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Objectives During the COVID-19 epidemic, due to the high risk associated with travel and group gatherings, the Ministry of Public Health in Qatar introduced home delivery of pharmaceutical services. This study aims to investigate the satisfaction and preferences of patients who used the new home delivery services provided by health centres (HCs).Study design A cross-sectional study was conducted using an exploratory questionnaire to assess patients’ preferences for pharmaceutical delivery services.Settings Primary care.Participants A convenient sample of 604 adults who used the pharmaceutical delivery services was recruited. The study tool measured satisfaction with a set of 11 service evaluation criteria on a Likert scale of 5 grades. The score ranged between 1 for highly dissatisfied and 5 for highly satisfied. A quantitative summary satisfaction score was calculated by summing the satisfaction rating for home delivery on the 11 service evaluation criteria. The final score was adjusted to a maximum of 100 for ease of understanding.Results Results showed that 45.5% of participants were highly satisfied with the overall quality of the home delivery service. Furthermore, 58.9% were willing to recommend the service to others, while only 30.9% considered the delivery cost to be reasonable. Among the factors associated with satisfaction was nationality, where Qatari nationals had a significantly higher mean satisfaction score (89%) compared with expatriates (79.5%).Outcome The satisfaction score exhibited a significant positive trend with age and educational level. Factors such as gender, the time required to access the HCs, frequency of requesting pharmacy service and income categories did not show a significant difference in the satisfaction score.Conclusion The home delivery service is a promising addition to primary care. It may play a crucial role in enhancing accessibility for the beneficiaries reducing unnecessary visits to HCs in the future.

Abstract Background Hepatocellular carcinoma (HCC) is a highly aggressive and rapidly progressing form of cancer with a poor prognosis. Recent advances in the management of HCC focused on the novel immunotherapeutic modalities for patients with advanced disease. PD-L1 has emerged as a promising immunotherapeutic approach for HCC. The evaluation of PD-L1 expression aids in identifying patients who can derive maximum benefits from these therapies. This study aims to examine and compare the expression of PD-L1 using two clones (22C3 and 28-8) in HCC patients. Methods Forty-six patients with HCC were selected between 2005 and 2022 from the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan. The patients' formalin-fixed paraffin-embedded (FFPE) tissue samples were retrieved from the department of pathology to conduct immunohistochemical analysis. Moreover, the clinicopathological data of these patients were gathered from the hospital information system (HIS). To assess the relationship between variables, bivariate analysis was carried out using either the chi-square test or Fisher exact test when necessary. Results Among the 46 tissue specimens analyzed, the presence of clone 22C3 was detected in 20 HCC patients, with 10 patients showing high expression (21.7%) and another 10 patients showing low expression (21.7%). 22C3 expression was not observed in 26 patients (56.5%). On the other hand, clone 28-8 was expressed in 10 patients, all of whom exhibited low expression (21.7%), while no expression of clone 28-8 was observed in 36 patients (78.3%). An association was found between the expression of 22C3 and 28-8 PD-L1 clones (p-value 0.01). Furthermore, upon closer examination, it was revealed that 12 cases exhibited positive results for 22C3 but negative results for 28-8. Interestingly, two cases displayed positive results for 28-8 but negative results for 22C3. Conclusion We obserevd that the PD-L1 clones, 22C3 and 28-8, are comparable. If PD-L1 expression using 22C3 is negative, considering the use of 28-8 for evaluating expression in HCC patients may be beneficial. However, further validation in a larger cohort is necessary.

Background  Microsurgical free flaps have largely supplanted pedicled flaps as the gold standard for head and neck cancer reconstruction. However, incidence of postoperative complications after accounting for patient comorbidities based on choice of reconstruction has not been well-defined in the literature in recent years. Methods  Patients undergoing head and neck reconstruction were identified in the 2011–2016 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database and stratified into groups by free flap, myocutaneous pedicled flap, and other reconstruction. Demographics were analyzed and covariates balanced using overlap propensity score-based weighting. Logistic regression was used for binary outcomes and Gamma generalized linear model was used for length of stay. Results  A total of 4,712 patients met inclusion criteria out of which 1,297 patients (28%) underwent free flap, 208 patients (4%) pedicled flap, and 3,207 patients (68%) had other, or no reconstruction performed. After adjusting for patient and disease-specific factors, pedicled flap reconstruction was associated with a higher risk of deep vein thrombosis (odds ratio [OR] = 2.64, confidence interval [CI] 1.02–6.85, p  = 0.045), sepsis (OR = 2.95, CI 1.52–5.71, p  = 0.001), and infection (OR = 2.03, CI 1.39–2.96, p <0.001) compared with free flap reconstruction. Free flaps had the longest mean operative time compared with the other two groups (unadjusted 578 vs. 440 vs. 326, p <0.001). Pedicled flaps had a lower incidence of bleeding requiring transfusion (adjusted OR = 0.65, CI 0.50–0.85, p  = 0.002), and lower incidence of prolonged mechanical ventilation (adjusted OR = 0.33, CI 0.12–0.92, p  = 0.034) compared with free flaps. There was no difference in rates of reoperation, hospital readmission, or hospital length-of-stay between pedicled and free flaps. Conclusion  Myocutaneous pedicled flaps are associated with higher overall short-term postoperative complications compared with free flaps in head and neck reconstruction, which demonstrate a more favorable morbidity profile without significantly impacting hospital readmission, reoperation, or length-of-stay. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy is a condition usually associated with increased vaginal discharge including vaginal infections like bacterial vaginosis, leading to adverse perinatal outcomes due to disturbance in vaginal ecosystem that warrants further evaluation and timely management. Aims & Objectives: The study was conducted to determine the prevalence of bacterial vaginosis in pregnancy and its contributing factors. Place and duration of study: Out Patient Department of Obstetrics & Gynecology, Shaikh Zayed Hospital, Lahore. Duration of the study was six months. Material & Methods: 120 pregnant females with age 20-40 years with singleton pregnancy of more than 12 weeks’ gestation were included. Women who were immunosuppressed and history of diabetes and hypertension and recent history of use of antibiotics were excluded. Vaginal swab specimen was taken & bacterial vaginosis was labelled after fulfilling Amsel criteria. Data was analyzed using SPSS version 21. Results: In this study, 120 cases were taken and mean age of participants was 27.55±3.97 years. The mean duration of gestation was 18.76±6.14 weeks. Bacterial vaginosis (BV) was seen in 24 (20%) of the cases. BV was seen in 19 (20.65%) cases with age 20-29 years’ vs 5 (17.86%) cases in age group 20-40 years with p= 1.0. Bacterial vaginosis was nearly significantly high in multiparous women where this was seen in 13 (27.65%) cases as compared to 11 (15.06%) cases in primiparous women with p= 0.11. Out of 20 cases of bacterial vaginosis, low education was seen in 12 (60%) of the cases. Conclusion: The prevalence of bacterial vaginosis in pregnancy at local setup is high and is seen nearly in 1 out of 5 cases. This demands health educational programs to enlighten women regarding screening and early detection & treatment to prevent complications during pregnancy.

Objectives: To investigate the maternal and peri-natal outcomes of dengue infection and frequency of dengue immunoglobulin G positivity in pregnant women along with pregnancy outcomes. Method: The observational two-phase study was conducted from 2012 to 2015 in Lahore, Pakistan. I In phase 1, pregnant women who had acute dengue fever were prospectively and retrospectively enrolled from 4 tertiary care hospitals. Demographic data, clinical/laboratory parameters and maternal/foetal outcomes were recorded for each subject. In the second phase, normal pregnant women with no current or past history of dengue fever were enrolled from Gynaecology Department of Shaikh Zayed Hospital, Lahore, to determine the frequency of dengue immunoglobulin G positivity and pregnancy outcome. Data was analysed using SPSS 20. ---Continue

Hamid Ehsan,1 Ahsan Wahab,2 Muhammad Ammar Shafqat,3 Muhammad Khawar Sana,4 Farhan Khalid,4 Syed Maaz Abdullah,4 Ali Jaan,4 Muhammad M Sheikh,5 Ahmad Muneeb,5 Sajid Ehsan,6 Ali Younas Khan,7 Raheel Iftikhar,8 Faiz Anwer9 1Biohazardous Threat Agents and Emerging Infectious Diseases, Georgetown University, Washington, DC, USA; 2University of Alabama at Birmingham, Birmingham, AL, USA; 3Department of Internal Medicine, Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan; 4Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan; 5Department of Internal Medicine, Faisalabad Medical University, Faisalabad, Pakistan; 6Department of Internal Medicine, Anne Arundel Medical Center, Annapolis, MD, USA; 7Department of Internal Medicine, St. Joseph Mercy Hospital, Oakland, Pontiac, MI, USA; 8Department of Hematology/Oncology, Armed Forces Bone Marrow Transplant Center/NIBMT, Rawalpindi, Pakistan; 9Department of Hematology/Oncology, Cleveland Clinic, Taussig Cancer Center, Hematology-Oncology, BMT, Cleveland, OH, USACorrespondence: Hamid EhsanMD, FACP MUMH, Department of Medicine, 201 E. University Parkway, Baltimore 21218, USATel +19172875423Fax +14105542184Email he150@georgeotown.eduAbstract: The blood transfusion (BT) system in Pakistan is fragmented, demand-driven and depends on weakly regulated transfusion practices. There is a considerable possibility that transfusion-transmissible infections (TTIs) are contributing to the current epidemic of hepatitis B virus (HBV) and hepatitis C virus (HCV) (affecting 7.4% of the general population) in the country. To study this issue, we conducted a systematic review to identify articles related to TTIs and transfusion safety in Pakistan from January 1, 2010 to January 31, 2020. A review of 33 articles met the final criteria for qualitative synthesis. Analysis of these studies showed a cumulative frequency of HBV 2.04%, HCV 2.44%, HIV 0.038%, syphilis 1.1% and malaria 0.11%. The frequency of coinfections among blood donors varied from 0.0099% to 0.35%. The highest number of coinfections were HCV and syphilis, followed by HCV and HBV infections. Syphilis and malaria were tested in only 38% and 46% of all the blood donations in one study. The rate of voluntary non-remunerated donations (VNRDs) was less than 13%, and male donors were 95% to 100% in these studies. There was a significant difference in the frequency of HBV and HCV in VNRDs (0.48%) as compared to replacement donors (RDs) (4.15%). In short, this review shows a high frequency of TTIs, especially HBV, HCV and syphilis in the blood donor population in Pakistan. There is a high dependency on RDs, minimal use of healthy voluntary blood donation practices, inadequate screening of high-risk donors, repeated collections of the blood from RDs, poor quality of screening methods and limited knowledge of donor health. Without standardized safe transfusion practices, there will be an ongoing increase in transmission of TTIs, especially HBV, HCV, syphilis, and HIV leading to a significant adverse public health impact.Keywords: transfusion-transmitted infections, hepatitis B, hepatitis C, HIV, syphilis, malaria

Introduction: The oesophageal squamous papilloma (ESP) is a rare cause of dysphagia and hematemesis. The malignant potential of this lesion is uncertain; however, the malignant transformation and concurrent malignancies have been reported in the literature. Case description: We report a case of oesophageal squamous papilloma in a 43-year-old female who had a background diagnosis of metastatic breast cancer and liposarcoma of the left knee. She presented with dysphagia. Upper gastrointestinal (GI) endoscopy showed a polypoid growth, and its biopsy confirmed the diagnosis. Meanwhile, she presented again with hematemesis. A repeat endoscopy showed that the previously seen lesion had likely broken off, leaving behind a residual stalk. This was snared and removed. The patient remained asymptomatic, and a follow-up upper GI endoscopy at six months did not show any recurrence. Practical implications: To our knowledge, this is the first case of ESP in a patient with two concurrent malignancies. Moreover, the diagnosis of ESP should also be considered when presenting with dysphagia or hematemesis.

The role of self-expandable metallic stents is gradually evolving for a diverse group of benign and malignant gastrointestinal tract problems, with luminal obstruction being by far the most common. Although its role in refractory variceal bleeding is well established, it has rarely been tried for tumor-related bleeding, with only a few case reports in this regard. We share our experience of successfully controlling esophageal tumor–related bleeding with the use of a fully covered self-expandable metallic stent. A 58-year-old woman with irresectable distal esophageal cancer, presented with hematemesis. Esophago-gastro-duodenoscopy revealed an obstructing esophageal tumor with diffuse oozing of blood. This was unamenable to local injection of adrenaline and hemospray; therefore, a temporary self-expandable metallic stent was parked to create a tamponade effect. This successfully stopped bleeding and the patient remained asymptomatic till discharge. However, she was lost to follow-up, and therefore, the stent was removed after a period of 5 months instead of 2 weeks.

In this paper, a procedural analysis involved in the optimal design of the photovoltaic system (PV) is thoroughly described.The study has been carried out by following a proposed design procedure, involving different types of photovoltaic panelsand their tracking mechanisms. The proposed methodology is implemented in the twin districts of jammu & kashmir unionterritory (rajouri & poonch). The feasibility of the photovoltaic system has been made based on power output and the costof generation. A detailed financial analysis is also carried out to find the levelised cost of electricity, amortisation time, andinternal rate of return. This study will help the power utilities to mitigate their energy issues, by installing a photovoltaicsystem based on the proposed design methodology.

The nature of organic phosphorus (Po) in animal waste and in soil is important from both plant nutrition and environmental perspectives. The objectives of this study were (1) to monitor the nature of Po in different animal wastes and biosolids using solution state 31P NMR spectroscopy and (2) to understand the nature of Po as affected by crop P removal in soil amended with different animal wastes and biosolids under greenhouse conditions. Two types of stockpiled cattle (Bos taurus) manure (CM1 and CM2), solid turkey (Meleagris gallopava) litter (TL), solid hog (Sus scrofa) manure (HM), and aerobically digested biosolids (SS) were used. Two kg of Wabash silt loam soil was amended with 0 or 150 mg P kg-1 from the P sources. Seven harvests of corn (Zea mays L.) were collected, each 35 days after sowing. Organic P was extracted with 0.4 M NaOH from soil samples collected before cropping and after the seventh harvest, as well as from each P source. 31P NMR analysis suggested that sugar phosphomonoester was present in all P sources and was the dominant constituent of both CM1 and CM2. Phosphomonoester was detected in large amounts in TL, HM, and SS. Prior to crop P removal, the application of all P sources caused the relative content of sugar phosphomonoester to be greater than the control. Crop P removal resulted in reductions in the relative content of sugar phosphodiesters and phosphodiester in CM1- and CM2-amended soils, respectively. Phosphomonoester was also decreased in TL-, HM-, and SS-amended soils in response to cropping. [ABSTRACT FROM AUTHOR]

Miqdad Haider,1 Muhammad Nabeel Shafqat2 1Department of Medicine, Fatima Memorial Hospital, Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan; 2Department of Medicine, University of Medical Sciences “Serafin Ruiz de Zarate” Villa Clara (UCMVC), Villa Clara, CubaWe would like to write about the recently published article “An observational study of duloxetine versus selective serotonin reuptake inhibitors (SSRIs) monotherapy for the treatment of painful physical symptoms in Japanese patients with major depressive disorder: primary analysis” by Kuga et al, which we read with great interest.1 The study is a good step toward finding the best treatment option for painful physical symptoms (PPSs) in patients with major depressive disorder (MDD).View the original paper by Kuga and colleagues.

Miqdad Haider,1 Muhammad Nabeel Shafqat,2 Mariam Zafar3 1Department of Internal Medicine, Fatima Memorial Hospital, Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan; 2Department of Medicine, University of Medical Sciences “Serafin Ruiz de Zarate” Villa Clara (UCMVC), Villa Clara, Cuba; 3Department of Medicine, Basic Health Unit, Nankana Sahib, PakistanWe would like to comment on the article “Harmful impact of air pollution on severe acute exacerbation of chronic obstructive pulmonary disease: particulate matter is hazardous” by Choi et al which was published recently.1 Keeping in view the current state of affairs of our planet, and knowing that industrialization is growing fast, this article is very important in highlighting some critical issues. This is what makes this article interesting and important at the same time.View the original paper by Choi and colleagues.

Objective: Bone metastases in gastrointestinal (GI) malignancies are uncommon and known to be predominantly lytic thus rendering a limited role for conventional bone scintigraphy. The aim of the study is to review Tc99m MDP bone scans performed in patients with known GI malignancy and the utility of Single-photon emission computed tomography (SPECT)/CT in characterization of bone lesions. Methods: Retrospective review of bone scans was done from June 2014 to December 2016 in patients with known GI malignancy, using electronic Hospital Information System. Results: A total of 110 patients (60 males, 50 females; Age range: 22–84 years, Mean Age 51.4 years with SD of 14.8) had bone scan over a period of 30 months. The commonest indications for referral were suspected bone metastasis on other imaging modalities including [CT (n = 56), Magnetic resonance imaging (n = 10), Positron emission tomography/CT (n = 6)], musculoskeletal pain (n = 37), pathological fracture (n = 1), neurological symptoms (n = 1), hypercalcemia (n = 1) and others (n =14) including restaging workup etc. Metastatic lesions were identified in 32 (29%) patients whereas 78 (71%) patients had benign non-aggressive lesions leading to normal bone scans. Among 32 patients with osseous metastasis, 8 (25%) patients had unifocal lesion; axial skeleton (n = 2) appendicular skeleton (n = 6), 24 (75%) patients had multifocal lesions; axial skeleton (n = 6), appendicular skeleton (n = 6) and both axial + appendicular (n = 12). Four (12%) patients had concurrent visceral metastases. In our cohort, based on the location of primary tumour, the frequencies of osseous metastasis were; esophagus = 15 out of 43 (35%), gastric = 7 out of 18 (39 %), gastro-esophageal junction = 1 out of 8 (1.5%) and colorectal = 9 out of 40 (22.5). SPECT/CT was acquired in 29 out of 110 patients, which characterized metastatic lesions (n = 12) and benign looking non-aggressive entities (n =17). Overall, bone scan upstaged disease in 31% and down staged 15% patients. Conclusion: Bone metastases in GI malignancies, though uncommon, show an aggressive pattern, with axial and appendicular involvement, and can be readily identified with hybrid bone scintigraphy in symptomatic patients. Key words: Hybrid imaging, Tc99m MDP, bone metastases, gastrointestinal malignancies

Muhammad Nabeel Shafqat,1 Miqdad Haider,2 1Department of Medicine, University of Medical Sciences “Serafin Ruiz de Zarate” Villa Clara (UCMVC), Villa Clara, Cuba; 2Department of Internal Medicine, Fatima Memorial Hospital, Fatima Memorial College of Medicine and Dentistry, Lahore, PakistanWe would like to comment, with great interest, about the recently published article “Visceral-to-subcutaneous fat ratio as a predictor of the multiple metabolic risk factors for subjects with normal waist circumference in Korea” by Oh et al,1 which we found very interesting and valuable. This study is a good step to determine the predictive value of visceral-to-subcutaneous fat ratio (VSR) in persons with normal waist circumference for the diagnosis of risk factors for metabolic syndrome.View the original paper by Oh and colleagues.

Muhammad Nabeel Shafqat,1 Muhammad Aadil,2 Maria Shoaib31Department of Medicine, University of Medical Sciences “Serafin Ruiz de Zarate” Villa Clara (UCMVC), Villa Clara, Cuba; 2Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA; 3Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PakistanWe read with great interest the currently published article written by Pederson and Brook1 entitled “Sleep disturbance linked to suicidal ideation in postural orthostatic tachycardia syndrome”. Awareness of postural orthostatic tachycardia syndrome (POTS) has increased in recent years. However, sleep disturbance has not been thoroughly investigated as a cause of increased suicidal risk in patients with POTS. We would like to applaud the authors on conducting this novel cross-sectional study to understand and highlight the potential relationship between sleep disturbances and increased risk of suicide in patients suffering from POTS.1View the original paper by Pederson and Brook.

Muhammad Nabeel Shafqat,1 Muhammad Aadil,2 Maria Shoaib3 1Department of Medicine, University of Medical Sciences “Serafin Ruiz de Zarate” Villa Clara (UCMVC), Villa Clara, Cuba; 2Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA; 3Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan We read with great interest the recently published article “Sleep apnea and the subsequent risk of Parkinson disease: a 3-year nationwide population-based study” by Chou et al.1 The study is a step forward in understanding the underlying pathophysiology of Parkinson’s disease, the authors have deduced sleep apnea as one of the possible risk factors. View the original paper by Chou and colleagues.

Biliary stenting has been used since the 1970s to relieve biliary obstruction for a variety of causes including benign and malignant biliary strictures. Migration of stents proximally into the biliary tree or distally into the intestinal tract is relatively uncommon. We report a case of a 64-year-old female with a peri-ampullary tumour, who had symptomatic obstructive jaundice following endoscopic retrograde cholangiopancreatography and plastic stent insertion. Follow-up imaging showed proximal migration of the plastic stent and blockage of the distal common bile duct (CBD) secondary to the periampullary tumour. The biliary stent was safely removed endoscopically using balloon trawl. This case highlights that, while biliary stenting for strictures is generally safe and effective, stent migration to proximal CBD can occur. Balloon trawl is safe and effective way of removing such stents. Key words: Biliary stricture, common bile duct, endoscopic retrograde cholangiopancreatography, periampullary tumour, stents

Background: An inflammation of the nasal and paranasal sinus mucosa that lasts longer than three months is known as chronic rhinosinusitis. When corticosteroids and other medicinal treatments fail to relieve a patient's symptoms, then functional endoscopic sinus surgery (FESS) is a commonly performed procedure to alleviate the symptoms. The aim of the study was to evaluate the impact of oral steroids given prior to surgery on intraoperative bleeding in patients having functional endoscopic sinus surgery for chronic rhinosinusitis., Methods: The study was conducted in ENT Department of Shifa Foundation Community Health Centre (SFCHC) and Shifa International Hospital (SIH) Islamabad, in a period of three years from June 2019 to June 2021. A total of 72 patients consisting of 36 patients in study group and 36 in control group, fulfilling the inclusion criteria were included in the study. Per-operative bleeding was assessed by measuring the amount of blood collected in suction bottle at the end of the procedure (the amount of saline used during the procedure was subtracted) and the number of surgical gauzes stained with blood (1 partially stained gauze = 5 ml and 1 completely stained gauze = 10 ml). The surgeon performing the surgery was unaware of the study group of the patient. All the collected data was entered and analyzed with SPSS v. 25., Results: The mean age of group A (35.39±13.86 vs. 29.83±15.86, p-value > 0.05) was similar to group B. There was male dominance in both group (69.4% vs. 72%) males in group A and group B. Nasal obstruction and nasal discharge was observed in all patients of both groups. Post nasal drip (88.9% vs. 88.9%), headache (97.2% vs. 91.7%) and facial pain (97.2% vs. 94.4%) was present in majority patients of both groups without any significant (p-value >0.05) difference. Both the groups were compared on the basis of amount of blood loss per-operatively and it was seen that the mean blood loss in group A was (164.03±42.99 ml) significantly (p-value <0.05) lower as compared to (215.83±39.397 ml) in group B., Conclusions: This study showed that individuals with nasal polyps receiving preoperative steroids could successfully lower their perioperative morbidity, specifically intraoperative haemorrhage, after undergoing functional endoscopic sinus surgery.

The nasopharynx is a rare anatomical location where a foreign body may become lodged after being ingested or inhaled. We are presenting a rare case of nasopharyngeal foreign body impaction in a two-and-a-half-year-old child that had been missed for almost a year. The child presented with a history of right-sided foul-smelling nasal discharge, snoring and mouth breathing. An X-Ray soft tissue lateral view of the post-nasal space showed an irregular partially radiopaque nasopharyngeal foreign body. The removal of the foreign body was performed under general anaesthesia successfully. Foreign body impaction in the nasopharynx can easily be missed and it is important to keep this region in mind when dealing with missing inhaled or ingested foreign bodies.

Introduction: Tuberculosis (TB), a curable and preventable infectious disease, becomes difficult to treat if resistance against most effective and tolerable first line anti-TB drugs is developed. The objective of the present study was to evaluate the treatment outcomes and predictors of poor outcomes among drug-resistant tuberculosis (DR-TB) patients treated at a programmatic management unit of drug resistant tuberculosis (PMDT) unit, Punjab, Pakistan., Methods: This prospective observational study was conducted at a a PMDT unit in Multan, Punjab, Pakistan. A total of 271 eligible culture positive DR-TB patients enrolled for treatment at the study site between January 2016 and May 2017 were followed till their treatment outcomes were recorded. World Health Organization's (WHO) defined criteria was used for categorizing treatment outcomes. The outcomes of cured and treatment completed were collectively placed as successful outcomes, while death, lost to follow-up (LTFU) and treatment failure were grouped as unsuccessful outcomes. Multivariable binary logistic regression analysis was employed for getting predictors of unsuccessful treatment outcomes. A p-value <0.05 was considered statistically significant., Results: Of the 271 DR-TB patients analysed, nearly half (51.3%) were males. The patient's (Mean ± SD) age was 36.75 ± 15.69 years. A total of 69% patients achieved successful outcomes with 185 (68.2%) patients being cured and 2 (0.7%) completed therapy. Of the remaining 84 patients with unsuccessful outcomes, 48 (17.7%) died, 2 (0.7%) were declared treatment failure, 34 (12.5%) were loss to follow up. After adjusting for confounders, patients' age > 50 years (OR 2.149 (1.005-4.592) with p-value 0.048 and baseline lung cavitation (OR 7.798 (3.82-15.919) with p-value <0.001 were significantly associated with unsuccessful treatment outcomes., Conclusions: The treatment success rate (69%) in the current study participants was below the target set by WHO (>75%). Paying special attention and timely intervention in patients with high risk of unsuccessful treatment outcomes may help in improving treatment outcomes at the study site., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Massud et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Leadership and its connection with social sustainability are frequently prescribed for effective management. Integrating self-leadership among the employees is an emerging area to focus on empowering an organization. The principal objective of this study was to empirically investigate the impact of self-leadership on normative commitment and work performance through the mediating role of work engagement. This phenomenon of self-leadership was explained by using the theoretical lens of the social cognitive theory and intrinsic motivation theory. Data was collected from 318 employees who worked in the telecom sector in Pakistan and analyzed using Structural Equation Modeling (SEM) AMOS. The findings revealed that in the presence of self-leadership, employee's work engagement, commitment to the organization, and overall work performance elevated significantly. Furthermore, the results also illustrated the occurrence of two significant mediating paths. First, the mediating role of work engagement in the relationship between self-leadership and normative commitment, and second, the mediation of work engagement in the relationship between self-leadership and work performance. The findings of the study significantly contribute practically, and theoretically to the existing literature., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interests., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)

Purpose: The PEVAR Trial demonstrated that compared to open femoral exposure, elective percutaneous endovascular AAA repair (ePEVAR) is associated with decreased perioperative morbidity and access site complications. We hypothesized that PEVAR for ruptured AAA (rPEVAR) may also improve perioperative morbidity compared to open femoral exposure (rEVAR). There are currently no reports that evaluate the utility and outcomes of rPEVAR., Materials and Methods: From 2015 to 2021, all patients who underwent an endovascular repair of a ruptured AAA at a single institution were included in the study and grouped into rPEVAR and rEVAR. Demographics, procedural details (successful preclose technique, conversion to femoral cutdown), postoperative variables (blood transfusion, ICU and hospital length of stay) and short-term outcomes (30-day major adverse events (30-day MAE) and 30-day femoral access-site complications (30-day FAAC)) were collected and compared with 50 historical ePEVAR patients from the PEVAR Trial. Statistical significance was determined using χ 2 or Fisher's exact test for categorical variables, and Mann-Whitney U -test for continuous variables., Results: 35 patients were identified (21 rPEVAR; 14 rEVAR), 86% were male with a mean age of 72 ± 9 years. All patients underwent emergent endovascular aortic repair with 100% technical success. Seventeen patients (49%) presented with evidence of hemorrhagic shock and 22 patients (63%) had blood transfusion. 30-day MAE occurred in 12 patients (34%) (7 rPEVAR; 5 rEVAR). There was no difference in demographic, perioperative outcomes and 30-day MAE rate between rPEVAR and rEVAR patients. Compared to ePEVAR patient (from PEVAR trial), rPEVAR patients had higher rate of 30-day MAE (34% vs. 6%; p  < 0.006) but no difference in 30-day FAAC (19% vs. 12%; p  = 0.54). The success rate of the preclose technique was higher in ePEVAR compared to rPEVAR (96% vs. 76%; p  = 0.02), but the rate of conversion to femoral cutdown was similar between the two groups (10% vs. 4%; p  = 0.57)., Conclusion: Emergent rPEVAR appears to have similar outcomes when compared to rEVAR. Although patients undergoing rPEVAR have higher 30-day major adverse events rate compared to ePEVAR, the method of percutaneous femoral cannulation does not appear to increase the overall procedural or 30-day femoral artery access-site complications., 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., (© 2022 Tay, Zaghloul, Shafqat, Yang, Desai, De Silva, Sanchez and Zayed.)

Objective: Peripheral atherosclerosis that accumulates in the extracranial carotid and lower extremity arteries can lead to significant morbidity and mortality. However, atherosclerotic disease progression is often not homogenous and is accelerated by diabetes. We previously observed increased phospholipid content in minimally (Min)-diseased arterial segments compared to maximally (Max)-diseased segments. Since Peroxisome Proliferator-Activated Receptor alpha (PPARα) is a key regulator of lipid metabolism, we hypothesized that it may have differential expression and signaling in Min vs. Max-diseased peripheral arterial segments., Methods: Eighteen patients who underwent carotid endarterectomy (CEA), and 34 patients who underwent major lower extremity amputation were prospectively enrolled into a vascular tissue biobank. Min and Max-diseased segments were obtained in real-time from CEA plaque and amputated lower extremity arterial segments. mRNA and protein were isolated from specimens and the relative expression of ppara , and its downstream genes Acyl-CoA Oxidase 1 ( acox1 ) and Carnitine Palmitoyltransferase 1A ( cpt1a ) were also evaluated. We evaluated gene expression and protein content relative to atherosclerotic disease severity and clinical diabetes status. Gene expression was also evaluated relative to Hemoglobin A1c and serum lipid profiles., Results: In CEA segments of patients with diabetes, we observed significantly higher ppara and acox1 gene expression ( p < 0.01 and p < 0.001 respectively), and higher PPARα protein content ( p < 0.05). Hemoglobin A1c significantly correlated with expression of ppara (R 2 = 0.66, p < 0.001), acox1 (R 2 = 0.31, p < 0.05), and cpt1a (R 2 = 0.4, p < 0.05). There was no significant difference in gene expression between Min vs. Max-diseased CEA plaque segments. Conversely, in lower extremity arterial segments of patients with diabetes, we observed significantly lower ppara , acox1 , and cpt1a expression ( p < 0.05, p < 0.001, and p < 0.0001 respectively). Interestingly, CPT1A content was lower in arterial segments of patients with diabetes ( p < 0.05). Hemoglobin A1c and HDL-cholesterol had negative correlations with ppara (R 2 = 0.44, p < 0.05; R 2 = 0.42, p < 0.05; respectively)., Conclusion: This study demonstrates the significant differential expression of ppara and its immediate downstream genes in human carotid and lower extremity arteries relative to disease severity and diabetes. These findings highlight that mechanisms that influence atheroprogression in the carotid and lower extremities peripheral arteries are not homogenous and can be impacted by patient diabetes status and serum cholesterol profiles. Further elucidating these differential molecular mechanisms can help improve targeted therapy of atherosclerosis in different peripheral arterial beds., 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 Engel, Meade, Harroun, Penrose, Shafqat, Jin, DeSilva, Semenkovich and Zayed.)