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The aim of this study is to investigate the ongoing energy management and energy efficiency practices in the industries of Peshawar division of Khyber Pakhtunkhwa, Pakistan. The outcomes of this research shows that Khazana Sugar Mills, Caliph Pharmaceutical, Naguman Flour Mill have no or low awareness of energy management practices (awareness level mainly includes barriers to energy efficiency and drivers for energy efficiency) except FF steel mill. The major paces observed in lacking the awareness are (1) “understanding level of staff and workers about energy savings due to energy management practices” (2) “interest level of top managers for energy management implementation” (3) “awareness level regarding energy efficiency” (4) “lack of technical competence” (5) “use of standardized procedures”. When the industry managers were inquired about the relationship with energy service providers it is found that there is absolute absence of energy engineers, relationship with energy consultancies and long-term energy strategy in all the industries. It was also found that there is lack of using renewable energy technologies in all industries as they were relying upon using the generators during the blackout hours. In terms of percentage, the energy saving factor of 36 kWh/day has also observed with the replacement of fluorescent tube lights with light emitting diode (LED) tube lights. Proper maintenance and energy management practices in the heating, ventilation and air conditioning system (HVAC) would also save energy in a significant amount. The study shows that there is an overall improvement factor of 4% to 8% if the inclusion of energy management and energy efficiency practices would have been applied in all the stated industries.

Objective: Objective of this study is to assess the application of percutaneous screw fixation and closed reduction for tibial plateau fractures in Karachi, Pakistan. Methods: The study design of this study is case series with sample size of 58 patients calculated by WHO calculator with functional outcome of 80-100%. The duration of the study was about 6 months.Non-probability sequential technique was adopted for data collection. Results: The average patient age was 35.35±6.84 years however male patient were high in numbers (83.8%). Types of fractures (type I, II and IV) and functional outcomes (un-satisfactory and satisfactory) showed 17(29.3%), 33(56.8%) and 12(20.6%) and 4(6.45%) and 58(93.5%). The mean Rasmussen Score was 24.6(4.9%) however significant relationship between age and functional group were observed (p

Submerged spillways with large capacity outlets are generally provided below the dam crest to perform the dual functions of flood disposal and sediment flushing. Flood water passing through these spillways exhibits turbulent behavior. Moreover; hydraulic analysis of such turbulent flows is a challenging task. Therefore, the present study aims to use numerical simulations to examine the hydraulic behavior of submerged spillways constructed at Mangla Dam, Pakistan. Besides, the hydraulic performance of aerator was also evaluated at different operating conditions. Computational fluid dynamics code FLOW 3D was used to numerically model the flows of Mangla Spillway. Reynolds-averaged Navier–Stokes equations are used in FLOW 3D to numerically model the turbulent flows. The study results indicated that the developed model can simulate the submerged spillway flows as it computed the flow parameters with an acceptable error of up to 6%. Moreover, air concentration computed by model near spillway chute bed was 3% which raised to more than 6% after the installation of ramp on aerator which showed that developed model is also capable of evaluating the performance of submerged spillway aerator.

Background Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has a broad clinical spectrum, from asymptomatic to multi-organ dysfunction. Acute cerebrovascular events associated with coronavirus disease 2019 are mainly due to the severe acute respiratory syndrome coronavirus 2-induced prothrombotic state. Bilateral basal ganglia ischemia is rarely reported. Case presentation We report the case of a 64-year-old Asian (Pakistani) gentleman who presented initially with fever, cough, and shortness of breath, likely due to respiratory involvement by severe acute respiratory syndrome coronavirus 2. Later, he developed bilateral lower limb pain, followed by confusion and decreased level of consciousness. Accentuated large hypodense opacities were seen in the left and right basal ganglia, with mass effects on the left frontal horn. Conclusion This case demonstrates the importance of neuroimaging in the effective management of patients with neurological signs associated with coronavirus disease 2019.

Coronary artery disease (CAD) is a very ordinary health problem around the globe. CAD is affected by numerous factors like diabetes, obesity, smoking, gender, and diet. However, the association of CAD with diet is understudied in our region that’s why our study was aimed to evaluate the effect of diet on CAD incidence. This cross-sectional study was completed among local population of Rawalpindi, Pakistan in almost 6 months from November 2020 to April 2021. People were taken in our study via set criteria. Data was collected by self-structured proforma. Data analysis was performed by applying IBM SPSS version 25. Descriptive statistics were applied for quantitative variables. Statistical tests like Chi-square test and Spearman correlation analysis were applied to know the association, direction, and strength of study variables. Our current study displays overall high prevalence CAD (17.48%) among study population. Mean value of age for study participants was 45.42 with SD of ±8.01years. Prevalence of CAD was more common among females, faster food eaters and fresh fruit and raw vegetables non-eaters. Gender, fast food, and fresh fruits and vegetables were associated with CHD significantly with p-values 0.030, 0.0007, and 0.0006 respectively. Strength and direction for fast food and CAD association was very strong and positive while for association between fresh fruits and raw vegetables and CAD was very strong and negative with correlation coefficient +0.812 and -0.831 respectively. In a nutshell, current study indicates high prevalence of CAD especially among females, fast food eaters and fresh fruits and raw vegetables non-eaters. Higher consumption of fast foods leads to higher incidence of CAD and vice versa while higher consumption of fresh fruits and raw vegetables bring down the incidence of CAD incidence and vice versa. So, we need to create awareness among people about the impact of food on CAD and gender specific interventions for each gender to lower down the CAD incidence.

Background: Leishmaniasis is not an uncommon tropical disease. Cutaneous leishmaniasis is its most common form. The objectives of our study were to determine the distribution of cutaneous leishmaniasis by sex, age groups and residence in year 2020 in cutaneous leishmaniasis population of District D.I.Khan, Pakistan. Materials & Methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan from January 1, 2021 to January 23, 2021. The data for cutaneous leishmaniasis was retrieved from District Health Office, D.I.Khan for year 2020. A sample size of 419 was calculated from population at risk of 1,750,000 with 0.1034% margin of error, 95% confidence level and 0.01164% assumed prevalence of cutaneous leishmaniasis. Sex, age groups and residence were our three nominal variables. Distribution was analyzed by count and percentage with 95% confidence intervals. Three hypotheses for distribution were testified by chi-square goodness of Fit test. Results: Out of 419 positive cases of cutaneous leishmaniasis, 269 (64.20%) were men and 150 (35.80%) women, 254 (60.62%) were in age group up to 19 years, 101 (24.11%) in age group 20-39 years and 64 (15.27%) in age group ≥40 years, and 113 (26.97%) were urban and 306 (73.03%) rural. Our distribution by sex (p=0.01327), age groups (p=

Introduction Recent studies have evaluated and compared the efficacy of normal saline (NS) and lactated Ringer's (LR) in reducing the severity of acute pancreatitis (AP) and improving outcomes such as length of stay, the occurrence of the systemic inflammatory response syndrome (SIRS), ICU admission and mortality. We performed an updated systematic review and meta-analysis of the available studies to assess the impact of these fluids on outcomes secondary to AP. Methods We systematically searched the following databases: PubMed/Medline, Embase, Cochrane, and Web of Science through February 8th, 2021 to include randomized controlled trials (RCTs) and cohort studies. Random effects model using DerSimonian-Laird approach was employed and risk ratios (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated for binary and continuous outcomes, respectively. Results 6 studies (4 RCTs and 2 cohort studies) with 549 (230 in LR and 319 in NS) were included. The overall mortality (RR: 0.73, CI: 0.31–1.69) and SIRS at 24 h (RR: 0.69, CI: 0.32–1.51) was not significantly different. The overall ICU admission was lower in LR group compared to NS group (RR: 0.43, CI: 0.22–0.84). Subgroup analysis of RCTs demonstrated lower length of hospital stay for LR group compared to NS group (MD: 0.77 days, CI: 1.44 –0.09 days). Conclusion Our study demonstrated that LR improved outcomes (ICU admission and length of stay) in patients with AP compared to NS. There was no difference in rate of SIRS development and mortality between LR and NS treatments.

BACKGROUND: Dental caries is one of the most common diseases around the world. The newly erupted permanent posterior teeth are at great risk due to the complex occlusal morphology of pits and fissures, infraocclusion and incomplete maturation of enamel. Pit and fissure sealants are the treatment of choice in such conditions. OBJECTIVES: To compare the successful outcome of pit and fissure sealants bonded with etch-and-rinse adhesive system and self-etch adhesive systems in newly erupted permanent first molars. METHODS: This randomized clinical trial was conducted at the Fatimah Jinnah Dental Hospital from June 2017 to May 2019. Children aged between 6 to 9 years who fulfilled the inclusion criteria were recruited for this study after parents’ consent. Patients were randomly divided into two groups by the lottery method. Thirty patients with 60 first molar teeth in Group A were treated with etch-and-rinse adhesive system, while the other thirty patients with 60 first molar teeth in Group B were treated with self-etch adhesive system. After adhesive placement, all children received the same fissure sealants in newly erupted maxillary and mandibular permanent first molar. Each group was clinically evaluated at 6 and 12 months follow-up visit. Modified United States Public Health Service (USPHS) criteria were used for direct clinical evaluation of successful outcomes such as sealant retention and marginal discoloration. RESULTS: Successful outcome was statistically significant in Group B compared to Group A (60% vs. 30% p= 0.020) at 12 months follow-up. Stratification analysis was performed with respect to age in which a successful outcome was not significant (p= 0.43) between groups for 6 to 7 years of age, while it was significant (p= 0.012) between groups in 8 to 9 years of age children. CONCLUSION: Self-etch adhesive system is better than etch-and-rinse adhesive system in terms of long-term sealant retention. In addition, the bonding procedure is simple with relatively short clinical application time therefore it would offer great benefit to clinicians in treating pediatric patients.

A transsphenoidal surgical (TSS) approach is used for pituitary gland surgery involving pituitary adenomas, as well as for the biopsy of various neurosurgical tumors. TSS, although a relatively safe procedure, can lead to complications like hypopituitarism, visual impairment, nasal septal perforation, diabetes insipidus, carotid artery injury, and cerebrospinal fluid (CSF) leaks. Aseptic meningitis is also one of the complications of this procedure with an incidence of 1-2%, presenting with symptoms similar to bacterial meningitis, but with a low-grade fever of

Around half of all malocclusions that need orthodontic treatment are Class II in nature. Patients with Class II malocclusion primarily seek treatment for aesthetic improvement. Most of the skeletal class II malocclusions are because of mandibular deficiency, and can be best treated during the growing phase of development by removable functional appliances. The objective of this review is to evaluate and compare skeletal and dentoalveolar effects of various removable functional appliances in the treatment of class II malocclusion. Manual and electronic databases were searched, and out of 5,711 articles, 221 abstracts were shortlisted and reviewed. A total of 19 articles that fulfilled the selection criteria was then retrieved and analyzed. A significant increase in mandibular length and dentoalveolar effects with an increase in vertical dimension in a short time was observed with Twin-Block appliance treatment, followed by Bionator appliance treatment. The long-term stability of results achieved with Twin-Block appliance treatment is still questionable. In addition, Frankel appliance treatment effects are more skeletal in nature, with better control in the vertical dimension. However, it takes a more extended treatment duration to produce similar effects. Based on available evidence, we are convinced that removable functional appliances are valuable tools for correction of the Class II malocclusion at a growing age with a horizontal growth pattern.

The aim of this manuscript is to provide an overview of the past and current approaches for saliva stimulation with electro-stimulation devices (EDs) for the management of xerostomia. There are many causes and factors affecting the performance of salivary gland secretion, systematic or pathological, which compromise the lifestyle of the patient with long-term consequences that will impair health. Saliva contains a combination of many proteins, enzymes and peptides which helps in digestion, defense, and lubrication of the oral cavity. There are exceptionally good outcomes reported in the last few years from devices used to stimulate saliva via electronic impulses.

This is a critical review of the current evidence on patients’ experiences with oral cancer. The impact on the quality of life and implications to clinical practice and research were also discussed. A comprehensive search of three databases, PubMed, Scopus, and Google Scholar was undertaken. The search was restricted to English-language primary research papers from 2009 till 2019. The following keywords were used: mouth neoplasms, patients, experiences, oral cancer, physical, social, psychological. A total of 173 studies were retrieved using the search strategy. After removing duplicate reports and scrutinising those based on title and abstract, 68 studies were shortlisted for full text review. Three major themes emerged from the literature: (1) physical experiences of oral cancer patients, (2) psychological experiences of oral cancer patients, and (3) social experiences of oral cancer patients. Experiences of oral cancer patients are complex and subjective, and phases of physical, psychological, and social experiences of oral cancer have not been explored in detail. However, there is evidence that experiences such as pain, facial alterations, body image disturbances, anxiety, depression, social avoidance, social support, and financial implications affect patients’ quality of life. This review underlines the importance of further research to look into the type of support needed to address various experiences of oral cancer patients.

Objective: To qualitative and quantitatively review published literature assessing the oxidative stress marker malondialdehyde (MDA) in oral squamous cell carcinoma (OSCC). Methodology: Pubmed (MeSH), Science Direct, Scopus, Web of Science, Willey Online Library, Cochrane, and Cross Reference were searched for studies assessing MDA levels in OSCC samples. Results: From the 1008 articles identified, 849 were excluded based on title and abstract screening due to duplication and irrelevance to the topic of interest. Full-text assessment of the remaining 159 articles led to the inclusion of only 46 articles that satisfied the selection criteria. Of these, only 26 studies had data compatible for quantitative analysis. The MDA levels in OSCC groups are significantly increased (p < 0.00001) in plasma, serum, and saliva samples in the majority of the studies evaluated. In contrast, MDA levels in OSCC tissue samples are significantly attenuated (p < 0.00001) compared to healthy controls, supported by fewer studies. Conclusions: The augmented MDA levels in plasma, serum, and saliva samples of the OSCC reflect the heightened oxidative stress level accurately. Further studies are required to understand the attenuated MDA levels in the tissue samples of OSCC. Correlation analysis between MDA levels with established clinicopathological prognostic markers could aid in formulating oxidative stress-based prognostication and treatment planning.

The Internet of Things (IoT) is a network of wireless, interconnected, and networked digital devices that can gather, send, and store data without the need for human or computer interaction. The Internet of Things has a lot of promise for expediting and improving health care delivery by proactively predicting health issues and diagnosing, treating, and monitoring patients both in and out of the hospital. Understanding how established and emerging IoT technologies may help health systems deliver safe and effective treatment is becoming increasingly critical. The purpose of this viewpoint paper is to present an overview of existing IoT technology in health care, as well as to describe how IoT devices are improving health service delivery and how IoT technology can alter and disrupt global healthcare in the next decade. The promise of IoT-based health care is explored further to theorize how IoT can increase access to preventative public health services and help us migrate from our existing secondary and tertiary health care systems to a more proactive, continuous, and integrated approach. The intersection of the Internet of Medical Things (IoMT) for patient monitoring and chronic care management and the use of Artificial Intelligence (AI) is becoming more promising than ever as the adoption of telemedicine continues to grow dramatically. Connected devices generate huge volumes of data based on real-time measurements of patient vitals, which is delivered to cloud-based applications that are monitored by medical specialists in virtual contact centres. The policy is applied per-patient, and healthcare providers receive warnings and messages when a patient's heart rate, oxygen level, glucose level, blood pressure, or other measurement reaches a set threshold. Depending on the sort of telemedicine and telehealth platforms in use, this data is tracked and acted upon by specialists who monitor many patients for many different practices, and in other circumstances, this data is sent directly to the provider. AI in healthcare, as well as other crucial technologies are essential for resolving the issue and producing future prosperity.

Objective: To assess the association of dental caries and oral health related quality of life in mentally or physical disabled children studying in schools of Karachi. Study Design: Cross sectional study. Place and Duration of Study: Public and private sector special needs schools of Karachi, from Sep to Nov 2017. Methodology: This study was conducted on 196 disabled children (mental/physical) in Karachi Pakistan. Children aged 6-18 years and having a disability was included in the study. We calculated the prevalence of dental caries through an examination of the oral cavity using the Decayed, missing and filled teeth index. Data were analyzed in SPSS version 20. Results: Dental caries was found in 114 (58.2%). “Oral symptoms” score was (4.46 ± 0.85 vs. 4.95 ± 0.79; p

Sachin Tushar Patel,1 Syed Shah,1 Rhiya Prem Sood,2 Zohaib Siddiqui,1 Iain McKay-Davies1 1ENT Department, Tunbridge Wells Hospital, Tunbridge Wells, Kent, TN2 4QJ, UK; 2Leeds University School of Medicine, Leeds, LS2 9JT, UKCorrespondence: Sachin Tushar PatelENT Department, Tunbridge Wells Hospital, Tunbridge Wells, Kent, TN2 4QJ, UKTel +447886829357Email s.patel28@nhs.netPurpose: Medical education has faced new challenges with the recent coronavirus pandemic. Traditional teaching methods for face-to-face learning have shifted towards the delivery of digital teaching. The difficulty arises in specialties, such as otorhinolaryngology, where clinical procedural skills are necessary for diagnosis and management. This article aims to determine the impact of a clinical skills video on the confidence of postgraduate ENT trainees when managing nasal fractures.Patients and Methods: Postgraduate ENT trainees completed a baseline questionnaire, declaring their subjective confidence across 5 domains relating to nasal fractures using a 10-point Likert scale. They were then given a lecture, and this questionnaire was repeated. Lastly, trainees were shown a clinical skills video, and the questionnaire was repeated once more. The qualitative data was analysed using Kruskal–Wallis testing.Results: There was poor overall confidence in the management of nasal fractures prior to focused teaching. There was a marked statistically significant (P < 0.01) improvement in subjective confidence following the lecture intervention. There was further statistically significant improvement across all domains following the introduction of the clinical skills video.Conclusion: This study confirms that clinical skills videos are a useful accessible learning tool in medical education. We advocate their use in the postgraduate setting, to mirror their current use in undergraduate medical education.Keywords: confidence, ENT, clinical skills, video, postgraduate

Background Reconstruction of soft tissue defects around the lower leg, foot and ankle is a challenge for orthopedic surgeons. These defects commonly occur as a result of trauma, infection and tumor excision. Sural artery neurovascular island flap is a relatively thin, pliable and insensate flap with minimum donor-site morbidity and acceptable aesthetic outcome. Methods A retrospective analysis of a case series was conducted, all operated by a single surgeon over a period of 25 years from July 1996 to February 2020. Data were collected through a structured proforma; the variables included were as follows: demographic data, mechanism of injury, defect site and size, size of flap, hospital stay, complications, outcome of flap and functional status of limb. Data analysis was performed by using SPSS version 25.0. Results We included 89 patients out of 106, with 92 distally based sural artery flaps. The flap coverage was divided in two groups: group I for leg (n=41) and group II for foot (n=51). The mean flap dimension in leg was 9.98 ± 2.2 cm and 12.15 ± 3 cm in foot. Postoperatively functional outcomes were assessed using a self-designed tool and graded as excellent in 79 cases (leg=38; foot=41), good in 10 cases (leg=2; foot=8), fair in 3 cases (leg=1; foot=2) and poor in zero cases. All flaps survived uneventfully. Conclusion The reverse sural artery flap is versatile and reliable, and can be performed easily with good knowledge and using a microsurgical technique. It is useful for the reconstruction of soft tissue defects around the lower third of the leg, dorsum of the foot, malleoli and hind foot. The functional range of motion of the ankle is not compromised because of the flap's supple and pliable nature. The reverse sural artery flap is ideal for the coverage of the foot, ankle and lower one third of the leg. This flap is insensate and not suitable for the weight-bearing area of the heel.

Intrauterine undernutrition may lead to fetal vascular programming. We compared abdominal aortic intima-media thickness (aIMT) and aortic diameter (aD) between appropriate for gestational age (AGA) and growth-restricted fetuses (GRF). We recruited 136 singleton fetuses at 34–37 weeks of gestation from Fetal Medicine Unit of Aga Khan University Hospital, Karachi (January–November 2017). Subjects were classified as AGA (n = 102) and GRF (n = 34) using INTER-GROWTH 21st growth reference and standard ultrasound protocol. Their far- and near-wall aIMT and aD were compared after adjustment of maternal age, first-trimester body mass index, fetal gender, hypertension and hyperglycemia in pregnancy. As the severity of growth restriction increased in GRF, aIMT and aD showed an increasing and a decreasing trend, respectively. Both far- and near-wall aIMT in GRF [(adj. β = 0.082, 95% confidence interval [CI] 0.042–0.123) and (adj. β = 0.049, 95% CI 0.010–0.089)] were significantly greater with reference to AGA fetuses. GRF subgroup analysis into small for gestational age (SGA) fetuses and intrauterine growth restricted (IUGR) revealed highly significant difference between AGA and IUGR for far (0.142 mm, P-value < 0.001) and near-wall aIMT (0.115 mm, P-value < 0.001) and marginally significant aD difference (0.51 mm, P-value 0.05). These findings suggest that the extent of fetal aortic remodelling is influenced by the severity of growth restriction. Hence, the targeted interventions for the cardiovascular health promotion of IUGR and SGA born neonates are desirable during early childhood, particularly in set ups with high prevalence of low birth weight babies.

Purpose of review Hyperlipidaemia is associated with the development of neuropathy. Indeed, a mechanistic link between altered lipid metabolism and peripheral nerve dysfunction has been demonstrated in a number of experimental and clinical studies. Furthermore, post hoc analyses of clinical trials of cholesterol and triglyceride-lowering pharmacotherapy have shown reduced rates of progression of diabetic neuropathy. Given, there are currently no FDA approved disease-modifying therapies for diabetic neuropathy, modulation of lipids may represent a key therapeutic target for the treatment of diabetic nerve damage. This review summarizes the current evidence base on the role of hyperlipidaemia and lipid lowering therapy on the development and progression of peripheral neuropathy. Recent findings A body of literature supports a detrimental effect of dyslipidaemia on nerve fibres resulting in somatic and autonomic neuropathy. The case for an important modulating role of hypertriglyceridemia is stronger than for low-density lipoprotein cholesterol (LDL-C) in relation to peripheral neuropathy. This is reflected in the outcomes of clinical trials with the different therapeutic agents targeting hyperlipidaemia reporting beneficial or neutral effects with statins and fibrates. The potential concern with the association between proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor therapy and cognitive decline raised the possibility that extreme LDL-C lowering may result in neurodegeneration. However, studies in murine models and data from small observational studies indicate an association between increased circulating PCSK9 levels and small nerve fibre damage with a protective effect of PCSK9i therapy against small fibre neuropathy. Additionally, weight loss with bariatric surgery leads to an improvement in peripheral neuropathy and regeneration of small nerve fibres measured with corneal confocal microscopy in people with obesity with or without type 2 diabetes. These improvements correlate inversely with changes in triglyceride levels. Summary Hyperlipidaemia, particularly hypertriglyceridemia, is associated with the development and progression of neuropathy. Lipid modifying agents may represent a potential therapeutic option for peripheral neuropathy. Post hoc analyses indicate that lipid-lowering therapies may halt the progression of neuropathy or even lead to regeneration of nerve fibres. Well designed randomized controlled trials are needed to establish if intensive targeted lipid lowering therapy as a part of holistic metabolic control leads to nerve fibre regeneration and improvement in neuropathy symptoms.

The emergence of SARS-CoV-2 has been reported during December 2019, in the city of Wuhan, China. The transmission of this virus via human to human interaction has already been described. The novel virus has become pandemic and declared as a comprehensive emergency worldwide by World Health Organization due to its exponential spread within and outside China. There is a need of time to create a therapeutic agent and a vaccine to cure and control this lethal SARS-CoV-2. Conventionally, the vaccine development process is time taking, tiresome and requires more economical inputs with manpower. However, bioinformatics offers a key solution to compute the possibilities. The present study focuses on the utilization of bioinformatics platforms to forecast B and T cell epitopes that belong to SARS-CoV-2 spike glycoprotein. The protein is thought to have an involvement in triggering of momentous immune response. NCBI database was explored to collect the surface glycoprotein sequence and was analyzed to determine the immunogenic epitopes. This prediction analysis was carried out using IEDB web based server and the prediction of protein structure was done by homology modeling approach. This study resulted in prediction of 5 T cell and 13 B cell epitopes. Moreover, GPGPG linker was used to make these predicted epitopes a single peptide prior to further analysis. Afterwards, a 3D model of the final vaccine peptide was constructed, and the structure quality of the final construct was checked by Ramachandran Plot analysis and ProSA-web. Moreover, docking analysis highlighted three interactions of epitope against HLA-B7 including Lys 178, Gol 303 and Thr 31 residues. In conclusion, the predicted multi epitope peptide can be suggested as therapeutic or prophylactic candidate vaccine against SARS-CoV-2 after further confirmation by immunological assays.

Objective To characterize and investigate efficacy of loading functionalized ZrO2 nanoparticles in 3-dimensional (3D) printed acrylate ester-based resin subjected to accelerated aging in artificial saliva. As well as to evaluate the effect of ZrO2 nanoparticle volume fraction addition on mechanical and physical properties of printed composite. Methods Functionalized ZrO2 nanoparticles were characterized using TEM and Raman spectroscopy. 3D printed dental resin was reinforced, with ZrO2 nanoparticles, in the concentration range (0–5 wt.%). The resulted nanocomposites, in term of structure and physical/mechanical properties were evaluated using different mechanical testing, microscopic and spectroscopic techniques. Results ZrO2 based nanocomposite was successful and formed composites were more ductile. Degree of conversion was significant at the highest level with blank resin and 1 wt.%. Sorption revealed reduction associated with volume fraction significant to neat resin, however solubility indicated neat and 4 wt.% had the lowest significant dissolution. Vickers represented critical positive correlation with filler content, while nanohardness and elasticity behaved symmetrically and had the maximum strength at 3 wt.% addition. In addition, 3 wt.% showed the highest fracture toughness and modulus. Improvement of flexural strength was significantly linked to filler concentration. Overall properties dramatically were enhanced after 3 months aging in artificial saliva, especially degree of conversion, microhardness, nanoindentation/elasticity, and flexural modulus. However, significant reduction was observed with flexural modulus and fracture toughness. Significance The outcomes suggest that the newly developed 3D printed nanocomposites modified with ZrO2 nanoparticle have the superior potential and efficacy as long-term provisional dental restoration materials.

Background: Previous studies have established the fact that diabetic patients are predominantly inclined towards silent myocardial infarction (SMI). The objective of the present study is to determine the incidence of SMI in diabetes mellitus (DM) patients. Methodology: In this cross-sectional study, patient data was gathered on a predesigned proforma regarding the detailed history of dyspnea, DM and its duration, chest pain either present or not. Those patients who had normal ECG labeled negative for SMI, while those who had either ST-segment elevation or ST-segment deviation on resting ECG were positive for SMI. Study was conducted at the National Institute of Cardiovascular Diseases (NICVD) Karachi- Pakistan. Results: The mean age of the enrolled patients was 54.21±8.65 (40-70) years. Out of 210, majority were female (51.90%).Overall, 94(44.76%) patients were obese, 122(58.09%) were hypertensive, 90(42.85%) had dyslipidemia and 98(46.66%) diabetic patients were smokers. There were 93 (44.3%) DM patients who had SMI. Moreover, 109(51.90%) patients had a family history of myocardial ischemia. Conclusion: The SMI incidence among diabetic patients was found higher in local population. It is proposed that diabetic patients with demonstrated cardiovascular autonomic neuropathy must be screened for the manifestation of SMI.

Objective The removal of residual pulpal debris (RPD) from the root canal walls, especially in necrotic teeth is important for successful endodontic outcome. The aim of this study was to evaluate the RPD removal efficacy of handpiece mounted continuous irrigation with simultaneous root canal preparation from the apical third of root canals as compared to conventional syringe irrigation (SI). Materials and Methods Ninety extracted teeth were randomly divided into three groups: SI; handpiece mounted continuous irrigation (CI); and both syringe and continuous irrigation (CI+SI). After root canal preparation, roots were sectioned at 1 (a), 3 (b) and 5 (c) mm from apex and prepared for Hematoxylin-Eosin staining. Sections were microscopically examined for presence of RPD. Statistical Analysis Intergroup difference in average percentage of RPD at different root levels was calculated by using analysis of variance test (ANOVA). Tuckey test was used for pairwise comparison. Results ANOVA showed significant difference between all three groups (p < 0.05). SI group showed a significantly higher percentage of RPD as compared with CI and CI+ SI groups at all root levels (p < 0.01). At root level a, CI showed a significantly higher percentage of RPD as compared with CI+SI (p < 0.01). Conclusion Handpiece mounted CI during rotary instrumentation showed a significant reduction in RPD as compared with conventional syringe irrigation. This technique was found to be an effective method for an enhanced root canal debridement.

A series of novel theophylline-7-acetic acid (acefylline)-derived 1,2,4-triazole hybrids with N-phenyl acetamide moieties (11a–j) have been synthesized and tested for their inhibitory (in vitro) potential against two cancer cell lines, A549 (lung) and MCF-7 (breast), using MTT assay. Among these derivatives, 11a, 11c, 11d, 11g, and 11h displayed remarkable activity against both cancer cell lines having cell viability values in the 21.74 ± 1.60–55.37 ± 4.60% range compared to acefylline (86.32 ± 1.75%) using 100 μg/μL concentration of compounds. These compounds were further screened against the A549 cancer cell line (lung) to find their half-maximal inhibitory concentration (IC50) by applying various concentrations of these compounds. Compound 11g (2-(5-((1,3-dimethyl-2,6-dioxo-2,3-dihydro-1H-purin-7(6H)-yl)methyl)-4-phenyl-4H-1,2,4-triazol-3-ylthio)-N-p-tolylacetamide) with the least IC50 value (1.25 ± 1.36 μM) was discerned as a strong inhibitor of cancer cell multiplication in both cell lines (A549 and MCF-7). Their hemolytic studies revealed that all of them had very low cytotoxicity. Finally, in silico modeling was carried out to find the mode of binding of the highly active compound (11g), which was according to the results of anti-cancer activity.

Reactivation of cytomegalovirus (CMV) in immunocompetent patients may lead to increase morbidity and mortality. A clinical suspicion allows timely diagnosis, treatment, and favorable outcome. In a subject without apparent risk factors for acute myocardial infarction (AMI), CMV can be a possibility., CMV inclusion within an endothelial cell, lining the mucosal capillary within the ulcer base's granulation tissue

In 2016, based on recommendations of the American Association of Blood Banks (AABB), Choosing Wisely Canada released transfusion guidelines for patients with Iron Deficiency Anemia. The goal of the present study was to examine the number of transfusions given in Calgary emergency departments (EDs) before and after the release of these guidelines. We analyzed 11,786 anemia encounters from January 2014 to December 2019. A transfusion was considered potentially avoidable if the patient’s hemoglobin was > 70 g/L and if the patient was hemodynamically stable. We used time-series analyses to examine change in rate of total and potentially avoidable transfusions quarterly over the total and pre and post intervention periods. In total, 1409/11,786 (12.0%) of the encounters received transfusions; 80.0% (1127/1409) were indicated while 19.9% (281/1409) were potentially avoidable. In the pre-intervention period, the rate of potentially avoidable transfusions was 21.5% (133/618) and in the post-intervention period, the rate of potentially avoidable transfusions was 18.7% (148/791). The rate of potentially avoidable transfusions decreased quarterly at a rate of 0.3% which did not reach statistical significance (p = 0.06). Our data suggest that the number of potentially avoidable transfusions has not decreased since the release of Choosing Wisely Canada guidelines and local educational initiatives. This may be due to the fact that there is a pre-existing down trend in the number of transfusions provided.

Objective: To determine the frequency of dyslipidemia and its types in adult diabetics of Karachi. Study Design: Cross Sectional, Observational study. Setting: Diabetic Outpatient Clinic in JPMC, Karachi. Period: January 2019 to June 2019. Material & Methods: 248 adult diabetics presenting in diabetic outpatient clinic in JPMC, Karachi selected by non-purposive convenient sample technique. Diagnosed diabetics who were not on any lipid lowering therapy were included in the study. Non diabetics and those diabetics who are already on lipid lowering drugs were excluded. After relevant information is taken the lipid profile of the participants was done with a 12 hours fasting and the data was secured on a pre-designed performa. The results were analyzed on SPSS. Results: Among the 248 diabetics that presented 88(35.4%) were males and 160(64.5%) were females. The prevalence of dyslipidemia is 85.9% (213 diabetics had dyslipidemia). High triglycerides were present in 52.4% (130), high LDL in 28.2% (70) and low HDL in 175(70.6%). [P=0.000]. At least one dyslipidemic factor was deranged in 81(32.7%), two in 102(41.1%) and 3 in 30(12.1%) persons. In males, 53 out of 88(60.2%) were dyslipidemic, and in females all had dyslipidemia (100%). [P = 0.000]. Hypertriglyceridemia was present in 38(43.1%) males and 92(57.5%) females [P=.021], High LDL in 21(23.8%) males and 49(44%) females [P=.163], while low HDL was present in 16(22%) males and 159(99%) females [P=.000]. Conclusion: Dyslipidemia is highly prevalent in our population. Female diabetic patients had relatively higher triglycerides than men.

Transient elastography (TE) provides accurate quantification of liver fibrosis. Its usefulness could be significantly amplified in terms of predicting liver-associated clinical events (LACE). Our aim was to create a model that accurately predicts LACE by combining the information provided by TE with other variables in patients with chronic liver disease (CLD). We retrospectively reviewed the electronic medical records of patients who underwent liver elastography, at John H. Stroger Hospital in Cook County, Chicago, IL. The incidences of LACE were documented including decompensation of CLD, new hepatocellular carcinoma, and liver-associated mortality. Significant predicting factors were identified through a forward stepwise Cox regression model. We used the beta-coefficients of these risk factors to construct the Cook Score for prediction of LACE. Receiver-operating characteristic (ROC) curves were plotted for Cook Score to evaluate its efficiency in prediction, in comparison with MELD-Na Score and FIB-4 Score. A total of 3097 patients underwent liver elastography at our institution. Eighty-eight LACE were identified. Age (hazard ratio (HR) 1.04, p = 0.002), aspartate aminotransferase to alanine aminotransferase ratio (HR 2.61, p

Left-sided abdominal pain is an uncommon presentation of acute appendicitis. When a patient presents with this complaint, appendicitis can be difficult to diagnose, thus resulting in delayed definitive therapy and increased morbidity and mortality. In this report we discuss the case of a middle-aged man, who presented with left-sided abdominal pain, and was diagnosed to be suffering from acute appendicitis along with asymptomatic midgut malrotation.

Objective: The aim of this study was to determine the frequency of radial artery occlusion (RAO) in patients undergoing percutaneous cardiac catheterization. Study Design: Prospective study Place and Duration: The study was conducted at cardiology department of Cat A Hospital Batkhela and Fauji Foundation Hospital Peshawar for six months duration from January 2021 to June 2021. Methods: Total one hundred and forty patients of both genders were included in this study. Patients’ detailed demographics including age, sex and body mass index were recorded after taking informed written consent. Patients who underwent percutaneous cardiac catheterization were presented in this study. Hypertension, diabetes mellitus and smoking history were analyzed. Frequency of radial artery occlusion (RAO) was measured by Barbeau test. Chi square test and fisher test was used to measure prevalence of RAO with respect to comorbidities. Complete data was analyzed by SPSS 23.0 version. Results: There were 100 (71.4%) male patients and 40 (28.6%) patients were females. Mean age of the patients was 53.7±8.44 years with mean BMI 28.6±9.51 kg/m2. Mean height of the patients 167.5 ± 5.11 cm with mean weight 75.9±11.14 kg. Most common risk factor was hypertension found in 90 (64.3%) cases, followed by smokers 80 (57.14%) and diabetes mellitus 75 (53.6%). Prevalence of radial artery occlusion (RAO) was found among 25 (17.9%) cases, most of them were females. Prevalence of RAO was most common among smokers 20 (80%) followed by diabetes mellitus 17 (68%) and hypertension 14 (56%). Conclusion: We concluded in this study that frequency of radial artery occlusion (RAO) was 17.9% among patients undergoing percutaneous cardiac catheterization. Hypertension, smoking and diabetes were the most common risk factors among all these cases. To achieve long-term patency of the radial artery in patients with high predictors of RAO, meticulous management and close follow-up are essential. Keywords: Cardiac Catheterization, Radial Artery Occlusion (RAO), DM, HTN, Smoking

Avian coccidiosis is an important parasitic disease of birds, caused by genus Eimeria, and having great economic importance. The estimated global economic loss due to coccidiosis is up to US$3 bill...

Introduction: Afghan refugees in Pakistan is the third largest refugee community in the world. However, till date, information about their oral health and disease burden is very limited. The current is aimed to assess self-reported oral health status, practices, dental care access and associated factors among Afghan refugees in district Peshawar, Pakistan. Material & Methods: This pilot, cross sectional study was conducted on 644 adult Afghan refugees residing in district Peshawar from June to September 2020. Socio-demographic characteristics and data on selfreported oral health status, oral hygiene habits and dental care access was collected using self-reported oral health questionnaire. Statistical tests were applied to determine association between self-reported oral health status and participants characteristics using SPSS. Results: Of all the respondents, majority (79.3%) were Pashtun by ethnicity and 41.6% did not obtain any formal education. Nearly all (97.2%) of them reported cleaning their teeth regularly, at least once a day with tooth brush and tooth paste being the commonest cleansing agents. More than half participants (58.1%) rated their oral health good/very good and 68.0% were satisfied with their dental appearance. Tooth ache and sensitivity were the most commonly reported oral problems. 28.7% of the participants never visited dentist in their life. Most of the participants (82.6%) felt need of dental care in the past one year but could not get it due to financial constraints. Significant association were found between self-rated oral health and age, marital status, country of birth, formal education and dentist visit (p < 0.05). Conclusion: Afghan refugees in Pakistan have poor self-reported oral health status. Access to dental care and oral health promotion and educations programs are crucial to improve oral health of this vulnerable population.