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The regulation of immune mechanisms is controlled by major histocompatibility complex/human leukocyte antigen (MHC/HLA). Polymorphisms of the HLA region have an impact on susceptibility to complex infectious and autoimmune diseases. The present study was carried out to determine the frequencies of ASMA, AMA, ANA, dsDNA, and anti-LKM-1 auto-antibodies in hepatitis C patients and to determine their association with the HLA DRβ1 (*04) locus. It was a cross-sectional, analytical study, and 86 patients with chronic HCV were recruited. The presence of auto-antibodies (ASMA, AMA, ANA, dsDNA, and anti-LKM-1) was determined by indirect immunofluorescence and ELISA, while the HLA DRβ1 (*04) allele was assessed by sequence-specific conventional PCR. ANA was detected in 41%, ASMA in 17.4%, AMA in 7%, LKM-1 in 5.8% dsDNA in 4.6% of CHC patients while HLA-DRβ1 (*04) was present in 3.5% of patients, but this was not significantly associated with these auto-antibodies.

Blackboard is a collaborative virtual learning tool used for higher learning that has been found to be an effective and efficient means of interactions between teachers and students and offers effective educational information management. The aim of this research work is to assess the preclinical and clinical dental students’ perception of Blackboard Collaborate as a quality teaching and learning tool as well as to find out areas that might appear as barriers to quality teaching and learning. This cross-sectional study was conducted online using survey monkey involving 245 dental students who had participated in the virtual classroom lectures during the pandemic with 18 students not completing the survey. The survey instrument was a nine-item questionnaire that included the age, sex, and year of study of the students as well as previous exposure to online lectures. The data collated was analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for windows version 22. Among 245 respondents that were enrolled in the study, 227 respondents completed the survey, of which 58.1% (n = 132) were male while 41.9% (n = 95) were females. Of the 227 respondents that completed this study, 74.8% (n = 170) of them experienced minimum to moderate technical problems regarding connectivity during the online sessions while 1.8% (n = 4) of the respondents experienced very severe technical problems. The majority of the respondents 54.2% (n = 123) support the continuation of online lectures even after the pandemic. In conclusion, we found a positive perception of our respondents to online lectures using Blackboard Collaborate. Internet connectivity as well as a decline in the comprehension of the lectures as compared to face-to-face learning were found as barriers to online learning.

Cigarette smoking is one of the major modifiable and environmental risk factors which can alter the lipid profile that leads to the progression of atherosclerosis and cardiovascular diseases. The aim of the current study is to explore the association of cigarette smoking with Hyperlipidemia in male individuals. A cross-sectional study was carried out from March 2017 to Au-gust 2018 in Xuzhou, Jiangsu, China. A total of 1561 male individuals were enrolled in the study with a mean age (years) of 55.33 ± 14.41. We collected data on demographic, anthropometric and lifestyle indices. Total cholesterol (TC), triglyceride (TGL), and high-density lipoprotein cholesterol (HDL-C) were determined by the enzymatic colorimetric method. The mean level of serum TC, TG, and HDL-C were 4.85 ± 0.91, 1.69 ± 1.45 and 1.27 ± 0.32 mmol/L respectively. We found that age, body mass index, pack-years, marital status, annual household income, alcohol consumption, smoking status, education level, and occupational status have significant association with Hyperlipidemia. Adjusted multiple logistic regressions showed that in old age, smoking behavior can significantly increase the risk of Hyperlipidemia. With an increase in pack-years, a significant increase is found only in TC while decreasing trend noticed in HDL-C level. Current smokers showed a significant increase in the risk of Hyperlipidemia compared to those who never smoked while smoking cessation decreases the risk of Hyperlipidemia. This study concluded that cigarette smoking along with increased age and pack-years can significantly increase the risk of Hyperlipidemia that further leads to heart diseases.

Aims. Floods badly impact the food and nutrition security in developing countries. The role of the government and the impact of floods on the underweight status of children in the affected areas is not clear. We aimed to find the determinants of underweight in flood-affected areas of Khyber Pakhtunkhwa, Pakistan. Methods. We used a multistage sampling technique and selected 656 households during in the flood-affected areas of Pakistan. Data were collected in the three most affected districts. A validated questionnaire was used to find socioeconomic and demographic information, hygiene, and sanitation information. We used logistic regression to find the determinants of underweight, controlling for confounders. Results. The prevalence of global malnutrition based on underweight was 25.2%. The prevalence of underweight was higher in young age mothers (40.6%), younger age children (71.4%), large family size (28.4%), joint family (27%), and no toilet facility (28.9%). District Nowshera was at high risk of underweight based undernutrition, followed by district Charsadda compared to children belonging to Dera Ismail Khan. The significant risk factor that causes underweight was child lower age ( p < 0.01 ), young age of mothers ( p < 0.01 ), children access to unimproved water sources ( p < 0.01 ), and location (districts) due to environmental and constant flood consequences ( p < 0.01 ). Conclusion. In conclusion, risk factors of underweight should be appropriately targeted in the flood-hit areas of Pakistan. Governments should preallocate budgetary resources and enhance the emergency preparedness levels to facilitate the communities with flooding incidents and their aftermath in the shape of child underweight-based malnutrition.

BACKGROUND: The SARS-CoV-2 pandemic continues to expand globally, with case numbers rising in many areas of the world, including the Indian sub-continent. Pakistan has one of the world ‘s largest population, of over 200 million people and is experiencing a severe third wave of infections caused by SARS-CoV-2 that begun in March 2021.In Pakistan, during third wave until now only 12 SARS-CoV-2 genomes have been collected and among these 9 are from Islamabad. This highlights the need for more genome sequencing to allow surveillance of variants in circulation. In fact more genomes are available among travellers with a travel history from Pakistan, than from within the country itself. METHODS: or a better understanding of the circulating variants in Lahore and surrounding areas with a combined population of 11.1 million, within a week of April 2021, 102 samples were sequenced. The samples were randomly collected from 2 hospitals with a diagnostic polymerase chain reaction (PCR) cutoff value of less than 25 cycles. RESULTS: Analysis of the lineages shows that B.1.1.7 (first identified in the UK, Alpha variant) dominates, accounting for 97.9% (97/99) of cases, with B.1.351 (first identified in South Africa, Beta variant) accounting for 2.0% (2/99) of cases. No other lineages were observed. DISCUSSION: In depth analysis of the B.1.1.7 lineages indicates multiple separate introductions and subsequent establishment within the region. Eight samples were identical to genomes observed in Europe (7 UK, 1 Switzerland), indicating recent transmission. Genomes of other samples show evidence that these have evolved, indicating sustained transmission over a period of time either within Pakistan or other countries with low density genome sequencing. Vaccines remain effective against B.1.1.7, however the low level of B.1.351 against which some vaccines are less effective demonstrates the requirement for continued prospective genomic surveillance.

There is minimal literature regarding micronutrient deficiencies in flood-affected regions. In our study, we aimed to find the prevalence of micronutrient deficiencies (vitamin A, calcium, zinc, iron, and iodine) among preschool and school-age children in flood-hit areas of Khyber Pakhtunkhwa, Pakistan. In this cross-sectional study, a multi-stage sampling technique was used for the selection of 656 households. Serum micronutrient status was detected in the targeted population in the affected districts. The least significant difference test was used with analysis of variance to determine significant differences in nutrient contents in different areas. Of the total respondents, 90.8% of the children were calcium deficient, 88.3% were zinc deficient, 26.7% were iron deficient, 53.5% were vitamin A deficient, and 39.5% were had an iodine deficiency in flood-affected areas. A significant difference (P < 0.05) was found in different age groups of children for zinc (5.7–42.63 μg/dL) and urinary iodine (69.6–85.4 μg/L). The 10- to 12-year-old age group had a lower serum zinc concentration (5.7 μg/dL), whereas the 1- to 3-year-old age group had a lower urinary iodine concentration (69.6 μg/L) than other groups. There was no significant difference (P > 0.05) between male and female children and various age groups for calcium and iron status. Vitamin A levels were significantly (P < 0.05) different among different age groups (high in age group 4–6 years) and districts. Vitamin A concentration was lower in the Nowshera District, whereas serum iron and zinc were lower in the Dera Ismail Khan District. All the important micronutrients in the population of children were deficient in the flood-affected areas of Pakistan. Therefore, policymakers should implement potential prevention strategies, such as food security, school health nutrition, food fortification, nutrition in the first 1,000 golden days, nutrition knowledge, and awareness of the local population, to reduce the burden of micronutrients deficiencies in flood-affected areas.

Hand-Foot-and-Mouth disease (HFMD) is a viral illness commonly seen in young children, characterized by fever, vomiting, ulcerative lesions in oral mucosa, and vesicles on hands and feet. The early symptoms resolve but sometimes, it leads to more harsh neurological complications and even death. Therefore, the objective of this review was set to provide an overview of the symptoms, pathogenic agents, and treatment of neurological complications associated with HFMD.We reviewed literature from PubMed and Science Direct covering at least one of our objectives from inception to 4th March 2018.This review represents 6 countries including China, Vietnam, Cambodia, South Korea, Taiwan, and Australia. Fifteen studies with a total of 1043 patients were included. The majority of HFMD cases with neurological complications were reported in China, predominance in boys as compared to girls, with 97% cases under 15 years of age. Meningoencephalitis and brainstem encephalitis contributed 70% of all neurological complications related to HFMD. Human Enterovirus71 genotype C, especially C4a was a causative agent associated with severe complications. Among symptoms, fever, vomiting, myoclonic jerks or seizure, headache, convulsion, and rashes were reported in almost all neurological complications. The common and supportive treatments were the administration of intravenous immunoglobulin and glucocorticoid therapies.Early detection and appropriate treatment of severe neurological complications can minimize the risk of adverse health outcomes. Evidence based clinical practice guidelines for early detection and treatment would be significant in the management of these devastating neurological complications.

Aamir Jamal Gondal,1,2 Sidrah Saleem,1 Shah Jahan,3 Nakhshab Choudhry,4 Nighat Yasmin2 1Department of Microbiology, University of Health Sciences, Lahore, Pakistan; 2Department of Biomedical Sciences, King Edward Medical University, Lahore, Pakistan; 3Department of Immunology, University of Health Sciences, Lahore, Pakistan; 4Department of Biochemistry, King Edward Medical University, Lahore, PakistanCorrespondence: Aamir Jamal GondalDepartment of Biomedical Sciences, King Edward Medical University, Nelagumbad Chowk, Anarkali Bazar, Lahore 54000, PakistanTel +92-300-8822055Email ajgondal119@gmail.comPurpose: The emergence of multidrug-resistant Klebsiella pneumoniae (K. pneumoniae) is associated with the acquisition of multiple carbapenemases. Their clonal spread is a worldwide concern due to their critical role in nosocomial infections. Therefore, the identification of high-risk clones with antibiotic resistance genes is very crucial for controlling its global spread.Materials and Methods: A total of 227 K. pneumoniae strains collected during April 2018 to November 2019 were confirmed by PCR. Carbapenemases and extended-spectrum β-lactamases (ESBL) were detected phenotypically. Confirmation of carbapenemases was carried out by PCR and Sanger sequencing. The clonal lineages were assigned to selected isolates by multilocus sequence typing (MLST), and the plasmid analysis was done by PCR-based detection of the plasmid replicon typing.Results: Of the total K. pneumoniae, 117 (51.5%) were carbapenem resistant (CRKP) and 140 (61.7%) were identified as ESBL producers. Intermediate to high resistance was detected in the tested β-lactam drugs while polymyxin-B and tigecycline were found to be susceptible. Among CRKP, 91 (77.8%) isolates were detected as carbapenemase producing, while 55 (47%) were positive for blaNDM-1 23.9% (n=28), blaOXA-48 22.2% (n=26) and blaVIM 0.85% (n=1) while 12.7% (n=7) carried both blaNDM-1 and blaOXA-48 genes. The CRKP coharboring blaNDM-1 and blaOXA-48 genes (n=7) were positive for blaCTX-M blaSHV (n=3), blaSHV (n=1) and blaCTX-M (n=3). The novel CRKP with the coexistence of blaNDM-1, blaOXA-48, blaCTX-M and blaSHV genes were associated with the high-risk clone ST147 (n=5) and ST11 (n=2). The assigned replicon types were IncL/M, IncFII, IncA/C and IncH1.Conclusion: This is the first report of the coexistence of blaNDM-1, blaOXA-48, blaCTX-M and blaSHV genes on a high-risk lineage ST147 from Pakistan. This study highlights the successful dissemination of carbapenemase resistance genes in the high-risk clones that emphasizes the importance of monitoring and controlling the spread of these diverse clones globally.Keywords: high-risk clone, New Delhi metallo-β-lactamase, MLST, K. pneumoniae, carbapenem resistance

Background There are certain reported cases of unusual displacements of teeth involved in a maxillofacial trauma to the maxillary sinus, nasal cavity, gastrointestinal tract or the airway, if worst. All these usually lead to complication the worst being death. So enquiring about them is a very essential part of surveying a maxillofacial trauma patient involving dentition. Case This patient was referred to our department for a dental consultation for his ill-defined firm, mildly tender, non-suppurative, submental swelling unresponsive to medication. He had undergone a polytrauma involving his face two months back. An orthopantomogram was ordered which showed a lower central incisor from the fracture site had slipped through the fracture gap into the submental space possibly missed by the CT scan. There was also a lower border splaying at the fracture site. A layer-wise dissection was done extra-orally to retrieve the tooth. Conclusion This case envisages the importance of an OPG as an adjuvant to the basic radiographic study, in the emergency room, for a patient with oral and maxillofacial trauma. It also establishes the importance of a meticulous secondary survey, including counting the number of teeth and establishing a correct occlusion to avoid a complication and re-operation. Besides, a medical negligence lawsuit can also arise as some teeth may slip to lungs even.

This study aimed to measure the body composition, dietary patterns and its associated factors in medical students. A cross-sectional study was conducted among 695 students studying at Nanjing medical university, China. Data regarding dietary intake factors was collected by a validated food frequency questionnaire. Principle component analysis and multivariate linear regressions were used. Body composition including BMI and visceral fats index of the males were significantly higher (P < .05) than females. While body fats percentage and fats mass index/free fat mass index (FMI/FFMI) ratio of females was significantly higher (P < .05) than males. Three dietary patterns were identified: western dietary pattern, meat pattern, and vegetables and fruits pattern. The western pattern was having an independent negative association (P < .05) with age and financial status, while positive association (P < .05) with sleeping duration and FMI/FFMI ratio. Vegetables and fruits patterns was having positive association with physical exercise and while negative association with FMI/FFMI ratio. Meat pattern was having positive association with educational levels and sleeping duration, while negative association with physical exercise and FMI/FFMI ratio. In conclusion, medical students adopted less healthy dietary patterns as compared to healthy dietary patterns, which were found to be more associated with some adverse dietary and lifestyle behavior outcomes.

$K$-frames and atomic systems for an operator $K$ in Hilbert spaces were introduced by Gavruta \cite{12} and further studied by Xio, Zhu and Gavruta \cite{21}. In this paper, we have introduced the notion of an approximative atomic system for an operator $K$ in Banach spaces and obtained interesting results. A complete characterization of family of approximative local atoms of subspace of Banach space has been obtained. Also, a necessary and sufficient condition for the existence of an approximative atomic system for an operator $K$ is given. Finally, explicit methods are given for the construction of an approximative atomic systems for an operator $K$ from a given Bessel sequence and approximative $\mathcal{X}_d$-Bessel sequence.

Background/aim: Fanconi anemia (FA) is an autosomal recessive disease determined by mutations in at least 16 genes, with distinct distributions in different populations. To the best of our knowledge, there are no reports regarding the molecular basis of the disease in FA patients in Pakistan. The current study aimed to determine the frequency of FANCC gene mutations, i.e. IVS4+4A>T, del322G, and R548X, in FA patients. Materials and methods: Genomic DNA was obtained from 36 FA patients. All samples were analyzed by polymerase chain reaction and restriction fragment length polymorphism techniques. Results: Mutation IVS4+4A>T was identified in 26 (72.2%) patients. It was homozygous in 6 and heterozygous in 20 patients. Del322G and R548X were found with the following prevalences: del322G, 5.6%, and R548X, 5.6%. Patients with these two mutations were compound heterozygotes having concomitant IVS4+4A>T mutation. Conclusion: These results suggest that mutation IVS4+4A>T is the most prevalent mutation in our group of patients. This analysis of Pakistani patients also suggests that there is no significant difference between IVS4+4A>T homozygotes and the rest of the patients with regard to severity of clinical phenotype.