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Objective: To determine the ability of C-reactive protein as a useful predictor of difficult laparoscopic cholecystectomy. Study Design: Cross sectional study. Place and Duration of Study: General Surgery unit of Combined Military Hospital, Rawalpindi Pakistan, from Nov 2021–Nov 2022. Methodology: Fifty-six patients who underwent emergency or early laparoscopic cholecystectomy were made part of this study. After an informed consent age, gender, Body Mass Index and C-Reactive Protein levels were documented. Patients then underwent surgery and operative time along with “Nassar Difficulty Grade” was documented to define difficult cholecystectomy. Results: A total of 56 patients who were scheduled to undergo laparoscopic cholecystectomy were included with mean age of 44.32±5.37 years. 23(41.10%) were male patients while 33(58.90%) were female patients. Mean CRP levels were 20.00±8.81 mg/L. Frequency of "difficult laparoscopic cholecystectomy" in patients who had high preoperative CRP was 15/22(68.18%) while in patients who had low preoperative CRP it was 13/34(38.23%). Additionally, bivariate analysis of CRP levels and mean operative time showed that Pearson correlation coefficient (r) value was 0.355 showing a significant positive correlation (p=0.007). Conclusion: C-reactive protein levels in patients undergoing laparoscopic cholecystectomy for gallstones or any of its related problems are helpful in predicting whether or not the patient will have a challenging laparoscopic cholecystectomy.

Objective: To determine the ability of “Gallbladder Operating Score (G10)” to predict difficulty of surgery and timely conversion of laparoscopic to open cholecystectomy. Study Design: Cross sectional study. Place and Duration of Study: General Surgery Unit of Combined Military Hospital, Rawalpindi Pakistan, from Nov 2021 to Nov 2022. Methodology: One hundred and eleven cases scheduled to undergo laparoscopic cholecystectomy were recruited. After an informed consent age, gender, Body Mass Index, G10 score and category of severity ranging from mild to extreme was documented. Operative time was documented to define difficult cholecystectomy alongside conversion of laparoscopic to open cholecystectomy. Results: A total of 111[53(47.70%) male and 58(52.30% female)] cases who were scheduled to undergo laparoscopic cholecystectomy were included with mean age of 43.36±5.33 years. Median G10 score of patients was 3.00 (range: 1.00-8.00). Overall frequency of conversion from laparoscopic to open cholecystectomy was 9(8.10%). G10 between the study participants who experienced conversion of laparoscopic to open cholecystectomy as compared to those who had their laparoscopic cholecystectomy completed was statistically significant (p=0.003). Conclusion: Gallbladder Operating Score (G10) is helpful in predicting the difficulty cholecystectomy and conversion of laparoscopic to open cholecystectomy.

Bacillus thuringiensis (B. thuringiensis) is considered one of the most important entomopathogenic microorganisms. It produces potent toxins against insects. Therefore, the present study investigates the bioacaricidal properties of B. thuringiensis on the Hyalomma tick species. Firstly, we identify Hyalomma ticks based on morphological screening and molecular characterization. The cytochrome C oxidase subunit I (COX1) gene was selected for the polymerase chain reaction (PCR) analysis, which resulted in the amplification of 656 bp. The amplified products were sequenced, and the isolated (COX1) gene of ticks was submitted to the gene bank of NCBI (Accession No. OR077934.1). The nucleotide sequences were retrieved from the NCBI data bank by BLASTn analysis, which confirmed that all obtained sequences belong to genus Hyalomma, and multiple alignments confirmed that the sequence of Hyalomma anatolicum Tandojam-isolate (HA-TJ) 100% aligned with Hyalomma analoticum KP792577.1, Hyalomma detritum KP792595.1, Hyalomma excavatum KX911989.1, and H. excavatum OQ449693.1. The generated phylogenetic tree confirmed that sequences of HA-TJ COX1 clustered with a single clad of H. analoticum, H. excavatum, and H. detritum. The acaricidal effect of B. thuringiensis toxins B. thuringiensis spore crystal mix (BtSCM) and B. thuringiensis crystal proteins (Btcps) was evaluated against larvae and adult life stages of Hyalomma ticks in vitro. We applied Btcps and BtSCM separately with different concentrations and calculated the mortality percentage. Adult mortality was estimated at the 8th, 10th, 12th, and 15th days posttreatment and larval mortality after 24 h. During treatment of the adult life stage, at first, ticks were immersed in different concentrations of Btcps and BtSCM for 5 min after the treatments, and the samples were transferred to sterile containers and placed in an incubator with 80% humidity at 23°C. Furthermore, Btcps produced the highest mortality on Day 15, 89±1.00% at a concentration of 3000 μg/mL, followed by the 12th, 10th, and 8th days produced 83±1.91%, 70±1.15%, and 61±1.00%, respectively. BtSCM produced mortality of 69±1.91% on Day 15 at a concentration of 3000 μg/mL, followed by the 12th, 10th, and 8th days at 57±2.51%, 37±1.91%, and 34±2.00%. The present study revealed that B. thuringiensis toxins produced a significant (p

Objective: To correlate the operative findings of patients undergoing laparoscopic cholecystectomy, either acute or elective, with surgical complications and conversion to open cholecystectomy. Study Design: Comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital and Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2021 to Mar 2022. Methodology: Data from patients who underwent laparoscopic cholecystectomy was collected after gaining consent. Patients were evaluated for the correlation of operative findings of acute and nonacute gallbladder cases with the development of complications and conversion to open cholecystectomy. Results: Out of 250 patients, 205 were non-acute cases, whereas 45 were acute. The most common intraoperative complication was iatrogenic perforation of gallbladder 73(29.2%); more common in elective cases 49(19.6%) than in acute cases 24(9.6%). Post-operative complications included sub-hepatic collections 3(1.2%) and port site infections 2(0.8%). There were six overall conversions (2.4%), of which 3(1.2%) occurred in acute gallbladder cases and 3 in elective gallbladder. Acute cases were significantly more likely to be converted to open operations (p=0.039). They were found to have a significant association with gallstone spillage (p

Objective: To assess the outcome in patients with diabetic foot osteomyelitis being treated with antibiotics alone with those being treated with antibiotics coupled with conservative surgery. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi from Feb to Aug 2016. Methodology: Sixty patients with diabetic foot osteomyelitis, fulfilling inclusion criteria, were included in this study. They were divided into two groups of 30 each. The "Antibiotic-Group” received only antibiotics while, the "Surgical-Group" underwent surgery in addition to antibiotics. Results: There were 37 males (61.66%) and 23 females (38.33%). The average age of patients was 59.72±9.79 years. 20 patients (66.67%) had full recovery in the Surgical-Group, and in the Antibiotics-Group, 18 patients (60%) had healed wounds (pvalue=0.599) Conclusion: The outcome of antibiotics only and conservative surgery plus antibiotics is similar.

In this study, an algebraic model and its experimental verification was carried out to investigate the effect of moisture content on the heat loss that takes place due to conduction of sock fabrics. The results show that increasing moisture content in the studied socks caused a significant increase in their conductive heat loss. Plain knitted socks with different fiber composition were wetted to a saturated level, and then their moisture content was reduced stepwise. When achieving the required moisture content, the socks samples were characterized by the Alambeta testing instrument for heat transfer. Three different existing modified mathematical models for the thermal conductivity of wet fabrics were used for predicting thermal resistance of socks under wet conditions. The results from both ways are in very good agreement for all the socks at a 95% confidence level. In the above-mentioned models, the prediction of thermal resistance presents newly a combined effect of the real filling coefficient and thermal conductivity of the so-called “wet” polymers instead of dry polymers. With these modifications, the used models predicted the thermal resistance at different moisture levels. Predicted thermal resistance is converted into heat transfer (due to conduction) with a significantly high coefficient of correlation.

Socks’ comfort has vast implications in our everyday living. This importance increased when we have undergone an effort of low or high activity. It causes the perspiration of our bodies at different rates. In this study, plain socks with different fiber composition were wetted to a saturated level. Then after successive intervals of conditioning, these socks are characterized by thermal resistance in wet state at different moisture levels. Theoretical thermal resistance is predicted using combined filling coefficients and thermal conductivity of wet polymers instead of dry polymer (fiber) in different models. By this modification, these mathematical models can predict thermal resistance at different moisture levels. Furthermore, predicted thermal resistance has reason able correlation with experimental results in both dry (laboratory conditions moisture) and wet states.

Objective: To evaluate the association of marital status, early marriage and parity with fibroadenoma patients at a tertiary care hospital of Pakistan. Study Design: Case control study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2015 to Jan 2016. Methodology: A total of 156 cases were included which were diagnosed histologically for fibroadenoma. Similarly 152 controls were inducted which were matched for age and body mass index. The case and control groups were interviewed about exposure of risk factors. Results: All the patients were females. The mean age of case group was 23.71 ± 3.81 and mean age of control group was 23.99 ± 3.95 (p-value=0.544). There was no significant difference in body mass index of two groups (p-value=0.756). Marital status (OR=1.807 95% CI 1.074-3.039) and nulliparous status (OR=2.372 95% CI 1.398- 4.024) were associated with development of fibroadenoma. However early marriage did not have any significant relation with fibroadenoma (OR=0.928 CI 95% 0.511-1.683). Conclusions: Fibroadenoma is more likely to develop in unmarried and nulliparous women however early marriage may not be related to its development.

Poultry nutritionists strive to reduce the dietary crude protein for broilers without affecting their performance because of their environmental and economic benefits. Most of this work is being done on maize-based diets. This study was envisaged to examine the comparative response of crude protein reduction to maize and broken-rice based broiler diets. The 3 x 2 (3 crude protein levels i.e. high, medium and low; 2 grains i.e. maize and broken-rice) factorial arrangement of six treatment diets was offered to 360 broiler chicks from day 1 to 35, where each treatment had 6 replicates (10 birds/replicate). The crude protein had a difference of 1.5% between them i.e. starter (1-21 days) and finisher (22-35 days) had 20.5, 19, 17.5% and 19, 17.5, 16% crude protein, respectively. Body weight and feed intake were unaffected by grain source for the first 21 (P>0.05) days but were higher for maize as compared to broken-rice during 22-35 days and overall experimental period (P<0.05). Weight gain and feed intake decreased while feed conversion ratio worsened with the reduction in crude protein during all the stages of experiment (P<0.05), except feed intake and feed conversion ratio for 1-21 days where the changes were non-significant (P>0.05). Crude protein levels or grain source didn’t affect the dry matter and crude fat digestibility (P>0.05) except maize showing better dry matter digestibility than broken-rice (P<0.05). There was no interaction between crude protein level and grain source for any of the parameters (P>0.05) except crude protein digestibility where replacement of maize with brokenrice worsened the already poor crude protein digestibilitpay caused by dietary crude protein reduction (P<0.05). Replacement of maize with broken-rice significantly increased glucose, total cholesterol, high-density lipoprotein (P<0.05). While reducing the dietary crude protein increased the serum levels of glucose, total cholesterol, low-density lipoprotein, triglycerides, highdensity lipoprotein and alanine transaminase but decreased the uric acid levels (P<0.05). The present study suggests that although the effect of crude protein reduction on selected parameters is independent of grain source statistically, the overall response of crude protein reduction was poor to broken-rice based diets as compared to maize-based diets. [ABSTRACT FROM AUTHOR]

This study investigates the effect of material composition on moisture management properties. Fiber type has significant influence on the moisture management properties of knitted fabrics. In this article, single jerseys knitted fabric samples with different yarn compositions were prepared. Liquid moisture transportation properties including wetting time, absorption rate, spreading speed, one-way transportation capability, and OMMC were evaluated by Moisture Management Tester (MMT) and vertical wicking was evaluated using thermography system and image analysis. Knitted sample having fine cotton yarns with coolmax and micro denier multifilament polypropylene showed best liquid transportation properties. There is a strong co-relation between OMMC and accumulative oneway transport index with vertical wicking of knitted samples.

The aim of this study was to develop V-shape compression socks that should exert graduated lateral compression around the leg. For the development of socks, three types of yarns: main yarn (MY), plaiting yarn (PY) and inlaid yarn (IY) were used. Each yarn contained spandex yarn as the core. Machine adjustments were optimized to achieve the special V-shaped compression socks according to size of the wooden leg. Eighteen socks samples were developed and quantified for pressure exertion at ankle and calf portions using the MST MKIV, Salzmann pressure measuring device. Consequently, only two socks samples were accepted, which had the pressure exertion values of 21 mmHg and 23 mmHg with graduation percentage of 73% and 80%, respectively.

Objective: To compare the efficacy of ondansetron with a combination of ondansetron and dexamethasone after elective laparoscopic cholecystectomy in terms of postoperative nausea and vomiting. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Surgery, Combined Military Hospital Rawalpindi Pakistan, from Apr 2014 to Mar 2015. Materials and Methods: Two hundred and twenty two patients fulfilling the inclusion criteria were selected for study and divided into two groups of 111 each. Group A was given ondansetron while group B was given combination of ondansetron and dexamethasone at induction of general anesthesia. Patients of both groups were observed at 24 hours postoperatively for nausea and vomiting. Results: Sixty six patients in group A had nausea as compared to 50 patients in group B (p-value 0.03), 46 patients in group A had vomiting as compared to 19 patients in group B (p-value

Objective: To assess effect of “specialty oriented HMS software” on “quality of EMRs”. Study Design: Comparative interventional study. Place and Duration of Study: Obstetrics Out Patient Department (OPD) of Pak Emirates Military Hospital (PEMH) Rawalpindi and Combined Military Hospital (CMH) Lahore, from Apr 2015 to Mar 2018. Material and Methods: The study began in 2015 with a baseline survey of quality of EMRs produced by generic HMS software in vogue. We used an observational checklist derived from hospital SOPs including 12 mandatory EMR fields. We then collaborated with IT experts to develop and implement a specialty oriented test-HMS in obstetrics OPD, PEMH. After 6 months, quality of EMRs generated by test-HMS was assessed using same method. We cross tabulated the quality of pre and post intervention EMRs. EMR quality among individual EMR fields was also compared for each software. In 2018, we assessed quality of EMRs at tertiary care hospital, a year after the official launch of customized new-HMS software in the hospital. Results: Both the test-HMS and new-HMS had a statistically significant effect in improving quality of EMRs. A statistically significant variation was also observed among EMR quality of individual fields irrespective of the software being used. Conclusion: Customization of HMS improves the quality of EMRs but there may be other factors effecting EMR quality besides customization of HMS. We need to Identify and address those factors to attain true benefits of HMS.

Aim: This study was undertaken to assess the role of image-guided, fine needle aspiration cytology (FNAC) in the diagnosis of retroperitoneal and spinal lesions. Materials and Methods: Over a period of one year, ultrasonography and computerized tomography-guided FNAC was performed in 55 cases who had presented clinically with signs and symptoms related to the retroperitoneum and spine. Histopathological confirmation was available in 27 out of 55 cases. Results: Of the 55 cases, 39 were males and 16 were females. Malignant and benign lesions accounted for 58.2 and 29.1% respectively. Among the cases on whom radiologically guided FNAC was performed, the spine contributed the largest proportion of cases (32.7%), followed by renal lesions (20%). Among the malignant lesions, renal cell carcinoma was the most commonly found malignancy, followed by metastasis to the spine. In the benign and inflammatory category, tuberculosis of the spine and the lymph nodes was the most common lesion accounting for 68.7% of all cases. On correlating clinical, radiological, and cytologic features, the sensitivity, specificity, and overall accuracy of guided FNAC obtained in this study were 97.1, 84.2, and 92.4% respectively. Conclusions: Radiologically guided FNAC is a fairly accurate and safe procedure in diagnosing the most difficult cases in the region of the retroperitoneum and the spine.

The Chinese goose is one of the most economically important poultry birds and is a natural reservoir for many avian viruses. However, the nature and regulation of the innate and adaptive immune systems of this waterfowl species are not completely understood due to limited information on the goose genome. Recently, transcriptome sequencing technology was applied in the genomic studies focused on novel gene discovery. Thus, this study described the transcriptome of the goose peripheral blood lymphocytes to identify immunity relevant genes.De novo transcriptome assembly of the goose peripheral blood lymphocytes was sequenced by Illumina-Solexa technology. In total, 211,198 unigenes were assembled from the 69.36 million cleaned reads. The average length, N50 size and the maximum length of the assembled unigenes were 687 bp, 1,298 bp and 18,992 bp, respectively. A total of 36,854 unigenes showed similarity by BLAST search against the NCBI non-redundant (Nr) protein database. For functional classification, 163,161 unigenes were comprised of three Gene Ontology (Go) categories and 67 subcategories. A total of 15,334 unigenes were annotated into 25 eukaryotic orthologous groups (KOGs) categories. Kyoto Encyclopedia of Genes and Genomes (KEGG) database annotated 39,585 unigenes into six biological functional groups and 308 pathways. Among the 2,757 unigenes that participated in the 15 immune system KEGG pathways, 125 of the most important immune relevant genes were summarized and analyzed by STRING analysis to identify gene interactions and relationships. Moreover, 10 genes were confirmed by PCR and analyzed. Of these 125 unigenes, 109 unigenes, approximately 87%, were not previously identified in the goose.This de novo transcriptome analysis could provide important Chinese goose sequence information and highlights the value of new gene discovery, pathways investigation and immune system gene identification, and comparison with other avian species as useful tools to understand the goose immune system.

In this study, an algebraic model and its experimental verification was carried out to investigate the effect of moisture content on the heat loss that takes place due to conduction of sock fabrics. The results show that increasing moisture content in the studied socks caused a significant increase in their conductive heat loss. Plain knitted socks with different fiber composition were wetted to a saturated level, and then their moisture content was reduced stepwise. When achieving the required moisture content, the socks samples were characterized by the Alambeta testing instrument for heat transfer. Three different existing modified mathematical models for the thermal conductivity of wet fabrics were used for predicting thermal resistance of socks under wet conditions. The results from both ways are in very good agreement for all the socks at a 95% confidence level. In the above-mentioned models, the prediction of thermal resistance presents newly a combined effect of the real filling coefficient and thermal conductivity of the so-called "wet" polymers instead of dry polymers. With these modifications, the used models predicted the thermal resistance at different moisture levels. Predicted thermal resistance is converted into heat transfer (due to conduction) with a significantly high coefficient of correlation. [ABSTRACT FROM AUTHOR]

Sarcomatoid renal cell carcinoma (SRCC) is an aggressive tumor variant thought to arise predominantly from differentiation of clear cell carcinoma. A few reports of SRCC asso-ciated with non-clear cell tumors led to the presumption that SRCC may arise from any renal cell carcinoma, although direct evidence of this is lacking. We report a case of a 70-year-old male patient, who presented with acute left upper quadrant abdominal pain and was diagnosed to have SRCC after pathological examination. The patient is on high dose interleukin (IL-2)-based immunotherapy and is apparently free of disease six months after surgery.