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Introduction: The gut-brain axis is a bidirectional communication network linking the gastrointestinal tract and the central nervous system via neuronal, hormonal, and antibody signaling pathways. Central to this connection is gut health, encompassing the balance and functionality of gut microbiota, which significantly impacts on mental and cognitive health. This study investigates the association between gut health and cognitive functioning in adults, highlighting the mechanisms by which gut microbiota influence brain health., Objective: To examine the effects of gut health on adult cognitive performance, with a focus on the processes by which gut microbiota impacts brain health., Methods: A quantitative cross-sectional study was conducted in Islamabad from January 2024 to April 2024, involving 140 adult participants. Data were collected using a comprehensive 16-item gut health questionnaire and the cognition self-assessment rating scale (C-SARS). The psychometric properties of these scales were assessed, and the data were analyzed using Statistical Product and Service Solutions (SPSS, v26; IBM SPSS Statistics for Windows, Armonk, NY). Analytical and descriptive statistics, including regression, chi-square, independent sample t-tests, and mean and standard deviation, were applied., Results: The study found moderate associations between gut health and cognitive performance, particularly in memory and processing speed (R² = 0.17, β = -1.9, p = 0.12 for general cognition; R² = 0.01, β = -0.98, p = 0.02 for memory; R² = 0.03, β = -0.18, p = 0.03 for processing speed). Gender and marital status differences were significant, with males exhibiting better gut health scores than females (M = 34.1, SD = 3.2 vs. M = 31.2, SD = 3.2, p = 0.00), and singles showing better cognitive performance compared to married individuals (M = 9.4, SD = 5.4 vs. M = 6.5, SD = 3.7, p = 0.03)., Conclusion: The study highlights significant associations between gut health and cognitive functions, suggesting that gut microbiota composition can influence cognitive performance. Gender and marital status differences underscore the need to consider individual differences in gut-brain axis research. Future studies should replicate these findings in larger samples and explore gut microbiota-targeted interventions for cognitive health enhancement., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Brain Wave Research Center issued approval BRC-IRB-0015. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hameed et al.)

Background Ventilator-associated pneumonia (VAP) is a critical concern in the intensive care unit (ICU), with significant implications for patient outcomes. This retrospective cross-sectional study aimed to determine the prevalence of VAP in an ICU of a developing country, identify the predominant etiological factors, assess patient outcomes, and underscore the need for tailored interventions in high-risk patient groups. Methods This retrospective cross-sectional study included 589 ICU patients who underwent ventilator-assisted breathing for over 48 hours. Among them, 151 developed VAP. The diagnosis was made on clinical, laboratory, and radiological findings, and tracheal aspirate cultures. Exclusions included pediatric patients, less than 48 hours of ventilation, and pre-existing lung infections. Patient data encompassed gender, age, comorbidities, outcomes, admission reasons, isolated microorganisms, and clinical findings. Results 151 patients out of the 589 developed VAP. The age of the patients ranged between 31 to 69 years and the mean age was 45.43 ± 8.92 years. Clinical diagnoses upon ICU admission varied, including sepsis, trauma, stroke, and metabolic disorders. Chest X-rays commonly revealed atelectasis (19.2%), consolidation (21.9%), pleural effusion (11.9%), and lobar pneumonia (45.7%). Tracheal aspirate cultures predominantly isolated multidrug-resistant gram-negative rods, with methicillin-resistant gram-positive cocci and fungal pneumonia prevalent in neutropenic sepsis cases. Notably, only 54 (35.8%) of patients survived, with significantly poorer outcomes observed in sepsis, neutropenic sepsis, and stroke cases compared to trauma and post-operative admissions. Conclusion Multidrug-resistant organisms and the spread of nosocomial infections are the predominant causes of VAP in the ICU. This emphasizes the urgent need for multifaceted interventions to prevent and manage VAP effectively. Developing and implementing targeted strategies, considering the unique challenges faced in resource-constrained healthcare settings can aid in decreasing the mortality associated with it., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Nisar et al.)

Background: A lymphocele or lymphocyst is formed when lymphatic fluid accumulates in a space, following disruption of lymphatic channels. Here, we report a case of a giant lymphocele in a middle-aged female, who underwent Trendelenburg operation (saphenofemoral junction ligation) for varicose veins of her right lower limb., Case Presentation: A 48-year-old Pakistani Punjabi female presented to the plastic surgery outpatient department with a history of painful, progressive swelling of the right groin and medial aspect of the right thigh for 4 months. After investigation, it was diagnosed as a giant lymphocele. A pedicled gracilis muscle flap was used to reconstruct and obliterate the cavity. There was no recurrence of the swelling., Conclusion: Lymphocele is a common complication after extensive vascular surgeries. In the unfortunate case of its development, prompt intervention must be done to prevent its growth and ensuing complications., (© 2023. The Author(s).)

Environmental health is critical for the economy's social welfare and environmental sustainability. Using time series data from 1975 to 2020, the research examines the short- and long-run relationship between environmental pollutants and healthcare costs in the context of Pakistan. The study's results reveal that short-term and long-term efforts towards cleaner development in terms of carbon emissions, coal combustion, nitrous oxide (N 2 O) emissions, and industrial value-added have resulted in significant reductions in healthcare expenses due to improved management of industrial emissions. However, in the long run, particulate matter (PM 2.5 ) has a detrimental effect on a country's sustainable healthcare agenda, leading to increased healthcare costs. Furthermore, the increased use of coal-fired power plants that release polycyclic aromatic hydrocarbons (PAH) and revenue generated by contaminated production lead to higher out-of-pocket healthcare costs, increasing a country's risk of morbidity and mortality. The study's Granger causality estimations demonstrate that carbon emissions are responsible for emissions-driven healthcare expenses in a nation. Additionally, economic growth leads to increased carbon emissions and industrial toxins, which are also emission-led. Through variance decomposition analysis (VDA), the study finds that carbon emissions have the highest variance shock of 32.702% on healthcare expenditures in the next ten years. This is followed by polluted income and continued economic growth, which have a variance shock of 13.243% and 8.858%, respectively, over the same period. The findings indicate that the maximum healthcare benefits may be acquired by mitigating environmental pollutants via stringent environmental regulations, reducing industrial toxins through solid waste management techniques, and minimizing coal combustion reliance through renewable fuels. Environmental research is still required to provide more sustainable solutions to the sustainability of the global healthcare agenda., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The logistics business is a crucial contributor to economic development, yet it is also the leading source of carbon emissions. Economic growth at the expense of environmental deterioration is a challenging issue; this phenomenon offered a new avenue for scholars and policymakers to investigate and address these issues. The recent study is one of the attempts to explore this intricate subject. The goal of this research is to determine whether or not the Chinese logistics sector has an impact on Pakistan's GDP and carbon emissions as a result of CPEC. The research utilized data from 2007Q1 to 2021Q4 using the ARDL approach for an empirical estimate. Due to the mixed order of variable integration and finite data set, the ARDL technique is well deserved, which helps reach sound policy inferences. The study's key results indicated that China's logistic business enhances Pakistan's economic development and carbon emissions in the short and long term. Similarly, China's energy usage, technology, and transportation contribute to Pakistan's economic progress at the price of environmental damage. The empirical study may be a model for other developing nations, given Pakistan's viewpoint. With the support of the empirical results, policymakers in Pakistan and other associated countries would be able to plan for sustainable growth in conjunction with CPEC., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Mitochondrial malfunction and cell senescence have been defined as the hallmarks of aging. Cell senescence leads to the loss of health allied with aging. While deciphering the complex association between mitochondria and cellular senescence, it is observed that senescence has a two-faced nature being beneficial and hazardous. This duality of cellular senescence is associated with circumstantial aspects. During the process of cellular senescence, dysfunctional mitochondria are accumulated, the efficiency of the oxidative phosphorylation process declines along with the enhanced synthesis of reactive oxygen species. It is suggested that reduction in the negative consequences of senescence throughout old age might be accomplished by targeting the mitochondria as all roads lead towards mitochondria. It is unclear how perturbation of mitophagy in senescence results in the accumulation of mitochondria, impairment of mitochondrial biogenesis and onset of diseases. Understanding this complex interplay will bring about a long yet healthy lifespan. But definitely casual and specific players contribute in the initiation and conservation of the cell senescence. Variations in metabolism, quality control and dynamics of mitochondria are observed during cell aging process. Several On-target and Off-target mechanisms can also cause side effects in cellular senescence. Translational research of these mechanisms may lead to effective clinical interventions. This chapter reviews the role of mitochondria, homeostatic mechanisms and mitophagy as drivers and effectors of cell senescence along with multiple signalling pathways that lead to the initiation, maintenance, induction and suppression of cellular aging process during health and disease., (Copyright © 2023. Published by Elsevier Inc.)

Climate finance and carbon pricing are regarded as sustainable policy mechanisms for mitigating negative environmental externalities via the development of green financing projects and the imposition of taxes on carbon pollution generation. Financial literacy indicates that it is beneficial to invest in cleaner technology to advance the environmental sustainability goal. The current wave of the COVID-19 epidemic has had a detrimental effect on the world economies' health and income. The pandemic crisis dwarfs previous global financial crises in terms of scope and severity, collapsing global financial markets. The study's primary contribution is constructing a climate funding index (CFI) based on four critical factors: inbound foreign direct investment, renewable energy usage, research and development spending, and carbon damages. In a cross-sectional panel of 43 nations, the research evaluates the effect of climate funding, financial literacy, and carbon pricing in lowering exposure to coronavirus cases. The study utilized Newton-Raphson and Marquardt steps to estimate the current parameter estimates while evaluating the COVID-19 prediction model with level regressors using the robust least squares regression model (S-estimator). Additionally, the innovation accounting matrix predicts estimations over a specific period. The findings indicate that climate finance significantly reduces coronavirus exposure by introducing green financing initiatives that benefit human health, which eventually strengthens the immune system's ability to fight infectious illnesses. Financial literacy and carbon pricing, on the other hand, are ineffectual in controlling coronavirus infections due to rising economic activity and densely inhabited areas that enable the transmission of coronavirus cases across countries. Similar findings were obtained using the alternative regression apparatus. The COVID-19 predicted variable was used as a "response variable," and climate financing was shown to have a favorable impact on containing coronavirus exposure. As shown by the innovation accounting matrix, carbon pricing would drastically decrease coronavirus cases' exposure over a time horizon. The study concludes that climate finance and carbon pricing were critical in improving air quality indicators, which improved countries' health and wealth, allowing them to reduce coronavirus infections via sustainable healthcare reforms., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A green ultrasound assisted convenient approach has been reported for the ring opening of epoxides. As a result, a series of N-phenyl piperazine and morpholine based β-amino alcohols has been synthesized under ultrasound irradiation in DMSO for 60 minutes at 70°C. This methodology showed excellent tolerance with various epoxides and provided excellent yields upto 96%. All the synthetic derivatives (4a-e) (5c-d) significantly influence the catalytic activity of protease while 5d exhibited maximum (100%) inhibitory effect with a half-life of 40.76 minutes. Among the target derivatives, compound 4c exhibited significant antibacterial activity against Bacillus subtilis and Escherichia coli bacterial strains with zone of inhibition values 45 mm and 32 mm, respectively.

Aging is a degenerative, biological, time-dependent, universally conserved process thus designed as one of the highest known risk factors for morbidity and mortality. Every individual has its own aging mechanisms as both environmental conditions (75%) and genetics (25%) account for aging. Several theories have been proposed until now but not even a single theory solves this mystery. There are still some queries un-answered to the scientific community regarding mechanisms behind aging. However, oxidative stress theory (OST) is considered one of the famous theories that sees mitochondria as one of the leading organelles which largely contribute to the aging process. Many reactive oxygen species (ROS) are produced endogenously and exogenously that are associated with aging. But the mitochondrial ROS contribute largely to the aging process as mitochondrial dysfunction due to oxidative stress is considered one of the contributors toward aging. Although ROS is known to damage cell machinery, new evidence suggests their role in signal transduction to regulate biological and physiological processes. Moreover, besides mitochondria, other important cell organelles such as peroxisome and endoplasmic reticulum also produce ROS that contribute to aging. However, nature has provided humans with free radical scavengers called antioxidants that protect from harmful effects of ROS. Future predictions regarding aging, biochemical mechanisms involved, biomarkers internal and external factors can be easily done with machine learning algorithms and other computational models. This review explains important aspects of aging, the contribution of ROS producing organelles in aging, importance of antioxidants fighting against ROS, different computational models developed to understand the complexities of the aging., (© 2020 Published by Elsevier Ltd.)

This case control study was conducted in the out patient department (OPD), Enam Medical College & Hospital (EMCH), Dhaka, Bangladesh from 1st January 2017 to 31st December 2017. The aim of our study was to find the possible association between serum iron state and iron deficiency anemia with bronchial asthma in women. We investigated 40 diagnosed female cases of well controlled bronchial asthma and 20 healthy female as control. In both groups complete blood count (CBC) with peripheral smear was done, C-reactive protein (CRP), serum iron, serum ferritin, and serum total iron binding capacity (TIBC) was measured. We found asthma cases had lower hemoglobin than control (mean±SD 10.92±1.34 vs. 12.30±0.73, p value 0.013), serum iron and serum ferritin were significantly lower (p value 0.016 and 0.000 respectively) and TIBC was higher (p value 0.000) in asthmatic cases as compared to controls. Non anemic asthmatics showed significant lower serum ferritin compared with non-anemic healthy controls (p value 0.005). So we conclude that iron deficiency anemia is more prevalent in asthmatic women as compared to healthy controls.

The developmental triangle earlier comprises economic growth, income inequality, and poverty, while in this study, we extended it by incorporating environmental and resource factors, health and education factors, sectoral value added, and some other growth-specific factors for assessing pro-poor growth, by considering Bolivian economy as a case study. The elasticity estimates show that agriculture and industrial sector growth is not pro-poor due to account of high income inequality, while services sector played a vital role in country's economic development and supports poor livelihood in a country. Energy and environmental resources negatively impact on quality of life of the poor relative to non-poor, which create income differences among them. Health and education expenditures give favors to the poor and supported the notion of pro-poor growth, while country's per capita income and foreign direct investment inflows increase income inequality that lead towards pro-rich growth. The results conclude that, in general, Bolivian economy growth is fairly unstable, polluted, and unhealthy that biased to the poor relative to non-poor.

A series of (S)-tryptamine derivatives containing an allyl group and an aryl sulfonamide unit were designed, synthesized and evaluated for their potential application as anticancer agents. The structures of the synthesized compounds were characterized by 1 H NMR, 13 C NMR and ESI-MS spectral analyses. The target compounds were evaluated for their in vitro cytotoxicity against HepG2, HeLa, CNE1 and A549 human cancer cell lines. Some of the synthesized compounds showed moderate to good anticancer activities against four selected cancer cell lines, among of which 6ag was found to be the most active analogue possessing IC 50 values 16.5-18.7 μM. Further mechanism studies revealed that compound 6ag could significantly induce HepG2 cell cycle arrest at G1 phase, promote cell apoptosis, and inhibit the colony formation as well., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Taking sophoridine as a lead compound, 58 sophoridine derivatives were designed, synthesized and evaluated for their antiproliferative activity in the HepG2 cancer cell line. Among the 58 compounds, 33 compounds showed potent antiproliferative activity with IC 50 less than 10 μM. Compound 5w showed the most potent anti-proliferative activity in the HepG2 cancer cell line. Thus, we further extended our characterization of the antiproliferative activity of 5w in six cancer cell lines (HepG2, SMMC-7721, Hela, CNE1, CNE2 and MCF7). The representative compound 5w displayed robust anti-proliferative activities in all the tested cell lines with IC 50 values in range of 0.93-1.89 μM which were much lower than that of sophoridine. Here, we report the structure-activity relationships (SAR) in a sophoridine series of compounds, which indicated that introduction of N-benzyl indole group on the 14-carbon atom of sophoridine can significantly enhance the antiproliferative activity. By molecular docking and enzymatic assay, compound 5w was found to be able to inhibit the activity of DNA Topo I. Furthermore, apoptosis assay displayed that compound 5w could significantly induce the apoptosis of HepG2 cells in a dose-dependent manner by activating caspase-3, increasing expression of cleaved caspase-3 and reducing the ratio of Bcl-2/Bax. The in vivo antitumor assay demonstrated that 5w suppressed the growth of HepG2 xenografts in nude mice without any obvious side effects., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Using matrine (1) as the lead compound, a series of new 14-(N-substituted-2-pyrrolemethylene) matrine and 14-(N-substituted-indolemethylene) matrine derivatives was designed and synthesized for their potential application as anticancer agents. The structure of these compounds was characterized by 1 H NMR, 13 C NMR and ESI-MS spectral analyses. The target compounds were evaluated for their in vitro cytotoxicity against three human cancer cell lines (SMMC-7721, A549 and CNE2). The results revealed that compound A6 and B21 displayed the most significant anticancer activity against three cancer cell lines with IC 50 values in range of 3.42-8.05 μM, which showed better activity than the parent compound (Matrine) and positive control Cisplatin. Furthermore, the Annexin V-FITC/PI dual staining assay revealed that compound A6 and B21 could significantly induce the apoptosis of SMMC-7721 and CNE2 cells in a dose-dependent manner. The cell cycle analysis also revealed that compound A6 could cause cell cycle arrest of SMMC-7721 and CNE2 cells at G2/M phase., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: The most common symptom for which the patients are admitted in our hospitals is fever. This study was carried out to know the causes of fever based on clinical and laboratory findings., Methods: In this cross sectional study, 865 consecutive male patients with fever of 100 F and above were included in the study conducted from January 2010 to April 2012., Results: All the patients were male having age between 17 years and 45 years. Out of the 865 patients, 507 (58.61%) came out to be malarial parasite slide positive, 186 (21.50%) patients were malarial parasite slide negative but were having clinical picture of malaria and*responded to anti-malarial treatment, 73 (8.44%) patients were of respiratory tract infections, 21 (2.43%) patients were having gastro enteritis, 20 (2.31%) were diagnosed as cases of typhoid fever, 17 (1.97%) were having urinary tract infections, 24 (2.77%) patients were referred to medical specialist and the rest 1-7 (1.97%) were grouped as others., Conclusion: The most common cause of fever in our study was malaria. Respiratory tract infections are the second most common cause.

Objective: Vacuum assisted closure is a reported technique to manage complex wounds. We have utilized this technique by using simple locally available material in the management of our patients on outpatient basis. The objective of this study is to present our experience., Methods: This study was conducted from June 2011 to June 2013 at Dow University Hospital and Aga Khan University Hospital, Karachi. There were 38 patients managed with vacuum assisted closure. Mean age was 56±7.8 years. Twenty three patients presented with necrotizing fasciitis and 15 patients with gangrene. Lower limbs were involved in majority of the patients. Debridement or amputations were done. Vacuum dressing was changed twice weekly in outpatient department. Wounds were closed secondarily if possible or covered with split thickness skin graft in another admission., Results: All the wounds were successfully granulated at the end of vacuum therapy. Mean hospital stay was 7.5 days. Vacuum dressing was applied for a mean of 20 days. There was reduction in the size of the wound. Thirteen patients underwent secondary closure of the wound under local anesthesia, 18 patients required coverage with split thickness skin graft and 7 patients healed with secondary intention., Conclusion: Vacuum assisted closure appeared to be an effective method to manage complex diabetic wounds requiring sterile wound environment.

The lower third of the leg poses a surgical challenge in patients with complex injuries requiring reconstruction of soft tissue defects. The posterior tibial island fasciocutaneous flap is recognized as a suitable option for coverage of these defects, and provides a versatile solution for a complex problem. A retrospective audit was conducted at our institution from 1996 to 2008 including all patients who underwent this procedure. Patient's demographics, clinical features, outcome, and complications were noted. The study population was 24 patients (23 males, one female) with age ranging from 11 to 60 years. Mechanism of injury was road traffic accident in 20 patients and firearm injury in 4. The defect was located in the lower half of the leg in all cases. Tibial fracture was present in 15 patients, treated by external fixation in 13 and internal fixation in two patients. Fasciocutaneous flap from the medial aspect of leg was raised based on a perforator of the posterior tibial artery and rotated distally. Average length of the flaps was 12.3 cm. Patients were followed for an average of 11 months (minimum 3 months). Clinical outcome was graded as good in 19 patients, fair in four patients, and poor in one patient. Posterior tibial island flap appears to be a safe and reliable option for coverage of complex wounds in lower third of the leg., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: Chilblains or perniosis is a moderately severe form of cold injury, localized to peripheral parts of the body, which occurs after exposure to non-freezing temperatures and damp conditions. Although inter-individual variations exist with respect to susceptibility to develop chilblains, no study has been carried out in this region to determine the role of different weather conditions either alone or in combination, in predisposing the susceptible individuals to chilblains. The objective of this study was to determine the relationship between weather conditions and onset of chilblains at a moderately cold weather station., Methods: This study was conducted at the Department of Dermatology, Combined Military Hospital, Abbottabad, from Dec 2004 to Mar 2005. All patients fulfilling the clinical criteria for diagnosis of chilblains were included in the study. These patients were interviewed and examined thoroughly. A specially designed proforma was filled for each patient separately. Meteorological department was contacted for record of weather conditions. Onset of chilblains in each patient was related with weather conditions of that particular month. Computer programme SPSS 10 was used for statistical analysis., Results: Out of 111 patients, 67 (60.4%) were males and 44 (39.6%) were females. Eighty nine (80.2%), 90 (81.1%) and 90 (81.1%) patients had onset in relation with lower temperature (< 10 degrees C), relatively low atmospheric pressure (< 1500 kpa) and higher relative humidity (> 60%) respectively. There was statistically significant relationship of weather conditions with onset of chilblains when different groups, i.e., elderly and young, males and females, locals and non locals, outdoor workers and those remaining inside most of the time and those having disease of longer or shorter duration were compared., Conclusion: The cold weather conditions that can be endured by humans depend on combination of the duration and the extent of the exposure, in addition to physiological adaptive changes. However, susceptibility to chilblains increases when ambient temperature is less than 10 degrees C and relative humidity is more than 60%. Elderly, females, outdoor workers and those having chronic or recurrent episodes of chilblains are less tolerant to cold weather and develop the disease under lesser ambient cold.

A young man was operated for acute abdomen. Laparotomy revealed small bowel diverticulosis with very short mesentery leading to volvulus of near total small bowel. Resection and end to end anastomosis was performed. Patient ended up with short bowel syndrome.

Background: This study was carried out at Peshawar about the food habits of daily wages labourers working in the urban area., Methods: One to one interview was conducted with 50 randomly selected daily wages labourers, using structured questionnaire. At the same time specimen of capillary blood was obtained from their fingers tips for haemoglobin measurement., Results: The study revealed that due to lack of awareness and poor socio economic status the daily wages labourers are more prone to malnutrition and iron deficiency anaemia., Conclusion: There is a need of comprehensive health education and a strategy should be designed to provide a food locally available that could fulfill the requirement that occurs due to the deficiency of animal protein in the food of daily wages labourers.