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This paper presents the results from 92 fire load density surveys conducted in 52 office buildings of Pakistan. The combination method of surveying that includes both inventory and weighing methods is used to determine the fire load of 92 office rooms, including 44 private and 48 government offices. Multiple linear regression analysis techniques are applied to assess the relationship of Fire Load Density (FLD) with variables according to the characteristics of the office rooms, such as office type, category, combustible materials, room dimensions, and ventilation conditions. Probabilistic models for FLD are developed using the regression analysis of the survey data. The survey data is further used to determine the maximum fire intensity in office buildings in Pakistan. The survey results show that the FLD increases with the increase in the area of the office. The percentage of wood is found to be the most contributing factor in the fire load. It has been noted that the fire load values are different for government and private offices, whereas the Building Code of Pakistan (BCP) has the same value for both. Statistical results presented in this study will be helpful in the fire safety and fire-resistant structure design of buildings in Pakistan. [ABSTRACT FROM AUTHOR]

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Endemic flora is the bio-assets of a country being medicinally important with economic potential. But unfortunately, these plants are endangered and may become extinct because of their limited geographic distribution and small population size. DNA barcoding is one mong the prime steps for the conservation of a threatened species. Anemone obtusiloba var. potentilloides (Camb. ex Berant.) Lauener is an endemic plant species belonging to the family Ranunculaceae. The main aim of this study was to find the most effective DNA barcode regions for species identification and authentication. In this study, we used four DNA barcode markers (matK, rbcL, trnH-psbA and ITS) to explore their effectiveness and efficacy for correct identification of Anemone obtusiloba var. potentilloides. We examined their efficacy on the bbasisof amplification and sequencing success rate. The data was analysed by BLAST sequence similarity, TAXONDNA, and the Neighbour Joining Tree Method. The universal DNA barcode markers namely rbcL trnH-psbA and ITS had shown good amplification and sequence rate while matK remained challengeable. After evaluation of the candidate barcodes, only rbcL region had shown the highest number of variable sites (1142) as compared to other barcodes. Similarly, rbcL came up with the highest score of species identification with 98% and 80.55% in BLAST and TAXONDNA analyses respectively. In cladding analysis, the highest model support was in rbcL having the highest bootstrap value as 89% with its relative species. The finding of the current study supports rbcL as the best DNA barcode for the identification of Anemone obtusiloba var. potentilloides. Moreover, other candidate barcodes were not found efficient for correct identification of the species. This work has useful applications in the field of biodiversity conservation. [ABSTRACT FROM AUTHOR]

Ethnoecological knowledge refers to the local wisdom, innovations, traditional life style and practices of aboriginal communities. This knowledge also contributes a lot to understanding of conservation stata of culturally significant flora of a region. The present research work is the first one to focus on this particular aspect of cultural knowledge to assessing preliminary conservation status of 295 culturally significant plant species of district Tor Ghar. In such remote and less privileged areas interaction between plants and people is much stronger. Multistage random selection of 700 informants was made. The data was obtained through EPA, group discussion and semi structured interviews. The conservation status of all culturally significant plant species were assessed quantitatively by developing a new special mathematical relation that is CS = K (OC + AV + CE)/TF × RP. A scale was devised on the basis of CS value index and all 295 species were assigned to different IUCN categories. According to this classification 20 species were found critically endangered, 35 endangered, 56 vulnerable, 58 near threatened (rare) and 126 least concerned (secure). This categorization depicts a miniature of ethno-conservation of plants at local level. The current study leads to an enhanced understanding of cultural knowledge on mountain vegetation within the context of anthropogenic impacts and the role of indigenous communities in regional plant conservation strategies and future outlooks. [ABSTRACT FROM AUTHOR]

There must be unique indicator vegetation at Ecotonal Zone in the border region of Pakistan and Afghanistan. Keeping this hypothesis in mind the forest zone of District Kurram at Durand Line was ecologically surveyed. Stations were established, GPS readings, environmental gradients were recorded and soil samples were collected. Data was statistically analysed using PC-ORD version-5 and CANOCO version-4.5. Indicator Species Analysis (ISA), constancy and fidelity level were used to find indicator species of communities. Preliminary results showed that study area hosts 195 vascular plant species belonging to 145 genera and 60 families. Cluster Analysis classified vegetation into four plant communities; (a) Elaeagnus angustifolia-Rosa chinensis-Seriphidium kurramense (b) Platanus orientalis- Rosa moschata - Epilobium hirsutum (c) Quercus baloot -- Jasminum auriculatum-Foeniculum vulgare (d) Quercus dilatata-Hedera nepalensis-Calamintha umbrosa. Nitrogen, Sodium and Potassium were the strongest Physico-chemical factors (P ≤ 0.05) determining plant communities composition. Interestingly, Vincetoxicum cardiostephanum was reported as narrow endemic species. Distinguished indicator species had significant environmental preferences. Variables like grazing and fodder chopping were the major vegetation drivers. Altitude was one of the most important determinants, influencing directly species distribution; Current study could be potentially used elsewhere for vegetation management and conservation strategies. [ABSTRACT FROM AUTHOR]

The objectives of the present study were to explore, identify and document Pyrus (pears) species from Pakistan, their screening and recommendation for further breeding program. Extensive surveys were conducted during 2010-2011 to identify and document Pyrus (Pears) from Pakistan. Plant specimens were collected, processed and identified. Using established floristic keys for different countries and literature, four new records of the genus Pyrus L. (Rosaceae) viz., P. ussuriensis, P. armeniacifolia, P. hopeiensis and P. communis are reported for the flora of Pakistan. The detailed morphological description, flowering and fruiting duration, ecological notes, distribution, GPS coordinates, altitudes and voucher specimens of the taxa are reported in this paper, along with images, distribution map and a table of comparative differentiating characters of these taxa. [ABSTRACT FROM AUTHOR]

Citrus is the most valuable fruit industry in the world as well as in Pakistan, due to its different nutritional aspects. But this fruit industry is facing huge losses due to various biotic and abiotic diseases. Citrus gummosis caused by water loving fungus Phytophthora species is also one of the major diseases of citrus around the globe. This study was conducted to evaluate five different chemicals (Kasumin, Evito, Cabrio top, Topsin M, Kocide @ 100, 200 and 300 ppm concentrations) and three treatments of plant based nanoparticles (Silver, Copper and their combination @ 0.25, 0.5 and 1% concentrations) against Phytophthora spp. under lab conditions through poisoned food technique. Among fungicides, the least mycelial growth was observed by application of Evito at 300 ppm concentration followed Kasumin and Kocide at same concentration, whereas among nanoparticles combination of Silver and Copper nanoparticles was found most effective against the mycelial growth followed by solo application of silver and copper at 1 % concentration respectively. [ABSTRACT FROM AUTHOR]

A comprehensive, one year planed study was conducted to uncover the deviation of the zinc status in soil, forages, feed resources and blood plasma of lactating and non-lactating Nili Ravi buffaloes through the changing seasons of Thal Irrigated Canal Zone (Khushab district) of Punjab, Pakistan. According to preparation, the zone was divided into five randomly selected sites and representative samples of soil, forages, feed resources and blood plasma were taken from each site and analyzed for zinc concentration. In soil, Non-significant (p>0.05) difference was found between the seasons and sites while overall concentration of zinc was found deficient for the normal plant growth. Results also indicated no significant effect of physiological stage (lactating and non lactating) on blood plasma concentration of zinc and they were found above the critical limit for normal physiological functions in both lactating and non lactating animals. Among the forages and feed resources, concentrations of zinc in rice straw, sugar cane tops and corn grains were found deficient, millet, maize, oat and sorghum forages marginally deficient but cotton seed cake, barseem and rapeseed forages were found within the normal range to fulfill the animal's need. Non-Significant (p>0.05) difference was found in blood Plasma for Zinc among the sites during the summer and winter season and between the both seasons. [ABSTRACT FROM AUTHOR]

The objective of this study was to estimate the seasonal dynamics of sodium, potassium and magnesium in soil, forage, feed, water and blood plasma of Nili Ravi buffalos at three different stages of lactation (early, mid and late) in Muzaffargarh district of Punjab, Pakistan. Samples were collected from five randomly selected sites of the studied area during winter and summer seasons over a period of one year. Results indicated that season significantly (P<0.05) affected the sodium and magnesium concentrations of soil and potassium and sodium value of blood plasma at different stages of lactation. Stage of lactation showed significant (P<0.05) effect on the concentrations of potassium and sodium in blood plasma except magnesium, which showed non-significant (P>0.05) effect. Locations also significantly (P<0.05) affected the concentrations of all the minerals in soils and buffalo's blood plasma at different stages of lactation during both seasons while sodium, potassium and magnesium concentrations of water showed non-significant (P>0.05) effect of season and location. Potassium and magnesium concentrations in blood plasma were found within the normal range during all the stages of lactation except sodium which was found below the critical limit for normal physiological functions during both summer and winter seasons. Sodium and potassium were deficient in soil for normal plant growth in both seasons and in most of the feed resources to fulfill animals' need except magnesium, which was found above the critical level in soil but deficient in feed resources. Study indicated severe deficiencies of sodium and potassium in soil, sodium in animal's blood plasma and all the studied minerals in most of the feed resources, which needs proper supplementation. [ABSTRACT FROM AUTHOR]

Selected trace elements (Zn, Cu and Fe) were analyzed in two age groups (0-6 months and 6-12 months of age) of growing buffalo calves along with their concentrations in soils and dietary sources during winter and summer seasons. Samples were collected from livestock farms of five different locations, which were randomly selected from rice grown region of Punjab, Pakistan. Results depicted that season showed non-significant (P>0.05) effect on the concentrations of trace elements in soils and blood plasma of both age groups except zinc and ferrous which illustrate the seasonal effect (P<0.05) in soils. Zinc and copper concentrations in soils were significantly (P<0.05) affected by location except copper which showed no effect of location in soil. Blood plasma analysis indicated significant (P<0.05) effect of age groups on mineral concentrations of zinc, copper and ferrous while no effect of location on both of the age groups except ferrous which showed significant (P<0.05) effect of location in age group of 6-12 months. Zinc was found deficient for normal plant growth in the soils of all the locations while copper and ferrous concentrations were within the normal range. Concentrations of ferrous were below the critical limit in blood plasma of both age groups but zinc and copper were found normal. Zinc and copper concentrations in feed resources were marginal to deficient in most of the feed resources to fulfill the animal's requirement while ferrous was found higher than requirement in all the feed resources. On the basis on these results, it is concluded that soils of the studied area was deficient in zinc while feed resources were deficient in all studied elements and need supplementation. [ABSTRACT FROM AUTHOR]

Black gram (Vigna mungo) is a principal pulse crop worldwide. The research aimed to screen the genetic diversity among 10 black gram genotypes using biometrical tools, such as, genotypic and phenotypic correlation, path coefficient analysis, and heritability and genetic gain. The highest genotypic and phenotypic variability resulted from pods per plant, plant height, primary branches, and seeds per pod. The study recorded very low estimated heritability for all the studied traits. The correlation coefficient indicated that seed yield per plant showed a positive and significant correlation with pods per plant and pod length, indicating that further use of these characteristics can improve the black gram yield. Path coefficient analysis revealed a positive and direct effect on seed yield per plant with plant height, days to 50% flowering, primary branches, branch length, pod per plant, and seeds per pod. These traits proved relevant for the direct selection criteria and future breeding programs. The investigation results can be very helpful in selecting the black gram's suitable genotypes with appropriate yield for cultivation in rainfed conditions of Poonch Rawalakot, Azad Jammu and Kashmir, Pakistan. [ABSTRACT FROM AUTHOR]

Gene mutations are a source of genetic instability which fuels the progression of cancer. Mutations in BRCA1 and BRCA2 are considered as major drivers in the progression of breast cancer and their detection indispensable for devising therapeutic and management approaches. The current study aims to identify novel pathogenic and recurrent mutations in BRCA1 and BRCA2 in Pakhtun population from the Khyber Pakhtunkhwa. To determine the BRCA1 and BRCA2 pathogenic mutation prevalence in Pakhtun population from KP, whole exome sequencing of 19 patients along with 6 normal FFPE embedded blocks were performed. The pathogenicity of the mutations were determined and they were further correlated with different hormonal, sociogenetic and clinicopathological features. We obtained a total of 10 mutations (5 somatic and 5 germline) in BRCA1 while 27 mutations (24 somatic and 3 germline) for BRCA2. Five and seventeen pathogenic or deleterious mutations were identified in BRCA1 and BRCA2 respectively by examining the mutational spectrum through SIFT, PolyPhen-2 and Mutation Taster. Among the SNVs, BRCA1 p.P824L , BRCA2 p. P153Q, p.I180F, p.D559Y, p.G1529R, p.L1576F, p.E2229K were identified as mutations of the interaction sites as predicted by the deep algorithm based ISPRED-SEQ prediction tool. SAAFEQ-SEQ web-based algorithm was used to calculate the changes in free energy and effect of SNVs on protein stability. All SNVs were found to have a destabilizing effect on the protein. ConSurf database was used to determine the evolutionary conservation scores and nature of the mutated residues. Gromacs 4.5 was used for the molecular simulations. Ramachandran plots were generated using procheck server. STRING and GeneMania was used for prediction of the gene interactions. The highest number of mutations (BRCA1 7/10, 70 %) were on exon 9 and (BRCA2, 11/27; 40 %) were on exon 11. 40 % and 60 % of the BRCA2 mutations were associated Grade 2 and Grade 3 tumors respectively. The present study reveals unique BRCA1 and BRCA2 mutations in Pakhtun population. We further suggest sequencing of the large cohorts for further characterizing the pathogenic mutations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: Congenital heart defects (CHDs) are the heart structural malformations present at birth. Septal defects account for 40% of CHD, including atrial, ventricular and atrioventricular septal defects. In Pakistan, the prevalence of CHD is 3.4 in 1000, and a study estimated that 60,000 babies are born with CHD annually. Methylenetetrahydrofolate reductase (MTHFR), a chief enzyme, involved in the folate metabolism. The missense mutation, C677T (rs1801133), exists in MTHFR gene, results in a MTHFR thermolabile variant having low enzymatic activity. The study is aim to identify the MTHFR C677T variant association with septal defects., Methods: Samples of 194 CHD patients (age [Formula: see text]= 5.8 ± 5.1) and 50 normal echo controls (age [Formula: see text]= 6.0 ± 4.9), confirmed by pediatric consultant, were collected. Extracted DNA, quantified by agarose gel electrophoresis and nanodrop, was screened for SNP by high-resolution melting (HRM). Further, HRM results were confirmed using restriction analysis and sequencing. HRM was simply and precisely genotyped the samples within 3 h at low cost., Results: Genotypic data suggested that heterozygous mutant (CT) was frequent in congenital septal defect patients (0.26) which was higher than controls (0.143), p > 0.05. Mutant (TT) genotype was not found in this study., Conclusions: rs1801133 has lack of significant association with congenital septal defects. The absence of TT genotype in this study suggesting the role of natural selection in targeted population. HRM is an easy, fast and next generation of PCR, which may be used for applied genomics., (© 2024. The Author(s).)

Objective: To study the level of physical activity of Pakistani labourers in Saudi Arabia, and to find its relationship with body mass index., Methods: The observational study was conducted inside the Pakistan Embassy in Riyadh, Saudi Arabia, from October 2017 to March 2018, and comprised Pakistani males aged 22-60 years doing unskilled and semi-skilled jobs. Body mass index was calculated, and the level of physical activity was assessed using the short form of International Physical Activity Questionnaire. Data was analysed using SPSS 20., Results: There were 130 subjects with mean age of 33.53±7.9 years. There were 109(83.8%) subjects aged <40 years, and 21(16.2%) were aged >40 years. Mean body mass index of the sample was 26.13±5.29kg/m². Overall, 71(54.6%) participants were insufficiently active having energy expenditure <600 metabolic equivalent of task in minutes per week. No statistically significant result was found when total energy expenditure was considered (p>0.05), but significant result was found for energy expenditure due to 'walk alone' (p<0.05). Significant correlation was found between profession and overall energy expenditure and job-related energy expenditure. Significant but weak positive correlation was found between body mass index and walk-related energy expenditure (r=0.279), (p<0.001)., Conclusions: Mean body mass index of the sample was high compared to South Asian cut-off values, and the level of physical activity was very low, but the findings failed to show an inverse relationship between physical activity level and body mass index.

The aim of this study was to estimate the size at first sexual maturity (Lm) for 36 species belonging to 24 families from the marine habitat of Balochistan and Sindh in Arabian Sea, Pakistan through maximum length based an empirical and logistic model using commercial catch during June 2020 to May 2021. Individual total length (TL) was noted up to 0.1 cm using measuring broad. The Lm was calculated using two formulae; (i) log (Lm) = - 0.1246 + 0.9924 * log (Lmax) for Elasmobranchs and (ii) log (Lm) = -0.1189 + 0.9157* log (Lmax) for ray-finned fishes. The minimum Lm was recorded as 10.27 cm TL for Caranx malabaricus and 108.38 cm TL for Isurus oxyrinchus, respectively. Around Lm with 58.33% species were ranges from 19.00 cm to 25.00 cm TL. This study was estimated 16 newly Lm which is globally absent and rest 20 Lm are absent in the Arabian Sea (Pakistan coastal habitats). Therefore, the results will be helpful for the sustainable management and conservation of these marine fishes through the establishment of mesh size of trawl nets based on the size at sexual maturity (Lm).

Background: The high prevalence of tobacco use in Pakistan poses a substantial health and economic burden to Pakistani individuals, families, and society. However, a comprehensive assessment of the key risk factors of tobacco use in Pakistan is very limited in the literature. A better understanding of the key risk factors of tobacco use is needed to identify and implement effective tobacco control measures., Objectives: To investigate the key socioeconomic, demographic, and psychosocial determinants of tobacco smoking in a recent large nationally representative sample of Pakistani adults., Methods: N = 18,737 participants (15,057 females and 3680 males) from the 2017-18 Pakistan Demographic Health Survey, aged 15-49 years, with data on smoking use and related factors were included. Characteristics of male and female participants were compared using T-tests (for continuous variables) and χ2-tests (for categorical variables). Multivariable logistic regression models were used to identify gender-specific risk factors of tobacco use. The Receiver Operating Characteristic Curve test was used to evaluate the predictive power of models., Results: We found that the probability of smoking for both males and females is significantly associated with factors such as their age, province/region of usual residence, education level, wealth, and marital status. For instance, the odds of smoking increased with age (from 1.00 [for ages 15-19 years] to 3.01 and 5.78 respectively for females and males aged 45-49 years) and decreased with increasing education (from 1.00 [for no education] to 0.47 and 0.50 for females and males with higher education) and wealth (from 1.00 [poorest] to 0.43 and 0.47 for richest females and males). Whilst the odd ratio of smoking for rural males (0.67) was significantly lower than that of urban males (1.00), the odds did not differ significantly between rural and urban females. Finally, factors such as occupation type, media influence, and domestic violence were associated with the probability of smoking for Pakistani females only., Conclusions: This study identified gender-specific factors contributing to the risk of tobacco usage in Pakistani adults, suggesting that policy interventions to curb tobacco consumption in Pakistan should be tailored to specific population sub-groups based on their sociodemographic and psychosocial features., (© 2022. The Author(s).)

Northwest Pakistan has served as a point of entry to South Asia for different populations since ancient times. However, relatively little is known about the population genetic history of the people residing within this region. To better understand human dispersal in the region within the broader history of the subcontinent, we analyzed mtDNA diversity in 659 and Y-chromosome diversity in 678 individuals, respectively, from five ethnic groups (Gujars, Jadoons, Syeds, Tanolis and Yousafzais), from Swabi and Buner Districts, Khyber Pakhtunkhwa Province, Pakistan. The mtDNAs of all individuals were subject to control region sequencing and SNP genotyping, while Y-chromosomes were analyzed using 54 SNPs and 19 STR loci. The majority of the mtDNAs belonged to West Eurasian haplogroups, with the rest belonging to either South or East Asian lineages. Four of the five Pakistani populations (Gujars, Jadoons, Syeds, Yousafzais) possessed strong maternal genetic affinities with other Pakistani and Central Asian populations, whereas one (Tanolis) did not. Four haplogroups (R1a, R1b, O3, L) among the 11 Y-chromosome lineages observed among these five ethnic groups contributed substantially to their paternal genetic makeup. Gujars, Syeds and Yousafzais showed strong paternal genetic affinities with other Pakistani and Central Asian populations, whereas Jadoons and Tanolis had close affinities with Turkmen populations from Central Asia and ethnic groups from northeast India. We evaluate these genetic data in the context of historical and archeological evidence to test different hypotheses concerning their origins and biological relationships., (© 2022. The Author(s).)

The present study involves the chemical and bacteriological analysis of water from different sources i.e., bore, wells, bottle, and tap, from Peshawar, Mardan, Swat and Kohat districts of Khyber Pakhtunkhwa (KP) province, Pakistan. From each district, 50 water samples (10 samples from each source), regardless of urban and rural status, were collected from these sources and analysed for sulphates, nitrates, nitrites, chlorides, total soluble solids and coliforms (E. coli). Results indicated that majority of the water sources had unacceptable E. coli count i.e.> 34 CFU/100mL. E. coli positive samples were high in Mardan District, followed by Kohat, Swat and Peshawar district. Besides this, the some water sources were also chemically contaminated by different inorganic fertilizers (nitrates/nitrites of sodium, potassium) but under safe levels whereas agricultural and industrial wastes (chloride and sulphate compounds) were in unsafe range. Among all districts, the water quality was found comparatively more deteriorated in Kohat and Mardan districts than Peshawar and Swat districts. Such chemically and bacteriologically unfit water sources for drinking and can cause human health problems.

Objective: To compare the characteristics of connective tissue disease-associated interstitial lung disease with idiopathic pulmonary fibrosis at a tertiary care hospital., Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised demographical, clinical and radiological data of patients with interstitial lung disease between October 2016 and October 2017 accessed through the outpatient data registry. Data was compared in terms of characteristics and key features of patients with connective tissue disease-associated interstitial lung disease with those of idiopathic pulmonary fibrosis. Statistical analysis was done using STATA 12., Results: Of the 184 patients, 52(29.3%) had connective tissue disease-associated interstitial lung disease and 62(35%) had idiopathic pulmonary fibrosis. The most prevalent conditions among connective tissue disease-associated interstitial lung disease patients were rheumatoid arthritis 22(42.3%) and scleroderma 13(25%). Compared to patients with idiopathic pulmonary fibrosis, those with connective tissue disease-associated interstitial lung disease were predominantly younger (p<0.001) and female (p<0.001). History of gastroesophageal reflux disease was also significantly lower in connective tissue disease-associated interstitial lung disease (p=0.05)., Conclusions: Connective tissue disease-associated interstitial lung disease patients were found to be younger and predominantly female compared to patients of idiopathic pulmonary fibrosis.

With the emergence of modern genetic testing and profiling techniques, it has become imperative to assess the general public awareness and attitudes toward such developments. The public's perspective and possible responses are necessary for planning commercial, legal, medical, or healthcare initiatives. The purpose of this study was to assess the perception of the general public and professionals about the personal genome testing and genetic profiling. A questionnaire-based survey was conducted to investigate the attitudes of 2954 adults (56.4% male and 43.6% female) from more than 120 different educational, research, and professional organizations of Pakistan. The aim of the study was to assess interest in genomic testing. The findings of this survey will feed into the larger Genome Projects in Pakistan and will be helpful for the national bioethical committee, healthcare agencies, diagnostic companies, and other institutions for making policy decisions., (© 2021 John Wiley & Sons Ltd/University College London.)

Hepatitis C virus (HCV) is the serious global public health burden of liver disease. Approximately 170 million people in the world are infected with (HCV). In Pakistan, where the disease has high occurrence rate. The present study envisages an up-to-date prevalence of HCV and genotypic distribution in the general population of Mardan District, Khyber Pakhtunkhwa (KP), Pakistan. The blood samples from 6,538 individuals including 3,263 males and 3,275 females were analyzed for hepatitis C surface antigen by Immuno-chromatographic test (ICT), Enzyme-linked immunosorbent assay (ELISA), and reverse transcription-polymerase chain reaction (PCR). It was found that 396 (12.13%) out of 3263 individuals contained antibodies in their blood against HCV, while among the different age groups, the highest incidences of HCV antibodies were found in the 31-40 age group (11.01%). The ICT positive samples were further screened by nested PCR to determine the existence of active HCV-RNA. It was identified that 7.11% (3263) of the total population (6538) tested was positive, among which the 461 (14.07%) females possessed antibodies in their blood against HCV. Our data showed total HCV infection in the investigated population was 5.78%. Higher percentage of HCV prevalence was detected in males than females in the age group 31-40 and 41-50. To compare the prevalence of HCV genotypes age-wise in male and female genotype 3a was found most prevalent genotype followed by 1a, 2a and 3b, respectively.

Background: Since the first reports of COVID-19 infection, the foremost requirement has been to identify a treatment regimen that not only fights the causative agent but also controls the associated complications of the infection. Due to the time-consuming process of drug discovery, physicians have used readily available drugs and therapies for treatment of infections to minimize the death toll., Objective: The aim of this study is to provide a snapshot analysis of the major drugs used in a cohort of 1562 Pakistani patients during the period from May to July 2020, when the first wave of COVID-19 peaked in Pakistan., Methods: A retrospective observational study was performed to provide an overview of the major drugs used in a cohort of 1562 patients with COVID-19 admitted to the four major tertiary-care hospitals in the Rawalpindi-Islamabad region of Pakistan during the peak of the first wave of COVID-19 in the country (May-July 2020)., Results: Antibiotics were the most common choice out of all the therapies employed, and they were used as first line of treatment for COVID-19. Azithromycin was the most prescribed drug for treatment. No monthly trend was observed in the choice of antibiotics, and these drugs appeared to be a random but favored choice throughout the months of the study. It was also noted that even antibiotics used for multidrug resistant infections were prescribed irrespective of the severity or progression of the infection. The results of the analysis are alarming, as this approach may lead to antibiotic resistance and complications in immunocompromised patients with COVID-19. A total of 1562 patients (1064 male, 68.1%, and 498 female, 31.9%) with a mean age of 47.35 years (SD 17.03) were included in the study. The highest frequency of patient hospitalizations occurred in June (846/1562, 54.2%)., Conclusions: Guidelines for a targeted treatment regime are needed to control related complications and to limit the misuse of antibiotics in the management of COVID-19., (©Hashaam Akhtar, Samar Akhtar, Fazal-Ul Rahman, Maham Afridi, Sundas Khalid, Sabahat Ali, Nasim Akhtar, Yousef S Khader, Hamaad Ahmad, Muhammad Mujeeb Khan. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 27.05.2021.)

The COVID-19 outbreak started as pneumonia in December 2019 in Wuhan, China. The subsequent pandemic was declared as the sixth public health emergency of international concern on January 30, 2020, by the World Health Organization. Pakistan could be a potential hotspot for COVID-19 owing to its high population of 204.65 million and its struggling health care and economic systems. Pakistan was able to tackle the challenge with relatively mild repercussions. The present analysis has been conducted to highlight the situation of the disease in Pakistan in 2020 and the measures taken by various stakeholders coupled with support from the community to abate the risk of catastrophic spread of the virus., (©Hashaam Akhtar, Maham Afridi, Samar Akhtar, Hamaad Ahmad, Sabahat Ali, Sundas Khalid, Sajid Mahmood Awan, Shahzaib Jahangiri, Yousef Saleh Khader. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 19.05.2021.)

Pakistan is one of a few sites, associated with the earliest known independent domestication event in the evolutionary history of chicken, which is socio-economically and historically the most important poultry bird in the country. However, the divergence, past population dynamics, and demographic history of Pakistani chickens have not been addressed so far. Therefore, we herein investigated the indigenous Pakistani chickens using mitogenomic markers. We first prepared individual DNA samples from the chicken feathers, and generated nucleotide sequence data, which was then subjected to various population genetics analyses. In molecular phylogenetic analysis, the Pakistani chickens were clustered under nine different clades. Among the wild fowls, the Indian red jungle fowl (IRJF) shared very close affinities to Pakistani chickens. The Bayesian skyline plot showed an increase in the effective population size of Pakistani chickens during the last 50 years. Finally, a time-calibrated phylogeny inferred molecular divergence of the Pakistani chickens. A molecular rate of 3.6 × 10 -6 mutations/site/year (95% HPD interval: 2.28 × 10 -8 to 9.32 × 10 -6 ) was estimated for the data set. In a rooted tree with root-age of 12058 years (95% HPD interval: 1161-38411), the Pakistani chicken haplotypes showed divergence from IRJF haplotypes around 6987 years (95% HPD interval: 1132-20746) ago, and they shared their most recent common ancestor with Gallus gallus spadiceus , and G. g. jabouillei at the root of the tree. Overall, these results suggest that Pakistani chicken haplotypes share their ancestral gene pool with the IRJF as compared to other red jungle fowl subspecies.

Objective: To evaluate the direct and interactive role of personal and work-related factors in psychological burnout among doctors., Methods: The cross-sectional study was conducted in September, 2018, at three hospitals of the twin cities of Rawalpindi/Islamabad, Pakistan, and comprised doctors aged 24-49 years. Data was collected using a demographic questionnaire and the self-reporting Copenhagen Burnout Inventory. Data was analysed using SPSS 23., Results: Of the 161 doctors, 66(41%) were males and 96(59%) were female. The overall mean age of the sample was 26.44 4.80 years (range: 24-49 years). There was significant direct effect of work setting and indirect effect of gender and work setting on psychological burnout (p<0.05). Doctors experienced more burnout in emergency room settings compared to wards and outpatient departments (p<0.05). Further, young and low-salaried doctors were more prone to psychological burnout, and continuous working hours added to the adversity of burnout (p<0.05).., Conclusions: Personal and workplace related factors were found to play a significant role in psychological burnout which may possibly affect the overall efficiency of doctors.

The strategic location of Pakistan and its presence at the crossroads of Asia has resulted in it playing a central role in both prehistoric and historic human migratory events, thereby linking and facilitating contacts between the inhabitants of the Middle East, Central Asia, China and South Asia. Despite the importance of this region and its inhabitants for our understanding of modern human origins and population dispersals, the nature of mitochondrial DNA (mtDNA) variation among members of the myriad populations of this area has largely been unexplored. Here, we report mtDNA control region sequences in 58 individuals from the Khattak and the Kheshgi, two major Pakhtun tribes residing within the Peshawar Valley of northwestern Pakistan. The results reveal that these ethnic groups are genetically heterogeneous, having 55.7% West Eurasian, 33.9% South Asian and 10.2% East Asian haplogroups. The genetic diversity observed for the Kheshgi was somewhat higher than that of the Khattak. A multidimensional scaling plot based on haplogroup frequencies for the Khattak, Kheshgi and neighboring populations indicates that the Khattak have close affinities with Baluch, Uzbek and Kazak populations but are only distantly related to the Kheshgi and other Pakistani populations. By contrast, the Kheshgi cluster closely with other Pakhtun or Pathan populations of Pakistan, suggesting a possible common maternal gene pool shared amongst them. These mtDNA data allow us to begin reconstructing the origins of the Khattak and Kheshgi and describe their complex interactions with populations from the surrounding regions.

The primary malignancy of liver, known as hepatocellular carcinoma (HCC), comprises 9% of all hepatobiliary carcinomas. A steady rise has also been observed in adenocarcinoma (ADC) of the liver and ampullary carcinoma (AMC), ascending to 0.5% of gastrointestinal malignancies. Hepatobiliary carcinomas consist of 13% of all cancer occurrences worldwide. Purinergic receptor-based signaling holds the therapeutic potential based on its role in cell proliferation of several carcinomas. An altered ATP concentration in nanomoles may lead towards crucial changes in cancer growth patterns in liver tissue. A total of 40 tissue samples were collected (20 samples of HCC, 10 samples of ADC, and 10 samples of AMC) from patients that underwent surgery. P2X4 and P2X7 receptors exhibited significantly increased expression in HCC, ADC, and AMC samples as compared with the control tissue samples. While ADC and AMC samples showed higher expression of P2X4 and P2X7 than the control, statistically, HCC samples exhibited the most significant expression of both P2X4 and P2X7 receptors than control tissues. It may be inferred that higher expression of P2X4 and P2X7 receptors is significantly associated with the upregulated cellular stress leading to inflammation and it is plausible that both these receptors may be used in diagnostic, prognostic, and therapeutic tools for carcinoma studies in the future.

Despite the unique geographic, ethnic, social and cultural features of Kohistan in Pakistan, the origin and descent of Kohistanis remain still obscure. In an effort to address questions concerning the genetic structure, origin and genetic affinities of Kohistanis, we herein applied an ethnogenetic approach consisting on mitochondrial DNA (mtDNA) analysis and dental morphology analysis. We sequenced HVS1 of mtDNA, observed 14 haplotypes and assigned a total of 9 haplogroups belonging to macrolineages M (17%) and N (83%). Genetic diversity estimates in Kohistanis (Hd = 0.910 ± 0.014; Pi = 0.019 ± 0.001; θw = 0.019 ± 0.006) were similar to that of previous studies in other Pakistani populations. Overall, the analyses of dental morphology and mtDNA profile of Kohistanis resulted in similar findings. All the analyses indicate that Kohistanis share affinities to populations from Europe, Near East, Central Asia and South Asia. The Kohistani HVS1 haplotype 2 shares 100% identity to HVS1 haplotypes across the Europe. These results in light of recent insights into ancient genomics lead us to conclude that ancestry from Eurasian Steppe genetically linked Kohistanis to all these populations in the Bronze Age. This is consistent with linguistic evidence and also with the Indo-Aryan migration model for the peopling of South Asia., (Copyright © 2019 Elsevier B.V. and Mitochondria Research Society. All rights reserved.)

Genetic polymorphism of drug metabolizing enzymes and transporters may influence drug response. The frequency varies substantially between ethnicities thus having implications on appropriate selection and dosage of various drugs in different populations. The distribution of genetic polymorphisms in healthy Pakistanis has so far not been described. In this study, 155 healthy adults (98 females) were included from all districts of Karachi. DNA was extracted from saliva and genotyped for relevant SNVs in CYP1A1, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A4 and CYP3A5 as well as ALDH3A1, GSTA1, ABCB1 and ABCC2. About 64% of the participants were born to parents who were unrelated to each other. There was generally a higher prevalence (p < 0.05) of variant alleles of CYP450 1A2, 2B6, 2C19, 3A5, ALDH3A1, GSTM1 as well as ABCB1 and ABCC2 in this study cohort than in other ethnicities reported in the HapMap database. In contrast, the prevalence of variant alleles was lower in GSTA1. Therefore, in the Pakistani population sample from Karachi a significantly different prevalence of variant drug metabolizing enzymes and ABC transporters was observed as compared to other ethnicities, which could have putative clinical consequences on drug efficacy and safety.

Hepatitis is the principal cause of hepatocellular carcinoma (HCC) and decompensated cirrhosis. HCC is amongst the leading causes of deaths worldwide. Current therapeutic options have proven to be unsuccessful in treating this disease due to multifactorial nature of the disease. The present study was designed to investigate the role of IL-22 mediated survival of hepatocytes during cirrhosis and HCC. Resected/explanted liver tissue samples of patients with End Stage Liver Disease were obtained from Hepato-Pancreato-Biliary Liver Transplant Unit of Sheikh Zayed Hospital, Lahore, Pakistan. Qualitative expression of IL-22, SOCS3, and IL-22 induced anti-apoptotic protein, B-cell lymphoma extra-large (Bcl-xL), were evaluated by Immunohistochemical analysis (IHC). The IHC analysis revealed significantly high expression of IL-22, SOCS3, and Bcl-xL within explanted livers of HCC patients. Overall, the expression of SOCS3 was higher than any other protein, and the expression of all proteins showed significant variation in different group of patients based on clincopathological features. The results of the current study indicated that IL-22 mediated JAK-STAT pathway i.e. liver regeneration and healing is dependent on the disease progression and type of agent responsible for causing the infection in the first place. However, quantitative analysis of these factors in future can provide further evidence of the role of this pathway in HCC for development of anti-HCC therapies.

The large genus Leucoagaricus (Basidiomycota) is poorly studied in Pakistan, where the northern parts of the country are considered hot spots for biodiversity. Based on morphological and molecular data, five new species are described: Leucoagaricus badius, L. lahorensiformis, L. pakistaniensis, L. sultanii, and L. umbonatus. Descriptions and illustrations are given for the new taxa. A phylogeny based on morphology and four DNA regions, including the internal transcribed spacers (ITS1-5.8S-ITS2 = ITS) and D1-D2 domains of the 28S gene of the nuc rDNA, the gene for RNA polymerase II second largest subunit (RPB2), and the translation elongation factor 1-α gene (TEF1-α), shows that the new taxa are clustered in a clade representing Leucoagaricus section Rubrotincti subgenus Sericeomyces.

Objective: To determine the frequency distribution of dengue fever during the 2014 outbreak in a district in northern Pakistan., Methods: This cross-sectional study was conducted between June and November, 2014, at Saidu Sharif Teaching Hospital, Swat, Pakistan, where patients were screened for dengue virus non-structural protein using Dengue Duo strips from Standard Diagnostics (SD). Data was obtained from patient's record, filled forms and through questionnaire., Results: Of the total 812 patients, 290(35.71%) tested positive for dengue virus non-structural protein, of whom 175(60.34%) were males and 115(39.66%) were females. Overall, 146(50.34%), cases were recorded in the 16-30 age group, while 7(2.41%) were reported in those aged >60 years. The highest numbers of cases were recorded from Faizabad 84(28.96%), whereas the lowest numbers of cases 42(14.48%) were reported from Sethi Amankot., Conclusions: Dengue virus affected male individuals more compared to female. The affected areas had poor drainage and water storage system.

The ethnic groups that inhabit the mountainous Dir and Swat districts of northern Pakistan are marked by high levels of cultural and phenotypic diversity. To obtain knowledge of the extent of genetic diversity in this region, we investigated Y-chromosomal diversity in five population samples representing the three main ethnic groups residing within these districts, including Gujars, Pashtuns and Kohistanis. A total of 27 Y-chromosomal short tandem repeats (Y-STRs) and 331 Y-chromosomal single nucleotide polymorphisms (Y-SNPs) were investigated. In the Y-STRs, we observed very high and significant levels of genetic differentiation in nine of the 10 pairwise between-group comparisons (R ST 0.179-0.746), and the differences were mirrored in the Y-SNP haplogroup frequency distribution. No genetic differences were found between the two Pashtun subethnic groups Tarklanis and Yusafzais (R ST = 0.000). Utmankhels, also considered Pashtuns culturally, were not closely related to any of the other population samples (R ST 0.451-0.746). Thus, our findings provide examples of both associations and dissociations between cultural and genetic legacies. When analyzed within a larger continental-scale context, these five ethnic groups fall mostly outside the previously characterized Y-chromosomal gene pools of the Indo-Pakistani subcontinent. Male founder effects, coupled with culturally and topographically based constraints upon marriage and movement, are likely responsible for the high degree of genetic structure in this region., (© 2017 John Wiley & Sons Ltd/University College London.)

Background: The International Quality Improvement Collaborative (IQIC) was formed to reduce mortality and morbidity from congenital heart disease (CHD) surgeries in low/middle-income countries., Objectives: We conducted this study to compare the postoperative outcomes of CHD surgeries at a centre in Pakistan before and after joining IQIC., Methods: The IQIC provides guidelines targeting key drivers responsible for morbidity and mortality in postoperativepatients with CHD. We focused primarily on nurse empowerment and improving the infection control strategies at our centre. Patients with CHD who underwent surgery at this site during the period 2011-2012 (pre-IQIC) were comparedwith those getting surgery in 2013-2014 (post-IQIC). Morbidity (major infections), mortality and factors associated with them were assessed., Results: There was a significant decrease in surgical site infections and bacterial sepsis in the post-IQIC versus pre-IQIC period (1% vs 30%, p=0.0001, respectively). A statistically insignificant decrease in the mortality rate was also noted in post-IQIC versus pre-IQIC period (6% vs 9%, p=0.17, respectively). Durations of ventilation and intensive care unit (ICU) and hospital stay were significantly reduced in the post-IQIC period. Age <1 year, malnutrition, low preoperative oxygen perfusion, Risk Adjustment for Congenital Heart Surgery score >3, major chromosomal anomalies, perfusion-related event, longer ventilation and ICU/hospital stay durations were associated with greater odds of morbidity and mortality., Conclusion: Enrolling in the IQIC programme was associated with an improvement in the postsurgical outcomes of the CHD surgeries at our centre., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

In the current study, 17 Y-Chromosomal short tandem repeats (Y-STRs) included in theAmpFlSTR Y-Filer amplification kit (Applied Biosystems, Foster City, USA) were investigated in 146 unrelated Yousafzai males residing in the Khyber Pakhtunkhwa Province of Pakistan. A total of 94 (89.52%) unique haplotypes were observed. Discrimination capacity was 71.92%. Haplotype diversity ranged from 0.354 (DYS456) to 0.663 (DYS458). Both Rst pairwise analysis and multidimensional scaling plot showed that the genetic structure of the Yousafzais is significantly different from neighbouring populations.

Objective: To determine the clinical features and patterns of interstitial lung disease., Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised record of patients diagnosed with interstitial lung disease from January 2005 to December 2015. All patients aged 16 years and above diagnosed with interstitial lung disease on the basis of clinical features, radiological features on high-resolution computed tomography of the chest, and lung biopsies were included. SPSS 19 was used for data analysis., Results: Of the 537 patients, 324(60.3%) of the participants were females. The overall mean age was 60.5±14.9 years. The most common co-morbid condition was diabetes mellitus in 72(13.4%) patients, followed by hypertension in 48(8.9%) and ischaemic heart disease in 21(3.9%). The most common interstitial lung disease was idiopathic pulmonary fibrosis in 217(40.4%) patients, followed by non-specific interstitial pneumonia in 106(19.7%), sarcoidosis in 82(15.3%) and connective tissue disease-related interstitial lung disease in 56(10.4%) patients., Conclusions: Idiopathic pulmonary fibrosis was found to be the most common interstitial lung disease subtype followed by non-specific interstitial pneumonia, sarcoidosis and connective tissue disease-related-interstitial lung disease.

Mitochondrial DNA (mtDNA) is an important tool used to explore ethnogenetics and the evolutionary history of human populations. In this study, hypervariable segment I (HVSI) from mtDNA was analyzed to establish the genetic lineage of the Hazarewal populations residing in the Mansehra and Abbottabad districts of Northern Pakistan. HVSI was extracted from genetic specimens obtained from 225 unrelated male and female individuals belonging to seven distinct Pakistani ethnic groups (31 Abbassis, 44 Awans, 38 Gujars, 16 Jadoons, 23 Karlals, 33 Syeds, and 40 Tanolis). Eighty-three haplogroups, 39 of which were unique, were identified; haplogroup H was predominantly represented (in 40% of the people), followed by haplogroups M (21.78%), R (16.89%), N (15.56%), L (3.11%), and HV (2.67%). The results revealed a sex-biased genetic contribution from putative West Eurasian, South Asian, and Sub-Saharan populations to the genetic lineage of Hazarewal ancestry, with the effect of Eurasians being predominant. The HVSI nucleotide sequences exhibited some characteristic deletion mutations between 16,022 and 16,193 bp, which is characteristic of specific ethnic groups. HVSI sequence homology showed that Hazarewal populations fall into three major clusters: Syeds and Awans sorted out into cluster I; Tanolis, Gujars, and Karlals segregated in cluster II; and Abbassis and Jadoons in cluster III. Here, we have reported the firsthand genetic information and evolutionary sketch of the selected populations residing alongside the historical Silk Route, which provides a baseline for collating the origin, route of migration, and phylogenetics of the population.

Numerous epidemiological studies are preponderance of evidences intimating development of coronary artery disease caused by metal imbalance. The present study was aimed to analyze Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Pb, Sr, and Zn in the scalp hair of angina patients and healthy subjects/controls employing HNO3-HCLO4-based wet digestion followed by quantification with atomic absorption spectrophotometry. The average concentrations of Cd, Cu, Cr, Fe, Mn, Pb, and Sr revealed significantly higher levels in scalp hair of patients than controls; however, Na and Zn were appreciably higher in healthy subjects. Dissimilarity in the trace metal distribution was also observed with gender, residence, dietary habits, and smoking habits of both donor groups. The correlation study and multivariate analyses revealed diverse mutual relationships and apportionment of the trace metals in the scalp hair of patients and controls.

Ischemia heart disease has become a ubiquitous cause of morbidity and a leading contributor to mortality worldwide. The present study was aimed to quantify the elemental levels for Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Pb, Sr, and Zn in the scalp hair and nails of myocardial infarction (MI) patients and counterpart controls by flame atomic absorption spectrophotometry. The effects of elemental imbalances on the development of atherosclerosis were evaluated. Average concentrations of Pb (14.7 μg/g), Sr (21.6 μg/g), and Cr (3.70 μg/g) were significantly higher in the scalp hair of the patients, while those of Na, K, Mg, Fe, Mn, and Cd were measured at almost comparable levels in the scalp hair of the patients and controls. In the case of nail samples, average concentrations of Na (1260 μg/g), K (873 μg/g), Sr (70.9 μg/g), Cu (16.6 μg/g), and Mn (16.9 μg/g) were significantly higher in the patients than controls. The correlation study revealed significantly divergent mutual variations among the elements in MI patients and controls. Principal component analysis also manifested the diverse apportionment of the elements in both donor groups. Most of the elements revealed significant disparities in their concentrations based on gender, abode, and smoking habits of the donors in both groups. In conclusion, the elemental imbalance has potential proatherogenic effect that would have a significant impact on sensitive population groups.

The contamination of aquatic systems with heavy metals is affecting the fish population and hence results in a decline of productivity rate. River Kabul is a transcountry river originating at Paghman province in Afghanistan and inters in Khyber Pakhtunkhwa province of Pakistan and it is the major source of irrigation and more than 54 fish species have been reported in the river. Present study aimed at the estimation of heavy metals load in the fish living in River Kabul. Heavy metals including chromium, nickel, copper, zinc, cadmium, and lead were determined through atomic absorption spectrophotometer after tissue digestion by adopting standard procedures. Concentrations of these metals were recorded in muscles and liver of five native fish species, namely, Wallago attu, Aorichthys seenghala, Cyprinus carpio, Labeo dyocheilus, and Ompok bimaculatus. The concentrations of chromium, nickel, copper, zinc, and lead were higher in both of the tissues, whereas the concentration of cadmium was comparatively low. However, the concentration of metals was exceeding the RDA (Recommended Dietary Allowance of USA) limits. Hence, continuous fish consumption may create health problems for the consumers. The results of the present study are alarming and suggest implementing environmental laws and initiation of a biomonitoring program of the river.

Background: The utilization of ambulances in low- and middle-income countries is limited. The aim of this study was to ascertain frequency of ambulance use and characteristics of patients brought into emergency departments (EDs) through ambulance and non-ambulance modes of transportation., Methods: The Pakistan National Emergency Departments Surveillance (Pak-NEDS) was a pilot active surveillance conducted in seven major tertiary-care EDs in six main cities of Pakistan between November 2010 and March 2011. Univariate and multivariate logistic regression was performed to investigate the factors associated with ambulance use., Results: Out of 274,436 patients enrolled in Pak-NEDS, the mode of arrival to the ED was documented for 94. 9% (n = 260,378) patients, of which 4.1% (n = 10,546) came to EDs via ambulances. The mean age of patients in the ambulance group was significantly higher compared to the mean age of the non-ambulance group (38 ± 18.4 years versus 32.8 ± 14.9 years, p-value < 0.001). The most common presenting complaint in the ambulance group was head injury (12%) while among non-ambulance users it was fever (12%). Patients of all age groups were less likely to use an ambulance compared to those >45 years of age (p-value < 0.001) adjusted for gender, cities, hospital type, presenting complaint group and disposition. The adjusted odds ratio of utilizing ambulances for those with injuries was 3.5 times higher than those with non-injury complaints (p-value < 0.001). Patients brought to the ED by ambulance were 7.2 times more likely to die in the ED than non-ambulance patients after adjustment for other variables in the model., Conclusion: Utilization of ambulances is very low in Pakistan. Ambulance use was found to be more among the elderly and those presenting with injuries. Patients presenting via ambulances were more likely to die in the ED.

Background: The prevalence of self -medication with antibiotics is quite high in developing countries as opposed to developed countries. Antibiotics are often taken erroneously for certain ailments, without having the appropriate knowledge of their use. This carries potential risks for the individual as well as the community, in form of several side effects such as antibiotic resistance. Therefore the prevalence of self-medicated antibiotics in developing countries needs to be studied., Methods: A descriptive cross-sectional study was carried out at six different non-medical universities of Karachi. 431 students were included in the study. Data was collected using self-administered questionnaires and analyzed using SPSS version 19., Results: 50.1% students reported having self-medicated themselves in the past 6 months and 205 (47.6%) reported self-medication with antibiotics. Amoxicillin was the most self-prescribed antibiotic (41.4%). Awareness of the adverse effects of antibiotics was demonstrated by 77.3% of the students and sleep disturbance was the most commonly known (46.5%) side effect. 63.1% denied having any knowledge about antibiotic resistance and only 19.9% correctly knew that indiscriminate use of antibiotics can lead to increased antibiotic resistance., Conclusion: The prevalence of self-medication with antibiotics among the non-medical university students was high despite the awareness of adverse effects. Antibiotic resistance was a relatively unknown terminology.

Understanding the mode of temporal maintenance of plant pathogens is an important domain of microbial ecology research. Due to the inconspicuous nature of microbes, their temporal maintenance cannot be studied directly through tracking individuals and their progeny. Here, we suggest a series of population genetic analyses on molecular marker variation in temporally spaced samples to infer about the relative contribution of sexual reproduction, off-season survival and migration to the temporal maintenance of pathogen populations. We used the proposed approach to investigate the temporal maintenance of wheat yellow rust pathogen, Puccinia striiformis f.sp. tritici (PST), in the Himalayan region of Pakistan. Multilocus microsatellite genotyping of PST isolates revealed high genotypic diversity and recombinant population structure across all locations, confirming the existence of sexual reproduction in this region. The genotypes were assigned to four genetic groups, revealing a clear differentiation between zones with and without Berberis spp., the alternate host of PST, with an additional subdivision within the Berberis zone. The lack of any differentiation between samples across two sampling years, and the very infrequent resampling of multilocus genotypes over years at a given location was consistent with limited over-year clonal survival, and a limited genetic drift. The off-season oversummering population in the Berberis zone, likely to be maintained locally, served as a source of migrants contributing to the temporal maintenance in the non-Berberis zone. Our study hence demonstrated the contribution of both sexual recombination and off-season oversummering survival to the temporal maintenance of the pathogen. These new insights into the population biology of PST highlight the general usefulness of the analytical approach proposed., (© 2013 John Wiley & Sons Ltd.)

Objective: To study the role of hyperbilirubinaemia as a predictive factor for appendiceal perforation in acute appendicitis., Methods: The prospective, descriptive study was conducted at the Abbasi Shaheed Hospital and the Karachi Medical and Dental College, Karachi, from January 2010 to June 2012. It comprised all patients coming to the surgical outpatient department and emergency department with pain in the right iliac fossa with duration less than seven days. They were clinically assessed for signs and symptoms of acute appendicitis and relevant tests were conducted. Patients were diagnosed as a case of acute appendicitis on the basis of clinical and ultrasound findings, and were prepared for appendicectomy. Per-operative findings were recorded and specimens were sent for histopathology to confirm the diagnosis. SPSS version 10 was used to analyse the data., Results: Of the 71 patients, 37 (52.10%) were male and 34 (47.90%) were female. The age range was 3-57 years, and most of the patients (n = 33; 46.5%) were between 11 and 20 years. Besides, 63 (89%) patients had pain in the right iliac fossa of less than four-days duration, while 8 (11%) had pain of longer duration.Total leukocyte count was found to be elevated in 33 (46.5%) patients, while total serum bilirubin was elevated in 41 (57.70%). Ultrasound of abdomen showed 9 (12.70%) patients having normal appearance of appendix and 59 (83.30%) had inflamed appendix. Four (5.60%) patients had no signs of inflammation on naked eye appearance per operatively. Histopathology of appendix showed 10 (14.10%) patients had non-inflammatory appendix., Conclusion: Patients with signs and symptoms of acute appendicitis and a raised total serum bilirubin level indicated a complication of acute appendicitis requiring an early intervention to prevent peritonitis and septicaemia. A raised serum bilirubin level is a good indicator of complicated acute appendicitis, and should be included in the assessment of patients with suspected complicated acute appendicitis.

Objective: To study the indications, method, success rate and complications of intubation at the Emergency Department of a private, tertiary care hospital in Karachi, Pakistan., Methods: The case series involved 278 patients above 14 years of age who underwent emergency intubation at the Emergency Department of Aga Khan University Hospital, Karachi between 1998 and 2003. Descriptive statistics were used to compare rapid sequence intubation with crash intubation. The level of significance was p<0.05., Results: Of the total 278 intubations performed, 37 (13.3%) had to be left out for incomplete information.The study population remaining for inferential analysis comprised of 241 patients. Of the total 278 patients, 174 (63%) were males. Rapid sequence intubation was the commonest type (n=185, 67%) of intubation and was performed mostly by anaesthetists (n=236, 85%). Cardiogenic pulmonary oedema and head injury were commonly seen in these patients.The success on first attempt of intubation was 98% (n=181) in rapid sequence intubation, and 85% (n=48) in crash intubation. Overall, 15 (5.3%) complications were seen in these intubations., Conclusion: Study showed a satisfactory success rate in both rapid sequence and crash intubations.

Background: Mountain ecosystems all over the world support a high biological diversity and provide home and services to some 12% of the global human population, who use their traditional ecological knowledge to utilise local natural resources. The Himalayas are the world's youngest, highest and largest mountain range and support a high plant biodiversity. In this remote mountainous region of the Himalaya, people depend upon local plant resources to supply a range of goods and services, including grazing for livestock and medicinal supplies for themselves. Due to their remote location, harsh climate, rough terrain and topography, many areas within this region still remain poorly known for its floristic diversity, plant species distribution and vegetation ecosystem service., Methods: The Naran valley in the north-western Pakistan is among such valleys and occupies a distinctive geographical location on the edge of the Western Himalaya range, close to the Hindu Kush range to the west and the Karakorum Mountains to the north. It is also located on climatic and geological divides, which further add to its botanical interest. In the present project 120 informants were interviewed at 12 main localities along the 60 km long valley. This paper focuses on assessment of medicinal plant species valued by local communities using their traditional knowledge., Results: Results revealed that 101 species belonging to 52 families (51.5% of the total plants) were used for 97 prominent therapeutic purposes. The largest number of ailments cured with medicinal plants were associated with the digestive system (32.76% responses) followed by those associated with the respiratory and urinary systems (13.72% and 9.13% respectively). The ailments associated with the blood circulatory and reproductive systems and the skin were 7.37%, 7.04% and 7.03%, respectively. The results also indicate that whole plants were used in 54% of recipes followed by rhizomes (21%), fruits (9.5%) and roots (5.5%)., Conclusion: Our findings demonstrate the range of ecosystem services that are provided by the vegetation and assess how utilisation of plants will impact on future resource sustainability. The study not only contributes to an improved understanding of traditional ethno-ecological knowledge amongst the peoples of the Western Himalaya but also identifies priorities at species and habitat level for local and regional plant conservation strategies.

Background: Hepatitis B virus (HBV) infection is a major cause of severe liver diseases including fibrosis, hepatocellular carcinoma (HCC) and cirrhosis related end stage liver diseases (ESLD) in mankind. It is a common belief that infectious diseases have historically been responsible for the massiveness of war-related deaths, so the aim of this study was to estimate the prevalence of HBV infection and to demonstrate the various socio-economic, demographic and possible risk factors related to HBV infection among the conflict-affected peoples due to war against terrorism in North Waziristan., Methods: Blood samples were collected from total 790 suspected individuals from the conflict-affected population of North Waziristan and were analyzed initially tested for the presence of HBsAg, HBeAg antigens, Anti-HBc and Anti-HBs antibodies using ELISA methods. All the positive samples were tested by real time PCR to confirm the presence of HBV DNA in ELISA positive specimens., Results: Total of 126 (15.94%) samples were found positive for HBV DNA by real-time PCR. Among these positive subjects, 95 (75.5%) were males while 31 (24.5%) were females in a ratio of approximately 3:1. High HBV prevalence (41.26%) was observed among the subjects of subdivision Miran Shah relating to the high frequency of military activities against terrorism as compared to Mir Ali subdivision (35.7%) and Razmak subdivision (19.8%). Among the age groups, high prevalence (38.88%) was observed in age group 21-30 as compared to children and in older age groups. The modes of HBV transmission in this area was associated with re-uses of contaminated needles/syringes in medical care, barbers shops, sexual exposure and tattooing are the principal causal risks factors. Furthermore HBV infection was significantly higher in people with low socioeconomic status, in illiterate persons and in drivers., Conclusion: Our results indicate high prevalence rate of HBV infection in young subjects obviously confirms the entire absence of any program to fight HBV. Mass Immunization programs, awareness campaigns and education efforts should be practiced immediately to reduce HBV transmission among young peoples of this conflict zone., (Copyright © 2012 Elsevier B.V. All rights reserved.)