Factors Responsible for Worse Outcomes in STEMI Patients With Early vs Delayed Treatment Presenting in a Tertiary Care Center in a Third World Country.

The aim of the study is to compare the outcomes among ST-segment elevation myocardial infarction (STEMI) cases with early treatment vs delayed treatment. It was a prospective comparative study on 186 patients with consecutive (nonprobability) sampling. Two groups of cases were made as per their time to get admitted to the hospital (ie, within 2 hours of symptom onset = Group A; after 2 hours of symptom onset = Group B). Patients were asked for factors causing a delay in treatment after the onset of symptoms and were monitored for STEMI outcomes. The mean age of all patients was 46.62 ± 9.76 years and there were 140 (75.27%) male and 46 (24.73%) female, and male to female ratio 3:1.Factors significant for delayed treatment vs nondelayed treatment were poor social economic status (65.6% vs 20.4%), history of chronic stable angina (33.3% vs 11.8%), delayed response in the emergency room (20.4% vs 8.6%), delayed ECG acquisition (26.9% vs 8.6%), delayed ECG interpretation (25.8% vs 4.3%), pain at night 12:00-6:00 AM (21.5% vs 9.7%) and belief that the chest pain is noncardiac (26.9% vs 3.2%). Acute heart failure was significantly greater in group B (9.7%) in comparison with group A (2.2%), re-infarction was 18.3% in group B in comparison with 7.5% group A. Similarly sustained ventricular tachycardia and ventricular fibrillation and in-hospital mortality were higher in group B (12.9%, 14%, and 12.9% respectively). Due to delayed treatment patients had higher hospital stays, and complications, like acute heart failure, re-infarction, ventricular fibrillation, and in-hospital mortality.

Surface water quality, public health, and ecological risks in Bangladesh-a systematic review and meta-analysis over the last two decades.

Water quality has recently emerged as one of the utmost severe ecological problems being faced by the developing countries all over the world, and Bangladesh is no exception. Both surface and groundwater sources contain different contaminants, which lead to numerous deaths due to water-borne diseases, particularly among children. This study presents one of the most comprehensive reviews on the current status of water quality in Bangladesh with a special emphasis on both conventional pollutants and emerging contaminants. Data show that urban rivers in Bangladesh are in a critical condition, especially Korotoa, Teesta, Rupsha, Pashur, and Padma. The Buriganga River and few locations in the Turag, Balu, Sitalakhya, and Karnaphuli rivers have dissolvable oxygen (DO) levels of almost zero. Many waterways contain traces of NO3, NO2, and PO4-3 pollutants. The majority of the rivers in Bangladesh also have Zn, Cu, Fe, Pb, Cd, Ni, Mn, As, and Cr concentrations that exceed the WHO permissible limits for safe drinking water, while their metal concentrations exceed the safety threshold for irrigation. Mercury poses the greatest hazard with 90.91% of the samples falling into the highest risk category. Mercury is followed by zinc 57.53% and copper 29.16% in terms of the dangers they pose to public health and the ecosystem. Results show that a considerable percentage of the population is at risk, being exposed to contaminated water. Despite hundreds of cryptosporidiosis cases reported, fecal contamination, i.e., Cryptosporidium, is totally ignored and need serious considerations to be regularly monitored in source water.

A Comparative Study Between Use of Topical Honey and Edinburgh University's Solution of Lime (EUSOL) Dressing in Necrotizing Fascitis Wounds.

Introduction Necrotizing soft tissue infection is potentially life-threatening and involves subcutaneous fascial planes, later involving overlying skin and, eventually, underlying muscles. Early diagnosis and prompt treatment are necessary for this disease's management to avoid significant morbidity and fatality. After resuscitation and optimization, early surgical debridement is followed by serials of dressing. Various materials like Edinburgh University's solution of lime (EUSOL), normal saline, povidone-iodine, and honey have been used as dressing solutions for necrotizing fasciitis. This study is based on comparing the effects of honey and EUSOL as dressing solutions in necrotizing fasciitis wounds. Methods A randomized clinical trial was conducted at the Civil Hospital Karachi, from March 2020 to July 2021. This study has been approved by the ethical review committee of the institution and registered at clinicaltrial.gov. Based on the dressing solution for necrotizing fasciitis, patients were divided into two groups, The honey group (intervention group) contains 90 patients, and the EUSOL group (control group) has 85 patients. Results A total of 175 patients' data were analyzed, 90 in the honey group and 85 in the EUSOL group. Patients presented to the hospital with symptoms of 6.20 ± 2.72 days in the honey group and 6.67 ± 4.08 days in the EUSOL group. The days required for clearance of slough in the honey group were 2.83 ± 0.79, while 2.48 ± 0.82 days in the EUSOL group with a p-value of 0.005. The duration of hospital stay was 4.96 ± 1.31 days in the intervention group and 9.33 ± 1.45 days in the control group, with a p-value of 0.007. Wound healing days were 20.23 ± 4.45 in the intervention group while 28.38 ± 7.06 days in the control group, with a significant p-value of 0.000. Conclusion While managing necrotizing soft tissue infection wounds with honey. Honey promotes faster wound healing and shorter hospital stays compared to EUSOL.

Honey and Nigella sativa against COVID-19 in Pakistan (HNS-COVID-PK): A multicenter placebo-controlled randomized clinical trial.

Until now, no specific and effective treatment exists for coronavirus disease 2019 (COVID-19). Since honey and Nigella sativa (HNS) have established antiviral, antibacterial, antiinflammatory, antioxidant, and immunomodulatory properties, we tested their efficacy for this disease in a multicenter, placebo-controlled, and randomized clinical trial at four medical care facilities in Pakistan. RT-PCR confirmed COVID-19 adults showing moderate or severe disease were enrolled in the trial. Patients were randomly assigned in a 1:1 ratio to receive either honey (1 g kg-1 day-1 ) and Nigella sativa seeds (80 mg kg-1 day-1 ) or a placebo for up to 13 days along with standard care. The outcomes included symptoms' alleviation, viral clearance, and 30-day mortality in the intention-to-treat population. Three hundred and thirteen patients, 210 with moderate and 103 with severe disease, underwent randomization from April 30 to July 29, 2020. Among the moderate cases, 107 were assigned to HNS, whereas 103 were assigned to the placebo group. Among the severe cases, 50 were given HNS, and 53 were given the placebo. HNS resulted in ~50% reduction in time taken to alleviate symptoms as compared to placebo (moderate cases: 4 vs. 7 days, Hazard Ratio [HR]: 6.11; 95% Confidence Interval [CI]: 4.23-8.84, p < 0.0001 and for severe cases: 6 vs. 13 days, HR: 4.04; 95% CI: 2.46-6.64; p < 0.0001). HNS also cleared the virus earlier than placebo in both moderate cases (6 vs. 10 days, HR: 5.53; 95% CI: 3.76-8.14, p < 0.0001) and severe cases (8.5 vs. 12 days, HR: 4.32; 95% CI: 2.62-7.13, p < 0.0001). HNS further led to a better clinical score on day 6 with normal activity resumption in 63.6% vs. 10.9% among moderate cases (OR: 0.07; 95% CI: 0.03-0.13, p < 0.0001) and hospital discharge in 50% versus 2.8% in severe cases (OR: 0.03; 95% CI: 0.01-0.09, p < 0.0001). In severe cases, the mortality rate was less than 1/4th in the HNS group than in placebo (4% vs. 18.87%, OR: 0.18; 95% CI: 0.02-0.92, p = 0.029). No HNS-related adverse effects were observed. HNS, compared with placebo, significantly improved symptoms, expedited viral load clearance, and reduced mortality in COVID-19 patients. This trial was registered on April 15, 2020 with ClinicalTrials.gov Identifier: NCT04347382.

Effect of Consumption Value on Consumer Willingness to Consume GM Food: A Post-COVID-19 Analysis.

In this research, we debate the critical challenges posed by the COVID-19 pandemic such as food scarcity, by examining the influence of consumption values on consumers' willingness to consume genetically modified (GM) food in the presence of consumer food attitudes, animosity, and ethnocentrism, which could be the one possible option to deal with the food scarcity problem. The proposed relationship could help to understand the complex societal problem of food scarcity and import dependency in the food sector before and after the crisis. Therefore, based on the theory of consumption values, we investigated government actions, consumer attitudes, and their willingness to consume GM food through 1340 valid USA responses and 1065 Chinese responses. We observed that COVID-19 doubled the number of malnourished people in 2020 relative to 2019, while consumption values, to some extent, changed consumer food attitudes and were inclined toward other food alternatives such as GM food regardless of governmental support for GM food in both USA and China. Moreover, this research enables governments, policymakers, market practitioners, and other stakeholders to use the COVID-19 crisis as an opportunity to negotiate with other countries to share their food technology along with imports.

Pollen morphology of selected melliferous plants and its taxonomic implications using microscopy.

This research aimed to explore the melliferous bee flora pollen from arid zones of District Attock, Islamabad Capital and Rawalpindi. Morpho-palynological features has provided key information for the classification and help to explain the taxonomy of several genera and species. Therefore, in this work, we examined the morphological characters of pollen potentially to be used for the species delimitation of bee flora. A total of 18 bee floral species, classified into 12 different families were collected, pressed, identified and then acetolyized to observe the grains under microscopy. Bee pollen can be described by small, medium to large sized morphotypes presenting five types of shapes, prolate spheroidal in (seven species), sub-prolate (six species), oblate spheroidal (three species), oblate and prolate (one species each) was examined. The observed polar and equatorial diameter were found maximum in Zea mays 73.5 µm and Pelargonium inquinans 66.75 µm respectively. Pollen of six different types was found namely: tricolporate, 3-zonocolporate, monoportae, tetracolporate, tetraporate and mononsulcate. Whereas highest value of colpi length was measured in Grewia tenax (24.55 µm). Exine surface nature of pollen was examined echinate psilate and scabrate. Exine thickness noted to be maximum in Verbena tenuisecta (8.40 µm) and minimum in Citrus macrocarpa (0.4 µm). Bee floral species considered difficult to identify based on other morphological traits were successfully distinguished using pollen quantitative and qualitative traits, confirming the importance of pollen morphology to diagnose characters to correctly identify honeybee flora. RESEARCH HIGHLIGHTS: Pollen diversity among honeybee flora. Highly variations observed via microscopy in pollen micromorphology. Palyno-morph has taxonomic value for the identification of honeybee floral species.

Clinical efficacy of iodine complex in SARS-CoV-2-infected patients with mild to moderate symptoms: study protocol for a randomized controlled trial.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by the novel coronavirus-infected millions globally. Despite a wide range of advised options for the treatment of COVID-19, a single strategy to tackle this pandemic remains elusive, thus far. That is why we are conducting a clinical trial to find out the efficacy of iodine complex to clear a viral load of severe respiratory syndrome coronavirus-2 (SARS-CoV-2) along with a reduction in time taken to alleviate symptoms. METHOD: The proposed study is a placebo-controlled, add-on, randomized trial using parallel group designs. This is a closed-label and adaptive with sample size reassessment, multi-centered design with a 1:1:1:1 allocation ratio and superiority framework. It will be conducted in Shaikh Zayed Post-Graduate Medical Complex, Ali Clinic, and Doctors Lounge, Lahore, Pakistan. This study will have three arms of mild to moderately symptomatic COVID-19 patients (50 patients in each) which will receive ionic-iodine polymer complex with 200 mg of elemental iodine: interventional arm A will have encapsulated, arm B will receive suspension syrup form, arm C will get throat spray, while arm X will be standard care with placebo. Data will be collected on self-constructed, close-ended questionnaires after obtaining written consent. Data will be analyzed using SAS version 9.4. COVID-19 patients will be monitored by RT-PCR and HRCT (high-resolution computed tomography) chest. In addition to these, the duration of the symptomatic phase and mortality benefits will be analyzed in both groups. DISCUSSION: The study is designed to measure the superior efficacy of the iodine complex as an add-on in treating COVID-19-positive patients with mild to moderate symptoms. This combination is hypothesized to improve various parameters like rapid viral load reduction, clinical and radiological improvement, lower mortality, and reduction in hospitalization. The trial will aid in devising a better strategy to cope with COVID-19 in a relatively inexpensive and accessible way. The implications are global, and this could prove itself to be the most manageable intervention against COVID-19 especially for patients from limited-resource countries with deprived socioeconomic status. TRIAL REGISTRATION: ClinicalTrials.gov NCT04473261 . Registered on July 16, 2020.

Knowledge, attitude, and practice of clinicians about antimicrobial stewardship and resistance among hospitals of Pakistan: a multicenter cross-sectional study.

Considering that antimicrobial resistance (AMR) is a global challenge, there is a dire need to assess the knowledge, attitude, and practice (KAP) of clinicians in AMR endemic countries. The current multicenter, cross-sectional study aimed at highlighting gaps in antimicrobial (AM) stewardship and AMR among practicing doctors working in public tertiary care teaching hospitals of Lahore, Pakistan. A KAP survey, based on a self-administered questionnaire containing 45 questions, was distributed among 336 clinicians in 6 randomly selected hospitals. Overall, 92% of the clinicians considered AMR as a worldwide problem but only 66% disagreed that cold and flu symptoms require antibiotics. Moreover, around 68% of the doctors felt confident about their practice in AM but still, 96% felt the need to get more knowledge about AM drugs. The need for refresher courses on rational antibiotic use was expressed by 84% of the participants. The main contributing factors considered for AMR by the doctors included excessive AM usage in the medical profession (87.1%) and multiple antibiotics per prescription (76.4%). Pharmacologically, AM spectrum was accurately chosen by 1.4% for Ampicillin, 0.003% for Erythromycin and 0% for Levofloxacin. Clinically, more than 50% of the clinicians used miscellaneous AM for empirical therapy of respiratory tract infection and cholecystitis. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. It is concluded that the knowledge of clinicians is relatively poor for AM spectrum and drugs of choice for certain infections. However, the clinicians are aware of their shortcomings and desire for improvement.

Anti-COVID property of subcutaneous ivermectin in synergy with zinc among midlife moderately symptomatic patients: a structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: The study objective is to quantify the effectiveness of ivermectin (subcutaneous/oral IVM) in the presence or absence of zinc (Zn) for clinical and radiological improvement in coronavirus disease 2019 (COVID-19) patients with moderate severity. TRIAL DESIGN: This quadruple-blinded, placebo-controlled randomized clinical trial will be a multiarmed multi-centered study with superiority framework. PARTICIPANTS: Quinquagenarian and sexagenarian patients with moderate COVID-19 symptoms and positive severe respiratory syndrome coronavirus -2 (SARS-CoV-2) PCR will be included. Participants with co-morbidities and pregnant women will be excluded. Patient recruitment will be done in Shaikh Zayed Medical Complex, Doctors Lounge and Ali Clinic in Lahore (Pakistan). INTERVENTION AND COMPARATOR: The registered patients will be allocated in 6 groups (30 participants each). Patients will be taking subcutaneous IVM at 200 µg/kg/48 h (Arm A) or subcutaneous IVM at 200 µg/kg/48 h and oral Zn 20mg/8 h (Arm B) or oral IVM at 0.2 mg/kg/day (Arm C) or oral IVM at 0.2 mg/kg/day and oral Zn 20mg/8 h (Arm D) or alone oral Zn 20mg/8 h (Arm E) or placebo alone (Arm X). Patients in all arms will receive standard care and respective placebo (empty capsule 8 hourly and/or subcutaneous normal saline 2ml/48 h). MAIN OUTCOMES: Primary endpoints will be duration of symptomatic phase and SARS-CoV-2 clearance along with high resolution CT (HRCT) chest score and clinical grade scale (CGS) on day 6. 30-day mortality will be documented as a secondary endpoint. SARS-CoV-2 clearance will be calculated by second PCR on day 7. HRCT chest score will be measured by the percentage and lung lobes involvement on day 6 with a maximum score of 25. CGS will be recorded on a seven-point scale; grade 1 (not hospitalized, no evidence of infection and resumption of normal activities), grade 2 (not hospitalized, but unable to resume normal activities), grade 3 (hospitalized, not requiring supplemental oxygen), grade 4 (hospitalized, requiring supplemental oxygen), grade 5 (hospitalized, requiring nasal high-flow oxygen therapy and/or noninvasive mechanical ventilation), grade 6 (hospitalized, requiring ECMO and/or invasive mechanical ventilation) and grade 7 (death). RANDOMISATION: A simple lottery method will be used to randomly allocate scrutinized patients in 1:1:1:1:1:1 ratio in 6 groups. BLINDING (MASKING): Patients, primary care physicians, outcome assessors and the data collection team will be blinded. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 180 participants will be randomized into six arms with five investigational and one placebo group. TRIAL STATUS: Institutional Review Board Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan has approved the protocol (version 2.3) with ID SZMC/IRB/Internal0056/2020. The trial was approved on July 14, 2020, and enrolment started on July 30, 2020. The estimated completion date is October 30, 2021. TRIAL REGISTRATION: Clinical Trial has been retrospectively registered on www.clinicaltrials.gov with registration ID NCT04472585 dated July 16, 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.

Prophylactic potential of honey and Nigella sativa L. against hospital and community-based SARS-CoV-2 spread: a structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: Considering the therapeutic potential of honey and Nigella sativa (HNS) in coronavirus disease 2019 (COVID-19) patients, the objective of the study is defined to evaluate the prophylactic role of HNS. TRIAL DESIGN: The study is a randomized, placebo-controlled, adaptive clinical trial with parallel group design, superiority framework with an allocation ratio of 1:1 among experimental (HNS) and placebo group. An interim analysis will be done when half of the patients have been recruited to evaluate the need to adapt sample size, efficacy, and futility of the trial. PARTICIPANTS: All asymptomatic patients with hospital or community based COVID-19 exposure will be screened if they have had 4 days exposure to a confirmed case. Non-pregnant adults with significant exposure level will be enrolled in the study High-risk exposure (<6 feet distance for >10min without face protection) Moderate exposure (<6 feet distance for >10min with face protection) Subjects with acute or chronic infection, COVID-19 vaccinated, and allergy to HNS will be excluded from the study. Recruitment will be done at Shaikh Zayed Post-Graduate Medical Institute, Ali Clinic and Doctors Lounge in Lahore (Pakistan). INTERVENTION AND COMPARATOR: In this clinical study, patients will receive either raw natural honey (0.5 g) and encapsulated organic Nigella sativa seeds (40 mg) per kg body weight per day or empty capsule with and 30 ml of 5% dextrose water as a placebo for 14 days. Both the natural products will be certified for standardization by Government College University (Botany department). Furthermore, each patient will be given standard care therapy according to version 3.0 of the COVID-19 clinical management guidelines by the Ministry of National Health Services of Pakistan. MAIN OUTCOMES: Primary outcome will be Incidence of COVID-19 cases within 14 days of randomisation. Secondary endpoints include incidence of COVID-19-related symptoms, hospitalizations, and deaths along with the severity of COVID-19-related symptoms till 14th day of randomization. RANDOMISATION: Participants will be randomized into experimental and control groups (1:1 allocation ratio) via the lottery method. There will be stratification based on high risk and moderate risk exposure. BLINDING (MASKING): Quadruple blinding will be ensured for the participants, care providers and outcome accessors. Data analysts will also be blinded to avoid conflict of interest. Site principal investigator will be responsible for ensuring masking. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 1000 participants will be enrolled in the study with 1:1 allocation. TRIAL STATUS: The final protocol version 1.4 was approved by institutional review board of Shaikh Zayed Post-Graduate Medical Complex on February 15, 2021. The trial recruitment was started on March 05, 2021, with a trial completion date of February 15, 2022. TRIAL REGISTRATION: Clinical trial was registered on February 23, 2021, www.clinicaltrials.gov with registration ID NCT04767087 . FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.

COVID-19: A Potential Trigger for Thyroid Dysfunction.

Subacute thyroiditis (SAT) is a self-limiting thyroid dysfunction of viral origin. Relatively little is known about its occurrence in SARS CoV-2 infected COVID-19 patients. Herein, we report a case of SAT in a 58-year-old patient that was apparently triggered by infection with SARS CoV-2. Clinical, laboratory and imaging features of the patient are presented. The patient was vitally stable with a slightly tender and warm thyroid gland, which was painful on swallowing. His free thyroxine (FT4) was elevated, thyroid stimulating hormone (TSH) was below normal and free triiodothyronine (FT3) was in the physiological range. Previous thyroid exam conducted as a part of routine annual physical checkup was normal. The patient was put on prednisolone and recovered completely within three weeks.

Implication of scanning electron microscopy in the seed morphology with special reference to three subfamilies of Fabaceae.

The current research work was aimed to determine the morphological variation in the seeds of subfamilies Caesalpinioideae, Mimosoideae, and Papilionoideae using scanning electron microscope to investigate the different seed features including; Seed length, width, weight, hilum shape, position, fracture line pattern, pleurogram shape, texture crudeness, ornamentation wall, and surface ornamentation. A total of 12 species were collected. The study reveals that the seed types alters from psilate to rugose, pleurogram shape from lunar to U shape, hilum shape from elliptical to depressed, hilum position from terminal to subterminal, fracture line pattern from reticulate irregular ridges to psilate with regular ridges, texture crudeness from fine to coarse, surface ornamentation from reticulate to psilate, and ornamentation wall also varies from thin to thick. In all the studied species, it was found that seed surface was brown in color except in Senna alata, in which seed surface was black. Regarding the seed size, it was found that the smallest seed was observed for Sesbania sesban, while the largest seed was observed for Pongamia pinnata. The present research article indicates the taxonomic significance of seed morphology in the subfamilies Caesalpinioideae, Mimosaceae, and Papilionoideae.

A quadruple blinded placebo controlled randomised trial to evaluate the effectiveness of an Iodine complex for patients with mild to moderate COVID-19 in Pakistan (I-COVID-PK): A structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: The objective of the study is to measure the efficacy of ionic-iodine polymer complex [1] for clinical and radiological improvement in coronavirus disease 2019 (COVID-19) patients. TRIAL DESIGN: The trial will be closed label, randomized and placebo-controlled with a 1:1:1:1 allocation ratio and superiority framework. PARTICIPANTS: All PCR confirmed COVID-19 adult patients including non-pregnant females, with mild to moderate disease, will be enrolled from Shaikh Zayed Post-Graduate Medical Complex, Ali Clinic and Doctors Lounge in Lahore (Pakistan). Patients with any pre-existing chronic illness will be excluded from the study. INTERVENTION AND COMPARATOR: In this multi-armed study ionic-iodine polymer complex with 200 mg of elemental iodine will be given using three formulations to evaluate efficacy. Patients will be receiving either encapsulated iodine complex of 200 mg (arm A), iodine complex syrup form 40 ml (arm B), iodine complex throat spray of 2 puffs (arm C) or empty capsule (arm D) as placebo; all three times a day. All the 4 arms will be receiving standard care as per version 3.0 of the clinical management guidelines for COVID-19 established by the Ministry of National Health Services of Pakistan. MAIN OUTCOMES: Primary outcomes will be viral clearance with radiological and clinical improvement. SARS-CoV-2 RT-PCR and HRCT chest scans will be done on the admission day and then after every fourth day for 12 days or till the symptoms are resolved. RT-PCR will only be shown as positive or negative while HRCT chest scoring will be done depending on the area and severity of lung involvement [2]. Time taken for the alleviation of symptoms will be calculated by the number of days the patient remained symptomatic. 30-day mortality will be considered as a secondary outcome. RANDOMISATION: Stratification for initial COVID-19 status (or days from initial symptoms as a proxy), age groups, gender, baseline severity of symptoms and co-morbidities will be used to ensure that the study arms remain balanced in size for the 1:1:1:1 allocation ratio. Randomization will be done using the lottery method. As patients are being admitted at different times, they will be recruited after obtaining their voluntary written informed consent following all standard protocols of the infection, control and disinfection. BLINDING (MASKING): This is a quadruple (participants, care providers, investigators and outcomes assessors) blinded study where only the study's Primary Investigator will have information about the arms and their interventions. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 200 patients will be randomized into four groups with three experimental and one placebo arm. TRIAL STATUS: Protocol Version Number is 2.3 and it is approved from IRB Shaikh Zayed Hospital with ID SZMC/IRB/Internal0056/2020 on July 14th, 2020. The recruitment is in progress. It was started on July 30, 2020, and the estimated end date for the trial is August 15, 2021. TRIAL REGISTRATION: Clinical Trial has been retrospectively registered on www.clinicaltrials.gov with registration ID NCT04473261 dated July 16, 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.

Microscopic implication and evaluation of herbaceous melliferous plants of southern Khyber Pakhtunkhwa-Pakistan using light and scanning electron microscope.

The aim of the present study is to investigate the pollen morphology of melliferous plant taxa of Southern Khyber Pakhtunkhwa-Pakistan. Using light microscope (LM) and scanning electron microscope (SEM), the palynological study of 18 species of melliferous plants namely Calendula arvensis, Cenchrus pennisetiformis, Citrullus colocynthis, Cucumis melo subsp. agrestis var. agrestis, Cucurbita maxima, Cymbopogon jwarancusa, Cynodon dectylon, Dactyloctenium aegyptium, Helianthus annus, Lagenaria siceraria, Launaea procumbens, Luffa cylindrica, Pennisetum glaucum, Saccharum spontaneum, Sonchus asper, Verbesina encelioides, Xanthium strumarium, and Zea mays was carried out. Both qualitative and quantitative characteristics of pollen were studied. Variations were observed in pollen morphology. The dominant pollen shape was prolate-spheroidal (11 species). All the pollen units were monad. The highest exine thickness was found in Citrullus colocynthis (8.45 µm). The maximum polar and equatorial diameter (102 and 97.55 µm) was found in Luffa cylindrica. Similarly, the highest P/E ratio was found in Cucurbita maxima (1.46). Most of the species showed tricolpate and monoporate type of pollen. The exine sculpturing, number of spines per pollen and between colpi and the pollen fertility and sterility provided significant results for the documentation of melliferous plants. Thus, the information listed in this article will prove helpful to identify the potential melliferous plants in the area, geographical origin of the honey, and the availability of pure honey in the local and international market.

GM trust shaped by trust determinants with the impact of risk/benefit framework: the contingent role of food technology neophobia.

The present study is comparative in natures that focus on understanding the factors that influence the GM food trust level in the BRA framework and food technology neophobia in China and the USA. For this purpose, we collected 300 and 350 valid responses, respectively, through a structured questionnaire. By carefully evaluating the above relationships, we found that trust determinants such as institutional trust, technology trust, information revealed with GM food vary across both datasets. However, GM knowledge has a better association with GM food trust in both cases. Apart from this, the food technology neophobia slightly moderates the benefits-risk perception of consumers and GM trust. This study guides the policymakers to enhance GM knowledge, as GM food is scientifically proven safe for health and environment and can be a financial incentive for the farmers. Further, the study also provides direction for corporate managers to design effective marketing and communication strategies in two different countries by investigating GM food trust's primary motivators in both nations.

Microscopic investigation of pollen morphology of Brassicaceae from Central Punjab-Pakistan.

The intention of the current study is to provide an account on the palynological features of Brassicaceae from Central Punjab-Pakistan as a basis for future studies. Different morpho-palynological characteristics both qualitative and quantitative were analyzed during this research which includes shape of pollen, diameter of pollen, P/E ratio, exine sculpturing, thickness of exine, type of pollen, shape and size of lumens, and thickness of murus. Taxonomic keys were also constructed based on pollen morphological characters for correct identification of species. This study aims to provide detailed information of pollen diversity and their exine structure based on both qualitative and quantitative characters by using Light microscopy and Scanning electron microscopy. Shape of pollen is mostly prolate, but some species also have sub-prolate to spheroidal prolate types. Exine ornamentation in most species was reticulate, whereas micro reticulate (one species) and coarsely reticulate (one species) exine also observed in some pollen. All the pollen mentioned in this study have tricolpate apertures. Variation found in thickness of exine and other characters proved to be helpful at generic and specific level. The results reinforced the significance of pollen morphological features of family Brassicaceae and aid for valuable taxonomic tool in plant systematics.

The psychological perspective on the adoption of approved genetically modified crops in the presence of acceptability constraint: the contingent role of passion.

This study contributes to the literature on genetically modified crops by examining the impact of psychological distance on farmer adoption. The existing body of literature suggests that some farmers have the conservative perception to adopt genetically modified crops because of controversies regarding the side effects and profitability. To understand these social problems, we have relied upon construal-level theory which argues farmer passion about dynamics like here and now, likely or unlikely and the near or far from self are vital for the adoption of approved genetically modified crops. The data for the present study collected from three Asian countries through questionnaire, for China 300, India 350, Philippines 300 valid responses collected. The study founds a positive relation of psychological distance based on passion with farmer trust behavior to adopt genetically modified crops over time. The findings of the present study provide new insights into the development of farmer acceptability and encourage the use of novel crop technologies.Abbreviations: GM, genetically modified; TD, temporal distance; SPD, Spatial distance; SD, Social distance; TB, trust behavior; AGMC, Approved Genetically modified crops; CLT, Construal Level Theory.

Potential of soil amendments (Biochar and Gypsum) in increasing water use efficiency of Abelmoschus esculentus L. Moench.

Water being an essential component for plant growth and development, its scarcity poses serious threat to crops around the world. Climate changes and global warming are increasing the temperature of earth hence becoming an ultimate cause of water scarcity. It is need of the day to use potential soil amendments that could increase the plants' resistance under such situations. Biochar and gypsum were used in the present study to improve the water use efficiency (WUE) and growth of Abelmoschus esculentus L. Moench (Lady's Finger). A 6 weeks experiment was conducted under greenhouse conditions. Stress treatments were applied after 30 days of sowing. Plant height, leaf area, photosynthesis, transpiration rate (Tr), stomatal conductance and WUE were determined weekly under stressed [60% field capacity (F.C.)] and non-stressed (100% F.C.) conditions. Stomatal conductance and Tr decreased and reached near to zero in stressed plants. Stressed plants also showed resistance to water stress upto 5 weeks and gradually perished at sixth week. On the other hand, WUE improved in stressed plants containing biochar and gypsum as compared to untreated plants. Biochar alone is a better strategy to promote plant growth and WUE specifically of A. esculentus, compared to its application in combination with gypsum.

Extraordinary photoluminescence and strong temperature/angle-dependent Raman responses in few-layer phosphorene.

Phosphorene is a new family member of two-dimensional materials. We observed strong and highly layer-dependent photoluminescence in few-layer phosphorene (two to five layers). The results confirmed the theoretical prediction that few-layer phosphorene has a direct and layer-sensitive band gap. We also demonstrated that few-layer phosphorene is more sensitive to temperature modulation than graphene and MoS2 in Raman scattering. The anisotropic Raman response in few-layer phosphorene has enabled us to use an optical method to quickly determine the crystalline orientation without tunneling electron microscopy or scanning tunneling microscopy. Our results provide much needed experimental information about the band structures and exciton nature in few-layer phosphorene.

3-Hydr-oxy-1,2,3,9-tetra-hydro-pyrrolo[2,1-b]quinazolin-4-ium chloride dihydrate: (+)-vasicinol hydro-chloride dihydrate from Peganum harmala L.

The title compound, C(11)H(13)N(2)O(+)·Cl(-)·2H(2)O, the dihydrate of (+)-vasicinol hydro-chloride, is a pyrrolidinoquinazoline alkaloid. It was isolated from the ethyl acetate fraction of the leaves of Peganum harmala L. The pyrrolidine ring has an envelope conformation with the C atom at position 2 acting as the flap and the C atom at position 3, carrying the hydroxyl substituent, has an S configuration. The absolute configuration was determined as a result of the anomalous scattering of the Cl atom. In the crystal structure, mol-ecules stack along the a axis, connected to one another via inter-molecular O-H⋯Cl and N-H⋯Cl hydrogen bonds, forming approximately triangular-shaped R(2) (1)(7) rings, and O-H⋯Cl and O-H⋯O hydrogen bonds, forming penta-gonal-shaped R(5) (4)(10) rings. The overall effect is a ribbon-like arrangement running parallel to the a axis.