Use of Computed Tomography for Nasal and Paranasal Anatomic Variants

Augmentations and improvements in sinus surgical methods and computed tomography (CT) have concurrently elaborated interest in variable anatomical features of the nasal cavity and paranasal sinuses (PNS). Anatomical variations are normal morphological structures that are present in humans. The presence of these anatomical variations can affect nearby anatomical relations resulting in structural modifications. By the broad perspective of anatomical features in the sinonasal area, certain anatomical characteristics are supposed to be a risk factor for the advancement of sinus pathological conditions and hence it should be essential for the radiologist to be conscious of the variable anatomical structures residing within the nasal and PNS area, significantly if the treatment plan includes surgical procedures. The sinonasal tomographic imaging is required in symptomatic subjects of sinusitis to evaluate the mysterious sinonasal anatomy including morphology, variations, detailed bony visualization, and pathologies within the sinonasal region and surroundings. This review includes studies from 2013-2023 which were extracted from searching databases like Google Scholar, Internet sources, PubMed, Scopus, and Medline to establish a critical review of hidden anatomy of nasal and paranasal sinus region, detected by computed tomography and highlight the operative significance to enhance the surgical outcomes globally

MicroRNA-1 Attenuates the Growth and Metastasis of Small Cell Lung Cancer through CXCR4/FOXM1/RRM2 Axis

BACKGROUND: Small cell lung cancer (SCLC) is an aggressive lung cancer subtype that is associated with high recurrence and poor prognosis. Due to lack of potential drug targets, SCLC patients have few therapeutic options. MicroRNAs (miRNAs) provide an interesting repertoire of therapeutic molecules; however, the identification of miRNAs regulating SCLC growth and metastasis and their precise regulatory mechanisms are not well understood. METHODS: To identify novel miRNAs regulating SCLC, we performed miRNA-sequencing from donor/patient serum samples and analyzed the bulk RNA-sequencing data from the tumors of SCLC patients. Further, we developed a nanotechnology-based, highly sensitive method to detect microRNA-1 (miR-1, identified miRNA) in patient serum samples and SCLC cell lines. To assess the therapeutic potential of miR-1, we developed various in vitro models, including miR-1 sponge (miR-1Zip) and DOX-On-miR-1 (Tet-ON) inducible stable overexpression systems. Mouse models derived from intracardiac injection of SCLC cells (miR-1Zip and DOX-On-miR-1) were established to delineate the role of miR-1 in SCLC metastasis. In situ hybridization and immunohistochemistry were used to analyze the expression of miR-1 and target proteins (mouse and human tumor specimens), respectively. Dual-luciferase assay was used to validate the target of miR-1, and chromatin immunoprecipitation assay was used to investigate the protein-gene interactions. RESULTS: A consistent downregulation of miR-1 was observed in tumor tissues and serum samples of SCLC patients compared to their matched normal controls, and these results were recapitulated in SCLC cell lines. Gain of function studies of miR-1 in SCLC cell lines showed decreased cell growth and oncogenic signaling, whereas loss of function studies of miR-1 rescued this effect. Intracardiac injection of gain of function of miR-1 SCLC cell lines in the mouse models showed a decrease in distant organ metastasis, whereas loss of function of miR-1 potentiated growth and metastasis. Mechanistic studies revealed that CXCR4 is a direct target of miR-1 in SCLC. Using unbiased transcriptomic analysis, we identified CXCR4/FOXM1/RRM2 as a unique axis that regulates SCLC growth and metastasis. Our results further showed that FOXM1 directly binds to the RRM2 promoter and regulates its activity in SCLC. CONCLUSIONS: Our findings revealed that miR-1 is a critical regulator for decreasing SCLC growth and metastasis. It targets the CXCR4/FOXM1/RRM2 axis and has a high potential for the development of novel SCLC therapies. MicroRNA-1 (miR-1) downregulation in the tumor tissues and serum samples of SCLC patients is an important hallmark of tumor growth and metastasis. The introduction of miR-1 in SCLC cell lines decreases cell growth and metastasis. Mechanistically, miR-1 directly targets CXCR4, which further prevents FOXM1 binding to the RRM2 promoter and decreases SCLC growth and metastasis

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Ethnic Prejudice: Reasons and Its Impacts on urban population with Special Reference to Ethno-linguistic City; Karachi

As internal as well as external migration is quite common in big cities in order to get economic opportunities which causes of heterogeneity in urban areas. Karachi is one of the cities which consisted of multiple ethnic groups and each tries to follow its own customs and tradition. When it’s come to language, people consider it as their identity because it makes them different from others specifically in terms of ethnicheritage which forms a heterogeneous society. Due to multiethnic population discrimination, inequality, competitiveness, deprivation, dominancy, diversity, and socio-economic and ethnic status consciousness take place and become a part of urbanism and enormously affects its life due to increasing ethnic prejudice. The present research test the influence of ethnic socialization, ethic discrimination, ethnic relative deprivation, interethnic interaction on ethnic prejudice. Survey data were collected from the 192 citizen aged above 30. The multiple regression analysis demonstared that all the hypothesized relation were supported except the influence of interethnic interaction on ethnic prejudice. The study outlined implication and recommendations for the policy makers and government

المقارنة بين رواية الامام ورش و رواية الامام حفص في سورة البقره ضوء قصة (ابراهيم عليه السلام): The comparison between the Warsh recitation and the recitation of Imam Hafs in Surat Al-Baqarah in the light of the story (Ibrahim, peace be upon him)

Warsh 'an Naafi' is one of the main canonical methods of reciting the Qur'an. The recitations of the Quran, known in Arabic as Qira'at, are conducted under the rules of the Tajwid Science. It is attributed to Imam Warsh who in turn got it from his teacher Nafi‘ al-Madani who was one of the transmitters of the seven recitations. The recitation of Warsh 'an Naafi' is one of two major recitation traditions. The second is Hafs 'an 'Asim. The Warsh 'an Naafi' recitation of the Quran differs from Hafs 'an Asim in orthography. The majority of differences do not affect the meaning. Yet in some cases the differences change the implications of the verse. In verse 2:184 Hafs recites the verse to be "... a ransom [as substitute] of feeding a poor person...". On the other hand, Warsh reads it "... a ransom [as substitute] of feeding poor people..." Other variants orthography include 

STROKE, A FOREMOST CAUSE FOR DISABILITY AND FUNCTIONAL IMPAIRMENT

Stroke is a devastating and life altering incident which influence not just the individual with stroke, but also family members and caretakers. Stroke is a worldwide medical issue and is the 2nd familiar reason for demise and 4th important reason for handicap around the world. Roughly 20 million individuals get stroke every year and out of this, 5 million won't stay alive. In advanced nations, the most important reason for disability is stroke, second foremost reason for dementia and third important reason for death. Most commonly seen life threatening adverse events associated with stroke are Infections such as pneumonia and urinary tract infection; depression, fall and fracture. Immobility related complications are pressure ulcers, deep vein thrombosis, limb muscle contractures, shoulder pain, constipation and medical complications such as intracerebral bleed, another stroke and seizures. Advanced age and severity of stroke is the most common cause of greater length of stay in hospital following acute stroke. Further bed rest or immobility related adverse events may delay early discharge from the hospital. Research evidence says that very early, frequent and intensive mobilization activities including out of bed activities help in reducing the length of the hospital stay. In this paper, we will briefly review various aspects related to stroke. Key words: Stroke, cerebral injury, seizure

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4&nbsp;% presented with RS, while 13.6&nbsp;% had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7&nbsp;% vs RS: 37.5&nbsp;%). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1&nbsp;% vs. RS 32.0&nbsp;%), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders