Comparison of clinical characteristics, hospital treatment and outcomes in all four waves of Covid-19 patients at RTEH Muzaffargarh, Pakistan.

Background and Objective: The coronavirus pandemic followed a succession of COVID-19 waves globally, and had a varying pattern of frequency of cases and disease spectrum as each wave came with its distinct viral characteristics. The objective of this study was to compare clinical characteristics, treatments and outcomes of patients admitted with severe COVID -19 pneumonia in all four waves at Recep Tayyip Erdogan Hospital (RTEH). Methods: A cross sectional retrospective study was conducted at the COVID unit of Recep Tayyip Erdogan Hospital (RTEH), Muzaffargarh, from April 2020 to December 2021. Retrospective data was taken from Electronic Medical Records of patients of Covid pneumonia and divided into four groups according to four waves of Covid pandemic. The main objective was to compare disease spectrum, treatments and outcomes of patients admitted with severe COVID-19 pneumonia in all four waves at RTEH. Demographic characteristics, inflammatory markers such as C reactive protein (CRP), serum lactate dehydrogenase (LDH), serum ferratin and absolute lymphocyte counts, mortality, length of hospital and ICU stay and event of mechanical ventilation were compared between groups. The Kolmogorov-Smirnov test was applied to check the normality. P-value <0.05 was considered significance. Results: Of a total of 903 patients with covid pneumonia, 521(57.7%) were males and 382 (42.3%) females. Their mean age was 55.56±15.06 years. The mean length of stay (LOS) at the hospital was higher in first wave and least in fourth wave, 9.06±6.46 days and 6.56±5.34 days, respectively, (p<0.010). In first wave, LOS was generally >10 days with 21 (22.6%) while 33(26.8%) patients were shifted to ICU in first and second waves, respectively. Whereas, 35(8.2%) patients shifted to ICU in fourth wave (p<0.010). The use of mechanical ventilation was most common in first and second wave, 14 (15.1%) and 18 (14.6%), respectively. Mortality rate was highest in the third wave, 102 (38.9%, p<0.010) compared to the rest of the waves. Conclusion: Comparison of COVID-19 pneumonia patients across pandemic waves has revealed dynamic trends in patient outcomes. The initial waves had higher ICU admissions and mortality rate, suggesting a need for improved early response and resource allocation. Continuous adaptability in healthcare strategies was paramount for enhancing patient care during the ever-changing pandemic landscape.

An integrated gene-to-outcome multimodal database for metabolic dysfunction-associated steatotic liver disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the commonest cause of chronic liver disease worldwide and represents an unmet precision medicine challenge. We established a retrospective national cohort of 940 histologically defined patients (55.4% men, 44.6% women; median body mass index 31.3; 32% with type 2 diabetes) covering the complete MASLD severity spectrum, and created a secure, searchable, open resource (SteatoSITE). In 668 cases and 39 controls, we generated hepatic bulk RNA sequencing data and performed differential gene expression and pathway analysis, including exploration of gender-specific differences. A web-based gene browser was also developed. We integrated histopathological assessments, transcriptomic data and 5.67 million days of time-stamped longitudinal electronic health record data to define disease-stage-specific gene expression signatures, pathogenic hepatic cell subpopulations and master regulator networks associated with adverse outcomes in MASLD. We constructed a 15-gene transcriptional risk score to predict future hepatic decompensation events (area under the receiver operating characteristic curve 0.86, 0.81 and 0.83 for 1-, 3- and 5-year risk, respectively). Additionally, thyroid hormone receptor beta regulon activity was identified as a critical suppressor of disease progression. SteatoSITE supports rational biomarker and drug development and facilitates precision medicine approaches for patients with MASLD.

Reduced Graphene Oxide-Modified Spinel Cobalt Ferrite Nanocomposite: Synthesis, Characterization, and Its Superior Adsorption Performance for Dyes and Heavy Metals.

This work is dedicated to the synthesis, characterization, and adsorption performance of reduced graphene oxide-modified spinel cobalt ferrite nanoparticles. The as-synthesized reduced graphene oxide cobalt ferrite (RGCF) nanocomposite has been characterized using FTIR spectroscopy, FESEM coupled with EDXS, XRD, HRTEM, zeta potential, and vibrating sample magnetometer (VSM) measurements. FESEM proves the particle size in the range of 10 nm. FESEM, EDX, TEM, FTIR, and XPS analyses provide the proof of successful incorporation of rGO sheets with cobalt ferrite nanoparticles. The crystallinity and spinel phase of cobalt ferrite nanoparticles have been shown by XRD results. The saturation magnetization (M s) was measured as 23.62 emu/g, proving the superparamagnetic behavior of RGCF. The adsorption abilities of the synthesized nanocomposite have been tested using cationic crystal violet (CV) and brilliant green (BG) and anionic methyl orange (MO) and Congo red (CR) dyes. The adsorption trend for MO, CR, BG, and As(V) follows RGCF > rGO > CF at neutral pH. Adsorption studies have been accomplished by optimizing parameters like pH (2-8), adsorbent dose (1-3 mg/25 mL), initial concentration (10-200 mg/L), and contact time at constant room temperature (RT). To further investigate the sorption behavior, isotherm, kinetics, and thermodynamic studies have been conducted. Langmuir isotherm and pseudo-second-order kinetic models suited better for the adsorption of dyes and heavy metals. The maximum adsorption capacities (q m) obtained have been found as 1666.7, 1000, 416.6, and 222.2 mg/g for MO, CR, BG, and As, respectively, with operational parameters such as T = 298.15 K; RGCF dose: 1 mg for MO and 1.5 mg each for CR, BG, and As. Thus, the RGCF nanocomposite was found to be an excellent adsorbent for the removal of dyes and heavy metals.

Multifunctional Ternary NLP/ZnO@l-cysteine-grafted-PANI Bionanocomposites for the Selective Removal of Anionic and Cationic Dyes from Synthetic and Real Water Samples.

The development of competent adsorbents based on agro-waste materials with multifunctional groups and porosity for the removal of toxic dyes from aqueous solutions is still a challenge. Herein, a bionanocomposite made up of neem leaf powder (NLP), zinc oxide (ZnO), and amino acid (l-cysteine)-functionalized polyaniline (PANI), namely, NLP/ZnO@l-cysteine-grafted-PANI (NZC-g-PANI), has been prepared by an in situ polymerization method. The as-prepared bionanocomposite was tested for the adsorptive removal of three anionic dyes, namely, methyl orange (MO), amido black 10B (AB 10B), and eriochrome black T (EBT), as well as three cationic dyes, namely, brilliant green (BG), crystal violet (CV), and methylene blue (MB), from synthetic aqueous medium. The morphological and structural characteristics of the NZC-g-PANI nanocomposite were examined with the help of HR field emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM), X-ray diffraction (XRD), Fourier transform infrared (FTIR), and Raman spectroscopy. FTIR and Raman studies show that the formulated NZC-g-PANI have an ample number of functional moieties such as carboxyl (-COOH), hydroxyl (-OH), amines (-NH2), and imines (-N=), thus demonstrating outstanding dye removal capacity. C-S linkage helps to attach l-cysteine with polyaniline. Moreover, the predominance of chemisorption via ionic/pi-pi interaction and hydrogen bonding between the NZC-g-PANI nanocomposite and dyes (BG and MO) has been realized by FTIR and fitting of kinetics data to the PSO model. For both BG and MO dyes, the biosorption isotherm was precisely accounted for by the Langmuir isotherm with q max values of up to 218.27 mg g-1 for BG at pH 6 and 558.34 mg g-1 for MO at pH 1. Additionally, thermodynamic studies revealed the endothermic and spontaneous nature of adsorption. NZC-g-PANI showed six successive regeneration cycles for cationic (MO: from 96.3 to 90.4%) and anionic (BG: from 94.7 to 88.7%) dyes. Also, batch adsorption operations were validated to demonstrate dye biosorption from real wastewater, such as tap water, river water, and laundry wastewater. Overall, this study indicates that the prepared NZC-g-PANI biosorbent could be used as an effective adsorbent for the removal of various types of anionic as well as cationic dyes from different aqueous solutions.

Experimental Insights into Mesoporous Polyaniline-Based Nanocomposites for Anionic and Cationic Dye Removal.

This work presents the preparation of inorganic-organic hybrid nanocomposites, namely three-dimensional polyaniline (Pani)/activated silica gel (ASG) (3D Pani@ASG), their characterization, and in removing application as a potential adsorbent for cationic brilliant green (BG), crystal violet (CV), and anionic Congo red (CR), and methyl orange (MO) dyes. Pani@ASG nanocomposites have been prepared by the in situ polymerization method and characterized using various techniques such as Fourier transform infrared (FTIR), X-ray diffraction (XRD), field-emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM) with selected area electron diffraction, thermogravimetric analysis with derivative thermogravimetry, zeta potential analyses, and Brunauer-Emmett-Teller (BET). The scanning electron microscopy (SEM) study confirms the average particle size of the Pani@ASG nanocomposite is in the range of 5 nm. FESEM, TEM, FTIR, and XRD analysis proved the successful decoration of ASG over Pani. The BET result of Pani@ASG shows a mesoporous nature with a pore diameter of less than 3 nm and a surface area of 423.90 m2 g-1. Both SEM and TEM analyses show the proportional distribution of ASG over Pani's surface. The adsorption trend of BG and MO on the studied materials at pH 7 was found as follows: Pani@ASG > Pani > ASG. The highest sorption capacities of MO and BG on Pani@ASG were 161.29 and 136.98 mg/g (T = 298.15 K, and Pani@ASG dose: 0.04 g for MO and 0.06 g for BG), which were greater compared with bare Pani and bare ASG, respectively. The interaction mechanism behind the adsorption of BG and MO dyes onto the Pani@ASG nanocomposite includes electrostatic interaction, π-π interaction, and hydrogen bonding. The mechanistic pathway and the interactions between the targeted dyes and Pani@ASG were further studied using adsorption isotherm, adsorption kinetics, and thermodynamics.

Foot Involvement as the First Manifestation in Rheumatoid Arthritis Patients in Lahore.

Objective The objective of this study was to determine the involvement of the foot as the first manifestation in rheumatoid arthritis (RA). Methods This study was conducted on 100 patients who presented to the outpatient department of the Rheumatology Department at Fatima Memorial Hospital and College of Medicine and Dentistry in Lahore, Pakistan. The period of this cross-sectional study was three months - from October 2017 to December 2017. One hundred patients aged more than 16 years, who were diagnosed as cases of RA with foot involvement, and with a disease duration of less than two years (to minimize recall bias), were enrolled for the study. Results Out of the 100 patients, 20% were male and 80% were female. The mean age of the study population was 41.16 ± 12.343 years. Foot Involvement as the first manifestation was noted in 29 (29%) of the cases. The pattern of foot involvement shows a 59% forefoot involvement, 27% hindfoot involvement, and 14% midfoot involvement. Walking difficulty was most common in forefoot involvement (71.42% of cases), followed by hindfoot involvement (20% of cases), and least common in midfoot involvement (8.57% of cases) (p=0.0001). Conclusion Foot involvement as the first manifestation is quite common in RA and should not be ignored, especially in patients with large joint involvement sparing the hands.

Spirometry Assessment and Correlation With Postoperative Pulmonary Complications in Cardiac Surgery Patients.

Objective To observe spirometry and its correlation with postoperative pulmonary complications in cardiac surgery patients. Study design Prospective observational study Place and duration of the study Chaudhary Pervaiz Elahi Institute of Cardiology (CPEIC) Multan, from January 1, 2017, to June 30, 2020 Methodology Written informed consent was taken from 357 patients. Spirometry was performed in all the patients using the conventional method. Baseline data, including gender, age, body mass index (BMI), living area, smoking history, known lung illness, six-minute walk distance, predicted forced vital capacity (FVC) %, predicted forced expiratory volume in one second (FEV1) %, and type of the procedure such as aortic valve replacement (AVR), coronary artery bypass grafting (CABG), double-valve replacement (DVR), and mitral valve replacement (MVR) were documented for all the patients. Outcome data included postoperative ICU length of stay (LOS), respiratory failure, respiratory infection, atelectasis, and mortality. Results The most common procedure was CABG and MVR proceeded by n=254 (71.1%) and n=83 (23.2%) patients, respectively. Postoperative complications, such as respiratory failure, respiratory infection, and atelectasis, was noted in n=29 (8.1%), n=28 (7.8 %), and n=127 (35.6 %) patients, respectively, while n=5 (1.4%) patients died. Conclusion Deranged pulmonary function tests (PFTs) are associated with poor prognosis following elective cardiac surgery in terms of postoperative pulmonary complications such as pulmonary infection, respiratory failure, and atelectasis. There is a significant difference in percentage predicted of FVC and FEV1 in patients who developed atelectasis and respiratory tract infection.

Comparing the Effect of Incentive Spirometry with Acapella on Blood Gases in Physiotherapy After Coronary Artery Bypass Graft.

Objective To compare the effect of incentive spirometry with Acapella (Smiths Medical Inc, Carlsbad, California) in physiotherapy after coronary artery bypass surgery. Methods A randomized controlled trial comparing incentive spirometry with Acapella was conducted in the intensive care unit of Chaudhary Pervaiz Elahi Institute of Cardiology (CPEIC) Multan. The study began from December 2017 to August 2019 after getting approval from the ethical committee of the hospital. Informed written consent was taken from all 270 patients who were included in the study. Patients who underwent coronary artery bypass graft (CABG) were divided into two groups by the lottery method. The primary end-point of the study was to check the blood gases on Day 3 after the procedure at room air and compare it with the baseline and with blood gases immediately after the procedure. SPSS 23 (IBM Corp., Armonk, NY) was used to analyze the data of this study. For qualitative variables in data such as gender, place of living, patients with any comorbidities, and education status were statistically analyzed in percentage and frequencies. For numerical variables, such as age, body mass index, blood gases values, distance covered in a six-minute walk test, and spirometry values were analyzed and statistically measured as mean and standard deviation. A P-value of less than .05 was considered significant. Results The mean partial pressure of oxygen (PaO2) of incentive spirometry was 58.1±2.31 and 67.2±3.24 after extubation and after three days, respectively. While the PaO2 of Acapella was 56.3±3.43 and 66.4±3.54 after extubation and after three days, respectively. The mean PCO2 of incentive spirometry was 41.4±3.26 and 36.1±2.11 after extubation and after three days, respectively. While the partial pressure of carbon dioxide (PCO2) of Acapella was 39.4±2.55 and 37.5±3.58 after extubation and after three days, respectively. The differences were statistically significant at p-value ≤0.05. Conclusion It was concluded that both Acapella and incentive spirometry treatment after coronary artery bypass graft improved blood gases.

Field Emission Characteristics of Polyaniline/Se Nanocomposites.

Polyaniline (PAni)/Se nanocomposites have been synthesized in different compositions employing chemical route and shown excellent field emission behaviour. Detailed studies on the field emission for all composites with different concentrations of dopant are performed in an indigenously fabricated set up in a vacuum chamber with a base pressure of 10(-6) Torr at room temperature and analysed with current density versus Electric field (J-E) and Fowler-Nordheim (FN) plots. Comparative field emission results showed that 10% (w/w) doped PAni/Se nanocomposite depicts highest emission characteristics, current density and field enhancement factor with turn-on field as low as 1.2 V/µm in comparison with other composites, while pure PAni shows no field emission characteristics. These composites have also been characterized by Scanning Electron Microscope (SEM) and Fourier Transform Infrared Spectrometry (FTIR). FTIR results supply the evidence for the occurrence of the polymer in its conducting state. The ease of synthesis route and interesting field emission properties recommend these composites as a promising material for field emission based applications in vacuum micro-nanoelectronic devices and also for plastic display industry.