Frequency and Anatomical Distribution of Pulmonary Embolism on CT Pulmonary Angiography

Background: Pulmonary embolism, with its growing prevalence, has become a potentially life-threatening medical condition with crucial symptoms. However, prognosis is good if timely diagnosis is made and to the level of segmental and sub segmental arteries as well. Standard computed tomography pulmonary angiography (CTPA) is thus used to diagnose acute pulmonary embolism. Objective: The primary objective of the current study was to determine and investigate the anatomical distribution frequency of pulmonary emboli, where segmental, sub segmental, and lobar arteries on CT pulmonary angiography are included. Methodology: In a descriptive cross-sectional study, single-centered studies and CTPA scans of 98 patients were included. Data was obtained from Shalimar Hospital and University of Lahore – Teaching Hospital, Lahore, Pakistan. Sample size included patients of all age groups with suspected pulmonary embolism, with no differentiation of male or female samples. Results: According to statistics and analysis, the current study results indicated the presence of pulmonary embolism in 36 patients and its absence in 62 patients. Results indicated that amongst the 98 patients scanned, the highest frequency of pulmonary emboli was found in the pulmonary trunk and lobar artery in 8 patients (8.2%). Furthermore, CTPA of the participants detected pulmonary emboli in segmental and sub-segmental arteries of 5 patients (5.1%), with another 2 patients showing pulmonary emboli in only the sub-segmental artery (2.0%). Another 2-2 patients showed pulmonary emboli in lobar and segmental artery and lobar, segmental and sub-segmental artery respectively (2.0%, 2.0%). Conclusion: The largest number of pulmonary emboli were found in the pulmonary trunk, followed by emboli of segmental and lobar arteries in patients. It is concluded that CTPA evaluates pulmonary embolism with great precision and anatomical distribution localized main trunk, and pulmonary artery emboli along with lobar, segmental and sub-segmental artery emboli. Keywords: Computed Tomography Pulmonary Angiography (CTPA), pulmonary emboli, segmental artery, sub segmental artery, lobar arteries DOI: 10.7176/JHMN/100-02 Publication date:May 31st 202

Pediatricians’ Compliance to the Clinical Management Guidelines for Community-Acquired Pneumonia in Infants and Young Children in Pakistan

Community-acquired pneumonia (CAP) is among the most commonly prevailing acute infections in children that may require hospitalization. Inconsistencies among suggested care and actual management practices are usually observed, which raises the need to assess local clinical practices. The current study was conducted to evaluate pediatricians’ compliance with the standard clinical practice guidelines and their antibiotic-prescribing behavior for the management of CAP in children. Methods: A descriptive cross-sectional study was conducted using a self-administered questionnaire; which was provided to pediatricians by the researchers. Statistical analysis was performed with SPSS 25 Statistics; χ2 tests (or Fisher-exact tests) with the p-value set at Results: The overall response rate was 59.2%. Male respondents were (n = 101; 42.6%), and the respondents (n = 163; 68.7%) were under 30 years of age. Amoxicillin (n = 122; 51.5%) was considered as the most commonly used first-line treatment for non-severe pneumonia, whereas a smaller proportion (n = 81; 34.2%) of respondents selected amoxicillin–clavulanate. Likewise, amoxicillin (n = 100; 42.2%) was the most popular choice for non-severe pneumonia in hospitalized children; however, if children had used antibiotics earlier to admission, respondents showed an inclination to prescribe a macrolide (n = 95; 40.0%) or second-generation cephalosporin (n = 90; 37.9%). More than 90% responded that children n = 71; 29.9%), improving antibiotic prescribing (n = 59; 24.8%), and using the appropriate dose of antimicrobials (n = 29; 12.2%) were considered the major factors by the respondents to reduce antimicrobials resistance. Conclusions: The selection of antibiotics and diagnostic approach was as per the recommendations, but indication, duration of treatment, and hospitalization still can be further improved

Economic Interactions among Stock Market Performance and Macroeconomic Variables with Mediating Role of Gold Prices Volatilities: An Evidence from Pakistan

In all emerging economies, one of the most challenging issues for investors is the multifaceted inter-relationship between volatility of gold prices and stock market index. During the COVID-19 sub-periods, gold has shown a strong hedging behavior against stock market performance. The main objective of this study was to quantify the long-run relationship among multiple independent macroeconomic variables (predictors) on stock market index (response variable) using the volatilities of gold prices as a mediator factor. This study applied the descriptive statistics, correlation, t-test and OLS multiple regression Model. The specific data comprised of period 2011-2020 regarding the fluctuations in gold prices, exchange rate, interest rate, inflation rate and performance of stock market index has been utilized. The statistical outputs of models showed that exchange rate (Dollar to PKR) was positively affecting the performance of Karachi Stock Exchange (KSE)-100 Index, whereas inflation rate and interest rate were negatively affecting the overall performance of KSE100 index. The findings of this study suggested that to achieve better performance of stock market, relatively low interest rate and inflation rate contribute a significant role. However, to increase the generalization capabilities of this study the impact of mentioned macroeconomic variables in other sectors like industrial production, oil & gas and energy sectors with wider time span can be more helpful

Clinical Outcome of Pediatric Ewing sarcoma and Significance of Pathological Necrosis for Mortality after Neoadjuvant Chemotherapy: Single Institutional Study

Purpose: Tumor necrosis and histopathological changes in Ewing sarcoma following neoadjuvant chemotherapy are important predictors of disease outcome. The aim of our study is to determine the clinical outcome and significance of pathological necrosis after neoadjuvant chemotherapy as it has not been reported in our country so far. Methods: Data was reviewed after IRB approval from January 2010 to December 2015 were retrospectively reviewed for patients with newly diagnosed Ewing sarcoma on histopathology and less than 20 years of age at the time of diagnosis.  Results: A Total of 124 patients were included, in which 89 patients (72%) were non metastatic and 35 patients were metastatic (28%). Histopathology report after doing surgery showed Little or no (Grade 1 ) necrosis seen in 14 patients (11%) and 50-90% (Grade II) necrosis seen in 9 patients (7%), 90-99% (Grade III) necrosis seen in 8 patients (5.5%), and 100% (Grade IV) necrosis in 14 patients (11%). EFS of grade 4 necrosis was 93%, grade-3 71%, grade- 2 22% and grade-1 35%. OS of grade 4 necrosis was 93%, grade -3 75%, grade-2 25 % and grade-1 50%. EFS of Ewing sarcoma patients were 38% and OS was 38%. Conclusion: Tumor necrosis and histopathological changes after surgery has great impact on survival outcome in Ewing Sarcoma. Continuous...

Translation and validation study of Quality of Life Questionnaire for Physiological Pregnancy at Sandeman Provincial Hospital, Quetta, Pakistan

Objective To examine the psychometric properties of the Urdu version of the Quality of Life Questionnaire for Physiological Pregnancy (QOL-GRAV). Methods This cross-sectional study was conducted at the Obstetrics, Gynecology department of Sandeman Provincial Hospital, Quetta. The QOL-GRAV was translated into Urdu by using a forward-backward procedure. The test-retest reliability was assessed through Cronbach’s alpha reliability analysis. The validity of the translated questionnaire was constructed by using Exploratory Factor Analysis (EFA) through principal axis factoring extraction and Oblique rotation with Kaiser Normalization. SPSS v 20.0 was used for data analysis with p<0.05 as significant. Results The Urdu version of the questionnaire (QOL-GRAV-U) exhibited acceptable alpha values of 0.780 (Test) and 0.812 (Retest) at two-time points with an overall value of 0.790 (field test). All items of the QOL-GRAV-U showed good stability with Intraclass Correlation Coefficient values of > 0.80. The Kaiser-Meyer-Olkin measure of sampling adequacy for the factor analysis was 0.812. Barlett’s Test of Sphericity was significant (Chi-square = 1032.43; p 0.40).  Conclusion The results of this study conclude that the translated version of QOL-GRAV-U is a valid and reliable instrument for the assessment of QoL for pregnant women in regions where Urdu is a prime language of communication. Continuous...

On Eccentricity-Based Topological Indices and Polynomials of Phosphorus-Containing Dendrimers

In the study of the quantitative structure&ndash;activity relationship and quantitative structure-property relationships, the eccentric-connectivity index has a very important place among the other topological descriptors due to its high degree of predictability for pharmaceutical properties. In this paper, we compute the exact formulas of the eccentric-connectivity index and its corresponding polynomial, the total eccentric-connectivity index and its corresponding polynomial, the first Zagreb eccentricity index, the augmented eccentric-connectivity index, and the modified eccentric-connectivity index and its corresponding polynomial for a class of phosphorus containing dendrimers

Disposal practices of unused and expired pharmaceuticals among the general public in Quetta city, Pakistan.

ObjectiveAlthough community practices towards disposal of expired and unused medications vary globally, the phenomenon is neglected specifically in developing countries. We, therefore, aimed to assess the disposal practices of unused and expired pharmaceuticals among the general public in Quetta city, Pakistan.MethodsA questionnaire-based, cross-sectional survey was conducted among 830 respondents in Quetta city, Pakistan. A pre-validated, structured questionnaire was used for data collection. Data were coded and analyzed by Statistical Package for Social Science (SPSS) version 26. Both descriptive and inferential statistics were sued and pResultsAlmost 87% of the respondents had unused medicines at their homes and reusing the medications was the purpose of medicine storage (50%). Medicines were mostly kept in refrigerators (36.0%) followed by bedrooms (28.8%). Fifty percent of the respondents never checked the expiry date before using the medications. The procedure to dispose of nearly expired or expired medicines was unknown to 88% of the respondents and for those reasons, medicines were disposed either in household trash or flushed in the toilet or sink. Interestingly, medicines were kept at home even after being expired by 27% of the respondents. Income was associated with reason of storing medicines (p = 0.004; φc = 0.402) while educational status had significant associations with storage of medications (p = 0.002; φc = 0.399), reading about storage instructions (p = 0.008; φc = 0.452) and checking expiry date before purchasing and using the medicines (p = 0.007; φc = 0.114 and p = 0.001; φc = 0.100) respectively.ConclusionImproper storage and disposal of unused and expired medications is a common practice among study respondents and raised serious concerns. Findings of the current study call upon immediate development and implementation of the strategies to promote awareness and strengthen the pharmaceutical waste management program at the societal level

Frequency and evaluation of the perceptions towards caesarean section among pregnant women attending public hospitals in Pakistan and the implications

Objective: There is increasing prevalence of caesarean sections (CS) worldwide; however, there are concerns about their rates in some countries including potential fears. Consequently, we aimed to determine the frequency of CS, and explore patient’s perception towards CS attending public hospitals in Pakistan, to provide future guidance. Methods: A two-phased study design (retrospective and cross sectional) was adopted. A retrospective study was conducted to assess the frequency of CS over one year among four public hospitals. A cross sectional study was subsequently conducted to determine patients’ perception towards CS attending the four tertiary care public hospitals in Quetta city, Pakistan, which is where most births take place. Results: Overall prevalence of CS was 13.1% across the four hospitals. 728 patients were approached and 717 responded to the survey. Although 78.8% perceived CS as dangerous, influenced by education (p=0.004), locality (p=0.001) and employment status (p=0.001), 74.5% of patients were in agreement that this is the best manner to save mother’s and baby’s lives if needed. 62% of respondents reported they would like to avoid CS if they could due to post operative pain and 58.9% preferred a normal delivery. There was also a significant association with education (p=0.001) and locality (p=0.001) where respondents considered normal vaginal delivery as painful. Conclusion: The overall frequency of CS approximates to WHO recommendations, although appreciable variation. When it comes to perception towards CS, women had limited information. There is a need to provide mothers with education during antenatal period, especially those with limited education, to accept CS where needed

Regulation of autophagy by polyphenols: Paving the road for treatment of neurodegeneration

In the present paper, we will discuss on the importance of autophagy in the central nervous system, and outline the relation between autophagic pathways and the pathogenesis of neurodegenerative disorders. The potential therapeutic benefits of naturally occurring phytochemicals as pharmacological modulators of autophagy will also be addressed. Our findings provide renewed insight on the molecular modes of protection by polyphenols, which is likely to be at least in part mediated not only by their potent antioxidant and anti-inflammatory effects, but also through modulation of autophagic processes to remove the aberrant protein aggregates