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Background: Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods: The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths, Bill and Melinda Gates Foundation, BMGF: OPP1148988.8; Johnson and Johnson, J&J; Merck; Roche; AbbVie, This publication is based on research funded in part by the Bill & Melinda Gates Foundation (grant number OPP1148988.8). ES reports grants from Bill and Melinda Gates Foundation, during the conduct of the study; grants, personal fees and non-financial support from Astra Zeneca Inc, grants, personal fees and non-financial support from Merck & Co., grants, personal fees and non-financial support from Regeneron Inc, grants, personal fees and non-financial support from Pfizer Inc, personal fees, non-financial support and other from Abbvie Inc, personal fees from Alere Inc, grants, personal fees and non-financial support from Roche Inc, other from GSK Inc, grants from Johnson and Johnson, grants and nonfinancial support from Novavax Inc, outside the submitted work; FP reports grants and personal fees from JANSSEN, grants and personal fees from NOVAVAX, INC, personal fees from BAVARIAN NORDIC A/S, personal fees from PFIZER, personal fees from SANOFI, personal fees from REGENERON, personal fees from MERCK, outside the submitted work.

Several lipid-based nanophytomedicines for illustrations, solid lipid nanoparticles, nanocomposites, lipid carriers, phytosomes, cubosomes, nanoemulsions, microcapsules, ethosomes, etc., are exploited to enhance the efficacy and safety of various bioactive phytochemicals with respect to their delivery to therapeutic target sites. Less lipid solubility, week stability, complex moiety, and inadequate metabolism in the gut are approximate of the serious problems of phytomedicine that have been emphasized extremely. In addition, these help design therapeutically efficacious and active nanophytomedicines. Disease diagnosis and compound imaging have also become important applications of nano-phytomedicine now. The aim of this review is to provide the current progress of lipid-based nanophytomedicines for the treatment of various life-threatening diseases and their theranostic applications.

We investigated what proportion of the population acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and whether the herd immunity threshold has been reached in 10 communities in Qatar. The study included 4,970 participants during June 21–September 9, 2020. Antibodies against SARS-CoV-2 were detected by using an electrochemiluminescence immunoassay. Seropositivity ranged from 54.9% (95% CI 50.2%–59.4%) to 83.8% (95% CI 79.1%–87.7%) across communities and showed a pooled mean of 66.1% (95% CI 61.5%–70.6%). A range of other epidemiologic measures indicated that active infection is rare, with limited if any sustainable infection transmission for clusters to occur. Only 5 infections were ever severe and 1 was critical in these young communities; infection severity rate of 0.2% (95% CI 0.1%–0.4%). Specific communities in Qatar have or nearly reached herd immunity for SARS-CoV-2 infection: 65%–70% of the population has been infected.

Objective: To determine the ST resolution in patients given streptokinase along with guideline medical therapy Methodology: This descriptive cross sectional study was carried out in department of Cardiology DHQTH KDA Kohat on 109 patients after obtaining informed consent from the patients. Patients were given guideline directed medical therapy & streptokinase for ST elevation MI. The ST-segment elevation resolution was calculated after 90 minutes of treatment with streptokinase, and stratified as complete ST segment resolution (> 70% ST-resolution), partial resolution (30-70% ST-resolution), or failed resolution (< 30% ST-resolution). Results: Out of 109 patients, 33 were females & 76 were male patients. Mean age of the population was 57±11.64 (95% CI). Time from onset of chest pain to administration of thrombolytic & guideline directed medical therapy was within 6 hours for 95 patients (87.5%).Out of 109, 9(8%) patients had minor gum bleeding. Conclusion: Administration of streptokinase is cost effective therapy for STEMI patients & give good resolution of ST segment on ECG. Key Words: Myocardial infarction, ST resolution

The spatial–temporal assessment of vector diseases is imperative to design effective action plans and establish preventive strategies. Therefore, such assessments have potential public health planning-related implications. In this context, we here propose an integrated spatial disease evaluation (I-SpaDE) framework. The I-SpaDE integrates various techniques such as the Kernel Density Estimation, the Optimized Hot Spot Analysis, space–time assessment and prediction, and the Geographically Weighted Regression (GWR). It makes it possible to systematically assess the disease concentrations, patterns/trends, clustering, prediction dynamics, and spatially varying relationships between disease and different associated factors. To demonstrate the applicability and effectiveness of the I-SpaDE, we apply it in the second largest city of Pakistan, namely Lahore, using Dengue Fever (DF) during 2007–2016 as an example vector disease. The most significant clustering is evident during the years 2007–2008, 2010–2011, 2013, and 2016. Mostly, the clusters are found within the city’s central functional area. The prediction analysis shows an inclination of DF distribution from less to more urbanized areas. The results from the GWR show that among various socio-ecological factors, the temperature is the most significantly associated with the DF followed by vegetation and built-up area. While the results are important to understand the DF situation in the study area and have useful implications for public health planning, the proposed framework is flexible, replicable, and robust to be utilized in other similar regions, particularly in developing countries in the tropics and sub-tropics.

Background Breastfeeding is known to reduce risk of enteropathogen infections, but protection from specific enteropathogens is not well characterized. Objective To estimate the association between full breastfeeding (days fed breast milk exclusively or with non-nutritive liquids) and enteropathogen detection. Design 2,145 newborns were enrolled in eight sites, of whom 1,712 had breastfeeding and key enteropathogen data through 6 months. We focused on eleven enteropathogens: adenovirus 40/41, norovirus, sapovirus, astrovirus, and rotavirus, enterotoxigenic Escherichia coli (ETEC), Campylobacter spp, and typical enteropathogenic E. coli as well as entero-aggregative E. coli, Shigella and Cryptosporidium. Logistic regression was used to estimate the risk of enteropathogen detection in stools and survival analysis to estimate the timing of first detection of an enteropathogen. Results Infants with 10% more days of full breastfeeding within the preceding 30 days of a stool sample were less likely to have the three E. Coli and Campylobacter spp detected in their stool (mean odds 0.92���0.99) but equally likely (0.99���1.02) to have the viral pathogens detected in their stool. A 10% longer period of full breastfeeding from birth was associated with later first detection of the three E. Coli, Campylobacter, adenovirus, astrovirus, and rotavirus (mean hazard ratios of 0.52���0.75). The hazards declined and point estimates were not statistically significant at 3 months. Conclusions In this large multi-center cohort study, full breastfeeding was associated with lower likelihood of detecting four important enteric pathogens in the first six months of life. These results also show that full breastfeeding is related to delays in the first detection of some bacterial and viral pathogens in the stool. As several of these pathogens are risk factors for poor growth during childhood, this work underscores the importance of exclusive or full breastfeeding during the first six months of life to optimize early health., Accepted for publication in AJCN

The coronavirus disease (COVID-19) was first reported in China (Wuhan) at the end of 2019. It has rapidly spread over 216 countries, including the USA, UK, Europe, Russia, and many Asian countries. It has affected more than 4.5 million people, and around 0.3 million deaths have been reported globally. Many preventive measures have been adopted worldwide to mitigate its spread. The government of Pakistan has also taken many preventive measures to combat the COVID-19 outbreak, such as rapid response by governance, continuous monitoring of the pandemic spread in the affected areas, and integration of resources from multiple sectors, including health, education, defense, and media. According to global statistics, the number of COVID-19 cases in the country remained remarkably lower than the expected number for the first 169 days, as compared to other countries. A total of 286,674 confirmed cases, including 16,475 active, 6,139 deaths, and 264,060 (92%) recoveries were reported. The study finds that strict adherence to national policies, effective governance, and unity at the national level resulted in better outcomes. Hence, the preventive measures, rapid responses, and strategies adopted for combating the challenges could be adopted as a learning tool for other countries having similar work environments and financial constraints. This paper can help and guide governance/public actions in response to the possible rebound of coronavirus this fall/winter.

During the outbreak of an epidemic, it becomes significantly essential to monitor the effects of containment measures and forecast the outbreak, including the epidemic peak. Many countries have either implemented strict lockdown to counter the spread of coronavirus disease or taken necessary preventive measures across the world to reduce the outbreak of this epidemic war. Several epidemic models have been presented across the world to examine the effects of public health-related strategies on mitigating the spread of current infectious disease, yet no reputable model has been presented for Pakistan as well as other South-Asian developing countries as per the authors’ knowledge. In this research, an actual coronavirus prediction in Pakistan is presented, which may guide the decision-makers as to how this pandemic has spread across the country and how it can be controlled. Furthermore, in the absence of targeted medicines, the analysis helps to develop a precise plan for the eradication of the outbreak by adopting the calculated steps at the right time. The mathematical phenomenological models have been adopted in this study to predict, project, and simulate the overall affected cases reflected due to the recent outbreak in Pakistan. These models predict the expected growth, and the estimated results are almost well matched with the real cases. Through the calibration of parameters and analyzing the current situation, forecast for the appearance of new cases in Pakistan is reported till the end of this year. The constant level of number of patients and time to reach specific levels are also reported through the simulations. The drastic conditions are also discussed which may occur if all the preventive restraints are removed. This research quantitatively describes the significant characteristics of the spread of corona cases. It acknowledges and provides an understanding of a short-term and long-term transmission of coronavirus outbreak in the country as three evolutionary phases. Therefore, this research provides a pathway to cope with the emerging threat of a severe outbreak in developing and nondeveloping countries.

Aim This study is aimed to assess the safety of esophageal dilation (ED) in a large cohort of eosinophilic esophagitis (EoE) cases in a single center. Background & Method EoE, the leading cause of food impaction, is a chronic immune-mediated disorder characterized by esophageal dysfunction and mucosal eosinophilic infiltration (≥ 15 eos/hpf). ED is considered a second-line therapy for EoE after failure of medication, due to concern of perforation. We performed a retrospective review of EoE patients who received ED at University of Iowa Hospitals and Clinics from 2006 to 2018. ED types, complications, and symptomatic improvement were extracted via chart review. Descriptive statistic with univariate analysis was performed. Results Of 1050 EoE patients, 160 received 295 EDs, ranging from 1-12 dilations per patient, with 67 patients requiring >1 dilations. Procedures were generally well-tolerated, without major bleeds or perforations. The overall complication rate was 6.1%, mostly post-procedural chest pain (4.8%). Three patients had sedation-related complications: one aspiration pneumonia and two ICU admissions for respiratory distress. Symptomatic improvement was documented in 87% of dilations on follow up. Conclusion EoE prevalence is increasing with rates of 1 cases per 1000 individuals, with up to one-third requiring ED for symptomatic relief. Previous reports suggested an increased procedure-related risk, mainly esophageal perforation. However, recent systematic reviews have shown low perforation rate of

Objective Two principal vector species, Aedes aegypti and Aedes albopictus, are known for transmission of dengue (DEN) and chikungunya (CHK) in Pakistan. We aimed to investigate their spatial and temporal distribution. Methods and results The Maximum Entropy algorithm revealed current climatic suitability of A. albopictus by highlighting variables contributing to its spatial distribution: Land use cover was the most important environmental factor (63.1%) followed by elevation-normalised difference vegetation index (10.9%), NDVI (8.5%) and annual precipitation (7.9%). As per Normalized Difference Vegetation Index values, the vector's presence was highly likely in areas with little vegetation such as built-up spaces or uncultivated fields, and in areas with sparse vegetation such as grasslands and cultivated fields. Temperature variables showed differing effects on vector ecology with annual temperature being the most important. Logistic regression models showed that presence of the vector, build-up and distance to roads contributed significantly to the distribution of both DEN and CHIK. Conclusion In Swabi, the mean temperatures of warmest and driest quarters are more important in the spatial distribution of A. albopictus than mean temperatures of the wettest and coldest quarters. Finally, disease modelling reflects a high probability for both DEN and CHIK in the same regions over a huge area.

The study was carried out on the effects of cadmium (Cd) on liver, gizzard and kidney of Larus argentatus. Significant alterations were observed after the treatment of high and low dose of cadmium chloride injected to Larus argentatus. Investigation of the effects of Cd on body tissues was done by sectioning of fixed tissue by paraffin section techniques. Major changes were noted at high dose of cadmium chloride in liver, kidney and gizzard. While, under low dose of cadmium chloride, mild to moderate changes in hepatocytes around blood vessels in liver; reduction in thickness of epithelium and muscular layer in gizzard; and slight alterations in arrangement of tubules of loop of henle in the kidney of proximal convoluted tubules with granular cytoplasm were observed. No lesions were found in the mentioned body tissues of Larus argentatus of control group.

Plants, miracle of nature, are able to synthesize hundreds of chemical compounds for various metabolic functions. Numerous phytochemicals (secondary metabolites) with potential biological activity have been identified in most of the plant species. In order to determine the proximate composition, phytochemical analysis and antioxidant capacity of three well known selected plants species, a study was carried out during June 2016 in Khyber Pakhtunkhwa Peshawar. The plants under study were Aloe vera Linn (leaves), Cannabis sativa Linn (whole plant) and Mentha longifolia Linn (whole plant) in PCSIR Labs Complex Peshawar. The results from proximate analysis indicated that the plants contained crude protein in the range 0.447 to 0.953%, crude fiber ranged from 12.33 to 28.47 % and crude fat in the range of 5.87 to 14.86%. Furthermore, analysis showed the presences of important phytochemicals such as tannins, flavonoids, alkaloids, glycosides and saponins in the investigated species. Antioxidant activity of the selected plants by DPPH (2,2-diphenyl-1-picrylhydrazyl radical) scavenging assay and using ascorbic acid as a standard indicated that Cannabis sativa and Aloe vera has the strongest and nearly the same activity with IC50353µg/ml. These plants can be used as herbal products. Keywords: Antioxidants; Chemical analysis; Phytochemicals http://dx.doi.org/10.19045/bspab.2018.700131

Spontaneous coronary artery dissection (SCAD) is one of the rarest causes of acute coronary syndromes, which include myocardial infarction (MI), stable and unstable angina, cardiogenic shock, and sudden death. The course of the disease, its etiology, prevalence, prognosis, and treatment remain ill-defined. Adding to the complexity is the fact that patients may lack typical risk factors for coronary heart disease. Herein, we report a case of a 42-year-old woman with vitamin B12 deficiency, who presented with chest pain; electrocardiography (ECG) findings were consistent with the acute anterior wall MI. Cardiac catheterization was done, which showed a very large left anterior descending (LAD) artery dissection.

Takayasu arteritis is an idiopathic chronic vasculitis that involves large blood vessels, including the aorta and its main branches. This disease presents typically as ischemia or aneurysms that could be prevented by timely diagnosis and vigilant management. We present here the case of a 19-year-old male who presented with a history of visual disturbance, chest pain, dizziness, and a feeble pulse.

Ali Asad Khan*, Ali Salman Khan, Yasir Shafi, Anam Ali and Sajid Abaidullah King Edward Medical University, Lahore, Punjab, Pakistan Corresponding Author: Ali Asad Khan King Edward Medical University Lahore, Punjab, Pakistan E-mail: asad.kemcolian@gmail.com Retraction Note The article entitled “Body mass index: not a predictor for hiatus hernia of esophagus” has been accepted for publication in the Clinical Practice (Therapy): Open Access considering the statements provided in the article as personal opinion of the author which was found not having any conflict or biasness towards anything. As the article was a perspective one, information provided by the author was considered as an opinion to be expressed through publication. Publisher took decision to make the article online solely based on the reviewers suggestion which considered the article not but a personal opinion of the author. However, it is found that the author have some personal concerns and issues, therefore, being retracted from the journal.

Dengue and its impacts are growing environmental, economic and health concerns in Lahore. Disease pattern is important to know for better control and effective management, GIS is one of the tested tools and quite efficient for this purpose. In this study, firstly month-wise dengue cases mapping for seven consecutive years (2007-2013) is performed in order to reveal temporal or seasonal pattern of dengue disease in Lahore district. Then a composite analysis was conducted using Inverse Distance Weighted (IDW) technique in order to show dengue most affected locations (towns) and in this analysis, all cases of the study period (2007-2013) were appended and visualized by IDW. Temporally, September (6548 cases) was the most dengue affected month of all years whereas February (4 cases) was marked as least affected throughout the dengue incidence period. Endemic Foci is noticed in 2011 most affected months. This cluster of disease is agglomerated near Ravi River and Densely Populated Towns, which further aggravated the incidence of dengue in economically deprived areas. Data Gunj Baksh town was the most affected town and IDW results showed that this town is composite endemic foci where cases were agglomerated most frequently. The reason of prevalence in this town would possibly be due to its more density of population and proximity of Ravi River.

Objectives: Patients with chronic kidney disease (CKD) develop anemia which is treated with erythropoietin-stimulating agents (ESAs). However, ESAs do not reduce the risk of cardiovascular mortality. Furthermore, this is unclear whether ESAs therapy has any association with adverse cardiovascular events. Methods: After an informed consent 275 male and female patients, between ages 35 to 75 years, with CKD stage V on ESAs undergoing twice weekly hemodialysis were enrolled. The dose of ESAs was calculated according to weight as 50mg/kg with target hemoglobin being 11 – 12 g/dl. Dose adjustments were made in the patients who failed to achieve target hemoglobin. The patients were followed for a year with the primary end point being new evidence of acute myocardial infarction (MI) diagnosed through ECG or echocardiography. Safety outcomes included stroke or death. Results: The data was entered and analyzed in Statistical Package for Social Sciences (SPSS) version 18 Out of 275 patients, 164 (59.6%) patients were males and 111 (40.4%) were females. Mean age of the patients was 51.52 with standard deviation of ± 5.73. According to the results, 52 (18.9%) patients reported with MI and 223 (81.1%) patients had no evidence of MI. Out of 52 patients who had MI, 37 (71.1%) were males and 15 (28.8%) patients were female. Conclusion: ESAs are associated with an increased risk of MI in CKD patients on hemodialysis. Whether there is a direct association or there are other factors involved remains to be seen.

Dengue fever (DF) is a national health problem in Pakistan. It has become endemic in Lahore after its recent reemergence in 2016. This study investigates the impacts of climatic factors (temperature and rainfall) on DF transmission in the district of Lahore through statistical approaches. Initially, the climatic variability was explored using a time series analysis on climatic factors from 1970 to 2012. Furthermore, ordinary and multiple linear regression analyses were used to measure the simulating effect of climatic factors on dengue incidence from 2007 to 2012. The time series analysis revealed significant annual and monthly variability in climatic factors, which shaped a dengue-supporting environment. It also showed a positive temporal relationship between climatic factors and DF. Moreover, the regression analyses revealed a substantial monthly relationship between climatic factors and dengue incidence. The ordinary linear regression of rainfall versus dengue showed monthly R2 = 34.2%, whereas temperature versus dengue presented R2 = 38.0%. The multiple regression analysis showed a monthly significance of R2 = 44.6%. Consequently, our study shows a substantial synergism between dengue and climatic factors in Lahore. The present study could help in unveiling new ways for health prediction modeling of dengue and might be applicable in other subtropical and temperate climates.

Background: A major reason for poor childhood vaccine coverage in developing countries is the lack of awareness among parents and caregivers regarding the need for immunization and the importance of completing the entire series of vaccines. Short message service (SMS)–based interventions have been quite effective in different programs such as smoking cessation, treatment adherence, health care scheduled appointment attendance, antenatal care attendance, and compliance to immunization. However, there are limited data from low- and middle-income countries on the role of SMS and automated call–based messages and interventions to improve routine immunization (RI) coverage. Objective: The primary objective of this study is to evaluate whether automated mobile phone–based personalized messages (SMS or automated call) can improve RI uptake at 6, 10, and 14 weeks of age per the expanded program immunization schedule, compared with a usual care control group. Secondary objectives include assessing the effects of different types of automated SMS text or calls on RI coverage at 20 weeks of age. Methods: This is a mixed methods study using a clustered randomized controlled trial with 4 intervention arms and 1 control arm, augmented by qualitative interviews for personalizing the message. The study is being conducted in Pakistan (an urban site in Karachi and a rural site Matiari). In Karachi, 250 administrative structures are taken as 1 cluster, whereas in Matiari, a catchment area of 4 Lady Health Workers is considered as 1 cluster. The intervention targets families to receive weekly 1-way or 2-way (interactive) personalized automated SMS or automated phone call messages regarding vaccination. Possible barriers to vaccination are assessed in each family at the time of inclusion to determine the type of personalized messages that should be sent to the family to increase the chance of a positive response. Finally, in-depth interviews using purposive sampling are conducted before and after the trial to determine the family’s vaccination experience and related factors. Results: All study participants for the cluster randomized trial were enrolled by January 14, 2019. Study exit interviews at 20-weeks follow-up visits will be completed by June 2019. Conclusions: The results of this study will be useful to understand the respective effects of SMS text messages versus automated phone–based communication to improve RI coverage and timelines. Moreover, information regarding families’ perceptions of vaccination and the daily life challenges for timely visits to the vaccine clinic will be used for developing more complex interventions that use mobile phone messages and possibly other approaches to overcome barriers in the uptake of correct and timely immunization practices. Trial Registration: ClinicalTrials.gov NCT03341195; https://clinicaltrials.gov/ct2/show/NCT03341195 (Archived by WebCite at http://www.webcitation.org/78EWA56Uo) International Registered Report Identifier (IRRID): DERR1-10.2196/12851

Despite extensive investigation, the pathophysiology of human inflammatory bowel disease (IBD) remains incompletely understood. We examined the existence of oxidative and nitrosative stress and also alterations in epidermal growth factor (EGF) secretion in saliva of IBD patients. Saliva samples were obtained from 30 nonsmoking IBD patients including 16 Crohn’s disease (CD) patients and 16 ulcerative colitis (UC) patients and 16 age- and sex-matched controls. Samples were analyzed for thiobarbituric reactive substances (TBARS) as a marker of lipid peroxidation, ferric reducing ability (antioxidant power), and EGF and nitric oxide (NO) levels. Saliva TBARS levels increased significantly (P &< 0.01) in CD patients but not in UC patients. Analysis of antioxidant power revealed that saliva of CD patients has lower antioxidant power (P &< 0.01) than saliva of the healthy control population. The concentration of EGF was found to be increased (P &< 0.01) in saliva of CD patients in comparison to that of healthy subjects. NO levels increased in saliva of both CD and UC patients in comparison to that of healthy subjects. It is concluded that excessive NO production is present in saliva of both CD and UC patients but only saliva of CD patients is oxidatively stressed. EGF secretion is normal in UC patients, although CD patients show a significant increase in salivary EGF levels.

Background: The effects of probiotics on ulcerative colitis has still remained a contraversy. The aim of this study was to assess the effects of Lactobacillus casei strain ATCC PTA-3945 in treating ulcerative colitis. Materials and Methods: Thirty four patients with mild to moderately active ulcerative colitis randomly received a probiotic preparation of L. casei strain ATCC PTA-3945 (n = 17) or its placebo (n = 17) plus conventional medical therapy for their active disease. After a maximum of 2 months, remitted patients were again randomised to receive L. casei strain ATCC PTA-3945 or placebo, and also maintained on mesalazine or sulfasalazine tablets for a maximum of 6 months. Results: The numbers of patients achieving remission did not statistically differ between probiotic and placebo groups (82% vs. 76% at intention to treat analysis [P = 1.00], and 100% vs. 81.2% at per-protocol analysis [P = 0.23], respectively). The mean time to clinical remission were 25 days and 32 days in probiotic and placebo groups, respectively (P = 0.11). Relapse rates also did not significantly differ between probiotic and placebo groups (14.3% vs. 26.7% at ITT analysis [P = 0.65] and 16.7% vs. 33.3% [P = 0.64], respectively). Mean time to relapse were 96 days and 74 days in the probiotic and the placebo group, respectively (P = 0.51). Conclusion: The results of this preliminary study showed no significant effect by using L. casei strain ATCC PTA-3945 probiotic in the treatment of ulcerative colitis patients.

We report an unusual presentation of Ewing's sarcoma in an adult female who was treated for tuberculous chronic osteomyelitis before a diagnosis of Ewing's sarcoma was finally made. Emphasis is on the fact that these two conditions can masquerade each other with delays in diagnosis and possibility of devastating results.

The transverse divergent dislocation of elbow in children is a rare occurrence. Case of a 12-year-old girl is presented who sustained this injury along with circulatory compromise and ipsilateral fracture of distal radius and ulna. An early closed manipulation of the elbow restored joint and circulatory function. The distal radius fracture required open reduction and K wiring for optimum reduction and stability.

Background: Gastrointestinal (GI) disorders are commonly associated with chronic conditions such as diabetes, obesity, and hypertension. Direct consequences are obstipation or diarrhea as opposite aspects of the irritable bowel syndrome, and more indirectly, alteration of appetite, feeling of fullness, flatulence, bloatedness, and eventually leading to altered absorption of nutrients. Moreover, GI retention and passage times have been recognized as important factors in determining the release site and hence the bioavailability of orally administered drugs. To facilitate the understanding of physiological and pathological processes involved, it is necessary to monitor the gut motility in animal models. Here, we describe a method for studying the GI transit time using technetium-labeled activated charcoal diethylenetriaminepentaacetic acid (99mTc-Ch-DTPA) detected by single-photon emission computed tomography (SPECT). Methods: Tc-DTPA was adsorbed onto activated charcoal and administered orally to trypan blue-tainted (n = 4) 129SvEv mice (50 to 80 MBq/animal, n = 11). The exact distribution and movement of radioactivity in the gastrointestinal tract was measured at intervals of 1, 3, 6, 12, and 22 h by SPECT-CT. In addition, in order to validate the imaging of GI transient time, loperamide (0.25 mg/animal, n = 3) was used to delay the GI transit. Results: The transit time measured as the peak radioactivity occurring in the rectum was 6 to 7 h after gavaging of 99mTc-Ch-DTPA. After 1 h, the bolus had passed into the small intestine and entered the cecum and the colon. At 6 and 8 h, the cecum, the ascending, transverse, and descending colon, and the rectum showed significant labeling. Several pellets were stored in the rectum for defecation. After 22 h, little activity remained in the stomach and none was detected in the transverse colon or other GI locations. In contrast, 6 h after administration of loperamide, only the cecum and part of the transverse colon were labeled. After 22 h, both structures retained significant amount of label. This delay has been verified by non-radiolabeled dye trypan blue GI measurements (n = 4). Conclusion: Here, we present the first non-invasive study of mouse GI transit time, allowing clear differentiation between vehicle- and loperamide-treated animals. This technique is useful for the investigation of GI motility in mice. Published version