Outcome of Hepatitis-E Virus Infection among Pregnant Women Admitted in a Tertiary Care Hospital

PURPOSE:  To study the effect of post-operative Non-Steroidal Anti-inflammatory (NSAID) eye drops on macular thickness in patients without diabetic retinopathy measured by Optical Coherence Tomography (OCT) STUDY DESIGN: Quasi experimental study PLACE & DURATION OF STUDY:  removed for blind review METHODOLOGY: Diabetic patients without retinopathy who required cataract surgery for visual rehabilitation were included in study. They were than divided into two groups. Group A included patients who received routine steroid+antibiotic post-operative drops while Group B comprised of patients who received nepafenac (0.1%) eye drops eight hourly in addition to routine post-operative eye drops. All patients underwent standard phacoemulsification and intraocular lens implantation followed by use of NSAID eye drops for a month. OCT measurements were done pre-operatively, 7 and 28 days post operatively. RESULTS: Comparison of central macular thickness between groups was significant at (Pre & 7 day post op) and insignificant at (7th day & 28th day post op) and (Pre & 28th day post op) i.e. 0.043, 0.834 and 0.084 respectively. However, difference of mean central macular thickness was significant at all follow-up periods i.e.0.003, 0.006, and 0.000 CONCLUSION: Post-operative NSAID in diabetic patients without retinopathy leads to a significant decrease in macular thickness as compared to controls after cataract surgery. KEY WORDS: Phacoemulsification, Optical Coherence Tomography, Non-steroidal Anti-Inflammatory Agent

Outcome of Hepatitis-E Virus Infection among Pregnant Women Admitted in a Tertiary Care Hospital

PURPOSE:  To study the effect of post-operative Non-Steroidal Anti-inflammatory (NSAID) eye drops on macular thickness in patients without diabetic retinopathy measured by Optical Coherence Tomography (OCT) STUDY DESIGN: Quasi experimental study PLACE & DURATION OF STUDY:  removed for blind review METHODOLOGY: Diabetic patients without retinopathy who required cataract surgery for visual rehabilitation were included in study. They were than divided into two groups. Group A included patients who received routine steroid+antibiotic post-operative drops while Group B comprised of patients who received nepafenac (0.1%) eye drops eight hourly in addition to routine post-operative eye drops. All patients underwent standard phacoemulsification and intraocular lens implantation followed by use of NSAID eye drops for a month. OCT measurements were done pre-operatively, 7 and 28 days post operatively. RESULTS: Comparison of central macular thickness between groups was significant at (Pre & 7 day post op) and insignificant at (7th day & 28th day post op) and (Pre & 28th day post op) i.e. 0.043, 0.834 and 0.084 respectively. However, difference of mean central macular thickness was significant at all follow-up periods i.e.0.003, 0.006, and 0.000 CONCLUSION: Post-operative NSAID in diabetic patients without retinopathy leads to a significant decrease in macular thickness as compared to controls after cataract surgery. KEY WORDS: Phacoemulsification, Optical Coherence Tomography, Non-steroidal Anti-Inflammatory Agent

Ewing\u27s sarcoma arising from the adrenal gland in a young male: a case report

Background: Ewing\u27s sarcoma uncommonly arises from extraosseous soft tissue or parenchymal organs. Primary adrenal Ewing\u27s Sarcoma, although very rare, is extremely aggressive and commonly fatal. CASE PRESENTATION: A 17 year old Pakistani male was referred to the outpatient oncology clinic at our center with a three month history of concomitant pain, swelling and dragging sensation in the right hypochondrium. Abdominal examination revealed a large, firm mass in the right hypochondrium extending into the right lumbar region and epigastrium. His genital exam was unremarkable and there were no stigmata of hepatic or adrenal disease.Computed tomography scans revealed a large peripherally enhancing mass in the hepatorenal area, biopsy of which showed a neoplastic lesion composed of small round blue cells which exhibited abundance of glycogen and stained diffusely positive for CD99 (MIC2 antigen). Fluorescence in situ hybridization demonstrated gene rearrangement at chromosome 22q12 which confirmed the diagnosis of Ewing\u27s sarcoma. Staging scans revealed pulmonary metastasis and hence he was commenced on systemic chemotherapy. CONCLUSION: This case report highlights the importance of keeping Ewing\u27s sarcoma in mind when a young patient presents with a large non-functional adrenal mass

Modeling and piezoelectric analysis of nano energy harvesters

The expedient way for the development of microelectromechanical systems (MEMS) based devices are based on two key steps. First, perform the simulation for the optimization of various parameters by using different simulation tools that lead to cost reduction. Second, develop the devices with accurate fabrication steps using optimized parameters. Here, authors have performed a piezoelectric analysis of an array of zinc oxide (ZnO) nanostructures that have been created on both sides of aluminum sheets. Various quantities like swerve, stress, strain, electric flux, energy distribution, and electric potential have been studied during the piezo analysis. Then actual controlled growth of ZnO nanorods (NRs) arrays was done on both sides of the etched aluminum rod at low-temperature using the chemical bath deposition (CBD) method for the development of a MEMS energy harvester. Micro creaks on the substrate acted as an alternative to the seed layer. The testing was performed by applying ambient range force on the nanostructure. It was found that the voltage range on topside was 0.59 to 0.62 mV, and the bottom side was 0.52 to 0.55 mV. These kinds of devices are useful in low power micro-devices, nanoelectromechanical systems, and smart wearable systems.Open Access funding was provided by the Qatar National Library. This work is supported by Qatar University Internal Grant No. QUCG-CAM-2020\21-1

Occult Hepatitis B in Patients with Decompensated Chronic Liver Disease: A Cross Sectional Study at Tertiary Care Hospital, Peshawar

OBJECTIVES The objective of this study was to find the frequency of occult hepatitis B in patients presenting with Decompensated chronic liver disease. METHODOLOGY This descriptive, cross-sectional study was conducted at a tertiary care hospital at Peshawar-KP from 31st December 2021 to 31st May 2022.143 patients were enrolled. Informed consent was taken from all patients who were enrolled in this study. We included patients aged 18-60 years of either gender. All patients admitted to medical units or visiting Medical OPDs having decompensated Chronic liver disease were enrolled. A consecutive sampling technique was used to enroll patients for our study. Baseline characteristics, demographics and laboratory data were collected on predesigned proforma. All patients were screened for Hepatitis B infection by performing HBsAg with ELISA, and patients with negative surface antigens were eligible for the study.RESULTSOur study population age range was from 18 to 60 years, with a mean age of 43.30±8.00 years. There were 100 male (69.9%) patients and 43 female (30.1%) patients. Occult Hepatitis B was observed in 40(28%) patients with decompensated chronic liver disease. Among these patients, 26 were male, and 14 were female. Stratification for Occult Hepatitis B was done concerning age & gender to see any significant difference in distribution. There was no significant difference in the distribution of Occult Hepatitis B among different age groups and gender. CONCLUSION This study has shown that a significant proportion of decompensated chronic liver disease patients had evidence of occult hepatitis B infection. Methodology: This was a descriptive, cross sectional study that was conducted at a tertiary care hospital at Peshawar-KP from 31st December 2021 till 31st May 2022.. 143 patients were enrolled in this study. An informed consent was taken from all patients who were enrolled in this study. We included patients having age 18-60 years of either gender. All patients admitted in medical units or visiting Medical OPDs having decompensated Chronic liver disease were enrolled. Consecutive sampling technique was used to enroll patients for our study. Baseline characteristics, demographics and laboratory data was collected on predesigned proforma. All patients were screened for Hepatitis B infection by performing HBsAg with ELISA and patients with negative surface antigen were eligible for the study. Results: Our study population age range was from 18 to 60 years with mean age of 43.30±8.00 years There were 100 male (69.9%) patients and 43 female (30.1%) patients. Occult Hepatitis B was observed in 40(28%) of patients with decompensated chronic liver disease. Among these patients, 26 were male and 14 were female. Stratification for Occult Hepatitis B was done with respect to age & gender to see any significant difference in distribution. There was no significant difference in distribution of Occult Hepatitis B among different age groups and gender. Conclusion: This study has shown that significant proportion of decompensated chronic liver disease patients had evidence of occult hepatitis B infection

Synthesis and characterization Al2O3-ZrO2 bio-nanostructures with sintering effect, residual and thermally stable analysis

The thermal stability of nano composite materials is the important aspect of the modern era. In the advance modern devices, the nanostructures and nano composite material are used for the biological and other applications. The aluminum oxide is the most prominent oxides and composite at nano scale that show different structures, electrical and thermal properties which make it useful in different applications. Sol-Gel technique was used for synthesis to grow these nanostructures of Al2O3-ZrO2. Thermal stability was achieved and thermo-gravimetric (TGA) graphical analysis of synthesized material was performed. Size, phase and structure validation about the productive material was studied by X-Ray diffraction powder technique. Reaction completion and idea about annealing temperature of the synthesized material had pointed out by DSC-TGA (SDT) graphical peaks. Effect of the temperatures with equal variation from 5000C, 7000C, 9000C and 11000C was performed to achieve the target thermal stability. Thermal analysis was also conducted in ANSYS workbench to visualize the thermal distributes like heat flux through the material. Optical properties such as band gap variation with temperature were studied by UV-vis analysis. Fourier transform infrared (FTIR) analysis was also performed. This work provides useful information related to nanostructures with sintering effect, residual and thermally stable analysis

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Screening of resynthesized hexaploid wheats for durable rust resistance

Wheat is one of the most important food crops, and its yield losses range from 20 to 100% due to leaf, stripe and stem rusts caused by Puccinia triticina, P. striiformis and P. graminis, respectively. New sources of resistance are strategically essential to limit the devastating effect of ever-evolving rust pathogens. In this study, we characterized 200 synthetic hexaploid wheats (SHWs) against all three rusts using rust pathotypes at seedling and adult plant stages in Queensland, Australia. We identified 57 accessions resistant to leaf rust, 77 to stripe rust and 69 accessions resistant to stem rust at the seedling stage. Ten SHWs were resistant to all three rusts, while 32 SHWs had dual resistance against leaf and stem rusts, and 28 SHWs had dual resistance to stripe and stem rust. We identified 24 SHWs carrying adult plant resistance (APR) for leaf, stripe and stem rust. The coefficient of correlation between yellow rust scores at seedling and adult plant stages were highest (r= 0.89), followed by stem rust (r= 0.77), and leaf rust (r= 0.72), which indicate the possibility of adult plant resistance in SHWs. The diagnostic kompetitive allele-specific PCR (KASP) markers for known rust resistance genes revealed that 14 SHW accessions carried Lr34, 85 carried Lr46, and 3 SHW carried Lr67, while none of the SHW carried Sr2. This study identified useful SHW lines for breeding resistance against all three types of rusts; some carried known durable resistance genes while others likely carry novel resistance loci

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

BackgroundTranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding.MethodsWe did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.FindingsBetween July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98).InterpretationWe found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial.</div