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Objective: The aim of this study was to analyze the clinical profiles and outcomes of pediatric brainstem gliomas treated at our institute. Methodology: We reviewed the files of 18 pediatric age group patients diagnosed with brainstem glioma at our institution. The following variables were recorded: age, sex, duration of symptoms, date of diagnosis, main clinical symptoms, Karnofsky performance status score, magnetic resonance imaging findings, histopathology findings, details of the treatment given, disease progression, and date of mortality/last follow-up. This data were then transferred to SPSS version 23 which was used for further analysis. Results: The mean age of our cohort was 8.6 years (range 3–15). There were 11 (61.1%) males and 7 (38.9%) females. There were 16 (88.9%) patients with diffuse intrinsic pontine gliomas (DIPGs), 1 (5.6%) patients with exophytic medullary gliomas, and 1 (5.6%) patient with midbrain/tectal glioma. Mean overall survival (OS) was 9.7 months. Mean progression-free survival (PFS) was 6.3 months. All patients with DIPG eventually passed away from their disease. Patients with DIPG who received radiotherapy had a longer OS and PFS than those who did not (9.8 and 6 months vs. 3.4 and 2.4 months). Diagnostic latency >1 month was found to have a statistically significant longer progression-free interval. Conclusion: DIPGs in the pediatric population have a poor prognosis. Radiotherapy serves to increase survival time but is not curative.

The study was conducted in Nagarparker area, Thar, Pakistan to assess the small dam’s impact on groundwater quality for domestic use and water level variance in wells during pre and post-monsoon pe...

Due to global warming under climate change scenarios, Indus delta region of Pakistan is under serious threat since the last few decades. The present study was thus conducted to determine the spatiotemporal variations in the LST and its impact on the vegetation of the Indus delta, using satellite data for the past 27 years (1990-2017). The analysis revealed that on average, there was an increase of 1.74 oC in LST during the last 27 years. The temporal variation in the Normalized Difference Vegetation Index (NDVI), an indicator of vegetation, showed the highest NDVI of 0.725 in the year 2005 followed by the year 2010 with NDVI of 0.712. While the lowest NDVI of 0.545 was observed during the year 2017. The LST was integrated with NDVI which showed a fair but negative statistical correlation with a coefficient of determination R2 = 0.65. A correlation analysis between NDVI and the yield of the wheat crop of the Delta showed a positive relationship with R2 = 0.89. Several factors may contribute to an increase in LST, such as an increase in residential areas, change in the cropping pattern and overall global climate change. Such studies are important for determining the climatic influences on ecological parameters.

The present study was conducted to analyze the suitability of groundwater and surface water of the Indus Delta, Pakistan for domestic and irrigation purposes based on the concentrations of arsenic (As), total dissolved solids (TDS), and chloride (Cl). Around 180 georeferenced groundwater and 50 surface water samples randomly collected were analyzed and mapped spatially using ArcGIS 10.5 software. The results were compared with their respective WHO and FAO guidelines. The analysis revealed that as in groundwater and surface water samples ranged up to 200, and 25 µg/L respectively. Similarly, the TDS in the groundwater and surface water ranged from 203 to 17, 664 mg/L and 378 to 38,272 mg/L respectively. The Cl in groundwater and surface water varied between 131 and 6,275 mg/L and 440 to 17,406 mg/L respectively. Overall, about 18%, 87% and 94% of the groundwater, and 10%, 92% and 56% of the surface waters possessed higher concentrations of As, TDS, and Cl, respectively. The higher levels of Cl in the samples are attributed to subsurface seawater intrusion in the delta. Analysis results and GIS mapping of water quality parameters revealed that in most of the delta, the quality of water was not suitable for drinking and agricultural purposes, thus should be properly treated before its use.

The small dams were constructed in the study area for storing the rainwater. The present study was conducted to assess the impact of small dams on the LCC (Land Cover Change) in Nangarparkar, Pakistan based on the satellite data. The ENVI (Environment for Visualizing Images) software was used for classification of the four year’s images and three classes viz. water, vegetation, and soil were taken for detection of LCC. The MLH (Maximum Likelihood) supervised method was used to classify the multispectral satellite images. The classified results of the classes were found different each year before and after dam construction. Average results of the two years before dam’s construction revealed that water availability, vegetation cover and soil cover was 3.02%, 18.52%, and 32.30% respectively. However, after the dam construction, the water availability, vegetation cover and soil cover was 8.49%, 34.33%, and 17.15% respectively. Overall results revealed that water availability and vegetation cover were increased by 5.47 % and 15.18% respectively while soil cover decreased 15.15% after the construction of dams. Hence, based on the results, it is confirmed that the constructions of small dams have a direct and indirect positive impact on the land cover changes and it can play an important role in the resettlement of the communities of the arid areas.

Under changing climate scenario, groundwater aquifers in the coastal areas of Pakistan are under serious threat. Looking at the gravity of the problem, and concerns of the civil society, this study...

Impacts of climate change and human-made interventions have altered the fluvial regime of most rivers. The increasingly uncertain floods would further threaten the flow delivery system in regions such as Pakistan. In this study, an alluvial reach of the Indus River below Kotri barrage was investigated for the geomorphologic effects of sediments deposited over the floodplain as well as the influences on the downstream flood-carrying capacity. The hydrodynamic modeling suite HEC-RAS in combination with ground and remotely sensed data were used to undertake this analysis. Results suggest that the morphology of the river reach has degraded due to depleted flows over a long period and hydrological extremes that have led to excessive sediment deposition over the floodplain and an enhancement in flood water extension possibility over the banks. A deposition of 4.3 billion cubic meters (BCM) of sediment increased the elevation of the channel bed which in turn reduced a 17.75% flood-carrying capacity of the river reach. Moreover, the excessive deposition of sediments and the persistence of low flows have caused a loss of 48.34% bank-full discharges over the past 24 years. Consequently, the river’s active reach has been flattened, with a live threat of left levee failure and the inundation of the populous city of Hyderabad. The study would gain insights into characterizing the impacts associated with a reduction in the flood-carrying capacity of the alluvial channel on account of the inadequate sediment transport capacity after heavy flow regulations.

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types., Graphical abstract, D’Antonio et al. characterize associations between GWAS signals for COVID-19 disease and eQTLs in 69 human tissues to identify causal variants and their underlying molecular mechanisms. They show that diverse symptoms and disease severity of COVID-19 are associated with variants affecting gene expression in a wide variety of tissues.

In recent years, reports from developed countries have shown that awake craniotomy has been shown to improve outcomes of surgical resection of brain tumors. However, no such data is available from low- and middle-income countries. We retrospectively reviewed 200 cases of awake craniotomy performed at our center for excision of brain tumors during last 5 years, and assessed clinical outcomes. Data was collected from patients’ medical records, and included demographics, tumor location/histology, clinical complains, and functional status. We used Karnofsky performance scale (KPS) to assess function. Extent of resection was determined on post-operative MRI. Statistical analysis was done using SPSS version 22. Seven attending surgeons performed these cases; however, 168 (84%) surgeries were performed by a single surgeon who is the senior author (SA Enam). Mean age was 39.3 ± 11.9 years and 79% (158) were male. Left frontal lobe was the most common location for tumors (50; 25%). Although 52% (104) patients had malignant neoplasms, seizures were the most common presenting symptom in 63% (126) cases followed by motor deficits in 29% (58). The most common tumors were low grade oligodendroglioma (58; 29%%) followed by glioblastoma (42; 21%). Mean length of hospital stay was 3.15 days ± 1.7 days. Gross total resection was achieved in 82 (41%) patients. New intraoperative neurological complains were seen in 31 (15.5%) patients, however, 22 (11%) of these had recovered by median follow-up of 1.4 months. KPS at last follow-up improved in 92 (46%), remained stable in 94 (47%) and deteriorated in 14 (7%) patients. Although absence of a control group decreases the strength of this, with our large sample size we can safely conclude that AC allows maximum safe excision of brain tumors, and offers a good chance of preserving patients’ functional status, along with adequate extent of resection.

INTRODUCTION In Pakistan, brain tumor epidemiology has been examined in single-centre studies or as part of general cancer registries, which are limited by catchment area, age group, or are not specific to brain tumors. The Pakistan Society of Neuro-Oncology conducted a nationwide study to assess the distribution of brain tumor distribution and associated risk factors. This unfunded study explores data from across Pakistan and serves as a potential model for LMICs to emulate. METHODS A cross-sectional study was designed to include patients diagnosed with brain tumors in major neurosurgical centers in Pakistan retrospectively from January-December 2019. Patients, both alive and deceased, with a radiological diagnosis of a brain tumor were included. Data were recorded on a comprehensive online form from 35 centers, encompassing an estimated 85% of all the brain tumor patients seeking initial treatment by a neurosurgeon from the public and private sectors. Data collection was split into three regions: Sindh and Balochistan; Punjab; and Khyber Pakhtunkhwa and Islamabad. Data collection occurred between August 2020 and January 2021. RESULTS A total of 2750 brain tumor cases were recorded of which 1897 (69%) were diagnosed in the private sector hospitals. MRIs were a more common radiological study compared to CT scans. 2666 surgeries were performed, 174 individuals underwent chemotherapy and 479 underwent radiation therapy; approximately two-thirds of the patients that require adjuvant treatment are not able to receive it. Gliomas were the most common tumor, while pineal tumors were the least common. Findings indicate a low metastasis frequency and few females seeking care. CONCLUSION The study shows that brain tumors are mostly diagnosed and operated on in the private sector; the public sector should be more engaged. The study also highlights that despite inconsistencies in hospital records for brain tumor patients, reliable information can be collected in LMIC settings.

Very little research has been conducted on brain tumor epidemiology in Pakistan and a few studies that do exist provide regional data only. Conducting population based epidemiological studies in low-and-middle income countries (LMICs) like Pakistan can be particularly challenging due to limited resources, poor clinical and research infrastructure, unreliable or incomplete hospital records and a lack of standardization across the health care system. Population-wide studies and registries play an important role in cancer epidemiology and can help identify the current magnitude of cancer burden and its likely future evolution, allowing for better planning of prevention, diagnosis, management, and rehabilitation. This paper describes our experience in designing and conducting Pakistan Brain Tumor Epidemiology Study (PBTES), a first-ever nationwide study carried out to assess the distribution of brain tumors in Pakistan. In addition to the aforementioned obstacles, we were also faced with the global health crisis caused by the COVID-19 pandemic and had to promptly adjust our study accordingly. Other investigators conducting epidemiological studies in LMICs with similarly challenging and constricting settings could benefit from our experiences.

Herein, we describe the fabrication of green bell pepper, Capsicum annuum L. extract capped gold nanoparticles (CA-AuNPs) in aqueous medium using tetrachloroaurate (HAuCl

BACKGROUND: To determine factors that facilitate and are barriers to self-monitoring of blood glucose in type 2 diabetic patients visiting family medicine clinics at a tertiary care teaching hospital Karachi Pakistan. METHODS: Approximately 255 patients were consecutively recruited from the clinics during April 2018 to May 2019 at Family Medicine outpatient clinics at the Aga Khan University Hospital. Data on socio-demographic status, facilitators and barriers to SMBG were extracted through a questionnaire, after obtaining an informed written consent. Data was entered and analyzed in SPSS version 19.RESULTS: Among study participants 47.5% were above 50 years and 51.4% were males. About 30.2% of the participants were practicing SMBG at least once a month and 26% were practicing it daily. Fear of complications was the biggest facilitator (80.1%) and being expensive (51.4%) was barrier for SMBG. Over half of the SMBG practicing participants (59.7%) were diagnosed with diabetes for more than 05 years (p: 0.63). CONCLUSION: Assessment of blood glucose is a critical component of diabetes treatment and management. It can motivate patients to become active participants in their own care. Health care providers should communicate and educate the patients about the advantages of SMBG.

This article explores the water policy narrative in Pakistan, and identifies its historical trajectories and influences, as well as the impact of the global agenda setting of water for 2030. For this purpose, water sector reforms in Pakistan are examined as a case study. The National Water Policy (NWP) 2018 and Participatory Irrigation Management (PIM) reforms are critically evaluated and loopholes identified, in terms of both theoretical aspects and constraints in their practical implementation. The overall analysis reveals that the engineering narrative is dominant in policy circles and large-scale infrastructure construction is seen as an exceptional measure to overcome the current loss of storage potential due to sedimentation. On the other hand, the adoption of the Integrated Water Resource Management (IWRM) framework reflects the desire of state institutions to imbue water policy reform with international credibility. The IWRM framework has been adopted as isomorphic mimicry to appease international financing institutions and donors. PIM reform is thus far from delivering the desired results due to ideological battles among new (i.e., the Participatory Farmers Institution) and traditional bureaucratic irrigation institutions. As adopted, the global agenda setting of water, in the shape of IWRM, is a repackaging of existing activities, and prevents alternative thinking in the setting of water priorities according to developmental needs.

To date, information on the management of specific neurosurgical tumors, such as glioma, in Pakistan remains scattered and scarce. Our review synthesizes the predicaments of glioma management routinely presented to the neurosurgery, medical oncology, radiation oncology, and radiology departments in Pakistan. Expert opinions were integrated from each of the relevant fields in the form of personal citations. The data presented in our review were collected from various PubMed and non-PubMed indexed articles, coupled with various health reports from the Government of Pakistan along with the World Health Organization. Through these data, it was postulated that the utilization of innovative and instrumental technologies is a constant struggle for neurosurgeons in Pakistan, considering the cost-effectiveness. Hence, this results in significant limitations for surgeons to provide the best outcome for their patients. As most Pakistanis (74%) pay out of pocket, measuring cost-effectiveness is extremely crucial. It was found that significant differences in intra-operative and postoperative care existed among various centers. Public sector institutions fared much worse. The role of diagnostics in glioma surgery is severely limited across centers in Pakistan and as such, research and training need to be addressed promptly. In order to achieve success in glioma management, the data in our article demonstrate various facets of health care that need to be addressed simultaneously and swiftly. Surgical access needs to be improved; only then, optimal management of glioma can be accomplished in Pakistan.

Radial blanket pins of Prototype Fast Breeder Reactor (PFBR) are made by encapsulating Deeply Depleted UO2 (DDUO2) pellets in a D9 austenitic stainless steel clad tube. The ends of the tubes are sealed by TIG welding of end plugs at both the ends. This is a critical weld as any failure will lead to spread of radioactivity in sodium coolant circuit of PFBR. At present, integrity of these welds is ensured by 100% radiography by using double wall single image full compensating block tangential radiography method. The present work aims at understanding the nature of defects encountered in the end plug welds and developing an Ultrasonic Testing (UT) methodology in lieu of radiography for qualification of the end plug welds. Typical defects have been examined by metallography and statistical analysis of weld zone has been carried out. A detailed analysis on various parameters affecting detection of tight lack of penetration (LOP) defects in radiography has also been carried out. A UT technique based on B-scan imaging in pulse-echo mode has been explored for inspection of end plug weld. Testing has been carried out with a highly damped spherically point focused 20 MHz transducer to produce 450 shear wave in weld joint area. End plug welds with different types of natural defects have been generated by varying different TIG welding parameters. UT and radiography of the same have been carried out. LOP has been detected with good sensitivity and UT results show good correlation with radiography.

Objective: The aim of the current study was to observe functional outcomes of patients undergoing decompressive craniectomy (DC) for raised intracranial pressure (ICP) after blunt head injury and to assess possible predictive factors. Methodology: This study was a prospective cohort study which was conducted at Aga Khan University Hospital, Karachi over a period of 2 years (January 2015–December 2016). Adult patients, aged between 15 and 65 years of both genders undergoing DC during the study period were selected. Outcomes of DC were assessed at an interval of 3 months following injury using the Glasgow outcome score. The data were analyzed on IBM statistics SPSS version 21. Results: Seventy-two patients underwent DC for raised and refractory ICP. Glasgow Outcome Scale (GOS) at discharge, 1-month and 3-month follow-up were reported. GOS at 3-month follow-up showed 21 patients (29.2%) patients had a good recovery, moderate disability was reported in 16 patients (22.2%), and severe disability in 12 patients (16.7%), persistent vegetative state was seen in five patients (6.9%). Eighteen patients had in hospital mortality (25.0%). Tracheostomy and sphenoid fractures were found to be negative predictors of good functional outcome. Conclusions: DC is associated with an in hospital mortality of 25.0%. Favorable outcomes were seen in 51.4% patients. Tracheostomy and sphenoid fractures were negative predictors of good functional outcome. The results are comparable to international literature.

Introduction Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D) is a genetic disorder characterized by fibrofatty replacement of right ventricle. Extensive research revealed the involvement of desmosomal, non-desmosomal and modifier genes in the etiology of the ARVC/D. Further, environmental factors with modifier genes influence the severity of the disease. One of the well-known modifier genes is HSP90α polymorphism, which is involved in protein folding and regulation as well as apoptosis etc. Therefore, in this study, an investigation was carried out to find the possible association between HSP90α polymorphism and ARVC/D. Material and methods This study included 240 healthy control samples without any family history of cardiac diseases and 61 ARVC/D patients. Diagnosis of patients was carried out using ECG and 2-D echocardiography, following revised diagnostic criteria: definite, borderline diagnosis and possible diagnosis. Scoring of genotypes was carried out by allelic-specific PCR. Results A statistically significant association was observed between HSP90α polymorphism and ARVC/D. In codominant and overdominant models, ‘C/G’ was found to be risk conferring. Further, in dominant model, ‘C/G’ and ‘G/G’ genotypes were susceptible for ARVC/D. Moreover, ‘G’ allele which was predominant in ARVC/D was found to risk conferring towards ARVC/D. Conclusion These findings suggest that possible role ofHSP90α polymorphism in the etiology of ARVC/D. The ‘G’ allele of HSP90α polymorphism damages the 3-D native conformations, which is required for the interaction between client proteins such as desmosomes, ryanodine receptor-2 and sodium channel leading to mislocalization of these proteins. Furthermore, loss of inhibitory interaction between HSP90α protein and Apaf-1 trigger apoptosis.