Band Ligation VersusGlue Injection for Bleeding Gastric Varices

Background : To compare endoscopic variceal sclerotherapy with N-butyl-2-cyanoacrylate- Histoacryl (EVS) and endoscopic variceal band ligation (EBL) for treatment of bleeding gastric varices (GV).Methods: In this  randomized control trial 140 patients  with bleeding gastric varices were included.Bleeding GV patients diagnosed endoscoically were treated with EVS or EBL in two equal groups after randomization. Bleeding control or otherwise was confirmed during the procedure. Patients were followed for 1 month for re-bleeding. Comparison of the patients undergoing EVS or EBL was done in terms of bleeding control and re-bleeding during follow up period. Chi2 test was used to seek statistically significant association in this regard. Results: Endoscopic bleeding control was confirmed in all except 1 of EBL patients who expired. 4 (5.7%) of EVS 10 (14.28%) EBL patients had re-bleeding (P >0.05).Conclusion: EVS and EBL are comparative procedures for treatment ofbleeding GV for control of active bleeding and re-bleeding over one month follow up

Neurodevelopment outcome of neonates treated with intraventricular colistin for ventriculitis caused by multiple drug-resistant pathogens-A case series

Background: Multiple-drug-resistant Gram-negative bacteria (MDR-GNB)-associated neonatal ventriculitis is a life-threatening complication that needs timely diagnosis and effective treatment with broad-spectrum antimicrobials in critical-care settings. Inadequate penetration of antibiotics through the blood-brain barrier also demands an intraventricular (IVT) route of administration. This study reports mortality and neurodevelopmental sequelae of neonates till 18 months of age, who received IVT-colistin for treating MDR-GNB associated ventriculitis. Methods: In a case series of seven neonates with ventriculitis due to MDR-GNB at NICU of Aga Khan University Hospital, Pakistan, between June 2015 and 2018, we reviewed IVT-colistin therapy in critically ill neonates. Treatment outcomes were assessed based on clinical sign\u27s resolution and MDR-GNB eradication in subsequent CSF cultures. Neurodevelopmental outcomes were evaluated at 18 months after discharge. Results: The average birth weight was 1.38 kg (range: 1.02-1.5 kg), and the average gestational age was 30.7 weeks (ranged: 26-34 weeks). All neonates reported colistin-sensitive MDR-GNB in CSF, five with Acinetobacter baumannii, and polymicrobial CNS infection was found in two patients (one due to Klebsiella pneumonia and A. baumannii and one due to K. pneumonia and Escherichia coli). All neonates received IVT colistin and concomitant intravenous meropenem, and five of them also received intravenous colistin. One neonate died. At the 18-month assessment, only one neonate had cerebral palsy and hydrocephaly and 50% had seizure disorders. Conclusion: Practicing intraventricular antibiotics in the neonatal population is challenging but may be used successfully, especially to overcome the limitation of poor penetration through the blood-brain barrier

Meropenem-induced pancytopenia in a preterm neonate: A case report

Background: A post-marketing surveillance study has reported an association between meropenem use and the incidence of hematologic abnormalities, including leukopenia, thrombocytopenia, hemolysis, and neutropenia, but the precise incidence in neonates is unknown. Here, we report meropenem-induced pancytopenia in a preterm neonate.Case presentation: A preterm newborn Pakistani received intravenous meropenem 40 mg/kg every 8 hours to treat Klebsiella pneumoniae in blood cultures and suspected meningitis. The baby developed severe thrombocytopenia, with a platelet count of 22 × 103 cells/mm3, low hemoglobin level of 9.7 g/dl, and low absolute neutrophil count (ANC) of 816 cells/mm3 on days 3, 14, and 17 of meropenem therapy, respectively. Based on the blood culture and institutional guidelines, meropenem treatment was continued with monitoring and supportive care for a total of 19 days. After discontinuation of meropenem, the baby was monitored continuously for hematological changes, and low counts persisted for 3 days. ANC improved to \u3e 1500 cells/mm3 on the fourth day, and the platelet count reached \u3e 150 × 103 cells/mm3 for the first time on the seventh day of meropenem discontinuation. All subsequent complete blood count (CBC) reports showed improving trends. The baby was discharged on the 48th day of life (DOL), with follow-up monitoring of CBC. The baby was kept on iron supplements, and hemoglobin level of 11.2 g/dl was observed on the 59th DOL.Conclusion: Neonatal pancytopenia may lead to serious health complications; therefore, clinicians and pharmacists need to vigilantly monitor CBC in this vulnerable population, even when administering meropenem in septic doses for the recommended duration

Psychological Assessment of Health Care Workers in Intensive Care Units During the COVID-19 Pandemic

ABSTRACT Background Fear and depression are common to any pandemic particularly in healthcare workers as they are in the front line to treat the diseased. Such a state directly affects the performance of the health system and the patients who are seeking care. This study aimed at assessing the psychological effect of COVID-19 among the healthcare workers in the intensive care units of two tertiary care hospitals of Rawalpindi & Islamabad.   Methods It was a descriptive cross-sectional study, conducted over five months i.e., 1st July 2020 to 1st November 2020. Non-probability consecutive sampling technique was used for recruiting health care workers. PHQ-9 tool was used including 9 questions (items) related to the depression due to COVID-19. Other tool Fear of COVID-19 scale was based on 5 points Likert scale as ‘strongly disagree’, ‘disagree’, ‘neutral’, ‘agree’ and ‘strongly agree’. Besides descriptive frequencies, mean and standard deviation, Spearman correlation (r) was applied to check the correlation between fear of COVID-19 with age (years) and professional experience (years).   Results Out of 382 healthcare workers (doctors, nurses & other staff) recruited in the study, around 50% were found to be suffering from severe depression and have developed a fear of the disease. A significant positive correlation was observed between the age of the healthcare worker and the degree of fear of COVID-19 (p<0.05). Similarly, a significant positive correlation was observed between the number of professional experience and the fear of COVID-19 (p<0.05).   Conclusion It is concluded that healthcare workers in ICU are at risk of depression because of fear of COVID-19. The current situation highlights the areas that need attention. Special training or orientation must be arranged for a situation of an outbreak or a pandemic and skills for keeping one’s psychological wellbeing and mental health must be imparted. KEYWORDS: Fear; Depression; Psychological impact; COVID-19, Healthcare workers, Pakista

Zinc nutrition application augments morpho-physiological attributes, productivity and grain zinc bioavailability of Paddy Rice

Zinc (Zn) deficiency is the most important micronutrient disorders affecting plants and human health. Present study evaluated the potential of various Zn application methods in improving the performance of selected rice genotypes and Zn bioavailability in grains. Pre-selected Zn application methods through pot experiments were validated in the field. Harvested grains were fed to albino rats for Zn bioavailability. Results revealed that soil + foliar application of Zn was effective in improving the seedling growth of rice genotypes by modulating the agronomic, water related and biochemical attributes. The rats gained more body weight fed with rice genotype Accession-164 (high Zn accumulator) compared with the minimum for Super Basmati (low Zn accumulator) feed. In crux, soil application of Zn at 15 kg ha-1 followed by foliar application of 0.25% ZnSO4.7H2O solution at tillering and heading stages produced the highest grain yield (26.25%, 29.11%) with maximum bioavailable Zn (21.02%, 22.50%) during both years, respectively, in the grains for combating malnutrition in the tested rats

Tyrosinase inhibition: conformational analysis based studies on molecular dynamics calculations of bipiperidine based inhibitors.

Two series of variably N-substituted biperidines were synthesized by condensing various acid chlorides, alkyl halides and anhydrides with 1,4-bipiperidine. The new compounds were tested as tyrosinase inhibitors and a structure-activity relationship (SAR) study was carried out. Potent inhibition was observed in the case of the 4'-methylbenzyl substitution on this atom (IC50 = 1.72 microM) with this compound being a lead for future drug design. Additionally, calculations of the important QSAR molecular descriptors were done on the biperidine analogues after their 2 ps molecular dynamics (MD) simulations using molecular mechanics force field (MMFF) approaches. Using MD simulations potential and total energies were calculated for the energy minimized models of bipiperidine and the most active analogs 2, 3, 4, 6, 8 and 10

Role of foliar spray of plant growth regulators in improving photosynthetic pigments and metabolites in Plantago ovata (Psyllium) under salt stress – A field appraisal

Salinity is one of the major abiotic factors that limit the growth and productivity of plants. Foliar application of plant growth regulators (PGRs) may help plants ameliorate the negative impacts of salinity. Thus, a field experiment was conducted at the Botanical Garden University of Balochistan, Quetta, to explore the potential role of PGRs, i.e., moringa leaf extract (MLE; 10%), proline (PRO; 1 µM), salicylic acid (SA; 250 µM), and thiourea (TU; 10 mM) in ameliorating the impacts of salinity (120 mM) on Plantago ovata, an important medicinal plant. Salinity hampered plant photosynthetic pigments and metabolites but elevated oxidative parameters. However, foliar application of PGRs enhanced photosynthetic pigments, including Chl b (21.11%), carotenoids (57.87%) except Chl a, activated the defense mechanisms by restoring and enhancing the metabolites, i.e., soluble sugars (49.68%), soluble phenolics (33.34%), and proline (31.47%), significantly under salinity stress. Furthermore, foliar supplementation of PGRs under salt stress led to a decrease of about 43.02% and 43.27% in hydrogen peroxide and malondialdehyde content, respectively. Thus, PGRs can be recommended for improved photosynthetic efficiency and metabolite content that can help to get better yield under salt stress, with the best and most effective treatments being those of PRO and MLE to predominately ameliorate the harsh impacts of salinity

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Cattaneo-Christov heat and mass transmission of dissipated Williamson fluid with double stratification

The vast significance and applications in various industrial works such as heat and cooling process, chemical reactors, food storage systems and several medical works motivated the author to conduct this type of study. The aim of this paper is to inspect the two-dimensional incompressible magnetohydrodynamic flow of Williamson fluid through a stretching sheet. The Cattaneo-Christov temperature and concentration flow is considered with the effects of double stratification and viscous dissipation. The leading nonlinear partial differential equations of flow are transformed into ordinary differential equations by means of renowned similarity transformations and the solutions of flow problem are obtained by means of bvp4c method on MATLAB software. The Williamson fluid parameter depending on time relaxation and declines the fluid motion. The motion of fluid slowed down due to Hartman number. The mass and heat flow is noted to be decline due to thermal and solutal relaxation parameters. The rises in stratification coefficient reduce the mass and heat transferal rate