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Immune check-point inhibitors (ICPi) are immunomodulating agents, which have revolutionized the management of advanced metastatic cancers. Being immunomodulating agents, they are predisposed to causing colitis. This descriptive review article emphasized on the management of ICPi-associated colitis in advanced metastatic cancers. We used PubMed, Google Scholar, Scopus, and Embase databases for literature review, and terminologies commonly searched were “management,” “immune check-point inhibitors,” “colitis,” “metastatic,” “cancers,” “literature,” and “review.” We reviewed a total of 11 articles done in the last 15 years relevant to ICPi colitis and its management; all the articles showed that diarrhea and colitis are the most common adverse effects observed in patients on ICPi, but prior to establishing the diagnosis of ICPi-causing colitis, possibility of Clostridium difficle or cytomegalovirus infections should be ruled out. Once the diagnosis of ICPi colitis is established, treatment should be started depending upon the severity of colitis. In mild severity, discontinuation of ICPi can resolve the symptoms but, in most of the patients with moderate to high severity of colitis, corticosteroids are considered a cornerstone treatment. Patients unresponsive to steroid treatment should be re-evaluated for infections after which anti-TNF therapy—infliximab or vedolizumab, cyclosporine, mycophenolate mofetil—can be considered.

IntroductionInconsistent results observed in recent phase III trials assessing chimeric antigenic receptor T (CAR-T) cell therapy as a second-line treatment compared to standard of care (SOC) in patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) prompted a meta-analysis to assess the effectiveness of CAR-T cell therapy in this setting.MethodsRandom-effects meta-analysis was conducted to pool effect estimates for comparison between CAR-T cell therapy and SOC. Mixed treatment comparisons were made using a frequentist network meta-analysis approach.ResultsMeta-analysis of three trials with 865 patients showed significant improvement in event-free survival (EFS: HR: 0.51; 95% CI: 0.27-0.97; I2: 92%), progression-free survival (PFS: HR: 0.47; 95% CI: 0.37-0.60; I2: 0%) with CAR-T cell therapy compared to SOC. Although there was a signal of potential overall survival (OS) improvement with CAR-T cell therapy, the difference was not statistically significant between the two groups (HR 0.76; 95% CI: 0.56 to 1.03; I2: 29%). Mixed treatment comparisons showed significant EFS benefit with liso-cel (HR: 0.37; 95% CI: 0.22-0.61) and axi-cel (HR: 0.42; 95% CI: 0.29-0.61) compared to tisa-cel.DiscussionCAR-T cell therapy, as a second-line treatment, appears to be effective in achieving higher response rates and delaying the disease progression compared to SOC in R/R DLBCL.

Background: Pediatric dental anomalies refer to irregularities or abnormalities in the development, structure, or positioning of the teeth in the oral cavity of children. These anomalies can encompass a wide range of conditions that affect the number, size, shape, and structure of teeth. In Karachi, there is limited evidence regarding the prevalence of dental anomalies in children. Objective: This study investigated the prevalence of dental anomalies in the pediatric population of the Abbasi Shaheed Hospital, Karachi, Pakistan. Material and Methods: A cross-sectional study was conducted among 278 children aged between 3 and 12 years. The socio-demographic and thorough medical history were recorded on a predesigned performa. The diagnosis of all dental anomalies was based on clinical interpretation using sterilized mouth mirrors, probes, or tongue depressors. Difficult cases were addressed by senior faculty members. Data analysis was conducted using SPSS version 19. Descriptive statistics were used to present the frequency and Mean ± SD. Result: The prevalence of dental anomalies was 7.4%. in the study area. Male-to-female ratio was 2.2:1. Boys exhibited a higher prevalence of 10.05% compared to girls (4.3%). Peg Lateral Incisors and Fusion/Gemination were the most common anomalies among both genders. Dilaceration, Dentinogenesis Imperfecta, Amelogenesis Imperfecta, Talon Cusp, Anodontia, and supernumerary Tooth (disto-molar) were not identified in either boys or girls. The highest number of dental anomalies was recorded at ages 11 and 12 years. Conclusion: The prevalence of dental anomalies was high in the study area, underscoring the significance of early diagnosis and careful management to prevent complications.

In this case report, we present a case of non-ossifying fibroma in the mandible of an eleven-year-old girl who reported to the Oral and Maxillo-Facial Surgery Department with facial asymmetry and painless swelling on palpation over the lower right mandibular region. In this paper, we review the radiographic features, clinical presentation, and histopathological features of non-ossifying fibromas. Non-ossifying fibromas present with a unique extra-gnathic appearance in the skull. It is usually asymptomatic and has diverse histological features. Co-related histological, radiological, and clinical features differentiate it from other odontogenic and non-odontogenic tumors and cysts of the oral cavity. Ortho-pantogram revealed a well-demarcated, expansile radiolucency with pronounced sclerotic borders with striations reaching the anterior and superior regions and thus slowly approaching a multilocular stage. The treatment plan comprised of excisional resection with curettage under general anesthesia. After excisional biopsy of the lesion, the specimen was sent for histopathological evaluation in neutrally buffered 10 % formalin solution, which confirmed it to be a Non-Ossifying Fibroma. Prior to surgery, informed consent and written permission to collaborate with a case report encompassing her findings were obtained from the patients’ guardians. Confidentiality of patient has been taken care of before documenting the report. A meticulous literature review of previous case reports on non-ossifying fibromas revealed typical behaviors and characteristics of this lesion.

This paper presents two Elliptical Trajectories for Efficient Data-gathering and Delay-tolerant (TETD2) routing schemes for Underwater Wireless Sensor Networks (UWSNs). The TETD2 protocol consists of two phases. The first phase involves creating an atomic-shaped trajectory for an Autonomous Underwater Vehicle. In second phase, to improve the delay tolerance of the protocol, communication between random nodes (RNs), destination nodes (DNs), autonomous underwater vehicles (AUVs) and the sink node have been proposed. The latency between RNs in the network reveals the necessary time for choosing the prospective forwarders for making association linkages. The shortest path from a multipath environment sends a packet from its origin to the destination node using the RNs-to-DNs model in the shortest time possible. To gather data as quickly as possible, the novel trajectory model maximizes the number of DNs for RNs associations. In addition, a cooperation process has been introduced to allow for data sharing from parent AUV to child and onward to the sink node. The performance of TETD2 was tested using the network simulator (NS-2) and compared to the currently used method for data-gathering, the Effective Data Gathering (AEDG) protocol. The simulation results showed that TETD2 outperformed the ASEDG in terms of throughput and end-to-end delay. The TETD2 protocol offers a promising solution for efficient data-gathering in UWSNs and has the potential to significantly improve the performance of such networks.

The rapid advancement of grid modernization and the proliferation of smart grids have engendered a critical need for cyber-physical security. Recent cyber-attacks targeting grid infrastructure, notably leading to substantial blackouts in Ukraine, underscore the vulnerabilities and potentially catastrophic consequences of such incursions. These attacks, whether stemming from cyber threats such as Denial of Service (DOS), False Data Injection Attacks (FDIA), or complex cyber-physical manipulations, emphasize the imperative of robust cybersecurity protocols in smart grid operations. This research investigates a pivotal approach to fortify and safeguard smart grid systems by integrating blockchain technology with wireless sensor nodes. By leveraging a Proof of Authority (PoA) Ethereum Blockchain framework, the study delves into the transformative capabilities of Blockchain within Supervisory Control and Data Acquisition (SCADA) networks. Specifically, it examines configurations across IEEE 14-bus, 30-bus, and 118-bus topologies. In addition to elucidating the inherent vulnerabilities in traditional SCADA systems, this study meticulously evaluates an array of performance matrices. Statistical analyses encompassing mean, standard deviation, skewness, kurtosis, and confidence levels provide nuanced insights into the efficacy of blockchain mechanisms in enhancing SCADA resilience against contemporary cyber threats. This research endeavors to bridge the gap in modern cybersecurity paradigms by fusing blockchain technology with wireless sensor nodes. By fortifying data integrity, elevating the reliability of data transmission, and augmenting trustworthiness within SCADA infrastructures, this study aims to present robust solutions to the escalating cybersecurity challenges faced by smart grid systems.

Abstract Neurons and their connecting axons gradually degenerate in neurodegenerative diseases (NDs), leading to dysfunctionality of the neuronal cells and eventually their death. Drug delivery for the treatment of effected nervous system is notoriously complicated because of the presence of natural barriers, i.e., the blood-brain barrier and the blood cerebrospinal fluid barrier. Palliative care is currently the standard care for many diseases. Therefore, treatment programs that target the disease’s origin rather than its symptoms are recommended. Nanotechnology-based drug delivery platforms offer an innovative way to circumvent these obstacles and deliver medications directly to the central nervous system, thereby enabling treatment of several common neurological problems, i.e., Alzheimer’s, Parkinson’s, Huntington’s, and amyotrophic lateral sclerosis. Interestingly, the combination of nanomedicine and gene therapy enables targeting of selective mutant genes responsible for the progression of NDs, which may provide a much-needed boost in the struggle against these diseases. Herein, we discussed various central nervous system delivery obstacles, followed by a detailed insight into the recently developed techniques to restore neurological function via the differentiation of neural stem cells. Moreover, a comprehensive background on the role of nanomedicine in controlling neurogenesis via differentiation of neural stem cells is explained. Additionally, numerous phytoconstituents with their neuroprotective properties and molecular targets in the identification and management of NDs are also deliberated. Furthermore, a detailed insight of the ongoing clinical trials and currently marketed products for the treatment of NDs is provided in this manuscript. Graphical abstract

Producing and supplying energy efficiently are important for many countries. Using models to predict energy production can help reduce costs, improve efficiency, and make energy systems work better. This research predicts solar electricity production in the Najran and Riyadh regions of Saudi Arabia by analyzing 14 weather factors. The weather factors that were considered in the study include date, time, Global Horizontal Irradiance (GHI), clear sky, top of atmosphere, code, temperature, relative humidity, pressure, wind speed, wind direction, rainfall, snowfall, and snow depth. GHI is the most important factor because it determines how much solar energy a system can produce. Therefore, it is important to be able to predict GHI accurately. This study used a variety of data-driven models to predict GHI, including the elastic net regression, linear regression, random forest, k-nearest neighbor, gradient boosting regressor, light gradient boosting regressor, extreme gradient boosting regressor, and decision tree regressor. The models were evaluated using a set of metrics, including the mean absolute error, mean squared error, root mean square error, coefficient of determination (R2), and adjusted coefficient of determination. This study found that the decision tree regression, Random Forest (RF), and Extreme Gradient Boosting (XGB) models performed better in the Riyadh region than in the Najran region. The R2 values for the Riyadh region were 99%, 99%, and 98%, while the R2 values for the Najran region were 89%, 94%, and 94%. This suggests that the Riyadh region is a more suitable location for solar energy conversion systems. These findings are important for policymakers and investors who are considering the development of solar energy projects in Saudi Arabia.

Introduction: Earlier, patients with advanced ovarian cancer were treated with a combination of cytoreductive surgery and platinum-based chemotherapy, which had significant outcomes in the past until an increase in relapse and resistance to treatment, which led to the use or development of bevacizumab (a vascular endothelial growth factor inhibitor) in the treatment of primary or relapsed ovarian cancer. Method and Methodology: This study includes five-phase three randomized controlled clinical trials designed to study the impact of bevacizumab in combination with platinum-based chemotherapy compared with platinum-based chemotherapy alone. Results: This study demonstrated significant improvement in the progression-free span but no improvement in overall survival in the treatment group when compared with the control group. Also, adverse effects reported with combination therapy were tolerable and easily manageable by decreasing the infusion rate or by decreasing the frequency of infusion.

] Accurate classification of brain tumors is essential for effective medical diagnosis and treatment planning. Traditional approaches rely on convolutional neural networks (CNNs) for tumor detection, but they often suffer from high computational demands due to the large number of parameters. In this paper, we propose a novel approach for brain tumor classification using involutional neural networks (InvNets), which are designed to mitigate the parameter-intensive nature of CNNs. Unlike the spatial-agnostic and channel-specific convolution kernel, the involution kernel is location-specific and channel-agnostic. This location-specific operation allows the network to adapt to various visual patterns with respect to different spatial locations, enhancing its ability to capture intricate features within the medical images. Our study focuses on a four-class brain tumor classification problem, aiming to differentiate between different tumor types based on medical imaging data. In a comparative analysis, we demonstrate that conventional CNNs require over 4 million parameters, whereas our proposed InvNets require less than 0.2 million parameters, making them more efficient and resource-friendly. The evaluation of both CNNs and InvNets is carried out using standard performance matrices: accuracy, precision, recall, F1 score, and AUC-ROC values. Our findings reveal that the InvNets consistently outperform traditional CNNs. The InvNet architecture achieves an impressive 92% accuracy rate, showcasing its potential for accurate brain tumor classification. This improved accuracy, combined with the reduced parameter count, highlights the effectiveness of InvNets for medical image analysis tasks, especially in scenarios with limited computational resources.

Introduction: With an increase in number of cases of relapsed or refractory multiple myeloma (RRMM), scientist have discovered various combination of medications among which one is daratumumab, Daratumumab is a mono-clonal antibody which attacks CD-38 markers present in abundance on the surface of myeloma cells and is used universally for the treatment of primary newly diagnosed multiple myeloma patients. Methods and Methodology: This meta-analysis was conducted according to Cochrane Collaboration guidelines in which initially 679 articles were evaluated for relevance on abstract level followed by full text screening of final list of 45 articles. Out of the 45 articles, only 10 articles qualified for selection criteria for eligibility. Three Phase 3 randomized control clinical trials which includes primary outcomes of progression free span and secondary outcomes including complete response, partial response or very good partial response and adverse effects reported were included in this study. Results: A total of three studies including 1533 patients (849 in Daratumumab treatment group while 684 patients in control group) were included in the study. All three of these studies were phase 3 clinical trial conducted to observe the role of daratumumab in relapsed and refractory multiple myeloma. Mean age reported was 65 years in both treatment and control groups. This study showed that daratumumab improves primary and secondary outcomes including progression free span, overall response rate, very good partial response, and complete response. However, daratumumab increases drug induced adverse effects. Conclusion: Our study confirmed that daratumumab in combination therapy improved primary and secondary outcomes when compared with platinum-based chemotherapy, but more adverse effects were reported in the combination group. So, we recommend that combination therapy should include daratumumab in treatment of relapsed and refractory multiple myeloma patients.

The mental and physical well-being of healthcare workers is being affected by global COVID-19. The pandemic has impacted the mental health of medical staff in numerous ways. However, most studies have examined sleep disorders, depression, anxiety, and post-traumatic problems in healthcare workers during and after the outbreak. The study's objective is to evaluate COVID-19's psychological effects on healthcare professionals of Saudi Arabia. Healthcare professionals from tertiary teaching hospitals were invited to participate in the survey. Almost 610 people participated in the survey, of whom 74.3% were female, and 25.7% were male. The survey included the ratio of Saudi and non-Saudi participants. The study has utilized multiple machine learning algorithms and techniques such as Decision Tree (DT), Random Forest (RF), K Nearest Neighbor (KNN), Gradient Boosting (GB), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM). The machine learning models offer 99% accuracy for the credentials added to the dataset. The dataset covers several aspects of medical workers, such as profession, working area, years of experience, nationalities, and sleeping patterns. The study concluded that most of the participants who belonged to the medical department faced varying degrees of anxiety and depression. The results reveal considerable rates of anxiety and depression in Saudi frontline workers.

The mental and physical well-being of healthcare workers is being affected by global COVID-19. The pandemic has impacted the mental health of medical staff in numerous ways. However, most studies have examined sleep disorders, depression, anxiety, and post-traumatic problems in healthcare workers during and after the outbreak. The study’s objective is to evaluate COVID-19’s psychological effects on healthcare professionals of Saudi Arabia. Healthcare professionals from tertiary teaching hospitals were invited to participate in the survey. Almost 610 people participated in the survey, of whom 74.3% were female, and 25.7% were male. The survey included the ratio of Saudi and non-Saudi participants. The study has utilized multiple machine learning algorithms and techniques such as Decision Tree (DT), Random Forest (RF), K Nearest Neighbor (KNN), Gradient Boosting (GB), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM). The machine learning models offer 99% accuracy for the credentials added to the dataset. The dataset covers several aspects of medical workers, such as profession, working area, years of experience, nationalities, and sleeping patterns. The study concluded that most of the participants who belonged to the medical department faced varying degrees of anxiety and depression. The results reveal considerable rates of anxiety and depression in Saudi frontline workers.

Sepsis, a life-threatening condition, commonly affecting critically ill patients, is a major cause of death worldwide. It is thus of great importance to determine the optimum management to cure this condition. This review article summarizes the role and effects of corticosteroids in the treatment of sepsis and septic shock, and to determine its mortality benefits. We used PubMed, Google scholar, Scopus, and Embase databases for literature review, and terminologies commonly searched were ‘sepsis’, ‘septic shock’, ‘therapeutic use’ and ‘corticosteroids’. In this review article, we reviewed a total of eight different articles being done in last 10 years, relevant to the clinical outcome and effects of corticosteroids. Among those, two demonstrated improved clinical outcomes, two showed both improved clinical outcomes and decreased mortality, three showed increased adverse effects, and the remaining one showed unequivocal results.

Hemophagocytic lymph histiocytosis (HLH) is not an independent disease but is instead a clinical syndrome that occurs in many underlying conditions involving all age groups. HLH is the consequence of a severe, uncontrolled hyperinflammatory reaction that in most cases is triggered by an infectious agent. Acquired HLH is much more common than primary HLH syndrome but primary is more fatal, and it does have the worst prognosis with no definitive treatment available to date. This review article mentioned all the latest advancements regarding etiologies, pathogenesis, treatment, and outcomes in critically ill patients who got diagnosed with HLH syndrome in last 15 years.

The city of Jeddah experienced a severe flood in 2020, resulting in loss of life and damage to property. In such scenarios, a flood forecasting model can play a crucial role in predicting flood events and minimizing their impact on communities. The proposed study aims to evaluate the performance of machine learning algorithms in predicting floods and non-flood regions, including Gradient Boosting, Extreme Gradient Boosting, AdaBoosting Gradient, Random Forest, and the Light Gradient Boosting Machine, using the dataset from Jeddah City, Saudi Arabia. This study identified fourteen continuous parameters and various classification variables to assess the correlation between these variables and flooding incidents in the analyzed region. The performance of the proposed algorithms was measured using classification matrices and regression matrices. The highest accuracy (86%) was achieved by the Random Forest classifier, and the lowest error rate (0.06) was found with the Gradient Boosting regressor machine. The performance of other algorithms was also exceptional compared to existing literature. The results of the study suggest that the application of these machine learning algorithms can significantly enhance flood prediction accuracy, enabling various industries and sectors to make more informed decisions.

Rapid population growth and high rate of urbanization make municipal solid waste management a challenging task for municipalities. Lack of sufficient infrastructural facilities worsen this challenging situation. To curb this, transfer stations, which are facilities located close to residential areas and are used to receive and hold waste temporarily until it is transported to distant landfills. It reduces waste transportation cost and provide a place for waste segregation. In Lahore open transfer station is built near river Ravi and residential areas which is creating air and land pollution. This study is carryout to select the suitable location for waste transfer station in Lahore that meets the USEPA criteria. Buffer command of Arc GIS is used for site selection. Best suitable sites selected for Lahore in this analysis are UC Sultanki and UC Chandrai where more buffers are joint during buffer analysis. Furthermore, cost estimation for the construction and operation of both waste transfer stations are done.

Background: The term asymptomatic bacteriuria (ASB) refers to the isolation of bacteria in a urine specimen of individuals who denied symptoms of urinary tract infection. Diabetes mellitus (DM) is a disease involving multiple organ systems, hallmarked for its chronicity and thus-forth endless complications including asymptomatic bacteriuria. Objectives: This study aimed to determine the characteristics of asymptomatic bacteriuria and antibiotic susceptibility pattern amongst patients with diabetes. Settings and Design: A prospective observational study was conducted at a tertiary care hospital in Karachi, Pakistan. Methods and Material: The study included all those patients with a diagnosis of diabetes with no signs and symptoms of urinary tract infection but showing the growth of an organism in urine culture. Pregnant females and subjects who used antibiotics in last two weeks were excluded. A total of 222 urine cultures were observed prospectively who met the inclusion criteria through non-probability consecutive sampling. Results: Out of 222 urine cultures observed, mean age of subjects were 62.89 ± 13.77 out of which 76% were females, and 61% had a family history of diabetes. The most frequent organisms isolated were Escherichia. Coli (E. Coli), Enterococcus, Klebsiella, Pseudomonas, and Enterobacter species. A total of 20 subjects got dual bacterial growth in their cultures among which 17 subjects had a growth of Enterococcus with any other pathogen causing UTI. Gender, family history of diabetes, levels of HBA1c, and older age groups all were found significantly associated with ASB. Conclusions: Our study is the first to analyze and study the associated risk factors amongst ASB in DM patients, and to identify the pathogens involved along with assessing their antibiotic resistance profiles. Also, due to the increase resistance to antibiotics we would recommend to use antibiotics in ASB patients only if they have any two or more comorbidities.

Sepsis is extremely common amongst critically ill patients and requires early diagnosis. Hence, identifying a biomarker that could acknowledge sepsis at its prior stage is of vital significance. Immature platelets are a percentage of circulating platelets that contain RNA and is a newer parameter that is measured using automated hematology analyzers in diagnosing sepsis. This review article discusses 10 articles that reveal the role of immature platelet fraction in predicting the onset of sepsis and its relationship with mortality in sepsis. Literature search was done using PubMed, Scopus and Google Scholar and words like platelet indices and immature platelet fraction were typed in the search bar. The aim of this review article is to present a precise form of data that talk about immature platelet fraction (IPF) and its association with the severity and mortality of sepsis. Five out of 10 articles suggest that immature platelet fraction can predict the onset of sepsis and eight out of 10 articles suggest that increased IPF values are associated with high mortality.

It is common upon admission or during stay at a hospital or intensive care unit (ICU) for patients to present with or acquire a serum sodium abnormality. Hyponatremia, serum sodium level less than 135 mmol/L, frequently associated with critical illnesses such as heart failure and liver cirrhosis, is an indicator of disease severity as well as a risk factor for poor prognosis. Hypernatremia, serum sodium level greater than 145 mmol/L, results due to any ailment disabling a patient's modality of thirst or the ability to relieve it once sensed. Hypernatremia has a more frequent iatrogenic component than hyponatremia. It can develop insidiously among patients through IV fluid administration of saline; both its presentation upon admission and development during stay is associated with mortality. Hyponatremia is associated with increased mortality and its treatment with morbidity as it carries a risk of overcorrection and consequently the development of central pontine myelinolysis. This review article covers the findings, and subsequent correlation between findings sought, of six articles catering to underscore the correlation between sodium disorders and prognosis of hospitalized or critically ill patients. PubMed search engine was utilized to select articles befitting the purpose of this review. Cumulatively, this review article substantiates the need to diligently evaluate and treat serum sodium disorders in hospitalized patients to achieve better prognosis.

This case details a 33-year-old female who presented with a suggestive autoimmune history, arthralgias, and splenomegaly, and tested positive for Sjögren’s syndrome and anti-liver–kidney microsomal antibody. This was further validated by findings from a liver biopsy, confirming a very rare association with Type 2 autoimmune hepatitis. Primary Sjögren’s syndrome is a sporadic disease with a global prevalence of 61 per 100,000 people and a total prevalence of 0.4% for secondary Sjögren’s syndrome. The prevalence of autoimmune hepatitis in association with primary Sjögren’s syndrome is 4–47%. It is divided into two types, associated with characteristic antibodies. Type 2 autoimmune hepatitis is rarely reported with Sjögren’s syndrome; much of the association reported in the literature has been with Type 1 autoimmune hepatitis.

Haemophagocytic lymphohistiocytosis (HLH) is a rare but potentially aggressive and life-threatening syndrome of overactive histiocytes and lymphocytes that commonly affects infants; it is also observed in children and adults of all ages. The disease is differentiated into either primary or secondary causes. Primary HLH tends to be of genetic origin, while secondary HLH results from either infection, autoimmune disorders, or malignancies. Secondary HLH is most commonly associated with viral infections in immunocompromised patients. This paper presents a case of HLH in a tertiary care hospital, associated with adult-onset Still’s disease, diagnosed on both biochemical criteria and histopathologic examination of bone marrow smear.

Guillain–Barré syndrome (GBS) is a form of rapidly progressive, acute inflammatory demyelinating polyradiculopathy. Acute inflammatory demyelinating polyradiculopathy is the most common variant of GBS, especially in the western hemisphere. It is diagnosed without hesitation when it presents with its characteristic clinical features of ascending paralysis and areflexia. It is when an atypical presentation appears, with brisk or very brisk reflexes, that diagnosis becomes difficult. In this case, a patient who presented with progressive motor weakness, unilateral facial palsy, and hyperreflexia on examination is described in order to demonstrate a variant of GBS and its management. Keeping in mind that the management of the disease does not change with the variant, the diagnostic challenge that is put forward by those variants needs a focussed approach by physicians.

A 30-year-old Asian male with a significant history of deep vein thrombosis and family history positive for pulmonary embolism presented with complaints of fever, nonradiating epigastric pain, and a sense of abdominal fullness. After the initial workup, ultrasonography of the whole abdomen was carried out which showed thrombus formation in the portal vein. A CT scan of the abdomen was performed, which showed findings suggestive of mesenteric panniculitis. Keeping the significant family history and imaging findings in mind, the clotting and thrombin profiles were analysed and came back positive for the factor V Leiden gene (homozygous). A CT angiogram was performed to demonstrate extensive thrombosis throughout the abdominal vasculature with cavernous transformation. It is asserted that the chronic thrombosis on a background of factor V mutation led towards chronic inflammation of the mesentery. To the authors’ knowledge it is the first reported case of mesenteric panniculitis in a patient with factor V homozygous gene mutation.

Microscopic polyangiitis (MPA) is a primary systemic vasculitis characterized by inflammation of small-sized vessels associated with the presence of anti-neutrophilic cytoplasmic antibodies. We report a case of a 39-year-old female diagnosed with microscopic polyangiitis as an incidental finding who presented with signs and symptoms of a stroke at a young age. Usually, it presents with fever, malaise, skin rash, weight loss, mononeuritis multiplex, and arthralgia/myalgia. Very rarely, it can involve meninges to cause meningeal vasculitis which can present as a febrile seizure. The most frequent neurological manifestation is peripheral neuropathy. Cerebral infarction or hemorrhage as an isolated finding is very rarely observed in the patient with MPA as was seen in our patient.

A 35-year-old male of Asian ethnicity presented with complaints of high-grade fever, severe headache, vomiting, generalized seizures, deteriorated conscious level and neck stiffness. After all baseline workup Computed Tomography (CT) scan of the brain was done, which turned out to be unremarkable. CT scan was then followed by lumbar puncture (LP) and Cerebrospinal fluid (CSF) detailed report was sent, which was highly suggestive of bacterial meningitis with the predominance of polymorphonuclear leukocytes. Later on, CSF culture and sensitivity report showed growth of Escherichia coli, which is one of the rare causes of meningitis in immunocompetent adults without any history of craniocerebral trauma, neurosurgical intervention, urinary or gastrointestinal tract infections, and an immunocompromised state. Abbreviations CSF: Cerebrospinal fluid; LP: Lumbar puncture; CT: Computerized tomography; E-coli: Escherichia coli; GCS: Glasgow coma scale; COPD: Chronic Obstructive Pulmonary Disease; HTLV1: Human T-Lymphotropic virus −1; PCR: Polymerase chain reaction

We present a case of sigmoid volvulus in a young male patient with culture-proven Salmonella Typhi in the blood which was sensitive to Meropenem and Azithromycin only, presented with fever, vomiting, loose stools, hematochezia, abdominal distention and tenderness with no signs of perforation on erect chest x-ray. Further, radiological imaging showed signs of sigmoid volvulus. An urgent colonic decompression with untwisting of the mesentery was performed. In our case, it can be said that sigmoid volvulus was developed as a complication of multiple drug-resistant strains of Salmonella Typhi. The resistance is acquired by alteration in the genome sequence. Currently, it is important to control such an unknown outbreak of multiple drug-resistant strains of Salmonella Typhi as it is a serious health care issue of disease control and prevention in Pakistan.

A 45-year-old Asian woman was presented with fever, easy fatigability, shortness of breath, cervical and axillary lymphadenopathy and other signs and symptoms of anemia. After all the baseline work-up, the patient was investigated for Mono-coombs C3d levels, which were elevated, suggesting the diagnosis of Cold autoimmune hemolytic anemia (Cold AIHA). An Ultrasound-guided true-cut biopsy was done to determine the primary cause associated with it, which showed the presence of tumor cells arranged in cords and clusters. They have dark staining cells with mitotic activity, suggestive of breast carcinoma as an association of Cold AIHA. Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) were sent, which came out to be positive. So, the patient was diagnosed with Cold AIHA in association with triple-positive breast cancer.

Approximately 30% of the global population is suffering from obesity and being overweight, which is approximately 2.1 billion people worldwide. The ratio is expected to surpass 40% by 2030 if the current balance continues to grow. The global pandemic due to COVID-19 will also impact the predicted obesity rates. It will cause a significant increase in morbidity and mortality worldwide. Multiple chronic diseases are associated with obesity and several threat elements are associated with obesity. Various challenges are involved in the understanding of risk factors and the ratio of obesity. Therefore, diagnosing obesity in its initial stages might significantly increase the patient’s chances of effective treatment. The Internet of Things (IoT) has attained an evolving stage in the development of the contemporary environment of healthcare thanks to advancements in information and communication technologies. Therefore, in this paper, we thoroughly investigated machine learning techniques for making an IoT-enabled system. In the first phase, the proposed system analyzed the performances of random forest (RF), K-nearest neighbor (KNN), support vector machine (SVM), decision tree (DT), logistic regression (LR), and naïve Bayes (NB) algorithms on the obesity dataset. The second phase, on the other hand, introduced an IoT-based framework that adopts a multi-user request system by uploading the data to the cloud for the early diagnosis of obesity. The IoT framework makes the system available to anyone (and everywhere) for precise obesity categorization. This research will help the reader understand the relationships among risk factors with weight changes and their visualizations. Furthermore, it also focuses on how existing datasets can help one study the obesity nature and which classification and regression models perform well in correspondence to others.

ABSTRACT Objective: To describe two cases of unusual variants of sickle cell disease. Case description: We present two cases of sickle cell disease variants (haemoglobinopathies), from unrelated families, in the state of Balochistan (Pakistan). One was diagnosed with sickle cell disease in the haemoglobin electrophoresis, whereas the other was diagnosed with sickle cell SE disease. Both were diagnosed based on the presentation of osteomyelitis. Comments: Haemoglobin SD disease (Hb SD) and haemoglobin SE disease (Hb SE) are rare haemoglobinopathies in the world. The lack of available literature suggests that both are variants of sickle cell disease (SCD), with heterogeneous nature. The prevalence of sickle cell disease with compound heterozygotes was found at a variable frequency in the population of the Asian Southeast. The frequency of osteomyelitis in SCD is 12 to 18%, but its occurrence among variant haemoglobinopathies is little reported. Both reported cases presented with osteomyelitis as a characteristic of the disease presentation.

Objective: To determine the frequency of immunisation of children upto 5 years of age according to vaccination card in the outpatient department of Abbasi Shaheed Hospital and Pakistan Naval Station (PNS) Shifa, Bahria University Hospital Karachi. Methods: A hospital based cross-sectional study was done for the period of two years from 2014 to 2016 in the Paediatric outpatient department (OPD) and vaccination center of Abbasi Shaheed Hospital and PNS Shifa Hospital. The study was done after the approval of ethical review board of Karachi Medical and Dental College (KM&DC). Sampling procedure was non-probability convenience sam- pling. A total of 1408 children were included in study. The informed valid verbal consent was taken from the parents before entering the data on pre designed vaccination charts according to the Ex- panded Program of Immunisation (EPI) schedule. Data was entered after confirmation from child's vaccination card only. Data was analysed using SPSS version 20.0 for statistical analysis. Results: Out of 1408 children 53.8% were male, 46.2% females. Age of the children was 0 to 60 weeks (5 years) out of which 73.0% were under one year of age. At birth, 46.3% received Bacille Calimette-Guerin (BCG) vaccine, 64.5% received both Oral Polio Vaccine (OPV) and Pentavalent 1 (Diphtheria, Pertussis, Tetanus, Hep-B, H. influenza) at 6 weeks, 57.8% received OPV and Pentavalent 2 at 10 weeks, 56.4% received OPV and Pentavalent 3 at 14 weeks. Only 34.9% were vaccinated for measles at 9 months, which was reduced to 22.7% at 15 months. A total of 51.8% were completely vaccinated, 41.6% were incompletely vaccinated and 6.6% were unvaccinated. Conclusion: This study suggests that the rate of complete immunisation is still low and there are drop-outs to the subsequent vaccines that needs immediate control. Moreover, about 40% of children appear incompletely vaccinated which is indeed an alarming situation.

Objective: To explore the effect of black radish (Raphanus sativus L. var niger) root extract on liver enzymes, oxidative stress, and histopathological alterations in mice with sodium valproate-induced hepatotoxicity. Methods: Thirty-two mice were divided into four groups: the control group received drinking water by gavage, the second group was administered with 100 mg/kg of sodium valproate, the third group received 300 mg/kg of black radish root extract, and the fourth group was given both sodium valproate (100 mg/kg) and black radish root extract (300 mg/kg). After 28 days, the mice were euthanized, and serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP), along with liver malondialdehyde (MDA), reactive oxygen species (ROS), mitochondrial parameters, tumor necrosis factor-alpha (TNF-α) gene expression, and histopathological changes were assessed. Results: Sodium valproate caused hepatic damage in mice, characterized by elevated serum levels of liver enzymes, increased MDA and ROS levels and TNF-α gene expression, as well as histopathological alterations. The black radish root extract significantly alleviated sodium valproate-caused hepatic injury by decreasing the serum levels of ALT and AST, MDA, ROS, TNF-α gene expression, as well as mitochondrial impairment, but did not have a significant effect on sodium valproate-induced histopathological changes. Conclusions: The black radish root extract demonstrates protective effects against sodium valproate-induced liver injury, possibly through mitigating oxidative stress, mitochondrial impairment, and inflammatory mediator expression.

Abstract Urinary incontinence (UI) could negatively affect a person’s quality of life (QoL). This study investigates the association among gynecological cancers, their treatments, UI, and its effect on the QoL of survivors of gynecological cancer. This cross-sectional questionnaire-based study included 121 cases from 405 patients who had undergone gyneco-oncological therapy. The participants were asked whether they experienced any form of UI and whether it impacted their QoL. The following therapies were used to treat the 12 gynecologic tumor types found in the participants: surgery (n = 116, 95.87%), chemotherapy (CTx) (n = 51, 42.2%), radiotherapy (RTx) (n = 31, 25.6%), and antibody therapy (ABT) (n = 11, 9.1%). No significant association was determined between tumor type and UI. However, body mass index (BMI), radical hysterectomy, vulvar or vaginal surgery, and presence of UI before treatment had significant impacts on the presence of UI. The surgical access routes, CTx, ABT, and hysterectomy had significant impacts on the severity of UI after treatment. Among all patients, 55.4% reported very good QoL. These reports of good QoL by patients could be due to their very good adjustment to the situation, with regard to being diagnosed with and receiving treatment for cancer, or due to the patients considering UI to not be much of an issue. Additionally, 34% of patients reported they had not been informed about the risk of UI before treatment. Informing patients about UI as one of the risks of therapy before initiating the treatment is crucial as patients who had been informed beforehand coped with UI far better than those who were not informed. Hence, the treatment of UI is often successful, so patients should be encouraged to receive urogynecological consultation.

Backgroundand endotracheal intubation under direct vision in both anticipated and unexpecteddifficult intubation situations.: The LMA CTrach system is a new device for airway managementMethodsdifferent types of elective surgeries. After randomly selecting the patients for intubationwith this new device, the airway characteristics, height,weight, dental overbiteand thyromental distance were all evaluated before induction.Our goal was to exploreprimarily the success rate of intubation with LMACTrach.:We used this system in 100 patients undergoing general anesthesia forResultsall 100 patients. Nonetheless,successful tracheal intubation was performed in 95 patients.Among our patients,2 had Mallampati grade IV airways with short necks,body mass index(BMI) > 30, and without the capability to bite their upper lips.Amazingly both patients were intubated with this method,proving a device as an assuringapproach in cases of difficulty with ventilation and intubation. Of all patients,44 were females and 56 males.The mean age was 34 ± 2 years. BMI measured for allpatients was 20-25 except for two cases who had BMI > 30.: We were able to insert LMA CTrach and provide optimal ventilation inConclusionand vocal cords during intubation even in difficult cases,it can be assumed that thisdevice is a precious aid as equal as fiberoptic bronchoscopy for the anesthesiologists.:Since the LMA CTrach provided us with direct view of the larynx

BACKGROUND: Cirrhosis is terminal stage of many chronic liver diseases like hepatitis C and hepatitis B. In some studies the role of helicobacter pylori has been demonstrated in progress of cirrhosis and its complications, but none of the previous studies has investigated the role of socioeconomic conditions of patients in childhood period in this issue. METHODS: In a case-control study, we examined 100 cirrhotic patients due to hepatitis (49 hepatitis B and 51 hepatitis C patients) and 101 socioeconomically matched healthy controls presenting to Taleghani Hospital for IgG antibody to helicobacter pylori. RESULTS: IgG antibody to helicobacter pylori was present in 73% of cirrhotic patients and 52% of control group (P CONCLUSIONS: The relative frequency of IgG antibody to helicobacter pylori found to be higher in cirrhotic patients than in controls with regard to socioeconomic condition in childhood. KEY WORDS: Cirrhosis, hepatitis C, hepatitis B, helicobacter pylori, liver disease.

Objectives: To evaluate the knowledge, attitude and practices of the undergraduate college students towards corona virus disease (COVID-19) and adoption of personal protective measures as per standard operating procedures (SOPs) stipulated by Federal government for reopening of educational institute. Methodology: This was cross sectional survey conducted at Hyderabad and Faisalabad based colleges form 25 September to 15 October 2020. Prior to the study, permission was taken from principal of concerned colleges (vide no.TSS/22/2021, Kotri Jamshoro) Structured proforma comprised of 28 questions concerning knowledge, attitude and practices toward the COVID-19 and implementation of SOPs in educational institutes was used. Questionnaire was formed on Google form and its link was shared among 200 college students of various disciplines through WhatsApp. Results from the response summary were compiled and analyzed. Results: Structured proforma was distributed among 200 undergraduate students of age range18-20 years, only 170 students’ submitted complete responses. Response rate was 85%. More than half (70.9%) of the subjects have good knowledge and positive attitude concerning COVID-19. Majority of the students (89.2%) were using masks, 88.6% were in habit of regular hand washing ,while 84.3 % of students preferred to use sanitizers, 91.6% practiced social distancing and avoided crowded places ,75.3% students avoided unnecessary travelling. 98-99% of students agreed that SOPs set by government was strictly followed in the colleges. Conclusion: Majority of the students were aware of the preventive measures for COVID outbreak. Students have positive attitude and are adequately practicing precautionary measures to avoid contracting COVID-19. SOPs are following in the colleges to alleviate the risk of spread of lethal Corona.