Analysis of the convective heat transfer through straight fin by using the Riemann-Liouville type fractional derivative: Probed by machine learning.

This work aims to analyze the transfer of heat through new fractional-order convective straight fins by using the Riemann-Liouville type fractional derivatives. The convection through the fins is considered in such a way that the thermal conductivity depends on the temperature. The transformed fractional-order problems are constituted through an optimization problem in such a way that the L2 norm remains minimal. The objective functions are further analyzed with the hybrid Cuckoo search (HCS) algorithm that use the artificial neural network (ANN) mechanism. The impacts of the fractional parameter ß, the thermo-geometric parameter of fin ψ, and dimensionless thermal conductivity α are explained through figures and tables. The fin efficiency during the whole process is explained with larger values of ψ. It is found that the larger values of ψ decline the fin efficacy. The fractional parameter declines the thermal profile as we approach the integer order. The convergence of HCS algorithm is performed in each case study. The residual error touches E-14 for the integer order of α. The present results are validated through Table 6 by comparing with HPM, VIM and LHPM, while the error for HCS-ANN touches E-13. This proves that the proposed HCS is efficient.

Outcomes of liver diseases in pregnant females: A study from a tertiary care medical center in Pakistan.

Objective: To determine the etiologies and outcomes of liver disease in pregnancy in a developing country. Method: A total of 336 consecutive pregnant women with liver disease were included in this prospective cohort study conducted at the Department of Gastroenterology, Jinnah Postgraduate Medical Center, Karachi from August 2019 to August 2021. Patients' baseline demographic, clinical, and laboratory data and outcomes were collected on a pre-designed questionnaire. Results: Among all the pregnant females, the most common liver disease was acute hepatitis E virus (HEV) infection (37.2%), followed by preeclampsia (PEC)/eclampsia (EC), hemolysis, elevated liver enzymes & low platelets (HELLP) syndrome, and hyperemesis gravidarum (HG). The most common maternal complications were fulminant hepatic failure (FHF) in 14.9% and placental abruption in 11.0%. Fetal complications included intrauterine death (IUD) in 20.8% and preterm birth in 8.6%. The maternal and neonatal mortality rates were 11.6% and 39.6%, respectively. Among the predictors, low maternal weight, low body mass index (BMI), and low hemoglobin (Hb) were associated with increased maternal mortality. Low fetal weight, height, maternal systolic blood pressure (SBP), and low maternal Hb were independent predictors of fetal mortality. Conclusion: In our cohort of pregnant females in a tertiary care medical center, acute HEV was the most common liver disease, followed by PEC/EC, HELLP, and HG. Maternal and fetal deaths were alarming in this group of patients and demanded careful management.

Advancements in Reference Gene Selection for Fruit Trees: A Comprehensive Review.

Real-time quantitative polymerase chain reaction (qRT-PCR) has been widely used in gene expression analyses due to its advantages of sensitivity, accuracy and high throughput. The stability of internal reference genes has progressively emerged as a major factor affecting the precision of qRT-PCR results. However, the stability of the expression of the reference genes needs to be determined further in different cells or organs, physiological and experimental conditions. Methods for evaluating these candidate internal reference genes have also evolved from simple single software evaluation to more reliable and accurate internal reference gene evaluation by combining different software tools in a comprehensive analysis. This study intends to provide a definitive reference for upcoming research that will be conducted on fruit trees. The primary focus of this review is to summarize the research progress in recent years regarding the selection and stability analysis of candidate reference genes for different fruit trees.

Environmental sustainable: Biogenic copper oxide nanoparticles as nano-pesticides for investigating bioactivities against phytopathogens.

Endocrine-disrupting chemicals (EDCs) are of interest in human physiopathology and have been extensively studied for their effects on the endocrine system. Research also focuses on the environmental impact of EDCs, including pesticides and engineered nanoparticles, and their toxicity to organisms. Green nanofabrication has surfaced as an environmentally conscious and sustainable approach to manufacture antimicrobial agents that can effectively manage phytopathogens. In this study, we examined the current understanding of the pathogenic activities of Azadirachta indica aqueous formulated green synthesized copper oxide nanoparticles (CuONPs) against phytopathogens. The CuONPs were analyzed and studied using a range of analytical and microscopic techniques, such as UV-visible spectrophotometer, Transmission electron microscope (TEM), Scanning electron microscope (SEM), X-ray diffraction (XRD) and Fourier transformed infrared spectroscopy (FTIR). The XRD spectral results revealed that the particles had a high crystal size, with an average size ranging from 40 to 100 nm. TEM and SEM images were utilized to verify the size and shape of the CuONPs, revealing that they varied between 20 and 80 nm. The existence of potential functional molecules involved in the reduction of the nanoparticles was confirmed by FTIR spectra and UV analysis. Biogenically synthesized CuONPs revealed significantly enhanced antimicrobial activities at 100 mg/L concentration in vitro by the biological method. The synthesized CuONPs at 500 µg/ml had a strong antioxidant activity which was examined through the free radicle scavenging method. Overall results of the green synthesized CuONPs have demonstrated significant synergetic effects in biological activities which can play a crucial impact in plant pathology against numerous phytopathogens.

Esterases as emerging biocatalysts: Mechanistic insights, genomic and metagenomic, immobilization, and biotechnological applications.

Esterase enzymes are a family of hydrolases that catalyze the breakdown and formation of ester bonds. Esterases have gained a prominent position in today's world's industrial enzymes market. Due to their unique biocatalytic attributes, esterases contribute to environmentally sustainable design approaches, including biomass degradation, food and feed industry, dairy, clothing, agrochemical (herbicides, insecticides), bioremediation, biosensor development, anticancer, antitumor, gene therapy, and diagnostic purposes. Esterases can be isolated by a diverse range of mammalian tissues, animals, and microorganisms. The isolation of extremophilic esterases increases the interest of researchers in the extraction and utilization of these enzymes at the industrial level. Genomic, metagenomic, and immobilization techniques have opened innovative ways to extract esterases and utilize them for a longer time to take advantage of their beneficial activities. The current study discusses the types of esterases, metagenomic studies for exploring new esterases, and their biomedical applications in different industrial sectors.

Assessment of Medical Professionalism among Students and Faculty Members of Shalamar Medical and Dental College, Lahore.

INTRODUCTION: Medical professionalism is an essential part of training and professional development of medical students. Unprofessional behavior in medical school may lead to professional misconduct in the future careers. The Learner's Attitude of Medical Professionalism Scale (LAMPS) is a self-assessment questionnaire. It has been used in this study to assess and compare self-reported attitudes about different domains of medical professionalism among First and Final Year students and Faculty of Shalamar Medical and Dental College (SMDC). LAMPS has been used to identify the gaps in the attitudes of medical students and professionals, which can be addressed through a training program of professionalism. METHODS: This is a cross-sectional survey conducted in SMDC from June to Dec 2018. First Year and Final Year Students and Faculty were recruited by non-probability convenience sampling. The sample size was calculated by the Cochran's Formula, keeping the level of significance at 5% and margin of error at 3%. The reliability of LAMPS using Cronbach's alpha is 0.7. It has been validated by 32 experts followed by pilot testing. The domains of professionalism were scored according to Likert Scale. The data were analyzed using SPSS 24. T-test was used for comparison of the means. RESULTS: There were a total of 204 study participants; 88 students from First Year, 78 from Final Year and 38 Faculty Members. Honor/Integrity was the most valued trait and Excellence/Autonomy was the lowest scored domain of medical professionalism. There was a significant difference among attitudes of the First and Final Year students in the domains of Excellence/Autonomy and Altruism. Excellence/Autonomy and Honor/Integrity showed a significant difference between the Final Year students and Faculty. CONCLUSIONS: Medical students and faculty have significantly different views of certain attributes of professionalism. Honor/Integrity was the most valued trait and Excellence/Autonomy was the lowest valued trait of medical professionalism.

Coronaviruses: An overview with special emphasis on COVID-19 outbreak with musculoskeletal manifestations.

An acute respiratory illness caused by a novel coronavirus, namely, severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19), began spreading across China in late December 2019. The disease gained global attention as it spread worldwide. Since the COVID-19 pandemic began, many studies have focused on the impact of the disease on conditions such as diabetes, cardiovascular disease, pulmonary disorders, and renal malfunction. However, few studies have focused on musculoskeletal disorders related to COVID-19 infection. In this review, we update the current knowledge on the coronavirus with special reference to its effects during and after the pandemic on musculoskeletal aliments, which may inform clinical practice.

Functional and Radiological Outcome Analysis of Osteoperiosteal Decortication Flap in Nonunion of Tibia.

INTRODUCTION: The treatment of long bone shaft nonunions is challenging. The technique of osteoperiosteal decortications flap for approaching the nonunion site coupled with fixation modalities was first described by Judet in 1963. Despite promising clinical and radiological union, this technique is not popular among orthopaedic surgeons. Our study aimed to evaluate the radiological union and functional results of shaft tibia nonunions treated by the osteoperiosteal decortication approach. METHODS: This retrospective study included all the cases with established tibial shaft nonunion following stringent inclusion and exclusion criteria and operated upon by following the principle of osteoperiosteal flap technique from April 2015 to July 2019. Further subgroups were made based on nonunions complexity based on nonunion scoring system (NUSS) score. The outcome measures included radiological union scale in tibial fractures (RUST) and lower extremity functional scale (LEFS). The preoperative scores for union and function were recorded, and the subsequent scores were obtained at three, six, and nine months and one year. Appropriate statistical analysis of the data was done. RESULTS: Thirty-four cases were shortlisted for analysis, fulfilling our inclusion and exclusion criteria. There were 22 males (64.7%) and 12 females (35.3%) with a mean age of 34.17 ± 10.3 years. Subgroup analysis based on the complexity of nonunion (NUSS score) revealed 14 cases in group A, 10 cases in group B, 10 cases in group C, and 0 cases in group D. The average time from fracture to surgery in these cases was 14.6 months. The average time to achieve union was 9.6 months, with patients in groups A, B, and C, having a mean duration of 9, 10.5, and 12 months, respectively. Statistically, significant improvement was seen in both RUST scores and LEFS score. Complications included infection in seven cases, wound dehiscence in two cases, and four cases of persistent nonunion. CONCLUSION: Osteoperiosteal decortication remains a highly effective surgical technique in the management of nonunion of long bones. NUSS scoring is an essential tool for prognosticating nonunion cases. This score is inversely related to the radiological union (RUST score) of the bone and functional recovery (LEFS score) of the patient.

CCN3 Proteins as a diagnostic marker in osteosarcoma patients: A case control study.

BACKGROUND: Osteosarcoma is the most prevalent type of primary bone sarcoma and is the major cause of deaths associated with cancer in children and adolescents. Despite novel and innovative therapies, early diagnosis of the osteosarcoma is still critically needed. Our study aimed to analyse the CCN3 proteins as a diagnostic marker and correlate their expression level with the severity of primary osteosarcoma patients. METHODS: In this prospective case-control study, after ethical clearance and informed consent, a total of 35 cases with primary osteosarcoma and ten otherwise healthy controls were enroled according to our strict inclusion-exclusion criteria. Tissue samples were collected during biopsy procedures in suspected cases and in controls during bone grafting procedures. The CCN3 expression level was measured by the western blotting assay. The clinic-radiological examinations were done in cases and graded according to the AJCC classification. Comparisons of CCN3 expression were measured between cases and controls, followed by correlation of their expression level with severity/grade of osteosarcoma in cases. RESULTS: All the demographic parameters showed insignificant differences. The CCN3 protein expressions were significantly upregulated in tissue samples of osteosarcoma patients (cases) compared to controls. The mean difference (p<0.0001) in CCN3 protein expression between cases' and controls' bony tissues was significant but showed insignificant correlation with the different grades of osteosarcoma. CONCLUSIONS: The upregulated CCN3 protein expression in osteosarcoma tissue along with significant differential manifestation in accordance with different grades of osteosarcoma make CCN3 suitable for a potential diagnostic biomarker. However, the author recommends further extensive multi-centric collaborative studies to increase our study reliability and generalizability.

Can impaired diaphyseal fracture healing be predicted early?: A cohort study of biomarkers.

BACKGROUND: Currently, the clinico-radiological method was used to analyze the healing progression of fractures globally, but even they are also unable to presume the impaired healing early. Hence till date, no reliable methods are available to predict the impaired healing early, so that it could be interventionally managed as required within the time. METHODS: In this prospective observational study, a total of 121 adults fractured patients and 108 healthy controls were analyzed. Peripheral blood samples were taken from controls (at once) and fractured cases (at different follow-ups) to quantify the Osteocalcin and Osteopontin mRNA and protein expression using qRT-PCR and western blotting assay respectively. In parallel to that the clinico-radiological follow-up examinations also done at various specific follow-up intervals up to 24th post-fracture weeks. RESULTS: As per the clinico-radiological status at the 24th week, fracture patients were divided into normal healing (n = 102) and impaired healing (n = 19) groups. Mean RUST score between normal healing and the impaired healing group showed a significant statistical difference at each follow-up. In both groups, expressions of Osteocalcin (mRNA & protein) were gradually up-regulated from the baseline to end of follow-ups, whereas Osteopontin mRNA as well as protein gradually up-regulated from the baseline to a peak value at 10th day, then declined. In general, the Osteocalcin and Osteopontin mean fold expressions were higher in normal healing as compared to the impaired healing groups.A significant correlation was found between the mRNA expressions of Osteocalcin and Osteopontin with the RUST score at most of the follow-ups. However, the protein expressions were not shown any significant correlation. CONCLUSIONS: The Osteocalcin and Osteopontin expression will provide an early prediction of the healing outcomes of tibial fractures. This may open a new horizon for innovations to deal with complications associated with impaired fracture healing, especially in tibial bone fractures.

Magnitude and Spectrum of Injuries Sustained in Road Traffic Accidents Among Two Wheeler Riders and Correlation with Helmet Use.

BACKGROUND: Helmet, as a protective gear to prevent fatal injuries while riding two-wheelers, needs to be evaluated by quality data. The aim of the study was to find out spectrum of injuries sustained with downstream outcomes in relation to acceptable ways of use of crash-proof helmet among motorized two-wheeler riders compared to nonuse following road traffic accidents. METHODS: The present study was an analytical cross-sectional multicentric study conducted at three dedicated trauma care centers of India: (a) Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, (b) King George's Medical University, Lucknow, Uttar Pradesh, and (c) Narayana Medical College and Hospital, Nellore, Andhra Pradesh. Detailed information was collected on correct use of crash-proof helmets versus nonusers. RESULTS: Among 317 traumatic brain injury victims (mean age 31.4 ± 12.5 years; range 11-70 years; highest (38%) in the 21-30 years age group), majority were from urban areas (84%), were brought directly to trauma center (76%), and were "Drivers" (73.50%), and their vision was "normal with or without using corrective lenses" (96%). Two-thirds of the victims were carrying "Formal driving licenses," one-thirds were "Primary earning member of the family," and one-tenths were under influence of alcohol. Half of the two-wheeler riders were using helmet, still lesser fastened helmet properly (45%), and few others used ISI quality "Crash proof" (38.5%). Helmet use during accidents had significantly better outcomes and significantly low clinical symptoms such as loss of consciousness, vomiting, ear/nose/oral bleed, headache, seizures with associated bony, abdominal, and chest injuries. CONCLUSIONS: Helmets have protective effects on riders if helmets are of crash-proof quality, fastened properly, and consistently used even for short spells and distances of rides.

Effectiveness and Safety of Polygeline in Patients with Hypovolemia due to Trauma.

BACKGROUND: This retrospective study examined the effectiveness and safety of polygeline in adult patients with hypovolemia due to traumatic injury. MATERIALS AND METHODS: Polygeline was administered after evaluating the amount of blood loss and estimating hematological and biochemical parameters. Changes in vital signs, serum electrolytes, arterial pH, and serum lactate were evaluated. The safety was evaluated by recording the adverse events if any. RESULTS: Sixty patients with the mean age 37.5 ± 11.26 years were included in the study. All patients had blood loss < 20%. The mean total polygeline administered was 1025.0 ± 464.18 ml. Blood transfusion was required in 3.33% of patients. Diastolic, systolic, and mean arterial blood pressure and pulse rate significantly increased after 1 h of polygeline administration (P < 0.0001). There was a trend toward increase in urine output (P = 0.0715) after 1 h. The improvement in vital parameters was consistent at 6, 14, and 18 h after administration of polygeline. Arterial pH significantly increased from 7.2 ± 0.12 to 7.3 ± 0.11 after 1 h of administration (P < 0.0001) and was consistent till 24 h (P = 0.035). Blood lactate decreased after 1 h (P < 0.0001). Changes in laboratory parameters were not clinically significant. After mean duration hospital stay of 10.5 ± 4.63 days all patients were discharged without any clinically significant abnormality or adverse event. CONCLUSION: Polygeline improved hemodynamic stability in patients with hypovolemia due to traumatic injury. The improvement was seen within 1 h (golden hour) of polygeline administration and maintained consistently. Polygeline can be safely administered to patients with traumatic injury to improve hemodynamic parameters and achieve stability.

Identification of the cysteine-rich 61 (CYR61) gene variations in osteosarcoma patients.

BACKGROUND/AIM: Osteosarcoma requires an angiogenesis process. CYR61 is one of the extracellular signaling molecules that promote angiogenesis, tumor growth, and the malignancy of osteosarcoma. In the present study, we investigate the CYR61 gene variations in osteosarcoma and their correlations with clinicopathological findings. MATERIALS AND METHODS: We performed variation analysis of the CYR61 gene in 58 patients with osteosarcoma. With an aim to ascertain the variety of variations in exons 2, 3, 4, and 5 of the CYR61 gene in osteosarcoma, we did a PCR-SSCP followed by DNA sequencing. RESULTS: In osteosarcoma the CYR61 gene variations found were 18.96% (11/58) in exon 2, 3.44% (2/58) in exon 3, 8.62% (5/58) in exon 4, and 15.51% (9/58) in exon 5. In our variation analysis, we detected one missense variation in exon 2 (Arg47Trp), one silent variation in exon 3 (Lys152Lys), one missense variation in exon 4 (Phe213Leu), and two missense variations in exon 5 (Gly315Arg and Asp339Asn). The overall CYR61 variation frequency in exons 2, 3, 4, and 5 was determined to be 46.55% (27/58). CONCLUSION: Our study specifies the role of CYR61 gene variation in osteosarcoma. The result signifies that CYR61 might be used as a prognostic/diagnostic marker in osteosarcoma patients.

CYR61-An angiogenic biomarker to early predict the impaired healing in diaphyseal tibial fractures.

BACKGROUND: Angiogenesis is a prerequisite for fracture repair, whereas insufficient blood supply is likely to result in impaired healing. In the present study, we aimed to determine the correlation of simple tibial fracture healing outcome with serial estimation of CYR61 expressions in the early phase of healing. METHODS: In total, 107 adult fractured patients and 97 healthy controls were analysed. Peripheral blood samples were taken from controls (at once) and fractured patients at 4th, 7th, 10th, 15th, 20th and 28th days of post-fracture follow-ups to quantify the CYR61 mRNA and protein expression by qRT-PCR and Western blotting assay, respectively. Clinic-radiological follow-up was done at 6th, 10th, 16th, 20th, and 24th weeks of post-fracture follow-ups using RUST scores to analyse the fracture healing progression and their final outcomes. RESULTS: By considering controls as Group I (n = 97), as per the clinico-radiological status at 24th week, fracture patients were divided into two groups: Group II (normal healing, n = 91) and Group III (impaired healing, n = 16). Both CYR61 mRNA and protein expressions were lower (baseline) in Group I than in Groups II and III; however, a significant difference was observed only with the Group II. In both groups, expressions of CYR61 mRNA as well as protein gradually upregulated from the baseline to a peak and then declined. Both, the CYR61 mRNA as well as protein expressions were significantly higher at all follow-ups in Group II than in Group III. Mean RUST scores between Group II and Group III showed a significant statistical difference at each follow-up. Significant correlation was found between the CYR61 expressions and the RUST score (fracture healing progression). CONCLUSION: We conclude that CYR61 expression provides an early prediction of the healing outcomes of simple diaphyseal tibial fractures. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: Such an approach would benefit not only the patients' wellbeing but also the entire health care system in terms of the cost implications associated with long lasting treatment interventions and hospitalisation. However, the authors recommend further multicentric study with a large sample size to increase the validity, reliability, and generalisability of our observation and inferences.

Phosphorylated neurofilament heavy: A potential blood biomarker to evaluate the severity of acute spinal cord injuries in adults.

AIMS: The aim of this study is to analyze the serial estimation of phosphorylated neurofilament heavy (pNF-H) in blood plasma that would act as a potential biomarker for early prediction of the neurological severity of acute spinal cord injuries (SCI) in adults. SETTINGS AND DESIGN: Pilot study/observational study. SUBJECTS AND METHODS: A total of 40 patients (28 cases and 12 controls) of spine injury were included in this study. In the enrolled cases, plasma level of pNF-H was evaluated in blood samples and neurological evaluation was performed by the American Spinal Injury Association Injury Scale at specified period. Serial plasma neurofilament heavy values were then correlated with the neurological status of these patients during follow-up visits and were analyzed statistically. STATISTICAL ANALYSIS USED: Statistical analysis was performed using GraphPad InStat software (version 3.05 for Windows, San Diego, CA, USA). The correlation analysis between the clinical progression and pNF-H expression was done using Spearman's correlation. RESULTS: The mean baseline level of pNF-H in cases was 6.40 ± 2.49 ng/ml, whereas in controls it was 0.54 ± 0.27 ng/ml. On analyzing the association between the two by Mann-Whitney U-test, the difference in levels was found to be statistically significant. The association between the neurological progression and pNF-H expression was determined using correlation analysis (Spearman's correlation). At 95% confidence interval, the correlation coefficient was found to be 0.64, and the correlation was statistically significant. CONCLUSIONS: Plasma pNF-H levels were elevated in accordance with the severity of SCI. Therefore, pNF-H may be considered as a potential biomarker to determine early the severity of SCI in adult patients.

Polygeline in hypovolemia due to traumatic injury: Results of an open label study in Indian population.

OBJECTIVE: Evaluation of efficacy and safety of polygeline in adult patients with hypovolemia. MATERIALS AND METHODS: In an open label, non-comparative study intravenous infusion of polygeline was administered to adult patients with hypovolemia following traumatic injury. Efficacy was evaluated by noting changes in the signs and symptoms of hypovolemia while safety was evaluated by recording adverse events. RESULTS: Forty nine patients with mean age 33.67 ± 15.36 years having long bones fracture were enrolled. The mean and percentage of blood loss was 1291.30 ± 168.43 ml and 26.09 ± 3.13% respectively. Polygeline was given to all patients while other intravenous fluids were required in 44 patients. Baseline heart rate reduced from 100.09 ± 9.13 per minute to 98.45 ± 12.60 and 86 ± 10.10 at one hour (P < 0.05) and at two hours (P < 0.001) respectively. The reduction in heart rate was significant at other time points (<0.001) too. Systolic blood pressure (BP) increased from 79.06 ± 10.22 to 94.27 ± 9.18 mm Hg at one hour and 109.18 ± 6.80 mm Hg at two hours (both one and two hours; P < 0.001). Similarly diastolic BP also increased from 57.79 ± 10.59 to 62.89 ± 9.62 mm Hg at one hour and 69.41 ± 11.59 mm Hg at two hours (both one and two hours; P < 0.001). Rise in blood pressure was consistent till 24 hours. Overall improvement was seen in 97.92% patients. Improvement in pallor, dry tongue, and skin changes six and 24 hours was observed in 77.08%, 79.17%, 59.57% and 87.50%, 100% and 93.62% patients respectively (all parameters at six and 24 hours P < 0.0001). No patient reported adverse event. CONCLUSION: Polygeline is safe and effective treatment for correcting hemodynamic instability in hypovolemia due to trauma. Use of polygeline resulted in early and significant improvement in hemodynamic parameters.

Role of alpha-crystallin, early-secreted antigenic target 6-kDa protein and culture filtrate protein 10 as novel diagnostic markers in osteoarticular tuberculosis.

Osteoarticular tuberculosis constitutes about 3% of all tuberculosis cases. Early and accurate diagnosis of tuberculosis is a challenging problem especially in the case of osteoarticular tuberculosis owing to the lower number of bacilli. However, an accurate and timely diagnosis of the disease results in an improved efficacy of the given treatment. Besides the limitations of conventional methods, nowadays molecular diagnostic techniques have emerged as a major breakthrough for the early diagnosis of tuberculosis with high sensitivity and specificity. Alpha-crystallin is a dominantly expressed protein responsible for the long viability of the pathogen during the latent phase under certain stress conditions such as hypoxia and nitric oxide stress. Two other proteins-early secreted antigenic target-6 and culture filtrate protein-10-show high expression in the active infective phase of Mycobacterium tuberculosis. In this article, we focus on the different proteins expressed dominantly in latent/active tuberculosis, and which may be further used as prognostic biomarkers for diagnosing tuberculosis, both in latent and active phases.

Does Serum Albumin Level Affect the Healing Outcomes of Simple Diaphyseal Tibial Fractures?

AIMS: To quantify the serum albumin level and its correlation with fracture healing progression and outcomes in adult patients. SETTINGS AND DESIGN: A prospective cohort study at an institutional trauma center. MATERIALS AND METHODS: A total of 50 adult patients with simple, fresh traumatic diaphyseal fractures of both bones of the leg managed conservatively were included in the study. Serum albumin was measured initially and at the 6th week postfracture. The clinico-radiological follow-up was done to analyze the fracture healing progression and their final outcomes, which were correlated with the quantified serum albumin level of the patients. STATISTICAL ANALYSIS USED: Student t-test, Mann-Whitney U-test and Pearson correlation coefficient. RESULTS: As per the last clinico-radiological follow-up at the 24th week, patients were grouped into two groups: Group I (normal union n = 38) and Group II (impaired healing n = 12). The mean serum albumin levels were significantly higher in Group I when compared to Group II. The association between the serum albumin level at baseline and at the 6th week was moderate. The best cut-off measure of serum albumin level was 3.45 g/dL, both at baseline and at the 6th week after fracture to predict the healing outcome. The correlation of serum albumin levels with fracture healing outcomes was statistically significant. CONCLUSION: Serum albumin is moderately associated with the baseline and 6th-week values and showed a positive correlation with the bony healing progression and may provide an early predictor of the healing outcomes of simple diaphyseal tibial fractures.

Pattern of fall injuries in Pakistan: the Pakistan National Emergency Department Surveillance (Pak-NEDS) study.

BACKGROUND: We aimed to analyse the frequency and patterns of fall-related injuries presenting to the emergency departments (EDs) across Pakistan. METHODS: Pakistan National Emergency Departments surveillance system collected data from November 2010 to March 2011 on a 24/7 basis using a standardized tool in seven major EDs (five public and two private hospitals) in six major cities of Pakistan. For all patients presenting with fall-related injuries, we analysed data by intent with focus on unintentional falls. Simple frequencies were run for basic patient demographics, mechanism of falls, outcomes of fall injuries, mode of arrival to ED, investigations, and procedures with outcomes. RESULTS: There were 3335 fall-related injuries. In cases where intent was available, two-thirds (n = 1186, 65.3%) of fall injuries were unintentional. Among unintentional fall patients presenting to EDs, the majority (76.9%) were males and between 15-44 years of age (69%). The majority of the unintentional falls (n = 671, 56.6%) were due to slipping, followed by fall from height (n = 338, 28.5%). About two-thirds (n = 675, 66.6%) of fall injuries involved extremities, followed by head/neck (n = 257, 25.4%) and face (n = 99, 9.8%). Most of the patients were discharged from the hospital (n = 1059, 89.3%). There were 17 (1.3%) deaths among unintentional fall cases. CONCLUSION: Falls are an important cause of injury-related visits to EDs in Pakistan. Most of the fall injury patients were men and in a productive age group. Fall injuries pose a burden on the healthcare system, especially emergency services, and future studies should therefore focus on safety measures at home and in workplaces to reduce this burden.

The Pakistan National Emergency Department Surveillance Study (Pak-NEDS): Introducing a pilot surveillance.

BACKGROUND: Evidence-based decision making is essential for appropriate prioritization and service provision by healthcare systems. Despite higher demands, data needs for this practice are not met in many cases in low- and middle-income countries because of underdeveloped sources, among other reasons. Emergency departments (EDs) provide an important channel for such information because of their strategic position within healthcare systems. This paper describes the design and pilot test of a national ED based surveillance system suitable for the Pakistani context. METHODS: The Pakistan National Emergency Department Surveillance Study (Pak-NEDS) was pilot tested in the emergency departments of seven major tertiary healthcare centres across the country. The Aga Khan University, Karachi, served as the coordinating centre. Key stakeholders and experts from all study institutes were involved in outlining data needs, development of the study questionnaire, and identification of appropriate surveillance mechanisms such as methods for data collection, monitoring, and quality assurance procedures. The surveillance system was operational between November 2010 and March 2011. Active surveillance was done 24 hours a day by data collectors hired and trained specifically for the study. All patients presenting to the study EDs were eligible participants. Over 270,000 cases were registered in the surveillance system over a period of four months. Coverage levels in the final month ranged from 91-100% and were highest in centres with the least volume of patients. Overall the coverage for the four months was 79% and crude operational costs were less than $0.20 per patient. CONCLUSIONS: Pak-NEDS is the first multi-centre ED based surveillance system successfully piloted in a sample of major EDs having some of the highest patient volumes in Pakistan. Despite the challenges identified, our pilot shows that the system is flexible and scalable, and could potentially be adapted for many other low- and middle-income settings.