Public health impact and cost-effectiveness of switching from bivalent to nonavalent vaccine for human papillomavirus in Norway: incorporating the full health impact of all HPV-related diseases.

AIM: The objective of this study was to estimate and compare the cost-effectiveness of switching from a bivalent to a nonavalent human papillomavirus (HPV) vaccination program in Norway, incorporating all nonavalent vaccine-preventable HPV-related diseases and in the context of the latest cervical cancer screening program. METHODS: A well-established dynamic transmission model of the natural history of HPV infection and disease was adapted to the Norwegian population. We determined the number of cases of HPV-related diseases and subsequent number of deaths, and the economic burden of HPV-related disease under the current standard of care conditions of bivalent and nonavalent vaccinations of girls and boys aged 12 years. RESULTS: Compared to bivalent vaccination, nonavalent vaccination averted an additional 4,357 cases of HPV-related cancers, 421,925 cases of genital warts, and 543 cases of recurrent respiratory papillomatosis (RRP) over a 100-year time horizon. Nonavalent vaccination also averted an additional 1,044 deaths over the 100-year time horizon when compared with bivalent vaccination. Total costs were higher for the nonavalent strategy (10.5 billion NOK [€1.03 billion] vs. 9.3-9.4 billion NOK [€915-925 million] for bivalent vaccination). A switch to nonavalent vaccination had a higher vaccination cost (4.4 billion NOK [€433 million] vs. 2.7 billion NOK [€266 million] for bivalent vaccination) but resulted in a savings of 627-694 million NOK [€62-68 million] in treatment costs. A switch to nonavalent vaccination demonstrated an incremental cost-effectiveness ratio of 102,500 NOK (€10,086) per QALY versus bivalent vaccination. CONCLUSIONS: Using a model that incorporated the full range of HPV-related diseases, and the latest cervical cancer screening practices, we found that switching from bivalent to nonavalent vaccination would be considered cost-effective in Norway.

Human papillomavirus (HPV) is a sexually transmitted infection that is common in Norway. Vaccination against HPV has substantially reduced the burden of HPV-related diseases globally. The HPV vaccine is available in bivalent, quadrivalent, and nonavalent forms. The bivalent vaccine is currently used in the Norwegian national immunization program, but the nonavalent vaccine is also licensed in Norway. In order to gain a more complete understanding of the benefits of nonavalent vaccination, it is necessary to evaluate the cost-effectiveness of switching from the bivalent vaccine to the nonavalent vaccine in light of the full array of vaccine-preventable diseases, including both cervical and noncervical cancers, genital warts, and recurrent respiratory papillomatosis (RRP). Our results show that, when the full range of HPV-related diseases is considered, nonavalent vaccination would be cost-effective relative to bivalent vaccination in Norway. Compared to bivalent vaccination, nonavalent vaccination averted an additional 4,357 cases of HPV-related cancers, 421,925 cases of genital warts, and 543 cases of RRP over a 100-year time horizon. Nonavalent vaccination also averted an additional 1,044 deaths over the 100-year time horizon when compared with bivalent vaccination. While total costs were higher for the nonavalent strategy (10.5 billion NOK [€1.03 billion] vs. 9.3-9.4 billion NOK [€915­925 million] for bivalent vaccination), switching to the nonavalent strategy resulted in a savings of 627­694 million NOK [€62­68 million] in treatment costs compared to the bivalent strategy.

Metaverse in Healthcare Integrated with Explainable AI and Blockchain: Enabling Immersiveness, Ensuring Trust, and Providing Patient Data Security.

Digitization and automation have always had an immense impact on healthcare. It embraces every new and advanced technology. Recently the world has witnessed the prominence of the metaverse which is an emerging technology in digital space. The metaverse has huge potential to provide a plethora of health services seamlessly to patients and medical professionals with an immersive experience. This paper proposes the amalgamation of artificial intelligence and blockchain in the metaverse to provide better, faster, and more secure healthcare facilities in digital space with a realistic experience. Our proposed architecture can be summarized as follows. It consists of three environments, namely the doctor's environment, the patient's environment, and the metaverse environment. The doctors and patients interact in a metaverse environment assisted by blockchain technology which ensures the safety, security, and privacy of data. The metaverse environment is the main part of our proposed architecture. The doctors, patients, and nurses enter this environment by registering on the blockchain and they are represented by avatars in the metaverse environment. All the consultation activities between the doctor and the patient will be recorded and the data, i.e., images, speech, text, videos, clinical data, etc., will be gathered, transferred, and stored on the blockchain. These data are used for disease prediction and diagnosis by explainable artificial intelligence (XAI) models. The GradCAM and LIME approaches of XAI provide logical reasoning for the prediction of diseases and ensure trust, explainability, interpretability, and transparency regarding the diagnosis and prediction of diseases. Blockchain technology provides data security for patients while enabling transparency, traceability, and immutability regarding their data. These features of blockchain ensure trust among the patients regarding their data. Consequently, this proposed architecture ensures transparency and trust regarding both the diagnosis of diseases and the data security of the patient. We also explored the building block technologies of the metaverse. Furthermore, we also investigated the advantages and challenges of a metaverse in healthcare.

Lead-induced modification of growth and yield of Linum usitatissimum L. and its soil remediation potential.

This study was designed to evaluate the pre-reproductive and reproductive responses of Linum usitatissimum L. (flax, linseed plant) to different levels of Pb in the soil. Flax seeds were sown in garden soil-filled earthen pots and treated with three different levels of lead as lead chloride (150, 450, and 750 mg Pb kg-1 soil) except control, and each treatment was replicated three times. Growth and reproductive parameters and photosynthetic pigments were significantly reduced (p ≤ 0.05) for all treatments. Quantitatively, Chlorophyll b content decreased more than chlorophyll a and the amount of proline content in the leaves increased in lockstep with the increase of Pb levels in the soil. Pb was found in substantial amounts in the roots, shoots, and seeds. The pattern of Pb accumulation in different organs was root > shoot > seeds. Pb levels in seeds obtained from 750 mg Pb kg-1 soil-treated plants exceeded the permissible limits. Biological concentration factor (BCF), biological accumulation coefficient (BAC) and translocation factor (TF) values showed that roots of L. usitatissimum absorbed and accumulated a substantial quantity of Pb but translocated only a fraction of that to the shoots. Therefore, L. usitatissimum L. can be used in phytostabilization rather than phytoextraction of Pb.

This manuscript evaluates the potential of flaxseeds to cause biomagnification of lead (Pb) in the human body when grown under different concentrations of Pb and assessment of the risk posed to consumer health in a food chain. This study also provides insight to evaluate the uptake and extraction efficiency of Linum usitatissimum L. to remediate the Pb-polluted soil and use of Pb contaminated plant products (stem fibers and linseed oil) in an ecofriendly manner.

A Systematic Review of Publications Using the Dundee Ready Education Environment Measure (DREEM) to Monitor Education in Medical Colleges in Saudi Arabia.

BACKGROUND This systematic review aimed to identify and evaluate publications using the Dundee Ready Educational Environment Measure (DREEM) and its domains, genders, and educational level (EL) to monitor the education environment in medical colleges (MCs), applied medical science colleges (AMSCs), and dental colleges (DCs) in Saudi Arabia (SA). MATERIAL AND METHODS A literature search was performed using PubMed, ScienceDirect, Scopus, Wiley Library, and Web of Science database keywords and medical, applied medical science, dental colleges headings, followed by a summary and analysis of results. We included all related studies that used DREEM as a tool and were published up to 2022. The following information was extracted from the included studies: researcher's name(s), publication year, overall DREEM, domain, gender, and educational levels. RESULTS Among the 40 studies included in this review, 25 papers were conducted in medical colleges, 5 in applied medical science, and 10 in dental colleges. Overall, DREEM scores among all involved colleges were "more positive than negative," with scores between 101 and 150. In relation to the 5 domains of DREEM, the percentages of medical colleges ranged from 75% to 88% for all domains, whereas it was higher in dental (80% to 90%) in most domains, but considerably lower for applied medical science (50% to 75%). Females had higher DREEM values in dental than medical and applied medical science colleges, whereas educational levels were higher in applied medical science colleges. CONCLUSIONS Overall, DREEM scores were more positive than negative and moved in the correct direction among all involved colleges, with varying degrees of significance between genders and educational levels.

Detection of COVID-19 in X-ray Images Using Densely Connected Squeeze Convolutional Neural Network (DCSCNN): Focusing on Interpretability and Explainability of the Black Box Model.

The novel coronavirus (COVID-19), which emerged as a pandemic, has engulfed so many lives and affected millions of people across the world since December 2019. Although this disease is under control nowadays, yet it is still affecting people in many countries. The traditional way of diagnosis is time taking, less efficient, and has a low rate of detection of this disease. Therefore, there is a need for an automatic system that expedites the diagnosis process while retaining its performance and accuracy. Artificial intelligence (AI) technologies such as machine learning (ML) and deep learning (DL) potentially provide powerful solutions to address this problem. In this study, a state-of-the-art CNN model densely connected squeeze convolutional neural network (DCSCNN) has been developed for the classification of X-ray images of COVID-19, pneumonia, normal, and lung opacity patients. Data were collected from different sources. We applied different preprocessing techniques to enhance the quality of images so that our model could learn accurately and give optimal performance. Moreover, the attention regions and decisions of the AI model were visualized using the Grad-CAM and LIME methods. The DCSCNN combines the strength of the Dense and Squeeze networks. In our experiment, seven kinds of classification have been performed, in which six are binary classifications (COVID vs. normal, COVID vs. lung opacity, lung opacity vs. normal, COVID vs. pneumonia, pneumonia vs. lung opacity, pneumonia vs. normal) and one is multiclass classification (COVID vs. pneumonia vs. lung opacity vs. normal). The main contributions of this paper are as follows. First, the development of the DCSNN model which is capable of performing binary classification as well as multiclass classification with excellent classification accuracy. Second, to ensure trust, transparency, and explainability of the model, we applied two popular Explainable AI techniques (XAI). i.e., Grad-CAM and LIME. These techniques helped to address the black-box nature of the model while improving the trust, transparency, and explainability of the model. Our proposed DCSCNN model achieved an accuracy of 98.8% for the classification of COVID-19 vs normal, followed by COVID-19 vs. lung opacity: 98.2%, lung opacity vs. normal: 97.2%, COVID-19 vs. pneumonia: 96.4%, pneumonia vs. lung opacity: 95.8%, pneumonia vs. normal: 97.4%, and lastly for multiclass classification of all the four classes i.e., COVID vs. pneumonia vs. lung opacity vs. normal: 94.7%, respectively. The DCSCNN model provides excellent classification performance consequently, helping doctors to diagnose diseases quickly and efficiently.

Removal of organochlorine pesticides using zerovalent iron supported on biochar nanocomposite from Nephelium lappaceum (Rambutan) fruit peel waste.

Unique zerovalent iron (Fe0) supported on biochar nanocomposite (Fe0-BRtP) was synthesized from Nephelium lappaceum (Rambutan) fruit peel waste and were applied for the simultaneous removal of 6 selected organochlorine pesticides (OCPs) from aqueous medium. During facile synthesis of Fe0-BRtP, Rambutan peel extract was used as the green reducing mediator to reduce Fe2+ to zerovalent iron (Fe0), instead of toxic sodium borohydride which were used for chemical synthesis. For comparison, chemically synthesized Fe0-BChe nanocomposite was also prepared in this work. Characterization study confirmed the successful synthesis and dispersion of Fe0 nanoparticles on biochar surface. Batch experiments revealed that Fe0-BRtP and Fe0-BChe nanocomposites combine the advantage of adsorption and dechlorination of OCPs in aqueous medium and up to 96-99% and 83-91% removal was obtained within 120 and 150 min, respectively at initial pH 4. Nevertheless, the reactivity of Fe0-BChe nanocomposite decreased 2 folds after being aged in air for one month, whilst Fe0-BRtP almost remained the same. Adsorption isotherm of OCPs were fitted well to Langmuir isotherm and then to Freundlich isotherm. The experimental kinetic data were fitted first to pseudo-second-order adsorption kinetic model and then to pseudo-first-order reduction kinetic model. The adsorption mechanism involves π-π electron-donor-acceptor interaction and adsorption is facilitated by the hydrophobic sorption and pore filling. After being reused five times, the removal efficiency of regenerated Fe0-BChe and Fe0-BRtP was 5-13% and 89-92%, respectively. The application of this Fe0-BRtP nanocomposite could represent a green and low-cost potential material for adsorption and subsequent reduction of OCPs in aquatic system.

Forecasting the Trends of Covid-19 and Causal Impact of Vaccines Using Bayesian Structural time Series and ARIMA.

Several researchers have used standard time series models to analyze future patterns of COVID-19 and the Causal impact of vaccinations in various countries. Bayesian structural time series (BSTS) and ARIMA (Autoregressive Integrated Moving Average) models are used to forecast time series. The goal of this study is to look at a much more adaptable effective methodology for dissecting the major components of a time series that breaks down the main parts of a time series. Within the period of March 1, 2020, to June 30, 2021, we used these state space model to explore the forecast patterns of COVID-19 in five afflicted nations.In addition, we used intervention analysis under BSTS models to examine the casual effect of vaccines in these countries, and we reached higher levels of accuracy than ARIMA models. According to forecasts, the number of confirmed cases in the United States, the United Kingdom, the United Arab Emirates, Bahrain, and India will climb by 1.17%, 19.4%, 15.5%, 13.8% , and 8%, respectively, during the next 60 days. On the other side, death rates in the United States, the United Kingdom, the United Arab Emirates, Bahrain, and India are expected to rise by 2.7%, 3.5%, 15.8%, 9.4%, and 14.8%, respectively. In addition, By using effective and quick vaccination, the United States, United Kingdom, and UAE have been able to reduce the number of mortality. On the other hand, vaccination is currently unable to decrease the rate of cases and deaths in India. Overall, the Indian healthcare system is likely to be seriously over-burdened in the next month. Though the USA and UK have managed to cut down the rates of COVID-19 deaths,but in UK and UAE number of confirmed cases are high as compared to other nations,so serious efforts will be required to keep these controllable. On the other hand,To keep things under control, Bahrain and four other countries has to speed up vaccinations.

Blood Quality Diagnostic Device Detects Storage Differences Between Donors.

In 2013, nearly 15 million units of banked blood were transfused in the United States of America alone. Blood shortages are expected to increase globally. Donated blood is not equal due to differences in quality and deterioration rate. There are no methods to detect time-dependent biochemical and biophysical changes of red blood cells (RBCs) or the deterioration rate of donated RBCs. Nine randomly selected RBC units collected by the San Diego Blood Bank were examined for interdonor variability over six weeks of storage. In vitro RBC quality was assessed weekly by conventional biochemical tests including free Hb, K+, ATP, P50, 2,3 DPG, lactate, and pH. Deformability was measured via cell filtration. Briefly, the RBC suspension (10% Hct), was forced through a 5.0-µm pore membrane (106 mm2) at various flow rates. No interdonor variability in biochemical or mechanical parameters was observed at baseline. Interdonor variability in biochemical properties (free Hb, K+, ATP, P50, 2,3 DPG, lactate, and pH) was observed after 14 days of storage. However, significant differences from baseline in RBC mechanical properties (i.e., filterability) were observed as early as 7 days into storage at the lowest flow rates and after 28 days of storage at all flow rates. There was a net decrease in filterability over time for all donors, but the rate at which filterability decreased (i.e., deterioration rates) was different when comparing individual donors. Changes in all biochemical parameters were significant different between donors. These data suggest that filterability is more sensitive to changes in blood quality than conventional biochemical parameters.

Reliability analysis using an exponential power model with bathtub-shaped failure rate function: a Bayes study.

Models with bathtub-shaped hazard function have been widely accepted in the field of reliability and medicine and are particularly useful in reliability related decision making and cost analysis. In this paper, the exponential power model capable of assuming increasing as well as bathtub-shape, is studied. This article makes a Bayesian study of the same model and simultaneously shows how posterior simulations based on Markov chain Monte Carlo algorithms can be straightforward and routine in R. The study is carried out for complete as well as censored data, under the assumption of weakly-informative priors for the parameters. In addition to this, inference interest focuses on the posterior distribution of non-linear functions of the parameters. Also, the model has been extended to include continuous explanatory variables and R-codes are well illustrated. Two real data sets are considered for illustrative purposes.

Active Case Finding of Tuberculosis: Randomized Evaluation of Simple and Infotainment Chest Camps.

BACKGROUND: In Pakistan, many tuberculosis (TB) cases are not reported to the national surveillance system. An active case finding strategy in the form of conventional (simple) or innovative (infotainment) chest camps can contribute to diagnosing these missed cases. OBJECTIVE: To compare the yield in terms of TB patients detected at a simple chest camp (SCC) versus an infotainment chest camp (ICC) in rural areas. METHODS: A cluster randomized controlled trial with 2 parallel arms was conducted in 4 districts of Pakistan from June 2012 to May 2013. Rural neighborhoods (n = 318) were randomly allocated in a ratio of 1:3 to receive either SCC or ICC. Incidence of TB (all forms and sputum smear positive [SS+]) and number needed to screen (NNS) to diagnose 1 TB case were calculated. Cluster analysis was done according to intention to treat and risk ratio (RR), and 95% confidence intervals (CIs) were calculated. FINDINGS: A total of 3086 participants were tested at the SCC and 9029 at the ICC, of whom 38.5% were female. Mean age was 37.4 ± 15.9 years. Incidences of previously undiagnosed TB (all forms) for SCC and ICC were 23.6 (95% CI 20.04-27.4) and 22.1 (95% CI 20.3-24.1) per 100,000 population (P = .42), SS+ TB 22.5 (95% CI 19.3-26.1) and 21.6 (95% CI 19.8-23.6) (P = .67), respectively. NNS to diagnose 1 TB case were 260 (95% CI 234.3-289.6) and 258 (95% CI 233.3-287.9) for SCC and ICC, respectively (P = .9). RRs for all forms of TB and SS+ TB in SCC compared to ICC were 0.94 (95% CI 0.73-1.19) and 0.95 (95% CI 0.74-1.22) and P values were .58 and .71, respectively. CONCLUSIONS: Both types of chest camps are equally effective in active case finding of previously undiagnosed TB cases in rural areas in 2 provinces in Pakistan.

A phantom study on the behavior of Acuros XB algorithm in flattening filter free photon beams.

To study the behavior of Acuros XB algorithm for flattening filter free (FFF) photon beams in comparison with the anisotropic analytical algorithm (AAA) when applied to homogeneous and heterogeneous phantoms in conventional and RapidArc techniques. Acuros XB (Eclipse version 10.0, Varian Medical Systems, CA, USA) and AAA algorithms were used to calculate dose distributions for both 6X FFF and 10X FFF energies. RapidArc plans were created on Catphan phantom 504 and conventional plans on virtual homogeneous water phantom 30 × 30 × 30 cm(3), virtual heterogeneous phantom with various inserts and on solid water phantom with air cavity. Dose at various inserts with different densities were measured in both AAA and Acuros algorithms. The maximum % variation in dose was observed in (-944 HU) air insert and minimum in (85 HU) acrylic insert in both 6X FFF and 10X FFF photons. Less than 1% variation observed between -149 HU and 282 HU for both energies. At -40 HU and 765 HU Acuros behaved quite contrarily with 10X FFF. Maximum % variation in dose was observed in less HU values and minimum variation in higher HU values for both FFF energies. Global maximum dose observed at higher depths for Acuros for both energies compared with AAA. Increase in dose was observed with Acuros algorithm in almost all densities and decrease at few densities ranging from 282 to 643 HU values. Field size, depth, beam energy, and material density influenced the dose difference between two algorithms.

Bayesian analysis of generalized log-Burr family with R.

Log-Burr distribution is a generalization of logistic and extreme value distributions, which are important reliability models. In this paper, Bayesian approach is used to model reliability data for log-Burr model using analytic and simulation tools. Laplace approximation is implemented for approximating posterior densities of the parameters. Moreover, parallel simulation tools are also implemented using 'LaplacesDemon' package of R.

Efficient heterogeneous catalytic hydrogenation of acetone to isopropanol on semihollow and porous palladium nanocatalyst.

Highly efficient and remarkable selective acetone conversion to isopropanol has been achieved via a heterogeneous catalytic hydrogenation of acetone by NaBH4 in the presence of semihollow palladium nanoparticles (PdNPs) grown on ITO substrate. PdNPs with high surface defect grown on an indium tin oxide (ITO) surface were prepared via a simple immersion of the substrate into a solution containing K2PdCl6, sodium dodecyl sulphate (SDS), and formic acid for 2 h at room temperature. The sample showed remarkably high heterogeneous catalytic efficiency by producing 99.8% of isopropanol within 6 min using only 0.28 µg of PdNPs on the ITO surface. The present system exhibits heterogenenous catalytic hydrogenation efficiency 1 × 10(6) time higher than using the conventional Raney Ni system.

Chlorhexidine-alcohol compared with povidone-iodine for surgical-site antisepsis in cesarean deliveries.

OBJECTIVE: To estimate the incidence of surgical-site infection with use of chlorhexidine-alcohol compared with povidone-iodine among women undergoing cesarean deliveries. METHODS: This was a retrospective cohort review of 1,000 consecutive cases in women who underwent cesarean delivery over a 1-year interval. The primary outcome was any surgical-site infection within 30 days (Centers for Disease Control and Prevention criterion). RESULTS: Mean age and parity were equivalent (29.8±5.9 years; 2.6±1.4). Women were similar regarding baseline characteristics, including acknowledged surgical-site infection comorbidities (body mass index [BMI, calculated as weight (kg)/[height (m)]2], gestational diabetes, smoking; P>.05). Method of skin incision closure was different, with 91% among povidine-iodine compared with 81% among chlorhexidine-alcohol using staples (P<.001). Although the duration of surgical time was higher among chlorhexidine women (67.2 compared with 60.0 minutes; P<.001), fewer women in the chlorhexidine group were classified as having undergone an "urgent" cesarean delivery (29% compared with 46%; P<.001). Concerning surgical-site infection, the overall rate was similar between the two groups (5% [n=25] chlorhexidine and 5.8% [n=29] povidone-iodine; P=.58). In multivariable analysis and after control for potential confounders, odds for surgical-site infection remained similar between the two groups (adjusted odds ratio 0.74, 95% confidence interval 0.41-1.33; P=.32). The only significant predictor of surgical-site infection was duration of cesarean delivery, in which every 1-minute increase in duration increased the odds for infection by 1.3% (adjusted odds ratio 1.013, 95% CI 1.004-1.022; P=.004). CONCLUSION: The single significant predictor of surgical-site infection is operative time. Cleansing with povidone-iodine may be a cost-effective and equally efficacious alternative to chlorhexidine-alcohol among women undergoing cesarean deliveries. LEVEL OF EVIDENCE: II.

Antibacterial activity of leaves extracts of Trifolium alexandrinum Linn. against pathogenic bacteria causing tropical diseases.

OBJECTIVE: To investigate antibacterial potential of Trifolium alexandrinum (T. alexandrinum) Linn. against seven gram positive and eleven gram negative hospital isolated human pathogenic bacterial strains responsible for many tropical diseases. METHODS: Non-polar and polar extracts of the leaves of T. alexandrinum i.e., hexane, dichloromethane (DCM), ethyl acetate (EtOAc), methanol (MeOH) and aqueous (AQ) extracts at five different concentrations (1, 2, 5, 10 and 15 mg/mL) were prepared to evaluate their antibacterial value. NCCL standards were strictly followed to perform antimicrobial disc susceptibility test using disc diffusion method. RESULTS: Polar extracts demonstrated significant antibacterial activity against tested pathogens. EtOAc and MeOH extracts showed maximum antibacterial activity with higher inhibition zone and were found effective against seventeen of the tested pathogens. While AQ plant extract inhibited the growth of sixteen of the test strains. EtOAc and MeOH plant extracts inhibited the growth of all seven gram positive and ten of the gram negative bacterial strains. CONCLUSIONS: The present study strongly confirms the effectiveness of crude leaves extracts against tested human pathogenic bacterial strains causing several tropical diseases. Since Egyptian clover is used as a fodder plant, it could be helpful in controlling various infectious diseases associated with cattle as well.

Antibacterial efficacy of the seed extracts of Melia azedarach against some hospital isolated human pathogenic bacterial strains.

OBJECTIVE: To investigate the antibacterial potential of the polar and non-polar extracts of the seeds of Melia azedarach (M. azedarach) L. (Meliaceae) against eighteen hospital isolated human pathogenic bacterial strains. METHODS: Petrol, benzene, ethyl acetate, methanol, and aqueous extracts at five different concentrations (1, 2, 5, 10 and 15 mg/mL) were evaluated. Disk diffusion method was followed to evaluate the antibacterial efficacy. RESULTS: All extracts of the seeds demonstrated significant antibacterial activity against tested pathogens. Among all extracts, ethyl acetate extract revealed the highest inhibition comparatively. The present study also favored the traditional uses reported earlier. CONCLUSIONS: Results of this study strongly confirm that the seed extracts of M. azedarach could be effective antibiotics, both in controlling gram-positive and gram-negative human pathogenic infections.

Antibacterial efficacy of the seed extracts of Melia azedarach against some hospital isolated human pathogenic bacterial strains

<p><b>OBJECTIVE</b>To investigate the antibacterial potential of the polar and non-polar extracts of the seeds of Melia azedarach (M. azedarach) L. (Meliaceae) against eighteen hospital isolated human pathogenic bacterial strains.</p><p><b>METHODS</b>Petrol, benzene, ethyl acetate, methanol, and aqueous extracts at five different concentrations (1, 2, 5, 10 and 15 mg/mL) were evaluated. Disk diffusion method was followed to evaluate the antibacterial efficacy.</p><p><b>RESULTS</b>All extracts of the seeds demonstrated significant antibacterial activity against tested pathogens. Among all extracts, ethyl acetate extract revealed the highest inhibition comparatively. The present study also favored the traditional uses reported earlier.</p><p><b>CONCLUSIONS</b>Results of this study strongly confirm that the seed extracts of M. azedarach could be effective antibiotics, both in controlling gram-positive and gram-negative human pathogenic infections.</p>

Stapled hemorrhoidopexy: The Aga Khan University Hospital experience.

BACKGROUND/AIM: Stapled hemorrhoidopexy for prolapsing hemorrhoids is conceptually different from excision hemorrhoidectomy. It does not accompany the pain that usually occurs after resection of the sensitive anoderm. This study was carried out to evaluate the clinical outcome of stapled hemorrhoidopexy at The Aga Khan University Hospital. MATERIALS AND METHODS: A sample of 140 patients with symptomatic second-, third-, and fourth-degree hemorrhoids and circumferential mucosal prolapse underwent stapled hemorrhoidopexy from July 2002 to July 2007. They were evaluated for postoperative morbidity, analgesic requirement, and recurrence. RESULTS: Seventy-eight percent were males and the mean age was 45 (range 16-90) years. The mean operative time was 35 (15-78) min. The mean parenteral analgesic doses during the first 24 h were 2.1. All patients received oral analgesics alone after 24 h. No significant postoperative morbidity was observed. The mean in-patient hospital stay was 1.3 (0-5) days. Patients were followed-up for 24 (range, 2-48) months. Minor local recurrence of hemorrhoids was seen in four patients and was managed by band ligation. CONCLUSION: Stapled hemorrhoidopexy procedure was found safe, well tolerated by patients with minimal parenteral analgesic use and early discharge from the hospital.