Leptochelins A-C, Cytotoxic Metallophores Produced by Geographically Dispersed Leptothoe Strains of Marine Cyanobacteria.

Metals are important cofactors in the metabolic processes of cyanobacteria, including photosynthesis, cellular respiration, DNA replication, and the biosynthesis of primary and secondary metabolites. In adaptation to the marine environment, cyanobacteria use metallophores to acquire trace metals when necessary as well as to reduce potential toxicity from excessive metal concentrations. Leptochelins A-C were identified as structurally novel metallophores from three geographically dispersed cyanobacteria of the genus Leptothoe. Determination of the complex structures of these metabolites presented numerous challenges, but they were ultimately solved using integrated data from NMR, mass spectrometry and deductions from the biosynthetic gene cluster. The leptochelins are comprised of halogenated linear NRPS-PKS hybrid products with multiple heterocycles that have potential for hexadentate and tetradentate coordination with metal ions. The genomes of the three leptochelin producers were sequenced, and retrobiosynthetic analysis revealed one candidate biosynthetic gene cluster (BGC) consistent with the structure of leptochelin. The putative BGC is highly homologous in all three Leptothoe strains, and all possess genetic signatures associated with metallophores. Postcolumn infusion of metals using an LC-MS metabolomics workflow performed with leptochelins A and B revealed promiscuous binding of iron, copper, cobalt, and zinc, with greatest preference for copper. Iron depletion and copper toxicity experiments support the hypothesis that leptochelin metallophores may play key ecological roles in iron acquisition and in copper detoxification. In addition, the leptochelins possess significant cytotoxicity against several cancer cell lines.

Rates of the Trans-radial Approach in Elective and Emergency Coronary Angiography in Iraq: A Cross-Sectional Study.

Background and aims The trans-radial access is becoming the default approach in many cardiac centers worldwide. Data from the Middle East, including Iraq, on the trends and rates of the use of trans-radial access are scarce. The aim of this study is to determine the rates of trans-radial approach (TRA) versus transfemoral approach (TFA) in patients with coronary artery syndromes undergoing coronary angiography and/or percutaneous coronary intervention (PCI) in Iraq. Methods In this multicenter prospective study, we collected 885 cases of coronary artery disease undergoing coronary angiography/PCI from three main cities of the Kurdistan Region in Iraq from 2022 to 2023. Results Of the total sample, 57.2% were diagnostic coronary angiography and 42.8% were PCI, 57.1% of all cases were TFA and 42.9% were TRA, and 64.3% of PCI cases were performed through TFA. Eghty-two percent of total emergency PCI included (primary PCI) cases underwent the procedure through the TFA, and only 18% of such cases were through the TRA. The overall crossover rate between both approaches happened in 14 (3.6%) cases. Conclusions Despite its main benefits, the radial access use in the Cath lab is yet underused in our region. Further steps in training programs are indicated to popularize the use of radial access among interventional cardiologists in addition to transfemoral access.

The effect of warm ischemia and donor ejection fraction on 30-day mortality after donation after circulatory death heart transplantation: A national database analysis.

Donation after circulatory death (DCD) donor hearts recovered using the direct procurement and perfusion method experience variable durations of warm ischemia at the time of procurement (WIP). We used the Organ Procurement and Transplantation Network database to assess the effect of WIP on 30-day mortality after DCD heart transplantation. The analysis evaluated outcomes in 237 recipients of DCD heart transplantation, demonstrating an optimal WIP cut point of <36 minutes. Multivariable logistic regression modeling identified donor left ventricular ejection fraction (LVEF) <60% as an independent predictor of 30-day mortality. The area under the receiver operating characteristic curve for predicting 30-day mortality based on WIP ≥36 minutes and donor LVEF <60% was 0.90. Based on these findings, we do not recommend proceeding with DCD heart transplantation for patients with WIP ≥36 minutes, particularly in donors with LVEF <60%.

Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve: A Case Report.

Among other valvular heart disease Aortic stenosis (AS) is the most common in the developed world. Transcatheter Aortic Valve Replacement (TAVR) is most acceptable treatment option for patient with severely calcified aortic stenosis with high and intermediate risk group. Among several challenges, one of the main challenges is to deal with bicuspid aortic valve (BAV). Non-circular annulus, bulky leaflets leading to perivalvular leaks and risk for rupture and often very severe calcification may contribute to periprocedural strokes leading to poor clinical outcome. This case, a 68-year-old woman with a history of type 2 diabetes mellitus (DM), hypothyroidism, bicuspid aortic valve and severe aortic stenosis, bronchial asthma, who had repeatedly refused any suggestion for open heart surgery, was our volunteer candidate for TAVR. After successful TAVR the peak pressure gradient decreased from 100mmHg to 17mmHg. So, TAVR could be a viable option for highly selected patients with severe aortic stenosis and bicuspid aortic valve who have favourable anatomy.

A Systematic Review of Total Endovascular Aortic Arch Repair: A Promising Technology.

BACKGROUND: Total endovascular aortic arch repair (TEAAR) represents an emerging alternative for the treatment of aortic arch disease in patients at prohibitive risk for open surgery. A systematic review of TEAAR was performed to delineate early outcomes with this new technology. METHODS: All studies (excluding single-patient case reports) of CE-certified "custom made" or "off-the-shelf" zone 0 stent graft deployments were included. The primary search of Medline, Embase, CINAHL, and the Cochrane CENTRAL registry was supplemented with searches of Web of Science, ClinicalTrials.gov, and conference abstracts (within last 3 years), and a hand search of citations within relevant articles. Articles underwent 2-stage screening by 2 independent reviewers before inclusion. RESULTS: Fifteen relevant investigations were identified. Indications for TEAAR were chronic arch dissection with degenerative aneurysmal disease (54%, 148/273), pure arch aneurysm (41%, 112/273), penetrating atherosclerotic ulcer (2%, 5/273), and type IA endoleak from a zone 2 thoracic endograft (1%, 3/273). Double-branch (70%, 192/273), triple-branch (19%, 53/273), and single-branch (into innominate artery; 10%, 28/273) devices were used. Adjunct left carotid-subclavian bypass occurred in 90% of double- and single-branch procedures. Procedural success with TEAAR was 93% (95% CI 85.8%-96.3%). The proportion of all-cause mortality was 16% (95% CI 8%-26%), stroke 14% (8%-24%), peripheral vascular events 7% (1%-33%), and myocardial infarction 4% (2%-7%). Endoleaks were identified in 13% (7%-25%) of the study population. CONCLUSIONS: TEAAR represents an emerging option for the management of aortic arch disease wth high procedural success rates and acceptable early outcomes in a high-risk patient population.

Ultra-sculpturing of seed morphotypes in selected species of genus Salvia L. and their taxonomic significance.

The taxonomic importance of macromorphological and micromorphological seed characteristics was investigated using SEM of ten species of the Salvia genus from Pakistan. The aim was to identify diagnostic seed ultrastructural features that could aid in species delimitation, correct identification and phylogenetic position. The ultrastructure of Salvia varies greatly, and a wide range of unique micromorphological features have been observed. Seed micromorphological features were explored by SEM, including seed shape, colour, texture, cell outline, surface sculpturing, epidermal cell arrangement, anticlinal, and periclinal wall pattern. Seed shapes were categorized as obovate, spherical, spheroid, broadly elliptic, elliptic and oblong, mostly with a terminal hilum. Seed colours were black, light brown, dark brown, brown and yellow. Exo-morphological characters, i.e. epidermal cell arrangements, included irregular, wavy pentagonal-hexagonal, regular pentagonal-hexagonal. Cluster analysis was used to assess similar and distinct species within Salvia with a feasible explanation. Taxonomic keys were made based on micromorphological qualitative features that help to delimit species and identify them quickly within the Salvia genus. Seed morphology of ten Salvia species was described and investigated, and the diagnostic significance of features evaluated using SEM. This study analysed seed features, especially at the species level, which might provide much new taxonomic information. The results revealed that, in seed morphology, using SEM can help with taxon identification, especially at the genus and species levels.

A Systematic Review and Meta-Analysis of Robot-Assisted Mitral Valve Repair.

OBJECTIVE: Robot-assisted surgery is a minimally invasive approach for repairing the mitral valve. This study aimed to assess its safety and clinical efficacy when compared with conventional sternotomy, partial sternotomy, and right minithoracotomy. METHODS: A systematic review of peer-reviewed studies comparing robot-assisted mitral valve repair with conventional sternotomy, partial sternotomy, and right minithoracotomy was conducted following Cochrane Collaboration guidelines. Meta-analyses were performed where possible. RESULTS: The search strategy yielded 15 primary studies, of which 12 compared robot-assisted with conventional sternotomy, 2 compared robot-assisted with partial sternotomy, and 6 compared robot-assisted with right minithoracotomy. The overall quality of evidence was low, and there was a lack of data on long-term outcomes. Individual studies and pooled data demonstrated that robotic procedures were comparable to conventional sternotomy and other minimally invasive approaches with respect to the rates of stroke, renal failure, reoperation for bleeding, and mortality. Robot-assisted mitral valve repair was superior to conventional sternotomy with reduced atrial fibrillation, intensive care unit and hospital stay, pain, time to return to normal activities, and physical functioning at 1 year. However, robot-assisted mitral valve repair had longer cardiopulmonary, aortic cross-clamp, and procedure times compared with all other surgical approaches. CONCLUSIONS: Based on current evidence, robot-assisted mitral valve repair is comparable to other approaches for safety and early postoperative outcomes, despite being associated with longer operative times. Ideally, future studies will be randomized controlled trials that compare between robot-assisted surgery, conventional surgery, and other minimally surgery approaches focusing on hard clinical outcomes and patient-reported outcomes.

Prevalence and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus from Nasal Specimens: Overcoming MRSA with Silver Nanoparticles and Their Applications.

Staphylococcus aureus is a cause of high mortality in humans and therefore it is necessary to prevent its transmission and reduce infections. Our goals in this research were to investigate the frequency of methicillin-resistant S. aureus (MRSA) in Taif, Saudi Arabia, and assess the relationship between the phenotypic antimicrobial sensitivity patterns and the genes responsible for resistance. In addition, we examined the antimicrobial efficiency and application of silver nanoparticles (AgNPs) against MRSA isolates. Seventy-two nasal swabs were taken from patients; MRSA was cultivated on Mannitol Salt Agar supplemented with methicillin, and 16S rRNA sequencing was conducted in addition to morphological and biochemical identification. Specific resistance genes such as ermAC, aacA-aphD, tetKM, vatABC and mecA were PCR-amplified and resistance plasmids were also investigated. The MRSA incidence was ~49 % among the 72 S. aureus isolates and all MRSA strains were resistant to oxacillin, penicillin, and cefoxitin. However, vancomycin, linezolid, teicoplanin, mupirocin, and rifampicin were effective against 100% of MRSA strains. About 61% of MRSA strains exhibited multidrug resistance and were resistant to 3-12 antimicrobial medications (MDR). Methicillin resistance gene mecA was presented in all MDR-MRSA strains. Most MDR-MRSA contained a plasmid of > 10 kb. To overcome bacterial resistance, AgNPs were applied and displayed high antimicrobial activity and synergistic effect with penicillin. Our findings may help establish programs to control bacterial spread in communities as AgNPs appeared to exert a synergistic effect with penicillin to control bacterial resistance.

Solubility enhancement of some poorly soluble drugs by solid dispersion using Ziziphus spina-christi gum polymer.

A high percentage of marketed drugs suffer from poor water solubility and require an appropriate technique to increase their solubility. This study aims to compare physically modified and unmodified gum polymers extracted from Ziziphus spina-christi fruits as solid dispersion carriers for some drugs. Taguchi Orthogonal Design (L9) was chosen for the screening and optimization of the solid dispersions. The design has four factors: type of drug, type of polymer, type of solid dispersion process, and drug to polymer ratio. Each factor was varied in three stages and the total number of runs was 9 in triplicate. The polymer was physically modified by heating (M1ZG) or freeze-drying (M2ZG). The drugs were selected according to the biopharmaceutical classification system, namely loratadine and glimepiride (class II) and furosemide (class IV). Drugs were dispersed in the polymer in three different ratios 1: 1, 1: 2, and 1: 3. Solid dispersions were made by co-grinding, solvent evaporation, and kneading methods. Modified and unmodified polymers were characterized in terms of their organoleptic properties, solubility, powder flowability, density, viscosity, swelling index, and water retention capacity. Solid dispersions were characterized in terms of percentage practical yield, solubility improvement, and drug compatibility. The results showed that the organoleptic properties of polymers were not changed by the gum modification. The swelling index of the polymer was doubled in M1ZG. The viscosity and water retention capacity of the polymer was increased in both modified polymers. All solid dispersions showed a high practical percentage yield of more than 93%, the higher values ​​being more associated with loratadine and furosemide than with glimepiride. The improvement in solubility was observed in all solid dispersions prepared, the values ​​varying with the pH of the medium and the method of modification. The FTIR results indicated that there was no chemical interaction between these drugs and the polymer used. Analysis of the results according to the Taguchi orthogonal design indicated 51 folds aqueous solubility enhancement for loratadine using M2ZG polymer at a ratio of 1: 3 of Drug: polymer. This study showed the possibility of improving the solubility of other poorly soluble drugs.

The modernization of cardiology in Iraq (From apprenticeship to competency-based approach).

•This report is unprecedent in treating a shift in medical training, particularly cardiology, in Kurdistan and whole Iraq.•It attempts to motivate a scientific debate to advance post graduate learning process in cardiology.•It distinguishes the apprenticeship from the competency-based approach and encourages a move towards the latter.•It links this shift with the development of competencies determining cardiological advancement.

Impact of alien fishes on the distribution pattern of indigenous freshwater fishes of Punjab, Pakistan / Impacto de peixes invasores no padrão de distribuição de peixes de água doce em Punjab, Paquistão

Pakistan is the country with mega freshwater fish diversity of native and alien species. In the presence of enormous native fishes varies species of exotic fishes have been introduced into the freshwater bodies of Pakistan which are competing with native freshwater fish fauna and making them deprive of food and habitat as well. Intentional or accidental introductions of animals, plants and pathogens away from their native niche is considered as major leading problem for biodiversity of invaded habitat. Three years study (from January 2017 to December 2019) was conducted in freshwater bodies of Province Punjab, Pakistan. Study was designed to know exotic species impacts on the distribution of native species of fishes. During current survey a total of 68 (indigenous and exotic) fish species belonging to 14 families were recorded from head Qadirabad, head Baloki, Islam headworks and Rasul barrage. Statistical analysis showed that Shannon-Wiener diversity index was the highest (1.41) at both Rasul barrage and Islam headworks but, invasive species were present in very less number in these study sites i.e. Oreochromis mozambicus, O. niloticus, Hypophthalmichthys nobilis, Carassius auratus, Ctenophryngdon idella, Cyprinus carpio and H. molitrix. The diversity index showed that comparatively low diversity was present in both area head Qadirabad (1.30) and head Baloki (1.4) due to high pressure of invasive species. Direct observation of species and statistical analysis showed that aliens’ species produced negative impact on the local fish fauna diversity, evenness, and numbers. It is concluded that many factors are impacts on the diversity of native fishes, but alien (invasive) species also play a major role to reduction of native species, because aliens’ species produce competition for native species. So it is urgent need to analysis the aliens and native food web and roosting sites in Pakistan, in future.

O Paquistão é um país com ampla diversidade de espécies nativas e exóticas de peixes de água doce. Contudo, diversas espécies de peixes exóticos estão sendo introduzidas nos corpos de água doce paquistanês, as quais estão competindo com a fauna nativa de peixes, tornando-os privados de alimento e habitat. A introdução intencional ou acidental de animais, plantas e patógenos fora de seu nicho nativo é considerada o principal problema da biodiversidade do habitat recém-invadido. Assim, foi realizado um estudo de três anos, de janeiro de 2017 a dezembro de 2019, em corpos de água doce na província de Punjab, Paquistão. A pesquisa foi desenvolvida para conhecer os impactos de espécies exóticas na distribuição de espécies nativas de peixes. Durante a pesquisa, foi registrado um total de 68 espécies de peixes (nativas e exóticas), pertencentes a 14 famílias, nas nascentes dos rios Qadirabad, Baloki e Islam e na barragem de Rasul. A análise estatística mostrou que o índice de diversidade de Shannon-Wiener foi mais alto (1,41) na barragem Rasul (RB) e na nascente do rio Islam (IH); e que a maioria das espécies introduzidas estava presente em um número muito menor, isto é, Oreochromis mossambicus, Oreochromis niloticus, Hypophthalmichthys nobilis, Carassius auratus, Ctenopharyngodon idella, Cyprinus carpio e Hypophthalmichthy smolitrix nessa área de estudo. Por outro lado, o índice Shannon-Wiener mostrou que a diversidade estava baixa nas nascentes dos rios Qadirabad (1,30) e Baloki (1,4) em razão da alta pressão de espécies invasoras. A observação direta das espécies e a análise estatística indicaram que as espécies invasoras produziram impacto negativo na diversidade, uniformidade e números de peixes da fauna local. Conclui-se que muitos fatores impactam na diversidade de peixes nativos, mas as espécies exóticas (invasoras) também desempenham um papel importante na redução das espécies nativas, em razão da competição existente entre elas. Portanto, é [...].

Impact of alien fishes on the distribution pattern of indigenous freshwater fishes of Punjab, Pakistan

Abstract Pakistan is the country with mega freshwater fish diversity of native and alien species. In the presence of enormous native fishes varies species of exotic fishes have been introduced into the freshwater bodies of Pakistan which are competing with native freshwater fish fauna and making them deprive of food and habitat as well. Intentional or accidental introductions of animals, plants and pathogens away from their native niche is considered as major leading problem for biodiversity of invaded habitat. Three years study (from January 2017 to December 2019) was conducted in freshwater bodies of Province Punjab, Pakistan. Study was designed to know exotic species impacts on the distribution of native species of fishes. During current survey a total of 68 (indigenous and exotic) fish species belonging to 14 families were recorded from head Qadirabad, head Baloki, Islam headworks and Rasul barrage. Statistical analysis showed that Shannon-Wiener diversity index was the highest (1.41) at both Rasul barrage and Islam headworks but, invasive species were present in very less number in these study sites i.e. Oreochromis mozambicus, O. niloticus, Hypophthalmichthys nobilis, Carassius auratus, Ctenophryngdon idella, Cyprinus carpio and H. molitrix. The diversity index showed that comparatively low diversity was present in both area head Qadirabad (1.30) and head Baloki (1.4) due to high pressure of invasive species. Direct observation of species and statistical analysis showed that aliens species produced negative impact on the local fish fauna diversity, evenness, and numbers. It is concluded that many factors are impacts on the diversity of native fishes, but alien (invasive) species also play a major role to reduction of native species, because aliens species produce competition for native species. So it is urgent need to analysis the aliens and native food web and roosting sites in Pakistan, in future.

Resumo O Paquistão é um país com ampla diversidade de espécies nativas e exóticas de peixes de água doce. Contudo, diversas espécies de peixes exóticos estão sendo introduzidas nos corpos de água doce paquistanês, as quais estão competindo com a fauna nativa de peixes, tornando-os privados de alimento e habitat. A introdução intencional ou acidental de animais, plantas e patógenos fora de seu nicho nativo é considerada o principal problema da biodiversidade do habitat recém-invadido. Assim, foi realizado um estudo de três anos, de janeiro de 2017 a dezembro de 2019, em corpos de água doce na província de Punjab, Paquistão. A pesquisa foi desenvolvida para conhecer os impactos de espécies exóticas na distribuição de espécies nativas de peixes. Durante a pesquisa, foi registrado um total de 68 espécies de peixes (nativas e exóticas), pertencentes a 14 famílias, nas nascentes dos rios Qadirabad, Baloki e Islam e na barragem de Rasul. A análise estatística mostrou que o índice de diversidade de Shannon-Wiener foi mais alto (1,41) na barragem Rasul (RB) e na nascente do rio Islam (IH); e que a maioria das espécies introduzidas estava presente em um número muito menor, isto é, Oreochromis mossambicus, Oreochromis niloticus, Hypophthalmichthys nobilis, Carassius auratus, Ctenopharyngodon idella, Cyprinus carpio e Hypophthalmichthy smolitrix nessa área de estudo. Por outro lado, o índice Shannon-Wiener mostrou que a diversidade estava baixa nas nascentes dos rios Qadirabad (1,30) e Baloki (1,4) em razão da alta pressão de espécies invasoras. A observação direta das espécies e a análise estatística indicaram que as espécies invasoras produziram impacto negativo na diversidade, uniformidade e números de peixes da fauna local. Conclui-se que muitos fatores impactam na diversidade de peixes nativos, mas as espécies exóticas (invasoras) também desempenham um papel importante na redução das espécies nativas, em razão da competição existente entre elas. Portanto, é urgente uma análise futura das espécies invasoras e da teia alimentar nativa no Paquistão..

Impact of alien fishes on the distribution pattern of indigenous freshwater fishes of Punjab, Pakistan / Impacto de peixes invasores no padrão de distribuição de peixes de água doce em Punjab, Paquistão

Pakistan is the country with mega freshwater fish diversity of native and alien species. In the presence of enormous native fishes varies species of exotic fishes have been introduced into the freshwater bodies of Pakistan which are competing with native freshwater fish fauna and making them deprive of food and habitat as well. Intentional or accidental introductions of animals, plants and pathogens away from their native niche is considered as major leading problem for biodiversity of invaded habitat. Three years study (from January 2017 to December 2019) was conducted in freshwater bodies of Province Punjab, Pakistan. Study was designed to know exotic species impacts on the distribution of native species of fishes. During current survey a total of 68 (indigenous and exotic) fish species belonging to 14 families were recorded from head Qadirabad, head Baloki, Islam headworks and Rasul barrage. Statistical analysis showed that Shannon-Wiener diversity index was the highest (1.41) at both Rasul barrage and Islam headworks but, invasive species were present in very less number in these study sites i.e. Oreochromis mozambicus, O. niloticus, Hypophthalmichthys nobilis, Carassius auratus, Ctenophryngdon idella, Cyprinus carpio and H. molitrix. The diversity index showed that comparatively low diversity was present in both area head Qadirabad (1.30) and head Baloki (1.4) due to high pressure of invasive species. Direct observation of species and statistical analysis showed that aliens' species produced negative impact on the local fish fauna diversity, evenness, and numbers. It is concluded that many factors are impacts on the diversity of native fishes, but alien (invasive) species also play a major role to reduction of native species, because aliens' species produce competition for native species. So it is urgent need to analysis the aliens and native food web and roosting sites in Pakistan, in future.

O Paquistão é um país com ampla diversidade de espécies nativas e exóticas de peixes de água doce. Contudo, diversas espécies de peixes exóticos estão sendo introduzidas nos corpos de água doce paquistanês, as quais estão competindo com a fauna nativa de peixes, tornando-os privados de alimento e habitat. A introdução intencional ou acidental de animais, plantas e patógenos fora de seu nicho nativo é considerada o principal problema da biodiversidade do habitat recém-invadido. Assim, foi realizado um estudo de três anos, de janeiro de 2017 a dezembro de 2019, em corpos de água doce na província de Punjab, Paquistão. A pesquisa foi desenvolvida para conhecer os impactos de espécies exóticas na distribuição de espécies nativas de peixes. Durante a pesquisa, foi registrado um total de 68 espécies de peixes (nativas e exóticas), pertencentes a 14 famílias, nas nascentes dos rios Qadirabad, Baloki e Islam e na barragem de Rasul. A análise estatística mostrou que o índice de diversidade de Shannon-Wiener foi mais alto (1,41) na barragem Rasul (RB) e na nascente do rio Islam (IH); e que a maioria das espécies introduzidas estava presente em um número muito menor, isto é, Oreochromis mossambicus, Oreochromis niloticus, Hypophthalmichthys nobilis, Carassius auratus, Ctenopharyngodon idella, Cyprinus carpio e Hypophthalmichthy smolitrix nessa área de estudo. Por outro lado, o índice Shannon-Wiener mostrou que a diversidade estava baixa nas nascentes dos rios Qadirabad (1,30) e Baloki (1,4) em razão da alta pressão de espécies invasoras. A observação direta das espécies e a análise estatística indicaram que as espécies invasoras produziram impacto negativo na diversidade, uniformidade e números de peixes da fauna local. Conclui-se que muitos fatores impactam na diversidade de peixes nativos, mas as espécies exóticas (invasoras) também desempenham um papel importante na redução das espécies nativas, em razão da competição existente entre elas. Portanto, é urgente uma análise futura das espécies invasoras e da teia alimentar nativa no Paquistão.

A rare case of absolute thrombocytopaenia in a COVID-19 patient: Case report.

INTRODUCTION: Thrombocytopaenia, one of the most common haematological disorders worldwide, is characterised by platelet counts <150,000/mm3. Patients with coronavirus disease (COVID-19) were found to commonly exhibit haematological abnormalities, often with mild forms of thrombocytopaenia. Absolute thrombocytopaenia tends to be rare among these patients and is believed to be secondary to immune-induced thrombocytopaenia. CASE PRESENTATION: A 53-y-old man presented with fever and generalised body ache that persisted for a few days. His polymerase chain reaction test was positive for COVID-19, for which he was treated with acetaminophen, levofloxacin, and favipiravir. On the third day of treatment, he noticed bruising and bleeding, mainly in the oral cavity, with clot formation. A complete blood picture (CBP) revealed severe thrombocytopaenia with an almost-zero count. Prednisone 1 mg/kg/d and frequent doses of intravenous platelet transfusion were administered as rescue therapy to prevent fatal bleeding. The patient was able to recover. CLINICAL DISCUSSION: Immune thrombocytopaenia should be considered in patients presenting with bleeding tendencies after severe acute respiratory syndrome coronavirus 2 infection. Serial CBP is recommended for vulnerable patients, especially during the second and third weeks of hospitalisation, for the early detection and prevention of life-threatening COVID-19 complications. CONCLUSIONS: Absolute thrombocytopaenia is a rare condition. Such a condition should be considered in patients presenting with bleeding tendencies with severe Covid-19 infection. With early diagnosis and appropriate treatment, patients' lives can be saved.

Moringa oleifera and Musa sapientum ameliorated 7,12-Dimethylbenz[a]anthracene-induced upregulations of Ki67 and multidrug resistance 1 genes in rats.

OBJECTIVES: Moringa oleifera (MO) and Musa sapientum (MS) are plants of ethnomedicinal importance. We evaluated the effects of MOF6 (extracted from MO leaves) and MSF1 (extracted from MS suckers) on immunomodulations of Ki67 (proliferation biomarker) and multidrug resistance 1 (MDR1) genes in the liver of rats in 7,12-Dimethylbenz[a]anthracene (DMBA)-induced hepatotoxicity and mutagenesis to determine their antiproliferation, anti-drug resistance, and anticancer potentials. METHODS: Forty-five adult male rats were randomly divided into nine groups (n = 5). Groups 1 and 2 received physiological saline and 15 mg/kg bodyweight of DMBA, respectively. Groups 3 and 4 received 15 mg/kg bodyweight DMBA and were treated with 15 and 30 mg/kg bodyweight of MOF6, respectively. Group 5 received 15 mg/kg bodyweight DMBA and was treated with 10 mg/kg bodyweight of MSF1. Group 6 received 15 mg/kg bodyweight DMBA and was treated with 3.35 mg/kg bodyweight of doxorubicin and intravenous injection of 0.5 ml/200 g of cisplatin. Groups 7-9 received only 15 and 30 mg/kg bodyweight of MOF6 and 10 mg/kg bodyweight of MSF1, respectively. DMBA, doxorubicin, and extracts doses were administered orally. The duration of our experimental procedure was 8 weeks. Consequently, liver histopathology (hematoxylin and eosin technique) and enzyme-linked immunosorbent assay homogenates' concentrations of Ki67 and MDR1 were evaluated. Computed data were statistically analyzed (P ≤ 0.05). RESULTS: Results showed normal histoarchitectures of the liver in all groups. Statistical analyses showed significant (P ≤ 0.05) and non-significant decreased concentrations (P ≥ 0.05) of Ki67 and MDR1 in Groups 3-9 compared with Group 2. Therefore, MOF6 and MSF1 ameliorated DMBA-induced hepatotoxicity, abnormal proliferation, and drug resistance. CONCLUSION: MOF6 and MSF1 possess antiproliferation, anti-drug resistance, and anticancer potentials.

Anticancer effects of Morinda lucida and Annona muricata on immunomodulations of Melatonin, tumor necrosis factor-alpha and p53 concentrations in lead acetate-induced toxicity in rats.

OBJECTIVES: Lead poisoning accounts for about 0.6% of global burden of disease. Lead-induced toxicity is through confinement of oxidative stress in affected organs. We evaluated the effects of MLF1 (extracted from Morinda lucida leaves) and AMF1 (extracted from Annona muricata leaves) on lipid peroxidation and immunomodulations of Melatonin, tumor necrosis factor-alpha (TNF-α), and p53 proteins in lead acetate (LA)-induced toxicity in rats. METHODS: Sixty adult female rats were randomly divided into 12 groups (n = 5). Groups 1 and 2 received physiological saline and 100 mg/kg bodyweight of LA, respectively, for 5 weeks. Groups 3-6 received 100 mg/kg bodyweight LA for 2 weeks, followed by treatments with 7.5 and 15 mg/kg bodyweight of MLF1, and 7.5 and 10 mg/kg bodyweight of AMF1, respectively, for 3 weeks. Groups 7-10 received 7.5 and 15 mg/kg bodyweight of MLF1, 7.5 and 10 mg/kg bodyweight of AMF1, respectively, for 5 weeks. Groups 11-12 received co-administrations of 100 mg/kg bodyweight LA with 15 mg/kg bodyweight MLF1 and 10 mg/kg bodyweight of AMF1, respectively, for 5 weeks. Drugs and extracts were administered orally. Consequently, liver histopathology (Hematoxylin and Eosin), sera Melatonin, and TNF-α (enzyme-linked immunosorbent assay [ELISA]) levels were evaluated. Malondialdehyde (MDA) (thiobarbituric acid assay) and p53 (ELISA) levels were evaluated in liver homogenates. Data were statistically analyzed (P ≤ 0.05). RESULTS: Results showed normal liver histology in all Groups. Statistical analyses showed significant (P ≤ 0.05) and non-significant decreased levels (P ≥ 0.05) of MDA, TNF-α and p53 in Groups 3-12, compared with Group 2. Furthermore, results showed significant (P ≤ 0.05) and non-significant increased Melatonin levels (P ≥ 0.05) in Groups 4-12 compared with Group 2. CONCLUSION: This study confirmed that MLF1 and AMF1 confer a degree of antioxidant, anticancer and hepato-protetive potentials against LA-induced toxicity in rats.

Impact of alien fishes on the distribution pattern of indigenous freshwater fishes of Punjab, Pakistan.

Pakistan is the country with mega freshwater fish diversity of native and alien species. In the presence of enormous native fishes varies species of exotic fishes have been introduced into the freshwater bodies of Pakistan which are competing with native freshwater fish fauna and making them deprive of food and habitat as well. Intentional or accidental introductions of animals, plants and pathogens away from their native niche is considered as major leading problem for biodiversity of invaded habitat. Three years study (from January 2017 to December 2019) was conducted in freshwater bodies of Province Punjab, Pakistan. Study was designed to know exotic species impacts on the distribution of native species of fishes. During current survey a total of 68 (indigenous and exotic) fish species belonging to 14 families were recorded from head Qadirabad, head Baloki, Islam headworks and Rasul barrage. Statistical analysis showed that Shannon-Wiener diversity index was the highest (1.41) at both Rasul barrage and Islam headworks but, invasive species were present in very less number in these study sites i.e. Oreochromis mozambicus, O. niloticus, Hypophthalmichthys nobilis, Carassius auratus, Ctenophryngdon idella, Cyprinus carpio and H. molitrix. The diversity index showed that comparatively low diversity was present in both area head Qadirabad (1.30) and head Baloki (1.4) due to high pressure of invasive species. Direct observation of species and statistical analysis showed that aliens' species produced negative impact on the local fish fauna diversity, evenness, and numbers. It is concluded that many factors are impacts on the diversity of native fishes, but alien (invasive) species also play a major role to reduction of native species, because aliens' species produce competition for native species. So it is urgent need to analysis the aliens and native food web and roosting sites in Pakistan, in future.

Intestinal Obstruction Secondary to Multiple Gastrointestinal phytobezoars, A Rare presentation.

INTRODUCTION: Intestinal obstruction considered to be one of the most common surgical presentation. Adhesions secondary to previous operations, hernias, neoplasms, inflammatory bowel disease, intussusception, or volvulus are the usual causes of intestinal obstruction but bezoar can presents in 0.4-4%. Bezoar can be trapped in different locations throughout the gastrointestinal tract and it can be solitary or multiple lesions. CASE PRESENTATION: This is a 37-year-old male, known case of diabetes mellitus, Presented to the Emergency Department complaining of generalized abdominal pain for 2 days duration. Associated with abdominal distention, fever, nausea, vomiting and obstipation. There was a history of persimmon intake. Unremarkable past surgical history. On examination, He was tachycardic, other vital signs were within normal. Abdominal examination showed abdominal distention and Sluggish bowel sound. Abdominal X-ray revealed multiple air-fluid levels. An abdominal CT scan with IV contrast revealed an intra-luminal mass in the ileum and intra-gastric mass with suspicious of bezoars. He underwent exploratory laparotomy, gastrostomy to remove intra-gastric bezoar, and enterotomy to remove the ileal bezoar. CLINICAL DISCUSSION: Intestinal obstruction is considered to be the most common complication of this entity; other possible complications include gastric ulcer, gastritis, and gastric perforation. Due to limitations of endoscopy and barium enema in the diagnosis of bezoar, Abdominal CT-scan is considered to be the gold standard in the diagnosis. The management of phytobezoar can be either conservative or surgical, depends on the lesion size and location. CONCLUSION: Although intestinal obstruction secondary to bezoar is rare, multiple levels of gastrointestinal obstruction should raise the suspicion of bezoar.