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This review presents the composition, structure, mechanical characteristics, and applications of alumina (aluminum oxide) in biomedical. Alumina used for implant manufacturing is either single-crystal sapphires or high density and quality polycrystalline. The major sources of highly-purity alumina are organic corundum and bauxite. Like any other brittle component, polycrystalline alumina's mechanical characteristics are largely dependent on grain size and porosity distribution. It was shown that, due to slowed subcritical crack production, the fatigue intensity of alumina could be increased above the crucial pressure due to the presence of liquid. Due to its high inertness, that results in outstanding biocompatibility and tissue nonsensitization, alumina has significant benefits over other products in biomedical uses. Just like in artificially joints and teeth, the higher compressive strength than tensile strength allows it more efficient for compressive loadings. There were some attempts for coating alumina on steel substrates in order to benefit of its outstanding biocompatibility and to resist metal oxidation.

Background:Varicella-zoster virus (VZV) is one of the most common infections of childhood causing chickenpox, which in a majority of cases is self-limiting without any complicating consequences. However, in a meagre 0.01-0.03% cases, chickenpox may lead to serious neurological complications. Among them is acute cerebellar ataxia, which presents with the characteristic sign of broad-based gait abnormality, progressing gradually over the course of days, the mechanism of which is still debated upon. As a treatment option, the use of antiviral remains controversial, and some recommend it for better prognosis while others do not base on its autoimmune pathogenesis. This case is being communicated due to its rarity. Case Presentation:A case of a two-year-old female with a recent history of chickenpox eruption presented with the complaint of progressive loss of normal gait and difficulty in talking followed by generalized to-and-fro movements of her body leading to a diagnosis of post-viral acute cerebellar ataxia. There was no significant history of any past illnesses. Bacille Calmette Guerin (BCG) vaccine was given at birth, later followed by a single dose of pentavalent (Penta) vaccine. Management:Central nervous system (CNS) examination showed ataxic gait, pupils bilaterally equally reflective to light (BERL), nystagmus, dysmetria, and decreased muscle tone. Laboratory investigations were within the normal range. Imaging modalities that were all normal excluded other causes, including metabolic, tumors, and toxins. The patient was empirically treated with IV acyclovir BD for one week. Conclusion:As the rash of chickenpox resolves spontaneously in most cases, it is important that children infected with VZV should be closely observed for any neurological symptoms for timely and effective intervention. Link:http://aeirc-edu.com/ojs14/index.php/IJEHSR/article/view/459/592

Aim: Rats are accused in disseminating many zoonotic diseases. This study aimed to isolate and identify bacteria from internal organs of rats captured in Baghdad City, Iraq. Materials and Methods: A total of 120 black rats (R. rattus) were trapped from different areas in Baghdad city. Rats were kept in individual plastic cages for 3 h before euthanizing. Deep pharyngeal swab, intestinal content, urine, and pieces of the liver and spleen, lung, kidney, and brain were obtained aseptically. The specimens were inoculated into peptone water and incubated at 37°C for 24 h for enrichment. A loopful of each specimen was then subcultured onto MacConkey Agar, Blood Agar, and Mannitol Salt Agar. CHROMagar O157 H7 and CHROMagar Listeria were used to detect Escherichia coli 157:7 and Listeria spp., respectively. Biochemical tests on analytical profile index, microscopic examination, and commercial kit for latex agglutination test for serotyping E. coli O157:H7 were used. Results: Mixed bacterial isolates were recorded as 116, 52, 36, 28, 18, 6, and 4 from intestinal contents, deep pharyngeal, liver and spleen, urine, lung, brain, and kidney, respectively. Microorganisms included E. coli, Staphylococcus aureus, Streptococcus spp., Bacillus spp., Pseudomonas aeruginosa, Citrobacter freundii, Proteus vulgaris, E. coli O157:H7, Enterobacter cloacae, Listeria spp., Klebsiella spp., Ochrobactrum anthropi, Aeromonas spp., Brucella spp., Pseudomonas fluorescens, Escherichia fergusonii, Micrococcus spp., Morganella spp., Proteus mirabilis, Pseudomonas luteola, and Streptobacillus spp. The highest bacterial prevalence (88; 73.33%) was recorded for E. coli, where 68 isolates were identified from the intestinal contents. Of these, four isolates were E. coli O157:H7. Conclusion: Rats are important carriers and transmitters of a number of pathogens and can disseminate these microorganisms to humans and animals.

Numerous non-skeletal diseases have been reported to be associated with vitamin D status including type2diabetes mellitus (T2DM). Different studies provide evidence that vitamin D status as well as other elementssuch as vitamin D binding protein (DBP) and vitamin D receptor (VDR) may play substantial role in glucosetolerance. Present study was designed to investigate the role of vitamin D status and their elements ininsulin resistance or sensitivity in T2DM patients Current study includes 84 participants of both gender(56 patients and 28 as control). Clinical samples were collected from clinically proved DM2 patients.Serum levels of insulin, FBS, VD, VDR, and DBP were measured of each subjects. Using of HomeostasisModel Assessment Insulin resistance (HOMA-IR), T2DM patients were sub grouped to insulin resistance(IR) and insulin sensitivity (IS) groups. Relations among studied factors, FBS showed significant positiveand negative relation with HOMA-IR and VD3 respectively, furthermore HOMA-IR revealed significantpositive relation with DBP and VDR. Also, DBP revealed significant positive relation with each of VDRand HOMA-IR. On the other hand, VD3 levels showed significant and non-significant elevation in IS groupcompared to C and IR group respectively, while DBP revealed significant and non-significant dropping in ISgroup compared to C and IR groups respectively. Levels of VDR in IS group showed significant droppingcompared to C and IR groups respectively. Our study concludes that VD3 alone or with its elements playsubstantial role in regulation of blood sugar levels particularly related to insulin sensitivity

Background The coronavirus disease (COVID-19) pandemic has put an excessive strain on healthcare systems across the globe, causing a shortage of personal protective equipment (PPE). PPE is a precious commodity for health personnel to protect them against infections. We investigated the availability of PPE among doctors in the United States (US) and Pakistan. Methods A cross-sectional study, including doctors from the US and Pakistan, was carried out from April 8 to May 5, 2020. An online self-administered questionnaire was distributed to doctors working in hospitals in the US and Pakistan after a small pilot study. All analysis was done using Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY). Results After informed consent, 574 doctors (60.6% from Pakistan and 39.4% from the US) were included in the analysis. The majority of the participants were females (53.3%), and the mean age of the participants was 35.3 ± 10.3 years. Most doctors (47.7%) were from medicine and allied fields. Among the participants, 87.6% of doctors from the US reported having access to masks/N95 respirators, 79.6% to gloves, 77.9% to face-shields or goggles, and 50.4% to full-suit/gown. Whereas, doctors in Pakistan reported to have poor availability of PPE with only 37.4% having access to masks/N95 respirator, 34.5% to gloves, 13.8% to face-shields or goggles, and 12.9% to full-suit/gown. The reuse of PPE was reported by 80.5% and 60.3% physicians from the US and Pakistan, respectively. More doctors from Pakistan (50.6%) reported that they had been forced to work without PPE compared to doctors in the US (7.1%). Conclusion There is a lack of different forms of PPE in the US and Pakistan. Doctors from both countries reported that they had been forced to work without PPE. Compared to the US, more doctors from Pakistan reported having faced discrimination in receiving PPE.

Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by symptoms such as palpitations, dyspnea, chest discomfort, and lightheadedness affecting various systems. The pathophysiology of POTS is not completely understood due to a variety of symptoms showing that the disease is multifactorial. There is no approved uniform management strategy for POTS and hence, no drug has been approved by the United States (US) Food and Drug Administration (FDA) for it. Ivabradine is an FDA-approved drug for stable symptomatic heart failure (HF) and patients with an ejection fraction (EF) of ≤35%. Previous studies have depicted improvement in symptoms of POTS with the use of ivabradine. It is a selective inhibitor of funny sodium channels (If) in the sinoatrial (SA) node cells resulting in the prolongation of the slow diastolic depolarization (phase IV) and reduction in the heart rate (HR). Although beta-adrenoceptor blockers are commonly used to lower HR in patients with POTS, they are less ideal due to numerous adverse effects. This review aims to provide a comprehensive and up-to-date picture of all the studies and case reports that utilized ivabradine for the treatment of POTS along with a precise overview of epidemiology, pathophysiology, and types of POTS. To conclude, we recommend further research on the effectiveness of ivabradine in patients who experience symptoms of POTS. Other than stable chronic angina pectoris, its application in this setting has been proven to be effective and safe. Further evaluation by means of randomized control trials is required to encourage use of this HR-lowering agent in common disorders other than HF and stable angina, i.e. POTS.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to almost every country on the globe, and each country is reporting the symptomatic presentation of their patients to give better insight into the various clinical presentations of SARS-CoV-2. However, the epidemiological literature from Pakistan is scanty. Methods We retrospectively analyzed data from 412 patients who were residents of East Karachi and tested positive for SARS-CoV-2 between February 26 to April 24, 2020. Patients' demographics, symptoms, travel and contact history, and outcomes were recorded. All statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 22 (IBM SPSS Statistics for Windows, IBM Corp, Armonk, NY). Results Most of the patients were male (64.6%), the majority (43.3%) belonging to the 21- to 40-year age group. Most of the patients (65.5%) were residents of Gulshan Iqbal. A total of 15.8% of the patients were admitted to the hospital, and 3.9% of patients expired. The three most common presenting symptoms were fever (74.8%), cough (60.4%), and flu (35.5%). The majority of patients (89.3%) gave a history of contact with SARS-CoV-2 patients. Conclusion The number of SARS-CoV-2 cases is rapidly increasing in Karachi, Pakistan. There is a need to educate the population about the most common sign and symptoms of the virus so that individuals can identify these symptoms and get themselves tested. The concerned authorities should devise an adequate and effective plan to flatten the infectivity curve.

Protein C (PC) is a 62-kD vitamin K dependent glycoprotein produced by the liver as a zymogen and is activated by binding to the thrombin-thrombomodulin complex, with protein S (PS) acting as a cofactor. Among its various functions, PC acts as a naturally occurring anticoagulant and its deficiency, either homozygous or heterozygous, predisposes the individual to a state of thrombosis, particularly venous thromboembolism, and mainfests as myocardial infarction (MI), deep venous thrombosis, pulmonary embolism, or stroke. This review discusses the pathophysiology of the anticoagulatory effect of PC, mode of inheritance of its deficiency, the arterial and venous involvement in patients with stroke, and its risk factors. A detailed analysis of published case reports on PC deficiency as a causative agent of stroke in young adults has also been included along with the management of such patients.

Hereditary thrombophilia (HT), including the mutation of factor V gene and the deficiency of proteins C, protein S, or antithrombin, is a risk factor for portal vein thrombosis (PVT). PVT in acute cases is usually asymptomatic, whereas chronic cases mostly present as variceal bleeding and splenomegaly. However, cavernous transformation of the portal vein secondary to a long-standing PVT is very rare. Here we present a case of a 28-year-old female who was admitted with complaints of left upper abdominal pain and swelling for four to five years. Using laboratory and radiological examinations, a confirmatory diagnosis of cavernous transformation of a thrombosed portal vein due to protein C and S deficiency was made. The patient was managed through splenectomy with splenorenal shunting along with life-long prescription of anticoagulants.

Background Non-alcoholic fatty liver disease (NAFLD) is a common liver disorder caused by the deposition of lipids and fats in the hepatocytes, in individuals who consume little or no alcohol, which eventually progresses to cirrhosis and carcinoma. Apart from the known risk factors like obesity, metabolic syndrome (MS), and lack of physical activity (PA), diet also plays a major role in the development of NAFLD. A high body mass index (BMI) and waist circumference (WC) have positive associations with NAFLD. The aim of this study was to find the prevalence of risk factors of hepatic steatosis in NAFLD population and to raise public awareness about the condition. Method We conducted a cross-sectional study from October to December 2019 with a sample size of 98 subjects determined by using a confidence interval (CI) of 99.9%. Patients presenting to Essa Laboratory, Karachi for abdominal ultrasound (US) were scanned for fatty changes in the liver, after obtaining consent, and were then assessed for risk factors by administering a 20-item questionnaire along with registering their BMI and WC measurement. The collected data was analyzed using the Statistical Package for Social Sciences (SPSS), version 22 (IBM, Armonk, NY). The independent sample t-test was applied for the exploration of variables and a p-value

Insulinomas are rare, functional pancreatic neuroendocrine tumors arising from the pancreatic multipotent stem cells or neuroendocrine islet, occurring with a higher proportion in females. Majority of insulinomas have a sporadic etiology; however, only 5%-10% develop as a part of multiple endocrine neoplasm type 1 syndrome. They usually present with symptoms of hypoglycemia including disturbance in orientation, tremors, diaphoresis, altered mental state, seizures and visual changes among others. The diagnosis is based on appreciation of the classic Whipple triad, i.e. neuroglycopenic symptoms and sympathetic drive along with low serum glucose levels (

Meckel’s diverticulum (MD), a congenital abnormality of the gastrointestinal tract, is usually found in the pediatric population younger than two years of age; hence, its incidence in adults is rare. Although MD is mostly clinically silent, in adults, it may present with intestinal obstruction and diverticulitis. The complications of MD include hemorrhage, perforation, enterolith formation, torsion, Littre’s hernia, ulceration and neoplasm. Among these, torsion is one of the rarely reported complications of MD. MD being attached to the ileal mesentery or umbilicus, presence of mesodiverticular band, and the length, breadth and base diameter of the diverticulum contribute as a risk factor for torsion. A similar clinical picture of acute appendicitis must be excluded. We report a case of a 25-year-old male who presented with signs of intestinal obstruction in whom intraoperative finding of a torted MD with necrotic and twisted base was found upon emergency exploratory laparotomy.

Protein C (PC) and protein S (PS) are natural anticoagulants that protect the body against thrombosis, and their deficiency, either inherited or acquired, renders the body to a hypercoagulable state. This leads to venous thromboembolism manifesting as thrombosis, pulmonary embolism and superficial thrombophlebitis among other causes. The involvement of arteries is rare and has been explained by only a few studies. Hence, the presentation of PC and PS deficiencies with stroke and myocardial infarction (MI) is rarely observed, especially in young patients. We report a case of a 33-year old male with a past medical history of stroke and MI for which no underlying cause was found. He presented now with shortness of breath and left-sided chest pain and after a series of workup, eventually diagnosed as a rare case of PC and PS deficiencies.

Every year, the world produces one million tons of glass garbage. Once the glass has been broken down, it is dumped in landfills, where it will remain inert for hundreds of years. glass is mainly made of silica. For long-term infrastructure development, ground glass as a partial cement substitute may be a major advance (environmentally friendly, energy-saving, and economic). Secondary calcium silicate hydrate is expected to be produced when glass waste is crushed into microscopic particles and then reacts with cement hydrate through pozzolanic interactions (C-S-H). There were experiments done on concrete utilizing (0-35 per cent) ground glass and superplasticizer, silica fume, fine sand and fibres, with the water to binder (cement + glass) ratio maintained constant for all degrees of replacement on compressive strength, modulus of elasticity and tensile strength. Steel is a fixed quantity that applies to all conceivable configurations. Concrete cube samples were made and tested for strength (28 days curing). It was discovered that the recycled glass concrete outperformed control samples in compressive strength tests. Compressive strength, tensile strength, and modulus of elasticity are all greatest in the 25 per cent glass powder. It was decided that using recycled glass trash in place of 25 per cent of the cement was a good idea because of the economic and environmental advantages.

Cavernous transformation of the portal vein (CTPV), also known as portal cavernoma, is a sequelae of thrombosis in the portal vein causing its occlusion and portal hypertension. The etiology, however, remains unknown. Gastroesophageal variceal bleeding, splenomegaly, portosystemic collaterals, and ultimate hematologic abnormalities are among the prominent clinical features. Among the causes, predisposing an individual to CTPV is natural anticoagulant protein C and antithrombin III deficiencies. Determination of the etiology of CTPV may also give a direction toward the management plan to not only relieve the patient of the already developed complications but also to treat the primary cause of the pathology We discuss a case of a nine-year-old male child diagnosed as CTPV secondary to protein C and antithrombin III deficiency who was treated symptomatically for anemia and varices and was referred for transjugular intrahepatic portosystemic shunt (TIPS).

Inositol, an emerging novel therapy for the treatment of gestational diabetes mellitus (GDM), is a cyclic polyol that has insulin-like effects and plays an important role in glucose homeostasis. The conventional treatment of GDM with insulin and oral antihyperglycemic drugs usually comes with side effects, paving the way for and shedding spotlight on clinical trials involving inositol. This review analyzed a host of recent trials that involved inositol supplementation for preventing GDM and their positive outcomes in reducing the rate of GDM among obese and overweight pregnant women, as well as women with polycystic ovarian syndrome (PCOS) or a family history of type 2 diabetes mellitus.

Malignant rhabdoid tumor of the kidney (MRTK) is a rare neoplasm of infancy. We report a case of a nine-month-old male infant who presented to the pediatrics outpatient department with the history of fever, lethargy, and abnormal head movements. On gross examination, the patient had a firm, non-tender, intra-abdominal mass at the right lumbar region with irregular margins. Computed tomography scan of the abdomen revealed a lobulated soft tissue arising from the kidney with areas of necrosis. Brain magnetic resonance imaging was also performed, which showed a large heterogeneous lesion in the posterior fossa. Histopathologic study revealed loss of INI1 protein. Since MRTK and atypical teratoid rhabdoid tumor (ATRT) of the brain share a common mutation in the gene (hSNF5/INI1), hence a diagnosis of MRTK with co-existent ATRT of the brain was established. Actinomycin-D and vincristine failed to show any improvement and the condition of the patient deteriorated progressively, resulting in his death within 15 days of hospital admission.

Background Opioid analgesics, also known as narcotics, are medicinal drugs used primarily for the management of pain secondary to any type of cancer, severe injury or surgery. Due to the ease of availability, opioids are commonly abused. In 2015, reported deaths exceeded 33,000 Americans from opioid overdose. A survey in 2013 revealed nearly 1.6 million Pakistanis abusing prescription opioids for non-medical needs. Although commonly prescribed by primary care physicians, most of them are diffident to stand by all the recommended strategies to reduce the incidence of opioid abuse. Methods A cross-sectional study was conducted during the period of August through October 2018. A sample size of 365 was determined using a 95% confidence interval at a degree of precision of 5%. A 22-item questionnaire was given to doctors with at least two years practicing experience either from a private or a public healthcare setup. Doctors who had never prescribed opioids were excluded from the study. Out of the eligible participants, 15 refused to take part in the survey, and the co-operation rate was recorded as 95.8%. Collected data were analyzed using statistical package for social science (SPSS) version 22 for Windows. Frequencies, percentages, mean, standard deviation, and chi-square were used to explore the variables. The statistical significance level was considered at p < 0.5. Results Opioids were reported to be used mainly for treating acute pain (40.5%), chronic pain (24.7%) and both acute and chronic (34.8%). A minority of doctors (29%) screened their patients for opioid addiction. A significant association (p = 0.000) between the frequency of opioid prescription and prior screening for depression was determined. Surprisingly, only 23.2% clinicians frequently screened their patients for depression before prescribing opioids. The rate of counselling regarding drug tapering was found to be 71.6%. A majority, i.e., 88%, of the respondents anticipated the misuse of opioids they prescribe whereas 74% also held a belief that patients self-medicate their untreated pain. Participants reported addiction (54%) as the most common reason for abuse followed by the role of pharmaceutical companies (43%) and pharmacies (41%). About 80.2% clinicians believed that patients addicted to opioids could get well and return to their daily routine. Conclusion The rising opioid epidemic is a major concern for doctors prescribing opioids. Adaptation of medical school curricula and appropriate training can equip doctors for better management of patients requiring opioids. This includes the screening of patients using standard risk assessment tools for opioid abuse leading to a more controlled opioid prescription practice. Dissemination of these tools will boost doctors' confidence and may help in reducing morbidity and mortality from opioid abuse.

Background: The prostate gland is a male sexual organ which has a number of diseases associated with it, such as prostatitis, benign prostatic hyperplasia (BPH), and prostatic cancer (PC). BPH is the most common neoplasm, and it causes significant urinary symptoms in adult males. According to the World Health Organization (WHO) report of 2014, out of all the cancers, PC had the fifth highest incidence in males throughout Pakistan. The purpose of this study was to determine the awareness of elderly men of Karachi regarding prostate diseases (PDs) and their attitude towards screening practices. Method: From September to December 2018, a cross-sectional study was performed among 450 men of Karachi older than 50 years of age. Frequencies and percentages were evaluated for categorical variables using Statistical Package for Social Sciences (SPSS), version 22 (IBM SPSS Statistics, Armonk, NY). Chi-square test was used to determine if there was any significant difference. A p-value of < 0.05 was considered significant. Result: A total of 350 respondents answered the questionnaire. The mean age of the respondents was 61 years. Almost half of the population had heard about the prostate but 64% did not know any PDs, whereas 48% were aware of the increased risk of PDs in the elderly. Almost 48% of the respondents believed that age was the main cause of disorders involving the prostate. Even though the knowledge was lacking, people had an overall positive attitude. Most respondents (66%) had the attitude that all adult men must undergo prostate screening. The majority of respondents (85%) had not undergone screening of the prostate as the huge group of participants (86%) had not been advised to do it. Upon statistical testing, having heard about the prostate and undergoing prostate screening in the past (p = 0.008 and 0.024, respectively) was significantly associated with age. Having prior experience with prostate screening was also associated significantly with marital status (p < 0.001). Conclusion: Respondents have inadequate knowledge about PC but a good attitude about undergoing prostate examination. It is absolutely crucial to increase information on the risks of PDs, particularly PC, and the benefits of early detection.

Protein C and protein S are vitamin K dependent anti-coagulant proteins required for the inhibition of activated protein V and VIII. In an inherited thrombophilia, hypercoagulability caused by the deficiency of protein C and protein S predisposes an individual to increased risk of thromboembolism (TE) that could herald as a venous thromboemboilsm (VTE) in the leg, pulmonary embolism (PE), stroke, or Budd-Chiari syndrome. However, very rarely does inherited thrombophilia cause coronary artery thrombosis leading to the development of myocardial infarction (MI). We report a case of a young male with combined protein C and protein S deficiency who presented with acute MI, worsened ventricular systolic function, and progressive declination of ejection fraction (EF) secondary to dilated cardiomyopathy (DCM).

Hemophilia A is an X-linked hereditary bleeding disorder that is rarely encountered by most physicians and surgeons in their practice. Patients with mild hemophilia A tend to bleed profusely after surgery or trauma whereas a severe variant may manifest as spontaneous bleeding after minor trauma, mainly into the joints and muscles. However, seldom do we find a case where the patient experiences bleeding into multiple joints at the same time. In the South Asian population, the incidence of hemarthrosis in hemophilic patients holds scarce literature, making this an under-reported entity.

Congenital talipes equinovarus (CTEV), otherwise known as clubfoot (CF), is a common congenital abnormality of the foot, stemming in most cases from an idiopathic cause or in the remaining non-idiopathic occurrences, from meningomyelocele (MMC). Ponseti method (PM), being a gold standard treatment for the correction of this foot deformity, requires a series of regular casting usually accompanied by percutaneous tenotomy of the Achilles tendon and later maintained via abduction braces. Osteomyelitis (OM), as a complication of PM, is rarely reported especially in cases of CF-associated with MMC in which majority of the patients present with varying level of sensory deficit in the lower limbs. Therefore, the absence of pain due to neuropathy leads to a delayed diagnosis of cellulitis and chronic abscesses. We present a case of an eight-year-old male child with exogenous OM as a complication of PM affecting the tarsal bones of his right foot. After an established diagnosis using laboratory results and imaging modalities, the patient was successfully treated with broad spectrum antibiotics achieving full resolution of his clinical symptoms. We report this case due to its rarity.

Rhino-oculo cerebral mucormycosis (ROCM) is a rare, invasive, and rapidly progressive fungal infection affecting nose, paranasal sinuses and often extending to orbit, brain, and palate. The immunocompromised, more commonly patients with diabetes mellitus, fall victim to this lethal form of fungus. Although the therapeutic approach includes aggressive surgical and medical interventions, ROCM remains a life-threatening infection with poor prognosis. This rare case addresses the outcomes of ROCM in a young patient with delayed diagnosis and resistance to amphotericin B (Ampho B) contributing to dreadful outcomes.

Cases on concurrent infection of dengue and malaria are uncommon in Pakistan. Dengue and malaria are the two very common, mosquito-borne infections, which may have significant morbidity and mortality if not managed properly. Concurrent infections of dengue and malaria are rare due to the different habitats of its vectors and activities of different bearer mosquitoes. The first case was reported in 2005. Since then, several co-existing infections have been reported consisting of the dengue virus (DENV) and the malaria protozoans. Symptoms of each infection may be disguised by a coincident second infection, resulting in delayed treatment and severe complications. We report a case of concurrent malaria and dengue viral hemorrhagic fever in a 19-year-old male.

An artificial pacemaker is a medical device that can generate electrical impulses which are delivered by electrodes to maintain the controlled rhythm of the heartbeats. Such a medical device can assist for extensive period of time and thereby regulates the pumping capacity of the heart. Usually, the need for a permanent pacemaker implantation arises from the occurrence of cardiac diseases such as failure of impulse formation (sick sinus syndrome) and/or conduction (A-V block). Functionally, a pacemaker comprises of at least three parts: an electrical pulse generator, a power source (battery) and an electrode (lead) system. This paper aims to provide a design of the trainer board of a typical pacemaker, which generates a QRS pulse and displays it on an oscilloscope which will help understand the basic components of the device for educational purposes. To do so, an extensive literature review was undertaken to comprehend the theory behind the design of a pacemaker. Further, the paper describes the practical methodology adopted in the design of the pacemaker and the achieved results of this study while making suggestions for future work.

In this paper, the air temperature and humidity levels in the infant' incubator are monitored remotely by means of Arduino microcontroller with different sensors and an open source internet of things (IoT) applications. The system is connected to a network via a wireless fidelity (Wi-Fi) connection to be linked to an application on the smart phone or to the computer. The system is designed using Arduino microcontroller, DHT11/DHT22 sensor for measuring the body parameters, such as the temperature and the humidity, LCD monitor, ESP8266 WiFi modules, and NodeMCU-v3.The results have shown that real time updated medical records can be transferred to the medical staff utilizing ThingSpeak IoT applications.