Joy Learning: Smartphone Application For Children With Parkinson Disease

Parkinson's is a Neurologic disorder that not only affects the human body but also their social and personal life. Especially children having the Parkinson's disease come up with infinite difficulties in different areas of life mostly in social interaction, communication, connectedness, and other skills such as thinking, reasoning, learning, remembering. This study gives the solution to learning social skills by using smartphone applications. The children having Parkinson's disease (juvenile) can learn to solve social and common problems by observing real-life situations that cannot be explained properly by instructors. The result shows that the application will enhance their involvement in learning and solving a complex problem

Frequency of Myocardial Infarction in Type 2 Diabetic Patients with Peripheral Arterial Disease

Objective:  This study aimed at determining the frequency of MI in diabetic Pakistani patients with PAD in a Pakistani tertiary care hospital. Methodology: A cross-sectional study carried out at Diabetes Research Centre, Nishtar Hospital Multan for six months from July 10, 2018 to January 09, 2019. The study was approved from the institutional ethics committee. As per study inclusion/exclusion criteria, the patients suffering from DM with PAD were enrolled, after signing the study informed consent. Each patient underwent electrocardiogram (ECG) recording under PI supervision. Patients having pathological Q waves (0.04 seconds wide and 2 mm deep) in two relevant leads were labeled as having myocardial infarction. Results: A total of 290 patients (men: 56.2% and women: 43.8%) were included in the study. Mean age of the patients was 51.29 ± 8.54 years with age range of 40-85 years. There were 71 (24%) smokers and 219 (76%) non-smoker patients. Fifty percent of the total patients were obese. Mean duration of diabetes was 7.39 ± 0.36 years whereas mean duration of peripheral arterial disease was 1.604 ± 0.005 years. The frequency of MI among diabetic patients with PAD was 14.8%. Conclusion: Prevalence of 14.8% MI in the present study alarms to diagnose and treat diabetes and PAD patients at earlier stage

Uterine Artery Doppler Pulsatility Index in the First Trimester as a Forecaster of Pre-Eclampsia in Primary Gravida

Objective: To uncover a correlation between a high uterine artery pulsatility index on Doppler ultrasound and the early onset of pre-eclampsia to reduce maternal and fetal morbidity and mortality. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital, Multan Pakistan, from Jun 2020 to Dec 2021. Methodology: After Ethical Approval and informed consent, the umbilical artery pulsatility (UAPI) of the patients was measured by a transabdominal scan(TAS) between 75 and 100 days. Raised UAPI was correlated with early onset preeclampsia. Results: One hundred and sixty pregnant women were included in the study, out of which 34(21.3%) women developed preeclampsia, and 126(78.8%) were normal patients. Maternal weight (p=0.001), maternal BMI (p=0.002), gestational age and weight at delivery (p=0.001), and uterine artery doppler pulsatility index (p=0.001) had statistically significant differences with pre-eclampsia and regular patients among the target population. Conclusion: First-trimester uterine artery pulsatility index on Doppler ultrasound is a beneficial technique to recognize the women by risk status and target them to prevent pre-eclampsia

1-[1-(4-Bromo­phen­yl)ethyl­idene]-4-(2,4-dimeth­oxy­phen­yl)thio­semicarbazide

In the title compound, C17H18BrN3O2S, the dihedral angle between the aromatic rings is 9.15 (17)°. A bifurcated intra­molecular N—H⋯(N,O) hydrogen bond generates two S(5) rings and a weak intra­molecular C—H⋯S inter­action completes an S(6) ring motif. In the crystal, inversion dimers linked by pairs of N—H⋯S hydrogen bonds generate R 2 2(8) loops and weak C—H⋯S and C—H⋯π inter­actions are also present

Restoring Degraded Landscapes through An Integrated Approach Using Geospatial Technologies in the Context of the Humanitarian Crisis in Cox’s Bazar, Bangladesh

The influx of nearly a million refugees from Myanmar's Rakhine state to Cox's Bazar, Bangladesh, in August 2017 put significant pressure on the regional landscape leading to land degradation due to biomass removal to provide shelter and fuel energy and posed critical challenges for both host and displaced population. This article emphasizes geospatial applications at different stages of addressing land degradation in Cox’s Bazar. A wide range of data and methods were used to delineate land tenure, estimate wood fuel demand and supply, assess land degradation, evaluate land restoration suitability, and monitor restoration activities. The quantitative and spatially explicit information from these geospatial assessments integrated with the technical guidelines for sustainable land management and an adaptive management strategy was critical in enabling a collaborative, multi-disciplinary and evidence-based approach to successfully restoring degraded landscapes in a displacement setting

Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Funding: F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006.proofepub_ahead_of_prin

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Homozygous LEPR mutation as a cause of early onset childhood obesity in a Pakistani girl

Background: Monogenic nonsyndromic obesity is severe, has early-onset with abnormal eating behaviour and endocrine disorders. Leptin (LEP), Leptin receptor (LEPR), and Melanocortin 4 receptor (MC4R) gene mutations are identidied as the cause of early-onset childhood obesity. These pathogenic mutations are rare and have been described in less than 50 obese individuals worldwide, from consanguinous families. A cohort of Pakistani obese children from consanguineous parents showed LEP gene mutation in up to17% cases. LEP mutations result in a complete lack of its protein, loss of function mutations in the LEPR renders the carrier insensitive to leptin, both leptin and leptin receptor deficiency result in identical early-onset severe hyperphagic obesity. This is the first case of LEPR mutation leading to early onset obesity in a girl from our center.Objective: To describe a case of morbid early onset childhood obesity due to LEPR and MC4R mutations.Case Summary: We report a 1 year old girl, weighing 23 KG (BMI:31.8kg/m2), with progressive and rapid weight gain since 1 month of life. Born at term with, no prenatal or postnatal concerns, parents were first cousins. Father, 2 paternal uncles and 5 maternal aunts had history of early onset obesity till 5-6 years of age after which their weights normalized. Her birth weight was 3 Kg, 11.7 kg at 4 months of age (BMI: 26.4kg/m2) and 16 kg at 5 and a half months of age (BMI: 30.4kg/m2) when she presented. She was on exclusive breast feeding. Weaning foods were very rarely taken. Her gross motor milestones were slightly delayed but intellectual development was normal with no other associated illness. Considering the possibility of a genetic form of obesity, a monogenic obesity panel was sent in which testing of 68 genes was done. Two homozygous Pathogenic variants were identified in LEPR,(Exon 4,c.133_136dup (p.Tyr46*). This sequence change creates loss of function in LEPR gene and leptin receptor deficiency with very early onset childhood obesity which is most likely the case in our patient giving the matching phenotype and clinical presentation. An additional heterozygous variant of uncertain significance identified in the MC4R gene,(Exon1,c.63_64del (p.Tyr21*) also creates a premature translational stop signal in the MC4R gene and is found in patients with early onset obesity. Parents genetic testing has been sent and is awaited.Conclusions: Our case highlights the implication of rare LEPR mutations in severe early-onset obesity in a consanguineous family diagnosing which is important for understanding of satiety regulation. Genetic diagnosis can help devising strategies of lifestyle interventions to support the patient and parents in coping

Newborn screening for congenital hypothyroidism through dried blood spot in Low middle income country (LMIC): Experience from a tertiary care center

Background: Neonatal screening is a preventive strategy for various endocrine,metabolic and genetic conditions.Congenital hypothyroidism (CH) is one of the most common preventable and treatable causes of intellectual disability,and delayed diagnosis can lead to disastrous consequences.Incidence of CH is1:3000-1:4000 neonates worldwide but data varies globally.Pakistan lacks a national newborn screening programme for any inherited disease,but Aga Khan University Hospital (AKUH) is doing newborn screening for Congenital Hypothyroidism (CH).Since April 2019 CH screening is done through dried blood spot (DBS). Pakistan has a very scarce data regarding incidence of CH,indicating the importance of working in this direction.We present our data on CH screening through DBS over a period of two and a half year.Objective: To determine the proportion of screen positive newborns(\u3e33 weeks gestation) between April 2019 –October 2021,for Congenital Hypothyroidism as part of newborn screening programme done through DBS and also to identify confirmed CH cases on serum TSH testing.Methods: Retrospective review of Laboratory data of DBS TSH levels of neonates \u3e33 weeks of gestation from April 2019-October 2021.Screening is done between 48-72 hours of life and after 24 hours in case of early discharge.TSH is quantitatively determined and values ≥10 μIU/ml were taken screen positive,up to10 μIU/mL were taken normal,between 10-20μIU/mL were considered ambiguous, above 20 μIU/mL were labeled as presumptive positive. Ambiguous and presumptive positive babies were recalled to get TSH+/-FreeT4 tests.CH was confirmed on the basis of low FT4 and highTSH \u3e10μIU/ml and treatment was started.Results: 97%(14283 out of 14379)of the live born babies were screened for Congenital Hypothyroidism. To identify safe minimum recall criteria, babies were recalled if the DBS TSH level was more than 10 mU/l and if they were not preterm(\u3c33 weeks).226 (96%) out of 235 screen positive babies were recalled,out of which serum TSH and/or FT4 was repeated in 158 babies(70%). Recall rate being 96%.15 newborns were diagnosed Congenital hypothyroidism through serum TSH testing and started on treatment within 2 weeks of life. Proportion of babies diagnosed with Congenital Hypothyroidism is 0.10% with average incidence rate being 1:1000 babies.\u3e \u3e33 weeks).226 (96%) out of 235 screen positive babies were recalled, out of which serum TSH and/or FT4 was repeated in 158 babies(70%). Recall rate being 96%.15 newborns were diagnosed Congenital hypothyroidism through serum TSH testing and started on treatment within 2 weeks of life. Proportion of babies diagnosed with Congenital Hypothyroidism is 0.10% with average incidence rate being 1:1000 babies.Conclusion: Due to high incidence rate of CH in our neonates, implementating a national screening program and also conducting further studies to determine the main risk factors for the high incidence of CH is essential. Overall coverage of CH screening programme at AKUH has been 97% which need to be further increased