Total Endoscopic or Endoscope-Assisted Excision of Non-embolized Advanced Juvenile Nasopharyngeal Angiofibroma: A Clinical Case Series.

Background Surgical excision is the primary treatment for juvenile nasopharyngeal angiofibroma (JNA), but this procedure is challenging due to its high vascularity and local aggressiveness. Moreover, preoperative embolization is a subject of debate. Objective The objective of this study is to assess the efficacy, safety, and feasibility of endoscope-assisted excision as a surgical intervention for non-embolized advanced JNA. Materials and methods This case series involved six male patients (mean age: 16 years) with JNA, classified as stages Ⅱc to Ⅲb according to the Radkowski classification. None underwent preoperative embolization. Results Two stage Ⅱc cases underwent total endoscopic endonasal excision. One patient with stage Ⅲa and another with stage Ⅲb underwent surgery via an endoscope-assisted sublabial approach. Two patients, one with stage Ⅱc JNA and another with Ⅲb, underwent a two-stage procedure. Postoperative CT scans showed no residual disease at the six-month mark. On average, each procedure required 1.5 units of blood transfusion. One patient experienced intraoperative bleeding, whereas the remaining patients were free of any major complications. The mean operation duration was 175 minutes per procedure. The mean length of stay at the hospital was 3.75 days per procedure. Conclusion Endoscope-assisted or purely endoscopic approaches can be safely and effectively employed for the complete excision of non-embolized advanced JNAs.

SEM and LM insights: Spore morphology and its taxonomic significance in Sino Himalayan, Malesian, and European elements of Pteridaceae.

The Pteridaceae family, known for its taxonomic complexity, presents challenges in identification due to high variability among its species. This study investigates the spore morphology employing both SEM and LM techniques in 10 Pteridaceae taxa phytogeographicaly Sino-Himalayan, Malesian, and European elements in Pakistan. The taxa include Adiantum capillus-veneris, A. incisum, A. venustum, Aleuritopteris bicolor, Oeosporangium nitidulum, O. pteridioides, Onychium cryptogrammoides, O. vermae, Pteris cretica, and P. vittata. The objective is to assess their taxonomic relevance and develop a spore-based taxonomic key. Findings indicate differences in spore shape, sizes, exospore thickness, and in surface ornamentation highlighting the potential for taxonomic differentiation. Spores are trilete, and notable differences are observed in the dimension of spores in both distal and proximal sides. Equatorial dimensions vary between 35 and 50 µm, while the polar diameter ranges from 29 to 50 µm. SEM revealed different spore ornamentation types that show several useful characteristics establishing valuable taxonomic variations. The studied Adiantum taxa feature a perispore with tubercules and a micro-granulose surface. The spores of examined Oeosporangium and Aleuritopteris taxa shows cristate sculptures with variable ornamentations. Both species of Onychium have tuberculate-pleated tubercles with sinuous folds on both distal and proximal sides. The surface ornamentation among examined Pteris taxa show variability. PCA analysis indicated that spore quantitative data identified distinct groups, underscoring taxonomic significance. Nevertheless, there was variation observed in surface ornamentation and spore shape, indicating the potential for discrimination among taxa. RESEARCH HIGHLIGHTS: Spore morphology of 10 Pteridaceae taxa has been investigated through LM and SEM. Investigated species shows differences in spore shape, sizes, exospore thickness, and in surface ornamentation. Ornamentation on the perispore provides several valuable characteristics, establishing useful taxonomic distinctions. Spore morphological analysis is effective at the generic level, with minor distinctions discernible at the species level.

Audiological Outcomes of Type 1 Tympanoplasty Using Conchal Cartilage and Temporalis Fascia.

OBJECTIVE: To compare the efficacy of conchal cartilage graft and temporalis fascia graft in Type 1 tympanoplasty in terms of graft uptake and hearing improvement. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Otolaryngology, Khyber Teaching Hospital, Peshawar, Pakistan, from January 2020 till December 2022. METHODOLOGY: Using quota sampling, 2 groups were made i.e. conchal cartilage group (Group A) and temporalis fascia group (Group B). Total of 124 records were selected with 62 records from each group. Graft uptake rate and audiological outcomes were compared between the groups. Moreover, postoperative complication rate was also noted for each group. RESULTS: The graft uptake rates between Group A and B at 3rd month were compared postoperatively (98.39%, 93.55%, p=0.36). The difference between preoperative mean air-bone gap (ABG, 28.05 ± 2.19dB, 28.68 ± 2.38 dB, p=0.12) and postoperative mean ABG (13.35 ± 3.45, 14.47 ± 3.29, p=0.69) was also statistically not significant. However, the differences regarding audiological success rate between cartilage and fascia groups (96.77%, 82.25%, p=0.01) and average operating time (51.8 ± 2.1 vs. 43.5 ± 3.2 minutes, p=0.009) were significantly different. CONCLUSION: In chronic otitis media (COM) patients with subtotal perforations, endoscopic tympanoplasty using conchal cartilage or temporalis fascia as graft yielded comparable outcomes in terms of graft uptake, hearing improvement, and postoperative complications. However, using conchal cartilage, the procedure showed better audiological success rate. With temporalis fascia as graft, the procedure was performed in a shorter time. KEY WORDS: Chronic otitis media, Tympanoplasty, Temporalis fascia, Conchal cartilage, Subtotal perforation.

Genetic Characterization of Advance Bread Wheat Lines for Yield and Stripe Rust Resistance.

Wheat (Triticum aestivum L.) is a prominent grain crop. The goal of the current experiment was to examine the genetic potential of advanced bread wheat genotypes for yield and stripe rust resistance. Ninety-three bread wheat genotypes including three varieties (Kohat-2017, Pakistan-2013, and Morocco) were field tested in augmented design as observational nurseries at three locations (i.e., Kohat, Nowshera, and Peshawar) during the 2018-19 crop season. Various parameters related to yield and stripe rust resistance showed significant differences among genotypes for most of the characters with few exceptions. The analysis of variance revealed significant variations for all the genotypes for all the traits at all three sites with few exceptions where nonsignificant differences were noticed among genotypes. Averaged over three locations, genotypes exhibiting maximum desirable values for yield and yield components were KT-86 (325 tillers) for tillers m-2, KT-50 (2.86 g) for grain weight spike-1, KT-49 (41.6 g) for 1000-grain weight, KT-50 (74 grains) for grains spikes-1, KT-55 (4.76 g) for spike weight, and KT-36 and KT-072 (4586 kg ha-1) for grain yield. Correlation analysis revealed that grain yield had a significant positive correlation with grain spike-1 and grain weight spike-1 at Kohat, with grains spike-1, tillers m-2, and grain weight spike-1 at Nowshera, and with plant height, spike weight, 1000-grain weight, and tillers m-2 at Peshawar. Molecular marker data and host response in the field at the adult stage revealed that Yr15 and Yr10 are both still effective in providing adequate resistance to wheat against prevalent races of stripe rust. Four lines showing desirable lower average coefficient of infection (ACI) values without carrying Yr15 and Yr10 genes show the presence of unique/new resistance gene(s) in the genetic composition of these four lines. Genotype KT-072 (4586 kg ha-1 and 1.3 ACI), KT-07 (4416 kg ha-1 and 4.3 ACI), KT-10 (4346 kg ha-1 and 1.0 ACI), and KT-62 (4338 kg ha-1 and 2.7 ACI) showed maximum values for grain yield and low desirable ACI values, and these lines could be recommended for general cultivation after procedural requirements of variety release.

Green Fabrication, Characterization of Zinc Oxide Nanoparticles Using Plant Extract of Momordica charantia and Curcuma zedoaria and Their Antibacterial and Antioxidant Activities.

In recent years, the rapid increase in the resistance of microorganisms to antibiotics has produced major health issues. Novel applications for these compounds have been developed by integrating modern technologies such as nanotechnology and material science with the innate antibacterial activity of metals. The current study demonstrated the synthesis of zinc oxide nanoparticles (ZnO NPs) from Momordica charantia and Curcuma zedoaria plant extracts, as well as their antibacterial properties. The synthesis of ZnO NPs was confirmed via UV-visible spectroscopy, showing clear peaks at 375 and 350 nm for M. charantia and C. zedoaria, respectively. Scanning electron microscopy (SEM) analysis revealed crystals of irregular shapes for the majority of the nanoparticles synthesized from both plants. The existence of ZnO NPs was confirmed using X-ray diffraction while the particle size was calculated using Scherrer's equation, which was 19.65 for C. zedoaria and 17.02 for M. charantia. Different functional groups were detected through Fourier transform infrared spectroscopy analysis. The antibacterial activity of the ZnO NPs at three different concentrations (250, 500, and 1000 µg/ml) was assessed against three different bacterial strains, i.e., Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), and Pseudomonas aeruginosa (P. aeruginosa), using disc diffusion methods. The ZnO nanoparticles showed promising antibacterial activity against bacterial strains. For C. zedoaria, the highest growth inhibition was observed at a concentration of 1000 µg/ml, which was 18, 19, and 18 mm as compared to antibiotics (15, 11, and 15.6 mm) against E. coli, P. aeruginosa, and S. aureus, respectively. Similarly, at 1000 µg/ml of NPs, M. charantia showed the highest growth inhibition (18, 15, and 17 mm) as compared to antibiotics (15, 11, and 14.6 mm) against E. coli, P. aeruginosa, and S. aureus, respectively. In conclusion, compared to pure plant extract and antibiotics, ZnO NPs at a higher concentration (1000 µg/ml) exhibited a significant difference in zone of inhibition against all the bacterial strains. Different concentrations of ZnO using M. charantia and C. zedoaria caused increments in the scavenging of 2,2-diphenyl-1-picrylhydrazyl (DPPH) radicals and 2,2-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS). The nanoparticles extracted using C. zedoaria exhibited higher antioxidant activity than M. charantia. Greenly synthesized ZnO nanoparticles have remarkable antibacterial properties and antioxidant activity, making them a promising contender for future pharmaceutical application.

Otorhinolaryngological presentations of mucormycosis amid COVID-19 pandemic in a tertiary care hospital.

Objective: To describe presentations, comorbidities, investigations, and surgical treatment of patients with mucormycosis amid the COVID-19 pandemic in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan. Methods: This descriptive study was conducted at the department of ENT, and Head and Neck Surgery, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan from June 2020 to June 2021. All the patients fulfilling the inclusion criteria were included. Patients with COVID-19 were diagnosed based on real-time polymerase chain reaction (RT-PCR). After diagnosing mucormycosis computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were performed for subsequent surgical clearance. After taking informed consent demographic data were collected on a proforma and analyzed using SPPS version 25. Results: Out of 23 patients males were 14(60.9%), females were 9 (39.1%) with a male: female ratio of 1.5:1. Mean ± SD age was 51.26 ± 1.41 years. Nasal obstruction and headache were the most common (8, 34.8%) presentations. The commonest co-morbidities were hypertension with diabetes mellitus (8, 34.8%). Out of 23 patients, 16(69.6%) had COVID-19 PCR positive. The majority of patients (17, 73.9%) were not vaccinated against COVID-19. Most of the patients (9, 39.1%) had HbA1c levels of 7% to 8.9%. The commonest surgery was endoscopic debridement of paranasal sinuses (9, 39.1%), while the commonest CT scan finding was a heterogeneous lesion involving the nose, maxillary and ethmoid sinuses (12, 52.2%). Conclusion: Mucormycosis of paranasal sinuses with/or without intracranial extension is frequently seen in unvaccinated patients having uncontrolled diabetes and COVID-19 infection.

Targeted metabolomics reveals fatty acid abundance adjustments as playing a crucial role in drought-stress response and post-drought recovery in wheat.

Drought stress is one of the abiotic stresses restricting plant development, reproductive growth, and survival. In the present study, the effect of drought stress and post-drought recovery for the selected local wheat cultivar, Atta Habib, was studied. Wheat was grown for 16 days followed by drought stress for 7 days and allowed to recover for 7 days after the removal of the drought stress. Same-aged untreated plants were also grown as a control. The effect of drought stress and post-drought recovery on morphology (root length, shoot length, root weight, and shoot weight), enzymatic activity, and fatty acid profile were analyzed. The results showed that shoot weight (93.1 mg), root weight (85.2 mg), and shoot length (11.1 cm) decreased in the stressed plants but increased steadily in the recovered plants compared to the same-aged control plants, while root length showed a higher increase (14.0 cm) during drought stress and tended to normalize during the recovery phase (13.4 cm). The ascorbate peroxidase activity increased in the stressed plants (5.44 unit/mg protein) compared to the control, while gradually normalizing in the recovery phase (5.41 unit/mg protein). Gas chromatography coupled mass spectrometric analysis revealed abundance changes in important fatty acids, such as palmitic acid, stearic acid, oleic acid, linoleic acid, and linolenic acid. Palmitic acid (39.1%) and oleic acid (2.11%) increased in the drought-stressed plants, while a reduction in linoleic acid (6.85%) and linolenic acid (51.18%) was observed compared to the same-aged control plants, i.e., palmitic (33.71%), oleic (0.95%), linoleic (7.52%), and linolenic acid (55.23%). The results suggest that wheat tries to recover in the post-drought stage by repairing oxidative damage through ascorbate peroxidase, and by adjusting fatty acid abundances under drought stress and during the post-drought phase in an effort to maintain membranes' integrity and a suitable fat metabolism route, thus helping recovery. Targeted metabolomics may be further used to explore the role of other metabolites in the drought-stress response mechanism in wheat. Furthermore, this relatively little explored avenue of post-drought recovery needs more detailed studies involving multiple stress durations.

Antagonistic Activity of Trichoderma spp. Against Fusarium oxysporum in Rhizosphere of Radix pseudostellariae Triggers the Expression of Host Defense Genes and Improves Its Growth Under Long-Term Monoculture System.

Under consecutive monoculture, the abundance of pathogenic fungi, such as Fusarium oxysporum in the rhizosphere of Radix pseudostellariae, negatively affects the yield and quality of the plant. Therefore, it is pertinent to explore the role of antagonistic fungi for the management of fungal pathogens such as F. oxysporum. Our PCR-denatured gradient gel electrophoresis (DGGE) results revealed that the diversity of Trichoderma spp. was significantly declined due to extended monoculture. Similarly, quantitative PCR analysis showed a decline in Trichoderma spp., whereas a significant increase was observed in F. oxysporum. Furthermore, seven Trichoderma isolates from the R. pseudostellariae rhizosphere were identified and evaluated in vitro for their potentiality to antagonize F. oxysporum. The highest and lowest percentage of inhibition (PI) observed among these isolates were 47.91 and 16.67%, respectively. In in vivo assays, the R. pseudostellariae treated with four Trichoderma isolates, having PI > 30%, was used to evaluate the biocontrol efficiency against F. oxysporum in which T. harzianum ZC51 enhanced the growth of the plant without displaying any disease symptoms. Furthermore, the expression of eight defense-related genes of R. pseudostellariae in response to a combination of F. oxysporum and T. harzianum ZC51 treatment was checked, and most of these defense genes were found to be upregulated. In conclusion, this study reveals that the extended monoculture of R. pseudostellariae could alter the Trichoderma communities in the plant rhizosphere leading to relatively low level of antagonistic microorganisms. However, T. harzianum ZC51 could inhibit the pathogenic F. oxysporum and induce the expression of R. pseudostellariae defense genes. Hence, T. harzianum ZC51 improves the plant resistance and reduces the growth inhibitory effect of consecutive monoculture problem.

Molecular epidemiology and associated risk factors of Anaplasma marginale and Theileria annulata in cattle from North-western Pakistan.

Ticks and tick-borne pathogens are one of the major threats to livestock production worldwide. The aim of present study is to specify the molecular epidemiology and its associated risk factors of two well-distributed tick-borne pathogens Anaplasma marginale and Theileria annulata in cattle population from North-western Pakistan. Blood samples were Collected from 60 (32.6 %) local breed cattle, 101 (54.9 %) from crossbreed, and 24 (13.0 %) from exotic breed with total of 184 blood samples. Species-specific PCR assays were performed to detect the presence of A. marginale and T. annulata based on 16S rRNA and 18S rRNA genetic makers respectively. PCR results showed that A. marginale was 16.3 % prevalent and T. annulata was 29.9 % prevalent in the study area with a total prevalence rate of 46.2 % (85/184) of the tested blood samples. District wise analysis revealed that both pathogens were highly prevalent in district Dir Upper (13.6 %) and least prevalent in district Chitral (10.3 %). Univariable analysis of risk factors showed that only breed and acaricidal treatment were significant determinants (P < 0.05) for A. marginale infection, however, in case of T. annulata infection; breed, age, gender, grazing practice, and acaricidal treatment were potential determinants (P < 0.05). Multivariable analysis specified that breed and acaricidal treatment were considered as significant risk factors for A. marginale infection (P < 0.05) whereas acaricidal treatment was found to be a significant determinant for T. annulata infection (P < 0.05). Phylogenetic analysis indicated that A. marginale 16S rRNA and T. annulata 18S rRNA isolates showed similarities and shared phylogeny with same isolates reported from Asia. This is the first molecular report on the epidemiology and risk factors analysis of A. marginale and T. annulata infections in cattle population from NW Pakistan. Further large scale study is required to investigate molecular, epidemiological and genotypic aspects as well as potential risk factors analysis from the country to facilitate designing strategies to control tick-borne pathogen and reduce losses to cattle industry.

Pattern of hepatitis C virus genotypes and subtypes circulating in war-stricken Khyber Pakhtunkhwa, Pakistan: Review of published literature.

Infection due to hepatitis C virus (HCV) is a major cause of fibrosis and hepatocellular carcinoma in Pakistan. In the current review, pattern of HCV genotypes and subtypes in Khyber Pakhtunkhwa province was ascertained in light of the available literature. After thorough analysis, genotype 3 (58.27%) was determined to be the leading HCV genotype, followed by genotypes 2 (12.39%), 1 (9.54%) and 4 (0.86%). The proportions of genotypes 5 and 6 were recorded as 0.09% and 0.22% respectively. Subtype wise, 3a accounted for 48.67%, followed by subtype 2a (10.91%), 3b (9.43%), 1a (5.84%), 1b (3.66%), 2b (1.45%) and genotype 4 with its undefined subtypes contributed a portion of 0.86%. The cumulative share of subtypes 1c, 2c, 3c, 5a and 6a was less than 1%. In 11.51% cases, the subtype was untypeable while in 7.17% cases mixed subtypes were recorded. Gender wise, proportions of most HCV subtypes were marginally higher among males as compared to females. On the basis of studied groups, 3a was pervasive among all groups except in intravenous drug users where 2a was the major HCV subtype. Similarly, based on various geographical locations (provincial divisions), subtype 3a revealed a ubiquitous distribution. Conclusively, HCV 3a persists to be the principal subtype across the province of Khyber Pakhtunkhwa. The considerable number of untypeable subtypes in most studies urges for an improved genotyping system on the basis of local sequence data and practice of sequencing for determination of underlying subtype in untypeable cases. Further, studies on identification of subtypes transmission pattern are imperative for assessment of transmission origin and reinforcement of efficient control strategies. In addition, the current review emphasizes the need of attention toward HCV risk groups and ignored southern side of Khyber Pakhtunkhwa province for better holistic understanding of HCV genotype distribution pattern in the province.