Exopolysaccharide-producing bacterial cultures of Bacillus cereus and Pseudomonas aeruginosa in soil augment water retention and maize growth

Land productivity in arid and hot climate regions is constrained by water scarcity due to low rainfall and organic matter, which limit both soil-water retention and crop yields. Main objective of this research was to explore the potential of exopolysaccharide (EPS) producing bacteria screened from different soils for enhancing soil-water retention, phosphorus solubilization and maize growth. Twelve soil samples were drawn from diverse ecologies (sub-humid and arid) to isolate EPS-producing bacteria (EPB), and cultured on LB and Pikovskaya media. Nine bacterial strains were found to have EPS production characteristic; among from them, 2 most efficient EPB strains were selected and characterized through morphological, biochemical and molecular standard procedures of bacterial identification. These potent EPB-strains were characterized as Pseudomonas aeruginosa EPB9 and Bacillus cereus EPB17. Broth cultures of 2 and 10 days old (2d and 10d) both EPB strains were used as soil inoculant to grow maize in growth chamber under triplicated factorial CRD. Treatments were: Control, LB broth (without inoculum), EPB9-2d, EPB9-10d, EPB17-2d, and EPB17-10d inoculation in both non-stressed and drought-stressed soils. Experiment lasted for 24 days, when soil and plant leaf water contents, plant growth attributes and antioxidant enzymes were measured. Inoculation of both EPB strains significantly enhanced maize growth and soil-water retained until harvesting stage. Higher water contents in soil and plant leaves, as well as fresh shoot and root weight were with EPB9-10d. Plant leaf area and shoot length were greater with EPB17-10d inoculation. Bacterial EPS also caused higher protein and sugar, and lower proline contents in plants. Antioxidant enzymes (SOD, POD and CAT) remained lower with both EPB treatments due to reduced drought stress than in control. It was evident that efficient EPB strains could survive even under osmotic stress, and retain more soil-water for longer time. Further, antioxidant enzymes and EPS interact together for drought tolerance and growth promotion of plants. Therefore, study concludes that under limited water conditions, soil inoculation with bacterial cultures having the characteristics of greater EPS production and antioxidative enzyme system bears the potential of improving land productivity.

Enhancing Radar Echo Extrapolation by ConvLSTM2D for Precipitation Nowcasting

Precipitation nowcasting in real-time is a challenging task that demands accurate and current data from multiple sources. Despite various approaches proposed by researchers to address this challenge, models such as the interaction-based dual attention LSTM (IDA-LSTM) face limitations, particularly in radar echo extrapolation. These limitations include higher computational costs and resource requirements. Moreover, the fixed kernel size across layers in these models restricts their ability to extract global features, focusing more on local representations. To address these issues, this study introduces an enhanced convolutional long short-term 2D (ConvLSTM2D) based architecture for precipitation nowcasting. The proposed approach includes time-distributed layers that enable parallel Conv2D operations on each image input, enabling effective analysis of spatial patterns. Following this, ConvLSTM2D is applied to capture spatiotemporal features, which improves the model's forecasting skills and computational efficacy. The performance evaluation employs a real-world weather dataset benchmarked against established techniques, with metrics including the Heidke skill score (HSS), critical success index (CSI), mean absolute error (MAE), and structural similarity index (SSIM). ConvLSTM2D demonstrates superior performance, achieving an HSS of 0.5493, a CSI of 0.5035, and an SSIM of 0.3847. Notably, a lower MAE of 11.16 further indicates the model's precision in predicting precipitation.

Effectiveness of functional electrical stimulation machine in managing neurological diseases - A retrospective study

Background & Objective

Cerebrovascular Accident (CVA) or stroke, Spinal Cord injury can lead to neurological diseases resulting in major loss in motor function causing hemiplegia or tetraplegia. In 2019, according to The Global Burden of Diseases (GBD) CVA/Stroke is the second leading cause of death and the third leading cause of death and disability combined, globally. Its prevalence vary drastically among South Asian countries. The objective of this study was to determine the effectiveness of Functional Electrical Stimulation (FES) machine on neurologically impaired patients at the Physical Therapy department at IHHN, Karachi, Pakistan.

Method

In this retrospective study data was extracted from August 2016 to February 2022 on patients with neurological symptoms i.e. hemiplegia or paraplegia with muscle power of two or less on Manual Muscle Testing (MMT). The parameters for evaluating patients progress pre and post treatment were MMT results and their mobility status. The number of sessions ranged between 40 to 100 sessions of Functional Electrical Stimulation (FES) provided on alternate days according to the patient's need.

Result

Data of 51 patients who had completed their treatment were extracted and analyzed. The mean age of patients who completed treatment was 49.62 ± 17.26 years. Out of 51(100%), 30 (58.8%) were male and 21 (41.2%) were female. Pre- and post-treatment median (IQR) showed remarkable improvement in MMT of upper limb muscle (from 1.0 to 4.0) and lower limb muscle (from 2.0 to 4.0).

Conclusion

FES cycling is an effective treatment for patients with neurological impairments, as it resulted in improvement in both upper and lower limb muscle strength, along with mobility status.

The impact of climate change on the lives and livelihoods of readymade garment (RMG) workers: an exploratory study in selected readymade garment factories in Bangladesh

BACKGROUND

There is a paucity of resources focusing on the climate change experience of readymade garment (RMG) workers in developing countries such as Bangladesh. Therefore, this mixed method approach aims to understand the distinctive types of climate change experiences from a health and occupational perspective, along with the consequences of these changes among RMG workers in Bangladesh.

METHODS

The study was conducted from January 2022 and February 2022 where the quantitative data were collected from 200 RMG workers in 10 randomly selected garments and two focus group discussions took place with 20 conveniently selected RMG workers. The key informants were relevant stakeholders in the industry. Quantitative findings were reported using descriptive methods and qualitative findings were analysed using a content analysis approach.

RESULT

A total of 200 RMG workers were included in the study of which the majority belonged to the age group of 26-30 years (44%), were male (55%), worked in a compliant factory (70%), and were machine operators (79%). Half of the respondents experienced damage from natural disasters (51%), but only approximately 37% received humanitarian help. Migration and urbanisation were among the aftermath of the damage caused by e natural disasters, and 42% were forced to shift their homes due to natural disasters. Competition in the job market increased, and the owners had the opportunity to take on employees at a reduced salary. The respondents flagged climate change as a major contributor to their disease patterns. More than three-quarters of the respondents became sick because of increased heat while working; however, only half received any treatment.

CONCLUSION

Employee participation in hazard recognition, employer preparedness, prevention through design, research, surveillance, and upholding workplace ethics and standards can be the answers to climate change problems for readymade garment workers.

Burden of mental disorders by gender in Pakistan: analysis of Global Burden of Disease Study data for 1990-2019

AIMS AND METHOD

We aimed to examine the burden of mental disorders in Pakistan over the past three decades. We used the crude data of disability-adjusted life-years (DALYs) obtained from the Global Burden of Disease Study database (1990-2019) to represent burden. Data were retrieved on 26 January 2021. Data for adults of reproductive age (aged 15-49 years) were analysed to discuss and interpret the disease burden. An analysis was conducted on total DALYs separately for the genders for ten mental disorders reported in Pakistan.

RESULTS

DALYs increased drastically with the onset of reproductive age. Depressive disorder was the most reported mental disorder, contributing 3.13% (95% CI 2.25-4.24) of total DALYs, and varied significantly between genders: females 3.89% (95% CI 2.73-5.29) versus males 2.37% (95% CI 1.62-3.25).

CLINICAL IMPLICATIONS

A nationwide high-quality epidemiological surveillance system should be implemented to monitor mental disorders and offer culturally appropriate preventive services.

Ultrasound simulation training to meet the 2021 Royal College of Radiologists' curriculum for radiology trainees: South East London experience

AIM

To enhance ultrasound teaching delivery to radiology trainees using a simulation course matched to the 2021 Royal College of Radiologists (RCR) curriculum.

MATERIAL AND METHODS

An ultrasound simulation training course was designed for specialty trainees (ST) 1 in radiology, which was based on the 2021 RCR curriculum and covered the top ultrasound training priorities. The course was piloted initially on two occasions in a 1-day format to the August 2021 and the March 2022 ST1 intake trainees. Based on the feedback, a comprehensive 4-day course was developed and delivered between October and December 2022 for the August 2022 ST1 intake, funded by Health Education England. The outcomes measured were subjective trainee feedback using numerical scores and free text.

RESULTS

All King's College Hospital NHS Foundation Trust radiology ST1 trainees from the August 2021 to the August 2022 intake participated in ultrasound simulation training. The training matched the RCR curriculum and increased the trainees' confidence and competency in medical ultrasound.

CONCLUSIONS

Ultrasound simulation training can be successfully delivered to ST1 trainees to match the 2021 RCR curriculum and enhance training in medical ultrasound for radiologists.

How to eradicate polio in Pakistan: Insights from community health workers

Pakistan, along with Afghanistan, is one of two countries where wild poliovirus is still endemic. Frontline workers (FLWs) are the staff most intimately familiar with both implementation challenges and community context. Harnessing their expertise may be a way to improve the community-polio program interface, which has been a persistent and shifting challenge in polio-endemic areas of both countries. From 2020-2022, we engaged frontline workers in 18 Super High-Risk Union Councils (SHRUCs) in Pakistan through a Human-Centered Design ideas competition. In that competition, teams of polio FLWs identified the most significant barriers they faced in conducting their work, and suggested solutions to those problems-a window into the issues the program faces by the people who know it best. The suggestions of FLWs on how to eradicate polio fell into four main categories. First, there were suggestions to tackle community fatigue by reducing touchpoints, particularly visits solely for data collection. Second, there were calls to improve Primary Health Care in SHRUCs, as a way of addressing community frustrations over an intense focus on just one disease in the context of numerous acute needs. Third, there were suggested ways to increase community engagement through locally relevant channels. Finally, many workers suggested improvements to Human Resources processes and workplace dynamics. Across these ideas, one repeated concept is the need for balance between the intensity of polio activities required for eradication and the provision of other government services, including health services. FLWs engaged the process deeply, providing well thought out problem statements and ideas for change. It is our view that there is no one more qualified to speak to the issues on the ground than FLWs. There are critical insights available if we listen to people who are instrumental to the success of health programs, but not commonly involved with creating policy.

Correction: Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries

[This corrects the article DOI: 10.1371/journal.pgph.0001205.].

The Outcome Of Pedicled Medial Sural Artery Perforating Flap For Proximal Leg Reconstruction

BACKGROUND

Reconstruction of defects around the knee and proximal leg are difficult to reconstruct. Out of the multiple flaps described for reconstruction, the pedicled Medial Sural Artery Perforating Flap (MSAP) has recently gained popularity. We conducted this study to assess the clinical outcomes of pedicled MSAP for this purpose at our hospital.

METHODS

A descriptive case series was conducted from April 2022 to March 2023. All patients above 18 years with defects around the knee and proximal leg were included. Patients with tissue loss in the calf area were excluded.

RESULTS

A total of 14 patients were included. Twelve (86%) were males, while only 2 were females (14%). The mean age was 33.5 years (±8.76). The most common cause of the defect was trauma (n=11, 85%). The Mean distance of the distal-most perforator from the popliteal crease was 12.714 (±1.990) cm (range 9-16 cm). It was observed that the most distal perforator is usually present in a 2 cm radius of the medial musculo-tendinous junction of the gastrocnemius. Complications were seen in 2 (14%) patients. The mean duration of hospital stay was 4.2 (±0.96) days. Patients were followed up weekly for the first two weeks and then at 1, 3 and 6 months.

CONCLUSIONS

MSAP Flap is a reliable thin, long pedicled fasciocutaneous flap with low donor site morbidity and aesthetically good results for reconstruction around the knee and proximal leg.

Low back pain among professional bus drivers: a cross-sectional study from Bangladesh

BACKGROUND

Low back pain (LBP) is a common condition contributing to impaired quality of life among professional vehicle drivers. Our study aimed to assess LBP prevalence and associated factors among professional bus drivers in Bangladesh.

METHODS

A cross-sectional study was conducted among 368 professional bus drivers using a semi-structured questionnaire. A Nordic Musculoskeletal Questionnaire (NMQ) subscale was used to measure LBP. Multivariable logistic regression analysis was used to identify the factors associated with LBP.

RESULTS

In the last month, 127 (34.51%) participants reported experiencing pain or discomfort in the lower backside. Multivariable logistic regression analysis showed that age of more than 40 years (adjusted odds ratio (aOR): 2.07, 95% confidence interval (CI): 1.14 to 3.75), the income of more than 15,000 BDT per month (aOR: 1.91, 95% CI: 1.11 to 3.26), work duration more than ten years (aOR: 2.53, 95% CI: 1.12 to 5.70), working more than 15 days per month (aOR: 1.93, 95% CI: 1.02 to 3.65), working more than 10 h per day (aOR: 2.46, 95% CI: 1.05 to 5.75), poor condition of the driving seat (aOR: 1.80, 95% CI: 1.08 to 3.02), current smoking habit (aOR: 9.71, 95% CI: 1.25 to 75.15), illicit substances use (aOR: 1.97, 95% CI: 1.11 to 3.48), and four hours or less sleeping time per day (aOR: 1.83, 95% CI: 1.09 to 3.06) were positively associated with LBP.

CONCLUSION

The high burden of LBP among the participants calls for a focus on this vulnerable group's occupational health and safety, with particular emphasis on implementing standard measures.

Frequency of abnormal Pap smear in patients presenting with postcoital bleeding in Tertiary Care Hospital, Karachi, Pakistan

Postcoital bleeding increases the chance of detecting cervical dysplasia and cancer; and the Pap smear is the recommended screening test in these patients. We conducted a cross-sectional study that included 110 women to find out the frequency of abnormal Pap smear in such patients. Their age range was 15-65 years with a mean age of 31.2 ± 11.2 years. Abnormal Pap smear was found in 54 (49%) women. Atypical squamous cells of unknown significance (ASCUS) were found in 13.6%, low-grade squamous intraepithelial lesion (LSIL) in 20.9%, high-grade squamous intraepithelial lesion (HSIL) in 11.8% and carcinoma in 2.7% of those. Because of the high frequency of abnormal Pap smear associated with postcoital bleeding in our population, cervical screening and strict monitoring are suggested as the important screening indications.

"Walking on eggshells": experiences of underrepresented women in medical training

INTRODUCTION

Medicine remains an inequitable profession for women. Challenges are compounded for underrepresented women in medicine (UWiM), yet the complex features of underrepresentation and how they influence women's career paths remain underexplored. This qualitative study examined the experiences of trainees self-identifying as UWiM, including how navigating underrepresentation influenced their envisioned career paths.

METHODS

Ten UWiM family medicine trainees from one Canadian institution participated in semi-structured group interviews. Thematic analysis of the data was informed by feminist epistemology and unfolded during an iterative process of data familiarization, coding, and theme generation.

RESULTS

Participants identified as UWiM based on visible and invisible identity markers. All participants experienced discrimination and "otherness", but experiences differed based on how identities intersected. Participants spent considerable energy anticipating discrimination, navigating otherness, and assuming protective behaviours against real and perceived threats. Both altruism and a desire for personal safety and inclusion influenced their envisioned careers serving marginalized populations and mentoring underrepresented trainees.

DISCUSSION

Equity, diversity, and inclusion initiatives in medical education risk being of little value without a comprehensive and intersectional understanding of the visible and invisible identities of underrepresented trainees. UWiM trainees' accounts suggest that they experience significant identity dissonance that may result in unintended consequences if left unaddressed. Our study generated the critical awareness required for medical educators and institutions to examine their biases and meet their obligation of creating a safer and more equitable environment for UWiM trainees.

First report of Fusarium sporotrichioides causing Fusarium fruit rot on peaches in Pakistan

Peach (Prunus persica) is an important stone fruit crop cultivated on 14,350 hectares in temperate areas of Pakistan, where post-harvest fungal rots cause major economic losses for growers. During April-August 2019, rotted peaches were observed in fruit markets of Rawalpindi district (33° 37' 33.8052'' N and 73° 4' 17.1912'' E), Punjab Province, Pakistan. Symptomatic fruit were surface sterilized for 3 min in 0.5% NaClO and 1 min in 70% ethanol, then rinsed three times in sterilized distilled water and air-dried for 30 minutes on filter paper. Tissue segments were excised from the margins of rot lesions and placed on potato dextrose agar (PDA), followed by incubation for one week at 25 +1o C. Furthermore, to maintain original sporodochial morphology and conidial description tissue segments were also grown on carnation leaf agar (CLA) and synthetic nutrient agar (SNA) (Sever et al., 2012). A total of 22 isolates were obtained from different fruit markets; colonies were fast-growing with pinkish-white, fluffy mycelia. Microconidia were abundant, 7.5 to 11.3 × 2.1 to 4.1 μm, oval to spindle-shaped, thin-walled, and hyaline whereas, macroconidia were thick-walled, sickle-shaped, 5- to 7-septate, hyaline, and 23.5 to 39.7 × 3.7 to 7.0 μm on carnation leaf agar. Virulence intensity of fungal isolates was confirmed after pathogenicity. Based on morphological characteristics, isolates were identified provisionally as Fusarium sporotrichioides (Leslie and Summerell 2006). For molecular identification, three target gene regions (ITS, elongation factor (EF), and β-tubulin benA) were amplified for highly pathogenic fungal isolates (FUS21K, FUS9SM, and FUS63KP) (O'Donnell et al. 2015). BLAST searches of the obtained sequences indicated 100% homology with GenBank accession number MN452643, and 99.56% homology with MT635298 for the ITS region, similarly 100% identity with GenBank accession numbers MN555016, MN555126, and MN555037 for the EF gene, and 100% homology with GenBank accession numbers MK435577, MH791363, and GQ915448 for β-tubulin benA of the F. sporotrichioides species complex (O'Donnell et al. 2015). Sequences were deposited in GenBank; accession numbers for each gene were as follows: ITS, ON180670, ON180671, and ON180672; EF, ON312093, ON312094, and ON312095; and β-tubulin benA, ON312090, ON312091, and ON312092. Maximum likelihood analysis on RPB1 and RPB2 nucleotide sequences of various fusaria was conducted which revealed that F. sporotrichioides formed a monophyletic relationship to terminal fusarium clade (TFC) comprising 22 strongly supported species complexes and 10 monotypic lineages, which were provisionally recognized as Fusarium. To complete Koch's postulates, 10μl aliquots of spore suspensions (106 spores/ml) of each FUS21K, FUS9SM and FUS63KP were pipetted individually onto six ripe, asymptomatic peaches. Sterile distilled water was applied as a negative control on four fruit. Fruit were incubated at 25 ± 1°C for one week in a sterile moist chamber, and the trial was conducted three times. Rot symptoms associated with pinkish-white fluffy mycelia were observed on inoculated fruits after 72 hours, whereas no mycelium was observed on the negative controls. The cultures on PDA, CLA and SNA from each of the inoculated fruit were morphologically identical to the original culture. The pathogen was confirmed as a member of F. sporotrichioides species complex based on pinkish-white mycelium, with red color on the underside of petri plates and the manner in which conidia are born on conidiophores. This is the first report of F. sporotrichioides on peaches from Pakistan, providing an important foundation for peach growers, agricultural advisers, plant pathologists, and plant breeders to improve the management of this economically damaging disease.

Heterologous expression of cry1Ia12 insecticidal gene in cotton encodes resistance against pink bollworm, Pectinophora gossypiella (Lepidoptera: Gelechiidae); an alternate insecticidal gene for insect pest management

BACKGROUND

Cotton is continuously exposed to sucking and chewing insect pest pressure since emergence to harvesting. Pink bollworm (Pectinophora gossypiella) has become major chewing insect pest to reduce the cotton yield and results in bad lint quality even in transgenic crops. The efficiency of insecticidal genes has been compromised due to extensive utilization of transgenic crops.

METHODS AND RESULTS

The present study was conducted to evaluate the efficacy of an alternate cry1Ia12 insecticidal gene against pink bollworm (PBW) in cotton. Agrobacterium tumefaciens strain LBA4404 harboring pCAMBIA2300 expression vector containing cry1Ia12 gene under the control of 35S CaMV was used to transform a local cotton cultivar GS-01. The various molecular analyses revealed the transgene integration and expression in primary transformants. Among five selected transgenic plants, tcL-08 showed maximum (16.06-fold) mRNA expression of cry1Ia12 gene whereas tcL-03 showed minimum (2.33-fold) expression. Feeding bioassays of 2nd and 3rd instar pink bollworm (PBW) larvae on immature cotton bolls, flowers and cotton squares revealed up to 33.33% mortality on tcL-08 while lowest mortality (13.33%) was observed in tcL-03 and tcL-15. Furthermore, the average weight and size of survived larvae fed on transgenic plants was significantly lesser than the average weight of larvae survived on non-transgenic plants.

CONCLUSIONS

The present study suggests the cry1Ia12 gene as an alternate insecticidal gene for the resistance management of cotton bollworms, especially PBW.

Fintech Growth during COVID-19 in MENA Region: Current Challenges and Future prospects

In the wake of ongoing challenges faced by the disruption of COVID-19, the current study attempts to investigate fintech growth during COVID-19 in the Middle East and North African (MENA) region. The study applies descriptive analysis, content analysis, and keyword selection criteria to segregate current challenges and future prospects of fintech growth in the MENA region. Our study comprises 250 research articles, web reports, news articles, opinion papers, and commentaries. The study reported privacy issues, cybercrimes, financial disruption and instability, exploitation of social norms and values, rising inequalities, and non-compliance of regulatory authorities as major challenges posed by fintech startups in the MENA region. On the contrary, the future prospects of FinTech growth in the MENA region are employment opportunities, decentralization, cost-effectiveness, financial outreach, networking, and breaking traditional financial biases. The study recommended multiple implications for policymakers, regulation bodies, countries in the MENA region, and fintech developers.

Prostate cancer therapy personalization via multi-modal deep learning on randomized phase III clinical trials

Prostate cancer is the most frequent cancer in men and a leading cause of cancer death. Determining a patient's optimal therapy is a challenge, where oncologists must select a therapy with the highest likelihood of success and the lowest likelihood of toxicity. International standards for prognostication rely on non-specific and semi-quantitative tools, commonly leading to over- and under-treatment. Tissue-based molecular biomarkers have attempted to address this, but most have limited validation in prospective randomized trials and expensive processing costs, posing substantial barriers to widespread adoption. There remains a significant need for accurate and scalable tools to support therapy personalization. Here we demonstrate prostate cancer therapy personalization by predicting long-term, clinically relevant outcomes using a multimodal deep learning architecture and train models using clinical data and digital histopathology from prostate biopsies. We train and validate models using five phase III randomized trials conducted across hundreds of clinical centers. Histopathological data was available for 5654 of 7764 randomized patients (71%) with a median follow-up of 11.4 years. Compared to the most common risk-stratification tool-risk groups developed by the National Cancer Center Network (NCCN)-our models have superior discriminatory performance across all endpoints, ranging from 9.2% to 14.6% relative improvement in a held-out validation set. This artificial intelligence-based tool improves prognostication over standard tools and allows oncologists to computationally predict the likeliest outcomes of specific patients to determine optimal treatment. Outfitted with digital scanners and internet access, any clinic could offer such capabilities, enabling global access to therapy personalization.

Prostate cancer risk in African American men evaluated via digital histopathology multi-modal deep learning models developed on NRG Oncology phase III clinical trials

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Background: Artificial intelligence (AI) tools can display racial bias as a result of existing systemic health inequities and biased datasets. We have previously developed multi-modal AI (MMAI) prognostic models based on digital pathology images from five phase III randomized radiotherapy prostate cancer trials that outperform NCCN risk groups for prediction of distant metastasis (DM), biochemical failure (BF), prostate cancer-specific mortality (PCSM) and all-cause mortality (OS). In this study, we assessed the algorithmic fairness of the locked MMAI models between African American (AA) and non-AA populations in the five randomized trials. Methods: Patients enrolled in NRG/RTOG 9202, 9408, 9413, 9910, and 0126 with digitized biopsy histopathology slides were included in this study. The locked MMAI models were applied, and subgroup analyses were conducted by comparing distributions of clinical variables and MMAI scores (medians for continuous variables and proportions for categorical variables reported), and evaluating MMAI models’ prognostic ability among AA and non-AA men. The performance of the models were compared using DM as the primary endpoint and secondary endpoints of BF, PCSM, OS (death without an event as a competing risk) with Fine-Gray or Cox Proportional Hazards models. Either Kaplan Meier or cumulative incidence estimates were computed and compared using log-rank or Gray’s test. Results: This study included 5,624 men: 932 (17%) AA, 4503 (80%) white, and 189 (3%) other races. AA had younger median age (69 vs 71 year [yr]), higher median baseline PSA (12 vs 10 ng/mL), more T1-T2a (62% vs 57%), more Gleason < 7 (42% vs 36%) and 8-10 (15% vs 12%), and more NCCN low and high risk (12% vs 10% and 41% vs 33%). AA and non-AA had estimated 5-yr BF rates 27% and 27%, 5-yr DM rates 5% and 5%, 10-yr PCSM 5% and 7%, and 10-yr OS 58% and 60%, respectively. The median (interquartile range) score of the model optimizing for 5-yr DM (5-yr DM MMAI) was 0.044 (0.037–0.059) in AA and 0.043 (0.036–0.057) in non-AA. Similarly, all other MMAI models had differences in the medians between AA and non-AA ranging from 0.001 to 0.02. For all endpoints, the 5-yr DM MMAI model showed strong prognostic signal (hazard ratio [HR] per one standard deviation increase: 1.6 for DM, 1.4 for BF, 1.6 for PCSM and 1.3 for OS, all p-values < 0.001) and had comparable trends within AA vs. non-AA in the entire cohort (e.g., HR for DM 1.4 vs 1.6). Similar results were observed for the MMAI model optimizing for 10-yr PCSM. Conclusions: To our knowledge, this represents the first comparative analyses of a digital pathology AI prognostic model in AA vs. non-AA prostate cancer patients. The prognostic performance of the AI models was found to be comparable between subgroups. Our data supports the use of these models across racial groups, though further validation in AA cohorts is ongoing.

Genetic diversity and marker trait association for phytophthora resistance in chilli

BACKGROUND

Chilli is an important commercial crop with positive returns tendency. Phytophthora root rot causes drastic damage to chilli plant. Dearth of detecting marker trait associations is a major hinderance in practicing marker assisted selection in chilli breeding.

METHODS AND RESULTS

Herein, 110 chilli accessions were assessed for 15 agronomic traits under control and disease infected conditions for two crop seasons (2018-2019). The SSR genotyping revealed high values of major allele frequency (MAF = 0.70), genetic diversity (GD = 0.39) and Polymorphic Information Content (PIC = 0.31). Principal coordinate analysis and population structure analysis showed distribution of diverse genotypes in all groups by dividing 110 genotypes in three populations and nine sub-populations. The UPGMA based Archaeopteryx tree was in concordance with population structure analysis. Linkage disequilibrium analysis evaluated that LD decays within 3-10 bp. Marker trait association (MTA) revealed the associations of 35 SSRs with 14 morphological traits. The significant MTA for marker CAeMS073 with relative leaf damage (RLD, 0.183 R²) under control and treated conditions was consistently observed in both models. The markers, CAMS173 and CAMS194 were found to be strongly associated with RLD and Disease Index (DI), respectively. The absence of MTA was detected for height of first branch.

CONCLUSION

The MTAs reported in this study can facilitate marker assisted breeding for developing chilli germplasm resistant against Phytophthora capsici.

Using infrared spectroscopy to analyze breath of patients diagnosed with breast cancer

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Background: Population-level screening programs aimed at early detection and treatment of breast cancer saves lives. Analyzing breath using infrared spectroscopy offers a highly sensitive, non-invasive, and cost-effective mechanism for identifying exhaled volatile organic chemicals, and it is hypothesized that it may identify differences in the “breathprint” of women with breast cancer relative to those without a breast cancer diagnosis. Methods: Alveolar breath samples (10 L) were collected using a Breathe BioMedical alveolar breath sampler onto Tenax TA sorbent tubes. Corresponding room air samples (10 L) were collected in the same manner. Absorption spectra of the samples at a desorb temperature of 75 °C were measured by infrared cavity ring-down spectroscopy (IR-CRDS), a highly sensitive method of measuring absorption coefficients due to trace volatile organic compounds (VOCs) present in exhaled breath. After subtracting room air absorption and ordering each measured spectrum by increasing wavelength, missing values were imputed using spline interpolation. The absorption spectra were then normalized using one of four techniques: min-max, vector, peak or standard normal variate normalization. The first derivatives of the normalized absorption coefficients (187 values in total) were then used as features for discriminating samples from subjects with breast cancer and controls. The most useful features were selected based on minimum redundancy and maximum relevance (mRMR) and were used to train a linear support vector machine (SVM) classifier. Performance of classification models was estimated based on two data splitting configurations, non-nested leave-one-out cross-validation (LOOCV) and nested LOOCV. These approaches provide upper and lower bounds of expected model performance. Classification performance was used for tuning the number of features included in each model. Results: The analysis of this study is based on the spectra obtained from 70 participants (38 breast cancer and 32 controls), collected at the Saint John Regional Hospital in New Brunswick, Canada. Table below shows the non-nested and nested performance characteristics of classifiers with the best performing normalization technique. The number of features given for the nested model is not an integer as it indicates an average across the cross-validation folds. Conclusions: These results suggest that the classification of alveolar breath using IR-CRDS is a promising technique for the detection of breast cancer. Performance of classification models. AUC is the area under the receiver operator characteristics curve.[Table: see text]

Population diversity of sheep bot fly, Oestrus ovis (Linné, 1758) (Diptera: Oestridae: Oestrinae), using SDS polyacrylamide gel electrophoresis

The study was planned to evaluate the inter, and intra population genetic variation in general protein banding pattern in Oestrus ovis larvae, by using 10% sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE). The larvae were collected from slaughtered goats head from five different locations (AAS, PN, LA, GM, and BC) of Karachi, Pakistan. The data obtained was subjected to POPGENE (Population Genetic Analysis) software for analysis. The polymorphic loci within populations ranged from 45.45% to 90.91%. Polymorphic loci observed in all populations were 90.91%. The expected heterozygosity observed was 0.182 ± 0.096 in all populations. The chi-square test showed 5 out of 11 loci at H-W equilibrium. The overall fixation index (FST) value was 0.108, showing that the likelihood of subpopulations being differentiated from one another is about 11 percent. The gene flow value (Nm = 2.065) was higher, showing that genes flow occurs between populations. The values of genetic identity were greater, and genetic distance were smaller among all the populations, which means that all the populations were more alike and closer to each other. It was concluded that there was no sympatric and parapatric population differentiation observed among all the population of O. ovis and the populations of the five different locations were not genetically and reproductively isolated from each other.

Development and validation of a prognostic AI biomarker using multi-modal deep learning with digital histopathology in localized prostate cancer on NRG Oncology phase III clinical trials

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Background: Prognostication in localized prostate cancer is reliant on non-specific tools, an issue that leads to the over- and under-treatment of patients. Various tissue-based molecular biomarkers have attempted to fill this unmet need, but most lack prospective randomized trial validation. Herein, we train and validate prognostic biomarkers in localized prostate cancer using five phase III randomized trials, by leveraging multi-modal deep learning on digital histopathology. Methods: Histopathology image data was generated from pre-treatment biopsy slides in five NRG Oncology phase III randomized radiotherapy prostate cancer trials (RTOG 9202, 9408, 9413, 9910, and 0126). The trials were randomly split into training (80%) and validation (20%) cohorts. A multi-modal artificial intelligence (MMAI) architecture was developed to take clinicopathologic and image-based (histopathology) data as input and predict binary outcomes. Using this architecture, various models were trained to predict relevant clinical endpoints: biochemical recurrence (BCR), distant metastasis (DM), prostate cancer-specific survival (PCaSS), and overall survival (OS). These models were then validated for measures of prognostic discrimination using the time-based area under the curve (AUC) method. Results: Clinicopathologic and histopathology image data was available for 5,654 of 7,957 eligible patients (71.1%), yielding 16.1 TB of data from 16,204 histopathology slides of pretreatment biopsy samples. After training the models, locking them, and evaluating them on the validation cohort, we found that the MMAI prognostic model had superior discrimination compared to the NCCN model (PSA, T-stage, and Gleason score) for 5-year DM (AUC of 0.84 vs 0.73), 5-year BCR (AUC of 0.69 vs 0.58), 10-year PCaSS (AUC of 0.79 vs 0.66), and 10-year OS (AUC of 0.65 vs 0.58). Within each of the individual trials in the validation cohort, the MMAI-model had superior performance compared to NCCN risk groups for all clinical endpoints. Conclusions: This represents the first ever development and validation of prognostic biomarkers in localized prostate cancer using multiple large phase III clinical trials. We have successfully validated that our MMAI-prognostic biomarkers are superior to standard clinical and pathologic variables in identifying future BCR, DM, PCaSS, and OS. This massively scalable technology is feasible and can help personalize the management of prostate cancer patients. Funding: This project was supported by grants U10CA180868 (NRG Oncology Operations), U10CA180822 (NRG Oncology SDMC), UG1CA189867 (NCORP), U24CA196067 (NRG Specimen Bank) from the National Cancer Institute (NCI).

Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries

In people with TB, co-existence of long-term conditions (e.g., depression, diabetes and HIV) and risk factors (e.g.,alcohol misuse, malnutrition, and smoking) are associated with increased mortality and poor treatment outcomes including delayed recovery, TB treatment failure and relapse. However, it is unclear as to what extent these comorbidities are addressed in TB policy and practice. Between August and October 2021, we conducted an online cross-sectional survey in high-TB burden countries. We recruited a purposive sample of TB health workers, managers, policy makers, advisors and advocates from these countries. The survey enquired about the extent to which various comorbid conditions are: (a) mentioned in TB policies, plans, and guidelines; (b) screened, diagnosed, treated or referred to specialist services by TB healthcare workers. We summarised using descriptive analysis. Of the 1100 potential respondents contacted in 33 countries, 543 responded but only 446 (41%) from 27 countries provided sufficient data for inclusion in the study. We found no notable differences between these providing insufficient data and those completing the survey. HIV, diabetes mellitus, depression and tobacco and alcohol use disorders were identified as the most common and concerning comorbid conditions in TB. HIV was screened for and managed by TB services in most countries. Screening for diabetes and/or tobacco and alcohol use disorders was offered by almost half of all TB services but only a few offered relevant treatments. Depression was rarely screened for, almost never treated, and only infrequently referred to specialist services. Most respondents felt confident in screening/diagnosing these comorbid conditions but not in treating these conditions. With the exception of HIV, chronic comorbid conditions are only partially screened for and rarely managed within TB services. Mental health conditions are for the most part neglected. Given their adverse impact on TB outcomes, integrating screening and management of these comorbidities within TB programmes offers a significant opportunity to meet TB targets, address non-communicable diseases and improve patient well-being.

Gestational Anaemia and its Associated Factors in Normal Pregnant Women

Objectives: To determine the hemoglobin levels in normal pregnant women and investigate the association of anemia with gestational age, number of antenatal visits, obstetrical complications and mode of delivery. Methodology: This is a cross-sectional study conducted at the Lady Willingdon Hospital, Khairpur Mirs, Pakistan from May 2021 to August 2021. A total of 139 normal pregnant women were recruited during antenatal visits. Patients were grouped into normal and anemic groups based on serum hemoglobin levels. Gestational age, obstetrical complications, mode of delivery and fetal outcome were recorded to find its association with anemia. Data was analyzed on SPSS 20.0 and p-value < 0.05 was considered as statistically significant. Results: Out of n=139 normal pregnant women, n=26 women had normal hemoglobin levels, n=49 were mild anemic, n=46 had moderate anemia whereas n=18 had severe anemia. Overall, the prevalence of gestational anemia was 81%. There was significant association between hemoglobin status and number of antenatal visits and complications in previous pregnancies. Hemoglobin status was not significantly associated with gestational age and mode of delivery. Conclusion: In conclusion, we found that gestational anemia is highly prevalent in Pakistan. Early detection of anemia and its correction via supplementations are recommended.

High rate of successful treatment outcomes among childhood rifampicin/multidrug-resistant tuberculosis in Pakistan: a multicentre retrospective observational analysis

Background

There was a complete lack of information about the treatment outcomes of rifampicin/multidrug resistant (RR/MDR) childhood TB patients (age ≤ 14 years) from Pakistan, an MDR-TB 5th high burden country. Therefore, this study evaluated the socio-demographic characteristics, drug resistance pattern, treatment outcomes and factors associated with unsuccessful outcomes among childhood RR/MDR-TB patients in Pakistan.

Methods

This was a multicentre retrospective record review of all microbiologically confirmed childhood RR/MDR-TB patients (age ≤ 14 years) enrolled for treatment at seven units of programmatic management of drug-resistant TB (PMDT) in Pakistan. The baseline and follow-up information of enrolled participants from treatment initiation until the end of treatment were retrieved from electronic nominal recording and reporting system. World Health Organization (WHO) defined criterion was used for deciding treatment outcomes. The outcomes of “cured” and “treatment completed” were collectively grouped as successful, whereas “death”, “treatment failure” and “lost to follow-up” were grouped together as unsuccessful outcomes. Multivariable binary logistic regression analysis was used to find factors associated with unsuccessful outcomes. A p-value < 0.05 reflected statistically significant findings.

Results

A total of 213 children RR/MDR-TB (84 RR and 129 MDR-TB) were included in the study. Majority of them were females (74%), belonged to the age group 10–14 years (82.2%) and suffered from pulmonary TB (85.9%). A notable proportion (37.1%) of patients had no history of previous TB treatment. Patients were resistant to a median of two drugs (interquartile range: 1–4) and 23% were resistant to any second line anti-TB drug. A total of 174 (81.7%) patients achieved successful treatment outcomes with 144 (67.6%) patients being cured and 30 (14.1%) declared treatment completed. Among the 39 (18.3%) patients with unsuccessful outcomes, 35 (16.4%) died and 4 (1.9%) experienced treatment failure. In multivariable analysis, the use of ethambutol had statistically significant negative association with unsuccessful outcomes (odds ratio = 0.36, p-value = 0.02).

Conclusions

In this study, the WHO target of successful treatment outcomes (≥ 75%) among childhood RR/MDR-TB patients was achieved. The notable proportion of patients with no history of previous TB treatment (37.1%) and the disproportionately high number of female patients (74%) respectively stress for infection control measures and provision of early and high quality care for female drug susceptible TB patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06935-6.

Outcome Of Endodontic Procedures Performed By Dental Interns Using Stainless Steel And Niti Files: A 10- Year Retrospective Study

BACKGROUND

Preparation of root canal according to its desired anatomy and complete disinfection is a laborious task. Several factors influence the endodontic treatment including operator's skill and knowledge, anatomy of the tooth, the instruments and equipment used. In the past stainless-steel instruments were used to prepare the root canal but it causes many iatrogenic errors. Nickel titanium instruments evolved to overcome the iatrogenic damages caused by stainless steel instruments. Keeping this in mind a comparative study was conducted on the clinical work of dental intern using stainless steel files and progressively taper nickel titanium instruments. The objective of this study was to compare the performance of interns using either stainless Steel or progressively tapered hand operated NiTi instruments.

METHODS

This retrospective study included post-treatment radiographs of root canal treatments performed by interns by using either stainless steel files or NiTi Protaper files, in the endodontic department of Hamdard University Dental Hospital, Karachi, Pakistan. It was a 10-year audit, from 2008 to 2018, of endodontic performance. A total of 1219 post treatment radiographs of good quality and showing at least 2mm periapical area beyond the root apex were included. In SS group, preparation were performed by step back method, while in NiTi group the Protaper instruments for hand were used. Scoring criteria was used to evaluate technical quality. The data was analysed using SPSS for windows version 17.0. Chi-square test was used to determine difference in proportions between the outcomes in SS and NiTi groups at p0.05.

RESULTS

A total of 1219 radiographs were included out of which 584 (47.9%) belonged to SS and 635 (52.1%) to NiTi group. Overall satisfactory performance was in 553 (45.4%) teeth. Treatment done with NiTi was only marginally better than that achieved with SS files (NiTi n=298 (46.9%), SS n=255 (43.7%)). In the SS group, there were more overfills and internal and external transportation (p<0.001). NiTi reported more cases of inadequate lateral seal and separated instruments (p<0.05).

CONCLUSIONS

Endodontic performance of interns was not improved with progressive taper NiTi manual instruments.

Serum Calcium Levels in Preeclampsia

Objectives: To determine the serum calcium levels in mild and severe preeclampsia and compare it with normal pregnancy. Methods: It was a comparative cross sectional study. Thirty five normotensive pregnant women, n=30 women with mild preeclampsia and n=70 with severe preeclampsia were recruited at Liaquat University of Medical and Health Sciences, Hospital. The serum calcium was measured and levels were compared among three groups. The data was analysed on SPSS v. 20. Results: The gestational age was more in the normal pregnancy compared to mild and severe preeclampsia (38.7±2.1 vs 36.7±3.6 and 36.2±2.8, p-value=0.0002). The calcium concentration was less in the both groups of preeclampsia i.e., 8.41± 0.96 mg/dl in mild and 8.02± 0.77 mg/dl in severe preeclampsia vs 9.2± 0.32 mg/dl in normal pregnant women, (p-value <0.001). Conclusion: We found lower levels of serum calcium in preeclampsia, suggesting its possible role in pathogenesis. Further studies to investigate the potential role of dietary supplementation of micronutrients during pregnancy are recommended.

Generalized Anxiety Disorder and Depressive Symptoms among Pakistani Population during the Second Wave of the COVID-19 Pandemic: A Regression Analysis

Over a span of 1 year, with millions infected, COVID-19 has spread to every part of the world and now poses a health threat to each and every one of us. The outbreak has consequently resulted in multiple health problems such as stress, anxiety, depressive symptoms, insomnia, panic, and denial globally. Several factors have contributed to this rising number of psychiatric consults all over the world. The primary objective of this study was to investigate the impact of COVID-19 pandemic on the mental health of Pakistani population during the second wave of the pandemic in this region. We conducted an online web-based cross-sectional survey comprising 500 participants. The questionnaire assessed the demographic information, attitude, and knowledge concerning COVID-19 outbreak in addition to generalized anxiety disorder (GAD) utilizing the GAD-7 scale and depressive symptoms using the Center for Epidemiology Scale for Depression (CES-D) scale. The response rate of the study was 90.9%. The results of the survey indicated a prevalence of 25.4% of GAD, and 18.8% of depressive symptoms. Furthermore, nearly 34.8% of participants feared contracting COVID-19, 62.8% obtained constant critical updates regarding COVID-19, while 17.6% did not understand the knowledge regarding COVID-19. In the multivariate regression models, GAD was significantly associated with gender, age, and checking constantly of critical updates regarding COVID-19. Similarly, participants under 30 years had a higher risk of developing depressive symptoms than those above (> 30 years). Lastly, participants with no formal education were also found to be more prone to developing depression. We identified a potential threat to mental health during the pandemic.

Humic acid and nitrogen dose application in corn crop under alkaline soil conditions

ABSTRACT Humic acid (HA), as a bio-stimulant and a major component of organic matter (OM), can improve plant physiology, soil fertility, and nutrient availability, mainly in low OM soils. Nitrogen (N) is one of the most important nutrients that affect several metabolic and biochemical activities, leading to improved plant development. This study was conducted to investigate the combined effect of HA and N doses on soil organic matter (SOM) and total N concentration, N uptake, corn growth, and grain yield under conventional tillage at Peshawar, Pakistan. Treatments were tested in a randomized block design with four replicates arranged in a factorial scheme 3 × 4 + 1. The respective doses of HA (1.5, 3,0 and 4.5 kg ha-1) were applied at the corn sowing, whereas N doses (80, 120, 160, and 200 kg ha-1) were applied in three splits (1/3 at sowing, 1/3 at the V5 stage, and remaining 1/3 at the tasselling stage) with one control (no HA and N). The application of HA, regardless of the applied doses, had positive effects on SOM, N concentration, N uptake, corn development, and grain yield. However, the application of 4.5 kg ha-1 of HA was the most effective in promoting SOM (0.83%) and total N (0.31%), shoot biomass (10610 kg ha-1), N uptake (1.13%), and grain yield (3780 kg ha-1), even when combined with the N doses of 80, 120 and 160 kg N ha-1. Increasing N doses positively influenced SOM, N concentration, N uptake, and corn growth. The greatest grain yield was obtained at 150 kg ha-1 of N regardless of HA applied doses.

COVID-19 and inequalities: the need for inclusive policy response

In this essay, the authors analyze the COVID-19 pandemic from the perspective of inequalities and socio-economic vulnerabilities. We argue that the current pandemic has been looked at mainly through the lens of biology, leaving sociological blind spots in the response to this pandemic that have had adverse effects. We conclude with the suggestion that apart from recommendations from health sciences, policy makers must also take into account local societal structures in order to design effective policies to control the contagion.

Method comparison of Particle Enhanced Immunoturbidimetry (PEIT) with High Performance Liquid Chromatography (HPLC) for glycated hemoglobin (HbA1c) analysis

BACKGROUND AND OBJECTIVE

High Performance Liquid Chromatography (HPLC) technique is considered as a gold standard for HbA1c analysis however all laboratories cannot adopt it due to certain limitations. Our aim was to compare Particle Enhanced Immunoturbidimetry (PEIT) method with High Performance Liquid Chromatography (HPLC) for HbA1c analysis.

METHOD

All blood samples were analyzed by HPLC assay on a Bio-Rad D-10 analyzer and PEIT on an Erba XL-200 analyzer. Precision studies were undertaken and Coefficient of Variation (%CV) calculated. Systemic Error (SE), Random Error (RE) and Total Error (TE_calc) were obtained. The Total Allowable Error (TEa) set by the National Glycohemoglobin Standardization Program (NGSP) for HbA1c is 6%.The acceptable evaluation method is where TE_calc is less than TE_a. RESULTS: The Precision studies were satisfactory with Coefficient of Variation (%CV) being less than 4% for both techniques. Mean HbA1c levels were slightly higher from HPLC than PEIT 9.07 ± 2.23% and 8.93 ± 2.10% respectively, although the difference was minimal. RE was 1.41%, TE_calc was 1.55%, which was less than TEa set by the NGSP. Both methods strongly correlated with the correlation coefficient (r) 0.9716, p < 0.0001.

CONCLUSION

Our study showed HbA1c analysis by PEIT technique is precise, accurate, rapid and convenient and can be employed as an alternative to HPLC technique in countries where cost is a major problem for diagnosis and treatment.

Effect of pre-cooling agent on intensity of pricking pain at intraoral injection site in adults: An experimental study

OBJECTIVE

To determine the effect of pre-cooling agent on the intensity of pricking pain at the intraoral injection site in adult patients.

METHODS

The in-vivo interventional study was conducted at the Department of Operative Dentistry, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, from September 2018 to August 2019, and comprised adult patients of either gender. The pricking pain perception during needle administration was assessed using split-mouth technique. Topical anaesthesia benzocaine gel was applied on the left side, which was treated as controls, for 1 min, while on the right side, which was treated as the experimental side, refrigerated cartridge was placed for 2 min. Infiltration anaesthesia was then administered on both sides. Pain perception ratings were measured through visual analogue scale. After profound anaesthesia was achieved, restorative treatment was performed under rubber dam isolation. Data was analysed using SPSS 24.

Results

Of the 152 subjects, 77(50.65%) were females and 75(49.34%) were males. The overall mean age was 35.97±8.669 years (range: 21-50 years). The effect of refrigerated cartridge was significant on the intensity of pricking pain at the intraoral injection site in patients aged 41-50 years, and in female patients aged 21-30 years (p<0.05), whereas its effect was non-significant in males aged 21-30 years and patients aged 31-40 years (p>0.05).

CONCLUSIONS

Pre-cooling agent was found to be effective in decreasing pricking pain felt by patients.

Folding Behaviour and Antibacterial Activity of Ionic Complementary Peptide EAK-16

Aim: A major challenge in the development of new antibiotics is the biocompatibility within biological environment. Ionic complementary peptide (EAK-16) from amyloid protein, have the ability to adopt secondary structure conformation at membrane interfaces. This study aimed to investigate the effect of membrane on EAK-16 peptide folding and their antibacterial applications. Methodology: We studied secondary structural conformation of EAK-16 using circular dichroism (CD) spectroscopy in an aqueous environment and at membrane bilayers interfaces. Initially, the antibacterial efficacy was investigated against both Gram-positive and Gram-negative bacteria. Membrane mimicking models were synthesised with dimyristoylphosphatidylcholine (DMPC) and dimyristoylphosphatidylserine (DMPS) lipid vesicles using calcein leakage assay. Results: EAK-16 showed transition in secondary structural conformation. In aqueous environment, it was predominantly β-sheets and at membrane interfaces, it was mainly α-helical. EAK-16 peptide was highly active against bacteria (at minimum concentration applied) and membrane leakage was found to be > 60%. This effect was confirmed with both anionic lipids (DMPS) and neutral lipids (DMPC). The helical transition of EAK-16 could be a major factor to disrupt the membrane and bacterial death Conclusion: The secondary structural conformation and calcein leakage data suggest that EAK-16 has potential to kill bacteria by adopting helical tilted conformation and membrane perturbation via lysis. This study revealed structure-function relationship of peptide and lipid bilayers to further investigate the mode of pore formation and mode of action of EAK-16 in membrane perturbation and antibacterial efficacy.

Facile Green Synthesis of Iron Oxide Nanoparticles Using Phoenix dactylifera L. Seed Extract and Their Antibacterial Applications

Aim: The synthesis methods of iron oxide nanoparticles (IONPs) have got great attention in recent years, due to their variety in physicochemical properties and applications. This study aimed for the green synthesis of the IONPs using an aqueous extract of P. dactylifera L. seeds for its antibacterial applications. Methodology: IONPs were prepared in an aqueous seed extract of P. dactylifera L. The physicochemical characterisations were performed with transmission electron microscopy (TEM) to study the shape of obtained nanoparticle, energy-dispersive spectroscopy (EDS) for elemental confirmation of iron and oxygen, dynamic light scattering (DLS) for particles size measurement, vibrating sample magnetometer (VSM) for saturation magnetisation, Infrared spectroscopy (FTIR) for chemical confirmation of function groups and X-ray diffraction (XRD) for crystalline nature. The polyphenols contents were also determined; we suggest that the presence of phenolic compounds is the key element involved in the formation and the stabilisation of IONPs. Antibacterial activity was determined using disc diffusion assay and minimum inhibitory concentration (MIC) of the IONPs were determined by broth dilution assay. Results: The biosynthesised IONPs showed crystalline magnetite spherical morphologies with average diameter 30 nm. Discs with all the concentrations of IONPs tested in this study (10 - 100 ug.mL-1) showed antibacterial activity against bacterial strains tested (Staphylococcus epidermidis, Klebsiella pneumoniae and Pseudomonas aeruginosa). MIC values were found to be 30 ug.mL-1, 50 ug.mL-1 and 60 ug.mL-1 for S. epidermidis, K. pneumoniae and P. aeruginosa respectively. Conclusion: The biosynthesis of IONPs has provided, reliable, safe, simple and eco-friendly method. Hence, this study has focused on biological method of synthesis of IONPs. The IONPs synthesized in this study can be used as the therapeutic agents against bacteria.

In vivo hepatoprotective and in vitro antimicrobial potential of Ceasalpinia bonduc (Linn): Pharmacological correlation with identified phytochemicals

The in vivo hepatoprotective potential of methanolic extract of Ceasalpinia bonduc (CBLM) has been explored against carbon tetrachloride (CCl₄) induced acute liver injury in rats. Treatment of plant extract on CCl₄ intoxicated liver significantly reduced the hepatoxicity, along with serum enzymes GPT and GOT. To explore the chemical constituents from CBLM extract, it was fractionated into non-polar to moderately polar fractions (CBLM-H, CBLM-HEt, CBLM-Et, CBLM-EtM, CBLM-M) and subjected to GC/GC-MS analysis. Altogether twenty seven (~71%) phytochemicals were identified from different fractions by using Electronic Mass Spectral Library GC-MS (NIST 20). Out of which twenty one are first time reported from Ceasalpinia bonduc, fourteen from genus Caesalpinia and ten from family Fabaceae. The identified phytochemicals 2-ethyl-2-hydroxy-1,3-dimethylcyclopentanecarboxylic acid, ethyl ester (21) and 1,3,5-triazine-2,4-diamine,6-hydroxy-N,N-dicyclohexyl (23) are first time identified as plant metabolites. To explore the antimicrobial potential four strains of Gram-positive and eight strains of Gram-negative bacteria were used along with pure cultures of five saprophytic fungus (molds) and two strains of yeast were utilized. CBLM-H and CBLM-HEt were exhibited praiseworthy antimicrobial potential. CBLM-H showed complete growth inhibition of P. mirabilis and V. cholerae at the concentration of 0.1g/mL while CBLM-HEt at 0.05g/mL halted the growth of S. aureus.

Incidence of Cardiac Arrhythmias in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Associated Outcomes During the First 24 Hours

Background Acute myocardial infarction (AMI) is the most life-threatening manifestation of coronary artery diseases. The majority of deaths in AMI are due to arrhythmias. Therefore, the aim of this study was to evaluate the incidence and risk factors and outcomes of cardiac arrhythmias in AMI patients undergoing primary percutaneous coronary intervention (PCI) during the first 24 hours of the index hospitalization. Methodology This prospective observational study was conducted at the adult cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Patients undergoing primary PCI were included in this study. All the patients were kept under observation for the first 24 hours of AMI and monitored through telemetry system monitoring and the incidence of cardiac arrhythmias and the outcomes were recorded. Results A total of 110 patients were included; the mean age was 59.6±13.1 years. Most of them were male (70.9%). Arrhythmias were observed in 89.1% of the patients, with 169 episodes. The accelerated idioventricular rhythm was the most common type of arrhythmia (37.3%) followed by sinus tachycardia (36.4%), ventricular tachycardia (22.7%), and complete heart block (20.0%). Lethal arrhythmias were observed in 64.5% (71) of the patients. During the hospital course, 65.5% developed arrhythmias during arrival to balloon time, 30% during the procedure, and 53.6% within 24 hours of the procedure. The in-hospital mortality rate was 15.5% with a significant association with the development of lethal arrhythmias within 24 hours of the procedure (21.1% vs. 5.1%; p=0.026). Conclusions The incidence of arrhythmias within 24 hours of hospitalization is high in patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI, and it has been observed to be associated with an increased rate of in-hospital mortality.

Acute Renal Problems Still a Great Challenge in Obstetrics

Objective: To assess the early risk factors and outcomes of the patients presented with acute renal issues, at tertiary care Hospital. Methodology: This descriptive study was conducted at gynaecology and obstetrics department of Liaquat University of medical and health Sciences. Study duration was six months from June 2019 to November 2019. Women having age more than 18 years, developed renal impairment as serum creatinine level more than 1.2 mg/dl were included. All data was collected via self-made proforma. SPSS version 20 was used for the data analysis. Results: Total 58 women having renal problems during pregnancy were studied, their mean age was 28.40+4.68 years and mean gestational age was 28.40+4.68 years. Most of the women 70.2% were un-booked. Parity 1-3 was commonest. Anaemic women were on high risk of renal impairment as most of the patients had moderate anemia. Hypertension was in 35.1% patients, placental abruption was in 10.5% cases, tow patients had diabetes, 12.3% presented with pregnancy induced hypertension and postpartum haemorrhage was in 05.3% cases. There was a significant negative correlation between haemoglobin level and serum creatinine level, (r-value 0.029). Conclusion: Anemia was the commonest reason for renal impairment during pregnancy. Most of the women were un-booked, having high parity and were presented with anemia. This morbidity can be decreased and prevented by stabilizing the haemoglobin level by taking proper antenatal care.

Reasons of relapse and pattern of drug use among the substance users in Bangladesh: A nationwide study

This study aimed at investigating the reasons of relapse and patterns of drug use among the substance users in Bangladesh. We have conducted a descriptive type of cross-sectional study among the relapse cases of substances users in the whole of Bangladesh. Concerning the reasons for relapse after taking treatment; family unrest (29.5%), peer pressure (27.4%), to reduce depression (24.8%) and craving for drugs (24.3%) were the most frequent. Amphetamine was reported to be the most used drug (76.1%, n = 693), followed by cannabis (75%, n = 683) and alcohol (54.3%, n= 495). Further extensive studies are also needed to explore the association.

Analysis of exhaled breath of lung cancer patients using infrared spectroscopy

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Background: Currently low-dose computed tomography is used for lung cancer (LC) screening, but is limited by radiation exposure, cost, and a high false detection rate (1,2). An accurate, accessible and affordable screening technology is needed to improve detection of LC in high risk individuals. Methods: We conducted an unblinded, prospective cohort study on the effectiveness of a novel technology utilizing infrared absorption measurements via cavity ringdown spectroscopy (IR-CRDS) to differentiate the expired breath of treatment-naïve LC patients from controls without known cancer. Breath samples were taken from 100 LC patients and 98 control subjects but, only 62 non-small cell lung cancer (NSCLC) and 96 control samples were analyzed. Patients on treatment were eligible but, the protocol was amended to exclude these due to signal ambiguities. Samples were also excluded due to missing data, unclear histologic subtypes, or if they were classified as small cell LC samples to prevent obscuring the NSCLC signal. A piecewise cubic spline interpolation was used for the spectra with missing values (3). After first- and second-derivative spectra were computed to increase the information density, a one-dimensional local binary pattern extracted features from the spectra (4). Meaningful spectra-based features were selected using a minimum redundancy maximum relevance algorithm (5). Finally, a classification model was built using a support vector machine classifier (3). Results: The table below characterizes each cohort. The discriminant analysis differentiated between NSCLC and control cases with a cross validation accuracy of 86.1% (89.6% sensitivity and 80.7% specificity) using 20 selected spectra-based features. Conclusions: IR absorption measurements can be used to accurately discriminate between NSCLC and control participants. We continue to build our database to support more robust machine learning models. To our knowledge, this is the first time IR-CRDS has been used to differentiate between NSCLC and control cases. [Table: see text]

Drug repurposing approach to target FtsZ cell division protein from Salmonella Typhi

Drug repurposing is an efficient alternative approach to counter the increasing drug-resistant pathogens to treat infectious diseases. FtsZ is an essential bacterial cytokinesis protein involved in the formation of cell-division complex and targeting FtsZ using FDA approved drugs is a promising strategy to identify and develop a new antibacterial drug. Using in silico pharmacophore-based screening of drug bank, molecular docking and molecular dynamics simulations, we identified six drugs inhibiting the function of stFtsZ from Salmonella Typhi. The selected drugs target stFtsZ at the hydrophobic cleft formed between the C-terminal domain and helix α7 with binding energy better than -8 kcal/mol. Out of these six drugs, benzethonium chloride showed promising results at 8 μM concentration where it inhibits stFtsZ GTPase activity by 80% and prevents polymerization. Benzethonium chloride also possesses an excellent antibacterial activity against the bacterial culture of Salmonella Typhi (ATCC 19430), Staphylococcus aureus (ATCC 43300) and Escherichia coli (ATCC 25922) with the MIC values of 8 μg/mL, 1 μg/mL and 12 μg/mL, respectively. Based on our current study, the scaffold of benzethonium chloride can be used for the development of broad-spectrum antibacterial agents against drug-resistant pathogens.

Structural Plasticity of EAK-16 Peptide Inducing Vesicle Membrane Leakage

BACKGROUND

Ionic complementary peptide EAK-16 has been studies for anticancer drug delivery application. This is a 16 residues, short sequence peptide has ability to trosnform into micro/nanoparticle via self-assembly. However, it is still not clear that how this can bind with cell membrane to induce membrane leakage or delivering their cargo inside cell membrane.

OBJECTIVE

The main objective of this work was to understand behaviour of secondary structure conformation of peptide in solution and at lipid membrane interfaces and membrane permeability of synthetic ionic complementary peptide EAK-16. The corresponding secondary structure conformation was evaluated.

METHODS

We performed biophysical investigation to probe the interaction of synthesised ionic complementary peptide (EAK-16) with dimyristoylphospholcholine (DMPC) and dimyristoylphosphoserine (DMPS) membrane interfaces. The folding behaviours of EAK-16 were studied with Circular Dichroism (CD) spectroscopy. Membrane leakage with peptide was confirmed with calcein leakage assay.

RESULTS

Our finding of this study showed that in aqueous phase EAK-16 was predominantly folded into β-sheets. The temperature could alter the β-sheets. However, in DMPC and DMPS membrane interfaces, EAK-16 adopted helical conformation. EAK-16 has preference in perturbing anionic compared Zwitterionic lipid vesicles. This study proposed that hydrophobic grooves of EAK-16 might be a key in the association with lipid bilayers. Secondly, a charge distribution of ionic residues would also support the orientation at lipid bilayers. This peptide membrane association would facilitate the membrane destabilisation.

CONCLUSION

This study demonstrated the supporting evidence that EAK-16 could interact with lipid membranes and conforming to helical structure, while the helical conformation induced the lipid membrane leakage. Overall, this study provides a physical rationale that ionic complementary peptide can be a useful tool for designing and development of novel antibiotics and anticancer agents along its previous drug delivery applications.

Audiovisual Distraction: A Pricking Pain Reduction Modality among Ladies Receiving Intraoral Injections

OBJECTIVE

To determine the effect of audiovisual distraction (AVD) using virtual reality device (bobo VRZ4-VRBOX) on intensity of pricking pain at the intraoral injection site among different age groups in ladies.

STUDY DESIGN

Experimental study.

PLACE AND DURATION OF STUDY

Department of Operative Dentistry, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, during September 2018 to March 2019.

METHODOLOGY

An in-vivo interventional study, using split-mouth technique was conducted in 50 lady patients of sample size of 50, to investigate pricking pain perception during needle insertion. Topical anesthesia (benzocaine gel) was applied on left side (control) for 1 minute without audiovisual distraction (AVD); whereas, on the experimental side (right), similar methodology was followed after topical anesthesia but with AVD via VR-Z4 video eyeglasses after the local anesthesia was administered. Patients' pain perception ratings were measured through visual analog scale (VAS). After profound anesthesia was achieved, restorative treatment was performed under rubber dam isolation.

RESULTS

Audiovisual (AV) device was effective in decreasing the pricking pain sensed by the patients during infiltrate anesthesia; but the score remained within the same pain category. The effect of audiovisual distraction (AVD) using virtual reality device (VRZ4-VRBOX) was statistically insignificant on intensity of pricking pain at the intraoral injection site among different age groups in ladies.

CONCLUSION

AV device is not dependent on age (21-50 years) in reducing the pricking pain. Pain is effectively reduced after the use of AV device, but this reduction is not statistically significant.