Disease Outcomes of COVID-19 in Diabetic and Hypertensive Patients During the Hospital Stay.

Background A single-stranded RNA genome-encapsulated virus known as severe acute respiratory syndrome coronavirus 2 is known to cause severe acute respiratory syndrome in humans. People with diabetes and hypertension are often more susceptible to developing coronavirus disease 2019 (COVID-19) and experience a disproportionately higher rate of morbidity and death compared to the general population. The COVID-19 pandemic has become an urgent worldwide issue. Therefore, the main goal of this study is to assess how diabetes and hypertension, both separately and together, affect clinical outcomes in terms of morbidity and mortality in patients hospitalized with COVID-19. This study aimed to evaluate the disease outcomes in hypertensive and diabetic patients hospitalized with COVID-19. Methodology This descriptive, cross-sectional study was conducted from June 2022 to November 2022. Using purposive selective sampling, a total of 90 known hypertensive and diabetic patients with COVID-19 aged 18-90 years admitted in COVID-19 isolation wards and intensive care units (ICUs) of Mayo Hospital Lahore were recruited in this study after obtaining informed consent and IRB approval from the Institutional Review Board of King Edward Medical University, Lahore. Patients who did not provide consent, patients whose positive polymerase chain reaction reports for COVID-19 were not available, pregnant females, and patients with other comorbidities were excluded from the study. Data were collected from the COVID-19 isolation medical wards and ICUs from patient charts containing age, the status of hypertension and diabetes, disease status, severity, and levels of inflammatory markers, i.e., D-dimers, serum lactate dehydrogenase (LDH), serum ferritin, C-reactive protein (CRP). Data were analyzed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Quantitative variables such as age were presented as mean ± SD. Qualitative variables such as hypertension, diabetes, and levels of inflammatory markers were presented as frequency and percentages. Results In this study, 90 patients were included, with 51 (57%) females and 39 (43%) males, all of whom were either hypertensive, diabetic, or both. In total, 70 (78%) patients were admitted to ICUs and 20 (22%) to COVID-19 medical isolation wards. Among 70 ICU patients, 39 (43.3%) were on continuous positive airway pressure/bilevel positive airway pressure, seven (7.8%) were on ventilators, and 44 (48.8%) were on normal oxygen masks/non-rebreather masks with high-flow oxygen. Overall, 100% of the patients included in the study had raised levels of inflammatory markers, low lymphocyte count, and increased neutrophil count. In total, 84 (93%) patients had severely high and six (7%) patients had moderately high CRP levels. Moreover, 33 (36.7%) patients had severely high and 57 (63.3%) patients had moderately high D-dimer levels. Further, 25 (28%) patients had severely high, 26 (29%) patients had moderately high, and 39 (43.3%) patients had significantly raised levels of serum ferritin. In total, 21 (23%) patients had severely high, 37 (41%) had moderately high, and 32 (36%) had significantly raised levels of serum LDH. Among the 90 patients, 65 (73%) expired and 25 (27%) survived. Of the expired patients, 62 (95%) were admitted to ICUs, and three (5%) were admitted to wards. Conclusions Diabetes and hypertension are strong predictors of COVID-19 severity in terms of morbidity and mortality due to respiratory deterioration.

Numerical simulation of lead-free vacancy ordered Cs2PtI6 based perovskite solar cell using SCAPS-1D.

In recent years, vacancy-ordered halide double perovskites have emerged as promising non-toxic and stable alternatives for their lead-based counterparts in optoelectronic applications. In particular, vacancy ordered Cs2PtI6 has emerged as a star material because of its high absorption coefficient, band gap of 1.37 eV, and long minority carrier lifetime. Despite substantial experimental research on this new class of material, theoretical simulations of their device properties remain scarce. In this work, a novel n-i-p device architecture (FTO/SnO2/Cs2PtI6/MoO3/C) is theoretically investigated using a solar cell capacitance simulator (SCAPS-1D). Theoretical investigations are carried out in order to optimize the device performance structure by varying the perovskite and selective charge transport layer thickness, absorber and interface defect density, operating temperature, back contact, series and shunt resistance, respectively. The optimized device showed an impressive power conversion efficiency (PCE) of 23.52% at 300 K, which is higher than the previously reported values. Subsequent analysis of the device's spectral response indicated that it possessed 98.9% quantum efficiency (QE) and was visibly active. These findings will provide theoretical guidelines for enhancing the performance of Cs2PtI6-based photovoltaic solar cells (PSCs) and pave the way for the widespread implementation of environmentally benign and stable perovskites.

Research on dye sensitized solar cells: recent advancement toward the various constituents of dye sensitized solar cells for efficiency enhancement and future prospects.

It is universally accepted that the financial advancement of a state is essentially dependent upon the energy sector as it is essential in the growth, development, and improvement of the farming, mechanical, and defense sectors. A dependable source of energy is expected to enhance society's expectation of everyday comforts. Modern industrial advancement, which is indispensable for any nation, relies upon electricity. The principal explanation behind the energy emergency is rapidly increasing the use of hydrocarbon resources. Thus, the use of renewable resources is essential to overcome this dilemma. The consumption of hydrocarbon fuels and their discharge has destructive consequences on our surroundings. Third-generation photovoltaic (solar) cells are latest encouraging option in solar cells. Currently, dye-sensitized solar cells (DSSC) utilize organic (natural and synthetic) dye and inorganic (ruthenium) as a sensitizer. The nature of this dye combined with different variables has brought about a change in its use. Natural dyes are a feasible alternative in comparison to expensive and rare ruthenium dye owing to their low cast, easy utility, abundant supply of resources, and no environmental threat. In this review, the dyes generally utilized in DSSC are discussed. The DSSC criteria and components are explained, and the progress in inorganic and natural dyes is monitored. Scientists involved in this emerging technology will benefit from this examination.

Recent progress in use of MXene in perovskite solar cells: for interfacial modification, work-function tuning and additive engineering.

The use of perovskites in photovoltaic and related industries has achieved tremendous success over the last decade. However, there are still obstacles to overcome in terms of boosting their performance and resolving stability issues for future commercialization. The introduction of a new 2D material of halide perovskites is now the key advancement in boosting the solar energy conversion efficiency. The implication of a new 2D material (MXene) in perovskite solar cells has been initiated since its first report in 2018, showing excellent transparency, electrical conductivity, carrier mobility, superior mechanical strength, and tunable work function. Based on distinctive features at the hetero-interface, halide perovskite and MXene heterostructures (HPs/Mx) have recently exhibited exceptional improvements in both the performance and stability of perovskite solar cells. Furthermore, the wide families of HPs and MXene materials allow playing with the composition and functionalities of HP/Mx interfaces by applying rational designing and alterations. In this review a comprehensive study of implementing MXenes in perovskite solar cells is presented. First, the implementation of MXenes in perovskites as an additive, and then in charge extraction layers (HTL/ETL), is described in detail. It is worth noting that still only Ti3C2Tx, Nb2CTx,V2CTx MXene is being incorporated into perovskite photovoltaics. Finally, the present obstacles in the use of MXenes in PSCS are discussed, along with the future research potential. This review is expected to provide a complete and in-depth description of the current state of research and to open up new opportunities for the study of other MXenes in PSCs.

Hydrothermal synthesis and characterization of transition metal (Mn/Fe/Cu) co-doped cerium oxide-based nano-additives for potential use in the reduction of exhaust emission from spark ignition engines.

The goal of this work was to synthesize new cerium oxide-based nano-additives to minimise emissions from spark ignition (SI) engines fueled with gasoline blends, such as carbon monoxide (CO), unburned hydrocarbons (HC) and oxides of nitrogen (NO x ). To investigate the effect of transition metal dopants on their respective catalytic oxidation activity, nano-sized CeO2 catalysts co-doped with Mn, Fe, Cu and Ag ions were successfully produced by a simple hydrothermal technique. The synthesis of nano-catalysts with cubic fluorite geometry was confirmed by XRD data. The addition of transition metal ions to the CeO2 lattice increased the concentration of structural defects like oxygen vacancies and Ce3+ ions, which are advantageous for the catalytic oxidation reaction, as also supported by XAFS and RAMAN analysis. Further, nano-gasoline fuel emission parameters are measured and compared to straight gasoline fuel. The results demonstrated that harmful exhaust pollutants such as CO, HC and NO x were significantly reduced. The high surface area, better redox characteristics and presence of additional oxygen vacancy sites or Ce3+ ions have been linked to the improved catalytic performance of the synthesized catalyst.

Selected organic dyes (carminic acid, pyrocatechol violet and dithizone) sensitized metal (silver, neodymium) doped TiO2/ZnO nanostructured materials: A photoanode for hybrid bulk heterojunction solar cells.

A photoactive nanohybrid material consisting of pyrocatechol violet, carminic acid and dithizone dyes functionalized silver and neodymium-doped TiO2/ZnO nanostructured materials is reported here, as photoactive blend, for solid-state dye sensitized solar cell. First of all we synthesized metals (silver, neodymium) doped (TiO2) Titanium oxide nanoparticles and their nanocomposites (TiO2/ZnO, M-TiO2/ZnO) using the sol-gel and reflux technique, respectively. The synthesized samples were then characterized by UV-Visible spectroscopy, X-Ray diffraction Analysis (XRD), Scanning electron microscopy (SEM), Energy dispersive X-Ray Analysis (EDX), and Fourier Transform infrared spectroscopy (FTIR). Optical studies were done through UV-Visible spectroscopy and the absorption spectra were used to calculate band gaps. The value of the energy gap for TiO2 nanoparticles is 3.10 eV which was gradually tuned to 2.47 eV after incorporating metals (Ag and Nd) and forming respective nanocomposites. X-Ray diffraction Analysis (XRD) patterns revealed the purity and crystallinity in samples. Scanning electron microscopy (SEM) confirmed the irregular morphology (nanorods and spherical shaped) of ZnO and TiO2 nanostructures respectively. The elemental composition of nanomaterials was successfully investigated using energy dispersive X-ray analysis (EDX). In the absence of any impurities, Fourier Transform infrared spectroscopy (FTIR) was used to identify the functional groups in synthesized material. For device fabrication, a solid-state electrolyte, P3HT, a hole conducting polymer was used. Characterization of fabricated solar cells was done using I-V measurements. Under simulated solar irradiation, the DSSC based on pyrocatechol violet sensitized neodymium doped TiO2/ZnO nanohybrid materials exhibited the best PCE (power conversion efficiency) of 2.38 % and significantly improved Jsc (short circuit current density) of 15.68 mA/cm2 as compared to carminic acid and dithizone in photovoltaic measurements. The improved power conversion efficiency of this device is ascribed to the particle size, increased dye adsorption, increased surface area and thus improved short circuit current density (Jsc).

Medicinal plants resources of Western Himalayan Palas Valley, Indus Kohistan, Pakistan: Their uses and degrees of risk of extinction.

Present study was intended with the aim to document the pre-existence traditional knowledge and ethnomedicinal uses of plant species in the Palas valley. Data were collected during 2015-2016 to explore plants resource, their utilization and documentation of the indigenous knowledge. The current study reported a total of 65 medicinal plant species of 57 genera belonging to 40 families. Among 65 species, the leading parts were leaves (15) followed by fruits (12), stem (6) and berries (1), medicinally significant while, 13 plant species are medicinally important for rhizome, 4 for root, 4 for seed, 4 for bark and 1 each for resin. Similarly, thirteen species were used as a whole while twelve species as partial for medicinal purpose. Further, it is concluded that every part of plants such as bulb, rhizome, roots, barks, leaves, flowers, fruit and seed were used for various ailments. Moreover, among 65 plants species, 09 species are threatened and placed into Endangered (EN) and Least Concern (LC) categories of IUCN. The recorded data are very useful and reflects the significance of the Palas valley as medicinal plants resource area.

Association of Serum Vitamin D and Immunoglobulin E Levels With Severity of Allergic Rhinitis.

Objective The aim of this study was to determine the association of serum vitamin D and immunoglobulin E (IgE) levels with the severity of allergic rhinitis (AR). Methods This case-control study was conducted at Mayo Hospital, Lahore, from June to September 2020 after obtaining ethical approval. Patients of AR were included and divided with the help of allergic rhinitis and its impact on asthma (ARIA) classification, into group A (cases), patients presenting with moderate to severe symptoms, and into group B (control), patients with mild symptoms, after treatment of AR. The mean difference between serum IgE and serum Vitamin D levels of both groups were compared by t-test. Association was determined by logistic regression and odds ratio. Results A total of 224 patients were included in the study, 112 patients in group A and 112 patients in group B. There were 106 (47.3%) female and 118 (52.7%) male. The mean age of patients in group A was 26.78± 8.92 years and in group B, it was 25.72±8.12 years. Mean serum vitamin D levels in group A were 16.24±6.7 ng/ml and in group B 26.92±35 ng/ml (p=0.0001). Mean serum IgE levels in group A were 383.69±154.86 IU/ml and in group B, they were 373.03±106.83 IU/ml (p=0.0001). Vitamin D deficient patients were 24 times more likely to develop moderate to severe AR disease. Conclusion This study showed that in moderate-severe AR, IgE levels are raised statistically as compared to mild AR and the deficiency of Vitamin D is associated with increasing severity of allergic rhinitis symptoms.

Megakaryocytic Clustering in Chronic Myeloid Leukemia: Can it be a Predictor of Clinical Outcome?

OBJECTIVE: To compare clinical outcome in patients of chronic myeloid leukemia (CML) with and without megakaryocytic clustering. STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Pathology Department and CML Clinic Oncology Department, King Edward Medical University from March 2018 to March 2019.  Methodology: Ninety-four patients diagnosed with chronic phase of CML were included. Complete record of complete blood count, splenomegaly, findings of bone marrow aspirate and trephine biopsy was noted. Bone marrow trephine biopsy was reviewed for megakaryocytic clustering. Sokal scoring was done; and follow-up data for clinical outcome, i.e complete hematological response (CHR) at 3 months and major molecular response (MMR) at 6 months and 1 year (as per Institute's protocol) was obtained. All the data were analysed using SPSS version 25. RESULTS: Megakaryocytic clustering was present in 57 (60.6%) patients and absent in 37 (39.4%). In patients with megakaryocytic clustering, CHR was absent in 12 (21.1%), MMR at 6 months was absent in 21 (36.8%) and MMR at 1 year was absent in 25 (43.9%) patients. In patients without megakaryocytic clustering, absent CHR, MMR at 6 months and MMR at 1 year were seen in 1 (2.7%), 2 (5.4%) and 2 (5.4%x), respectively. The correlation of megakaryocytic clustering and high sokal score was found to be statistically significant with a p-value <0.001. CONCLUSION: Patients with megakaryocytic clustering have poor clinical outcome as indicated by their sokal score, absent CHR, MMR at 6 months and 1 year. Key Words: Chronic myeloid leukaemia, Megakaryocytic clustering, Complete haematological response, Major molecular response, Cytogenetic response.

Are Peripheral Blood Counts Predictor of Bone Marrow Infiltration and Hypocellularity in Malignant Neoplasms?

OBJECTIVE: To determine the association of peripheral blood counts (cytopenia and normal counts) with bone marrow findings in patients with malignant neoplasms. STUDY DESIGN: Descriptive study. Place and Duration of the Study: King Edward Medical University from 2017 to 2019. METHODOLOGY: Patients having malignant diseases, of both gender and all ages, were included. Clinical data and results of bilateral bone marrow aspiration and biopsy were noted.  Results were categorised as groups with bone marrow infiltration, normal morphology with normal cellularity and normal morphology with decreased cellularity. Results were analysed using SPSS V21 applying Chi-square test, keeping the confidence interval 95% and p-value of <0.05 as significant. RESULTS: A total of 157 patients were included (107 men, 50 women). The main categories of neoplasm included non-Hodgkin's lymphoma [93 (59.2%)] Hodgkin's lymphoma [31 (19.7%)], and solid organ malignancy [33 (21.0%]. Bone marrow infiltration was seen in 50 (31.8%) patients, normal morphology with decreased cellularity in 51 (32.5%) and normal morphology with normal cellularity in 56 (35.7%) patients. Cytopenias were seen in 88 (56.1%) patients (out of these 28 (31.8%) had bone marrow infiltrarion, 32 (36.4%) had decreased cellularity and 28 (31.8%) with normal cellularity). In 69 (43.9%) patients with normal CBC, 22 (31.9%) had infiltration, 19 (27.5%) had decreased cellularity and 28 (40.6%) had normal cellularity. No association of cytopenia with bone marrow results was obtained (p = 0.086). CONCLUSION: Bone marrow infiltration and hypocellularity are not reflected by peripheral blood counts. Therefore, bone marrow biopsy remains decisive in patients with malignant neoplasm for disease staging and selection of treatment options. Key Words: Peripheral blood counts, Bone marrow infiltration, malignant neoplasms, bone marrow hypocellularity.

Estrogen and Progesterone Receptor Expression in Breast Carcinoma and Its Association With Clinicopathological Variables Among the Pakistani Population.

Introduction The prognosis of breast cancer depends on the histological type, size of the tumor, tumor necrosis, skin, nipple and chest wall invasion, lymphovascular invasion, grade, stage, the status of estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 (HER2), cell proliferation marker (ki-67), and type of therapy. Estrogen receptor and progesterone receptor expression in breast cancer is, so far, the most useful predictive marker. We have undertaken this study to find the expression of ER and PgR in breast carcinoma and its association with other prognostically important clinicopathological variables. Materials and methods In this cross-sectional study, a total of 130 cases of modified radical mastectomy that have been diagnosed as malignant on histopathology were collected from the pathology department of Allama Iqbal Medical College, Lahore, from January 2016 to May 2018. The demographic data and gross and microscopic findings were recorded. Immunohistochemistry (ER, PgR) was applied to suitable tumor sections and their status was evaluated semi-quantitatively by histopathologists using College American Pathologist (CAP) guidelines. Result Most of the breast cancer patients (69; 53.1%) were below 50 years of age. Fifty-nine (45.4%) and 48 (36.9%) cases were positive for ER and PgR, respectively, showing lower hormonal receptor positivity than that reported in the western population where ER expression has been found in 50%-80% of cases and PR expression is found in 60%-70% of cases of invasive ductal carcinoma. The association of the expression of hormone receptors with a clinicopathological variable was demonstrated. ER-/PgR- tumors showed a higher histologic grade, greater tumor size, and more lymph node involvement by metastasis. Conclusion Low hormone receptor positivity is associated with young patients, advanced stage at presentation, and higher grade in our population. The tumor characteristics are different as compared to the western population. This suggests more consideration to the screening, early diagnosis, and molecular or immunohistochemical typing of this cancer in our population.

Comparison of Immature Platelet Fraction (IPF) in Patients with Central Thrombocytopenia and Peripheral Thrombocytopenia.

ABSTRACT  Objective: To determine immature platelet fraction (IPF) in patients with thrombocytopenia and correlation with their bone marrow findings and to determine its predictive value in differentiating peripheral (hyper destructive) thrombocytopenia from central (hypo-productive) thrombocytopenia. STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: King Edward Medical University (KEMU) and Doctors Hospital Lahore, from December 2018 to February 2019. METHODOLOGY: Patients of both genders and all age groups with thrombocytopenia presenting for bone marrow biopsy were included in the study. Clinical data, complete blood count (CBC) sample in EDTA, bone marrow aspirate and trephine biopsy were obtained. Slides were prepared and reviewed. CBC sample was analysed for counts and IPF in Doctors Hospital Laboratory within 4 hours of collection. RESULTS: According to bone marrow findings, patients were grouped under two categories; Group 1 with central (hypo-productive group) thrombocytopenia and Group 2 with peripheral (hyper-destructive group). Group1 (n=44) showed median interquartile range (IQR) IPF 8.2 (4.6-16.7), which was significantly lower (p <0.001) than that of Group 2 (n=14) in which Median IQR IPF was 25.5 (15.2-39.3). A significant moderate degree negative (inverse) correlation was observed between platelet counts and IPF in thrombocytopenic patients in both groups by Pearson correlation. It was statistically significant at p <0 .001 level. IPF in hyper-destructive group has 100% predictive value compared to 31% in hypo-productive group. CONCLUSION:  IPF is a useful parameter and can reliably identify patients having thrombocytopenia due to peripheral destruction. In other cases, IPF should be used in conjunction with other investigations like bone marrow biopsy etc. Key Words: Immature platelet fraction, Complete blood count, Central thrombocytopenia, Peripheral thrombocytopenia, Bone marrow failure, Peripheral destruction.

Association of Programmed Death Ligand-1 Overexpression with the Grade and Stage of Oral Squamous Cell Carcinoma.

ABSTARCT Programmed Death Ligand-1(PD-L) expression can be used to predict targeted therapy against PD-L1/PD-1 pathway in oral squamous cell carcinoma (OSCC). Forty-nine patients were included in the study. Out of the total, 42 well differentiated tumor 3 (7.1%) exhibited strong PD-L1 membranous and cytoplasmic staining, 14 (33.3%) weak staining, and 25 (29.5%) negative staining. Moderately differentiated tumor, (6/49), showed strong staining in 1 (16.7%), weak in none, and negative in 5 (83.3%) cases. Poorly differentiated tumor (1/1) showed strong staining (100%) (p = 0.018). Stage I tumors (n = 38) showed strong staining pattern in 4 (10.5%) cases, weak in 10 (26.3%), and negative in 24 (63.2%) cases. Stage II (n = 8) tumors had strong PD-L1 expression in 1 (12.5%), weak in 3 (37.5%), and negative in 4 (50%) cases. Stage III had negative in 2/3 (66.7%), weak in 1/3 (33.3%) cases, (p = 0.929). Key Word: Grade, PD-L1, Stage, Squamous cell carcinoma, Oral cracinoma.

Association of Comorbid Conditions with Six-month Survival and Disease Outcome in Patients of Necroinflammatory Otitis Externa.

OBJECTIVE: To determine association of gender, causative organisms, control of diabetes, facial paralysis, infectious agent, and hearing loss with disease outcome, in terms of six-month improvement of symptoms, static condition or expiry of patients presenting with necroinflammatory otitis externa (NOE). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: ENT Department in collaboration with Pathology Department, KEMU/Mayo Hospital, Lahore from 2016 to 2019.  Methodology: Patients with NOE were inducted. Studied variables included age at presentation, gender, diabetes, glycated hemoglobin (HbA1c) levels, comorbid conditions, facial nerve involvement, hearing loss, CT and biopsy findings, and causative organisms; and their association with outcome was observed with significance at p<0.05. RESULTS: Out of 28 patients, there were 17 males (60.7%) and 11 females (39.3%). Association between gender and survival showed that 41.2% (7) males and 27.3% (3) females survived; and 23.5% (4) males and 1 (9.1%) female expired within six months of diagnosis. Thinning of temporal bone (2/5=40%) was common among the expired patients. Twenty percent (1/5) patients diagnosed with squamous cell carcinoma and 80% (4/5)with granulation tissue (GT) expired (p=0.543) All ten patients (100%) that improved had mild to moderate hearing loss (p <0.001). Among expired group, 80% (4/5) had HBA1c of more than 7 and 20% (1/5) had good control of diabetes. Aspergillus (2/5=40%) and Pseudomonas (1/5=20%) were the commonest among expired patients; Staphylococcus (6/10=60%) and Pseudomonas (3/10=30%) infections were more frequent among the survived (p=0.005). CONCLUSION: Previously pseudomonal infection was described as the only causative agent of NOE. This study showed a rising community-acquired disease with Staphylococcus aureus 6/10 (60%) and Pseudomonas 3/10 (30%) infection. Fungal infection is associated with poor survival and death, thus requiring aggressive management. Thinning of temporal bone on CT, uncontrolled diabetes, sever hearing loss and facial paralysis score V/VI were associated with poor outcome of disease. Key Words: Necroinflammatory otitis externa, Pseudomonas aeruginosa. Diabetes, Hearing loss, Facial paralysis, Temporal bone thinning, CT scan.

Implementation of Universal Tumor Screening of Colorectal Cancer for Detection of Lynch Syndrome at a Hispanic-Rich County Hospital.

INTRODUCTION: In 2014, a reflexive screening protocol for Lynch syndrome (LS) via an immunohistochemistry (IHC) assay was shown to be cost-effective; however, the screening rates at a predominant Hispanic-rich institution are unclear. We hypothesized that implementation of a universal tumor screening (UTS) protocol requiring screening for LS via IHC in patients with newly diagnosed colorectal cancer (CRC) at our Hispanic-rich institution would improve detection of LS by increasing screening rates. METHODS AND MATERIALS: This is a retrospective analysis of screening rates of 3 sequential cohorts of newly diagnosed patients with CRC between January 2012 and April 2016 at the University Health System and with follow-up at National Cancer Institute-designated Mays Cancer Center at University of Texas Health San Antonio. Cohort 1 consisted of patients screened using old screening guidelines (PRE). Cohort 2 consisted of patients screened when treating clinicians were receiving education on the new protocol (PERI). Cohort 3 consisted of patients screened after implementation of the UTS protocol (POST). RESULTS: The majority of 312 patients were Hispanic (62.5%), 18.1% were < 50 years, and 81.9% were ≥ 50 years of age (median age, 57 years). Of patients with CRC screened for LS via IHC, the PRE, PERI, and POST cohorts had screening rates of 31%, 64%, and 58%, respectively. We found significant differences when comparing the PRE with POST sequential cohorts (P < .01). CONCLUSION: The quality of Lynch syndrome-related family histories and screening rates were significantly improved after implementation in our Hispanic-rich population. Future studies are warranted to provide insight into clinical effects of increased screening, provider and patient surveillance, and screening-related systemic barriers.

Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis.

OBJECTIVE: To determine the frequency of Allergic Fungal Rhino-sinusitis (AFRS) in Chronic Rhino-sinusitis (CRS) patients and the accuracy of fungal culture in diagnosing AFRS. METHODS: Immunocompetent patients with CRS and without invasive fungal rhino-sinusitis presenting over a period of 3 years in ENT department of Mayo Hospital, from April 2014 to September 2017 were included in the study. AFRS was diagnosed clinically and on Bent and Kuhn diagnostic criteria. All patients underwent endoscopic sinus surgery. Removed tissue histopathology and fungal culture was done. Diagnostic accuracy of fungal culture in AFRS patients was determined. RESULTS: Out of 216 patients of CRS, 45 (20.8%) had AFRS. Mean age of patients diagnosed with AFRS was 29.49±9.16. Out of 45 patients, 26 were male and 19 were female. Nasal polyps were present in 45 (100%) patients, fungal stain was positive in 39(86.7%). CT scan showed sinus expansion in 28(62.2%) patients, heterogeneous opacity in 45(100%) patients and bone destruction in 13(28.9%). Presence of Allergic Mucin was seen in 45(100%) patients, high IgE levels in 36(80.0%), eosinophilia in 21(46.7%), presence of Charcot Leyden crystals in 27(60.0%). Asymmetrical involvement of sinuses was seen in 30 (66.7%) and co-existent asthma was seen in 18(40.0%). Fungal culture positive patients were 25(55.6%). Diagnostic accuracy of fungal culture was 91.6%. CONCLUSION: Fungal culture has a key role in confirming diagnosis of AFRS. We also noted that frequency of AFRS is increasing in CRS patients.

Radiotherapy alone with concurrent chemoradiotherapy plus temozolamide in locally advanced soft tissue sarcoma at Mayo Hospital Lahore: A randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of combining an oral chemotherapeutic agent temozolamide with radiotherapy in the management of the un-resectable non-metastatic soft tissue sarcomas compared with radiotherapy alone. METHODS: The randomised controlled phase 3, double-arm study was conducted at King Edward Medical University/Mayo Hospital, Lahore, Pakistan, from December 2012 to July 2017. Patients with all sub-types of locally advanced un-resectable soft tissue sarcomas were randomised into two groups. Group-A received radiotherapy alone while Group-B received concomitant chemoradiotherapy with temozolamide after receiving two cycles of standard chemotherapy. Response was evaluated according to response evaluation criteria in solid tumours through computed tomography scan or magnetic resonance imaging after 6 weeks following completion of radiotherapy. SPSS 21 was used for data analysis. RESULTS: Of the 64 patients, 32(50%) were assigned to each group. The mean age of Group-A was 36.25±20.31 and of Group-B 37.84±15.79 years .There were 18(56.3%) males in Group-A and 20(62.5%) in Group-B. Improvement in trends of overall response rate was observed in Group-B 24(75%) compared to 18(56.3%) in Group-A (p=0.12).. CONCLUSIONS: Though not statistically significant, there was improvement in response rate with the addition of temozolamide to standard radiation therapy.

Engineering electroactive and biocompatible tetra(aniline)-based terpolymers with tunable intrinsic antioxidant properties in vivo.

Under different pathological conditions, high levels of reactive oxygen species (ROS) cause substantial damage to multiple organs. To counter these ROS levels in multiple organs, we have engineered highly potent novel terpolymers. We found that combination of FDA-approved polyethylene glycol, fumaric acid moieties and electroactive tetra(aniline) by varying the content of tetra(aniline) results into a novel drug composition with biologically active and tunable intrinsic antioxidant properties. To test the intrinsic antioxidative properties of these novel terpolymers, we used alloxan to induce diabetes in rats where ROS generation is known to be higher. The systemic administration of terpolymers to the diabetic rats showed strong electroactive antioxidant behavior which not only normalized ROS levels, but also improved the levels of enzymatic antioxidants including superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH). As a proof-of-principle, we here show TANI based novel drug composition of terpolymers with tunable intrinsic antioxidant properties in multiple organs.

Genotoxicity and repair capability of Mus musculus DNA following the oral exposure to Tramadol.

Tramadol is an analgesic and psychoactive drug that acts primarily upon the central nervous system where it alters brain function, resulting in temporary changes in perception, mood, consciousness and behavior. The aim of present study was to analyze the genotoxicity and repair capability of DNA after Tramadol exposure in albino mice (Mus musculus). For this purpose, forty mice were divided equally into four groups as; a control group (without drug) and three treatment groups that were treated with three doses of Tramadol as minimum dose group, Intermediate dose group and maximum dose group, corresponding to 25 mg/kg, 50 mg/kg and 75 mg/kg of body weight respectively. The dose was given orally for 15 days. After 15 days peripheral blood was drawn from half mice of each group and subjected to comet assay. While the remaining half mice were given a recovery period of 15 days and same procedure was used for blood collection and comet assay. Significant difference in various comet parameters was observed among control and exposed groups. Maximum damage was observed at highest concentration 75 mg/kg of Tramadol and minimum damage was observed at dose 25 mg/kg of Tramadol, while results of repaired mice group showed that repair capability of Tramadol was minor and recovery of Tramadol required a lot of time. It can be concluded that Tramadol cause genotoxicity that is dose dependent and has low repair capability.

Comparative Analysis of Nasal Smear Eosinophilia and Serum IgE Levels for the Diagnosis of Allergic Rhinitis.

OBJECTIVE: To compare and determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of nasal smear eosinophilia and serum IgE levels for the diagnosis of allergic rhinitis (AR). STUDY DESIGN: Analytical study. PLACE AND DURATION: ENT and Pathology Departments, KEMU/Mayo Hospital, Lahore from January 2018 to December 2019.   Methodology: Two hundred and twenty-one patients presenting with recurrent rhinitis were included in the study. They were divided into two groups: group 1 presented with history suggestive of allergy for more than four weeks and confirmed to be AR on skin prick tests; group 2 patients with negative skin prick tests taken as controls. Both groups were subjected to serum IgE levels and nasal smear for eosinophilia. Prick test was taken as gold standard, and p<0.05 was taken statistically significant. RESULTS: One hundred and twenty-one patients diagnosed as allergic rhinitis on skin prick tests in group 1 and 100 patients as controls in group 2 had negative skin prick tests. Ninety-one (75.2%) patients had AR on nasal smear eosinophilia in group 1 and 89 (73.6%) patients had AR on serum IgE levels in group 1. Sixty-eight patients (56.2%) were males and 53 (43.8%) were females in group 1. In group 2, 51 (51%) were males and 49 (49%) were females. Mean difference in nasal smear eosinophil count and serum IgE levels in AR and control group was statistically significant (p<0.001). Sensitivity, specificity, PPV and NPV of nasal smear  eosinophilia was 77.8%,71.2%, 75.2%, and 74%; and of IgE level was 82.4%, 71.7%, 73.6%, and 81%, respectively. CONCLUSION: Serum IgE and nasal smear eosinophilia levels are helpful in diagnosing allergic rhinitis; however, serum IgE level has better sensitivity and higher NPV than smear eosinophilia. Specificity of both tests is comparable. Key Words: Allergic rhinitis, Nasal smear eosinophilia, Serum IgE level.