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Synthetic images ar­­­e created using computer graphics modeling and artificial intelligence techniques, referred to as deepfakes. They modify human features by using generative models and deep learning algorithms, posing risks violations of social media regulations and spread false information. To address these concerns, the study proposed an improved generative adversarial network (GAN) model which improves accuracy while differentiating between real and fake images focusing on data augmentation and label smoothing strategies for GAN training. The study utilizes a dataset containing human faces and employs DCGAN (deep convolutional generative adversarial network) as the base model. In comparison with the traditional GANs, the proposed GAN outperform in terms of frequently used metrics i.e., Fréchet Inception Distance (FID) and accuracy. The model effectiveness is demonstrated through evaluation on the Flickr-Faces Nvidia dataset and Fakefaces d­­ataset, achieving an FID score of 55.67, an accuracy of 98.82%, and an F1-score of 0.99 in detection. This study optimizes the model parameters to achieve optimal parameter settings. This study fine-tune the model parameters to reach optimal settings, thereby reducing risks in synthetic image generation. The article introduces an effective framework for both image manipulation and detection.

Machine learning-based sports activity recognition has captured a lot of interest in recent years. Automatic activity recognition not only reduces cost and time but is very helpful in analyzing health-sensitive data acquired using smart wearable technology. Gym activity recognition by incorporating smart wearable technology comes within the scope of this topic. This paper present a system for classifying gym activities using feature engineering techniques applied to time series data. The collected time series data consists of an athlete’s body movement using an internal 3-axis accelerometer build into the zephyr bio-harness 3 device. The data were gathered by implementing a six-week fitness routine trying to target six muscle groups, preceded by one day of rest and recovery each week. The raw time-series data of the accelerometer is transformed to extract new features from it for identifying gym activities. The feature engineering techniques applied in this research are not limited to gym activity recognition but can be extended to any domain involving time-series data. The collected data was just three features, which are the reading of the tri-axial accelerometer signal as vertical, lateral, and sagittal axes. In order to formulate new features, basic concepts of statistics and mathematics were applied to the data. furthermore, we trained six GridSearchCV-based classifiers on the extracted features and tested their performance in four different types of experiments.

Groundwater pollution is considered a major concern in today’s world. Most industries in Pakistan produce untreated wastewater, extracting from and contaminating a nearby water source and the soil. This study was conducted in the Nithar Ke area of Chiniot District to assess the impact of the flow of wastewater over the area on groundwater quality. It aimed to: (1) investigate the conditions of industrial wastewater; (2) study the spatial variability of different parameters in groundwater using a GIS map; and (3) check the appropriateness of groundwater for drinking purposes using the water quality index (WQI). Physical and chemical characteristics, including pH, electrical conductivity, total dissolved solids, TSS, CO3, HCO3, chlorides, alkalinity, total hardness, Ca, Mg, arsenic, copper, chromium, nickel, iron, manganese, and sulfate, were tested using groundwater samples, and variance in groundwater was analyzed using a GIS (geographic information system). The water quality index (WQI) was developed for the Nithar Ke area to determine the appropriateness of the groundwater for drinking purposes. WQI values were determined within the range of 41 to 89.5, which showed a poor to good water quality. It was discovered that parameters such as BOD, COD, iron, and TDS had average concentrations of 192 mg/L, 264 mg/L, 2.62 mg/L, and 6039 mg/L, respectively, in the polluted water, which exceeded the permissible limit. Iron and manganese were the most common contaminants found in that area. The biplot and correlation circle showed that iron and turbidity had a positive relationship. Further study on soil stratification and soil characteristics is recommended in this area for a detailed analysis of the causes of metal contamination.

Direct and indirect disposal of different wastes either due to some accidental spillage or due to practicing of sewage sludge to agricultural fields for diverse reasons in the water reservoirs contributes towards contamination of our ecosystem. Physical removal or immobilization is required for making soil and water contaminant-free from such kind of heavy metals. The Earth crust is mainly composed of these heavy metals and as they are non-degradable in nature, so there is a greater risk of their entrance into the food web and lead to various health hazards. Phytoremediation is an innovative, environment friendly, cost-effective, and aesthetically pleasing approach to remove/immobilize heavy metals. Processes mainly involves the detoxification, removal, or stabilization of retentive pollutants via utilization of vegetation and is a green environmental-friendly tool for cleaning polluted soils. It is a broad-spectrum remediation mechanism in which several processes are involved as mentioned here includes phyto-stabilization, rhizo-filtration, rhizo-degradation, phyto-degradation, phyto-extraction, and phyto-volatilization. Use of aromatic non-edible plants is sustainable and the best treatment approach for the elimination of toxic metals. These plants are not removed directly by humans or animals like non-aromatic edible crops such as cereals, pulses, or vegetables. This research is entirely based on qualitative analysis with descriptive approach. The crops like mustard plant, sunflower, rapeseed etc. are effectively put in an application at sites with superficial contamination of organic or inorganic contaminants via the above-mentioned six techniques. Phytoremediation is a reliable reclaiming treatment and hence the most demanding remediation technology in the world.

Groundwater Arsenic (As) data are often sparse and location-specific, making them insufficient to represent the heterogeneity in groundwater quality status at unsampled locations. Interpolation techniques have been used to map groundwater As data at unsampled locations. However, the results obtained from these techniques are affected by various inherent and external factors, which lead to uncertainties in the interpolated data. This study was designed to determine the best technique to interpolate groundwater As data. We selected ten interpolation techniques to predict the As concentration in the groundwater resources of Punjab, Pakistan. Two external factors, the spatial extent of the study area and data density, were considered to assess their impact on the performance of interpolation techniques. Our results show that the Inverse Distance Weighting (IDW) and Spline interpolation techniques demonstrate the highest accuracy with the lowest RMSE (13.5 ppb and 16.7 ppb) and MAE (87.8 ppb and 89.5 ppb), respectively, while the Natural Neighbor technique shows the lowest accuracy with the highest RMSE (2508.7 ppb) and MAE (712.1 ppb) to interpolate groundwater As data. When the study area’s extent was modified, IDW showed the best performance, with errors within ±1.5 ppb for 95% of the wells across the study area. While data density has a positive correlation with interpolation accuracy among all techniques, the IDW remained the best method for interpolation. It is therefore concluded that IDW should be used to interpolate groundwater quality data when observed data are sparse and randomly distributed. The utilization of IDW can be useful for As monitoring and management in groundwater resources.

Current study was conducted to evaluate the effects of different seed priming and foliar spray of micronutrients on bread wheat performance in semi-arid region in Northwest of Iran. Pre-sowing treatments were S1: no pre-sowing treatment (intact seeds), S2: hydro-priming, S3: bio-priming (seed inoculation with plant promoting rhizobacteria consortium: Azotobacter chroococcum + Azospirillum lipoferum), S4: micronutrient seed priming and foliar feeding include, check (0): distilled water spray, Fe: foliar spray of iron, Zn: foliar spray of zinc. All seed priming treatments significantly increased plant height, tiller number, canopy width, total biomass, spike mass, seed number per spike and seed yield compared to intact seeds. A brief comparison of the effect of seed priming and fertilizer treatments showed that the effects of priming treatments on improving growth and seed yield was more obvious than fertilizer treatments. The greatest increase in seed yield and yield components was recorded for plants grown from bio-fortified seeds by essential trace elements. However, comparison of fertilizer treatments showed that growth parameters were significantly affected by Zn application. From the present study, it may be concluded that combined seed priming through pre-sowing hydration, soaking in micronutrients and microbial inoculation is useful to enhance wheat production and agricultural sustainability for smallholder farmers in semi-arid region.

Energy efficient building concerns to the structure and using the process that is environmental liable and material efficient all around a building lifecycle. The basic principle of this building to minimize the energy consumption for heating and cooling system. The paper investigates the thermal behavior of hemp fiber insulation in timber framed wall panels for which timber framed structures will be experimented. Steps to enhance the energy performance were applied to building structure, window area, window glazing, lightning, heating ventilation and air conditioning (HVAC) system. We were measured the U-values of timber walls, hemp fiber insulation and window glazing. Results showed that energy efficient building enjoy the benefits of saving 40-50% energy by reducing greenhouse gases emissions into atmosphere. We have discussed about the rating system of energy efficient building or green building. In this paper, information pertaining to building life cycle and detailed explanation regarding fundamentals of building energy will be provided.

Water purification for human consumption purposes consists in the removal of different contaminants as chemicals (i.e., pollutants, toxic metals), biological contaminants (algae, bacteria, fungi, parasites, and viruses), suspended solids, and gases. But we will use simple method to clean water which has algae, parasites activities, etc. by simple gravel, sand, and earthen materials. Filtration is the process in which the solid particles are removed in a liquid or gaseous fluid are removed by use of filter medium. And control the amount of TDS, EC, pH, and other parameters. We applied simple law of physics that is gravity. We filtered the wastewater from tube containing layer of earthen materials and lastly, we filtered the semi cleaned water from UV membranes (Nano membrane). We used three boxes in which 1st box had small gravels and in other 2nd box had sand and charcoal passed through water from these medium and final products collect in 3rd box and checked the different medias of water. This experiment was performed with different sources of water, and this gave good results with good efficiency of medias like TDS, EC, PH etc. this experiment is performed with low income and with the help of natural coagulants.

Nearly two-third part of earth cover by water and this water is not for drinking from this only one percent is only for human use and which is not of sufficient to fulfill the human needs as water is the base of life so to overcome this water shortage problems there are different techniques which are helpful for the treatment of water like Desalination, phytoremediation, reverse osmosis, filtration, chlorination, coagulation and flocculation. As above-described processes solar water distillation is one of the most economic and renewable technique which is easily available everywhere. Many varieties of solar still are now developed regarding design like symmetric solar still, Asymmetric solar still, inclined single slope still, double slope still Steeped solar still and vacuum tube solar still etc. There are different natural factors which effect the yield of water purification like solar radiation, water depth in the basin, ambient temperature, and wind speed. These solar still are successful in arid atmosphere like in continent Africa and some parts of Asia where there is water shortage and irradiance values are higher there. Solar still working principle is to evaporate water in the basin and condense it on glass inner surface and then collect it in the collector. Conventional solar stills are less productive as compared to stills with vacuum tubes and steeped solar still in which internal reflectors were used.

The strict lockdown measures not only contributed to curbing the spread of COVID-19 infection, but also improved the environmental conditions worldwide. The main goal of the current study was to investigate the co-benefits of COVID-19 lockdown on the atmosphere and aquatic ecological system under restricted anthropogenic activities in South Asia. The remote sensing data (a) NO2 emissions from the Ozone Monitoring Instrument (OMI), (b) Aerosol Optical Depth (AOD) from the Moderate Resolution Imaging Spectroradiometer (MODIS), and (c) chlorophyll (Chl-a) and turbidity data from MODIS-Aqua Level-3 during Jan–Oct (2020) were analyzed to assess the changes in air and water pollution compared to the last five years (2015–2019). The interactions between the air and water pollution were also investigated using overland runoff and precipitation in 2019 and 2020 at a monthly scale to investigate the anomalous events, which could affect the N loading to coastal regions. The results revealed a considerable drop in the air and water pollution (30–40% reduction in NO2 emissions, 45% in AOD, 50% decline in coastal Chl-a concentration, and 29% decline in turbidity) over South Asia. The rate of reduction in NO2 emissions was found the highest for Lahore (32%), New Delhi (31%), Ahmadabad (29%), Karachi (26%), Hyderabad (24%), and Chennai (17%) during the strict lockdown period from Apr–Jun, 2020. A positive correlation between AOD and NO2 emissions (0.23–0.50) implies that a decrease in AOD is attributed to a reduction in NO2. It was observed that during strict lockdown, the turbidity has decreased by 29%, 11%, 16%, and 17% along the coastal regions of Karachi, Mumbai, Calcutta, and Dhaka, respectively, while a 5–6% increase in turbidity was seen over the Madras during the same period. The findings stress the importance of reduced N emissions due to halted fossil fuel consumption and their relationships with the reduced air and water pollution. It is concluded that the atmospheric and hydrospheric environment can be improved by implementing smart restrictions on fossil fuel consumption with a minimum effect on socioeconomics in the region. Smart constraints on fossil fuel usage are recommended to control air and water pollution even after the social and economic activities resume business-as-usual scenario.

Road development projects are important as they provide economical, political and social benefits but delays can occur. EIA is conducted for every project as required by the Environmental Protection Act of 1997 and the Environmental Policy of Pakistan for the purpose of ensuring mitigation of environmental impacts due to project activities. The Kashmir Underpass project in Faisalabad is assigned to FDA, for the purpose of satisfying growing need of traffic load due to population increase in surrounding areas in newly developed societies. This research examines the different factors of project affecting the environment. Questionnaire approach was utilized to gain insights of environmental impacts due to the project. Results showed that 93% of respondents didn’t knew about EIA and why it is necessary. Respondents were facing impacts from dust particles, noise, traffic, business loss etc. These impacts were analyzed and guidelines were developed for EIA of Kashmir Underpass Project.

Objective: The objective of the study was to compare the efficacy and safety of intrathecal ropivacaine versus intrathecal bupivacaine as anesthetic agents in patients undergoing lower abdominal surgeries. Materials and Methods: In this prospective, randomized trial, patients (n = 60) were divided into two groups of 30 each. Group R (n = 30) received intrathecal ropivacaine 0.75%, 3 ml (isobaric), whereas Group B (n = 30) received intrathecal bupivacaine 0.5%, 3 ml (isobaric). The two study groups were compared with respect to onset, duration, and level of sensory block. The time for the onset of motor block, total duration of motor block, and postoperative side effects were also recorded. Statistical Analysis: Quantitative data and categorical data were analyzed using t-test and Chi-square test, respectively. P < 0.05 was considered statistically significant. Results: The maximum sensory level of T4 was reached in 6.7% and 13.3% of the cases of ropivacaine and bupivacaine (P = 0.68), respectively. The onset time (2.54 vs. 2.91 min; P > 0.05) and level (7.38 vs. 8.14 min; P > 0.05) of sensory block achieved were found to be similar to both the drugs. The duration of sensory block was comparable in both the study groups (321.72 vs. 301.45 min; P > 0.05), whereas the duration of motor block was significantly shorter with ropivacaine than bupivacaine (214.5 vs. 283.36 min; P < 0.05). Nonsignificant higher incidence of bradycardia (10% vs. 3.3%) and hypotension (13.3% vs. 3.3%) was observed with bupivacaine than ropivacaine. Conclusion: Intrathecal ropivacaine may be considered superior to intrathecal bupivacaine in terms of early motor recovery and similar duration of sensory block. Lower incidence of hypotension and bradycardia with ropivacaine, though apparently insignificant in this study, may indicate its better safety profile as compared to bupivacaine.

Understanding the pixel-scale hydrology and the spatiotemporal distribution of regional precipitation requires high precision and high-resolution precipitation data. Satellite-based precipitation products have coarse spatial resolutions (~10 km–75 km), rendering them incapable of translating high-resolution precipitation variability induced by dynamic interactions between climatic forcing, ground cover, and altitude variations. This study investigates the performance of a downscaled-calibration procedure to generate fine-scale (1 km × 1 km) gridded precipitation estimates from the coarser resolution of TRMM data (~25 km) in the Indus Basin. The mixed geographically weighted regression (MGWR) and random forest (RF) models were utilized to spatially downscale the TRMM precipitation data using high-resolution (1 km × 1 km) explanatory variables. Downscaled precipitation estimates were combined with APHRODITE rain gauge-based data using the calibration procedure (geographical ratio analysis (GRA)). Results indicated that the MGWR model performed better on fit and accuracy than the RF model to predict the precipitation. Annual TRMM estimates after downscaling and calibration not only translate the spatial heterogeneity of precipitation but also improved the agreement with rain gauge observations with a reduction in RMSE and bias of ~88 mm/year and 27%, respectively. Significant improvement was also observed in monthly (and daily) precipitation estimates with a higher reduction in RMSE and bias of ~30 mm mm/month (0.92 mm/day) and 10.57% (3.93%), respectively, after downscaling and calibration procedures. In general, the higher reduction in bias values after downscaling and calibration procedures was noted across the downstream low elevation zones (e.g., zone 1 correspond to elevation changes from 0 to 500 m). The low performance of precipitation products across the elevation zone 3 (>1000 m) might be associated with the fact that satellite observations at high-altitude regions with glacier coverage are most likely subjected to higher uncertainties. The high-resolution grided precipitation data generated by the MGWR-based proposed framework can facilitate the characterization of distributed hydrology in the Indus Basin. The method may have strong adoptability in the other catchments of the world, with varying climates and topography conditions.

Urban aquifers are experiencing increasing pressures from climate change, land-use change, and abstraction, consequently, altering groundwater levels and threatening sustainable water availability, consumption, and utilization. Sustainability in such areas requires the adaptation of groundwater resources to these stressors. Consequently, this research made projections about future climate, land use, and abstraction, examines how these drives will affect groundwater levels, and then proposes adaptation strategies to reduce the impact on Lahore’s groundwater resources. The objectives are achieved using an integrated modeling framework involving applications of Soil Water Assessment Tool (SWAT) and MODFLOW models. The results indicated a projected rise in Tmin by ~2.03 °C and Tmax by ~1.13 °C by 2100 under medium (RCP 4.5) and high-end (RCP 8.5) scenarios, respectively. Future precipitation changes for mid, near and far periods are projected to be −1.0%, 25%, and 24.5% under RCP4.5, and −17.5%, 27.5%, and 29.0% under RCP8.5, respectively. The built-up area in the Lahore division will dominate agricultural land in the future with an expansion from 965 m2 to 3716 km2 by the year 2100 under R1S1 (R2S2) land-use change scenarios (significant at p = 5%). The future population of the Lahore division will increase from 6.4 M to 24.6 M (28.7 M) by the year 2100 under SSP1 (SSP3) scenarios (significant at p = 5%). Groundwater level in bult-up areas will be projected to decline from 185 m to 125 m by 2100 due to increasing groundwater abstraction and expansion in the impermeable surface under all scenarios. In contrast, agricultural areas show a fluctuating trend with a slight increase in groundwater level due to decreasing abstraction and multiple recharge sources under combined scenarios. The results of this study can be a way forward for groundwater experts and related institutions to understand the potential situation of groundwater resources in the Lahore division and implement adaptation strategies to counteract diminishing groundwater resources.

Groundwater risks driven by population growth and industrialization in metropolitan cities have become a worldwide problem. Faisalabad is Pakistan’s third largest city with a population of more than 2 million and is renowned for its diverse industries. Many factories in the area dump their untreated effluent into nearby drainage systems, having a direct negative effect on the marine ecosystem. This research focuses on the Madhuana drain and Khurrianwala industrial region of Faisalabad to investigate groundwater quality status. Sixty water samples from groundwater bore wells and open wells were obtained, and all these samples were subjected to lab experiments for physical and chemical analysis. Sixteen physiochemical parameters, namely, electrical conductivity (EC), pH, total dissolved solids (TDS), total suspended solids (TSS), turbidity, carbonate, Ca2+, Fe, HCO3−, Cl−, Mg2+, SO24−, As, Cr, Cu, and Mn, were examined. To provide a comprehensive picture of water quality from a human perspective, we calculated the water quality index (WQI) by integrating 16 physiochemical criteria. The results revealed that a larger proportion had poor drinking quality due to direct releases of toxins by industries. It was observed that 87% of the water samples showed an unsuitable status of groundwater for drinking purposes in terms of pH, EC, Fe, Mn, Cu, and Cr. The results of this study could be used to build and construct wastewater treatment plant facilities for the Madhuana drain, reducing pollution loads on the drain and river, as well as contaminant seepage rates into groundwater. The research’s resulting maps will help policymakers to manage groundwater supplies more efficiently for sustainable development.

The world is facing soil, air and water pollution problems which may arise the soil degraded, global warming, food shortage and droughts. For our future generations we have to develop sustainable environment technologies. Many studies have addressed some scientific aspects and have been limited focus on the commercial implementation based on urban food production industrial-scale production in rural areas small scale farming is developed in different countries for education and decoration inside buildings. We must encourage the sustainable small farming as indoor fish farming which is the farming of the new millennium aquaponic is a structure of closed-loop combine the elements of hydroponics and aquaculture which could contribute the addressing these problems. This system emphasis on improvement through management and integration of the living components and the bio filter system. From trickling bio filters and plant uptake of aquaculture wastewater results in improved water and nutrients use efficiency and conversation. The challenge to sustainability centers on balancing the aquaculture system environment for the optimum growth of these organism’s maximum production outputs and minimize effluent discharges to the environment emission and might develop the future application of aquaponic for food security.

Malnutrition a health disorders arising due to over or low use of minerals, vitamins and nutritional substances required for proper functioning of body tissues and organs. Zinc (Zn) is the most important mineral required for the normal metabolism of plants and humans. Zinc-deficiency is one of the major cause of malnutrition globally. Maize is highly susceptible to Zn-deficiency and inflicts Zn-deficiency to humans and other animals being nourished on it. This study evaluated the effect of zinc-lysine chelate alone (0.1, 0.5, 1.0 and 1.5%) as seed priming and in combination with Zn-solubilizing bacteria (PMEL-1, PMEL-48, PMEL-57and PMEL-71)) on grain biofortification of autumn maize. The Zn accumulation in different parts (roots, stem, leaves, grains and cob pith) was quantified. Results indicated that Zn contents were 18.5% higher in the seeds primed with 1.5% solution of Zn-lysine chelate and inoculation of ZSB strains compared to control treatments. Seed priming with 1.5% Zn-lysine chelate in combination with ZSB inoculation significantly improved cob diameter and cob length by 16.75% and 42% during 2016 and by 11.36% and 34.35% during 2017. The increase in 100 grains weight over control was 18.4% and 15.27% for 2016 and 2017, respectively. The Zn contents were increased by 15.3%, 15.6%, 49.1%, and 33.0% in grain, cob-pith, stemand roots, respectively compared from control. Thus, the combined application of 1.5% Zn-lysine chelates along with ZSB inoculation could be used for combating malnutrition.

Objectives: Fracture of endodontically treated restored teeth is a common concern. Premolars are subjected to high shear and tensile forces. This study aimed to assess the fracture resistance and fracture mode of endodontically treated premolars restored with direct and indirect onlay restorations. Materials and Methods: In this in-vitro experimental study, 45 human maxillary premolars were divided into three groups (n=15) of control (sound teeth), direct onlay, and indirect onlay. In groups 2 and 3, the teeth underwent endodontic treatment. Mesio-occluso-distal cavities were prepared and restored with direct composite (P60) and indirect IPS e.max ceramic onlays, respectively. The teeth were subjected to vertical forces after cyclic loading. The maximum load causing fracture was recorded in Newtons. Data were analyzed using analysis of variance, chi-square test, and Tukey’s test. Results: The highest and the lowest fracture resistances were noted in sound teeth and direct onlay restorations, respectively. The difference in fracture resistance was significant among the three groups (P

Advancements in information and communication technology (ICT) have expanded the possibilities for trade in modern services. Many emerging and developed Asian economies are increasingly participating in these new trade activities. This study examines the export performances of emerging and developed Asian economies in selected modern services—computer and information, business and professional, and telecommunications—using a stochastic frontier gravity model. Estimation results show that the performances of emerging economies in South Asia and the Association of Southeast Asian Nations (ASEAN), in terms of realization of export potential, are considerably weaker than those of developed economies in North America and Europe. The results show that the number of graduates and the quality of ICT infrastructure in emerging economies are among the key factors in realizing services export potential. These findings suggest that emerging economies need to remove behind-the-border constraints and adopt advanced technologies to catch up with high-performing developed economies.

Purpose: To compare the outcomes of surgical procedures in the treatment of inferior oblique muscle overaction (IOOA) as a common disorder of ocular motility. Methods: This retrospective study was performed on patients with primary and secondary IOOA who underwent three surgical treatment procedures including disinsertion, myectomy and anterior transposition, between 2001 and 2011. Type of strabismus, ocular alignment, presence of pre-and post-operative dissociated vertical deviation (DVD), pre- and post-operative degree of IOOA were obtained using specified checklist. Results: A total of 122 eyes of 74 patients with mean age of 13 ± 11.7 (range, 1-51) years were included in this study. Disinsertion was performed on 12 eyes (9.8%), myectomy in 91 eyes (74.6%) and anterior transposition in 19 (15.6%). Preoperative V-pattern and DVD existed in 67 and 17 eyes; after surgery they remained in only 10 and 8 eyes, respectively. The success rate (IOOA

Background: The purpose of the present study was to discuss some new concepts of the desirable characteristics of smile tooth display. Due to the increasing application of cosmetic dental treatments, there is an increasing need for better understanding of the esthetic principles. Materials and Methods: In the present descriptive study, with 212 participants, included were patients with no history of orthodontic treatment, loss or prosthetic replacement of anterior teeth, extracted teeth, lips with asymmetry or a history of trauma. Chi-square test was used to determine possible significances in the relation of smile line to Angle occlusion class, overbite and overjet and arch form. A P level of

Objective. To determine intrafamilial seropositivity of HBV and HCV and to compare them in families of infected persons with HBV and HCV in Hamadan clinic of hepatitis.Material and methods. In this analytic cross-sectional study, 651 family members of 200 HBV and HCV infection index cases were entered into the study and after signing an informed consent, they were referred to Blood Transfusion Center. With completion of laboratory tests, interviewers filled the questionnaires.Results. One hundred and eighteen (20.5%) and 107 (18.6%) family members were HBsAg and HBcAb positive respectively. 21 (3.6%) were isolated HBcAb positive. Only one person (1.3%) was HCVAb positive. The general rate of infection in family members of HBV infected people (atleast one case) (49.4%) was significantly higher than that of HCV infected people (3.3%), p < 0.001. Interspouses transmission was evaluated and prevalence of interspouses HBV and HCV infection were 32.3 and 8%, respectively.Conclusion. Intrafamilial and interspousal seropositivity of HBV is obviously more than those of HCV. More attention should be paid to screening and risk lowering activities particularly about HBV infected people and their families.

Objective: To determine the effectiveness of cyclosporin A (CSA) monotherapy in treating patients with non-severe aplastic anaemia (NSAA)., Study Design: A cross-sectional observational study. Place and Duration of the Study: Department of Clinical Haematology, Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan, from January 2022 till December 2023., Methodology: A total of 51 patients of NSAA, classified as aplastic anaemia not satisfying criteria for severe and very severe disease as per Modified Camitta Criteria, were included. Results were evaluated in terms of survival rate (OS) and responses. Responses were assessed as complete response (CR), partial response (PR), overall response (ORR), and no response (NR) by using standard British Committee for standard Haematology (BCSH) response criteria at 3, 6, and 12 months., Results: Out of 51 patients, 34 (67%) were males and 17 (33%) were females. Median age at the time of diagnosis was 25 (IQR 26) years. At follow-up of 12 months, OS was 86.3%. Overall response rates to cyclosporin monotherapy at 3, 6, and 12 months were 49%, 57%, and 59%, respectively. Baseline haemoglobin was associated with responses at 6 and 12 months and a significant association was found between transfusion dependency at 3, 6, and 12 months with overall survival (p = 0.01, 0.005, and 0.04, respectively). Responses at time-defined points also had significant impact on OS (3 months Plog-rank = 0.046, 6 months Plog-rank = 0.01, and 12 months Plog-rank = 0.008)., Conclusion: Overall response rates at 3, 6, and 12 months indicate the potential of CSA as a viable treatment option, particularly in resource-constrained settings. Despite some patients experiencing treatment-related complications, CSA demonstrated a generally tolerable safety profile., Key Words: Cyclosporin A, Non-severe aplastic anaemia, Survival rate, Response rate, Complete response, Partial response.

Hemophagocytic Lymphohistiocytosis (HLH) is a rare disorder of immune dysregulation characterized by fever, cytopenias, and splenomegaly. Its primary form poses a therapeutic challenge due to its high fatality when left untreated. We retrospectively analyzed 28 patients who underwent related-donor allogeneic stem cell transplant for primary HLH from 2010 to 2021. Among them were 10 cases of familial HLH, 8 cases of Griscelli syndrome type 2, and 1 case each with PRF1 and STX11 mutations. All the patients underwent transplants with reduced-intensity or myeloablative conditioning and 26 of them achieved neutrophil engraftment at a median of day + 14. The donors were either fully matched (68%) or haploidentical (32%). With a median follow-up of 1 year, overall survival was 68% (n = 19) and disease-free survival was 64.4% (n = 18). OS was better in patients transplanted with a sibling donor (compared to parent donor), who achieved complete donor chimerism, and those transplanted early in the course of the disease (diagnosis to transplant duration less than 6 months)., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Rhupus syndrome is an autoimmune disorder that combines the symptoms of lupus and rheumatoid arthritis. It is a rare condition that affects the connective tissues of the body such as the joints, muscles, and skin. The symptoms of rhupus syndrome can be similar to those of lupus, including joint pain, fatigue, and skin rashes. However, rhupus syndrome can also cause symptoms of rheumatoid arthritis, such as joint stiffness and swelling. Treatment for rhupus syndrome usually involves a combination of medications and lifestyle changes to manage symptoms and improve the overall quality of life. A 24-year-old female patient was referred by a local physician for evaluation of pancytopenia. Her history dates back to six months when she developed progressive fatigue, dyspnea on mild exertion, and polyarthralgia. Initial laboratory investigations revealed pancytopenia, positive antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA), and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Bone marrow examination confirmed the diagnosis of aplastic anemia. She was started on cyclosporine with an aim to maintain a trough level between 200 and 250 ng/mL. She responded well with hematological recovery in three to four months. This case highlighted the excellent response to cyclosporine hematologically and clinically in rhupus syndrome complicated with aplastic anemia. Further studies are required to establish the long-term efficacy of cyclosporine in this patient population., Competing Interests: Due to a shared interest in clinical hematology, my colleague Dr. Malik and I approached Dr. Shahbaz for research opportunities., (Copyright © 2024, Saqib et al.)

Objective: To determine the outcome of beta thalassemia major (BTM) patients undergoing haematopoietic stem cells (HSCT), with fully matched parents as donors vs. matched sibling donors (MSD)., Study Design: Observational Study. Place and Duration of the Study: Department of Clinical Haematology and Bone Marrow Transplantation Centre, Rawalpindi, Pakistan, from January 2013 to July 2023., Methodology: Group A consisted of BTM patients who underwent HSCT with fully matched siblings as donors, and Group B consisted of BTM patients who underwent HSCT with fully matched parents as donors. Study data included the age and gender of both recipients and donors, source and dose of stem cells infused, and stage and grades of acute and chronic graft versus host disease (GvHD). All patients received Myeloablative conditioning regimen (MAC). Data were collected to assess patients' demographics, response to HSCT, remission rate, disease free survival (DFS), relapse, and GvHD free survival (GRFS), and overall survival (OS)., Results: The mean age of the 54 patients was 5.90 ± 3.29 years. The mean TNC and CD34 doses were 4.99 + 1.13 and 5.42 + 3.70, respectively. Mean time for neutrophil engraftment in both groups was 14.88 + 4.51 days and platelets engraftment was 23.0 + 5.35 days. Most common cause of death was neutropenic sepsis followed by aGVHD. Seven patients had graft rejection. There was no significant association found between graft rejection with donor relation though graft rejection was higher in OS in this study was 70.4%. OS was equal in both groups. Disease free survival was superior in MSD (63%) than parent group (57.7%)., Conclusion: Allogenic bone marrow transplantation with parents as donors in BTM patients yields outcomes comparable to those with matched sibling donors. This finding is especially relevant in regions like Pakistan, where donor registries and high-resolution HLA typing may be limited., Key Words: Beta thalassemia major, Haematopoietic stem cell transplant, Post-transplant outcome.

Objective: To compare donor graft characteristics and clinical outcomes in recipients of allogeneic heamatopoietic stem cell transplantation (HSCT) using GCSF primed bone marrow (GBM) and steady-state bone marrow (SBM) as stem cell sources., Study Design: Observational study. Place and Duration of the Study: Department of Clinical Haematology, Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan, from August 2018 to October 2020., Methodology: Eighty patients undergoing allogeneic HSCT were analysed. Among these, forty each received GBM and SBM from HLA identical siblings. Graft characteristics, such as total nucleated cells, CD34+ cell yield; clinical outcomes such as neutrophil and platelet engraftment, primary and secondary graft failure (GF), as well as the frequency of acute and chronic graft versus host disease (GvHD), were recorded and compared using the t-test, with significance at p <0.05., Results: A statistically significant difference was observed in CD34+ dose with median dose 7.68 (p=0.002) but not in TNC dose with meadin dose 5 (p=0.86). Neutrophil engraftment occurred much more quickly with median of 13.43 days in the GBM than SBM group (p=0.025). While no statistically significant difference (p=0.89) in platelet engraftment was reported in both SBM and GBM. At the same time, patients with both GBM and SBM transplants showed a comparable ratio of acute to chronic GvHD and primary to secondary GF., Conclusion: GBM is associated with better CD34+ stem cell yield and quicker neutrophil engraftment in clinical outcomes., Key Words: Granulocyte colony-stimulating factor, Bone marrow, Hematopoietic stem cell transplantation.

This study aimed to compare the mean plasma levels of Amyloid β42, Phosphorylated Tau and Neurofilament Light chain in patients diagnosed with Alzheimer's Clinical Syndrome (ACS), and other neurodegenerative dementias to find affordable and less-invasive means of diagnosing Alzheimer's disease (AD) early in its course. Blood samples of 36 subjects presenting with cognitive decline to the neurology OPDs of Dow and Civil hospitals, Karachi, were centrifuged, and plasma was stored at -80℃. Before analysis, it was thawed at 4℃ and protein levels were measured through ELISA. Two-thirds of the patients were females but age distribution across both the groups was not significantly different (p=0.21). No difference was observed in the mean plasma concentrations of Aβ42, P-Tau, and NFL between the two groups (p-values 0.78 and 0.27 and 0.09 respectively). Our study suggests that despite being promising in CSF, Aβ42, P-Tau, and NFL cannot differentiate between different neurodegenerative dementias when measured in plasma.

Background/objective: The aim of this study is to identify frequencies of various neurological disorders (NDs) and associated disability in patients attending neurologic clinics in rural and urban centers in Pakistan., Methods: This is an observational study conducted in 39 neurological centers in both rural and urban areas, public and private health sectors all over Pakistan. This study was conducted between august 2017 to December 2019., Results: A total of 28,845 adults were enrolled. Mean age of the study participants was 46.2 ± 17.2 years, 15,252 (52.9%) were men and 13,593 (47.1%) were women. Most common comorbid medical condition was hypertension 7622(26.4%) followed by Diabetes 3409(11.8%). Among neurological diagnoses, vascular diseases (20%) were the most common followed by Headache disorders (18.6%), Epilepsy (12.5%), nerve and root diseases (12.4%), Psychiatric diseases (10%), Dementias (8%) and movement disorders (7.9%). Half of the patients 15,503(53.7%) had no neurological disability, while minor disability was present in 10,442(36.2%) of cases. Moderate to severe disability was present in 2876(10%) cases. Headache disorders, psychiatric diseases, muscle pain/muscle related disorders and demyelinating diseases were more common in women. Vascular diseases, movement disorders and Dementias were more common in 46 years and above age group whereas headache disorders, Epilepsy and Psychiatric disorders were more prevalent in <46 years age groups., Conclusion: Vascular diseases are the most common presentation of patients in neurology clinics followed by headache disorders and epilepsies. Minor disability was present in 36% while moderate to severe disability was present in 10% cases., Competing Interests: Declaration of Competing Interest Authors declare no conflict of interest relevant to this manuscript., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Limited data are available from developing countries regarding the frequency of CMV infection and treatment outcomes. We enrolled 230 consecutive patients undergoing allogeneic HSCT for various hematologic disorders at the Armed Forces Bone Marrow Transplant Center/National Institute of Blood And Marrow Transplant between February 2017 and December 202. CMV reactivation post-HSCT was monitored weekly starting at day +30 and continuing until day +100, and preemptive antiviral therapy was administered to prevent CMV disease in all HSCT recipients with ≥2000 CMV copies/mL. The median age of the study cohort was 9.5 years (range, .6 to 53 years), and the male:female ratio was 2.4:1. The most frequent indication for HSCT was beta thalassemia major (36.1%), followed by aplastic anemia (23.9%). Malignant disorders constituted 20% of all the patients. Pretransplantation CMV seropositivity was 99.1% for the recipients and 99.5% for the donors. CMV infection was seen in 66.1% of the patients, and the median time to CMV DNAemia was 36 days (range, 12 to 95 days). Preemptive antiviral therapy was administered to 140 patients with a CMV viral load ≥2000 copies/mL (61%). In multivariate analysis, patient age >12 years, steroid administration, and use of mycophenolate mofetil with or without post-transplantation cyclophosphamide was associated with the greatest probability of CMV reactivation. Overall survival was 97.4% in patients without CMV reactivation, compared to 80.3% in those with CMV reactivation (P = .001). Event-free survival was 78.7% in the total study cohort, including 89.7% for patients without CMV reactivation and 73% for patients with CMV reactivation (P = .003). Our study is the first from this region to explore the frequency of CMV seropositivity and CMV infection, risk factors for CMV reactivation, and outcomes of antiviral therapy in HSCT recipients., (Copyright © 2023 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

The National Institute on Aging-Alzheimer's Association's research framework in 2018 proposed a molecular construct for the diagnosis of Alzheimer's disease (AD). Nonetheless, the clinical exclusionary strategy is still the mainstay of AD diagnosis in Pakistan. We looked at the plasma levels of amyloid beta-42 (Aβ-42), phosphorylated tau (P-tau), and neurofilament light (NFL) in patients with Alzheimer's clinical syndrome (ACS) and healthy controls (HC) from the Pakistani population to keep pace with the global efforts towards establishing accessible and affordable biochemical diagnostic markers for AD in Pakistan. Consultant neurologists screened patients who presented with cognitive impairment to three large tertiary care hospitals in Karachi, and after receiving informed consent, recruited participants with ACS and HC from the same facilities. We collected 5cc of blood in EDTA tubes along with demographic and lifestyle information of the subjects. Plasma aliquots were stored at -80°C after centrifugation. For analysis it was thawed at 4℃ and levels of the three proteins were measured through ELISA. Data from 28 ACS patients and 28 age matched healthy controls were evaluated. Among demographic factors, education and depression were related with health status ( p  = 0.03 and 0.003, respectively). NFL and P-tau mean values demonstrated a significant difference between the ACS and control groups ( p  = 0.003 and 0.006), however Aβ42 did not ( p  = 0.114). ROC analysis showed that plasma P-tau and NFL, with AUCs of 0.717 and 0.735, respectively, could substantially distinguish ACS from the HC group ( p  = 0.007 and 0.003, respectively). Both plasma P-tau ( r  = -0.389; p  = 0.004) and NFL ( r  = -0.424; p  = 0.001) levels were significantly and negatively correlated with individuals' MMSE scores. NFL and plasma P-tau show promise in differentiating AD patients from healthy individuals. However, similar larger studies are needed to validate our findings., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

It is evident that inflammation and metabolic syndrome instigated by diabetes mellitus can precipitate diabetes-induced neuropathy (DIN) and pain. In order to find an effective therapeutic method for diabetes-related problems, a multi-target-directed ligand model was used. 6-Hydroxyflavanone (6-HF) carrying anti-inflammatory and anti-neuropathic pain potential due to its quadruplicate mechanisms, targeting cyclooxygenase-2 (COX-2), 5-lipoxygenase (5-LOX), and opioid and GABA-A receptors was investigated. The anti-inflammatory potential of the test drug was confirmed utilizing in silico, in vitro, and in vivo tests. A molecular simulation approach was utilized to observe the interaction of 6-HF with the inflammatory enzyme COX-2 as well as opioid and GABA-A receptors. The same was confirmed via in vitro COX-2 and 5-LOX inhibitory assays. In vivo tests were performed to analyze the thermal anti-nociception in the hot-plate analgesiometer and anti-inflammatory action in the carrageenan-induced paw edema model in rodents. The potential anti-nociceptive effect of 6-HF was evaluated in the DIN model in rats. The Naloxone and Pentylenetetrazole (PTZ) antagonists were used to confirm the underlying mechanism of 6-HF. The molecular modeling studies revealed a favorable interaction of 6-HF with the identified protein molecules. In vitro inhibitory studies revealed that 6-HF inhibited the COX-2 and 5-LOX enzymes significantly. The 6-HF at dosages of 15, 30, and 60 mg/kg substantially reduced heat nociception in a hot plate analgesiometer as well as carrageenan-induced paw edema in rodent models. The authors discovered that 6-HF had anti-nociception properties in a streptozotocin-induced diabetic neuropathy model. According to the findings of this study, 6-HF was demonstrated to diminish inflammation caused by diabetes as well as its anti-nociception effect in DIN.

Background: Aplastic Anaemia (AA) is characterized by pancytopenia and hypocellular marrow. Immunosuppressive therapy (IST) SHOWS impressive haematological response; however, risk of relapse and clonal evolution persists. The objective of the study is to assess response to IST in patients with aplastic anaemia., Methods: A retrospective single centre study at AFBMTC / NIBMT for patients of acquired AA was conducted from January 2005 to December 2019.Inclusion criteria included diagnosed cases of acquired AA receiving IST for at least 12 weeks and age >2 years. IST included cyclosporine (CsA) alone, CsA + androgens, CsA + rabbit anti thymocyte globulin (rATG), CsA + horse anti thymocyte globulin (hATG). Primary outcome measure was response to IST; secondary outcome measure was overall survival (OS)., Results: A total of 513 patients received IST. Median age was 23 years (range 2-97 years). In study cohort, 155 (30.2%) patients responded to the IST, 63 (12.3%) achieved complete response (CR) while 92 (17.9%) achieved partial response (PR). The ORR of CsA in NSAA, SAA and VSAA was 52.6%, 28.10% and 10% respectively; whereas ORR of CsA + rATG in NSAA, SAA and VSAA was 50%, 35.1% and 22.5% respectively. OS was 38% at a median follow up of 36 months. There was a significant difference in the survival distributions of different treatment modalities (p=0.016). Median survival time 60 months (CsA), 9 months (CsA+ androgens) and 39 months (CsA+ rATG/hATG.) ., Conclusion: In resource constrained settings, single agent CsA remains a reasonable alternative with modest activity and acceptable side effect profile.

Background: Hairy cell leukaemia (HCL) is an uncommon neoplasm of mature B-lymphoid cells which is characterized by cytopenias, commonly of all three cell lines, with typical hairy cells on peripheral smear and/or bone marrow along with organomegaly. Objective was to document the outcomes of HCL patients treated at a tertiary care hospital in Pakistan., Methods: Medical records of patients from 2004 to 2020 were reviewed and data was collected to assess patient's demographics, symptomatology, remission rate and overall survival. The record flies of all patients presenting to AFBMTC with HCL were included in the study. The record file with insufficient data were excluded., Results: 26 patients with a mean age of 48.12±11.43 years were diagnosed with HCL and treated at AFBMTC. Out of these, 23 (88.4%) were male and 03 (11.5%) females. The main presenting complaints were generalized body aches (34.6%), fever (15.4%), incidental finding of cytopenias (11.5%) and abdominal discomfort (26.9%). Splenomegaly was found in 76.92% while hepatomegaly was found in 46.15% of patients. A total of 12 (46.15%) patients received Cladribine (either intravenous or subcutaneous) and splenectomy was done in 7 (26.92%) as 1st line treatment. Eleven patients out of 12 (83.33%) who received Cladribine and 05 (71.42%) patients out of seven who underwent splenectomy; achieved complete remission (CR) after 1 st line of treatment. One patient received Cladribine as 1st line of treatment but did not respond and CHOP regimen was given as second line. Out of the 26 patients, 5 patients (19.23%) relapsed at a median interval of 5.83±6.6 years. Two patients received Cladribine + Rituximab while 03 patients received cladribine as their salvage therapy. Disease free survival (DFS) of 71.4% among the patients underwent splenectomy while 75.0% among the patients received Cladribine. DFS for combination therapy (included CHOP and CVP) was 66.7% while OS was calculated among patients who received cladribine, splenectomy and combination chemotherapy as 100%, 85.7%, 66.7% respectively., Conclusions: Cladribine has a significant efficacy and encouraging acute and long-term benefits when administered to patients with HCL. A single course of cladribine was able to induce CR in a vast majority of patients. At a median follow up of 4.6 years the OS was 100% with cladribine and 85% with splenectomy. Those who relapsed were successfully retreated with cladribine + Rituximab.

Background: Acute promyelocytic leukaemia (APL) characterized by t (15;17) leading to formation of fusion protein PML-RARA is an acute leukaemia with highest mortality. A remarkable improvement in the outcomes has been witnessed due to evolution of highly effective targeted therapies replacing the traditional chemotherapy is most patients. However limited data is available regarding treatment outcomes of APL using various novel regimens from developing countries like Pakistan., Methods: This was a retrospective descriptive study which included APL patients treated at AFBMTC Rawalpindi from 2005 to 2020. It included a total of 51 eligible patients with a diagnosis of de novo APL confirmed by the presence of PML-RARA transcript or presence of t (15;17) by cytogenetics or FISH analysis. The protocols used for treatment included the UKAML MRC 12, the LPA-99/LPA-2005 PETHEMA, the APML4 and non-chemotherapy based ATO-ATRA protocol., Results: The study included 51 patients in which 31 (60.78%) were male and 20 (39.2%) were female. The median age at diagnosis was 30 years (range 5-70). The commonest symptom was fever seen in 43 (84.3%) patients and bruising was the commonest physical finding present in 44 (86.3%) patients. High-risk patients were 23 (46.1%), 18 (35.3%) were intermediate risk and 10 (19.6%) were low risk. The LPA99/LPA2005 was most frequently employed protocol being used in 36 (72%) patients. There were 2 deaths during induction and 44 (86.3%) achieved CR post induction. The median follow up time was 32 months (range 1 to 190 months) with an overall survival (OS) of 76.5% and a relapse free survival (RFS) of 66.7., Conclusions: Our study shows APL is a highly curable malignancy and outcomes have improved with newer non chemotherapy based therapies. It can also be concluded that outcomes of APL gradually improved over the past 2 decades due to improvement in supportive care, provision of blood products and use of newer protocols. The prognosis remains less favourable in high risk patients.

The objective of this study was to evaluate the role of Ruxolitinib in steroid-refractory graft versus host disease. This retrospective descriptive study was conducted from January 2018 to December 2021. A total of 157 patients underwent allogeneic stem cell transplants during the study period. Of these, 20 patients having steroid-refractory GVHD treated with Ruxolitinib were selected for the study. The primary endpoint was the overall response rate to Ruxolitinib measured at 4 weeks and 24 weeks for acute and chronic GVHD, respectively. The secondary endpoints were overall survival and failure-free survival. Of these 20 patients, 7 (35%) had acute GVHD, and 13 (65%) had chronic GVHD. Of acute GVHD, 2 (10%) had grade II, 4 (20%) had grade III, and 1 (5%) had grade IV acute GVHD. Of 13 patients with chronic GVHD, 7 (35%) had moderate and 6 (30%) had severe chronic GVHD. In steroid-refractory acute GVHD, the overall response rate to Ruxolitinib was 85.7%, and in chronic GVHD, it was 84.6%. The failure-free survival was 80% and overall survival was 85%. Adverse events of any grade occurred in 16 (80%) patients with grade III/IV adverse events in 4 (20%) patients only. The study showed that Ruxolitinib is a safe and effective second-line therapy for acute and chronic steroid-refractory GVHD. Key Words: Ruxolitinib, GVHD, Allogeneic stem cell transplant.

Objectives: This study aimed to evaluate the etiology, outcomes and prognostic factors associated with status epilepticus (SE) admissions in Neurology Department of a tertiary care hospital., Methods: A retrospective review was performed on all SE admissions at Dr. Ruth K.M. Pfau Civil Hospital Karachi over a five-year period from July 2015 to June 2020. Demographic, clinical, and etiological factors were investigated for prognostic value. Statistical tests were applied to determine significant prognostic factors. A five percent significance level was used., Results: A total of 176 patients were included in the study. Mortality was reported in 22 cases (12.5%) and morbidity at six months was observed in 44 cases (25.0%). Male gender, previous history of SE, prolonged seizure duration, and late presentation to hospital were significantly associated with mortality (p<0.05). De novo cases of SE tended to be older (p=0.048) and were associated with morbidity at follow-up (p=0.000). The most common causes of epilepsy in our patients with SE were CNS infections (n=54) and Idiopathic epilepsy (n=34). Non-compliance to medicines/under-dosing was the most common provocative factor (n=68). Acute symptomatic causes of SE were more likely to be associated with greater morbidity (p=0.000). Refractory and super-refractory SE were strongly associated with higher mortality (p=0.000). A longer duration of hospital stay was associated with higher morbidity (p=0.000)., Conclusion: Male gender, poor control of seizures, CNS infections, prolonged seizures, delayed hospital arrival and refractory/super-refractory status epilepticus were key determinants of mortality in our setting. Previous history of status epilepticus, and acute and symptomatic etiologies were associated with higher morbidity., Competing Interests: Conflicts of Interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

Objective: Guillain-Barré syndrome (GBS) is an autoimmune disease characterized by weakness in limbs or cranial nerve innervated muscles. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common variant. Electrophysiologic abnormalities and elevated cerebrospinal fluid (CSF) protein are frequently present in AIDP, but the relationship between these two parameters is not well known. We aimed to fill this gap by studying this relationship. Methods: This was a prospective cross-sectional study conducted for two years in the Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan. All 90 adult patients with the AIDP variant of GBS were selected. Nerve conduction studies were performed to determine the degree of demyelination through the four electrophysiologic demyelination criteria. The CSF sample was sent to lab immediately after lumbar puncture. SPSS version 20.0 was used. The CSF protein level was measured with mean ±SD. Demyelination criteria were measured in frequency and percentages. Chi-square test was applied to a number of demyelination criteria and T-test/ANOVA was applied on mean CSF protein level. Results: We found a mean CSF protein of 37.41 mg/dl (±3.69) with one demyelination criterion, 81.87 mg/dl (±17.39) with two demyelination criteria, 119.75 mg/dl (±31.42) with three demyelination criteria, and 134.00 mg/dl (±42.87) with four demyelination criteria (P-value <0.001). Conclusion: This study demonstrates a significant relationship between CSF protein levels and degree of demyelination in the AIDP variant of GBS. This is an under-researched area in GBS and this study adds favorably to limited data in this regard., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2021 Jawaid et al.)

Objective: We aimed to assess the response and impact of covid 19 pandemic at tertiary care centers in Pakistan especially pertaining to neurological care, facilities and training., Methods: A pre-tested survey form was sent to 40 neurology tertiary care centers in all the provinces in the country in the first week of July 2020. 33 filled forms were received, out of which 18 were public (government) and 15 were private hospitals., Results: Estimated 1300 HCW (faculty, medical officers, trainees and nurses) work at these 33 participating centers. There were 17 deaths among HCW (1.3%) at ten centers. Sufficient personal protective equipment (PPE) were provided to 158 HCW (12%). 129 (10%)HCW tested positive for COVID 19 at 31 centers including trainees/medical officers (39), consultants (29) and nursing and other staff (61). Due to low neurology admissions, 23/33 hospitals (70%) posted neurology trainees in COVID 19 units to contribute to covid care. Less than 50% hospitals did covid screening PCR before admission to neurology wards. Only 10% hospitals provide training and regular update to HCW. Neurology tele-health services were started for clinically stable patients at 15 (45%) centers. Only 60% neurology training programs were able to start online training. Ongoing research studies and trials focusing neurological manifestations of COVID-19 were done at 10 (30%) centers. Modification of facilities for COVID patients showed that 24(72%) hospitals strictly reduced the number of attendants accompanying patients. Only 10 (30%) centers had neurophysiological tests being conducted on COVID-19 patients. Mental health support services to HCW were provided at 12 (36%) centers., Conclusions: Among HCW 10% tested positive for covid and 1.3% died. Mental health support services offered for HCW were available in 36% institutions. Neurology training was substantially affected due to low admissions, limited ward rounds and limited availability of online training., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Treatment options for newly diagnosed aplastic anemia (AA) patient includes upfront allogeneic hematopoietic stem cell transplant (HSCT) or immunosuppressive therapy (IST). With recent advances in supportive care, conditioning regimens and post-transplant immunosuppression the overall survival for HSCT approaches 70-90%. Transplant eligibility needs to be assessed considering age, comorbidities, donor availability and probability of response to immunosuppressive therapy (IST). Upfront HSCT should be offered to children and young adults with matched related donor (MRD). Upfront HSCT may also be offered to children and young adults with rapidly available matched unrelated donor (MUD) who require urgent HSCT. Bone marrow (BM) graft source and cyclosporine (CsA) plus methotrexate (MTX) as graft versus host disease (GVHD) prophylaxis are preferable when using anti-thymocyte globulin (ATG) based conditioning regimens. Alemtuzumab is an acceptable alternative to ATG and is used with CsA alone and with either BM or peripheral blood stem cells (PBSC). Cyclophosphamide (CY) plus ATG conditioning is preferable for patients receiving MRD transplant, while Fludarabine (Flu) based conditioning is reserved for older adults, those with risk factors of graft failure and those receiving MUD HSCT. For haploidentical transplant, use of low dose radiotherapy and post-transplant cyclophosphamide has resulted in a marked reduction in graft failure and GVHD., (Copyright © 2020 Elsevier Ltd. All rights reserved.)