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Abstract Introduction People with Xeroderma Pigmentosum (XP) have a heightened sensitivity to ultraviolet radiation (UVR) and are advised to wear photoprotective clothing including a visor covering the face and neck. Photoprotective visors are homemade and predominately worn by children with decreasing frequency as age increases. To improve upon the current design and efficacy we were tasked with developing a prototype visor to meet patients’ needs. Methods Adopting a codesign methodology, patients’ experiences of wearing a visor and patient and carer views of emerging prototypes were explored during interviews. A thematic analysis was conducted in parallel with data collection and themes were interpreted into design cues; desirable attributes of a visor that would counteract the negative user experiences and meet the requirements described by patients and carers. The design cues guided the iterative development of prototypes by academic engineers. Results Twenty-four interviews were conducted with patients and carers. Thematic analysis resulted in the following five themes: Being safe from UVR exposure; self-consciousness; temperature effects; acoustic difficulties; and material properties. The following design cues were developed from the themes respectively; materials and design with high UVR protection; ability to customise with own headwear; ventilation to reduce steaming up; acoustic functionality to enable hearing and speech; foldable, portable, and easy to put on and take off. Conclusions It is important to understand people’s experiences of using medical devices to improve their safety, efficiency and user satisfaction. The user experience themes and design cues, informed the iterative development of low fidelity visor prototypes as part of a codesign process. These design cues and responses to the prototypes are guiding commercial manufacturing and regulatory approval. The visor can then be prescribed to patients, providing an equitable service of care.

Background: Traumatic abdominal wall hernias (TAWH) are uncommon injuries classically associated with high-energy blunt traumatic mechanisms. Motor vehicle collisions cause the highest proportion of all TAWH. Literature is currently limited, with some debate existing over surgical management strategies. Case presentation: A 67-year-old man presented after falling from a short step stool while landscaping his yard. On exam, an exquisitely tender lateral flank mass was present with peristaltic movement. CT imaging revealed a TAWH with incarcerated large and small bowel. He was taken to the OR for exploratory laparotomy and mesh hernia repair. The patient was discharged on the third postoperative day with no untoward complications. Discussion: This patient’s mechanism and injury pattern are together a rare combination. Exam findings and radiologic technologies are used to hone the clinical index of suspicion for TAWH. Traumatic abdominal wall defects can have unusual anatomic borders, not always obeying well-known hernia patterns. In this case, the potential space for visceral herniation was created by an 11th rib fracture with associated avulsion of the oblique musculature. Operative approach can be open or laparoscopic, however concomitant injuries directly influence surgical management. Evidence for mesh versus primary repair for TAWH is conflicted by the current literature. Conclusions: Nearly any amount of blunt abdominal force can cause TAWH. For wall defects with bowel herniation caused directly by trauma, the safest approach may involve exploratory laparotomy. Future multi-center studies may be able to distinguish TAWH repair strategies based on herniation through old defects versus newly-created abdominal wall injuries.

Noise pollution refers to the excessive and unnecessary intensity of sound that can pose harmful or dangerous effects on humans and the surrounding ecosystem. Unfortunately, the occurrence of noise pollution is worsening because of ongoing country development. Construction sites have emerged as significant contributors to noise pollution in urban areas, as the continuous development and construction projects necessitate high levels of noise. This research conducts a study on Sindh construction projects because the government of Sindh is involved in constructing mega projects. The presence of noise pollution at construction sites poses a significant health risk to individuals involved in construction projects and those who spend extended periods of time at these sites. Therefore, the primary goals of this study are to identify the factors contributing to noise pollution at construction sites and examine the impact of this noise on various parties such as engineers, contractors, and others. Additionally, this study aims to propose solutions to mitigate and reduce noise pollution at construction sites to minimize its negative effects. This study designs the questionnaire survey form and collects the data from 94 respondents working in Sindh construction sectors to identify the most significant factors that impact and solution for minimizing noise pollution on construction sites. The received data were analyzed through average index technique to achieve the results. Based on results the significant factors impact on construction site was operating of heavy machineries that effect on construction workers and surrounding residences during sleeping disturbance. This study suggested that construction stakeholders should take necessary precautions to reduce noise pollution.

The paper evaluates the performance of the Takaful and insurance companies in Malaysia. It examines the impact of ownership, business model, and market structure on conventional and Takaful companies’ performance. The inter-firm comparisons provide information about the performance and competitiveness of firms operating under different modes of business. The study adopts the unbalanced panel data approach with Panel Corrected Standard Error (PCSE) regression to analyse the data of 44 Malaysian Takaful and insurance companies with 255 firm observations over the period from 2011 to 2016. The study’s findings show that Takaful and insurance companies perform at par in terms of their premiums. However, Takaful has better investment income. Foreign-owned firms perform better than local firms. The efficient market hypothesis is more powerful than the structural conduct hypothesis in explaining the firms’ performance. The study’s implications are expected to help improve and develop the Takaful and insurance sector as an efficient industry in-line with regulation changes. To the best of our knowledge, this paper is the first to compare the Takaful with conventional insurance in Malaysia concerning their performance, market structure, and ownership.

Plantar fasciitis (PF) is one of the most common musculoskeletal complain of the foot affecting a huge population. However there is a scarcity of evidence regarding treatment efficacy, therefore this trial aimed to compare the efficacy of Kinesiotaping (KT) vs. Ultrasound Therapy (UT) in the management of pain and physical functioning of foot/ankle in patients with PF. Methodology: Two arms, parallel-group design RCT was conducted on PF patients. Participants aged between 25-60 years, having symptoms of PF for at least 6 months, presenting with unilat-eral and/or bilateral heel pain were included. However, patients with fractures, dislocations, or open wounds around ankle/soles and patients allergic to taping were excluded. 30 patients were randomly divided into group A (KTG=15): received KT and group B (UTG=15): received Ultra-sound Therapy (UT). Both the groups also received cold pack with stretching exercises. Treat-ment was provided on an alternate days for 30 minutes to each group for two weeks. Visual An-alogue Scale (VAS) was used to determine pain and Foot/Ankle disability index (FADI) was used to assess foot and ankle functioning. Readings were taken pre and post intervention. Results and discussion: The mean pain score before treatment was 8.00 but after treatment was reduced to 1.13, in KTG. However, in UTG mean pain score before treatment was 9.13 and after treatment reduced to 4.20. The mean FADI score before treatment was 52.80 but after treatment decreased to 11.46 in KTG. However, in UTG the mean score of FADI before treatment was 58.53 and after treatment, it was decreased to 39.46. Conclusion: The results concluded that KT and UT both are effective techniques for reducing pa-in and improving ankle/foot physical functioning in patients with PF. However, KT was found to be more effective than UT.

BACKGROUND:Antimicrobial resistance (AMR) has become an emerging issue in the developing countries as well as in Bangladesh. AMR is aggravated by irrational use of antimicrobials in a largely unregulated pluralistic health system. This review presents a 'snap shot' of the current situation including existing policies and practices to address AMR, and the challenges and barriers associated with their implementation. METHODS:A systematic approach was adopted for identifying, screening, and selecting relevant literature on AMR situation in Bangladesh. We used Google Scholar, Pubmed, and Biomed Central databases for searching peer-reviewed literature in human, animal and environment sectors during January 2010-August 2019, and Google for grey materials from the institutional and journal websites. Two members of the study team independently reviewed these documents for inclusion in the analysis. We used a 'mixed studies review' method for synthesizing evidences from different studies. RESULT:Of the final 47 articles, 35 were primary research, nine laboratory-based research, two review papers and one situation analysis report. Nineteen articles on human health dealt with prescribing and/or use of antimicrobials, five on self-medication, two on non-compliance of dosage, and 10 on the sensitivity and resistance patterns of antibiotics. Four papers focused on the use of antimicrobials in food animals and seven on environmental contamination. Findings reveal widespread availability of antimicrobials without prescription in the country including rise in its irrational use across sectors and consequent contamination of environment and spread of resistance. The development and transmission of AMR is deep-rooted in various supply and demand side factors. Implementation of existing policies and strategies remains a challenge due to poor awareness, inadequate resources and absence of national surveillance. CONCLUSION:AMR is a multi-dimensional problem involving different sectors, disciplines and stakeholders requiring a One Health comprehensive approach for containment.

Introduction: Traumatic intracranial hemorrhages (ICHs) are high priority injuries. Traumatic brain bleeds can be categorized as traumatic subarachnoid hemorrhage (SAH) versus non-SAH-ICH. Non-SAH-ICH includes subdural, epidural, and intraventricular hematomas and brain contusions. We hypothesize that awake patients with SAH will have lower mortality and needless interventions than awake patients with non-SAH-ICHs. Study Design and Methods: A review of data collected from our Level I trauma center was conducted. Awake was defined as an initial Glasgow coma score (GCS) 13–15. Patients were divided into two cohorts: awake SAH and awake non-SAH-ICH. Chi-square and t-test analyses were used with statistical significance defined as P < 0.05. Results: A total of 12,482 trauma patients were admitted during the study period, of which 225 had a SAH and GCS of 13–15 while 826 had a non-SAH-ICH with a GCS of 13–15. There was no significant difference in demographics between the two groups. Predicted survival between the two groups was similar (97.3 vs. 95.7%,P > 0.05). Mortality rates were, however, significantly lower in SAH patients compared to the non-SAH-ICH (4/225 [1.78%] vs. 22/826 [2.66%], P < 0.05). The need for neurosurgical intervention was significantly different comparing the SAH group versus non-SAH-ICH (2/225 [0.89%] vs. 100/826 [12.1%], P < 0.05). Conclusion: Despite similar predicted mortality rates, awake patients with a SAH are associated with a significantly lower risk of death and need for neurosurgical intervention when compared to other types of awake patients with a traumatic brain bleed.

Aim: To evaluate the factors that motivate and discourage medical and nonmedical students from donating blood voluntarily and to assess the level of awareness and knowledge regarding blood donation. Materials and Methods: We conducted a cross-sectional descriptive study from August 2011 to May 2012 across different universities of Karachi covering both private and public sector. Predesigned questionnaires were filled by students. A total of 690 students participated in the study, 345 from each. Data collected was analyzed using SPSS Version 17.0. Simple frequencies and percentages were calculated, and Pearson Chi-square and Fisher's exact tests were applied to calculate association between different variables with P value set as significant when

The paper investigates whether there is a significance difference between the practices of discretionary loan/finance loss provisions between Islamic and conventional banks. Same time, the paper tests whether the efficiency may influence the behaviour of discretionary loans/finance loss provisions, taken into consideration other micro and macro variables. The study utilizes panel data runs over 1996–2011 with unbalanced observations for 16 banks, of which 4 Islamic banks. In order to achieve research objectives, the two-stage approach is adopted to examine the factors that may influence the behaviour of discretionary loan/finance loss provisions with specific emphasize on the efficiency. Furthermore, efficiency scores are estimated using Data Envelopment Windows Analysis. The findings of the research show that Islamic banks employ the discretionary loans/finance loss provisions to manage their earnings. However, the magnitude of discretion of accruals is significantly lower than conventional banks with exception for foreign banks which have reported lower discretionary loans/finance loss provisions than Islamic banks. Moreover, the analysis showed that efficiency affects the overall discretionary loans/finance loss provision positively, although this impact is shaped differently for Islamic and conventional banks.

OBJECTIVE: to identify the socio-demographic factors and their association with health care awareness and practices of foot care among diabetic patients visiting the diabetic clinics of Jinnah postgraduate medical center (JPMC) and Civil Hospital, Karachi. METHODOLOGY: This observational descriptive study was conducted at diabetic clinics of JPMC and civil hospital Karachi, from June to October, 2012 on a nonprobability convenience sample of 786 diabetics. The mean of the knowledge and practice scores of the individuals, categorized in respective age groups, gender and socioeconomic status, based on monthly income and education, were analyzed. RESULT: Out of 786 diabetic patients, 356(45.3%) were females and 430(54.7%) were males; 395 (50.3%) had no primary education while 480 (61.1%) patients had low monthly income. There were 466 (59.3%) patients who were unaware of the fact that smoking causes poor circulation of the feet and 357 (45.4%) patients were unaware about the temperature of water they should use to wash their feet in. Two hundred & forty two (30.8%) patients did not use warm water to wash their feet and 632 (80.4%) did not receive any health educational counseling about the type of footwear they should purchase and wear. However, 688 (87.5%) washed and 510 (64.9%) inspected their feet regularly. Poor education and low socio economic status were significantly associated with the lower awareness and practice scores. CONCLUSION: Majority of the diabetics were not following the proper guidelines recommended by diabetic foot care counsels, especially those who were lacking education and of a low socioeconomic status.

ABSTRACT: Objective: To describe a case of hypertensive emergency following embolization of a large myelolipoma.Methods: Using the case report format to present clinical, laboratory, imaging, and dynamic testing data supporting clinical decision making. This is accompanied by a literature review.Results: A 40-year-old male with a history of hypertension presented with acute right upper abdominal pain and shortness of breath. Imaging completed at the transferring facility revealed a large right adrenal mass encapsulating the inferior vena cava. The blood hemoglobin was 7.8 g/dL because of internal hemorrhage into the mass. He underwent embolization of arterial flow to the right adrenal mass. A hypertensive emergency developed, and endocrinology was consulted to evaluate for pheochromocytoma. The plasma and urine normetanephrine were elevated, but the corresponding metanephrines remained normal. Surgery was imminent, and a clonidine suppression test in the surgical intensive care unit resulted in 60% suppression of plasma norepinephrine concentrations. He was cleared for surgery. The pathologic findings confirmed giant myelolipoma with internal hemorrhage.Conclusion: A giant myelolipoma with compressive effects can mimic a pheochromocytoma. To support clinical decision making for short-notice surgical clearance, the clonidine suppression test proved to be a simple supplementary test to differentiate pheochromocytoma and hyperadrenergic state of critical illness.Abbreviations: BP blood pressure CT computed tomography HPLC high-performance liquid chromatography HU Hounsfield units IVC inferior vena cava

In this work we bring together replicating rapid prototyping technology with electrohydrodynamic phenomena to develop a device with the ability to build structures in three-dimensions while simultaneously affording the user a degree of designing versatility and ease that is not seen in conventional computer numerically controlled machines. An attempt at reproducing an actual human ear using polycaprolactone was pursued to validate the hardware. Five different polycaprolactone solution concentrations between 7-15 wt% were used and printing was performed at applied voltages that ranged from 1 to 6 kV and at flow rates from 5 µl/min to 60 µl/min. The corresponding geometrical and aesthetic features of the printed constructs were studied to determine the effectiveness of the device. The 15 wt% concentration at 60 µl/min under an applied electric field of 6 kV was identified as the best operating parameters to work with.

Background: Treatment of large vessel occlusion (LVO) using mechanical thrombectomy with or without intravenous thrombolysis has demonstrated better outcomes compared to medical treatment alone. Large-bore aspiration catheters have been recently introduced. Their effectiveness and safety have not been demonstrated in a randomized trial. The SUMMIT MAX study is designed to address this question., Methods: SUMMIT MAX is a randomized controlled trial where the effectiveness and safety of the large-bore Monopoint Reperfusion system (Route 92 Medical, San Mateo, CA), will be compared to the currently largest available FDA-cleared aspiration thrombectomy device the AXS Vecta Aspiration system (Stryker Neurovascular, Fremont, CA). The study is a multi-center, prospective, randomized, controlled, interventional, open label clinical trial. The hypothesis is that the effectiveness measured by the recanalization rate (modified thrombolysis in cerebrovascular infarction - mTICI) and safety measured by symptomatic intracranial hemorrhage rate (sICH) of the medical monopoint reperfusion system is non-inferior to the AXS Vecta Aspiration system., Results: Up to 250 subjects are enrolled with at least 50% of subjects enrolled by US sites. The primary effectiveness endpoint is successful arterial revascularization defined as an mTICI score ≥ 2b after use of the assigned device adjudicated by an independent core lab. The primary safety endpoint is defined as sICH within 24 h (-8/+24) post-procedure. Secondary endpoints include successful arterial revascularization defined as a mTICI score ≥ 2b after use of the assigned device with or without adjunctive therapy; device-related serious adverse events; all asymptomatic hemorrhages; time from groin puncture to final angiogram; and rate of first pass effect defined as mTICI 2b after first pass with the assigned device stratified by age (≤85, ≥ 86)., Conclusion: SUMMIT MAX is a randomized controlled trial comparing the effectiveness and safety of a new large bore class of aspiration devices to the currently largest FDA-cleared aspiration device available.

Introduction: Thrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes., Patients and Methods: In this multicenter retrospective cohort study, consecutive patients with vessel perforation during thrombectomy between January 2015 and April 2023 were included. Vessel perforation was defined as active extravasation on digital subtraction angiography. The primary outcome was modified Rankin Scale (mRS) at 90 days. Factors associated with the primary outcome were assessed using proportional odds models., Results: 459 patients with vessel perforation were included (mean age 72.5 ± 13.6 years, 59% female, 41% received thrombolysis). Mortality at 90 days was 51.9% and 16.3% of patients reached mRS 0-2 at 90 days. Thrombolysis was not associated with worse outcome at 90 days. Perforation of a large vessel (LV) as opposed to medium/distal vessel perforation was independently associated with worse outcome at 90 days (aOR 1.709, p  = 0.04) and LV perforation was associated with poorer survival probability (HR 1.389, p  = 0.021). Patients with active bleeding >20 min had worse survival probability, too (HR 1.797, p  = 0.009). Thrombolysis was not associated with longer bleeding duration. Bleeding cessation was achieved faster by permanent vessel occlusion compared to temporary measures (median difference: 4 min, p  < 0.001)., Discussion and Conclusion: Vessel perforation during thrombectomy is a severe and frequently fatal complication. This study does not suggest that thrombolysis significantly attributes to worse prognosis. Prompt cessation of active bleeding within 20 min is critical, emphasizing the need for interventionalists to be trained in complication management., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: V. S.-Z. discloses speaker fees from Medtronic Inc. (money paid to institution). M.R.L. discloses unrestricted educational grants from Medtronic and Stryker; consulting for Medtronic, Stereotaxis, Metis Innovative and Aeaean Advisers; equity interest in Proprio, Fluid Biomed, Stroke Diagnostics, Hyperion Surgical, Apertur; editorial board of Journal of NeuroInterventional Surgery; data safety monitoring board of Arsenal Medical. M.-N.P. discloses unrestricted grants from Swiss National Science Foundation (SNF), Bangerter-Rhyner Stiftung, Stryker Neurovascular Inc., Phenox GmbH, Medtronic Inc., Rapid Medical Inc., and Penumbra Inc for the DISTAL trial, grant for SPINNERS trial from Siemens Healthineers AG (money paid to institution) and the following speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Rapid Medical Inc. and Siemens Healthineers AG (money paid to institution).

Objective: Decision for intervention in acute subdural hematoma patients is based on a combination of clinical and radiographic factors. Age has been suggested as a factor to be strongly considered when interpreting midline shift (MLS) and hematoma volume data for assessing critical clinical severity during operative intervention decisions for acute subdural hematoma patients. The objective of this study was to demonstrate the use of an automated volumetric analysis tool to measure hematoma volume and MLS and quantify their relationship with age., Methods: A total of 1789 acute subdural hematoma patients were analyzed using qER-Quant software (Qure.ai, Mumbai, India) for MLS and hematoma volume measurements. Univariable and multivariable regressions analyzed association between MLS, hematoma volume, age, and MLS:hematoma volume ratio., Results: In comparison to young patients (≤ 70 years), old patients (>70 years) had significantly higher average hematoma volume (old: 62.2 mL vs. young 46.8 mL, P < 0.0001), lower average MLS (old: 6.6 mm vs. young: 7.4 mm, P = 0.025), and lower average MLS:hematoma volume ratio (old: 0.11 mm/mL vs. young 0.15 mm/mL, P < 0.0001). Young patients had an average of 1.5 mm greater MLS for a given hematoma volume in comparison to old patients. With increasing age, the ratio between MLS and hematoma volume significantly decreases (P = 0.0002)., Conclusions: Commercially available, automated, artificial intelligence (AI)-based tools may be used for obtaining quantitative radiographic measurement data in patients with acute subdural hematoma. Our quantitative results are consistent with the qualitative relationship previously established between age, hematoma volume, and MLS, which supports the validity of using AI-based tools for acute subdural hematoma volume estimation., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective Identifying ischemic stroke is a diagnostic challenge in the trauma subpopulation. We describe our early experience with artificial intelligence-assisted image analysis software for automatically identifying acute ischemic stroke in trauma patients.  Methods Patients were retrospectively screened for (i) admission to the trauma service at a level one trauma center between 2020 and 2022, (ii) radiologist-confirmed intracranial occlusion, (iii) occlusion identified on computed tomography angiography performed within 24 hours of admission, (iv) no intracranial hemorrhage, and (v) contemporaneous analysis with the large vessel occlusion (LVO) detection program. Baseline characteristics, stroke detection, response-activation, and outcome data were summarized.  Results Of 9893 trauma patients admitted, 88 (0.89%) patients had a cerebral stroke diagnosis, of which 10 patients (10/88; 11.4%) met inclusion criteria. Most patients were admitted following a fall (8/10; 80%). Six (6/10; 60.0%) patients had LVOs. The program correctly detected 83.3% (5/6) of patients, and these patients were triaged in less than one hour from arrival on average. The program did not falsely identify non-LVOs as LVOs for any patients. Conclusions Identifying adjunct tools to aid timely identification and treatment of ischemic stroke in trauma patients is necessary to increase the chances for meaningful neurological recovery. Our early experience exhibited potential for using automated software to aid occlusion identification and subsequent stroke team mobilization. Future studies in larger cohorts will expand upon these preliminary findings to establish the accuracy and clinical benefit of automated stroke detection tool integration for the trauma population., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2024, Koneru et al.)

Background and Importance: Neurointervention is a very competitive specialty in the United States due to the limited number of training spots and the larger pool of applicants. The training standards are continuously updated to ensure solid training experiences. Factors affecting candidate(s) selection have not been fully established yet. Our study aims to investigate the factors influencing the selection process., Methods: A 52-question survey was distributed to 93 program directors (PDs). The survey consisted of six categories: (a) Program characteristics, (b) Candidate demographics, (c) Educational credentials, (d) Personal traits, (e) Research and extracurricular activities, and (f) Overall final set of characteristics. The response rate was 59.1%. As per the programs' characteristics, neurosurgery was the most involved specialty in running the training programs (69%). Regarding demographics, the need for visa sponsorship held the greatest prominence with a mean score of 5.9 [standard deviation (SD) 2.9]. For the educational credentials, being a graduate from a neurosurgical residency and the institution where the candidate's residency training is/was scored the highest [5.4 (SD = 2.9), 5.4 (SD = 2.5), respectively]. Regarding the personal traits, assessment by faculty members achieved the highest score [8.9 (SD = 1)]. In terms of research/extracurricular activities, fluency in English had the highest score [7.2 (SD = 1.9)] followed by peer-reviewed/PubMed-indexed publications [6.4 (SD = 2.2)]., Conclusion: Our survey investigated the factors influencing the final decision when choosing the future neurointerventional trainee, including demographic, educational, research, and extracurricular activities, which might serve as valuable guidance for both applicants and programs to refine the selection process., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: We report the largest multicenter experience to date of utilizing the Comaneci device for endovascular treatment of refractory intracranial vasospasm., Methods: Consecutive patients undergoing Comaneci mechanical dilatation for vasospasm were extracted from prospectively maintained registries in 11 North American centers (2020-2022). Intra-arterial vasodilators (IAV) were allowed, with the Comaneci device utilized after absence of vessel dilation post-infusion. Pre- and post-vasospasm treatment scores were recorded for each segment, with primary radiological outcome of score improvement post-treatment. Primary clinical outcome was safety/device-related complications, with secondary endpoints of functional outcomes at last follow-up., Results: A total of 129 vessels in 40 patients (median age 52 years; 67.5% females) received mechanical dilation, 109 of which (84.5%) exhibited pre-treatment severe-to-critical vasospasm (ie, score 3/4). Aneurysmal subarachnoid hemorrhage was the most common etiology of vasospasm (85%), with 65% of procedures utilizing Comaneci-17 (92.5% of patients received IAV). The most treated segments were anterior cerebral artery (34.9%) and middle cerebral artery (31%). Significant vasospasm drop (pre-treatment score (3-4) to post-treatment (0-2)) was achieved in 89.9% of vessels (96.1% of vessels experienced ≥1-point drop in score post-treatment). There were no major procedural/post-procedural device-related complications. Primary failure (ie, vessel unresponsive) was encountered in one vessel (1 patient) (1/129; 0.8%) while secondary failure (ie, recurrence in previously treated segment requiring retreatment in another procedure) occurred in 16 vessels (7 patients) (16/129; 12.4%), with median time-to-retreatment of 2 days. Favorable clinical outcome (modified Rankin Scale 0-2) was noted in 51.5% of patients (median follow-up 6 months)., Conclusions: The Comaneci device provides a complementary strategy for treatment of refractory vasospasm with reasonable efficacy/favorable safety. Future prospective trials are warranted., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Neonatal HNT in the pharynx is a rare cause of respiratory distress and poor feeding in the newborn, but must be differentiated from teratoma, encephalocele, and nasal glioma. While surgical resection is the preferred treatment modality, we posit there is a role for sclerosis of the glial heterotopic cyst if complete surgical excision is not possible or carries risk of high morbidity. Here, we present a case of a 7-day-old neonate presenting with acute respiratory distress found to have a nasopharyngeal/oropharyngeal mass ultimately treated with sclerotherapy at 9 months of age.

Background Tuberculosis (TB) continues to pose a serious threat to public health despite great efforts. For many years, management and screening for active TB cases have been the main focus of TB control programs. Latent TB is a stage where TB can be prevented and controlled. Therefore, designing a comprehensive TB control program that includes latent tuberculosis infection (LTBI) management diseases is needed to be implemented among the healthcare workers (HCWs) who have been found to be at a higher risk for active TB compared to the general population. The objective of the study The objective of the study is to assess the knowledge and perceptions of LTBI among HCWs. In addition to estimating the prevalence of LTBI among HCWs using closed-end questions in a self-administered questionnaire. Subjects and methods Through a cross-sectional study and non-random sampling technique, 324 (84%) healthcare workers who met the inclusion criteria completed and submitted the electronic questionnaire. Results Among all participants, the study reported a good knowledge about LTBI; however, a third of HCWs had poor knowledge about the difference between LTBI and active TB. Eighteen percent of participants were diagnosed with LTBI, and two-thirds accepted the treatment. Of all participants who started the treatment, 55% completed the treatment course. The compliance rate was high among young HCWs and physicians who had a short course of LTB treatment regimen.  Conclusion The study reported a low acceptance and completion rate of LTBI therapy among HCWs. Low knowledge about some clinical facts of LTBI, the long duration of treatment, and being the treatment optional in Saudi health institutes were all barriers to accepting and completing the treatment of LTBI. All of these factors need to be addressed to increase the compliance rate to LTBI treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Almugti et al.)

Introduction: Neonatal mortality rates in resource-limited hospitals of Sub-Saharan Africa (SSA) remain disproportionately high and are likely underestimated due to misclassification of extremely preterm births as "stillbirths" or "abortions", incomplete death registries, fear of repercussions from hospital and governmental authorities, unrecorded village deaths, and cultural beliefs surrounding the viability of premature newborns. While neonatology partnerships exist between high income countries and hospitals in SSA, efforts have largely been directed toward improving newborn survival through neonatal resuscitation training and provision of equipment to nascent neonatal intensive care units (NICUs). These measures are incomplete and fail to address the challenges which NICUs routinely face in low-resource settings. We draw on lessons learned in the development of a low-technology referral NICU in Tanzania that achieved an overall 92% survival rate among infants., Lessons Learned: Achieving high survival rates among critically ill and preterm neonates in SSA is possible without use of expensive, advanced-skill technologies like mechanical ventilators. Evidence-based protocols adapted to low-resource hospitals, mentorship of nurses and physicians, changes in hierarchal culture, improved nurse-infant staffing ratios, involvement of mothers, improved procurement of consumables and medications, and bedside diagnostics are necessary steps to achieving high survival rates. Our NICU experience indicates that low-technology solutions of thermoregulation, respiratory support via continuous positive airway pressure, feeding protocols and infection control measures can ensure that infants not only survive, but thrive., Conclusions: Neonatal mortality and survival of preterm newborns can be improved through a long-term commitment to training NICU staff, strengthening basic neonatal care practices, contextually appropriate protocols, and limited technology., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Swanson, Martinez, Shaikh, Philipo, Martinez and Mushi.)

Background: Brucellosis causes a disabling human disease and loss of animals' lives. The clinical significance of Brucella bacteremia is still unclear and Brucella identification in blood culture is suboptimal., Methods: This was a retrospective study conducted in Medina in Saudi Arabia from August 2016 to May 2019. We included cases with brucellosis symptoms and a positive culture or serological evidence for brucellosis, comparing bacteremic with non-bacteremic brucellosis cases for the rates of complications, infection relapses and brucellosis development. Also, we estimated blood culture positivity rates and the time to detect Brucella in an automatic blood culture instrument., Results: Of the total number of 147 cases, 62 (42%) had a positive blood culture for Brucella, and the blood culture instrument (BACT/ALERT 3D) detected all positive blood cultures within 3 d of incubation. We found higher rates of chronic brucellosis in bacteremia than non-bacteremia cases (OR 7.25, 95% CI 1.41 to 37.23; p=0.018). Patients aged <15 y developed a higher rate of bacteremia than those aged ≥15 yr (OR 11.93 95% CI 1.37 to 103.75; p=0.025)., Conclusion: Brucella bacteremia is an independent predictor for the development of chronic infection. Brucella bacteremia cases may need long follow-up periods and a more thorough evaluation to exclude deep-seated infection., (© The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: The use of tobacco, especially smokeless variety, is common and culturally accepted among Indian women. Hence, oral cavity cancers rank as the fourth most common cancers among Indian women., Objectives: The objectives of this study were to study factors determining compliance of women for oral cancer screening in a population-based program in Mumbai and to create awareness among women regarding ill effects of tobacco and importance of oral cancer screening., Materials and Methods: This is a community-based organized service program for awareness and screening of oral cavity cancers among women residing in low socioeconomic areas of Mumbai, India. Screening was conducted by oral visual inspection by trained primary health workers (PHWs). Univariate and multivariate logistic regression analyses were conducted to identify predictors of participation in oral cancer screening., Results: 138,383 population was surveyed, out of which 13,492 eligible women were enlisted for oral cancer screening. Among these, 12,495 were contacted and 11,895 (95.12%) women participated in a cancer awareness program and 11,768 (94.18%) participated in oral cancer screening. According to results of multivariate logistic regression analysis, women belonging to Hindu religion 94.57%, with mother tongue Marathi 94.76%, and with family history of cancer 95.84% complied significantly higher to oral cancer screening as compared to other women., Conclusion: This program has assisted in identifying predictors of compliance to oral cavity screening. Furthermore, it demonstrates that good compliance can be achieved through multiple household visits, personal invitation during camps, organizing well-planned Health Education Program, and the use of simple, low-cost visual inspection test performed by trained PHWs., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Community Medicine.)

Delayed cerebral ischemia due to vasospasm following subarachnoid hemorrhage continues to have high morbidity and mortality despite current treatments. This report highlights the use of the Comaneci (Rapid Medical, Yokneam, Israel), a device FDA approved for temporary coil embolization assistance, for the treatment of symptomatic vasospasm. Ten days post subarachnoid hemorrhage, a patient developed acute left-sided hemiparesis with angiographic vasospasm. Through a Headway 17 microcatheter, a Comaneci 17 was deployed in the right ICA terminus, M1, M2, A1, and, A2 segments resulting in improvement of angiographic vasospasm and the patient's left-sided hemiparesis. On the following day, a repeat angiogram demonstrated no recurrence of vasospasm. The patient had complete return on neurologic function by post bleed day 18 continuing to her four-week follow-up appointment. This case demonstrates the feasibility of the Comaneci device as an effective tool in the treatment of vasospasm following subarachnoid hemorrhage.

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

Introduction: The delivery of urgent ("stat") medications to hospitalized children is important for safe quality care. The goal of this study was to evaluate the effect of a set of interventions on the percentage of stat medications administered within 30 minutes of ordering., Methods: A pre-post study in 2 pediatric units (36 beds) in a private hospital in Saudi Arabia between January 2015 and September 2016. Interventions included structured communication requirements, introduction of a dedicated electronic inbox for stat medication orders sent by nurses to the pharmacy, and the use of a pink envelope for the delivery of stat medications. A multivariate logistic regression model was used to model percentage of medications administered within goal., Results: Three hundred four stat orders met inclusion criteria. The proportion of orders meeting the 30-minute goal increased from a mean of 20% to a mean of 49% after the interventions ( P < 0.001). In the final month of the study, compliance reached a peak of 67%. The mean turnaround time from ordering to the administration of the medication decreased from 59.7 to 40.7 minutes ( P < 0.001). On multivariate analysis, medication type and unit-based availability of medications were statistically significant predictors of turnaround time. The odds of compliance being achieved was 0.3 times less if the medication was not available on the unit., Conclusions: A set of interventions significantly increased the percentage of stat medications delivered within 30 minutes.

Objectives: This study aimed to describe the epidemiology of diabetes mellitus over the past two decades in Oman, particularly in terms of its prevalence and incidence. In addition, the study sought to estimate the future incidence of diabetes in Oman., Methods: Three national and three regional surveys conducted between 1991 and 2010 were analysed to obtain the age-adjusted prevalence and undiagnosed proportion of type 2 diabetes mellitus (T2DM) among Omani subjects aged ≥20 years. Diabetes mellitus registers and published studies were used to determine incidence rates of both type 1 diabetes mellitus (T1DM) and T2DM in Oman. Linear regression was used to determine trends and projections for diabetes in 2050., Results: The age-adjusted prevalence of T2DM in Oman varied from 10.4% to 21.1%, while the highest prevalence of impaired fasting glucose was found in males (35.1%). In comparison to men, higher incidence rates of T2DM were found in women (2.7 cases compared to 2.3 cases per 1,000 person-years, respectively). No significant trends were observed for the prevalence or incidence of T2DM in both genders. Undiagnosed T2DM was more common in men (range: 33-68%) than women (range: 27-53%). The results of this study show that by 2050, there will be an estimated 350,000 people with T2DM living in Oman (a 174% increase compared to estimates for 2015)., Conclusion: Health authorities need to prioritise diabetes prevention and control in order to prevent or delay long-term complications and avert a potential epidemic of diabetes in Oman.

Echis carinatus (saw-scaled viper) has been the major culprit responsible for serious envenomation casualties throughout the subcontinent. The present study describes the electrophoretic and zymographic characterization of E. carinatus venom and its effect on mammalian smooth muscle. Crude venom showed the presence of disintegrin, PLA2, C-type lectin/lectin-like components, CRISP, Serine protease, l-amino acid oxidase and very high concentrations of SVMPs. E. carinatus venom (1, 10, 30, 50, 100 μg/ml) inhibited the active tension/force of muscle contraction in a time and concentration dependent manner. The observed effects abolished when the venom was heated at 100 °C for 5 min. However, a decrease in bath temperature from 37 °C to 26 °C or an increase in CaCl2 concentration to 5 mM did not prevent the inhibition of contractile activity. The contractile response elicited by exogenous application of 50 mM KCl and 1 μM acetylcholine (ACh) was also significantly inhibited by all venom concentrations. Prior administration of commercially available polyvalent anti-venom partially neutralized and prevented the effect of E. carinatus venom whereas addition of anti-venom at t50 failed to reverse the inhibitory effect. Studies on isolated intestinal muscle indicate involvement of myotoxic and apoptotic components in E. carinatus venom for irreversible damage to muscle tissue., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Prostate gland of male reproductive system is about the size of walnut and surrounds the urethra. Most frequently encountered diseases affecting prostate are Prostatitis, Benign prostatic hyperplasia and Prostatic cancer .Our objective of study was to evaluate the spectrum and correlation of prostatic lesions with presenting complaints of patient., Methods: It was a cross-sectional study conducted in Pathology Department of Dow Medical College, Dow University of Health Sciences during the period of 1st January 2010 to December 2012. Pathology department of Dow Medical College collected specimens from both Civil Hospital and Lyari General Hospital Karachi, Pakistan. Specimens were taken through transurethral resection of prostate (TURP), simple prostatectomy and radical prostatectomy. A questionnaire was made and information including name, age, ward name of hospital, laboratory number, clinical diagnosis and symptoms were noted in it. Data was entered and analyzed through SPSS 19., Result: During the targeted months, 48 prostatic specimens were received with a mean age of 65.7 + -7.6 years. Common presenting complains were urinary retention in 23(47.9%) patients, followed by dribbling in 12(25%). Out of 48 patients, 42 have Benign Prostatic Hyperplasia and 6 have Prostatic Adenocarcinoma. Both Benign Prostatic Hyperplasia and Prostatic Adenocarcinoma were more prevalent in the age group of 60-70 years., Conclusion: Frequency of prostatic cancer is on the rise and measures should be taken for its early detection. Screening protocols and awareness programs need to be introduced. Screening programs should be focused on level of androgens and molecular pathogenesis.

Background: The Expanded Program on Immunization (EPI) was initiated by World Health Organization (WHO) in 1974 in order to save children from life threatening, disabling vaccine-preventable diseases (VPDs). In Pakistan, this program was launched in 1978 with the main objectives of eradicating polio by 2012, eliminating measles and neonatal tetanus by 2015, and minimizing the incidence of other VPDs. However, despite the efforts of government and WHO, this program has not received the amount of success that was desired. Hence, the objectives of this study were to elucidate the main reasons behind not achieving the full immunization coverage in Pakistan, the awareness of children's attendant about the importance of vaccination, their attitudes, thoughts and fears regarding childhood immunization, and the major hurdles faced in pursuit of getting their children vaccinated., Methods: This was an observational, cross-sectional, questionnaire-based study conducted during a one year period from 4th January, 2012 to 6th January, 2013 at the pediatric outpatient clinics of Civil Hospital (CHK) and National Institute of Child Health (NICH). We attempted to interview all the parents who could be approached during the period of the study. Thus, convenience sampling was employed. The parents were approached in the clinics and interviewed after seeking informed, written consent. Those patients who were not accompanied by either of their parents were excluded from the study. The study instrument comprised of three sections. The first section consisted was concerned with the demographics of the patient and the parents. The second section dealt with the reasons for complete vaccination or under-vaccination. The last section aimed to assess the knowledge, attitudes and beliefs of the respondents., Results: Out of 1044 patients, only 713(68.3%) were fully vaccinated, 239(22.9%) were partially vaccinated while 92(8.8%) had never been vaccinated. The vaccination status showed statistically significant association with ethnicity, income, residence, number of children and paternal occupation (p < 0.05 for all). The most common provocative factor for vaccination compliance was mass media (61.9%). The most common primary reason for non-vaccination was lack of knowledge (18.1%), whereas the most common secondary reason for non-vaccination was religious taboos (31.4%). Majority of the respondents demonstrated poor knowledge of EPI schedules or VPDs. However, most believed that there was a need for more active government/NGO involvement in this area., Conclusion: The most common primary reason for non-vaccination, i.e. lack of knowledge, and the most common secondary reason, i.e. religious taboos, imply that there is dire need to promote awareness among the masses in collaboration with NGOs, and major religious and social organizations.

Background: To evaluate the spectrum of breast diseases and their association with presenting complains of patients., Methodology: It was a cross sectional study conducted from 1st January 2010 - 30th December 2012. A total of 254 breast specimens of patients, who were admitted in Civil Hospital Karachi with breast complaints, were included. Specimens were collected either from mastectomy, lumpectomy or needle biopsy from the admitted patients. Informed written consent was taken from all the patients. All patients with primary breast diseases were included. Patients undergoing chemotherapy or with secondary breast disease and slides with insufficient specimen were excluded. All data was entered and analyzed through SPSS 19., Result: There were 254 breast lesions, histologically diagnosed in 3 year review period. The overall mean age of patients with breast lesion was 25.18, SD ± 11.73 with a wide age range of 12-74 years. Most common cases identified are benign 191(75.3%), followed by inflammatory 30(11.8%) and malignant lesions 30(11.8%). Most patients presenting with the complain of pain have diagnosis of fibroadenoma 24 (63.2%) while patient with complain of lump also have the most common diagnosis of fibroadenoma 147 (72.8%)., Conclusions: Study shows that in Pakistani females, mostly encountered breast lesion was fibroadenoma. Due to lack of awareness breast diseases present lately. Awareness must be created among women to reduce the mortality and morbidity with breast lesions., Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1037059088969395.

Background: Gallstones represent a significant burden for health care systems worldwide and are one of the most common disorders presenting to emergency room. Ultrasonography, complete blood picture test and liver function tests are procedures of choice in suspected gallstones or biliary diseases. They are the most sensitive, specific, non-invasive and inexpensive tests for the detection of gallstones. Our main objective was to evaluate the relationship of ultrasonographic findings, hemolytic indices and liver function tests with gallstones., Methodology: It was a prospective study carried out in Civil Hospital Karachi (DUHS) and Liaquat National Hospital, two largest tertiary care hospitals of Karachi, Pakistan. Duration of the study was from July 2011 to October 2012. The study was carried out on diagnosed, pre-operative and symptomatic patients of cholelithiases. Exclusion criteria were patients of gallbladder and pancreatic carcinoma, emergency operations, patients having age <12 years and non-cooperative patients, who refused to give written consent for participation in the study. Total two tests were performed on each patient after diagnosis by ultrasonography. These were complete blood count and liver function tests. All the demographic data, laboratory findings and ultrasonographic features were noted in a pre-structured Performa. Sample size was calculated by using open-epidemiological sample size calculator prevalence (p) = 35%, d = 5%, and confidence interval (CI) 95% = 350. All the data was entered and analyzed through SPSS 19., Result: There were 454 diagnosed and pre-operative cases of gallstones present in the study. There were 120(26.4%) males and 334(73.6%) females, with a mean age of 42.80 ± 12.26 years. Most of the suspects had multiple stones 384 (84.5%) while few had single stones 70(15.4%). Fatty liver was found to be present in 144(31.7%) patients and 92(20.2%) had hepatomegaly. Splenomegaly was present in 16(3.5%) patients. Alkaline phosphatase was elevated in 186(41.0%) patients while SGPT was found to be raised in 160(35.2%). Blood urea nitrogen was found to be elevated in 186(41%) patients and serum creatinine was elevated in 46(10.1%) patients., Conclusion: In the light of findings it is recommend that all patients should go through the process of ultrasonography and all the biochemical parameters should be analyzed before surgery.

We have discovered a rare example of a cationically charged inorganic material. The layered structure is an example outside the extensively studied isostructural set of anionic clays/layered double hydroxides and our previously reported lead fluoride nitrate. For the present compound, the antimony oxide hydroxide layers are positively charged and are templated by anionic alkylenedisulfonate. The organic molecules are only bonded electrostatically to the layers with sulfonate oxygen to antimony distances beyond the covalent range. The material catalyzes a ketal formation reaction as a Lewis acid without the need for drying the solvent before the reaction or a nonaqueous medium such as toluene. The catalyst is heterogeneous and is completely recovered after the catalysis for reapplication.

A new type of glycoconjugate mimetic is introduced that combines a glycocluster head group with a peptide part. These 'glycocluster peptides' are designed to serve as mimetics of glycocalyx constituents. A convergent synthetic scheme was followed, consisting of (i) the synthesis of a clustered carbohydrate head group carrying an amino acid at the focal point, and (ii) the solid phase synthesis of the peptide moiety. Finally, peptide coupling on resin furnished two prototype glycocluster peptides, which each exposes three alpha-mannosyl residues in the form of a dendritic wedge, with different conformational features. Extensive purification and NMR studies were necessary to characterize the target compounds and the results of these investigations are reported here together with the synthesis.

A retrospective study was conducted on 45 children with congenital hypothyroidism (CH) to estimate the number of missed cases of CH among Omani children per year and compare the intellectual outcome of children diagnosed by neonatal screening (Group A) with those who were diagnosed clinically at a later age (Group B). Our results revealed 14 children in Group A, diagnosed at a mean age of 2.3 +/- 0.8 months and 31 children in Group B diagnosed at a mean age of 9.8 +/- 2.5 months. IQ assessment revealed that 67 per cent of the children in Group A had a normal IQ compared to only 15 per cent of those in Group B. The above results point to a great demand for a national screening programme in the Sultanate of Oman.

We report an interesting case of severe neonatal hyperparathyroidism (SNHP) treated by sub-total parathyroidectomy, as her fourth parathyroid gland could not be identified. The clinical course changed over time to a more benign course resembling familial hypocalciuric hypercalcemia. This indicates that the natural course of SNHP is probably gradual spontaneous improvement, if patient survives the first few months of life.

Gastrocnemius muscles of Uromastix were used to observe the effects of short term (7 days) immobilization in flexed position. Results demonstrated significantly (P < 0.01) lesser magnitude as well as rate of rise in isometric twitch and tetanic tensions with insignificantly different twitch/tetanus ratio in the immobilized muscles. Both the twitch and tetanus also demonstrated significantly (P<0.01) higher twitch half relaxation and twitch/tetanus half relaxation time ratio. While, immobilized muscles showed insignificantly higher twitch contraction, tetanus half relaxation and duration of active state as well as peak twitch duration, than control ones. These changes in the mechanical contraction parameters were not found to be associated with changes in weight, resting, stretched and shortened length of the immobilized muscles. A comparison of present results with previous work performed on skeletal muscles of Uromastix at longer period (20 days) of immobilization has suggested that Uromastix muscles are no prone to a significant immobilization atrophy. However, decreased mechanical response after immobilization irrespective of the period of immobilization in Uromastix muscles is probably due to a depletion in various substrates involved in muscle mechanics.

The gastrocnemius muscles of Uromastix hardwickii were used to determine the effects of the absence of neural influence on them. For this purpose, the muscles were denervated for 7 days and were used to record isometric twitch and tetanus. The contraction parameters thus obtained from the denervated muscles were then compared with their own controls. The isometric tensions and time dependent tension parameters were significantly lower in the denervated muscles. The time dependent parameters, peak duration in twitch and duration of active state in twitch were however, found to be unaffected by short-term denervation with the exception of twitch/tetanus half relaxation time ratio, which was significantly higher in the denervated muscles. The denervation effects observed on the mechanical contraction behaviour of the gastrocnemius muscle have been discussed in terms of electrical excitation, excitation-contraction coupling and cross bridge interaction.

The gastrocnemius muscles of the reptile, Uromastix hardwickii were tenotomized for seven days according to the method described earlier and their mechanical responses were recorded to study the effect of cessation of proprioceptive impulses on the functioning of these muscles. The parameters measured were isometric twitch and tetanic tensions, time dependent tension parameters and other time dependent parameters of twitch and tetanus records. The isometric twitch and tetanic tensions, their ratios and the rate of rise in twitch and tetanus along with P/ms were found significantly lesser in the tenotomized muscles. The other time dependent tension parameters, i.e. twitch contraction and tetanus half relaxation times and their ratios were however, unaffected as compared to their controls. The duration of active state on the contrary, was significantly reduced in the tenotomized muscles. The tenotomization effects observed on the mechanical parameters are discussed in terms of muscle fiber architecture and the degree/rate of cross bridge interaction in these muscles.

Seasonal variations in the isometric activity of the isolated gastrocnemius muscle of Uromastix hardwickii was studied from winter to summer in Karachi, Pakistan. A constant 20 degrees C temperature was maintained during experimentation to avoid influence of this factor on seasonal changes. The twitch and tetanic tensions recorded at resting lengths showed a significant rise from winter to summer (p less than 0.0005) with a greater effect on tetanic tensions. The rate of rise of tensions also showed a significant elevation (p less than 0.0005) from winter to summer, while the duration of active state decreased by 66% during spring and summer. The results are discussed in terms of speed of summation of active state, cross bridge interaction, and characteristic expression of gastrocnemius muscle morphology on its mechanical behaviour from winter to summer.

Effect of hypothermia was studied on the twitch and tetanic contractions of the chronically denervated rat diaphragm muscles under isotonic conditions. The muscles were denervated for 15-20 days and the temperature was lowered from 35 degrees C to 15 degrees C. The results showed that hypothermia and chronic denervation had very little effect on the isotonic contraction parameters since these were found to be unaltered at all temperatures except at 15 degrees C. It is suggested that denervation has no significant effect on the contractile component of our experimental muscles.

Effect of live mesogenic strains of Mukteswar and Komarov ND vaccines was studied on the egg production of laying birds. The results showed that pullets vaccinated with Mukteswar ND vaccine produced more eggs than the Komarov vaccinated or non vaccinated birds. The peak egg production was noted at the age of 29 weeks in these birds and this latter decreased. When birds were re-vaccinated with the same vaccine and route, at the age of 32 weeks, the egg production again increased to 81%. Intra muscular vaccination with Komarov ND vaccine demonstrated 11% less egg production than the birds vaccinated with Mukteswar ND vaccine. In all the experiments, birds were found to be severely affected by the hot weather resulting in a drop of egg production.

Effects of chronic denervation and temperature were studied on the maximum rate of rise of tension in isometric twitch and tetanus of rat diaphragm muscles. The muscles were denervated for 15-20 days and the maximum rate of rise of tension was measured according to Hill (1951). The results showed that the maximum rate of rise of tension in twitch and tetanus was temperature dependent, exponentially increasing with increasing temperatures in both the normal and denervated muscles. A further observation was that the maximum rate of rise of tension in denervated muscle was always smaller than normal controls. It is suggested that probable changes in the series elasticity and duration of active state in the denervated muscle are responsible for the observed changes.

A comparative study was carried out to observe the effects of ethanol, acetylcholine and adrenaline on various parameters of the contraction cycle of rabbit intestine. Acetylcholine and adrenaline were used in concentrations of 10(-3), either alone or in combination with absolute ethanol. The results showed that ethanol and acetylcholine had no effect on the rate of intestinal contractions while adrenaline increased it significantly. However, all these drugs decreased the active tension of the contracting intestine, the decrease being minimum for ethanol, moderate for acetylcholine and maximum for adrenaline. On the contrary, a small transient decrease in resting tension was produced by ethanol and this occurred at a very fast rate while adrenaline produced a marked decrease in this parameter, its rate being 6-10 times slower. Ethanol and acetylcholine were also found to increase the resting tension, it being 2 times greater and occurring at a faster rate with acetylcholine. It is suggested that these drugs produce their effect by altering resting membrane potential, Ca++ and other ion fluxes.