Chemically synthesized ciprofloxacin-PEG-FeO nanotherapeutic exhibits strong antibacterial and controlled cytotoxic effects.

Aim: To develop a biocompatible conjugated ciprofloxacin-PEG-FeO nanodelivery system with increased efficacy of available therapeutics in a controlled manner. Materials & methods: FeO nanoparticles were synthesized by chemical and biological methods and modified as ciprofloxacin-PEG-FeO nanoformulations. After initial antibacterial and cytotoxicity studies, the effective and biocompatible nanoformulations was further fabricated as nanotherapeutics for in vivo studies in mouse models. Results: Chemically synthesized ciprofloxacin-PEG-FeO nanoformulations demonstrated boosted antibacterial activity against clinically isolated bacterial strains. Nanoformulations were also found to be compatible with baby hamster kidney 21 cells and red blood cells. In in vivo studies, nanotherapeutic showed wound-healing effects with eradication of Staphylococcus aureus infection. Conclusion: The investigations indicate that the developed nanotherapeutic can eradicate localized infections and enhance wound healing with controlled cytotoxicity.

Complementary Feeding Pattern and Nutritional Status of Children.

OBJECTIVE: To determine the complementary feeding patterns and their association with malnutrition. STUDY DESIGN: Prospective observational study. Place and Duration of the Study: Outpatient clinics of Aga Khan University Hospital, Pakistan, from June to November 2019. METHODOLOGY: A total of 207 children from age six to twenty-four months, who presented in the outdoor clinics of the study place, were enrolled. Data were recorded in a predesigned data sheet adopted from the infant and young child feeding module. Chi-square test was applied post-stratification and a p-value of <0.05 was taken as significant. RESULTS: Among a total of 207 children, 115 (55.6%) were males and 92 (44.4%) were females, with a mean age of 14.15 ± 5.6 months. Complementary feeding was started at an appropriate age in 124 (60%) children. Normal weight was seen in 133 (64.3%) children, while 73 (35.3%) were underweight. Stunting was presented in 44 (21.3%) children, whereas 163 (78.7%) children were of normal length. The most common reason for early initiation of complementary feeding was difficulty in continuing to breastfeed (n=50, 24.2%); the most common reason behind late complementary feeding was bottle feeding (n=45, 21.7%). CONCLUSION: Only sixty percent of mothers living in an urban setting started complementary feeding at an appropriate age. Various myths are counteracting complementary feeding practices. KEY WORDS: Complementary feeding, Infant's nutrition, Stunting, Wasting, Z-score.

Eye Health Service Uptake among People with Visual Impairment and Other Functional Difficulties in Bangladesh: A Cross-Sectional Study with Short-Term Follow Up.

People with visual impairments are disproportionately likely to also have other impairments. However, little is known about whether these other impairments affect access to eye health services. This study among cataract and refractive error patients in four districts in Bangladesh explores the relationship between self-reported difficulties in hearing, mobility, self-care, communication and cognition domains, eye health service uptake, and location of initial eye health assessment. Cataract and refractive errors were diagnosed through ophthalmic clinical assessment, and the Washington Group Short Set (WG-SS) was used to ascertain difficulties in other functional domains. Univariate and multivariate analyses were used to examine the relationship between functional difficulties and uptake of cataract and refractive error services. We found that people with self-reported functional difficulties were less likely to take up refractive error services compared to people with same need but with no functional difficulties, and that they were more than twice as likely to access surgical services after attending an outreach camp compared with a hospital facility. Since a high proportion of people attending eye health assessment services have difficulties in a range of functional domains, strategies to improve the uptake of hospital-based health services are urgently required.

Seroepidemiology and associated risk factors of hepatitis B and C virus infections among pregnant women attending maternity wards at two hospitals in Swabi, Khyber Pakhtunkhwa, Pakistan.

BACKGROUND & AIM: Hepatitis B and C infections are global issues that are associated with a massive financial burden in developing countries where vertical transmission is the major mode and remains high. This cross-sectional study was designed to investigate the seroepidemiology and associated risk factors of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among 375 pregnant women attending antenatal care health facilities at Bacha Khan Medical Complex (BKMC) Shahmansoor and District Head Quarter (DHQ) Hospital Swabi, Khyber Pakhtunkhwa, Pakistan. METHODOLOGY: From a total of 375 pregnant women selected using systematic random sampling from both hospitals, 10 ml of blood samples were collected and alienated serum was examined for indicators identification through the Immuno-Chromatographic Test (ICT) and 3rd Generation Enzyme-Linked Immunosorbent Assay (ELISA). A pre-structured questionnaire was used to collect the socio-demographic data and possible risk factors. The data was analyzed via SPSS 23.0 statistical software. A chi-square analysis was performed to determine the association between variables. P-value < 0.05 was set statistically significant. RESULTS: The overall frequency of HBV and HCV among 375 pregnant women involved in the study was 3.7% and 2.1% respectively. None of the pregnant women were co-infected with HBV and HCV. Dental extraction (P = 0.001) and blood transfusion (P = 0.0005) were significantly allied with HBV infection while surgical procedure (P = 0.0001) was significantly associated with HCV infection. Moreover the sociodemographic characteristics: residential status (P = 0.017) and educational level (P = 0.048) were found significant risk factors of HBsAg and maternal age (P = 0.033) of anti-HCV, respectively. CONCLUSION & RECOMMENDATION: HBV and HCV infections are intermediary endemic in the study area. A higher prevalence of HBV was detected among pregnant mothers with a history of dental extraction, history of blood transfusion, resident to the urban area and low educational level. The age and surgical procedures were the potential risk factors found significantly associated with HCV positivity among pregnant mothers in our setup. Future negotiations to control vertical transmission should include routine antenatal screening for these infections early in pregnancy and the requirement of efficient preventive tools including the birth dose of the hepatitis B vaccine in combination with hepatitis B immune globulins to the neonate.

Environmental impacts, water footprint and cumulative energy demand of match industry in Pakistan.

A comprehensive life cycle assessment (LCA) was conducted for the matchsticks industry in the Khyber Pakhtunkhwa province of Pakistan to quantify environmental footprint, water footprint, cumulative energy use, and to identify improvement opportunities in the matchsticks manufacturing process. One carton of matchsticks was used as reference unit for this study. Foreground data was collected from the matchsticks industry through questionnaire surveys, personal meetings, and field measurements. The collected data was transformed into potential environmental impacts through the Centre for Environment Studies (CML) 2000 v.2.05 method present by default in the SimaPro v.9.1 software. Water footprint was calculated using methodology developed by Hoekstra et al., 2012 (water scarcity index) V1.02 and cumulative energy demand by SimaPro v.9.1 software. The results showed that transport of primary material (wood logs), sawn wood for matchsticks, red phosphorous, acrylic varnish, and kerosene fuel oil contributed to the overall environmental impacts. Transport of primary materials and sawn timber for matchsticks contributed significantly to abiotic depletion, global warming, eutrophication potential, ozone depletion, corrosion, human toxicity, and aquatic ecotoxicity effects. The total water footprint for manufacturing one carton of matchsticks was 0.265332 m3, whereas the total cumulative energy demand was 715.860 Mega Joules (MJ), mainly sourced from non-renewable fossil fuels (708.979 MJ). Scenario analysis was also conducted for 20% and 30% reduction in the primary material distance covered by trucks and revealed that reducing direct material transport distances could diminish environmental impacts and energy consumption. Therefore, environmental footprint could be minimized through diverting matchsticks industries freight from indigenous routes to high mobility highways and by promoting industrial forestry close to industrial zones in Pakistan. Many industries did not have emissions control systems, exceeding the permissible limit for emissions established by the National Environmental Quality Standards (NEQS) of Pakistan. Thus, installation of emissions control system could also diminish emissions from match industry in Pakistan.

Bursting the Virulence Traits of MDR Strain of Candida albicans Using Sodium Alginate-based Microspheres Containing Nystatin-loaded MgO/CuO Nanocomposites.

INTRODUCTION: Candida albicans is a major opportunistic pathogen that causes a wide range of human infections. Currently available therapeutic agents are limited for treating these fungal infections due to multidrug resistance as well as their nonbiodegradability, poor biocompatibility and toxicity. In order to battle these limitations, we have synthesized a polymeric system as microcarriers to deliver the antifungal drug. The objective of the present study was to immobilize MgO/CuO nanocomposite and nystatin-loaded MgO/CuO nanocomposites in nontoxic, nonimmunogenic, biodegradable and biocompatible sodium alginate microspheres for the first time. MATERIALS AND METHODS: Nanoparticle-loaded sodium alginate microspheres were prepared by ionotropic gelation technique using calcium chloride as a cross-linker. Synthesized microspheres were characterized using standard characterization techniques and were evaluated for biological activity against MDR strain of C. albicans. RESULTS: Characterization of microspheres by Fourier-transform infrared spectroscopy confirmed loading of Nys-MgO/CuO NPs, scanning electron microscopy (SEM) revealed rough spherical beads with a highly porous surface having an average size in the range of 8-10 µm. X-ray diffraction (XRD) analyzed its semicrystalline structure. Entrapment efficiency of Nys-MgO/CuO NPs was 80% and release kinetic study revealed sustained and prolonged release of drug in pH 5.5. Flow cytometry analysis showed yeast cell death caused by Nys-MgO/CuO MS exhibits late apoptotic features. In cytotoxicity assay 5-14 mg of microspheres did not cause hemolysis. Microspheres reduced virulence traits of C. albicans such as germ tube and biofilm formation were compromised at concentration of 5 mg/mL. Antimicrobial assessment results revealed a pronounced inhibitory effect against C. albicans. CONCLUSION: The in vitro experiments have shown promising results based on good stability, Nys-MgO/CuO NP-encapsulated microspheres can be used as a prolonged controlled release system against MDR pathogenic C. albicans.

Pneumothorax in Mechanically Ventilated Patients with COVID-19 Infection.

Data on patient-related factors associated with pneumothorax among critically ill patients with COVID-19 pneumonia is limited. Reports of spontaneous pneumothorax in patients with coronavirus disease 2019 (COVID-19) suggest that the COVID-19 infection could itself cause pneumothorax in addition to the ventilator-induced trauma among mechanically ventilated patients. Here, we report a case series of five mechanically ventilated patients with COVID-19 infection who developed pneumothorax. Consecutive cases of intubated patients in the intensive care unit with the diagnosis of COVID-19 pneumonia and pneumothorax were included. Data on their demographics, preexisting risk factors, laboratory workup, imaging findings, treatment, and survival were collected retrospectively between March and July 2020. Four out of five patients (4/5; 80%) had a bilateral pneumothorax, while one had a unilateral pneumothorax. Of the four patients with bilateral pneumothorax, three (3/4; 75%) had secondary bacterial pneumonia, two had pneumomediastinum and massive subcutaneous emphysema, and one of these two had an additional pneumoperitoneum. A surgical chest tube or pigtail catheter was placed for the management of pneumothorax. Three out of five patients with pneumothorax died (3/5; 60%), and all of them had bilateral involvement. The data from these cases suggest that pneumothorax is a potentially fatal complication of COVID-19 infection. Large prospective studies are needed to study the incidence of pneumothorax and its sequelae in patients with COVID-19 infection.

Feeding habits and habitat use of barking deer (Muntiacus vaginalis) in Himalayan foothills, Pakistan.

Northern red muntjac (Muntiacus vaginalis; "barking deer") is a shy and small-sized cervid mammal, limited to the outer Himalayan foothill forests in Pakistan. Habitat characteristics were measured by locating direct and indirect signs. To quantify habitat utilization of barking deer, 80 field surveys were conducted in the study area along transects. 1200 Quadrats at 50 m intervals were deployed along these transect lines to determine microhabitat factors associated with seasonal distribution. The food composition of the barking deer was determined through fecal droppings analysis by micro-histological technique. Forty-five fecal samples of barking deer were collected from the study area (Murree-Kotli Sattian-Kahuta National Pak); summer (28) and winter (17). The micro-histological analysis revealed that more plant species are available in its habitat during the summer season (27) as compared to winter (19). Due to browsing nature barking deer mostly feed on trees in both seasons. While shrubs are slightly higher in winters. In summer barking deer consumed 10 Trees, 6 Shrubs, 5 Herbs, and 6 kinds of grass species. Dominant tree species were Phyllanthus emblica and Acacia modesta. Dominant shrub species were Ziziphus nummularia and Justicia adhatoda. In winter barking deer consumed 8 Trees, 7 Shrubs, 3 Herbs, and 1 Grass. Dominant tree species were Bauhinia variegata and Acacia modesta while shrubs included Ziziphus nummularia and Carissa opaca.

Comparison of the reverse bevel versus Franseen type endoscopic ultrasound needle.

BACKGROUND: Reverse bevel (RB) needle is widely used for endoscopic ultrasound fine needle biopsy (EUS-FNB). A 3-plane symmetrical needle with Franseen geometry (FG) has recently become available. AIM: To compare the clinical efficacy of FG to that of RB needle. METHODS: A retrospective cohort study of all adult patients who underwent EUS-FNB for solid and mixed lesions either with 22G RB needle or 22G FG needle between January 2016 and February 2019 was undertaken. All cytology slides were reviewed by an independent gastrointestinal cytopathologist blinded to the needle used and the initial cytology report. The primary and secondary outcomes were to assess the sample adequacy using Euro-cytology criteria and the number of cell clusters, respectively. RESULTS: Two hundred and twenty six procedures were included in the study. RB needle was used in 128 procedures and FG needle in 98 procedures. The baseline characteristics of both groups were comparable. On multivariable analysis, FG needle (P = 0.02) and location of the lesion (P < 0.01) were independently associated with adequate tissue. Further, the use of FG needle (P = 0.04) and the size of the lesion (P = 0.02) were independently associated with acquisition of increased number of cell clusters. CONCLUSION: FG needle is superior to RB needle in acquiring adequate tissue and attaining higher number of cell clusters for solid and mixed lesions.

The Hidden Variable: A Case of Dasatinib-Induced Respiratory Failure.

Tyrosine kinase inhibitors that target the BCR/ABL mutation have been used as therapies of BCR/ABL positive acute lymphoblastic leukemia (ALL) with significant results. Dasatinib is a multitargeted tyrosine kinase inhibitor with significant activity in Philadephia positive ALL which is resistant to imatinib, as well as in treatment-naïve patients. We present a case of an elderly patient with Philadelphia chromosome-positive ALL, who presented with acute hypoxic respiratory failure in the setting of active immunotherapy with dasatinib.

Isolation and Molecular Characterization of a Model Antagonistic Pseudomonas aeruginosa Divulging In Vitro Plant Growth Promoting Characteristics.

The use of microbial technologies in agriculture is currently expanding quite rapidly with the identification of new bacterial strains, which are more effective in promoting plant growth. In the present study 18 strains of Pseudomonas were isolated from soil sample of Balochistan coastline. Among isolated Pseudomonas strains four designated as SP19, SP22, PS24, and SP25 exhibited biocontrol activities against phytopathogenic fungi, that is, Rhizopus microsporus, Fusarium oxysporum, Aspergillus niger, Alternaria alternata, and Penicillium digitatum; PS24 identified as Pseudomonas aeruginosa by 16srRNA gene bank accession number EU081518 was selected on the basis of its antifungal activity to explore its potential as plant growth promotion. PS24 showed multiple plant growth promoting attributes such as phosphate solubilization activity, indole acetic acid (IAA), siderophore, and HCN production. In order to determine the basis for antifungal properties, antibiotics were extracted from King B broth of PS24 and analyzed by TLC. Pyrrolnitrin antibiotic was detected in the culture of strain PS24. PS24 exhibited antifungal activities found to be positive for hydrogen cyanide synthase Hcn BC gene. Sequencing of gene of Hcn BC gene of strain PS24 revealed 99% homology with the Pseudomonas aeruginosa strain PA01. The sequence of PS24 had been submitted in gene bank accession number KR605499. Ps. aeruginosa PS24 with its multifunctional biocontrol possessions can be used to bioprotect the crop plants from phytopathogens.

Cervical cancer in Pakistan: A review.

Cervix carcinoma is the second commonest condition in women under 50 years of age and third after breast and oral cavity cancers across all age groups. Though a preventable disease, the mortality rate is very high because it is an ignored ailment in Pakistan in terms of screening, prevention and vaccination. More than 70% of cancer patients report with very advanced stage of malignancy and this is the cause of the high rate of mortality in Pakistan. We covered studies cited during the previous 11 years (2005-2015) that reviewed many aspects of cervical cancer in Pakistan, including epidemiology, risk factors, screening test and their barriers, clinical presentation and prevention. Our analysis indicated that infections associated with human papillomavirus posed the greatest risk of carcinoma and consequent mortality rate, especially because of low socioeconomic status and poor knowledge of screening. Emphasis is laid on a need to organise proper screening programme taking into account what already is known about Pakistani women.

RAM1 and RAM2 function and expression during arbuscular mycorrhizal symbiosis and Aphanomyces euteiches colonization.

The establishment of the symbiotic interaction between plants and arbuscular mycorrhizal (AM) fungi requires a very tight molecular dialogue. Most of the known plant genes necessary for this process are also required for nodulation in legume plants and only very recently genes specifically required for AM symbiosis have been described. Among them we identified RAM (Reduced Arbuscular Mycorrhization)1 and RAM2, a GRAS transcription factor and a GPAT respectively, which are critical for the induction of hyphopodia formation in AM fungi. RAM2 function is also required for appressoria formation by the pathogen Phytophtora palmivora. Here we investigated the activity of RAM1 and RAM2 promoters during mycorrhization and the role of RAM1 and RAM2 during infection by the root pathogen Aphanomyces euteiches. pRAM1 is activated without cell type specificity before hyphopodia formation, while pRAM2 is specifically active in arbusculated cells providing evidence for a potential function of cutin momomers in the regulation of arbuscule formation. Furthermore, consistent with what we observed with Phytophtora, RAM2 but not RAM 1 is required during Aphanomyces euteiches infection.

Outcome of pure mucocele-like lesions diagnosed on breast core biopsy.

AIM: Current guidelines recommend that mucocele-like lesions (MLL) of the breast diagnosed on needle core biopsy (NCB) should be categorized as a lesion of uncertain malignant potential (B3). However, data on the outcome of MLL diagnosed on NCB remains limited due to the rarity of this lesion. The aim of this study was to assess the outcome of pure MLL without atypia diagnosed on NCB using a large series of cases and a review of the literature to provide evidence that can guide management. METHODS AND RESULTS: Patients who underwent diagnostic excision biopsy after a core biopsy diagnosis of MLL without atypia were identified from several centres. Two of 54 patients (4%) with MLL without atypia on core biopsy had ductal carcinoma in situ in the subsequent excision specimen. This is similar to the rate in previous studies of 4% (four of 106). If there is atypia in the core biopsy, previous studies found that the frequency of malignancy is much higher at 21% (seven of 33). CONCLUSIONS: Our results provide evidence that pure MLL without atypia diagnosed on NCB is usually associated with a benign outcome.

Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis.

UNLABELLED: Papillary carcinoma (PC) of the breast, which accounts for 0.5% to 1% of breast cancer, is a distinct histologic subtype that is characterized by malignant epithelial proliferation supported by fibrovascular stalks. However, the classification of PC (whether they are in situ or invasive), its behavior, and management remain a matter of debate. METHODS: In this study, we reviewed 302 PCs including 247 pure PCs without coexisting conventional non-PCs collected from 3 institutions. This included 208 (84%) intracystic PCs (IPC), 30 (12%) solid PCs (SPC), and 9 (4%) papillary ductal carcinoma in situ (DCISs). In addition, previous studies of PC were reviewed. This included 339 pure PCs of a total of 521 PC patients. Clinical and outcome analyses were carried out to assess nature and behavior of these lesions and to determine their optimal outcome-based management. RESULTS AND CONCLUSIONS: SPC is more frequently associated with coexisting conventional invasive carcinoma than IPC (P<0.05). Although the majority of papillary DCIS and some cases of IPC and SPC (both called encapsulated PC) that are surrounded by an intact layer of myoepithelial cells are considered to be true in situ lesions, PC lacking a peripheral layer of myoepithelial cells can be regarded as a special type of invasive carcinoma associated with low incidence of stromal/skeletal muscle invasion, low frequency of lymph node metastasis (3%), and infrequent development of local or distant recurrence. These lesions are therefore characterized by indolent behavior and extremely favorable prognosis. Encapsulated PC can be treated with adequate local therapy. Routine use of adjuvant therapy, particularly chemotherapy, is clearly not appropriate in view of the very low risk of subsequent events. However, hormonal therapy may be indicated in certain cases such as recurrent PC.

Fine needle aspiration cytology of pseudopapillary tumour of pancreas.

The solid-cystic pseudopapillary neoplasm is a rare pancreatic tumor having indolent course and amenable to complete excision. This is a report of two cases of this tumour, diagnosed on fine needle aspiration cytology. One of the cases had complete surgical excision of the mass and subsequent histological evaluation. This benign and rare neoplasm of pancreas often causes few symptoms. The characteristic cytomorphological features point towards the diagnosis.