Pharmacognostic Evaluation, Chemical Characterization, and Antibacterial Activity of Bassia indica (Wight) A.J. Scott.

Bassia indica (Wight) A.J. Scott is an Indian origin plant with documented medicinal and nutritional value, but has not been fully characterized yet. The present study was designed to establish pharmacognostic standards for the proper identification of the B. indica plant and its chemical characterization. The plant was standardized with World Health Organization (WHO) standardization tools and chemically characterized by Fourier transform infrared spectroscopy (FTIR) and gas chromatography-mass spectroscopy (GC-MS) analysis. Antibacterial potential was assessed by the zone of inhibition and minimum inhibitory concentration (MIC), and molecular docking studies were also performed. Pharmacognostic evaluation established the macroscopic and microscopic parameters for the identification of whole plant and its powder. Physicochemical parameters were also set forth while quantitative phytochemical analysis showed that the ethyl acetate fraction had the highest quantity of phenols, flavonoids, and tannins. FTIR analysis showed several functional groups such as phenols, alkanes, and alcohols while 55 phytochemicals were identified in the GC-MS analysis of the crude fraction. The crude extract and other fractions showed marked antibacterial activity, while the ethyl acetate fraction showed the least MIC (1.95-31.25 mg/mL). Phytochemicals identified in the GC-MS showed good molecular docking interactions against the DNA gyrase subunit B of bacteria with binding energies ranging from -4.2 to -9.4 kcal/mol. The current study describes the pharmacognostic characterization and phytochemical profiling of B. indica and provides scientific evidence to support its use in infections.

Glanzmann Thrombasthenia in Pakistani Patients: Identification of 7 Novel Pathogenic Variants in the Fibrinogen Receptor αIIbß3.

Glanzmann thrombasthenia (GT) is a rare autosomal recessive inherited platelet disorder occurring frequently in populations with high incidence of consanguineous marriages. GT is characterized by quantitative and/or qualitative defect of the platelet αIIbß3 (GPIIb/IIIa) receptor caused by pathogenic variants of the encoding genes: ITGA2B and ITGB3. Patients present with a moderate to severe bleeding tendency with normal platelet count. Platelets show reduced/absent aggregation for all agonists except ristocetin in light transmission aggregometry and reduced/absent αIIbß3 expression in flow cytometry (FC). In this study, we investigated a cohort of 20 Pakistani patients and 2 families collected from the National Institute of Blood Disease, Karachi and Chughtai's Lab, Lahore. Platelet aggregation studies, FC (platelet CD41, CD61, CD42a, CD42b) and direct sequencing of the candidate genes were performed. All patients showed altered platelet aggregation, but normal agglutination after stimulation with ristocetin. Absent/reduced αIIbß3 receptor expression was present in the platelets of 16 patients, in 4 patients expression was borderline/normal. Candidate gene sequencing identified pathogenic/likely pathogenic variants in 15 patients. Seven variants are novel. One patient with absent receptor expression remained without genetic finding. 13 (86.7%) of 15 patients stated consanguinity reflected by homozygosity finding in 14 (93.3%) patients.

Our experience of treating adult bone lymphoma, A retrospective cross-sectional study in a tertiary care center, Aga Khan University Hospital, Karachi.

OBJECTIVE: To determine the experience at the Aga Khan University Hospital in diagnosing and treating adult patients with primary lymphoma of bone. METHODOLOGY: All patients with Primary lymphoma of bone (PLB) that were diagnosed and/or treated at Aga Khan University Hospital, Karachi from 2005 to 2019 were included as part of this study. RESULTS: There were 17 patients with PLB including 13 (76.5%) males and 4 (23.5%) females with a mean age of 44 ± 16.5 years. Nine patients were between 30-59 years of age at diagnosis. The mean follow-up time of patients was 80±46.7 months. Six patients had tumours of pelvic bone followed by tibia (5) and femur (4). Four patients had a pathological fracture at the time of presentation whereas 2 (11.8%) required surgical fixation of the pathological fracture. The stage of the tumour was based on Ann Arbor classification. Nine (52.9%) cases had Stage 1 disease, 7 (41.2%) had stage IV disease with metastasis in extra nodal tissues. As for treatment, every patient received chemotherapy whereas 5 (29.4%) received adjuvant radiotherapy. Complete remission in the size of the tumour was seen in 11 (64.7%) patients while 6 (35.3%) had partial remission. Post-treatment, 4 (23.5%) patients expired. The mean Overall Survival (OS) time was 80.18 ± 46.71months with a survival rate of 76.5. CONCLUSIONS: Primary lymphoma of the bone can be treated with medical regime and good prophylactic surgeries to avoid pathological fracture such as intramedullary nailing.

Functional outcomes and complications of total hip arthroplasty with dual mobility cup : an audit.

OBJECTIVE: To determine the functional outcomes in total hip arthroplasty with a dual mobility cup, performed in our hospital. METHODS: After receiving an exemption from the Ethics review committee of the hospital, data collection for audit was started in January 2019. Records from July 2016 to June 2018 were included. All patients who underwent total hip arthroplasty with dual mobility prosthesis without any age limit were included. A proforma was prepared to collect the required information. Data was entered and analyzed on SPSS v. 21. RESULTS: Two hundred and ten patients were included, 114 females and 96 males. Of the total, 188 patients underwent unilateral surgery while 22 had bilateral hip arthroplasty. The mean postoperative hospital stay was 5.91±3.9 days. . Mean pre-op Harris score was 33.7±7.6 and the post-op mean score was 75.9± 5.34. Eighty-three (39.5 %) patients had the neck of femur fracture, 31(14.8%) had osteoarthritis while 28(13.3%) had avascular necrosis. Post-surgery complications included, wound infection, surgical site haematoma, NSTEMI, and only one patient reported dislocation after use of dual mobility cup. CONCLUSIONS: The dislocation rate which was the prime concern, has been reduced with the use of dual mobility implant in total hip arthroplasty patients.

Functional outcomes of modified Bristow procedure in recurrent shoulder dislocation.

The glenohumeral joint is the most mobile in humans. Of all the joints 50% of dislocations involve the shoulder, mostly young males. When the first dislocation occurs in a patient under 20 years age the risk for recurrent instability increases to 90%. Many techniques are available to reduce and stabilise the glenohumeral joint; in cases of anterior dislocations one of which is the famous Bristow's procedure, originally described in 1954 by Laterjet. The purpose of this study is was to determine the Functional Outcomes of the modified Bristow procedure. This retrospective review was conducted at Aga Khan University Hospital, Karachi from January 2000- December 2015, comprising patients who underwent the modified Bristow procedure. All patients recruited in the study underwent modified Bristow procedure. A total of 70 patients were included, which comprised of 61(87.1%) males and 9(12.9%) females with a mean age of 31.6±11.0 years The maximum number of shoulder dislocations occurred primarily due to road traffic accidents in 48 (68.57%) patients while the second highest cause in 13 (18.57) patients was due to playing sports. The mean number of dislocations before surgery were 3.50±0.5 whereas no patient had an episode of dislocation in the post-operative period. Two patients presented with subluxations but none required further surgical intervention. The Modified Bristow-Latarjet procedure is considered an effective surgical treatment for the recurrent glenohumeral instability of the joint.

Melanoma Detection and Classification using Computerized Analysis of Dermoscopic Systems: A Review.

Malignant melanoma is considered as one of the most deadly cancers, which has broadly increased worldwide since the last decade. In 2018, around 91,270 cases of melanoma were reported and 9,320 people died in the US. However, diagnosis at the initial stage indicates a high survival rate. The conventional diagnostic methods are expensive, inconvenient and subject to the dermatologist's expertise as well as a highly equipped environment. Recent achievements in computerized based systems are highly promising with improved accuracy and efficiency. Several measures such as irregularity, contrast stretching, change in origin, feature extraction and feature selection are considered for accurate melanoma detection and classification. Typically, digital dermoscopy comprises four fundamental image processing steps including preprocessing, segmentation, feature extraction and reduction, and lesion classification. Our survey is compared with the existing surveys in terms of preprocessing techniques (hair removal, contrast stretching) and their challenges, lesion segmentation methods, feature extraction methods with their challenges, features selection techniques, datasets for the validation of the digital system, classification methods and performance measure. Also, a brief summary of each step is presented in the tables. The challenges for each step are also described in detail, which clearly indicate why the digital systems are not performing well. Future directions are also given in this survey.

Mabry Syndrome in a Child of South Asian Descent.

Mabry syndrome is the triad of seizures, hyperphosphatasia, and mental disability. It usually manifests in first year of life and has an autosomal recessive mode of inheritance. Besides the usual triad, other manifestations of Mabry syndrome include hypoplasia of distal phalanges, brachytelencepahly, gastrointestinal malformations and constipation, hypertelorism, short nose with a broad nasal bridge and dip, and thin upper lip with down turned corners of the mouth. More than 20 cases of Mabry syndrome have been reported in medical literature. Herein, we report the case of a six-month child with Mabry syndrome that presented with decreased neck holding, hypotonia and delayed motor milestones. The child also had a high-arched palate and hyperplastic malar eminences. Constipation was present but had a delayed onset, starting at 19 months of age. This is the first case of Mabry syndrome occurring in a child of South Asian descent.

Sprengel's Deformity.

Various shoulder bone deformities have been identified in the pediatric age group, with the most common being undescended scapula. Sprengel's deformity is dysplasia and malposition of the scapula, especially in the supraspinatus portion, mainly due to abnormal descent in the embryonic period. The clavicle is shorter and has a different contour. In some patients cervical spine deformities are also noted. This is a case of 3 years old girl presented to the clinic with difficulty in abducting right shoulder and sleeping with an internal rotation of the right arm. With physical examinations and radiological investigations sprengel's deformity was diagnosed. Sprengel's deformity is a male predominant disease which almost never occurs in isolation and is usually associated with deformities in the thoracic rib cage and the cervical and thoracic vertebrae. Our patient also had hyperpigmentation along the lines of Blaschko, which has never been previously reported with Sprengel's deformity. Sprengel's may have an association with cutaneous mosacism syndrome.

Malnutrition and poor oral health status are major risks among primary school children at Lasbela, Balochistan, Pakistan.

BACKGROUND: This survey was focusing on health and oral hygiene status of primary school children at Lasbela district considering the comparatively less developed and socio demographically deprived part of the Country. METHODS: A cross sectional survey was conducted to determine the health status of primary school children in seven tehseels of district Lasbela, Balochistan after applying proportionate sampling technique from March 2015 to July 2015. Field teams visited assigned schools to screen children and collect health related data on predesigned and pre coded proforma. RESULTS: Out of 200 schools, 196 schools found opened, while 2% of schools (04) remained closed. A total of 6363 students were clinically screened. About 45% of the school children had normal body mass index (BMI) and rest were falling in different categories of malnutrition. More than 19% had ear, nose and throat (ENT) problems and around 19% presented with clinical anemia. Less than 50% of children had scar of BCG vaccination and 4% informed about use of gutka/supari chewing (smokeless tobacco use). CONCLUSION: In conclusion, we estimated high prevalence of malnutrition, poor oral health including smokeless tobacco use, and low BCG coverage among primary school children at Lasbela. Current scenario suggests immediate and contextually focused interventions to confine existing public health risks and avoid future burden of disease.

Autosomal recessive inherited bleeding disorders in Pakistan: a cross-sectional study from selected regions.

BACKGROUND: Autosomal recessive bleeding disorders (ARBDs) include deficiencies of clotting factors I, II, V, VII, X, XI, XIII, vitamin K dependent clotting factors, combined factor V & VIII, Von Willebrand Disease (vWD) type 3, Glanzmann's thrombasthenia (GT) and Bernard-Soulier syndrome. Patients with primary bleeding disorders from all the major provincial capitals of Pakistan were screened for ARBDs. Prothrombin (PT), activated partial thromboplastin time (APTT), bleeding time (BT) and fibrinogen levels were measured. Cases with isolated prolonged APTT were tested for factors VIII and IX using factor assays This was followed by FXI:C level assessment in cases with normal FVIII and FIX levels. vWD was screened in patients with low FVIII levels. Factors II, V and X were tested in patients with simultaneous prolongation of PT and APTT. Peripheral blood film examination and platelet aggregation studies were performed to assess platelet disorders. Urea clot solubility testing was done to detect Factor XIII levels where platelet function tests were normal. Descriptive analysis was done using SPSS version 16. RESULTS: Of the 429 suspected bleeding disorder patients, 148 (35%) were diagnosed with hemophilia A and 211 (49.1%) patients had ARBDs. 70 patients (16.3%) remained undiagnosed. Out of 211 patients with ARBD; 95 (33.8%) had vWD type 3. Fibrinogen deficiency was found in 34 patients (12%), GT in 27 (9.6%), factor XIII deficiency in 13 (4.6%), factor VII deficiency in 12 (4.3%), factor V deficiency in 9 (3.2%). Eight patients (2.8%) had vitamin K-dependent clotting factor deficiency, Bernard-Soulier syndrome was diagnosed in seven patients (2.5%), factor X deficiency in 2 (0.7%), factor II deficiency in 2 (0.7%), factor XI deficiency and combined factor V and VIII deficiency in 1 (0.4%) patient each. CONCLUSION: vWD type 3 was the most common ARBD found in our sample of patients in Pakistan, followed by fibrinogen deficiency and GT in respective order.

Pediatric laparoscopic surgery; initial experience from Pakistan; first 100 cases in single center.

In a developing country like Pakistan, laparoscopic surgeries are not considered favourable by many, possibly because of high costs or a lack of expertise. It is an established fact that laparoscopic surgery offers better surgical treatments with a shorter hospital stay and fewer complications. The current retrospective study was conducted at a tertiary care hospital in Karachi and comprised of laparoscopy cases performed by a single surgeon from March 2012 to September of 2014. A total of 100laparoscopic surgeries were performed; mostly appendectomies 49(49%) and undescended testes (UDTs) 34(34%). Overall, there were 70(70%) male patients. The mean age of the patients was 7.1 years and standard deviation (SD) of 2. Four (4%) patients had cellulitis. Laparoscopy paediatric surgery offered advantages of fewer wound-associated complications, less incisional pain, a shorter recovery time, and improved cosmesis.

Covert network analysis for key player detection and event prediction using a hybrid classifier.

National security has gained vital importance due to increasing number of suspicious and terrorist events across the globe. Use of different subfields of information technology has also gained much attraction of researchers and practitioners to design systems which can detect main members which are actually responsible for such kind of events. In this paper, we present a novel method to predict key players from a covert network by applying a hybrid framework. The proposed system calculates certain centrality measures for each node in the network and then applies novel hybrid classifier for detection of key players. Our system also applies anomaly detection to predict any terrorist activity in order to help law enforcement agencies to destabilize the involved network. As a proof of concept, the proposed framework has been implemented and tested using different case studies including two publicly available datasets and one local network.

Some facts and issues related to livestock theft in Punjab province of Pakistan --findings of series of cases.

Stock theft is an endemic crime particularly affecting deep rural areas of Pakistan. Analysis of a series of cases was conducted to describe features of herds and farmers who have been the victims of cattle and/buffalo theft in various villages of Punjab in Pakistan during the year 2012. A structured interview was administered to a sample of fifty three affected farmers. The following were the important findings: i) incidents of theft were more amongst small scale farmers, ii) the rate of repeat victimization was high, iii) stealing was the most common modus operandi, iv) the majority of animals were adult, having high sale values, v) more cases occurred during nights with crescent moon, vi) only a proportion of victims stated to have the incident reported to the police, vii) many farmers had a history of making compensation agreements with thieves, viii) foot tracking failed in the majority of the cases, ix) all the respondents were willing to invest in radio frequency identification devices and advocated revision of existing laws. The study has implications for policy makers and proposes a relationship between crime science and veterinary medicine.

Forming-free bipolar resistive switching in nonstoichiometric ceria films.

The mechanism of forming-free bipolar resistive switching in a Zr/CeOx/Pt device was investigated. High-resolution transmission electron microscopy and energy-dispersive spectroscopy analysis indicated the formation of a ZrOy layer at the Zr/CeOx interface. X-ray diffraction studies of CeOx films revealed that they consist of nano-polycrystals embedded in a disordered lattice. The observed resistive switching was suggested to be linked with the formation and rupture of conductive filaments constituted by oxygen vacancies in the CeOx film and in the nonstoichiometric ZrOy interfacial layer. X-ray photoelectron spectroscopy study confirmed the presence of oxygen vacancies in both of the said regions. In the low-resistance ON state, the electrical conduction was found to be of ohmic nature, while the high-resistance OFF state was governed by trap-controlled space charge-limited mechanism. The stable resistive switching behavior and long retention times with an acceptable resistance ratio enable the device for its application in future nonvolatile resistive random access memory (RRAM).

Backache due to alkaptonuria in a middle aged man.

Alkaptonuria is a rare cause of backache. A 55 years old gentleman, a retired army personal had been having pain and stiffness in the spine for the last 15 years, accompanied by bluish black discolouration of face and hands. Kyphosis and reduced movement of spine were present. Other joints were spared. Osler spots were visible on the sclera. X-rays revealed calcification of intervertebral discs. Asymptomatic renal stone was identified. There was no cardiac involvement. Symptomatic care was provided.

Variation in bioactive principles of Artemisia amygdalina Decne. in wild and tissue culture regenerants.

Wild and tissue culture raised regenerants of Artemisia amygdalina, a critically endangered and endemic plant of Kashmir and North West Frontier Provinces of Pakistan were screened for the amount of bioactive principles and in particular antimalarial compound artemesinin. Phytochemical screening of extracts revealed the presence of terpenes, alkaloids, phenolics, tannins (polyphenolics), cardiac glycosides and steroids in wild (aerial, inflorescence) and tissue culture regenerants (in vitro grown plant, callus and green house acclimatized plants). HPLC of Artemisia amygdalina revealed the presence of artemesinin in petroleum ether extracts of wild aerial part, tissue culture raised plant and green house acclimatized plants. Acetonitrile and water in 70:30 ratios at flow rate of 1ml/min was standardised as mobile phase. Retention time for standard chromatogram was 6.7. Wild inflorescences and callus does not produce artemesinin. This is the first report of phytochemical screening and artemesinin estimation of wild and tissue culture raised regenerants of Artemisia amygdalina.

Prevalence and molecular characterization of dengue viruses serotypes in 2010 epidemic.

During August to November 2010, a dengue (DEN) outbreak occurred, and several cities of Pakistan were affected. In this study, serum samples from 317 patients, based on clinical symptoms and blood test, were included from Lahore, Sheikhpura and Gujranwala cities for further diagnosis of different genotypes of DEN virus. The samples were categorized into 2 groups: group 1 containing patients with dengue fever (DF) without hemorrhagic manifestations (DF) (n=228) and group 2 involving patients having DF with hemorrhagic manifestations (dengue hemorrhagic fever) (n=89). The samples found positive for DEN in reverse transcriptase polymerase chain reaction (PCR) by targeting capsid and premembrane genes containing fragment of size ∼2.5 kb for groups 1 and 2 were found to be 83.33% and 91.01%, respectively; however, the detection limit was quite low by immunoglobulin M antibody capture enzyme linked immunosorbent assay in case of both groups and was found to be 34.70% and 68.53%, respectively. The 16.67% and 8.99% samples of groups 1 and 2, respectively, were found negative in reverse transcriptase PCR analysis. In case of group 1 and group 2, by adopting seminested multiplex PCR strategy, predominant genotype was DEN virus type 2 with prevalence rates of 45.17% and 65.16%, respectively. DEN virus type 1 was the second most prevailing genotype in the population with prevalence rates of 18.85% and 19.10% for groups 1 and 2, respectively.

Gastro esophageal reflux: an over investigated entity in neonates and infants.

OBJECTIVES: To determine the outcome of clinically suspected gastro esophageal reflux in neonates and infants. To find a protocol for evaluation of these patients in order to reduce unnecessary radiation to neonates and infants. METHODS: Fifty three neonates and infants of up to 1 year of age with clinical suspicion of gastro esophageal reflux (GER) were referred for Upper gastro intestinal barium studies. This retrospective descriptive case study was carried out over a period of one year starting from October, 2006 to September, 2007. Positive cases were followed for another one year to see the final outcome. The neonate and infants of upto one year of age, referred from Neonatal intensive care unit (NICU), Paediatric ward and Out Patient Department (OPD) were included in this study. RESULTS: Out of 53 cases 32 were positive for G.E.R and no reflux could be identified in rest of the patients. Out of these positive cases only 4 had massive or severe G.E.R. These patients were prescribed conservative and medical treatment and were advised to follow up in the O.P.D where on subsequent follow ups the medical treatment was stopped as there were no further complaints .These patients showed normal weight gain on subsequent O.P.D visits. Other positive cases only had mild to moderate G.E.R and they were managed conservatively. These patients showed normal weight gain on subsequent O.P.D visits with complete resolution of symptoms. CONCLUSION: Regurgitation or gastro esophageal reflux is a common finding in the first 3 months of life (especially in preterm infants) and usually resolves by 6-12 months of age and should not be over investigated.

Diagnostic dilemma in sicklers with acute bone crisis: role of subperiosteal fluid collection on MRI in resolving this issue.

OBJECTIVES: To establish MRI criteria to diagnose early osteomyelitis in sickle cell disease patients with acute bone crisis and to differentiate it from normally occurring ischaemic changes in these patients. METHODS: MRI study with and without Gadolinium contrast was carried out in 59 sickle cell disease patients who presented with acute bone crisis from August 2007 to July 2008, and had clinical suspicion of osteomyelitis. We studied the ability of MRI especially the presence of subperiosteal fluid, for the early diagnosis of osteomyelitis and its differentiation from ischaemic changes in these patients. RESULTS: Depending on MRI diagnostic criteria, we diagnosed 32 cases for osteomyelitis. In 26 patients diagnosis was confirmed microbiologically while 6 patients were treated on clinico radiological basis which showed marked improvement on follow up. Five patients with osteomyelitis had established MR features of osteomyelitis while in 27 cases the diagnosis was made on the basis of presence of subperiosteal fluid. CONCLUSION: Early osteomyelitis is a challenging diagnosis clinically and radiologically in patients with sickle cell disease, which can be diagnosed on M.R.I if special emphasis is put on subperiosteal fluid collection.