Human-black bear conflict: crop raiding by Asiatic black bear (Ursus thibetanus) in Azad Jammu and Kashmir, Pakistan

Abstract Asiatic black bear has long been in conflict with human beings crop raiding is a major cause of this conflict frequently noted in South Asia. Crops raided by black bears affected by temporal, spatial and anthropogenic attributes. Insight in this conflict and its mitigation is vital for the conservation of this threatened species. Present study aimed to evaluate crop raiding by black bears in the mountainous region of Azad Jammu and Kashmir. Field surveys were carried out to observe spatial and temporal crop raiding features between 2015-2020 and data gathered using designed questionnaires randomly tailored in villages nearby the forests. Results revealed that maize was the sole crop raided by black bears. A total of 28-acre area was raided by black bear in the fall season (Aug-November) resulting in a damage of 51 metric tons, whole raiding was carried out at night. Each respondent received crop damage on 0.09 acre with a loss of 0.17 metric ton yield. Crop quantity and area were significantly correlated to each other. District Neelum shared 49% of the total crop loss, while 47% of the maize was raided at the altitudinal range of 2100-2500 m. crop raiding was highly significantly ( χ 2 = 1174.64 ; d f = 308 ; p < 0.01) dependent upon distance to the forest. Linear regression revealed that maize quantity was determined by area, time and the total field area. Farmers faced 3.8 million PKRs loss due to crop damage by black bears. Despite the huge loss, the majority (23%) of the respondents did not respond to the query on mitigation measures indicating a poor adaptation of preventive measures. Preferred strategy to avoid crop damage was making noise (27.8%) when bears attacked their crops. A start of compensation scheme to the farmers is recommended that will have turned their negative attitude into a positive one toward the wildlife and black bear particularly. Study provides a new insight in human-bear conflict, particularly in spatial and temporal context of crop raiding in AJ&K.

Magnetorotational instability in dense electron-positron-ion plasmas

We in this manuscript analyzed the magnetorotational instability (MRI) by using a multi-component quantum fluid model with the effect of spin magnetization in a differentially rotating degenerate electron-positron-ion (e-p-i) quantum plasma. The electrons and positron having the same mass but opposite charge are taken to be degenerate whereas ions are considered as classical owing to their large inertia. The general dispersion relation is derived and a local dispersion relation for MRI is obtained by applying MHD approximations. To obtained MRI and to analyze the results numerically, reduced dispersion relation is derived using the local approximations. The obtained results are applied to the astrophysical situations exist there in the interiors of White Dwarfs and neutron stars. Contribution from spin magnetization and the number densities of electrons and positrons plays a vital role in the dynamics and can alter the instability. The increase in the electron number density, hence spin magnetization enhances the growth rate of the mode and leads the system to instability which results in the core collapse of certain massive stars.

Systematic characterisation, and effect of nutritional and physical parameters on culturability, laccase production and dye decolorisation potential by P. pistillaris from Pakistan

Podaxis pistillaris is neutraceutically, cosmoceutically and medicinally recognised macrofungus. During this research work, this edible mushroom was systematically characterised. Its culturability, laccase production, and dye decolorisation potential were evaluated and optimised. Among the different media tested, PDA proved as most efficient medium for culturability of P. pistillaris. Conditions for laccase production were optimised in submerged state fermentation. Maximum laccase secretion was noted after 14th day of Incubation at 35 °C with 130 rpm and 5 pH of medium. Fructose and ammonium-phosphate was found as best carbon and nitrogen source, while wheat straw revealed as good ligno-cellulosic source for strengthening laccase production. Congo-red dye decolorisation capability by crude laccase enzyme was evaluated and found maximum decolorisation potential (92.2%) after 288h of incubation. From this pilot study, it was confirmed that this edible macrofungus has culturability, laccase production and dye decolorisation attributes that will further contribute in delignification, biosorption and bioremediation.

Exome Sequencing Reveals SLC4A11 Variant Underlying Congenital Hereditary Endothelial Dystrophy (CHED2) Misdiagnosed as Congenital Glaucoma

Autosomal recessive congenital hereditary endothelial dystrophy (CHED2) may be misdiagnosed as primary congenital glaucoma (PCG) due to similar clinical phenotypes during early infancy. In this study, we identified a family with CHED2, which was previously misdiagnosed as having PCG, and followed up for 9 years. Linkage analysis was first completed in eight PCG-affected families, followed by whole-exome sequencing (WES) in family PKGM3. The following in silico tools were used to predict the pathogenic effects of identified variants: I-Mutant 2.0, SIFT, Polyphen-2, PROVEAN, mutation taster and PhD-SNP. After detecting an SLC4A11 variant in one family, detailed ophthalmic examinations were performed again to confirm the diagnosis. Six out of eight families had CYP1B1 gene variants responsible for PCG. However, in family PKGM3, no variants in the known PCG genes were identified. WES identified a homozygous missense variant c.2024A>C, p.(Glu675Ala) in SLC4A11. Based on the WES findings, the affected individuals underwent detailed ophthalmic examinations and were re-diagnosed with CHED2 leading to secondary glaucoma. Our results expand the genetic spectrum of CHED2. This is the first report from Pakistan of a Glu675Ala variant with CHED2 leading to secondary glaucoma. The p.Glu675Ala variant is likely a founder mutation in the Pakistani population. Our findings suggest that genome-wide neonatal screening is worthwhile to avoid the misdiagnosis of phenotypically similar diseases such as CHED2 and PCG.

The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries

Background

Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival.

Methods

We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models.

Findings

The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope).

Interpretation

This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.

Funding

Queen Elizabeth Diamond Jubilee Trust.

Causes of Delayed Presentation of Retinoblastoma in a Tertiary Care Hospital of Pakistan

Purpose:  To find out the causes of delayed presentation of Retinoblastoma in a tertiary care hospital. Study Design:  Questionnaire based Survey. Place and Duration of Study:  Pediatric ophthalmology department of The Children’s Hospital, Lahore, from January 2018 to December 2019. Methods:  Mothers of patients who presented in the hospital were recruited for this survey. A questionnaire with details of the patient were noted. It included first symptom, time lapse since onset of first symptom, gender, age at presentation to first doctor (general practitioner), time lapse to presentation at tertiary care center (The Children’s Hospital & Institute of Child health), gender and laterality. General physical Examination was done by an oncologist and examination under anesthesia was done by a pediatric ophthalmologist. Data was analyzed using SPSS version 20. Pearson Chi Square test was used to find significance of each cause. Results:  Seventy participants were included in the study. Delayed presentation was seen in 42 patients (60%). The  various factors identified for delay in diagnosis and treatment in descending order are residence in rural areas 54 %, lack of finances 64%, social pressure 27%, awareness about   disease severity 60%, lack of transport 54%, Fear of enucleation 38% and seeking non-medical treatment/ alternate medication  32%. Significance of each factor was calculated using chi-square test. Conclusion:  The causes identified can be highlighted on national level for development of health facilities in rural areas. Key Words:  Retinoblastoma, Cancer, Malignant tumor, Leucocoria.

Severe isolated mitral stenosis: are we facing different phenotypes?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Rheumatic mitral valve stenosis (MS) causes progressive left atrial (LA) fibrosis and functional impairment, pulmonary artery systolic hypertension and right ventricular (RV) dysfunction.

Purpose

The aim of the study was the evaluate the different characteristics between high gradients (HG) and low gradient (LG) MS and, within the LG group those with high (LG-HF) or low flow (LG-LF). Moreover, we wanted to evaluate if there was any difference in overall complications and atrial fibrillation (AF) incidence.

Methods

A total of 147 patients with isolated severe MS were retrospectively enrolled from the institutional echo database.  Echocardiograms were read offline and clinical information were obtained from patients` records. Patients were divided into a group with HG (31 patients, mean MS gradient &gt; 10 mmHg) and LG (116 patients, mean MS gradient ≤ 10 mmHg). The group of LG was then divided in low flow (Stroke volume index (SVi) ≤ 35 ml/m2, LF-LG: 68 patients) and in high flow (SVi &gt; 35 ml/m2, HF-LG: 48 patients).

Results

The HG group was younger, although the difference did not reach statistical significance, higher percent of males (45% M vs 22% F, p = 0.02), higher heart rate (HR), left atrial volume, higher tricuspid regurgitation velocity (TVR) and derived pulmonary artery systolic pressure (PASP), RV fractional area changes (RV FAC) but similar RV longitudinal contraction. Moreover, the HG group had more severe MS calculated according to PHT.  The group of LG was divided according to SVi:  LF-LG group compare to HG-MS had higher percent of females (45% F vs 13% M, p &lt; 0.001), similar AF (43% vs 32%, p = ns) and pre surgical complications (19% vs 16%, p = ns). LF-LG group had smaller LA systolic volume (117 ± 51 51 ml vs 148.6 ± 38 ml, p &lt; 0.0001), lower LV-S` (5.3 ± 1.4 vs 6 ± 1.6 cm/s, p = 0.004), lower TRV (2.47 ± 0.5 vs 3.24 ± 0.7 m/s, p &lt; 0.0001), higher TAPSE/PASP (0.64 ± 0.3  vs 0.45 ± 0.29, p &lt; 0.001), lower RV S` (9.79 ± 2.01m/s vs 11.25 ± 3.1 m/s, p = 0.01), higher RVFAC (38.5 ± 9.6% vs 30.9 ± 9.2%, p = 0.0005). The group of LG-LF had also less severe MS (1.3 ± 0.6 cm2 vs 1.15 ± 0.3 cm2, p &lt; 0.01).

Conclusion

Patients with HG MS were those with worst left ventricular involvement, higher PASP and lower RV function. The LF-LG MS were older, and more females were included and even though they had smaller LA, lower values of PASP they had significantly higher percent of AF and similar pre surgical complications.  It could be speculated that LF-LG severe MS patients could be a different phenotype of the disease.

Stuck mechanical valve complication in non-COVID-19 patients during COVID-19 pandemic: single center experience

Funding Acknowledgements

Type of funding sources: None.

Background

Stuck valve is a very rare and severe complication that occurs in mechanical valve replacement patients with ineffective anticoagulation. However, with COVID-19 restriction measures, it became challenging to regularly assess INR to make sure it falls within the target therapeutic range to prevent this complication.

Purpose

We wanted to explore how did the COVID-19 pandemic restrictions impacted mechanical valve replacement patients on chronic anticoagulation and the long-term consequences of limiting their access to health service.

Methods

We present a series of 10 patients on warfarin anticoagulation therapy who either underwent transthoracic echocardiography for a suspected stuck valve or were seen at the outpatient valve clinic with the residual consequences of a stuck valve during the COVID-19 restriction measures in our institute.

Results

Eight patients were female, two of whom were pregnant at the first trimester and eventually went on to receive an abortion; six patients received urgent valve replacement cardiac surgery; four patients were managed medically e.g. with heparin; none had thrombolytic therapy. Stuck prosthetic valves incident has increased significantly during this period, particularly those in the mitral position for which urgent replacement and prolonged hospitalization including intensive care admission, with high in-hospital mortality rates and high costs were necessary. Mean hospital admission time was 27.5 ± 18.5 days.  The cost of treatment, as average estimated reimbursement, was 11,000 USD for medical admission only, and 43,200 USD when surgery was required, up to 64,000 USD when ECMO was part of patient management.

Conclusion

Despite governments’ efforts to implement telemedicine and virtual clinics, COVID-19 restrictions and health-messaging affected the routine follow-up of non-COVID-19 patients. We report dramatic consequences to this drastic change in healthcare: clinical complications, lost lives and inflated healthcare costs in patients with a prosthetic valve. We believe that non-COVID-19 patients have paid, and will continue to pay in the future, a price that is much greater than those patients who have suffered from COVID-19. Active engagement of patients should be implemented in a time of emergencies, and further studies should address the efficacy and cost-effectiveness of public policies aimed to decrease the burden of avoidable complications and missed diagnoses. Abstract Figure. Fluoroscopy in a 70 years old patient

Clinical and Immunological Profile of Childhood Systemic Lupus Erythematosus: Observational Study

Background: Childhood SLE is a severe autoimmune disease involving multiple systems that effect peoples globally. Aim: To delineate the spectrum of clinical manifestations of childhood SLE at the Government Children’s Hospital Lahore. Study design: Descriptive observational study. Methodology: Study was carried out at department of Pediatric medicine, unit 1, Children’s hospital Lahore from January 2016 to December 2019. Applying a nonprobability convenience sampling technique, children between 1-16 years of age with childhood systemic lupus erythematosus attending rheumatology outpatient clinic or admitted through emergency were included in study. Written and verbal informed consent was obtained after explanation of study purpose. Results: There were 59 (78.70%) female and 16 (28.3%) male patients enrolled in the study. Mean age at diagnosis was 10.89±3.4% years. Female predominance was noticeable. Amongst the clinical features fever (96%) was the commonest, followed by oral ulcers (74.70%), alopecia (72%), renal manifestations (69.30%), rash (61.30%), arthritis (56%), and hematological abnormalities (48%), photosensitivity (44%), neurological features (36%) in 24% of patients. Conclusion: It was concluded that disease was prevalent among all races around the world but in South Asia there are few studies available on its prevalence. Timely diagnosis by a detailed history, physical examination and laboratory evaluation can improve the chances of prolonged disease-free periods and better survival of children. Keywords: Childhood SLE, ACR and SLICC.

Congenital orbital teratoma: A case report

Background: Teratoma originates from all three germinal layers and commonly found at the sacrococcygeal region. The orbit is an unusual site of occurrence, but they grow rapidly and cause massive proptosis. Case Presentation: A 9-day-old female neonate presented with marked unilateral proptosis of the right eye. Imaging workup gave a suspicion of a complex mass with internal hemorrhage or a teratoma. Modified exenteration was performed. Histopathological examination revealed mature cystic teratoma. Conclusion: Orbital teratoma presents with marked disfiguring proptosis in neonatal life. Prompt complete surgical excision is curative in the case of mature lesions.

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance

Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.

Objectives

To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis.

Design, Setting, and Participants

A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017.

Main Outcomes and Measures

Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis.

Results

The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]).

Conclusions and Relevance

This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

Comparative effects of addition of superoxide dismutase and reduced glutathione on cryopreservation of Sahiwal bull semen

The present study aimed to investigate effects of superoxide dismutase (SOD) and reduced glutathione (GSH) on the quality of frozen-thawed semen of Sahiwal bulls. Semen was collected twice a week for 8 weeks by artificial vagina from six Sahiwal bulls, kept at the Semen Production Unit Qadirabad, Sahiwal-Pakistan. After gross and microscopic evaluation, qualifying semen ejaculates were divided into 10 equal aliquots and diluted in extenders enriched with no antioxidants (control); or supplemented with either SOD (50, 100 and 200 IU/mL), or GSH (0.5, 1 and 2 mM) or their combinations (50 IU/mL SOD and 0.5 mM GSH, 100 IU/mL SOD and 1 mM GSH and 200 IU/mL SOD and 2 mM GSH). Samples were then frozen and stored in liquid nitrogen at -196°C for 24 h. The following parameters were evaluated for semen quality: post-thawed sperm motility, viability, acrosome and membrane integrity. According to the results, sperm motility, viability, acrosome and membrane integrity were significantly (P<0.05) higher in samples treated either with 100 IU/mL of SOD; 1 mM and 2 mM of GSH or 50 IU/mL of SOD plus 0.5 mM of GSH. In conclusion, semen quality might be improved by supplementing semen extenders with 100 IU/mL of SOD; 0.5 and 1 mM of GSH and combination of 50 IU/mL and 0.5 mM of SOD and GSH, respectively.

Interpersonal sensitivity in the at-risk mental state for psychosis in Karachi, Pakistan

Introduction

Interpersonal sensitivity can be explained as a personality trait in which there is an excessive and expanded awareness of the behavior and emotions of others. Individuals having high interpersonal sensitivity are sensitive to interpersonal relationships and self-deficiencies in comparison to others. Studies report that high interpersonal sensitivity can cause low self-esteem and feelings of insecurity.

Objectives

The objective of this study was to examine the level of interpersonal sensitivity in individuals with an at-risk mental state (ARMS) for psychosis compared to the individuals not at risk for psychosis.

Methods

A total sample of 50 individuals was recruited from Bahria University, Karwan-e-Hayat and Karachi Psychiatric Hospital: 25 with ARMS for psychosis and 25 participants who were not ARMS, according to scores on Schizophrenia Proneness Inventory-Adult (SPI-A). All of the participants then responded to self-report questionnaire on Interpersonal Sensitivity Measure.

Results

Results showed that the group with ARMS had a significantly higher interpersonal sensitivity on average (112.5) as compared to healthy individuals (91.8). Results show significant difference in both of the groups (t = –5.049; P < .0001) indicating that interpersonal sensitivity in people with ARMS was relatively high compared to those who were not at risk.

Conclusion

This study suggests that being ‘hypersensitive’ to interpersonal interactions is a psychological feature of the potentially prodromal phase of psychosis. Addressing difficulties in interpersonal relationships and offering early psychotherapeutic interventions can be beneficial, not only in averting serious illness, but preventing loss to individual and national productivity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Numerical Study of MHD Viscoelastic Fluid Flow with Binary Chemical Reaction and Arrhenius Activation Energy

Here we address the influence of heat/mass transfer on MHD axisymmetric viscoelastic fluid flow developed by an elastic sheet stretching linearly in the radial direction. Constitutive relations of Maxwell fluid model are utilized in mathematical formulation of the problem. Non-linear radiation heat flux is factored in the model which accounts for both small and large temperature differences. Chemical reaction effects with modified Arrhenius energy function are analyzed which are not yet explored for viscoelastic fluid flows. Highly accurate numerical computations are performed. Our computations show S-shaped profiles of temperature function in case of sufficiently large temperature differences. Species concentration increases when activation energy for chemical reaction is increased. However, both chemical reaction rate and temperature gradient tend to reduce the solute concentration.

Rotating Flow of Magnetite-Water Nanofluid over a Stretching Surface Inspired by Non-Linear Thermal Radiation

Present study explores the MHD three-dimensional rotating flow and heat transfer of ferrofluid induced by a radiative surface. The base fluid is considered as water with magnetite-Fe₃O₄ nanoparticles. Novel concept of non-linear radiative heat flux is considered which produces a non-linear energy equation in temperature field. Conventional transformations are employed to obtain the self-similar form of the governing differential system. The arising system involves an interesting temperature ratio parameter which is an indicator of small/large temperature differences in the flow. Numerical simulations with high precision are determined by well-known shooting approach. Both uniform stretching and rotation have significant impact on the solutions. The variation in velocity components with the nanoparticle volume fraction is non-monotonic. Local Nusselt number in Fe₃O₄–water ferrofluid is larger in comparison to the pure fluid even at low particle concentration.

Gamma Irradiation Treatment of Cherry – Impact on Storage Quality, Decay Percentage and Post- Refrigeration Shelf-Life Extension

Present study was conducted to investigate the effect of gamma irradiation on storage quality and post refrigeration shelf-life extension of cherry. Two commercial varieties of cherry fruit (Misri and Double) after harvest at commercial maturity were gamma irradiated in the dose range of 0.3 -1.5 kGy followed by storage under ambient (temperature 25 ± 2 0C, RH 70%) and refrigerated (temperature 3 ± 1 0C, RH 80%) conditions. Among treatments, dose of 1.2 and 1.5 kGy effectively maintained the storage quality and significantly (p≤0.05) delayed the decay of the cherry varieties. In samples treated with dose of 1.2 and 1.5 kGy no decay was recorded up to 9 days of ambient storage. Under refrigerated conditions, cherry samples of control and those irradiated in the range of 0.3 – 0.9 kGy started decaying after 14 days of storage. No decay was observed in 1.2 and 1.5 kGy samples of both the varieties up to 28 days of refrigerated storage. The treatments of 1.2 and 1.5 kGy gave an extension of 6 days in shelf life of cherry varieties during post-refrigerated storage at 25 ± 2 0C, RH 70% following 28 days of refrigeration. Firmness comparison of treatments revealed that dose of 1.2 kGy was found to be better compared to 1.5 kGy due to decrease in firmness observed in cherry samples irradiated at 1.5 kGy. Thus, radiation processing of Kashmiri Cheries at 1.2 kGy can prove beneficial in facilitating the marketing of the fruit to distant places other than the local markets, thereby benefiting the growers.

Indian health care professionals' attitude towards spiritual healing and its role in alleviating stigma of psychiatric services

Persons with mental illnesses in India and rest of developing world continue to consult religious/spiritual (R/S) healers or traditional, complementary and alternative medicine (TCAM) professionals prior to seeking psychiatric services that are devoid of spiritual components of care. We aim to understand TCAM and allopathic professionals' perspectives on patients' R/S needs within mental health services, cross-sectional study was conducted at five TCAM and two allopathic tertiary care hospitals in three different Indian states; 393 participants completed RSMPP, a self-administered, semi-structured survey questionnaire. Perspectives of TCAM and allopathic health professionals on role of spirituality in mental health care were compared. Substantial percentage, 43.7 % TCAM and 41.3 % allopathic, of participants believe that their patients approach R/S or TCAM practitioners for severe mental illness; 91.2 % of TCAM and 69.7 % of allopaths were satisfied with R/S healers (p = 0.0019). Furthermore, 91.1 % TCAM and 73.1 % allopaths (p = 0.000) believe that mental health stigma can be minimized by integrating with spiritual care services. Overall, 87 % of TCAM and 73 % of allopaths agreed to primary criterion variable: 'spiritual healing is beneficial and complementary to psychiatric care.' A quarter of allopaths (24.4 %) and 38 % of TCAM physicians reportedly cross-refer their grieving patients to religious/TCAM healer and psychiatrist/psychologist, respectively; on logistic regression, significant (p < 0.05) predictors were clinical interactions/references to r/s healers. Providing spiritual care within the setup of psychiatric institution will not only complement psychiatric care but also alleviate stigma against mental health services. Implications on developing spiritual care services like clinical chaplaincy are discussed.

Perspectives of Indian traditional and allopathic professionals on religion/spirituality and its role in medicine: basis for developing an integrative medicine program

Allopathic medical professionals in developed nations have started to collaborate with traditional, complementary, and alternative medicine (TCAM) to enquire on the role of religion/spirituality (r/s) in patient care. There is scant evidence of such movement in the Indian medical community. We aim to understand the perspectives of Indian TCAM and allopathic professionals on the influence of r/s in health. Using RSMPP (Religion, Spirituality and Medicine, Physician Perspectives) questionnaire, a cross-sectional survey was conducted at seven (five TCAM and two allopathic) pre-selected tertiary care medical institutes in India. Findings of TCAM and allopathic groups were compared. Majority in both groups (75% of TCAM and 84.6% of allopathic practitioners) believed that patients' spiritual focus increases with illness. Up to 58% of TCAM and allopathic respondents report patients receiving support from their religious communities; 87% of TCAM and 73% of allopaths believed spiritual healing to be beneficial and complementary to allopathic medical care. Only 11% of allopaths, as against 40% of TCAM, had reportedly received 'formal' training in r/s. Both TCAM (81.8%) and allopathic (63.7%) professionals agree that spirituality as an academic subject merits inclusion in health education programs (p = 0.0003). Inclusion of spirituality in the health care system is a need for Indian medical professionals as well as their patients, and it could form the basis for integrating TCAM and allopathic medical systems in India.

Development of radiochemistry in Pakistan – 1960 to 2010

With the inception of Pakistan Atomic Energy Commission (PAEC) in 1956, peaceful uses of atomic energy commenced for the benefit of scientific community as well as masses of Pakistan. Radiochemistry played a vital role right from the beginning. The research and development in this field accelerated soon after the criticality of the first research reactor named as Pakistan Research Reactor (PARR- 1) at the Pakistan Institute of Nuclear Science and Technology (PINSTECH), Islamabad. The first radioisotope produced at PARR-1 for application in nuclear medicine was 131I. Later on, many other radioisotopes were prepared and radiopharmaceuticals were synthesised for their use in industry and hospitals. Besides providing pure radioactive tracers for nuclear medicine, radiochemistry also enhanced the detection limit of impurities at all stages of nuclear fuel cycle for power generation. In 1983, research in the field of nuclear data measurement began. The main aim was to identify suitable conditions for the production of radionuclides for cancer diagnostics, treatment and therapy. With the establishment of a second research reactor (PARR-2) at PINSTECH, research in neutron activation analysis, radioisotope production and separation studies gained more momentum and many research articles were published. Solvent extraction, adsorption and ion-exchange were the main routes of separation in those studies. Separation of heavy metals and treatment of waste generated in a nuclear power plant are other important aspects related to environmental restoration and nuclear waste management, where radiochemistry is required. In future, work in radiochemistry will be continued on similar lines to develop novel radiopharmaceuticals, identify indigenous schemes for nuclear waste management and work out intelligent procedures for material characterization for benefit to mankind, especially the people of Pakistan.

Juvenile rheumatoid arthritis

OBJECTIVE

To determine the spectrum of clinical presentation, laboratory parameters and drug therapy in patients with Juvenile Rheumatoid Arthritis (JRA).

STUDY DESIGN

Case series.

PLACE AND DURATION OF STUDY

The Children's Hospital and The Institute of Child Health, Lahore, from October 2008 to October 2011.

METHODOLOGY

All patients who fulfilled the American College of Rheumatology criteria for JRA were enrolled. Their clinical features, investigations done and treatment received for JRA were noted. Statistical analysis of data was done on SPSS version 16.0 for obtaining descriptive statistics.

RESULTS

Out of 185 patients, 50.3% (n = 93) were females; 54% (n = 100) were between 10 - 15 years of age. Polyarthritis was found in 71.9% (n = 133) followed by oligoarthritis (22.7%, n = 42) and systemic onset disease (5.4%, n = 10). Morning stiffness (78%) and fever (68%) were the most common clinical presentations. All patients with systemic onset disease had fever (n = 10) followed by skin rash, hepatosplenomegaly and lymphadenopathy. Uveitis was found in 2 patients, and both belonged to the oligoarticular group. Rheumatoid factor was found in 10.27% (n = 19) of all patients. All patients were given non-steroidal anti-inflammatory drugs (NSAIDs). Disease modifying agents (methotrexate) were given to 43.8% (n = 81). Steroids were used in 61% (n = 113) of patients either with NSAIDs alone or NSAIDs plus methotrexate.

CONCLUSION

Disease profile of JRA at the study centre showed that polyarthritis is the commonest type. Recognition of subtypes will help in planning the management of these patients.

Evaluation of Pakgen 99mTc generators loaded with indigenous fission 99Mo

Fission produced 99Mo/99mTc generators, called Pakgen, have been manufactured at the PINSTECH generator production facility since 2000 for nuclear medicine applications in Pakistan. These generators were loaded with fission 99Mo imported from NTP South Africa. Recently production of fission 99Mo has begun in the Molybdenum-99 Production Facility at PINSTECH. Prior to use in the clinic, eight sets of generators were produced, 23 GBq and 74 GBq at time of calibration, and they were subjected to various quality control procedures recommended in the pharmacopoeia to assess their performance. The elution profile, volume, activity, pH, radionuclidic, chemical, radiochemical and biological purity, and expiry time of the eluates were examined. Labeling efficiency tests were also carried out with a number of the more widely used in vivo radiopharmaceutical kits like DTPA, MDP and MIBI. Performance of 99mTc generators loaded with locally produced and imported fission 99Mo was comparable, and the users of Pakgen generators were fully satisfied. The effect of a wet vs. a dry column on 99mTc yields of generators loaded with low and high activity was also studied for the first time.

Alfvén solitons in a Fermionic quantum plasma

The propagation of Alfvén envelope solitons through a Fermionic quantum plasma is considered. Starting from the governing equations for Hall magnetohydrodynamics including quantum corrections, coupled Zakharov-type equations are derived for circularly polarized Alfvén waves. The equations are numerically solved for time-independent and time-dependent cases. The time-independent case shows that variations in density take the form of dressed density solitons in which an approximately Gaussian peak is surrounded by smaller sinusoidal variations in the density envelope. The mathematical basis for this behavior is explained. A limited time-dependent case is obtained which uses the numerical time-independent soliton solutions as the initial conditions. This confirms that the soliton solutions retain the same profile as they propagate. The relevance of this work to dense astrophysical plasmas like the interiors of white dwarf stars is discussed.

Classical relativistic model for spin dependence in a magnetized electron gas

The response of a cold electron gas is generalized to include the spin of the electron described by the relativistically correct quasiclassical Bargmann-Michel-Telegdi (BMT) equation. The magnetization of the electron gas is assumed to be along the background magnetic field B and the spin-dependent contribution to the response tensor is proportional to the magnitude of the magnetization. The dispersion equation is shown to be quadratic in the refractive index squared, and dispersion curves for the two wave modes are plotted for cases where the magnetic field associated with magnetization is comparable with B. Two intrinsically spin-dependent wave modes are identified: one bounded by two resonances and the other by two cutoffs. The counterpart of the z mode can escape without encountering a resonance or a cutoff.

Dispersion in a thermal plasma including arbitrary degeneracy and quantum recoil

The longitudinal response function for a thermal electron gas is calculated including two quantum effects exactly, degeneracy, and the quantum recoil. The Fermi-Dirac distribution is expanded in powers of a parameter that is small in the nondegenerate limit and the response function is evaluated in terms of the conventional plasma dispersion function to arbitrary order in this parameter. The infinite sum is performed in terms of polylogarithms in the long-wavelength and quasistatic limits, giving results that apply for arbitrary degeneracy. The results are applied to the dispersion relations for Langmuir waves and to screening, reproducing known results in the nondegenerate and completely degenerate limits, and generalizing them to arbitrary degeneracy.

Synthesis and biodistribution of 99mTc-Vancomycin in a model of bacterial infection

Vancomycin Hydrochloride is an antibiotic produced by the growth of certain strains of Streptomyces orientalis. As Vancomycin Hydrochloride is poorly absorbed after oral administration; it is given intravenously for therapy of systemic infections. Vancomycin was labeled with technetium-99m pertechnetate using SnCl2·2H2O as reducing agent. The labeling efficiency depends on ligand/reductant ratio, pH, and volume of reaction mixture. Radiochemical purity and stability of 99mTc-Vancomycin was determined by thin layer chromatography. Biodistribution studies of 99mTc-Vancomycin were performed in a model of bacterial infection in Sprague–Dawley rats. A significantly higher accumulation of 99mTc-Vancomycin was seen at sites of S. aureus infected animals. Whereas uptake of 99mTc-Vancomycin in turpentine inflamed rats were quite low.

Lead (Pb) column for concentration of 99mTc-pertechnetate

Because of the high content of inactive molybdenum in neutron irradiated MoO3, large columns containing alumina or gel are needed to produce chromatographic 99Mo→99mTc generator. This results in large elution volumes containing relatively high 99Mo breakthrough and low concentrations of 99mTcO4 -. The decrease in specific volume of 99mTc places a limitation on reconstitution of some kits for 99mTc radiopharmaceuticals applied in diagnostic nuclear medicine. Hence concentration technique is mandatory for effective utilization of (n,γ) produced 99Mo/99mTc generators at the start of its life whereas in case of fission 99Mo/99mTc generator the technique may be quite useful at the end of first week of its life. We report post elution concentration of 99mTc using in house prepared Pb column. The high bolus volumes (10–60 ml saline) can conveniently be concentrated in ∼1 ml of saline.

Extraction of medically interesting 188Re-perrhenate in methyl ethyl ketone for concentration purposes

The high bolus volumes (20–40mL) of the generator-produced Rhenium-188 require post elution concentration of the eluate for the preparation of a dissolved β− source and radiopharmaceuticals labeled with Re-188 for radiotherapy. Solvent extraction of 188Re in methyl ethyl ketone was studied. With the increase of organic phase volume, extraction of 188Re was enhanced while mixing time of aqueous and organic phases did not show any significant effect on the extractability of 188Re in the organic phase. Almost 80% of 188Re was extracted in methyl ethyl ketone at a volume ratio of 1:2 for aqueous and organic phases. By evaporation/distillation of methyl ethyl ketone, 188Re was concentrated and dissolved in the desired volume of physiological saline.

Preparation of188Re-lanreotide peptide and its quality control

A simple method is described for the preparation of188Re-Lanreotide, a radiolabeled synthetic peptide derived from an analogue of somatostatin, using Lanreotide (50 μg) and stannous tartrate to which is added carrier-free188Re. The radiolabeling has been carried out with ~555 MBq (15 mCi) with a >95% labeling efficiency and no need for subsequent purification. ITLC and HPLC techniques were employed for monitoring the stability and labeling yield. Radiolabeling results in one major peak when analyzed by reverse-phase (RP) HPLC.

Concentration of 99mTc-pertechnetate and 188Re-perrhenate

The radioactive concentrations of 99mTc/188Re from their generators are dependent upon the specific activity of 99Mo/188W, which dictates the bed size of the alumina/gel column and the volume of physiological saline needed as eluent. Because of the high content of inactive molybdenum/tungsten in neutron irradiated MoO3/WO3, large columns containing alumina/gel are needed to produce chromatographic 99Mo → 99mTc/188W → 188Re generators. This results in large elution volumes containing relatively high 99Mo/188W contents and low concentrations of 99mTc/188Re. The decrease in radioactive concentration, or specific volume, places a limitation on some of the clinical procedures. We report post elution concentration of 99mTc/188Re using in house prepared silver cation exchange and alumina column. The high bolus volumes (10 − 60 ml saline) can conveniently be concentrated in 1 ml of saline. This approach also works very effectively to yield high specific volume solutions of 99mTc-pertechnetate from a fission 99Mo loaded alumina generator towards the end of its normal working life.

Ictal and interictal phonophobia in migraine-a quantitative controlled study

The aim of the study was to evaluate quantitatively ictal and interictal phonophobia in episodic migraine (EM). We included subjects with EM and age- and gender-matched controls. Sound stimuli were pure tones at frequencies of 1000, 4000 and 8000 Hz. Sound aversion thresholds (SATs) were determined as the minimal sound intensity perceived as unpleasant or painful. Migraineurs were examined both between and during attacks. We compared interictal SATs in migraineurs with those in controls. We also compared ictal and interictal SATs in migraineurs. Sixty migraineurs and 52 controls were included. Interictal mean SAT of migraineurs, averaged for the three frequencies, was significantly lower than that of controls [90.4 (0.8) dB vs. 105.9 (1.1) dB, respectively, P < 0.0001]. In migraineurs, mean ictal SAT, averaged for the three frequencies, was significantly lower than interictal SAT [76.0 (0.9) dB vs. 91.0 (0.8) dB, respectively, P < 0.0001]. Patients with EM exhibit increased sound aversion between attacks that is further augmented during an acute attack.