Search

Background: This study aimed to determine the clinical burden, spatial dynamics, and associated risk factors of Plasmodium infection among the natives of Chakwal, Punjab Pakistan from 2019 to 2023 to guide targeted screening and treatment interventions. Method: A community-based cross-sectional study was conducted using primary and secondary data sources. Participants were recruited using a multi-stage cluster sampling by taking informed consent for the primary data sources. Whereas a secondary dataset of Plasmodium infection was obtained from the database of surveyed hospitals after ethical consideration. All the participants living in the study area for at least 3 months were included, while patients with chronic illness were excluded. Sociodemographic and environmental data were collected using a structured questionnaire. Plasmodium infection was diagnosed using microscopy, rapid diagnostic tests (RDTs), and nested polymerase chain reaction (PCR) as the reference standard. A Zero-inflated negative binomial logistic regression model and interpolation of malaria distribution to environmental variables were employed to determine the association and spatiotemporal patterns of malaria in Chakwal. Results: Among the 2457 participants, the prevalence of Plasmodium vivax infection (99%) was significantly higher than P. falciparum (0.8%) and mixed infection (0.2%). Females had a higher infection rate than males and the infection rate was higher in adults (21–40 years) and children (0–20 years). Age category (61–100), P. vivax species, temperature, rainfall, monsoon season, and mixed infection factors were significantly associated (p < 0.05) with increased Plasmodium infection risk. Geospatial mapping indicated potential malaria hotspots in Sarkal Kasar, Chak Baili, Mulkwal, Chohan, and other close areas of the Potohar region. Conclusion: The clinical burden of P. vivax was the highest during monsoon season in Chakwal. Age, gender, climatic factors, and mixed infection were significant risk factors for malaria transmission in this region. Targeted screening and treatment strategies should prioritize identified hotspots and high-risk groups to effectively control malaria in Potohar region of Pakistan. [ABSTRACT FROM AUTHOR]

BACKGROUND: Translation and validation of important scales in other languages reduce bias in reporting the functional status of the patient. OBJECTIVE: To translate the Back Pain Functional Scale into Urdu (BPFSu), adapt it for use in other cultures, and evaluate its psychometric properties. METHOD: According to Beaton guidelines, translation and cultural adaption was carried out. On 100 Urdu-literate men and women aged 18–60 years with lower back pain, the final BPFSu was assessed for psychometric qualities. First at baseline and again after 7 days, participants completed the BPFSu, the Functional Rating Index (FRI), and the Numeric Pain Rating Scale (NPRS). RESULTS: Internal consistency of the BPFSu was excellent (Cronbach's alpha: 0.937). No floor and ceiling effects were found Excellent test-retest reliability (ICC = 0.882, CI 95%; 0.830–0.919) was achieved. Spearman correlation coefficient showed criterion validity with the NPRS (rho = â ⁢ ˆ ⁢ ’ 0.701, p ⩽ 0.001) and Pearson correlation coefficient showed construct validity with the FRI (r = â ⁢ ˆ ⁢ ’ 0.740, p ⩽ 0.001). The minimum detectable changes were 9.96, while the standard error of measurement was 3.6. CONCLUSION: The BPFSu is a valid and reliable instrument for assessing physical function in individuals experiencing low back discomfort. [ABSTRACT FROM AUTHOR]

Background: Lung cancer, often diagnosed late, is a leading cause of death worldwide. Bronchoscopic biopsies are crucial for early detection, especially in smokers. In Pakistan, where smoking is prevalent, understanding lung cancer patterns is essential. This study examines the types and locations of lung cancers diagnosed via bronchoscopic biopsies in a tertiary care hospital, providing insights for better diagnosis and treatment. Objectives: To determine the prevalence of different types of lung malignancies by using bronchoscopic guided endobronchial biopsies. Methodology: It was a retrospective cross-sectional study conducted in in-patient of Department of Pulmonology, department Nishtar Medical University Multan study of 43 patients enrolled between June 2022 to Oct 2023 by using consecutive non probability sampling method. All were smokers more than 20 pack year. Data analysis was done by using SPSS 23 version. Results: Out of 43 patients 34 (79%) were male and 9 (21%) were female. Bronchoscopic biopsy result showed small cell carcinoma being the most common tumour in our study 15 (34.88%) cases followed by Squamous cell carcinoma 14 (32.55%), Adenocarcinoma 6(13.95%), invasive carcinoma with hepatoid features 1 (2.32%), carcinoid tumour 1(2.32%), organizing Pneumonia 1(2.32%) and in biopsy was inconclusive in 5 (11.62%) cases. Tumour involvement by the location was also assessed in the present study. Most common site of origin was found to be Left main bronchus 11 (25.58%) followed by Right Main bronchus 9 (20.93%), Left upper lobe 9 (20.93%), Right upper lobe 5(11.62%), Left lower lobe 4 (9.30%), Lingular lobe 3 (6.97%), Right lower lobe 2(0.86%). Conclusion: This study revealed that small cell carcinoma is the most prevalent type of lung cancer diagnosed via bronchoscopic biopsies among smokers with over 20 pack-years of smoking history. These findings highlight the critical role of bronchoscopic biopsies in the early detection of lung cancer in high-risk populations, underlining the need for targeted screening and tailored treatment approaches to improve patient outcomes in regions with high smoking prevalence. [ABSTRACT FROM AUTHOR]

Introduction: Insertable cardiac monitors (ICMs) are commonly used to diagnose cardiac arrhythmias. False detections in the latest ICM systems remain an issue, primarily due to inaccurate R‐wave sensing. New discrimination algorithms were developed and tested to reduce false detections of atrial fibrillation (AF), pause, and tachycardia episodes in ICMs. Methods: Stored electrograms (EGMs) of AF, pause, and tachycardia episodes detected by Abbott Confirm Rx™ ICMs were extracted from the Merlin.net™ Patient Care Network, and manually adjudicated to establish independent training and testing datasets. New discrimination algorithms were developed to reject false episodes due to inaccurate R‐wave sensing, P‐wave identification, and R–R interval patterns. The performance of these new algorithms was quantified by false positive reduction (FPR) and true positive maintenance (TPM), relative to the existing algorithms. Results: The new AF detection algorithm was trained on 5911 EGMs from 744 devices, resulting in 66.9% FPR and 97.8% TPM. In the testing data set of 1354 EGMs from 119 devices, this algorithm achieved 45.8% FPR and 97.0% TPM. The new pause algorithm was trained on 7178 EGMs from 1490 devices, resulting in 70.9% FPR and 98.7% TPM. In the testing data set of 1442 EGMs from 340 devices, this algorithm achieved 74.4% FPR and 99.3% TPM. The new tachycardia algorithm was trained on 520 EGMs from 204 devices, resulting in 57.0% FPR and 96.6% TPM. In the testing data set of 459 EGMs from 237 devices, this algorithm achieved 57.9% FPR and 96.5% TPM. Conclusion: The new algorithms substantially reduced false AF, pause, and tachycardia episodes while maintaining the majority of true arrhythmia episodes detected by the Abbott ICM algorithms that exist today. Implementing these algorithms in the next‐generation ICM systems may lead to improved detection accuracy, in‐clinic efficiency, and device battery longevity. [ABSTRACT FROM AUTHOR]

Introduction: Among patients with non‐valvular atrial fibrillation (AF) and percutaneous left atrial appendage closure (LAAC) undergoing direct current cardioversion (DCCV), the need for and use of LAA imaging and oral anticoagulation (OAC) is unclear. Objective: The purpose of this study is to evaluate the real‐world use of transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CCTA) before DCCV and use of OAC pre‐ and post‐DCCV in patients with AF status post percutaneous LAAC. Methods: This retrospective single center study included all patients who underwent DCCV after percutaneous LAAC from 2016 to 2022. Key measures were completion of TEE or CCTA pre‐DCCV, OAC use pre‐ and post‐DCCV, incidence of left atrial thrombus (LAT) or device‐related thrombus (DRT), incidence of peri‐device leak (PDL), and DCCV‐related complications (stroke, systemic embolism, device embolization, major bleeding, or death) within 30 days. Results: A total of 76 patients with AF and LAAC underwent 122 cases of DCCV. LAAC consisted of 47 (62%), 28 (37%), and 1 (1%) case of Watchman 2.5, Watchman FLX, and Lariat, respectively. Among the 122 DCCV cases, 31 (25%) cases were identified as "non‐guideline based" due to: (1) no OAC for 3 weeks and no LAA imaging within 48 h before DCCV in 12 (10%) cases, (2) no OAC for 4 weeks following DCCV in 16 (13%) cases, or (3) both in 3 (2%) cases. Among the 70 (57%) cases that underwent TEE or CCTA before DCCV, 16 (23%) cases had a PDL with a mean size of 3.0 ± 1.1 mm, and 4 (6%) cases had a LAT/DRT on TEE resulting in cancellation. There were no DCCV‐related complications within 30 days. Discussion: There is a widely varied practice pattern of TEE, CCTA, and OAC use with DCCV after LAAC, with a 6% rate of LAT/DRT. LAA imaging before DCCV appears prudent in all cases, especially within 1 year of LAAC, to assess for device position, PDL, and LAT/DRT. [ABSTRACT FROM AUTHOR]

Background: Lung parenchyma lesions present a range of potential differential diagnoses, necessitating a comprehensive evaluation for appropriate treatment. However, when it comes to definitive confirmation, tissue histopathology or culture remains the gold standard. Objective: This study was conducted with the objective of assessing the safety of ultrasound-guided Tru-cut biopsy when performed by pulmonologists. Methodology: Patients with underlying peripheral lung lesion underwent CT chest with iv contrast then they underwent tru cut biopsy by using 18G Dr. J needle under ultrasound guidance using convex probe 2-5 MHz. Histopathology reports were collected and then retrospective analysis of data was done. Results: Out of 50 patients 36 (72%) were male and 14 (28%) were female ranging from 16 years to 73 years. Squmaous Cell Carcinoma was found in 17 cases (34%), most common tumour in our study and most common site of lung tumor was right lower lobe (22%). Conclusion: Pulmonologists can efficiently performtru cut lung biopsies under ultrasound guidance with minimal to no complications. [ABSTRACT FROM AUTHOR]

Background: Transesophageal echocardiography (TEE) and cardiac computed tomography angiography (CCTA) are currently utilized for left atrial appendage closure (LAAC) planning. During the recent global iodine contrast media shortage in 2022, cardiac magnetic resonance imaging (CMR) was utilized for the first time for LAAC planning. This study sought to assess the utility of CMR versus TEE for LAAC planning. Methods: This single center retrospective study consisted of all patients who underwent preoperative CMR for LAAC with Watchman FLX or Amplatzer Amulet. Key measures were accuracy of LAA thrombus exclusion, ostial diameter, depth, lobe count, morphology, accuracy of predicted device size, and devices deployed per case. Bland‐Altman Analysis was used to compare CMR versus TEE measurements of LAA ostial diameter and depth. Results: 25 patients underwent preoperative CMR for LAAC planning. A total of 24 (96%) cases were successfully completed with 1.2 ± 0.5 devices deployed per case. Among the 18 patients who underwent intraoperative TEE, there was no significant difference between CMR versus TEE in LAA thrombus exclusion (CMR 83% vs. TEE 100% cases, p =.229), lobe count (CMR 1.7 ± 0.8 vs. TEE 1.4 ± 0.6, p =.177), morphology (p =.422), and accuracy of predicted device size (CMR 67% vs. TEE 72% cases, p = 1.000). When comparing the difference between CMR and TEE measurements, Bland‐Altman analysis demonstrated no significant difference in LAA ostial diameter (CMR‐TEE bias 0.7 mm, 95% CI [−1.1, 2.4], p =.420), but LAA depth was significantly larger with CMR versus TEE (CMR‐TEE bias 7.4 mm, 95% CI [1.6, 13.2], p =.015). Conclusions: CMR is a promising alternative for LAAC planning in cases where TEE or CCTA are contraindicated or unavailable. [ABSTRACT FROM AUTHOR]

Background: COPD is one of the biggest causes of mortality all around the world. This disease represents significant and potentially rising burden on health services on global level. COPD is thought to rise to fourth rank the list of diseases with highest mortality. It is also expected to rise to 7th number among the diseases with highest burden on the health system by 2030. COPD is the cause of mortality in 2.5 million people all over the world. COPD is commonly associated with cardiovascular diseases, and CVD is the commonest cause of mortality among COPD patients. Objective: To determine the frequency of deep vein thrombosis (DVT) among the patients with COPD presenting at a tertiary care hospital. Methodology: This was a cross sectional study conducted at Department of Pulmonology, Nishtar Hospital Multan, from August 2019 to January 2020. Total 211 patients were selected for the study. Mean and standard deviation were calculated for continuous data while frequencies and percentages were calculated for the nominal data Effect modifiers such as age, gender, obesity, diabetes, dyslipidemia, hypertension, duration of disease, smoking, residential status, and socioeconomic status were controlled by stratification and chi-square test was applied, keeping p=0.05 as statistically significant. Results: Of these 211 study cases, 133 (63%) patients were male while 78 (37%) patients were female. Mean age of the patients was 53.81±9.90 years. Diabetes was present in 54 (25.6%), and hypertension was present in 93 (44.1%) of all the patients. Mean BMI was 25.19±2.34 kg/m2 and 32 (15.2%) patients were obese. Of these 211 study cases, 71 (33.6%) were smokers. Dyslipidemia was present in 55 (26.1%) of patients. Deep vein thrombosis was present in 23 (10.9%) of all the patients included in study. Conclusion: High prevalence of deep vein thrombosis was observed in current study in the patients with COPD. Deep vein thrombosis was highly associated with poor control of hypertension, smoking, obesity, and long duration of the disease. [ABSTRACT FROM AUTHOR]

Purpose: Bowel and mesenteric injuries are rare in patients following blunt abdominal trauma. Computed tomography (CT) imaging has become a mainstay in the work-up of the stable trauma patient. The purpose of this study was to identify radiographic predictors of therapeutic operative intervention for mesenteric and/or bowel injuries in patients after blunt abdominal trauma. Methods: All patients with a discharge diagnosis of bowel and/or mesenteric injury after blunt trauma were identified over a 5-year period. Admission CT scans were reviewed to identify potential predictors of bowel and/or mesenteric injury. Patients were then stratified by operative intervention [therapeutic laparotomy (TL) vs. non-therapeutic laparotomy (NTL)] and compared. All potential predictors included in the initial regression model were assigned one point and a score based on the number of predictors was calculated: the radiographic predictors of therapeutic operative intervention (RAPTOR) score. Results: 151 patients were identified. 114 (76%) patients underwent operative intervention. Of these, 75 patients (66%) underwent TL. Multifocal hematoma, acute arterial extravasation, bowel wall hematoma, bowel devascularization, fecalization, pneumoperitoneum and fat pad injury, identified as potential predictors on univariable analysis, were included in the initial regression model and comprised the RAPTOR score. The optimal RAPTOR score was identified as ≥ 3, with a sensitivity, specificity and positive predictive value of 67%, 85% and 86%, respectively. Acute arterial extravasation (OR 3.8; 95% CI 1.2–4.3), bowel devascularization (OR 14.5; 95% CI 11.8–18.4) and fat pad injury (OR 4.5 95% CI 1.6–6.2) were identified as independent predictors of TL (AUC 0.91). Conclusions: CT imaging remains vital in assessing for potential bowel and/or mesenteric injuries following blunt abdominal trauma. The RAPTOR score provides a simplified approach to predict the need for early therapeutic operative intervention. [ABSTRACT FROM AUTHOR]

Introduction: Defibrillation testing (DT) is recommended during the subcutaneous defibrillator (S‐ICD) placement. We sought to compare 10 J shock impedance in sinus rhythm (SR) with 65 J defibrillation impedance and evaluate device position on a postimplant chest X‐ray (CXR) using an intermuscular (IM) technique. Methods: Consecutive S‐ICD implantations between 12/2019 and 12/2020 at The Ohio State University were reviewed. All implantations were performed using a two‐incision IM technique. Standard DT with 65 J shock and 10 J shock in SR were performed unless contraindicated. The PRAETORIAN score was calculated based on CXR. Results: A total of 37 patients (age: 47.2 ± 15.8 years old, male: n = 26 [70.3%], body mass index: 30.1 ± 6.7 kg/m2) underwent IM S‐ICD implantation, and of those, 27 (73%) underwent both 65 J shock and 10 J shock in SR. The coefficient of determination (R2) between 10 J shock impedance and 65 J shock impedance was 0.84. The mean of an impedance difference was 1.6 ± 4.8 Ω (minimum – 11 and maximum 8). Postimplant CXR was available for 33 out of 37 patients (89.2%). The PRAETORIAN score was less than 90 in all patients and the mean score was 32.7 ± 8.8. Conclusion: We demonstrated that 10 J shock impedance in SR correlated well with 65 J defibrillation impedance during IM S‐ICD implantation. An IM implantation technique provides excellent generator location on postimplant CXR. The IM technique combined with 10 J shock in SR may be sufficient to predict and ensure the defibrillation efficacy of the S‐ICD. [ABSTRACT FROM AUTHOR]

Introduction: The LARIAT epicardial suture snaring device has been fraught with technical challenges and procedural complications. Over time, technique modification and improved operator experience have helped overcome many of these challenges. Methods and Results: Studies reporting left atrial appendage epicardial closure over a 12‐year period from 2009 to 2020 were evaluated. The primary efficacy outcome evaluated was left atrial appendage closure with residual flow ≤1 mm. Safety outcomes evaluated were periprocedural and long term complications after device placement. Nine studies consisting of 1430 patients were included in this analysis, of which 1386 (97%) underwent successful device placement. The mean age was 69.3 years, with a mean CHADS2‐VASC score of 3.78. Primary efficacy end point was achieved in 95.8% patients immediately after device placement, and in 92.8% patients on long term follow‐up. Early procedural complications consisted of pericardial effusion 5.6%, cardiac perforation 2.7%, pericarditis 2.6%, and need for open heart surgery 1.5%. Long term complications consisted of all‐cause mortality 2.3%, stroke 1.5%, and left atrial appendage thrombus 2.3%. Reduced complications were noted using micropuncture needles (2.20% vs. 10.14%; p <.0001), a longer duration pericardial drainage, and use of anti‐inflammatory medications (1.58% vs. 8.4%). Oral anticoagulation use decreased from 44.7% to 22.9% post device implantation, and to 8.5% on last clinical follow up. Conclusions: The LARIAT device is effective in epicardial closure of the left atrial appendage. Improvement in device techniques such as use of micropuncture needle, prophylactic colchicine, and maintenance of a pericardial drain have helped improve safety over time. [ABSTRACT FROM AUTHOR]

Exceptional precautionary measures have been adopted to stop the transmission and control of COVID-19 through the world and Pakistan is facing lockdown in this scenario. Public loyalty to precautionary measures is affected by their knowledge, attitude, risk factors and practices (KAP) towards COVID-19. The present study was conducted among the Pakistani residents to observe the knowledge, attitude, practices and risk factors towards COVID-19 outbreak in Pakistan. A questionnaire was designed, and a cross-sectional survey was conducted among participants of the study area. Participants were asked the questions regarding knowledge, attitude, practices and risk factors towards COVID-19. Data were analyzed by SPSS and t/F test and correlation was applied among the knowledge, attitude, risk factors and practices. A total of 1060 questionnaires were received. 1004 were included while 56 were excluded. The highest representation was from Punjab province (65.6%), female (63%) and age group of 21–30 years (62.1%). Most participants were single (85%), Muslim (99.4%), Urdu speaking (45.6%) and were graduates (51.5%). Most of the participants were students (52.9%) and were from economically middle-class families (40.8%). The knowledge was positively correlated with attitude and practices whereas negatively correlated with risk factors (P < 0.05). The attitude was negatively correlated with risk factor and positively correlated with practices. The risk factors and practices were positively correlated with each other. Health education program to improve the COVID-19 knowledge, attitude, practices and risk factors should be initiated to combat current health challenge. [ABSTRACT FROM AUTHOR]

Background: The leadless Micra transcatheter‐pacing system (Micra‐TPS) is implanted via a femoral approach using a 27‐French introducer sheath. The Micra Transcutaneous Pacing Study excluded patients with inferior vena cava (IVC) filters. Objective: To examine the feasibility and safety of Micra‐TPS implantation through an IVC filter. Methods: This multicenter retrospective study included patients with an IVC filter who underwent a Micra‐TPS implantation. Data for clinical and IVC filter characteristics, preprocedure imaging, and procedural interventions were collected. The primary outcome was a successful leadless pacemaker (LP) implantation via a femoral approach in the presence of an IVC filter. Periprocedural and delayed clinical complications were also evaluated. Results: Of the 1528 Micra‐TPS implants attempted, 23 patients (1.5%) had IVC filters. The majority (69.6%) of IVC filters were permanent. Six (26.1%) patients underwent preprocedural imaging to assess for filter patency. One patient's filter was retrieved before LP implantation. The primary outcome was achieved in 21 of 22 patients (95.5%) with an existing IVC filter. An occluded IVC precluded LP implantation in one patient. Difficulty advancing the stiff guidewire or the 27‐Fr sheath was encountered in five patients. These cases required repositioning of the wire (n = 2), gradual sheath upsizing (n = 2), or balloon dilation of the filter (n = 1). Postprocedure fluoroscopy revealed intact filters in all cases. During a median 6‐month follow‐up, there were no clinical complications related to the filter or the Micra‐TPS. Conclusion: This multicenter experience demonstrates the feasibility and safety of Micra‐TPS implantation via an IVC filter without acute procedural or delayed clinical complications. [ABSTRACT FROM AUTHOR]

Background: The perioperative anesthesia care during subcutaneous implantable cardioverter‐defibrillator (S‐ICD) implantation is still evolving. Objective: To assess the feasibility and safety of S‐ICD implantation with monitored anesthesia care (MAC) versus general anesthesia (GA) in a tertiary care center. Methods: This is a single‐center retrospective study of patients undergoing S‐ICD implantation between October 2012 and May 2019. Patients were categorized into MAC and GA group based on the mode of anesthesia. Procedural success without escalation to GA was the primary endpoint of the study, whereas intraprocedural hemodynamics, need of pharmacological support for hypotension and bradycardia, length of the procedure, stay in the post‐anesthesia care unit, and postoperative pain were assessed as secondary endpoints. Results: The study comprises 287 patients with MAC in 111 and GA in 176 patients. Compared to MAC, patients in GA group were younger and had a higher body mass index. All patients had successful S‐ICD implantation. Only one patient (0.9%) in the MAC group was converted to GA. Despite a similar baseline heart rate (HR) and mean arterial blood pressure (MAP) in both groups, patients with GA had significantly lower HR and MAP during the procedure and more frequently required pharmacological hemodynamic support. Length of the procedure, stay in the postanesthesia care unit, and postoperative pain was similar in both groups. Conclusion: This retrospective experience suggests that implantation of S‐ICD is feasible and safe with MAC. Use of GA is associated with more frequent administration of hemodynamic drugs during S‐ICD implantation. [ABSTRACT FROM AUTHOR]

Processing huge repository of medical literature for extracting relevant and high-quality evidences demands efficient evidence support methods. We aim at developing methods to automate the process of finding quality evidences from a plethora of literature documents and grade them according to the context (local condition). We propose a two-level methodology for quality recognition and grading of evidences. First, quality is recognized using quality recognition model; second, context-aware grading of evidences is accomplished. Using 10-fold cross-validation, the proposed quality recognition model achieved an accuracy of 92.14 percent and improved the baseline system accuracy by about 24 percent. The proposed context-aware grading method graded 808 out of 1354 test evidences as highly beneficial for treatment purpose. This infers that around 60 percent evidences shall be given more importance as compared to the other 40 percent evidences. The inclusion of context in recommendation of evidence makes the process of evidence-based decision-making "situation-aware." [ABSTRACT FROM AUTHOR]

Burnout is a state of vital exhaustion lasted as a disorder and affects many including teachers. The rapidly increasing workload is among the key factors responsible for burnout in teachers. This study was aimed to explore the relationship of the workload with burnout among the college teachers of Pakistan. All the working teachers in public colleges of Pakistan were the population of this study while 200 teachers were conveniently selected as the population of the study. We used the Maslach Burnout Inventory to identify burnout in teachers and developed a simple questionnaire to measure workload in teachers with items measured on a 7-point Likert scale. The design of the quantitative phase of the study was correlational and results revealed a positive relationship of the workload with a burnout in teachers. Semi-structured interviews were used as a qualitative tool for data triangulation the results of qualitative data analysis supported the results of descriptive statistics. The writers suggest that certain workload standards should be established for teachers so that they do not reach the threshold of burnout and maintain optimal proficiency. [ABSTRACT FROM AUTHOR]

Peste des petits ruminants (PPR) is a highly contagious viral disease of domestic and wild small ruminants and thus has serious socioeconomic implications. In Pakistan, during the year 2012-2013, estimated losses due to PPR were worth Rs. 31.51 billions. Close contact between infected and susceptible animals is an important route of transmission of PPR. Therefore, carrier animals play an important role in unnoticed transmission of PPR. The objective of the study was to investigate the detection of PPR virus in goats recovered from PPR. A suspected PPR outbreak was investigated and confirmed as PPR after analysing appropriate samples collected from infected animals using rRT-PCR. A longitudinal study was conducted over the period of 16 weeks to ascertain the detection of PPR virus (PPRV) in faecal samples of recovered goats. Ninety-six (96) faecal samples from each sampling were collected at 4, 8, 12, and 16 weeks after the outbreak. Faecal samples were analysed using rRT-PCR. Of 96 from each sampling a total of 46, 37, 29, and 25 samples were positive for PPR viral genome at 4, 8, 12, and 16 weeks, respectively, after recovery. Attempts were made for the isolation of PPR virus on Vero cells, but results were negative. These results indicated the detection of PPR viral RNA up to 16 weeks after infection. Therefore, these results may help in the future epidemiology of PPR virus shedding and possible role as source of silent infection for healthy animals especially when there is no history of any outbreak in nearby flock or area. [ABSTRACT FROM AUTHOR]

Background Recent studies have suggested that prolonged outpatient rhythm monitoring results in increased detection of atrial fibrillation (AF) in patients with cryptogenic stroke (CS). However, the best monitoring strategy and its clinical utility is debatable. Objective To compare the effectiveness of implantable loop recorder (ILR) versus wearable devices in identifying AF in patients with CS. Methods and Results Three randomized controlled trials (RCTs) and 13 observational studies were identified by database searches. Seven studies (enrolling 774 patients) employed ILR for AF detection for a median duration of 365 days (range 50-569 days). Ten studies (enrolling 996 patients) employed continuous monitoring with wearable devices for a median duration of 21 days (range 4-30 days). One study performed 7 days of monitoring with wearable device followed by implantation of ILR, thus included in both groups. Pooled odds ratio (OR) of identifying AF in RCTs showed increased detection of AF with prolonged monitoring (OR 4.54, 95% confidence interval [CI] 2.92, 7.06; P < 0.00001) compared to routine outpatient follow-up. Overall detection of AF with outpatient monitoring was 17.6% (CI: 12.5-22.7). There was significantly higher AF detection with ILR (23.3%; CI: 13.83-32.29) compared to wearable devices (13.6%; CI: 7.91-19.32; P < 0.05). Patients with AF were older in age compared to patients without AF. Conclusion AF detection in patients with CS is improved with prolonged rhythm monitoring and is better with ILR compared to wearable devices. AF was more common in older patients. The clinical significance of these findings is unknown at this point. [ABSTRACT FROM AUTHOR]

Background Radiation exposure in the electrophysiology lab is a major occupational hazard to the electrophysiologists. A catheter localization system (MediGuide Technology, St. Jude Medical Inc., St. Paul, MN, USA) allows the integration of electroanatomical mapping and x-ray imaging, and has been shown to be effective in reducing radiation exposure during several electrophysiological procedures. We intended to evaluate the feasibility of this catheter tracking system to guide transseptal (TS) access. Methods The feasibility of performing TS puncture with MediGuide (MDG) was assessed in a prospective observational study in 16 patients undergoing radiofrequency ablation for atrial fibrillation. These patients were compared to 16 matched patients undergoing similar procedures during the same time frame using conventional approach. There were no differences in mean age, gender distribution, and body mass index between the two groups. Total duration of fluoroscopic exposure during TS puncture was compared between the two groups. Results All patients underwent successful TS puncture. Fluoroscopy time for double TS puncture using the MDG system was significantly lower than the control group (0.48 ± 0.17 minutes vs. 5.9 ± 0.65 minutes; P < 0.0001). No major complications occurred during the procedures in either group. Conclusions TS puncture can be successfully performed using MDG, and results in significant reduction in radiation exposure. [ABSTRACT FROM AUTHOR]

Pleural Effusions After the Lariat Procedure Background The Lariat procedure is increasingly used for the exclusion of the left atrial appendage (LAA) in atrial fibrillation (AF) patients. There are anecdotal reports of pleural effusions after the Lariat procedure. However, the incidence, demographics, and pathophysiology of these effusions are largely unknown. Objective Characterization of pleural effusions in patients who underwent LAA exclusion using the Lariat procedure. Methods We report the incidence, demographics, and clinical and laboratory characteristics of patients from a multicenter prospective registry who underwent the Lariat procedure and subsequently developed pleural effusions. Results A total of 10 out of 310 (3.2%) patients developed significant pleural effusions after the Lariat procedure. The mean age of these patients was 67 ± 9, ranging from 52 to 78 years and included 5 (50%) males. Nine patients had persistent AF with median CHADS2 score of 2.7 ± 1.2. The LAA was successfully ligated in all these patients. Post-Lariat procedure, 6 patients developed bilateral and 4 patients developed left-sided pleural effusions. Pleural tap revealed transudative in 2 and exudative in 6 patients. The remaining 2 patients responded to active diuresis and behaved clinically like transudative effusions. There is a statistically significant difference between the onset of pleural effusion after the Lariat procedure between tPLE versus ePLE groups (14 ± 1.2 vs. 6 ± 6, P = 0.05). Conclusion Incidence of clinically significant pleural effusion is uncommon after the Lariat procedure and can be either exudative or transudative in nature depending on the underlying mechanisms. More prospective studies are needed to study the pathophysiologic basis of development of pleural effusions after the Lariat procedure. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance In the study area, the traditional knowledge and cultural practices of utilizing medicinal plants in the human healthcare is primarily restricted to the old age members of the community, while younger generation is mostly unaware of the natural wealth usage. Aim of the study We provide the first ever ethno medicinal insights into the management of dental disorders in Pakistan. The prime objective of the study was to explore novel knowledge of these local and remote community members and share it with rest of the world in documented form. Materials and methods Field surveys were arranged for collection and documentation of medicinal plants of Manoor valley during 2015. Total 71 local inhabitants were interviewed randomly through questionnaire. The data obtained were quantitatively analyzed using the use value (UVi), relative frequency citations (RFCs), fidelity level index (FL%) and consensus index (CI%). For novel uses all plants were thoroughly checked with previously published articles on the same disorder and analyzed through Jaccard index (JI) and Sorensen's similarity index (QS). The collected specimens after confirmation were submitted to the Herbarium, Department of Botany, Hazara University, Mansehra, Pakistan (HUP). Results In present study 25 plants belonging to 17 families are reported, these plants were used commonly as ethno medicine. There were herbs (64%), shrubs (20%) and trees (16%) whereas, Lamiaceae with 4 species was the leading family. Majority of medicinal plant species were used in treatment of toothache (38%), wound healing (19%), gum infections (16%) whereas and lowest percentage of species were used for mouth ulcer as well as teeth powder (3%). Leaves were the most widely part used plant part in the treatment of different diseases (36%). Dominated medicinal plants with high used values were Juglans regia (UVi=0.94), Rumex dentatus (0.89) and Indigofera heterantha (0.88). Based on the RFC values, the most valuable and cited medicinal plant species used by the traditional drivers are Juglans regia having (RFCs=0.69) and Rumex dentatus (0.58). CI results show that most respondents percentage was for Juglans regia having CI%=69%, followed by Rumex dentatus (57.7%). Medicinal plants with high fidelity level and reported for one dental disorder were Berberis lycium, Geranium wallichianum, Lathyrus aphaca, Platanus orientalis, Sedum spp. and Urtica dioica for toothache. Further, new medicinal uses of Abies pindrow, Ajuga integrifolia, Berberis lycium, Urtica dioica , Indigofera heterantha were recorded for the first time from Pakistan and Astragalus grahamianus , Corydalis cornuta, Prunella vulgaris, Ranunculus muricatus, Rumex hastatus, Stellaria media, Tagetes minuta, Taraxacum officinale and Lathyrus aphaca, across the world for the current reported medicinal uses. All mentioned plant species are reported for the first time ever for dental disorders from Manoor Valley. Nonetheless, this is a novel study as no single ethno medicinal study on dental disorder up-till now has been reported from Pakistan. Conclusion The present study is the first ever documentation of ethno medicinal practices aiming at the dental disorders in Pakistan, which resulted in 64% of medicinal uses new claims. So, the reported species of remote valley should be further evaluated for proper experimentation and pharmacological activities to authenticate their current traditional usage. Field observation revealed vegetation of the area was generally threatened due to its unwise use by the local communities. Trends like deforestation, over grazing, habitat fragmentation and introduction of the exotic taxa were the visible threats. So conservation of such an important natural God gifted treasure is mandatory. [ABSTRACT FROM AUTHOR]

• In this article we have provided, allelic data for 22 autosomal STRs, their frequencies, and the forensic statistical parameters of 601 unrelated healthy individuals from Pakhtuns, Balochi and Balti population of Pakistan. • The most discriminatory locus was Penta E in all groups and allele 15 was most frequent at D22S1045 in Balti whereas allele 8 was common at TPOX in others. • Furthermore, the population differentiation and phylogenetic relationship among Pakistani samples and other nationalities were analysed. In this study we have provided forensic genetic data of 22 autosomal STRs for Pakhtun, Balochi and Balti population of Pakistan in total of 601 samples. Among these loci, Penta E was found the most discriminatory in all groups and allele 15 was observed most frequent at D22S1045 in Balti whereas in other two populations allele 8 was more common at TPOX. The combined power of discrimination, combined power of exclusion and the combined matching probability was calculated as 0.999999999999999999999999998385, 0.999999988089728 and 1.615 × 10-27 respectively. Based on population differentiation test, significant differences were observed when compared with other populations however, phylogenetic analysis revealed close genetic associations among Pakistani Populations. [ABSTRACT FROM AUTHOR]