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The purpose of the current studies was to develop ocular insert of betaxolol hydrochloride (BXH), using arabinoxylan (AX) as a film former. The inserts were prepared by sandwiching I mg of BXH between two films of AX. Six different formulations of ocular inserts were prepared in such a way that first three formulations contained varying concentrations of AX along with glycerol as plasticizer, whereas, rest of the formulations were added with 0.5mg of sodium alginate, sandwiched between two films of AX along with 1mg of BXH. Chemical compatibilities of the ingredients were assessed by using FTIR. Prepared ocular inserts were subjected to various physicochemical characterizations. The dissolution studies showed that ocular inserts containing sodium alginate with the AX showed sustained release effect better than the formulations with AX alone. Addition of sodium alginate resulted in inhibition of sudden release in initial phase and further sustained the release of drug from ocular inserts. Ocular inserts were pH compatible to the eyes as well as there was no interaction among the drug and excipients, suggesting that the selected excipients were suitable for the development of sustained release ocular inserts of BXH.

Introduction Breast density on mammography can affect the sensitivity of breast cancer detection and is an independent risk factor for breast cancer. The incidence of breast cancer in Pakistani women is reported to be the highest among women in Asia. No published data is describing the patterns of mammographic breast density in this population. We undertook this study to assess the Breast Imaging Reporting and Data System (BI-RADS) patterns of breast density on mammography, factors that affect breast density, and inter-observer variability in breast density assessment. Methods Bilateral breast mammograms were retrospectively reviewed for breast density by two separate readers (resident and attending radiologist). Breast density was categorized into four types according to the BI-RADS lexicon. Types 1 and 2 were grouped into non-dense and types 3 and 4 into dense breasts. The association of patient factors with breast density was assessed, with p < 0.05 considered statistically significant. The inter-observer variability in breast density assessment between the two readers was calculated using Cohen's κ coefficient. Results A total of 612 women underwent mammography in the study period. Type 3 (heterogeneously dense breast parenchyma) was the most frequent pattern (51.6%) followed by type 2 (scattered fibroglandular) pattern (38.9%). Fatty parenchyma (type 1) and extremely dense parenchyma (type 4) were the least common. Breast density was inversely related to age (p < 0.001) and parity (p <0.002). Breast density was also lower in postmenopausal women (p < 0.001). There was no statistically significant difference in mean age at menarche, age at first delivery, family history of breast cancer, or presence of cancer among women with dense and non-dense breasts. The inter-observer agreement was almost perfect (κ = 0.86).  Conclusion The majority of women in our population (56.9%) had dense breasts (BI-RADS type 3 and 4) which decrease the sensitivity of breast cancer detection on mammography suggesting it may be insufficient as the sole screening/diagnostic tool in this population. Lower breast density was associated with increasing age, parity, and post-menopausal status. Breast density assessment was almost perfect among the resident and attending radiologist., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Fatima et al.)

The characterization of saccharidic compounds in atmospheric aerosols is important in order to retrieve information about organic carbon sources and their transport pathways through the atmosphere. In this study, composition and sources of saccharides in PM 10 were determined in a South Asian megacity (Faisalabad) during the year 2015 - 2016. PM 10 sampled on quartz filters was analyzed by anion exchange chromatography for the selected saccharidic compounds. The average PM 10 concentration was found to be 744 ± 392 μg m -3 , exceeding the daily limits proposed by Pak-EPA (150 μg m -3 ), US-EPA (150 μg m -3 ), and WHO (50 μg m -3 ). The average total saccharidic concentration was found to be 2820 ± 2247 ng m -3 . Among the different saccharidic categories, anhydrosugars were the most abundant in concentration followed by primary sugars and sugar alcohols. The correlation and principal component analysis indicated emissions from biomass combustion, soil suspensions from areas such as farmlands having high microorganism activity, and biogenic emissions such as airborne fungal spores and vegetation detritus as major sources of saccharides in the aerosol samples.

Carbon dioxide (CO 2 , a common combustion pollutant) releasing continuously into the atmosphere is primarily responsible for the rising atmospheric temperature. Therefore, CO 2 sequestration has been an indispensable area of research for the past several decades. On the other hand, the concept of aromaticity is often employed in designing chemical reactions and metal-free frustrated Lewis pairs (FLPs) have proved ideal reagents to achieve CO 2 reduction. However, considering FLP and aromaticity together is less developed in CO 2 capture. Here we report theoretical investigations on the aromaticity-promoted CO 2 activation, involving heterocyclopentadiene-bridged P/N-FLPs. The calculations reveal that furan- and pyrrole-bridged P/N-FLPs can make CO 2 capture both thermodynamically and kinetically favorable (with activation energies of 5.4-7.7 kcal mol -1 ) due to the aromatic stabilization of the transition states and products. Our findings could open an avenue to the design of novel FLPs for CO 2 capture., (© 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Unusual 1,2-migration reactions of N-heterocyclic carbene (NHC) on transition metals were investigated using density functional theory calculations. Our results reveal that the electronic properties, ring strain of the four-membered ring, and aromaticity of NHC play crucial roles in the thermodynamics of such a 1,2-migration. Further studies show that changing the methylene on the metal center in the reactant with a more electronegative group (NH or O) will lead to the formation of products with nitrogen coordinating to the metal center, whereas other groups (BH, CF 2 , and SiH 2 ) will make such a 1,2-migration reverse. In addition, the reversed rearrangement of 1,2-boron, silyl migration could be thermodynamically and kinetically favorable., (© 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: Poorly water-soluble drugs do not dissolve well in aqueous-based gastrointestinal fluid; therefore, they are not well absorbed. Thus, employing a suitable solubility enhancing technique is necessary for such a drug. Drug/HP‑β‑CD complexation is a promising way to improve solubility and dissolution of a poorly water-soluble drug. Levodropropizine was used as a model drug in this study., Objectives: The purpose of this research was to enhance the aqueous solubility and dissolution rate of levodropropizine by employing the inclusion complexation technique., Material and Methods: A microparticle formulation was prepared from levodropropizine and hydroxypropyl-β-cyclodextrin (HP‑β‑CD) in a 1:1 molar ratio through the spray-drying technique. The host-guest relationship between levodropropizine and HP‑β‑CD was also investigated using the molecular docking computational methodology. The aqueous solubility and dissolution rate of levodropropizine in formulations were assessed and compared with those of the drug alone. X-ray diffraction (XRD), differential scanning calorimetry (DSC), scanning electron microscopy (SEM), and Fourier transform infrared spectroscopy (FTIR) were applied for the solid-state characterization of the prepared samples., Results: According to the research outcomes, the levodropropizine/HP‑β‑CD formulation had enhanced the aqueous solubility (351.12 ±13.26 vs 92.76 ±5.00 mg/mL) and dissolution rate (97.83 ±3.36 vs 3.12 ±1.76% in 10 min) of levodropropizine, compared to the plain drug powder. The levodropropizine/ HP‑β‑CD formulation had converted the crystalline drug into its amorphous counterpart. Furthermore, no covalent interaction was found to exist between levodropropizine and HP‑β‑CD. The spray-dried particles were discrete. Each particle had a shriveled appearance., Conclusions: The levodropropizine/HP‑β‑CD formulation is, therefore, recommended for the more effective administration of levodropropizine through the oral route.

Stroke is one of the most feared complications of aortic valve replacement. Although the outcomes of transcatheter aortic valve implantation (TAVI) improved substantially over time, concerns remained about a potentially higher incidence of stroke with TAVI compared with surgical replacement (SAVR). However, comparative data are sparse. We performed a meta-analysis comparing the incidence of stroke among patients undergoing TAVI versus SAVR. Of the 5067 studies screened, 28 eligible studies (22 propensity-score matched studies and 6 randomized trials) were analyzed. Primary endpoints were 30-day stroke and disabling stroke. Secondary endpoints were 1-year stroke and disabling stroke. A total of 23,587 patients were included, of whom 47.27% underwent TAVI and 52.72% underwent SAVR. For each endpoint, pooled estimates of odds ratio (OR) with 95% confidence interval (CI) were calculated. The pooled estimates for stroke (2.7% vs 3.1%, OR 0.86; 95% CI 0.72 to 1.02; p=0.08) and disabling stroke (2.5% vs 2.9%, OR 0.96; 95% CI 0.57 to 1.62; p=0.89) were comparable following TAVI versus SAVR at 30 days. Similarly, the pooled estimates for stroke (5.0% vs 4.6%, OR 1.01; 95% CI 0.79 to 1.28; p=0.96) and disabling stroke (4.1% vs 4.5%, OR 0.92; 95% CI 0.92 to 1.39; p=0.71) were similar at 1 year. A sensitivity analysis including only RCTs yielded similar results. Our meta-analysis documents comparable rates of strokes and disabling strokes following TAVI or SAVR both at 30 days and 1 year., (Copyright © 2018. Published by Elsevier Inc.)

Over the past decade there is increased use of vitamin D supplementation because of its benefits on bone health. It is a fat-soluble vitamin and cannot be excreted from the body. There is need for monitoring 25-hydroxyvitamin D levels in infants and children who receive long-term vitamin D supplementation at or above the upper level intake that is currently recommended. Vitamin D intoxication can present from mild ignorable to severe life-threatening symptoms. We present a 7- month-old infant with vitamin D intoxication at recommended daily doses of vitamin D.

Introduction Trauma constitutes a major public health problem. Ninty percent of world's fatalities on road occur in low and middle-income countries. Focused assessment with sonography in trauma (FAST) has a key role in trauma investigation, altering subsequent management in a significant number of patients. There is a rising trend of introducing FAST examination to non-radiologists and junior members of healthcare team to hasten triage of trauma patients. Objective To determine interobserver agreement on focused assessment with sonography for trauma in blunt abdominal injury between senior and junior residents. Methods This cross-sectional study was conducted at Aga Khan University Hospital. Three hundred patients with blunt abdominal trauma meeting inclusion criteria were enrolled. FAST was performed using standard curvilinear 3.5-5 MHz transducer. Agreement between junior and senior residents was measured and Kappa statistic was calculated. Results Mean age of the patients included in the study was 30.04 ± 18.09 years. Among these 237 (79%) were male and 63 (21%) were female. Sixteen (5.3%) were positive for intraperitoneal free fluid while the remaining 284 (94.7%) were negative. A total of 19 FAST examinations were reported positive by junior residents, of which 15 (78.9%) were confirmed by a senior resident to be correct, while four (21.05%) were falsely labeled positive by a junior resident. A total of 281 negative FAST examinations were reported by junior residents, of which 280 (99.6%) were confirmed by a senior resident, while only one (0.003%) was falsely labeled negative. Kappa statistic was calculated for inter-observer agreement on FAST examination findings, which showed a kappa value of 0.84 (very good agreement), with a p-value of <0.001. Conclusion Our study suggests very good interobserver agreement on FAST examination between senior and junior resident in patients with blunt trauma to the abdomen. Results suggest that FAST can be easily learnt with minimal radiology training and may have greater applicability in trauma., Competing Interests: The authors have declared that no competing interests exist.

Schistosomiasis may cause diverse symptoms and it is usually not considered as a cause of disease especially in patients with normal immune system. We are reporting an eleven-year-old child who was initially diagnosed as a case of lymphoma but later on proved to be a case of acute schistosomiasis.

Background: In 2008, the European Cooperative Acute Stroke Study-3 (ECASS-3) demonstrated that intravenous-tissue plasminogen activator could be safely administered for acute stroke patients presenting between 3 and 4.5 hours from symptom onset. Recently, the Food and Drug Administration rejected expansion of this time window in the United States. We sought to determine how many fewer patients would be treated by maintaining this restricted time window., Methods: We reviewed charts from patients who received intravenous thrombolysis at the University of Alabama at Birmingham between January 2009 and December 2011. Patients were divided into two groups (treated within 3 hours of onset, treated between 3 and 4.5 hours from onset). Demographics, stroke severity and protocol deviations according to the ECASS-3 trial were collected. Our safety measures were any hemorrhagic transformation, symptomatic intracerebral hemorrhage and systemic hemorrhage., Results: Two hundred and twelve patients were identified, of whom 192 were included in our analysis. A total of 36 patients (19%) were treated between 3 and 4.5 hours. No statistical differences were seen between age (p=0.633), gender (p=0.677), race (p=0.207) or admission stroke severity (p=0.737). Protocol deviations from the ECASS-3 criteria were found in 20 patients (56%). These were primarily age > 80 and aggressive blood pressure management. Despite these deviations, we did not see significant increases in the rates of adverse events in patients treated in the extended time window., Conclusions: Our data are consistent with previously reported international data that IV thrombolysis can safely be used up to 4.5 hours from symptom onset. Restricting the time window to 3 hours would have resulted in almost one-fifth fewer patients treated at our center.

Objective: To compare the efficacy of Transurethral Incision of Prostate (TUIP) with Transurethral Resection of Prostate (TURP), in terms of improvement in peak flow rate (Q-Max) and number of complications., Study Design: It was an interventional, quasi-experimental study., Place and Duration of Study: This study was conducted at the Armed Forces Institute of Urology (AFIU), Rawalpindi, from November 2006 to December 2007., Methodology: A total of 60 patients were inducted in the study with thirty patients in each group undergoing TUIP (Group A) and TURP (Group B). Patients of any age with prostate less than 35 grams needing surgical interventions were included in the study. Patients with recurrent disease, multiple co-morbid conditions, higher center dysfunctions, neurogenic bladder and associated strictures were excluded. In TUIP, a single median incision was made at 6 'O clock position, starting from interureteric ridge upto verumontanum, going upto prostatic capsule. In group B, standard TURP was done. All the cases were operated by the same consultant under spinal anaesthesia. Follow up was done at the end of the 1st week and 1st, 3rd and 6th months., Results: Mean operative time was shorter (17.01+/-1.97 minutes) in group A as compared to group B (27.06+/-23.06 minutes, p<0.05). There was no statistically significant difference between the two groups regarding peak flow. Complications were less in group A (08) and more in group B (n=28, <0.05)., Conclusion: TUIP and TURP were equal in terms of improvement in flow rate, but operative time was shorter in TUIP with less post operative complications. So, TUIP is a better choice in prostates weighing less than 35 grams.