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Aim and objective: Drug-drug interaction (DDI) is of major concern in patients with complex therapeutic regimens. The study aims to assess the prevalence of DDIs in the prescriptions of patients during the hospitalization to evaluate the DDIs of drugs regarding its severity, pharmacodynamic and pharmacokinetic. Methodology: The prescribed drugs in the admission chart of 183 patients were screened for Drug-drug interaction using Mediscape interaction screening program. Drug-drug interactions have been classified on the basis of severity (contraindicated, significant, minor, major, moderate and serious). Frequency and the percentage of pairs of drugs with DDIs, number of prescribed drugs, demographics and DDIs on the basis of and Pharmacodynamics, Pharmacokinetics have been analysed. Results: The overall result shows the frequency and percentage of drug-drug interaction present in hospitalized patients, out of 183 was 125(68.3%). Majority of interactions was found on the basis pharmacokinetic DDI 108(59.0%). On the basis of severity, minor Drug-drug interaction was found dominant 91(49.7%) followed by contraindicated 19(10.4%). Conclusion: Drug-drug interaction is common among hospitalized patient’s medications. My study evaluated a positive relation between prevalence of DDIs and number of drugs prescribed. Survey concluded that percentage of minor and contraindicated DDIs at admission were produced by changes of medication during hospitalization.

Post-translational modification (PTMs) of proteins by ubiquitin and ubiquitin-like modifiers such as interferon-stimulated gene 15 (ISG15) and small ubiquitin-related modifier (SUMO) play a critical role in the regulation of brain pathophysiology. Protein ISGylation is a covalent attachment of ISG15 to its target proteins, which is a unique PTM among other ubiquitin-like modifiers. Although, ISG15 shares sequence homology to ubiquitin, yet the functional significance of protein ISGylation is distinct from ubiquitination and SUMOylation. Further, ISG15 highly conserved among vertebrate species, unlike the other ubiquitin-like modifiers. ISGylation modulates various intracellular mechanisms such as Janus kinase/signal transducers and activators of transcription (JAK-STAT) pathway, autophagy, DNA repair, etc., indicating its biological significance. ISGylation emerged as one of the important mechanisms in the regulation of various neurological disorders including stroke, traumatic brain injury (TBI), basal ganglia calcification, and ataxia-telangiectasia. It appears that protein ISGylation is an endogenous neuroprotective mechanism. This review discusses the role of ISGylation in various brain pathologies with a particular emphasis on cerebral ischemia/stroke and on structural similarities between ISG15 and ubiquitin. Further, recent advancements on the role of ubiquitination and SUMOylation with relevance to ISGylation will also be discussed. The overall goal is to provide better insights on the mechanistic link between ISGylation and other ubiquitin-like modifiers, which may be helpful to establish novel therapeutic strategies for neuroprotection.

BACKGROUND & OBJECTIVE: De Quervain's tenosynovitis is tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons, occurs due to chronic overuse of the wrist and hand. To compare effectiveness of steroid injection with conservative management of De Quervains’s tenosynovitis. METHODOLOGY: Randomized prospective study was conducted at the various private orthopedic clinic across Rawalpindi district, along with collaboration of community medicine department, Rawal Institute of health sciences, Islamabad. The study population was divided into two groups, i.e., group A and group B. Group A was given inj. corticosteroid and group B was given conservative management. The severity of pain (Visual analogue scale) and Finkelstein test were recorded on baseline and after 3 weeks follow up. RESULTS: Our study included 96 diagnosed cases of de Quervains tenosynovitis on a positive Finkelstein test; 48 were given corticosteroid injection and 48 were conservatively treated. The mean age in corticosteroid’s injection group was 34.76+6.95 years whereas the mean age in conservative management group was 31.7+8.91 years. Post-intervention 13, 29 patients had a positive Finkelstein test in corticosteroid and conservative groups respectively. Although the difference in pre intervention pain score between the two groups was not statistically significant but significantly lesser pain scores in the corticosteroid group; (p= 0.00). CONCLUSION: Steroid injection produced better results in terms of relief in pain and negative Finkelstein test as compared to conservative treatment.

Residues, potential sources and ecotoxicological effects of polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) were analyzed in typical urban river networks of Shanghai. In total, 47 surface sediments were collected in each of the sampling seasons (summer and winter). Laboratory analysis by GC-ECD showed that OCPs and PCBs concentrations were in medium levels compared to other national and international areas. As for OCP compounds, HCHs and DDTs were two dominant pollutants, with ∑HCHs concentrations ranging from 1.74 to 28.78 ng/g and ∑DDTs concentrations ranging from 0.88 to 25.45 ng/g. For individual HCHs, β-HCH was the most dominant HCH compound, with a mean value of 5.06 ng/g, followed by α-HCH (3.50 ng/g) in winter. A similar case of HCHs was also found in the summer season. Concentrations of ∑18PCBs varied from 6.67 to 37.10 ng/g in winter and from 10.63 to 45.55 ng/g in summer. Individual PCB 28, 101, 118 and 123 were dominant among all congeners, with averages of 3.16, 1.55, 2.47 and 2.37 ng/g in winter, 3.11, 2.34, 4.92 and 4.41 ng/g in summer, respectively. ∑20OCPs (the sum of twenty OCPs) concentrations in cultivated land areas were more abundant than that in artificial surface areas, indicating an abundance of pesticides and fertilizers in cultivated lands. Analysis of possible sources indicated that both industrial and agricultural residues contributed to higher HCHs and DDTs concentrations, which mainly originated from weathered pesticides with aerobic transformation processes. For PCB compounds, a significant seasonal variation, atmospheric precipitation, and surface runoff were the major factors for fluctuated PCBs concentrations. Ecotoxicological assessment based on established sediment quality guidelines (SQGs) showed that DDT compounds have a potential threat to the aquatic environment of our study area.

Back pain is a commonly known problem for drivers and passengers traveling in long route vehicles, especially buses and trucks. The problem becomes more severe for people suffering from bedsores. The current embodiment is a step toward addressing this problem. This method helps to regulate blood flow and provide comfort to the drivers and bedsore patients. Pneumatic cylinder and 24 semi-circular designed aluminum buds are used in the assembly that moves up and down along with the comforter foam and sheet to serve the purpose. This design is an active way of providing comfort and has significantly helped in reducing back and lower body pain. A survey was conducted by 100 participants to analyze the comfort of the current embodiment. The age of these participants was divided into two categories. Results showed that comfort varies with age and pressure. It was concluded from the survey that young people from 20 to 30 years appreciate high pressure, whereas elderly people from 30 to 50 years like low pressure. The results from analysis of variance were found to be significant with feedback results. This system is also helpful in regulating blood flow. It was concluded that most people like high pressure and the first pattern.

Background Epilepsy is a neurological disorder that affects over 2% of the world population. Epilepsy patients suffer from recurring seizures that can be very harmful. The unpredictability of seizures is a major concern for medical practitioners because uncontrollable seizures can lead to sudden death and morbidity. A system that could warn patients and doctors alike about the impending seizure event would dramatically enhance the quality of life for patients. Methods While most previous research works focused on using signal processing tools appropriate for stationary signals, we propose here to use time and frequency (TF) analysis to extract features capable of discriminating normal from abnormal EEG traces (both ictal and interictal). The features are extracted using Singular Value Decomposition (SVD) of the EEG signal Time Frequency matrix. The left singular vectors of the time frequency matrix are used to obtain robust feature vectors. In contrast to existing techniques, the proposed TF-based technique can be used to detect the specific moments of seizure occurrences in time so that this information is used to discriminate interictal from ictal EEG traces. Instead of extracting the features directly from the TF matrix, we transform the left eigenvectors obtained from the SVD of the TF matrix into a feature vector that behaves like to a probability density function. Results We show that almost all classical classification techniques achieve excellent seizure detection results when used with the proposed TF features, irrespective of the classifier used. Contrary to existing works, we test our approach across several real-life scenarios covering 2, 3, and 5 possible classes of data. Our tests provided consistent results across different scenarios. The results, under different scenarios, outperformed existing ones achieving consistently more than 97.3% and up to 99.5% in terms of accuracy, sensitivity, and specificity. Conclusion Experimental results show that the novel features have successfully represented the characteristics of the underlying disease phenomenon from EEG data. Also, we conclude that learning based classifiers are better suited for this application, compared to Bayesian classifiers that have difficulty in adapting to the varying nature of the features' probability distribution function.

Background & Objectives: The study was undertaken to estimate the prevalence of body and blood fluid exposure incidents such as needle stick injuries, direct contact, splashes, and cuts among health care personnel (HCP) in operation theaters (OTs). The study objective was to investigate perception of safety culture and potential challenges faced by HCP in Pakistani context. Methods: An analytical cross-sectional survey was conducted in four tertiary care hospitals of Rawalpindi and Islamabad that were Akbar Niazi Teaching Hospital (ANTH), Fauji Foundation Hospital (FFH), Benazir Bhutto Hospital (BBH) and Holy Family Hospital (HFH) during March, 2019 to June, 2019. The data of the current study was collected from surgical staff in OTs at four tertiary care teaching hospitals including nurses, house officers, post graduate trainees, registrars, consultants, and technicians in the twin cities i.e., Rawalpindi and Islamabad. Results: In our findings (N=367) there was a high prevalence of exposure incidents in past six months, 45% had had got a needle injury, 36% have got a splash, 28.8% had direct contact and 35.6% had a cut once respectively in past six months, the occurrence of exposure incidents twice, thrice and more is also enormous. Conclusion: The study reflected a dire need of trainings at hospitals so that very strategically the importance of safety being a priority and value of HCP is inculcated on daily basis. doi: https://doi.org/10.12669/pjms.37.2.2946 How to cite this:Hameed T, Bashir EA, Khan AQ, Ahmad M. Safety culture implications on safe work practices and work place exposure incidents in Operation Theater. Pak J Med Sci. 2021;37(2):379-383. doi: https://doi.org/10.12669/pjms.37.2.2946 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Understanding fluid flow in shale rocks is critical for the recovery of unconventional energy resources. Despite the extensive research conducted on water and oil flow in shales, significant uncertainties and discrepancies remain in reported experimental data. The most noted being that while oil spreads more than water on shale surfaces in an inviscid medium, its uptake by shale pores is much less than water during capillary flow. This leads to misjudgement of wettability and the underlying physical phenomena. In this study, therefore, we performed a combined experimental and digital rock investigation on an organic-rich shale including contact angle and spontaneous imbibition, X-ray and neutron computed tomography, and small angle X-ray scattering tests to study the potential physical processes. We also used non-equilibrium thermodynamics to theoretically derive constitutive equations to support our experimental observations. The results of this study indicate that the pre-existing fractures (first continuum) imbibe more oil than water consistent with contact angle measurements. The overall imbibition is, however, higher for water than oil due to greater water diffusion into the shale matrix (second continuum). It is shown that more water uptake into shale is controlled by pore size and accessibility in addition to capillary or osmotic forces i.e. configurational diffusion of water versus oil molecules. While the inorganic pores seem more oil-wet in an inviscid medium, they easily allow passage of water molecules compared to oil due to the incredibly small size of water molecules that can pass through such micro-pores. Contrarily, these strongly oil-wet pores possessing strong capillarity are restricted to imbibe oil simply due to its large molecular size and physical inaccessibility to the micro-pores. These results provide new insights into the previously unexplained discrepancy regarding water and oil uptake capacity of shales.

Schistosomiasis is a major public health problem that is included in the neglected tropical diseases. The early diagnosis and detection of the pathogen are of critical importance in the control of the disease. The diagnostic techniques in use include the detection of worm's eggs in fecal examination or detection of circulating antigens in immunological based assays. These traditional strategies lack sensitivity in earlier detection of the schistosomiasis. Cell-free DNA (cfDNA) that includes the fragments of parasitic DNA circulating in the body fluids of host offers an alternative mean for the rapid pathogen detection and thus is a useful diagnostic tool. In this study, we explored the usefulness of the mitochondrial cfDNA markers for the diagnosis of schistosomiasis from the experimentally infected hosts (rabbits and mice). In this study we found mitochondrial DNA fragment cytochrome B gene as persistent and useful cfDNA marker for the early detection of schistosomiasis. We evaluated the sensitivity of cfDNA marker with varying numbers of cercaria. Overall, our results suggest that cfDNA markers can be useful for developing a diagnostic tool for the detection of S. japonicum infection.

Shallow urban lakes are important urban ecosystems; however, these systems are subject to severe polycyclic aromatic hydrocarbons (PAHs) contamination. An understanding of the distribution and dynamics of PAHs in lakes is required to restore the functions of lake ecosystems and to ensure the ecological security of urban water sources. The Quantitative Water Air Sediment Interaction (QWASI) model and partition coefficient and fugacity fraction methods were applied to estimate the multimedia transfers of PAHs in Dianshan Lake, a typical shallow lake in Shanghai, China. In addition, some new concepts and methods related to PAH transfers were introduced. The results showed that while the gas-solid partition in the area remained in non-equilibrium, the influence of pollution sources tended to weaken. Atmospheric advection was the main source of PAHs to the lake, and a portion of the net loss of advection was transformed into total flux of cross-interface transfers, in which transport fluxes from air to water and from water to sediment were dominant, with a significant correlation between the two types of transfer. The large resuspension of high molecular weight (HMW)-PAHs occurred, possibly related to frequent hydrodynamic disturbances. Furthermore, this study explored the distribution of PAHs among different compartments and the seasonal variation of multimedia transfers. Sensitivity analysis showed that the model is remarkably sensitive to four parameters including temperature and advection. Monte Carlo uncertainty analysis verified that the simulation results were stable and reliable. The results can provide a theoretical basis for the monitoring and control of shallow lake pollution.

PM2.5 samples in four representative periods were collected from a highly industrialized district in Shanghai, China. The concentrations of PM2.5 and PM2.5-bound PAHs were analyzed. Positive matrix factorization (PMF) model was used to identify the potential sources. Relationship between PAHs distribution and meteorological parameters was assessed meanwhile. The incremental lifetime cancer risks (ILCRs) model was applied to quantitatively evaluate the exposure risk of PAHs. Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLT) model was used to track the potential pollution area of PM2.5 along with a Potential Source Contribution Function (PSCF) and Concentration Weighted Trajectory (CWT) methods. The results showed concentrations of PM2.5 and PAHs ranged from 14.83 to 185.58 μg/m3, 2.58 to 123.62 ng/m3, respectively. The source apportionment model indicated that traffic emissions were the most important sources in each sampling season, which accounted for 38.44%, 34.48%, 39.04% and 45.03%, respectively. Spearman correlation coefficient showed that PAHs had negative correlation with ambient temperature and relative humidity in some periods, while had no significant correlation with atmospheric pressure and visibility. The average estimated lifetime cancer risk for total PAHs reached 4.7 × 10−5, 4.5 × 10−5 and 4.1 × 10−5, 4.0 × 10−5 to exposed children and adults in winter and autumn, respectively, meaning that PM2.5-bound PAHs had high potential risk. HYSPLIT model suggested that monsoon greatly influenced the air quality in both winter and autumn.

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Vaccinations against Novel Coronavirus 2019 (COVID-19) for immunocompromised individuals have been increasingly prioritized to avoid severe infection. Here is a case of severe COVID-19 infection in a patient with malignant lymphoma who completed the vaccination course. CASE PRESENTATION: A 79-year-old male with malignant lymphoma on active Rituximab was diagnosed with COVID-19 two months after completing the Pfizer vaccination course. He presented with a worsening cough despite receiving monoclonal antibodies outpatient. On evaluation, his vitals were stable. Chest x-ray revealed bilateral pleural effusions with bibasilar opacities. During his hospitalization, he received a full course of dexamethasone, ivermectin, remdesivir and baricitinib. However, his cough and oxygenation progressively worsened, with eventual intubation and vasopressor support. Computed Tomography (CT) Chest showed progressive worsening of COVID-19 Pneumonia. Originally on admission he had tested negative for the IgM and IgG antibodies against the Nucleocapsid (N) Protein which raised the suspicion that he had not mounted an immune response to the vaccine. On further evaluation, he was found to have positive antibody titers against Spike (S) proteins which confirmed that he had mounted a response to the vaccine despite his immunocompromised status. DISCUSSION: Anti-CD20 therapy is one of the primary therapies for hematological malignancies. Despite T cell function being the primary role against COVID-19, there is increasing evidence that B-cell depletion may inhibit protective immunity following infection and vaccination. A two-dose regimen of BNT162b2 (Pfizer) conferred 95% protection against COVID-19 in persons 16 years of age or older, and decreased the rate of severe infection. However, only 4% of the vaccinated patients suffered from any malignancy;0.2% of them had metastatic solid tumors, leukemia, lymphoma and none were on chemotherapy. The efficacy of the vaccine was extrapolated to include the subset of individuals on active chemotherapy. Interestingly, despite having an active immunological response to the vaccine and normal T-cell function, the patient suffered from severe COVID pneumonia. CONCLUSIONS: Though widespread immunization against COVID-19 is underway, patients with hematological malignancies still remain a vulnerable population. The decision to halt immunomodulatory therapy to improve efficacy of the vaccine needs further investigation. REFERENCE #1: Baker D et al. (2020). COVID-19 vaccine-readiness for anti-CD20-depleting therapy in autoimmune diseases. Clinical & Experimental Immunology, 202(2), 149–161. https://doi.org/10.1111/cei.13495 DISCLOSURES: No relevant relationships by Luke Alessi, source=Web Response No relevant relationships by Louis Avvento, source=Web Response No relevant relationships by Abdul Qadeer, source=Web Response No relevant relationships by Kathryn Saxby, source=Web Response No relevant relationships by Howard Sklarek, source=Web Response No relevant relationships by LAKSHMI SUBRAMANIAN, source=Web Response No relevant relationships by Daisy Young, source=Web Response

Schistosomiasis occurs in 240 million people worldwide and is a major public health concern. Thus, early diagnosis and monitoring of schistosomiasis progression are needed to treat patients. Cell-free DNA (cfDNA) is present as fragments of parasite-derived DNA in host body fluids. Detection of this cfDNA in host blood may be a promising diagnostic marker of schistosomiasis. Therefore, in this study, we investigated the potential of internal transcribed spacer 2 (ITS2), a molecular taxonomy and barcoding marker, in diagnosing schistosomiasis using infected rabbit and mice sera. A 192 bp fragment of ITS2 was detected in the serum-isolated DNA from the infected host on different days after infection. We also determined the sensitivity of detecting ITS2 in mice with varying numbers of cercaria: cfDNA was present even in mice with low abundance of the parasite. Overall, our results show that cfDNA may be a potential tool for the early diagnosis and therapeutic evaluation of S. japonicum infection.

The analysis of the ECG signal provides important information useful for heart disease diagnosis. Moreover, it can also help in identifying other problems such as neonatal seizures. Considering the nature of ECG patterns, several features can be extracted and used for the purpose of heartbeat and rhythm classification. In this paper, we discuss a set of 13 ECG geometric features for the purpose of identifying five abnormal types of heart beats. The proposed algorithm for feature extraction is based on the Pan-Tompkins QRS model. The MIT-BIH arrhythmia database is used in this study to test the performance of the proposed algorithm. The results show that different types of ECG based features are optimal for different types of heartbeat abnormalities. More importantly, we show that using the developed 13 features, we can identify at least 5 types of abnormalities with an accuracy of more than 92%.

Schistosomiasis is a severe chronic disease caused by parasitic worms of the genus Schistosoma. Recent studies indicate that schistosomes can secrete extracellular vesicles (EVs), which play important regulatory roles in many biological processes. However, the mechanisms underlying EV biogenesis in schistosomes are poorly understood. In this study, we performed bioinformatic analyses and identified several genes putatively involved in EV biogenesis in Schistosoma japonicum, which were then confirmed by PCR. Quantitative transcriptional profiles of the selected genes indicated that they were differentially expressed in male and female worms as well as in the different developmental stages of S. japonicum. Thus, the highest expression of VAMP3 was detected in cercariae, whereas that of ARF6 was detected in eggs. RAB11A and the Syntenin-encoding gene SDCBP were highly expressed in 14-day schistosomula and VPS4A and RAB27A were highly expressed in 35-day-old adult schistosomes. The expression of RAB11A, CHMP4C, VPS4A, and SDCBP was higher in male worms, whereas that of ARF6, VAMP3, and RAB27A was higher in female worms. Our results are expected to provide important clues for understanding the role of EV biogenesis in S. japonicum development.

Objective: To find out effectiveness of revisional laparoscopic sleeve gastrectomy (RLSG) in the patients who had laparoscopic adjustable gastric banding (LAGB) and failed to reduce or regained the weight and effectiveness of sweet abstaining and exercise on postoperative weight loss. Methods: This retrospective observational study was conducted at AlMoosa Hospital, Al-Ahsa, Kingdom of Saudi Arabia from December 2011 to November 2016. The patients who failed to reduce, regained the weight or had complications after LAGB, were performed RLSG. They were followed-up at three, six, twelve and twenty-four months intervals. Their weight, percent excess weight loss (%EWL) and body mass index (BMI) at pre-RLSG were compared with post-RLSG. The data was recorded in SPSS 22 and analyzed. Results: Thirty-six patients with male/female ratio of 1:5 underwent RLSG. Twelve (33.3%) were frequent sweet-eaters and twenty-four (66.7%) were not. Fourteen (38.88%) did not have exercise, while twenty-two (61.11%) had daily regular exercise. Their mean pre-RLSG weight, percent excess weight loss (%EWL)and BMI were compared with post-RLSG at the period of three, six, twelve and twenty-four months. Their mean weight reduced from 111.69 kilograms to 96.94, 87.25, 79.56 and 76.11 kilograms respectively. Their mean of the percent excess weight loss (%EWL) reduced to 22.08, 45.75, 59.64 and 66.42 kilograms respectively. Their mean pre-RLSG BMI was 43.50 kg.m-2, which reduced to the mean of 37.79, 34.02, 30.97 and 29.70 respectively. There were no post-operative complications in thirty (83.3%), mild like wound infection and seroma in four (11.1%) and bleeding in two (5.6%) patients. None of the patients had leakage. The patients who kept themselves abstained from sweet consumption and performed regular postoperative exercise had better results. They also had considerable reduction in appetite after RLSG. Conclusion: RLSG is an effective procedure after failed LAGB in terms of weight loss having minimal rate of complications. Moreover, abstaining from sweet consumption and continuing exercise postoperatively has better results.

Spatial-temporal distributions, sources identification and risk assessment of polycyclic aromatic hydrocarbons (PAHs) in overlying water and surface sediments in urban river networks of Shanghai were studied. Analytical results showed that there was a significant seasonal variation in concentrations of ∑16PAHs in water, suspended particulate matter (SPM) and sediment phases in this study area. The PAHs pollution in these multi-phases were in the medium level compared with other areas around the world, and the levels of PAHs contamination in SPM and sediment phases in hierarchical rivers showed TS (the third-order stream) > FS (the first-order stream) > SS (the second-order stream). Two manners of isomer ratios and principal component analysis (PCA) were used to identify PAHs origins, and suggested that combustion processes are dominant for PAHs sources. The ratios of PAHs origins by fossil fuels combustion, coke burning and crude oil in hierarchical rivers were determined with FS > SS > TS in SPM and sediment phases, and the ratio of PAHs origins by traffic emissions was analyzed with TS > SS > FS. PAHs in water samples have a certain impact on aqueous ecological system especially due to the fact that the ∑ceq values of nine PAHs were calculated from 0.715 to 15.831 μg/L in winter, which inferred serious ecological risk to some special aquatic organisms. The calculations of MERMQ in sediment samples showed that the MERMQ values ranged from 0.021 to 1.209 in winter and 0.019 to 0.643 in summer, which suggested high toxicity at six sampling sites in winter and only one location in summer due to high levels of PAHs. Furthermore, the toxicity degree of sediments were demonstrated with TS > FS > SS.

To observe the frequency of smoking in female medical students and to determinethe associated factors. Study Design: Cross-sectional survey. Setting: Data was collectedthrough a self-administered questionnaire from female students at Rawal Institute of HealthSciences. Period: February 2015 to August 2015. Methods: Information about demographiccharacteristics, smoking status in family members, number of cigarettes smoked per day,influence for starting smoking and use of sheesha and hash was obtained. Results: A total of100 female students were asked to fill the questionnaires. Response rate was 60%, out of which,52.6 % (31/60) were smokers and 48.4% were non-smokers.6 out of 31 were hash smokersand 20 out of 60 were cigarette smokers, remaining were sheesha smokers. Majority of thesefemales started smoking after 18 years of age, with greatest influence being life style and peerpressure. Our results show substantial trend of smoking in female medical students. Majorityhave smokers in their families but their families were not aware of their smoking habit. Eventhough almost everyone was aware of the associated risks, 24% never tried to quit. Most of thestudents spent Rs 1500 to 3000 per month on smoking.

Objectives: To determine the frequency of hypothyroidism in patients with viralhepatitis receiving interferon treatment. Study Design: Descriptive cross sectional. Setting:Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi. Duration of Study: Sixmonths. Subjects and Methods: All patients with age 30 to 60 years of either gender havingpersistent or intermittent elevation of alanine arninotransferase (ALT, the upper limit of normalALT is 40 IU/L) over a six-month period and Anti-HCV positivity and detection of HCV-RNA inthe sera On IFN-α mono therapy for more than 3 months were enrolled. History of duration ofdisease and treatment was obtained from patients. A 3 cc blood sample of Patients were drawnand send for TSH level. Presence of TSH level >4.0 miU/L was labelled as Hypothyroidism.Results: Mean age of the patients was 51.79±7.96 years. There were 51 (43.60%) males and 66(56.40%) females. Mean TSH level was 3.98±0.23 mIU/L. Mean duration of HCV was 6.42±1.67months. Mean duration of treatment was 5.42±1.67 months. Frequency of hypothyroidism wasfound in 62 (53%) patients. Conclusion: The frequency of hypothyroidism in patients with viralhepatitis receiving interferon treatment was found to be 62 (53%).

Knee joint’s muscle strength and range of motion get affected after total knee replacement and anterior cruciate ligament surgeries. Therefore, the purpose of this study is to design a rehabilitative device for knee joint muscle strength and range of motion enhancement. The device will work using a Printed Circuit Board-Arduino based electronic circuit which will operate the geared DC motor. The degrees of flexion /extension, speed of movement and duration could be set by physiotherapists remotely, using android technology. The android application will also store patient’s history of the exercises performed and can also send the patient’s feedback about improvement in his condition to physiotherapist.

Objective We compared 1-year outcomes in insulin-treated diabetes mellitus (ITDM) and non-ITDM patients compared to nondiabetic (DM) patients following contemporary percutaneous coronary intervention (PCI). Background ITDM is associated with extensive atherosclerotic disease and worse cardiovascular prognosis compared to non-ITDM patients. Methods We evaluated PCI patients at a large tertiary center from 2010 to 2016, grouped according to diabetes and treatment status at baseline. One-year major adverse cardiac events (MACE) were defined as a composite of death, myocardial infarction (MI), or target vessel revascularization. Outcomes were adjusted using multivariable Cox regression methods. Results During the study period, 16,889 patients underwent PCI including 13.7% ITDM, 34.0% non-ITDM, and 52.3% non-DM patients. Patients with DM were younger, including more females and non-white patients, with higher body mass index and greater prevalence of prior revascularization and chronic kidney disease. Compared to others, ITDM patients more often presented with acute coronary syndrome, in-stent restenosis, or severe lesion calcification. There were no differences in discharge rates of dual antiplatelet therapy and statins, whereas beta-blockers were more commonly prescribed in DM patients. At 1-year, both ITDM and non-ITDM patients had greater risk of MACE compared with non-DM patients, and ITDM conferred greater adjusted risk than non-ITDM (ITDM = HR: 2.11, 95% CI [1.79,2.50]; non-ITDM = HR: 1.27, 95%CI [1.09,1.47]). Conclusions The negative prognostic effect of DM following contemporary PCI is heightened in the presence of insulin treatment, compared to non-DM patients. Focus on secondary prevention, prescription of and adherence to optimal medical therapy is necessary for post-PCI risk reduction.

Aims Catheter ablation for atrial fibrillation (AF) is associated with a transitory increase in the risk of both thromboembolic and bleeding events. Evidence on the use of nonvitamin K antagonist oral anticoagulants (NOACs) in patients undergoing AF ablation mostly comes from small observational studies, underpowered to detect differences in clinical outcomes between NOACs and vitamin K antagonists (VKAs) treated patients. This updated meta-analysis aimed to determine the safety and efficacy of periprocedural anticoagulation with NOACs compared with VKAs in AF patients undergoing catheter ablation. Methods We searched MEDLINE, Cochrane library, and web sources for randomized and observational studies comparing periprocedural treatment with NOACs and VKAs in patients undergoing AF ablation. The primary safety endpoint was major bleeding events, and the primary efficacy endpoint was thromboembolic events (a composite of systemic thromboembolism, transient ischemic attack, and stroke). Results A total of 29 studies with 12 644 patients were included in the meta-analysis. Overall, patients on NOACs had a significantly lower risk of major bleeding compared to VKAs either in observational studies (Peto OR 0.68; 95% CI: 0.48-0.95; P = 0.022; I2 = 20%) or in RCTs (Peto OR 0.30; 95% CI: 0.14-0.62; P = 0.001; I2 = 28%). Uninterrupted NOACs reduced the risk of major bleeding when compared to uninterrupted VKAs (Peto OR 0.66; 95% CI: 0.45-0.96; P = 0.028; I2 = 1%), similarly, interrupted NOACs lowered the risk of major bleeding compared to interrupted VKAs (Peto OR 0.29; 95% CI: 0.13-0.66; P = 0.003; I2 = 0%; Pinteraction = 0.076). The rate of thromboembolic complications was very low and did not significantly differ between the study groups either in observational studies (Peto OR 0.91; 95% CI: 0.49-1.67; P = 0.755; I2 = 0%) or in RCTs (Peto OR 0.14; 95% CI: 0.01-1.30; P = 0.083; I2 = 0%). Conclusions Use of NOACs compared to VKAs significantly reduced the risk of bleeding in patients with AF ablation. Similarly, the risk of bleeding was lower with uninterrupted NOACs than with uninterrupted VKAs, and with interrupted NOACs than with interrupted VKAs. The rate of thromboembolic complications was extremely low in both study groups without any differences.

Tako-tsubo cardiomyopathy is a heart disease that imitates acute myocardial infarction. Classical findings include apical and mid segment hypokinesia. However, it may have different appearance than was originally described. In our case report we describe a case of woman with tako-tsubo cardiomyopathy (TTC), who was admitted to hospital after a stressful event because of chest pain, with normal coronary angiogram and with mild elevation of Troponin-I level. Electrocardiogram corresponded with non-Q myocardial infarction of inferior wall. Following left ventriculography, echocardiography and magnetic resonance, impaired contractility of the basal part of inferior wall was noticed, together with good global ejection fraction. Full recovery was attained in five weeks after the onset. This impairment of left ventricle is not typical for TTC. In our patient, the basal part of left ventricle was affected, and not the apex as it is usually seen in TTC. This finding corresponds to rare “inverted” form of TTC. Another atypical feature is segmental involvement that, moreover, covered the inferior wall. This morphological pattern, according to our best knowledge, has not yet been described in literature. Pathophysiology, epidemiology and clinical significance are shortly reviewed in the paper.

Background: Though magnetic resonance imaging (MRI) is popular as a diagnostic tool, questions arise regarding imaging when clinical diagnosis of most internal derangements of knee can be done. Treatment of meniscal and anterior cruciate ligament (ACL) injuries usually involves arthroscopic surgery after MRI. But accurately performed examination with positive signs alone will be justified for arthroscopy directly without MRI. The aims and objectives of this study are to assess the impact of MRI in selecting or excluding cases which genuinely require an arthroscopic surgery. To know whether routine MRI is required pre-operatively in all cases with positive clinical findings.Methods: 60 cases underwent clinical examination of affected knee and a preliminary diagnosis was made. Further they were subjected to MRI. Results of arthroscopy were considered as definitive diagnosis and results of clinical examination and MRI were judged accordingly.Results: Of 60 patients, examination revealed 85% accuracy, 82% sensitivity, 89% specificity for ACL injuries. For medial meniscus 58% accuracy, 66% sensitivity, 48% specificity. For lateral meniscus 55% accuracy, 58% sensitivity, 50% specificity. MRI revealed 73% accuracy, 82% sensitivity, 63% specificity for ACL injuries. For medial meniscus 63% accuracy, 90% sensitivity, 39% specificity. For lateral meniscus 62% accuracy, 79% sensitivity, 50% specificity.Conclusions: Clinical examination is more sensitive, specific and accurate in diagnosis of ACL. MRI is more sensitive but less specific for meniscal injuries. Clinical examination for cruciate injuries can surpass the MRI findings. Arthroscopy can be performed without MRI in single lesion injuries. However, MRI will play a role in meniscal injuries or doubtful cases.

Aims: To compare the level of awareness and willingness of eye donation between first and last year medical students of Karachi, Pakistan. Methodology: A total of 1010 medical students were selected from 4 different medical universities of Karachi through random sampling of which 524 (52%) were first year students and 486 (48%) were final year students. Cross sectional study design was conducted to access their perception towards eye donation. For this a self-administered semi structured questionnaire was used which covered individual’s awareness, willingness, source of information and compelling factors for eye donation. Results: 522 out of 524 first year (99.6 %) and 486 out of 486 final year (100%) medical students were well aware of eye donation. Willingness to donate eyes after death was seen in only 151/524 (28.8 %) first year students and 217/486 (44.6%) last year students. Most common source of information for first year students regarding eye donation was through mass media, TV and radio 320/524 (61%) however for the last year students it was through exposure in hospitals and information by medical specialist 311/486 (64%). Lastly humanitarian grounds was considered most common promoting factor for eye donation by both first (368/524 (70.2%)) and last (359/486 (73.8%)) year students. Conclusion: Awareness of eye donation was found high among both year of students despite this fact very less number of students were willing to donate eyes. This reflects that having awareness of eye donation isn’t enough thus measures should be taken to promote students to donate eyes by encouraging them to help the needy, inciting them with religious benefits and clearing any misconceptions about religion and ethical issues in this regard.

Studies on the impact of concomitant coronary artery disease (CAD) on clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) have shown conflicting results. We analyzed 803 consecutive patients enrolled in a single center TAVR registry between 2012 and 2016. Patients

Preeclampsia is a serious medical complication during pregnancy. In response to an increasing number of preeclamptic cases and scarcity of data concerning the interrelation between trace element levels and preeclampsia, we carried out a hospital based case–control study in Riyadh, Saudi Arabia to study the correlation between levels of serum trace elements and risk of preeclampsia. One hundred and twenty pregnant women were enrolled in this study and divided into three groups of 40 each—Control group, HR group (women at high risk of preeclampsia) and PET group (Preeclampsia group). Serum trace element levels were estimated by inductively coupled plasma optical emission spectrophotometer. The analysis found that mean values of Ca, Mg and Zn were 90.08 ± 6.38, 19.33 ± 3.32 and 1.30 ± 0.83 mg/L respectively in normotensive control and 77.85 ± 4.47, 15.44 ± 1.43 and 0.98 ± 0.63 mg/L respectively in the HR group. The mean values of Ca, Mg and Zn in the preeclamptic group were 70.37 ± 4.66, 13.58 ± 1.98 and 0.67 ± 0.59 mg/L, respectively. Interelement analysis reflected a negative correlation between Ca and Mg and between Mg and Zn whereas positive correlation between Ca and Zn in preeclamptic women. However the correlation was not statistically significant. In conclusion, our study suggests that decreased levels of these trace elements in serum may act as predisposing factors in pathogenesis of Preeclampsia. Keywords: Preeclampsia, Risk factors, Calcium, Magnesium, Zinc

Chronic lymphocytic leukemia (CLL) is the most common adult leukemia and is currently incurable. To expand the therapeutic armamentarium, we investigated neem leaf extract (NLE) after a patient with CLL demonstrated disease regression upon taking oral NLE. NLE-mediated apoptosis was examined in peripheral blood mononuclear cells (PBMCs) from 41 patients with CLL. NLE induced a dose-dependent reduction in CLL cell viability with signifi cant apoptosis observed at 0.06% (w/v) by 24 h. Annexin-V staining and poly(ADP-ribose) polymerase 1 (PARP-1) and caspase 3 cleavage were observed after NLE treatment. However, a pan-caspase inhibitor only partially blocked NLE-mediated cell death. NLE also caused loss of mitochondrial outer membrane permeability and nuclear translocation of apoptosis-inducing factor. Furthermore, NLE treatment resulted in LC3-I cleavage. Biochemical analyses revealed that NLE also inhibits Bcl-2 and p53 proteins. In summary, NLE exhibits anti-leukemic properties in patient primary CLL cells and demonstrates clinical effi cacy, warranting further investigation as a potential therapy for CLL.

This paper gives an outline of our ongoing work in the field of a capable web browser for J2ME enabled mobile devices, especially cell phones. The paper gives a basic overview of the current stage in web browsing and additional networking advancements in portable devices as well as the progress achieved and future advancements in our project we are looking forward to. At the present stage, cell phones include their own web browsers but with limited functionalities and low multimedia support, especially on low bandwidth GPRS networks. The inability of J2ME in parsing a webpage and its substitutes like xml parsing are discussed. Our current work has reached web page parsing, downloading documents and multimedia files. Also, video streaming is currently in development phase but the current status promises positive achievements in future.

The prevalence of Cysticercus bovis at Jos abattoir during post mortem examination conducted on Fourteen thousand three hundred and seventy two (14,372) slaughtered cattle over a period of two years (January 1997 – Dec. 1999), using evagination method. Out of 14,372 carcasses examined 1924 (13.4 %) tested positive for C. bovis. The sites of the location of the larvae varied from one organ to another with the heart having the highest 48 (30.0 %) and the least affected were the visceral organs livers, lungs and esophagi. There is a positive correlation between the number of C. bovis cyst and the percentage frequency of the organ affected (P

The website census is an effort to enumerate all the websites on the World Wide Web (WWW) without using crawling. Crawling is a traditional way of website discovery. It is conceptually simple but the very size of the WWW makes the implementation complex and resource demanding. The enormous amount of bandwidth, a huge persistent storage pool, a sufficiently large cluster of machines for data processing and a complex set of software systems are just a few examples of the needed resources. In this work, we use exhaustive IP range probing to detect the presence of a web server on TCP port 80. Although this probing is exhaustive in nature, it is lightweight in terms of resource demands. This enumeration of websites has many applications. The most obvious is to use it as a seed to the conventional crawling. It can be refined to be used as a top level domain (TLD) specific seed for targeted crawling.

The focus of this study is the analysis of biometric data related to the effects of the foetal growth based on the social status of vegetarian and non-vegetarian patients referred to clinicians. We have analyzed multiple biometric parameters such as age, socio-economic status, last menstrual period, and their associated biometric data. Out of thirty random patients, twelve patients were selected for investigation. Our results indicate that the growth rate of vegetarians is 56 grams/week, while for non-vegetarians it is 36 grams/week at the second and third trimester of the middle class patients.