Correction: Optimized Cu-doping in ZnO electro-spun nanofibers for enhanced photovoltaic performance in perovskite solar cells and photocatalytic dye degradation.

[This corrects the article DOI: 10.1039/D4RA01544D.].

Environmental impacts and performance assessment of recycled fine aggregate concrete.

Natural disasters and human demolition create vast amounts of construction and demolition waste (CDW), with a substantial portion being concrete waste. Managing this concrete waste is a daunting challenge for developing countries with limited resources, aiming to mitigate its harmful environmental effects. Therefore, the proposed approach involves using recycled fine aggregates (RFA) instead of fresh fine aggregates (FFA) in concrete, which aligns closely with achieving sustainable environmental objectives. Extensive laboratory tests were conducted to assess the effects of adding RFA to concrete. The influence of 0 to 100% RFA replacement and different curing times was investigated on compressive strength, tensile strength, resistance against chloride ion penetration and chemicals exposure, and quality of aggregates. So, around 30%, 35%, 20%, and 79% reductions in compression strength, tensile strength, modulus of elasticity, and workability were estimated when 100% RFA was used in recycled aggregate concrete (RAC). However, according to results analyses, the performance of RAC is reliable up to 50% of RFA in proposed conditions and mix design. In addition, major environmental impacts such as global warming potential, aquatic eutrophication, and aquatic acidification were reduced by 47%, 40%, and 18%, respectively, for concrete having 50% RFA than concrete having 100% FFA.

Optimized Cu-doping in ZnO electro-spun nanofibers for enhanced photovoltaic performance in perovskite solar cells and photocatalytic dye degradation.

Perovskite solar cells (PSCs) compete with conventional solar cells regarding their low-temperature processing and suitable power conversion efficiency. In PSCs, the electron transport layer (ETL) plays a vital role in charge extraction and avoiding recombination; however, poor charge transport of ETL leads to high internal resistance and associated low fill factors. To successfully resolve this challenge, copper-doped zinc oxide nanofibers as an electron transport layer are prepared with various doping levels of 1, 2, and 3 wt% using the electrospinning sol-gel method. The 3 wt% doping of Cu revealed the optimum performance as an ETL, as it offers an electrically efficient transporting structure. SEM images revealed a randomly oriented distribution of nanofibers with different sizes having mesoporous uniformity. Optical properties of doped nanofibers examined using UV-visible analysis showed an extended light absorption due to heteroatom-doping. Adding Cu into the ZnO leads to enhanced charge mobility across the electron transport material. According to Hall measurements, dopant concentration favors the conductivity and other features essentially required for charge extraction and transport. The solar cell efficiency of ZnO doped with 0%, 1%, 2%, and 3% Cu is 4.94%, 5.97%, 6.89%, and 9.79%, respectively. The antibacterial and photocatalytic activities of the prepared doped and undoped ZnO are also investigated. The better light absorption of Cu-ZnO showed a pronounced improvement in the photocatalytic activity of textile electrodes loaded with doped ZnO. The dye degradation rate reaches 95% in 180 min under visible light. In addition, these textile electrodes showed strong antibacterial activity due to the production of reactive oxygen species under light absorption.

Association Between Triglyceride-Glucose Index and Homeostasis Model Assessment for Insulin Resistance with Estimated Glucose Disposal Rate.

This cross-sectional study was aimed to compare insulin resistance, Triglyceride- Glucose (TyG) index, fatty liver index (FLI) and hepatic steatosis index (HSI), glycaemic and lipids among groups/quartiles based upon estimated Glucose Disposal Rate (eGDR) from August 2022 to December 2022 among 249 male participants. The eGDR results in (mg/kg/min) were divided into four quartiles as: Group-I: {<6.88, n = 62}, Group-II: {<6.88-9.45, n = 63}, Group-III: {9.46-10.39, n = 62}, and Group-IV: {>10.39, n = 62}. Fasting plasma glucose (FPG), HbA1c, low density lipoprotein (LDL), homeostasis model assessment for insulin-resistance (HOMAIR), and TyG index demonstrated significant worsening increase from high to low eGDR groups. Receiver operating curve (ROC) analysis to calculate area under curve (AUC) for diagnostic efficiency candidate indices for eGDR demonstrated highest AUC for FLI as AUC: 0.736 (95% CI: 0.669-0.803), p < 0.001, followed by FPG: AUC: 0.682 (95% CI: 0.606-0.757), HOMAIR: AUC: 0.670 (95% CI: 0.602-0.739), HSI: AUC: 0.660 (95% CI: 0.589-0.731), TyG index: 0.658 (95% CI: 0.583-0.732), and HbA1c: 0.639 (95% CI: 0.583-0.732). Glycaemic measures, lipid indices, insulin resistance and TyG index deteriorated with declining eGDR. Diagnostic performance as evaluated by AUC for eGDR was highest for FLI, followed by FPG, HOMAIR, HSI, TyG index, HbA1c, and triglycerides. Key Words: Triglyceride, Insulin, Glucose, Diabetes.

Reinforcement using undoped carbon quantum dots (CQDs) with a partially carbonized structure doubles the toughness of PVA membranes.

Nano-carbon-reinforced polymer composites have gained much consideration in functional applications due to their attractive mechanical strength and cost-effectiveness. The surface chemistry and associated mechanical strength of carbon nanotubes (CNTs), graphene, and other carbon derivative-based nanocomposites are well understood. While CQDs are considered emerging carbon derivatives, their surface chemistry, unique physio-chemical properties, and dispersion behavior in polymers are yet to be explored. Therefore, in this work, CQDs with different structures were synthesized from lemon pulp and urea, and their rheology and mechanical strength were studied in the PVA matrix. The surface chemistry and structure of CQDs were controlled using different solvents and reaction temperatures, respectively. CQDs possessed a circular shape, with a size of <10 nm, having a suitable carbon core and functional groups, as confirmed by TEM and FTIR spectroscopy. The dynamic viscosity and particle size of PVA/CQDs films peaked at 4% inclusion due to the maximum crosslinking of U-CQDs with reinforcement at 180 °C. Compared with pure PVA, the optimized composite showed an 80% larger particle size with 67% better tensile strength at 4% U-CQDs concentration. In addition to enhanced mechanical strength, CQDs exhibited antibacterial activity in composites. These CQDs-reinforced PVA composites may be suitable for different functional textile applications (shape memory composites and photo-active textiles).

Enhancing Medical Education: A Pathway to Nurturing Future Healthcare Professionals.

Introduction As medical knowledge, technology, and healthcare delivery continue to evolve, it is critical that upcoming healthcare workers possess the skills and information needed to ensure optimal patient care. Numerous studies indicate that students achieve better learning outcomes through active practice rather than solely relying on theoretical knowledge. The average human attention span is only 8.25 seconds, so an effective teaching program should employ various modes and techniques to ensure that students remain involved and interested. Aims and objectives The aim is to identify the primary areas where medical students need teaching and guidance and form the basis of a new teaching program to meet those needs. Materials and methods An anonymous online questionnaire, designed by the author was distributed to medical students who came for their clinical rotations at Basildon University Hospital, Mid and South Essex NHS Foundation Trust, United Kingdom, and that laid the foundations for introducing a new teaching program at the education department of the hospital in April 2023. The progress of the teaching program was evaluated by a second questionnaire-based survey conducted after six months, in October 2023. The teaching program we designed employed various modes and techniques including simulation, flip classroom, graded quizzes, and constructive feedback. The technique we used for giving feedback to students was the "star star wish" to encourage growth and further participation. The teaching program also made use of Lev Vygotsky's "Learning zone model" to ensure optimum learning. Results and discussion The program received immensely positive feedback from the students, and they felt that it catered perfectly to their requirements. Twenty-three students took part in this study and the results showed that 39% of the students felt adequately prepared for ward rounds in October 2023 in contrast to only 17% in April 2023. The mean score, on a scale of 1-10 on how comfortable the students felt in discussing patient care plans and management with the rest of the team rose from 2.78 in April 2023 to 4.26 in October 2023. When asked to score how confident the students felt in performing bedside examinations in wards, 26% scored 5 or above (on a scale of 1-10) in April 2023 as compared to 62% scoring 5 or above in October 2023. The students were then asked how confident they felt in using their theoretical knowledge in practical situations and the majority scored 2 or 3 (on a scale of 1-10) in April 2023 whereas in October, the majority scored 4 or above. Conclusions A significant number of medical students were satisfied with the teaching program and demanded more frequent sessions. The results of this study showed that in order to foster increased student engagement and effective participation, it is essential for teaching to incorporate diverse techniques and approaches.

Differences Between Conventional and Newer Anthropometric Measures Among Individuals with and without Fatty Liver Disease.

A cross-sectional analysis was conducted to compare conventional and emerging anthropometric measures among male participants with and without fatty liver disease (FLD). The objective was to assess differences and diagnostic efficiency of anthropometric-parameters using receiver operating curve (ROC) analysis at Combined Military Hospital Multan, NUMS from April to October 2022. Comparison for anthropometric measurements between non-FLD (n=164) vs. FLD (n=85) indicated significant differences in weight (74.01 + 11.96 vs. 85.91 + 14.07 kg, p<0.001), waist circumference (9.38 + 9.82 vs. 101.35 + 10.74 cm, p<0.001), BMI (24.81 + 4.0 vs. 29.21 + 4.38 kg/m2, p<0.001), waist-to-hip ratio (WHpR) (0.924 + 0.054 vs. 0.971 + 0.054, p<0.001), waist-to-height ratio (WHtR) (0.508 + 0.054 vs. 0.578 + 0.062, p<0.001), and abdominal volume index (AVI) (16.17 + 3.56 vs. 20.77 + 4.61, p<0.001). Fatty liver index (FLI) also showed significant difference between non-FLD vs. FLD groups (38.35 + 27.12 vs. 72.01 + 21.31, p<0.001). AUCs for various significant anthropometric measurements from highest to lowest as 0.821 (95% CI: 0.767-0.874) for FLI, 0.815 (95% CI: 0.761-0.869) for WHtR, 0.809 (95% CI: 0.754-0.863) for AVI, and 0.808 (95% CI: 0.754-0.863) for waist circumference with lowest recorded AUC for height as 0.422 (95% CI: 0.347-0.497). Key Words: Fatty liver disease (FLD), Body mass index (BMI), A body shape index (ABSI), C-index, Abdominal volume index (AVI), Body roundness index (BRI).

Diagnostic Accuracy of Immature Platelet Fraction (IPF) to Differentiate Between Thrombocytopenia due to Peripheral Destruction versus Bone Marrow Failure.

OBJECTIVE: To analyse the predictive value of immature platelet fraction (IPF) as an independent diagnostic marker to differentiate between hyperdestructive and hypoproductive thrombocytopenia. STUDY DESIGN: Cross-sectional observational study. Place and Duration of the Study: Armed Forces Institute of Pathology Rawalpindi, from February to July 2022. METHODOLOGY: A total of 164 samples were included in the study by non-probability consecutive sampling. Among these, 80 were obtained from normal individuals serving as control; 43 were obtained from patients having hyperdestructive thrombocytopenia (idiopathic thrombocytopenia, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation); and 41 were obtained from those hypoproductive thrombocytopenia (acute leukaemia, aplastic anaemia, chemotherapy). Sysmex automated haematology analyzer, XN-3000 was used to determine the immature platelet fraction (IPF) of the patients. ROC curves analysis was done to ascertain area under curve. RESULTS: Immature platelet fraction (IPF %) was significantly higher in consumptive / hyperdestructive thrombocytopenia group i.e. median (IQR), 21% (14.4-26.2) as compared to 6.5% (4.6-8.9) in hypoproductive thrombocytopenia, and 2.6% (1.3-4.1) in normal control group (p <0.001). Cut-off value with the highest sensitivity and specificity for IPF vs. normal population was 7.95% with sensitivity of 97.7% and specificity of 86%. CONCLUSION: Immature platelet fraction (IPF of 7.95%) possesses high diagnostic accuracy, sensitivity and specificity for differentiation between hyperdestructive vs. hypoproductive thrombocytopenia. It can be used as a reliable marker to differentiate between the two entities. KEY WORDS: Immature platelet fraction, Thrombocytopenia, Bone marrow failure, Peripheral destruction.

Integrating wheat straw and silica fume as a balanced mechanical ameliorator for expansive soil: a novel agri-industrial waste solution.

Resource utilization of agricultural and industrial wastes with minimal screening is highly desirable in the context of sustainable development and environmental protection. In this regard, the current study proposes a novel solution of integrating milled wheat straw (WS) with minimal screening and silica fume (SF) in the form of composite binary admixture (CBA) for the stabilization of highly expansive soils. The optimum amount of WS and SF to produce CBA was determined based on a series of Atterberg's limit tests. The mechanical performance of CBA-treated soil was assessed based on the unconfined compression, direct shear, and flexural tests which showed that unconfined compressive strength (qu), cohesion (c), and flexural strength (f) were increased by 94.3%, 65.7%, and 90.7%, respectively, with an addition of 16% of CBA and 28 days of curing. Furthermore, the CBA-treated soil underwent only a 26% reduction in deformability index (ID) with an addition of 24% CBA. Furthermore, volumetric change response was assessed based on ID consolidation and swelling tests which showed that compression index (Cc), recompression index (Cr), swell potential, free swell index (FSI), and swell pressure were reduced by 72.5%, 47.7%, 59%, 35.8%, and 65%, respectively, with an addition of 16% CBA in the soil and 28 days of curing. In addition, wetting-drying (W-D) cycle tests demonstrated that CBA-treated soil was less vulnerable to W-D seasons as compared to untreated soil. Mineralogical and microstructural tests revealed that the balanced Ca:Si and Ca:Al environment created by CBA within the soil matrix produces cementing compounds, i.e., CSH and CAH, imparts strong bonds, and causes aggregation improving the mechanical response of expansive soil.

Remediation methods of heavy metal contaminated soils from environmental and geotechnical standpoints.

Heavy metal contaminated soil (HMCS) threatens world health and sustainable growth, owing to which numerous remediation methods have been devised. Meanwhile, environmental sustainability and geotechnical serviceability of remediated HMCS are important considerations for reusing such soils and achieving sustainable development goals; therefore, these considerations are critically reviewed in this article. For this purpose, different onsite and offsite remediation methods are evaluated from environmental and geotechnical standpoints. It was found that each remediation method has its own merits and limitations in terms of environmental sustainability and geotechnical serviceability; generally, sustainable green remediation (SGR) and cementation are regarded as effective solutions for the problems related to the former and latter, respectively. Overall, the impact of remediation techniques on the environment and geotechnical serviceability is a developing area of study that calls for increased efforts to improve the serviceability, sustainability, reusability and environmental friendliness of the remediated HMCS.

HLA-DQ2 and HLA-DQ8 Alleles in Celiac Disease Patients and Healthy Controls.

OBJECTIVE: To compare HLA-DQ2 and HLA-DQ8 alleles between celiac disease patients and healthy control group. STUDY DESIGN: Observational cross-sectional study. PLACE AND DURATION OF STUDY: Department of Immunology, Armed Forces Institute of Pathology (AFIP), from April to December 2018. METHODOLOGY: Subjects were included: 100 celiac disease patients selected by non-probability consecutive sampling, and 100 healthy subjects. After collecting peripheral blood in EDTA tubes, chromosomal DNA was extracted and amplified, using sequence specific primers. Post-amplification electrophoresis was performed on two per cent agarose gel, followed by ethidium bromide staining; and specific band patterns were recorded under ultraviolet illumination to determine the HLA-DQ alleles. The subtypes of HLA-DQ2, i.e. HLA-DQ2.5 and HLA-DQ2.2 were also assessed. Frequency, percentage, mean and SD were calculated. Post-stratification Chi-square test was applied. RESULTS: The mean age of celiac disease group and healthy subjects was 14.79 ± 5.32 years and 14.71 ± 5.21 years, respectively. The frequency of HLA-DQ2 and HLA-DQ8 among celiac disease patients was 93% and 4%, respectively. Among HLA-DQ2 positive, HLA-DQ2.5 and HLA-DQ2.2 were found in 92% and 8%, respectively. Statistically significant difference (p <0.05) was observed between the celiac disease patients and healthy group. There was no significant difference observed among different age groups and gender (p >0.05). CONCLUSION: HLA-DQ2 detection reliably diagnoses celiac disease among all age groups and either gender. It can be used as an effective marker for early diagnosis of celiac disease instead of invasive procedures such as intestinal biopsy. The diagnosis can be pin-pointed by presence of HLA-DQ2.5. Key Words: Celiac disease, HLA-DQ2, HLA-DQ8, HLA-DQ2.5, HLA-DQ2.2.

Optimization of COVID-19 face mask waste fibers and silica fume as a balanced mechanical ameliorator of fat clay using response surface methodology.

The balanced amelioration of mechanical characteristics of fat clay with an additive refers to the attainment of high strength without compromising ductility, which is unattainable by solitary usage of a cementing additive. For this purpose, an amalgamated binary admixture (ABA) is proposed by assimilating shredded face mask (FM) waste, which is posing serious environmental concerns these days, with a cementitious waste material, i.e., silica fume (SF). However, for such ABA, the optimization of mix design is desirable because an excessive amount of one component could disturb the required balance. To address this issue, response surface methodology (RSM) is used in the current study, which is a strong technique used during the process of production to develop, improve, and optimize product inputs. Several experiments are designed and conducted to evaluate mechanical responses, i.e., unconfined compressive strength (qu), brittleness index (IB), deformability index (ID), and California bearing ratio (CBR) value, of treated fat clay by varying mix designs of ABA. Based on the test results, mathematical models are developed which are found to be statistically valid to predict the subjected responses using SF and FM as inputs. Afterward, an optimized mix design is determined by integrating developed models with a desirability function model and setting maximization of strength and ductility as the optimization goals. An ABA having 7.9% SF and 1.2% FM is observed to provide the highest strength and ductility for multiple applications, i.e., road and buildings, with desirability factor close to unity; responses of which are also validated by performing tests. Furthermore, analysis of cleaning aspect shows that the use of optimized ABA in place of cement for subgrade improvement of 1 km two-lane road could avoid CO2 emission of around 79,032 kg of C, save 42,720 kWh and 1174.8 GJ of electrical and thermal energy, respectively, and clean 43 Mg of FM waste; however, astute protocols of COVID-19 FM waste handling and disinfection are needed to be established and followed.

A Young Man with a Rare Case of Adrenal Incidentaloma.

Adrenal incidentalomas (AIs) are adrenal masses discovered as incidental finding, often on imaging studies, unrelated to adrenal disorders. Sometimes, they are discovered as part of work-up for adrenal pathology. AIs are mostly nonfunctional (hormonally silent), but can also be functional (hormonally active). The differential diagnosis includes many primary, metastatic, benign and malignant conditions. The current case is a young male, who went to a peripheral health facility with complaints of dysuria and burning micturition. His laboratory and radiological investigations suggested a urinary tract infection with an incidental finding of adrenal mass. After referral, his detailed work-up was done at Endocrine Clinic of Armed Forces Institute of Pathology (AFIP), Rawalpindi, which revealed history of episodic headaches and palpitations with paroxysmal spikes of high blood pressure up to 200/120 mmHg. Adrenalectomy was performed by laparoscopic surgery. Histopathological examination confirmed the diagnosis of pheochromocytoma with PASS score of 5/20. This is one of the rare cases of adrenal incidentaloma, often an autopsy finding. Pheochromocytoma needs to be investigated in all cases of AIs. Key Words: Adrenal incidentaloma, Pheochromocytoma, Urinary tract infection.

Effect of Temperature and Preservative on Neo-ethanol Formation in Postmortem Whole Blood Samples.

OBJECTIVE: To determine the association of temperature, time duration, and preservatives with ethanol neo-genesis in postmortem whole blood samples. STUDY DESIGN: Observational cross-sectional study. PLACE AND DURATION OF STUDY: Department of Chemical Pathology and Toxicology, Armed Forces Institute of Pathology, Rawalpindi, in collaboration with Combined Military Hospital, Rawalpindi from August 2020 to January 2021. METHODOLOGY: Whole blood samples were obtained from cardiac chamber of an autopsy case with aseptic measures and were drawn into six tubes (3 x EDTA tubes and 3 x NaF tubes). These six tubes were stored at 4˚C, 25˚C, and 37˚C. All samples were analysed along with internal standard, on head space gas-chromatography on Day-0, Day-07, Day-14, Day-21, and Day-28 of sampling. RESULTS: A total of 60 samples out of 10 autopsies, were analysed. Blood alcohol concentrations of all samples were negative on 1st day (Day-0) of analysis. Samples stored at 4˚C did not produce any ethanol at any day of analysis, regardless of preservatives used. Neo-ethanol levels of blood samples stored in EDTA preservative were significantly raised (p <0.001) as compared to samples stored in NaF preservative. Samples stored at 37˚C showed significant increase in neo-ethanol concentration (p <0.001) in comparison with samples stored at 4˚C and 25˚C. Neo-ethanol levels increased with duration of storage till 14th day of analysis. CONCLUSION: Sodium fluoride (NaF) should be used as preservative to avoid ethanol neo-genesis during storage and transportation of blood samples for alcohol analysis. Cold chain maintenance is of pivotal importance to exclude false positive blood alcohol results. Key Words: Neo-ethanol, Neo-genesis, Ethylenediaminetetra acetic acid (EDTA), Sodium fluoride (NaF).

Association of Therapeutic Dose of Valproic Acid and Plasma Glycine Levels in Epileptic Patients.

OBJECTIVES: To determine the frequency of hyperglycinemia in epileptic patients taking valproic acid (VPA); and the correlation between therapeutic dose of valproic acid and plasma glycine levels in epileptic patients. STUDY DESIGN: Observational, cross-sectional study. PLACE AND DURATION OF STUDY: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology Rawalpindi, in collaboration with Combined Military Hospital, Rawalpindi, from August 2020 to January 2021. METHODOLOGY: Plasma glycine levels were analysed on ion exchange chromatography (IEC)-based instrument, Biochrome 30+ of epileptic patients undergoing treatment with anti-epileptic agents. Therapeutic doses of valproic acid were taken as serum trough levels of valproic acid and analysed on chemiluminescence-based Abbott Architect Plus i1000 SR. Mann-Whitney U-test was applied to compare plasma glycine levels in epileptic patients on valproic acid and those on multiple anti-epileptic agents. Spearman's correlation was used to correlate plasma glycine levels in epileptic patients with trough levels of valproic acid, duration of treatment and frequency of fits/year. RESULTS: A total of 77 participants, upto 15 years of age, were enrolled. Plasma glycine levels were significantly raised (p <0.001) in those epileptics who were on valproic acid (monodrug therapy), in comparison with those on multiple anti-epileptic agents. There were significant positive correlations between glycine levels and trough valproic acid levels (r = 0.830), duration of treatment (r = 0.525) and frequency of seizures (r = 0.326). CONCLUSION: Epileptic patients treated with valproic acid (VPA) had raised plasma glycine levels, that increased with therapeutic dose of valproic acid and duration of treatment and was associated with increased frequency of fits in those patients. Key Words: Epilepsy, Seizure, Glycine, Valproic acid.

Reuse of COVID-19 face mask for the amelioration of mechanical properties of fat clay: A novel solution to an emerging waste problem.

Not only has the COVID-19 pandemic caused a global health crisis, but it has also changed the dynamics of waste generation around the world. This situation demands a productive solution for face mask (FM) waste management to solve several associated environmental issues. In the current study, a novel soil treatment method is proposed for the improvement of mechanical characteristics of fat clay by using FM as fiber reinforcement and silica fume (SF) as the cementitious agent in the form of a composite binary admixture (CBA). The performance of the proposed CBA is compared with SF and FM as the lone stabilizers by conducting extensive geotechnical testing. The SF treatment exponentially improves the strength characteristics of soil but it marginalizes the ductility of soil, inviting sudden failure and instability under dynamic loadings. It is observed that the proposed CBA not only improves the strength characteristics more than SF but also regulates the ductility and deformability of treated soil due to the presence of FM fibers. In addition, the policies and protocols on the logistics of collecting FM waste and making it ready for the proposed geotechnical application are reviewed; associated health risks, socioeconomic conditions and available technologies are the major governing factors to formulate and implement these policies. Moreover, the prolonged storage of COVID-19 FM waste for disinfection is found to be suitable for the proposed soil stabilization method as per the literature. The current study helps in achieving cost-effective filler/foundation material, solving COVID-19 FM waste problems and promoting resource conservation.

Comparison of Estimated Glomerular Filtration Rate with Both Serum Creatinine and Cystatin C (eGFRcr-cys) versus Single Analyte (eGFRcr or eGFRcys) Using CKD-EPI and MDRD Equations in Tertiary Care Hospital Settings.

OBJECTIVES: To assess and compare the glomerular filtration rate (eGFR) estimated through MDRD and CKD-EPIcr equations in early and late stages of chronic kidney disease on biochemical marker creatinine (eGFRcr), cystatin C (eGFRcys); and combined (eGFRcr-cys), using CKD-EPI equation. STUDY DESIGN: Observational, comparative cross-sectional study. PLACE AND DURATION OF STUDY: Chemical Pathology and Endocrinology Department, Armed Forces Institute of Pathology (AFIP), Rawalpindi in collaboration with Armed Forces Institute of Urology (AFIU), Rawalpindi from October 2019 to March 2020. METHODOLOGY: GFR was assessed on the basis of creatinine clearance taking serum and 24-hour urinary specimens. MDRD and CKD-EPI equations were applied to calculate eGFR by serum creatinine (eGFRcr), cystatin C (eGFRcys), and combined (eGFRcr-cys). Pearson correlation technique was used to compare eGFR calculated by different equations with creatinine clearance in different stages of CKD. Performance of equations was evaluated and compared in different stage of CKD. RESULTS: A total of 181 subjects were enrolled. Median age was 57 years (IQR, 25). Median (IQR) GFR (ml/min/1.73m2) calculated by CrCl, MDRD, CKD-EPIcr, CKD-EPIcys and CKD-EPIcr-cys equations were 45.1 (41.5), 50.6 (23.8), 52.0 (28.0), 43.0 (65.0) and 45 (47), respectively. eGFR calculated by CKD-EPIcr had positive and slightly higher correlation (r=0.880) than MDRD study equation (r=0.867). While comparing the markers, it was observed that CKD-EPIcys had better correlation in early stages of CKD (r=0.889); whereas, CKD-EPIcr performed better in late stages (r=0.896). CKD-EPIcr-cys had the highest correlation (r=0.984) at all stages of CKD. CONCLUSION: eGFR calculated by CKD-EPI equation considered as better diagnostic efficient response than MDRD equation in diagnosis and staging of chronic kidney disease. While applying CKD-EPI equation for measurement of eGFR, eGFRcr-cys performs better than any of eGFRcr or eGFRcys at all stages of CKD. Key Words: Estimated glomerular filtration rate (eGFR), Cystatin C (Cys), Creatinine (Cr), Creatinine clearance (CrCl), CKD-EPI equation, MDRD equation.

Caregiver's Burden of the Patients With Traumatic Brain Injury.

Insufficient attention towards caregivers has resulted in the emergence of psychological and health complaints. Affliction tethers more towards spouses as compared to parents and females as compared to males. The role of sibling care givers was found to be no different from parents or spouses. Marital relationships were found to suffer the most, with the caregiver leaving the traumatic brain injury (TBI) patient in his time of need. The Brief Symptom Inventory (BSI) and family assessment device (FAD) predicted a correlation between patient variables and caregiver discontent. The Blacks/Hispanics proved to cope better with stress and their caregiver roles as compared to Whites. Time elapsed since the injury was found to relieve distress, while the surprising severity of the injury has no recorded impact. Social support or rather a lack of it has been seen to have an impact on family homeostasis, which can further be deteriorated by substance abuse by the patient. The therapeutic intervention found to be most advantageous was the D'Zurilla and Nezu social problem-solving model. Current evidence suggests that emphasis should be given on proper education and encouragement of caregivers before discharge of TBI patients from hospital to reduce the incidence of stressors. Additionally, counseling sessions should be led by professionally led support groups for dealing with psychological symptoms and peer-led group to eliminate social insecurities of caregivers.

Pericardial Tamponade Masquerading as Abdominal Pain Diagnosed by Point-of-care Ultrasonography.

An 18-year-old female presented to the emergency department with a complaint of right-sided abdominal pain for one day. An abdominal computed tomography was significant for hepatic congestion and a large pericardial effusion. The patient was found to have early signs of cardiac tamponade on point-of-care ultrasonography. She was taken to the operating room for pericardial window and had immediate resolution of her symptoms. Patient was diagnosed with systemic lupus erythematosus based on laboratory and clinical findings. This case report details the atypical clinical features of our patient and highlights the subtle signs that should indicate the need for point-of-care cardiac ultrasonographic assessment in these patients.

Predictive value of sGaw, FEF(25-75), and FEV1 for development of asthma after a negative methacholine challenge test.

BACKGROUND: A 20% change in forced expiratory volume in 1 second (FEV(1)) during methacholine challenge testing (MCT) is a reliable marker of asthma. When the FEV(1) decrease is < 20%, there is controversy whether other changes in flows and conductance may be useful. We conducted this study to determine whether changes in sGaw, FEF(25 - 75), and FEV(1) in a negative MCT could predict future occurrence of asthma over a 3-year period. METHODS: A total of 100 consecutive patients with clinical suspicion of asthma but who had a negative MCT per ATS FEV(1) criteria (< 20% FEV(1) decline at 16 mg/mL of methacholine) performed by the 5-breath dosimeter method were analyzed. Two pulmonary fellows, blinded to MCT results, reviewed the patients' medical records. Patients were classified into one of three categories: asthmatic, unclear, and not asthmatic. Decreases in sGaw, FEF(25 - 75), and FEV(1) in the five groups were then retrieved. Analysis of variance (ANOVA) was used for data analysis. RESULTS: Of 100 patients, 23 were excluded owing to lack of a 3-year follow-up. After complete data review, the number of patients (n) in each group was as follows: asthmatic (n = 15), unclear (n = 7), and not asthmatic (n = 55). sGaw and FEF(25 - 75) decreases from the negative MCT could not predict asthma; however, decreases in FEV(1) were associated with future asthma occurrence (sGaw p = 0.21, FEF25-75 p = 0.07, FEV(1) p = 0.0009). Forty-three percent of the patients who had a 10% to 20% decline in FEV(1) eventually developed asthma. CONCLUSION: Up to 20% of patients who have symptoms suggestive of asthma but a negative MCT can still develop asthma. Declines in sGaw and FEF(25 - 75) in a negative MCT appear to have no clinical significance. A decrease in FEV(1), especially 10% to 20%, is associated with the diagnosis of future asthma.