A Rare Presentation of Wilson Disease: A Case Report

Wilson Disease results from autosomal recessive mutation in ATP7B gene which leads to reduced formation of ceruloplasmin protein in the body that acts as a copper transporter. Due to its deficiency, there is the build-up of copper in the liver and brain among other organ systems and it leads to the development of various clinical abnormalities but commonly presents either as hepatic dysfunction and/or cirrhosis in young patients with movement disorder. Here we present a case that presented with hypoglycemia and hypothermia in absence of any infection, drug abuse or metabolic abnormality. He was later diagnosed as Wilson disease. Wilson Disease is mostly thought of hepatic /neurological disease. Contrary to this Wilson’s disease is a multisystem disease affecting multiple organ system including, kidneys, endocrine system and musculoskeletal system and can present with manifestations of above-mentioned systems

Study of erythrocytes as a novel drug carrier for the delivery of artemether

Resealed erythrocytes have been explored in various dimensions of drug delivery, owing to their high biocompatibility and inability to initiate immune response. The present research was designed to evaluate the drug delivery potential of erythrocytes by loading a hydrophobic anti-malarial drug, Artemether. Three different loading techniques were applied to achieve maximum optimized drug loading. A HPLC method was validated for drug quantification in erythrocytes. The relatively high loading was achieved using hypotonic treatment was 31.39% as compared to other two methods. These, drug loaded erythrocytes were characterized for membrane integrity via ESR showing higher ESR values for drug loaded cells as compared to normal cells. Moreover, microscopic evaluation was done to observe morphological changes in erythrocytes after successful loading which showed swollen cells with slight rough surface as compared to smooth surface of normal cells. Drug release was studied for 8 h which showed more than 80% release within 3-7 h from erythrocytes treated with different hypotonic methods. Overall, the study revealed a potential application of erythrocytes in delivery of hydrophobic drugs using hypotonic treatment as compared to other methods

Experimental and in silico evaluation of Carthamus tinctorius L. oil emulgel: a promising treatment for bacterial skin infections

PurposeThe current study aimed to develop a topical herbal emulgel containing Carthamus tinctorius L. (CT) oil extract, which has been scientifically proven for its antibacterial and antioxidant activities for the ailment of bacterial skin infections.MethodThe CT emulgel was formulated by response surface methodology (RSM) and was evaluated by various parameters like extrudability, spreadability, pH, viscosity, and antibacterial and antioxidant activities. Molecular docking was also performed using AutoDock.ResultsAmong all formulated CT emulgels, F9 and F8 were optimized. Optimized formulations had shown good spreadability and extrudability characteristics. Sample F8 had % inhibition of 42.131 ± 0.335, 56.720 ± 0.222, and 72.440 ± 0.335 at different concentrations. Sample F9 had % inhibition of 26.312 ± 0.280, 32.461 ± 0.328, and 42.762 ± 0.398 at concentrations of 250 µg/ml, 500 µg/ml, and 1,000 µg/ml, respectively, which shows that both samples F8 and F9 have significant antioxidant potential. Optimized CT emulgels F8 and F9 had significant antibacterial activity against Staphylococcus aureus and Escherichia coli at p-value = 0.00, the Emulgel-F8 shows zone of inhibition of 24 mm for E-coli and 19 mm for S-aureus. Emulgel-F9 shows zone of inhibition of 22 mm for E-coli and 15 mm for S-aureus while pure CT- Oil extract shows zone of inhibition of 25 mm for E-coli and 20 mm for S-aureus and ciprofloxacin used as standard shows 36mm zone of inhibition against both E-coli and S-aureus. The comparative investigation through molecular docking binding affinities and interactions of ligands with various target proteins provides insights into the molecular processes behind ligand binding and may have significance for drug discovery and design for the current study.ConclusionThe current study suggests that C. tinctorius L.-based emulgel has good antioxidant and antibacterial activities against E. coli for the treatment of bacterial skin infections

Insight into biological activities of chemically characterized extract from Marrubium vulgare L. in vitro, in vivo and in silico approaches

Aqueous extracts of Marrubium vulgare L. (M. vulgare) are widely used in traditional medicine for their therapeutic effects. Hence, this study aims to evaluate in vitro, in vivo, and in silico the biological activities of M. vulgare aqueous extract to further support their traditional use. Qualitative phytochemical tests of M. vulgare extracts showed the presence of primary and secondary metabolites, while quantitative analyses recorded revealed the contents of total phenols, flavonoids, and tannins, with values of 488.432 ± 7.825 mg/EAG gallic acid extract/g, 25.5326 ± 1.317 mg/EQ Quercetin extract/g and 23.966 ± 0.187 mg/EC catechin extract/g, respectively. Characterization of the phytochemical constituents of the extract revealed the presence of catechin and maleic acid as the most abundant while the evaluation of the antioxidant power revealed that the extract possesses significant antioxidant capacity, antimitotic potential, and antimicrobial properties against Streptococcus agalactiae and Staphylococcus epidermidis among many others. The antidiabetic activity of the extract showed a potent antihyperglycemic effect and a significant modulation of the pancreatic α-amylase activity as revealed by both in vitro and in vivo analysis, while an in silico evaluation showed that chemicals in the studied extract exhibited the aforementioned activities by targeting 1XO2 antimitotic protein, W93 antidiabetic protein and 1AJ6 antimicrobial protein, which revealed them as worthy of exploration in drug discovery odyssey. Conclusively, the result of this study demonstrates the numerous biological activities of M. vulgare and gives credence to their folkloric and traditional usage

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Cyclic behavior of RC beam-column joints with stone aggregate concrete in columns and brick aggregate concrete in beams

The Reinforced Concrete (RC) moment frame system is the most common building type in developing countries. The practice of using different types of coarse aggregates for beams and columns of the same frame is not uncommon in countries where stone aggregates are relatively expensive. This practice impacts the beam-column joint (BCJ) region where the different concrete mixes come together. These BCJ regions are the most susceptible zone under earthquakes in an RC frame structure, which warrants careful attention considering the increasing number of recent earthquake occurrences. However, there is very limited study in the literature that focuses on the seismic performance of these structures where dissimilar coarse aggregate concrete mixes are used in the same frame. The present study focuses on the structural behavior of RC joints cast with dissimilar coarse aggregate concrete mixes under the action of cyclic loading which are designed and detailed following the Codes ACI 318 and BNBC 2020. Four one-third scale exterior BCJ specimens were prepared to determine their behavior with respect to cracking and failure characteristics, hysteresis response, ductility, stiffness degradation, and energy dissipation capacity. The ductility of specimens cast with dissimilar coarse aggregate concrete mixes was 9.8–23.3 % lower compared to the specimens cast with uniform coarse aggregate concrete mixes, while the energy dissipation capacity was also 14.8–22.1 % lower. The cracks appeared earlier in lower displacements for specimens with dissimilar coarse aggregates, although the strength and elasticity of the concrete mixes were similar. Thus, the present study suggests that BCJs with dissimilar coarse aggregate concrete must be carefully analyzed and designed in terms of the seismic requirements of the structure before their use

Comparison of tooth shade matching using visual and digital camera methods

Accurate recording of the shade of the tooth, its communication to the dental laboratory and its reproduction plays a fundamental role in the restorative and prosthetic procedures. Visual shade selection with a reference shade guide is the most common method for shade matching employed in routine clinical practice but it is associated with a high degree of subjectivity. Recently digital devices like colorimeters and spectrometers have been developed to objectively measure the colour. These devices can read the colour data in terms of luminance (L), chroma (C), and hue (h). Researchers have also used high end digital cameras in combination with graphical softwares to measure the tooth colour. A photograph with a digital camera can replicate the true colours and presents this information in terms of numerical data. The aim of this study is to compare the tooth shade matching using simple visual method and digital camera assisted method. In vitro experimental study conducted at the prosthetic laboratory of Aga Khan University Hospital, Pakistan All shade tabs from a vita classic shade guide were photographed using a compact digital camera to acquire three images of each tab at a pre-set object-camera distance generating 144 reference images. Same was done with six masked tabs to acquire a set of 18 test images. Colour values were obtained for an area over body of each image and the closest match between test and reference tabs was determined for digital method. For visual method, participants were asked to match the tooth shade. The outcome was correct match versus incorrect match. Data was analyzed using SPSS 19.0. Chi square test was applied to compare the visual and digital methods and to compare colour matching skills of the dentists and their assistants. P value of \u3c0.05 was taken as significant. With the visual and digital method, correct shade was selected in 39.4% and 66% cases respectively. The digital method yielded better shade matching that was statistically significant Digital colour matching was found to be superior to the visual method. Significantly better shade selection can be done by using compact digital cameras as compared to the visual method alone. Males and dental assistants exhibited better colour matching skills than females and the dentists

Technology incubators and institutional development

Globally, technology business incubator (TBI) has become a growing initiative to promote the entrepreneurship. Recently TBIs has gained significant attention from research scholars and play a vital role to facilitate the development of entrepreneurial society. The institutions are established and leadership is groomed via entrepreneurial society. Moreover, entrepreneurial culture encourages the entrepreneurial society for economic development, innovation, technology competitiveness and sustainable job creation. A government backed TBI, Plan9, is presented to highlight the significance towards developing an entrepreneurial society in a developing country context, Pakistan. Plan9 has introduced unique practices with a broad vision for a sustainable entrepreneurial growth. University industry linkages are created, entrepreneurial education and training programs for social awareness are operationalized, innovative ideas are encouraged and financial innovation without equity share and funding support are designated. This paper presents a comprehensive spotlight over the dynamic capabilities and entrepreneurial culture of plan9. Furthermore plan9 is encouraging to promote entrepreneurial society, institutional development and leadership. Lastly this research recommends that the other TBIs should be initiated by the collaboration of government and private sector to nurture the entrepreneurial society