Electrocardiogram (EKG) knowledge and interpretation proficiency among healthcare professionals in Pakistan: a prospective cross-sectional study.

Background: Electrocardiogram (EKG) is a commonly used diagnostic tool for the evaluation of the electrical activity of the heart. The purpose of this study was to assess the knowledge and interpretation proficiency of EKG among healthcare professionals (HCPs) in Pakistan. Methods: This prospective cross-sectional study was conducted among HCPs working in different healthcare settings. A structured questionnaire was used to assess the participants' theoretical knowledge and ability to interpret EKG findings. The data were analyzed using descriptive statistics and χ2 tests. The study indicates that EKG knowledge and interpretation proficiency among HCPs in Pakistan is unsatisfactory. The inadequacy of training periods of EKG training sessions and insufficient participation of HCPs in offered training opportunities put forward the need for the formation and introduction of better structured and efficient EKG training programmes. Results: A total of 511 HCPs participated in the study, 28% of whom reportedly had received formal training for EKG interpretation. About 80% of the participants correctly identified theoretical questions pertaining to EKG, while 58% of the participants were able to accurately interpret EKG findings, and most HCPs (69.9%) read fewer than ten EKGs per week. Conclusion: This study demonstrates a lack of expertise and a poor understanding of EKG in HCPs of Pakistan. The low level of EKG knowledge and interpretation proficiency among HCPs may lead to diagnostic errors and poor patient outcomes. Therefore, efforts should be made to improve EKG education and training among HCPs in Pakistan.

Assessment of cell death in the liver of Labeo rohita on exposure to an emerging contaminant aspirin: an immunofluorescent, flow cytometric and biochemical investigation.

Aspirin is one of the most frequently detected non-steroidal anti-inflammatory drugs in aquatic environments. Despite its prevalence, toxicity possessed by aspirin to non-target organisms like fish is poorly explored. In the present study, cell death induced by different concentrations of aspirin (1, 10, and 100 µg/L) has been investigated in the liver of fish, Labeo rohita exposed for 28 days. A significant increase (p < 0.05) in the density of caspase-3 positive cells in a dose and duration-dependent manner assessed through immunofluorescent staining indicates caspase-dependent pathway of cell death which may be either through intrinsic or extrinsic pathway. The flow cytometric analysis, in addition, revealed a significant (p < 0.05) decline in the live cells and an increase in apoptotic cells in the liver of fish exposed to aspirin. Cell death due to apoptosis is further indicated by a significant increase (p < 0.05) in the Kupffer cells and tumor necrosis factor-α. The decrease in the activity of cyclooxygenase (COX) enzyme significantly (p < 0.05) in all three exposure concentrations of aspirin suggests COX-dependent pathway of cell death. The present study provides in-depth insights into aspirin-induced cell death in the liver of fish at environmentally realistic concentrations.

Applications, limitations and advancements of ultra-low-field magnetic resonance imaging: A scoping review.

Background: Ultra-low-field magnetic resonance imaging (ULF-MRI) has emerged as an alternative with several portable clinical applications. This review aims to comprehensively explore its applications, potential limitations, technological advancements, and expert recommendations. Methods: A review of the literature was conducted across medical databases to identify relevant studies. Articles on clinical usage of ULF-MRI were included, and data regarding applications, limitations, and advancements were extracted. A total of 25 articles were included for qualitative analysis. Results: The review reveals ULF-MRI efficacy in intensive care settings and intraoperatively. Technological strides are evident through innovative reconstruction techniques and integration with machine learning approaches. Additional advantages include features such as portability, cost-effectiveness, reduced power requirements, and improved patient comfort. However, alongside these strengths, certain limitations of ULF-MRI were identified, including low signal-to-noise ratio, limited resolution and length of scanning sequences, as well as variety and absence of regulatory-approved contrast-enhanced imaging. Recommendations from experts emphasize optimizing imaging quality, including addressing signal-to-noise ratio (SNR) and resolution, decreasing the length of scan time, and expanding point-of-care magnetic resonance imaging availability. Conclusion: This review summarizes the potential of ULF-MRI. The technology's adaptability in intensive care unit settings and its diverse clinical and surgical applications, while accounting for SNR and resolution limitations, highlight its significance, especially in resource-limited settings. Technological advancements, alongside expert recommendations, pave the way for refining and expanding ULF-MRI's utility. However, adequate training is crucial for widespread utilization.

Impact of Microplastics on Pregnancy and Fetal Development: A Systematic Review.

Microplastic (MP) pollution is a growing global concern because of its potential to impair human health, particularly with regard to fetal development. However, the origins of prenatal MP exposure and its effects on fetal development have not been well studied. This study aimed to provide a systematic review of the literature regarding the impact of microplastics on pregnancy and fetal development. PubMed, Embase, ScienceDirect, Web of Science, Scopus, and Google Scholar were searched from 2010 until March 2024. Original publications exploring the impact of microplastics on pregnancy and fetal development were included in the study. After selecting papers, two independent reviewers extracted data regarding study characteristics, microplastics identified, and reproductive impacts. The quality of studies was assessed using the Critical Appraisal Checklists for Studies created by the Joanna Briggs Institute (JBI). Twelve studies, including 234 subjects, were selected from a total of 2,809 citations for the final qualitative analysis. Articles were published between 2021 and 2024, and most were conducted in China. The results of the included studies confirmed the existence of microplastics with varying sizes (2.1 to 100 micrometers) in the placenta and the fetal body. Studies revealed correlations between lifestyle choices and the presence of microplastics in the placenta. They also reported correlations between the level of microplastics and diminished microbiome diversity, reduced birthweights, affected gestational age, and fetal growth and development. Microplastics may be detrimental to a developing fetus during pregnancy. Nonetheless, more thorough research is required to comprehend the impact of microplastic exposure on pregnancy and fetal development.

Assessment of triclosan induced histopathological and biochemical alterations, and molecular docking simulation analysis of acetylcholinesterase enzyme in the gills of fish, Cyprinus carpio.

Triclosan (TCS), an antimicrobial additive in various personal and health care products, has been widely detected in aquatic environment around the world. The present study investigated the impacts of TCS in the gills of the fish, Cyprinus carpio employing histopathological, biochemical, molecular docking and simulation analysis. The 96 h LC50 value of TCS in C. carpio was found to be 0.968 mg/L. Fish were exposed to 1/1000th (1 µg/L), 1/100th (10 µg/L), and 1/10th (100 µg/L) of 96 h LC50 value for a period of 28 days. The histopathological alterations observed in the gills were hypertrophy, hyperplasia, edematous swellings, and fusion of secondary lamellae in TCS exposed groups. The severity of these alterations increased with both the concentration as well as the duration of exposure. The present study revealed that the activity of antioxidant enzymes such as superoxide dismutase, catalase, glutathione-S-transferase, glutathione reductase, glutathione peroxidase, and reduced glutathione content decreased significantly (p < 0.05) in both concentration and duration dependent manner. However, a significant (p < 0.05) increase in the activity of the metabolic enzymes such as acid phosphatase and alkaline phosphatase was observed in all three exposure concentrations of TCS from 7 to 28 days. The activity of acetylcholinesterase declined significantly (p < 0.05) from 7 to 28 days whereas the content of acetylcholine increased significantly at the end of 28 day. The experimental results were further confirmed by molecular docking and simulation analysis that showed strong binding of TCS with acetylcholinesterase enzyme. The study revealed that long-term exposure to sublethal concentrations of TCS can lead to severe physiological and histopathological alterations in the fish.

Digital eye strain and its associated factors among radiology physicians in Pakistan: a cross-sectional survey using logistic regression analysis.

Background and aims: Increased use of digital devices in the modern era has led to the development of digital eye strain (DES) or computer vision syndrome in their users. This can result in the development of various ocular and visual symptoms among them. In this study, the authors aimed to view the prevalence of digital eye strain among radiology physicians in Pakistan and their associated risk factors. Materials and methods: A cross-sectional study was conducted to evaluate occupational DES among radiology physicians in Pakistan. The data collection was done using the convenience sampling technique, and the data were analyzed using IBM SPSS for Windows, Version 25.0. Results: Out of the 247 respondents, 33.6% were males and 66.4% were females. 41.7% of them were between 30 and 40 years of age and 51.8% of them were radiology residents. 52.2% of the participants had a refractive error and were using a corrective lens. The majority of the radiologists in our study (84.2%) preferred picture archiving and communication system (PACS) over films and 82.2% of them reported having breaks of less than 15 min. Major symptoms reported by the participants were tired or heavy eyes (69.6%) and headache (69.3%). The proportion of developing DES was higher in females [P=0.001, adjusted odds ratio (aOR)=2.94], radiology residents (P=0.031, aOR=3.29), and working hours of more than 4 h per day (P<0.001, aOR=0.04). Conclusion: With recent advances in the field of radiology in Pakistan, the frequency of developing DES among radiologists is increasing. Being a female, having long working hours, and having noticeable flickers on the digital screens were among the significant factors in developing DES among radiologists.

The interplay between diabetes and non-alcoholic fatty liver disease: a cross-sectional study from Pakistan.

Background and objectives: Non-alcoholic fatty liver disease (NAFLD) is characterized by ectopic deposition of fat in the liver, in the absence of other secondary causes of fat buildup. The relationship between NAFLD, including alanine aminotransferase (ALT), and glycated haemoglobin (HbA1c), is important for predicting the severity of disease and prognosis. This study aims to investigate the association of HbA1c in type 2 diabetes mellitus (T2DM) patients with NAFLD via measuring the ALT levels. Materials and methods: This retrospective cross-sectional study enroled 130 patients with T2DM and NAFLD. The association between levels of HbA1c and ALT in patients of NAFLD with controlled and uncontrolled T2DM, respectively, was investigated. Stratification was done based on gender and diabetic control, using HbA1c levels as a marker of glycemic control. Serum ALT levels were also compared in both groups. Results: The mean age of the participants was 50.2±5.7 years. The total participants were 130, of which 77 (59.3%) were females and 53 (40.7%) were males. The numbers of patients having uncontrolled T2DM (HbA1c>7%), and controlled T2DM (HbA1c <7%) were 78 (60%) and 52 (40%), respectively. Moreover, 46 (35.3%) females and 32 (24.7%) males had uncontrolled T2DM, and 31 (23.8%) females and 21 (16.2%) males had controlled T2DM. The mean ALT level for uncontrolled and controlled T2DM in female patients was found to be 24.6±3.4 and 13.5±2.4, respectively, (P <0.05). For male patients, it was found to be 54.0±4.9 and 29.1±5.4, respectively (P=0.008). Conclusion: There is a positive association between elevated HbA1c and ALT levels in T2DM patients with NAFLD.

Diabetes mellitus: Is Pakistan the epicenter of the next pandemic?

Estimated age-adjusted comparative diabetes prevalence in adults (20-79 years) in Pakistan from the year 2011 to 2021.

An Investigation of Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention: A Cross-Sectional Study From Pakistan.

Background and objective Contrast-induced acute kidney injury (CIAKI) is a complication observed among individuals undergoing primary percutaneous coronary intervention (PCI) and is associated with high morbidity and mortality rates. It is characterized by an elevation in serum creatinine (SCr) levels >0.5 mg/dl or a 50% relative increase in SCr from the baseline value following exposure to contrast within a 48- to 72-hour timeframe, in the absence of any alternative causes for acute kidney injury (AKI). This study aimed to assess the incidence of CIAKI in patients following PCI. Methods This prospective study was conducted from July to December 2022, after obtaining ethical approval from the institutional ethics committee (reference no: 147/LRH/MTI). A total of 159 consecutive patients who met the selection criteria were enrolled. A detailed patient and family history was obtained, and a thorough physical examination was conducted. Baseline tests, including SCr, were performed, with SCr repeated 72 hours post-PCI. All investigations were performed in the affiliated hospital's main laboratory and conducted by the same biochemist. Results The study included 159 patients presenting with myocardial infarction, angina pectoris, or ischemic features on EKG, exercise tolerance test (ETT), or echocardiogram and underwent PCI. The patients had a mean age of 51 ± 9 years, baseline SCr of 0.77 ± 0.41 mg/dl, SCr 72 hours post-procedure of 0.83 ± 0.41 mg/dl, and an average contrast volume of 128.6 ± 63 ml; 87 (55%) patients were male, and 72 (45%) were female. CIAKI was observed in 15 (9.4%) patients. Hypertension and diabetes mellitus were the most prevalent comorbidities. Male gender, diabetes mellitus, and hypertension had a clinically significant association with the development of CIAKI (p<0.05). ST-elevation myocardial infarction (STEMI) was the predominant clinical presentation in 81 (50.9%) cases. Conclusions This study examines the frequency, risk factors, and associations of CIAKI following PCI at a tertiary care hospital in a low-middle-income country. We believe our findings provide future directions for identifying and minimizing the risk of CIAKI in this patient population.

Molecular Targets of Valeric Acid: A Bioactive Natural Product for Endocrine, Metabolic, and Immunological Disorders.

BACKGROUNDS: Postbiotics produced by gut microbiota have exhibited diverse pharmacological activities. Valeric acid, a postbiotic material produced by gut microbiota and some plant species like valerian, has been explored to have diverse pharmacological activities. METHODS: This narrative review aims to summarise the beneficial role of valeric acid for different health conditions along with its underlying mechanism. In order to get ample scientific evidence, various databases like Science Direct, PubMed, Scopus, Google Scholar and Google were exhaustively explored to collect relevant information. Collected data were arranged and analyzed to reach a meaningful conclusion regarding the bioactivity profiling of valeric acid, its mechanism, and future prospects. RESULTS: Valeric acid belongs to short-chain fatty acids (SCFAs) compounds like acetate, propionate, butyrate, pentanoic (valeric) acid, and hexanoic (caproic) acid. Valeric acid has been identified as one of the potent histone deacetylase (HDAC) inhibitors. In different preclinical in -vitro and in-vivo studies, valeric acid has been found to have anti-cancer, anti-diabetic, antihypertensive, anti-inflammatory, and immunomodulatory activity and affects molecular pathways of different diseases like Alzheimer's, Parkinson's, and epilepsy. CONCLUSION: These findings highlight the role of valeric acid as a potential novel therapeutic agent for endocrine, metabolic and immunity-related health conditions, and it must be tested under clinical conditions to develop as a promising drug.

Brain herniation and subsequent complications following partial resection of high-grade glioma: A case report.

Key Clinical Message: This case highlights the need for tailored strategies to address issues like brain herniation, subdural hygroma, and cerebrospinal fluid leak, which, if not managed promptly, can lead to long-term neurological deficits. Additionally, the role of specialized facilities in delivering highly specialized care for managing such intricate cases cannot be understated. Abstract: Decompressive craniectomy-induced subdural hygroma (SDH) frequently coexists with external cerebral herniation, resulting in neurological impairments. The incidence of brain herniation through a craniectomy defect postoperatively is 25%. Brain herniation (BH), SDH, and cerebrospinal fluid leak require urgent neurosurgical management as they can lead to irreversible long-term neurological deficits. We report a case of a 42-year-old male who presented with headache and grand mal seizures. He was diagnosed with herniation of brain parenchyma through the surgical defect with a displacement of the bone flap by a heterogeneously enhancing lesion in the left parietal lobe along with SDH in the left frontoparietal region post partial resection of high-grade glioma. In this report, we discuss the pathogenesis and management strategies of brain herniation, wound infection, cerebrospinal fluid (CSF) leak, ipsilateral SDH, floating bone flap, and communicating hydrocephalus in an adult patient following partial resection of high-grade glioma. This particular case emphasizes the value of an individualized patient-centered surgical approach to minimize the risk of postoperative complications.

Cardiac contractility modulation: A new horizon in the management of heart failure with preserved ejection fraction (HFpEF).

Cardiac contractility modulation (CCM) is a new therapy that has shown promising results in heart failure with preserved ejection fraction (HFpEF) management. This therapy involves the use of a device that delivers electrical signals to the heart during the refractory period, enhancing cardiac contractility without changing heart rate or rhythm. This short article explores the potential of CCM as a new horizon in the management of HFpEF, highlighting its mechanism of action, clinical trials, and future directions for research. Overall, CCM has emerged as a promising therapy for improving the outcomes of patients with HFpEF and provides hope for the development of more effective treatments in the future.

Alterations in certain immunological parameters in the skin mucus of the carp, Cirrhinus mrigala, infected with the bacteria, Edwardsiella tarda.

The bacterial fish pathogen Edwardsiella tarda causes heavy stock mortality, severely hampering fish production, resulting in great economic loss to the farming industry. The first biological barriers that confer immune protection against pathogen entry are the fish mucosal surfaces. The present study was undertaken to investigate the influence of E. tarda on certain enzymatic and non-enzymatic parameters in the skin mucous secretions of the fish Cirrhinus mrigala using spectrophotometry and zymography. Fish were randomly divided into three groups: control, vehicle control, and infected. A sublethal dose of E. tarda (2.2 × 106 CFU/fish) suspended in 50 µL of PBS was injected intra-peritoneally at 0 day (d). Subsequently, mucus samples were collected at 2 d, 4 d, 6 d and 8 d post-infection. The activities of lysozyme (LYZ), protease (PROT), alkaline phosphatase (ALP), acid phosphatase (ACP), catalase (CAT), peroxidase (PER), superoxide dismutase (SOD), and glutathione S-transferase (GST) decreased significantly in the skin mucus of the challenged fish, indicating the suppressed immune system and decreased antioxidant capacity of C. mrigala to E. tarda infection. Lipid peroxidation (LPO) and total nitrate-nitrite were significantly higher at several time points post-infection, suggesting that physiological functions have been impaired following pathogen challenge. The present findings could be relevant for fish aquaculture and underline the importance of skin mucus not only for assessing fish immune status but also for identifying early warning signals of disease caused by pathogens.

The tendency of segmental distribution of hepatic metastasis according to couinaud classification: a comparison of portal versus systemic route of metastatis due to primary colorectal and breast tumors.

Objective: The liver is the commonest site of metastatic disease for patients with colorectal cancer (CRC), with at least 25% of patients developing liver metastasis (LM) during their illness. About 50% of patients diagnosed with metastatic breast cancer develop LM, and 5-12% of these patients develop LM as the main site of breast cancer recurrence. This study aims to determine the frequency of segmental distribution of LM seeding from portal versus systemic routes of dissemination due to primary CRC and breast carcinoma, respectively. Material and methods: This retrospective study was conducted in a tertiary care teaching hospital in Pakistan. Ethical approval was taken from the institutional review board. A total of 587 patients were included in the study with 297 CRC patients with LM and 300 breast carcinoma patients with LM. Segment I involvement was excluded from the calculation because of the dual blood supply. Patients' detailed demographics and other information were collected on a predesigned proforma. The authors evaluated axial and multiplanar reformatted computed tomography images for LM and CRC metastasis. Data analysis was done using SPSS version 25. P value less than or equal to 0.05 was considered statistically significant. Results: A study population of 587 patients was employed that comprised 287 CRC and 300 breast carcinoma patients. There were 179 (30.5%) male and 408 (69.5%) female patients. The mean age of patients was 54.9±13.3. The study revealed that 204 (34.8%) CRC patients showed right lobe (V, VI, VII, VIII) and 83 (14.1%) CRC patients showed left lobe involvement of metastasis while 192 (32.7%) breast carcinoma patients showed right lobe involvement and 108 (18.4%) breast carcinoma patients showed left lobe involvement in metastasis (P=0.02). We also found 40 (6.8%) colorectal and 55 (9.4%) breast carcinoma patients showed left lateral segment (II, III) involvement. Medial segment involvement (IV) was seen in 43 (7.3%) CRC patients and 53 (9%) breast carcinoma patients (P=0.03). Conclusion: The right hepatic lobe is the predominant site of metastasis independent of the portal or systemic route of dissemination in primary carcinoma. Moreover, in left lobe metastasis medial segment (IV) is more affected in CRC while the lateral segment (II, III) is more affected in breast carcinoma.

White Matter Stroke Masquerading as Subarachnoid Hemorrhage After High-Risk Percutaneous Coronary Intervention: A Case Report.

Considering the context of percutaneous coronary artery angiography (PCI), stroke is a rare but severe complication and is associated with high morbidity and mortality. A computed tomography (CT) scan of the brain is an indispensable imaging modality to diagnose ischemic stroke changes following PCI. A 75-year-old female who presented with sudden onset chest pain was diagnosed with anterior-wall myocardial infarction which required primary PCI. However, an hour following the procedure, she suddenly developed drowsiness, confusion, and hemiparesis. Non-contrast CT showed hyperdense signals in posterior falx and tentorium cerebelli suggesting subarachnoid hemorrhage (SAH) as well as low attenuation signals in bilateral periventricular region suggestive of microvascular ischemic changes. It was critical to decide about the continuation of dual antiplatelet therapy (DAPT), aspirin and P2Y12 inhibitor, as soon as possible. Based on the clinical presentation and mixed picture on the CT scan, a second opinion was sought by a multidisciplinary team, which concluded that the findings were consistent with white matter stroke and DAPT was resumed. The hemiparesis improved gradually with the reversal of CT scan findings. There is a lack of reported literature about ischemic stroke and SAH following high-risk PCI and what should be the best approach in ambiguous cases. The management of white matter stroke and SAH is contrasting, particularly in deciding whether to continue the DAPT after PCI; hence it is critical to diagnose them promptly. Thus, this case highlights the importance of differentiating SAH from white matter stroke for prompt treatment of post-PCI complications to ensure positive outcomes.

Degradation of co-applied Atrazine and Fipronil in Phanerochaete Chrysosporium Augmented Biobeds.

White rot fungi possess an enzymatic system that is non-specific to any pesticide and can be used for pesticide detoxification in biobeds. The present study evaluated potential of Phanerochaete chrysosporium to degrade co-applied atrazine and fipronil in ash or biochar biomixtures. Five biomixtures were prepared by partially replacing compost in rice straw-compost biomixture (BM) with 10% rice husk ash (RHA), 10% sugarcane bagasse ash (SBA), and 1 and 5% wheat straw biochar (WBC). Results suggested that after 30 days P. chrysosporium augmented biobeds resulted in 60.52-72.72% atrazine and 69.57-72.52% fipronil degradation. Hydroxyatrazine and fipronil sulfone were detected as the only metabolite of atrazine and fipronil, respectively, and were further degraded. Although, SBA significantly enhanced atrazine degradation, RHA or SBA had no significant effect on fipronil degradation. WBC (5%) slowed down degradation of both pesticides.

Giant Sinoatrial Nodal Artery Aneurysm with Fistula into the Right Atrium Treated by Partial Resection and Plication: A Case Report.

Coronary artery aneurysms (CAAs) occur when an artery dilates 1.5 times the reference vessel. They occur most commonly because of atherosclerosis. CAAs are a rare phenomenon, and it is even rarer to find a giant CAA, which is roughly defined as a size 400% above the reference vessel. Giant CAAs are commonly found in the right coronary artery. The sinoatrial nodal artery (SNA) is among the least common sites for CAA involvement. Sometimes, communication exists between the aneurysm and a chamber of the heart or a great vessel. The consequences of the fistula depend on its size. Because of the rarity of the condition, guidelines are not well developed. However, small CAAs can be managed conservatively, whereas giant CAAs require resection, ligation, and bypass grafting. CAAs have a predilection for males and the elderly. We describe a 40-year-old South Asian woman presenting with mild dyspnea on exertion of 1 year's duration. Echocardiography showed a 60×60 mm cystic sac, subsequently confirmed by computerized tomography, which showed 3 large aneurysms (70×61 mm) and 3 small aneurysms in the SNA. Coronary angiography illustrated that the SNA branched off the left main coronary artery, and the aneurysm communicated with the right coronary artery. The aneurysm was partially resected and plicated.

Epidermal modifications in a hill stream catfish, Hara hara in relation to its natural habitat: A scanning electron microscope and histochemical investigation.

In the present study, the epidermis of the hill stream fish Hara hara has been investigated employing scanning electron microscope, histology, histochemistry and immunofluorescence techniques. The epidermis is characteristically differentiated into plaques separated from each other by deep furrows. In plaques, the epidermis is keratinized. In contrast, in furrows, it is mucogenic. Surface epithelial cells in plaques get modified into characteristic spine-like unculi. At the distal ends of these unculi, we find tree-like branched dendritic structures. The keratinized epithelial cells in plaques together with unculi frequently exfoliate at the surface. The epidermis in furrows is equipped with secretory glandular cells, that is, mucous goblet cells, sacciform cells and club cells; and sensory structures, that is, the taste buds. These glandular cells are involved in the elaboration of different types of carbohydrate and protein moieties. Further, in the epidermis of both, plaques and furrows, melanophores are frequently interspersed between the epithelial cells. In the plaque epidermis, in addition to melanophores, melanin granules are observed in epithelial cells undergoing keratinization as well as in those sloughing at the surface. Sloughing of keratinized epithelial cells together with spine-like unculi at the surface of the plaques; the secretions of the glandular cells, the distribution of melanophore and the taste buds interspersed between the epithelial cells and the presence of melanin granules in the keratinized epithelial cells have been associated with different functional roles. These include hydrodynamic advantage, protection from mechanical stress, pathogens, UV radiation, localization of food accurately and so on in relation to the natural habitat of the fish.

Knowledge assessment of radiologists, radiology residents, and radiographers regarding contrast materials and management of adverse drug reactions occurring due to contrast materials: a cross-sectional study.

The purpose of this study was to assess the knowledge of the radiology personnel regarding contrast media used in radiology and the management of associated adverse drug reactions. Methods: A questionnaire-based cross-sectional study was conducted from 21 February to 31 March 2019 in five major hospitals of Peshawar, Pakistan. A 30-item questionnaire was adopted from the existing literature containing both open and closed-ended questions and the authors conducted a pilot study among 25 participants to assess the face validity of the tool. A universal sampling technique was adopted. Descriptive statistics were used to summarize the findings of the study. Results: Less than half of the participants could correctly classify iodinated contrast media used in radiology on the basis of ionicity and osmolaity. Sixty-three percent chose severe contrast material-induced allergic reaction as type I hypersensitivity reaction while almost half of them correctly identified the features of iodinated contrast media associated with lesser side effects. Very few of them (6.7%) had read the ACR 2018 manual on contrast media. Regarding the risk factors for acute adverse reactions and signs/symptoms of anaphylaxis few could answer satisfactorily. Twenty-eight percent of participants correctly identified epinephrine as the initial medication in an anaphylactic reaction. Regarding the preferred route of administration, concentration and dose of epinephrine, the participants' correct response was quite poor (43.8%, 6.7%, and 8.6%, respectively). More than 65% of participants could name a single intravenous corticosteroid and antihistamine. Conclusion: Radiology personnel's knowledge regarding contrast material and management of severe contrast material-induced allergic reactions is unsatisfactory.