Development of hybrid feature learner model integrating FDOSM for golden subject identification in motor imagery

Brain-computer interfaces (BCIs) based on motor imagery (MI) face challenges due to the complex nature of brain activity, nonstationary and high-dimensional properties, and individual variations in motor behaviour. The identification of a consistent "golden subject" in MI-based BCIs remains an open challenge, complicated by multiple evaluation metrics and conflicting trade-offs, presenting complex Multi-Criteria Decision Making (MCDM) problems. This study proposes a hybrid brain signal decoding model called Hybrid Adaboost Feature Learner (HAFL), which combines feature extraction and classification using VGG-19, STFT, and Adaboost classifier. The model is validated using a pre-recorded MI-EEG dataset from the BCI competition at Graz University. The fuzzy decision-making framework is integrated with HAFL to allocate a golden subject for MI-BCI applications through the Golden Subject Decision Matrix (GSDM) and the Fuzzy Decision by Opinion Score Method (FDOSM). The effectiveness of the HAFL model in addressing inter-subject variability in EEG-based MI-BCI is evaluated using an MI-EEG dataset involving nine subjects. Comparing subject performance fairly is challenging due to complexity variations, but the FDOSM method provides valuable insights. Through FDOSM-based External Group Aggregation (EGA), subject S5 achieves the highest score of 2.900, identified as the most promising golden subject for subject-to-subject transfer learning. The proposed methodology is compared against other benchmark studies from various key perspectives and exhibits significant novelty in several aspects. The findings contribute to the development of more robust and effective BCI systems, paving the way for advancements in subject-to-subject transfer learning for BCI-MI applications.

Expression of Concern: The controlled synthesis and DFT investigation of novel (0D)-(3D) ZnS/SiO2 heterostructures for photocatalytic applications

Expression of Concern for 'The controlled synthesis and DFT investigation of novel (0D)-(3D) ZnS/SiO2 heterostructures for photocatalytic applications' by Mohamed F. Sanad et al., RSC Adv., 2021, 11, 22352-22364, https://doi.org/10.1039/D1RA02284A.

Unveiling the Antibiotic Susceptibility and Antimicrobial Potential of Bacteria from Human Breast Milk of Pakistani Women: An Exploratory Study

Background

Human life quality and expectancy have increased dramatically over the past 5 decades because of improvements in nutrition and antibiotic's usage fighting against infectious diseases. Yet, it was soon revealed that the microbes adapted to develop resistance to any of the drugs that were used. Recently, there is great concern that commensal bacteria from food and the gastrointestinal tract of humans and animals could act as a reservoir for antibiotic resistance genes. Methodology. This study was intended for evaluating the phenotypic antibiotic resistance/sensitivity profiles of probiotic bacteria from human breast milk and evaluating the inhibitory effect of the probiotic bacteria against both Gram-negative and Gram-positive bacteria.

Results

The results point out that some of the isolated bacteria were resistant to diverse antibiotics including gentamycin, imipenem, trimethoprim sulfamethoxazole, and nalidixic acid. Susceptibility profile to certain antibiotics like vancomycin, tetracycline, ofloxacin, chloramphenicol, streptomycin, rifampicin, and bacitracin was also observed. The antimicrobial qualities of cell-free supernatants of some probiotic bacteria inhibited the growth of indicator bacteria. Also, antimicrobial properties of the probiotic bacteria from the present study attributed to the production of organic acid, bacterial adhesion to hydrocarbons (BATH), salt aggregation, coaggregation with pathogens, and bacteriocin production. Some isolated bacteria from human milk displayed higher hydrophobicity in addition to intrinsic probiotic properties like Gram-positive classification, catalase-negative activity, resistance to gastric juice (pH 2), and bile salt (0.3%) concentration.

Conclusion

This study has added to the data of the antibiotic and antimicrobial activity of some probiotic bacteria from some samples of Pakistani women breast milk. Probiotic bacteria are usually considered to decrease gastrointestinal tract diseases by adhering to the gut epithelial and reducing population of pathogens and in the case of Streptococcus lactarius MB622 and Streptococcus salivarius MB620 in terms of hydrophobicity and exclusion of indicator pathogenic strains.

The educational value of ward rounds as a learning and teaching opportunity for house officers, medical officers, and registrars in Sudanese hospitals: a multi-center cross-sectional study

BACKGROUND

Ward rounds are a cornerstone in the educational experience of junior doctors and an essential part of teaching patient care. Here, we aimed to assess the doctors' perception of ward rounds as an educational opportunity and to identify the obstacles faced in conducting a proper ward round in Sudanese hospitals.

METHOD

A cross-sectional study was conducted from the 15^th to the 30^th of January 2022 among house officers, medical officers, and registrars in about 50 teaching and referral hospitals in Sudan. House officers and medical officers were considered the learners, while specialist registrars were considered the teachers. Doctors' perceptions were assessed using an online questionnaire, with a 5-level Likert scale to answer questions.

RESULTS

A total of 2,011 doctors participated in this study (882 house officers, 697 medical officers, and 432 registrars). The participants were aged 26.9 ± 3.2 years, and females constituted about 60% of the sample. An average of 3.1 ± 6.8 ward rounds were conducted per week in our hospitals, with 11.1 ± 20.3 h spent on ward rounds per week. Most doctors agreed that ward rounds are suitable for teaching patient management (91.3%) and diagnostic investigations (89.1%). Almost all the doctors agreed that being interested in teaching (95.1%) and communicating appropriately with the patients (94.7%) make a good teacher in ward rounds. Furthermore, nearly all the doctors agreed that being interested in learning (94.3%) and communicating appropriately with the teacher (94.5%) make a good student on ward rounds. About 92.8% of the doctors stated that the quality of ward rounds could be improved. The most frequently reported obstacles faced during ward rounds were the noise (70%) and lack of privacy (77%) in the ward environment.

CONCLUSION

Ward rounds have a special value in teaching patient diagnosis and management. Being interested in teaching/learning and having good communication skills were the two major criteria that make a good teacher/learner. Unfortunately, ward rounds are faced with obstacles related to the ward environment. It is mandatory to ensure the quality of both ward rounds' teaching and environment to optimize the educational value and subsequently improve patient care practice.

Streptococcus lactarius MB622 and Streptococcus salivarius MB620 isolated from human milk reduce chemokine IL-8 production in response to TNF-α in Caco-2 cell line, an exploratory study

Streptococci are a predominant genera of the human milk microbiome. Among different lactic acid bacteria (LAB) a few Streptococcal strains are also considered as probiotics. Probiotic bacteria are reported to modulate immunity when consumed in adequate amount and bacterial hydrophobicity can be considered as a preliminary experiment for the adhesive capability of probiotic bacteria to the epithelial cells. The present study aimed to investigate the probiotic, hydrophobic and immune modulation property of Streptococcus lactarius MB622 and Streptococcus salivarius MB620, isolated from human milk. S. lactarius MB622 and S. salivarius MB620 displayed higher hydrophobicity (78 % and 59 % respectively) in addition to intrinsic probiotic properties such as gram positive classification, catalase negative activity, resistance to artificially stimulated gastric juice and gastrointestinal bile salt concentration. In conclusion Streptococcus lactarius MB622 and Streptococcus salivarius MB620 isolated from human milk when administered in sufficient amount and for certain duration could be used to reduce inflammation inside the colon by reducing the production of inflammatory booster (IL-8) in diseased state.

Engineering S-scheme CuO/ZnO heterojunctions sonochemically for eradicating RhB dye from wastewater under solar radiation

In this research, S-scheme heterojunctions composed of different concentrations of CuO and ZnO nanoparticles are fabricated for eradicating rhodamine B dye under solar radiation. ZnO nanoparticles are designed through a facile sol-gel route employing Triton X-100. Spherical CuO nanoparticles of 15.2 nm and 1.5 eV band gap energy are deposited on ZnO nanoparticles in an ultrasonic bath of 300 W intensity. The physicochemical performance of the photocatalyst is explored by HRTEM, SAED, BET, XRD, DRS and PL. The in situ homogeneous growth of spherical CuO nanoparticles on ZnO active centers shifts the photocatalytic response to the deep visible region and enhances the efficiency of charge carrier separation and transportation. Among all heterojunctions, ZnCu10 containing 10 wt% CuO displays the best photocatalytic rate for expelling 93% of RhB dye within 240 min, which is twenty-fold higher than that of pristine ZnO and CuO. Reactive oxygen species are the predominant species in degrading the dye pollutant on the heterojunction surface, as shown from scrubber trapping experiments and PL spectrum of terephthalic acid. Coupling ZnO as an oxidative photocatalyst and CuO as a reductive photocatalyst generates an efficient S-scheme heterojunction with strong redox power in destructing various organic pollutants.

Engineering S-scheme Ag2CO3/g-c3N4 heterojunctions sonochemically to eradicate Rhodamine B dye under solar irradiation

The use of natural solar radiation is a low-cost significant technology for water pollution remediation and production of clean energy. In this work, S-scheme Ag₂CO₃/g-C₃N₄ heterojunctions were engineered for carefully eradicating Rhodamine B dye under natural sunlight irradiation. Solid thermal decomposition reactions generate g-C₃N₄ sheets by annealing urea at 520 °C. Ag₂CO₃ nanoparticles are directed and localized sonochemically to the active centers of g-C₃N₄ sheets. The physicochemical properties of the solid specimen were determined by PL, DRS, XRD, HRTEM, mapping, EDX, N₂-adsorption-desorption isotherm and XPS analyses. As elucidated by HRTEM, PL and DRS analyses, 5 wt% of spherical Ag₂CO₃ nanoparticles deposited on the g-C₃N₄ sheet surface and nearly equidistant from each other elevate the electron-hole separation efficiency and broaden the absorption capacity of photocatalysts. Rhodamine B dye was degraded at a rate of 0.0141 min^-1 by heterojunctions containing 5 wt% Ag₂CO₃ and 95 wt% g-C₃N₄, which is three-fold higher than that on pristine g-C₃N₄ nanosheets. Free radical scrubber experiments revealed the contribution of charge carriers and reactive oxygen species to the decomposition of RhB dye with a preferential role of positive holes and superoxide species. PL measurements of terephthalic acid and scrubber trapping experiments provide confirmatory evidence for charge diffusion via the S-scheme mechanism that accounts for the production of electron-hole pairs with strong redox power. This novel research work is contributory to manipulate the S-scheme heterojunction for efficient and low-cost wastewater treatment under natural solar irradiation.

Influence of Sapindus mukorossi extract in comparison to 17% EDTA as final root canal irrigant on the sealer penetration and microleakage of dentinal tubules

OBJECTIVE

The study evaluated the effect of Sapindus mukorossi (SM) extract as a final root canal irrigant on sealer penetration (SP) in dentinal tubules and microleakage.

MATERIALS AND METHODS

Samples were selected based on inclusion and exclusion criteria. An access opening in all samples was performed and the working length was decided using pro taper for canal finishing along with constant irrigation. Specimens were randomly divided into 3 groups. Group 1 was irrigated with 3 ml of 17% EDTA; group 2 was irrigated with SM irrigant and group 3 samples were irrigated with 0.9% saline. After obturation, samples were vertically placed in 1% methylene blue dye cut in half longitudinally, and viewed under a stereomicroscope. Analysis of SP in the dentinal tubule was assessed using scanning electron microscopy (SEM). For microleakage assessment, mean and standard deviation were reported and One-Way ANOVA was applied. SP was compared using Kruskal-Wallis' test. For inspecting the interaction between SM/EDTA and NaOCl, Fisher's exact test was applied. No statistically significant difference between microleakage in any of the tested groups was observed. The control group showed minimum leakage as compared to EDTA and SM.

RESULTS

The results displayed that there was no significant difference, (p=0.67), between dentinal tubule SP at 2 mm. A significant difference between dentinal tubule SP among groups at 5 mm was observed (p<0.05).

CONCLUSIONS

SM ethanolic extract showed comparable outcomes of smear layer removal and sealer penetration to 17% EDTA, as a final irrigant in root canal cleaning. Therefore, SM has the potential to be used as an adjuvant final irrigant in conjunction with NaOCl.

Isolation and Characterization of Lactobacillus crispatus, Lactococcus lactis, and Carnobacterium divergens as Potential Probiotic Bacteria from Fermented Black and Green Olives (Olea europaea): An Exploratory Study

Background

Table olives are becoming well recognized as a source of probiotic bacteria that might be used to create a health-promoting fermented food product by traditional procedures based on the activities of indigenous microbial consortia present in local environments. Methodology. In the present study, the characterization of probiotic bacteria isolated from mince, chunks, and brine of fermented green and black olives (Olea europaea) was done based on morphological, biochemical, and physiological characteristics.

Results

Bacterial isolates demonstrated excellent survival abilities at 25, 37, and 45°C and at a variable range of pH. However, the optimum temperature is 37 and the optimum pH is 7 for all three isolates. An antimicrobial susceptibility pattern was found among these isolates through the disc diffusion method. Most of the isolates were susceptible to streptomycin, imipenem, and chloramphenicol, whereas, amoxicillin showed resistance to these isolates, and variable results were recorded for the rest of the antibiotics tested. The growth of the isolates was optimum with the supplementation of 3% NaCl and 0.3% bile salt. The isolated bacteria were able to ferment skimmed milk into yogurt, hence making it capable of producing organic acid.

Conclusion

Isolates of Lactobacillus crispatus MB417, Lactococcus lactis MB418 from black olives, and Carnobacterium divergens MB421 from green olives were characterized as potential candidates for use as starter cultures to induce fermentation of other probiotic food products.

Mechanical dyssynchrony, a novel marker to predict long-term survival in patients with cardiac resynchronization

Background

Cardiac resynchronization therapy (CRT) is an established therapy in patients with symptomatic heart failure with reduced left ventricular ejection fraction (LVEF &lt;35%) (HFrEF) that have conduction disturbances as measured by prolonged QRS duration of &gt;130 ms. Mechanical dyssynchrony (MD) in echocardiography has not proven benefit to determine CRT indication, but is hypothesized to be of predictive value. Both MD aspects of “apical rocking” (AR) but also “septal flash” (SF) have been shown to be a predictive value in short- and medium-term follow-up in CRT, but no trial has tested long-term effects yet.

Purpose

This study investigated the impact of AR and SF on long-term survival in CRT recipients.

Methods and results

425 HFrEF patients (mean age: 63.0±10.6 years, 72.3% male, 60.7% non-ischemic etiology) with ESC guideline-derived CRT indication have been implanted and additionally investigated for MD markers at baseline as well as after a 11.5±8.0 months follow-up including long-term survival. Herein AR and/or SF were identified in 307 (72,2%) participants at baseline. During follow-up both AR and/or SF disappeared in 256 (83.4%) patients through CRT use. The overall mean survival was 95.9±52.9 months. Univariable analysis showed beneficial survival for women over men (109.1±52.4 vs. 90.9±52.4 months; p&lt;0.001). Moreover, younger (&lt;60 years) patients profit more than older patients (110.6±53.7 vs. 88.6±51.1 months; p&lt;0.001). Interestingly, patients with MD markers at baseline generally had an improved overall survival (106.2±52.0 vs. 68.9±45.4 months; p&lt;0.001), and in addition to that we found the best survival in patients with disappeared over persisting mechanical dyssynchrony echocardiography parameters in CRT (111.6±51.2 vs. 79.7±47.6 months p&lt;0.001). Multivariate analysis shows age and presence of MD at baseline to be powerful predictors for long-term survival in CRT HFrEF patients (Figures 1 and 2).

Conclusion

Novel echocardiography MD parameters before CRT implantation predict long-term survival. Moreover, long-term survival even further improves when AR and/or SF disappear through CRT in HFrEF. Our results encourage a prospective, randomized, controlled, multicenter trial to study clinical implementation of MD in CRT patients.

Funding Acknowledgement

Type of funding sources: None.

Outcome of Reduction of Subcondylar Fracture in Retromandibular Transparotid Approach

Among all mandibular fracture 25.0 to 40.0% fractures are regarded as condylar and subcondylar fracture. Commonly, reduction of subcondylar fracture is done under general anaesthesia. Different approaches were found for the surgical treatment of condylar fractures besides intraoral approaches such as the pre-auricular, submandibular, rhytidectomy, retromandibular. This is a prospective observational study which was performed to find out the outcome of retromandibular approach for subcondylar fracture treatment of mandible i.e. to find out correction of occlusion and establishment of jaw function, infection, hematoma, salivary fistula, facial nerve damage, haematoma etc complication. Surgical treatment of subcondylar fractures of 15 patients was done in Dhaka Dental College and Hospital and different private centres in Dhaka and Mymensingh, Bangladesh from January 2019 to December 2021 in retromandibular transparortid approach. The patients were evaluated for hematoma, infection, Frey's syndrome, salivary fistula, facial nerve damage, occlusion, fracture site stability, chronic pain in the fracture site and temporomandibular joint movements in the post operative period. Facial nerve injury was not observed. Postoperative swelling of parotid region developed in first two patients. Single patient developed paresis in zygomatic branch of facial nerve causing left upper eyelid muscle weak and after two weeks of physiotherapy it became normal. Salivary fistula developed in three patients which resolved spontaneously. Outcome of this approach like good anatomy and function was found in all cases. Good articular function was obtained in all the cases. By this retromandibular approach condylar fracture reduction; fixation and healing were managed comfortably. However, direct vision of facial nerve fibres has limited the risk of facial nerve injury.

Integration of fuzzy-weighted zero-inconsistency and fuzzy decision by opinion score methods under a q-rung orthopair environment: A distribution case study of COVID-19 vaccine doses

Owing to the limitations of Pythagorean fuzzy and intuitionistic fuzzy sets, scientists have developed a distinct and successive fuzzy set called the q-rung orthopair fuzzy set (q-ROFS), which eliminates restrictions encountered by decision-makers in multicriteria decision making (MCDM) methods and facilitates the representation of complex uncertain information in real-world circumstances. Given its advantages and flexibility, this study has extended two considerable MCDM methods the fuzzy-weighted zero-inconsistency (FWZIC) method and fuzzy decision by opinion score method (FDOSM) under the fuzzy environment of q-ROFS. The extensions were called q-rung orthopair fuzzy-weighted zero-inconsistency (q-ROFWZIC) method and q-rung orthopair fuzzy decision by opinion score method (q-ROFDOSM). The methodology formulated had two phases. The first phase 'development' presented the sequential steps of each method thoroughly.The q-ROFWZIC method was formulated and used in determining the weights of evaluation criteria and then integrated into the q-ROFDOSM for the prioritisation of alternatives on the basis of the weighted criteria. In the second phase, a case study regarding the MCDM problem of coronavirus disease 2019 (COVID-19) vaccine distribution was performed. The purpose was to provide fair allocation of COVID-19 vaccine doses. A decision matrix based on an intersection of 'recipients list' and 'COVID-19 distribution criteria' was adopted. The proposed methods were evaluated according to systematic ranking assessment and sensitivity analysis, which revealed that the ranking was subject to a systematic ranking that is supported by high correlation results over different scenarios with variations in the weights of criteria.

Clinical Features and Outcomes of Acute Chlorine Gas Inhalation; a Brief Report

Introduction

On March 6^th,2020, chlorine gas leak was reported at Engro Polymer & Chemicals Plant in Karachi City, Pakistan. This study aimed to evaluate the clinical features and outcomes of patients who presented to emergency department (ED) following this event.

Methods

This retrospective cross-sectional study, evaluated the clinical features and outcomes (length of hospital stay, complications, and mechanical ventilation requirement) of patients presenting to ED of Aga Khan University Hospital, Karachi, Pakistan, with history of chlorine gas exposure at the Engro Plant from 6^th March to 14^th March 2020.

Results

38 patients with mean age of 33.1 ± 8.1 years presented to ED with history of chlorine gas exposure (100% male). 4 (10.5%) cases had comorbid diseases. Most common presenting symptom was dyspnea, observed in 33 (86.8%) cases, followed by cough, seen in 27 (71.1%) subjects. 13.2% (5/38) patients had infiltration on chest x-ray and 33 (86.8 %) required hospitalization. 6 (15.8%) patients had repeat presentation requiring hospitalization or ED visit. 18 (47.4%) were managed with high flow oxygen therapy, 9 (23.7%) required non-invasive ventilation and one patient was intubated due to development of pneumo-mediastinum. Mean length of stay was 1.55 ± 1.58 days and no patients died. Presence of tachycardia was the only finding significantly associated with need for oxygen (p = 0.033) and non-invasive ventilation (p = 0.012).

Conclusion

The majority of patients presenting with acute chlorine gas exposure showed good clinical outcomes and rapid recovery, however, a high index of suspicion and vigilance should be maintained for complications such as pneumomediastinum and acute respiratory distress syndrome in these patients.

Effect of Application of Platelet-Rich Plasma on Bone Regeneration after Removal of Jaw Cysts

Platelets are involved in regeneration at sites of bony defect, apart from their function in coagulation. An autologous preparation platelet-rich plasma gel applied to sites of bony defects after surgical treatment of jaw cyst. This case-control study was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU) in the department of Oral and Maxillofacial Surgery from September 2017 to August 2018. Total 30 patients were chosen having jaw cyst. They were divided into 2 groups; Group A and Group B, where Group A got the platelet rich plasma, after removal of the cystic lesion; and Group B got the normal usual treatment. Platelet rich plasma gel was prepared using a standardized technique and applied to the surgical site of the Group A. The differences of radiographic changes between the two groups at 6th, 12th, 18th and 24th weeks after surgery were analyzed. Study showed significant changes in early bone regeneration in group A at 12th and 18th weeks post operatively. Platelet rich plasma induces early bone regeneration and it has proven successful outcome.

Multi-perspectives systematic review on the applications of sentiment analysis for vaccine hesitancy

A substantial impediment to widespread Coronavirus disease (COVID-19) vaccination is vaccine hesitancy. Many researchers across scientific disciplines have presented countless studies in favor of COVID-19 vaccination, but misinformation on social media could hinder vaccination efforts and increase vaccine hesitancy. Nevertheless, studying people's perceptions on social media to understand their sentiment presents a powerful medium for researchers to identify the causes of vaccine hesitancy and therefore develop appropriate public health messages and interventions. To the best of the authors' knowledge, previous studies have presented vaccine hesitancy in specific cases or within one scientific discipline (i.e., social, medical, and technological). No previous study has presented findings via sentiment analysis for multiple scientific disciplines as follows: (1) social, (2) medical, public health, and (3) technology sciences. Therefore, this research aimed to review and analyze articles related to different vaccine hesitancy cases in the last 11 years and understand the application of sentiment analysis on the most important literature findings. Articles were systematically searched in Web of Science, Scopus, PubMed, IEEEXplore, ScienceDirect, and Ovid from January 1, 2010, to July 2021. A total of 30 articles were selected on the basis of inclusion and exclusion criteria. These articles were formed into a taxonomy of literature, along with challenges, motivations, and recommendations for social, medical, and public health and technology sciences. Significant patterns were identified, and opportunities were promoted towards the understanding of this phenomenon.

Telehealth utilization during the Covid-19 pandemic: A systematic review

During the coronavirus disease (COVID-19) pandemic, different technologies, including telehealth, are maximised to mitigate the risks and consequences of the disease. Telehealth has been widely utilised because of its usability and safety in providing healthcare services during the COVID-19 pandemic. However, a systematic literature review which provides extensive evidence on the impact of COVID-19 through telehealth and which covers multiple directions in a large-scale research remains lacking. This study aims to review telehealth literature comprehensively since the pandemic started. It also aims to map the research landscape into a coherent taxonomy and characterise this emerging field in terms of motivations, open challenges and recommendations. Articles related to telehealth during the COVID-19 pandemic were systematically searched in the WOS, IEEE, Science Direct, Springer and Scopus databases. The final set included (n = 86) articles discussing telehealth applications with respect to (i) control (n = 25), (ii) technology (n = 14) and (iii) medical procedure (n = 47). Since the beginning of the pandemic, telehealth has been presented in diverse cases. However, it still warrants further attention. Regardless of category, the articles focused on the challenges which hinder the maximisation of telehealth in such times and how to address them. With the rapid increase in the utilization of telehealth in different specialised hospitals and clinics, a potential framework which reflects the authors' implications of the future application and opportunities of telehealth has been established. This article improves our understanding and reveals the full potential of telehealth during these difficult times and beyond.

COVID-19 Presenting with Spontaneous Pneumothorax

The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease mainly affects respiratory system. Its common clinical findings include fever, cough and shortness of breath. Characteristic radiological features of the disease include peripherally distributed, bilateral ground-glass opacities, predominantly involving the lower lung zones. In this report, we present a case of COVID-19 disease presenting with spontaneous pneumothorax. A 26-year male patient was admitted to the Emergency Department with fever, dry cough, shortness of breath and right-sided chest pain. Radiographic imaging of the patient revealed pneumothorax on the right and peripherally distributed non-homogenous opacification. The patient underwent right lateral tube thoracostomy. COVID-19 was diagnosed on testing of nasopharyngeal swab. In conclusion, spontaneous pneumothorax is one of the rare presentations of COVID-19 pneumonia and should be kept in mind in patients presenting with shortness of breath and chest pain. Key Words: Spontaneous pneumothorax, Corona, pneumonia.

A novel BiVO3/SnO2 step S-scheme nano-heterojunction for an enhanced visible light photocatalytic degradation of amaranth dye and hydrogen production

The destruction of toxic pollutants and production of hydrogen gas on the surface of semiconductors under light irradiation is the main significance of photocatalysis. Heterojunctions with matching in band gap energy are urgently required for enhancing the redox power of the charge carriers. A step S-scheme BiVO₃/SnO₂ nano-heterojunction was carefully synthesized for a successful photodegradation of amaranth dye and photocatalytic hydrogen evolution. Tetragonal SnO₂ nanoparticles of 80 m² g^-1 surface area and distinct mesoporous structure were fabricated by a sol-gel route in the presence of Tween-80 as the pore structure directing agent. BiVO₃ nanoparticles were deposited homogeneously on the SnO₂ surface in an ultrasonic bath of power intensity 300 W. The photocatalytic efficiency in the destruction of amaranth dye soar with increasing BiVO₃ contents of up to 10 wt%. The hydrogen evolution rate reached 8.2 mmol g^-1 h^-1, which is eight times stronger than that of pristine SnO₂. The sonicated nanocomposites were investigated by XRD, BET, FESEM, HRTEM, EDS, DRS and PL techniques. The step S-scheme heterojunction with superior oxidative and reductive power is the primary key for the exceptional photocatalytic process. The PL of terephthalic acid and the scavenger trapping experiments reveal the charge migration through the step S-scheme mechanism rather than the type (II) heterojunction mechanism.

Brain Abscess Caused by Lactococcus Lactis in a Young Male

Lactococcus lactis cremoris is one of the gram positive cocci, not known to be pathogenic in humans. We report a case of brain abscess due to lactococcus lactis in an adolescent. An 18-year male with congenitally corrected transposition of great arteries and dextrocardia was admitted with fever, headache and right-sided numbness. Magnetic resonance imaging revealed a well circumscribed irregular heterogeneous abnormal signal intensity lesion in left temporo-parietal lobe having central area of diffusion restriction and peripheral wall enhancement on post-contrast images. He underwent mini-craniotomy for abscess drainage. Pus culture revealed growth of lactococcus lactis. He was treated with ceftriaxone and remained disability-free on six month follow-up. To our knowledge, this is one of the few reports of brain abscess caused by lactococcus lactis. Key Words: Brain abscess, Lactococcus lactis, Adolescent.

The controlled synthesis and DFT investigation of novel (0D)-(3D) ZnS/SiO2 heterostructures for photocatalytic applications

A ZnS/SiO2 photocatalyst was synthesized using a low-cost sol-gel wet chemical procedure. The as-synthesized ZnS/SiO2 nanocomposites with different molar ratios exhibited superior performance in the photodegradation of two organic dyes under UV irradiation, with complete degradation of both dyes after 2 hours of exposure to UV irradiation. The photocatalyst structure, microstructure, and surface area were studied using X-ray diffraction (XRD), high-resolution transmission electron microscopy (HRTEM), field emission scanning electron microscopy (FESEM), and nitrogen adsorption (S BET) studies. The results demonstrate that the ZnS/SiO2 photocatalyst with 15% ZnS content has a bandgap energy similar to that of ZnS alone with a higher surface area of approximately 150 m2 g-1, which effectively increases the number of active sites and improves the photocatalytic activity of the prepared material. The measured bandgap energies were compared with the theoretical values obtained using the density functional theory (DFT) method, and the values were found to be very similar, with a low error percentage. In the case of a high ZnS content (greater than 15%), active site blocking occurred, and the removal rate dropped below 50%. The obtained results indicate that the photocatalytic data are in good agreement with the experimental characterization results for the prepared materials, including the BET and XRD results, confirming a close association between the photocatalytic activity and the surface area of the fabricated photocatalyst.

Diversity of Vibrio parahaemolyticus in marine fishes of Bangladesh

AIMS

To determine the occurrence, diversity, antibiotic resistance and biofilm formation of Vibrio parahaemolyticus isolated from marine fishes in Bangladesh.

METHODS AND RESULTS

A total of 80 marine fishes were obtained from the local markets and examined for the presence of V. parahaemolyticus. All the isolated V. parahaemolyticus were characterized for the presence of virulence markers, thermostable direct hemolysin (TDH) or thermostable direct hemolysin related hemolysin (TRH). Isolates were serotyped and further characterized by enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR) typing to analyse the genetic diversity. Moreover, biofilm formation and antibiotic resistance patterns were also determined. About 63·75% (51/80) of the tested marine fishes were contaminated with V. parahaemolyticus. From the contaminated fishes, 71 representatives V. parahaemolyticus were isolated and none of them harboured tdh and trh virulence genes. Nine different O-groups and seven different K-types were found by serological analysis and the dominant serotype was O5:KUT. In ERIC-PCR analysis, eight clusters (A-H) were found and the most common pattern was A (46·5%). All of the isolates were resistant to ampicillin and 78·9% of isolates were resistant to streptomycin. The highest biofilm formation was found at 37°C compared to 25°C and 4°C.

CONCLUSION

Diverse V. parahaemolyticus are present in marine fishes in the local market of Bangladesh with antibiotic-resistant properties and biofilm formation capacity.

SIGNIFICANCE AND IMPACT OF THE STUDY

The widespread prevalence of diverse V. parahaemolyticus in marine fishes is an issue of serious concern, and it entails careful monitoring to ascertain the safety of seafood consumers.

Sociodemographic, Clinical Characteristics, and Outcomes of Influenza Pneumonia Patients Admitted in a Tertiary Care Hospital in Karachi, Pakistan: Findings from a Cross-sectional Study

OBJECTIVE

To determine the sociodemographic, clinical characteristics, and outcomes of influenza pneumonia patients in tertiary care hospital, Karachi Pakistan.

STUDY DESIGN

A cross-sectional study.

PLACE AND DURATION OF STUDY

The Aga Khan University Hospital Karachi Pakistan from  January 2013 to December 2018.  Methodology: All adult patients who were older than 18 years and suspected to have viral pneumonia were included in the study. Data were abstracted on 105 patients and were entered on preformed proforma after reviewing the files of patients.

RESULTS

Ninety-four (89.5%) patients were influenza positive and 15.2% (n=16) had been vaccinated. Around 92.4% (n=97), 81.9% (n=86) and 61.9% (n=65) patients had cough, fever and shortness of breath, respectively; and 63.8% (n=67), 16.2% (n=17), and 2.9% (n=3) patients had consolidation, nodules, and cavitation, respectively. Almost 91.4% (n=96) patients were given treatment and discharged home; however, 7.6% (n=8) died. Procalcitonin, creatinine, HCO3 , lactate, and bilirubin level were increased in 2nd group (mortality group) after 48 hours; however, the results were only significant for HCO3 (p = 0.035).

CONCLUSION

Influenza pneumonia is very common in our population and older people are more likely to be affected by this disease. Patients can be prevented from adverse outcomes and complications, if diagnosed and treated in time. Key Words: Influenza, Clinical characteristics, Outcome, Patients.

COVID-19 Presenting with Spontaneous Pneumothorax

The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease mainly affects respiratory system. Its common clinical findings include fever, cough and shortness of breath. Characteristic radiological features of the disease include peripherally distributed, bilateral ground-glass opacities, predominantly involving the lower lung zones. In this report, we present a case of COVID-19 disease presenting with spontaneous pneumothorax. A 26-year male patient was admitted to the Emergency Department with fever, dry cough, shortness of breath and right-sided chest pain. Radiographic imaging of the patient revealed pneumothorax on the right and peripherally distributed non-homogenous opacification. The patient underwent right lateral tube thoracostomy. COVID-19 was diagnosed on testing of nasopharyngeal swab. In conclusion, spontaneous pneumothorax is one of the rare presentations of COVID-19 pneumonia and should be kept in mind in patients presenting with shortness of breath and chest pain. Key Words: Spontaneous pneumothorax, Corona, pneumonia.

Reorganising for COVID-19 Pandemic: A Review of Structural Modifications by the Department of Internal Medicine in Low to Middle-income Countries

Scientists classified the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a novel coronavirus on January 7, 2020. The World Health Organization (WHO) acknowledged the SARS-CoV-2 outburst a public health emergency of international concern on January 30, 2020. Since its origin, this virus has disrupted the best healthcare systems, economies, and strained financial resources; and for underdeveloped countries' healthcare systems, the virus has become a crisis. To tackle the potential hazards from this virus, our Department restructured the services that not only helped us to cope with the pandemic, but also provided an example to copy for other contemporary institutes. This article aims to describe the measures and structural changes undertaken by the Internal Medicine Department, Aga Khan University Hospital (AKUH), Karachi, Pakistan. Key Words: COVID-19, Internal medicine, Structural modifications, Pandemic.

The effect of gestational age on women's preference for quality goods

Background

It is a well-established fact that hormonal changes significantly influence the consumer behaviors and their purchase intentions. However, attention to the conspicuous buying due to the mood swings, as a result of hormonal changes, during the pregnancy have been largely ignored in the literature.

Aims

The current research aims to examine the prospective association of conspicuous purchase intentions with hormonal changes and mood swings during the pregnancy.

Methods

An experimental procedure was used to assess the data collected from pregnant women (n = 116) and the hypotheses were analyzed using recall probability and recall position measures.

Results

The hormonal changes during the pregnancy were analyzed in three stages known as pregnancy trimesters suggested by the relevant literature (Trimester-1 = 39, Trimister-2 = 36 and Trimester-3 = 41). The respondents were exposed to visual attention of specifically designed images with a unique combination of the status and functional products. The ROC values for Trimester 2 is higher in all 4 graphs (0.923, 0.960, 0.892, and 0.923) respectively than Trimester 1 and 3.

Conclusion

Findings revealed that the women purchase preferences shift as pregnancy move from one trimester to another. Women pay more attention to status products during the 2^nd trimester as compared to 1^st and 3^rd trimesters of pregnancy.

GGE biplot analysis of Line by tester for seed yield and its attributes in sunflower

Nine genetically diverse sunflower promising lines in their economic trait were crossed using line by tester mating design in 2018 spring season, to estimate per se performance, combining ability, heterosis, gene action and heritability for earliness, yield and its attributes traits. The parents involved four sunflower CMS lines namely L1 (A3), L2 (A5), L3 (A9) and L4 (A13) (called hereafter “Lines” (as female parents) and five sunflower genotypes T1 (RF9), T2 (RF10), T3 (RF11), T4 (RF14) and T5 (RF1) as male parents (called hereafter “Tester”). In 2018 and 2019 summer season, the nine parents along with their 20 F1s seeds were evaluated at Shandaweel Agricultural Research Station, ARC, Sohag Governorate, Egypt using a randomized complete blocks design with three replications. Mean squares due to parents (P), crosses (C), CMS lines (L), RF testers (T), P vs C and L x T were significant for all studied traits. A larger magnitude of non-additive gene action than additive was revealed by greater ratios (GCA/ SCA) than unity for all studied traits (except for days to 50% flowering). A5 and A13 of CMS lines and RF11 and RF14 of RF lines proved to be the best general combiners for seed weight plant-1 and one or more of its attributes traits. Moreover, the best cross combinations A13 x RF11, A13 x RF1 and A5 x RF9 performed better than other developed hybrids in view of seed weight plant-1 and one or more of its attributes, hence these F1 hybrids could further be used on commercial exploitation.

Pretreatment of sugarcane bagasse using hydrodynamic cavitation technology: Semi-continuous and continuous process

Development of new technologies for pretreatment of lignocellulosic biomass is a current research challenge. In this way, hydrodynamic cavitation (HC) was used to assist alkaline hydrogen peroxide pretreatment of sugarcane bagasse (SCB) in sequential batches (SB-HC), semi-continuous (SC-HC) and continuous (C-HC) processes. Pretreatment resulted in compositional modifications in the material, mainly regarding the cellulose and lignin contents. The released sugars after enzymatic hydrolysis resulted, on average, in 42 g and 32-35 g of glucose per 100 g of SCB for samples treated in B-HC (10 min of process) and SC-HC process (7.5 min residence time), respectively. In C-HC process, with an average residence time of 7.5 min and 3.75 min, 38-46 g and 32-38 g of glucose per 100 g of SCB were obtained respectively in enzymatic hydrolysis step. HC technology was shown as a promising alternative for pretreatment of lignocellulosic biomass in all evaluated configurations aiming to produce high value bioproducts.

An efficient adsorption of indigo carmine dye from aqueous solution on mesoporous Mg/Fe layered double hydroxide nanoparticles prepared by controlled sol-gel route

A new approach for removal of indigo carmine blue (IC) dye which is extensively used in jeans manufacture was successfully performed on novel mesoporous [LDH] nanoparticles prepared by sol-gel route using CTAB as shape and pore directing agent. The physicochemical features were monitored by X-ray diffraction (XRD), Fourier transformer infra-red (FTIR), N₂ adsorption-desorption isotherm, Field emission electron microscope (FESEM) and high resolution transmission electron microscope (HRTEM). The influence of reaction parameters affecting dye adsorption including contact time, initial dye concentration, pH and temperature were investigated. Textural analysis and HRTEM images indicate the existence of mesoporous spherical nanoparticles of size = 26 nm connected to each other's and embedded large numbers of mesopores of average pore radius = 43.5 Å. A successful adsorption of IC on LDH nanoparticles of surface area = 85.6 m²/g at various pH with maximum adsorption capacity = 62.8 mg/g at pH = 9.5. Langmuir model is more favorable to describe the adsorption of IC rather than Freundlich model which reflecting the preferential formation of monolayer on the surface of LDH. Both film diffusion and the intraparticle diffusion affect the dye adsorption. The values of enthalpy change (ΔH) for and (ΔS) are + 28.18 and + 0.118 kJ/mol, respectively indicating that the removal process is endothermic. The results indicated that LDH nanoparticles conserved a good activity even after five consecutive cycles of reuse. Our results suggest that mesoporous LDH nanoparticles are considered a potential novel adsorbent for remediation of wastewater containing IC.

Metabolic adaptation via regulated enzyme degradation in the pathogenic yeast Candida albicans

The virulence of Candida albicans is dependent upon fitness attributes as well as virulence factors. These attributes include robust stress responses and metabolic flexibility. The assimilation of carbon sources is important for growth and essential for the establishment of infections by C. albicans. Previous studies showed that the C. albicans ICL1 genes, which encode the glyoxylate cycle enzymes isocitratelyase are required for growth on non-fermentable carbon sources such as lactate and oleic acid and were repressed by 2% glucose. In contrast to S. cerevsiae, the enzyme CaIcl1 was not destabilised by glucose, resulting with its metabolite remaining at high levels. Further glucose addition has caused CaIcl1 to lose its signal and mechanisms that trigger destabilization in response to glucose. Another purpose of this study was to test the stability of the Icl1 enzyme in response to the dietary sugars, fructose, and galactose. In the present study, the ICL1 mRNAs expression was quantified using Quantitative Real Time PCR, whereby the stability of protein was measured and quantified using Western blot and phosphoimager, and the replacing and cloning of ICL1 ORF by gene recombination and ubiquitin binding was conducted via co-immuno-precipitation. Following an analogous experimental approach, the analysis was repeated using S. cerevisiaeas a control. Both galactose and fructose were found to trigger the degradation of the ICL1 transcript in C. albicans. The Icl1 enzyme was stable following galactose addition but was degraded in response to fructose. C. albicans Icl1 (CaIcl1) was also subjected to fructose-accelerated degradation when expressed in S. cerevisiae, indicating that, although it lacks a ubiquitination site, CaIcl1 is sensitive to fructose-accelerated protein degradation. The addition of an ubiquitination site to CaIcl1 resulted in this enzyme becoming sensitive to galactose-accelerated degradation and increases its rate of degradation in the presence of fructose. It can be concluded that ubiquitin-independent pathways of fructose-accelerated enzyme degradation exist in C. albicans.

Plasmodium knowlesi - an emerging pathogen

Ten years have passed since the publication of a large focus of Plasmodium knowlesi infections in the human population. The discovery was made during a molecular investigation of atypical P. malariae cases in the Kapit Health Division, Sarawak, Malaysian Borneo. Patients were more symptomatic with higher parasite counts than expected in P. malariae infections. The investigation found only P. knowlesi DNA present in patient blood samples. Morphological similarity had allowed P. knowlesi to masquerade as P. malariae during routine diagnostic microscopy for malaria. P. knowlesi, a malaria parasite of macaque monkeys, had entered the human population. The subsequent development of P. knowlesi species-specific PCR assays soon demonstrated that the entry was not confined to the Kapit Division but extended across island and mainland Southeast Asia. Relevant clinical descriptions and guidelines for the treatment and management of patents with P. knowlesi malaria were not available. Nor was it clear whether P. knowlesi had undergone a host switch event into the human population or if infections were zoonotic. The outputs of studies on P. knowlesi malaria during the past 10 years will be summarized, highlighting major findings within the context of pathophysiology, virulence, host switch events, treatment, control and importantly malaria elimination.

A Psoriatic Arthritis Patient with Multiple Rare Complications – case report and review of literature

A 28 year old male patient of psoriasis was admitted in a tertiary care hospital of Bangladesh with typical skin lesions for 18 years, nail changes for 16 years, arthritis for 12 years and eye changes for 3 years. In addition he had other rare extra articular complications like severe aortic stenosis, moderate aortic regurgitation and mild mitral regurgitation. He had a positive family history of psoriasis. HLAB27 is positive and X-ray of hands and feet showed classical findings of psoriatic arthritis. We presented the case to show the early age of onset, severity of the disease with rapid progression and multiple extra articular complications. DOI: http://dx.doi.org/10.3329/pulse.v5i2.20266 Pulse Vol.5 July 2011 p.48-53

Repetitive transcranial magnetic stimulation in neuropathic pain secondary to malignancy: a randomized clinical trial

BACKGROUND

Significant analgesic effects of repetitive transcranial magnetic stimulation (rTMS) have been found in several studies of patients with chronic pain of various origins, but never for malignancy. The objective of this study was to assess the efficacy of 10 sessions of rTMS over the primary motor cortex (M1) in patients suffering from malignant neuropathic pain.

METHODS

Thirty-four patients were randomly allocated into one of two groups to receive real (20 Hz, 10 s, 10 trains with 80% intensity) or sham rTMS daily for 10 consecutive days. Patients were evaluated using a verbal descriptor scale (VDS), a visual analogue scale (VAS), Leeds assessment of neuropathic symptoms and signs (LANSS) and Hamilton rating scale for depression (HAM-D) at baseline, after the first, fifth and 10th treatment sessions, and then 15 days and 1 month after treatment.

RESULTS

There were no significant differences between real and sham groups in the duration of illness or pain rating scores at the baseline. A significant 'Time × Group' interaction was recorded indicating that real and sham rTMS had different effects on the VDS, VAS, LANSS and HAM-D scales. Post-hoc testing showed that the group of patients treated with real rTMS had greater improvement in all scales that persisted up to 15 days, but were not present 1 month later. Significant positive correlations between the percentage of pain reduction and HAM-D after the 10th session and 15 days later were recorded.

CONCLUSION

The results demonstrate that 10 rTMS sessions over the M1 can induce short-term pain relief in malignant neuropathic pain.

Low-temperature solution-processed flexible solar cells based on (In,Ga)N nanocubes

Indium gallium nitride nanocubes were syntheized via a low-temperature chemical route. Energy-dispersive X-ray spectroscopy and X-ray diffraction analyses confirmed the successful fabrication of (In,Ga)N with various indium mole fractions. The bandgap of the material was tunded as a function of the indium content. The fabricated nanocubes showed a deep level photoluminescence emission at 734 nm as well as in the visible region at 435-520 nm. The Hall effect measurements showed the hole concentration to constantly increase from 6.2 × 10(16) to 2.3 × 10(18) cm(-3), while the hole mobility to decrease from 0.92 to 0.1 cm(2) /(V s) as the doping ratio increases from 0.005 to 0.025 cm(-3). The solar cell device made of nanocubes film containing 0.4 indium on flexible substrates showed a short-circuit current density of 12.47 mA/cm(2) and an open-circuit voltage (Voc) of 0.48 V with 54% fill factor. The relationship between Voc and indium content in the fabricated films was also investigated.

Effectiveness of levofloxacin in enteric fever

This intervention study was conducted to determine the efficacy of Levofloxacin in the treatment of uncomplicated enteric fever. Among 100 patients, who were purposively selected for the study had presented sign and symptoms of enteric fever with blood culture positive salmonella in laboratory findings during the admission in the department of Medicine, Uttara Adhunik Medical College & Hospital, Dhaka. Patients who fulfilled the diagnostic criteria were enrolled in the study and divided into two groups. One group was treated with oral levofloxacin 750mg once daily (OD) and another was injected with Levofloxacin 500mg once daily for 7 days. All the patients were examined twice daily to observe the clinical cure or failure of levofloxacin. Study was conducted from January 2008 to December 2008. Statistical analysis was performed by using statistical software SPSS version 12. Among the 100 patients in the study, majority of them 46(92%) were aged between 15 to 25 years, the next group was between 25 to 35 years 26(52%) and only three patients were aged above 65 years. Significant number of the patients were male (67), and the rest of them were female. The patients were clinically examined specially for anaemia, jaundice, caecal gurgling, hepatosplenomegaly in both the groups and the relevant investigations were performed. It was found that 46 patients in group A, who took oral levofloxacin, were cured after seven days, whereas 48 patients in group B were fully cured by taking injectable levofloxacin by seven days. In this study, levofloxacin was found to be the most effective drug in both oral and injectable form in one-week treatment of uncomplicated typhoid.

Preparation and characterization of nanometric Mn ferrite via different methods

The structure and magnetic properties of MnFe(2)O(4) ferrites have been investigated using five different preparation methods, including the ceramic technique, flash combustion, co-precipitation, sol-gel and citrate methods. The characteristics of one sample prepared by different methods have been studied to select the better method, i.e. the one that is the simplest and does not require an elaborate instrumental set-up. The results indicated that the citrate method gives the lowest value for the lattice parameter and particle size (14.1 nm), while the highest values are obtained with the ceramic method. The smallest nanosizes were obtained in the citrate and flash methods (14.1 and 40.7 nm, respectively).

Effect of daily repetitive transcranial magnetic stimulation for treatment of tinnitus: comparison of different stimulus frequencies

We compared the effect of different frequencies of repetitive transcranial magnetic stimulation (rTMS) (1 Hz, 10 Hz, 25 Hz and sham (occipital, 1 Hz)), given daily over the left temporoparietal cortex for 2 weeks, on 66 patients with chronic tinnitus randomly divided into four treatment groups. Patients were assessed using the Tinnitus Handicap Inventory, self-ratings of symptoms and audiometric measures of residual inhibition before, immediately after 2 weeks' treatment and monthly thereafter for 4 consecutive months.

RESULTS

There were no significant differences in basal measures between the four groups of patients. A two-factor ANOVA revealed a significant "rTMS" x "time" interaction for all measures. This was because real rTMS produced greater improvement than sham. However, there was no significant difference between the responses to different frequencies of rTMS. The response to rTMS depended on the duration of tinnitus: patients who had tinnitus for the longest period of time were the least likely to respond to treatment.

CONCLUSION

Daily sessions of rTMS over the temporoparietal cortex may be a useful potential treatment for tinnitus.

Platelet aggregation and physiological anticoagulants in sickle-cell disease

During the period January 2002-December 2004, we assessed 30 sickle-cell anaemia patients admitted to hospital in Al Khobar with vaso-occlusive crisis for levels of antithrombin (AT) III, protein C (PC) and protein S (PS). We also did platelet aggregation studies. Steady state levels were assessed during follow-up and compared with 36 adult controls. Levels of PC, PS and AT III in the control group were significantly higher than in those in vaso-occlusive crisis and those in steady state (P < 0.001). There was a statistically significant difference between controls and patients for all platelet aggregation factors except adrenaline. There was no significant difference between the levels of PC, PS, AT III and platelet aggregation variables in patients in the steady state and in vaso-occlusive crisis.

Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain

BACKGROUND AND OBJECTIVE

A single session of repetitive transcranial magnetic stimulation (rTMS) over motor cortex had been reported to produce short term relief of some types of chronic pain. The present study investigated whether five consecutive days of rTMS would lead to longer lasting pain relief in unilateral chronic intractable neuropathic pain.

PATIENTS AND METHODS

Forty eight patients with therapy resistant chronic unilateral pain syndromes (24 each with trigeminal neuralgia (TGN) and post-stroke pain syndrome (PSP)) participated. Fourteen from each group received 10 minutes real rTMS over the hand area of motor cortex (20 Hz, 10x10 s trains, intensity 80% of motor threshold) every day for five consecutive days. The remaining patients received sham stimulation. Pain was assessed using a visual analogue scale (VAS) and the Leeds assessment of neuropathic symptoms and signs (LANSS) scale, before, after the first, fourth, and fifth sessions, and two weeks after the last session.

RESULTS

No significant differences were found in basal pain ratings between patients receiving real- and sham-rTMS. However, a two factor ANOVA revealed a significant "+/- TMS" x "time" interaction indicating that real and sham rTMS had different effects on the VAS and LANSS scales. Post hoc testing showed that in both groups of patients, real-rTMS led to a greater improvement in scales than sham-rTMS, evident even two weeks after the end of the treatment. No patient experienced adverse effects.

CONCLUSION

These results confirm that five daily sessions of rTMS over motor cortex can produce longlasting pain relief in patients with TGN or PSP.

Placental pathology in relation to the White's classification of diabetes mellitus

The objective of this study was to investigate various macroscopic and microscopic features of the placenta in pregnancies complicated by diabetes according to White's classification. A total of 148 placentas were studied. Sixty-five were from control patients and 83 from diabetic mothers. The diabetic mothers were further divided into three groups according to White's classification. There were 40 cases in White's group A and 36 cases in White's group B. There were 7 cases in White's groups C and D combined. Advanced maternal age and grandmultiparity were significantly higher in White A, White B and White C&D compared to the normal group. Mean weight of the mother was higher in White group A and group B compared to the control group and group C&D. The placental weight and neonatal weight were increased provided the diabetes was not complicated by vascular disease. With accompanying vascular disease the placental weight and neonatal weight were reduced compared to the controls. As a result of increased perinatal jeopardy the rate of operative delivery was higher in diabetic mothers. No major difference was observed in microscopic changes of placentas in different groups according to White's classification and the normal group.

Frequency of ABO blood groups in the Eastern region of Saudi Arabia

OBJECTIVE

To document the frequency of the ABO and Rhesus blood groups in Saudi male donors, and to compare our results with the results of other studies in the Kingdom and elsewhere.

METHODS

This study included a total of 57396 male potential blood donors; 19496 blood donors between the years 1985-1989 (referred to as first period of study) and 37700 blood donors between the years 1995-1999 (2nd period). The blood donors were Saudis, coming to donate blood for various reasons to the Blood Bank Department of King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. ABO and Rhesus blood groups from 200 Saudi females were also determined. The frequency of ABO blood groups and Rhesus status were calculated separately.

RESULTS

Our results revealed the most common blood group was O, (52%) during the first period of study and likewise the most common blood group (51%) during the 2nd period. The lowest blood group frequency was AB (4%) and (4%) during the first and 2nd period. Rhesus positive blood donors comprised 93% and Rhesus-negative donors were 7% during the first period, while they amounted to 91.5% and 8% during the 2nd period. Overall frequency of ABO and Rhesus blood groups during the 2 periods were the following: O-positive 48% and 46%; A-positive 24% and 24.5%; B-positive, 17% and 17%; AB positive 4% and 4%; O negative 4% and 5%; A negative 2% and 2%; B-negative 1% and 2%; and AB negative, 0.23% and 0.32%. Comparison of our results with the other studies from the Kingdom and other nationalities is also presented.

CONCLUSION

Our results show that the most frequent blood group in Saudis is O-positive. Blood group A is observed at a lower frequency relative to values from Western populations, whereas a significant increase in blood group B combined with a slight increase in blood group AB was recorded. Knowledge of the frequencies of the different blood groups in Saudi Arabia is very important for Blood Banks and transfusion service policies. Knowledge of blood group phenotype distribution is also important for clinical studies (for example disease association), as well as for population studies.

Ulcerative colitis in Saudi Arabia: a retrospective analysis of 33 cases treated in a regional referral hospital in Gizan

BACKGROUND

Until recently ulcerative colitis (UC) was considered rare among Arabs. Information on its occurrence among Saudi is scant and limited to a few reports from urban populations.

AIM OF STUDY

to assess the frequency and clinico-pathologic pattern of this disease in a rural population in Gizan region, Saudi Arabia.

METHODS

thirty three patients found to have UC over a 4-year period in King Fahad Central Hospital were analyzed retrospectively.

RESULTS

there were 24 males and nine females patients with UC (ages ranged from 17-70 years, mean age 43.5 years). The commonest presenting symptoms were abdominal pain and diarrhea in 30 and 26 patients respectively. Extra-intestinal manifestations were rare, occurred in only two patients. Total or pancolitis was found in ten (30%) patients and it was severe in nine of them. The disease extended to the splenic flexure in eight (24.2%) of the patients. A total colectomy was required in one patient with severe pan-colitis and a focus of malignancy was present in the resected specimen. No patient died during the follow-up period that ranged from one to six years.

CONCLUSION

the study confirmed the occurrence of UC among the rural population studied. The male preponderance, the older age at presentation and relatively milder diseases appeared to be differentiating features from the pattern among western populations.

Familial thrombocytosis as a recessive, possibly X-linked trait in an Arab family

Familial thrombocytosis (FT) has previously been described as an autosomal-dominant disorder with manifestations similar to those of sporadic essential thrombocythaemia. We studied an Arab family consisting of four brothers, aged 4-8 years, who had either sustained markedly elevated (> 1000 x 109/l) or moderately elevated (> 500 x 109/l) platelet counts, two healthy sisters and their parents who had normal platelet counts. The four brothers with FT had normal plasma thrombopoietin levels and are currently not presenting with any thrombotic or haemorrhagic complications. Mutation analysis at the thrombopoietin gene (THPO) of the affected family members failed to detect the intron 3 G-->C splice mutation that had been described as causing FT. In addition, segregation analysis using a polymorphic CA marker revealed completely discordant THPO alleles among the affected brothers. We postulate the existence of a new locus for FT whereby the disease is transmitted as a recessive, possibly X-linked trait.

The status of rubella immunity among pregnant women in Kuwait: screening in childbearing age should be reintroduced

The objective of this study was to investigate the immunity against rubella in the obstetric population in Kuwait by testing 600 pregnant women at a prenatal clinic, using the haemagglutination inhibition technique. In addition, a comparison was made between this study and one done in 1978 at the same clinic; its relation to the vaccination programme is also discussed. 7.7% of the population under study were non-immune. Statistically significant effect was demonstrated for maternal age but not for parity and nationality. Though it has been almost 20 years since an intense rubella vaccination programme was implemented, the percentage of non-immune pregnant women has not decreased. In Kuwait, termination of pregnancy for congenital rubella syndrome is prohibited. As a result, it is recommended that women be screened and vaccinated at the time of marriage.

Middle cerebral artery to umbilical artery resistance index ratio in the prediction of neonatal outcome

OBJECTIVE

The objectives of this study were to evaluate the usefulness of the middle cerebral artery to umbilical artery resistance index ratio (C/U ratio) as a predictor of adverse perinatal outcome, and to show that the absence of fetal umbilical artery end-diastolic velocity (AEDV) in SGA fetuses is associated with high morbidity and mortality.

METHOD

In this prospective study, color Doppler flow imaging was used for the estimation of the C/U ratio in fetuses that were small for their gestational age, in 70 singleton pregnancies between 29 and 42 weeks of gestation. The subjects were categorized into two groups, with Group A consisting of 35 small for gestational age (SGA) fetuses with a normal C/U ratio (1.05 or higher), and Group B comprising 35 SGA fetuses with an abnormal C/U ratio (below 1.05).

RESULT

The mean C/U ratio values for birth weight and gestational age were higher in group A than in group B. Fetuses born to mothers in group B stayed longer in the neonatal special care unit (NSCU), whereas the period from ultrasound examination to delivery was higher in the cases in group A. A higher percentage of mothers with an abnormal C/U ratio underwent cesarean section. Fetuses with an absent end-diastolic velocity of the umbilical artery had a higher morbidity. Three stillbirths occurred in fetuses with an absent end-diastolic velocity of the umbilical artery.

CONCLUSION

Our results suggest that the C/U ratio is a good predictor of neonatal outcome, and could be used to identify fetuses at risk of morbidity and mortality. Fetal umbilical artery AEDV with intrauterine growth restriction is associated with high perinatal morbidity and mortality.

Nutritive value of traditional sweets consumed in the Arab Gulf countries

Proximate, mineral, fatty acid and cholesterol composition of eight traditional sweets commonly consumed in the Arab Gulf countries were determined. Four sweets were obtained from Bahrain, whereas the other sweets were obtained from Oman. Protein level ranged from 0.2 to 9.0%, while the fat content ranged from 7.9 to 18.0%. In general, the sweets were found to be high in energy content but poor in most minerals. Iron and zinc contents were low (less than 2 and less than 1 mg/100 g for iron and zinc, respectively). Cholesterol was high in four sweets (range from 10.6 to 20.4 mg/100 g), mainly because of the use of animal fat in preparation of these sweets. The fatty acids profiles showed that palmitic and oleic acids were predominant. One sweet (eggbaith) was found to be very high in linoleic (42%) and low in palmitic (9.6%) acids. The study showed that some traditional sweets are nutritious, while others should be consumed with moderation.

Cytogenetics of the Anopheles gambiae complex in Sudan, with special reference to An. arabiensis: relationships with East and West African populations

The species composition of malaria vector mosquitoes belonging to the Anopheles gambiae complex (Diptera: Culicidae) from >40 localities in Sudan, representing most ecological situations, was determined by analysis of ovarian polytene chromosomes. Of 2162 females, 93% were identified as An. arabiensis Patton and 7% were An. gambiae Giles sensu stricto. No hybrids were found between the two species. Anopheles arabiensis occurred in all but two sites, whereas An. gambiae s.s. was effectively limited to the southernmost, more humid localities. For chromosomal paracentric inversions, the degree of polymorphism was low in An. gambiae s.s. (inversions 2La, 2Rb and 2Rd), higher in An. arabiensis (inversions Xe, 2Ra, b, bc, d1, s; 3Ra, d). Anopheles gambiae samples from Sudan were all apparently panmictic, i.e. they did not show restricted gene flow such as observed among West African populations (interpreted as incipient speciation). Chromosomal inversion patterns of An. gambiae in southern Sudan showed characteristics of intergrading Savanna/Forest populations similar to those observed in comparable eco-climatic situations of West Africa. Anopheles arabiensis was polymorphic for inversion systems recorded in West Africa (2Ra, 2Rb, 2Rdl, 3Ra) and for a novel 2Rs polymorphism, overlapping with inversion systems 2Rb and 2Rd1. Samples carrying the 2Rs inversion were mostly from Khashm-el-Girba area in central-eastern Sudan. In the great majority of the samples all polymorphic inversions were found to be in Hardy-Weinberg equilibrium. Sudan populations of An. arabiensis should therefore be considered as generally panmictic. Anopheles arabiensis shows more inversion polymorphism in west than in east African populations. Sudan populations have more evident similarities with those from westwards than those from eastwards of the Great Rift Valley. The possible influence of the Rift on evolution of An. arabiensis is discussed.