Determination of chromium in foodstuffs by using novel adsorbent in vortex assisted-dispersive solid phase micro-extraction method: An application of multivariate techniques.

A new graft copolymer composed of polystyrene and polylinoleic acid (PLinas) with the sodium salt of iminodiacetate (Ida) was synthesized and used as an adsorbent. The vortex-assisted dispersive solid-phase micro-extraction (VA-dSPµE) method was used for the extraction and pre-concentration of chromium. Multivariate methodologies, such as factorial design and 3D surface plots, were applied for screening and optimizing effective extraction parameters. The influence of diverse analytical parameters, such as pH, sample volume, and interfering ions, on the extraction of chromium was studied. The calibration standard curve exhibited a linear range from 0.01 to 0.50 µg L-1. The relative standard deviation and limit of detection were found to be 1.65 % and 0.003 µg L-1, respectively. Extraction recoveries were found in the range of 96 to 99 % by using certified reference materials (CRMs). The adsorbent capacity of PLinas-Ida was found to be 112 mg g-1. The VA-dSPµE method demonstrated its effectiveness in the pre-concentration and determination of chromium within samples of foodstuffs by graphite furnace-atomic absorption spectrometry (GF-AAS).

Road map for sustainable and effective carbon pricing: bridging the gap of realities and ambitions.

An increase in policy ambition is needed to close the gaps related to climate change mitigation and those required to meet the targets of Paris Agreement. This article examines the contemporary situation of carbon pricing and suggests how carbon costs would help countries adopt comprehensive climate policies. This paper explores the carbon pricing imitative across different regions and the associated issues and proposes how to format holistic, ambitious approaches for effective implementation of carbon pricing. The carbon taxes and emission trading programs are the primary tools for implementation costs. Carbon taxes, fuel taxes, subsidies for fossil energy, and emission trading systems (ETSs) all contribute to these costs. Different countries have adopted different approaches to adopt and mitigate the adverse effect of carbon emissions, but coordinated and integrated efforts are needed. This paper emphasizes the effective carbon pricing and integrating role of finance departments in climate policy; new synergies can be developed to boost government agencies' ability to implement climate policy. Governments may increase their involvement in carbon pricing beyond direct carbon pricing if they implement efficient carbon pricing. Governments, international organizations, and civil society can all play a role in pushing for effective carbon prices to encourage more ambitious targets. Furthermore, the article stresses the need for open communication and a proper understanding of carbon pricing potential to implement climate policy.

Comparison of the effects of perioperative and adjuvant chemotherapy on outcomes of operable gastric cancer: A retrospective cohort experience from a tertiary cancer center.

OBJECTIVE: To compare the overall survival and disease-free survival rates with perioperative or adjuvant chemotherapy regimens in operable gastric cancer cases. METHODS: The retrospective, observational study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised date from January 2015 to December 2020 of operable gastric cancer patients who had perioperative or adjuvant chemotherapy. Overall survival and disease-free survival were evaluated. Data was analysed using SPSS 23. RESULTS: Of the 108 patients in the aga range 27-80 years, 71(65.74%) were males. The overall median age was 49.50 years (interquartile range: 28 years). There were 69(63.88%) patients on perioperative and 39(36.12%) on adjuvant chemotherapy. The probability of 2- and 3-year overall survival was 68.20% and 57.32% in the perioperative group, and 51.09% and 45.43%, respectively, in the adjuvant group. The probability of 2- and 3-year disease-free survival was 55.45% and 49.30% in the perioperative group, while 2-year disease-free survival was 38.39% in the adjuvant group which had no patient reaching the 3-year mark. The median overall survival for the perioperative group was 49.29 months (interquartile range: 44.50 months) and for the adjuvant group it was 28.23 months (interquartile range: 25.00months) (p=0.07). The median disease-free survival was 35.46 months (interquartile range: 38.50 months) for the perioperative group and 10.19 months (interquartile range: 14.00months) for adjuvant group (p=0.16). The difference between the groups was not significant (p>0.05), but there was a trend suggestive of the superiority of perioperative chemotherapy over adjuvant chemotherapy. CONCLUSIONS: In operable gastric cancer cases, the difference between the groups was not significant, but there was a trend suggestive of the superiority of perioperative chemotherapy over adjuvant chemotherapy with respect to overall survival and disease-free survival.

The Clinicopathologic Characteristics and Outcomes of Gastroentero-pancreatic Neuroendocrine Tumors - Experience from A Tertiary Cancer Center.

OBJECTIVE: Gastroentero-pancreatic neuroendocrine tumor (GEP NETs) are a heterogeneous group of tumors with variable behaviors. Our aim was to study the baseline characteristics and outcomes of GEP-NETs and to establish the impact of tumor grade and resectability on the survival. METHODS: A single center retrospective review of patients registered at SKMCH &RC Pakistan with the diagnosis of GEP-NETs was carried out from the Hospital Information System. The baseline characteristics of 134 diagnosed patients from January 2006 to August 2020 were analyzed. Overall survival (OS) and Disease Free Survival (DFS) was calculated using Kaplan-Meier curve. The impact of tumor grade and resectability was seen on the OS and DFS. Data was analyzed through SPSS version 23. Categorical parameters were computed using ChiSquare test, keeping p-value =0.05 significant. RESULT: A large majority had Grade 1 disease (59%) along with localized stage at presentation (73.1%) as compared to Grade 2 (23.9%) and Grade 3 (17.1%) disease with metastatic stage at presentation (26.9%). The 5 year OS according to tumor grade was, 88%, 57% and 0% in low, intermediate and high grade respectively. The 5-year OS was 94%, 79% and 43% in the completele, incomplete and in unresectable disease group, respectively. CONCLUSION: GEP-NETs are rare tumors with good outcomes in Grade I and II and poor outcomes in grade III Neuroendocrine Carcinomas (NEC). Tumor grade and complete surgery of the primary tumor are important predictors of response outcomes and prognosis.

Comparison of three standard neoadjuvant chemotherapy regimens based on pathological tumor response in breast cancer patients.

We compared the efficacy of different neoadjuvant chemotherapy regimens and pathological factors related to higher pCR in localized breast cancer. This comparative retrospective study included 313 patients with breast carcinoma who received neoadjuvant therapy from January 2017 till July 31, 2019 at our institute. Patients were grouped in 3 different categories according to the treatment arms. In Arm A, patients received dose-dense AC [4 Cycles] followed by dose dense paclitaxel [4 Cycles]. In Arm B, 2 weekly dose dense AC [4 Cycles] followed-by paclitaxel every week [12 Cycles], while Arm C received 3 weekly AC [4 Cycles] and 3 weekly paclitaxel [4 Cycles]. pCR was seen in 135(43.1%) patients with the highest pCR in arm B i-e 33(55%), followed by 39(43.3%) in arm A, and 63(38.6%) in arm C. Triple-negative patients had the highest percentage of pCR 38 (65.5%). HER2 positive patients who received neoadjuvant Trastuzumab also had increased pCR rate of 21 (61.7%). ER/PR positive, HER2 negative patients had the lowest pCR 56 (33.5%). Dose dense AC [4 cycles] followed-by weekly Paclitaxel [12 cycles] is the most effective neoadjuvant therapy regimen for breast cancer patients, particularly if they were also triple negative and HER2 positive receiving Trastuzumab.

COVID-19 BBIBP-CorV vaccine and transient heart block - A phenomenon by chance or a possible correlation - A case report.

IMPORTANCE: Bradyarrhythmia during COVID19 illness carries prognostic significance. Electrophysiological side effects of COVID19 vaccine remain largely unknown. It is imperative to report nature of cardiovascular side effects of the vaccine. CASE PRESENTATION: An 80 years-old-man presented with complains of dizziness, trepidation and shortness of breath following his first shot of COVID-19 BBIBP-CorV (Sino-pharm). ECG on arrival showed 2:1 atrioventricular block with an underlying old left bundle branch block. The AV block changed into Mobitz type-I over the course of next 2 days and into a sinus 1:1 conduction on fourth day of presentation. However, our patient underwent permanent pacemaker implantation due to the underlying conduction tissue disease and intermittent 2:1 AV block during the hospital stay. CLINICAL DISCUSSION: It is likely that patients with an already diseased conduction system are at an increased risk of worsening of AV block following inoculation of the vaccine. Vaccine associated AV blocks are likely to be reversible. Presence of prior coronary artery disease and electrical abnormalities are important considerations. CONCLUSION: COVID-19 vaccine may have added side effects in subjects with known heart disease. Humoral response towards the vaccine might interfere with the conduction system of the heart and more so in patients with diseased and scarred myocardium.

Clinical Outcomes of Physiologically-guided Revascularisation.

OBJECTIVE: To assess the clinical outcomes of revascularisation based on fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY:  Department of Medicine, The Aga Khan University Hospital, Karachi from January 2012 to January 2020. METHODOLOGY:  A cohort of patients having moderate to severe coronary stenosis, undergoing coronary revascularisation based on invasive physiological assessment (FFR or iFR) were assessed. The participants were divided into the revascularisation-deferred group and the revascularization-performed group, based on the physiological results. Cox-proportional hazard model building was done, using a stepwise approach by assessing all plausible interactions and considering p-value ≤0.05 as statistically significant. RESULTS:  The frequency of major adverse cardiac event (MACE) and target vessel revascularisation was 8.4% and 3.2% in the revascularisation-performed group as compared to 6.4% and 3.2% in the revascularisation-deferred group. In adjusted models, no statistically significant difference was noted in MACE when comparing the revascularisation-performed group with a deferred group. CONCLUSION:  Revascularisation guided by invasive physiological assessment with FFR or iFR is clinically safe and led to better resource utilisation. Key Words: Fractional flow reserve, Instantaneous wave-free ratio, Invasive physiological assessment, Low-middle income country.

Comparing sensitivity and specificity of pacemaker ID application and cardiac rhythm management device-finder application in identifying cardiac implantable electronic device manufacturer using chest radiograph - An observational study.

BACKGROUND: Smartphone-based applications to identify cardiac implantable electronic devices (CIED) are extremely useful in circumstances, where urgent device interrogation is needed, and a device identification card is not available. Few studies have provided insights regarding the utility of these applications. We have studied two widely available applications i.e., Pacemaker ID app (PMIDa) or Cardiac Rhythm Management Device-Finder (CRMD-f) to identify device manufacturers in CIEDs. METHODS: 547 patients who underwent CIED implantation from the year 2016-2020 in our institute were enrolled. There were 438 Medtronic and 109 St. Jude's devices. All chest radiographs were de-identified and resized into 225*225 pixels focusing on the CIED. PMIDa and CRMD-f applications were used to identify the CIED. Accuracy, sensitivity, specificity, negative predictive value, and positive predictive value for both applications were calculated and compared. RESULTS: Overall, CRMD-f application has higher specificity (93.58 vs. 82.5%) but lower sensitivity (53.6 vs. 55%) than PMIDa. The accuracy of both applications was comparable (61.6% vs. 60.5%). Accuracy varied with CIED model and type tested, and radiograph projection used. Accuracy is greatest with Cardiac-Resynchronization-Therapy (CRT) devices for both applications, followed by a single lead pacemaker. CONCLUSION: CRMD-f has higher accuracy and specificity for CIED manufacturer identification. Both PMIDa and CRMD-f are specific tools to identify CIED but have low sensitivity.

Clinical Characteristics of COVID-19-Infected Cancer Patients in Pakistan: Differences Between Survivors and Non-Survivors.

BACKGROUND: Cancer patients are considered as highly vulnerable individuals in the current COVID-19 pandemic. We studied the clinical characteristics of survivor and non-survivor COVID-19-infected cancer patients in Pakistan. PATIENTS AND METHODS: We did a retrospective study of 70 cancer patients with PCR-confirmed COVID-19 infection from Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and Peshawar, Pakistan between April 13 and July 09, 2020. These patients were discharged from the hospital or had died by July 09, 2020. Clinical, pathological and radiological characteristics were compared between survivors and non-survivors by fisher's exact test and chi-square test. Univariable and multivariable logistic regression models were performed to explore the risk factors of mortality. RESULTS: Seventy cancer patients with SARS-CoV-2 infection were enrolled and the majority were males 38 (54.3%). 57 (81.4%) had solid tumors and 13 (18.6%) had hematological malignancies. Dyspnea (44 cases) was the most common symptom (62.9%). Complications were reported in 51 (72.9%) patients during the course of disease. 19 (27.1%) patients were admitted to an intensive care unit (ICU). A significant increase in the C-reactive protein level and neutrophil count was observed in the deceased patients as compared to the surviving patients. D-dimer values of ≥0.2 mg/L were significantly associated with mortality (P=0.01). We identified two independent risk factors associated with death, ICU admission (P=0.007) and D-dimer (P=0.003). CONCLUSION: Pakistani cancer patients with COVID-19 infection reported poor prognosis. Intensive surveillance of clinicopathological characteristics of cancer patients infected with COVID-19 especially D-dimer values may play a pivotal role in the outcome of the disease.

COVID-19-positive cancer patients undergoing active anticancer treatment: An analysis of clinical features and outcomes.

BACKGROUND: Cancer patients, particularly those on active anticancer treatment, are reportedly at a high risk of severe coronavirus disease 2019 (COVID-19) infection and death. This study aimed to describe the clinical characteristics and outcomes of patients diagnosed with COVID-19 whilst on anticancer treatment in a developing country. METHODS: This is a retrospective observational study of all adult cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan, from March 15, 2020 to July 10, 2020, diagnosed with COVID-19 within 4 weeks of receiving anticancer treatment, where a purposive sampling was performed. Cancer patients who did not receive anticancer treatment and clinical or radiological diagnosis of COVID-19 without a positive reverse transcription-polymerase chain reaction (RT-PCR) test were excluded. The primary endpoint was all-cause mortality after 30 days of COVID-19 test. Data was analyzed with SPSS version 23 (SPSS Inc., Chicago, IL, USA). Categorical parameters were computed using chi-square test, keeping p value < 0.05 as significant. RESULTS: A total of 201 cancer patients with COVID-19 were analyzed. The median age of patients was 45 (18-78) years. Mild symptoms were present in 162 (80.6%) patients, whereas severe symptoms were present in 39 (19.4%) patients. The risk of death was statistically significant (p < .05) amongst patients with age greater than 50 years, metastatic disease, and ongoing palliative anticancer treatment. Anticancer treatment (chemotherapy, radiotherapy, hormonal therapy, targeted therapy, and surgery) received within preceding 4 weeks had no statistically significant (p > .05) impact on mortality. CONCLUSIONS: In cancer patients with COVID-19, mortality appears to be principally driven by age, advanced stage of the disease, and palliative intent of cancer treatment. We did not identify evidence that cancer patients on chemotherapy are at significant risk of mortality from COVID-19 correlating to those not on chemotherapy.

Impact of COVID-19 on Cardiovascular Disease Presentation, Emergency Department Triage and Inpatient Cardiology Services in a Low- to Middle-Income Country - Perspective from a Tertiary Care Hospital of Pakistan.

Aims: To identify the changes in cardiovascular disease presentation, emergency room triage and inpatient diagnostic and therapeutic pathways. Methods: We conducted a retrospective cohort study at the Aga Khan University Hospital, Karachi. We collected data for patients presenting to the emergency department with cardiovascular symptoms between March-July 2019 (pre-COVID period) and March-July 2020 (COVID period). The comparison was made to quantify the differences in demographics, clinical characteristics, admission, diagnostic and therapeutic procedures, and in-hospital mortality between the two periods. Results: Of 2976 patients presenting with cardiac complaints to the emergency department (ED), 2041(69%) patients presented during the pre-COVID period, and 935 (31%) patients presented during the COVID period. There was significant reduction in acute coronary syndrome (ACS) (8% [95% CI 4-11], p < 0.001) and heart failure (↓6% [95% CI 3-8], p < 0.001). A striking surge was noted in Type II Myocardial injury (↑18% [95% CI 20-15], p < 0.001) during the pandemic. There was reduction in cardiovascular admissions (coronary care unit p < 0.01, coronary step-down unit p = 0.03), cardiovascular imaging (p < 0.001), and procedures (percutaneous coronary intervention p = 0.04 and coronary angiography p = 0.02). No significant difference was noted in mortality (4.7% vs. 3.7%). The percentage of patients presenting from rural areas declined significantly during the COVID period (18% vs. 14%, p = 0.01). In the subgroup analysis of sex, we noticed a falling trend of intervention performed in females during the COVID period (8.2% male vs. 3.3 % female). Conclusions: This study shows a significant decline in patients presenting with Type I myocardial infarction (MI) and a decrease in cardiovascular imaging and procedures during the COVID period. There was a significant increase noted in Type II MI.

Determination of trace levels of selenium in natural water, agriculture soil and food samples by vortex assisted liquid-liquid microextraction method: Multivariate techniques.

A green vortex assisted based liquid-liquid microextraction (VA-LLME) method was developed for preconcentration of selenium. Ammonium pyrrolidine dithiocarbamate (APDC) was used to form a hydrophobic complex with selenium in natural water, agricultural soil and food samples by GFAAS. Whereas Triton X-114, a nonionic surfactant and 1-butyl-3-methylimidazolium hexafluorophosphate ionic liquid were used for Se extraction as a dispersing medium. The conical flasks contents were shack on a vortex mixer to increase the extraction efficiency. Multivariate techniques were used to evaluate extraction parameters; pH, vortex time, APDC amount, volume of ionic liquid and Triton X-114 and centrifugation rate on the recovery of Se. The central composite design (CCD) was used for further optimization of the essential extraction parameters. The enhancement factor and limit of detection were obtained as 98.7 and 0.07 µg L-1. The certified reference materials was used for accuracy of method and the related standard deviation was found to be 3.51%. The resulted data indicated that concentrations of Se in all types of water samples were below the permissible limit recommended by WHO.

Drug-Eluting Balloon for Management of Coronary In-Stent Restenosis in a South Asian Population: Experience From a Tertiary-Care Hospital in Pakistan.

BACKGROUND: Emerging evidence suggests that the South Asian (SA) population has an increased rate of in-stent stenosis (ISR) after percutaneous coronary intervention (PCI) when compared with other ethnicities. Drug-eluting balloons (DEBs) have emerged as a viable option for the treatment of ISR. However, data describing the outcomes of DEB-PCI in the SA population are limited. Since the magnitude of the problem is high in the SA population, it is essential to evaluate the outcomes of DEB-PCI for ISR. METHODS: In this cohort study, we investigated the incidence of target-lesion revascularization (TLR) and major adverse cardiac event (MACE) after PCI with DEB for ISR at 1 year and at long-term follow-up in Pakistani patients. From January 2010 to January 2019, a total of 147 ISR lesions in 112 patients were treated with DEB-PCI at our center. RESULTS: The incidence of clinically driven TLR and MACE after a 1-year follow-up was 15.2% and 16.1%, respectively. At mean long-term follow-up of 2.73 ± 2.14 years, the TLR and MACE rates were 26.8% and 35.7%, respectively. The major predictors for TLR were diffuse and occlusive ISR types, DEB for a recurrent restenosis lesion, and the presence of ≥3 traditional cardiovascular disease risk factors. CONCLUSIONS: The high rates of follow-up TLR and MACE reported in this study may suggest that the outcomes of DEB-PCI for ISR in the SA population may be unsatisfactory. With the increasing use of DEBs, it is imperative to further investigate DEB-PCI outcomes in the SA population with large, prospective studies.

Green and innovative technique develop for the determination of vanadium in different types of water and food samples by eutectic solvent extraction method.

A green and innovative eutectic solvent based extraction method was proposed for the determination of trace level vanadium in water and food samples by graphite furnace atomic absorption spectrometry. In this extraction technique magnetic stirrer was used for preparation of eutectic solvent by mixing of zinc chloride and acetamide at different molar ratios. Extraction capability of eutectic solvent was increased by adding a non ionic surfactant (Triton X-114) to enhanced phase transfer ratio, to significantly increase the recovery of hydrophobic complex of vanadium with ammonium pyrrolidine dithiocarbamate. A multivariate technique was applied to evaluate the important extraction parameters, which plays important role for optimum recovery of the targeted analyte by proposed extraction method. Multivariate techniques such as (factorial design and central composite design) were applied to screening out the most significant extraction parameters and optimized them. Under optimized extraction conditions, limit of detection and enhancement factor were found to be 0.01 µg L-1 and 64.6, respectively. The relative standard deviation for the determination of trace level vanadium at 0.32 µg L-1 concentration, was achieved to be <3.0% (n = 10). Validity and accuracy of the proposed extraction method was checked by analysis of certified reference materials of Canadian lake water and tomato leaves with % age recovery >98%. The eutectic solvent extraction method was successfully applied for the determination of the trace level vanadium in real water samples of different sources and acid digested food samples, collected from different locations of Tokat city, Turkey.

Frequency and causes of anemia in Lymphoma patients.

OBJECTIVE: Purpose of this study was to find out frequency of anemia and its causes in newly diagnosed treatment naive lymphoma patients. METHODS: We retrospectively studied all lymphoma patients (> 18 years age) diagnosed and treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, from January 2016 till January 2017. The data was collected from electronic Hospital Information System. Descriptive statistics were done by using summary measures for categorical variables as well as continuous variables. RESULTS: Out of a total 408 patients, 272 were males and 136 females. Median age of patients was 33 years (18-76). Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL) were the diagnosis in 201 and 134 patients respectively; rest of the patients had low grade lymphomas. Anemia was present in 184 (45%) patients. Anemia of chronic disease was the commonest cause of anemia and was present in 61 (33.1%) patients. Remaining patients had anemia secondary to marrow involvement 50(27.17%); iron deficiency anemia, Vitamin B-12 deficiency anemia and hemolytic anemia were the causes in 7.6, 1.6%, % and 0.54% respectively. CONCLUSION: Anemia is a common feature in newly diagnosed lymphoma patients with anemia of chronic disease as the commonest cause. It is more frequent in patients with higher stages of lymphoma especially when bone marrow is involved by lymphoma. Since anemia is an important adverse prognostic factor for the outcome of lymphoma patients, work up for anemia prior to initiation of chemotherapy should be done in every lymphoma patient in order to help improve the management of these patients.

Volatilization of toxic elements from coal samples of Thar coal field, after burning at different temperature and their mobility from ash: Risk assessment.

In present study, the volatilization of arsenic (As), cadmium (Cd), mercury (Hg) and lead (Pb) by the burning of coal samples in the electric furnace was evaluated. The coal samples were obtained from different blocks of newly developed Thar coal field, Pakistan. The replicate coal samples were heated/burned in an electric furnace at laboratory scale for three temperature intervals (200, 400 and 900 °C). The ash obtained after each temperature intervals were analyzed for selected toxic elements. The resulted data indicated that the total contents of As, Cd, and Pb in coal samples of block X and XI were found in the range of 16.8-18.5, 4.21-4.72, and 14.2-18.8 mg/kg, respectively. Whereas, 67.8-79.7%, 34.3-36.8% and 9.89-10.8% of As, Cd, and Pb, respectively, were volatized out after combustion of coal samples at 900 °C. The total contents of Hg in selected coal samples of block X and XI were observed in the range of 0.985-1.46 and 0.992-1.41 mg/kg, respectively. The contents of Hg volatilized out via burning in a furnace at 200 °C and 400 °C, were observed in the range of 32.0-36.5% and >91.0% of its total contents, respectively, whereas at 900 °C, it was not detected in ash. The partitioning and mobility of studied toxic elements in residue termed as (laboratory made ash) obtained after burning at 900 °C, was carried out by three-step sequential extraction scheme. The resulted data of present study will give a better knowledge about the quality of coal and its burning product, which may help to take measure to reduce the adverse effects on the environment in future.

Improvement In Symptoms Of Gaucher's Disease By Enzyme Replacement Therapy.

Gaucher's disease is the most common lysosomal storage disease which occurs due to a deficiency of the enzyme glucocerebrosidase. This enzyme deficiency leads to accumulation of glucocerebrosidase in the cells of macrophage-monocyte system. It is inherited as an autosomal recessive mutation and has three clinical subtypes. The disease presents with anaemia, hepatosplenomegaly, skeletal disorders and organ dysfunction. We present the case of an 18- month old male child who had presented to Civil Hospital, Karachi with fever, progressive pallor, abdominal distention for 6 months and was diagnosed as a case of type 1 Gaucher's disease on the basis of low leukocyte glucocerebrosidase activity, raised plasma chitotriosidase and the presence of Gaucher cells on bone marrow biopsy. The disease was treated with Intravenous replacement of the enzyme Imiglucerase (cerezyme) and the patient was followed. An informed Consent of the parents was taken prior to the writing of the manuscript.

Characteristics and outcomes of patients with multiple myeloma : Data from a developing country.

Background: Multiple myeloma (MM) is a plasma cell disorder characterized by presence of monoclonal protein in serum or urine or both, increased bone marrow plasma cells, osteolytic lesion, hypercalcemia, and anemia. Several combination regimens are commonly recommended for treatment of multiple myeloma. The present study aimed at determining the characteristics and outcomes of patients with multiple myeloma treated at our centre. Methods: During July 2012 and December 2015, all patients with proven diagnosis of MM were included in this study. Data were collected from hospital information system. The characteristics and outcomes of all patients were analyzed. Progression- free survival and overall survival of patients were also estimated. Kaplan-Meier curves and Log-rank test were applied and SPSS Version19 was used for data analysis. Results: A total of 82 patients, with the median age of 51 years (Range: 23-64 yrs.) were available for final analysis. The number of patients with IgG and IgA type was 48 (58.5%) and 15(18.3%), respectively. There were 7 (8.5%) patients with non-secretory type. Most of the patients (n= 59; 71.9%) were treated with CTD regimen and 13 (15.8%) received bortezomib-based treatment. The median progression-free survival time was 30 months, and overall survival time was 48 months. The cumulative probability of survival at 36 months was 85%. Conclusion: Based on our results, the onset of multiple myeloma occurs in relatively younger age groups. A small number of patients received bortezomib due to cost issues. PFS and OS in our study were comparable with published literature.

Vortex-Assisted Modified Dispersive Liquid-Liquid Microextraction of Trace Levels of Cadmium in Surface Water and Groundwater Samples of Tharparkar, Pakistan, Optimized by Multivariate Technique.

A simple vortex-assisted modified dispersive liquid-liquid microextraction procedure is proposed for the enrichment of cadmium (Cd+2) in surface (stored rainwater) and groundwater of the Tharparkar district in Pakistan, before analysis by flame atomic absorption spectrometry. Ammonium pyrrolidinedithiocarbamate was used as a ligand to make a hydrophobic complex of Cd+2, which was extracted in an ionic liquid (1-butyl-3-methylimidazolium hexafluorophosphate), and the nonionic surfactant Triton X-114 was applied as a dispersing medium. The contents of tubes were shaken for different time intervals on a vortex mixer to enhance extraction efficiency. A multivariate strategy was used to simultaneously evaluate seven factors including, concentration of the complexing reagent, pH, amounts of ionic liquid and Triton X-114, vortex shaking time, centrifugation time and extracting solution for their influence on the percentage recovery of the analyte. The important variables were further optimized by central composite design. The preconcentration factor and LOD were observed as 76.9 and 0.048 µg/L, respectively. The Certified Reference Material SRM1643e was used to check the validity of the developed method, and the RSD was found to be 4.02%. The proposed technique was successfully applied for the enrichment of Cd+2 in groundwater and surface water samples from the southeastern part of Pakistan. The observed results revealed that the concentration of Cd+2 in groundwater was higher than the World Health Organization recommended value of 3 µg/L for drinking water. For adults weighing approximately 60 kg, consumption of groundwater for drinking and other domestic purposes would provide levels of Cd+2 that are 2- to 3-fold higher than the provisional maximum tolerable daily intake.

Evaluation of mercury and physicochemical parameters in different depths of aquifer water of Thar coalfield, Pakistan.

In the current study, mercury (Hg) and physicochemical parameters have been evaluated in aquifer water at different depths of Thar coal field. The water samples were collected from first aquifer (AQ1), second aquifer (AQ2), and third aquifer (AQ3) at three depths, 50-60, 100-120, and 200-250 m, respectively. The results of aquifer water of three depths were interpreted by using different multivariate statistical techniques. Validation of desired method was checked by spiking standard addition method in studied aquifer water samples. The content of Hg in aquifer water samples was measured by cold vapor atomic absorption spectrometer (CV-AAS). These determined values illustrate that the levels of Hg were higher than WHO recommended values for drinking water. All physicochemical parameters were higher than WHO permissible limits for drinking water except pH and SO42- in aquifer water. The positive correlation of Hg with other metals in aquifer water samples of AQ1, AQ2, and AQ3 of Thar coalfield except HCO3- was observed which might be caused by geochemical minerals. The interpretation of determined values by the cluster technique point out the variations within the water quality parameter as well as sampling location of studied field. The aquifer water AQ2 was more contaminated with Hg as compared to AQ1 and AQ3; it may be due to leaching of Hg from coal zone. The concentration of Hg in aquifer water obtained from different depths was found in the following decreasing order: AQ2 < AQ1 < AQ3.