Risk factors associated with ectopic pregnancy: A case control study.

Introduction: Ectopic pregnancy (EP) accounting for 10% of all pregnancies is a major health problem for women of childbearing age and leading cause of maternal deaths. The identified risk factors are previous ectopic pregnancy, previous pelvic surgery, induction of ovulation, intrauterine device usage, history of pelvic inflammatory disease, and smoking at the time of conception. Objective: To identify risk factor for ectopic pregnancy so that appropriate directional strategies may be developed to reduce its prevalence.  Methodology: This observational case control study was conducted with sample size of 100 (50 cases, 50 control) from January 2017 to 30 July 2017 at different hospitals of Sindh and Punjab. For this study, case was defined as a pregnant woman with a confirmed tubal ectopic gestation, while control as pregnant women with a confirmed normal intrauterine pregnancy. Information regarding demographic socio-economic status and risk factors were also collected. Results:  The case & control groups were almost similar with respect to age, education, residence, age of marriage and parity. There was a significant associa­tion between prior ectopic pregnancy (OR 15.47, CI 95% 1.92-124.3, p=0.00) , history of previous pelvic inflammatory diseases (PID) (OR 13.5, CI 95% 5.09-35.83, p=0.01), smoking (OR 15.47, CI 95% 1.92-124.3, p=0.00), history of endometriosis (OR 4.04, CI95%1.22-13.47, p=0.00), use of intrauterine contraceptive device (IUCD) (OR 5.41, CI 95% 1.66-17.65, p=0.00), and previous cesarean section(OR 2.42,CI 95%1.04-5.63, p=0.02). Conclusion: Identification of risk factors for ectopic pregnancy may help in early detection and appropriate management. Risk factors modification, such as cigarette smoking, use of IUCD and first pregnancy interval may be effective as risk-reduction strategies. Key Word:  Ectopic pregnancy, Intrauterine contraceptive device, Pelvic inflammatory disease

On-site cellulase production by Trichoderma reesei 3EMS35 mutant and same vessel saccharification and fermentation of acid treated wheat straw for ethanol production

Bioethanol production from lignocellulosic raw materials involves process steps like pretreatment, enzymatic hydrolysis, fermentation and distillation. In this study, wheat straw was explored as feedstock for on-site cellulase production by T. reesei 3EMS35 mutant, and as a substrate for second generation bioethanol production from baker yeast. Scanning electron microscopy (SEM) and X-ray diffractography (XRD) of untreated wheat straw (UWS) and acid treated wheat straw (TWS) were done to understand the structural organization and changes in the cellulase accessibility and reactivity. The effect of delignification and structural modification for on-site cellulase enzyme production was comparably studied. The efficiency of crude cellulase enzyme for digestion of UWS and TWS and then production of ethanol from TWS was studied using same-vessel saccharification and fermentation (SVSF) technique, both in shaking flasks as well as in fermenters. Two different methods of operation were tested, i.e. the UWS Enz method, where UWS was used for on-site enzyme production, and TWS Enz method where TWS was applied as substrate for cellullase production. Results obtained showed structural modifications in cellulose of TWS due to delignification, removal of wax and change of crystallinity. UWS was better substrate than TWS for cellulase production due to the fact that lignin did not hinder the enzyme production by fungus but acted as a booster. On-site cellulase enzyme produced by T. reesei 3EMS35 mutant hydrolyzed most of cellulose (91 %) in TWS within first 24 hrs. Shake flasks experiments showed that ethanol titers and yields with UWS Enz were 2.9 times higher compared to those obtained with TWS Enz method respectively. Comparatively, titer of ethanol in shake flask experiments was 10 % higher than this obtained in 3 L fermenter with UWS Enz. Outcomes from this investigation clearly demonstrated the potential of on-site cellulase enzyme production and SVSF for ethanol production from wheat straw

Utjecaj sastava podloge na komercijalnu proizvodnju alkalne proteaze s pomoću soja Bacillus licheniformis N-2

Protease production by alkalophilic B. licheniformis N-2 was investigated in 50 mL of the growth medium consisting of (in g/L): glucose 10.0, soybean meal 10.0, K2HPO4 3.0, MgSO4·7H2O 0.5, NaCl 0.5 and CaCl2·2H2O 0.5 at pH=10. Different carbon and nitrogen sources in the form of fine powder of organic, inorganic and defatted meals were studied to select the suitable substrate for alkaline protease production. The highest level of alkaline protease (677.64 U/mL) was obtained in the medium containing glucose followed by soluble starch and wheat bran. Among various nitrogen sources, defatted soybean meal was found to be the best inducer of alkaline protease, while inorganic nitrogen sources in the form of ammonium salts repressed the enzyme activity up to 96 %. Thermostability studies showed that the enzyme in the presence of 10 mM Ca2+ ions retained its residual activity up to 80 % even after incubation at 40 °C for 12 h. The enzyme was found stable over a broad range of pH (8–11) and lost 52 % of its residual activity at pH=12. After the treatment with Tween 20, Tween 45, Tween 65, Triton X-405, H2O2 and sodium perborate, each at 1.0 % concentration, the enzyme showed residual activity of 105, 82, 116, 109, 135 and 126 %, respectively. The application of alkaline protease for removal of blood stains from cotton fabric also indicates its potential use in detergent formulations.U radu je istražena proizvodnja proteaze s pomoću alkalofilnog soja bakterije Bacillus licheniformis N-2 u 50 mL podloge sastava (u g/L): glukoza 10,0; sojina sačma 10,0; K2HPO4 3,0; MgSO4·7H2O 0,5; NaCl 0,5 i CaCl2·2H2O 0,5; pH=10. Dodatkom raznih izvora ugljika i dušika u obliku finih praškastih organskih, anorganskih i nemasnih hranjiva, odabran je prikladan supstrat za proizvodnju alkalne proteaze. Najviše alkalne proteaze (677,64 U/mL) proizvedeno je u podlozi s glukozom, a nešto manje sa škrobom i mekinjama. Utvrđeno je da je nemasna sojina sačma najbolji izvor dušika za proizvodnju alkalne proteaze, dok su amonijeve soli smanjile aktivnost enzima i do 96 %. Ispitivanje termostabilnosti enzima pokazalo je da on, u prisutnosti Ca2+ iona u koncentraciji od 10 mM, zadržava čak do 80 % aktivnosti i nakon inkubacije pri 40 °C tijekom 12 sati. Enzim je bio stabilan u području pH-vrijednosti od 8 do 11, a pri pH=12 izgubio je 52 % rezidualne aktivnosti. Nakon obrade različitim 1,0 %-tnim otopinama izmjerena je ova rezidualna aktivnost enzima: 105 % s Tween 20, 82 % s Tween 45, 116 % s Tween 65, 109 % s Triton X-405, 135 % s H2O2 i 126 % s natrijevim perboratom. Alkalna se proteaza može primijeniti u proizvodnji detergenata za uklanjanje mrlja od krvi pri pranju tkanina

Comparison of Safety and Efficacy of Potassium Hydroxide versus Combination of Salicylic and Lactic Acid for Molluscum Contagiosum

Background: Molluscum contagiosum (MC) is a contagious cutaneous infection caused by MC virus, affecting mainly the pediatric population. It is characterized by flesh-colored umbilicated papules occurring on the skin surface. Potassium hydroxide (KOH) and salicylic acid plus lactic acid combination being keratolytic agents, are effective treatment options. The objective of the study was to compare the efficacy and safety of 10% KOH solution versus salicylic acid/ lactic acid combination in treating Molluscum contagiosum in pediatric population. Material and Methods: A total of 80 children (age range 1-13 years) with Molluscum contagiosum lesions were selected from the Dermatology Out-Patient Department, and were randomly allocated into two groups by lottery method. Group A was given topical 10% KOH solution and group B was given Salicylic plus Lactic acid preparations for topical application. Patients were followed after two weeks to see regression in size of the lesion, and development of any side-effects. Final visit was scheduled at 6 weeks. Statistical analysis was carried out using SPSS (version 16) with p value less than 0.05 considered as statistically significant. Results: Patients with MC (n = 80) were equally divided into group A (treated with 10% KOH) and group B (treated with combination of Salicylic acid and Lactic acid). After 6 weeks, complete remission from Molluscum contagiosum virus was seen in 29 (72.5%) patients of group A and 34 (85%) patients of group B. There were 12 (30%) patients in group A who developed local irritation and 4 (10%) developed local erythema after 6 weeks. None of the patients of group B had any such side effects. Conclusion: 10% KOH solution is as effective as the combination of Salicylic and Lactic acids for treatment of Molluscum contagiosum in pediatric population, however it is associated with side effects of local irritation and erythema

Empirically testing Keynesian defense burden hypothesis, nonlinear hypothesis, and spillover hypothesis: Evidence from Asian countries

The objective of the study is to evaluate different alternative and plausible hypothesis, i.e., Keynesian defense burden hypothesis, nonlinear hypothesis, and spillover hypothesis by controlling governance indicators in a panel of 5 Asian selected countries during a period of 2000 to 2016. The study employed panel Fully Modified OLS (FMOLS) and Dumitrescu-Hurlin panel causality estimates for robust inferences. The results confirmed the defense burden hypothesis where high military expenditures decrease country’s economic growth. The real interest rate, trade openness, and government education expenditures substantially decreases country’s per capita income due to market imperfection, arms import, and low spending on education. The political instability decreases economic growth while voice and accountability and regulatory control largely support country’s economic growth. The causality estimates confirmed the feedback relationship between i) per capita income and exports ii) trade openness and military expenditures, and iii) real interest rate and exports, while growth led military expenditures and arms conflict, military led exports and political instability, and trade led regulatory control established in causality framework

Development and evaluation of scaffold-based nanosponge formulation for controlled drug delivery of naproxen and ibuprofen

Purpose: To develop and evaluate nanosponge (NS) based sustained release formulations of naproxen (NAP) and ibuprofen (IBU).Method: Six formulations of each candidate drug were prepared by emulsion solvent diffusion method, using varying ratios of polymers, i.e., ethyl cellulose and polyvinyl alcohol. The prepared formulations were evaluated for various parameters including production yield, particle size, polydispersity index, actual drug content and entrapment efficiency. Morphological, structural and thermo-analytical evaluations were performed using various techniques. In vitro release studies were performed on selected formulations.Results: Nanosponge (NS) formulations of naproxen and ibuprofen were successfully prepared by emulsion solvent diffusion method. The particle size of naproxen and ibuprofen nanosponge formulations ranged from 347.6 to 1358 nm and 248.7 to 327.6 nm, respectively. Formulations with equal proportion of ethyl cellulose and drug resulted in nanosponges with the desired particle size. Production yield, actual drug content and entrapment efficiency was dependent on the ratio of ethyl cellulose and polyvinyl alcohol. Formulations with equal proportion showed least PDI values (0.09 for NAP and 0.07 for IBU) and highest zeta potential (-27.2 mV for NAP and -28.2 mV for IBU). Morphological, structural and thermo-analytical analysis confirmed the encapsulation of drugs in nanosponge cavities, and exhibited spherical and porous morphology. Nanosponge formulations gave a sustained release pattern, based on Higuchi model. Drug release mechanism was Fickian followed Korsmeyer-Peppas model, due probably to the porosity of the nanosponge.Conclusion: Sustained release nanosponge formulations of naproxen and ibuprofen have successfully been prepared.Keywords: Nanosponge, Naproxen, Ibuprofen, Emulsion solvent diffusion method, Sustained releas

Morphological spectrum of vesiculobullous skin lesions: An institutional perspective

Introduction: A vesiculobullous lesion of the skin encompasses a group of dermatological disorders with protean clinicopathological features. They usually occur as a part of the spectrum of various infectious, inflammatory, drug-induced, genetic, and autoimmune disorders. Therefore, accurate diagnosis of these lesions is essential for appropriate management and to reduce the associated morbidity and mortality. The conventional skin punch biopsy is the mainstay in the diagnosis of dermatological diseases, especially when combined with confirmatory tests, such as direct immunofluorescence (DIF). Our study evaluated the clinicopathological spectrum of vesiculobullous lesions.Methods: We studied 150 cases of vesiculobullous lesions at the Department of Histopathology, Liaquat National Hospital and Medical College Karachi, Pakistan. Written and informed consent was taken from the patients followed by skin punch procedure in which three biopsies were obtained, which included one biopsy from the lesion and two peri-lesional biopsies. One peri-lesional biopsy was sent in cryomatrix for DIF studies, whereas the other two were sent in formalin to follow the standard tissue-processing protocol.Results: Our results showed that most patients belonged to the geriatric age group of more than 50 years (44.7%), and 54.7% of the patients were females. Total 74.7% of the patients had generalized lesions, followed by lower limbs (9.3%) and trunk (7.3%) involvement. Most patients were diagnosed with bullous pemphigoid (31.3%), followed by pemphigus vulgaris (27.3%), dermatitis herpetiformis (15.3%), Darier’s disease (14.7%), pemphigus foliaceus (4.7%), epidermolysis bullosa (2%), linear immunoglobulin A dermatosis (2%), paraneoplastic pemphigus (0.7%), and drug reactions (0.7%). DIF studies were applied on 60 cases, out of which complement protein C3c was the most commonly deposited protein (53.3%).Conclusion: Our study emphasized the diagnostic role of skin punch biopsy in the proper evaluation of vesiculobullous skin lesions. Histopathology is the cornerstone diagnostic tool in this regard, with DIF being a useful adjunct

Hybrid Workload Enabled and Secure Healthcare Monitoring Sensing Framework in Distributed Fog-Cloud Network

The Internet of Medical Things (IoMT) workflow applications have been rapidly growing in practice. These internet-based applications can run on the distributed healthcare sensing system, which combines mobile computing, edge computing and cloud computing. Offloading and scheduling are the required methods in the distributed network. However, a security issue exists and it is hard to run different types of tasks (e.g., security, delay-sensitive, and delay-tolerant tasks) of IoMT applications on heterogeneous computing nodes. This work proposes a new healthcare architecture for workflow applications based on heterogeneous computing nodes layers: an application layer, management layer, and resource layer. The goal is to minimize the makespan of all applications. Based on these layers, the work proposes a secure offloading-efficient task scheduling (SEOS) algorithm framework, which includes the deadline division method, task sequencing rules, homomorphic security scheme, initial scheduling, and the variable neighbourhood searching method. The performance evaluation results show that the proposed plans outperform all existing baseline approaches for healthcare applications in terms of makespan

Molecular Modeling Guided Drug Designing for the Therapeutic Treatment of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory disorder that can cause destructive joint disease, significant disability, and increased mortality. RA is the most frequent of all chronic inflammatory joint diseases, and its prevalence frequency in Pakistan is 1.6 per thousand people. Different cytokines and receptors were involved in the triggering of RA, including interleukin-6 (ILR-6), major histocompatibility complex (MHC) antigen human leukocyte (HLA-DR) receptor, and CD20. Several studies illustrated RA as an inherent immune response and triggered due to the "shared epitope."Therefore, the involvement of all these receptors (IL-6, HLA-DR, and CD20) leads to the neurological, ocular, respiratory, cardiac, skin, and hematological manifestations that have been considered a potential therapeutic target for drug design. Various herbal, natural, and synthetic source inhibitors of interleukin-6 (IL-6), human leukocyte (HLA-DR), and CD20 were studied and reported previously. Reported inhibitors are compared to elucidate the best inhibitor for clinical trials, leading to the orally active drug. In this study, a computer-aided drug designing approach disclosed the potential inhibitors for all receptors based on their distinct binding affinity. Moreover, drug suitability was carried out using Lipinski's rule by considering the adsorption, distribution, metabolism, and excretion (ADME) of ligands. Results elucidated "calycosin 7-O-glucoside"and "angeliferulate"as putative ligands for IL-6 and HLA-DR, respectively. However, the pharmacokinetic properties (ADMET) revealed angeliferulate as an effete ligand for the biological system compared to calycosin 7-O-glucoside. Based on docking, drug toxicity profiling or pharmacokinetics, and MD simulation stability, this study highlights orally active therapeutic inhibitors to inhibit the activity of pivotal receptors (IL6, HLA-DR, and CD20) of RA in humans. After clinical trials, the resultant inhibitors could be potential therapeutic agents in the drug development against RA