SERUM MAGNESIUM LEVELS DERANGEMENTS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD).

Background; chronic obstructive pulmonary disease (COPD) leads to significant morbidity and poor quality of life among patients. This study was conducted to evaluate serum magnesium levels among patients with COPD as there is no such study done in Pakistan on this topic. Material and Methods; A total of 137 patients presenting with COPD were registered from Department of medicine, Nishtar Hospital, Multan in this cross-sectional study from June 2016 to June 2017. Once registered in the study, all the relevant baseline investigations were done. Venous blood sample was taken (3 ml) and sent to central laboratory of Nishtar Hospital Multan, for serum Mg levels. Statistical analysis was performed by entering all the data in SPSS version 20. Results; Of these 137 study cases, 84 (61.3%) were male patients while 53 (38.7%) were female patients. Mean age of our study cases was 56.79 ± 4.81 years. Of these 137 study cases, 41 (29.9%) were from rural areas while 96 (70.1%) were from urban areas and 109 (79.6%) were poor. Diabetes was present in 28 (20.4%) and hypertension in 56 (40.9%) our patients. Mean height of our patients was 152.24 ± 10.87 centimeters while mean weight of our study cases was 66.41 ± 7.23 kilograms and mean body mass index was 24.87 ± 4.13 kg/m2. Our study results reported 66 (48.2 %) were normal weight, 41 (29.9 %) were overweight and 30 (21.9 %) were obese. Smoking was noted in 53 (38.7 %) of our study cases. Mean duration of illness was 30.81 ± 14.74 months and 112 (81.8%) had disease duration more than 18 months. Mean serum magnesium level of our patients was 1.52 ± 0.54 meq/liter (Range; 1.15 meq/liter to 2.75 meq/liter) and hypomagnesemia was present in 50 (36.5 %) patients. Conclusion; Frequency of hypomagnsemia among patients with chronic obstructive pulmonary disease was very high in our study. Hypomagnesemia was significantly associated with male gender, increasing age, poor socioeconomic status, diabetes, hypertension, smoking and prolonged disease duration. Clinicians treating such patients should monitor their serum magnesium levels on regular basis to improve their prognosis and to decrease disease morbidity. Keywords; Chronic Obstructive pulmonary disease, hypomagnesemia, frequency.

PREDICTORS OF POST STROKE DEPRESSION AMONG STROKE SURVIVORS.

Background; Post stroke depression is an important factor limiting recovery and rehabilitation in acute stroke patients. This study was done to ascertain frequency of depression and role of different underlying factors among patients with ischemic stroke in our local population of Southern Punjab. Material and methods; All the cases of ischemic stroke (96), fulfilling inclusion criteria were recruited from outdoor of Department of medicine, Nishtar Hospital Multan and patients were assessed for depression using hospital anxiety and depression scale. The patients were categorized having depression the basis of hospital anxiety and depression scale (HADS) scoring. Data was entered and analyzed by SPSS-18. Results; Of these 96 study cases, 50 (52.1 %) were male patients while 46 (47.9 %) were female patients. Mean age of our study cases was 49.17± 9.10 years. Of these 96 study cases, 45 (46.9 %) were from rural area while 51 (53.1 %) from urban areas, 29 (30.2 %) were diabetic and 58 (60.4 %) were hypertensive. Mean body mass index (BMI) of our study cases was 24.12 ± 2.88 kg/m2 and obesity was present in 17 (17.7 %). History of smoking was present in 21 (21.9 %). Mean disease duration of our study cases was 8.36 ± 4.31 months and 50 (52.1 %) had disease duration more than 6 months while 67 (69.8%) had monthly family income up to Rs. 25000 and history of alcohol consumption was zero. Previous history of stroke was present in 16 (16.7 %) while family history of stroke was noted in 17 (17.7 %) of our study cases and 67 (69.8 %) were illiterate and 29 (30.2 %) were literate. Depression was noted in 63 (65.6%) of our study cases. Conclusion; Very high frequency of depression was observed in our study among patients having ischemic stroke. Depression was significantly associated with gender, residential status, smoking, hypertension, educational level, smoking, prolonged duration of illness and occupation. Clinicians treating patients should anticipate depression and diagnose them to treat them in early stages. Keywords; Depression, Ischemic stroke, Frequency.

Activation of nano kaolin clay for bio-glycerol conversion to a valuable fuel additive

High production of biodiesel results in a surplus of glycerol as a byproduct that leads to a drastic decline in the glycerol price as well as overall biodiesel production. Alternative methods must be introduced for the economical process for biodiesel production via utilization of crude glycerol into valuable chemicals or fuel additives. This study introduces an ecofriendly process of solketal synthesis from glycerol and acetone in the presence of a novel metakaolin clay catalyst, which is a useful additive in biodiesel or gasoline, in order to enhance the octane number and to control the emissions. Moreover, kaolin clay catalysts are low cost, abundantly available, eco-friendly and one of the more promising applications for solketal synthesis. In this study, raw kaolin clay was activated with an easy acid activation technique, modification in physicochemical and textural properties were determined by using X-ray diffraction (XRD), Fourier Transform Infra-Red (FTIR) spectroscopy, Brunauer–Emmett–Teller (BET) and Field Emission Scanning Electron Microscope. Among all acid-treated catalysts, metakaolin K3 have shown best catalytic properties, high surface area and pore size after acid activation with 3.0 mol/dm3 at 98 °C for 3 h. Acetalization of glycerol with acetone carried out in the presence of an environmentally friendly and inexpensive novel metakaolin K3 catalyst. The maximum yield of solketal obtained was 84% at a temperature of 50 °C, acetone/glycerol molar ratio 6/1 and for 90 min with novel metakaolin clay catalyst. Effect of various parameters (time, temperature, acetone/glycerol molar ratio, catalyst loading) on the solketal yield and glycerol conversion was discussed in detail. This approach offers an effective way to transform glycerol into solketal—a desirable green chemical with future industrial applications

Cytogenetic abnormalities in myelodysplastic syndromes: An overview

Karyotype is one of the main constituents of the International Prognostic Scoring System (IPSS) and revised-IPSS that are the cornerstones for the prognostication of patients with myelodysplastic syndromes (MDS). Del(5q), -7/del(7q), +8 and -Y are among the most extensively studied cytogenetic abnormalities in MDS. The same applies for normal karyotype. There are hundreds of other rare cytogenetic abnormalities that have been reported in MDS, included but not limited to -X, 3q abnormalities, +13/del(13q), i(17q), +21/-21. However, due to a very low number of patients, their impact on the prognosis of MDS is limited. Knowledge of the molecular consequences of different cytogenetic abnormalities allows us to modify treatment regimens based on drugs most active against the specific karyotype present, allowing for the opportunity to individualize MDS treatment and improve patient care and prognosis

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

MICROWAVE IRRADIATION PROCESS FOR BIODIESEL PRODUCTION USING WASTE SUGARCANE BAGASSE DERIVED ACID ACTIVATED CATALYST

Production of biodiesel has been increased globally during the last decade to overcome the problems of increasing prices of petro-diesel and depletion of fossil fuels. The production of biodiesel using homogeneous or heterogeneous catalysts is not favorable due to difficult catalyst recovery, purification of the product in case of homogeneous catalysts and longer reaction time, severe reaction conditions and high production cost are the drawbacks of heterogeneous catalysts. The focus of this study is to utilize agro-waste sugarcane bagasse in the synthesis of heterogeneous catalyst for biodiesel production from waste feedstock i.e., waste cooking oil which is leftover on a large scale after cooking and frying purposes. Waste sugarcane bagasse was converted into biochar through partial carbonization and activated through sulfonation at given reaction conditions. The prepared catalysts were found to be thermally stable up to 500 as observed by thermogravimetric analysis. Attachment of functional groups (-COOH, -OH, SO3H) was confirmed by fourier transform infrared spectroscopy, porous structure after sulfonation by scanning electron microscope, amorphous nature by x-ray diffraction and amount of carbon, hydrogen, nitrogen, and sulfur was determined by CHNS analyzer. The prepared catalyst exhibited an excellent surface area (20.78 m2. g-1) as determined by BET and total acid density 3.94 mmol. g-1. The process of biodiesel production was done in a modified microwave reactor equipped with thermocouple to maintain temperature and condenser to avoid the evaporation of solvent. The maximum conversion of triglycerides 95.45% and biodiesel yield of 92.12% was obtained at 60 ℃ with 5 wt.% of catalyst using 15:1 of methanol to oil molar ratio after 15 minutes. The results of experiments were validated by using response surface methodology based on the selected quadratic model with a confidence level of (R2= 0.92). Kinetic studies of the experiments depicted that the use of sulfonated catalyst lowered the activation energy (10.5 kJ. mol-1) and reactants attained equilibrium point after a short interval of time under microwave heating

The potential of adopting natural fibers reinforcements for fused deposition modeling: Characterization and implications

Natural fibers or their derivatives have gained significant attention as green fillers or reinforcement materials due to their abundant availability, environment-friendly nature and biodegradability for sustainable development. Despite the availability of modern alternatives such as concrete, glass-fiber/resin composites, steel, and plastics, there is still considerable demand for naturally occurring based materials for different applications due to their low cost, durability, strength, heat, sound, and fire-resistance characteristics. 3D printing has provided a novel approach to the development and advancement of natural fiber-based composite materials, as well as an important platform for the advancement of biomass materials toward intelligentization and industrialization. The features of 3D printing, particularly fast prototyping and small start-up, allow the easy fabrication of materials for a wide range of applications. This review highlights the current progress and potential commercial applications of 3D printed composites reinforced with natural fibers or biomass. This study discussed that 3D printing technology can be effectively utilized for different applications, including producing electroactive papers, fuel cell membranes, adhesives, wastewater treatment, biosensors, and its potential applications in the automobile, building, and construction industries. The research in the literature showed that even if the field of 3D printing has advanced significantly, problems still need to be solved, such as material incompatibility and material cost. Further studies could be conducted to improve and adapt the methods to work with various materials. More effort should be put into developing affordable printer technologies and materials that work with these printers to broaden the applications for 3D printed objects

Microbiological and antimicrobial pattern of diabetic foot ulcers (DFUs) at a tertiary care center in North West, Pakistan

Objective: To determine the pattern of antimicrobial sensitivity of common microorganisms isolated from diabetic foot infections presenting at a tertiary care center in North West, Pakistan. Methods: 201 patients were included in the study, which was conducted over a period of 08 months from January 2019 to August 2019, at the Diabetes & Footcare Clinic (DFC), Mayo Hospital Lahore. Deep-seated tissue samples (0.5 x 0.5 cm) were taken from ulcer bed and immediately sent for culture & sensitivity (C&S) testing. Antimicrobial susceptibility was determined in accordance with Clinical & Laboratory Standards Institute (CLSI) guidelines. Statistical analysis was performed using SPSS version 26.0. Data was presented as Mean ± SD for continuous variables & frequency with percentage for categorical variables. Results: Mean age of participants was 53.05 ± 10.70, from which 66.7 % (134) were male. Grade 3 DFUs (51.7%) and grade 2 DFIs were most prevalent (62.7%). Out of 201 tissue specimens, 389 bacterial isolates were collected. Monomicrobial specimens accounted for 28.4%, with the rest (71.6%) being polymicrobial. Gram negative organisms were 238 (61.11%) while the rest (38.89%) were gram positive organisms. There was a high incidence of methicillin resistant S. aureus (MRSA) at 64.58%. Highest susceptibility of S. aureus was reported with vancomycin and fusidic acid at 100% and 79.35%. Continuous..

Surveillance of aetiologies, clinical presentation, and most common types of epilepsy among paediatric patients at a tertiary care hospital in Pakistan

Epilepsy is the third most common neurological disease in the world associated with a high frequency in the paediatric age group. This study aims to evaluate the prevalence, types and aetiologies of epilepsy within the Pakistani population. A retrospective review of the charts of all patients, below the age of 18 years, presenting with epilepsy to the Department of Neurology at The Children\u27s Hospital and Institute of Child Health, Lahore, from January 2016 to December 2020, was carried out. Analysis was performed using SPSS Version 26. A p value of \u3c0.05 was considered statistically significant. A total of 1,097 patients were studied, of which 644 (58.8%) were males and 451 (41.2%) females. a vast majority, i.e. 1,021 (96.1%), of the study participants, belonged to the province of Punjab. Afebrile seizures [n=798 (72.7%)] were more commonly reported than febrile seizures [n=299 (27.3%)]. Among seizure types, generalised seizures were the most common type of seizure reported in 520 (49.8%) patients. Refractory seizures were the least common type reported in 3 (0.3%) patients. Aetiology was mostly idiopathic [n=540 (49.2)], followed by congenital [n=228 (20.8%)]. The most frequently reported duration of seizure was between one and three minutes [n=116 (42.3%)]. The most common ictal features seen were a combination of up-rolling of eyes and frothing from the mouth [n=206 (34.9%)]. Results from this study can be used by health care providers to better formulate therapeutic interventions for a timely diagnosis and effective treatment of epileps