Endemic Bladder Stone Disease in Children, Pattern And Current Management: Experience From A Centre In Peri-Urban Setting In Pakistan.

PURPOSE: To share our recent experience of the pattern and demography of endemic bladder calculi in children and the outcomes of current management strategies for the removal of bladder calculi in a peri-urban setting. MATERIAL AND METHODS: This retrospective longitudinal study was carried out at a dedicated urology centre. All patients with endemic bladder stones from January 2020 to December 2021 managed at our centre were included in this study. After discharge, each patient was followed up for 1 year. Data analysis was carried out with IBM SPSS v23. Mean and standard deviation were calculated for normally distributed continuous variables; for non-normally distributed continuous variables, median and IQR were calculated; frequency and percentage were calculated for categorical variables. RESULTS: This study included 254 patients, with a male-to-female ratio of 10.5:1. The mean age of the patients was 4.80 ± 2.86 years. Ninety-one percent of the patients belonged to rural areas. Open cystolithotomy (OC) was performed in 11 (4.3%) patients, transurethral cystolithotripsy (TUCL) in 165 (65.0%), and percutaneous cystolithotomy (PCCL) in 78 (30.7%). The mean operative time was 48.8±4.34 minutes for TUCL, 36.18±7.4 minutes for open cystolithotomy, and 38.6±5.2 minutes for PCCL. The most common stone composition was ammonium urate + calcium phosphate (33.1%). The complication rate was 4.8% in TUCL, 12.8% in PCCL, and 27.3% in open cystolithotomy. Stone clearance was 98.1% for TUCL and 100% for both PCCL and OC. CONCLUSION:   Pediatric bladder calculus is still endemic in rural areas of Sindh with poor socioeconomic backgrounds. Timely diagnosis and early intervention with preventive measures can lead to better outcomes and fewer complications. Minimally invasive methods of cystolithotomy have a shorter hospital stay, are more cost-effective, and have fewer complications as compared to open cystolithotomy.

Drug-eluting balloon to treat immediate post-coronary artery bypass grafting ST-elevation myocardial infarction: a case report.

Background: Coronary artery bypass graft (CABG) surgery represents a major cardiovascular operation and may be associated with post-operative ST-elevation myocardial infarction (STEMI) due to graft failure. This is challenging to diagnose and treat as the implanted grafts may be prone to complications when treated percutaneously with drug-eluting stents. Case summary: A man in his 60 s underwent CABG and developed new persistent ST elevations of 2 mm in anterior leads with no significant chest pain, although, administered with intravenous opiates post-operatively. Transthoracic echocardiography was non-diagnostic. Invasive angiography performed emergently showed a thrombotic occlusion of the mid-left anterior descending artery at the site of the anastomosis with the left internal mammary artery (LIMA) graft. Intervention via the graft was considered high risk of complications, therefore, native coronary arteries were used to approach the occlusion, which was successfully cleared with a combination balloon angioplasty with a semi-compliant and then a drug-eluting balloon. The LIMA started working again with the resolution of ST elevation and no immediate complications. Discussion: Early post-operative ST elevations in continuous leads should not be ignored as they often may be the only feature of new-onset STEMI. Drug-eluting balloons represent a feasible and possibly safer option than drug-eluting stents to treat these conditions.

Drug repurposing: identification of SARS-CoV-2 potential inhibitors by virtual screening and pharmacokinetics strategies.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic caused global health, economic, and population loss. Variants of the coronavirus contributed to the severity of the disease and persistent rise in infections. This study aimed to identify potential drug candidates from fifteen approved antiviral drugs against SARS-CoV-2 (6LU7), SARS-CoV (5B6O), and SARS-CoV-2 spike protein (6M0J) using virtual screening and pharmacokinetics to gain insights into COVID-19 therapeutics. METHODOLOGY: We employed drug repurposing approach to analyze binding performance of fifteen clinically approved antiviral drugs against the main protease of SARS-CoV-2 (6LU7), SARS-CoV (5B6O), and SARS-CoV-2 spike proteins bound to ACE-2 receptor (6M0J), to provide an insight into the therapeutics of COVID-19. AutoDock Vina was used for docking studies. The binding affinities were calculated, and 2-3D structures of protein-ligand interactions were drawn. RESULTS: Rutin, hesperidin, and nelfinavir are clinically approved antiviral drugs with high binding affinity to proteins 6LU7, 5B6O, and 6M0J. These ligands have excellent pharmacokinetics, ensuring efficient absorption, metabolism, excretion, and digestibility. Hesperidin showed the most potent interaction with spike protein 6M0J, forming four H-bonds. Nelfinavir had a high human intestinal absorption (HIA) score of 0.93, indicating maximum absorption in the body and promising interactions with 6LU7. CONCLUSIONS: Our results indicated that rutin, hesperidin, and nelfinavir had the highest binding results against the proposed drug targets. The computational approach effectively identified SARS-CoV-2 inhibitors. COVID-19 is still a recurrent threat globally and predictive analysis using natural compounds might serve as a starting point for new drug development against SARS-CoV-2 and related viruses.

Artificial Intelligence - Perception of Clinical Laboratories' Technical Staff a Nationwide Multicentre Survey in Pakistan.

Introduction: As Artificial Intelligence (AI) technology continues to assimilate into various industries, there is a huge scope in the healthcare industry specifically in clinical laboratories. The perspective of the laboratory professionals can give valuable insight on the ideal path to take for AI implementation. Methods: The study utilized a cross-sectional survey design and was conducted at the section of Chemical Pathology, Department of Pathology and Laboratory Medicine, the Aga Khan University (AKU), Karachi, Pakistan in collaboration with Consultant Pathologists of 9 clinical laboratories associated with teaching hospitals across Pakistan from October-November 2023. The survey was for a duration of 2 weeks and was circulated to all working laboratory technical staff after informed consent. Results: A total of 351 responses were received, of which 342 (male=146, female=196) responses were recorded after exclusion. Respondents ranged from technologists, faculty, residents, and coordinators, and were from different sections (chemical pathology, microbiology, haematology, histopathology, POCT). Out of the total 312 (91.2%) of respondents stated that they were at least somewhat familiar with AI technology. Experts in AI were only 2.0% (n=7) of all respondents, but 90% (n=6) of these were < 30 years old. 76.3% (n=261) of the respondents felt the need to implement more AI technology in the laboratories, with time saving (26.1%) and improving performances of tests (17.7%) cited to be the greatest benefits of AI. Security concerns (n=144) and a fear of decreasing personal touch (n=143) were the main concerns of the respondents while the younger employees had an increased fear of losing their jobs. 76.3% were in favour of an increase in AI usage in the laboratories. Conclusion: This study highlights a favourable perspective among laboratory professionals, acknowledging the potential of AI to enhance both the efficiency and quality of laboratory practices. However, it underscores the importance of addressing their concerns in the thoughtful implementation of this emerging technology.

In Vitro In Vivo Extrapolation and Bioequivalence Prediction for Immediate-Release Capsules of Cefadroxil Based on a Physiologically-Based Pharmacokinetic ACAT Model.

Physiologically based pharmacokinetic (PBPK) modeling is a mechanistic concept, which helps to judge the effects of biopharmceutical properties of drug product such as in vitro dissolution on its pharmacokinetic and in vivo performance. With the application of virtual bioequivalence (VBE) study, the drug product development using model-based approach can help in evaluating the possibility of extending BCS-based biowaiver. Therefore, the current study was intended to develop PBPK model as well as in vitro in vivo extrapolation (IVIVE) for BCS class III drug i.e. cefadroxil. A PBPK model was created in GastroPlus™ 9.8.3 utilizing clinical data of immediate-release cefadroxil formulations. By the examination of simulated and observed plasma drug concentration profiles, the predictability of the proposed model was assessed for the prediction errors. Furthermore, mechanistic deconvolution was used to create IVIVE, and the plasma drug concentration profiles and pharmacokinetic parameters were predicted for different virtual formulations with variable cefadroxil in vitro release. Virtual bioequivalence study was also executed to assess the bioequivalence of the generic verses the reference drug product (Duricef®). The developed PBPK model satisfactorily predicted Cmax and AUC0-t after cefadroxil single and multiple oral dose administrations, with all individual prediction errors within the limits except in a few cases. Second order polynomial correlation function obtained accurately predict in vivo drug release and plasma concentration profile of cefadroxil test and reference (Duricef®) formulation. The VBE study also proved test formulation bioequivalent to reference formulation and the statistical analysis on pharmacokinetic parameters reported 90% confidence interval for Cmax and AUC0-t in the FDA acceptable limits. The analysis found that a validated and verified PBPK model with a mechanistic background is as a suitable approach to accelerate generic drug development.

Radiolabeling and preclinical animal model evaluation of DTPA coupled 99mTc-labelled flutamide complex ([99mTc]DTPA-FLUT) as a potential radiotracer for cancer imaging.

BACKGROUND: Advances in molecular imaging strategies have had an effect on precise diagnosis and treatment. Research has been intensified to develop more effective and versatile radiopharmaceuticals to uplift diagnostic efficiency and, consequently, the treatment. PURPOSE: To label the flutamide (FLUT) coupled with diethylenetriamine pentaacetate (DTPA) with technetium-99 m (99mTc) and to evaluate its binding efficiency with rhabdomyosarcoma (RMS) cancer cells. MATERIAL AND METHODS: Radiolabeling of FLUT with 185 MBq freshly eluted 99mTcO4-1 was carried out via DTPA bifunctional chelating agent using stannous chloride reducing agent at pH 5. The labeled compound was assessed for its purity using chromatography analysis, stability in saline and blood serum, AND charge using paper electrophoresis. Normal biodistribution was studied using a mouse model, while binding affinity with RMS cancer cells was studied using an internalization assay. The in vivo accumulation of RMS cancer cells in a rabbit model was monitored using a SPECT gamma camera. RESULTS: Radiolabeling reaction displayed a pharmaceutical yield of 97% and a stability assay showed >95% intact radiopharmaceutical up to 6 h in saline and blood serum. In vitro internalization studies showed the potential of [99mTc]DTPA-FLUT to enter into cancer cells. This biodistribution study showed rapid blood clearance and minimum uptake by body organs, and scintigraphy displayed the [99mTc]DTPA-FLUT uptake by lesion, induced by RMS cancer cell lines in rabbit. CONCLUSION: Stable, newly developed [99mTc]DTPA-FLUT seeks its way to internalize into RMS cancer cells, indicating it could be a potential candidate for the diagnosis of RMS cancer.

Enhancing trash classification in smart cities using federated deep learning.

Efficient Waste management plays a crucial role to ensure clean and green environment in the smart cities. This study investigates the critical role of efficient trash classification in achieving sustainable solid waste management within smart city environments. We conduct a comparative analysis of various trash classification methods utilizing deep learning models built on convolutional neural networks (CNNs). Leveraging the PyTorch open-source framework and the TrashBox dataset, we perform experiments involving ten unique deep neural network models. Our approach aims to maximize training accuracy. Through extensive experimentation, we observe the consistent superiority of the ResNext-101 model compared to others, achieving exceptional training, validation, and test accuracies. These findings illuminate the potential of CNN-based techniques in significantly advancing trash classification for optimized solid waste management within smart city initiatives. Lastly, this study presents a distributed framework based on federated learning that can be used to optimize the performance of a combination of CNN models for trash detection.

Approaches in Managing Resistant Hypertension: A Review.

In India, around 234 million adults (one in three) suffer from hypertension (HTN). An average of 10% of these cases are likely to be resistant hypertension (RH). This load of 23 million patients is expected to expand further with revisions in diagnostic criteria. The treatment and control rates of hypertension in India average around 30% and 15%, respectively. Pharmacological management involves a stepwise approach starting with optimizing the A-C-D (angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide-like diuretics) triple-drug combination, followed by substitution with a thiazide-like diuretic and use of spironolactone as a next step (fourth drug). The subsequent steps are suggestions based on expert input and must be individualized. These include using a ß-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when target blood pressure (BP) values are not achieved. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are likely to be helpful in managing RH due to their renal and cardiovascular protection as well as mortality benefits. SGLT2i lowers BP independent of the dosage and concomitant anti-hypertensive medications. Patient education and tools to monitor BP and treatment compliance will improve outcomes with these medications. In addition to therapeutic intervention, a preventive approach for RH mandates a need to identify patients at risk and use appropriate preventive and optimal therapy to prevent uncontrolled hypertension in patients with cardiovascular disorders.

Use of fibrinolytics for percutaneous drainage of intrabdominal hematoma: a case report.

Background: Intrabdominal hematoma can be managed with angioembolization, surgical drainage, or percutaneous drainage depending on the patient factors, underlying pathology, and size and stability of hematoma. During the past decades, advancements have been made in the percutaneous management of intrapleural fluid collections using fibrinolytics. However, intrabdominal hematoma resolution with the help of fibrinolytic-assisted percutaneous drainage has not been as widely studied as intrapleural fibrinolytics. Our case presents a scenario where effective percutaneous drainage of abdominal fluid collection using fibrinolytics avoided an operative intervention in a patient with a history of multiple abdominal surgeries. This case report in essence can help navigate future studies into exploring non-operative management options in patients with a history of multiple abdominal surgeries. Case Description: In this report, we present a 51-year-old female status post hiatal hernia repair with jejunostomy tube (J-tube) exchange complicated by walled off intraabdominal hematoma who presented with persistent abdominal pain and leakage around her J-tube. Due to her past history of multiple abdominal surgeries including multiple hiatal hernia repairs, distal esophagectomy with Roux-en-Y, and revision of the said Roux-en-Y complicated by wound dehiscence, surgical drainage was deferred in favor of trialing fibrinolytic administration via catheters. For this purpose, we employed the protocol for fibrinolytic administration used by the Second Multicenter Intrapleural Sepsis Trial (MIST2). Conclusions: Use of tissue plasminogen activator (t-PA) and deoxyribonuclease (DNase) as per MIST2 protocol was safely replicated for intrabdominal walled off hematoma and resulted in a near complete resolution of the hematoma in 1 week. The patient was eventually discharged with no complications. This case highlights safe and efficacious use of fibrinolytics for non-operative management of intrabdominal hematomas.

Staff radiation doses during Sentinel Lymph Node procedure of breast cancer from injection to surgeon.

The Sentinel Lymph Node (SLN) or Sentinel Lymph Node Biopsy (SLNB) technique involves various professionals from different departments in clinical settings to manage breast cancer patients properly. Tracing the nodular involvement of breast cancer patients requires radiation source Tc99m labeled with colloidal albumin to be injected at the tumor site. The patient becomes a radiation source for a sufficient time, which concerns the Nuclear Medicine (NM) and surgical staff. The study aims to provide the radiation doses of staff in the NM department during the SLN scintigraphy procedure and obtain an empirical model for calculating the radiation doses to staff in the surgical department from that particular patient. Radiation doses in SLN technique for breast cancer patients are minimal, and a sufficient number of SLN biopsy procedures can be performed by hospital staff within the category of non-radiation workers.

Cytogenetic abnormalities associated with reproductive failure in Pakistani population: Experience of a tertiary care hospital.

Constitutional chromosomal abnormalities play a significant role in causing reproductive anomalies in individuals of reproductive age. With the rapid advancement of genome engineering techniques, it has now become possible to cure different genetic disorders. However, very limited data is available regarding the prevalence of such aberrations in the Pakistani population. Considering this factor, this retrospective analysis was undertaken to elucidate the type and prevalence rate of such abnormalities in our population. A total of 241 individuals, who were referred to the Liaquat National Hospital, from January 2017 to December 2021, with a history of infertility or miscarriages, were evaluated using the standard GTG banding technique. The results revealed a notably high percentage 44(18.2%) of chromosomal abnormalities in our population. Surprisingly, the frequency of these anomalies was observed to be higher in males than in females. However, further research is needed using a larger sample size to confirm the findings of this investigation.

Functionalized Single Crystal Perovskite Materials for SERS and Their Potential Detection Applications.

Recent advances in detection and diagnostic tools have improved understanding and identification of plant physiological and biochemical processes. Effective and safe Surface Enhanced Raman Spectroscopy (SERS) can find objects quickly and accurately. Raman enhancement amplifies the signal by 1014-1015 to accurately quantify plant metabolites at the molecular level. This paper shows how to use functionalized perovskite substrates for SERS. These perovskite substrates have lots of surface area, intense Raman scattering, and high sensitivity and specificity. These properties eliminate sample matrix component interference. This study identified research gaps on perovskite substrates' effectiveness, precision, and efficiency in biological metabolite detection compared to conventional substrates. This article details the synthesis and use of functionalized perovskites for plant metabolites measurement. It analyzes their pros and cons in this context. The manuscript analyzes perovskite-based SERS substrates, including single-crystalline perovskites with enhanced optoelectronic properties. This manuscript aims to identify this study gap by comprehensively reviewing the literature and using it to investigate plant metabolite detection in future studies.

Cultivating a greener future: Exploiting trichoderma derived secondary metabolites for fusarium wilt management in peas.

This study aimed to identify efficient Trichoderma isolate(s) for the management of Fusarium wilt in peas. Four different pea germplasms (Sarsabz, Pea-09, Meteor and Supreme) were evaluated for resistance against Fusarium oxysporum in pot assay. Resistant germplasm exhibits a varying range of disease severity (23%) and percent disease index (21%), whereas susceptible and highly susceptible germplasm exhibit maximum disease severity (44-79%) and percent disease index (47-82%). The susceptible germplasm Meteor was selected for in vivo experiment. Five different Trichoderma spp. (Trichoderma koningii, T. hamatum, T. longibrachiatum, T. viride, and T. harzianum) were screened for the production of hydrolytic extracellular enzymes under in vitro. In-vitro biocontrol potential of Trichoderma spp. was assayed by percentage inhibition of dry mass of Fusarium oxysporum pisi (FOP) with Trichoderma spp. metabolite filtrate concentrations. Maximum growth inhibition was observed by T. harzianum (50-89%). T. harzianum metabolites in filtrate conc. (40%, 50%, and 60%) exhibited maximum reduction in biomass and were thus used for in vivo management of the disease. The pot experiment for in-vivo management also confirmed the maximum inhibition of FOP by T. harzianum metabolites filtrate at 60% by reducing disease parameters and enhancing growth, yield, and physiochemical and stress markers. Trichoderma strains led to an increase in chlorophyll and carotenoids (34-26%), Total phenolic 55%, Total protein content 60%, Total Flavonoid content 36%, and the increasing order of enzyme activities were as follows: CAT > POX > PPO > PAL in all treatments. These strains demonstrate excellent bio-control of Fusarium wilt in pea via induction of defense-related enzymes. The present work will help use Trichoderma species in disease management programme as an effective biocontrol agent against plant pathogens.

Management of Chronic Osteomyelitis and Antibiotic Stewardship; An Effort to Delay the Post-Antibiotic Era.

OBJECTIVE: To develop an effective antimicrobial strategy for the management of chronic osteomyelitis. STUDY DESIGN: Observational study. Place and Duration of the Study: Departments of Microbiology and Orthopaedics, Combined Military Hospital Malir, Karachi, Pakistan, from January 2021 to February 2022. METHODOLOGY: Bone biopsies of 45 enrolled participants were taken for microbiological evaluation. Intravenous antibiotic therapy was begun as per empirical therapy based on the local antibiogram and antibiotic policy. Once the susceptibility pattern was available, targeted therapy started and continued for 28 to 42 days. Patients were evaluated based on inflammatory markers and clinical conditions for a minimum of six months to a maximum of one year. RESULTS:  Out of the 45 patients, the majority 29% were soldiers, 40% belonging to the age group of 31-60 years. The common predisposing factor was trauma/fractures followed by diabetes and implants leading to chronic sinus discharge and decubitus ulcers. The most commonly isolated organism was Staphylococcus aureus (38%) followed by Methicillin-resistant Staphylococcus aureus (MRSA) (31%). Cotrimoxazole and Rifampicin turned out to be good treatment options. Only 4.4% showed unsatisfactory prognosis, nonetheless, no mortality was observed during the course of treatment. CONCLUSION: In this study, highly resistant strains were observed with limited treatment options for chronic osteomyelitis, however, effective stewardship programmes with accurate diagnostic reporting and judicious use of antimicrobials can prevent overuse of the valuable resources. KEY WORDS: Antimicrobial stewardship, Osteomyelitis, Methicillin-resistant Staphylococcus aureus, Empirical therapy, Antimicrobial resistance.

Computational Fluid Dynamics (CFD) Analysis of Bioprinting.

Regenerative medicine has evolved with the rise of tissue engineering due to advancements in healthcare and technology. In recent years, bioprinting has been an upcoming approach to traditional tissue engineering practices, through the fabrication of functional tissue by its layer-by-layer deposition process. This overcomes challenges such as irregular cell distribution and limited cell density, and it can potentially address organ shortages, increasing transplant options. Bioprinting fully functional organs is a long stretch but the advancement is rapidly growing due to its precision and compatibility with complex geometries. Computational Fluid Dynamics (CFD), a carestone of computer-aided engineering, has been instrumental in assisting bioprinting research and development by cutting costs and saving time. CFD optimizes bioprinting by testing parameters such as shear stress, diffusivity, and cell viability, reducing repetitive experiments and aiding in material selection and bioprinter nozzle design. This review discusses the current application of CFD in bioprinting and its potential to enhance the technology that can contribute to the evolution of regenerative medicine.

Acoustic and Text Features Analysis for Adult ADHD Screening: A Data-Driven Approach Utilizing DIVA Interview.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder commonly seen in childhood that leads to behavioural changes in social development and communication patterns, often continues into undiagnosed adulthood due to a global shortage of psychiatrists, resulting in delayed diagnoses with lasting consequences on individual's well-being and the societal impact. Recently, machine learning methodologies have been incorporated into healthcare systems to facilitate the diagnosis and enhance the potential prediction of treatment outcomes for mental health conditions. In ADHD detection, the previous research focused on utilizing functional magnetic resonance imaging (fMRI) or Electroencephalography (EEG) signals, which require costly equipment and trained personnel for data collection. In recent years, speech and text modalities have garnered increasing attention due to their cost-effectiveness and non-wearable sensing in data collection. In this research, conducted in collaboration with the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, we gathered audio data from both ADHD patients and normal controls based on the clinically popular Diagnostic Interview for ADHD in adults (DIVA). Subsequently, we transformed the speech data into text modalities through the utilization of the Google Cloud Speech API. We extracted both acoustic and text features from the data, encompassing traditional acoustic features (e.g., MFCC), specialized feature sets (e.g., eGeMAPS), as well as deep-learned linguistic and semantic features derived from pre-trained deep learning models. These features are employed in conjunction with a support vector machine for ADHD classification, yielding promising outcomes in the utilization of audio and text data for effective adult ADHD screening. Clinical impact: This research introduces a transformative approach in ADHD diagnosis, employing speech and text analysis to facilitate early and more accessible detection, particularly beneficial in areas with limited psychiatric resources. Clinical and Translational Impact Statement: The successful application of machine learning techniques in analyzing audio and text data for ADHD screening represents a significant advancement in mental health diagnostics, paving the way for its integration into clinical settings and potentially improving patient outcomes on a broader scale.

Characteristics and health implications of fine particulate matter near urban road site in Islamabad, Pakistan.

The escalating issue of air pollution has become a significant concern in urban regions, including Islamabad, Pakistan, due to the rise in air pollutant emissions driven by economic and industrial expansion. To gain a deeper understanding of air pollution, a study was conducted during winter 2022-2023, assessing physical, chemical, and biological factors in Islamabad. The findings revealed that the average concentration of fine particulate matter (PM2.5) was notably greater than the World Health Organization (WHO) guidelines, reaching 133.39 µg/m³. Additionally, the average concentration of bacteria (308.64 CFU/m³) was notably greater than that of fungi (203.55 CFU/m³) throughout the study. Analytical analyses, including SEM-EDS and FTIR, showed that the PM2.5 in Islamabad is composed of various particles such as soot aggregates, coal fly ash, minerals, bio-particles, and some unidentified particles. EF analysis distinguished PM2.5 sources, enhancing understanding of pollutants origin, whereas Spearman's correlation analysis elucidated constituent interactions, further explaining air quality impact. The results from the Inductively Coupled Plasma Atomic Emission Spectroscopy (ICP-OES) indicated a gradual increase in the total elemental composition of PM2.5 from autumn to winter, maintaining high levels throughout the winter season. Furthermore, a significant variation was found in the mass concentration of PM2.5 when comparing samples collected in the morning and evening. The study also identified the presence of semi-volatile organic compounds (SVOCs) in PM2.5 samples, including polycyclic aromatic hydrocarbons (PAHs) and phenolic compounds, with notable variations in their concentrations. Utilizing health risk assessment models developed by the US EPA, we estimated the potential health risks associated with PM2.5 exposure, highlighting the urgency of addressing air quality issues. These findings provide valuable insights into the sources and composition of PM2.5 in Islamabad, contributing to a comprehensive understanding of air quality and its potential environmental and health implications.

Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases.

BACKGROUND: Epiploic appendagitis (EPA) is an uncommon emergency surgical condition that causes acute abdominal pain, rendering a list of differential diagnoses. Therefore, careful examination and imaging tools are required. EPA is a self-limiting condition that can be resolved in 1-2 weeks and rarely needs surgical intervention. Its low incidence makes EPA less well-known among the public and some medical professionals, and it is frequently under-diagnosed. We aimed to explore the incidence, clinical presentation, modalities of imaging to diagnose and options for treating EPA. METHODS: An observational retrospective analysis was conducted between 2016 and 2022 at a tertiary hospital in an Arab Middle Eastern country. RESULTS: There were 156 EPA cases diagnosed over six years, with a mean age of 33 years. Males represented 82% of the cohort. The entire cohort was treated non-operatively except for eight patients who had surgical intervention using open or laparoscopic surgery. The diagnosis was made by a computerized tomographic scan (CT). However, plain X-ray, abdominal ultrasound, and magnetic resonance imaging (MRI) were performed initially in a few selected cases to rule out other conditions. No specific blood test indicated EPA; however, a histopathology examination was diagnostic. No mortality was reported in the study cohort. CONCLUSION: This is the most extensive study analyzing EPA patients from the Middle East. EPA is a rare and mostly self-limiting acute abdominal disorder; however, early ultrasound and CT scan can pick it up quickly after a high index of suspicion.