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Cost information can help to improve the quality of medical care budgeting, and it can also improve the efficient allocation of resources and patient outcomes. The objective of this study was to estimate the inpatient unit cost of healthcare services in a secondary hospital in Saudi Arabia. A cross-sectional retrospective approach was applied to categorize the inpatients discharged from the hospital from January to December 2018. A top-down costing method for cost estimation was used. We found that the overhead cost center holds 40.17% of the total hospital cost, and intermediate and final care cost centers consumed 25.50% and 34.33%, respectively. Among inpatients wards, the Surgical ward had the highest operational cost (39.27%). Human resources consumed the hospital's highest resources (75%) on salaries. The hospital's cost structure was not remarkable and needs revolutionary changes to adopt the new payment mechanism envisioned in the 2030 Saudi vision.

During the past two decades, Pakistan witnessed a significant progress in maternal health outcomes. However, there exist persistent urban-rural and socio-economic inequalities in access and utilization of maternal healthcare services across the country. The overall objective of this research was to identify the significant socio-economic factors determining the choice of healthcare institutions for delivery care. This was a cross-sectional study conducted in Rajan Pur, a predominantly rural district in Punjab province. Using a multi-stage random sampling technique, 368 mothers who had childbirths from 1st October to 31st December 2020 in different healthcare institutions were interviewed. Data for the study was collected through a validated study instrument used by earlier studies on maternal healthcare utilization. The results of logistic regression analysis showed that use of public healthcare facilities for delivery care increases with increasing maternal education, monthly household income, and distance to healthcare facilities. The findings and recommendations drawn from the research would provide some insights to health policymakers and planners in developing an integrated and viable maternal healthcare program in Pakistan.

Pakistan witnessed a significant improvement in maternal health outcomes during the past two decades. However, persistent urban-rural and socio-economic inequalities exist in access to maternal healthcare services across the country. The objective of this study was to estimate out-of-pocket expenditure (OOPE) on delivery care by women in the public and private health sectors in RajanPur district. This was a cross-sectional study conducted, among 368 randomly selected mothers who had childbirths from 1st October to 31st December 2020. The study applied multi-stage random sampling technique to select the study participants. The results showed that about two-thirds of mothers preferred public hospitals for most recent delivery. The percentage of cesarean deliveries conducted in private hospitals (43.8%) was 4.7 times higher than in public hospitals (9.3%). About 99% of mothers incurred OOPE during delivery care, and the mean OOPE incurred during delivery care was PKR 2840 (US$ 17.75) in public hospitals and PKR 25596 (US$159.9) in private hospitals. OOPE on cesarean delivery in private hospitals (PKR 39654.7, US$247.8) was 2.5 times higher than the public hospitals (PKR16111.9, US$100.69), whereas OOPE incurred on normal delivery care in private hospitals (PKR14339, US$89.62) was 9.5 times higher than OOPE in public hospitals(PKR 1501.4, US$9.38).To conclude, the findings and recommendations drawn from the research would provide some insights to health policymakers and planners in developing an integrated and viable maternal healthcare program in Pakistan.

Celebrity endorsement is a very popular marketing type that has dominated the industry. This research paper analyses the impact of celebrity endorsement on brands. This form of marketing became common since television was born. It involves the feature of celebrities in the commercials to help people develop a connection with the brand. Three important attributes discussed in this paper are; brand perception, brand loyalty, and the buying behaviour of the consumer. This study also sheds light on a growing trend of endorsements by celebrities in Pakistan with the youth being the main focus of marketers as these days; they are the ones who seem most impacted by this marketing approach. There are several objectives associated with celebrity brand endorsements. These objectives include the determination of the relationships that exist between the two main variables namely; celebrity endorsement and customer values.

Objective: To analyze modulating effect of Curcuma longa on Pancreatic Islet β-cell function and insulin resistance in alloxan induced diabetic rat model. Study Design: Experimental study. Setting: Department of Anatomy, Pharmacology and Pathology, SRMCH, T. Adam. Period: February 2019 to January 2020. Material & Methods: One hundred adult male rats were selected according to criteria and grouped A to E. Group A and B was negative and positive control rats, and C –E were diabetic experimental rats. Alloxan (120 mg/Kg body weight) was injected intraperitoneally (i.p) to induce diabetes mellitus. Curcuma longa was used in doses of 200, 300 and 500 mg/d for 28 days. Body weight, blood glucose, HbA1c, insulin and C-peptide were estimated. Insulin resistance (HOMA-IR) and β- cell function (HOMA-β) were calculated by formulae. Data was analyzed on SPSS package ver. 21.0 (IBM, incorporation, USA) (p≤ 0.05). Results: Twenty eight days therapy of Curcuma longa extract ameliorates blood glucose, A1C, serum Insulin levels and C-peptide levels. Insulin resistance (HOMA-IR) was found improved and β- cell function (HOMA-β) was augmented in in Curcuma longa treated experimental rats (P=0.0001). Conclusion: Administration of Curcuma longa positively modulates the Islet β-cell function and insulin resistance in alloxan induced diabetic rats.

Objective: To determine effects of Curcuma longa (CL) on the glycemic control, blood lipids and atherogenic index of plasma (AIP) in alloxan induced diabetic male Wistar albino rat model. Study Design: Experimental study. Setting: Department of Basic Medical Sciences, Suleman Roshan Medial College, Tando Adam, Sindh. Period: February 2019 to January 2021. Material & Methods: A sample of 100 rats was divided into negative controls (C-), positive (diabetic) control (C+), and experimental groups D, E and F. DM was induced by injecting Alloxan (120 mg/Kg body weight) intraperitoneally (i.p) to overnight fasting rats. Diabetic groups D, E, and F were treated with ethanol extract of Curcuma longa 100 mg, 300 mg and 500 mg orally daily for six weeks. Blood samples were collected for biochemical analysis. Atherogenic Index of Plasma (AIP) was calculated by log TAG/HDLc. Data analyzed on SPSS package (ver. 21.0, IBM, incorporation, USA) (p≤ 0.05). Results: Significant improvement in glycemic status and blood lipids was observed in Curcuma longa treated groups D, E and F (P=0.0001). Atherogenic index of plasma (AIP) in negative (C-) and positive (C+) control was 0.08±0.03 and 1.11 ±0.1 respectively (P=0.0001) that improved in Curcuma longa treated groups D, E and F noted as; 0.77±0.3, 0.68±0.3 and 0.62±0.4 respectively. Conclusion: Present study found ethanolic extract of Curcuma longa improves the glycemic control, lipid profile and atherogenic index of plasma (AIP) in alloxan induced diabetic rat model.

Mango (Mangifera indica) is a popular fruit in Pakistan and ranks second to citrus. Pakistani mangoes have a large export potential in overseas markets that has yet to be realized. In Pakistan, important fruit trees such as citrus, mango, guava, etc. are facing a decline. Among these fruits, mango decline has been addressed strongly as they are important foreign exchange earnings and export items. In the case of mango, the decline has different forms, generally known as progressive, slow decline, or dieback; quick dieback, and sudden death. This type of condition is most common in poorly managed orchards that do not follow correct nutrition, plant protection, or irrigation techniques. Such a drop can be easily addressed if orchards are cultivated using the greatest possible production methods. The updated studies on the occurrence of mango decline are necessary to become a reference for further research and management strategies. Therefore, the present study was designed for disease estimation in the mango-growing areas of the Punjab province of Pakistan. According to the results, maximum mean disease severity of 2.70 was observed in district Bahawalpur followed by Khanewal (2.30), Multan (2.11), and Muzaffar Garh (2.00). The minimum disease severity (1.90) was recorded in Rahim Yar Khan district. Similarly, the maximum mean disease incidence (100%) was found in Khanewal followed by Bahawalpur (99.30%), Muzaffar Garh (96.00%), and Multan (96.00%) while the minimum disease incidence (90.00%) was observed in Rahim Yar Khan. The disease index which gives the actual picture of the disease was found to be the maximum in Bahawalpur (53.30%) followed by Khanewal (46.50%), Rahim Yar Khan (39.10%), and Muzaffar Garh (37.30%) while the minimum disease index of 36.89 was found in Multan district. This information will serve as the baseline information for research and management strategies in mango decline.

Objective: To analyze effects of turmeric in glycemic control and insulin secretagogue activity in alloxan induced diabetic rat model. Study Design: Experimental Study. Setting: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad. Period: February 2019 to January 2020. Material & Methods: A sample of 100 adult male rats was selected according to inclusion criteria. Rats were grouped as negative control (group A), positive control – diabetic rats (group B), and experimental groups C – E. Group C- was diabetic rat + 100 mg ethanol extract of turmeric, Group D- was diabetic rat + 300 mg ethanol extract of turmeric, and Group E- was diabetic rat + 500 mg ethanol extract of turmeric. Overnight fasting rats were administered Alloxan 120 mg/Kg body weight intraperitoneally (i.p) by pinching abdominal wall under skin for the induction of diabetes mellitus in the rats. Blood glucose, glycated hemoglobin A1 (A1C) and serum insulin were analyzed. Statistical analysis was performed on SPSS package (ver. 21.0, IBM, incorporation, USA) at p≤ 0.05 (Confidence interval 95%). Results: Blood glucose, A1C and serum Insulin levels were improved in turmeric treated experimental rats. Significant reduction in blood glucose and A1C were found in turmeric treated rats (P=0.0001). Serum insulin levels were found increased in turmeric treated experimental groups C – E compared to positive control B (P=0.0001). Conclusion: Administration of turmeric significantly reduced the blood glucose and A1C with increased serum insulin levels in alloxan induced diabetic rats.

The current study aimed to assess broccoli's phytochemical profile and determine its antioxidant activity. Fresh broccoli was procured from a local farm and divided into two major treatment groups (cooked and dried). There were five sub-treatments in the cooking group (conventional, microwave, boiling, blanching, and steaming) and three treatments in the drying group (sun drying, freeze drying, and hot air drying). Ascorbic acid content, total carotenoids, TPC, TFC, and antioxidant activity were evaluated for every sub-treatment. The results depicted that the antioxidant constituent of cooked broccoli was complementary to dried broccoli samples. The maximum amount of ascorbic acid content (10.80 mg/100 g), total carotenoids (3.976 mg/g), total phenolic contents (225.80 mg/g), and the total flavonoid contents (42.92 mg/g) were found in freeze-dried broccoli. Freeze-dried broccoli also showed the highest antioxidant activity for DPPH free radical scavenging assay (62.45%), hydrogen peroxide radical scavenging assay (53.67%), and ABTS radical scavenging assay (65.84%).

Maternal health is one of the most critical public health challenges in many developing countries availability of comprehensive maternal healthcare services by skilled health professionals can improve the quality of maternal health outcomes. In Pakistan, the rate of institutional delivery is lower than many other developing countries and a significant proportion of mothers seek maternal healthcare in the private health sector. There are many factors associated with utilization of maternal healthcare services including both supply side and demand side factors. The objective of this paper is to identify significant socio-economic factors affecting utilization of delivery and postnatal services in public and private healthcare facilities in district Rajanpur, Pakistan. Using multi-stage random sampling technique, 368 mothers who delivered within 6 months prior to data collection in selected basic health unit (BHU) areas were selected. Multivariate binary logistic regression was applied on primary data collected from Rajanpur district during 1st November, 2020 – 31st January, 2021. The results indicated that the household’s preference for private healthcare sector for delivery and postnatal care increases with increase in households’ education and incomes. It also showed that accessibility to healthcare facilities is significant in utilization of maternal healthcare services. Distance to healthcare facilities, cost of transport and out-of-pocket expenditure are significantly affecting the choice of healthcare institutions.

Diarrhea caused by enteric infections is one of leading causes of morbidity and mortality across the world. Several bacterial pathogens are known to cause diarrhea including Vibrio cholera, Clostridium difficile, Shigella and selected strains of Escherichia coli (E. coli). Clinical features of acute infectious diarrhea include abdominal cramps, nausea, fever, vomiting and blood and mucus in the stool. Islamabad, the capital territory of Pakistan has recently come into a wrap of an outbreak of infectious diarrhea which is affecting the masses and is still continuing to do so. Islamabad health care system came collapsing during the last major outbreak of Corona Virus and showed areas that needed improving, thus this endemic should be taken seriously while it is in its bud. This letter addresses the latest outburst of diarrhea that demands an urgent and immediate attention. Letter also provides with precautionary measures and management techniques that should be picked up the relevant authorities and public

Background & Objective: There is no first line antiviral treatment for Corona Virus Disease 2019 (Covid-19). Remdesivir is used as antiviral drug for covid 19 in different parts of world with variable results.The objective of our study was to assess the effect of Remdesivir in Covid-19, in terms of time to discharge from hospital and mortality rate benefit. Methods: An interventional, single-center study conducted at Corona Wards of DHQ University teaching hospital Gujranwala. Two categories were made using simple random sampling technique. First category was marked 'Remdesivir group', to whom after Informed Consent Injection Remdesivir (200 mg on the principal day followed by 100 mg every day for the following four days) was given. Second category was the'Control group'; they were not given the injection Remdesivir. Total 248 patients were selected for the study. The Remdesivir category included 124 patients and the Control category involved 124 patients. Collected data was analyzed using SPSS 23.0. All baseline characters and variables in history were calculated as Mean and standard deviations for quantitative variables and as percentages for frequencies of qualitative variables. Univariate comparison for binary variables was performed with Chi-Square test. A p-value of

Electronic health information systems (EHIS) are considered a backbone for healthcare planning and quality services. This study was designed to explore the acceptance, reliability, and satisfaction of the end users' experience with the hospital electronic health information system. We also investigated the perception of data quality by the users who were directly involved in data entry. We conducted a questionnaire based cross-sectional survey to collect quantitative data from different EHIS users. The questionnaire contained six sections: demographic user information; general HIS assessment; accessibility and availability of computer terminals in the hospital; EHIS and the patient care; user satisfaction with the HIS and perception of data quality. Desktop computers were available throughout the hospital, but the hospital was lacking handheld computers or computers on wheels. Participants of the study were satisfied with the data entry and retrieval process but they were lacking job training related to troubleshooting. EHIS users were not aware and prepared for the downtime of the system and procedures were also not clear to them. Regarding the perception of data quality, most of the participants responded that data is of adequate quality. There is a need for proper technical support and enhance the hospital's networking speed for better response. Laptops and hand-held computers are the need of time for data entry in critical situations and during wards visit. This can also enhance the quality of data, and reduce the chances of data loss.

The human monkeypox is an emerging zoonotic orthopoxvirus with a clinical presentation similar to that of smallpox. It is difficult to differentiate monkeypox from other orthopedic infections, and laboratory diagnosis is the primary component of disease identification and monitoring. However, current diagnostics are time-consuming, and new tests are needed for rapid and precise diagnosis. Most cases have been reported in Central Africa; however, an increasing number of cases have been reported in Europe, the United States of America (USA), Australia, and the United Arab Emirates. Although investigation of the current global outbreak is still ongoing, viral transmission seems to have occurred during crowded events in Spain and Belgium. New therapeutics and vaccines are being deployed for the treatment and prevention of monkeypox, and more research on the epidemiology, biology, and ecology of the virus in endemic areas is required to understand and prevent further global outbreaks.

The objective of this work was to formulate co-loaded bilayer tablets containing ezetimibe (EZB) and atorvastatin (ATC). ATC loaded in the immediate-release (IR) layer is an HMG CoA reductase inhibitor, while EZB, added in the sustained-release (SR) layer, is a lipid-lowering agent. This study was conducted to evaluate the effects of polymer on the formulation and characterization of bilayer tablets, as well as the therapeutic impact of the concurrent use of both drugs having a sequential release pattern. To obtain the optimized results, four different formulations with variable compositions were developed and evaluated for different parameters. The drug release studies were carried out using a type II dissolution apparatus, using phosphate buffer solution (PBS) of 1.2 pH for IR of EZB for an initial 2 h, followed by 24 h studies for ATC in PBS 6.8 pH. The IR layer showed rapid drug release (96%) in 2 h, while 80% of the ATC was released in 24 h from the SR layer. Locally obtained, 6-week-old female albino rats were selected for in vivo studies. Both preventive and curative models were applied to check the effects of the drug combination on the lipid profile, atherosclerosis and physiology of different organs. Studies have shown that the administration of both drugs with different release patterns has a better therapeutic effect (

For effective varietal improvement of horticultural crops peach (Prunus persica) and nectarine (Prunus persica var. nucipersica), information about their population structure and genetic relatedness plays an important role. In this study we used retrotransposon-based markers (iPBS) to estimate the genetic diversity and population structure of 48 peach and nectarine genotypes from various distinct geographical regions of Punjab and Khyber Pakhtunkhwa, Pakistan. A total of 461 alleles were identified from PCR amplicons derived from nine iPBS primer pairs with an average of 8.5 alleles/locus. Among all four groups the genotypes collected from Swat and Hunza had the highest and the lowest expected heterozygosity, unbiased expected heterozygosity and Shannon’s information index, respectively. We constructed a Neighbour-Joining dendrogram and performed principal coordinate analysis based on the distance matrices, and both forms of analysis grouped the 48 genotypes into two distinct clusters. The STRUCTURE software distributed the forty-eight genotypes into two main populations (k = 2) indicating a low diversity between genotypes collected from Chakwal, Swat, Mansehra and Hunza.

Background Efficiency remains one of the most important drivers of decision making in health care system. Fund allocators need to receive structured information about the cost healthcare services from hospitals for better decisions related to resource allocation and budgeting. The objective of the study was to estimate the unit cost for health services offered to inpatients in King Fahd Central hospital (KFCH) Jazan during the financial year 2018. Methods We applied a retrospective approach using a top-down costing method to estimate the cost of health care services. Clinical and Administrative departments divided into cost centres, and the unit cost was calculated by dividing the total cost of final care cost centres into the total number of patients discharged in one year. The average cost of inpatient services was calculated based on the average cost of each ward and the number of patients treated. Results The average cost per patient stayed in KFCH was SAR 19,034, with the highest cost of SAR 108,561 for patients in the Orthopedic ward. The average cost of the patient in the Surgery ward, Plastic surgery, Neurosurgery, Medical ward, Pediatric ward and Gynecology ward was SAR 33,033, SAR 29,425, SAR 23,444, SAR 20,450, SAR 9579 and SAR 8636 respectively. Conclusion This study provides necessary information about the cost of health care services in a tertiary care setting. This information can be used as a primary tool and reference for further studies in other regions of the country. Hence, this data can help to provide a better understanding of tertiary hospital costing in the region to achieve the privatization objective.

To assess the reliability and validity of gray level co-occurrence matrices (GLCM) in the quantification of choriocapillaris and describe GLCM features in normal and eyes with resolved acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and serpiginous choroiditis (SC).In this, multicenter, reliability, validity and comparative study; OCTA was performed on eyes with resolved APMPPE and SC and normal individuals. CC texture classification, low flow area measurements and GLCM feature extraction were performed.A total of 13 normal, 8 APMPPE and 15 SC eyes were analyzed. All GLCM parameters demonstrated an excellent reliability. GLCM parameters were differently distributed across the three groups. Decision-tree based on the random forest predictive model provided an overall accuracy of 86% in classifying the three groups using GLCM features.These data demonstrated an excellent reliability and validity of GLCM features in quantifying the choriocapillaris in healthy and diseased eyes.

Hypertension is declared as the major risk factor of cardiovascular diseases and stroke, and the leading cause of premature deaths. ACE is a zinc dependent dipeptidyl peptidase and plays key role in controlling blood pressure via renin angiotensin system (RAS), and hence serves as the promising target for antihypertension drugs. Many food derived antihypertensive peptides have been identified recently. However, their ACE inhibitory activity, interactions and stability are not fully evaluated. Our work focused on combination of modern bioinformatics techniques for efficient evaluation of potent ACE inhibitory food peptides and understanding of interactions between ACE and inhibitory peptides. We reported novel antihypertensive peptide IQDVPS, LQPGS, VIP from date, salmon and soybean proteins respectively. Food proteins were digested in-silico to release peptides. Molecular docking studies revealed high binding affinities and interactions with ACE active site. MD simulations and Alanine Scanning were carried out to study the stability of these ACE-peptide complexes in cell like environment. The results showed that the suggested peptides competitively inhibit ACE by tightly binding to its active site, meanwhile maintaining the structural stability of the complex. ACE-LQPGS (Salmon) was found to have best binding with least structural fluctuations.

The cytoplasmic dynein light chain 1 (DYNLL1) is an important constituent of motor proteins complex. In human it is encoded by DYNLL1 gene. It is involved in cargo transport functions and interacts with many viral proteins with the help of short linear consensus motif sequence (K/R) XTQT. Viral proteins bind to DYNLL1 through its consensus short linear motif (SLiM) sequence to reach the target site in the cell and cause different infections in the host. It is still unknown if bacterial proteins also contain the same conserved SLiMs sequence through which they bind to this motor protein and cause infections. So, it is important to investigate the role of DYNLL1 in human bacterial infections. The interaction partner proteins of DYNLL1 against conserved viral motif sequences were predicted through PDBSum. Pairwise sequence alignment, between viral motif sequence and that of predicted proteins, was performed to identify conserved region in predicted interaction partners. Docking between the DYNLL1 and new pathogenic interaction partners was performed, by using PatchDock, to explore the protein-protein binding quality. Interactions of docked complexes were visualized by DimPlot. Three pathogenic bacterial proteins i.e., enterochelin esterase (3MGA), protective antigen (3J9C) and putative lipoprotein (4KT3) were selected as candidate interaction partners of DYNLL1. The putative lipoprotein (4KT3) showed low quality binding with DYNLL1. So, enterochelin esterase (3MGA) and protective antigen (3J9C) were speculated to be involved in human bacterial infections by using DYNLL1 to reach their target sites. Keywords: Motor protein, Protein-peptide docking, Human pathogenic bacteria, Protein-protein interaction, Short linear motifs

The effect of intradermal TA on melasma was evaluated as a possible treatment modality on all of the 11 patients (fitting the inclusion criteria) presenting in the out-patient department of the Benazir Bhutto Hospital, Rawalpindi during Sep 2019 to Mar 2020. Their pre- and post-interventional results were evaluated after being injected with 4 mg/ml of TA on the lesions once weekly for 6 weeks, using Wilcoxon signed rank test in SPSS v 24. The average duration of melasma in our patients was 25.3 ± 7.6 in months. The mean modified MASI score rating was 12.2 (2.3) and 5.1 (1.4) before and after intervention with intradermal TA respectively. The largest difference obtained in the mMASI scores of the patients was 10.8. TA has a distinctive effect as a treatment modality for melasma, as it is easily employable with very few side effects. Keywords: Melasma, Tranexamic acid, TA, intradermal TA, mMASI.

The objective of this work was to formulate co-loaded bilayer tablets containing ezetimibe (EZB) and atorvastatin (ATC). ATC loaded in the immediate-release (IR) layer is an HMG CoA reductase inhibitor, while EZB, added in the sustained-release (SR) layer, is a lipid-lowering agent. This study was conducted to evaluate the effects of polymer on the formulation and characterization of bilayer tablets, as well as the therapeutic impact of the concurrent use of both drugs having a sequential release pattern. To obtain the optimized results, four different formulations with variable compositions were developed and evaluated for different parameters. The drug release studies were carried out using a type II dissolution apparatus, using phosphate buffer solution (PBS) of 1.2 pH for IR of EZB for an initial 2 h, followed by 24 h studies for ATC in PBS 6.8 pH. The IR layer showed rapid drug release (96%) in 2 h, while 80% of the ATC was released in 24 h from the SR layer. Locally obtained, 6-week-old female albino rats were selected for in vivo studies. Both preventive and curative models were applied to check the effects of the drug combination on the lipid profile, atherosclerosis and physiology of different organs. Studies have shown that the administration of both drugs with different release patterns has a better therapeutic effect (p < 0.05), both in preventing and in curing hyperlipidemia. Conclusively, through the sequential release of ATC and EZB, a better therapeutic response could be obtained.

To compare the differences in musculoskeletal health with vitamin D alone in comparison with vitamin D with physical activity (PA) among chronic kidney disease (CKD) patients.An open labeled, randomized, controlled trial was conducted at two tertiary care centers in Pakistan. Patients with CKD stage 2-4 and vitamin D deficiency (20 ng/mL) were recruited in the trial. Both the arms were given oral vitamin D (cholecalciferol) drops (4000 IU) once daily for three months. One arm received only vitamin D (VD arm), while the second arm received vitamin D along with PA (VDPA arm).Of the 1,235 CKD stage 2-4 subjects contacted, forty-six subjects were enrolled. Eighteen were assigned to VD arm and twenty-eight were assigned to VDPA arm. Between groups comparison shows that bicep strength increases from 15 to 17 kg. Likewise, back flexibility and aerobic fitness also increased among those who receive vitamin D and physical activity, however these differences were not statistically significant (p0.05). Sensitivity analysis within group comparison shows rise of bicep strength from 13.8 kg to 15.2 kg in the VD alone arm (p=0.05); however, in the VDPA arm, there is a greater difference of 14.3 kg to 17.2 kg (p0.001).Targeted PA among CKD patients has potential to improve bicep strength and back flexibility. However, as the sample size was small, further studies would be required to suggest whether a PA should be included as part of the treatment regimen.

Abdulrahman M Jabour,1 Joe Varghese,1 Ahmed H Damad,2 Khalid Y Ghailan,3 Asim M Mehmood1 1Health Informatics Department, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia; 2Quality & Patient Safety Department, King Fahd Central Hospital - Jazan, Jazan, Saudi Arabia; 3Epidemiology Department, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi ArabiaCorrespondence: Abdulrahman M JabourHealth Informatics Department, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi ArabiaTel +966-17329500 Ex 5545Email ajabour@jazanu.edu.saIntroduction: Many studies have explored social media and users search activities such as Google Trends to predict and detect influenza activities. Studies that examined Google Trends correlation with the actual hospital influenza cases were conducted in non-tropical regions that have clearly defined seasons. Tropical areas are known for having less-defined seasonality and the extent of Google Trends concordance with actual influenza cases is unknown for these areas. The goal of this study is to compare Google Trends with hospital cases in tropical regions.Methods: We analyzed 48,263 influenza cases in the time period of 2010 to 2019. The cases were retrieved from central hospital medical records in tropical regions using the corresponding codes for influenza ICD-10 AM. Cases from the medical records were compared with Google Trends to determine trends, seasonality, and correlation.Results: Graphically, there were some similar areas of the trend, but cross-correlation analysis did not show any significant correlation between hospital and Google Trends with a maximum correlation rate of 0.300. Seasonality analysis showed a clear pattern that peaked around November in Google Trends while hospital data showed less defined seasonality with a smaller peak occurring at the end of December and beginning of January.Conclusion: Based on the results, there is a weak correlation between Google Trends and hospital data. More innovative methods are emerging to predict influenza activity using social media and user search data and further study is needed to examine the concurrent trends derived using these methods across regions that have different humidity levels and temperatures.Keywords: influenza, predictive, surveillance, data quality, disease outbreaks, big data, epidemiological monitoring

Background: Self-medication or self-care is regarded as an unhealthy practice. However, it is widely accepted and practiced in the low and middle-income countries (LMICs) due to scarcity of health resources. Objectives: To assess the prevalence and practice of self-medication among university students in Pakistan through online resources. Methodology: A descriptive cross-sectional study was conducted between May 2017 and August 2017 by involving 991 university students. A questionnaire was administered to obtain data. Results: The majority 85.9% (852/991) of the respondents knew aboutonline medicines and their uses of self-medication. Overall, 68% (674/991) of them have to travel long-distances to access essential health services. Nearly half (41.7%) of the respondents procured drugs through the online sources, while only 15.6% of them obtained through pharmacies. Conclusions: The rampant irrational use of drugs without medical guidance could contribute to adverse consequences viz.; the emergence of multi-drug resistance, adverse drug reactions, drug interactions etc. Strict regulations must be enforced to limit public access to online-drugs by the law-enforcement agencies.

Wheat (Triticum aestivum) is a staple crop of most of the irrigated as well as rainfed areas of the world including Pakistan. Thirty wheat genotypes were used to study the effect of low moisture stress by using Polyethylene Glycol (PEG-6000) under concentration (0%, 15% and 25%) of PEG-6000 at the germination stage. Data was recorded for germination percentage, shoot length, root length, coleoptile length, shoot dry weight and root dry weight. The results of the analysis were significant and positively Co-related among all parameters. About fourteen genotypes shows 100 % germination in both control as well as under 15% PEG-6000 conditions. Chakwal- 81, Punjab- 2011, AAS- 2011, Pirsabak- 2005, Pakistan- 2013, Chakwal- 50, Pisabak - 91 and Lasani- 2008 performance was better under control as well as 15 % PEG-6000 among all thirty genotypes. While AAUR-10 and Bhakkar-2002 showed no growth under all three concentrations because of fungal growth.

Objectives: To determine the urothelial carcinoma and its association with age and gender. Study Design: Retrospective study. Setting: Pathology department of Liaquat university of Medical and Health Science. Period: One year from January 2016 to December 2016. Material and Methods: Four micrometer thick paraffin-embedded and formalin-fixed sections were prepared from transurethral resection6of bladder6tumor (TURBT) samples of urothelial carcinoma patients and were examined. Histological grading was categorized as low and high grades. All the data was collected by self-made proforma. Data was analyzed by SPSS version 20. Results: Total 83 cases were enrolled in current study; their mean age was 49.19+12.33 years. Males were found in the majority 51(61.4%) and females were 32(38.6%). Most common age group was 46-60 years 36(43.4%). According to the histological grading high grade was most common as 65.10%, and low grade urothelial carcinoma was 34.90%. There was no significant difference according to age of histological grading. Male gender was most common, while progression of disease was higher among females in contrast to males as high grade carcinoma was significantly higher among females, p-value 0.014. Conclusion: It was concluded that male gender is the contributing factor of urothelial carcinoma, but disease progression significantly high among females. No significant association has been found according to age.

Background: Breast cancer is a multifactorial disease with the highest frequency in females. Genetic and environmental factors can cause mutation in several genes like tyrosine kinase, JAK2 gene which may initiate cancer. Molecular analysis of mutations in the JAK2 gene along with determination of environmental, clinical and haematological risk factors associated with breast cancer patients is need of hour to improve patient's healthcare. Somatic JAK2 valine-to-phenylalanine (617 codon) mutation is one of the widely prevalent mutations. Methods: Blood was collected from seventy breast cancer patients after their consent. The questionnaire included risk factors, age group, locality, number of children, tumor type, family history, time of initial diagnosis, no of cycles/month, water conditions and exposure to radiations. Molecular analysis were carried out from genomic DNA using Sanger sequencing and allele-specific PCR to check the V617F point mutation. Results: The breast cancer risk factors includes unfiltered water (68.57%), urban (58.57%), menopause (55.71%), family history of cancer (18.57%), tumor grades (II, 37.14% and III, 35.71%), consanguineous marriages (44.28%) and having more than 3–4 children (45.71%). Prevalence of breast cancer was higher after the age of 35 and maximum at 35–50. In allele-specific PCR of 70 patients, 25 patients were wild type (229 bp), 25 patients were with partially deleted gene (200 bp), and 20 patient had shown no or less than 40 bp size fragments. In Sanger's sequencing of 70 BC cases, 18% were found to be positive for V617F point mutation, including 6 homozygous (T/T) and 7 heterozygous (G/T) mutations at nucleotide position 1849 in exon 14 of the JAK2 gene. Conclusions: Environmental and clinical risk factors were associated with breast cancer which can be overcome by improving awareness of associated risks, health facilities and reducing stress. Keywords: Breast cancer, JAK2, V617F mutation, Allele-specific PCR, Sanger’s sequencing

Objective: Phosphorous is an essential micronutrient of plants and involved in critical biological functions. In nature, phosphorous is mostly present in immobilized inorganic mineral and in the fixed organic form including phytic acid and phosphoesteric compounds. However, the bioavailability of bound phosphorous could be enhanced by the use of phosphate solubilizing microorganisms such as bacteria and fungi. The phytases are widespread in an environment and have been isolated from different sources comprising bacteria and fungi. Methodology: In current studies, we show the successful use of gamma rays and EMS (Ethyl Methane Sulphonate) mutagenesis for enhanced activity of phytases in a fungal strain Sporotrichum thermophile. Results: We report an improved strain ST2 that could produce a clear halo zone around the colony, up to 24 mm. The maximum enzymatic activity was found of 382 U/mL on pH 5.5. However, the phytase activity was improved to 387 U/ml at 45 °C. We also report that the mutants produced through EMS showed the greater potential for phytase production. Conclusion: The current study highlights the potential of EMS mutagenesis for strain improvement over physical mutagens. Keywords: Gamma rays, EMS mutagenesis, Fungus, Phosphate solubilizer

Dermatological diagnosis are mainly clinical; however, skin biopsies are frequently done to support clinical diagnosis when in doubt. Aim of this study is to relate the clinical diagnosis of various dermatological conditions with histopathological diagnosis.In this descriptive prospective study, 223 patients were enrolled from dermatology OPD at Benazir Bhutto Hospital through non-probability consecutive sampling. Patients were diagnosed clinically and skin biopsies of all patients were taken after informed consent and clinical data was sent to a histopathologist.Patients between ages of 2-85 years were evaluated. Mean age was 39.65±19.43 years. Out of total 223 patients 112 were males and 111 were females. Clinical diagnosis was same as histopathological diagnosis in 180 (80.7%). Out of 80.7% cases, most common disorder was Eczema, 18 cases (10%). The diseases lying in the inflammatory dermatosis group have highest sensitivity, specificity, PPV and NPV, i.e., 91.2%, 90.8%, 84.1% and 86.8% respectively. The discordance between clinical and histological diagnosis was highest in infectious disease group. The concordance between clinical and histological diagnosis in infectious diseases was just 28%.Documenting a histological diagnosis is essential in dermatology as most of the dermatosis have mimicking clinical presentation. The inflammatory lesions have superior clinical and histopathological correlation as compared to infectious diseases and therefore dermatologists should try to biopsy infective dermatosis more often rather than relying on clinical judgment solely.

The first step in plant defense mechanism is to sense the insect attack stimulus. Plant sensitivity of an insect attack is the first step of defense. Molecules generated by the oral secretion of the insect interact with the plant receptors to trigger plant defense mechanisms. We selected some highly cited insect elicitors molecules, volicitin, caeliferin, bruchin which interact with plant defense by interacting with plant elicitors (systemin, inceptin and peps) located on the plant cell surface. This interaction activates plant receptors SYR1, LRR, PEPR and triggers downstream defense signaling. The octadecanoid pathways, involving enzymes allene oxide synthase (AOS) and Hydroxyperoxide lyase (HPL) are activated. These enzymes mediate production of green leafy volatiles and Jasmonic acid by interacting with hydroxperoxide molecules. We docked the elicitors with receptors and enzymes with substrates in the pathway of JA production. Phe was found to be an important amino acid that interacts with 13-hydroxyperoxides in the case of AOS to produce JA but not in the case of HPL. JA is converted to JA-Ile which shows strong binding with COI1 and COI1-JA-Ile complex docked with JAZ which showed strong interaction with 􀂦ve hydrogens and one salt bridge bond. AOS and HPL showed less than 40% identity for sequence and structure alignment. AOS and HPL had shown an interaction between each other and showed a common interaction partner of the Lipoxygenase family. HPL shows interaction with ADH2 (Alcohol dehydrogenase) involved in GLVs production. AOS also showed interaction partner AOC, COI1 and OPR1 which are involved in JA-induced plant defense mechanism., peer-reviewed

Objective: To study the putative effects of Advanced Oxidation Protein Products (AOPPs) and Advanced Glycation End Products (AGEs) in the development and progression of cardiovascular disease (CVD). Methodology: AGEs, AOPPs, e-NOS, lipid profile, circulating stress and inflammatory biomarkers were evaluated among fifty cardiovascular patients and fifty controls. Independent student’s t-test was done for statistical analysis. Results: The malondialdehyde mean level in CVD patients (5.45 nmol/ml) was significantly higher than control (1.36 nmol/ml) (p value = 0.018). Nitric oxide in CVD patients (55.72 ng/ml) was remarkably increased as compared to normal subjects (19.19 ng/ml). A significant change in the mean serum level of AGEs in CVD patients (2.74 ng/ml) and normal individuals (0.85 ng/ml) was recorded (p value = 0.000). The AOPPs also showed significant increased levels in CVD group (132.07 ng/ml) in comparison with normal subjects (83.05 ng/ml) (p value = 0.011). The mean eNOS serum level in CVD group (15.50 U/L) was higher than control group (11.28 U/L) (p value = 0.004). Cardiovascular disease patients, in comparison with healthy controls, showed increased level of total cholesterol (5.48 mmol/L vs 4.45 mmol/L), triglycerides (2.59 mmol/L vs 1.24 mmol/L), and low density lipoprotein (2.47 mmol/L vs 2.31 mmol/L) along with decrease in high density lipoprotein (1.39 mmol/L vs 1.74 mmol/L). The mean MMP-11 serum levels in CVD group (98.69 ng/ml) was almost double of control group (45.60 ng/ml) (p value = 0.017). The mean serum level of TNF-α and IL1-α were 32.16 pg/ml and 6.64 pg/ml in CVD patient. The significant decreasing trend of SOD (p value = 0.041), CAT (p value = 0.018), GSH (p value = 0.036) and GRx (p value = 0.029) but increasing drift of GPx (0.023) level was observed in CVD patients. Conclusion: This study provides strong evidence that CVD patients presented with elevated oxidative stress, enhanced inflammation and lipid profile in their serum. Therefore, the study strongly approves that AGEs, AOPPs, inflammatory and lipoxidative biomarkers hold predictive potential in causing and aggravating the disease, thus by controlling these factors CVD progression can be inhibited. Keywords: Cardiovascular diseases, Advanced glycation end products, Advanced oxidation protein products, Endothelial nitric oxide synthase, Matrix metalloproteinase-11

Background: Cancer patients when treated with different chemotherapeutic drugs often develop mild to severe sight threatening diseases during or after chemotherapy. The mechanism involved in the pathogenesis of ocular toxicities is poorly understood. Oxidative stress, inflammation and MMPs (angiogenic factor) are involved in the progression of chemotherapy related ocular disorders. Materials and methods: The concentration of oxidative stress markers such as MDA, NO and levels of different antioxidant molecules such as SOD, CAT, GSH, GPx, GPr, VIT A, VIT E and VIT C present in the serum of chemotherapy treated patients (n = 50) and in normal persons (n = 20) were estimated by the direct spectrophotometric method while the concentration of TNF-α and MMP-9 activity were determined using human TNF-α and MMP-9 ELISA kits. Results: The concentration of SOD and CAT (0.356 ± 0.05 μg/dl and 1.26 ± 0.01 μmol/mol of protein) was significantly lower as compared to that (1.09 ± 0.03 μg/dl and 3.99 ± 0.04 μmol/mol of protein) in controls. The levels of GPx (0.06 ± 0.01 mmol/dl) in the cancer patients were much lower than those in the controls (0.78 ± 0.06 mmol/dl). Lower level of GSH (0.96 ± 0.003 μg/dl) in serum of the diseased group was observed as compared to healthy group (7.26 ± 1.40 μg/dl). The level of Vit A, Vit C and Vit E was lower in systemic circulation of cancer patients (109.99 ± 6.35 μg/ml, 1.26 ± 0.36 μg/ml and 1.29 ± 0.191 μg/ml) as compared to control subjects (166.35 ± 14.26 μg/ml, 3.25 ± 0.099 μg/ml and 6.354 ± 2.26 μg/ml) respectively. The concentration of nitric oxide was significantly higher in the cancer patients (45.26 ± 6.35 ng/ml) than that in the normal subjects (16.35 ± 3.26 ng/ml). The higher concentration of MDA (8.65 ± 3.26 nmol/ml) was observed in the patients than normal ones (1.254 ± 0.065 nmol/ml). The quantity of TNF-α was significantly higher in chemotherapy treated patients (32.68 ± 4.33 pg/ml) as compared to the control group (20.979 ± 1.98 pg/ml). Significantly higher concentration of MMP-9 (40.26 ± 3.26 ng/ml) was observed in the cancer patients than the controls (7.256 ± 1.95 ng/ml). Conclusion: Lower levels of antioxidant enzymes and non-enzymatic small molecules and higher levels of oxidative stress and inflammatory clinical parameters such as NO, MDA, TNF-α and MMP-9 may be involved in the pathogenesis of systemic chemotherapy related ocular complications such as cataract, glaucoma, blepharitis, retinitis pigmentosa, macular degeneration, pterygium and retinal degeneration. Keywords: Oxidative stress, Cancer, Chemotherapeutic drugs, TNF-α, MMPs, Ocular complications

Consultants play a pivotal role in the Environmental Impact Assessment (EIA) process because they are the ones who carry out assessments, deal with multiple stakeholders and thus face the most pressure. Considering the ineffectiveness of the EIA process, the current study attempts to identify the challenges faced by consultants in Punjab whilst dealing with stakeholders. Participant observation, professional practice and unstructured interviews were employed as data collection methods. Key challenges identified include the lack of equal treatment, insufficient capability of Environmental Protection Agency (EPA) and consultants, and the lack of awareness on the parts of the proponents and the public. Legislations accompanied with procedural controls exist in Punjab regarding EIA but the implementation is weak. A strong political will is necessary for implementation of EIA rules and regulation, awareness of the proponents and the public and capacity building of EPA. Registration and accreditation can help bring competent consultants in the field who can improve the process.