Harmonic Scalpel Hemorrhoidectomy Vs Milligan-Morgan Hemorrhoidectomy

Background: To compare Harmonic Scalpel Hemorrhoidectomy (HSH) with classical Milligan Morgan Hemorrhoidectomy (MMH) in terms of operation time and post-operative pain to establish effectiveness of this novel procedure.Methods: A total of 62 patients planned for excision hemorrhoidecotmy were randomly selected into HSH and MMH groups. Mean operation time was calculated during surgery and pain at time of first defecation was recorded on visual analog scale (VAS).Results: Mean VAS after surgery at time of first defecation was 4.32 (SD 0.909) in HSH group and 6.97 (SD 1.426) in MMH group (p value <0.000). Mean Operation time in HSH group was 18.13 (SD 3.956) minutes and that of MMH group was 22.90 (SD 4.901) minutes (P value <0.000).Conclusion: Harmonic Scalpel Hemorrhoidectomy is better than Milligan Morgan hemorrhoidectom

Detailed analysis of allergic cutaneous reactions to spinal cord stimulator devices

The use of spinal cord stimulation (SCS) devices to treat chronic, refractory neuropathic pain continues to expand in application. While device-related complications have been well described, inflammatory reactions to the components of these devices remain underreported. In contrast, hypersensitivity reactions associated with other implanted therapies, such as endovascular and cardiac rhythm devices, have been detailed. The purpose of this case series is to describe the clinical presentation and course of inflammatory reactions as well as the histology of these reactions. All patients required removal of the entire device after developing inflammatory reactions over a time course of 1–3 months. Two patients developed a foreign body reaction in the lead insertion wound as well as at the implantable pulse generator site, with histology positive for giant cells. One patient developed an inflammatory dermatitis on the flank and abdomen that resolved with topical hydrocortisone. “In vivo” testing with a lead extension fragment placed in the buttock resulted in a negative reaction followed by successful reimplantation of an SCS device. Inflammatory reactions to SCS devices can manifest as contact dermatitis, granuloma formation, or foreign body reactions with giant cell formation. Tissue diagnosis is essential, and is helpful to differentiate an inflammatory reaction from infection. The role of skin patch testing for 96 hours may not be suited to detect inflammatory giant cell reactions that manifest several weeks post implantation

Impact of foreign direct investment on economic growth: A case study of Pakistan

Purpose- This research paper aims to analyze the impact of foreign direct investment (FDI) in Pakistan for the period 1981 to 2010. It evaluated the GDP growth performance and assessed the historical trends of the FDI and CPI in Pakistan. Methodology/Sample- The link between gross domestic product (GDP,) foreign direct investment and Inflation is measured with the help of multiple regression models. GDP in this model is used as dependent variable whereas FDI and inflation (CPI) are measured as independent variables. Findings- According to the results, the model is overall significant with the positive and significant association of GDP and FDI while a negative and significant relationship found between GDP and inflation. Practical Implications- On the basis of the empirical results acquired, Policy proposals are advised to attract FDI in Pakistan. Foreign direct investment (FDI) is an essential factor for economic growth in the developing countries. FDI allows the transfer of technology, uplift competition in the domestic input market, contributes to human capital development and Profits created by FDI contribute to corporate tax revenues in the host country

Impact of foreign direct investment on economic growth: A case study of Pakistan

Purpose- This research paper aims to analyze the impact of foreign direct investment (FDI) in Pakistan for the period 1981 to 2010. It evaluated the GDP growth performance and assessed the historical trends of the FDI and CPI in Pakistan. Methodology/Sample- The link between gross domestic product (GDP,) foreign direct investment and Inflation is measured with the help of multiple regression models. GDP in this model is used as dependent variable whereas FDI and inflation (CPI) are measured as independent variables. Findings- According to the results, the model is overall significant with the positive and significant association of GDP and FDI while a negative and significant relationship found between GDP and inflation. Practical Implications- On the basis of the empirical results acquired, Policy proposals are advised to attract FDI in Pakistan. Foreign direct investment (FDI) is an essential factor for economic growth in the developing countries. FDI allows the transfer of technology, uplift competition in the domestic input market, contributes to human capital development and Profits created by FDI contribute to corporate tax revenues in the host country

Presentation of Acute Lymphoblastic Lymphoma and Colorectal Carcinoma in the Context of Constitutional Mismatch Repair Deficiency Syndrome (CMMRD): a Case Report with Literature Review

Introduction: Constitutional mismatch repair deficiency (CMMRD) is a rare autosomal recessive disease-carrying an increased risk of cancers (pediatric tumors of central nervous system, haemato-lymphoid malignancies along with gastrointestinal (GI) cancer(s), which are usually seen in the second and third decade) leading to syndromic presentation. Causal mutations are detected in DNA mismatch repair (MMR) genes, including MLH1, PMS2, MSH2, and MSH6 that are also known for their established role in Lynch syndrome. We describe a case of CMMRD with an earlier (first decade of life) presentation of mediastinal acute lymphoblastic lymphoma and colorectal malignancy. Case Presentation: A five-year-old boy presented with respiratory complaints, bilateral cervical lymphadenopathy, multiple café au lait macules (CALMs) on the lower back, history of parental consanguinity with the death of three sisters due to brain tumor within 6 months of diagnosis. Computerized tomographic (CT) scan chest revealed a huge mediastinal mass. The patient underwent a trucut-biopsy of the mass. The results were significant for a pre T-cell acute lymphoblastic lymphoma. Suspicion of CMMRD was raised based on a combination of factors described above. A panel of mismatch repair (MMR) proteins was applied on the biopsy tissue that revealed loss of nuclear expression of MLH1 and PMS2 immunostaining in tumor cells with positive external controls. While on maintenance therapy for lymphoma, about a year later, the patient developed sub-acute intestinal obstruction due to a stenosing polypoidal circumferential tumor in the mid-sigmoid colon found on flexible sigmoidoscopy that was followed by endoscopic biopsies and insertion of a fully-covered self-expanding metallic adult biliary stent with a diameter of 10 mm and length of 6 cm leading to immediate relief of obstruction. Biopsies revealed adenocarcinoma with neuroendocrine differentiation. Metastatic tumor deposits were seen in the omentum, anterior abdominal wall, and the left peritoneal wall. Practical Implications: Earlier (first decade) presentation of gastrointestinal malignancy warrants that an earlier screening through radiological scans for any possible tumors and MMR protein expression analysis (loss in tumor plus normal non-tumor cells) are essential in patients having CALMs and family history of pediatric tumors

Effect of bovine lactoferrin on seroconversion following polio vaccine administration in children: Protocol for a double-blinded randomised controlled trial

Introduction: The oral polio vaccine (OPV) has substantial results in eliminating wild poliovirus and the vaccine of choice in polio eradication. However, the mucosal immunity induced by the OPV is still uncertain. Literature has shown that bovine lactoferrin (BLF) is a safe and useful protein found in cow\u27s milk with extraordinary antimicrobial, antiviral, antiinflammatory and immune-modulatory functions that help children\u27s gut to fight against micro-organisms like poliovirus. However, limited data exist regarding the effect of BLF on polio vaccine immune response. The primary objective is to evaluate the effect of BLF in enhancing mucosal and humoral immunity in children following the administration of oral and inactivated polio vaccines.Methods and analysis: This is a two-arm double-blinded randomised controlled trial comparing 462 neonates (231 in both groups) receiving either BLF or placebo with breast milk. The intervention is administered from day 1 till 6 weeks of age to a full-term healthy singleton newborn born at the Aga Khan University Hospitals, Karachi, Pakistan. The primary outcome is the seroconversion, 1 month after the receipt of two doses of OPV (at 10 weeks). For descriptive statistical analysis, Stata will be used, the frequency with percentages will be reported to describe baseline characteristics of the participants. A χ2 test will be used to compare categorical variables and a simple t test to compare continuous variables. The proportion of seroconversion and shedding will be compared using χ2 test or Fisher\u27s exact test.Ethics and dissemination: The Ethics approval has been granted by the Ethics Review Committee (ERC) of Aga Khan University for the proposed trial (ID: 2019-1955-5013). Furthermore, the National Bioethics Committee (NBC) of Pakistan has also approved the study for human subject research (ID: 4-87/NBC-443/19/669). Study findings will be disseminated through presentations at scientific conferences and educational practice workshops and will be published in an international peer-reviewed scientific journal

Detection, quantification and genotype distribution of HCV patients in Lahore, Pakistan by real-time PCR

Background: Hepatitis C virus (HCV) is considered as \u201cViral Time Bomb\u201d suggested by the World Health Organization and if it is not treated timely, it will lead towards cirrhosis and hepatocellular carcinoma (HCC). Objective: The purpose of the present research is to study possible risk factors, frequent genotypes of HCV and its association with different age groups. Methods: Suspected blood samples from HCV patients were collected from different hospitals of Lahore, Pakistan. Out of 1000 HCV suspected samples, 920 samples were found HCV positive detected by Anti-HCV ELISA, CobasR. kit. The quantification of HCV load was determined by HCV quantification kit and LINEAR ARRAY KIT (Roche) was used for genotype determination by Real-Time PCR (ABI). Statistical analysis was done by using Microsoft Excel. Results: Out of 920 subjects, 77 subjects (8.4%) were false positive and they were not detected by nested PCR. Three PCR positive samples were untypeable. Genotype 3 was predominant in Lahore which was 83.5%, whereas type 1 and 2 were 5.1% and 0.7% respectively. There were also mixed genotypes detected, 1 and 3 were 0.4%, 2 and 3 were 1.41% and 3 and 4 were 0.2% only. Male were more infected of HCV in the age <40 years and females >40years. Conclusion: The major risk factor for HCV transmission is by use of unsterilized razors/blades. It is necessary to spread awareness among the general population of Pakistan about HCV transmission risk factors. Regular physical examination at least once a year is recommended, so that early detection of HCV could be done

Cowpea [Vigna unguiculata (L.) Walp] herbage yield and nutritional quality in cowpea-sorghum mixed strip intercropping systems

En los sistemas tradicionales de cultivo intercalado de frijol caupí y sorgo en franjas y filas, el rendimiento de forraje del frijol caupí se reduce significativamente debido a la intensa competencia y al dominio del sorgo en la adquisición de recursos para el cultivo. Este estudio de campo evaluó novedosos sistemas de cultivo intercalado en franjas mixtas de frijol caupí forrajero y sorgo con diferente número de filas de cultivo en diferentes disposiciones espaciales. El frijol caupí se intercaló con el sorgo en franjas de 8, 12 y 16 filas con un espaciamiento de 30, 45 y 60 cm entre las filas. En cada franja se mantuvo igual número de filas de frijol caupí y sorgo. Para la ejecución de los ensayos de campo durante las temporadas de verano de 2013 y 2014 se utilizó un diseño factorial en bloques completos aleatorizados con tres repeticiones. Las franjas con 12 filas y un espaciamiento de 60 cm entre las filas afectaron positivamente a todas las variables agronómicas del frijol caupí que condujeron al máximo rendimiento forrajero (22.2 y 23.7 t/ha en 2013 y 2014, respectivamente) y de biomasa de materia seca (6.63 y 6.94 t/ha en 2013 y 2014, respectivamente). En cambio, las franjas de 8 filas con un espaciamiento de 30 cm superaron a otros sistemas de cultivo intercalado al obtener el rendimiento máximo de hierba y de biomasa de materia seca del sorgo. El sistema de cultivo intercalado compuesto por franjas de 12 filas con un espaciamiento de 60 cm entre las filas siguió siendo superior, al registrar el contenido máximo de proteína bruta, grasas y cenizas junto con el mínimo contenido de fibra de frijol caupí. Además, este sistema de cultivo intercalado bajo el resto de las disposiciones espaciales también permaneció incomparable, mientras que las franjas de 16 filas bajo todas las geometrías de siembra permanecieron inferiores a otros sistemas de cultivo intercalado. Por lo tanto, el cultivo intercalado de frijol caupí con sorgo en franjas de 12 filas con un espaciado de 60 cm ofrece una solución biológicamente viable para mejorar la biomasa y la calidad del forraje del caupí en cultivo intercalado con sorgo.In traditional row and strip cowpea-sorghum intercropping systems, cowpea forage yield reduces significantly due to intense competition and dominance of sorghum in acquiring growth resources. This field study evaluated novel mixed strip intercropping systems of forage cowpea and sorghum having different number of crops rows arranged under different spatial arrangements. Cowpea was intercropped with sorghum in 8, 12 and 16 rows strips with row-row spacing of 30, 45 and 60 cm. In each strip, equal number of rows of cowpea and sorghum were maintained. Factorial arrangement of randomized complete block design with three replicates was used to execute the field trials during summer seasons of 2013 and 2014. Strips having 12 rows and 60 cm row-row spacing positively affected all agronomic variables of cowpea which led to maximum forage yield (22.2 and 23.7 t ha-1 during 2013 and 2014 respectively) and dry matter biomass (6.63 and 6.94 t ha-1 during 2013 and 2014 respectively). In contrast, 8-rows strips having line spacing of 30 cm outperformed other intercropping systems by yielding the maximum herbage yield and dry matter biomass of sorghum. The intercropping system comprising of 12-rows strips with 60 cm row-row spacing remained superior in recording the maximum crude protein, fats and total ash along with the minimum fiber content of cowpea. In addition, this intercropping system under rest of spatial arrangements also remained unmatched, while 16-rows strips under all planting geometries remained inferior to other intercropping systems. Thus, cowpea intercropping with sorghum in 12-rows strips having 60 cm spacing offers biologically viable solution to improve biomass and forage quality of cowpea in intercropping with sorghum

Transition metal doped CeO2 for photocatalytic removal of 2-chlorophenol in the exposure of indoor white light and antifungal activity

Besides natural sunlight and expensive artificial lights, economical indoor white light can play a significant role in activating a catalyst for photocatalytic removal of organic toxins from contaminated water. In the current effort, CeO2 has been modified with Ni, Cu, and Fe through doping methodology to study the removal of 2-chlorophenol (2-CP) in the illumination of 70 W indoor LED white light. The absence of additional diffractions due to the dopants and few changes such as reduction in peaks’ height, minor peak shift at 2θ (28.525°) and peaks’ broadening in XRD patterns of modified CeO2 verifies the successful doping of CeO2. The solid-state absorption spectra revealed higher absorbance of Cu-doped CeO2 whereas a lower absorption response was observed for Ni-doped CeO2. An interesting observation regarding the lowering of indirect bandgap energy of Fe-doped CeO2 (∼2.7 eV) and an increase in Ni-doped CeO2 (∼3.0 eV) in comparison to pristine CeO2 (∼2.9 eV) was noticed. The process of e-– h+ recombination in the synthesized photocatalysts was also investigated through photoluminescence spectroscopy. The photocatalytic studies revealed the greater photocatalytic activity of Fe-doped CeO2 with a higher rate (∼3.9 × 10−3 min-1) among all other materials. Moreover, kinetic studies also revealed the validation of the Langmuir-Hinshelwood kinetic model (R2 = 0.9839) while removing 2-CP in the exposure of indoor light with a Fe-doped CeO2 photocatalyst. The XPS analysis revealed the existence of Fe3+, Cu2+ and Ni2+ core levels in doped CeO2. Using the agar well-diffusion method, the antifungal activity was assessed against the fungus M. fructicola and F. oxysporum. Compared to CeO2, Ni-doped CeO2, and Cu-doped CeO2 nanoparticles, the Fe-doped CeO2 nanoparticles have outstanding antifungal properties