Phytochemistry and Pharmacological Review: Spathodeacampanulata

Spathodeacampanulata (S.campanulata) belongs to the family Bignoniaceae, commonly known as the Fountain tree, African tulip tree, Flame-of-the forest. S.campanulata parts of the plant such as flowers, leaves, stem, bark, and roots are used for anti-malaria, healing of wound, diureticanalgesic and anti-inflammatory activities in folk medicine. The S.campanulata is known to possess various therapeutic properties have been reported for possessing anti-inflammatory, analgesic, cytotoxic, anti-diabetic, and anticonvulsant activity. Phytochemical study shows the presence of various secondary metabolites like alkaloids, tannins, flavonoids, glycosides, and sterols. This review aims to provide detailed information regarding geographical distribution, phytochemicals, and pharmacological properties of the S.campanulata

Genetic Investigation of Consanguineous Pakistani Families Segregating Rare Spinocerebellar Disorders

Spinocerebellar disorders are a vast group of rare neurogenetic conditions, generally characterized by overlapping clinical symptoms including progressive cerebellar ataxia, spastic paraparesis, cognitive deficiencies, skeletal/muscular and ocular abnormalities. The objective of the present study is to identify the underlying genetic causes of the rare spinocerebellar disorders in the Pakistani population. Herein, nine consanguineous families presenting different spinocerebellar phenotypes have been investigated using whole exome sequencing. Sanger sequencing was performed for segregation analysis in all the available individuals of each family. The molecular analysis of these families identified six novel pathogenic/likely pathogenic variants; ZFYVE26: c.1093del, SACS: c.1201C>T, BICD2: c.2156A>T, ALS2: c.2171-3T>G, ALS2: c.3145T>A, and B4GALNT1: c.334_335dup, and three already reported pathogenic variants; FA2H: c.159_176del, APTX: c.689T>G, and SETX: c.5308_5311del. The clinical features of all patients in each family are concurrent with the already reported cases. Hence, the current study expands the mutation spectrum of rare spinocerebellar disorders and implies the usefulness of next-generation sequencing in combination with clinical investigation for better diagnosis of these overlapping phenotypes

Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan : Evidence from two longitudinal cohort studies 15 years apart

Funding Information: Study 1 was funded through the Applied Diarrheal Disease Research Program at Harvard Institute for International Development with a grant from USAID (Project 936–5952, Cooperative Agreement # DPE-5952-A-00-5073-00), and the Aga Khan Health Service, Northern Areas and Chitral, Pakistan. Study 2 was funded by the Pakistan US S&T Cooperative Agreement between the Pakistan Higher Education Commission (HEC) (No.4–421/PAK-US/HEC/2010/955, grant to the Karakoram International University) and US National Academies of Science (Grant Number PGA-P211012 from NAS to the Fogarty International Center). The funding bodies had no role in the design of the study, data collection, analysis, interpretation, or writing of the manuscript. Publisher Copyright: © 2020 The Author(s).Peer reviewedPublisher PD

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

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

La maladie de takayasu chez l’enfant à propos de 4 cas

La maladie de Takayasu est une artérite des gros vaisseaux affectant préférentiellement l’aorte et ses branches. Nous rapportons 4 cas de la maladie de Takayasu à révélation pédiatrique selon les critères de l’ACR, pris en charge à l’unité de nephro-pédiatrie au service de pédiatrie IV, à l’hôpital d’enfant rabat. Les quatre cas sont de sexe féminin, leur âge est compris entre 10 et 16 ans au moment du diagnostic. La maladie a été révélée par des céphalées chez deux d’entre eux, alors qu’elle a été révélée par une fièvre ou des convulsions avec état de mal épileptique chez les deux autres cas. Les quatre cas ont présenté une hypertension artérielle maligne. L’exploration radioangiographique a montré un épaississement pariétal de l’aorte chez les 4 cas associé à celui de la sous clavière et des artères rénales chez 3 cas, des carotides chez deux cas et du tronc artériel brachio-céphalique chez un cas. Le traitement médical a compris les antihypertenseurs et la corticothérapie. Le cyclophosphamide a été ajouté vu la non normalisation de la symptomatologie (tension artérielle, bilan inflammatoire...) en plus du methotrexate qui fût nécessaire chez le quatrième cas. Deux de nos quatre cas ont bénéficié d’un traitement chirurgical et ont décédé en postopératoire immédiat. L’état des deux autres cas reste stable sous traitement médical avec un recul moyen d´un an Cependant, d’après les résultats de notre modeste série, le traitement de la maladie de Takayasu chez l’enfant reste donc médical puisque les deux cas qui ont subit le traitement chirurgical ont décédé tandis que les deux autres restent stable sous traitement médical. En guise de conclusion, la maladie de Takayasu est une maladie rare chez l’enfant et multifactorielle. L’IRM apparait être un examen non invasif prometteur pour le diagnostic et le suivi de ces enfants grâce au dépistage des signes inflammatoires précoces des parois artérielles. Des facteurs pro-inflammatoires restent encore des hypothèses pour expliquer l’etiopathogénie de la maladie. L’espoir fait donc appel à une bonne connaissance de ces facteurs afin de prévenir cette maladie ou du moins limiter son évolution. Les anti-TNF sont de nouvelles thérapeutiques en cours d’essai, ayant fait preuve d’efficacité dans certaines expériences, ils constituent une classe thérapeutique qui semble particulièrement intéressante dans la maladie de Takayasu, cependant des études randomisées semblent être nécessaire pour confirmer leur efficacité

Fatty acid profile of normal and imposex Thais carinifera (Mollusca: Gastropoda) from Karachi coast, Pakistan

1171-1175Fatty acids (FAs) profile of prosobranchneogastropod species Thais cariniferawas analyzed. Morphologically tested imposex, normal female and male individuals of Thais carinifera were examined and variation in fatty acid profiles among all three target groups was investigated in digestive gland/ gonad complex by using gas chromatography mass spectrometry (GC-MS) technique. A total of 39 compounds were detected with a number of carbons C14 to C24 in all sex categories. A clear variable percentile difference in components of saturated (SFAs), monounsaturated fatty acids (MUFA), n-6 polyunsaturated (n-6 PUFA) and n-3 polyunsaturated fatty acids (n-3 PUFA) was encountered in males, females and imposex samples. Increasing levels of MUFA and PUFA were observed in imposex females as compared to other target groups

Body & organ donation in Bihar – A multicentre study on awareness among students of 1st professional MBBS course

Background: With the attendant rise of the number of medical colleges in India over past few decades, the demand for cadavers used in medical education and research is growing. However, there is an insufficient supply of donated cadavers available for dissection. Objective: The present study aimed to assess the awareness about Body & Organ Donation among students of 1st Professional MBBS course in Bihar, India. Materials and Methods: This retrospective, longitudinal cohort, observational multi-center study was carried out between March-2022 to May-2022 on consecutive 500 medical students admitted in 1st Professional MBBS course, studying at KATIHAR MEDICAL COLLEGE, KATIHAR, MADHUBANI MEDICAL COLLEGE, MADHUBANI and PATNA MEDICAL COLLEGE, PATNA, between the study duration. Inclusion criteria composed of only newly admitted first year medical students, following their informed consent whereas, second year, third year and fourth year medical students were excluded from this study. Approval was obtained from Institutional Ethics Committee. A structured questionnaire containing 29 items was administered after due consent by the department of anatomy of each of the above-mentioned medical colleges. The collected data was entered in Microsoft Excel to maintain the quality of data.&nbsp