Protocol of Pakistan randomized and observational trial to evaluate coronavirus treatment among newly diagnosed patients with COVID-19: Azithromycin, Oseltamivir, and Hydroxychloquine

Background & Objective: This study aimed to assess the clinical effectiveness of Hydroxychloroquine Sulfate (200 mg orally 8 hourlies thrice a day for 5 days), oseltamivir (75 mg orally twice a day for 5 days), and Azithromycin (500 mg orally daily on day 1, followed by 250 mg orally twice a day on days 2-5) alone and in combination (in seven groups). Methods & Analysis: An adaptive design is deployed, set within a comprehensive cohort study, to permit flexibility in fast-changing clinical and public health scenario. Primary outcomes include turning the test negative for coronavirus nucliec acid and in bringing about clinical improvement on day 7 of follow-up on a seven-point ordinal scale. The randomized study will recruit participants of either gender above 18 years of age who will test positive for SARS-CoV-2 on Quantitative Reverse Transcription Polymerase Chain Reaction (PCR). Pregnant or lactating females, and those with severe respiratory distress, or with serious comorbidities will be excluded. Randomization will be done maintaining concealment of allocation sequence using a computer-generated random number list. The sample size will be subjected to periodic reviews by National Data Safety and Monitoring Board. Ethics and Dissemination: The trial is approved by the National Bioethics Committee (No.4-87/NBC- 471-COVID-19-05/20/) and institutional Ethical Review Committee. This clinical trial conducted under Good Clinical Practice is expected to inform patients clinical guidelines for the use of these drugs in newly diagnosed with SARS-CoV-2.Spanish Governmen

Unremitting chronic skin lesions: A case of delayed diagnosis of glucagonoma

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.A 54-year-old Caucasian male with history of hypertension, hyperlipidemia, insulin-dependent diabetes mellitus, and chronic skin rash of 4 years presented to the emergency department with worsening rash and weight loss. Physical examination revealed diffuse erythematous rash, skin ulceration, bullae with associated paresthesia in the lower extremities, trunk, bilateral upper extremities, and palms and soles. A computed tomography (CT) scan with contrast showed a large, heterogenously enhancing pancreatic mass measuring 9.4 × 3.8 cm with surrounding low-attenuation soft tissue thickening. Blood tests showed hemoglobin A1C of 10.0%. Glucagon level was elevated to 2,178 (normal < 80 pg/dl). Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) from the pancreatic mass was suggestive of pancreatic endocrine tumor. The tumor cells were positive for synaptophysin, chromogranin, CD56, and pan-cytokeratin with focal positivity for glucagon, suggestive of glucagonoma. The patient underwent distal pancreatectomy along with splenectomy and cholecystectomy. The glucagon level normalized to 25 pg/dl within a week of tumor resection, and during his 6-week outpatient follow up, skin rash had completely resolved

2-(2-Methyl­anilino)-N′-(propan-2-yl­idene)acetohydrazide

The conformation of the title compound, C12H17N3O, is consolidated by an intra­molecular N—H⋯O hydrogen bond, generating an S(5) ring. In the crystal, inversion dimers linked by pairs of N—H⋯O inter­actions occur, resulting in R 2 2(8) ring motifs

Patient safety attitudes of frontline healthcare workers in Lahore: A multicenter study

All funding has been arranged by University of Health Sciences (UHS) Lahore, Punjab, Pakistan.Objectives: To evaluate patient safety attitudes of the frontline health workers in hospitals of Lahore, Pakistan. Methods: A self-administered Safety Attitudes Questionnaire (SAQ) survey was deployed in five hospitals across Lahore, Pakistan (July 2019 to June 2020). A total of 1250 consecutive consenting nurses and postgraduate trainee physicians of under five years working experience were recruited. Assessment for each of the six subdomains (teamwork climate, safety climate, job satisfaction, stress recognition, perception of management, working conditions) was done on a 0-100 scale. Multivariate analyses examined their relationship with job cadre (nurses and physicians), duration of respondents’ work experience (< 2 years, 3 - 4 years, > 4 years), and hospital sector (private and public). Results: The response rate was 97% (1212 individuals; 765 nurses, 447 physicians). Nurses scored less than physicians in teamwork climate (-2.4, 95% CI -4.5 – -0.2, p=0.02) and stress recognition (-10.6, 95% CI -13.5 – -7.7, p<0.001), but more in perception of management (4.2, 95% CI 1.5 – 6.8, p=0.002) and working conditions (3.4, 95% CI 0.66 – 6.2, p=0.01). Increasing work experience was related to greater scores in all subdomains. Private hospitals scored generally higher than public ones. Conclusion: Duration of job experience was positively correlated with patient safety attitudes of hospital staff. These finding could serve as the baseline to shape staff perceptions by cadre in both public and private sector hospitals.University of Health Sciences (UHS) Lahore, Punjab, Pakista

Simulering af trafikafvikling ved Bybusterminalen i Aalborg

Aalborg Kommune står over for at skulle vælge strategi for adaptiv busprioritering i et antal signalregulerede kryds. For at vurdere effekterne for fremkommeligheden for henholdsvis busser og øvrige trafikantgrupper har Aalborg Kommune valgt at anvende mikrosimulering af trafik- og signalafviklingen ved brug af VISSIM. I dette paper beskrives det fremtidige busprioriteringssystem i Aalborg samt metoder, overordnede resultater og erfaringer med simuleringsværktøjet VISSIM

Clippers (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids)–case report with neuroimaging

Background: CLIPPERS syndrome (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an inflammatory disease process primarily involving the pons and adjacent structures. Clinically, the patient may present with cerebellar signs such as dysarthria, gait ataxia and with cranial nerve palsies. It shows good response to steroids / immunosuppressive therapy. Pathologically, there is infiltration of T lymphocytes into the perivascular spaces of brainstem. The disease follows a relapsing and a remitting course and the earlier the treatment is started with high dose steroids and the more prolonged it is, the better the clinical outcome will be

Spontaneous intracranial hypotension; three case reports with similar clinical manifestations, treated successfully using different management techniques.

Spontaneous Intracranial hypotension (SIH) is a rare neurological disorder, characterized by orthostatic headaches. Due to the complicity of its diagnosis and lack of awareness amongst physicians, SIH remains an under-diagnosed disease and its true prevalence remains unknown. It is a reversible condition, if diagnosed early. Delay in diagnosis can result in life threatening complications.Case Reports:We present a case series of three patients who presented with typical symptoms of SIH. But management course of each patient varied. The first patient responded well to the EBP (epidural blood patch) while the second improved with conventional symptomatic treatment. The third patient needed a surgical intervention for complication developed due to SIH. This case series hence covers a variety of treatment options for patients with SIH.Conclusion:SIH is an emerging challenge for neurologists worldwide. Awareness amongst physicians regarding this disease along with a high level of suspicion and good history skills will allow early diagnosis of the disease and prevent delay in treatment and hence complications

Efficacy and safety of sofosbuvir based antiviral therapy for chronic hepatitis C infection in patients with advanced chronic kidney disease

Background: Screening studies for hepatitis C have proved that it is more prevalent in patients with renal diseases. Chronic hepatitis C infection in patients with kidney disease not only accelerates renal deterioration but also adversely effects morbidity and mortality. Availability of direct acting antiviral drugs has revolutionized treatment of hepatitis C even in difficult patients. In advanced kidney diseases, selection of treatment is difficult. Aim of this study was to evaluate the efficacy and safety of Sofosbuvir based DAAs in patients with advanced CKD.Methods: In this Quasi experimental study, CHC patients with or without cirrhosis having advance CKD (eGFR <30 ml/min per 1.73 m2) and/or on dialysis were enrolled. End points of the study were documentation of SVR 12 or discontinuation of therapy. Different regimens of oral DAAs with or without Ribavirin were used.Results: 86 patients with a median age of 53 years were enrolled. 37 patients were on maintenance dialysis and 49 were not on dialysis with eGFR <30 ml/min per 1.73 m2. Virological response was 92.68% at the end of treatment and SVR was achieved by 90.2% twelve weeks after therapy. Insomnia 14%, headache 11% and anemia 7% were main dverse effects. Mean eGFR and creatinine before and after treatment remained the same. Only 2 patients relapsed, both were on dialysis thrice weekly.Conclusions: All Sofosbuvir based regimens used for the treatment of CHC in patients with end stage renal disease are effective and well tolerated. Close follow up is advised to monitor side effects

Application Potentials of Plant Growth Promoting Rhizobacteria and Fungi as an Alternative to Conventional Weed Control Methods

Weeds are the plants usually grown on unwanted places and are notorious for causing interruptions in agricultural settings. Remarkable yield losses have been reported in fields infested with weeds worldwide. So far, these weeds cause about 34% of losses to yields of major agricultural crops and pose threats to economic condition of the farmers. Conventionally, weed control was achieved by the use of chemical herbicides and traditional agronomic practices. But these methods are no more sustainable as the magnitude of threats imposed by these conventionally outdated methods such as chemical herbicides is greater than the benefits achieved and their continuous use has disturbed biodiversity and weed ecology along with herbicide resistance in some weeds. Herbicide residues are held responsible for human health hazards as well. Therefore the future of weed control is to rely on alternative approaches which may be biological agents such as bacteria and fungi. This chapter highlights the potentials of using bacterial and fungal biocontrol agents against weeds in farmer fields. Moreover, detailed review on merits and demerits of conventional weed control methods is discussed in this chapter