FREQUENCY OF CORONARY ARTERY DISEASE USING CALCIUM SCORING BY 640 SLICE CT

Coronary artery disease is the narrowing of coronary arteries which is usually caused by the atherosclerosis that leads to restriction of blood flow to the heart muscles. Atherosclerosis is a buildup of plaque or deposition of fats on the inner walls of arteries and is calculated by calcium scoring. Calcium scoring is a test to assess the presence and degree of plaque in the coronary arteries. Objective: To find the frequency of coronary artery disease using calcium scoring by 640 slice CT.   Methods: A descriptive study was conducted at Punjab Institute of Cardiology, Lahore. 155 participants including 117 (75.5%) males and 38 (24.5%) females were selected through convenient sampling technique. SPSS version 21.0 was used for data analysis. Results: Analysis of data showed that out of 155 patients, 54 (34%) patients had no lesion and 101 (65.2%) had CAD. Only 2 patients had 5 lesions. Out of 117 males, 38 had no plaque and 40 males had moderate plaque in coronary arteries. Out of 38 females, 16 female patients had no plaque, 5 female patients had moderate plaque. 99 (63.9%)  patients were non-smokers, out of them, 46 patients had no plaque and 17 patients had moderate plaque. 56 (36.1%) patients were smokers, out of these 8 had no plaque and 28 patients had moderate plaque. In total 103 (66.5%) patients who were hypertensive, 28 patients had no plaque, 36 had moderate plaque. Out of 52 (33.5%) patients who were without hypertension, 26 patients had no plaque, 36 patients had moderate plaque. Out of 155, 94 (60.6%) patients had diabetes, out of these 27 patients had no plaque, 32 patients had moderate plaque. Of 61 (39.4%) patients with diabetes, 27 had no plaque, 13 were with moderate plaque. 52 patients who were between the age of 26-35 years, 18 patients had no plaque, 14 patients had moderate plaque and of 8 patients between the age of 66-75 years, 3 had moderate plaque. Conclusions: In our sample the ratio of males was greater than females. In males, moderate plaques are most common and most of the females are those with no plaque. 54 % patients have no plaque and only 3 patients have minimal plaque. Smokers were least affected. It is concluded that hypertension affects the population more than any other risk factor. From our study it is also concluded that the people within the age range of 26 to 35 years are most likely to develop CAD Key words: Computed Tomography, Calcium Scoring, Coronary Artery Disease DOI: 10.7176/JHMN/71-13 Publication date: February 29th 202

Protocol for a scoping review of the use of information and communication technology platforms for the delivery and utilisation of transgender healthcare

Introduction In recent years, there has been strong interest in making digital health and social tools more accessible, particularly among vulnerable and stigmatised groups such as transgender people. While transgender people experience unique physical, mental and sexual health needs, not much is currently known about the extent to which they use information and communication technologies such as short messaging service and videoconferencing to access health services. In this paper, we discuss our protocol for a scoping review of the literature about the delivery and utilisation of digitally mediated health services for transgender populations. Methods and analysis This scoping review of the provision and experience of telemedicine among transgender people will follow the methodological framework developed by Arksey and O’Malley. The search will be conducted using three online databases, namely PubMed, CINAHL and Scopus, with additional literature explored using Google Scholar to identify grey literature. Relevant English-language studies will be shortlisted after completing a title and abstract review based on defined inclusion criteria. Following that, a final list of included studies will be compiled after a full-text review of the shortlisted articles has been completed. To enable the screening process, a team of researchers will be assigned refereed publications explicitly referring to the provision and experience of transgender healthcare through telemedicine. Screening performed independently will then collaboratively be reviewed to maintain consistency. Ethics and dissemination The research is exempt from ethics approval since our analysis is based on extant research into the use of digital technologies in providing healthcare to transgender people. The results of this study will be disseminated through peer-reviewed academic publications and presentations. Our analysis will guide the design of further research and practice relating to the use of digital communication technologies to deliver healthcare services to transgender people

Information and communication technology-based health interventions for transgender people: A scoping review

In the recent past, there has been a strong interest in the use of information and communication technology (ICT) to deliver healthcare to ‘hard-to-reach’ populations. This scoping review aims to explore the types of ICT-based health interventions for transgender people, and the concerns on using these interventions and ways to address these concerns. Guided by the scoping review frameworks offered by Arksey & O’Malley and the PRISMA-ScR checklist, literature search was conducted in May 2021 and January 2022 in three databases (PubMed, CINAHL and Scopus). The two searches yielded a total of 889 non-duplicated articles, with 47 of them meeting the inclusion criteria. The 47 articles described 39 unique health projects/programs, covering 8 types of ICT-based interventions: videoconferencing, smartphone applications, messaging, e-coaching, self-learning platforms, telephone, social media, and e-consultation platforms. Over 80% of the health projects identified were conducted in North America, and 62% focused on HIV/sexual health. The findings of this review suggest that transgender people had often been regarded as a small subsample in ICT-based health projects that target other population groups (such as ‘men who have sex with men’ or ‘sexual minority’). Many projects did not indicate whether transgender people were included in the development or evaluation of the project. Relatively little is known about the implementation of ICT-based trans health interventions outside the context of HIV/sexual health, in resource limiting settings, and among transgender people of Asian, Indigenous or other non-White/Black/Hispanic backgrounds. While the range of interventions identified demonstrate the huge potentials of ICT to improve healthcare access for transgender people, the current body of literature is still far from adequate for making comprehensive recommendations on the best practice of ICT-based interventions for transgender people. Future ICT-based interventions need to be more inclusive and specified, in order to ensure the interventions are safe, accessible and effective for transgender people

The study of removal chromium (VI) ions from aqueous solution by bimetallic ZnO/FeO nanocomposite with Siltstone: Isotherm, kinetics and reusability

In this study, nanocomposites of Baghanwala Siltstone (BSS) with ZnO (BSS/ZnO), FeO (BSS/FeO), and BSS/ZnO/FeO were successfully prepared for the removal of hexavalent chromium [(Cr (VI)] from aqueous solutions via a batch adsorption process. The characterization studies by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and scanning electron microscopy-energy-dispersive X-ray spectroscopy (SEM-EDX) found successful synthesis of the composites and demonstrated the occurrence of different active functional groups that played an active role in Cr ion adsorption. The effect of Cr initial concentrations (25–100 mg/L), adsorbent dose (0.5–2 g/L), pH (2–8), and contact time (0–160 min) on Cr remediation from contaminated water was examined. The order of Cr ion removal was BSS/ZnO/FeO (77–87%) \u3e BSS/ZnO (74–83%) \u3e BSS/FeO (71–77%) \u3e BSS (68–74%). The as-synthesized BSS/ZnO/FeO led to successful Cr removal (87%) at a 25 mg/L Cr concentration at pH 4.0. The Cr ion adsorption by the BSS/ZnO/FeO nanocomposite was well explained by the Langmuir adsorption isotherm model (R2 \u3e 0.99), while the kinetic experimental data was well fitted with the pseudo-second-order model (R2 \u3e 0.99). Among the as-synthesized adsorbents, the BSS/ZnO/FeO nanocomposite showed excellent stability and reusability in seven sorption cycles. The results showed that the as-synthesized BSS/ZnO/FeO nanocomposite had the greatest adsorption potential for removing Cr ions from contaminated water

Improving diagnosis of tuberculous lymphadenitis by combination of cytomorphology and MPT64 immunostaining on cell blocks from the fine needle aspirates

Background: Extra pulmonary tuberculosis (EPTB) constitutes 18% of all tuberculosis (TB) cases and tuberculous lymphadenitis (TBL) constitutes 20–40% of EPTB. Diagnosis of TBL is challenging because of the paucibacillary nature of the disease. Objective: To investigate the diagnostic potential of a new antigen detection test based on the detection of M. tuberculosis complex specific antigen MPT64 from fine needle aspirate (FNA) cytology smears and biopsies obtained from patients with clinically suspected TBL using immunohistochemistry (IHC). Materials and methods: This study was conducted at Khyber Teaching Hospital and Rehman Medical Institute, Peshawar, Pakistan, from January 2018 to April 2019. Samples, including FNA (n = 100) and biopsies (n = 8), were collected from 100 patients with presumptive TBL. Direct smears and cell blocks were prepared from the FNA samples. All samples were subjected to hematoxylin–eosin (H&E) staining, Ziehl-Neelsen (ZN) staining, and immunostaining with polyclonal anti-MPT64 antibody. The culture was performed only for biopsy specimens. All patients were followed until the completion of anti-TB treatment. The response to treatment was included in the composite reference standard (CRS) and used as the gold standard to validate the diagnostic tests. Results: The sensitivity, specificity, positive and negative predictive values for ZN staining were 4.4%,100%,100%,56%, for culture were 66%,100%,100%,50%, for cytomorphology were 100%,90.91%,90%,100%, and for immunostaining with anti-MPT64 were all 100%,respectively. The morphology and performance of immunohistochemistry were better with cell blocks than with smears. Conclusion: MPT64 antigen detection test performed better than ZN and cytomorphology in diagnosing TBL. This test applied to cell blocks from FNA is robust, simple, and relatively rapid, and improves the diagnosis of TBL

Biomedical and photocatalytic applications of biosynthesized silver nanoparticles: Ecotoxicology study of brilliant green dye and its mechanistic degradation pathways

© 2020 Elsevier B.V. The preparation of nanoparticles from biological materials is an economic and environmentally friendly strategy with several advantages. The current study is focused to synthesize silver nanoparticles using Petroselinum crispum plant extract. Various characteristics of biologically synthesized AgNPs were determined with UV–Visible (UV/Vis) Spectroscopy, X-ray Diffraction (XRD), Fourier Transform Infrared (FTIR) Spectroscopy, and High-Resolution Transmission Electron Microscopy (HRTEM). The plasmonic resonance peak at 425 nm ensured the formation of AgNPs. The FTIR analysis showed that the as-synthesized particles contain alcoholic and polyphenolic constituents, which are responsible for their capping and reduction. The HRTEM results revealed spherical shape of AgNPs with size ranging from 25 to 90 nm. The as-synthesized particles demonstrated excellent antibacterial properties against Gram positive and Gram-negative bacteria. The antioxidant applications of the particles were determined with 2,2-diphenyle-1-picrylhydrazyl (DPPH). Moreover, the photocatalytic application of the synthesized AgNPs was evaluated for brilliant green dye (BG). The results demonstrated high degradation of BG due to small size and well-dispersed nature of AgNPs. Degradation products of BG were identified to suggest degradation pathways. The eco-toxicity of the BG and constituents derived from the dye were studied with Ecological Structure Activity Relationship (ECOSAR) software

Genetic Diversity of Endangered Sheep Breed of Valley Swat, Pakistan, Based on Microsatellite Analysis

Morphologically, Kutta breed is black coat color sheep, with short tail and having thick wool fiber diameter. Weight differences in Kutta sheep exists as animals found in plain areas are slightly heavier and bigger than those found in hilly and remote areas of upper Kalam and Malamjaba of valley Swat with an average body weight of 23.2 ±0.34 kg. Aim of the study is to provide information on the genetic structure of the Kutta breed. A set of 31 FAO recommended microsatellite (SSR) markers was used to access the genetic variability in 21 DNA samples extracted.The breed showed high level of genetic diversity. Out of the total 31 FAO recommended markers, 23 were fully amplified during Polymerase Chain reactions (PCR), having a total of 151 different alleles obtained, with an effective allele of (6.57) per locus. Similarly high level of average heterozygosity (0.77) and gene diversity (0.80) was observed. The within breed estimate (FIS) in breed was found extremely low (0.002). Shannon information Index (I) was found (1.65). The mean Chi-square value for the Hardy Weinberg Equilibrium (0.10) indicates that the population has lost its equilibrium on the overall basis. Majority of the markers were found neutral when test on Evens-Watterson, which suggest that decreases in heterozygosity in the population was not due to selection. Test for mutation drift equilibrium in the population showed that the population had preserved its effective size and has not experienced genetic bottleneck at least in the recent past

Impact of a multifaceted intervention on physicians' knowledge, attitudes and practices in relation to pharmaceutical incentivisation: protocol for a randomised control trial.

INTRODUCTION: In settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients' well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs' professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands. METHODS AND ANALYSIS: This study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs' medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and will be randomly assigned to intervention and control groups. The intervention group GPs will be exposed to emotive and educational seminars on medical ethics, whereas control group GPs will be given seminars on general medical topics. The primary outcome measure will be GPs' prescribing practices, whereas the secondary outcome measures will be their knowledge and attitudes regarding COI that arises from pharmaceutical incentivisation. In addition to a novel standardised pharmaceutical representatives (SPSR) method, in which field researchers will simulate pharmaceutical marketing with GPs, presurvey and postsurvey, and qualitative interviewing will be performed to collect data on GPs' knowledge, attitudes and practices in relation to COI linked with pharmaceutical incentives. Univariate and multivariate statistical analyses will be performed to measure a change in GPs' knowledge, attitudes and practices, while qualitative analysis will add to our understanding of the quantitative SPSR data. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Pakistan National Bioethics Committee (# 4-87/NBC-582/21/1364), the Aga Khan University (# 2020-4759-1129) and the London School of Hygiene and Tropical Medicine (# 26506). We will release results within 6-9 months of the study's completion. TRIAL REGISTRATION NUMBER: ISRCTN12294839

Loss-to-follow-up and delay to treatment initiation in Pakistan's national tuberculosis control programme

BACKGROUND: Researchers and policy-makers have identified loss to follow-up as a major programmatic problem. Therefore, the objective of this study is to quantify TB related pre-treatment loss to follow up and treatment delay in private sector health care facilities in Pakistan. METHODS: This was a retrospective, descriptive cohort study using routinely collected programmatic data from TB referral, diagnosis and treatment registers. Data from 48 private healthcare facilities were collected using an online questionnaire prepared in ODK Collect, for the period October 2015 to March 2016. Data were analysed using SPSS. We calculated the: (1) number and proportion of patients who were lost to follow-up during the diagnostic period, (2) number and proportion of patients with pre-treatment loss to follow-up, and (3) the number of days between diagnosis and initiation of treatment. RESULTS: One thousand five hundred ninety-six persons with presumptive TB were referred to the laboratory. Of these, 96% (n = 1538) submitted an on-the-spot sputum sample. Of the 1538 people, 1462 (95%) people subsequently visited the laboratory to submit the early morning (i.e. the second) sample. Hence, loss to follow-up during the diagnostic process was 8% overall (n = 134). Of the 1462 people who submitted both sputum samples, 243 (17%) were diagnosed with sputum smear-positive pulmonary TB and 231 were registered for anti-TB treatment, hence, loss in the pre-treatment phase was 4.9% (n = 12). 152 persons with TB (66%) initiated TB treatment either on the day of TB diagnosis or the next day. A further 79 persons with TB (34%) commenced TB treatment within a mean time of 7 days (range 2 to 64 days). CONCLUSION: Concentrated efforts should be made by the National TB Control Programme to retain TB patients and innovative methods such as text reminders and behavior change communication may need to be used and tested