Search

Introduction: Coronavirus Disease-2019 (COVID-19) is an ongoing global pandemic. Changes in haematological variables in patients with COVID-19 are emerging as important features of the disease. These changes in haematological variables may provide significant clues in the prognosis post Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. Aim: To determine the significance of various haematological variables in cardiac outcomes post SARS-CoV-2 infection. Materials and Methods: This was a prospective cohort study conducted at Prince Faisal bin Khalid Cardiac Centre, Abha, Kingdom of Saudi between March 2021 and October 2021. A total of 59 patients who were infected with SARS-CoV-2 with or without cardiac complaints were involved. Demographic, clinical, and laboratory data were recorded. Leukocyte counts, Neutrophil Counts, Lymphocyte counts, Neutrophil to Lymphocyte Ratio (NLR), platelet counts, Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), and D-Dimer were assessed and compared between subjects who developed Cardiovascular Complications (CVC+ group) and the subjects who did not develop CVC post SARS-CoV-2 infection (CVCgroup). Statistical analyses were performed using R scripting language and R Studio (version 1.2.5033, Orange Blossom). For continuous variables, t-test (for normally distributed) and MannWitney U test (for non normally distributed) were employed. For categorical data, Chi-square test (c2 ) was used. A p-value

Abstract Production and utilization of grey and blue hydrogen is responsible for emission of millions of tons of carbon dioxide (CO2) across the globe. This increased emission of CO2 has severe repercussions on the planet earth and in particular on climate change. Here in, we explored advance bimetallic (BM) CuO/Ag and trimetallic (TM) CuO/Ag/NiO based nanoporous materials supported with silica nanoparticles (SiNPs) via sol–gel route. The explored nanocatalysts were characterized by Powder X-ray diffraction (P-XRD), scanning electron microscopy (SEM), transmittance electron microscopy (TEM), X-ray photoelectron spectroscopy (XPS), energy dispersive X-ray spectroscopy (EDX), and Raman spectroscopic techniques. These advance nanocatalysts were evaluated for the green hydrogen production through electrocatalysis and photocatalysis. The catalysts exhibited an exceptional catalytic performance, the onset potential for hydrogen evolution reaction (HER) was determined to be − 0.9 V BMSiNPs-GCE and − 0.7 V (vs Ag/AgCl) for TMSiNPs-GCE, whereas η@10 for BMSiNPs-GCE and TMSiNPs-GCE is − 1.26 and − 1.00 V respectively. Significantly, the TMSiNPs composite and the BMSiNPs composite exhibited superior photochemical H2 evolution rates of 1970.72 mmol h−1 g−1 and 1513.97 mmol h−1 g−1, respectively. The TMSiNPs catalyst presents a highly promising material for HER. This study reveals a cost-effective approach to develop sustainable and resourceful electrocatalysts for HER.

Introduction: Human Rotavirus Virus (HRV) is amongst the common enteric viral diarrheal diseases that indirectly or directly influence school-going children in low-income countries. Inadequate information exists on the presence of rotavirus, with reference to drinking water supplies of primary schools in Sindh, Pakistan. Aims & Objectives: We estimated the risk of rotavirus-associated diarrhea through drinking water. The study further compared the HRV-associated risk of diarrheal disease by a type of water source. Place and Duration of Study: A cross-sectional survey was conducted in ten representative districts of Sindh from February 2022 to December 2022. The samples for drinking water were collected from primary schools of ten representative districts of Sindh. This study was a part of the WASH Project funded by USAID (USPCASW Seed Grant P-II) Material & Methods: We selected 425 samples of drinking water from primary schools based on pre-defined selection criteria. We used a Quantitative Microbial Risk Analysis using indicator organisms, i.e., E. coli, to predict the possible health risks of rotavirus. Data was entered and analyzed on SPSS version 26. The graphs were developed using Arc GIS version 3. Morbidity and mortality were predicted using the Quantitative Microbial Risk Assessment (QAMRA) model. Results: Our data revealed that the highest daily risk of HRV-associated diarrhea amongst school children was 11 per 10,000 schoolchildren, resulting in 8.4% annual risk, and the minimum risk was estimated to be 1 in 10,000 children. The burden of diseases for rotavirus using the QAMRA model revealed the severity of the diarrhea. Majority of the children presented with mild diarrhea (86%) followed by severe, and the probability of death was less than

Introduction: Human Rotavirus Virus (HRV) is amongst the common enteric viral diarrheal diseases that indirectly or directly influence school-going children in low-income countries. Inadequate information exists on the presence of rotavirus, with reference to drinking water supplies of primary schools in Sindh, Pakistan. Aims & Objectives: We estimated the risk of rotavirus-associated diarrhea through drinking water. The study further compared the HRV-associated risk of diarrheal disease by a type of water source. Place and Duration of Study: A cross-sectional survey was conducted in ten representative districts of Sindh from February 2022 to December 2022. The samples for drinking water were collected from primary schools of ten representative districts of Sindh. This study was a part of the WASH Project funded by USAID (USPCASW Seed Grant P-II) Material & Methods: We selected 425 samples of drinking water from primary schools based on pre-defined selection criteria. We used a Quantitative Microbial Risk Analysis using indicator organisms, i.e., E. coli, to predict the possible health risks of rotavirus. Data was entered and analyzed on SPSS version 26. The graphs were developed using Arc GIS version 3. Morbidity and mortality were predicted using the Quantitative Microbial Risk Assessment (QAMRA) model. Results: Our data revealed that the highest daily risk of HRV-associated diarrhea amongst school children was 11 per 10,000 schoolchildren, resulting in 8.4% annual risk, and the minimum risk was estimated to be 1 in 10,000 children. The burden of diseases for rotavirus using the QAMRA model revealed the severity of the diarrhea. Majority of the children presented with mild diarrhea (86%) followed by severe, and the probability of death was less than

Abstract Background COVID-19 preventive measures required a drastic shift to online teaching-learning in most of countries. Institutions used different combinations of live online lectures (synchronous) requiring students to attend the class in real-time, as well as recorded lectures uploaded by the instructors to be accessed by students as per their own convenience (asynchronous). We undertook this study to assess and compare the perceptions of students regarding their learning experiences in the synchronous versus asynchronous mode of instruction using their teaching-learning during the compulsory online mode of instruction at the peak of the COVID-19 pandemic. Methodology This cross-sectional questionnaire-based study received responses from 122 final-year medical students studying at the College of Medicine, King Khalid University, Abha, Saudi Arabia. An online 5-point Likert scale-based questionnaire was used to collect data regarding experience and perception towards synchronous and asynchronous learning. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A P-value less than 0.05 was considered significant. Result All the students found both synchronous and asynchronous learning to be equally satisfying, enjoyable and comfortable. No statistically significant difference was found when both the methods were analyzed for enhancement of knowledge. The students opined that asynchronous learning helped them manage their time better whereas synchronous learning encouraged more interaction during the live lectures. Conclusion Overall, the students' perceptions regarding both synchronous and asynchronous online learning were positive. As both methods have their advantages/limitations, a mix of both synchronous and asynchronous methods may be adopted depending upon the content of the topic and the desired learning outcomes.

Abstract Potential role of triacontanol applied as a foliar treatment to ameliorate the adverse effects of salinity on hot pepper plants was evaluated. In this pot experiment, hot pepper plants under 75 mM NaCl stress environment were subjected to foliar application of 25, 50, and 75 µM triacontanol treatments; whereas, untreated plants were taken as control. Salt stress had a significant impact on morphological characteristics, photosynthetic pigments, gas exchange attributes, MDA content, antioxidants activities, electrolytes leakage, vitamin C, soluble protein, and proline contents. All triacontanol treatments significantly mitigated the adversative effects of salinity on hot pepper plants; however, foliar application triacontanol at 75 µM had considerably improved the growth of hot pepper plants in terms of plant height, shoot length, leaf area, plant fresh/dry biomasses by modulating above mentioned physio-biochemical traits. While, improvement in gas exchange properties, chlorophyll, carotenoid contents, increased proline contents coupled with higher SOD and CAT activities were observed in response to 75 µM triacontanol followed by 50 µM triacontanol treatment. MDA and H2O2 contents were decreased significantly in hot pepper plants sprayed with 75 µM triacontanol followed by 50 µM triacontanol foliar treatment. Meanwhile, root and shoot lengths were maximum in 50 µM triacontanol sprayed hot pepper plants along with enhanced APX activity on exposure to salt stress. In crux, exogenous application triacontanol treatments improved hot pepper performance under salinity, however,75 µM triacontanol treatment evidently was more effective in mitigating the lethal impact of saline stress via controlling the ROS generation and increment in antioxidant enzyme activities.

Objective: To determine the potential adverse renal histopathological effects on the proximal convoluted tubules in male, Wistar rats due to ingestion of subchronic dose of triazophos. Study Design: Randomized controlled trial. Place and Duration of Study: A study of 3 weeks duration (plus 1 week for slide preparation & histological study), was held in the animal house-PGMI, Bird wood road, Lahore. Materials and Methods: Two equal groups were made, of 6 Wistar, male rats each. Group A was control while experimental group B was given triazophos, in a dose of 8.2 mg/kg-subchronic dose (1/10 of LD 50), a commonly used pesticide, as 1:100 dilution solution through oral gavage for 21 consecutive days. On day 22, the rats were sacrificed and tissues preserved for histological examination and measurement of proximal and distal tubular diameters by using micrometric grid. Results: The micrometric measurement of diameters of PCT in group A and B indicated that they increased significantly from 38.90 ± 2.72μm in group A to 50.35 ± 2.61μm in group B (p-value

Background Azo dyes are recalcitrant organic pollutants present in textile industry effluents. Conventional treatment methods to remove them come with a range of disadvantages. Nanoparticles and their nanocomposites offer more efficient, less expensive and easy to handle wastewater treatment alternative. Methods In this study, nanoparticles of nickel oxide (NiO-NPs), copper oxide (CuO-NPs) and their nanocomposite (NiO/CuO-NC) were synthesized using co-precipitation method. The functional groups present on the surface of synthesized nanomaterials were verified using Fourier-transform infrared spectroscopy (FTIR). Surface morphology was assessed using scanning electron microscopy (SEM) whereas purity, shape and size of the crystallite were determined using X-ray diffraction (XRD) technique. The potential of these nanomaterials to degrade three dyes i.e., Reactive Red-2 (RR-2), Reactive Black-5 (RB-5) and Orange II sodium salt (OII) azo dyes, was determined in an aqueous medium under visible light (photocatalysis). The photodegradation effectiveness of all nanomaterials was evaluated under different factors like nanomaterial dose (0.02–0.1 g 10 mL−1), concentration of dyes (20–100 mg L−1), and irradiation time (60–120 min). They were also assessed for their potential to adsorb RR-2 and OII dyes. Results Results revealed that at optimum concentration (60 mgL−1) of RR-2, RB-5, and OII dyes, NiO-NPs degraded 90, 82 and 83%, CuO-NPs degraded 49, 34, and 44%, whereas the nanocomposite NiO/CuO-NC degraded 92, 93, and 96% of the said dyes respectively. The nanomaterials were categorized as the efficient degraders of the dyes in the order: NiO/CuO-NC > NiO-NPs > CuO-NPs. The highest degradation potential shown by the nanocomposite was attributed to its large surface area, small particles size, and quick reactions which were proved by advance analytical techniques. The equilibrium and kinetic adsorption of RR-2 and OII on NiO-NPs, CuO-NPs, and NiO/CuO-NC were well explained with Langmuir and Pseudo second order model, respectively (R2 ≥ 0.96). The maximum RR-2 adsorption (103 mg/g) was obtained with NiO/CuO-NC. It is concluded that nanocomposites are more efficient and promising for the dyes degradation from industrial wastewater as compared with dyes adsorption onto individual NPs. Thus, the nanocomposite NiO/CuO-NC can be an excellent candidate for photodegradation as well as the adsorption of the dyes in aqueous media.

Objective: To assess the existing healthcare and delivery services and to evaluate the factors that affect the effectiveness of the care of patients. Study Design: Cross-sectional study. Place and Duration of Study: Seven Districts Headquarter Hospitals of Azad Jammu and Kashmir Pakistan from Dec 2020 to May 2021. Methodology: The data were collected using a questionnaire based on the Material Safety Data Sheet (MSDS) set standards by Punjab Healthcare Commission (PHC) for monitoring and evaluating the services delivery at the hospitals. Data were collected by observing every department of the hospital, interviewing the concerned person of every department, and checking the medical record of the hospital. Results: All the seven DHQ hospitals including DHQ Neelum, DHQ Hattian Bala, DHQ Pallandari, DHQ Bagh, DHQ Kotli, DHQ Bhimber, and DHQ Mirpur were working throughout the week and service delivery was ensured for 24 hours in all health facilities. It was observed in this study that the management of medication was the area with the highest degree of compliance (76.2%). On the other hand, the area involving patient rights and education showed the lowest level of compliance with an average score of 6 and a percentage compliance of 25%. Conclusion: The compliance of health delivery services with respect to MSDS was very low in district headquarter hospitals of AJK. Targeted strategies are needed to improve the overall quality of the service delivery.

Abstract The Coronavirus Disease 2019 (COVID-19) global pandemic has threatened the lives of people worldwide and posed considerable challenges. Early and accurate screening of infected people is vital for combating the disease. To help with the limited quantity of swab tests, we propose a machine learning prediction model to accurately diagnose COVID-19 from clinical and/or routine laboratory data. The model exploits a new ensemble-based method called the deep forest (DF), where multiple classifiers in multiple layers are used to encourage diversity and improve performance. The cascade level employs the layer-by-layer processing and is constructed from three different classifiers: extra trees, XGBoost, and LightGBM. The prediction model was trained and evaluated on two publicly available datasets. Experimental results show that the proposed DF model has an accuracy of 99.5%, sensitivity of 95.28%, and specificity of 99.96%. These performance metrics are comparable to other well-established machine learning techniques, and hence DF model can serve as a fast screening tool for COVID-19 patients at places where testing is scarce.

Abstract Objective: To determine the association between osteoporosis and dyslipidemiain pre-menopausal women. Study Design: Comparative cross sectional study. Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, from Jul to Dec 2014. Methodology: In study group A, fifty (n=50) osteoporotic females were taken, while same number offemales were included in group B. Detailed medical history of every patient was documented. Fasting blood samples were obtained and analyzed for plasma glucose, bone profile and serum lipid profile. Dyslipidemia was assessed using guidelines from the National Cholesterol Education Project Adult Treatment Panel III (ATP III) and was defined as “total cholesterol >6.2 mmol/l, HDL-C 3.4 mmol/l or triglycerides >2.3 mmol/l”. Results: Among 100 study participants, the difference in mean ages of group A and group B was insignificant (44.32 ± 5.17 yearsand 43.46 ± 5.53 years, p>0.05). Frequency of dyslipidemia was significantly higher in group Athan their group B (p

Objective: To determine the effect of variable traction forces on discogenic low back pain. Method: The experimental study was conducted at the Department of Physical Medicine and Rehabilitation at the Combined Military Hospital, Okara, Pakistan, from July to December 2018, and comprised patients of low back pain who were randomised into group 1 treated with high-force lumbar traction, hot pack and lumbar stabilisation exercises, and group 2 treated with low-force lumbar traction, hot pack and lumbar stabilisation exercises. There were a 3 sessions per week for 3 weeks for a total of 9 sessions. Modified Oswestry disability index and visual analogue scale were used to measure outcomes. Data was analysed using SPSS 20. Result: Of the 30 patients, there were 15(50%) in each of the two groups. There were 18(60%) females and 12(40%) males, with an overall mean age of 30+5.5 years. There was significant improvement in pain in both groups (p

The Peroxisome proliferator-activated receptor-gamma (PPARγ) is a member of the nuclear receptor family of transcription factors. In addition to its role in lipid and glucose metabolisms, PPARγ has possible roles in tumor suppression. One of the most common variations in PPARγ is the Pro12Ala polymorphism. It is the change of proline amino acid to alanine amino acid by the conversion of cytosin (C) to guanine (G) at 34th nucleotide of the 12th codon PPARγ gene. Several recent studies have shown that Pro12Ala polymorphism may be associated with many diseases, such as obesity, diabetes, and some types of cancer. Moreover, Pro12Ala polimorphism has been shown to affect PPARγ mRNA expression in the context of obesity. However, there have been no studies investigating the relationship Pro12Ala polymorphism and PPARγ mRNA expression in cancer. In this study, Pro12Ala polymorphism in PPARγ gene was investigated in cancer and normal cell lines via using restriction fragment length polymorphism and Sanger Sequencing. Depending on the Pro12Ala status, the effect of the polymorphism on PPARγ mRNA expression was investigated via using Real Time Polymerase Chain Reaction. In conclusion; amongst 13 cell lines that were screened, heterozygous Pro12Ala polymorphism was detected only in AGS and Caki-1 cancer cell lines. PPARγ mRNA expression in these cell lines was found to be lower than PPARγ mRNA expression in cell lines without Pro12Ala polymorphism such as MCF10A, SK-BR-3, MDA-MB-468. Taken together, Pro12Ala polymorphism may modulate the mRNA expression level of PPARγ. The role of this modulation in cancer should further be investigated. [Med-Science 2019; 8(4.000): 841-6]

Aims and Objectives: To determine the effect of Blood Flow Restriction with strengthening exercises on Knee Osteoarthritis patients. Subjects and Method: This case-control study was conducted at Department of Physical Medicine and Rehabilitation in Combined Military Hospital Okara after signing ethical approval letter by ethical committee from June 2018 to December 2018 with 30 Knee Osteoarthritis participants selected by non-purposive consecutive sampling among which 15 participants were assigned to group A (strengthening exercises with blood flow restriction) and 15 to group B (strengthening exercises without blood flow restriction) using lottery method. 16 sessions were arranged for both groups with 4 sessions per week for 4 weeks with 5 minutes warm up on a stationary bike. Visual Analogue Scale and Kujala Scoring Questionnaire were applied for outcome measures. Results were analyzed by paired-t test and independent-t test using Statistical Package for Social Sciences 20. Result: Most of participants were female i.e. 66.7% with 70% had BMI value > 25 kg/m2. Significant improvement in pain on Visual Analogue Scale (p-value 0.00 for group A and 0.01 for group B) and disability on Kujala Scoring Questionnaire (p-value 0.00 for both groups) was found, but for Muscle Girth, group A showed significant improvement with p-value 0.01 as compared to group B with p-value 0.33. However, inter-group analysis showed no significant difference between outcome measures. Conclusion: Strengthening exercises reduce pain and disability. However, addition of blood flow restriction also improves muscle size and strength. Keywords: Knee Osteoarthritis, Strengthening Programs, Vascular Occlusion, Tourniquet, Continuous...

Objective: To examine the effects of delayed admission to rehabilitation on functional outcomes in post stroke patients. Study Design: Observational study. Place and Duration of Study: Department of Physical Medicine and Rehabilitation of Combined Military Hospital Kohat, from Sep 2016 to Sep 2017. Material and Methods: A total of 55 patients with age ranging from 20-80 years who were diagnosed with first ever stroke and reported within 150 days of the onset of stroke to rehabilitation setup were selected through non-probability purposive sampling. The patients were divided into 2 groups as early (group-A ≤30 days) and delayed admission group (group-B=30-150 days) based on the length of time from stroke onset to admission to inpatient rehabilitation facility. Reasons for delay admission were identified and noted. Functional independence measure (FIM) score was used to assess functional status of the patient at admission. Patients in both groups underwent identical eight weeks of regular rehabilitation program with therapy sessions 3 hours a day, 5 days a week. Functional independence measure score was noted again at eight week of indoor rehabilitation. Results: Total 52 patients completed the study with 27 (51.9%) male and 25 (48.1%) female. Lack of awareness of Rehabilitation was the most common patient related factor found in 11 (34.4%) while Lack of care giver support was most common external factor reported in 6 (18.7%). The patients with early admission to inpatient rehabilitation facility had a better functional independent measurement scores gain than the patients with delayed admission to inpatient rehabilitation facility (40.4 ± 11.4 vs. 11.9 ± 8.4, p=0.01). However, FIM scores at admission in both groups were not statistically significant. Conclusion: Delayed admission to inpatient rehabilitation facility after stroke event caused poorer functional outcomes in stroke patients.

Objective: To compare the intra-articular corticosteroid versus physiotherapy in the management of adhesive capsulitis in terms of mean pain score. Study Design: Randomized controlled trial. Place and Duration of Study: Outpatient department, at Armed Forces Institute of Rehabilitation Medicine, from Jul 2013 to Jul 2015. Material and Methods: A total of 90 patients with adhesive capsulitis were enrolled as per inclusion criteria by non probability consecutive sampling. Forty five patients were assigned to group “A” and were given intra-articular injection of triamcinolone 40mg (2ml) and bupivacain 2ml into the shoulder joint. Group “B”, having forty five patients received eight session of physiotherapy on alternate day. Outcome measure included mean pain score using visual analogue scale at six week follow-up. Results: Statistically significant improvement in pain score on visual analogue scale was found in patients with group “A”, with improvement in score from 7.2 ± 0.91 at the start of the study to 5.6 ± 0.18 at six week follow-up (p

Background and objectives: Self-medication is commonly practiced throughout the world. The aim of this study was to ascertain the use prevalence and knowledge of harmful effects of self-medication among college students of health professions and non-health professions. Methods: A cross-sectional study was performed among 1,167 students from 12 faculties of a public university and two private universities in Kuwait. Data were collected using a self-administered pretested questionnaire containing 32 questions. Results: Among the participants, 70.4% (822/1,167) used self-medication. The prevalence of self-medication was significantly higher among students of non-health professions compared with those of health professions (35.9% vs. 25.9%, p = 0.004, 95% CI, 6.28% to 13.73%, respectively). Pain killer medicines (52.9%), vitamins/minerals (13.1%), and antihistamines (9.0%) were the most commonly used non-prescription medications. Antibiotics and sleeping pills were used without a prescription in 2.9% and 2.1%, respectively. Older age, non-Kuwaiti national, and students of 5th to 7th year of study were significant predictors of self-medication. Knowledge scores of harmful effects of self-medication were about two-fold higher among females than their male counterparts. Similarly, students of higher years of study (5th to 7th year) had higher knowledge score compared with others. Conclusions: The prevalence of self-medication was alarmingly high among young adults in Kuwait. People should be informed about adverse effects of self-medication through mass and social media campaign. IMC J Med Sci 2018; 12(2): 57-68. EPub date: 19 June 2018 Address for Correspondence: Prof. Amal K. Mitra, Professor of Epidemiology, Department of Epidemiology and Biostatistics, Jackson State University, 350 W. Woodrow Wilson Dr., PO Box 17038, Jackson, MS 39213, E-mail: amal.k.mitra@jsums.edu

OBJECTIVE: To evaluate the levels of serum uric acid in the patients with primary thyroid dysfunction METHODS: This cross-sectional study was carried out at Military Hospital (MH) Rawalpindi, Pakistan from July-December 2014 after obtaining the ethical and institutional permission. A total of sixty patients of both genders and newly diagnosed with primary thyroid dysfunction were recruited. Informed written consent was obtained from each participant. Patients were categorized in primary hyperthyroid (serum TSH 4.50 mIU/L and reduced fT4) groups. Serum uric acid levels of both groups were estimated and levels >420 µmol/L in males and >360 µmol/L in females were labeled as hyperuricemia. Results were entered and analyzed through SPSS version 21. RESULTS: Out of sixty participants, 21 (35%) patients were male while 39 (65%) patients were females and mean age was 42.31±11.27 years. Primary hypothyroidism group consisted of 43 (71.7%) patients while 17 (28.3%) patients were in primary hyperthyroidism group. Elevated serum uric acid levels were present in 65% patients (n=39). In the patients with hypothyroidism, 31 out of 43 (72%) patients were diagnosed with hyperuricemia while the corresponding numbers in hyperthyroid group were 8 out of 17 (47%). However, difference among mean Serum uric acid levels of both groups was insignificant (385.27±182 µmol/L and 316.95±169 µmol/L, p>0.01). CONCLUSION: Patients with primary thyroid dysfunction have elevated serum uric acid levels that are more frequent in primary hypothyroidism as compared to primary hyperthyroidism.

Objective: Treatment with aminoglycosides is a preventable cause of acute kidney injury (AKI). Early predictive markers of AKI are crucial in preventing this condition. This study aimed to examine the role of serum neutrophil gelatinase-associated lipocalin (NGAL) level as a predictive marker of AKI in patients receiving gentamicin. Materials and Methods: In this prospective study, 37 patients with brucellosis (23 males, 14 females; mean age = 10.7 ± 33.7 years) were studied in a health center between March 2013 and March 2014. Serum creatinine and NGAL levels at baseline, and 3, 5 and 7 days after the administration of gentamicin were measured. In this study, a 25% increase in the serum creatinine levels compared with the baseline levels was considered a criterion for AKI risk. Results: The frequencies of patients prone to AKI at the first, third, fifth and seventh day of administration of gentamicin were 0%, 8.1%, 18.9%, and 13.5%, respectively. In total, 24.3% of the patients (n = 9) were prone to AKI. No statistically significant difference was observed between NGAL levels before and after the administration of gentamicin (P = .082). Conclusion: The serum NGAL level is not a sensitive and specific predictor of AKI following the administration of gentamicin. Therefore it is recommended to increase the frequency of sNGAL measurement and using more sensitive kits in more patients.

The prevalence of chronic Hepatitis B Virus (HBV) infection is 2-4% in the Pakistani population, defining Pakistan as an intermediate prevalence country. In this study, hepatitis B surface antigen (HBsAg) reactive blood donations were screened using a combination of serological and molecular methods to identify immune escape HBV mutant strains and to determine the HBV genotypes and subtypes present in Pakistan.Blood donations were collected at the Armed Forces Institute of Transfusion (AFIT) located in northern Pakistan and the Hussaini Blood Bank (HBB) located in the south. From 2009 to 2013 a total of 706,575 donations were screened with 2.04% (14,409) HBsAg reactive. A total of 2055 HBsAg reactive specimens, were collected and screened using a monoclonal antibody based research assay to identify immune escape mutants followed by PCR amplification and DNA sequencing to identify the mutation present. DNA sequences obtained from 192 specimens, including mutant candidates and wild type strains, were analyzed for escape mutations, genotype, and HBsAg subtype.Mutations were identified in approximately 14% of HBsAg reactive donations. Mutations at HBsAg amino acid positions 143-145 are the most common (46%) with the mutation serine 143 to leucine the most frequently occurring change (28%). While regional differences were observed, the most prevalent HBV strains are subgenotypes of D with subgenotype D1/subtype ayw2 accounting for the majority of infections; 90.2% at AFIT and 52.5% at HBB.The high frequency of immune escape HBV mutants in HBV infected Pakistani blood donors highlights the need for more studies into the prevalence of escape mutants. Differences between vaccinated and unvaccinated populations, the correlation of escape mutant frequency with genotype, and impact of escape mutations in different genotype backgrounds on the performance of commercially available HBsAg assays represent avenues for further investigation.

Purpose: The prevalence of cerebral palsy is high in Pakistan, however, it needs to be further explored. This study aimed at assessing clinical presentations and etiological factors among children with cerebral palsy in a Pakistani hospital. Materials and Methods:It was a descriptive case series recruiting 102 children who presented to cerebral palsy rehabilitation clinic of Armed Forces Institute of Rehabilitation Medicine, Rawalpindi fulfilling the criteria adopted by Surveillance of Cerebral Palsy in Europe. Results:Of 102 children, 46 (45.1%) were male and 56 (54.9%) were female with a mean age of 5.6 +/- 2.25 years. Spastic cerebral palsy was the commonest presentation (90.2%) mainly presenting as diplegia (33.3%) and quadriplegia (32.4%) followed by atonic, ataxic/mixed and athetoid CP accounting for 3.9%, 3.9%, and 2.0% respectively. Birth asphyxia was the most encountered etiologic factor (32.4%) followed by prematurity (26.5%), kernicterus (12.7%) and meningoencephalitis (10.8%). Spastic quadriplegic and diplegic CP were primarily related to birth asphyxia, hemiplegic, ataxic and mixed CP to prematurity and atonic and athetoid CP to kernicterus. Conclusion:Spastic quadriplegia or spastic diplegia are the commonest presentations in Pakistani children diagnosed with CP. The frequent etiological factors in CP development are birth asphyxia, prematurity, meningoencephalitis and kernicterus. [Cukurova Med J 2014; 39(4.000): 705-711]

Suprascapular Nerve injury is an uncommon cause of shoulder pain and weakness. Lesions of the Suprascapular Nerve can occur at the Supraspinatus or the Spinoglenoid Notch. We present here, report of a 26-year-old washer man who presented with pain in left shoulder and difficulty washing clothes. Clinical evaluation and electrodiagnostic studies confirmed injury to the left Suprascapular Nerve at the Spinoglenoid Notch. The patient was managed conservatively for six weeks with relative rest, supervised physiotherapy and non-steroidal anti-inflammatory drugs, following which he showed substantial reduction in pain and improvement in functional activities.

The aim of this study was to determine the stress level of medical students and the relationship between stress and academic year. A cross-sectional, descriptive study was conducted at an undergraduate medical school with a five-year curriculum, in Pakistan, from January 2014 to April 2014. Medical students in the first four years were included in the study. The Kessler Psychological Distress Scale (K10), a self-administered questionnaire, was distributed to the students. A total of 445 medical students completed the questionnaire. The average stress score was 19.61 (SD=6.76) with a range from 10 to 43. Stress was experienced by 169 students (41.7%). The scores of female students were higher than scores of males, indicating a higher stress level (P=0.011). The relationship between stress and academic year was insignificant (P=0.392).

The chromatin remodeling protein ATRX, which targets tandem repetitive DNA, has been shown to be required for expression of the alpha globin genes, for proliferation of a variety of cellular progenitors, for chromosome congression and for the maintenance of telomeres. Mutations in ATRX have recently been identified in tumours which maintain their telomeres by a telomerase independent pathway involving homologous recombination thought to be triggered by DNA damage. It is as yet unknown whether there is a central underlying mechanism associated with ATRX dysfunction which can explain the numerous cellular phenomena observed. There is, however, growing evidence for its role in the replication of various repetitive DNA templates which are thought to have a propensity to form secondary structures. Using a mouse knockout model we demonstrate that ATRX plays a direct role in facilitating DNA replication. Ablation of ATRX alone, although leading to a DNA damage response at telomeres, is not sufficient to trigger the alternative lengthening of telomere pathway in mouse embryonic stem cells.