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Pulmonary arterial hypertension (PAH) is characterized by endothelial dysfunction, uncontrolled proliferation and migration of pulmonary arterial endothelial cells leading to increased pulmonary vascular resistance resulting in great morbidity and poor survival. Bone morphogenetic protein receptor II (BMPR2) plays an important role in the pathogenesis of PAH as the most common genetic mutation. Non-muscle myosin light chain kinase (nmMLCK) is an essential component of the cellular cytoskeleton and recent studies have shown that increased nmMLCK activity regulates biological processes in various pulmonary diseases such as asthma and acute lung injury. In this study, we aimed to discover the role of nmMLCK in the proliferation and migration of pulmonary arterial endothelial cells (HPAECs) in the pathogenesis of PAH. We used two cellular models relevant to the pathobiology of PAH including BMPR2 silenced and vascular endothelial growth factor (VEGF) stimulated HPAECs. Both models demonstrated an increase in nmMLCK activity along with a robust increase in cellular proliferation, inflammation, and cellular migration. The upregulated nmMLCK activity was also associated with increased ERK expression pointing towards a potential integral cytoplasmic interaction. Mechanistically, we confirmed that when nmMLCK is inhibited by MLCK selective inhibitor (ML-7), proliferation and migration are attenuated. In conclusion, our results demonstrate that nmMLCK upregulation in association with increased ERK expression may contribute to the pathogenesis of PAHby stimulating cellular proliferation and migration.

Prcis: This study demonstrated significant differences in ultra-short-term IOP fluctuations, measured by a contact lens sensor between progressive and stable PACG eyes, during the first one hour after falling asleep., Purpose: To identify the most sensitive period for detecting significant ultra-short-term intraocular pressure (IOP) fluctuation associated with disease progression in primary angle closure glaucoma (PACG)., Materials and Methods: PACG eyes, which had been followed up for over 2 years under the CUHK PACG Longitudinal (CUPAL) Study, were recruited. Eyes with or without functional or structural glaucomatous progression were classified into 'progressive' or 'stable' groups on the basis of serial visual field and retinal nerve fiber layer (RNFL) thickness documentations, respectively. Ultra-short-term IOP fluctuations were recorded by Sensimed Triggerfish sensors (Sensimed AG, Lausanne, Switzerland) with 288 readings over 30 seconds, at 5-minute intervals, over a 24-hour period. In each of 7 activity-related 1-hour periods during the examining day, the mean value of the amplitude-frequency profiles of the signal fluctuations in twelve 30-second intervals was calculated by semivariogram/semi-variance. The 'progressive' and 'stable' groups were compared by permutation tests on functional t-statistics., Results: Among the 25 recruited PACG eyes, 16 eyes were classified as RNFL 'progressive' group (the mean rate of change in global RNFL thickness: -0.199 ±0.128 μm/mo). Higher signal fluctuations, in terms of amplitude-frequency, were found during the first 1-hour period of sleeping in the RNFL 'progressive' group compared with the RNFL 'stable' group ( P =0.028)., Conclusions: Between RNFL 'progressive' and 'stable' PACG eyes, significant differences in ultra-short-term IOP fluctuation at the 1-hour period after falling asleep were identified. The first hour of sleeping may be the most sensitive period for detecting significant ultra-short-term IOP fluctuation in PACG eyes., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Chiral Metal-Organic Frameworks (CMOFs) are unique crystalline and porous class of materials which is composed of organic linkers and metal ions. CMOFs surpass traditional organic and inorganic porous materials because of their tunable shape, size, functional diversity, and selectivity. Specific applications of CMOFs may be exploited by introducing desired functional groups. CMOFs have chiral recognition abilities, making them unique for chiral compound synthesis and separation. The CMOFs can be synthesized through different approaches. Two main approaches have been discussed, i.e., direct and indirect synthesis. Synthetic strategies play an essential role in getting desired properties in MOFs. CMOFs find potential applications in adsorption, asymmetric catalysis, luminescence, degradation, and enantioselective separation. The MOFs' porosity, stability, and reusability make them an attractive material for these applications. The plethora of applications of CMOFs have motivated chemists to synthesize novel MOFs and number of MOFs have been ever-escalating. Herein, the synthetic methods of CMOFs and their various applications have been discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Altaf, Hassan, Pejcic, Baig, Hussain and Sohail.)

Background: Critical care research in Canada is conducted primarily in academically-affiliated intensive care units with established research infrastructure, including research coordinators (RCs). Recently, efforts have been made to engage community hospital ICUs in research albeit with barriers. Automation or artificial intelligence (AI) could aid the performance of routine research tasks. It is unclear which research study processes might be improved through AI automation., Methods: We conducted a cross-sectional survey of Canadian ICU research personnel. The survey contained items characterizing opinions regarding research processes that may be amenable to AI automation. We distributed the questionnaire via email distribution lists of 3 Canadian research societies. Open-ended questions were analyzed using a thematic content analysis approach., Results: A total of 49 survey responses were received (response rate: 8%). Tasks that respondents felt were time-consuming/tedious/tiresome included: screening for potentially eligible patients (74%), inputting data into case report forms (65%), and preparing internal tracking logs (53%). Tasks that respondents felt could be performed by AI automation included: screening for eligible patients (59%), inputting data into case report forms (55%), preparing internal tracking logs (51%), and randomizing patients into studies (45%). Open-ended questions identified enthusiasm for AI automation to improve information accuracy and efficiency while freeing up RCs to perform tasks that require human interaction. This enthusiasm was tempered by the need for proper AI education and oversight., Conclusions: There were balanced supportive (increased efficiency and re-allocation of tasks) and challenges (informational accuracy and oversight) with regards to AI automation in ICU research.

The development of a simple and efficient synthetic methodology to engineer functional polymer materials for gas adsorption is necessary due to its relevance for various applications. Herein, we report the synthesis of metalorganic poly(vinylene sulfide) copolymers CTP1-3 with iron(II) clathrochelate of various side groups connected by tetraphenylbenzene units. CTP1-3 were subsequently oxidized into their respective poly(vinylene sulfone) copolymers CTP4-6 under green reaction conditions. The target copolymers CTP1-6 were characterized using various instrumental analysis techniques. Examination of the iodine adsorption properties of the copolymers revealed high iodine uptake properties, reaching 2360 mg g -1 for CTP2, and whose reusability tests proved its efficient regeneration, thus proving the importance of iron(II) clathrochelate polymers in iodine capture.

We report the synthesis of three highly soluble metalorganic copolymers, TCP1-3, that were made from a one-pot complexation of iron(II) clathrochelate units that are interconnected by various thioether-containing contorted groups. TCP1-3 were converted into their poly(vinyl sulfone) derivatives OTCP1-3 quantitatively via the selective oxidation of the thioether moieties into their respective sulfones. All of the copolymers, TCP1-3 and OTCP1-3, underwent structural analysis by various techniques; namely, 1 H- and 13 C-nuclear magnetic resonance (NMR), Fourier transform infrared (FTIR), X-ray photoelectron spectroscopy (XPS), and gel permeation chromatography (GPC). The copolymers were tested as potent lithium ions adsorbents revealing a maximum adsorption (q m ) value of 2.31 mg g -1 for OTCP2. Furthermore, this same copolymer was found to be a promising adsorbent of methylene blue (MEB); an isothermal adsorption study divulged that OTCP2's uptake of MEB from an aqueous solution (following the Langmuir model) was, at maximum adsorption capacity, (q m ) of 480.77 mg g -1 ; whereas the kinetic study divulged that the adsorption follows pseudo second-order kinetics with an equilibrium adsorption capacity (q e,cal ) of 45.40 mg g -1 .

Background: Diverse strategies are employed globally to integrate medical curricula. Nevertheless, a gap exists in assessing the role of medical instructors in meaningful integration. We developed and used a tool to explore the current level of integration, score medical instructors' individual practices for integration, and investigate contextual elements minimizing integration., Methodology: This cross-sectional study, conducted in September-November-2020, used convenience-sampling. The study participants were basic-sciences and clinical instructors at two private-sector medical colleges in Karachi-Pakistan (with a response rate of 53.5%, n = 107). We validated a paper-based questionnaire through a pilot study on five participants. This tool with 11 close-ended questions on a 5-point Likert scale generated instructors' integration scores, and six open-ended questions probed instructors' perspectives., Results: The mean integration score was 37.4±6.7. Participants' perspectives indicated a need for participation of clinical faculty in teaching initial undergraduate years, involving lecturers in curriculum meetings, and integration of assessment. The questionnaire Cronbach-alpha was 0.732 with satisfactory principal-component-analysis., Conclusion: Medical instructors facilitated integration mainly through concurrent timetabling of similar topics. Moreover, formal consultation through committee meetings, with discipline-based and integrated approaches complementing each other, were in practice to achieve curricular goals., (© 2022 Baig, Siddiqui, Baig, Khursheed, Meah; licensee Synergies Partners.)

Oily wastewater has become one of the leading causes of environmental pollution. A massive quantity of oily wastewater is released from industries, oil spills, and routine activities, endangering the ecosystem's sustainability. Due to the enormous negative impact, researchers put strenuous efforts into developing a sustainable solution to treat oily wastewater. Microfiltration/ultrafiltration membranes are considered an efficient solution to treat oily wastewater due to their low cost, small footprint, facile operation, and high separation efficiencies. However, membranes severely fouled during the separation process due to oil's adsorption and cake layer formation, which shortens the membranes' life. This review has critically discussed the microfiltration/ultrafiltration membrane synthesizing methods and their emulsion's separation performance. In the end, key challenges and their possible solutions are highlighted to provide future direction to synthesize next-generation membranes., (© 2022 The Chemical Society of Japan & Wiley-VCH GmbH.)

Environmental emissions of mercury from industrial waste and natural sources, even in trace amounts, are toxic to organisms and ecosystems. However, industrial-scale mercury detection is limited by the high cost, low sensitivity/specificity, and poor selectivity of the available analytical tools. This review summarizes the key sensors for mercury detection in aqueous environments: colorimetric-, electrochemical-, fluorescence-, and surface-enhanced Raman spectroscopy-based sensors reported between 2014-2021. It then compares the performances of these sensors in the determination of inorganic mercury (Hg 2+ ) and methyl mercury (CH 3 Hg + ) species in aqueous samples. Mercury sensors for aquatic applications still face serious challenges in terms of difficult deployment in remote areas and low robustness, reliability, and selectivity in harsh environments. We provide future perspectives on the selective detection of organomercury species, which are especially toxic and reactive in aquatic environments. This review is intended as a valuable resource for scientists in the field of mercury sensing., (© 2022 The Chemical Society of Japan & Wiley-VCH GmbH.)

Background: Nearly 90% of out-of-hospital cardiac arrest (OHCA) patients are witnessed, yet only 2.3% received bystander cardiopulmonary resuscitation (CPR) in Pakistan. This study aimed to determine retention of knowledge and skills of Hands-Only CPR among community participants in early recognition of OHCA and initiation of CPR in Karachi, Pakistan., Methods: Pre and post-tests were conducted among CPR training participants from diverse non-health-related backgrounds from July 2018 to October 2019. Participants were tested for knowledge and skills of CPR before training (pre-test), immediately after training (post-test), and 6 months after training (re-test). All the participants received CPR training through video and scenario-based demonstration using manikins. Post-training CPR skills of the participants were assessed using a pre-defined performance checklist. The facilitator read out numerous case scenarios to the participants, such as drowning, poisoning, and road traffic injuries, etc., and then asked them to perform the critical steps of CPR identified in the scenario on manikins. The primary outcome was the mean difference in the knowledge score and skills of the participants related to the recognition of OHCA and initiation of CPR., Results: The pre and post-tests were completed by 652 participants, whereas the retention test after 6 months was completed by 322 participants. The mean knowledge score related to the recognition of OHCA, and initiation of CPR improved significantly (p < 0.001) from pre-test [47.8/100, Standard Deviation (SD) ±13.4] to post-test (70.2/100, SD ±12.1). Mean CPR knowledge after 6 months (retention) reduced slightly from (70.2/100, ±12.1) to (66.5/100, ±10.8). CPR skill retention for various components (check for scene safety, check for response, check for breathing and correct placement of the heel of hands) deteriorated significantly (p < 0.001) from 77.9% in the post-test to 72.8% in re-test. Participants performed slightly better on achieving an adequate rate of chest compressions from 73.1% in post-test to 76.7% in re-test (p 0.27)., Conclusion: Community members with non-health backgrounds can learn and retain CPR skills, allowing them to be effective bystander CPR providers in OHCA situations. We recommend mass population training in Pakistan for CPR to increase survival from OHCA., (© 2022. The Author(s).)

Introduction: High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field., Methods: We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors' affiliations and funding sources. We compared the proportion of authors affiliated with each income bracket using Χ 2 analysis. We conducted logistic regression to identify factors associated with first or last authorship affiliated with the study country., Results: There were 14 113 authors in 1751 articles. Nearly half (45.5%) of the articles reported work conducted in lower middle-income countries (MICs), 23.6% in upper MICs, 22.5% in low-income countries (LICs). Authors affiliated with HICs were most represented (40.7%); 26.4% were affiliated with lower MICs, 17.4% with upper MICs, 10.3% with LICs and 5.1% with mixed affiliations. Among single-country studies, those without any local authors (8.7%) were most common among those conducted in LICs (14.4%). Only 31.0% of first authors and 21.3% of last authors were affiliated with LIC study countries. Studies in upper MICs (adjusted OR (aOR) 3.6, 95% CI 2.46 to 5.26) and those funded by the study country (aOR 2.94, 95% CI 2.05 to 4.20) had greater odds of having a local first author., Conclusions: There were significant disparities in authorship representation. Authors affiliated with HICs more commonly occupied the most prominent authorship positions. Recognising and addressing power imbalances in international, collaborative emergency medicine (EM) research is warranted. Innovative methods are needed to increase funding opportunities and other support for EM researchers in LMICs, particularly in LICs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Traumatic lumbar hernias are rare, with little surgical literature describing their management. In this we report about a 41-year-old patient admitted to University Hospital Southampton following a high velocity road traffic collision, of estimated speed 140 mph. He suffered multiple bony injuries, and a traumatic right inferior lumbar hernia containing the ascending colon. The hernia was surgically repaired extra-peritoneally with mesh and abdominal wall muscles approximated and sutured., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2022.)

Objectives: To determine the association between the laboratory biomarkers (C-reactive protein (CRP), Ferritin, lactate dehydrogenase (LDH), Procalcitonin, and D-dimer) with complications and in-hospital mortality in COVID-19 patients., Methods: This single-center, cross-sectional study was conducted at the Department of Emergency Medicine of Aga Khan University Hospital from April 01, 2020, to July 31, 2020. Descriptive statistics were presented as Mean±SD and Median along with Range. The frequencies and percentages were calculated for all categorical variables. Univariate and multivariate analysis was carried out to evaluate the significant association between the laboratory biomarkers and in-hospital mortality., Results: A total of 310 adult COVID positive patients were included. The most common complication was acute respiratory distress syndrome (ARDS) (37.1%), followed by myocardial injury (MI) (10.7%), deep vein thrombosis (DVT) (0.6%), and pulmonary embolism (PE) (0.3%). In-hospital mortality was 15.2%. In univariate analysis, it was observed that increased values of all biomarkers were significantly associated with the prediction of in-hospital mortality using binary logistic regression analysis (OR > 1.0, P <0.05). In multivariate analysis, increased levels of LDH and D-dimer at admission were significantly associated with increased odds of mortality (P <0.05)., Conclusion: Serum CRP, ferritin, Procalcitonin, LDH, and D-dimer levels at the time of admission can predict complications like ARDS and MI and also predict mortality in COVID-19 infection. Serum LDH and D-dimer are the best amongst them for predicting mortality., Competing Interests: Conflict of interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

The release of mercury into the environment has adverse effects on humans and aquatic species, even at very low concentrations. Pyrene and its derivatives have interesting fluorescence properties that can be utilized for mercury (Hg 2+ ) ion sensing. Herein, we reported the highly selective pyrene-functionalized silica nanoparticles (Pyr-NH@SiO 2 NPs) for chemosensing mercury (Hg 2+ ) ions in a seawater sample. The Pyr-NH@SiO 2 NPs were synthesized via a two-step protocol. First, a modified Stöber method was adopted to generate amino-functionalized silica nanoparticles (NH 2 @SiO 2 NPs). Second, 1-pyrenecarboxylic acid was coupled to NH 2 @SiO 2 NPs using a peptide coupling reaction. As-synthesized NH 2 @SiO 2 NPs and Pyr-NH@SiO 2 NPs were thoroughly investigated by 1 H-NMR, FTIR, XRD, FESEM, EDS, TGA, and BET surface area analysis. The fluorescent properties were examined in deionized water under UV-light illumination. Finally, the developed Pyr-NH@SiO 2 NPs were tested as a chemosensor for Hg 2+ ions detection in a broad concentration range (0-50 ppm) via photoluminescence (PL) spectroscopy. The chemosensor can selectively detect Hg 2+ ions in the presence of ubiquitous ions (Na + , K + , Ca 2+ , Mg 2+ , Ba 2+ , Ag + , and seawater samples). The quenching of fluorescence properties with Hg 2+ ions (LOD: 10 ppb) indicates that Pyr-NH@SiO 2 NPs can be effectively utilized as a promising chemosensor for mercury ion detection in seawater environments.

Oily wastewater from industries has an adverse impact on the environment, human and aquatic life. Poly(vinylidene fluoride) (PVDF) membrane modified with a zwitterionic/hydrophobic pentapolymer (PP) with controlled pore size has been utilized to separate oil from water from their nano-emulsions. The PP has been synthesized in 91% yield via pentapolymerization of four different diallylamine salts [(CH 2 =CHCH 2 ) 2 NH + (CH 2 ) x A - ], bearing CO 2 - , PO 3 H - , SO 3 - , (CH 2 ) 12 NH 2 pendants, and SO 2 in a respective mol ratio of 25:36:25:14:100. Incorporating PP into PVDF has shown a substantially reduced membrane hydrophobicity; the contact angle decreased from 92.5° to 47.4°. The PP-PVDF membranes have demonstrated an excellent capability to deal with the high concentrations of nano-emulsions with a separation efficiency of greater than 97.5%. The flux recovery ratio (FRR) of PP-5 incorporated PVDF membrane was about 82%, which was substantially higher than the pristine PVDF., (© 2022. The Author(s).)

Background: In the era of COVID-19 where there is emphasis on the importance of wearing a mask, wearing it rightly is equally important. Therefore, the purpose of this study was to assess the knowledge, attitude and practice of wearing a mask in the general population of a developing country at three major tertiary care hospital., Materials and Methods: Participants of this cross-sectional study were patients and attendants at three major tertiary care hospital of Karachi Pakistan. Selected participants, through non-probability convenient sampling technique, were interviewed regarding knowledge, attitude, and practice of wearing mask using an Urdu translated version of a questionnaire used in an earlier study. Three summary scores (0 to 100) were computed to indicate participants' mask wearing practice, technique of putting it on, and technique of taking if off. Collected data were analyzed with the help of IBM SPSS version 19., Results: A total of 370 selected individuals were interviewed, out of which 51.9% were male and mean age was 37.65±11.94 years. For more than 90% of the participants, wearing a face mask was a routine practicing during the pandemic. The mean practice score was 65.69±25.51, score for technique of putting on a face mask was 67.77±23.03, and score of technique of taking off a face mask was 51.01±29.23. Education level of participant tends to have positive relationship with all three scores, while presence of asthma or chronic obstructive pulmonary disease (COPD) as co-morbid had negative impact on mask wearing practice., Conclusion: We have observed suboptimal knowledge, attitude and practice of wearing mask among the selected individuals. There is a continued need to spread awareness and educate general population about the importance of using a face mask, as well as the proper technique of wearing and taking off a face mask., Competing Interests: The authors have declared that no competing interests exist.

Background: Intravenous (IV) vasopressors to support hemodynamics are a primary indication for intensive care unit (ICU) admission. Utilization of oral vasopressor therapy may offer an alternative to IV vasopressor therapy in the ICU, thus decreasing the need for ICU admission. Oral vasopressors, such as midodrine, have been used for hemodynamic support in non-critically ill patients, but their evaluation in critically ill patients to potentially spare IV vasopressor therapy has been limited., Methods: The LIBERATE study will be a multicenter, parallel-group, blinded, randomized placebo-controlled trial. It will recruit adult (i.e., age ≥ 18 years) critically ill patients receiving stable or decreasing doses of IV vasopressors. Eligible patients will be randomized to receive either midodrine 10 mg administered enterally every 8 h or placebo until 24 h post-discontinuation of IV vasopressors. The primary outcome will be ICU length of stay. Secondary outcomes include all-cause mortality at 90 days, hospital length of stay, length of IV vasopressor support, re-initiation of IV vasopressors, rates of ICU readmission, and occurrence of AEs. Health economic outcomes including ICU, hospital and healthcare costs, and cost-effectiveness will be evaluated. Pre-planned subgroup analyses include age, sex, frailty, severity of illness, etiology of shock, and comorbid conditions., Discussion: LIBERATE will rigorously evaluate the effect of oral midodrine on duration of ICU stay and IV vasopressor support in critically ill patients., Trial Registration: ClinicalTrials.gov NCT05058612 . Registered on September 28, 2021., (© 2022. The Author(s).)

Objective: To assess the nourishment level of married women of reproductive age in a two rural setting., Methods: The cross-sectional study was based on secondary data of the Impact Assessment Survey 2019, which was conducted by the People's Primary Health Care Initiative from January to May, 2019, in Dadu and Jacobabad districts of the province of Sindh, Pakistan. Nutritional status of married women of reproductive age was analysed using mid-upper arm circumference; <23cm being indicative of under-nourishment, and <21cm of severe under-nourishment. Predicting factors were identified using multivariate logistic regression. Data was analysed using STATA 15., Results: Of 10,388 subjects, 5,138(49.5%) were from Dadu and 5,250(50.5%) from Jacobabad. The overall mean age was 32.9±8.1 with 4,739(45.6%) aged 25-35 years. Overall, 2,336(22.5%) subjects were undernourished and 609(5.9%) were severely undernourished. Age, education, socio-economic status and parity were significant predictors of the nourishment status (p<0.05), while location and health facility type were significant predictors of severe undernourishment (p<0.05), but were not related to undernourishment (p>0.05)., Conclusions: Overall nutrition status of the married women of reproductive age in the two rural districts of Sindh was less than satisfactory.

Introduction: The reuse of cardiac implantable electronic devices may help increase access to these therapies in low- and middle-income countries (LMICs). No published data exist regarding the views of patients and family members in LMICs regarding this practice., Methods and Results: An article questionnaire eliciting attitudes regarding pacemaker reuse was administered to ambulatory adult patients and patients' family members at outpatient clinics at Centro Nacional Cardiologia in Managua, Nicaragua, Indus Hospital in Karachi, Pakistan, Hospital Carlos Andrade Marín, and Hospital Eugenio Espejo in Quito, Ecuador, and American University of Beirut Medical Center in Beirut, Lebanon. There were 945 responses (Nicaragua - 100; Pakistan - 493; Ecuador - 252; and Lebanon - 100). A majority of respondents agreed or strongly agreed that they would be willing to accept a reused pacemaker if risks were similar to a new device (707, 75%), if there were a higher risk of device failure compared with a new device (584, 70%), or if there were a higher risk of infection compared to a new device (458, 56%). A large majority would be willing to donate their own pacemaker at the time of their death (884, 96%) or the device of a family member (805, 93%). Respondents who were unable to afford a new device were more likely to be willing to accept a reused device (79% vs. 63%, p < .001)., Conclusions: Patients and their family members support the concept of pacemaker reuse for patients who cannot afford new devices., (© 2022 Wiley Periodicals LLC.)

Accurate and rapid diagnosis of coronavirus disease 2019 (COVID-19) is critical for proper care and identification of affected individuals. This led to early availability of many serological assays in the market, but with limited validation. In this study, we aimed to validate the serological assays based on different techniques. We evaluated 15 different assays based on four immunoassay techniques in 235 patients. The most sensitive kits employed were as follows: immunochromatography (Zybio severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] IgM/IgG Antibody Assay Kit - 83%), ELISA (Aeskulisa SARS-CoV-2 NP IgG -88.1%), chemiluminescence (Alinity SARS-CoV-2 IgG - 82.2%), and immunofluorescence (Lifotronic FA160 (Shenzhen SARS-CoV-2 Assay Kit [IgG]) - 88.9%). The kits by Uniper (Singuway Biotec COVID-19 IgM/IgG Presumptive Kit), Genrui 2019-nCoV IgM/IgG Test Kit, Wondfu SARS-CoV-2 Antibody Test, and Aeskulisa SARS-CoV-2 NP IgG exhibited 100% specificity, whereas IgG assay using Lifotronic FA160 (Shenzhen SARS-CoV-2 Assay Kit) exhibited the lowest specificity at 58%. Maximum agreement was observed between Aeskulisa SARS-CoV-2 NP IgG and Alinity SARS-CoV-2 IgG at 94%. Serological tests are practical alternatives, but their reliability depends on critical validation. The COVID-19 pandemic warranted investment in healthcare research at both the national and international levels.

An ultra-sensitive sensor of dopamine is introduced. The sensor is constructed by encapsulating platinum nanoparticles (PtNPs) between reduced graphene oxide (GR) nanosheets. The sandwiched PtNPs between GR layers acted as a spacer to prevent aggregation and provided a fine connection between the GR nanosheets to provide fast charge transfer. This specific orientation of the GR nanosheets and PtNPs on the graphite pencil electrode (GPE) substantially improved the electrocatalytic activity of the sensor. The synthesized graphene oxide and the fabricated sensor were comprehensively characterized by Fourier-transform infrared spectroscopy (FTIR), Raman spectroscopy, field emission-scanning electron microscopy (FE-SEM), electrochemical impedance spectroscopy (EIS), cyclic voltammetry (CV), and square wave voltammetry (SWV). The value of the charge transfer coefficient ( α ), apparent heterogeneous electron transfer rate constant ( k s ), and electroactive surface area for dopamine were found to be about 0.57, 8.99 s -1 , and 0.81 cm 2 , respectively. The developed sensor is highly sensitive towards dopamine, and the detection limit is 9.0 nM. The sensor response is linear for dopamine concentration from 0.06 to 20 μM ( R 2 = 0.9991). The behavior of the sensor for dopamine in the presence of a high concentration of l(+) Ascorbic acid and other potential interferents was satisfactory. High recovery percentage between 90% and 105% in the human urine sample, good reproducibility, and facile fabrication of the electrode make it a good candidate for dopamine sensing., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Layered double hydroxides (LDHs) represent an exciting class of two-dimensional inorganic materials with unique physicochemical properties. They have been widely employed in water treatment due to their high surface areas, excellent ion exchange capacities, and highly tunable structures. They have also been employed in the fabrication and development of membranes for water treatment. 2D nanostructures as well as tailorable "structure forming units", surface functionalization with desired moieties, and interlayer galleries with adjustable heights and internal compositions make them attractive materials for membrane separations. This paper critically overviews the recent advancements in the synthesis and applications of LDH based membranes in water purification. The synthesis techniques and the effect of LDH incorporation into different membrane compositions have been described. LDH-based membranes showed excellent antifouling capability and improved water flux due to enhanced hydrophilicity. Such membranes have been successfully used for the treatment of inorganics, organics from environmental water samples. This review will be useful for understanding the current state of the LDH-based membranes for water purification and defining future research dimensions. In the end, we highlight some challenges and future prospects for the efficient application of LDH-based membranes in water decontamination., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: Acute lymphoblastic leukaemia (ALL) is the most common malignancy in children, with a male predominance. Paediatric ALL is usually of B-cell lineage; T-cell leukaemia is uncommon and extremely rare under 1 year of age. Mixed-lineage leukaemia gene rearrangement is the best-known hallmark of infantile leukaemia and is a poor prognostic indicator. While multiagent high-dose chemotherapy remains the first line of treatment for paediatric T-cell lineage ALL (T-ALL), there are numerous side effects of these regimens, and most patients undergo relapse. Due to the rarity of the disease, treatment protocols for infantile T-ALL have not been established to date., Clinical Description: We present a case of a 7-month-old Pakistani male that presented with fever and cough and was subsequently diagnosed with T-cell ALL. T-ALL was diagnosed on flow cytometry. Due to poor prognosis, the patient was assigned palliative care., Practical Implications: Management of infantile leukaemia has yet to be studied in-depth. With a lack of clear treatment guidelines, the approach toward these patients remains challenging. Further research and clinical trials in this area of study are paramount to improving clinical outcomes for these young patients., Competing Interests: Nil., (Copyright: © 2022 Baig, et al.)

Potato (Solanum tuberosum L.) is one of the most important crops with a worldwide production of 370 million metric tons. The objectives of this study were (1) to create a high-quality consensus sequence across the two haplotypes of a diploid clone derived from a tetraploid elite variety and assess the sequence divergence from the available potato genome assemblies, as well as among the two haplotypes; (2) to evaluate the new assembly's usefulness for various genomic methods; and (3) to assess the performance of phasing in diploid and tetraploid clones, using linked-read sequencing technology. We used PacBio long reads coupled with 10x Genomics reads and proximity ligation scaffolding to create the dAg1&#95;v1.0 reference genome sequence. With a final assembly size of 812 Mb, where 750 Mb are anchored to 12 chromosomes, our assembly is larger than other available potato reference sequences and high proportions of properly paired reads were observed for clones unrelated by pedigree to dAg1. Comparisons of the new dAg1&#95;v1.0 sequence to other potato genome sequences point out the high divergence between the different potato varieties and illustrate the potential of using dAg1&#95;v1.0 sequence in breeding applications., (© The Author(s) 2021. Published by Oxford University Press on behalf of Genetics Society of America.)

Lithium-ion consumption has risen significantly in recent years due to its use in portable devices. Alternative sources of lithium, which include the recovery from brine using the sustainable and eco-friendly electrodialysis technology, has been explored. This technology, however, requires effective cation-exchange membranes that allow the selective permeation of lithium ions. In this study, we have investigated, via molecular dynamics simulations, the role of the two common charged groups, the sulfonic and the phosphoric groups, in promoting the adsorption of monovalent ions from brine comprising Li + , Na + , Mg 2+ , and Ca 2+ ions. The analysis of the mean square displacement of the ions revealed that Li + and Na + ions exhibit superior diffusion behaviors within the polyelectrolyte system. The O-atoms of the charged groups bind strongly with the divalent ions (Mg 2+ and Ca 2+ ), which raises their diffusion energy barrier and consequently lowers their rate of permeation. In contrast, the monovalent ions exhibit weaker interactions, with Na + being slightly above Li + , enabling the permeation of Li + ions. The present study demonstrates the role of both charged groups in cation-exchange membranes in promoting the diffusion of Li + and Na + ions, and could serve as a guide for the design of effective membranes for the recovery of these ions from brine.

The capability of Hyperspectral Imaging (HSI) in rapidly acquiring abundant reflectance data in a non-invasive manner, makes it an ideal tool for obtaining diagnostic information about tissue pathology. Identifying wavelengths that provide the most discriminatory clues for specific pathologies will greatly assist in understanding their underlying biochemical characteristics. In this paper, we propose an efficient and computationally inexpensive method for determining the most relevant spectral bands for brain tumor classification. Empirical mode decomposition was used in combination with extrema analysis to extract the relevant bands based on the morphological characteristics of the spectra. The results of our experiments indicate that the proposed method outperforms the benchmark in reducing computational complexity while performing comparably with a 7-times reduction in the feature-set for classification on the test data.

We report the synthesis, characterization, and photophysical properties of novel metal oxide nanoparticles (NPs) coated with specially designed fluorescein substituents which are capped with electron-withdrawing groups. The fluorescein-coated nanoparticles were synthesized in excellent yields, and their structures were confirmed using various advanced spectroscopic, instrumental, and surface analysis techniques, revealing the formation of the target functionalized nanoparticles (FNPs) which show superior chemical and thermal stabilities. In addition, the photophysical properties of the FNPs were examined using UV-visible absorption and fluorescence spectroscopy. These latter techniques disclosed aggregation-induced emission (AIE) properties for most of the target FNPs, namely those which are soluble in common organic solvents at selective concentration ranges of water fractions in the solvent mixture., (© 2021 The Authors. Published by Wiley-VCH GmbH.)

The presence of oil-related contaminants in water has emerged as a severe threat to the environment. The separation of these contaminants from water has become a great challenge, and extensive efforts are being made to develop suitable, environmentally friendly materials. Highly hydrophobic materials are effective in the selective separation of oil from water. In this work, silver (Ag)-incorporated, highly hydrophobic dopamine-modified cellulose sponge was prepared by functionalizing with the range of alkyl silanes. The Ag nanoparticle-incorporated dopamine provided the appropriate roughness, whereas the alkyl component provided the low surface energy that made it selective towards oil. It was found that the alkyl groups with a longer chain length were more effective in enhancing the hydrophobicity of the Ag nanoparticle-incorporated, dopamine-modified cellulose. The developed materials were characterized by Fourier transform infrared spectroscopy (FTIR), field emission-scanning electron microscopy (FE-SEM), energy-dispersive X-ray spectroscopy (EDX), elemental mapping, and contact angle goniometry. The maximum water contact angle on the functionalized surfaces was observed at 148.4°. The surface of the C18s-Ag-DA-Cell-F showed excellent selectivity towards the oily component that rapidly permeated, and water was rejected wholly. The developed material showed a separation efficiency of 96.2% for the oil/water mixture. The C18s-Ag-DA-Cell-F material showed excellent reusability. Due to their environmentally friendly nature, excellent selectivity, and good separation efficiency, the functionalized cellulose materials can be used to separate oil and water effectively.

Introduction: Very little is known and predictable on how long the COVID-19 pandemic will last, even though dramatic preventive measures to flatten the curve and stop its transmission have been taken worldwide periodically since its start. These preventive measures coupled with people's fear of COVID-19, significantly altered people's health-seeking behavior and healthcare accessibility. This study aims to measure the impact of the COVID-19 pandemic on the utilization of reproductive, maternal, newborn, and child health (RMNCH) care services at primary health care (PHC) facilities in Pakistan.  Methods: A retrospective study was conducted in 22 districts using data from 1169 primary health care facilities. The District Health Information System (DHIS) was used to retrieve district-wise services utilization data from January to April 2020 i.e. January to February 2020 (pre-COVID-19) and March to April 2020 (during COVID-19). The monthly difference (in percentage change) for selected RMNCH services indicators was calculated using the expected number of clients (January to February average) versus the actual number of clients for March and April 2020., Results:  We observed a decrease of 12.5% for March and 33% for April 2020 in the total number of clients who availed of primary health care services in Sindh as compared to the pre-COVID-19 monthly average. A decrease in first antenatal care visits (15.6% and 16.3%), delivery coverage (12.8% and 17.9%) and family planning client visits (31.6% and 36.3%) were observed for March and April 2020 respectively. The pentavalent vaccine results revealed a decrease of 19.3% and 63.1%, while a decrease of 17.3% and 54.3% were observed for children receiving the first dose of measles vaccine in March and April, respectively.  Conclusions: Our findings show that the number of clients who avail of routine care or RMNCH services at the primary health care level considerably declined during the initial phase of the first wave of the COVID-19 outbreak in Sindh, Pakistan. These results highlight a rising threat to poor RMNCH and outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Baloch et al.)

Silver nanowires (AgNWs) with ultrahigh purity and high yield were successfully synthesized by employing a modified facile polyol method using PVP as a capping and stabilizing agent. The reaction was carried out at a moderate temperature of 160 °C under mild stirring for about 3 h. The prepared AgNWs exhibited parallel alignment on a large scale and were characterized by UV-vis spectroscopy, scanning electron microscopy (SEM), X-ray diffraction (XRD), and PL spectroscopy. The luminescent AgNWs exhibited red emission, which was accredited to deep holes. The SEM results confirmed the formation of AgNWs of 3.3 to 4.7 µm in length with an average diameter of about 86 nm, that is, the aspect ratio values of the AgNWs exceeded 45. An ink consisting of hydroxyethyl cellulose (HEC) and AgNWs was transferred to polyethylene terephthalate (PET) films by simple mechanical pressing. The PET films retained transparency and flexibility after the ink coating. The maximum transmittance value of as-prepared PET films in the visible region was estimated to be about 92.5% with a sheet resistance value of ca. 20 Ω/sq. This makes the films a potential substitute to commonly used expensive indium tin oxide (ITO) in the field of flexible optoelectronics., (Copyright © 2021, Naz et al.)

Three copolymers TCP1-3 bearing Trӧger's base (TB) units intercalated with various thioether groups were synthesized using a catalyst-free thiol-yne click reaction. TCP1-3 display excellent solubility in common organic solvents allowing for their structural, and photophysical characterization. The thioether groups in TCP1-3 were selectively oxidized into their respective sulfone derivatives under mild oxidation reaction conditions affording the postmodified copolymers TCP4-6. Investigation of organic dye uptake from water by TCP1-6 proved their efficiency as selective adsorbents removing up to 100% of the cationic dye methylene blue (MEB) when compared to anionic dyes, such as Congo red (CR), methyl orange (MO) and methyl blue (MB). The sulfone-containing copolymers TCP4-6 display superior and faster MEB removal efficiencies with respect to their corresponding synthons TCP1-3., Competing Interests: The authors declare no conflict of interests., (This journal is © The Royal Society of Chemistry.)

Water quality plays a central role in the well-being of all the living organisms on planet Earth. The ever-increasing human population and consequently increasing industrialization, urbanization, and chemically boosted cultivation are rapidly contaminating already stressed water resources. The availability of clean drinking water has become scarce for masses across the globe, and this situation is becoming alarming in developing countries. Therefore, the immediate need for cost-effective, easily accessible, eco-friendly, portable, thermally efficient, and chemically stable technologies and materials is desperately felt to meet the high global demand for clean water. To search for effective materials for wastewater treatment, the hyper-cross-linked porous polymers (HCPs) have emerged as an excellent class of porous materials for wastewater treatment due to their unique features of high surface area, tunability, biodegradability, and chemical versatility. This review describes the advances in fabrication strategies and the efficient utilization of hyper-cross-linked porous polymers for wastewater treatment. Moreover, this review specifically discusses the hyper-cross-linked porous polymers effectiveness for the separation of the dyes, nutrients, inorganic ions, organic contaminants, and toxic metals ions. Finally, the review provides insight into the challenges and prospects in the area of hyper-cross-linked porous polymers. Overall, the hyper-cross-linked porous polymers with empowering proper functionalization can provide an opportunity for the wastewater treatment not only to remove toxic contaminants but also to make contaminated water useful for various applications., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: We sought to construct and validate a patient-reported outcome measure for screening and monitoring vision-related anxiety in patients with inherited retinal degenerations., Design: Item-response theory and graded response modeling to quantitatively validate questionnaire items generated from qualitative interviews and patient feedback., Methods: Patients at the Kellogg Eye Center (University of Michigan, Ann Arbor, Michigan, USA) with a clinical diagnosis of an inherited retinal degeneration (n = 128) participated in an interviewer-administered questionnaire. The questionnaire consisted of 166 items, 26 of which pertained to concepts of "worry" and "anxiety." The subset of vision-related anxiety questions was analyzed by a graded response model using the Cai Metropolis-Hastings Robbins-Monro algorithm in the R software mirt package. Item reduction was performed based on item fit, item information, and item discriminability. To assess test-retest variability, 25 participants completed the questionnaire a second time 4 to 16 days later., Results: The final questionnaire consisted of 14 items divided into 2 unidimensional domains: rod function anxiety and cone function anxiety. The questionnaire exhibited convergent validity with the Patient Health Questionnaire for symptoms of depression and anxiety. This vision-related anxiety questionnaire has high marginal reliability (0.81 for rod-function anxiety, 0.83 for cone-function anxiety) and exhibits minimal test-retest variability (ρ = 0.81 [0.64-0.91] for rod-function anxiety and ρ = 0.83 [0.68-0.92] for cone-function anxiety)., Conclusions: The Michigan Vision-Related Anxiety Questionnaire is a psychometrically validated 14-item patient-reported outcome measure to be used as a psychosocial screening and monitoring tool for patients with inherited retinal degenerations. It can be used in therapeutic clinical trials for measuring the benefit of an investigational therapy on a patient's vision-related anxiety., (Copyright © 2021 Elsevier Inc. All rights reserved.)

We report the synthesis of metalorganic copolymers made from the palladium catalyzed Sonogashira cross-coupling reaction between various iron(ii) clathrochelate building blocks with diethynyl-triptycene and fluorene derivatives. The target copolymers CCP1-5 were isolated in excellent yield and characterized by various instrumental analysis techniques. Interestingly, investigation of the copolymers' porosity properties discloses BET surface areas up to 337 m 2 g -1 for the target compounds bearing fluorinated iron(ii) clathrochelate units CCP2,5. Moreover, the fluorinated copolymers display an outstanding uptake capacity of iodine with a maximum adsorption of 200 wt%. The target metalorganic copolymers CCP1-5 reveal very good adsorption of organic dyes, namely, methyl blue and methylene blue, from aqueous media., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Purpose: To compare the 10-year clinical outcomes of eyes with acute primary angle closure (APAC) randomized to receive either early phacoemulsification or laser peripheral iridotomy (LPI)., Methods: Sixty-two APAC patients, who underwent either early phacoemulsification (phaco group) or laser peripheral iridotomy (LPI group) in a previous randomized controlled trial, were invited for assessment 10 years after the interventions. The results of the 2 groups were compared., Results: Forty of 62 patients (64.5%; 19 in phaco group and 21 from LPI group) were examined. None of them underwent additional glaucoma procedure but 15 (71.4%) patients in the LPI group received lens extraction before this assessment. The mean follow-up duration was 10.7±0.7 years. The phaco group used less medication (0.16±0.37 vs. 0.76±1.09 bottle per eye, P=0.028), had less extensive anterior synechiae (120.0±116.12 vs. 244.3±139.8 degree, P=0.010), and greater mean Shaffer gonioscopy grading (1.79±0.84 vs. 1.40±0.87; P=0.021) than the LPI group. Five eyes had persistent intraocular pressure elevation of >21 mm Hg in 2 consecutive visits and 4 eyes had blindness (best-corrected visual acuity worse than 6/60 and/or central visual field of <20 degree) in the LPI group, compared with none in the phaco group (P=0.022 and 0.045, respectively). There was no significant difference in the mean intraocular pressure, best-corrected visual acuity, and the number of eyes with visual field progression., Conclusion: At 10 years, APAC eyes that underwent early phacoemulsification required less medication, less peripheral anterior synechiae, lower incidence of intraocular pressure elevation and a lower incidence of blindness compared with APAC eyes that underwent initial LPI., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Traditional, instructor led, in-person training of CPR skills has become more challenging due to COVID-19 pandemic. We compared the learning outcomes of standard in-person CPR training (ST) with alternative methods of training such as hybrid or online-only training (AT) on CPR performance, quality, and knowledge among laypersons with no previous CPR training., Methods: We searched PubMed and Google Scholar for relevant articles from January 1995 to May 2020. Covidence was used to review articles by two independent researchers. Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess quality of the manuscripts., Results: Of the 978 articles screened, twenty met the final inclusion criteria. All included studies had an experimental design and moderate to strong global quality rating. The trainees in ST group performed better on calling 911, time to initiate chest compressions, hand placement and chest compression depth. Trainees in AT group performed better in assessing scene safety, calling for help, response time including initiating first rescue breathing, adequate ventilation volume, compression rates, shorter hands-off time, confidence, willingness to perform CPR, ability to follow CPR algorithm, and equivalent or better knowledge retention than standard teaching methodology., Conclusion: AT methods of CPR training provide an effective alternative to the standard in-person CPR for large scale public training.

Cost-effective separation of oil and immiscible organic contaminants from water has become an urgent challenge to protect aquatic and human life from devastating effects. Therefore, it has become imperative to develop super-selective materials for efficiently separating oil from water. In this work, a superhydrophobic surface has been formed that consists of a silane@polystyrene-coated polypropylene fibrous network (silane@PS-PPF) for efficient separation of accidentally spilled oil from water. The superhydrophobic PPFs were designed by a simple, cost-effective two-step process that includes photochemically controlled polymerization of styrene and subsequent dip coating in octadecyltrichlorosilane solution. The hydrophobic surface (CA=129°±4°) of the PS coated PPF after treating with silane was turned into a superhydrophobic body (CA=161°±2°). The achieved silane@PS-PPF fibrous network selectively allowed the fast permeation of the oils and non-polar organic liquids by altogether rejecting water during operation. The separation efficiency for various oils from the contaminated water was 96 to 99%, with a high flux in the range of 7606±312 L m -2 h -1 to 9870±151 L m -2 h -1 . Apart from being used as a filter, the silane@PS-PPF was also used as an oil absorber and has shown an absorption capacity in the range of 1185 to 1535% for various oils. We anticipate that the developed silane@PS-PPF, due to its facile synthetic route, cost-effectiveness, and high performance, can be effectively used in oily wastewater treatment and clean-up of large oil spills from water., (© 2021 Wiley-VCH GmbH.)

Objective: We aimed to assess the parent-reported screen time of children, identify the perceived risk factors for increased screen time and its relationship to psychological distress in children., Materials and Method: A cross sectional study was conducted at a teaching hospital in Karachi, Pakistan. A total of 230 employees from medical and non-medical departments were included. Participants were employees with child/children ages 4-12 year who consented to participate in the study, we included 135 fathers and 91 mothers. The questionnaire included (i) demographic data (ii) Media history exam form and (iii) parent reported strength and difficult questionnaire (SDQ)., Result: The average daily screen time reported was 2.5 (1.5-5) hour for boys and 2 (1-4) hour for girls. Preschoolers had greater screen time as compared to school-aged children (Median (IQR): 3 (1.5-5.6) vs 2 (1-4), P = 0.46). The children owned devices with approximately equal distribution of preschoolers and school-aged children (19 (27.1%) and 48 (30%), P = 0.661 respectively). Emotional score was found higher in school-aged group in comparison to preschoolers ( p = 0.036). Moreover, mother screen time and number of devices owned by a child were found to be positively associated with child's screen time., Conclusion: We conclude that as we are embracing the digital age providing a tech free zone to children is virtually impossible. Children screen time related activities in our part of the world exceeds the limitation. Parental awareness and co-viewing screen with their children are essential to avoid media related behavior problems., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family Medicine and Primary Care.)

Purpose: To create a psychometrically validated patient-reported outcome measure for inherited retinal degenerations., Design: Qualitative and quantitative patient-reported outcome (PROs) questionnaire development using item response theory validation., Methods: One hundred twenty-eight patients with a diagnosis of an inherited retinal degeneration at the Kellogg Eye Center (University of Michigan) were recruited and administered a 166-item questionnaire comprising 7 expert-defined domains. The questionnaire was re-administered 4-16 days later to a subset of 25 participants to assess test-retest variability. Graded response models were fit by Cai's Metropolis-Hastings Robbins-Monro algorithm using the R (version 3.6.3) package mirt. Model data were fit to assess questionnaire dimensionality, to estimate item information, and to score participants. Poorly functioning items were removed, and the model was refit to create the final questionnaire., Results: The psychometrically validated PROs measure was reduced to a 59-item questionnaire measuring 7 unidimesnional domains: central vision, color vision, contrast sensitivity, scotopic function, photopic peripheral vision, mesopic peripheral vision, and photosensitivity. A total of 39 items were removed because of poor factor loading, low item information, poor person-ability differentiation, or high item-level interdependence. This novel questionnaire produces a reliable domain score for person ability that does not show significant test-retest variability across repeated administration., Conclusions: The final PRO questionnaire, known as the Michigan Retinal Degeneration Questionnaire, is psychometrically validated and available for use in the evaluation of patients with inherited retinal degenerations., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: To assess the current knowledge related to hand washing and efficiency of intervention on hand washing techniques amongst school children., Methodology: A randomized control trial was conducted amongst class II students of a private school in Korangi, Karachi. Pre-intervention assessment including baseline knowledge and observed practices of hand washing in comparison with World Health Organization (WHO) standard hand washing techniques was done. This was followed by education and demonstration of proper hand washing steps by principal investigator utilizing visual aids. Participants were then randomized into two group: Group A (education only group) and Group B (education along with glow gel application group). First post-intervention assessment was conducted on same day where both groups were observed for the hand washing steps and scored for hand washing technique. In addition, participants of group B were shown germs under Ultraviolet (UV) light. School was revisited after 1 week later and participants were reassessed for their hand washing technique along with cleanliness grade after applying glow gel and observing under UV light. Data was entered and analyzed using SPSS version 21.0., Result: No significant differences were found in median hand washing scores pre-intervention between both the groups (Group A vs B: 4 vs 5, P value = 0.659), while significant improvement in median hand washing scores was seen post intervention in group B as compared to group A (7 vs 6, P value = 0.011). However, no significant differences were seen in median hand washing scores at follow-up between both the groups (Group A vs B: 9 vs 8.5, P value = 0.715) but a significant improvement was observed in both the groups in the hand washing practices from baseline ( P -value = 0.000). On the contrary, no significant differences were found in median cleanliness grade between both the groups (Median for both the groups was 5, P value = 0.695)., Conclusions: Hand washing education utilizing various aids is an effective method to improve children's hand washing capability. This short-term intervention was effective even in absence of glow gel, but no cleanliness of hands was observed in both the groups., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family Medicine and Primary Care.)

Introduction: Thrombo-inflammatory biomarkers play an important role in the pathogenesis of lymphoma. We aimed to characterize the interrelationship of thrombo-inflammatory biomarkers and blood cellular indices in lymphoma patients., Materials and Methods: Ninety-eight lymphoma patient samples were collected from Lymphoma Center of Clinic of Hematology, University of Belgrade, Serbia. Normal controls (n = 50) represented plasma from healthy individuals. Plasminogen activator inhibitor (PAI-1), D-Dimer, factor XIII, C-reactive protein (CRP), microparticles (Mp), Von Willebrand factor (vWF), total protein S, urokinase-type plasminogen activator (uPA), tumor necrosis factor (TNF α ), β 2-glycoprotein I ( β 2GPI), and fibronectin levels were measured utilizing commercially-available ELISA methods. Thrombin generation profile (TGA) was measured using a fluorometric kinetic assay. Platelets, leukocytes, lymphocytes, and neutrophils were measured in conjunction with the complete blood profile., Results: Statistically significant differences were noted in levels of PAI-1, D-Dimer, factor XIII, CRP, microparticles, vWF, uPA, TNF α , β 2GPI, fibronectin, and TGA when compared to normal (all P values < .001). Platelet to leukocyte ratio (PLA) correlated to TNF α and fibronectin ( R  = -0.31 and -0.53, respectively) and the platelet to neutrophil ratio (PNR) correlated to factor XIII and β 2GPI ( R  = 0.40 and 0.40, respectively)., Conclusion: Plasma samples from lymphoma patients demonstrated a significantly altered thrombo-inflammatory biomarker profile that has notable correlations to blood cellular indices.

Background: WHO recommends simplified antibiotics for young infants with sepsis in countries where hospitalisation is not feasible. Amoxicillin provides safe, Gram-positive coverage. This study was done to determine pharmacokinetics, drug disposition and interpopulation variability of oral amoxicillin in this demographic., Methods: Young infants with signs of sepsis enrolled in an oral amoxicillin/intramuscular gentamicin treatment arm of a sepsis trial in Karachi, Pakistan, were studied. Limited pharmacokinetic (PK) sampling was performed at 0, 2-3 and 6-8 hours following an index dose of oral amoxicillin. Plasma concentrations were determined by high-performance liquid chromatography/mass spectrometry. Values of ≥2 mg/L were considered as the effect threshold, given the regional minimal inhibitory concentration (MIC) of resistant Streptococcus pneumoniae. RESULTS: Amoxicillin concentrations were determined in 129 samples from 60 young infants. Six of 44 infants had positive blood cultures with predominant Gram-positive organisms. Forty-four infants contributing blood at ≥2 of 3 specified timepoints were included in the analysis. Mean amoxicillin levels at 2-3 hours (11.6±9.5 mg/L, n=44) and 6-8 hours (16.4±9.3 mg/L, n=20) following the index dose exceeded the MIC for amoxicillin (2.0 mg/L) against resistant S. pneumoniae strains. Of 20 infants with three serum levels, 7 showed a classic dose-exposure profile and 13 showed increasing concentrations with time, implying delayed absorption or excretion., Conclusion: Amoxicillin concentrations in sera of young infants following oral administration at 75-100 mg/kg/day daily divided doses exceeds the susceptibility breakpoint for >50% of a 12-hour dosing interval.Oral amoxicillin may hold potential as a safe replacement of parenteral ampicillin in newborn sepsis regimens, including aminoglycosides, where hospitalisation is not feasible., Trial Registration Number: NCT01027429., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: We aimed to study the extent of liver fibrosis in chronic hepatitis C patients with indeterminate APRI score of ≥ 0.5 - ≤2 (between higher and lower cut off value) and correlate it to transient elastography (TE) and FIB 4 index., Method: A cross-sectional study, 80 patients with CHC mono infection, APRI score ≥ 0.5 - ≤2 were interviewed from the cohort visiting the CHC program clinic at a tertiary care hospital in Karachi, Pakistan. Data were analyzed using STATA 14.0 and R 3.5.2 and SPSS 24.0 software according to their capabilities., Result: Of 80 patients, 50 (62.5%) were females and 30 (37.5%) were males with mean (±SD) ages of 41.73 (±11.5) years and 41.16 (±9.24) years respectively. The FIB 4 value among indeterminate APRI was reported as 1.47 (IQR 1.05-2.43). TE categories was reported: F0-F1 ( n = 29; 36%), F1-F2 ( n = 10; 12.5%), F2 ( n = 9; 11.2%) F3 ( n = 13; 16.2%), F3-F4 ( n = 1; 1.2%) F4 ( n = 18; 22.5%). FIB4 had a moderate positive correlation with TE while a weak positive correlation was found between APRI and TE (0.488, P < 0.0001 and 0.289, P < 0.001, respectively). TE was taken as a gold standard and compared with FIB4. The model constructed reported FIB4 as a good prediction for liver fibrosis with diagnostic accuracy 72%., Conclusion: The combination of two serum markers proves to be a low-cost noninvasive testing strategy for CHC patients having an indeterminate APRI score. By being readily accessible both biochemical scores can simplify liver assessment in lower middle-income countries (LMIC) and help family physicians to take appropriate decisions about treatment initiation with minimum delays., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

Cis -prenyltransferases such as undecaprenyl diphosphate synthase (UPPS) and decaprenyl diphosphate synthase (DPPS) are essential enzymes in bacteria and are involved in cell wall biosynthesis. UPPS and DPPS are absent in the human genome, so they are of interest as targets for antibiotic development. Here, we screened a library of 750 compounds from National Cancer Institute Diversity Set V for the inhibition of Mycobacterium tuberculosis DPPS and found 17 hits, and then IC 50 s were determined using dose-response curves. Compounds were tested for growth inhibition against a panel of bacteria, for in vivo activity in a Staphylococcus aureus / Caenorhabditis elegans model, and for mammalian cell toxicity. The most active DPPS inhibitor was the dicarboxylic acid redoxal (compound 10 ), which also inhibited undecaprenyl diphosphate synthase (UPPS) as well as farnesyl diphosphate synthase. 10 was active against S. aureus , Clostridiodes difficile , Bacillus anthracis Sterne, and Bacillus subtilis , and there was a 3.4-fold increase in IC 50 on addition of a rescue agent, undecaprenyl monophosphate. We found that 10 was also a weak protonophore uncoupler, leading to the idea that it targets both isoprenoid biosynthesis and the proton motive force. In an S. aureus / C. elegans in vivo model, 10 reduced the S. aureus burden 3 times more effectively than did ampicillin.

Background: To present an unusual intra-operative complication of micropulse transscleral cyclophotocoagulation (MPTSC)., Case Presentation: A 72-year old Chinese gentleman, who had primary angle closure glaucoma and had received bilateral laser iridotomy, presented with progressive left eye blurred vision (visual acuity of 20/40 OD and 20/200 OS). Examination reviewed left eye central retinal venous occlusion. The intraocular pressure (IOP) was 19 mmHg OS and was on maximally tolerated topical medications. Four weeks later, the left eye was complication by neovascular glaucoma; the IOP was raised to 26 mmHg despite additional oral acetazolamide and remained elevated after pan-retinal photocoagulation as well as cataract extraction by phacoemulsification. MPTSC was performed 8 days after the phacoemulsification. During the procedure, a sudden protrusion was formed on the corneal surface. On-table examination with operating microscope and portable slit-lamp reviewed an intact corneal epithelium with a globular-shaped collection of fluid at the subepithelial layer - acute corneal subepithelial hydrops (ACSH). The anterior chamber was formed and the globe was intact. After approximately 10-15 minutes, the swelling spontaneously ruptured and became a corneal epithelial defect. The defect healed on the tenth day after the event with conservative management. There was no irreversible corneal damage and the patient subsequently underwent a successful second MPTSC of the left eye because of poorly controlled IOP., Conclusion: ACSH is a possible intra-operative complication of MPTSC. We have proposed the possible mechanisms of ACSH. It is best to exercise caution when using MPTSC shortly after any incisional intraocular surgery.

Since 1988, when World Health Organization (WHO) Member States and partners launched the Global Polio Eradication Initiative, the number of wild poliovirus (WPV) cases has declined from 350,000 in 125 countries to 176 in only two countries in 2019 (1). The Global Commission for the Certification of Poliomyelitis Eradication (GCC) declared two of the three WPV types, type 2 (WPV2) and type 3 (WPV3), eradicated globally in 2015 and 2019, respectively (1). Wild poliovirus type 1 (WPV1) remains endemic in Afghanistan and Pakistan (1). Containment under strict biorisk management measures is vital to prevent reintroduction of eradicated polioviruses into communities from poliovirus facilities. In 2015, Member States committed to contain type 2 polioviruses (PV2) in poliovirus-essential facilities (PEFs) certified in accordance with a global standard (2). Member states agreed to report national PV2 inventories annually, destroy unneeded PV2 materials, and, if retaining PV2 materials, establish national authorities for containment (NACs) and a PEF auditing process. Since declaration of WPV3 eradication in October 2019, these activities are also required with WPV3 materials. Despite challenges faced during 2019-2020, including the coronavirus disease 2019 (COVID-19) pandemic, the global poliovirus containment program continues to work toward important milestones. To maintain progress, all WHO Member States are urged to adhere to the agreed containment resolutions, including officially establishing legally empowered NACs and submission of PEF Certificates of Participation., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

α-Glucosidase and α-amylase are enzymes which are associated with diabetic II. These enzymes break macromolecules of sugar into monosugar molecules which is soluble in body, hence increase the sugar level in blood. There is need to develop economical and save inhibitors to prevent them from breaking sugar macromolecules to soluble molecules which will control the level of sugar in blood. Therefore, we synthesized indole-based derivatives (1-18) and evaluated as dual inhibitor for α-glucosidase and α-amylase. These chemical scaffolds were built with variation in aryl ring which were found active with good to moderate activity for α-glucosidase having IC 50 value ranging from 13.99 ± 0.10 to 59.09 ± 0.30 μM when compared with standard acarbose with IC 50 of 11.29 ± 0.10 μM; for α-amylase IC 50 value ranging from 13.14 ± 0.10 to 58.99 ± 0.30 μM when compared with the standard acarbose with IC 50 of 11.12 ± 0.10 μM. Structure activity relationship (SAR) has been established for all compounds. Enzymatic kinetic study and molecular docking study have been carried out to investigate the binding interactions α-glucosidase and α-amylase enzyme., Competing Interests: Declaration of competing interest The authors declare no competing financial interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Anti-stigma interventions for school and college students have been studied in several countries, but to the best of our knowledge, this has not been addressed in Singapore. The current study was designed to address this lacuna and aimed to evaluate the effectiveness of an anti-stigma intervention focusing on depression among university students in Singapore., Methods: A one-off intervention comprising education and personal contact with a person with lived experience of depression was carried out in nine consecutive sessions over 6 months (October 2018 to April 2019) among 390 university students. Knowledge of depression and extent of stigma toward mental illness were assessed pre- and post-intervention as well as at 3-month follow-up., Results: The intervention was effective in improving depression knowledge ( d = 1.09; p < 0.001), as well as reducing social distancing ( d = 0.54; p < 0.001) and personal stigma (dangerous/undesirable: d = 0.60; p < 0.001 and weak not sick: d = 0.10; p < 0.033) pre- to post-intervention as well as pre- intervention to 3-month follow-up ( p < 0.005)., Limitations: While 3-month follow-up data indicates favorable medium-term impact on knowledge and stigma; the study lacks long-term follow-up to examine the impact of anti-stigma interventions across time. The data were collected through self-report measures; however, social desirability bias is possible despite the assurances of confidentiality., Conclusion: Given the impact of the intervention, there is a need to consider the feasibility, challenges, and enablers of implementation of such interventions into the curriculum of university students to ensure a broader and sustained outreach and stigma reduction., (Copyright © 2020 Subramaniam, Shahwan, Abdin, Goh, Ong, Tan, Baig, Samari, Kwok and Chong.)