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Human history is full of evidence showing a larger number of human and animal populations got affected by infectious diseases, viruses, and bacteria. Like previous life-threatening pandemics, coronavirus appeared to be a deadly virus in 2019 and declared as pandemic in 2020 by WHO. As per Global Reports, senior citizens have been most vulnerable to the corona virus attacks. This paper explores the experiences of family members dealing with elderly at home in the midst of the Covid-19 outbreak and how they managed them keeping in view their mindset on disease and socio-cultural constraints. For this purpose, qualitative research methods were adopted. 20 participants were selected for the in-depth interviews through purposive sampling. Following themes generated as a result of the data analysis: stubborn and rigid behavior of elderly, emotionally complex reactions, socio-cultural barriers, and traditional approach to the disease. Findings depicted the most common social cultural barriers in dealing with the difficult nature of elderly people are family ties, religious norms, respect, and empathy towards elderly people. Further, research findings highlighted major sentiments of older adults comprise attachment towards their grandchildren, feeling of insecurity, feeling of getting stigmatized, considering themselves as a virus spreader and feeling of being left out. It was found that older adults felt stigmatized, lonely, left out and considered SOPs (Standard Operating Procedures) as imposed remedial steps. Overall, it was found that at older age people express more anxiety and fear towards loneliness. Findings will help in sensitizing policy makers to design awareness sessions, religious and other home-based social activities for elderly people to combat stress related to loneliness in older age.

Objective: To compare the outcomes of three-port versus four-port laparoscopic cholecystectomy (LC) and assess the safety and efficacy of three-port LC as routine procedure. Study Design: Retrospective comparative study. Place and Duration of Study: Combined Military Hospital Kohat/CMH Multan, from Oct 2013 to Dec 2016. Methodology: Total of 403 patients were selected and were divided into two groups based on the principles of non-randomized clinical trial; group A having three-port laparoscopic cholecystectomy (LC) and group B having four-port laparoscopic cholecystectomy (LC). Fourth port in right axillary line at umbilicus level was not established in group A. Outcomes were recorded in terms of operating time, complications, pain assessment/analgesic requirement and hospital stay. Results: A total of 218 (54.09%) patients in group A and 185 (45.91%) patients in group B were assessed. The difference in terms of verbal pain score, analgesic requirement and duration of hospital stay/return to activity were significant statistically, all being less in group A. Cosmetic outcome as perceived by patients was also better in the group A because of less numbers of scars. Operative time (minutes) was less in group A in our study (35.59 ± 10.75) as compared to group B (50.17 ± 10.14). Results of other variables including intra-operative/postoperative complications were comparable among the two groups. Conclusion: Three-port LC has advantages of being less painful, with less analgesics requirement and reduced hospital stay without compromising the safety and efficacy. It is more acceptable to patients due to less numbers of scars and better cosmesis. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic accuracy of high neutrophil-to-lymphocyte ratio levels versus leukocytosis in detecting acute cholecystitis. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Dec 2021 to Jun 2022. Methodology: One hundred eighteen patients with the clinical diagnosis of acute cholecystitis were included in the study. Patients with neoplastic or autoimmune disease or ongoing chronic infections were excluded. All patients underwent a test for complete blood counts to document the total leucocyte count and the neutrophil-to-lymphocyte ratio. The diagnosis of acute cholecystitis was confirmed on contrast-enhanced computed tomography abdomen. Results: The study sample had a mean age of 46.56±13.78 years, with 81(68.6%) females. The total leucocyte count had a sensitivity of 67.1%, a specificity of 73.3% and a diagnostic accuracy of 69.5% for predicting the presence of acute cholecystitis. In contrast, the neutrophil to lymphocyte ratio, with a cut-off of 3, had a sensitivity of 73.7%, a specificity of 68.9% and a diagnos-tic accuracy of 71.2% in predicting the presence of acute cholecystitis using contrast-enhanced computed tomography as a gold standard. Conclusion: Both total leucocyte count and the neutrophil to lymphocyte ratio were equally effective for diagnosing acute cholecystitis in clinically diagnosed patients. [ABSTRACT FROM AUTHOR]

In pectin regulation, polygalacturonases (PGs) and pectin methylesterases (PMEs) are critical components in the transformation, disassembly network, and remodeling of plant primary cell walls. In the current study, we identified 36 PG and 47 PME genes using the available genomic resources of grapevine. Herein, we provide a comprehensive overview of PGs and PMEs, including phylogenetic and collinearity relationships, motif and gene structure compositions, gene duplications, principal component analysis, and expression profiling during developmental stages. Phylogenetic analysis of PGs and PMEs revealed similar domain composition patterns with Arabidopsis. The collinearity analysis showed high conservation and gene duplications with purifying selection. The type of duplications also varied in terms of gene numbers in PGs (10 dispersed, 1 proximal, 12 tandem, and 13 segmental, respectively) and PMEs (23 dispersed, 1 proximal, 16 tandem, and 7 segmental, respectively). The tissue-specific response of PG and PME genes based on the reported transcriptomic data exhibited diverged expression patterns in various organs during different developmental stages. Among PGs, VvPG8, VvPG10, VvPG13, VvPG17, VvPG18, VvPG19, VvPG20, VvPG22, and VvPG23 showed tissue- or organ-specific expression in majority of the tissues during development. Similarly, in PMEs, VvPME3, VvPME4, VvPME5, VvPME6, VvPME19, VvPME21, VvPME23, VvPME29, VvPME31, and VvPME32 suggested high tissue-specific response. The gene ontology (GO), Kyoto Encyclopedia of Genes and Genomics (KEGG) enrichment, and cis-elements prediction analysis also suggested the putative functions of PGs and PMEs in plant development, such as pectin and carbohydrate metabolism, and stress activities. Moreover, qRT-PCR validation of 32 PG and PME genes revealed their role in various organs of grapevines (i.e., root, stem, tendril, inflorescence, flesh, skins, and leaves). Therefore, these findings will lead to novel insights and encourage cutting-edge research on functional characterization of PGs and PMEs in fruit crop species. [ABSTRACT FROM AUTHOR]

Objectives: Hepatitis C virus (HCV) and bacterial vaginosis (BV) coinfection generate sustained inflammation with bulk production of reactive oxygen species. They have the potency to cause hepatocellular carcinoma, vaginal apoptosis, disturb pregnancy, and influence drug treatment and follow-up. This case-control study aimed to compare the redox status in HCV and BV coinfection with respect to BV mono-infection among pregnant females (PFs)., Methods: Blood samples and vaginal secretions were drawn from 75 PFs divided into three groups: coinfection (n = 25), monoinfection (n = 25), and control PFs (n = 25) who are presumed healthy subjects. Blood samples were analyzed for HCV detection based on conserved 5' untranslated region via real-time polymerase chain reaction and hematological parameters. Markers of oxidative stress (malondialdehyde and peroxidase) and antioxidants (catalase and superoxide dismutase) were checked in plasma as well as vaginal secretions of patients among all three groups., Results: Hematological analysis reveals that hemoglobin levels, platelets, and lymphocytes decreased significantly ( p < 0.050) among the coinfection followed by mono-infection group compared to the control group. Moreover, the higher isolation frequency of pathogenic bacteria ( Acinetobacter spp.) and Nugent score trend was observed among the coinfection group. Antioxidant levels were significantly lower ( p < 0.050) among the vaginal secretions and blood plasma of patients having coinfection with respect to the mono-infection and control groups. While oxidative stress marker was significantly highest ( p < 0.050) among vaginal secretions and blood plasma of coinfection followed by mono-infection and control group. These results validate that overall redox severity was more among the coinfection compared to the mono-infection and control groups., Conclusions: Redox indexes should be considered in early diagnosis and treatment of HCV and BV coinfection which may also facilitate the better treatment of hepatocellular carcinoma and vaginal apoptosis., (Copyright © 2023, Oman Medical Journal.)