Vitamin D deficiency (VDD) and susceptibility towards severe Dengue fever:a prospective cross-sectional study of hospitalized Dengue fever patients from Lahore, Pakistan

Dengue is a mosquito-borne flaviviral serious febrile illness, most common in the tropical and subtropical regions including Pakistan. Vitamin D is a strong immunomodulator affecting both the innate and adaptive immune responses and plays a pivotal role in pathogen-defense mechanisms. There has been considerable interest in the possible role of vitamin D in dengue viral (DENV) infection. In the present prospective cross-sectional study, we assessed a possible association between serum vitamin D deficiency (VDD) and susceptibility towards severe dengue fever (DF) illness. Serum vitamin D levels were measured at the time of hospitalization in 97 patients diagnosed with dengue fever (DF), dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) at Mayo Hospital, King Edward Medical University, Lahore, PK, from 16 November 2021 to 15 January 2022. In terms of disease severity, 37 (38.1%) patients were DF, 52 (53.6%) were DHF grade 1 and 2, and 8 (8.2%) were DSS. The results revealed that most patients (75 (77.3%)) were vitamin-D-deficient (i.e., serum level &lt; 20 ng/mL), including 27 (73.0%) in DF, 41 (78.8%) in DHF grade 1 and 2, and 7 (87.5%) in DSS. The degree of VDD was somewhat higher in DSS patients as compared to DF and DHF grade 1 and 2 patients. Overall, serum vitamin D levels ranged from 4.2 to 109.7 ng/mL, and the median (IQR) was in the VDD range, i.e., 12.2 (9.1, 17.8) ng/mL. Our results suggest that there may be a possible association between VDD and susceptibility towards severe dengue illness. Hence, maintaining sufficient vitamin D levels in the body either through diet or supplementation may help provide adequate immune protection against severe dengue fever illness. Further research is warranted.</p

Early Experience with Percutaneous Transpedicular Screw Fixation for Thoracolumbar Fractures at a Tertiary Hospital in Pakistan.

Objective:&nbsp;&nbsp;To present our early experience with percutaneous transpedicular screw fixation for thoracolumbar fractures at a tertiary care hospital in Pakistan. Material &amp; Methods:&nbsp;&nbsp;A case series of 20 patients with thoracolumbar fractures, who met the inclusion and exclusion criteria were followed for up to six months to evaluate their functional status using the Oswestry Disability Index (ODI). Kendall’s tau, Spearman’s rho and Pearson correlations were conducted to draw useful conclusions. Results:&nbsp;&nbsp;85% patients’ injury was reported from ‘fall from height’. 55% of the fracture was the dorsal-lumbar junction (T12-L1). Burst type morphology was reported in maximum number of patients (65%). 55% of patients were reported to be neurologically intact. ODI score’s mean percentage decreased from 40% to 23% during the first week to six months, indicates an improvement in the disabilities. A significant (p&lt;0.050) positive correlation was found between fracture morphology and ODI. All patients had an accurate screw trajectory postoperatively and no postoperative complications were documented. Neurology was stable for all patients at 1, 3 and 6 months. Conclusion:&nbsp;&nbsp;Percutaneous transpedicular screw fixation can be a viable approach for thoracolumbar burst fractures with intact posterior ligamentous complex in all types of thoracolumbar fractures, including type C and leads to an improvement the quality of life. Fracture morphology has a significantly positive correlation with a higher disability index score, with more severe fracture morphologies as per the Thoracolumbar Injury Classification and Severity (TLICS) score having a higher disability

On the Efficiency of Software Implementations of Lightweight Block Ciphers from the Perspective of Programming Languages

Lightweight block ciphers are primarily designed for resource constrained devices. However, due to service requirements of large-scale IoT networks and systems, the need for efficient software implementations can not be ruled out. A number of studies have compared software implementations of different lightweight block ciphers on a specific platform but to the best of our knowledge, this is the first attempt to benchmark various software implementations of a single lightweight block cipher across different programming languages and platforms in the cloud architecture. In this paper, we defined six lookup-table based software implementations for lightweight block ciphers with their characteristics ranging from memory to throughput optimized variants. We carried out a thorough analysis of the two costs associated with each implementation (memory and operations) and discussed possible trade-offs in detail. We coded all six types of implementations for three key settings (64, 80, 128 bits) of LED (a lightweight block cipher) in four programming languages (Java, C#, C++, Python). We highlighted the impact of choice relating to implementation type, programming language, and platform by benchmarking the seventy-two implementations for throughput and software efficiency on 32 & 64-bit platforms for two major operating systems (Windows & Linux) on Amazon Web Services Cloud. The results showed that these choices can affect the efficiency of a cryptographic primitive by a factor as high as 400

Usability and acceptability of a mobile app for behavior change and to improve immunization coverage among children in Pakistan: A mixed-methods study

Background: Pakistan\u27s immunization uptake rates are still significantly lower than anticipated despite several initiatives. Lack of awareness, forgetting about vaccination schedule, and vaccine misconception/misinformation are a few of the major drivers that mitigate the rates of immunization. The current COVID-19 pandemic emphasizes the importance of immunization. The significant reductions in regular childhood vaccination during pandemic have increased the risk of outbreaks of vaccine-preventable diseases. Concerns among parents over possibly exposing their children to COVID-19 during child visits may have contributed to the reported declines. Innovative and cost-effective mHealth interventions must be implemented in order to address the problem of inadequate immunization rates. In addition, it is also critical to understand the end user needs in order to reflect on the highly relevant essence of the customized healthcare experience.Objective: The aim of this study was to learn about caregivers\u27 attitudes toward the usability and acceptability of behavior-change smartphone applications (mobile phones) for improving immunization coverage in Pakistan.Methods: A mixed-method design was employed for this study. The study was conducted at Aga Khan University, Hospital. Parents visiting the Community Health Center for 6-week vaccination of their children were recruited. The study was conducted in two stages. Stage 1 consisted of qualitative interviews that grasped the parent\u27s attitudes and challenges to immunization, as well as their acceptability and accessibility of the smartphone-based behavior-change application to increase vaccine uptake. Stage 1 was followed by stage 2, in which data were collected through a questionnaire designed by using data from qualitative interviews.Results: The majority of participants agreed that immunization serves an important role in protecting their child from illnesses that cause morbidity and mortality. Almost all of them emphasized the importance of using a pre-appointment method at vaccination center in order to reduce the waiting time. Furthermore, participants were also interested in AI-based behavior modification applications related to immunization. They also wanted to have applications in their native language for better understanding and communication of related information. In our study, approximately 95.2 percent of participants agreed to accept SMS immunization updates, which was also reasonably high. Lastly, the majority of them identified forgetfulness as a significant contributor to regular immunization.Conclusion: To enhance the uptake of childhood vaccines, overall vaccination rates, and overcome barriers related to vaccination coverage, cost-effective and user-friendly mHealth AI-based smart phone applications are required to raise awareness regarding the continuation of vaccination service and the importance of timely vaccination. Parents\u27 experiences and attitudes must be considered while designing and evaluating the efficacy of mHealth-based interventions

Lhermitte-Duclos Disease: a rare cerebellar hamartoma presenting following traumatic brain injury and a review of the literature

Lhermitte-Duclos Disease (LDD) is an extremely rare hamartoma of the cerebellum and is associated with the cancer syndrome Cowden’s disease. We report such a patient whose disease was diagnosed incidental to traumatic brain injury. A 40-year-old male presented after fall from stairs. CT scan revealed a large lesion in the right cerebellar hemisphere. Clinical history recounted multiple short episodes of vomiting (&gt;10 a week) for the past 30 years and development of posterior fossa symptoms over the recent months. Neither of these had him referred due to lack of access to primary healthcare. T1 MRI with contrast showed an isointense focal mass, enhancement along the folia, and distortion of the 4th ventricle. On T2 MRI, tiger striped appearance was noted. Endoscopic third ventriculostomy was performed followed by gross total resection of the hamartoma. Histology confirmed LDD. All reported symptoms resolved following surgery. Due to lack of access to the expensive genetic testing for Cowden’s he is in regular biannual follow up to be evaluated clinically for associated malignancies. We present this case to highlight the clinical-pathological characteristics of LDD, its treatment, and discuss management in the absence of genetic testing in our socio-economic demographic

Effects of Microwave and Light Emitting Diode as Disinfection Methods on the Dimensional Stability of Polymethyl Methacrylate and Polyamide Denture Base Resin

Objective: To compare the effects of microwave and light emitting diode disinfection on the dimensional stability of two denture base materials; polymethyl methacrylate and polyamide. Study Design: In-vitro study Place and Duration of Study: Peshawar Dental College and Material Research Laboratories, University of Peshawar from 10 June 2021 to 8 December 2021. Materials and Methods: Fifteen specimens each for polymethylmethacrylate and polyamide were divided into three groups, control, microwave & light emitting diode. The specimens for microwave group were irradiated at 1000W for 3 minutes, thrice a week. The specimens for light emitting diode group were disinfected in a device for 30 minutes, thrice a week. The control group specimens were placed in distilled water for 4 weeks. Dimensions were measured before disinfection, and four weeks after the assigned disinfection. The mean and the standard deviation of the differences between three groups were statistically analyzed using one-way ANOVA and after obtaining significant values, through post hoc Tukey HSD. Results: For polymethylmethacrylate highest dimensional difference (-9.02mm) was noted for microwave disinfected group while the control group showed the lowest value (-6.99mm). For polyamide, the highest dimensional changes were recorded for light emitting diode group (8.66mm) and the lowest (-7mm) for the control group. Statistical analysis showed that the differences were significant for both polymethylmethacrylate and polyamide when compared with the control (p0.05) Conclusion: No significant difference in dimensional stability of both the denture base resins was observed after disinfection with microwave and light emitting diode

Neonatal haemolytic disease with co-existing Anti-D and Anti-C antibodies: an unusual experience

Neonatal haemolytic disease in the new-born remains of prime importance for paediatricians due to high perinatal morbidity and mortality rates. The Rh antigen family comprises several different antigens, out of which, D antigen incompatibility is well known for causing severe haemolytic disease in the foetus. Although the current literature shows anomalous cases where coexisting non-D-Rh and D-Rh antigens are the causative agents, there is very little information regarding post-natal outcomes in neonates bearing two different incompatibilities simultaneously. Herein, we discuss an unusual case of anti-D as well as anti-C antibodies (non-D-Rh) in a male neonate born to a Rh-negative mother, who developed jaundice and haemolysis in post-natal life. The neonate underwent exchange transfusion and photo therapy due to raised serum bilirubin levels, supplemented with repeated blood transfusions, intravenous immunoglobulin therapy, and immunosuppressive therapy. --Continu