Primary IgA and IgG subclass deficiency in a 17-year-old Pakistani girl: a case report

Primary immunodeficiency disorders pose a diagnostic dilemma for physicians in the developing countries such as Pakistan because of lack of adequate diagnostic facilities. We present here the case of a 17-year-old girl who had a history of recurrent respiratory tract infections since childhood and had been treated with anti-tuberculous medications thrice; for a total of 24 months. She had also received multiple courses of antibiotics. Her initial presentation to our hospital was with acute bronchopneumonia. Her past medical history of recurrent infections also alerted the treating physician to the possibility of bronchiectasis secondary to a variety of underlying potential pathologies such as post-infection, immunodeficiency syndromes or ciliary dyskinesia disorders. Cystic fibrosis was also an important consideration. Direct enquiry revealed that there was no history of consanguineous marriage in her parents. Her sweat chloride test was within normal range (<40 mmol/L). Blood analysis was performed which showed IgA, IgG2 and IgG4 deficiency. She has been following up at our hospital for the past few years. In that course of time, she has had multiple episodes of pneumonia, gastroenteritis and maxillary sinusitis. She was successfully treated with intravenous immunoglobulins on four occasions when she presented with systemic crisis secondary to severe systemic infection. She also developed biopsy proven intermediate grade non-Hodgkin’s lymphoma five years after the diagnosis of immunoglobulin deficiency was first made. This appeared to be a complication of her immunodeficient state. She has been receiving chemotherapy for the lymphoma. Physicians should be cognizant of the morbidity that primary immunodeficiency syndromes such as immunoglobulin deficiency can have in the form of multiple infections and increased risk of malignancies as seen in our patient

Sorghum an Important Annual Feedstock for Bioenergy

Plant-based renewable biofuels guarantee sustainable solutions to food and energy demands. High-biomass C4 grasses including sugarcane, corn, and sorghum are potential candidates for bioenergy. Among these, sorghum enjoys the status of a highly diverse food, feed, and biofuel source worldwide. The natural attributes like abiotic stress tolerance, diverse genetic base, viable seed industry, and sound breeding system make sorghum a perfect candidate for establishing an efficient and low-cost biofuel industry. Scientists are exploring ways to exploit forage, sweet, and biomass sorghums as climate-smart energy crops. In this context, conventional breeding has played a significant role in developing high-yielding sorghum varieties. For biomass sorghum, stem compositional analysis helps screen low lignin and high polysaccharide types as feedstocks for biofuels. Recent tools of phenomics, genomics, proteomics, and genome editing are key players of designing eco-friendly bioenergy sorghum. Here, we report stem compositional analysis and proteomics-based evaluation of USDA sorghum germplasm as a baseline to develop sorghum as a biofuel feedstock

‘Violating my home boundaries makes me dislike my job’: a multiple mediation model

The purpose of this study is to understand negative outcomes of boundary violation events or interruptions at home in which the work life crosses the home boundaries. In the line of boundary theory and affective events theory, the aim of this study is to analyze the effect of daily events of boundary violations at home on work interference with family (WIF). Moreover, incorporating the ego depletion theory, we study the impact of WIF on an individual’s emotional state (i.e., emotional exhaustion), and the impact of emotional exhaustion on job satisfaction. The data were collected through questionnaires (daily diary method for boundary violations and at one point in time for other variables) from the manufacturing (textile) sector of Pakistan. The results indicate a direct negative effect of average boundary violations at home on job satisfaction and an indirect negative impact through the sequential mediation of WIF and emotional exhaustion. Theoretical and managerial implications are also discussed

Control of Aflatoxin Production Using Herbal Plant Extract

The aflatoxins are a group of chemically similar poisonous, carcinogenic fungal secondary metabolites produced by Aspergillus flavus, A. parasiticus, and A. nomius, which are abundant in warm and humid regions of the world. They are probably the most intensively researched toxins in the world due to their carcinogenic and mutagenic effects. Aflatoxins have also been identified as a potential biological weapon for food and water contamination. The four major aflatoxins commonly isolated from different foods and feed stuffs are AFB1, AF B2, AFG1, and AFG2. Aflatoxin contamination of food and feed has gained global significance as a result of its deleterious effects on human as well as livestock health including gastrointestinal dysfunction, reduced feed utilization, anemia, jaundice, liver damage and immunity suppression. The profitability and marketing of various agricultural products are adversely affected by either contamination of aflatoxins or aflatoxin‐producing fungi. The foods at highest risk of aflatoxin contamination are maize, chilies, peanuts, and cotton seeds. There are various physical, chemical, and natural methods investigated to prevent aflatoxin production and the growth of aflatoxin‐producing fungus in various agricultural products. Here, we describe various natural plant extracts that would be potential source of controlling aflatoxin production in agricultural products

Gemella morbillorum endocarditis in a patient with a bicuspid aortic valve.

Infective endocarditis caused by Gemella morbillorum is a very rare occurrence and only a few cases have been reported in the literature so far. We describe a case of G. morbillorum endocarditis in a 31-year-old Pakistani woman who had a congenitally bicuspid aortic valve. She had also undergone repair of a large aortic aneurysm 1 year before this presentation. She presented to our institution with a 1.5-month history of fever, exertional dyspnea and generalized edema. A transthoracic echocardiogram showed two large, echogenic and mobile vegetations (7 x 15 mm and 8 x 10 mm) attached to the right coronary cusp and non-coronary cusp. Blood cultures of the Patient grew pan-sensitive G. morbillorum. The Patient fulfilled the Duke\u27s criteria for infective endocarditis. She was successfully treated with ceftriaxone and gentamycin therapy. At two years\u27 follow up she has remained well. This case represents a rare cause of infectious endocarditis that was successfully managed with medical treatment alone in a Patient with the predisposing risk factor of a bicuspid aortic valve

Ethical Considerations Surrounding Vaccine Development During A Public Health Crisis

Epidemics and Pandemics have been plaguing mankind since many centuries, and are a cause of major healthcare expense in modern times. The novel coronavirus pandemic of 2019-2020 spread worldwide faster than many previous pandemics, including EBOLA in 2017. Although personal protective equipment, and social distancing slowed the outbreak, a vaccine is needed to ensure global immunization and to stop this deadly outbreak. Developing a vaccine in times of a public health crisis comes with a lot of ethical considerations, including overlooking proper informed consent, the issue of using placebo in control arm of trials, extended timelines of development of vaccines, randomized placebo control trial of secondary vaccine once the first vaccine is approved, and utilizing vulnerable population for trials. These issues are often overlooked due to the urgency of the situation, and the need of developing a cure/vaccine can lead to potential oversight of many regulations. We discuss some of these issues related to vaccine development in a pandemic situation in this commentary paper. We also discuss some of the arguments supporting a secondary vaccine development such as logistical/economic issue, better efficacy, and the conditions of Equipoise

Investigations of Acacia modesta Wall. leaves for in vitro anti‑diabetic, proliferative and cytotoxic effects

The leaves of Acacia modesta Wall. have been shown to possess diverse pharmacological properties. Therefore, we aimed at evaluating anti-diabetic, cytotoxic and proliferative effects of extracts of Acacia modesta Wall. leaves. After evaluating the primary and secondary metabolites, anti-diabetic activity of various extracts was assessed by α-amylase inhibition, glucose uptake by yeast cells and non-enzymatic glycosylation of hemoglobin assay. Cytotoxicity and proliferative potential was assessed by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) and short term proliferation assays, respectively, using human liver carcinoma cell line, HepG2. Among other extracts, chloroform extract exhibited 34.16% inhibition of α-amylase, 90.65% inhibition of hemoglobin glycosylation and 94.75% glucose uptake employing α-amylase inhibition, non-enzymatic glycosylation of hemoglobin and glucose uptake by yeast cells assays, respectively. Moreover, extracts exhibited no significant effects on HepG2 cell viability and proliferation. So, this data suggested that chloroform extract of leaves of Acacia modesta Wall., exhibited higher anti-hyperglycemic activity in comparison to extracts in other solvents, while no extract demonstrated cytotoxic and proliferation effects when tested using HepG2 cell line

Crimean-Congo hemorrhagic fever in a dengue-endemic region: lessons for the future.

Crimean-Congo hemorrhagic fever and dengue hemorrhagic fever are endemic in Pakistan. However, the overlap of geographic distribution and early clinical features between the two conditions make a reliable diagnosis difficult in the initial stage of illness. A 16-year-old boy presented with a history of hematemesis and high-grade fever. A preliminary diagnosis of dengue hemorrhagic fever was made and supportive treatment was instituted; however, the patient continued to deteriorate clinically. Dengue IgM antibody testing was negative on the third day of admission. Qualitative polymerase chain reaction test for Crimean-Congo hemorrhagic fever viral RNA was sent but the patient expired shortly after the results became available on the sixth day of admission. Considerable resources had to be expended on contact tracing and administration of ribavirin prophylaxis to all the health-care workers who had come in contact with the patient. It is crucial that Crimean-Congo hemorrhagic fever be recognized and treated at an early stage because of longer term financial and health implications for contacts such as health-care workers in the setting of a developing country. Increased surveillance of dengue and Crimean-Congohemorrhagic fever cases is warranted for the derivation of reasonably reliable, cost-effective and prompt predictors of disease diagnosis. These predictors can help guide future decisions in the management of similar cases. Ultimately, such a strategy may translate into better cost containment in resource-poor settings. Institution of ribavirin prophylaxis in selected patients also merits consideration

Translating knowledge for action against stroke--using 5-minute videos for stroke survivors and caregivers to improve post-stroke outcomes: study protocol for a randomized controlled trial (Movies4Stroke).

Background: Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing \u3e70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers. Methods: Movies4Stroke will be a randomized control, outcome assessor blinded, parallel group, single center superiority trial. Participants with an acute stroke, medically stable, with mild to moderate disability and having a stable primary caregiver will be included. After obtaining informed consent the stroke survivor-caregiver dyad will be randomized. Intervention participants will have the movie program software installed in their phone, desktop, or Android device which will allow them to receive, view and repeat 5-minute videos on stroke-related topics at admission, discharge and first and third months after enrollment. The control arm will receive standard of care at an internationally accredited center with defined protocols. The primary outcome measure is medication adherence as ascertained by a locally validated Morisky Medication Adherence Scale and control of major risk factors such as blood pressure, blood sugar and blood cholesterol at 12 months post discharge. Secondary outcome measures are post-stroke complications and mortality, caregiver knowledge and change in functional outcomes after acute stroke at 1, 3, 6, 9 and 12 months. Movies4Stroke is designed to enroll 300 participant dyads after inflating 10 % to incorporate attrition and noncompliance and has been powered at 95 % to detect a 15 % difference between intervention and usual care arm. Analysis will be done by the intention-to-treat principle. Discussion: Movies4Stroke is a randomized trial testing an application aimed at supporting caregivers and stroke survivors in a LMIC with no rehabilitation or chronic support systems