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Background/Objectives: Chronic Venous Insufficiency (CVI) is a progressive vascular condition characterized by venous hypertension and chronic inflammation, leading to significant clinical and socioeconomic impacts. This study aimed to evaluate the efficacy and safety of emerging pharmacological interventions for CVI, focusing on clinical outcomes such as pain, edema, cutaneous blood flow, and quality of life. Methods: Eligible interventions comprised new vasoprotective drugs, such as hydroxyethylrutoside, Pycnogenol, aminaphthone, coumarin + troxerutin, and Venoruton, compared to the standard therapy of diosmin and hesperidin. Results: Hydroxyethylrutoside and Pycnogenol showed significant benefits in pain reduction and resting flux improvement, with mean differences of 38 (95% CI: 10.56–65.44) and 25.30 (95% CI: 18.73–31.87), respectively. Improvements in edema and quality of life were less consistent. Substantial heterogeneity was observed (I2 = 100%, p < 0.001). Conclusions: Hydroxyethylrutoside and Pycnogenol emerge as promising alternatives for managing CVI. However, limitations such as high heterogeneity, small sample sizes, and methodological inconsistencies highlight the need for more robust and standardized clinical trials. This study underscores the importance of personalized and cost-effective strategies, particularly in resource-limited settings.

Objective: To analyze the correlation between the burden of family caregivers of cancer patients in Palliative Care and the variables gender, age, health problems, and length of care. Method: Descriptive correlational study with a non-probabilistic sample of 147 family caregivers at the Oncological Palliative Care Clinic in 2021 in Belém do Pará - Brazil. The Zarit Overload Scale was used to collect data, with descriptive and inferential statistical analysis. Results: 86 (58.5%) of the caregivers were female, 66 (44.9%) caregivers felt "Very overloaded", and 104 (70.7%) had Moderate to Severe overload. There was no consistency in concluding that the variables gender, age group, health problems, or length of care had a statistically significant relationship (p>0.05). Conclusion: It is hoped that the results will contribute to increasing knowledge of the subject, supporting care practice, and formulating public policies to meet the needs of caregivers of family members who are ill with cancer.

Objetivo: analisar a correlação entre sobrecarga dos cuidadores familiares de adoecidos por câncer em Cuidados Paliativos e as variáveis sexo, idade, problemas de saúde e tempo de cuidado. Método: estudo descritivo correlacional com amostra não probabilística de 147 cuidadores familiares, na Clínica de Cuidados Paliativos Oncológicos, em 2021, na cidade de Belém do Pará - Brasil. Utilizou-se a Escala de Sobrecarga de Zarit para coleta de dados com análise estatística descritiva e inferencial. Resultados: 86 (58,5%) dos cuidadores eram do sexo feminino, 66 (44,9%) cuidadores se sentem “Muito sobrecarregados”, 104 (70,7%) apresentaram sobrecarga Moderada a Severa. Não houve consistência para concluir as variáveis sexo, faixa etária, problemas de saúde ou tempo de cuidado uma relação estatisticamente significante (p>0,05). Conclusão: espera-se que os resultados contribuam para aumentar o conhecimento do tema, subsidiando a prática assistencial, e na formulação de políticas públicas para o atendimento das necessidades dos cuidadores de familiares adoecidos por câncer.

Objetivo: Analizar la correlación entre la sobrecarga de los cuidadores familiares de pacientes oncológicos en cuidados paliativos y las variables sexo, edad, problemas de salud y tiempo de cuidado. Método: estudio descriptivo correlacional con una muestra no probabilística de 147 cuidadores familiares, en la Clínica de Cuidados Paliativos Oncológicos, en 2021, en la ciudad de Belém do Pará - Brasil. Para recoger los datos se utilizó la Escala de Sobrecarga de Zarit, con análisis estadísticos descriptivos e inferenciales. Resultados: 86 (58,5%) de los cuidadores eran mujeres, 66 (44,9%) cuidadores se sentían "Muy sobrecargados", 104 (70,7%) tenían una sobrecarga de Moderada a Severa. No hubo coherencia a la hora de concluir que las variables sexo, grupo de edad, problemas de salud o tiempo de atención tuvieran una relación estadísticamente significativa (p>0,05). Conclusión: Se espera que los resultados contribuyan a aumentar el conocimiento sobre el tema, apoyar la práctica asistencial y la formulación de políticas públicas para satisfacer las necesidades de los cuidadores de familiares enfermos de cáncer.

Objective: to investigate the sociodemographic and surgical profile of neuro-oncology patients subjected to neurological surgeries. Method: a descriptive and retrospective study with a quantitative approach, conducted during a five-year period (2014-2018) in a hospital with 236 beds, which is a reference in cancer treatment in the state of Pará. The data were collected from September to December 2019 and analyzed by means of descriptive statistics. Results: the profile was characterized by the age group of 41 to 50 years old (30.8%; n=20) and by individuals with complete elementary school (44.6%; n=29). They were subjected to elective surgeries (87.7%; n=57), considered clean (95.4%; n=62), and large (96.9%; n=63). The main complications were surgical site infection (10.7%; n=8) and tumors located in the encephalus (60%; n=39). Conclusion: the paper contributed to delineate the profile of the population served by the hospital, enabling the expansion of debates aimed at improving hospital planning and at refining the quality of the health services and of the Nursing assistance.

Objective: to validate the content of a booklet to subsidize the self-care of family caregivers of cancer patients in home-based palliative care. Methods: this is a methodological study. The participants were 11 expert judges. This study was aided by a questionnaire organized according to a Likert scale with items distributed in objectives, structure, presentation and relevance. The quantitative verification of the results was based on a descriptive statistical analysis. Results: validation was based on the analysis of the judges, reaching a higher parameter than the one proposed (0.78) for the content validity index; the 21 items surpassed the value of 80.0%. Conclusion: it is considered that the booklet is validated and can promote self-care of caregivers of cancer patients in the home setting.

Political participation is one of the most complex problems of modern society, yet popular participation Hvz•h‌Hay era. In this study, the tenth presidential election in Iran as one of the most important aspects of political participation or better N‌Ha in the country, according to the electoral behavior of these approaches lie in the areas studied. The purpose of this study was to evaluate the impact of economic policies and the victory of Mahmoud Ahmadinejad in televised debates. The other hypothesis of the present study, the relationship between television debates and voters tend to Mr Ahmadi-Nejad points. This is the Joulgah part of the province's the presidential election. This paper presents a theoretical framework and political economy theory is the dominant ideology. Results of this study suggest that the economic policies Ahmdy‌Nzhad and television debates on the one hand and on the other hand There is a victory. Bh‌Gvnh‌Ay the data are the data also confirmed this. The results show that the impact of televised debates attracted a lot of votes to be elected president. Results of this study suggest that the economic policies Ahmdy‌Nzhad and television debates on the one hand and on the other hand There is a victory.

OBJECTIVE:To determine Bruch's membrane opening (BMO) minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements, acquired with optical coherence tomography (OCT) in healthy Brazilian individuals self-reported as African Descent (AD), European Descent (ED) and Mixed Descent (MD). METHODS:260 healthy individuals (78 AD, 103 ED and 79 MD) were included in this cross-sectional study conducted at the Clinics Hospital of the University of Campinas. We obtained optic nerve head (24 radial B scans) and peripapillary retinal nerve fiber layer (3.5-mm circle scan) images in one randomly selected eye of each subject. RESULTS:After adjustment for BMO area and age, there were no significant differences in mean global MRW (P = 0.63) or RNFLT (P = 0.07) among the three groups. Regionally, there were no significant differences in either MRW or RNFLT in most sectors, except in the superonasal sector, in which both MRW and RNFLT were thinner among ED (P = 0.04, P

Aim and Background: This study aimed to evaluate the efficacy of silymarin in improving liver function and reducing liver stiffness in chronic liver disease (CLD) patients. Silymarin, a hepatoprotective agent, has shown potential benefits in non-alcoholic fatty liver disease (NAFLD) and liver fibrosis, but evidence in CLD with varied etiologies remains limited. This study addresses the gap by assessing its impact across diverse etiological subgroups., Material and Method: A non-randomized clinical trial was conducted at Lahore General Hospital, Lahore, over 18 months. Out of 148 enrolled chronic liver disease (CLD) patients, 141 completed the 12-week follow-up. Patients were stratified into two groups: silymarin (200 mg twice daily) plus standard care and standard care alone. Baseline and follow-up data, including clinical, biochemical, and FibroScan (EchoSens, Ivry-sur-Seine, France) was collected and stratified analysis based on etiology was performed using Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY)., Results: This study evaluated 141 chronic liver disease (CLD) patients who completed the three-month follow-up, 68 in the standard treatment group and 73 in the silymarin group. Baseline characteristics were comparable except for age and body mass index (BMI). Alanine aminotransferase (ALT) levels significantly reduced in the silymarin group (63.04 ± 22.38 U/L) compared to the standard group (78.49 ± 22.93 U/L, p=0.000), with higher ALT normalization in the silymarin group (35.6% vs. 22.1%, p=0.076). Aspartate aminotransferase (AST) levels were also significantly lower in the silymarin group (57.08 ± 20.94 U/L vs. 65.90 ± 24.18 U/L, p=0.022). Improvements in hepatic encephalopathy, ascites, and Child-Turcotte-Pugh (CTP) class were similar across groups (p > 0.05). The stratified analysis highlighted greater ALT and AST reductions for hepatitis B virus (HBV) and non-alcoholic fatty liver disease (NAFLD) in the silymarin group. FibroScan (EchoSens, France) scores, bilirubin, albumin, international normalized ratio (INR), and prothrombin time (PT) showed no significant differences between groups. These findings suggest silymarin's potential in improving liver enzymes, particularly in metabolic etiologies., Conclusion: This study demonstrates that silymarin effectively reduces ALT and AST levels and achieves higher ALT normalization compared to standard treatment in CLD patients. While improvements in hepatic encephalopathy, ascites, and CTP class were comparable between groups, silymarin showed greater efficacy in metabolic conditions like NAFLD., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board, Postgraduate Medical Institute, Ameer-ud-Din Medical College, Lahore General Hospital, Lahore issued approval PGMI/AMC/LGH/2021/09/133. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Amjad et al.)

Background and aim The study aimed to address the need for reliable and non-invasive biomarkers (NIBM) for detecting fibrosis among patients with chronic liver disease (CLD). Material and methods This was a diagnostic validation study executed at the Department of Gastroenterology, Jinnah Hospital, Lahore. The study was carried out from July 2023 to June 2024, enrolling a total of 88 patients using non-probability consecutive sampling. Patients with chronic liver disease (CLD) due to chronic viral hepatitis B (HBV), hepatitis C (HCV), and non-alcoholic fatty liver disease (NAFLD) were included in the study. A cut-off value of 12.5 kPa was used to label fibrosis using transient elastography. Blood samples were collected for recording values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and platelet count, and the appropriate formulas were applied to calculate the aspartate aminotransferase to platelet ratio index (APRI), Fibrosis-4 (FIB-4), AST/ALT-to-platelet ratio index (AARPRI), and BARD scores (a scoring system for NAFLD fibrosis that predicts the risk of advanced fibrosis in NAFLD patients; the components include body mass index (BMI), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, and diabetes status). Spearman's rank correlation coefficient was used to assess the strength and direction of the association between these variables. Results Among the 88 patients, 61.4% were male and HCV was the most common cause of CLD (63.6%). Statistically significant correlations were found between transient elastography and NIBM: FIB-4 (p < 0.001, area under receiver operating characteristic curves (AUROC), 0.835; sensitivity, 47.7%; specificity, 90.9%), APRI (p = 0.020; AUROC, 0.769; sensitivity, 25.0%; specificity, 93.2%), AARPRI (p = 0.011, AUROC, 0.782), and BARD (p = 0.033; AUROC, 0.648). FIB-4 demonstrated the strongest correlation with liver stiffness measurements (LSM) (r = 0.617), indicating its reliability in detecting liver fibrosis, whereas the aspartate aminotransferase to alanine aminotransferase ratio (AAR) showed the weakest correlation (r = 0.163). Conclusion This study reported that FIB-4 displayed the highest correlation with liver stiffness measurements obtained through transient elastography in detecting liver fibrosis. APRI and AARPRI reported a moderate correlation, while AAR and BARD were less consistent in their performance. These findings suggest that FIB-4, APRI, and AARPRI are effective non-invasive tools for assessing liver fibrosis in a limited resource setting where transient elastography is not available., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethical Committee, Jinnah Hospital, Lahore issued approval 379/20/10/2023/S1 ERB. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Asif et al.)

Aim and Background: This study aimed to evaluate the quality of life (QoL) in end-stage kidney disease (ESRD) patients on maintenance hemodialysis through the Missoula-Vitas Quality of Life Index-15 (MVQOLI-15) to identify factors affecting their well-being., Materials and Methods: A cross-sectional study was conducted at the Dialysis Unit of the Nephrology Department, Nishtar Hospital Multan. Over six months, 140 eligible patients were enrolled using non-probability consecutive sampling. Participants aged 18-80 years on maintenance hemodialysis for at least six months were evaluated using the MVQOLI-15 questionnaire assessing symptoms, function, interpersonal, well-being, and transcendence dimensions of QoL. Data were analyzed using the IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York). Inferential statistical tests, including the t-test for comparing two groups and analysis of variance (ANOVA) for comparing multiple groups, were utilized to determine the significance of differences in QoL scores among different demographic and clinical categories. P-values less than 0.05 were considered statistically significant., Results: The study analyzed 140 hemodialysis patients, with a mean age of 52.41 ± 16.31 years and an average hemodialysis duration of 4.55 ± 2.46 years. Most participants were aged 61-80 years (35.7%), had secondary education (44.3%), and were married (67.1%). QoL scores, measured using the MVQOLI, indicated mean values for symptoms at 4.51 ± 10.71, function at 5.77 ± 8.04, interpersonal at 7.49 ± 13.67, well-being at -13.60 ± 7.11, transcendence at 8.24 ± 13.12, and a total score of 16.24 ± 2.75. Significant findings include the following: females had higher symptom scores (p=0.001) and lower well-being scores (p=0.000); younger patients (<30 years) had higher function scores (p=0.054); patients on hemodialysis three times per week had higher function scores (p=0.006); patients taking 1 to 3 pills per day had higher transcendence scores (p=0.000); unmarried patients had higher symptoms scores (p=0.064) and lower well-being scores (p=0.004); and illiterate patients had higher symptoms (p=0.005) and transcendence scores (p=0.034). In total score, patients on hemodialysis once per week reported significantly better scores (p=0.011)., Conclusion: This study highlights varied QoL experiences among hemodialysis patients, with transcendence scoring the highest and well-being, the lowest. Demographic factors such as age, gender, and education level significantly impact the QoL dimensions. Understanding these findings can guide personalized interventions to improve the well-being of hemodialysis patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Nishtar Medical University and Hospital issued approval 7510. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ahmed et al.)

Aim and Background: Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. This study aimed to assess the frequency of cardiac abnormalities across different stages of CKD, providing insights into the relationship between renal dysfunction and cardiac abnormalities., Material and Methods: A cross-sectional observational study was conducted at Lahore General Hospital's Nephrology Department, enrolling 356 non-dialysis CKD patients (stages I-V) over one year. Participants aged 18-65 years with CKD duration of three months or more were included. Exclusion criteria encompassed dialysis dependency, transplantation, acute kidney injury, and various cardiac conditions. Detailed echocardiographic evaluation of cardiac structure and function was noted., Results: This study included 356 patients with CKD across stages I-V, with the majority in stages III (44.7%) and IV (36.5%). Significant variations were observed in age (p<0.000), hypertension prevalence (p=0.004), and smoking status. Haemoglobin, calcium, and phosphate levels differed significantly across stages (p<0.001). Echocardiographic findings revealed significant differences: left ventricular hypertrophy frequency increased from 12.5% in stages I-II to 60.0% in stage V (p=0.001); diastolic dysfunction worsened, with grades 2-3 dysfunction increasing from 6.2% in stages I-II to 51.4% in stage V (p=0.000); systolic dysfunction increased with reduced ejection fraction (<45%) more common in advanced stages (p=0.000); global longitudinal strain worsened from -18.47% to -15.34% (p=0.000); left atrial volume index and pulmonary hypertension also increased significantly (p=0.049)., Conclusion: This study demonstrates a significant correlation between the progression of CKD and the severity of echocardiographic abnormalities. As CKD advances, structural and functional cardiac abnormalities increase, underscoring the importance of early cardiac evaluation and intervention to improve cardiovascular outcomes in non-dialysis-dependent CKD patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Postgraduate Medical Institute/Lahore General Hospital, Lahore issued approval AMC/PGMI/156/1/2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hussain et al.)

Background Chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma significantly impair quality of life and impose a substantial burden on healthcare systems. Proper inhalation technique is important for effective management of these diseases, yet remains poorly performed by many patients. This study evaluated the impact of structured counseling and training sessions on inhaler use among patients with COPD and asthma, aiming to enhance technique correctness and disease control. Methodology This cross-sectional study analyzed 150 patients with asthma and COPD who fulfilled the inclusion criteria for inhalation techniques. Patients were counseled regarding the proper seven-step inhalation technique for each inhaler type [metered-dose inhaler (MDI), MDI with spacer, and dry powder inhaler (DPI)] through practical demonstration at baseline visits. Correct use of inhalers was assessed by a predefined checklist for each inhaler device at the baseline visit and after three months. The correctness of the inhalation technique was evaluated by scoring each of the seven steps. The disease control assessment was done using the COPD assessment test (CAT) and asthma control test (ACT) at the baseline visit and after three months. Results In this study of 150 patients, there were 97 (64.7%) males and 53 (35.3%) females. In total, 67 (44.7%) were diagnosed with asthma and 83 (55.3%) with COPD. The mean age was 45.33 ± 12.62 years. Post-counseling improvements in inhaler technique were marked, with MDI users enhancing their technique score from an average of 4.4 to 6.1, MDI with spacer from 4.56 to 6.26, and DPI from 4.92 to 6.24 (p < 0.001 for all). Disease control also showed significant gains; CAT scores decreased for MDI users from 23.4 to 20.5, MDI with spacer from 23.92 to 20.96, and DPI from 24.89 to 21.96. Concurrently, ACT scores increased for MDI users from 16.4 to 18.0 (p = 0.002), MDI with spacer from 17.29 to 19.04, and DPI from 16.42 to 18.37 (p < 0.001 for both), reflecting substantive advances in managing COPD and asthma symptoms. Furthermore, patients with primary education exhibited a significant boost in technique mastery post-counseling (p < 0.001), underscoring the potential of well-crafted counseling to transcend educational barriers in promoting effective inhaler use. Conclusions Post-counseling, inhaler technique improved significantly across all types, with MDI with spacer users demonstrating the most progress. Technique scores increased notably (p < 0.001), and disease control scores for COPD and asthma, measured by CAT and ACT, also showed significant improvements (p < 0.001). Remarkably, primary education level participants exhibited substantial technique gains post-intervention, emphasizing the effectiveness of counseling irrespective of initial educational status in enhancing inhaler use and disease management., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Committee Pak Emirates Military Hospital, Rawalpindi issued approval A/28/EC/436/2022. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Abbas et al.)

Background Chronic liver disease (CLD) is associated with a variety of consequences, including thrombocytopenia and esophageal varices, which significantly impact patient prognosis and management. Thrombocytopenia, frequently observed in patients with CLD, may correlate with the severity of esophageal varices, a critical complication leading to variceal bleeding. Methodology A cross-sectional study was carried out in the Department of Medicine and Gastroenterology, Pak Emirates Military Hospital, Rawalpindi, from October 2021 to March 2022. The study enrolled 94 patients, aged 18-70 years, diagnosed with CLD, regardless of the cause. These patients were categorized into four groups based on platelet count: <50,000/uL, 50,000-99,999/uL, 100,000-150,000/uL, and >150,000/uL. Pearson's correlation was utilized to evaluate the association between the severity of thrombocytopenia and the grading of esophageal varices. Results A total of 94 patients were enrolled in the study, with 53 (56.4%) males and 41 (43.6%) females. The mean age of patients was 51.06 ±11.09 years. Seventeen (18.1%) had no esophageal varices, 16 (17.0%) were diagnosed with Grade I varices, 35 (37.2%) with Grade II varices, and 26 (27.7%) had Grade III varices. Most patients without varices had a platelet count above 150 x 10 3 (17, 18.1%). Conversely, most patients with Grade III varices (19, 20.2%) had platelet counts below 50 x 10 3 . Patients with no esophageal varices had a mean platelet count of 173.70 ± 37.48 x 10 3 . Among the patients, those with Grade III esophageal varices exhibited the lowest mean platelet count, recorded at 78.54 ± 24.14 x 10 3 . These findings indicate a statistically significant difference in mean platelet counts across the various esophageal varices grades ( P = 0.000). There was an inverse correlation of platelet count with the grading of esophageal varices ( r  = -0.645, P < 0.000). Conclusions A negative correlation was observed between the platelet count and the grading of esophageal varices, implying that as the severity of esophageal varices increased, the platelet counts proportionally decreased., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Abbas et al.)

Aim: The prevalence of Helicobacter pylori is escalating in developing countries, exacerbated by unjustified antibiotic usage, which leads to increased resistance. This trend has been notably amplified since the COVID-19 pandemic. Consequently, the effectiveness of existing eradication regimens has been compromised. This study aimed to compare the efficacy of two weeks of vonoprazan-based quadruple sequential therapy and lansoprazole-based quadruple sequential therapy in treating H. pylori infection.  Methods: A non-randomized clinical trial was conducted over 18 months at the Department of Gastroenterology, Lahore General Hospital, Lahore, Pakistan. It included patients presenting with dyspepsia, as defined by the Rome IV criteria, and who tested positive on the urea breath test. Patients were divided into two groups, i.e., Group A and Group B. Group A patients received lansoprazole 30 mg + amoxicillin + tinidazole + tab. colloidal bismuth subcitrate for the first seven days, followed by lansoprazole + levofloxacin + azithromycin + colloidal bismuth subcitrate. Group B patients received vonoprazan + amoxicillin + tinidazole + colloidal bismuth subcitrate for the first seven days, followed by vonoprazan + levofloxacin + azithromycin + colloidal bismuth subcitrate. Both regimes continued for 14 days. Four weeks after 14 days of the treatment, an early morning urea breath test was conducted to evaluate the efficacy of the treatment. Patients were scheduled for follow-up visits at seven and 14 days post-treatment initiation to record adverse events and assess compliance with the treatment regimen. Patients who lost the follow-up and remained non-compliant to the medications were excluded from the final data analysis as per standard protocols of the per-protocol analysis.  Results: A total of 252 patients were included. In Group A and Group B, 6/126 (4.76%) and 8/126 (6.35%) of the patients were lost to follow-up, respectively. The non-compliance rate in Group A was 5/126 (3.97%), compared to Group B with 3/126 (2.38%). Finally, the per-protocol analysis of the results included 115 patients in each group. Baseline characteristics, including demographics, lifestyle, and clinical factors, were comparable between groups with p-values of 0.138 for age, 0.356 for gender, 0.126 for BMI, 0.495 for residence, 0.500 for water source, 0.866 for meal habit, 0.863 for smoking, 0.188 for nonsteroidal anti-inflammatory drug (NSAID) use, 0.145 for proton pump inhibitor (PPI) use, 0.213 for antibiotics, and 0.456 for treatment history. Both treatments effectively eradicated H. pylori , as determined by a negative urea breath test at four weeks post-treatment, with Group B showing a higher eradication rate of 96.5% compared to 92.2% in Group A, although the difference was not statistically significant (p = 0.153). There was no difference in adverse effects in both treatment groups (p-value > 0.05).  Conclusion: The study found that while the vonoprazan-based regime exhibited a slightly higher eradication rate of H. pylori compared to lansoprazole, the difference was not statistically significant. It was concluded that both regimens demonstrated comparable efficacy and similar profiles of adverse effects in treating H. pylori infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Nizam et al.)

Clathrate hydrate growth, deposition, and plug formation during oil and gas transportation causes blockage of pipelines. An effective strategy to solve this problem is to mitigate the hydrate formation and reduce its adhesion on pipe walls through a coating process. However, durability failure, corrosion, inability to self-heal, high cost, and strong hydrate adhesion remain unsolved issues. To address these challenges, in this work, we present an in situ self-replenishing nonfluorinated durable hydrate-phobic coating of candle soot particles. The candle soot coating reduces hydrate adhesion by promoting a thick barrier film of hydrocarbons between the hydrate and the soot coated substrate. The hydrocarbons permeating the soot coating display a high contact angle for water and inhibit the formation of water bridges between the hydrate and soot coated substrate. The spherical cyclopentane hydrate slides off easily on the candle soot coating inside the cyclopentane environment. The hydrate former, cyclopentane-water emulsion, and THF-water mixture have high contact angles as well as low hydrate adhesion on soot coating simultaneously. In addition, the coating is flow-induced long-term slippery, durable, low cost, anticorrosion, self-cleaning, and suitable for practical applications.

Ice accumulation on exposed surfaces is unavoidable as time elapses and the temperature decreases sufficiently. To mitigate icing problems, various types of icephobic substrates have been rationally designed, including superhydrophobic substrates (SHSs), aqueous lubricating layers, organic lubricating layers, organogels, polyelectrolyte brush layers, electrolyte-based hydrogels, elastic substrates, and multicrack initiator-promoted surfaces. Among these surfaces, elastic substrates show excellent enhanced surface icephobicity during dynamic processes (i.e., water-impacting and de-icing tests). Herein, we summarize recent progress in elastic icephobic substrates and discuss the reasons that surface icephobicity can be enhanced on elastic substrates in terms of enhanced water repellency and further lowering the ice adhesion strength. For enhanced water repellency, we focus on reducing the contact time of water impacting such that water droplets can be easily shed from an elastic substrate before ice occurs. Reducing the contact time of water impacting various substrates (i.e., micro/nanostructured rigid SHSs, macrotextured rigid SHSs, and elastic SHSs) is discussed, followed by exploring their mechanisms. We argue that the ice adhesion strength can be further lowered on an elastic substrate by rationally tuning the elastic modulus and surface textures (i.e., surface textured and hollow subsurface textured) and combining elastic substrate with other passive anti-icing strategies (or functioning passive icephobic substrates with an electrothermal or photothermal stimulus). In short, the introduction of an elastic substrate into a passive or active icephobicity surface opens an avenue toward designing a versatile icephobic surface, providing great potential for outdoor anti-icing applications.

The non-fullerene acceptors A1-A5 with diflourobenzene or quinoline core (bridge) unit, donor cyclopenta[1,2-b:3,4-b']dithiophene unit and 2-(2-methylene-3-oxo-2,3-dihydro-1H-inden-1-ylidene)malononitrile as acceptor unit with additional phenyl, fulvene or thieno[3,2-d]pyrimidinyl 5-oxide groups have been designed through DFT calculations. The optimization of molecular geometries were performed with density functional theory (DFT) at B3LYP 6-31G (d,p) level of theory. The frontier molecular orbital (FMO) energies, band gap energies and dipole moments (ground and excited state) have been calculated to probe the photovoltaic properties. The band gap (1.42-2.01 eV) and dipole moment values (5.5-18. Debye) showed that these designed acceptors are good candidates for organic solar cells. Time-Dependent Density Functional Theory (TD-DFT) results showed λ max (wave length at maximum absorption) value (611-837 nm), oscillator strength (f) and excitation energies (1.50-2.02 eV) in gas phase and in CHCl 3 solvent (1.48-1.89 eV) using integral equation formalism variant (IEFPCM) model. The λ max in CHCl 3 showed marginal red shift for all designed acceptors compared with gas phase absorption. The partial density of states (PDOS) has been plotted by using multiwfn which showed that all the designed molecules have more electronic distribution at the donor moiety and lowest at the central bridge. The reorganization energies of electron (λ e ) (0.0007 eV to 0.017 eV), and the hole reorganization energy values (0.0003 eV to - 0.0403 eV) were smaller which suggested that higher charged motilities. The blends of acceptors A1-A5 with donor polymer D1 provided open circuit voltage (V oc ) and ∆HOMO off-set of the HOMO of donor and acceptors. These blends showed 1.04 to 1.5 eV values of V oc and 0 to 0.38 eV ∆HOMO off set values of the donor-acceptor bends which indicate improved performance of the cell. Finally, the blend of D1-A4 was used for the study of distribution of HOMO and LUMO. The HOMO were found distributed on the donor polymer (D1) while the A4 acceptor was found with LUMO distribution. Based on λ max values, and band gap energies (E g ), excitation energies (E x ), reorganization energies; the A3 and A4 will prove good acceptor molecules for the development of organic solar cells., (© 2021. The Author(s).)

The copolymerization of ethylene‒diene conjugates (butadiene (BD), isoprene (IP) and nonconjugates (5-ethylidene-2-norbornene (ENB), vinyl norbornene VNB, 4-vinylcyclohexene (VCH) and 1, 4-hexadiene (HD)), and terpolymerization of ethylene-propylene-diene conjugates (BD, IP) and nonconjugates (ENB, VNB, VCH and HD) using two traditional catalysts of C 2 -symmetric metallocene-silylene-bridged rac-Me 2 Si(2-Me-4-Ph-Ind) 2 ZrCl 2 (complex A) and ethylene-bridged rac-Et(Ind) 2 ZrCl 2 (complex B)-with a [Ph 3 C][B(C 6 F 5 ) 4 ] borate/TIBA co-catalyst, were intensively studied. Compared to that in the copolymerization of ethylene diene, the catalytic activity was more significant in E/P/diene terpolymerization. We obtained a maximum yield of both metallocene catalysts with conjugated diene between 3.00 × 10 6 g/mol Mt ·h and 5.00 × 10 6 g/mol Mt ·h. ENB had the highest deactivation impact on complex A, and HD had the most substantial deactivation effect on complex B. A 1 H NMR study suggests that dienes were incorporated into the co/ter polymers' backbone through regioselectivity. ENB and VNB, inserted by the edo double bond, left the ethylidene double bond intact, so VCH had an exo double bond. Complex A's methyl and phenyl groups rendered it structurally stable and exhibited a dihedral angle greater than that of complex B, resulting in 1, 2 isoprene insertion higher than 1, 4 isoprene that is usually incapable of polymerization coordination. High efficiency in terms of co- and ter- monomer incorporation with higher molecular weight was found for complex 1. The rate of incorporation of ethylene and propylene in the terpolymer backbone structure may also be altered by the conjugated and nonconjugated dienes. 13 C-NMR, 1 H-NMR, and GPC techniques were used to characterize the polymers obtained.

The kinetics of ethylene and propylene polymerization catalyzed by homogeneous metallocene were investigated using 2-thiophenecarbonyl chloride followed by quenched-flow methods. The studied metallocene catalysts are: rac -Me 2 Si(2-Me-4-Ph-Ind) 2 ZrCl 2 (Mt-I), rac -Et(Ind) 2 ZrCl 2 (Mt-II) activated with ([Me 2 NPh][B(C 6 F 5 ) 4 ] (Borate-I), [Ph 3 C][B(C 6 F 5 ) 4 ] (Borate-II), and were co-catalyzed with different molar ratios of alkylaluminum such as triethylaluminium (TEA) and triisobutylaluminium (TIBA). The change in molecular weight, molecular weight distribution, microstructure and thermal properties of the synthesized polymer are discussed in detail. Interestingly, both Mt-I and Mt-II showed high activity in polyethylene with productivities between 3.17 × 10 6 g/mol Mt ·h to 5.06 × 10 6 g/mol Mt ·h, activities were very close to each other with 100% TIBA, but Mt-II/borate-II became more active when TEA was more than 50% in cocatalyst. Similarly, Polypropylene showed the highest activity of 11.07 10 6 g /mol Mt ·h with Mt-I/Borate-I/TIBA. The effects of alkylaluminum on PE molecular weight were much more complicated; MWD curve changed from mono-modal in Mt-I/borate-I/TIBA to bimodal type when TIBA was replaced by different amounts of TEA. In PE, the active center fractions [C*]/[Zr] of Mt-I/borate were higher than that of Mt-II/borate and average chain propagation rate constant ( k p ) value slightly decreased with the increase of TEA/TIBA ratio, but the Mt-II/borate systems showed higher k p 1007 k p (L/mol·s). In PP, the Mt-I/borate presented much higher [C*]/[Zr] and k p value than the Mt-II. This work also extend to investigate the mechanistic features of zirconocenes catalyzed olefin polymerizations that addressed the largely unknown issues in zirconocenes in the distribution of the catalyst, between species involved in polymer chain growth and dormant state. In both metallocene systems, chain transfer with alkylaluminum is the dominant way of chain termination. To understand the mechanism of cocatalyst effects on PE M w and (MWD), the unsaturated chain ends formed via β -H transfer have been investigated by 1 H NMR analysis.

Polluted water is a worldwide problem; therefore, effective separation of oil/water and removal of dyes, organic micropollutants, and heavy metals in wastewater are the need of the hour. Herein, hydrophilic β-cyclodextrin-grafted carboxymethyl cellulose, biodegradable polyvinyl alcohol, and chitosan were used as main raw materials to construct a multifunctional aerogel framework by simple sol-gel and directional freeze-drying methods. Featuring intrinsic superamphiphilic wettability in air, robust superoleophobic wettability underwater, and excellent shape-recovery characteristics, the biomass-derived aerogel presents durable oil/water separation even after 10 cycles. The aerogels possess prominent adsorption capacity for methyl blue, 1-naphthylamine, and Cu 2+ , which was as high as 121.55 mg/g, 33.96 mg/g, and 122.6 mg/g, respectively. In addition, various pollutant mixtures could be effectively adsorbed by the aerogel at the same time with the adsorption capacity of 121.75 mg/g for methyl blue, 0.97 mg/g for bisphenol A, and 20.11 mg/g for Cu 2+ .

Creating a robust omniphobic surface that repels various liquids would have broad technological implications for areas ranging from biomedical devices and fuel transport to architecture. The present omniphobic surfaces still have the problems of complex fabrication methods, high cost, and being environmentally harmful. To address these challenges, here we report a novel process to design a non-fluorinated, long-term slippery omniphobic surface of candle soot nanoparticles with a silicone binder that cures at room temperature. The porosity, nanoscale roughness, strong affinity of the substrate with the silicone lubricant, and retention of lubricant after curing of the binder play an important role in its stability and low ice adhesion strength at sub-zero temperature. The developed surface exhibits damage resistant slippery properties, repellency to several liquids with different surface tensions including blood, delay in freezing point along with ultra-low ice adhesion strength (2 kPa) and maintains it even below 7 kPa under harsh environmental conditions; 90 frosting/defrosting cycles at -90 °C; 2 months under an ice layer; 2 months at 60 °C; 9 days flow in acidic/basic water and exposure to super-cold water. In addition, this novel technique is cheap, easy to fabricate, environmentally benign and suitable for large-scale applications., Competing Interests: The authors declare no competing financial interest., (This journal is © The Royal Society of Chemistry.)

Ice formation and accretion affect residential and commercial activities. Icephobic coatings decrease the ice adhesion strength (τ ice ) to less than 100 kPa. However, rare icephobic coatings remove the ice under the action of gravity or natural winds. The icephobicity of such coatings depends on materials with low interfacial toughness. We develop durable candle soot icephobic coating with RTV-1 as a low-modulus binding material. Heterogeneous nucleation on 20-40 nm candle soot particles and their fracture mechanism are discussed. The developed coating always shows durable Cassie-Baxter superhydrophobic state with low ice adhesion (18 kPa) and maintains the τ ice value of about 25 kPa after severe mechanical abrasion, 30 liquid nitrogen/water cycles, 100 frosting/defrosting cycles, 100 icing/deicing cycles, acid/base exposure, under UV light, and exposure to natural freezing rain in Hangzhou. In addition, the proposed technique is time-efficient, inexpensive, and suitable for large-scale applications.

Various organogel materials with either a liquid or solid surface layer have recently been designed and prepared. In this work, amphiphilic organogels (AmOG) are innovatively developed from copolymer P(PDMS-r-PEG-r-GMA) and 2,2'-diaminodiphenyldisulfide via epoxy group addition reaction and then infiltrated with amphiphilic lubricants instead of traditional hydrophilic or hydrophobic lubricants. Because of synergistic effects of hydrophilic and hydrophobic segments of amphiphilic lubricants, the AmOG surfaces showed high stability and excellent anti-icing performance. The delay in the freezing point of water was 1000 s on AmOG surfaces, which is 40 times longer as compared to the untreated hydrophilic glass surface. More importantly, low ice adhesion strength (15.1 kPa) was observed on AmOG which remained about 40 kPa even after 20 icing-deicing cycles. The novel amphiphilic organogels provide a new idea to prepare long-term anti-icing materials for practical applications.

Ice formation and accretion on surfaces is a serious economic issue in energy supply and transportation. Recent strategies for developing icephobic surfaces are intimately associated with superwettability. Commonly, the superwettability of icephobic materials depends on their surface roughness and chemical composition. This article critically categorizes the possible strategies to mitigate icing problems from daily life. The wettability and classical nucleation theories are used to characterize the icephobic surfaces. Thermodynamically, the advantages/disadvantages of superhydrophobic surfaces are discussed to explain icephobic behavior. The importance of elasticity, slippery liquid-infused porous surfaces (SLIPSs), amphiphilicity, antifreezing protein, organogels, and stimuli-responsive materials has been highlighted to induce icephobic performance. In addition, the design principles and mechanism to fabricate icephobic surfaces with superwettability are explored and summarized.

Background: Posterior urethral valve (PUV) is life-threatening congenital anomaly of the urinary tract that results in vesicoureteric reflux, recurrent UTI, voiding dysfunction and renal insufficiency if not treat timely. Endoscopic ablation of posterior urethral valves using cold knife or laser is the current gold standard therapy. Many urologists go for repeat cystoscopy to see residual valve or stricture while others repeat VCUG to measure the posterior to anterior urethral ratio for residual obstruction. In this study, we have standardized by regularly doing re-look cystoscopy at 3 months whether the child is symptomatic or not to see justification for re-look cystoscopy after PUV ablation., Methods: In this prospective study, first 50 cases that underwent posterior urethral valve fulguration were included. Diagnosis of posterior urethral valve was made by voiding symptoms, ultrasonography and confirmed by voiding cysto-urethrogram (VCUG). All children were treated by endoscopic fulguration of posterior urethral valves (PUV) using cold knife as urethral valvotome and were followed clinically for voiding symptoms and with ultrasonography and laboratory test at 3 and 6 months. All patients underwent re-look cystoscopy at three months to see residual valves irrespective of their clinical improvement., Results: Mean age at presentation was 4.9±3.2 years. The most common symptoms were poor stream (76%), straining at voiding (72%), dribbling of urine (54%), fever (42%) and urinary retention (14%). Residual valves on re-look cystoscopy were seen in 78%. Four (8%) patients had urethral stricture on re-look cystoscopy., Conclusions: We suggest routine re-look cystoscopy after primary fulguration of PUV to pick more residual obstructive valves.

Objective: To compare the outcome of percutaneous nephrolithotomy (PCNL) in terms of operative time, hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients., Study Design: Descriptive case series., Place and Duration of Study: Shifa International Hospital, Islamabad, from January 2010 to December 2013., Methodology: Aretrospective analysis of 155 patients who underwent PCNL from January 2010 to December 2013. The patients were divided into 2 groups: patients aged ≤12 years were included in paedriatic group (A) while patients aged > 12 years were included in adult group (B). The patients were analyzed for age, gender, stone size, operative time, stone clearance, hospital stay, and peroperative and postoperative complications. Data was collected by chart review on specified proforma., Results: One hundred and twenty-nine (129) patients including 44 (34.10%) females and 85 (65.89%) males with a mean age of 45.00 ±1.44 years were adults. Twenty-six palrents with mean age of 9.21 ±5.70 years, 17 (65.4%) males and 9 (34.6%) females, were included in the paedriatic group. Mean stone size was 2.12 ±1.01 cm in paedriatic group compared to 2.52 ±0.77 cm in adult group (p = 0.023). Mean operative time in paedriatic group was 158.8 ±39.63 minutes compared to 119.34 ±37.06 minutes in adult group (p < 0.001). Mean hospital stay in paedriatic group was 2.76 ±1.14 days compared to 3.12 ±1.27 days in adult group (p=0.1881). Peroperative stone clearance was in paedriatic group was 93.28 ±9.23% compared to 90.81 ±12.23% in adult groups (p = 0.331). One patient in the adult group developed urosepsis., Conclusion: There was no significant difference in outcome of percutaneous nephrolithotomy in terms of hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients. Operative time was significantly shorter in adult cases compared to paedriatic cases.

Objective: To determine the effect of two weeks preoperative finasteride therapy in reducing prostate vascularity in terms of mean microvessel density (MVD) and expression of VEGF in prostate urothelium among patients of BPH by comparing with controls., Study Design: Randomized controlled trial., Place and Duration of Study: Shifa International Hospital, Islamabad, from January 2013 to January 2014., Methodology: A total of 80 patients of Benign Prostatic Hyperplasia (BPH) planned for Trans-Urethral Resection of Prostate (TURP) having prostate size of more than 40 grams on trans-abdominal ultrasonography was randomized into two groups, each group having 40 patients. The finasteride group (Group A) was prescribed oral 5 mg of finasteride daily for 2 weeks before surgery. The control group (Group B) did not receive any agent. After 2 weeks, TURP was performed and prostate samples were sent for histopathological determination of MVD and expression of VEGF., Results: The mean age of patients was 66.21 ±10.08 years, ranging from 48 to 86 years. The mean prostate gland size was comparable in both groups (55 ±10.7 vs. 58.1 ±10.8 grams, p=0.21). Mean MVD in finasteride group (20.25 ±10.3) was significantly lower as compared to control group (48.9 ±22.6, p < 0.001). Similarly expression of VEGF was also significantly lower in finasteride group (30%) as compared to control group (65%) [p= 0.0017]. Mean MVD had a significant weak correlation with the size of prostate gland on Pearson correlation test (2-tailed) with r = 0.222., Conclusion: Finasteride reduces microvessel density and hence prostate vascularity with only 2-week therapy and the mean MVD is clearly correlated with size of prostate.

Endophytic fungi inhabit apparently healthy plant tissues and are prevalent in terrestrial plants, especially root tissues, which harbour a wide assemblage of fungal endophytes. Therefore, this study focused on the isolation and characterisation of endophytic fungi from the roots of wild banana (Musa acuminata). A total of 31 isolates of endophytic fungi were isolated from 80 root fragments. The endophytic fungi were initially sorted according to morphological characteristics and identified using the sequences of the translation elongation factor-1α (TEF-1α) gene of Fusarium spp. and the Internal Transcribed Spacer (ITS) regions of other fungi. The most common fungal isolates were species of the genus Fusarium, which were identified as F. proliferatum, Fusarium sp., F. solani species complex, and F. oxysporum. Other isolated endophytic fungi included Curvularia lunata, Trichoderma atroviride, Calonectria gracilis, Rhizoctonia solani, Bionectria ochroleuca, and Stromatoneurospora phoenix (Xylariceae). Several of the fungal genera, such as Fusarium, Trichoderma, Rhizoctonia, and Xylariceae, are among the common fungal endophytes reported in plants. This study showed that the roots of wild banana harbour a diverse group of endophytic fungi.

Background: Vesicoureteral reflux (VUR) is a common anomaly affecting 1-3% of all children and 30-50% of those with urinary tract infection (UTI). In the past febrile vesicoureteric reflux on chronic antibiotic prophylaxis were treated by open surgery. Now a day's endoscopic injection of a bulking material has replaced open surgical procedure in cases of primary VUR. Our objective was to assess the efficacy of endoscopic treatment for primary vesico-ureteric reflux in children., Methods: This was a descriptive case series. One hundred and five patients with either unilateral or bilateral VUR (181 ureters) underwent endoscopic treatment for primary VUR between January 2011 and January 2014. Children from 1 to 12 years of age with grade-II to IV reflux on preoperative voiding cystourethrogram (VCUG) were enrolled through consecutive non-probability sampling. Efficacy of treatment was evaluated at three months post injection by a standard VCUG. Ureters with no or grade-I reflux were considered successful treatment., Results: Out of 105 patients 76 had bilateral while 29 had unilateral reflux. Mean age was 5.7 years (SD ± .7). Among 181 refluxing ureters, 116 (64%) were free of reflux, while 49 (27%) showed down gradation and 16 (8.8%) showed no response to treatment on postoperative VCUG., Conclusion: Endoscopic treatment for VUR is a viable option for patients with primary VUR and may be considered in management of such cases.

Isolated female epispadias without bladder exstrophy is a rare congenital anomaly. Patients present with total or partial urinary incontinence. The diagnosis can only be made on careful genitalia examination by separating the labia majora. That is why it is often missed by most physicians even after being extensively investigated. The physical findings include patulous urethra, flattened mons pubis, and bifid clitoris with lack of anterior labial commissure. In most of the cases, single stage reconstruction of urethra, labia minora and clitoris is enough to achieve urinary continence with cosmetically acceptable genitalia.

Neuroblastoma is one of the commonest malignancy of childhood. Neuroblatoma in horseshoe kidney is an extremely rare condition. There is only one case of this tumour occurring in horseshoe kidney described in the literature. Recently we successfully treated a boy with neuroblastoma in horseshoe kidney.