Long COVID in Pakistan: a cross-sectional analysis of health and psychosocial outcomes

According to the World Health Organization-led Delphi consensus, long COVID corresponds to the occurrence of symptoms beyond twelve weeks after the onset of acute COVID-19 illness that cannot be explained by alternate diagnosis. This cross-sectional study aimed to analyse the impacts of long COVID on general health and psychosocial well-being. For this study, the participants were interviewed either face to face or via telephone, and their responses were recorded on a questionnaire capturing information on demographics, COVID-19 status, duration of symptoms and long COVID symptoms. The psychosocial impacts of the pandemic were assessed using scales like Short Mood and feeling questionnaire (sMFQ), Warwick-Edinburgh Mental Well-being Scale (WEMWBS), Generalized Anxiety Disorder Assessment (GAD-7) and Perceived Stress Scale (PSS). Regression analysis was conducted to analyse the predictors of long COVID. A total of 300 participants were interviewed, of which 155 (52%) had COVID-19 illness. Of these 54 (35%) had persistent symptoms for a period of more than 12 weeks classified as long COVID. Muscle problems and fatigue were the most frequent (14.7%) symptoms encountered, followed by breathing problems (12.6%) and cognitive issues (12.6%). The symptoms of decrease in appetite and confusion or disorientation during the initial phase of the infection were associated with long COVID. The majority of the participants (83.3%) had moderate level of perceived stress, while moderate to severe levels of stress were observed in 17.3% of the individuals. Moreover, a high level of positive mental well-being was also observed. This study highlights the need for further research into the clinical aspects and implications of long COVID in Pakistan and emphasizes the importance of ongoing support for affected individuals.

Genetic and clinical characteristics of patients with lipoprotein lipase deficiency from Slovenia and Pakistan: case series and systematic literature review

Introduction

Hypertriglyceridemia (HTG) is a complex disorder caused by genetic and environmental factors that frequently results from loss-of-function variants in the gene encoding lipoprotein lipase (LPL). Heterozygous patients have a range of symptoms, while homozygous LPL deficiency presents with severe symptoms including acute pancreatitis, xanthomas, and lipemia retinalis.

Methods

We described the clinical characteristics of three Slovenian patients (an 8-year-old female, an 18-year-old man, and a 57-year-old female) and one Pakistani patient (a 59-year-old male) with LPL deficiency. We performed next-generation sequencing (NGS) targeting all coding exons and intron-exon boundaries of the LPL gene, and Sanger sequencing for variant confirmation. In addition, we performed a systematic literature review of all cases with three identified variants and described their clinical characteristics.

Results

Two Slovenian patients with a heterozygous pathogenic variant NM_000237.3:c.984G>T (p.Met328Ile) were diagnosed within the first three years of life and had triglyceride (TG) values of 16 and 20 mmol/L. An asymptomatic Pakistani patient with TG values of 36.8 mmol/L until the age of 44 years, was identified as heterozygous for a pathogenic variant NM_000237.3:c.724G>A (p.Asp242Asn). His TG levels dropped to 12.7 mmol/L on dietary modifications and by using fibrates. A Slovenian patient who first suffered from pancreatitis at the age of 18 years with a TG value of 34 mmol/L was found to be homozygous for NM_000237.3:c.337T>C (p.Trp113Arg).

Conclusions

Patients with LPL deficiency had high TG levels at diagnosis. Homozygous patients had worse outcomes. Good diet and medication compliance can reduce severity.

The structural, optical and photovoltaic properties of Zn-doped MAPbI2Br perovskite solar cells

The spin coating method was used to deposit MAPbI2Br films on FTO-glass substrates. Zn2+ (zinc) doping was used for these films at intensity rates of 2% and 4%, respectively. XRD analysis proved that MAPbI2Br films had a cubic structure and a crystalline character. 2% Zn doping into the MAPbI2Br film had a modest large grain size (38.09 nm), Eg (1.95 eV), high refractive index (2.66), and low extinction coefficient (1.67), according to XRD and UV-vis analyses. To facilitate and enhance carrier transit, at contacts as well as throughout the bulk material, the perovskite's trap-state densities decreased. The predicted MAPbI2Br valence and conduction band edges are -5.44 and -3.52, respectively. The conduction band (CB) edge of the film that was exposed to Zn atoms has been pressed towards the lower value, assembly it a better material for solar cells. EIS is particularly useful for understanding charge carrier transport, recombination mechanisms, and the influence of different interfaces within the device structure. Jsc is 11.09 mA cm-2, Voc is 1.09, PCE is 9.372% and FF is 0.777. The cell made with the 2% Zn doped into the MAPbI2Br film demonstrated a superior device.

Bandgap reduction and efficiency enhancement in Cs2AgBiBr6 double perovskite solar cells through gallium substitution

Lead-free halide double perovskite (LFHDP) Cs2AgBiBr6 has emerged as a promising alternative to traditional lead-based perovskites (LBPs), offering notable advantages in terms of chemical stability and non-toxicity. However, the efficiency of Cs2AgBiBr6 solar cells faces challenges due to their wide bandgap (Eg). As a viable strategy to settle this problem, we consider optimization of the optical and photovoltaic properties of Cs2AgBiBr6 by Gallium (Ga) substitution. The synthesized Cs2Ag0.95Ga0.05BiBr6 is rigorously characterized by means of X-ray diffraction (XRD), UV-vis spectroscopy, and solar simulator measurements. XRD analysis reveals shifts in peak positions, indicating changes in the crystal lattice due to Ga substitution. The optical analysis demonstrates a reduction in the Eg, leading to improvement of the light absorption within the visible spectrum. Importantly, the Cs2Ag0.95Ga0.05BiBr6 solar cell exhibits enhanced performance, as evidenced by higher values of open circuit voltage (Voc), short-circuit current (Jsc), and fill factor (FF), which are 0.94 V, 6.01 mA cm-2, and 0.80, respectively: this results in an increased power conversion efficiency (PCE) from 3.51% to 4.52%. This research not only helps to overcome film formation challenges, but also enables stable Cs2Ag0.95Ga0.05BiBr6 to be established as a high-performance material for photovoltaic applications. Overall, our development contributes to the advancement of environmentally friendly solar technologies.

Impact of Ce doping on the optoelectronic and structural properties of a CsPbIBr2 perovskite solar cell

This paper provides a detailed analysis of pure CsPbIBr2 and 4% Ce-doped CsPbIBr2 perovskite films, emphasizing their structural, optical and photovoltaic properties. X-ray diffraction confirms a predominant cubic perovskite phase in both samples, with Ce doping leading to the increased crystal size (21 nm to 32 nm). UV-vis spectroscopy reveals a reduced bandgap energy (2.2 eV to 2.1 eV) with Ce doping. Dielectric constant analysis indicates the enhanced permittivity of the Ce-doped sample, crucial for solar-cell light trapping. Energy band structure analysis demonstrates improved photovoltaic cell performance with Ce doping, yielding higher open-circuit voltage, short-circuit current, and efficiency (9.71%) compared to pure CsPbIBr2 (8.02%). Ce doping mitigates electron-hole recombination, enhancing cell stability, electron affinity, and power output. This research underscores the potential of cost-effective, efficient, and stable CsPbIBr2 perovskite solar cells.

Eco-Innovative UHPC-Enhancing Sustainability, Workability, and Ductility with Recycled Glass Cullet Powder and Plastic Bottle Hybrid Fibers

Utilizing waste materials in producing ultra-high-performance concrete (UHPC) represents a highly effective approach to creating environmentally sustainable concrete using renewable resources. This study focused on incorporating ground glass cullet (GP) at various replacement levels in UHPC production. Additionally, plastic bottle fibers (PBFs) were derived from discarded plastic bottles and employed in the mix. The replacement levels for GP spanned from 0% to 40%. Single-use plastic bottles were transformed into strip fibers, both with and without the inclusion of microsteel fibers, at varying contents of 1.1% and 2.2% (volume-based). A single-fiber test was conducted on PBFs under different strain rates. The introduction of optimal GP content had a profound positive iMPact on compressive strength. Incorporating 2.2% plastic strips induced strain hardening behavior, while further inclusion of microsteel fibers resulted in substantial enhancements in mechanical properties. Two types of microsteel fibers were employed, characterized by different aspect ratios of 65 and 100. The optimum GP content was identified as 10%. Moreover, the UHPC mix achieved superior compressive strength, exceeding 140 MPa when composed of 1.3% (volume-based) microsteel fibers with an aspect ratio of 65 and 2.2% PBF (volume-based). Notably, mixtures featuring microsteel fibers with a higher aspect ratio demonstrated the highest flexural strength, exceeding 8000 N in the presence of 2.2% PBF. Longer microsteel fibers exhibited adequate slip properties, facilitating strain transfer and achieving a strain-hardening response in conjunction with plastic bottle fibers. These findings illuminate the potential for harnessing hazardous waste materials to improve the performance and sustainability of UHPC formulations.

Robust Machine Learning Framework for Modeling the Compressive Strength of SFRC: Database Compilation, Predictive Analysis, and Empirical Verification

In recent years, the field of construction engineering has experienced a significant paradigm shift, embracing the integration of machine learning (ML) methodologies, with a particular emphasis on forecasting the characteristics of steel-fiber-reinforced concrete (SFRC). Despite the theoretical sophistication of existing models, persistent challenges remain-their opacity, lack of transparency, and real-world relevance for practitioners. To address this gap and advance our current understanding, this study employs the extra gradient (XG) boosting algorithm, crafting a comprehensive approach. Grounded in a meticulously curated database drawn from 43 seminal publications, encompassing 420 distinct records, this research focuses predominantly on three primary fiber types: crimped, hooked, and mil-cut. Complemented by hands-on experimentation involving 20 diverse SFRC mixtures, this empirical campaign is further illuminated through the strategic use of partial dependence plots (PDPs), revealing intricate relationships between input parameters and consequent compressive strength. A pivotal revelation of this research lies in the identification of optimal SFRC formulations, offering tangible insights for real-world applications. The developed ML model stands out not only for its sophistication but also its tangible accuracy, evidenced by exemplary performance against independent datasets, boasting a commendable mean target-prediction ratio of 99%. To bridge the theory-practice gap, we introduce a user-friendly digital interface, thoroughly designed to guide professionals in optimizing and accurately predicting the compressive strength of SFRC. This research thus contributes to the construction and civil engineering sectors by enhancing predictive capabilities and refining mix designs, fostering innovation, and addressing the evolving needs of the industry.

Flowability and Strength Characteristics of Binary Cementitious Systems Containing Silica Fume, Fly Ash, Metakaolin, and Glass Cullet Powder

The present study examines the effects of supplementary cementitious materials (SCMs) on the flowability and strength development of binary mixes. This study was primarily motivated by the need to bridge the knowledge gap regarding paste and mortar mixes containing binary cement from a variety of performance perspectives. This study examined the flowability and strength development of binary mixes in their pastes and mortars when they contain various doses of silica fume (SF), fly ash (FA), metakaolin (MK), and glass cullet powder (GP) compared with the control mix. While the presence of SF and MK reduced workability because of the nature of their particles, the addition of FA and GP improved it to a certain extent because of the spherical and glassy nature of their particles, respectively. In addition, GP was used to compare its performance against SF, MK, and FA as an alternative cementitious material. In this study, the GP performed comparably to the other SCMs investigated and was found to be satisfactory. An investigation of the rheological properties, heat of hydration, thermal analysis, and pore systems of these mixes was conducted. Compared to the control mix, the presence of 5% GP improved the rheological properties and reduced the heat of hydration by 10%. The reduced workability in SF and MK mixes resulted in a lower content of pore water, while GP and FA incorporation enhanced it, owing to improved workability. The pore area is related to the pore water, which is directly related to improved workability. According to the following order, SF > MK > GP > FA, the strength was highest for mixes containing SF and MK, whereas, with GP and FA, there was a gradual reduction in the strength proportional to replacement level and improved workability. SF, GP, and FA can be identified as performance enhancers when formulating ternary and quaternary cementitious systems for low-carbon cement.

Multi-Criteria Optimization of Cost-Effective and Environmentally Friendly Reactive Powder Concrete Incorporating Waste Glass and Micro Calcium Carbonate

In pursuit of developing an eco-friendly and cost-effective reactive powder concrete (RPC), we utilized a multi-objective optimization technique. This approach pivoted on the incorporation of byproducts, with a spotlight on ground glass powder (GP) as a pivotal supplementary cementitious material (SCM). Our goal was twofold: engineering cost-efficient concrete while maintaining environmental integrity. The derived RPC showcased robust mechanical strength and impressive workability. Rigorous evaluations, containing attributes like compressive strength, resistance to chloride ion penetration, ultrasonic pulse speed, and drying shrinkage, highlighted its merits. Notably, the optimized RPC, despite an insignificant decrease in compressive strength at 90 days compared to its traditional counterpart, maintained steady strength augmentation over time. The refinement process culminated in a notable 29% reduction in ordinary Portland cement (OPC) usage and a significant 64% decrease in silica fume (SF), with the optimized mix composition being 590 for cement, 100 for SF, 335 for GP, and 257 kg/m3 for calcium carbonate. Additionally, the optimized RPC stood out due to the enhanced rheological behavior, influenced by the lubricative properties of calcium carbonate and the water conservation features of the glass powder. The reactive properties of SF, combined with GP, brought distinct performance variations, most evident at 28 days. Yet, both mixtures exhibited superior resistance to chloride, deeming them ideal for rigorous settings like coastal regions. Significantly, the RPC iteration, enriched with selective mineral admixtures, displayed a reduced tendency for drying-induced shrinkage, mitigating potential crack emergence.

Evaluation of the Performance of Low-Cement Strain-Hardening Cementitious Composites Containing Desert Sand and Ground Scoria Rocks

Fine aggregates are the main ingredients that control the success of the preparation and performance of strain-hardening cementitious composites (SHCCs). Worldwide deserts can be used as eternal sources of fine aggregates for the preparation of SHCCs. Arabian Peninsula desert sand spreads over the largest desert area in the world, covering an area of 2,300,000 km2 among the Arabian Gulf countries. White and dune desert sands were procured for use in this study. The morphological structure is important in selecting the appropriate sand for use in the preparation of SHCCs. The utilization of microfibers such as polyvinyl alcohol (PVA) has become common practice for the preparation of SHCCs. The presence of desert sand is proven to enhance the dispersibility of PVA due to its spherical structure, which alleviates the friction among the ingredients forming SHCCs. Two mechanisms are defined under the tensile force at the interface of microfibers and natural sand, namely, a strong frictional force leading to rupture or a weaker force causing pullout. The synergy between fibers and fine aggregate grains depends on their surface characteristics, which can be modified using different types of mineral admixtures. In this research, the alignment of microfibers as an indication of the quality of dispersion could be evaluated using a proposed approach based on an advanced technique of microstructural analysis. PVA dispersion and its relation to strain-hardening properties are visually correlated to the surface interaction of the mineral admixture and dune sand. The microdurability and cost effectiveness of SHCCs could be assessed using the proposed approach, as depicted by the results obtained in this research work.

Behavioral Evaluation of Strengthened Reinforced Concrete Beams with Ultra-Ductile Fiber-Reinforced Cementitious Composite Layers

In the literature, there is little information available regarding the behavior of composite beams made up of reinforced concrete (RC) and ultra-ductile fiber-reinforced concrete (UDFRC). In this study, UDFRC was examined for its effectiveness in enhancing the strength of RC beams. With a tensile strength of 4.35 MPa and a strain capacity of 2.5%, PVA-based UDFRC was prepared. The performance of 12 medium-sized reinforced concrete (RC) beams was measured under four-point flexural loading. The beams measured 1800 mm long, 150 mm wide, and 200-260 mm deep. The experimental program on beam specimens was divided into two phases. In the first, four 150 × 200 × 1800 mm RC beams with UDFRC layer thicknesses of 0, 30, 60, and 90 mm were tested. Additionally, four concrete and four concrete-UDFRC beams were investigated, measuring 150 × 230 × 1800 mm and 150 × 260 × 1800 mm, respectively. The study focused on medium-sized, slender RC beams under quasi-static loads and room temperature with additional or substituted UDFRC layers. As a result of replacing concrete with UDFRC, the load-carrying capacity at first crack and steel yield significantly increased between 18.4 and 43.1%, but the ultimate load-carrying capacity increased only in the range of 6.3-10.8%. Furthermore, beams with additional UDFRC layers could carry 30-50% more load than their concrete counterparts. An RC-UDFRC beam had a load-carrying capacity 10-15% greater than that of a comparable RC beam. Generally, there is a lower deflection response in UDFRC-concrete composite RC beams than in control concrete beams. The UDFRC layering can potentially improve the load-carrying capacity of RC beams, at least when ductility provisions are considered.

Mapping of familial hypercholesterolemia and dyslipidemias basic management infrastructure in Pakistan: a cross-sectional study

Background

Familial hypercholesterolemia (FH) is an autosomal inherited disorder characterised by elevated low-density lipoprotein cholesterol and premature cardiovascular events. Despite being declared as a public health priority, FH remains highly underdiagnosed, generally due to the lack of awareness and shortcomings in the available infrastructure, particularly in lower income countries.

Methods

To map the existing infrastructure for the management of FH, a survey was conducted among 128 physicians (cardiologists, paediatricians, endocrinologists, and internal medicine specialists) from different regions of Pakistan.

Findings

The respondents encountered a limited number of adults or children with diagnosed FH. A very small proportion of the population had access to free cholesterol and genetic testing even when indicated by a physician. In general, cascade screening of the relatives was not performed. Uniform diagnostic criteria for FH had not been established even within the same institution or province. The use of statins and ezetimibe in addition to lifestyle changes were the most common recommended treatment option for FH patients. The respondents considered lack of financial resources as a major barrier for the management of FH and stressed on taking relevant measures for a uniform FH screening programs around the country.

Interpretation

National FH screening programmes are not in place worldwide hence FH is commonly undiagnosed, and many individuals are at a high risk for cardiovascular diseases. Timely screening of population for FH requires knowledge about FH among the clinicians and the availability of fundamental infrastructure coupled with sufficient financial resources.

Funding

The authors confirm independence from the sponsor. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. FS received funding from Higher Education Commission, Pakistan (Grant 20-15760) and UG received grants from Slovenian Research Agency (J3-2536, P3-0343).

Indirect calculation of LDL using thirteen equations in Pakistani population

BACKGROUND

Owing to the atherogenic properties, low density lipoprotein cholesterol (LDL-C) is the primary target for treatment and diagnosis of cardiovascular diseases (CVDs), hence accurate measurement of LDL-C is critical. Despite the availability of direct measurement assays for LDL-C, it is routinely calculated by Friedewald equation in clinical settings in Pakistan mostly due to financial constraints. However, the validity of this equation is impacted by several factors, therefore several other equations have been developed for the calculation of LDL-C.

MATERIALS AND METHODS

LDL-C of 39,385 individuals measured directly by homogenous assays (dLDL) was compared with LDL-C calculated by thirteen equations (cLDL-C). Stratifications based on different lipids i.e., triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL) were made to check the validity of these equations across all ranges of lipid profile. The correlation and median difference between dLDL and cLDL-C was statistically analyzed.

RESULTS

Overall Teerakanchana equation displayed a strong positive correlation (ρ = 0.967) and least median difference (-8.81) with dLDL, followed by Martin equation (ρ = 0.967). For higher TG ranges (>500 mg/dL), Teerakanchana equation had the least median difference (1.31) and a strong correlation (ρ = 0.800).

CONCLUSION

Our data suggest that Teerakanchana equation may be employed as an alternative to Friedewald equation for Pakistani population.

Normovolumetric Haemodilution and Auto Transfusion in Major Operations Prevents Transfusion- Related Complications

Objective: To assess the efficacy and safety normovolumetric haemodilution and auto transfusion in patients undergoing major surgical operations. To compare the outcome differences between normovolumetric haemodilution and auto transfusion with allogenic transfusion group. Methods: The number and intensity of transfusion related complications in 36 patients, who received normovolumetric haemodilution and auto transfusion were compared with 36 patients who received similar amount of allogenic blood in the similar clinical environment and situation. The number and intensity of the complications encountered in study and control groups were compared and evaluated. Results: The study revealed statistically significant reduction in number and frequency of transfusion related complications in the study group comparing with the control group. The study also demonstrated reduction in number and intensity of surgery and anesthesia related complications compared with the control group without detection of harmful effect of haemodilution and auto transfusion. The study group also had statistically insignificant shorter hospital stay comparing with control group. Conclusion: Autologous transfusion with normovolemic haemodilution appears to be a safe and feasible method of reducing the need for homologous transfusion. Transfusion-related complications were significantly fewer in the autotransfusion group in comparison with allotransfusion, in patients undergoing major operations. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 547-552

Patency and Complications of Arterio-venous Fistula Created in Pre- and Post-dialysis Settings

OBJECTIVES

To determine the difference in patency and complication rates of arterio-venous fistula (AVF) constructed in pre-dialysis versus post-dialysis settings.

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

The Department of Vascular Surgery, Shifa International Hospital, Islamabad from January 2014 to August 2020.

METHODOLOGY

Computerised record of 726 patients, who had undergone vascular access surgery for haemodialysis, was collected. Patients were divided into two groups according to those who had undergone AVF surgery: a) prior to the commencement; or b) after the commencement of haemodialysis. Primary and secondary patency rates were determined clinically by using duplex scans. Complications and suitability of AV fistula were assessed in both the groups. Data was collected and analysed using SPSS version 25, considering p-value of less than 0.05 as statistically significant.

RESULTS

Early fistula failure was significantly higher in post-dialysis group compared with pre-dialysis group, while primary patency was higher in pre-dialysis (78.2%) group comparing with post-dialysis (66.1%) group. Secondary patency was 88.9% and 75.8% in pre- and post-dialysis groups, respectively. Early dialysis suitability failure rates were 12.2% and 15.1%; and late suitability failure rates were 7.9% and 16.1% in the pre- and post-dialysis groups, respectively. Higher rates of complications like maturation failure, low flow AVF, stenosis, thrombosis, venous hypertension, AV aneurysm, and infections were encountered in post-dialysis group compared to pre-dialysis group.

CONCLUSION

Surgical creation of AVF three months prior to commencement of haemodialysis is advantageous in terms of patient outcomes and healthcare resources. However, a multidisciplinary approach and timely referral of patients to a vascular clinic further enhances the outcome with respect to the suitability of vascular access for dialysis.

KEY WORDS

Arterio-venous fistula, Dialysis, Patency, Complications, Suitability.

Change of Hemoglobin Level among Exclusively Breastfed Term and Preterm Babies up to Six Months of Age

There is progressive increase of Hb levels is observed during course of intrauterine development of fetus but high concentrations found at birth. In preterm neonate normal Hb is characteristically deviated from term neonate. Breast milk is the only natural ideal food for both term and preterm babies from birth up to 6 months. Preterm milk was found to contain significantly higher concentrations nutrients particularly iron than term milk. Preterm human milk is more suitable for the premature infant than term human milk. As Hb concentration varies in term and preterm babies in different counties in different feeding practices. The purpose of this longitudinal descriptive study is to find out the pattern of changes in the Hb level among exclusively breastfed preterm and term infants during the first six months of life. This study was carried in the Neonatal Intensive Care Unit (NICU), Mymensingh Medical College Hospital (MMCH), Mymensingh from September 2016 to February 2018. One hundred fifty (150) neonates both term and preterm were included in this study and followed up to 6 months of age. After admission informed written consent was taken from parents, thorough history taking and clinical examination were done. Data were collected in a pre-designed case record form. All the babies of Group A provided 2mg/kg iron supplementation from 6 weeks for 2 months for universal recommendation. Hb level was measured of all exclusively breast feed babies at admission after birth then next follow-up at 6 weeks, 3 months and 6 months. All information regarding history, anthropometrics measurement, Hb level was recorded in structural questionnaire. Data analysis was done by SPSS version 20.0. Male were predominant in both groups. Most of the preterm (72.0%) and term babies (65.3%) were delivered by vaginal route. Mean Hb level was found significantly higher among preterm babies than term babies after birth were 16.55g/dl and 15.98g/dl respectively. Sharp fall of Hb concentration was observed after birth up to 6 weeks in both preterm and term babies but Hb level was found significantly lower in preterm in comparison to term babies (9.27gm/dl vs. 9.58gm/dl). In term babies, even after 6 weeks fall of Hb level continued to 3 months of age followed by gradual increase up to 6 months without iron supplementation. Hb level of in preterm babies gradually increased from 6 weeks up to 6 months with universal iron supplementation. Hb level fall sharply up to 6 weeks in both exclusively breastfed term and preterm babies but even after 6 weeks term babies experienced gradual fall of Hb levels up to 3 months. Hb level increases in exclusively breast-fed term babies without iron supplementation from 3 months of age. Hb level in exclusively breastfed preterm babies increase from 6 weeks onward might be effect of universal iron supplementation.

Comparative analysis of brain in relation to the body length and weight of common carp (Cyprinus carpio) in captive (hatchery) and wild (river system) populations

Cyprinus carpio is the member of family cyprinidae commonly called common carp. This study was aimed to find out the comparison of brain of wild (river system) and captive (hatchery reared) population of common carp. A total of thirty samples (15 from hatchery and 15 from river Swat) were collected. All the specimens were examined in Laboratory of Parasitoloy, Zoology Department, University of Malakand. Findings indicated that wild population were greater in brain size and weight as compared to hatchery reared population. The fish samples collected from captive environment (hatchery) were showing more weight and length as compared to wild population of common carps. The mean value of total weight of hatchery fishes 345±48.68 and the mean value of brain weight of hatchery reared fishes 0.28±0.047. The mean value of wild fish's total body weight 195.16±52.58 and the mean value of brain weight of wild fishes are 0.45±0.14. Present research calls for the fact that fish in dependent environmental conditions possess brain larger in size as compared to its captive population, it is due to use and disuse of brain in their environmental requirements.

Strength and Acid Resistance of Ceramic-Based Self-Compacting Alkali-Activated Concrete: Optimizing and Predicting Assessment

The development of self-compacting alkali-activated concrete (SCAAC) has become a hot topic in the scientific community; however, most of the existing literature focuses on the utilization of fly ash (FA), ground blast furnace slag (GBFS), silica fume (SF), and rice husk ash (RHA) as the binder. In this study, both the experimental and theoretical assessments using response surface methodology (RSM) were taken into account to optimize and predict the optimal content of ceramic waste powder (CWP) in GBFS-based self-compacting alkali-activated concrete, thus promoting the utilization of ceramic waste in construction engineering. Based on the suggested design array from the RSM model, experimental tests were first carried out to determine the optimum CWP content to achieve reasonable compressive, tensile, and flexural strengths in the SCAAC when exposed to ambient conditions, as well as to minimize its strength loss, weight loss, and UPVL upon exposure to acid attack. Based on the results, the optimum content of CWP that satisfied both the strength and durability aspects was 31%. In particular, a reasonable reduction in the compressive strength of 16% was recorded compared to that of the control specimen (without ceramic). Meanwhile, the compressive strength loss of SCAAC when exposed to acid attack minimized to 59.17%, which was lower than that of the control specimen (74.2%). Furthermore, the developed RSM models were found to be reliable and accurate, with minimum errors (RMSE < 1.337). In addition, a strong correlation (R > 0.99, R² < 0.99, adj. R² < 0.98) was observed between the predicted and actual data. Moreover, the significance of the models was also proven via ANOVA, in which p-values of less than 0.001 and high F-values were recorded for all equations.

Case report: A rare cause of chest pain: Kommerell's diverticulum

INTRODUCTION AND IMPORTANCE

Kommerell diverticulum is a very rare congenital defect of the aortic arch associated with the aberrant subclavian artery. It can present with signs of dysphagia, chest pain, or distal embolization in the upper limb.

CASE PRESENTATION

We present a case of Kommerell diverticulum with associated large subclavian artery aneurysm in a male patient with chest pain of unknown origin and hypertension. There was an incidental finding of the wide mediastinum on chest X-ray and the patient had a difference in systolic blood pressure in both arms. A right thoracotomy incision was used to successfully excise the aneurysm and reconstruct the subclavian artery. Patient recovery was uneventful.

CLINICAL DISCUSSION

Endovascular approaches are also an alternative to conventional open surgeries in the treatment of Kommerell diverticulum.

CONCLUSION

Kommerell diverticulum with subclavian artery aneurysm should be considered in the differential diagnosis of non-cardiac chest pain. A simple investigation such as a chest X-ray can make a difference in these patients. Coarctation related to the right ASA might not always be a true coarctation. Endovascular treatment is an alternative to open repair in selected cases, but it needs further investigation in large randomized control trials.

Parasitic prevalence in bat fauna captured from selected sites in northwestern Pakistan

Present study was conducted to record ecotoparasitic prevalence in bat fauna of the northwestern parts of Pakistan. A total of 204 bat specimens representing 14 species were captured during a two year survey, extending from June 2015 through May 2016. A species of soft ticks Argas vespertilionis was identified from 23 bat specimens. Similarly, members of the family Dermanyssoidae (dermanyssoid mites) were isolated from 10 bat specimens, that of Spinturnicidae (spinturnicid mites) from 3 and Streblidae (bat flies) from 2 bat specimens. These parasites were collected using entomological tweezers and were identified on morphological basis. Further studies on parasitic prevalence, molecular characterization of bat parasites and their control measures are recommended.

Episode of Hepatitis C viral infection in the people of Swat, Pakistan

Infectious agents cause serious diseases in humans worldwide and are responsible for the high rate of morbidity and mortality. The prevalence and epidemiology of infectious disease (HCV) in the hospital visited patients referred by the physicians through the initial findings and their associated risk factors were studied in Swat. The data of 174 infected patients were collected during the period of 2015 to 2017 from two clinical laboratories of Tehsil Matta Swat. Inform consent form was taken before blood collection. After taking informed consent blood samples were collected and ICT test was performed and then ICT positive cases were conform through PCR. A total of 174 ICT positive samples [106 male and 68 females] were included in this study. Age was considered from 10 to 72 years. Of the 174 ICT strip positive, 99 [63 males, 36 females] were confirmed through PCR. The prevalence rate was recorded 56.89%. I.V/I.M injection was recorded in 100% of the individuals. Visits to the barber shop was reported in (58%) of the individuals, married individuals were (81.0), surgical operation was reported in (44.8%), sharing toothbrush was observed in (29.9%), piercing was reported in (39.7%), family history was reported in (26.4%), dental treatment was observed in (21.8%), jaundice were (13.2%) and tattooing was (1.7%). Blood transfusion, surgical operations, Jaundice, family history and dental treatment were found significant risk factors for acquiring HCV infection. It was concluded that proper implementation of precautionary measures should be needed to control the spread of HCV in far near future.

Studies on the recombinant production and anticancer activity of thermostable L- asparaginase I from Pyrococcus abyssi

L-Asparaginase catalysing the breakdown of L-Asparagine to L-Aspartate and ammonia is an enzyme of therapeutic importance in the treatment of cancer, especially the lymphomas and leukaemia. The present study describes the recombinant production, properties and anticancer potential of enzyme from a hyperthermophilic archaeon Pyrococcus abyssi. There are two genes coding for asparaginase in the genome of this organism. A 918 bp gene encoding 305 amino acids was PCR amplified and cloned in BL21 (DE3) strain of E. coli using pET28a (+) plasmid. The production of recombinant enzyme was induced under 0.5mM IPTG, purified by selective heat denaturation and ion exchange chromatography. Purified enzyme was analyzed for kinetics, in silico structure and anticancer properties. The recombinant enzyme has shown a molecular weight of 33 kDa, specific activity of 1175 U/mg, KM value 2.05mM, optimum temperature and pH 80°C and 8 respectively. No detectable enzyme activity found when L-Glutamine was used as the substrate. In silico studies have shown that the enzyme exists as a homodimer having Arg11, Ala87, Thr110, His112, Gln142, Leu172, and Lys232 being the putative active site residues. The free energy change calculated by molecular docking studies of enzyme and substrate was found as ∆G - 4.5 kJ/mole indicating the affinity of enzyme with the substrate. IC50 values of 5U/mL to 7.5U/mL were determined for FB, caco2 cells and HepG2 cells. A calculated amount of enzyme (5U/mL) exhibited 78% to 55% growth inhibition of caco2 and HepG2 cells. In conclusion, the recombinant enzyme produced and characterized in the present study offers a good candidate for the treatment of cancer. The procedures adopted in the present study can be prolonged for in vivo studies.

Effects of different combinations of N, P and K at different time interval on vegetative, reproductive, yield and quality traits of mango (Mangifera Indica. L) cv. Dusehri

The experiment was carried out on mango cv. Dusehri to investigate the effect of N, P and K fertilizers on vegetative, reproductive growth, yield and fruit quality. Eight different fertilizer combinations such as T1 (control), T2 (N), T3 (P), T4 (K), T5 (NP), T6 (NK), T7 (PK) and T8 (NPK) were used. Individual or combine fertilizer application of N (1000 g), P (750 g) and K (750 g) were applied during growing season in February and August. All the treatments significantly influenced on vegetative growth, flowering, fruiting, yield and other physiochemical attributes of mango as compared to control. Least effect was observed with individual fertilizer application while combine fertilizer treatments enhanced most of the investigated parameters. Especially, qualitative traits showed non-significant differences between treated and untreated mango trees. However, among the different treatments T8 (NPK) showed significance for fruiting aspects such as maximum size of growth flushes (177.51 mm), total number of panicles/tree (845), total number of flowers/panicle (974), sex ratio (69.18%), fruit retention (13.85%), total number of fruits/tree (379), yield (82 kg/tree), fruit weight (197.5 g), pulp weight (135.5 g) and physiochemical parameters namely TSS (24.53), Vit. C (57.63 mg/100 mL) and total sugar (20.84%). In general, combine application of NPK (T8) were the most effective in enhancing fruiting aspects, yield, physiochemical characteristics as well as improved fruit quality of mango trees.

Morphometrics of the indian false vampire bat (Megaderma lyra) from district Jhelum, Pakistan

During the present study thirteen Megaderma lyra bats were observed roosting in dark, domed shaped room of Rohtas Fort, district Jhelum. Out of these, six specimens were captured from the roosting site, using hand net. All captured specimens were male. These bats were identified through their unique facial features, an erect and elongated nose-leaf, large oval ears that joined above the forehead and no tail. Mean head and body length of captured specimens was 80 mm, forearm length was 67 mm while average lengths of 3rd, 4th and 5th metacarpals were 51.73 mm, 55.17 mm and 60.42 mm, respectively. Mean skull length was 29.84 mm, breadth of braincase was 12.77 mm. Average Penis length of two specimens was 6.6 mm and total bacular length was 3.08 mm respectively. This is the first record of Megaderma lyra from district Jhelum.

Neuro-developmental Outcome of High Risk Neonates in a Tertiary Level Hospital

An observational longitudinal study was conducted in the Department of Neonatology and Child Developmental Center, Mymensingh Medical College Hospital (MMCH), Bangladesh during the period of September 2016 to February 2018 to find out the neuro-developmental outcome of high risk neonates at the age of 6 months. Five hundred seventy six (576) high risk neonate who were admitted in the neonatology department in Mymensingh Medical College Hospital were selected as study population by Purposive sampling technique. After admission written informed consent from parents or guardians obtained and Data was collected in a pre-designed case record form. At 6th months of age total 400 baby were came to Child Development Centre and their motor, cognition and behavior development were assessed by Bayley Scale of Infant Development and severity of cognitive, motor and behavior impairment were graded. All data were compiled, tabulated and then analyzed by computer software SPSS version 20.00. Mean age was 7.2±3.3 days. Among studied newborns 18.1% were preterm and 81.9% were term. Most of the newborn were male (63.0%). Developmental delay was found in 81.5% and neuro-developmental outcome was found normal in only 18.5% newborns. Significant delayed motor performance was found in 52% newborns where 17% had mild delay. Significantly delayed mental performance was found in 57.0% and 28.52% had mildly delayed mental performance. Non-optimal behavior was found in 57.0% newborns and14% had questionable behavior. Very low birth weight, preterm very low birth weight, home delivery, perinatal asphyxia and neonatal seizure were found to have significant relation with developmental delay. Most of the high risk neonates develop developmental delay.