Acute Kidney Injury in Subarachnoid Hemorrhage: Exploring its Clinical Significance and Prognostic Implications.

OBJECTIVES: Subarachnoid hemorrhage (SAH) from spontaneous rupture of an aneurysm is a debilitating condition with high morbidity and mortality. Patients with SAH remain understudied, particularly concerning the evaluation of incidence and consequences of subsequent acute kidney injury (AKI). In this study, we aim to explore the risk factors and outcomes of AKI in patients with SAH. MATERIALS AND METHODS: International Classification of Diseases, 9th Edition and 10th Edition (ICD-10-CM) codes were used to query the National Inpatient Sample (NIS) for patients with a diagnosis of SAH between 2010-2019. Subgroup analysis was stratified by AKI diagnosis during the same hospitalization. AKI and non-AKI groups were assessed for baseline clinical characteristics, interventions, complications, and outcomes. Descriptive statistics, multivariate regressions, and propensity score-matching were performed using IBM SPSS 28. NEED TO MENTION NIH-SSS RESULTS: Of 76,553 patients diagnosed with nontraumatic SAH between 2010-2019, 10,634 (13.89%) had a comorbid diagnosis of AKI. Patients with AKI were older (p<0.01) and more often obese (p < 0.01), compared to the non-AKI group. A multivariate regression found the diagnosis of AKI to be independently correlated with poor functional outcome (p<0.001), above average length of stay (p < 0.001), and in-hospital mortality (p < 0.001) when controlling for age, SAH severity, and other comorbidities. CONCLUSIONS: This study showed significant association between AKI and adverse outcomes in SAH patients, and a correlation between AKI and heightened complication rates, poor functional outcome, extended hospital stays, and elevated mortality rates. Early detection of AKI in SAH patients is vital to enhance their chances of recovery.

Epidemiological investigation of norovirus infections in Punjab, Pakistan, through the One Health approach.

Introduction: Norovirus, mainly associated with acute gastroenteritis, is very contagious and can affect a vast range of species ranging from cattle, pigs, dogs, mice, cats, sheep, and lions to humans. It is a foodborne pathogen that mainly transmits through the fecal-oral route. Methods: This is the first-ever study conducted in Lahore and Sheikhupura districts of Punjab, Pakistan, to investigate noroviruses through the One Health approach. From January 2020 to September 2021, 200 fecal samples were collected from clinical cases of hospitalized patients and 200 fecal samples from sick animals at veterinary hospitals and local farms. In addition, 500 food and beverage samples were collected from street vendors and retail stores. A predesigned questionnaire was used to assess the risk factors and clinical characteristics of sick people and animals. Results and discussion: Overall, 14% of the human clinical samples were positive by RT-PCR for genogroup GII. All bovine samples were negative. Food and beverage samples were tested in pools, resulting in sugarcane juice samples positive for genogroup GII. Previous contact with acute gastroenteritis patients, sex, and presence of vomiting were found to be significant risk factors (p ≤ 0.05). The substantial number of diarrhea cases associated with noroviruses calls for additional studies to investigate the epidemiology and transmission and to improve surveillance.

Inflammatory fibroid polyp (Vanek's tumor) causing double compound ileo-ileal intussusception in an adult patient, a case report.

INTRODUCTION AND IMPORTANCE: The majority of the of small bowel intussusception causes are benign, and different types of benign tumors have been reported as the lead points of an intussusception. Among these, some studies have reported inflammatory fibroid polyp as a cause of small bowel intussusception. However, according to our knowledge this is the first case to be reported in Africa of an adult double compound intussusception due to an inflammatory fibroid polyp. CASE REPORT: A 32-year-old female presented with epigastric abdominal pain, nausea, vomiting and diarrhea for 2 weeks. Investigations revealed a small bowel obstruction due to intussusception, and exploratory laparotomy was planned. CLINICAL DISCUSSION: Inflammatory fibroid polyp causing this unique feature of double compound ileo-ileal intussusception should be observed in adult patients who presents with intestinal obstruction. A CT scan is the diagnostic modality of choice, and we think that the disease is the first of its kind to be reported in Africa. CONCLUSIONS: Double ileo-ileal intussusception is a rare cause of intestinal obstruction in adult patients. INTERVENTIONS AND OUTCOME: Laparotomy reviled an ileo-ileal intussusception. After manual reduction of this intussusception, another intussusception was observed and containing a polyp. A clear margin resection and end-to-end primary anastomosis were performed. The histopathological report established the diagnosis of Inflammatory Fibroid Polyp. After the procedure, the patient's condition improved well with no complications. METHODS: This case report has been reported in line with the SCARE Criteria (Agha et al., 2020 [1]).

Effects of safety pattern, cabin ergonomics, and sleep on work-related stress and burnout of city and transit bus drivers in Lahore, Pakistan.

The health and working environment of bus drivers is compromised in low-middle-income countries like Pakistan which leads to burnout and excessive Road Traffic Crashes. Hence, this study delves into factors affecting their safe operations from health and work environment perspectives and measures their associated stress and Burnout level. In a study of four hundred and ninety-nine (499), 86% city and 14% transit bus drivers are surveyed through a questionnaire. Stress is estimated for city and transit bus drivers, using the Effort/Reward Imbalance Model (ERI) of Siegrist, and burnout is calculated using the Copenhagen Burnout Inventory (CBI). For the determination of important determinants, descriptive and regression analyses are conducted. Findings show that stress has emerged as a negative factor for the physical and psychological health of city and transit bus drivers. Results based on bus drivers' responses suggest that organisational awareness and emphasis on health and safety levels can significantly reduce driver stress and burnout. Practitioner Summary: This study explores burnout and work-related stress of bus drivers in Lahore (Pakistan). City and transit bus drivers were interviewed through a questionnaire, containing three sections, using different subjective ratings based upon their past reliability. Results indicate that stress in bus drivers emerged as a physical and psychological health-damaging factor.

Abdominal cocoon syndrome, a case report of a rare disease entity causing intestinal obstruction.

INTRODUCTION AND IMPORTANCE: Abdominal cocoon syndrome is a rare condition characterized by small bowel encapsulation by a fibrous membrane or a cocoon-like sac. It is an uncommon cause of intestinal obstruction. Less than 300 cases have been reported from all over the world. This is the first case of such a disease entity to be reported from Sudan. CASE PRESENTATION: A young female patient, presented with features of intestinal obstruction that was managed conservatively. Failure of the conservative management has warranted a laparotomy. CLINICAL FINDINGS AND INVESTIGATIONS: Her features were suggestive of intestinal obstruction that was confirmed radiologically. INTERVENTIONS AND OUTCOME: Laparotomy revealed a membrane-like fibrous material and extensive multiple loops adhesions, findings consistent with primary sclerosing encapsulating peritonitis (PSEP), also known as abdominal cocoon's disease. The membrane was excised and adhesiolysis was done. Intestinal obstruction was relieved after surgery and the patient showed good outcome. CONCLUSIONS: Abdominal cocoon syndrome is a rare cause of intestinal obstruction. RELEVANCE AND IMPACT: The takeaway lesson from this case would be that the PSEP should be sought in any patient with no clear cause for obstruction can be identified. A contrast-enhanced CT scan is the diagnostic modality of choice. Finally, we think that the disease is underreported from Africa and more efforts should be carried out to increase patients' access to healthcare especially in rural areas with no access to hospitals in order to bring more cases to light. This case report has been reported in line with the SCARE Criteria (Agha et al., 2020 [17]).

Time to Wake-Up: Extending the Window for Management of Unknown-Onset Strokes.

The term "Wake-Up Stroke" is applied to a patient who displays no symptoms before sleep, but wakes with neurologic deficits suggestive of stroke. The current guidelines for acute ischemic stroke limit intravenous tissue plasminogen activator use to stroke patients in whom symptom onset or last known well is less than 4.5 hours. Approximately one-third of acute ischemic stroke patients present with unknown time of symptom onset and are often not eligible for intravenous reperfusion therapy in clinical practice. This review provides an overview of several earlier trials that used advanced neuroimaging to determine eligibility for reperfusion therapy in patients with unknown stroke onset. The reassuring results of these earlier trials that led to recent thrombolysis trials specifically targeted at "wake-up stroke" patients are discussed in this review. Ongoing studies aim to expand our knowledge regarding the safety and efficacy of thrombolysis in these patients.

Management of Small Unruptured Intracranial Aneurysms: To Treat or Not to Treat?

Unruptured intracranial aneurysms measuring <7 mm in diameter have become increasingly prevalent due to advances in diagnostic imaging. The most feared complication is aneurysm rupture leading to a subarachnoid hemorrhage. Based on the current literature, the 3 main treatments for an unruptured intracranial aneurysm are conservative management with follow-up imaging, endovascular coiling, or surgical clipping. However, there remains no consensus on the best treatment approach. The natural history of the aneurysm and risk factors for aneurysm rupture must be considered to individualize treatment. Models including population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from a prior aneurysm, site of aneurysm score, Unruptured Intracranial Aneurysm Treatment Score, and advanced neuroimaging can assist physicians in assessing the risk of aneurysm rupture. Macrophages and other inflammatory modulators have been elucidated as playing a role in intracranial aneurysm progression and eventual rupture. Further studies need to be conducted to explore the effects of therapeutic drugs targeting inflammatory modulators.

Knowledge, attitude and practice (KAP) survey of canine rabies in Khyber Pakhtunkhwa and Punjab Province of Pakistan.

BACKGROUND: This study aimed to assess the extent of knowledge and understanding of rabies disease in rural and urban communities of Pakistan. It also identified malpractices after suspected dog bite that might pose a risk for humans contracting rabies. METHODS: A cross-sectional study was conducted (n = 1466) on people having different age groups and educational levels in four different geographic regions of Punjab and Khyber Pakhtunkhwa provinces in Pakistan. Knowledge, attitude, and practices of people were assessed using a structured questionnaire. We used a bivariate and multivariate analysis to study the association between rabies related mortalities in near or extended family members and different risk behaviors. RESULTS: Our results demonstrate that the majority of the juvenile population (less than 18 years of age) were not aware of the clinical signs of rabies in animals. 75% of the total respondents were not vaccinated against rabies, 60% did not seek a doctor's advice after a suspected animal bite, and 55% had inadequate health care facilities for rabies patients in local hospitals. Respondents that had pets at home had not vaccinated (38%; p < 0.05; odds ratio 1.58) themselves against rabies due to lack of knowledge and awareness of pre-exposure prophylaxis for rabies (51%; p < 0.05; odds ratio 1.25). They also tend to not visit doctor after suspected bite (52%; p < 0.05; odds ratio 1.97), which may had resulted in more deaths (65%; p < 0.05; odds ratio 1.73) of someone in their near or extended family due to rabies. CONCLUSIONS: Lack of knowledge about the nature of rabies disease and prophylaxis has contributed to increase of rabies related deaths. Inadequate health care facilities and poor attitude of not seeking medical attention after suspected dog bite are the major reasons of rabies related deaths. These findings could help in devising a targeted management strategy and awareness program to control and reduce the incidence of human rabies related deaths in Pakistan.

Modeling Impact of Word of Mouth and E-Government on Online Social Presence during COVID-19 Outbreak: A Multi-Mediation Approach.

Although social presence plays an essential role under general conditions, its role becomes significant for societal protection during the quarantine period in epidemic outbreak. In this study, we attempted to identify the role of E-government and COVID-19 word of mouth in terms of their direct impact on online social presence during the outbreak as well as their impacts mediated by epidemic protection and attitudes toward epidemic outbreaks. For this purpose, a unique multi-mediation model is proposed to provide a new direction for research in the field of epidemic outbreaks and their control. Through random sampling, an online survey was conducted and data from 683participants were analyzed. Partial least squares structural equation modeling was used to test the relationships between the variables of interest. The study results revealed that the roles of E-government and COVID-19 word of mouth are positively related to online social presence during the outbreak. Epidemic protection and attitude toward epidemic outbreak were found to positively moderate the impact of the role of E-government and COVID-19 word of mouth on online social presence during the outbreak. The key findings of this study have both practical and academic implications.

Biology-Oriented Synthesis (BIOS) of Piperine Derivatives and their Comparative Analgesic and Antiinflammatory Activities.

BACKGROUND: Serious side effects such as gastric intestinal ulcer, bleeding etc. are associated with most of the antiinflammatory and analgesic drugs. So, there is a need to search novel, potent, and safer antiinflammatory and analgesic drug. METHOD: Based on "biology-oriented synthesis approach", piperine alkaloid was isolated from Piper nigrum L. and some derivatives of piperine having azomethine, sulfamoyl, propanoyl, acetamoyl and heterocyclic oxadiazole were synthesized. The structures of synthetic derivatives were confirmed by using different spectroscopic techniques such as 1H-, 13C-NMR, EI-MS, and IR. Melting points were also determined for all compounds. Piperine and its all the synthetic derivatives were subjected to comparative in vivo evaluation of analgesic and antiinflammatory activities at the oral dose of 6 mg/kg/day. Analgesic activity was evaluated by tail immersion, hot plate and acetic acid writhing methods. While, antiinflammatory activity was evaluated by carrageenan-induced paw inflammation. In silico studies of all synthetic compounds was also conducted on COX-2 and adenosine kinase enzymes. RESULTS: A number of derivatives showed enhanced antiinflammatory and analgesic activities as compared to piperine and standard drug diclofenac. CONCLUSION: The newly identified molecules may serve as lead for the future research in connection of potent and safer antiinflammatory and analgesic drug candidate.

1-Chloro-methyl-4-nitro-benzene.

In the title compound, C(7)H(6)ClNO(2), the nitro group is almost coplanar with the aromatic ring [dihedral angle = 2.9 (2)°], but the Cl atom deviates from the ring plane by 1.129 (1) Å. In the crystal, mol-ecules are linked by weak C-H⋯O inter-actions to generate chains.