Esophagoscopy in the early detection and treatment of Plummer Vinson Syndrome

Background: To determine the role of esophagoscopy as a safe and cost-effective procedure which can be used for early diagnosis and treatment of Plummer Vinson Syndrome and prevent development of carcinoma of post-cricoid area. Methods: The study was carried out in E.N.T. department, Rawalpindi General Hospital, Rawalpindi. A total of 25 patients diagnosed with Plummer Vinson Syndrome presented to our department from July 2005 to June 2007 of which 23 patients were included in the study. 2 female patients were found to have carcinoma of hypopharynx and were excluded from the study. Blood CP, serum iron, barium swallow, esophagoscopy and biopsy was done in all the patients. Results: The ratio between female and male was found to be 10:1. Mean hemoglobin was 8 gm/dl. Average mean corpuscular volume (MCV) was 68.5%. Serum iron level was less than 40 ug/dl in females and less than 65 ug/dl in males. Web was seen on barium swallow in all the patients and was confirmed on esophagoscopy. Biopsy of esophageal web was taken in all patients. Biopsy of 2 female patients turned out to be squamous cell carcinoma of post-cricoid region while other 21 biopsies showed normal esophageal mucosa. Conclusion: Plummer Vinson Syndrome is still a common condition in females. Esophagoscopy, excision and dilatation of the web and iron replacement is safe and cost-effective procedure to diagnose and treat the disease. If untreated, may lead to serious complications like post-cricoid carcinoma

Annotation and curation of hypothetical proteins: prioritizing targets for experimental study

Completely sequenced organisms have some uncharacterized proteins that are gene-encoded products. These proteins can be predicted through in-silico approaches and their biological activities are not proved by experimental evidence and known as hypothetical proteins (HPs). These proteins are important due to their excessive involvement in different cellular and signaling pathways. Structural and functional characterization of HPs reveal crucial roles in microorganisms, especially in pathogens related to human diseases. Here, we discussed all possibilities of in-silico analysis tools and other recently reported methods for hypothetical protein characterization and biomedical applications, including drug and vaccine development. Different methodologies, including meta-proteomics have been used to study protein expression by identification of HPs and comparative genomics have also come under observation due to the emergence of evolutionary study among different organisms. Structural characterization of proteins acts as a base for their functional prediction, novel drug target identification for disease treatment, vaccine production and sero-diagnosis. HPs have played major roles in different vital phenomenon for life including host adaptation, wound healing and chemotaxis. In the current era of drug and antibiotic resistance, HPs can be novel targets to treat related diseases. Identification and characterization of most HPs are under observation and will be the most promising genomic and bioinformatics techniques in structure-based drug designing and vaccine production in future

Vitamin D deficiency (VDD) and susceptibility towards severe Dengue fever:a prospective cross-sectional study of hospitalized Dengue fever patients from Lahore, Pakistan

Dengue is a mosquito-borne flaviviral serious febrile illness, most common in the tropical and subtropical regions including Pakistan. Vitamin D is a strong immunomodulator affecting both the innate and adaptive immune responses and plays a pivotal role in pathogen-defense mechanisms. There has been considerable interest in the possible role of vitamin D in dengue viral (DENV) infection. In the present prospective cross-sectional study, we assessed a possible association between serum vitamin D deficiency (VDD) and susceptibility towards severe dengue fever (DF) illness. Serum vitamin D levels were measured at the time of hospitalization in 97 patients diagnosed with dengue fever (DF), dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) at Mayo Hospital, King Edward Medical University, Lahore, PK, from 16 November 2021 to 15 January 2022. In terms of disease severity, 37 (38.1%) patients were DF, 52 (53.6%) were DHF grade 1 and 2, and 8 (8.2%) were DSS. The results revealed that most patients (75 (77.3%)) were vitamin-D-deficient (i.e., serum level &lt; 20 ng/mL), including 27 (73.0%) in DF, 41 (78.8%) in DHF grade 1 and 2, and 7 (87.5%) in DSS. The degree of VDD was somewhat higher in DSS patients as compared to DF and DHF grade 1 and 2 patients. Overall, serum vitamin D levels ranged from 4.2 to 109.7 ng/mL, and the median (IQR) was in the VDD range, i.e., 12.2 (9.1, 17.8) ng/mL. Our results suggest that there may be a possible association between VDD and susceptibility towards severe dengue illness. Hence, maintaining sufficient vitamin D levels in the body either through diet or supplementation may help provide adequate immune protection against severe dengue fever illness. Further research is warranted.</p

FEDRP Based Model Implementation of Intelligent Energy Management Scheme for a Residential Community in Smart Grids Network

ABSTRACT In the framework of liberalized deregulated electricity market, dynamic competitive environment exists between wholesale and retail dealers for energy supplying and management. Smart Grids topology in form of energy management has forced power supplying agencies to become globally competitive. Demand Response (DR) Programs in context with smart energy network have influenced prosumers and consumers towards it. In this paper Fair Emergency Demand Response Program (FEDRP) is integrated for managing the loads intelligently by using the platform of Smart Grids for Residential Setup. The paper also provides detailed modeling and analysis of respective demands of residential consumers in relation with economic load model for FEDRP. Due to increased customer&apos;s partaking in this program the load on the utility is reduced and managed intelligently during emergency hours by providing fair and attractive incentives to residential clients, thus shifting peak load to off peak hours. The numerical and graphical results are matched for intelligent energy management scenario

Comparative bioavailability study of supplemental oral Sucrosomial ® vs. oral conventional vitamin B12 in enhancing circulatory B12 levels in healthy deficient adults: a multicentre, double-blind randomized clinical trial

Background: Vitamin B12 is essential for neurological function, red blood cell formation, and DNA synthesis. Deficiency can lead to diverse health conditions, including megaloblastic anemia and neurological issues. Oral supplementation is a standard treatment for B12 deficiency. The Sucrosomial® carrier system offers an innovative approach that enhances supplemental nutrient absorption and bioavailability. Objectives: This study aimed to compare the effectiveness of oral Sucrosomial® vitamin B12 formulation vs various conventional B12 supplements, randomly selected from local pharmacies, in increasing and maintaining circulatory B12 levels in healthy deficient adults (200–300 pg/mL). Methods: A randomized, double-blind clinical trial was conducted across three centers in Pakistan from April to July 2024. At KEMU, participants received either Sucrosomial® vitamin B12 or Mecogen SL B12; at LRH, Sucrosomial® B12 or B-SUB B12; and at LUMHS, Sucrosomial® B12, Evermin B12, or Neuromax B12. Participants took a daily single dose of 1,000 μg of the assigned B12 formulation for 7 days. Serum B12 levels were measured at baseline (day 0) and on days 1, 3, 5, and 7. Results: Sucrosomial® B12 was significantly more effective than conventional B12 formulations in increasing and maintaining higher serum B12 levels across all time points. At KEMU, it reached a peak concentration of 454 ± 3.9 pg/mL by day 5, compared to 274 ± 11.1 pg/mL with Mecogen SL B12. At LRH, it peaked at 496 ± 34.4 pg/mL by day 5 versus 304 ± 49.4 pg/mL for B-SUB B12. At LUMHS, it reached 592.7 ± 74.3 pg/mL by day 7, compared to 407.24 ± 41.6 pg/mL for Evermin B12 and 263.82 ± 23.8 pg/mL for Neuromax B12. Sucrosomial® B12 was the only formulation to surpass the deficiency-borderline threshold (200–300 pg/mL) within 24 h of the first dose and was well tolerated with no reported side effects. Conclusion: Sucrosomial® vitamin B12 demonstrated superior efficacy in rapidly and consistently elevating and maintaining higher circulatory B12 levels compared to conventional supplements. Its characteristic absorption mode and proven efficacy suggest it could effectively address B12 deficiency in a broad range of populations, including those with gastrointestinal conditions and pernicious anemia, thereby supporting overall health. Clinical trial registration: clinicaltrials.gov, NCT06376591

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Inclusive Education: Strategies for Successful Inclusion of Students with Disabilities in Mainstream Classrooms

This study aimed to assess the strategies that facilitate the effective inclusion for students with disabilities in mainstream classroom settings. It employed a descriptive quantitative research methodology, utilizing a pre-designed questionnaire for data collection that was informed by an extensive investigation of relevant literature and statistical analysis was performed using SPSS. This study included descriptive statistics as well as inferential methods such as t-tests and ANOVA to analyse the replies. The findings indicate that educators hold a predominantly positive view of inclusive education strategies, particularly in relation to co-teaching, differentiated instructions and Universal Design for Learning (UDL). While variations were observed based on gender, title, and region, it was evident that collaborative planning among teachers was crucial. These disclosures highlight the importance of continuous professional development, collaborative relationships, and adequate allocation of resources in promoting inclusive practices. The objective of future research should be to enhance equitable learning environments for all students by conducting in-depth investigations into the professional backgrounds and contextual factors that influence the execution of inclusive education

Costs and Coping Strategies of Tuberculosis Inpatients in Tertiary Care Hospital Settings in Lahore, Pakistan

Background: Despite free treatment and screening programs, Tuberculosis can reduce the working capability of patients due to the costs they incur. Eventually, it can lead to economic crises in low- and middle-income countries with a high prevalence of Tuberculosis. The objectives were to look into the costs incurred by Tuberculosis patients and to determine the coping strategies they adopted while admitted to the Hospitals for treatment of Tuberculosis. Methods: In this cross-sectional study, data was collected using an adapted questionnaire based on World Health Organization’s TB patient cost survey protocol. The study was conducted in two tertiary care hospitals in Lahore from November to December 2019. In all 309 TB patients admitted in these hospitals were administered the questionnaire. The data was analyzed with SPSS version 23 software. Results: The estimated direct medical costs per TB patient were 42,106.7 Pakistani Rupees ($271.65). Indirect costs per patient were double of this i.e. 76,013.4 Pakistani Rupees ($490.40). About 65.3 % of patients suffered Catastrophic Health Expenditure with a significant difference between the household income before and during TB treatment. About 52.10% of total patients borrowed money from others and 28.76% sold their assets for meeting the costs incurred. Conclusion: Disparities in household income and treatment total costs lead to a decrease in financial risk protection of TB inpatients. A multi-sectoral approach may help cope with the costs of patients and increase the knowledge of newly diagnosed TB patients to decrease the incidence and achieve the END TB goals by 2035.</jats:p