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The ongoing pandemic that initiated in Wuhan, China, has been an international public health emergency since January 2020. India has been battling a brutal COVID-19's second wave since April 2021. The healthcare system was struggling with a substantial increase in COVID-19 cases when the lack of necessary resources further aroused a major setback. Opportunistic fungal infections, specifically mucormycosis and candidiasis have become a pressing matter of concern. Recent cases of aspergillosis have also heightened public alarm. Hence, call for an immediate response to this public health crisis is the need of the hour by establishing countrywide surveillance, diagnostic, and management system, as well as public awareness to alleviate the burden of COVID-19 and fungal infections in India., Competing Interests: The authors declare that there is no conflict of interests., (© 2022 The Author(s).)

Cardiac amyloidosis is a rare disease which is under diagnosed in this region. This study was aimed to assess the clinical presentation, cardiac magnetic resonance (CMR) imaging findings and prognosis of patients with cardiac amyloidosis in Pakistani population presenting to a tertiary care setting. A total of eight patients were included with the confirmed diagnosis of cardiac amyloidosis on CMR, after reviewing the CMR data of Aga Khan University Hospital from January 2011 to August 2019. Mean age was 51±11.5 years with the majority (75%) being male. All patients presented with heart failure. Suboptimal myocardial nulling on late gadolinium images was the most common finding on CMR. Late gadolinium enhancement was diffuse transmural in 5 patients (62.5%) and diffuse sub-endocardial in 3 patients (37.5%). On a mean follow up of 14±10 months, 3 patients (37.5%) died while 7 patients (87.5%) had hospital admissions due to heart failure.

Broad complex tachycardia (BCT) during head up tilt test (HUTT) is infrequent. Electrophysiology Study (EPS) plays an important part in further differentiation of BCT. We present a case of BCT during HUTT in a patient presenting with presyncope which later on EPS with 3D mapping was diagnosed as ventricular tachycardia. This case highlights the unusual occurrence of BCT during HUTT, the differential diagnosis of BCT and the utility of EPS to reliably identify the type and origin of BCT., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

In Pakistan, HIV has increased at an alarming rate in recent decades, and the death toll has risen. It is a public health challenge amidst the COVID-19 pandemic that is not being given due importance. The present article looks at the challenges and efforts being made to deal with HIV among children in Ratodero, Pakistan, and addresses measures that can be taken to control the disease in the child population epidemiologically., Competing Interests: No conflict of interest declared., (© 2021 Published by Elsevier B.V. on behalf of INDIACLEN.)

Introduction: This study aimed at determining the frequency and association of stress levels with modes of transportation and was likely to reveal the contributing transportation-related factors for stress in medical students., Methods: This was a questionnaire-based, cross-sectional study that included undergraduate medical students of a public sector medical university in Karachi, Pakistan. A total of 573 students participated voluntarily, of which 300 were provided a manual questionnaire and 273 filled it online. The reliability of the questionnaire was assessed using Cronbach's alpha at 0.791. The collected data were analysed using IBM SPSS Statistics for Windows, version 21.0., Results: Out of 573 participants, 99.3% (n = 298) of students filled the questionnaire manually, whereas 100% of students filled the questionnaire online. Almost two-thirds of students used university transport; more than 90% lived more than 5 km from the university and 56% had a traveling time of more than an hour. Approximately 15.4% of students reported physical trauma and some form of harassment. Sheldon Cohen's stress scale surprisingly revealed 90% of students to be within the moderate-to-high stress category. Risk factors were associated with stress levels and significant associations were observed with noise exposure ( P = 0.023) and sleep quality ( P = 0.001). The most common reported stressors associated with commuting included overcrowding, long travel, and air and noise pollution. Noise pollution was the main predictor of stress among commuters., Conclusion: Poor transportation has adverse effects on health and academic performance. Administration in their respective jurisdictions is needed to investigate this matter to make commuting a routine rather than a hassle., Competing Interests: Conflict of Interest None., (© Penerbit Universiti Sains Malaysia, 2021.)

Telesurgery, or remote surgery, is widely known as a master-slave technology. It has achieved a milestone in surgical technology and intervention, providing widespread prospects of operating on a patient in a remote area with increased accuracy and precision. It consists of one or more arms controlled by a surgeon and a master controller in a remote area accessing all the information being transferred via a telecommunication system. This paper reviews the present advancements and their benefits and limitations in the field of telesurgery. A handful of operations have been done so far. However, due to time-lag (latency), global networking problems, legal issues and skepticism, and on top of the cost of robotic systems and their affordability have led to the concept of telerobotics and surgery to lag. However, with more information and high speed, 5G networking, which has been in a trial to reduce latency to its minimum, is beneficial. Haptic feedback technology in telesurgery and robotics is another achievement that can be improved; further, this allows the robotic arms to mimic the natural hand movements of the surgeon in the control center so that the master controller can perform surgeries with more dexterity and acuity. Due to coronavirus (COVID-19), this type of surgery approach can reduce the probability of contracting the virus, saving more lives and the future., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Mohan et al.)

Films of SiGe nanocrystals (NCs) in oxide have the advantage of tuning the energy band gap by adjusting SiGe NCs composition and size. In this study, SiGe-SiO 2 amorphous films were deposited by magnetron sputtering on Si substrate followed by rapid thermal annealing at 700, 800 and 1000 °C. We investigated films with Si:Ge:SiO 2 compositions of 25:25:50 vol.% and 5:45:50 vol.%. TEM investigations reveal the major changes in films morphology (SiGe NCs with different sizes and densities) produced by Si:Ge ratio and annealing temperature. XPS also show that the film depth profile of SiGe content is dependent on the annealing temperature. These changes strongly influence electrical and photoconduction properties. Depending on annealing temperature and Si:Ge ratio, photocurrents can be 10 3 times higher than dark currents. The photocurrent cutoff wavelength obtained on samples with 25:25 vol% SiGe ratio decreases with annealing temperature increase from 1260 nm in SWIR for 700 °C annealed films to 1210 nm for those at 1000 °C. By increasing Ge content in SiGe (5:45 vol%) the cutoff wavelength significantly shifts to 1345 nm (800 °C annealing). By performing measurements at 100 K, the cutoff wavelength extends in SWIR to 1630 nm having high photoresponsivity of 9.35 AW -1 .

Multilayer structures comprising of SiO 2 /SiGe/SiO 2 and containing SiGe nanoparticles were obtained by depositing SiO 2 layers using reactive direct current magnetron sputtering (dcMS), whereas, Si and Ge were co-sputtered using dcMS and high-power impulse magnetron sputtering (HiPIMS). The as-grown structures subsequently underwent rapid thermal annealing (550-900 °C for 1 min) in N 2 ambient atmosphere. The structures were investigated using X-ray diffraction, high-resolution transmission electron microscopy together with spectral photocurrent measurements, to explore structural changes and corresponding properties. It is observed that the employment of HiPIMS facilitates the formation of SiGe nanoparticles (2.1 ± 0.8 nm) in the as-grown structure, and that presence of such nanoparticles acts as a seed for heterogeneous nucleation, which upon annealing results in the periodically arranged columnar self-assembly of SiGe core-shell nanocrystals. An increase in photocurrent intensity by more than an order of magnitude was achieved by annealing. Furthermore, a detailed discussion is provided on strain development within the structures, the consequential interface characteristics and its effect on the photocurrent spectra., (Copyright © 2019, Sultan et al.; licensee Beilstein-Institut.)

Magnetorheological fluids (MRF) that undergo a change in their viscoelastic properties under the magnetic fields have been considered as one of most important smart functional materials for vibration dampers and shock absorbers in several engineering applications. However, the use of magnetorheological fluids in practical applications has been limited by poor sedimentation ratio and on-state yield stress. Herein, we report hybrid rGO-MoS 2 additives for a high-performance magnetorheological fluid. Two different kinds of hybrid additives, which are called non-magnetic rGO-MoS 2 and magnetic Fe-rGO-MoS 2 , were synthesized by using a hydrothermal method. The rGO-MoS 2 added suspensions remained stable for the first 90 min whereas the CIP MRFs settled down quickly (65%) in the first 10 minutes. The Fe-rGO-MoS 2 additives showed a 24% higher on-state shear stress as compared to CIP MRFs. On the other hand, an increase of 60% in the on-state yield stress for Fe-rGO-MoS 2 MRF can be attributed to the gap-filling by the hybrid additives during columnar-structure formation. Among two-dimensional (2D) materials, Molybdenum Disulphide (MoS 2 ) is a member of transition metal dichalcogenides (TMDCs), traditionally used as solid lubricant, while reduced graphene-oxide (rGO) is a well-known 2D material with supreme mechanical properties. We believe that this study will blaze the new way for developing a high-performance magnetorheological fluids based on various 2D material hybrids.

Objective: To determine the mean post-operative pain in scalpel versus diathermy opening of midline laparotomies., Methods: The randomised controlled study was conducted at Civil Hospital and Dow University of Health Sciences, Karachi, from May to November 2010, and comprised patients undergoing midline laparotomy. Patients were equally divided into two groups; those who received incision with diathermy were placed in group A, and those who received incision with scalpel in group B. Mean post-operative pain scores were recorded using numerical analogue scale on second post-operative day. SPSS 16 was used for statistical analysis., Results: Of the 58 patients, there were 29(50%) in each group. The overall mean age of the patients was 31.8±12.8 years. Besides, 40(68.9%) patients were male. The mean post-operative pain scores at 48 hours in diathermy group was 1.48±0.68 while in scalpel group it was 2.17±0.46 (p<0.05)., Conclusions: The use of diathermy for midline laparotomy incision had significant advantage over scalpel in reducing pain on second post-operative day.

Background: There is strong evidence that delayed diagnosis of breast cancer is associated with poor survival. The objectives were to determine the frequency of breast cancer patients with delayed presentation, the reasons of delay and its association with different socio-demographic variables in our settings., Methods: We interviewed 315 histologically confirmed breast cancer patients. Delay was defined as more than 3 months from appearance of symptoms to the consultation from doctor. Questions were asked from each patient which could reflect their understanding about the disease and which could be the likely reasons for their delayed presentation., Results: A total of 39.01% (n=123) of patients presented late and out of those, 40.7% wasted time using alternative medicines; 25.2% were not having enough resources; 17.1% presented late due to painless lump; 10.6% felt shyness and 6.5% presented late due to other reasons. Higher age, negative family history, <8 school years of education and low to middle socio-economic status were significantly associated with delayed presentation (P<0.05). Education and socioeconomic status were two independent variables related to the delayed presentation after adjustment for others [odds ratios (OR) of 2.26, 2.29 and 95% confidence intervals (CI) was 1.25-4.10, 1.06-4.94 respectively]., Conclusions: Significant percentage of women with breast cancer in North Pakistan is experiencing presentation delay due to their misconceptions about the disease. Coordinated efforts with public health department are needed to educate the focused groups and mitigating the barriers identified in the study. Long term impact will be reduced overall burden of the disease in the region.