Etiology of pancytopenia in patients presenting at tertiary care hospital in Islamabad

Objective: To find the common etiological factors causing pancytopenia in patients presenting to tertiary care hospital in IslamabadStudy Design: Cross sectional observational studyPlace and duration of study: The study was conducted within the department of Hematology (Pathology), Pakistan institute of medical sciences (PIMS) Islamabad from January 2018 to June 2018Patients and Methods: 50 patients with the diagnosis of pancytopenia were listed in the study.  Documentation of patients’ history and physical examination was done. Complete blood counts were done using automated blood analyzer. Bone marrow aspiration and biopsy were done following standard protocols and evaluated microscopically. Data of each patient was documented properly. Consent was taken from all patients and also from the in charge of pathology department for conducting study. Data was analyzed using Microsoft office and SPSS version 2012. Data was expressed in the form of tables.Result: 260 patients from different units were received for bone marrow biopsy during 6 months duration. 50 patients out of 260(19%) were having pancytopenia. The most common cause of pancytopenia was found to be megaloblastic anemia (18%), followed by hypersplenism (16%) and infection related changes (16%). Megaloblastic anemia was most commonly found in the middle aged population (>40-60 years)Conclusion: The study showed that single most common cause of pancytopenia in adult population is megaloblastic anemia, followed by hypersplenism and overwhelming infection. Bone marrow examination is most useful investigation in understanding the etiology of pancytopenia

The Role of Mediation on Work Practices and Employee Involvement

Organizations face many challenges regarding employee engagement and employee job satisfaction. To increase the level of employee job satisfaction, HIWP must be implemented in order to have an impact on employee performance satisfaction. The purpose of this study was to examine the relationship between high-involvement work practices (HIWP) and job satisfaction with the mediating effect of employee engagement; HIWPs consist of four main attributes: (a) power (b) information (c) reward (d) knowledge. This study investigates the relationship between the three variables. Here, convenience sampling was used and data were collected through questionnaires from 185 organizational respondents in the banking sector. Regression analysis was used to test the hypothesis and Andrew F. Hayes model 4 was used to examine the mediating effect. The results showed that there was a significant relationship between the mediating variables and the effect of employee engagement. This study expands on HIWP employment and job satisfaction. The practical implication of this research is to measure the level of job satisfaction of employees by using HIWP can be implemented for managers and employees

Self-Concept and Self-Esteem among Adults

Despite an ample study and analysis of Self concept and Self esteem, not a solitary deconstructive work has been done on the Effect of Self concept on Self esteem. So, this study aimed at the disclosure of all the ways through which self concept affects the self esteem among university students. The research method applied on the paper was quantitative. The study adopted a Multiple Self Concept Scale byBruce A. Bracken and Rosenberg’s Self- esteems scale (Rosenberg, 1965). The collected data analysis was accomplished statistically using the t-test and coefficient of correlation techniques. A sample of 250 students comprised of 75 males and 175 females was taken from BZU Multan. The inferences of the study conceded that Self Concept has a significant effect on Self esteem among university adults. Besides, the research inquiry brought the fact to light that there is, no doubt, a significant disparity of influences of self concept on self esteem between male and female

New solitary wave and computational solitons for Kundu-Eckhaus equation

The goal of this research is to find novel optical solutions to the Kundu-Eckhaus equation, which possess crucial roles in the field of nonlinear optics. A collective variable (CV) strategy is adopted to solve governing equation including the Raman effect and quintic nonlinearity. This method is a suitable to deal with both conservative and non-conservative systems by exposing a set of equations of motion regardless of nonlinearities or dissipative components. The parameters employed in this approach are chirp, temporal position, phase, amplitude, frequency and width, namely, collective variables. The fourth order Runge-Kutta technique is a well-known numerical scheme that aims towards the solution of the resulting system of ordinary differential equations representing the variables involved in the pulse ansatz. This technique presents the evolution of pulse parameters with regard to propagation variables. The graphical profiles at suitable values of pulse parameters are also provided. The unified technique is also applied to find soliton solutions. The obtained solution is a periodic solitary wave, showed graphically. The results developed in this article are found to be new in the literature and the approach utilized, can be applied to solve a variety of nonlinear problems in the mathematical sciences.Open Access funding provided by the Qatar National Library.Scopu

Cardiovascular Complications of Systemic Lupus Erythematosus: Impact of Risk Factors and Therapeutic efficacy--a Tertiary Centre Experience in an Appalachian State

OBJECTIVES: Cardiovascular complications became a notable cause of morbidity and mortality in patients with lupus as therapeutic advancements became more efficient at managing other complications. The Appalachian community in Kentucky has a higher prevalence of traditional cardiovascular risk factors, predisposing them to cardiovascular events. Namely, the mean body mass index of the members of the Kentucky Appalachian community was reported at 33 kg/m2 and 94.3% of male members of this community use tobacco. We sought to identify risk factors that predispose patients with lupus to cardiovascular morbidities and examine the effect of immunomodulatory drugs. METHODS: We identified 20 UKHS patients having both a lupus diagnosis and experienced at least one cardiovascular event. We chose three controls matched for birth-year ±5 years to each case. In a case-control design, we analysed lupus manifestations, cardiovascular risk factors and immunosuppressive therapies. We collected Systemic Lupus Erythematosus Disease Activity Index 2000 disease activity index during the cardiovascular event. RESULTS: We identified 308 patients with lupus from among all University of Kentucky Health System patients. 20 (6.5%) of such patients with lupus were confirmed to cardiovascular complication. Of those 20, 7 (35%) had experienced myocardial infarction, 10 (50%) had experienced stroke and 4 (20%) had peripheral ischaemia. Tobacco use and male gender were the only traditional cardiovascular risk factors higher in the cases group. Hydroxychloroquine and steroids were less utilised in the cases than in the controls (70% vs 100% in hydroxychloroquine, 30% vs 82% in steroids). Venous thrombosis was found to be significantly higher in the cases. On multivariate analysis, venous thrombosis remained significant. CONCLUSION: Despite tobacco use partially explaining the increased risk of cardiovascular disease among the cases group, the higher prevalence of venous thrombosis in the cases group suggests lupus as a potential additional risk factor of cardiovascular morbidity among patients with lupus in this Appalachian community

Caffeine – An Invisible Addiction

Caffeine, an alkaloid, is a stimulant of the central nervous system and is the most popularly consumed psychoactive drug worldwide. This stimulant can have both positive and negative effects on health. The objective of this study was hence to determine the common side effects associated with consumption of caffeinated drinks along with any symptoms stated by the participants that indicate withdrawal. A questionnaire-based descriptive epidemiological study was conducted at three major universities of Lahore, Pakistan. Among the target population that fell in the age ranging from 18-28 years, 35% started consuming caffeinated drinks between the ages 10-15, while tea was consumed by 60% of the sample population. 50% consume caffeinated drinks once or twice a day whereas 60% could refrain from consuming a single drink per day. 38.5% stated to suffer from increased urination while 22% suffered from increased blood pressure upon consumption. Caffeine addiction is one of the most prevalent and ever-expanding addictions in the world which must be either eliminated from diet or replaced by a healthier alternative

Rearing of Trilocha varians (Lepidoptera: Bombycidae) on Ficus benjamina and its Parasitization with Trichogramma chilonis

Ficus benjamina commonly known as weeping fig is an ornamental that planted alongside the road to increase the aesthetic value. Leaf eating caterpillar, Trilocha varians was observed on Ficus benjamina and many other ornamental plants in the surrounding area of Muhammad Nawaz Shareef University. Large larval population was recorded on fig plants with 100 % defoliation. The rearing of Trilocha varians on F. benjamina was carried out under controlled conditions and parasitism of Trichogramma chilonis on eggs were checked. Incubation period was 5-6 days while single female laid 150-210 eggs in her whole life period. With five larval instars, duration period of 1st, 2nd, 3rd, 4th and 5th was 2.0 days, 3-5 days, 2-4 days, 3-6 days and 3-7 days, respectively. Pupa was obtect in nature. Mated and unmated female were long lived as compared to male, 7.50 and 9.25 % egg parasitization was recorded at 16 and 24 hours of exposure, respectively. The coefficient variations were 89.50, 55.92, 42.21 and 29.59 at 12, 16, 20 and 24 h. To determine the larval damage, five different host plants belonging to moraceae family were used. The moderate damage of larvae was observed on Ficus religiosa. The severe feeding damage was observed on F. benjamina and F. virens, while M. alba and F. elastica were found not favorable hosts of T. varians. The study concluded that Trichogramma chilonis was recorded the most suitable parasitoid of T. varians and further need to record the natural enemies of the pest in the country

Clinical Outcome of Ampullary Carcinoma: Single Cancer Center Experience

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Ampullary cancers represent a subset of periampullary cancers, comprising only 0.2% all gastrointestinal cancers. Localized disease is primarily managed by a surgical intervention, called pancreaticoduodenectomy (PD), followed in many cases by the administration of adjuvant chemotherapy (CT) or chemoradiation therapy (CRT). However, there are no clear evidence-based guidelines to aid in selecting both the modality and regimen of adjuvant therapy for resected Ampullary carcinoma. Methods. We retrospectively analyzed 54 patients at KU Cancer Center, who had undergone endoscopic resection or pancreaticoduodenectomy (PD) for Ampullary cancer from June 2006 to July 2016. We obtained patients’ baseline characteristics, clinical presentation, pathology, treatment modality, recurrence pattern, and survival outcomes. The time-to-events data were compared using Kaplan-Meier methods. A univariate and multivariate Cox proportional hazards regression was performed to evaluate factors associated with overall survival (OS) and generate hazard ratios (HR). Results. The mean age of the 54 patients was 68 (37-90). 38 (70%) were males and 16 (30%) were females. Most of the patients were Caucasian (76%). Approximately half of all patients had a history of smoking, 20% had alcohol abuse, and 13% had pancreatitis. Among the 54 patients with localized cancers, 9 (16%) were treated definitively with nonoperative therapies, usually due to a prohibitive comorbidity profile, performance status, or unresectable tumor. 45 out of 54 patients (83%) underwent surgery. Of the 45 patients who underwent surgery, 18 patients (40% of the study cohort) received adjuvant therapy due to concerns for advanced disease as determined by the treating physician. 13 patients (24%) received adjuvant CT and 5 patients (9.2%) received CRT. The remaining 27 patients (50%) underwent surgery alone. The median OS for the entire study cohort was 30 months. When compared to surgery alone, adjuvant therapy with either CT or CRT had no statistically significant difference in terms of progression-free survival (p=0.56) or overall survival (p=0.80). In univariate Cox proportional hazards regression analysis, high-risk features like peripancreatic extension (16%) and perineural invasion (26%) were found to be associated with poor OS. Lymph node metastasis (29%) did not significantly affect OS (HR 1.42, 95% CI 0.73-1.86; p=0.84). Lymphovascular invasion (29%) was not associated with poor OS (HR 1.22, 95% CI 0.52, 2.96; p=0.76). In multivariate Cox regression analysis, only age group>70 years was significantly associated with OS , while other factors, including the receipt of adjuvant therapy, lymph nodes, positive margin, and lymphovascular, perineural, and peripancreatic involvement, were not significantly associated with OS. These results are likely due to small sample size. Conclusions. Despite numerous advances in both cancer care and research, efforts in rare malignancies such as Ampullary cancer remain very challenging with a clear lack of an evidence-based standard of care treatment paradigm. Although adding adjuvant therapies such as chemotherapy or chemoradiotherapy is likely to improve survival in high-risk disease, there is no standardized regimen for the treatment of Ampullary cancer. More research is required to elucidate whether statistically and clinically relevant differences exist that may warrant a change in the current adjuvant treatment strategies

Innovative Methods of Mosquito Management

As the global human and animal population increases, deadly pathogens and parasites may be transmitted by arthropods. There are a number of vectors that pose a threat to human health due to their role in transmitting dangerous pathogens, including mosquitoes (Diptera: Culicidae). The most important drawback of these products is the incidence of insecticide resistance, which has increased rapidly in recent years. New approaches and vector-control tools targeting aquatic stages and adults are urgently needed. The three main mosquito genera, Anopheles, Aedes, and Culex, transmit the causative agents of numerous important diseases to humans as well as animals. A technique that involves the use of genetically modified (GM) mosquitoes for the purpose of vector control is another potential option. Other best ways to control the mosquito are by chemical, biological and genetic means