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Introduction: Dengue cases have increased extremely in recent years because of globalization, easy movement, population growth and urbanization, and climate change. Presently, dengue causes hundreds of daily dengue incidences and tens of human deaths in Dhaka. In this study, the impacts of weather parameters on the spread of dengue cases have been investigated for the city. Methods: The daily dengue cases and weather parameter values are collected for the city from public repositories. From these daily data, per-week average values were calculated to observe their weekly variations. Six different lagged week data have been generated by combining weekly average dengue cases with cumulative lagged weekly average weather parameters. Spearman rank correlation and quasi-Poisson generalized linear model have been applied in the lagged week data to assess the impacts of weather parameters on dengue cases. Results: A significant positive association for relative humidity and a negative association for wind pressure have been observed with dengue incidence. Also, stronger estimates have been examined for more cumulative lagged week weather parameter values with dengue incidence. July to October might be the sensitive season for dengue in the city for higher values of relative humidity and lower values of wind pressure. Conclusions: Dhaka is one of the most densely populated cities in the world. Also, the dengue incidence in the city has increased remarkably in the last several years. The findings observed in this study might help the city's decision-makers to initiate necessary steps before the dengue outbreak occurs.

Objective: To assess the accuracy of ultrasound-guided core biopsy in staging axillary lymph nodes in clinically node-negative invasive breast cancer patients using histopathology as the gold standard. Methods: This cross-sectional study was conducted in the Department of Pathology at Mekran Medical College, Turbat, Pakistan, from April 2023 to September 2023. The study included breast cancer patients who were clinically negative for lymph node involvement. Ultrasound-guided core biopsies were performed on suspicious axillary lymph nodes by experienced radiologists, with histopathological analysis serving as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated to assess diagnostic performance. Patient demographics, tumor characteristics, and axillary ultrasound findings were also recorded. Results: A total of 132 invasive breast cancer patients were included, with a mean age of 57.67 ± 13.03 years. The majority of patients were diagnosed with invasive ductal carcinoma, accounting for 113 (85.6%) cases. Hormone receptor positivity was prevalent, with estrogen receptor positivity in 119 (90.2%) and progesterone receptor positivity in 116 (87.9%) cases. The most common immunohistochemistry subtype was Luminal B, present in 66 (50%) patients, followed by Luminal A in 51 (38.6%) patients. Most tumors were of moderate grade 77 (58.4%) and early-stage (pT1) 63 (47.7%). Ultrasound-guided core biopsy exhibited a sensitivity of 87.9% and specificity of 100%, with positive and negative predictive values of 100% and 89.2% respectively, resulting in a diagnostic accuracy of 93.9%. Conclusion: Ultrasound-guided core biopsy demonstrates strong diagnostic performance in identifying metastatic axillary lymph nodes in clinically node-negative invasive breast cancer patients.

BackgroundPlastic pollution has reached an alarming magnitude, defining the contemporary era as the “Plastic Age.” Uncontrolled plastic production and inadequate recycling processes have led to widespread contamination of the environment with micro and nanoplastics. ObjectiveThe study aims to assess the environmental and human health consequences of exposure to microplastic particles (MPs) and their additives among plastic recycling workers in Dhaka. Specifically, it focuses on mapping the management pathways of plastic waste from collection to disposal, analyzing the types of MPs in the environment, and assessing the potential health impacts on plastic recycling workers. MethodsA cross-sectional exploratory study design was used, consisting of exposed and nonexposed groups in plastic recycling sites in Dhaka, Bangladesh. The study will establish possible associations between different health consequences and microplastic particle exposure with a systematic approach involving plastic recycling hot spot detection, management pathway mapping, and detecting the presence of environmental MP. MPs and heavy metals will be detected from environmental samples using fluorescence microscopy, Fourier-transform infrared spectroscopy, and inductively coupled plasma mass spectrometry. Human exposure will be assessed by detecting the metabolites of bisphenol and phthalates from urine samples using liquid chromatography–tandem mass spectrometry and thoroughly evaluating endocrine, reproductive, respiratory, and renal functions. The sample size was derived from the mean concentrations of urinary bisphenol and phthalates metabolites, requiring the participation of 168 respondents. A 1:1 exposure to nonexposed stratification would be sufficient to meet our study objectives, considering the conventional level of power and confidence interval. This study protocol (PR#22111) has received approval from the Research Review Committee and Ethical Review Committee of the icddr,b. ResultsThe project was funded in August 2022. We started collecting environmental samples in January 2023 and completed participant enrollment, exposure survey, and biological sample collection by December 2023. We enrolled 84 adult plastic recycling workers with at least 5 years of exposure history and 84 nonexposed participants who were not involved with plastic recycling activities. Data analysis is currently underway, and the first results are expected to be submitted for publication in November 2024. ConclusionsThe findings would provide valuable insights into the adverse impacts of microplastic pollution on both the environment and human health, aiding in better understanding the extent of the issue. International Registered Report Identifier (IRRID)DERR1-10.2196/60289

Background and Objective: The labial frenum plays an important role in providing attachment between the lip and the alveolar process and at the same time contributes significantly to the maintenance of proper oral hygiene. The main objective of this study was to evaluate the labial frenum attachment in both the upper and lower jaw and investigate its potential association with the age, gender, and oral hygiene condition among individuals presenting to a local tertiary care hospital Methodology: This cross-sectional study was carried out at Lahore Medical and Dental College, Lahore over a period of six months. A total of 360 patients were included in the study after obtaining permission from the institutional ethical review committee The labial frenum type was identified and recorded for both mandible and maxilla. The oral hygiene status was accessed using the oral hygiene index (simplified). Assessment of both frenal attachment and oral hygiene was done by the same examiner to minimize the chances of any bias. Results: Our study included a total of 360 patients with 47% (171) males and 53% (189) females. Moreover, in our study, the most common type of frenal attachment was gingival (65%), followed by mucosal (19%) and less commonly the papillary (11%) and papillary penetrating (6%) types. A strong association was observed between the frenal attachment type and oral hygiene status among our study population (P value= 0.00). Conclusion: The association of frenal attachment with oral hygiene and gender is statistically significant.

BackgroundAn estimated 6.7 million persons are living with dementia in the United States, a number expected to double by 2060. Persons experiencing moderate to severe dementia are 4 to 5 times more likely to fall than those without dementia, due to agitation and unsteady gait. Socially assistive robots fail to address the changing emotional states associated with agitation, and it is unclear how emotional states change, how they impact agitation and gait over time, and how social robots can best respond by showing empathy. ObjectiveThis study aims to design and validate a foundational model of emotional intelligence for empathetic patient-robot interaction that mitigates agitation among those at the highest risk: persons experiencing moderate to severe dementia. MethodsA design science approach will be adopted to (1) collect and store granular, personal, and chronological data using Personicle (an open-source software platform developed to automatically collect data from phones and other devices), incorporating real-time visual, audio, and physiological sensing technologies in a simulation laboratory and at board and care facilities; (2) develop statistical models to understand and forecast the emotional state, agitation level, and gait pattern of persons experiencing moderate to severe dementia in real time using machine learning and artificial intelligence and Personicle; (3) design and test an empathy-focused conversation model, focused on storytelling; and (4) test and evaluate this model for a care companion robot (CCR) in the community. ResultsThe study was funded in October 2023. For aim 1, architecture development for Personicle data collection began with a search for existing open-source data in January 2024. A community advisory board was formed and met in December 2023 to provide feedback on the use of CCRs and provide personal stories. Full institutional review board approval was received in March 2024 to place cameras and CCRs at the sites. In March 2024, atomic marker development was begun. For aim 2, after a review of open-source data on patients with dementia, the development of an emotional classifier was begun. Data labeling was started in April 2024 and completed in June 2024 with ongoing validation. Moreover, the team established a baseline multimodal model trained and validated on healthy-person data sets, using transformer architecture in a semisupervised manner, and later retrained on the labeled data set of patients experiencing moderate to severe dementia. In April 2024, empathy alignment of large language models was initiated using prompt engineering and reinforcement learning. ConclusionsThis innovative caregiving approach is designed to recognize the signs of agitation and, upon recognition, intervene with empathetic verbal communication. This proposal has the potential to have a significant impact on an emerging field of computational dementia science by reducing unnecessary agitation and falls of persons experiencing moderate to severe dementia, while reducing caregiver burden. International Registered Report Identifier (IRRID)PRR1-10.2196/55761

Limited mouth opening, which is also known as trismus or lockjaw, has a number of abeyant issues and its treatment depends on the major cause. The objective of this study is to figure out the common causes of limited mouth opening in Karachi and to ascertain the management approach for a patient with trismus. The level of awareness and skill amongst clinicians with reference to the management of patients with trismus has also been evaluated. About 300 dental clinicians were asked a group of questions by the help of a questionnaire. The survey was conducted amongst the public and private dental OPDs in Karachi. The questions have been asked to evaluate the level of awareness, diagnostic approach, and quality of management and care offered to the patients having trismus. The three most common causes of trismus according to the present study came out to be oral submucosal fibrosis (26.7%), infections (24.0%), and trauma (15.0%), respectively. The dentists have chosen different management approaches according to their field of specialization and case dependence such as physiological mouth opening exercises (50.7%), prescribing medications specially muscle relaxants (24.3%), incision on contracted oral mucosa (12.7%), correction of temporomandibular joint (TMJ) or bone deformity (7.7%), and intralesional corticosteroid therapy (4.7%). The study concluded that trismus can turn into a potentially life-threatening situation if misdiagnosed and managed improperly; therefore, special attention should be given to patients coming with any of the above-mentioned symptoms.

Abstract Background and Aims Given the significance of addressing neonatal mortality in pursuing the 2030 Sustainable Development Goal on child health, research focus on this area is crucial. Despite the persistent high rates of neonatal mortality rate (NMR) in Bangladesh, there remains a notable lack of robust evidence addressing inequalities in NMR in the country. Therefore, this study aims to fill the knowledge gap by comprehensively investigating inequalities in NMR in Bangladesh. Methods The Bangladesh Demographic and Health Survey (BDHS) data from 2000 to 2017 were analyzed. The equity stratifiers used to measure the inequalities were wealth status, mother's education, place of residence, and subnational region. Difference (D) and population attributable fraction (PAF) were absolute measures, whereas population attributable risk (PAR) and ratio (R) were relative measures of inequality. Statistical significance was considered by estimating 95% confidence intervals (CIs) for each estimate. Results A declining trend in NMR was found in Bangladesh, from 50.2 in 2000 to 31.9 deaths per 1000 live births in 2017. This study detected significant wealth‐driven (PAF: −20.6, 95% CI: −24.9, −16.3; PAR: −6.6, 95% CI: −7.9, −5.2), education‐related (PAF: −11.6, 95% CI: −13.4, −9.7; PAR: −3.7, 95% CI: −4.3, −3.1), and regional (PAF: −20.6, 95% CI: −27.0, −14.3; PAR: −6.6, 95% CI: −8.6, −4.6) disparities in NMR in all survey points. We also found a significant urban–rural inequality from 2000 to 2014, except in 2017. Both absolute and relative inequalities in NMR were observed; however, these inequalities decreased over time. Conclusion Significant variations in NMR across subgroups in Bangladesh highlight the need for comprehensive, and targeted interventions. Empowering women through improved access to economic resources and education may help address disparities in NMR in Bangladesh. Future research and policies should focus on developing strategies to address these disparities and promote equitable health outcomes for all newborns.

Objective: To determine the outcome of Mesenchymal Stem Cell therapy compared to controls in critically ill COVID-19 patients. Study Design: Quasi-Experimental Study. Place and Duration of Study: Department of Pulmonology, Pakistan Emirates Military Hospital, Rawalpindi Pakistan, from Oct 2020 to Apr 2021. Methodology: We selected 104 critically affected COVID-19 cases from the COVID High Dependency Unit and Intensive Care Unit. All patients were in critical condition and were not improving on the set protocols with high oxygen dependency. In the Intervention Group (Group-A, n=52) mesenchymal stem cell transplant Group, procedure was done using an intravenous drip in addition to the standard treatment as per hospital protocol while in the Control Group (Group-B, n=52) standard treatment was given using the hospital protocol. The study outcomes were improvement in High Resolution Computed Tomography score and reduction in Fraction of Inspired oxygen (FiO2) dependency up to 28 days post-transfusion or up to discharge. Results: The HRCT severity score (range from 0 to 40) significantly improved in MSCT Group 25.8/40±14.7/40 compared to the controls. Similarly, the FiO2 improved 0.58±0.30 in the MSCT-Group as compared to the Control-Group. Moreover, MSCT significantly decreased mortality 29(55.7%) vs 47(90.3%) compared to the controls. Conclusion: Mesenchymal stem cell therapy is very effective in decreasing the severity of HRCT score, improving oxygenation index and mortality in critical COVID-19 patients.

Objective: To determine the use of intravenous Ephedrine in crystalloid preload before spinal anesthesia in elective cesarean section to prevent hypotension to avoid detrimental effects of hypotension in obstetric patients. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Sep 2021 to Feb 2022. Methodology: A total of (250) full-term parturients (>36 weeks gestation) with an age range of 20 to 35 years, scheduled for elective cesarean section belonging to the American Society of anaesthesiologists classification II were included in the study. Bradycardia and tachycardia were endorsed as 30% of baseline respectively whereas

We conducted an epidemiologic assessment of disease distribution by race/ethnicity to identify subpopulation-specific drivers of tuberculosis (TB). We used detailed racial/ethnic categorizations for the 932 TB cases diagnosed in Arkansas, USA, during 2010–2021. After adjusting for age and sex, racial/ethnic disparities persisted; the Native Hawaiian/Pacific Islander (NHPI) group had the highest risk for TB (risk ratio 173.6, 95% CI 140.6–214.2) compared with the non-Hispanic White group, followed by Asian, Hispanic, and non-Hispanic Black. Notable racial/ethnic disparities existed across all age groups; NHPI persons 0–14 years of age were at a particularly increased risk for TB (risk ratio 888, 95% CI 403–1,962). The risks for sputum smear–positive pulmonary TB and extrapulmonary TB were both significantly higher for racial/ethnic minority groups. Our findings suggest that TB control in Arkansas can benefit from a targeted focus on subpopulations at increased risk for TB.

Objective: To determine the frequency of conversion of laparoscopic cholecystectomy to open cholecystectomy using proposed intra-operative scoring system and to check the validity of the scoring system. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted in the Department of Surgery, Federal Government. Polyclinic Hospital (FGPC) Islamabad from 1 February 2019 to 31 July, 2019. Materials and Methods: This study enrolled 197 patients of either gender with age ranging between 20-60 years planned for laparoscopic cholecystectomy (LC). All the recruits were assessed intraoperatively using proposed objective intraoperative scoring-system for difficult LC. The conversion rate of LC to open cholecystectomy was recorded in correlation with demographic data and co-morbidities. Data was entered and analyzed using SPSS version 25.0. Results: Out of 197 enrolled patients, 64% were females. The mean age of study population was 42.7 ± 12.1 years. Forty six percent (46%) patients had co-morbidities with fifty-nine (n=59) being diagnosed as hypertensive and thirty-two (n=32) as diabetic. A total of 8.1% (n=16/197) patients underwent conversion to open cholecystectomy. The overall mean objective intra-operative score was 3.6 ± 1.73; which was significantly higher in patients who underwent conversion to open cholecystectomy compared to those who did not undergo conversion (7.19 ± 0.83 vs 3.28 ± 1.39; p-value = 0.001). Conversion rate was significantly more in the patients who were above 40 years, hypertensive, and diabetic. (p

Abstract The risk of developing an eating disorder among university students is higher than the general population in Bangladesh. Since psychiatric disorders (such as depression and anxiety) and addictive behaviors (e.g., internet addiction) predominantly exist among university students in the country, these may increase their vulnerability to developing an eating disorder. The association of internet addiction, depression, and anxiety with the risk of eating disorders among Bangladeshi university students is relatively unknown; therefore, this study investigates the association. This study was a cross-sectional design. Students (N = 700) from two public universities in Bangladesh completed the Patient Health Questionnaire (PHQ-9) scale, the Generalized Anxiety Disorder (GAD-7) tool, and Orman's Internet Addiction Survey (OIAS) to measure exposure variables. Eating Attitudes Test-26 (EAT-26) assessed the outcome variable. Multivariable logistic regression analysis showed that internet addiction [adjusted odds ratio (aOR) for moderate addiction = 2.15 and severe addiction = 3.95], depressive (aOR 3.04), and anxiety (aOR 2.06) symptoms were associated with an increased risk of eating disorder among study participants. Future longitudinal studies on university students are recommended to gain a better understanding about the causal factors of eating disorder to support intervention initiatives and strategies by public health practitioners and policy experts.

Abstract Suicidal ideation is a complex phenomenon influenced by several predisposing, contextual, and mediating factors that seem more common among healthcare workers, especially nurses. We investigated the association of bullying and burnout with suicidal ideation among Bangladeshi nurses and identified the associated factors. We conducted a cross-sectional study among 1264 nurses in Bangladesh between February 2021 and July 2021. We applied a modified Poisson regression model with robust error variance to determine the association of bullying and burnout with suicidal ideation. Among 1264 nurses, the female was 882 (70.02%), and the mean age was 28.41 (SD = 5.54) years. The prevalence of high levels of suicidal ideation was 13.26%. In the Poison regression model, high risk bullying (RR = 6.22, 95% CI 3.13–12.38), targeted to bullying (RR = 7.61, 95% CI 3.53–16.38), and burnout (RR = 8.95, 95% CI 2.84–28.20) were found to be significantly associated with suicidal ideation. Furthermore, we found significant interaction between workplace bullying and burnout with suicidal ideation (p

Abstract Retinal diseases such as retinitis pigmentosa (RP) and age-related macular degeneration (AMD) are characterized by unrelenting neuronal death. However, electrical stimulation has been shown to induce neuroprotective changes in the retina capable of slowing down the progression of retinal blindness. In this work, a multi-scale computational model and modeling platform were used to design electrical stimulation strategies to better target the bipolar cells (BCs), that along with photoreceptors are affected at the early stage of retinal degenerative diseases. Our computational findings revealed that biphasic stimulus pulses of long pulse duration could decrease the activation threshold of BCs, and the differential stimulus threshold between ganglion cells (RGCs) and BCs, offering the potential of targeting the BCs during the early phase of degeneration. In vivo experiments were performed to evaluate the electrode placement and parameters found to target bipolar cells and evaluate the safety and efficacy of the treatment. Results indicate that the proposed transcorneal Electrical Stimulation (TES) strategy can attenuate retinal degeneration in a Royal College of Surgeon (RCS) rodent model, offering the potential to translate this work to clinical practice.

Objective: To compare the mean time of first rescue analgesia with Nalbuphine versus Tramadol as an adjuvant to Bupivacaine given for caudal block in children. Study Design: Quasi-experimental study Place and Duration of Study: Anesthesiology Department, Bolan Medical Complex Hospital, Quetta Pakistan, from Feb to Aug 2019. Methodology: The study included 60 patients, of either gender, aged 3-12 years. Group-A included patients who received 0.125% Bupivacaine 1ml/kg with Tramadol 2mg/kg body weight caudally. Group-B included patients who received 0.125% Bupivacaine with Nalbuphine 0.1mg/kg body weight caudally. The time required for the first rescue analgesia call was noted in all patients. Paracetamol 10 mg/kg intravenous was given as a rescue analgesic in all patients. Results: The mean age of patients was 8.30±3.03 years, and mean weight of patients was 23.33±6.92 Kg. There were 26(43.33%) female and 34(56.67%) male patients. The mean pain score was 3.53±1.43 in the Tramadol-Group and 1.86±1.25 in the Nalbuphine-Group (p-value

Abstract Background Fellowship programs offer training in a subspecialty focusing on distinct and advanced clinical/academic skills. This advanced postgraduate training allows physicians, who desire a more specialized practice, to further develop clinical, academic, research, and leadership/administrative skills. The Aga Khan University (AKU) is one of the few institutes offering paediatric sub-specialty training in Pakistan. We aimed to evaluate the current Paediatric fellowship programs at AKU. Methods Process evaluation of six paediatric fellowship programs (cardiology, neurology, endocrinology, critical care medicine, neonatology, and infectious disease) was conducted from September 2020 to April 2021 by senior clinicians and medical educationists. Evidence was collected through document review (using existing postgraduate medical education program information form), observation of teaching and learning support, and focused group discussions/interviews with program faculty and fellows were conducted. A review of the evaluation report was done as part of this study. This study received an exemption from the ethical review committee. The quantitative data were analyzed using SPSS (22.0) while the reports of discussion with fellows and friends underwent content analysis. Results All fellowship programs met the criteria for having a robust competency-based fellowship curriculum as per the institutional and national guidelines. Formative assessment in the form of continuous evaluation was found to be integrated into all the fellowship programs, however, most of the programs were found to lack a summative assessment plan. Fellows in training and program faculty were satisfied with the opportunities for mentorship, teaching, and learning. Thematic analysis of the discussion reports with faculty and fellows revealed three key themes including, program aspects translating into strengthening the training, gaps in the training program in delivering the expectations, and making ways to reach par excellence. Conclusions The process evaluation of paediatric fellowship programs provided an opportunity to holistically review the current strengths and quality of the training in individual programs along with the unmet needs of the trainees. This will help the program stakeholders to prioritize, align and allocate the resources to further enhance the quality of training and outcome of individual fellowship programs to ensure wider impacts at a regional, national, and international health system level.

Background Telehealth is comprised of telecommunications and electronic information systems to support and maintain long-distance healthcare services. Although it has not been thoroughly explored, the intention of using the service among the general public is critical to its success. We investigated the factors associated with the intention to utilize telehealth services among the general population of Bangladesh. Methods This cross-sectional study was conducted between May 22, 2021 and June 15, 2021 in Bangladesh, where the total number of participants was 1038. The Pearson chi-square test and Kruskal-Wallis H tests were used to examine the unadjusted relationship between the explanatory variables and the intention to use telehealth services. A multinomial logistic regression model was fitted to determine the adjusted association. Shapiro-Wilk tests were used to check the normality of continuous data. Data were processed and analyzed by software STATA-16. Results The probability of utilizing the service increased significantly with increasing knowledge, perceived benefit, and predisposition levels among respondents. However, when perceived concern increased, the likelihood of utilizing the service dropped significantly. Age, marital status, educational status, profession, residence, and perceived health status were significantly associated with the participants’ intention to utilize the telehealth service. Conclusions The influencing aspects of telehealth service utilization should be recognized by the respective authorities. Possible activities to enhance usability among people are also recommended.

Objective: To assess the impact of COVID-19 in pregnant women and determine the vertical transmission in newborns. Study Design: Case series. Place and Duration of Study: Department of Gynecology & Obstetric, Combined Military Hospital, Gujranwala Pakistan, from Jun to Sep 2020. Methodology: Forty consecutive pregnant women reported as COVID-19-positive cases were included. After taking clinical and demographic details, the maternal outcome was defined regarding shortness of breath, fever, oxygen saturation and ventilator support. The fetal outcome was defined based on APGAR score, birth weight, and Neonatal Intensive Care Unit admission. For vertical transmission, the neonatal nasopharyngeal swab samples were collected after 24 hours of birth. Result: Forty pregnant women were included in the study with the mean age of 30.05±2.8 years, and mean gestational age of 36.08±0.717 weeks. Of the included women, 67.5% underwent C-sections, and 25.0% underwent SVD. As per fetal outcome, most of the babies 80% were normally delivered, while 5% were IUD. Out of all, three neonates were diagnosed with vertical transmission, but none of them developed any complications. Conclusion: Vertical transmissions of COVID-19 among neonates were observed. No critical maternal outcome in terms of maternal severe morbidity or mortality was observed. However, further studies are required on this subject.

The current worldwide pandemic has significantly increased the need for online learning platforms, hence presenting difficulty in choosing appropriate course materials from the vast online educational resources due to user knowledge frameworks variations. This paper presents a novel course recommendation system called the Deep Learning-based Course Recommendation System (DLCRS). The DLCRS combines a hybrid Sequential GRU+adam optimizer with collaborative filtering techniques to offer accurate and learner-centric course suggestions. The proposed approach integrates modules for learner feature extraction and course feature extraction that is performed using (Embeddings from Language Models) ELMO word embedding technique in order to gain a thorough understanding of learner and course profiles and feedback. In order to evaluate the efficacy of the proposed DLCRS, several extensive experiments were carried out utilizing authentic datasets sourced from a reputable public organization. The results indicate a notable area under the receiver operating characteristic curve (AUC) score of 89.62%, which exceeds the performance of similar advanced course recommendation systems. The experimental findings support the viability of the DLCRS, as seen by a significant hit ratio of 0.88, indicating high accuracy in its suggestions.

BackgroundZinc deficiency poses significant health risks, particularly in low-income settings. This study aims to evaluate the impact of agronomically zinc biofortified (fermented and non-fermented) and post-harvest wheat flour flatbread on zinc status and metabolic health in adolescents and adult women in rural Pakistan.MethodsA four-arm triple-blind randomized controlled trial will be conducted in a rural district of Pakistan. Participants (adolescents aged 10-19 and adult women aged 20-40) will be assigned to receive fermented or unfermented high zinc agronomically biofortified wheat flour flatbread, post-harvest zinc-fortified wheat flour flatbread, or low zinc conventional whole wheat flour flatbread. The meal would be served once a day, six days a week for six months. The study aims to enroll 1000 participants and will be analyzed based on the intention-to-treat principle. The trial is registered with number NCT06092515.OutcomesPrimary outcomes will include serum zinc concentration and metabolic markers, while secondary outcomes include anthropometric measurements, blood pressure, and dietary intake.ConclusionThis trial will provide valuable insights into the efficacy of agronomically zinc biofortified wheat flour in improving zinc status and metabolic health. Findings may inform public health strategies to combat zinc deficiency in resource-limited settings.

Abstract Airborne transmission by droplets and aerosols is known to play a critical role in the spread of many viruses amongst which are the common flu and the more recent SARS-CoV-2 viruses. In the case of SARS-CoV-2, the nasal cavity not only constitutes an important viral entry point, but also a primary site of infection (Sungnak W. et al. Nat. Med. 26:681–687. https://doi.org/10.1038/s41591-020-0868-6 , 2020).. Although face masks are a well-established preventive measure, development of novel and easy-to-use prophylactic measures would be highly beneficial in fighting viral spread and the subsequent emergence of variants of concern (Tao K. et al. Nat Rev Genet 22:757–773. https://doi.org/10.1038/s41576-021-00408-x , 2021). Our group has been working on optimizing a nasal spray delivery system that deposits particles inside the susceptible regions of the nasal cavity to act as a mechanical barrier to impede viral entry. Here, we identify computationally the delivery parameters that maximize the protection offered by this barrier. We introduce the computational approach and quantify the protection rate obtained as a function of a broad range of delivery parameters. We also introduce a modified design and demonstrate that it significantly improves deposition, thus constituting a viable approach to protect against nasal infection of airborne viruses. We then discuss our findings and the implications of this novel system on the prevention of respiratory diseases and targeted drug delivery.

Objective: To compare the relative effectiveness of Oblique subcostal transversus abdominis plane block with Erector spinae plane block in reliving post-operative pain in patients subjected to elective laparoscopic cholecystectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Rawalpindi Pakistan, from Nov 2020 to Apr 2021. Methodology: Sixty-eight patients were equally divided into two groups, ESP and OSTAP (34 each). ESP-Group received a bilateral erector spinae block, and OSTAP-Group received a bilateral oblique subcostal transversus abdominis block. Ultrasound guidance was used for block execution in both Groups. Bupivacaine 0.375% 20 ml was used for each side of the block. Post-operatively, Acetaminophen 1g IV 8 hourly was given to all patients, and in addition, Tramadol was used as rescue analgesia. Endpoints included comparing total Tramadol usage and Numerical Rating Scale scores between respective Groups. Results: Post-operative Tramadol consumption in Group-ESP was 144.26±16.38 mg compared with 200.58±17.57 mg of the Group-OSTAP. This difference was significant (p

The complement system is an essential part of innate immunity. It is activated by invading pathogens causing inflammation, opsonization, and lysis via complement anaphylatoxins, complement opsonin’s and membrane attack complex (MAC), respectively. However, in SARS-CoV-2 infection overactivation of complement system is causing cytokine storm leading to multiple organs damage. In this study, the René Thomas kinetic logic approach was used for the development of biological regulatory network (BRN) to model SARS-CoV-2 mediated complement system signalling pathways. Betweenness centrality analysis in cytoscape was adopted for the selection of the most biologically plausible states in state graph. Among the model results, in strongly connected components (SCCs) pro-inflammatory cytokines (PICyts) oscillatory behaviour between recurrent generation and downregulation was found as the main feature of SARS-CoV-2 infection. Diversion of trajectories from the SCCs leading toward hyper-inflammatory response was found in agreement with in vivo studies that overactive innate immunity response caused PICyts storm during SARS-CoV-2 infection. The complex of negative regulators FI, CR1 and DAF in the inhibition of complement peptide (C5a) and PICyts was found desirable to increase immune responses. In modelling role of MAC and PICyts in lowering of SARS-CoV-2 titre was found coherent with experimental studies. Intervention in upregulation of C5a and PICyts by C3 was found helpful in back-and-forth variation of signalling pattern linked with the levels of PICyts. Moreover, intervention in upregulation of PICyts by C5a was found productive in downregulation of all activating factors in the normal SCCs. However, the computational model predictions require experimental studies to be validated by exploring the activation role of C3 and C5a which could change levels of PICyts at various phases of SARS-CoV-2 infection.

OBJECTIVES/GOALS: Susceptible mucocutaneous membranes of the eye and nasal cavity are easily infected by viruses leading to pink eye or respiratory infections whose direct cost has been estimated as $16 billion annually in the United States. We have developed a novel and effective barrier that will be agnostic to variants enveloped viruses like coronaviruses. METHODS/STUDY POPULATION: We evaluated the efficacy of hydroxypropyl cyclodextrin barrier in preventing respiratory coronavirus infections using 25 humanized angiotensin converting enzyme-2 receptor (hACE-2) mice under a BSL3 laboratory setting. We have shown the barrier is safe and efficacious in preventing coronavirus infections in in vitro respiratory cell lines. We instilled 10 uL aliquot of the barrier into the nostril of the mouse 30 minutes before exposing them to a 10uL titer containing 10,000 plaque forming units of the SARS-CoV-2 delta variant. The control mice received the SARS-CoV-2 infection but not the barrier. The mice were observed for 5 days after which they were sacrificed. We analyzed the lungs and nasal palates for viral load using reverse transcription-polymerase chain reaction. RESULTS/ANTICIPATED RESULTS: We observed our barrier to be effective in preventing SARS-CoV-2 delta variant infection in hACE2 mice models. The lungs and nasal secretions of treated mice were less infectious with lower viral load than the control mice. The lungs of treated mice showed decrease in IFN gene expression and many cytokines and chemokines that regulate virally induced inflammatory responses such as IL-1b, IL-8, CXCL9, CXCL10, and the CCLs. We observed the plasma Angiotensin I and Angiotensin II decreased with barrier treatment, correlating with the viral load observed in the lungs. These peptides may be useful biomarkers for monitoring viral load within the lungs of virally infected individuals. DISCUSSION/SIGNIFICANCE: This supports the barrier’s efficacy to reduce transmission and prevent infections of SARS-CoV-2. This easy to use barrier can augment the mucocutaneous layers of the eye and nasal cavity. Our agnostic barrier will reduce the economic and public health burden of seasonal respiratory and eye viral infections and their related deaths amongst the public.

Objective: To compare appendectomy under spinal anaesthesia versus combining Ketamine and Midazolam with spinal anaesthesia. Study Design: Quasi-experimental study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Jan to June 2022. Methodology: A sample of 100 patients fulfilling the inclusion/exclusion criteria was collected. A random segregation was made into two equal groups through the lottery method resulting in fifty patients in each Group-50. The Group A patients received spinal anaesthesia while and were given 0.25mg/kg Ketamine and 2mg Midazolam 2 minutes before incision. Group B patients only received spinal anaesthesia. Patients’ hemodynamics were monitored throughout surgery. The primary parameter studied was hemodynamic stability, and the secondary parameter was conversion into general anaesthesia. Results: The primary outcome was hemodynamic stability. 48(96%) patients remained hemodynamically stable in Group A. Only 2(4%) patients showed hemodynamic instability. The Group B patient had lower hemodynamic stability as 29(58%) patients were hemodynamically unstable versus 21(42%) being stable (p-value

A systematic literature review was conducted to summarize the overall thermal performance of different gasified cooking stoves from the available literature. For this purpose, available studies from the last 14 years (2008 to 2022) were searched using different search strings. After screening, a total of 28 articles were selected for this literature review. Scopus, Google Scholar, and Web of Science databases were used as search strings by applying “Gasifier cooking stove” AND “producer gas cooking stove” AND “thermal performance” keywords. This review uncovers different gasified cooking stoves, cooking fuels, and fabrication materials besides overall thermal performances. The result shows that the overall thermal performance of different gasified cooking stoves was 5.88% to 91% depending on the design and burning fuels. The premixed producer gas burner with a swirl vane stove provided the highest overall thermal performance range, which was 84% to 91%, and the updraft gasified stove provided the lowest performance, which was 5.88% to 8.79%. The result also demonstrates that the wood pellets cooking fuel provided the highest thermal performance and corn straw briquette fuel provided the lowest for gasified cooking stoves. The overall thermal performance of wood pellets was 38.5% and corn straw briquette was 10.86%.

Objective: To assess the average amount of corneal endothelial cell density reduction in patients with various anterior chamber depths and axial lengths after phacoemulsification. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jul 2022 to Dec 2022. Methodology: Ninety-four patients with cataract who underwent uneventful phacoemulsification surgery with IOL Implantation were included in the study. Patients were divided into two groups on the basis of anterior chamber depth and axial length values. All patients underwent surgery, and corneal endothelial cell density was measured and compared pre and post-operatively at pre-specified time points. Results: A significant decrease in the number of corneal endothelial cells was found between both the groups at pre and postop measurements. The mean CED decreased to 2420.04±296.73 post-operatively from 2608.44±237.22 (p

Objective: To determine the epidemiological trends of lung tumours on endobronchial biopsy in patients presenting to our hospital. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Pulmonology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2021 to Jun 2022. Methodology: Two hundred eighty-seven patients who exhibited clinical and/or radiological signs of a lung mass were enrolled in this study. Bronchoscopy was done to identify endobronchial lesions, followed by endobronchial biopsies submitted for histopathology and immunohistochemistry to diagnose the exact type of tumour. Patients who underwent bronchoscopy for some other indication but were found to have an endobronchial mass incidentally were also included in the study. Results: Squamous cell carcinoma was the most common 107(37.3%), followed by small cell carcinoma 76(26.5%). Adenocarcinoma was diagnosed in 75 patients (26.1%). Diagnosis of carcinoid tumour was made in 6 patients (2.09%). There were 5 cases (1.7%) of poorly differentiated carcinoma and metastatic adenocarcinoma each. Large cell carcinoma was present only in 2 cases (0.7%). Strangely, two patients (0.7%) had small and Squamous cells simultaneously, and one had adenosquamous carcinoma. Other tumours, including mantle cell lymphoma, Rhabdomyosarcoma, mucoepidermoid carcinoma, neuroendocrine tumours, spindle cell carcinoma and sarcomatoid carcinoma, were found in 8 cases (2.8%). Conclusion: Squamous cell carcinoma is the most common centrally arising tumour in our population in both genders, followed by small cell carcinoma and adenocarcinoma. Keywords: Epidemiology, Endobronchial mass, Lung cancer, Squamous cell carcinoma.

Introduction: Blood and blood components transfusion is a life-saving procedure, but it carries the risk of adverse outcomes. Hemo-vigilance is a surveillance system that includes reporting and analysis of adverse events related to blood transfusion and taking steps to prevent their occurrence or recurrence Aims & Objectives: This study is to determine the incidence and type of adverse transfusion reactions and type of blood products associated, in patients had undergone blood transfusion. Place and duration of study: A retrospective descriptive cross-sectional study Blood bank, Pathology department, University College of Medicine / University of Lahore Teaching Hospital, Lahore and Blood bank, Mansoorah Teaching Hospital, Lahore. The study was conducted over a period of 04 years (1st January 2018 to 31st December 2021). Material & Methods: All the adverse blood transfusion reactions reported to Blood Bank during the 4 years were analyzed according to institution's protocol. Results: Out of 9597 units transfused, 72 (0.75%) adverse transfusion reactions were reported. Febrile non hemolytic transfusion reactions (0.36%) were the most frequent type of reaction followed by Allergic reactions (0.33%). ATRs were mostly associated with whole blood followed by Pack Cell Volume (PCVs). Conclusion: For an accurate estimation of ATR incidence, proper transfusion monitoring and reporting of all such responses will be required. To enhance the quality, safety, efficacy, and cost-effectiveness of blood and its components and as well as the donation process, an effective hemo-vigilance system must be established

Objectives: To determine awareness and uptake of tetanus toxoid vaccination among females of reproductive age in Rawalpindi, Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Fauji Foundation Hospital, Rawalpindi Pakistan, from Feb to Sep 2018. Methodology: A consecutive sample of 400 females completed a structured questionnaire translated into Urdu after giving written informed consent. Females, 15 to 49 years, accompanying patients and seeking healthcare were enrolled, and all those belonging to the category of healthcare providers (doctors, nurses, paramedics, etc.) were excluded. Results: The study showed that 343(85.8%) women were aware of tetanus disease, and 230(57.5%) knew it could be prevented through vaccination. Only 147(36.8%) knew the correct range of reproductive age in females, 178(44.5%) knew the correct schedule, and 46(11.5%) knew the correct number of injections of tetanus vaccination program given by the World Health Organization (WHO) for females of reproductive age group. Around 321(80.3%) were willing to get vaccinated, and 338(84.5%) were willing to recommend it to other females. The number of females who ever received tetanus vaccination for females of reproductive age was 81(20.25%), out of which 7(1.8%) completed uptake of all five doses. Conclusion: Our study population was aware of tetanus disease with a positive attitude towards vaccination. However, awareness and uptake of the tetanus toxoid vaccine according to the tetanus vaccination program for females of reproductive age could have been better. Keywords: Reproductive age, Tetanus, Tetanus toxoid Vaccination.

Objective: To assess the diagnostic accuracy of the Doppler Cerebroplacental ratio for fetal growth restriction keeping fetal biometry as the reference standard. Study Design: Cross-sectional study. Place and Duration of Study: Department of Radiology, Combined Military Hospital, Multan Pakistan, from May to Oct 2020. Methodology: Two hundred and fifty-six-singleton pregnancies ≥ 30 weeks were included and underwent fetal biometry, including estimated fetal weight (EFW) by trans-abdominal ultrasound. The umbilical artery and middle cerebral artery resistive indices were evaluated using Doppler ultrasound, and Cerebroplacental ratio (CPR) was calculated. The presence or absence of fetal growth restriction (FGR) was noted using cut-off EFW of 10th centile and CPR of 1.0. Results: Cerebroplacental ratio showed FGR in 145(56.64%) patients. Fetal biometry showed FGR in 141 (55.08%) patients,whereas 115(44.92%) patients revealed none. Of 145 CPR-positive patients, 127(87%) were true positive, while 18(12%) were false positive. Among 111 CPR-negative patients, 14(0.12%) were false negative, while 97(87%) were true negative. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the Cerebroplacental ratio were 90.07%, 84.35%, 87.59%, 87.39% and 87.50%, respectively. Conclusions: Doppler Cerebroplacental ratio is sensitive for diagnosing fetal growth restriction; however, its role as a stand alone test needs further evaluation and may be enhanced with other tools such as estimated fetal weight.

Objective: To uncover a correlation between a high uterine artery pulsatility index on Doppler ultrasound and the early onset of pre-eclampsia to reduce maternal and fetal morbidity and mortality. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital, Multan Pakistan, from Jun 2020 to Dec 2021. Methodology: After Ethical Approval and informed consent, the umbilical artery pulsatility (UAPI) of the patients was measured by a transabdominal scan(TAS) between 75 and 100 days. Raised UAPI was correlated with early onset preeclampsia. Results: One hundred and sixty pregnant women were included in the study, out of which 34(21.3%) women developed preeclampsia, and 126(78.8%) were normal patients. Maternal weight (p=0.001), maternal BMI (p=0.002), gestational age and weight at delivery (p=0.001), and uterine artery doppler pulsatility index (p=0.001) had statistically significant differences with pre-eclampsia and regular patients among the target population. Conclusion: First-trimester uterine artery pulsatility index on Doppler ultrasound is a beneficial technique to recognize the women by risk status and target them to prevent pre-eclampsia.

Introduction: The genus Euphorbia is known to contain diterpenoids, and several isolated compounds which exhibited biological activities including significant multidrug resistance reversal effects. This work is focused on the isolation, in vitro and in silico studies of two natural bio-active flavonoids (1 & 2) isolated from Euphorbia pulcherrima bark for the very first time. Methods: The phytochemical investigation resulted in the identification of two flavonoids: 3,5,7-trihydroxy-2-(4-hydroxy-3-methoxyphenyl)-6-methoxy-4H-chromen-4-one (1) and 2-(3,4-dihydroxyphenyl)-3,5,7-trihydroxy-6-methoxy-4H-chromen-4-one (2), which were isolated for the first time from Euphorbia pulcherrima. Results: The chemical structures of the two isolated compounds were confirmed by 1H NMR, 13C NMR, and ESI-HRMS spectral data. The Bioactivity activity of these compounds was evaluated; results revealed that compounds 1 & 2 exhibit promising urease inhibitory potential with IC50 values of 15.3 ± 2.13 μM and 19.0 ± 2.43 μM, respectively, whereas the positive control thiourea had an IC50 of 21.0 ± 0.23 μM. Similarly, these compounds were also evaluated against the tyrosinase enzyme; results showed that compound 1 displays significant inhibitory activity with an IC50 value of 48.7 ± 2.19 μM, whereas compound 2 exhibited a moderate effect with an IC50 value of 74.8 ± 1.79 μM, when compared with the standard (alpha-kojic acid, IC50 = 47.6 ± 0.67 μM). Additionally, compounds 1 and 2 also exhibited anti-glycation and phosphodiesterase inhibitory activities. Conclusion: Studies dealing with the drug like properties such as in silico screening (docking study) was also carried out to discover the structural features of both compounds 1 and 2. Results indicated that the docking scores of compounds 1 and 2 are in agreement with their IC50 values. Key messages Isolation and characterization of two bioactive flavonoids (1 and 2) from Euphorbia pulcherrima. In silico and in vitro enzyme inhibition studies were conducted to identify the therapeutic potential of flavonoids 1 and 2. Drug-like properties were calculated to discover important pharmacophoric features.

Background: Urolithiasis is the third common disease of the urinary tract after UTIs and pathological diseases of the prostate. The objective of this study was to compare the efficacy of doxazosin versus tamsulosin in lower ureteric stone expulsion in adult population of District Dera Ismail Khan, Pakistan. Materials Methods: This non-randomized control trial was conducted in the Department of Urology, Gomal Medical College, Dera Ismail Khan, Pakistan from February 2020 to December 2020. The 252 patients included in our study were divided in to two groups. The patients in experimental group received Tab. doxazosin 4 mg daily for 4 weeks and Tab. diclofenac sodium 50 mg B.D for 5 days and then on need basis. The patients in control group received Cap. tamsulosin 0.4 mg daily for 4 weeks and similarly Tab. diclofenac sodium 50 mg as in experimental group. All the patients were followed regularly for expulsion of ureteric stones for four weeks. Sex, age and stone size were matching, while stone expulsion was a research variable. Hypothesis was verified by McNemar chi-square test. Results: Out of 252 patients, 113 (89.68%) patients in experimental group, while 77 (61.11%) patients in control group passed the stones. There was statistically significant difference in efficacy in doxazosin group as compared to tamsulosin group (p-value=.0001). Conclusion: The use of doxazosin as the medical expulsion therapy for the lower ureteric stone proved to be more effective as compared to tamsulosin as demonstrated by our results.

Background: Urinary stone disease is one of the commonest urological diseases worldwide. The objective of this study was to compare the efficacy of alfuzosin versus control group in upper ureteric stone expulsion in adult population of district Lahore, Pakistan. Materials Methods: This trial was conducted in Department of Urology, Sheikh Zayed Hospital, Lahore, Pakistan form January 2017 to June 2017. All adult patients with upper ureteric stone size 5-10 mm were eligible. Those with multiple stones, having fever, severe pain, history of surgery in past two weeks and growth on urine culture or pyuria were excluded. Experimental and control groups each had 30 patients. Experimental group received Tab. alfuzosin 10 mg daily for four weeks and Tab. diclofenac sodium 50 mg SOS for acute pain. The control group received Tab. diclofenac sodium 50 mg SOS for acute pain. We followed all patients for four weeks for expulsion of ureteric stones by X-ray KUB or CT KUB. Sex, age and stone size were matching variables. Stone expulsion (yes, no) was research variable. We compared count of stone expulsion between two groups by using McNemar chi-square test at alpha 0.5 using GraphPad. Results: Out of 30 patients in experimental group, 23 (76.67%) were men and seven (23.33%) women and out of 30 in control group, 20 (66.67%) were men and 10 (33.33%) women, almost similar in both groups. Mean age in experimental group was 39.45±10.33 years and in control group it was 37.38±8.28 years, almost similar in both groups. Mean stone size was 7.45±1.47 (5-10) mm in the experimental and 7.28±1.68 (5-10) mm in control group, being comparable in both the groups. In experimental group, stone expulsion was achieved in 23 (76.67%) cases and not in seven (23.33%) cases and in control group, it was achieved in 16 (53.33%) cases and not in 14 (46.67%) cases. There was statistically no significant difference in efficacy of alfuzosin versus control group (p=.1213). Conclusion: Our study showed no difference in efficacy of alfuzosin versus control group for upper ureteric stone expulsion in adult population of district Lahore, Pakistan.

Objective: To determine the frequency of medical errors committed by doctors and the prevalence of second victim phenomenon in a tertiary care hospital, and to find out the effects of the error on the second victim's life. Study Design: Cross sectional study Place and Duration of Study: This study was conducted in a tertiary care hospital of Islamabad from 1 February to 30 September 2016. Materials and Methods: A total of 200 male and female doctors were selected from a tertiary care hospital in Islamabad, Pakistan, through convenient sampling technique in order to fill a pretested structured questionnaire, for a period of six months. Questionnaire was adapted from a previous study and alpha eliability of the variables checked. Data was collected via face to face interviewing. It was analyzed using SPSS version 21. Results: Out of the 200 study participants, 62.5% belonged to the age group of 24-31 years, 53% of them were males and 43% were females. Major errors were 13.2 %, minor 57.2 %, near miss were 29.6%. The prevalence of second victims came out to be76 %, and it was almost equal in males (80.6%) and females (71.7%) and was the highest in Medicine department (35-40%). The main cause of errors was documented to be overwork by 72.5% of the participants. The major emotional effect as perceived by 50.5% participants was guilt, followed by sadness in 21.6%, embarrassment in 16.5% and sleep disturbance in 16%. Around 75.5%of the participants were of opinion that an organization should be in place to help second victims come out of their trauma.According to 83% study participants, medical errors should be disclosed to patients and their families. Conclusion: The study concludes that there is a high prevalence of medical errors in the tertiary care hospital and male and female doctors are equally becoming second victims of their errors. The major effects of medical error on the second victim's life are feeling of guilt, sadness, embarrassment and sleep disturbance.

BACKGROUND & OBJECTIVE: Dengue virus (DENV) genomic study is crucial for understanding how it spreads and presents and become dangerous. Three structural and seven non-structural proteins are encoded by the positive stranded RNA DENV. Caspid protein (C) is one of the structural proteins which helps in the encapsidation of viral RNA. Objective of the study is to identify the DENV serotypes and the most common geographic specific mutations in the C protein, circulating in Punjab province of Pakistan. METHODOLOGY: It was cross sectional study in which About 120 DENV isolates were selected, by the procedure of temporal sampling done in peak season of dengue fever in 2022, from the major tertiary care hospitals for whole genomes sequence analysis. Among which only 23 whole genomes sequences were performed after virus isolation, quantification and cDNA synthesis. RESULTS: All the samples were found to be of genotype 1 and 2 in which 44 non-synonymous mutations were detected in the C protein. The most common mutations were; N90S (n=11) and G70S (n=11) followed by V26G (n=5) and R10Q (n=4), in which G70S is novel. CONCLUSION: Mutations in the current study are of particular interest to design of DENV vaccine projects in future. Genomic epidemiology during each outbreak of DENV in different locations is critical for better public health and for designing new policies for future outbreaks.

Objective: To determine the association of body mass index with the severity of COVID-19 pneumonia in hospitalized patients. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, form May to Jun 2021. Methodology: Patients diagnosed with COVID-19 pneumonia on PCR and chest imaging and admitted to our hospital were included in the study. Body mass index was calculated on the first day of hospital admission, and they were followed up for two weeks during the disease. Increased oxygen demand, duration of admission, CT severity score and use of non-invasive ventilation were compared in patients with normal and increased body mass index. Results: A total of 800 COVID-19 patients admitted to the hospital were included in the final analysis. The mean age of the study participants was 41.36±4.55 years. Out of 800 patients, 337(42.1%) had normal BMI, 420(52.5%) were classed in the category of overweight and 43(5.4%) were obese. Furthermore, it was seen that increased demand for oxygen, high CT severity score and longer duration of hospital admission had a statistically significant relationship (p-value

ABSTRACT Objective: To determine the frequency of pain in teeth with irreversible pulpitis after single visit root canal treatment using intra-canal cryotherapy. Study design: Quasi experimental Place and duration of study: Department of Operative Dentistry, Armed forces institute of Dentistry Rawalpindi from 1st June 2017 to 31st December 2017. Material and Methods: Total of 140 patients from 20 to 65 years were equally divided into two groups Group A in which Cryotherapy was used and Group B was control group. After anesthetizing the tooth & application of Rubber Dam, Root canal preparation was done with Protaper next series and copious irrigation of 5.25% sodium hypochlorite and 17% EDTA solution. In group A patients the final irrigation was done with Normal saline at a temperature of 2.5°C. In the control group, final irrigation was performed with normal saline at room temperature. Obturation was done with cold lateral condensation and permanent restoration was done with composite. Patients were contacted by telephone after 24 Hours and were asked whether they experienced any pain. Results: Mean age was 39.26+12.61 years. There were 82 (58.6) male and 58 (41.4) female patients. Comparison of cryotherapy group and controls was done in terms of post-operative pain. After 24 Hours 80% of the patients in group A has no pain while in control group 61.4% were pain free. Conclusion: Key words: Root canal treatment, cryotherapy, irreversible pulpitis, postoperative pain

Abstract Background In Pakistan, 74 children out of 1000 lose their lives annually due to diarrheal illness. This commentary addresses the contributing factors aggravating this growing dilemma and the effect of a simultaneous rise in COVID‐19 cases in a healthcare system ready to collapse, along with providing recommendations to alleviate the problems causing this spike in diarrheal cases. Methods This narrative review has emphasized the causes of the spike in pediatric diarrheal illnesses in Pakistan as well as recommendations offered to lessen the burden by incorporating recent literature (n = 68). Tactics to tackle COVID‐19 alongside diarrheal illnesses were also included. Pakistan was chosen to be assessed due to its high burden of child and infant mortality due to preventable causes. Results The provision of safe drinking water, the proper use of Integrated Management of Newborn and Childhood Illnesses (IMNCI), adequate awareness of the benefits of breastfeeding, the use of correct rehydration techniques such as Oral Rehydration Therapy, and the crucial implementation of the EPI vaccination schedule can curb this increase in diarrheal cases. Conclusion The increased prevalence of diarrheal diseases amongst the pediatric population of Pakistan can be attributed largely due to unsanitary drinking water. Emphasis must be put in the provision of safe drinking water. During the first years of life, children can be kept safe from deadly pathogens just by adequate breastfeeding. IMNCI and EPI must also be properly implemented.

Objective: To determine the role of Methylprednisolone in managing COVID-19 patients. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Jan to Feb 2021. Methodology: This study was carried out at the Department of Medicine. Medical records of all moderate, severe and critical COVID-19 patients admitted and receiving Methylprednisolone were reviewed. Methylprednisolone was used in all patients at doses 0.-2 mg per kg. Results: A total of 200 cases were included. The most common presenting symptoms were cough (77.5%), fever (67.5%) and shortness of breath (63.5%). Most patients (85%) presented within the first week of their illness. One or more comorbidities were present in 75% of patients. Most common being hypertension in 70(35%) and diabetes mellitus in 63(31.5%).Complications seen in the study were Cytokine release storm 92(46%) and acute respiratory distress syndrome 44(22%). The median time for initiation of corticosteroid therapy was 4 hours (range 1-96 hours). Overall survival (OS) in the study was 83.5%. OS for patients with moderate, severe and critical diseases was 97.8%, 86.2% and 62%, respectively (p

Objective: to detect the presence of Methicillin-Resistant Staphylococcus Aureus (MRSA) on frequently touched surfaces in the community, like handles and seats of shopping trolleys and to identify disinfecting practices of the grocery store owners. Study Design: Cross-sectional study. Place and Duration of Study: Grocery stores in Rawalpindi, Pakistan from Jun to Nov 2019. Methodology: A total of 200 swabs from two separate surfaces of 100 trolleys were collected, with 100 samples each from handles and the seats. Trolleys from seven different grocery stores in Rawalpindi Pakistan, were selected by multistage sampling. The swabs were presented to the Microbiology laboratory at Fauji Foundation Hospital, Rawalpindi Pakistan to test for bacterial presence. Results: The samples showed growth on 65% of trolley handles and 66% of trolley seats. Trolleys washed once in 6 to 12 months, had 42.5% bacterial growth. Staphylococcus Aureus was present on 42 % of both surfaces, with 24% MRSA on Trolley handles and 18% on trolley seats. The significant association was observed in Bacterial growth on the handles of trolleys and servicing frequency of shopping trolleys with the p-value of

Introduction: There is a strong connection between sovereignty, provision of rights and health status of women. Females from middle and low-income countries have a poor perception of contraceptive choices and rights. Aims & Objectives: This study determined change in contraception related perceptions and associated rights in females through behavior change communication strategies. Place and duration of study: Basic Health Units of District Lahore, Pakistan during 2011-2016. Material & Methods: A community-based, quasi-interventional study was conducted on conveniently selected 100 Muslim married females with parity ? 4, attending randomly selected 10 basic health units out of 37 in district Lahore. Self-constructed, structured questionnaire was administered by interviewer in local language for pre and post intervention assessment of knowledge and perception about contraceptives and contraception-associated female rights was used. Religion-based messages which were tailored for this context were imparted using behavior change communication strategies. Reinforcement was done after sixth months and the post BCC assessment was carried out to measure the change in the knowledge, nine months after intervention. Results: The mean age of respondents was 28.15 ± 5.35 years, 37.0% were illiterate, 93% had income/capita/month ? Rs.3000. 59% of the respondents never used any method of contraception. Out of contraceptive users, 53.7% used condoms while 48.8% made decision of spacing after they had 2 or more children. After imparting BCC, there was significant change (p

Introduction: Reproductive age females in Pakistan are still having poor access to adequate contraceptive information and difficulty in decision making, resulting in abortions many times. Aims & Objectives: To identify contraceptive and abortion-related practice among married reproductive age females of lower income group in District Lahore. Place and duration of study: Study was conducted in 30 union councils (UCs) of District Lahore, Pakistan in 2011-2016. Material & Methods: A cross sectional descriptive study was carried out on a sample of 210 married females of reproductive age in 30 UCs of District Lahore. 30 UCs were randomly selected out of 150 followed by random selection of one village/ward which was considered as a cluster and 7 females were recruited through convenience sampling in each cluster. Data was collected on contraceptive use, preferences, decision making and abortion-related practice and their associations with socio-demographics of these females. Results: The survey was carried out among 210 females with mean age 29 ± 5.28. 97.6% were Muslims, 23.3% were illiterate and 96.2% were housewives. Per capita per month income was ? PKR 3000 in 99 % of the respondents. 20% females used contraception. 39% women were delivered by untrained birth attendants, 95.7% females breast fed and amongst them only 15.7% fed for two years. 33(15.7%) of respondents had 48 abortions and amongst them 27% got it done by a Dai while female neighbors did it in 4.2% cases so a total of 31.2 % abortions were conducted at home. Place of abortion and delivery was decided by husbands in 87.4% respondents. Lower age and age at marriage were found to be associated with higher contraceptive use and abortions (P

Mycosis fungoides (MF) is the commonest primary cutaneous T-cell lymphoma (CTCL). Classically MF is presented clinically as multilesional disease but occurrence of solitary lesion, though quite rare, is on the record. This rare variant of MF is clinically and histopathologically indistinguishable from classic MF. Due to the rarity of the presentation the clinician may miss the diagnosis and the pathologist may also be in diagnostic dilemma specially if not clinically oriented. Here we describe a case of unilesional/solitary MF (UMF) in a 59 years old male who was initially clinically diagnosed as inflammatory dermatosis and was treated accordingly without any appreciable clinical response for over 4 years. Unresponsiveness to empirical treatment led to biopsy which finally proved it to be UMF. The clinical, light microscopic and immunohistochemical features of UMF are briefly reviewed to create awareness among the clinicians and pathologists about this rare variant of MF. IMC J Med Sci 2022; 16(1): 006. DOI: https://doi.org/10.55010/imcjms.16.009 *Correspondence: Wasim Selimul Haque, Head, Department of Histopathology and Cytopathology, Jaber Al-Ahmed Armed Forces Hospital, Kuwait Armed, Forces, Subhan Cantonment, Kuwait. Email: audrirodelawasim@gmail.com

Objective: To explore the use of therapeutic plasma exchange as adjunctive therapy in COVID-19 patients with and without diabetes mellitus. Study Design: Prospective, observational study. Place and Duration of Study: Pakistan Emirates Military Hospital Rawalpindi, from Jan to Feb 2021. Methodology: A total of 90 male patients with laboratory-confirmed coronavirus infection were selected based on our inclusion criteria and their management and outcomes were recorded. The data were analyzed using SPSS-22 and Microsoft Excel. Results: The mortality rate was lower in patients who received 1 or more sessions of plasma exchange compared to those who did not receive plasma exchange (7.5% vs 12%). A lower mortality rate was seen in patients without diabetes who received therapeutic plasma exchange in addition to standard therapy compared to patients who received standard therapy alone (0 vs 14.82%, p=0.112). In patients with diabetes, a higher mortality rate was found in the group that had received therapeutic plasma exchange in addition to standard therapy instead of standard therapy alone (20% vs 8.7%, p=0.365). Conclusion: Overall our study supports the use of therapeutic plasma exchange in COVID-19 patients. However, although statistically insignificant, there appears to be a higher mortality rate in patients with diabetes who received therapeutic plasma exchange in addition to standard therapy. As such, we recommend further investigation of this aspect.

The advent of the COVID-19 pandemic has led to widespread disruptions in the delivery of all essential and non-essential health care globally, with individuals afflicted with cancer representing a particularly vulnerable sub set of those affected. This article reviews the published literature and guidelines on the management of gastrointestinal malignancies during the COVID-19 pandemic worldwide and summarizes the challenges posed, innovations made and outcomes of the various screening, diagnostic and therapeutic modalities employed during the period from March to December 2020.