Ocular morbidity and co-morbidities in children attending a nodal district early intervention center in Uttar Pradesh

Purpose: To obtain epidemiological data on children with ocular morbidity attending a nodal district early intervention center (DEIC). Methods: After parental consent, we recruited children with ocular morbidity. After detailed history and clinical evaluation, along with pediatric consultation and relevant neuro?radiological and ancillary investigation, information was entered in a pretested proforma: especially looking for perinatal morbidity, including developmental delay (DD). Visual acuity (VA) was assessed by age?appropriate means by an ophthalmic assistant trained to work with children with special needs. We diligently looked for strabismus and performed dilated ophthalmoscopy. Using JASP, we summarized data as means and proportions and reported 95% CIs. We explored the association of disability percentage with possible predictor variables using regression. Results: We enrolled 320 children, with a mean age of 34.43 ± 31.35 months; two?thirds were male; one?third belonged to lower socioeconomic status (36%), with most parents being illiterate. The mean presenting VA was 1.8 logMAR for both eyes, range: 0 to 3. Sixty?one percent were hyperopic and 27% were myopic. High refractive error, (>±6D) occurred in nine; anisometropia in one; strabismus in 149, mostly esotropia; congenital cataract in 25, whereas 63 had abnormal fundus. Seventy?six received a diagnosis of cerebral visual impairment (CVI). On multivariate linear regression (MLR), younger age, presence of DD, and CVI significantly predicted a higher disability percentage. Logistic regression revealed that statutory disability is likely associated with DD (odds ratio [OR]:13.43); whereas older age was protective (OR: 0.977). Conclusion: Our study suggests that in DEIC children with ocular morbidity, younger children, and the presence of DD significantly predict both greater disability and the likelihood of statutory levels

IMPACT OF OXIDATIVE STRESS IN THE PATHOGENESIS OF CERVICAL CANCER THERAPEUTIC APPROCHES

Cervical cancer (CC) is acknowledged as the most ubiquitous carcinoma among females along with the utmost prevalence in developing nations. The major cause of CC is HPV exposure, especially HPV16 and 18. Inflammation is linked to the carcinogenesis of CC in addition to HPV infection. Although the precise cause of CC is yet unknown, using oral contraceptives, being immunosuppressed, and smoking may enhance the risk of the disease. Oxidative stress (OS), in addition to HPV, is linked to cervical cancer. Across several clinical and preclinical research, the dysfunctional redox system and the impact of oxidative stress throughout the aetiology of CC have been examined. Redox homeostasis must therefore be maintained, which calls for both enzymatic and nonenzymatic redox regulators. In this study, we explored the therapeutic strategies used to preserve redox balance, lower cervical cancer mortality, and illustrate the contribution of oxidative stress in the aetiology of the disease

ROLE OF REAL TIME PCR (RT-PCR) IN CLINICAL DIAGNOSIS FOR COVID-19 REVIEW

The pandemic of Coronavirus Disease 2019 (COVID19) has compelled scientists to create highly reliable diagnostic tools quickly in order to successfully and properly diagnose this pathology and thereby prevent infection transmission. Even though structural and molecular properties of the severe acute respiratory syndrome coronavirus 2 (SARSCoV2) were previously unknown, private research institutes and biomedical firms quickly developed numerous diagnostic procedures beneficial for making a correct detection of COVID19. Rapid antigen or antibody testing, immunoenzymatic serological tests, and RT-PCR based molecular assays are the most frequently used and validated procedures now available. The PCR has grown in popularity in molecular diagnostics to the point where it is still considered the gold standard for finding nucleotides from a variety of sources becoming an indispensable tool in the research lab. Because of its improved speed, sensitivity, reproducibility, and lower likelihood of carry-over contamination, real-time PCR has gained greater popularity. Currently, five different chemistries are employed to detect PCR product during real-time PCR. The self- fluorescing amplicons, DNA binding fluorophores, 5? endonuclease, neighbouring linear and hairpin oligoprobes, and self-fluorescing amplicons are all detailed in depth. We also go through the problems that have hampered the development of multiplex real-time PCR and the importance of real-time PCR in nucleic acid quantification.

ROLE OF DNA REPAIR IN AGING AND MALIGNANCY

DNA repair enzymes are proteins that detect and repair physical damage to DNA induced by radiation, ultraviolet light, or reactive oxygen species. The repair of DNA damage prevents the loss of genetic information, the creation of double-strand breaks, and the formation of DNA crosslinks. The time-dependent reduction of functional properties is known as aging. Mitochondrial malfunction and the buildup of genetic damage are two common factors of aging. In fact, the poor maintenance of nuclear and mitochondrial DNA is likely a major factor in aging. When the DNA repair machinery isn't operating fine, DNA lesions and mutations can occur, which can lead to cancer development. In fact, the poor maintenance of nuclear and mitochondrial DNA is likely a major factor in aging. When the DNA repair enzymes isn't operating fine, DNA lesions and mutations can occur, which can lead to cancer development. The large number of alterations per cell, which can reach 105, has been identified as a driving mechanism in oncogenesis. These findings show that abnormalities in the DNA repair pathway contribute to the senescence as well as cancer. Nucleotide excision repair (NER), base excision repair (BER), double-strand break repair, mismatch repair (MMR), are all major DNA repair processes in mammalian cells. BER excises mostly oxidative and alkylation DNA damage, NER removes bulky, helix-distorting lesions from DNA (e.g., ultraviolet (UV) photodimers), MMR corrects replication errors

REVIEW ON STRUCTURE, PATHOGENECITY, TRANSMISSIBILITY AND EPIDEMIOLOGY OF HUMAN PATHOGENIC CORONAVIRUSES

Coronaviruses cause animal and human respiratory and bowel infections. They have not been deemed highly pathogenic to humans until the outbreak of severe acute respiratory syndrome (SARS) in 2002 and 2003 in Guangdong province, China. Coronaviruses (CoVs) are large, enveloped, positive-sense, single-stranded RNA viruses that can infect both animals and humans. Coronaviruses didn't just appear recently. They are large family of viruses that have been around for a long time. Formerly, coronaviruses (CoVs) were seen as relatively harmless respiratory pathogens to humans. However, two outbreaks of severe respiratory tract infection, caused by the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) caused high pathogenicity and mortality rates among human populations as a result of zoonotic CoVs crossing the species barrier. Now the recent detection of the 2019 novel coronavirus (COVID-19), added a new member in corona virus family.The novel coronavirus (COVID 19) is one of the member of coronavirus family which infect human. Scientists have divided coronaviruses into four sub- groupings, called alpha, beta, gamma and delta. Seven of these viruses can infect people. The four common coronaviruses are-229E(alpha), NL63(alpha), OC43(beta), HKU1(beta). The three less-common coronaviruses are- MERS-CoV(beta), SARS-CoV(beta), SARS-CoV-2. Our main target is to describe the the structure, Pathogenecity, Transmissibility and Epidemiology of above mentioned subgroups of corona viruses in our review

A PATH TO EFFECTIVE E-LEARNING IN MEDICAL EDUCATION: BARRIERS AND THEIR SOLUTION

Online learning in medical education is a relatively new concept and one which is rapidly expanding. Recently, due to the global widespread of COVID-19 pandemic, e-learning became the mainstreaming mode of teaching all over the world. Thus, it is critical to assess and work upon the potential challenges, drawbacks and barriers of effective implementation of successful e-learning. The general barriers to e- learning are often encountered as institutional or teaching method norms and technological drawbacks and behavior change in both the learner and the instructor is essential for successful implementation of e- learning in medical education. Although online course delivery has probably eliminated certain barriers that exist in face-to-face classrooms, such as geographic location, transportation issues, architectural and physical impediments, and social contexts which lead to inaccessible learning environments. Thus, it is the responsibility of the medical educators and administrators to look into these challenges and incorporate the solutions which can make begin a new era of better teaching-learning mode of education in medical education in the future This review article analyzes the prominent barriers to e-learning and solutions amongst medical educators to the implementation of online learning in medical education.

ROLE OF PERSONALIZED MEDICINE IN THYROID CANCER LATEST ASPECTS

Thyroid cancer is the prevalent endocrine cancers, and its incidence is growing all over the world, according to the World Health Organization. About 5–10 per cent of individuals with differentiated thyroid carcinoma may experience destructive behavior and metastasis, and their disease will be refractory to therapeutic techniques such as radiation therapy for an unknown cause, despite the favorable prognosis. Most aggressive, deadly, and unresponsive type of the cancer is thyroid carcinoma. Regrettably, existing treatments are not specific and are thus considered poor in treating thyroid malignancies. Consequently, mortality in this malignancy despite progress in diagnosis and treatment is a prominent issue in medicine. evidence linking cellular, molecular, and genetic to a diagnostic and therapeutic simplification. With the new idea of personalized therapy for thyroid cancer diagnosis, arranging the treatment, discovering the success of the treatment and assessing the visualization has improved in the last ten years. Personalized medicine treatment for thyroid cancer is supported by these studies. According to the findings of this review, cellular and molecular processes of cancer will lay concrete on the way for the development of narrative biomarkers for personalized medicine that take individual variations into account

The role of family configuration in early childhood intellectual development in the context of an extended family system in Pakistan.

CONTEXT: The confluence theory of intelligence by Zajonc and Markus emphasizes that individual intellectual difference of children manifests itself in the context of family configuration. Instead of assuming its generalizability, careful scientific work is required before applying the model to South Asian cultures where, predominantly, an extended family type exists. AIMS: To assess the role of extended family configuration on the child's intellectual development in a South Asian setting. SETTINGS AND DESIGN: A cross-sectional study was conducted on 4-5-year-old preschool children residing in Karachi, Pakistan. MATERIALS AND METHODS: Three hundred and forty-two child and mother dyads were assessed through a validated cognitive psychometric tool and through a structured questionnaire. Children who were registered at the main Mother and Child Health Centres (MCH) of the Aga Khan Health Services, Pakistan (AKHSP) Karachi and who were born between July 1st 1993-June 30th 1994 with traceable birth records at the maternity homes, were considered for this study. STATISTICAL ANALYSIS: Multivariate linear regression models were used to identify the individual effect of family configuration on the intellectual scores. RESULTS: Family configuration variables such as number of co-residents ( P P CONCLUSION: The findings suggest the positive role of co-residents of an extended family environment on the intellectual development in early childhood.

Residents' perceptions of work environment during their postgraduate medical training in Pakistan.

BACKGROUND: In Pakistan, there is a lack of information about the work environment of residency programs. This lack is a major impediment in their improvement. One of the approaches for improvement in these programs can be directed through the residents' own perception of their working conditions. Therefore, we collected data which would reflect working conditions of residents. AIM: To assess the perceived status of "work environment" in different specialities. MATERIALS AND METHODS: A cross-sectional survey was conducted in four teaching hospitals of Karachi from July 1999 to January 2000. Residents from selected programs were grouped into four broad groups: specialist, medical, surgical and multidisciplinary. Responses of residents were obtained on a Likert scale of 0 to 4. Indices were formed for two components of work environment: academic and mistreatment. STATISTICAL ANALYSIS: Differences between residents' groups were assessed through analysis of variance (ANOVA) at 5% significance. RESULTS: A total of 341 registered residents responded (response rate: 75%). Surgical residents were working more than 80 h/week and this was more than the other three groups. Medical residents were spending the highest actual time on research and teaching activities (10% and 14%, respectively). Academic index score was highest for surgical group (15.81, SD = 4.69) and lowest for multidisciplinary group (11.82, SD = 4.80). Medical group had the highest perceived mistreatment index score (5.56, SD = 4.57). CONCLUSIONS: In a study of work environment of residency programs, differential impact was found for the four groups on work environment perceptions. Most of the residents recognized undergraduate teaching, grand rounds, patient rounds and seminars or workshops as contributing to their academic learning. Reporting of sexual harassment was low, indicating either underreporting or cultural dynamics of our setting.

Residents' perceptions of communication skills in postgraduate medical training programs of Pakistan.

BACKGROUND: The importance of communication skills in postgraduate medical training is likely to be highlighted given the convergence of research and educational forces. Assessment of these skills in residency training is vital since it can provide basis for policy undertaking among Pakistani medical academia for improving postgraduate training programs. AIM: To assess the perceived status of communication skills of residents in different specialties. MATERIALS AND METHODS: A cross sectional survey was conducted in four teaching hospitals of Karachi between July 1999 and January 2001. A total of 455 residents in different residency programs were contacted. Residents registered both with College of Physicians and Surgeons of Pakistan and Postgraduate Medical Education office of selected hospitals were included in this study. Responses of residents were obtained on 5-point Likert scale. Indices were formed for three components of communication skills: informative, affective and professional communication. STATISTICAL ANALYSIS: Differences between residents' groups were assessed through analysis of variance. RESULTS: Total informative communication index was lowest for multi-disciplinary (12.05, SD = 4.87) and highest for surgical (15.27, SD = 2.51) residents. Total affective index was lowest for multi-disciplinary (12.58, SD = 5.68) and highest for medical (15.74, SD = 3.59) residents. The group differences for four groups of residency programs were not statistically significant for either professional attributes separately or for the total professional index. CONCLUSIONS: The residency programs must establish goals, process and outcomes to incorporate communication skills in postgraduate medical training since this can enhance residents' performance as effective health care providers. Accomplishment of better communication skills can be achieved if the importance of its teaching and training is valued by residency program coordinators.

Conversion from laparoscopic to open cholecystectomy: multivariate analysis of preoperative risk factors.

BACKGROUND: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion. However, there is a need to devise a risk-scoring system based on the identified risk factors to (a) predict the risk of conversion preoperatively for selected patients, (b) prepare the patient psychologically, (c) arrange operating schedules accordingly, and (d) minimize the procedure-related cost and help overcome financial constraints, which is a significant problem in developing countries. AIM: This study was aimed to evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy in our setting. SETTINGS AND DESIGNS: A case control study of patients who underwent laparoscopic surgery from January 1997 to December 2001 was conducted at the Aga Khan University Hospital, Karachi, Pakistan. MATERIALS AND METHODS: All those patients who were converted to open surgery (n = 73) were enrolled as cases. Two controls who had successful laparoscopic surgery (n = 146) were matched with each case for operating surgeon and closest date of surgery. STATISTICAL ANALYSIS USED: Descriptive statistics were computed and, univariate and multivariate analysis was done through multiple logistic regression. RESULTS: The final multivariate model identified two risk factors for conversion: ultrasonographic signs of inflammation (adjusted odds ratio [aOR] = 8.5; 95% confidence interval [CI]: 3.3, 21.9) and age > 60 years (aOR = 8.1; 95% CI: 2.9, 22.2) after adjusting for physical signs, alkaline phosphatase and BMI levels. CONCLUSION: Preoperative risk factors evaluated by the present study confirm the likelihood of conversion. Recognition of these factors is important for understanding the characteristics of patients at a higher risk of conversion.

A matched case-control study of risk factors for neonatal tetanus in Karachi, Pakistan.

BACKGROUND: Previous studies have identified various risk factors for neonatal tetanus (NNT) in rural areas of Pakistan. The present matched case control study was conducted to further evaluate these risk factors in an urban setting. AIM: The study was carried out to identify risk factors for NNT in Karachi. MATERIALS AND METHODS: Patients of NNT (n = 125) diagnosed from January 1998 to February 2001 were recruited through a surveillance system of Expanded Programme on Immunization (EPI). Two neighbourhood controls (n = 250) were matched for each case for gender and date of birth of the case. STATISTICAL ANALYSIS: Conditional logistic regression was performed to assess the independent effect of factors associated with NNT. RESULTS: The final multivariable model identified subsequent application of substances on the umbilical cord (adjusted matched odds ratio [adj. mOR] = 5.1 [2.7-9.7]), home delivery (adj. mOR = 1.8; 95% CI: 1.1- 3.1) and illiterate mother (adj. mOR = 1.6; 95% CI: 1.0- 2.0) as risk factors for NNT after adjusting for other variables in the model. Population attributable risk per cent (PAR %) for subsequent cord application was 69% and PAR % for home delivery was 31%. CONCLUSION: Health planners, while formulating control strategies through immunization programmes should also take into account the impact of post-delivery practices, such as 'subsequent cord application' along with pre-delivery practices. Health awareness regarding appropriate post-delivery practices should be promoted and counselling of pregnant women for giving preference to health care setting for delivery is also crucial.

Factors influencing the selection of surgical specialty among Pakistani medical graduates.

CONTEXT: The delineation between selection of surgery and non-surgery residency programmes could provide a pragmatic view of the influences on medical graduates' careers. This would also help coordinators and educators of residency programmes in surgery to further understand the dynamics of specialty selection. AIMS: To identify the different factors that influence the graduates to select surgical specialties in Pakistan. SETTINGS AND DESIGNS: A cross-sectional survey was conducted in 4 teaching hospitals of Karachi between July 1999 and January 2001. SUBJECTS AND METHODS: A total of 455 residents in 1-5 years of residency programmes were contacted. Three hundred and forty-one residents consented to the interview. Residents who were registered both with the College of Physicians and Surgeons of Pakistan (CPSP) and the Post Graduate Medical Education (PGME) office of the selected hospitals were included in this study. STATISTICAL METHOD USED: Logistic regression analysis. RESULTS: Final multivariate analysis identified 4 factors that remained significantly associated with the selection of surgical specialty: deriving gratification from direct patient care (adjusted odds ratio [aOR] = 5.79; 95% confidence interval [CI]: 1.24, 26.99), procedure-based medical practice (aOR = 2.85; 95% CI: 1.23, 6.61), nature of clinical problems (aOR = 3.39; 95% CI: 1.47, 7.84), and lack of consideration of stress during professional work (aOR = 2.27, 95%CI: 1.25, 4.13). CONCLUSIONS: Direct patient care is perceived to be an integral part of surgery residency and immediate patient outcome is a positive influence in selecting surgical specialty. The inclination towards surgery appeared to be determined by the type of procedures and technical skills involved in its practice. The nature of clinical problems is an important determinant of the choice of specialty. Stress was not perceived to be an important influencing factor for those who decided to select surgical specialties.

A comparative study of delayed neurotoxicity in hens following repeated administration of organophosphorus compounds.

Hens treated with Mipafox (10 mg/kg, sc), sarin (50 micrograms/kg, sc) or parathion (1 mg/kg, sc) daily for 10 days exhibited severe, moderate and no ataxia respectively on 14th day after the start of exposure. The neurotoxic esterase (NTE) activity was significantly inhibited in the brain, spinal cord and platelets of hens treated with mipafox or sarin whereas no change was noticed with parathion treatment. All three compounds significantly inhibited acetylcholinesterase (AChE) activity in the platelets. Spinal cord of hens treated with mipafox, sarin or parathion showed axonal degeneration heavy, moderate and none respectively. It is concluded that repeated administration of equitoxic doses of mipafox, sarin and parathion to hens are marked, moderate and non-delayed neurotoxic respectively.

Central hyperthermic effect of arsenic in rabbits.

Hyperthermic effect of arsenic was investigated in rabbits. Injections of arsenic trioxide (0.0001 to 0.1 micrograms) into a lateral cerebral ventricle of the rabbit evoked a dose-dependent hyperthermia, respiratory stimulation and peripheral vasodilatation. Heat loss through respiratory stimulation and peripheral vasodilatation appeared responsible for the long latent period and the slight hypothermia sometimes obtained during this period as these effects followed the same time course. These effects were centrally mediated as demonstrated by the lack of efficacy of the same doses by the intravenous route. The hyperthermic effect of arsenic was antagonized by the sulphydryl donator, dimercaprol, the a-adrenoceptor blocking agent-phenoxybenzamine and the PG-synthesis inhibitor-aspirin. Multiple sites, for antagonistic effects of these substances can be explained by the action of arsenic in inactivating sulphydryl containing enzymes which are many and catalyze diverse biochemical reactions.