Genome-wide identification of heavy-metal ATPases genes in Areca catechu: investigating their functionality under heavy metal exposure.

Heavy-metal ATPases (HMAs) play a vital role in plants, helping to transport heavy metal ions across cell membranes.However, insufficient data exists concerning HMAs genes within the Arecaceae family.In this study, 12 AcHMA genes were identified within the genome of Areca catechu, grouped into two main clusters based on their phylogenetic relationships.Genomic distribution analysis reveals that the AcHMA genes were unevenly distributed across six chromosomes. We further analyzed their physicochemical properties, collinearity, and gene structure.Furthermore, RNA-seq data analysis exhibited varied expressions in different tissues of A. catechu and found that AcHMA1, AcHMA2, and AcHMA7 were highly expressed in roots, leaves, pericarp, and male/female flowers. A total of six AcHMA candidate genes were selected based on gene expression patterns, and their expression in the roots and leaves was determined using RT-qPCR under heavy metal stress. Results showed that the expression levels of AcHMA1 and AcHMA3 genes were significantly up-regulated under Cd2 + and Zn2 + stress. Similarly, in response to Cu2+, the AcHMA5 and AcHMA8 revealed the highest expression in roots and leaves, respectively. In conclusion, this study will offer a foundation for exploring the role of the HMAs gene family in dealing with heavy metal stress conditions in A. catechu.

Open Minimally Invasive Parathyroidectomy Versus Minimally Invasive Video-Assisted Parathyroidectomy: A Systematic Review and Meta-Analysis.

Various minimally invasive techniques exist for surgical parathyroidectomy. The aim of this study was to conduct a meta-analysis comparing two popular minimally invasive techniques: minimally invasive video-assisted parathyroidectomy (MIVAP) and open minimally invasive parathyroidectomy (OMIP). An extensive search was conducted of online databases to identify all previous studies that had compared MIVAP and OMIP. The primary outcome measures considered were visual analog scale (VAS) score 24 hours postoperatively, conversion of operation (to open), failure rate and analgesic consumption. The data from these studies was extracted and compiled into a meta-analysis. The literature search yielded 104 studies of which four were included, enrolling 903 patients in this analysis. A significant difference was found regarding rates of conversion to open parathyroidectomy between the two groups, with the OMIP group demonstrating fewer conversions (MD = 3.52, CI = (2.04-6.08), P< 0.00001). No statistically significant differences were found between the two groups when comparing postoperative VAS scores at 24 hours (MD = -1.75, CI = (-9.8-6.3), P = 0.67), consumption of analgesia (OR = 0.49, CI = 0.07-3.54, P = 0.48) or failure rates (OR = 1.81, CI = 0.58-5.72, P = 0.31). OMIP was seen to require less need to convert to open parathyroidectomy with shorter operative times, while similar complication rates and scar lengths to MIVAP. More studies are required to evaluate the superior technique for parathyroidectomy.

Full-Thickness Skin Graft Versus Split-Thickness Skin Graft for Radial Forearm Free Flap Transfer in Oral Cavity Reconstruction: A Systematic Review and Meta-Analysis.

The radial forearm free flap (RFFF) is a surgical technique for addressing intraoral reconstruction. However, with the limitation of an unavoidable defect at the RFFF donor site, split-thickness skin grafts (STSGs) have been a solution for repairing these defects, but they are not without challenges. This study aimed to evaluate an approach using full-thickness skin grafts (FTSGs), comparing their effectiveness in terms of aesthetics, pain, complications, and scarring. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing FTSG with STSG for RFFF donor site repair in head and neck cancer patients were included. Primary outcomes measured were appearance and pain at the RFFF site, and secondary outcomes were infection, tendon exposure, graft loss, and scar assessment. A meta-analysis and systematic review of eight studies demonstrated that FTSG provided a superior aesthetic appearance at the RFFF donor site compared to STSG (p = 0.001), with low heterogeneity among the studies. The analysis found no significant difference in donor site pain between techniques. There were no significant differences in infection, tendon exposure, or skin graft loss between the two graft methods. This study suggests that FTSG is comparable to STSG in terms of donor site pain, scarring, and infection while offering superior aesthetic outcomes.

The potential use of bacteria and bacterial derivatives as drug delivery systems for viral infection.

Viral infections in humans are responsible for fatalities worldwide and contribute to the incidence of various human ailments. Controllable targeted medicine delivery against many illnesses, including viral infection, may be significantly aided by using bacteria and bacteria-derived products. They may accumulate in diseased tissues despite physical obstacles, where they can launch antiviral immunity. The ability to genetically and chemically modify them means that vaccinations against viral infections may be manufactured and delivered to affected tissues more safely and effectively. The objective of this study is to provide an overview of the latest advancements in the field of utilizing bacteria and bacterial derivatives as carriers for administering medication to treat viral diseases such as SARS-CoV-2, hepatitis B virus, hepatitis C virus, human immunodeficiency virus, human papillomavirus, influenza, and Ebola virus.

Shoulder Agony: A Painful Glenoid Cyst.

A ganglion cyst is a benign cystic lesion that can occur intraosseously. It is commonly a multiloculated lesion that consists of fibrous tissue with mucoid change and is usually located in the subchondral bone adjacent to the joint. Here, we present a rare case of a 33-year-old woman who presented to our orthopedic clinic with a five-year history of shoulder pain that gradually worsened. The pain was worst after any activity involving the right shoulder, and it also occurred at night and disturbed her sleep. Physical examination showed that the patient had limitations on the extreme range of movement. MRI revealed a subchondral bone cyst at the glenoid fossa. The ganglion cyst was subsequently curetted and packed with a bone graft from the iliac bone. Postoperatively, the pain resolved and the patient's range of movement improved. At the six-month follow-up, new bone formation over the void area caused by the cyst was observed on MRI.

A Systematic Review of Molecular Hydrogen Therapy in Cancer Management.

BACKGROUND: Cancer remains a challenging target to cure, with present therapeutic methods unable to exhibit restorative outcomes without causing severe negative effects. Molecular hydrogen (H2) has been reported to be a promising adjunctive therapy for cancer treatment, having the capability to induce anti-proliferative, anti-oxidative, pro-apoptotic and anti-tumoural effects. This review summarises the findings from various articles on the mechanism, treatment outcomes, and overall effectiveness of H2 therapy on cancer management. METHODS: Using Cochrane, PubMed, and Google Scholar as the search engines, full-text articles in the scope of the study, written in English and within 10 years of publication were selected. RESULTS: Out of the 677 articles, 27 articles fulfilled the eligibility criteria, where data was compiled into a table, outlining the general characteristics and findings. Throughout the different forms of H2 administration, study design and types of cancers reported, outcomes were found to be consistent. CONCLUSION: From our analysis, H2 plays a promising therapeutic role as an independent therapy as well as an adjuvant in combination therapy, resulting in an overall improvement in survivability, quality of life, blood parameters, and tumour reduction. Although more comprehensive research is needed, given the promising outcomes, H2 is worth considering for use as a complement to current cancer therapy.

Role of Diffusion-Weighted Imaging in the Evaluation of Post-Treatment Tumor Response in Rectal Carcinoma.

Introduction Rectal cancer has become a major cause of mortality worldwide. Imaging has a primary role in staging and assessing the response to therapy. MRI is superior to all other modalities in local staging of the rectal tumor and in predicting tumor response. Pelvic MRI has an undeniable role in the therapeutic management of rectal cancer, particularly for the determination of the circumferential resection margin (CRM), evaluation of sphincter invasion, and assessment of the extramural vascular invasion. Post-chemoradiotherapy (CRT) staging aims at assessing treatment response and choosing methods for further treatment such as surgical resection or extended CRT. MRI with diffusion restriction is a non-invasive and useful tool for assessing the treatment response of locally advanced lower rectal cancer. It will reduce the burden of extensive abdominoperineal resection (APR) surgery in patients. Objective The purpose of this study was to determine the role of diffusion-weighted imaging (DWI) in the evaluation of post-treatment tumor response in rectal carcinoma. Materials and methods The study was approved by our institutional review board, which waived the requirement for informed consent. The clinical data of all the patients treated for rectal carcinoma at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore between February 1, 2014, and February 28, 2019, were retrospectively evaluated. The inclusion criteria were as follows: (1) patients with histopathologically proven rectal adenocarcinoma, (2) those who underwent APR before February 2019 at our hospital, and (3) those who underwent MRI including DWI/apparent diffusion coefficient (ADC) imaging before and after CRT. Those patients who had upfront surgery without neoadjuvant CRT and those who did not have MRI imaging with DWI/ADC were excluded from the study. Results A total of 200 patients who fulfilled the inclusion criteria were included in this study. Among those, 141 were males and 59 were females. On histology, 110 had moderately differentiated adenocarcinoma, 25 had well-differentiated adenocarcinoma, and 65 had poorly differentiated adenocarcinomas. Overall diagnostic accuracy of DWI MRI sequence was calculated to be 91%, while the sensitivity was 98.09%, specificity was 65.12%, positive predictive value was 91.12%, and negative predictive value was 90.32%. Conclusion DWI was proven to be very useful in the post-treatment evaluation of tumor response with very high diagnostic accuracy.

Acute Retropharyngeal Calcific Tendonitis as a Rare Cause of Odynophagia and Neck Pain.

Retropharyngeal calcific tendonitis (RCT) is an aseptic inflammatory process of the superior oblique tendons of the longus colli muscle caused by the deposition of calcium hydroxyapatite crystals. We reported a 23-year-old woman who presented with a sudden onset of neck pain with odynophagia after waking up from sleep. Physical examination showed paracervical point tenderness with limited neck movement in all directions. Prior to surgery, further imaging was requested to aid in diagnosis, which in turn revealed RCT. It is important to be aware that RCT presentation may mimic other severe conditions such as retropharyngeal space abscess or meningitis.

A Rare Case of Primary Mediastinal Endodermal Sinus Tumor Presenting with Hemoptysis.

Mediastinal non-seminomatous germ cell tumors (NSGCTs) are very rare, with an approximate annual incidence of 500 in the United States. Here, we present a case of a 22-year-old male presenting with hemoptysis who was found to have primary mediastinal NSGCT, endodermal sinus tumor type (or yolk sac type). We review the imaging findings, pathology, and treatment of primary mediastinal endodermal sinus tumors.

Hepatobiliary Scintigraphy in Cholecystocolonic Fistula.

We report a case of a 50-year-old man diagnosed with cholecystocolonic fistula (CCF), confirmed by scintigraphy. After negative initial radiologic workup, a colonoscopy revealed findings of right-sided ischemic colitis. Soon after, a febrile episode prompted a repeat abdominal CT scan demonstrating a possible CCF, later confirmed with a nuclear medicine hepatobiliary scintigraphy and treated surgically. Less than 10% of CCFs are diagnosed preoperatively.

A Review of Benign Hepatic Tumors and Their Imaging Characteristics.

This paper concisely reviews the benign hepatic tumors most commonly encountered by clinicians. It includes the epidemiology, pathology, and imaging characteristics of hepatic hemangiomas, focal nodular hyperplasia (FNH), and hepatic adenomas (HAs).

Hepatic Angiosarcoma: A Case Presentation.

A 71-year-old male who presented with right upper quadrant pain was found to have hepatic angiosarcoma. We briefly review the epidemiology, presentation, imaging findings, and pathological diagnosis of hepatic angiosarcoma.

Pancreaticogastrostomy: A Safe Option in Pancreaticoduodenectomy for Pancreatic Head and Periampullary Neoplasms.

OBJECTIVE: To determine the safety of pancreaticogastrostomy in pancreaticoduodenectomy in patients with periampullary and pancreatic head neoplasms in terms of surgical technique, pancreatic fistula rate, 30 days mortality and three years survival. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from October 2014 to September 2017. METHODOLOGY: Patients undergoing pancreaticoduodenectomy for pancreatic head and periampullary tumors were included. Patients having metastatic disease or involvement of celiac artery, hepatic artery or superior mesenteric artery on preoperative scans, complete encasement of portal vein and superior mesenteric vein (SMV) were excluded. Patients' characteristics including the demographics, surgical technique, postoperative pancreatic fistula, 30 days mortality and three years survival were recorded. Mean ± standard deviation was used for continuous variables while frequencies and percentages were used for categorical variables. Kaplan-Meier method was used to estimate survival as a function of time, and survival differences were analysed by either Log-Rank test or Tarone-Ware test. Statistical significance was defined as a two-tailed p-value 0.05. RESULTS: One hundred and one patients underwent pancreaticoduodenectomy. Fifty-eight (57.4%) were males and 43 (42.4%) were females (n=43). Mean age was 51.5 ±14.17 years. The commonly found tumor was periampullary adenocarcinoma which was present in 49.5% (n=50) patients followed by pancreatic head adenocarcinoma which was present in 32.7% (n=33) patients and 17.8% (n=18) patients had other tumors. Most common pathological T-stage was T3 present in 47.5% (n=48) patients, followed by T2 found in 36.6% (n=37) patients and T1 stage was present in 15.8% (n=16) patients. 57.4% (n=58) patients had node positive disease. Pancreaticogastrostomy was done in 87.13% (n=88) patients, while pancreaticojejunostomy was done in 12.87% (n=13) patients. Recurrent disease was noticed in 11.9% (n=12) patients. Mean survival of pancreatic head adenocarcinoma was 787.04 ±81.89 days, which was comparatively less than periampullary adenocarcinoma, i.e. 983.10 ±52.27 days (p=0.08). Overall mean survival was 924 ±41.3 days. CONCLUSION: Patients with periampullary tumors had a better outcome than pancreatic head tumors in this series. Pancreaticogastrostomy can be a safe alternative to pancreaticojejunostomy, especially in patients having non-dilated pancreatic duct and soft pancreas.

Estimates of past and future time trends in age-specific breast cancer incidence among women in Karachi, Pakistan: 2004-2025.

BACKGROUND: The current demographic trends indicate that breast cancer will pose an even greater public health concern in future for Pakistan. Details on the incidence, disease severity and mortality in respect of breast cancer are limited and without such data, therefore, future health policies or systems in respect of this disease cannot be strategically planned or implemented. The aim of this study was to examine past trends of age-specific breast cancer incidence rates (2004-2015), and to estimate the future volume of breast cancer cases in Karachi through the year 2025. METHODS: Two statistical methods, namely the functional time series models and the log-linear regression model were used; additionally, their real forecasting efficacy in epidemic time series was also evaluated. RESULTS: In the past, women aged 60-64 years had the highest overall breast cancer incidence rates, while from 2016 to 2025, large increases in breast cancer rates among women aged 50 to 64 years are expected. The total projected breast cancer incidence will increase by approximately 23.1% in 2020 to 60.7% in 2025. Cases of breast cancer diagnosed in younger women, aged 30-34 years, will increase from 70.7 to 130.6% in 2020 and 2025 relative to 2015. CONCLUSIONS: The breast cancer incidence appeared to have been rising more rapidly among post-menopausal women (aged 55 to 59), while a stable increase in incidence in the youngest age group (15-29 years) of women is expected. The results also infer an expected increase in incidence cases of breast cancer among middle aged women in Karachi, Pakistan. An increase in the number of incident cases of cancer has implications for understanding the health-care needs of growing population and the subsequent demands on health-care system.

In vitro biological screening of a critically endangered medicinal plant, Atropa acuminata Royle Ex Lindl of north western Himalaya.

Atropa acuminata Royle Ex Lindl (Atropa acuminata) under tremendous threat of extinction in its natural habitat. However, the antimicrobial, antileishmanial and anticancer effects of the plant's extracts have not been reported yet. In the current study, an attempt has been made to evaluate the pharmacological potential of this plant's extracts against microbes, Leishmania and cancer. The roots, stems and leaves of Atropa acuminata were ground; then, seven different solvents were used alone and in different ratios to prepare crude extracts, which were screened for pharmacological effects. The aqueous, methanolic and ethanolic extracts of all parts carried a broad spectrum of anti-bacterial activities, while no significant activity was observed with combined solvents. Three types of cytotoxicity assays were performed, i.e., haemolytic, brine shrimp and protein kinase assays. The aqueous extract of all the parts showed significant haemolytic activity while n-hexane extracts of roots showed significant activity against brine shrimp. The acetone extracts strongly inhibited protein kinase while the methanolic extracts exhibited significant cytotoxic activity of roots and stem. The anti-leishmanial assays revealed that the methanolic extract of leaves and roots showed significant activity. These findings suggest that this plant could be a potential source of natural product based drugs.

Esthesioneuroblastoma: An Unusual Presentation with Intractable Headache.

Esthesioneuroblastoma, also known as olfactory neuroblastoma, is a malignant tumor of the upper nasal cavity. This report illustrates the case of a 63-year-old woman who presented with intractable headaches. Subsequent radiologic evaluation and correlation with histopathologic analysis confirmed esthesioneuroblastoma. We review herein the typical computed tomographic (CT) and magnetic resonance (MR) imaging findings related to this locally destructive tumor, the prompt diagnosis of which may help prevent long-term morbidity and potentially, mortality. Up-to-date diagnostic criteria, staging, and management considerations are also outlined.

Laparoscopy has a therapeutic role in the management of abdominal trauma: A matched-pair analysis.

INTRODUCTION: Laparoscopy is increasingly utilised as a diagnostic tool in management of abdominal trauma; however its role in therapeutic intervention remains unexplored. The aim of this study is to compare laparoscopy with laparotomy in the treatment of abdominal trauma in haemodynamically stable patients. METHODS: A review of patients undergoing surgery for abdominal trauma between January 2004-2014 identified 25 patients who underwent laparoscopy for therapeutic intervention (TL). This group was matched with 25 similar patients undergoing laparotomy (LT). Matching of the two cohorts was based on patient characteristics, severity of injuries, haemodynamic compromise and radiological findings. Peri-operative outcomes were compared. DISCUSSION: Patient characteristics were similar in TL and LT patients for age (median 33 vs. 26 years), gender distribution and clinical presentation. Injury severity score was also similar with a median of 16 in both groups (major trauma = ISS>15, normal range 0-75). Types of injuries included; hollow viscus [bowel repair = 10 (TL) vs. 16 (LT)] and solid organs [5(TL) vs. 2 (LT)]. Median operating time was similar in both groups; 105(TL) compared to 98 (LT) minutes. Post-operative complications (1 vs. 10, p = 0.02), analgesia requirements, specifically opiate use (34 vs. 136 morphine equivalents, p = 0.002) and hospital stay (4 vs. 9 days, p = 0.03) were significantly lower in the laparoscopy group. CONCLUSIONS: Abdominal trauma in haemodynamically stable patients can be managed effectively and safely with laparoscopy by experienced surgeons. Major benefits may include lower morbidity, reduced pain, and shorter length of hospital stay.

COMPARISON OF PEAK EXPIRATORY FLOW RATE AND LIPID PROFILE IN ASYMPTOMATIC SMOKERS AND NON-SMOKERS.

BACKGROUND: Tobacco is the major risk factor for chronic obstructive airway disease (COAD), other pulmonary diseases, cancer, cardiovascular and cerebrovascular diseases. The objective of study was to determine the mean Peak Expiratory Flow Rate (PEFR) and serum lipid profile. in apparently healthy male smokers and non-smokers. METHODS: This cross-sectional study was conducted in Ayub Teaching Hospital, Abbottabad from 15th December, 2009 to 15th June, 2010. Apparently healthy smokers and non-smokers from population coming to Hospital as attendants of the patients or as employees of the hospital were inducted in the study. PEFR and lipid profile of all the subjects was accessed. RESULTS: There were total of 300 male subjects, 150 smokers and 150 non-smokers. The mean age of study subjects was 26.6 +/- 5.5 years. The mean PEFR of smokers was 450.621/min and that of non-smokers was 494.81 L/min, the difference being statistically significant (p-value <0.05).The mean total cholesterol of smokers is 5.30 +/- 0.86 mmol/l and it was 3.84 +/- 0.54 mmol/l in non-smokers. Mean serum Triacyl Glycerols (TAGs) and Low Density Lipoproteins (LDL) cholesterol of smokers was 2.04 +/- 0.38 and 3.5 +/- 0.83 mmol/l whereas it was 1.44 +/- 0.52 and 2.02 +/- 0.66 mmol/l in non-smokers. Mean High Density Lipo-protein (HDL) of smokers was 0.86 +/- 0.30 mmol/l and of non-smoke is 1.20 +/- 0.41 mmo/l. There was statistically significant difference between serum lipid profile of smokers and non-smokers (p<0.05). the mean serum Total Cholesterol (TC), TAGs and LDL were significantly higher in smokers as compared to non-smokers. However HDL was significantly lower in smokers in comparison to non-smokers. CONCLUSION: There was statistically significant difference between PEFR of smokers and non-smokers.

INSPIRATION FOR SMOKING AMONG MEDICAL STUDENTS OF ABBOTTABAD, PAKISTAN.

BACKGROUND: Doctors are the best person to persuade their patients to quit smoking. Trend of smoking among young doctors is increasing day by day. The present study was conducted to observe the source of inspiration and smoking trends among medical students. METHODS: An observational study was conducted through a self-administered questionnaire from medical students of Ayub Medical College Abbottabad. RESULTS: A total of 230 students participated in this study and out of these 210 were males and 20 were females. Forty-eight students (20.86%) started smoking at the age of less than 15 years and 143 students (62.17%) started smoking between the age of 15-20 years and 39 students (16.95%) started smoking after 20 years of age. A total of 147 students (63.91%) were inspired by their friends, 32 (13.91%) by media, 39 (16.95%) by family members. Out of these 230 students 87 students (37.82%) smoked more than 10 cigarettes per day and 143 students (62.17%) smoked less than 10 cigarettes per day. CONCLUSION: Most of students started smoking at young age and their friends were source of inspiration.