Diagnostic Accuracy and Agreement between Magnetic Resonance Imaging and Ultrasound Finding for the Diagnosis of Rotator Cuff Tears

Objective: To determine the diagnostic accuracy and agreement between ultrasound and magnetic resonance (MR) imaging in determining rotator cuff tears. Study Design: Cross-sectional study. Place and Duration of the Study: Armed Forces Institute of Radiology and Imaging, Pak Emirates Military Hospital,Rawalpindi Pakistan, from Jul 2018 to Jan 2019. Methodology: Patients of either gender with a traumatic shoulder injury duration of less than 15 days were consecutively included. Rotator cuff tear on ultrasonography was diagnosed on the presence of a hypoechoic discontinuity in the tendon and accentuation of cartilage shadow, giving a 'double cortex' view while on MRI, the hyper-intense signal area within the tendon on T2W, fat-suppressed and GRE sequences, corresponding to fluid signal seen. Results: Of 88 patients, the mean age was 54.022±5.19 years. Ultrasound diagnosed rotator cuff tears in 42(47.7%) patients, and MRI diagnosed rotator cuff tears in 44(50.0%) patients. Diagnostic accuracy of ultrasound taking MR imaging as the gold standard showed sensitivity as 81.82%, specificity as 77.27%, negative predicted value as 78.26%, positive predicted value as 80.95%, and overall diagnostic accuracy as 79.55%. A moderate agreement was found between ultrasound and MRI findings (p-value=0.591). Conclusion: The findings of the current study showed significant moderate agreement between ultrasound and MR imaging in the determination of rotator-cuff tears

Synthesis of novel cyanoacetamides derivatives and their urease inhibition studies

The present study reports a convenient approach for the synthesis of cyanoacetamide based derivatives (7-27) via two-step process involving Knoevenagel reaction, followed by three component reaction to avail desired compounds. All the synthesized compounds were obtained in good to excellent yield and extensively characterized employing 1H NMR, 13C NMR, mass spectrometry and physical parameters. Further, these compounds were screened for urease inhibition. All of the synthesized compounds exhibited good to excellent urease activity notably compound 15 and 19 showed excellent urease inhibition activity with IC50 value ~17.34 μg/mL and 36.75 μg/mL in comparison to thiourea (used as standard) having IC50 value ~27.5 μg/mL

Assessment of Available Manganese in Milk by Using fodders Grown in Long-Term Wastewater Irrigated Soil

Heavy metals are considered as most important contaminations due to industrialization of countries and an influence on its existence in soil, plant and milk. A study was carried out to check manganese content in soil, forage and milk at three sites of city Jhang, Punjab, Pakistan. All samples (milk, soil, water, fodder plants and ground water) were analyzed for manganese by Atomic Absorption Spectrophotometer. Different health indices were also studied to check Mn flow in food chain. Level of Mn in samples was found within acceptable limits. Manganese level was higher in soil samples collected from Site-III than other sites. Manganese showed higher value (2.595 to 10.402 mg/kg) in soil than other samples. Fodders were found to accumulate manganese from 0.008 to 0.022 mg/kg. Manganese concentration was found to be 0.1482 to 1.241 mg/L, 0.164 to 0.9708 mg/L in water and milk, respectively. BCF and PLI values for manganese were also found to be less than 1. Estimated daily intake (EDI) and THQ of manganese are found within permissible limits in milk of cows feeding on fodders irrigated with wastewater and ground water. So, use of wastewater for irrigation purpose should be properly checked due to possible toxic effects

Rational Design and Advance Applications of Transition Metal Oxides

An attractive class of transition metal oxides (TMOs) have been freshly concerned with increasing research interest worldwide concerning stoichiometric and non-stoichiometric configurations as well, that usually exhibits a spinel structure. These TMOs will contribute substantial roles in the production of eco-friendly and low-cost energy conversion (storage) devices owing to their outstanding electrochemical properties. The current chapter involves the summary of the latest research and fundamental advances in the effectual synthesis and rational design of TMOs nanostructures with meticulous size, composition, shape, and micro as well as nanostructures. Also applications of TMOs such as effective photocatalyst, gas sensing, biomedical, and as an electrode material that can be utilized for lithium-ion batteries, and photovoltaic applications. Additionally, certain future tendencies and visions for the development of next-generation advanced TMOs for electrochemical energy storage methods are also displayed

New Pyrimidinone Bearing Aminomethylenes and Schiff Bases as Potent Antioxidant, Antibacterial, SARS-CoV-2, and COVID-19 Main Protease M Pro Inhibitors: Design, Synthesis, Bioactivities, and Computational Studies

New 2-thioxopyrimidinone derivatives (A1–A10) were synthesized in 87–96% yields via a simple three-component condensation reaction. These compounds were screened extensively through in vitro assays for antioxidant and antibacterial investigations. The DPPH assays resulted in the excellent potency of A6–A10 as antioxidants with IC50 values of 0.83 ± 0.125, 0.90 ± 0.77, 0.36 ± 0.063, 1.4 ± 0.07, and 1.18 ± 0.06 mg/mL, which were much better than 1.79 ± 0.045 mg/mL for the reference ascorbic acid. These compounds exhibited better antibacterial potency against Klebsiella with IC50 values of 2 ± 7, 1.32 ± 8.9, 1.19 ± 11, 1.1 ± 12, and 1.16 ± 11 mg/mL for A6–A10. High-throughput screenings (HTS) of these motifs were carried out including investigation of drug-like behaviors, physiochemical property evaluation, and structure-related studies involving DFT and metabolic transformation trends. The radical scavenging ability of the synthesized motifs was validated through molecular docking studies through ligand–protein binding against human inducible nitric oxide synthase (HINOS) PDB ID: 4NOS, and the results were promising. Furthermore, the antiviral capability of the compounds was examined by in silico studies using two viral proteins PDB ID: 6Y84 and PDB ID: 6LU7. Binding poses of ligands were discussed, and amino acids in the protein binding pockets were investigated, where the tested compounds showed much better binding affinities than the standard inhibitors, proving to be suitable leads for antiviral drug discovery. The stabilities of the molecular docked complexes in real systems were validated by molecular dynamics simulations

Assessment of Human Health Risk of Zinc and Lead by Consuming Food Crops Supplied with Excessive Fertilizers

For the study of heavy metals impact on human beings, areas in Sargodha city that were supplied with various types of fertilizers were chosen. The three industrial areas; (Bhalwal, Sillanwali, and Sahiwal) of this city were explored for research reasons. The researchers wanted to know how much heavy metal was in the soil, food crops, and human. Excess fertilizer use contributes to global pollution. Farmyard manure, urea, and potassium chloride were used on Site 1; urea phosphate, manure, and ammonium sulphate were used on Site 2; and super phosphate, ammonium phosphate, and nitrate phosphate were used on Site 3. Samples of commonly used food crops, their respective soils and blood of residents who ingested the food crops of the studied area were collected. The zinc and lead levels in soil (8.30-16.80 and 1.80-12.71 mg/kg) and food crops (0.26-2.02 and 2.26-4.70 mg/kg) were far lower than WHO permitted limits. Blood mean concentration of both Zn (2.30-4.30 mg/L) and Ni (0.24-0.70 mg/L) were found maximum in residents of Site 3. The values of pollution load index, bioconcentration factor, enrichment factor for both zinc and lead were (0.18-0.37 and0.220-0.948), (0.027-0.138 and 0.316-1.705), (0.020-0.144 and 0.515-2.780), respectively. Daily intake of metal (0.004-0.008 and 0.001-0.002 mg/kg/day) and health risk index (0.0001-0.016 and 0.005-0.115) values were observed to be lower in individuals for Zn and Pb, respectively. In present work values of all pollution indices wereSo, there would be no human health hazard

Effects of Fertilizers on Copper and Nickel Accumulation and Human Health Risk Assessment of Vegetables and Food Crops

Despite the fact that fertilizers have been used for millennia for sustainable crop production, this high and considerable dependence on fertilizers heightens environmental concerns with the indirect human exposure due to accumulation of toxins in food chain via soil contamination. The purpose of this study is to evaluate the application of fertilizers to the soil and their effect on the accumulation of copper and nickel in spinach (Spinacia oleracea), garlic (Allium sativum), wheat (Triticum aestivum), maize (Zea mays), and barley (Hordeum vulgare); as well as potential health concerns associated with consuming vegetables cultivated on this contaminated land. Samples of available soil, food crops, and human blood were collected from three different Tehsils: Bhalwal, Sahiwal, and Silanwali and were regarded as site 1, site 2 and site 3 respectively. Urea, farmyard manure, and potassium chloride were delivered to Site 1; urea phosphate, manure, and ammonium sulphate were delivered to Site 2; and superphosphate, ammonium phosphate, and nitrate phosphate were delivered to Site 3. Data was subjected to statistical analysis for computing out ANOVA and correlation. Analysis revealed that minimum copper concentration was found in the soil of T. aestivum grown at Site-1 while the inhabitants of Site 3 had the highest concentration of Cu in their blood. The highest level of HIR was found in the human beings that ate the S. oleracea grown at Site 3. It is strongly advised that fertilizers be used sparingly, as their excessive use can cause human health risks

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

HBV Induced HCC: Major Risk Factors from Genetic to Molecular Level

Hepatocellular carcinoma (HCC) is a deadly and emerging disease leading to death in Asian countries. High hepatitis B virus (HBV) load and chronic hepatitis B (CHB) infection increase the risk of developing HCC. HBV is a DNA virus that can integrate DNA into host genome thereby increase the yield of transactivator protein HBxAg that may deregulate many pathways involving in metabolism of cells. Several monogenic and polygenic risk factors are also involved in HCC development. This review summarizes the mechanism involved in HCC development and discusses some promising therapies to make HCC curative