Changing patterns and outcome of Dengue infection; report from a tertiary care hospital in Pakistan

Objective: To identify predictors of outcome in patients with Dengue Infections at a tertiary care hospital and to analyze that if pattern of Dengue infection is changing in the past two years. Methods: We reviewed 225 cases of confirmed dengue virus infection. The diagnosis was confirmed by presence of IgM antibodies against Dengue by ELISA in addition to fever according to WHO criteria. Results: From years 2000-2004, 30(73%) had Dengue Fever (DF), 10(24%) had Dengue Haemorrhagic Fever (DHF) and 1(2.4%) had Dengue shock syndrome (DSS) while after 2005, 107(58%) had DF, 71(39%) had DHF and 6(3%) had DSS. Six patients (2.6%) died. Presence of shock (OR 2.9, 95% CI; 1.7-6.2), coma at presentation (OR 1.89, 95% CI; 1.02-3.3) and seizures (OR 1.6, 95% CI; 0.9-3.0) were important predictors of mortality. Conclusion: These findings are suggestive of a change in pattern and outcome of Dengue at our institution. Larger data set from all around the country is needed to comment on epidemicity and endemicity pattern of the dengue in Pakistan (JPMA 58:488;2008)

Pontine haemorrhage due to chondrosarcoma of the skull base

A young adult presented with acute weakness of right side of body and slurring of speech. An initial brain CT scan showed a pontine haemorrhage, however MRI done a few days later revealed a mass in the left parapharyngeal space. Histopathology of the mass revealed that it was a chondrosarcoma. Subsequently the patient was initially treated with chemotherapy and radiotherapy and later surgery. Skull base chondrosarcomabe is to be included in the differentials of a young patient presenting with signs consistent with pontine haemorrhage

Comparative Study of Liquid Biodiesel From Sterculia foetida (Bottle Tree) Using CuO-CeO2 and Fe2O3 Nano Catalysts

This study examined the potential of nanocatalyst CuO-CeO2 and Fe2O3 for efficient conversion of Sterculia foetida seed Oil into biodiesel. S. foetida contains 40% oil content and low free fatty acid value (0.18 mg KOH/g). The synthesized nanocatalyst was characterized using X-Ray Diffraction (XRD), Fourier Transform Infrared Spectroscopy (FT-IR), and Scanning Electron Microscopy (SEM) techniques. The maximum conversion was achieved (92% yield) using CuO-CeO2 at 0.25% catalyst loading. The optimized reaction was carried out by experimental variables included molar ratio (1:9), temperature (70°C), reaction time (3 h) and stirring rate (600 rpm) using reflux transesterification method. The XRD results showed the size of crystals with order 54.4 nm for CuO-CeO2 and 31.3 nm for Fe2O3. The SEM images of CuO-CeO2 showed spherical structure having an average particle size of 32.3 nm. SEM images of Fe2O3 showed the size ranges from 46.27 to 28.76 nm having regular morphology, including spherical shape. The FT-IR analysis of this nanocatalyst also reinforced the results of this study. Gas Chromatography Mass Spectroscopy (GC-MS) and Fourier Transform Infrared Spectroscopy (FT-IR) confirmed the efficient conversion of S. foetida seed oil into biodiesel using prepared nanocatalysts. The prepared nanocatalysts are cheaper, readily available and can be used for industrial scale biofuel production assembly, making it economically feasible and more cost effective

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Exploring the fractional Hirota Maccari system for its soliton solutions via impressive analytical strategies

In the field of marine engineering, the characteristics of wave propagation play an imperative character. In many geographical regions, the key source of environmental effects on artificial floating or stationary structures or seashores is waves. This article deals with the Hirota Maccari system (HMs) via a new fractional derivative operator known as the beta derivative. This aforesaid equation is a significant model which deals with a variety of nonlinear phenomenons in the fields of optical fibers, physics and other scientific fields. A complex wave hypothesis is applied to transform the aforesaid system with beta derivative into an ODE system. The modified Kudryashov’s (New version) and the Auxiliary equation methods are used to build a variety of soliton solutions of HMs with beta derivative. The singular, periodic, bright, dark solitons and mixed solitons are constructed with the above-mentioned approaches via soft computation in Mathematica. Some of them are numerically simulated for 2D and 3D representation. All the solutions of fractional HMs produced by the above two techniques are novel and have not been derived yet

Afghanistan: Historical and Cultural Quarterly, Vol. 27, No. 1 (Spring 1353/June 1974)

This material from the personal archives of Professor M. Mobin Shorish is made available by the University of Arizona Libraries as part of the Afghanistan Digital Collections. Email [email protected] with your questions about this collection

Encephalitis and myelitis associated with dengue viral infection Clinical and neuroimaging features

Objectives: The objective of this study was to identify clinical and neuroima-ing features and outcome of Patients with encephalitis and myelitis associated with dengue viral infection. Patients and methods: We retrospectively reviewed 225 cases of dengue viral infection. The diagnosis of dengue was confirmed by serology (presence of IgM antibodies). Results: Six Patients (3%) had evidence of neurological infection (encephalitis: 5 Patients, encephalomyelitis: I Patient). Age range was 18-35 years (Mean 27 years). Five Patients (83%) were women. All Patients (100%) had drowsiness, five Patients (83%) had fever, four Patients (67%) presented with seizures and one Patient presented with paraparesis (16%). All patients had elevated CSF cell count (range 25-102, mean 61) with predominant lymphocytes. Five Patients (83%) had abnormal CT or MRI scan. Cerebral edema was present in three Patients. Other findings included low density signals in right temporal and occipital lobe (1 Patient), bi temporal hyperintensi ties and meningeal enhancement (1 Patient), Frontal and subcortical hyperintense lesion (1 Patient) and hyperintense lesion on T2 in Pons and cervical and thoracic spinal cord (1 Patient). EEG was done in four Patients and showed generalized slowing (2 Patients), bi temporal spikes (1 Patient) and burst suppression pattern (1 Patient). Two Patients (32%) died and one Patient was discharged in bedridden state. Conclusion: The involvement of brain and spinal cord is uncommon in dengue viral infection. Most Patient present with seizures. Neuroirnaging features are diverse. Prognosis is poor in Patients presenting with encephalitis or myelitis

Synthesis and Characterization of Waste Eggshell-Based Montmorillonite Clay Catalyst for Biodiesel Production from Waste Cooking Oil

The depletion of resources and increase in demand for fossil fuel raise concerns as it is natural and non-renewable. Therefore, it will cause limitation on its availability and continuous reduction. This issue has led to the search for more economic, sustainable, and environmentally friendly alternatives which is biodiesel. The major drawback that reduces the possibility of biodiesel commercialization is the high cost of oil feedstock as it covers 75% of its total production cost. The waste cooking oil is used as feedstock in continuous transesterification as it is the primary option to lower the cost of biodiesel production. Biodiesel can be prepared using waste cooking oil and catalyst through transesterification reaction. In this research, the focus is on the utilization of chicken and quail waste eggshell to synthesize highly active Calcium Oxide (CaO)-based heterogenous catalyst with montmorillonite clay to catalyze efficient conversion of waste cooking oil to biodiesel. The formation of CaO/montmorillonite catalyst was confirmed based on the outputs from X-ray diffraction (XRD) and Scanning Electron Microscopy (SEM). The physio-chemically characteristics of catalysts exhibited a BET surface area from the ranging from 9.2-9.5 m2/g and presence of around 87% of elemental calcium as constituent through XRF characterization. In addition to this, high-performance liquid chromatography (HPLC) analysis is used to determine the conversion of biodiesel using conventional and microwave heating method which revealed a maximum biodiesel production yield of 98%. This optimum biodiesel yield was obtained at reaction temperature, molar ratio of waste cooking oil to methanol, and catalyst amount of 60 ºC, 2 h, 1:12, 2.5 wt.% and 5 wt.% for both eggshells, respectively