Gut microbiota in obesity of different aetiology: cause or effect?

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Endostatin concentration in plasma of healthy human volunteers

Background: Angiogenesis is involved in many cardiovascular and cancerous diseases, including atherosclerosis and is controlled by a fine balance between angiogenic and angiostatic mediators. Endostatin is one of the main angiostatic mediators, and inhibits angiogenesis and prevents progression of atherosclerosis. The available literature shows a broad range of concentrations in relatively small samples of healthy controls and is calculated by using different techniques. This study was aimed to determine the basal endostatin concentration in plasma of healthy volunteers, to fully understand its physiological role. Methods: Fifty healthy adult volunteers were recruited to the study. Participants were advised not to participate in any physical activity on the day before the blood sampling. The volunteers’ physical activity, height, weight, heart rate and blood pressure were recorded. The samples were analysed for plasma endostatin concentration, using ELISA. The participants were divided by gender and ethnic groups to calculate any difference. Results: Endostatin and other variables were normally distributed. Most of the participants had a moderate level of physical activity with no gender related difference (p=0.370). The mean value for plasma endostatin in all samples was 105±12 ng/ml with range of 81–132 ng/ml. For males, it was 107±13 ng/ml, while for females; 102±12 ng/ml. There were no significant gender or ethnicity related differences in endostatin concentration. Moreover, endostatin was not significantly related with any anthropometric and physical variable. Conclusion: This study gives endostatin levels in normal healthy people and show no gender and ethnicity related differences in endostatin levels. Endostatin was not related with any anthropometric and physical variable

Association of clinical characteristics of patients presenting with influenza like illness or severe acute respiratory illness with development of acute respiratory distress syndrome

Clinical judgement and suspicion of influenza based on signs and symptoms of influenza-like illness and severe acute respiratory illness are critical for better patient outcome. Whether clinical characteristics of patients are associated with the development of acute respiratory distress syndrome and PCR positivity of samples was the aim of this study. We included all patients (n=37) presenting with influenza like illness (ILI) or severe acute respiratory illness (SARI) to a tertiary care hospital in northwest Pakistan during December 2015 until the end of January 2016. Each patient was assessed for signs and symptoms, clinical features, treatment, complications and outcome of ILI and SARI. Throat or nasopharyngeal swabs were obtained from 36 patient and analyzed for the presence of Influenza virus by quantitative PCR. Patients presenting with ILI or SARI were febrile (p<0.001, one sample t-test), significantly tachypneic (p<0.001) and had critically lower oxygen saturation (p<0.001). Nasal congestion at presentation (p=0.006, chi-square test for association) and infiltrates on chest radiographs (p=0.025) were significantly associated with acute respiratory distress syndrome. Likelihood of the occurrence of ARDS was significantly increased with decrease in oxygen saturation (Odds ratio; 0.75, 95% CI; 0.46, 1.21, p=0.048) and marginally significantly increased in lower age (Odds ratio; 0.82, 95% CI; 0.58, 1.15, p=0.055) and higher white cell count (Odds ratio; 1.001, 95% CI; 0.99, 1.002, p=0.054). The presence of Influenza type A/H1N1pdm09 strains was confirmed in 7/11 patients. However no significant difference was observed in the clinical features and complications of PCR positive and negative patients. Clinical signs and symptoms of influenza-like illness or severe acute respiratory illness significantly predict the development of complications irrespective of the positivity or negativity of laboratory qPCR reports

Morphology of the human hard palate:a study on dry skulls

To determine morphological variations of the hard palate in dry human skulls, 85 skulls of unknown age and sex from nine medical schools in Khyber Pakhtunkhwa, Pakistan were examined. The transverse diameter, number, shape and position of the greater (GPF) and lesser (LPF) palatine foramina; canine to canine inter-socket distance; distance between greater palatine foramen medial margins; on each side, the distances between greater palatine foramen and base of the pterygoid hamulus, median maxillary suture and posterior border of the hard palate; palatal length, breadth and height; maximum width and height of the incisive foramen; and the angle between the median maxillary suture and a line between the orale and greater palatine foramen were determined. Palatine index and palatal height index were also calculated. An oval greater palatine foramen was present in all skulls, while a mainly oval lesser palatine foramen was present in 95.8% on the right and 97.2% on the left. Single and multiple lesser palatine foramina were observed on the right/left sides: single 44.1%/50.7%; double 41.2%/34.8%; triple 10.2%/11.6%. The greater palatine foramen was located above the third molar in 74.7% (right)/87.8% (left), between the second and third molars in 25.3%/9.5%, and above the second molar in 2.7% (left). A single oval-shaped incisive foramen was observed in 87.1%. The median maxillary suture angle was 13.74±1.58° on the right and 13.14±1.68° on the left. In conclusion, no significant differences were observed in any distances on the right and left side related to greater palatine foramen; however a significant difference (p &lt;0.05) was observed between the right and left sides for median maxillary suture angle

An empirical demonstration of the effect of study design on density estimations

Funding was provided by the Snow Leopard Trust and Global Environmental Facility through Pakistan Snow Leopard and Ecosystem Protection Program (PSLEP). The publication of this article was funded by Qatar National Library.The simultaneous development of technology (e.g. camera traps) and statistical methods, particularly spatially capture-recapture (SCR), has improved monitoring of large mammals in recent years. SCR estimates are known to be sensitive to sampling design, yet existing recommendations about trap spacing and coverage are often not achieved, particularly for sampling wide-ranging and rare species in landscapes that allow for limited accessibility. Consequently, most camera trap studies on large wide-ranging carnivores relies on convenience or judgmental sampling, and often yields compromised results. This study attempts to highlight the importance of carefully considered sampling design for large carnivores that, because of low densities and elusive behavior, are challenging to monitor. As a motivating example, we use two years of snow leopard camera trapping data from the same areas in the high mountains of Pakistan but with vastly different camera configurations, to demonstrate that estimates of density and space use are indeed sensitive to the trapping array. A compact design, one in which cameras were placed much closer together than generally recommended and therefore have lower spatial coverage, resulted in fewer individuals observed, but more recaptures, and estimates of density and space use were inconsistent with expectations for the region. In contrast, a diffuse design, one with larger spacing and spatial coverage and more consistent with general recommendations, detected more individuals, had fewer recaptures, but generated estimates of density and space use that were in line with expectations. Researchers often opt for compact camera configurations while monitoring wide-ranging and rare species, in an attempt to maximize the encounter probabilities. We empirically demonstrate the potential for biases when sampling a small area approximately the size of a single home range-this arises from exposing fewer individuals than deemed sufficient for estimation. The smaller trapping array may also underestimate density by significantly inflating [Formula: see text]. On the other hand, larger trapping array with fewer detectors and poor design induces uncertainties in the estimates. We conclude that existing design recommendations have limited utility on practical grounds for devising feasible sampling designs for large ranging species, and more research on SCR designs is required that allows for integrating biological and habitat traits of large carnivores in sampling framework. We also suggest that caution should be exercised when there is a reliance on convenience sampling.Publisher PDFPeer reviewe

Cohort profile: The Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA) - Pakistan

Purpose: Pakistan has disproportionately high maternal and neonatal morbidity and mortality. There is a lack of detailed, population-representative data to provide evidence for risk factors, morbidities and mortality among pregnant women and their newborns. The Pregnancy Risk, Infant Surveillance and Measurement Alliance (PRISMA) is a multicountry open cohort that aims to collect high-dimensional, standardised data across five South Asian and African countries for estimating risk and developing innovative strategies to optimise pregnancy outcomes for mothers and their newborns. This study presents the baseline maternal and neonatal characteristics of the Pakistan site occurring prior to the launch of a multisite, harmonised protocol.Participants: PRISMA Pakistan study is being conducted at two periurban field sites in Karachi, Pakistan. These sites have primary healthcare clinics where pregnant women and their newborns are followed during the antenatal, intrapartum and postnatal periods up to 1 year after delivery. All encounters are captured electronically through a custom-built Android application. A total of 3731 pregnant women with a mean age of 26.6±5.8 years at the time of pregnancy with neonatal outcomes between January 2021 and August 2022 serve as a baseline for the PRISMA Pakistan study.Findings to date: In this cohort, live births accounted for the majority of pregnancy outcomes (92%, n=3478), followed by miscarriages/abortions (5.5%, n=205) and stillbirths (2.6%, n=98). Twenty-two per cent of women (n=786) delivered at home. One out of every four neonates was low birth weight (\u3c2500 \u3eg), and one out of every five was preterm (gestational age \u3c37 \u3eweeks). The maternal mortality rate was 172/100 000 pregnancies, the neonatal mortality rate was 52/1000 live births and the stillbirth rate was 27/1000 births. The three most common causes of neonatal deaths obtained through verbal autopsy were perinatal asphyxia (39.6%), preterm births (19.8%) and infections (12.6%).Future plans: The PRISMA cohort will provide data-driven insights to prioritise and design interventions to improve maternal and neonatal outcomes in low-resource regions

THE INCLUSION OF DISASTER RISK REDUCATION IN CLASSROOM AND EXTRA-CURRICULAR ACTIVITIES: A CASE OF RURAL BALOCHISTAN, PAKISTAN

Purpose – Balochistan, which makes up roughly 44 percent of Pakistan’s total land area, is home to 6 percent of the nation’s inhabitants. Due to long distances and low population density, service delivery is particularly challenging. The province’s educational services are impacted by natural disasters like earthquakes, floods, droughts, and migration. Disaster risk reduction is a widely recognized concept that emphasizes appropriate education to lower an individual’s personal, familial, and communal vulnerability. The role of the school is crucial in Disaster Risk Reducation (DRR) education. As a result, the study’s goal was to explore the approaches adopted for the inclusion of DDR through teaching in classroom and school activities. Methodology – A focus group discussion with three groups of Pakistan studies and Geography teachers was conducted that consisted of 10 male and 14 female members. Findings – Findings demonstrate that the current textbook continues to teach students less about disaster risk reduction; teachers include knowledge from their personal experience in planning lessons about DRR. School assemblies, child clubs and activities designed by school management, and social organizations play a prominent role in DRR education. Further, the role of teachers and school management was identified in psycho-social support during disasters and pandemics. Significance – The study concludes that in addition to extracurricular activities and the teacher’s role, prior disaster experience, school, and social organization played a significant role in DRR education in rural Balochistan. The study results will assist curriculum developers, policymakers, and education leadership in developing more effective school disaster management plans. The results will also clarify how schools and teachers can close the knowledge gap in disaster preparedness education. Organizations working on disaster risk education and education in emergencies will also benefit from additional research to respond to the need readily and effectively

Airway Management in Full Stomach Conditions

Pulmonary aspiration in the perioperative period is one of the well-known complications under anesthesia and procedural sedation. A full stomach condition either due to non-adherence to fasting guidelines or due to various other factors that delay gastric emptying are the most common causes. Following aspiration, a patient may develop a wide spectrum of clinical sequelae. The key factors in preventing aspiration include proper pre-operative assessment, appropriate premedication and operating room preparations. Rapid sequence induction and intubation is the recommended technique for securing the airway in cases of full stomach. Management of aspiration depends on the nature of the aspirate. Pre-operative fasting guidelines have been established by various medical societies which may be modified in special circumstances of high risk of aspiration. Prediction of difficult airway in certain cases of full stomach necessitates clinical expertise in airway management

Airway Management in Aviation, Space, and Microgravity

Although medical services in aviation have evolved over years based on our understanding of physiology, advancement in monitoring technology but airway management was only recently studied with a focus on space environment. The barometric pressure of ambient air declines as altitude increases, while the volume of air in a confined space will increase according to Boyle law, and therefore oxygen concentration remains at a constant 21%. Altitude sensitive equipment includes endotracheal and tracheostomy cuffs, pneumatic anti shock garments, air splints, colostomy bags, Foley catheters, orogastric and nasogastric tubes, ventilators, invasive monitors, and intra-aortic balloon pumps. The microgravity reduces the body compensation capacity for hemorrhage, while the redistribution of the blood can affect intubation by causing facial edema. Another change is the decreased gastric emptying during aviation. Acute respiratory failure, hypoxemia or inadequate ventilation and protection of the airway in a patient with impaired consciousness are common indications for advanced airway management in aviation. Airway management requires adequate training to maintain excellent medical care during aviation. Tracheal intubation using laryngoscopy would be difficult in microgravity, since the force exerted by the laryngoscope causes the head and neck move out of the field of vision by lever effect exerted on the head and generated through the laryngoscope blade by hand generating a lack of stability, resulting in the difficulty to insert the tracheal tube. While on the ground with the help of gravity, an adequate positioning of the patient is facilitated to achieve alignment of the laryngeal, pharyngeal and oral axes, which is known as sniffing position that allows visualization of the vocal cords and supraglottic structures allowing the introduction of an endotracheal tube