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Purpose of the study: This study was conducted with the sole aim to assess the prevalence of stigma in patients with Hepatitis C and to assess the association between them through the quantitative measure, i.e. chi-square test. Methodology: A cross-sectional-based study was designed from 361 sampled respondents (Hepatitis C patients) in 3 teaching hospitals in Peshawar-Pakistan. Data was collected on a three-level Likert Scale interview schedule covering both the study variables. A conceptual framework comprised of the dependent variable health-related quality of life among HCV patients was cross-tabulated and indexed with the independent variable social stigma disease carry through the application of chi-square test statistics. Principal Findings: The association of Health-Related Quality of Life was found significant with perceiving shaking hands with HCV patients as a cause of the disease (P=0.018), people hesitate in embracing HCV patients (P=0.000), people were uncomfortable while sitting beside HCV patients (P=0.001), family members are reluctant in carrying out HCV test for other family members (P=0.028), patients were given due attention at family (0.007), patients shared their problem with others without any fear (P=0.014), patients telling people about their disease (P=0.000), patients blamed themselves for disease (p=0.009) and patients participated in social activities (P=0.000). Applications of this study: Raising awareness, through reliable sources, among masses, especially with relation to symptoms and causes of HCV, to reduce the reluctance of people in contacting HCV patients and training families of HCV patients to adopt the allowable social interaction with HCV patients were some of the recommendations in light of the study. Novelty/Originality of this study: This cross-sectional study is designed to assess the prevalence of stigma in patients with Hepatitis C and to assess the association between them through the quantitative measure, i.e. chi-square test. This research has come under the domain of medical sociology, social psychology, along with diagnosing the hidden dilemma, which exists since its existence.

Purpose of the study: This research study was designed to analyze various social factors like population dynamics, institutional, land tenure, and gender other than the technological one that affects the production of sugarcane in farming communities. Methodology: The method of the study was qualitative, where the data was collected through FGDs. Two FGDs were conducted in two districts of the central valley of Khyber Pakhtunkhwa-Pakistan. Each FGD consisted of 10 participants. The data was analyzed through thematic analysis. Main Findings: The findings of the study revealed that sugarcane productivity is affected by sociological factors like technological ones. The poor socioeconomic status of the farmers, wasting resources in land disputes, frequent land division among heirs, a rapid increase of population growth, unplanned urbanization conversion of fertile agricultural land into the built environment, weakening the role of informal institutions like Jirga and farmers organizations, lack of access to agricultural institutions, the restricted role of women in farming and unfavourable attitude of farmers towards new agrarian technologies, all were the significant contributing factors that negatively influenced sugarcane productivity. Applications of this study: The findings of the study be used by the agricultural department, NGOs, and the government while taking into consideration the factors responsible for sugarcane productivity. Novelty/Originality of this study: This study is novel that no study has yet conducted while considering sociological factors in sugarcane production in Pakistan. This research a unique in that provides a base for agricultural scientists to keep in mind social factors as well in agrarian production besides technological factors.

Background Various prediction models have been developed to predict the risk of kidney failure in patients with CKD. However, guideline-recommended models have yet to be compared head to head, their validation in patients with advanced CKD is lacking, and most do not account for competing risks. Methods To externally validate 11 existing models of kidney failure, taking the competing risk of death into account, we included patients with advanced CKD from two large cohorts: the European Quality Study (EQUAL), an ongoing European prospective, multicenter cohort study of older patients with advanced CKD, and the Swedish Renal Registry (SRR), an ongoing registry of nephrology-referred patients with CKD in Sweden. The outcome of the models was kidney failure (defined as RRT-treated ESKD). We assessed model performance with discrimination and calibration. Results The study included 1580 patients from EQUAL and 13,489 patients from SRR. The average c statistic over the 11 validated models was 0.74 in EQUAL and 0.80 in SRR, compared with 0.89 in previous validations. Most models with longer prediction horizons overestimated the risk of kidney failure considerably. The 5-year Kidney Failure Risk Equation (KFRE) overpredicted risk by 10%-\18%. The four- and eight-variable 2-year KFRE and the 4-year Grams model showed excellent calibration and good discrimination in both cohorts. Conclusions Some existing models can accurately predict kidney failure in patients with advanced CKD. KFRE performed well for a shorter time frame (2 years), despite not accounting for competing events. Models predicting over a longer time frame (5 years) overestimated risk because of the competing risk of death. The Grams model, which accounts for the latter, is suitable for longer-term predictions (4 years).

Coronavirus disease 2019 (COVID-19) is a pandemic caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The spread of the virus was rapid and currently COVID-19 cases are present worldwide in 213 countries, area or territories. Researchers worldwide are working and sharing their contribution regarding epidemiology, prevention, treatment, clinical and diagnostic patterns of the COVID-19. Current review is another contribution to the current knowledge, presenting the data in organized and systematic format about the current pandemic of COVID-19. The epidemiological information presented in the paper is subject to change as new cases are diagnosed and status of active cases is updated on daily basis.La enfermedad por coronavirus de 2019 (COVID-19) es una pandemia causada por un nuevo coronavirus, el coronavirus causante del síndrome respiratorio agudo severo 2 (SARS-CoV-2). La difusión del virus fue rápida y, actualmente, existen casos de COVID-19 a nivel mundial en 213 países, áreas o territorios. Los investigadores internacionales trabajan y comparten sus contribuciones en cuanto a epidemiología, prevención, tratamiento, patrones clínicos y diagnósticos de COVID-19. La presente revisión es otra contribución al conocimiento actual, que presenta los datos sobre la pandemia de COVID-19 en formato organizado y sistemático. La información epidemiológica presentada en el documento está sujeta a cambios, a medida que se diagnostiquen nuevos datos y se actualice el estatus de los casos activos, de manera diaria.

The novel coronavirus disease 2019 (COVID-19) has become a severe health issue, especially to the patients who develop silent hypoxia condition after SARS-CoV-2 infection. Due to the lack of dyspnoea and extremely low oxygen saturation level, these patients are at exceptionally higher risk. Although the prevalence of silent hypoxia in COVID-19 patients has been evident in several cases, the underlying pathomechanism behind this condition is still unclear. Silent hypoxia in SARS-CoV-2 infected patients can be diagnosed with the help of a pulse oximeter, blood gas levels, and a 6-min walking test. While the clinicians and researchers figure out the exact reason for this phenomenon, the patients must be under strict day-to-day monitoring. In this article, we aim to provide comprehensive insights into the underlying symptoms, mechanism, and possible factors behind the occurrence of silent hypoxia among COVID-19 patients.

Globally field application of mineral potassium (K) fertilizer has grown, followed by reduced K use efficiency (KUE) and K agronomic efficiency (KAE) which ultimately leads to environmental pollution and economic loss. The soils of Pakistan have a low K level due to a higher proportion is present in an unavailable form. The objective of the current study was to isolate efficient plant growth-promoting fungus to sustainably manage huge burden of sugar industry waste press mud into a productive biofertilizer. K from biofertilizer was then evaluated in different treatments for maize biological yield, grain yield, harvest index (HI), K uptake in different maize parts, KUE and KAE in comparison to mineral fertilizer (MF). The efficiency of treatment was measured on higher KUE and KAE. In-vitro studies revealed that A. niger PM-4 was found to solubilize phosphate (389 ug/ml) and zinc (115 ug/ml) from insoluble tri-calcium phosphate and zinc oxide, respectively, at a wider temperature and pH range. The strain was also found to inhibit the production of aflatoxins and its inoculation into press mud produced non-phytotoxic and mature biofertilizer with germination index 96.5%. Bio-augmentation of press mud with A. niger shortens maturity period with improved nutrient contents. Higher grain yield and harvest index of maize were achieved with a higher amount of incorporated K from mineral and biofertilizer T5(100%Org+50%MF) than any other treatment. However, higher KUE and KAE were found in the following order: T6 > T5 > T2 > T3 > T4 > T1, demonstrating the integrated and balanced use of K from mineral and biofertilizer without threatening the environment.

In this study, a total of seventeen (17) waterborne, biofilm-producing isolates of Escherichia coli were used. The population analysis showed that biofilm consortia harbour three different phenotypes e.g. smooth surface phenotypes (SSP), rough surface phenotypes (RSP) and small colony variants (SCVs). The SSP was hydrophilic and the initiator of biofilm formation processes in response to environmental stress. The RSP exhibited hydrophobic properties and occupy the core of biofilm consortia. They were slow-growing and produced a high quantity of exopolysaccharides as compared to SSP and SCVs. The highly adhesive and hydrophobic SCVs appeared after 48 h of incubation and occupy the lower base of biofilm consortia. They were metabolically inactive and difficult to disperse after adhesion. Our experiments show that all the subject isolates of E. coli carry wcaF and flu gene. Besides, the comparative analysis showed that wcaF and flu gene expression was high in RSP. These phenotypes activate wcaF and flu genes to produce extracellular matrix material to persist in biofilm consortium. Comparative analysis showed the biofilm formation was initiated by SSP while the RSP and SCVs was a product of a cruel environment and has a major role in the stability and persistence of consortia.

Coronavirus disease-19 (COVID-19) is associated with significant mortality. The elderly, patients with comorbidities, and solid organ transplant (SOT) recipients are particularly at risk. We observed a low incidence of severe disease in our population and aimed to determine the outcomes of COVID-19 (disease severity/intensive care unit [ICU] admissions/mortality) in SOT recipients.All SOT recipients diagnosed with COVID-19 were included. Their demographic and clinical data were recorded from the hospital electronic system. Patients were assigned to 1 of 4 stages of disease severity: stage A = asymptomatic, stage B = mild, stage C = moderate, and stage D = severe.Of the 3052 SOT recipients, 67 were diagnosed with COVID-19. The mean age was 52 years, and 69% were male. There were approximately 25% patients in stage A, 28% in stage B, 34% in stage C, and 12% in stage D. Patients in stages C and D were older than those in stage A (P = 0.04) or stage B (P = 0.03). Lactic dehydrogenase (P0.01) and D-dimer (P0.01) levels were higher across the stages. Approximately 70% of patients were admitted for a median duration of 9 days and the median follow-up was 35 days. Acute kidney injury occurred in 19% of patients, and 45% required supplementary oxygen. The symptomatic patients were treated with Hydroxychloroquine (83%), Azithromycin (89%), and Tocilizumab (23%). Around 15% of patients were admitted to ICU and 2 patients have died.Most SOT recipients developed mild to moderate COVID-19 infection; few required ICU admission and 2 patients have died. Remaining patients have recovered and have been discharged from the hospital.

This study presents a detailed measurement of indoor and outdoor terrestrial gamma radiation levels in different cities of Pakistan. The measurements covered dwellings in 27 cities, covering all provinces and region of Azad Kashmir. Most of the houses were of attached type, made of brick walls and concrete roofs. The measurements were made by a handheld radiation survey meter containing Geiger–Muller tube. The average absorbed dose rate in air was 100 ± 32 nGy h−1 for indoor and 74 ± 30 nGy h−1 for outdoor. The population-weighted mean terrestrial dose rates were 90 nGy h−1 for indoor and 78 nGyh−1 for outdoor. The ratio of indoor to outdoor absorbed dose rate was 1.5 as compared to 1.3 for the world average. The estimated average annual effective dose rate was 0.58 ± 0.18 mSv a−1 and the mean excess life time cancer risk was 2.0 × 10−3.

Atypical spindle cell lipomatous neoplasm, also known as well-differentiated spindle cell liposarcoma, represents a newly discovered entity of adipocytic tumors. Recent research has shown this tumor variant to be more related to spindle cell lipoma, rather than the originally hypothesized atypical lipomatous tumor spectrum. Here we present a case of a 58-year-old man with a history of chronic lymphocytic leukemia with an enlarging mass on the posterior left shoulder, initially hypothesized to be a benign lipoma. However, magnetic resonance imaging showed a large, multiseptated, heterogeneous mass concerning for soft tissue sarcoma. After resection, pathologic analysis showed cells closely resembling spindle cell lipoma, with additional cellular and fascicular zones containing lipoblasts and mitotic figures. Molecular analysis showed no MDM2 amplification. This lack of amplification indicates this tumor is distinctly different from an atypical lipomatous tumor, which characteristically displays MDM2 amplification. However, tumor expression of RB1 was normal. The majority of atypical spindle cell lipomatous neoplasms are associated with RB1 deletions. We conclude that we have a unique example of an atypical spindle cell lipomatous tumor.

Panicle size is one of the yield determining traits in rice (Oryza sativa L.). In the current study, a rice mutant named cytokinin oxidase/dehydrogenase (Osckx2-2) was developed from the indica cultivar 9311 by ethyl methanesulfonate (EMS) mutagenesis. A comparison of agronomic traits showed that the panicle of the Osckx2-2 mutant was longer with dense branching pattern and higher seed setting rate compared to the wild-type (WT). In addition, the grains in the Osckx2-2 mutant were markedly longer, wider, and heavier compared to the WT. Histological analysis revealed that a higher number of the spikelet cells with bigger size resulted in larger grains in the Osckx2-2 mutant. By map-based cloning, SNP was detected in the 3′-UTR of the OsCKX2-2 gene which encodes cytokinin dehydrogenase and the cleaved amplified polymorphic sequence (CAPS) marker was developed based on the detected SNP. The RT-qPCR analysis displayed a decreased OsCKX2-2 expression in the Osckx2-2 mutant panicles. Meanwhile, the enzymatic activity assay showed the reduced cytokinin dehydrogenase enzyme activity, whereas the enzyme-linked immunosorbent assay (ELISA) revealed remarkably higher endogenous cytokinin content in the Osckx2-2 mutant in contrast to WT. The analysis of grain quality parameters showed that the degree of chalkiness and gel consistency decreased, while the amylose content and alkaline spreading value increased in the Osckx2-2 mutant. The OsCKX2-2 gene and Osckx2-2 mutant would be beneficial in marker-assisted backcrossing to improve yield in rice.

Nitrogen (N) deficiency is one of the critical environmental factors that induce leaf senescence, and its occurrence may cause the shorten leaf photosynthetic period and markedly lowered grain yield. However, the physiological metabolism underlying N deficiency-induced leaf senescence and its relationship with the abscisic acid (ABA) concentration and reactive oxygen species (ROS) burst in leaf tissues are not well understood. In this paper, the effect of N supply on several senescence-related physiological parameters and its relation to the temporal patterns of ABA concentration and ROS accumulation during leaf senescence were investigated using the premature senescence of flag leaf mutant rice (psf) and its wild type under three N treatments. The results showed that N deficiency hastened the initiation and progression of leaf senescence, and this occurrence was closely associated with the upregulated expression of 9-cis-epoxycarotenoiddioxygenase genes (NCEDs) and with the downregulated expression of two ABA 8′-hydroxylase isoform genes (ABA8ox2 and ABA8ox3) under LN treatment. Contrarily, HN supply delayed the initiation and progression of leaf senescence, concurrently with the suppressed ABA biosynthesis and relatively lower level of ABA concentration in leaf tissues. Exogenous ABA incubation enhanced ROS generation and MDA accumulation in a dose-dependent manner, but it decreased the activities of glutamine synthetase (GS) and glutamate dehydrogenase (GDH) in detached leaf. These results suggested that the participation of ABA in the regulation of ROS generation and N assimilating/remobilizing metabolism in rice leaves was strongly responsible for induction of leaf senescence by N deficiency.

The Zinc finger antiviral proteins (ZAP) are expressed by the cells in response to different viral attacks. The ZAP marks the viral mRNA for degradation with the help of different cellular proteins for exosome. Beside the degradation of viral mRNA, the ZAP protein also inihibits translation of proteins from this mRNA. Although it is not a universal antiviral protein, but a number of important human pathogenic viruses are controlled by the ZAP protein. In this review article we have discussed the current progress made in understanding the structure, function, mechanism and therapeutic roles of the ZAP protein.

Nutrients, vitamins, probiotics, and herbal products may be risk factors, or alternately, protect against the formation of urinary stones. The purpose of this review was to update knowledge of the role of nutraceuticals in renal stone formation. A systematic search of the relevant literature published in PubMed in the last ten years was conducted and a narrative review of the data from the included studies was done. Search screened 513 studies that were reduced to 34 after evaluation by title and abstract; other 38 studies were retrieved by references of the selected studies. Beverages high fluid intake confirmed protective effect; orange juice protective effect; apple or grapefruit juice not confirmed as risk factors; sugar-sweetened soda and punch increased risk of stone formation. Energy intake: very high energy intake increased risk factor for women (especially after menopause); dietary acid load increased risk at equal levels of energy intake. Macronutrients confirmed increased risk of high protein intake. Calcium and Oxalate: calcium intake protective effect; oxalate intake only modest increase of risk in men and older women. Metal cations zinc and iron intake no clear impact on the risk of stone formation, dietary copper increased risk; manganese intake reduced risk of stone formation. Fruits and Vegetables decreased risk. Vitamins B6 intake not associated to risk of stone formation; vitamin C intake increased risk in men; vitamin D or supplemental vitamin D intake not associated to increased risk in men and younger women, suggestion of a higher risk in older women; Probiotics Gut colonization with Oxalobacter formigenes associated to lower risk of stone formation, effect of oxalate-degraders probiotics on urinary oxalate equivocal. Herbal products efficacy of some herbal products demonstrated in some trials, more investigations needed to confirm their efficacy and safety.

Background Endoscopic resection of lesions involving the appendiceal orifice remains a challenge. We aimed to report outcomes with the full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis. Methods This was a retrospective study at 18 tertiary-care centers (USA 12, Canada 1, Europe 5) between November 2016 and August 2020. Consecutive patients who underwent resection of an appendiceal orifice lesion using the FTRD were included. The primary outcome was the rate of R0 resection in neoplastic lesions, defined as negative lateral and deep margins on post-resection histologic evaluation. Secondary outcomes included the rates of: technical success (en bloc resection), clinical success (technical success without need for further surgical intervention), post-resection appendicitis, and polyp recurrence. Results 66 patients (32 women; mean age 64) underwent resection of colonic lesions involving the appendiceal orifice (mean [standard deviation] size, 14.5 (6.2) mm), with 40 (61 %) being deep, extending into the appendiceal lumen. Technical success was achieved in 59/66 patients (89 %), of which, 56 were found to be neoplastic lesions on post-resection pathology. Clinical success was achieved in 53/66 (80 %). R0 resection was achieved in 52/56 (93 %). Of the 58 patients in whom EFTR was completed who had no prior history of appendectomy, appendicitis was reported in 10 (17 %), with six (60 %) requiring surgical appendectomy. Follow-up colonoscopy was completed in 41 patients, with evidence of recurrence in five (12 %). Conclusions The FTRD is a promising non-surgical alternative for resecting appendiceal lesions, but appendicitis occurs in 1/6 cases.

The gastrointestinal tract of every healthy human consists of a unique set of gut microbiota that collectively harbors a diverse and complex community of over 100 trillion microorganisms, including bacteria, viruses, archaea, protozoa and fungi. Gut microbes have a symbiotic relationship with our body. The composition of the microbiota is shaped early in life by gut maturation, which is influenced by several factors. Intestinal bacteria are crucial in maintaining immune and metabolic homeostasis and protecting against pathogens. Dysbiosis of gut microbiota is associated not only with intestinal disorders but also with extraintestinal diseases such as metabolic and neurological disorders. In this review, the authors examine different studies that have revealed the possible hypotheses and links in the development of neurological disorders associated with the gut microbiome.

This study reports the genome sequences of two severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) strains detected in the nasopharyngeal swab specimens of two coronavirus disease-2019 (COVID-19) patients from Dhaka, Bangladesh.

In vitro cultures of scarlet flax (Linum grandiflorum L.), an important ornamental flax, have been established as a new possible valuable resource of lignans and neolignans for antioxidant and anti-inflammatory applications. The callogenic potential at different concentrations of α-naphthalene acetic acid (NAA) and thidiazuron (TDZ), alone or in combinations, was evaluated using both L. grandiflorum hypocotyl and cotyledon explants. A higher callus induction frequency was observed on NAA than TDZ, especially for hypocotyl explants, with a maximum frequency (i.e., 95.2%) on 1.0 mg/L of NAA. The presence of NAA (1.0 mg/L) in conjunction with TDZ tended to increase the frequency of callogenesis relative to TDZ alone, but never reached the values observed with NAA alone, thereby indicating the lack of synergy between these two plant growth regulators (PGRs). Similarly, in terms of biomass, NAA was more effective than TDZ, with a maximum accumulation of biomass registered for medium supplemented with 1.0 mg/L of NAA using hypocotyls as initial explants (DW: 13.1 g). However, for biomass, a synergy between the two PGRs was observed, particularly for cotyledon-derived explants and for the lowest concentrations of TDZ. The influence of these two PGRs on callogenesis and biomass is discussed. The HPLC analysis confirmed the presence of lignans (secoisolariciresinol (SECO) and lariciresinol (LARI) and neolignan (dehydrodiconiferyl alcohol [DCA]) naturally accumulated in their glycoside forms. Furthermore, the antioxidant activities performed for both hypocotyl- and cotyledon-derived cultures were also found maximal (DPPH: 89.5%, FRAP 866: µM TEAC, ABTS: 456 µM TEAC) in hypocotyl-derived callus cultures as compared with callus obtained from cotyledon explants. Moreover, the anti-inflammatory activities revealed high inhibition (COX-1: 47.4% and COX-2: 51.1%) for extract of hypocotyl-derived callus cultures at 2.5 mg/L TDZ. The anti-inflammatory action against COX-1 and COX-2 was supported by the IC50 values. This report provides a viable approach for enhanced biomass accumulation and efficient production of (neo)lignans in L. grandiflorum callus cultures.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a highly pathogenic virus that causes coronavirus-19 disease (COVID-19), a severe respiratory damaging syndrome with serious health complications worldwide. SARS-CoV-2 was unfamilar before the epidemic started in Wuhan, China, in December 2019. COVID-19 is currently a pandemic influencing several countries worldwide. One of the mysteries of the new coronavirus is that it is deadlier for men than women with the male mortality rate is twice as high as that of females.

Background Mercury has been documented as an industrial risk that posed a serious danger to human health. Mercury exposure results in oxidative stress that may lead to the pathogenesis of male reproductive dysfunction. The present study investigated the ameliorating potential of Chenopodium album L. and vitamin C against mercuric chloride-induced oxidative deterioration of reproductive functions in adult male rats. Methods Group 1 (control) received saline. Group 2 received Mercury (0.15 mg/kg b.w, i.p) dissolved in distilled water. Groups 3 and 4 were given oral gavage of vitamin C (200 mg/kg b.w) and the ethanolic extract of C. album (200 mg/kg b.w) respectively, along with Mercury (0.15 mg/kg b.w, i.p). Group 5 was treated only with C. album (200 mg/kg b.w). After 30 days of the treatment, the rats were dissected and their testicular tissue and the cauda epididymis were used for biochemical analysis while blood plasma was used for protein determination. Results The applied dose-treatment of Mercury-induced oxidative stress in the testis and cauda epididymis tissues of the rats was apparent by a noteworthy decrease in total protein, CAT, SOD, POD, and GST values while there was increase in ROS and TBARS levels. Furthermore, Mercury decreases daily sperm production and enhanced sperm DNA damage as noticeable by an increase in the head and tail length of comets and decrease in intact DNA. There was no significant effect on the body weight and the weight of the reproductive tissues. Treatment with C. album significantly ameliorated the total protein, ROS, and TBARS content. Similarly, the level of CAT, SOD, POD, and GST was significantly improved and the daily sperm production was significantly increased. Furthermore, C. album administration significantly protected Mercury-induced sperm DNA damage. The results of the extract treatment group were compared with those of vitamin C in detoxifying the oxidative stress and restoring the sperm parameters. Conclusion C. album showed protection against Mercury-induced oxidative stress by ameliorating antioxidant enzyme activity, daily sperm production, and DNA damage in rat testes. This suggests that C. album could be beneficial against toxicity induced by an environmental toxicant.

Based on known cDNAs of rice starch synthase isoforms, we constructed dsRNA interference vectors for starch synthase I (SSI) to produce transgenic plants containing starch with a moderately high amylose content. We investigated the effect of SSI suppression on grain quality traits, starch biosynthesis, and amylopectin chain distribution in rice plants exposed to two different temperature regimes. The activities and transcripts of BEs, DBEs, and other SS isoforms were further investigated to clarify the effect of SSI suppression on these key enzymes and their specific isoforms under different temperature treatments. Suppression of SSI by RNAi altered grain starch component and amylopectin chain distribution, but it exerted only a slight effect on total starch content (%) and accumulation amount (mg kernel−1) and on starch granule morphology and particle size distribution. Under normal temperature (NT), insignificant differences in kernel weight, chalky kernel proportion, chalky degree, and starch granule morphology between SSI-RNAi line and its wild type (WT) were observed. However, amylose content (AC) level and granule-bound starch synthase (GBSS) activity in rice endosperms were markedly increased by SSI-RNAi suppression. The chalky kernel proportion and chalky degree of SSI-RNAi lines were significantly higher than those of WT under high temperature (HT) exposure at filling stage. Inhibition of SSI by RNAi affected amylopectin chain distribution and raised starch gelatinization temperature (GT) in two ways: directly from the SSI deficiency itself and indirectly by reducing BEIIb amounts in an SSI-deficient background. The deficiency of SSI expression led to an alteration in the susceptibility of grain chalkiness occurrence and starch gelatinization temperature to HT exposure, owing to a pleiotropic effect of SSI deficiency on the expression of other genes associated with starch biosynthesis. Keywords: Rice, Starch synthase I, RNA interference, Grain quality, Amylopectin, High temperature

For the robust identification of weeds of taxonomically complex families like Poaceae, scanning electron microscopy (SEM) and light microscopy (LM) are of significant implications. In this study, SEM and LM methods were used by investigating 12 Pakistani weedy grass species as an example for foliar epidermal micromorphological characters for its role in the identification of grasses species. Qualitative and quantitative foliar micromorphological variations in stomatal type, number, guard cells, subsidiary cells, silica bodies and trichomes were studied. Significant variation was observed in both qualitative and quantitative features and based on this diversity in epidermal characters, a key was drawn to delimitate the species. Variations in stomata, silica bodies (SiO2 ·nH2 O), macrohairs, microhairs, hooks, papillae, prickles, and other epidermal structures were used in establishing the taxonomic key. The data were also statistically evaluated by determining its mean, standard deviation, variance, the coefficient of variance, and standard error. Foliar epidermal characters such as silica bodies shape and trichomes were taxonomically more useful than stomatal types, subsidiary, and guard cells. SEM and LM micromorphological characters were of substantial importance in the delimitation of closely related species.

Bisphenol A (BPA) is a well-known endocrine-disrupting chemical with estrogenic activity. The widespread exposure of individuals to BPA is suspected to affect a variety of physiological functions, including reproduction, development, and metabolism. Here we report the mechanisms by which BPA and three of its analogues bisphenol B (BPB), bisphenol F (BPF), and bisphenol S (BPS) cause generation of reactive oxygen species (ROS), sperm DNA damage, and oxidative stress in both in vivo and in vitro rat models. Sperm were incubated with different concentrations (1, 10, and 100 µg/L) of BPA and its analogues BPB, BPF, and BPS for 2 h. BPA and its analogues were observed to increase DNA fragmentation, formation of ROS, and affected levels of superoxide dismutase at higher concentration groups. In an in vivo experiment, rats were exposed to different concentrations (5, 25, and 50 mg/kg/day) of BPA, BPB, BPF, and BPS for 28 days. In the higher dose (50 mg/kg/day) treated groups of BPA and its analogues BPB, BPF, and BPS, DNA damage was observed while the motility of sperm was not affected.

Alzheimer’s Disease (AD) is the most prevalent age-related dementia. AD can be caused by abnormal processing of amyloid precursor protein (APP) or by oxidative stress or may be due to the actions of kinases or the degeneration and loss of functions of neurons in the brain. Although various treatments have already gained success in the in vitro studies, however, till now not a single satisfactory drug has been proven that can cure this disease permanently till now. In this study, the best possible drug has been determined from a group of drug molecules using methods of molecular docking. Molecular docking is a computational approach which helps to determine the best molecule from a group of molecules which may bind with the highest affinity with the intended target by mimicking the original biological environment in a computer. The tested drug molecules in this experiment are the disease modifying agents, capable of inhibiting a particular protein involving in the AD pathway. Eight drug molecules (ligands)-memantine (-4.075 Kcal/mol), hymenialdisine (-8.079 Kcal/mol), tideglusib (-6.445 Kcal/mol), kenpaullone (-7.545 Kcal/mol), dihydrospiro[dibenzo[a,d][7]annulene-5,4’-imidazol] (-4.742 Kcal/mol), harmine (-7.57 Kcal/mol), harmol (-6.583 Kcal/mol) and 1-Methyl-4-Phenylpyridinium (-5.214 Kcal/mol), have been docked successfully against four targets (proteins)-N-Methyl-D-Aspartate Receptor (NMDAR), glycogen synthase kinase-3β (GSK-3β), beta-secretase (β-secretase) and dual specificity tyrosine (Y)-phosphorylation-regulated kinase 1A (DYR-K1A) in this experiment which are intended targets in current AD treatment approaches. Investigation of docking results, druglikeness properties and ADME/T testing results suggest that the best findings of this experiment are memantine, hymenialdisine, dihydrospiro[dibenzo[a,d][7]annulene-5,4’-imi- dazol] and harmol, that could be the best possible drugs for the treatment of AD.

Introduction Fine-needle aspiration (FNA) is a well-recognized procedure for the diagnosis of thyroid nodules, with the advantage of being safe and inexpensive. Fine-needle aspiration cytology (FNAC) is mainly performed for nodules showing suspicious sonographic features that may require thyroidectomy. Even when FNAC is performed under sonographic guidance, the cytological specimen obtained may be inadequate, leading to a non-diagnostic outcome. The aim of this study is to determine the sonographic and technical factors influencing the outcome of FNAC. Material and methods This cross-sectional study was conducted prospectively at the radiology department, Dr. Ziauddin Hospital, Karachi, from January 1, 2019, to December 31, 2020. This study was approved by the Ethical Review Committee (ERC) of Ziauddin University. All the patients undergoing ultrasound (US)-guided FNAC of thyroid nodules were included. Patients with a history of previous thyroid surgery, very large thyroid lesions (>5 cm), and those with adjacent soft tissue pathology obscuring the assessment of thyroid nodules were excluded from this study. Result Out of 176 nodules studied, 14 were non-diagnostic and 162 were diagnostic. A 22G needle was used in most of the patients, i.e. 102 (57.3%), which demonstrated no relationship with the non-diagnostic results. According to Bethesda, 136 (77.3%) patients were benign, 22 (12.5%) had lesions with atypia/follicular lesions of undetermined significance, 14 (8%) were non-diagnostic and four (2.3%) were suspicious for malignancy. A subset, including 76 nodules, was categorized according to Thyroid Imaging Reporting and Data System (TIRADS) as follows: 28 (36.8%) nodules were moderately suspicious, 24 (31.6%) were mildly suspicious, 20 (26.3%) were not suspicious, and four (5.3%) nodules were benign. It was also observed that none of the hypoechoic nodules yielded non-diagnostic cytology. Conclusion This study concludes that radiologists must be aware of the technical details, cytologic preparation, and procedure-related complications associated with US-guided FNA to optimize patient care and the diagnostic outcome.

During the last two decades the world has experienced an abrupt change in climate. Both natural and artificial factors are climate change drivers, although the effect of natural factors are lesser than the anthropogenic drivers. These factors have changed the pattern of precipitation resulting in a rise in sea levels, changes in evapotranspiration, occurrence of flood overwintering of pathogens, increased resistance of pests and parasites, and reduced productivity of plants. Although excess CO2promotes growth of C3plants, high temperatures reduce the yield of important agricultural crops due to high evapotranspiration. These two factors have an impact on soil salinization and agriculture production, leading to the issue of water and food security. Farmers have adopted different strategies to cope with agriculture production in saline and saline sodic soil. Recently the inoculation of halotolerant plant growth promoting rhizobacteria (PGPR) in saline fields is an environmentally friendly and sustainable approach to overcome salinity and promote crop growth and yield in saline and saline sodic soil. These halotolerant bacteria synthesize certain metabolites which help crops in adopting a saline condition and promote their growth without any negative effects. There is a complex interkingdom signaling between host and microbes for mutual interaction, which is also influenced by environmental factors. For mutual survival, nature induces a strong positive relationship between host and microbes in the rhizosphere. Commercialization of such PGPR in the form of biofertilizers, biostimulants, and biopower are needed to build climate resilience in agriculture. The production of phytohormones, particularly auxins, have been demonstrated by PGPR, even the pathogenic bacteria and fungi which also modulate the endogenous level of auxins in plants, subsequently enhancing plant resistance to various stresses. The present review focuses on plant-microbe communication and elaborates on their role in plant tolerance under changing climatic conditions.

Background Induction therapy with IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent in low immunological risk kidney transplant recipients. However, the role of IL2-RA in the setting of tacrolimus-based immunosuppression has not been fully investigated. Aims To compare different induction therapeutic strategies with 2 doses of basiliximab vs. no induction in low immunologic risk kidney transplant recipients as per KFSHRC protocol. Methods Prospective, randomized, double blind, non-inferiority, controlled clinical trial Expected outcomes 1. Primary outcomes: Biopsy-proven acute rejection within first year following transplant 2. Secondary outcomes: a. Patient and graft survival at 1 year b. eGFR at 6 months and at 12 months c. Emergence of de novo donor-specific antibodies (DSAs) Trial registration The study has been prospectively registered at clinicaltrials.gov (NTC: 04404127). Registered on 27 May 2020.

Gamma delta T-cells are commonly found in response to Listeria monocytogenes infection in mice, whereas this same immunological response has only been reported a few times in vivo in humans. Moreover, gamma delta T-cell response in cerebral spinal fluid samples in conjunction with Listeria meningitis has never been described in medical literature to date. Thus, we describe a 64-year-old male who presented with altered mental status, fever, and neck stiffness. After lumbar puncture revealed elevated glucose, protein, lactate dehydrogenase, and white blood cell count, further cytologic analysis was indicated. The CSF showed a markedly hypercellular sample with a lymphocytic pleocytosis, including some enlarged forms with irregular nuclear contours, and rare macrophage containing intracytoplasmic bacteria. Lymphocyte immunophenotyping was performed via flow cytometric analysis, which ultimately revealed a prominent CD4/CD8 negative T-cell population, suggestive of a gamma delta T-cell population. Thus, an initial suspicion of malignancy was considered but was ruled out due to the absence of mass lesion on imaging and overall features including heterogenous lymphocyte morphology. Shortly after, gram stain and cultures were obtained revealing Listeria monocytogenes. Unfortunately, the patient rapidly succumbed to disease following the diagnosis of Listeria meningitis. Studies suggest that gamma delta T-cells are activated by the protein components of Listeria and thus have been found to be an important mediator of resistance to Listeria infection. Studies have also discovered that the level of activation for these T-cells appears to be tissue specific and dose dependent, with most cases occurring within visceral organs. Hence, we herein present the first case of gamma delta T-cell activation due to Listeria monocytogenes within the cerebral spinal fluid of a human patient.

Background Alzheimer’s disease (AD) is a progressive neurodegenerative age-related dementia that results in memory loss of elderly people. Many hypotheses have been formally articulated till now to decipher the pathogenesis of this disease. According to the compelling amyloidogenic hypothesis, β-secretase is a key regulatory enzyme in AD development and is therefore considered as one of the major targets for the development of drugs to treat AD. In this study, 40 plant-derived phytocompounds, proven to have β-secretase inhibitory activity in different laboratory experiments, were evaluated using computational approaches in order to identify the best possible β-secretase inhibitor(s). Results Amentoflavone (IFD score: − 7.842 Kcal/mol), Bilobetin (IFD score: − 7.417 Kcal/mol), and Ellagic acid (IFD score: − 6.923 Kcal/mol) showed highest β-secretase inhibitory activities with high binding affinity among all the selected phytocompounds and interacted with key amino acids, i.e., Asp32, Tyr71, and Asp228 in the catalytic site of β-secretase. Moreover, these three molecules exhibited promising results in different drug potential assessment experiments and displayed signs of correlation with significant pharmacological and biological activities. Conclusion Amentoflavone, Biolbetin, and Ellagic acid could be investigated further in developing β-secretase-dependent drug for the effective treatment of AD. However, additional in vivo and in vitro experiments might be required to strengthen the findings of this experiment.

Although neuroblastoma is one of the most common extra-cranial tumors in the pediatric population, it is rarely seen as a metastasis to the mandibular bone. The following is a case report of a 3-year-old male who initially presented with a submandibular mass that was proven to be a poorly differentiated metastatic neuroblastoma through excisional biopsy. This report is one of the few case reports that demonstrates metastatic submandibular neuroblastoma with mandibular bone involvement in the pediatric population.

Background Being one of the rapidly growing dementia type diseases in the world, Alzheimer’s disease (AD) has gained much attention from researchers in the recent decades. Many hypotheses have been developed that describe different reasons for the development of AD. Among them, the cholinergic hypothesis depicts that the degradation of an important neurotransmitter, acetylcholine by the enzyme acetylcholinesterase (AChE), is responsible for the development of AD. Although, many anti-AChE drugs are already available in the market, their performance sometimes yields unexpected results. For this reason, research works are going on to find out potential anti-AChE agents both from natural and synthetic sources. In this study, 50 potential anti-AChE phytochemicals were analyzed using numerous tools of bioinformatics and in silico biology to find out the best possible anti-AChE agents among the selected 50 ligands through molecular docking, determination of the druglikeness properties, conducting the ADMET test, PASS and P450 site of metabolism prediction, and DFT calculations. Result The predictions of this study suggested that among the selected 50 ligands, bellidifolin, naringenin, apigenin, and coptisine were the 4 best compounds with quite similar and sound performance in most of the experiments. Conclusion In this study, bellidifolin, naringenin, apigenin, and coptisine were found to be the most effective agents for treating the AD targeting AChE. However, more in vivo and in vitro analyses are required to finally confirm the outcomes of this research.

Objectives: The group of human coronaviruses (HCoVs) consists of some highly pathogenic viruses that have caused several outbreaks in the past. The newly emerged strain of HCoV, the SARS-CoV-2 is responsible for the recent global pandemic that has already caused the death of hundreds of thousands of people due to the lack of effective therapeutic options. Methods: In this study, immunoinformatics methods were used to design epitope-based polyvalent vaccines which are expected to be effective against four different pathogenic strains of HCoV i.e., HCoV-OC43, HCoV-SARS, HCoV-MERS, and SARS-CoV-2. Results: The constructed vaccines consist of highly antigenic, non-allergenic, nontoxic, conserved, and non-homologous T-cell and B-cell epitopes from all the four viral strains. Therefore, they should be able to provide strong protection against all these strains. Protein-protein docking was performed to predict the best vaccine construct. Later, the MD simulation and immune simulation of the best vaccine construct also predicted satisfactory results. Finally, in silico cloning was performed to develop a mass production strategy of the vaccine. Conclusion: If satisfactory results are achieved in further in vivo and in vitro studies, then the vaccines designed in this study might be effective as preventative measures against the selected HCoV strains.

Toxoplasma infection is one of the most common human parasitic diseases. During 2018-2020, in the rural areas of three districts of Pakistan, we surveyed a total of 451 animals, belonging to different asymptomatic ruminant species, to determine the prevalence of Toxoplasma gondii antibodies. We used ELISA assay as well as recorded some associated risk factors contributing to its transmission. IgM antibodies were detected in 17% and IgG in 13.4% of ruminant samples with the highest percentage, 10% for IgM and 8.6% for IgG in sheep. A strong significant association was found between antibodies and different species (IgM, χ 2 = 29 .280, P = .000 , and IgG, χ 2 = 22.580 , P = .000 ), respectively. Infection with T. gondii seems mainly associated with different geographic features and the presence of cats in the environment, low hygiene water systems and livestock that are mostly dependent on outdoor drinking and grazing. There was no significant association between IgM and age grouping ( χ 2 = 6.660 , P = 0.840 nor for IgG ( χ 2 = 8.136 , P = 0.43 ). The results of this study may be considered the starting point to promote the awareness about parasitic infections in ruminants in Pakistan in order to prevent this infection from further spreading.

Introduction Hepatobiliary tree variant anatomy is crucial to understand the preoperative planning of hepatobiliary surgeries. Although the presence of variant anatomy is not an absolute contraindication for liver transplantation, inadvertent mapping can lead to postoperative biliary complications. These variants are also important to be recognized in various hepatobiliary surgeries and interventional procedures. Magnetic resonance cholangiopancreatography (MRCP) is an excellent non-invasive imaging tool that can identify biliary anatomy. The purpose of the current study is focused on determining anatomical variants of the biliary tree on MRCP in our population visiting a teaching hospital in Karachi. Methods This cross-sectional study was conducted on patients referred to Dr. Ziauddin Hospital for MRCP. MRCP was performed on MAGNETOM Avanto, SIEMENS, Belgium, Germany. Images were analyzed on a workstation by two radiologists and a postgraduate trainee. A senior radiologist reviewed equivocal cases. SPSS 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. Chi-square test was used to see the link between anatomical variants of biliary tree and gender. P-value of ≤0.05 was considered as statistically significant. Results We recruited 369 patients undergoing MRCP consecutively for our study. Out of 369, 342 patients were eligible for analysis (139 males and 203 females). Standard anatomy was found to be prevalent in 65.8%. Type 3 was the leading variant. A statistically significant difference was recorded for the type 2 anatomic variant which was more frequent in males than females (p-value

Cefepime-enmetazobactam is a novel β-lactam–β-lactamase inhibitor combination with broad-spectrum antimicrobial activity against a range of multidrug-resistant Enterobacteriaceae. This agent is being developed for a range of serious hospital infections. An understanding of the extent of partitioning of β-lactam–β-lactamase inhibitor combinations into the human lung is required to better understand the potential role of cefepime-enmetazobactam for the treatment of nosocomial pneumonia. A total of 20 healthy volunteers were used to study the intrapulmonary pharmacokinetics of a regimen of 2 g cefepime-1 g enmetazobactam every 8 h intravenously (2 g/1 g q8h i.v.). Each volunteer contributed multiple plasma samples and a single epithelial lining fluid (ELF) sample, obtained by bronchoalveolar lavage. Concentrations of cefepime and enmetazobactam were quantified using liquid chromatography-tandem mass spectrometry. The pharmacokinetic data were modeled using a population methodology, and Monte Carlo simulations were performed to assess the attainment of pharmacodynamic targets defined in preclinical models. The concentration-time profiles of both agents in plasma and ELF were similar. The mean ± standard deviation percentage of partitioning of total drug concentrations of cefepime and enmetazobactam between plasma and ELF was 60.59% ± 28.62% and 53.03% ± 21.05%, respectively. Using pharmacodynamic targets for cefepime of greater than the MIC and free enmetazobactam concentrations of >2 mg/liter in ELF of 20% of the dosing interval, a regimen of cefepime-enmetazobactam of 2 g/0.5 g q8h i.v. infused over 2 h resulted in a probability of target attainment of ≥90% for Enterobacteriaceae with cefepime-enmetazobactam MICs of ≤8 mg/liter. This result provides a rationale to further consider cefepime-enmetazobactam for the treatment of nosocomial pneumonia caused by multidrug-resistant Enterobacteriaceae.

Here, we examine the potential effect of the COVID-19 pandemic on future birth rates. This highly contagious disease originated in China, and rapidly spread worldwide, leading to extensive lockdown policies being implemented globally with the aim of containing the infection rates and its serious attendant consequences. Based on previous extant literature, this paper overviews the potential demographic consequences of the current progressively widespread epidemic on conception and fertility as driven by the data obtained during similar prior incidents. In general, epidemics manifest a common pattern as far as their impact on population, which is remarkably similar to natural disasters, i.e., a steep decline in birth rates followed by gradual increases and then followed by a baby boom. Additionally, we have also depicted how economic conditions, mental health, fear, and mortality may also influence future birth rates.

Background Gram-negative bacteria are frequently involved in nosocomial infections. These bacteria have a particular tendency to develop antibiotic resistance and may become extensively drug-resistant (XDR). This study aimed to detect the prevalence of XDR Gram-negative bacteria in a tertiary care hospital in Pakistan. Materials and methods Clinical samples were obtained from patients admitted to different inpatient wards and sent for microbial analysis and culture. Antibiotic susceptibility testing of isolates was performed by the disk diffusion method to detect XDR strains. Results Antibiotic susceptibility patterns of a total of 673 clinical samples were studied. Of all bacterial isolates, 64% were extensively drug-resistant. Klebsiella pneumoniae had the highest percentage of XDR isolates (68.4%), followed by Pseudomonas aeruginosa (67.6%) and Escherichia coli (56.1%). Most XDR pathogens were isolated from the burn unit (87.7%), followed by the intensive care unit (69.2%) and surgical unit (68.9%). Conclusions The rate of extensive drug-resistance is alarmingly high, which calls for strict surveillance and control measures to prevent the development of further resistance. Proper sanitation and rational prescription of antibiotics should be ensured.

Introduction: Portal vein (PV) is the principal blood vessel transporting blood from the alimentary tract and spleen to the liver. The aim of this study is to determine the prevalence of PV anatomical variations in our population using multidetector CT with maximum intensity projection (MIP) technique at a tertiary care hospital. Methods: This cross-sectional study was prospectively conducted from November 2018 to June 2019 in the Department of Radiology at a tertiary care hospital in Karachi. After informed consent, all the patients with no known hepatic pathology undergoing routine abdomen CT were included in this study. Patients with previous hepatic resection surgeries, undiagnosed large hepatic tumors/metastasis, and those with PV thrombosis were excluded. Results: A total of 500 patients (256 males and 244 females) were included in the study; the mean age of female patients was relatively higher as compared to the male patients (53.80 ± 18.44 vs. 44.15 ± 19.94 years; p = 0.000). Standard PV anatomy (type 1) was found in 438 patients (87.6%). Trifurcation (type 2) occurred in 18 patients (3.6%). Right posterior portal vein as the first branch of main PV (type 3) was found in 22 patients (4.4%). A separate branch of the right portal vein (RPV) to segment VII (type 4) and separate branch of the RPV to segment VI (type 5) were found in 6 (1.2%) and 16 (3.2%) patients, respectively. Conclusion: Our study displayed a relatively higher frequency of standard PV anatomy (type 1) compared to previous studies. We highlight the role of MIP in the analysis of hepatic venous anatomy with its utility demonstrating improved detection of variations.

Flavonoids are phytochemical compounds present in many plants, fruits, vegetables, and leaves, with potential applications in medicinal chemistry. Flavonoids possess a number of medicinal benefits, including anticancer, antioxidant, anti-inflammatory, and antiviral properties. They also have neuroprotective and cardio-protective effects. These biological activities depend upon the type of flavonoid, its (possible) mode of action, and its bioavailability. These cost-effective medicinal components have significant biological activities, and their effectiveness has been proved for a variety of diseases. The most recent work is focused on their isolation, synthesis of their analogs, and their effects on human health using a variety of techniques and animal models. Thousands of flavonoids have been successfully isolated, and this number increases steadily. We have therefore made an effort to summarize the isolated flavonoids with useful activities in order to gain a better understanding of their effects on human health.

Fungating malignant lesions pose a huge deal of agony to the patients. Their management is also deemed as difficult by most physicians. This report describes a case of a 45-year-old paraplegic female with delayed presentation of a very aggressive fungating left breast mass, which was diagnosed as invasive ductal carcinoma. The uncontrollable hemorrhage had the surgeons succumb to the option of emergency mastectomy as a palliative treatment to save the life of the patient. Hence, we infer that the emergency mastectomy in a hemorrhagic fungating breast lesion can be life-saving and can be performed with little to no risk to the patient. Such a procedure, surprisingly, has never been documented in the surgical literature before.

Background: Urology has become more complex over the last decades with surgical sophisticated technologies such as endoscopy, laparoscopy and robotic surgery. As these minimally invasive methods gain popularity throughout the world, this has led in some countries to a serious training gap as compared to other countries, and between generations of surgeons within national training systems. There is a huge heterogeneity in urological training between countries, whether developed or developing. This paper attempts to shed some light onto global urological training, comparing a significant number of various national systems, and to outline global tendencies in urological training. It will enable interested readers to see where their own system stands in international comparison, and hopefully enable them to identify training needs to achieve global quality standards. Materials and methods: This is a questionnaire-based assessment which was sent to 240 members of U-merge from 62 countries. In addition, there is ample literature on the requirements of structured training programs and assessments, and we have tried to briefly outline the key points in this paper. Results: We received responses from 32 countries Urology residency training is hugely heterogenous between countries. Only 44% of nations use a structured training program with assessments. Others use the Halstedian apprenticeship approach. Notably, some developing countries do use modern teaching and assessment methods, whereas some developed countries still use the outmoded apprenticeship model. For the interested reader, results have been tabled in detail, and training systems described country by country. Conclusions: Our results have shown a huge heterogeneity in quality urology training between countries and within continents. In systems without national structure of training, it can be assumed that such differences exist even between hospitals/ training institutions. There is no doubt in times of globalization with resident and doctor migration and exchanges that training needs structure and standardization. The still huge gap in developing countries to catch up and be able to afford latest surgical and learning technologies need to be addressed with the help of responsible outreach programs.

Background: Uterine cancer (UC) is one of the leading gynecologic neoplastic disorders in the United States (US), of which over 80% are endometrioid adenocarcinomas (EA). In contrast to EA, carcinosarcoma (CS) of the uterus is a sporadic and highly malignant tumor, phylogenetically containing both epithelial and mesenchymal histologic elements. This study sought to analyze demographic, pathological retrospectively, and survival characteristics of a large cohort of CS patients compared to EA patients to identify prognostic factors and treatment approaches that may improve the current clinical management of CS patients. Methods: Demographic and clinical data were abstracted from 88,530 patients diagnosed with uterine malignancy from the Surveillance, Epidemiology, and End Results (SEER) database for 38 years (1973-2010). Extracted variables were analyzed using the Chi-square test, paired t-test, and multivariate analysis, while Kaplan-Meier functions were used to compare survival between groups. Statistical analyses were performed with IBM Statistical Product and Service Solutions (SPSS©), version 20.2 (IBM Corp., Armonk, NY). Results: A total of 3,706 cases of CS comprised 38.2% of uterine sarcomas (n=9,702), and 4.1% of uterine cancers overall (n=88,530). EA made up 88.6% (n=78,481) of all uterine cancers. CS patients presented later in life (68.3±11.5 years) than EA (61.9±12.5 years). 65.2% of CS and 77.8% of EA occurred in Caucasians. The incidence (per million) of EA was higher in Caucasians compared to African-Americans (AA) (41% vs. 26.8%), while the incidence of CS was higher among AA than Caucasians (4% vs. 1.9%, p

Electromyography (EMG) signals have been successfully employed for driving prosthetic limbs of a single or double degree of freedom. This principle works by using the amplitude of the EMG signals to decide between one or two simpler movements. This method underperforms as compared to the contemporary advances done at the mechanical, electronics, and robotics end, and it lacks intuition to perform everyday life tasks. Recently, research on myoelectric control based on pattern recognition (PR) shows promising results with the aid of machine learning classifiers. Using the approach termed as EMG-PR, EMG signals are divided into analysis windows, and features are extracted for each window. These features are then fed to the machine learning classifiers as input. By offering multiple class movements and intuitive control, this method has the potential to power Prosthesis an amputated subject to perform everyday life movements. In this paper, we investigate the effect of the analysis window and feature selection on classification accuracy of different hand and wrist movements using time-domain features. We show that effective data preprocessing and optimum feature selection helps to improve the classification accuracy of hand movements. We use publicly available hand and wrist gesture dataset of 40 intact and 11 trans-radial amputated subjects for experimentation. Results computed using different classification algorithms show that the proposed preprocessing and features selection outperforms the baseline and achieve up to \(98\%\) classification accuracy for both intact and trans-radial subjects.

Herpes Simplex Virus (HSV) is a highly infectious virus that is responsible for various types of orofacial and genital infections. Two types of HSV exist i.e. HSV-1 and HSV-2, that are infecting millions of people around the world. However, no satisfactory treatment or counter-measure has yet been discovered to fight against the HSV infections. In this study, three possible polyvalent subunit vaccines against multiple strains of HSV-1 and HSV-2, targeting the envelope glycoproteins- E, B, and D, were designed using the tools of reverse vaccinology and immunoinformatics. The highly antigenic, non-allergenic, non-toxic, non-homolog (to the human proteome), and 100% conserved epitopes across the selected strains and species (eight epitopes from each of the CTL, HTL, and BCL epitope groups), were selected for vaccine construction. These designed vaccines are expected to be effective against the selected viral types simultaneously (as a polyvalent vaccine), without producing any unwanted adverse reaction within the body. Finally, from the three vaccine constructs, one best vaccine was determined by molecular docking analysis and thereafter, the MD simulation and immune simulation studies of the best vaccine construct also yielded satisfactory results, pointing towards quite good stability of the complex. Finally, in silico cloning was performed for analyzing the effective mass production strategy of the best vaccine construct. However, wet lab-based study should be conducted on the suggested vaccines for validating their potentiality, safety, and efficacy. Communicated by Ramaswamy H. Sarma

A 64-year-old male presents with shoulder pain, arm pain, and a chronic cough. CT imaging of the thorax shows a large 8.0 x 6.7 cm mass with central necrosis in the left upper lung lobe with invasion into the chest wall with partial destruction of the second and third ribs, and left axillary adenopathy. Bilateral adrenal nodules are identified via CT imaging and subsequently biopsied. Histologically, the mass reveals sheets of atypical epithelioid cells with round nuclei and abundant eosinophilic cytoplasm. Immunostaining is positive for CD31, CD34, FLI-1, AE1/AE3, and CK7, diagnostic of primary epithelioid angiosarcoma. The patient developed symptoms of confusion, dizziness, and ataxia. An MRI showed metastatic brain lesions. One month later, the patient had worsening symptoms. Repeat imaging demonstrates enlargement of the bilateral adrenal masses, a new lesion posterior to the left kidney, and doubling of the size of the brain lesions. This case illustrates the metastatic potential and pattern of the spread of an aggressive primary pleural angiosarcoma that is not described elsewhere in current literature. It also highlights the importance of timely intervention based on the rapid metastatic progression of this neoplasm.

Introduction and objective Effective risk stratification is integral to the management of acute coronary syndromes. The Thrombolysis in Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI) is based on eight high-risk parameters that can be used at the bedside for risk stratification of patients presenting with STEMI. This study was designed to determine the frequency of cardiac complications of anterior wall STEMI assessed on TIMI risk score and to compare the rate of cardiac complications according to the TIMI score. Materials and methods An observational case series study was conducted in the Department of Cardiology at Sandeman Provincial Hospital in Quetta, Pakistan. The study duration was six months, from September 22, 2016 to March 23, 2017. A total of 369 patients were selected who had anterior wall myocardial infarction and received thrombolytic therapy, according to the inclusion and exclusion criteria. The TIMI score was calculated by proforma at the time of admission. Patients were divided into three groups: low-risk, moderate-risk, and high-risk TIMI groups. The frequency of complications of anterior wall myocardial infarction at the time of discharge was compared among these groups. Results The study included 285 male patients (77.2%) and 84 (22.8%) female patients. A total of 174 (47.2%) patients were smokers, 79 (21.4%) were obese, and 93 (25.2%) had hyperlipidemia. Of the 369 patients, 205 (55.6%) were included in the low-risk group, 150 (40.7%) in the moderate-risk group, and 14 (3.8%) in the high-risk group. Post-myocardial infarction arrhythmias were noted in 33 (16.09%) patients in the low-risk group and six (4%) patients in the moderate-risk group. Left ventricular dysfunction was noted in 158 (77.07%) patients in the low-risk group, 78 (52%) patients in the moderate-risk group, and seven (50%) patients in the high-risk group. Cardiogenic shock occurred in seven (3.41%) patients in the low-risk group, 47 (31.33%) patients in the moderate-risk group, and 0 (0%) patient in the high-risk group. Death occurred in seven (3.41%) patients in the low-risk group, 19 (12.66%) patients in the moderate-risk group, and seven (50%) patients in the high-risk group. Conclusion TIMI scoring provides a better assessment in terms of complications caused by STEMI. The complications include the mechanical and electrophysiology of the heart.

The coronavirus disease 2019 (COVID-19) is a global health emergency of unprecedented proportions. Countries around the world have taken extraordinary steps to control the disease. The preventive measures face challenges in low and lower middle income countries (LICs and LMICs). Especially the marginalized communities, e.g., women are the hardest hit of the virus. This study took Bangladesh as a representative LMIC and aimed to determine the level of knowledge, perception, attitude, and preparedness related to COVID-19 among the adult women in the country. Using a comprehensive questionnaire, we channeled a cross-sectional study among adult women in Bangladesh. Participant's self-reported data on the knowledge, attitude, and preparedness were tabulated and analyzed using suitable statistical tools. A total of 1,869 adults from 61 districts of Bangladesh took part in this study. Ninety seven percentage of the participants claimed to have heard of COVID-19 before it arrived in Bangladesh. Regarding the general knowledge related to COVID-19's causal agent, symptoms, and treatment, the positive response rate was nearly 80%, with a mean of 10.68 ± 1.72. Younger and educated women had better knowledge levels compared to the older and lower-educated participants (p < 0.01). More efforts are required to educate women with older age and lower socioeconomic status. An overall positive attitude and perception were observed, although a significant proportion of the participants opined that the Government's efforts in controlling the outbreak were not adequate. Although the participants had a satisfactory level of knowledge and a positive attitude in adopting preventive measures against COVID-19, greater efforts are needed from the healthcare authorities and Government.

SARS Coronavirus-2 (SARS-CoV-2) pandemic has become a global issue which has raised the concern of scientific community to design and discover a counter-measure against this deadly virus. So far, the pandemic has caused the death of hundreds of thousands of people upon infection and spreading. To date, no effective vaccine is available which can combat the infection caused by this virus. Therefore, this study was conducted to design possible epitope-based subunit vaccines against the SARS-CoV-2 virus using the approaches of reverse vaccinology and immunoinformatics. Upon continual computational experimentation, three possible vaccine constructs were designed and one vaccine construct was selected as the best vaccine based on molecular docking study which is supposed to effectively act against the SARS-CoV-2. Thereafter, the molecular dynamics simulation and in silico codon adaptation experiments were carried out in order to check biological stability and find effective mass production strategy of the selected vaccine. This study should contribute to uphold the present efforts of the researches to secure a definitive preventative measure against this lethal disease.

The recent pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread so rapidly and severely affected the people of almost every country in the world. The highly contagious nature of this virus makes it difficult to take control of the present pandemic situation. With no specific treatment available, the coronavirus disease 2019 (COVID-19) presents a threat to people of all ages including the elderly people and people with other medical complications as a vulnerable group to this disease. Better understanding of viral pathogenesis, appropriate preventive measures, early diagnosis and supportive treatments of the infected patients are now the general solutions to fight against this viral transmission. But, as an emerging disease, most about it remains still poorly understood. This article holds an overview on the origin and structure, pathogenesis, diagnosis and possible therapeutic options for the causative agent, SARS-CoV-2 and disease, COVID-19. However, few therapeutic options, laboratory experiments and other strategies proposed here need to be further clinically tested.

Toll-like receptor 4 (TLR4) pathway is one of the major pathways that mediate the inflammation in human body. There are different anti-inflammatory drugs available in the market which specifically act on different signaling proteins of TLR4 pathway but they do have few side effects and other limitations for intended use in human body. In this study, Curcumin and its different analogs have been analyzed as the inhibitors of signaling proteins, i.e. Cycloxygenase-2 (COX-2), inhibitor of kappaβ kinase (IKK) and TANK binding kinase-1 (TBK-1) of TLR4 pathway using different computational tools. Initially, three compounds were selected for respective target based on free binding energy among which different compounds were reported to have better binding affinity than commercially available drug (control). Upon continuous computational exploration with induced fit docking (IFD), 6-Gingerol, Yakuchinone A and Yakuchinone B were identified as the best inhibitors of COX-2, IKK, and TBK-1 respectively. Then their drug-like potentialities were analyzed in different experiments where they were also predicted to perform well. Hopefully, this study will uphold the efforts of researchers to identify anti-inflammatory drugs from natural sources.