A comprehensive review of the classification of fibromyalgia, its possible genetic and environmental causes, and its epidemiology in Pakistan

Fibromyalgia (FM) is a common form of chronic pain that causes pain all over the body. It is thought to affect between 1% and 5% of the world's people. It happens more often in adults, but it can also happen in children. Its exact cause and effect are still not known. However, it is thought to be linked to neuronal over-sensitization, decreased conditioned pain modulation (CPM), cognitive dysfunction, dementia, and problems with how the brain processes information. It is now a disorder with physical symptoms (SSD). FM does not run in families. But it seems to happen more often in families where FM has happened before. One of the most common reasons why people get fibromyalgia is an SNP in the serotonin transporter gene, which can also cause emotional stress. The effects of genetic polymorphisms on serotonergic and catecholaminergic processes in the central nervous system seem to make fibromyalgia more likely. It can be stopped if it is found and treated quickly. Physical therapy and other treatments that don't involve drugs should be made to fit the person with FM. The Food and Drug Administration (FDA) has given the go-ahead for three treatments. In this review article, we looked again at the possible causes, effects, and treatments for fibromyalgia syndrome. &nbsp

The Experience of International Students and Institutional Recommendations: A Comparison Between the Students From the Developing and Developed Regions

Prior studies on the experiences of international students in China have mostly focused on their academic, sociocultural, and accommodation experiences. Hence, student health and safety, discrimination, and the services by the International Student Office (ISO) have remained unexplored. Moreover, due to the motivational differences between the students from developing and developed regions, a study that samples students from both regions may depict an exact picture of the experience of international students. Therefore, the objective of this study is to examine the influence of the dimensions (including those dimensions that have been ignored) of the experience of international students on their satisfaction. In addition, we make recommendations regarding Chinese institutes for future students based on a comparison between the students from developing and developed regions. Using hierarchical regression analysis, this study reveals that educational and non-educational experiences vary among students from different regions. Therefore, based on developing (e.g., Asia and Africa) and developed (e.g., America, Europe, and Australia) regions, important recommendations are discussed regarding how educational institutions and the Chinese government could best allocate resources and introduce policies to improve the experience of international students

Silver(I) triflate-catalyzed protocol for the post-ugi synthesis of spiroindolines

A silver(I) triflate-catalyzed protocol for the post-Ugi synthesis of tetracyclic spiroindolines has been developed. The protocol worked best for indole-3-carbaldehyde-derived Ugi adducts obtained using anilines and 3-aryl propiolic acids. Thus, it is complementary to the previous cationic gold-catalyzed procedure that was developed for analogues Ugi substrates derived from aliphatic amines and 3-alkyl propiolic acids. Furthermore, we have demonstrated that under our new settings this domino Friedel-Crafts ipso cyclization / imine trapping process could be efficiently combined with the preceding four-component Ugi reaction into a two-step one-pot transformation

Clinical features, pathological outcomes and management of internal rectal prolapse-combined retro-prospective observational study

Background: Internal rectal prolapse probably represents the first stage of a progressive anomaly that eventually leads to full thickness external prolapse. Non-surgical treatment modalities like dietary advice and feedback therapy should be used before doing any surgical intervention in such cases. This study focuses on clinical features, pathological outcomes and treatment modalities of internal rectal prolapse.Methods: The study is a combined prospective (from Aug. 2018 to Aug. 2020) and retrospective (from Aug. 2015 to Aug. 2018) conducted at Sher-I-Kashmir institute of medical sciences, Soura, SrinagarResults: A total of 79 patients were studied out of which 39 were retrospective and 40 were prospective. Internal rectal prolapse is usually missed by surgeons as a cause of obstructed defecation syndrome. So, it was worthwhile to study this entity in our patients.Conclusions: Before choosing any treatment strategy for internal rectal prolapse, conservative trial with dietary modification and feedback therapy should be attempted

Effectiveness of Vitamin D in Prevention of Dengue Haemorrhagic Fever and Dengue Shock Syndrome

Background: To compare the risk and severity of development of Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome(DSS) in patients receiving Vitamin D supplement compared to those not receiving it.Methods: Diagnosed patients of DF (n=124) were enrolled in this comparative study. Patients were randomized into two groups having 62 participants in each group. Group A received single dose of 200,000 IU Vitamin D and Group B received no intervention. Both groups were followed for development of DHF or DSS. Chi square was applied to compare the groups.Results: One patient (1.6%) in Group A developed DHF. Seventeen (27%) patients in Group B progressed to DHF. The relationship between Vitamin D and progression to DHF was significant, X2 (2, N=170) =16.43, p= 0.000). The calculated relative risk was 0.0588 (95% confidence interval, .0081 to .4285; p for trend = 0.0588).Conclusion: Vitamin D decreases the risk of DHF and may have a role in management of dengue fever

Self-care Practices of Type 2 Diabetes Patients by Socio-demographic and Clinical Factors: An Ordered Probit Model

Background: Diabetes prevalence has risen more rapidly in middle- and low-income countries and has emerged as the seventh highest cause of death in such countries. Socio-demographics, patient knowledge and clinical factors, such as family history of diabetes, have a vital effect on the disease outcomes. This study assessed self-care practices among patients with type 2 diabetes to determine the probability of self-care by predictor variables, including socio-economic and clinical factors, and quantify the marginal effects of these independent variables on different self-care practices among diabetic patients. Methods: This exploratory study collected data from 200 type 2 diabetes patients at a branch of private pharmacy in Pakistan using a convenient sampling technique and a semi-structured questionnaire. An ordered probit regression model was used to analyze the different self-care practices among diabetic patients. With self-practices ordered in four classes from poor to good, the marginal effects of each socio-economic and clinical factors were also calculated on the likelihood of aforesaid self-care practices among diabetic patients. Results: Results showed that the relationships of household income, patient’s choice of private or public hospital for treatment, and patient’s weight with self-care probability were statistically significant. These socio-demographics and clinical indicators significantly influenced each category of self-care practices. Conclusion: Socio-demographic and clinical factors played a decisive role in the healthcare practices among type-2 diabetes patients. Monthly household income, patient’s choice of private or public hospital for treatment, and patient’s weight influenced different levels of self-care practices. Income had a negative contribution in poor and fair self-care levels of practices, whereas it had a positive role in average and good self-care levels of practices. Keywords: type 2 diabetes; self-care practices; socio-economic factors; developing countr

Multi-modality detection of SARS-CoV-2 in faecal donor samples for transplantation and in asymptomatic emergency surgical admissions

Background: Faecal transplantation is an evidence-based treatment for Clostridioides difficile. Patients infected with SARS-CoV-2 have been shown to shed the virus in stool for up to 33 days, well beyond the average clearance time for upper respiratory tract shedding. We carried out an analytical and clinical validation of reverse-transcriptase quantitative (RT-qPCR) as well as LAMP, LamPORE and droplet digital PCR in the detection of SARS-CoV-2 RNA in stool from donated samples for faecal microbiota transplantation (FMT), spiked samples and asymptomatic inpatients in an acute surgical unit.  Methods: Killed SARS-CoV-2 viral lysate and extracted RNA was spiked into donor stool & FMT and a linear dilution series from 10-1 to 10-5 and tested via RT-qPCR, LAMP, LamPORE and ddPCR against SARS-CoV-2. Patients admitted to the critical care unit with symptomatic SARS-CoV-2 and sequential asymptomatic patients from acute presentation to an acute surgical unit were also tested. Results: In a linear dilution series, detection of the lowest dilution series was found to be 8 copies per microlitre of sample. Spiked lysate samples down to 10-2 dilution were detected in FMT samples using RTQPCR, LamPORE and ddPCR and down to 10-1 with LAMP. In symptomatic patients 5/12 had detectable SARS-CoV-2 in stool via RT-qPCR and 6/12 via LamPORE, and in 1/97 asymptomatic patients via RT-qPCR. Conclusion: RT-qPCR can be detected in FMT donor samples using RT-qPCR, LamPORE and ddPCR to low levels using validated pathways. As previously demonstrated, nearly half of symptomatic and less than one percent of asymptomatic patients had detectable SARS-CoV-2 in stool

Extrapulmonary tuberculosis in Pakistan- A nation-wide multicenter retrospective study

Background Pakistan is fifth among high burden countries for tuberculosis. A steady increase is seen in extrapulmonary tuberculosis (EPTB), which now accounts for 20% of all notified TB cases. There is very limited information on the epidemiology of EPTB. This study was performed with the aim to describe the demographic characteristics, clinical manifestations and treatment outcomes of EPTB patients in Pakistan. Method We performed descriptive analysis on routinely collected data for cohorts of TB patients registered nationwide in 2016 at health facilities selected using stratified convenient sampling. Findings Altogether 54092 TB including 15790 (29.2%) EPTB cases were registered in 2016 at 50 study sites. The median age was 24 years for EPTB and 30 years for PTB patients. The crude prevalence of EPTB in females was 30.5% (95%CI; 29.9–31.0) compared to 27.9% (95%CI; 27.3–28.4) in males. The likelihood of having EPTB (OR), was 1.1 times greater for females, 2.0 times for children, and 3.3 times for residents of provinces in the North-West. The most common forms of EPTB were pleural (29.6%), lymphatic (22.7%) and abdominal TB (21.0%). Pleural TB was the most common clinical manifestation in adults (34.2%) and abdominal TB in children (38.4%). An increase in the prevalence of pleural and osteoarticular and decline in lymphatic and abdominal TB was observed with advancing age. Diversity in demography and clinical manifestations were noted between provinces. The treatment success rate for all type EPTB was significantly high compared to bacteriology confirmed PTB with the exception of EPTB affecting CNS with a high mortality rate. Conclusions The study provides an insight into demography, clinical manifestations and treatment outcomes of EPTB. Further studies are needed to explain significant diversities observed between provinces, specific risk factors and challenges concerning EPTB management.publishedVersio

General practitioner\u27s knowledge regarding the diagnosis and drug therapy for acute myocardial infarction

OBJECTIVE: To assess the general practitioners (GP) knowledge regarding the diagnosis and initial drug therapy for acute myocardial infarction (AMI). METHODS: A questionnaire-based survey was conducted in randomly selected GPs of Karachi. Doctors working in community as GPs who were registered medical practitioners having a Bachelor of Medicine & Bachelor of Surgery degree were included in the study. Doctors working at tertiary care facilities or having a post graduate degree or post graduate training in a specialty other than family medicine were excluded from the study. RESULTS: A total of 186 GPs participated in our study. GPs who studied research journals were 2.33 times more likely to investigate serum cardiac troponins levels for the diagnosis of AMI compared to those who did not study research journals (P = 0.02). Twenty six percent of the GPs said that they would refer a patient with suspected AMI without treatment, while 76% said that they would consider some treatment prior to referral. Fifty eight percent of the GPs identified ST segment elevation myocardial infarction (STEMI) of \u3c 12 hours duration as an indication of thrombolysis while 28% identified posterior wall AMI as a thrombolytic indication. CONCLUSION: GPs, although adequately aware of the presenting features of AMI, were lacking in knowledge regarding the means for confirmation of diagnosis, initial drug therapy and were less likely to carry management steps in their practice

Mixed microalgae consortia growth under higher concentration of CO2 from unfiltered coal fired flue gas: Fatty acid profiling and biodiesel production

Biodiesel is produced by transesterification of fatty acid methyl esters (FAME) from oleaginous microalgae feedstock. Biodiesel fuel properties were studied and compared with biodiesel standards. Qualitative analysis of FAME was done while cultivating mixed microalgae consortia under three concentrations of coal fired flue gas (1%, 3.0% and 5.5% CO2). Under 1% CO2 concentration (flue gas), the FAME content was 280.3 μg/mL, whereas the lipid content was 14.03 μg/mL/D (day). Both FAMEs and lipid contents were low at other CO2 concentrations (3.0 and 5.5%). However, mixed consortia in the presence of phosphate buffer and flue gas (PB + FG) showed higher saturated fatty acids (SFA) (36.28%) and unsaturated fatty acids (UFA) (63.72%) versus 5.5% CO2 concentration, which might be responsible for oxidative stability of biodiesel. Subsequently, higher cetane number (52) and low iodine value (136.3 gI2/100 g) biodiesel produced from mixed consortia (PB + FG) under 5.5% CO2 along with 50 mM phosphate buffer were found in accordance with European (EN 14214) standard. Results revealed that phosphate buffer significantly enhanced the biodiesel quality, but reduced the FAME yield. This study intended to develop an integrated approach for significant improvement in biodiesel quality under surplus phosphorus by utilizing waste flue gas (as CO2 source) using microalgae. The CO2 sequestration from industrial flue gas not only reduced greenhouse gases, but may also ensure the sustainable and eco-benign production of biodiesel