Characterization of two novel fusariviruses co-infecting a single isolate of phytopathogenic fungus Botrytis cinerea.

A wide diversity of mycoviruses has been reported from Botrytis species, some with the potential to suppress the pathogenic abilities of this fungus. Considering their importance, this study was devised to find potential hypovirulence-associated mycoviruses found in Botrytis cinerea strains isolated from Pakistani strawberry fields. Here we report the complete genome characterization of two fusariviruses co-infecting a single isolate of phytopathogenic fungus B. cinerea (Kst14a). The viral genomes were sequenced by deep sequencing using total RNA fractions of the Kst14a isolate. The identified viruses were tentatively named Botrytis cinerea fusarivirus 9 (BcFV9) and Botrytis cinerea fusarivirus 3a (BcFV3a). Both viruses had a single-segmented (ssRNA) genome having a size of 6424 and 8370 nucleotides encoding two discontinuous open reading frames (ORFs). ORF-1 of both mycoviruses encodes for a polyprotein having a conserved domain of RNA-dependent RNA polymerase (RdRP) and a helicase domain (Hel) which function in RNA replication, while ORF2 encodes a hypothetical protein with an unknown function, respectively. Phylogenetic analysis indicated that BcFV9 made a clade with the genus Alphafusarivirus and BcFV3a fall in the genus Betafusarivirus in the family Fusariviridae. To our knowledge, this is the first report of two fusariviruses identified in isolates of B. cinerea from Pakistan. Both mycoviruses successfully transfected to a compatible strain of B. cinerea (Mst11). A comparison of virus-free (VF) and virus-infected (VI) isogenic lines showed the presence of these viruses was causing hypovirulence in infected strains. Virus-infected strains also had a small lesion size while testing the pathogenicity via apple assay.

Successful Management of Recurrent Cholangitis Post Cholecystectomy in a Primary Care Hospital.

Cholangitis, a pathological disease characterized by inflammation of the biliary system, often occurs in conjunction with gallstone blockage and may lead to various problems, persisting for extended periods after cholecystectomy. The present report provides a comprehensive account of a clinical case involving a 35-year-old female patient who had undergone cholecystectomy three years before and is now experiencing symptoms consistent with cholangitis. The individual was originally given conservative therapy, which included the administration of intravenous ceftriaxone antibiotics, analgesics, fluids, and gastrointestinal treatment. Subsequently, they were sent to a tertiary care hospital for the performance of endoscopic retrograde cholangiopancreatography (ERCP) and the placement of a stent. Following a period of seven days, laboratory tests showed a return to normalcy, showing a positive outcome in response to the use of conservative management strategies. The patient made the decision to have an elective laparoscopic cholecystectomy, resulting in a favorable recuperation and a hospitalization period of 24 hours. The aforementioned results jointly demonstrate the efficacy of conservative therapy in treating cholangitis and the potential for eventual elective surgery in individuals experiencing prolonged gallbladder problems. In conclusion, this case underscores the need to maintain a state of alertness with respect to complications associated with cholecystectomy, such as cholangitis. It also emphasizes the effectiveness of conservative treatment approaches and the probable necessity for elective surgical intervention.

Qualitative Thematic Analysis of Knowledge and Practices of Surgical Antimicrobial Prophylaxis at a Tertiary Care Teaching Hospital.

Background: Surgical antimicrobial prophylaxis (SAP) refers to the utilization of antibiotic agents for the prevention of surgical site infections (SSI), to prevent SSI-associated morbidity and mortality, reduce duration and cost of healthcare, and cause minimal adverse drug effects. The adherence rate among surgeons for the available international and national guidelines and optimal practice remains considerably low in many hospitals, especially in developing countries. The objective of this study was to assess the knowledge and compliance rate for SAP guidelines among various surgical specialties and those involved in providing SAP. Methods: An institution-based exploratory, multi-specialty, collective, mixed method approach (qualitative and quantitative) was used to assess the knowledge and compliance rate for SAP guidelines among the consultants and residents of surgical specialties. Quantitative analysis was performed using a pre-tested questionnaire. For qualitative analysis, focus group discussions were conducted. Thematic analysis was conducted by the Theoretical Domains Framework (TDF) and the Capabilities, Opportunities, Motivation and Behaviour (COM-B) model. Results: Twenty-eight focus groups and 16 paired interviews were undertaken. On thematic analysis six significant themes were noted and mapped to the COM-B model, and subthemes mapped to the relevant TDF domains in a combined framework. Key themes recognized were: (1) solitary focus on surgical skills; (2) following the hierarchy is more important than guideline compliance; (3) doubts and overcautious attitude of surgeons hinders appropriate SAP prescribing; (4) non-availability in-hospital supply of antimicrobial agents; (5) patient characteristics and type of surgery play a role in prescribing SAP; and (6) lack of national and local guidelines. Conclusions: The knowledge and attitudes of surgeons toward appropriate SAP prescribing are crucial factors for execution of guidelines. Including them in policy making decisions can help in strong execution of the same.

The effectiveness of surgical adjunctive procedures in the acceleration of orthodontic tooth movement: A systematic review of systematic reviews and meta-analysis.

OBJECTIVE: To identify and evaluate the body of the evidence regarding the effectiveness of surgical adjunctive procedures (SAPs) in accelerating orthodontic tooth movement (OTM). DATA SOURCES: Unrestricted search of three electronic databases and manual search up to 12 June 2020 were undertaken. DATA SELECTION: All systematic reviews of randomised and non-randomised controlled trials that investigate the effectiveness of the SAPs in accelerating OTM were included. DATA EXTRACTION: Study selection and data extraction were undertaken independently and in duplicate by two reviewers. A random-effects model with a 95% confidence interval (CI) was generated for comparable outcomes. Two reviewers assessed the quality of the included studies using AMSTAR2 and GRADE. RESULTS: Fourteen systematic reviews were included; however, four systematic reviews were assessed quantitatively. Meta-analysis showed that mean difference (MD) of canine retraction rate, for the first month after SAPs, was mild (MD = 0.65 mm/month). Compared to control, micro-osteoperforations (MOPs) statistically but temporally accelerate lower canine retraction and en masse retraction by 0.25 mm/month and 0.31 mm/month, respectively. There was no significant effect (P>0.05) in terms of molar anchorage loss (MAL) between control and MOP groups. Piezocision non-significantly shortens the duration of en masse retraction (4.30 months, P>0.05), but significantly shortens incisors retraction (101.64 days, P<0.001). MAL is mild but significantly less in the piezocision group compared to the control group (MD = 0.53 mm, P=0.03). Low-level evidence showed that SAPs have no significant effect on root resorption or periodontal health; however, piezocision is associated with transient acute inflammation and noticeable scars. CONCLUSION: Low-level evidence concludes that SAPs accelerate OTMs and reduce treatment duration, but the acceleration is minor and transient. The effect on anchorage loss is variable and technique related. Side effects of SAPs are transient, but some might be aesthetically noticeable. A cost-benefit analysis of SAPs should be considered while making the treatment decision.

Epidemiological and clinical characteristics of coronavirus disease (COVID-19) cases at a screening clinic during the early outbreak period: a single-centre study.

Introduction. Coronavirus disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Corona Virus-2 (SARS-CoV-2). The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province, and has since spread globally, resulting in the ongoing 2019-2020 corona virus pandemic. SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have a zoonotic origin. The virus is primarily spread between people during close contact, often via small droplets produced by coughing, sneezing or talking. People may also become infected by touching a contaminated surface and then touching their face. COVID-19 patients currently remain the primary source of infection. An epidemiological survey indicated that the general population is susceptible to SARS-CoV-2. The spectrum of this disease ranges from mild to life-threatening. Fever is the most common symptom, although older people and those with comorbidities may experience fever later in the disease. Other common symptoms include cough, loss of appetite, fatigue, shortness of breath, sputum production, and muscle and joint pains. Symptoms such as nausea, vomiting and diarrhea have been observed in varying percentages. Some cases might progress promptly to acute respiratory distress syndrome (ARDS) and/or multiple organ function failure. Asymptomatic carriers and those in the incubation period may also be infectious.Aim. To determine the epidemiological and clinical characteristics of patients presenting with COVID-19 at the screening clinic of a tertiary care hospital in Peshawar, Pakistan.Methodology. In this descriptive study, we analysed data of patients presenting to a newly established Covid-19 screening clinic in Rehman Medical Institute. Anyone who reported with new onset fever and/or cough was tested for SARS-CoV-2 in the screening clinic. We documented and analysed demographic, epidemiological and clinical characteristics, which included age, sex, travel history, clinical features, comorbidities and laboratory data of patients confirmed by real-time reverse-transcription (RT)-PCR at Rehman Medical Institute, Peshawar, Pakistan from 15 March till 21 April 2020. Paired specimens of throat swabs and nasal swabs were obtained from 845 patients, ribonucleic acid (RNA) was extracted and tested for SARS-CoV-2 by the RT-PCR assay.Results. A total of 845 specimens were taken as described above. The positive rate for SARS-CoV-2 was about 14.3%. Male and older population had a significantly higher positive rate. Of the 121 patients infected with SARS-CoV-2, the mean age was 43.19 years (sd, 17.57) and the infections were more frequent among male gender accounting for 85 (70.25 %) patients. Common symptoms included fever (88 patients, 72 %), cough (72 patients, 59.5 %) and shortness of breath (69 patients, 57 %). Twenty-two (18 %) patients had recent travel history outside Pakistan in the previous 14 days, the majority of whom had returned back from Saudi Arabia.Conclusion. In this single-centre, prospective, descriptive study, fever, cough and shortness of breath were the most common symptoms. Old age (>50 years), chronic underlying comorbidities and travel history may be risk factors. Therefore, we concluded that viral nucleic acid amplification tests (NAAT) played an important role in identifying SARS-CoV-2 infection in a screening clinic, which helped with isolation and cohorting of these patients.

Granulomatosis with polyangiitis: a 17 year experience from a tertiary care hospital in Pakistan.

OBJECTIVE: Granulomatosis with Polyangiitis (GPA) is an autoimmune, multi-system, small and medium vessel vasculitis with granulomatous inflammation. Aim of this study was to assess the clinical and radiological presentations of patients with GPA amongst the Pakistani population. It is a single centre retrospective single observation study. RESULTS: Study was conducted at the Aga Khan University Hospital, Karachi with records were reviewed from January 2000 to December 2017. Definitive diagnosis was made using a combination of serological anti-neutrophil cytoplasmic antibody (ANCA) testing along with the clinical and radiological presentation. A total of 51 patients met the diagnostic criteria in the time frame of the study. There were 23 males and 28 females with mean age of 44.0 ± 17.8 years on presentation. Arthritis was the most common symptom present in 41.2% of the cases followed by cough in 32.0%. Sixteen patients showed pulmonary infiltrates on chest X-ray. C-ANCA was positive in all of the patients compared with 21.6% p-ANCA positivity. A total of 13 biopsies were done. The median Birmingham Vasculitis Activity Score was 12. We report a 17.6% mortality rate with 5 deaths occurring due to respiratory failure. GPA is a diagnostic challenge leading to late diagnosis which can contribute to significant morbidity and mortality specially in the Third World.

Partial Nephrectomy in Adults - A Single-Centre Experience.

Partial nephrectomy is the preferred procedure in benign renal lesions requiring surgical removal. It has also been accepted procedure for malignant renal conditions of smaller size. The aim of this observational study was to determine the outcome of partial nephrectomy in terms of complications and recurrence rates. Twenty patients with renal mass underwent this procedure from January 2010 till June 2014 at our Department, with mean age of 46.51 ±1.53 years. There were 14 males and 6 females. Renal mass on CT scan had the mean size of 3.80 ±1.15cm. The mean hospital stay in this series was 5.11 ±1.42 days, while mean operative time was 247 ±79.71 minutes. Twelve patients had malignant histology. They were followed using CT scan abdomen and pelvis with contrast at six and 12 months. Out of these, 10 (83.3%) patients were found to have no recurrence after six months.

Prevalence of scrub typhus in pyrexia of unknown origin and assessment of interleukin-8, tumor necrosis factor-alpha, and interferon-gamma levels in scrub typhus-positive patients.

BACKGROUND: Scrub typhus is lesser known cause of fever of unknown origin in India. Even if there have been reports documenting the prevalence of scrub typhus in different parts of India, it is still an unknown entity, and clinicians usually do not consider it as differential diagnosis. The present study was performed to document the prevalence of scrub typhus among febrile patients in western part of Uttar Pradesh and to assess the clinical profile of infected patients on the one hand and knowledge, attitude, and practices among clinicians on the other. MATERIALS AND METHODS: A total of 357 adult patients with fever of more than 5-day duration were recruited. All patients underwent complete physical examination, and detailed clinical history was elicited as per predesigned pro forma. After primary screening to rule out malaria, enteric fever, and leptospirosis infection, secondary screening for scrub typhus was done by rapid screen test and IgM ELISA. RESULTS: Scrub typhus infection was positive in 91 (25.5%) cases. The most common symptoms among the patients were fever (100%), pain in abdomen (79.1%), pedal edema 56 (61.5%), rash 44 (48.3%), headache 44 (48.3%), vomiting 42 (46.1%), constipation 33 (36.2%), cough 28 (30.7%), and lymphadenopathy 20 (21.9%). The median values of interleukin-8, interferon-gamma, and tumor necrosis factor-alpha in healthy controls were 15.54 pg/ml, 7.77 pg/ml, and 54.1 pg/ml, respectively, while the median values of these cytokines in scrub typhus-positive patients were 21.04 pg/ml, 8.74 pg/ml, and 73.8 pg/ml, respectively. CONCLUSION: Our results highlight that scrub typhus infection is an important cause of pyrexia of unknown origin, and active surveillance is necessary to assess the exact magnitude and distribution of the disease.

Synthesis and characterization of Schiff base octaazamacrocyclic complexes and their biological studies.

A condensation reaction between 1,2-diphenylethane-1,2-dione dihydrazone (DPEDDH) and dimethyl or diethyloxalate in methanol resulted in a novel Schiff base octaazamacrocyclic ligand, (L): (6,7,14,15-tetraoxa-2,3,10,11-tetraphenyl-1,4,5,8,9,12,13,16-octaazacyclohexadecane-1,3,9,11-tetraene). Subsequently metal complexes of the type [MLX2] and [CuL]X2; (M=Mn(II), Co(II), Ni(II) and Zn(II); X=Cl or NO3) were synthesized by the reaction of the free macrocyclic ligand (L) with the corresponding metal salts in 1:1 molar ratio. These complexes were characterized on the basis of analytical data, molar conductivity and magnetic susceptibility measurements, ESI-mass, IR, NMR ((1)H and (13)C), EPR and electronic spectral studies. The thermal stability of the complexes was also studied by TGA and DTA analyses. These studies show that all the complexes have octahedral arrangement around the metal ions except copper complexes which are square planar. The ligand and its complexes were screened for their antibacterial activity in vitro against Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria and were also studied for their anticancer activity against the human cancer cells lines: HeLa (Human cervical carcinoma), MCF7 (Human breast adenocarcinoma) and Hep3B (Human Hepatocellular carcinoma). The recorded IC50 values for the tested compounds show moderate to good cytotoxicity against these cancer cell lines. The copper complex, [CuL]Cl2, showed excellent antimicrobial activity against tested microorganisms which is almost equivalent to the standard drug ciprofloxacin.

Trans-articular chondrosarcoma grade 2 of proximal phalanx resulting in its fracture along with destruction of middle phalanx of 2 toe right foot: a case report and review of the literature.

Foot is an unusual site for chondrosarcoma and involvement of phalanges is extremely rare. We report a case of grade 2 chondrosarcoma of proximal phalanx resulting in its fracture along with transarticular extension to the middle phalanx of the 2(nd) toe of right foot in a 62 year old female. The patient presented with 1 and (1/2) year history of pain and swelling in right 2(nd) toe. X-ray showed presence of expanding lytic lesion with amorphous calcification along with fracture proximal phalanx. Fine needle aspiration cytology showed some pleomorphs, osteoclasts and some giant cells. We went for amputation of toe without a biopsy. Histopathological examination of specimen showed multiple pleomorphic cells, nuclear atypia, hyperchromasia with some giant cells (grade 2 chondrosarcoma).

Frontal bone tuberculosis presenting with blindness in a 14-year-old girl: a case report.

INTRODUCTION: The occurrence of tuberculosis in the flat bones of the skull is very rare. Only eight cases of tuberculosis of the frontal bone have been reported in the literature. CASE PRESENTATION: A 14-year-old girl of Asian ethnicity presented with gradual loss of vision. A computed tomography scan of her head showed a diffuse, homogeneously ill-defined hyperdense lesion of size 2.9 x 5.3 cm (anteroposterior x thickness) involving the right orbit. Biopsy of the lesion confirmed the presence of epithelioid cells and Langerhans giant cells with caseous material. After surgical debridement with antitubercular treatment, the patient had an uneventful recovery. CONCLUSION: Although rare, tuberculosis can affect the flat bones of the skull. Tuberculosis of the frontal bone can be included in the differential diagnosis of blindness.