Optimizing sustainable agriculture: A comprehensive review of agronomic practices and their impacts on soil attributes.

This study explores agronomic management (AM) effects on soil parameters under diverse conditions. Investigating tillage practices (TP), nutrient management (NM), crop rotation (CR), organic matter (OM), irrigation management (IM), and mulching (MS), it aims to reveal impacts on soil productivity, nutrient availability, microbial activity, and overall health. Varied TP affect soil quality through compaction, porosity, and erosion risk. Proper NM is vital for nutrient cycling, preventing imbalances and acidification. CR disrupts pest cycles, reduces weed pressure, and boosts nutrient recycling. OM management enhances soil quality by influencing organic carbon, nutrient availability, pH, fertility, and water retention. Optimizing IM regulates soil water content without inducing waterlogging. MS contributes to OM content, nutrient retention, soil structure, and temperature-moisture regulation, benefiting soil biota, aggregation, soil health and agricultural productivity. The review emphasizes integrated nutrient, CR, and OM management's positive impact on fertility and microbial activity. Different TP and IM variations impact soil health and crop production. Judicious implementation of these practices is essential for sustainable agriculture. This synthesis identifies uncertainties and proposes research directions for optimizing productivity while ensuring environmental sustainability. Ongoing inquiry can guide a balanced approach between yields and resilient soil stewardship for future generations.

Physicochemical and mineral properties of suspended sediments of the Tigris and Euphrates rivers in the Mesopotamian Plain.

Most of the suspended river load from the Tigris and Euphrates rivers is deposited in the Mesopotamian Plain in Iraq. This suspended river load comprises sediments consisting of minerals and organic particles generated from weathering, erosion, transport, and sedimentation. Therefore, it is crucial to analyze, either quantitative or qualitatively, the types of minerals in the sediment particles transported by the suspended river load, in addition to the potential value they may add to the agricultural lands irrigated by the Tigris and Euphrates rivers. Herein, samples of suspended sediments were collected from both rivers for physical, chemical, and mineral assessments. The results revealed the predominance of silt particles, followed by clay, and then sand. The presence of clay particles increased while that of silt and sand decreased with further travel into the rivers. The pH values ranged from 7.39 to 7.70 and the electrical conductivity ranged from 1.39 to 2.16 ds m-1. The values of the total and active calcium carbonate minerals were 352.87-336.12 and 172.64-194.56 g kg-1 for the Tigris and Euphrates rivers, respectively. The mineral analysis identified the presence of non-clay minerals at a rate of 83 %, including calcite, quartz, albite, dolomite, and gypsum. Clay minerals, including chlorite, illite, montmorillonite, palygorskite, vermiculite, and kaolinite, were found at a rate of 17 %. Both rivers exhibited distributions of clay and non-clay minerals that vary as they move along the rivers.

EMHD Nanofluid Flow with Radiation and Variable Heat Flux Effects along a Slandering Stretching Sheet.

Nanofluids have gained prominence due to their superior thermo-physical properties. The current paper deals with MHD nanofluid flow over a non-linear stretchable surface of varying thickness in the presence of an electric field. We investigated the effects of nanometer-sized copper (Cu) particles in water (base fluid) as a nanofluid, as well as non-linear thermal radiation, variable fluid viscosity, Joule heating, viscous dissipation, and non-uniform heat flux. The current study's aim is influenced by the immense applications in industry and machine building. It has been observed that linear stretching sheets have been extensively used in heat transfer research. Moreover, no effort has been made yet to model a non-linear stretching sheet with variable thickness. Furthermore, the effects of electromagnetohydrodynamics (EMHD) boundary-layer flow of a nanofluid with the cumulative impact of thermal radiation, variable viscosity, viscous dissipation, Joule heating, and variable heat flux have been investigated. Sheets with variable thicknesses are practically significant in real-life applications and are being used in metallurgical engineering, appliance structures and patterns, atomic reactor mechanization and paper production. To investigate the physical features of the problem, we first examined the model and identified all the physical properties of the problem. This problem has been formulated using basic laws and governing equations. The partial differential equations (PDEs) that govern the flow are converted into a system of non-dimensional ordinary differential equations (ODE's), using appropriate transformations. The Adam-Bashforth predictor-corrector technique and Mathematica software are utilized to numerically solve the resulting non-dimensionalized system. The interaction of various developing parameters with the flow is described graphically for temperature and velocity profiles. It is concluded that the velocity of nanoparticles declines as the intensity of the magnetic field increases. However, the temperature of the nanomaterials rises, as increasing the values of the electric field also increases the velocity distribution. The radiation parameter enhances the temperature field. The temperature of the fluid increases the occurrence of space- and time-dependent parameters for heat generation and absorption and radiation parameters.

Heat Transfer of Magnetohydrodynamic Stratified Dusty Fluid Flow through an Inclined Irregular Porous Channel.

The primary objective of the study is to explore the phenomena of dusty fluid flow through an inclined irregular channel under the impact of the transversely applied magnetic field of fixed strength. The density and viscosity of the working fluid are assumed to vary along with the height of the channel as it behaves as a replica of many real world mechanisms. Hence, a stratified dusty fluid through a channel that tilts to an angle θ is the main objective of the present study. The prescribed flow is mathematically modeled and it is approached numerically under two distinct boundary conditions. The finite difference technique is employed to discretize the system of equations and solved using the Thomas algorithm. The velocity and temperature fields are discussed for different pertinent parameters which influence the flow. The friction factor and heat transfer rate are discussed as it has been a subject of interest in recent decades. The results show that the stratification decay parameter leads to enhancement in the momentum of the fluid flow. The temperature field is found to be higher in the convective boundary than the Navier slip boundary.

Modelling Entropy in Magnetized Flow of Eyring-Powell Nanofluid through Nonlinear Stretching Surface with Chemical Reaction: A Finite Element Method Approach.

The present paper explores the two-dimensional (2D) incompressible mixed-convection flow of magneto-hydrodynamic Eyring-Powell nanofluid through a nonlinear stretching surface in the occurrence of a chemical reaction, entropy generation, and Bejan number effects. The main focus is on the quantity of energy that is lost during any irreversible process of entropy generation. The system of entropy generation was examined with energy efficiency. The set of higher-order non-linear partial differential equations are transformed by utilizing non-dimensional parameters into a set of dimensionless ordinary differential equations. The set of ordinary differential equations are solved numerically with the help of the finite element method (FEM). The illustrative set of computational results of Eyring-Powell (E-P) flow on entropy generation, Bejan number, velocity, temperature, and concentration distributions, as well as physical quantities are influenced by several dimensionless physical parameters that are also presented graphically and in table-form and discussed in detail. It is shown that the Schemit number increases alongside an increase in temperature, but the opposite trend occurs in the Prandtl number. Bejan number and entropy generation decline with the effect of the concentration diffusion parameter, and the results are shown in graphs.

Comparison of the Efficacy of Continuous Femoral Nerve Block With Epidural Analgesia for Postoperative Pain Relief After Unilateral Total Knee Replacement.

Introduction With recent developments in postoperative pain management after total knee replacement (TKR), the continuous femoral nerve block is becoming a common practice. The purpose of this study was to compare a femoral nerve block with time-tested epidural analgesia in a tertiary care setup in a developing country. Methodology A randomized control trial took place at Shifa International Hospital (SIH), Islamabad, Pakistan. Sixty patients, aged 40 to 90 years old, 12 males and 48 females, who were undergoing unilateral TKR for osteoarthritis in American Society of Anesthesiologists (ASA) physical status classes I and II, weighing between 50 and 99 kg, and fully able to understand and respond to the numeric rating scale (NRS) were included in the study. While patients belonging to ASA physical status class ≥3, with chronic opiate therapy, having allergies to local anesthetics or equipment material, or with neuromuscular disease, were excluded from the study. Ethical approval was obtained, and patients were divided into two groups, with group A given epidural and group B given a femoral nerve block for pain management postop. Data were collected. The pain was recorded using the NRS at six, 12, and 24 hours postop. Results The results for six hours and 12 hours were found to be significant. Patients in group A had a lower NRS rating postop as compared to group B and required a lesser amount of additional boluses for pain management.  Conclusion The femoral nerve block is inferior to epidural analgesia for pain management after unilateral TKR in the first 24 hours, with a greater need for extra boluses to relieve pain.

Mediastinal Lymphadenopathy As A Predictor Of Worse Outcome In Severe Covid-19 Cases.

BACKGROUND: This cross-sectional study is aimed at evaluating the association of mediastinal lymphadenopathy with COVID-19 prognosis in severe cases. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Pakistan, from June to July 2020. METHODS: One hundred and fifty (150) laboratory-confirmed SARS CoV-2 infected, severe cases in Intensive Care Unit/ High Dependency Unit were included. These cases were divided into two categories, i.e., with and without mediastinal lymphadenopathy on High Resolution Computed Tomography chest. The two categories were compared on the basis of data obtained including age, gender, comorbid, White Blood Cell count, lymphocyte count, median days of hospitalization, need for invasive ventilation, Intensive Care Unit admission, clinical outcome and High-Resolution Computed Tomography chest findings. The data was compiled on a questionnaire and analysed on SPSS 24. RESULTS: Total 155 severe COVID-19 patients were reviewed, out of which 36 (23.2%) had mediastinal lymphadenopathy (category 1) and 119 (76.8%) had no mediastinal lymphadenopathy (category 2). Laboratory findings including median of white blood cells and lymphocyte percentage had no significant change in both categories. Intensive care unit admissions were 12 (33.3%) and 56 (47.1%) in category 1 and 2 respectively. Median days of hospitalization (8 days) and mortality rate (16%) were almost the same in both categories. CONCLUSIONS: Our study concludes that presence of mediastinal lymphadenopathy in severe COVID-19 cases is not associated with worse outcome. However, overall prevalence of mediastinal lymphadenopathy in severe cases is high (23.2%).

Lack of impact of OCTN1 gene polymorphisms on clinical outcomes of gabapentinoids in Pakistani patients with neuropathic pain.

BACKGROUND AND OBJECTIVE: Gabapentinoids are the first-line drugs for neuropathic pain. These drugs are the substrate of organic cation transporter (OCTN1) for renal excretion and absorption across the intestinal epithelium. Gabapentinoids exhibit wide interindividual variability in daily dosage and therapeutic efficacy which makes titration regimens prolonged for optimal efficacy. The present study aimed to investigate the possible influence of the single nucleotide polymorphism (SNP) of OCTN1 on therapeutic efficacy and safety of gabapentinoids in neuropathic pain patients of the Pakistani population. METHODS: Four hundred and twenty-six patients were enrolled in the study. All participants were genotyped for OCTN1 rs1050152 and rs3792876 by PCR-RFLP method and followed up for eight weeks. The therapeutic outcomes of gabapentinoids, reduction in pain score, inadequate or complete lack of response, adverse events (AEs) in responders and discontinuation of treatment on account of AEs were recorded for all patients. RESULTS: There was no significant association of genotypes and alleles of both SNPs on the clinical response of gabapentinoids (P ˃ 0.05). Similarly, significant differences were not found in the reduction of pain scores and AEs among different genotypes in the responders. The present study has reported the association of OCTN1 rs1050152 and rs3792876 polymorphisms with clinical outcomes of gabapentinoids for the first time in the real-world clinical setting. CONCLUSION: Our results suggest a lack of influence of OCTN1 genetic variants in the determination of clinical response to gabapentinoids in patients with neuropathic pain in the Pakistani population. These findings signify the role of renal functions in predicting the interindividual variability to therapeutic responsiveness of gabapentinoids.

Comparison of Continuous Thoracic Epidural With Erector Spinae Block for Postoperative Analgesia in Adult Living Donor Hepatectomy.

BACKGROUND: Thoracic epidural analgesia (TEA) is commonly used for pain management in donor hepatectomy. Erector spinae plane block (ESPB) is a newer ultrasound-guided block described for the management of thoracic and abdominal pain. There is limited literature available comparing the two techniques. The objective of this study was to compare the postoperative analgesic efficacy and adverse effects of continuous ESPB to continuous TEA in donor hepatectomy. METHODOLOGY: The randomized controlled trial (RCT) was registered on ClinicalTrials.gov (NCT04151511). A total of 82 patients undergoing donor hepatectomy between January 2020 and December 2020 were recruited, of whom 41 received TEA and 41 received ESPB. Randomization was done by the sealed opaque envelope method. RESULTS:  The mean visual analog scale (VAS) scores in donors who received TEA and ESPB in post-anesthesia care unit (PACU) (2.7 + 0.9 vs. 2.4 + 0.5; P = 0.02) at one hour (2.7 + 0.9 vs. 2.2 + 0.6; P = 0.008), six hours (1.8 + 0.9 vs. 0.8 + 0.5; P < 0.001), 12 hours (0.9 + 0.7 vs. 0.2 + 0.7; P < 0.001), and 24 hours (0.48 + 0.5 vs. 0.08 + 0.3; P < 0.001) were significantly different. Mean opioid consumption was 3.38 ± 6.24 mg in the ESPB group and 10.75 ± 9.64 mg in the TEA group (P < 0.001). Mean lung volume (MLV) at 24 hours in the TEA group and ESPB group was 1543 ml and 1815 ml (P < 0.001). MLV was 2545 ml in the TEA group and 2820 ml in the ESPB group at 48 hours (P < 0.001). Mean nausea and vomiting score at six hours was 0.1 vs. 0.03 (P = 0.02). CONCLUSION:  ESPB improves pain control after donor hepatectomy with an enhanced safety profile and reduced opioid consumption.

Recurrence Rate of Trigeminal Neuralgia With the Use of Percutaneous Stereotactic Continuous Radiofrequency Ablation at 80°C for 90 Seconds: A Single-Center Study.

Introduction With recent development in the treatment of trigeminal neuralgia (TN), percutaneous stereotactic rhizotomy is being widely used as an interventional technique. The purpose of this study was to find the recurrence rate of TN in patients who were treated with stereotactic rhizotomy at 80°C for 90 seconds, in a tertiary care set up in a developing country. Methodology A retrospective cohort study was conducted at Shifa International Hospital, Islamabad, Pakistan from September 2016 to August 31, 2021. A total of 57 patients (19 males and 38 females) aged 27-90 years old, whose MRI of the brain had ruled out organic or structural pathologies, and who fulfilled the International Classification of Headache Disorders, 3rd edition for TN were recruited for the study. Of these patients, 51 underwent radiofrequency ablation (RFA) of the trigeminal ganglion (one or more branches of the trigeminal nerve (cranial nerve V (CN V)) in the operation theater. Patients having concomitant comorbid conditions like brain tumors, vascular pathologies, or coagulopathies, those who had previously undergone trigeminal ganglion neurolysis with either alcohol or phenol, who were lost to follow-up before the completion of the six months or had not visited back after the procedure, and those on oral anticoagulants and the ones declared high risk or American Society of Anesthesiologists (ASA) 3 and above for general anesthesia were excluded. Ethical approval was obtained and data were collected from the medical records department. The pain was recorded using the Numeric Rating Scale and recurrence was recorded from the follow-up visits of the patient over at least 12 months. Results Out of 51 patients, three patients who underwent RFA reported recurrence of the same problem for which they had initially reported to the pain clinic and were treated again with RFA. Five patients came back with the neuralgia of a different but contiguous branch of the same Gasserian ganglion opted for the RFA and were treated with no subsequent recurrences. The initial pain relief rate was 84.31%. At the end of the five-year study period, 16 patients reported variable degrees of sensory deficit, and two patients experienced non-debilitating unilateral reversible motor weakness of the jaw. One patient experienced keratitis due to unintentional loss of corneal reflex and subsequent ipsilateral loss of vision. Conclusion RFA is one of the leading treatment options for TN, with lower recurrence at higher temperatures of the radiofrequency electrode, at the cost of more significant sensory and motor deficits.

Haematological Parameters And Outcome In Hospitalized Patients With Covid-19: A Developing Country Experience.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a multisystem disorder and haematological abnormalities are frequently documented in affected patients. METHODS: This retrospective study included 549 patients hospitalized with COVID-19 from 1st June to 15th July 2020 at Pak Emirates hospital, Rawalpindi Pakistan. p<0.05 was considered statistically significant. RESULTS: Median age was 60 years (range 12-94 years), males 442 (80.5%) and females 107 (19.5%). There was no patient with mild illness, 181 (32.9%) had moderate, 158 (28.7%) severe and 210 (38.2%) patients had critical disease. Patients with severe and critical disease had lower absolute lymphocyte count (ALC) and platelets (p<0.001 for both) while higher white blood cell count (WBC), neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6) and lactate dehydrogenase levels (LDH) levels (all p<0.001). Overall survival of study cohort was 83.2% (n=457). Median haemoglobin and platelet count were significantly lower (p<0.001) while WBC, ANC, NLR, prothrombin time (PT), activated partial thromboplastin time (APTT), ferritin, IL-6, LDH were significantly higher (p<0.001) for patients who died. On multivariate logistic regression analysis WBC count>10x109/l (odds ratio [OR] 2.19 [95% CI 1.3-4.2] p=0.01), NLR>9 (OR 3.4 [95% CI 0.87-6.8], p<0.001), platelets<150x109/l (OR 3.9 [95% CI 1.4-9.8] p<0.001), CRP >100; (OR 4.1[95% CI 0.78-10.9] p<0.001) and ferritin >1000 (OR 5.3 [95% CI 1.9- 13.5], p<0.001) were associated with increased risk of death in patients with COVID-19. CONCLUSION: Monitoring of haematological, coagulation and inflammatory parameters provide reliable, convenient, rapid and cost-effective method for predicting disease severity, complications and prognosis of COVID-19 patients.

Entropy Analysis of the Peristaltic Flow of Hybrid Nanofluid Inside an Elliptic Duct with Sinusoidally Advancing Boundaries.

Peristaltic flow of hybrid nanofluid inside a duct having sinusoidally advancing boundaries and elliptic cross-section is mathematically investigated. The notable irreversibility effects are also examined in this mathematical research by considering a descriptive entropy analysis. In addition, this work provides a comparison analysis for two distinct nanofluid models: a hybrid model (Cu-Ag/water) and a phase flow model (Cu/water). A comprehensive graphical description is also provided to interpret the physical aspects of this mathematical analysis.

Mechanics of non-Newtonian blood flow in an artery having multiple stenosis and electroosmotic effects.

The electro-osmotically modulated hemodynamic across an artery with multiple stenosis is mathematically evaluated. The non-Newtonian behaviour of blood flow is tackled by utilizing Casson fluid model for this flow problem. The blood flow is confined in such arteries due to the presence of stenosis and this theoretical analysis provides the electro-osmotic effects for blood flow through such arteries. The mathematical equations that govern this flow problem are converted into their dimensionless form by using appropriate transformations and then exact mathematical computations are performed by utilizing Mathematica software. The range of the considered parameters is given as 0.03<δl<0.12,2

Viscous flow between two sinusoidally deforming curved concentric tubes: advances in endoscopy.

Viscous flow between two sinusoidally deforming curved concentric tubes is mathematically investigated for the first time. Exact solutions are computed to analyse the flow between these two tubes and graphical outcomes are included for a thorough analysis of the solutions. The present article has prime applications in endoscopy as a novel peristaltic endoscope is introduced first time for a curved sinusoidal tube. This curved nature of outer sinusoidal tube with a flexible peristaltic endoscope placed inside it covers the topic of practical applications like endoscopy of human organs having curved shapes and the maintenance of complex machineries that involve complex curve structures. The usage of a flexible peristaltic endoscope inside a curved sinusoidal tube makes the process of catheterization more comfortable.

Effects of temperature dependent viscosity and thermal conductivity on natural convection flow along a curved surface in the presence of exothermic catalytic chemical reaction.

The natural convection boundary layer flow of a viscous incompressible fluid with temperature dependent viscosity and thermal conductivity in the presence of exothermic catalytic chemical reaction along a curved surface has been investigated. The governing non dimensional form of equations is solved numerically by using finite difference scheme. The numerical results of velocity profile, temperature distribution and mass concentration as well as for skin friction, heat transfer rate and mass transfer rate are presented graphically and in tabular form for various values of dimensionless parameters those are generated in flow model during dimensionalization. From the obtained results, it is concluded that the exothermic catalytic chemical reactions is associated with temperature dependent viscosity and thermal conductivity. Further, it is concluded that the body shape parameter also plays an important quantitative role for change in velocity profile, temperature field and mass concentration behavior in the presence of exothermic catalytic chemical reaction.

Convective heat transfer for Peristaltic flow of SWCNT inside a sinusoidal elliptic duct.

A mathematical model is presented to analyse the flow characteristics and heat transfer aspects of a heated Newtonian viscous fluid with single wall carbon nanotubes inside a vertical duct having elliptic cross section and sinusoidally fluctuating walls. Exact mathematical computations are performed to get temperature, velocity and pressure gradient expressions. A polynomial solution technique is utilized to obtain these mathematical solutions. Finally, these computational results are presented graphically and different characteristics of peristaltic flow phenomenon are examined in detail through these graphs. The velocity declines as the volume fraction of carbon nanotubes increases in the base fluid. Since the velocity of fluid is dependent on its temperature in this study case and temperature decreases with increasing volumetric fraction of carbon nanotubes. Thus velocity also declines for increasing volumetric fraction of nanoparticles.

Clearing the Fog: Is Hydroxychloroquine Effective in Reducing Coronavirus Disease-2019 Progression? A Randomized Controlled Trial.

Background Hydroxychloroquine (HCQ) has been considered for the treatment of coronavirus disease 2019 (COVID-19), but data on its efficacy are conflicting. We analyzed the efficacy of HCQ along with standard of care (SOC) treatment, compared with SOC alone, in reducing disease progression in mild COVID-19. Methods A single-center open-label randomized controlled trial was conducted from April 10 to May 31, 2020 at Pak Emirates Military Hospital, Rawalpindi. Five hundred patients of both genders between the ages of 18 and 80 years with mild COVID-19 were enrolled in the study. A total of 349 patients were assigned to the intervention group (standard dose of HCQ plus SOC) and 151 patients were assigned to SOC only. The primary outcome was progression of disease while secondary outcome was polymerase chain reaction (PCR) negativity on days 7 and 14. The results were analyzed on Statistical Package for Social Sciences (SPSS; IBM Corp., Armonk, NY) version 23. A p-value <0.05 was considered significant.  Results The median age of the intervention group was 34 ± 11.778 years and control group was 34 ± 9.813 years. Disease progressed in 16 patients, 11 (3.15%) of which were in the intervention group and 5 (3.3%) in the control group (p-value = 0.940). PCR negative cases in intervention and control groups on day 7 were 182 (52.1%) and 54 (35.8%), respectively (p-value = 0.001); and on day 14 were 244 (69.9%) and 110 (72.9%), respectively (p-value = 0.508). Consecutive PCR negativity on days 7 and 14 was observed in 240 (68.8%) patients in the intervention group compared to 106 (70.2%) in the control group (p-value = 0.321). Conclusion The addition of HCQ to SOC in hospitalized mild COVID-19 patients neither stops disease progression nor helps in early and sustained viral clearance.

Therapeutic plasma exchange for coronavirus disease-2019 triggered cytokine release syndrome; a retrospective propensity matched control study.

BACKGROUND: Cytokine release syndrome (CRS) plays a pivotal role in the pathophysiology and progression of Coronavirus disease-2019 (COVID-19). Therapeutic plasma exchange (TPE) by removing the pathogenic cytokines is hypothesized to dampen CRS. OBJECTIVE: To evaluate the outcomes of the patients with COVID-19 having CRS being treated with TPE compared to controls on the standard of care. METHODOLOGY: Retrospective propensity score-matched analysis in a single centre from 1st April to 31st July 2020. We retrospectively analyzed data of 280 hospitalized patients developing CRS initially. PSM was used to minimize bias from non-randomized treatment assignment. Using PSM 1:1, 90 patients were selected and assigned to 2 equal groups. Forced matching was done for disease severity, routine standard care and advanced supportive care. Many other Co-variates were matched. Primary outcome was 28 days overall survival. Secondary outcomes were duration of hospitalization, CRS resolution time and timing of viral clearance on Polymerase chain reaction testing. RESULTS: After PS-matching, the selected cohort had a median age of 60 years (range 32-73 in TPE, 37-75 in controls), p = 0.325 and all were males. Median symptoms duration was 7 days (range 3-22 days' TPE and 3-20 days controls), p = 0.266. Disease severity in both groups was 6 (6.6%) moderate, 40 (44.4%) severe and 44 (49%) critical. Overall, 28-day survival was significantly superior in the TPE group (91.1%), 95% CI 78.33-97.76; as compared to PS-matched controls (61.5%), 95% CI 51.29-78.76 (log rank 0.002), p<0.001. Median duration of hospitalization was significantly reduced in the TPE treated group (10 days vs 15 days) (p< 0.01). CRS resolution time was also significantly reduced in the TPE group (6 days vs. 12 days) (p< 0.001). In 71 patients who underwent TPE, the mortality was 0 (n = 43) if TPE was done within the first 12 days of illness while it was 17.9% (deaths 5, n = 28 who received it after 12th day (p = 0.0045). CONCLUSION: An earlier use of TPE was associated with improved overall survival, early CRS resolution and time to discharge compared to SOC for COVID-19 triggered CRS in this selected cohort of PS-matched male patients from one major hospital in Pakistan.

Influence of single nucleotide polymorphism of LAT1 on therapeutic response to gabapentinoids in Pakistani patients with neuropathic pain.

Gabapentinoids are substrate of L-type amino acid transporter 1 (LAT1) for distribution across the blood-brain barrier. The present study aimed to evaluate the effect of LAT1 rs4240803 genetic polymorphism on the clinical efficacy and tolerability of gabapentinoids in Pakistani patients with neuropathic pain. Three-hundred and ninety-two patients were recruited, genotyped for SNP rs4240803, and followed up for eight weeks to evaluate the clinical response to gabapentinoids in terms of pain relief, inadequate response, and the emergence of adverse events. LAT1 rs4240803 GG, GA, and AA genotype frequency were 33.42%, 47.96% and 18.62%, respectively. Out of 392 patients, 323 responded to the treatment and 17.6% discontinued either due to insufficient response or intolerable adverse events (AEs). GA genotype was more frequent in non-responder group (P Ë‚ 0.001). Maximum pain responders (≥50%) in combination with the lowest incidence of AEs were observed in the GG group, whereas partial responders belonged to GA genotype and with the highest frequency of somnolence (83.6%) and dizziness (69.9%). Overall, 72.5% patients with GA genotype experienced AEs (P Ë‚ 0.001). In conclusion, clinical outcomes of gabapentinoids are influenced by LAT1 rs4240803 polymorphism and population pharmacogenetics should be considered to evaluate the maximum potential of gabapentinoids in the management of neuropathic pain.

CALL Score and RAS Score as Predictive Models for Coronavirus Disease 2019.

BACKGROUND:  Coronavirus disease 2019 (COVID-19) is a novel infectious disease of multi-system involvement with significant pulmonary manifestations. So far, many prognostic models have been introduced to guide treatment and resource management. However, data on the impact of measurable respiratory parameters associated with the disease are scarce. OBJECTIVE:  To demonstrate the role of Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase (CALL) score and to introduce Respiratory Assessment Scoring (RAS) model in predicting disease progression and mortality in COVID-19. METHODOLOGY:  Data of 252 confirmed COVID-19 patients were collected at Pak Emirates Military Hospital (PEMH) from 10th April 2020 to 31st August 2020. The CALL score and proposed factors of RAS model, namely respiratory rate, oxygen saturation at rest, alveolar arterial gradient and minimal exercise desaturation test, were calculated on the day of admission. Progression of disease was defined and correlated with measured variables. Univariate and multivariate Cox regression analysis for each variable, its hazard ratio (HR) and 95% confidence interval (CI) were calculated, and a nomogram was made using the high-risk respiratory parameters to establish the RAS model. RESULTS:  Progression of disease and death was observed in 124 (49.2%) and 49 (19.4%) patients, respectively. Presence of more than 50% of chest infiltrates was significantly associated with worsening disease and death (p-value <0.001). Death was observed in 100% of patients who had critical disease category on presentation. Regression analysis showed that the presence of comorbidity (n: 180), in contrast to other variables of CALL score, was not a good prognosticator of disease severity (p-value: 0.565). Nonetheless, the CALL model itself was validated to be a reliable prognostic indicator of disease progression and mortality. Some 10 feet oxygen desaturation test (HR: 0.99, 95%CI: 0.95-1.04, p--value: 0.706) was not a powerful predictor of the progression of disease. However, respiratory rate of more than 30 breaths/minute (b/m) (HR: 3.03, 95%CI: 1.77-5.19), resting oxygen saturation of less than 90% (HR: 2.41, 95%CI: 1.15-5.06), and an elevated alveolar-arterial oxygen gradient (HR: 2.14, 95%CI: 1.04-4.39) were considered statistically significant high-risk predictors of disease progression and death, in the formed RAS model. The model resulted in 85% (95%CI: 80%-89%) of area under the receiver operating characteristic curve (AUROC), with substantial positive (76%, 95%CI: 68%-83%) and negative predictive values (80%, 95%CI: 73%-87%) for a cutoff value of seven. Patients with higher CALL and RAS scores also resulted in higher mortality. CONCLUSION:  CALL and RAS scores were strongly associated with progression and mortality in patients with COVID-19.