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Purpose: To determine the etiological spectrum of irreversible blindness in Kashmir Valley in India. Methods: Patients presenting to a tertiary care hospital in Kashmir, India, with unilateral or bilateral blindness from April 2019 to March 2020 were included in this cross-sectional study. Blindness was defined using the World Health Organization (WHO) criteria. All subjects had a complete ophthalmologic examination and information was gathered regarding their demographic profile, nature of ocular disorder whether primary or secondary and laterality, if the ocular involvement was unilateral. Results: 248 patients were enrolled in the study. The mean age of the patients was 57.17 years. The male: female ratio was 2.17:1. The commonest cause of unilateral or bilateral blindness was glaucoma (22.58%) followed by diabetic retinopathy (DR) (17.74%). Unilateral blindness was seen in 78.62% of the patients. Unilateral blindness occurred mainly due to glaucoma (16.41%), DR (14.87%), age-related macular degeneration (13.33%), and trauma (pellet injury: 10.76%, non-pellet injury: 10.25%). The major causes of bilateral blindness were glaucoma (45.28%), DR (28.30%), and hereditary/congenital retinal diseases (16.98%). Socioeconomic status and educational status were significantly associated (P < 0.05 each) while age, gender, place of residence, and occupation were not significantly associated (P > 0.05 each) with the number of eyes affected by blindness. Conclusion: Glaucoma and DR are the foremost causes of irreversible blindness in Kashmir. Public health plans aimed at encouraging good health education of patients should be developed in this region. Moreover, patients should be screened effectively for glaucoma and diabetes at the level of primary health care facilities.

Objective: To evaluate the general status and functioning of health information system (HIS) in district Nowshera. Methodology: An observational study was conducted in district Nowshera Khyber Pakhtunkhwa, Pakistan between June 2015-2016.The study population included all districts, health information system (HIS) health workers in Khyber Pakhtunkhwa. District Nowshera was selected for the purpose on non probability sampling technique. The data collection instruments used in this study was adapted from the PRISM tool package that was modified for the purpose of this study. Results: A total of 30 health facilities of District Nowshera were assessed for Quality of Data and Use of Information through DHIS Diagnostic Tool. 60% of the health facilities compile DHIS data and 93% do not get feedback from DHO office. 94% of the health facilities have not displayed map of their catchment areas. 87% of the health facilities do not arrange meetings regarding the managerial issues. Regarding the use of information, no documentation is available in any health facility of the district. The DHIS workers were assessed and interpreted according to the scale of Mann-Whitney-U method. The organizational and behavioral assessment was done which was statically insignificant. Conclusion: There is an immediate need to install the system wide up gradation of technology and software. The manageable data would help the health personnel and managers to formulate the policies that would be helpful in up grading the standard of HIS and a universal HIS should be operated throughout the province.

Objective: To determine the Role of medical therapy and surgical intervention in carcinoma of breast. Study Design: Prospective observational study. Place and Duration: Two years study from January 2018 to December 2020 was conducted at Liaquat university of Medical and Health Sciences Jamshoro. Methods: The study comprises 50 patients. Data was collected from all who were admitted at OPD. The patients were evaluated fully after history & Clinical examinations and Specific investigations of Fine Needle Aspiration Cytology (FNAC), Tru cut biopsy for Histology ERPR Receptor and Herceptin receptor, ultra sound of breast, and Abdomen, Mammography, C T scan, M R I, Tumor marker CA15.3. CA 125 for ovary and breast, X ray chest and Bone scan. Sentinel lymph node biopsy for lymphatic involvement, Liver Function Test, serum calcium, Complete Blood Picture (CBP), blood sugar, blood urea. HBSAG, HCV, HIV and COVID-19 Evaluated patients were evaluated fully after history, clinical examinations & specific investigations. Results: In this study 50 patients of Carcinoma of breast. The maximum numbers of patients were in age group 20 to 80 years. 15 patients were in age group 20 to 39 year, 24 patients were in age group 40 to 59 years, 11 patients were in age group 60 to 80 year. Out of 50 patients 29 patients were presented with breast lump, 8 patients were presented with bloody discharge, 7 patients were presented with nipple destruction and 6 Patients were presented with pricking sensation Out of 50 patients 21 patients were presented with stage I, 13 Patients presented with stage II, 9 patients were presented with stage III and 7 patients were presented with stage IV. Out of 50 patients 22 Patients were diagnosed duct cell carcinoma, 11 patients were diagnosed Phyllodes tumor, 9 patients were diagnosed lobular cell carcinoma, 5 patient were diagnosed tubular cell carcinoma and 3 patients were diagnosed Paget’s type of carcinoma .Out of 50 patients 25 patients were ERPR positive treated by Nolvadex (tamoxifeen) 16 Patients were ERPR negative treated by chemotherapy drugs and Aromatase inhibitors, 9 Patients were Her2neu receptor positive treated by Herceptin (Trastuzumab) Out of 50 patients 34 patients were treated by Modified radical mastectomy, 16 patients were initially were treated neo adjuvant therapy. Then Modified Radical Mastectomy, Out of 50 patients 25 patients were treated with Nolvadex (tamoxifeen) after Modified Radical Mastectomy better outcome seen in those patients. Conclusion: Carcinoma of breast is a common problem all over the word, patient can present with lump over the breast, bloody discharge, destruction of nipple or areola if not diagnosed and treat early stage, patient can die within a year without Medical and surgical treatment.

In this work, we report a one-pot [3 + 2] cycloaddition of 4-aminopyrazolones, indolenines, and aldehydes. The reaction utilized in situ generated azomethine ylides as 1,3-dipoles and 2-alkenylindolenines as dipolarophiles affording indolenine-derived spiro[pyrazolone-4,2′-pyrrolidine] scaffolds with four contiguous stereocenters with excellent yields (up to 95%) and diastereoselectivities (up to >20 : 1 dr) under simple conditions. The in situ generation of azomethine ylides and dipolarophiles in one pot is a unique feature of this process.

This work reports a facile [3 + 3] cycloaddition sequence of two important heterocyclic pharmacophores, pyrazolone and 2-indolylmethanol, integrated into a polycyclic hybrid scaffold. In this process, an in situ generated azomethine ylide obtained from 4-aminopyrazolone and benzaldehyde reacts with 2-indolylmethanols to offer spiro[pyrazolone–pyridoindole] scaffolds in high yields with excellent diastereoselectivities. Remarkably, the reaction is carried out at room temperature without any catalyst and base.

A metal-free catalyzed indirect heteroarylation of pyrazolones with 2-(3-hydroxy-3,3-diarylprop-1-yn-1-yl) phenols has been developed, and a series of novel 4-benzofuranyl substituted pyrazolone derivatives were obtained in moderate to excellent yields (up to 90%). The process has the salient features of metal-free catalysis, operational simplicity, good substrate compatibility and mild reaction conditions. In particular, the integration of the pyrazolone skeleton and benzofuran scaffold into a single molecule is expected to be of potential interest for medicinal research. In addition, the yield and efficiency are basically maintained in the gram-scale experiment, which makes the practical application of the process more prominent.

OBJECTIVE: To analysis the efficacy of 0.2% GTN in patients undergoing fistulectomy for fistula in ano low variety in terms of early wound healing. METHODOLOGY: A randomized controlled trail was conducted at general surgery department of Liaquat University Hospital Hyderabad from February 2013 to August 2013 among patients with low anal fistula. All participants underwent fistulectomy by a consultant general surgeon. Patients were divided into two groups using lottery methods. Group A treat fistula in ano with 0.2% glyceryl trinitrate ointment and group B treat fistula in ano without 0.2% glyceryl trinitrate ointment and wounds covered with pyodine soaked dressings. All patients were discharged on second postoperative day. Wound healing was assessed weekly for six weeks. Parameters of incomplete wound healing such as discharge, perineal irritation and pain were noted. Presence of granulation tissue at the end of 6 weeks was considered as sign of healing. Data was collected via study proforma. RESULTS: This study was conducted on 94 patients in Liaquat University Hospital Hyderabad. In GTN group 35(74.46%) were male while in Control group 38(80.85%) were male. In GTN group mostly observed single opening 37(78.72%) cases while in control group 35(74.46%) cases. The healing time in GTN Group was found to be between 21-36 days (mean 26.38 days), while the healing time control group was 32-46 days with a mean of 38.64 days (P. value

Background We recently reported prostate apoptosis response 4 (Par-4), a potential tumor suppressor protein restrains epithelial-mesenchymal transition (EMT) properties and promotes mesenchymal-epithelial transition (MET) in invasive cancer cells by repressing Twist-1 promoter activity. Here, we demonstrate that genetic as well as pharmacological modulation of Par-4 by NGD16 (a small molecule antimetastatic agent), limits EMT-induced chemoresistance in aggressive cancer cells by suppressing MDM-2, a downstream effector of Twist-1. Methods Matrigel invasion assay, gelatin degradation assay, cell scattering assay, MTT assay and colony formation assay were used to study the proliferation and migration abilities of invasive cancer cells. Immunoblotting, immunocytochemistry, and immunoprecipitation analysis were utilized for determining protein expression and protein-protein interaction. 4T1 aggressive mouse carcinoma model was employed to evaluate tumor growth and lung metastasis. Results Treatment of gemcitabine (nucleoside analogue anticancer agent) to pancreatic cancer (Panc-1, MiaPaca-2) and breast cancer (MDA-MB-231) cells amplified MDM-2 expression along with increase in EMT properties. Conversely, NGD16 boosted expression of tumor suppressor Par-4 and inhibited invasion and migration abilities of these cells. Moreover, induction of Par-4 effectively diminished MDM-2 along with pro-EMT markers, whereas, augmented the expression of epithelial markers. Furthermore, siRNA-mediated silencing of Par-4 divulged that NGD16 exerts its EMT inhibitory effects in a Par-4-dependent manner. Mechanistically, Par-4 activation provokes p53 by disrupting MDM-2-p53 interaction, which restored epithelial characteristics in cancer cells. Additionally, partial knockdown of MDM-2 through siRNA pronounced the anti-proliferative and anti-invasive effects of NGD16. Finally, NGD16 efficiently inhibited tumor growth and lung metastasis in mouse mammary carcinoma model without showing any undesirable effects. Conclusion Our findings unveil Par-4 as a key therapeutic target and NGD16 (the pharmacological modulator of Par-4) are potential tools to suppress EMT and associated chemoresistance, which could be exploited clinically for the treatment of aggressive cancers.

This paper describes the development and validation of an electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS) that captures the symptomatology, quality of life and clinically relevant data of patients presenting to vascular services.A two-stage survey was conducted in patients attending a tertiary vascular department. Patients completed the ePAQ-VAS remotely online, or on site using an electronic tablet. In the first stage of the survey, the responses were used to perform confirmatory factor analysis to assess the construct validity and remove redundant items. The internal reliability of disease-specific scales was investigated. In the second stage of the survey, the acceptability, known-group validity, test-retest reliability, and responsiveness of ePAQ-VAS was assessed.In total, 721 patients completed ePAQ-VAS. Their mean(s.d.) age was 63·5(15·7) years and 468 (64·9 per cent) were men. Some 553 patients (76·7 per cent) completed the questionnaire in clinic and the remainder completed the questionnaire online. The results of the confirmatory factor analysis confirmed the conceptual model for ePAQ-VAS structure and eliminated six items. Internal reliability was acceptable for all the scales (Cronbach's α greater than 0·7). The test-retest reliability measured by the intraclass correlation coefficient ranged from 0·65 to 0·99. The results showed that the instrument was responsive over time with the standardized response mean ranging from 0·69 to 1·60.ePAQ-VAS is a holistic data-collection process that is relevant to vascular service users and has potential to contribute to patient-focused care and the collection of aggregate data for service evaluation. A demonstration version of the final version of ePAQ can be viewed at http://demo-questionnaire.epaq.co.uk/home/project?id=VASC_1.7page=1.Este artículo describe el desarrollo y la validación de un cuestionario electrónico de evaluación personal para enfermedades vasculares (ePAQ-VAS) que incluye la sintomatología, la calidad de vida y los datos clínicamente relevantes para los pacientes que son atendidos en los servicios de patología vascular. MÉTODOS: Se llevó a cabo una encuesta en dos fases entre los pacientes atendidos en un servicio de patología vascular de tercer nivel. Los pacientes completaron el cuestionario ePAQ-VAS a distancia en línea o bien en el centro hospitalario mediante una tableta electrónica. En la primera fase de la encuesta, las respuestas se utilizaron para realizar un análisis factorial de confirmación para evaluar la validez del diseño y eliminar los elementos redundantes. Se investigó la fiabilidad interna de las escalas específicas de la enfermedad. En la segunda fase de la encuesta, se evaluó la aceptabilidad, la validez de grupo conocida, la fiabilidad test-retest y la capacidad de respuesta del ePAQ-VAS.En total, 721 pacientes completaron el ePAQ-VAS, la edad media fue de 63,5 años (DE 15,7); el 64,9% eran varones (468); el 76% de los pacientes (553) completaron el cuestionario en la clínica y los pacientes restantes lo hicieron electrónicamente a distancia. Los resultados del análisis factorial de confirmación confirmaron el modelo conceptual para la estructura ePAQ-VAS y eliminaron seis ítems. La fiabilidad interna fue aceptable para todas las escalas (alfa de Cronbach 0,7). La fiabilidad test-retest medida por el coeficiente de correlación intraclase osciló entre 0,65-0,99. Los resultados mostraron que el instrumento responde con el tiempo con una media de respuesta estandarizada que varía de 0,69 a 1,60. CONCLUSIÓN: El ePAQ-VAS es un proceso holístico de recopilación de datos que es relevante para los usuarios de servicios de patología vascular y tiene el potencial de contribuir a la atención centrada en el paciente y a la recopilación de datos agregados para la evaluación del servicio.

Heat stress induced by long periods of high ambient temperature decreases animal productivity, leading to heavy economic losses. This devastating situation for livestock production is even becoming worse under the present climate change scenario. Strategies focused to breed animals with better thermo-tolerance and climatic resilience are keenly sought these days to mitigate impacts of heat stress especially in high input livestock production systems. The 70-kDa heat shock proteins (HSP70) are a protein family known for its potential role in thermo-tolerance and widely considered as cellular thermometers. HSP70 function as molecular chaperons and have major roles in cellular thermotolerance, apoptosis, immune-modulation and heat stress. Expression of HSP70 is controlled by various factors such as, intracellular pH, cyclic adenosine monophosphate (cyclic AMP), protein kinase C and intracellular free calcium, etc. Over expression of HSP70 has been observed under oxidative stress leading to scavenging of mitochondrial reactive oxygen species and protection of pulmonary endothelial barrier against bacterial toxins. Polymorphisms in flanking and promoter regions in HSP70 gene have shown association with heat tolerance, weaning weight, milk production, fertility and disease susceptibility in livestock. This review provides insight into pivotal roles of HSP70 which make it an ideal candidate genetic marker for selection of animals with better climate resilience, immune response and superior performance. Keywords: HSP70, Heat stress, Thermo-tolerance, Molecular chaperons, Immunity, Livestock

Introduction: Dry eye syndrome [DES] is one of the commonest ocular disorders characterized by tear film instability, visual discomfort & disturbance with ocular surface inflammation potentially leading to damage to the ocular surface. Serum Vitamin-D deficiency has been reported to be associated with DES. Aim: To determine the Serum 25-hydroxy-vitamin-D levels in patients diagnosed as having DES. Methods: We conducted a prospective observational study and included in our study, serum vitamin D levels of the first 40 patients over the age of 18 years presenting with signs and symptoms and later diagnosed to have DES [confirmed with ocular surface disease index-OSDI questionnaire, Schirmer I test, kerato-epitheliopathy examination and tear-film breakup time-[TBUT] were analysed. Results: Schirmer's I test, interpreted as mild [11-15mm/5min], moderate [6-10 mm/5 min] and severe [

Early miscarriage (EMC) is a devastating obstetrical complication. ATP-binding cassette (ABC) transporters mediate cholesterol transfer across the placenta and enhance cell survival by effluxing substrates from target cells in the presence of stressors. Recent evidence reports an intricate interplay between autophagy and ABC transporters. We hypothesized that dysregulated autophagy and oxidative stress (OS) in the placenta leads to abnormal expression of membrane transporters contributing to poor pregnancy survival in EMC. We determined mRNA and protein expression of autophagy genes (Beclin-1/Bcl-2/LC3I/LC3II/p62) and ABC transporters (ABCA1/ABCG1/ABCG2) in placentae from EMC patients (n = 20), term controls (n = 19), first trimester (n = 6), and term controls (n = 5) controls. Oxidative/antioxidant status and biomarkers of oxidative damage were evaluated in maternal serum and placentae from EMC and healthy controls. In EMC, placental expression of LC3II/LC3I as well as of the key autophagy regulatory proteins Beclin-1 and Bcl-2 were reduced, whereas p62 was increased. Both in the serum and placentae of EMC patients, total OS was elevated reflected by increased oxidative damage markers (8-OHdG/malondialdehyde/carbonyl formation) accompanied by diminished levels of total antioxidant status, catalase, and total glutathione. Furthermore, we found reduced ABCG1 and increased ABCG2 expression. These findings suggest that a decreased autophagy status triggers Bcl-2-dependent OS leading to macromolecule damage in EMC placentae. The decreased expression of ABCG1 contributes to reduced cholesterol export to the growing fetus. Increasing ABCG2 expression could represent a protective feedback mechanism under inhibited autophagy conditions. In conclusion, dysregulated autophagy combined with increased oxidative toxicity and aberrant expression of placental ABC transporters affects materno-fetal health in EMC.

Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding UK Medical Research Council and Health Technology Assessment Programme.

BackgroundVascular services is changing rapidly, having emerged as a new specialty with its own training and specialised techniques. This has resulted in the need for reconfiguration of services to provide adequate specialist provision and accessible and equitable services.ObjectivesTo identify the effects of service configuration on practice, resource use and outcomes. To model potential changes in configuration. To identify and/or develop electronic data collection tools for collecting patient-reported outcome measures and other clinical information. To evaluate patient preferences for aspects of services other than health-related quality of life.DesignThis was a multiple methods study comprising multiple systematic literature reviews; the development of a new outcome measure for users of vascular services (the electronic Personal Assessment Questionnaire – Vascular) based on the reviews, qualitative studies and psychometric evaluation; a trade-off exercise to measure process utilities; Hospital Episode Statistics analysis; and the development of individual disease models and a metamodel of service configuration.SettingSpecialist vascular inpatient services in England.Data sourcesModelling and Hospital Episode Statistics analysis for all vascular inpatients in England from 2006 to 2018. Qualitative studies and electronic Personal Assessment Questionnaire – Vascular evaluation with vascular patients from the Sheffield area. The trade-off studies were based on a societal sample from across England.InterventionsThe data analysis, preference studies and modelling explored the effect of different potential arrangements for service provision on the resource use, workload and outcomes for all interventions in the three main areas of inpatient vascular treatment: peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. The electronic Personal Assessment Questionnaire – Vascular was evaluated as a potential tool for clinical data collection and outcome monitoring.Main outcome measuresSystematic reviews assessed quality and psychometric properties of published outcome measures for vascular disease and the relationship between volume and outcome in vascular services. The electronic Personal Assessment Questionnaire – Vascular development considered face and construct validity, test–retest reliability and responsiveness. Models were validated using case studies from previous reconfigurations and comparisons with Hospital Episode Statistics data. Preference studies resulted in estimates of process utilities for aneurysm treatment and for travelling distances to access services.ResultsSystematic reviews provided evidence of an association between increasing volume of activity and improved outcomes for peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. Reviews of existing patient-reported outcome measures did not identify suitable condition-specific tools for incorporation in the electronic Personal Assessment Questionnaire – Vascular. Reviews of qualitative evidence, primary qualitative studies and a Delphi exercise identified the issues to be incorporated into the electronic Personal Assessment Questionnaire – Vascular, resulting in a questionnaire with one generic and three disease-specific domains. After initial item reduction, the final version has 55 items in eight scales and has acceptable psychometric properties. The preference studies showed strong preference for endovascular abdominal aortic aneurysm treatment (willingness to trade up to 0.135 quality-adjusted life-years) and for local services (up to 0.631 quality-adjusted life-years). A simulation model with a web-based interface was developed, incorporating disease-specific models for abdominal aortic aneurysm, peripheral arterial disease and carotid artery disease. This predicts the effects of specified reconfigurations on workload, resource use, outcomes and cost-effectiveness. Initial exploration suggested that further reconfiguration of services in England to accomplish high-volume centres would result in improved outcomes, within the bounds of cost-effectiveness usually considered acceptable in the NHS.LimitationsThe major source of evidence to populate the models was Hospital Episode Statistics data, which have limitations owing to the complexity of the data, deficiencies in the coding systems and variations in coding practice. The studies were not able to address all of the potential barriers to change where vascular services are not compliant with current NHS recommendations.ConclusionsThere is evidence of potential for improvement in the clinical effectiveness and cost-effectiveness of vascular services through further centralisation of sites where major vascular procedures are undertaken. Preferences for local services are strong, and this may be addressed through more integrated services, with a range of services being provided more locally. The use of a web-based tool for the collection of clinical data and patient-reported outcome measures is feasible and can provide outcome data for clinical use and service evaluation.Future workFurther evaluation of the economic models in real-world situations where local vascular service reconfiguration is under consideration and of the barriers to change where vascular services do not meet NHS recommendations for service configuration is needed. Further work on the electronic Personal Assessment Questionnaire – Vascular is required to assess its acceptability and usefulness in clinical practice and to develop appropriate report formats for clinical use and service evaluation. Further studies to assess the implications of including non-health-related preferences for care processes, and location of services, in calculations of cost-effectiveness are required.Study registrationThis study is registered as PROSPERO CRD42016042570, CRD42016042573, CRD42016042574, CRD42016042576, CRD42016042575, CRD42014014850, CRD42015023877 and CRD42015024820.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.

Traditional medicine is still the only treatment in many rural areas especially the rural communities of east. Due to limited access to modern medicine, local people use medicinal plants to treat most diseases. Some herbs contain powerful contents and must be treated with the same precautionary care as in the case of drug, we do. In fact, a lot of drugs are basically based on artificial verities of natural composite in plants. For example, the heart drug Digitalis comes from a foxglove plant. Some drugs are single active substance derived from botanical sources. Herbalists believe that if the active ingredient is isolated from other parts of the plant, its action may be lost or its safety may be reduced. E.g, salicylic acid is present in a plant of meadowsweet which is used for aspirin production. Aspirin may cause bleeding in the gastric mucosa, but meadowsweet contains some other compounds naturally that interfere with the stimulation of salicylic acid. According to some practitioners, the effect of whole plant is greater than its parts individually. Critics believe that the nature of the herbs makes itself difficult to administer of such active ingredients. Herbs contain active ingredients, Mostly of them have unknown ingredients. As with other prescription drugs, herbs should always be prescribed by a qualified doctor.

To evaluate the causes and management outcomes of acquired corneal opacity in a preschool age group (0-5 years) at a tertiary care hospital.Medical records of all cases (0-5 years) with acquired corneal opacity presenting to the cornea clinic of a tertiary eye care hospital from February 2013 to January 2014 were evaluated for age of onset, age at presentation, sex, laterality, cause of opacity, visual acuity, nutritional status, and socioeconomic class of the parents. The etiology of corneal opacity and the type of intervention with outcome at 3 months follow-up were recorded.A total of 106 cases were included in the study. The most common cause of corneal scarring was healed infective keratitis (35.8%). Chemical injury, mechanical trauma, and keratomalacia were the other causes, affecting 21.8%, 20.8%, and 16% of the cases, respectively. Optical iridectomy was the most commonly performed procedure (35.8%), followed by lens aspiration with intraocular lens implantation (17.9%) and penetrating keratoplasty (17%). The mean corrected visual acuity (spectacle or contact lens) at the time of presentation and at 3 months after treatment was 2.9 ± 0.3 (perception of light) and 2.2 ± 0.9 (hand motions) logarithm of minimum angle of resolution (logMAR) units, respectively.Chemical injury and keratomalacia are the major causes of acquired corneal opacity in preschool age groups in India and are associated with poor visual prognosis.

STUDY DESIGN. Prospective, cohort study. OBJECTIVE. Demonstrate validity of Patient reported outcomes measurement information system (PROMIS) physical function, pain interference, and pain behavior computer adaptive tests (CATs) in surgically treated lumbar stenosis patients. SUMMARY OF BACKGROUND DATA. There has been increasing attention given to patient reported outcomes associated with spinal interventions. Historical patient outcome measures have inadequate validation, demonstrate floor/ceiling effects, and infrequently used due to time constraints. PROMIS is an adaptive, responsive National Institutes of Health (NIH) assessment tool that measures patient-reported health status. METHODS. Ninety-eight consecutive patients were surgically treated for lumbar spinal stenosis and were assessed using PROMIS CATs, Oswestry disability index (ODI), Zurich Claudication Questionnaire (ZCQ), and Short-Form 12 (SF-12). Prior lumbar surgery, history of scoliosis, cancer, trauma, or infection were excluded. Completion time, preoperative assessment, 6 weeks and 3 months postoperative scores were collected. RESULTS. At baseline, 49%, 79%, and 81% of patients had PROMIS pain behavior (PB), pain interference (PI), and physical function (PF) scores greater than 1 standard deviation (SD) worse than the general population. 50.6% were categorized as severely disabled, crippled, or bed bound by ODI. PROMIS CATs demonstrated convergent validity through moderate to high correlations with legacy measures (r = 0.35–0.73). PROMIS CATs demonstrated known groups validity when stratified by ODI levels of disability. ODI improvements of at least 10 points on average had changes in PROMIS scores in the expected direction (PI = −12.98, PB = −9.74, PF = −7.53). PROMIS CATs demonstrated comparable responsiveness to change when evaluated against legacy measures. PROMIS PB and PI decreased 6.66 and 9.62 and PROMIS PF increased 6.8 points between baseline and 3-months post-op (P < 0.001). Completion time for the PROMIS CATs (2.6 min) compares favorably to ODI, ZCQ, and SF-12 scores (3.1, 3.6, and 3.0 min). CONCLUSION. PROMIS CATs demonstrate convergent validity, known groups validity, and responsiveness for surgically treated patients with lumbar stenosis to detect change over time and are more efficient than legacy instruments.

A catalytic asymmetric sequential annulation/aldol reaction of 4-isothiocyanato pyrazolones and allenyl ketones has been developed, which furnished a series of spiro[pyrrole–pyrazolone] heterocycles and structurally novel spiro[thiopyranopyrrole–pyrazolone] derivatives in good yields with high to excellent enantioselectivities. Notably, parallel resolution of racemic spiro[pyrrole–pyrazolones] was achieved by a catalyst-controlled asymmetric intramolecular vinylogous aldol process. Structure diversity of the product was further enhanced by ready transformations.

Mesenchymal stem cells (MSCs) have become a potent source for cell therapy due their inherent properties of self-renewal and ability to undergo unlimited divisions in the field of regenerative medicine. In this study, equine adipose tissue stem cells (EASCs) have been evaluated on the basis of their morphology, proliferation potential and multilineage differentiation capabilities for their future usage in cell therapy. The cells were further differentiated into osteogenic and adipogenic cell lineages as well as into adipose derived neurospheres to ensure the stemness of propagated cells. In our study, we further successfully cultured the neurosphere derived cells which were cultured from neurospheres after enzymatic dissociation. The study exhibits that EASCs offer a suitable choice for cellular regenerative therapy in equines. Nonetheless, there is a still need to molecular characterization of EASCs in order to establish a standard practice in equine medicine.

Background Transthoracic echocardiography (TTE) plays a vital role in the assessment of the surgical management of patients with tetralogy of Fallot (TOF). Accurate assessment of the main pulmonary valve annulus, main pulmonary artery (MPA), and branch pulmonary arteries are crucial for decision-making regarding the surgical approach in the form of total correction. It is also important for performing a systemic-to-pulmonary artery shunt operation and affects the outcome. In some patients with poor echogenic windows, it is sometimes difficult to obtain accurate measurements. Cardiac computed tomographic angiography (CTA) can be a superior diagnostic modality. Therefore, the aim of this study was to evaluate the degree of agreement between TTE and CTA in assessing the main pulmonary valve annulus and the size of the MPA and its branches among patients with TOF patients. Methodology Patients above one year of age, with TOF, presented during the study period of six months - from January 1, 2019, to June 30, 2019, were included in the study. All the patients had TTE and cardiac CTA to assess the annulus and the size of the MPA and its branches (right pulmonary artery (RPA) and left pulmonary artery (LPA)). CTA measurement of all parameters was compared with TTE measurement of the same on three different views each by computing the Bland-Altman plot and Pearson correlation coefficients. Results A total of 73 TOF patients were included in this study. The correlation coefficients between CTA and TTE for the measurement of the annulus were 0.767 and 0.833 for the parasternal short-axis view and the subcostal view, respectively. The correlation coefficients between CTA and TTE for the measurement of MPA were 0.820 and 0.866 for the parasternal short-axis view and the suprasternal view, respectively. The correlation coefficients between CTA and TTE for the measurement of RPA were 0.883 and 0.897 for the parasternal short-axis view and the suprasternal view, respectively. Similarly, the correlation coefficients between CTA and TTE for the measurement of LPA were 0.848 and 0.877 for the parasternal short-axis view and the suprasternal view, respectively. Conclusion In conclusion, there is a strong correlation and agreement between cardiac CTA and TTE for the assessment of the annulus and the size of the pulmonary artery (PA) and its branches in patients with TOF.

Objectives To estimate the normal dimensions of lacrimal glands (LGs) in the Pakistani population using computed tomography (CT) scan and to determine the associations of LG dimensions with age, sex, and laterality. Methods The study population included subjects aged ≥16 years without orbital pathology who underwent CT evaluation of both the right and left LGs at Dr. Ziauddin University Hospital from June 2018 to November 2019. The mean axial length (AL), axial width (AW), coronal length (CL), and coronal width (CW) of each LG were measured separately. Results The 108 subjects enrolled in this study included 75 (69.4%) men and 33 (30.6%) women, with a mean age of 49±20 years. Right and left LG dimensions were similar, including mean AL (13.53±1.80 mm vs. 13.35±1.72 mm), mean AW (4.20±0.81 mm vs. 4.05±0.93 mm), mean CL (15.46±1.97 mm vs. 15.26±1.87 mm), and mean CW (3.99±0.80 mm vs. 3.86±0.81 mm). The AL of both LGs and the CL and CW of right but not left LGs were significantly lower in women than in men. Age showed significant correlations with the AL and CL of both LGs. Conclusion These findings establish the normal range of LG dimensions in adult Pakistani populations. Some LG dimensions are smaller in women than in men, as well as correlating with age.

Objectives The primary objective of this study was to determine post-treatment variations in the hematological profile of stage 2 breast cancer patients and investigate the influence of disease stage and treatment pattern on these changes. The secondary objective was to evaluate the role of post-treatment hemoglobin as a predictor of disease-free survival. Methods This prospective, observational study included 177 stage 2, female, breast cancer patients. Treatment included surgery, chemotherapy, radiotherapy, and hormonal (anti-estrogen) therapy. Patients were divided into treatment groups based on their histopathological features. Laboratory investigations, including hemoglobin and complete blood count, were carried out twice, first, at the initial cancer diagnosis and, second, eight weeks after completion of radiotherapy. The patients were followed for a period of four years and their disease-free survival was calculated. Results A significant post-treatment decrease in hemoglobin levels and red blood cell (RBC) count was observed in all patients except hormone receptor-positive disease stage 2A patients treated without chemotherapy. Total leukocyte counts were significantly decreased in all hormone receptor-negative patients, and significant neutropenia was observed in all stage 2 patients who received chemotherapy. The severity of anemia was observed to be significantly lower in stage 2A patients (without lymph node metastasis) as compared to stage 2B patients (with lymph node metastasis). Furthermore, no anemia was observed in hormone receptor-positive patients treated without chemotherapy, while moderate anemia was observed in hormone receptor-negative patients who received both pre and post-surgical chemotherapy. The post-treatment hemoglobin levels were found to be a significant predictor of disease-free survival in hormone receptor-positive patients (HR = 0.140, p= 0.000) and in patients of all disease stages except stage 2B (T3 N1 M0). Conclusion The incidence and severity of post-treatment anemia are low in patients treated with hormonal therapy and high in patients with lymph node metastasis. Higher post-treatment hemoglobin levels predict a longer duration of disease-free survival in hormone receptor-positive patients of disease stages 2A and 2B (T2).

Information regarding the menstrual knowledge and practices of Pakistani girls is sparse. Therefore, we aimed to evaluate the knowledge and practices of Pakistani girls regarding menstruation. This cross-sectional study was conducted among four categories of university female students of medical, pharmacy, nursing, and arts & humanities during a period of 5 months (November 2016–March 2017). The data were acquired using a self-administered questionnaire from 3 medical institutes, 2 pharmacy institutes, 3 nursing institutes and 2 arts & humanities institutes at Lahore, Pakistan. The mean age of participants (N = 1777) was 20.38 ± 2.39 years. Overall 39.5%, 76.1% and 29.3% respondents’ provided correct answers to the questions concerning menstrual cycle length, duration of menstrual bleeding and source of bleeding, respectively. Regarding the understanding of menstruation, around 27% understood it as monthly bleeding happening with every woman, whereas 18% stated that it was a sign of adulthood. However, a small proportion believed that it was removal of dirt from the body. Regarding the practices-related to menstruation, there were some malpractices regarding diet and dietary intake (avoiding certain foods, eating less, and less fluid intake). However, the hygienic practices were found to be satisfactory. In conclusion, Pakistani university girls have some misconceptions, misperceptions and malpractices related to menstruation. Our findings draw attention to conduct awareness programs in order to eradicate these misconceptions, myths and malpractices., Obstetrics & gynecology; Public health; Quality of life; Women's health; Health promotion; Knowledge; Menstruation; Practices; Pakistan.

Background The United Kingdom aortic aneurysms (AA) services have undergone reconfiguration to improve outcomes. The National Health Service collects data on all hospital admissions in England. The complex administrative datasets generated have the potential to be used to monitor activity and outcomes, however, there are challenges in using these data as they are primarily collected for administrative purposes. The aim of this study was to develop standardised algorithms with the support of a clinical consensus group to identify all AA activity, classify the AA management into clinically meaningful case mix groups and define outcome measures that could be used to compare outcomes among AA service providers. Methods In-patient data about aortic aneurysm (AA) admissions from the 2002/03 to 2014/15 were acquired. A stepwise approach, with input from a clinical consensus group, was used to identify relevant cases. The data is primarily coded into episodes, these were amalgamated to identify admissions; admissions were linked to understand patient pathways and index admissions. Cases were then divided into case-mix groups based upon examination of individually sampled and aggregate data. Consistent measures of outcome were developed, including length of stay, complications within the index admission, post-operative mortality and re-admission. Results Several issues were identified in the dataset including potential conflict in identifying emergency and elective cases and potential confusion if an inappropriate admission definition is used. Ninety six thousand seven hundred thirty-five patients were identified using the algorithms developed in this study to extract AA cases from Hospital episode statistics. From 2002 to 2015, 83,968 patients (87% of all cases identified) underwent repair for AA and 12,767 patients (13% of all cases identified) died in hospital without any AA repair. Six thousand three hundred twenty-nine patients (7.5%) had repair for complex AA and 77,639 (92.5%) had repair for infra-renal AA. Conclusion The proposed methods define homogeneous clinical groups and outcomes by combining administrative codes in the data. These methodologically robust methods can help examine outcomes associated with previous and current service provisions and aid future reconfiguration of aortic aneurysm surgery services.

The majority of traumatic lumbar injuries occur after a high-energy mechanism or as a result of preexisting congenital deformity. Although rare, these injuries can be seen in the elite athlete. Treatment can differ depending on the spectrum of injury. These patients necessitate a high index of suspicion and require meticulous evaluation immediately with an organized, routine checklist. Physical examination can alert the physician of the location of pain as well as neurologic deficits to guide advanced imaging with computed tomography (CT) or magnetic resonance imaging (MRI). Providing a controlled and safe environment for evaluation, transfer, and ultimately treatment both in the acute and follow-up periods is paramount for optimizing outcomes. It is also critical to recognize pathology that necessitates emergent operative intervention. Lastly, it is important to educate the athlete on complications associated with thoracolumbar injuries as long-term sequelae can result. Complications should be openly discussed with the patient, their coaches, and family to maintain accurate expectations for return to play.

Background\ud \ud The aim of this study was to use recent evidence to investigate and update volume–outcome relationships after open surgical repair (OSR) and endovascular repair (EVAR) of abdominal aortic aneurysm in England.\ud \ud \ud \ud Methods\ud \ud Hospital Episode Statistics (HES) data from April 2006 to March 2018 were obtained. The primary outcome was in‐hospital death. Other outcomes included duration of hospital stay, readmissions within 30 days, and critical care requirements. Case‐mix adjustment included age, sex, HES year, deprivation index, weekend admission, mode of admission, type of procedure and co‐morbidities.\ud \ud \ud \ud Results\ud \ud Annual volume of all repairs combined appeared to be an appropriate measure of volume. After case‐mix adjustment, a significant relationship between volume and in‐hospital mortality was seen for OSR (P

Background Due to dengue virus disease, half of the world population is at severe health risk. Viral encoded NS2B-NS3 protease complex causes cleavage in the nonstructural region of the viral polyprotein. The cleavage is essentially required for fully functional viral protein. It has already been reported that if function of NS2B-NS3 complex is disrupted, viral replication is inhibited. Therefore, the NS2B-NS3 is a well-characterized target for designing antiviral drug. Results In this study docking analysis was performed with active site of dengue NS2B-NS3 protein with selected plant flavonoids. More than 100 flavonoids were used for docking analysis. On the basis of docking results 10 flavonoids might be considered as the best inhibitors of NS2B-NS3 protein. The interaction studies showed resilient interactions between ligand and receptor atoms. Furthermore, QSAR and SAR studies were conducted on the basis of NS2B-NS3 protease complex docking results. The value of correlation coefficient (r) 0.95 shows that there was a good correlation between flavonoid structures and selected properties. Conclusion We hereby suggest that plant flavonoids could be used as potent inhibitors of dengue NS2B-NS3 protein and can be used as antiviral agents against dengue virus. Out of more than hundred plant flavonoids, ten flavonoid structures are presented in this study. On the basis of best docking results, QSAR and SAR studies were performed. These flavonoids can directly work as anti-dengue drug or with little modifications in their structures.

International audience; OBJECTIVE: Lower extremity peripheral arterial disease (PAD) is a chronic condition most commonly presenting with intermittent claudication (IC). Intermittent claudication limits walking ability and may negatively affect health-related quality of life. Treadmill assessment of maximal walking distance (MWD) is the gold standard to assess PAD symptom severity. Despite being a well-established and reproducible tool, it may be inappropriate (due to frailty or fear) for some patients and only describes maximal abilities for a single walk test. Global positioning systems (GPS) have been proposed as reliable and reproducible tool to measure total, mean and maximal walking distances in patients with PAD, in the community setting. Using GPS, our study attempted to explore what happens to the walking ability of patients with IC following no intervention under 'real-life' conditions.DESIGN AND METHODS: Using the GlobalSat DG100 GPS, forty-three patients (69±9years; nine female; no invasive interventions or rehabilitation) undertook two 60-min walking assessments, 6months apart. Assessments took place in community spaces that had even terrain, no tall trees or buildings and were free from motorized vehicles. Global positioning systems-measured maximum walking distance was the main study outcome measure.RESULTS: Over the 6-month period, patients demonstrated significantly shorter GPS-measured, mean (552m versus 334m; P=0·02) and maximum (714m versus 545m; P=0·04) walking distances, stopping also more frequently (nine versus five times; P=0·03).CONCLUSIONS: Given the reported symptom progression, we advocate early intervention (e.g. exercise interventions) combined with frequent patient monitoring in attempts to maintain or improve walking ability.

Objectives: To Analyze and compare the effect of oral vs parenteral iron therapyon various hematological parameters in women suffering from post-partum iron deficiencyanemia. Study Design: Comparative, randomized and prospective study. Setting: Departmentof Pharmacology, HCMD, HU in collaboration with the Dept of Obs/Gynae, JPMC Karachi.Period: January to December 2015. Subjects and Methods: 40 patients divided in two groupsA and B of 20 each. Group A received oral iron (Tab Iberet 525 mg once daily) for a period of 3months while group B was treated with intravenous iron sucrose complex (Inj Venofer 100mg/Amp) the total no of doses were calculated according to Hemoglobin deficit. Hemoglobin,Hematocrit and MCV were observed at day 0, 45 and 90 of the treatment. Results: Group Ashows a mean increase of 25.85% at day 90th of the treatment in comparison to this group Bshows a much better result with a mean increase of 36.71% in Hemoglobin conc. At the end of12 weeks therapy. Conclusion: Parenteral iron therapy was found to be an effective means oftreatment in patients with postpartum iron deficiency anemia.

There is growing interest to restore oyster populations and develop oyster reefs for their role in ecosystem health and delivery of ecosystem services. Successful and sustainable oyster restoration efforts largely depend on the availability and selection of suitable sites that can support long-term growth and survival of oysters. Hence, in the present study a habitat suitability index (HSI) model was developed for the intertidal rock oyster (Saccostrea cucullata), with special attention: (1) to the role of the monsoon in the suitability of oyster habitats, and (2) to identify potential suitable sites along the south-eastern Bangladesh coast. Seven habitat factors were used as input variables for the HSI model: (1) water temperature; (2) salinity; (3) dissolved oxygen; (4) particulate inorganic matter (PIM); (5) pH; (6) Chlorophyll-a; and (7) water flow velocity. Seven field surveys were conducted at 80 locations to collect geo-spatial environmental data, which were then used to determine HSI scores using habitat suitability functions. The model results showed that the areas suitable (HSI >0.50) for oyster settlement and growth were characterized by relatively high salinities, Chlorophyll-a, dissolved oxygen and pH values. In contrast, freshwater dominated estuaries and nearby coastal areas with high suspended sediment were found less suitable (HSI

Purpose To study the profile of sight-threatening diabetic retinopathy (STDR), its association with various factors affecting it, and awareness of diabetic retinopathy (DR) among patients with diabetes mellitus (DM) attending a tertiary care center in Kashmir. Methods In this prospective cross-sectional study, 625 consecutive patients with DM were assessed for STDR. Demographic/clinical data were obtained. Early treatment diabetic retinopathy study (ETDRS) criteria were used to grade fundus photographs. Severe nonproliferative DR, proliferative DR, and/or macular edema were classified as STDR. Optical coherence tomography was used to confirm the diagnosis of macular edema. Results The mean age of patients was 56.36 ± 9.29 years. The male-to-female ratio was 0.92:1. The majority (99.36%) of patients had type 2 DM. STDR was seen in 208 (33.28%) patients. Non-sight-threatening diabetic retinopathy (NSTDR) was seen in 173 (27.68%) patients. Eye care was sought by 313 (50.08%) patients for the first time. STDR had a significant association with difficulty in accessing the health care facilities, duration of diabetes, uncontrolled diabetes, presence of other diabetes complications, use of insulin, and hypertension (P < 0.05 for all). Awareness that diabetes can affect eyes showed a significant association with age, gender, educational status, duration of diabetes, glycemic status, DR, and STDR (P < 0.001 for all). Conclusion STDR is a common complication in diabetes and is duration- and glycemic control-dependent. Understanding the factors associated with STDR can help in making strategies for its prevention. Spreading awareness regarding STDR at the community level in the Kashmir valley is crucial in this regard.

Background: Cataract surgery has an IOP lowering effect. Aim of the study was to analyses and evaluate the effect of cataract surgery [phacoemulsification] for senile cataract on IOP.Methods: This prospective observational study was carried out at two private specialized ophthalmology centers at India over a period of one year from Jan 2015 to Dec 2015. Cataract surgery (phacoemulsification) was performed on single eye of all the test subjects presenting to the out-patient departments with senile cataract without any comorbidity. Preoperative intraocular pressure (IOP) readings were noted and then compared to the post-operative IOP readings. All the data was collected and analyzed.Results: Cataract surgery reduced the IOP by a mean of 1.6 mmHg. Eyes with a higher preoperative IOP had a much greater IOP reduction post cataract surgery. Patients having a shorter axial length had more IOP reduction after cataract surgery with a mean value of 2.4 mmHg, which was statistically significant with a p value of 0.02. Older patients had a greater decrease in IOP after cataract surgery and it was noted that the relationship between IOP and increasing age was statistically significant having a p value of 0.001.Conclusions: Cataract surgery (phacoemulsification) has a significant IOP lowering effect and it is more in eyes having higher pre-operative IOP, shallower anterior chamber and those of the elderly.

Cervical radiculopathy presents with upper extremity pain, decreased sensation, and decreased strength caused by irritation of specific nerve root(s). After failure of conservative management, surgical options include anterior cervical decompression and fusion, disk arthroplasty, and posterior cervical foraminotomy. In this review, we discuss indications, techniques, and outcomes of posterior cervical laminoforaminotomy.

Aim: To find out the risk factors associated with wound infection following caesarean section. Design: Prospective cohort study. Place and Duration of Study: This study was carried out in the Department of Obstetrics and Gynaecology, Lalla-Ded Hospital, Government Medical College, Srinagar from October 2014 to September 2015. Methodology: Total of 1560 women who had undergone CS for delivery during study period were considered as eligible. Wound was observed for the development of infection on the third, fifth and seventh postoperative day. Patients who developed wound infection constituted the cases (116) and those with healthy wound constituted the controls (1444). Results: Incidence of wound infection following caesarean section was found to be 7.4% in this Original Research Article Afzal and Nawaz; BJMMR, 14(2): 1-6, 2016; Article no.BJMMR.23909 2 study. Wound infection was found to be common in women who had BMI of ≥25, who had absent membranes before surgery, who were diabetic, who underwent emergency surgery and the woman who had vertical skin incision. Conclusion: The risk of developing wound infection after caesarean section depends on multiple factors. Therefore, increased awareness on these risk factors and prevention of these infections should be a clinical and public health priority.