Ryzumvi: pioneering advances in countering drug-induced mydriasis.

This article discusses the prevalence and impact of pharmacologically-induced mydriasis, a condition where the pupil becomes excessively dilated due to certain drugs. It highlights the challenges faced by medical professionals in dealing with this condition and the limitations of current treatments, like pilocarpine and dapiprazole, which come with systemic side effects and specific contraindications, limiting their regular use. The article introduces Ryzumvi, a novel ophthalmic solution approved by the US FDA, which effectively reverses mydriasis caused by adrenergic agonists and antimuscarinic drugs. The article provides insights into its mechanism of action, clinical efficacy, pharmacokinetics, safety, and tolerance based on extensive clinical trials. It emphasizes its rapid onset of action and effectiveness in restoring pupils to their initial size. It also underlines the potential for expanded applications, including in pediatric patients, solidifying its importance in the field of ophthalmology. Furthermore, Ryzumvi represents a promising advancement in managing pharmacologically-induced mydriasis, offering swift and effective relief while highlighting the importance of adhering to safety precautions and the continuous research and development efforts in ophthalmology to comprehensively address vision-related disorders and enhance patient outcomes.

The influence of sociodemographic factors on parental health-seeking behavior for illnesses among the pediatric age group in Karachi: A cross-sectional study.

Background: Health-seeking behavior (HSB) is an individual's reaction to sickness, for which they seek medical attention, regardless of the form such care may take. Poor HSB is frequently associated with lower health outcomes and greater mortality and disease rates in a nation. Sociodemographic factors, including age, gender, family structure, occupation, ethnicity, and rates of literacy and poverty, can influence a person's HSB. This study would benefit Pakistani parents of the paediatric population to make more informed health choices for their children. Aim: This study aims to determine the influence of sociodemographic factors on parental HSB for illnesses among the pediatric age group in Karachi. Materials and Methods: A cross-sectional study was conducted in which 214 parents were interviewed about their choices for health-seeking healthcare for their pediatric children of the pediatric age group (birth-18 years), who were attending the pediatric OPD and wards at Dr. Ruth Pfau Civil Hospital, Karachi in May 2023. Only parents or guardians with sick children were included. Their sociodemographic characteristics and health-seeking choices were asked. Informed consent was obtained, and all data were recorded. SPSS version 25 was used for analysis. Results: For the first choice, the majority of parents (82.7%) preferred to seek healthcare for their children from medical doctors, followed by spiritual healers (10.7%), traditional healers (5.6%), and homoeopathic doctors (0.9%). For the second choice, the highest percentage was for a doctor (76.2%), followed by a spiritual healer (18.7%), a homoeopathic doctor (3.3%), and a traditional healer (1.9%). A significant correlation was found between the first visit and the decision makers (p = 0.019), the father's education level of the father (p = 0.001), the mother's occupation of the mother (p = 0.019), and the mother's education level of the mother (p = 0.001). Conclusion: Sociodemographic characteristics greatly influence parents' HSBs of parents for their children. Despite having low-paying jobs and being uneducated, most people choose to refer to a doctor for their child due to awareness.

Care for breast cancer survivors in Asian countries: A review of sexual dysfunction.

Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.

Bedside manners: do we care?

BACKGROUND: Teaching bedside manner might prove to be one of the most challenging tasks in medical education as it is not easy to structure or formalise such training. Besides, the rigorous training process for acquiring clinical and technical skills often overshadows the humanistic aspect of medical care. The aim of this study was to assess the perception of final year medical students as well as the faculty regarding the teaching and practice of bedside manner including a brief evaluation of students' bedside manner. METHODS: A cross-sectional study was conducted involving final year medical students from five medical colleges (n = 193) and faculty from a single institution (n=29). Sample was selected using systematic random or convenient sampling techniques. Data was collected using self administered, anonymous, structured questionnaire. Data were analysed using SPSS-17. RESULTS: While evaluating students' bedside manner, 85% of the students reported they always take consent while interacting with a patient whereas, only 17% of the faculty members agreed with this. Only 3% of the faculty members reported that students take care of privacy of patients and none of them thought that students reassure a patient during an encounter whereas the percentages among students were 76% and 48%, respectively. Though students thought they need to improve, majority (56%) of them was confident of their bedside manner. On the other hand, 83% of the faculty members rated students' bedside manner from fair to poor. A large proportion (69%) of the faculty members were not satisfied with the quality of teaching regarding bedside manner, reporting lack of focus on this particular aspect of medical care as the most important cause. Majority of the students (87%) believed doctors have a better bedside manner in private as compared to public hospitals. CONCLUSION: Students have an inflated evaluation of their bedside manner but majority felt a need to improve. A sharp contrast exists between students' and faculty's opinion regarding the practice of bedside manner by students. An outright lack of focus on bedside manner was reported as the most important cause for inadequate emphasis on teaching this particular aspect of medical care.

Briumvi: a breakthrough in the treatment of relapsing multiple sclerosis: a review.

Multiple sclerosis (MS) is a chronic systemic autoimmune disorder characterized by plaques of demyelination, autoimmune inflammation, and astrocytic gliosis. The primary cells involved in the pathophysiology of MS are T cells. However, B cells have recently been implicated in the pathophysiology of the disease. Therefore, researchers have been exploring B cell therapy as an alternative treatment option for MS. B cell therapy is based on the targeted depletion of CD20-positive B cells. Rituximab, ocrelizumab, and ofatumumab are anti-CD20 antibodies already approved. Briumvi, the fourth type of anti-CD20 antibody was approved by FDA in December 2022, for the treatment of relapsing types of MS, including relapsing-remitting multiple sclerosis, active secondary progressive multiple sclerosis, and clinically isolated syndromes after the drug was tested in two randomized, double-blind, phase III, ULTIMATE I, and II trials which compared Briumvi (ublituximab) with Aubiago (teriflunomide). Ublituximab was found to have a much lower annual relapse rate in the ULTIMATE II trials than teriflunomide. Briumvi is a chimeric recombinant IgG1 monoclonal antibody directed against human CD20 with potential antineoplastic activity. Its mechanism of action involves several distinct processes that collectively lead to the depletion of B cells and suppression of the immune response. The primary mode of action of Briumvi is its high-affinity binding to CD20. Infusion-related reactions are the most common side effects encountered following intravenous administration of ublituximab.

Analyzing the role of meteorological parameters and CO2 emissions towards crop production: empirical evidence from South Asian countries.

It is need of the hour to investigate the impacts of climate parameters on agricultural production in a developing region of South Asia. Therefore, this work attempts to explore the climatic indicators on agricultural production for selected South Asian countries over the annual data of 1961-2016. This study estimates the impacts of rainfall, temperature, rural population, land under cereal production, and CO2 emissions (ECO2) on agricultural production. For empirical analysis, we applied second-generation unit root tests. After examining the order of integration of time series, we check for the co-integration among the variables. Before the co-integration test, we check for cross-section dependence among the variables. CD and LM tests confirm the existence of cross-section dependence. Afterward, we apply the Westerlund co-integration test to confirm the strong association among the variables. Further, we applied two methods for long-run coefficients of independent variables. Dynamic ordinary least square (DOLS) and fully modified ordinary least square (FMOLS) tests were applied to cross-check the findings. Our findings show that rural population and rainfall are negatively associated with agricultural production. Moreover, temperature, land area under cereal production, and ECO2 are positively associated with agricultural production. Our findings shed light on some important policy implications for South Asian countries.

Socio-Economic Drivers of Renewable Energy: Empirical Evidence from BRICS.

There is a need to implement efficient strategies to mitigate the challenges of climate change and income inequalities in developing countries. Several studies have been conducted to address the relationship among different econometric and environmental indicators of renewable energy (RE) but overlooked the relationship between RE and income inequalities. This study investigates the influence of the distribution of income on the RE in Brazil, Russia, China, and South Africa (BRICS) between 1988 and 2017. The econometric (economic growth and trade), environmental, and institutional parameters are also integrated into the model. The outcomes reveal that reduced inequality in income distribution increases the consumption of RE. In contrast, CO2 emissions have a positive correlation with RE. The governments should implement environmentally friendly policies and increase the consumption of renewable energy in the future with regards to reducing environmental pollution. Furthermore, findings from the study indicate a positive effect on the reduction of corruption in renewable energy. This shows that institutional quality can affect the uptake of renewable energy. The study further identified that growth in a country's economy decreases RE consumption, suggesting that these countries prefer fossil fuels to gain economic growth. The Granger causality results show that a bidirectional causality exists between income inequality and RE consumption. Bidirectional causality is observed between income distribution and CO2 emissions. The results from this study are important for policymakers to achieve sustainable development because fair income distribution and environmental quality are considered as two key factors for sustainable development. Strong institutions and control on corruption can bring sound social and economic gains. Therefore, fair distribution of income and strong institutional policies can increase RE consumption to achieve a clean environment.

Air pollution and hospitalization in megacities: empirical evidence from Pakistan.

Air pollution has become a threat to human health in urban settlements, ultimately leading to negative impacts on overall economic system as well. Already developed nations and still developing countries both are at the risk of air pollution globally. In this scenario, this work aims to investigate the associations of asthma (AS) and acute upper respiratory infection (ARI) patients with satellite-based aerosol optical depth (AOD) and meteorological factors, i.e., relative humidity (RH), temperature (TEMP), and wind speed (WS). We applied second-generation unit root tests to provide empirical evidence. Two sets of unit root tests confirmed mix order of integration, and the other Westerlund co-integration test further showed strong linkages between estimated variables. Fully modified ordinary least square (FMOLS) and dynamic ordinary least square (DOLS) tests were applied, only to explore that TEMP and WS lower the number of AS and ARI patients, but RH and AOD increase the number of patients. Therefore, in accordance with these findings, our study provides some important policy instruments to improve the health status in megacities of Pakistan.

A Novel RNA Virus Related to Sobemoviruses Confers Hypovirulence on the Phytopathogenic Fungus Sclerotinia sclerotiorum.

Infection by diverse mycoviruses is a common phenomenon in Sclerotinia sclerotiorum. In this study, the full genome of a single-stranded RNA mycovirus, tentatively named Hubei sclerotinia RNA virus 1 (HuSRV1), was determined in the hypovirulent strain 277 of S. sclerotiorum. The HuSRV1 genome is 4492 nucleotides (nt) long and lacks a poly (A) tail at the 3'- terminus. Sequence analyses showed that the HuSRV1 genome contains four putative open reading frames (ORFs). ORF1a was presumed to encode a protein with a conserved protease domain and a transmembrane domain. This protein is 27% identical to the P2a protein encoded by the subterranean clover mottle virus. ORF1b encodes a protein containing a conserved RNA-dependent RNA polymerase (RdRp) domain, which may be translated into a fusion protein by a -1 ribosome frameshift. This protein is 45.9% identical to P2b encoded by the sowbane mosaic virus. ORF2 was found to encode a putative coat protein, which shares 23% identical to the coat protein encoded by the olive mild mosaic virus. ORF3 was presumed to encode a putative protein with an unknown function. Evolutionary relation analyses indicated that HuSRV1 is related to members within Sobemovirus, but forms a unique phylogenetic branch, suggesting that HuSRV1 represents a new member within Solemoviridae. HuSRV1 virions, approximately 30 nm in diameter, were purified from strain 277. The purified virions were successfully introduced into virulent strain Ep-1PNA367, resulting in a new hypovirulent strain, which confirmed that HuSRV1 confers hypovirulence on S. sclerotiorum.

Spectrum of beta-thalassemia mutations in various regions of Punjab and Islamabad, Pakistan: establishment of prenatal diagnosis.

We present here an analysis of 888 unrelated beta-thal chromosomes consisting of 444 transfusion dependent children from various regions of Punjab and Islamabad Pakistan. By using Multiplex ARMS- PCR, restriction endonuclease analysis, allele specific oligonucleotide (ASO) hybridization and sequencing, 17 beta-thal mutations and 3 Hb variants were detected in 99.5 % (884/888) of the chromosomes analyzed. First trimester prenatal diagnosis by chorionic villus sampling (CVS) was also carried out in seven pregnancies at risk of beta-thalassemia. Our results indicate that three most common mutations accounted for 86.8% of the beta-thal alleles in this region. These findings have important implications for prevention of beta-thalassemia through genetic counseling and prenatal diagnosis in this part of Pakistan.

Prenatal diagnosis of beta-thalassemia in Southern Punjab, Pakistan.

Pakistan has a large population of more than 150 million people with an overall carrier frequency of approximately 5.6% for beta-thalassemia. Punjab is the largest province of the country having more than 50% of the population. The state of beta-thalassemia is alarming as consanguinity is very high (>81%) and the literacy rate is low in South Punjab. A thalassemia prevention program is the need of the hour in this part of Pakistan. In this study, we initiated awareness, screening, and characterization of the mutations causing beta-thalassemia as well as a genetic counseling program mainly in the districts of Faisalabad and D.G. Khan to establish prenatal diagnosis, a facility previously unavailable in this region for disease prevention. A total of 248 unrelated transfusion-dependent children and the available members of their families were screened to characterize the mutations and identify the carriers. Genetic counseling was provided to these families and prenatal diagnosis offered. In the samples analyzed, 11 beta-thalassemia mutations and three hemoglobin variants were detected mainly by using the Monoplex and Multiplex ARMS-PCR. First-trimester prenatal diagnosis was carried out through chorionic villus sampling (CVS) in seven pregnancies at risk. As a result of our campaign, 145 carrier couples planning to have more children gave their consent to have retrospective prenatal diagnosis in every pregnancy in future. A cooperative trend and a positive attitude toward the prevention of beta-thalassemia were noticed in the families with affected children and in the general population.