Outcome of Laproscopic Cholecystectomy in Acute Cholecystitis

Objective: To compare the outcome of early laparoscopic cholecystectomy in acute cholecytitis due to cholelithiasis as compared to interval cholecystectomy in terms of conversion rate, operative time and complications.Study design:  Descriptive studyPlace of study: Department of general surgery, Pakistan Atomic Energy Commission General Hospital, H-11/4 Islamabad.Duration of Study: January 2016 to June 2017.Methodology: Patients were divided into two groups. Group A had acute cholecystitis and were admitted through emergency room or surgical OPD and were operated in the same index admission on earliest possible list thus waiting time for surgery was one to four days approximately. While group B, had all elective cases, without any evidence of acute cholecystitis, mainly booked through OPD. All the patients included in both groups, were studied for initial diagnosis, duration of symptoms, duration of surgery, conversion to open cholecystectomy, per operative and post-operative complications and duration of hospital stay.Results: A total of 360 patients were operated in the hospital for cholelithiasis during the said period. Standard four ports were employed for the surgery. Group A (acute cholecystitis) had total 112 patients while group B (non-acute cholecystitis) had 248 patients. Of these 112 patients in group A, there were 77 males and 35 females.  In group B, there were 112 male and 248 female patients in group B. The mean operating time for group A was 64±13 min. whereas for group B the mean duration was 60± 12 min. The average amount of blood loss during surgery for group A was 45 ml ± 33 ml and for group B was 30ml + 20ml.Conclusion: Early laparoscopic Cholecystectomy, for acute cholecystitis is cost effective, has shorter total length of hospital stay and reduces the risk of repeat cholecystitis

Comparison of Effectiveness of Topical Versus Oral Nifedipine for Treatment of Chronic Anal Fissure

Objective: To compare the effectiveness of topical and oral Nifedipine in the treatment of chronic anal fissure.Patients and Methods: In this randomized control trial total of 124 patients with chronic anal fissure (CAF) were selected through OPD and divided randomly into two equal groups. In Group A the topical Nifedipine (2%) was applied, while in Group B the oral Nifedipine 10mg TDS was used. Both groups were compared in terms of pain and healing measured one month after starting treatment.Results: Mean age of the patients was 38.81±11.81 years. In both groups there was statistically significant difference for the age but no difference was found regarding gender and baseline visual analogue scale. Group A had better healing rate and pain relieve as compared to Group B. There was no difference between groups regarding the effectiveness of treatment.Conclusion: The topical Nifedipine has better healing effects as compared to the oral Nifedipine. The oral form is better in relieving pain after one month of treatment. There was no difference between oral and topical form in terms of overall effectiveness

Relationship of BMI and age with gallstone disease

Objective: To find out the relationship of BMI and age in patients with gallstone disease.  Methodology: This is a cross-sectional study done from March 2019 to February 2020 at the Department of General Surgery PIMS, Islamabad. All patients admitted with a diagnosis of Cholelithiasis were included and patients with previous abdominal surgery were excluded from the study. Patients’ data was collected about their age, sex, dietary habits, occupation and medical history. Their weight in kilograms and heights in centimeters were measured and BMI was calculated in kg/cm2. All data was collected, recorded and analyzed using SPSS 22. Results: A total of 158 patients were included in the study with mean age was 46.2±6.7 years (18 - 83 years). Majority (63%) of the patients were between 41 and 60 age group. There were 120 females and 38 males with ratio of 3:1. The mean BMI of the study population was 25.8 ± 7.61 (Range 19.37 - 33.12). Most of the patients were healthy (n=86, 54.4%) having their BMIs between 18 and 24.9 whereas 72 (46.6%) patients were overweight and obese. Conclusion: Increased frequency of cholelithiasis is found with increasing age even with normal BMI

Human papillomavirus and human cytomegalovirus infection and association with prognosis in patients with primary glioblastoma in Pakistan

Objective: Glioblastoma multiforme (GBM) is the most common adult primary brain tumor. Human cytomegalovirus (HCMV) has been studied for the past decade, and conflicting results have been reported with no conclusive role established yet. Human papillomavirus (HPV) is involved in the pathogenesis of many cancers and has a high prevalence in patients with cervical and oral cancer in Pakistan. The objective of our study was to identify the prevalence of HCMV and HPV in Pakistani patients with primary GBM.Methods: In total, 112 primary GBM biopsies were analyzed. HCMV and HPV infection was investigated using nested and conventional polymerase chain reaction, respectively. Positive HPV samples were further confirmed through sequencing. HPV status was correlated with histology and expression of other frequently mutated GBM molecular markers.Results: Our study comprised of 68% male and 32% female patients. HCMV was detected in only 1 patient whereas HPV infection was present in 28% of patients with no cases of HPV and HCMV coinfection. We report for the first time that a majority of HPV-positive patients with GBM harbored types 16 and 18 both. Among them, 16% were HPV-type 16 and 20% were HPV-type 18. Patients infected with HPV had longer survival times, but this was not statistically significant. The most commonly overexpressed molecular marker in HPV-positive patients was cyclo-oxygenase-2, and no histologic changes were seen in HPV-positive GBM cases.Conclusions: The presence of a single HCMV positive is intriguing. In addition, we discovered a substantially high 28% prevalence of HPV in GBM patients. The role of viruses in gliomagenesis warrants further investigation

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Outcome of Laproscopic Cholecystectomy in Acute Cholecystitis

Objective: To compare the outcome of early laparoscopic cholecystectomy in acute cholecytitis due to cholelithiasis as compared to interval cholecystectomy in terms of conversion rate, operative time and complications.Study design:  Descriptive studyPlace of study: Department of general surgery, Pakistan Atomic Energy Commission General Hospital, H-11/4 Islamabad.Duration of Study: January 2016 to June 2017.Methodology: Patients were divided into two groups. Group A had acute cholecystitis and were admitted through emergency room or surgical OPD and were operated in the same index admission on earliest possible list thus waiting time for surgery was one to four days approximately. While group B, had all elective cases, without any evidence of acute cholecystitis, mainly booked through OPD. All the patients included in both groups, were studied for initial diagnosis, duration of symptoms, duration of surgery, conversion to open cholecystectomy, per operative and post-operative complications and duration of hospital stay.Results: A total of 360 patients were operated in the hospital for cholelithiasis during the said period. Standard four ports were employed for the surgery. Group A (acute cholecystitis) had total 112 patients while group B (non-acute cholecystitis) had 248 patients. Of these 112 patients in group A, there were 77 males and 35 females.  In group B, there were 112 male and 248 female patients in group B. The mean operating time for group A was 64±13 min. whereas for group B the mean duration was 60± 12 min. The average amount of blood loss during surgery for group A was 45 ml ± 33 ml and for group B was 30ml + 20ml.Conclusion: Early laparoscopic Cholecystectomy, for acute cholecystitis is cost effective, has shorter total length of hospital stay and reduces the risk of repeat cholecystitis

Modern Stylometry: A Review & Experimentation with Machine Learning

The problem of authorship attribution has applications from literary studies (such as the great Shakespeare/Marlowe debates) to counter-intelligence. The field of stylometry aims to offer quantitative results for authorship attribution. In this paper, we present a combination of stylometric techniques using machine learning. An implementation of the system is used to analyse chat logs and attempts to construct a stylometric model for users within the presented chat system. This allows for the authorship attribution of other works they may write under different names or within different communication systems. This implementation demonstrates accuracy of up to 84 % across the dataset, a full 34 % increase against a random-choice control baseline

Analyzing the Effect of Squeeze Casting Process Parameters on Mechanical Properties of Overcast Al-Alloy Joint using RSM

This study contains, the overcast 2024-2024 wrought aluminium alloy joints produced by casting liquid 2024 wrought aluminium alloy onto the solid 2024 wrought aluminium alloy inserts using squeeze casting process. The quality of overcast joints fabricated via squeeze casting depend on mechanical properties such as ultimate tensile strength and yield strength. Mechanical properties depends upon the input casting parameters named as squeeze pressure, pressure duration and melt temperature. Response surface methodology (RSM) was employed to analyze the effect of above mentioned input parameters on UTS and YS. Empirical models for UTS and YS were developed which help the practitioners to achieve desired UTS and YS by using optimum vales of input parameters. ANOVA results shows that melt temperature has most significant effect on UTS and YS followed by squeeze pressure and pressure duration. Current study will provide efficacious approach to develop advance functional and structural materials

An Immunoinformatics Approach to Design a Potent Multi-Epitope Vaccine against Asia-1 Genotype of Crimean–Congo Haemorrhagic Fever Virus Using the Structural Glycoproteins as a Target

Crimean–Congo haemorrhagic fever (CCHF), caused by Crimean–Congo haemorrhagic fever virus (CCHFV), is a disease of worldwide importance (endemic yet not limited to Asia, Middle East, and Africa) and has triggered several outbreaks amounting to a case fatality rate of 10–40% as per the World Health Organization. Genetic diversity and phylogenetic data revealed that the Asia-1 genotype of CCHFV remained dominant in Pakistan, where 688 confirmed cases were reported between the 2012–2022 period. Currently, no approved vaccine is available to tackle the viral infection. Epitope-based vaccine design has gained significant attention in recent years due to its safety, timeliness, and cost efficiency compared to conventional vaccines. In the present study, we employed a robust immunoinformatics-based approach targeting the structural glycoproteins G1 and G2 of CCHFV (Asia-1 genotype) to design a multi-epitope vaccine construct. Five B-cells and six cytotoxic T-lymphocytes (CTL) epitopes were mapped and finalized from G1 and G2 and were fused with suitable linkers (EAAAK, GGGS, AAY, and GPGPG), a PADRE sequence (13 aa), and an adjuvant (50S ribosomal protein L7/L12) to formulate a chimeric vaccine construct. The selected CTL epitopes showed high affinity and stable binding with the binding groove of common human HLA class I molecules (HLA-A*02:01 and HLA-B*44:02) and mouse major histocompatibility complex class I molecules. The chimeric vaccine was predicted to be an antigenic, non-allergenic, and soluble molecule with a suitable physicochemical profile. Molecular docking and molecular dynamics simulation indicated a stable and energetically favourable interaction between the constructed antigen and Toll-like receptors (TLR2, TLR3, and TLR4). Our results demonstrated that innate, adaptive, and humoral immune responses could be elicited upon administration of such a potent muti-epitope vaccine construct. These results could be helpful for an experimental vaccinologist to develop an effective vaccine against the Asia-1 genotype of CCHFV