Patients’ visual experience during phacoemulsification cataract surgery and associated fear

Abstract Background: Data from several published studies indicate that patients undergoing phacoemulsification cataract surgery can experience a variety of visual sensations which can result in fear. This phenomenon has not been studied in Pakistan to-date. We examined the visual experience and its associated fear among patients undergoing phacoemulsification cataract surgery under topical anaesthesia. Methods: This cross-sectional study was carried out in Aga Khan University Hospital, a tertiary care hospital, in Karachi, Pakistan from August 2010 to July 2011. Adults \u3e18 years of age scheduled to undergo cataract surgery (phacoemulsification with intraocular lens implantation) under topical anaesthesia by a single surgeon were included. A structured questionnaire was used to collect data on socio-demographics, intraoperative visual experiences and subsequent reaction to these sensations. Participants were asked if they experienced visual sensations such as colours, shapes and movements during surgery. Moreover, they were asked if they developed fear due to these sensations. Results: Fifty three patients (mean age: 60.4 ± 12.4 years) were enrolled. Thirty (56.6%) of them were men and 23 (43.4%) were women. All of them reported having experienced visual sensations during surgery, the most common being light perception (100%), different colours (77.4%), movements of instruments or surgeon’s hands (37.7%) and different shapes (7.5%) such as circles, clouds and patches. The most common colours perceived included white (46.2%), blue (35.8%), red (30.2%) and yellow (30.2%). One out of every four (26.4%) participants reported having developed fear due to these visual sensations. Only 4 (7.5%) reported having received preoperative counselling regarding such sensations. Conclusion: Patients in our study experienced a variety of visual sensations during cataract surgery under topical anaesthesia. The prevalence of frightening visual sensations is higher than that reported in all previous published studies on the subject and needs to be addressed through targeted interventions

ZnO Nano-Flowers Assembled on Carbon Fiber Textile for High-Performance Supercapacitor’s Electrode

Herein, a crystalline nano-flowers structured zinc oxide (ZnO) was directly grown on carbon fiber textile (CFT) substrate via a simple hydrothermal process and fabricated with a binder-free electrode (denoted as ZnO@CFT) for supercapacitor (SC) utilization. The ZnO@CFT electrode revealed a 201 F·g−1 specific capacitance at 1 A·g−1 with admirable stability of >90% maintained after 3000 cycles at 10 A·g−1. These impressive findings are responsible for the exceedingly open channels for well-organized and efficient diffusion of effective electrolytic conduction via ZnO and CFT. Consequently, accurate and consistent structural and morphological manufacturing engineering is well regarded when increasing electrode materials’ effective surface area and intrinsic electrical conduction capability. The crystalline structure of ZnO nano-flowers could pave the way for low-cost supercapacitors

Phantom: Towards Vendor-Agnostic Resource Consolidation in Cloud Environments

Mobile-oriented internet technologies such as mobile cloud computing are gaining wider popularity in the IT industry. These technologies are aimed at improving the user internet usage experience by employing state-of-the-art technologies or their combination. One of the most important parts of modern mobile-oriented future internet is cloud computing. Modern mobile devices use cloud computing technology to host, share and store data on the network. This helps mobile users to avail different internet services in a simple, cost-effective and easy way. In this paper, we shall discuss the issues in mobile cloud resource management followed by a vendor-agnostic resource consolidation approach named Phantom, to improve the resource allocation challenges in mobile cloud environments. The proposed scheme exploits software-defined networks (SDNs) to introduce vendor-agnostic concept and utilizes a graph-theoretic approach to achieve its objectives. Simulation results demonstrate the efficiency of our proposed approach in improving application service response time

Hepatocellular carcinoma in Native South Asian Pakistani population; trends, clinico-pathological characteristics & differences in viral marker negative & viral-hepatocellular carcinoma

Background HCC is the fifth most common cancer globally. Our study was conducted to (1)investigate the trends and clinico-pathological characteristics of Hepatocellular carcinoma among native South Asian patients in Pakistan, (2)to estimate the prevalence as well as the trends of viral marker negative HCC and (3) to compare the clinico-pathological, radiological characteristics, applicability of treatment at diagnosis and prognostic factors among patients with both viral marker negative and viral marker positive-HCC being consulted at Aga Khan University Hospital(AKUH), Karachi, Pakistan. Method Patients ≥18 years, already diagnosed to have HCC and visiting AKUH during 1999–2009 were identified using ICD code 1550. The diagnosis of HCC was made in the presence of characteristic features of HCC on triple-phasic CT scan/MRI or with histological findings on biopsy. Results 645 patients were enrolled. Of these 546(84.7%) were viral-HCC and 99(15.3%) were viral marker negative HCC. Among viral-HCC group underlying etiology of cirrhosis was HCV in 67.9%, HBV in 21.8% and concomitant HBV with HCV or HDV in 10.3% cases. Majority (62.8%) patients had advanced HCC. Larger tumor size (p \u3c 0.001), shorter duration between diagnosis of cirrhosis and HCC (p 0.03), concomitant Diabetes Mellitus (p \u3c 0.001) were found significant factors associated with viral marker negative HCC. Conclusion The burden of hepatocellular carcinoma is rising among native South Asian Pakistani population and the viral marker negative HCC are not uncommon in our population. Viral marker negative HCC tend not to be under surveillance as compared to viral-HCC and are diagnosed mostly at advanced stage & when they became symptomatic

Antenatal Magnesium Sulfate for Preterm Neuroprotection: A Single-Center Experience from Kuwait Tertiary NICU

Objectives: The study aimed to evaluate the impact of antenatal exposure of magnesium sulfate (MgSO4) on short- and long-term outcomes in preterm neonates born less than 32 weeks gestation. Methods: Single-center retrospective cohort study of 229 neonates born between 24 and 32 weeks gestation was conducted from January 2018 through December 2018 in a level III neonatal care unit in Kuwait. Antenatal MgSO4 exposure was collected from the medical records, and the indication was for neuroprotection effect. Brain MRI was done on 212 neonates (median gestational age 36 weeks), and brain injury was assessed using the Miller’s score. Neurodevelopmental outcome was assessed by Bayley-III scales of infant development at 36 months corrected age (N = 146). The association of exposure to MgSO4 with brain injury and neurodevelopmental outcomes was examined using multivariable regression analysis adjusting for gestational age at MRI and variables with p value <0.05 on univariate analysis. Results: Among the 229 neonates, 47 received antenatal MgSO4. There were no differences between the groups in gestational age and birth weight. MgSO4 exposure was not associated with an increased risk of necrotizing enterocolitis, chronic lung disease, retinopathy of prematurity, and mortality. The incidence of cerebellar hemorrhage was significantly less in the MgSO4 group (0% vs. 16%, p value = 0.002). Neonates who received MgSO4 had lower risks of grade 3–4 intraventricular hemorrhage (IVH) adjusted OR 0.248 (95% CI: 0.092, 0.66), p = 0.006; moderate-severe white matter injury (WMI) adjusted odd ratio 0.208 (95% CI: 0.044, 0.96), p = 0.046; and grade 3–4 IVH and/or moderate-severe WMI adjusted OR 0.23 (95% CI: 0.06, 0.84), p = 0.027. Neurodevelopmental assessment at 36 months corrected age showed better motor (adjusted beta coefficient 1.08 [95% CI: 0.099, 2.06]; p = 0.031) and cognitive composite scores (adjusted beta coefficient 1.29 [95% CI: 0.36, 2.22]; p = 0.007) in the MgSO4 group. Conclusion: Antenatal exposure to MgSO4 in preterm neonates less than 32 weeks was independently associated with lower risks of brain injury and better motor and cognitive outcomes

Trends in traumatic brain injuries during the COVID-19 pandemic: a single-center review of patient charts from Pakistan

Introduction: A traumatic brain injury (TBI) is one of the leading causes of injury-related deaths, making it a public health concern of extreme importance. In a developing country such as Pakistan, TBIs are significantly underreported, with the treatment frequently being delayed and inadequate, especially in rural healthcare setups all across the country. This concern is further magnified by insufficient epidemiological data on TBIs available in Pakistan. The coronavirus disease 2019 (COVID-19) pandemic brought consequential changes to the healthcare system with the priority shifting toward COVID-19 patients, resulting in considerable changes to the workflow and management of TBIs. The primary objective of this study is to offer valuable insights into the epidemiology of TBIs in Pakistan and its relationship with the impact of the COVID-19 pandemic. Methods: A retrospective study was conducted at a tertiary care center in a metropolitan city in Pakistan. Patient charts were reviewed from January to August 2020, and data was extracted including demographics, clinical presentation, management, and outcomes for cases of TBI. Results: The total number of patients is 2126, male 78% and female 21.4%. The mean age of the patients was 28.85. The state of admissions at the hospital is at 99.7% for EME admissions and 0.282% for OPD admissions. Participants presented with loss of consciousness (70.7%), nosebleeds, (53.2%), vomiting (69.0%), and seizures (11.5%). The majority (51.1%) were related to road traffic accidents, followed by falls (20.7%), and assaults (4%). While 1202 (58.5%) of these were managed conservatively, others underwent surgical treatment in the form of craniotomy (28.0%), Burr holes (3.20%), and fracture elevation and repair (10.5%). A decrease in the number of reported TBI cases was observed with lockdown implementation in Pakistan. Conclusion: The transportation sector in Pakistan was severely affected by the COVID-19 pandemic, leading to a decline in road traffic injuries and TBIs. Stringent mobility constraints and changes in societal and cultural norms have contributed to this reduction

Biosynthesis and characterization of silver nanoparticles from Cedrela toona leaf extracts: An exploration into their antibacterial, anticancer, and antioxidant potential

This research work aims to synthesize environmentally benign and cost-effective metal nanoparticles. In this current research scenario, the leaf extract of Cedrela toona was used as a reducing agent to biosynthesize silver nanoparticles (AgNPs). The synthesis of AgNPs was confirmed by the color shift of the reaction mixture, i.e., silver nitrate and plant extract, from yellow to dark brown colloidal suspension and was established by UV-visible analysis showing a surface plasmon resonance band at 434 nm. Different experimental factors were optimized for the formation and stability of AgNPs, and the optimum conditions were found to be 1 mM AgNO3 concentration, a 1:9 ratio of extract/precursor, and an incubation temperature of 70°C for 4 h. The Fourier transform infrared spectroscopy spectra indicated the presence of phytochemicals in the leaf extract that played the role of bioreducing agents in forming AgNPs. X-ray diffraction patterns confirmed the presence of AgNPs with a mean size of 25.9 nm. The size distribution and morphology of AgNPs were investigated by scanning electron microscopy, which clearly highlighted spherical nanoparticles with a size distribution of 22–30 nm with a mean average size of 25.5 nm. Moreover, prominent antibacterial activity was found against Enterococcus faecalis (21 ± 0.5 mm), Bacillus subtilis (20 ± 0.9 mm), Pseudomonas aeruginosa (18 ± 0.3 mm), Staphylococcus aureus (16 ± 0.7 mm), Klebsiella pneumoniae (16 ± 0.3 mm), and Escherichia coli (14 ± 0.7 mm). In addition, antioxidant activity was determined by DPPH and ABTS assays. Higher antioxidant activity was reported in AgNPs compared to the plant extract in both DPPH (IC50 = 69.62 µg·ml−1) and ABTS assays (IC50 = 47.90 µg·ml−1). Furthermore, cytotoxic activity was also investigated by the MTT assay against MCF-7 cells, and IC50 was found to be 32.55 ± 0.05 µg·ml−1. The crux of this research is that AgNPs synthesized from the Cedrela toona leaf extract could be employed as antibacterial, antioxidant, and anticancer agents for the treatment of bacterial, free radical-oriented, and cancerous diseases

Improving the Probiotics Viability and Quality Characteristics of Yoghurt Enriched with Barley Bran

Results of current study reported that increase in addition of barley bran in yogurt containing bifidobacterium BB-12, L. bulgaricus and S. thermophillus significantly influence the probiotics numbers. Samples fortified with barley bran has more numbers of probiotics as compare to control samples during storage. Correlation between concentration of barley bran and bifidobacterium was optimistic. Maximum numbers of L. bulgaricus and bifidobacterium were found in yogurt containing 1.5%25 barley bran. Addition of barley bran increased the acidity percentage of yogurt and decreased viscosity value during 3 weeks of storage. Sensory scores of functional yogurt decreased with increased in barley bran. However sensory score of sample with (0.5%25 barley bran) did not significantly changed from control sample and number of bifidobacterium bacteria in this sample was higher than minimum standard level (log106 CFU%252Fg) of world health organization (WHO). Syneresis value of control sample was significantly reduced with storage period but yogurt sample enriched with different concentration of barley bran were showed minimum decreased in syneresis percentage of yogurt. Barley bran level 1%25 can be added to yogurt successfully. Barley bran enrichment increased the color parameters of yogurt during storage this may be due to the results of blueness color of barley bran

Photocatalytic degradation of organic dyes and biological potentials of biogenic zinc oxide nanoparticles synthesized using the polar extract of Cyperus scariosus R.Br. (Cyperaceae)

In this study, the polar root extract of Cyperus scariosus R.Br. was used for the biogenic synthesis of ZnO NPs. The results of this study show that ZnO NPs have a spherical structure with an average size of 85.4 nm. The synthesized catalysts were tested for their photocatalytic activity by degrading methyl orange and methylene blue under sunlight. Improved degradation efficiencies of 79.44% and 84.92% were achieved within 120 min. ZnO NPs exhibited strong antibacterial activity against both Gram-positive Listeria monocytogenes (18 mm) and Staphylococcus epidermidis (20 mm) and Gram-negative strains of Escherichia coli (16 mm) and Bordetella bronchiseptica (14 mm), as shown by the inhibition zones, which were comparable to the positive control (ceftriaxone) but larger than the plant root extract. ZnO NPs showed high antioxidant activity, as a ferric-reducing antioxidant power assay value of 66.29 µg (AAE µg·mL−1) and a DPPH value of 57.44 µg (AAE µg·mL−1) were obtained at a concentration of 500 µL, which was higher than those of the C. scariosus root extract. Quantification of the total phenolic and flavonoid content yielded values of 57.63 µg (GAE µg·mL−1) and 70.59 µg (QCE µg·mL−1), respectively. At a concentration of 500 μL (1 mg·mL−1), the tested nanoparticles (NPs) showed a greater anti-inflammatory effect (84.12%) compared to the root extract of C. scariosus (34.39%). Overall, our findings highlight the versatile properties of green synthesized ZnO NPs and demonstrate their potential for environmental remediation and antimicrobial formulations, as well as promising candidates for further investigation in biomedical fields such as drug delivery and therapy

Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR) : an international multicenter analysis

Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes. Methods: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000-2016) and three very-high-volume international centers in the United States and Japan (model validation 2004-2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. Results: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2-11%) at 5 high-volume (1 DP-CAR/year) and 18% (95 CI, 9-30%) at 18 low-volume DP-CAR centers (P=0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P=0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19months (95 CI, 15-25months). Conclusions: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor