Mediastinitis as a complication of Epstein-Barr virus infection: a rare entity

Epstein-Barr virus (EBV) is a member of the herpes virus family that can infect humans. Common manifestations of Epstein-Barr virus infection include fever, lymphadenopathy and pharyngitis with some rare complications including mediastinitis, myocarditis, pancreatitis, acute kidney failure and neurological disorders. Clinical findings along with serological evidences are needed to diagnose the infection. Early investigation for EBV in febrile patients can expedite both diagnosis and treatment

A cross sectional study on the risk factors of gallbladder stone

Background: Gallstone diseases are one of the most common public health problems. Approximately 10%-20% of the national adult populations currently carry gallstones, and gallstone prevalence is rising. The purpose of the study was to find out association of gallstone with fatty liver, gender and age in Lahore, Pakistan.Methods: Ultrasonographically Hundred patients were scanned for liver type and gall stone. The data was analyzed by using SPSS version 17.0. Chi-Square statistics was used to check the association between the variables. The effect of age and gender was also statistically analysed.Results: One hundred patients were scanned between ages 21-60 years. Out of hundred 76% patients were female and 24% were male. In this study there were no stones in 37% cases and there were stones in 63% cases. Gallbladder stone found associated with age as p-value is found less than 5% level of significance, maximum patients were found in age ranges between 31-35 years, showing that risk of developing gallstone increases by age. Gallstone is gender specific, females are more victims of developing the stone than among males, and those who have fatty liver are more at risk of developing gallstone than those having normal liver.Conclusions: The study showed that ultrasound (US) is the most sensitive, specific, yet very practical and useful imaging test for the detection of gallstones with a high degree of confidence. Gallstones represent high prevalence disease in adult females more than males and it increases by age where as those who have fatty liver, they are more likely to develop gallstone

Diagnostic accuracy of strain ultrasound elastography in differentiating benign and malignant thyroid nodules, taking histopathology as gold standard

Background: Elastography is a method recently being used in the evaluation of thyroid nodules by comparing tissue elasticity. Strain and shear wave elastography are two types of elastography still being used in clinical practice. Two kinds of elasticity can be assessed by strain elastography. First, colors around and within the nodules are evaluated and visually scored according to the 4-5 scale scoring systems. The aim of this study was to determine the diagnostic accuracy of strain ultrasound elastography in differentiation between benign and malignant thyroid nodules, taking histopathology as gold standardMethods: Total of 101 patients with palpable thyroid nodule of any size of age 30-70 years of either gender were included. Patients with previous thyroid surgery and already proven histopathology were excluded. Strain ultrasound elastography was performed in every patient by using a highresolution unit with a linear array probe centred at 7.5 MHz. Strain ultrasound elastography was performed in every patient by a consultant radiologist in the presence of researcher and benign or malignant thyroid nodules was noted. Strain USG elastography findings were compared with histopathology report.Results: All the patients were subjected to strain ultrasound elastography. USG supported the diagnosis of malignant thyroid nodules in all 52 patients. Histopathology confirmed malignant thyroid nodules in 47 (true positive) cases where as 5 (false positive) had no malignant lesion on histopathology. In USG negative patients, 46 were true negative while 3 were false negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of strain ultrasound elastography in differentiation between benign and malignant thyroid nodules, taking histopathology as gold standard is 94.0%, 90.20%, 90.38%, 93.88% and 92.08% respectively.Conclusions: According to this study, strain ultrasound elastography is the non-invasive modality of choice with high diagnostic accuracy in diagnosing malignant thyroid nodules

A narrative review on the role of folate-mediated one-carbon metabolism and its associated gene polymorphisms in posing risk to preeclampsia

Preeclampsia (PE) presents a major obstetrical problem for mother and fetus which is characterized by the onset of hypertension and proteinuria in formerly normotensive women. Altered folate-mediated one-carbon metabolism is one of the factors for PE development either due to nutritional insufficiencies such as folate deficiency or polymorphisms in genes that code for the key enzymes of the cycle. Commonly, there are four genes in the cycle whose polymorphisms have been described in relation to PE. These factors could cause elevation of homocysteine; the toxic metabolite, which subsequently leads to the development of PE. Sufficient levels of folate have been considered important during pregnancy and may reduce the risk of development of PE. This review aims at discussing genetic polymorphisms and nutritional deficiencies as probable predisposing factors and suggests considering fetal genotypes, varied ethnicities, and interaction of various other factors involved to render better conclusiveness to the present studies

MTHFR A1298C polymorphism: a predictor of reduced risk of preeclampsia in Punjab, Pakistan

Objectives This study aimed to investigate the genetic association between MTHFR (A1298C) SNP and preeclampsia (PE) in Punjab, Pakistan. Methods A sample of 80 pregnant women (40 healthy pregnant women and 40 with PE) was pooled for genotyping MTHFR A1298C polymorphism by using the tetra-primer amplification refractory mutation system (ARMS) PCR. The Genotypic and allelic assessments were performed using various statistical techniques. Results The AC genotype and C allele of MTHFR A1298C were found to be associated with decreased risk of PE (odds ratio [OR]: 0.31, risk ratio [RR]: 0.58, p = 0.01), and (odds ratio [OR]: 0.49, risk ratio [RR]: 0.61, p = 0.04), respectively. Conclusion In conclusion, genetic polymorphism A1298C in MTHFR may pose a protective effect in the studied population

Comparison of carbamazepine alone and in combination with baclofen in trigeminal neuralgia

Introduction: Trigeminal neuralgia is a type of neuropathic facial pain that is characterized by unilateral paroxysmal pain that affects one or more trigeminal nerve divisions and is brought on by unimportant stimuli. People over the age of 40 are more likely to get it, and women are more frequently affected than males. Trigeminal neuralgia has been treated with a variety of drugs, including carbamazepine, oxcarbazepine, baclofen, lamotrigine, levetiracetam, gabapentin, sodium valproate, botulinum toxin-A injection, and surgical. OBJECTIVES: The current study's objective was to assess the efficacy of carbamazepine in treating trigeminal neuralgia in individuals both on its own and in combination with baclofen. METHODS: A randomized control trial was conductedat Khyber College of Dentistry and Peshawar Dental College among the patients of trigeminal neuralgia presenting to OPD. Total 60patients were randomly selected into two groups, each group had 30 patients.Carbamazepine was given to the Group A in the dose range of 300-600mg TDSwhereas, Carbamazepine 300mg TDS along with Baclofen in the dose range of 10-20 mg B.D was given to Group B. The two groups were given the drugs for a period of thirty days. The data was collected through a self-structuredquestionnaire

Roeder’s Knot: Solution to Intra-Corporeal Knot Tying

 Background: To evaluate the security and diversity of application of Roeder's knot. Methods: In this prospective study patients (n=771) undergoing laparoscopic surgery, along with application of Roeder's knot, were included. The formula for making the Roeder’s knot was (1:3:1) ‘one hitch, three winds and one locking hitch’. Loop was made around a post and then a simple knot was made. With the shorter end, three winds were made around both posts and were secured with the last half hitch. Excess length of the string was trimmed . Knot was held in the grasper and was slided down the trocar into the abdominal cavity. Once inside the abdominal cavity, the structure to be ligated, was placed through the loop. Free end of the string was passed thorough the eye of a knot pusher and knot pusher was slided through the trocar and knot was tightened. End of the knot was trimmed with scissors . For a structure that is not blind ended (eg. an artery or cystic duct), the thread was passed under the structure. Both ends were taken out, loop was tied in a similar manner and was then tightened with knot pusher. To tie the knot, over a suture, needle was brought outside and procedure was repeated.Results: Roeder’s knot was placed in a total of seven hundred and seventy one cases out of total 1883 procedures performed during the study period. The time to assemble the knot was 33 seconds. The time to place a pre-tied knot was two minutes three seconds. The time to assemble and place Roeder’s knot in laparoscopic appendectomies averaged about 2 minutes 36 seconds. It took an average of 3 minutes 40 seconds to assemble and place it in laparoscopic cholecystectomies. While time to place a traditional square knot intra-abdominally averaged about 4 minutes and 39 seconds. In all 771 cases where the Roeder’s knot was placed,an incidence of knot slippage or hematoma formation was not observed. Roeder’s knot was applied in all appendectomies, laparoscopic cholecystectomies in which cystic duct diameter was greater than clips and hernial sac not reduced completely. Conclusion: Roeder's knot is easy to assemble and place, secure and is a cost effective alternate to intra-corporeal suturing and staples during laparoscopic surgeries

A cross sectional study on the risk factors of gallbladder stone

Background: Gallstone diseases are one of the most common public health problems. Approximately 10%-20% of the national adult populations currently carry gallstones, and gallstone prevalence is rising. The purpose of the study was to find out association of gallstone with fatty liver, gender and age in Lahore, Pakistan.Methods: Ultrasonographically Hundred patients were scanned for liver type and gall stone. The data was analyzed by using SPSS version 17.0. Chi-Square statistics was used to check the association between the variables. The effect of age and gender was also statistically analysed.Results: One hundred patients were scanned between ages 21-60 years. Out of hundred 76% patients were female and 24% were male. In this study there were no stones in 37% cases and there were stones in 63% cases. Gallbladder stone found associated with age as p-value is found less than 5% level of significance, maximum patients were found in age ranges between 31-35 years, showing that risk of developing gallstone increases by age. Gallstone is gender specific, females are more victims of developing the stone than among males, and those who have fatty liver are more at risk of developing gallstone than those having normal liver.Conclusions: The study showed that ultrasound (US) is the most sensitive, specific, yet very practical and useful imaging test for the detection of gallstones with a high degree of confidence. Gallstones represent high prevalence disease in adult females more than males and it increases by age where as those who have fatty liver, they are more likely to develop gallstone

Synthesis and characterization of heavy metal-based hydroxyapatite for batch adsorption of turquoise blue dye: equilibrium, kinetic, and thermodynamic studies

In this study, different metal hydroxyapatite (HAP) nanoparticles were synthesized at a laboratory scale. All the methods used were very economical because all reagents used in this work were cheap and easily available in laboratories. The synthesized products were characterized by X-ray diffractometer (XRD), Brunauer–Emmett–Teller and Barrett–Joyner–Halenda, scanning electron microscopy, and Fourier transform infrared spectroscopy analysis to confirm the synthesis of respective products by ensuring the presence of phosphate and hydroxyl functional groups. These metal HAP nanoparticles were applied in water treatment applications as adsorbents for the elimination of turquoise blue dye from the aqueous solution. Batch experiments were performed, and all effective parameters were optimized. Their optimized values were as follows: pH = 8, dosage of adsorbent = 0.05 g, contact time = 75 min, temperature = 30 °C, and dye concentration = 75 ppm. The order of adsorption capacity of four different metal HAP products was determined as calcium-HAP (Ca-HAP) > lead-HAP (Pb-HAP) > strontium-HAP (Sr-HAP) > barium-HAP (Ba-HAP). Ca-HAP, Ba-HAP, Sr-HAP, and Pb-HAP have the highest concentration of 0.5 N, giving 54–69.29% desorption. Moreover, the effect of surfactants and electrolytes was also studied. Langmuir isotherm and pseudo-second-order kinetic model were best fitted for turquoise blue dye adsorption. The reaction was exothermic and spontaneous in nature. HIGHLIGHTS Synthesis of nano metal hydroxyapatite (HAP) by the wet precipitation method.; Applications of HAP as a useful material in turquoise blue dye adsorption.; The order of adsorption capacity of four different metal HAP products was determined as Ca-HAP > Pb-HAP > Sr-HAP > Ba-HAP.; The Langmuir model and pseudo-second-order kinetic model were best fitted.

Chemical synthesis of ZnO, CuO, MnO and FeO Nano adsorbent and their application in anionic reactive blue turquoise 71 dye (RB-71 dye) and real effluents remediation: Batch adsorption and column studies

Industrial dye production chemicals contribute significantly to environmental pollution. This study explores the use of nanotechnology, specifically nano fertilizers and adsorption technology, for efficient removal of synthetic anionic dyes and enhancing agricultural production. Nano adsorbents (MnO, FeO, ZnO, and CuO) were generated using the co-precipitation method. Optimal conditions for Manganese oxide (MnO) were pH 2 (33.2 mg/g), dosage 0.01 g/50 mL, and adsorption capacity 77.2 mg/g. FeO optimal conditions were pH 2 (21.5 mg/g), dosage 0.01 g/50 mL, and qe 40.5 mg/g. CuO optimal conditions were pH 2 (28.2 mg/g), dosage 0.01 g/50 mL, and qe 71.3 mg/g. ZnO optimal conditions were pH 2 (25.4 mg/g), dosage 0.01 g/50 mL, and qe 64.2 mg/g. Pseudo 1st order and Freundlich sorption isotherms were best-fit models. Endothermic reactions were observed, indicating the sorption process’s nature and feasibility. Electrolyte concentrations affected the sorption potential. Surfactants/detergents reduced sorption efficiency. 0.5 N NaOH proved most effective for desorption. In column studies, optimal conditions for acidic RB-71 dye sorption were 3 cm bed height, 1.8 mL/min flow rate, and 70 mg/L inlet dye concentration. Metal oxide showed exhibited crystal and polymorphs structure. FT-IR spectra depicted metal-oxide peaks between 400 and 899 cm−1. SEM micrograph reveals a spherical shape with an approximate size of 10–50 μm. The adsorption method’s novelty lies in its easy handling, eco-friendliness, and cost-effectiveness, making it a promising technology for practical-scale application in addressing dye pollution. Functionalization of the nano-adsorbent with other materials increases their surface area and subsequently, their uptake capacity. ZnO, CuO, MnO and FeO nanoparticles were synthesized using chemical co precipitation method. Efficient removal of anionic dye RB-71 dye. Adsorption process was well fitted to Freundlich isotherm, Pseudo-1st order kinetics and Intraparticle diffusion models. Desorption and reusability studies indicated excellent results and stability.</p