Erythematous Plaque Studded With Papules and Pustules in an Immunocompetent Patient.

A male patient was evaluated by the dermatology inpatient consult service after a 5-week history of a skin lesion on the right anterior thigh with intermittent itching and mild tenderness to palpation. What is your diagnosis?

Treatments on the horizon for locally advanced basal cell carcinoma.

Basal cell carcinoma (BCC) is one of the most common human cancers. Most cases of BCC are amenable to surgical and topical treatments with excellent prognosis if diagnosed timely and managed appropriately. However, in a small percentage of cases, it could be locally advanced BBC (laBCC) and not amenable to surgery or radiation, including recurrent, large tumors or tumors that invade deeper tissue. Hedgehog inhibitors (vismodegib and sonidegib) are approved as the first-line treatment of laBCC. PD-1 inhibitor immunotherapy (cemiplimab) is indicated for cases that progressed on or could not tolerate hedgehog inhibitors or when hedgehog inhibitors are contraindicated. Given the modest response and bothersome side effects of some of the agents above, there are reports of novel treatments, and clinical trials are currently evaluating multiple agents.

Evaluation of air quality and health risks associated with trace elements in respirable particulates (PM2.5) from Islamabad, Pakistan.

Fine atmospheric particulates are associated with numerous environmental and health issues as they can penetrate deeply in the respiratory tract thereby adversely affecting the human health. This study aimed to investigate the concentrations of trace elements in the respirable (PM2.5) fraction of the atmospheric particulates and to understand their pollution status and health risks. The samples were collected from Islamabad, and the metals were extracted using HNO3 and HCl based extraction method. Atomic absorption spectroscopy was employed to quantify the concentrations of selected trace elements. PM2.5 exhibited considerable variations in their minimum (4.737 µg/m3) and maximum (108.1 µg/m3) levels. The significant contributors among the selected elements bound to PM2.5 were Ca (1016 ng/m3), K (759.8 ng/m3), Mg (483.0 ng/m3), Fe (469.7 ng/m3), and Zn (341.1 ng/m3), while Ag (0.578 ng/m3) was found at the lowest levels with an overall descending order: Ca > K > Mg > Fe > Zn > Cu > Pb > Ni > Cd > Mn > Sr > Cr > Co > Li > Ag. Multivariate PCA and CA identified industrial activities, combustion processes and automobile emissions as the main anthropogenic contributors to particulate pollution. Enrichment factors and geoaccumulation indices were computed to assess the pollution status. The results also revealed that among the trace elements, Cd showed extremely high contamination, followed by Ag, Zn, and Pb, which showed moderate to high contamination in the atmospheric particulates. Carcinogenic health risks from Pb and Ni were found to be within the safe limit (1.0 × 10-6); however, Cr, Co, and Cd exposure was linked to significant cancer risks. The present elemental levels in PM2.5 were also compared with the reported levels from other regions around the world.

Appraisal of contamination, source identification and health risk assessment of selected metals in the agricultural soil of Chakwal, Pakistan.

Contamination of metals in agricultural soil is a serious global threat but there are limited reports related to their risks in major agronomic areas. The current study is aimed to assess the distribution of selected macroelements and essential/toxic trace metals (Ca, Mg, Na, K, Sr, Li, Ag, Fe, Zn, Co, Cu, Mn, Cd, Cr, Pb and Ni) in the agricultural soil of Chakwal, Pakistan, in order to appraise their contamination status, source identification and probable human health risks. Quantification of the metals was performed by AAS employing aqua regia digestion method. Among the selected metals, dominant mean concentrations were observed for Ca (48,285 mg/kg) and Fe (30,120 mg/kg), followed by Mg (9171 mg/kg), K (973.3 mg/kg), Mn (399.0 mg/kg) and Na (368.9 mg/kg). The correlation study indicated strong mutual relationships among the metals as well as physicochemical properties. Multivariate analysis (PCA/CA) of the metal levels revealed their diverse anthropogenic sources in the soil. Various pollution indices indicated extremely high contamination/enrichment of Cd, followed by moderate enrichment/contamination of Ag in the soil. The HQ values for most of the metals manifested insignificant non-cancer risks. The average CR value of Cr was exceeding the safe limit (1.0E-06) for both ingestion and inhalation exposure, indicating a considerable lifelong cancer risk for the population. The results of this study will provide a better understanding related to the contamination of agricultural soil and its effects on human health and to promote effective actions to reduce the soil pollution.

Sequential extraction of selected metals to assess their mobility, pollution status and health risk in roadside soil.

Assessment of the mobility and contamination of trace metals in the roadside soil is important to explore the environmental quality and potential risks to the public health. The contents of selected metals (Ca, Mg, Sr, K, Na, Li, Fe, Mn, Zn, Cu, Ag, Co, Ni, Cr, Cd and Pb) in the roadside soil collected from major highways/roadsides of Lahore, Pakistan were quantified employing mBCR sequential extraction. Among the metals, Ca, Sr and Na showed highest contribution in exchangeable fraction, Pb in the reducible fraction and K, Li, Fe, Ag, Ni, Cu and Cr in the residual fraction. However, Mg and Mn exhibited relatively higher contents in exchangeable and residual fractions while Cd, Co and Zn showed relatively higher concentration in all four fractions. Comparatively higher mobility and availability in the soil was shown by Ca followed by Sr, Pb, Na, Cd, Zn, Co, Mn, Cu, Ag and Ni. Principal component analysis demonstrated considerable anthropogenic contributions of the trace metals in the roadside soil. The pollution indices showed that the soil was heavily to extremely polluted by Cd and Ag, followed by significant to very high contamination for Co, Ni and Pb. The modified degree of contamination (4.60 and 3.99 in summer and winter, respectively) revealed an overall high degree of contamination. The health risk assessment revealed that the calculated risks were within the safe limit thereby indicating insignificant non-carcinogenic and carcinogenic heath risk to the populace.

Assessment of water quality, trace metal pollution, source apportionment and health risks in the groundwater of Chakwal, Pakistan.

Groundwater quality evaluation is the main concern in the regions like Chakwal where it is major source of water for drinking and irrigation due to low storage capacity of the surface water and lack of proper irrigation system. The aim of the present study was to evaluate various physicochemical parameters (pH, EC, TDS, DO, TA, TH and chlorides) and selected essential/toxic trace metal concentrations (Na, K, Ca, Mg, Sr, Li, Ag, Zn, Fe, Cu, Co, Mn, Cr, Cd, and Pb) in order to explore their distribution, correlation, spatial variations and health risk assessment. Average concentration of some trace metals (Co, Cd and Pb) and physicochemical parameters (EC, TDS, and alkalinity) were found to exceed the national/international standards. Multivariate methods of analysis showed strong associations among Fe-Li-K, Sr-Mg-Ca, Cd-Mn, Cu-Zn, Ag-Co, and Cr-Pb-Na which were significantly contributed by anthropogenic activities. Irrigation water quality index exhibited intermediate suitability of the groundwater for irrigation purpose. Health risk evaluation of the trace metals revealed significant non-carcinogenic risks for Cd, Co and Pb (HQing > 1) especially for children. Similarly, significant carcinogenic risk was found to be associated with Pb and Cr which exceeded the safe limit, suggesting the lifetime carcinogenic risk associated with these metals in the groundwater. The present health risk problems should be considered on top priority and immediate actions should be taken to safeguard the water quality in the study area.

Elemental Analysis of Laryngeal Cancer Patients in Comparison with Controls Using Scalp Hair as an Analytical Tool.

Laryngeal cancer, a rare form of head and neck cancer, is more common in men, and various factors play important roles in its etiology. In the current study, trace elemental contents in the scalp hair of laryngeal cancer patients and healthy subjects were evaluated. Selected essential and toxic elements were measured using flame atomic absorption spectrophotometry after the hair samples were digested with HNO3-HClO4. The mean/median levels of Pb in the scalp hair of patients were significantly higher than the healthy donors, but Sr, Zn, and Co exhibited comparatively lower levels in the laryngeal cancer patients. In comparison to healthy donors, the correlation pattern among the elements in the hair of the patients exhibited diverse mutual relationships. The multivariate apportionment of the elemental levels in the scalp hair of both donor groups was significantly divergent. The average elemental levels varied significantly among the cancer types (glottic, supraglottic, transglottic, and subglottic) as well as the cancer stages (I, II, III, IV). The average levels of the elements also exhibited considerable variations depending on the donors' habitat, gender, food, and smoking habits. Overall, the study revealed significantly divergent disparities among the elemental contents in the scalp hair of the laryngeal cancer patients in comparison with counterpart controls.

Investigation of imbalances in essential/toxic metal levels in the blood of laryngeal cancer patients in comparison with controls.

Laryngeal carcinoma is one of the common types of head and neck cancer, with men being more likely than women to develop it. Diet, age, gender, smoking habits, and environmental factors play important roles in its development. The goal of this study was to ascertain if there were imbalances in essential and toxic trace metals owing to the initiation and progression of laryngeal cancer. Atomic absorption spectrometry was employed to quantify selected macroelements, and essential/toxic trace metals in blood of the cancerous patients and matching controls. Significantly higher concentrations of Pb, Cu, Fe, and Sr while substantially lower levels of Na, K, Ca, and Mg were observed in the cancer patients compared with the controls. Considerably disparate mutual relationships among the macroelements, and essential/toxic trace metals in the patients and controls were manifested by their correlation coefficients. Similarly, multivariate apportionment of the metal levels showed appreciably diverse associations and grouping in the patients and controls. The laryngeal cancer patients exhibited significant disparities in the metal levels among various sub-types (supraglottic, subglottic, transglottic, and glottic cancer) and stages (I, II, III, and IV) of the disease. Most of the metals revealed distinct differences based on the gender, habitat, age, eating preferences, and smoking habits in both donor groups. Overall, the study demonstrated significant imbalances among the macroelements, and essential/toxic trace metal levels in the blood of laryngeal cancer patients compared to the controls.

Mobility, bioaccessibility, pollution assessment and risk characterization of potentially toxic metals in the urban soil of Lahore, Pakistan.

The present study is based on the measurement of potentially toxic metal contents employing various extraction methodologies aimed at the evaluation of their mobility, bioaccessibility and bioavailability in the urban soil (n = 56) of Lahore, Pakistan. Selected metal levels in the soil were quantified using flame atomic absorption spectrometry. On the average basis, aqua regia and glycine extracts revealed comparatively higher contents for most of the metals; average concentrations of Fe, Mn, Zn, Pb, Cu, Cr, Co and Cd were found at 1566, 451.1, 114.8, 52.84, 39.15, 24.82, 12.59 and 3.953 mg/kg in aqua regia extract, while in glycine extract the metal levels were found at 579.6, 174.2, 74.72, 49.74, 19.28, 7.103, 4.692 and 3.357 mg/kg, respectively. However, Cd, Pb, Cu and Zn showed significantly higher mobility and bioavailability in the soil, while Co, Fe and Mn were least mobile/bioavailable. The pollution index was assessed in terms of enrichment factor and modified degree of contamination which revealed severe to significant contamination and anthropogenic enrichment of Cd, Pb, Cu and Zn. Multivariate analysis showed mostly anthropogenic contributions for Zn-Cu-Cr-Pb-Cd. Health risk assessment revealed relatively higher exposure of the metals through ingestion, while only minor contributions were noted for inhalation and dermal contact. Hazard quotient index was within the safe limit (< 1.0) in all soil extractions, thereby indicating no significant non-carcinogenic health risks. The incremental lifetime cancer risk for Cr (4.1E-06) through ingestion was comparatively higher than the safe limit which showed significant lifetime cancer risk to the local population.

Recurrence of hepatitis C virus after treatment with pegylated interferon and direct acting antivirals in Punjab Pakistan / Recorrência do vírus da hepatite C após tratamento com interferon peguilado e antivirais de ação direta em Punjab, Paquistão

Although increased response rates concomitant in hepatitis C virus but relapse after treatment is threatened. Therefore, it is terrible requirement to evaluate the response of Pegylated interferon and direct acting antivirals in Punjab Pakistan. The study was conducted to find the rate of recurrence of HCV infection after treatment with Pegylated Interferon and Direct Acting Antivirals in Punjab Pakistan. This study was conducted at Department of Pathology, Nawaz Sharif Medical College Gujrat, while treatment effects monitored in different Government and Private Hospitals of Punjab, Pakistan. Total 973 patients who administered the recommended dose and divided in two groups (i) Interferon based therapy (ii) direct acting antivirals (DAAs).Other parameters like ALT and viral load studied. The rate of recurrence was higher in female infected with genotype 2b and in male with mixed genotype 3a/2b after six month of antiviral therapy. Genotype 3a showed significant response to therapy after three month. 32 among 374 (8.5%) were positive after 24 weeks of treatment with interferon, 29 (7.7%) patients have same genotype while 3 patients were re-infected with different HCV strains. With DAAs, only 27 (4.8%) patients were positive among 558 after 2 weeks and one patient re-infected with different genotype. Early and sustained virological response noted in DAAs. ALT and viral load decreased faster with DAAs that not achieved after 4 weeks with pegylated interferon. Sustained virological response appears in DAAs and recurrence rate is high in interferon therapy compared to DAAs. Therefore, reinfection has implications for correct treatment efficiency and to select strategies for retreatment cases.

Embora aumentem as taxas de resposta concomitantes no vírus da hepatite C (HCV), há risco de recidiva após o tratamento. Portanto, é um requisito terrível avaliar a resposta do interferon peguilado e antivirais de ação direta em Punjab, Paquistão. O estudo foi conduzido para encontrar a taxa de recorrência da infecção por HCV após o tratamento com interferon peguilado e antivirais de ação direta em Punjab, Paquistão. Este estudo foi conduzido no Departamento de Patologia Nawaz Sharif Medical College Gujrat, enquanto os efeitos do tratamento foram monitorados em diferentes hospitais públicos e privados de Punjab, Paquistão. Total de 973 pacientes que administraram a dose recomendada foram divididos em dois grupos: (i) Terapia baseada em interferon, (ii) antivirais de ação direta (DAAs). Outros parâmetros como ALT e carga viral foram estudados. A taxa de recorrência foi maior em mulheres infectadas com o genótipo 2b e em homens com genótipo misto 3a / 2b após seis meses de terapia antiviral. O genótipo 3a mostrou resposta significativa à terapia após três meses. 32 entre 374 (8,5%) foram positivos após 24 semanas de tratamento com interferon, 29 (7,7%) pacientes têm o mesmo genótipo, enquanto 3 pacientes foram reinfectados com diferentes cepas de HCV. Com DAAs, apenas 27 (4,8%) pacientes foram positivos entre 558 após duas semanas e um paciente reinfectado com genótipo diferente. Resposta virológica precoce e sustentada observada em DAAs. ALT e carga viral diminuíram mais rapidamente com DAAs, que não alcançou após 4 semanas com interferon peguilado. A resposta virológica sustentada aparece em DAAs, e a taxa de recorrência é alta na terapia com interferon em comparação com DAAs. Portanto, a reinfecção tem implicações para a eficiência do tratamento correto e para selecionar estratégias para casos de retratamento.

Recurrence of hepatitis C virus after treatment with pegylated interferon and direct acting antivirals in Punjab Pakistan

Abstract Although increased response rates concomitant in hepatitis C virus but relapse after treatment is threatened. Therefore, it is terrible requirement to evaluate the response of Pegylated interferon and direct acting antivirals in Punjab Pakistan. The study was conducted to find the rate of recurrence of HCV infection after treatment with Pegylated Interferon and Direct Acting Antivirals in Punjab Pakistan. This study was conducted at Department of Pathology, Nawaz Sharif Medical College Gujrat, while treatment effects monitored in different Government and Private Hospitals of Punjab, Pakistan. Total 973 patients who administered the recommended dose and divided in two groups (i) Interferon based therapy (ii) direct acting antivirals (DAAs).Other parameters like ALT and viral load studied. The rate of recurrence was higher in female infected with genotype 2b and in male with mixed genotype 3a/2b after six month of antiviral therapy. Genotype 3a showed significant response to therapy after three month. 32 among 374 (8.5%) were positive after 24 weeks of treatment with interferon, 29 (7.7%) patients have same genotype while 3 patients were re-infected with different HCV strains. With DAAs, only 27 (4.8%) patients were positive among 558 after 2 weeks and one patient re-infected with different genotype. Early and sustained virological response noted in DAAs. ALT and viral load decreased faster with DAAs that not achieved after 4 weeks with pegylated interferon. Sustained virological response appears in DAAs and recurrence rate is high in interferon therapy compared to DAAs. Therefore, reinfection has implications for correct treatment efficiency and to select strategies for retreatment cases.

RESUMO Embora aumentem as taxas de resposta concomitantes no vírus da hepatite C (HCV), há risco de recidiva após o tratamento. Portanto, é um requisito terrível avaliar a resposta do interferon peguilado e antivirais de ação direta em Punjab, Paquistão. O estudo foi conduzido para encontrar a taxa de recorrência da infecção por HCV após o tratamento com interferon peguilado e antivirais de ação direta em Punjab, Paquistão. Este estudo foi conduzido no Departamento de Patologia Nawaz Sharif Medical College Gujrat, enquanto os efeitos do tratamento foram monitorados em diferentes hospitais públicos e privados de Punjab, Paquistão. Total de 973 pacientes que administraram a dose recomendada foram divididos em dois grupos: (i) Terapia baseada em interferon, (ii) antivirais de ação direta (DAAs). Outros parâmetros como ALT e carga viral foram estudados. A taxa de recorrência foi maior em mulheres infectadas com o genótipo 2b e em homens com genótipo misto 3a / 2b após seis meses de terapia antiviral. O genótipo 3a mostrou resposta significativa à terapia após três meses. 32 entre 374 (8,5%) foram positivos após 24 semanas de tratamento com interferon, 29 (7,7%) pacientes têm o mesmo genótipo, enquanto 3 pacientes foram reinfectados com diferentes cepas de HCV. Com DAAs, apenas 27 (4,8%) pacientes foram positivos entre 558 após duas semanas e um paciente reinfectado com genótipo diferente. Resposta virológica precoce e sustentada observada em DAAs. ALT e carga viral diminuíram mais rapidamente com DAAs, que não alcançou após 4 semanas com interferon peguilado. A resposta virológica sustentada aparece em DAAs, e a taxa de recorrência é alta na terapia com interferon em comparação com DAAs. Portanto, a reinfecção tem implicações para a eficiência do tratamento correto e para selecionar estratégias para casos de retratamento.

Evaluation of Potentially Toxic Trace Metals and Associated Health Risk Assessment in Buffalo Milk.

The contamination of toxic trace metals in the food chain is one of the major threats to human health. Milk is part of a balanced diet, which is essential for proper growth, but the ingestion of contaminated milk may cause chronic health disorders. The present study is focused on the assessment of contamination of toxic trace metals in buffalo milk and the associated health risks to the consumers of Abbottabad, Pakistan. Standard analytical methods were employed to quantify the metal contents in the milk samples collected from various shops and homes in the months from June 2021 to October 2021. Health risk assessment was accomplished by computing estimated daily intake (EDI), health risk index (HRI), target hazard quotient (THQ), hazard index (HI), and target cancer risk (TCR). On a comparative basis, the mean concentration of Cr was found to be highest in both shop and home milk samples (101.3 ± 45.33 and 54.11 ± 24.20 mg/L, respectively), followed by Pb, Zn, Ni, and Cd levels. In buffalo milk collected from homes, the highest concentration of the metals was found in October, followed by July, September, June, and August. In shop milk, the increasing trend of metal contents was July > October > September > June > August. Significantly strong positive relationships were noted between the metal concentrations in the milk samples. Multivariate cluster analysis and principal component analysis exhibited significant anthropogenic contributions of the metals in buffalo milk. Mostly, the EDI and HRI values were exceeding the recommended limits; however, THQ, HI, and TCR showed that the intake of these metals through milk consumption was within the safe limit and thus revealed no significant carcinogenic or non-carcinogenic risks to the consumers. It is high time to ensure the continuous monitoring of organic/inorganic toxins in the milk and concerned authorities should take strict measures to control the contamination of milk and other food products.

A Rare Presentation of Extragenital Bowenoid Papulosis.

Bowenoid papulosis is an uncommon skin disorder usually seen in the genital area and associated with human papillomavirus (HPV) infection. Clinically, patients usually present with solitary or multiple skin- to brown-colored papules. Plaque morphology of lesions and extragenital location are unusual. Diagnosis is mainly based on clinical presentation and confirmed with a skin biopsy demonstrating keratinocyte atypia. Chromogen in situ hybridization for HPV can also be done. Herein, we present a rare case of bowenoid papulosis with a plaque morphology on the face with no concomitant involvement of the anogenital, oropharyngeal, or periungual areas in an immunocompromised patient. Histopathologic sections stained positive with the in situ hybridization technique for high-risk oncogenic HPV serotypes (16, 18, 31, 33, 35, 45, 51, 52, and 56), confirming the diagnosis.

Concomitant hypertrophic lichen planus and squamous cell carcinoma: Clinical features and treatment outcomes.

BACKGROUND: Patients with hypertrophic lichen planus (HLP) and squamous cell carcinoma (SCC) diagnoses present clinicians with diagnostic and disease management challenges. OBJECTIVE: To better define the clinical and treatment outcomes of patients with concomitant diagnoses of HLP and SCC. METHODS AND MATERIALS: A retrospective review was performed from January 1, 2008, to July 31, 2015, at Mayo Clinic. Patients with a histologic diagnosis of HLP and SCC were included. Patient demographics, associated comorbidities, histopathologic characteristics, treatment, and outcomes were evaluated. RESULTS: Thirty-three patients were identified; 79% were female, and mostly the lower extremities were involved. Most of the SCCs were well-differentiated and in situ with the majority treated with destruction or excision. There were no cases of local recurrence, metastasis, or disease-specific death during the follow-up period (mean 55.8 months). CONCLUSION: Patients with diagnoses of both HLP and SCC appear to be a distinct population that is predominantly female with lesion predilection for the lower extremities. However, regardless of treatment modality or tumor size, there were no adverse outcomes. An initial trial of more conservative treatment measures with close follow-up may be reasonable with biopsy of lesions unresponsive to conventional treatment.

The Impact of Consuming Zinc-Biofortified Wheat Flour on Haematological Indices of Zinc and Iron Status in Adolescent Girls in Rural Pakistan: A Cluster-Randomised, Double-Blind, Controlled Effectiveness Trial.

Biofortification of wheat is potentially a sustainable strategy to improve zinc intake; however, evidence of its effectiveness is needed. A household-based, double-blind, cluster-randomized controlled trial (RCT) was conducted in rural Pakistan. The primary objective was to examine the effects of consuming zinc-biofortified wheat flour on the zinc status of adolescent girls aged 10−16 years (n = 517). Households received either zinc-biofortified flour or control flour for 25 weeks; blood samples and 24-h dietary recalls were collected for mineral status and zinc intake assessment. Plasma concentrations of zinc (PZC), selenium and copper were measured via inductively coupled plasma mass spectrometry and serum ferritin (SF), transferrin receptor, alpha 1-acid glycoprotein and C-reactive protein by immunoassay. Consumption of the zinc-biofortified flour resulted in a moderate increase in intakes of zinc (1.5 mg/day) and iron (1.2 mg/day). This had no significant effect on PZC (control 641.6 ± 95.3 µg/L vs. intervention 643.8 ± 106.2 µg/L; p = 0.455), however there was an overall reduction in the rate of storage iron deficiency (SF < 15 µg/L; control 11.8% vs. 1.0% intervention). Consumption of zinc-biofortified flour increased zinc intake (21%) but was not associated with an increase in PZC. Establishing a sensitive biomarker of zinc status is an ongoing priority.

Variations in Total Phenolic, Total Flavonoid Contents, and Free Radicals' Scavenging Potential of Onion Varieties Planted under Diverse Environmental Conditions.

Genetic diversity and Agro-climatic conditions contribute significantly to the agronomic and morphological features of the food plant species, and their nutraceutical potential. The present study was intended to evaluate the impact of growing conditions on total phenolic and total flavonoid contents, and in vitro antioxidant potential in the bulbs and leaves of onion varieties planted under diverse environmental conditions. Standard analytical methods were used to quantify total phenolic content (TPC), total flavonoid content (TFC), and free radicals' scavenging/antioxidant capacity. The impact of climatic and soil conditions was assessed using statistical tools. In general, onion varieties cultivated at three different locations viz. Kalar Kahar, Lahore and Swabi exhibited significant variations in TPC and TFC, and antioxidant activities. The bulbs and leaves of Mustang (V1) variety planted at Lahore and Swabi had significantly (p < 0.05), high levels of TPC (659.5 ± 6.59, and 631.1 ± 8.58 mg GAE/100 g, respectively). However, leaves of Red Orb (V2) and bulbs of Mustang (V1), and Golden Orb (V6), harvested from Kalar Kahar depicted the highest concentration of TFC (432.5 ± 10.3, 303.0 ± 6.67, and 303.0 ± 2.52 mg QE/100 g DW, respectively). Likewise, bulbs of V1 planted at Kalar Kahar, Lahore and Swabi exhibited maximum inhibition of DPPH, ABTS, and H2O2 radicals (79.01 ± 1.49, 65.38 ± 0.99, and 59.76 ± 0.90%, respectively). Golden Orb (V6) harvested from Lahore had the highest scavenging of OH radical (67.40 ± 0.09%). Likewise, bulbs of V1 variety planted at KalarKahar and Swabi had significant capacity to scavenge ferric ions (415.1 ± 10.6 mg GAE/100 g DW), and molybdate ions (213.7 ± 0.00 mg AAE/100 g DW). Conversely, leaves of Amazon (V8), planted at Lahore and Swabi depicted significant levels of DPPH, ABTS, H2O2 radical scavenging (90.69 ± 0.26, 63.55 ± 1.06, 51.86 ± 0.43%, respectively), and reduction of ferric ions (184.2 ± 6.75 mg GAE/100 g DW). V6 leaves harvested from Lahore and that of Super Sarhad (V3) from Swabi showed the highest inhibition of OH radical (61.21 ± 0.79%), and molybdate ions (623.6 ± 0.12 mg AAE/100 g DW), respectively. Pearson correlation and principal component analysis revealed strong relationships of climatic conditions, soil properties and elevation with TPC, TFC and free radicals' scavenging potential in the bulbs and leaves of onion varieties. The variations in the total phenolic and flavonoid contents, and antioxidant potential of different varieties, and their associations with climatic and soil factors revealed the complexity of the growing conditions and genetic makeup that imposed significant impacts on the synthesis of secondary metabolites and nutraceutical potential of food and medicinal plant species.

Rationale and Design of the TARGET-EFT Trial: Multicomponent Intervention for Frail and Pre-frail Patients Hospitalized with Acute Cardiac Conditions.

BACKGROUND: With the aging population and rising rates of cardiovascular disease (CVD), cardiologists and cardiac surgeons are encountering a growing number of frail older patients that have complex cardiac and non-cardiac issues. Measuring frailty provides valuable prognostic information to help personalize treatment decisions. However, there is minimal evidence on multicomponent frailty interventions in this setting. The TARGET-EFT (The MulTicomponent Acute Intervention in FRail GEriatric PaTients with cardiovascular disease using the Essential Frailty Toolset) trial aims to target physical and non-physical frailty deficits to improve health-related quality of life and hospital-acquired disability in frail patients hospitalized with CVD. METHODS: The TARGET-EFT trial is a single-center parallel-group randomized clinical trial in frail and pre-frail older adults ≥65 years admitted to the cardiovascular unit (CVU) at the Jewish General Hospital, Montreal, Quebec. The trial will compare usual inpatient care to a multicomponent intervention targeting physical weakness, cognitive impairment, malnutrition, and anemia. Outcomes of interest in both groups will be assessed at three time points: (1) study enrollment, (2) discharge from the CVU, and (3) 30 days after hospital discharge. CONCLUSIONS: The overarching goal is to treat patients' frailty in parallel with their CVD, and in doing so, optimize patient functional losses while in-hospital and shortly thereafter. The results of this trial will inform best practices for patient-centered care in this vulnerable patient group.

Recurrence of hepatitis C virus after treatment with pegylated interferon and direct acting antivirals in Punjab Pakistan.

Although increased response rates concomitant in hepatitis C virus but relapse after treatment is threatened. Therefore, it is terrible requirement to evaluate the response of Pegylated interferon and direct acting antivirals in Punjab Pakistan. The study was conducted to find the rate of recurrence of HCV infection after treatment with Pegylated Interferon and Direct Acting Antivirals in Punjab Pakistan. This study was conducted at Department of Pathology, Nawaz Sharif Medical College Gujrat, while treatment effects monitored in different Government and Private Hospitals of Punjab, Pakistan. Total 973 patients who administered the recommended dose and divided in two groups (i) Interferon based therapy (ii) direct acting antivirals (DAAs).Other parameters like ALT and viral load studied. The rate of recurrence was higher in female infected with genotype 2b and in male with mixed genotype 3a/2b after six month of antiviral therapy. Genotype 3a showed significant response to therapy after three month. 32 among 374 (8.5%) were positive after 24 weeks of treatment with interferon, 29 (7.7%) patients have same genotype while 3 patients were re-infected with different HCV strains. With DAAs, only 27 (4.8%) patients were positive among 558 after 2 weeks and one patient re-infected with different genotype. Early and sustained virological response noted in DAAs. ALT and viral load decreased faster with DAAs that not achieved after 4 weeks with pegylated interferon. Sustained virological response appears in DAAs and recurrence rate is high in interferon therapy compared to DAAs. Therefore, reinfection has implications for correct treatment efficiency and to select strategies for retreatment cases.

Evaluation of Contamination Status and Health Risk Assessment of Essential and Toxic Metals in Cyprinus carpio from Mangla Lake, Pakistan.

Although fish as a diet has many health benefits, metal accumulation in fish has been an increasing public health concerns across the world. The Cyprinus carpio samples were collected from Mangla Lake, Mirpur, Azad Kashmir, Pakistan, and analyzed for 18 essential and toxic trace metals. In edible muscles of the fish, average concentration (µg/g) of K (3002) was the highest, followed by Na (648), Ca (435), Mg (227), and Zn (161). Relatively lower levels (µg/g) were noted for Fe (16.9), Pb (6.05), Sr (4.01), Se (3.49), Co (2.90), Ni (2.37), Mn (2.29), As (1.48), and Cu (1.37), while least levels (µg/g) were found for Cr (0.61), Cd (0.52), Hg (0.15), and Li (0.09) in muscles. Majority of the metals revealed higher accumulation in gills compared with those in scales and muscles. Mean levels of Zn, Mn, Co, Pb, As, and Cd in Cyprinus carpio muscles were found to be exceeding most of the international permissible limits in muscles for safe human consumption. Estimated daily/weekly intakes and hazard quotients/index suggested a high risk related to the intake of Cyprinus carpio from Mangla Lake due to heavy metal contamination. Likewise, target cancer risk (TCR) also indicated significant lifetime carcinogenic health risks to the consumers.