatment of Parkinson's Disease using In Silico Approach

BACKGROUND

Parkinson's disease is characterized by decreased level of dopaminergic neurotransmitters and this decrease is due to the degradation of dopamine by protein Monoamine Oxidase B (MAO-B). In order to treat Parkinson's disease, MAO-B should be inhibited.

OBJECTIVE

To find out the novel phytochemicals from plant Ocimum basilicum that can inhibit MAO-B by using the in silico methods.

METHODS

The data of chemical constituents from plant Ocimum basilicum was collected and inhibitory activity of these phytochemicals was then predicted by using the Structure-Based (SB) and Ligand-Based Virtual Screening (LBVS) methods. Molecular docking, one of the common Structure-Based Virtual Screening method, has been used during this search. Traditionally, molecular docking is used to predict the orientation and binding affinity of the ligand within the active site of the protein. Molegro Virtual Docker (MVD) software has been used for this purpose. On the other hand, Random Forest Model, one of the LBVS method, has also been used to predict the activity of these chemical constituents of Ocimum basilicum against the MAO-B.

RESULTS

During the docking studies, all the 108 compounds found in Ocimum basilicum were docked within the active site of MAO-B (PDB code: 4A79) out of which, 57 compounds successfully formed the hydrogen bond with tyr 435, a crucial amino acid for the biological activity of the enzyme. Rutin (-182.976 Kcal/mol), Luteolin (-163.171 Kcal/mol), Eriodictyol-7-O-glucoside (- 160.13 Kcal/mol), Rosmarinic acid (-133.484 Kcal/mol) and Isoquercitrin (-131.493 Kcal/mol) are among the top hits with the highest MolDock score along with hydrogen interaction with tyr 435. Using the RF model, ten compounds out of 108 chemical constituent of Ocimum basilicum were predicted to be active, Apigenin (1.0), Eriodictyol (1.0), Orientin (0.876), Kaempferol (0.8536), Luteolin (0.813953) and Rosmarinic-Acid (0.7738095) are predicted to be most active with the highest RF score.

CONCLUSION

The comparison of the two screening methods show that the ten compounds that were predicted to be active by the RF model, are also found in top hits of docking studies with the highest score. The top hits obtained during this study are predicted to be the inhibitor of MAO-B, thus, could be used further for the development of drugs for the treatment of Parkinson's disease (PD).

The level of Cry1Ac endotoxin and its efficacy against H. armigera in Bt cotton at large scale in Pakistan

A biophysical survey was conducted in 15 cotton-growing districts of Pakistan. Four hundred cotton growers were approached and inquired about the production technology of Bt cotton. Further, 25 strip tests using combo strips (Cry1Ac, Cry2Ab, Vip3Aa and Cp4, EPSPS gene) were performed at each farmer’s field. Out of 10,000 total-tested samples, farmers claimed 9682 samples as Bt and 318 samples as non-Bt. After performing a strip test, 1009 and 87 samples were found false negative and false positive, respectively. Only 53 samples were found positive for Cry2Ab, 214 for EPSPS and none for Vip3Aa gene. Quantification of Cry endotoxin and bioassay studies were performed by taking leaves from upper, middle, and lower canopies, and fruiting parts at approximately 80 days after sowing from 89 varieties. Expression was highly variable among different canopies and fruiting parts. Moreover, Cry endotoxin expression and insect mortality varied significantly among varieties from 0.26 µg g⁻¹ to 3.54 µg g⁻¹ with mortality ranging from 28 to 97%, respectively. Highest Cry1Ac expression (3.54 µg g⁻¹) and insect mortality (97%) were observed for variety FH-142 from DG Khan. Cry endotoxin expression varied significantly across various plant parts, i.e., IUB-13 variety from upper canopy documented 0.34 µg g⁻¹ expression with 37% insect mortality in Layyah to 3.42 µg g⁻¹ expression and 96% insect mortality from DG Khan. Lethal dose, LD95 (2.20 µg g⁻¹) of Cry1Ac endotoxin was optimized for effective control of H. armigera. Our results provided evidence of practical resistance in H. armigera and way forward.

NK Cells Negatively Regulate CD8 T Cells to Promote Immune Exhaustion and Chronic Toxoplasma gondii Infection

NK cells regulate CD4+ and CD8+ T cells in acute viral infection, vaccination, and the tumor microenvironment. NK cells also become exhausted in chronic activation settings. The mechanisms causing these ILC responses and their impact on adaptive immunity are unclear. CD8+ T cell exhaustion develops during chronic Toxoplasma gondii (T. gondii) infection resulting in parasite reactivation and death. How chronic T. gondii infection impacts the NK cell compartment is not known. We demonstrate that NK cells do not exhibit hallmarks of exhaustion. Their numbers are stable and they do not express high PD1 or LAG3. NK cell depletion with anti-NK1.1 is therapeutic and rescues chronic T. gondii infected mice from CD8+ T cell exhaustion dependent death, increases survival after lethal secondary challenge and alters cyst burdens in brain. Anti-NK1.1 treatment increased polyfunctional CD8+ T cell responses in spleen and brain and reduced CD8+ T cell apoptosis in spleen. Chronic T. gondii infection promotes the development of a modified NK cell compartment, which does not exhibit normal NK cell characteristics. NK cells are Ly49 and TRAIL negative and are enriched for expression of CD94/NKG2A and KLRG1. These NK cells are found in both spleen and brain. They do not produce IFNγ, are IL-10 negative, do not increase PDL1 expression, but do increase CD107a on their surface. Based on the NK cell receptor phenotype we observed NKp46 and CD94-NKG2A cognate ligands were measured. Activating NKp46 (NCR1-ligand) ligand increased and NKG2A ligand Qa-1b expression was reduced on CD8+ T cells. Blockade of NKp46 rescued the chronically infected mice from death and reduced the number of NKG2A+ cells. Immunization with a single dose non-persistent 100% protective T. gondii vaccination did not induce this cell population in the spleen, suggesting persistent infection is essential for their development. We hypothesize chronic T. gondii infection induces an NKp46 dependent modified NK cell population that reduces functional CD8+ T cells to promote persistent parasite infection in the brain. NK cell targeted therapies could enhance immunity in people with chronic infections, chronic inflammation and cancer.

Molecular docking analyses of CYP450 monooxygenases of Tribolium castaneum (Herbst) reveal synergism of quercetin with paraoxon and tetraethyl pyrophosphate: in vivo and in silico studies

Pest management in stored grain industry is a global issue due to the development of insecticide resistance in stored grain insect pests. Excessive use of insecticides at higher doses poses a serious threat of food contamination and residual toxicity for grain consumers. Since the development of new pesticide incurs heavy costs, identifying an effective synergist can provide a ready and economical tool for controlling resistant pest populations. Therefore, the synergistic property of quercetin with paraoxon and tetraethyl pyrophosphate has been evaluated against the larvae and adults of Tribolium castaneum (Herbst). Comparative molecular docking analyses were carried out to further identify the possible mechanism of synergism. It was observed that quercetin has no insecticidal when applied at the rate of 1.5 and 3.0 mg/g; however, a considerable synergism was observed when applied in combination with paraoxon. The comparative molecular docking analyses of CYP450 monooxygenase (CYP15A1, CYP6BR1, CYP6BK2, CYP6BK3) family were performed with quercetin, paraoxon and tetraethyl pyrophosphate which revealed considerable molecular interactions, predicting the inhibition of CYP450 isoenzyme by all three ligands. The study concludes that quercetin may be an effective synergist for organophosphate pesticides depending upon the dose and type of the compound. In addition, in silico analyses of the structurally diversified organophosphates can effectively differentiate the organophosphates which are synergistic with quercetin.

Ligand based screening of chemical constituents from African medicinal plants for the identification of MAOB inhibitors

Ligand based virtual screening (LBVS) is based on the hypothesis that similar structures have similar biological functions. In this research paper, ligand based virtual screening has been performed in order to predict the inhibitors for monoamine oxidase (MAO-B), an enzyme specifically involved in the metabolism of non-hydroxylated amines such as benzylamine and beta-phenylethylamine (PEA), thus, could be the target to treat various neurodegenerative disorders like Parkinson's disease. For this purpose, Afro Database, a subset of ZINC natural compound database has been screened using Random Forest Modeling (RF). For the training of RF model, 36 reference molecules, the known inhibitors of MAO have been collected from Duke's phyto-chemical and ethno-botanical database. As an outcome of this screening, 31 compounds out of 968 compounds from Afro Database (compounds from African medicinal plants) are predicted to be active as MAO-B inhibitor, Out of the 31 predicted active compounds, Norlichexanthone (ZINC05765089) is predicted to be most active against MAO-B with highest RF score 0.795181, along with the other top hits, could be the putative drug candidates for the prevention/ treatment of Parkinson's disease.

MOLECULAR CHARACTERIZATION OF ASIAN CITRUS PSYLLID (Diaphorina citri) USING MITOCHONDRIAL CYTOCHROME OXIDASE 1 (MTCO1) GENE FROM PUNJAB PAKISTAN

Citrus greening caused by (Candidatus liberibacter spp.) is one of the most destructive bacterial disease of citrus all over the world and it is transmitted by grafting and psyllid (Diaphorina citri) is responsible for its spread. This study was aimed to detect the prevalence of CLas in different varieties of citrus in Pakistan and molecular characterization of mtco1 gene in Diaphorina citri. DNA was extracted from fourteen different citrus cultivars infected with citrus greening from different orchards of Sargodha Punjab, Pakistan. Specific primers were used to amplify (Mtco1 gene) in Diaphorina citri and also Las specific primers were also used to detect HLB pathogen. Amplified fragments of 507bp, 1500bp and 2500bp were observed in CLas and Mtco1 gene of Asian isolates. The resulted fragments were TA cloned and sequenced from both strands. The infectious bacterium was found in 3 samples out of 14 (21.5 %) while from psyllid it was found in 5 samples (37.5%). The weather changes effect the prevalence of CLas in citrus but usually it decrease during autumn and found Las positive vector in spring or summer season up to 42oC. So there is a need to research on management of citrus greening disease in Pakistan as it caused major yield loses

Community-based integrated approach to changing women's family planning behaviour in Pakistan, 2014-2016

Setting: Karachi, Pakistan. Objective: To assess the effectiveness of a community-based integrated approach in changing women's behaviour regarding contraceptive use. Design: The Sukh Initiative is a multipronged approach with door-to-door services using community health workers to provide quality family planning/reproductive health services at both public and private facilities and a 24/7 family planning helpline service that provides youth skill-based education. Methods: Retrospective pre- and post-intervention data using samples of 5140 and 3810 women, respectively. Results: The contraceptive prevalence rate increased by 10.7%, from 42.3% at baseline to 53.0% mid-intervention, with an increase in use of modern contraceptive methods of 9.2%. A significant association was found between door-to-door counselling and the use of contraceptive methods (OR 3.4, 95%CL 2.9-4.1) and access to public and private facilities for modern contraceptives (OR 2.4, 95%CL 2.0-3.0). However, support group meetings and 24/7 helpline use did not show any association with use of contraceptive method. Conclusion: The study helped to increase access to and choice of family planning services through a community-based approach that successfully reduced unmet needs and improved continuity in contraceptive use.

Did diabetes mellitus affect treatment outcome in drug-resistant tuberculosis patients in Pakistan from 2010 to 2014?

Settings: All hospitals managing drug-resistant tuberculosis (DR-TB) according to national guidelines in Pakistan. Objectives: To assess the effect of diabetes mellitus (DM) and factors associated with unfavourable outcomes in DR-TB. Methods: A cross-sectional study based on a retrospective record review of patients enrolled on DR-TB treatment from 2010 to 2014 in Pakistan. DR-TB data reported to Pakistan's National TB Control Programme on a monthly basis were used for the study. Result: Among 5811 patients enrolled on second-line drugs, 8.8% had DM. Overall, 68.9% had favourable outcomes. No association was found between DM and DR-TB treatment outcomes (risk ratio 0.90, 95%CI 0.74-1.05). Unfavourable outcomes were more frequent among DR-TB patients with human immunodeficiency virus (HIV) co-infection (OR 11.58, 95%CI 2.20-60.72), extensively drug-resistant TB patients (OR 5.36, 95%CI 1.00-28.72), patients with exposure to both first-line and second-line anti-tuberculosis drugs (OR 2.45, 95%CI 1.21-4.97) and those with a previous history of treatment in the private sector (OR 1.53, 95%CI 1.16-2.02). Conclusion: Although there were limitations to correctly measuring DM and its management, DM appears not to be a risk factor for unfavourable outcomes in DR-TB patients in our study. DR-TB and HIV co-infection, second-line drug resistance and history of treatment in the private sector were nevertheless more frequently associated with adverse outcomes.

Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan

Setting: Adult pulmonary tuberculosis (TB) patients unable to expectorate quality sputum represent a diagnostic challenge. A private hospital in Pakistan routinely performs gastric aspiration in adults with difficulties expectorating. Objective: To assess the usefulness of gastric specimens (GS) in diagnosing pulmonary TB (PTB) and drug-resistant TB in adult presumptive TB patients unable to expectorate, and to compare the diagnostic yield and sensitivity of smear, culture and the Xpert^® MTB/RIF assay. Design: This was a comparative cross-sectional study based on retrospective record review. Results: Of 900, 885 and 877 GS tested by smear, Xpert and culture, respectively, interpretable results were obtained for respectively 900 (100%), 859 (97.1%) and 754 (86.0%), with a diagnostic yield of respectively 23.6%, 30.3% and 24.9%. The yield was significantly higher for Xpert in previously treated patients. There were 313 patients with definite TB, defined as positive on Xpert and/or culture. The 82.8% sensitivity of Xpert was significantly higher than that of smear (61.0%) and culture (67.8%). Conclusion: GS obtained by aspiration under routine programme conditions is useful for detecting TB and drug-resistant TB in adult patients unable to expectorate. Xpert, with its rapid testing, high proportion of interpretable results and better sensitivity, can substantially improve the diagnosis of bacteriologically confirmed TB and rifampicin resistance.

Alarming rates of attrition among tuberculosis patients in public-private facilities in Lahore, Pakistan

Setting: All public-private mix (PPM) facilities caring for tuberculosis (TB) patients in Lahore city, Pakistan, under four models: PPM1 (general practitioners), PPM2 (non-governmental organisations), PPM3 (private hospitals) and PPM4 (others). Objective: To assess the pre-treatment loss to follow-up (LTFU), defined as patients documented in the laboratory registers but not in the treatment registers of any PPM facility, among sputum smear-positive TB patients diagnosed during January-March 2015, and unfavourable treatment outcomes among patients registered for treatment and associated factors. Design: This was a retrospective cohort study reviewing existing programme records. Poisson regression was used to identify factors associated with outcomes. Results: Of 2473 patients diagnosed, 1590 (64%) were lost to follow-up before treatment. This was higher among males (68%) and the elderly (79%), and lower among 'high positives' (smear grading 2+ or 3+, 53%) and in the PPM1 model (34%). Of 883 patients started on treatment, 165 (19%) had unfavourable outcomes: 8% LTFU, 5% treatment failure, 3% died and 3% not evaluated. Previously treated patients (34%) and children (44%) had the worst outcomes. Conclusion: Pre-treatment LTFU was alarmingly high and requires urgent attention, including the development and institution of mechanisms for patient tracking using information and mobile phone technology, and making TB notification mandatory in the private sector.

Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing?

Setting: Ten hospitals managing drug-resistant tuberculosis (TB) in Pakistan. Objective: To assess the implementation of TB infection control (IC) practices and reasons for non-adherence to guidelines. Design: This was a descriptive study conducted between April and October 2016 with three components: 1) non-participant observation of service delivery areas (SDAs) (n = 82) in hospitals (n = 10) using structured checklists; 2) exit interviews with 100 patients (10 per hospital); and 3) interviews with 100 health-care workers (HCWs, 10/hospital). Results: Of the 82 SDAs, posters were displayed in 34 (41%), mechanical ventilation was implemented in 79% and functional ultraviolet germicidal irradiation (UVGI) was available in only 26%. Patient interviews showed 50-65% adherence to triage and use of personal protective measures. Key reasons for non-adherence were lack of adequate supplies, discomfort using N-95 masks, a lack of knowledge or training, perceived non-cooperation by patients, poor maintenance of mechanical ventilators and UVGI due to unstable electricity supply, a lack of clarity in roles (no-one designated in charge) and staff shortages and subsequent workloads. Adherence to natural ventilation usage was poor for reasons related to climate and privacy. Conclusion: Implementation of TBIC measures in hospitals was suboptimal. Urgent measures need to be put in place, including retraining of HCWs, addressing weaknesses in mask and poster supplies and constant supervision and monitoring.

Pre-treatment loss to follow-up among smear-positive TB patients in tertiary hospitals, Quetta, Pakistan

Setting: Three public sector tertiary care hospitals in Quetta, Balochistan, Pakistan, with anecdotal evidence of gaps between the diagnosis and treatment of patients with tuberculosis (TB). Objectives: To assess the proportion of pre-treatment loss to follow-up (LTFU), defined as no documented evidence of treatment initiation or referral in TB registers, among smear-positive pulmonary TB patients diagnosed in 2015, and the associated sociodemographic factors. Design: A retrospective cohort study involving the review of laboratory and TB registers. Results: Of 1110 smear-positive TB patients diagnosed (58% female, median age 40 years, 5% from outside the province or the country), 235 (21.2%) were lost to follow-up before starting treatment. Pre-treatment LTFU was higher among males; in patients residing far away, in rural areas, outside the province or the country; and in those without a mobile phone number. Conclusion: About one fifth of the smear-positive TB patients were lost to follow-up before starting treatment. Strengthening the referral and feedback mechanisms and using information technology to improve the tracing of patients is urgently required. Further qualitative research is needed to understand the reasons for pre-treatment LTFU from the patient's perspective.

Comparative Analysis of Conventional Natural Killer Cell Responses to Acute Infection with Toxoplasma gondii Strains of Different Virulence

Conventional natural killer (cNK) cells, members of group 1 innate lymphoid cells, are a diverse cell subpopulation based on surface receptor expression, maturation, and functional potential. cNK cells are critical for early immunity to Toxoplasma gondii via IFNγ production. Acute cNK cell responses to infection with different strains of T. gondii have not yet been characterized in detail. Here, we comprehensively performed this analysis with Type I virulent RH, Type II avirulent ME49, and fully attenuated Type I cps1-1 strains. In response to these three parasite strains, murine cNK cells produce IFNγ and become cytotoxic and polyfunctional (IFNγ+CD107a+) at the site of infection. In contrast to virulent RH and avirulent ME49 T. gondii strains, attenuated cps1-1 induced only local cNK cell responses. Infections with RH and ME49 parasites significantly decreased cNK cell frequency and numbers in spleen 5 days post infection compared with cps1-1 parasites. cNK cell subsets expressing activating receptors Ly49H, Ly49D, and NKG2D and inhibitory receptors Ly49I and CD94/NKG2A were similar when compared between the strains and at 5 days post infection. cNK cells were not proliferating (Ki67−) 5 days post infection with any of the strains. cNK cell maturation as measured by CD27, CD11b, and KLRG1 was affected after infection with different parasite strains. RH and ME49 infection significantly reduced mature cNK cell frequency and increased immature cNK cell populations compared with cps1-1 infection. Interestingly, KLRG1 was highly expressed on immature cNK cells after RH infection. After RH and ME49 infections, CD69+ cNK cells in spleen were present at higher frequency than after cps1-1 infection, which may correlate with loss of the mature cNK cell population. Cytokine multiplex analysis indicated cNK cell responses correlated with peritoneal exudate cell, spleen, and serum proinflammatory cytokine levels, including IL-12. qPCR analysis of parasite-specific B1 gene revealed that parasite burdens may affect cNK cell responses. This study demonstrates infection with RH and ME49 parasites impacts cNK cell maturation during acute T. gondii infection. Different cNK cell responses could impact early immunity and susceptibility to these strains.

Ledipasvir and sofosbuvir for treatment of post- renal transplant hepatitis C infection: A case report with review of literature

Liver disease due to hepatitis C infection in renal transplant recipients is difficult to treat and often associated with reduced patient survival. A 43-year-old male, a renal allograft recipient, presented at 6 years follow-up with significant weight loss over 3 months. He was detected to have new onset diabetes mellitus together with hepatitis C virus (HCV) infection (genotype 1). His HCV load remained high despite the change of immuno-suppression from tacrolimus to cyclosporine. A decision to treat with a new anti-viral combination of ledipasvir and sofosbuvir for 12 weeks was taken. Within 3 weeks, his raised serum transaminases levels normalized and viral load became undetectable. At the end of 16 weeks, he continues to do well with normal renal function, has sustained remission from hepatitis C infection and resolution of diabetes.

Success of active tuberculosis case detection among high-risk groups in urban slums in Pakistan

BACKGROUND

In Pakistan, patients with symptoms suggestive of tuberculosis (TB) seek care from a wide array of health care providers, many of whom do not notify cases to the National TB Programme (NTP).

SETTING

We evaluated an active case detection intervention in five randomly selected districts in urban slums of Sindh Province, Pakistan.

OBJECTIVE

To evaluate the increase in case notification of smear-positive TB by active case finding at community-based chest camps by engaging the private providers.

DESIGN

A cross-sectional study of TB case detection associated with a project using integrated intervention and chest camps.

RESULTS

From April 2011 to September 2012, the total number of clients seen in the camps was 165 280. Of all the attendees, 13 481 (12.7%) were examined by sputum smear microscopy. The proportion of smear-positive results was significantly higher among those from engaged private providers than among those referred from camps (OR 1.54, 95%CI 1.42-1.66). During the project, the total number of smear-positive TB notifications increased over the intervention period from 5158 to 8275.

CONCLUSION

Active case detection by engaging private providers and chest camps can significantly increase the number of smear-positive TB case notifications.

Can the number of patients with presumptive tuberculosis lost in the general health services in Pakistan be reduced?

The frequency of patients with presumptive tuberculosis (TB) who are not investigated by sputum smear microscopy is unknown in Pakistan. Using a simple intervention comparing patient and laboratory registers, patients with presumptive TB were identified in two districts from July to December 2013, a list of missing patients was prepared and the patients traced. The intervention significantly reduced the number of patients with presumptive TB lost, from 8.5% before the intervention to 6.9% after. A systematic comparison of out-patient and laboratory registers, followed by tracing missing persons, can reduce the proportion of patients with presumptive TB lost before diagnosis.