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Background: Pseudomonas aeruginosa is a major cause of multidrug resistant (MDR) nosocomial pathogen isolated from clinical samples of patients admitted to the intensive care unit. Treating the ever-increasing antimicrobial resistance in P. aeruginosa isolates has turned into a challenge. Materials and Methods: All data were extracted from the hospital information system on P. aeruginosa pneumonia from July 2017 to July 2022. All isolates were identified by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry and routine biochemicals. A comparison between the consequences of antibiotic susceptibility testing, demographics, and risk factors between the patients with community-acquired and nosocomial-acquired pneumonia due to either P. aeruginosa or multidrug-resistant P. aeruginosa was performed. Results: In this study, 576 (576/19224, 2.99%) patients developed P. aeruginosa pneumonia over 6 years. There were 114 (19.79%) cases of community-acquired pneumonia and 462 (80.21%) cases of nosocomially acquired pneumonia in this study. P. aeruginosa showed high resistance to cefoperazone-sulbactam and imipenem, which was statistically significant in cases of patients suffering from nosocomially acquired pneumonia compared to community-acquired pneumonia. High susceptibility to colistin was statistically significant in cases of community-acquired pneumonia compared to nosocomially acquired pneumonia. A total of 182 (182/576, 31.59%) deaths occurred among cases of P. aeruginosa pneumonia. Conclusion: This study explains the emergence of resistance among the P. aeruginosa isolates causing community-acquired pneumonia or nosocomially acquired pneumonia over 6 years.

Introduction This study aimed to test how normal physical treatment, with or without home-based intense bimanual training, affected hand coordination and daily living activities in children with cerebral palsy. Methods A randomised controlled experiment was carried out at DHQ Hospital in Kasur, Pakistan. Thirty children with unilateral spastic cerebral palsy took part in the study. The first group received standard physical treatment, whereas the second group received bimanual training along with routine physical therapy. Follow-ups were performed in the fourth and sixth weeks. The paediatric motor log activity scale and the ABILHAND questionnaire were used to assess daily activities and coordination, respectively. Results At baseline, no significant association was seen between treatment groups and hand coordination outcome among the patients ( p = 0.0450) and no significant difference was seen in patients in both treatment groups regarding their activities of daily living. In group A, no significant improvement was seen in hand coordination from baseline until the 6th week ( p = 0.257) while in group B, a significant difference was seen in hand coordination from baseline until the 6th week follow-up ( p = 0.000). Conclusions This study concluded that the combined effect of home-based bimanual exercises and routine physical therapy shows significant achievements in hand coordination and activities of daily living.

BackgroundThe preadmission clinic (PAC) is crucial in perioperative care, offering evaluations, education, and patient optimization before surgical procedures. During the COVID-19 pandemic, the PAC adapted by implementing telephone visits due to a lack of infrastructure for video consultations. While the pandemic significantly increased the use of virtual care, including video appointments as an alternative to in-person consultations, our PAC had not used video consultations for preoperative assessments. ObjectiveThis study aimed to develop, implement, and integrate preoperative video consultations into the PAC workflow. MethodsA prospective quality improvement project was undertaken using the Plan-Do-Study-Act (PDSA) methodology. The project focused on developing, implementing, and integrating virtual video consultations at London Health Sciences Centre and St. Joseph Health Care (London, Ontario, Canada) in the PAC. Data were systematically collected to monitor the number of patients undergoing video consultations, address patient flow concerns, and increase the percentage of video consultations. Communication between the PAC, surgeon offices, and patients was analyzed for continuous improvement. Technological challenges were addressed, and procedures were streamlined to facilitate video calls on appointment days. ResultsThe PAC team, which includes professionals from medicine, anesthesia, nursing, pharmacy, occupational therapy, and physiotherapy, offers preoperative evaluation and education to surgical patients, conducting approximately 8000 consultations annually across 3 hospital locations. Following the initial PDSA cycles, the interventions consistently improved the video consultation utilization rate to 17%, indicating positive progress. With the onset of PDSA cycle 3, there was a notable surge to a 29% utilization rate in the early phase. This upward trend continued, culminating in a 38% utilization rate of virtual video consultations in the later stages of the cycle. This heightened level was consistently maintained throughout 2023, highlighting the sustained success of our interventions. ConclusionsThe quality improvement process significantly enhanced the institution’s preoperative video consultation workflow. By understanding the complexities within the PAC, strategic interventions were made to integrate video consultations without compromising efficiency, morale, or safety. This project highlights the potential for transformative improvements in health care delivery through the thoughtful integration of virtual care technologies.

Dear Editor, Cancer is one of the major public health concerns globally. Despite the advances in anticancer therapies, we still lack the approach to enhance its efficacy. Although the gold standard of treatment for most cancers includes a combination of chemotherapy, radiation and surgery, many patients still suffer from poor prognosis and alternative effective therapy is required.

Background: Meningitis can be attributed to bacterial, fungal, or viral agents. In this study, we demonstrate the common bacterial agents causing meningitis along with their antibiotics susceptibility pattern in patients of all age groups. Material and Methods: This retrospective, observational study was carried out in the Department of Microbiology with cerebrospinal fluid (CSF) samples collected from November 2019 to May 2022. We collected 1986 nonrepeat CSF samples from clinically suspected patients of bacterial meningitis, and clinical information about the patients was extracted from the hospital information system. Results: Out of the 1986 CSF samples included in our study, 150 (7.55%) were found to be positive on bacterial culture. Most of our patients were in the age group of 0–20 years. Common clinical manifestations observed in our patients were: high-grade fever, 87 patients (58%); severe headache, 126 patients (84%); neck rigidity, 47 patients (31.3%); altered mental status, 76 patients (50.7%) and photophobia, 83 patients (55.3%). The most commonly isolated bacteria was Acinetobacter species (30%). The mean length of hospitalization (37.76 ± 25.30), the mean total cell count, high levels of protein (mg/dl) and low levels of glucose (mg/dl) of CSF were statistically significant in meningitis caused by multidrug-resistant bacteria. Conclusion: We recognized the spectrum of pathogens causing meningitis at our center along with the antibiotic resistance pattern to guide and facilitate early treatment by primary health care professionals and family medicine practitioners.

Purpose – This study aims to explore how businesswomen running micro and small enterprises (MSEs) use social media (SM) to engage customers. The study also investigates how SM (vs traditional media) and customer engagement improve business performance. Design/methodology/approach – This qualitative study is based on interviews with businesswomen. Findings – Businesswomen use SM actively but not effectively. SM are used primarily for advertising and promotion. External factors, such as family and friends, are more influential in the decision of women to use SM in business. Women mostly use defensive rather than offensive strategies. Effective use of SM in conjunction with conventional marketing tools can improve customer engagement and increase business performance. Practical implications – The research findings are valuable for marketing managers, women entrepreneurs and micro and small businesses in making decisions to effectively use SM. Originality/value – This study investigates customer engagement from the owner/manager’s perspective in contrast to the general customer-centric approach. The study contributes analysing an important and scarcely explored area, which is the use of SM by women-run MSEs in less developed countries to engage consumers. ¿Cómo atraen las empresarias a los clientes en las redes sociales? Propósito – Este estudio explora cómo las mujeres de negocios que dirigen micro y pequeñas empresas (MSE) utilizan las redes sociales para atraer a los clientes. El estudio también investiga cómo las redes sociales (frente a los medios tradicionales) y la involucración de los clientes mejoran el rendimiento empresarial. Metodología – Este estudio cualitativo se basa en entrevistas con mujeres empresarias. Conclusiones – Las mujeres empresarias utilizan las redes sociales de forma activa, pero no eficaz. Las redes sociales se utilizan principalmente para la publicidad y la promoción. Los factores externos, como la familia y los amigos, influyen más en la decisión de las mujeres de utilizar las redes sociales en los negocios. Las empresarias utilizan sobre todo estrategias defensivas en lugar de ofensivas. El uso eficaz de las redes sociales junto con las herramientas de marketing convencionales puede mejorar el compromiso de los clientes y aumentar el rendimiento de la empresa. Implicaciones prácticas – Los resultados de la investigación son valiosos para las directivas de marketing, las mujeres empresarias y las micro y pequeñas empresas a la hora de tomar decisiones y para utilizar eficazmente las redes sociales. Originalidad – Este estudio investiga el compromiso del cliente desde la perspectiva del propietario/gerente en contraste con el enfoque general centrado en el cliente. El estudio contribuye a analizar un área importante y escasamente explorada, que es el uso de las redes sociales por parte de las microempresas dirigidas por mujeres en los países menos desarrollados para involucrar a los consumidores. 女企业家如何在社交媒体上吸引客户？ 目的 – 本研究探讨了经营微型和小型企业（MSEs）的女商人如何使用社交媒体来吸引客户。该研究还调查了社交媒体（相对于传统媒体）和客户参与如何提高企业绩效。 方法 – 这项定性研究是基于对女商人的采访。 研究结果 – 女商人积极使用社交媒体, 但并非有效。社交媒体主要用于广告和推广。外部因素, 如家庭和朋友, 对妇女在商业中使用社交媒体的决定更有影响力。女性大多使用防御性而非进攻性策略。将社交媒体与传统的营销工具有效地结合起来使用, 可以提高客户的参与度, 增加企业的业绩。 实践意义 – 研究结果对营销经理、女企业家和小微企业做出有效使用社交媒体的决定很有价值。 原创性 – 本研究从业主/经理的角度调查了客户参与度, 与一般的以客户为中心的方法不同。该研究有助于分析一个重要的、很少被探索的领域, 即欠发达国家的妇女经营的微型企业使用社交媒体来吸引消费者。

Purpose The composting of manure is the common practice for the feedlots of cattle, but emission of gasses during composting was poorly understood. So, there is need to enhance nutrient contents in composting material, reduce odor and other impurities by various amendment in composting material. This study was planned to find best composting condition for quality compost production. Method Experiment was performed under completely randomized design (CRD) with three factors. First factor (treatment) comprised of three levels e.g.: T1: CM + WS (25% + 75%), T2: CM+WS (50%+50%) and T3: CM +WS (75% +25%). Second factor was composting conditions consisted of two levels e.g., aerobic and anaerobic conditions. Third factor was duration of composting (days). Results Composting conditions significantly influenced emission of greenhouse gasses and compost quality. Maximum gas volume (658 ml) and methane production (58.89%) were produced under anaerobic decomposition of cow manure and wheat straw 3:1, respectively. Maximum carbon dioxide (18.56%) was produced under the aerobic decomposition of cow manure and wheat straw mixed in 1:3 ratio. Nutrient analysis of compost revealed that high-quality compost with maximum total organic carbon (20.1%), total nitrogen (2.47%), phosphorus (0.76%) and potassium (1.49%) was observed from compost produced from anaerobic decomposition of cow manure and wheat straw mixture @ 3:1.Conclusion This work highlights that the anaerobic composting of cow manure and wheat straw has potential to produce the biogas as well as best quality compost.

Wheat is one of the most important food crops, both in China and worldwide. Wheat production is facing extreme stresses posed by different diseases, including Fusarium head blight (FHB), which has recently become an increasingly serious concerns. FHB is one of the most significant and destructive diseases affecting wheat crops all over the world. Recent advancements in genomic tools provide a new avenue for the study of virulence factors in relation to the host plants. The current review focuses on recent progress in the study of different strains of Fusarium infection. The presence of genome-wide repeat-induced point (RIP) mutations causes genomic mutations, eventually leading to host plant susceptibility against Fusarium invasion. Furthermore, effector proteins disrupt the host plant resistance mechanism. In this study, we proposed systematic modification of the host genome using modern biological tools to facilitate plant resistance against foreign invasion. We also suggested a number of scientific strategies, such as gene cloning, developing more powerful functional markers, and using haplotype marker-assisted selection, to further improve FHB resistance and associated breeding methods.

Infections caused by multi-drug resistant Klebsiella pneumoniae are a leading cause of mortality and morbidity among hospitalized patients. In neonatal intensive care units (NICU), blood stream infections by K. pneumoniae are one of the most common nosocomial infections leading to poor clinical outcomes and prolonged hospital stays. Here, we describe an outbreak of multi-drug resistant K. pneumoniae among neonates admitted at the NICU of a large tertiary care hospital in India. The outbreak involved 5 out of 7 neonates admitted in the NICU. The antibiotic sensitivity profiles revealed that all K. pneumoniae isolates were multi-drug resistant including carbapenems and colistin. The isolates belonged to three different sequence types namely, ST-11, ST-16 and ST-101. The isolates harboured carbapenemase genes, mainly blaNDM-1, blaNDM-5 and blaOXA-232 besides extended-spectrum β-lactamases however the colistin resistance gene mcr-1, mcr-2 and mcr-3 could not be detected. Extensive environmental screening of the ward and healthcare personnel led to the isolation of K. pneumoniae ST101 from filtered incubator water, harboring blaNDM-5, blaOXA-232 and ESBL genes (blaCTX-M) but was negative for the mcr genes. Strict infection control measures were applied and the outbreak was contained. This study emphasizes that early detection of such high-risk clones of multi-drug resistant isolates, surveillance and proper infection control practices are crucial to prevent outbreaks and further spread into the community.

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Background and Purpose There are reports of decline in the rates of acute emergency presentations during coronavirus disease 2019 (COVID-19) pandemic including stroke. We performed a meta-analysis of the impact of COVID-19 pandemic on rates of stroke presentations and on rates of reperfusion therapy. Methods Following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, we systematically searched the literature for studies reporting changes in stroke presentations and treatment rates before and during the COVID-19 pandemic. Aggregated data were pooled using meta-analysis with random-effect models. Results We identified 37 observational studies (n=375,657). Pooled analysis showed decline in rates of all strokes (26.0%; 95% confidence interval [CI], 22.4 to 29.7) and its subtypes; ischemic (25.3%; 95% CI, 21.0 to 30.0), hemorrhagic (27.6%; 95% CI, 20.4 to 35.5), transient ischemic attacks (41.9%; 95% CI, 34.8 to 49.3), and stroke mimics (45.6%; 95% CI, 33.5 to 58.0) during months of pandemic compared with the pre-pandemic period. The decline was most evident for mild symptoms (40% mild vs. 25%–29% moderate/severe). Although rates of intravenous thrombolytic (IVT) and endovascular thrombectomy (EVT) decreased during pandemic, the likelihood of being treated with IVT and EVT did not differ between the two periods, both in primary and in comprehensive stroke centers (odds ratio [OR], 1.08; 95% CI, 0.94 to 1.24 and OR, 0.95; 95% CI, 0.83 to 1.09, respectively). Conclusions Rates of all strokes types decreased significantly during pandemic. It is of paramount importance that general population should be educated to seek medical care immediately for stroke-like symptoms during COVID-19 pandemic. Whether delay in initiation of secondary prevention would affect eventual stroke outcomes in the long run needs further study.

Introduction: Acinetobacter is a non fermenting, Gram negative bacillus, a causative pathogen of hospital-acquired infections due to its inherent Multidrug-Resistant (MDR) property. It is held responsible for the majority of nosocomial meningitis in patients undergoing neurosurgical procedures. Aim: To identify the clinical characteristics, drug-resistance and mortality rate among the patients suffering from meningitis caused by Acinetobacter baumannii. Materials and Methods: This retrospective, single-centre study was carried out in the Bacteriology section of the Department of Microbiology at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, from February 2019 to February 2022. A total of 150 Cerebrospinal Fluid (CSF) samples from routine bacterial culture-confirmed patients were included in the study. All clinical data were extracted from the Hospital Information System (HIS). All the isolates were identified by Matrix Assisted Laser Desorption/Ionisation-Time of Flight-Mass Spectrometry (MALDI-TOF-MS) assay and antibiotic sensitivity testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: The study included 150 (7.55%) cases of culture-proven bacterial meningitis among 1986 CSF samples collected from February 2019 to February 2022. There were 45 (30.0%) cases of Acinetobacter meningitis. Thirty-five (77.8%) patients had undergone neurosurgical procedures for the removal of space-occupying lesions from the brain parenchyma. Forty-two (93.3%) isolates were resistant to amikacin and a cumulative resistance of almost 93.3-95.6% was observed among cephalosporins. Fluoroquinolone resistance was observed in 43 (95.6%) patients and carbapenem resistance was observed in 42 (93.33%) isolates. Overall, 12 (26.7%) succumbed to their infections. Conclusion: Acinetobacter meningitis causes delay in the recovery of the patient undergoing intracranial surgery, amounting to a delay in brain parenchyma healing in the case of neurosurgical patients.

Dear Madam/Sir, The COVID-19 outbreak has swiftly changed into a worldwide pandemic. This transition has had adverse consequences for public institutions raising questions particularly for medical schools. (1) Following the pandemic, nationwide lockdown has impacted 89% of the world’s student population. (2) In this Letter, our focus is to highlight the challenges faced by medical students during this prolonged period of online education concluded by some suggestions to overcome them. A number of changes were done to address the imminent challenge of closure and improve the durability of educational systems in Pakistan. The primary shift was to plan and deliver learning sessions where students and teachers are geographically remote from each other. Online synchronous instruction sessions were quickly introduced using platforms like Zoom and Microsoft Team. (3) Although these efforts contributed to the efficient delivery of content, they also caused instructors, and learners to struggle with the process. (4) In an underdeveloped country like Pakistan, online learning is ineffective as majority of the students lack internet facilities due to technical and financial issues. Some of the other difficulties faced by students include absence of in person interaction with the tutor, lack of immediate tutor response and absence of on campus social interaction. (5) This effect of COVID-19 became an immediate concern among medical students. They were suspended from attending their clinical training which led to reduced exposure causing a pernicious effect on exam performance. A vast number of students missed the opportunity of doing electives abroad as most of them were cancelled due to the increasing number of cases. (6) To conclude, e-learning did influence the quality of medical education and therefore requires a collaborative approach to address the situation. There are some points we would like to suggest. Firstly, the teaching faculty should be given proper virtual training by allotting an IT professional to each one of them. Secondly, the lectures conducted should be interactive rather than being recorded in order to increase student engagement. This should be followed by routine assessments to evaluate their knowledge retention. Lastly, online problem-based learning techniques should be implemented so that the deficit of clinical exposure can be fulfilled. Despite the challenges posed by the pandemic, we must take this as an opportunity to develop e-learning programs which can open new horizons in distant-learning medical education.

Objective: To investigate the mutation in Vangl1 gene in patients of myelomeningocele. Method: The cross-sectional study was conducted from July 2017 to December 2017 in the Dow Diagnostic and Research Laboratory, Karachi, after approval from the ethics review committee of Dow University of Health Sciences, Karachi, and comprised clinically diagnosed infants and 10 healthy individuals from the outpatient department of Jinnah Postgraduate Medical Centre, Karachi. Several anatomical parameters were considered, such as size and site of the cyst. Blood samples were drawn and polymerase chain reaction was conducted for the identification of mutation in Vangl1 gene. Mutation analysis was carried out by aligning the sequence with the reference sequence. Results: Of the 60 subjects, 50(83.3%) were cases with age range 0-10 years, and 10(16.6%) were age matched controls. Majority of the patients 44 (88%) were aged

Objective Lumbar fusion with implantation of interbody cage is a common procedure for treatment of lumbar degenerative disease. This study aims to compare the fusion and subsidence rates of titanium (Ti) versus polyetheretherketone (PEEK) interbody cages after posterior lumbar interbody fusion and investigate the effect of clinical and radiological outcomes following fusion on patient-reported outcomes. Methods A systematic search strategy of 4 electronic databases (MEDLINE, Embase, Web of Science, and Cochrane) was conducted using different MeSH (medical subject headings) terms until January 2020. Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using fixed and random-effect models based upon the heterogeneity (I2) to estimate the association between interbody cages and the measured outcomes. Results A total of 1,094 patients from 11 studies were reviewed. The final analysis included 421 patients (38.5%) who had lumbar surgery using a Ti and/or a Ti-coated interbody cage and 673 patient (61.5%) who had lumbar surgery using a PEEK cage. Overall, PEEK interbody devices were associated with a significantly lower fusion rate compared with Ti interbody devices (OR, 0.62; 95% CI, 0.41–0.93; p = 0.02). There was no difference in subsidence rates between Ti and PEEK groups (OR, 0.91; 95% CI, 0.54–1.52; p = 0.71). Also, there were no statistically significant differences in visual analogue scale (VAS)-low back pain (p = 0.14) and Japanese Orthopedic Association scale (p = 0.86) between the 2 groups. However, the PEEK group had lower odds of leg pain after surgery compared to the Ti group (OR [VAS-leg], 0.61; 95% CI, 0.28–0.94; p = 0.003). Conclusion Ti and Ti-coated PEEK cages used for posterior lumbar interbody fusion are associated with similar rates of subsidence, but a higher rate of fusion compared to PEEK interbody cages. Randomized controlled trials are needed to better assess the effect of cage materials and potential factors that could influence the outcomes of interbody lumbar fusion.

LPS-responsive beige-like anchor protein (LRBA) deficiency is a primary immunodeficiency caused by a mutation in the LRBA gene. Affected individuals present with a variety of clinical symptoms including hypogammaglobulinemia, recurrent infections, splenomegaly, hepatomegaly, and autoimmune cytopenias. Except for hypogammaglobulinemia, the remaining features resemble autoimmune lymphoproliferative syndrome (ALPS). Here, we report the case of a 14-year-old boy with the ALPS phenotype, eventually diagnosed with LRBA deficiency. He presented with lymphadenopathy and hepatosplenomegaly, along with autoimmune cytopenia. Due to recurrent infections and worsening gastrointestinal symptoms, whole-exome sequencing was conducted and revealed a novel homozygous pathogenic variant in the LRBA gene (c.534del; p.9Asp179IIef*16). The patient recently suffered from clinical deterioration due to SARS-COV-2 which appears to have triggered an acute worsening of his existing Cytomegalovirus colitis leading to an eventual demise. A literature search for reported LRBA deficient patients with ALPS-like phenotype revealed 11 patients. The most common clinical presentations in LRBA patients with ALPS-like phenotype included autoimmunity (100%), splenomegaly (91%), lymphadenopathy (36.4%), and respiratory tract infections (63.6%). LRBA deficiency is unique in the fact that it encompasses immune deficiency, autoimmunity, and lymphoproliferation. In children with multiple symptoms related to these domains, a genetic diagnosis is necessary to ensure tailored and precise medical therapy.

ObjectiveSigmoid sinus (SS) stenosis is a complication of translabyrinthine approach. Velocity changes in the SS measured by intra-operative doppler ultrasound may help in identifying patients at risk for sinus occlusion.PatientsSS velocity was measured using doppler ultrasound prior to opening dura and again prior to placement of the abdominal fat graft.InterventionData collected included: patient age, surgical side, sinus dominance, tumor volume, intra-operative doppler ultrasound measurements, post-operative venous sinus imaging, anticoagulation, and morbidities and mortalities.Main Outcome MeasureSS patency and velocity.ResultsEight patients were included in the analysis (22 to 69 years). Four had left-sided and four had right-sided craniotomies. Sigmoid sinuses were either right-side dominant or co-dominant. The mean velocity ± standard deviation (SD) prior to dura opening and abdominal fat packing was 23.2 ± 11.3 and 25.5 ± 13.9 cm/s, respectively, p = 0.575. Post-operative Magnetic Resonance Venography (MRV) imaging showed four sigmoid sinus occlusions; seven patients showed sigmoid sinus stenosis, and one internal jugular vein occlusion. One patient had post-operative Computed Tomography Venography (CTV) only. Of the four patients with MRV occlusions, CTVs were performed with three showing occlusion and all four-showing stenosis. One patient with internal jugular vein occlusion on MRV received warfarin anticoagulation. There was one cerebrospinal fluid leak requiring ear closure, one small cerebellar infarct, and one with facial nerve palsy (House-Brackman Grade 3).ConclusionSS velocity changes before and after tumor resection were not predictive of sinus occlusion. We hypothesize that sinus occlusion may be caused by related factors other than thrombosis, such as external compression of the sinus secondary to abdominal fat grafting.

Propionic acidemia (PA) is a rare autosomal recessive inborn error of metabolism (IEM) with relatively higher prevalence in the United Arab Emirates (UAE). Absence of propionyl-CoA carboxylase (PCC) enzyme classically leads to acute decompensation in the early neonatal period. We report a novel homozygous frameshift variant c.2158_2159insT; p.Glu720Valfs*14 (NM_000282.3) in the last exon of the PCCA gene which led to a severe presentation of PA in a newborn Emirati female. Uniquely the diagnosis remained unclear since newborn screening revealed an isolated elevation in plasma proprionylcarnitine (C3) while urinary organic acids remained persistently negative for the classic biochemical abnormalities even during the period of critical illness. Additionally, the patient had an unexplained diagnosis of neonatal thyrotoxicosis. This case explores possible underlying causes through an extensive literature search. To date, there have been no similar reported cases in existing literature.

Background Cotton leaf curl disease (CLCuD) is a disease of cotton caused by begomoviruses, leading to a drastic loss in the annual yield of the crop. Pakistan has suffered two epidemics of this disease leading to the loss of billions in annual exports. The speculation that a third epidemic of CLCuD may result as consequence of the frequent occurrence of Tomato leaf curl New Delhi virus (ToLCNDV) and Cotton leaf curl Kokhran Virus-Burewala Strain (CLCuKoV-Bu) in CLCuD infected samples, demand that the interactions taking between the two viruses be properly evaluated. This study is designed to assess virus-virus interactions at the molecular level and determine the type of co-infection taking place. Methods Based on the amino acid sequences of the gene products of both CLCuKoV-Bu and ToLCNDV, protein structures were generated using different software, i.e., MODELLER, I-TASSER, QUARKS, LOMETS and RAPTORX. A consensus model for each protein was selected after model quality assessment using ERRAT, QMEANDisCo, PROCHECK Z-Score and Ramachandran plot analysis. The active and passive residues in the protein structures were identified using the CPORT server. Protein–Protein Docking was done using the HADDOCK webserver, and 169 Protein–Protein Interaction (PPIs) were performed between the proteins of the two viruses. The docked complexes were submitted to the PRODIGY server to identify the interacting residues between the complexes. The strongest interactions were determined based on the HADDOCK Score, Desolvation energy, Van der Waals Energy, Restraint Violation Energy, Electrostatic Energy, Buried Surface Area and Restraint Violation Energy, Binding Affinity and Dissociation constant (Kd). A total of 50 ns Molecular Dynamic simulations were performed on complexes that exhibited the strongest affinity in order to validate the stability of the complexes, and to remove any steric hindrances that may exist within the structures. Results Our results indicate significant interactions taking place between the proteins of the two viruses. Out of all the interactions, the strongest were observed between the Replication Initiation protein (Rep) of CLCuKoV-Bu with the Movement protein (MP), Nuclear Shuttle Protein (NSP) of ToLCNDV (DNA-B), while the weakest were seen between the Replication Enhancer protein (REn) of CLCuKoV-Bu with the REn protein of ToLCNDV. The residues identified to be taking a part in interaction belonged to domains having a pivotal role in the viral life cycle and pathogenicity. It maybe deduced that the two viruses exhibit antagonistic behavior towards each other, and the type of infection may be categorised as a type of Super Infection Exclusion (SIE) or homologous interference. However, further experimentation, in the form of transient expression analysis, is needed to confirm the nature of these interactions and increase our understanding of the direct interactions taking place between two viruses.

Recently, yeast-derived glucan particles (GP) have emerged as novel drug delivery agents that provide for receptor-mediated uptake by phagocytic cells expressing β-glucan receptors. In our previous study, we prepared GP loaded with high payload (40.5 + 1.9%) of rifabutin (RB) nano-particles [(RB-NPs)-GP]. We investigated the anti-mycobacterial efficacy and cellular activation responses within Mycobacterium tuberculosis (M. tuberculosis) infected J774 macrophage cells following exposure to the (RB-NPs)-GP formulation. The exposure was seen to augment a robust innate immune response including the induction of reactive oxygen and nitrogen species, autophagy and apoptosis within M. tuberculosis infected macrophage. Further, the efficacy testing of these particles in murine macrophage exhibited that the (RB-NPs)-GP formulation enhanced the efficacy of RB drug by ∼2.5 fold. The study suggests that the set of innate responses conducive to killing intracellular bacteria evoked by (RB-NPs)-GP play a pivotal role in impeding the intracellular M. tuberculosis survival, resulting in enhanced efficacy of the formulation. Our results establish that the (RB-NPs)-GP formulation not only activate M. tuberculosis infected, immune-suppressed macrophage, but also adds significantly to the efficacy of loaded drug, and thus forms a promising approach that should be explored further as an alternative or adjunct form of TB therapy.HighlightsNano-Rifabutin loaded Glucan microparticles [(RB-NPs)-GP] administered to M. tuberculosis infected macrophage.(RB-NPs)-GP induces appropriate innate immune responses in host macrophage.Mycobactericidal Effect of Rifabutin was markedly enhanced by its nano-entrapment in GP.Intracellular drug delivery supplements the innate response in M. tuberculosis infected macrophage.

The potential of big data analytics to improve the quality of care for patients with spine tumors is significant. At this moment, the application of big data analytics to oncology and spine surgery is at a nascent stage. As such, efforts are underway to advance data-driven oncologic care, improve patient outcomes, and guide clinical decision making. This is both relevant and critical in the practice of spine oncology as clinical decision making is often made in isolation looking at select variables deemed relevant by the physician. With rapidly evolving therapeutics in surgery, radiation, interventional radiology, and oncology, there is a need to better develop decision-making algorithms utilizing the vast data available for each patient. The challenges and limitations inherent to big data analyses are presented with an eye towards future directions.

Abstract: This article discusses the background of lawyer’s movement and gives concept of social movement in detail including civil society and social change, difference between social movement and other movement’s social movement and development on political culture and world system and social change. We can get peace and rights of humanity through movements. This is an analytical descriptive type qualitative research mainly literature review highlight the case study. Civil society is very supportive for lawyers and independent judiciary because lawyers and judiciary faced so many difficulties. They are deep rooted, constituency based, self-organized and self-finance. In Pakistan political scenery, lawyers movement present amazing and excellent example of such a civil society organization

Pythium myriotylum is a notorious soil-borne oomycete that causes post-emergence damping-off in chili pepper. Of various disease management strategies, utilization of plant growth promoting rhizobacteria (PGPR) in disease suppression and plant growth promotion is an interesting strategy. The present study was performed to isolate and characterize PGPR indigenous to the chili rhizosphere in Pakistan, and to test the potential to suppress the damping-off and plant growth promotion in chili. Out of a total of 28 antagonists, eight bacterial isolates (4a2, JHL-8, JHL-12, 1C2, RH-24, 1D, 5C, and RH-87) significantly suppressed the colony growth of P. myriotylum in a dual culture experiment. All the tested bacterial isolates were characterized for biochemical attributes, and 16S rRNA sequence based phylogenetic analysis identified these isolates as Flavobacterium spp., Bacillus megaterium, Pseudomonas putida, Bacillus cereus, and Pseudomonas libanensis. All the tested bacterial isolates showed positive test results for ammonia production, starch hydrolase (except 4a2), and hydrogen cyanide production (except 4a2 and 1D). All the tested antagonists produced indole-3-acetic acid (13.4–39.0 μg mL–1), solubilized inorganic phosphate (75–103 μg mL–1), and produced siderophores (17.1–23.7%) in vitro. All the tested bacterial isolates showed varying levels of susceptibility and resistance response against different antibiotics and all these bacterial isolates were found to be non-pathogenic to chili seeds and notably enhanced percentage seed germination, plumule, redical length, and vigor index over un-inoculated control. Additionally, under pathogen pressure, bacterization increased the defense related enzymes such as Peroxidase (PO), polyphenol oxidase (PPO), and phenylalanine ammonia-lyase (PAL) activates. Moreover, the treatment of chili seeds with these bacterial isolates significantly suppressed the damping-off caused by P. myriotylum and improved PGP traits compared to the control. In addition, a positive correlation was noticed between shoot, root length, and dry shoot and root weight, and there was a negative correlation between dry shoot, root weight, and seedling percentage mortality. These results showed that native PGPR possesses multiple traits beneficial to the chili plants and can be used to develop eco-friendly and effective seed treatment formulation as an alternative to synthetic chemical fungicides.

This article bounce off the framework of lawyer’s movement and aims to describe the power of social media. Media is very important and strong pillar of any state stability which activated to all civil society for the restoration of judiciary and supremacy of Law.. This is an analytical descriptive type qualitative research mainly literature review highlight the case study. It finds out that social media is major aspect which helped and facilitate this social movement .For free democratisation judicial actors can play very important roll but electronic media is very helpful for this. The cooperative lawyer’s movement and strong civil society approach can bring a positive change in the judicial system. It suggest that political intervention must be evaded in prompt obligation and progress rules for make safe more lawful judiciary.

Human T-cell lymphotropic virus type 1 (HTLV-1) is an infectious virus that has been linked to adult T cell leukemia /lymphoma, aggressive CD4-T cell malignancy and many other immune-related medical illnesses. So far, no effective vaccine is known to combat HTLV-1, hence, the current research work was performed to design a potential multi-epitope-based subunit vaccine (MEBV) by adopting the latest methodology of reverse vaccinology. Briefly, three highly antigenic proteins (Glycoprotein, Accessory protein, and Tax protein) with no or minimal (

Human T-cell lymphotropic virus type 1 (HTLV-1) is an infectious virus that has been linked to adult T cell leukemia /lymphoma, aggressive CD4-T cell malignancy and many other immune-related medical illnesses. So far, no effective vaccine is known to combat HTLV-1, hence, the current research work was performed to design a potential multi-epitope-based subunit vaccine (MEBV) by adopting the latest methodology of reverse vaccinology. Briefly, three highly antigenic proteins (Glycoprotein, Accessory protein, and Tax protein) with no or minimal (

Abstract Background Choroid plexus epithelial cells express high levels of transthyretin, produce cerebrospinal fluid and many of its proteins, and make up the blood-cerebrospinal fluid barrier. Choroid plexus epithelial cells are vital to brain health and may be involved in neurological diseases. Transgenic mice containing fluorescent and luminescent reporters of these cells would facilitate their study in health and disease, but prior transgenic reporters lost expression over the early postnatal period. Methods Human bacterial artificial chromosomes in which the transthyretin coding sequence was replaced with DNA for tdTomato or luciferase 2 were used in pronuclear injections to produce transgenic mice. These mice were characterized by visualizing red fluorescence, immunostaining, real-time reverse transcription polymerase chain reaction, and luciferase enzyme assay. Results Reporters were faithfully expressed in cells that express transthyretin constitutively, including choroid plexus epithelial cells, retinal pigment epithelium, pancreatic islets, and liver. Expression of tdTomato in choroid plexus began at the appropriate embryonic age, being detectable by E11.5. Relative levels of tdTomato transcript in the liver and choroid plexus paralleled relative levels of transcripts for transthyretin. Expression remained robust over the first postnatal year, although choroid plexus transcripts of tdTomato declined slightly with age whereas transthyretin remained constant. TdTomato expression patterns were consistent across three founder lines, displayed no sex differences, and were stable across several generations. Two of the tdTomato lines were bred to homozygosity, and homozygous mice are healthy and fertile. The usefulness of tdTomato reporters in visualizing and analyzing live Transwell cultures was demonstrated. Luciferase activity was very high in homogenates of choroid plexus and continued to be expressed through adulthood. Luciferase also was detectable in eye and pancreas. Conclusions Transgenic mice bearing fluorescent and luminescent reporters of transthyretin should prove useful for tracking transplanted choroid plexus epithelial cells, for purifying the cells, and for reporting their derivation from stem cells. They also should prove useful for studying transthyretin synthesis by other cell types, as transthyretin has been implicated in many functions and conditions, including clearance of β-amyloid peptides associated with Alzheimer’s disease, heat shock in neurons, processing of neuropeptides, nerve regeneration, astrocyte metabolism, and transthyretin amyloidosis.

The aim of this study was to evaluate the mobility and transport of Aluminum (Al) by shoot and grain crops (wheat and maize) grown on two different agricultural soil irrigated with water have high (lake water) and low levels (canal water) of Al. The total and bioavailable fractions (deionized water, 0.11M CH3COOH, 0.05M ethylenediaminetetraaceticacid (EDTA) and 0.1 M HCl extractable) of Al in both understudied agricultural soils and correlate with respective total Al in the edible parts (grains) and non edible parts (Shoots) of wheat and maize. The Al content in lake and canal water samples was found in the range of 750 – 1340 and 90 – 150 µg/L respectively. The total and extractable Al in both agricultural soil samples, edible and non edible parts of wheat and maize were analysed by atomic absorption spectrometry after acid digestion in microwave oven. The edible and non edible part of both crops absorbed significantly high levels of Al grown on agricultural soil irrigated with lake water (SILW) as compared to those grown on soil irrigated with canal water (SICW) had low level of Al (p

The best way to communicate and disseminate knowledge in a profession is through publications and research activities. Maintaining and developing the body of knowledge specific to physiotherapy is crucial for enhancing the current knowledge and supporting the idea of evidence-based physiotherapy practice. This study aimed to investigate the research output of physiotherapy professionals in Pakistan during the last three decades (1992-2022). The bibliometric analysis technique was adopted to conduct this study. Data from the Web of Science (core collection) was extracted in November 2022 via electronic searching using the query: ALL= (Physical therapy AND Pakistan OR physiotherapy AND Pakistan OR manual therapy AND Pakistan OR physical rehabilitation AND Pakistan OR Exercise therapy AND Pakistan. The search yielded 2, 390 articles that were published between 1992 and 2022. 508 relevant publications were finally selected for further analysis based on the study's inclusion criteria. The bibliometric analysis results highlighted that there has been a consistent rise in the number of published articles over the past 30 years, with the peak publication trend seen in 2020. The analysis also revealed the most productive authors, journals, and their co-authors' networking in this domain. The most frequently used author keywords and the most collaborative country in research with Pakistan were also identified. However, it was observed that there were specific clusters of research work; certain institutions and authors were very active in research, highlighting a somewhat non-diversified research activity in the profession. Furthermore, the articles were primarily published in Pakistan-based journals, indicating a limited spread of knowledge.