Evaluating the Performance of Proposed Switched Beam Antenna Systems in Dynamic V2V Communication Networks.

This paper develops a novel approach for reliable vehicle-to-vehicle (V2V) communication in various environments. A switched beam antenna is deployed at the transmitting and receiving points, with a beam management system that concentrates the power in each beam using a low-computation algorithm and a potential mathematical model. The algorithm is designed to be flexible for various environments faced by vehicles. Additionally, an anti-failure system is proposed in case the intelligent transportation system (ITS) system fails to retrieve real-time Packet Delivery Ratio (PDR) values related to traffic density. Performance metrics include the time to collision in seconds, the bit error rate (BER), the packet error rate (PER), the average throughput (Mbps), the beam selection probability, and computational complexity factors. The proposed system is compared with traditional systems. Extensive experiments, simulations, and comparisons show that the proposed approach is excellent and reliable for vehicular systems. The proposed study demonstrates an average throughput of 1.7 Mbps, surpassing conventional methods' typical throughput of 1.35 Mbps. Moreover, the bit error rate (BER) of the proposed study is reduced by a factor of 0.1. Additionally, the proposed framework achieves a beam power efficiency of touching to 100% at computational factor of 34. These metrics indicate that the proposed method is both efficient and sufficiently robust.

Determinants of early neonatal mortality (hospital based retrospective cohort study in Somali region of Ethiopia).

Early neonatal mortality occurs when a newborn dies within the first seven days of life. Despite interventions, neonatal mortality remains public health problem over time in Ethiopia (33 per 1000 live births). Determinants varies on level of neonatal mortality. The study's goal was to determine magnitude of early newborn death, as well as its determinants and causes in Newborn Intensive Care Unit of Referral hospital in Ethiopia's Somali region. Health facility based retrospective study review was conducted between May 2019 to May 2021 in Shiek Hassan Yabare Referral Hospital of Jigjiga University of Ethiopia. All neonates admitted at neonatal intensive care unit (NICU) with complete data and get registered using the new NICU registration book from May 2019 to May 2021 were included. Kobo toolkit was used for data collection and analyzed in SPSS 20. The magnitude of early neonatal mortality rate was defined as death between 0 and 7 days. Logistic regression model was used to estimate maternal and neonatal characteristics as a determinant variables on neonatal mortality. The statistical significance was considered at P-value < 0.05. The magnitude of early neonatal mortality rate of Ethiopia's Somali region is estimated to be 130 per 1000 live births-that is say 130 newborn couldn't celebrate their seventh day in every 1000 live births. Hypothermia, prematurity, maternal death at birth and shorter length of stay in NICU were increasing the chance of neonatal mortality at early stage while neonatal resuscitation had shown protective effect against neonatal mortality. Similarly birth asphyxia, preterm, sepsis, and congenital abnormalities were major causes of admission and death in the NICU. The magnitude of early neonatal mortality is considerable and most of the determinants are preventable. Enhancing quality of intra-partum and NICU care including infection prevention, managing hypothermia and neonatal resuscitation as per the national standard within the first golden hour is key.

Omega 3 fatty acids - Potential modulators for oxidative stress and inflammation in the management of sickle cell disease

Abstract Objective Sickle cell disease is characterized by clinical complications resulting in vaso-occlusive crisis with prominent attributes of oxidative stress, inflammation, and pain. Inflammation is an integral part of this disease which further exacerbates the pain during a crisis. Omega-3 fatty acids are known to possess anti-inflammatory and anti-aggregatory properties and assist in diminishing the slow physiological inactivation. Methods A pilot nutritional interventional study was conducted wherein forty-three children with sickle cell disease aged 5-16 years were supplemented with omega-3 fatty acids for a period of six months. Analysis of oxidative stress, as well as inflammatory parameters, was done pre and post-supplementation. Results Increased free oxygen radical transference values depicting free radical generation is enhanced in these patients along with a reduced antioxidant defense, as seen by decreased free oxygen radical defense values. Supplementation with omega-3 fatty acids for a period of six months significantly reduced the inflammatory marker homocysteine in all patients, whereas high sensitive C reactive protein was significantly reduced only in females of the age group 11-16years. Simultaneously a significant reduction in oxidative stress parameters with a concomitant increase of antioxidant defense was observed in all patients. Conclusion The authors' findings suggest the regulatory effects of omega-3 fatty acids as cellular activators in alleviating the complications due to sickle cell disease. Omega-3 fatty acids hold promise as future therapeutic candidates in patients with sickle cell disease.

Determinants of severe acute malnutrition among children aged 6-36 months in Kalafo district (riverine context) of Ethiopia.

Malnutrition remains prevalent and existing health problem globally. Particularly Undernutrition is a major public health issue in developing countries. Globally the causes of severe acute undernutrition varies across context. The aim of this study was to identify the determinants of severe acute malnutrition to uncover contextual factors based on UNICEF conceptual framework, as there was no study done in a similar context in Ethiopia. Health facility based (health post) un-matched case control study with Key informant interview was conducted to identify determinant factors of severe acute malnutrition (SAM) among children between 6 and 36 months. 246 children (82 cases and 164) with their mothers or care takers participated the study which was conducted between December 20, 2019 to January 20, 2020 in Kalafo district in Shebele River. Odds ratio with 95% confidence interval was calculated to identify the determinants of SAM among children aged 6-36 months using multivariate logistic regression. The odds of severe acute malnutrition was 2.28 (1.22, 4.26); 4.68 (2.29, 9.58); 2.85 (1.26, 6.45); 2.39 (1.16, 4.96) and 3.262 (1.46, 7.31) and 3.237 (1.45, 7.23); respectively for mothers with three or more under five children, Children with inadequate dietary diversity, experienced diarrhea in past 2 weeks, their mothers had not nutrition counselling during pregnancy and younger (6-11 and 12-17 months) children as compared to controls. The finding of this study reveals the main determinants of severe acute malnutrition in riverine context are multi-level. In addition to this, poor childcare and polygamy identified in qualitative finding. Decisive and multi-sectoral approach is required to addressing SAM in the riverine area.

Omega 3 fatty acids - Potential modulators for oxidative stress and inflammation in the management of sickle cell disease.

OBJECTIVE: Sickle cell disease is characterized by clinical complications resulting in vaso-occlusive crisis with prominent attributes of oxidative stress, inflammation, and pain. Inflammation is an integral part of this disease which further exacerbates the pain during a crisis. Omega-3 fatty acids are known to possess anti-inflammatory and anti-aggregatory properties and assist in diminishing the slow physiological inactivation. METHODS: A pilot nutritional interventional study was conducted wherein forty-three children with sickle cell disease aged 5-16 years were supplemented with omega-3 fatty acids for a period of six months. Analysis of oxidative stress, as well as inflammatory parameters, was done pre and post-supplementation. RESULTS: Increased free oxygen radical transference values depicting free radical generation is enhanced in these patients along with a reduced antioxidant defense, as seen by decreased free oxygen radical defense values. Supplementation with omega-3 fatty acids for a period of six months significantly reduced the inflammatory marker homocysteine in all patients, whereas high sensitive C reactive protein was significantly reduced only in females of the age group 11-16years. Simultaneously a significant reduction in oxidative stress parameters with a concomitant increase of antioxidant defense was observed in all patients. CONCLUSION: The authors' findings suggest the regulatory effects of omega-3 fatty acids as cellular activators in alleviating the complications due to sickle cell disease. Omega-3 fatty acids hold promise as future therapeutic candidates in patients with sickle cell disease.

Ilizarov fixator pin site infection: A comparison between transverse wires and half pins.

OBJECTIVE: To evaluate the difference in the infection rates between Ilizarov wires and half-pins in routine practice. METHODS: This was an observational, prospective; single-centre study approved by the institutional ethics committee. Hundred cases were treated from June 2014 to May 2018 at Ilizarov Surgery Unit, Department of Orthopaedic Surgery & Traumatology Liaquat University of Medical & Health Sciences Jamshoro Sindh Pakistan. All patients were subjected to an evaluation of half-pins and Ilizarov wires. Patients with monolateral fixators were excluded from the study. The demographic data included patient's age and sex, surgical indication, application and removal of Ilizarov fixator, follow-up duration and type of pin (transverse wire or half pin) used. Non probability consecutive sampling technique was used and sample size was calculated randomly. RESULTS: Of the total 100 cases, 79(79%) were male and 21(21%) were female with a mean age of 42.8±8.2 years. A total of 890 pins were applied in 100 patients with 170(19.10%) Half pins and 720(80.89%) wires. The transverse wire's infection rate according to Paley's grading system of Pin tract infection was, 46(53.48%), 25(29.06%) and 15(17.44%) in Grade I, Grade II and Grade III respectively. In case of half pin's infection, the majority of the cases were categories in grade II 22(55.0%) followed by Grade I 12(30.0%) and Grade III 06(15.0%). CONCLUSIONS: The tensioned transverse wires had a significantly low infection rate as compared to half pins.

TRAP transporter TakP: a key player in the resistance against selenite-induced oxidative stress in Rhodobacter sphaeroides.

Almost one-third of all proteins require metal ions as an essential component in key biological processes and approximately half of all enzymes are associated with one or more metal ions. The naturally occurring selenium is very toxic at higher levels, but few bacteria can reduce it into the less toxic insoluble elemental selenium. Selenium is required for the synthesis of selenocysteine, an essential residue involved in the active sites of various enzymes. The purple non-sulphur bacteria, Rhodobacter sphaeroidesis demonstrated for its selenite reduction capacity. The exact mechanism of selenite toxicity is unknown but it reacts with glutathione to form selenodiglutathione, producing the highly toxic compounds namely, H2O2and O2-. A R. sphaeroidesstrain with mutated takP gene, a member of the TRAP (tripartite ATP-independent periplasmic) family of transporter, was reported to be showing more resistance towards selenite in the growth medium but the reason for the resistance is unknown. TRAP transporters are the best-studied family of substrate-binding protein and in our previous study it was confirmed that the gene takP in R. sphaeroides is down-regulated by a small non-coding RNA SorY, providing more resistance to the bacterium against the oxidative stress. By comparative growth analysis and sensitivity assays in the presence of 2 mM selenite, it was observed that the SorY knockout strain is more sensitive to selenite while overexpression of the sRNA conferred more resistance to the bacterium like the takP mutant strain. TakP is involved in the import of malate into the cell, which under oxidative stress needs to be down-regulated to limit malate flux into the cell. Limited malate flux leads to metabolic rearrangements in the cell to avoid excessive generation of prooxidant NADH and facilitate constant generation of antioxidant NADPH. In the presence and absence of selenite, a drastic increase in the NADPH and decrease in the NADH levels are reported respectively. Accumulation of metallic selenium in the cytoplasm was detected via atomic absorption spectrophotometer and our analysis clearly demonstrated the presence of more selenium in the electron micrographs of the SorY knockout strain compared to the takP mutant grown under dark semi-aerobic growth conditions in the presence of selenite. Hence based on our analysis, it is confirmed that lack of TakP transporter led to reduced selenite influx into the cytoplasm, relieving cells with limited generation of ROS, eventually exhibiting more resistance against selenite-induced oxidative stress.

Enoxaparin Attenuates Acute Lung Injury and Inflammasome Activation after Traumatic Brain Injury.

Traumatic brain injury (TBI) patients frequently develop cardiopulmonary system complications such as acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). However, the mechanism by which TBI causes ALI/ARDS is not fully understood. Here, we used a severe TBI model to examine the effects of a low-molecular-weight heparin, enoxaparin, on inflammasome activation and lung injury damage. We investigated whether enoxaparin inhibits ALI and inflammasome signaling protein expression in the brain and lungs after TBI in mice. C57/BL6 mice were subjected to severe TBI and were treated with vehicle or 1 mg/kg of enoxaparin 30 min after injury. Lung and brain tissue were collected 24 h post-TBI and were analyzed by immunoblotting for expression of the inflammasome proteins, caspase-1 and interleukin (IL)-1ß. In addition, lung tissue was collected for histological analysis to determine ALI scoring and neutrophil and macrophage infiltration post-injury. Our data show that severe TBI induces increased expression of inflammasome proteins caspase-1 and IL-1ß in the brain and lungs of mice after injury. Treatment with enoxaparin attenuated inflammasome expression in the brain and lungs 24 h after injury. Enoxaparin significantly decreased ALI score as well as neutrophil and macrophage infiltration in lungs at 24 h after injury. This study demonstrates that enoxaparin attenuates ALI and inhibits inflammasome expression in the brain and lungs after TBI. These findings support the hypothesis that inhibition of the neural-respiratory inflammasome axis that is activated after TBI may have therapeutic potential.

Anti NMDA receptor antibody encephalitis in Pakistan: Clinicopathological features and treatment outcomes.

Anti-NMDA receptor antibody encephalitis (anti-NMDAR Encephalitis) is the most common subtype of autoimmune encephalitis in which IgG antibodies directed against NR1 subunit of NMDA receptors are present. It is a potentially lethal encephalitis which responds favourably to timely immunosuppressive therapy. If untreated, its progression leads from delusions, paranoia, movement disorder, memory deficit and seizures into a state of unresponsiveness with autonomic instability and even death. We present clinicopathological features, treatment and outcomes of eight autoantibodyproven cases of anti-NMDAR Encephalitis. There were 7 females and 1 male with a mean age of 15 years (age range: 1 to 28 years). Clinical features included seizures, altered consciousness, memory deficit, delusions, paranoia and hallucinations. Hyperactivity and irritability were prominent features among the children. Patients treated with immunosuppressive therapy including steroids, IVIg, plasmapheresis and Rituximab, recovered completely within a month of therapy. Whereas patients who received only steroids as immunosuppressive therapy suffered from residual brain damage.

C1Q Nephropathy: A Multifaceted Disease With Infrequent Diagnosis.

BACKGROUND: C1q nephropathy (C1qN) is a rare glomerulopathy, with a very low prevalence world wide varying from 0.2 to 2.5%. Even though more than three decades have passed since this entity was first explained, still, it remains a dilemma for many due to the rarity of this lesion. This study was carried out principally to determine the clinical presentation, morphologic features and distribution of C1qN in our region based on renal biopsies studied by light microscopy (LM), and immunofluorescence (IF) so that this entity is better understood both by nephrologists and pathologists as no such study has ever been conducted in Pakistan to our knowledge. METHODS: It was a cross-sectional study carried out from 1st January 2012 to 30th December 2016 in Histopathology department, Shifa International Hospital. All cases diagnosed as C1q nephropathy were retrieved from the hospital's computerized database. Their clinical profiles, morphology and immunohistochemical profiles were studied.. RESULTS: Over this period a total of 31 cases were diagnosed with C1qN. Mean age of the patients was 32.09±18.66 years. The most common clinical presentation was nephrotic syndrome seen in 22 (71%) patients. The most frequent morphological pattern seen was minimal change disease (MCD) in 13 (41.9%) cases. All cases showed dominant 22 (71%) or codominant 9 (42.9%) mesangial±membranous C1q deposition. No correlation was found (p-value >0.05) between morphological pattern and clinical presentation of the disease or immunofluorescence findings. CONCLUSIONS: C1qN is a rare entity which is primarily diagnosed on the basis of immunofluorescence findings with a dominant or codominant fluorescent intensity for C1q. It is recommended that C1qN is sought for preferably with immunofluorescence staining of biopsies for immune reactants, especially for C1q. Studies from this part of the world are strongly recommended to predict clinical outcome and treatment options.

Assessment of focused antenatal care utilization and associated factors in Western Oromia, Nekemte, Ethiopia.

OBJECTIVE: Despite the fact that quality antenatal care is one of the essential aspects in maternal and child health care, the current perceived quality and associated factors of this service is not well acknowledged in Ethiopia. This study was therefore undertaken to assess focused antenatal care service utilization and associated factors in western Ethiopia. RESULT: This study has measured the utilization of focused antenatal care services in terms of regularity of frequency of attendance, initiation time and completeness of the components. In about 19.8% of mothers attendance was irregular. While than three-fourths 330 (78.6%) started in the second trimester, and 42 (10%) of them commenced in the third trimester. The essential components of the services like counseling on nutrition, family planning, and HIV/AIDS were respectively missing in 1.9%, 8.3% and 7.4% of clients. Providing and receiving quality ANC was found to have emanated from different factors which were related to mothers, providers and facilities. Although the overall ANC utilization noticed deceivingly seems satisfactory, it was not fully comprehensive, focused and not to its current standard. Further efforts in terms of effective planning, monitoring and evaluation activities on the service are therefore strongly recommended.

Highly integrated nanocomposites of RGO/TiO2 nanotubes for enhanced removal of microbes from water.

Highly integrated nanocomposite of Graphene oxide (GO) and its derivatives with metal oxides is essential for enhanced performance for various applications. Tuning the morphology is an important aspect during nanomaterials synthesis; this has an amplifying influence upon physicochemical properties of advanced functional materials. In this research work, GO/TiO2 nanotube composites have been successfully synthesized via alkaline hydrothermal treatment method by augmenting GO layers with two different phases of TiO2 (anatase and rutile) nanoparticles, followed by the hydrothermal treatment that also have caused reduction of GO to reduced GO (RGO). The morphology of the as-prepared samples appeared to be nanotubes with a large aspect ratio (length to diameter). The synthesized materials have been characterized using various techniques to determine their morphological and functional properties. Large surface area (158 m2/g) nanotube composites found accountable as effective disinfectant for water containing microorganisms. The antimicrobial activity of the synthesized composites was examined by disk diffusion method and optical density for bacterial growth using two different bacterial species; Escherichia Coli (E.coli, Gram-negative) and Staphylococcus Aureus (Methicillin-resistant Staphylococcus aureus, Gram-positive). The antibacterial study revealed that, the anatase phase RGO/TiO2 nanotube composites manifested appreciable effect on both bacteria as compared to rutile phase RGO/TiO2 nanotubecomposite.

T cell reactivity to Collagen II as a possible prognostic marker in patients with rheumatoid arthritis.

OBJECTIVE: To compare the frequency and the functional state of the collagen II reactive T cells with disease activity in rheumatoid arthritis patients and healthy controls. METHODS: This case-control cross-sectional study was carried out at the Department of Immunology; Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from June to October 2014. Rheumatologist from Rehmat Noor Rheumatology Clinic, a private health facility of the city, was requested to send in patients with clinical diagnosis of rheumatoid arthritis. Samples were obtained and relevant investigations were carried out. Data were compared with a group of age and gender-matched healthy subjects. T cell proliferative response was assessed against bovine collagen II by measuring incorporation of bromodeoxyuridine into deoxyribonucleic acid of proliferating cells and by expression of CD25 on proliferating cells as percentage of CD3+/bromodeoxyuridine+ and CD3+/CD25+ T-cells, respectively. Among the patients, the frequency of T cells with disease activity was compared. Patients were classified into groups of mild, moderate and severe disease and frequency of CD3+/bromodeoxyuridine+, frequency of CD3+/CD25+ cells, mean fluorescent intensity of bromodeoxyuridine-fluorescein isothiocyanate and mean fluorescent intensity of CD25-fluorescein isothiocyanate were compared in the groups. RESULTS: Of the 60 subjects, 30(50%)were patients and 30(50%) were controls. Of the patients, 5(16.66%) were males and 25(83.33%) were females with an overall mean age of 42±12 years. The mean age of the controls was 41±9.28 years. Mean disease duration of the patients was 10.5 ± 4.2 years. Percentage of CD3+/CD25+ cells and CD3+/bromodeoxyuridine+ cells stimulated with collagen II, in patients was much higher than the controls(p<0.05).Statistically significant differences were observed when frequency of CD3+/bromodeoxyuridine+ cells and CD3+/CD25+ cells was compared among the mild, moderate and severe patient groups (p<0.05). CONCLUSIONS: Collagen II was found to be an important auto antigen in joints of rheumatoid arthritis patients.

Discordant disease expression of neonatal lupus erythematosus in twins.

Neonatal lupus erythematosus is an autoimmune disease resulting from the trans-placental passage of maternal anti-SSA/Ro, anti-SSB/La, and less frequently anti-RNP antibodies to the foetus. At the time of diagnosis 50% of mothers are asymptomatic. Neonatal manifestations of this multisystem disease may include congenital heart block, cutaneous lesions and haematological abnormalities. We present the case of congenital neonatal lupus erythematosus in non-identical twins, showing variability in clinical manifestation of this disease,despite receiving the same level of antibodies from the mother. This case adds to the growing body of evidence about the role of genetics and other feto-maternal contributing factors in addition to the presence of auto antibodies. It raises interesting questions about discordant disease expression in offspring's of the same mother.

Superficial temporal artery - middle cerebral artery bypass for internal carotid artery petrous aneurysm: A case report.

A 13 years old boy presented with persistent ear bleed following a blow to the head. The boy was found to have a bleeding congenital aneurysm of the Petrous part of the internal carotid artery. He underwent a bypass surgery for the aneurysm and a successful Superficial Temporal Artery to Middle Cerebral Artery bypass was made.

Determinants of institutional delivery service utilization among pastorals of Liben Zone, Somali Regional State, Ethiopia, 2015.

Maternal health service utilizations are poorly equipped, inaccessible, negligible, and not well documented in the pastoral society. This research describes a quantitative and qualitative study on the determinants of institutional delivery among pastoralists of Liben Zone with special emphasis on Filtu and Deka Suftu woredas of Somali Region, Ethiopia. The study was funded by the project "Fostering health care for refugees and pastoral communities in Somali Region, Ethiopia". This community-based cross-sectional study was conducted during November 2015. Interviews through a questionnaire and focus group discussions were used to collect the data. Proportional to size allocation followed by systematic sampling technique was used to identify the study units. The major determinants of institutional delivery in the study area were as follows: being apparently healthy, lack of knowledge, long waiting time, poor quality services, cultural beliefs, religious misconception, partner decision, and long travel. Around one-third (133, 34.5%) of the women had visited at least once for their pregnancy. More than half (78, 58.6%) of the women had visited health facilities due to health problems and only 27 (19.9%) women had attended the recommended four antenatal care visits. Majority (268, 69.6%) of the pregnant women preferred to give birth at home. Women who attended antenatal care were two times more likely to deliver at health facilities (AOR, 95% confidence interval [CI] =2.38, 1.065-4.96). Women whose family members preferred health facilities had 14 times more probability to give birth in health institutions (AOR, 95% CI =13.79, 5.28-35.8). Women living in proximity to a health facility were 13 times more likely to give birth at health facilities than women living far away (AOR, 95% CI =13.37, 5.9-29.85). Nomadic way of life, service inaccessibility, and sociodemographic and cultural obstacles have an effect on the utilization of delivery services. Increasing access, information, education, and communication need to reach pastoral women in need.

Reasons and Motivations for Cigarette Smoking and Barriers against Quitting Among a Sample of Young People in Jeddah, Saudi Arabia.

BACKGROUND: Cigarette smoking is one of the leading causes of death in the world. Tobacco consumption has grave negative consequences for health so that it is important to understand the reasons and motivations towards cigarette smoking and barriers against quitting smoking among the young generation for developing effective policies to control this widespread problem. MATERIALS AND METHODS: This crosssectional survey was carried out at the Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia. A total of 438 young smokers participated from the University and the general population. Data were collected through anonymous, selfadministered questionnaires in the Arabic language that contained questions about the reasons and motivations towards cigarette smoking and barriers against quitting smoking. The questionnaire also contained several questions regarding knowledge and attitude of the participants towards cigarette smoking. The data was analyzed on SPSS16. RESULTS: The mean age of the respondents was 22.9±3.48, out of 438 subjects 87 (19.9%) were married, and 351 (80.1%) were unmarried, and 331 (75.6%) belonged to urban areas while 107 (24.5%) were from the rural areas. Responding to a question about a number of cigarettes smoked per day, 31% answered 1120, 29% answered 2130, and 25% answered 110. Questioned about smokers in the family, 34.5% responded more than one, with 19% for brother and 13% for father. About the reasons for not quitting smoking, 26% described lack of willpower, 25% had no reason, 22% said that people around me smoke, and 15.3% responded stress at home/work. The major motivation for smokers was smoker friends (42%), for 33.8% others, for 12% father/brother and 7.8% media. CONCLUSIONS: There are several avoidable and preventable reasons and barriers against quitting smoking. However, knowledge and attitude about smoking were good, and the majority of the smokers were well aware of the associated hazards. Therefore, there is a need to search out ways and means to help them to quit this addiction.

Chronic granulomatous disease.

Chronic granulomatous disease is a rare inherited disorder characterised by inability of phagocytes to generate reactive oxygen species needed for intracellular killing of phagocytosed microorganisms. We report the case of an 8-month-old male child with recurrent chest infections and perianal abscess that had no response to conventional antibiotic treatment. His two elder brothers died due to similar complaints at the ages of 4 and 5 months. Four elder sisters were healthy and alive. This history indicated that the patient might have X-linked chronic granulomatous disease. A definite absence of superoxide activity in the patient's granulocytes detected by dihydrorhodamine test and nitroblue tetrazolium dye reduction test confirmed this diagnosis.

HLA- DR Alleles in Pakistani Patients of Pemphigus Vulgaris.

OBJECTIVE: To determine frequency of HLA-DR alleles in Pakistani patients of pemphigus vulgaris in comparison with local healthy controls. STUDY DESIGN: Cross-sectional, comparative study. PLACE AND DURATION OF STUDY: Department of Immunology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from January 2011 to January 2014. METHODOLOGY: Twenty eight patients with biopsy proven diagnosis of pemphigus vulgaris referred from Department of Dermatology, Military Hospital, Rawalpindi were included. Patients were compared with a group of 150 unrelated local healthy subjects. DNA was extracted from peripheral blood collected in Tri-potassium EDTA. HLA-DRB1 typing was carried out on allele level (DRB1*01--DRB1*16) using SSP (sequence specific primers). HLA type was determined by agarose gel electrophoresis and results recorded. Phenotype frequency of various alleles among patient group and control group was calculated by direct counting and significance of their association was determined by Fisher's exact test/ Chi square test. RESULTS: A total of 12 male and 16 female patients, with age ranging from 21 to 34 (mean 23.4 years) were genotyped for HLA-DRB1 loci. A statistically significant association of the disease with HLA-DRB1*04 was observed (50% versus 20.7% in controls, p < 0.05). CONCLUSION: There is a strong association of HLA-DRB1*04 with pemphigus vulgaris in Pakistani population.