Multipara with utero-vesical fistula following repeat cesarean section: A rare iatrogenic complication

Utero-Vesical fistulas are the rarest of all urogenital fistulas, with most cases occurring after cesarean section. Its prevalence is increasing worldwide because of the increasing indications of cesarean section. Patient usually presents with urine leak, amenorrhea and cyclic hematuria. Herein, we present a case of patient presenting with complain of severe urinary tract infection following cesarean section. Review and update of recent literature regarding the diagnostic imaging of this entity are described

Disparities of Agricultural Productivity in Balochistan A GIS Perspective

Abstract A systems approach to agriculture has gained favou

A review of factors affecting patient satisfaction with nurse led triage in emergency departments

Aim To determine the factors that affect patient satisfaction with nurse-led-triage in EDs using a systematic review. Background Nurses' involvement in the triage services provided in the Emergency Department has been an integral part of practice for several decades in some countries. Although studies exploring patient satisfaction with nurse-led ED triage exist, no systematic review of this evidence is available. Methods MEDLINE, CINAHL, PsycInfo, EMBASE, the Cochrane Library, Joanna Briggs Library and Google Scholar were searched (January 1980–June 2013). Result Eighteen studies that met the inclusion criteria were reviewed. Factors that affect patient satisfaction with nurse-led-triage include nurses' abilities to provide patient centred care, communication skills, nurses' caring abilities, concern for the patient and competence in diagnosing and treating the health problem. Other factors include availability and visibility of nurses, provision of appropriate health related information in a jargon-free language, nurses' ability to answer questions, and an ability to provide patients with an opportunity to ask questions. Conclusion There is continued scope for nurse-led-triage services in the ED. Patients are generally satisfied with the service provided by nurses in EDs and report a willingness to see the same professional again in the future if needed

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

Characterizing a regulatory axis of microRNA-200b, the RNA-binding protein quaking, and cyclin D1 in modulating tumor angiogenesis and metastasis

Angiogenesis is critical to cancer development and metastasis. However, anti-angiogenic agents have only had modest therapeutic success, partly due to an incomplete understanding of tumor endothelial cell (EC) biology. The Pecot lab previously reported that the microRNA (miR)-200 family inhibits metastasis through regulation of tumor angiogenesis, but the underlying molecular mechanisms are poorly characterized. Here, using integrated bioinformatics approaches, I identified the RNA-binding protein (RBP) quaking (QKI) as a leading miR-200b endothelial target with previously unappreciated roles in the tumor microenvironment (TME) in lung cancer. In lung cancer samples, both miR-200b suppression and QKI overexpression corresponded with tumor ECs relative to normal ECs, and QKI silencing phenocopied miR-200b-mediated inhibition of sprouting. Additionally, both cancer cell and endothelial QKI expression in patient samples significantly corresponded with poor survival and correlated with angiogenic indices. QKI supported EC function by stabilizing cyclin D1 (CCND1) mRNA to promote EC G1/S cell cycle transition and proliferation. Both nanoparticle-mediated RNA interference (RNAi) of endothelial QKI expression and palbociclib blockade of CCND1-CDK4/6 function potently inhibited metastasis in concert with significant effects on tumor vasculature. Altogether, this work demonstrates the clinical relevance and therapeutic potential of a novel, actionable miR/RBP axis in tumor angiogenesis and metastasis.Doctor of Philosoph

SEMT Labelings and Deficiencies of Forests with Two Components (II)

Given a simple graph G(V, E), consider a bijective function Γ from V (G) ∪ E(G) to [ν + ε], where ν = |V (G)| = order of G, ε = |E(G)| = size of G. If for all e = xy ∈ E(G), Γ(x) + Γ(e) + Γ(y) is a constant, then Γ is called an edge-magic total (EMT) labeling. Moreover, if Γ(V (G)) = [ν], then Γ is a super edge-magic total (SEMT) labeling of G and G is a SEMT graph. If a graph G has at least one SEMT labeling then the smallest of the magic constants for all possible distinct SEMT labelings of G describes super edge-magic total (SEMT) strength, sm(G), of G. For any graph G, SEMT deficiency is the least number of isolated vertices which when uniting with G yields a SEMT graph. This paper focuses on finding SEMT strength of generalized comb Cbτ (2, 3, . . . , τ +1) and evaluating SEMT labeling and deficiency of forests be composed of two components, where one of the components for each forest is aforesaid generalized comb and other component is star, bistar, comb, path respectivel

Impact of working status on their lives: a survey of working women at a teaching hospital in Karachi, Pakistan

Objective: To study the impact of working status on the lives of working women.Methodology: A questionnaire based cross sectional survey was conducted at the Family Practice Center, Aga Khan University Hospital, Karachi, Pakistan, from July to December 2006. The Questionnaire included data on the demographic profile of the patient and questions in line with study objectives. Ethical requirement including the administration of written informed consent and the provision of confidentiality were ensured. SPSS computer software was used for data analysis. Results: Two hundred working women were interviewed. The mean age was 29.05 years. A majority was married (53.5%) with more than grade XII education (67%). Sixty three (31.5%) women were working due to need and eighty three (41.5%) were finding it difficult to carry out home responsibilities because of it. Extra understanding and support was received from family by 155 (77.5%) and 115 (57.5%) women respectively. One hundred twenty three (61.5%) women felt they did not have enough time for themselves. The status of working women is better than non-working women according to 123 (61.5%) respondents. Financial benefits outweigh other disadvantages according to 105 (52.5%) respondents. Marriage prospects of working women and their children are better than non-working women and their children according to eighty one (40.5%) and eighty (40%) respondents respectively. Confidence in working women is higher than non-working women according to 142 (71%) respondents. Eighty one (40.5%) respondents feel that working women’s financial independence has negative impact on theirs husband’s self esteem. Conclusions: Working women find it difficult to carryout their home responsibilities. There is need for further studies on how to improve the working conditions and home situation for working women in our society

Targeting Accessories to the Crime: Nanoparticle Nucleic Acid Delivery to the Tumor Microenvironment

Nucleic acid delivery for cancer holds extraordinary promise. Increasing expression of tumor suppressor genes or inhibition of oncogenes in cancer cells has important therapeutic potential. However, several barriers impair progress in cancer gene delivery. These include effective delivery to cancer cells and relevant intracellular compartments. Although viral gene delivery can be effective, it has the disadvantages of being immuno-stimulatory, potentially mutagenic and lacking temporal control. Various nanoparticle (NP) platforms have been developed to overcome nucleic acid delivery hurdles, but several challenges still exist. One such challenge has been the accumulation of NPs in non-cancer cells within the tumor microenvironment (TME) as well as the circulation. While uptake by these cancer-associated cells is considered to be an off-target effect in some contexts, several strategies have now emerged to utilize NP-mediated gene delivery to intentionally alter the TME. For example, the similarity of NPs in shape and size to pathogens promotes uptake by antigen presenting cells, which can be used to increase immune stimulation and promote tumor killing by T-lymphocytes. In the era of immunotherapy, boosting the ability of the immune system to eliminate cancer cells has proven to be an exciting new area in cancer nanotechnology. Given the importance of cancer-associated cells in tumor growth and metastasis, targeting these cells in the TME opens up new therapeutic applications for NPs. This review will cover evidence for non-cancer cell accumulation of NPs in animal models and patients, summarize characteristics that promote NP delivery to different cell types, and describe several therapeutic strategies for gene modification within the TME