Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Unstable Homes, Unstable Lives: A Psychogeographic Exploration of Gentrification in Awais Khan’s In the Company of Strangers

Spaces are never neutral; they actively shape an individual’s consciousness. In the wake of gentrification, these spaces become sites of exclusion, moral decay, and profound loss, where individuals struggle to maintain their sense of self amid shifting social and spatial orders. This article examines Awais Khan’s In the Company of Strangers (2019) through the intersecting lenses of Guy Debord’s concept of psychogeography and Sharon Zukin’s theory of gentrification to explore how urban spatial transformation in Lahore disrupts the psychological and moral integrity of the character(s). The study argues that gentrified spaces are not merely physical constructs but also psychogeographic forces that shape consciousness, manipulate desire, and erode individual agency. The research employs textual analysis, and looks into how Khan uses figurative language, spatial metaphors, visual motifs, and irony to depict the city as both seductive and alienating. Ali’s journey shows how gentrified spaces, built to serve the rich, lead the poor into confusion and loss. Drawn by false hopes of a better life, he becomes trapped in a city that controls his choices and slowly breaks down his sense of self. Moreover, this article argues that Khan’s portrayal of Lahore transforms the city into a symbolic landscape, where gentrification operates as psychological violence and leads to Ali’s tragic unravelling and eventual death

External aluminium supply regulates photosynthesis and carbon partitioning in the Al-accumulating tropical shrub Melastoma malabathricum

Peer reviewe

Can age adjusted Charlson comorbidity index predict prognosis in hospitalised COVID-19 patients?

Background: Age adjusted Charlson comorbidity index (ACCI) has previously shown to predict outcome in wide range of diseases. We aim to assess if ACCI can predict 30-day all-cause mortality and need for critical care in COVID-19 patients. Methods: Prospective cohort study of hospitalised patients with confirmed COVID-19 in three acute hospitals. Patients were divided into two groups based on ACCI: Low ACCI (0-4) and high ACCI (≥ 5). Electronic case notes were analysed and results were compared. Results: 173 patients were identified, 108 (62.4%) were males, mean age was 68.4 ± 14.6 years. Median ACCI was 4 (range 0-11). 108 (62.4%) patients were in low ACCI. High ACCI had more ≥ 71 years-old patients (30.6% vs. 81.5%, p < 0.001). Low ACCI had more patients with normal renal function (78.7% vs. 44.6%, p < 0.001) and more likely to present with COVID-19 symptoms (87.0% vs. 56.9%, p < 0.001).More patients in low ACCI were transferred to critical care (42.6% vs. 3.1%, p < 0.001) and intubated (30.6% vs. 1.5%, p < 0.001). However, 30-day all-cause mortality and overall poor outcome was similar in both groups, (15.7% vs. 23.1%, p = 0.229 and 35.2% vs. 24.6%, p = 0.146, respectively). Conclusion: The outcome in COVID-19 hospitalised patients cannot be reliably predicted by ACCI

Impact of the COVID-19 pandemic on core surgical training

Background and aims: COVID-19 pandemic has caused significant disruption in training which is even more pronounced in the surgical specialties. We aim to assess the impact of COVID-19 pandemic on core surgical training. Methods: All core surgical and improving surgical trainees in West of Scotland region were invited to participate in an online voluntary anonymous survey via SurveyMonkey. Results: 28 of 44 (63.6%) trainees responded, 15 (53.6%) were CT1/ST1. 14 (50.0%) working in teaching hospital and 15 (53.6%) working in general surgery. 20 (71.4%) felt that due to the pandemic they have less opportunity to operate as the primary surgeon. 21 (75.0%) have not attended any outpatient clinics. 8 (28.6%) did not have any form of access to the laparoscopic box-trainer. 20 (71.4%) felt their level of confidence in preforming surgical skills has been negatively impacted. 18 (64.3%) found it difficult to demonstrate progress in portfolio. 21 (75.0%) trainees have not attended any teaching. 10 (35.7%) trainees have been off-sick. 8 (28.6%) trainees have felt slightly or significantly more stressed. Conclusion: COVID-19 pandemic has an unprecedented negative impact on all aspects of core surgical training. The long term impact on the current cohort of trainees is yet to be seen

Hartmann's Pouch Stones and Laparoscopic Cholecystectomy: the challenges and the solutions

Background & Objective: Hartmann's pouch stones (HPS) encountered during laparoscopic cholecystectomy (LC) may hinder safe dissection of the cystic pedicle or be complicated by mucocele, empyema, or Mirizzi syndrome; distorting the anatomy and increasing the risk of bile duct injury. We studied the incidence, presentations, operative challenges, and outcomes of HPS. Methods: A cohort study of a prospectively maintained database of LCs and bile duct explorations performed by a single surgeon. Patients were divided into two groups: those with HPS and those without. Patients' demographics, clinical presentation, intra-operative findings, and postoperative outcomes were compared. Results: Of the 5136 patients, 612 (11.9%) had HPS. The HPS group were more likely to present with acute cholecystitis (27.9% vs 5.9%, P = .000) and more patients underwent emergency LC (50.7% vs 41.5%, P = .000). The HPS group had more difficult cholecystectomies, with 46.1% vs 11.8% in the non-HPS group being operative difficulty grade 4 and 5. Mucocele, empyema, and Mirizzi syndrome were more common in the HPS group (24.0% vs 3.7% P = .000, 30.9% vs 3.7% P = .000, 1.8% vs 0.9% P = .000, respectively). There was no significant difference in the open conversion rate or complications. Conclusion: HPS increase the difficulty of LC. Surgeons should be aware of their presence and should employ appropriate dissection strategies. Sharp or diathermy dissection should be avoided. Dislodging the stone into the gall bladder, stone removal, swab dissection, and cholangiography are useful measures to avoid ductal injury and reduce the conversion rate

Case report: incidental findings of COVID-19 infection on positron emission tomography/computed tomography for staging of a giant gastric gastrointestinal stromal tumor

We report the incidental finding of COVID-19 in a 59-year-old male, with no significant cardiorespiratory past medical history who underwent a fluorodeoxyglucose positron emission tomography (FDG-PET) scan for investigation of a likely gastric gastrointestinal stromal tumor (GIST). There may be significant discrepancies between clinical symptoms and radiological severity with COVID-19 infection. FDG-PET scanning has the potential to complement traditional radiological imaging in COVID-19 in diagnosis of subclinical diagnosis or early stage disease, as well as monitoring disease progression

Sensitivity of nasal and oropharyngeal swabs in diagnosing COVID-19 in hospitalised patients

Background: To evaluate the sensitivity of nasal and oropharyngeal swabs in diagnosing COVID-19 in hospitalised patients and comparing patient factors and admission investigations to the swab result. Methods: Multicentre retrospective cohort study of all COVID-19 swab positive patients who were in-patients on 9th April 2020. Electronic case notes were analyzed for baseline characteristics including; age, gender, co-morbidities, admission blood tests and swab results. The results of each consecutive swab for COVID-19 was analysed for each patient. The number of swabs required to achieve a positive test was used to assess the sensitivity of the test. Results: Of the 173 patients identified, 108 (62.4%) were males, mean age was 68.4 ± 14.7 years. Commonest co-morbidity was hypertension (50.9%). 152 (87.9%) patients had their first swab positive. Age over 71 years was positively associated (53.3% vs. 23.8%, p = 0.018) and age-adjusted Charlson Comorbidity Index ≤ 2 was negatively associated (25.0% vs. 52.4%, p = 0.009) with the first swab being positive. Admission blood tests and chest X-ray findings did not influence the swab results. Conclusion: The sensitivity of swab for symptomatic and hospitalised patients was higher than previously thought and admission investigations do not predict the result of swab in COVID-19 positive patients

Performance of Some Advance Desi Chickpea Genotypes against Pod Borer, Helicoverpa armigera (Hubner) Resistance

Abstract.-Twelve advance desi chickpea ( Cicer arietinum L.) genotypes developed at Nuclear Institute for Agriculture and Biology, Faisalabad were evaluated along with check variety for resistance against chickpea pod borer (CPB), Helicoverpa armigera (Hubner) (Lepidoptera: Noctuidae) infestation in a field trial during 2006-2007. None of the tested genotypes showed complete resistance against CPB after studying larval population, pod damage and grain yield parameters. Pod damage ranged from 10.9 to 22.8% among different genotypes. With respect to the check (CM 98) the minimum damage was −35.9% and maximum as 33.1%. Grain yield increase was recorded up to 100% over check in CH 16/02. Comparison of resistance among the genotypes against CPB showed that CM 188/01, CH 07/02, CH 20/02 and CH 84/02 possessed good resistance with increased grain yield over check. Intermediate resistance was evinced in CH 11/02, CH 15/02, CH 17/02 and CH 85/02. While genotypes CM 72/02, CM 246/02, CM 282/02 and CM 98 possessed minimum resistance against CPB. So genotype CH 16/02 showed over all better resistance against CPB, with low larval population, low pod damage and high grain yield