Essential oils of four wild plants inhibit the blood seeking behaviour of female Aedes aegytpi.

Aedes aegypti (Diptera: Culicidae) mosquito is an important vector of many disease-causing pathogens. An effective way to escape from these mosquito-borne diseases is to prevent mosquito bites. In the current study, essential oils of Lepidium pinnatifidum, Mentha longifolia, Origanum vulgare, and Agrimonia eupatoria were evaluated for their repellent potential against Ae. aegypti females. Essential oils were extracted using steam distillation from freshly collected aerial parts of the plants and tested against 4-5 day old females of Ae. aegypti through the human bait technique for repellency and repellent longevity assays. The chemical composition of extracted essential oils was explored by gas chromatography coupled with mass spectrometry (GC-MS). The essential oils of L. pinnatifidum, M. longifolia, O. vulgare, and A. eupatoria at a dose of 33 µg/cm2 showed 100%, 94%, 87%, and 83% mosquito repellent activity, respectively. Furthermore, M. longifolia and O. vulgare essential oils exhibited 100% repellency at a dose of 165 µg/cm2, whereas A. eupatoria essential oil showed 100% repellency only at 330 µg/cm2. In the time-span bioassay, M. longifolia and O. vulgare essential oils showed protection against Ae. aegypti bites for 90 and 75 min, respectively whereas both A. eupatoria and L. pinnatifidum were found active for 45 min. Phenylacetonitrile (94%), piperitone oxide (34%), carvacrol (20%) and α-pinene (62%) were the most abundant compounds in L. pinnatifidum, M. longifolia, O. vulgare and A. eupatoria essential oils, respectively. The current study demonstrates that M. longifolia and O. vulgare essential oils possess the potential to be used as an alternative to synthetic chemicals to protect humans from mosquito bites.

Flood risk perception and communication: The role of hazard proximity.

Climate change-induced extreme events have increased worldwide, including riverine flooding in rural areas. Risk communication is an effective mechanism that affects risk perception and can significantly reduce flood risk. This study quantifies risk perception and communication in flood-prone rural areas of District Dera Ghazi Khan, Pakistan. The rural communities were divided into two zones based on the distance from rivers, i.e., Zone 1 (households within 0-3 km) and Zone 2 (households within 3-6 km). After a thorough literature review, indicators measured on the Likert scale were selected for risk perception and communication. Using Yamane's sampling, 420 samples were collected using a household survey. Chi-square and t-tests were used to identify differences between the two zones. Linear regression was performed to identify the socioeconomic determinants of risk communication and perception. Results showed that the people living away from the river had higher risk perception and received better risk communication than their peers. The main reason was attributed to their past flood experiences. The study also found a strong correlation between flood risk perception and risk communication. Hazard proximity was also found to affect risk perception and communication. People with higher risk perception are likely to seek risk communication information and engage in flood preparedness and mitigation measures. This study provides an insight into the need for risk communication for improving the effectiveness of flood risk reduction.

Overactive bladder: A multicenter study in Pakistan.

OBJECTIVE: To determine the overall prevalence of overactive bladder in Pakistan, and to determine the difference in prevalence in relation to gender. METHODS: The multicenter study was conducted from February 2017 to October 2018 at 11 institutions across the country, and comprised randomly selected healthy subjects of either gender who were assessed on the basis of symptoms defined by the International Continence Society for overactive bladder. Data was collected using a questionnaire based on the symptoms which was filled for the respondent by designated health workers. Data was analysed using SPSS 23. RESULTS: Of the 1291 respondents, 632(49%) were males with a mean age of 37.8±14.4 years, and 659(51%) were females with a mean age of 38.3±13.7 years. The overall prevalence of overactive bladder was 82(6.4%). Among the males, it was 15(2.4%) and among the females 67(10.2%) (p=0.001). Urgency, frequency and nocturia were reported by 82(6.4%) respondents; 15(1.2%) males and 67(5.2%) females (p=0.001). CONCLUSIONS: The prevalence of overactive bladder was found to be low when assessed with strict application.

Headache and Methemoglobinemia.

AIM: This basic review is intended to summarize the current knowledge of methemoglobinemia as an important cause of secondary headache with the hope of generating a growing interest in studying this phenomenon. BACKGROUND: We describe the pathological underpinnings of headaches generated by hypoxia. Possible mechanisms include cerebral vasodilation-associated stretching of the vessel nociceptors, sensitization of perivascular nociceptors mediated by nitric oxide, cerebral calcitonin gene-related peptide, activation of the cyclic adenosine monophosphate pathway, cortical spreading depression, disruption of the blood-brain barrier, and neurogenic inflammation. We review the clinical features, pathophysiology, and management of methemoglobinemia. We conducted a literature review of reports of symptomatic methemoglobinemia with headache. In addition, we describe a case report of a patient who presented with an acute onset of severe holocranial headache associated with rapidly progressive perioral paresthesia, cyanosis in lips and hands, nausea, and mild dyspnea on exertion. These features can be misinterpreted as an acute attack of migraine with pain-related hyperventilation syndrome and anxiety leading to clinically detrimental delay in the management of the progressive hypoxia. Her symptoms resolved following treatment with methylene blue. The complex relationship of migraine and hypoxia-related headaches is also reviewed. We propose that methemoglobinemia-associated headaches are possibly generated by stretching of the nociceptor nerve endings during cerebral vasodilation and hypoxia-mediated oxidative stress. CONCLUSIONS: The case highlights the need to broaden the formulated differential diagnosis of an acute onset severe holocranial headache and pay careful attention to other signs and symptoms that may provide hints on potential mechanism(s) for secondary headaches. We provide justification for the need to incorporate "Headache attributed to Methemoglobinemia" as a subtype under the section "Headache attributed to hypoxia and/or hypercapnia" of the International Classification of Headache Disorders to support clinical decision making.

Burnout among gynaecological residents in Lahore, Pakistan: A cross-sectional survey.

OBJECTIVE: To determine the prevalence of burnout among gynaecological residents and factors associated with it. METHODS: This cross-sectional study was performed at the University Medical and Dental College, Faisalabad, Pakistan, from March to April 2016, and comprised female medical students. Participants were divided into groups on the basis of their ABO blood groups and on body mass index criteria. Blood groups were determined by simple conventional slide method. Blood pressure was estimated by manual auscultatory technique with a mercury sphygmomanometer. Data was analysed usingSPSS20. RESULTS: Of the 102 participants, 57(55.9%) were satisfied after choosing gynaecology as career. It was found that emotional exhaustion and depersonalisation were significantly higher among residents working in government institutions than private institutions (p<0.05). Those having more than 2 years of post-graduate experience had significantly higher depersonalisation than those with lesser experience (p=0.016). Also, working for 50-60 hours/week and feeling dissatisfied with the specialty were associated with significantly higher emotional exhaustion and depersonalisation (p<0.05). CONCLUSIONS: Burnout was highly prevalent among gynaecological residents.

Glycaemic Control Of Type 2 Diabetic Patients During Ramazan Fasting.

BACKGROUND: Among five main pillars of Islam Fasting is one of the key elements, all healthy adult Muslims have to observe fast from dawn till dusk during the holy month of Ramadan. According to a 2009 demographic study, Islam has 1.57 billion believers, making up 23% of the world population of 6.8 billion, and is growing by 3% per year. EPIDIAR (epidemiology of diabetes and Ramadan) study showed that 43% patients with type 1 and 79% patients with type2 diabetes observe fast during the month of Ramadan. Whereas those people who are suffering from diabetes and are fasting may be at risk of adverse outcomes and the risks may rise with longer fasting periods. Ideal management of diabetic patients who wish to fast during Ramadan needs to be done to avoid the complications. The purpose of this study was to observe the effect of fasting on glycaemic control in type 2 diabetic patients during the month of Ramadan. METHODS: This was an observational cross sectional study; it was conducted at outpatient department Jinnah institute of diabetes and endocrinology Jinnah hospital Lahore during the month of Ramadan. Patients were advised to monitor blood sugar levels for two days before and after three meals (lunch, breakfast and dinner) before Ramadan and then during Ramadan blood sugar levels were monitored for four days in first Ashra before and two hours after Sehari, for four days at noon during second Ashra and then for four days pre and two hours after Iftar in last Ashra of Ramadan. Patients were educated Pre-Ramadan about glucose monitoring and drug dosage adjustments were done along with dietary counselling. RESULTS: Blood glucose levels two days before and during Ramadan fell within range of mean glucose level of 150-187 mg/dl showing no extreme fluctuations in blood glucose levels only one patient reported symptomatic and biochemical hypoglycaemia severe enough to break the fast at noon. CONCLUSIONS: We concluded that in Ramadan fasting, type 2 diabetic patients with proper education, dietary counselling and drug dosage adjustments glycaemic control can remain in safe acceptable range preventing any life-threatening complication.

Asymptomatic COVID-19 presenting with features of mixed pattern acute liver injury in a young healthy female, a case report.

COVID-19 associated severe acute liver injury in a young healthy patient has not been reported much in the literature. And currently, there are no standard management guidelines. We want to report a case of acute liver injury of mixed pattern in a young healthy female with asymptomatic COVID-19 infection. She presented with abdominal pain, nausea, vomiting and yellowish discoloration of her skin. Further laboratory investigations revealed mixed pattern liver injury with highly raised liver enzymes. She was managed with N-acetyl cysteine protocol and monitoring of her liver enzymes. Other causes of acute liver injury were ruled out. She remained stable during her hospital stay and follow up. Our aim is to highlight the significance of acute liver injury in COVID 19 patients that may lead to fatal outcomes if not managed and monitored accordingly.

Snodgrass Hypospadias Repair At Ayub Teaching Hospital: An Audit Of Complications And Outcomes.

BACKGROUND: There are many reported techniques for the repair of hypospadias, and new ones are being reported, which suggests that none is perfect. This study reports the anatomical success rate when using Snodgrass Technique. METHODS: In this descriptive case series, 296 patients who fulfilled the inclusion criteria, by being treated by Snodgrass urethroplasty, were enrolled. The study was conducted at the Department of Surgery, Unit-C, MTI, Ayub Teaching Hospital Abbottabad between May 2008 and June 2021. RESULTS: Mean age of the patients was 2.4±.8 years, 79.7% (n=236) had anterior (glanular, coronal, sub coronal) meatal location and 20.3 % (n=60) had middle urethral meatus (distal & mid-shaft). The mean operative time was 52 min. 5.1% of patients developed neo-meatal stenosis (n=15), 7.1% (n=21) patients develop a urethral cutaneous fistula (compared to 5% in larger centers, 16% from smaller centers), 11.8% (n=35) developed wound infection, 2% (n=6) had complete disruption. The cosmetic appearance of the penis was "excellent"/good (shape of meatus was slit-like and vertically oriented) in 60.1% (n=178) patients, "acceptable" in 30.1% (n=89), and "not acceptable" in 9.8% (n=29). CONCLUSIONS: Snodgrass technique has a low complication rate, offers an acceptable cosmetic outcome and can be successfully applied to a wide range of defects from distal to mid-shaft hypospadias. Common complications include urethral-cutaneous fistula and meatal stenosis; both occur in a low and acceptable number of patients.

A normal appendix in a painful sliding hernia--an unusual case.

An Amyand's hernia, with a frequency of 0.6% to 1%, is the rare finding of an appendix within an inguinal hernia. This term is applicable to both findings of inflamed as well as a non inflamed appendix. The condition is commonly misdiagnosed as an incarcerated hernia and its diagnosis is almost always made intraoperative. A 63 years old male presented to the out patient department with a right inguinoscrotal swelling that had recently developed pain, radiating to the scrotum on the same side. A right inguinal herniotomy was planned and upon opening the sac a non-inflamed appendix was seen as a sliding component of the hernia. An appendectomy followed by a standard Lichtenstein tension free mesh repair was performed, and the patient was discharged on the second postoperative day without any complications.

Clinical results of the intra-cytoplasmic sperm injection with surgically retrieved sperms in azoospermic men at Sindh Institute of Reproductive Medicine, Karachi.

OBJECTIVE: To analyse the result of intra-cytoplasmic sperm injection (ICSI) by using surgically retrieved sperms in the azoospermic male. METHODS: Eight (9 cycles) azoospermic men were given the intra-cytoplasmic sperum injection after sperms were collected through surgical retrieval either by percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE) at the Sindh Institute of Reproductive Medicine (SIRM), Karachi, which is an assisted reproductive technology centre. Fertilisation, cleavage and pregnancy rates were calculated in their spouses with surgical sperm collection (SSC) and intra-cytoplasmic sperm injection. The study related to the period between September 2007 and February 2009. Statistical analysis were done using SPSS version 11.0. RESULT: After the intra-cytoplasmic sperm injection procedure, fertilisation rate of 72.72% and cleavage rate of 78.12% were achieved in the eight patients. A total of 3 (33.33%) clinical pregnancies were obtained through the transfer of embryo from surgical sperm collection in the azoospermic men. CONCLUSION: Intra-cytoplasmic sperm injection with surgical sperm collection proved to be the only successful treatment for men with azoospermia. It gave 33.33% chances of fatherhood in men who were previously labelled infertile. Results were found to be promising and are expected to improve with time and experience.

Elective hemi transurethral resection of prostate: a safe and effective method of treating huge benign prostatic hyperplasia.

OBJECTIVE: To evaluate the safety and efficacy of elective hemi-resection of prostate in patients with huge gland, weighing more than 120 grams. STUDY DESIGN: Multicentric, analytical comparative study. PLACE AND DURATION OF STUDY: Department of Urology, Karachi Medical and Dental College, Abbasi Shaheed Hospital and Dr. Ziauddin Hospital, Karachi, from August 2006 to July 2009. METHODOLOGY: All benign cases were included in this study and divided into two groups. In group A, patients having hugeprostate (> 120 grams) were placed and hemi TURP was performed. In group B, patients having 60 to 100 grams prostate were placed and conventional Blandy's TURP was performed. Results of both groups were compared in terms of duration of surgery, amount of tissue resected, operative bleeding, postoperative complications, duration of postoperative catheterization, re-admission and re-operations. Effectiveness of procedure was assessed by a simple questionnaire filled by the patients at first month, first year and second year. Patients satisfaction in terms of their ability to void, control urination, frequency, urgency, urge incontinence, haematuria, recurrent UTI, re-admission and re-operations were also assessed. Fisher exact test was applied to compare the safety and efficacy of variables. RESULTS: In group A and B, average age range was 72 and 69 years, average weight of prostate was 148 and 70 grams, average duration of surgery was 102 and 50 minutes respectively. Average weight of resected tissue was 84 and 54 grams and haemoglobin loss was two grams and one gram respectively. Total hospital stay was 5 and 4 days. Total duration of indwelling Foley's catheter (postoperative) was 5 days and 2 days. Patient satisfaction in term of urine flow, urinary control, improvement in frequency and nocturia were comparable in both groups. UTI and re-admission was more in hemiresection group. At the end of 2 years follow-up, there is no statistical difference between the safety and efficacy of two methods of treatment. CONCLUSION: In selected population, elective hemi TURP for huge obstructed prostate is a safe treatment. It's safety and short terms efficacy is comparable with the results of conventional TURP.