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Purpose: To determine the outcome of microscopic carpal tunnel release in patients with carpal tunnel syndrome who failed to respond to conservative treatment. Methodology: This descriptive case series was carried at Department of Neurosurgery, D.H.Q Hosptial Charsadda over 1 year from Jan 2019 to Dec 2020, indicate the sampling method used to select the study participants involving 94 patients; both men and women with ages in the range 30-70 years diagnosed of carpal tunnel syndrome who failed to respond to conservative treatment and were planned for surgical release. Microscopic CTS release was performed and outcomes were assessed in terms of improvement in VAS score for wrist pain, symptom severity score and function status scale 3 and 6 months after the surgery. Recurrence of symptoms was also noted. A written informed consent was obtained from every patient. Indicate the method of data collection and data analysis Findings: The mean age of the patients with carpal tunnel syndrome was 41.6±7.9 years. There was slight female predominance with male to female ratio of 1:2.1. History of diabetes was recorded in 29 (31.0%) patients while 34 (37.0%) patients were obese. Right hand was more frequently involved (53.0%) than the left hand (47.0%). The mean VAS score for wrist pain reduced from 7.9±1.2 at baseline to 1.8±0.7 3 months after the surgery (p- value

Poly ( l -lacticacid) (PLLA) is an FDA approved material for bone tissue engineering but its inherent brittleness and low melting ability are major challenges for its large-scale commercial applications. This challenge can be overcome by making its blends. This study reports blends of PLLA with a relatively new class of polymer i.e. cyclic olefinic copolymer and their miscibility, thermal behavior, morphology, crystallinity, degradability, and excellent biocompatibility is evaluated. Blends were prepared by taking 5–30 weight percent COC with PLLA matrix using solvent casting method. Scanning electron microscopy (SEM) images revealed that PLLA/COC form miscible blends up to 5–20 wt% of COC. FTIR, XRD, and differential scanning calorimetry (DSC) data showed that addition of COC to PLLA resulted in decrease in crystallinity along with formation of new α′-crystalline phase which coexists with inherent α-phase of PLLA in the blends. The transformation of α′-form is due to the presence of Van der Waals forces of interactions of the polymer chain moieties between PLLA and COC. Interestingly, PLLA/COC blends exhibited superior mechanical properties in relation to the pure PLLA. Compressive modulus values for PLLA/COC 10wt% increased 117% as compared to pure PLLA. PLLA/COC blends at 10 wt% have maximum ultimate tensile strength, modulus, and toughness ~ 123%, 67.8% and, 18.87% respectively. PLLA/COC blends showed increased swelling and degradation results as compared to PLLA. PLLA/COC blends exhibited excellent cytocompatibility over PLLA with preosteoblast (MC3T3-E1) and bone marrow stem cells (BMSc) cell lines suggesting possible candidate for Bone Tissue Engineering.

Bone whitlockite (WH) exists in the collagen matrix along with hydroxyapatite (HA) and plays a vital role during earlier stages of bone development. It is present in short-range order and is difficult to identify in the bone, as compared to HA mineral, that covers 80% of the bone inorganic phase. It has the same structural analogy with β-TCP, but detailed structural and crystallographic analyses of bone have shown that β-tricalcium phosphate (β-TCP) is merely a synthetic analog of bone whitlockite, having the same crystalline structure but different chemically. WH contains magnesium at Ca(IV), Ca(V) positions, and HPO42− on a threefold axis in a rhombohedral crystal lattice. Its biocompatibility, functionality, negative surface charge, mechanical strength, and stability in physiological solvents make it an ideal bone substitute as compared to hydroxyapatite (HA) and β-TCP. It has magnesium as a major component that has a strong affinity with integrin protein. Integrin protein plays a vital role in bone tissue integration. It is bioresorbable and biodegradable and the rate of degradation complements with regeneration. However, despite these excellent properties, this material has always been overshadowed by other calcium phosphates (CaPs), because it is difficult to synthesize. In this review article, we present a comprehensive study on the difference in the crystalline structure of bone whitlockite and β-TCP, its presence in the natural system, and conditions under which its nucleation occurs in native bone and at lab scale. Furthermore, the reaction conditions that favor homogenous precipitation of synthetic WH and the role of magnesium in the stabilization of different CaPs to obtain pure WH phase are also discussed. Finally, the applications of WH in biomedical and for heavy metal adsorption are summarized.

Background: Infection in hemodialysis is a very dangerous condition for the patients. Objective: The purpose of the present study was to find out the incidence of infective endocarditis among hemodialysis patients. Methodology: This was a cross sectional study which was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the periods of July 2010 and June 2012. Hemodialysis patients who were attending in the Department of Nephrology at BSMMU, Dhaka were taken as study population. Results: A total number of 50 patients presented with hemodialysis. Out of 50 patients 34(68.0%) cases were male and 16(32.0%) cases were female. The mean with SD of age of the patients was 38.44±13.0 years with a range of 18 to 68 years. Out of 50 patients 6(12.0%) cases had positive blood culture of which 3 cases had shown Staphylococcus aureus, 1 case had Escherichia coli, 1 case had Enterococci species and 1 case had Salmonella typhi, Among the 50 patients 5 (10.0%) had vegetation on cardiac valve. The patients frequency of dialysis 2 times per week showed 01 (2.43%) positive blood C/S and 5 positive in 3 times per week showed 05 (55.55%) positive blood C/S (p>0.001). Conclusion: In conclusion infective endocarditis causes infection with high mortality among the patients of CKD undergoing hemodialysis. Journal of Current and Advance Medical Research, January 2021;8(1):54-58

The second wave of COVID-19 pandemic has started globally, right now 220 countries are infected and a total of 71,351,695 confirmed cases and 1,612,372 deaths due to COVID-19 have been reported. Infection Prevention and Control (IPC) measures for COVID-19 all have proved vital in decreasing the transmission rates among the communities. Methodology: Unmatched Case-Control Study was conducted where cases were defined as “every PCR positive contact (symptomatic or asymptomatic) for any index case” similarly controls were defined as “every PCR negative contact (symptomatic or asymptomatic) for any index case who was home quarantined for 14 days based on suspicion by PDSRU team”. A simple random technique was used and 300 individuals were made part of this study. Results: The major findings of this study shows that PCR positive contacts poorly adopted certain COVID-19 IPC measures of interest in their daily life hence got infected. The odds for all the variables of interest were found to be statistically significant among cases as compared to controls like the odds for knowingly and intentionally contacted with a COVID-19 positive case was 13.7 times more among the PCR positive contacts as compare to PCR negative contacts (p = 0.00, C.I = 7.62 - 24.90), similarly, the odds of being a family member of the index COVID-19 case was 7.07 times more among the PCR positive contacts as compared to the PCR negative contacts (p = 0.00, C.I = 3.25 - 15.86). Conclusion: Before the development and availability of a vaccine, the only tools that can help prevent the spread of COVID-19 are IPC measures.

Background: COVID-19 Pandemic is still circulating within the human population and proving to be a deadlier disease with a mortality rate ranging from 0.5% to 7%. Since COVID-19 is a highly transmissible disease; there is always a probability for its outward spread towards the general public and community from the hospitals and healthcare facilities where they come to seek treatment. Methodology: A prospective cohort study design was used, considering the limited available resources and time—a total of 200 healthcare workers (including doctors, nurses, para-medical staff, janitorial staff, reception staff & pharmacists) working in the OPDs of the two major public sector hospitals of Quetta were made part of this study. The study participants were selected using a simple random sampling technique and selection was made from the daily attendance register. The study participants from “Hospital-A” were first of all educated and trained on various COVID-19 IPC measures later on various COVID-19-IEC materials; written in simple Urdu language, were displayed clearly everywhere in the OPD. Similarly, handwashing stations along with hand sanitizers/soaps and surgical face masks were also made available free of cost for all the study participants of Hospital-A. Moreover the importance and effectiveness of COVID-19 IPC measures were continuously announced in the OPD gallery of Hospital-A, these announcements used simple wording in local languages (i.e., Urdu, Pashto, Balochi and Brahvi). On the other hand, in the OPD of “Hospital-B”, no such interventions were made. The study participants of both the hospitals were followed for one month and observations like which group showed more on-job noncompliance towards various COVID-19 IPC measures were recorded. The data was recorded on daily basis (from 1st May-to-31st May 2021) after observing the study participants for compliance towards using face masks, face shields, personal protective gowns, gloves, hand sanitizers, maintaining 6 feet social distancing and implanting triage at his or her OPD counter. Any study participant with daily proper practice of at least face masks, gloves, hand sanitizer and maintaining a 6 feet social distancing SOPs during duty hours at the outdoor patients department was considered to be a compliant individual if even one of these minimum required SOPs has not practiced the study participant, he/she was classified as non-compliant individual. A checklist was used to record these findings for every study participant on daily basis by trained data collectors. Lastly, all the data was analyzed using Microsoft Excel 2007 version. Results: The major findings of this study are almost in line with the set objectives, the study results are clearly showing the Risk Ratio (RR) as 0.27, indicating that the intervention group participants were only 27% as likely to develop on-job non-compliance for various COVID-19 IPC measures compare to the non-intervention group. Discussion & Conclusion: It is highly recommended that various COVID-19 specific infection prevention and control interventions like COVID-19 IPC trainings, COVID-19 IEC and BCC materials be displayed clearly everywhere in the healthcare facilities especially in the OPD department. Moreover, audio announcements made in simple wording using local languages like Urdu, Pashto, Balochi and Brahvi could really serve as constant reminder tools especially in an OPD department where every next patient in the queue could present with a different infectious bug.

Introduction: COVID-19, a novel disease, appeared in December 2019 in China and rapidly spread across the world. Till the second week of April 2020, high incidence (2.9/100,000) and cases fatality rates (1.7%) were observed in Pakistan. This study was conducted to determine the temporal and spatial distribution of the first 100 deaths attributed to COVID-19 in Pakistan and their associated demographic factors. Method: A record review of the first 100 deaths reported among RT-PCR confirmed COVID-19 cases was conducted. Demographic, epidemiological, and risk factors information was obtained associated comorbidities and clinical signs and symptoms were recorded and frequencies were determined. Results: A total of 100 mortalities with an overall case fatality rate of 1.67% (CFR) were analyzed. The median age of patients was 64.5 years (IQR: 54-70) with 75% (n=75) males. Among all deaths reported, 71 (71%) cases had one or more documented comorbidities at the time of diagnosis. The most frequently reported co-morbidities were: hypertension (67%), followed by Diabetes Mellitus (45%) and Ischemic Heart Diseases (27%). The most frequent presenting symptoms were shortness of breath (87%) and fever (79%). The median duration of illness was eight days (IQR: 4-11 days), the median delay reaching hospital to seek health care was three days (IQR: 0-6 days) while the median duration of hospital stay was also three days (IQR: 1-7 days). Among all, 62% had no history of international travel. The most affected age group was 60-69 years while no death reported in the age group below 20 years.

The degree of malnutrition is very high in India. Early detection of the possibility for a child to be affected by malnutrition can combat the situation to some extent. Birth weight prediction of n...

Cholera is deadly watery diarrhea caused by Vibro cholerae. Approximately 550,000 Pakistani children die each year due to waterborne illnesses including diarrhea. Vibro cholera bacterium strain O1eLtOR is a major cause of diarrhea in Pakistan. Since it is a waterborne bacteria, people relying on tap water (not filtered) are the most vulnerable to this disease. In current study, tap water was disinfected by using different concentrations of sodium dichloroisocyanurate (NADDC) to devise an effective and inexpensive method to make water safe for drinking. Different concentrations of NADDC were utilized to disinfect water and 1.2 mg of NADDC in 40 ml water was effective to disinfect water from bacterial colonies The experimental data is represented through the proposed mathematical model i.e. exponential decay model and statistical analysis of the generated data is also done. The graphical representation is also done to show the exponential decay of bacterial growth. The results of our study reveal that NADCC is an effective chemical agent to purify drinking water from Vibrio cholerae.

Background During August 2017, increased numbers of suspected dengue fever cases were reported in the hospitals of Rawalpindi district. A case control study was conducted to determine the risk factors among urban areas, dengue serotype, and recommend preventive measures. Objective The objective of the investigation was to determine the risk factors among urban areas, dengue serotype, and recommend preventive measures. Methods A case was defined as having acute febrile illness with one or more of the following symptoms: retro-orbital pain, headache, rash, myalgia, arthralgia, and hemorrhage. The cases were residents of Rawalpindi and were confirmed for dengue fever from August 30, 2017, to October 30, 2017. All NS1 confirmed cases from urban areas of Rawalpindi were recruited from tertiary care hospitals. Age- and sex-matched controls were selected from the same community with a 1:1 ratio. Frequency, univariate, and multivariate analyses were performed at 95% CI with P Results Totally 373 cases were recruited. The mean age was 36 (SD 2.9) years (range 10-69 years), and 280 cases (75%) were male. The most affected age group was 21-30 years (n=151, attack rate [AR] 40%), followed by 31-40 years (n=66, AR 23%). Further, 2 deaths were reported (case fatality rate of 0.53%). The most frequent signs or symptoms were fever (n=373, 100%), myalgia and headache (n=320, 86%), and retro-orbital pain (n=272, 73%). Serotype identification was carried out in 322 cases, and DEN-2 was the dominant serotype (n=126, 34%). Contact with a confirmed dengue case (odds ratio [OR] 4.27; 95% CI 3.14-5.81; P Conclusions Stored water in containers inside houses and subsequent mosquito breeding were the most probable causes of this outbreak. Based on the study findings, undertaking activities to improve the use of mosquito repellents and removing sources of breeding (uncovered water stored indoors) are some recommendations for preventing dengue outbreaks.

Background On October 23, 2016, 79 dengue fever cases were reported from the Union Council Tarlai to Federal Disease Surveillance and Response Unit Islamabad. A team was established to investigate the suspected dengue outbreak. Objective The aim of this study was to determine the extent of the outbreak and identify the possible risk factors. Methods Active case finding was performed through a house-to-house survey. A case was defined as an acute onset of fever ≥38℃ in a resident of Tarlai from October 2 to November 11, 2016, with a positive dengue virus (nonstructural protein, NS-1) test and any of the two of following signs and symptoms: retroorbital/ocular pain, headache, rash, myalgia, arthralgia, and hemorrhagic manifestations. A structured questionnaire was used to collect data. Age- and sex-matched controls (1:1) were identified from residents in the same area as cases. Blood samples were taken and sent to the National Institute of Health for genotype identification. Results During the active case search, 145 cases of dengue fever were identified by surveying 928 houses from October 23 to November 11, 2016. The attack rate (AR) was 17.0/10,000. The mean age was 34.4 (SD 14.4) years. More than half of the cases were male (80/145, 55.2%). Among all cases, 29% belonged to the 25-34 years age group and the highest AR was found in the 35-44 years age group (35.6/10,000), followed by the 55-64 years age group (35.5/10,000). All five blood samples tested positive for NS-1 (genotype DENV-2). The most frequent presenting signs/symptoms were fever and headache (both 100%). Stagnant water around houses (odds ratio [OR] 4.86, 95% CI 2.94-8.01; P Conclusions Stagnant water acting as breeding grounds for vectors was identified as the probable cause of spread of the dengue outbreak. Establishment of surveillance and an early reporting system along with use of protective measures against the vector are strongly recommended.

The addressed work explains SWCNTs (Single walled carbon nanotubnes) and MWCNTs (Multi walled carbon nanotubnes) nanofluid flow under the influences of temperature dependent viscosity and mixed convection. Comparative study of SWCNTs and MWCNTs suspended in base liquid is presented. Further heat and mass transfer are addressed for nanofluid effected by radiation, heat generation/absorption and diffusion species. Mathematical development of problem is taken in cylindrical coordinates. System of highly nonlinear differential equations are constructed via appropriate transformations. The system of equations are tackled numerically by bvp4c MATLAB solver. The findings of the study show that larger volume fraction $$\left( \phi \right)$$ ϕ contributes to enhance the nanoliquid flow. The velocity by submerging MWCNTs is noted higher than SWCNTs. Furthermore, the relationship between the viscosity variable $$\left( \theta _{r}\right)$$ θ r and the temperature is such that the temperature near the surface decreases with increase in $$\left( \theta _{r}\right)$$ θ r , while at the same time the temperature away from the surface increases. Subsequently, higher temperature is observed in SWCNTs-liquid compared to the MWCNTs-liquid to the similar values of $$\left( \theta _{r}\right)$$ θ r . Further, heat transfer is an increasing function of varying viscosity variable $$\left( \theta _{r}\right)$$ θ r .

BackgroundIn the second week of October 2019, five suspected cases of dengue fever were reported from union council Sohan, Islamabad rural (population 45,747) to the health department, Islamabad Capital Territory (ICT). Outbreak investigation was conducted with the objectives to identify risk factors and recommend control measures.MethodsOutbreak investigation was conducted from 17th October to 25th November 2019. A case was defined as, “fever and two or more of the following signs/symptoms; headache, retro-orbital pain, joint/bone pain, myalgia and petechial rash with NS1 test (Nonstructural Protein 1) positive during 8th October to 25th November 2019 among residents of Sohan”. Age and sex-matched controls were recruited from the same neighborhood. All cases were positive for NS1 antigen. Blood samples from five suspected cases were collected and tested for laboratory confirmation.ResultsA total of 547 households were surveyed and 85 cases were identified. The mean age was 34.4 years + 16.05 (range 3-71 years). The attack rate was 0.19% whereas the most affected age group was the 45-54 years (AR 0.43%). Males were predominantly affected (n=48 56.5%). Among all cases, 32% (n=27)) had stagnant water inside or around their houses (aOR 2.65, CI 1.20-5.83, P=0.005), 33% (n=28) were using mosquito repellent (aOR 0.35, CI 0.17-0.70, PP=0.041), and 73% (n=62) used full protective clothing (aOR 0.17, CI 0.05-0.58, PConclusionThe presence of accumulated rainwater in pools and empty receptacles around houses acted as breeding grounds for Aedes aegypti mosquitos and was the most probable cause of this outbreak. Following our recommendations, the health department-initiated mosquito breeding sites control activities through residual insecticide spray and advocacy on the use of protective measures against mosquito bites.

IntroductionSerological surveys are valuable tools to evaluate the extent of disease transmission, measuring preventive effectiveness and proportion of asymptomatic individuals. This age-stratified, serological survey was aimed to measure the COVID-19 distribution and determinants in district Islamabad of Pakistan.MethodologyThree-stage cluster sampling, using population proportionate to size technique, starting with a random number was used. A structured, pretested questionnaire was used after taking informed written consent, to gather demographic, risk factor information.ResultsSeroprevalence was found 16.5% (AR: 16.5%/100,000). The mean age was 35 (±16 Years). The majority were male (64%), self-employed (29%), and had primary level education (33%). The highest seroprevalence was found in the 21-30 years age group (24.8%) while the 41-50 years age group showed the highest attack rate (112.9/100,000 population). The proportion of the population tested that were asymptomatic was 69% (n=711) while the most frequently reported sign/symptom was cough (99%) followed by fever (20%). No known co-morbidity was reported in 86% (n=884) of respondents while hypertension remained the most reported condition (8%). High seroprevalence was observed in urban areas (12.3%) compared to rural union councils (6.4%). Visiting a house where COVID-19 case was isolated (OR 2, CI 1.38-2.84, P< 0.001), history of contact with a known case of COVID-19 (OR 1.42, CI 1.11-1.82, P=0.005), and attending a mass gathering (OR 1.21, CI: 1.02-1.42, p=0.02) were significant risk factors associated with contracting an infection. A Chi-Square test of independence showed significant protection while using regular hand hygiene practices (6.5; pConclusionSeroprevalence gives a direct estimation of population groups exposed to the virus. A remarkable difference in prevalence is found in urban and rural areas, extreme age groups, and socioeconomic statuses, suggesting targeted public health interventions. Sero-studies are affordable counterparts of molecular testing where quick estimation, prevention effectiveness, and data-driven public health policies are priorities.

Background: The objective of the study was to compare the results of conservative management and volar locking plate by assessing the functional and radiological parameters using Stewart et al. system (1) and Sarmiento’s modification of Gartland and Werley scores (2) respectively in cases of unstable distal radius fractures. Materials & Methods: This was a prospective comparative study, which included 50 cases of distal radius fractures with 32 cases in the conservative group and 18 cases in the operative group. Radiographic and functional outcomes were assessed at 2 weeks, 3 months and 6 months using Stewart et al. system and Sarmiento’s modification of Gartland and Werley scores respectively. Results: In operative group, radiological results were well to excellent results in 100% of the patients while in conservative group, 30% had excellent results, 17% had good results and 53% had fair result. At 6 months after surgery, functional results in both groups were improved. In operative group, 100% had excellent results while in conservative group 48% had excellent, 44.44% had good, and 7% had fair results. Conclusion: This study shows that volar locking plates evidently has better results in terms of achieved faster and accelerated functional recovery.

Quadruplets are set of four off springs born at one birth. Quadruplets occurring more frequently as assisted reproduction technique but spontaneous conception and delivery of 4 male live fetuses are something rare case to be reported. Improved MCH care in high risk obstetric cases with team work and Obstetric ICU/HDU and NICU. We report a case of 28 year old multiparous woman presented at around 10 week of amenorrhea with positive pregnancy test. After evaluation she was found to carry 4 live fetuses. She was managed conservatively till 34 week of gestation with regular ANC monitoring. Caesarean section was performed when labour pain was started for obstetrical complications and successful delivery of 4 healthy live male children of 1.75, 1.5, 1.5, 1.2 kg. Entire delivery was possible in Obstetric HDU set up and level 3 NICU setup. This case is unique due to SPONTANEOUS conception of quadruplet pregnancy with regular ANC checkups and delivery at centre with obstetric ICU back up & team work. We followed this case for entire post natal period and infant age of all Children. Keywords: Multiple gestation, Quadruplets, Dizygotic.

Background Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. Methods We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. Findings In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286–873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5–68·5) and in mortality rate (from 362·7 deaths [330·1–392·0] per 100 000 children to 118·9 deaths [109·8–128·3] per 100 000 children; 67·2% decrease, 63·5–70·1). LRI incidence declined globally (32·4% decrease, 27·2–37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0–24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1–6·3), and reductions in household air pollution (8·4%, 6·8–9·2). Interpretation Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths. Funding Bill & Melinda Gates Foundation.

Background and Aims: To study the clinical profile of genetically proven Huntington's disease (HD) patients from eastern India. Methods: This cross sectional study selected patients of HD after genetic confirmation of expanded CAG repeats in Huntingtin (HTT) gene. We performed detail clinical evaluation including cognitive and neuropsychological assessment, and imaging of brain. Results: This study included 75 patients (male: 57.3%; female: 42.7%). Mean age at onset was 37.12 (range 16-62) years; juvenile variety (onset below 20 years) was detected in 5.3%. Paternal transmission was commoner. Manifestations at onset were motor in 81.3% patients, behavioral in 10.7% and cognitive impairment in 8%. After chorea, next common movement disorder was dystonia. Frontal lobe dysfunction was found in 77.3% patients. Behavioral disturbances were observed in 77.3% patients and commonly manifested as depression, irritable behavior and anxiety. Among the three onset groups (motor/behavioral/cognitive), there was no significant difference regarding age at onset, gender distribution, pattern of inheritance (paternal/maternal), and at the time of evaluation, all groups had essentially similar pattern of clinical features. Mean CAG repeat of the patients was 48.25 (range 40-79). Our study showed some differing clinical characteristics compared to previous studies from the Indian subcontinent. Conclusion: Clinical features in our study showed differences from previous studies from the Indian subcontinent. We had more cognitive-onset patients. However, behavioral onset was lower in our study. Motor, behavioral and cognitive onset groups of HD were comparable regarding demographics, family history, CAG repeat lengths and major clinical features at the time of evaluation.

A pharmacophoric motif decorated with supramolecular functionalities (TZT) was designed for potential interaction with biological targets. Main insights of this work include the correlation of supra functionalities of TZT with its binding ability to proteins leading to the modulation of their structure and bioactivity as a promising perspective in the field of cellular protection from oxidative stress. To investigate the role of TZT in obliterating oxidative stress at a molecular level, its binding propensity with bovine serum albumin (BSA) and bovine liver catalase (BLC) was characterized using various biophysical methods. The binding constants of TZT with BSA (Kb = 2.09 × 105 M-1) and BLC (Kb = 2.349 × 105 M-1) indicate its considerable interaction with these proteins. TZT efficiently triggers favourable structural changes in BLC, thereby enhancing its enzyme activity in a dose dependent manner. The enzyme kinetics parameters of TZT binding to BLC were quantified using the Michaelis-Menten model. Both in silico and experimental results suggest that an increased substrate availability could be the reason for enhanced BLC activity. Furthermore, physiological relevance of this interaction was demonstrated by investigating the ability of TZT to attenuate oxidative stress. Treatment with TZT was found to mitigate the inhibition of A549 cell proliferation in the presence of high concentrations of vitamin C. This finding was confirmed at a molecular level by PARP cleavage status, demonstrating that TZT inhibits apoptotic cell death induced by oxidative stress.

In the present work, an attempt has been made to develop immediate release coated tablets of Ritonavir by hot met extrusion method using 16 station rotary tablet punching machine. The blend of all the formulations showed good flow properties such as bulk density, tapped density. The prepared IR coated tablets of ritonavir shown good post compression parameters. They passed all the quality control evaluation parameters as per USP limits. Among all the formulations, F5 formulation showed maximum % drug release i.e., 99 % in 120 mins hence it is considered as optimized formulation. The optimized formulation was compared to innovator tablets. Keywords: Ritonavir, HPMC, Ethyl cellulose, Copovidone immediate release tablets.

Silver nanoparticles (NPs) were synthesized using Diospyros lotus fruit extract. Plant biomolecules were extracted through two solvents i.e. water and methanol. Effect of both solvents on the extraction process as well as effect of both extracts on the reduction of precursor salt to NPs has been studied and reported. Employing the synthesized Ag NPs as a component of nanocomposites, hydrogel membranes were prepared with starch and polyvinyl alcohol (PVA). Synthesized Ag NPs as well as prepared nanocomposites membranes were fully characterized through FTIR, XRD, SEM and UV–Visible spectroscopy. The ultimate tensile strength of the hydrogel membranes with 50 ppm Ag NPs was found to be highest among all the compositions while swelling tendency of the membranes was found to increase with increase in the NPs concentrations. Additionally, no significant decrease in gel fraction of the hydrogel membranes could be observed with the addition of NPs. However, addition of NPs resulted in reduced water evaporation from the membranes. Finally, anti-bacterial test of the Ag NPs as well as hydrogel membranes showed comparable results as shown for the ciprofloxacin, indicating the potential of such membranes to be used in wound dressing application.

Mathematical modeling of cerebral tumor growth is of great importance in clinics. It can help in understanding the physiology of tumor growth, future prognosis of tumor shape and volume, quantify tumor aggressiveness, and the response to therapy. This can be achieved at macroscopic level using medical imaging techniques (particularly, magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI)) and complex mathematical models which are either diffusive or biomechanical. We propose an optimized generic modeling framework that couples tumor diffusivity and infiltration with the induced mass effect. Tumor cell diffusivity and infiltration are captured using a modified reaction-diffusion model with logistic proliferation term. On the other hand, tumor mass effect is modeled using continuum mechanics formulation. In addition, we consider the treatment effects of both radiotherapy and chemotherapy. The efficacy of chemotherapy is included via an adaptively modified log-kill method to consider tissue heterogeneity while the efficacy of radiotherapy is considered using the linear quadratic model. Moreover, our model efficiently utilizes the diffusion tensor of the diffusion tensor imaging. Furthermore, we optimize the tumor growth parameters to be patient-specific using bio-inspired particle swarm optimization (PSO) algorithm. Our model is tested on an atlas and real MRI scans of 8 low grade gliomas subjects. Experimental results show that our model efficiently incorporates both treatment effects in the growth modelingprocess. In addition, simulated growths of our model have high accuracy in terms of Dice coefficient (average 87.1%) and Jaccard index (77.14%) when compared with the follow up scans (ground truth) and other models as well.

Background Public trust is central to the collection of genomic and health data and the sustainability of genomic research. To merit trust, those involved in collecting and sharing data need to demonstrate they are trustworthy. However, it is unclear what measures are most likely to demonstrate this. Methods We analyse the ‘Your DNA, Your Say’ online survey of public perspectives on genomic data sharing including responses from 36,268 individuals across 22 low-, middle- and high-income countries, gathered in 15 languages. We examine how participants perceived the relative value of measures to demonstrate the trustworthiness of those using donated DNA and/or medical information. We examine between-country variation and present a consolidated ranking of measures. Results Providing transparent information about who will benefit from data access was the most important measure to increase trust, endorsed by more than 50% of participants across 20 of 22 countries. It was followed by the option to withdraw data and transparency about who is using data and why. Variation was found for the importance of measures, notably information about sanctions for misuse of data—endorsed by 5% in India but almost 60% in Japan. A clustering analysis suggests alignment between some countries in the assessment of specific measures, such as the UK and Canada, Spain and Mexico and Portugal and Brazil. China and Russia are less closely aligned with other countries in terms of the value of the measures presented. Conclusions Our findings highlight the importance of transparency about data use and about the goals and potential benefits associated with data sharing, including to whom such benefits accrue. They show that members of the public value knowing what benefits accrue from the use of data. The study highlights the importance of locally sensitive measures to increase trust as genomic data sharing continues globally.

Background Hyderabad, Pakistan, was the first city to witness an outbreak of extensively drug resistant (XDR) typhoid fever. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, thus greatly limiting treatment options. However, despite over 5000 documented cases, information on mortality and morbidity has been limited. Objective To address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan. Methods We reviewed the medical records of culture-confirmed typhoid cases in 5 hospitals in Hyderabad from October 1, 2016, to September 30, 2018. We recorded data on age, gender, onset of fever, physical examination, serological and microbiological test results, treatment before and during hospitalization, duration of hospitalization, complications, and deaths. Results A total of 1452 culture-confirmed typhoid cases, including 947 (66%) XDR typhoid cases and 505 (34%) non-XDR typhoid cases, were identified. Overall, ≥1 complications were reported in 360 (38%) patients with XDR typhoid and 89 (18%) patients with non-XDR typhoid (P Conclusions As this first XDR typhoid outbreak continues to spread, the increased duration of illness before hospitalization and increased rate of complications have important implications for clinical care and medical costs and heighten the importance of prevention and control measures.

Background Extensively drug resistant typhoid fever (XDR-TF) has been responsible for an ongoing outbreak in Pakistan, which began in November 2016. Objective This study aimed to determine the risk factors associated with XDR-TF. Methods This age- and sex-matched case-control study was conducted during May-October 2018 in Karachi. All patients with XDR-TF were identified from the laboratory-based surveillance system data. Cases included patients aged Results A total of 75 cases and 75 controls were included in this study. On univariate analysis, the odds of having XDR-TF were 13-fold higher among participants who used piped municipal water than among those who did not (odds ratio [OR] 12.6, 95% CI 4.1-38.6). The use of bore water was significantly associated with XDR-TF (OR 5.1, 95% CI 1.4-19.0). Cases were more likely to report eating French fries with sauce (OR 13.5, 95% CI 3.9-47.0) and poppadum (OR 3.4, 95% CI 1.7-6.7) from street vendors than controls. Boiling water at home was negatively associated with XDR-TF (OR 0.3, 95% CI 0.2-0.7). On multivariate analysis, 2 factors were independently associated with XDR-TF. Using piped municipal water (OR 10.3, 95% CI 3.4-30.4) and eating French fries with sauce from street vendors (OR 8.8, 95% CI 2.1-36.2) were significantly associated with an increased odds of XDR-TF. Conclusions Community water supply and street food eating habits were implicated in the spread of the superbug S typhi outbreak, which continues to grow in Karachi. Therefore, it is recommended to improve the community water supply to meet recommended standards and to develop a policy to improve the safety of street food. In addition, health authorities are required to conduct mass vaccination for TF among high-risk groups.

'Background:' On 1 March, 2018, 15 students of a religious boarding school presented to a tertiary care hospital in Islamabad with complaints of nausea, vomiting, abdominal pain and diarrhea. A team of FELTP fellows were tasked to investigate the suspected outbreak to confirm diagnosis, determine magnitude, evaluate possible risk factors, identify the source and implement control measures. 'Methods:' A retrospective cohort study was conducted from 25 February to 5 March, 2018. Medical records were reviewed at the hospital. All the students and staff of the boarding school were interviewed using a structured questionnaire. A case was defined as any student of the religious school reported with nausea, abdominal discomfort and one of the following symptoms of vomiting, diarrhea, and chills on 1 March, 2018. Information on demographics, history of food intake and clinical features was collected. Suspected food items and drinking water samples were sent to the National Institute of Health for microbiological analysis. Frequencies and attack rates were calculated and risk ratios computed at 95% confidence interval at the margin of error P

The techniques of data mining are used widely in the healthcare sector to predict and diagnose various diseases. Diagnosis of heart disease is considered as one of the very important applications of these systems. Data is being collected today in a large amount where people need to rely on the device. In recent years, heart disease has increased excessively and heart disease has become one of the deadliest diseases in many countries. Most data sets often suffer from extreme values that reduce the accuracy percentage in classification. Extreme values are defined in terms of irrelevant or incorrect data, missing values, and the incorrect values of the dataset. Data conversion is another very important way to preconfigure the process of converting data into suitable mining models by acting assembly or assembly and filtering methods such as eliminating duplicate features by using the link and one of the wrap methods, and applying the repeated discrimination feature. This process is performed, dealing with lost values through the "Remove with values" methods and methods of estimating the layer. Classification methods like Naive Bayes (NB) and Random Forest (RF) are applied to the original datasets and data sets with the feature of selection methods too. All of these operations are implemented on three various sets of heart disease data for the analysis of pre-treatment effect in terms of accuracy.

BackgroundThis paper analyses any possible association of various factors like gender, last COVID-19 PCR test results, BCG Vaccination, Seasonal Flu vaccination, Occupation and confirmed case contact history with COVID-19 RDT results of the participants. COVID-19 will soon become endemic in Pakistan, the government should adopt COVID-19 RDT kits for trace, test and quarantine activities.MethodologyConsidering the availability of COVI-19 rapid diagnostic kits, 596 individuals all previously COVID-19 PCR tested were made part of this cross sectional study. Simple random sampling was used for the selection of study participants. The whole study was conducted during September and October 2020.ResultsThe major findings of this study is clearly showing that the Positive Likely hood ratio of the COVID-19 RDT Kits (LR+) is well above 1; similarly the Negative Likely hood ratio is approaching 0.On the other hand the Sensitivity and Specificity 80% and 74% respectively. Similarly study found statistically significant association was between RDT out comes and Last PCR Test status, Occupation and Contact with COVID-19 positive individuals. While other variables like Gender, BCG Vaccination and history of seasonal flu vaccinations were found to have no significant associations with COVID-19 RDT Kit out comes.ConclusionBeing the first study of its kind in Pakistan the major findings of this study are almost in line with the set hypothesis and objectives of this study and based on study findings it will be of high value to use COVID-19 RDT kits during mass screening especially during Test, Trace and Quarantine activities.

Magic realism is a distinct subgenre of writing that works on the mechanism of paradoxes of placing two opposites together to make a rich and complex meaning – the fusion of real and fantastic as Angel Flores calls it ‘amalgamation of realism and fantasy’. Magic Realism can also be read as a Postcolonial weapon as it fight backs the traditional tendencies and the staunch realism of western literature. Female voices have also employed magic realism to say aloud the problems of women across the globe. Magic Realism has thrived well in the hands of women writers across cultures and continents. Toni Morrison, Isabel Allende, Laura Esquivel, Chitra Divakaruni Banerjee, Arundhathi Roy, Sarah Addison Allen, Yaa Gyasi, Raja Alem etc. This paper proposes to bring into limelight the Latin American Women Writers who are often left out to be mentioned along the list of men Latin American writers.

Background: Dengue has emerged as a vector-borne disease with an increase in number of cases with multiple outbreaks throughout Pakistan and hospitalization each passing year, thus stretching available health resources in Pakistan. Methods: This was a descriptive cross-sectional study involving 233 dengue fever indoor cases. Complete clinical findings were recorded followed by laboratory and other diagnostic tests. Results: Most of the cases were admitted from peri-urban areas of Islamabad with symptoms of fever. Seasonal patterns of typical post-monsoon and clusters of cases from low socio-economic backgrounds from areas of Bhara Kau, Bari-Imam, Sohan and G6 and G-7 sectors were found. Platelets and WBCs counts were found on the lower side of the normal values. IgM and IgG and NS1 tests were performed. Affected age group) was young (20-40 years) and male gender being more exposed to vector. Conclusion: Dengue has emerged in the poor peri-urban areas of Islamabad typically in post-monsoon seasons reaching peak during the months of September , gradually declining and waning off in the month of December. A combination of clinical symptoms and diagnostic tests IgM, IgG and NS1 could greatly help in early diagnosis and treatment of cases thus minimizing compilations and mortality.

Green syntheses of nanoparticles using plant materials are of tremendous scope. Here we report advantageous green synthesis for silver nanoparticles (AgNPs) using aqueous-root extract of Jurinea dolomiaea and AgNO3. Color change of solution and UV-Vis absorption at 444 nm indicated the formation of AgNPs. XRD confirmed their face centered cubic structure (fcc) with average particle size of 24.58 nm. SEM analysis showed their spherical, cubic and triangular structures. FT-IR indicated the presence of functional groups of reducing and stabilizing phytochemicals. Methanol-root extract of J. dolomiaea revealed high flavonoid (445 mg RE/g) and phenolic contents (92 mg GAE/g). Methanol-extract showed high antioxidant potency (IC50 = 0.494 μg/mL), rationally due to its high phenolic and flavonoid contents. These AgNPs showed the highest and equal antimicrobial activities against Escherichia coli and Pseudomonas aeruginosa (Inhibition zone 11.0 mm) whereas, methanol-roots extract showed equal and intermediate activities (Inhibition zone 8.0 mm) against both pathogens but aqueous extract showed poor activities (Inhibition zone 6.0 mm) against these both pathogens. AgNPs are playing a major role in the field of nanotechnology and nanomedicine due to their antimicrobial and drug delivery efficacy as well as reasonable tolerance in human biology.