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Bitter gourd (Momordica charantia L.) belongs to family Cucurbitaceae, and is a popular vegetable crop in the tropical and sub-tropical countries. It is an annually grown herbaceous vine that requires warm climate for growth. The leaves, stem and roots of bitter gourd contains a lot of bio-active components having nutritional and medicinal importance. Alternaria leaf blight (Alternaria cucumerina Ellis & Everh.) is a fungus which causes leaf blight on bitter gourd and leads to significant crop damage. The present study investigated the efficacy of five different fungicides against Alternaria leaf blight (ALB) of bitter gourd under in vivo and in vitro conditions. The single hyphal tip method was used to isolate and purify the fungal pathogen from the ALB infected leaves of bitter gourd. Five commercially available fungicides (1. Melody duo 66.8% WP, 2. Polyram DF 70%, 3. Score 250 EC, 4. Tilt 250 EC, 5. Flumax 60% EC) were evaluated at concentrations of 50 ppm and 100 ppm for effective ALB diseased control. Among tested fungicides, maximum inhibition (90 %) of fungal growth was given by Melody duo @ 100 ppm concentration followed by Polyram (81 %), Score (77 %) and Tilt (70 %), whereas Flumax resulted in minimum (45 %) fungal inhibition under in vivo. Melody duo revealed minimum disease incidence (15.67 %) compared to disease incidence recorded in polyram (17.83 %), Score (20.50 %) and Tilt (22.33 %) treated crop. Flumax was not tested in vitro because it gave minimum disease control in in vitro experiments. The control plants showed high disease incidence (56%).

Objective: In this study we will determine risk and frequency of the depression in stroke patients associated with quality of life. Methodology: Study duration was from January 2020 to December 2020. An observational Cross Sectional Study was conducted on 105 patients. Study conducted in Medical units PUMHS Hospital Nawabshah. After the consent of patient, Detailed history, complete CNS examination CT Scan Brain was done. Data were analyzed by using SPSS 15 version Depression was assessed by instrument beck depression inventory. Results: Age ranged from 48-68 years, 58 males, 48 females, Education of the patient 66 were uneducated, 17 primary pass and 22 middle pass. occupation of the patient 41 were unemployed, 40 were housewife and 24 were self employed. Depression level was 20 patients with borderline depression, 59 with moderate depression and 26 with severe depression. Conclusion: Post stroke depression is major problem after survival. Proper Treatment of stroke and depression can be prevented from complications and quality of life can be improved. Antidepressant drugs after acute stroke cognitive function can be improved with decreased mortality.

Background: Acute pancreatitis is one of the most common causes of acute abdominal pain in patients presenting to tertiary care hospital. The prevalence of acute pancreatitis in Pakistan is 0.03%. Assessment of prognosis is important in management of patients with acute pancreatitis. A simple and clinical oriented scoring system to predict the severity of acute pancreatitis at the time of presentation is required. Objectives: To determine the agreement between BISAP score and CRP in assessing severe acute pancreatitis. Methodology: A cross-sectional study was conducted at a tertiary care centre on 15 patients diagnosed as acute pancreatitis who fulfilled the inclusion criteria. Demographic data was noted and their BISAP Score and CRP values were calculated and statistical analysis was done using SPSS 20.0 Software. Results: Mean + SD age of the study participants was 46.73 + 8.29 years. Nine (60%) were males and six (40%) patients were females. The agreement of BISAP score and CRP level in assessing the severity of acute pancreatitis was 66.7%. Conclusion: There is a substantial agreement in favor of both CRP criteria and BISAP scoring in diagnosing acute severe pancreatitis.

Aim: Multidrug resistance (MDR) is a major public health problem worldwide. The aim of this study was to assess the prevalence, levels of antimicrobial susceptibility and extended-spectrum beta lactamase (ESBL) production by Escherichia coli O157: H7. Methodology: A cross sectional study was performed and a total of 116 stool samples were collected from children aged ≤ 5 years presenting diarrhoea from hospital located at district Khairpur. E. coli O157: H7 was isolated on Sorbitol MacConkey agar and isolates were initially characterized by Gram staining. Subsequently biochemical characteristics except oxidase test (which was performed manually) and drug sensitivity test was performed by using Automated MicroScan® walkaway machine. ESBL production by isolates was determined by disc diffusion method as per Clinical & Laboratory Standards Institute (CLSI) guidelines. Results: Out of 116 diarrheal samples tested, 16 (13.79%) samples were positive for E. coli O157:H7. High number of E. coli O157: H7 were isolated from children aged up to 1 year followed by 2-3 years aged. Isolates were frequently found in summer season (12 times) followed by winter (3 times) and Autumn (1 time). The isolates were found 100% resistant against Nalidixic acid, Imipenem, Amoxycillin /Clavulanic Acid, Norfloxacin, Chloramphenicol, Vancomycin, Doxycycline, and Ampicillin and 90% resistant to Cifixime. ESBL production was noted in 12 (75%) out of 16 E. coli O157:H7 isolates as confirmed by CLSI protocol. Conclusion: This study revealed that E. coli O157: H7 should be considered as major pathogenic bacterium causing diarrhea in children less than three years. The prevalence of ESBL producer MDR E. coli O157: H7 is of great concern, which requires monitoring of infection control measures through efficient antimicrobial management to ensure an uncompromised public health.

Introduction: Bacterial Infections in cirrhosis of liver is one of the main complications with increase mortality rate. Infection of ascitic fluid in cirrhosis of liver was introduced by Conn and fessel [2], termed as spontaneous bacterial peritonitis. Objective: To determine the frequency of Spontaneous Bacterial Peritonitis (SBP) in patients presenting with cirrhosis of liver. Methodology: It is a descriptive cross-sectional study which was performed in the Medicine Ward at People’s Medical College Hospital Nawabshah Pakistan from 1st June 2018 to 31 July 2020. Total 100 admitted patients were selected for this study, male patient were 58 and female patient were 42. Consent was taken from the patients and their relatives. Primary and secondary outcomes measured. All the patients with diagnosis of cirrhosis of liver were included for this study, ascites due to other causes and patients on antibiotic therapy were excluded from this study. Ascitic fluid aspirated for culture and DR. Blood CP, Urea, Creatinine, LFT and PT was performed. Results: Among these 100 patients 13 were culture positive raised ascites PMN, 17 were culture negative raised ascites PMN. E. coli was detected in majority of the culture positive patients. 70 patients presented with sterile ascites. SBP patients presented with fever, abdominal pain, jaundice, Encephalopathy and raised prothrombin time. Conclusion: SBP common complication of cirrhosis associated with high mortality. All cirrhotic Patients admitted in medical wards with history of abdominal pain, fever and Encephalopathy, diagnostic paracentesis is compulsory. Early management with intravascular expansion with albumin and antibiotics with good prognosis mortality can be reduced.

Introdution: Cancer and depression, independently, cause massive human suffering worldwide. By the end of 2030 the unipolar major depression disorder could be as the chief source of ailment as estimated by World Health Organization. Objective: Objective of this study is to detect prevalence the frequency and severity of the depression in cancer patients presenting to tertiary care hospital of Karachi. Methodology: The current prospective cross-sectional research was performed over a period of six months from August 2020 to January 2021 on 179 patients in the Department of Oncology of Civil Hospital Karachi, after approval of synopsis from CPSP and the ethical committee of Civil Hospital. All patients who fulfilled the inclusion criteria and visited OPD of Civil hospital were selected in the study. Informed consent was taken after explaining the procedure, risks and benefits of the study.Patients were assessed clinically by using ICD-10 criteria and then for validity and reliability, patients were screened for presence of depression and its severity through PHQ-9.Patients scoring higher than 4 was labeled as having depression and PHQ-9 score of 5 to 9, 10 to 14, 15 to 19, 20-27 were labeled mild, moderate, moderately severe and severe depression correspondingly. Observed data was entered in the predesigned Performa was gathered and SPSS version 20.0 was used for data analysis. Mean ± SD of age was 47.75±14.901years. Out of 179 patients 95 (53.1%) were male and 84 (46.9%) were female. 93(52%) cancer patients were depressed while 86(48%) were normal. Patients suffering from mild depression were 3.2%, moderate depression were 54.85%, moderately severe depressed were 19.4%, while 22.6% cancer patients were severely depressed. It is to be concluded that out of 179cancer patients 93(52%) diagnosed to have depression while 86(48%) did not have depression. Based on our study findings, it is suggested that depression commonly presented in cancer patients and there is a need to screen all cancer patients for depressive disorder.

The Ebola outbreak in 2014 caused many infections and deaths. Some literature works have proposed some models to study Ebola virus, such as SIR, SIS, SEIR, etc. It is proved that the fractional order model can describe epidemic dynamics better than the integer order model. In this paper, we propose a fractional order Ebola system and analyze the nonnegative solution, the basic reproduction number $R_{0}$ R 0 , and the stabilities of equilibrium points for the system firstly. In many studies, the numerical solutions of some models cannot fit very well with the real data. Thus, to show the dynamics of the Ebola epidemic, the Gorenflo–Mainardi–Moretti–Paradisi scheme (GMMP) is taken to get the numerical solution of the SEIR fractional order Ebola system and the modified grid approximation method (MGAM) is used to acquire the parameters of the SEIR fractional order Ebola system. We consider that the GMMP method may lead to absurd numerical solutions, so its stability and convergence are given. Then, the new fractional orders, parameters, and the root-mean-square relative error $g(U^{*})=0.4146$ g ( U ∗ ) = 0.4146 are obtained. With the new fractional orders and parameters, the numerical solution of the SEIR fractional order Ebola system is closer to the real data than those models in other literature works. Meanwhile, we find that most of the fractional order Ebola systems have the same order. Hence, the fractional order Ebola system with different orders using the Caputo derivatives is also studied. We also adopt the MGAM algorithm to obtain the new orders, parameters, and the root-mean-square relative error which is $g(U^{*})=0.2744$ g ( U ∗ ) = 0.2744 . With the new parameters and orders, the fractional order Ebola systems with different orders fit very well with the real data.

Liver diseases such as hepatic carcinoma are one of the main health problems worldwide. Herbal drugs are largely used to treat liver injury in the indigenous system of medicine and may provide lead compounds for hepatoprotective drug discovery. The present study is investigated to test the Corydalis govaniana Wall. extract, fraction, and isolate therapeutically active constituents to explore their hepatoprotective, anti-inflammatory, and antioxidant activities. For this purpose, the antioxidant activity of govaniadine, caseadine, caseamine, and protopine was performed by assessing the scavenging events of the stable 2,2-diphenyl-1-picrylhydrazyl. Hepatoprotection of govaniadine was assessed in terms of reduction in serum enzymes (alanine aminotransferase, aspartate transaminase, and alkaline phosphatase) caused by CCl4-induced liver injury in rats and by histopathological techniques. All the compounds showed significant antioxidant activity with a percentage inhibition of 92.2, 86.7, 85.3, and 79.7, respectively, compared to propyl gallate 90.3%. Treatment with govaniadine reduced the serum enzyme level down to normal levels in the CCl4-treated group while inhibiting the increase of malondialdehyde, and the induction of superoxide dismutase and the glutathione level was upregulated. Histopathology showed ∼47% damage to the liver cells in the CCl4-treated group; reduction in this damaged area was found to be better upon using govaniadine. Immunohistochemistry results showed that govaniadine as compared to silymarin has exceedingly decreased the inflammation by halting the CCl4-induced activation of hepatic macrophages. In carrageenan-induced paw edema assay, govaniadine significantly alleviated the edema after 1–5 h at a dose of 20 mg/kg (26.00 and 28.5%), 50 mg/kg (22.05 and 27.0%), and 100 mg/kg (20.02 and 25.30%), respectively. The results of our experiments suggest that govaniadine showed antioxidant and hepatoprotective activity in liver injury. The hepatoprotective function of govaniadine may be associated to the scavenging of the free radical and attenuation of oxidative stress as well as inflammatory responses in the liver. Hence, govaniadine may be a lead compound for the hepatoprotective drug discovery process and further research is needed to find out their molecular mechanism of protection.

Objective: Electrolyte imbalance is common in acute stroke; it may cause severe morbidity and mortality, so timely management of electrolyte imbalance may improve morbidity and mortality in cerebro-vascular accident. The purpose of this study was to evaluate electrolyte imbalance in acute stroke and its effect on the outcome of patients. Material and Methods: This study was prospective descriptive in nature and it is comprised of 106 patients of acute stroke after clinically diagnosis confirmed by CT scan brain plain admitted in Khairpur Medical College Hospital. Serum electrolyte along with the other baseline investigation was performed. Results: Hyponatremia was comparatively more common in brain infraction than spontaneous ICH. Hypokalemia is also more common in brain infarction as compared to the hemorrhagic stroke patients of this study. Conclusion: Incidence of Hyponatremia was more common than hypokalemia in patients with acute stroke. Keywords: Hemorrhage, Infraction, Hyponatremia, Hypokalemia.

Background: There is increasing concern that the depression may be associated with infertility. Objective: The current research was aimed to explore the frequency of depression in infertile males. Study Design: This was a cross sectional study. Duration: March 2016 to September 2018. Place: Department of Medicine, PUMHS Nawabshah, Pakistan. Materials and Methods: A total of 385 infertile male subjects who reported for the semen analysis at young age group were included in the study. Depression was assessed by using Hamilton Depression Rating Scale. Data was collected via self-made proforma and analyzed by using SPSS version 20. Results: A total of 385 infertile males were studied. Mean age of individuals was 30.28+6.18 years. Mild depression was found in 34.8% patients, moderate depression was seen in 18.2% patients, severe depression was in 8.1% patients and very severe depression was in 9(2.3%) patients. Moderate and severe depression was higher in cases of Oligospermia and Azoospermia as compared to those having normal sperm count, while results were statistically insignificant (p=0.747). Conclusions: In the observation of this study, there was a significant relationship between infertility and depression in infertile males. Depression was found in 64.6% of infertile males, ranging from mild to very severe levels.

This study investigates the tele-connection of the southeast Asian monsoon systems by comparing the summer monsoon (June to September) rainfall variability between Pakistan and south Korea. The daily data sets (1981-2014) of rainfall of Pakistan and south Korea are utilized to explore the possible link. Thedata products of the National Centers for Environmental Predictionand National Center for Atmospheric Research (NCEP/NCAR) were also used for the understanding of the large-scale atmospheric environments. The patterns of summer monsoon rainfall on a daily basis between Pakistan and south Korea followed to eachotherthroughout the year. Sub-seasonal differences of the summer monsoon revealed that July is the wettest month in both countries. The large-scale atmospheric environment of higher geopotential height revealed that the Tibetan high and the western north Pacific subtropical high are showing positive anomalies during positive phases over south Asia and east Asia,respectively. The anomalies of zonal wind are negative during positive phase and adversein the negative phase between 20-40oN. The reduced westerly is interpreted as the seasonal variation and moving of jet streams from the east Asian route. The Tibetan high, northwestern Pacific subtropical high and the east Asian jet stream have reliable and sufficient linkage between the Pakistan and south Korea summer monsoon system.

Objective: To determine the frequency of acute renal failure in patients presented with Blackstone poisoning in a tertiary care Hospital. Study Design: Cross sectional study. Setting: Medical wards and ICU at Peoples Medical College Hospital, Nawabshah. Period: September 2017 to March 2018. Material & Methods: All the patients of age 20 to 50 years having Paraphenylenediamine (PPD) poisoning (kala-patthar) during ≥6 hours after ingestion and either of gender were included. AKI was labelled as positive if either of any stage was present on the basses of urine output measurement for 24 hours through urine beg r urine output (UO) criteria. All the data was documented in self-made proforma. Results: The mean age for patients was 24.9±8.9 years, 46(19.08%) subjects were male and 195(80.91%) were female. 18(7.5%) study subjects had acute renal failure, out of them 6 study subjects had ARF of stage I, 5 patients had stage II and 7 study subjects had acute renal failure stage III. Conclusion: Acute renal injury is a common complication following PPD ingestion 7.5%. Paraphenylenediamine toxicity is a threat to the region of Asia and is evolving as a substitute to the poisoning of organophosphorus due to its easy accessibility and low cost.

Objective: To compare the outcomes of sclerotherapy with bleomycin versus surgical resection in children with cystic hygroma. Study Design: Comparative/Observational Place and Duration: Paediatric department of Khalifa Gul Nawaz Medical Teaching Institute, Bannu for 20 months duration from 1st August 2019 to 31st March 2021. Methods: Total 40 patients of both genders with ages 1 month to 15 years presented with cystic hygroma were included in this study. Patients' detailed demographics were recorded after written consent from parents/guardians. Patients were divided in to two groups’ i.e. Group A consist of 20 patients and received sclerotherapy with intra-lesional bleomycin and Group B consist of 20 patients received surgical excision. Outcomes were analyzed at post-procedure 3 and 6 months post-procedure and compared the findings between both groups. Results: There was no significant difference observed between both groups regarding age, gender and site of lymphangioma p-value >0.05. In Group A 15 (75%) patients showed excellent results, 3 (15%) patients showed good results and 2 (10%) showed poor results. In Group B 13 (65%) showed excellent results, 4 (20%) showed good results and 3 (15%) showed poor results. At final follow-up there were no patient with recurrence in Group A while in Group B 2 (10%) patients had recurrence, Conclusion: It is concluded that sclerosing treatment with bleomycin is a safe and effective treatment modality with no recurrence as compared to surgical rexection. Keywords: Cystic Hygroma, Sclerotherapy, Bleomycin, Surgery, Recurrence

Context: Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is the seventh coronavirus that has humans as the host. Because of its highly infectious nature, toward the end of January 2020, the WHO declared it a public health emergency of international concern. The present review is about understanding the journey of SARS-CoV-2 to its present form with an attempt to assess the genetic basis of its pandemic-causing abilities. Evidence Acquisition: The data for the present review were accessed through different publications and preprint repositories. Results: SARS-CoV-2 is a beta-coronavirus, and is approximately 60 - 140 nm in size. The appearance of its structure as a crown shape under an electron microscope led to the coining of its name ‘Coronavirus’. Comparative genome and proteome analysis exhibits similarities and differences with reference to SARS-CoV. The open reading frames (ORFs) found on the SARS-CoV-2 genome, and their corresponding proteins have been discussed. Bats may act as reservoir hosts but not exclusively. The possibility of snakes as the host, as well as other intermediate hosts, before reaching humans seems plausible. This has been supported by ACE2 receptor diversity and conservation across different tissues and organisms. The role of spike glycoprotein and its interaction with the receptor through specific residues for invading host cells makes a perfect therapeutic target, but the variations therein and the resulting impact on interactions pose challenges for the same. Conclusions: Though the differences between the MERS, SARS-CoV, and SARS-CoV-2 genomes indicate amino acid changes, leading to the present pandemic situation, the fact that new variants are still emerging signifies that the journey is an ongoing one, which requires monitoring.

Hepatitis is an inflammatory disease of the liver and is considered one of the leading causes of death worldwide. Due to its scavenging activity, Punica granatum may be used for the treatment and prevention of liver diseases. The current study investigated the protective mechanism underlying the effects of pomegranate against a rat model of carbon tetrachloride–induced liver injury. Intraperitoneal injection of CCl4 resulted in liver inflammation, oxidative stress, and accumulation of lipid in hepatocytes. CCl4 induced a downregulation of superoxide dismutase (SOD), glutathione (GSH), and melonaldehyde (MDA). Pomegranate protection was assessed in terms of biochemical parameters, histopathology, and immunohistochemistry. Promegranate administration decreased inflammation, elevated serum enzymes and ROS production, and countered the debilitating effects caused by CCl4. In addition, CCl4-induced histological changes were absent in the crude pomegranate extract group, which also enhanced the scavenging activity of reactive oxygen species by enhancing the antioxidant defense mechanism as confirmed by detecting MDA, SOD, and GSH expressions. The migration of CD68+ macrophages was halted at the injured area of the central vein and the number of macrophages was reduced to the normal control by the crude extract compared to the positive control silymarin group. Likewise, protective effects of ethylacetate and the aqueous fraction of the crude extract were also observed. However, the butanol and n-hexane fractions displayed increased levels of ALT, AST, and ALP as compared to silymarin. About 25% damage to hepatocytes was observed in the butanol and n-hexane group by histopathological examination, which is a little better compared to the CCl4-treated group. The crude extract and its ethyl acetate and aqueous fractions may be accountable for the hepatoprotective potential of Punica granatum, which was further confirmed by in vivo experiments. Together, these findings confirm that pomegranate exerts hepatoprotective activity against CCl4-induced oxidative stress and liver damage.

Objectives/Background: With decreased patient downtime and reduction in health expenditures, endovascular treatments have become popular for the treatment of venous insufficiency. In this study, we assessed the outcomes of using radiofrequency ablation (RFA) and sclerotherapy for refluxing veins and incompetent perforators in a developing country. Materials and Methods: Subjects were selected from an ongoing registry from October 15, 2015 to April 5, 2018. Patients were followed up until 6 months. Pre- and post-procedural Clinical, Etiologic, Anatomic, and Pathophysiologic (CEAP) scores were compared, and complications were documented and treated accordingly. Results: In total, 102 limbs (n=97) with 76 great saphenous veins (GSVs) and 26 small saphenous veins (SSVs) underwent RFA, with 79% undergoing concomitant sclerotherapy. Mean follow-up time was 188 days (±33.16). Moreover, 59% were males and 41% females. At the end of follow-up, 99% of the legs had complete occlusion. Pre- and post-procedural CEAP scores were 4.21±1.5 and 3.36±1.7, respectively (p-value

Introduction The objective of our study was to compare the 30-day post-operative outcomes of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Materials and Methods This randomized controlled study contained patients who underwent bariatric surgery from June 13, 2018 to October 12, 2019. A total of 116 patients having body mass index (BMI) > 35 kg/m2 (morbidly obese), age 18 to 65 years and with failure of conservative treatment were included. Group I patients underwent bariatric surgery using LRYGB technique while group II patients underwent bariatric surgery using the LSG technique. All patients were followed 30 days after surgery to determine early post-operative outcomes. Results The demographic profile, such as age and BMI, was similar between the groups. The mean operating time was 72 ±12 minutes in the LSG group and 156 ± 18 min in the LRYGB group (p-value 0.0001). Major complications were seen in five (8.62%) patients in LSG patients and in four (6.89%) patients in LRYGB group (p-value 0.12). Minor complications were seen in 21 (36.2%) patients in LSG group and in 19 (32.75%) patients in LRYGB group (p-value 0.15). The length of stay in the hospital in LSG group was 6.2±4.2 versus 9.4± 4.6 (p-value 0.0002). Conclusion Both LRYGB and LSG are effective and safe bariatric procedures with a similar incidence of major complications. However, LSG is associated with shorter operative time and hospital stay. Long-term follow-up studies are required to compare the effectiveness of these procedures.

The SARS-CoV-2 infection spread at an alarming rate with many places showed multiple peaks in incidence. Present study involves a total of 332 SARS-CoV-2 sequences from 114 Asymptomatic and 218 Deceased patients from twenty-one different countries. The mining of mutations was done using the GISAID CoVSurver (www.gisaid.org/epiflu-applications/covsurver-mutations-app) with the reference sequence ‘hCoV-19/Wuhan/WIV04/2019’ present in NCBI with Accession number NC-045512.2. The impact of the mutations on SARS-CoV-2 proteins mutation was predicted using PredictSNP1(loschmidt.chemi.muni.cz/predictsnp1) which is a meta-server integrating six predictor tools: SIFT, PhD-SNP, PolyPhen-1, PolyPhen-2, MAPP and SNAP. The iStable integrated server (predictor.nchu.edu.tw/iStable) was used to predict shifts in the protein stability due to mutations. A total of 372 variants were observed in the 332 SARS-CoV-2 sequences with several variants incident in multiple patients accounting for a total of 1596 incidences. Asymptomatic and Deceased specific mutants constituted 32% and 62% of the repertoire respectively indicating their exclusivity. However, the most prevalent mutations were those present in both. Though some parts of the genome are more variable than others but there was clear difference between incidence and prevalence. NSP3 with 68 variants had total occurrence of only 105 whereas Spike protein had 346 occurrences with just 66 variants. For Deleterious variants, NSP3 had the highest incidence of 25 followed by NSP2 (16), ORF3a (14) and N (14). Spike protein had just 7 Deleterious variants out of 66. Deceased patients have more Deleterious than Neutral variants as compared to the symptomatic ones. Further, it appears that the Deleterious variants which decrease protein stability are more significant in pathogenicity of SARS-CoV-2.

Numerous cropping systems of the world are experiencing the emergence of new weed species in response to conservation agriculture. Conyza stricta Willd. is being a newly emerging weed of barley-based cropping systems in response to conservational tillage practices. Seed germination ecology of four populations (irrigated, rainfed, abandoned and ruderal habitats) was studied in laboratory and greenhouse experiments. The presence/absence of seed dormancy was inferred first, which indicated seeds were non-dormant. Seed germination was then recorded under various photoperiods, constant and alternating day/night temperatures, and pH, salinity and osmotic potential levels. Seedling emergence was observed from various seed burial depths. Seeds of all populations proved photoblastic and required 12-hour light/dark period for germination. Seeds of all populations germinated under 5–30°C constant temperature; however, peak germination was recorded under 17.22–18.11°C. Nonetheless, the highest germination was noted under 20/15°C alternating day/night temperature. Ruderal and irrigated populations better tolerated salinity and germinated under 0–500 mM salinity. Similarly, rainfed population proved more tolerant to osmotic potential than other populations. Seeds of all populations required neutral pH for the highest germination, whereas decline was noted in germination under basic and alkaline pH. Seedling emergence was retarded for seeds buried >2 cm depth and no emergence was recorded from >4 cm depth. These results add valuable information towards our understanding of seed germination ecology of C. stricta. Seed germination ability of different populations under diverse environmental conditions suspects that the species can present severe challenges in future if not managed. Deep seed burial along with effective management of the emerging seedlings seems a pragmatic option to manage the species in cultivated fields. However, immediate management strategies are needed for rest of the habitats.

The ongoing global pandemic of SARS-CoV-2 implies a corresponding accumulation of mutations. Herein the mutational status of 611 genomes from India along with their impact on proteins was ascertained. After excluding gaps and ambiguous sequences, a total of 493 variable sites (152 parsimony informative and 341 singleton) were observed. The most prevalent reference nucleotide was C (209) and substituted one was T (293). NSP3 had the highest incidence of 101 sites followed by S protein (74 sites), NSP12b (43 sites) and ORF3a (31 sites). The average number of mutations per sample for males and females was 2.56 and 2.88 respectively suggesting a higher contribution of mutations from females. Non-uniform geographical distribution of mutations implied by Odisha (30 samples, 109 mutations) and Tamil Nadu (31 samples, 40 mutations) suggests that sequences in some regions are mutating faster than others. There were 281 mutations (198 ‘Neutral’ and 83 ‘Disease’) affecting amino acid sequence. NSP13 has a maximum of 14 ‘Disease’ variants followed by S protein and ORF3a with 13 each. Further, constitution of ‘Disease’ mutations in genomes from asymptomatic people was mere 11% but those from deceased patients was over three folds higher at 38% indicating contribution of these mutations to the pathophysiology of the SARS-CoV-2.

The novel Coronavirus from Wuhan China discovered in December 2019 (nCOV-2019) has since developed into a global epidemic with major concerns about the possibility of the virus evolving into something even more sinister. In the present study we constructed the phylo-geo-network of nCOV-2019 genomes from across India to understand the viral evolution in the country. A total of 611 full length genomes were extracted from different states of India from the EpiCov repository of GISAID initiative and NCBI. Their alignment uncovered 270 parsimony informative sites. Further, 339 genomes were divided into 51 haplogroups. The network revealed the core haplogroup as that of reference sequence NC_045512.2 (Haplogroup A1) with 157 identical sequences present across 16 states. The rest were having not more than ten identical sequences across not more than three locations. Interestingly, some locations with fewer samples have more haplogroups and most haplogroups (41) are localized exclusively to any one state only, suggesting the local evolution of viruses. The two most common lineages are B6 and B1 (Pangolin) whereas clade A2a (Covidex) appears to be the most predominant in India. However, since the pandemic is still emerging, the final outcome will be clear later only.

Background Venous compromise is still the most common cause of free flap failure. The need of a second venous anastomosis to prevent free flap failure is controversial. It is proposed that the use of dual venous anastomoses reduces venous compromise. However, some surgeons suggest that dual venous drainage reduces venous blood flow causing a potential risk of thrombosis. Objective This study aimed to compare the frequency of reexploration secondary to venous thrombosis in free flap surgeries in reconstruction of soft tissue defects with 1-vein versus 2-vein anastomosis. Materials and methods We performed a retrospective cohort study including 298 flaps. In 180 of these patients, 2-vein anastomosis was done, and in 118, 1-vein anastomosis was done. The study was conducted at Aga Khan University Hospital from January 2017 to December 2018. Results The number of venous anastomosis was not associated with flap survival. The group with dual anastomosis required more frequent reexploration as compared with 1 venous anastomosis group (8% vs 1.7%).Outcome and salvage rate were better in the 2-vein group as compared with the 1-vein group (64% vs 50%). Conclusion There is no difference in flap survival in single or dual venous anastomosis, but we have noticed higher reexploration rates in the 2-vein group. However, outcome is better in the 2-vein group.

Objective: To evaluate effects of atypical antipsychotics on the serum lipid contents of inpatients suffering from psychosis at Psychiatry Hospital Hyderabad, Pakistan. Patients and Methods: Total 160 patients suffering from psychosis were randomly selected from psychiatry hospital Hyderabad, Sindh, Pakistan during October 2014 to September 2015 along with 188 control subjects and they were followed from baseline (drug naïve-first-episode psychosis (FEP) patients); on admission to 3rd month of their treatment with three different antipsychotic drugs (i.e. risperidone, olanzapine and clozapine). Blood samples were collected on admission and after completion of each month for analysis of serum lipid contents. Results: Concentration of serum high-density lipoprotein cholesterol (HDL–C), total cholesterol (TC), triglycerides (TGs), very low-density lipoprotein cholesterol (VLDL–C) as well as total lipids (TL) were significantly reduced in baseline psychotic patients when compared with controls. When 2nd and 3rd months risperidone treated psychotic patients were compared with baseline psychotic patients, TC, TG, VLDL–C and TL were significantly increased. Serum lipid contents in Olanzapine and Clozapine treated psychotic patients were significantly increased in 2nd and 3rd months as compared to baseline psychotic patients, whereas, reverse was true for HDL–C. The low-density lipoprotein cholesterol (LDL–C) was increased in 2nd month treated psychotic patients as compared to baseline psychotic patients. When all three drugs were compared, clozapine was found highly associated with dyslipidemia. Conclusion: Atypical Antipsychotics may play a role in developing dyslipidemia. Among three psychotic drugs Clozapine is the most significant in causing dyslipidemia to the psychotic patients in Pakistan.

Patients undergoing cytotoxic or immunosuppressive therapy for cancer have an established predilection for hepatitis B virus reactivation; however, the risk associated with newer molecularly targeted agents has not been well investigated. Imatinib, a small molecule tyrosine kinase inhibitor, induces rapid and sustained clinical benefit by inhibiting a number of signaling pathways, including BCR-ABL and c-KIT. We report the case of a patient who developed hepatitis B virus reactivation while receiving imatinib therapy for gastrointestinal stromal tumor. Furthermore, a structured literature search of the medical databases consisting of MEDLINE and PubMed was performed using the terms “hepatitis B”, “reactivation”, and “imatinib”. The search identified nine case reports only. The data on patients’ characteristics, epidemiology, clinical features, comorbid conditions, diagnosis, and management are summarized. Imatinib-associated hepatitis B virus reactivation was reported in seven patients with chronic myeloid leukemia, one with desmoid tumor, and one with gastrointestinal stromal tumor. This review serves to outline our current understanding of the epidemiology, risk factors, and pathophysiology of chronic hepatitis B virus reactivation secondary to imatinib therapy as well as the current approaches to diagnosis and management of this condition. We aim to increase awareness about this possible association and advocate for hepatitis B virus screening prior to imatinib therapy, especially in patients who are at increased risk for chronic hepatitis B virus infection.

Objectives: The object of this study was to observe prevalence of Goiter disorderand to classify the Goiter patients regarding sex, age and find various conditions of goiter patientin different talukas of district Sukkur, Sindh, Pakistan. Introduction: Thyroid gland is the largestorgan of the endocrine system, located in the region of neck. Thyroid disease is a conditionthat disturbs the function of the thyroid gland. Over activity of thyroid gland to release excessquantity of hormones is called hyperthyroidism and under activity of thyroid gland to releaseless quantity of hormones is called hypothyroidism. Enlargement or swellings in the neck regionresulting from goiter disorder of the thyroid gland. Goiter is caused due to iodine deficiencyas seen in more than 90.54% cases worldwide. Hypothyroidism and hyperthyroidism are twocondition that can develop goiter disorder. Study Design: Prospective study was carried outthrough a questionnaire. Setting: Different Taluka Hospitals of District Sukkur, Sindh, Pakistan.Period: January-2017 to March-2017. Methodology: The data was collected from 57 patients indifferent taluka hospitals of district Sukkur. The collected data includes interviewing of patientsand their Physicians, review of their biochemical tests to check levels of; T3, T4 and TSH andtheir radiological features (thyroid scan). Recorded data was related to age, gender, body mass(weight), life style and family history. Result: The highest prevalence of goiter was observed inAnwar Piracha hospital 45%, Civil hospital Sukkur 14 %, Red Crescent hospital 8.8 %, Sukkurhospital 7.0 %, Taluka hospital Panoaqil 5.3 %, Taluka hospital Rohri 5.3 %, and Al-khair hospital3.5 %. In these areas, the ratio of female patients (94.7 %) was greater than ratio of male patients(5.3%). In our study it was observed that the female patients were greatly affected from the ageof 25-50 years as compare to male patients. The patients with hypothyroidism were observed inhigh percentage (24.6%) and high percentage in cold nodule in (left and right lobe) (17.5%) ascompare to other goiter conditions. Conclusion: This study concludes that the goiter diseaseis present at an alarming level in different talukas of district Sukkur Sindh Pakistan. Therefore,proper actions should be taken to control goiter disorder in district Sukkur, Sindh, Pakistan.

Background The radial forearm free flap (RFFF) has remained a leading choice of many plastic surgeons as a fasciocutaneous flap due to its versatility, pedicle length, and simple elevation technique. However, donor site morbidity has led many reconstructive surgeons to limit their use of the RFFF and to use other flaps instead. We propose that using a narrow RFFF (nRFFF) decreases the aesthetic and functional morbidity of the donor site. Methods We report our experiences with the nRFFF from April 2012 through May 2015 at the Department of Plastic, Reconstructive, and Hand Surgery at Liaquat National Hospital, Karachi. The donor defects were closed primarily. The Stony Brook Scar Evaluation Scale and comparison with the contralateral hand were used to assess aesthetic and functional outcomes, respectively. Results A total of 24 patients underwent nRFFF procedures during the study period. The donor arm showed excellent motor function in 22 cases (91.7%), and very good function in the remaining two cases (8.3%). The aesthetic outcomes were excellent in four patients (16.6%), very good in eight patients (33.3%), good in 10 patients (41.6%), and fair in two patients (8.3%) who developed a hypertrophic scar. All flaps were successful and there were no cases of partial or complete loss. Conclusions For small to medium-sized soft tissue defects, the nRFFF had acceptable outcomes due to its thinness, pliability, and major reduction in donor site aesthetic and functional morbidity.

To improve a cancer patient’s quality of life, short treatment duration resulting in rapid tumour removal while sparing normal tissue are highly desirable. Photodynamic therapy (PDT) commonly applied in a single treatment, while often effective can be limited at low photosensitizer or light doses. Combination therapies can overcome the efficacy limitations while not increasing treatment-associated morbidity. Here the efficacy of combination therapy comprised of doxorubicin (DOX) or methotrexate (MTX) with Photosens mediated PDT was investigated in three cell lines in vitro, employing multiple incubation sequences. Photosense is a mixture of aluminium phthalocyanines with different sulfonation. The results demonstrated higher synergistic effects when DOX or MTX-mediated chemotherapy preceded PDT light activation by 24 h. MTX is marginally more cytotoxic than DOX, when combined with Photosens (AlPcS2-4) mediated PDT. While MTX and DOX exposure prior to AlPcS2-4 incubation may enhance mitochondrial localisation photosensitizer, the simultaneous targeting of DNA, proteins, and lipids of the combination therapies leads to the observed high cytotoxicity at sub μM drug doses. Keywords: Photodynamic Therapy, Chemotherapy, Cancer, Combination therapy

The demand for natural medicines has increased because of their limited adverse effects. The aim of study is to explore the antidiabetic potential of isolated steroidal alkaloid from Sarcococca saligna in streptozotocin induced diabetic rats. To determine the antidiabetic activity of steroidal alkaloids, diabetes was induced in rats by injecting streptozotocin intraperitoneally at a dose of 40 mg/Kg. After a week of STZ injection the treatment were started and the 8th day was considered as the 1st day of treatment and up to four weeks the rats were treated with steroidal alkaloids. Animals were divided into five groups, group 1 considered as a control group by receiving normal saline (1 ml/Kg) twice daily and group 2, 3, 4 were treated with active compound sarcovagine-D, saracodine and holaphylline at the dose of 5 mg/Kg subcutaneously twice a day while group 5 was treated with a standard drug glibenclamide at a dose of 1 mg/Kg/day. The result showed that treated group 2 and 4 reduced the glucose level in blood significantly while group 3 showed moderate glucose reduction. The fructosamine level reduced significantly in treating group 4 from the 2nd week of treatment while group 2 and 3 decreased the level significantly in week 4 in diabetic rats. The treated groups showed gradual decreases the glucose level in 1st and 2nd week of oral glucose tolerance test compared to control group. The group receiving holaphylline (4) and sarcovagine-D (2) showed good improvements in blood lipids while the effect of compound on body weight showed less significant improvement. The present study concluded that steroid alkaloids from isolated Sarcococca saligna possess hypoglycemic effect and improve others diabetes associated complications. Together these finding further research is needed using a range of doses to explore the other possible beneficial effects in diabetes mellitus and its molecular mechanism.

Ulnar artery aneurysm cases have been rarely reported in the literature previously. A number of these cases occur in the adult population and are mostly occupational associated. In children, however, this condition is much less. Only 10 cases in children have been reported in the literature to the best of our knowledge, and the minimum age was 1 year. The etiology is mainly post-traumatic. We present a case for discussion of an ulnar artery aneurysm in a 6-month-old baby with the habit of hitting his hand against a table and the floor.

Background The SARS-CoV-2 infection has spread at an alarming rate with many places showing multiple peaks in incidence. Present study analyzes a total of 332 SARS-CoV-2 genome sequences from 114 asymptomatic and 218 deceased patients from twenty-one different countries to assess the mutation profile therein in order to establish the correlation between the clinical status and the observed mutations. Methods The mining of mutations was carried out using the GISAID CoVSurver ( www.gisaid.org/epiflu-applications/covsurver-mutations-app ) with the reference sequence ‘hCoV-19/Wuhan/WIV04/2019’ present in NCBI with Accession number NC-045512.2. The impact of the mutations on SARS-CoV-2 proteins mutation was predicted using PredictSNP1(loschmidt.chemi.muni.cz/predictsnp1) which is a meta-server integrating six predictor tools: SIFT, PhD-SNP, PolyPhen-1, PolyPhen-2, MAPP and SNAP. The iStable integrated server (predictor.nchu.edu.tw/iStable) was used to predict shifts in the protein stability due to mutations. Results A total of 372 variants were observed in the 332 SARS-CoV-2 sequences with several variants present in multiple patients accounting for a total of 1596 incidences. Asymptomatic and deceased specific mutants constituted 32% and 62% of the repertoire respectively indicating their partial exclusivity. However, the most prevalent mutations were those present in both. Though some parts of the genome are more variable than others but there was clear difference between incidence and prevalence. Non-structural protein 3 (NSP3) with 68 variants had a total of only 105 incidences whereas Spike protein had 346 incidences with just 66 variants. Amongst the Deleterious variants, NSP3 had the highest incidence of 25 followed by NSP2 (16), ORF3a (14) and N (14). Spike protein had just 7 Deleterious variants out of 66. Conclusion Deceased patients have more Deleterious than Neutral variants as compared to the asymptomatic ones. Further, it appears that the Deleterious variants which decrease protein stability are more significant in pathogenicity of SARS-CoV-2.

Antibiotics are commonly used as additional material in livestock and poultry feed. Nevertheless, the absorption of antibiotics is not complete in the gastrointestinal tract, and as a result, a large quantity of these agents are excreted from the body in urine and ultimately in fertilizer and manure. Manure is used as a foundation of plant nutrients and a means of organic material to expand soil as well, particularly in organic and sustainable agronomy. Different studies were conducted in greenhouses related to uptake of these antimicrobial agents from soil in which animal dung was used as fertilizer to find out whether or not these antibiotics are present in manure (dung). The purpose of this study was to analyze the major health issues that arise when vegetables grown in soils supplemented with antimicrobial agents and animal dung are used. There are chances of increased sensitivity and resistance against antimicrobials in humans by consumption of such contaminated food items. Antibiotics degradation may cause intense problems as dispersal of antibiotic resistance genes in surroundings. Further investigations are needed to detect how these agents and bacterial species that have developed resistance over time and enter the endo-symbiotic systems of plant. The role of direct exposure to such systems is still unclear.

The study was conducted to check the prevalence of Plasmodium species in population of Taluka Pano-aqil, Sindh, Pakistan during January to December, 2014. The data was collected age, sex and month wise. A total of 2257 samples were collected and out of them only 15% were positive with malaria. Among positive cases, 80% were P. vivax and 20% were P. falciparum. The month-wise data shows the maximum burden of P. vivax (100%) was recorded in July and minimum burden was recorded in March (58%), whereas, the maximum burden of P. falciparum (41.66%) was recorded in March and minimum load was recorded in September (15.21%). The age-wise prevalence shows the maximum burden of P. vivax (85.14%) in over 21 year age group and minimum burden (77.27%) in 1-10 and 11-20 year age group, whereas, the maximum burden of P. falciparum (22.77%) in 1-10 and 11-20 year age group and minimum burden (14.85%) in over 21 year age group. Keywords: P. falciparum; P. vivax; Pano-aqil; Sindh; Pakistan http://dx.doi.org/10.19045/bspab.2019.80082

Objectives: The objective of this study is to compare the surgical outcome between modified trabeculotomy v/s combined modified trebeculotomy & trebeculectomy in primary congenital glaucoma. Study Design: Interventional case series. Setting: Paediatric Ophthalmology Department, Chandka Medical College. Period: June 2016 to June 2017. Method: This is a comparative study done to compare the outcomes of trabeculectomy and combined trabeculotomy and trabeculectomy. For comparison a prospective interventional study conducted in paediatric ophthalmology, Chandka Medical College during the duration of August 2014 to August 2016 was chosen. After examination by slit lamp and under anaesthesia, combined modified trabeculotomy and trabeculectomy was performed. Results: A total of 45 eyes of 29 patients with primary congenital glaucoma underwent modified trabeculotomy, 15 (51.72%) were males and 14 (48.28%) were females. Mean age of patients was 2.29 ± 3.70 years. On the other hand, combined modified trabeculotomy and trabeculectomy was performed in 22 eyes of 17 patients out of which 08 (47.06%) were males and 09 (52.94%) were females. Mean age ± standard deviation was 3.37 ± 4.40 years. Statistically significant reduction in IOP, corneal diameter and axial length were found. Conclusion: Combined trabeculotomy-trabeculectomy has better outcomes than trabeculotomy alone. It requires greater surgical expertise and time. Higher success rates are reported in previous studies due to dual outflow of aqueous humour.

Neurogenic stunned myocardium (NSM) is defined as the occurrence of cardiac abnormalities due to neurological events such as stroke, seizures, etc. These events lead to dysfunction of the autonomic nervous system (ANS) and ultimately cause injury to the myocardium. The clinical features seen in NSM include elevated troponin level, left ventricular dysfunction, and changes on the electrocardiogram (ECG). However, these features are also seen in Takotsubo cardiomyopathy as well as in an acute coronary syndrome (ACS). Hence, diagnosing the condition by clinical presentation alone is difficult. Thus, a patient of NSM who is at increased risk of developing coronary heart disease may require invasive procedures such as cardiac catheterization to rule out ACS. This review aims at raising awareness about NSM among physicians so that management of patients can be individualized.

Our article will discuss bladder pain syndrome (BPS), which is the presence of chronic suprapubic pain to bladder filling accompanied by other urinary symptoms, such as frequency, urgency, discomfort with filling, and relief with emptying of the bladder in the absence of infections or other pathology. It is mostly seen in females and occurs in 0.06%-30% of the population. Some of the proposed mechanisms causing BPS include damage to the bladder lining, a problem manifesting in the pelvic musculature, endocrine, neurological, allergic, autoimmune system, and inflammatory system; however, a definite cause has not been yet identified. Two types of this syndrome have been identified, ulcerative and non-ulcerative. In the ulcerative disease, areas of reddened mucosa associated with small vessels radiating towards a central scar (at times, covered by a small clot or fibrin) can be seen. In the non-ulcerative type, a normal bladder mucosa can be observed initially, and the subsequent development of glomerulations after hydrodistension is considered a definite sign of its diagnosis. The diagnosis of BPS is primarily clinical; however, cystoscopy and biopsy can also be performed, if needed. Finally, we will discuss in detail the treatment of BPS, which constitutes three different guidelines (The European Association of Urology (EAU) Guidelines 2017, the American Urology Association (AUA) Guidelines 2014, and The Royal College of Obstetricians and Gynecologists (RCOG) in conjunction with the British Society of Urogynaecologists (BSUG) Guidelines 2016). All are proposing different types of therapy, including conservative, medical, and surgical treatment.

In a quest to use Raman spectroscopy as an optical diagnostic tool, we recorded Raman spectra of 32 dengue virus (DENV)-infected and 28 healthy sera samples in the near-infrared spectral range (540 to 1700 cm−1) using laser at 785 nm as the excitation source. We observed clear differences in the Raman spectra of DENV-infected sera as compared with those of healthy individuals. Here, as a result of our study, we report 12 unique Raman bands associated with DENV-infected sera that are not reported earlier. After applying analysis of variance and t-test (p

Tomato leaf curl virus (TLCV) is an emerging problem in tomato growing areas of Pakistan. Relationship of TLCV disease and environmental conditions were studied on five tomato cultivars. Temperature (maximum and minimum) and relative humidity significantly contributed in the development of TLCV disease during two years (2012 and 2013). The TLCV disease incidence increased with rise in maximum and minimum temperature and decreased with the increase in relative humidity. The contribution of maximum temperature was explained by linear regression which showed 83 to 91% variability in the disease incidence and minimum temperature explained 75 to 85% variability. Relative humidity exerted 78 to 85% contribution in the disease development. The linear regression could not explain the contribution of rainfall and wind speed in disease development. The characterization of favorable environmental conditions for TLCV disease development would contribute towards accurate prediction and timely management of the disease. © 2016 Friends Science Publishers

Hepatitis C virus (HCV) infection is one of the leading causes of morbidity and mortality worldwide. Mortality linked with HCV infection can be lowered with effective and prompt diagnosis in early stages of infection. In this study potential of Raman spectroscopy to differentiate between healthy and HCV infected serum samples was investigated. Clear differences were observed in the Raman spectra of HCV infected and healthy sera samples. Using the analysis of variance (ANOVA) and t-test (p 0.001) on Raman spectra of diseased and healthy samples, we observed eleven unique Raman bands at 676, 825, 853, 936, 1029, 1105, 1155, 1305, 1620, 1654 and 1757 cm

Plant-derived natural products are of great interest due to their diversity in modern drug discovery. Sarcococca saligna has been used for the treatment of different diseases. The present study was aimed at isolating phytochemical constituents including Alkaloid-C (a), Dictyophlebine (b), Sarcovagine-D (c) and Saracodine (d) Holaphylline (e) from Sarcococca saligna to investigate the anticancer effect of these compounds. These compounds were evaluated for inhibition of aromatase enzyme of breast cancer in assistance by molecular docking simulations to understand molecular interaction between the enzyme and ligands. The IC50 values of compound 1 and 5 were found 138.27 ± 0.01 µl and 12.91 ± 0.01 µl, respectively, and both were found active due to their bulky structures in comparison to the active site of aromatase enzyme. The standard drug exemestane showed potent activity in comparison with the test compounds, having IC50 values of 0.052 ± 0.01 µl. Both compounds showed favorable electrostatic interactions with the active site of aromatase enzyme but the shape and steric bulk of the compounds was the limiting factor in their inhibitory effects. New lead compounds could be generated after extensive modifications guided by computational and experimental tools as a possible anticancer agents by targeting aromatase enzyme.