Distribution, prevalence and diversity of ticks (Acari: Ixodidae) infesting one-humped camels from Southwest Punjab, Pakistan.

In tropical countries like Pakistan, ticks are the most prevalent vectors for transmitting diseases to wild and domestic animals leading to their morbidity and mortality. In the present study, a total of 593 ticks infesting one-humped camels (n = 244) were collected during April till June 2021 from two tehsils of Layyah district located in Punjab (Pakistan) in order to investigate their diversity, prevalence and distribution. Data analysis revealed that camels located in Tehsil Choubara were significantly more tick infested than camels from Tehsil Layyah (P = 0.02). It was observed that the older camels were more prone to tick infestation that younger ones. Hyalomma and Rhipicephalus were the two tick genera identified during the present study and tick specimens of Hyalomma genus were the most prevalent (n = 590, 99.5%). In particular, Hyalomma dromedarii was the most prevalent tick species (n = 559, 94.3%), followed by Hyalomma anatolicum (n = 24, 4%), Hyalomma marginatum (n = 7, 1.2%) and Rhipicephalus sanguineus sensu lato (n = 3, 0.5%). The overall abundance of male ticks was higher than the female ticks with a ratio of 1:2.1. Neck was the most preferred site for the tick infestation followed by ventral, sternum, under tail, head, udder and back of analyzed camels. To our knowledge, this is the first report regarding tick diversity on camels from Layyah district and based on our finding, we recommend large-scale tick control strategies to be implemented in this district to uplift the livestock sector.

Flavonoids as Antidiabetic and Anti-Inflammatory Agents: A Review on Structural Activity Relationship-Based Studies and Meta-Analysis.

Flavonoids are a group of naturally occurring polyphenolic secondary metabolites which have been reported to demonstrate a wide range of pharmacological properties, most importantly, antidiabetic and anti-inflammatory effects. The relationship between hyperglycaemia and inflammation and vascular complications in diabetes is now well established. Flavonoids possessing antidiabetic properties may alleviate inflammation by reducing hyperglycaemia through different mechanisms of action. It has been suggested that the flavonoids' biochemical properties are structure-dependent; however, they are yet to be thoroughly grasped. Hence, the main aim of this review is to understand the antidiabetic and anti-inflammatory properties of various structurally diverse flavonoids and to identify key positions responsible for the effects, their correlation, and the effect of different substitutions on both antidiabetic and anti-inflammatory properties. The general requirement of flavonoids for exerting both anti-inflammatory and antidiabetic effects is found to be the presence of a C2-C3 double bond (C-ring) and hydroxyl groups at the C3', C4', C5, and C7 positions of both rings A and B of a flavonoid skeleton. Furthermore, it has been demonstrated that substitution at the C3 position of a C-ring decreases the anti-inflammatory action of flavonoids while enhancing their antidiabetic activity. Correlation is discussed at length to support flavonoids possessing essential pharmacophores to demonstrate equipotent effects. The consideration of these structural features may play an important role in synthesizing better flavonoid-based drugs possessing dual antidiabetic and anti-inflammatory effects. A meta-analysis further established the role of flavonoids as antidiabetic and anti-inflammatory agents.

COVID-19 Testing Crisis Management Through a Public-Private Partnership in Sindh, Pakistan.

As the coronavirus disease (COVID-19) pandemic spread, meeting the testing needs to control the spread of infection became a major challenge worldwide. In Pakistan, the lack of the requisite infrastructure and training compounded the acute shortage of testing kits and other consumables. Against this backdrop and to urgently improve province-wide access to high-quality COVID-19 polymerase chain reaction (PCR) testing with rapid turnaround times, the Government of the Sindh (GoS) province of Pakistan entered into a public-private partnership with Indus Hospital & Health Network (IHHN). Under this partnership, the GoS undertook sample collection and Indus Hospital in Karachi, Sindh, centralized testing. We describe the implementation strategies adopted by the partnership, as well as the challenges, opportunities, and lessons learned. Notably, up to 40% and 22% of total COVID-19 PCRs done in Sindh in the first 2 months of the pandemic, respectively, were performed at Indus Hospital in Karachi, though this percentage declined gradually as other centers caught up with their testing capacities. The rapid scaling up was achieved through a combination of mechanisms and factors including building on preexisting partnerships between the GoS and IHHN, pooling resources and harnessing distinct and complementary roles, relocating existing resources, introducing automation and information technology system changes, establishing risk mitigation strategies, and introducing quality measures within testing processes. The primary outcome of the partnership was rapid province-wide access to quality COVID-19 PCR testing with short turnaround times and at no cost to the patient. Furthermore, implementation of the partnership goals established new mechanisms as well as strengthened existing ones to enable rapid response to the future global health security challenges in Sindh, Pakistan.

Regression analysis of hydro-meteorological variables for climate change prediction: A case study of Chitral Basin, Hindukush region.

In the present study, hydro-meteorological variables of Chitral Basin in Hindukush region of Pakistan were studied to predict the changes in climatic components such as temperature, precipitation, humidity and river flow based on observed data from 1990 to 2019. Uncertainties in climate change projection were studied using various statistical methods, such as trend variability analysis via stationarity test and validation of regression assumptions prior to fitting of regression estimates. Also, multiple regression models were estimated for each hydro-meteorological variables for the given 30 years of observed data. Results demonstrated that temperature and, precipitation were inversely related with one another. It was observed from the regression model that temperature is decreases by 0.309 °C on the average increases in precipitation by one unit. Temperature also decreases for the increase in humidity by average 0.086 °C. Since, precipitation is negatively related with temperature, thus for increases in temperature the annual precipitation decreases by 0.278 mm annually. Humidity on the other hand, increases by 0.207% by increasing in precipitation and the temperature that causes humidity to decrease by 0.99%. Thus, it demonstrated that the flow in Chitral river increases due to precipitation by 0.306 m3/s for the change in precipitation by one unit. Findings from the present study negated the general perceptions that flow in the Chitral river has increased due to recession of glaciers with increase in the intensity of temperature.

Appraisal of groundwater recharge in Neelum watershed (Upper Indus Basin) using geospatial water balance technique.

Water availability is important for survival of millions of people living in the Himalayan region of Upper Indus Basin and adequate monitoring system is for better water resources management. In the present study, groundwater recharge appraisals in the Neelum watershed (Upper Indus Basin) were investigated by using water balance and geospatial modeling techniques on monthly time-scale climate data from 1989 to 2015. Results demonstrated that on an average out of total annual rainfall (i.e., 2028 mm), about 46% of the rainfall convert to surface runoff and 35% loss to atmosphere via evapo-transpiration (ET), while the remaining 18% contribute to infiltrate the groundwater recharge. Groundwater recharge enhanced during snow-melt from December to March and the rainfall infiltration increased during July and August months. Similarly, the infiltration ranges 106-177 mm from January to March and 45-51 mm from December to July. The groundwater discharge in the form of oozing from the spring occurred during the remaining six months, which ultimately contributed to the baseflow of the stream. Findings from the study revealed variations in groundwater recharge during the years and hence recommended more hydrological studies to predict future changes in climate and land use for sustainable development of freshwater resources in the Upper Indus Basin.

Knowledge, awareness and dietary practice on urolithiasis among general population in Kuantan, Pahang, Malaysia: Preliminary findings.

BACKGROUND: To date, no studies have been published at evaluating the level of knowledge, awareness and practice of dietary, particularly regarding to urolithiasis in patients or the general population. This study aims to provide basic information on the level of knowledge, awareness and dietary practice among general population in Kuantan, Pahang. DESIGN AND METHODS: The respondents (n=30) were conveniently recruited within 10 kilometres radius of Kuantan city. The data were obtained using semi-guided administered questionnaires, which consists of four parts: socio-demographic data, lifestyle and clinical history (Part A); attitude and awareness on dietary practice regarding urolithiasis (Part B); food frequency questionnaire on urolithiasis (Part C) and level of knowledge on urolithiasis (Part D). RESULTS: Majority of the respondents were women (70%), Malay (83.3%), mean age of 33.97 (±9.27), married (63.3%), completed higher education level (60%), working with government sector (33.3%) and have fixed monthly income (53.3%). Some of them had hypertension (n=4), diabetes (n=1), gout (n=1) and intestinal problem (n=1). Majority (80%) claimed having no family history of urolithiasis, consumed alcohol (10%), exercise with average frequency 2-3 times/week (46.7%) and heard about urolithiasis from healthcare worker (46.7%). The respondents' awareness about urolithiasis is considered to be good [81.23 (±9.98)] but having poor knowledge score [2.70 (±1.149)]. Majority preferred wholemeal bread, white rice, chicken meat, mackerel fish, chicken egg, apple, carrot, mustard leave and fresh milk in daily intake. Lesser plain water intake than standard requirement was noticed among respondents. Seasoning powder was commonly used for seasoning. CONCLUSIONS: Generally, the general population of Kuantan, Pahang was aware of urolithiasis disease but needed more information on dietary aspect in terms of knowledge and food choice.

Maternal diet and its association with human milk energy and macronutrient composition among exclusively breastfeeding Malaysian Malay mothers

@# Introduction: This study aimed to determine the relationship of maternal dietary intake with human milk nutritional composition, among Malay mothers during the postpartum period of exclusive breastfeeding. Methods: Human milk samples (20- 30ml) were collected from mothers (n=32) at least once monthly for six months postpartum. Macronutrients and fatty acids contents were determined using proximate analysis and gas chromatography methods, respectively. Maternal dietary intakes were recorded using the multiple-pass diet recall method prior to each milk sampling and were analysed using the Nutritionist ProTM software. Associations between the milk composition and maternal diet were tested using Spearman correlation. Results: The energy content ranged between 49.6-59.2 kcal/100ml, protein 1.3-1.4 g/100ml, carbohydrate 6.5-9.7 g/100ml and total fat 6.5-9.7 g/100ml. The polyunsaturated, monounsaturated, and saturated fatty acids concentrations were 10.5-19.1 %, 40.6-43.5 %, and 38.0-49.7 %, respectively. During confinement (first month postpartum), total energy and total fat content of human milk were the highest whereas total carbohydrate was the lowest, compared to the rest of the exclusive breastfeeding period. In contrast, intakes of total calorie and total fat were the lowest, whereas protein was the highest during this period. However, no associations were detected between human milk nutritional contents and maternal dietary intake. Conclusion: In our study population, the composition of maternal diet and nutritional content of human milk differed between confinement and post-confinement periods. However, the association between maternal diet and human milk composition itself warrants further investigation.

Assessment of tap water quality and corrosion scales from the selected distribution systems in northern Pakistan.

Corrosion deposits formed within drinking water distribution systems deteriorate drinking water quality and resultantly cause public health consequences. In the present study, an attempt was made to investigate the concurrent conditions of corrosion scales and the drinking water quality in selected water supply schemes (WSS) in districts Chitral, Peshawar, and Abbottabad, northern Pakistan. Characterization analyses of the corrosion by-products revealed the presence of α-FeOOH, γ-FeOOH, Fe3O4, and SiO2 as major constituents with different proportions. The constituents of all the representative XRD peaks of Peshawar WSS were found insignificant as compared to other WSS, and the reason could be the variation of source water quality. Well-crystallized particles in SEM images indicated the formation of dense oxide layer on corrosion by-products. A wider asymmetric vibration peak of SiO2 appeared only in Chitral and Abbottabad WSS, which demonstrated higher siltation in the water source. One-way ANOVA analysis showed significant variations in pH, turbidity, TDS, K, Mg, PO4, Cl, and SO4 values, which revealed that these parameters differently contributed to the source water quality. Findings from this study suggested the implementation of proper corrosion prevention measures and the establishment of international collaboration for best corrosion practices, expertise, and developing standards.

Liposomal Bupivacaine in Total Knee Arthroplasty for Better Postoperative Analgesic Outcome and Economic Benefits.

When orthopedists consider which analgesia to use after total knee arthroplasty (TKA), the primary objective is to relieve pain with fewer adverse side effects. Over the last decade, substantial efforts have been made to improve pain control following TKA, but it is still very challenging to obtain optimal control. Current modalities in use, such as opioids, epidurals, and nerve blocks, provide substantial pain relief, but they are associated with substantial side effects and serious complications. Recently, bupivacaine, a commonly used nonopioid analgesic, has been formulated into an aqueous suspension of multivesicular liposomes that provide long-lasting analgesia, while avoiding significant adverse effects of opioids. The purpose of this review is to analyze the use of traditional postsurgical pain management and the potential contribution of a long-acting liposomal formulation of bupivacaine as part of the analgesic regimen in TKA, including its mode of action, injection technique, efficacy on pain, and health care costs.

Serum zinc level in patients with pneumonia: a six-month long cross-sectional descriptive study at Liaquat University Hospital Hyderabad, Sindh, Pakistan.

OBJECTIVE: To determine the serum zinc level in patients with pneumonia. METHODS: The descriptive cross-sectional study was conducted at the Liaquat University Hospital, Hyderabad, Pakistan, from September 2008 to February 2009. All patients above 12 years of age and of either gender who had been diagnosed with pneumonia were further evaluated for their serum zinc status.The data was analysed through SPSS 10.00, and p<0.05 was considered statistically significant. RESULT: The mean age of the 118 patients in the study was 25.64 +/- 6.53 years. The mean serum zinc level was 8.279 +/- 2.77 mmol/L, while the mean serum zinc levels in patients having low and normal levels was 6.740 +/- 1.47 mmol/L and 13.243 +/- 1.52 mmol/L respectively (p<0.001). The serum zinc was low in 42 of the 72 (58%) males, and 35 of the 46 (76%) females (p<0.04). There was also significant difference between mean serum zinc level in male and female patients (p<0.03). Out of 77 (65%) hypozincaemic patients, 69 (90%) recovered, while 08 (10%) failed to recover) during their hospital stay (p<0.33). Of the 69 who recovered, 29 (42%) patients did so in less than 2 weeks, while 40 (58%) patients recovered in more than 02 weeks. CONCLUSION: Serum zinc level was found to be low in patients with pneumonia.

Acute appendicitis in the elderly; Pakistan Ordnance Factories Hospital, Wah Cantt. experience.

OBJECTIVE: To review the clinical experience in diagnosis, management and outcome of elderly patients presenting with acute appendicitis at the Pakistan Ordnance Factories Hospital, Wah Cantt. METHODS: All patients of age 60 years and above presenting with abdominal pain were prospectively reviewed. Patients who were diagnosed as acute appendicitis were included in this case series which was conducted at Pakistan Ordnance Factories Hospital, Wah Cantt, from December 2006 to May 2008. Detailed history and clinical examination, co-morbid conditions, clinical manifestations and post-operative outcome were recorded. The diagnosis was made on the basis of history and clinical examination. The diagnosis was also confirmed on histopathology. All the details were recorded on a questionnaire. Approval from our own ethical committee was taken. SPSS 16 was used for statistical analysis. RESULTS: A total of 75 patients presented with acute abdominal pain. Of them 42 were admitted with tenderness in right iliac fossa and lower abdomen. Finally, 36 (48%) were diagnosed as acute appendicitis and were included in the study. There were 20(56%) men and 16(44%) women with age range of 60 to 78 years and a mean age of 65.5 +/- 4.2 years. Associated illness occurred in 25(70%) patients. Symptoms included abdominal pain in 32(90%), nausea in 17(48%), and emesis in 9(25%) patients. Signs included right lower quadrant tenderness in 26(74%) patients, leukocytosis in 17(47.2%), and fever (>99'F) in 11(30.5%). Laparoscopy was used as an important diagnostic as well as therapeutic modality. Of the patients, 9 (25%) had gangrenous appendix, while 12 (33.3%) had perforated appendix. A total of 12 (33.4%) patients developed complications. Hospital stay was considerably increased in patients with a delayed diagnosis (5-7 days), perforations (5-9 days) and postoperative complications (5-15 days). One patient, a known case of ischaemic heart disease, died of cardiopulmonary arrest. CONCLUSION: Acute appendicitis needs to be considered in the differential diagnosis of all patients with abdominal pain. A high index of suspicion is necessary to guard against mis-diagnosis, especially in the elderly. Delays in presentation and diagnosis are associated with higher rates of perforation and, hence, higher morbidity. Repeated clinical examination, a high index of suspicion and urgent investigations are necessary for a correct and rapid diagnosis.

Selective removal of some polyhydric phenols from aqueous solution by ferric antimonate.

Ferric antimonate, a cation-exchanger, has been investigated as an adsorbent for the removal of phenol and polyhydric phenols from aqueous solution. It has been found that ferric antimonate in H+ form selectively adsorbs polyhydric phenols having hydroxyl groups on adjacent positions. While phenol, resorcinol, and quinol did not show any appreciable adsorption, catechol, pyrogallol, and gallic acid having hydroxyl groups on adjacent positions exhibited considerable adsorption on ferric antimonate. Batch equilibrium experiments were carried out to study the effect of contact time, initial concentration of phenolic compounds, and temperature on the adsorption of phenolic compounds on ferric antimonate. The equilibrium time was found to be 1.5 hours for gallic acid and pyrogallol and 2 hours for catechol and salicylic acid. The adsorption data of the phenols at temperatures of 30 degrees, 40 degrees, and 50 degrees C have been described by Langmuir and Freundlich isotherm models. The best fit was obtained with the Langmuir model in the whole range of concentrations studied at all temperatures, indicating a monolayer adsorption onto a homogeneous adsorption surface. On the basis of the Langmuir isotherm, the maximum adsorption capacity of ferric antimonate for gallic acid, pyrogallol, catechol, and salicylic acid was found to be 3.915, 3.734, 2.397, and 2.758 mg/g, respectively at 30 degrees C. The maximum sorption capacity of ferric antimonate for the phenolic compounds studied is in the following order: gallic acid > pyrogallol > salicylic acid > catechol. The adsorption of phenolic compounds was found to decrease with an increase in temperature. Thermodynamic parameters like free energy, enthalpy, and entropy changes were calculated and discussed. The adsorption of polyhydric phenols on ferric antimonate is exothermic and spontaneous in nature.

Outcome of acutely perforated colorectal cancers: experience of a single district general hospital.

INTRODUCTION: Perforation of colorectal cancer (CRC) is rare and is associated with a significantly high mortality and morbidity. The aim of the current study was to evaluate various factors influencing the outcome in these patients. MATERIAL AND METHODS: A retrospective analysis of 42 patients with perforated CRC between 1999 and 2003 was performed. A number of variables including age, sex, site of perforation, presence of faecal peritonitis, grade of surgeon, presence of metastasis, stage of tumour, type of surgery, ASA grade and CR POSSUM score were analysed for their influence on the outcome in these patients using MS Excel, MS Access and Stata. RESULTS: Of the 42 patients 19 were female and 23 were male. The mean age of the patients was 70.5 (range 44-96yr). Thirty patients had perforation at the tumour, 10 proximal to the tumour, and one distal to the primary tumour. The perforation was localised in 25 patients. However, 17 patients had free perforation with frank faecal peritonitis. Twenty-one patients had resection and anastomosis, 18 patients had resection without restoration of bowel continuity and 3 had palliative colostomy. The in-hospital mortality (within 30d) was 40.5% (n=17) with only 15 patients being alive at the end of 2yr with an overall mortality of 64.3% (n=27). The outcome was not altered by variables such as sex, surgeon's grade, surgical procedure, Dukes' staging or the site of perforation (p>0.5). Univariate analysis showed that advanced age (p<0.01), higher ASA grade (p<0.001), higher CR POSSUM score (p<0.001) and degree of peritonitis (p<0.01) were strongly associated with adverse outcomes. However, in stepwise multivariate logistic regression analysis ASA grade (p=0.01) and CR POSSUM score (p=0.01) were the only significant predictors of in-hospital mortality. CONCLUSION: The outcome of perforated colonic cancer continues to be poor. ASA score and CR POSSUM score are good predictors of the short-term outcome.

Injection sclerotherapy versus electrocoagulation in the management outcome of early haemorrhoids.

OBJECTIVE: To study the symptomatology of early hemorrhoids and to compare injection sclerotherapy (IS) with electrocoagulation (EC) in the management outcome of early haemorrhoids with respect to pain during the procedure, reduction in bleeding per rectum, and overall patient satisfaction score. METHODS: A total of 102 patients were included in this experimental study at the POF Hospital, Wah Cantt from October 2004 to June 2005. A detailed history was taken and proctoscopic examination was performed. Patients were then randomly divided into two groups (Lottery method). One group was subjected to EC and the other to IS. In the EC, using the EC machine (Wieda, China), direct current of 10-20 mA was applied in the submucosal plane of each pile core for 5-7 minutes. In the IS 1-2 ml of 5% phenol in almond oil was injected in the same plane in each pile core. Pain during the procedure, reduction in bleeding per rectum and overall patient satisfaction, were studied as outcome measures. RESULTS: The mean age of the patients was 44 years, 86 were males and 16 were females. Two thirds of the patients were having symptoms for more than 6 months. A third of patients had associated local pain while another third had associated mucous discharge. Chronic constipation was present in 81% patients. Only 24.5% of the patients had a positive family history of haemorrhoids. Patients in the electrocoagulation (EC) group experienced more pain during the procedure than the injection sclerotherapy (IS) group (P < 0.000), but EC was significantly more effective than IS in terms of reducing the bleeding per rectum (P = 0.039), and also significantly higher number of patients were fully satisfied with EC than with IS (P < 0.04). CONCLUSION: EC, although more painful, is a safe, more effective and a highly satisfying procedure for treating early hemorrhoids.