Neurological disorders and disability in Pakistan: A cross-sectional multicenter study.

BACKGROUND/OBJECTIVE: The aim of this study is to identify frequencies of various neurological disorders (NDs) and associated disability in patients attending neurologic clinics in rural and urban centers in Pakistan. METHODS: This is an observational study conducted in 39 neurological centers in both rural and urban areas, public and private health sectors all over Pakistan. This study was conducted between august 2017 to December 2019. RESULTS: A total of 28,845 adults were enrolled. Mean age of the study participants was 46.2 ± 17.2 years, 15,252 (52.9%) were men and 13,593 (47.1%) were women. Most common comorbid medical condition was hypertension 7622(26.4%) followed by Diabetes 3409(11.8%). Among neurological diagnoses, vascular diseases (20%) were the most common followed by Headache disorders (18.6%), Epilepsy (12.5%), nerve and root diseases (12.4%), Psychiatric diseases (10%), Dementias (8%) and movement disorders (7.9%). Half of the patients 15,503(53.7%) had no neurological disability, while minor disability was present in 10,442(36.2%) of cases. Moderate to severe disability was present in 2876(10%) cases. Headache disorders, psychiatric diseases, muscle pain/muscle related disorders and demyelinating diseases were more common in women. Vascular diseases, movement disorders and Dementias were more common in 46 years and above age group whereas headache disorders, Epilepsy and Psychiatric disorders were more prevalent in <46 years age groups. CONCLUSION: Vascular diseases are the most common presentation of patients in neurology clinics followed by headache disorders and epilepsies. Minor disability was present in 36% while moderate to severe disability was present in 10% cases.

Prioritizing candidate eQTL causal genes in Arabidopsis using RANDOM FORESTS.

Expression quantitative trait locus mapping has been widely used to study the genetic regulation of gene expression in Arabidopsis thaliana. As a result, a large amount of expression quantitative trait locus data has been generated for this model plant; however, only a few causal expression quantitative trait locus genes have been identified, and experimental validation is costly and laborious. A prioritization method could help speed up the identification of causal expression quantitative trait locus genes. This study extends the machine-learning-based QTG-Finder2 method for prioritizing candidate causal genes in phenotype quantitative trait loci to be used for expression quantitative trait loci by adding gene structure, protein interaction, and gene expression. Independent validation shows that the new algorithm can prioritize 16 out of 25 potential expression quantitative trait locus causal genes within the top 20% rank. Several new features are important in prioritizing causal expression quantitative trait locus genes, including the number of protein-protein interactions, unique domains, and introns. Overall, this study provides a foundation for developing computational methods to prioritize candidate expression quantitative trait locus causal genes. The prediction of all genes is available in the AraQTL workbench (https://www.bioinformatics.nl/AraQTL/) to support the identification of gene expression regulators in Arabidopsis.

Gelatin- and Papaya-Based Biodegradable and Edible Packaging Films to Counter Plastic Waste Generation.

Most of the food packaging materials used in the market are petroleum-based plastics; such materials are neither biodegradable nor environmentally friendly and require years to decompose. To overcome these problems, biodegradable and edible materials are encouraged to be used because such materials degrade quickly due to the actions of bacteria, fungi, and other environmental effects. In this work, commonly available household materials such as gelatin, soy protein, corn starch, and papaya were used to prepare cost-effective lab-scale biodegradable and edible packaging film as an effective alternative to commercial plastics to reduce waste generation. Prepared films were characterized in terms of Fourier transform infrared spectroscopy (FTIR), water vapor transmission rate (WVTR), optical transparency, and tensile strength. FTIR confirmed the addition of papaya and soy protein to the gelatin backbone. WVTR of the gelatin-papaya films was recorded to be less than 50 g/m2/day. This water vapor barrier was five times better than films of pristine gelatin. The gelatin, papaya, and soy protein films exhibited transparencies of around 70% in the visible region. The tensile strength of the film was 2.44 MPa, which improved by a factor of 1.5 for the films containing papaya and soy protein. The barrier qualities of the gelatin and gelatin-papaya films maintained the properties even after going through 2000 bending cycles. From the results, it is inferred that the prepared films are ideally suitable for food encapsulation and their production on a larger scale can considerably cut down the plastic wastage.

Effects of Different Solvents Extractions on Total Polyphenol Content, HPLC Analysis, Antioxidant Capacity, and Antimicrobial Properties of Peppers (Red, Yellow, and Green (Capsicum annum L.)).

Plants possessing various bioactive compounds and antioxidant components have gained enormous attention because of their efficacy in enhancing human health and nutrition. Peppers (Capsicum annuum L.), because of their color, flavor, and nutritional value, are considered as one of the most popular vegetables around the world. In the present investigation, the effect of different solvents extractions (methanol, ethanol, and water) and oven drying on the antioxidant and antimicrobial properties was studied of red, yellow, and green peppers. The green pepper water extract showed the highest total polyphenol content (30.15 mg GAE/g DW) followed by red pepper water extract (28.73 mg GAE/g DW) and yellow pepper water extract (27.68 mg GAE/g DW), respectively. The methanol extracts of all the pepper samples showed higher TPC as compared to the ethanol extract. A similar trend was observed with the total flavonoid content (TFC). The antioxidant assays (DPPH scavenging and reducing power) echoed the findings of TPC and TFC. In both antioxidant assays, the highest antioxidant activity was shown by the water extract of green pepper, which was followed by the water extract of red pepper and yellow pepper. Furthermore, all extracts were assessed for their potential antimicrobial activity against bacterial and fungal pathogens. Aqueous extracts of all three pepper samples exhibited slightly higher inhibition zones as compared to their corresponding ethanolic and methanolic extract. Minimum inhibitory concentration (MIC) values ranged from 0.5 to 8.0 mg/ml. The lowest MIC values ranging from 0.5 to 2.0 mg/ml concentration were recorded for aqueous extracts of green pepper. High-performance liquid chromatography (HPLC) analysis revealed tannic acid as the major phenolic compound in all three pepper samples. Thus, it is envisaged that the microwave drying/heating technique can improve the antioxidant and antimicrobial activity of the pepper.

Caffeoyl-CoA 3-O-methyltransferase gene family in jute: Genome-wide identification, evolutionary progression and transcript profiling under different quandaries.

Jute (Corchorus sp.), is a versatile, naturally occurring, biodegradable material that holds the promising possibility of diminishing the extensive use of plastic bags. One of the major components of the cell wall, lignin plays both positive and negative roles in fiber fineness and quality. Although it gives mechanical strength to plants, an excess amount of it is responsible for the diminution of fiber quality. Among various gene families involved in the lignin biosynthesis, Caffeoyl-CoA 3-O-methyltransferase (CCoAOMT) is the most significant and has remained mostly unexplored. In this study, an extensive in-silico characterization of the CCoAOMT gene family was carried out in two jute species (C. capsularis L. and C. olitoroius L.) by analyzing their structural, functional, molecular and evolutionary characteristics. A total of 6 CCoAOMT gene members were identified in each of the two species using published reference genomes. These two jute species showed high syntenic conservation and the identified CCoAOMT genes formed four clusters in the phylogenetic tree. Histochemical assay of lignin in both jute species could shed light on the deposition pattern in stems and how it changes in response to abiotic stresses. Furthermore, expression profiling using qPCR showed considerable alteration of CCoAOMT transcripts under various abiotic stresses and hormonal treatment. This study will lay a base for further analysis and exploration of target candidates for overexpression of gene silencing using modern biotechnological techniques to enhance the quality of this economically important fiber crop.

Effect of Microwave Roasting and Extraction Solvents on the Bioactive Properties of Coffee Beans.

Coffee is an intricate mixture of thousands of chemical compounds that are accountable for its flavor and aroma. Roasting is a key step in the processing of coffee beans. This study assessed the effect of microwave roasting (MW) and extraction solvents (ES) on the total polyphenol content, total flavonoid content, and antioxidant activity of coffee beans. The untreated and microwave-roasted (MR) coffee beans showed a total polyphenol content of 40.40 and 35.15 mg GAE/gm DW, respectively, when methanol was used as the solvent for extraction. Similarly, for the untreated coffee beans, the methanol extracted coffee had a significantly (p < 0.05) higher total flavonoid content (39.34 mg CE/g DW) as compared to ethanol (34.82 mg CE/g DW). The obtained IC50 for the untreated and microwave-roasted samples as extracted by methanol were 4.13 and 5.68 mg/mL, respectively, while the IC50 values of untreated and microwave-roasted samples extracted by ethanol were 4.59 and 6.24 mg/mL, respectively. Untreated coffee beans exhibited a higher reducing power (1.237) than that of the microwave-roasted ones (0.839) when extracted with methanol. Chlorogenic acid was the major (2.31-2.68%) phenolic compound found in all the coffee samples whether it was untreated or microwave-roasted. Vanillin demonstrated the lowest (0.118-0.166%) phenolic compound found in the coffee bean samples. These results might be helpful for obtaining the maximum health benefits from coffee.

Identification and expression profiling of proline metabolizing genes in Arabidopsis thaliana and Oryza sativa to reveal their stress-specific transcript alteration.

The amino acid, proline, is utilized by different organisms to offset cellular imbalances caused by environmental stresses. The wide use of proline as a stress adaptor molecule indicates that proline has a fundamental biological role in stress response. A comprehensive analysis of the transcript abundance of proline metabolizing genes is fundamental for the assessment of function and regulation of each gene. Using available microarray data and quantitative real-time RT-PCR, the expression profiles of gene encoding key proline biosynthesis and degradation enzymes i.e., OAT, P5CS, P5CR and PDH were examined. Interestingly, validation of candidate genes in rice using in-silico data provided strong evidence for their involvement in stress response. Note that, OsOAT, OsP5CS1, OsP5CS2, OsP5CR showed similar expression pattern in quantitative real-time RT-PCR results as compared to microarray data. However, OsPDH showed a different expression pattern which may be due to the genotypic variation. Furthermore, a biochemical assay measuring proline content gave us a proper indication of the accumulation of proline under stressed conditions. Identification of key proline metabolizing genes from rice and Arabidopsis provides insights on the molecular regulation of proline homeostasis, to initiate metabolic engineering to develop stress-resilient plants. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12298-021-01023-0.

Comprehensive in silico Characterization of Universal Stress Proteins in Rice (Oryza sativa L.) With Insight Into Their Stress-Specific Transcriptional Modulation.

In a world where climate change is real and its consequences are unprecedented, understanding of the plant adaptive capacity and native stress-responsive machinery is crucial. In recent years, universal stress proteins (USPs) have received much attention in the field of plant science due to their stress-specific transcriptional regulation. This study focuses on the extensive characterization of the USP gene family members in the monocot crop rice (Oryza sativa L. var. japonica). Here, we report a total of 44 USP genes in the rice genome. In silico characterization of these genes showed that domain architecture played a major role in the functional diversification of the USP gene family which holds for all plant USPs. On top of that, a higher conservation of OsUSP members has been exhibited with a monocot genome (Zea mays L.) as compared to a dicot genome (Arabidopsis thaliana L.). Expression profiling of the identified genes led to the discovery of multiple OsUSP genes that showed pronounced transcript alteration under various abiotic stress conditions, indicating their potential role as multi-functional stress-specific modules. Furthermore, expression validation of OsUSP genes using qRT-PCR provided a strong evidence for the utility OsUSP genes in building multi-stress tolerant plants. Altogether, this study provides leads to suitable USP candidates that could be targeted for plant breeding and genetic engineering experiments to develop stress resilient crop species.

Preparedness and impact of COVID 19 infection at tertiary care neurology centers in Pakistan.

OBJECTIVE: We aimed to assess the response and impact of covid 19 pandemic at tertiary care centers in Pakistan especially pertaining to neurological care, facilities and training. METHODS: A pre-tested survey form was sent to 40 neurology tertiary care centers in all the provinces in the country in the first week of July 2020. 33 filled forms were received, out of which 18 were public (government) and 15 were private hospitals. RESULTS: Estimated 1300 HCW (faculty, medical officers, trainees and nurses) work at these 33 participating centers. There were 17 deaths among HCW (1.3%) at ten centers. Sufficient personal protective equipment (PPE) were provided to 158 HCW (12%). 129 (10%)HCW tested positive for COVID 19 at 31 centers including trainees/medical officers (39), consultants (29) and nursing and other staff (61). Due to low neurology admissions, 23/33 hospitals (70%) posted neurology trainees in COVID 19 units to contribute to covid care. Less than 50% hospitals did covid screening PCR before admission to neurology wards. Only 10% hospitals provide training and regular update to HCW. Neurology tele-health services were started for clinically stable patients at 15 (45%) centers. Only 60% neurology training programs were able to start online training. Ongoing research studies and trials focusing neurological manifestations of COVID-19 were done at 10 (30%) centers. Modification of facilities for COVID patients showed that 24(72%) hospitals strictly reduced the number of attendants accompanying patients. Only 10 (30%) centers had neurophysiological tests being conducted on COVID-19 patients. Mental health support services to HCW were provided at 12 (36%) centers. CONCLUSIONS: Among HCW 10% tested positive for covid and 1.3% died. Mental health support services offered for HCW were available in 36% institutions. Neurology training was substantially affected due to low admissions, limited ward rounds and limited availability of online training.

CovidEnvelope: A Fast Automated Approach to Diagnose COVID-19 from Cough Signals

The COVID-19 pandemic has a devastating impact on the health and well-being of global population. Cough audio signals classification showed potential as a screening approach for diagnosing people, infected with COVID-19. Recent approaches need costly deep learning algorithms or sophisticated methods to extract informative features from cough audio signals. In this paper, we propose a low-cost envelope approach, called CovidEnvelope, which can classify COVID-19 positive and negative cases from raw data by avoiding above disadvantages. This automated approach can pre-process cough audio signals by filter-out back-ground noises, generate an envelope around the audio signal, and finally provide outcomes by computing area enclosed by the envelope. It has been seen that reliable datasets are also important for achieving high performance. Our approach proves that human verbal confirmation is not a reliable source of information. Finally, the approach reaches highest sensitivity, specificity, accuracy, and AUC of 0.92, 0.87, 0.89, and 0.89 respectively. The automatic approach only takes 1.8 to 3.9 minutes to compute these performances. Overall, this approach is fast and sensitive to diagnose the people living with COVID-19, regardless of having COVID-19 related symptoms or not, and thus have vast applicability in human well-being by designing HCI devices incorporating this approach.

Boron Doped ZnO Nanostructures for Photo Degradation of Methylene Blue, Methyl Orange and Rhodamine B.

The design of sensitive and efficient photo catalyst for the energy and environmental applications with minimum charge recombination rate and excellent photo conversion efficiency is a challenging task. Herein we have developed a nonmetal doping methodology into ZnO crystal using simple solvothermal approach. The boron (B) is induced into ZnO. The doping of B did not make any significant change on the morphology of ZnO nano rods as confirmed by scanning electron microscopy (SEM) without considerable change on periodic arrangement of nanostructures. The existence of B, Zn, and O is shown by energy dispersive spectroscopy (EDS). The X-ray diffraction (XRD) patterns are well matched to the hexagonal phase for both pristine ZnO and B-doped ZnO. The XRD has shown slight dislocation of 2theta degree. The UV-visible spectroscopy was used to measure the optical bandgap and photo catalytic activity for the degradation of organic dyes. The nonmetal doped ZnO has shown potential and outstanding photo catalytic activity for the photo degradation of methylene blue (MB), methyl orange (MO) and rhodamine B in aqueous solution. The photo degradation efficiency of MB, MO and rhodamine B is found to be 96%, 86% and 80% respectively. The enhanced photo catalytic activity of B-doped ZnO is indexed to the inhibited charge recombination rate due to the reduction in the optical bandgap. Based on the obtained results, it can be said that nonmetal doping is excellent provision for the design of active materials for the extended range of applications.

Dietary intake of artificial food color additives containing food products by school-going children.

Nutritional risk in children is associated with food safety. This is the first study to identify the food type consumed by 6-17-year-old school-going children in Saudi Arabia. Eight permitted artificial food color additives, including Tartrazine (E102), Sunset Yellow (E110), Carmoisine (E122), Allura Red (E129), Indigo Carmine (E132), Brilliant Blue (E133), Fast Green (E143), and Black PN (E151), and two non-permitted ones, Erythrosine (E127) and Red 2G (E128), were determined using 24-h dietary recall questionnaires. Artificial color additives in 839 food products were divided into nine categories, including biscuits, cakes, chocolates, chips, ice cream, juices and drinks, candy, jelly, and chewing gum, are determined using high performance liquid chromatography and diode array detector. The results indicated a high intake of juices and drinks, ice cream, and cakes, but low consumption of chewing gum among school-going children. Among the permitted artificial food color additives, Brilliant Blue (E133) (54.1%) and Tartrazine (E102) (42.3%) were the most commonly used. Sunset Yellow (E110) in one chocolate sample, Tartrazine (E102) and Sunset Yellow (E110) in one and two juice and drink samples, respectively, and Brilliant Blue (E133) in two candy samples exceeded the permitted level. Therefore, further investigations are needed to provide insights into the possible adverse health effects of high intake of these additives in artificial food coloring on the test population are warranted.

Insight into single-element nobel metal anisotropic silver nanoparticle shape-dependent selective ROS generation and quantification.

The biocidal action mechanism of single element noble metal anisotropic nanoparticles has remained a perplexing challenge. Herein, we investigated the photogenerated anisotropic AgNP ROS production kinetics and each ROS species' direct impact on Gram-negative and Gram-positive bacteria. Three shapes (Triangular, Cubes, Rods) of AgNP with excellent morphology were fabricated via plasmon mediated synthesis. The results demonstrated a distinct bactericidal capacity of each NP shape where Ag-Tri outperformed Ag-Cub and Ag-Rod by displaying complete bacterial mutilation at a very low dose of 18 µg mL-1 for the shortest exposure time of 180 min. In contrast, Ag-Cub needed 66.6% higher NP concentration, while Ag-Rod was unable to achieve complete bacterial mutilation. In contrast to O2˙-, (Ag-Tri 69 ± 3.2, Ag-Cub 72 ± 2.9, Ag-Rod 68.5 ± 3.7 µM), the amount of ˙OH production was considerably lower (Ag-Tri 11 ± 1.6, Ag-Cub 10.4 ± 1.9, Ag-Rod 11.3 ± 2.2 µM), while 1O2 remained undetected for all NP shapes. Moreover, antimicrobial activity of selective ROS species revealed O2˙- as a dominant species among ROS. However, O2˙- was not found as a decisive factor in microbial mutilation. SEM images affirmed the significance of the specific geometrical shape and its resultant attachment to bacterial surface to be of paramount significance. The sharp-tip morphology with high-atom density active {111} facets played a pivotal role in physically deteriorating bacterial cells. Ag-Tri morphology in synchronization with ROS species assisted its wedging into the bacterial cell, translating into superior and multifaceted antibacterial performance.

COVID-19 trend in Bangladesh: deviation from epidemiological model and critical analysis of the possible factors

BackgroundSince its first report on March 08, COVID-19 positive cases and number of deaths are increasing in Bangladesh. In the first month of COVID-19 infection, incidence of daily positive cases did follow the susceptible, infected and recovered (SIR) based predictions we reported in April, but started to deviate in the following months. COVID-19 transmission and disease progression depends on multifaceted determinants e.g. viral genetics, host immunity, social distancing, co-morbidity, socio-demographic and environmental parameters. Therefore deviation in confirmed cases from predicted model may appear and warrant thorough investigation. MethodsIn this short report, we compared real data with SIR model and analyzed the possible factors associated with the deviation which included preventive intervention strategies, socioeconomic capabilities, climatic and meteorological indexes, acquired immunity of Bangladeshi population, demographic characteristics, health indicators and food habits. ResultsThe key factor responsible for the observed deviation was found to be the number of tests performed. Having population with low median age, young age groups are being mostly infected. Low prevalence of non-communicable diseases among them and strong immunity compared to the elderly might have kept most of them asymptomatic with silent recovery. Warm temperature, humidity and UV index of Bangladesh during this summer period might have contributed to the slow progression of infection. Longer daylight mediated immunity, fresh air circulations and ventilation, less population density in rural areas and certain food habits perhaps helped the large number of populations to restrict the infection up to a level. ConclusionDespite all these helpful determinants in Bangladesh, person to person contact is still the leading risk factor for COVID-19 transmission. Infection may increase rapidly if safe distance and preventive measures are not strictly followed while resuming the normal social and work life. Expanding test capacity, strong collaborative action plans, strategies and implementation are needed immediately to prevent catastrophe. HighlightsO_LILimited number of tests compared to large population was the key reason for possible low daily positive cases reported in Bangladesh. C_LIO_LIControlled interventions viz. official leave; transport ban and social distancing had helped initially to slow down the transmission. C_LIO_LIWarm weather, high humidity and UV index, sunlight mediated immunity, fresh air circulations, low pollutions, food habit and heterologous immunity might have reduced the transmission capabilities of SARS-CoV-2. C_LIO_LIHaving large number of young people with strong immunity might have kept most of the infected asymptomatic who recovered silently. C_LIO_LIPerson to person contact still remain as key risk factor in COVID-19 transmission, so strict health measures should be in place even after reopening social activities to contain further transmission. C_LI

Lifestyle acquired immunity, decentralized intelligent infrastructures and revised healthcare expenditures may limit pandemic catastrophe: a lesson from COVID-19

Human race has often faced pandemic with substantial number of fatalities. As COVID-19 pandemic reached and endured in every corner on earth, countries with moderate to strong healthcare support and expenditure seemed to struggle in containing disease transmission and casualties. COVID-19 affected countries have variability in demographic, socioeconomic and life style health indicators. At this context it is important to find out at what extent these parametric variations are actually modulating disease outcomes. To answer this, we have selected demographic, socioeconomic and health indicators e.g. population density, percentage of urban population, median age, health expenditure per capita, obesity, diabetes prevalence, alcohol intake, tobacco use, case fatality of non communicable diseases (NCDs) as independent variables. Countries were grouped according to these variables and influence on dependent variables e.g. COVID-19 test positive, case fatality and case recovery rates were statistically analyzed. The results suggest that countries with variable median age has significantly different outcome on test positive rate (P<0.01). Both median age (P=0.0397) and health expenditure per capita (P=0.0041) has positive relation with case recovery. Increasing number of test per 100K population showed positive and negative relation with number of positives per 100K population (P=0.0001) and percentage of test positives (P<0.0001) respectively. Alcohol intake per capita in liter (P=0.0046), diabetes prevalence (P=0.0389) and NCDs mortalities (P=0.0477) also showed statistical relation with case fatality rate. Further analysis revealed that countries with high healthcare expenditure along with high median age and increased urban population showed more case fatality but also had better recovery rate. Investment in health sector alone is insufficient in controlling pandemic severity. Intelligent and sustainable healthcare both in urban and rural settings and healthy lifestyle acquired immunity may reduce disease transmission and comorbidity induced fatalities respectively.

Impact of control strategies on COVID-19 pandemic and the SIR model based forecasting in Bangladesh.

BackgroundCOVID-19 is transmitting worldwide drastically and infected nearly two and half million of people so far. Till date 2144 cases of COVID-19 is confirmed in Bangladesh till 18th April though the stage-3/4 transmission is not validated yet. MethodsTo project the final infection numbers in Bangladesh we used the SIR mathematical model. Confirmed cases of infection data were obtained from Institute of Epidemiology, Disease Control and Research (IEDCR) of Bangladesh ResultsThe confirmed cases in Bangladesh follow our SIR model prediction cases. By the end of April the predicted cases of infection will be 17450 to 21616 depending on the control strategies. Due to large population and socio-economic characteristics, we assumed 60% social distancing and lockdown can be possible. Assuming that, the predicated final size of infections will be 3782558 on the 92th day from the first infections and steadily decrease to zero infection after 193 days ConclusionTo estimate the impact of social distancing we assumed eight different scenarios, the predicted results confirmed the positive impact of this type of control strategies suggesting that by strict social distancing and lockdown, COVID-19 infection can be under control and then the infection cases will steadily decrease down to zero.

Accuracy and Reproducibility of Linear and Angular Measurements in Virtual Reality: a Validation Study.

The purpose of this experimental study is to validate linear and angular measurements acquired in a virtual reality (VR) environment via a comparison with the physical measurements. The hypotheses tested are as follows: VR linear and angular measurements (1) are equivalent to the corresponding physical measurements and (2) achieve a high degree of reproducibility. Both virtual and physical measurements were performed by two raters in four different sessions. A total of 40 linear and 15 angular measurements were acquired from three physical objects (an L-block, a hand model, and a dry skull) via the use of fiducial markers on selected locations. After both intra- and inter-rater reliability were evaluated using inter-class coefficient (ICC), equivalence between virtual and physical measurements was analyzed via paired t test and Bland-Altman plots. The accuracy of the virtual measurements was further estimated using two one-sided tests (TOST) procedure. The reproducibility of virtual measurements was evaluated via ICC as well as the repeatability coefficient. Virtual reality measurements were equivalent to physical measurements as evidenced by a paired t test with p values of 0.413 for linear and 0.533 for angular measurements and Bland-Altman plots in all three objects. The accuracy of virtual measurements was estimated to be 0.5 mm for linear and 0.7° for angular measurements, respectively. Reproducibility in VR measurements was high as evidenced by ICC of 1.00 for linear and 0.99 for angular measurements, respectively. Both linear and angular measurements in the VR environment are equivalent to the physical measurements with high accuracy and reproducibility.

Spectrum of neurological disorders in neurology outpatients clinics in urban and rural Sindh, Pakistan: a cross sectional study.

BACKGROUND: Neurological disorders are the most common cause of morbidity and mortality in developing countries. Available evidence on urban-rural differences on neurological diseases is scare in such countries. Our study objective was to determine the prevalence of neurological diseases in urban and rural tertiary care hospitals of Sindh, Pakistan. METHODS: This was a cross sectional study conducted in selected urban and rural region of tertiary care hospitals of Sindh, Pakistan. The outpatients medical records of adults (18 years and above) was obtained from January 1st, 2014 to December 31st, 2014. RESULTS: A total of 10,786 outpatients visit were recorded in this period. Mean age of the participants was 40.6 ± 15 years; majority was females 6104 (56.6%). About three-fourth of the patients were from rural hospital 7828 (72.6%). Common neurological diseases were headache disorders 3613 (33.4%), nerve and root lesion 2928 (27.1%), vascular diseases 1440 (13.3%), epilepsies 566 (5.2%), muscle disorders 424 (3.9%), psychiatric disorders 340 (3.1%) and CNS infection 303 (2.8%). Comparison between the urban and rural samples showed that ischaemic stroke (72.7% vs. 82%) and psychiatric disorders (2.1% vs. 3.5%) were more prevalent in rural area as compared to urban setting. CONCLUSION: Stroke, headache and nerve and root lesion are major causes of neurological disorders in urban and rural settings of Sindh, Pakistan. The policy and planning must be focus on primary care, preventive measures and the promotion of health.

Detection of genetic alterations in gastric cancer patients from Saudi Arabia using comparative genomic hybridization (CGH).

BACKGROUND: The present study was conducted to discover genetic imbalances such as DNA copy number variations (CNVs) associated with gastric cancer (GC) and to examine their association with different genes involved in the process of gastric carcinogenesis in Saudi population. METHODS: Formalin-fixed paraffin-embedded (FFPE) tissues samples from 33 gastric cancer patients and 15 normal gastric samples were collected. Early and late stages GC samples were genotyped and CNVs were assessed by using Illumina HumanOmni1-Quad v.1.0 BeadChip. RESULTS: Copy number gains were more frequent than losses throughout all GC samples compared to normal tissue samples. The mean number of the altered chromosome per case was 64 for gains and 40 for losses, and the median aberration length was 679115bp for gains and 375889bp for losses. We identified 7 high copy gain, 52 gains, 14 losses, 32 homozygous losses, and 10 copy neutral LOHs (loss of heterozygosities). Copy number gains were frequently detected at 1p36.32, 1q12, 1q22, 2p11.1, 4q23-q25, 5p12-p11, 6p21.33, 9q12-q21.11, 12q11-q12, 14q32.33, 16p13.3, 17p13.1, 17q25.3, 19q13.32, and losses at 1p36.23, 1p36.32, 1p32.1, 1q44, 3q25.2, 6p22.1, 6p21.33, 8p11.22, 10q22.1, 12p11.22, 14q32.12 and 16q24.2. We also identified 2 monosomy at chromosome 14 and 22, 52 partially trisomy and 22 whole chromosome 4 neutral loss of heterozygosities at 13q14.2-q21.33, 5p15.2-p15.1, 5q11.2-q13.2, 5q33.1-q34 and 3p14.2-q13.12. Furthermore, 11 gains and 2 losses at 1p36.32 were detected for 11 different GC samples and this region has not been reported before in other populations. Statistical analysis confirms significant association of H. pylori infection with T4 stage of GC as compare to control and other stages. CONCLUSIONS: We found that high frequency of copy number gains and losses at 1p36.23, 1p32.1, 1p36.32, 3q25.2, 6p21.33 and 16q24.2 may be common events in gastric cancer. While novel CNVs at 1p36.32 harbouring PRDM16, TP73 and TP73-AS1 genes showed 11 gains and 2 losses for 11 different GC cases and this region is not reported yet in Database of Genomic Variants may be specific to Saudi population.

Clofazimine-induced methemoglobinemia: A rare incidence.

Clofazimine is commonly used for the treatment of leprosy and chronic use of it can lead to methemoglobinemia, which is a rare but major concern. Iron of hemoglobin remains in the form of ferric (Fe3+) in methemoglobinemia as compared with ferrous form (Fe2+) in normal situation. This transformation prevents oxygen carriage and results in higher level of MetHb in blood which could be dangerous to life. In normal patients the level of MetHb is <1%. We report a case where acute ingestion of many tablets of clofazimine resulted in methemoglobinemia. Cyanosis was not apparent in this case leading to delayed diagnosis, and despite >30% MetHb levels, the clinical presentation was not very suggestive. Because of the nonavailability of intravenous methylene blue and parenteral ascorbic acid, tablet ascorbic acid was used for the management. Gradual decrease of MetHb levels was observed, with amelioration of symptoms and improvement in patient's condition. Review of the literature failed to reveal publication of acute methemoglobinemia with such presentation in the past. Awareness about possibility of methemoglobinemia and its possible contributors will help primary care physician and emergency physician suspect this condition early in patients presenting with history of unknown drug overdose and work in proper direction.