Unveiling diagnostic prowess: a comparative study of exercise treadmill test and CT coronary in coronary artery disease detection in Pakistan (2021-2023)

Coronary Artery Disease (CAD) is a global health concern, with diagnostic modalities and risk factors that exhibit regional variations. This study, conducted at the Islamabad Diagnostic Center, Pakistan, aimed to provide a comprehensive assessment of CAD prevalence, severity, and associated risk factors, while also evaluating the diagnostic accuracy of Computed Tomography Coronary Test (CTT) and Exercise Treadmill Test (ETT) in a cohort of 2909 patients. Among the patients assessed via CT Coronary scans, CAD was universally observed, presenting with varying degrees of severity. Our findings indicated that 24.5% of patients had mild CAD, 28.6% exhibited mild to moderate CAD, 16.3% were diagnosed with moderate CAD, 18.4% demonstrated moderate to severe CAD, and 20.4% displayed severe CAD. This spectrum underscores the diverse nature of CAD within the study population. In addition to CTT, we conducted a detailed evaluation of ETT results in 49 patients. These results revealed that 55.1% of patients tested positive for ischemia during the exercise test, emphasizing the prevalence of cardiac stress and underlying CAD. Conversely, 32.7% of patients exhibited negative ETT results, indicating favorable cardiac tolerance during physical activity. A subset of patients yielded non-diagnostic or inconclusive results, necessitating further clinical assessment. Disease history analysis showed a dichotomy within the cohort, with 20.4% having a known medical history and 79.6% possessing an unknown disease history, highlighting the importance of comprehensive medical records in clinical practice. Hypertension, a critical cardiovascular risk factor, was identified in 87.8% of patients, underscoring its significance. Smoking history displayed notable variation, with 69.4% categorized as smokers, 14.3% as ex-smokers, and 10.2% as non-smokers. Lipid profile analysis indicated that 69.4% of patients had abnormal lipid levels. To assess the diagnostic accuracy of CTT and ETT, we calculated Positive Predictive Values (PPV) and Negative Predictive Values (NPV). CTT exhibited a PPV of approximately 5.99% and an NPV of approximately 4.40%, whereas ETT displayed a higher PPV of around 26.44% and a substantially higher NPV of about 49.24%. This study offers valuable insights into CAD prevalence, severity, and associated risk factors in a Pakistani cohort, emphasizing the importance of holistic risk assessment and tailored interventions in clinical practice. Our findings also highlight the diagnostic utility of ETT in CAD assessment.

SARS-CoV-2 clearance in term of Cycle Threshold (Ct) during first two waves of COVID-19 in Pakistan: a phenomenon of delayed viral clearance post-corticosteroid treatment

SARS-CoV-2 is recently emerged virus, which caused millions of deaths, all over the world. To tackle COVID-19 pandemic, there is an utmost need for in-depth analysis of viral replication. We aimed to examine viral load in SARS-CoV-2 patients during first two waves of COVID-19 in Pakistan. 225,615 suspected subjects from 75 different regions of Pakistan were selected in the study. SARS-CoV-2 RNAs were detected via real time PCR. During first wave (period of June-July, 2020) of COVID-19 the prevalence of SARS-CoV-2 was 20.38%. However, during second wave (period of November-December, 2020) of COVID-19, the rate of prevalence was 9.41%. During first wave of COVID-19 96.31% of participants remained PCR positive for 14 to 21 days, 3.39% of subjects showed positive results for 22 to 35 days, while delayed Ct values were observed among 0.26% of participants for 36 to 49 days. However, during second wave of COVID-19 89.31% of the subjects exhibited symptoms and showed real-time PCR positive results for 14 to 21 days, 9.42% showed positive results for 22 to 35 days, while significantly delayed Ct value results were observed among 1.026% of participants for 36 to 63 days (3.95 times higher than first wave). In contrast to first wave of COVID-19, the factors that were different in second wave were neither viral (different strains) nor host (same population). But treatment factors changed significantly. As during second wave besides azithromycin, corticosteroid dexamethasone consumption was increased consequently causing delayed Ct value negativity. This suggests that corticosteroid treatment might be linked with delayed Ct value or viral clearance. This study is crucial for re-considering effective therapeutic options against COVID-19.

The effect of antiplatelet therapy and oral anticoagulants on the accuracy of faecal immunochemical testing

INTRODUCTION

Faecal immunochemical testing (FIT) has been adopted to identify patients requiring further investigations on the colorectal cancer (CRC) referral pathway. We aimed to investigate the effect of antiplatelet and anticoagulant drugs on the accuracy of FIT results.

METHODS

This observational study categorised patients with suspected CRC symptoms, who completed both FIT and colonic investigations, into two groups (control and exposed) based on their use of antiplatelet and anticoagulant drugs. Two-by-two tables and receiver operating characteristic (ROC) curve analysis were used to determine accuracy.

RESULTS

A total of 928 patients were divided into a control (n=683) and an exposed group (n=245). A nonsignificant higher proportion of patients tested positive in the exposed group (24.1% vs 18.4%, p=0.063). For detection of CRC, improved sensitivity of 87% vs 81.2%, specificity of 84.8% vs 79.9% and negative predictive value of 99.2% vs 98.3% was calculated in the control vs exposed groups, respectively. The positive predictive value was comparable between the two groups (21.4% vs 22% in the control and exposed groups, respectively). In ROC analysis, there was no difference between the groups (AUC 90% vs 87%, p=0.56). The use of antiplatelet and anticoagulant drugs did not increase the risk of positive FIT results on multivariate logistic regression analysis.

CONCLUSIONS

FIT accuracy for CRC detection remained unaffected despite more patients testing positive in the exposed group. FIT should be considered a supplementary tool for triage. Antiplatelet and anticoagulant drugs do not need to be discontinued before collection of FIT.

Hypophosphatasia: presentation and response to asfotase alfa

Hypophosphatasia (HPP) is a rare bone disease with limited scientific evidence on the tolerability and safety of its novel treatment, Asfotase Alfa (AA). We report 7 HPP patients' heterogenous presentations and the significant improvement in various clinical outcomes attained with AA shedding light on this highly effective and safe therapy.

INTRODUCTION

Hypophosphatasia (HPP) is a rare inherited metabolic bone disorder characterized by a deficiency in the tissue non-specific alkaline phosphatase (TNSALP) due to loss of function mutation in the ALPL gene. HPP is associated with impaired skeletal mineralization due to elevations in inorganic pyrophosphate and altered phosphate : pyrophosphate ratio. Asfotase alfa (AA) "enzyme replacement" was approved for treatment of HPP in 2015. We present 7 patients with HPP, 5 with pediatric-onset, and 2 with adult-onset, who have been treated with AA and describe the efficacy and safety in these patients.

METHODS

7 patients (4 females, 3 males) aged 19-68 years with HPP were included in this study. Diagnosis of HPP was confirmed by DNA analysis. AA was administered in doses of 6mg/kg/week with a mean follow-up of 6 months (SD= 5).

RESULTS

Subjective improvement in muscle strength, muscle pain, walking ability, and walking distance with a reduction in the use of gait aids was seen "with AA in HPP patients." Muscle strength and pain improved by up to 70% from baseline as quantified subjectively by patients. Walking distance improved by up to 100%. Patients also reported improved cognition, mood, and energy levels, with up to 90% improvement in mood and 75% improvement in energy levels. 4 out of 6 patients first noted clinical signs of improvement after 3 months of being on therapy. 1 out of the 7 patients sustained a toe fracture 10 months from being on AA. AA was well-tolerated with injection site reactions being the most reported adverse effect.

CONCLUSION

HPP treatment with AA in individuals with both pediatric and adult-onset forms resulted in significant subjective improvement in musculoskeletal and cognitive manifestations in addition to patients' quality of life. The drug was well tolerated in 6 patients. 1 patient discontinued therapy because of minor adverse effects with myalgias.

Analytical assessment of clinical sensitivity and specificities of pharmaceutical rapid SARS-CoV-2 detection nasopharyngeal swab testing kits in Pakistan

Despite of the global unity against COVID-19 pandemic, the threat of SARS-CoV-2 variants on the lives of human being is still not over. SARS-CoV-2 pandemic has urged the need of rapid viral detection at earliest. To cope with gradually expanding scenario of SARS-CoV-2, accurate diagnosis is extremely crucial factor which should be noticed by international health organizations. Limited research followed by sporadic marketing of SARS-CoV-2 rapid pharmaceutical detection kits raises critical questions against quality assurance and quality control measures. Herein we aimed to interrogate effectivity and specificity analysis of SARS-CoV-2 pharmaceutical rapid detection kits (nasopharyngeal swab based) using conventional gold standard triple target real-time polymerase chain reaction (USFDA approved). A cross-sectional study was conducted over 1500 suspected SARS-CoV-2 patients. 100 real time-PCR confirmed patients were evaluated for pharmaceutical RDT kits based upon nasopharyngeal swab based kits. The SARS-CoV-2 nasopharyngeal swab based rapid diagnostic kit (NSP RDTs) analysis showed 78% reactivity. Among real time PCR confirmed negative subjects, 49.3% represented false positivity. The positive predictive analysis revealed 67.82%, while negative predictive values were 64.40%. The NSP RDTs showed limited sensitivities and specificities as compared to gold standard real time PCR. Valid and authentic detection of SARS-CoV-2 is deemed necessary for accurate COVID-19 surveillance across the globe. Current study highlights the potential consequences of inadequate detection of SARS-CoV-2 and emerging novel mutants, compromising vaccine preventable diseases. Current study emphasizes need to wake higher authorities including strategic organizations for designing adequate measures to prevent future SARS-CoV-2 epidemics.

Oleuropein, a phenolic component of Olea europaea L. ameliorates CCl4-induced liver injury in rats through the regulation of oxidative stress and inflammation

OBJECTIVE

This study aimed to assess the hepatoprotective role of oleuropein (Olp), a phenolic compound found in olive, against carbon tetrachloride (CCl4)-induced liver damage in rats.

MATERIALS AND METHODS

The research involved male albino rats, which received intraperitoneal injections of 100 mg/kg b.w. of oleuropein for 8 consecutive weeks before being subjected to carbon tetrachloride (CCl4) at a dosage of 1.0 ml/kg b.w. Changes induced by CCl4 in antioxidant and inflammatory marker levels were assessed using ELISA assay kits. Moreover, CCl4-induced liver tissue architecture alteration, fibrosis, and expression pattern of protein were evaluated by performing H&E, Sirius red, Masson trichrome, and immunohistochemistry staining.

RESULTS

Increased serum transaminases and massive hepatic damage were observed by this liver toxicant. The hepatic injury was further evidenced by a significant decrease in antioxidant enzyme activity [superoxide dismutase (SOD), glutathione peroxidase (GPx), Glutathione (GSH) and Total Antioxidant Capacity (T-AOC)]. The administration of CCl4 resulted in an increased inflammatory response, which was measured by C-reactive protein, interleukin-6, as well as tumor necrosis factor-alpha. Olp as a curative regimen led to significant attenuation in the inflammatory response and oxidative/nitrosative stress. This polyphenol treatment improved the hepatic tissue architecture and decreased fibrosis. In the CCl4 treatment group, the expression pattern of IL-6 protein was high, whereas expression was decreased after Olp, as evidenced by immunohistochemistry staining.

CONCLUSIONS

The study suggests that oleuropein treatment has the potential to reduce liver damage caused by CCl4 induction by inhibiting oxidative stress and inflammation and maintaining liver tissue architecture. This could make it a promising treatment option for liver pathogenesis.

Disinfection by methylthionine chloride and chitosan in combination with Photo radiation therapy on caries affected dentin nano hardness, adhesive integrity, and bond failure

OBJECTIVE

The aim of the study was to assess the disinfection efficacy, bond integrity, and nano hardness of caries-affected dentin (CAD) surface bonded to resin cement when disinfected with chlorhexidine (CHX), Methylene blue activated by Photodynamic therapy (MB-PDT), chitosan, silver diamine fluoride (SDF), chitosan activated by PDT, and SDF-diode laser against S. mutans.

MATERIALS AND METHODS

A total of 60 human mandibular molars were extracted non-traumatically and gathered using ICDAS criteria. The dentin surface was prepared, leaving CAD to receive a disinfection procedure. After inoculation with S. mutans, the CAD samples were divided into six groups and disinfected with various disinfectants (n = 10) CHX, MB-PDT, chitosan, chitosan-PDT, SDF, and SDF+ diode laser. Survival rates of S. mutans were analyzed following the restoration of samples with resin cement via the etch and rinse method to assess SBS. Also, nano hardness was analyzed. Statistical analysis was performed by using the ANOVA and the Tukey multiple test (p<0.05). The Kruskal-Wallis test was used to evaluate the change in survival rate.

RESULTS

Related to the survival rates, the SDF+ diode laser displayed the highest reduction in S. mutans levels and chitosan presented the lowest level of disinfection. The intergroup comparison revealed that CHX and chitosan-PDT displayed comparable outcomes of S. mutans survival rate to that of SDF+ diode laser (p>0.05). Likewise, MB-PDT and SDF displayed a comparable survival rate of S. mutans to Chitosan disinfection (p>0.05). Considering SBS and nano hardness, the highest SBS and NH were exhibited by the SDF+ diode laser, and the lowest SBS and NH values were exhibited by MB-PDT. The intragroup comparison revealed that CAD specimens disinfected with Chitosan-PDT showed comparable SBS and NH values to the SDF+ diode laser (p>0.05). CHX, chitosan, and SDF exhibited bond values and NH comparable to MB-PDT (p<0.05).

CONCLUSIONS

Synergistic use of Silver diamine fluoride with diode laser and chitosan activated by PDT can be used as an alternative to CHX for controlling S. mutans growth, promoting enhanced bond efficacy and nano hardness for bonding resin cement to the caries-affected dentin.

Antidiabetic and hepato-renal protective effects of medicinal plants in STZ induced diabetic rats

Abstract The antidiabetic and hepato-renal protective effects of Citrullus colocynthis and Momordica charantia ethanol extracts were investigated in streptozotocin (STZ) induced diabetic male albino rats. Diabetic rats were treated with C. colocynthis, M. charantia or C. colocynthis + M. charantia mixed extract at a dose of 250 mg /kg body weight per oral per day for 21 days. The mean body weight of all the diabetic rat groups on day 1 of treatment (day 10 of diabetes) was significantly lower than the normal control rat group (P<0.05). The blood glucose level of all the diabetic rat groups on day 1 of treatment (day 10 of diabetes) was significantly (P<0.05) higher (> 200 mg/dl) than the normal control rat group (95.5 ± 2.7). At the end of treatment (day 21), the diabetic rats treated with plant extracts showed significant increase (P<0.05) in body weight and significant (P<0.05) reduction in blood glucose level when compared to diabetic control animals. Significant increase (< 0.05) was observed in the serum bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), urea and creatinine levels of diabetic control rat group. The serum levels of these liver and kidney-related parameters of diabetic rats treated with plant extract were significantly lower when compared to diabetic control rat group (p < 0.05). Photomicrographs of liver and kidney microsections from diabetic rats treated with these plant extracts showed amelioration in the hepato-renal histoarchitectures. It was concluded that the C. colocynthis and M. charantia methanol extracts are antidiabetic and hepato-renal protective in STZ induced diabetic male rats. Treatment of the diabetic rats with C. colocynthis + M. charantia mixed extract is more effective in the amelioration of diabetes and hepato-renal injuries in STZ induced diabetic male rats.

GCMS characterization and biological potential of the seeds and aerial part of Galium tricorne Stokes

Abstract Natural products have long been proven very effective against various challenging diseases including cancer and bacterial infections. Galium tricorne is one of the important source of natural products, which has not been explored till date in spite of its profound ethnomedicinal prominence. The current study has been designed to explore the biological potential of G. tricorne and to extract and isolate chemical constituents from its aerial part and seeds respectively along with identification of their chemical constituents. Phytochemical screening was performed to figure out the presence of secondary metabolite in G. tricorne. Crude Methanolic extract (Gt.Crd), which was obtained from the aerial part while the fatty acids were extracted from the seeds, which were later on analyzed by GCMS. Similarly, Well Diffusion and MTT method were used for antibacterial activity and cancer cell line assay respectively. To evaluate the cytotoxic potential, brine shrimps were used. Likewise, in Gas Chromatography-Mass Spectroscopy (GC-MS) analysis a total number of 23 compounds were identified in Gt.Crd extract out of which 7 compounds were sorted out to have some sort of toxicity profile. In the same fashion, 5 fatty acids were identified in the seeds of G. tricorne. Moreover, among the fractions, chloroform fraction (Gt.Chf) exhibited greater zone of inhibition (ZOI) 20.37 mm followed by Gt.Crd 18.40 mm against S. aureus and S. pyogenes respectively. In cytotoxicity Gt.Chf was more active followed by ethyl acetate fraction (Gt.Eta) by exhibiting 88.32±0.62% (LC50=60 µg/mL) and 73.95±2.25% (LC50=80 µg/mL) respectively at 1000 µg/mL concentration of the tested sample. Gt.Chf exhibited greater cell line inhibitory activity (IC50=61 µg/mL) against HeLa cell line. Similarly, Gt.Crd displayed IC50 values of 167.84 µg/mL and 175.46 µg/mL against HeLa and NIH/3T3 cell line respectively. Based on the literature review and screenings, it may be concluded that the aerial part and seeds of G. tricorne are the rich sources of bioactive compounds. The results of the current study also authenticate the scientific background for the ethnomedicinal uses of G. tricorne.

Ammonia gas treatment in low cost biological reactor

Ammonia gas contributes to a number of environmental and human health concerns. The use of chalk, a cheap alkalinity source may reduce costs for biological systems. This research studies a closed liquid flow reactor to treat ammonia gas using chalk as biomass media and alkalinity source with high value calcium nitrate fertilizer production. The proposed reactor showed complete ammonia gas removal at high rate (500 mg N/L/day) and with low cost; where chalk dissolution and ammonia gas absorption contributed to alkalinity in the water for nitrification. High calcium ion concentration (up to 10,000 mg Ca2+ as CaCO3/L) showed only minor effects on ammonia absorption and nitrification rate.

Mechanical Control of Polaritonic States in Lead Halide Perovskite Phonons Strongly Coupled in THz Microcavity

We demonstrate the generation and control of polaritonic states in perovskite phonon polaritons, which are strongly coupled in the middle of a flexible Fabry-Perot cavity. We fabricated flexible perovskite films on a microporous substrate coated with graphene oxide, which led to a virtually free-standing film incorporated into the microcavity. Rabi splitting was observed when the cavity resonance was in tune with that of the phonons. The Rabi splitting energy increased as the film thickness increased, reaching 1.9 meV, which is 2.4-fold higher than the criterion for the strong coupling regime. We obtained dispersion curves for various perovskite film thicknesses exhibiting two polariton branches; clear beats between the two polaritonic branches were observed in the time domain. Flexible cavity devices with perovskite phonons enable macroscopic control over the polaritonic energy states through bending processes, which add an additional degree of freedom in the manipulation of polaritonic devices.

Hepatitis C virus associated ALT, AST, GGT, Bili T, HB, HBA1C, CREAT, PT, aPPT, AFP, CEA, CA 125, CA 19-9, iPTH biomarkers, computed tomography and HCV burden of disease during pre COVID-19 era (2018-2019) and post COVID-19 era (2020-2022) in Pakistan

The national burden of HCV has significantly mounted over the period of last few decades placing Pakistan at the worst placement of second largest burden of HCV globally. Herein for the first time from Pakistan, we examined clinical correlation of potential biomarkers with HCV. Nation-wide study was conducted on 13,348 suspected HCV patients during 2018-2022. During pre-COVID-19 era of 2018-2019, prevalence of HCV remained 30%. During 2018, among HCV positive patients, 91% of ALT, 63% of AST, 67% of GGT, 28% of Bili T, 62% of HB, 15% of HBA1C, 25% of CREAT, 15% of PT, 15% of aPTT and 64% of AFP were abnormal. During 2019, among HCV infected 74.47% of ALT, 63.54% of AST, 70.24% of GGT, 24.71% of Bili T, 8.77% of HB and 75% of AFP were raised. CT/CAT scan revealed 4.65% liver complications (mild 13.04%, moderate 30.43% and severe 56.52%). During 2020, HCV prevalence remained 25%. 65.17% of ALT, 64.20% of AST, 68.75% of GGT, 31.25% of Bili T, 20.97% of HB, 4.65% of CREAT and 73.68% of AFP levels were raised. CAT analysis revealed liver complications among 4.41% (14.81% mild, 40.74% moderate, and 44.44% sever). 85.71% of participants diabetes was out of control. During 2021, HCV prevalence remained 27.1%. ALT (73.86%), AST (50.6%), GGT (67.95%), Bili T (28.21%), HB (20%), CREAT (5.8%) and AFP (82.14%) levels were abnormal. During 2022, the levels of ALT (56.06%), AST (56.36%), GGT (56.6%), Bili T (19.23%), HB (43.48%), HBA1C (14.81), CREAT (18.92%), AFP (93.75%) were abnormal. CAT analysis revealed 7.46% liver complications (25% mild, 30.36% moderate, and 42.86% sever). During 2021-2022, 83.33% of subject's diabetes was not controlled.

Evaluation of histo-toxicity of nimesulide in Black Kites (Milvus migrans): a pharmacodynamic study

The present experimental work was conducted to elucidate the toxicity of nimesulide at three different doses in black kites (Milvus migrans). M. migrans is one of the most common raptors near human habitations. The goal of the current investigation was to determine whether nimesulide is similarly hazardous to raptors as was diclofenac sodium and to investigate the acute oral toxicity of nimesulide in these birds. For this study, eight adult male black kites (M. migrans) were randomly divided into four groups. M. migrans in the control group (n = 02) were not treated with nimesulide. The other three groups were given nimesulide doses. The birds in the first (n = 02) were declared the control group. The second (n = 02), third (n = 02), and fourth groups were administered nimesulide at a low, medium, and high dose of 2, 4, and 6 mg/kg live body weight of bird/day, respectively, for 10 days. Nimesulide-addled birds became listless and despondent, then anorexic. The birds were standing there with their eyes closed and showing no signs of life. There was an increase in saliva production, a slowing of breathing, and dilated pupils. No clinical signs were observed in the control group. No mortality was seen in the control or treated groups. The control group did not show lesions of gout, but black kites intoxicated with nimesulide at 2, 4, and 6 mg/kg live body weight of bird/day showed inflammation, apoptosis, hemorrhage, necrosis, and leukocytic infiltration tissues of the liver, kidney, and heart of black kites (M. migrans) treated with different concentrations of nimesulide. The treated groups also showed apoptosis of myofibrils and hyperplasia. The hypertrophy, atrophy, fibrosis, necrosis of skeletal muscles and hemorrhage were prominent in the muscles of black kites (M. migrans) intoxicated with nimesulide. All observed histological alterations got worse in a dose-related way. There was no significant difference in AST, ALT, ALP, serum uric acid, but a significant difference was observed in the values of serum urea (p = 0.001) and serum creatinine (p = 0.019).

Immunization coverage in a rural area of Bareilly district: a cross-sectional community-based study

INTRODUCTION: Infectious diseases are a major cause of morbidity and mortality in children. Immunization remains a cost-effective method for child survival against vaccine-preventable diseases. Despite all the interventions put in by the government for 100% immunization coverage, there remain pockets of low coverage, especially in rural areas.Our aim was to estimate the immunization coverage and assess sociodemographic factors associated with immunization among children aged 12-23 months in a rural area of Bareilly. METHODS: The present cross-sectional study was carried out in the field practice area under RHTC from January 2016 to June 2016 using a 30 by 7 cluster sampling technique. A total of seven children aged 12-23 months were interviewed from each cluster on a preformed, pretested, and semi-structured questionnaire, thus giving a sample size of 210. Statistical analysis was done using the Chi-square test. RESULTS: More than two-thirds (69%) of study participants were completely vaccinated, whereas about 31% were partially or not vaccinated. Immunization coverage was found to be highest for BCG (80.4%) and lowest for the third dose of DPT (69.0%). The most common reason for partial or non-immunization was found to be unawareness (45.5%) and fear of side effects (43.9%). CONCLUSION: There is a need to create awareness and increase knowledge among caretakers of children about the importance and benefits of getting immunization for their children as a major step toward achieving Sustainable Development Goals (SDGs) goals.

A novel scoring system to predict cardiac device implantation in patients presenting with syncope

Background

Cardiac syncope occurs when the heart fails to maintain cardiac output to match cerebral need and can occur due to either mechanical/structural defect of the heart or secondary to an arrhythmia. It has a raised 1-year mortality with some figures estimating this as high as 30%. Implantable loop recorders (ILR) are a useful diagnostic tool in patients presenting with syncope or pre-syncope to ascertain a cardiac cause. A higher number of patients are presenting with advancing age and undergoing ILR implantation. Subsequently, they end up requiring a cardiac implantable electronic device (CIED) implantation, adding to additional costs, exposure to procedural complications and frequent hospitalisations.

Purpose

To investigate the number of patients undergoing CIED implantation following implantation of ILRs for syncope and identify predictors of CIED implantation in patients presenting with syncope.

Methods

A retrospective analysis of 736 patients who underwent ILR implantation at our teaching hospital trust between November 2012 to October 2020. Data on demographics, clinical characteristics, pathology results, ECGs, holter findings and CIED implanted was collected using the local electronic patient record system. The data was analysed using SPSS software. Univariable and multivariable regression analysis and ROC curve analysis was carried out to determine prediction model for CIED implantation.

Results

The mean age of patients who underwent an ILR implantation was 65±19 years. 22% of patients required CIED implantation, 68% of patients did not require a cardiac device and were safely discharged and 10% of patients died during follow up. Age (p&lt;0.001), male sex (p=0.006), impaired left ventricular function (p=0.04) and presence of hypertension (p=0.04) were found to be independent predictors of CIED implantation on univariable and multivariable regression analysis (see Table 1).

Conclusions

Old age, presence of coronary artery disease, impaired left ventricular function and presence of hypertension are inter-linked and in our study were found to be key predictors of poor prognosis and thus requiring CIED implantation. We propose a scoring system based on age &gt;75, male sex, presence of ischaemic heart disease, heart failure and hypertension as key markers of conduction abnormalities requiring CIED implantation (see fi−ure 1).

Funding Acknowledgement

Type of funding sources: None.

163 Anterior Sacral Meningocystocele Manifesting as Vague Gastrointestinal and Urinary Syndromes – Two Case Reports

Aim

Anterior Sacral Meningocystocele (ASM) carries a unique place in the current literature regarding its rarity. The condition arises in association with a congenital defect of the sacrum and coccyx through which the caudal part of the meninges may herniate to form a cyst-like structure. The disorder derives from a genetic defect of the coccyx and sacrum of which some meningeal segments protrude or herniate, forming a cyst-like entity.

Method

We report two cases of ASM. The first is a 65-year-old male with active complaints of urinary retention and hesitancy for two weeks and chronic constipation associated with lower back pain. The second, a 17-year-old girl, was presenting with abdominal bloating, pain, and backache. Magnetic resonance imaging (MRI) of the pelvis and lumbosacral spine was conducted for both patients, respectively, each scan exhibiting evidence of ASM development. Surgical correction and closure of the ASM's were performed via a posterior midline approach, which successfully alleviated the symptoms presented clinically by both patients.

Conclusions

ASM may develop asymptomatically, often with incidental discovery. Although ASM is well-regarded as a rare anomaly, diagnosis of such a defect must always be kept pertinent when a cystic structure in the pelvis is unveiled on ultrasound or during surgery. Puncture or aspiration of the cyst should be avoided if the diagnosis is in doubt. A posterior midline approach with careful obliteration of the meningocele sac opening may be curative.

Drought stress enhances the efficiency of floral dip method of Agrobacterium-mediated transformation in Arabidopsis thaliana

The Agrobacterium-mediated floral dip protocol is the most extensively used transformation method for a model plant Arabidopsis thaliana. Several useful methods for Agrobacterium tumefaciens-mediated transformations of Arabidopsis are existing, but they are time consuming and with low transformation efficiency. Here, we developed a transgenic Arabidopsis lines TET12p::TET12-RFP in a short period of time and enhanced transformation efficiency by using a modified transformation method by applying drought stress after floral dip. In this protocol, Agrobacterium cells carrying TET12p::TET12-RFP recombinant vectors were resuspended in a solution of 5% sucrose, 0.05% (v/v) silwet L-77 to transform female gametes of developing Arabidopsis inflorescences. Treated Arabidopsis were then applied with different levels of drought stresses to stimulate plants for the utilization of maximum plant energy in seed maturation process. The applied stresses achieved the fast maturation of already treated inflorescences while stopped the growing of newly arising untreated inflorescence, thus decreased the chances of wrong collection of untransformed seeds. Consequently, the collected seeds were mostly transgenic with a transformation frequency of at least 10%, thus the screening for positive transformants selection was more advantageous on a selective medium as compared to a classical floral dip method. Within 2-3 months, two hundred of individual transgenic plants were produced from just 10 infiltrated plants. This study concludes that application of drought stresses in a specific stage of plant is a beneficial strategy for achieving the transgenic Arabidopsis in a short period of time with high transformation efficiency.

Magnesium sulfate as a potential dye additive for chlorophyll-based organic sensitiser of the dye-sensitised solar cell (DSSC)

In this work, a new chlorophyll dye-sensitiser derived from mitragyna speciosa (MS) leaves, also known as Kratom, was employed for dye-sensitised solar cells (DSSCs). The influence of magnesium sulfate (MgSO₄), a low-cost dye additive, and suitable extraction solvents on the performance of DSSCs were examined. Here, the optical properties were investigated using UV-Visible spectroscopy and the functional anchoring group were investigated by FTIR spectroscopy. Meanwhile, the photovoltaic parameters were investigated by I-V measurements. The highest conversion efficiency is obtained when using a dye extracted from methanol solvent in combination with MgSO₄ additive, namely methanolic magnesium sulfate (MMSO). This higher power conversion efficiency is mainly attributed to the enhancement of the hydroxyl group in the MMSO dye solutions, which promotes higher dye adsorption and provides an organic dye passivation layer that reduces back-recombination in the cell. Furthermore, MgSO₄ aids in the replenishment of magnesium lost in the chlorophyll porphyrin ring during the degradation process. These combined effects have contributed to the overall conversion efficiency of the MMSO cell at 0.26 %, followed by 0.24 % for ethanolic magnesium sulfate (EMSO), respectively.

Study of resveratrol against bone loss by using in-silico and in-vitro methods

By applying the in-silico method, resveratrol was docked on those proteins which are responsible for bone loss. The Molecular docking data between the resveratrol and Receptor activator of nuclear factor-kappa-Β ligand [RANKL] receptors proved that resveratrol binds tightly to the receptors, showed the highest binding affinities of -6.9, -7.6, -7.1, -6.9, -6.7, and -7.1 kcal/mol. According to in-vitro data, Resveratrol reduced the osteoclasts after treating Marrow-Derived Macrophages [BMM] with Macrophage colony-stimulating factor [MCSF] 20ng / ml and RANKL 50ng / ml, with different concentrations of resveratrol (2.5, 10 μg / ml) For 7 days, the cells were treated with MCSF (20 ng / ml) and RANKL (40 ng / ml) together with concentrated trimethyl ether and resveratrol (2.5, 10 μg / ml) within 12 hours. Which, not affect cell survival. After fixing osteoclast cells with formaldehyde fixative on glass coverslip followed by incubation with 0.1% Triton X-100 in PBS for 5 min and after that stain with rhodamine phalloidin staining for actin and Hoechst for nuclei. Fluorescence microscopy was performed to see the distribution of filaments actin [F.actin]. Finally, resveratrol reduced the actin ring formation. Resveratrol is the best bioactive compound for drug preparation against bone loss.

Dietary habits of lesser bandicoot rat (Bandicota Bengalensis) in an agro-ecosystem, Pothwar Plateau, Pakistan

Dietary habits of bandicoot rats (bandicota bengalensis) were investigated in the agricultural crops of the Pothwar Plateau, Pakistan by analysing stomach contents. The research activities were conducted in major field crops including wheat-groundnut and in the fallow lands during non-crop season at the field boundaries. The specimens were captured from the fields using kill/snap traps, and dissected to collect their stomach samples for laboratory analysis. Light microscopic slides of the plant material were recovered from stomach samples and the reference materials were collected from the field. Results revealed that the bandicoot rat predominantly fed upon cultivated crops during cropping season but consumed wild vegetation during non-cropping season. There was no significance difference between summer and winter diets. Most frequently consumed crop food items were wheat (Triticum aestivum; 28.57%), groundnut (Arachis hypogea; 11.26%), sorghum (Sorghum bicolor; 10.17%), chickpea (Cicer arietinum; 9.52%), maize (Zea mays; 6.49%), millet (Pennisetum glaucum; 5.84%), barley (Hordeum vulgare; 4.98%) and mustard (Brassica campestris; 4.98%). Among wild vegetation were consumed khbal gha (Cynodon dactylon; 7.79%), baron dhab (Demostachya bipinnata; 7.36%) and Prickly flower (Achyranthes aspera; 3.03%). The study concludes that, in addition to consuming wheat and groundnut crops, the Lesser bandicoot rat also subsists on grasses, weeds, and some fodder crops, as important component of its diet in agro-ecosystem of the Pothwar Plateau.

Death caused by covid-19 in top ten countries in Asia affected by covid-19 pandemic with special reference to Pakistan

The COVID-19 is a contagious viral disease, was first emerged in Wuhan, China in December 2019 and became the whole world on alert. The mortality rate in top most countries in Asia with special reference to Pakistan has been focused. Since February 26 to September 2020 the total confirmed cases and mortality rate was measured through Wikipedia and the notable journals. Iran is the only country having highest number of deaths (5.73%) followed by Indonesia (3.77%) while Saudi Arabia shows the lowest number of deaths as 1.39%. In Pakistan the first case was confirmed in 26th February, 2020. The nCov-19 has closely related to severe acute respiratory syndrome (SARS) hence SARS COV-2 was named. This virus is responsible for more than 33.9 million deaths in over all the world as of 20th September, 2020. The number of new cases is increasing time to time. Sindh province of Pakistan has reported the highest number of cases till September, 20, 2020 as compared to other parts of the country and has the highest number of death followed by Khyber Pakhtunkhwa. Because of the person to person contact the disease is spreading rapidly. The individuals who has already infected with other diseases like cancer or diabetic etc. are vulnerable. The nCOV-19 is the most contagious due to its mode of transmission. There is still no vaccine is available for the treatment of disease caused by nCoV-2019. It is therefore the only option to control this pandemic is to adopt effective preventive measures.

Three-dimensional simulation of aesthetic outcome from breast-conserving surgery compared with viewing photographs or standard care: randomized clinical trial

INTRODUCTION

Over half of women with surgically managed breast cancer in the UK undergo breast-conserving treatment (BCT). While photographs are shown prior to reconstructive surgery or complex oncoplastic procedures, standard practice prior to breast conservation is to simply describe the likely aesthetic changes. Patients have expressed the desire for more personalized information about likely appearance after surgery. The hypothesis was that viewing a three-dimensional (3D) simulation improves patients' confidence in knowing their likely aesthetic outcome after surgery.

METHODS

A randomized, controlled trial of 117 women planning unilateral BCT was undertaken. The randomization was three-way: standard of care (verbal description alone, control group), viewing two-dimensional (2D) photographs, or viewing a 3D simulation before surgery. The primary endpoint was the comparison between groups' median answer on a visual analogue scale (VAS) for the question administered before surgery: 'How confident are you that you know how your breasts are likely to look after treatment?'

RESULTS

The median VAS in the control group was 5.2 (i.q.r. 2.6-7.8); 8.0 (i.q.r. 5.7-8.7) for 2D photography, and 8.9 (i.q.r. 8.2-9.5) for 3D simulation. There was a significant difference between groups (P < 0.010) with post-hoc pairwise comparisons demonstrating a statistically significant difference between 3D simulation and both standard care and viewing 2D photographs (P < 0.010 and P = 0.012, respectively).

CONCLUSION

This RCT has demonstrated that women who viewed an individualized 3D simulation of likely aesthetic outcome for BCT were more confident going into surgery than those who received standard care or who were shown 2D photographs of other women. The impact on longer-term satisfaction with outcome remains to be determined.Registration number: NCT03250260 (http://www.clinicaltrials.gov).

Feasibility of youth empowerment initiative for identifying never- and under-immunized children

Background

One-in-every 5 children globally remains deprived of life-saving vaccines. We developed and implemented the Adolescent Health and Leadership Program (AHLP) among school girls from grades 8-10 (Kiran Sitaras (KSs); Shining Stars) to provide them with soft skills and community mobilization skills and equipping them to become community advocates for immunization. We evaluated the feasibility of KS community mobilization through validating KSs' ability to accurately identify and link never- and under-immunized children with immunization services.

Methods

We implemented a mixed-methods study in six public schools located in peri-urban areas of Karachi, Pakistan. After the development and roll-out of AHLP in schools, KSs conducted door-to-door visits in their neighborhoods to identify never-and under-immunized children. This was followed by verification visits by field staff to establish accuracy and immunization camps to vaccinate never- and under-immunized children identified by KSs.

Results

From January 28 to February 22, 2020, 591 KSs visited 10,330 households, screened 3,295 under-2 children and identified 7.5% (247/3,295) never- and 27.0% (889/3,295) under-immunized children, with an accuracy of 90.4% and 49.6%, respectively. In January 2021, 291 never- and under-immunized children were invited to immunization camps, of which 28.9% (84/291) received vaccinations, while 57.0% (166/291) did not respond to the invite and 14.1% (41/291) were deemed ineligible (illness, overage, etc.).

Conclusions

We demonstrated the feasibility of empowering adolescent girls to boost immunization uptake in LMIC settings. Engaging young women from within the community provides an organic and sustainable solution for promoting immunization coverage and equity today and ensuring they will continue to champion the cause in their capacity as tomorrow's mothers. We are actively scaling-up our solution across the country to create a force of 100,000+ KSs to magnify our efforts.

Key messages

The Kiran Sitara initiative, via its community-centered approach, leverages the force of adolescent school girls to boost demand and referrals for immunization in unreached geographical pockets. The Kiran Sitara initiative utilizes the power of youth engagement to identify never- and under-immunized children, and subsequently increase vaccine-uptake.