Absolute Lymphocyte Count and its Correlation with Serum Ferritin Level: An early indicator of disease severity in COVID-19

Introduction: The massive number of cases with SARS-Cov-2 has put a tremendous pressure on healthcare systems all over the world. Most of the countries have declared health emergency. In these highly challenging times and also to reduce the risk of morbidity early warning signs may be helpful.6 Objective: To correlate lymphocyte count with serum ferritin levels in patients with COVID-19 admitted in the intensive care unit of a tertiary care hospital. Material and Methods: This cross-sectional study was carried out at Fauji Foundation Hospital Rawalpindi from July 2020-December 2020. A positive COVID-19 patient was the one who had a positive real time polymerase chain reaction (PCR) for SARS-CoV-2 by sampling through nasopharyngeal swabs. 3 ml of blood is taken for Blood CP in ethylene diamine tetra acetic acid containing vacutainers and was run on Sysmex-XN series. For serum ferritin 4 ml clotted blood was collected in plain test tube. Serum ferritin was performed on AXSYM system by immunoassay using AXSYM Ferritin reagent kit pack. Covid -19 disease severity classification proposed by WHO was used to categorise the patients. (WHO COVID 19 interim guidelines). 11 Results: A total of 91 patients diagnosed with covid-19 by RT-PCR testing admitted in intensive care units (severe and critical disease) were included in the study. Out of these 91 patients ;41 were males and 50 patients were females. Mean age of the patients was 61+/- 9 years. The age range was (28-75) years. The median nadir lymphocyte count was 0.2 X 10 9/L. Mean lymphocyte count was 1.1 +/- 0.2 SD. Mean Ferritin value was 1148.5 +/- 60 SD. The Pearson correlation coefficient showed an r value of -0.60 which shows a moderate negative correlation. Conclusion: There is a significant negative correlation between lymphocyte count and serum ferritin level

Association of Microalbuminuria with the Severity of Diabetic Retinopathy in Patients with type II Diabetes Mellitus.

Objective: To evaluate the association of microalbuminuria with the severity of diabetic retinopathy. Methodology: This is a cross-sectional study that was conducted at Combined Military Hospital Lahore from Dec 2019 to Dec 2020. All Patients having type II diabetes mellitus fulfilling the inclusion and exclusion criteria were selected for this study. All patients underwent complete ocular examination including fundoscopy to grade the stage of diabetic retinopathy using the ETDRS chart. To assess the extent of microalbuminuria, a urine albumin to creatinine ratio was carried out using the urine spot test and classified as mild, moderate and severe according to KIDGO 2012 clinical practice guidelines. Results:   Out of 300 patients 104 (34.6%) had some stage of diabetic retinopathy.  Microalbuminuria was present in all (104) patients with diabetic retinopathy and in 55 (28.06%) patients with no diabetic retinopathy. The severity of microalbuminuria correlates with the advancement in stages of retinopathy with   as the number of patients with moderate and severe microalbuminuria had higher stages of diabetic retinopathy. None of the patients with very mild diabetic retinopathy had moderately or severely increased microalbuminuria whereas 88% of patients with advanced diabetic retinopathy had moderately increased microalbuminuria and 4% had severely increased microalbuminuria.  Furthermore, 76% of the patients had moderately increased and 12% had severely increased microalbuminuria in patients >7 HbA1c and only 28% of patients had moderately increased microalbuminuria and none had severely increased microalbuminuria in patients with ≤ 7 HbA1c. Conclusion: This study showed that the degree of microalbuminuria increases with each higher stage of diabetic retinopathy.

Impact of diabetes continuing education on health care professionals’ attitudes towards diabetes care in a Yemeni city

Purpose: To evaluate the impact of a continuing education (CE) program on the attitudes of health care professionals (HCPs) towards diabetes care in Yemen.Methods: A pre- and post-intervention study was carried out in Mukalla City, Hadramout, Yemen and was offered to all physicians, pharmacists, and nurses registered in the Health Office in the Mukalla City. The HCPs were invited to attend a CE program. All participants filled out a questionnaire before the intervention (pre-test) that measured the attitudes of the participants towards diabetes. An interventional program was given in the form of a seminar, and participants were requested to complete the same questionnaire after the seminar.Results: A total of 73 HCPs attended the CE, including 19 pharmacists (26 %), 37 physicians (50.7 %), and 17 (23.3 %) nurses. The pre- and post-intervention changes in the questionnaire responses were significant only for attitude toward the values of blood glucose levels (p = 0.009) and attitude toward autonomy of diabetes patients (p = 0.023).Conclusion: HCPs in Mukalla City have positive attitudes toward diabetes. Physicians were more aware of the sequelae of diabetes than other healthcare professional groups with nurses showing the least understanding. Therefore, more emphasis should be placed upon designing education programs for diabetes specifically tailored for nurses and pharmacists.Keywords: Diabetes, Continuing education, Attitude, Health care professional

Evaluation of the knowledge and practices of pregnant Yemeni Women regarding teratogens

Purpose: To investigate the knowledge and practice of pregnant women with regards to teratogens.Methods: A month-long cross-sectional study was carried out among 150 pregnant women selected from four Motherhood and Child Healthcare Centers (MCHCs) in Mukalla District of Yemen. Data collection was conducted during face-to-face interviews using a questionnaire. Descriptive and simple regression analyses were used.Results: Of the 150 pregnant women who participated in the study, 95.3 % of the pregnant women were < 36 years old, 7.4 % had children with congenital malformations, 62 % indicated that they had heard about folic acid; however, only 16.6 % knew the significance of folic acid. Regarding toxoplasmosis, 94.7 % indicated that they had heard about toxoplasmosis, and 76 % knew about the serious consequences of the disease (congenital malformation and abortion) during pregnancy. Based on simple regression analysis, the results indicate that education and parity, irrespective of age or income level, were the major factors determining better knowledge and practices in pregnancy with regards to toxoplasmosis.Conclusion: Knowledge of folic acid deficiency among pregnant women in Mukalla District of Yemen is relatively low. Furthermore, preventive practices to avoid folic acid deficiency are minimal.Keywords: Knowledge, Practices, Teratogens, Pregnant Yemeni women, Folic acid deficienc

Phytochemical and Biological Activities of Four Wild Medicinal Plants

The fruits of four wild plants, namely, Capparis decidua, Ficus carica, Syzygium cumini, and Ziziphus jujuba, are separately used as traditional dietary and remedial agents in remote areas of Khyber Pakhtunkhwa, Pakistan. The results of our study on these four plants revealed that the examined fruits were a valuable source of nutraceuticals and exhibited good level of antimicrobial activity. The fruits of these four investigated plants are promising source of polyphenols, flavonoids, alkaloids, terpenoids, and saponins. These four plants' fruits are good sources of iron, zinc, copper, manganese, selenium, and chromium. It was also observed that these fruits are potential source of antioxidant agent and the possible reason could be that these samples had good amount of phytochemicals. Hence, the proper propagation, conservation, and chemical investigation are recommended so that these fruits should be incorporated for the eradication of food and health related problems

Mechanistic evaluation of a novel cyclohexenone derivative?s functionality against nociception and inflammation: An in-vitro, in-vivo and in-silico approach

The synthesis of a novel cyclohexanone derivative (CHD; Ethyl 6-(4-metohxyphenyl)-2-oxo-4-phenylcyclohexe-3-enecarboxylate) was described and the subsequent aim was to perform an in vitro, in vivo and in silico pharmacological evaluation as a putative anti-nociceptive and anti-inflammatory agent in mice. Initial in vitro studies revealed that CHD inhibited both cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LOX) enzymes and it also reduced mRNA expression of COX-2 and the pro-inflammatory cytokines TNF-α and IL-1β. It was then shown that CHD dose dependently inhibited chemically induced tonic nociception in the abdominal constriction assay and also phasic thermal nociception (i.e. anti-nociception) in the hot plate and tail immersion tests in comparison with aspirin and tramadol respectively. The thermal test outcomes indicated a possible moderate centrally mediated anti-nociception which, in the case of the hot plate test, was pentylenetetrazole (PTZ) and naloxone reversible, implicating GABAergic and opioidergic mechanisms. CHD was also effective against both the neurogenic and inflammatory mediator phases induced in the formalin test and it also disclosed anti-inflammatory activity against the phlogistic agents, carrageenan, serotonin, histamine and xylene compared with standard drugs in edema volume tests. In silico studies indicated that CHD possessed preferential affinity for GABAA, opioid and COX-2 target sites and this was supported by molecular dynamic simulations where computation of free energy of binding also favored the formation of stable complexes with these sites. These findings suggest that CHD has prospective anti-nociceptive and anti-inflammatory properties, probably mediated through GABAergic and opioidergic interactions supplemented by COX-2 and 5-LOX enzyme inhibition in addition to reducing pro-inflammatory cytokine expression. CHD may therefore possess potentially beneficial therapeutic effectiveness in the management of inflammation and pain

Insect Pest Complex of Wheat Crop

Wheat Triticum aestivum L. is grown on broad range of climatic conditions because of edible grains, cereal crop and stable food of about 2 Billion peoples worldwide. Additionally, it is the rich source of carbohydrates (55–60%), vegetable proteins and contributed 50–60% daily dietary requirement in Pakistan. Globally, wheat crops is grown over 90% area of total cultivated area; facing devastating biotic and abiotic factors. The estimated economic losses in wheat quantity and quality are about 4 thousands per tonne per year including physical crop losses and handling. Economic losses of about 80–90 million USD in Pakistan are recorded due to inadequate production and handling losses. Wheat agro-ecosystem of the world colonizes many herbivore insects which are abundant and causing significant losses. The feeding style of the insects made them dispersive from one habitat to another imposing significant crop loss. Areas of maximum wheat production are encountered with either insect which chew the vegetative as well as reproductive part or stem and root feeders. This chapter provides the pest’s taxonomic rank, distribution across the globe, biology and damage of chewing and sucking insect pest of wheat. It is very important to study biology of the pest in accordance with crop cycle to forecast which insect stage is economically important, what the proper time to manage pest is and what type of control is necessary to manage crop pest. The chapter will provide management strategies well suited to pest stage and environment

Early Intervention in Psychosis and Management of First Episode Psychosis in Low- and Lower-Middle-Income Countries: A Systematic Review

Background and Hypothesis People with first-episode psychosis (FEP) in low- and lower-middle-income countries (LMIC) experience delays in receiving treatment, resulting in poorer outcomes and higher mortality. There is robust evidence for effective and cost-effective early intervention in psychosis (EIP) services for FEP, but the evidence for EIP in LMIC has not been reviewed. We aim to review the evidence on early intervention for the management of FEP in LMIC. Study Design We searched 4 electronic databases (Medline, Embase, PsycINFO, and CINAHL) to identify studies describing EIP services and interventions to treat FEP in LMIC published from 1980 onward. The bibliography of relevant articles was hand-searched. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Study Results The search strategy produced 5074 records; we included 18 studies with 2294 participants from 6 LMIC countries. Thirteen studies (1553 participants) described different approaches for EIP. Pharmacological intervention studies (n = 4; 433 participants) found a high prevalence of metabolic syndrome among FEP receiving antipsychotics (P ≤ .005). One study found a better quality of life in patients using injectables compared to oral antipsychotics (P = .023). Among the non-pharmacological interventions (n = 3; 308 participants), SMS reminders improved treatment engagement (OR = 1.80, CI = 1.02–3.19). The methodological quality of studies evidence was relatively low. Conclusions The limited evidence showed that EIP can be provided in LMIC with adaptations for cultural factors and limited resources. Adaptations included collaboration with traditional healers, involving nonspecialist healthcare professionals, using mobile technology, considering the optimum use of long-acting antipsychotics, and monitoring antipsychotic side effects