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Inflammation is an essential component of several respiratory diseases, such as chronic obstructive pulmonary disease (COPD), asthma and acute respiratory distress syndrome (ARDS). It is central to lung cancer, the leading cancer in terms of associated mortality that has affected millions of individuals worldwide. Inflammation and pulmonary manifestations are also the major causes of COVID-19 related deaths. Acute hyperinflammation plays an important role in the COVID-19 disease progression and severity, and development of protective immunity against the virus is greatly sought. Further, the severity of COVID-19 is greatly enhanced in lung cancer patients, probably due to the genes such as ACE2, TMPRSS2, PAI-1 and furin that are commonly involved in cancer progression as well as SAR-CoV-2 infection. The importance of inflammation in pulmonary manifestations, cancer and COVID-19 calls for a closer look at the underlying processes, particularly the associated increase in IL-6 and other cytokines, the dysregulation of immune cells and the coagulation pathway. Towards this end, several reports have identified epigenetic regulation of inflammation at different levels. Expression of several key inflammation-related cytokines, chemokines and other genes is affected by methylation and acetylation while non-coding RNAs, including microRNAs as well as long non-coding RNAs, also affect the overall inflammatory responses. Select miRNAs can regulate inflammation in COVID-19 infection, lung cancer as well as other inflammatory lung diseases, and can serve as epigenetic links that can be therapeutically targeted. Furthermore, epigenetic changes also mediate the environmental factors-induced inflammation. Therefore, a better understanding of epigenetic regulation of inflammation can potentially help develop novel strategies to prevent, diagnose and treat chronic pulmonary diseases, lung cancer and COVID-19.

Aim: To evaluate the application of the principles of Patient and Family-centered Care Methodology: A cross-sectional study was conducted in the Pediatric and Neonatal Intensive care unit of a tertiary care hospital in Punjab, Pakistan. IRB approval was granted, and the study spanned a period from January 2019 to June 2019. A questionnaire was created to survey the pediatric patient's parents. Data analysis was done using SPSS 25. Results: A total of 158 responses were recorded. The majority of the parents felt that patient and family-centered care was not being applied to the admitted patients' management plans in the pediatric and neonatal ICUs. Conclusion: The treatment of patients in the pediatric and neonatal ICUs was not following the principles of patient and family-centered care. Therefore, further studies are required to improve the ease of access, alongside limiting the barriers to the patient and family-centered care in Pakistan. This way, patients can benefit from improved outcomes associated with PFCC. Keywords: Neonatal intensive care unit (NICU), intensive care unit (ICU), pediatric intensive care unit (PICU), patient and family-centered care (PFCC).

This study aims to propose organic materials for the development of light-emitting semiconductor diodes for colored displays. Studies show that these materials are capable of creating a variety of different colors rather than white light. But of Organic Light-Emitting Diodes (OLEDs) are only used as a source of white back-light for OLED displays and liquid crystals are used for color generation. This work suggests that OLEDs can be used to make color displays on their own without the help of Liquid Crystals (LCs). Recently, organic devices are widely under discussion as are comparatively cheap, can be processed economically and effortlessly at ambient temperature besides their effortless handling. The calculation of the electronic properties of molecular species was achieved by the use of ab-initio quantum mechanical methods, i.e., Density Functional Theory (DFT). DFT methods are suited to calculate the electronics properties of the organic molecules, enabling the determination of band gaps and quantum efficiencies. DFT views electron stochastic nature and thus calculates the material’s solid-state properties. DFT calculations on isolated molecules were carried by the Gaussian software package to predict electronic properties. Pentacene is used as test molecule in this work. B3LYP functional use Kohn-Sham orbitals to predict the band energy values said material rather than LDA functional that depends on the value of electronic density at each point on the space. The substitution process was used to make changes in bandgaps; which affect shades of light emitted by OLEDs.

Aim: To determine the viral load in the patients admitted in Covid-19 isolation and its correlation with the inflammatory markers and the following clinical outcome. Methodology: A retrospective study was conducted in the Pathology Department of Doctors Hospital and Medical Centre in Lahore, Pakistan from November 2020 to January 2021. IRB approval was granted. A total of 86 patients met the inclusion criteria for the study. Data was analyzed using research tool SPSS 24. Results: Increased serum viral load in SARS-CoV-2 infection showed positive correlation with inflammatory markers IL-6 (P =0.04) and D-dimer (P =0.029). Inflammatory markers LDH, Ferritin, Procalcitonin, D-Dimers and viral load itself (CT) all correlated with higher mortality while IL-6 did not. Conclusion: Serum viral load in patients infected with SARS-CoV-2 correlates with higher mortality rates itself and also raises certain inflammatory markers (IL-6, D-Dimers), which are independently accountable for causing higher mortality as well. Hence, increased inflammatory markers resulted in poor prognosis regardless of high or low viral load. Their correlation with mortality can still serve as prognostic indicators. Keywords: viral load, inflammatory markers, Covid-19, mortality

Production from unconventional tight gas resources plays significant role in energy market. It is commonly held that the tight gas has gained considerable importance in meeting energy needs and is widely developed across the world. It is also worth noting that several countries are engaged in pursuing the tight gas resources development to meet energy challenges. However, the copious concerns have emerged to technical and economic development of tight gas potential. Hence, it is essential to accurately assess the resources and to address the key technical issues and economic feasibilities that will support in mitigating the risk and to increase the investment opportunities. This paper provides a systematic review about current status, field development best strategies; in addition, the paper also addresses the obstacles and issues for development of tight gas potential in Pakistan. Although, the efforts made by the Exploration and Production (E&P) firms operating in Pakistan are not very encouraging for tight gas resources development. Hence; this requires further improvements and accurate assessments to develop tight gas resources effectively. Thus, for accurate assessment of tight gas potential, various imperative approaches, ideas, considerations, several challenges and the best strategies for field development are highlighted that offers significant improvement in materializing the future trends in tight gas potential development. The paper will be a kind of helpful tool for the policy makers, potential investors and industry professionals working in Pakistan’s E&P industry.

The textile industry is a very labour intensive industry which mainly comprises of small and medium enterprises (SMEs).In developing countries, usually occupational health and safety programs are focused on large-scale organisations. Across-sectional study on evaluating ergonomics risk factors associated with task performing strategies has been carriedout at cutting and sewing units of a garment industry organisation. A reliable direct observational ergonomics riskassessment method Rapid Entire Body Assessment (REBA) was used to find out the risk associated with workingpostures adopted by the workers. Data was collected through physical observations, walkthrough, interviews, and videorecordings. Data analysis was carried out on 180 selected postures by using REBA method. It concluded that overallworking strategies were poorly designed as more than 30% of postures highlighted a high level of risk of MSDs thatnecessitates immediate investigation for improvement. Major causes of risk were linked with the postural movementsattached with the wrist, lower arm, and neck. The findings of the study add to the understanding of working conditionsof cutting and sewing activities at garment manufacturing industries, these could help in the design of ergonomicsinterventions for reducing musculoskeletal symptoms and improving job quality which eventually increases workproductivity.

Pneumonia like the pandemic COVID-19 is a virus disease, first time came into light in December 2019 in the Wuhan city of China. As of today, more than two million deaths from more than 210 countries have been confirmed. This disease has modeled a great threat to human mental health, physical health, and forcefully stuck the routine life with psychosocial consequences globally. The COVID-19 disease is caused by SARS-CoV-2 which leads to acute respiratory distress. The pathogenesis of the disease started from virus entry to the host cell where it controlled the cellular system of the patient directly or indirectly. Population having cardiovascular, immunosuppressive, AIDS, and diabetes-like complications are thought to be very risky for mortality caused by the SARS-CoV-2 virus. The correlation to Noncommunicable diseases like cardiovascular disorders and diabetes has led our attention towards the management of these diseases in the corona outbreak. Thus, this review aimed to better understand the threats modeled by the disease COVID-19 to the cardiovascular system, and the medical community should share their experiences promptly. It is concluded that both published research and real-time experiences shared on social media by world experts will act as a valuable tool and will help to learn more about this disease. Several preventive and therapeutic measures including drug therapy are suggested to manage the disease in comorbidities conditions.

Objective: To find out the effective method of endotracheal intubation among patients of intracranial bleed. Methods: A quasi experimental research was performed at emergency department of Ziauddin University Hospital Karachi. 236 intracranial bleed patients were selected by consecutive sampling, half of them were intubated at upright position (45°) and remaining half at supine position. Patients of musculoskeletal deformities, ischemic stroke and previously intubated were excluded. Success or failure of endotracheal tube was confirmed by measuring oxygen saturation and audible breath sounds on chest. Results: Success rate of endotracheal placement (p-value

Detection of abnormal behavior in surveillance videos is essential for public safety and monitoring. However, it needs constant human focus and attention for human-based surveillance systems, which is a challenging process. Therefore, automatic detection of such events is of great significance. Abnormal event detection is a challenging problem due to the scarceness of labelled data and the low probability of occurrence of such events. In this paper, we propose a novel multi-stream two-stage architecture to detect abnormal behavior in videos. Our contributions are three-fold: 1) In the first stage, we propose a 3D Convolutional Autoencoder (3DCAE) architecture for appearance and motion feature extraction from both video frame input and dynamic flow input streams of normal event training videos in an unsupervised manner. 2) We have used a multi-objective loss function for 3DCAE reconstruction which can focus more on foreground moving objects rather that the stationary background information. 3) In the second stage, the fused latent features from both video frames and dynamic flow inputs are grouped together into different clusters of normality. Then we eliminate the smaller or sparse clusters, which are supposed to contain noisy patterns in the training data, to represent stronger normality patterns. A Deep one-class Support Vector Data Description (SVDD) classifier is then trained on these 3D normality clusters to generate anomaly scores for each sample in 3D clusters to differentiate between normal and abnormal occurrences. Experimental results on three benchmarking datasets: UCSD Pedestrian, Shanghai Tech, and Avenue, show significant improvement in the performance compared to the state-of-the-art approaches.

Background: For controlling unwilling pregnancy, sustaining gorgeousness and good health, among the elite level female athletes the use of contraceptive pills is quite common. Objective: Oxidative stress in female athletes is understudied. This research study was carried out in order to assess the alteration in metabolic rate of blood urea, bilirubin and oxidative stress induced by Levonorgestrel and Ethinylestradiol (oral contraceptive pills). The outcome of the study will reveal the impact of oral contraceptive pills on the overall health of the females. Methods: User and non-user of oral contraceptive pills were included as participants of the study. Sixty elite level female athletes using Levonorgestrel and Ethinylestradiol were recruited as experimental group and twenty four female (non-users) as a control group were taken as sample of the study. Blood sample (5ml) was taken from all the subjects. Blood urea and bilirubin metabolism were estimated through kidney functional test and for the measurement of oxidative stress FRAP assay was used. The data obtained through kidney functional tests and FRAP assay were processed through statistical package for social sciences (SPSS, Version 23.0) Results: A significant difference was found between control and experimental subjects in FRAP values because (t (82) = 3.236, P

Working eternally from the shoreline is all around considered as a distressing profession where work environment stress is accepted as a noteworthy danger aspect for mental ailment. Then again, stress-related writing relating to this part is scant. The aim of present research is to investigating the impacts of work-stress among the individuals working in managerial cadres of oil and gas sector organizations at Pakistan. A self designed instrument was used to gather information for this cross-sectional examination. Measure's legitimacy was built up by ascertaining Cronbach's alpha (0.914). Exploratory factor analysis (EFA) with Principal Component Analysis extraction method and Oblimin with Kaiser Normalization rotation method was applied on the collected information. Barlett test of sphericity and the Kaiser-Meyer-Olkin (KMO) proved the suitability of factor analysis as an explanatory apparatus for the analysis of the collected data. EFA distinguished four components for the impacts of work-stress: Psychological; Performance; physiological, and Cognitive. These components explained 73.62% of total variance. The component Psychological was the most noteworthy component. This investigation has not just recognized the significant impacts of work-stress in seaward oil organizations at Pakistan yet in addition gave an organized rundown of these factors. Discoveries of the investigation will support analysts, arrangement creators, bosses and the specialists to devise and execute pressure avoidance and development technique. This is the ever first work of its sort in Pakistan.

Background: Autism Spectrum Disorder (ASD) is a multifaceted neurodevelopmental condition characterized by multiple psychological and physiological impairments in young children. According to the recent reports, 1 out of every 58 newly-born children is suffering from autism. The aetiology of the disorder is complex and poorly understood, hindering the adaptation of targeted and effective therapies. There are no well- established diagnostic biomarkers for autism. Hence the analysis of symptoms by the pediatricians plays a critical role in the early intervention. Methods: In the present report, we have emphasized 24 behavioral, psychological and clinical symptoms of autism. Results: Impaired social interaction, restrictive and narrow interests, anxiety, depression; aggressive, repetitive, rigid and self-injurious behavior, lack of consistency, short attention span, fear, shyness and phobias, hypersensitivity and rapid mood alterations, high level of food and toy selectivity; inability to establish friendships or follow the instructions; fascination by round spinning objects and eating non-food materials are common psychological characteristics of autism. Speech or hearing impairments, poor cognitive function, gastrointestinal problems, weak immunity, disturbed sleep and circadian rhythms, weak motor neuromuscular interaction, lower level of serotonin and neurotransmitters, headache and body pain are common physiological symptoms. Conclusion: A variable qualitative and quantitative impact of this wide range of symptoms is perceived in each autistic individual, making him/her distinct, incomparable and exceptional. Selection and application of highly personalized medical and psychological therapies are therefore recommended for the management and treatment of autism.

Takotsubo Cardiomyopathy (TC) is a syndrome characterized by reversible left ventricular dysfunction in the presence of possible emotional or physical triggers but without evidence of obstructive coronary artery disease. It has become increasingly reported worldwide and is associated with significant morbidity and mortality. TC may present with an array of electrocardiographic (ECG) findings. These ECG findings, if accurately interpreted, can play an important role in the diagnosis and risk stratification of this syndrome. In the last three decades since the disease was first described, multiple diagnostic criteria have been established. The key diagnostic tools for TC include clinical symptomatology, cardiac biomarkers, non-invasive cardiac imaging, and coronary angiography. The ECG findings in TC can be variable, however, some ECG scores have been proposed in association with TC with reasonably good diagnostic sensitivity and specificity. This article aims to provide a succinct review of important electrocardiographic findings associated with TC and its impact on clinical outcomes.

Aims: The aim of present investigation was to evaluate the traditional claim of Ficus retusa as an anti-diarrheal and anti-spasmodic agent using different pharmacological models. Background: Diarrhea is considered as major cause of mortality, especially in children and aged persons. Because of diarrhoea, 17% of admitted children get die. In order to treat the diarrhea, natural drugs may be useful. Objective: In order to prove the traditional claim of Ficus retusa, present work was undertaken with objective to prove antidiarrheal and antispasmodic activity. Methods: The anti-diarrhoeal activity was evaluated by magnesium sulphate induced diarrhea and 5-hydroxy tryptamine(5HT) induced diarrhea. Further, the exact were subjected to gastrointestinal motility test using standard procedure. Conclusion: The response towards bioactivity was dose dependent. It was concluded that 400mg/kg bw of ethanolic extract is most potent in antidiarrhoeal and antispasmodic activity.

This paper tends to present a systematic review of the applications of Artificial Intelligence (AI) in the field of medical diagnosis vis-a-vis fluid cytology. The study is based on the research articles published in various reputed international and national journals and the conference proceedings from 1990 to till date. AI-based systems are becoming useful as alternative approaches to conventional techniques and are also becoming integral components of many diagnostic systems. Artificial intelligence is being increasingly used to solve complex practical problems in various areas and is becoming more and more popular nowadays. The use of AI for tackling various problems in medical science has diversified significantly during this period. It emerges as a dominant technique for addressing various difficult research problems. This paper follows the trend and evolution of application-based research during the last three decades. It also presents a technical comparison of novel methodologies developed by the researchers to deal with diagnostic problems in the analysis of body cavity fluids. Abnormalities in body cavity fluids lead to various serious disorders like meningitis, subarachnoid hemorrhage, CNS malignancy, demyelinating disease, heart failure, pulmonary embolism, cirrhosis, pneumonia, pleurisy, and pericarditis, arthritis, joint Infection and joint hemorrhage. Moreover, the paper includes recent research articles published during 2018 and 2019 to present the recent progress in this domain.

Objective: 1.To determine the pattern of resistance of salmonella Typhi strains to multiple antibiotics in Islamabad and adjoining areas. 2.Suggestions regarding the regular upgradation of antibiogram according to the most susceptible strains. Method: Cross sectional study conducted for duration of one year ,recruited those patients whose blood cultures were found positive for Salmonella Typhi at Islamabad Diagnostic Center. We analyzed 100 samples and Positive culture were then assessed for sensitivity by using various antibiotics and pattern of resistance was analyzed. Results: Majority of positive patients were male and children. Sensitivity to the conventional antibiotics was found to be more in children. In all the positive isolates, 89% were sensitive to the first line treatment options.Among them, 96.6%were showing sensitivity to third generation cephalosporin. However, a few cases were having extensively drug resistant patterns (XDR). Conclusion: Despite the fact that extensively drug resistantstrains are emerging and indicating an alarming situation,its found out that more than 80% of patients are responding to the conventional therapy,making it a dire need for upgradation of antibiograms, so that the side effects of second line and advanced antibiotic can be avoided, mostly in paediatric population.

Objective Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers. Methods Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated. Results Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54–5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36–3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27–7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12–4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales. Conclusions Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded.

BACKGROUND & OBJECTIVE: primary Hepatitis C is a serious public health problem and is the cause of liver cirrhosis, hepatocellular carcinoma (HCC), and numerous end-stage liver disease manifestations. The management of hepatitis C is to preclude liver cirrhosis, lessen the risk of hepatocellular carcinoma or hepatoma, and curing the extra hepatic diseases. Initially, interferon was the cornerstone for treating hepatitis C, but due to its cumbersome complications, route of administration, and limited treatment access, many patients showed noncompliance. New therapies for chronic hepatitis C have been introduced based on direct antiviral effects. Several genotypes of hepatitis C have been discovered and they are responsive to different antiviral therapies. Our objective was to assess the genotypic distribution of HCV in our local setup and their pattern of response to different combination of anti-viral therapies by assessing the sustained viral response (SVR) after 12 weeks post-treatment. To determine the most prevalent genotype of hepatics C virus in our population and pattern of the response of multiple genotypes to different antiviral regimens. METHODOLOGY: It is a cross-sectional study conducted for duration of six months and recruited those patients whose polymerase chain reaction (PCR) was found positive for hepatitis C virus at Islamabad Diagnostic Center. We analyzed 100 patients, both children and adults. Patients were assessed for different genotypes and then different combinations of antiviral treatments were administered. Their clinical data, hematological parameters and viral load before and after treatment were also analyzed. RESULTS: In a total of 100 positive hepatitis C virus-infected patients, 55% were females and 45% males. The frequencies of genotypes observed were 91 %, 06%, and 03% of genotype 3, 1a, and 1b respectively. 51 out of 91 patients with type 3 genotype, who were on antiviral therapy of sofosbuvir and ribavirin, all of them achieved SVR. 30 out of 91 patients with type 3 genotype were treated with sofosbuvir alone, the percentage of failure to achieve SVR in them was 6.7%. Treatment failure percentage of 10% was observed when a combination of Interferon (INF) alpha and ribavirin was used in type 3 genotype. Remaining six patients with type 1a and three patients of type 1b genotype achieved SVR with different regimens used. CONCLUSION: Although the increased load of HCV in our setup is an alarming situation the prevalence of type 3 genotype is a blessing in disguise. The success of sustained viral response after various combinations of direct antiviral therapy and interferon-free treatment is hope for the ultimate cure of the disease and avoidance of debilitating side effects related to interferon.

The threat from deliberate or accidental exposure to halogen gases is increasing as is their industrial application and use as chemical warfare agents. Biomarkers that can identify halogen exposure, diagnose victims of exposure or predict injury severity, and enable appropriate treatment are lacking. We conducted these studies to determine and validate biomarkers of bromine (Br(2)) toxicity and correlate the symptoms and the extent of cardiopulmonary injuries. Unanesthetized rats were exposed to Br(2) and monitored noninvasively for clinical scores and pulse oximetry. Animals were euthanized and grouped at various time intervals to assess brominated fatty acid (BFA) content in the plasma, lung, and heart using mass spectrometry. Bronchoalveolar lavage fluid (BALF) protein content was used to assess pulmonary injury. Cardiac troponin I (cTnI) was assessed in the plasma to evaluate cardiac injury. The blood, lung, and cardiac tissue BFA content significantly correlated with the clinical scores, tissue oxygenation, heart rate, and cardiopulmonary injury parameters. Total (free + esterified) bromostearic acid levels correlated with lung injury as indicated by BALF protein content and free bromostearic acid levels correlated with plasma cTNI levels. Thus, BFAs and cardiac injury biomarkers can identify Br(2) exposure and predict the severity of organ damage.

The Thal region of Punjab often experiences dry weather conditions with extreme variability in rainfall on a spatiotemporal scale during Rabi cropping season. The current study assesses the impacts of agricultural drought on wheat crops for 2000–2015. MOD13Q1 and CHIRPS data were used for identifying and assessing variation in agricultural drought patterns and severity. Standardized Precipitation Index (SPI), Normalized Difference Vegetation Index (NDVI), Vegetation Condition Index (VCI), Stress Vegetation Index (STVI) and wheat crop yield anomalies were computed to characterize the gravity of drought across the Thal region. The results indicate that the wheat Rabi cropping seasons of the years 2000–2002 experienced extreme agricultural drought, with a spatial difference in severity level causing low and poor yield, while the years 2011 and 2014 were almost normal among all the years, leaving varied impacts on wheat yield. The combined agricultural risk map was generated by integrating the agricultural and meteorological droughts severity maps. The combined risk map generated using weighted overlay analysis of all the parameters indicate that the total Thal area can be classified into slight, moderate and no drought covering 28.12, 12.76, and 59.12% respectively of the total area. Hence an agricultural risk map would be extremely helpful as a tool to guide the decision-making process for monitoring drought risk on agricultural productivity.

Objectives: To know about the Neurosurgical burden of Hydrocephalus in a tertiary care hospital, in developing world. Study Design: Cross sectional study. Setting: Department of Neurosurgery, MTI/LRH Peshawar. Period: September 2015 to August 2016. Material & Methods: The age, gender, indication for surgery, type of surgery and mode of surgery i.e. whether as elective or emergency, was recorded on a proforma. All patients undergoing surgery primarily for hydrocephalus due to any cause were included in the study. Patients undergoing surgery for indications other than hydrocephalus as well as patients primarily explored for other etiologies and intervened for hydrocephalus in the midst of procedure were excluded from the study. Results: During the study period a total of 2844 patients were operated and amongst them were 437 (15.34%) cases operated for hydrocephalus. Of them were 242 males and 195 females, and the male to female ratio was 1.24. The age range was one month to 68 years and the mean age was 5±4.8 years. There were 250 new shunts and 69 revisions and 13 removal procedures, 70(2.4%) endoscopic hydrocephalus related procedures, 28 external ventricular drains and 7 lumboperitoneal shunts. 189 cases were done on elective list while 248 as emergency. Conclusion: Every 3rd case done on emergency list and every 10th case done on elective list was related to hydrocephalus and accounted for 16% of all the cases done in the neurosurgery.

Background/Purpose We assessed commonly reported patient- and circuit-related adverse events involving extracorporeal membrane oxygenation (ECMO) devices by analyzing post-marketing surveillance data from the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database. ECMO is a rescue therapy for critically ill patients requiring oxygenation and cardiopulmonary support. Key configurations include veno-venous (VV) ECMO for respiratory support and veno-arterial (VA) ECMO for cardio-respiratory support. Robust data on the most commonly reported complications associated with ECMO therapy are limited. Methods/Materials The MAUDE database was queried from January 1, 2009, through March 31, 2019, yielding 93 reports. After excluding duplicate reports, 82 reports were included in the final analysis. Results Percentages represent the proportion of total submitted MAUDE reports on ECMO. Of the reported cases, 24 were VV-ECMO, 8 were VA-ECMO, and the remainder were unspecified. The most commonly reported patient-related adverse events included hemodynamic decompensation of patients (12.2%), death (12.2%), atrial perforation (7.3%), and bleeding (7.3%). The most commonly reported failure modes were in the following circuit components: mechanical pump (19.5%, mostly due to technical failure or clots), membrane oxygenator (19.5%, mostly due to tear in the membrane or temperature probe), and access cannulae (18.3%, mostly due to structural damage). Conclusions Analysis of the MAUDE database demonstrates that in real-world practice, ECMO devices are associated with important complications. With broadened global utilization of ECMO devices, standard complication and failure reporting policies may improve patient selection, operator proficiency, and existing device technology. Summary An analysis of the Food and Drug Administration's Manufacturer and User Facility Device Experience database demonstrates that in real-world practice, extracorporeal membrane oxygenation devices are associated with serious complications. The most commonly reported patient-related adverse events were hemodynamic decompensation of patients and death, and the most commonly reported failure modes were in the device's mechanical pump and membrane oxygenator.

Background Comorbid chronic obstructive pulmonary disease (COPD) increases morbidity and mortality among aortic valve replacement patients undergoing conventional surgery. The impact of COPD in patients undergoing less invasive transcatheter aortic valve insertion (TAVI) is unclear. Hypothesis This study evaluates the in‐hospital outcomes of TAVI in patients with and without COPD. Methods This population‐based, retrospective study of 8466 TAVI patients (29.87% with COPD) evaluates the effects of COPD on short‐term clinical outcomes (in‐hospital mortality, length of hospital stay, and postoperative complications) using data from the National Inpatient Sample database from 2011 to 2014. Logistic regression analysis was used to determine factors associated with in‐hospital mortality and postoperative complications. Linear regression analysis was used to identify factors associated with length of hospital stay. Results COPD is significantly associated with increased risk of respiratory complications and pneumonia after TAVI (aOR = 1.43, 95% CI: 1.24‐1.64; P

This study describes the importance of multivariate techniques in evaluating the underlying mechanisms responsible for the spatial–temporal dynamics in physicochemical characteristics of a riverine ecosystem. Evaluation and assessment of physicochemical variables of Marusudar River, Chenab valley, and Northwestern Himalayas, India are very important due to the plan for exploiting this river for hydropower generation. In this study, the physicochemical variables were taken from 15 sampling locations spread over the entire river basin (winter 2014, summer, and autumn 2015) were investigated. The results of the study indicate that the datasets obtained are clusterable, and the whole river basin can be categorized in two recognizable clusters with different water quality identified by Hopkin’s statistics, hierarchical cluster analysis, and subsequently validated by the silhouette coefficient measures. Correlation and regression tests showed that water quality variables bear significant positive and negative relationships and significantly explain the significant proportion of variations produced in the dependent variables predictable from the independent variables. The results of Wilks’ statistics corroborate with the principal component analysis of the entire river and cluster-wise dataset, showing the influence of natural and anthropogenic factors as drivers of the overall water quality in the Marusudar River. The water quality of the cluster 2 sites displayed the impact of anthropogenic activities. Furthermore, pH, total dissolved solids, and total hardness were the main and effective contributors to water quality index evaluation and determination. Gibbs and Piper’s analysis indicated the rock-water dominance with calcium-bicarbonate hydrochemical facies in the river basin.

OBJECTIVE: To determine the frequency of sensorineural hearing loss in chronic suppurative otitis media. MATERIAL AND METHODS: A cross sectional descriptive study was done at department of ENT-B, Hayatabad Medical Complex (HMC), Peshawar, from March 2016 to September 2016. In this study a total of 174 patients were observed by using 95% confidence interval and 5% margin of error with expected frequency of sensorineural hearing loss 13% among cases with chronic suppurative otitis media with the help of WHO formula for sample size determination. More over consecutive (non-probability) sampling technique was used for sample collection. RESULTS: In this study mean age was 26 years with standard deviation ± 11.62. Forty five percent patients were male while 55% patients were female. More over the incidence of sensorineural hearing loss was found to be 18% in patients with chronic suppurative otitis media. CONCLUSION: The incidence of sensorineural hearing loss was found to be 18% in patients with chronic suppurative otitis media. KEY WORDS: Bacteriology, antibiotic sensitivity, chronic suppurative otitis media, sensory neural hearing loss

Background: Pulmonary arterial hypertension (PAH) is a progressive proliferative vasculopathy associated with mechanical and electrical changes, culminating in increased vascular resistance, right ventricular (RV) failure, and death. With a main focus on invasive tools, there has been an underutilization of echocardiography, electrocardiography, and biomarkers to non-invasively assess the changes in myocardial and pulmonary vascular structure and function during the course of PAH.Methods: A SU5416-hypoxia rat model was used for inducing PAH. Biventricular functions were measured using transthoracic two-dimensional (2D) echocardiography/Doppler (echo/Doppler) at disease onset (0 week), during progression (3 weeks), and establishment (5 weeks). Similarly, electrocardiography was performed at 0, 3, and 5 weeks. Invasive hemodynamic measurements and markers of cardiac injury in plasma were assessed at 0, 3, and 5 weeks.Results: Increased RV systolic pressure (RVSP) and rate of isovolumic pressure rise and decline were observed at 0, 3, and 5 weeks in PAH animals. EKG showed a steady increase in QT-interval with progression of PAH, whereas P-wave height and RS width were increased only during the initial stages of PAH progression. Echocardiographic markers of PAH progression and severity were also identified. Three echocardiographic patterns were observed: a steady pattern (0–5 weeks) in which echo parameter changed progressively with severity [inferior vena cava (IVC) expiratory diameter and pulmonary artery acceleration time (PAAT)], an early pattern (0–3 weeks) where there is an early change in parameters [RV fractional area change (RV-FAC), transmitral flow, left ventricle (LV) output, estimated mean PA pressure, RV performance index, and LV systolic eccentricity index], and a late pattern (3–5 weeks) in which there is only a late rise at advanced stages of PAH (LV diastolic eccentricity index). RVSP correlated with PAAT, PAAT/PA ejection times, IVC diameters, RV-FAC, tricuspid systolic excursion, LV systolic eccentricity and output, and transmitral flow. Plasma myosin light chain (Myl-3) and cardiac troponin I (cTnI) increased progressively across the three time points. Cardiac troponin T (cTnT) and fatty acid-binding protein-3 (FABP-3) were significantly elevated only at the 5-week time point.Conclusion: Distinct electrocardiographic and echocardiographic patterns along with plasma biomarkers were identified as useful non-invasive tools for monitoring PAH progression.

Schizophrenia is a chronic, heterogeneous neurodevelopmental disorder that has complex symptoms and uncertain etiology. Mounting evidence indicates the involvement of genetics and epigenetic disturbances, alteration in gut microbiome, immune system abnormalities, and environmental influence in the disease, but a single root cause and mechanism involved has yet to be conclusively determined. Consequently, the identification of diagnostic markers and the development of psychotic drugs for the treatment of schizophrenia faces a high failure rate. This article surveys the etiology of schizophrenia with a particular focus on gut microbiota regulation and the microbial signaling system that correlates with the brain through the vagus nerve, enteric nervous system, immune system, and production of postbiotics. Gut microbially produced molecules may lay the groundwork for further investigations into the role of gut microbiota dysbiosis and the pathophysiology of schizophrenia. Current treatment of schizophrenia is limited to psychotherapy and antipsychotic drugs that have significant side effects. Therefore, alternative therapeutic options merit exploration. The use of psychobiotics alone or in combination with antipsychotics may promote the development of novel therapeutic strategies. In view of the individual gut microbiome structure and personalized response to antipsychotic drugs, a tailored and targeted manipulation of gut microbial diversity naturally by novel prebiotics (non-digestible fiber) may be a successful alternative therapeutic for the treatment of schizophrenia patients.

Advance Digital Signal Processing (DSP) techniques are controlling a wide range of signals in Smart Grid (SG) and narrowing the communication gap between various SG entities. Therefore, DSP is considered the backbone of SG that will meet future needs. The DSP interactions within SG are vital for SG reliability and efficiency. The advanced techniques for DSP interactions within SG are playing a pivotal role in improving the Power Quality (PQ). PQ includes technical challenges, such as instrumentation, measurement, and DSP techniques to increase knowledge of disturbances suffered by SG. PQ disturbances can have significantly different parameters and SG must deal with wide ranges of voltage and current magnitude disturbances, frequency drifts, and duration of disturbances. Power electronic components, such as (a) AC/DC converters, (b) adjustable-speed drives, (c) inverters, and (d) light dimmer controls the flow of power by de-shaping, flattening, or chopping sinusoidal power system voltages and currents. The aforementioned distortion of waveforms can affect PQ and create problems for nearby loads. SG ensures to operate linear and non-linear loads: (a) without damaging them, and (b) without reducing the efficiency of the power system.

This study aims to highlight the impact of promotional advertising on children's buying behavior.Promotions are tools that maximize the sales of any organization. Retailers or manufacturers apply this toolto invite consumers to buy more products. The proposed study aims to focus the advertising impact on childpurchases in the Pakistani capital. It is convenient to sample 500 respondents and collect data with the helpof the questionnaire. The results show that there is a negligible correlation between the purchase behaviorand coupons. On the contrary, buying one-to-one free, the physical environment impacts significantly on thepurchase behavior. The proposed research helps marketers recognize most effective promotional ads thatcan significantly affect a child's buying behavior

Takotsubo syndrome is a wide spectrum disease with a dramatic clinical presentation mimicking acute coronary syndrome albeit without obstructive coronary disease and typically manifests in the backdrop of intense emotional or physical trigger. Pathophysiology is incompletely understood with multifactorial mechanistic pathways circling around a heart-brain-endocrine axis. Several anatomic and phenotypic variants exist with varied clinical manifestations. The aftermath of Takotsubo syndrome is not always benign and both short- and long-term complications can occur which may impact its prognosis. Several gaps in knowledge exist providing an impetus for tremendous future research opportunities.

Students understanding of science education in Pakistan is not up to the standard level. The main aim of the study is to see either comprehension level is raised through Synectics among high school students. A systematic review of related literature and Meta-analysis has been done. Literature leads to conclusion that there is a need to study the utility of Synectics model. Findings show that Synectics is more effective than routine methods in teaching. Synectics help in the development of creativity, training in creativity, and scholastic achievement. It is recommended that teachers and students must be familiar with Synectics and also implement this technique into teacher training institutes for quality education.

Introduction Musculoskeletal pain is common among Physical therapy students due to prolonged study hours and clinical practice. The objective of current study was to determine the prevalence of upper back pain among physical therapy students and its association with demographic information, length of study hours and use of cell Phones. Methods This cross sectional survey was conducted in Peshawar, Pakistan from November 2017 to March 2018. 232 students from different physical therapy institutes were included in the study through consecutive sampling. Self-administered questionnaire was used as the study conducting tool having questions regarding demographic information, Body mass index (BMI) study hours, use of cell phone and upper back pain. Results The Prevalence of upper back pain among DPT students was 44.8% (n=104) in which 33(31.7%) male students and 71(68.3%) female students had upper back pain. There was significant association between female gender and upper back pain (p-value Conclusion The frequency of upper back pain was high among physical therapy students. Female gender was highly associated with upper back pain. There was no significant association of upper back pain with BMI, study hours and use of cell phones.

Objective: To determine the frequency and associated factors of knee and low back pain among adults with pes planus. Methods: This cross-sectional study was conducted in Hayatabad Medical Complex Peshawar, Pakistan from May 2017 to November 2017. Two hundred diagnosed Pes Planus patients were included. Questionnaire was used to collect data regarding demographic information, knee and low back pain, foot wear and severity of pes planus. Results: Out of total 200 patients, mean age of the patients was 29.14±7.69 years. Knee pain was observed in 123 (61.5%) participants, back pain in 110 (55%) whereas both knee and back pain was observed in 83 (41.5%) patients. Knee pain was significantly associated with age (p-value 0.001), gender (p-value 0.032), BMI (p-value 0.006) and occupation. Back pain was significantly associated with age (p-value 0012), gender (p-value

Despite the high morbidity and mortality among patients with extensive cutaneous burns in the intensive care unit due to the development of acute respiratory distress syndrome, effective therapeutics remain to be determined. This is primarily because the mechanisms leading to acute lung injury (ALI) in these patients remain unknown. We test the hypothesis that cutaneous chemical burns promote lung injury due to systemic activation of neutrophils, in particular, toxicity mediated by the deployment of neutrophil extracellular traps (NETs). We also demonstrate the potential benefit of a peptidyl arginine deiminase 4 (PAD4) inhibitor to prevent NETosis and to preserve microvascular endothelial barrier function, thus reducing the severity of ALI in mice. Our data demonstrated that phenylarsine oxide (PAO) treatment of neutrophils caused increased intracellular Ca2+-associated PAD4 activity. A dermal chemical burn by lewisite or PAO resulted in PAD4 activation, NETosis, and ALI. NETs disrupted the barrier function of endothelial cells in human lung microvascular endothelial cell spheroids. Citrullinated histone 3 alone caused ALI in mice. Pharmacologic or genetic abrogation of PAD4 inhibited lung injury following cutaneous chemical burns. Cutaneous burns by lewisite and PAO caused ALI by PAD4-mediated NETosis. PAD4 inhibitors may have potential as countermeasures to suppress detrimental lung injury after chemical burns.

Rapid ramp up of immune responses against SARS-CoV-2 during pandemic enables adequate prevention and treatment for COVID-19. Estimating levels of SARS-CoV-2 spike protein antibodies post vaccination is crucial for designing mass-vaccination strategies. The aim of this study was to evaluate effectiveness of Sputnik V first dose in Pakistan. A cross-sectional study of 2000 participants was conducted for examining Gam-COVID-Vac or Sputnik V first dose effects at 21st days post administration at Islamabad Diagnostic Center, Islamabad, Pakistan. From 100 real-time PCR negative (SARS-CoV-2 RNA) individuals, samples were collected and analyzed for antibodies to the SARS-CoV-2 spike protein using Electro-chemiluminescence immunoassay (ECLIA) (Elecsys # 09289267190 Roche, USA). 85% of the participants showed strong positive results with SARS-CoV-2 spike protein antibodies > 1.5 AU/ml. The individuals with antibody titer > 250 AU/ml were 34.9%. Among those with antibody levels > 250 AU/ml 52% had previous history of COVID-19 infection. While participants with > 100 AU/ml of antibodies were 12.7%. However 9.5% showed antibody titer of > 25 AU/ml. 27% of participants had antibody titers of > 1.5–2.5 AU/ml. While antibody titers of

Introduction: Current study was designed to evaluate the wound healing activity of a Saudi pomegranate peel extract on excision wound healing in experimentally induced diabetes in rats.Methodology: Animals were divided into three groups: diabetic excision wound with no treatment, diabetic excision wound with gel alone and diabetic excision wound with Saudi pomegranate peel extract in gel. Animals were monitored for clinical signs, weekly body weight, morbidity and mortality during entire study period. The efficacy parameters evaluated were percent wound contraction, Hydroxyproline content, estimation of Transforming Growth Factor ß1 (TGF-ß1), Vascular Endothelial Growth Factor (VEGF), and Epidermal Growth Factor (EGF) in wound lysates by ELISA, mRNA expression of TGF-ß1, VEGF, and EGF in wound lysates by qPCR, Estimation of nitric oxide (NO) and NO synthase (NOS) in Wound Lysates and histopathology of skin for reepithelization, neovascularization, and inflammation.Results: The Saudi pomegranate peel extract in gel (5.0 g extract per 100 g gel) showed significant wound healing activity when compared to the vehicle control [p < 0.05] following 21 days of treatment. Animals in the control and treatment groups were apparently normal through the study with no significant differences in body weights between groups. Expression of mRNA of TGFβ1, EGF and VEGF in wounds was the highest on day 14 post treatment 4.3, 3.5 and 0.9 fold higher respectively in the treatment group when compared to vehicle control, and on day 21, the values were 0.12, 0.3 and 0.83, respectively. No statistically significant differences were observed in TGF-ß1 levels in wounds on days 4, 7, 14 and 21 post treatment when compared to the vehicle control (p > 0.05). Significantly higher levels of VEGF were observed in treatment group on day 7 and 21 when compared to vehicle control (p < 0.05). Significantly higher levels of EGF were observed in treatment group on day 7 and 21 when compared to vehicle control (p < 0.05). Mean hydroxyproline levels were higher in treatment group on days 4 and 7 when compared to vehicle control. NO levels in treatment group were significantly lower on days 7, 14 and 21 when compared to vehicle control (p < 0.05). NOS activity in treatment group were significantly lower on days 4 and 7 when compared to vehicle control (p < 0.05). Histopathological changes in skin wound in the treatment group were consistent with wound healing when compared to the vehicle group.Conclusion: This study’s findings suggest that topical application of SPPE gel effectively enhanced wound healing in experimentally induced diabetic conditions.

Background: Alström syndrome (AS) is a very rare childhood disorder characterized by cardiomyopathy, progressive hearing loss and blindness. Inherited genetic variants of ALMS1 gene are the known molecular cause of this disease. The objective of this study was to characterize the genetic basis and understand the genotype–phenotype relationship in Saudi AS patients.Methods: Clinical phenotyping and whole-exome sequencing (WES) analysis were performed on six AS patients belonging to two unrelated consanguineous Saudi families. Sanger sequencing was performed to determine the mode of inheritance of ALMS1 variant in first-degree family relatives and also to ensure its rare prevalence in 100 healthy population controls.Results: We identified that Alström patients from both the families were sharing a very rare ALMS1, 3′-splice site acceptor (c.11873−2 A>T) variant, which skips entire exon-19 and shortens the protein by 80 amino acids. This disease variant was inherited by AS patients in autosomal recessive mode and is not yet reported in any population-specific genetic databases. AS patients carrying this mutation showed heterogeneity in clinical presentations. Computational analysis of the mutant centroid structure of ALMS1 mRNA revealed that exon-19 skipping enlarges the hairpin loop and decreases the free energy, eventually affecting its folding pattern, stability, and function. Hence, we propose c.11873–2A as an AS causative potential founder mutation in Saudi Arabia because it is found in two families lacking a common lineage.Conclusions: We conclude that WES analysis potentially helps in clinical phenotyping, early diagnosis, and better clinical management of Alström patients showing variable clinical expressivity.

BackgroundEndovascular thrombectomy (EVT) in large vessel occlusion (LVO) in anterior circulation acute ischaemic stroke (AIS) results in good functional outcomes in only approximately 60% of the patients. Internal cerebral veins (ICVs) are easily visible, with a consistent midline location, and are linked to stroke outcomes. We hypothesize that ICV asymmetry on multiphasic CT angiogram (mCTA) can be an adjunctive predictor for poor functional outcomes.MethodsWe studied consecutive AIS patients from 2017 to 2019 with anterior circulation LVO treated with EVT regardless of intravenous thrombolysis. Asymmetrical ICV was defined as the presence of hypodensity (less opacification) on the ipsilateral occlusion side as compared with the contralateral side. The primary outcome was modified Rankin Score (mRS) score at 3 months. Secondary outcomes were good recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3), symptomatic hemorrhage, and mortality.ResultsA total of 185 patients were included with a median age of 70 years (IQR 59–77); 87 patients (47%) were female. 82 patients (44.3%) achieved good functional outcomes (mRS 0–2) at 3 months. On multivariate analysis, National Institutes of Health Stroke Scale (NIHSS) (OR 1.076, 95% CI 1.015 to 1.140; pConclusionICV asymmetry is a novel radiological sign which is independently associated with poor functional outcomes in EVT, even after correction for collateral circulation. Further studies are needed to validate this finding.

Hemodynamic support is widely utilized for unprotected left main (ULM) percutaneous coronary interventions (PCI) despite lack of evidence from randomized studies and the risk of device-related complications. We aimed to compare ULMPCI with and without intra-aortic balloon pump (IABP) support. A single-center, retrospective analysis was performed for patients undergoing ULMPCI with and without IABP support. Clinical, procedural, in-hospital, and 30-day cardiovascular outcomes were compared. From 2003 through 2018, 217 patients underwent non-emergent ULMPCI, 55 with elective IABP support (IABP group), and 162 without support (No-IABP group). The study population comprised 56.4% men and 74.5% Caucasians in the IABP group and 53.7% men and 62.3% Caucasians in the No-IABP group. The mean age for IABP and No-IABP group patients was 75.75 ± 12.34 years and 73.47 ± 15.19 years, respectively (p = 0.315). Procedural success was achieved in 99% of IABP and 95.3% of No-IABP patients (p = 0.089). In-hospital and 30-day mortality was 5.5% for the IABP group and 5.6% for the No-IABP group (p = 0.977). Rates of major complications were statistically similar between the groups. Bailout IABP was required in 10% of No-IABP patients. Hospital and intensive care unit length of stay was statistically longer in the IABP group. In conclusion, ULMPCI without IABP support was not associated with increased mortality and major cardiovascular outcomes compared with supported patients and was associated with shorter hospital and intensive care unit stay. A randomized trial comparing unsupported versus supported ULMPCI is warranted to identify patients who would benefit from hemodynamic support.

Introduction: Acute myocardial infarction (MI) and acute ischaemic stroke (AIS) are leading causes of morbidity and mortality. There is scarce data examining the interplay between post-MI left ventricular systolic dysfunction (LVSD), with or without atrial fibrillation (AF), and subsequent AIS, especially in patients with milder degrees of LVSD (ejection fraction 40-49%). Evidence of an association would be helpful in developing new strategies of reducing AIS after MI. As such, we sought to study this relationship in a real-world population-based registry. Methods: This study involved linking national-level data from the Singapore Myocardial Infarction Registry with the Singapore Stroke Registry from 1st January 2007 to 31st December 2018. Both data sets have similar definitions for patient demographics. The ejection fraction (EF) and AF status were recorded during the MI episode. The outcome studied was the first instance of AIS that developed after the MI episode. We also studied the relationship between EF, AF and the severity of AIS as measured by the NIH Stroke Scale (NIHSS). Results: There were 64,512 patients available for analysis. The median age was 65.7 (IQR 56.1-76.5) and 69.5% were male. The median duration post-MI to develop AIS was 16.9 (IQR 1.6-46.1) months. There was an independent association between LVSD and the outcome of AIS (adjusted HR 1.18, 95% CI 1.10-1.27); this was evident even in mild forms of LVSD (adjusted HR 1.16, 95% CI 1.06-1.27). AF was not a statistically significant predictor of AIS in post-MI patients with LVSD. Amongst patients without AF, post-MI LVSD was associated with a more severe stroke and higher NIHSS. Conclusion: Post-MI LVSD is associated with the occurrence of subsequent AIS. Although this relationship was independent of AF status, patients with LVSD but no AF had suffered a more severe AIS. These findings support the need to develop effectives therapies to prevent AIS post-MI, especially among those with LVSD.

Background: The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. Objectives: We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. Methods: This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. Results: We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre- and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p =0.004, 95% CI 6.513 - -2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable ( p = 0.519, 95% CI -1.605 - 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 hours (-4 versus -4, p = 0.685) were largely similar between the pre- and during DORSCON orange periods. Conclusions: The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore.

Introduction: Endovascular thrombectomy(EVT) is considered standard of care for anterior circulation acute ischemic stroke(AIS) with large vessel occlusion(LVO). Young AIS-LVO patients have distinctly different underlying stroke mechanisms and etiologies. Methods: In this multicenter cohort study conducted from August 2014 to January 2020, we investigated the safety and effectiveness of EVT in young AIS-LVO patients aged≤50 years and evaluated associations between demographics, stroke etiology, neuroimaging factors and clinical outcomes, including functional outcomes, in-hospital mortality and symptomatic intracranial haemorrhage(sICH) in univariable and multivariable regression models. Results: 275 AIS-LVO patients from 10 tertiary centers in Germany, Sweden, Singapore and Taiwan were included. The more common TOAST subtypes included cardioembolism (82/275, 29.8%) and stroke of undetermined etiology (85/275, 30.9%). Arterial dissection was the most prevalent stroke etiology (42/195, 21.5%) and had the highest rate of good functional outcomes (29/42, 69.0%). Successful reperfusion was achieved in 85.1% (234/275). Excellent and good functional outcomes were achieved in 48.0% (132/275) and 66.0% (182/275) respectively. sICH occurred in 6.5% (18/275). National Institute of Health Stroke Scale (NIHSS) at presentation was inversely related with good functional outcomes (aOR0.92, 95% CI 0.88- 0.96 per point increase, p Conclusion: While differences in functional outcomes exist across varying stroke aetiologies, high rates of successful reperfusion and good outcomes are generally achieved in young AIS-LVO patients undergoing EVT.

Hyperammonemic encephalopathy is an uncommon, potentially lethal adverse effect of 5-fluorouracil (5-FU). Being one of the most common and versatile chemotherapy agents, it is important to understand this important side effect of 5FU. There is paucity of data in this subject. Here, we report a case of 5FU-induced encephalopathy in a patient on induction chemotherapy for head and neck cancer. In this case report, the clinical presentation, diagnosis, and management of 5FU-induced encephalopathy is reported.

Objective: To know the impact of acne among female university students on their quality of life. Methodology: A cross sectional study conducted included 260 female students at the King Khalid University. A self-administered questionnaire was used in Arabic for data collection. It consisted of personal data, practices and conditions related to health, specific questions on acne vulgaris and the Acne Quality of Life (QOL) questionnaire. Results: Prevalence of acne among participant students was 87%. Its severity among 48% of participants was mild, 39.6% was moderate, while 12.3% had severe acne. Its prevalence did not differ significantly according to participants’ personal characteristics. The mean score for self-perception was 18.4+8.0, for role emotional was 14.4+8.8, for role social was 14.4+6.4, for acne symptoms was 13.4+5.2, while mean overall score was 60.5+24.4. Acne QOL scores for all domains were significantly lower among students who have acne. Scores for all domains and overall scores were lowest among students having severe acne. Students’ acne QOL scores differed significantly according to their family monthly income regarding “self-perception” (p=0.005), role emotional (p=0.037) and overall (p=0.012). Conclusions: Prevalence of facial acne is very high among students and significantly affects their QOL. During management of acne patients, health care professionals should consider its psychosocial aspect. Limitations: Generalizability of the results is limited to female university students only and limited personal characteristics were assessed in the present study. Conflict of interest: There is no conflict of interest involved with this study Key words: Acne, quality of life, female university students.