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OBJECTIVES: The accuracy of clinical tests (Lachman, McMurray, Anterior Drawer) in the diagnosis of knee joint injuries in comparison to arthroscopy taken as gold standard. METHODOLOGY: This cross-sectional study was conducted at the Department of Orthopedic Surgery, Khyber Teaching Hospital, Peshawar for 3 years. Total of 48 patients were recruited in the study. Data was collected after ethical approval from the hospital ethical committee using consecutive non-probability sampling techniques. Written informed consent was obtained from the patients. Arthroscopy examination was taken as a gold standard. Data analysis was performed using statistical software SPSS 21 and MEDCALC online software for calculating sensitivity and specificities of the clinical tests. RESULTS: Mean age was 26.4+6.5 years. Lachman and Anterior Drawer tests were noted to have 91.67% and 66.67% sensitivity for anterior cruciate ligament while McMurray test was noted only 66.67% sensitive for both meniscal injuries. On the other hand, Lachman was 95.8% specific, McMurray was 77.78%, and Anterior Drawer was 79.2% specific. Regarding accuracy, Lachman was 93.7%, McMurray 70.8% and Anterior Drawer was 72.9% accurate. CONCLUSION: Among clinical examination and specific examination tests, Lachman has high sensitivity, specificity and accuracy followed by Anterior Drawer test and MacMurray for diagnosing anterior cruciate ligament and meniscal injuries of knee joint.

Background Enforced social distancing (i.e., lockdowns) greatly facilitated control of coronavirus disease-19 (COVID-19). While access to hospitals was restricted, outpatient care continued remotely. The aim of this study was to determine the satisfaction of patients with severe asthma with telemedicine, and the impact of COVID-19 lockdown on severe asthma patients on biologics therapy. Methods A cross-sectional survey of patients with severe asthma scheduled to receive biologic therapy at our hospital during the lockdown. The survey had sections about demographic data, asthma history, subjective perception of change in asthma control with biologic agent, the effect of COVID-19 pandemic on access to maintenance therapy for asthma, asthma exacerbation management, and satisfaction with telephone follow-up. Results Fifty-four patients participated (response rate 93.1%; male 17; mean age 46.7 years). All had been on biologic therapy for over 3 months (mean 38.4 months ± standard deviation 26.5 months). Of the 45 patients living in Riyadh, 9 did not receive biologic therapy. Five of the nine patients living outside Riyadh did not receive biologic therapy. Alarmingly, 16 (29.6%) had insufficient medications, and 27 (50%) had difficulty obtaining medications. Fifty (92.6%) had telephone follow-up, 31 (57.4%) were satisfied with telemedicine. Conclusion Many patients were satisfied with telemedicine, so this could be used to deliver routine outpatient tertiary care postpandemic. However, logistics around supplying medications and biologics must be considered in plans preparing for the second wave of COVID-19.

A field study was conducted at village Sardheri, district Charsadda for the year 2017 in order to evaluate the efficacy of bio-insecticides and synthetic agrochemicals against the aphids and Helicoverpa. armigera on Okra. There were eight treatments including control. The highest % reduction control of aphids after 3rd spray was 91.2 recorded for T6 treatment and T5 was the next superior treatment having a % reduction of 86.2. The highest percent reduction in pod damage (75.5%) was recorded for T6 after 3rd spray, while T5 was the next superior treatment and the pod borer damage was noted to be 72.2%. T5 yielded the highest mean produce of Okra per plant and was recorded to be 446.3 g. These findings revealed that bio-insecticide can be effectively used to control aphid population as well as the fruit infestation of Okra and improving the yield of Okra. The bio-insecticides can also lower the inputs of residues in the crops and pose least toxicity to non-targeted organism and also readily degradable.

A field study was conducted to investigate the effect of botanical extracts i.e. neem oil emulsified with NIFA adjuvant, turmeric and hinge crude extracts and neem oil in combination with white oil emulsified with NIFA adjuvants and the synthetic insecticides i.e. emamectin and bifenthrin on the control of Helicoverpa armigera on tomato crop. It was found that the highest control of H. armigera was observed for emamactin and the lowest was recoded for control. Similarly, the highest yield of tomato was recoded for neem-white oil treatment and lowest infestation was recorded for emamactin benzoate. The neem oil and neem oil in combination with white oil emulsified with NIFA adjuvant also showedbetter results than bifenthrin and hinge and turmeric crude extracts in controlling the larvae population of H. armigera. On the basis of these findings, neem oil and neem oil combined with white oil is the best management technique for controlling the H. armigera, as these agents pose least environmental hazards and are relatively nontoxic to beneficial insects and humans and readily photodegrade. Keywords

Hereditary Spastic paraplegias (HSPs) are heterogeneous group of degenerative disorders characterized by progressive weakness and spasticity of the lower limbs, combined with additional neurological features. This study aimed to identify causative gene variants in two nonrelated consanguineous Pakistani families segregating HSP. Whole exome sequencing (WES) was performed on a total of five individuals from two families including four affected and one phenotypically normal individual. The variants were validated by Sanger sequencing and segregation analysis. In family A, a novel homozygous variant c.604G > A (p.Glu202Lys) was identified in the CYP2U1 gene with clinical symptoms of SPG56 in 3 siblings. Whereas, a previously reported variant c.5769delT (p.Ser1923Argfs*28) in the SPG11 gene was identified in family B manifesting clinical features of SPG11 in 3 affected individuals. Our combined findings add to the clinical and genetic variability associated with CYP2U1 and SPG11 variants highlighting the complexity of HSPs. These findings further emphasize the usefulness of WES as a powerful diagnostic tool.

Microcephaly (MCPH) is a genetically heterogeneous disorder characterized by non-progressive intellectual disability, small head circumference, and small brain size compared with the age- and sex-matched population. MCPH manifests as an isolated condition or part of another clinical syndrome; so far, 25 genes have been linked with MCPH. Many of these genes are reported in Pakistani population, but due to a high rate of consanguinity, a significant proportion of MCPH cohort is yet to be explored. MCPH5 is the most frequently reported type, accounting for up to 68.75% alone in a genetically constrained population like Pakistan. In the current study, whole exome sequencing (WES) was performed on probands from 10 families sampled from South Waziristan and two families from rural areas of the Pakistani Punjab. Candidate variants were validated through Sanger sequencing in all available family members. Variant filtering andin silicoanalysis identified three known mutations inASPM, a MCPH5-associated gene. The founder mutation p.Trp1326*was segregating in 10 families, which further confirmed the evidence that it is the most prominent mutation in Pashtun ethnicity living in Pakistan and Afghanistan. Furthermore, the previously known mutations p.Arg3244*and p.Arg1019*were inherited in two families with Punjab ethnic profile. Collectively, this study added 12 more families to the mutational paradigm ofASPMand expanded the Pakistani MCPH cohort.

GPR56 gene is best known for its pivotal role in cerebral cortical development. Mutations in GPR56 give rise to cobblestone-like brain malformation, white matter changes and cerebellar dysplasia. This study aimed to identify causative variant in a consanguineous family having five individuals affected with developmental delay, mild to severe intellectual disability, speech impairment, strabismus and seizures. Whole exome sequencing was performed to identify mutation in affected individuals. Variants were filtered and further validated by Sanger sequencing and segregation analysis. A novel frameshift variant c.1601dupT leading to p.Ala535GlyfsTer17) was identified in GPR56 gene by whole exome sequencing and subsequent filtering. All five affected individuals were homozygous for the mutant allele while four asymptomatic individuals carried the variant in heterozygous state. Radiological findings of a representative patient presented features of GPR56-associated cobblestone like brain malformation. MRI findings suggested paucity of sulci, dilated ventricular system and brainstem atrophy. The microgyria were observed in a simplified gyral pattern (cobblestone). This single bp insertion, and the consequent frameshift, results in the truncation of GPR56 protein. This could result in a malformed cortex giving the brain a cobblestone like shape. Our study identified a 7th novel frameshift variant from Pakistani population in GPR56 gene, thus broadening mutation spectrum.

Congenital microcephaly is the clinical presentation of significantly reduced head circumference at birth. It manifests as both non-syndromic—microcephaly primary hereditary (MCPH)—and syndromic forms and shows considerable inter- and intrafamilial variability. It has been hypothesized that additional genetic variants may be responsible for this variability, but data are sparse. We have conducted deep phenotyping and genotyping of five Pakistani multiplex families with either MCPH (n = 3) or Seckel syndrome (n = 2). In addition to homozygous causal variants in ASPM or CENPJ, we discovered additional heterozygous modifier variants in WDR62, CEP63, RAD50 and PCNT—genes already known to be associated with neurological disorders. MCPH patients carrying an additional heterozygous modifier variant showed more severe phenotypic features. Likewise, the phenotype of Seckel syndrome caused by a novel CENPJ variant was aggravated to microcephalic osteodysplastic primordial dwarfism type II (MOPDII) in conjunction with an additional PCNT variant. We show that the CENPJ missense variant impairs splicing and decreases protein expression. We also observed centrosome amplification errors in patient cells, which were twofold higher in MOPDII as compared to Seckel cells. Taken together, these observations advocate for consideration of additional variants in related genes for their role in modifying the expressivity of the phenotype and need to be considered in genetic counseling and risk assessment. Higher Education of Commission (HEC) of Pakistan Center for Molecular Medicine Cologne - 38-RP Center for Molecular Medicine Cologne - 2635/8029/01 Center for Molecular Medicine Cologne- 2635/8326/01 Koeln Fortune Program, Faculty of Medicine, University of Cologne - 381/2020 WOS:000653928700001 PMID: 34068194 Q2

Item does not contain fulltext Steroid-resistant nephrotic syndrome (SRNS) almost invariably progresses to end-stage renal disease. Although more than 50 monogenic causes of SRNS have been described, a large proportion of SRNS remains unexplained. Recently, it was discovered that mutations of NUP93 and NUP205, encoding 2 proteins of the inner ring subunit of the nuclear pore complex (NPC), cause SRNS. Here, we describe mutations in genes encoding 4 components of the outer rings of the NPC, namely NUP107, NUP85, NUP133, and NUP160, in 13 families with SRNS. Using coimmunoprecipitation experiments, we showed that certain pathogenic alleles weakened the interaction between neighboring NPC subunits. We demonstrated that morpholino knockdown of nup107, nup85, or nup133 in Xenopus disrupted glomerulogenesis. Re-expression of WT mRNA, but not of mRNA reflecting mutations from SRNS patients, mitigated this phenotype. We furthermore found that CRISPR/Cas9 knockout of NUP107, NUP85, or NUP133 in podocytes activated Cdc42, an important effector of SRNS pathogenesis. CRISPR/Cas9 knockout of nup107 or nup85 in zebrafish caused developmental anomalies and early lethality. In contrast, an in-frame mutation of nup107 did not affect survival, thus mimicking the allelic effects seen in humans. In conclusion, we discovered here that mutations in 4 genes encoding components of the outer ring subunits of the NPC cause SRNS and thereby provide further evidence that specific hypomorphic mutations in these essential genes cause a distinct, organ-specific phenotype.

Primary microcephaly (MCPH) is a prenatal condition of small brain size with a varying degree of intellectual disability. It is a heterogeneous genetic disorder with 28 associated genes reported so far. Most of these genes encode centrosomal proteins. Recently, AKNA was recognized as a novel centrosomal protein that regulates neurogenesis via microtubule organization, making AKNA a likely candidate gene for MCPH. Using linkage analysis and whole-exome sequencing, we found a frameshift variant in exon 12 of AKNA (NM_030767.4: c.2737delG) that cosegregates with microcephaly, mild intellectual disability and speech impairment in a consanguineous family from Pakistan. This variant is predicted to result in a protein with a truncated C-terminus (p.(Glu913Argfs*42)), which has been shown to be indispensable to AKNA’s localization to the centrosome and a normal brain development. Moreover, the amino acid sequence is altered from the beginning of the second of the two PEST domains, which are rich in proline (P), glutamic acid (E), serine (S), and threonine (T) and common to rapidly degraded proteins. An impaired function of the PEST domains may affect the intracellular half-life of the protein. Our genetic findings compellingly substantiate the predicted candidacy, based on its newly ascribed functional features, of the multifaceted protein AKNA for association with MCPH.

Pyomyositis is a common health problem with significant complications andmorbidity. Surgical drainage and Antibiotic treatment is the mainstay of its treatment. Properculture and sensitivity of etiological bacteria is crucial for successful treatment of Pyomyositis.Objectives: To determine the frequency of Pyomyositis and its common bacteria with theirantibiotics sensitivity among children presenting with highly suspected clinical features.Design: Cross sectional descriptive study. Setting: Department of Orthopedics and Trauma,Khyber Teaching Hospital, Peshawar. Period: 12 months from19th July, 2012 to 18th July, 2013.Materials and Methods: 156 patients presented with highly suspected clinical features ofPyomyositis were examined clinically and were investigated by Ultra sound and CBC. Thosepatients who were having Pyomyositis, pus samples were taken for culture and sensitivity testand the data was analyzed by Statistical Package for Social Sciences (SPSS) version 10.0.Results: There were147 (94.23%) patients having Pyomyositis out of 156 patients. On cultureand sensitivity test, 87 (59.18%) have positive growth while 60 (40.82%) have no growth. Themost common bacteria isolated was Staphylococcus aureus55 (63.21%) followed by E. coli 10(11.49%), Pseudomonas Aeruginosa 7 (8.04%), and Streptococcus Pyogenes 5 (5.74%). Allisolated bacteria showed more than 95% and 90% sensitivity to Vancomycinand and Fusidicacid respectively while all bacteria showed maximum resistance to Penicillin i.e. more than35%. Conclusion: Prompt diagnosis of pyomyositis in highly suspected patients, detection ofits etiological bacteria and their antibiotic sensitivity tests are very important for the treatmentof Pyomyositis.

This study aimed to develop a practical and accurate 4-dimensional (4D) magnetic resonance imaging (MRI) method using a non-navigator, image-based internal respiratory surrogate derived by dimensionality reduction (DR). The use of DR has been previously suggested but not implemented for reconstructing 4D MRI, despite its practical advantages. We compared multiple image-acquisition schemes and refined a retrospective-sorting process to optimally implement a DR-derived surrogate. The comparison included an unconventional scheme that acquires paired slices alternately to mitigate the internal surrogate's dependency on a specific slice location. We introduced 'target-oriented sorting', as opposed to conventional binning, to quantify the coherence in retrospectively sorted images, thereby determining the minimal scan time needed for sufficient coherence. This study focused on evaluating the proposed method using digital phantoms which provided unequivocal gold standard. The evaluation indicated that the DR-based respiratory surrogate is highly accurate: the error in amplitude percentile of the surrogate signal was less than 5% with the optimal scheme. Acquiring alternating paired slices was superior to the conventional scheme of acquiring individual slices; the advantage of the unconventional scheme was more pronounced when a substantial phase shift occurred across slice locations. The analysis of coherence across sorted images confirmed the advantage of higher sampling efficiencies in non-navigator respiratory surrogates. We determined that a scan time of 20 s per imaging slice was sufficient to achieve a mean coherence error of less than 1% for the tested respiratory patterns. The clinical applicability of the proposed 4D MRI has been demonstrated with volunteers and patients. The diaphragm motion in 4D MRI was consistent with that in dynamic 2D imaging which was regarded as the gold standard (difference within 1.8 mm on average).

Phase contrast magnetic resonance imaging (PC-MRI) and color-coded duplex ultrasonography (CDUS) are commonly used for measuring cerebral blood flow in the internal carotid (ICA) and vertebral arteries. However, agreement between the two methods has been controversial. Recent development of high spatial and temporal resolution blood vessel wall edge-detection and wall-tracking methods with CDUS increased the accuracy and reliability of blood vessel diameter, hence cerebral blood flow measurement. The aim of this study was to compare the improved CDUS method with 3 T PC-MRI for cerebral blood flow measurements. We found that cerebral blood flow velocity measured in the ICA was lower using PC-MRI than CDUS (left ICA: PC-MRI, 18.0 ± 4.2 vs. CDUS, 25.6 ± 8.6 cm/s; right ICA: PC-MRI, 18.5 ± 4.8 vs. CDUS, 26.6 ± 6.7 cm/s, both p

Objective: Menstrual disorders constitute one of the major problems faced by medical students globally. Amongst the various factors attributed as causative factors in menstrual cycle variations, include body mass index [BMI] is the most easily modifiable factor. As we still do not have clear answers, this study was planned to study the association of menstrual disorders with BMI.Methodology: This is a cross sectional study, done in undergraduate female medical students in the age group of 18 to 30 years. Exclusion criteria included pregnancy, breast feeding

Zkoumání materiálů s vysokou účinností pro příští generace optoelektronických a fotovoltaické aplikace je velmi důležité. V tomto článku se budeme zkoumat potenciál nově navržených krychlových strukturované Siliconmonochalcogenides (π- SiS, π-SiSe, a π-SiTe) pro fotovoltaické a optoelektronické aplikace. Funkční teorie hustota byla přijata metoda založená na plný potenciál linearizovaný rozšířené rovině vlna a místní okružní (FP-L (APW + lo)) k provedení této studie. Tyto materiály mají soudržné a formace energie srovnatelný s ostatními stabilní binární chalkogenidů odrážejí jejich termodynamickou stabilitu v kubickou strukturu. Výsledky elektronických pásových struktur odhalit jim nepřímé bandgap materiály bandgap energie 1,09, 0,88 a 0,47 eV pro π-SiS, π-SiSe, a π-SiTe v tomto pořadí. Tato nová třída monochalcogenides bylo zjištěno, bohatý na několik zajímavých vlastností, jako je velké hustoty stavů kolem Fermiho úrovni, relativně ploché valence a pásma vodivosti hran a těžších mas nosičů náboje. Výsledkem je, že bylo pozorováno vysoké absorbance světla (~106 / cm) ve viditelné a spodní ultrafialové (UV) oblasti. Podobně, vhodné optické odrazivosti ve vyšší UV oblasti bylo zaznamenáno, které poukazuje na jejich potenciál pro použití jako ochrana proti UV záření. Tento článek se dále zabývá exciton vazebné energie, energie Plasmon je a nízko a vysokofrekvenční dielektrické konstanty těchto materiálů. Naše výsledky ukazují krychlových strukturované Simonochalcogenides jako termodynamicky stabilní a slibné materiály pro špičkové optoelektronických a fotovoltaické aplikace. Exploring the high-efficiency materials for next-generation optoelectronic and photovoltaic applications is of great importance. In this article, we explore the potential of the newly designed cubic-structured Siliconmonochalcogenides (π- SiS, π-SiSe, and π-SiTe) for photovoltaic and optoelectronic applications. The density functional theory based fullpotential linearized augmented-plane-wave plus local-orbital (FP-L(APW + lo)) method has been adopted to carry out this study. These materials possess cohesive and formation energies comparable to the other stable binary-chalcogenides reflecting their thermodynamic stability in the cubic structure. The results of electronic band structures reveal them indirect bandgap materials of bandgap energy 1.09, 0.88 and 0.47 eV for π-SiS, π-SiSe, and π-SiTe respectively. This new class of monochalcogenides has been found rich in several interesting features such as large density of states around the Fermi-level, relatively flat valence and conduction band edges, and heavier masses of charge carriers. As a result, the high absorbance of light (∼106/cm) in the visible and lower ultraviolet (UV) regions has been observed. Similarly, a suitable optical reflectivity in the higher UV region was recorded which highlights their potential for application as a shield against UV radiations. This article further addresses the exciton binding energies, plasmon's energies, and low and high-frequency dielectric constants of these materials. Our results demonstrate the cubic-structured Simonochalcogenides as thermodynamically stable and promising materials for cutting-edge optoelectronic and photovoltaic applications.

KEY POINTS Cerebral autoregulation (CA) is a key mechanism to protect brain perfusion in the face of changes in arterial blood pressure, but little is known about individual variability of CA and its relationship to the presence of brain white matter hyperintensity (WMH) in older adults, a type of white matter lesion related to cerebral small vessel disease (SVD). This study demonstrated the presence of large individual variability of CA in healthy older adults during vasoactive drug-induced changes in arterial pressure assessed at the internal carotid and vertebral arteries. We also observed, unexpectedly, that it was the 'over-' rather than the 'less-reactive' CA measured at the vertebral artery that was associated with WMH severity. These findings challenge the traditional concept of CA and suggest that the presence of cerebral SVD, manifested as WMH, is associated with posterior brain hypoperfusion during acute increase in arterial pressure. ABSTRACT This study measured the individual variability of static cerebral autoregulation (CA) and determined its associations with brain white matter hyperintensity (WMH) in older adults. Twenty-seven healthy older adults (13 females, 66 ± 6 years) underwent assessment of CA during steady-state changes in mean arterial pressure (MAP) induced by intravenous infusion of sodium nitroprusside (SNP) and phenylephrine. Cerebral blood flow (CBF) was measured using colour-coded duplex ultrasonography at the internal carotid (ICA) and vertebral arteries (VA). CA was quantified by a linear regression slope (CA slope) between percentage changes in cerebrovascular resistance (CVR = MAP/CBF) and MAP relative to baseline values. Periventricular and deep WMH volumes were measured with T2-weighted magnetic resonance imaging. MAP was reduced by -11 ± 7% during SNP, and increased by 21 ± 8% during phenylephrine infusion. CA demonstrated large individual variability with the CA slopes ranging from 0.37 to 2.20 at the ICA and from 0.17 to 3.18 at the VA; no differences in CA were found between the ICA and VA. CA slopes measured at the VA had positive correlations with the total and periventricular WMH volume (r = 0.55 and 0.59, P

Partial nephrectomy is the preferred procedure in benign renal lesions requiring surgical removal. It has also been accepted procedure for malignant renal conditions of smaller size. The aim of this observational study was to determine the outcome of partial nephrectomy in terms of complications and recurrence rates. Twenty patients with renal mass underwent this procedure from January 2010 till June 2014 at our Department, with mean age of 46.51 ±1.53 years. There were 14 males and 6 females. Renal mass on CT scan had the mean size of 3.80 ±1.15cm. The mean hospital stay in this series was 5.11 ±1.42 days, while mean operative time was 247 ±79.71 minutes. Twelve patients had malignant histology. They were followed using CT scan abdomen and pelvis with contrast at six and 12 months. Out of these, 10 (83.3%) patients were found to have no recurrence after six months.

Objective To compare the non-contrast computed tomography (NCCT) scan-based parameters of ureteric stones affecting the outcome of extracorporeal shock wave lithotripsy (ESWL). Materials and methods We retrospectively evaluated the pre-procedure NCCT of 74 patients who had ESWL for solitary ureteric calculi of 5-20 mm in diameter. We assessed the age, sex, basal metabolic index (BMI), laterality, location, presence of double 'J' (DJ) stent, skin to stone distance (SSD), stone maximum diameter, Hounsfield unit (HU), Hounsfield density (HD), area, and volume. All those who had no stone on follow-up imaging within 30 days were declared successful while those who had residual stone were declared failures. Results The overall success rate was 78% (58/74). Sixty (81.1%) patients were male. The success of ESWL was correlated with lower SSD, Hounsfield units (HU) and Hounsfield density (HD). However, in multivariate analysis, SSD, Hounsfield unit, and stone area showed correlation with success of procedure but Hounsfield density failed to show correlation. The success rate in patients with stone HU 1000 were 93.9%, 69%, and 58.3%, respectively. Patients with lower BMI (30 kg/m2) and higher HD (>76 HU/mm). Conclusion BMI, SSD, stone Hounsfield units and Hounsfield unit density were strong predictors of outcome of ESWL for ureteric stone.

INTRODUCTION With the increased use of extracorporeal shock wave lithotripsy (ESWL), the management of urolithiasis has become much convenient for the patients and the health care professionals alike. However, associated with the procedure is the common complaint of pain. No agreed upon pain management strategy has yet been developed for the procedure. We compared the effect of different analgesia drug regiments for pain control. METHODOLOGY A randomised controlled trial was carried out in Shifa International Hospital from between July 2015 to January 2016. A total of 135 patients were divided into three groups; group A received 30 g lidocaine 2% gel applied locally on corresponding lumber area 30 minutes before the procedure, group B received oral naproxen sodium 550 mg 45 minutes before the procedure, and group C received both oral naproxen and lidocaine gel. Patients were supplemented with intravenous nalbuphine during the procedure. The pain was assessed with 0-10 visual analogue scale. Both pre-procedure and post-procedure pain score was measured. RESULTS Among 135 patients, 105 (77.8%) were male and 29 (21.5%) were female with mean age of 38.7 ± 1.31 years. There was no difference of mean pain score or need for supplemental intravenous nalbuphine between groups B and C but there was significantly decreased mean pain score and need for supplemental intravenous nalbuphine in groups B and C in comparison with group A. CONCLUSION The use of oral naproxen sodium with or without the addition of lidocaine gel during ESWL is a promising option for pain management during the procedure with significant improvement in comparison with lidocaine gel alone.

Effect of five salt concentrations viz, 0, 130, 160, 190, 220 and 250 mM on germination and seedling growth of sorghum cultivars (Asian, Indian, Mycho and Summer graze) was evaluated under laboratory condition. Analysis of variance (ANOVA) revealed significant differences for germination percentage, plumule and radicle growth, fresh and dry weight for different salt concentrations except moisture contents. Inter cultivars genetic variation and concentration x cultivars interaction showed significant differences for all the parameters studied. Data for germination percentage, plumule and radicle growth, fresh and dry weight and moisture contents clearly demonstrated varietal differences. Though results clearly showed that salinity stress decreased all the parameters studied for sorghum cultivars significantly, tolerance of sorghum cultivars to such high levels of salt stress is worth mentioning and it can be suggested that sorghum can be tried for cultivation on moderately saline areas. Key words: germination percentage, plumule and radicle growth, fresh and dry weight, moisture contents.

Electronic optical properties of In 2 X 2 O 7 (X = Si, Ge, Sn) compounds were calculated using density functional theory (DFT) calculation based on full potential linear augmented plane wave (FPLAPW). Four schemes LDA, GGA, EVGGA and mBJ were used to solve exchange correlation factor. The calculations of In 2 X 2 O 7 show that mBJ give better band splitting. The band structure of In 2 Ge 2 O 7 show an indirect band gap (X → Г) of about 3.55 eV while In 2 Si 2 O 7 and In 2 Sn 2 O 7 exhibit direct band gap (Г → Г) of 5.59 eV and 2.44 eV. The frequency dependent dielectric functions of In 2 X 2 O 7 compounds show the highest transparency at the infrared (IR) region. The In 2 Si 2 O 7 and In 2 Ge 2 O 7 are broad band semiconductors starting from ultraviolet (UV) region while In 2 Sn 2 O 7 start from visible region. The reflectivity spectra shows that In 2 X 2 O 7 compounds are suitable for antireflection coating layer in solar cells and filters in far UV region. As In 2 Si 2 O 7 and In 2 Sn 2 O 7 are a direct band gap material, that make them suitable for light emitting diodes (LED’s). In 2 Si 2 O 7 is suitable for UV light while In 2 Sn 2 O 7 is fit to emit green, blue and violet light. The present work provides information about variation of the electronic and optical properties by replacing Si by Ge and by Sn in the pyrochlore oxide which helps to understand the electronic and optical properties of this group of compounds.

Objectives: To determine the functional outcome of one stage posteromedial release in congenital clubfoot in terms offunctional and radiological assessment. Methodology: Forty five patients having clubfoot deformity were included in the study. Fifteen patientshad bilateral deformities. The outcome was evaluated by functionally assessing the foot in the last review visit (at the end of 14thweek ofsurgery) using the rating system of McKay, which has ten categories and has a maximum score of 180 points. It rates the outcome as excellent,good, fair, poor and failure (Fig-1). Radiological assessment is made by measuring various angles on anteroposterior and lateral radiograph ofthe foot with gonometer at 3,6,10 and 14 weeks after release (Table-II). . The values of talocalcaneal angle (measured during every visit) on APand lateral views will be summated to yield talocalcaneal index, and an index of >40 degree was taken as normal. Results: Forty five patientsincluded in the study with clubfoot deformity. Out of these patients, 33 (73.33%) were males and 12 (26.66%) were females (table-I). They weregraded according to the McKay rating system. In this short term follow up of one year, the following results were observed. Thirty-nine (65%)patients had excellent results, 11 (18.33%) patients had good results, 3 (5%) patients had fair results and 7 (11.66%) patients had poor results(Fig-1). No case can be labeled as failure. Conclusions: Mild to moderated clubfoot deformities can be successfully treated in children up tofive years of age by one stage postero-medial release.

Objectives: To know the functional outcome of Intramedullary Kirschner Wire fixation of unstable Radius-Ulna fractures in children. Study Design: Descriptive study. Period: 27/03/2009 to 26/03/2010. Setting: Department of Orthopedic and Trauma, Khyber Teaching Hospital, Peshawar. Patients and Methods: All patients were admitted from OPD . Children less than 16 years with Unstable Radius- Ulna fractures were included in the study. Patients with open fractures and adults with polytrauma were excluded from the study. Unstable Radius-Ulna fractures were treated by Intramedullary Kirschner Wire fixation under general anesthesia and tourniquet control. Follow up till radiological and clinical union was done. K-wires were removed after healing of fractures. Patients were assessed functionally and radiologically and results were graded according to Price et al Criteria. Results: A total of 64 children with unstable radius and ulna fractures were included in the study. The age range was 6 to 15 years with average age of 10.41 years. 47 were male and 17 were female. The average time of radiological union was 7 weeks and K-wires were removed at 8 weeks time. At final assessment there were 47 Excellent, 10 Good and 7 Fair results. Conclusions: Excellent results can be achieved by Intramedullary K-Wires fixation. In children with unstable Radius-Ulna fractures. It should be the method of choice for treating these fractures.

Background: Intertrochanteric (IT) fracture is common in elderly population. The dynamic hip screw is widely accepted in the treatment of IT fractures of the proximal femur. Objectives: To determine the outcome of dynamic hip screw in intertrochanteric fracture of femur in elderly patients. Design: A descriptive observational study Setting: Department of Orthopaedic Khyber Teaching Hospital, Peshawar.Period: From 7th Jan 2008 to 7th Jan 2009. Material and Methods: 113 consecutive patients with intertrochanteric fracture of the femur treated with dynamic hip screw. All patients were investigated and optimized for surgery. An accurate close reduction was done under fluoroscopic control. A dynamic hip screw (DHS) was inserted by a standard technique. Patients were reviewed clinically and radiographically on 2nd, 6th, 12th and 24th weeks. Results: We studied 113 Patients of intertrochanteric (IT) fracture, 13 patients were lost to follow up and the study was completed on 100 patients. Forty seven (47.0%) patients were male and 53 (53.0%) were female. Postoperatively seven patients (7%) suffered from infections, 3 (3.0 %) patients suffered from restricted hip joint movements. There was shortening of lower limb in 3 (3.0%) patients, 2 (2.0%) patients developed non union of the fracture site, 1 (1.0%) patient develop varus deformity. Seven (7.0%) patients had implant failure, 3 of which have lag screw cut-out through superior cortex, 3 patients have broken leg screw at barrel shaft junction and 1 patient has broken leg screw at 3 sites. 77 (77.0%) healed without complications. Conclusion It is concluded that the Dynamic Hip Screw is safe, suitable and reliable method of fixation for Boyd and Griffin type I and type II intertrochanteric fracture of femur.

Purpose To evaluate the impact of various computed tomography scan-based parameters of renal stones on the outcome of extracorporeal shock wave lithotripsy (ESWL). Materials and methods We conducted a retrospective study of patients who underwent ESWL for renal stones (sized 5-20 mm) from January 2013 to December 2016. We evaluated body mass index, location of the stone, skin-to-stone distance (SSD), stone attenuation value (SAV), stone diameter, Hounsfield density, stone area, and stone volume. Statistical analysis was done and significance was confirmed by multivariate logistic regression analysis. Results Of the 203 patients 122 (60.1%) had successful clearance of the stone. The presence of a double J stenting, a lower pole location, a higher SAV, higher Hounsfield density, larger stone area, larger stone diameter, and higher stone volume were negative predictors of ESWL outcome. When these parameters were analyzed with multivariate logistic regression analysis, stone location, SSD, and SAV were the only significant independent predictors of the outcome of ESWL. Conclusions Stone location, SSD, and SAV are reliable and strong predictors of ESWL outcome for the treatment of renal stones.

Background Vascular disease and dysfunction are associated with the higher risk of Alzheimer's disease hypothetically due to cerebral hypoperfusion. Brain perfusion is protected by cerebral autoregulation, which, under normal conditions, maintains a constant cerebral blood flow and brain tissue oxygenation. Objective To determine whether dynamic regulation of cerebral blood flow and tissue oxygenation is impaired in patients with amnestic mild cognitive impairment (aMCI). Methods Twenty-seven patients with aMCI and 15 control subjects with normal cognitive function underwent the measurements of cerebral hemodynamics, brain MR imaging, and neurocognitive assessment. Dynamic regulation of cerebral blood flow and tissue oxygenation were assessed by transfer function analysis of changes in mean blood pressure (MBP), normalized cerebral blood flow velocity (CBFV%), and cerebral tissue oxygenation index (TOI) at baseline and during a sit-stand maneuver. Results Patients with aMCI demonstrated lower cognitive performance in memory and executive function, accompanied by smaller entorhinal cortex volumes. At baseline, cerebral TOI was lower in patients with aMCI than in control subjects. Lower cerebral TOI was also correlated with lower cognitive performance in memory and executive function in all subjects. Transfer function gain and phase between MBP and CBFV% and between CBFV% and cerebral TOI were not different between the groups. Within aMCI patients, greater oscillations of cerebral TOI and higher transfer function gain between cerebral TOI and CBFV% were associated with the lower scores on delayed recall. Conclusion Dynamic regulation of cerebral tissue oxygenation is associated with neurocognitive dysfunction in aMCI patients.

Blood ejected from the left ventricle perfuses the brain via central elastic arteries, which stiffen with advancing age and may elevate the risk of end-organ damage. The purpose of this study was to determine the impact of central arterial aging on cerebral hemodynamics. Eighty-three healthy participants aged 22 to 80 years underwent the measurements of cerebral blood flow (CBF) and CBF velocity (CBFV) using magnetic resonance imaging (MRI) and transcranial Doppler, respectively. The CBF pulsatility was determined by the relative amplitude of CBFV to the mean value (CBFV%). Central arterial stiffness (carotid-femoral pulse wave velocity), wave reflection (carotid augmentation index), and pressure were measured using applanation tonometry. Total volume of white-matter hyperintensity (WMH) was quantified from MR images. Total CBF decreased with age while systolic and pulsatile CBFV% increased and diastolic CBFV% decreased. Women showed greater total CBF and lower cerebrovascular resistance than men. Diastolic CBFV% was lower in women than in men. Age- and sex-related differences in CBF pulsatility were independently associated with carotid pulse pressure and arterial wave reflection. In older participants, higher pulsatility of CBF was associated with the greater total volume of WMH. These findings indicate that central arterial aging has an important role in age-related differences in cerebral hemodynamics.

The discovery that kisspeptin was critical for normal fertility in all mammalian species including humans, ushered in a new chapter in our understanding of the control of GnRH secretion. Kisspeptin, the product of the KISS1 gene, plays an essential role in the regulation of spermatogenesis acting primarily at the hypothalamic level of the gonadotropic axis. Among the many identified substances in human semen, fructose is becoming increasingly significant. Fructose is synthesized and secreted by the seminal vesicles. Its synthesis is regulated by androgens and it is correlated directly with the levels of testosterone. Dose dependent degeneration of seminal vesicle has been described following intraperitoneal kisspeptin treatment; however, effects of kisspeptin administration on the levels of seminal fructose remain elusive till date. The present study, therefore, addresses the effects of 12-day administration of kisspeptin on seminal fructose levels in male mice. Kisspeptin-10 was administered intraperitoneally at different dosage concentrations (1 μg, 1 ng, and 10 ρg) to adult male mice, twice daily for 12 days. Seminal fructose levels were studied photometrically after 12 days of treatment. At the end of the treatment, seminal fructose levels decreased significantly after all tested doses. Chronic intermittent kisspeptin-10 administration negatively regulates seminal fructose levels in adult male mice.

White matter (WM) integrity declines with normal aging. Physical activity may attenuate age-related WM integrity changes and improve cognitive function. This study examined brain WM integrity in Masters athletes who have engaged in life-long aerobic exercise training. We tested the hypothesis that life-long aerobic training is associated with improved brain WM integrity in older adults.Ten Masters athletes (3 females, age=72.2 ± 5.3 years, endurance training15 years) and 10 sedentary older adults similar in age and educational level (2 females, age=74.5 ± 4.3 years) participated. MRI fluid-attenuated-inversion-recovery (FLAIR) images were acquired to assess white matter hyperintensities (WMH) volume. Diffusion tensor imaging (DTI) was performed to evaluate the WM microstructural integrity with a DTI-derived metric, fractional anisotropy (FA) and mean diffusivity (MD).After normalization to whole-brain volume, Masters athletes showed an 83% reduction in deep WMH volume relative to their sedentary counterparts (0.05 ± 0.05% vs. 0.29 ± 0.29%, p0.05). In addition, we found an inverse relationship between aerobic fitness (VO2max) and deep WMH volume (r=-0.78, p0.001). Using TBSS, Masters athletes showed higher FA values in the right superior corona radiata (SCR), both sides of superior longitudinal fasciculus (SLF), right inferior fronto-occipital fasciculus (IFO), and left inferior longitudinal fasciculus (ILF). In addition, Masters athletes also showed lower MD values in the left posterior thalamic radiation (PTR) and left cingulum hippocampus.These findings suggest that life-long exercise is associated with reduced WMH and may preserve WM fiber microstructural integrity related to motor control and coordination in older adults.

Background: To determine if global brain hypoperfusion and oxygen hypometabolism occur in patients with amnestic mild cognitive impairment (aMCI). Methods: Thirty-two aMCI and 21 normal subjects participated. Total cerebral blood flow (TCBF), cerebral metabolic rate of oxygen (CMRO2), and brain tissue volume were measured using colorcoded duplex ultrasonography (CDUS), near-infrared spectroscopy (NIRS), and MRI. TCBF was normalized by total brain tissue volume (TBV) for group comparisons (nTCBF). Cerebrovascular resistance (CVR) was calculated as mean arterial pressure divided by TCBF. Results: Reductions in nTCBF by 9%, CMRO2 by 11%, and an increase in CVR by 13% were observed in aMCI relative to normal subjects. No group differences in TBV were observed. nTCBF was correlated with CMRO2 in normal controls, but not in aMCI. Conclusions: Global brain hypoperfusion, oxygen hypometabolism, and neurovascular decoupling observedin aMCI suggest that changes in cerebral hemodynamics occur early at a prodromal stage of Alzheimer’s disease, which can be assessed using low-cost and bedside-available CDUS and NIRS technology.

Introduction Little is known regarding the causes and outcomes of peritoneal dialysis (PD) patients admitted to the intensive care unit (ICU). We explored the outcomes of technique failure and mortality in a cohort of PD patients admitted to the ICU. Methods Using a provincial database of 990 incident PD patients followed from January 1997 to June 2009, we identified 90 (9%) who were admitted to the ICU. Parametric and nonparametric tests were used as appropriate to determine differences in baseline characteristics. The Cox proportional hazards and competing risk methods were used to investigate associations. Results Compared with other patients, those admitted to the ICU had been on PD longer ( p < 0.0001) and were more often on continuous ambulatory PD (74.2% vs 25.8%, p = 0.016). Cardiac problems were the most common admitting diagnosis (50%), followed by sepsis (23%), with peritonitis accounting for 69% of the sepsis admissions. The 1-year mortality was 53.3%, with 12% alive and converted to hemodialysis, and one third remaining alive on PD. In multivariate Cox modeling, age [hazard ratio (HR): 1.01; 95% confidence interval (CI): 0.99 to 1.03], white blood cell count (HR: 1.02; 95% CI: 1.00 to 1.04), temperature (HR: 0.75; 95% CI: 0.61 to 0.92), and peritonitis (1.64; 95% CI: 1.21 to 2.22) at admission to the ICU were associated with the composite outcome of technique failure or death. In a competing risk analysis, the risk for death was 30%, and for technique failure, 36% at 1 year. Conclusions Patients on PD have high rates of death and technique failure after admission to the ICU.

This chapter describes the vascular pathologies that underlie cerebral microbleeds (CMBs), concentrating on the two commonest disorders: hypertensive small vessel disease (SVD) and cerebral amyloid angiopathy (CAA). It also describes the process of blood degradation, and the correlation of imaging with histological findings. The chapter concentrates on hypertensive arteriopathy and CAA, which is usually diagnosed following symptomatic lobar intracerebral hemorrhage (ICH). Hypertensive arteriopathy is thought to be caused by a forced dilation of resistance vessels: that is, those vessels that regulate the blood supply volume to the distal capillary bed. The first event in a hemorrhage is the extravasation of all constituents of blood along with plasma. Extravasation may occur by rhexis (rupture of a vessel wall) or by diapedesis affecting arterioles, veins or capillaries. From the perspective of neuroimaging, CMBs are focal deposits of hemosiderin and can be visualized with MRI.

The present invention discloses a susceptibility weighted imaging. A method of magnetic resonance (MR) imaging to improve small structure visibility comprising applying a phase image mask (120) to a MR magnitude image (140) a number of times q (150) wherein q is determined by calculating a contrast-to-noise ratio (CNR) as a function of q.

Background: To study the degree of hepatotoxicity of Doxycycline molecule on the basis of biochemicaland histopathological changes in the serum/liver of rabbits at different doses.This descriptive and analytic study was conducted in the Department of Biotechnology, University ofMalakand, Dir and Department of Biochemistry, SMC,Swat.Matterial And Methods:Different oral doses of doxycycline were administered to healthy rabbits, dividedin to six groups A, B, C, D, E & F. The strength of the dose was kept as 10, 20, 40, 80, & 100 mg/kg bodyweight for four consecutive days respectively, while the group F was kept as untreated control. Serum ALTlevels were measured at 1st, 4,h, 8th, & 12th post medicated days to evaluate degree of hepatotoxicity. Postmortem examinations of all groups were performed at the end of experiment.Results: Significant rise in ALT was observed in all treated subjects as compared to un-treated control(group F). The maximum ALT levels were found in group D & E medicated at dose rate of 80 mg/kg of bodyweight & 1OOmg/kg of baody weight, respectively. High mortality rate occurred in treated groups; GroupD and Group E were 25% and 50%, respectively. Histopathological changes occurring in the liver of treatedgroups were observed in thestudy.Conclusion: It is concluded from this study that the degree of hepatotoxicity increases as the doxycyclinedose increases.This issupported both by biochemical derangement as well as histopathological study.Keywords: Doxycycline,AlanineAminotransf-erase (ALT), toxicity, rabbits