Hydrochar as a bio-based adsorbent for heavy metals removal: A review of production processes, adsorption mechanisms, kinetic models, regeneration and reusability.

The spread of heavy metals throughout the ecosystem has extremely endangered human health, animals, plants, and natural resources. Hydrochar has emerged as a promising adsorbent for removal of heavy metals from water and wastewater. Hydrochar, obtained from hydrothermal carbonization of biomass, owns unique physical and chemical properties that are highly potent in capturing heavy metals via surface complexation, electrostatic interactions, and ion exchange mechanisms. This review focuses on removing heavy metals by hydrochar adsorbents from water bodies. The article discusses factors affecting the adsorption capacity of hydrochars, such as contact time, pH, initial metal concentration, temperature, and competing ions. Literature on optimization approaches such as surface modification, composite development, and hybrid systems are reviewed to enlighten mechanisms undertaking the efficiency of hydrochars in heavy metals removal from wastewater. The review also addresses challenges such as hydrochar regeneration and reusability, alongside potential issues related to its disposal and metal leaching. Integration with current water purification methods and the significance of ongoing research and initiatives promoting hydrochar-based technologies were also outlined. The article concludes that combining hydrochar with modern technologies such as nanotechnology and advanced oxidation techniques holds promise for improving heavy metal remediation. Overall, this comprehensive analysis provides valuable insights to guide future studies and foster the development of effective, affordable, and environmentally friendly heavy metal removal technologies to ensure the attainment of safer drinking water for communities worldwide.

Disseminated hydatid cyst disease; a rare presentation in a tertiary care hospital of Azad Jammu Kashmir.

Cystic Echinococcosis (CE) is one of the many neglected animal-based diseases also called zoonotic, it has been highlighted by the World Health Organization. It is a human and animal health issue in numerous endemic regions around the globe. CE is caused by the tapeworm Echinococcus granulosus. We will discuss a case of a 36 years old female from a rural area who presented to the emergency department with abdominal distension, fever, and shortness of breath. History revealed that she reared sheep in her village so ELISA for anti-Echinococcus antibodies shows positive titers, and CT scan revealed type IIA and III hydatid cysts in the lungs, chest, liver, spleen, abdomen, and pelvis. An extensive exploratory laparotomy was performed and an effort was made to remove all cysts from the liver, pelvis, spleen, and abdomen. The patient remained in a vegetative state post-operatively on ventilator support. She passed away five days post-surgery. As per author's knowledge, there has not been a similar case reported as yet.

Transcatheter Artery Embolization for Postoperative Haemorrhage after Arterio-Venous Malformation - Safer Option.

SUMMARY INTRODUCTION: Hemorrhage is one of the commonest and dreaded complications especially with pelvic surgeries. Gestational trophoblastic neoplasias (GTN) are notorious for their propensity to bleed torrentially and metastasis to vital organs. GTN is associated with an arterio-venous malformation (AVM) about 10-15% of the time, which can lead to bleeding after surgery or after complete remission. After the failure of conventional management with chemotherapy or surgery one is compelled to take another modality of management. One of such methods is the use of transcatheter artery embolization in cases of GTN or post-hysterectomy cases of GTN. Transcatheter arteryembolization (TAE) was effective in controlling bleeding due to arterio-venous malformation in 96% of cases. CASE: 46 years P2L2A5 (para 2, living issue 2, abortion 5) post-hysterectomy patient presented with bleeding from the vagina after surgery. Twice she underwent vaginal vault repair after hysterectomy but failed. Ultrasonography (USG) showed arterio-venous malformation (AVM); angiography revealed massive extravasation from (left internal iliac artery and abnormal vascularity from the right internal iliac. She was taken up for bilateral internal iliac arteries embolization but again had a heavy bout of bleeding after one week. CT scan confirmed a residual lesion and she underwent a repeat embolization after which the bleeding stopped. Serum BHCG was advised during workup and it was 1997 IU/ml. A diagnosis of GTN was confirmed. The patient was discharged after two cycles of chemotherapy with advice to review for the third one on an outpatient department basis. CONCLUSION: We concluded that TAE is an effective and safer alternative to surgery in postoperative bleeding from AV malformation in the case of GTN. It can be repeated and should be made to more liberal use in emergency settings.

Evaluating motor performance with the Bruininks-Oseretsky Test of motor proficiency in impoverished Pakistani children.

OBJECTIVE: To evaluate the sensitivity of the modified Brief Form of Bruininks Oseretsky Test in identifying motor differences secondary to malnutrition and poverty. METHODS: This longitudinal cohort study was conducted at Nowshero Feroze, Sindh from 2013 to 2014 and comprised data drawn from children who participated in a randomised controlled trial, that assessed responsive stimulation and nutrition interventions in the first two years of life. Outcome measures included motor development assessed using Brief Form of Bruininks Oseretsky Test, child anthropometry and household economic and demographic information. Data was analysed using SPSS 15 and STATA 12. RESULTS: Of the 1058 children, 570(53%) were boys. Moderate-severe stunting was reported in 171(16.12%) subjects, while moderate-severe underweight was reported in 117(11.1%). Also, 591(56%) subjects belonged to poor families, 343(32%) had illiterate mothers, and 392(37%) were food-insecure. Malnutrition, socio-economic status and maternal literacy were significantly associated with a 6-item motor composite of the Brief Form of Bruininks Oseretsky Test (p<0.05). CONCLUSIONS: The 6-item motor composite of the Brief Form of Bruininks Oseretsky Test was found to be a reliable tool to measure motor performance in Pakistani pre-school children.

Intravenous Mesenchymal Stem Cells in Extracorporeal Oxygenation Patients with Severe COVID-19 Acute Respiratory Distress Syndrome

BackgroundThere is an ongoing critical need to improve therapeutic strategies for COVID-19 pneumonia, particularly in the most severely affected patients. Adult mesenchymal stem cell (MSC) infusions have the potential to benefit critically ill patients with acute respiratory syndrome SARS-COV-2 infection, but clinical data supporting efficacy are lacking. MethodsWe conducted a case-control study of critically ill patients with laboratory-confirmed COVID-19, severe acute respiratory distress syndrome (ARDS). To evaluate clinical responsiveness in the most critically ill patient we examined outcomes in a sub-group of those requiring extracorporeal membrane oxygenation (ECMO) support. Patients (n=9) were administered with up to 3 infusions of intravenous (IV) MSCs and compared to a local ECMO control group (n=31). The primary outcome was safety, and the secondary outcomes were all-cause mortality (or rate of hospital discharge), cytokine levels, and viral clearance. FindingsMSC infusions (12 patients) were well tolerated and no side effects occurred. Of ECMO patients receiving MSC infusions, 2 out of 9 died (22.2%; 95%CI: 2.8%, 60.0%) compared with a mortality of 15 of 31 (48.4%; 95%CI: 30.2%, 66.9%; p = 0.25) in the ECMO control group. Isolated plasma exosomes containing the SARS-COV-2 Spike protein decreased after MSC infusions between day 14 or 21 after administration (p=0.003 and p=0.005, respectively) and was associated with a decrease in COVID-19 IgG Spike protein titer at same time points (p = 0.006 and p=0.007, respectively). Control ECMO patients receiving convalescent plasma did not clear COVID-19 IgG over the same time frame. InterpretationTogether these findings suggest that MSC IV infusion is well tolerated in patients with a broad range of severity including the most severe COVID-19 ARDS requiring ECMO. These data also raise the possibility that MSCs, in addition to exerting an immunomodulatory effect, contribute to viral clearance and strongly support the conduct of randomized placebo-controlled trial.

An overview of dengue fever in Pakistan

Dengue is a viral disease caused by bite of infected mosquitoes. The symptoms of this disease are headaches, pain behind eyes, nausea, flu, muscle pains, rash and swollen glands, etc. It can also develop into lethal disease known as severe dengue. The initial report of dengue fever in Pakistan was in 1994. It was seen sudden rise in cases of dengue fever. Dengue fever cases were recorded from published data from 2013 to August 2018 in different geographic regions of Pakistan. A total of 64 047 cases of dengue fever have been reported from all over Pakistan from period 2013 to August 2018. The prevalence of disease was varied in different areas of Pakistan: Fata is 1%, Islamabad 5%, AJK 0%, Punjab 19%, Sindh 22%, KPK 53% and Baluchistan 0%. Mosquito breeding sites and living in tropical areas or traveling within these areas may cause risk factor of this disease. The first dengue vaccine, Dengvaxia was recorded in several countries from 2015 to 2016. This was used for humans living in endemic areas. The WHO mentioned that countries should consider introducing of the dengue vaccine Dengvaxia only in areas where epidemiological data specify a high rate of disease.

An overview of chikungunya in Pakistan

Chikungunya is a viral disease which can infect human by bite of infected mosquitoes. This disease was initially reported in Tanzania. The symptoms of chikungunya are joint pain and fever. In Pakistan, cases were reported from different areas especially from Karachi. Many other cases of chikungunya were reported from Rawalpindi and Islamabad. Chikungunya cases were recorded from published data from Dec 2016 to September 2018 in different geographic regions of Pakistan. Chikungunya cases are being reported from many areas of Pakistan, but it is most common in Sindh. A total of 766 cases of chikungunya have been reported from all over Pakistan from Dec 2016 to September 2018. The prevalence of disease varied in different areas of Pakistan: FATA is 0%, Islamabad 4%, GB 0%, AJK 0%, Punjab 8%, Sindh 62%, KPK 22% and Baluchistan 4%. Mosquito breeding sites to human tenancy cause significant risk factor for dengue fever and chikungunya. There is no comprehensive treatment available of chikungunya in Pakistan. Generally speaking, antiviral drugs are administered during viral attack, but there is no antiviral drug for this dangerous disease. The WHO responds to chikungunya by providing guidance, technical support to many underdeveloped countries so they can effectively manage cases of chikungunya.

Emerging trend of leishmaniosis in Pakistan: Current status and future prospects

Leishmaniosis is a disease caused by a Leishmania protozoan parasite, which is transmitted by the bite of an infected sand fly. Leishmaniasis is among the most dangerous and neglected tropical diseases. In Pakistan, limited research work has been done yet on this neglected disease. Overall cases of leishmaniasis were retrieved from Khyber Pakhtunkhwa (KPK) and Baluchistan provinces from 2018 to 2019. The major risk factors responsible for these outbreaks were also determined. Recent outbreak resulted in more than 28 000 cases of leishmaniasis in KPK from November 2018 to April 2019. Many of the cases were children and approximately 7 810 diagnosed patients did not receive treatment with meglumine antimoniate. Leishmaniasis cases were also identified in the tribal areas of Khyber (n=9 378), Mohmand (n=5 373), Kurram (n=525), Orakzai (n=163), and Karak (n=554). In Balochistan, around (n=5 000) cases of leishmaniasis were reported in 2018 from the District of Killa Abdulla. The poor infrastructure and sanitary conditions increase the breeding and resting sites of sandflies. The local population's poor socio-economic conditions increase access to sandflies and the risk of acquiring leishmaniasis. In Pakistan, leishmaniasis is currently neglected by the health authorities, largely due to a lack of data on the number of cases and the monetary and non-monetary impacts that these cases are having on the country. There is a dire need for outreach activities to provide information to communities about the disease and preventive measures. This is a call to the national and international research communities, and to the WHO, to take notice of the threat of leishmaniasis in Pakistan and to help devise a strategy to address this neglected yet important public health problem.

An update on HIV in transgenders of Pakistan

Objective: HIV is a worldwide contagious disease and recent emergence in transgenders reflecting the alarming situation in Pakistan. Transgender people are one of the most affected groups by the HIV epidemic and are 49 times more likely to be living with HIV than the general population. HIV is an emerging disease in Pakistan. Transgender people in Pakistan often face legal, economic, social and religious exclusion. Even though research on HIV/AIDS has conducted since several years ago, still we have a little knowledge about HIV in transgender people. This study aims to investigate the current status of HIV infection among Pakistan transgender population. Methods: Overall cases of HIV in 2017 were retrieved from all four provinces of Pakistan by using all available published data. Results: In 2017, totally 66 264 positive HIV cases were reported in transgenders from Punjab (n=52 656), Sindh (n=13 596) and KPK (n=22) provinces of Pakistan. In Sindh province majority of the patients were from Karachi (n=9 123) followed by Hyderabad (n=1 062), Sukkur (n=1 609), Larkana (n=1 130), Mirpurkhas (n=289) and Nawabshah (n=383), respectively while in Khyber Pakhtunkhwa (KPK), the number of HIV/AIDS transgender patients increased up to 450, out of which 22 cases were registered under provincial AIDS control program in 2017. Conclusions: More efforts by international agencies are needed to combat HIV among transgender communities in Pakistan. Government and NGOs should collaborate to find some strategies for control and prevention of HIV. Social and human rights activists should help and encourage them mainly at the point where their legal rights are not respected. Transgender communities and health department should go hand in hand. Initiatives should be taken to link social justice, human rights, health and advocacy to prevent HIV among transgender in near future.

Molecular epidemiology of Echinococcus species in Pakistan

Objective:Cystic echinococcosis (CE) is a zoonotic parasitic disease and a neglected infectious disease affecting more than one million people globally. It is caused by the tapeworm parasite of Echinococcus granulosus sensu lato. It is endemic in the neighbours of Pakistan. However, there are limited studies on molecular epidemiology of CE in Pakistan.Methods:Discrimination of Echinococcus species has been done mostly by morphologically and less work has been done by molecular methods in Pakistan. There are limited studies have been conducted to explore the molecular epidemiology of Echinococcus species in human and livestock. In human just retrospective studies have been conducted and there is a serious lack of studies on molecular basis.Results:So far in Pakistan just four studies have been published on genotyping of Echinococcus spp. common sheep strain (G1) and buffalo strain (G3) in livestock (small and large ruminants) and Echinococcus granulosus sensu stricto (G1-G3) in buffaloes, while Echinococcus granulosus sensu stricto (G1-G3), Echinococcus multilocularis, Echinococcus canadensis (G6/7) in human have been reported. Based on these four studies clearly shows that CE is yet neglected in Pakistan. These findings indicate that due to the higher population of sheep and buffaloes, G1 and G3 strains are highly prevalent in human and animals. Association of stray dogs with sheep herds and other livestock at the grazing sites is responsible for the higher prevalence of CE that acts an active role in the transmission of CE while the wild animals and camel are responsible for the less infection.Conclusion:There is dire need of more studies on molecular identification of CE to understand its species diversity and molecular epidemiology in Pakistan. It is an important step toward management of echinococcosis based on One Health Concept.

Prevalence of hydatidosis in livestocks in Chakwal District of Pakistan

Background:Hydatidosis is a zoonotic parasitic disease and a serious human and animal health problem in many endemic areas of the world. It is caused by the tapeworm parasite of Echinococcus granulosus sensu lato. This parasite is endemic in the neighboring countries like China, Iran and India. There are limited studies on CE in Pakistan.Methods:This study primarily aimed to determine the prevalence of hydatidosis in slaughtered livestocks in Chakwal district (Chakwal, Bhaun, Kallar kahar, Choa saidan shah and Balkasar) from June to December 2015. The livestocks were inspected after slaughtering and the ages, breeds and organ wise prevalence were recorded.Results:A total of 6 095 animals (sheep, goat, buffaloes and cattle) of different genders, ages and breeds were inspected after slaughtering. Overall prevalence was 8.55% (88/1 045) in sheep followed by 8.42% (88/1 045), 6.90% (4/58), 2.99% (138/4 608) in cattle, buffaloes and goats, respectively. Liver wise prevalence was 7.75%, 6.90%, 0.06%, 1.30% in cattle, buffaloes, goats and sheep, respectively while lung wise prevalence was 7.55%, 0.67%, 0.00%, 0.00%, in sheep, cattle, buffaloes and goats, respectively. Male (9.50%) were more infected than female (1.96%) in all hosts. Breed wise prevalence was higher in desi breed of cattle followed by crossbreed and other breeds. In goats, teddhi breed was more infected then beetal while in sheep Afghani breed was more infected than the others. Cattle of 6-9 years groups were more infected than 0-3 and 3-6 years age groups. Buffaloes of the only age group of 6-9 years were infected while in goat and sheep 3-6 years were more infected than 0-3 years. According to the statistical analysis there was a significant difference (P<0.05) in prevalence of hydatidosis when ages, genders and organs were compared.Conclusion:The hydatidosis is a serious parasitic problem in the study area for livestocks. The disease should be monitored on regular basis in other areas of Pakistan and future studies should be carried out to explore the real prevalence in Pakistan.

A Retrospective Analysis on the Cystic Echinococcosis Cases Occured in Northeastern Punjab Province, Pakistan

A retrospective study was performed to report the case occurrence of cystic echinococcosis (CE) in three hospitals of north-eastern region in Punjab Province, Pakistan. We reviewed retrospectively the clinical records of patients in 4 hospitals which were diagnosed with CE during 2012–2017. A total of 198 cases, 82 (41.4%) male and 116 (58.6%) females were detected as CE. The most Highest incidence was revealed in.... 21–30 years-old group (24.2%) followed by 41–50 (22.7%), 31–40 (16.2%), 11–20 (13.6%), 51–60 (8.1%), below 10 (5.5%), over 71 (5.1%) and 61–70 year-old group (4.5%). CE was detected in various organs of infected individuals. However, most of CE cases were detected in the liver (47.4%) and lung (18.6%). The present study indicated that CE is more or less prevalent in surveyed areas and one of the most important public health problems in Punjab Province, Pakistan.