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The objective of this study is to assess the role of intrathecal and topical vancomycin in the prevention of ventriculoperitoneal shunt infection. Infections of the ventriculoperitoneal (VP) shunt are a frequent consequence of shunt surgery. Different strategies, and protocols in addition to prophylactic intravenous antibiotic administration have been described to limit the infection rate, but the burden still remains high. The use of intrathecal Vancomycin along with topical application can be implemented as an additional measure to limit shunt-related infections. The study includes 105 patients who underwent ventriculoperitoneal shunt insertions for different reasons. Apart from the standard operative protocols used for shunt surgeries, intraoperatively intrathecal and topical vancomycin were administered to all the patients. Postoperatively, all the patients were followed for three months to assess shunt-related infections The study showed that the infection rate after administration of intrathecal and topical Vancomycin was found to be low, which is 4.7%, which shows a reduction of 5.8% from our baseline infection rate of 10.5%. We also found that patients having tuberculous meningitis were more at risk of developing shunt-related infections, the p-value being significant (0.001*). Therefore, we conclude that as part of a standardized shunt operation routine, Intrathecal and topical vancomycin treatment may be an appropriate option for preventing pediatric shunt infections. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of the SLR test in elderly patients suffering from lumbar disk herniation with sciatica and low back pain, using magnetic resonance imaging (MRI) as the gold standard. Materials and Methods: A cross-sectional study was conducted at Jinnah Postgraduate Medical Center and a total of 120 patients, above 60 years of age, with symptomatic lumbar disk herniation were enrolled. SLR test was performed and the results recorded. MRI of the lumbar spine was undertaken for confirmation of disk herniation. Results: The sensitivity of the SLR test in patients 60 years and older is 33.3%. A decrease in the diagnostic accuracy of the SLR test with an increment in age was also noted. Conclusion: It was found that with an increment in age, there is a steady decline in the diagnostic accuracy of SLR Test. [ABSTRACT FROM AUTHOR]

Atomically-abrupt interfaces in transition metal oxide (TMO) heterostructures could host a variety of exotic condensed matter phases that may not be found in the bulk materials at equilibrium. A critical step in the development of such atomically-sharp interfaces is the deposition of atomically-smooth TMO thin films. Optimized deposition conditions exist for the growth of perovskite oxides. However, the deposition of rutile oxides, such as VO 2 , with atomic-layer precision has been challenging. In this work, we used pulsed laser deposition to grow atomically-smooth VO 2 thin films on rutile TiO 2 (101) substrates. We show that an optimal substrate preparation procedure followed by the deposition of VO 2 films at a temperature conducive for step-flow growth mode is essential for achieving atomically-smooth VO 2 films. The films deposited at optimal substrate temperatures show a step and terrace structure of the underlying TiO 2 substrate. At lower deposition temperatures, there is a transition to a mixed growth mode comprised of island growth and layer-by-layer growth modes. VO 2 films deposited at optimal substrate temperatures undergo a sharp metal to insulator transition, similar to that observed in bulk VO 2 , but at a transition temperature of ∼ 325 K with ∼ 10 3 times increase in resistance. [ABSTRACT FROM AUTHOR]

Objective: To compare the marginal integrity of Class-I amalgam and bonded amalgam restorations in maxillary and mandibular molars at seven days, three, six and twelve-months intervals. Study Design: Comparative prospective study. Place and Duration of Study: Department of Operative Dentistry, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Jul 2017 to Jul 2018. Methodology: A total number of 114 patients of either gender with an age range of 14-45 years having Class-I cavities in first and second maxillary and mandibular molars on both sides were equally distributed in two groups. Group-A received conventional Amalgam, and Group-B received bonded amalgam restorations. All the fillings were placed and carved using routine instruments used for amalgam restorations, and the restorations were polished after 24 hours. The patients were initially evaluated for marginal ditching around restorations with the help of a dental mirror and explorer at seven days, followed by inspection at 3, 6 and 12 months. Results: Of the 114 participants, all showed excellent marginal integrity at seven-days intervals regardless of the restorative material used. However, marginal integrity deteriorated swiftly with time among those 57(50%) participants who acquired conventional Amalgam. Marginal integrity at 3, 6 and 12-months period was 51(89.5%), 35(61.4%) and 17(29.8%), respectively. Bonded amalgam restorations performed superiorly with 100%, 56(98.2%) and 43(75.4%) successful marginal integrity at 3, 6 and 12-months, respectively. Conclusion: Bonded amalgams can be a better substitute than non-bonded amalgam restorations with superior longevity in marginal integrity. [ABSTRACT FROM AUTHOR]

Background: Acute pancreatitis (AP) has been defined as an "acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems". Increasing incidence of AP worldwide with 33.74 cases per 100,000 persons per year reported globally over the last few years has landed it amongst the most common gastrointestinal disorders requiring hospitalization. Objective: To determine the efficacy of C Reactive Protein (CRP), in predicting severity and outcome of Acute Pancreatitis (AP), taking CT scan findings as gold standard. Study type, settings & duration: This cross-sectional research was conducted at the Department of General Surgery (Unit III), Jinnah Postgraduate Medical Center, Karachi, from January to March 2021. Methodology: A sample of 186 patients (obtained via non-probability - consecutive sampling), presenting with acute pancreatitis (based on Revised Atlanta Classification - RAC). After taking written informed consent, patient data was recorded on a structured questionnaire (containing inquiries pertaining to basic biodata, sociodemographic details, presenting complaints, inferences obtained from disease history and clinical examination, laboratory investigation (CRP values and variations - at scheduled intervals), CT findings, and patient outcome. The data obtained was analyzed using SPSS. v. 21.0. Results: The mean age of the sample was 39 (SD ± 4) years and 119 (63.9%) were males, while the remaining 67 (36.1%) were females. A raised CRP (= 150 mg/dL) was present among 163 (87.6%) of the patients. CRP changes at 24, 48 and 72 h were synonymous with disease severity and a positive association between CRP level / CRP change (rise) and disease severity was noted (p value 0.035). Recovery was achieved during the study period among majority of the patients, however complaints such as pancreatic necrosis were reported in 24 (12.9%), abscesses in 32 (17.2%), and pseudocysts in 25 (13.4) patients. Mortality was reported in 2 cases. Conclusion: CRP has a high efficacy at predicting disease severity of acute pancreatitis. The evidence yielded has offer much needed solace from AP, which is a pressing situation, both for the patient and healthcare provider. The resources (infrastructural and financial) for CT evaluation of AP patients are often not available and thus, CRP may offer help for the much needed insight into the disease severity quickly, easily and at a lower cost. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic significance of reticulocyte maturity indices in iron deficiency anaemia. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi, from Sep 2019 to Jun 2020. Methodology: A total of 340 children, ages between 1 and 5 years of either gender, were divided into two groups based on haemoglobin and ferritin level. Group A comprised of 203 children with haemoglobin >11 g/dL andferritin level >7 ng/ mL. Group B comprised of 137 children with haemoglobin <11g/dL and ferritin <7 ng/mL. Red blood cell and reticulocyte parameters were compared. Results: Iron deficiency anaemia was found to be 37.6% in the study population. Comparison revealed that the children in groups B had significantly higher mean red cell distribution width (17.1 ± 1.3% vs. 13.3 ± 1.3%) and significantly lower hemoglobin (9.5 ± 1.0 g/dL vs. 12.7 ± 1.0 g/dL), mean corpuscular hemoglobin (21.8 ± 2.5 pg vs. 28.6 ± 2.3 pg), mean corpuscular volume (69.4 ± 3.5 fL vs. 80.4 ± 3.3 fL), mean corpuscular hemoglobin concentration (31.5 ± 1.8 g/dL vs. 32.7 ± 1.6 g/dL) and serum ferritin level (4.5 ± 2.6 mg/mL vs. 55.9 ± 32.1 ng/mL). No significant differences in the mean total red blood cell count, hematocrit and reticulocytes between two groups were noted (p>0.05) and significant differences were noted in terms of low, medium & high fluorescence ratios in both groups (p<0.05). Conclusion: Our findings suggest that medium fluorescence ratio and high fluorescence ratio were higher among children with iron deficiency anaemia. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of Nucleated RBC (NRBC) Count using a fully automated haematology analyzer versus manual counting. Study Design: Cross-Sectional Study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, from Sep 2019-Jun 2020. Methodology: Routine fresh whole blood samples were run on Sysmex XN-3000 automated haematology analyzer and 384 samples with results of ≥0.1% Nucleated red blood cells were included in this study. Manual NRBC counting was carried out twice on Leishman-stained peripheral blood smears from all 384 samples. Comparison between manual and automated nucleated red blood cell counting methods was statistically analyzed through linear regression analysis & coefficient correlation. The degree of agreement between two methods was analyzed through Bland-Altman plot. Finally, concordance between the two methods was also analyzed at 5 different ranges of nucleated red blood cells. Results: Linear regression analysis revealed a (r2) value of 0.97. Regression equation was calculated as XN = 0.76MC ± 1.28, with 95% limits of agreement between ± 40.42% and -24.47%. A mean bias of 7.97% was demonstrated through Bland-Altman plot. Concordance analysis revealed a concordance rate of 93.74% (360/384). Nucleated red blood cell counting between two methods were more concordant when nucleated red blood cell counts were <200%. Conclusion: Nucleated red blood cells counting by XN-3000 automated hematology analyzer is statistically comparable to manual nucleated red blood cell counting. We suggest that automated counting can be adopted in routine hematology laboratory as a replacement of manual NRBC counting. [ABSTRACT FROM AUTHOR]

The transfer of charge carriers across the optically excited hetero-interface of graphene and semiconducting transition metal dichalcogenides (TMDCs) is the key to convert light to electricity, although the intermediate steps from the creation of excitons in TMDC to the collection of free carriers in the graphene layer are not fully understood. Here, we investigate photo-induced charge transport across graphene–MoS2 and graphene–WSe2 hetero-interfaces using time-dependent photoresistance relaxation with varying temperature, wavelength, and gate voltage. In both types of heterostructures, we observe an unprecedented resonance in the inter-layer charge transfer rate as the Fermi energy (EF) of the graphene layer is tuned externally with a global back gate. We attribute this to a resonant quantum tunneling from the excitonic state of the TMDC to EF of the graphene layer and outline a new method to estimate the excitonic binding energies (Eb) in the TMDCs, which are found to be 400 meV and 460 meV in MoS2 and WSe2 layers, respectively. The gate tunability of the inter-layer charge transfer timescales may allow precise engineering and readout of the optically excited electronic states at graphene–TMDC interfaces. [ABSTRACT FROM AUTHOR]

Objective: To carry out preoperative assessment of scoring system designed for prediction of difficult cholecystectomy in patients with symptomatic gall stones. Study Design: Prospective observational study. Place and Duration of Study: The study was conducted in General Surgery Unit 1, ward 3, JPMC, from Jun 2017 to Aug 2018. Methodology: During the study, 208 patients were enrolled who presented for the elective cholecystectomy. Personal data, comorbid illness, sonographic, clinical and biochemical parameters were assessed. Based on the preoperative scoring, outcome measure was easy, difficult or very difficult cholecystectomy. Results: On the basis of preoperative assessment and scoring, 157 (75.5%) patients were preoperatively predicted for easy cholecystectomy whereas 51 (24.5%) patients were predicted for difficult cholecystectomy. Sensitivity and specificity of this scoring method were 96.5% and 68.5% respectively. Positive predictive value of this scoring method was 89.1% and 72.5% for easy and difficult cases, respectively. Conclusion: The scoring system proposed in our study incorporating all the known factors for difficult cholecystectomy does provide a definite, objective and reliable prediction of difficult case pre operatively. [ABSTRACT FROM AUTHOR]

This study aims to analyse the impact of public spending on economic growth in Pakistan. Various econometric techniques have been applied to estimate the relationship among public spending on education, health, road length, defence, trade openness, worker remittances, total cropped area and economic growth. Pakistan' economic growth rate fluctuated from 1972 to 2014. During this period for some years, the economic growth was high while it slowed down in some years. The study utilised Annual time series data from 1972 to 2014. Empirical evidence suggests that public spending has a significant positive influence on economic growth. Augmented Dickey-Fuller (ADF) has been used for investigating the unit root in time series data. Johansen's Cointegration test and error correction model (ECM) is applied to estimate the long run and the short run relationship amongst the variables. The long-run analyses revealed the existence of a positive relationship among variables. The coefficient of ECM term (-0.389026) was found to be negative and statistically significant, which validates stable long-run relationship among variables, with a speed of 39 per cent to restore disequilibrium in case of any shock. The empirical estimation reveals that public spending on education, health, total road length, trade openness, worker remittances and total cropped area have a strong positive impact on economic growth. Moreover, the study also examines the impact which Pakistan's economic growth has had on the Agriculture sector. While public spending on defence has failed to contribute to economic growth. The study suggests the allocation of more resources to education, health, transport and communication for increasing Pakistan's economic growth. [ABSTRACT FROM AUTHOR]

Objectives To evaluate patient follow-up and complexity in cancer clinical trial delivery, using consensus methods to: (1) identify research professionals’ priorities, (2) understand localised challenges, (3) define study complexity and workloads supporting the development of a trial rating and complexity assessment tool (TRACAT). Design A classic eDelphi completed in three rounds, conducted as the launch study to a multiphase national project (evaluating follow-up and complexity in cancer clinical trials). Setting Multicentre online survey involving professionals at National Health Service secondary care hospital sites in Scotland and England varied in scale, geographical location and patient populations. Participants Principal investigators at 13 hospitals across nine clinical research networks recruited 33 participants using pre-defined eligibility criteria to form a multidisciplinary panel. Main outcome measures Statements achieving a consensus level of 70% on a 7-point Likert-type scale and ranked trial rating indicators (TRIs) developed by research professionals. Results The panel developed 75 consensus statements illustrating factors contributing to complexity, follow-up intensity and operational performance in trial delivery, and specified 14 ranked TRIs. Seven open questions in the first qualitative round generated 531 individual statements. Iterative survey rounds returned rates of 82%, 82% and 93%. Conclusions Clinical trials operate within a dynamic, complex healthcare and innovation system where rapid scientific advances present opportunities and challenges for delivery organisations and professionals. Panellists highlighted cultural and organisational factors limiting the profession’s potential to support growing trial complexity and patient follow-up. Enhanced communication, interoperability, funding and capacity have emerged as key priorities. Future operational models should test dialectic Singerian-based approaches respecting open dialogue and shared values. Research capacity building should prioritise innovative, collaborative approaches embedding validated review and evaluation models to understand changing operational needs and challenges. TRACAT provides a mechanism for continual knowledge assimilation to improve decision-making. [ABSTRACT FROM AUTHOR]

Background: Anorectal fistula is a common illness which is seen among the middle-aged male patients. Various surgical procedures have been proposed and are associated with the recurrence of the fistula, repeated surgery and in some cases incontinence which may reach up to 43% in complicated fistulas. The purpose of this study was to assess and formulate a non-surgical procedure for fistula in ano through irrigation of the fistula tract with 1% of silver nitrate solution in healing the low perianal fistula. Methods: Seventy-nine patients presenting to the outpatient department of Ward 3, Surgical unit 1 in Jinnah Postgraduate Medical Centre during a period of 8 months from April to November 2017 with complain of perianal pain and pussy discharge were included in the study. Three patients of the total 79 patients lost to follow up. Outcome measure were cessation of the symptoms for consecutive 10 weeks. Results: Seventy-six patients were assessed and underwent irrigation using this 1% of silver nitrate solution. Out of 76 patients, 58 (76.3%) patients showed complete clinical healing while 18 (23.68%) of patients showed failure to clinical healing. Patients with continuous discharge had a significantly higher rate of complete clinical healing than those with intermittent discharge. Conclusion: From this study it can be concluded that cauterizing and corrosive properties of silver nitrate are effective in treating the patients with low lying perianal fistula. We suggest that this method should be used as a first line treatment option for all the patients presenting with low lying anal fistula since it is simple, can be easily performed on an OPD basis is minimally invasive and avoids any complication. [ABSTRACT FROM AUTHOR]

The purpose of this study is to analyse the impact of government spending on agricultural growth in Pakistan. The relationship among agriculture value added per worker and public spending on education, health, road length, the number of tube wells in the agriculture sector, improved seed distribution has been estimated through various econometric approaches in the study. Pakistan's agriculture growth has registered mixed trends from 1972 to 2014. Empirical evidence from developing countries suggests that public spending has a profoundly positive relationship with agricultural growth. Agriculture is the second largest sector of Pakistan's economy, accounting for more than one-fifth of Gross Domestic Product (GDP) and employing almost half of the country's workforce. The study utilized time series data for the period 1972 to 2014. The stationarity of time series data has checked through Augmented Dickey-Fuller (ADF) test. Johansen Co-integration test and Error Correction Model (ECM) have employed for the long run and short run empirical estimation. The Co-integration test results show the presence of a long run relationship among the variables. The coefficient of the ECM term (-.537563) in the ECM model is negative and statistically significant, which validates stable long-run equilibrium relationship among the variables, with speed of 53 per cent to restore disequilibrium in case of any shock. The regression results reveal that public spending on education, health and road length has a positive influence on agriculture value addition in Pakistan. The study recommends the allocation of greater resources to education, health and transport and communication sectors for agricultural growth. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare outcome of thyroid surgery with harmonic versus conventional clamp-and tie thyroidectomy. STUDY DESIGN: A Randomized control trial PLACE AND DURATION: Jinnah Post Graduate Medical College, Department of Surgery, Unit I, Karachi. From 1st June, 2016 to 28th Feb, 2017. METHODOLOGY: All patients were divided in two groups i.e. Group A, in whom dissection and hemostasis were performed using conventional method and Group B, in which the Harmonic Focus were used. All the patients underwent near total/total thyroidectomy and the parameters includes post-operative hospital stay, intra-operative blood loss, postoperative pain and operative time were assessed. RESULTS: Total number of patients were 60 and Mean age of group A was 30.93±12.29 and in group B age was 34.73±10.22. Recurrent Laryngeal Nerve palsy in both groups was 6.7% vs 3.3% respectively. Mean post-operative hospital stay of group A was 3.03 and in group B age was 1.56 in days, mean intra-operative loss of blood of group A was 35.3ml and in group B was 28.06ml, mean postoperative pain measure of group A was 5.93 whereas in group B was 3.66, mean of operative time of group A was 105.4min and in group B was 79.83min. CONCLUSION: Use of the Harmonic Scalpel in total/near total thyroidectomy is safer, quicker and also decrease the post-operative hospital stay and post-operative pain. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the diagnostic accuracy of Tzanaki's scoring in diagnosing acute appendicitis. STUDY DESIGN: A prospective observational study. PLACE AND DURATION: Surgical ward 3 of Jinnah Postgraduate Medical Centre, Karachi, Pakistan from 1st March 2015 to 31st August 2016. METHODOLOGY: Patients presented in emergency department with clinical diagnosis of acute appendicitis were included in the study. There are four variables in Tzanakis's Scoring System and these are presence of right lower abdominal tenderness(4 Points), Rebound tenderness(3 points), presence of white blood cells greater than 12000/mm3 in complete blood count(2 points) and positive Ultrasound scan finding for appendicitis(6 points) . The diagnosis was confirmed on the basis of histopathological features of appendicitis by the pathologist. Patient's age, sex, Tzanakis's Score, Ultrasound findings and histopathology reports were recorded on a Performa. RESULTS: Among 214 appendectomies, histopathologically proven Acute Appendicitis was found in 89.7% and 10.3% were found to have normal appendix. Sensitivity, specificity and overall diagnostic score of Tzanaski score was found to be 99%, 91% and 95% respectively. CONCLUSION: The Tzanakis score is simple and easy to be applicable and effective for diagnosing acute appendicitis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mastitis is not uncommon among lactating woman. This is caused by local inflammation and/or infection of terminal lactiferous ducts. Incision and drainage followed by postoperative antibiotics is the treatment of choice for such abscesses depending on culture and sensitivity. Ultrasound guided needle aspiration is also effective for breast abscesses. OBJECTIVE: To compare the outcome of percutaneous aspiration with incision drainage for management of breast abscess among lactating mothers. METHODOLOGY: This comparative study was carried out at Jinnah Postgraduate Medical Centre, Karachi, Pakistan from August 2015 to August 2016. A total of 90 women with breast abscess were included according to inclusion and exclusion criteria. These women were randomly allocated into two groups. Forty-five in group A, treated with percutaneous aspiration, and 45 patients in group B treated with incision and drainage for breast abscess. Percutaneous aspiration was done after radiological estimation of size, site and shape. After the intervention, all the patients were observed for the outcome parameter i.e. early restoration of breast feeding, as if the mother starts feeding the baby within 24 hours after the procedure All the information was collected on a specially designed Performa. RESULTS: Rate of early restoration of breast feeding was significantly high in group A (percutaneous aspiration) as compared to group B (drainage for breast abscess) [82.2% vs. 57.8%); 0.011]. CONCLUSION: We conclude that percutaneous aspiration of breast abscess is a minimally invasive, simple outpatient procedure without the need of general anesthesia with superior cosmetic results and high satisfaction rate. [ABSTRACT FROM AUTHOR]

The acidic phospholipase A[sub 2] isoform from the spitting cobra Naja mossambica mossambica is activated irreversibly by treatment with a molar equivalent of oleoyl imidazolide. The kinetics of the chemical modification of the enzyme can also be monitored by measuring the large reduction of tryptophan fluorescence, which is accompanied by a distinct red shift. The addition of a single molar equivalent of oleic acid to the enzyme produces an instantaneous reduction in fluorescence but with a barely detectable red shift, confirming that the response to oleoyl imidazolide results from covalent modification of the protein rather than hydrolysis of the reagent. The pH dependence of both activation and fluorescence reduction by oleoyl imidazolide has an optimum rate near pH 8.0. We propose that long-chain fatty acids and long-chain acyl imidazolides bind at a single activation site and that the reaction of the imidazolides involves two protein residues, one of which is a nonessential histidine residue and the other a primary amino group. [ABSTRACT FROM AUTHOR]

Abstract: We report the protein isolation, cloning and characterization of members of an unusual protein family, which comprise the most abundant proteins present in the squid eye. The proteins in this family have a range of molecular weights from 32 to 36 kDa. Electron microscopy and detergent solubilization demonstrate that these proteins are tightly associated with membrane structures where they may form tetramers. Despite this, these proteins have no stretches of hydrophobic residues that could form typical transmembrane domains. They share an unusual protein sequence rich in methionine, and contain multiple repeating motifs. We have therefore named these proteins Methionine-Rich Repeat Proteins (MRRPs). The use of structure prediction algorithms suggest very little recognized secondary structure elements. At the time of cloning no sequence or structural homologues have been found in any database. We have isolated three closely related cDNA clones from the MRRP family. Coupled in vitro transcription/translation of the MRRP clones shows that they encode proteins with molecular masses similar to components of native MRRPs. Immunoblot analysis of these proteins reveals that they are also present in squid brain, optic lobe, and heart, and also indicate that MRRP-like protein motifs may also exist in mammalian tissues. We propose that MRRPs define a family of important proteins that have an unusual mode of attachment or insertion into cell membranes and are found in evolutionarily diverse organisms. [Copyright &y& Elsevier]