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Copyright of Brazilian Journal of Biology is the property of Instituto Internacional de Ecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Brazilian Journal of Biology is the property of Instituto Internacional de Ecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Brazilian Journal of Biology is the property of Instituto Internacional de Ecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Wheat grain yield decreases by 1.50% per day with a subsequent delay in optimum sowing and the crop becomes vulnerable to numerous abiotic and biotic stresses. However, climate change had apparent effects on the environment and created an alarming scenario for wheat breeders to tackle the problem in different ways. The present research is aimed to identify the stable wheat genotypes through stress selection indices, principal component, and biplot analyses under genotype by environment interaction with non-stress and stress environments. Thirty-six wheat genotypes were appraised through genotype by environment interactions under optimum (non-stressed) and late (stressed) planting environments during 2017-18 at the Cereal Crops Research Institute (CCRI), Pirsabak - Nowshera, Pakistan. The experiment was laid out in a randomized complete block design with three replications. In addition to stress selection indices, the principal component and biplot analyses were also used to assess the performance and stability of the wheat genotypes under non-stress and stress environments. Genotypes, planting environments, and genotype-by-environment interactions (GEI) revealed significant differences for the majority of the traits. Across both planting environments, cultivar Pakistan-13 produced the highest grain yield, followed by genotypes Zincol-16 and PR-122. Under optimum planting environment, the best performing cultivar was Israr-17, followed by two other genotypes NIFA-Lalma-13 and Paseena-17. However, genotypes PR-122, Zincol-16, and Pakistan-13 produced higher grain yields under the stressed environment. According to stress selection indices, principal component, and biplot analyses, wheat cultivars Pirsabak-13, Zincol-16, and PR-122 were found as the most tolerant and high-yielding genotypes and could be used as source material for the development of stress-tolerant genotypes. [ABSTRACT FROM AUTHOR]

Invasive plant species have deliberately affected and reduced the populations of native species, thereby increasing their risk of extinction. The objective of this research was to compare the effects of the two most aggressive invasive alien species currently invading habitats of Calotropis procera “an ecologically and medicinally important native plant” in northwest Pakistan, most probably by altering vegetation and soil physical and chemical characteristics. We sampled invaded and non-invaded vegetation of exotic invasive and native species in diverse habitats with corresponding environmental and soil parameters for multiple comparisons like species richness, diversity, and total plant coverage to assess the invasion effects. Our results exposed that soil physiochemical characteristics significantly differed among the native and exotic invaded-derived soils. Principal component analysis revealed that C. procera dominated vegetation was strongly affected by the invasion of X. strumarium and P. hysterophorus as a result of altered soil characteristics, thereby offering strong evidence that invasion of both exotic invasive species alter soil chemistry and ecology, which may create conditions favourable for invasive plants over native plants. Likewise, results showed that invasive species have completely dominated invaded sites (IV ≥45%) whereas in native vegetation both species are overlapping (IV ≥15%) and might be the strong competitors affecting community structure in the future. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Biology is the property of Instituto Internacional de Ecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Brazilian Journal of Biology is the property of Instituto Internacional de Ecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Brazilian Journal of Biology is the property of Instituto Internacional de Ecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Antimicrobial resistance is increasingly reported worldwide, however, there is scarcity of data from Pakistan. Particularly, data from food-producing animals and their products is totally lacking. Here, we report on the ESBL-genotypes, integron types, insertion sequence, plasmid replicon typing and susceptibility to commonly usedantimicrobials of E. coli recovered from poultry-meat in live bird market of District Mardan, Khyber Pakhtunkhwa, Pakistan. Random E. coli isolates were picked up for screening of ESBL-production and-genotype, antimicrobial resistance profile through disc diffusion method and integron and plasmid replicon typing. Of the 33 E. coli multidrug resistant isolates (resistant to tetracycline, ampicillin, cefotaxime and novobiocine), 28 (phylogroup B2=11, A=9 and D=8) were ESBL producers harboring blaCTX-M (blaCTXM-9=25 and blaCTXM-1=3, blaCTXM-15=3), while, none of them were carrying blaSHV or blaTEM. Majority of these ESBL producers were carrying class-1 integron (n=21), although 11 isolates were carrying ISCR1, which found to be linked with blaCTX-M among 5 isolates (45.5%). PCR based plasmid replicon typing revealed that FrepB replicon was found most dominantly and carried by 27 isolates followed by B/O replicon. This suggests that poultry raw meat may contribute to spread of ESBL-producing E. coli or ESBL-genes. [ABSTRACT FROM AUTHOR]

Banana is mostly propagated by conventional method of sucker which is very slow process. Moreover, in vegetative propagation, the plants once infected by pathogen can shift it to many generations and the whole plant population may be infected within few years. In vitro propagation of banana is the best alternative approach that leads to a rapid process of propagation and also the production of disease-free plants. Therefore, the present study was conducted at Plant Tissue Culture Laboratory and Plant Sciences Laboratory, Science Complex, Allama Iqbal Open University, Islamabad, Pakistan during the year 2017. In seven different treatments, Murashige and Skoog basal media was supplemented with different concentrations of BAP and IAA. During this study, the experiments were performed using completely randomized design (CRD) with three replications. Least significant difference (LSD) test was applied to assess the significant differences among means. The results reveal that the highest number of shoots (366.6) was produced after 6th subculture. During this study, the highest proliferation rate (92.22%) was recorded in T6; MS salts supplemented with BAP (2.0 mg/l) and IAA (0.5 mg/l). The minimum number of days (6) for bud initiation was recorded in T6. Similarly, the highest average fresh weight (14.88 g) was recorded in T6. The highest number of main roots (9.25 ± 2.08) were recorded in MS basal media supplemented with IAA (2.0 mg/l) and BAP (0.5 mg/l). It was followed by MS basal media fortified with IAA (3.0 mg/l) and BAP (1.0 mg/l) that gave 7.81 ± 1.03 number of shoots. The survival rate (92%) was recorded in acclimatization when the plantlets were transferred in plastic pots having peat moss under controlled condition. This optimized protocol would be helpful for mass scale production of high yielding and disease-free banana plants in future. [ABSTRACT FROM AUTHOR]

Cryptosporidium is a prevalent enteric zoonotic parasite of domestic and wild animals, reptiles, birds and fish. This study was conducted to find out the prevalence and risk factors associated with the Cryptosporidium in apparently healthy sheep (Ovis aries), in three districts of Khyber Pakhtunkhwa (KPK), Pakistan. From January 2016 to December 2016, 1080 fecal samples were screened for the presence of Cryptosporidium oocysts through microscopy of smears stained by modified Ziehl-Neelsen technique. Results showed an overall prevalence of 17.96% (194/1080). The highest prevalence was recorded in Kohat (19.72%), followed by Bannu (18.61%) and Lakki Marwat (15.15%). Season-wise prevalence showed significant difference (P≤0.05) among different seasons, with highest prevalence during summer (25%), followed by spring (19.44%), autumn (17.72%) and the winter (10.55%). Statistical analysis revealed significant difference (P≤0.05) among sheep of different age groups with highest prevalence in newborns to ≤1 years of age (22.38%), followed by those of 1-2 years of age (18.03%) and more than 2 years of age (13.46%). Non-significant higher prevalence was recorded in females (18.80%) than males (17.02%). This debut study of Cryptosporidium in sheep will help designing disease control measures, as asymptomatic sheep is the key source of infection transmission to humans. [ABSTRACT FROM AUTHOR]

Developing countries are often beset by poverty and hunger. While provisioning ecosystem services (Prov.ES) are essential for eradication of these issues, they are being rapidly depleted due to climate change and anthropogenic impacts. However, their depletion has not been accounted for in sustainable use policy. Taking Pakistan as a case study, this research focuses on assessing and evaluating the dynamics of Prov.ES. It evaluates the contribution of Prov.ES to poverty reduction using key indicators over different spatiotemporal scales. Among provisioning services, livestock's contribution was the highest, followed by agricultural products, while fisheries and forests contributed the least. Prov.ES were shown to be important to Pakistan's economy. Product analysis revealed that livestock was the most contributing service (53%), followed by agriculture (44%), while fisheries and forests contributed to a smaller extent (≤2%). Livestock products, major crops, marine fish products, and medicinal plants are the main contributors in those respective fields. Our results showed a net present value of 569 US$/ha/year, which is very close to the median value of the 16 previous studies analyzed. Incorporating natural resource conservation into sustainable development policies, with a focus on the impacts of climate change and the increasing human population, is essential. [ABSTRACT FROM AUTHOR]

Wheat is one of the most commonly consumed foods on the Indian subcontinent, especially in Pakistan. It is difficult to find literature regarding wheat consumption forecasting, although some researchers have already focused on wheat production forecasting. Time-series modeling has been adopted with only historical data on wheat, while several influential factors have been neglected. This paper proposes that historical consumption data cannot provide complete information and lacks the power to forecast future values accurately; thus, a simple but powerful model is derived that includes economic and social factors. The proposed model is also compared with conventional approaches, demonstrating its ability to capture highly efficient and accurate forecasts. [ABSTRACT FROM AUTHOR]

Objective: Chronic wound infections impose major medical and economic costs on health-care systems, cause significant morbidity, mortality and prolonged hospitalisation. The presence of biofilm producing bacteria in these wounds is considered as an important virulence factor that leads to chronic implications including ulceration. The undertaken study aimed to isolate and identify the biofilm aerobic bacterial pathogens from patients with chronic wound infections, and determine their antibiotics resistance profiles Method: During this study, swab specimens were collected from patients with chronic wounds at teaching hospitals of Peshawar, Pakistan between May 2013 and June 2014. The isolated aerobic bacterial pathogens were identified on the basis of standard cultural characteristics and biochemical tests. Antibiotics resistance profiles of biofilm producing bacteria against selected antibiotics were then determined. Results: Among the chronic wound infections, diabetic foot ulcers were most common 37 (37%), followed by surgical ulcers 27 (27%). Chronic wounds were common in male patients older than 40 years. Among the total 163 isolated bacterial pathogens the most prevalent bacterial species were Pseudomonas aeruginosa 44 (27%), Klebsiella pneumoniae 26 (16%), Staphylococcus species 22 (14%) and Streptococcus spp. 21 (13%). The isolation rate of bacterial pathogens was high among patients with diabetic foot ulcers 83 (50.9%). Among bacterial isolates, 108 (66.2%) were observed as biofilm producers while 55 (33.8%) did not form biofilm in our model. The investigated biofilm producing bacterial isolates showed comparatively high resistance against tested antibiotics compared to non-biofilm producing bacterial isolates. The most effective antibiotics were amikacine and cefepime against all isolates. Conclusion: Increased multidrug resistance in biofilm producing bacteria associated with chronic wounds was observed in this study. Judicious use of antibiotics is needed to control the wound associated biofilm associated pathogens. Declaration of interest: The author(s) declare that they have no competing interests. [ABSTRACT FROM AUTHOR]

Genetic potential and combining ability were studied in 6 × 6 F1 cross of Gossypium hirsutum L. at the University of Agriculture, Peshawar, Pakistan. Six parental genotypes (CIM-446, CIM-496, CIM-499, CIM-506, CIM-554 and CIM- 707) and their 30 F1 diallel progenies were grown in a randomized complete block design with three replications. Significant (p<0.01) differences were observed among the genotypes for bolls per sympodia, bolls per plant, boll weight, seed cotton yield per plant, lint % and lint index. F1 hybrids showed significant increase over parental means for all the traits. Mean squares due to GCA and SCA were highly significant for all the traits. The GCA mean squares were higher than SCA for majority traits which revealed that additive genes controlled the inheritance. Utilization of best general combiners (CIM-446 and CIM-554) as one of the parents produced promising F1 population (CIM-446 × CIM-554, CIM-446 × CIM-496 and CIM-506 × CIM-554) with desirable SCA and mean performance for yield and fiber traits. Therefore, high × low, low × high and in some cases high × high GCA parents showed best performance for majority traits. Correlation of seed cotton yield was significantly positive with yield related traits however, the association was negative with lint %. Additive gene action controlled the inheritance, and selection in above promising hybrids could be used in early segregating generations and in hybrid cotton production to enhance the seed cotton yield. [ABSTRACT FROM AUTHOR]

Gynecological morbidity has been reported to be associated with psychological distress among women. However, no formal research has been conducted in Pakistan on psychological and gynecological morbidity in women presenting with vaginal discharge. This study aimed (1) to examine whether women presenting with a primary complaint of vaginal discharge are more likely to have a Common Mental Disorder compared with those not presenting with vaginal discharge and (2) to examine whether gender disadvantage is associated with vaginal discharge. Psychological morbidity was examined in women (n=377) presenting at gynecological clinics with and without a primary complaint of vaginal discharge. Gynecological and Psychological morbidity were assessed using Urdu version of General Health Questionnaire (GHQ-28) and the National Family Health Survey Interview. Women presenting with a primary complaint of vaginal discharge were significantly more likely to have a common mental disorder than women presenting with other gynecological problems. Hunger, a marker of poverty, and low social integration, a domain of gender disadvantage, were associated with vaginal discharge in the multivariate model. Pakistani women presenting with vaginal discharge were at increased risk of having a common mental disorder. This research highlights the need for training of medical professionals such as gynecologists to identify common mental disorders among women reporting with gynecological problems. Study limitations and suggestions for future research are discussed. [ABSTRACT FROM PUBLISHER]

An experiment was laid out in randomized complete block design with four replications to assess heterosis, heterobeltiosis and inbreeding depression for yield and yield components in 5 x 5 F2 and F3 diallel cross of Gossypium hirsutum L. during 2002-05 at Sindh Agriculture University, Tandojam, Pakistan. Heterosis was manifested by F2 populations for all the characters but extent of heterosis varied among the characters. It may be assumed that heterosis in one or more than one yield components conferred heterosis for seed cotton yield. The F2 hybrids Reshmi x TH-3/83, Reshmi x Mc-Niar-3150, CIM-109 x Mc-Niar-3150, CIM-109 x TH-3/83 and Mc-Niar-3150 x CIM-109 displayed positive heterosis and heterobeltiosis for seed cotton yield along with one or more yield components character. Reduction in F2 and F3 heterosis was due to decrease in heterozygosity through allelic fixation. Generally, expected inbreeding depression was quite higher than observed for all quantitative traits except seed index, the discrepancy between observed and expected inbreeding depression may be attributable to several reasons that involve linkage disequilibrium, epistasis and abnormal segregation at meiosis due to high ploidy level. [ABSTRACT FROM AUTHOR]

Importance of reservoirs for supplying fresh water has increased significantly at present. In order to move a step forward towards making the present day un-sustainable reservoirs into sustainable infrastructure, this article reviews the sediment erosion and reservoir sedimentation estimates at global scale and applies the Reservoir Conservation Tool (RESCON) for one of the large reservoirs: Tarbela Dam in Pakistan. The article points out the wide variations of the estimates both for soil erosion and reservoir sedimentation and shows how the various reservoir level and duration of flushing will effect in achieving the sediment balance ratio in the Tarbela reservoir. It is found that the flushing can be done efficiently with Sediment Balance Ratio (SBR) greater than 1. The long term sustainable capacity of the reservoir is about 27% with respect to its original capacity. [ABSTRACT FROM AUTHOR]

Genotype-by-environment (GEI) interaction provides the basic information that helps breeders to select stable and superior genotypes for targeted environments. Climate change also alters the recommendations of the genotype for a specific condition. The field study carried out during the cropping seasons of 2015-2016 determined the performance of 16 wheat genotypes (13 lines and three cultivars) at three different locations: The University of Agriculture, Peshawar (UAP), Nuclear Institute of Food and Agriculture, Peshawar (NIFA), and Cereal Crops Research Institute (CCRI), Pirsabak-Nowshera, Khyber Pakhtunkhwa, Pakistan. Data on yield contributing parameters (days to heading, spike length, spikelets spike-1, grain weight spike-1, 1000-grain weight, and grain yield) were collected and analysed using analysis of variance (ANOVA) and stability analysis. Mean square values revealed highly significant results for all the traits under consideration for genotypes (G) and locations (L). Likewise, interactions (GEI) were highly significant for all the traits except grain weight spike-1. The performance of genotypes under different locations indicated no similarity. However, the overall performance of genotypes displayed better under environmental conditions of the Cereal Crops Research Institute (CCRI-Location No: 03). According to the Eberhart and Russell approach, the genotypes K-87, PR-113, Pak-13, PR-112, NR-449, and KT-338 were confirmed stable under tested locations for yield contributing traits as their regression coefficient (bi) value exhibited close to unity. Correlations of grain yield with yield contributing traits considered were significant and positive except for days to heading. [ABSTRACT FROM AUTHOR]

This study is a secondary analysis of data collected in Dacca, East Pakistan in a government low income housing colony. Data were gathered separately from both husband and wife. Eight major areas were subject to factor analysis as an initial step in the study of patterns of communication between husbands and wives in a Muslim society. Three dimensions were produced which were labelled 'role empathic relationship,' 'husband dominant relationship,' and 'shared values relationship.' Results indicate that factors other than age, duration of marriage, and education are significant in interspouse communication and that more socio-psychological study is needed in this area. There is support for including husbands, from each type of relationship, in family planning education programs. The tentative results suggest further consideration of inter-spouse relationships of several kinds rather than a one-sided, Western-biased, research focus on the highly communicative couple as a model of husband-wife concurrence and solidarity. [ABSTRACT FROM AUTHOR]

The article discusses a study which estimated the effects of chlorhexidine vaginal and infant wipes on fetal and perinatal mortality and infection-related morbidity in Pakistan. Results revealed similar composite rate of neonatal sepsis or 28-day perinatal mortality for both the chlorhexidine and saline placebo groups. Findings also showed a lower rate of neonatal infection and less frequent 7-day hospitalization in the chlorhexidine group. No other significant differences between the groups were observed.

Interrelationship of factors influencing seed yield of cotton, Gossypium hirsutum L., were examined in twenty populations generated from a complete 5x5 diallel cross grown in a randomized complete block design with three replications at the Botanical Garden, Department of Plant Breeding & Genetics, Sindh Agriculture University Tandojam, Pakistan. Cotton seed yield/plant exhibited positive and highly significant correlation with plant height, sympodiaiplant, boils/plant, and boll weight at the phenotypic level. Results further demonstrated that 80.30%, 56.80%, and 27.10% of the variation in cotton seed yield was mainly due to the variation in boils/plant, plant height, and boll weight, respectively. Path analysis based on phenotypic correlations also confirmed the highest positive direct effect of the number of boIls/plant (0.8967) and boll weight (0.3802) on cotton seed yield/plant. It is concluded that the selection based on boils/plant and boll weight could be the most effective tool in breeding high yielding cotton genotypes. [ABSTRACT FROM AUTHOR]

To establish the sensitivity and specificity of a batch of 'OptiMAL 48' rapid antigen tests procured by the World Health Organization in Afghanistan, a sample was tested, in parallel with routine, microscopical diagnosis, at basic health units (BHU) within Afghan refugee camps in Pakistan. The results of both methods of field diagnosis were compared with those of cross-checking microscopy at a reference laboratory, which were taken as the 'gold standard'. Out of 499 patients examined, 36% were diagnosed as malaria cases by field microscopy and 34% by the rapid test. For the OptiMAL 48 test, cross-checking of the corresponding smears at the reference laboratory gave a sensitivity of 79.3% and a specificity of 99.7% for Plasmodium falciparum and corresponding values of 86.1% and 98.7% for P. vivax infections. The performance of the field microscopy was better, with a sensitivity and specificity of 85.2% and 99.7% for P. falciparum, and 90.4% and 98.7% for P. vivax, respectively. These results show that the performance of OptiMAL 48 is adequate for acute- and post-emergency situations when the alternative is just clinical diagnosis. However, in the developing health system of Afghanistan, the main focus should be on the expansion of the existing network for microscopical diagnosis and quality control, to meet the needs of a stable situation. Rapid antigen tests are more suited to investigations of outbreaks in remote situations, where health services are deficient or absent. [ABSTRACT FROM AUTHOR]

The emergence of hypervirulent and carbapenem-resistant hypermucoviscous Klebsiella pneumoniae strains presents a significant public health challenge due to their increased virulence and resistance to multiple antibiotics. This study evaluates the antibiotic susceptibility patterns and virulence profiles of classical and hypervirulent K. pneumoniae strains isolated from various clinical samples. A total of 500 clinical samples were collected from patients at the Mardan Medical Complex and Ayub Medical Complex in KPK between July 2022 and June 2024. Among these, 64 K. pneumoniae strains were isolated and subsequently subjected to antimicrobial susceptibility testing (AST) and phenotypic virulence detection. Among the 64 isolates, 21 (32.8%) exhibited hypermucoviscosity, a characteristic associated with increased pathogenicity. Hemagglutination was observed in 35 (54.1%) of the isolates, indicating the presence of surface adhesins that facilitate bacterial adherence to host tissues. A high prevalence of biofilm formation was noted, with 54 (84%) isolates capable of forming biofilms, which are known to protect bacteria from antibiotics and the host immune response. Most isolates (59/64, 92.1%) were resistant against ampicillin, highlighting its limited efficacy against these strains. Conversely, the lowest resistance was observed for tigecycline, with only 15% (10/64) of the isolates showing resistance, indicating its potential utility as a treatment option. The study also found that 38 (59.3%) of the isolates were extended-spectrum beta-lactamase (ESBL) producers, 42 (65.6%) were multidrug-resistant (MDR), 32 (50%) were extensively drug-resistant (XDR), and 13 (20.3%) were resistant to carbapenems. The genetic study revealed biofilm producer and enhancer genes ( mrkD , pgaABCD , fimH , treC , wzc , pilQ , and luxS ) mainly in the hypervirulent strains. These hypervirulent strains also show a high number of resistance genes. The findings of this study underscore the critical need for the active surveillance of antimicrobial resistance and virulence determinants in K. pneumoniae . The coexistence of high levels of antibiotic resistance and virulence factors in these isolates poses a severe threat to public health, as it can lead to difficult-to-treat infections and increased morbidity and mortality.

Objective: To evaluate the relationship between volume and pneumatization pattern of sphenoid sinus using computed tomography images., Methods: The prospective, cross-sectional study was conducted at the Radiology Department of Dow University of Health Sciences, Karachi, from October 2020 to February 2021, and comprised patients of either gender aged 20-70 years who were subjected to computed tomography of paranasal sinuses. The scans were analysed for sphenoid volume and four pneumatization types of sphenoid sinus, including Type-I conchal, Type-II presellar, Type-III sellar and Type-IV postsellar. Significant differences in sphenoid volume and pneumatization pattern were noted. Data was analysed using GraphPad Prism 9., Results: Of the 300 patients with mean age 39.28±10.99 years171(57%) were males and 129(43%) were females. The mean sphenoid volume in males was 11.01±3.50cm3 compared to 7.7±2.13cm3 in females. The majority of sinuses presented postsellar pneumatization type 192(64%), followed by sellar 84(29%), presellar 26(8.7%) and conchal pneumatization 2(0.7%). Significant difference in volume was observed with respect to gender and typology of the sphenoid sinus (p<0.001)., Conclusion: There was a significant relationship of sphenoid volume with and gender and pneumatisation variants, confirming the significance of ethnic heterogeneity.

Objectives: To identify and analyse the different types and frequencies of morphological pattern in endometrial biopsies along with their associated diagnoses across different age groups., Methods: The cross-sectional study was conducted at the Histopathology Section of the Dow Diagnostics Reference and Research Laboratory, Dow University Health Sciences, Karachi, from October 2022 to October 2023. Data was obtained from pre-existing medical record of samples of endometrial biopsies. Open Epi sample size calculator is used for the estimation of sample size. The patients were divided into two aged-based groups; reproductive age ≤45 years in group 1 and postmenopause age ≥46 years in group 2. The histological diagnosis was made by a consultant histopathologist., Results: Of the 430 endometrial biopsies 222(51.6%) were in group 1 and 208(48.4%) were in group 2. In both groups, the most common finding was polyps 271(63%). Malignant changes were found in 12(5.7%) group 2 cases compared to 4(1.8%) group 1 cases., Conclusions: The most common endometrial lesion in both age groups was endometrial polyp. Malignant changes were seen more in postmenopausal women compared to those in the reproductive age group.

Background: Hereditary motor and sensory neuropathy (HMSN) refers to a group of inherited progressive peripheral neuropathies characterized by reduced nerve conduction velocity with chronic segmental demyelination and/or axonal degeneration. HMSN is highly clinically and genetically heterogeneous with multiple inheritance patterns and phenotypic overlap with other inherited neuropathies and neurodegenerative diseases. Due to this high complexity and genetic heterogeneity, this study aimed to elucidate the genetic causes of HMSN in Pakistani families using Whole Exome Sequencing (WES) for variant identification and Sanger sequencing for validation and segregation analysis, facilitating accurate clinical diagnosis., Methods: Families from Khyber Pakhtunkhwa with at least two members showing HMSN symptoms, who had not previously undergone genetic analysis, were included. Referrals for genetic investigations were based on clinical features suggestive of HMSN by local neurologists. WES was performed on affected individuals from each family, with Sanger sequencing used to validate and analyze the segregation of identified variants among family members. Clinical data including age of onset were assessed for variability among affected individuals, and the success rate of genetic diagnosis was compared with existing literature using proportional differences and Cohen's h., Results: WES identified homozygous pathogenic variants in GDAP1 (c.310 + 4 A > G, p.?), SETX (c.5948&#95;5949del, p.(Asn1984Profs*30), IGHMBP2 (c.1591 C > A, p.(Pro531Thr) and NARS1 (c.1633 C > T, p.(Arg545Cys) as causative for HMSN in five out of nine families, consistent with an autosomal recessive inheritance pattern. Additionally, in families with HMSN, a SETX variant was found to cause cerebellar ataxia, while a NARS1 variant was linked to intellectual disability. Based on American College of Medical Genetics and Genomics criteria, the GDAP1 variant is classified as a variant of uncertain significance, while variants in SETX and IGHMBP2 are classified as pathogenic, and the NARS1 variant is classified as likely pathogenic. The age of onset ranged from 1 to 15 years (Mean = 5.13, SD = 3.61), and a genetic diagnosis was achieved in 55.56% of families with HMSN, with small effect sizes compared to previous studies., Conclusions: This study expands the molecular genetic spectrum of HMSN and HMSN plus type neuropathies in Pakistan and facilitates accurate diagnosis, genetic counseling, and clinical management for affected families., (© 2024. The Author(s).)

Background: Hereditary Spastic Paraplegias (HSPs) and Hereditary Cerebellar Ataxias (HCAs) are progressive neurodegenerative disorders encompassing a spectrum of neurogenetic conditions with significant overlaps of clinical features. Spastic ataxias are a group of conditions that have features of both cerebellar ataxia and spasticity, and these conditions are frequently clinically challenging to distinguish. Accurate genetic diagnosis is crucial but challenging, particularly in resource-limited settings. This study aims to investigate the genetic basis of HSPs and HCAs in Pakistani families., Methods: Families from Khyber Pakhtunkhwa with at least two members showing HSP or HCA phenotypes, and who had not previously been analyzed genetically, were included. Families were referred for genetic analysis by local neurologists based on the proband's clinical features and signs of a potential genetic neurodegenerative disorder. Whole Exome Sequencing (WES) and Sanger sequencing were then used to identify and validate genetic variants, and to analyze variant segregation within families to determine inheritance patterns. The mean age of onset and standard deviation were calculated to assess variability among affected individuals, and the success rate was compared with literature reports using differences in proportions and Cohen's h., Results: Pathogenic variants associated with these conditions were identified in five of eight families, segregating according to autosomal recessive inheritance. These variants included previously reported SACS c.2182 C > T, p.(Arg728*), FA2H c.159&#95;176del, p.(Arg53&#95;Ile58del) and SPG11 c.2146 C > T, p.(Gln716*) variants, and two previously unreported variants in SACS c.2229del, p.(Phe743Leufs*8) and ZFYVE26 c.1926&#95;1941del, p.(Tyr643Metfs*2). Additionally, FA2H and SPG11 variants were found to have recurrent occurrences, suggesting a potential founder effect within the Pakistani population. Onset age among affected individuals ranged from 1 to 14 years (M = 6.23, SD = 3.96). The diagnostic success rate was 62.5%, with moderate effect sizes compared to previous studies., Conclusions: The findings of this study expand the genotypic and phenotypic spectrum of HSPs and HCAs in Pakistan and emphasize the importance of utilizing exome/genome sequencing for accurate diagnosis or support accurate differential diagnosis. This approach can improve genetic counseling and clinical management, addressing the challenges of diagnosing neurodegenerative disorders in resource-limited settings., (© 2024. The Author(s).)

Background: Sarcopenia's impact on post-liver transplant outcomes remains a subject of debate, with limited data from South Asia on its association with post-liver transplant hospital stays. This study aims to investigate sarcopenia's influence on post-transplant hospitalization duration in South Asians., Methods: In this retrospective study, patients with liver cirrhosis who underwent living-donor liver transplantation (LDLT) at Shifa International Hospital in Islamabad, Pakistan, between January 2022 and January 2023 were included. Computed tomography (CT) images were used to assess the skeletal muscle index (SMI). The areas of the psoas, erector spinae, multifidus, quadratus lumborum, rectus abdominis, transverse abdominis, and internal/external oblique muscles were quantified at the level of L3. The data were analyzed using SPSS version 29.0 (IBM)., Results: There was a total of 84 patients. Mean age was 47.4 ± 12.0 years. There were 62 (73.8%) male patients and 22 (26.2%) female patients. Hepatitis C was noted in 36 (42.9%) patients. Twenty-two (26.2%) patients had hepatocellular carcinoma. Sarcopenia was identified in 58 (69.0%) patients. No significant association was observed between sarcopenia and intensive care unit (ICU) or general floor stays. Regression analysis identified pre-transplant model for end-stage liver disease-sodium (MELD-Na) score as the sole significant factor associated with both ICU and total length of stay (P value .002; P value .009)., Conclusion: In our population, sarcopenia did not correlate with post-transplant ICU or overall hospital stay. The pre-transplant MELD-Na score emerged as the most influential predictor of length of stay. Therefore, delaying liver transplant procedures based on muscle mass estimations may not be a practical clinical approach for South Asian patients., 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 Elsevier Inc. All rights reserved.)

This retrospective cohort study aims to describe the clinical characteristics and outcomes and assess risk factors for mortality across the epidemic waves in hospitalized COVID-19 patients in a major tertiary-care center in Pakistan. A total of 5368 patients with COVID-19, hospitalized between March 2020 and April 2022 were included. The median age was 58 years (IQR: 44-69), 41% were females, and the overall mortality was 12%. Comparative analysis of COVID-19 waves showed that the proportion of patients aged ≥ 60 years was highest during the post-wave 4 period (61.4%) and Wave 4 (Delta) (50%) (p < 0.001). Male predominance decreased from 65.2% in Wave 2 to 44.2% in Wave 5 (Omicron) (p < 0.001). Mortality rate was lowest at 9.4% in wave 5 and highest at 21.6% in the post-wave 4 period (p = 0.041). In multivariable analysis for risk factors of mortality, acute respiratory distress syndrome (ARDS) was most strongly associated with mortality (aOR 22.98, 95% CI 15.28-34.55, p < 0.001), followed by need for mechanical ventilation (aOR 6.81, 95% CI 5.13-9.05, p < 0.001). Other significant risk factors included acute kidney injury (aOR 3.05, 95% CI 2.38-3.91, p < 0.001), stroke (aOR 2.40, 95% CI 1.26-4.60, p = 0.008), pulmonary embolism (OR 2.07, 95% CI 1.28-3.35, p = 0.003), and age ≥ 60 years (aOR 2.45, 95% CI 1.95-3.09, p < 0.001). Enoxaparin use was associated with lower mortality odds (aOR 0.45, 95% CI 0.35-0.60, p < 0.001. Patients hospitalized during Wave 4 (aOR 2.22, 95% CI 1.39-3.56, p < 0.001) and the post-wave 4 period (aOR 2.82, 95% CI 1.37-5.80, p = 0.005) had higher mortality odds compared to other waves. The study identifies higher mortality risk in patients admitted in Delta wave and post-wave, aged ≥ 60 years, and with respiratory and renal complications, and lower risk with anticoagulation during COVID-19 waves., (© 2024. The Author(s).)

Background and Objectives : In the undertaken study, proteomics alterations of blood-borne XDR S. Typhi isolated from Pakistan were investigated using mass spectrometry. Materials and Methods : MDR and XDR S. Typhi total protein lysates were fractionated, digested, and processed for nanoflow LC-LTQ- Orbitrap MS analysis. Results : Among the 1267 identified proteins, 37 were differentially regulated, of which 28 were up-regulated, and 9 were down-regulated in XDR S. Typhi as compared to MDR S. Typhi. Based on the functional annotation, proteins found up-regulated are involved mainly in metabolic pathways (ManA, FadB, DacC, GpmA, AphA, PfkB, TalA, FbaB, OtsA, 16504242), the biosynthesis of secondary metabolites (ManA, FadB, GlpB, GpmA, PfkB, TalA, FbaB, OtsA), microbial metabolism in diverse environments (FadB, GpmA, PfkB, NfnB, TalA, FbaB), and ABC transporters (PstS, YbeJ, MglB, RbsB, ArtJ). Proteins found down-regulated are involved mainly in carbon metabolism (FadB, GpmA, PfkB, FalA, FbaB) and the biosynthesis of amino acids (GpmA, PfkB, TalA, FbaB). Most of the identified differential proteins were predicted to be antigenic, and matched with resistome data. Conclusions : A total of 28 proteins were up-regulated, and 9 were down-regulated in XDR S. Typhi. Further characterization of the identified proteins will help in understanding the molecular signaling involved in the emergence of XDR S . Typhi.

The Hindu Kush high-altitude regions of Pakistan are currently experiencing severe consequences as a result of global warming. In this sense, increasing soil erosion and the quick melting of glaciers are two particularly evident effects. In such a scenario, understanding long-term temperature changes is crucial for making accurate forecasts about how the Hindu Kush region may experience regional temperature changes in the future. In this study, the climate tree-ring width (TRW) analysis designated a positive and significant correlation (r = 0.622, p < 0.001) between the TRW chronology and the June to September (summer) mean maximum temperature (MMT). Using the tree-ring width of Pinus wallichiana A. B. Jackson, we reconstructed summer temperatures in the Hindu Kush region from 1790 CE. Statistical analysis showed that the reconstruction model has explained 38.7% of the climate variance during the instrumental period of 1967 to 2018 CE. Five extremely warm summer periods (≥ 4 years; before the instrumental period 1967-2018 CE) of 1804-1830, 1839-1862, 1876-1879, 1905-1910, 1923-1935 CE, and six cold summer periods of 1790-1803, 1832-1838, 1863-1875, 1880-1904, 1911-1922, and 1936-1945 CE have been observed during the past 229 years. Individually, the year 1856 CE experienced severe warmth (31.85 °C), whereas 1794 CE was relatively cooler (29.60 °C). The spectral multi-taper method (MTM) shows significant (p < 0.05) cycles, which take place about every 9.3, 5.7, 4.2, and 3.6 years. In particular, the 9.3-year cycle, which closely aligns with the 11-year solar activity cycle, suggests a potential correlation between solar activity and local temperature fluctuations. Moreover, our reconstruction demonstrates a significant degree of consistency when compared to actual climate data and regional temperature reconstruction series, reporting a strong logic of trust in the reliability and accuracy of our findings. This evidence reaffirms that our reconstruction shows significant and dependable regional temperature signals, notably being representative for the Hindu Kush region., (© 2024. The Author(s) under exclusive licence to International Society of Biometeorology.)

In the Pakistani/British Pakistani community in England it is quite common for people to marry close cousin relatives, which can increase the chances of certain genetic problems in their children. Families in these situations often have little knowledge of genetics and encounter difficulties accessing genetic counselling services and culturally appropriate genetics information is needed to support these families. We describe the co-design of a prototype culturally sensitive smart phone app with the British Pakistani community, to improve understanding of genetics and genetic services.

Mycotoxin contamination poses a significant problem in developing countries, particularly in northern Pakistan's fluctuating climate. This study aimed to assess aflatoxin contamination in medicinal and condiment plants in Upper Dir (dry-temperate) and Upper Swat (moist-temperate) districts. Plant samples were collected and screened for mycotoxins (Aflatoxin-B1 and Aflatoxin-B-2). Results showed high levels of AFB-1 (11,505.42 ± 188.82) as compared to AFB-2 (846 ± 241.56). The maximum contamination of AFB-1 in Coriandrum sativum (1154.5 ± 13.43 ng to 3328 ± 9.9 ng) followed by F. vulgare (883 ± 9.89 ng to 2483 ± 8.4 ng), T. ammi (815 ± 11.31 ng to 2316 ± 7.1 ng), and C. longa (935.5 ± 2.12 ng to 2009 ± 4.2 ng) while the minimum was reported in C. cyminum (671 ± 9.91 ng to 1995 ± 5.7 ng). Antifungal tests indicated potential resistance in certain plant species (C. cyminum) while A. flavus as the most toxins contributing species due to high resistance below 80% (54.2 ± 0.55 to 79.5 ± 2.02). HPLC analysis revealed hydroxyl benzoic acid (5136 amu) as the dominant average phytochemical followed by phloroglucinol (4144.31 amu) with individual contribution of 8542.08 amu and 12,181.5 amu from C. cyaminum. The comparison of average phytochemicals revealed the maximum concentration in C. cyminum (2885.95) followed by C. longa (1892.73). The findings revealed a statistically significant and robust negative correlation (y = - 2.7239 ×  + 5141.9; r = - 0.8136; p < 0.05) between average mycotoxins and phytochemical concentrations. Temperature positively correlated with aflatoxin levels (p < 0.01), while humidity had a weaker correlation. Elevation showed a negative correlation (p < 0.05), while geographical factors (latitude and longitude) had mixed correlations (p < 0.05). Specific regions exhibited increasing aflatoxin trends due to climatic and geographic factors., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

The aim of the experiment was to evaluate the potential of promising summer maize genotypes and optimal stage of harvesting these genotypes for ensiling in terms of dry matter (DM), starch, and crude protein (CP) yields, silage fermentation quality, nutrients profile, total digestible nutrients, metabolizable energy (ME) content, Cornell Net Carbohydrate and Protein System (CNCPS) carbohydrate (CHO) subfractions composition, in vitro DM digestibility (DMD) and in situ starch degradation characteristics. Six maize genotypes were chosen for the study: DK9108 from Monsanto, P30Y87, P3939 from Pioneer, QPM-300 (quality protein maize) and W94 from the International Maize and Wheat Improvement Center (CIMMYT), and a local cultivar, Afgoii, from the Cereal Research Institute (Persabaq, KP). A total of 72 plots (8 m × 10 m) were blocked in three replicate fields, and within each field, each genotype was sown in four replicate plots according to a randomized complete block design. For the data analysis, the Proc-Mixed procedure of Statistical Analysis System with repeated measure analysis of variance was used. The DM yield was strongly influenced (P < 0.001) by maize genotypes, varying from 12.6 to 17.0 tons/ha. Except for total CHO and ammonia nitrogen (NH 3 -N), the contents of all measured chemical components varied (P < 0.001) among the genotypes. Further comparison revealed that, genotype P3939 had a higher (P < 0.05) content of CP (7.27 vs. 6.92%), starch (36.7 vs. 27.9%), DMD (65.4 vs. 60.0%), ME (2.51 vs. 2.30 Mcal/kg) and lactic acid (5.32 vs. 4.83%) and lowest content of NDF (37.3 vs. 43.1%), pH (3.7 vs. 4.10) compared to the local cultivar (Afgoii). Advancement of post-flowering maturity from 25 to 35% DM (23 to 41 days after flowering (DAF)) increased (P < 0.05) the DM yield (10.4 to 17.8 tons/ha), starch content (29.1 to 35.0%), DMD (65.3 to 67.3%) and ME (2.34 to 2.47 Mcal/kg), and decreased (P < 0.001) the contents of CP (7.42-6.73%), NDF (48.8-38.5%), pH (4.10 to 3.60), NH 3 -N (8.93-7.80%N) and effective degradability of starch (95.4 to 89.4). Results showed that for higher yields and silage nutritional and fermentation quality, maize crops should be harvested at whole crop DM content of 30-35% (34 to 41 DAF). It was further concluded that genotype P3939 is the most suitable summer maize genotype for silage production in terms of yields and silage nutritional and fermentation quality under the hot environmental conditions of the tropics., (© 2024. The Author(s).)

Aim: Dopamine β-hydroxylase (DBH) is a copper-containing enzyme that has an important role in maintaining the cellular homeostasis between the two neurotransmitters, dopamine (DA) and nor-adrenaline (NA). DBH functional polymorphisms are associated with multiple neuro-psychiatric conditions and are found to alter the DBH protein levels in serum affecting DBH enzymatic activity. The current study was conducted to determine the genetic and serum levels association of DBH rs1611115 functional polymorphism with major depressive disorder (MDD), bipolar disorder (BD) and schizophrenia (SHZ) in the Pakistani population., Methods: In total n  = 1097 subjects including MDD ( n  = 427), BD ( n  = 204), SHZ ( n  = 134) and healthy controls ( n  = 332), were screened for the functional polymorphism by polymerase chain reaction-restriction fragment length polymorphism. Univariate logistic regression analysis was applied and the results were adjusted for age and sex. The DBH levels in serum were determined through enzyme-linked immunosorbent assay (ELISA) and the Mann Whitney U test was applied., Results: The minor allele (-1021 C > T) was found to be significantly associated with a higher risk of developing BD and SHZ in both univariable and multivariable analyses. The overall total serum concentration of DBH was comparatively raised in MDD, however, in cross-comparison DBH serum levels were found markedly higher in CC homozygotes compared to TT homozygotes within the BD group., Conclusion: The present study suggested a significant association of DBH rs1611115 with BD and SHZ and also the effect of rs1611115 on DBH serum levels in MDD and BD for the first time in the Pakistani population.

Background: Epilepsy, a challenging neurological condition, is often present with comorbidities that significantly impact diagnosis and management. In the Pakistani population, where financial limitations and geographical challenges hinder access to advanced diagnostic methods, understanding the genetic underpinnings of epilepsy and its associated conditions becomes crucial., Methods: This study investigated four distinct Pakistani families, each presenting with epilepsy and a spectrum of comorbidities, using a combination of whole exome sequencing (WES) and Sanger sequencing. The epileptic patients were prescribed multiple antiseizure medications (ASMs), yet their seizures persist, indicating the challenging nature of ASM-resistant epilepsy., Results: Identified genetic variants contributed to a diverse range of clinical phenotypes. In the family 1, which presented with epilepsy, developmental delay (DD), sleep disturbance, and aggressive behavior, a homozygous splice site variant, c.1339-6 C > T, in the COL18A1 gene was detected. The family 2 exhibited epilepsy, intellectual disability (ID), DD, and anxiety phenotypes, a homozygous missense variant, c.344T > A (p. Val115Glu), in the UFSP2 gene was identified. In family 3, which displayed epilepsy, ataxia, ID, DD, and speech impediment, a novel homozygous frameshift variant, c.1926&#95;1941del (p. Tyr643MetfsX2), in the ZFYVE26 gene was found. Lastly, family 4 was presented with epilepsy, ID, DD, deafness, drooling, speech impediment, hypotonia, and a weak cry. A homozygous missense variant, c.1208 C > A (p. Ala403Glu), in the ATP13A2 gene was identified., Conclusion: This study highlights the genetic heterogeneity in ASM-resistant epilepsy and comorbidities among Pakistani families, emphasizing the importance of genotype-phenotype correlation and the necessity for expanded genetic testing in complex clinical cases., (© 2024. The Author(s).)

Background: This research depicts the linkage of public leadership on public health delivery (PHD) and collaborative administration. The research is also focused to examine the effect of public leadership on public health delivery through the intervening variable of collaborative administration by using both social information processing theory and collaboration theory., Methods: This research is based on quantitative method. Data was collected from 464 public hospital administration in the context of Pakistan. This study evaluated data using SPSS, AMOS, and PROCESS Macro., Results: Public leadership has a positive profound effect on public health delivery and collaborative administration, and that collaborative administration significantly promotes public health delivery. The outcomes also exposed that public leadership has substantial influence on public health delivery through intervening collaborative administration., Conclusions: Whilst public leadership demonstrated positive outcomes on public health delivery and collaborative administration, there is a need for more rigor studies on collaborative governance leadership, collaborative ethics and collaborative norms in the public health service., (© 2024. The Author(s).)

Introduction: Countries are grappling with a rapidly worsening upsurge in the opioid-related overdose deaths, misuse and abuse. There is a dearth of data in Pakistan regarding the practices and competencies of pharmacists in handling opioid-related issues., Study Design: A cross-sectional study, conducted across Punjab, Pakistan., Method: The study deployed a validated survey to evaluate the competencies and practices of the community and hospital pharmacists., Results: 504 community pharmacists and 279 hospital pharmacists participated in the survey with an overall response rate of 85.5%. Almost half of the respondents 'never' or 'sometimes' made clinical notes in a journal or dispensing software to monitor ongoing opioid use. Generally, pharmacists were reluctant to collaborate with physicians or notify police regarding the abuse/misuse of opioids. Hospital pharmacists achieved significantly higher mean competency scores than chain and independent community pharmacists (p<0.05). In competency evaluation, three priority areas emerged that require additional training, that is, 'opioid overdose management', 'opioid use monitoring' and 'therapeutic uses of opioids'., Conclusion: Both community and hospital pharmacists hold significant positions and potential to contribute meaningfully to the mitigation of harms and risks associated with opioids. Nevertheless, this study underscores notable deficiencies in the competence of pharmacists, whether in hospital or community settings in Punjab, concerning various aspects related to the dispensing and utilisation of opioids. It also highlights the pressing need for the development of strategies aimed at improving several practice areas including the documentation, the quality of patient counselling, the effectiveness of reporting mechanisms for opioid abuse and the stringent enforcement of regulatory policies to curtail opioid misuse. Thus, to mitigate the opioid epidemic in Pakistan, it is imperative to institute opioid stewardship initiatives aimed at rectifying the competency and procedural deficiencies within the pharmacist workforce., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Population in South Asia is increasing ever than a faster rate, subsequently; food security, climate change, and capital intensive agro farming techniques are the prevailing challenges in this region. This is a tri-country penal analysis, Pakistan, India, and Bangladesh, and the study covers the data throughout (1973-2020). This study has used modern farm input data besides demographic variables in the study. In this study, we use panel data set, ARDL (PMG) approach, autoregressive distributed lag model pooled mean group, which is an extensively dynamic modeling technique for heterogeneous data. The results of the study explore that transition in the demographic pattern in Pakistan, India, and Bangladesh is the real cause of low crop productivity and land intensification. Technology innovation is the only ray of hope to fulfill the food demand of the future ahead and climate agriculture practices can hamper the further deterioration of the small farmlands., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Significant brain development in children occurs from birth to 2 years, with environment playing an important role. Stimulation interventions are widely known to be effective in enhancing early childhood development (ECD). This study aims to assess the feasibility and effectiveness of integrating ECD care delivered by lady health visitors (LHVs) at public health facilities in rural Pakistan., Method: A cluster randomized controlled trial was conducted through public health facilities in 2 districts of Punjab, Pakistan. A total of 22 clusters (rural health centers and subdistrict hospitals) were randomly allocated to receive routine care (control: n=11 clusters, 406 mother-child pairs) or counseling (intervention: n=11 clusters, 398 mother-child pairs). All children aged 11-12 months without any congenital abnormality were eligible for enrollment. The intervention was delivered by the LHVs to mothers with children aged 12-24 months in 3 quarterly sessions., Results: The primary outcome was the prevention of ECD delays in children aged 24 months (assessed with the Ages and Stages Questionnaire-3). Analysis was done on an intention-to-treat basis. A total of 804 mother-child pairs were registered in the study, of which 26 (3.3%) pairs were lost to follow-up at the endpoint. The proportion of children with 2 or more developmental delays was significantly less in the intervention arm (13%) as compared to the control arm (41%) at an endpoint (odds ratio=0.21; 95% confidence interval=0.11, 0.42). Children in the intervention arm also had significantly better anthropometric measurements when aged 24 months than the children in the control arm., Conclusion: The integrated ECD care intervention for children aged 12-24 months at public health facilities was found to be effective in enhancing ECD and reducing the proportion of children with global development delays., (© Khan et al.)

Background: The COVID-19 pandemic has revealed gaps in global health systems, especially in the low- and middle-income countries (LMICs). Evidence shows that patients with non-communicable diseases (NCDs) are at higher risk of contracting COVID-19 and suffering direct and indirect health consequences. Considering the future challenges such as environmental disasters and pandemics to the LMICs health systems, digital health interventions (DHI) are well poised to strengthen health care resilience. This study aims to implement and evaluate a comprehensive package of DHIs of integrated COVID-NCD care to manage NCDs in primary care facilities in rural Pakistan., Methods: The study is designed as a pragmatic, parallel two-arm, multi-centre, mix-methods cluster randomised controlled trial. We will randomise 30 primary care facilities in three districts of Punjab, where basic hypertension and diabetes diagnosis and treatment are provided, with a ratio of 1:1 between intervention and control. In each facility, we will recruit 50 patients who have uncontrolled hypertension. The intervention arm will receive training on an integrated COVID-NCD guideline, and will use a smartphone app-based telemedicine platform where patients can communicate with health providers and peer-supporters, along with a remote training and supervision system. Usual care will be provided in the control arm. Patients will be followed up for 10 months. Our primary indicator is systolic blood pressure measured at 10 months. A process evaluation guided by implementation science frameworks will be conducted to explore implementation questions. A cost-effectiveness evaluation will be conducted to inform future scale up in Pakistan and other LMICs., Discussion: Our study is one of the first randomised controlled trials to evaluate the effectiveness of DHIs to manage NCDs to strengthen health system resilience in LMICs. We will also evaluate the implementation process and cost-effectiveness to inform future scale-up in similar resource constrained settings., Trial Registration: ClinicalTrials.gov Identifier-NCT05699369., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Wei et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The present study was conducted on Head Punjnad (HP) and Head Taunsa (HT) to evaluate the contamination of Pb, Cr, As, Hg, and Cd in water, soil, sediment, fish as a whole and fish organs. Fish, water, soil and sediment samples were collected from different sites of HT and HP on a monthly basis for 8 months. Heavy metals in water, soil, and sediment were determined by a polarized Zeeman atomic absorption spectrophotometer and in fish and fish organs by an atomic absorption spectrophotometer. Contamination of Cd, Hg, and As was significantly (P<0.05) higher in water of HP as compared to HT, while Cr showed a non-significant (P>0.05) difference at HP and HT. Pb was significantly (P<0.05) higher in water of HT as compared to HP. In the case of soil, Cd, Hg, and Pb were higher at HT as compared to HP, while As and Cr were significantly (P<0.05) higher at HP as compared to HT. In sediment, contamination of Cd, Hg, and As were significantly (P<0.05) higher at HP as compared to HT, while the Cr difference was non-significant (P>0.05) but Pb showed a significantly (P<0.05) higher value at HT than HP. Cd accumulation in different fish species was recorded as R. rita ˃O. niloticus ˃C. marulius ˃S. sarwari ˃C. idella ˃C. catla ˃N. notopterus ˃E. vacha ˃L. rohita ˃C. carpio, respectively. Hg as O. niloticus ˃S. sarwari ˃R. rita ˃C. marulius ˃C. catla ˃N. notopterus ˃E. vacha ˃L. rohita ˃C. carpio ˃C. idella, respectively. As as O. niloticus ˃R. rita ˃S. sarwari ˃C. marulius ˃C. catla ˃C. carpio ˃N. notopterus ˃C. idella ˃E. vacha ˃L. rohita, respectively. Cr accumulation recorded as L. rohita ˃C. idella ˃O. niloticus ˃C. marulius ˃E. vacha ˃R. rita ˃C. catla ˃C. carpio ˃S. sarwari ˃N. notopterus, respectively. Pb accumulation in different fish species was recorded as C. idella ˃C. carpio ˃N. notopterus ˃L. rohita ˃O. niloticus ˃C. marulius ˃R. rita ˃S. sarwari ˃E. vacha ˃C. catla, respectively. Cd accumulation in different organs was recorded as kidney ˃liver ˃gills ˃muscle ˃skin ˃scale. Hg accumulation in different organs was recorded as kidney ˃gills ˃liver ˃skin ˃muscle ˃scale. As accumulation in different organs was recorded as kidney ˃liver ˃gills ˃muscle ˃skin ˃scale. Cr accumulation in different organs was recorded as gills ˃ liver ˃skin ˃muscle ˃kidney ˃scale. Pb accumulation in different organs was recorded as gills˃ kidney˃ skin˃ liver˃ muscle˃ scale., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Iqbal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study reports prevalence of antibodies against bluetongue virus (BTV) in animals kept on Government farms/research stations in North-western Pakistan and its association with different risk factors. In total, 1257 blood samples were collected, at random, from animals on 12 separate Government farms/research stations. The prevalence of antibodies against BTV was evaluated using a competitive ELISA. Mixed effects univariate and multivariate logistic regressions were applied to ascertain different risk factors associated with the prevalence of the infection using farm as random effect variable. The overall weighted seroprevalence was recorded as 52%. In univariate analysis, a significant association between sero-conversion to BTV infection and species (P < 0.0001), sex (P < 0.0001), herd size (P = 0.0295) and age of animal (P < 0.0001) was recorded. In multivariate mixed effects logistic regression analysis, prevalence of the infection was found to be 7 (95% CI =2-28) times higher in goats and buffalo than in sheep. Prevalence of the infection was found to be 2.5 (95% CI =1.7-3.3) times higher in female than male animals. However, no significant association was found between sero-conversion of BTV and herd size in multivariate mixed effects logistic regression. Age was found to be a risk factor for the sero-conversion; odds of sero-conversion to BTV increased by 1.29, 1.4, 1.32 and 1.6 times per year increase in age of sheep, goats, buffalo and cattle, respectively. Prevalence of bluetongue was found higher in animals maintained on Government owned farms than that in individual holdings, as previously reported in Pakistan., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Breast cancer incidence is rising among Pakistani women in the United Kingdom. However, uptake of breast screening remains low. This study aimed to improve access to breast screening for British-Pakistani women by exploring their knowledge of breast cancer and the role of primary care and community networks to support screening access amongst British-Pakistani women., Methods: We undertook a secondary qualitative analysis of 18 semi-structured interviews with British-Pakistani women from East Lancashire in the United Kingdom. Anonymized transcripts of the interviews were used for a thematic analysis., Results: Three themes were identified in the interviewees' responses: (i) 'Women's knowledge of breasts and breast cancer', which described how a cultural taboo exists around Pakistani women's bodies and around breast cancer; (ii) 'Role of primary care', which detailed how General Practitioners can support informed decisions and offer a trusted and valued information source; (iii) 'Community engagement', which described the potential to disseminate breast-screening information through the whole community, including primary care providers, all family members and mosques., Conclusions: Our analysis suggested three main targets for future interventions to improve access to breast screening for British-Pakistani women: (i) co-produced strategies to increase knowledge of breasts and breast screening; (ii) greater collaboration with local General Practitioners to support women to make informed choices about screening; and (iii) community engagement involving General Practitioners and community leaders, to inform everyone - not just screening-age women - about breast cancer and screening.

Edwardsiella tarda is one of the most significant fish pathogens, causes edwardsiellosis in a variety of freshwater fish species, and its antibiotic resistance against multiple drugs has made it a health risk worldwide. In this study, we aimed to investigate the antibiotic resistance (ABR) genes of E. tarda and establish its antibiotic susceptibility. Thus, 540 fish (299 Oreochromis niloticus , 138 O.mossambicus , and 103 O. aureus ) were collected randomly from twelve fish farms in three districts of Punjab in Pakistan. E. tarda was recovered from 147 fish showing symptoms of exophthalmia, hemorrhages, skin depigmentation, ascites, and bacteria-filled nodules in enlarged liver and kidney. Antimicrobial susceptibility testing proved chloramphenicol, ciprofloxacin, and streptomycin effective, but amoxicillin, erythromycin, and flumequine ineffective in controlling edwardsiellosis. Maximum occurrence of qnrA, blaTEM, and sul3 genes of E. tarda was detected in 45% in the liver, 58%, and 42% respectively in the intestine; 46.5%, 67.2%, and 55.9% respectively in O. niloticus ; 24%, 36%, and 23% respectively in summer with respect to fish organs, species, and season, respectively. Motility, H 2 S, indole, methyl red, and glucose tests gave positive results. Overall, E. tarda infected 27.2% of fish, which ultimately caused 7.69% mortality. The Chi-squared test of independence showed a significant difference in the occurrence of ABR genes of E. tarda with respect to sampling sites. In conclusion, the misuse of antibacterial agents has led to the emergence of ABR genes in E. tarda , which in association with high temperatures cause multiple abnormalities in infected fish and ultimately resulting in massive mortality.

Background: Retinitis Pigmentosa (RP) is a clinically and genetically progressive retinal dystrophy associated with severe visual impairments and sometimes blindness, the most common syndromic form of which is Usher syndrome (USH). This study aimed to further increase understanding of the spectrum of RP in the Khyber Pakhtunkhwa region of Pakistan., Methodology: Four consanguineous families of Pashtun ethnic group were investigated which were referred by the local collaborating ophthalmologists. In total 42 individuals in four families were recruited and investigated using whole exome and dideoxy sequencing. Among them, 20 were affected individuals including 6 in both family 1 and 2, 5 in family 3 and 3 in family 4., Result: Pathogenic gene variants were identified in all four families, including two in cone dystrophy and RP genes in the same family (PDE6C; c.480delG, p.Asn161ThrfsTer33 and TULP1; c.238 C > T, p.Gln80Ter) with double-homozygous individuals presenting with more severe disease. Other pathogenic variants were identified in MERTK (c.2194C > T, p.Arg732Ter), RHO (c.448G > A, p.Glu150Lys) associated with non-syndromic RP, and MYO7A (c.487G > A, p.Gly163Arg) associated with USH. In addition, the reported variants were of clinical significance as the PDE6C variant was detected novel, whereas TULP1, MERTK, and MYO7A variants were detected rare and first time found segregating with retinal dystrophies in Pakistani consanguineous families., Conclusions: This study increases knowledge of the genetic basis of retinal dystrophies in families from Pakistan providing information important for genetic testing and diagnostic provision particularly from the Khyber Pakhtunkhwa region., (© 2023. The Author(s).)

Background: Congenital ichthyosis is a diverse group of keratinization disorders associated with generalized scaling of skin of varying severity. The non-syndromic forms of congenital ichthyosis are further grouped into common ichthyosis (ichthyosis vulgaris and X-linked ichthyosis), autosomal recessive congenital ichthyosis, and keratopathic ichthyosis., Objective: To identify sequence variants involved in different forms of hereditary ichthyoses., Methods: We studied eight families with different types of ichthyosis including four families with autosomal recessive congenital ichthyosis and four families with common ichthyosis. Whole exome sequencing and PCR based genotyping was carried out to find out the molecular basis of disease., Results: In one family, a novel duplication sequence variant NM&#95;002016.2:c.2767dupT; NP&#95;002007.1:p.Ser923PhefsTer2 was identified in FLG gene; in four families a previously reported nonsense sequence variant NM&#95;000359.3:c.232C>T; NP&#95;002007.1:p.Arg78Ter was identified in TGM1 gene, while, in three families of X-linked recessive ichthyosis, the whole STS gene (NM&#95;001320752.2; NP&#95;001307681.2) regions were deleted., Study Limitation: Gene expression studies have not been performed that would have strengthened the findings of computational analysis., Conclusion: This study highlights the significance of the c.232C>T variant in the TGM1 gene as a possible founder mutation, complete STS gene deletion as reported previously in Pakistani population, while novel sequence variant in the FLG gene expands the spectrum of variations in this gene. These findings may be used for genetic counseling of the studied families., (© 2023 the International Society of Dermatology.)

Objective: To determine the clinical characteristics, management and outcomes of patients presenting with chlorine gas exposure in an emergency setting., Methods: The single-centre, retrospective cross-sectional study was conducted at the emergency department of Aga Khan University Hospital, Karachi, and comprised data of all patients who presented on March 06, 2020, due to acute chlorine gas exposure after a specific industrial accident. Demographic and clinical data was recorded from the medical record files. The association between risk factors and complications was explored. Data was analysed using SPSS 20., Results: There were 51 male patients with a mean age of 33.10±8.37 years. The most commonly affected organ system was respiratory 49(96%), with 43(84.3) having shortness of breath. Eye irritation was found in 44(86.3%) cases and the central nervous system was involved in 14(27.4%). Most of the patients were admitted from the emergency department 36(70%). Regarding treatment, 1(1.9%) patient each required invasive and non-invasive mechanical ventilation. Complications included toxic pneumonitis 3(5.9%) and pneumomediastinum 1(1.7%). No correlation was found between smoking and complications (p>0.05)., Conclusions: Most patients showed complete resolution of symptoms after receiving supportive treatment, while complications were rare and there was no mortality.