Global variation of COVID-19 mortality rates in the initial phase

Objectives@#Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused devastation in over 200 countries. Italy, Spain, and the United States (US) were most severely affected by the first wave of the pandemic. The reasons why some countries were more strongly affected than others remain unknown. We identified the most-affected and lessaffected countries and states and explored environmental, host, and infrastructure risk factors that may explain differences in the SARS-CoV-2 mortality burden. @*Methods@#We identified the top 10 countries/US states with the highest deaths per population until May 2020. For each of these 10 case countries/states, we identified 6 control countries/ states with a similar population size and at least 3 times fewer deaths per population. We extracted data for 30 risk factors from publicly available, trusted sources. We compared case and control countries/states using the non-parametric Wilcoxon rank-sum test, and conducted a secondary cluster analysis to explore the relationship between the number of cases per population and the number of deaths per population using a scalable EM (expectation– maximization) clustering algorithm. @*Results@#Statistically significant differences were found in 16 of 30 investigated risk factors, the most important of which were temperature, neonatal and under-5 mortality rates, the percentage of under-5 deaths due to acute respiratory infections (ARIs) and diarrhea, and tuberculosis incidence (p < 0.05) @*Conclusion@#Countries with a higher burden of baseline pediatric mortality rates, higher pediatric mortality from preventable diseases like diarrhea and ARI, and higher tuberculosis incidence had lower rates of coronavirus disease 2019-associated mortality, supporting the hygiene hypothesis.

Global variation of COVID-19 mortality rates in the initial phase

Objectives@#Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused devastation in over 200 countries. Italy, Spain, and the United States (US) were most severely affected by the first wave of the pandemic. The reasons why some countries were more strongly affected than others remain unknown. We identified the most-affected and lessaffected countries and states and explored environmental, host, and infrastructure risk factors that may explain differences in the SARS-CoV-2 mortality burden. @*Methods@#We identified the top 10 countries/US states with the highest deaths per population until May 2020. For each of these 10 case countries/states, we identified 6 control countries/ states with a similar population size and at least 3 times fewer deaths per population. We extracted data for 30 risk factors from publicly available, trusted sources. We compared case and control countries/states using the non-parametric Wilcoxon rank-sum test, and conducted a secondary cluster analysis to explore the relationship between the number of cases per population and the number of deaths per population using a scalable EM (expectation– maximization) clustering algorithm. @*Results@#Statistically significant differences were found in 16 of 30 investigated risk factors, the most important of which were temperature, neonatal and under-5 mortality rates, the percentage of under-5 deaths due to acute respiratory infections (ARIs) and diarrhea, and tuberculosis incidence (p < 0.05) @*Conclusion@#Countries with a higher burden of baseline pediatric mortality rates, higher pediatric mortality from preventable diseases like diarrhea and ARI, and higher tuberculosis incidence had lower rates of coronavirus disease 2019-associated mortality, supporting the hygiene hypothesis.

Folic acid effect on artemether-induced cardiac anomalies in mice embryos

Objective: To determine the role of folic acid in preventing the adverse effects of artemether, on fetal heart in Albino mice

Study Design: Experimental study

Place and Duration of Study: Department of Anatomy, University of Health Sciences, Lahore, from July 2011 to January 2012

Methodology: Eighteen pregnant Albino mice were randomly divided into three groups A, B, and C of six mice each. The control group A was treated with intramuscular injection of solvent arachis oil 10.7 mg/kg, group B was given intramuscular injection of artemether 10.7 mg/kg, and group C was given intramuscular injection of artemether 10.7 mg/kg and folic acid 4.93 mg/kg, dissolved in 0.1 ml. of distilled water orally, from 6th to 10th day of pregnancy. On 18th gestational day, the mice were sacrificed, and dissected to deliver live fetuses of group A [n=46], group B [n=16], and group C [n=20] were delivered. After dissection of the fetuses, the hearts were isolated and fixed in 10% formalin and processed in a usual way for histological examination with the light microscope after H and E staining, using X4, X10, and X40 objectives. The sections were evaluated for presence of septal defects, thickness of ventricular and atrial septa was calculated by micrometery. For statistical analysis, SPSS version 18 was used

Results: Post-Hoc Tukey's test indicated statistically significant difference in mean atrial septal thickness between groups A and B [p < 0.001], groups B and C [p=0.015], and insignificant difference between groups A and C [p=0.178]. There was statistically significant thinning of ventricular septa between groups A and B [p < 0.001], groups B and C [p < 0.001], and groups A and C [p < 0.001]

Conclusion: Folic acid protected the toxic effects of artemether on the development of heart

Effect of flaxseed oil on lipofundin-induced hepatotoxicity in adult male albino rats

Objective: To find out the preventive effect of flaxseed oil on the hepatic damage produced by the Lipofundin, a soya-bean based lipid emulsion used in parenteral therapies

Study Design: Experimental study

Place and Duration of Study: The study was carried out at the University of Health Sciences, Lahore for a period of one year, from Jan 2015 to Dec 2015

Material and Methods: Experimental study has been performed to study the effect of flaxseed oil on the lipofundin induced hepatotoxicity. Thirty-two male adult albino rats were obtained from animal house of University of Health Sciences, Lahore and divided into four equal groups. Group A [control group] was given flaxseed oil 3ml/kg intraperitonially daily for 10 days and sacrificed on day 11. Group B was given Lipofundin 2ml/kg intravenously daily for 10 days and sacrificed on day 11. Group C was given Lipofundin 2ml/kg intravenously daily for 10 days and sacrificed on day 21. Group D was given Lipofundin 2ml/kg intravenously for 10 days followed by Flaxseed oil 3ml/kg intraperitonially for 10 days and sacrificed on day 21

Results: Flaxseed oil was observed to restore the hepatic tissue damage caused by the lipofundin administration

Conclusion: Flaxseed oil has an ameliorative effect on the hepatic tissue damage caused by the Lipofundin.Hence its use may help prevent hepatic tissue damage caused by lipofundin used in parenteral therapies

Comparison of efficacy of oral zinc sulphate with intramuscular meglumine antimoniate in patients of cutaneous leishmaniasis

Objective: To compare the efficacy of oral zinc sulfate [ZnSO4] with intramuscular meglumine antimoniate [MA] in the treatment of cutaneous leishmaniasis

Study Design: Randomized controlled trial

Place and Duration of Study: Dermatology Department, Military Hospital, Rawalpindi from 1st May 2013 to 1st Jan 2014

Material and Methods: Eighty patients of cutaneous leishmaniasis from dermatology OPD fulfilling the inclusion criteria were selected after informed consent and permission from Hospital Ethical Committee. Using simple randomization patients were assigned into two treatment groups. Group A received oral zinc sulfate in a dose of 10 mg/kg/day during 45-day period in three divided doses, and group B received systemic MA [glucantime] 20 mg/kg/day intramuscularly for 20 days. The size and induration of lesions was measured by ruler and palpation respectively. Patients were followed up till the end of treatment. Three patients were excluded from the study due to discontinuation of treatment. Acceptable cure indicated efficacy at the end of treatment duration

Results: In group A 14 [35.9%] patients had moderate improvement followed by total clearance in 12 [30.8%] patients. In group B, majority of the patients i.e. 26 [68.4%] patients had total clearance followed by moderate improvement in 9 [23.7%] patients. Group B had significantly better response as compared to group A. Efficacy of the drug was significantly higher in group B as compared to group A [p = 0.001]

Conclusion: Oral zinc sulfate 10mg/kg is not better than intramuscular MA in treatment of cutaneous leishmaniasis but can be considered as a treatment option if MA cannot be used

Level of maternal education is a significant determinant of neonatal survival: a PEARL study analysis

The study analyzed the demographic and socio-economic determinants of neonatal mortality. The variables included one fetal variable [gender], three maternal variables [level of education, occupation, age], three paternal variables [level of education, occupation, age], and seven household [family] variables [nationality, consanguinity, family income, house ownership, type of housing, family type, domestic help]. One calendar year data [January to December 2011] was extracted from Qatar's National Perinatal Registry and analyzed using a univariate regression model. Qatar had a total of 20,583 live births and 102 neonatal deaths during 2011 [NMR 4.95/1000]. Less than secondary school maternal education level, as compared to secondary school or above maternal education level, was the only variable significantly associated with neonatal mortality [OR 2.08, 95% CI 1.23 - 3.53, p=0.009]. The association between the remaining thirteen variables and neonatal mortality was non-significant. Priority investment to raise female literacy above secondary school level may significantly improve neonatal survival

Effect of Phoenix dactyliferia [date palm] pit powder on nicotine induced spermatotoxicity in adult albino mice

To study the effect of Phoenix Dactyliferia pit powder on nicotine-induced spermatotoxicty in adult albino mice. The study was conducted at the University of Health Sciences, Lahore, from February to November 2012, and comprised adult male albino mice aged 6-8 weeks. The animals were divided into five equal groups. Group A consisted of controls who were treated with 1.5ml/kg of normal saline for 15 days, while nicotine 0.5mg/kg was administered intraperitoneally daily to experimental groups B, C and D for the first 15 days. Group B was sacrificed on the 15[th] day to confirm toxicity, whereas nicotine treatment was stopped in groups C and D. Group C was given normal saline [1.5ml/kg] whereas group D was given date palm pit powder 500mg/kg for the next 30 days. However, Group E was given nicotine 0.5mg/kg for 45 days and date palm pit powder was added orally from the 16[th] day and it continued daily till the end of the experiment. SPSS 18 was used for statistical analysis. The mean weight of each of the 40 animals in the study was 30 +/- 5gm, and all the five groups had 8[20%] mice each. Group B exhibited features of toxicity evident by statistically significant decrease in Johnsen score [p<0.001] and diameter of seminiferous tubule [p<0.001]. Group C showed partial reversal of toxic effects but these positive effects were less compared to group D which showed complete reversal of toxicity evident by statistically significant increase in Johnsen score [p<0.001] and diameter of seminiferous tubule [p<0.001]. However, reversal of toxic effect was not evident in group E. Partial recovery from nicotine-induced spermatotoxicity occurred after withdrawal of nicotine treatment whereas near normal restoration of structure was seen with administration of date palm pit powder after the stoppage of nicotine

Role of primary closure in the management of early cases of typhoid intestinal perforation, in our set up

To see the benefits of primary closure in typhoid intestinal perforation in early cases, regarding morbidity and mortality in KPK. Prospective study. Study was performed at teaching hospital of KMU-IMS, Kohat from March 2006 to March 2014. In this prospective study, we included 76 cases of single perforation of less than 24 hours in terminal ileum in typhoid fever patients, these patients had primary closure in 2 layers. Data was collected on a structured proforma. Patients' data included demography, clinical features, investigation post-operative complications, hospital stay and follow up. 76 cases were included in the study over 8 years. Mean age was 24 +/- 10.32 years with m:f ratio of 1:2.6. In 100 % cases pain abdomen, fever, tenderness in either right iliac fossa or generalized in the abdomen were observed. Widal test, Typhidot and blood culture was positive in 51 ,54 and 58 out of 76 patients in same order. Wound sepsis was a common post-operative complication 12/76 [15%] other post-operative complications were pulmonary infection, abdominal dehiscence, intra peritoneal abscesses and Intestinal haemorrhage. Mean duration of hospital stay was 13.34 +/- 4.20 days. Mortality was 1.3% Two layer primary closure is an effective procedure having good results. Both morbidity and mortality are low and associated with reasonable length of hospital admission

Effect of acetylsalicylic acid on spermatogenesis in adult albino mice

To Observe the histological and morphological effects of acetylsalicylic acid [ASA] on Spermatogenesis in male albino mice. Laboratory based randomized controlled trial. Department of Anatomy University of Health Sciences, Lahore from Apr, 2012 to Dec, 2012. Thirty nine male albino mice, 6-8 weeks old weighing 30 +/- 5 gm, were used; these were randomly divided into three groups having thirteen mice in each using random numbers table. Group A served as a control and was given distilled water orally via oral gavage 10 ml per kg for 30 days. Group B was given acetylsalicylic acid 100 mg/kg dissolved in 10 ml distilled orally for a period of 30 days. Group C was given acetylsalicylic acid 25 mg/kg dissolved in 2.5 ml distilled orally for a period of 30 days. Animals were sacrificed 24 hours after the last dose and the testes were removed, fixed in Bouin's fixative for 48 hours. Five microns thick sections of processed tissue were stained with H and E and PAS for calculation of Johnsen score and diameter of seminiferous tubules. Serum testosterone level was measured by testosterone enzyme immunoassay test kits. Microscopic examination demonstrated that ASA treatment lead to statistically significant increase in the mean Johnsen score and mean diameter of seminiferous tubules. It was concluded from the current study that ASA treatment enhances spermatogenesis

Effect of corn silk extract on acetaminophen induced renal damage in mice

To evaluate the protective role of Corn Silk extract on Acetaminophen induced nephrotoxicity in albino mice. Laboratory based randomized controlled trials. The study was carried out in experimental research laboratory University of Health Sciences and Anatomy department, Lahore. The study duration was one year from February 2012 to February 2013. Twenty seven male albino mice, 6-8 weeks old weighing 30 +/- 5 gm, were used; these animals were randomly divided into three groups having nine mice in each group. Group A served as control and was given 16.6ml/kg normal saline intraperitoneally on first day of experiment and was sacrificed on 10th day of the experiment. Group B was treated with acetaminophen 600 mg/kg dissolved in 16.6 ml of normal saline intraperitoneally on 1st day of experiment and was sacrificed after 48 hours. Group C was given acetaminophen at a dose of 600 mg/kg intraperitoneally on first day of experiment and then corn silk extract was given by oral route at a dose of 400 mg/kg for next 8 days. The animals were sacrificed on 10th day of the experiment, the kidneys were removed; 3mm three tissue pieces were fixed in 10% formaline; processed and stained with H and E for histological study. It was observed on microscopic examination that Corn silk extract reduced deleterious effects of acetaminophen on tubules of kidney as evidenced by reduction of tubular vacuolation and necrosis, absence of protein casts, vascular congestion and inflammation. It is concluded from current results that corn silk extract protects acetaminophen induced nephrotoxicity

Incidences of developing eating disoreders due to binge eating

Binge eating or chaotic eating refers to unhealthy eating patterns that are found in low incidences comparatively to verify and diagnosed eating disorders. Altered eating behaviors may lead to severe eating disorders like Binge eating disorder and bulimia nervosa that could be life threaten if left undiagnosed The purpose of this study is to investigate unordered or binge eating attitudes among individuals with respect to their eating patterns. An observational study has been done in which a randomized data of 120 individuals have been selected within a group of 24 males and 96 females with the help of a questionnaire based survey on food habits, preference of type of food intake, tea consumption, munching habits, workplace or home eating and eating during working hours. R Results were analyzed on the basis of percentage values and SPSS 17.0 different associations between variables. out of 120 people 58.3%of the individuals including both genders did not have a feeling of fullness, 50.83% of the total individuals eat during working hours and possess munching habit, 83% use to eat biscuits to munch .Unordered eating patterns also affect the frequency of bowel movements, 58.30% people have bowel movements once a time. Irregular eating and munching habits does not initiate a feeling of fullness in the beginning of a meal, due to binge eating people do get satisfied by the smell of food and did not take a proper meal to fulfill nourishment requirements. However, binge eating lead to increase appetite as the munching material including snacks digest quickly which cause more food intake and people did not get fully satisfied by the smell of food only and excessive tea intake is one of the contributing factors. Binge eating affects normal appetite, eating attitudes and Bowel movements which may further lead to severe eating disorders like Bulimia nervosa which should be clarified early instead left undiagnosed

Effect of nigella sativa extract on renal functions in amphotericin b induced nephrotoxicity in mice

Amphotericin B is considered as one of the most effective antifangal drugs presently used to treat systemic fungal infections; however, nephrotoxicity remains the major side effect. The current study is therefore, designed to determine Amphotericin B induced nephrotoxicity and its prevention by administration of Nigella sativa [NS] extract in albino mice. Thirty two albino mice, 6-8 weeks of age, 30 +/- 5 gm body wt, were randomized into four groups of eight mice each. Group A [control] was injected 3.7 ml/kg of 5% dextrose solution intraperitoneally daily for 7 days. Group B was treated with Amphotericin B [18.5 mg/kg dissolved in 3.7ml 0/5% dextrose solution] iritraperitoneally daily for 7 days. Group C received Amphotericin B [18.5 mg/kg dissolved in 3/nil of 5% dextrose solution] intraperitoneally along with Extract of Nigella sativa [500 mg/kg] orally daily for 7 days. Group D received Amphotericin B [18.5 mg/kg dissolved in 3.7 ml of 5% dextrose solution] intraperitoneally for initial 7 days; after completing the injection regimen, extract of Nigella sativa 500 mg/kg was given orally daily for next 7 days. At the end of the experiment, cardiac puncture was performed to draw blood from each animal for renal function tests. Nigella sativa when co-administered with Amphotericin B significantly contained serum urea and serum weatinine levels [p < 0.001] implying thereby that Amphotericin B induced nephrotoxicity was significantly reduced. However, when Nigella sativa extract was given after Amphotericin B, the toxic effects of the drug persisted unabated thus indicating that Nigella sativa protects but do not ameliorates the toxic effects of the drug

Effects of administration of vitamin a to pregnant dams on the skin of the fetuses of albino mice

For differentiation and maintenance of epithelial cells in vitro and vivo wider the influence ofretinoic acid treatment, skin seems to be a major target organ for both the normal and patholo-gical states. The current study was conducted to evaluate the effects ofretinoic acid on fetal skin if given to albino mice during pregnancy. Twelve pregnant albino mice were divided into two groups of 6 each; the experimental group was given 60 mg/kg/day ofretinoic acid [RA] dissolved in o.iml of olive oil orally on 7, 8 and 9 day of gestation. Fetuses were delivered and dissected on 18[th] day of gestation; skin samples were removed and processed for microscopic study. Histological examination of fetal skin in RA treated group showed increased keratinocyte proliferation resulting in increased number of epidermal cell layers and increased epidermal thickness. It also inhibited the development of hair follicles which are seen in the form of rudimentary buds in the dermis. So its usage during pregnancy should be warranted. Given the essential role of retinoids in epidermal differentiation and their effectiveness in the treatment of several skin orders it is important to see its histological effects on skin

Protective effects of vitamins C and E against sodium arsenate induced effects on maternal weight in Albino mice

Exposure to arsenic through drinking water, food and occupational sources are common throughout the world. Women are more susceptible than men to the adverse effects of arsenic, as it interacts with estrogen hormones. This study was designed to evaluate the role of vitamin C and E in mitigating the toxic effects of sodium arsenate on maternal weight gain. Thirty two Albino mice of BALB/c strain [twenty four females and eight males], 10 weeks old, weighing 30 - 35 gm were used; animals were divided into four groups having six female mice in each. Group A[1] served as control and was given a single I/P dose of weight related distilled water on 8[th] day of gestation. Groups A[2], A[3] and A[4] animals received sodium arsenate [35 mg/kg] on 8[th] gestational day and vitamin C and E were given by I/P injection,[9 mg/kg/day and 15 mg/kg/day] respectively, from 8[th] day for rest of pregnancy period. The body weight of dams was recorded every day after the confirmation of pregnancy, till the time of sacrifice. The actual weight of dams was calculated as the difference between dam's total weight and that of total fetal weight. There was normal weight gain in dams of group A[1], whereas in group A[2] the maternal weight gain was reduced and the difference was statistically significant as compared to groups A[1], A[3] and A[4]. It was therefore, concluded from the current results that vitamin C and E are useful in protecting sodium arsenate induced reduction of weight gain

Achieving excellence in maternal, neonatal and perinatal survival: executive synopsis of pearl study annual report 2011

PEARL Study [Perinatal Neonatal Outcomes Research Study in the Arabian Gulf] is Qatar's prospective National Perinatal Epidemiologic Study funded by QNRF [Qatar National Research Fund - grant # QNRF-NPRP-09-390-3-097]. The study is a joint collaborative research project between Hamad Medical Corporation [HMC], Doha, Qatar and the University of Gloucestershire, Gloucester, United Kingdom. The project aims at building a National Neonatal Perinatal Registry for Qatar called Q-Peri-Reg which will be used to quantify Maternal, Neonatal and Perinatal mortality and morbidities and their correlates. The study is approved by the Research Ethics Committee [IRB] of Hamad Medical Corporation [protocol#9211/09], which is responsible for providing ethical approval to all health care research projects in the State of Qatar

Various clinical presentations of falciparum malaria and outcome: a study of 100 patients

Various clinical presentations of falciparum malaria and outcome. Malaria is an important disease worldwide, result in estimated 300-500 million new cases and 1.5-2.7 million deaths per year. Most deaths occur due to Plasmodium Falciparum infection. Falciparum malaria is a major community problem in our country. Presentation of falciparum malaria with paroxysms of fever chills and rigors are easy to diagnose and treat. Case series study. This study was conducted at DUHS from January 2011 to December 2011. 100 patients above 12 years of age with any gender, presenting with high grade fever and diagnosed as a case of Falciparum malaria on thick and thin film are included in this study. Among 100 patients 69 were male and 31 females. Clinically all patients presents with fever, while 69 with headache, 39 with vomiting and 28 with altered level of consciousness. The most common sign was anemia i.e. in 40 patients, splenomegaly in 37, and jaundice was found in 35 patients. 7 patients were expired during the study. Falciparum malaria is a notorious for various presentations which may mimic like upper and lower respiratory tract infection, acute gastroenteritis and bacterial meningitis. The treating physician should be aware of the various presentations because early detection and treatment may reduce the morbidity and mortality associated with falciparum malaria

Variations in cerebral arterial circle of Willis in adult Pakistani population

To identify the anatomical variations in cerebral arterial circle of Willis. Descriptive study. Department of Anatomy, University of Health Sciences, Lahore, from February 2009 to January 2010. Human brains were removed from fifty-one consecutive cadavers at the time of autopsy from Forensic Department, King Edward Medical University, Lahore, to observe anatomical variations in the cerebral arterial circle regarding its completeness, pattern and symmetry. The individual cerebral vessels were also noted for the presence, origin, caliber and symmetry. Pictures from each dissection, showing the complete circle were taken. The variations of the circle as whole and segmental variations were studied and described in percentage. Thirty-seven [72.5%] of the 51 [100%] cerebral arterial circles were complete; 15 subjects [29.4%] had typical configuration; 25 [49%] had symmetrical arrangement and 39 subjects [76.4%] had different types of variations in their component vessels. Variations were most common in the posterior communicating artery followed by anterior communicating artery, pre-communicating segments of the posterior cerebral and pre-communicating segments of anterior cerebral arteries. No circle was found with aneurysm. Different variations in the formation of circle of Willis and in its component vessels are common in the local adult population of Pakistan. These should be taken into consideration during angiographic evaluation and neurosurgical procedures on the anterior circulation

Panax ginseng, its effects on development of hair follicles - an experimental study

The use of Herbal medicines in developed and developing countries is rapidly increasing on the presumption that they are better and safer than conventional medicines. It is now being reported that herbal preparations have far reaching effects on body systems especially in the developmental processes. The current study was conducted to evaluate the effect of Panax ginseng on developing hair follicle of albino mice. Thirty mice, 6 - 8 weeks old weighing 30 - 35 gm were housed together for mating and pregnancy was confirmed by vaginal plug. The fetuses were delivered and dissected on the 19[th] day and the fetuses were delivered, microscopic slides of the hair follicles small pieces of skin were removed and processed for to be examined under light microscope. The pregnant dams were treated with Panax Ginseng and the litter obtained showed an increase in the number of hair follicles. Histological sections showed signs of haemorrhages and tissue degeneration. Although, embryo - toxicity in experimental model of animals may not reflect the situations in humans, further investigation and monitoring of the adverse effects of the Panax ginseng during pregnancy is warranted in humans

Ethanol induced hepatotoxicity in albino rats

Twelve male albino rats of 6-8 weeks old, weighing 150-200 gm each were divided into two groups of 6 rats each. Group A was used as control while Group B was given ethanol at a dose of 0.6 ml [0.5 gm]/100 gm/day for 8 weeks. Serum enzymes and liver histology was determined in both groups. Statistically significant increase in the mean enzyme levels, liver weight and volume were observed in the ethanol treated group compared to the controls. Histologically, hepatocytes contained large number of cytoplasmic vacuoles, pyknotic nuclei, and lymphocytic infiltration in treated animals. Ethanol appeared to be hepatotoxic in albino rats