Molecular dynamics simulation of entecavir-silver nanoparticles at different biological pH.

Entecavir is a well-known antiviral drug, commonly prescribed for the treatment of hepatitis B and showed promising therapeutic effects against HBV polymerase. The replication of Hepatitis B Virus requires HBV-DNA polymerase and its natural substrate is deoxyguanosine triphosphate. Entercavir inhibit its activity by phosphorylating into its active metabolite. Furthermore, the efficiency of silver nanoparticles as an antimicrobial or antiviral agent is known for centuries. This study focused on the in-silico stability studies of silver nanoparticles of entecavir. The silver nanoparticles of entecavir synthesized by previously reported method. The stability of drug metal complex was predicted by analysis of variations in internal energies including potential energy, kinetic energy and different non-bonded energies during the simulation run of 4000 picoseconds of different molecular systems. After the simulation run it was concluded that the molecular systems of drug metal complex in aqueous solution at pH 4 showed greater instability as compared to the pH 2 and 6.9. This research gives the idea about the significance of molecular dynamics simulation technique in the field of pharmaceutical sciences for the analysis and characterization of pharmaceutical products and visualizes the effects of different environmental parameters on the structure and physicochemical properties of drug molecules.

Synthesis, characterization and assessment of antioxidant and antibacterial potential of dihydroquinoline-3-carboxylic acid and their metal derivatives.

Metal complexes of drug are used to inhibit growth of pathogenic microorganisms and reduces drug resistance. Moxifloxacin is a dihydroquinoline-3-carboxylic acid 4th generation fluoroquinolone antibiotic that has tendency to bind with metal ions. In current study four moxifloxacin-metal complexes i.e. Moxifloxacin-sliver (Moxi-Ag), Moxifloxacin-rhodium (Moxi-Rh), Moxifloxacin-titanium (Moxi-Ti) and Moxifloxacin-rubidium (Moxi-Rb) have been synthesized and evaluated for antibacterial activities against resistant microorganisms along with antioxidant effects. The structure elucidation was carried out using FTIR, 1H- NMR and UV-Vis spectroscopy. Agar well diffusion method and DPPH (1, 1- dipheny1-2-picrylhydrazyl) methods were used to study the antibacterial and antioxidant activity respectively. Both 1H NMR and FTIR spectra clearly showed that Moxi-metal complexes are formed due to change in their carboxyl stretching band in IR, H-2 and H-5 peak position in 1H NMR. All the Moxi-metal complexes showed distinguished antibacterial effects against both Gram-negative and Gram-positive bacteria as compared to drug which was found resistant against many microorganisms. Moxi-Rb and Moxi-Ag metal complexes showed higher antioxidant activity (IC50 values range from 8.26 - 9.19 µg/ml) than Moxi-Ti and Moxi-Rh metal complexes (IC50 range from 11.23 - 14.65 µg/ml).

Dural Tears In Patients With Depressed Skull Fractures.

BACKGROUND: The presence of skull fracture in patients sustaining traumatic brain injury is an important risk factor for intracranial lesions. Assessment of integrity of dura in depressed skull fracture is of paramount importance because if dura is torn, lacerated brain matter may be present in the wound which needs proper debridement followed by water tight dural closure to prevent meningitis, cerebral abscess, and pseudomeningocoele formation. The objective of this study was to determine the frequency of dural tear in patients with depressed skull fractures. METHODS: This cross-sectional study was conducted at Department of Neurosurgery Ayub Teaching Hospital Abbottabad. All the patients of either patients above 1 year of age with depressed skull fracture were included in this study in consecutive manner. Patients were operated for skull fractures and per-operatively dura in the region of depressed skull fracture was closely observed for any dural tear. The data were collected on a predesigned pro forma. RESULTS: A total of 83 patients were included in this study out of which 57 (68.7%) were males and 26 (31.3%) were females. The age of the patients ranged from 1-50 (mean 15.71±13.49 years). Most common site of depressed skull fracture was parietal 32 (38.6%), followed by Frontal in 24 (28.9%), 21(25.3%) in temporal region, 5(6.0%) were in occipital region and only 1 (1.2%) in posterior fossa. Dural tear was present in 28 (33.7%) patients and it was absent in 55 (66.3%) of patients. CONCLUSIONS: In depressed skull fractures, there are high chances of associated traumatic dural tears which should be vigilantly managed.

Comparison Of Efficacy Of Phenytoin And Levetiracetam For Prevention Of Early Post Traumatic Seizures.

BACKGROUND: The incidence of early post-traumatic seizures after civilian traumatic brain injury ranges 4-25%. The control of early post-traumatic seizure is mandatory because these acute insults may add secondary damage to the already damaged brain with poor outcome. Prophylactic use of anti-epileptic drugs have been found to be have variable efficacy against early post-traumatic seizures. The objective of this study was to compare the efficacy of Phenytion and Levetiracetam in prevention of early post-traumatic seizures in moderate to severe traumatic brain injury. METHODS: This randomized controlled trial was conducted in department of Neurosurgery, Ayub Medical College, Abbottabad from March, 2012 to March 2013. The patients with moderate to severe head injury were randomly allocated in two groups. Patients in group A were given phenytoin and patients in group B were given Levetiracetam. Patients were followed for one week to detect efficacy of drug in terms of early post traumatic seizures. RESULTS: The 154 patients included in the study were equally divided into two groups. Out of 154 patients 115 (74.7%) were male while 29 (25.3%) were females. Age of patients ranges from 7-48 (24.15±9.56) years. Ninety one (59.1%) patients had moderate head injury while 63 (40.9%) patients had severe head injury. Phenytoin was effective in preventing early post traumatic seizures in 73 (94.8%) patients whereas Levetiracetam effectively controlled seizures in 70 (90.95%) cases (p-value of .348). CONCLUSIONS: There is no statistically significant difference in the efficacy of Phenytoin and Levetiracetam in prophylaxis of early posttraumatic seizures in cases of moderate to severe traumatic brain injury.

MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA.

BACKGROUND: Trigeminal Neuralgia (TGN) is the most frequently diagnosed type of facial pain. In idiopathic type of TGN it is caused by the neuro-vascular conflict involving trigeminal nerve. Microvascular decompression (MVD) aims at addressing this basic pathology in the idiopathic type of TGN. This study was conducted to determine the outcome and complications of patients with idiopathic TGN undergoing MVD. METHODS: In a descriptive case series patients with idiopathic TGN undergoing MVD were included in consecutive manner. Patients were diagnosed on the basis of detailed history and clinical examination. Retromastoid approach with craniectomy was used to access cerebellopontine angle (CP-angle) and microsurgical decompression was done. Patients were followed up for 6 months. RESULTS: A total of 53 patients underwent MVD with mean age of 51.6±4.2 years and male predominance. In majority of cases (58.4%) both Maxillary and Mandibular divisions were involved. Per-operatively superior cerebellar artery (SCA) was causing the neuro-vascular conflict in 33 (62.2%) of the cases, anterior inferior cerebellar artery (AICA) in 6 (11.3%) cases, both CSA and AICA in 3 (5.6%) cases, venous compressions in only 1 (1.8%) patient and thick arachnoid adhesions were seen in 10 (18.9%) patients. Postoperatively, 33 (68%) patients were pain free, in 14 (26.45%) patients pain was significantly improved whereas in 3 (5.6%) patients there was mild improvement in symptoms. Three (5.6%) patients did not improve after the primary surgery. Cerebrospinal fluid (CSF) leak was encountered in 7 (13.2%) patients post-operatively, 4 (7.5%) patients developed wound infection and 1 (1.8%) patient developed aseptic meningitis. Three (5.6%) patients had transient VII nerve palsy while one patient developed permanent VII nerve palsy. CONCLUSION: MVD is a safe and effective surgical option for treating patients with idiopathic TGN with better surgical outcome and fewer complications.

OUTCOME OF OPEN CARPAL TUNNEL RELEASE SURGERY.

BACKGROUND: Carpel tunnel syndrome is a common compression neuropathy of the median nerve causing pain, numbness and functional dysfunction of the hand. Among the available treatments, surgical release of the nerve is the most effective and acceptable treatment option. The aim of this study was to see the outcomes of surgical release of carpel tunnel using open technique. METHODS: This descriptive case series was conducted at the Department of neurosurgery, Ayub Teaching Hospital Abbottabad from April 2013 to March 2014. One hundred consecutive patients with carpel tunnel syndrome were included who underwent open carpel tunnel release surgery. They were followed up at 1, 3 and 6 months. Residual pain, numbness and functional improvement of the hand were the main outcome measures. RESULTS: Out of 100 patients, 19 were males. The age ranged from 32 to 50 years with a mean of 39.29±3.99 years. The duration of symptoms was from 5 to 24 months. In the entire series patient functional outcome and satisfaction was 82% at 1 month, 94% at 3 months and 97% at 6 months. 18% patient had residual pain at 1 month post-operative follow-up, 6% at 3 months and 3% at 6 month follow-up. CONCLUSION: Open carpel tunnel release surgery is an effective procedure for compression neuropathy of the median nerve. It should be offered to all patients with moderate to severe pain and functional disability related to carpel tunnel syndrome.

EARLY RESPONSE OF LOCAL STEROID INJECTION VERSUS MINI INCISION TECHNIQUE IN TREATMENT OF CARPAL TUNNEL SYNDROME.

BACKGROUND: Carpal tunnel syndrome (CTS) is one of the commonest peripheral neuropathies which effects mainly middle aged women. Different techniques are being tried to decrease the postoperative pain in patients operated for CTS. The objective of this study was to compare effectiveness of local injection of steroid and mini incision technique in the treatment of carpal tunnel syndrome. METHODS: This randomized control trial was conducted at department of Orthopedics and department of Neurosurgery, Ayub Teaching Hospital, Abbottabad from Aug 2011 to Feb 2013. A total of 116 patients of CTS were randomly allocated to either of the two groups.58 Patient in Group A were subjected to local steroid injection and the same number of patient in Group B underwent mini incision technique. All patients of were advised to report to the OPD after one month to determine intervention effectiveness in terms of improvement in at least one grade of pain. RESULTS: In this study mean age of the patients was 32.8 +/- 5.1 years. Female gender was in dominance with 99 (86.3%) cases. In this study we compared the effectiveness of local steroid injection and mini incision technique in the treatment of carpel tunnel syndrome. We found out that the steroid injection was effective in 69.0% cases while mini incision technique was effective in 56.9% cases. The difference being statistically insignificant with a p-value of 0.17. CONCLUSION: The difference in pain after 1 month of the intervention was not statistically significant.

FREQUENCY OF EXTRADURAL HAEMATOMA IN PATIENTS WITH LINEAR SKULL FRACTURE.

BACKGROUND: Apparently normal looking patients after traumatic brain injury can have serious neurological deterioration, and one of the common causes of such deterioration is extradural haematomas. This study was conducted to determine the frequency of extradural hematoma and common types of trauma leading to it among patients presenting with skull fracture due to head injury. METHODS: This cross-sectional study was conducted in the department of Neurosurgery Ayub Medical College, Abbottabad from June 2011 to June 2012. All patients who were suspected to have Skull fracture on X-ray skull, during the study period, were included in study after informed consent and later on CT-Scan brain was done to see for extradural hematoma. Findings were recorded on a predesigned pro fonna including demographic data, radiological findings and the type of head trauma. RESULTS: Out of 114 patients 85 (74.5%) were males and 29 (225.4%) were females. Age ranged from 2 to 70 years (18.23 +/- 16.5 years). Among these patients the most important cause of head injury was fall from height in 65 (57%), followed by road traffic accidents in 39 (34.2%), and assault in 10 (8.8%) patients. The most common site of fracture was parietal in 49 (43%) of patients, followed by frontal bone in 28 (24.6%) of patients, occipital bone in 24 (21.1%) of patients, and temporal bone in 23 (20.2%) of patients. Frequency of extradural hematoma among linear skull fracture was in 34 (29.8%) patients. Extradural hematoma was most common with parietotemporal linear skull fractures (73.5%). CONCLUSION: Extradural haematoma occurs commonly with linear skull fractures, so patients with linear skull fracture should be properly evaluated with CT brain.

SUCCESSFUL TREATMENT OF MULTIDRUG-RESISTANT ACINETOBACTOR BAUMANII BLISTERS ON THE KNEE.

Acinetobacter baumannii (A. baumannii), nosocomial infections, especially those due to multi-drug resistant (MDR) strains, are increasingly detected. This study reports the case of a 50-year-old man with blisters on the right knee for 8 months, first admitted through the outpatient department for incisional biopsy. Microbiological and histo-pathological examination confirmed the diagnosis of blisters extending deeply up to the knee joint caused by MDR- A. baumannii. A broad spectrum antibiotic therapy was administered and later readjusted according to the results of microbiological culture and biopsy report. Intensive hemodynamic support was required. An extensive surgical debridement was promptly performed and repeated until complete control of the infection with intravenous colistins. Blisters were excised; wounds were dressed daily with chlorhexidine dressings and polymyxine-impregnated dressing. Wounds were finally covered with split-thickness skin grafts. The infection was overcome 120 days after admission. The graft take was 40%. Postoperative rehabilitation was required because of the functional limitation of lower limb movements at the knee joint. Follow-up at 8 months showed no functional deficit and an acceptable aesthetic result. AB-MDR affecting soft tissues is a life-threatening disease, especially in patients with poor immunity and limited access to health facilities, whose clinical diagnosis may sometimes be challenging. Early recognition and treatment represent the most important factors influencing survival.

Frequency of cerebellopontine angle tumours in patients with trigeminal neuralgia. .

BACKGROUND: Though the classical type of trigeminal neuralgia is the most common type with the neurovascular conflict causing the symptoms, yet quite some patients have the secondary type of trigeminal neuralgia in which space occupying lesions are responsible for the symptoms. This study was conducted to determine the frequency of cerebellopontine angle tumours in patients presenting with complaints of trigeminal neuralgia. METHODS: This case series descriptive study was conducted in the department of Neurosurgery, Ayub Medical College, Abbottabad, from January 2009 to January 2012. It included patients who presented with symptoms of trigeminal neuralgia. Patients were subjected to further radiological investigation like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) to look for secondary causes of trigeminal neuralgia. RESULTS: Among the 134 patients with age ranges 13-64 (51?4.3) years of age, 78(58.2%) were females and 56 (41.7%) were males. Frequency of cerebellopontine angle tumours in patients was 14 (10.4%), among them epidermoid was most common lesion being present in 10 (7.4%) of patients and accounted for 75% of Cerebellopontine Angle tumours in these patients. Meningioma and vestibular schwanoma accounted for 2(1.4%) cases each. In secondary trigeminal neuralgia mean age of onset of symptoms was 39.5±5.2 years as compared to classic trigeminal neuralgia which is 53±2.1 years. CONCLUSION: Trigeminal Neuralgia can be a typical symptom in cerebellopontine angle tumours like epidermoid, especially in young patients, so all the patients with trigeminal neuralgia should be investigated for lesion in cerebellopontine region.

Eventration of diaphragm in adults: eleven years experience.

BACKGROUND: Eventration of diaphragm is a congenital condition in which there is absence of muscle fibers in the diaphragm while maintaining all the anatomical attachments normally. Surgical treatment is warranted in symptomatic patients so as to reduce the abnormal ascent of diaphragm. The present study was conducted to analyse the perioperative outcome of thoracotomy in adult patients with diaphragmatic eventration. METHODS: This descriptive case series was carried out in Cardiothoracic Surgery-Unit, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan. Medical records of patients operated upon for eventration from June 2002 to June 2013 were reviewed. Patients of either gender, above 16 years who were operated for symptomatic eventrtaion were included in study. All the demographic data, presenting complaints, baseline and post-postoperative dyspnea grade, forced expiratory volume at 1 second (FEV1) and forced vital capacity (FVC) were recorded on predesigned pro forma and analysed using SPSS-16. RESULTS: A total of 38 adult patients underwent surgery for diaphragmatic eventration over the past 11 years in our unit out of which 29 (76%) were males and rest of 9 (24%) were females. Mean age of patients was 41.6±13.84 years. In 31 (81.5%) patients left side was involved. Majority of patients had a dyspnea grade-3 on presentation. Preoperative dyspnoea score (MRC), FEV1 and FVC values were 2.6±0.73, 63.5±13.3 and 67.2±14.6 respectively. Pre-operative and 6-months follow-up values of dyspnoea grade, FEV1 and FVC values showed statistically significant improvement. CONCLUSION: Our study showed that adult patients with symptomatic unilateral eventration of diaphragm significantly benefit from diaphragmmatic plication.

Current progress and future perspective of microalgae biomass pretreatment using deep eutectic solvents.

Pretreatment process is considered as the most important step for effective microalgae biomass refining and has gained more interest since last decades. However, the main obstacles to commercialize microalgae products are recalcitrant cell wall and lack of cost-effective, green, and sustainable pretreatment approaches. Till now, various microalgae pretreatment approaches have been applied prior to extraction steps to enhance the accessibility of solvent inside the cells. However, high energy consumption and the hazardousness of solvents are considerable problem for these pretreatment methods. In this regard, deep eutectic solvents are recognized as sustainable and green solvents possessing great potential for microalgae biomass processing due to their low toxicity, low cost, biodegradability, easy recycling, and reuse. This article provides the fundamentals of DES composition, synthesis, properties, and the current advances in the application of microalgae biomass process.

Lumbar disc herniation in patients with chronic backache.

BACKGROUND: Low back pain with or without lower extremity pain is the most common problem among chronic pain disorders with significant economic, social, and health impact. This study was conducted to determine the frequency of lumbar disc herniation and its different levels, among patients with chronic backache. METHODS: This cross sectional study was conducted in the department of Neurosurgery, Ayub Medical College Abbottabad from January 2011 to January 2013. All the patients presenting with chronic low backache of either gender above the age 14 years were included in the study. Magnetic resonance imaging (MRI) was done in all the patients included in the study to look for lumbar disc herniation. RESULTS: A total of 477 patients with chronic low backache were included in the study out of which 274 (57.4%) were males. Age of the patients ranged from 19 to 75 (39.92 +/- 12.31) years. Out of 477 patients 38 (7.9%) had significant radiological evidence of disc prolapse at lumbar vertebral levels, with 26 (9.5%) males and 12 (5.9%) females. Among these 38 patients with inter-vertebral disc, 20 (52.6%) of patients had disc herniation at L5-S1, 15 (39.5%) at L4-L5, 2 (5.26%) cases at L3-L4 level and only one case (2.6%) had the involvement of L2-L3 level. No cases of L1-L2 disc prolapse were found. CONCLUSION: Patients with chronic backache can have inter-vertebral lumbar disc prolapsed disease. Middle age group are more affected by lumbar disc disease especially at the lower lumbar regions.

Breast cancer therapy by laser-induced Coulomb explosion of gold nanoparticles.

OBJECTIVE: Laser-induced Coulomb explosion of gold nanoparticles for breast cancer has been studied by nanophotolysis technique. This study aimed to investigate whether laser-induced bubble formation due to Coulomb explosion can provide an effective approach for selective damage of breast cancer with gold nanoparticles. METHOD: Numerical method involves laser-induced Coulomb explosion of gold nanoparticles. Different parameters related to nanophotolysis such as laser fluence, tumor depth, cluster radius, laser pulse duration, and bubble formation is studied numerically. Numerical simulation was performed using Mat lab. RESULTS: The gold nanoparticles of 10, 20, 30, 40, and 50 nm in radius could penetrate into tumor 1.14, 1.155, 1.189, 1.20 and 1.22 cm in depth respectively. The maximum penetration depth in tumor could be obtained with nanoparticles of 50 nm radius. Short laser pulse of 40 ns with nanoparticles of 10 nm radius could penetrate into tumor 1.14 cm in depth. Bubbles with a radius of 9 µm could effectively kill breast cancer cells without damaging healthy ones. The bubble radius increased from 4 to 9 µm with an increase in pulse duration in the range of 10 to 30 ns. CONCLUSIONS: Gold nanoparticles with increasing radius and bubble formation for selective damage of breast cancer cells are successfully probed. The present calculated results are compared with other experimental findings, and good correlation is found between the present work and previous experimental values. It was demonstrated that bubble formation in tumor may further increase the efficacy of breast cancer treatment.

Efficacy Of Prophylactic Intrawound Application Of Vancomycin Powder In Preventing Surgical Site Infections In Spinal Instrumentation Surgery.

BACKGROUND: Surgical site infection (SSI) is always a matter of utmost concern in cases of spinal instrumentation in low-income countries. This study was conducted to determine the efficacy of local intrawound application of vancomycin powder in reducing postoperative SSI following Thoracolumbar-Sacral spinal instrumentation. METHODS: This randomized controlled trial was done in the Department of Neurosurgery, Ayub Teaching Hospital Abbottabad from 1st July 2019 to 31st December 2021. Seventy-eight patients of either gender with an age range from 15 to 65 years, who were planned for posterior spinal instrumentation surgery (transpedicular screw fixation), were included in the study. Patients were divided into two equal groups, A (Vanco group) and B (control group). In addition to standard systemic prophylaxis, 1 gm of Vancomycin powder was applied over the implant in Group A patients. RESULTS: The mean age of the patients in Group A was 36±16.6 while the mean age of patients in the group was 33.7±15.9 years. A statistically significant reduction of surgical site infection was observed in those who received a prophylactic intra-wound application of vancomycin powder (Vanco group) (5.2%) compared to the control group (20.5%). CONCLUSIONS: Intrawound vancomycin powder administration significantly decreases SSI following spinal instrumentation surgeries. Patients at high risk of infection are highly recommended as a candidate for this technique.

Employing Cationic Kraft Lignin as Additive to Enhance Enzymatic Hydrolysis of Corn Stalk.

A water-soluble cationic kraft lignin (named JLQKL50), synthesized by combining quaternization and crosslinking reactions, was used as an additive to enhance the enzymatic hydrolysis of dilute-alkali-pretreated corn stalk. The chemical constitution of JLQKL50 was investigated by Fourier transform infrared spectroscopy, 1H nuclear magnetic resonance (NMR) and 13C NMR spectroscopy, and elemental analysis. The enzymatic hydrolysis efficiency of corn stalk at solid content of 10% (w/v) was significantly improved from 70.67% to 78.88% after 24 h when JLQKL50 was added at a concentration of 2 g/L. Meanwhile, the enzymatic hydrolysis efficiency after 72 h reached 91.11% with 10 FPU/g of cellulase and 97.92% with 15 FPU/g of cellulase. In addition, JLQKL50 was found capable of extending the pH and temperature ranges of enzymatic hydrolysis to maintain high efficiency (higher than 70%). The decrease in cellulase activity under vigorous stirring with the addition of JLQKL50 was 17.4%, which was much lower than that (29.7%) without JLQKL50. The addition of JLQKL50 reduced the nonproductive adsorption of cellulase on the lignin substrate and improved the longevity, dispersity, and stability of the cellulase by enabling electrostatic repulsion. Therefore, the enzymatic hydrolysis of the corn stalk was enhanced. This study paves the way for the design of sustainable lignin-based additives to boost the enzymatic hydrolysis of lignocellulosic biomass.

Physicians' Perception About the Side Effects of COVID-19 Vaccine and Their Role in Vaccination Program.

INTRODUCTION: The Coronavirus disease 2019 (COVID-19) caused many problems in the health sector. Effective and safe vaccines are the only tool to combat the COVID-19 disease. Researchers and regulatory agencies have made efforts to develop such vaccines and healthcare professionals were prioritized for the vaccination program as first-line care providers. Considering this prioritization, we aimed to assess the physicians' perceptions regarding the side effects of the COVID-19 vaccine. METHODS: An interview-based study was conducted from May 5 May to November 5, 2021 (6 months) in a teaching hospital in the capital city of Islamabad, Pakistan. RESULTS: Among the 200 physicians who agreed to participate in the interview, 74% were male. A total of 94% did not experience any side effects after receiving the COVID-19 vaccine, regardless of the type of vaccine; 6% experienced side effects. Furthermore, 90% of physicians were afraid of side effects due to the high number of vaccine doses. CONCLUSION: Conclusively, physicians had a positive perception regarding the COVID-19 vaccine. Healthcare authorities and related departments must take precautions to ensure the effective and safe COVID-19 vaccine to change the perceptions of physicians who had a negative perception. This will not only reduce the reluctance among physicians regarding administering COVID-19 vaccine, but will also boost and facilitate the vaccination program for the general public as well.

Knowledge, Attitude, and Practices (KAPs) of Community Pharmacists Regarding COVID-19: A Cross-Sectional Survey in 2 Provinces of Pakistan.

OBJECTIVE: The 2019 coronavirus disease (COVID-19) is a global pandemic with no therapy, and pharmacists being a part of the health care system have a vital role in the management of COVID-19. The purpose of this study is to assess the knowledge, attitude, and practices of community pharmacists (CPs) regarding COVID-19. METHOD: An online survey was conducted among 393 CPs in 2 provinces of Pakistan during the lockdown period. A validated questionnaire (Cronbach's alpha, 0.745) was used for data collection. All statistical analyses were analyzed by using SPSS, version 21 (IBM Corp, Armonk, NY). RESULTS: Among 393 participants, 71.5% (n = 281) had good knowledge, 44% (n = 175) had a positive attitude, and 57.3% (n = 225) had good practices regarding COVID-19. Social media (45.29%, n = 178) were reported as the main source to seek information of COVID-19. Good knowledge, age ≥ 26 years, and a PhD degree level were the substantial determinants (P = < 0.05) of a good attitude. Similarly, a CP with experience of > 5 years, a PhD degree, good knowledge, and a good attitude has higher odds of having good practices as compared with reference categories (P = < 0.05). CONCLUSION: In short, a majority of the CPs had good knowledge but had a poor attitude and practice toward the management of COVID-19. Standard-structured educational and counseling programs for CPs regarding COVID-19 are needed for effective management.

Intradiploic Epidermoid Cyst Of The Skull.

Intradiploic epidermoid cyst is an uncommon, benign, slow growing neoplasm that occurs between two tables of cranial bones and constitute 0.4% of all cranial epidermoid. It usually occurs due to the entrapped ectodermal embyronal remnants within the skull bones or rarely secondary to trauma. Pre-operative diagnosis on the basis of radiologic investigations is difficult. Complete surgically excision is usually required in order to prevent complications like super infection, intracranial rupture with pneumocephalus and rarely malignant degeneration. We are presenting a case of incompletely resected and chronically infected intradiploic epidermoid cyst of right parietal bone operated inadvertently by a general surgeon elsewhere without doing any radiological investigations.

Al-doped α-MnO2 coated by lignin for high-performance rechargeable aqueous zinc-ion batteries.

Zn/MnO2 batteries, one of the most widely studied rechargeable aqueous zinc-ion batteries, suffer from poor cyclability because the structure of MnO2 is labile with cycling. Herein, the structural stability of α-MnO2 is enhanced by simultaneous Al3+ doping and lignin coating during the formation of α-MnO2 crystals in a hydrothermal process. Al3+ enters the [MnO6] octahedron accompanied by producing oxygen vacancies, and lignin further stabilizes the doped Al3+ via strong interaction in the prepared material, Al-doped α-MnO2 coated by lignin (L + Al@α-MnO2). Meanwhile, the conductivity of L + Al@α-MnO2 improves due to Al3+ doping, and the surface area of L + Al@α-MnO2 increases because of the production of nanorod structures after Al3+ doping and lignin coating. Compared with the reference α-MnO2 cathode, the L + Al@α-MnO2 cathode achieves superior performance with durably high reversible capacity (∼180 mA h g-1 at 1.5 A g-1) and good cycle stability. In addition, ex situ X-ray diffraction characterization of the cathode at different voltages in the first cycle is employed to study the related mechanism on improving battery performance. This study may provide ideas of designing advanced cathode materials for other aqueous metal-ion batteries.