Bears in Pakistan: Distribution, Population Biology and Human Conflicts

We conducted questionnaire based interviews (n = 1873) of respondents coming from 258 localities about bear tracts in northern parts of Pakistan in 2012-2014 to study Himalyan brown (U. arctos isalbellinus) and Himalayan black (U. t. laniger) bears. Brown bears were more frequent in northern latitudes (northern Chitral, Ghizer, Gilgit and Skardu), while black bears were widely distributed in southern latitudes (Battagram). Both brown and black bears are present in central latitudes (Astor, Diamir, Kohistan and Mansehra). We identified 34 populations of brown bears; a large population in the Deosai Plateau and small to very small populations in other localities. We identified 9 isolated meta-populations sharing common gene pools; 7 (Bomborat, Gias, Chowgram, Laspur-Malkov, Koshi-Palas, Phunder-Yasin, Khunjerab) very small with serious inbreeding and threat of extinction, while Deosai and Diamir-Astor populations were large but were expected to have a high level inbreeding. Black bears were present in 45 localities; larger populations in three localities of Battagram (Nagram, Rahing and Shamli). We identified 6 meta-populations of black bears; Kohistan-Batagram-Mansehra, Diamir-Astor and south Chitral meta-populations were large; but 3 other populations (Thack, Hisper-Minipin and Chasma) were small/very small, possibly having high inbreeding. Bears raid standing maize crops (regular and severe in 2 localities and irregular and severe in 6) and fruit (apricot, grape, mulberry and walnut). Average annual bears depredation of 54 cattle, 188 goat/sheep, 4 yaks, and 9 horses/donkeys/mules were reported, inflicting an economic loss of Pak Rs. 2,840,000 (US$ 28,400) to the livestock farming community. Respondents reported 4 incidences of bear attack (1 killed, 3 injured) and 2 cases of cub poaching during 2013

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

The Distribution, Population Status, and Wildlife Product Trade of Himalayan Musk Deer in Gilgit-Baltistan, Pakistan

Himalayan musk deer (Moschus chrysogaste leucogaster) is an IUCN Red List Endangered species that reaches its western range limit in Pakistan, although its distribution or population size is unknown. Here, we mapped its distribution, described habitat preferences, estimated population sizes, recruitment and mortality, and reported the market values of musk deer wildlife products. We used two approaches: analyzing local wisdom (traditional ecological knowledge) through the use of questionnaires, and conducting confirmatory field surveys of selected areas. Questionnaire respondents indicated musk deer sightings in 28 of 84 localities; mainly in Himalayan dry temperate forests with \u3e20% forest cover. There were an estimated 224-363 individuals. When females were observed with offspring, there were often two fawns present, suggesting twinning. Hunting appears largely opportunistic, with approximately 20% of the population killed each year. Musk, skins and canine teeth are sold in markets. Future threats include future human population growth, growing awareness about musk deer product values and political instability

Comparison of Single-Stage Reverse Sural Artery Flap Versus Two-Staged Interpolated Flap in Distal Lower Limb Injuries

Background and Objective: Plastic surgeons face challenging conditions when dealing with soft tissue injuries or defects involving the lower part of the leg and the proximal part of the foot. The objective of the current study is to compare single-staged reverse sural artery flaps with two-staged interpolated flaps in distal lower limb injuries. Methods: It was a prospective study carried out at the Department of Plastic Surgery, Allama Iqbal Memorial Teaching Hospital, Sialkot, Pakistan, over 5 years from 2015 to 2020. Sixty-eight (n = 68) patients with distal lower limb soft-tissue defects were enrolled and randomly allotted a two-stage interpolated flap design (group A) or single-stage reverse sural artery flap design (group B). The measured outcomes included the frequency of flap-tip necrosis, epidermolysis, partial or total flap loss, and additional procedures needed for managing these complications. Results: Out of all the patients, 72% were of male gender and 28% were females with a mean age of 38.38 &plusmn; 10.76 years. In group A, there were 6% of the cases where tip necrosis was the only impediment as compared to 17% in group B. In patients of group A, epidermolysis was seen in 12% as compared to 35% in group B whereas only 6% of patients in group A required secondary procedures for flap tip necrosis as compared to group B (47%). Paired t-test was used to calculate the statistical significance of the outcome between the two groups (p-value of 0.0491). Conclusion: The two-staged interpolated flap procedure results in fewer complications as compared to a single-staged reverse sural artery flap procedure. However, the shorter hospital stay in single-staged flap design is satisfying for the patients who did not report any complications with this procedure.</p

Foreland basin unconformity, Western Himalaya, Pakistan: timing gap, regional correlation and tectonic implications

Abstract This study estimates the timing of unconformity between marine–continental transitional sequence of the Kuldana Formation and continental sequence of the Murree Formation for the first time across the Hazara-Kashmir syntaxis, western Himalaya, Pakistan. The ages of the studied units are constrained using detrital zircon U–Pb geochronology. The maximum depositional ages constrained by weighted mean and youngest detrital zircon age are 37 ± 1.7 Ma and 22.5 ± 0.6 Ma for top of Kuldana and base of Murree formations, respectively. Based on this age, the duration of hiatus is estimated to be ~ 14.5 Ma. The comparison of this unconformity and sedimentation pattern along strike suggests that the initial collision occurred in the central segment causing its early uplift and erosion with development of the unconformity. The sedimentation in the central segment culminated at ~ 37 Ma and resumed at ~ 22.5 Ma. The wider gap in central segment becomes narrower at western and eastern margin suggesting discontinuous deposition due to gradually closure of western and eastern margin. This supports the diachronous collision of the Indian and Asian plates with initial contact at the central segment